MBT

Dr. Amol Pharande

McLaughlin
Bennett
Trevisi

2
Richard P McLaughlin DDS
San Diego, California, USA

John C Bennett LDS, DOrth

London, UK

Hugo J Trevisi
Presidente Prudente, Brazil
3
 1993 1997 2001

4
Treatment goals
Condyles in seated position – in centric
relation
Relaxed healthy musculature
A “six keys” class I occlusion
Ideal functional movements – a mutually
protected occlusion
Periodontal health
Best possible aesthetics

5
Historical Background
Until mid 1970s – standard edgewise
bracket

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 Historical Background
Two major disadvantages –
Archwire bends time-consuming & tedious
Undertreated cases –
Molars not in

true class I
Upp incisors
lacked torque
‘nice orthodontic

result’
7
The work of Andrews
Study of 120 non-orthodontic normal cases,
1972

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Angulation / Tip

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 Inclination / Torque

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The work of Andrews
Study of 120 non-orthodontic normal cases

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The work of Andrews
Maxillary average angulations & inclinations

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 The work of Andrews

Mandibular average angulations & inclinations

13
 The work of Andrews
 Non-orthodontic normals

Tip/
1 2 3 4 5 6 7
Torque

Max. 5/7 9/3 11/-7 2/-7 2/-7 5/-9 5/-9

Mand. 2/-1 2/-1 5/-11 2/-17 2/-22 2/-30 2/-35

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The work of Andrews
Straight–Wire Appliance (SWA) – 1972

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The work of Andrews
However, early results with Straight-wire
Appliance were disappointing.
Traditional heavy edgewise forces
continued to be used
‘Roller coaster’ effect

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The work of Andrews
‘Roller coaster’ effect

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The work of Andrews
‘Roller coaster’ effect

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The late 1970s
Two possible ways to proceed –
Maintain the same force levels & treatment
mechanics, but introduce features in the
bracket system
Wide range of brackets
Translation series brackets – anti-tip, anti-
rotation
Three sets of incisor brackets with varying
degrees of torque

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 Tooth II molar I Molar II PM I PM Canine
Maxillary 5/-9 5/-9 2/-7 2/-7 11/-7
(10o offset) (10o offset)

Mandibula 2/-35 2/-35 2/-22 2/-17 5/-11

r

Counter tip Counter Counter

rotation buccoling. tip
Minimum 2 2 -4
Medium 3 4 -5
Maximum 4 6 -6
 The Roth prescription
 2nd generation of preadjusted brackets
Tooth II I Molar II PM I PM Canine Lateral Central
molar
Max. 5/-14 5/-14 0/-7 0/-7 13/-2 9/8 5/12
(10o (10o
offset) offset)

Mand. -1/-35 -1/-30 -1/-22 -1/-17 7/-11 2/-1 2/-1

4o offset 4o offset

 Standard wide archform 21

The late 1970s
Alternative route – abandoning the
traditional concepts of treatment
mechanics

22
The work of McLaughlin & Bennett
between 1975 and 1993
The transition from
standard edgewise to
preadjusted appliance
systems. JCO, 1989.
Controlled space closure
with a preadjusted
appliance system.
JCO, 1990.
Finishing and detailing
with a preadjusted
appliance system.
JCO, 1991.
23
The work of McLaughlin & Bennett
between 1975 and 1993

Bracket positioning – middle of clinical

crown
Medium sized standard ovoid archform
Lacebacks, bendbacks, light forces, sliding
mechanics.

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The work of McLaughlin, Bennett and
Trevisi between 1993 and 1997
Re–design the entire bracket system – third
generation bracket system
Andrews’ original findings & two Japanese
studies-
Sebata E 1980, An orthodontic study of teeth and
dental arch form on the Japanese normal occlusions.
The Shikwa Gakuho 80(7):945-969
Watanabe et al 1996, A morphometric study on
setup models of Japanese malocclusions. The
Shikwa Gakuho

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The work of McLaughlin, Bennett and
Trevisi between 1993 and 1997

Anterior tip reduced

26
The work of McLaughlin, Bennett and
Trevisi between 1993 and 1997

Disadvantages of ant. Tip –

Significant drain on A-P anchorage
Increased tendency of bite deepening
Upper canine root apex too close to 1st PM
root

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The work of McLaughlin, Bennett
and Trevisi between 1993 and 1997
SWA tip MBT

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The work of McLaughlin, Bennett and
Trevisi between 1993 and 1997
Extra torque with ant & molar regions
Inefficient torque control

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The work of McLaughlin, Bennett
and Trevisi between 1993 and 1997

30
The work of McLaughlin, Bennett and
Trevisi between 1993 and 1997
Versatile canine brackets

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The work of McLaughlin, Bennett and
Trevisi between 1993 and 1997

Bracket shape – rectangular to rhomboid

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The work of McLaughlin, Bennett and
Trevisi between 1993 and 1997
Brackets positioned with the help of
gauges

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 The work of McLaughlin, Bennett
and Trevisi between 1993 and 1997

