Lingual Bracket Jig

Dr. Mazor Yoav
A specialist in Orthodontics & Dento-Facial Orthopedics.
Member of the Israeli Orthodontic Society.
Graduated Dental School at the Tel Aviv University on 1990
Clinical instructor & a lecturer at the Prosthodontic dep. for
more then 10 years.
Today:
Orthodontist
“Shiba” hospital – Special needs
Specialization program in Orthodontics - Bulgaria.
Professional advisor for R&D.
Professional manager of a 12 branch Policlinic.
Lecturer
WHY
Lingual Orthodontics?
More adults
- Invisible
- Not interfere with their everyday function & physical
appearance.
What can we offer them?
What alternatives:
Ceramic brackets
Clear Aligners
Lingual Orthodontics
History
of L.O
1841 Pierre Joachim Lefoulon
lingual arch for expansion & alignment
1975 Craven Kurz- USA
Used plastic brackets – easy to adapt to anterior lingual surface.
Only Invisible, please
-Debondings
-Uncomfortable
Modern lingual appliance – “K. Fujita” Japan
1978 – introduced his method.
3 piece bracket
3 slots: V, H, Oc.
Commercial interest – Ormco (Kurz)
1st generation (1977) – 7th generation(1990)
1st
2nd - add hooks
3rd - add hooks on molars
4th - profile change for
easier wire insertion
5th - bite plane, more
torque, accessory tube
6th - longer hooks
7th - romboid bite plan to
increase IBD, PM longer slot
The American Lingual Orthodontic Association – 1987
1987 AAO – Disappointment - Poor results
- lack of study & experience
- poor laboratory systems
- inadequate training
- lack of preformed lingual archwires.
The first Buccal clear brackets were
presented… A company – “starfire”
The European Society of Lingual Orthodontics - 1992
France
Fontenelle – 1978 – first publish
Fillion Didier – research, publish, lecture. ESLO
+ Alaine Decker – Paris V - lingual program
Italy
Massimo Ronchin (1st president of ESLO) developed in 1994 the
L- SLB (Forestadent), 2D lingual brackets- MTM
Giusepe Scuzzo (3rd) with Takemoto – STb (Ormco), book
Germany Dirk Wiechmann – customized approach
– individual wires (robot), Incognito (3M)
Israel
Silvia Geron – lingual bracket jig
Korea
Kim & Kyung (MS)
Japan
Largest lingual association today.
1996 – the first study cub
(Kurz, Laughlin, Creekmore, Wildman, Scuzzo, Fillion…)
Evolution of the Lingual systems
- Buccal brackets, direct bonding.
- Commercial lingual brackets, direct bonded
- Commercial lingual brackets, laboratory, indirect bonding, SW
- Commercial lingual brackets, laboratory , indirect bonding,
individual customized wires.
- Laboratory, individual customizes lingual Brackets, individual
customizes wires, indirect bonding.
Developments
- “light” lingual Orthodontics (2D systems, MTM)
-lingual SLB - Harmony-AO, eBrace-Riton,
- Forestadent, GAC.. - MTM
-Special wires – bidimensional, double offset
-Lingual jigs – Silvia Geron
The different Laboratory approaches
Indirect Bonding:
Important. Presents the total value of the laboratory work:
• Accuracy – setup, visualization, access,
anatomical variances..
• Reduced chair-time.
2 layers: Hard, soft: eBrace / Kadent
1 layer – Medium.
Additional type Silicone (Polivinil Siloxan)
soft & hard (Putty & wash)
CLASS System – Custom Lingual Appliance Setup (Ormco)
Malocclusion model & a Set-up model
Bracket positioning on set-up model
A photo is taken for wire fabrication
“Cap” fabrication
The brackets are transferred to the malocclusion model – Cap.
Transfer tray fabrication.
Advantage
Set-up model: early visualization.
Disadvantage
Many steps – errors – may require finishing steps
TARG - Torque Angulation Reference Guide (Ormco 1984)
The buccal surface & a specific blade are used for the lingual
positioning.
Allows accurate individual torque and angulation prescription.
