Self Ligation

SELF LIGATION
in orthodontics
Dr. Gurjeet Kaur Randhawa

Dr. Vijaysinh Tanpure
Dr. Amruta Gothkinde
Dr. Amol Holambe
SELF LIGATION in orthodontics
Shivapuja PK, Jeff Berger. A comparative study of

conventional ligation and self-ligation bracket systems
Am J Orthod Dentofac Orthop 1994 ; 106: 472-480
Stolzenberg J. The Russell attachment and its improved

advantages. Int. J. Orthod. Dent. Child 1935 ; 21: 837-
840.
Stolzenberg J. The efficiency of the Russell attachment. J.

Orthod. Oral Surg 1946; 32: 572-582.
ROSEWOOD PUBLICATION Thomas S, Sherriff M, Birnie D. A. comparative in vitro

MAHAMAYA TEMPLE, AMBIKAPUR CHATTISGARH SARGUJA study of the frictional characteristics of two types of self-
497001
ligating brackets and two types of pre-adjusted edgewise
ISBN: 978-93-90650-11-8
EMAIL: rosewoodpub@gmail.com brackets tied with elastomeric ligature. Eur J Orthod
INSTAGRAM: rosewood_publication 1998;20:589-596.
FACEBOOK: Rosewood publication
WEBSITE: www.rosewoodpub.com Thorstenson GA, Kusy RP. Resistance to sliding of self-
All rights reserved. No part of this book may be reproduced, ligating brackets verses conventional stainless steel twin
stored in a retrieval system, or transmitted, in any form by any
brackets with second order angulations in the dry and wet
means, Electronic, Mechanical, Magnetic, Optical, Chemical,
Manual, Photocopying, Recording or otherwise (Except for (saliva) states. Am J Orthod Dentofacial Orthop 2001;
mention in reviews or edited excerpts in the media) without the 120:361-370.
prior written consent of its writer and publisher.
Thorstenson A, Kusy RP. Comparison of resistance to
NON FICTION 1st Edition sliding between different self-ligating brackets with
COVER DESIGN: SHAHBAZ KHAN
second order angulations in the dry and wet saliva states.
PRICE: Rs.180/-
The opinions/ contents expressed in this book are solely of the Am J Orthod Dentofacial Orthop 2002; 121:472-482.
author and do not represents the opinions/ standings/ thought
of publisher.
121
Miles PG. Self ligating vs conventional twin brackets

during en masse space closure with sliding mechanics.
Am J Orthod Dentofacial Orthop 2007;132, 223-225
Pandis N, Polychronopoulou A and Eliades Theodore.

Self-ligating vs conventional brackets in the treatment of
mandibular crowding: A prospective clinical trial of We dedicate the book to our families and mentors.
treatment duration and dental effects Am J of Orthod
Dentofacial Orthop 2007,132;208-215
Pandis N, Strigou S, Eliades T .Maxillary incisor torque

with conventional and self ligating brackets. Orthod
Craniofacial Res 9,2006;193-198
Pizzoni L, Ravnholt G, Melson B. Frictional forces

related to self- ligating brackets. Eur J Orthod 1998; 20:
283- 291.
Readward GE, Jones SP, Davies EH. A comparison of

self-ligating and conventional orthodontic bracket
systems. Br J Orthod 1997; 24:309-317
Rinchuse D. J. and Miles PG. Self-ligating brackets:

Present and future. Am J of Orthod Dentofacial Orthop
2007; 132, 216-222
Sandra P, Henao BS, Robert P. Kusy. Evaluation of the

Frictional Resistance of Conventional and Self-ligating
Bracket Designs Using Standardized Archwires and
Dental Typodonts. Angle Orthod 2004; 74: 202 211
120
Harradine NWT. Self-ligating brackets: where are we

now? JO 2003; 30: 262-273.
Heiser W. A new orthodontic philosophy. J Clin Orthod

1998; 35: 44-53.
Kapur R, Sinha PK, Nanda RS. Frictional resistance of

Damon SL bracket. J Clin Orthod 1998; 32:485-489
Kim Tae-Kyung, Kim Ki-Dal ,Baek Seung-Hak .

Comparison of frictional forces during the initial leveling
stage in various combinations of self-ligating brackets and
archwires with a custom-designed typodont system. Am J
Orthod Dentofacial Orthop 2008; 133, 187.e15-187.e24
Loftus BP, Artun J, Nicholls JI, Alonzo TA, Stoner JA.

Evaluation of friction during sliding tooth movement in
various bracket- arch wire combinations. Am J Orthod
Dentofacial Orthop 1999;116:336-45.
Maijer R, Smith D C. Time savings with self-ligating

brackets. J Clin Orthod 1990; 24:29-31
Miles PG. SmartClip versus conventional twin brackets

for initial alignment: is there a difference? Aust Orthod J
2005; 21: 123- 127.
Miles PG, Weyant RJ, Rustveld. A Clinical Trial of

Damon 2 Vs Conventional Twin Brackets during Initial
Alignment. Angle Orthod 2006; 76: 480-485
119
and conventional brackets. Clin. Orthod. Res. 2001;

4:228-234.
PREFACE
Franchi L, Bacetti T, Camporesi M, Barbato. Forces
released during sliding mechanics with passive self
ligating brackets or non conventional elastomeric
This book gives a vivid explanation to newer self ligating
ligatures. Am J Orthod Dentofacial Orthop 2008, 133, 87-
methods in orthodontics. Efforts have been made to
93 completely include the evolution and discuss the various
different kinds of self-ligating systems currently
Hain M, Dhopatkar A, Rock P. The effect of ligation
available. Their advantages and disadvantages have been
method on friction in sliding mechanics. Am J Orthod discussed in details.
Dentofacial Orthop 2003;123:416-22 The book have also mentioned about esthetic
modifications in self-ligation. Images and diagrams are
Hain M, Dhopatkar A and Rock P. A comparison of included for better illustration and understanding of the
different ligation methods on friction. Am J of Orthod topic.
Dentofacial Orthop 2006;130:666-70
Hanson GH. The SPEED System: A report on the

development of new edgewise appliance. Am. J. Orthod
1980 ; 78: 243-265.
Hanson GH. The SPEED bracket auxiliary slot. J Clin

Orthod 1999; 33:318-321.
Harradine NWT, Birnie DJ. The clinical use of Activa

self-ligating brackets. Am J Orthod Dentofacial Orthop
1996; 109:319-28
Harradine NWT. Self-ligating brackets and treatment

efficiency. Clin. Orthod. Res. 2001; 4: 220-227.
118
References :
CONTENT
Berger J. The influence of SPEED bracket's self-ligating
design on force levels in tooth movement. Am J Orthod
Dentofac Orthop. 1990; 97: 219-228
INTRODUCTION
Berger JL. The SPEED Appliance: A 14-year update on
DEFINITION, CLASSIFICATION AND PROPERTIES this unique self-ligating orthodontic mechanisum. Am J
OF SELF LIGATION Orthod Dentofacial Orthop 1994; 105:217-23.
EVOLUTION OF SELF-LIGATING BRACKETS Berger J. Self-Ligation in the year 2000. J Clin Orthod
Feb 2000; 34:74-81.
ACTIVA SELF LIGATING BRACKETS
Berger J, Byloff FK. The clinical efficiency of self-ligated
SPEED -- SELF LIGATING BRACKETS brackets. J Clin Orthod 2001; 35: 304-310.
DAMON - SELF LIGATING BRACKETS Cacciafesta V, Sfondrini MF, Riccardi A, Scribante A,
Klersy C, Auricchio F. Evaluation of friction of stainless
IN OVATION BRACKET SYSTEM
steel and esthetic self-ligating brackets in various bracket-
TIME SELF LIGATING BRACKETS archwire combinations. Am J Orthod Dentofacial Orthop
2003; 124:395-402.
SMART CLIP SELF LIGATING BRACKETS
Damon DH. The Damon low friction bracket: A
ESTHETIC SELF LIGATING BRACKETS biologically compatible straight-wire system. J Clin
SELF LIGATING LINGUAL BRACKET Orthod 1998; 32:670-680.
Eberting JJ, Straja SR, Tuncay OC. Treatment time,

outcome, and patient satisfaction comparisons of Damon
117
SELF LIGATION in orthodontics SELF LIGATION in orthodontics
archwire (eg, when seated on a chair, if you place your

arms under the chair and pull the chair up and yourself
Chapter 1
down into the chair; it neither lifts the chair off the ground
nor places any extra force on the ground).
INTRODUCTION
A module exerting 50 g of force pulling the wire into the
base of the slot is the load or normal force, so it is pertinent The field of orthodontics is making significant
in friction when sliding but does not place a direct force developments in biomaterials and biomechanics every
on the tooth. The deflection of the archwire exerts the now and then .the bracket system has evolved in an
force on the tooth. Friction, which impedes sliding excellent way . Self ligating brackets appear to be one
movements, is determined by multiplying the coefficient such significant outcome of design and engineering in
of friction of the materials in contact by the normal force, orthodontics.
which is the force of ligation. Therefore, friction is
The concept of self-ligating brackets is not new,
directly proportional to the force of ligation.
with the first designs dating back to the l930s, with the
The force applied to the tooth comes from the deflection introduction of the russell attachment, by dr. Jacob
of the archwire; so, if the module does not deflect the stolzenberg. Since 1970, there has been a constant
archwire, then it is passive, and no force is applied to the endeavor to perfect self-ligating brackets and several
tooth (ligation force only comes in when sliding the wire brackets were introduced like edgelok (jim wildman-
along the bracket). This normal force is avoided by using 1971), mobil-lock (franz sander- 1973), speed system
a Da (herbert hanson1976), activa (erwin pletcher-1986), time
only when the brackets and wire are ideally aligned (so no (wolfgang heiser-1995),42 damon sl (dwight damon-
movement occurs). Any deflection of the archwire that 1996), twinlok (jim wildman-1998). damon system ii
engages the bracket due to rotation, tip, or torque creates (dwight damon-l999)70 and in-ovation (michael c.alpem-
a normal force and therefore classical friction. If this 2008).
deflection is greater, eventually binding and notching
Self ligating brackets are a ligatureless bracket
occur; these cannot be avoided by any bracket design, SL
system that has a mechanical device built into the bracket
or conventional.
to close off the slot the straight wire appliance was the
116 1
first orthodontic mechanism that was based on sliding adverse effects of play. If an orthodontist uses a .019 ×
mechanics . The increasing use of sliding mechanics in .025-in stainless steel finishing wire in a .022 × .028-in
orthodontics has led to considerable research interest in bracket slot, various permutations of torque outside the
the frictional forces developed between the archwire and bracket prescription will result. Moreover, extrapolating
bracket, which may inhibit tooth movement. To overcome from the data of Proffit and Fields (2000) regarding
the frictional force to achieve the desirable results, comparable effective torque for undersized wires, a .019
increased force is applied, due to which there is more × .025-in stainless steel wire in a .022-in slot bracket
patient discomfort and pain and also increases anchorage would actually deliver only 0.4° of effective torque for a
demands. Orthodontic brackets have been modified in bracket torque angle of 10°, 6.5° of torque for a 22° torque
several ways to decrease frictional resistance and improve angle, and 20.4° of torque for a 30° torque angle. Hence,
the efficiency of sliding mechanics. One such way is in addition to various permutations of torque values with
changes in ligation. play, undersized finishing wires deliver significantly
lower torque values compared with the bracket
prescription. This has contributed to a trend to increase
Self-ligating brackets are supposed to be torque values for many \ prescriptions, especially in the
advantageous in that they provide greater patient comfort, incisors.
reduced friction between bracket and archwire, shortened
Miles et al (2006) discussed the rotational play in the
treatment time and reduced chair time. They offer more Damon 2 bracket because it essentially has a 0.028-in slot
precise control of tooth translation, reduced overall depth. A 0.014-in wire in the passive Damon 2 bracket
anchorage demands, rapid alignment and more certain allows 8.5° of rotational play compared with a
space closure. There is reduced incidence of soft-tissue theoretically fully engaged conventional twin bracket. A
lacerations, improved oral hygiene, less chance of cross
0.016 × 0.025-in archwire would be more active in the
infection risk and better esthetics. Damon 2 but still not fully engaged because of the 0.028-
in slot depth, leaving 1.8° of rotational play.
Another principle to elucidate is that the ligation force is

