Review Article University J Dent Scie 2021; Vol.
7, Issue 3
“Misplaced or Intentionally Misplaced – A Bracket
Positioning Overview”.
Abstract:
In orthodontics, bracket positioning is the utmost part of the treatment planning. Ideally if the clinician using MBT prescription then they should follow the MBT
bracket positioning charts to achieve more aesthetic result. Deflection in a bracket positioning to MBT chart may alter the final result as well as may prolong the
finishing and detailing stage. Although in some conditions alteration in a bracket positioning may reduce the treatment time as well as reduces chances of the
relapse. Generally in a first look it seems that the particular bracket was misplaced but with the help of proper understanding of the basic biomechanics and well
planned treatment strategy that the bracket position was justified as intentionally misplaced. This article well discuss all those conditions in which the alteration
in a bracket positioning can help clinician to achieve a desired result comparatively in less time with more stability.
Key words: Aesthetic result, Intentionally misplaced, MBT prescription, Misplaced bracket, Stability.
Introduction: premolar was the key for bracket height positioning in Roth's
system. McLaughlin, Bennett and Trevisi developed third
Bracket positioning is one of the most important key factor for generation of brackets in the form of MBT™ Versatile+
affecting final treatment result and duration. Ideal bracket Appliance System. They recommended the use of MBT gauge
positioning remains always a controversial point for the for the bracket placement with Bracket Placement Chart.[2-4]
clinician to achieve the finest result. Various authors
Some time ideal bracket positioning is was not able to express
suggested various bracket positions with different bracket full bracket prescription as well as to align the teeth in a
prescriptions. According to Tweed, incisal edge was guided desirable position due to morphology and malposition of the
for the bracket positioning and middle third of the crown was teeth. Small alteration in the bracket positioning may be
opted as an ideal position for the bracket by Saltzmann.
Holdaway suggested that in the deep bite cases occlusal third 1
ASHISH KUSHWAH, 2MUKESH KUMAR, 3SHRUTI
of the crown was the site for bracket placement and in the open PREMSAGAR, 4SHASHANK SONI, 5RAHUL JESWANI
1
Department of Orthodontics and Dentofacial Orthpaedics,
bite cases gingival third of the crown was the site for bracket
Peoples College of Dental Sciences & Research Centre,
placement. With the advent of preadjusted edgewise brackets Bhopal,
2
importance of the accurate bracket positioning has further Department of Orthodontics and Dentofacial Orthpaedics,
Teerthanker Mahaveer Dental College and Research
amplified as it is necessary for proper expression of the inbuilt Center, Moradabad
3
prescription. [1] Department of Orthodontics and Dentofacial Orthpaedics,
ITS dental College & Research Centre, Greater Noida
4
Consultant Orthodontist, Gwalior,
Lawrence F. Andrews advocated an imaginary plane “The 5
Department of Orthodontics and Dentofacial Orthpaedics,
Andrews Plane” for his straight wire appliance (SWA). When Maharana Pratap Dental College & Research Centre,
teeth were in normal occlusion then this plane was passing Gwalior
through long axis of the crowns. Ronald Roth developed the
Address for Correspondence: Dr. Ashish Kushwah
second generation of brackets with some modification in the
MDS in Orthodontics
Andrews's prescription to allow overcorrection. Canine & Senior lecturer, Peoples College of Dental Sciences &
Research Centre, Bhopal,
Access this article online
Email: [email protected]
Quick Response Code
Website:
Received : 27 July, 2021, Published : 31 December, 2021
www.ujds.in
DOI: How to cite this article: Kushwah, A., Kumar, M., Premsagar, S., Soni, S., &
Jeswani, R. (2021). Misplaced or Intentionally Misplaced – A Bracket Positioning
https://doi.org/10.21276/ujds.2021.7.3.21 Overview. UNIVERSITY JOURNAL OF DENTAL SCIENCES, 7(3).
