MBT Technique /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


The MBT Bracket System
• The MBT bracket system is based on a
more balanced mix of science,tradition and
experience.
• It is a bracket system for use with light
continuous forces, lacebacks and bendbacks
• It is designed ideally to work with sliding
mechanics.

Requirements for Providing
Quality Orthodontic Care
• Good diagnosis and treatment planning.
• Best available bracket system.
• Correct positioning and repositioning of
brackets.
• Clear philosophy on arch form.
• Effective aligning technique.

• Ability to level the dental arches and
control overbite.
• Correction of Class II and Class III
discrepancies .
• Controlled space closure, with sliding
mechanics.
• Persistence in finishing.
• Good retention protocol.

Diagnosis and treatment planning
-The Dental VTO
DENTAL VTO provides organized and simplified
information about direction and amount of dental
movement in UL arches.
The information includes,the initial position and
desired movement of first molars ,the cuspids and
the dental midlines.
It is helpful in extraction and non-extraction decision
and can be referred during regular follow-up.

INITIAL MIDLINE AND MOLAR
POSITION
Right

Left

Midline Molars
Chart 1


LOWER ARCH DISCREPANCY
Right
Crowding

Left

3x3
6x6

Protrusion
Curve of Spee
Midline
Total

3x3
6x6
Chart 2


Secondary factors to provide
additional space.
• Interproximal enamel reduction.
• Uprighting or distal movement of lower
first molars.
• Buccal uprighting of lower canines and
lower posterior teeth.
• Leeway space or ‘E’space.

ANTICIPATED TREATMENT
CHANGE
Right

Left

Midline
Cuspids
1st Molars
Chart-3


Case - 1
•
•
•
•
•
•
•
•
•

12 year old male patient.
Class II skeletal pattern.
High angle with increased lower facial height
4mm Class II on right side.
3.5mm Class II on left side.
Lower midline deviated 1mm to right.
4mm lower incisor crowding.
2mm Curve of Spee.
Lower anteriors 6mm in front of A.pog line.

INITIAL MIDLINE AND MOLAR
POSITION
Right

Left

4mm

3.5mm

1mm
Chart-1


LOWER ARCH DISCREPANCY
3x3

Right
-3

Left
-1

6x6

-3

-1

Protrusion

-2

-2

Curve of Spee

-1

-1

Midline

+1

-1

3x3

-5
-5

Crowding

Total

6x6

Chart 2

-5
-5


ANTICIPATED TREATMENT
CHANGE
Right

Left

2mm

9mm

0

8.5mm

1.5mm

(7)

(7)
2mm

(7)

(7)
5mm

1mm

Chart-3.


5mm

2mm

Bracket Specification
THE FIRST GENERATION PAE
• The original SWA was introduced by Andrews in
1972 and it had the features of Siamese edgewise
bracket.
• He recommended a wide range of brackets.
- For extraction cases, anti-tip,anti-rotation, and
power arms for control space closure.
-Three sets of incisor brackets with varying
degrees of torque for different clinical situation.

THE SECOND GENERATION PEA
• To avoid inventory difficulties or multiple
bracket system, ROTH recommended a
single appliance system to manage both
extraction and non-extraction cases.
• The appliance prescriptions developed by
Andrews and Roth were based on the
treatment mechanics used in their practice.

THE THIRD GENERATION PEA
• The MBT has been developed from the combined
clinical experience of the authors for more than 70
years.
• It also introduced additional research input from
Japanese sources to update the scientific input.
• It is designed ideally to work with sliding
mechanics,with light continuous forces, lacebacks
and bendbacks.

The MBT Versatile Appliance
System.
Victory Series Brackets.

Unitek Full-Sized Twin
Brackets.

Clarity Brackets.

Molar bands,molar
bonding bases,and buccal
tubes.


Design features of a modern
bracket system
• Range of brackets
- Standard size metal brackets.
- Mid-size metal brackets.
-Esthetic brackets.

• Improved i.d system
Laser numbering of standard size metal
brackets.

• Rhomboidal shape
Reduces bulk and assists accuracy of bracket
placement. www.indiandentalacademy.com

• Torque in base-the CAD factor
Using CAD it is possible to program the
computer to create the correct relationship
between the mid-point on the tooth and the slot
base,as with traditional torque-in-base.

• Refinement of bracket base design
It is incorporated to increase strength and help
plaque control in difficult areas.


• Drawing of original
SWA bracket.
• Dots (upper) and
dashes (lower) were
used for i.d purposes.


• Drawing of MBT
brackets.
• Standard size
brackets have a
rhomboidal form
and numerical
i.d.system.


