CLASSIFICATION OF

BRACKETS BASED
ON TECHNIQUE
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

1. E Arch Appliance –

E-arch appliance was developed by Angle in early 1900. It is also referred to as Edward

Angle’s E arch. It was the first Angle’s Orthodontic appliance developed to treat

malocclusions.

E arch appliance consists of bands which are placed on molar teeth on either side of the

arch of a heavy labial arch wire extended around the arch. The end of the wire was

threaded, and a small nut placed on the threaded portion of the arch allowed the

archwire to be advanced so that the arch perimeter increased. Individual teeth were

ligated with the heavy labial extended arch wire with ligature wire of 0.010".[2]

To treat Class I cases that were frequently complicated by crowding without ordering

extractions, which, by then, he had decided were inadmissible, the expanded the dental

arches with the “E-Arch.” The goal was to place all the teeth on the ideal curve of the

arch that Angle called “the line of occlusion.” [3]

Fig 5
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Fig 6

Disadvantages: The E-arch was capable only of tipping teeth to a new position. It was

notable to precisely position any individual tooth. It can deliver only heavy interrupted

force.

2. Pin and Tube Appliance –

Angle invented and introduced an appliance, the Pin and Tube appliance in 1912. He

called it a “bone growing appliance” because, he thought, in normal function its action

of transmitting force to the roots would stimulate the growth of bone.[4]

In this pin and tube appliance, all teeth are banded. Vertical tubes were welded to the

bands on the labial surface in the centre of the crown for all teeth in the arch.
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Fig 7

Arch wires were secured with soldered pins that inserted into the vertical tubes. Tooth

movement was achieved by altering the placement of these pins. Pin and tube appliance

are also used for treating malocclusions.

With this appliance, tooth movement was accomplished by repositioning the individual

pins at each appointment.

14

Fig 8
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Disadvantages:

• An incredible degree of craftsmanship was involved in constructing and adjusting

this pin and tube appliance. Soldering and unsoldering the pins at each adjustment

was time consuming and tedious.

• Relatively heavy base arch meant that spring qualities were poor.

• Many small adjustments were needed.

• The appliance design made rotational adjustments most difficult.

• In practice, the device turned out to be extremely difficult to manipulate. It is said

that only Angle himself and one of his students ever mastered the appliance. It was

useful for elite of technically group of especially dexterous practitioners; the others

were unable to adjust it correctly and had many failures with its use.

3. Ribbon Arch Appliance –

Angle attempted to achieve three axis control of tooth movement when he introduced

the Ribbon Arch in 1916.

Ribbon arch was the 1st appliance to use a true bracket. Angle modified the tube on

each tooth to provide a vertically positioned rectangular slot behind the tube. The

bracket has a vertical slot facing occlusally. A ribbon arch of 10 x 20 gold wire was

placed into the slot and held with pins. The ribbon arch was an immediate success,

primarily because the arch wire, unlike any of its predecessors, was small enough to
15

have good spring qualities and was quite efficient in aligning malposed teeth. Although
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the ribbon arch could be twisted as it was inserted into its slot.
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Bracket of Ribbon Arch Appliance

Fig 9

Bracket attached to the band material. The outer edge is rounded, as are its corner and

its two ends, its side being straight and parallel. Inwardly, a deep transverse slot extends

downward in the bracket one-half the length of the bracket, terminating in a concave

floor. The walls of the slot are parallel, one of them being formed by the band material

and other by the inside of the bracket proper. In the centre of the latter wall is a delicate

square perpendicular groove which passes downwards and through the floor of the

bracket. The band is formed at the lingual surface of the tooth and that the brackets are

located at the centre of the labial surfaces of the tooth. The bracket has the vertical slot

facing occlusally.[5]

Ribbon Expansion Arch

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Fig 10
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

It is a very delicate, flat continuous or non-sectional, expansion arch with parallel side

and rounded edges. It has therefore the form of a ribbon. It is 0.022” in thickness and

0.036” in width. Its ends are also flat, but threaded, and are provided with friction lock

nuts, which have been greatly reduced in diameter in order that they may conform to

the delicate proportions of this arch, which is used in connection with the usual anchor

clamp bands, the sheaths of which are also reduced in diameter.

Disadvantages:

• The major weakness of the appliance was that it provided relatively poor control of

root position.

• The resiliency of the ribbon arch wire simply did not allow generation of the

moments necessary to torque roots to a new position.

4. Edgewise Appliance –

In order to overcome the deficiencies encountered with his previous techniques Angle

desired a metal bracket that could give a better control over individual tooth movement.

The edgewise bracket has a rectangular slot facing labially, rather than occlusally or

gingivally, which receives a rectangular arch wire. This unique feature of rectangular

arch wire in a rectangular slot enabled control of tooth movement in all three planes of

space. Furthermore, the bracket has four wings, two occlusal and two gingival, which

increase the surface of arch wire with the bracket slot and thus give accurate control

over tooth movement. The edgewise appliance was developed and introduced to
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orthodontic by Edward H Angle in the year 1925. [6,7,8,9]

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Edgewise brackets and their modifications becomes the mainstay in orthodontic

practice today. They are employed in edgewise technique. Most Edgewise brackets

have rectangular horizontal slot with four wings, two gingival and two occlusal. The

rings help securing arch wire in the slot and brackets may also have hooks for attaching

auxiliaries such as elastics. They are available as a set of different brackets for different

teeth.

The basic mechanical component was a metal bracket with a rectangular slot whose

original size was 0.022” by 0.028”. The edgewise slot received a rectangular wire of

0.022” by 0.028”, which was inserted into the bracket in the narrowest or edgewise

position; hence the name edgewise appliance.

Fig 11

A unique feature of the rectangular wire in the rectangular slot was that twisted or

torqueing forces could be imparted to the arch wire to control the axial inclination of

the teeth. With this appliance it was possible to move the teeth in all three planes of

space with a single arch wire.

For the rectangular arch wires to move the teeth into the “line of occlusion”, it had to
18

be shaped into normal arch form and given proper twist or torque for each individual
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

tooth. If an arch wire is placed in brackets with uniform slot depths, it must take the

form of the outlines of buccal and labial surface of the teeth.

Fig 12

Over the years, changes have been made in the basic appliance itself. The bracket has

been modified many times. Gold alloy arch wires were used exclusively in the

formative years of the appliance. Although Angle intended the edgewise appliance to

be used only for treatment without removal of teeth, the mechanical principles of his

original thinking were so sound that the concepts are still in use today and will probably

have considerable value in orthodontics for years to come.

Fig 13

Single width brackets [10] –

The original edgewise bracket was 0.050-inch-wide and soldered to the gold band
19

material. Unlike the ribbon arch bracket, it was so designed that the arch wire did not
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rest against the surface of the orthodontic band but only to the bottom of the bracket
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

slot. Because of the narrow width involved, the bracket itself was ineffective for tooth

rotation. To overcome this problem, Angle devised soldered gold eyelets to be placed

in appropriate position. Ligature wires tied from the eyelet to the arch wire rotated the

tooth by means of deflection of the arch wire and compression of the periodontal

ligament.