not transmitted to the tooth but is counteracted by the
equal and opposite force of the SL bracket against the
2 115
Damon treatment times reported by Harradine and greater

than those reported in the literature with conventional
Chapter 2
brackets by Fink and Smith (23.1 months), and Skidmore
et al (23.5 months).
DEFINITIONS, CLASSIFICATION AND
Retrospective studies such as these are potentially biased PROPERTIES OF SELF LIGATION
despi
factors might affect the outcome. It is unclear what
techniques were used or which variables were controlled
Self-ligating brackets (Stolzenberg, 1935, 1946) are
and which were not. These include greater experience,
ligature less bracket systems that have a mechanical
modified appointment intervals, differing archwires, and
device built into the bracket to close off the edgewise slot
altered wire sequences. Observer bias can affect the result
(cacciafesta et al., 2003)
if the practitioner is unknowingly doing a little more due
to enthusiasm with the new appliance. These potentially A self ligating bracket is defined as a bracket, which
confounding variables might have played a major role in utilizes a permanently installed, moveable component to
reducing treatment time. For these reasons, prospective entrap the archwire.
research with randomized or consecutive assignment is
preferred. A self ligating bracket restrains the archwire within the
slot by means of a slide or a clip that covers the slot
Several investigators and many clinicians reported (Voudoris1997).
difficulties in finishing patients with self-ligating brackets
(Harradine NWT1996). Particularly, torque and tip SL brackets can be dichotomized into those with a spring
control can be compromised due to the greater play of the clip that can press against the archwire (active) and those
archwire in the slot of SL brackets (Kusy RP 2000) and with a passive system of ligation, in which the clip,
(Thorstenson GA, Kusy RP 2002). ideally, does not press against the wire.
In the Damon system, a .022-in slot is advocated with

finishing wires of .019 × .025-in stainless steel, or beta
titanium. Creekmore and Kunik(1993) described the
114 3
Passive self-ligation 0.014-in Damon copper-nickel-titanium wire (Ormco),

and, at 10 weeks, the wire was changed to 0.016 × 0.025-
Passive self ligating brackets use a rigid moveable
in Damon copper-nickel-titanium wire. The results of this
component to entrap the archwire. study demonstrated that, after the 20-week period, the
Tooth movement with passive brackets is determined SmartClip bracket was no more effective in reducing
solely by the fit between bracket slot and the archwire. irregularity than a conventional twin bracket ligated with
elastomeric modules or stainless steel ligatures with the 2
is passive only when teeth are ideally aligned in 3 wires tested.
dimensions (torque, angulation, and in-out), and an In an in-vivo study by Harradine comparing treatment
undersized wire would not touch the walls of the bracket efficiency with conventional fully programmed brackets
slot. Passive brackets are inherently imprecise in their and the now superceded Damon SL brackets, the
ability to control tooth movements because of their total following results were reported. The consecutively treated
reliance on the fit between the archwire and the bracket Damon SL patients on average finished 4 months sooner
slot. As a result, tooth control is frequently compromised and had 4 fewer appointments than patients with
with undersized wires housed in what is essentially an conventional brackets when treated to an equivalent level
arch wire tube. Examples in the passive group are the of occlusal regularity as measured by peer assessment
Damon bracket, Activa bracket, Twin lock bracket and the
rating (PAR) scores. The greater efficiency of the Damon
SmartClip bracket. SL compared with placing and removing elastic ligature
With the Damon bracket, the so- ties with conventional brackets was modest and of little
comparable to a buccal tube. clinical relevance.
In a similar retrospective study, Eberting et al (2001)

found an average reduction in treatment time of 6 months
Active self-ligation (from 31 to 25) and 7 visits (from 28 to 21) for Damon SL
patients compared with conventional ligation patients.
Active brackets use a flexible component to entrap the
This indicates clinically significant improvements in
arch wire. This flexible component constrains the arch
treatment efficiency for passive SL brackets. However,
wire in the arch wire slot and has the ability to store and
those reduced treatment times are still longer than the pre-
4 113
subsequently release energy through elastic deflection.

This gentle action imparts a light but continuous level of
The answers are axiomatic, and they can be logically
force on the tooth and its supporting structures, resulting
deduced. That is, the larger the bracket slot and the in precise and controlled movement. The homing action
smaller the wire, the less frictional resistance, less 3D of the flexible component may be described as the ability
control (ie, Damon bracket). Conversely, the smaller the of the bracket to reorient itself and its accompanying tooth
bracket slot and the larger the wire, the more frictional
in three dimensions until the arch wire is seated fully in
resistance there is, and likewise more 3D control (ie, In- the arch wire slot, the
rotation, tipping or torquing during tooth movement of
As a generalization, SL brackets show excellent any kind results in the labial deflection of the flexible
performance in vitro with smaller wires that are used component and reactivates this homing behavior.
early in treatment. However, when larger wires are used Examples of active self-ligating brackets are In-Ovation
such as .016 × .022 in and .019 × .025 in nickel-titanium PEED, and Time brackets.
in the austenitic phase, no differences were found between
SL brackets and conventional brackets. (Henao SP, Kusy
RP 2004). In other words, SL brackets demonstrated low
frictional resistance only up to certain size archwires in a
.022-in slot.
In an in-vivo study, Miles (2005) compared the

effectiveness in a .022-in slot of SmartClip brackets and
conventional twin brackets, Victory MBT, for initial
alignment of the mandibular arch. In this prospective
study 58 patients were alternately assigned to a SmartClip
or a conventional group. The irregularity index was used
to determine differences, and measurements were taken
before treatment, 10 weeks after initial archwire
placement, and again at 20 weeks. The initial wire was a
112 5
PROPERTIES OF IDEAL LIGATION Third, past studies are limited to the investigation of .022-
in slot brackets and not the .018-in slot (Henao SP, Kusy
Ligation should:
RP 2004) and (Thorstenson G , Kusy RP 2002)
Fourth, in-vitro vibration simulation of in-vivo occlusal

and masticatory forces can lack validity (Harradine NWT
2003)
Fifth, in-vitro research involves rates of movement [0.5

mm per minute (Berger J 1990) and (Henao SP, Kusy RP
2004) to 10 mm per minute (Thorstenson G , Kusy RP
2002)]; this is 21,700 to 435,000 times faster than occurs
and cannot take into account tooth movement due to

alveolar remodeling that can occur clinically before the
archwire slides through the bracket.
It is instructive to consider the performance of
conventional wire and elastomeric ligatures in relation to Sixth, comparisons of .022-in slot conventional brackets
these requirements: and passive slide SL brackets (Damon, SmartClip) with
SL brackets with a spring clip (In-
Speed) are like comparing apples to oranges. The .022-in
Secure robust ligation slot SL bracket with a spring clip is not a true .022 × .028-
in slot. The horizontal gingival wall is reduced (in the In-
It is highly desirable that, once ligated, the system is very in) and not .028 in, and therefore
resistant to inadvertent loss of ligation. Wire ligatures are the spring clip invades the bracket slot. Consequently, this
good in this respect, whilst elastomeric ligatures are reduces the dimensions and size of the bracket slot.
inferior, especially if left for too long without being
renewed. The force decay of elastomerics has been well Moreover, these in-vitro studies dealing with frictional
documented. resistance with nickel-titanium archwires simulating early
stages of treatment seem somewhat superficial.
6 111
al(2004), V cacciafesta (2003),Griffiths et al(2005), Full bracket engagement

Thomas et al(1998), M Hain(2003), L Pizzoni (1998),
It is a large advantage if the archwire can be fully engaged
Shivapuja and Berger (1994), Sims et al(1993)}.
in the bracket slot and maintained there with certainty.
Moreover, during the past decade, the initial clinical Wire ligatures do not stretch to an extent that engagement
handling difficulties associated with their use have been once achieved at ligation is subsequently lost, so they can
overcome, and the application of these appliances has meet this requirement.
been significantly simplified.
Elastomerics are worse, since they may frequently exert
However, most advantages of self-ligation remain largely insufficient force to fully engage even a flexible wire and
presumptive. The validity of past studies on Self Ligating the subsequent degradation of their elastic performance
brackets is questionable. may cause a significant loss of full engagement as the
elastomeric stretches. Twin brackets with the ability to
First, most studies are in vitro. They cannot simulate
biologic responses, and the laboratory setup might not respect, but certainly not a complete answer.
represent the clinical situation. For example, for canine
retraction, the archwire is relatively constrained at each
end by the posterior and anterior teeth but is often
cantilevered in vitro. This relative constraint affects the Quick and easy to use
mechanical loading at the bracket-archwire interface and This is a major weak point of wire ligatures and the
thus the frictional resistance. The ratio of the normal principal reason for the enormous decline in their use.
forces on an archwire constrained at both ends to that of a
cantilevered archwire can vary from 3:1 to over Maijer and Smith(1990), and Shivapuja and Berger(1994)
9:1{Braun S. et al(1999)} have shown that wire ligation is very slow compared to
elastomerics. In the latter study, the use of wire ligatures
Second, for the most part, in-vitro studies are limited to added almost 12 minutes to the time needed to remove and
fragmented or small aspects of overall orthodontic replace two archwires. This is the largest and very
treatment such as frictional resistance with nickel- understandable reason why so few wire ligatures are now
titanium wires relating to initial alignment (Henao SP, used.
Kusy RP 2004)
110 7
Low friction
Chapter 13
Wire ligatures produce substantially lower friction forces
than elastomerics. However, the forces generated by wire
ligation still reach high and very variable levels relative to CONTROVERSIES IN SELF LIGATION
those force levels that are thought to be optimal for tooth
movement. Low friction levels are considered to enhance
orthodontic tooth movement. Most tooth movements with
Self-ligating brackets were introduced in this specialty in
most mechanical procedures involve relative movement
a first form some decades ago; Harradine (2003) reported
between the archwire and bracket. These movements
that the concept of self-ligation is as old as that of the
include leveling, buccolingual alignment, rotation,
edgewise bracket. Nonetheless, in the past 2 decades,
correction of angulation, opening of space, and any space
there has been a boost in the manufacturing and release of
closure with sliding mechanics. Friction between the
self-ligating appliances with active or passive ligation
bracket and the archwire is a force that must be overcome
modes.
before the intended tooth moving forces can have their
effect and this relative movement between the bracket and The basic advantages of these brackets involve the
the archwire can occur. Frictional forces arising from the elimination of certain utilities or materials such as
method of ligation are an additional resistance to this elastomeric modules along with the process or tools
relative movement. Correspondingly higher forces must associated with their application. This brings several
therefore be applied and this has two related potential favorable features to treatment, including the elimination
effects that inhibit tooth movement. of potential cross-contamination with elastic ligatures,
consistently full engagement without the undesirable
First, the net effective force is much more difficult to
force relaxation of elastomeric modules, supposed
assess and is more likely to be undesirably higher than
reduced risk for enamel decalcification from the
force levels best suited to create the optimal biologic
elimination of the retentive site for plaque accumulation,
response. Second, the binding forces are higher both
hypothetically reduced friction in sliding mechanics, and
between bracket and wire and also at the contacts between
assumed low-magnitude forces resulting in fewer side
irregular adjacent teeth. These binding forces also
effects as shown by various authors{ B. Khambay et
inhibitthe required relative movement. Certain tooth
8 109
Selective locking of individual brackets to the archwire movements, such as space closure with closing loops
with elastomeric can be helpful in those designs which placed in the space, expansion of a well-aligned arch, and
have a full conventional tie-wing assembly. torque changes are not facilitated by a low-friction
method of archwire ligation.
Small V-shaped notches in the midline of flexible wires
can also limit the scope for wire swivelling. These are
commercially available or can be bent into nickel-
Easy attachment of elastic chain
titanium wires with triple beak pliers. Pre-notched wires
are usually more expensive. Sometimes in the lower arch Conventional brackets have tie-wings which make
the notches are too large for the available inter-bracket attachment of elastic chain and if desired, elastomeric
span. Also, some notches can creep into the adjacent ligatures, convenient. The recently developed self-
bracket and cause irregularity of that tooth. Small sections ligating brackets all have tie-wings.
of stainless steel tube can be crimped onto the archwire.
This is quick, easy, versatile and recommended. 0.5 mm
tubing (approx. 0.020 inch internal diameter) is a good
Assistance to good oral hygiene
size for smaller diameter wires. With larger wires, 0.7-
mm tubing is required, but a crimp-on hook may be a Elastomerics accumulate plaque more than tie-wires do
better option since it is harder to crimp tubing securely and fluoride-releasing elastomerics have yet to reach
onto the flat surface of a rectangular wire. reliably robust performance levels by way of
compensation. The ends of wire ligatures are, however, an
The neatest solution is probably the crimp-on split tube
additional obstacle to oral hygiene.
available from manufactures such as Unitek and Speed.
These can be squeezed onto almost all wires, require no
fabrication, are unobtrusive and effective. The cost is a
factor. It is recommended that the stop is not placed on a Comfortable for the patient
significantly active part of the archwire. This would
Elastomerics are good in this respect, but wire ligatures
diminish the range of action of the wire where it is most
require careful tucking in of the ends to avoid soft tissue
needed.
108 9
trauma, and can occasionally be displaced between called Kasso D2 pliers. They make all slides very easy to
appointments and cause discomfort. open. Importantly, no downward rotation is required
when using these pliers.
What is wrong with conventional ligation?
engagement results in poor control of tooth movement. Wire pokes
nal values are increased. Low friction increases wire displacement.

