360 PASSIVE SELF-LIGATING BRACKETS – CLINICAL CASE

Bracket 360 is the first dental depot in Madrid and Spain specialized in orthodontics. We are a team of professionals with experience in the manufacture and distribution of high quality orthodontic material. We like what we do and we have a clear objective: to facilitate the work in your clinic every day. At Bracket 360 we are defined by a common feeling: our passion for orthodontics.

Today we would like to share with you a clinical case of 360 passive self-ligating brackets. 

Self-ligating brackets have emerged strongly in the last two decades and are increasingly being requested by orthodontists and patients. Their low friction is a primary factor that allows for more effective treatments, resulting in less chair time, shorter and more spaced visits and therefore shorter treatments. This article describes the possible advantages that 360 Passive Self-Ligating brackets can offer over conventional braces in a clinical case study.

Self-ligating brackets are divided into two main types according to the locking mechanism of their lids: active and passive. Active self-ligating brackets have a closing spring that presses the archwire to the bottom of the bracket slot for greater control of rotation and torque movements.  Passive self-ligating brackets, on the other hand, have a mechanism that does not invade the slot, are designed in such a way that they have a sliding locking cap, and therefore do not exert any active force on the archwires.

Self-ligating brackets have been attributed many advantages over conventional brackets. The main advantages of these brackets are that they generate less friction between the archwires and the brackets, resulting in alignment and leveling of the teeth in less time than traditional brackets. 

Also due to the lower friction it is considered that they can achieve greater arch expansion with less incisor proinclination, because in the alignment phase the arch slides easily backwards and, therefore, facilitates the resolution of certain crowding sometimes without the need for extractions. Other advantages are attributed to it being more efficient in chair time, which includes shorter, more spaced appointments and less overall treatment time. Increased patient comfort results in the ease of better oral hygiene with greater cooperation and acceptance. Still, regardless of the appliances you choose to use during orthodontic treatment, a good diagnosis and a well-structured treatment plan are always necessary.

The properties sought in all cases are summarized as follows:

• Safe and resistant
• Low friction at the arch-bracket interface
• Easy and fast to use
• Access to higher friction when the case requires it
• Easy hygiene
• Comfort.

We show the evolution of a clinical case with the Bracket 360 Passive Self-Ligating bracket with MBT prescription, in combination with round section superelastic archwires, in which a significant evolution of crowding was observed in 3 months of treatment.

Clinical case with passive self-ligating brackets

Female patient, 22 years and 6 months old. Presented for consultation with the reason “I want to have straight teeth”. No medical history. No allergies. She does not take any medication.

Intraoral examination: permanent dentition, absence of 46, moderate-severe crowding, bilateral class II molar, bilateral class II canine, canines in high position, increased overbite and compression of dental arches.

Treatment plan: alignment and leveling with round and rectangular arches to coordinate dental arches. No extractions. Use of elastics to correct molar and canine class II. Stripping therapy if necessary to resolve remaining crowding.

Appliance: fixed appliance multibrackets Passive Self-Ligation 360 metallic, with prescription MBT 0.22”. Round and square section superelastic archwires. This technology is chosen due to:

• Low friction, being more effective in resolving the crowding presented by the patient in the early stages of treatment
• More biological forces thanks to the design of the 360 Passive Self-Ligating brackets and the use of superelastic archwires, thus avoiding traditional elastic ligatures
• Less chair time, due to the easy removal and placement of the superelastic archwires through the easy opening and closing of the cap on the 360 Passive Self-Ligating brackets
• Increased comfort, the design of the 360 Passive Self-Ligation bracket offers more comfort to the patient.

Treatment progress: At the first appointment, Passive Self-Ligating 360 (MBT 0.22") brackets were cemented in the upper and lower arches, including the 1st permanent molars, with the exception of piece 46, as the patient did not have it. Superelastic archwires of 0.14 Niti round section were placed in both arches with stops for archwire immobilization.

After 3 months of treatment, the patient went for a check-up where almost 90% of the teeth were aligned and leveled, resolving the crowding. No stripping (interproximal wear) was performed to make room for alignment. In this appointment it is clearly observed how the teeth involved in the crowding are aligned in place and how the teeth 13 and 23 that were in a high position were intruded.

Treatment protocols with Passive Self-Ligating 360° brackets

The four phases are:

• Initial phase. Round copper nickel-titanium archwires are used which are free in the bracket slot, allowing the teeth to slide along the archwire with minimal friction. Tooth movement, leveling, alignment, rotation control, and arch form is established. It is important to note that this phase includes bite disarticulation with occlusal stops that greatly facilitate tooth movement during alignment and leveling.
• Second phase. In this phase, the arch form continues to develop, the leveling and rotational control finishes and the torque and root angulations begin to be worked with rectangular arches, which should be left to act for the necessary time.
• Third phase or main mechanical phase. This is the working phase of the archwire sequence. It includes posterior space closure, anteroposterior dental correction and adjustment of buccolingual discrepancies. Low friction titanium molybdenum alloy and stainless steel archwires are used to maintain vertical and buccolingual control.
• Finishing and detailing phase. When adjustments and minimal twisting are required, the working arc may be the finishing arc. When bending and/or moderate torsion is required, a low friction titanium molybdenum alloy archwire is recommended. This smooth archwire facilitates treatment completion for the patient and for the orthodontist, as it allows for proper detailing and coupling which will be important in the retention phase for treatment stability.

* Dr. Eva Bustillo has a degree in Dentistry and a European Specialist Master's Degree in Orthodontics (Alfonso X University). She is also specialized in Surgical Orthodontics at the Ramón y Cajal Hospital in Madrid.