• Lower premolar
bracket may be
offset on specially
designed bases,to
increase bond
strength and reduce
the risk of bond
failure.

• Tapered bracket
bases on lower
incisors can help
in plaque control
in this difficult
area.

Tip specification
ANTERIOR TIP
Reduced anterior tip was incorporated
into the appliance to conform to Andrews
original research,and to dramatically reduce
the anchorage needs of each case.


Incisor Tip

Cuspid Tip

Upper
Central

Upper
Lateral

Lower
Central

Lower
Lateral

Upper

Lower

MBT
Versatile+

4.0°

8.0°

0°

0°

8.0°

3.0°

Original
SWA3

5.0°

9.0°

2.0°

2.0°

11.0°

5.0°


UPPER POSTERIOR TIP
•Upper bicuspid brackets are provided with
00 tip to keep these teeth in a more upright
position .
•Upper molar brackets are provided with
00 tip, which when placed parallel to the
occlusal plane,introduces 50 tip into the
upper molars.

Bicuspid Tip

Molar Tip

Upper First

Upper
Second

Upper First

Upper
Second

MBT Versatile+

0°

0°

0°

0°

Original SWA

2.0°

2.0°

5.0°

5.0°


Upper tip considerations
The authors prefer a 00 tip bracket,with
the band seated parallel to the buccal
cusps.This gives 50 tip.
If a 50 bracket is used,the band must be
seated more gingivally at the mesial.
If a 50 bracket is used,and the band is
seated parallel to the buccal cusps,this
will result in an effective 100 tip on the
molar.

LOWER POSTERIOR TIP
•Lower posterior tip in the first and second
bicuspid brackets is maintained at 20, to
slightly incline these teeth forward.
•For the lower first and second molars,
00 tipped brackets are provided, which
when placed parallel to the occlusal
plane,introduces 20 of tip to these teeth.

Lower Bicuspid Tip

Lower Molar Tip

Lower First

Lower
Second

Lower First

Lower
Second

MBT Versatile+

2.0°

2.0°

0°

0°

Original SWA

2.0°

2.0°

2.0°

2.0°


Torque specification
INCISOR TORQUE
•Upper incisor brackets are provided with
additional palatal root torque;while lower
incisor brackets are provided with additional
labial root torque.
•This adjustment aids in the correction of the
most common torque problems occurring in
the incisor areas.

Upper central incisor torque
• Increased palatal
root torque for
upper centrals.


Upper lateral incisor torque
• Increased
palatal root
torque for
upper lateral
incisors.

Lower incisor torque
• Increased
labial root
torque for
lower
incisors.

Incisor Torque

Incisor Torque

Upper Central

Upper
Lateral

Lower
Central

Lower
Lateral

MBT Versatile+

17.0°

10.0°

-6.0°

-6.0°

Original SWA

7.0°

3.0°

-1.0°

-1.0°


Upper Cuspid ,bicuspid and
molar torque.
•Upper cuspid and bicuspid brackets are
provided with the normal -70 of torque.
•Upper molar brackets are provided with an
additional 50 of buccal root torque (-90 to -140 )
to reduce palatal cusp interferences with these
teeth.

• Upper canine torque.
• Available in –70 ,00 ,
+70 , torque.
• The 00 and +70 options
are for cases with
narrow maxillary bone
form andor prominent
canine roots,and are
often used with
archwires in the tapered
form.

Upper torque considerations
There was a tendency for
upper first molar palatal
cusps to extrude.
In some cases it is necessary to
add buccal root torque to the
upper archwire ,even when
using a –140 torque bracket.
A bracket with – 140 of
buccal torque gives extra
control.

Upper Cuspid, Bicuspid and Molar Torque
Upper
Cuspids

Upper 1st
Bicuspids

Upper 2nd
Bicuspids

Upper 1st
Molars

Upper 2nd
Molars

MBT
Versatile+

-7.0

-7.0

-7.0

-14.0

-14.0

Original
SWA

-7.0

-7.0

-7.0

-9.0

-9.0


Lower cuspid,bicuspid and
molar torque.
•Progressive buccal crown torque is
provided in the brackets of the lower
posterior segments.
•This allows for buccal uprighting of these
teeth,which is beneficial in most cases.


• Lower canine
torque available in
–60 ,00 ,+60 ,
• The 00 and +60
options are for
cases with narrow
mandibular bone
form or prominent
canine roots,or
deep bites at start of
treatment.

