J Orofac Orthop

https://doi.org/10.1007/s00056-018-0129-1

ORIGINAL ARTICLE

Coordinating bracket torque and incisor inclination

Part 1: The development of widely applicable equations

Bernd Zimmer1 · Hiba Sino1

Received: 4 June 2017 / Accepted: 6 February 2018

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Abstract
Purpose The objective of this investigation was to develop equations to describe the geometric relations among “targeted
incisor inclinations” (tU1, tL1) accommodating different cephalometric norms (Ricketts, Bergen, etc.) with the “expected
inclinations” (eU1, eL1), as they can be generated by bracket torque values according to Andrews, Roth, Ricketts, and
MBT.
Methods In its key parts, the present study is a theoretical work in which structural relationships are described using
standard mathematical and geometric methodologies.
Results The “targeted norm-inclinations” (tU1, tL1) were calculated relative to a single reference plane (BOP according to
Downs), thus, allowing for a direct comparison of different cephalometric values. Referring to the “expected inclinations”
(eU1, eL1), it was found that in addition to bracket torque (BT) morphological and structural parameters also have to be
taken into account. These are the “torque coordination angle” (TCA) representing the variation in dental morphology and,
the correction angles between BOP and the upper (uOP) (α1) or the lower (lOP) occlusal plane (β1). Moreover, the angles
α2 between an upper (uBPP) and β2 between a lower bracket positioning plane (lBPP) and the occlusal planes (uOP, lOP)
have to be considered. As a consequence, suitable equations were developed (eU1(BOP) = 90° – BT(U1) – TCA(U1) + α1 – α2, and
eL1(BOP) = 90° – BT(L1) – TCA(L1) + β1 – β2), allowing the calculation of expected torque-dependent inclinations (eU1, eL1) and
representing the prerequisite for a comparison with the cephalometric targeted values (tU1, tL1).
Conclusions By developing suitable equations, it became possible to name and quantify those parameters that are respon-
sible for incisor inclinations and enable a comparison with targeted cephalometric values.

Keywords Orthodontic brackets · Reference planes · Occlusal plane · Bracket positioning plane · Bisected occlusal plane

Koordination von Brackettorque und Schneidezahninklination

Teil 1: Entwicklung allgemein anwendbarer Gleichungen

Zusammenfassung
Zielsetzung Ziel dieser Publikation ist die Entwicklung von Gleichungen zur Berechnung der geometrischen Zusam-
menhänge von „angestrebten Schneidezahninklinationen“ (tU1, tL1) nach verschiedenen kephalometrischen Verfahren
(Ricketts, Bergen u. a.) mit den „erwarteten Inklinationen“ (eU1, eL1), wie sie Brackettorquewerte nach Andrews, Roth,
Ricketts und MBT hervorrufen.
Methoden Die vorliegende Untersuchung ist in den wesentlichen Teilen eine theoretische Arbeit, in der strukturelle
Zusammenhänge mit Hilfe mathematisch-geometrischer Verfahren beschrieben werden.

 Bernd Zimmer
bzimmerkfo@aol.com

1
Orthodontic Practice, Teichstr. 24, 34130 Kassel, Germany

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 B. Zimmer, H. Sino

Ergebnisse Die angestrebten Norminklinationen (tU1, tL1) wurden auf eine singuläre Bezugsebene (BOP nach Downs)
umgerechnet, sodass nun direkt vergleichbare kephalometrische Zielwerte zur Verfügung stehen. Hinsichtlich der „er-
warteten Inklinationen“ (eU1, eL1) wurde festgestellt, dass zu ihrer Berechnung neben dem Brackettorque (BT) auch
morphologische und strukturelle Parameter Berücksichtigung finden müssen. Dies sind der „torque coordination angle“
(TCA) zur Erfassung von Variationen in der Schneidezahnmorphologie, die Winkel α1 und ß1 als Korrekturwinkel zwi-
schen BOP und der oberen (uOP) bzw. der unteren Okklusalebene (lOP) sowie α2 und β2 als Korrekturwinkel zwi-
schen einer oberen (uBPP) bzw. unteren Bracketpositionierungsebene (lBPP) und der oberen (uOP) bzw. unteren Ok-
klusalebene (lOP). Mit den ermittelten Parametern wurden 2 Gleichungen (eU1(BOP) = 90° – BT(U1) – TCA(U1) + α1 – α2, bzw.
eL1(BOP) = 90° – BT(L1) – TCA(L1) + β1 – β2) entwickelt, welche die Berechnung der erwarteten brackettorqueabhängigen Inkli-
nationen (eU1, eL1) ermöglichen und die Voraussetzung für einen Vergleich mit den kephalometrischen Zielwerten (tU1
bzw. tL1) darstellen.
Schlussfolgerungen Durch die Entwicklung geeigneter Gleichungen ist es möglich geworden, die für die Schneide-
zahninklination relevanten Parameter zu benennen, zu quantifizieren und Vergleiche mit kephalometrischen Zielwerten
vorzunehmen.

