CLINICIANS' CORNER

The clinical use of Activa self-ligating brackets

Nigel W. T. Harradine, BDS, FDS RCS, MB BS, MSc (Orth), M. Orth. RCS," and
David J. Birnie, BDS, FDS RCS, M. Orth. RCS b
Bristol, England

The advantages and disadvantages of Activa self-ligating brackets ("A" Company, San Diego, Calif.)
are discussed in the light of extensive clinical experience and the currently available data concern-
ing frictional forces between arch wires and these brackets. Detailed practical recommendations are
made concerning the problems that are encountered. The principal clinical advantages arise from
the unusual combination of very low friction and excellent control of arch wire engagement. The
potential benefits are the rapid alignment of very irregular teeth, lower anchorage requirements,
and facilitation of sliding mechanics. Several problems arise from the unfamiliarity of a bracket
without tie-wings, but the most significant drawback is the bond failure rate which is currently higher
than with conventional brackets from the same manufacturer. (AM J ORTHODDENTOFACORTHOP
1996; 109:319-28.)

A c t i v a brackets are fully programmed pre-
adjusted brackets that were introduced in 1986.
Starting in that year, we have since treated a
substantial number of cases with these brackets
while continuing, until recently, to use other con-
ventional fully programmed brackets with tie-wings
on the majority of cases. Over the past 3 years,
Activa brackets have become the predominant
bracket type used by the authors in cases requiring
substantial tooth movement. Very little information
has been published on these brackets, which re-
main unfamiliar to the majority of clinicians. This
article discusses the differences, benefits, and po-
tential drawbacks of using Activa. Photographs
from cases treated since 1986 will illustrate the
salient points.
ESSENTIAL DESIGN FEATURES OF
ACTIVA BRACKETS
These are illustrated in Fig. 1. The arch wire is
retained by a resilient clip that rotates into a
retaining groove gingival to the arch wire, position-
ing two straps labial to the wire and creating a
bracket that is very similar mechanically to a molar
tube with twin channel caps. The clips can be
opened and shut with a wide range of commonly
used hand instruments including ligature tuckers,
aConsultant orthodontist, Bristol Dental Hospital, and senior clinical
lecturer, Bristol Dental School.
bConsultant orthodontist, Portsmouth, and senior, visiting lecturer, Bristol
Dental School.
Copyright © 1996 by the American Association of Orthodontists.
0889-5406/96/$5.00 + 0 8/1/58093
flat plastics, and Mitchell's trimmers. All brackets
have vertical slots behind the arch wire channel and
permanent, as well as painted, identification marks.
Brackets for the anterior teeth have gingival and
occlusal tabs to assist orientation relative to the
facial axis of the clinical crown. More recently,
premolar brackets have been supplied with rectan-
gular bonding bases. The brackets are also avail-
able prewelded to bands.
ADVANTAGES OF ACTIVA
When originally designed by Irwin Pletcher, the
principal intention was to speed the process of
ligation. An article by Maijer and Smith 1 demon-
strated a four-fold reduction in ligation time com-
pared with wire ligation of conventional brackets. It
should also be remembered that arch wire "liga-
tion" using Activa brackets does not require a
chairside assistant to speed the process. However,
we believe that the speed advantages compared
with elastomeric ligation are marginal and that
other advantages are much more significant
clinically.
Advantages of Activa brackets
We suggest that there are essentially four
worthwhile advantages, of which the first two are
much more significant clinically.
1. Low friction between bracket and arch wire.
2. More certain full arch wire engagement.
3. Less chairside assistance.
4. A vertical slot for hooks and auxiliaries.

319
320 Hatradine and Birnie
.which arch wire sliding must occur.
Fig. 1. A, Activa bracket with clip open. Clip retaining groove
is visible on the gingival surface. B, Activa bracket with the clip
closed. C, Arch wires engaged in Activa brackets. Alignment
tabs and distogingival marker dots can be seen.
