How to put brackets: protocol, process and steps

It makes sense to discuss the choice and installation of the bracket system after the patient has already chosen his orthodontist, you can find detailed recommendations on the choice of the orthodontist in one of our articles.

Stage 1: Diagnosis

Diagnostics is an obligatory stage for the preparation of an orthodontic treatment plan, which is also important for selecting the bracket system itself. For diagnosis, it is first necessary to take x-rays (most often it is computed tomography - CT) and digital photos. There is no need to take pictures beforehand: an orthodontist performs a photo protocol - a series of photographs of teeth, faces and smiles from different angles.

Stage 2: Orthodontic Treatment Plan

After the diagnosis, the orthodontist needs about a week to analyze all the material, make calculations and make an individual treatment plan.

Treatment plans can be one or several. Each of them may have their own characteristics, pros and cons. The orthodontist most often voices the treatment plan to which he is inclined and considers the most optimal in this case.

The patient can choose any of the proposed treatment plans, recognizing the difference between them and understanding the point of view of the doctor. After the patient and the doctor agree on one of the plans, the choice of the bracket system occurs - this is a strategic question in which the patient and his doctor need to come to a consensus.

Stage 3: Sanitation and oral hygiene

Sanitation includes the treatment of caries, pulpitis, periodontitis, including those teeth that do not bother the patient today. Sometimes old fillings, which have ceased to perform their function, also require replacement. Some teeth may require removal, but we strongly recommend that you do not make decisions on your own.

We often encounter the fact that patients, coming to an orthodontist’s appointment, already remove their teeth in advance. You do not need to do this! Very often, for effective orthodontic treatment, it is better to remove teeth in the course of treatment only six months or a year after it has begun.

If you have already undergone a sanitation in advance, it is enough to provide the orthodontist with a certificate of sanitation and go through a free follow-up confirmatory consultation of the Konfidencia dental therapeutist of the clinic.

After therapeutic sanitation, it is necessary to carry out professional oral hygiene with special training in proper hygiene with brackets. Hygienists also individually select for the patients hygiene products - brushes that suit this particular patient.

Stage 4: Fixing the bracket system using indirect fixation

To install brackets, there is a basic standard protocol for direct fixation of oral brackets, which is very common in Russia - brackets are glued without careful checking of its position, which is easier and faster for a specialist.

An expert group of orthodontists of the clinic Konfidentia applies a progressive protocol for fixing brackets based on the best techniques of recognized Italian and French specialists in orthodontics. The key feature of this protocol is indirect fixation, which has obvious advantages in the form of accuracy and comfort for the patient.

Indirect fixation is the most progressive method now, which is already actively used by European orthodontists. When a doctor has a model of the patient's teeth in his hands, and his eyes and photographs in front of his eyes, the doctor has the opportunity to perfectly accurately outline each tooth, put all the axes on it and place the bracket in the most correct position. This can be done only on the model, and not in the mouth, where soft tissues can interfere. In addition, the patient does not need to spend several hours in the chair at the doctor.

What gives the accuracy of fixing brackets to the patient? The more accurate is the bracket on the tooth, the more correct will be its position. Indirect fixation makes it possible to get results faster and with less manipulation for the doctor and patient.

The second plus for the patient is that the brackets are not glued one by one. If this is done carefully, then even an experienced doctor will take a large amount of time not even to fix the brace on the tooth, but to check its position from all sides. With indirect fixation, the speed and comfort of installing brackets is reduced by 2-3 times.
Often patients ask how long installation takes? One jaw - about 1 hour, on both jaws - an average of 1.5 hours. This does not mean that the procedure itself lasts so much - most of the time is occupied by a conversation with the patient and detailed recommendations.

How does fixation of brackets technically occur?

  1. The tooth is treated with gel, then a special varnish is applied. At the same time, the tooth is never treated with boron and the enamel is not ground off.
  2. Brackets are fixed on the tooth surface with orthodontic filling material.
  3. Between the bracket and the enamel adhesion occurs - gluing.
  4. On the last in the row of teeth are the locks into which the archwire is inserted.
  5. Further, in each bracket, if it is Damon or Insignia, an archwire is inserted by pressing on the slot and the lid is closed in turn from the center to the side sections.
  6. If it is ligature brackets, then the archwire is attached to each bracket with a metal or elastic ligature. This is the main drawback of ligature brackets, because a ligature, especially an elastic one, loses its properties over time, stretches and ceases to adequately hold the archwire in the bracket, namely, the archwire is the driving force.
  7. After closing the brackets, you must also install a special stopper on the front brackets.

