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Bonding for an exquisite Finish/ Part I: Concepts of Bracket Bonding Dalia El-Bokle
Manage episode 300778249 series 2830917
Join me for a summary of Dalia El Bokle’s lecture exploring finishing in orthodontics. Part 1 focuses on bracket positioning concepts and Dalia’s own take to achieve more predictable ideal outcomes
Current bracket positioning technique
1. Middle middle – middle vertically and horizontally (FA point)
o Challenges
§ Accuracy = measure each tooth
§ If gingival swelling / not fully erupted = inaccuracy
2. Bracket charts – use of bracket gauges
o Accurate and reproducible, introduced in 1994
§ Typical chart
· Upper incisor 4-4.5mm from invasive edge
· Lateral 0.5mm incisal than lateral
· Canine 1mm more gingival than central
o Challenges
§ Appropriate for ideal tooth sizes only, can result in uneven marginal ridge heights if tooth size discrepancy present = bone loss, food impaction, premature contact and relapse
§ Can flatten smiles
3. Smile arch protection (SAC) Tom Pitts
o Bonding for consonant arch
o Method
§ Canine gingival to the contact point
§ Lateral 0.75-1mm cervical to the canine
§ Central 1.5mm more cervical to the canine
· Side effects – oral hygiene and deep bite
Solution by Dalia
Customised approach
· Factors
§ Marginal ridge heights, Upper incisor show, tooth size and shape, Incisor inclination, Overbite
· Method of positioning
1. Mesiodistal
§ All teeth bond in centre of the teeth
§ Molars – if extra cusp = tube design = mesial position and distal in rotation
· Solution = bond centre of the tooth, even if not in Mesiobuccal grove = extra composite used or modify bracket
§ Canine = EXCEPTIONS
· Place bracket mesial to long axis
· Mesial in rotation if placed in the centre
o Requires mesial out rotation to align with the lateral incisor
o Solution
§ Place upper and lower canines mesially
2. Axial (tip)
§ Draw long axis on the model
§ Use of OPG / CBCT to draw long axis
§ Modifications
· Overcorrect 5 degrees adjacent to extractions = prevent dumping in
· Overcorrect severely tipped teeth (usually in case of early loss of 1st molar)
3. Vertical
§ Posterior bond first 7-3
· Bond relative to marginal ridges – not incisal edges Kelange technique 2007
· Draw marginal ridge height line, then slot line
· Canine same level as premolars for marginal height
§ Anterior positioning
· Lateral = bracket gauge of the canine to tooth tip, add 0.25mm (more cervical)
· Central – add 0.25-0.5mm than canine
o = subtle smile arc protection
o Subtle smile arc – less steep difference in connectors when compared to SAP by Tom Pitts
§ Modifications
· 3-3 bonded 1mm more gingival = AOB / reduced incisal show, or 1mm more incisal for deepbite / gummy smile
§ Lower arch
· Canines are bonded 0.5mm more cervical for canine guidance
· Deep bite = 1mm more incisal
Incisal recontouring
· At the beginning of treatment = visually aid final position and improve aesthetics for patient
112 פרקים
Manage episode 300778249 series 2830917
Join me for a summary of Dalia El Bokle’s lecture exploring finishing in orthodontics. Part 1 focuses on bracket positioning concepts and Dalia’s own take to achieve more predictable ideal outcomes
Current bracket positioning technique
1. Middle middle – middle vertically and horizontally (FA point)
o Challenges
§ Accuracy = measure each tooth
§ If gingival swelling / not fully erupted = inaccuracy
2. Bracket charts – use of bracket gauges
o Accurate and reproducible, introduced in 1994
§ Typical chart
· Upper incisor 4-4.5mm from invasive edge
· Lateral 0.5mm incisal than lateral
· Canine 1mm more gingival than central
o Challenges
§ Appropriate for ideal tooth sizes only, can result in uneven marginal ridge heights if tooth size discrepancy present = bone loss, food impaction, premature contact and relapse
§ Can flatten smiles
3. Smile arch protection (SAC) Tom Pitts
o Bonding for consonant arch
o Method
§ Canine gingival to the contact point
§ Lateral 0.75-1mm cervical to the canine
§ Central 1.5mm more cervical to the canine
· Side effects – oral hygiene and deep bite
Solution by Dalia
Customised approach
· Factors
§ Marginal ridge heights, Upper incisor show, tooth size and shape, Incisor inclination, Overbite
· Method of positioning
1. Mesiodistal
§ All teeth bond in centre of the teeth
§ Molars – if extra cusp = tube design = mesial position and distal in rotation
· Solution = bond centre of the tooth, even if not in Mesiobuccal grove = extra composite used or modify bracket
§ Canine = EXCEPTIONS
· Place bracket mesial to long axis
· Mesial in rotation if placed in the centre
o Requires mesial out rotation to align with the lateral incisor
o Solution
§ Place upper and lower canines mesially
2. Axial (tip)
§ Draw long axis on the model
§ Use of OPG / CBCT to draw long axis
§ Modifications
· Overcorrect 5 degrees adjacent to extractions = prevent dumping in
· Overcorrect severely tipped teeth (usually in case of early loss of 1st molar)
3. Vertical
§ Posterior bond first 7-3
· Bond relative to marginal ridges – not incisal edges Kelange technique 2007
· Draw marginal ridge height line, then slot line
· Canine same level as premolars for marginal height
§ Anterior positioning
· Lateral = bracket gauge of the canine to tooth tip, add 0.25mm (more cervical)
· Central – add 0.25-0.5mm than canine
o = subtle smile arc protection
o Subtle smile arc – less steep difference in connectors when compared to SAP by Tom Pitts
§ Modifications
· 3-3 bonded 1mm more gingival = AOB / reduced incisal show, or 1mm more incisal for deepbite / gummy smile
§ Lower arch
· Canines are bonded 0.5mm more cervical for canine guidance
· Deep bite = 1mm more incisal
Incisal recontouring
· At the beginning of treatment = visually aid final position and improve aesthetics for patient
112 פרקים
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