The Damon 3 bracket is a passive orthodontic system featuring a rigid sliding door with guiding grooves for its locking mechanism Made from acrylic, the bracket's base and body allow for efficient function, while a specialized instrument is required to open the bracket in a caudal direction.
(i.e., occlusal for the upper jaw and gingival in the lower jaw) On delivery, the bracket is open.
Despite some potential discoloration (see Table 3.1), this bracket is believed to retain its aesthetic qualities over an extended period in clinical settings The operator experiences a brief learning curve, enabling accurate bracket positioning quickly Adequate rotational and torque control can be achieved by following the manufacturer's recommended archwire sequence, and elastomeric chains can be easily integrated beneath the archwire.
Maintaining oral hygiene can be challenging, especially for smokers, making professional dental cleanings essential The acrylic component of brackets often limits the use of elastic chains or steel ligatures over the archwire due to poor abrasion characteristics Additionally, using rectangular wires measuring 0.020×0.020 or larger may compromise the sensitive locking mechanism, potentially leading to damage if food residue or plaque is present Furthermore, during the debonding process, most of the composite bonding material tends to remain on the tooth, resulting in extended chair time for adhesive removal.
The Damon 3 system is considered a balanced option for achieving both aesthetics and functionality in orthodontics Its compact bracket design makes it less suitable for severely rotated teeth or those requiring substantial torque control However, it is an ideal choice for patients who prioritize aesthetics and maintain good oral hygiene.
Chlorhexidine rinse, Meridol, nicotine, coffee, red wine, and certain foods like turmeric are not recommended, as they can cause early discoloration of brackets.
Fig 3.4 A Damon 3 bracket after opening. The bracket is identified by color coding The lateral edges of the bracket serve as orienta- tion for positioning parallel to the long axis.
Fig 3.5 A Damon 3 bracket with a 0.021×0.025 facially coated
The esthetic NiTi archwire effectively fills the bracket slot, enabling optimal application of torque and rotational moments However, its rigid locking mechanism can make ligation challenging in clinical settings.
Passive self-ligating systems often encounter rotational issues, as illustrated by tooth 41 The rigid clip of the bracket is unable to close on a 0.021×0.025 wire, making the application of steel ligatures impossible Additionally, the acrylic tie-wings of the bracket show signs of abrasion.
The In-Ovation R is an advanced active bracket system featuring a contoured bracket base and a classic twin design The bracket's base is securely connected to its body through laser welding, ensuring durability Made from a chromium-molybdenum alloy, the clip allows for efficient opening from gingival to occlusal, which can be performed using a specialized tool or a similarly shaped explorer.
The In-Ovation R bracket offers effortless placement and convenient opening and closing, ensuring excellent rotational and torque control Additionally, elastic chains can be positioned either over or under the archwires for enhanced versatility.
This metal bracket may not fulfill the highest aesthetic standards and can present challenges when using archwire sizes of 0.018 × 0.018 in the 0.022 system and larger It is crucial to ensure that the current wire is passive before advancing to the next size.
Severe crowding can be effectively addressed with In-Ovation R brackets, which provide excellent torque control when paired with rectangular archwires larger than 0.020 These brackets are manufactured to high standards and feature a durable ligation mechanism, making them an ideal choice for beginners looking to gain experience with self-ligating systems.
The In-Ovation bracket should not be used in patients with known allergies to chromium–molybdenum or nickel.
The In-Ovation R bracket features a closed slot design, with color coding for easy identification Its lateral edges provide a clear orientation, ensuring precise positioning parallel to the long axis for optimal performance.
Brackets can be identified by markings on their base, as shown in Fig 3.8 The In-Ovation R system features a facially coated esthetic 0.021×0.025 NiTi wire, depicted in Fig 3.9 This design allows for the archwire to be actively pushed into the slot, providing maximum torque and rotational control Additionally, the elastic clip facilitates easy ligation, even with full-sized archwires.