Fig 14

Posterior Bracket –

Another early development was the evolution of a solid bracket that was twice as wide

as the original edgewise bracket. It was called as posterior bracket. It was approximately

0.100-inch-wide and although designed to be used on posterior teeth, it had gained

popularity for use on practically all teeth.

Fig 15

Twin Bracket –

The next development was the joining together of two edgewise brackets on a common
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base. These were named “Siamese Twin brackets” by Swain.[11] The space between the
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

two brackets was approximately 0.050 inch equal to the width of one of the brackets.

The Siamese twin bracket quickly gained popularity for use on upper central incisors

and on molar teeth.

Its main advantage was its ability to affect most of the tooth rotation without the use

of auxiliary eyelet ties. Success with these early Siamese twin bracket prompted the

development of Siamese twin bracket that were not as wide as the original.

Terminology was changed to a shortened name of “twin bracket”.

Eventually these brackets were offered in different widths, and thus they could be used

not only on the wide central incisors but also on any tooth in the mouth. There are four

sizes of twin brackets: extra wide, standard, intermediate and junior. The original

Siamese twin bracket was about the same width as extra wide twin bracket available

today.

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Fig 16
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Curved base twin bracket –

After many years another evolutionary step was the curving of the base of the twin

bracket to conform to the curvatures of the canines and premolars. Until this time, most

of the edgewise brackets had a slight curvature of the base that generally conformed to

the curvature of the anterior teeth. To use the twin bracket successfully on canines and

premolar teeth, however, required bending the base of the bracket with plier so it would

conform to the curvature of the tooth. This resulted in deflection between brackets that

a straight section of arch wire passing through them would not lie flat in the bracket

base.

Fig 17

Advantages of Twin Bracket –

It controls axial inclination of the teeth.

Disadvantages of Twin Bracket –

• Increased width of twin bracket decreases the amount of arch wire

available between the brackets, thus reducing the resiliency of the arch

wire.
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

• The decrease in the interbracket span also is a disadvantage in the

edgewise technique that employ closing loops arch wires and second

order bends. If the arch wire is to slide posteriorly during activation of

closing loops, the decreased interbracket span interferes with the amount

of closing action that can be obtained.

Lewis Bracket –

It developed by Lewis to overcome the problem of efficient tooth rotation. He soldered

auxiliary rotation arms that abutted against the bracket itself and thus offered a lever

arm to deflect the arch wire and rotate the tooth. The present Lewis rotation bracket is

a one-piece bracket with internal rotation wings. It is equivalent to the original edgewise

bracket but with the tooth rotation deficiencies of the latter overcome while the “single

width” feature is maintained.[12]

Fig 18

The Lewis bracket is rigid and utilizes the same principles of tooth rotation as do twin

brackets (i.e., deflection the resilient arch wires). It is highly desirable that all tooth

rotations be accomplished early in treatment. One decided advantage is that 100% of

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the desired tooth rotation is easily obtained. It is also possible to overcorrect rotations.
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

The rotation wings, although rigid, can be bent to effect over-rotation of the tooth. This

is accomplished by bending one wing closer to the tooth and opposite wing further

away. It is also possible to correct slight errors in the placement of the bracket on the

tooth.

Curved Base Lewis Bracket –

The next development of the Lewis bracket was the curving of the base and the wings

of the brackets to conform to the canine and premolar teeth. This is a decided advantage

on the canines and premolars because it allows greater contact with the band or bonding

pad. The wings lie close to the tooth for most of its length, which reduces trapping of

food around the wings.

Fig 19

Vertical slot Lewis Bracket –

A refinement in the Lewis Bracket has been the incorporation of a 0.020” by 0.020”

vertical slot, making possible the use of uprighting springs to correct axial inclinations

if necessary. The use of vertical slot uprighting springs on teeth adjacent to extraction
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spaces, preferred by some orthodontists, necessitates that the bracket slot be enlarged
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

by a separating disk to allow free tipping. Angulation of the bracket, however, will

eliminate the need of uprighting springs.

Fig 20

Steiner Brackets (1967) –

Shortly after the introduction of the Lewis Bracket, another approach to the problem

was a bracket designed by Steiner.[13] The bracket incorporated flexible rotation arms

and therefore did not rely entirely on the resiliency of the arch wire for tooth rotation.

The flexibility of the arms of the bracket also afforded a rotational effect.

Fig 21

The Steiner rotation brackets utilizes a single width edgewise brackets and therefore

has the inherent advantages and disadvantages of this type of appliance. It is easy to tie

and is quite efficient for tooth rotation. It works satisfactorily as long as the flexible

arms do not take on a permanent deformation. Once a permanent deformation of the

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arms has occurred, complete rotation will not be affected unless the arms are readjusted
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to their original position.

 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Broussard Brackets (1964) –

Another modification of the edgewise brackets has been the addition of a 0.0185” by

0.046” vertical slot to accept a doubled 0.018” auxiliary wire. This bracket was

designed by Garford Broussard.[14]

Fig 22

Modifications of Edgewise Brackets –

1. Sved Modification (1937) –

The original alignment bracket used in conjunction with the edgewise arch

is a very rigid attachment. While it is very efficient in producing root

movements, it is extremely violent in its action. It was shown that, if the

edgewise arch is locked into the original type of brackets, the reaction of the

teeth may reach several pounds in magnitude.

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

It was also shown that in free attachments the reactions brought about by the

same wire are very much reduced in intensity. These facts suggested a necessary

change in the alignment brackets, and an attachment has been designed in which

the rigidity has been entirely eliminated.

On account of the difficulty in the manufacture, however, the new design was

altered by Professor R. C. Brunlfield [15] and the bracket in its final form answers

all the requirements of treatment. It differs from the original bracket in the form

of the slot, which instead of being a horizontal channel is formed by two

opposing wedges. This arrangement permits the turning of the arch wire in the

slot, so that the relationship between the axis of the tooth and the arch wire can

be changed; this is not possible with the original bracket.

Fig 23

On account of the rounded edges, the brackets are well tolerated by the lips and

the cheeks, and the grooves behind the upper and lower arms of the brackets

provide a very secure attachment for the ligatures. The improved bracket allows

every possible tooth movement which may be required, and its use will be

described under the discussion of treatment.

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

2. Universal Appliance –
Developed by Dr. Spencer Atkinson in 1929.[16] It was introduced in 1937 as a

combination of the ribbon arch and edgewise appliances and followed

Oppenheim’s theory of using light forces. It was a double action bracket.

Oppenheim wrote that “gentle force continuously applied will not only move

teeth far more rapidly than great force, but that great force causes congestion

and often wholly retards the functional activity of the cells.”

The gingival or horizontal slot, into which an 0.008" up to an 0.014" round wire

may be fitted, opens buccally. This slot controls the mesiodistal inclinations and

serves as a fulcrum for labio-lingual movements. The incisal slot is vertical and

opens incisally, similar to Angle's ribbon arch bracket or Begg's light wire

bracket. This slot controls the tooth bucco-lingually and also controls rotations.