Schlüsselwörter Kieferorthopädische Brackets · Bezugsebenen · Okklusalebene · Bracketpositionierungsebene ·

Okklusalebene nach Downs

Introduction An illustration of the interrelationships between slot in-

All over the world, orthodontists make therapeutic decisions
by analyzing cephalometric images and relying on norms
for incisor inclinations [14, 27, 33, 34, 36, 38]. However,
what makes this problematic are the numerous analytic pro-
cedures being applied whose values are fundamentally not
comparable because their reference planes differ. For exam-
ple, Jarabak and Fizell refer to the NS line [18], Schwarz
[32], Tweed [39], Björk and Skieller [6] report values rela-
tive to lines NL and ML, Ricketts [27] considers the APo
line, and Steiner [36], Hasund and Boe [14], as well as
Segner [33] and Segner and Hasund [34] take their mea-
surements relative to NA and NB. Several authors have car-
ried out comparative investigations [1, 9, 10, 24]. Corelius
and Linder-Aronson [10] report on a satisfactory correlation
between the lower incisors’ inclination and measurements
taken relative to ML and NB. Aldrees [1] observed good
correlations for the upper and lower incisors’ inclinations
with regard to the angle but not linear measurements. Yet
there is still no evidence revealing the extent to which norm
values obtained from different analytic procedures relate to
a shared and procedure-overlapping reference plane.
Bracket torque plays a key role in successfully chang-
ing tooth axes in relation to these reference planes, as the
bracket torque should trigger an effect on the crown’s posi-
tion and thereby also the direction of the tooth’s long-axis
in general and especially the incisors’ inclinations [2, 3, 5,
21, 27, 29]. In the literature, it is remarkable how widely
the bracket torque recommendations for one and the same
incisor vary to achieve the target inclination, e. g., those
of Andrews [3] and Ricketts [27] for the upper central in-
cisors range from 7° to 22°; obviously, not all values can
be equally well-suited for a specific inclination (Fig. 1).
clination, bracket basis, and adhesive site as associated with
brackets with torque in the slot and those with torque in
the base, as already found in Andrews’ research [3], re-
veal the geometric complexity. A concrete technical de-
scription of what we understand by “bracket torque” is pro-
vided in DIN EN ISO 27020:2010 [22] as a “torque angle”
(Fig. 2a and b). The “torque angle” this norm refers to is de-
fined as the angle originating from the mesiodistal or lateral
perspective onto the bracket between the axis halving the
bracket slot and a perpendicular on the tangent at the point
where this axis meets the bracket base [22]. Ultimately, the
intersection point on the angle’s arms that build the bracket
torque is located at the bracket base.
The geometrically constructed line connecting the inter-
section points of all the teeth in the jaw is called the bracket
positioning plane (BPP; [3]). As a BPP is determined by
the specific prescriptions of various bracket system design-
ers, its precise position is subject to considerable variation.
Andrews defines the BPP as the connection between the
LA points in the upper or lower jaw, respectively, which is
called the “Andrews plane” [3]. The BPP according to Roth
on the other hand is tilted in a slightly anterior direction,
as he favors a more incisal bracket position to avoid any
compensatory bending [28]. Following study results with
anatomical and clinical crown lengths as well as analyzing
outstanding orthodontic outcomes, McLaughlin and Ben-
nett [21] modified Andrews’ prescription, thus, making an
alteration in the BPP’s position highly probable. Regardless
of their precise positions, every BPP exists in a geomet-
ric relationship with the different occlusal planes, such as
upper, lower, functional, and bisected occlusal plane [2, 3,
28] defined earlier. The exact geometric deviations between
these planes are so far unknown.

