Damonsystembydranalhaqshaikh 190423132606 PDF

BY DR ANALHAQ SHAIKH
2 ND YEAR PG
Dr ANALHAQ SHAIKH 2
CONTENTS
• Introduction
• Self ligating brackets
• Damon System
• Damon Philosophy
• Biomechanics and Cellular Biology
• Damon Q Torque Prescription
• Damon Q Opening and Closing technique
• Disarticulation and Damon System
• Managing Anchorage 3
Dr ANALHAQ SHAIKH
CONTENTS
• Bracket Positioning
• Pitts Protocol for Bracket Positioning
• Archwires
• Elastics
• Stability of Damon System
• Summary
• References
4
Dr ANALHAQ SHAIKH
Introduction
• Orthodontics is an Art and Science.
• Orthodontic science always strived hard to deliver the best
possible, both the patient and practicing Orthodontist.
• PEA helped us to move the teeth more predictably, but
certain drawbacks associated with conventional ‘ligation’
slows down the phase considerably.
Dr ANALHAQ SHAIKH 5
• At the present day SLBs are primarily developed and used
with the concept of low friction at “bracket – Arch wire”
interface; because of which Light forces generated by
copper NiTi wires are so successful in bringing about
levelling, aligning and de crowding.
Self Ligating Brackets
• “Self ligation brackets are ligature less bracket system that
have a mechanical device built into the bracket to close off
the edgewise slot.”
• The cap holds the archwire in the bracket slot and replaces
the steel/elastomeric ligature. With the self-ligation
brackets the movable fourth wall of the bracket is used to
convert the slot into a tube.
Dr ANALHAQ SHAIKH 7
“A bracket, which utilizes a permanently
installed , moveable component to entrap the arch wire”
Classify
ACT I VE CL I P S PA S S I VE S L I D E
Active and passive self-ligation refer to the action of the locking slide or clip on the wire.
Dr ANALHAQ SHAIKH 8
Active Clip
• It uses a flexible component to entrap the arch wire .
• This flexible component constrains the arch wire in the
arch wire slot and has the ability to store and
subsequently release energy through elastic deflection.
• This gentle action imparts a light but continuous level of
force on the tooth and supporting structures
Dr ANALHAQ SHAIKH 9
Passive Slides
• It uses the rigid movable
component to entrap the arch
wire.
• Tooth control is determined
solely by the fit between
bracket slot and arch wire .
Dr ANALHAQ SHAIKH 10
Properties of an Ideal Ligation System
• Be secure and robust,
• Ensure full bracket engagement of the archwire,
• Exhibit low friction between bracket and archwire,
• Be quick and easy to use,
• Permit easy attachment of elastic chain,
• Assist good oral hygiene, and
• Be comfortable for the patient.
DAMON SYSTEM
• The Damon System (Ormco Corp., 1332 South Lone Hill
Ave., Glendora, CA 91740-0000) is a passive self-ligation
system that was originally introduced in 1994.
• The Damon philosophy is based on the principle of using
just enough force to initiate tooth movement—the
threshold force.
• A passive self-ligation mechanism has the lowest frictional
resistance of any ligation system.
• Thus the forces generated by the archwire are transmitted
directly to the teeth and supporting structures without
absorption or transformation by the ligature system.
Dr. Dwight Damon

About Damon System
• Damon philosophy is not centered around Damon brackets
alone, but a treatment planning concept that focuses on
facial aesthetics as the critical foundation for diagnosis.
• For those who still get hung up on the extraction vs non-
extraction debate, it should be noted that this is not a “non-
extraction” philosophy.
• The facially driven treatment planning concept is again
emphasized in the patients where treatment is planned
with extractions to achieve a desire change in facial
esthetics.
The damon system arsenal:
1. Damon SL (1996)
2. Damon 2 (2000)
3. Damon 3 (2004)
4. Damon 3MX (2005)
5. Damon Q™ (2009)
6. Damon Clear – ceramic variant
7. Insignia
8. Damon Q2 (2017)
• To quote Dr Damon : Over the past few years, I have had
the opportunity to lecture in many parts of the world. It is
very interesting and informative to observe the reaction of
clinicians when exposed to a “new way of looking at our
clinical force systems.”
• After spending nearly 20 years, carefully evaluating the
rationale of my clinical mechanics, it became very apparent
that I was using the force system that was simply not
“biologically sensible”.
• It made very little sense to be using a bracket system to
move teeth along an arch wire that was tightly tied.
• To overpower this binding and friction, we have found it
nearly impossible to use forces that are consistent with
biologic principles of tooth movement.
Clin Orthod Res. 1998 Aug;1(1):52-61.
The rationale, evolution and clinical application of the self-ligating bracket.