Even with very irregular teeth, the very low friction with
self-ligating brackets enables aligning archwires to slip
control is not optimal. through the brackets and an archwire end to protrude.
Steps to prevent this can include:

displaced.
.Using tie-backs with flexible wires over extraction sites

time-consuming clinical procedure
to lessen the effects of occlusal forces on unprotected
Wire ties are secure, robust, enable full, partial or distant spans of wire.
ligation, and have lower friction than elastomerics. Their Thorough turning in the ends of flexible archwires. An
largest drawback is the time required for ligation. interesting innovation in this respect is the Bendistal plier
Elastomerics are quick, but less good in every other described by Khouri (1998). This is designed to place an
respect effective distal end bend in a super-elastic wire without
the need for over-bending which can be difficult and
uncomfortable and also risks the loss of a bonded molar
tube.
10 107
PROPERTIES OF SELF-LIGATING BRACKETS

position.
Time and Speed brackets are opened with a probe or

other fairly sharp instrument, such as a Mitchells trimmer The various features of self-ligating brackets can be
using the hole in the clip. Speed brackets can also be described related to
opened in the same way as In-Ovation. Friction between bracket and archwire;
Archwire engagement;
Chair side assistance;
Archwire removal and ligation time.
Cost effectiveness and treatment efficiency
A) FRICTION
to the common boundaries between two bodies when,

under the action of an external force, one body moves or
Damon2 brackets can be opened with ordinary tends to move relative to the surfac
pliers. Specific Damon pliers, which resemble modified et al., 1990).
distal end cutters, are slightly easier to use. Both these
types of pliers work better if there is a slight downward It may be affected by:
rotation to the opening movement.
(1) Kinematics of the surfaces in contact (i.e. the direction
Very specific and extremely effective pliers for and magnitude of the relative motion between the surfaces
Damon2 brackets are manufactured by Plydentco and in contact);
106 11
(2) Externally applied loads and/or displacements Once the wire is fully engaged, In-Ovation brackets and
(including orthodontic ligation); Speed brackets can be closed with a finger. Damon2
brackets can be closed with ordinary light-wire or bird
(3) Environmental conditions such as temperature and beak pliers.
lubricants;
(4) Surface topography;
(5) Material properties.
Franchi L (2008) conducted a study to evaluate the

frictional forces generated by 4 types of passive stainless
steel self ligating brackets and by non conventional
elastomeric ligatures and conventional elastomeric
ligatures during sliding mechanics. The results of the
study showed significantly smaller static and kinetic
forces were generated by the self ligating brackets and non Fully seating arch wire with fine director and closing
conventional elastomeric ligatures compared with the SPEED appliance with gloved finger
conventional elastomeric ligatures. The authors
concluded that self ligating brackets and non conventional
elastomeric ligatures are valid alternatives for low friction
Opening clips/slides
B) ARCHWIRE ENGAGEMENT
In-Ovation brackets are opened by pushing in an
Full engagement is a feature of self-ligation because a occlusal direction on the tail of the clip behind the bracket.
clip/slide is either fully shut or it is not. Unintentional An important point is to avoid getting composite resin
partial engagement is not possible. There is no problem of near this tail during bracket placement. Such excess
decay of the ligature as with elastic ligatures. However, adhesive can hinder or prevent clip opening. This problem
security of ligation will depend on the clip/slide being is more difficult and more important to avoid in the lower
12 105
slide closure on teeth where the wire requires lingual robust and not inadvertently opening. Until very recently,
pressure for full engagement. With thermally active wires, this requirement for security of performance was not fully
it is potentially easier to insert a wire in some awkward met by self- ligation designs. Secure, full archwire
teeth if the Cool Tool is kept in the freezer. engagement maximizes the potential long range of action
of modern low modulus wires and minimizes the need to
Whereas engagement of an irregular tooth with an regain control of teeth where full engagement is lost
elastomeric ligature can involve considerable pulling on
during treatment.
the tooth, with a self-ligating bracket, a pushing force is
required. Reduction of a pulling force on the tooth when C) CHAIRSIDE ASSISTANCE AND LIGATION/
placing an elastomeric is difficult, but it is easy to reduce ARCHWIRE REMOVAL TIME
the net push on the tooth when engaging a wire in a self-
ligating bracket use a labio- The original motive when developing the earlier self-
As the tooth is pushed from the labial (e.g. with a Cool ligating brackets was to speed the process of ligation. For
Tool), the tooth should be pushed from the lingual/palatal example, a paper by Maijer and Smith (1990)
with a thumb of the same hand. The net force on the tooth demonstrated a four-fold reduction in ligation time with
is greatly reduced and the wire is fully engaged more Speed brackets compared to wire ligation of conventional
easily and comfortably. brackets.
If the tooth is very rotated and one end of the slot is too D) COST AND TREATMENT EFFICIENCY
close to the adjacent tooth for an instrument to be used to Currently available self-ligating brackets are more
seat the wire, dental floss or a ligature wire looped over expensive than most good quality tie-wing brackets. A
the archwire can be used to fully engage the wire on that modest balancing factor is the cost of elastic ligatures,
side which are, of course, not required. However, this
Another useful manoeuvre on a very rotated or displaced significant extra cost must be measured against savings in
tooth with any self-ligating bracket is to first close the clip time an expensive commodity. If self-ligating brackets
or slide, and then thread the aligning wire through the save any appreciable
closed bracket before engaging the other brackets, i.e. to Chair side time, this would provide an offsetting saving.
104 13
Chapter 12
Chapter 3 CLINICAL MANAGEMENT
Evolution of self ligating brackets Archwire engagement
Self ligating brackets are evolving from the early 20 th It is much more important to fully engage the wire before
century. The history goes as follow clip closure, rather than attempt to close the clip and
simultaneously engage the wire EXCEPT WHEN the
1) FORD LOCK by J. W. Ford (1933) was 1st wire is passive labio-lingually
manufactured in 1933. They featured a circular ring to
create a rigid wall to entrap the arch wire in slot. As the The wire can be held into the slot base with a variety of
circular member was incapable of interacting with arch tools. Simple tools, such as an amalgam plugger, ligature
wire for rapid tooth movement, Ford bracket turned to be
a passive SLB. Manufactured by Dee Gold Company of these only push on one side of the bracket and may fail to
Chicago, Illinois, it did not get wide spread clinical fully engage the wire across the whole width of the slot.
acceptance. Production was abandoned because the The Cool Tool is a specific tool, which is rather akin to a
design proved to be too expensive and bulky to be torquing key. Dwight Damon has developed this
commercially viable. The bracket was reintroduced in instrument for engagement of wires, via balanced pressure
1951 by his son William F Ford, but it was marketed on both sides of the bracket. GAC has more recently
primarily for the Johnson twin wire technique. developed the R tool, which resembles a double ligature
tucker and works in the same way. These specific tools
2) BOYD & RICHARDSON (1933)- (passive) At about can reassure the clinician that slide closure is not being
the same time Boyd & Richardson introduced several attempted over an incompletely seated wire. They can
designs to the orthodontic world. The 1st featured with a
also assist cheek/lip retraction during slide closure and
movable rigid bar that entrapped the arch wire. Other such a tool is firmly recommended as a routine part of
14 103
Phantom Lingual Self Ligating Bracket designs included rigid clips fixed to either sides of bracket
bodies which were designed to the arch wire. These
passive designs did not gain wide spread clinical
acceptance.
3) BRUSSES & GODDARD (1941)- (Passive) In 1941

Brusse & Goddard introduced a noble bracket which
could be used without ligatures. This passive design
featured 2 flexible arms which could deflect upon arch
wire engagement, there by trapping the arch wire. These
passive designs did not gain wide spread clinical
acceptance.
4) J. E. LASKIN (1945)- (Passive) In 1945 Laskin

introduced 2 SLB. The 1st design featured rigid parallel
fingers which are clamped on the arch wire. The 2nd
Phantom by Gestenco International is a poly-ceramic self featured a rotating bracket body which could be adjusted
ligating bracket. The lingual surfaces of the teeth are to entrap the arch wire. Neither of these passive designs
reshaped and the brackets are bonded directly in the did not gain wide spread clinical acceptance.
mouth after which the irregularities are filled with
flowable composite. 5) H. J. RUSSELL (1951)-(passive) The continued
interest in developing self ligating brackets led to the
Russell attachment, which was developed by New York
orthodontic pioneer, Dr. Jacob Stolzenberg. This bracket
had a flat-head screw seated snugly in a circular, threaded
opening in the face of the bracket. For the orthodontist,
archwire changes were quick and simple. The horizontal
screw could be loosened or tightened with a small watch-
repair screwdriver to obtain the desired tooth movement.
102 15
Loosening allowed bodily translation on a round wire, In-Ovation-L self ligating lingual bracket
while tightening facilitated root torquing with a
rectangular or square wire.
The mechanism of this revolutionary bracket was in stark

contrast to the traditional approach of tying steel ligatures
tightly around each bracket. And for those patients of Dr.
Russell brackets, treatment was considerably more

comfortable, with shorter office visits and shorter overall
treatment time. Perhaps because Dr. Stolzenberg was
ahead of his time, the concept of self-ligating brackets fell
more or less into obscurity
6) J.E. JOHNSON (1954)-(Passive) In the same time

period Johnson invented another type of passive SLB. These lingual brackets are twin, horizontal slot brackets,
This featured a built in ligature tie which was hinged on with an interactive clip with very easy effortless opening.
one side & could rotate the arch wire. The arch wire slot The base of the incisors brackets is bent to fit the anatomy
was unique as it was held between cylindrical hinge & the of the palatal surface of the incisors. The brackets wings
opposing catch. It could accommodate 2 wires of small and clips have a very low profile. Minimal bucco lingual
diameter. This passive design did not gain wide spread width allow a larger archwire perimeter and an increased
clinical acceptance. interbracket distance has added advantages in lingual
orthodontics. Bracket positioning of these brackets can be
7) H. KESLING (1959)-(Passive) I performed with different techniques, like the TARG, the
Kesling invented a light wire self ligating orthodontic CLASS, the HIRO, and the Lingual Bracket Jig
attachment which featured a deflectable wings which techniques.
could overlap the arch wire slot. These wings temporarily
flexed to made insertion or removal of arch wire. Arch
wires could snapped in & snapped out of the slot.
16 101
Bracket positioning of the Adenta Evolution brackets is 8) M. Wallshein (1962) In 1962 Wallshein, introduced
done indirectly, using a laboratory HIRO system, several self ligating attachments. The first two were
similar in design & featured a curved flexible spring
combined with individual transfer caps comprises a mini which was fixed to one end onto the bracket body. This
transfer tray for indirect bonding and simplifies the spring could be flexed there by permitting arch wire
lingual technique system. insertion or removal. The first design was passive as it
allowed for complete freedom of movements throughout
In a study comparing the 3D Forestadent and Adenta the slot.
Evolution brackets it was found that both brackets had
some limitations in handling. The Adenta brackets were The 2nd design was quite unique as the reduced
cross section of the bracket body permitted the curved
could not open because of bonding material that remained spring to interact in corrective tooth movement. Due to
on the gingival margins of the brackets. Some of the this interaction this particular design turned to be
brackets accidentally debonded, possibly because of ACTIVE!
application of shear forces during opening of the bracket
clip. The Forestadent brackets were also difficult to Others design brought by Wallshein featured
handle during opening the wings that secure the archwire, deflectable arms which could entrap the arch wire & resist
its release. But none of these designs got wide spread
and some of the brackets were accidentally debonded.
Both 3D Forestadent and Adenta Evolution brackets are clinical acceptance.
wide mesiodistally, and this caused difficulties in 9) RUBIN & RUBIN (1963)- Passive Also in early 1960s
handling due to reduced interbracket distance. introduced another passive SLB, which featured a rigid
movable door that rotated about a pivot joint there by
entrapping the arch wire. This design could not gain wide
spread clinical acceptance.
10) F. W. JOHNSON (1964)-

design featured a rigid movable slide which served to
entrap the arch wire. A small V groove in the bracket body
ensured that the opening instrument is properly positioned
100 17
prior to open the bracket. Even this design could not get Adenta Evolution Lingual Bracket
clinical acceptance.
11) BRUNSON & DAVIS (1966)-Passive A few years

The Adenta Evolution lingual bracket is designed as a one
which was similar to the famous Goren lock. This passive piece bracket with a clip that opens at the incisal edge and
design featured a permanently mounted screw which allows insertion of the archwire from the occlusal
direction.
could be rotated until its pointed end entraps the arch wire.
Despite the popularity of Goren lock this design could not The clip can serve also as a bite plate, and consequently
gain clinical acceptance. presses the archwire further into the slot when biting.
12) A.C. BRADER (1967)-Passive I
Brader introduced 2 more SLB which were similar to
arms which could deflect upon arch wire engagement.