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Bracket torque and incisor inclination
Fig. 1 Graphics of different bracket torque values (BT) of upper
central incisors: Andrews 7°, Roth 12°, MBT 17°, Ricketts 22°.
BPP bracket positioning plane
Abb. 1 Graphische Darstellung verschiedener Brackettorquewer-
te (BT) oberer mittlerer Incisivi: Andrews 7°, Roth 12°, MBT 17°,
Ricketts 22°. BPP Bracketpositionierungsebene
Fig. 2 a Torque angle (“bracket torque”, BT) according to DIN EN
ISO 27020:2010 for a “torque-in-the-base” bracket. Blue line: repre-
senting the inclination of the bracket base (BB) at the point of torque
expression, brown line: axis halving the bracket slot (BS), green line:
perpendicular on the bracket base at the point of torque expression
(PBB). b Projection of the torque angle on the vertical plane (by 90°
rotation) visualizes the effect of bracket torque close to a tooth’s crown
surface. Blue line: representing the inclination of the bracket base (BB)
at the point of torque expression, violet line: representing a 90° rotation
of the axis halving the bracket slot (BS + 90°)
Abb. 2 a Torquewinkel (Brackettorque, BT) nach DIN EN ISO 27020:
2010 für ein Bracket mit Torque in der Basis. Blaue Linie: Inklination
der Bracketbasis (BB) am Ort der Torqueexpression. Braune Linie:
Den Bracketslot halbierende Achse (BS). Grüne Linie: Senkrechte auf
die Bracketbasis am Ort der Torqueexpression (PBB). b Die Projek-
tion des Torquewinkels auf die vertikale Relation (Drehung um 90°)
visualisiert den Effekt eines Brackettorques (BT) an der Zahnkronen-
oberfläche. Blaue Linie: Inklination der Bracketbasis (BB) am Ort der
Torqueexpression. Violette Linie: 90°-Rotation der den Bracketslot
halbierenden Achse (BT + 90°)
The aim of part one of this investigation was to develop
suitable equations to describe the structural interrelation-
ships between the targeted incisor inclinations according
to cephalometric norm values relative to various morpho-
logical reference planes and several bracket torque values
relative to different bracket positioning planes. As a conse-
quence, an attempt will be made to coordinate both systems.
Materials and methods
This investigation is primarily a theoretical endeavor in
which we describe geometric relationships via mathemat-
ical and geometric formulas. Wherever connecting data
were missing and in order to impart our equations practical
and clinical validity, we relied on additional measurements
taken from cephalometric images and dental casts.
Cephalometric analyses
To make the calculations on a common reference plane, we
chose cephalometric methods that rely on various accepted
reference planes (NL, ML, NS, APo, NA, NB; Table 1).
Moreover, we provide an example of an individualized anal-
ysis method that follows the “floating norms” of Segner and
Hasund [33, 34]. The common reference plane chosen was
the “bisected occlusal plane” (BOP) according to Downs
[11], as it enables all cephalometric target sizes to be cal-
culated. The norm values relating to BOP calculated in this
manner are described herein as “targeted inclinations for
the upper incisors” (tU1) and “targeted inclinations for the
lower incisors” (tL1), respectively.
For this investigation and our calculations, we had ac-
cess to essential data from 107 analogous and high-qual-
ity cephalometric images of consecutive, final orthodontic
treatment outcomes (49 males, 58 females, mean 15.4 ±
1.2 years) that at that time revealed a Peer Assessment
Rating (PAR) index equaling or less than 3 (PAR index
3). These were final outcome findings after exclusively
fixed nonextraction treatment. All these treatments were
carried out according to a modified straight-wire protocol
with a 0.018 inch slot system and the Roth prescription.
The brackets were applied following Bennett and McLaugh-
lin’s prescription [5, 21]. Our study group consisted exclu-
sively of previous adolescent patients of Caucasian origin
whose ANB values ranged from 1 to 5°; their ML/NL val-
ues ranged from 20 to 26°. The study’s exclusion crite-
ria were adult patients, functional therapies, any therapeu-
tic interventions aimed at restricting or promoting growth,
and any syndromes, clefts, or extraction therapy. All the
cephalometric data were generated with the DiagnoseFix-
program™ 2016 (version Ka2, Dr. J. Wingberg, Germany).
Reference planes
Five reference planes were taken into consideration in or-
der to coordinate cephalometric norms and bracket torque
values: BOP according to Downs (I) is defined as a plane
determined anteriorly by the intersection of the incisor over-
bite and posteriorly by the intersection of the vertical over-
lap of the first molar cusps [11]. The upper occlusal plane
(uOP) (II) functions as the straight line between the up-
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 B. Zimmer, H. Sino

Table 1 Cephalometric norm-values (targeted inclinations), tU1: targeted inclination of upper central incisors, tL1: targeted inclination of lower
central incisors. Angles’ values measured relative to different reference planes
Tab. 1 Kephalometrische Zielgrößen (angestrebte Inklinationen), tU1 Angestrebte Inklination der oberen mittleren Incisivi, tL1 angestrebte Inkli-
nation der unteren mittleren Incisivi. Winkelangaben relativ zu verschiedenen Bezugsebenen
Schwarz, Tweed Jarabak Ricketts Björk Bergen Floating norms
tU1(NL) 110° x x x x x
tU1(NA) x x x x 22° Individual
tU1(NS) x 102° x x x x
tU1(APo) x x 28° x x x
tL1(ML) 90° x x 95° x x
tL1(NB) x x x x 25° Individual
tL1(APo) x x 22° x x x

