Copy of selection of mbt appliance /certified fixed orthodontic courses by Indian dental academy

11
FEATURES OF THE MBTFEATURES OF THE MBT
VERSATILE+ APPLIANCEVERSATILE+ APPLIANCE
1.1. Design Features of MBTDesign Features of MBT
Bracket SystemBracket System
2.2. The Versatility of the MBTThe Versatility of the MBT
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22
Design FeaturesDesign Features
1.1. Range of bracketsRange of brackets
 Size (standard, mid)Size (standard, mid)
 Shape (rhomboidal)Shape (rhomboidal)
 EstheticsEsthetics
1.1. In-out PrescriptionIn-out Prescription
 Upper second premolarsUpper second premolars
1.1. Tip PrescriptionTip Prescription
 Tip in anterior bracketsTip in anterior brackets
 Tip in molar tubeTip in molar tube
1.1. Torque PrescriptionTorque Prescription
 IncisorsIncisors
 CaninesCanines
 Upper molarsUpper molars
 Lower premolars and molarsLower premolars and molars

33
RANGE OFRANGE OF
BRACKETSBRACKETS

44
Range of bracketsRange of brackets
1.1. Standard size metal bracketsStandard size metal brackets
 where control is the main requirementwhere control is the main requirement
1.1. Mid-size metal bracketsMid-size metal brackets
 Give less control,Give less control,
 but are useful for cases with smallbut are useful for cases with small
teeth,teeth,
 where there is poor oral hygiene, orwhere there is poor oral hygiene, or
 where control needs are modestwhere control needs are modest
1.1. Esthetic bracketsEsthetic brackets
 For older patients, where a metalFor older patients, where a metal
appearance will not be acceptable.appearance will not be acceptable.

55
Rhomboidal shapeRhomboidal shape
 Rhomboidal shape reduces theRhomboidal shape reduces the
bulk of each bracket andbulk of each bracket and
coordinates perspective linescoordinates perspective lines
through only two planes,through only two planes,
thereby assisting accuracy ofthereby assisting accuracy of
bracket placement.bracket placement.
8

66
TORQUE IN THE FACETORQUE IN THE FACE
vsvs
TORQUE IN THE BASETORQUE IN THE BASE

77
PastPast
Roth once said :Roth once said :
 ““the A-company’s SWA asthe A-company’s SWA as
developed by L. Andrewsdeveloped by L. Andrews is truly ais truly a
SWASWA from the stand point of afrom the stand point of a levellevel
slot lineupslot lineup..
 …… i.e. all the slots of the brackets arei.e. all the slots of the brackets are
at the same height and level in allat the same height and level in all
three dimensions when the teeth arethree dimensions when the teeth are
in the correct positions”.in the correct positions”.

88
 This is accomplished by theThis is accomplished by the
contours forcontours for torquetorque,, rotationsrotations
andand in-outin-out being built into thebeing built into the
base of the bracketsbase of the brackets”.”.
 It isIt is physically impossiblephysically impossible toto
achieve this slot lineup with anyachieve this slot lineup with any
appliance that does not haveappliance that does not have
the compound contoured basethe compound contoured base
with torque in the base”.with torque in the base”.

99
PresentPresent
 During 1During 1stst
& 2& 2ndnd
generation PEAgeneration PEA
brackets, technology was notbrackets, technology was not
available to set bracket slots in theavailable to set bracket slots in the
correct position relative to the facialcorrect position relative to the facial
surfaces of the crowns ( i.e.surfaces of the crowns ( i.e. level slotlevel slot
lineuplineup) without torque-in-base.) without torque-in-base.
 With the introduction of CAD-CAM,With the introduction of CAD-CAM,
however, the torque-in-base concepthowever, the torque-in-base concept
has been given less importance.has been given less importance.

1010
 Modern bracket systems,Modern bracket systems,
including the MBTincluding the MBTTMTM
system,system,
have been developed usinghave been developed using
CAD-CAM.CAD-CAM.
 However, at present this isHowever, at present this is
available with theavailable with the Mid-Size MBTMid-Size MBT
bracketsbrackets only.only.