Only malocclusion model – mounted on a swivel base, teeth are
aligned to a blade which is tilted to a specific torque & angulation
“virtual” setup- resin customized base brackets are bonded on the
malocclusion model with specific prescription for each tooth.
But since the TARG machine does not consider the different
thicknesses of the teeth, many 2nd order bends are required.
BEST - Bonding with Equal Specific Thickness
Fillion 1986 “Electronic TARG”
Improvement of the TARG – which compensate for the teeth BL
different thicknesses & allow SW approach.
The lingual brackets are bonded on the malocclusion model with the
specific prescription for each tooth, no set-up.
The wires are fabricated with the help of computer software (DALI)
according to the data generated from the specific prescription of
each tooth, fabricating the ideal individual wire.
LBJ - Lingual Bracket Jig
“Geron” Israel
The only system which allow direct & indirect bracket bonding.
The system consists of 6 upper anterior teeth & 1 universal jig for the
posterior teeth & a specific ruler.
The jig allows to transfer a labial prescription to the lingual surface &
BL thickness compensation.
It can be used with any prefabricated lingual bracket.
The disadvantage is the limited number of prescription jigs available.
KISS - Korean Indirect Bonding Set-up
Korean Society of Lingual Orthodontics members.
Accurate set-up model & a machine which positions all brackets in
one time.
Allows posterior & anterior height differences in set up for intrusion /
extrusion.
HIRO System - Hiro Japan, Takemoto & Scuzzo.
Do not require any specific equipment.
Set-up model with perfect teeth positioning. Brackets are positioned
& placed on a 018X025 SS wire. Individual resin transfer trays are
fabricated & used as indirect single tooth trays.
Advantage – low cost, simple
Disadvantage – long chair time at bonding, tray sensitivity.
Simplified Technique - Ormco, STb
Developed for the STb brackets.
Direct positioning on the malocclusion model: anterior brackets at
1.5-2 mm from incisal, canines at 2.5-3 mm, posterior teth at the
center of the clinical crown, indirect individual bonding tray using
warm glue gun
Advantages – fast, low cost, simple
Disadvantage – compensating bends…
1.5-2 mm
2.5-3 mm
center
TOP Transfer Optimized Positioning - “Wiechmann”, Germany
(2001)
The technique uses a set-up model as the BEST (Fillion).
Here the brackets are bonded directly on the malocclusion model
with NO BL compensations. The compensations are made by an
individual lingual wires which are fabricated by a robot.
Most of the prescription is “in the wire” & the correct wire must be
used & fully sited.
CAD CAM systems - Incognito (3M), eBrace (Riton), Harmony (AO)
The later format of the system, the brackets are designed by a
computer software to maximize the bracket pad to the tooth form.
The Brackets & wires contain a specific prescription for each tooth
Advantages & Disadvantages of
Lingual Orthodontics
disadvantages:
- Expensive.
(Materials, laboratory, chair time)
- Relatively more discomfort to the patient.
- More difficult for the operator
(bonding, rebonding, biomechanics view, manipulation)
- “laboratory dependency”
(Indirect bonding).
- Limitations
(Anatomical, periodontal, esthetical, OH, case selective).
advantages:
- Good esthetics - Invisible
- Good control & results
- Visualization of progress – dental, gingival
- Not affecting the buccal enamel
- Beneficial in some clinical procedures
Anterior intrusion / Posterior extrusion
Maxillary arch expansion
Maxillary molar distalization
Habits – tongue training, bruxism
TMJ deprogramming
Maxillary molar distalization & expansion.
More bodily – CoR is more palatal to the long axis
Basic Lingual Approaches & systems
The conventional lingual bracket
1. Anterior bite plane
2. Wide base
3. Hooks
1
3
2
Vertical slot
tip control - posterior teeth
Horizontal slot
Horizontal slot
torque control – anterior teeth
Vertical slot
1. Commercial lingual brackets - Laboratory adapted
Those systems use commercial premade brackets & wire
The brackets are adapted to the patient’s lingual tooth side by adding
composite on the lingual bracket pad.
Considered also as SW lingual systems
Mushroom
1-5
Ormco 7th generation (Kurz) (1990)
Rounded contours
Large hook for attachments
Increased tie wing area, to enable double over tie
Bracket base is large to improve bonding.