Damon DH.
Abstract
There is ample evidence in the literature that conventional orthodontic mechanics
while intended to move teeth efficiently rarely achieve atraumatic remodeling of
periodontal tissues. The vascular supply is often interrupted, which in turn affects the
oxidative metabolism. Moreover, teeth splinted in groups do not appear to move as
efficiently as single teeth. The novel bracket design and treatment regimen described
in this report allow teeth to move individually, yet stay within a group.
The self-ligating bracket design allows for rapid leveling because teeth drift along the
path of least resistance with little or no friction between the bracket and slot of the
wire. The hinge mechanism eliminates much of the friction created by the
conventional wire or latex ties used to secure the archwire in the bracket slot.
Thus, sliding mechanics is achieved in the true sense of the word.
This system is capable of increasing the appointment intervals, and possibly reducing
the overall treatment time.
PMID: 9918646
[Indexed for MEDLINE]
3 Pillars of Damon System Bio-adaptive
Therapy
• Passive Self-Ligating Brackets – Low friction, improved
comfort, better hygiene
• New Wire Technology – Lighter forces, fewer
adjustments
• Minimally Invasive Mechanics – Far fewer
extractions and the near- elimination of headgear
or rapid palatal expansion
Pillars of Damon System
Damon Philosophy
• “Orthodontics is a type of controlled pathology where we
institute bone break-down and bone rebuilding at the same
time.”
• Here underlies the magic of orthodontics… how to get the
bone to change shape which then allows the teeth to be
repositioned in the most efficient means.
A magnified look of at the fragile lace-like vascular network in the periodontal ligament close to
the root
Capillaries entering the foramina of the cortical bone
• Do not crush these vessels with heavy forces.
• Here is where the magic occurs. For the bone to remodel,
an excellent blood supply is a must. The Damon Philosophy
incorporates a self ligation brackets, super elastic wires and
thoughtful patience by the orthodontist.
• Damon philosophy is not about the bracket, it is about the
System.
• A low friction bracket, light force mechanics and respect for
the biologic responses that allow tooth movement.
• Dr. Dwight Damon argues that he creates a functional
adaptation similar to the Frankel effect with very light wires
in his friction-free appliance and that tipping the balance of
forces in a positive direction (thereby reestablishing a
functional balance) allows the alveolar process to create a
new arch form specific for each individual.
• Dr. Dwight sees this as adaptation rather than expansion.
• The difference is that in using light forces to facilitate
adaptation, you’re not creating an artificially preset arch
form with rigid wires or other high-force means such as
expanders.
• You’re fostering the formation of a new arch form through
low-force, flexible wires overcoming the original functional
abnormality.
• Dwight refers to this phenomenon as physiologically
determined tooth position.
Design Criteria for the Damon SL Bracket
The Damon SL bracket was designed to satisfy the following
major criteria:
• Andrews Straight Wire Appliance concept
• Twin configuration
• Slide forming a complete tube
• Passive slide on outside face of bracket
• Brackets opening inferiorly in both arches
Cellular Biology
• Proffit proposed that the optimum force levels for
orthodontic tooth movement would be just high enough to
stimulate cellular activity without completely occluding
blood vessels in the PDL. If a force is great enough to
occlude the blood vessels and cut off the blood supply, a
hyalinized, avascular area is formed that must revascularize
before teeth can move. Pain is related to the development
of ischemic areas in the PDL.
Proffit, W.R. and Fields, H.W.: The biologic basis of orthodontic therapy, in Contemporary Orthodontics, C.V. Mosby
Dr ANALHAQ SHAIKH
Co., St. Louis, 1993, pp. 266288. 30
Note the amount of blood flow in the PDL, and concentrated in the
area of new bone deposition.
TOOTH MOVEMENT AND OXYGEN
• Tuncay suggested that oxygen is the trigger mechanism for
remodelling of the periodontium.
• According to Proffit, if vascularity is critical to tooth
movement, there is no doubt that light, continuous forces
produce the most efficient tooth movement and that heavy
forces should be avoided.
Tuncay, O.C. et al.: Oxygen tension regulates osteoblast function, Am. J. Orthod. 105:457463, 1994
Pressure Side
Traditional Heavy Forces
Note how blood vessels are crushed in the necrotic PDL and how much
bone must be eroded to cause movement with undermining resorption.33
Dr ANALHAQ SHAIKH
Why light forces?
Pressure Side
Characteristics of Light Forces
capillaries
• Rygh recommended light,
continuous forces for more
effective tooth movement in areas
Conventional forces with necrotic
with cortical bone or bone with few PDL
marrow spaces.
• Use forces that do not interrupt the
vascular supply.
Rygh, P.: Periodontal response to toothmoving force: Is trauma