There by trapping the arch wire.
13) EDGLOKTM (1973) passive {TMEDGLOK is the

trade mark of Ormco corp.}
In 1971, Dr. Jim Wildman of Eugene, Oregon, developed

the Edgelok bracket, which had a round body with a rigid
labial sliding cap. A special opening tool was used to
move the slide occlusally for archwire insertion. When the
cap was closed over the archwire with finger pressure, the
bracket slot was converted to a tube. The rigidity of this
outer fourth wall rendered the
interplay with the archwire.
18 99
The Forestadent 3D Torque-Lingual self-ligating brackets The Edgelok was the first passive self-ligating bracket,
have the similar flat design as the Philippe 2D self ligating and the first to enjoy any sort of commercial success.
brackets, but have a vertical slot for 3-dimensional
control. The vertical opening of the slot provides fast and A similar bracket, designed by Dr. Franz Sander of
easy archwire insertion. The archwire is used like a Germany, was introduced two years later. The Mobil-lock
ribbon-arch, with the widest edge of the wire lying against required a special tool to rotate the semicircular labial disk
into the open or closed position. As with the Edgelok, the
the tooth surface; therefore the bucco-lingual slot
dimension is smaller than the occluso gingival slot passive outer wall transformed the bracket slot into a tube
that loosely contained the archwire. Perhaps because of
dimension and the bracket is relatively flat, with a low
profile. the simultaneous introduction of elastomeric ligatures,
however, neither the Edgelok nor the Mobil-lock gained
The archwire is secured in the slot by small wings that can much of a following.
be pushed or opened like the wings of the Philippe 2D
self-ligating lingual brackets. By pushing the wings 14) SPEEDTM (1973)-Active {SPEEDTM trade mark of
Strite industries Ltd.}
Weingart utility pliers, the archwire is secured in the slot. Dr. Herbert Hanson of Hamilton, Ontario, was creating
A thin spatula placed between the wings and the base of prototypes of a self-ligating bracket that by 1976 became
the bracket is used for opening the bracket for archwire the basic SPEED design. After four more years of design
replacement. refinement and clinical trials, the bracket was introduced
The brackets are designed with 45° of torque for all the in the market in 1980. The SPEED bracket features a
upper and lower incisors, and with 0° of torque for all the r-
bicuspids and molars. Individual prescription and occluso-gingivally around a miniaturized bracket body.
adaptation of the bracket base for each tooth, for each The labial arm of the Spring Clip, which forms the flexible
case, according to the requirements of the orthodontist, is fourth wall of the bracket slot, not only constrains the
archwire, but interacts with the archwire. This sets the
done in the laboratory by an indirect bracket positioning
technique based on a lingual setup and bracket positioner, SPEED system as a active self ligating bracket.
using specially designed jigs to hold the brackets. 15) R. FOERSTER (1980)- passive Also brought to the
98 19
by Rolf Foster. These consisted an edgewise model & a The Philippe 2D self-ligating brackets have an extremely
self ligating Begg bracket. low profile and are barely noticeable by the patient.
The edgewise version was based on a design Four types of Philippe brackets are available:
movable arch wire hook. It consisted of semi circular disk
of variable thickness which could be rotated to entrap the A standard medium twin (regularly used for the lingual
arch wire with arch wire of adequately large dimensions. technique),
The disk could be rotated there by locking the arch wire. A narrow single-wing bracket for lower incisors
The Begg version featured a rotating cylinder A large twin bracket
with a protruding tab. The cylinder could be rotated to
permit insertion of arch wire & rotated back to its original A three-wing bracket for attachment of intermaxillary
position to entrap the arch wire. Both of these passive elastics.
designs could not gain wide spread clinical acceptance.
Philippe self-ligating brackets can be placed directly intra
16) FOGEL-MAGILL (1980)- passive Another design orally or prepared for indirect bonding on the
malocclusion model.. They are suitable for simple cases
a self ligating design based on earlier much written about that do not require 3-dimensional control since they have
Fogel- Magill edgewise combination bracket. SL model no slot.
featured integral C- clip, which were adjacent to arch wire
Forestadent 3d Torque-Lingual Self-Ligating Brackets
slot.
Arch wire could be snapped into the flared openings in

the C-clips. Arch wire removal involved snapping the
arch wire out of the C-clips. This passive design could not
get that much clinical acceptance.
17)ACTIVATM (1986)- Passive {TMACTIVA is a trade

mark of Ormco Corp.} In 1986, the self-ligating
Activa bracket, designed by Dr. Erwin Pletcher, offered
20 97
contain the archwire. Brackets are directly bonded to the another alternative. The Activa bracket had an inflexible,
lingual surfaces without an indirect setup. curved arm that rotated occluso-gingivally around the
cylindrical bracket body. The arm could be moved into a
- -
alone; once closed, the rigid outer wall of the movable arm
converted the bracket slot into a tube. in short, It featured
a circular door which rotates around cylindrical bracket
body permitting insertion & removal of arch wire. Each
bracket also featured a vertical slot.
As with the Edgelok bracket, the passive configuration of

the Activa bracket limited its interplay with the archwire.
Drawbacks such as the ease with which patients could
open the bracket and a large mesiodistal bracket width
eventually led to its commercial demise.
18)TIME TM (1996)- Passive { TMTIME is a trade mark of

Philippe 2D self-ligating lingual bracket, ARE
Adenta}
USED for the correction of simple malocclusions, such as
minor crowding or spacing. These brackets have no slot; In 1995, another self-ligating model entered the
they include small wings welded to the brackets base. The marketplace. Designed by Dr. Wolfgang Heiser of
wings are used to secure the archwire to the brackets base. Innsbruck, Austria, the Time bracket is similar in
The wings are closed, or pushed against the base of the appearance to the SPEED bracket, but its design and mode
brackets with Weingart utility pliers to hold the archwire, of action are significantly different. About the size of a
and can be opened for archwire replacement, using a thin conventional bracket, the Time features a rigid, curved
spatula (Haideman) placed between the wings and the arm that wraps occlusogingivally around the labial aspect
base of the bracket. of the bracket body.. The stiffness of the bracket arm
prevents any substantial interaction with the archwire,
thereby rendering Time a passive bracket.
96 21
19) DAMON SLTM 1 (1997) Passive {TMDamon SL1 is

a trademark of Ormco corporation}
Chapter 11
st SELF LIGATING LINGUAL BRACKETS
of several Damon
brackets was introduced. It featured a rigid slide. This
slide was wrapped around the bracket body could be
moved to permit arch wire insertion & returns to its
original position to entrap the arch wire. The Damon 1
The use of self-ligating brackets in lingual orthodontics
was unique & popularized due to utilization of tie wings
was first presented by Neumann and Holtgrave, who
in self ligating designs. This design went several
suggested the use of SPEED self-ligating labial brackets
variations and replaced by Damon 2 design.
for application in the lingual technique.
20) TWIN LOCKTM (1997)-Passive {TMTwin Lock is a
He used labial upper incisor brackets upside down for
trade mark of Ormco company}
lingual bonding on the bicuspids, and for bonding on the
The TwinLock bracket, a second endeavor by Dr. Jim lingual of the incisors, he used Ormco Generation 7
Wildman, was introduced in 1998. Its flat, rectangular lingual brackets, since the labial SPEED brackets could
slide, housed between the tie wings of an edgewise twin not be adapted to the lingual surface unless a very thick
bracket, is moved occlusally into the slot-open position custom resin pad was added. This combination was
with a universal scaler. It then slides gingivally with unable to offer the benefits of specifically designed self-
finger pressure to entrap the archwire in a passive ligating brackets such as improved hygiene, less chair side
configuration. time, and less friction.
21) DAMONTM 2 (1999)-Passive {TMDamon 2 is a

trade mark of Ormco Corporation}
Phillipe 2 D Self Ligating Lingual Brackets
Similar self-ligating bracket designs were introduced in
Phillipe lingual self ligating brackets were introduced in
1996 and 1999 by Dr. Dwight Damon, of Spokane,
the year 2002. Instead of a rectangular slot, the Philippe
Washington. The Damon SL and the Damon 2 are both
2D lingual bracket has 2 wings on the lingual surface to
edgewise twin brackets; the difference between these two
22 95
IN OVATION C BRACKET SYSTEM generations is that the first featured a labial cover that
straddled the tie wings, while the second incorporates a
flat, rectangular slide between the tie wings.
In both versions, the slide moves incisally on the

maxillary brackets and gingivally on the mandibular
brackets.Both the Damon SL and the Damon SL 2 form
rectangular edgewise tubes by means of a solid outer wall.
A passive hybrid, composite metal bracket, the Damon 3
bracket became available in 2004.
22) INOVATIONTM (1999)-Passive {TMInOvation is a

trade mark of GAC International
The introduction of the In-ovation bracket (GAC

International) in 2000 was an attempt, similar to the
In- Ovation C is a ceramic self ligating bracket. It is Damon design, to interest orthodontists in a bracket that
translucent and has a rhodium coated clip for esthetics. was self ligating and featured tie-wings. This combined
design resulted in a rather bulky bracket that incorporated
ADVANTAGE
Full slot coverage for true twin rotational control elgiloy spring clip renders the In-Ovation an active self
ligating appliance. These are very similar to the SPEED
Easy opening and easy closing bracket in conception and design, but are of a twin
Its coballoy spring clip technology is easy to use: closing configuration.
In 2002, smaller brackets for the anterior teeth

correct engagement which provides better torque became available In-Ovation R (Reduced). This
expression narrower width is very welcome in terms of greater inter-
bracket span
94 23
23) SMART CLIPTM (2004)-Passive {TMSmart Clip is Self ligating mechanism

a trade mark of 3M Unitek}
The Clarity SL self ligating brackets has a pair of nickel
Most recently one more SLB design has titanium clips as its primary ligation mechanism. Ceramic
invented which also closely resembles those of the past. rotation arms extend from the mesial- distal side of the
bracket body to hold the clips. The cap at end of the
featured Nickel Titanium C-clips which flex open to rotation arm retains the clip in the mesial- distal direction.
archwire insertion or removal. The twin design provides the flexibility to use only one
clip or to use traditional ligatures if desired.
24) OYSTERTM (2004)-Passive {TMOyster is a trade
mark of Genstenco Corporation} The nickel titanium clips on the bracket do not apply any
force to even a full size archwire. If additional force is
25) OPALTM (2004)-Passive {TMOpal is a trade mark needed, the clarity SL bracket can be ligated in the same
of UP Dental} manner as a conventional bracket. This feature (the ability
to ligate with convention -on-
disappeared from the orthodontic design has begun its
way into the design of SLB. Two passive SLB designs ligature wire is used with the Clarity SL bracket, the
have recently emerged. The Oyster & Opal bracket, both frictional properties of the clarity SL bracket are similar
of them are entirely made of plastic & featured a hinged to those of conventional clarity ceramic bracket
cap which rotates open for arch wire insertion or removal.
Their success is questionable but they are still
commercially available.
26) DAMONTM 3 (2005) & DAMON 3 MX-Passive