The In-Ovation C is an active ceramic bracket (Figs.
The bracket features a well-contoured design with a one-piece construction, created through a ceramic injection molding technique Its clip has been specially treated to achieve a matte finish, enhancing its aesthetic appeal Additionally, this ceramic bracket is slightly larger than traditional metal brackets.
The In-Ovation R bracket features a unique design that allows for opening from the gingival direction with a specialized tool, making it suitable for all teeth except molars and lower premolars While the company provides ceramic tubes for lower premolar attachments, these tubes are prone to fracturing during the insertion or removal of thicker archwires.
Forestadent)
The Quick bracket (Figs 3.19–3.21) is an active bracket It is a one-piece construction using metal injection molding
(MIM), followed by sintering The elastic clip is made from a chromium–molybdenum alloy This bracket can be opened with a specially designed instrument either from the gingival or labial aspects.
The Quick bracket offers easy positioning and resembles conventional twin brackets, making it accessible for operators with minimal experience in self-ligating brackets Its clear markings facilitate orientation, while the user-friendly clip mechanism enhances operability Additionally, it provides excellent rotational and torque control, and the placement of elastomeric chains is straightforward.
Even very thick archwires (0.021 and above) can be li- gated It also has an additional 0.016×0.016 auxillary slot.
The disadvantages of this bracket are mainly esthetic; as with all metal brackets, it may not meet patients’highest requirements.
The small, sturdy metal bracket is ideal for patients with severe crowding, offering excellent rotational control and torque management, even with archwires larger than 0.020 It is particularly recommended for beginners in self-ligation due to its user-friendly design, and the added auxiliary slot enhances its versatility.
These are mainly esthetic and if patients have any known allergies to the metals used to produce the bracket.
Fig 3.19 Quick 2 closed; identification and orientation of the bracket are easy due to color coding.
Fig 3.20 Quick 2 with a facially coated
The 0.021×0.025 NiTi archwire is designed to be actively pressed into the bracket slot, enabling optimal torque and rotational control The clip's elasticity facilitates easy ligation of full-sized archwires, while the bracket also features an additional archwire slot for auxiliary components.
Fig 3.21 Elastomeric chains can be easily placed under or over the archwire due to the bracket’s twin-wing design.
The SmartClip bracket is a passive orthodontic system featuring a traditional twin bracket design with two laser-welded clips positioned mesial and distal to the tie-wings This innovative bracket eliminates movable parts like lids or locks, relying instead on two nickel-titanium clips that automatically open when the archwire is dislodged in the buccal-lingual direction To enhance usability, specialized instruments are available for effective ligation and disengagement of the archwire.
The SmartClip bracket is easy to position on the tooth; its main characteristics are those of a normal twin bracket.
The SmartClip bracket is user-friendly, requiring no additional training or experience for optimal positioning It offers excellent rotational and torque control when paired with appropriately sized wires The clear markings on the brackets and the ease of placing elastic chains enhance usability Additionally, the absence of locking mechanisms facilitates better oral hygiene In later treatment stages, the bracket can be transformed into an active one by ligating traditional ligatures to the tie-wings, allowing for improved control of tooth movement.
The brackets come precoated with 3M's Transbond™ Plus adhesive and are individually packaged in sealed containers This packaging enhances inventory management and ensures consistent bonding results by preventing bracket base contamination and variations in adhesive application.
The insertion and removal of thick archwires can be challenging, potentially resulting in bracket debonding and patient discomfort To address this, manufacturers suggest utilizing multiple small archwires in certain situations rather than a single large wire Additionally, larger rectangular hybrid wires can aid in ligation, although they may compromise torque control.
This bracket has good leveling and alignment properties.
Patients with known metal allergies should avoid using brackets, as they may not be suitable for those with heightened sensitivity Additionally, the process of inserting and removing archwires can lead to discomfort, which can be alleviated through the use of proper techniques.