necessary? in Orthodontics: State of the Art, Essence of the Science,
ed. L.W. Graber, C.V. Mosby Co., St. Louis, 1986, pp. 100115.
Low forces with vascular PDL
• Proffit noted that "root remodeling is a constant feature of
orthodontic tooth movement, but that permanent loss of
root structure occurs only if repair does not replace the
initially resorbed cementum. Activating an appliance too
frequently, short circuiting the repair process, can produce
damage to the teeth or bone that a longer appointment
cycle would have prevented or at least minimized. If the
appliance is springy and light forces produce continuous
frontal resorption, there is no need for further activation."
• Warita compared the application of a light, continuous
force (5g/f) vs. a light, dissipating force (10g/f) for 39 days
on rat molars. He found 1.8 times greater tooth movement
with the light, continuous force. "Histological observation
showed that the PDL applied with light continuous force
tended to be more physiologically preserved than that
applied with light dissipating force."
Warita, H. et al.: A study on experimental tooth movement with NiTi alloy orthodontic wires: Comparison between light
continuous force and light dissipating force, J. Jap. Orthod. Soc. 55:515527, 1996.
• Clearly, the use of light, continuous forces and appropriate
appointment timing can dramatically enhance patient
comfort and shorten treatment.
Biocompatible Mechanics
• Large dimension, high tech wires are often placed at the bonding
appointment and retied until the teeth are leveled and aligned.
• Thus, the archwire sequence is based on a bracket and ligature system
with significant amounts of friction.
• These wires can overpower the friction in the system, but, according to
Dr. Damon, with far greater patient discomfort and longer treatment
times than if patients are started with small dimension, high tech
archwires in a nearly friction free bracket system.
• Starting cases with .014" superelastic nickel titanium or occasionally
.012" superelastic nickel titanium wires, leveling and alignment occur in
much less time, with no apparent harmful effects on roots, bone, or
tissue. And also fewer complaints from patients about discomfort from
tooth movement.
• In conventional treatment, if high maxillary cuspids are engaged, the
normal response is for the adjacent teeth to move superiorly in response
to the cuspids moving inferiorly. With low friction mechanics, cuspids
erupt without adversely affecting the adjacent teeth.
• Headfilms and intraoral photographs clearly show that the
lip musculature is not overpowered by the light archwires.
The orbicularis oris and mentalis muscles produce a "lip
bumper“ effect on the maxillary and mandibular incisors.
Capturing the essence of the Damon approach
• Dr. Dwight Damon wanted a bracket that acts like a tube because, after
30 years in orthodontics, he knew that such a conduit was the only
mechanism that would give him the tooth movement he wanted using
light forces.
• It provides a well-documented means, a virtually friction-free tube, by
which the most advanced wire technologies can work to their maximum
advantage, an aim most of us have aspired to but have not been able to
achieve in conventionally ligated edgewise systems.
Alan Pollard. Capturing the essence of the Damon approach. Clinical Impressions 2003; 12(2):4-11.
1.I thought Dwight’s focus was on eliminating ligatures. My first revelation
when visiting him was that this was not his intent at all. Dwight actually
designed the bracket to meet a much more significant clinical function.
I’m not talking about the way the slide works in the bracket. Sure, that’s
important from a practical standpoint, but his idea is much more
powerful than that.
2.He’s taken the concepts of Angle and Begg, pulled out the bits worth
saving and discarded the rest. What are some of those good bits? Rapid
alignment with gentle forces, functional adaptation and accurate,
predictable tooth positioning with micro precision. The buzz phrase of
the new millennium is convergent technology and the Damon system is
exactly that.
7 Essential Damon Principles
1. Treatment planning must be facially based.
2. Do not allow the orthodontic forces to overpower the biological
system during any treatment phase.
3. The aim of the Ni-Ti® phases of treatment is not only to level and
align but also to reshape the arch form specific to each individual
patient through functional adaptation.
4. Complete leveling, alignment and rotational control require full-depth
rectangular archwires.
Alan Pollard. Capturing the essence of the Damon approach. Clinical Impressions 2003; 12(2):4-11.
5. The Working/Final Phase of treatment requires rigid wires.
6. Sagittal relationship corrections are best carried out by functional
adaptation achieved via intermaxillary forces applied en masse.
7. Retention requires careful consideration.
• Retention requires careful consideration.
Following the Path of Least Resistance
• There is a misconception about Dwight’s arch form being
too broad.
• Dwight doesn’t really have a preset arch form. Each
patient’s final arch form is determined by the functional
adaptation in the Ni-Ti Phases by flexible wires.
• The Working/Final Phase wire is bent to the shape of the
resulting mandibular arch after alignment/adaptation.
• The maxillary arch form is made identical to the mandibular
wire.
• The adaptive arch form that the Ni-Ti wires create with the
Damon System does not have much to do with the shape
of the Damon archwire.
• The posterior adaptation results from interplay among the
tongue, the alignment forces and the resistant lip
musculature.
• During alignment with light forces in a passive system, the
lips and tongue encourage the teeth to follow the path of
least resistance, which is posterolaterally, so you see that
movement rather than the anterior dumping that you see
from a conventionally ligated appliance.
• the considerable adaptation you realize from
the Damon System is due to the functional
interplay among the light forces of the Ni-Ti
wires, the tongue and the lips that causes the
buccal teeth to move laterally in the path of
least resistance. It’s the path of least
resistance because the lower lip is
maintaining incisal position.
• In superimposing the arch from this fully
aligned case onto its original arch at the
canines, you see the lateral movement of the
buccal teeth. The final lower incisor position
will depend upon a number of factors,
including the original axial inclination of the
canines and the position of the tongue.
Damon Q Torque Prescription
UPPER 1st BICUSPIDS Standard -12
Standard -11
BICUSPIDS
2nd BICUSPIDS Standard -17