 The MBTTM Versatile+

bracket system

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 The MBT Versatile+ bracket
TM

system
 Appliance specifications
Tip/
1 2 3 4 5 6 7
Torque
8/0
Max. 4/17 8/10 0/-7 0/-7 0/-14 0/-14
8/-7
3/0
Mand. 0/-6 0/-6 2/-12 2/-17 0/-20 0/-10
3/-6
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MBT Versatile+
TM

Design features
Range of brackets –

Standard size metal brackets

Mid-size metal brackets

Esthetic ClarityTM brackets

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 Standard

 Mid-size

 Clarity

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MBT Versatile+
TM

Design features
Rhomboidal shape

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MBT Versatile+
TM

Torque in base – the CAD factor

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MBT Versatile+
TM

Resulting bracket can have torque in base,

torque in face, or a combination of the two

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MBT Versatile+
TM

Since the advent of CAD-CAM bracket

design, it is not necessary to discuss this
historical issue any longer!

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MBT Versatile+ : Appliance
TM

Specifications - Incisors
Tip/ Maxillary Mandibular
Torque Central Lateral Central Lateral
MBT 4/17 8/10 0/-6 0/-6

Normal 5/7 9/3 2/-1 2/-1

SWA 5/7 9/3 2/-1 2/-1

Roth 5/12 9/8 2/-1 2/-1

 Tip - reduced 42
 Appliance Specifications - Incisors

Torque – increased
Class II - Torque tends to
be ‘lost’
Class III – compensate
for mild Class III dental
bases

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Incisors

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Incisors

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Incisors
Variations in bracket positioning

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Incisors
Variations in bracket positioning

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Appliance Specifications - Cuspids
Tip/
Torque Maxillary Mandibular
MBT 8/-7 or 8/0 3/-6 or 3/0

Normal 11/-7 5/-11

SWA 11/-7 5/-11

Roth 13/-2 7/-11

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Cuspids
Tip reduced

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Cuspids
Torque

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Cuspids
Torque

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Cuspids
Torque

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Cuspids
Torque
Tucking-in the upper cuspids

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Bicuspids
Tip/ Maxillary Mandibular
Torque 1st 2nd 1st 2nd
MBT 0/-7 0/-7 2/-12 2/-17

Normal 2/-7 2/-7 2/-17 2/-22

SWA 2/-7 2/-7 2/-17 2/-22

Roth 0/-7 0/-7 -1/-17 -1/-22

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Bicuspids

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 Molars
Tip/ Maxillary Mandibular
Torque 1st 2nd 1st 2nd
MBT 0/-14 0/-14 0/-20 0/-10

Normal 5/-9 5/-9 2/-30 2/-35

SWA 5/-9 5/-9 2/-30 2/-35

Roth 5/-14 5/-14 -1/-30 -1/-35

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Upper Molars
Tip considerations
o
Buccal groove (long axis) – 4.9o to 5.7 to
occlusal plane

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Upper Molars

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Upper Molars

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Upper Molars

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Upper Molars
10 distal offset
O

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Upper Molars
Torque – increased

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Lower Molars
Torque – reduced
Narrow arch – uprighting
‘rolling-in’

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Lower Molars

0O offset
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Molars
Band positioning

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The Versatility Of The Bracket
System
Aspects of versatility
1. Options for palatally displaced upp lat incisors
2. Three torque options for upper canines
3. Three torque options for lower canines
4. Interchangeable lower incisor brackets
5. Interchangeable upper premolar brackets
6. Use of upp 2nd molar tubes on 1st molars
7. Use of low 2nd molar tubes for upp molars of the
opposite side- when finishing to Class II molar
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Aspects of Versatility
Palatally displaced upp lateral incisors

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Aspects of Versatility
Palatally displaced upp lateral incisors

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Aspects of Versatility
Three torque options for upp canines
(-7 ,0 ,+7 )
O O O

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Aspects of Versatility
Three torque options for lower canines
(-6 ,0 ,+6 )
O O O

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Which canine bracket to use?
Arch form
Canine prominence
Extraction decision
Overbite
Rapid palatal expansion
Missing upp lat, where space is to be
closed

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Which canine bracket to use?
Arch form

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Which canine bracket to use?
Canine prominence
0O or +7O and +6O

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Which canine bracket to use?
The extraction decision (tip control)
Premolar extraction cases
0O

Rapid palatal expansion cases

0O or +6O lower

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Which canine bracket to use?
Overbite
Class II/2, deep bite – 0O or +6O

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Which canine bracket to use?
Missing upper lateral incisors, where space
is to be closed
+7O

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Aspects of Versatility
Interchangeable lower incisor brackets

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Aspects of Versatility
Interchangeable upper premolar brackets

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Aspects of Versatility
Upp 2nd molar tubes on 1st molars in non –
HG cases

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Aspects of Versatility
Use of low 2nd molar tubes for upp 1st & 2nd
molars of the opposite side, when finishing
cases in Class II molar relationship