Lower Cuspid, Bicuspid and Molar Torque
Lower
Cuspids

Lower 1st
Bicuspids

Lower 2nd
Bicuspids

Lower 1st
Molars

Lower 2nd
Molars

MBT
Versatile+

-6.0

-12.0

-17.0

-20.0

-10.0

Original
SWA

-11.0

-17.0

-22.0

-30.0

-35.0


In-out specification
• It is 100% fully expressed.
• In upper premolars an alternative bracket
which is 0.5mm thicker than normal,is used.
• This is helpful in obtaining good alignment
of marginal ridges in cases with small upper
second premolars.


In-out modifications.
• An upper second
bicuspid bracket with an
additional 0.5mm of
in-out compensation is
provided for the
common situation in
which upper second
bicuspids are smaller
than upper first
bicuspids.

Horizontal bracket placement
errors
• If brackets are placed
to the mesial or distal
of the vertical long
axis of the clinical
crown,improper tooth
rotation can occur.


Axial or paralleling bracket
placement errors
• These will occur if the
bracket wings do not
straddle the vertical
long axis of the crown
in a parallel manner.
• Such errors lead to
improper crown tip.


Thickness errors.
• Excess bonding agent
beneath the bracket
base can cause
thickness and
rotational errors.
• Can be eliminated by
pressing the bracket
against the tooth.

Vertical errors
• Vertical errors in
bracket placement are
caused by placing
brackets gingival or
incisalocclusal to the
center of the clinical
crown.


Gingival Concern.
• Partially erupted tooth.
• It is difficult to visualize
the center of the clinical
crown on partially
erupted teeth,when
treating young patients.


Gingival Inflammation
Gingival inflammation causes foreshortening,effectively
reducing the length of the clinical crowns.
• Top:Healthy gingivae.
• Bottom :The same case
with inflamed gingivae in
the upper right quadrant.


Teeth with palatally or lingually
displaced roots.
• Individual teeth with
lingually displaced
roots can produce
short clinical crowns.


Teeth with facially displaced
roots.
• Individual teeth with
facially displaced
roots can produce long
clinical crowns.


Incisal or Occlusal concerns.
• Incisal crown
fractures or
tooth wear make
it difficult to
visualize the
center of the
clinical crown.


Crowns with long tapered
buccal cusps
• Cuspids with
tapered clinical
crowns often do not
have adequate
contact with the
opposing teeth.


Axial/paralleling variation
The tip position of the lateral
incisor brackets was varied to
help root paralleling.
In this case a lower incisor has been
extracted and root paralleling has
been helped by changing axial
positions of adjacent brackets.

Palatally positioned lateral
incisors.
It is important to create adequate
space before attempting to move
palatally placed incisors.

It is beneficial to invert the
bracket on instanding lateral
incisors,giving –100 torque.

Upper first molar bracket
positioning.
Correct position.
Band is seated more gingivally at
the mesial when treating Class II
molar relationship.
It is common error to allow the
band to seat too gingivally at
the distal,causing excessive
crown tip.

Lower first molar bracket
positioning.
Correct band positioning.
A common error is to allow the
band to seat too gingivally at
the mesial .

Lower first molar bracket
positioning
Occlusal interferences can be a
problem in some cases.

A lower second molar tube can be
used on lower first molars to avoid
interferences in some cases.

Bracket Placement Gauge


Arch form considerations for
stability and esthetics.
• Bonwill and Hawley in 1905,suggested the
geometric method of constructing the ideal arch
form.
- The lower six anterior teeth lie along a circle
whose radius equaled their combined widths.
-From this circle an equilateral triangle is
created,the base of which represented the condylar
width.
-Premolars and molars should lie along these
extended lines.

• In 1907 Angle- The form of line from the premolars and

molars should resemble a parabolic curve.
-He proposed the need for natural curvature in
molar region.

• In 1934 Chuck-Noted variation in arch form –square, oval,
tapering.
-The premolar region should be wider than
canines to prevent excessive expansion of the
canines.

• In 1963 Boone –
-Superimposed Bonwill-Hawley arch form on a
millimeter grid and used Angles method for construction.
-Thus Bonwill-Hawley arch form is used as a
template in edgewise.

• Braun et al,1998
-Reported that the human arch form could be
represented by a complex mathematical formula,known as
the Beta function.
-This was calculated by entering measurements of
dental landmarks on orthodontic models into a computer
curve-fitting program.

Traditional edgewise
wire bending and
Boone arch form.


• The Catenary curve is
formed by extending a
chain from two fixed
points.
• Many of the tapered
arch forms provided
by orthodontic
manufactures today
are based on Catenary
curve.


Brader Archform


Relapse tendency after changing
arch form.
• Riedel in 1969,postulated that arch form, in the
mandibular arch,cannot be permanently altered
during appliance therapy.
• Similar research was done by Shapiro, Gardner,
Felton,De La Cruz and Burke suggesting that
changes in inter-molar width seem to be more
stable than those of inter-canine width.