Horizontal slot allows easier torque control.
Bite plan in the upper anterior brackets to plan direct the occlusal
forces through the center of resistance of the anterior teeth, opening
the bite and creating intrusion of the upper and lower anterior teeth.
Molar - twin brackets/ tubes with mesial ball hooks.
ORG – ORJ- Romano-Geron
Mid form - 7th & STb
American Orthodontics
Small, narrow and smooth
Horizontal slot .020x.020”
Auxiliary vertical slot
STb (ORMCO) (Scuzzo-Takemoto brackets)
Forestadent
2D, 3D, SL
Low Profile
Adenta - Evolution a self-ligating lingual bracket
Modified Hiro system
GAC
Innovation-L
self ligating brackets
“Phantom”
Lingual wires
The lingual arch-wire is mushroom like with a 3-4 mm inset between
the upper 3-4 & a 2-3 mm between the lower 3-4.
A smaller inset is made at the transition between 5 & 6
Premolar inset
Molar inset
New
Pre-fabricated Bi-dimensional wires.
Pre-fabricated double offset
SW
2. Systems use commercial premade brackets, which have no
adaptation or compensations
Commercial lingual premade wires which
are bent by the operator (MTM, social 6, 2D)
Laboratory fabricated individual lingual wires –
(“Sure-smile”, Top)
Bring the Control to US.
Choose between buccal and lingual braces, combine between
different bracket systems- and yet- get full coordination
of the arches!
Visualize the bone coverage on every tooth (if needed)
No miracles..! Let the orthodontic knowledge have true
expression and influence.
3. Cad Cam individual lingual bracket systems.
Those systems are computer supported.
The brackets & wires are digitally 3D individually designed. Each
tooth have a custom made bracket with a specific
prescription, size & form.
A set of wires are individually fabricated for the patient.
CAD – CAM Lingual Systems
Use of plaster mal-occlusion model & set-up model.
Use of 3D scanners (intra-oral or model/ impression scanning) to
produce a 3D digital model.
Monitoring the set-up
This data is transformed to produce the individual brackets & wires.
Advantages of the CAD CAM system:
1. Since there is no need for composite base
adaptations, the brackets are Low profile bracket
that reduces patient discomfort during the
adaptation phase.
2. Accurate – less finishing needs, control
3. Exact & easy direct rebonding in the event of
bracket loss
Disadvantages
1. Cost
2. Time & Dependency on the laboratory
3. Extra costs in case of bracket / wire lost
eBrace specific features
Fully programmed Brackets
Optimal Control
1. Set-up
2. Bracket design
Mesh Pad Base
Rotation aids
6 individual upper jigs
Prevention
Transitional Brackets
Bands
Occlusal Pads
No extra
charge
The 2nd Generation Bracket
• Widen the anterior slot ；
Easily control teeth rotation
The 2nd Generation Bracket
• Deepen the anterior slot ；
the wire can be fully inserted into the slot that
can control the torque better
Digital setup—3shape Ortho-Analyzer TM
• The comparison between malocclusion and ideal setup
Incognito
comments
eBrace
comments
Gold
Nickel allergy
Non precious alloy
Lower weight
Mesh base
Ad. in rebonding
No contamination
Full prescription in
bracket
Limited robot
Simpler wires
Wires need upgrading
Smooth base
Prescription in
bracket & wire
robot
Limited doctor
control
Full doctor control
Price
Price
Bands, brackets
extra charged
price
No charge for bands,
extra brackets
price
Bonding aids
Prevent hook blockage
6 jigs
Accurate easy
rebonding
CAD CAM individualized
Self Ligating Systems
Incognito – 3M Germany
Harmony - AO
eBrace SL - Riton
The Self Ligating Bracket
-May 2013
-Manipulation
-Upper wing for easy elastics ligation
-2nd “slot”
Advantages of the self ligating systems
1. Less friction / better siding / faster treatment
2. less finishing needs due to better wire engagement
3. Easier & faster wire engagement
4. less chair-time
Disadvantages of the self ligating systems
1. Manipulation – on finishing