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Aspects of Versatility
Mesial-in rotation – Class II finish

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Aspects of Versatility
0 tip
O

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Additional bracket & tube options
Bracket for small upper 2nd premolars

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Additional bracket & tube options
Bracket for small upper 2nd premolars

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Additional bracket & tube options
Lower 2nd premolar tubes

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Additional bracket & tube options
Bondable mini 2nd molar tubes

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Bracket Positioning & Case Set-up
Standard edgewise brackets – placed
using millimeter gauge

87
Bracket Positioning –
Avoiding Errors
Avoid viewing teeth from the side, from
above or below

88
Bracket Positioning –
Avoiding Errors
Horizontal accuracy –

89
Bracket Positioning –
Avoiding Errors
Rotated incisors

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Bracket Positioning –
Avoiding Errors
Axial accuracy

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Bracket Positioning –
Avoiding Errors
Thickness errors

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Bracket Positioning –
Avoiding Errors
Vertical accuracy
Most difficult

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Avoiding Errors -
Vertical accuracy
Gingival concerns during vertical bracket
positioning –
Partially erupted teeth

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 Avoiding Errors -
Vertical accuracy
Gingival concerns during vertical bracket
positioning –

 Gingival
inflammation

95
Avoiding Errors -
Vertical accuracy
Gingival concerns during vertical bracket
positioning –
Teeth with palatally or lingually displaced
roots -

96
Avoiding Errors -
Vertical accuracy
Gingival concerns during vertical bracket
positioning –
Teeth with facially displaced roots

97
Avoiding Errors -
Vertical accuracy
Incisal or occlusal concerns –
Incisal crown fractures/ irregularities

98
Avoiding Errors -
Vertical accuracy
Proportionally long or short clinical crowns

99
The Four-part Study to Investigate
the Location of the Center of the
Clinical Crown
Part one – Anatomic crown height
‘that part of dentin covered by enamel’
Woelfel JB. Dental Anatomy: it's relevance to
dentistry, 1990.
Kraus BS, Jordan RE, Abrams L. Dental
anatomy and occlusion, 1969.

100
The Four-part Study
Part two – Clinical crown height
‘that portion of enamel visibly present in the oral
cavity’
120 pre-treatment study models-
Fully erupted clinical crowns throughout the dentition
No apparent evidence of proportionally large or small
teeth
No evidence of significant lingual or palatal displacement
of tooth crowns
No significant gingival inflammation
No evidence of excessive crown wear or fracture

101
 The Four-part Study
Part two – Clinical crown height
‘That portion of enamel visibly present in the
oral cavity’

 Clinical crown heights

1mm shorter than
anatomic crown ht 102
The Four-part Study
Part two – Clinical crown height
Theoretical bracket placement values

103
The Four-part Study
Part three – Evaluation of cases treated to
Andrews’ six keys
Non-extraction American Board & Angle
Society cases

104
The Four-part Study
Part three – Evaluation of cases treated to
Andrews’ six keys

105
The Four-part Study
Part four – Measurement of bracket ht on
clinical cases at the time of debanding
Case settled into a good occlusion-six keys
Bracket position was adequate to allow for
placement of ‘straight’ archwire

106
The Four-part Study
Recommended bracket placement chart -

107
Advantages of using Bracket
Placement Chart
Potential gingival errors are eliminated
Proportionally large or small teeth

108
Accurate bracket positioning
‘In the past the best results were achieved
by orthodontists who were the best wire
benders. In the era of preadjusted
appliances, the best results in the future
will be achieved by those who are best at
accurate bracket positioning.’

109
Technique for Vertical Bracket
Placement
Measuring the clinical crown heights on as
many fully erupted teeth as possible

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Technique for Vertical Bracket
Placement
Recommended bracket positioning chart

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 Technique for Vertical Bracket
Placement
Individualized bracket positioning charts

 Individualized bracket positioning chart – after completion

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Chart individualization
For some canines & premolars

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Chart individualization
In cases with abnormal incisal edges

114
Chart individualization
Deep & open bite cases

Incisor & canine brackets – 0.5mm more

occlusally in deep bite cases
Open bite – 0.5mm more gingival

115
Chart individualization
Premolar extraction cases –
To avoid vertical steps at extn sites

116
Technique for Vertical Bracket
Placement
Clinical use of gauges –

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Technique for Vertical Bracket
Placement
Clinical use of gauges –
o
Incisors – 90 to labial surface

118
Technique for Vertical Bracket
Placement
Clinical use of gauges –
Canines & premolars – ll with occl plane

119
Technique for Vertical Bracket
Placement
Clinical use of gauges –
Molar – ll to occl surface of individual molars

120
Band Placement
Tube should straddle the buccal groove

121
Direct Bonding of Brackets
Bracket positioned at the estimated
midpoint

122
Direct Bonding of Brackets
Checking vertical positioning –

123
 Direct Bonding of Brackets

Re-checking axial &

horizontal positioning

Light - curing

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125