1111
Adv. of CAD-CAM:Adv. of CAD-CAM:
 To create correct relationshipTo create correct relationship
between the midpoint on thebetween the midpoint on the
tooth & the slot basetooth & the slot base (as with(as with
traditional torque-in-base)traditional torque-in-base) &&
 Flexibility of design in relationFlexibility of design in relation
to:-to:-
 brackets strengthbrackets strength
 depth of tie wing &depth of tie wing &
 labio-lingual profile of bracket.labio-lingual profile of bracket.

1212
IN-OUTIN-OUT
SPECIFICATIONSPECIFICATION

1313
IN-OUT SPECIFICATIONIN-OUT SPECIFICATION
 For second premolar:For second premolar:
 AnAn alternative bracketalternative bracket which is 0.5mmwhich is 0.5mm
thicker than normal is helpful inthicker than normal is helpful in
obtaining good alignment of marginalobtaining good alignment of marginal
ridges in cases with small upper secondridges in cases with small upper second
premolars.premolars.
 Rest of the teeth:Rest of the teeth:
 Original SWA in-out specification wasOriginal SWA in-out specification was
used.used.

1414
TIPTIP
SPECIFICATIONSSPECIFICATIONS

1515
Upper and Lower Anterior TipUpper and Lower Anterior Tip
 Anterior Tip measurements in SWAAnterior Tip measurements in SWA
are greater than non-orthodonticare greater than non-orthodontic
normals.normals.
 This was presumably done toThis was presumably done to
control thecontrol the ““wagon wheelwagon wheel”” effect thateffect that
torque places on anterior crown tip.torque places on anterior crown tip.
 Note:Note:
 As palatal root torque is added to theAs palatal root torque is added to the
anterior segment, mesial crown tip isanterior segment, mesial crown tip is
reduced.reduced.

1616
Advantage of reduced anterior tip:Advantage of reduced anterior tip:
1.1. Reduced tip value of cuspids avoidsReduced tip value of cuspids avoids
the problem ofthe problem of cuspid and bicuspidcuspid and bicuspid
rootsroots that finish in close proximity.that finish in close proximity.
2.2. It also reduces the need forIt also reduces the need for anchorageanchorage
control.control.
3.3. Since the value is identical to normalSince the value is identical to normal
values, there isvalues, there is no compromise inno compromise in
idealideal static occlusionstatic occlusion..
4.4. And if the condyles are in centricAnd if the condyles are in centric
relation, there isrelation, there is no compromise inno compromise in
idealideal functional occlusionfunctional occlusion asas
described by Roth.described by Roth.www.indiandentalacademy.comwww.indiandentalacademy.com

1717
Clinical pointClinical point (Tip visualization)(Tip visualization)

Tip in the Molar tubesTip in the Molar tubes
 When usingWhen using 5/-9° brackets5/-9° brackets (tip = +5°) in(tip = +5°) in
the upper molars it is necessary tothe upper molars it is necessary to
placeplace the bands at 5° to the buccalthe bands at 5° to the buccal
cusps,cusps, in order to get the bracket wingsin order to get the bracket wings
parallel to the buccal groove of theparallel to the buccal groove of the
tooth.tooth.
 BandsBands do not fit welldo not fit well in this position andin this position and
it is difficult to routinely place them init is difficult to routinely place them in
this way.this way.
 It is preferable therefore to useIt is preferable therefore to use 0/-9°0/-9°
bracketsbrackets (tip = - 5°) and place the molar(tip = - 5°) and place the molar
bandsbands parallel with buccal cuspparallel with buccal cusp of theof the
molarsmolars 1818

1919
 If molar tubes are placedIf molar tubes are placed
parallel to the buccal cuspsparallel to the buccal cusps ofof
the molars athe molars a 00° tip bracket° tip bracket willwill
deliverdeliver 
 5° of tip for the uppers and5° of tip for the uppers and
 2° of tip for the lowers.2° of tip for the lowers.

