Aesthetic orthodontic brackets Clinical
Are they all the same?
Preet Bhogal compares and contrasts the advantages and disadvantages of various aesthetic labial brackets on the market
History of aesthetic brackets The last 30 years in particular have seen an increasing need to produce an aesthetic, well-hidden camouflaged labial bracket that is acceptable to the discerning patient. With the recent increase in demand for orthodontic treatment, this essential requirement has been stressed further by dentists and patients alike. It is important to learn from the abun-
dant research that has already been carried out in order to avoid using poor materials and provide evidence-based treatments for our patients. Orthodontic brackets can be clas-
sified by material type (metal, plastic, composite and ceramic), shape (siamese, self-ligating) and slot size (0.022” x 0.028” or 0.0ı8” x 0.028” most commonly). We will not be considering metal
brackets here, which are made of stain- less steel alloy. Modern ceramic bracket technology has developed significantly since the mid-ı980s. The aim of this article is to compare the
properties of various types of aesthetic labial brackets available and highlight their relative advantages and disadvantages. It is important that the clinician chooses the best available materials for clinical use and is able to distinguish between high and low-quality materials. All the various types of brackets have been previously tried and tested by numerous researchers. You should ask yourself the following questions about the brackets you use: • What is the prescription? • What material are they made of? • What is the design of the base?
• What is the bond strength? • Have they been tested for quality? • How rigorous is this quality control? • Would you be comfortable using your current materials after reading this review?
• Are they actually value for money? • Which ones would you use on yourself or a family member?
Bracket prescriptions It is the interaction of the orthodontic bracket and the archwire that controls tooth movement. The relation of one to another can be manipulated to produce desired movements in all planes of space. The size and properties of each can also be altered to change how forces between the two are transmitted. The bracket slot size in straightwire
fixed appliances is most commonly 0.022” x 0.028” as this allows for lighter forces in the early stages of treatment and is good for archform co-ordination and sliding mechanics. The first straightwire brackets were
essentially composed of a horizontal slot (in which the archwire sits) passing through a twin (or Siamese) bracket. All tooth movements were effected via the orthodontist skill and required great tech- nical ability in wire bending. Pre-adjusted brackets have in-built
values that predetermine tooth move- ments and are specific for each tooth or tooth group. Essentially, they have a “prescription” for ıst, 2nd and 3rd order bends, or putting it another way values for in-out, tip and torque (Fig ı).
The most common pre-adjusted bracket
prescriptions used by orthodontists worldwide are: • Andrews • Roth • MBT • Damon. Each of these have their own justifications based on the approach and research of their developers, all of whom are/were esteemed orthodontists and based on observations of large numbers of treated cases. The benefit of a well-known and tested
prescription (such as those listed) that has been rigorously tested and proven is obvious. As a prescribing dentist, you would be expected to have knowledge of (and therefore use) a tested and widely accepted appliance prescription. For those
Continued » Ireland’s Dental magazine 23
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