2. The stability & resistance of the existing systems
3. Patient comfort –higher profile
The Orthodontic Lingual treatment
Case Selection
Lingual Orthodontics is
relatively easy in the following cases:
Non-extraction cases – good facial pattern
• Deep bite, Class I cases with mild crowding
• Deep bite, Class I with spacing or diastema
• Deep bite, mild Class II
• Class II division 2 with retruded mandible
Extraction cases
• Class II, maxillary first, mandibular second bicuspid extraction
• Class II, maxillary first bicuspid extraction
• Mild bi-maxillary protrusion with four first bicuspid extraction
• Class III tendency with deep bite
relatively difficult in the following cases:
• Surgical cases
• Open bite cases, dolico-cephalics
• Periodontal involvement with reduced bone level
• Class III high angle case
• Class II high angle cases
• Severe Class II discrepancies
• Cases with multiple restorative work
• Short, abraded & irregular lingual tooth surfaces
• Poor oral hygiene
• Mutilated
should be avoided in the following cases
• Acute TMJ dysfunction
• Unresolved periodontal problems
• Inadaptable personality type
Patient Evaluation & preparation:
• Proper expectation understanding – esthetical & facial
• Explanation of the specific nature of the lingual appliance
• Identification of the specific gingival, tooth form, size & color
problems
• Aesthetic evaluation
• Periodontal and Prosthetic evaluation
• Personality
Sarver 12/2004 AJODO
J.Morley JADA 01.2001
Diagnosis considerations:
● General, with particular reference to esthetics
● Periodontal and gingival
● Dental, with particular reference to the presence of crowns
and large restorations
● Dento-alveolar discrepancy
● 3D analysis dental / skeletal problems: Vertical, AP, transverse
● Surgical cases
● Pre-prosthetic cases
1. Records
2. Diagnosis
• Skeletal and growth pattern
• Dental analysis
• Space analysis
• Aesthetic evaluation
• Periodontal and Prosthetic evaluation
• TMJ evaluation
• Personality
3. Case preparation
- Periodontal initial preparation
- Restorations and prosthesis:
• Old amalgam restorations can be replaced with composite
restorations.
• Bridges can be separated to units, or used as one unit if not
separated.
• Root treated teeth should be prepared with posts and
temporary crowns, permanent cement.
• When transferring from expansive appliance to lingual, a
retainer is needed to avoid inaccuracy of the model
• Lingual tooth surfaces changes should be reformed when
deep fosse or pronounced bulges are present.
- Impression taking
• use silicone (poly vinyl siloxane) accurate material.
• Accuracy is important (2 step).
Laboratory procedure
The laboratory procedure allows individual adaptation of
the brackets to each tooth.
Laboratory instructions
1. consider treatment plan
2. consider side effects
Teeth
Consider changes
M
41
42
0.2
43
0.2
D
Teeth
M
D
0.1
32
0.2
33
0.2
0.2
35
0.2
0.2
0.2
Consider changes
Consider changes
Additional brackets
accessories
Active treatment
• Chair side Indirect bonding
• Banding
• Extraction (timing is important)
• Treatment Mechanics:
Leveling, aligning, rotational control and bite opening
Torque control
Consolidation and Retraction (En masse retraction)
Detailing and finishing
Retention
Follow-up documentation: photos, models, x-rays
Lingual Orthodontics (Li) and Labial Orthodontics (La)
biomechanical differences
Bite plane effect
- Anterior bite plate
- Anterior teeth intrusion (!!!) – more bodily & less
proclination
- Posterior teeth extrusion
can be avoided.
- More intrusive effect on the lower incisors - age
changes.
IBD (inter-bracket distance)
The IBD is 40% smaller then buccal
Increase wire stiffness
- X 3 times for 1st & 2nd order bends &
- X1.5 times for the 3rd order bends
Heavier forces in LO, more difficult to control rotations
angulations & torque since activation range is reduced.