Low friction
This has been clearly demonstrated and quan-
tified in work by Griffies et al. 2 and more recently
by Sims et al. 3'4 The friction is dramatically lower
than with elastomeric rings and conventional brack-
ets. Other bracket t y p e s - m o s t notably Begg brack-
e t s - h a v e low friction by virtue of an extremely
loose fit between a round arch wire and a very
American Journal of Orthodontics and Dentofacial Orthopedics
March 1996
narrow bracket, but this makes full control of tooth
position correspondingly more difficult. Some
brackets with an edgewise slot have incorporated
shoulders to distance the elastomeric from the arch
wire and thus reduce friction, but this type of
design relies on the ability of the deformable elas-
tomeric ring to provide sufficient force to maintain
the arch wire in the slot without actively pressing
on the arch wire to an extent that increases friction.
The combination of very low friction and very
secure arch wire engagement in an edgewise slot is
currently only possible with self-ligating brackets
and is by far the most beneficial feature of Activa
brackets. This combination enables a tooth to be
slid along an arch wire with lower and more pre-
dictable net forces and, yet, under complete control
with almost none of the undesirable rotation of the
tooth resulting from a deformable mode of ligation.
This in turn can conserve anchorage for two rea-
sons. First, with low friction, the net forces are
more predictably low and the reciprocal forces
correspondingly smaller. Second, individual teeth
(e.g., canines) can be retracted separately along an
arch wire and thus potentially reduce the overall
anchorage demands by reduction of the root area
of teeth to be moved at any one time, but with none
of the potential disadvantages of other methods of
separate canine retraction, e.g., loss of canine con-
trol. After such separate canine retraction, the low
friction of Activa brackets then permits the sensible
use of sliding mechanics to retract incisors even
though there will now be a minimum of three
brackets distal to the remaining space through
The other situation in which the combination of
low friction and secure full engagement is particu-
lary useful is in the alignment of very irregular
teeth and especially the resolution of severe rota-
tions where the capacity of the wire to slide
through the brackets of the rotated and adjacent
teeth significantly facilitates derotation. These fea-
tures are shared to an extent by Speed brackets,
which we also used on a significant number of cases
in the past. Speed brackets (Speed System Orth-
odontics, Cambridge, Ontario, Canada) differ in
having an active spring to retain the wire and in
being very significantly narrower mesiodistally than
the majority of brackets with an edgewise slot.
The low friction when using Activa brackets
therefore permits rapid alignment and more cer-
tain space closure, whereas the secure bracket
engagement permits full engagement with severely
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 109, No. 3
Fig. 2. Initial visit (8 weeks) producing 40 ° of canine derotation.
displaced teeth and also full control while sliding
teeth along an arch wire. Figs. 2 and 3 show these
attributes over one visit of derotation of severely
rotated canines with 0.012-inch nickel titanium
arch wires, Fig. 4 illustrates rapid canine retraction
with no loss of control of tooth position, even
though small diameter wires are employed at this
early stage of treatment. The low friction has per-
mitted low net forces to be used, enhancing anchor-
age and tooth control. Fig. 5 demonstrates incisor
retraction on an 0.018-0.025-inch arch wire from
March 1993 to August 1993.
Less chairside assistance
Self-ligating brackets require no passing of elas-
tomeric or wire ligatures to the operator during
ligation.
A vertical slot
This is always a useful feature in a bracket, but
is essential in a bracket without tie-wings. Fig. 6
illustrates several applications of the vertical slot in
addition to the retraction of canines previously
Harradine and Birnie 321
Fig. 3. One visit (8 weeks) of derotation using O.012-inch
nickel titanium arch wire in O.022-inch slot.
discussed. The T-shaped locking pins are a pre-
formed auxiliary.
Possible further advantages
It has been suggested that self ligating brackets
have further advantages due to the absence of
ligatures and tie-wings.
1. Smoother and more comfortable? (no wire
ligatures)
2. Easier oral hygiene? (no ligatures)
3. Less cross-infection risk? (no wire ligatures
with sharp ends)
4. Better esthetics? (smaller than many brack-
ets and no elastomerics to discolor)
We believe that these potential advantages are
much less significant than those discussed previ-
ously.
DISADVANTAGES OF ACTIVA
Our use of these brackets has taken some years
to grow to the majority of our current cases, and
322 Harradine and Birnie
Fig. 4. Three successive visits showing canine retraction with 9-week intervals between visits.
Fig. 5. Space closure using nickel titanium retraction coil on
0.018-O.025-inch arch wire over 19-week period.
this lack of immediate and complete enthusiasm is
due to the following list of disadvantages.
