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    Yasser Magrami
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    179 views10 pages

    Smile Arc Protection A New Table To Guide Bracket Placement Based On The Concept of

    Uploaded by

    Yasser Magrami
    Ygvu

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
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    Anew table to guide bracket placement based on the concept of “smile arc protection” Published on September 6, 2014 by Orthodontic Practice BT™ Versatile App ket Placement! ide P7 j6 fs | 4 | 3 | 2 | 1 _| Superior | 12.0 | 4.0 | 5.0 | 5s | 60 | 55 | 6.0 ]+1.0mm| 12.0 | 2.0 | 3.0 | 3.5 | 40 | 35 | 40 | -1.0mm] p7 fio [is {is | 3 | 2 | i | interior | P33 [35 [4s [50 [ss [$0 [50 [710mm [2.0 [2.0 [25 | 30 | 13.0 | 3.0 | Drs. Toms Custllanos and Thomas Pits inroducea new tbleto guide venical pheement of bkets based ntheetiett upon thesia a Summary Background/objective: The correct placement of brackets is essential not only for functional but for esthetic smile success of the treatment, The objective of this paper is to introduce a new table to guide vertical placement of brackets, basedon the effect uponthe sme are ‘Therefore, the table is named Guide Position Smile-Are (GPS-A), Materials/methods: Two tables, one for upper dentition and one for lower dentition were designed to guide the bracket pheement, in order to obtain oF retain thebestestheti smile are, based on the authors ‘clinical ‘experience. The imitations of other commonly used tables (Alexander and MBT™) are presented as antecedents ofthe new table, Results: Instructions touse the table are descrbed in detail. Indications for previous dental morphology adjustment, use of positioners, and specifications for special situations are descr Conclusions implications: The advantages ofusingths guide are summarized, The clinical table provides an ‘easy and reliable guide for clinicians to place brackets for predictable pleasant smiles and functional ‘occlusions. Introduction Image 1: Srila crv fatorad ater thodonte reatmert. mage 2: Consonant Srie- Arc, recut of banding brackets Sracits boncee wih cowersera eights. Patert ated with GPS-A (Gut Position SmileAc} Tom Te yD Temds Castatancs — MET brackets} ‘reatad by Or Tords Castafaros — is brackets, Facial and smile esthetics are essentially inherent characteristics of the patient. Nonetheless, within momphologic-functional limits, and thanks to the advances in today’s orthodonti technology, it is possible not ‘only to obtain an excellent occlusion but to improve patient esthetics according to his/herexpectations. Planning the treatment based on facial esthetics as a purpose to protectthe sme are is parallel to a st achiove ocelusal purposes, The funetional aim of orthodontics & always to achieve a mutually protected ‘occlusion; that, anterior teeth protect posteriortecth from interference during lateral and protrusive movements, and posterior teeth protectanterior teeth as well, providing an adequate contact in closed-mouth position eayto ‘The smile arc, in a frontal view, has been defined as the relationship of the curvature of the superior incisive and canine incisal edges with the curvature ofthe inferior fp in smiling position, In an ideal smile are, the ‘curvature of the superior incisal edge is parallel to thelowest smiling lip curvature. The tem “consonant describes this parallel relationship. In a non-consonant or at sme, the mavillary incisal curvature is Hatter than the inferior lip in smiling position According to Frush and Fisher,3 a more sharp curvature of the upper ineisal edges from more attrictive'youthfulthana flatter curvature. Therefore, in individuals who don’t show curvature of the lower lip on smile, a snile arc is still the most desirable, The ideal smile are as.2 guidance for anterior upper tweth indicates that the purpose should bean ideal position from canine to canine and a functional anterior bite Accunite bracket positioning is essentialto finish treatment with an excellent occlusion and beautifil smile Additionally, the most common reason for unnocessary delay of troatment and the diseovery of difficukies in the final stage s the incorrect bonding of the appliances. The need for excessive first order bends is notdue 10 a failure in design of the orthodontic appliances, but due to incomeet bracket positioning. When some teeth are inexreme malposition, it is not always possibleto place a bracket in an ideal position during the first visit, but is recommended to attempt to place the brackets inthe hest possible position to avoid further repositioning