Bracket Placement Review

A prominent orthodontic educator recently stated that "In the 1960's, the best orthodontics was done by the best wire benders. Today, the best orthodontics is done by the best bracket positioners." I couldn't agree more with this statement.

•Horizontal Positioning of Brackets

Visualize center of tooth directly from the facial surface, then look down long axis of the tooth

May need to use a mirror for bicuspids

Placement errors lead to rotations

•Rotational(axial) errors

Cause unwanted tipping

Keep incisal edge of bracket parallel to incisal edge of tooth

use same visualization techniques as for horizontal placement

•Excess bonding agent under the bracket

may cause rotational errors

To avoid these, push bracket firmly onto tooth

•Vertical errors

Cause excessive extrusion or intrusion

Check the same tooth on the other side of the arch and make sure the inciso-gingival position is the same on both sides- this prevents occlusal plane tipping

•Mesio-distal position

- Position bracket on the mesio-distal center of the tooth for all upper and lower centrals, laterals, and cuspids

- In most cases, position the brackets in the mesio-distal center of all molar and premolar teeth

Inciso-gingival position

•Deep bite patients

-Position brackets 1 to 2 mm incisal to the center of the tooth

•Open bite patients

-Position brackets 1 to 2 mm gingival to the center of the tooth

Occluso-gingival placement of premolars

•Deep bite cases

-Position brackets 1 to 2 mm gingival to the center of the tooth

•Open bite cases

-Position brackets 1 to 2 mm occlusal to the center of the tooth

Upper molar bracket (or band) position

•Anterior portion of bracket bisects the MB cusp

•Final band seat is accomplished with lingual pressure

•Bracket in the occluso-gingival center for all cases

Lower molar bracket (or band) position

•Bracket always placed in the center of tooth

•Final band seat is accomplished with buccal pressure