1. Higher bond failure rate
2. Less convenient with elastomeric chain
3. Unfamiliarity
American Journal of Orthodontics and Dentofacial Orthopedics
March 1996
4. H a r d e r to hold and seat when bonding
5. Partial slot engagement not possible
6. Breakage of arch wire retaining clips
7. Low friction increases wire displacement
Higher bond failure rate
This is a definite, but not enormous current
disadvantage. Several factors probably contribute
to the lower bond strength. First, as discussed later,
operators who are new to these brackets tend to
fail to fully seat them on the teeth. Second, the
bases are slightly smaller than with most brackets.
Third, the absence of tie-wings means that a
smaller percentage of the bracket base is attached
to overlying bracket, and this may possibly lead to
less rigidity of the bracket base and easier distor-
tion of the base and consequent bond failure under
external loading forces. More recently, the premo-
lar Activa brackets have been supplied on the
standard rectangular bracket bases with a conse-
quent marked reduction in loss of these bonds and
a claimed increase in bond strength of 45% to 60%
depending on adhesive type. It is reportedly
planned to similarly modify the bases on the Activa
brackets for all other teeth. Such a change would
probably also ease the adverse effect of visual
unfamiliarity on correct bracket positioning, par-
ticularly with canine teeth.
Less convenient with power chain
When closing multiple spaces, elastic chain
must either be placed behind the arch wire or
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 109,No. 3
Fig. 6. A, Closure of diastema with T pins and elastic chain. B, Ligature connection of palatal canine
to buccal sectional wire. C and D, Rotating spring used to overrotate a canine.
Fig. 7. A, Initial bracket positioning. This tweezers grip pro-
vides good vision for orientation and control of composite
amount and distribution but is not suitable for final seating. B,
Firm pressure for full bracket seating can be applied through
orientation tags.
H a r r a d i n e a n d Birnie 323
Fig. 8. Correct angulation of upper canine bracket but lower
canine bracket will cause distal angulation.
T-shaped locking pins must be placed in several
brackets. Neither of these is a big problem, but
tie-wings are more convenient in this instance,
Placement of the chain behind the wire means
keeping the chain out of the slots during placement
and also means removing the arch wire when re-
newing the chain. When closing extraction spaces
with chain or nickel-titanium coil run to hooks on
the arch wire, these factors do not apply.
Unfamiliarity and difficulties during
bracket placement
Orthodontists are so used to having tie-wings,
that the minor alterations of techique necessitated
324 Harradine and Birnie
Fig. 9. Dental floss has been used to engage wire on distal of
premolar, permitting clip closure.
Fig. 10. Initial engagement through previously closed bracket
of very rotated tooth.
by their absence are a source of initial disquiet.
Tie-wings are useful holding points for tweezers
and their absence dictates minor changes in
bracket placement technique. Fig. 7, A illustrates a
favored method of initial bracket positioning, and
Fig. 7, B shows an altered tweezers position that
enables firm pressure and seating of the bracket.
Also, the very different shape and the unfamiliar
aligning tags on the bases require close concentra-
tion if errors of bracket placement are to be
avoided. This particularly applies to the angulation
of canine brackets. The eye is easily distracted by
the arch wire slot and clip from the task of aligning
the oblique tags with the facial axis of the tooth.
Fig. 8 shows a lower canine with the slot tending to
a right angle with the facial axis rather than at the
correct angle as indicated by the tags. Increasing
awareness and familiarity soon eliminate these po-
tential pitfalls.
American Journal of Orthodontics and Dentofacial Orthopedics
March 1996
Fig. 11. Activa seating key can facilitate complete arch wire
engagement and hold this engagement while closing clip.
Fig. 12. Elastic string in lower lateral incisor bracket to in-
crease friction and minimize wire swivelling.