Table 2 Distances of bracket positioning points (in mm) from the in-
cisal edges (U1, L1) and cusp tips (U6, L6) for the MBT- and LA-point
oriented prescription
Tab. 2 Abstände der Bracketpositionierungspunkte (mm) von den
Schneidekanten (U1, L1) und Höckerspitzen (U6, L6) für die MBT-
und LA-Punkt orientierten Präskriptionen
MBT (mm) LA (mm)
U1 5.0 5.3
U6 3.0 3.8
U1–U6 2.0 1.5
L1 4.0 4.5
L6 2.5 3.8
L1–L6 1.5 0.7
per incisal point and midpoint on the straight connection
between the mesiobuccal and distobuccal cusp tips of the
upper first molars and likewise, the lower occlusal plane
(lOP) (III) as the straight line between the lower incisal
point and midpoint on the straight connection between the
mesiobuccal and distobuccal cusp tips of the lower first mo-
lars. We employed the cephalometric images of the same
107 patients (see above) to calculate the angle deviations
between the BOP and the occlusal planes.
The deviations of the uOP, and lOP from the up-
per (uBPP) (IV) and lower bracket positioning plane
(lBPP) (V) were calculated according to the bracket posi-
tioning instructions after Bennett and McLaughlin (MBT
prescription) [5, 21] and after Andrews (LA point-oriented
prescription; [3]). Those calculations were based on the
following geometric relationships: each BPP can be con-
structed through two points. To do this, we employed the
bracket positioning points as recommended by the two
aforementioned prescriptions on the central incisors and
first molars, each measured from the incisal edge or cusp tip
(Table 2). The LA-point values correspond to data provided
by Woelfel [5, 40]. BPPs constructed in this manner reveal
in the anterior and posterior regions different distances
from the corresponding points used to construct the upper
and lower occlusal planes. These differences amount to
U1–U6 2 mm and L1–L6 1.5 mm for the MBT values.
The requirements for the LA point are U1–U6 1.5 mm
and L1–L6 0.7 mm. Parallel shifts of uBPP and lBPP
until contact with uOP or lOP make angle deviations obvi-
ous, whereby the angles’ opposite sides are represented by
the calculated differences. The adjacent sides correspond
to the straight connections between the anterior and pos-
terior adhesive point in their projections onto the sagittal
plane. They are subject to negligible dependency on set
requirements, but they differ for the upper and lower dental
arches. Their lengths were determined by measuring 40 oc-
clusograms randomly chosen from our study group. We
did this by constructing the perpendicular from one central
incisor bracket positioning point onto the straight line be-
tween the adhesive points on the first molars. As a result
we found mean lengths of 32.4 ± 2.1 mm for the upper
and 27.1 ± 1.5 mm for the lower arch, which represent the
adjacent sides of the triangles. As a consequence, the angle
dimensions between uOP and uBPP and between lOP and
lBPP can be calculated for both prescriptions by using the
tangent function.
Bracket torque
To evaluate the bracket torque, we used recommended
torque values for the upper (U1) and lower (L1) central
incisors according to Andrews: 7° (U1), 4° (L1), Roth: 12°
(U1), 0° (L1), Bennet/McLaughlin: 17° (U1), –6° (L1) and
Ricketts: 22° (U1), 0° (L1). The 4° torque value for L1
follows the Andrews prescription for skelettal Cl.II patients
[3]. It was selected to provide a maximum range of values
for study reasons. Then, the angular relationships between
the relevant morphological structures and reference planes
involved were analyzed. Consequently, angles could be
found in order to calculate the theoretically expected in-
cisor inclinations originated by bracket torque. As this
study proceeded, we named the corresponding inclinations
calculated for the different torque values “expected inclina-
tions of upper incisors” (eU1), and “expected inclinations
of lower incisors” (eL1).

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Bracket torque and incisor inclination

Statistics Table 3 Equations for transforming cephalometric norm values (tar-

geted inclinations) on the common reference plane BOP
Tab. 3 Gleichungen zur Transformation kephalometrischer Ziel-
We determined the examiner reliability by analyzing 20
größen (angestrebte Inklinationen) auf die gemeinsame Bezugsebene
randomly selected cephalorams a second time after a pe- BOP nach Downs
riod of 4 weeks. The Dahlberg formula served as a tool to – Original U1 Relative to BOP U1(BOP)
calculate the error of measurements for the angles μ, ε, γ, Schwarz 110°, relative to NL 180°–110°–μ,
τ, φ, δ (Tables 3 and 4), uOP/BOP and lOP/BOP. In ad- μ = NL/BOP angle
dition, the intrarater reliability according to Houston [16] Jarabak 102°, relative to NSL 180°–102°–φ,
was determined. Examiner reliability was 0.6° deviation φ = NSL/BOP angle
for all measurements and the worst intrarater reliability was Ricketts 28°, relative to APo τ–28°,
98.47%. As a consequence, both parameters revealed a con- τ = APo/BOP angle
siderable reliability. The analogous procedure was carried Bergen 22°, relative to NA δ–22°,
δ = NA/BOP angle
out regarding the measurements on dental casts. Examiner
– L1 L1(BOP)
reliability for the sagittal distance between the anterior and
Schwarz 90°, relative to ML 180°–90°–γ,
posterior adhesive points was 1.2 mm, and we calculated γ = ML/BOP angle
an intrarater reliability of 97.35%. Björk 94°, relative to ML 180°–94°–γ,
γ = ML/BOP angle
Ricketts 22°, relative to APo 180°–22°–τ,
Results τ = APo/BOP angle
Bergen 25°, relative to NB ε–25°,
Transformation of cephalometric norm inclinations ε = NB/BOP angle
BOP bisected occlusal plane
The reference planes of our cephalometric analyses differ
geometrically from the common reference plane BOP in
each case by one specific angle only. Therefore, it is possi- B: Example “floating norms” Determining targeted values
ble to calculate the targeted values for the upper and lower after the “floating norms” concept requires an individual-
incisors relative to BOP by employing six different angles ized calculation according to the following equations:
(μ, γ, φ, τ, δ, ε) and the corresponding eight algorithms.
Table 3 illustrates the equations to transform cephalomet- U1.NA/ = −2.19 ANB − 0.61 PgNB .mm/ + 27.1
ric targeted values up to the common reference plane BOP. L1.NB/ = 1.51 ANB − 0.80 PgNB .mm/ + 22.4
Table 4 shows the six angles’ statistical values as deter-
mined after we evaluated patient records (n = 107). As ex- For example, a calculation for an ANB-angle of –1.5°,
amples, we illustrate our calculations of mean values for a PgNB value of 2 mm, a δ angle of 82° and an ε angle of
the Bergen analysis (A) and provide an example of an indi- 100.5° is as follows:
vidualized determination according to the “floating norms”
concept (B). tU1.NA/ = −2.19  .−1.5/ − 0.61  2 + 27.1
tU1.NA/ = 28.9ı
A: “targeted inclinations” according to Bergen tU1.BOP/ = • − 28.9ı
tU1.NA/ = 22ı tU1.BOP/ = 82ı − 28.9ı = 53.1ı
tU1.BOP/ = • − 22ı ; • = angle NA/BOP and • = 84ı tL1.NB/ = 1.51  .−1.5/ − 0.8  2 + 22.4