The four components of archform
i.

ii.

ANTERIOR CURVATURE
Based on inter-canine width. Its shape
becomes more tapered when inter-canine width
is narrow and more square when inter-canine
width is wide.
INTER-CANINE WIDTH
This appears to be the most critical aspect of
arch form,because significant relapse occurs if
this dimension is changed.

•

POSTERIOR CURVATURE
In the posterior area a gradual curvature between
canine and second molars are preferred.

•

INTER-MOLAR WIDTH
Treatment changes in this dimension is more
stable.
Arch form in the inter-molar region can be
widened or narrowed,depending on the needs of
the case.

MBT ARCH FORM
• The three basic arch forms are tapered,
square and ovoid.
• When superimposed they vary mainly in
inter-canine width,giving a range of
approximately 6mm.
• Inter-molar widths are similar ,but the
molar areas can be widened or narrowed as
needed,by easy wire bending.

THE TAPERED ARCH FORM
• Indicated for patients with narrow ,tapered
arch form and gingival recession in canine
and premolar regions.
• Cases undergoing single arch treatment,in
this way no expansion of treated arch
occurs.


THE SQUARE ARCH FORM
• Indicated in cases with broad arch form.
• Cases that require buccal uprighting of the
lower posterior segments and expansion of
the upper arch.
• After over-expansion has been achieved ,it
may be beneficial to change to the ovoid
arch form in the later stages of treatment.

THE OVOID ARCH FORM
• It is the most preferred arch form. The ovoid arch
form has proved to be good, reliable arch form for
high percentage of cases treated with PAE
• Treated cases have shown good stability, with
minimal amounts of post-treatment relapse.


ARCH FORMS - MBT


Selection of Archform
i. Arch form template are placed on lower
study models.
-The inter-canine width is evaluated.
ii.If buccal uprighting is needed in the lower
arch, a wider arch form is selected.

In 70% of cases buccal uprighting will result in
lower anterior relapse.
Cases in which buccal uprighting will be stable
include(a) Cases in which maxillary expansion is
indicated.
(b)Deep bite cases such as Class II /2 cases.
iii.Contour and width in the lower posterior
segment is estimated but this can be easily
customized.

Arch wire Sequencing
 EARLY IN TREATMENT .015”/ .0175” multistranded /.014” SS
OR
.016” HANT. Less effect on arch form , so
ovoid arch form indicated for all cases.
 MID TREATMENT –
.014”/.016”/.018” SS
OR
.019x.025” Rec. HANT.
Influence arch form –requires full inventory.
 LATE TREATMENT.019x.025”SS – stocks of three arch forms.

Archwire Coordination
• It is important throughout treatment.
• Most critical with heavier round wires and .
019x.025 SS.
• Arch form templates can be used for coordination.
• The upper wire should superimpose approximately
3mm outside lower wire.
• This is representative of overlap of the upper teeth
relative to the lower teeth.

SLIDING MECHANICS
Passive tiebacks.

Type 1 active tiebacks


SLIDING MECHANICS
Type 2 active tieback.

Type 3 active tieback.


ARCH WIRE WITH
SOLDERED HOOKS


Arch form during finishing and
detailing
• Phase of settling is preferred with lighter wires.
-Lower arch- .014”SS or .016” NiTi
- Upper arch- .014”SS sect.,with light
triangular elastics.
• Teeth adjacent to extraction sites lightly tied
together.
• An upper removable plate is required to maintain
maxillary expansion.
• In Class II/1 cases to prevent overjet relapse, a full
.014”SS arch wire with bendbacks is advocated.

EXCLUSIVE MBT
APPLIANCE FEATURES.
•
•
•
•

Reduced anterior tip.
Upper bicuspid brackets with 00 tip.
Lower bicuspid brackets with 20 tip.
Additional palatal root torque for upper
incisors and additional labial root torque for
lower incisors.
• Upper cuspid brackets with the normal –7 0
torque or 00 torque.

• Upper molar brackets with additional 50 buccal
root torque.
• Progressive buccal crown torque in lower cuspids
and lower buccal segments.
• Optional upper second bicuspid brackets with an
additional 0.5mm of in-out compensation.
• Three bracket types,Clarity Aesthetic Brackets,
Victory Series brackets, and Unitek Full Size
Twin Brackets,all available with APC Adhesive
Coating.

MBT Technique /certified fixed orthodontic courses by Indian dental academy

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MBT Technique /certified fixed orthodontic courses by Indian dental academy