This bracket has a precurved base for better adaptation. Available in two sizes,

a long one with a body height of 0.150" and a short one of 0.125". Both slots

allow the tooth to move bodily during retraction

Fig 24
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Both the gingival and the incisal wires are locked into the bracket by a single

lock pin or by an .008" or .010" soft stainless-steel ligature wire. The turned end

of the lock pin or the pigtail of the ligature wire are tucked alongside the lateral

tabs of the bracket to protect the soft tissues. These tabs are used to control

correction of mesio-distal inclinations.

Fig 25

A variation of this bracket was “root torqueing bracket”. Its tabs are an eyelet

type which extend outward permitting extra ligation. It is used mainly for wide

teeth or severely rotated teeth.

Limitation of The Original Universal Bracket:

• Problems of post treatment stability.

• The lateral extending tabs or wings were too bulky.

• The central vertical shaft was too narrow and shallow to accommodate the

archwires and pins or ligatures comfortably.

The 3-D Universal Bracket:

29

The next step towards evolution was to design a bracket with such specifications
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and to submit it to clinical test to prove its performance. The result was the latest
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Universal bracket called the 3-D Universal Bracket due to its tridimensional

mechanical principle.[17]

This bracket is essentially a vertical hollow shaft with two lateral welding tabs.

The central shaft has two slot openings. The horizontal one opens labially at the

gingival third. The vertical slot opens incisally near its base and extends

gingivally one-third of the bracket height. The two curvatures of the base of the

bracket provide a smooth adaptation to the band and to the surface of the teeth.

Fig 26

It will accommodate a single wire, a double wire, a twisted bundle of round

wires, or a single ribbon or flat wire ranging from 0.008”, 0.020” up to 0.016”

×0.028”. Compared to one of the most frequently used Universal brackets, the

3-D Universal Bracket is wider mesiodistally and slightly deeper

buccolingually. It has no extending or curling lateral tabs.

Advantages of 3-D Universal Bracket:

• Efficiency in leveling and correcting rotations and mesiodistal axial

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inclinations.
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

• Permits bodily movement of teeth in a mesiodistal direction.

• Retracts canines without tipping.

• Torques automatically in most cases. Individual torque is also easily

achieved.

3. Twin Wire Appliance

It was introduced by Joseph Johnson in the 1932.[18] The philosophy behind its

use was that by virtue of two light wires placed in the same bracket, more

physiologic tooth movement could be obtained than with one heavy wire.

Indeed, the twin-wire attachment and bracket permit rapid reduction of rotations

with relatively little discomfort to the patient.

The twin wire alinement arch is composed of two small hard stainless-steel

wires, ranging in size from 0.009 to 0.014 inch in diameter. These wires are

passed through end tubes. The double end of the twin wire is drawn into the end

tube. The opposite end is put through the remaining end tube, and cut off to the

required length. The end is then crimped and the wire then drawn back into the

end tube. Thus, the twin wires are held in the tubes by means of friction. These

end tubes have an outside diameter of 0.040 inch. They are made an inch long

and can be cut into proper lengths to fit each case. The end tube is made of

stainless steel with an outside diameter of 0.036”, inner diameter is 0.02” and is

1 1/8” in length. A hook is soldered to this tubing when intermaxillary elastics

are to be used.[19]
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Fig 27

The twin wire appliance consists of:

• Twin labial arch Cap and

• Channel bracket

Cap and channel bracket:

It consists of a locking device which is attached to the labial surface of the bands

to be cemented to the teeth. This locking device is composed of a male and a

female part.

Fig 28
32

As this type of arch has been found to be worthless if ligated to the teeth by
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means of wire ligatures, a locking device has been designed composed of two
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

parts, male and female. The male part is welded to the band. It has parallel walls

forming a channel in which the twin wires are seated. The outside wall is

dovetailed. The female part, which slips over the male and fits very accurately,

is held in place by friction. The locks are made in two sizes, one to fit a double

0.014-inch wire and the other to fit a double 0.010-inch wire. The locks are one-

eighth inch long, one sixteenth inch wide and one-thirty-second inch thick. They

come brazed to the bands, which are made with a loop similar to my loop molar

band.

Fig 29

The important advantages of two small wires over one heavy wire are these:

• A small wire is more resilient than a large wire. By using an extremely small

wire, we get the resiliency required to cause the arch wire to spring back

into its original shape when forced into the locks. As a single wire with

enough resiliency to spring back to its normal shape would not exert enough

pressure to move the teeth, the required amount of force to move the teeth
33

and sufficient resiliency for the small wire to return to its former shape is
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

obtained by doubling the wire. Thus, when the twin arch wire is bent into

the shape of a normal dental arch, and then sprung into the locks on the teeth,

the teeth automatically move into the position of a normal arch.

• The twin arch wires move the teeth bodily when fastened to them by means

of a locking device, and this cannot be done with the use of a single round

wire.

Limitation of The Twin Wire Appliance:

• Problem of anchorage.

• Lack of control of canine and premolar teeth after correction of rotations.

Today, the twin wire appliance finds less use in orthodontic speciality circles,

largely because of its non-extraction orientation and greater difficulty in

controlling teeth and achieving torque when teeth have been removed.

Tweed - Merrifield Edgewise Appliance

Charles h. Tweed gave the four objectives of orthodontic treatment with emphasis and

concern for facial aesthetics which includes concept of uprighting teeth over basal bone

with emphasis on mandibular incisors, Extraction of teeth for orthodontic reasons

(1936), diagnostic facial triangle (1954) and anchorage preparation (1954). Tweed

along with Merrifield who advocated sequential appliance placement, tooth movement

and sequential mandibular anchorage preparation developed the Tweed Merrifield

appliance system. This appliance system consists of brackets with 0.022” X 0.028” Slot

0.022” buccal tubes. The sequence of wires used were 0.017” x 0.022”, 0.018” x 0.025”,
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0.019”x 0.025”, 0.020” x 0.025”, and0.021” x 0.028” rectangular wires. First, second
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and third order bends were incorporated into the archwire.

 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

5. Begg’s Appliance –

Dr. Percival Raymond Begg was an Australian dentist who worked with Dr. Angle from

1924-25 before returning to practice in Australia. During that time, Angle was still

teaching the ribbon arch appliance.

Dissatisfied with the techniques available to him he began developing his own bracket

design, which was introduced in 1933. He turned the ribbon arch bracket by 900 and

inserted it “edgewise” into “tie brackets” with slots in their faces. It was the first bracket

to use single round wires of .016 inch in diameter or less.[20]

Although the technique is no longer commonly used, elements of Begg’s technique

have been incorporated into a variety of other orthodontic techniques. In 1956 Begg

introduced his multi-loop, light wire, differential force technique, now known as the

Begg technique. It used a modified ribbon arch bracket with a gingival facing vertical

slot.[21]

The Begg technique used differential force and concentrated on tipping the teeth crowns

rather than bodily movement. The roots were torqued at the end of the treatment. This

crown tipping technique allowed the correction of large overbites and rapid closure of

extraction spaces. The technique required great skill on the behalf of practitioners to

keep the movement of the teeth under control, as they could often give the appearance

of being over tipped during treatment. In addition, the design of the bracket allowed

teeth to continue moving and there was no way to hold teeth into their corrected
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positions. The technique also required a lot of complex wire bending and the
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

construction of springs for individual tooth root correction, making it a time-consuming

technique.[22]

Begg was also unhappy with the gold wire commonly in use at the time, finding it too

expensive and with insufficient forces. In the 1940s, in conjunction with the

metallurgist A.J. Willcock, he developed Australian austenitic arch wires. This

Australian wire was inexpensive, biocompatible, flexible and resilient.