SmartClip brackets feature color coding for easy identification and can be positioned with relative ease compared to other self-ligating options Additionally, they include a vertical groove that facilitates precise alignment along the long axis, enhancing the overall efficiency of the orthodontic process.
Fig 3.23 SmartClip with a facially coated
The 0.021×0.025 NiTi esthetic archwire is designed to be passively held in the slot; however, ligating full-sized archwires can pose challenges due to the elastic clip mechanism Additionally, when using coated esthetic archwires, it is common for the coating to wear off during the initial ligation process.
A detailed view of a 0.021×0.021 NiTi archwire in a SmartClip bracket in the lower jaw illustrates the effectiveness of this passive system in maintaining good rotational control, thanks to the lateral positioning of the clips relative to the tie-wings However, the ligation of rectangular archwires can be challenging While 3M provides beveled archwires, they may not always facilitate complete torque expression.
The Clarity SL bracket is a passive orthodontic system featuring a ceramic body with a metal slot integrated into its base to enhance frictional properties Similar to the SmartClip bracket, it utilizes a self-ligating mechanism that incorporates a NiTi clip attached to the mesial and distal sides of the twin bracket Additionally, specialized tools are provided for the efficient insertion and removal of archwires.
The Clarity SL bracket offers the same placement method as traditional ligation brackets, requiring no extra training or experience It provides exceptional rotational and torque control, features easily identifiable markings, and allows for simple application of elastomeric chains.
Cleaning is easy for the patient, as there are no additional mobile parts such as lids or other locking mechanisms.
Debonding is relatively convenient for a ceramic bracket, due to an intentional weak spot at which the bracket fractures when the proper debonding technique is used.
Like the SmartClip bracket, it is individually packaged and precoated with adhesive.
Ligation and removal of rigid archwires can cause discomfort for patients, so it is advisable to use specialized instruments to prevent clip breakage during these processes Additionally, the coating on tooth-colored esthetic archwires may be damaged during ligation It is important to note that the bracket cannot be reused for repositioning or repairs, as it features a predetermined fracture point along its vertical axis, designed specifically for easy removal at the end of orthodontic treatment.
This bracket offers quick and effective leveling and alignment, along with favorable frictional characteristics Its design is aesthetically pleasing, as most metal components are concealed behind the archwire However, initial alignment stages may slightly compromise its aesthetics, particularly with visible clips on rotated teeth.
American Orthodontics)
The Time 2 bracket is an innovative active system crafted as a single unit using the MIM technique, featuring an integrated base and body It can be opened with a specialized tool inserted labially, allowing for a hinged mechanism that operates gingivally Closing the bracket requires a uniquely designed tool, ensuring optimal functionality and ease of use.
The Time 2 bracket is user-friendly and requires minimal expertise for installation Its clear markings facilitate easy adjustment, while the large design enhances rotational control when the locking mechanism is securely closed.
The large size of the bracket negatively impacts its aesthetic appeal, while elastomeric chains can become trapped in the closing mechanism Additionally, the locking mechanism may fail to effectively transfer forces from the clip to the archwire, complicating rotational and torque control In such situations, utilizing a steel ligature is often beneficial.
The first type of bracket in this comparison features a hinge that opens in the direction of the active wire's push In scenarios involving significant rotation, the force exerted by the wire may cause the bracket to open, resulting in the wire becoming disengaged.
The Time 2 bracket is a large, solid metal bracket, and ligation of heavy archwires (larger than 0.020) is possible.
It is a good self-ligating bracket that is well suited for novices in this field.
The bracket is not ideal for patients with small teeth, allergies to any of the alloy components, or high esthetic requirements Rotational control can be challenging.
Fig 3.31 Time 2 is an active bracket Per- manent laser etching allows identification of the bracket The long axis is not marked.