and compensatory bendings as treatment progresses. Previously established positions for brackst placements based on tooth dimensions, as freq) ently taughtin ‘orthodontic courses and programs, are inappropriate for optimum esthetics. For instance, if one assumes that all patients have the maxilary central incisors located 45 mm above the incisal edge, literal incisors at 4 mm, ‘and canines at $ mm, and the orthodontist fils to account forthe relationship of incisal edges with the lower lip, the position may not adjust for the esthetic criteria needed. Customized appliance phcements haveas uch importance as customized treatment phans.4 Dr. Tom Pitts has developed a protocol for Smike Are Protection (SAP) bracket positions that consistently ‘produces beautifial Smile Arcs. Dr. Toms Castellanos has quantified this esthetie positioning by measuring the length of the tecth. Hence, this is a “Tom-Tom” production. ‘The vertical position’ Figure S: Aaa maasuremert fr each tect with cigtal gaupe Minanyo™ Suner-Calper Scar Powered Sries 600 — oe ess am \ Se brackets is a challenge for many orthodontists. This problem diminishes when positioning devices and customized tables are used to guide bracket placement, when using direct or direct bonding. ‘The Aleander techniques uses the premolar height (X in the Vari-Simplex table for bracket heights) (Figure 1) for bracket positions in the entire arch For cxumple, if the normal slot height for a premolar bracket is 45 mm fiom the occlusal cusp, the other indicated heights demonstrated by this table should be 5.0 mm for canine, 4.0 mm for lateral, and 4.5 mm for centrals The MBT™ table (Figure 2) olfers another commonly used bracket positioning guide. It suggests average positions for brackets in the maxillary arch of 4.5 mm for the first promolar (X05 mm), 50 mm for canine (0, 45 mm for lateral (X— 05 mm), and $0 mm for central (X)6 ‘These and othertechniques for bracket placement, basedon popular tables and positioning devices, provide accuracy and high reproducibility. Unfortunately, bracket placements with these height discrepancies lypxally flatten the smile curve Flaitening of the smile are during orthodontic treatment can occur by different mechanisms. The normal ‘alignment of maxillary andmandibular dental arches may result in a reduction of curvature of the upper incisors with respect to the inferior lip curvature ‘Ackerman, et al,4 evaluated smile arcs in treated and non-treated patients in their own practices. Almost 40% ‘ofthe weated patients presented discemible changes in the smile are with flattening of the smile are occurring in 32% In the control group (which was the treated group), 13% presented changes inthe smile arcs, but flattening occured in only 5% of this group. They reported no gender differences regarding smile features in treated or untreated groups ‘The present anicke introduces a new table to guide vertical phcement of brackets, based on the smile arc effect — therefore, the table is named Caride Position Smile-Are (GPS-A) (Images 1 and 2) Table suggested for vertical placement of brackets Rationale The table presented Figures 3 and 4) is basedupona great number of clinical studies and measurements taken on plaster casts and digital models from patients treated by the team of Drs. Tom Pitts and Toms Castellanos. Its versatility and efficacy will be the subject of otherarticles presenting cases successfully treated applying this table, ‘The table facilitates the verieal placement of brackets in positions that result in adequatesmile curves, as well as mutually protected occlusions. Ittakes into account ocelusal mosphology, suchas the angle of the articular eminence that is more vertical in dolichocephalie subjects than in mesocephalic or brachycephale patients. In dolicocephalic patients as ‘compared to brachycephalic, the molar cusps are higher, and fossaeare deeper; anterior teeth clinieal crowns, are longerin a cervico-ineisal direction. All these characteristics indicate that more overbite is necessary to disocclude posterior teeth in eccentric movements in dolicocephalie subjects. On the other hand, individuals with shorter faces, fatter TMJ eminences, and anterior teeth with shorterclinical crowns, less ovesbite is necessary to disocclude posterior teeth in eccentric movements. Also when consideringthe incisal-smile are relationship, clinicians must extrude the up Fire 7: The thin stp fed he lower canna cronn eng measurement and he stsoquet postions forthe mandinlar rackets per incisors in fat sre eases or maintain the incisal smile are when itis esthetically adequate, For a finctionally