2020
TORQUETORQUE
SPECIFICATIONSSPECIFICATIONS

Additional Incisor TorqueAdditional Incisor Torque
 In most of the cases, it isIn most of the cases, it is
necessary to achieve palatalnecessary to achieve palatal
root torque for theroot torque for the upperupper
incisors and labial root torqueincisors and labial root torque
for the lower incisors.for the lower incisors.
 Increasing the torque values inIncreasing the torque values in
these bracketsthese brackets reduces thereduces the
amount of wire bendingamount of wire bending at laterat later
stages.stages.
2121

2222
Torque visualizationTorque visualization

Upper Canine TorqueUpper Canine Torque
 The prescription on the canineThe prescription on the canine
brackets have been reducedbrackets have been reduced
and currentlyand currently 0° canine brackets0° canine brackets
are used so that the canineare used so that the canine
roots are keptroots are kept in cancellousin cancellous
bonebone while retracting, whichwhile retracting, which
offers lesser resistance.offers lesser resistance.
12323

2424
Lower Canine TorqueLower Canine Torque

2525
Upper Molar TorqueUpper Molar Torque
 The upper molars, on the otherThe upper molars, on the other
hand, frequently show excessivehand, frequently show excessive
buccal crown torque with palatalbuccal crown torque with palatal
cuspscusps “hanging down”“hanging down” which createswhich creates
centric, balancing side and workingcentric, balancing side and working
side interferences.side interferences.
 For this reason it is preferable toFor this reason it is preferable to
use -14° of buccal root torque inuse -14° of buccal root torque in
these teeth, as opposed to only -9°these teeth, as opposed to only -9°
of buccal root torque in SWA.of buccal root torque in SWA.

2626
Lower Premolar & MolarLower Premolar & Molar
TorqueTorque
 Many orthodontic cases demonstrateMany orthodontic cases demonstrate
narrowing in the maxillary archnarrowing in the maxillary arch withwith
lower posterior segments that arelower posterior segments that are
compensated toward the lingual. Thesecompensated toward the lingual. These
cases benefit from buccal uprighting ofcases benefit from buccal uprighting of
the lower posterior segment.the lower posterior segment.
Therefore, the lingual crown torque isTherefore, the lingual crown torque is
reducedreduced by
 5°5° in the lower premolars, byin the lower premolars, by
 10°10° in the lower first molars,in the lower first molars, && byby
 25°25° in the lower second molars.in the lower second molars.www.indiandentalacademy.comwww.indiandentalacademy.com

2727
Lower posterior torqueLower posterior torque
 It has been consistentlyIt has been consistently
observed that lower secondobserved that lower second
molars with -35° of torquemolars with -35° of torque
consistentlyconsistently “roll in”“roll in” lingually.lingually.

2828
Torque in the BaseTorque in the Base
VSVS
Torque in the FaseTorque in the Fase

2929

3030
FEATURES OF THE MBTFEATURES OF THE MBT
VERSATILE+ APPLIANCEVERSATILE+ APPLIANCE
1. Design Features of MBT Bracket System
2.2. The Versatility of the MBTThe Versatility of the MBT

3131
Aspects of VersatilityAspects of Versatility
1.1. Palatally placed upper lateral incisors (-Palatally placed upper lateral incisors (-
10 )10 )
2.2. Three Torque options forThree Torque options for
 Upper canines (-7,0,+7).Upper canines (-7,0,+7).
 Lower canines (-6,0,+6).Lower canines (-6,0,+6).
1.1. Interchangeable brackets –Interchangeable brackets –(same tip and(same tip and
torque)torque)
 Lower incisor bracketsLower incisor brackets
 Upper premolar bracketsUpper premolar brackets
1.1. Finishing to a Class II molar relationshipFinishing to a Class II molar relationship
 Use of second molar tubes for the upper first andUse of second molar tubes for the upper first and
second molars of the opposite side.second molars of the opposite side.
1.1. In non-HG casesIn non-HG cases
 Use of upper second molar tubes on first molars.Use of upper second molar tubes on first molars.
Explained
later

3232
Palatally Displaced UpperPalatally Displaced Upper
Lateral IncisorsLateral Incisors
 During alignment stage, it isDuring alignment stage, it is
necessary to create enough space.necessary to create enough space.
1 3 1 1

3333
 Lateral incisor is moved gently into
the space created using .016 HANT
17°

3434
 Extra torque is required to act onExtra torque is required to act on
lateral incisor to align its root.lateral incisor to align its root.
17°1010°°

3535
 Lateral incisor bracket is rotatedLateral incisor bracket is rotated
180° which changes the torque from180° which changes the torque from
+10° to –10°+10° to –10°
1 3 1 11 2
12

3636
Interchangeable lowerInterchangeable lower
incisor bracketsincisor brackets
Interchangeable

3737
Interchangeable upper premolar brackets

3838
In non-HG casesIn non-HG cases  Use of upperUse of upper
second molar tubes on first molarssecond molar tubes on first molars

3939
Finishing to a Class II molarFinishing to a Class II molar
relationshiprelationship  Use of second molar tubes for theUse of second molar tubes for the
upper first and second molars of the opposite side.upper first and second molars of the opposite side.
..