UPPER
Standard -18
1st MOLAR
LOWER 1st
Standard -28
UPPER MOLAR
nd Standard -27
2 MOLAR
LOWER 1st
Standard -10
MOLAR
Bracket Selection
High Torque Brackets
Examples of where high torque brackets may be used on
upper incisors are as follows:
• Extraction cases where treatment mechanics may
excessively retrocline the upper incisors;
• Class II Division 1 malocclusions where treatment
mechanics may excessively retrocline the upper incisors;
and
• Class II Division 2 malocclusions.
Examples of where high torque brackets may be used on
upper cuspids are as follows:
• First premolar extraction cases; and
• Cases where the crowns of the upper cuspids are palatally
tipped.
Standard Torque Brackets
• Standard torque brackets are used where the inclination of
the teeth is satisfactory before treatment and the
treatment mechanics will not adversely affect the
inclinations during treatment.
• Dr. Dwight Damon suggests using standard torque in cases
where extreme gingival placement is required to improve
incisor display (smile arc), for low angle cases and severe
open bites. Standard torque is also suggested on lower
anteriors in cases that are periodontally challenged or
compromised.
Low Torque Brackets
Examples of where low torque brackets may be used on
upper incisors are as follows:
• Excessively proclined upper incisors;
• Isolated upper incisors with palatally positioned roots (e.g.
upper lateral incisor in the palate);
• Malocclusions where treatment mechanics may result in
excessive upper incisor proclination;
• Moderate and severe upper arch crowding; and
• Anterior open bite cases with proclined incisors.
Examples of where low torque brackets may be used on
lower incisors are as follows:
• Cases where it is necessary to control the proclination of
lower incisors, e.g. extreme lower labial segment crowding,
cases using Class II elastics, and fixed Class II correctors
attached to the brackets, buccal tubes, or archwires; and
• Lingually placed lower incisors.
• The brackets with optional torque values should not be
used as “sets.”
• The clinician should study the case carefully beforehand
and individually select the bracket with the correct torque
for each tooth.
Damon Q Opening and Closing Technique
• Opening and closing the Damon Q bracket is made easy
with the use of Ormco’s innovative SpinTek™ slide. With its
chambered lingual leading edge the SpinTek slide
facilitates fast, easy wire changes for enhanced patient
comfort.
• Average self-ligation brackets exert up to 1.34 kilograms of
unidirectional force during slide opening. SpinTek disperses
forces in opposite directions, exerting a net force of
virtually 0 kilograms even despite calculus build-up.
Disarticulation and Damon System
• The most significant aspect of the Damon System is
combining passive four-walled self-ligating brackets with
advanced wire technology that, together, deliver
consistent, light forces in the range of 120-180 grams.
• Mastication and occlusal forces fall in the range of 1800 to
22500 grams.
• Failing to disarticulate is one of the most prevalent errors
that doctors new to the Damon System commit.
• Conceptually the use of bite turbos is either anterior or
posterior. They may not always go on the cuspid or first
molar. The location of the turbos is dependent on the
individualized patient need from both an occlusal and
aesthetic viewpoint so placement may vary.
Posterior Bite turbos
• WHY??? – Intrude Molars
• In fossa whenever possible: seems to be more comfortable.
• If need buccal root torque on molar, place on palatal cusp
Anterior Bite turbos
• WHY???
• Level by eruption of buccal segment
• Prevent intrusion of upper anteriors which protects smile
• Immediate bracket placement on lower arch
• No reverse curve wires
• Control OB throughout treatment
Why not to use posterior bite turbos in Deep
OB???
• Causes intrusion of molars rather than extrusion
• Adds time to the treatment if a deep bite
• Used for openbite and high angle cases
OVERBITE
• deeper overbite place
more gingival
• increase height of the
turbo during leveling
for patient comfort
OVERBITE
• deeper overbite place
more gingival
• don’t open greater than
1.5 mm posteriorly
OVERJET
• with greater overjet the
turbo must be more
gingival and longer
• don’t open greater than
1.5 mm posteriorly
• watch that the
lower arch does
not slip behind the
turbo
OVERJET
• Turbos may need to be
moved to the cuspids in
cases with excessive
overjet, THEN…
• And, they should be
moved further anterior
as the overjet is
reduced
Where should we
place TURBOS ?
This particular case
does not
need disclusion . It is
strictly used to
illustrate a flared
situation and the
possible risk!
Simply imagine a
deeper OVERBITE
Flared Incisors
• TURBOS can
increase flaring
77
Retroclined Incisors
• the action of the anterior