126 University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India
University J Dent Scie 2021; Vol. 7, Issue 3
judged as a misplaced positioned bracket by some clinician but in the rotated tooth condition ( figure 3) this offset work as
but final outcome was the evidence which clearly shown that overcorrection and increase the stability.[3-6]
the particular bracket was intentionally misplaced. In this
article we are discussing various alterations in the bracket
positioning from MBT chart with MBT prescription to
achieve more esthetic and stable result without using any
other bracket system.
Alteration in bracket positioning:
Various alterations in the bracket positioning along with their Figure 3- Bracket positioning in the rotated tooth condition.
benefits can be explained under following headings:
ii) In an angle to vertical plane- When a bracket is placed on
A). In reference of vertical and horizontal plane: the tooth in an angle to vertical plane (long axis of the tooth)
I) In vertical plane- If we change the bracket position in then it will helps the clinician for uprighting the tooth. This
vertical plane then it helps to do intrusion and extrusion of that bracket positioning alteration generally used in finishing and
tooth. (5) detailing stage.[6]
For example, gingivally placed bracket helps the clinician for iii) Inverting bracket- If we invert the bracket on same tooth
tooth extrusion. This alteration can be used in case of the open in that case the tip remains same but torque will change.
bite where extrusion of anterior teeth was required (figure 1). For example in case of blocked lateral incisor (figure 4) if we
invert the bracket then tip (8 degree) will remain same but the
torque (+ 10 degree to -10 degree) will change which helps to
place the root of the lateral incisor root in cancellous bone.[7]
Figure 1- Gingivally placed brackets in anterior teeth in open
bite case.
Similarly incisally placed bracket helps the clinician for tooth
intrusion. In case of the deep bite clinician should placed
braces incisally in anterior teeth which promote the intrusion
of anterior teeth (figure 2).
Figure 4- Bracket positioning in case of blocked lateral
incisor.
B). In reference of midline & occlusal plane:
Figure 2- Incisally placed brackets in anterior teeth in deep I) Intra arch – If we change a bracket position in same arch by
bite case. crossing the midline of the arch in that condition torque
remain same but the tip change.
I) In horizontal plane- Ideally bracket midline should be For example in case of mesially inclined maxillary canine if
coincide with the long axis of the tooth. Any alteration or we interchanged the maxillary canine bracket then the torque
offset from the long axis create marginal ridge discrepancy
127 University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India
University J Dent Scie 2021; Vol. 7, Issue 3
of canine will remain same but the intentionally misplaced C). Special consideration:
bracket tip helps to upright the canine (figure 5).(8)
IV) Finishing in Class II- McLaughlin, Bennett and
Trevisi introduced the aspect of versatility of MBT brackets.
Placing the lower molar tube on upper molar tooth when
finishing to a Class II molar relationship, taking advantage of
the prescription's 0° offset.
For example, if a lower left second-molar tube is placed on the
Figure 5- Changing intra arch bracket position. upper right first or second molar, the lower molar tube's
original prescription remains the same but 0 degree offset
I) Inter arch ( without crossing midline)- If we changed a helps in a proper Class II molar finish (figure 7).(2,9)
bracket position from one arch to another arch without
crossing the dental midline in that condition tip and torque
both will change.
For example if we placed lower right canine bracket on upper
right canine without inverting the bracket then tip will change
from positive to negative and torque will change from
negative to positive (figure 6).
Figure 7- Interchange of molar tube in finishing in Class II
molar relation.
I) In dental compensatory Class III- Retroclination of lower
] incisors is common error with normal prescription to prevent
this in Class III situation better to invert mandibular incisors
bracket to give +6 degree. In high anchorage cases in which
there is need of enhancing molar anchorage it is very much
beneficial to invert mandibular incisor bracket. For easy
Figure 6- Changing inter arch bracket position. helpful mechanics one should switch the bracket of canine
from wither side (intraarch), in Class III treatments i.e.
Bracket inversion along with crossing occlusal line will changing tip from +3 degree to -3 degree (figure 8).(10)
change the tip but torque remains the same.
