Self-ligating Brackets in Orthodontics: Current Concepts and Techniques

253 Pages·2012·32.797 MB·English

by  Bjoern Ludwig, Dirk Bister, Sebastian Baumgaertel

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Self-Ligating Brackets
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g in Orthodontics
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A comprehensive overview of modern orthodontic treatment t is
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using self-ligating bracket systems—with evaluations of systems t
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Current Concepts and Techniques
currently available r
Promising numerous advantages in design, treatment efficacy, and reduced treatment S Bjoern Ludwig
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time, self-ligating brackets have become a major part of modern orthodontic practice.
l
Self-Ligating Brackets in Orthodontics: Current Concepts and Techniques summarizes f- Dirk Bister
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contemporary information and clinical studies on these popular systems, integrating
i Sebastian Baumgaertel
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them with the authors’ practical and hands-on experience. Encompassing all aspects
a
of treatment with self-ligating fixed appliances from biomechanics to material proper- t
i
ties and also including diagnostic and therapeutic principles, this book provides a n
step-by-step visual guide to this groundbreaking field. g

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Special features: r
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• Provides more than 1500 outstanding color photographs that show the sequence
c
of steps for all procedures involving self-ligating brackets from start to finish k
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• Objectively evaluates the advantages and disadvantages of commercially available
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self-ligating bracket systems to help you make the best choices for your patients s
• Covers the full scope of treatment, including oral hygiene, adhesive techniques,
biomechanics, esthetic choices, retention and stability, and more
• Includes multiple case studies as well as information on risks, pitfalls, practical tips,
and clinical pearls that aid in decision-making and reinforce the treatment concepts
Written by a team of international specialists, this book is a quintessential guide for all
practitioners who want to keep up to date with the latest developments in self-ligating
brackets and offer state-of-the-art treatment techniques for their patients. This book
is designed to be a useful introduction to newcomers to self-ligation as well as a guide
for experienced orthodontists on how to successfully incorporate this highly popular
technique into their practices.
Bjoern Ludwig, MD, is Associate Professor at the University Clinic Homburg/Saar and
in Private Practice in Traben-Trarbach, Germany.
Dirk Bister, MD, DD, MOrth RCS Edinburgh, is Consultant Orthodontist, Guy’s and
St. Thomas’ Dental Hospital, London, and Addenbrooke’s Hospital, Cambridge, UK.
Sebastian Baumgaertel, DMD, MSD, FRCD(C), is Clinical Associate Professor, Department
of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland,
Ohio, USA.
An award-winning international medical and scientific publisher, Thieme has demonstrated
its commitment to the highest standard of quality in the state-of-the-art content and
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ISBN 978-3-13-154701-9
www.thieme.com

Self-Ligating Brackets in Orthodontics
Current Concepts and Techniques
Bjoern Ludwig, MD
UniversityofHomburg/Saar
PrivatePractice,Traben-Trarbach
Germany
Dirk Bister, MD, DD
ConsultantOrthodontist
Guy’sandSt.Thomas’DentalHospital
London
Addenbrooke’sHospital
Cambridge
UK
Sebastian Baumgaertel, DMD, MSD, FRCD(C)
ClinicalAssociateProfessor
DepartmentofOrthodontics
SchoolofDentalMedicine
CaseWesternReserveUniversity
Cleveland,Ohio
USA
With contributionsby
Franziska Bock, Jens Bock, BettinaGlasl, Heiko Goldbecher, ThomasLietz, Joerg A. Lisson
1470 illustrations
Thieme
Stuttgart · New York
LibraryofCongressCataloging-in-PublicationDataisavailablefrom Importantnote:Medicineisanever-changingscienceundergoing
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tinuallyexpandingourknowledge,inparticularourknowledgeof
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of the German edition: Selbstligierende Brackets: Konzepte und
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Behandlung.
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Translator:DirkBister inaccuraciesnoticed.Iferrorsinthisworkarefoundafterpublica-
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Reviewer:SebastianBaumgaertel descriptionpage.