BRACKET CONFIGURATION:

• The archwire slot is 0.020 x 0.045 inches to accept both a 0.020-inch arch wire and,

when required, a 0.016-inch torqueing auxiliary.

• Two vertical slots, one on either side of the archwire, accept lock pins and/or

auxiliaries.

• The Begg technique employs modified ribbon arch brackets whose flanges accept

a direct bonding pad or can be spot welded to a band.

Fig 30
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

BRACKET PLACEMENT:

Brackets are centered mesiodistally on the labial or buccal surface of the teeth with the

base of the arch wire slot 4 mm from the incisal edges or cusp tips.

Fig 31

In this technique, advantage is taken of the principle that, for moving anterior teeth with

small root surface area, relatively light archwire and rubber ligature forces produce the

most rapid movement with least disturbance to tooth-investing tissues. Also, at the same

time, these light forces leave the larger rooted, posterior anchor teeth almost stationary.

Conversely, relatively larger forces cause the anterior teeth to resist the pressure, so that

the anterior teeth, paradoxically, can be made to operate as anchor teeth, as they then

move very slowly, while with this large force the posterior teeth, the so-called anchor

teeth, move rapidly.

The main reasons for using ribbon arch brackets, instead of tie brackets, are:

• Rotations of teeth can be carried out without using eyelets;

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

• The narrowness of ribbon arch brackets leaves plenty of space on the labial and

buccal surfaces of the teeth for the vertical spurs on the arch wire to bear against

the teeth;

• The arch is held right against the tooth bands by ribbon arch brackets and allows

the vertical arch spurs to the in contact with the teeth along the full length of the

spurs, as also are the lugs, stoppers, and hooks; and

• With this thin arch wire, the locking of the arch in the brackets is easy to do,

whereas, if tie brackets are used, ligature wires cannot be tied properly when

spurs and stoppers are touching the sides of the brackets. It is largely the use of

ribbon arch brackets that makes universal tooth movement possible with thin

round steel wire.

Begg’s technique is divided into 3 separate and distinct stages that must not be allowed

to overlap. It is chiefly with the objective of preventing anchorage failure that the

technique is divided into 3 distinct stages of tooth movement:

1.Stage I

2.Stage II

3.Stage III

Stage I

Objectives of Stage I –

• Correction of deep anterior over bite

• Correction of antero-posterior occlusal relationship of the buccal segments

• Correction of anterior spacing

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• Correction of crowding
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

• Correction of rotations.

• Correction of posterior cross bite

Archwire used for Stage I - 0.016 special AJW. It has a property of combination of

resiliency and flexibility and adequate stiffness for bite opening. It incorporates

Intermaxillary hooks, Molar anchorage bends, Toe-in or toe-out bends, Vertical loops

and Bayonet bends.

Tip back/ Anchor bends are placed immediately posterior to the 2nd premolar bracket.

They are bent so that when inserted into the buccal tubes the anterior section of the

archwire lies in the buccal sulci.

Fig 32

The purpose of anchor bends in the upper arch is to prevent mesial migration of the

molars while in lower arch is to supply bodily control of the lower molars as these are

moved forwards by action of Class II elastics.

Vertical Loops are used to supply local increased arch flexibility or used for space

opening or closing, stops, rotation. The most vertical loops to align six anterior teeth
39
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are five, one in each interproximal area.

 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Fig 33

Objectives of Stage II –

• Maintain all corrections achieved during first stage.

• Close any remaining posterior space.

Archwire used in Stage II is 0.018” or 0.022” SS to maintain the corrections already

achieved and to stabilize the teeth against any adverse reciprocal forces may occur as a

result of the application of elastics or auxiliaries.

Remaining posterior spaces are closed by using elastics.

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Fig 34
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Objectives of Stage III –

• Maintain all corrections achieved during first and second stages.

• Achieve desired axial inclinations of all teeth.

Archwire used in stage III is 0.020” SS.

Changes in the mesiodistal inclinations of teeth are accomplished by the use of

individual root spring or mesiodistal uprighting spring.

Uprighting Springs are made from 0.014” SS for canine and premolars, 0.012” SS for

incisors. The helix and the active arm face the tooth surface and lie on the gingival

aspect of the arch wire. The base arch wire is ligated and the ligature tie beneath the

archwire.

Fig 35

Advantages of Begg’s Appliance:

• Light optimum force levels are used throughout the treatment, which are

physiologically more acceptable and are comfortable to the patient.

• Relatively continuous force application.

41

• Minimal friction of wires in brackets and tubes.

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

• Rapid alignment, leveling and rotation of anterior teeth.

• Rapid and efficient overbite correction chiefly by means of molar extrusion and

incisor intrusion.

• Simultaneous crown tipping and retraction of all anterior teeth.

• Relatively continuous paralleling of roots at extraction sites by auxiliary

springs.

• Relatively continuous torqueing of upper, or occasionally, lower incisors.

• Extra-oral force not necessary except with extreme anchorage problems.

Disadvantages of Begg’s Appliance:

• Difficulty in coordinating maxillary and mandibular arch form and width.

• Difficulty in obtaining bilateral symmetry.

• Difficulty in obtaining control of premolar and molar torque without the use of

auxiliaries.

• Difficulty in stabilizing teeth during final artistic positioning.

6. Straight wire Appliance –

Lawrence F. Andrews established the need for fully programmed appliances from a series

of 5 studies. In 1960 he examined a number of post treatment dental casts, and naturally

occurring optimal occlusion in 1964 from 120 study models collected over a period of 4
[25, 26]
years. In 1972 he established the six keys to optimal occlusion based on the 6

characters that were consistently present in 120 models and gave the measurements made

in 120 samples that supplied the data for the design of new appliance system. During the
42

period of 1965-1975 he compared the post treatment sample with untreated optimal
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

sample and confirmed the need for a fully adjusted appliance system. He developed the

pre adjusted appliance system that eliminated the need for complex wire bending. [23, 24]

Andrew's system: This was introduced by L.F. Andrews in the year 1970. It was also

sometimes called “sophisticated edgewise appliance”. Although it employs an

edgewise slot, the SWA fits no existing appliance category because of certain

innovation in concept, in implementation and in effects or results. Andrews described

the three systems.

a) Non programmed - A set of brackets designed the same for all tooth types,

relying totally on wire bending (except possibly for angulation if the bracket is

angulated) to achieve the optimal position for each individual tooth.

