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Bracket Placement
for Indirect Bonding
Customized Bracket Placement
In recent years we have seen many improvements
in bracket systems, wires, and adhesives; but bracket placement
via direct bonding still remains a challenge. Indirect Bonding,
when properly used, gives the orthodontist a tool for controlling
bracket placement and achieving clinical efficiency. At Specialty,
we have a prescription form that facilitates communication with
our Indirect Bonding customers. Detailed bracket placement instructions
can be specified on a per-case basis, ensuring accurate positioning.
Bracket Height:
We place all brackets at a "standard"
height using the incisal or occlusal edges as a references,
unless otherwise requested. On "normal" sized teeth
we place the archwire slot on the upper centrals for example,
between 4.5 and 5.0mm from the incisal edge. The rest of the
brackets are then placed at corresponding heights. We vary these
standard heights based on the overall size of the teeth. On
the Rx form, there is a chart available to indicate changes
in heights (in mm) from our standard values listed. This can
be done on a "per case" basis, or set as a standard
"special instruction" in your computerized file at
Specialty Appliances. For example, the case illustrated to the
right requests the bracket placement on the upper teeth to be
1/2mm more incisal than our Standard Heights. |
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Bracket
Angulation:
Unless done in the doctor's office, we place a long axis line
on the models for all teeth to be bracketed as a visual indicator
to reference the vertical "centerline" of the bracket.
The specific orientation of the brackets to the long axis
may vary depending on the alignment references (bracket body,
slots and bases) used by various manufacturers. We use the
reference information supplied by each manufacturer to place
brackets on the long axis lines. On the chart on our Rx form,
there is a diagram available to indicate in degrees, changes
in angulation from the values built into a particular bracket
prescription. For example, on a 1st bicuspid extraction case,
the cuspids may require an additional 5 degrees of angulation.
This can be marked on the Rx form as illustrated. |
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Torque and In/Out:
The torque and In/Out with regards to bracket placement at Specialty
is determined by the values built into each manufacturers prescription.
As a standard service we do not alter these dimensions. However,
brackets with varying torque values can be placed depending on your
case requirements. For example, we can place upper anterior brackets
with an increased torque value (from 14 degrees to 22 degrees) on
individual cases where additional torque is required.
Molar Bracket Placement:
On bonded molars, as a standard, we place the brackets on the center
groove (mesial/distal) of the tooth. When using the smaller "mini
molar tubes" we reference the archwire slot to the buccal surface
of the tooth (from mesial to distal) according to the manufacturers
recommendations or clinicians preference. Rotational control of
molars with regards to bracket placement, is dependent on the manufacturer's
"offset" built into the specific appliance prescription.
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