{TMDamon is a trade mark of Ormco Corporation}
Plastic also made its way into Damon

brackets. The Damon 3 features a metal arch wire slot &
rectangular slide housed in a plastic shell. This plastic
24 93
Disadvantages shell forms bracket base & tie wings. The rectangular
slide functions same as in previous Damon models.
Poor Dimensional Stability
Damon 3 and Damon 3 MX brackets have a
Staining nature different location and action of the retaining spring, and
this has produced a very easy and secure mechanism for
opening and closing. In addition, Damon 3 brackets are
CLARITY SL Self-Ligating Brackets semiesthetic. However, early production Damon 3
brackets suffered three significant problems: a high rate
of bond failure, separation of metal from reinforced resin
components, and fractured tie wings. These three
problems all received rapid and effective investigation
and correction, but illustrate that it continues to be a
significant challenge for manufacturers to extrapolate
from the experience with prototype brackets in the hands
of skilled enthusiasts to subsequent full-scale production
and the use by relative novices. It is interesting that such
early difficulties did not prevent the enthusiastic adoption
of these brackets. This was probably due to the greatly
increased appreciation of what self-ligation could do and
The Clarity SL is an aesthetic passive Self Ligating
also to the greater willingness of manufacturers to invest
Bracket. These brackets synergize the aesthetic properties
in finding solutions. The recently launched all metal
of clarity ceramic brackets with the technology of smart
Damon D3 MX bracket has clearly benefited from
clip self ligating brackets. The strength of the alumina
manufacturing and clinical experience with previous
material used allows for a small bracket body. The
Damon brackets.
injection-molding process allows for a smooth, round
design.
92 25
Patent Bracket Mode Moving Currently
File of Components Available
The brackets, like most resin brackets are best suited for
Date action
short treatment cases.
1933 Boyd Passive Rigid No
band sliding bar
bracket OYSTER Self Ligating Brackets
1933 Ford Passive Rigid No
Lock rotational
lock
1952 Russell Passive Rigid No

appliance sliding lock
1966 Branson Passive Rigid No

rotational
screw
1972 SPEED Active Highly Yes

system flexible
spring clip
1972 Edgelok Passive Rigid No These are the First Translucent polycarbonate Self-
bracket sliding clip Ligating Brackets made by Gestenco and introduced in
the year 2003.
1979 Mobil Passive Rigid Yes
lock rotational They are made of Fiberglass reinforced composite
bracket disk polymer. The self ligating mechanism consists of a cap
which can be removed and place back again. The brackets
have a mushroom hook for elastic attachment
26 91
1986 Activa Passive Rigid No

Chapter 10 bracket rotational
arm
ESTHETIC SELF LIGATING BRACKETS 1995 Time Passive Rigid Yes

bracket rotational
arm
ULTRADENT OPAL BRACKETS 1996 Damon Passive Solid Yes
bracket indented
slide
1998 Twin Passive Solid labial No

Lock slider
bracket
2000 In- Active Flexible Yes

Ovation spring clip
2004 Damon Passive Rigid solid Yes

III slide
2005 Smart Passive Ni Ti spring Yes

Opal brackets are resin aesthetic self ligating brackets
clip
designed and developed by professor Norbert Abels. They
are made of translucent, nickel-free, glass-filled material
They have are no tie wings, so elastic chain is placed in . Table 1: An overview of the evolution of self-ligating
the auxiliary slot prior to closing the cap. brackets
90 27
and distal wings. By means of pressing the handles

Chapter 4 together, the wire disengages from the bracket slot
ACTIVA self ligating brackets
Disengaging the archwire from the SmartClip brackets
28 89
Wire Insertion
Activa brackets are active self ligating brackets designed
One end of the insertion instrument has a rectangular
by Irwin Pletcher and introduced in 1986. They are fully
notch, allowing the engagement of the orthodontic programmed preadjusted self ligating brackets in which
archwire. This notch allows the clinician to direct the the arch wire is retained by a resilient clip that rotates into
archwire into the bracket slot, applying very gentle a retaining groove gingival to the arch wire, positioning
pressure to pass the wire through the clips and engage it
two straps labial to the wire and creating a bracket that is
into the bracket slot. The opposite end of the insertion very similar mechanically to a molar tube with twin
instrument is designed to be used as a torquing key to aid
channel caps.
in the insertion of full size rectangular archwires. When
applying The clips can be opened and shut with a wide range of
commonly used hand instruments including ligature
pressure to the wire, the clinician should support the tooth tuckers, flat plastics, and Mitchell's trimmers.
from the lingual, using the fingers to provide comfort for
the patient. To make the wire insertion easier, it is advised All brackets have vertical slots behind the arch wire
to initiate archwire insertion at the upper and lower central channel and permanent, as well as painted, identification
incisors. Flexible archwires may be fed through the slots marks.
created by the clips in the premolar and molar brackets if
the wire ends have not been bent back before insertion of Brackets for the anterior teeth have gingival and occlusal
the wire. tabs to assist orientation relative to the facial axis of the
clinical crown. Premolar brackets have rectangular
bonding bases.
Wire disengagement
The disengagement instrument is used to disengage

orthodontic archwires from the bracket slot. The
disengagement tool has two hooks to engage the wire, and
its central part holds over the buccal surface of the mesial
88 29
ADVANTAGES OF ACTIVA The appliance may also be used with full size (.028)
archwires; doing so will leave the clip in a slightly open
1. Speed the process of ligation.
configuration, also compressing the archwire to the slot
Maijer and Smith (1990) demonstrated a four-fold base.
reduction in ligation time compared with wire ligation The ability to vary frictional effects to
of conventional brackets. a greater degree than is possible with conventional
2. Low friction between bracket and archwire appliances, in addition to force levels, is an inherent
advantage to the Smart Clip. Optimized utilization of the
This has been clearly demonstrated and quantified in work Smart Clip Appliance System includes a variable friction
by Griffies et al. and by Sims et al. The friction is approach, depending upon the stage of treatment and the
dramatically lower than with elastomeric rings and specific treatment objectives related to that stage. The
conventional brackets. greater play within the bracket slot of the smart clip
dictates consideration, especially if the finishing is to be
Nigel Taylor and Keith Ison(1996) assessed the frictional
done with the light wires.
forces for the three types of 0.022x0.028 brackets:
preadjusted edgewise stainless steel premolar bracket,
Activa brackets and SPEED brackets with five wire sizes
from round to rectangular wires and found that Activa Insertion and Disengagement of Wires
brackets produced the least friction for all the wires. The Nitinol clips in the SmartClip self-ligating appliance
3. Very secure arch wire engagement in an edgewise slot system present some resistance to archwire insertion and
is currently only possible with self-ligating brackets and disengagement, with the amount of the resistance varying
is by far the most beneficial feature of Activa brackets. based on archwire size and shape. Hand instruments have
been manufactured to make the insertion and
This combination enables lower and more predictable net disengagement of the archwires easier. Their use also
forces no undesirable rotation of the tooth resulting from allows easier insertion of rectangular archwires with
a deformable mode of ligation. anchorage conservation torque added to the wire.
rapid alignment .
30 87
The mini-twin design allows selective engagement of 4. Less chairside assistance:

mesial or distal tie-wings with the ability to compress the
Self-ligating brackets require no passing of elastomeric or
archwire into the bracket slot when appropriate. This
option is not available with other self-ligating brackets. wire ligatures to the operator during ligation.
Additionally, it has no moving parts. 5. A vertical slot:
Another factor to augment rotational control, is selective The T-shaped locking pins are a preformed auxiliary. It
engagement of mesial or distal tie-wings, thereby has been suggested that Activa self ligating brackets have
compressing the wire into the slot as necessary for further advantages due to the absence of ligatures and tie-
elimination of rotations. It should be noted that with wings.
passive self-ligating brackets, there is no force
compressing the archwire into the bracket slot base. 6.Smoother and more comfortable
In addition to "passive'' self-ligation, No wire ligatures

other self-ligating alternatives include so called "active"
7. Good oral hygiene
self-ligating brackets, where a compressive force actively
presses the archwire into the base at the bracket slot, and No ligatures
'"interactive" self-ligating brackets, which are engineered
to be "active" or "passive" depending on the size of the 8. Better esthetics
archwire. The best current evidence suggests that both
Smaller than many brackets and no elastomerics to
"active" and "passive''' states have advantages and
discolor
disadvantages.
The design of Smart Clip brackets allows the clinician to

readily embrace either state. Smart Clip brackets are
designed to maintain a passive state, meaning there is no
compressive force on the bracket slot with the typical wire
sequencing. However, the active configuration is
available "on demand" by using ligatures or elastomerics.
86 31
DISADVANTAGES OF ACTIVA Nitinol clip
1. Higher bond failure rate Each bracket contains two clips made of
Nitinol material. The integral nickel-titanium clips permit
This is because of - easy and simple archwire insertion and removal.
Failure to fully seat bracket on the teeth.
Smaller bases than with most brackets. APPLIANCE FUNCTION

the absence of tie-wings and small bases lead to less The Smart Clip Self-ligating Appliance System,
rigidity and easier distortion of the base and consequent the archwire is "passively" held in the bracket by means
bond failure under external loading forces.
of the programmed nickel-titanium clip. There is no
More recently, the premolar Activa brackets have been constant normal force of ligation, and therefore friction is
supplied on the standard rectangular bracket bases with a reduced. There is more rapid leveling and alignment of the
consequent marked reduction in loss of these bonds and a dentition. The clip is designed to release if force becomes
claimed increase in bond strength of 45% to excessive
60%depending on adhesive type.
2. Less convenient with power chain
When closing multiple spaces, elastic chain must either be

placed behind the arch wire or T-shaped locking pins must
be placed in several brackets.
Placement of the chain behind the wire means keeping

the chain out of the slots during placement and also means
removing the arch wire when renewing the chain..
32 85
the archwire exerts a force on the clip. The bracket

contains no moving door or latch. The feature of no
3. Unfamiliarity and difficulties during bracket placement
moving doors or latches can eliminate problems such as
sticking, spontaneous opening, plaque build-up, etc., that Tie-wings are useful holding points for tweezers and their
are associated with other types of self-ligating brackets. absence dictates minor changes in bracket placement
technique.
BRACKET DESIGN AND MANUFACTURE Also, the very different shape and the unfamiliar aligning
tags on the bases require close concentration, particularly
The main bracket body is molded using the angulation of canine brackets. The eye is easily distracted
metal injection molding process. A high-precision laser by the arch wire slot and clip from the task of aligning the
process cuts the Nitinol clip and subsequent processes oblique tags with the facial axis of the tooth.
smooth the clip. The bracket holds the clip through
mechanical means.
The mesh bonding base is laser-welded onto the bracket 4. Partial slot engagement is not possible
body. Smart Clip brackets are the only true self-ligating The wire retaining clip is either fully closed or not at all
bracket, because the clip automatically closes and secures WHICH CREATES PROBLEM IN ECTOPIC AND
the archwire in the wire slot. A Smart Clip Appliance hand SEVERELY ROTATED TEETH
instrument is designed to simplify the process of archwire
engagement and disengagement. Because of the true twin IN SUCH CASES,, the wire can be held into the slot base
design, the clinician has the option of selectively engaging with an amalgam plugger or ligature tucker or the
the archwire in only one clip when teeth are severely ubiquitous Mitchell's trimmer and the clip can then easily
maloccluded. In addition, the familiar tie-wing design be closed. If the tooth is very rotated and the end of the
allows for the use of traditional ligation at the option of slot is too close to the adjacent tooth for an instrument to
the clinician. This design also facilitates simple and easy be used to seat the wire, dental floss looped over the arch
use of chain ligatures when needed for space closure. wire can be used to engage the wire on that side. Another
useful maneuver is to first close the clip on a very rotated
tooth and then thread the aligning wire through the closed
84 33
bracket before engaging the other brackets. Where the