Higher friction
Reduce wire stiffness
- Use of small diameter Nickel Titanium / heat activated wires
- increasing the inter-bracket wire and arch perimeter:
- small size brackets
- ½ bracket, small attachment,
- do not legate all brackets
- use of individual bracket systems
- chose the best system according to the case needs
(2D / full prescription)
Friction
Multifactorial
Bracket type & material, wire material & size, wire stiffness, play,
archwire-bracket combination moment (binding), OH…
Since the IBD is smaller, the wire stiffness in higher more friction &
binding is incresed.
Ligating mode: double over tie
The point of force application & line of force relative to the center
of resistance (CoR)
Vertical
Buccal – intrusive force will procline the teeth
Lingual - more complicated.
The effect cannot be accurately anticipated, since it depends
on bracket position and initial tooth inclination.
Up to a certain transitional degree of initial tooth inclination, intrusive
force create retroclination or labial root moment, from this point on
the moment will roll over and the tooth proclines
The transitional point in which the pure intrusion occurs without
proclination or retroclination moments was defined in a theoretical
model as 200 (Geron et al 2004) - ???
Horizontal force
labial and lingual - develop moments that tends to move the crown in
the direction of force, and the root in the opposite direction.
For retraction - moment tends to retrocline the incisors
The size of the moment (retroclination) depends on the distance
between the PF and CR (Moment = Force x Distance).
d
F
When the teeth are proclined, the moments developed using lingual
for retraction/ protraction forces are higher compared to buccal due
to the larger moment arm, the incisors tends to retrocline/ procline
more in lingual and it is more difficult to control the incisors torque
during retraction. The more the tooth is proclined the higher the
difference between moments created by lingual and buccal.
Torque control: increase anterior torque:
Use of high torque brackets / Laboratory
G7
LBJ
Add torque in wire
Molar Intrusion
canting of Occlusal
Lingual Root Torque
Anterior
Extrusion
The tongue spurs effect.
Disadvantage of the lingual appliance – patient discomfort
Advantage - Open bites, tongue habits
- tongue education – more posterior position.
Anchorage
“Resistance to force to avoid movement / un desired movement”
maximal
“Gianelli” & “ Burstone”• Maximal
• Moderate (50:50)
• Minimal
moderate
minimal
Anchorage Considerations
Which tooth to extract? 1st / 2nd premolar?
Esthetic consideration – adults, solutions
Disarticulation
En Masse retraction
Takemoto
value of molar anchorage in Lingual approach is higher…
-Line of the retraction force closer to the CoR
-Buccal root torque & disto-palatal rotation, cortical anchorage
Buccal - sliding mechanics showed significantly more anchorage loss
then in lingual.
No difference in anchorage loss was found between first or
second premolar extractions in cases treated with the lingual
technique.
Takemoto K: Anchorage control in lingual orthodontics,in Romano R (ed): Lingual Orthodontics. Hamilton, Canada, BC Decker, 1998, pp
75-82
Takemoto K: Lingual orthodontic extraction therapy.Clin Impressions 4(3):2-7, 1995
Anchorage Control in Lingual Orthodontics
1.
2.
3.
4.
5.
6.
Molar tip back
Bi-dimentional mechanics – wire / slot – friction reduction
Posterior bite blocks
Light forces
Use of inter-maxillary elastics
Add 2nd molar
TAD
TAD
Treatment steps
Leveling & alignment
- Small diameter wires
- Full engagement of the wires in the slot
1. Regular elastic tie
2. Double over tie
3. Still ligature Double over tie
4. Power tie
5. Power chain
Space considerations - Non Extraction Cases
1.
2.
3.
4.
IPR
Advancement – loops – chair side / laboratory
Crimpable stops
Distalization.
Maxillary arch expansion.
Faster due to the disarticulation
Less buccal tipping
- Cetrifugical effect like QH & RPE / RME
- tongue
- Point of force application is closed to the center of resistance
Rotations
Retraction
Torque control during retraction:
- Use of horizontal slot
- Rectangular wires on retraction / bi dimensional wires
- Prescribing over-torque in the bracket
- Reducing the retraction force.
Side effects
Bowing effect
Deformation of the arch the vertical & horizontal dimensions:
- Lateral open bite at premolar area
- Extrusion of molars & incisors
- buccal tipping of the lateral teeth.
How to avoid (or treat) vertical and transverse bowing effect?