In Fig 3.32, a facially coated aesthetic 0.021×0.025 NiTi archwire is actively pressed into the slot, highlighting the challenge of translating torque and rotation to the teeth effectively due to insufficient tension To address these limitations, the use of stainless-steel and elastomeric ligatures is recommended.
American Orthodontics)
The Time 3 bracket (Fig 3.33) is a smaller version of the
The Time 2 bracket features a base and body crafted using the Metal Injection Molding (MIM) technique This innovative bracket is designed to be opened with a specialized tool that is inserted labially, allowing the door to hinge open gingivally The same instrument is utilized for closing the bracket, ensuring ease of use and efficiency in dental applications.
Opening and closing the Time 3 bracket requires very little additional training to position The markings are easy to identify.
Elastomeric chains may interfere with the locking mech- anism The tension exerted by the clip is often not suffi- cient for full torque and rotational control.
The Time 3 bracket is a solid medium-sized bracket that allows ligation of even very thick rectangular archwires (larger than 0.020) It can be recommended for novices in the field.
This bracket should not be used for patients who have known allergies to the alloy components of the bracket or high esthetic requirements.
Fig 3.33 Time 3 bracket Laser etching al- lows identification of the bracket The long axis is not marked.
The Vision LP is an advanced orthodontic system featuring tie-wings, constructed through the MIM sintering technique for its base and body This innovative bracket can be easily opened using a specialized instrument or dental probe, and it operates by rotating around a gingival hinge from occlusal to gingival Closing the bracket is also straightforward, achievable either with a special tool or simply by applying finger pressure.
The Vision LP bracket offers effortless positioning and features increased thickness, which may lead to easier debonding compared to other self-ligating brackets, especially in the lower jaw Its discreet markings enhance usability, allowing for relatively simple opening and closing.
The tension between the locking mechanism and the archwire may lack sufficient strength for complete rotational and torque control, as noted in the Time 2 bracket description To enhance this control, incorporating additional steel ligatures tied around the tie-wings can be beneficial.
The Vision LP bracket is a durable, medium-sized metal bracket designed for the effortless ligation of heavy archwires exceeding 0.020 inches Its user-friendly design facilitates easy positioning and opening/closing, making it suitable for both experienced orthodontists and novices in self-ligation.
The locking mechanism's large cavity can trap food debris and plaque beneath the archwire To ensure proper oral hygiene, it is often recommended to have a professional hygienist, auxiliary, or therapist clean the bracket slot by opening the brackets.
Fig 3.34 Vision LP bracket Color coding allows bracket identification The long axis is not marked.
Fig 3.35 The high-profile construction of the mandibular brackets increases the like- lihood of premature contacts with the up- per arch which can lead to bracket failure.
The Discovery SL bracket is a passive orthodontic system characterized by tie-wings and a well-contoured base, crafted using the MIM sintering technique It features a door that functions as an opening and closing mechanism, operated with a specialized tool in an incisal-gingival direction.
The Discovery SL bracket features distinct markings for easy identification and a well-contoured base that facilitates secure bonding and positioning Its smooth surface minimizes irritation to soft tissues, while the tie-wings enable handling similar to traditional twin brackets Additionally, its compact size enhances the aesthetic appeal of this metal self-ligating bracket.
Torque control has its disadvantages, primarily influenced by the mesiodistal width of the bracket and the door's opening direction To mitigate these issues, additional elastomeric ligatures can be employed effectively However, it's important to note that the space beneath the clip may lead to the accumulation of food particles and plaque.
The Discovery SL system features a compact self-ligating bracket designed for the effective ligation of heavy rectangular arch-wires exceeding 0.020 inches This bracket is an excellent choice for beginners in orthodontics, providing a valuable opportunity to gain hands-on experience with self-ligation techniques.
Brackets should be avoided in patients with known metal allergies Issues may arise if hinge doors open and disconnect the wire, particularly if oversized wires are selected prematurely or if there are excessive rotations, mirroring problems seen with the Time bracket series.