difficulty is the full engagement of a stiff rectangular wire,
Chapter 9
the special Activa seating key is the best instrument to SmartClip self-ligating bracket system
assist clip closure
5. Breakage of arch wire retaining clips
It is extremely uncommon for this to occur between

appointments. Loss of control of tooth position through
ligation failure is therefore rarely a problem. However,
clip breakage does occur if the operator employs
excessive force when trying to engage an arch wire on a
stiff and incompletely engaged wire.
Should a clip break, it is possible to replace it with a new

clip without the need to remove and replace the bracket.
Separate clips are supplied for this purpose. Placing a new
clip in the circumstance is a slightly awkward little task
that rapidly becomes quicker and easier with practice. The smart clip brackets are passive self ligating
Fractional enlargement of the radius of the circular brackets introduced in the year 2004. Manufactured with
portion of the clip (with light-wire pliers) before pressing -
it onto the bracket eases placement. titanium, which has an intrinsic memory for shape and
t self-ligating mechanism
secures the archwire in place, yet is specially calibrated to
release the archwire if forces exceed a predetermined
6. Low friction increases wire displacement
level.
Even with very irregular teeth, the very low friction
The Smart Clip Bracket's self ligating
enables aligning arch wires to slip through the brackets
mechanism consists of two Nitinol clips that open and
and an arch wire end to protrude excessively. Steps to
closes through elastic deformation of the material when
34 83
values. This is more marked in lower incisor with prevent this include using tie-backs over extraction sites
reduction of prominence by 1/3 to lessen the effects of occlusal forces on unprotected
spans of wire.
The Time bracket base has microetched mechanical
undercuts .Several studies have found mechanical bases Also, elastic string can be closed into the slot with the arch
to be inferior to mesh bases in terms of debonding strength wire to deliberately increase the friction on selected slots
and lessen arch wire travelling
Selective locking of individual brackets to the arch wire

with elastic string can be helpful under other
circumstances, e.g., to reinforce anchorage during center-
line correction. Small V-shaped notches in the midline of
flexible wires can also limit the scope for wire swiveling.
Particular care should be taken to turn up the ends of all
flexible aligning wires.
7. Difficulty obtaining perfect alignment
This can be because of -
incorrectly positioned as a result of their visual

unfamiliarity.
inadequately seated brackets because of the lack of tie-

wings that are the usual place on which to push.
arch wires of less than full slot dimensions
82 35
8. Finishing cases with Activa brackets Advantages of TIME brackets
Roth has recommended that on occasion it is even

preferable to change to conventional straight wire
brackets for the last 2 to 4 months, where torque alignment Minimal force and friction (passive) in the early stage of
is a major consideration. treatment
Greater use of 0.021 to 0.025-inch finishing arch wires is Torque and rotational control (active) in the middle and
therefore indicated and nickel-titanium or TMA arch finishing stages of treatment
wires are very useful in this respect. Occasionally, Low profile (low in-out relationships)
localized torque in a TMA arch wire is required alignment
with Activa brackets is usually rapid and very good. Unwanted rotations do not occur during retraction,
because the spring clips and light forces control any
Errors of bracket positioning resulting from a lack of tendencies
familiarity with these unusually shaped brackets are a
larger source of finishing difficulties than would be A simple to open-close clip mechanism for ease of wire
anticipated. changes
The capacity to achieve finishing details in a controlled

manner in all three planes of space.
Early torque control from the interactive spring clips

allows treatment to be finished sooner
Disadvantages
With one piece bracket system, the distance between slot

and base is increased which in turn reduces the inout
36 81
Chapter 5
SPEED self ligating bracket system
Closing spring clip seat s0 .018" x 0 .025" archwire

against slot walls, producing full torque control.
Therefore, torque control can be achieved much earlier in

treatment than other bracket systems. A .018" x .025" or
CLOSED OPEN
.019" x .025" stainless steel archwire provides the same
torque as a wire in a .022" slot. Time creates the torque;
the torque does not need to be added to the archwire.
It is an Active Self ligating Bracket described by Dr.
Hanson in the year 1975.
Hanson combined Angle's edgewise appliance with his

own concept of developing both a dynamic and self-
ligating appliance. This resulted in a spring-loaded, self-
adjusting ligature less design that possessed the unique
quality of retaining and actively influencing control of the
80 37
arch wire within the arch wire slot. This design is now
known as the SPEED appliance (Strite Industries Ltd.,
Ontario, Canada). The name is derived from the
descriptive terms Spring loaded, Precision, Edgewise,
Energy and Delivery, all of which describe features of the
design. This fully preadjusted edgewise appliance, which
in clinical use since 1977 and commercially available

since 1980.
(A) The Time interactive self-ligating bracket with a
In the SPEED bracket system, the arch wire is retained round archwire in the slot showing the bracket in passive
in the arch wire slot by means of a built-in, escape-proof, mode. (B) The Time interactive self-ligating bracket with
flexible spring clip. Unlike the traditional edgewise a rectangular archwire in the slot showing the bracket in
bracket, it requires no ligature tie, thus reducing the active mode.
frictional force.
The Spring Clip, through elastic deflection, gently imparts

a light, continuous level of force on the archwire, resulting Thus, the brackets provide reduced friction with the
in precise and controlled tooth movement. Hanson smaller wires used for leveling, retraction, or molar
the distalization, and torque control with rectangular later in
ability of the SPEED bracket to reorient itself three- treatment.
dimensionally until the archwire is fully seated in the slot. It is not necessary to engage a full-size wire to achieve the
Any subsequent rotation, tipping, or torquing, during desired torque, because the spring clip presses the wire
tooth movement of any kind, results in a labial deflection against bottom and walls of the bracket slot.
of the spring that reactivates this homing behavior.
38 79
control the force required for tooth movement. The SPEED APPLIANCE DESIGN
magnitude of the force depends on the diameter of the
Each SPEED attachment consists of four components:
wire and the direction of pull. In a study by David
S.(1998) it was found that a force of 1.17 Newton is bracket body, permanently installed spring clip, an in-out
needed to pull an .014" round nickel titanium wire, adaptor, and a foil mesh bonding base. Although SPEED
parallel to the slot, through a conventional bracket, attachments are similar in appearance they are uniquely
designed for each corresponding tooth.
compared to .01N for a Time bracket and .01N for a
Damon SL bracket.
A 0.019" x 0.025" stainless wire took 2.25N of force with

the conventional bracket, .75N with the Time bracket, and
.07N with the Damon SL bracket.
With smaller wires, there is essentially no difference

between passive, tube like self-ligating brackets such as
Activa and Damon SL and active self-ligating brackets
such as SPEED and Time.
The Time spring clip is stopped by a notch .018" from the

bracket base. For wire sizes up to .018", therefore, it acts
like a convertible tube. The SPEED spring is .016" from
the bracket. With lesser diameters, there is no contact
between the archwire and the spring clip, and friction is
greatly reduced.
The bracket body:
When the wire exceeds .018", in the case of Time
The SPEED appliance uses a narrow, single bracket body.
brackets, the force of the clip will produce friction. The
The body design differs slightly in width between the
force delivered by a spring clip to the archwire is 250-
anterior and posterior teeth.
350g, depending on the width of the clip.
78 39
* Narrow form for the incisors, elastics in any desired configuration. The resultant bracket
is a simple design without unnecessary additions.
*Slightly wider posterior body
* Miniaturized mushroom-shaped hook from the distal-

gingival of each bracket body. Opening and closing the bracket
* Three horizontal slots being comprised of a pre-torqued The Time bracket can be opened either with a dental
arch wire slot, an auxiliary slot, and a spring retainer slot. probe or with its own special opening instrument. A hole
machined in the spring clip places the probe in the correct
* The arch wire slot is available in either 0.018 x 0.025 location. The spring clip opens far enough for a wire
inch or 0.022 x 0.028 inch and can accomm odate round, inserted, but the opening is limited by a stop between the
rectangular, square, or SPEED shaped arch wires. clip and the bracket body.
*The 0.016-inch square auxiliary slot is designed to
Resistance will be felt when the opening is reached;
accommodate a variety of preformed hooks for use with opening the clip any farther could deform it enough that it
elastics and can house any configuration of segmental would have to be replaced. If necessary, the spring clip
arch wires. Also, ligature tie or elastomeric thread may be can be removed by over-opening it or by sliding it
fed through the auxiliary slot and then tied to the arch
mesially or distally. This will allow the bracket to be used
wire. For lingually displaced teeth, this approach tends to with conventional ligatures.
minimize overstressing of the arch wire or periodontium.
The Time bracket is closed by inserting the same
* The spring retainer slot can house the recurved tip of instrument into the hole in the spring clip and rotating the
the spring clip. This slot is deep enough and shaped with spring to closed position.
an outer lip to securely house the spring clip during the
most severely of transient stresses.
Archwire Friction and function:
The relatively high friction of

conventional preadjusted brackets makes it difficult to
40 77
function in either a passive mode or an active mode with The spring clip:
archwires of specific dimensions.
The clip is the unique roll-shaped, flexible spring
clip. This highly resilient spring clip opens and closes in
a vertical manner to permit arch wire removal and
insertion and, hence, replaces the steel or elastomeric tie
as used on conventional brackets as a means of ligation.
This flexible spring clip can occupy either of two resting
capable of storing energy, which is gently released as

corrective tooth movement occurs.
When corrective tooth movement is required, archwire

The clip is accessed through a hole in its face with a engagement results in the elastic deflection of the spring
simple hand instrument, similar in appearance to a right clip as. This elastic deflection represents energy stored in
angle dental explorer. Exposure of the bracket slot for the spring clip, which is released as the bracket and its
archwire insertion or removal is easily accomplished by accompanying tooth are reoriented relative to the
engaging the hole of the clip with the instrument and archwire, in a corrective manner. Any subsequent
rotating the clip in a gingival direction. movement of the tooth from this ideal position results in
a repeat of this corrective process and a return of the tooth
Closure and containment (full engagement) of the
to its correct position. The SPEED design ensures precise
archwire is accomplished with equal ease by rotating the
control of tooth movement in all three planes of space.
clip back to the occlusal closed and locked position.
Kobayashi hooks or hooks cast as part of the bracket are

not required because the gingival undercut area of the
bracket is more than sufficient to allow co-ligation,
placement of elastomeric chain, or patient placement of
76 41
is interactive, in that it exhibits both passive and active

properties under specific conditions that are under direct
control of the orthodontist.
The Time bracket system is manufactured in b
Bracket design
(A) The range of motion of the spring clip is illustrated. About the size of a conventional bracket, the time
The stored energy in the spring clip acts progressively to features a rigid, curved arm that wraps occluso gingivally
move the tooth until the archwire is fully seated in the around the labial aspect of the bracket body.
home position in the bracket slot. (B) This illustrates the
low friction metal-to-metal contact between the archwire The bracket body is a cast (metal injected molded), one-
and the SPEED bracket. (C) The spring clip activated for piece twin design with an integral bonding base. Oriented
rotation is shown. The spring clip will continually act to
rotate the tooth until the archwire is seated in the home -shaped stainless steel
position in the bracket, as in Fig B. retaining clip. The clip is shaped and hinged on the tie
specific dimensions.
The In-Out Adaptor
Within the occlusal tie wings of the bracket body is a
The SPEED adaptor features both an angular and a
recess that contains the free end of the clip and limits its
translational dimension which ensures the creation of an
travel to a defined dimension in the lingual direction, thus
exceptionally smooth arch form that is achieved through
delineating a geometric zone wherein the bracket can
- -out adaptors
42 75
The Mesh Pad