tU1.BOP/ = 62ı tL1.NB/ = 18.5ı

tL1.BOP/ = © − 18.5ı
tL1.BOP/ = 100.5ı − 18.5ı = 82ı
After having accommodated our calculation of targeted
tL1.NB/ = 25ı values (“targeted inclinations”) to the common reference
tL1.BOP/ = © − 25ı ; © = angle NB/BOP and © = 92.9ı plane BOP, a direct comparison of differing cephalometric
tL1.BOP/ = 67.9ı norms is made possible. As primary information, in Table 5
we note that for the inclination of upper incisors (tU1),
values between 58.3° and 62° (3.7°) can be regarded as
“norm values” relative to BOP. The corresponding range of
values is 67.9° up to 74.8° (6.9°) for the lower incisors. As

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Table 4 Statistical values for 6 transformed angles (n = 107)
Tab. 4 Statistische Kennwerte für 6 Umrechnungswinkel (n = 107)
Angle NL/BOP ML/BOP NSL/BOP
μ γ φ τ
Mean 8.5° 15.2° 16.1°
SD ±3.9° ±3.5° ±5.3°
BOP bisected occlusal plane, SD standard deviation
Table 5 Coordinated cephalometric norm values (targeted inclinations) relative to the bisected occlusal plane (BOP)
Tab. 5 Koordinierte kephalometrische Zielgrößen (angestrebte Inklinationen) relativ zur BOP nach Downs
Schwarz Jarabak Ricketts
tU1(BOP) 61.5° 61.9° 58.3°
tL1(BOP) 74.8° – 71.7°
a consequence, the Bergen- compared to the Ricketts-user
strives for 3.7° steeper upper and for 3.8° flatter lower cen-
tral incisors based on an averaged perspective. Fig. 3a and b
point out graphically the targeted inclinations (tU1(BOP) or
tL1(BOP)) for the upper and lower incisors.
Coordination of reference planes
In the two-dimensional lateral perspective typical for
cephalometrical analysis, the “bisected occlusal plane”
(BOP) differs from the bracket positioning planes for the
upper (uBPP) and the lower arch (lBPP) by two angles,
called α and β (Fig. 4a). The following is valid:
BOP = uBPP ˙ ’ and BOP = lBPP ˙ “
To determine the size of angles α and β, it is helpful to
differentiate in parts α1, β1 (Fig. 4b), and α2, β2 (Fig. 4c). α1
and β1 describe the differences between BOP and the upper
(uOP) and lower occlusal plane (lOP; Fig. 4b), whereas α2,
and β2 represent the deviations between the occlusal planes
(uOP, lOP) and upper (uBPP) and lower (lBPP) bracket
positioning planes (Fig. 4c). The angles’ absolute values
are equal for α1 and β1 because BOP is defined as a bisector
between the upper and lower occlusal plane. The conversion
onto BOP results in an alteration in the same direction for
the incisor inclination in both jaws. Therefore, the angles’
signs do not change either. The deviations can be retrieved
directly from the cephalograms.
In contrast to that, the angles α2 and β2 are variable.
First of all, they are dependent on the bracket system de-
veloper’s prescription and patient’s tooth morphology, and
ultimately on the application mode selected by the treating
orthodontist. These angles are preferably unequal because
the lengths of the clinical crowns (relevant to LA-point ap-
plication) and the prescriptions for the upper and lower teeth
(relevant when measuring relative to the incisal edges) are
not identical. The alterations in angles are opposite to those
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B. Zimmer, H. Sino
APo/BOP NA/BOP NB/BOP
δ ε
86.3° 84.0° 92.9°
±3.3° ±4.7° ±3.0°
Björk Bergen Floating Max
norms
62.0° Individual 3.7°
70.8° 67.9° Individual 6.9°
of angles α1 and β1 because the conversion (expressed by
angles α2 and β2) onto occlusal planes (uOP and lOP) in-
stead of bracket positioning planes (uBPP and lBPP) makes
the expected inclinations (eU1 and eL1) flatter, whereas the
reference towards bisected occlusal plane (BOP; expressed
by the angles α1 and β1) instead of occlusal planes (uOP and
lOP) enable the expected inclinations to become steeper.
After differentiation, the following apply:
BOP = uBPP + ’1 − ’2 and BOP = lBPP + “1 − “2
In our final treatment outcomes revealing a normal over-
bite, we determined the angles α1 and β1 with a mean value
of 1.7° (standard deviation [SD] ± 0.7°; Table 6). Our cal-
culations for the angles α2 and β2 were done based on the
prescriptions from Bennet/McLaughlin and Andrews, re-
spectively. A difference in the bracket adhesive level of
2 mm in the upper and 1.5 mm in the lower arch between
central incisors and molars resulted in angle values mea-
suring α2 = 3.6° and β2 = 3.2° for the MBT prescription and
α2 = 2.7° and β2 = 1.6° for the LA-point-oriented prescrip-
tion (Table 6). Moreover, it is possible to determine the
individual differences between the reference planes by mea-
suring and applying individual values.
Transformation of bracket torque
DIN EN ISO 27020 defines the geometric relationship be-
tween bracket torque (BT) and the buccal surface on the
clinical crown. As a consequence, bracket torque influences
a tooth’s crown inclination, which we therefore refer to as
“bracket-induced crown inclination” (bCI). The following
relationship applies:
bCI(BPP) = 90ı − BT
where BPP represents the bracket positioning plane (Fig. 2b).
Bracket torque and incisor inclination

