MBT™ Bracket Placement Technique

M c L a u g h l i n , B e n n e t t , T r e v i s i

MBT™ Bracket Placement Technique

Traditionally, it has been recom- Horizontal errors Axial or paralleling errors

mended that preadjusted appliance Brackets can be placed to the Brackets can be rotated off the
brackets be placed with the twin mesial or distal of the vertical long vertical long axis of the clinical
bracket wings straddling, in a parallel axis of the clinical crown, leading crown if the bracket wings do not
fashion, the vertical long axis of the to improper tooth rotation (fig. 1). straddle the long axis of the crown
clinical crown, and that the center Elimination of such errors can be best in a parallel manner (fig. 2). Such
of the bracket slot be placed on the achieved by visualizing the vertical errors lead to improper crown tip
center of the clinical crown.1 Potential long axis of the crown directly from and can also be avoided by viewing
errors or potential deviations from the facial surface, as well as from the the crown directly from the facial
this desired position can occur as incisal or occlusal surface with a surface, as well as from the incisal
follows: mouth mirror. Some orthodontists or occlusal surface. Such errors can
even consider drawing a line through be eliminated by using the same
the vertical long axis of the clinical techniques described for the
crown for more accurate visualization. elimination of horizontal errors.

F i g u r e 1 F i g u r e 2 F i g u r e 3

Horizontal bracket placement errors. These can Axial or paralleling bracket placement errors. These Excess bonding agent beneath the bracket base
normally be avoided with careful technique. can normally be avoided with careful technique. can cause thickness and rotational errors.
T h e M B T ™
S y s t e m B r a c k e t P l a c e m e n t T e c h n i q u e

Thickness errors Vertical errors Gingival Concerns

Such errors can occur if excessive Vertical bracket placement errors 1. Partially erupted teeth. It is
adhesive is left underneath one occur when the bracket is placed difficult to locate the center of
portion of the bracket base (fig. 3), gingival or incisal/occlusal to the the clinical crown on partially
or if the contour of the tooth does center of the clinical crown (fig. 4). erupted teeth (fig. 5) when treating
not correspond accurately to the Such errors lead to extrusion or young patients. The apparent
contour of the base of the bracket. intrusion of teeth, as well as potential clinical crown is foreshortened,
Such errors can cause improper torque and in/out errors. and the tendency is to place the
tooth torque or rotation, and can be The human eye is quite accurate bracket too incisally or occlusally,
eliminated by pressing the bracket at bisecting and locating the center especially with bicuspids and
against the tooth at placement, so of a given object such as a crown, (as lower second molars.
that excessive adhesive flows from Andrews stated1). Therefore, brackets 2. Gingival inflammation.
beneath the bracket, or by contouring can be placed accurately using direct Gingival inflammation (fig.6)
the bracket base to more accurately visualization on fully erupted and causes foreshortening, with the
fit the tooth surface. anatomically normal teeth. However, tendency to place the bracket too
in the following clinical situations occlusally or incisally.10
(which occur quite frequently),
direct visualization is more difficult.

F i g u r e 4 F i g u r e 5 F i g u r e 6

Gingival inflammation causes foreshortening,

Vertical errors in bracket placement are caused It is difficult to visualize the center of the clinical effectively reducing the length of the clinical crowns.
by placing brackets gingival or incisal/occlusal crown on partially erupted teeth, when treating Top: Healthy gingivae. Bottom: The same case with
to the center of the clinical crown. young patients. inflamed gingivae in the upper right quadrant.
M c L a u g h l i n , B e n n e t t , T r e v i s i

F i g u r e 7
3. Teeth with palatally or lingually 2. Crowns with long tapered buccal
displaced roots. With such teeth, cusps. Occasionally a crown on a
gingival tissue covers a greater tooth such as a cuspid or bicuspid
11mm portion of the clinical crown than will show an unusually long and
normal, producing a shorter tapered buccal cusp (fig. 10). If
clinical crown. The tendency is the bracket is placed in the center
to place the bracket too incisally of the clinical crown, adjacent
10mm
or occlusally (fig. 7). marginal ridges will not be prop-
4. Teeth with facially displaced erly aligned. This situation can be
Individual teeth with lingually displaced
roots. Such teeth tend to show a corrected by selec­tively reducing
roots can produce short clinical crowns.
lengthened clinical crown, creating the height of the cusp prior to
a tendency to place the bracket bracket placement.
F i g u r e 8
too gingivally (fig. 8). This is a
common occurrence with cuspids. Proportionally long or short clinical crowns