The procedure is absolutely painless. To eliminate possible discomfort from dry lips, moisturizer is always applied beforehand.

How are lingual braces fixed

Lingual and any other brackets with digital technologies (Insignia, Win, Incognito) come to the clinic already in finished form in a cap. They are already located in the position in which the computer program has positioned them. This is the same technology of indirect fixation, according to which all brackets are installed in the Konfidencia clinic.

Why do we need an orthodontic archwireh?

If you simply stick brackets on all your teeth, there will be no movement of the teeth.

Brackets do nothing with the tooth. A bracket is a small computer that contains information about how a tooth should stand. Without an archwire, he cannot do this.

In the bracket there is information that is not implemented by itself. It depends on how tightly the archwire is in the bracket how well the embedded information is realized. If it is ligature brackets, then it is more likely that ligatures will stretch in a week or two after installation, which is not very good for treatment.

Why do we need a stopper on brackets and what can their absence lead to?

Often patients come to us from other doctors who do not have a stopper clamped. If the bracket system does not have ligatures, but only brackets lids, then the archwire can easily slide in the slot and, despite the fact that the covers are closed, will shift to the right and left. Shifting, the sharp end of the archwire can rest on the cheek. To prevent this you need a stopper - a metal cap on the archwire. It is firmly fixed in such a way that rests on brackets on both sides and does not allow them to move. This is a guaranteed protection against unpleasant sensations on the mucous membrane.

How do we protect our patients from discomfort when installing brackets?

When installing the first archwire, our orthodontists do not fix the orthodontic archwireh into the very last bracket on the seventh tooth. The fact is that usually the first archwire is very thin and lacks the strength to move a powerful tooth with large roots. And the distance between this and the next, sixth, tooth is usually quite large, in which case a thin archwire can jump out and scratch the soft tissues of the cheek.

In addition, closing the last bracket, the orthodontist bends the archwire in a loop by 90 degrees. This is another factor protecting the patient from injury to the mucous membrane. By bending the archwire into a circular loop, the orthodontist minimizes the discomfort and risk of injury to the patient's mucosa, even if the archwire begins to protrude.

When are archwire bends used?

The bends are applied to a rigid archwire, closer to the middle or end of the treatment, when the dentition is more or less even. Most often this happens about 8 months after the start of treatment. Very rarely bends are applied to soft archwirehes, but such manipulations are aerobatics, not all orthodontists are proficient in this technique.

Why are bends on the orthodontic archwireh needed?

Despite the fact that we use indirect fixation of the bracket system, which ensures maximum accuracy of the position of each bracket on the tooth, even indirect fixation has some error. The first stage at which we begin to solve the problem of this inaccuracy is the plywood stage. After about 4-6 months, when the teeth are practically aligned, we take a picture of the orthopantomogram in order to assess the alignment of the roots of the teeth. We remove some brackets and fix them in a new position, focusing on the image and the evenness of the teeth in the mouth, which is a very important point on the way to the perfect evenness of the teeth. The fact is that the parallelism of the roots after the alignment of the teeth is the key to the stability of the result. Uneven root can be the cause of the curvature of the teeth after removing the bracket system. The most experienced lecturers, including Western ones, say that they re-stick brackets very much, which is one of the secrets of their success. However, besides the inaccuracy of the position of the bracket on the tooth, there is also some loss of information embedded in the bracket. The archwire should be as tight as possible into the bracket. If the archwire completely repeated the dimensions of the space inside the bracket for it, then it would be impossible to enter it there. In order for all the information to be implemented, and the teeth to become perfectly smooth, we apply bends on the archwires.

What are the methods of final correction of the position of individual teeth?

There are two options: to re-glue the bracket to a new position or to bring the position of the teeth to the ideal by bending the archwire.

Can brackets stand crooked?

Sometimes patients say that the bracket is crooked and not in the center of the tooth. In principle, brackets are not placed in the center of the tooth, they are placed at special points and parallel axes. It may look like a strong displacement to the edge of the tooth - on the right, on the left, slightly higher, slightly lower. This placement is done consciously according to calculations, it is not an orthodontist's mistake.

Stage 5: Recommendations after fixing the bracket system

Do your teeth hurt or not after installing brackets?

Teeth after installing brackets may hurt or may not hurt. Both situations are normal. Often coming the next time, patients ask the question: “Did my teeth not hurt, it means that the teeth do not even out?”. No, it is not, just an individual sensitivity.
Most often, patients may experience pain not at rest, but during a meal, while biting on the teeth. The normal period is up to 1 week, extremely rarely up to 2 weeks. It should be noted that there should not be unbearable pain.