turbo may hinder
uprighting of the upper
incisors
78
Managing Anchorage
DURING LEVELLING AND ALIGNMENT
• Use light force to prevent anterior proclination.
• Use light push coil springs in between to bring about
anterior de crowding. In doing this your force vector is in
transverse direction which eliminates the risk of proclining
the anterior teeth.
• Do not use any transverse holding devices such as TPA or
lingual arch which would hamper ‘Transverse Arch
Development’.
• Never progress to rectangular wire until crowding is
resolved.
• Judiciously use incisor low torque brackets, super torque
canine and premolar brackets wherever possible/available.
DURING RETRACTION
• Its is very important to bond and include second molar in
your anchorage plane before attempting retraction.
• Make sure you are on significantly stiff stainless steel wire
before attempting retraction.
• You can incorporate RCS design in the arch wire to prevent
loss of torque and to have better vertical control on
incisors.
Expansion with Damon System
• No trance of palatal devices is used in Damon System to
bring about what is traditionally known as Expansion.
• In fact Damon users do not coin the term expansion. Arch
Development is the term used to explain the changes
that take place during the first and second phase of
treatment using Damon System.
• Forces used in this phase with 0.013” and 0.014 x 0.025”
copper NiTi wires and push coil springs made of 0.009” NiTi
wire, are so light that this could never meet the force level
delivered by traditional ‘Transpalatal Arch’.
TO BE CONTINUED…
RECAP…
PART 2
CONTENTS
• Bracket Positioning
• Pitts Protocol for Bracket Positioning
• Archwires
• Elastics
• Stability of Damon System
• Insignia
• Conclusion
• References
87
Dr ANALHAQ SHAIKH
Good placement to enhance smile for the
aging process
• Upper lip becomes longer with age and loses mobility.
Anticipate the AGING PROCESS
Incisor display at rest Gingival display on smile
Position your incisor lower in older patient Diminishes with age
Create a smile not for the 14 year old boy/girl but for the 40, 50 year old aged smile.
Consequently,
We will have to make choices,
Considering that
Aging will affect Incisor Display
Elements Affecting Smile Arc
• Occlusal plane inclination
• Bonding position
• The wedge effect
• Recountouring of cuspids
• Gingiva placement of upper centrals and laterals
Maxillary Posterior Bracket Position
First molar: bracket slot point coincides with
FA point. Equal amount of mesial & distal
cusps above a line tangent to the incisal border
of the bracket pad.
Second molar: slightly occlusal to first molar

(minimizes hyper-occlusion and occlusal
prematurities).
First premolar: bracket slightly gingival to
second premolar, due to anatomy more buccal
cusp showing above the occlusal border of the
bracket pad.
Second premolar: bracket position with slot

point on or about FA point. May be
individualized vertically to insure that distal
marginal ridge is equal in height to mesial
marginal ridge of first molar.
Mandibular Posterior Bracket Position
Bracket slot points coincides with FA points.
Marginal ridges generally line up.
Mandibular Anterior Bracket Position
Bracket slot points coincident with FA point

with canine brackets slightly mesial to height
of contour.
When no significant enamel attrition/ wear is
present, equal amounts of enamel should be
present above the occlusal borders of the
incisor bracket pads.
When no significant enamel attrition/wear is

present, equal amounts of canine cusps should
be present above the occlusal borders of the
bracket pads.
• For smile arc protection, place upper centrals 1mm more gingival than upper
canines. Then place the lateral between the central and cuspid height.
Incisor Bracket Positioning Philosophy
Based on Desired Maxillary Incisor Position.