Fig 3.36 Discovery SL Permanent laser- etched markings help with the horizontal and vertical positioning of the bracket on the tooth.
Table 3.1 A comparison of esthetic self-ligating brackets
+ Available for all teeth; useful for narrow teeth
−Sometimes poor rotation and torque control, marked abrasion of the acrylic possible
+ Hygiene easily maintained, even for narrow teeth; discoloration- resistant ceramic
−Clips can damage coated esthetic archwires; difficult ligation of larger archwires
+ Good patient comfort at lips and cheeks
−Discolorations of acrylic, sometimes poor rotation and torque control
+ Discoloration-resistant ceramic; good mechanical properties; resilient clip
−Visible clip (more so than for In-Ovation C)
+ Discoloration-resistant ceramic; good mechanical properties; best combination of esthetics and function
−Clip not as resilient as QuicKlear
Fig 3.37 Bracket identification by perma- nent laser etching on the bracket base.
Fig 3.38 Discovery SL with a facially coa- ted esthetic 0.021×0.025 NiTi archwire The archwire is engaged passively Stainless-steel ligatures can be used to ligate the wire.
Table 3.2 A comparison of metal self-ligating brackets
+ Very small, low-profile, lip- and cheek-friendly surface
−Due to size and ligation principle (passive), sometimes poor rotation and torque control
+ Very good rotation and torque control; small, smooth-running door−Initial irritation of lips and cheeks possible due to surface properties
+ Smooth surface, due to ligation characteristics (passive):
−shortcomings in rotation and torque control, elastomeric chain can get caught
+ Very good rotation and torque control; small, precise and smooth-running mechanism
−Initial irritation of lips and cheeks possible due to surface properties
+ very good rotation control, bonding like“regular”twin-bracket
−poor torque control, discomfort during ligation of archwires
+ Very small; inexpensive; locking mechanism is easy to operate but seizes easily
−Due to the small size: poor rotation control, moderate manufacturing quality, binding of archwires possible
+ Easy to bond, easy application of elastic chains
−Due to poor tension of clip: rotation and torque control resemble a passive bracket, elastic chains can get caught
+ Easy to bond, easy application of elastic chains
−Due to poor tension of clip: rotation and torque control resemble a passive bracket, elastic chains can get caught
[Fig] Vision LP (American Orthodontics)
+ Smooth-running mechanism; easy application of elastic chains
−Passive bracket with sometimes poor rotation and torque control; high profile; bonding requires practice
Table 3.3 Overview of currently available self-ligating brackets, arranged by material and product name
Bracket Manufacturer Lock Type Material Available Further information available at
Name Principle From/since To
Autonomy SL Ortho-byte Passive Mobile clip Metal 2006 www.ortho-byte.com
Carriere LX OrthoOrganizer Passive Vertical slider Metal 2007 www.orthoorganizers.com
Damon 1 Ormco Passive Vertical slider Metal 1996 1999
Damon 2 Ormco Passive Vertical slider Metal 1999 2005
Damon MX Ormco Passive Vertical slider Metal 2007 www.ormco.com
Discovery SL Dentaurum Passive Hinge door Metal 2008 www.dentaurum.de
Flair Adenta Active Mobile clip Metal 2005 www.adenta.de
In-Ovation R GAC Active Mobile clip Metal 1997 www.gacinovation.com
Opal M Ultradent Passive Hinge door Metal 2007 www.opalorthodontics.com
Praxis Glide Lancer Passive Vertical slider Metal www.lancerortho.com
Protect PT China Passive Mobile clip Metal 2008
Quick Forestadent Active Mobile clip Metal 2005 2007
Quick 2.0 Forestadent Active Mobile clip Metal 2007 www.forestadent.de
first-generation 3 M Unitek Passive Static clip Metal 2004 2006
SmartClip, second- generation 3 M Unitek Passive Static clip Metal 2006 http://solutions.3 m.com/wps/portal/
Speed Strite Industries Active Mobile clip Metal 1976