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V
List of Contributors
FranziskaBock,MD HeikoGoldbecher,MD
PrivatePractice PrivatePractice
Fulda Halle
Germany Germany
JensBock,MD ThomasLietz
PrivatePractice PrivatePractice
Fulda Neulingen
Germany Germany
BettinaGlasl,MD JoergA.Lisson,MD
UniversityofHomburg/Saar Professor
PrivatePractice DepartmentofOrthodontics
Traben-Trarbach UniversityofHomburg/Saar
Germany Germany
BjoernLudwig,MD
UniversityofHomburg/Saar
PrivatePractice,Traben-Trarbach
Germany
VI
Foreword
Sincetheearlybeginningoforthodontics,clinicianshave Active self-ligating appliances may allow better torque
progressivelyproducedmodificationsandenhancements control with undersize archwires than can be achieved
toimproveforcedeliveryoftheappliancesandclinician’s withpassiveappliances;aspringclipmightalsoenhance
efficiency.Majoradvancessincethelastcenturyincluded thepotentialforbucco-lingualalignment.Theresistance
thedevelopmentbyDr.AngleoftheEdgewiseappliance, to sliding is thought to be lower for passive appliances,
the introduction of enamel direct and indirect bonding however, which may improve the aligning capability of
techniques, the advent of the Preadjusted Straight Wire thesesystems.Self-ligatingsystemsoutperformconven-
appliancesandthedevelopmentoffullycustomizedLin- tionalbracketsinthein-vitrosituation,producingconsid-
gualAppliances(IBracesorIncognito).Inthelast10years, erablylessfrictionwithintheappliancesystems,butthis
self-ligatingapplianceshavecapturedtheimaginationof effect is less marked in-vivo. Clinical data documenting
many clinicians and are increasing in popularity. Those the efficiency of rotational correction and space closure
brackets have been developed to overcome the limita- withself-ligatingsystemsremainlimited.Useofself-lig-
tionsofstainlesssteelandelastomericligaturesinterms atingbracketsresultsinamarginalreductioninchairtime
ofergonomics, efficiency, plasticdeformation, discolora- requiredforappliancemanipulation.Also,thereislimited,
tion,plaqueaccumulation,andfriction. retrospectiveevidencepointingtoreducedoveralltreat-
A self-ligating bracket is a ligature-less systemwith a menttimewithfewerscheduledappointmentswiththe
mechanicaldevicebuiltintocloseofftheedgewiseslot. useofself-ligatingsystems.
Secure engagement may be produced by a built-in clip Whilemanycliniciansrecommendselectedself-ligating
mechanism replacing the stainless steel or elastomeric appliancestofacilitateexpansioninnon-extractiontreat-
ligature. Both active and passive self-ligating brackets ment,therearenopublishedlong-termfollow-upstudies
have been manufactured, referring to the bracket/arch- onthestabilityofthisapproach.
wire interaction. The active type has a spring clip that
pressesagainstthearchwire.Inthepassivetype,theclip VittorioCacciafesta,DDS,MSc,PhD
orrigiddoordoesnotactivelypressagainstthearchwire. Milan,Italy
VII
Preface
Self-ligating brackets—in recent years these words have mentsforclinicaluseandtreatmentpossibilities.Theaim
taken on almost unbelievable magic powers. It is now oftheauthorsistosummarizeexistingknowledgeandto
almost impossible to envisage orthodontic treatment complement it with their own experiences and study
without such brackets. Keywords supporting this idea results,in order to provide readers with an overviewof
are: greater user comfort; better differentiation from SLbracketsthatisascomprehensiveascanbe.Followinga
competitors; more marketing possibilities, economical, chapteronthehistoryofSLbrackets,thefirstpartofthe
shorterchairtimes,easy-to-use,patientcomfort,perfect bookpresentsaspectsdealingwithmaterialandtechni-
foryourpatients,andsoon.Theconclusionis:everything ques, including the evaluation of selected systems. The
workseasierandquicker.Sometimesthephrase“intelli- second partof thebook isdedicated toclinicalpractice.
gentsystem”isused.Somewhatexaggerated,itseemsas Herealsotheauthorshavetriedtodemonstratethecom-
ifthebracketatlastcaninformthetoothwhoisnowin plexityof the topicfrom the first to the final treatment
charge of moving from the falseto the correct position. steps. Statements are illustrated using numerous case
And the tooth? It follows the new brackets obediently, studies. The conclusion drawn from this section could
friction-free,andatabreathtakingpace. be: SL brackets are and will remain interesting tools, if
Byputtingthisratherironictextatthefrontofaspecial- they are properly used. They are just one of the many
istbook,theauthorsattempttomakeitclearthattheyare therapeutic choices in the hands of a doctor, and not a
attemptingtoreplacesuggestiveremarkswithfactsand “magicpill.”
to be critical about advertising slogans. All the authors Thisbookisintendedtobebothaguideandacompen-
havebeenworkingwithself-ligatingbracketsforalong dium,teachingbeginnershowtousethismethod,helping
time and willbe presenting theirinvestigationsand ex- advanceduserstodetectsourcesoferrors,andencourag-
periencesaccordinglyinthisbook. ingreaderstogoinanew,creativedirection.
