Sunday, May 20, 2012

Bracket repositioning

Question: In this treatment, initial leveling and aligning is complete, so it is time reposition the brackets. Here is the panorex. How do I know what brackets to reposition? Do I look at the way roots are supposed to be? In this case, no repositioning has been done; I just want to be certain I get the concept of repositioning brackets. Thanks for your time.


         Right                                                     Left
Answer: Yes you do reposition brackets based on root position as viewed on on the panorex as well as (on premolars and molars) marginal ridge heights as viewed in the mouth. Ideal bracket positioning results in slight distal inclination of all the roots. In this case, I would reposition both upper lateral brackets because both roots are mesially inclined. By aligning the long axis of the bracket with the pulp canal (rotate both brackets disto-gingivally) distal root inclination will be accomplished. Also, the upper 1st premolar roots need more distal inclination and, on the lower, both lower 5's and the lower right 2 need more distal root inclination. After repositioning, use 016niti for a month to align the repositioned brackets. After aligning is accomplished, continue with mechanics. Here is a way to help position brackets correctly: At the repositioning appointment, take a panorex to check for incorrectly positioned brackets. Evaluate root position (also called 2nd order position), and reposition the brackets to improve root position. Also check posterior marginal ridge height and reposition brackets to obtain level marginal ridges. Repositioning is time consuming and difficult, but correcting 2nd order inclination will result in much better occlusion. Root inclination is the main focus of repositioning because 2nd order arch wire bends are difficult to make. When repositioning, first identify teeth with incorrect root inclination. Reposition the brackets on those teeth so the long axis of the bracket is parallel to the pulp canal. Ideally, brackets should be checked (and repositioned, if necessary) twice during treatment. The first repositioning is done after the wire progression is complete (usually about 7 to 10 months into treatment) and the second repositioning is done at the start of finishing (usually about 4 months before removal). Look at the x-ray below and evaluate root position.
Is there a method to quickly determine how to position brackets to achieve optimal root position? Fortunately, there is. Focus on the inclination of the bracket slot. If distal root movement is needed, angle the bracket slot disto-gingivally, and if mesial root movement is needed, angle the slot meso-gingivally. Look at the example below.
The outlined tooth (red) represents the current root position. To tip the root to the distal, change the inclination of the bracket slot so it is angled disto-gingivally.
Here is how a correctly positioned
bracket should look. 
Notice how changing the slot inclination changes how the root will be positioned. (Thanks to Gerry Samson, for allowing the use of these photos. You can find more information about Gerry’s CE courses at www.gnathosce.com .












23 comments:

My nam is Kieu Trinh.. said...

thanks alot for your usful experience!hope you could share as much as possible...

Ron Johnson said...

I've been looking into orthodontics in Bedford and want to get the most out of it. Thanks for posting all the helpful information!

Lance Tankmen said...

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Sampson Greenovich said...

To me having a perfect smile is about having a really good Orthodontist. Without someone who understands how teeth move and how braces can help there is little hope of straightening your mouth to the point that it becomes comfortable. I don't know what I would have done without my orthodontist.

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Jak Manson said...

When it comes to orthodontics, what is the difference between regular orthodontics and practical orthodontics? I have been wanting to know this for awhile now and I really would like to find out. There is just so much that I have to ask after this question too.
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Elin martin said...

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Jason Strong said...

It's amazing to see what braces can do! I had braces for a year and half when I was fourteen, and it made the world of difference with my teeth, and my over all look. Investing time and money in a good orthodontist is well worth it.

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Bill Stewart said...

I'm glad that I got my teeth repositioned. They would be a mess otherwise. I wonder how eating would feel.
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DentalCare Canada said...

Orthodontics has come a long way. It's amazing how far your teeth can be moved by orthodontic procedures. The metal bands have been replaced with brackets that are bonded directly to the front of the teeth. Less noticeable and more comfortable. Our dentist offer quality Orthodontics in etobicoke to the children's who desire to have aligned teeth.

Jennifer Davies said...

I've never seen pictures like that. The roots of the teeth in the first image look terrible-- is that common, or are those exceptionally bad? I've never thought about the repositioning of teeth that braces do. It really does have repercussions throughout the entire jaw. Braces are incredible.

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Kyle McDonald said...

I make sure that I take my kids to the dentist every six months. The kids love him. He always acts like a clown in front of them to make sure they have the best experience at the dentist. http://www.smilesbygentledental.com/

deny lost said...

Great blog post! I don’t understand how long it will require me to obtain through all of them! Dearborn Dentistry

Amber Johnson said...

My kids are growing up and it is about time for them to get braces. I want to be sure they get the best care that they can. I think it is important to get these things taken care of when they are younger. Thanks for sharing! http://www.kujakortho.com

Emily Smith said...

I have always thought orthodontics was cool. It was amazing to me that these orthodontists could straighten out my teeth with a little bit of metal. I am now in school to be an orthodontist. I still have a ways to go. I am really excited to start my career in a few short years.
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Dolores Brown said...

Do orthodontist reposition brackets very often, or is that pretty rare? I thought the brackets were sort of permanent and that they really took a lot to move them. Does it hurt at all the patient to have the brackets moved? I wouldn't want to go through that. http://www.kidbraces.com

Keara Littner said...

It makes sense that you'd want to change the angle of the bracket slot if you want to rotate a tooth's root. Though, I am curious about one thing. Once you figure out the angle it should be placed at, how difficult is it to actually put the bracket on at the correct angle?
http://www.hamiltondentist.ca/orthodontics.html

mona said...

Thank you

Jim Peters said...

My kid has been going to the orthodontist for the past 3 years. This morning he woke up and his bracket was really bothering him. Usually we go straight to the orthodontist when this happens, but the problem is that he is out of town. What do you suggest doing to get rid of the pain? http://www.marorthodontics.ca/locations/st-albert-office

faryal naaz said...

This is really tremendous that the way you describe I'll really appreciated your work.hope i'll come back to get some more information .Thanks
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Simonclrak said...

Wow, cool post. I’d like to write like this too – taking time and real hard work to make a great article… but I put things off too much and never seem to get started.
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jayashree said...

Really a great work and thus how it is possible to change the shape of the jaw bone, it is really a great article. i am looking forward more things from you.


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