this is dr. Amanda with straight smile solutions and today we're gonna be talking about different
types of brackets and how to pick the right biomaterial for your bracket for your case and
I know I work with a lot of general and pediatric dentists who are just getting started with the
brackets and wires straight wire for the first time it can be super overwhelming understanding
all the variables that are out there and picking the right bracket for your patient and for your
office so I just kind of want to go over it just really on a high level so hopefully you
can understand it so let's talk about the three major biomaterials for brackets and the pros and
cons so three major biomaterials are going to be metal ceramic and composite plastic okay so metal
is kind of like what you see here your standard metal white ones will either be made of ceramic
or plastic okay so within those categories of your metal ceramic and plastic you have your
regular mini twin brackets for the most part and your self ligating bracket so many twins are the
ones that are gonna use the little ties here these little rubber o-rings to ligate it you just have
to stretch them and put them on and take them off really easy simple easy to learn lower cost okay
self ligating are always gonna be more expensive these are the ones that have the trap door like
right here that you're gonna have to open okay and then shut each time you change a wire so pros of
the mini twin is that it's cheaper and easier to take in and out but these little rubber o-rings
that are here okay these degrade over time so it's a little bit more of an undulating force
a variable force level you're gonna put them on they're gonna feel tight and then over time
they're gonna kind of relax and they're gonna have to be changed so frequency at the beginning most
people change them every six to ten weeks or so or maybe around eight being average so initially
you'll be seeing these patients between six and ten weeks if you do self ligating the pros are
that you don't have anything to change nothing has to be changed so a few long as you're keeping in
the same wire you can go a greater interval in between appointments assuming that you put the
brackets on correctly and everything will actually go faster and self-lighting but you pay more right
and then sometimes patients want color so self ligating doesn't have colors that kind of defeats
the purpose so so many things to think about so a lot of doctors they see the pros in the self
ligating is that there's less appointment right um then things get done a little faster because
there's less appointments but it's also more expensive and there's no colors so sometimes
they might charge a little bit more or sometimes they just give these to their older patients so we
talked about that okay so self ligating bracket sweet we talked about that they have the little
trapdoor some of the breaded names are like daemon speed smart clip again price point is I'd say at
least three times and and I'm just giving like random prices of brackets there's so many prices
out there depending on if you're buying in bulk or volume so I mean like a couple dollars per bracket
for regular mini twin brackets regular brackets and then like three times the price for ourself
legging so they may be somewhere around 10-ish per bracket for self legging 10 to 15 whereas like two
or three four dollars for a mini twin you know I'm assuming you're buying these in bulk though
so it is a big price difference now the doctors I work with who are using indirect bonding and
they're going to the labs where they're using six months miles or they're using one of the partner
labs that I work with that are charging around 300 dollars for the set up that price is for
the metal mamie twin so that 300 dollars that includes the trays the treatment plan and the
brackets in the trays so that's pretty good you know that's not bad if you're doing the
clear it's gonna be a little bit more I think it's around 4 or 450 I don't know that any of
them are offering the self ligating at this time but that's still something you could do
on your own okay so advantages we talked about the advantages of self ligating brackets being
that it's less appointments less often they need to be at the chair overall shorter treatment time
some people think it's less friction because it is like smooth and polished and there's no
rubber that it's sliding against so um you know those are some of the benefits and people say
that it's a little more engaged because it like snaps down and there's no rubber but I'm not sure
about that mostly I would say definitely less appointments slightly less treatment time I'm
really not sure why we have improved infection control sure about that what that was on there
but anyways disadvantages the little trapdoors can totally break if you don't know how to close them
you can bend them and they're expensive to replace and they are expensive yeah so let's talk a little
bit more now that we've talked about self ligating bracket tsa's traditional mini twin brackets let's
talk about metal brackets and the advantages of those so Vantage's is they're cheap theoretically
you can recycle them but I do know some doctors that sterilize them in between patients I think
that's gross but I think more like I just have an issue with that it's there's something wrong with
it and a lot of people do it I just think that's wrong but you know from like let's say you have
on your patient let's say you wanted to take the bracket off and move it to a slightly different
position or if the patient knocks it off and you need to put it back on for the most part the metal
ones on the same patient you can just um you know like sandblast the back or drill off the plasti he
sivan the back and you can reuse it on the same patient so that's the benefit of that let's see
what else metal ones generally have really good sliding mechanics so things tend to go faster than
with ceramic for the most part not that expensive and I don't know I've seen all kinds of junky
metal ones so it says they resist deformation or fracture I've definitely seen I seen a lot
of them deform and you know there's higher quality ones and lower quality ones and over time you'll
kind of learn what's what over time they can corrode I've never seen them stained teeth
so I don't know about that okay so main things to look at when you're picking a bracket look at the
bracket base flip it over you want to have really good retention there should be a really good mesh
in there so it can you know grip good so I'm you can definitely like look closely at it it should
look pretty complicated when you look at the back of it look at it up close right different things
about the metal this is things you could just ask but I do know that the best ones are usually
mi em middle injection molded the cast ones are junk don't get these these things like they Bend
and they distort these are those are the cheap ones even the milled ones are not so good from
my experience they're just not as accurate so I would definitely ask if yours our Mr am I am I
think it's better alright let's go on to aesthetic brackets or clear or white brackets okay so these
are either gonna be plastics or ceramics so the cheaper ones are the plastic the more expensive
ones are ceramic plastic has a not so great they stain more they don't slide as well they tend to
get deformed and broken more people think ceramic would get broken but actually these have better