Fig. 3 a Coordinated cephalometric norm values (targeted inclinations) for the upper incisors relative to BOP (tU1(BOP)) in graphic relation.
b Coordinated cephalometric norm values (targeted inclinations) for the lower incisors relative to BOP (tL1(BOP)) in graphic relation. “Target
zones” between the lowest and highest values for the upper and lower inclinations appear that should be matched by bracket torque values
(assuming sufficient validity)
Abb. 3 a Darstellung der koordinierten FRS(Fernröntgenseiten)-Zielgrößen (angestrebte Inklinationen) für die oberen Incisivi relativ zu BOP
(tU1(BOP)) in graphischer Relation. b Darstellung der koordinierten FRS-Zielgrößen (angestrebte Inklinationen) für die unteren Incisivi relativ zu
BOP (tL1(BOP)) in graphischer Relation. Zwischen dem kleinsten und größten Wert entsteht für die oberen und unteren Incisivi eine „Zielzone“,
die bei zufriedenstellender Validität von einem Brackettorquewert erreicht werden sollte

Fig. 4 a Differences between “bisected occlusal plane” (BOP) and bracket positioning plane for the upper (uBPP; angle α) and lower arch (lBPP;
angle β), respectively. b Differences between BOP and upper (uOP; angle α1) and lower occlusal plane (lOP; angle β1). The angles α1 and β1 are
equal because BOP is an intersection between uOP and lOP. c Differences between upper occlusal plane (uOP) and upper bracket positioning plane
(uBPP; angle α2) and between lower occlusal plane (lOP) and lower bracket positioning plane (lBPP; angle β2)
Abb. 4 a Abweichungen zwischen der halbierten Okklusalebene („bisected occlusal plane“, BOP) und der Bracketpositionierungsebene für den
oberen (uBPP; Winkel α) und den unteren Zahnbogen (lBPP; Winkel β). b Abweichungen zwischen der BOP und der oberen (uOP; Winkel α1),
bzw. der unteren Okklusalebene (lOP; Winkel β1). Die Winkel α1 und β1 sind gleich groß, da BOP eine Winkelhalbierende zwischen uOP und
lOP darstellt. c Abweichungen zwischen der oberen Okklusalebene (uOP) und der oberen Bracketpositionierungsebene (uBPP; Winkel α2), sowie
zwischen der unteren Okklusalebene (lOP) und der unteren Bracketpositionierungsebene (lBPP; Winkel β2)

The bracket-induced crown inclination (bCI) must be
differentiated from the expected incisor inclination (eU1,
eL1). eU1 and eL1 are defined as angles between the long
axis of a tooth, meaning the straight line from point Incisale
to point Apicale, and the reference plane of choice.
Due to the fact that both lines are not parallel with a high
probability, we need to take a possible angle deviation be-
tween bCI and eU1 or eL1 into account. Subsequently,
that angle is referred to as the “torque coordination angle”
(TCA; Fig. 5). The following mathematical relationship ap-
plies:
eU1.BPP/ = bCI − TCA = 90ı − BT − TCA
and
eL1.BPP/ = bCI − TCA = 90ı − BT − TCA
Transformation towards the selected reference plane
BOP requires taking the angles α = α1 – α2 and β = “1 – “2
into consideration. As a consequence, we established the
following equations of general validity, differentiated for
the upper and lower jaw:

K
 B. Zimmer, H. Sino

Table 6 Statistical values for the correction angles of reference planes α1 and α2 (upper jaw), and β1 and β2 (lower jaw) for two prescriptions
(LA-point-oriented and according to MBT-standard values)
Tab. 6 Statistische Kennwerte für die Ebenenkorrekturwinkel α1 und α2 (Oberkiefer) bzw. β1 und β2 (Unterkiefer) für 2 Präskriptionen (LA-Punkt-
orientiert und nach MBT-Standardwerten)
Angle uOP/BOP uOP/uBPP uOP/uBPP lOP/BOP lOP/lBPP lOP/lBPP
(LA-Prescrip.) (MBT-Prescrip.) (LA-Prescrip.) (MBT-Prescip.)
α1 α2 α2 β1 β2 β2
Mean 1.7° 2.7° 3.6° 1.7° 1.6° 3.2°
SD ±0.7° ±0.3° ±0.3° ±0.7° ±0.2° ±0.4°
Min 0.5° 2.3° 3.4° 0.5° 1.4° 2.9°
Max 3.5° 3.2° 4.0° 3.5° 1.9° 4.0°
SD standard deviation, Prescrip. prescription, uOP upper occlusal plane, BOP bisected occlusal plane, uBPP upper bracket positioning plane,
IOP lower occlusal plane , IBPP lower bracket positioning plane

