|Year : 2018 | Volume
| Issue : 6 | Page : 115-126
Clinical experiences with self-ligation brackets in India
Gurkeerat Singh1, Rajesh Patil2
1 Prof., Department of Orthodontics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
2 Dr., Private Practitioner, Mumbai, Maharashtra, India, Mumbai
|Date of Submission||20-Nov-2018|
|Date of Acceptance||27-Nov-2018|
|Date of Web Publication||7-Dec-2018|
Prof. Gurkeerat Singh
D-32 The Dental Centre, D-32, South Extension Part-1, New Delhi - 110 049
Source of Support: None, Conflict of Interest: None
As the markets get flooded by ever evolving self-ligation brackets, the clinician is likely to get carried away by marketing gimmicks and false promises. A simple yet extensive review of self-ligating brackets used by the authors is presented along with case reports. The purpose is not to be critical of individual products but present the wide variety of such brackets available today. The choice of the bracket system is based on multiple factors and quality of certain products just makes the life of the clinician as well as the patient more comfortable. The case reports emphasis that the end result is primarily due to the clinical acumen of the operator and every individual system requires a learning curve to be overcome.
Keywords: Brackets, clinical experience, nonextraction, self-ligation
|How to cite this article:|
Singh G, Patil R. Clinical experiences with self-ligation brackets in India. J Indian Orthod Soc 2018;52, Suppl S2:115-26
|How to cite this URL:|
Singh G, Patil R. Clinical experiences with self-ligation brackets in India. J Indian Orthod Soc [serial online] 2018 [cited 2018 Dec 16];52, Suppl S2:115-26. Available from: http://www.jios.in/text.asp?2018/52/6/115/247059
| Introduction|| |
The concept of self-ligation is neither new nor lacking in documentation.,,, The self-ligating brackets have existed in the Indian market since the early 21st century. There use was restricted to a limited few due to the cost differences prevalent between the conventional preadjusted brackets and the self-ligation brackets. These were further aggravated by the monopolizing policies by certain brands as well as the introduction of experimental designs by companies into the Indian market in the name of introducing “high end” brackets into a third world market. A major lacunae exist about their use in our country, primarily because a wide variations exist between treatment charges and material costs to orthodontists. This article intends to educate the readers about the pros and cons of the various brackets used by the authors and may help them to decide what would be ideal in their practices.
All the brackets used have been cataloged in a tabular fashion [Table 1] with certain pros and cons mentioned against each. The list is definitely incomplete and includes only those brackets that have been personally used by the authors. This article in no means is meant to pass judgment over any of these brackets or companies. Newer and better brackets are being introduced with every passing month, and the same companies highlighted here are introducing improved versions of the same bracket. It is in the interest of the reader to make an informed choice based on his/her requirement and/or preference. A series of case reports follow which highlight the excellent results achievable with self-ligation brackets.
| Case Reports|| |
Case report 1
An 11-year-old male patient reported with a chief complaint of mal-aligned teeth. On examination, he was found to be Skeletal Class I with a Angle's Class II tendency, high placed canines and multiple retained deciduous teeth and fractured 11 and 21 [Figure 1]a. All deciduous teeth were extracted except the upper left second deciduos molar. As per Damon protocol, all the teeth were bonded and 0.013” Cu NiTi wires engaged [Figure 1]b. As the arches developed, the right side came into Class I relationship. The 65 was extracted and a coil spring was used to maintain the space and Class II 3 oz elastics to correct the Class II relationship on that side [Figure 1]c. The finishing was done using 0.019” × 0.025” titanium-molybdenum alloy (TMA) wire. A Bolton discrepancy existed between the two arches and veneers were suggested on the maxillary incisors. The case was debonded after 18 months of active treatment [Figure 1]d.
|Figure 1: (a) (i-iii) Pretreatment photographs. (b) (i-iii) With 0.013” copper nickel-titanium in place. (c) With 0.019” ×). 0.025” titanium-molybdenum alloy finishing wire. (d) (i-iii) Posttreatment photographs|
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Case report 2
OC easy, 3B orthodontics
A 12-year-old female patient reported with a chief complaint of digit sucking. On examination, she was found to be suffering with an anterior open bite with skeletal and dental Class I relationship [Figure 2]a. Both arches had moderate amounts of crowding. She was treated with a full bonded fixed appliance [Figure 2]b along with a habit reminder appliance. As the causative factor was removed the light forces exerted using the OC Easy bracket and copper nickel-titanium (CuNiTi) combination, the arch aligned and settled into perfect occlusion [Figure 2]c. Upper lateral to lateral and lower canine to canine bonded retainers were given for retention.
|Figure 2: (a) (i-iii) Pretreatment photographs. (b) (i-iii) Mid-Treatment photographs. (c) (i-iii) Posttreatment photographs|
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Case report 3
Vision, American Orthodontics
A 15-year-old female patient reported with a chief complaint of mal-aligned teeth long with an unerupted tooth. On examination, she had a Class I skeletal and dental relationship with an impacted 13 [Figure 3]a. The complicating factor was a 90° mesial dilacerations of the 14 roots [Figure 3]b. The patient was explained the complication and alignment was started using self-ligation brackets and light wires. The canine was exposed and pulled into alignment with the CuNiTi flexible wires [Figure 3]c. The canine alignment could not be completed in the vertical plane due to the dilacerated 14 root [Figure 3]d. The case was retained using bonded retainers in both the arches. A 5 years' follow-up showed a well-settled occlusion [Figure 3]e.