1. Proportionally long clinical

11mm
Incisal or Occlusal Concerns crowns. When individual clinical
1. Incisal or occlusal crown frac- crowns are proportionally longer
tures or tooth wear. With such than the mean for the individual’s
teeth (fig. 9) it is difficult to visualize dentition (frequently seen with
12mm the center of the clinical crown the upper central incisors), an
since the apparent clinical crown inherent esthetic and occlusal error

Individual teeth with facially displaced is foreshortened. Correction of this will be created if the brackets are
roots can produce long clinical crowns.
problem can be made by either placed in the centers of the clinical
restoring the crown to its appro- crowns. Esthetically, these crowns
F i g u r e 9 priate length, or by estimating will be too long, and functionally
how long the crown was before they will create an interference
fracture or wear. with the opposing dentition. In

Incisal crown fractures or tooth wear

make it difficult to visualize the center
of the clinical crown.
T h e M B T ™
S y s t e m B r a c k e t P l a c e m e n t T e c h n i q u e

this situation, it is necessary to crown. While this adjustment may F i g u r e 1 0

place brackets slightly incisal to also produce a minor error in the

the center of the clinical crowns torque relationship and thickness
of the oversize teeth. While this relationship of these teeth, the
Cuspids with tapered clinical crowns often do not
adjustment may produce a minor problem is normally minimal, and have adequate contact with the opposing teeth.

error in the torque relationship if necessary must be corrected in

and thickness relationship of these the finishing stages of treatment
teeth, the problem is normally with archwire bends. F i g u r e 1 1

minimal, and if necessary must

be corrected in the finishing stages In an attempt to reduce the
of treatment with archwire bends. errors inherent in using only a direct
2. Proportionally short clinical visualization method of bracket
crowns. When clinical crowns are placement, a study was carried out
proportionally shorter than the to provide a method that could serve
mean for the individual’s dentition as a supplement to the direct visual-
(sometimes seen with the upper ization technique. This study was
lateral incisors) (fig. 11), an published in May 1995 in the Journal
inherent esthetic and occlusal of Clinical Orthodontics.2 The result
error is also created if the brackets of this study was the development
are placed in the centers of the of a bracket placement chart which
clinical crowns. Esthetically, these aided in the location of the center of
crowns will be too short, and the clinical crown for each individual
functionally they will be out patient. This in turn allowed for
of contact with the opposing more accurate vertical bracket
dentition. In this situation, it is placement in the above clinical
necessary to place brackets slightly situations. The bracket placement
gingival to the center of the clinical chart is shown in Table 1.

Case with large (and disproportionately sized)

upper central incisors and small lateral incisors
Discussion

Use of the Bracket Placement The technique that has been

Chart (table 1) eliminates potential developed for bracket placement
gingival errors because measure- with this method is as follows:
ments are made from the occlusal or
incisal edge of the teeth. This alone is Step one

a major advantage, since the majority Dividers and a millimeter ruler

of vertical bracket placement errors are used to measure the clinical
that do occur are the result of inability crown heights on as many fully
to accurately visualize the gingival erupted teeth as possible on the
half of the clinical crown. It also patient’s study models.
eliminates the difficulty presented
with proportionally large or small Step two

teeth within the dentition. When These figures are recorded,

these teeth are present, it is necessary divided in half and rounded to the
to place the bracket slightly off of the nearest .5 mm to obtain measure-
center of the clinical crown in order ments for the distance from the
to avoid occlusal interferences, lack incisal or occlusal surfaces to the
of occlusal contact, and esthetic center of the clinical crowns.
height problems. The Bracket
Placement Chart allows for this Step three

adjustment. The only potential The row on the bracket

errors that cannot be avoided are placement chart that contains the
on crowns with incisal or occlusal greatest number of recorded figures
fractures or wear, or on crowns with is selected for bracket placement.
unusually long tapered facial cusps.
When these situations occur, an
appropriate millimeter adjustment
needs to be made to allow the crown
to be properly positioned.
M c L a u g h l i n , B e n n e t t , T r e v i s i