Chapter 8
The foil mesh bonding pad has complex asymmetric
TIME self-ligating bracket system curvatures.These, along with the miniaturized dimensions
of each mesh pad, ensure ideal bracket to tooth adaptation.
Furthermore, the recent change in size of the brazed foil
mesh from a fine 100 gauge to a coarser 60 gauge has
further enhanced the bond strength of the SPEED
attachment.
ARCH WIRES- selection and use
The speed bracket is an edgewise appliance that

accepts edgewise wires and permits the use of
conventional archwire mechanics. Some specialty
The Time is a active self ligating bracket, designed by Dr. archwires have been developed to exploit the unique
Wolfgang Heiser in 1995. The Time bracket is the first mechanical behavior of the spring clip which maximizes
one-piece self-ligating system which was developed over the efficiency of SPEED appliance .
a period of three years using CAD/CAM computer
technology
-ligating bracket, with both integrated Super cable archwire

passive and active elements (interactive) the Time
Super cable is a 7 strand super elastic nickel titanium co-
bracket is similar in appearance to the speed bracket but
axial wire that was designed specifically to complement
its design and mode of action are significantly different.
the action of the nickel titanium spring clip.
The Time system
74 43
*Super cable exerts dramatically reduced force levels

compared with solid nickel titanium and thermally
sensitive wires of similar dimension.
* Super cable archwires are engaged easily and fully

with no plastic deformation.
*The extremely low unloading force plateau and the super

elastic qualities of the wire ensure that appliance induced
stresses with in the periodontium will remain at near
optimal levels through the full range of de activation.
Fig.36 -Mesial view of R-system bracket showing (A)
active or clip friction on rectangular wire & (B)
passive or no clip friction on a square wire.
Supercable consists of seven strands of superelastic nickel

titanium wire in a coaxial form. It is impossible to
permanently deform Supercable regardless of the
malalignment of the dentition.
44 73
flex buccally if the wire is not fully seated. At maximum D wire
D- Wire is half round and half square that is suited ideally

force. If a tooth moves out of proper sliding alignment
for 3 dimensional control during sliding mechanics and
archwire and actively reseats the archwire. The clip gently ensure a high degree of precision and control with reduced
and securely guides the archwire into the bracket slot until friction during sliding mechanics. D-wire is available in
0.018x 0.018 inch and 0.021x 0.021 inch dimension
on the bracket, as shown in Fig 36 B, and the clip becomes
passive with no force on the wire. If more retraction
movement causes the tooth to again move, the process Hills dual geometry archwire
repeats itself. Thus, the bracket maintains proper tooth
Hills dual geometry archwire has been engineered to be
position as it slides along the archwire.
an optimal wire for sliding mechanics in the posterior
segments via a polished round posterior segment while
gingival and vertical internal walls of the orthodontic slot ensuring maximum anterior incisor crown torque control
are 0.0185_ long. The occlusal or incisal wall of the with a square anterior segment. The archwire is
bracket slot is longer, at 0.0255_, as shown in Fig 3A. An constructed with an ultra high tensile strength stainless
steel with optimum stiffness. The Hills archwire is
but does not contact the clip.12,73 A fully seated square available in 2 sizes: 0.018x0.018 inch anterior with 0.018
0.018_ _ 0.018_ archwire in an 0.018 inch round posterior for the 0.018 slot and 0.021 x 0.021
full in-out, tip and torque control without clip friction. inch anterior with 0.020 inch round posterior for the 0.022
slot
72 45
SuperMesh base has proven itself in millions of cases,

providing the best in retention and debonding cleanup.12
It layers a wide mesh over a tighter mesh for more surface
area, without raising the profile.
Instruments used with In- Ovation brackets:
1. TN3: The TN3 has a specially designed scaler to

quickly and easily clean flash around the base. The other
end is a flat slot blade for orienting the bracket, and is
notched for referencing the height during bracket
The Hills Dual-Geometry wire features a square anterior
placement.
portion for torque control and a rounded polished
posterior to enhance sliding mechanics 2. Engage-R: The Engage-R makes placing wires on
rotated teeth easier than ever. The lips span the bracket to
grab the wire and seat it in the slot, allowing you to snap
SPEED finishing archwires: the cap closed with minimal patient discomfort and
The beveled labial- finishing which automatically seats the sliding cap for easy opening
archwires encourages full expression of the interaction every time.
between the superelastic spring clip, the archwire, and the
archwire slot .Any deviation of the bracket position -ligating bracket evolved from the
relative to the wire results in deflection of the spring clip, In-Ovation bracket design and has a closing clip that can
which stores appropriate energy for recovery. apply pressure or no clip pressure to the archwire as the
situation requ
This energy is released gently through precise 3 passive or active self-
dimensional tooth positioning. In addition, this quarter
round archwire shape facilitates wire insertion and spring
46 71
clip closure. The rounded edge of the archwire is always

directed occlusally in the labial-gingival in either arch.
Enhanced Hygiene
The wires are available in either 0.017x0.022 inch for
Elastomeric ties deform and decompose, and their the0.018 slot or 0.020x 0.025 inch for the 0.022 slot.
decay may attract plaque near the enamel surface. Steel
ties have sharp edges that can attract plaque and irritate
the patient, while increasing the risk of cross-
contamination. In-
into the bracket body reducing many of the potential
with enamel
discoloration or gingival inflammation.
Enhanced Inter-Bracket Distance
Greater inter-bracket distance equals greater

working range. Without the binding and clutter of bulky
elastomers, the added wire length especially with near The SPEED finishing archwire has a quarter round
shape, which facilitates archwire
constant, low force Sentalloy type arch wires can
relieve periodontal stress. In-Ovation is self-ligating Insertion, spring closure, and is highly effective in torque
system with complete four dimensional programming control
which combines Metal Injection Molding (MIM) with
Computer Numerated Controlled (CNC) milling. MIM
provides a smaller design, with greater strength and full
THE SPEED APPLIANCE FUNCTION
compound-contouring of the base. CNC milling ensures
the truest slots available today.12 The wingless SPEED appliance and the
presence of the flexible spring clip is primarily
responsible for controlling tooth movement in all three
planes of space through rotation, tip, and torque. It also
70 47
ensures a more continuous delivery of force and a reduced

level of friction.
Chapter 7
Rotational control IN-OVATION BRACKET SYSTEM
On arch wire engagement, the SPEED spring clip is In- Ovation brackets were introduced in the market in the
automatically activated by its displacement from the year 2000 by GAC Company.
resting position. The inherent nature of the spring clip is Advantages
to return to this resting position.
Reduced Resistance
Any rotational correction is achieved through the
torsional component of the deflection of the spring clip. In-Ovation seats the arch wire in the base of the slot
This deflection creates a rotational couple consisting of a for predictable results without the high resistance
fulcrum and spring clip force that results in subsequent associated with traditional steel and elastomeric ties.
tooth movement. Unlike Passive Brackets, In-Ovation reduces the
resistance without sacrificing control by seating the arch
wire fully in the base of the slot. In-Ovation is the first
Tip control: twin bracket to offer both these important advantages.
The labial arm of the SPEED spring clip forms a resilient Reduced Chairtime
outer wall to the arch wire slot. It is the inclination and In terms of initial placement (and then eventual
resiliency of this wall that ensure full tip control. Any replacement) conventional ligation techniques are
required tip correction is achieved through the labial extremely time consuming. Self-ligating systems have
deflection and subsequent return of the spring clip to its been shown to require up to 75% less time for arch wire
resting position changes.
48 69
Torque control:
DAMON MX The geometry of SPEED's torque control resides in the

combination of the mechanical action of the arch wire in
the slot with the constant force application of the spring
clip. The synergistic effect of these two components
ensures the full expression of built-in torque. The
efficiency of this action is further enhanced through the
combined effect of the spring clip and the uniquely
beveled shaped SPEED arch wire. SPEED shaped arch
wires take full advantage of the inclined plane created by
the SPEED spring clip and are ideally suited as finishing
arch wires.
These brackets are all metal and have essentially the same
sliding mechanism as Damon 3 with further refinements. Continuous force delivery:
They are designed to be fully compatible with Damon 3.
The SPEED appliance is unique in its force delivery
They have a vertical slot behind the archwire slot into
system because of the employment of a resilient and
which pre fabricated click in auxiliary hooks can be added
flexible stainless steel spring clip.. The use of flexible
to any bracket as required
stainless steel material in the spring clip imparts a constant
and more physiologic force to accompanying teeth and
supporting tissues. This gentle action results in greater
patient comfort and improves the efficiency of tooth
movement as well as decreasing treatment time.
68 49
Low frictional coefficient: A tooth colored composite resin base and upper tie wing
which reduces the visual impact of the bracket.
The absence of friction laden elastomeric and stainless
steel ties enables the SPEED appliance to reduce frictional A completely new vertical placed chair shaped spring clip
resistance during translation. It has been determined that behind the slide. This has produced a slide which is
the SPEED ligation system reduces friction by over 93% extremely easy and consistent to open and close. The slide
when compared with conventional ligating systems. Such is closed with finger pressure and has a positive tactile and
low friction increases the efficiency of tooth movement. audible signal when fully closed. It is opened with a
special opening tool resembling a modified blunt dental
Opening and closing the SPEED appliance: probe. The technique is to slide the point of the tool down
Opening the SPEED appliance can be achieved through the v shaped ramp on the front of the slide until it engages
the use of any fine curved instrument, such as a sickle in a small hole at the base of the slide; pressing inwards
scaler or SPEED opening instrument. The instrument tip while continuing to press downwards releases the clip
is centrally positioned on the gingival aspect of the A rhomboidal shape of the bracket and slide which
bracket against the indent in the spring clip. A light force facilitates bracket siting.
of approximately 300 gm applied in an occlusal direction
will displace the spring clip into its "slot open" resting
position.
The configuration of the SPEED clip prevents accidental

or even intentional opening of the spring clip and
subsequent arch wire removal by the patient.
Closure of the SPEED appliance is achieved simply by

applying a gingivally directed force to the spring clip.
This force can be applied with a gloved finger or thumb.
50 67
Damon 2 brackets and conventional twin brackets during Suggested Arch wire progression with speed appliance
initial alignment, found that Damon 2 bracket was no
better during initial alignment, and had a higher bracket
failure rate. Although it was less painful initially, it was Level & align 0.016 supercable 0.018 supercable
more painful when placing the second archwire. Max
Hain et al (2006) designed a study to compare the Continue to 0.018 supercable 0.020 supercable
frictional properties of polymeric coated elastomeric level & align
module with those of other common ligation methods and
concluded that Damon 2 produced no recordable friction Initial arch 0.016 or 0.018 0.018 or 0.020
of ligation. form NiTi NiTi
Start torque &

arch form NiTi SPEED NiTi
DAMON 3
Increase torque
& arch form SPEED NiTi NiTi
Initial sliding
mechanics D- wire D-wire or 0.021
-wire
Differential
sliding Hills
mechanics 0.021 Hills
Artistic bends
& final TMA TMA
detailing
These brackets have 3 major changes from previous
Damon brackets
66 51
Final torque &

arch form SPEED steel SPEED steel
Clinical studies:
A recent study done by Nicolas Turnbull and David

Birnie(2007) assessed the relative speed of archwire
changes, comparing Damon 2 self ligating brackets with
conventional elastomeric ligation methods and further
assessed this in relation to the stage of orthodontic
treatment represented by different wire sizes and types
.Results of the study showed that Damon 2 self ligating
bracket system had a significantly shorter mean archwire
ligation time for both placing and removing wires
compared with conventional elastomeric system. Opening
Torque values for SPEED appliance
a Damon slide was on average 1 sec quicker per bracket
than removing elastic from the mini twin bracket and
closing a slide was 2 sec faster per bracket and they
concluded that the type of bracket and size of wire used
are statistically significant predictors for speed of ligation
time and chair side time
Nikolaos Pandis et al (2007) did a study to

investigate the duration of mandibular-crowding
alleviation with Damon 2 self-ligating brackets compared
with conventional appliances and the accompanying
dental effects and they concluded that overall, there is no
difference in the time required to correct mandibular
crowding with Damon 2 and conventional brackets. Peter
Miles (2006) compared the effectiveness and comfort of
52 65
Chapter 6
The imperfections in Damon SL brackets led to the
development of Damon 2 brackets, which retain the same
vertical slide action and U-shaped spring to control
opening and closing, but place the slide within the shelter DAMON self-ligating bracket system
of the tie wings.
Combined with the metal injection moulding

manufacture, which permits closer tolerances, these
developments have almost completely eliminated
inadvertent slide opening or slide breakage.
Although special and excellent slide-opening tools are

provided with these brackets, they can after some
practice be easily opened and closed with conventional
light-wire pliers in combination with the Cool- Tool
archwire-seating implement.
A side effect of this design change has been to reduce the