Table 7 Equations for the expected bracket torque-induced inclina-

tions of upper incisors (eU1) relative to BOP
Tab. 7 Gleichungen für die erwarteten brackettorqueinduzierten Inkli-
nationen der oberen Incisivi (eU1) relativ zu BOP
Universal eU1.BOP/ = 90ı − BT.U1/ − TCA.U1/ + ’1 − ’2
validity
Andrews eU1.BOP/ = 90ı − 7ı − TCA.U1/ − 1.9ı
Roth eU1.BOP/ = 90ı − 12ı − TCA.U1/ − 1.9ı
MBT eU1.BOP/ = 90ı − 17ı − TCA.U1/ − 1.9ı
Ricketts eU1.BOP/ = 90ı − 22ı − TCA.U1/ − 1.9ı
BOP bisected occlusal plane, TCA torque coordination angle Fig. 5 Torque coordination angle (TCA) as a second influencing factor
besides bracket torque (BT) on the inclination of incisors relative to
bracket positioning planes
eU1.BOP/ = 90ı − BT.U1/ − TCA.U1/ + ’1 − ’2 Abb. 5 Der TCA („torque coordination angle“) als zweite einfluss-
nehmende Größe neben dem Brackettorque (BT) auf die Inklination
and von Schneidezähnen relativ zu den Bracketpositionierungsebenen

eL1.BOP/ = 90ı − BT.L1/ − TCA.L1/ + “1 − “2 MBT prescription:

Our measurements of the angle deviations between the
reference planes BOP and upper and lower occlusal planes
(uOP, lOP), as well as those between the occlusal planes and
upper and lower bracket positioning planes (uBPP, lBPP)
enabled us to integrate the correction values into the equa-
tions. It can be inferred from the values that reliance on the
BOP rather than BPPs results in a decline in the expected
inclinations of 1.9° in the upper and 1.5° in the lower arch
when applying the Bennett/McLaughlin prescription. Cor-
respondingly, applying the LA-point oriented bracket led
to a 1° reduction in the upper arch’s inclination, but to an
increase of 0.1° in the lower arch. This alteration in the
prescription protocol as investigated in this study led to mi-
nor consequences for the possible incisor inclinations only.
However, regardless of which bracket application rationale
is followed, the inclination values rise by 1.7° if the or-
thodontist relies on reference to the upper (uOP) or lower
occlusal plane (lOP) rather than the upper (uBPP) or lower
bracket positioning plane (lBPP).
eU1.BOP/ = 90ı − BT.U1/ − TCA.U1/ + 1.7ı − 3.6ı
eU1.BOP/ = 90ı − BT.U1/ − TCA.U1/ − 1.9ı
and
eL1.BOP/ = 90ı − BT.L1/ − TCA.L1/ + 1.7ı − 3.2ı
eL1.BOP/ = 90ı − BT.L1/ − TCA.L1/ − 1.5ı
LA-point oriented prescription:
eU1.BOP/ = 90ı − BT.U1/ − TCA.U1/ + 1.7ı − 2.7ı
eU1.BOP/ = 90ı − BT.U1/ − TCA.U1/ − 1ı
and
eL1.BOP/ = 90ı − BT.L1/ − TCA.L1/ + 1.7ı − 1.6ı
eL1.BOP/ = 90ı − BT.L1/ − TCA.L1/ + 0.1ı
Provided bracket torque values and the correction an-
gles for coordinating reference planes are known, torque-
value specific equations for different bracket systems can
be formulated (Tables 7 and 8). From these we observe