Self-Ligating Denrum Passive Vertical slider Metal 2007 www.denrum.com.cn
SWLF Synergy R Rocky Mountain Passive Convertible lid Metal 2007 www.rmortho.com
T3 American Orthodontics Active Mobile Clip Metal www.americanortho.com
Tenbrook Axis Ortho Classic Passive Rotating slider Metal 2008 www.orthoclassic.com
Time Adenta Active Mobile clip Metal 1994 www.adenta.de
Time 2 American Orthodontics Active Mobile clip Metal www.americanortho.com
Vision LP American Orthodontics Passive Mobile clip Metal 2007 www.americanortho.com
Self-ligating brackets—tooth-colored
Clarity-SL 3 M Unitek Passive Ceramic 2007 http://solutions.3 m.com/wps/portal/
Clippy C Tomy Passive Mobile clip Ceramic 2007 www.tomyinc.co.jp
Damon 3 Ormco Passive Vertical slider Acrylic + metal 2005 www.ormco.com
In-Ovation C GAC Active Mobile clip Ceramic 2007 www.gacinovation.com
Opal Ultradent Passive Hinge door Acrylic 2004 2008
Oyster 2.0 Gestenco Passive Hinge door Acrylic www.gestenco.com
QuicKlear Forestadent Active Mobile clip Ceramic 2008 www.forestadent.de
Clippy L Tomy Passive Mobile clip Metal www.tomyinc.co.jp
Evolution Adenta Active Mobile clip Metal www.adenta.com
In-Ovation L GAC Active Mobile clip Metal www.gacinovation.com
Phantom Gestenco Passive Hinge door Composite www.gestenco.com
2 D Bracket Forestadent Active Static clip Metal www.forestadent.de
2 D Bracket, third-generation Forestadent Active Static clip Metal 2008 www.forestadent.de
Self-ligating bracket systems are marketed by manufacturers as offering several benefits over traditional ligation methods These advantages include faster and more effective treatment, reduced forces exerted by brackets and archwires, and a lower risk of root resorption Additionally, self-ligation is believed to promote better oral hygiene and minimize discomfort during orthodontic treatment.
A number of these claims are discussed below in greater detail, focusing particularly on the following claims:
1 Chairside time is shorter for each appointment.
2 Overall treatment time is shorter.
3 Self-ligating brackets are more hygienic and easier to keep clean.
4 There are longer intervals between adjustments, so that fewer adjustments are necessary.
5 The dental practice is able to work with fewer staff.
To effectively test the theory that self-ligating brackets reduce chairside time, it is crucial to establish appropriate reference standards The authors utilized the German health-insurance schedule (BEMA 2004) to standardize the payments dentists receive for specific dental services Their assessment focused on procedures such as bonding time for straight-wire brackets, separate etching and priming of teeth, and the use of elastomeric elements for ligating archwires The calculations were based on the average time required by an operator for each procedure.
1 Approximately 3 minutes for placement of a bracket
2 Approximately 9 minutes for placement and cement- ing of a band
3 Approximately 9 minutes for an archwire change (re- moval and placement of a new wire)
4 About 1 minute to remove a bracket or band (per bracket and band)
The stated durations do not account for preparation activities, including cleaning surfaces or providing the patient with instructions on oral hygiene Consequently, the emphasis is solely on the time the doctor dedicates to interacting with the patient.
Using the above data, the average chair times for ortho- dontic treatment were:
• Band placement and cementing: 72 minutes (8 × 9 minutes)
• Archwire change: 108 minutes (12×9 minutes; assum- ing that 12 visits are necessary)
• Remove bands and brackets: 28 minutes (28×1 minute)
The average chairside time totals 268 minutes, as illustrated in Fig 3.39 Achieving these times consistently requires the expertise of an experienced operator It is important to note that the data presented is for reference only and does not evaluate its validity.