Sometimesitmayseemthatself-ligating(SL)brackets Theauthorsthankeveryonewhoplayedapartincom-
are a recent invention. This is not the case. The first pletingthemanuscriptbygivingadviceandhelp,whether
experiments with brackets that fixed the wire into the directlyorindirectly,andthosewhomotivatedustoin-
slotdatebacktothe1930s.TheeraofmodernSLbrackets vesta greatamount ofworkto reach our goal.Without
beganwithSpeedBracketsaround1980.Foralmosttwo this help the project would not have been realized so
furtherdecadestheSLbracketsexistedinthebackground. quickly.OurspecialthanksgototheEditorialDepartment
Thegrowingnumberofsystemsandconceptsfromrecent ofThiemePublishersinStuttgartfortheirexcellentcoop-
yearsisdifficulttoexplain.Theexplosivegrowthinpop- erationandthewayinwhichtheywereabletoturnour
ularitybecamequiteuncontrolled,andthisbookwilltry notalwayssimpleideasintoreality.
tocleartheundergrowthasitwere.
Therehavebeenmanypublicationsonthistopicduring BjoernLudwig,MD
recentyears.Alotofexperiencehasbeengainedregard- DirkBister,MD,DD
ing friction and treatment times as well as the require- SebastianBaumgaertel,DMD,MSD,FRCD(C)
VIII
Contents
Contents
I Basics
1 The Developmentand History of FixedAppliances
FranziskaBock
DevelopmentofSelf-LigatingBracketSystems . . 2 The21stCentury. . . . . . . . . . . . . . . . . . . . . . . 6
The1980s. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ExpectationsandReality. . . . . . . . . . . . . . . . . 7
The1990s. . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2 Materials
BjoernLudwigandBettinaGlasl
Self-LigatingBrackets. . . . . . . . . . . . . . . . . . . . 10 RotationandFriction. . . . . . . . . . . . . . . . . . . . 23
BracketBase . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Rotation . . . . . . . . . . . . . . . . . . . . . . . . . . 23
ShapeoftheBase. . . . . . . . . . . . . . . . . . . . . 10 Friction. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
BondStrength. . . . . . . . . . . . . . . . . . . . . . . 12
Archwires. . . . . . . . . . . . . . . . . . . . . . . . . . . 26
BracketBody. . . . . . . . . . . . . . . . . . . . . . . . . . 15
ArchwireSequence . . . . . . . . . . . . . . . . . . . . . 29
Slot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ArchwireShape . . . . . . . . . . . . . . . . . . . . . . . 29
Friction . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Torque. . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Auxiliaries. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
AuxiliarySlots. . . . . . . . . . . . . . . . . . . . . . . . . 22 Elastics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Clips,etc.—SLMechanics . . . . . . . . . . . . . . . . . . 22 NiTiCoilSprings. . . . . . . . . . . . . . . . . . . . . . . 31
ActiveSystems. . . . . . . . . . . . . . . . . . . . . . . 22
PassiveSystems. . . . . . . . . . . . . . . . . . . . . . 23
3 Bracket Systems
HeikoGoldbecher
BasicPrinciples. . . . . . . . . . . . . . . . . . . . . . . . 34 Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . 50
TheVariousSelf-LigatingBracketSystems . . . . . 35 ShorterChairsideTime. . . . . . . . . . . . . . . . . . . 50
Damon3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 BondingofBrackets. . . . . . . . . . . . . . . . . . . 50
In-OvationR(GAC). . . . . . . . . . . . . . . . . . . . . . 36 LigationofArchwires. . . . . . . . . . . . . . . . . . 51
In-OvationC(GAC). . . . . . . . . . . . . . . . . . . . . . 37 DebondingoftheFixedAppliances. . . . . . . . . 53
Opal(Ultradent). . . . . . . . . . . . . . . . . . . . . . . . 38 Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
OpalM(Ultradent). . . . . . . . . . . . . . . . . . . . . . 39 ReductionofOverallTreatmentTime . . . . . . . . . 55
Quick2(Forestadent) . . . . . . . . . . . . . . . . . . . . 40 ActiveTreatment. . . . . . . . . . . . . . . . . . . . . 55