III) Inter arch (with crossing midline)- If we changed bracket
position from one arch to another arch with crossing the dental
midline in that case the tip will remain same but torque will
change.
For example if we placed the lower left canine bracket on
upper right canine without inverting it then tip will remain
same but torque will change (figure 6).
Bracket inversion along with crossing dental midline will not Figure 8- Inversion lower incisor brackets in dental
affect bracket prescription. compensatory Class III.
128 University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India
University J Dent Scie 2021; Vol. 7, Issue 3
ii) Switching bracket for tooth substitution- In case of the I) For midline diastema closure- If we interchange the
congenital missing teeth (for example upper right canine) or upper incisors brackets then tip will change and torque
unfavorable impacted teeth of extracted tooth due to some remained same. It causes mesial root movement and when we
pathology adjacent tooth will substitute that canine in the applied diastema closure force then crown moves towards
extraction line of treatment by placing the canine bracket on mesial direction.
upper right first premolar to convert it in to canine.(9,11)
Discussion:
iii) For smile arc- For esthetic smile arc there is a special
prescription called Smile Arch Protection (SAP) bracket Any orthodontic treatments require planned approach
positioning in which for patient unique aesthetic need through which a clinician gains a improved finishing within
position of bracket is planned. Mostly the maxillary incisors less required treatment time. So we need prior judgment of
positioned more towards gingival side than the bracket of placement of the bracket. In this we place the bracket
canine. The mandibular posterior teeth bracket are positioned intentionally to add a more correction and stability.
towards gingival side to avoid hindrance from occlusion,
while the mandibular front brackets are placed incisally for Andrews support the bracket placement at the long axis of the
proper overbite control.(12,13) center of crown until middle of the slot is at the centre of the
crown height, but if we require the rotation, intrusion or
iv) For correction of occlusal cant- Occlusal cant is an extrusion then we have to place the bracket according to our
important factor affecting smile esthetics. Rotation of the jaw need.[17-20]
in its longitudinal plane also called ROLL. For correction of
the dental occlusal cant clinician should placed the braces In 1975 Roth [21, 22] use the preadjusted bracket prescription
occlusally in one quadrant and gingivally on the opposite for 5 years after this he adapted the bracket prescription to
quadrant for selective intrusion and extrusion of teeth overcorrected position through which he established an
respectively.[14,15] overcorrected position of teeth at the end of orthodontic
treatment. If we are not making changes we are not making
v) For therapeutic molar relationship- For achieving the progress. According to Meyer and Nelson [23] if there is an
therapeutic Class I molar relationship we have to place molar error of 3mm to the long axis of bracket placement on
tube in that manner so that we can see more of the distobuccal premolar vertically so we found a change in 15 degree torque
cusp than the mesiobuccal cusp. For achieving the therapeutic and 0.04 mm change in the in/out adjustment. This change
Class II molar relationship we have to place molar tube in that found due to change in the inclination of the buccal and facial
manner so that molar tube should be parallel to the occlusal surface of the crown.
plane. Therapeutic Class III is the opposite of the therapeutic
Class I molar relationship. For achieving therapeutic Class III All the changes and advancement of the orthodontic treatment
molar relationship we have to place molar tube in that manner require the clinician precisely study the pretreatment position
so that we can see more of the mesiobuccal cusp than the of the teeth and place the bracket position in an approved
distobuccal cusp (figure 9).[16] manner on the tooth so that in the end of treatment we found a
better result of the dentition/ occlusion.
Conclusion:
There are various types of bracket prescriptions like Andrews,
Roth and MBT, but the clinicians require more cost, inventory
and knowledge for using the multi-bracket systems or
customize bracket systems. Alteration in the bracket position
during start of the treatment requires less time for the finishing
of the treatment. Intentionally alteration of the bracket
position at beginning on the tooth provides a better finishing
Figure 9- Molar tube position for therapeutic molar relation. and detailing on occlusion which reduce the repositioning of
129 University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India
University J Dent Scie 2021; Vol. 7, Issue 3
the brackets in finishing and detailing stage. Only we have to 12. Sarver, DM. The importance of incisor positioning in the
decide which condition of the tooth position requires esthetic smile: The smile arc. Am. J. Orthod dentofacial
intentionally alteration of the same bracket on different tooth orthop 2001;129:96-111.