Fig 36

b) Partly programmed - A set of brackets designed with some built in features, but

that always requires some wire bending (though less than in required by non-

programmed appliance).
43
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

c) Fully programmed - A set of brackets designed to guide teeth directly to their

goal positions with unbent arch wires.

Fig 37

Shortcomings of Standard Edgewise Appliance (as listed by Andrews) –

• Bracket bases are perpendicular to the bracket stem

• Bracket bases are not contoured occlusogingivally

• Slots are not angulated

• Bracket stems are of equal faciolingual thickness

• Maxillary molar offset is not built in

• Bracket sitting techniques are not satisfactory

• Considerable wire bending is needed throughout the treatment

The SWA, if used as designed, utilizes a “straight” wire throughout treatment. Worth

noting is a fact that is significant to the entire SWA concept: at the beginning of

treatment when SWA bracket slots are as “maloccluded” as are the teeth, the slots
44
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

actually are nearly enough aligned so they will accept the archwire that is merely

deflected, not kinked.[29]

Straight-Wire technology is dependent, first, on the use of a specific, reliably locatable

bracket-siting point. It is also dependent on certain appliance design features. The SWA

contains some proprietary features not found collectively in conventional edgewise or

pretorqued appliances. Among SWA innovations are torque built into the base of all

brackets, a base contoured vertically as well as horizontally, tip built into the bracket,

and in/out and molar offset built into the appliance.

• Torque in Bracket Base – The bracket base is inclined in relation to the stem,

allowing the stem to be parallel to the Andrews plane, and the LA-point, base

point and slot point to be included in the Andrews plane. A separate bracket for

each tooth type is necessary, with torque built into the bracket base. Nothing in

SWA design, except compound base curvature, is so vital to effectiveness of

the appliance.

Fig 38
45
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

• Compound Contoured Bases – This is the second of "the crucial elements in

SWA design." Most conventional appliances have simple horizontal

curvature in the bracket base. The Straight-Wire Appliance added vertical

curvature. It is the combination of the two that we refer to as “compound

contour” or “compound curvature”.

Fig 39

• Angulated Slots – Correct mesiodistal angulation is delivered by a process

that is direct and cleanly efficient. A gently flexed archwire is inserted into

slots that are exactly as maloccluded as are the untreated teeth. The slots are

angulated for tip, but each bracket is squarely aligned with the LACC. As

the archwire straightens itself, it carries along the teeth to their desired

positions. Most or all, manual wire-bending is eliminated.

46

Fig 40
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

To obtain the full effects of the Straight-Wire approach, tip must be built into

the slot of the bracket, torque must be in the base, and the base of each

bracket must be contoured to fit firmly and unchangingly when the bracket

is installed "squarely" (not angulated) at the chosen site.

• In/Out and Molar Offset – Elimination of first order archwire bends has several

advantages, including time-saving and the enabling of en masse space

closures without interference from wirebends. A 10-degree offset for the

distal cusps of the upper molars is incorporated in the SWA brackets

for those teeth.

Fig 41

• Other Aspects – Designing an individual bracket for each tooth type also

permits innovations not involving the slot or the base. SWA tie-wings,

instead of being bilaterally symmetrical, step-out farther on the gingival

47
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

sides of posterior brackets, resulting in easier ligation and less frequent

gingival impingement.

Fig 42

Fig 43

Fig 44
48
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Fig 45

Fig 46

7. Roth Prescription –

In 1979, Ronald H. Roth introduced a bracket setup containing modifications of the tip,

torque, rotations and in out movement of the Andrews Standard setup bracket. The

major difference between Andrews philosophy and the Roth approach to the use of the

straight wire appliance has to do with the manner in which the teeth are moved and not

necessarily the desired end result or the result attained.

Andrews attempted to translate teeth throughout the treatment without ever tipping

teeth. This leads to the necessity of utilizing sliding mechanics and number of different

series of brackets to solve the problem of translating teeth depending on how far the

teeth must be moved. Andrew’s occlusion study was based purely upon anatomical

measurements of tooth positions on untreated normal. According to him, the teeth

49

should be positioned from an “Anatomical Standpoint”.[30]

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

In the Roth approach, tipping of teeth is allowed, by using round wires in the initial

phase of treatment, but the attempt is to keep the tipping to a minimum wherein it is not

necessary to resort to complex mechanics to do the uprighting. Roth’s occlusion study

was based purely upon pantographically recorded and mounted a large number of post

treatment orthodontic cases on the Stuart Articulator. According to him, the natural

teeth should be positioned from a “Gnathological Standpoint”.[31]

What made Roth to modify Andrew’s SWA?

• Inventory Problem – to teat different cases clinicians were to buy band kits for all

Andrews sets and series. They are very extensive inventory on the shelf. Also.

Changing anything about the appliances would be prohibitively expensive.

• Anchorage loss – when mesially angulated brackets are placed on the posterior

teeth, the teeth tend to tip mesially and migrate forward that resulted in anchorage

loss.

• Problems in finishing – to achieve desired tooth positions with the standard SWA,

it was necessary to finish the mechanotherapy phase of treatment by placing

compensating and reverse curve in the upper and lower archwire.

Roth’s Rationale for his bracket set up –

The purpose of Roth setup was to provide over corrected tooth positions prior to

appliance removal that would allow the teeth in most instances to settle to what was
50

found is non orthodontic normal studied by Andrews.

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

• With the appliance in place, it is virtually impossible, because of bracket

interference, to position the teeth precisely into the occlusion shown by the non-

orthodontic normal sample.

• After appliance removal no matter how well treated the patient may be, the teeth

will shift slightly from the positions they occupied at the time the appliance

were removed.

• Play or tipping freedom – due to play between the archwire and bracket, the

delivered tip, torque and rotation forces are less than the designated amount

“built in” the slot which need over correction to compensate for play.

• The Curve of Spee will return or deepen after appliance removal.

• Teeth adjacent to an extraction site will tend to rotate and tip towards the

extraction site.

• As the teeth in the buccal segments settle, they will rotate and tip mesially, so if

they are overcorrected and slightly tipped distally, they will tend to settle better

than teeth that are already mesially inclined.

• As the band spaces closes, there is a corresponding loss of torque of the anterior

teeth.

Fig 47
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Roth Set-Up

It is available in both 0.018 and 0.022 slot. Roth preferred 0.022 slot brackets

because it offered more advantages in term of wire size selection, in terms of

stabilizing arches as anchor units and for orthognathic surgery, and for control

of torque in buccal segments, which is very important from the standpoint of

functional occlusion.

The Roth setup incorporated into it a member of hooks for various types of

elastic configuration and also double/triple and lip bumper tube for the use of

auxiliary wires and attachments.

Fig 48

Roth Tru-Arch Form –

It was derived from his extensive clinical testing and recording of jaw

movements patterns in treated patients who were out of retention and had

remained stable. The Roth Tru-Arch Form actually overcorrects the arch width
52

slightly. In the front part of the arch, the widest pat is at the bicuspids, not at the
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cuspids. The widest point of the entire arch is at the fist molar region.
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

There are actually five arcs in the arch –

• A curve across the front

• A curve in the cuspid-bicuspid area

• A uniform curve in the buccal segment to allow for proper rotational

position of the buccal segment teeth.