overall size of the bracket to very compact dimensions.
This reduced size is an advantage. The larger inter-bracket OPEN CLOSED
span produces lower forces, but the secure full
engagement retains much better control than for a
conventional bracket of the same width. The Damon System is a passive self-ligation system that
was originally introduced in 1994 by Dwight Damon.
One unique and useful feature of the slides on Damon
Since then, both the bracket and the philosophy behind the
brackets is that they open inferiorly in both arches in order system have undergone continuous evolution.
to give an unobstructed view of the slot.
64 53
If the development of the Edgelok (Ormco Corp.) 5. The architecture and thickness of alveolar bone appears
appliance by Wildman in 1972 and the development of the to improve over time in retention following low-force
SPEED appliance by Hanson in 1980 marked the start of orthodontics.
modern self-ligating appliances, then the Damon System
has probably been responsible for a fuller understanding 6. The low-force mechanics used through the Damon
of the influence of passive self-ligation on orthodontic System indicate improved bone response for teeth that
have not been allowed to erupt through facial or lingual
treatment and the increasing popularity and utilization of
the concept. cortical plates. For this reason early tooth guidance is
strongly encouraged.
These passive self ligating brackets had
a slide, which moved vertically on the labial surface of an 7. Low-force orthodontics can have a positive impact on
otherwise fairly conventional twin tie-wing bracket. The the bone of periodontal patients.
slide clicked into a positive open or shut position and DAMON 2
opened in a downwards direction in both jaws to give a
full view of the slot. A tiny U-shaped wire spring lay
the slide to provide positive open and shut positions.
The pre-adjusted Damon appliance is available in 0.022-

and 0.018- inch slots. The Damon appliance commonly is
referred to as a bracket, but the term tube is a more useful
description for this passive appliance. The appliance is a
tube with tie-wings rather than a conventional bracket and
as such has a static facial wall when the self-locking slide
is closed. The Damon tube is manufactured by metal
injection molding which makes it possible to manufacture
exceedingly small, accurate parts that allow movement of
the slide and provide the close tolerances of the archwire OPEN CLOSED
slot.
54 63
The following observations were made from studying the The bracket design of the Damon bracket has had the
results of Damon System therapy on 13 patients ranging following characteristics since its introduction as the
in ages from 13 years 6 months to 56 years: Damon SL bracket:
1. Alveolar bone can be altered and reshaped with low ssive self-ligating design with conventional tie
clinical forces. wings, and
Light wires acting in an almost friction free environment -ligating gate, with a positive mechanism to keep
in the Damon tube appear to be able to correct the the gate either open or closed that opens to allow operator
functional imbalance and to allow the alveolar process to to see into slot.
create a new, individualized arch form.
As the bracket has evolved, the following features have
2. With low-force, low-friction orthodontics via the changed:
Damon System, the alveolar bone will allow the
movement of teeth with minimal tipping in all planes of
and more rounded contours resulting in a bracket that is
space.
more comfortable for the patient.
3. Alveolar bone is exceedingly thin on the labial, buccal,
and lingual of teeth that clinicians are trying to move. This
observation calls for low-force therapy that respects the and advances in manufacturing technology, the gate
delicate nature of this bony architecture. mechanism has become more reliable, and simpler to
open and close.
4. In many lower arches, pretreatment roots routinely are
positioned within the cortical plate. The observation
mandates the deployment of extremely low clinical force
systems that take into account the low vascularity of
cortical plate. These brackets were a major step forward, but suffered
two irritating problems the slides sometimes opened
inadvertently and they were prone to breakage.
62 55
The study by Harradine quantified these problems. In 25 corrective appliances, plus the precision finishing
consecutive cases in treatment for more than one year, 31 attainable with preadjusted edgewise appliances.
slides broke and 11 inadvertently opened between visits.
This compared with 15 broken and lost elastomeric With muscle-imbalance corrective appliances, Frankel
ligatures in 25 consecutive cases treated for at least a year demonstrated that the posterior arch form could be altered
with conventional brackets. Slide breakage was due to and in long term could be stable. Why the Damon System
appears to have an effect similar to the Frankel effect with
work hardening of the slide corners. The loss of slide was
sometimes due to breakage at the slide angles caused by its concomitant impact on the physiological adaptation of
the muscles is not understood completely.
work hardening, but was also due to the overall length of
the slide and the play in the slide/bracket contact. This With use of very light, biologically sensible
permitted over-opening of the slide, which could pass forces to start to unravel crowding, the changing arch
beyond the stop provided by the underlying U-shaped
wire. create a new balance of the orofacial musculature as
suggested by Alan Bagden. This phenomenon allows the
tongue to seek a higher level in the oral cavity, thus
instigating new force interplay among the tongue, cheeks,
and lips. This newly created balance (of the muscles,
bone, and soft tissue) is what determines the new tooth
position and arch form. Complete dentitions can be
maintained, even in many crowded arches and in most
cases ,the body not the clinician determines the final
arch form.
Computed tomography scans taken on patients just

debonded to those more than 5 years in retention show
promising results from the low-force therapy offered via
the Damon System and its underlying treatment philos-
ophy.
56 61
This allows extended intervals between treatment visits, DAMON PHILOSOPHY

particularly in the early stages of treatment, a reduced
number of visits during a course of treatment, and
shortened treatment times. The philosophy underlying the intended use of the Damon
Eberting JJ et al (2001) designed a study to compare the System is to approximate the forces that normal
effectiveness and efficiency of Damon self ligating functioning muscles have on tooth position and the
developing arch form. The Damon philosophy is based on
brackets to those brackets ligated with either steel
ligatures or elastomeric rings. Patient responses showed the principle of using just enough force to initiate tooth
that Damon patients perceived their treatment time as movement the threshold force.
being shorter than expected. Also faster orthodontic The underlying principle behind the threshold force is that
treatment can be better, as measured with ABO criteria. it must be low enough to prevent occluding the blood
NWT Harradine (2001) designed a study to compare vessels in the periodontal membrane to allow the cells and
treatment efficiency with conventional fully programmed the necessary biochemical messengers to be transported
brackets and Damon SL self ligating brackets. He to the site where bone resorption and apposition will occur
concluded that Damon SL bracket produced statistically and thus permit tooth movement.
and clinically significant reductions in treatment time and The Damon achieves its goal by means of a passive,
number of patient visits. Also the reduction in time virtually friction free, self locking fixed appliance conduit
required to place and remove ligatures with these self that maximizes the full potential of
ligating brackets was modest and of little clinical wires. By doing so, the Damon system provides a reliable
significance. and simple means of achieving the best possible facial
balance for each patient through the use of light forces that
foster corrective functional adaptation of the arch form
Many malocclusions are simply the result of functional while maximizing patient comfort during treatment.
abnormalities. The Damon system when properly applied
provides patients with physiological improvements Voudouris compared friction produced by passive and
possible with the Frankel appliance and other muscular active conventional and self-locking brackets. With the
use of a 0.019- x 0.025-inch stainless steel arch wire,
60 57
conventional brackets with elastomeric ties showed 400 Compared with conventional preadjusted edgewise
(125.42 g/cm2) to more than 600 (152.30 g/cm2) times appliances, it is suggested that the use of passive self
greater friction; steel ties showed 400 (97.07 g/cm2) times ligation results in a significant reduction in the:
greater friction; and active self-ligating brackets showed
216 (54.12 g/cm2) times the friction of the passive self-
ligating Damon tube (0.25 g/cm2). Rupali kapur, Pramod resistance generated by ligatures is not present.
Sinha, Ram Nanda(1998) also concluded that Damon SL
bracket showed significantly lower kinetic frictional quadhelices or W-springs because the force of the
forces than the Mini-Twin bracket with both wires archwire is not transformed or absorbed by the ligatures
Passive self ligation maintains play in the mechanical and the necessary expansion can be achieved by the force
system during all stages of treatment. The small wire-to- of the archwires.
lumen ratio is essential to leveling and aligning, and arch
adaptation in a friction free environment but limits because alignment is not hindered by frictional resistance
rotational control initially. Accurate tooth positioning, from ligatures and can therefore largely be achieved with
including rotational control, requires a full-depth arch small diameter copper nickel titanium archwires. Tooth
wire to fill the slot in a passive system. The play in the alignment therefore places minimal stress on the
system when using 0.014-x 0.025-inch, 0.016- x 0.025- periodontium as it occurs and so the possibility of
inch, 0.017- x 0.025-inch and 0l9- x 0.025-inch iatrogenic damage to the periodontium is reduced.
rectangular wires in a 0.022-inch slot provides the needed
rotational control and allows for 7 to 10 degrees of torque In addition, a passive edgewise self-ligation system
play in both directions with excellent rotational control provides three key features
later in the wire progression. Rotational control is
Very low levels of static and dynamic friction,
achieved primarily with the second larger archwire, but
the lack of friction and binding enables the overall Rigid ligation due to the positive closure of the slot by the
correction to proceed faster. gate or slide, and
Control of tooth position because there is an edgewise slot

of adequate width and depth.
58 59

Self Ligation

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Self Ligation

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SELF LIGATION

Dr. Gurjeet Kaur Randhawa

Shivapuja PK, Jeff Berger. A comparative study of

Stolzenberg J. The Russell attachment and its improved

Stolzenberg J. The efficiency of the Russell attachment. J.

ROSEWOOD PUBLICATION Thomas S, Sherriff M, Birnie D. A. comparative in vitro

Miles PG. Self ligating vs conventional twin brackets

Pandis N, Polychronopoulou A and Eliades Theodore.

Pandis N, Strigou S, Eliades T .Maxillary incisor torque

Pizzoni L, Ravnholt G, Melson B. Frictional forces

Readward GE, Jones SP, Davies EH. A comparison of

Rinchuse D. J. and Miles PG. Self-ligating brackets:

Sandra P, Henao BS, Robert P. Kusy. Evaluation of the

Harradine NWT. Self-ligating brackets: where are we

Heiser W. A new orthodontic philosophy. J Clin Orthod

Kapur R, Sinha PK, Nanda RS. Frictional resistance of

Kim Tae-Kyung, Kim Ki-Dal ,Baek Seung-Hak .

Loftus BP, Artun J, Nicholls JI, Alonzo TA, Stoner JA.

Maijer R, Smith D C. Time savings with self-ligating

Miles PG. SmartClip versus conventional twin brackets

Miles PG, Weyant RJ, Rustveld. A Clinical Trial of

and conventional brackets. Clin. Orthod. Res. 2001;

Hanson GH. The SPEED System: A report on the

Hanson GH. The SPEED bracket auxiliary slot. J Clin

Harradine NWT, Birnie DJ. The clinical use of Activa

Harradine NWT. Self-ligating brackets and treatment

Eberting JJ, Straja SR, Tuncay OC. Treatment time,

archwire (eg, when seated on a chair, if you place your

Another principle to elucidate is that the ligation force is

Damon treatment times reported by Harradine and greater

In the Damon system, a .022-in slot is advocated with

Passive self-ligation 0.014-in Damon copper-nickel-titanium wire (Ormco),

In a similar retrospective study, Eberting et al (2001)

subsequently release energy through elastic deflection.

In an in-vivo study, Miles (2005) compared the

Fourth, in-vitro vibration simulation of in-vivo occlusal

Fifth, in-vitro research involves rates of movement [0.5

and cannot take into account tooth movement due to

al(2004), V cacciafesta (2003),Griffiths et al(2005), Full bracket engagement

engagement results in poor control of tooth movement. Wire pokes

nal values are increased. Low friction increases wire displacement.

Steps to prevent this can include:

.Using tie-backs with flexible wires over extraction sites

PROPERTIES OF SELF-LIGATING BRACKETS

Time and Speed brackets are opened with a probe or

Chair side assistance;

Archwire removal and ligation time.

Cost effectiveness and treatment efficiency

to the common boundaries between two bodies when,

(4) Surface topography;

(5) Material properties.

Franchi L (2008) conducted a study to evaluate the

Evolution of self ligating brackets Archwire engagement

3) BRUSSES & GODDARD (1941)- (Passive) In 1941

4) J. E. LASKIN (1945)- (Passive) In 1945 Laskin

The mechanism of this revolutionary bracket was in stark

Russell brackets, treatment was considerably more

6) J.E. JOHNSON (1954)-(Passive) In the same time

10) F. W. JOHNSON (1964)-

11) BRUNSON & DAVIS (1966)-Passive A few years

arms which could deflect upon arch wire engagement.

13) EDGLOKTM (1973) passive {TMEDGLOK is the

In 1971, Dr. Jim Wildman of Eugene, Oregon, developed