K
Bracket torque and incisor inclination
Table 8 Equations for the expected bracket torque-induced inclina-
tions of lower incisors (eL1) relative to BOP
Tab. 8 Gleichungen für die erwarteten brackettorqueinduzierten Inkli-
nationen der unteren Incisivi (eL1) relativ zur BOP
Universal valid- eL1.BOP/ = 90ı − BT.L1/ − TCA.L1/ + “1 − “2
ity
Andrews (for eL1.BOP/ = 90ı − 4ı − TCA.L1/ − 1.5ı
torque L1: +4°)
Roth eL1.BOP/ = 90ı − TCA.L1/ − 1.5ı
MBT eL1.BOP/ = 90ı + 6ı − TCA.L1/ − 1.5ı
Ricketts eL1.BOP/ = 90ı − TCA.L1/ − 1.5ı
BOP bisected occlusal plane, BT bracket torque, TCA torque coordina-
tion angle, β1 angle between lower occlusal plane and BOP, β2 angle
between lower occlusal plane and lower bracket positioning plane
that a further parameter of relevance (TCA) exists in addi-
tion to bracket torque and reference planes correction val-
ues—namely, one that represents a dental–morphological
factor.
Discussion
During the course of our study we calculated equations that
enable a direct comparison of norm values for upper and
lower incisor inclinations and which are an essential part of
standard cephalometric analysis. Not having had access to
an orthodontically untreated group with ideal natural occlu-
sions, we focused on a group of former patients who were
skeletally well-balanced and presented an occlusal status
“close to ideal”. We therefore conclude that any differences
from an untreated norm group can be considered irrelevant
and that the conclusions drawn from our study findings
are in good accordance with the basic relationships that are
valid. To make the calculations we did, angle measurements
that are not a part of standard cephalometric diagnosis were
necessary. However, we focused exclusively on structures
that can be measured with sufficient precision [4, 12, 25].
This assumption is supported by our findings on objectivity
and examiner reliability.
As a result, we detected maximum differences of 3.7°
for the upper and of 6.9° for the lower central incisors,
representing a metric manifestation of satisfactory or suf-
ficient accordance between the accepted norm values. The
differences themselves already reveal essential significance
for orthodontic diagnosis because every therapist is capa-
ble of obtaining information on which method he or she
prefers when planning treatment accommodating the ac-
cepted norms. In contrast to other cranial reference planes
like NSL or the Frankfort horizontal [38], we chose BOP
as a common reference plane because it represents a loca-
tion in the center of cranial chewing activity. The reference
to this plane coincides with a high degree of visualization
for determining ideal incisor positions, an integral aspect in
orthodontic treatment planning.
The variability of targeted cephalometric norm values
stands in contrast to a spectrum of bracket torque values
that cover a range of 15° for the upper and of 10° for
the lower central incisors. However, it became possible to
directly compare target zones according to cephalometric
criteria and optional torque values, but not before the ref-
erence planes had been coordinated. In that respect we are
compelled to mention that although the bracket system de-
signers provide us with differentiated definitions of recom-
mended bracket positioning planes, when referring to “the
occlusal plane” [3, 21] we find that their explanations are
nearly always inadequate, as the therapist is not informed
as to which of the various occlusal planes is meant in the
actual given situation [3, 5, 21, 28, 29]. One essential aim
of the present study was to detect suitable structures and to
integrate them into a geometric model. Schudy [31] and Ja-
cobson [17] already highlight that the definitions of occlusal
planes vary in the literature. First of all, we disregarded the
types of occlusal planes of minor interest in the context of
this study, e. g., the anterior, posterior, functional [17, 19],
and prosthetic [30] occlusal plane. But moreover, differing
reports on the posterior reference point like the first [31] or
the second molar [26, 35], the mesio- [15] or distobuccal
[31] cusp, contact points in the molar area [23], the inter-
section of molar cusp overlap [11, 17, 19] or the midpoint
of the first molar at the occlusal level [19] could be found.
Our decision to rely on an upper and lower occlusal
plane after having specified the reference points reflects
not just the necessity of coordinating cephalometric and
bracket torque values. It also enabled us to answer relevant
questions. One of those was: what consequences do differ-
ing bracket prescriptions with different bonding levels have
regarding incisor inclinations relative to the planes of inter-
est? Moreover, the perception that occlusal planes should
not be considered as being parallel to bracket positioning
planes, but rather that they differ in relation to the selected
prescription by 2.7–3.6° in the upper and by 1.6–3.2° in
the lower arch from the BPPs, is of genuine orthodontic
interest.
Finally, our coordination of reference planes enables us
to develop equations that are suitable for calculating the
corresponding incisor inclinations derived from different
bracket torque values. Those we designated as “expected
incisor inclinations” relative to BOP. In their generally ap-
plicable versions, the equations make it possible to calculate
suitable bracket torque values for a given individual incli-
nation value or an average-based norm inclination, both
while considering differing dental morphologies and bond-
ing prescriptions. What the relationships we have devised
do in particular is reveal that, in addition to a specific torque
value, the patient’s individual tooth morphology represents
K

a second essential parameter responsible for the expected
incisor inclination. Several studies have emphasized the sig-
nificance of dental morphology [7, 8, 13, 37]. Loenen et al.
[20] reported relevant variability of the crown–root angle
of 24° when analyzing upper central incisors. In the course
of the present study, we introduced the “torque coordina-
tion angle”. Its advantage is that only one angle needs to be
measured when considering the dental–morphologic aspect
on the axial inclination of teeth.
The “torque coordination angle” is formed, on the one
hand, by a tooth’s long axis, as defined as a straight line
between point Apicale and Incisale and, on the other hand,
by a tangent or secant located on the buccal crown surface.
Andrews already defined a comparable structure [3]. While
determining a tooth’s long-axis is an accepted procedure in
orthodontic routine diagnosis [4, 12, 25], there is no satis-
factory data so far on the second arm of the TCA. Therefore,
part two of this study will clarify the TCA’s reproducibil-
ity (objectivity, reliability). Moreover, we intend to gather
basic information about the relevant statistic values while
considering different clinical-crown morphologies and var-
ious bracket positions.
Conclusions
The development of suitable equations enables us to com-
pare “targeted inclinations” according to norm values based
on different cephalometric analyses with “expected inclina-
tions” as they theoretically generated via different bracket
torque values and prescription rationales. The prerequisite
for coordinating both systems (cephalometric values and
bracket torque) was the mathematical–geometric differen-
tiation of relevant reference planes. We demonstrate that
there is a second dental–morphologic parameter in addition
to bracket torque, one that we designate the “torque coordi-
nation angle” (TCA). This angle is potentially relevant for
achieving an ideal incisor inclination.
Compliance with ethical guidelines
Conflict of interest B. Zimmer and H. Sino declare that they have no
competing interests.
Ethical standards All studies on humans described in the present
manuscript were carried out with the approval of the responsible eth-
ical standards and in accordance with national law and the Helsinki
Declaration of 1975 (in its current, revised form). Informed consent
was obtained from all patients included in studies.
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