Fig 49

8. Tip Edge Brackets –

The Tip Edge Concept was first introduced in Kesling – Rocke Orthodontic Centre,

Westville, Indiana, USA, in 1986 by Dr. P. C. Kesling.[32] He concluded that differential

tooth movement (crown tipping followed by controlled root uprighting) requires that

each tooth tip freely either mesially or distally-not in both directions. Of course, the use

of round arch wires permits labial or lingual tipping of all teeth. During the early stages

of treatment, the crowns of all teeth tip distally with the exception of those distal to

extraction sites (and mesial to the anchor molars), which tip mesially. When teeth are

free to move in this manner, it is possible to correct deep anterior overbites and retract

dental arches with light (2 oz), intraoral elastic and arch wire forces that leave the

anchor molars upright and relatively undisturbed. Initial crown tipping is followed by

controlled root up righting with straight archwire (differential tooth movements with
53
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

straight archwires). Therefore, it is also known as the “Differential straight arch

technique”.

By chamfering diagonally opposed corners of the conventional edgewise arch wire slot,

it is possible to create an edgewise-type bracket that is programmed to permit either

mesial or distal crown tipping and yet still control final crown inclination. Central

ridges and uprighting surfaces of the arch wire slot are also pre-angulated to provide

final labial or lingual crown torque with a straight, rectangular arch wire. However, as

is true with any “straight wire appliance,” it is necessary to consider also the individual

crown inclinations required for each patient.

Fig 50

The central ridges of the arch wire slot provide pivot points for the arch wire that

enhance free crown tipping and diminish lateral root apex displacement. Therefore, Tip-

edge brackets permit anterior teeth to depress under light arch wire forces, which results

in relatively rapid bite opening and subsequent correction of anteroposterior

discrepancies through predetermined crown tipping.

The Tip-edge bracket is the first edgewise-type bracket to provide automatic

54

mesiodistal tip control and 100% interbracket distance. The importance of maximum
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

horizontal distance between brackets to enhance flexing of the arch wire and reduce

initial force values to the teeth has long been appreciated. If malposed teeth are tipped

mesiodistally, at different levels or rotated, interbracket distances become extremely

important. Even if a small round arch wire is used, the force couples and associated

torque influences created often are detrimental to attaining treatment objectives.

The diagonally opposed crown tipping and root uprighting control surfaces of the arch

wire slot determine whether a tooth tips toward its ultimate position or remains upright

to serve as an anchorage unit according to the needs of the case and the direction of the

applied force.

Another unique feature of the slot design is that the same set of brackets functions

properly to correct Class I, II, or III malocclusions. Tip-edge arch wire slots also permit

the retraction of both dental arches as would be required in a Class I bimaxillary

malocclusion with generalized spacing.

Lateral extensions of the bracket behind the arch wire provide maximum rotational

control even when the tooth is tipped. Therefore, the bracket body can be narrow for

maximum aesthetics. The wings are lingual to the arch wire and therefore not visible.

Each bracket has a vertical slot to accept rotating or uprighting springs, power pins and

jigs for accurate direct bonding. The slot is rectangular (0.020" x 0.020) with both the

gingival and incisal ends chamfered to facilitate the insertion of auxiliaries from either

direction. It also can be used to accept a ligature on a lingually displaced tooth.

55
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Side Winder Spring –

This used to be the everyday ‘workhorse’ among Tip-Edge auxiliaries. Primarily, it

generates mesio-distal root movement. The Side-Winder is well proven to produce

torque correction as well, when used in conjunction with rectangular archwires. It is

made in .014-inch high tensile stainless-steel wire.

Fig 51

Bracket placement –

Usually the distance from the arch wire slots to the incisal edges or cusp tips is 4 mm.

If this distance is less, the chances for occlusal interferences and / or bracket

displacement increase. If this distance increases and the brackets are placed further

gingivally, there will be less room for torque spurs and other auxiliaries.

Features of tip – edge technique –

1. Variable anchorage

2. Light forces
56

3. Anterior vertical control

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

4. Elimination of interbracket torque effect

5. Effective slot size variability

6. Bracket escape

7. No need for over tip or torque angulations

8. Bracket permits the programming of tooth movements

9. Early bite opening

Advantages of Tip Edge over Edgewise Technique –

1. Archwire slots open and close

2. Ease of archwire change

3. Prevents undesirable couples on anterior teeth

4. Diminished anchorage bends

5. Light forces are used – anterior teeth retracted by crown tipping

6. Facilitates space opening and closing

7. Enables correction of interarch malrelationships by making use of

intermaxillary anchorage

8. Increased vertical control

9. Permits distal tipping of 6-8 teeth with no flexing of the wire, preventing

elongation of incisors.

10. Easy bite opening as 0.016 wires with anchor bends are used

11. Decreased gingival and root morbidity

Advantages of Tip Edge over Begg’s Technique –

1. Horizontally facing slots facilitate archwire engagement especially on rotated

57

teeth
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

2. Elastomeric ties act as a cushion, increased patient comfort and decreased bond

failure

3. In out compensations eliminate need for molar offsets

4. Limited crown tipping and root uprighting

5. Programmed differential mechanics at work

6. Better finishing due to greater dimensional control

9. Vari Simplex Discipline –

This system which is based on edgewise philosophy was developed by Dr. R.G. Wick

Alexander in 1983 with basic goals of high-quality results, patient comfort, and reduced

chair time. With these goals in mind, he developed an appliance called the Vari-Simplex

Discipline. “Vari” refers to the variety of bracket types used. “Simplex” relates to the KISS

Principle (Keep It Simple, Sir). [33, 38] “Discipline” was chosen, rather than “Appliance”, to

reflect the idea that the orthodontist must be knowledgeable in edgewise mechanics and

must play an active role in the application of the appliance to the individual patient. [36, 37]

The most important factors in determining the design of the Vari-Simplex Discipline are

the size and shape of the teeth, especially the mesiodistal width and curvature. These affect

interbracket width, which, in turn, affects the ability to rotate the teeth and level the arch

without using time-consuming vertical springs, multiloops, or extra archwires. [34, 35]

The system evolved around five factors related to brackets: bracket selection, bracket

height, bracket angulation, bracket torque, and bracket in-out.

58
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Bracket Selection –

Each tooth has a particular bracket that is most effective.

• Twin Brackets – Twin brackets (Diamond brackets) are used on large, flat- surfaced

teeth— maxillary central and lateral incisors. The Diamond bracket is designed so

that all the horizontal lines are placed parallel to the incisal edge of the tooth, and

the rhomboid design makes it possible to align the vertical lines parallel to the long

axis of the tooth. The flat surfaces of maxillary centrals and laterals permit full

archwire engagement in the twin brackets. The accessibility of these teeth negates

the usual difficulty in tying twin brackets. Also, twin brackets on the incisors allow

5-6mm of inter-bracket width, which is sufficient for flexibility, rotational control,

and torqueing ability.