BEGIN WITH THE END IN MIND

Protocol for bracket positioning and protect
/enhance Smile Arc
This numbered progression should be

modified according to clinical length
crown

BONDING STEPS
Mandibular arch first:
• Second molar to canine (L7-L3) on half the arch ;
• Second molar to canine (L7-L3) on the other half ;
• Finish by bonding lateral to lateral (L2-2).
Repeat steps above with Maxillary arch;

• Right side of the arch should mirror left side (in terms of bracket height);
• Use a Height Gauge on both arches (canine-to-canine) to ensure
uniform height on respective teeth. 105
Dr ANALHAQ SHAIKH
BRACKET PLACEMENT
Maxillary Anteriors
• Plan positioning for the entire arch after determining
position of the canines;
• Incisal edge of bracket wings need to be placed on a line
drawn from mesial to distal contact at height of contour
interproximally (referred to as the mesiodistal contact line)

Recountouring
Sometimes , NOT ONLY THE

CUSPID !…
To be done on the Upper Anteriors ,

labial & lingual BEFORE Bonding to
ensure a good TORQUE expression , an
adequate light reflection, & obtain the
best socked in occlusion.

Before After
• Do it before bonding

“We are what we repeatedly do, excellence,
then, is not an act but a habit” - Aristotle

PITTS PEARLS 1
I can save 1-2 appointments if I bond every tooth at the
bonding appointment (even if I don’t use it until later in
treatment). It allows patients to get used to the brackets all
at once. Waiting to bond later in treatment disrupts the
schedule and at times can lengthen treatment.

PITTS PEARL 2
Minimize wire bends instead, reference contact points. “Key
off the canines.”

PITTS PEARLS 3
Placing brackets too incisal diminishes smile arc and hinders
torque control.

Basic Principles of the Pitts Placement
Protocol
• There are certain bracket placement protocols employed:
1. Develop a detailed bonding plan prior to bonding day and
carefully select torques.
2. Ensure tray setup entails all the items essential to
efficient bonding.
Thomas Pitts. Begin with the end in mind: Bracket placement and early elastics protocols for smile arc protection. Clinical
Impressions 2009:17(1); 4-15
3. Use two assistants to assist in bonding.
4. Recontour teeth for esthetics and bracket fit.
5. Follow an exacting bracket placement protocol to protect
or enhance the smile arc and align buccal segment cusp
tips and marginal ridges.

Adhere to bracket placement protocol
and/or enhance Smile Arc
Bonding guidelines:
• Maxillary anteriors - for aesthetics and smile arc protection;
• Mandibular anteriors - for overbite and overjet;
• Canines- transition from anterior-posterior segment
• Integral to aesthetic and functional occlusion
• Key on upper cuspids to ensure upper lateral and first
bicuspid contacts are aesthetic and functional.

“Today’s Orthodontist practices at the
intersection of art and technology. The
challenge of applying appropriate levels
of technology to an artistic end result is
the art of case management.
The best case managers have a sound
understanding of the technology they
apply on a daily basis”.

The 14 Keys to Pitts Case Management
1. Positive and Negative Coronoplasty
2. “SAP Bracket Position” as a tool in gaining optimal
esthetics
3. “Bracket and Torque selection”
4. “ELSE” - Early, Light, Short, Elastics
5. “Disarticulation” - bite turbos, or occlusal pads as a tool in
increasing effectiveness of ELSE

6. Arch Wire Selection and Progression - as a tool in
controlling axial inclination early in treatment
7. Patient Motivation - as a tool of controlling axial
inclination early in treatment
8. NMI - “neuromuscular intervention” as a tool in improving
results
9. “PRACM” - the critical “read and react” milestone
10. Arch Wire Adjustments - As a tool of controlling axial
inclination, arch form, and transverse arch development

11. “Overcorrection”: as a tool of controlling rebound
12. “CO=CR”: as a tool in supporting long term joint health: I
treat cases to CR whenever possible
13. “Micro-Esthetic Detailing”: as a tool in providing dental
esthetics
14. “Tooth size refinement”: as a tool in perfecting guidance
systems

The heights for bracket bonding in the maxillary arch are
selected as follows:
The first step is measure the length of the maxillary canine crown, from the cusp tip to the
gingival margin (after reconstruction, recontouring, or gingivoplasty).
Normal Occlusal Plane
One of the factors contributing to the smile arc is cant of the occlusal plane. With an 8 degree
cant, it is easier to attain
Dr ANALHAQ SHAIKH
smile arcs, and esthetics is less sensitive to bracket placement.
125
Flat Occlusal Plane
Upper incisors too proclined with flat occlusal planes smile arc is more difficult to attain.
126
Dr ANALHAQ SHAIKH
Smile arc
Beautiful smile arc...where would the brackets
have to be placed to create this?
There is no “single” ideal bracket position.
Bracket position depends on the esthetic and
functional needs of the individual patient
SAP Bracket position