sliding mechanics they look way nicer these are much prettier they're very pretty when you look
at them they don't like they look translucent so they look they'd much less noticeable than these
so you know and for the most part that's pretty much all you need to know I always would go with
ceramic but then the downside of ceramic you're gonna see in a second is that they can fracture
right and they're harder to get off so so many things to think about right okay so let's talk
about the composite or the plastic brackets if you're using six month smiles these are plastic
brackets they tend to not you tend to not be able to make complex prescriptions built into
them they're real simple so you're not gonna get really complex movements like torque and
stuff so the outcomes are not quite as good so it's great for anterior alignment but not good
for comprehensive alignment so most orthodontists are not gonna use plastic they're gonna use the
ceramic okay so again issues are staining lack of strength more likely to to break break off they
don't they can't express more complex movement to automatically come with it so things to keep
in mind okay ceramic brackets we talked about this definitely I mean if I had a choice I'll
always use metal over ceramics and usually most patients that want ceramics I'm just gonna try to
talk them into aligners because it's just weight you see her to deal with but occasionally you get
people who are old school that still really want ceramic brackets so whatever it is what it is so
issues can be some friction of course if you have ceramic brackets opposing a natural tooth
it's gonna wear the natural tooth so you have to think wisely about picking the right cases
for this course they're very expensive they look pretty though and also the other issue is
they're really hard to get off they bond really really secure so they're really hard to remove
and there's a trick to removing them and sometimes they take some tooth structure with them when you
remove them so you have to I would never let an assistant take ceramic brackets off unless they
knew what they were doing okay so yeah we talked about abrasion enamelware ceramics or seven times
harder than enamel so um just have to watch out right so bond strength is super strong watch out
what type of teeth I wouldn't want to bond them to crack teeth or teeth with caries or anything at
the key teef of thin enamel heavily restored gene because when you get them off you might break the
tooth and then you're responsible if you break the tooth so it does make me a little bit nervous I
pick my cases very wisely to bond ceramics to okay again we talked about Yamla fractured be bonding
Oh other thing yes when your D bonding patients with ceramics you have to our safety glasses the
patient has to wear safety Gus is the operator the doctor the assistant because it can shoot in your
eye really badly and it can go down your throat so you have to watch out okay many twin brackets
your traditional metal brackets are pretty easy to get in yeah pretty simple alright let's talk
a little bit about lastly about slot size oh 1 8 vs o 2 2 that's something that can be a little
overwhelming initially when you're picking your bracket doctors get all very confused you know
it really just comes down to personal preference so obviously if you're using an O 1/8 slot there's
a there's less wires you can use because you're gonna fill that slot way quicker right so you're
gonna probably need to stock more wires if you do that whereas an O 2 - sorry you're gonna stock
more wires if you have Oh - 2 versus o18 ona it's gonna be less wires so that's the benefit but it
can be a little harder if you get the wires in and 1/8 unless you're experienced to do it so
I would say most general dentists do go with o2 2 because it's just easier to tie in it's more
forgiving a little less discomfort to the patient initially because you're not filling this lot as
easier there's more slop so but either way you can go with either way I think mostly you want
to just give it a shot and see how it feels see what what it feels like to tie it in but I believe
most systems that out there for general Dennis ro to to slot most orthodontists I think use Oh
1/8 so I was trained on o2 too and residency then I switch tohe name so I just got used to it but I
can use either I just have to know what the slot is and then just thinking of things differently
okay lastly real lightly we're gonna talk about different bracket prescriptions just to explain
I mean this can get super complicated again for general dentists and pediatric dentists but for
the most part the tiny different prescriptions out there and I really don't even worry about it
like obviously you want to have a prescription and the olden days you had to put all the bends
in the wires in order to get them to move now you just buy the brackets with everything prescribed
in the slot it does the work for you so the most two common ones are gonna be your Roth and your
enmity to me I can't tell the difference if I look at one case to another I have no idea I'm
happy with either I don't care it all looks good to me so you know I wouldn't worry about it but
I mean if you are buying a IDB system you should ask what type of brackets is the main thing that
you have to keep in mind is you need to keep it consistent so if you get a transfer case in you
don't want to take a transfer case unless they're prescription that they use on that patient matches
your prescription because if the patient breaks a bracket then it's not gonna look right you can't
you can't piecemeal so you can't use some brackets from OAuth and some brackets from MBT and some you
don't know because it's just not gonna work out things that gonna look symmetrical so you always
have to keep it consistent so I usually recommend a patient any time that you get a transfer patient
that's not your patient that you put the braces on you just take them off and put your own on and
that's usually what most people do I know patients get upset about this but unless they're like done
done and you're about to take them off there's a good chance that they're gonna break something and
unless you know that your prescription matches what the other doctor did and odds are it's not
because there's tons of different prescriptions out there and brands that you're gonna have
trouble later and then you're gonna have to repack it the whole case which is gonna get expensive so
now if you can get a copy of their records and find out what prescription they use and you can
match it that's a different story so just things to think about that's that's the most complicated
part right so again this is the Roth prescription a little bit Roth came out in 1979 so some people
say that Roth has better torque and stuff like that I don't think most people are going to notice
the difference MBT is another one it stands for Mick Bennett or mcLaughlin Bennett's treatment
or something like that slightly different shape of the brackets but for the most part some people
think that this one's better I mean I don't think it really matters right an offset is just a little
bit about the counter rotation that's built in this is more of an issue having to do with
extraction cases so I wouldn't worry about that yeah that's it that's al all about bracket so
hopefully that's a high-level explanation for you if you have any questions please do visit
straight smile solutions calm and we'll be glad to answer your questions all right thanks so much