- Email: [email protected]
Modification of the orthodontic bracket to facilitate exposure and bonding of impacted teeth
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery 46 (2008) 688–689
Technical note
Modification of the orthodontic bracket to facilitate exposure and bonding of impacted teeth S. Gowrishankar a,∗ , K. Andi a , R. Marinho b , J. Carter a a b
Oral & Maxillofacial Surgery, Barts and The Royal London NHS Trust, United Kingdom Lifecenter Hospital, Belo Horizonte, Brazil
Accepted 12 April 2008 Available online 27 May 2008
Keywords: Expose and Bond; Orthodontic brackets; Impacted teeth; Bracket modification
Ever since its inception by Nielsen et al1 , exposure and bonding of unerupted teeth has been routinely carried out in most oral and maxillofacial departments after joint treatment has been planned with hospital or practice-based orthodontists. Becker2 showed that bonding at the time of exposure was superior to bonding at any other time, but this can be quite challenging particularly when the angulation required for optimal placement is awkward. This is often exacerbated because of the inadequate surface area on the bracket on to which an instrument may be applied. Occasionally, the bracket may be dropped, further increasing the surgeon’s frustration. We report a simple technique to improve holding and gripping the bracket to facilitate its intraoperative placement on the tooth, as well as reducing the incidence of lost brackets. A ball of light-cured composite [3M Unitek; TransbondTM XT] about 2–3 mm in diameter is rolled and flattened into a sphere before being placed and cured on the hooked surface of the bracket (Fig. 1). The procedure takes seconds and a batch of modified brackets can be produced in one sitting for later use. Naturally, the additional composite increases the surface area for gripping; it holds and positions the bracket on the tooth with ease using mosquito forceps, college forceps, or a curved haemostat.
∗ Corresponding author. 16 Walnut Grove, Harlow. Essex, CM20 1EJ, United Kingdom. Tel.: +44 01279 424877/44 7955447599. E-mail addresses: [email protected], mg [email protected] (S. Gowrishankar).
We have also found that vision or access is not compromised in any way. This modification has been used successfully in a number of cases in our department. There has been no problem with increased bulk in terms of patients’ discomfort, wound dehiscence, or tissue reaction.
Authors contribution Contribution of Authors involved Original Idea: Mr. Siddharth Gowrishankar and Mr. John Carter.
Fig. 1. The modified bracket on the left is easier to grip.
0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2008.04.005
S. Gowrishankar et al. / British Journal of Oral and Maxillofacial Surgery 46 (2008) 688–689
Manuscript preparation: Mr.Siddharth Gowrishankar. Operating Surgeon: Mr.Kavin Andi (Spr) and Mr.Carter. Patients admitted under: Mr. John Carter (Consultant). 54 patients independently operated by Mr.R Marinho (in Brazil). Patient statistics Total no patients treated between August 2006 and February 2007 (6 month period). At Princess Alexandra Hospital, under Mr. John Carter – 57. At Lifecenter Hospital, Belo Horizonte, Brazil, under Mr. R. Marinho – 54. Totalling 111. Complications No serious complications reported thus far. (Minimum follow up 6 months).
689
No significant inflammatory or allergic response in any patient. Acknowledgments We thank Mr Michael Williams, Oral & Maxillofacial technician, Princess Alexandra Hospital. References 1. Nielsen IL, Prydso U, Winkler T. Direct bonding on impacted teeth. Am J Orthod 1975;68:666–70. 2. Becker A, Shpack N, Shteyer A. Attachment bonding to impacted teeth at the time of surgical exposure. Eur J Orthod 1996;18:457–63.
British Journal of Oral and Maxillofacial Surgery 46 (2008) 688–689
Technical note
Modification of the orthodontic bracket to facilitate exposure and bonding of impacted teeth S. Gowrishankar a,∗ , K. Andi a , R. Marinho b , J. Carter a a b
Oral & Maxillofacial Surgery, Barts and The Royal London NHS Trust, United Kingdom Lifecenter Hospital, Belo Horizonte, Brazil
Accepted 12 April 2008 Available online 27 May 2008
Keywords: Expose and Bond; Orthodontic brackets; Impacted teeth; Bracket modification
Ever since its inception by Nielsen et al1 , exposure and bonding of unerupted teeth has been routinely carried out in most oral and maxillofacial departments after joint treatment has been planned with hospital or practice-based orthodontists. Becker2 showed that bonding at the time of exposure was superior to bonding at any other time, but this can be quite challenging particularly when the angulation required for optimal placement is awkward. This is often exacerbated because of the inadequate surface area on the bracket on to which an instrument may be applied. Occasionally, the bracket may be dropped, further increasing the surgeon’s frustration. We report a simple technique to improve holding and gripping the bracket to facilitate its intraoperative placement on the tooth, as well as reducing the incidence of lost brackets. A ball of light-cured composite [3M Unitek; TransbondTM XT] about 2–3 mm in diameter is rolled and flattened into a sphere before being placed and cured on the hooked surface of the bracket (Fig. 1). The procedure takes seconds and a batch of modified brackets can be produced in one sitting for later use. Naturally, the additional composite increases the surface area for gripping; it holds and positions the bracket on the tooth with ease using mosquito forceps, college forceps, or a curved haemostat.
∗ Corresponding author. 16 Walnut Grove, Harlow. Essex, CM20 1EJ, United Kingdom. Tel.: +44 01279 424877/44 7955447599. E-mail addresses: [email protected], mg [email protected] (S. Gowrishankar).
We have also found that vision or access is not compromised in any way. This modification has been used successfully in a number of cases in our department. There has been no problem with increased bulk in terms of patients’ discomfort, wound dehiscence, or tissue reaction.
Authors contribution Contribution of Authors involved Original Idea: Mr. Siddharth Gowrishankar and Mr. John Carter.
Fig. 1. The modified bracket on the left is easier to grip.
0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2008.04.005
S. Gowrishankar et al. / British Journal of Oral and Maxillofacial Surgery 46 (2008) 688–689
Manuscript preparation: Mr.Siddharth Gowrishankar. Operating Surgeon: Mr.Kavin Andi (Spr) and Mr.Carter. Patients admitted under: Mr. John Carter (Consultant). 54 patients independently operated by Mr.R Marinho (in Brazil). Patient statistics Total no patients treated between August 2006 and February 2007 (6 month period). At Princess Alexandra Hospital, under Mr. John Carter – 57. At Lifecenter Hospital, Belo Horizonte, Brazil, under Mr. R. Marinho – 54. Totalling 111. Complications No serious complications reported thus far. (Minimum follow up 6 months).
689
No significant inflammatory or allergic response in any patient. Acknowledgments We thank Mr Michael Williams, Oral & Maxillofacial technician, Princess Alexandra Hospital. References 1. Nielsen IL, Prydso U, Winkler T. Direct bonding on impacted teeth. Am J Orthod 1975;68:666–70. 2. Becker A, Shpack N, Shteyer A. Attachment bonding to impacted teeth at the time of surgical exposure. Eur J Orthod 1996;18:457–63.