R e co m m e n d e d B r ac k e t P l ac e m e n t C ha r t

U7 U6 U5 U4 U3 U2 U1

2.0 4.0 5.0 5.5 6.0 5.5 6.0 +1.0mm

2.0 3.5 4.5 5.0 5.5 5.0 5.5 +0.5mm

2.0 3.0 4.0 4.5 5.0 4.5 5.0 Average

2.0 2.5 3.5 4.0 4.5 4.0 4.5 -0.5mm

2.0 2.0 3.0 3.5 4.0 3.5 4.0 -1.0mm

L7 L6 L5 L4 L3 L2 L1

3.5 3.5 4.5 5.0 5.5 5.0 5.0 +1.0mm

3.0 3.0 4.0 4.5 5.0 4.5 4.5 +0.5mm

2.5 2.5 3.5 4.0 4.5 4.0 4.0 Average

2.0 2.0 3.0 3.5 4.0 3.5 3.5 -0.5mm

2.0 2.0 2.5 3.0 3.5 3.0 3.0 -1.0mm

s Table 1. Highlighted figures represent the three minor maxillary arch changes and the
three minor mandibular arch changes that were made from the initial Bracket Placement
Chart. These changes were based on evaluations of the American Board-Angle Society case
measurements and cases measured at the debanding appointment.
M c L a u g h l i n , B e n n e t t , T r e v i s i

A. Because of the possible presence Step five gingivally and place a step bend to
of proportionately large teeth (i.e. A bracket placement gauge is avoid extrusion of the tooth, or to
upper central incisors) or small then used to confirm that the brackets place all brackets proportionately
teeth (i.e. upper lateral incisors) are at a height that represents the more gingival on the lower arch.
some recorded figures will be appropriate figures in the selected When the interference occurs in the
larger or smaller than the numbers column of the bracket placement incisor region, it is normally due to
in the selected column and in chart. The authors prefer to use the the presence of a deep overbite. The
turn in the numbers used for bracket positioning instruments choices in this situation are to leave
bracket placement on these teeth. from 3M Unitek. brackets off of the lower incisors
B. As stated above, when crowns A. For direct bonding procedures, until bite opening occurs, to allow
show incisal or occlusal wear the use of a light curing adhesive the interference to occur until bite
or fracture, or excessively long system is most beneficial since opening is achieved, or to place an
tapered cusps, an appropriate slightly more time is required to anterior bite plate until bite opening
millimeter adjustment must be assure correct positioning with occurs. The specific decision to be
made to assure correct position the bracket placement gauge. made in each case is dependent on
of these crowns. the clinical situation.
With the placement of any The authors have tested this
Step four bracket on the lower arch, there is method of bracket placement on a
At the time of banding and always the potential for interferences variety of cases for over three years
bonding, brackets are placed by with the upper dentition. When this and have found that it has improved
visualizing the vertical long axis of situation occurs in the molar region, treatment efficiency during leveling
clinical crowns (buccal groove on the it is generally due to lingually and aligning, with fewer cases
molars) as a vertical reference and inclined crowns which elevate the requiring bracket repositioning
the estimated center of the clinical position of the bracket on the buccal due to vertical placement errors.
crown as a horizontal reference. surface. When this occurs the choices It has also been most helpful in the
are to allow the interference to occur repositioning procedures required
until crown uprighting occurs, to on cases bonded and banded prior
place an upper anterior bite plate to the development of the Bracket
and eliminate the interference, Placement Chart.
to place the effected bracket more
T h e M B T ™
S y s t e m B r a c k e t P l a c e m e n t T e c h n i q u e

Summary and conclusions

Direct visualization of the center technique becomes more difficult. check bracket positions after visual
of the clinical crown is a satisfactory Such situations do occur quite fre- placement. The technique has been
method of locating this point on fully quently in an orthodontic practice. used in the practices of the authors for
erupted and anatomically normal A bracket placement chart was several months and has dramatically
teeth. However in situations in developed that allows the orthodontist reduced the need for bracket reposi-
which there are gingival variations, to select a set of numbers representing tioning due to incorrect visualization
differences in tooth size within the average center of the clinical of the center of the clinical crown.
the dentition, or incisal or occlusal crown for a given patient. Measure­
variations, this direct visualization ment gauges can then be used to

2.0 –2.5 mm, REF. 900-836

3.0 –3.5 mm, REF. 900-837

4.0 –4.5 mm, REF. 900-838

5.0 –5.5 mm, REF. 900-839

3M Unitek Bracket Positioning Gauges are offered individually or as a kit of 4 instruments.

References
1. Andrews, L.F.: Straight-Wire - The Concept and The Appliance. Los Angeles. Wells Company. 1989.

2. McLaughlin, R. P. and Bennett, J. C.: “Bracket Placement with the Preadjusted Appliance”
Journal of Clinical Orthodontics May 1995; 29: 302-311.
3
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