Partial slot engagement is not possible
The wire retaining clip is either fully closed or
not at all. However, the vertical slot enables liga-
tion to very ectopic teeth and the use of derotating
springs on such teeth. Furthermore, when a tooth is
sufficiently aligned for engagement, Activa brackets
provide a much more certain full engagement than
a ligature or elastomeric module and modern flex-
ible wires permit full engagement without arch wire
distortion in substantially irregular teeth. If arch
wire engagement and clip closure is difficult for
a particularly irregular tooth, several practical
dodges are worth knowing. First, the wire can be
held into the slot base with an amalgam plugger or
ligature tucker or the ubiquitous Mitchell's trimmer
and the clip can then easily be closed. If the tooth
is very rotated and the end of the slot is too close
to the adjacent tooth for an instrument to be used
to seat the wire, dental floss looped over the arch
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 109, No. 3
wire can be used to engage the wire on that side
(Fig. 9). Another useful maneuver is to first close
the clip on a very rotated tooth and then thread
the aligning wire through the closed bracket before
engaging the other brackets (Fig. 10). Where the
difficulty is the full engagement of a stiff rectan-
gular wire, the special Activa seating key is the best
instrument to assist clip closure (Fig. 11), although
this is rarely a problem in cases where full en-
gagement of a stiff wire is indeed possible. The use
of Activa brackets reveals that with conventional
brackets we frequently fail to fully engage a thick
wire on insertion. The clinician's visual estimate
of what size of wire can be fully engaged is
therefore sometimes deceived when starting to use
Activa and a slight increase in the use of inter-
mediate or finishing thick wires of a lower modulus
of elasticity (nickel-titanium or TMA) is one sen-
sible response.
Breakage of arch wire retaining clips
It is extremely uncommon for this to occur
between appointments. Loss of control of tooth
position through ligation failure is therefore rarely
a problem. However, clip breakage does occur if
the operator employs excessive force when trying to
engage an arch wire on a stiff and incompletely
engaged wire. The remarks in the preceding para-
graph concerning the engagement of still rectangu-
lar wires therefore describe the means of avoiding
the irritation of broken clips. Should a clip break, it
is possible to replace it with a new clip without the
need to remove and replace the bracket. Separate
clips are supplied for this purpose. Placing a new
clip in the circumstance is a slightly awkward little
task that rapidly becomes quicker and easier with
practice. Fractional enlargement of the radius of
the circular portion of the clip (with light-wire
pliers) before pressing it onto the bracket eases
placement. The problem of clip breakage is very
largely another reflection of operator inexperience
with these brackets and ironically, by the time the
operator has replaced four or five clips and can do
it very rapidly, he or she has probably also learned
to not try to use excessive force on an incompletely
engaged stiff arch wire, and this newly acquired
skill is only very occasionally required.
Low friction increases wire displacement
Even with very irregular teeth, the very low
friction enables aligning arch wires to slip through
the brackets and an arch wire end to protrude
Harradine and Birnie 325
Fig. 13. Lower canines slightly lingually inclined on 0.018-
0.025-inch arch wire. This was corrected with 0.021-0.025-inch
TMA arch wire.
excessively. Steps to prevent this include using
tie-backs over extraction sites to lessen the effects
of occlusal forces on unprotected spans of wire.
Also, elastic string can be closed into the slot with
the arch wire to deliberately increase the friction
on selected slots and lessen arch wire swivelling
(Fig. 12). As an alternative, a piece of an intraoral
elastic band can also be used in this role, but these
tend to degrade and swell between visits, giving an
unsightly appearance to the bracket, so elastic
string is preferred. Selective locking of individual
brackets to the arch wire with elastic string can be
helpful under other circumstances, e.g., to rein-
force anchorage during center-line correction.
Small V-shaped notches in the midline of flexible
wires can also limit the scope for wire swivelling.
These are commercially available or can be bent
into nickel-titanium wires with triple beak pliers.
Finally, particular care should be taken to turn up
the ends of all flexible aligning wires.
Difficulty obtaining perfect alignment
This can arise as an accumulation of several
factors. First brackets may have been incorrectly
positioned as a result of their visual unfamiliarity.
Second, brackets may have been inadequately
seated because of the lack of tie-wings that are the
usual place on which to push. As described earlier,
it is necessary to push firmly on the base or at both
ends of the tube with the tweezers or within the slot
by using a flat plastic or Hollenbeck carver.
Third, there is a factor that may not be imme-
diately apparent. Unlike a wire or elastic ligature,
the retaining clip does not force the wire to the
326 Harradine and Birnie
Fig. 14. After overjet reduction with functional appliance, this case was completed in 5 months with
four pairs of arch wires shown here (second premolars were congenitally absent).
base of the slot, indeed this is a large contributor to
the low arch wire friction. It follows that there is
more freeedom for a tooth to take advantage of the
play between the bracket slot and arch wires of less
than full slot dimensions. This will be a very small
factor in the tip/angulation dimension, a slightly
larger factor in the plane of tooth rotations, but a
significant factor in terms of torque, where the
well-known scope for arch wire "slop" is more able
to express itself with the lower frictional binding of
these brackets. For example, lower canines may
sometimes appear to need an offset, but in fact
they need labial crown torque (Fig. 13). It is pos-
sible that occlusal forces from upper canines are
able to incline these teeth lingually beause of the
very low frictional resistance.