adequate occlusion and esthetic smile curvature, a divergence must be kept between the ‘occluso-gingival position of the slot with ocelusalcusps orincisal edges,measured in mm, from the second ‘molar tube all the way tothe maxillary central incisor. ‘This divergence is important as well, considering thatthe difference in mm between the slotheight ofthe central incisor and the height in mm from the second molar tube gives an idea of the amount of overbite one will obtain at the end of treatment, It also affects the occlusal plane cant. ‘The final overbite of any deep bite or open bite also depends on elastics dis articulation buttons, mint and otherausdliary elements that potentiate the expression of the bracket’s torque. OF course, mini-screws can also help enliancethe maxilary atesor position by ntrudag the mandibular incisors when needed. ‘The transition point between the anterior and posterior dental segments additionally establishes the wack of the smile arc, and therefore, the positioning for the whole dental arch should be planned taking this pointas a clue, When the maxilry incisors are further extruded to enhance the smile curve and enamel display, a deeper bite ‘can be produced by inereasing the overbite. To avoid this effect, the table introduces a compensation in the position of the slot of mindibular canine-to-canine brackets, Instructions touse the table (Figures 3 and) Previous to using the table, some patients require a recontouring to provide basic Weal momphology to each ‘tooth, This ameloplastic procedure is based in the study of plastermodels and removes only the necessary minimum dental enamel ‘The amelophisty includes pronounced marginal ridges on the lingual surfices,of'ineisors’ angles and incisal ridges, as well as imegular vestibubrsurfaces. Imegular vestibular surfaces preventan optimum placement of ‘brackets, which control rotations and torque. In most cases,canines require re- contouring to improve their role in the smile are, This process does not interfere with their functional rok of canine disocclusion Gingival nurgins are very important for anterior esthetics. Sometimes clinicians need to perform initial gingivoplasties with lise, electro surgery, or any other sumar technique. tis important to provide theright morphology, but clinicians should not re- contourall hard and sof Figure &: Vrsatis high-precision postoner fer proper lca tor of each bracket fhm second molars to conta sors (PSA is a versatie tigh-recson postion from Oto Classic reat arn ortoiassic car} tissues, since leaving small diserepancies until the endof, treatment allows for final detailing when the teeth have the best possible position. When teeth have fractures or abnommal wear, the teeth should be reconstructed prior to bracket bonding, in onder to assure the ideal dental anatomy. Clinicians should communicate this to the patient, since future restorations may be necessary Ifthe masillary molars present high and pronounced mesopalatal cusps, they should receive recontouring to avoid interferences or early contacts. The same apples to the lingual cusps of the premlars ‘Alter obtaining the teal dental momphologs 2s follows: Measure the length ofthe maxillary canine crown, fiom the cusptip tothe gingival margin (after Reconstruction, recontouring, or gingivopsty). the heights forbracket bondingin the maxillary arch are selected Find this measurement in thecolumms ofthe table GPS-A. Guide Position Smile-Are_ upper), and choose the adjacent number in therow. Figure 6), The number in this file indicates the position for cach bracket ct in a similar way the height to bond brackets for mandibular teeth:a)measure the length of theerown of the mandibular canine, from cusp tip to gmgival margin (after reconstniction, recontouring,and gingivoplasty);b) find this number in the colina of the table GPS-A. (Guide Position Smike-Ate lower), and choose the number in the adjacent row. This number indicates the postion for bonding each bracket in the mandibulir area (Figure 7) Specific considerations The muxiliry second:molars must always be intruded. ts tubes are always positioned to slightly intrude these teeth to provide a negative coronal melination and avoid functional interferences Thediscrepaneyheecn milly incisors and them eal ncsormust be ep between 0S mm tnd | tm to low ihomovement ofthe mandinls canine darhg prtasive ecuions and addon, impove mean a LDnger nesor eqn a ger height ifrence For thosestuions the tbl incudes two addtional AXuhelvel ofthe manu mols, is inportnt to maintain a ous plane tat pants comet

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