What pills to take?

This can be any drug that usually helps with headaches: Analgin, Nise, Ketanol, any other analgesics. However, it is important to understand that taking these drugs uncontrollably will lead to slower movement of the teeth - they block the enzyme that is responsible for the rearrangement of bone tissue and the tooth slows down movement. Most patients say that their teeth ached a little, but they did not take a pill or took 1 pill on the first day. “I was sitting on pills for a week” - in our clinic not a single orthodontist encountered this.

Does taking pills affect orthodontic treatment?

When orthodontic treatment is associated with other internal diseases and the patient is prescribed medications that affect bone tissue, this can have a significant impact on the treatment process. A professional orthodontist must understand that in such a situation it is not always the cause of the slowdown that is the bracket system, but there are drugs that affect the treatment. It is better for the patient to discuss this with the doctor in advance.

Are there lifehacks how to make wearing brackets faster and more comfortable?

Archwires that are installed after fixing the bracket system are thermoactive. Archwires are thermoactive for ligature and self-ligating brackets. Therefore, if you constantly eat ice cream and drink cold drinks, lower the temperature of the oral cavity, then they do not work. That is, if we want the teeth to be aligned faster at an early stage, then it is better not to get involved in such products. But it is also possible to use this information in a different way: for example, in the first days after fixation of brackets, to relieve toothache is not painkillers, but ice cream.

Food program in brackets or orthodontic “diet”

With brackets you shouldn’t eat everything that is hard - nuts, crackers, or something viscous and sticky that can stick to the bracket and peel it off - toffee, for example. Apple, meat, carrots - all this can be eaten, but you can not bite off, you must cut into small pieces.

Why it is impossible to tear off the brackets, what's wrong with that?

Tearing off the bracket and not being able to glue it again for a long time, you can get a situation where all the other teeth are aligned, and this tooth assumes the wrong position. The second point - during orthodontic treatment, we change the archwire from thin to more and more rigid. If the patient has lost the bracket, and within a month he did not find time to visit the orthodontist for re-fixation, then most likely, this tooth will interfere with placing another archwire - it will not be inserted into the bracket groove. This is a loss of time up to 2 months of treatment. Therefore, we ask patients to be careful.

What to do if the bracket has come off?

If this happens, it is better to come within 2-3 days, a maximum of a week to stick it. If the patient is on vacation, you need to do this immediately after returning.
If one of the brackets on the front teeth has come off, it will just hang on the archwire. This does not usually bring any discomfort.
If the last bracket (lock) has come off, then, considering that he has no support behind him, he will be in the mouth. And the patient's task is to try not to swallow it and throw it away. It is not damaged in any way, therefore it can be brought to the orthodontist, and he will process it and fix it on the tooth again.

What will happen if you swallow the bracket?

For health, nothing terrible will happen, the bracket itself is small and it does not have sharp edges that can damage the stomach lining. It will be necessary to simply put a new bracket during a visit to the orthodontist.

Can brackets rub?

This should not happen. If there is discomfort, it means that something has happened to the archwire or the bracket has come off. In this case, you need to visit the orthodontist, and he will easily adjust, trim or archwireh.

Wax for brackets

Discomfort of the mucous membrane of the cheeks or lips is possible at the time of getting used to the brackets, but not often. Orthodontic wax helps to soften discomfort. In fact, it is a "plasticine", which softens in the patient's fingers and is glued to the place that scratches: the bracket, the archwire, the hook. They can cover everything that is in the mouth and that brings discomfort. It is important to first take a cotton pad and dry the place where we want to stick the wax. This wax is food, so if it flies, and you swallow it, then nothing terrible will happen. In the Confidencia Clinic we always give wax to patients with us after fixing the bracket system.

Are there any speech defects when wearing brackets?

With external brackets can not be. The more the patient talks, the faster the addiction occurs, but this is more characteristic of internal brackets. Orthodontists of our clinic recommend that patients with lingual brackets read out loud for several days after fixation for quick adaptation.

How does technically removing brackets occur?

  1. The bracket is compressed at the base with special forceps and just bounces off, all the material remains on the tooth.
  2. Boron removes the surface part of the material, but not completely, so as not to touch the enamel.
  3. The remaining thin layer of material is slowly, with cooling, removed by polishing discs and rubber bands.
  4. The tooth becomes brilliant, the enamel is in no way damaged.
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