& same bracket at different position of the same tooth. Thus 13. Thomas R. Pitts. Bracket positioning for smile arc
this will give the information to the clinician about the use protection. J Clin Orthod 2017;51(3):142-56.
how to change the bracket at different position and that will 14. Ackerman JL, Proffit WR, Sarver DM, Ackerman MB,
provide a better result in orthodontic treatment. Kean MR. Pitch, roll, and yaw: Describing the spatial
orientation of dentofacial traits. Am J Orthod Dentofacial
References: Orthop 2007; 131: 305-10.
15. Kumar M, Goyal M, Sharma H, Kushwah A, Mishra S.
1. Balut N, Klapper L, Sandrik J, Bowman D. Variations in Asymmetrical extraction in an asymmetrical face. J Clin
bracket placement in the preadjusted appliance. Am J Orthod 2020;54(3):177-85.
Orthod Dentofacial Orthop 1992;102: 62-67. 16. Nangia A, Darendeliler MA. Finishing occlusion in
2. McLaughlin R.P, Bennett JC : “Bracket Placement with Class II or Class III molar relation: therapeutic Class II
the Preadjusted Appliance.” J Clin Orthod 1995; 29: 302- and III. Aust Orthod J 2001;17(2):89-94.
311. 17. Andrews FL. The straight wire appliance origin,
controversy, commentary. J Clin Orthod 1976;10:99.
3. McLaughlin R, Bennette J, Trevisi H. Systemized
18. Andrews FL. Straight wire appliance, arch form, wire
orthodontic treatment mechanics, Mosby,St.
bending and experiment. J Clin Orthod 1976;10:8.
Louis,2001.
19. Andrews FL. The S.W.A. explained and compared. J
4. Fowler PV. Variation in the perception of ideal bracket
Clin Orthod 1976;10:174.
location and its implication for the preadjusted appliance.
20. Andrews FL. The S.W.A. syllabus of philosophy and
Br J Orthod 1990;17: 306-10.
techniques. San Diego: LF Andrews Foundation for
5. Sardarian, A, Danaei SM, Shahidi S, Boushehri SG,
Orthodontic Education and Research, 1974.
Geramy A. The effect of vertical bracket positioning on
21. Roth HR. Five years clinical evaluation of the Andrews
torque and the resultant stress in the periodontal
S.W.A. J Clin Orthod 1981;11:175.
ligament—A finite element study. Prog. Orthod 2014;
22. Roth HR. Functional occlusion for the orthodontists, part
15:50. III. J Clin Orthod 1981;11:175.
6. Brandao, R.C.B. and Brandao, L.B.C.: Finishing
procedures in orthodontics: Dental dimensions and
proportions (microesthetics),Dent. Press J. Orthod.
18:147-174, 2013.
7. Thickett E, Taylor NG, Hodge TM. Choosing a pre-
adjusted orthodontic appliance prescription for anterior
teeth. J orthod 2007;34(2):95-100.
8. Kravit ND, Miller S, Prakash A, Eapen JC. Canine
bracket guide for substitution cases. J clin orthod
2017;51(8):450-3.
9. Kravit ND, Miller S. The rules of bracket flipping and
switching. J clin orthod 2020;54(2):518-20.
10. Johnson E. Selecting custom torque prescriptions for the
straight-wire appliance. Am J Orthod Dentofacial
Orthop 2013;143(4):161-7.
11. Palma ED, Giuseppe BD, Tepedino M, Chimenti C.
Orthodontic management of bilateral maxillary canine-
first premolar transposition and bilateral agenesis of
maxillary lateral incisors: a case report. Dental Press J
Orthod 2015; 20(2): 100–109.
130 University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India