Upper incisor brackets are positioned apical to
FA to protect the smile arc.
Note: This plane can be more gingival to FA on
the anteriors to enhance or protect the smile
arc.
SAP versus Traditional Bracket Placement
SAP Approach with vertical height of bracket determined by
aesthetic need with Smile arc protected or enhanced.
Bracket slot at FA with vertical height of bracket set at FA with
Smile Arc flattened with slot positions at FA or incisal to FA, smile
arc can be flattened.
Bracket Divergence
Brackets slots heights
progress more apically from
posterior to anterior.
Lower Arch Compensation

In the lower arch, anteriors are
“overleveled” to allow
development of the smile arc
without deepening the bite.
Upper Buccal Segment and Cuspid
The cuspid sets the Smile Arc, divergence continues
through the anteriors, and the position of the
anteriors is critical.
• Use posts on archwires to distribute force evenly over all
teeth.
• Gentle force is respectful of tissue.
• Eliminating bracket hooks keeps appliance clean and
promotes healthy tissue.

• Bilateral Class II Elastics
• Objective: Correct Class II Anteroposterior Dental Relationships
5/16" 6 oz Moose Elastics

• Class II Elastics with Anterior Trapezoid
• Objective: Correct Class II Anteroposterior Dental Relationships and
Anterior Openbite

• Class II Elastics with Anterior Cross Elastics
• Objective: Correct Class II Anteroposterior Dental Relationships with
Anterior Midline Discrepancy

• V Posterior Elastics with Anterior Cross Elastics
• Objective: Correct Posterior Openbite with Anterior Midline
Discrepancy

• V Posterior Elastics
• Objective: Correct Posterior Openbite

• V Posterior Elastics with Anterior Trapezoid
• Objective: Correct Anterior and Posterior Openbite

• Class III Elastics
• Objective: Correct Class III Anteroposterior Discrepancies
5/16" 6 oz Moose Elastics (major correction needed)

5/16" 6 oz Moose Elastics (minimal correction needed)

• Class III Elastics with Anterior Trapezoid
• Objective: Correct Class III Anteroposterior Discrepancy with Anterior
Openbite

• Tent Elastics
• Objective: Correct Openbite in a Specific Area

• Finishing Elastics
• Objective: Finish a Case with a Challenging Bite to Close
Note maxillary tieback to maintain
posterior space closure.
Note sectional mandibular archwire cut and

removed distal to mandibular cuspid
• Finishing Elastics with Anterior Trapezoid

• Box Elastics
• Objective: Correct Posterior Openbite in Molar Area.
Upper and lower archwire sectioned

and removed in molar area.

Damon Arch Form
• Dr. Dwight Damon developed this arch form after carefully
studying 7,000 photographs of exceptional smiles.
• Dr. Damon believes that a great smile is exemplified by six
well-positioned anterior teeth and an arch form that
displays the first bicuspid, second bicuspid, and the
mesiobuccal surface of the first molar when viewed from
the anterior.
• This arch form prevents the “dark corner syndrome” in the
posterior of the mouth.

• More importantly, Dr. Damon feels that an
arch form must function in a manner
consistent with gnathologic principles.
• After he carefully evaluated several
hundred patients and their articulated
models, tomograms and headfilms, it was
apparent that this arch form enhances
dental function.

• In the final phase of treatment, Low-Friction TMA has
become an invaluable part of wire armamentarium.
• Low-Friction TMA’s greater flexibility allows you to more
easily bend torque in the archwire with moderate forces
without hindering your ability to close the slide.
• It is also easier to insert the wire and close the slide than
stainless steel when small detail bends are desired at the
end of treatment.

Stability of the Damon System
• A principal benefit of the Damon System is the ability to
gain arch width without rapid palatal expansion.
• The benefits of eliminating RPEs – to the orthodontist in
terms of time and cost savings and to the patient in terms
of reduced trauma – are self-evident.
• The question is whether the light-force approach of the
Damon System is stable.

• This can be illustrated by :
• Clinicians can gain significant transverse arch width
without rapid palatal expansion.
• Gains in posterior arch width result primarily from bodily
movement.
• Bone displays remodeling.

• The Damon System is capable of facilitating significant
transverse arch development and may thus negate the
need for rapid palatal expansion.
• Maxillary posterior transverse arch gain is primarily bodily
tooth movement with minimal tipping.
• Bone around the roots of the teeth remodels.
• This treatment modality can be stable, even in very
challenging cases.

• The arch form is created by altering the balance of
muscular and soft-tissue forces within the oral environment
with the addition of light alignment forces from the initial
elastic archwires.
• Damon argues that the distortion of arch form results from
a misfiring somewhere in the functional matrix during
development and maturation and reverses this situation
with gentle archwire forces.