Fig 52

• Lang Bracket – Lang brackets were invented by Dr. Howard Lang. We use these
brackets with the Diamond design on large, round-surfaced teeth at the corners of

the arch— maxillary and mandibular cuspids. The pad is contoured so that this

bracket fits beautifully on most cuspids. The straight wing of the Lang bracket

eliminates interference with complete archwire engagement at this most curved

59

position in the arch. The single bracket allows for easy ligation and increased inter-
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

bracket width. The wing can easily be activated for rotational control. In extraction

cases, the cuspids can be retracted on round wire with very little tipping or rotation.

Fig 53

• Lewis Bracket – They are used on large round surfaced teeth that the not at the
curve of the arch, the maxillary and mandibular bicuspids. They are also used on

small flat surfaced teeth, the mandibular incisor. The bracket is designed with a

wedge shape, which places the tie wing close to the tooth occlusally and further

away gingivally. This makes the bracket easy to ligate and to keep clean. The

gingival wing can be used as a hook for elastics.

Fig 54

Bracket height

Bracket height is extremely important in the design of a fully activated appliance. Each

bracket is placed at a predetermined position on each tooth relative to the other teeth.

Placing a bracket higher or lower affects the amount of torque and angulation, and the

incisogingival position of the tooth. Bicuspid bracket height is the key (X on the chart
60
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

below) because its clinical crown height is so variable. Its normal height is 4.5mm. The

other bracket heights are calculated in relation to X, as shown on the chart.

Maxillary Mandibular

Central X Central X – 0.5 mm

Lateral X – 0.5mm Lateral X – 0.5 mm

Cuspid X + 0.5 mm Cuspid X + 0.5 mm

Bicuspid X Bicuspid X

1st Molar X – 0.5 mm 1st Molar X – 0.5 mm

2nd Molar X – 1mm

Table 3

Bracket Angulation

The objective is to position the teeth in the most ideal axial inclinations. This allows

the roots to be parallel to each other and the crowns to be placed in their most esthetic

and functional positions.

Maxillary Banding Bonding Mandibular Banding Bonding

(Incisal (Long axis (Incisal (Long axis

Edge Reference) Edge Reference)

Reference) Reference)

Central 3º 5º Central 2º 2º

Lateral 6º 8º Lateral 2º 2º
61

Cuspid 6º 10º Cuspid 6º 6º

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

1Bicuspid 0º 0º Bicuspid 0º 0º

1st Molar 0º 0º 1st Molar -6º -6º

2nd Molar 0º 0º 2nd Molar 0º 0º

Table 4

Bracket Torque

My system is designed so that the best results are achieved when an .017" .025"

archwire is used to fill the .018" bracket slots. This leaves enough play to permit easy

archwire engagement to the base of the bracket slot, which increases patient comfort.

The rule of thumb is that .001" of play equals about 4º of torque, so each of the torques

listed below should be considered to be plus or minus 4º due to play.

Maxillary Mandibular

Central 14º Central -5º

Lateral 7º Lateral -7º

Cuspid 3º Cuspid -11º

Bicuspid -7º Bicuspid -17º

1st Molar -10º 1st Molar -22º

2nd Molar -10º 2nd Molar 0º or -27º

62

Table 5
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Bracket In-Out

The fifth component of the Vari-Simplex Discipline is bracket in-out. The appliance

incorporates a system of interrelated, compensating bracket base thicknesses to replace

the usual first-order bends or offsets.

Maxillary Mandibular

Centrals Standard Anteriors Thick

Laterals Thick Cuspids & Thin

Bicuspids

Cuspids & Thin Molars Thinnest

Bicuspids

Molars thinnest

Table 6

10. Combination Anchorage Technique (CAT) –

The system was designed by William. J. Thompson in the year 1981.[39] The original

concept of the CAT was to use a light wire appliance system to establish the early

organization of the malocclusion and then to finish the treatment with a more rigid and

precise straight wire appliance.

With combination treatment, it is possible to use light wire mechanics at their optimum for

rapid anterior alignment, maximum retraction of incisors and superb bite opening. At the
63
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desired point in treatment, the anchorage resistance can be altered by changing slots, wire
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

size and friction to produce maximum edge wise control and resistance in a specific area

of the appliance.

To optimize the capability of the combination treatment it is essential that the combination

anchorage brackets be designed to produce optimum light wire and/or optimum straight

wire tooth movements. The gingival slot provides the most effective light force tipping

movement because it closely resembles a true Begg ribbon arch bracket. It produces

maximum, speed, max tipping, and minimum pain, the least amount of friction and

maximum effectiveness for auxiliary up righting and torqueing springs. In contrast, the

design of the edgewise part of the bracket must facilitate optimum 3 dimensional edgewise

treatment.

The CAT bracket is comfortable and aesthetically pleasing to the patient. It has a 0.022" X

0.035" gingival or ribbon arch slot and either 0.018" x 0.025" or 0.022" x 0.028" straight

wire edgewise slot. An enclosed vertical slot also is incorporated into the bracket for use

with uprighting or rotating springs elastics, hooks, etc., all brackets are identified by colour

coding dots at the disto-gingival aspect. Maxillary are red and mandibular are blue.

64

Fig 55
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Bracket size and contour have been reduced, gingival extension of all pads and bracket has

been reduced to make placement more accurate and occlusal interference less likely. Molar

attachments now available have convertible double tubes to facilitate extending the straight

wire into 2nd molar tubes.

11. MBT (Mclaughlin Bennet Trevisi) [40] –

Fig 56

In the period 1975 to 1993 McLaughlin and Bennett preferred to work mainly with the

standard SWA bracket system. Instead of initially modifying the basic bracket design,

for more than 15 years they developed and refined treatment mechanics based on sliding

mechanics and continuous light forces, mainly using standard SWA brackets.
65

Fig 57
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Having established an overall approach and a successful system of treatment mechanics

using the preadjusted bracket system in its standard form, McLaughlin and Bennett then

worked with Trevisi (from 1993 to 1997) to re-design the entire bracket system to

complement their proven treatment philosophy and to overcome the perceived

inadequacies of the original SWA. They re-examined Andrews' original findings, and

took into account additional research input from Japanese sources when designing the

MBT™ bracket system. This third-generation bracket system retained all that was best

in the original design, but at the same time introduced a range of improvements and

specification changes to overcome the clinical shortcomings. Its design was based on a

balance of basic science and many years of clinical experience. MBTTM is a version of

the preadjusted bracket system specifically for use with light, continuous forces,

lacebacks and bendbacks, and it was designed to work ideally with sliding mechanics.

Fig 58

In order to complete a modern systemized method of treatment mechanics, it became

necessary to address the subjects of archwire selection and force levels. Although an

ovoid arch form had proved useful in the early years, because of previous and current

arch form research, it was recommended in 2001 that three basic shapes of arch form -
66

tapered, square, and ovoid - would be required. When superimposed, they vary mainly
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

in inter-canine and inter-premolar width, giving a range of approximately 6 mm. Inter-

molar widths of the three shapes are quite similar, but the molar areas of wires can be

widened or narrowed as needed, by easy wire bending.