SmartClip(3MUnitek) . . . . . . . . . . . . . . . . . . . 41 OralHygieneofSelf-LigatingBrackets. . . . . . . . . 58
ClaritySL(3MUnitek). . . . . . . . . . . . . . . . . . . . 42 LongerIntervalsbetweenAdjustments . . . . . . . . 59
Speed(StriteIndustries,Ltd.) . . . . . . . . . . . . . . . 43 ReductionofStaff . . . . . . . . . . . . . . . . . . . . . . 60
Time2(AmericanOrthodontics). . . . . . . . . . . . . 44
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Time3(AmericanOrthodontics). . . . . . . . . . . . . 45
VisionLP(AmericanOrthodontics) . . . . . . . . . . . 46
DiscoverySL(Dentaurum) . . . . . . . . . . . . . . . . . 46
IX
Contents
II Treatment
4 Diagnosis
BjoernLudwigandBettinaGlasl
StandardDiagnosticToolsinOrthodontics. . . . . 62 AdditionalDiagnosticTools. . . . . . . . . . . . . . . 71
DiagnosisandTreatmentPlanning . . . . . . . . . . 65
5 Oral Hygiene
HeikoGoldbecherandJensBock
Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 ProphylacticMeasures . . . . . . . . . . . . . . . . . . . 75
SymptomsandEtiologyofCaries. . . . . . . . . . . . . 73 Bonding. . . . . . . . . . . . . . . . . . . . . . . . . . . 75
EpidemiologyofCaries . . . . . . . . . . . . . . . . . . . 74 ActiveToothMovement . . . . . . . . . . . . . . . . 76
GingivitisandPeriodontitis . . . . . . . . . . . . . . . . 74
ActiveMeasures. . . . . . . . . . . . . . . . . . . . . . . 78
HygieneApproachesforFixed-Appliance OralHygieneafterFixed-ApplianceTreatment. . 81
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
6 BondingTechniques
HeikoGoldbecherandJensBock
TheDevelopmentandHistoryofBonding DirectandIndirectBondingTechniques . . . . . . 92
Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . 83 DirectBonding . . . . . . . . . . . . . . . . . . . . . . . . 92
PositioningofBrackets . . . . . . . . . . . . . . . . . . 83 IndirectBonding. . . . . . . . . . . . . . . . . . . . . . . 94
VerticalPositioning. . . . . . . . . . . . . . . . . . . . . . 83 TransferTrays. . . . . . . . . . . . . . . . . . . . . . . . . 94
HorizontalPositioning. . . . . . . . . . . . . . . . . . . . 84 SiliconeTransferTrays. . . . . . . . . . . . . . . . . 94
Vacuum-FormedTrays. . . . . . . . . . . . . . . . . 94
Bonding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
PositioningofSelf-LigatingBrackets . . . . . . . . . 88
7 Treatment
BjoernLudwigandBettinaGlasl
SpaceCreation . . . . . . . . . . . . . . . . . . . . . . . . 98 CorrectionofSkeletalDiscrepancies. . . . . . . . . 148
Alignment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 CorrectionofaClassIIBuccalSegment
Biomechanics . . . . . . . . . . . . . . . . . . . . . . . 98 Relationship. . . . . . . . . . . . . . . . . . . . . . . . . . 148
ExpansionoftheArches . . . . . . . . . . . . . . . . 101 FunctionalMandibularAdvancer . . . . . . . . . . 148
CrowdingandEctopicCanines . . . . . . . . . . . . 104 Easy-FitJumper . . . . . . . . . . . . . . . . . . . . . 152
TreatmentofOcclusionafterLevelingand CorrectionofClassIIIMalocclusions . . . . . . . . . . 155
Alignment. . . . . . . . . . . . . . . . . . . . . . . . . . 116
EstheticTreatment. . . . . . . . . . . . . . . . . . . . . 159
SpaceCreationbyDistalization. . . . . . . . . . . . . . 124
Self-LigatingCeramicBrackets. . . . . . . . . . . . . . 159
SpaceCreationbyExpansionofArches. . . . . . . . . 135
LingualSelf-LigatingBrackets . . . . . . . . . . . . . . 163
SpaceCreationbyExtractingTeeth . . . . . . . . . . . 142
SpaceCreationbyInterproximalReduction(IPR) . . 148
8 Auxiliary Equipment and Techniques
BjoernLudwig,BettinaGlasl,andThomasLietz
PracticalApplicationofSelf-LigatingBrackets. . . 173 DetailingBends. . . . . . . . . . . . . . . . . . . . . . . . 180
ArchwireShift . . . . . . . . . . . . . . . . . . . . . . . . 178 IndividualizedArches. . . . . . . . . . . . . . . . . . 180
SlipperyArchwires. . . . . . . . . . . . . . . . . . . . . . 178 CorrectionoftheOcclusion. . . . . . . . . . . . . . 181