4040
Factors Which Govern theFactors Which Govern the
Selection of Canine Brackets:-Selection of Canine Brackets:-
1.1. Arch formArch form
2.2. Canine prominenceCanine prominence
3.3. Extraction decisionExtraction decision
4.4. OverbiteOverbite
5.5. Rapid palatal expansion casesRapid palatal expansion cases
6.6. Agenesis of upper lateral incisorAgenesis of upper lateral incisor

4141
Why Torque options for theWhy Torque options for the
canines :canines :
 Effective torque control of the upperEffective torque control of the upper
canines is necessary, because theycanines is necessary, because they
are key elements in a mutuallyare key elements in a mutually
protected occlusion.protected occlusion.
 The inefficiency of the PEA inThe inefficiency of the PEA in
delivering torque is evident whendelivering torque is evident when
working with canines (longest rootsworking with canines (longest roots
in the human dentition).in the human dentition).
 The MBT philosophy usedThe MBT philosophy used twotwo typetype
of canine brackets (in each arch) toof canine brackets (in each arch) to
provideprovide three possible torque optionsthree possible torque options
(in each arch).(in each arch).www.indiandentalacademy.comwww.indiandentalacademy.com

4242
1. Arch form1. Arch form
 Well developed arches:Well developed arches:
(not requiring substantial tooth movement)(not requiring substantial tooth movement)
 -7-7°° upper caninesupper canines
 -6-6°° lower canineslower canines
 Ovoid or tapered arch form:Ovoid or tapered arch form:
 00°° for upper caninesfor upper canines
 00°° for lower caninesfor lower canines
 Narrow tapered arch form:Narrow tapered arch form:
 +7+7°° upper caninesupper canines
 +6+6°° lower canineslower canines

4343
2. Canine prominence2. Canine prominence
 Prominent canines orProminent canines or
 Gingival recession present:Gingival recession present:
 upper canines = 0upper canines = 0°° or +7or +7°° torquetorque
 lower canines = +6lower canines = +6°° torquetorque

4444
3. Extraction decision3. Extraction decision
 In premolar extraction cases orIn premolar extraction cases or
 In cases where there isIn cases where there is
considerable canine tip to beconsiderable canine tip to be
corrected:corrected:
 00°° torquetorque
As they tend to maintain the canineAs they tend to maintain the canine
roots in cancellous bone, therebyroots in cancellous bone, thereby
making tip control of the jcaninemaking tip control of the jcanine
roots easier.roots easier.

4545
4. Overbite4. Overbite
 In class II/2 cases andIn class II/2 cases and
 Other deep bite situationsOther deep bite situations
 Lower canine = 0Lower canine = 0°° or +6or +6°° torquetorque
There is often a requirement toThere is often a requirement to
move the lower canine crownsmove the lower canine crowns
labially, but to maintain the rootslabially, but to maintain the roots
centered in the bone.centered in the bone.

4646
5. Rapid palatal expansion5. Rapid palatal expansion
casescases
 Widening of the upper archWidening of the upper arch
creates a secondary widening increates a secondary widening in
the lower arch = torque changesthe lower arch = torque changes
among lower teeth.among lower teeth.
 lower canine = 0lower canine = 0°° or +6or +6°° torquetorque
Recommended to assist thisRecommended to assist this
favorable change.favorable change.

4747
6. Agenesis of upper lateral6. Agenesis of upper lateral
incisorincisor
 If to close the spaces of missingIf to close the spaces of missing
lateral incisors with caninelateral incisors with canine
mesialization:mesialization:
 Canine bracket = +7Canine bracket = +7°° torquetorque

4848
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Copy of selection of mbt appliance /certified fixed orthodontic courses by Indian dental academy

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Copy of selection of mbt appliance /certified fixed orthodontic courses by Indian dental academy