hey it's dr amanda with straight smile solutions straightsmilesolutions.com
and today we're going to talk about free handing bracket placement now if you've
listened to my other videos of course you know that i'm a huge fan of indirect bonding
it is an affordable solution that you can get from a variety of different vendors right now
that when you're first starting with brackets i mean if you're gonna freehand you're gonna do
a lot of them really wrong you know um and you kind of have to learn the hard way and you know
same thing happens with orthodontic residents when you're in residency the first you put
you do a lot of ones wrong and you learn from your mistakes and then you start to get a
better eyeball of how to place the brackets and it's really hard to kind of teach that because
people a lot of general dennis think that there is like an instrument that you can use to
to freehand brackets to help make it accurate but i actually find the people that use these
i don't really care for their bracket positioning it doesn't turn out very well it's very mechanical
every mouth every teeth is unique and it's really hard to you really there is no instrument that can
make it work turn out as well as if you are doing it accurately just it's just something
you're going to learn over time anyways so for that reason i recommend that all general
dentists use indirect bonding but there's gonna be times when a bracket's gonna break and maybe
you don't have the template you don't wanna wait for another one to get made you don't wanna rescan
um and you're gonna have to freehand so i'm making this video as a guide for that you know
um you know for those one-offs that come up so in general no i don't use an instrument to place
i've heard of these instruments and i've never i've seen a lot of cases that were completely done
with it and i didn't care for the bracketing at all so the reason why i don't think it works for
most cases sometimes it will is that people have all different anatomies of teeth there's big teeth
there's little teeth so that only works if you have really average normal sized teeth you know
like run-of-the-mill generic teeth which that a lot of people don't have they have some weird
shaped ones and weird angled ones and it's really hard to worn ones attrition there's all kind of
variables that's going to change the position of the brackets so this is what i recommend
if you have to free hand first of all you have to have a good panel a recent panel before you start
put it up you know on the computer in front of you and as same thing orthodontists do as we're
placing brackets we're looking back and forth at the panel and we're also looking clinically
and mostly what i like to do is i like to do it i like to do things parallel right and i don't
necessarily do the whole mouth at one time i might do an arch i mean when you get fast you can do the
whole mouth at one time but initially i would just recommend doing a quadrant or an arch at a time
um having the panel up and then the main thing is is just mirroring you know eight and nine need
to marry each other seven and a ten need to marry each other you know six and 11 need to mirror each
other and just i just go back and forth and check these front four ones need to mirror each other
you know etc so and that is of course you can get thrown off if one like here eight and nine are not
symmetrical right this one has like a different shaped edge than this one so which edge are
we going to treat to are we going to line these museum side edges up are we going to intrude this
you need to know what you're planning to do so you know how to place the brackets so that's the first
thing i'm going to do is i'm going to look and be like okay well what's my plan where do i want this
to go am i going to try to match up the gum lines and then restore the teeth i mean there's so many
things you have to keep in mind and that's why i love doing indirect bonding because you can
see it all and you can see how it's going to look and then you can tweak things but anyways
so panel up and then you're going to imagine here i've drawn here the long axis of each tooth on the
panel so if i had the panel up you know this is what the long axis would look like and this is
what the long axis would look like and i didn't draw them all but in residency they made us draw
them all you know so we knew exactly and we'd bisect you know like this bisects this and then
here's the square right so you know these front teeth are a little bit longer than i'd say i like
them they're not worn at all so for that reason i normally i put the bracket in the center of the
clinical crown but for this reason i actually want to intrude them a little bit relative to the other
teeth which i think are a little bit short and small so for these i would put in the center of
the clinical crown right like this and this would mirror this for the most part because i'm going to
treat to the measle incisal edge and i'm going to probably smooth this little section off so
this should mirror this so you can use a probe right here and make sure that this
um parallels this in terms of size so that you can do and this should parallel this it should
match this in terms of where the bracket is and this should match this with the periaprobe so
i think you get the idea so let's take a look at the bracketing that they did here and just
you know critique it a little bit so for the most part i think the bracketing is actually pretty
good well this one might be off a little bit it might need to go a little bit clockwise but i
can't really see because i'm not looking at it you know straight on but i'm sure if we took a period
when we measured here here here and here it would be symmetrical so yes this tooth is down so when
we look at this this bracket should be down to bring it up right so this looks relatively correct
and when we're done you know this tooth should sit a little bit because it's not worn higher than
these right it should be a little bit higher this tooth should be a little bit lower than this one
right maybe i would have put this a little more gingival but i'm not totally sure yet but all in
all this is pretty darn good bracketing maybe i would have taken this one and put it a little bit
clockwise just looking at it it's eyeballing i think it's not quite maybe like five eight
degrees clockwise would be i think the long axis like is tipped like i had right there so i don't
necessarily think this is right totally i think it's gonna swing it too much but you know what
once the initial wire levels out this is probably a 16 nine tie once it levels out and you get maybe
all the kinks to twist and turns out you'll be able to see how it is and then you can always take
the bracket off and move it so that's pretty much it all right hopefully that was helpful
if you have any questions about indirect bonding don't hesitate to reach out thanks