|Figure 3: (a) (i-iii) Pretreatment photographs. (b) Pretreatment orthopantomogram. (c) (i-iii) The alignment of the 13 using flexible round copper nickel-titanium wires. (d) (i-iii) Posttreatment photographs. (e) (i-iii) Well-settled occlusion 5-year posttreatment|
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Case report 4
Damon Q, Ormco, USA
A 13-year-old female patient reported with a chief complaint of mala-aligned teeth. On examination, the patient had a Class III skeletal pattern with a Class I Angle's molar relationship with moderate crowding in both the maxillary and mandibular arches, retroclined mandibular anteriors and with 16 and 26 in cross-bite [Figure 4]a. The lips were competent and the profile straight. It was decided to treat the case nonextraction with the Damon Q appliance with standard torque. Both the arches were bonded and 0.014” CuNiTi wires used for initial alignment [Figure 4]b. The case was finished with a 0.19” × 0.025” TMA wire. At the end of active treatment, which lasted 14 months, the molar relationship was Super Class I with the canines in Class I relationship [Figure 4]c. A bonded retainer was placed in both the arches. A 5-year follow-up revealed a stable and well-settled occlusion [Figure 4]d.
|Figure 4: (a) (i-iii) Pretreatment photographs. (b) (i-iii) The alignment was done using 0.014” copper nickel-titanium wires. (c) (i-iii) Posttreatment photographs. (d) (i-iii) Well-settled occlusion 5 years' posttreatment|
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Case report 5
H4 classic; Ortho Classic, USA
An 18-year-old male patient reported with a chief complaint of mal-aligned teeth. On examination, the patient had a Class I skeletal pattern with Angle's Class I molar relationship. Both the maxillary and mandibular teeth exhibited moderate crowding, with “V-” shaped arches and supra-erupted mandibular anteriors [Figure 5]a. It was decided to treat the patient with a self-ligating appliance and align using light forces. H4 brackets were bonded, and alignment started using round CuNiTi wires. After an initial phase, the 0.016” × 0.016” Thermal NiTi wires were inserted as a transition wire before rectangular wire phase [Figure 5]b. The case was finished using 0.019” × 0.025” TMA wires. Following settling, the case was debonded [Figure 5]c. Bonded coaxial wire retainers were used for retention.
|Figure 5: (a) (i-iii) Pretreatment photographs. (b) (i-iii) The alignment was done using 0.014” copper nickel-titanium wires. (c) (i-iii) Posttreatment photographs|
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Case report 6
Protect IV, 3B orthodontics, China
An 11-year-old female patient reported with a chief complaint of a missing tooth. On clinical examination, the 13 was found to be impacted due to a lack of space as the posterior dentition has moved anteriorly [Figure 6]a. The upper mid-line was shifted to the right by 1 mm; the left canine was also erupting more labial. It was decided to treat the patient nonextraction with a self-ligating appliance. Protect IV brackets with an MBT prescription were bonded [Figure 6]b and alignment achieved in a treatment spanning 18 months. Bonded coaxial wire retainers bonded on the maxillary incisors and the mandibular anteriors for placed for retention. The settled occlusion would hold the posterior segment in place [Figure 6]c.
|Figure 6: (a) (i-iii) Pretreatment photographs. (b) (i-iii) The alignment using 0.014” × 0.025” copper nickel-titanium wires. (c) (i-iii) Posttreatment photographs|
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| Conclusion|| |
Six cases, six different bracket systems and acceptable cases finishes. Self-ligation brackets have created a niche for themselves, and this is only partially due to the ideal properties as listed by Nigel Harradine. Marketing has played a major role in their success story. Their success is also not without reason. In the right hands, they are definitely capable of reducing chair-side time, provide faster initial alignment as well as better hygiene, but none of these could be collaborated. In the right hands and with adequate experience, the brackets perform well and do have the added advantage of being available in different torque prescriptions, if nothing else they do decrease the need for wire bending but nothing without overcoming the learning curve.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Harradine NW. Self-ligating brackets: Where are we now? J Orthod 2003;30:262-73.
Fleming PS, DiBiase AT, Lee RT. Self-ligating appliances: Evolution or revolution? J Clin Orthod 2008;42:641-51.
Rinchuse DJ, Miles PG. Self-ligating brackets: Present and future. Am J Orthod Dentofacial Orthop 2007;132:216-22.
Miles PG. Self-ligating brackets in orthodontics: Do they deliver what they claim? Aust Dent J 2009;54:9-11.
Harradine H. The history and development of self-ligating brackets. Semin Orthod 2008;14:5-18.
Fleming PS, Johal A. Self-ligating brackets in orthodontics. A systematic review. Angle Orthod 2010;80:575-84.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]