Fig 59

Design of a modern bracket system –

• Range of bracket – The modern orthodontist expects to have three main bracket

systems available to meet the needs of a typical caseload –

▪ Standard size metal brackets - where control is the main requirement.

▪ Mid-size metal brackets - these give less control, but are useful for cases

with average to small teeth, where there is poor oral hygiene, or where

control needs are modest

▪ Esthetic brackets - these will be needed for older patients, where a metal

appearance is not acceptable.

• Improved identification system – Laser numbering of standard size metal

brackets.

• Rhomboidal shape – reduces bulk and assists accuracy of bracket placement.

67
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Fig 60

• Tip specification – The tip feature of preadjusted brackets is almost fully

expressed. With light continuous force mechanics, tip can be well controlled,

and tip specifications are fully and rapidly expressed in clinical use. The

research figures for tip were closely adhered to when the MBT™ bracket system

was designed, although small changes were made to the tip specification for

molar and upper premolar attachments.

Fig 61

• Torque specification – As a result of the relative inefficiency of preadjusted

brackets in delivering torque, it was necessary to build extra torque into the
68
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

incisor, molar, and lower premolar brackets, in order to meet clinical goals with

a minimum of wire bending.

Fig 62

Versatility of the Bracket System –

1. Options for palatally displaced upper lateral incisors (-10°).

2. Three torque options for the upper canines (-7°, 0°, and +7°).

3. Three torque options for lower canines (-6°, 0", and +6").

4. Interchangeable lower incisor brackets - the same tip and torque.

5. Interchangeable upper premolar brackets - the same tip and torque.

6. Use of upper second molar tubes on first molars in non-Head Gear cases.

7. Use of lower second molar tubes for the upper first and second molars of the opposite

side, when finishing cases to a Class II molar relationship.

Arch Forms

The three shapes - tapered, square, and ovoid - used by the authors early in treatment

are shown below. Later in treatment an individual arch form (IAF) is used for each

patient.
69
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Fig 63

12. Lingual Orthodontics [41] –

The 1970s was an interesting decade for orthodontists. The straight wire appliance was

developed, treatment demands had increased and the adults were seeking treatment in

greater numbers. This increasing demands for adult treatment brought unique concerns

to the profession. Aesthetics was then and continues to be a primary concern of the

patients. During the early 1970s, Dr. Craven Kurz, an orthodontist, then assistant

professor of occlusion and gnathology at the UCLA School of Dentistry, found his

private orthodontic practice to be increasingly dominated by adult patients. As many of

his patients were public figures, aesthetics became a major concern. From the demands

of an appliance that did not show, the concept of lingually bonded appliance was born.

After much advice and consultation from orthodontic colleagues, particularly Dr. Jim

Mulick, also at the UCLA School of Dentistry, Dr. Kurz developed the first true lingual

appliance. The appliance consisted of plastic Lee Fisher brackets bonded to the lingual

aspect of the anterior dentition and metal brackets bonded to the lingual aspect of the
70

posterior dentition.
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Fig 64

The turning point in the development of the appliance was the addition of an anterior

inclined plane as an integral part of the maxillary anterior brackets. This inclined plane

converted the shearing forces produced by the mandibular incisors to compressive

forces applied in an intrusive and labial direction. These forces also produced a natural

physiological bone resorption in the maxillary and mandibular incisor area, allowing

the teeth to intrude at generally less than 100 milligrams in force each time the patient

swallowed (approximately 2000 times per day).

Fig 65

Bond failures decreased dramatically. Redirecting the forces by the use of an anterior

inclined plane appeared to be the missing link in the development of a viable lingual

appliance. It was with this design that Dr. Kurz applied for a patent for the Kurz Lingual

Appliance on November 15, 1976. Product development began in earnest in 1978, and
71

Ormco manufactured a usable metal bracket by 1979.

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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

From Generation #1 to Generation #7—A Summary of Progress

GENERATION #1—1976

The first Kurz Lingual Appliance was manufactured by Ormco. This appliance had a

flat maxillary occlusal bite plane from canine to canine. The lower incisor and premolar

brackets were low profile and half-round, and there were no hooks on any brackets.

Fig 66

GENERATION #2—1980

Hooks were added to all canine brackets.

72

Fig 67
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

GENERATION #3—1981

Hooks were added to all anterior and premolar brackets. The first molar had a bracket

with an internal hook. The second molar had a terminal sheath without a hook but had

a terminal recess for elastic traction.

Fig 68

GENERATION #4—1982–84

This generation saw the addition of a low profile anterior inclined plane on the central

and lateral incisor brackets. Hooks were optional, based upon individual treatment

needs and hygiene concerns.

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Fig 69
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

GENERATION #5—1985–86

The anterior inclined plane became more pronounced, with an increase in labial torque

in the maxillary anterior region. The canine also had an inclined plane; however, it was

bi-6beveled to allow intercuspation of the maxillary cusp with the embrasure between

the mandibular canine and the first premolar. Hooks were optional. A transpalatal bar

attachment was now available for the first molar bracket

Fig 70

Fig 71

GENERATION #6—1987–90

The inclined plane on the maxillary anteriors become more square in shape. Hooks on
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the anteriors and premolars were elongated. Hooks were now available for all the
 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

brackets. The transpalatal bar attachment for the first molar band was optional. A hinge

cap, allowing ease of archwire manipulation, was now available for molar brackets.

Fig 72

GENERATION #7—1990 TO PRESENT

The maxillary anterior inclined plane is now heart-shaped with short hooks. The

lower anterior brackets have a larger inclined plane with short hooks. All hooks have

a greater recess/access for ligation. The premolar brackets were widened

mesiodistally and the hooks were shortened. The increased width of the premolar

bracket allows better angulation and rotation control. The molar brackets now come

with either a hinge cap or a terminal sheath.

Fig 73
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 CLASSIFICATION OF BRACKETS BASED ON TECHNIQUE

Advantages of Lingual brackets

• The labial surface of anterior teeth plays an important esthetic role.

• In labially placed brackets, the susceptibility of enamel surface to chemical results

and plaque accumulation with poor oral hygiene is increased.

• Permanent and unsightly decalcification marks can result in labial.

• Easy access for routine oral hygiene procedures on the labial surfaces.

• Clinical judgement of treatment progress can be enhanced.

• Evaluation of individual tooth position can be easily accomplished by having labial

surface free of distracting metal or plastic brackets.

• Soft tissue responses of the lips and cheeks to treatment can be judged accurately

because there is no distortion of shape or irritation caused by labial appliance.

Disadvantages of Lingual brackets

• Discomfort to the tongue, tissue irritation and gingival impingement.

• Occlusal interferences

• Difficulty in speech, which usually improves after 2-3 weeks of appliance

placement.

• Extended chair side time needed for appliance placement, wire placement and

ligation.

• Expensive
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