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, our prescription forms allow detailed placement instructions on a per case basis for accurate positioning.


Bracket Height



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.


Bracket Angulation



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. The chart on our Rx form has a diagram available to indicate in degrees the 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.


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.