bracket positioning in orthodontics.pptx

bracket positioning charts and methods

1. VERTICAL BRACKET AND TUBE POSITIONING

2. Bracket placement charts and gauges are used for vertical accuracy because they deal with difficulties such as partly erupted tooth Tooth length discrepancis Labially and lingually displaced roots Gingival hyperplacia

3. The method is given as follows; Several fully erupted teeth in the arch are measured either in the mouth or in the models The chart is then used to deside upper and lower row based on the size of the patients teeth There may be size difference between upper and lower arches With experience ,tooth size can be estimated visually or using gauges

4. After selecting a row of values ,gauges are used for accurate vertical positioning Gauges are used differently in various areas of mouth

5. For incisors the gauge is placed at 90* to the tooth surface

6. Canine and premolar- parallel with the occlusal plane Molar region-the gauge is parallel with the occlusal surface of each tooth When direct bonding ,gauges can be pressed on to the bracket to remove excess bonding material from beneath the bracket base

7. For indirect bonding , Zand or MJ Measurement marker gauges are used to make pencil marks on the the models MJ Measurement marker gauge is preffered because it allows easy measuring of tooth height and width and very accurate bracket placement pencil marks

8. Clinical guidelines for vertical placement of anterior brackets Incisors may have irregular incisal edges ,due to ename fractures,attritional wear,prounced mamelons or other reasons. These should be discussed at the time of consultation appointment,so that the patient can agree the planned management. If there is a major enamel damage good orthodontics will normally be easier if a temperory or semipermanent restoration is placed before treatment. No adjustment to vertical bracket positioning is requires for a correctly restored tooth

9. In many cases anterior teeth have minor enamel damage or unaesthetic mamelons.these will require enamel reshaping ,which will slightly reduce the length of the clinical crown When setting up a case with deep bite ,some orthodontist find it helpful to bond the incisor brackets 0.5mm more incisally,and for a case with open bite 0.5mm more gingivally.

10. If the case have pointed canines it is helpful to reshape them before bracket placement ,if the patient is ageeable . Otherwise the canine bracket should be bonded a little more gingivally,in anticipation of later reshaping after levelling and aligning .

11. Marginal ridge accuracy with upper premolar Marginal ridges can be defined as elevated convex crests that form the mesial and distal occlusal margins of posterior teeth At the end of treatment the marginal ridges in the molar and premolar region should be at the same level. this inturn will ensure proper occlusal contacts and flat bone levels in a healthy individual

12. ABO uses marginal ridges to grade the proper vertical positioning of molars and premolars,and requires the marginal ridge of adjacent posterior teeth to be at the same level or within 0.5mm of the same level in an ideal result

13. KALANGE METHOD Kalange derived a practical method to level the marginal ridges by bracket placement kalange though favors indirect bonding but hid technique of bracket positioning can be used in direct bonding too by making measurements on a study model and applying them in the mouth. It is mainly applicable in the upper arch,but can be used for lower molars when appropriate

14. MOLAR TUBES Low profile non-convertible molar tubes are preffered Strong , comfortable,cause fewer interferences than convertible tubes They are normally bonded,but for cases with deep molar overbite or where lingual or palatal arches are needed ,molar bands are used. If using bands,good separation is needed and is helpful if molar tubes are welded more to the occlusal to the bands rather than to the gingival

15. The lower first molar tube should be welded at 2.0mm or 2.5mm . If bonding the second molar tubes are bonded well to the occlusal in both arches ,and the first molar tubes ,particularly in the lower teeth should not be too gingival