Finishing cases with Activa brackets
The factors discussed in the preceding para-
graph will be most clearly revealed in the final
American Journal of Orthodontics and Dentofacial Orthopedics
March 1996
stages of active treatment. This problem is noted
by Roth in his chapter in the Graber-Vanarsdall
book. ~ Roth has recommended that on occasion it is
even preferable to change to conventional straight
wire brackets for the last 2 to 4 months, where torque
alignment is a major consideration? Steps to fa-
cilitate rapid and accurate finishing should there-
fore begin preventatively with the additional care
in bracket placement and full seating previously
discussed. With regard to the increased scope for
the expression of arch wire "slop,"this is primarily
dealt with by a more consistent application of the
frequently advocated practice of using large di-
mension arch wires to more fully express the values
built into the bracket slot in all three dimensions.
Greater use of 0.021 to 0.025-inch finishing arch
wires is therefore indicated and nickel-titanium or
TMA arch wires are very useful in this respect.
Occasionally, localized torque in a TMA arch
wire is required. We have never employed still
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 109, No. 3
Fig. 14. cont'd.
larger dimension arch wires, but a braided rectan-
gular 0.022 to 0.028-inch nickel-titanium arch wire
may have a place here as an extension of the same
principle. It should be borne in mind that the
biomechanical situation is essentially no different
from that which normally occurs in molar teeth
with their tubes, as opposed to brackets, apart from
the greater mesiodistal width of a molar tube that
will diminish the scope for slop in the first-order
plane of space. Despite these observations, it
should be noted that alignment is usually rapid and
very good (Fig. 14). It is probable that the errors of
bracket positioning resulting from a lack of famil-
iarity with these unusually shaped brackets are a
larger source of finishing difficulties than would be
anticipated.
CONCLUSIONS
We have presented a clinical critique of Activa
brackets. These brackets are a very interesting
development of the straight wire appliance, offer-
ing the possibility of a significant reduction in
Harradine and Birnie 327
average treatment times and anchorage require-
ments through an unusual combination of very low
arch wire friction and secure bracket engagement.
We have discussed potential disadvantages and
illustrated them in some detail, but most of these
are largely due to unfamiliarity on the part of the
clinician. Further development of the bonding
bases on anterior brackets should improve the
accurate positioning and retention of these brack-
ets. No change in treatment mechanics is required
although the combination of low friction and excel-
lent control while sliding encourages the adoption
of slightly altered mechanics to take advantage
of these features. Compatibility with the other
straight wire brackets and bands facilitates a trial of
these brackets and we consider that the advantages
outlined in this article merit much wider clinical
assessment.
REFERENCES
1. MaijerR, Smith DC. Time savingwith self-ligatingbrackets.
J Clin Orthod 1990;24:29-31.
328 Harradine and Birnie American Journal of Orthodontics and Dentofacial Orthopedics
March 1996

2. Griffies JM et al. Evaluation of Activa brackets on friction 5. Roth RN. Treatment mechanics for the straight wire appli-
resistance in sliding mechanics. AM J ORTHOD DENTOFAC ance. In: Grabor TM, Vanarsdall RL. Orthodontics: Current
ORTHOP 1993;p97 abstract. principles and techniques. 2nd ed. St. Louis: Mosby-Year
3. Sims APT, Waters NE, Birnie D J, Pethybridge RJ. A com- Book, 1994:685-711.
parison of the forces required to produce tooth movement in
vitro using two self-ligating brackets and a pre-adjusted
bracket employing two types of ligation. Eur J Orthod 1993; Reprint requests to:
15:377-85. Dr. N, W. T. Harradine
4. Sims APT, Waters NE, Birnie DJ. A comparison of the forces Bristol Dental Hospital
required to produce tooth movement in vitro through three Lower Mandlin St.
types of preadjusted brackets when subjected to determined Bristol BS1 2LY
• torque and tip values. Br J Orthod 1994; [in press]. England

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