• He suggests that the tongue’s resting position changes
during treatment to occupy a higher location in the palatal
vault, creating a new force equilibrium.
• Dwight utilizes a number of retention strategies, which to
me seem intrinsic to his approach. He commonly employs
what he calls a bimaxillary splint, which is a simply
constructed device made of two sheets of biocryl vacuum-
formed and joined together by cold-cure acrylic in a bite
relationship carefully registered to maintain any Class II
correction
• The beauty of this simple device is that it maintains the
transverse arch adaptation achieved in the alignment
phase.
• Dwight also uses bonded retainers, routinely canine-to-
canine in the lower arch and on two or four upper incisors.
Patients will also wear an Essix-type removable retainer.

• Does Dwight believe in permanent retention?
• The answer to that appears to be a qualified sometimes.
• It appears from the evidence available that there is no
absolute treatment or retention rationale that will
guarantee long-term stability.
• Given the choice between beautiful occlusions, facial
balance and healthy periodontal tissues maintained with
some form of long-term retention or a more traditional
limited retention approach.
Summary
• “The Damon approach to arch development is simple and
effective and offers an excellent alternative to rapid palatal
expansion.”
– Stephen Bradford, DMD
• “The Damon System is an exciting revolution. It provides a
well-documented means by which we can achieve
functional adaptation and accurate, predictable tooth
positioning with micro precision.”
– Allan Pollard, MDS, Melbourne, Australia
• “By applying light, biologically sensible forces as prescribed
by Dr. Damon, we can now level and align cases in less than
half the time it took with conventional braces. We are also
treating far more cases without extractions, surgery or
rapid palatal expanders.”
– Monte Collins, DDS, MSD, Bedford, TX
• “The Damon System helps me to finish my cases to a higher
level of precision and in less time than any other appliance
I’ve ever used.”
– Tom Pitts, DDS, MSD, Reno, NV
Making the impossible…
possible.

References
• Damon DH. The rationale, evolution and clinical application of the
self-ligating bracket. Clin Orthod Res. 1998 Aug;1(1):52-61
• Damon DH. The Damon LowFriction Bracket: A Biologically
Compatible StraightWire System. JCO 1998. 32(11):670-680.
• Damon DH. Damon System The Workbook.
• Proffit, W.R. and Fields, H.W.: The biologic basis of orthodontic
therapy, in Contemporary Orthodontics, C.V. Mosby Co., St. Louis,
1993, pp. 266288.
• Tuncay, O.C. et al.: Oxygen tension regulates osteoblast function,
Am. J. Orthod. 105:457463, 1994.

• Rygh, P.: Periodontal response to toothmoving force: Is trauma
necessary? in Orthodontics: State of the Art, Essence of the Science,
ed. L.W. Graber, C.V. Mosby Co., St. Louis, 1986, pp. 100115.
• Warita, H. et al.: A study on experimental tooth movement with NiTi
alloy orthodontic wires: Comparison between light continuous force
and light dissipating force, J. Jap. Orthod. Soc. 55:515527, 1996.
• Alan Pollard. Capturing the essence of the Damon approach. Clinical
Impressions 2003; 12(2):4-11.
• Birnie D. The Damon Passive Self-Ligating Appliance System. Semin
Orthod 2008; 14: 19-35.

• Thomas Pitts. Begin with the end in mind: Bracket placement and
early elastics protocols for smile arc protection. Clinical Impressions
2009:17(1); 4-15
• Pitts T. Begin with the end in mind and finish with beauty. Eur J Clin
Orthod 2014; 2:39-46.
• Pitts T. Pitts’ Protocol. Issue 1

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BY DR ANALHAQ SHAIKH

Dr. Dwight Damon

The rationale, evolution and clinical application of the self-ligating bracket.

Thus, sliding mechanics is achieved in the true sense of the word.

Traditional Heavy Forces

Rygh, P.: Periodontal response to toothmoving force: Is trauma

2nd BICUSPIDS Standard -17

• the action of the anterior

Second molar: slightly occlusal to first molar

Second premolar: bracket position with slot

Mandibular Anterior Bracket Position

Bracket slot points coincident with FA point

When no significant enamel attrition/wear is

Dr ANALHAQ SHAIKH 100

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This numbered progression should be

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Repeat steps above with Maxillary arch;

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Sometimes , NOT ONLY THE

To be done on the Upper Anteriors ,

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SAP Bracket position

Lower Arch Compensation

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5/16" 6 oz Moose Elastics

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5/16" 6 oz Moose Elastics

5/16" 6 oz Moose Elastics

5/16" 6 oz Moose Elastics

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5/16" 6 oz Moose Elastics

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5/16" 6 oz Moose Elastics

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5/16" 6 oz Moose Elastics (major correction needed)

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5/16" 6 oz Moose Elastics

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5/16" 6 oz Moose Elastics

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Note sectional mandibular archwire cut and

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Upper and lower archwire sectioned

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