1. Use Stiffer wires (.016x.022 S.S)
2. Add 2nd molars
3. Compensating horizontal and vertical wire bending
4. Apply short-span forces (3 unit systems)
5. Do not connect chains to terminal molar
5. Add torque/ tip/ angulation (positioning / laboratory / wires)
6. Tube & bracket positioning
7. Add anchorage:
palatal bars, Nance…
8. Loop mechanics
Special clinical situations
CL II increased over jet.
- CL II aggravation due to bite opening
- Sever proclination might increase.
- After initial re3traction a upper incisor blockage by lower incisors –
anchorage lost
- Accentuated in cases with bone lost – apical CoR –
increased “d”
Use of posterior bite opening.
Force vector labial to CoR
Special clinical situations
Deep Over bite
The anterior bite opening & molar extrusion are beneficial
- Deep bite + sever retroclination
Aggravation of retroclination- force/CoR
Bite opening & proclination first
Special clinical situations
Deep bite + large over-jet
- No bite opening effect.
- Retraction blockage
- Anchorage lost
Molar bite blocks are advised with the use of Cl II elastics for
Mandibular advancement.
Special clinical situations
Open bite
Correction of AOB
- Molar intrusion and / or incisor extrusion and retroclination
- Molar intrusion – TAD, bite blocks…
- Myofunctional adaptation (?)
CL III cases
necessary to create four points of occlusal contact:
Anterior unlocking
Finishing
• Most challenging and difficult stage of treatment.
• In certain cases - more time and effort than to correct the
major malocclusion.
• Longer & more difficult then buccal Orthodontics
• Better clinical judgment then buccal
Difficulty due to:
• Need of specific individual considerations.
• Anatomy of the lingual surfaces.
• Lingual mechanics.
Need of specific individual considerations.
Adults:
Dental conditions
- restorations,
- missing teeth
- abrasions
Periodontal conditions
- gingival heights
System limitations
- bracket positioning & O-G height
- bracket repositioning
- rebonding inaccuracy
- need of laboratory assistance - costs
( “Sure-smile” )
Lingual biomechanics
Requirements of 3D bends
Short lingual anatomical crown
Small IBD
Step up + step in
Step out + step down
Lingual biomechanics
Difficult movements:
• Up-righting
• Torque
• Rotations
Late bracket prescription expression
Need for full wire engagement
Specific ligation modes
Adopt the MBT recommendation for 3 months expression
Basic principals for Finishing
1. Try to avoid the side effects
- Individualized systems
- Positioning jigs
- Anticipation: step-up, photos, prescription
bracket positioning
- Light forces (bowing, tip, rotations, retroclination…)
Avoid the side effects
Extraction case
Ligature tie 6-7
Chain 6M-4
Avoid the side effects
Extraction case
Use of tubes on molars – not brackets !!
Use buccal attachments
2 . Allow full prescription expression.
Return to rectangular elastic wire (NT / CuNT)
Full engagement of the wire
In case of Extraction case – secure the arch with SS ligature wire to
avoid space opening
Bowing correction
3. Occlusion settling
•
•
•
•
Includes correction of minor midline, A-P & vertical
Using inter-maxillary elastics – in the different modes
Lower arch is stabilized – rectangular SS / TMA wire
Upper arch with full / sectional, small diameter round wire
(014)
4. Finishing bends
Chair side
On model – photos can be added.
Upper - 017X025 TMA
Lower - 016 TMA (IBD)
V-bend (tent bend)- incisor angulation
Combined with expansion
eBrace Cases
Adult . CL II skeletal & dental.
Mild retrognathic mandible.
Moderate proclination of upper incisors.
Strait retrognathic profile.
Open Naso- labial angle
6
Treatment objectives:
L & A by IPR.
Remove buccal composite excess on tooth 21 for future laminate.
No OJ change.
8 months
Treatment Objectives:
Upper only
lateral expansion, IPR 2.8 mm in total
5 months in treatment
Oct. 2012
15 months
Feb. 2013 – 18 months
Dr. Geron Silvia
4 months - 18.July 2011
7 months
9 months
Dr Zhang
Dr Lei Feifei
2011-02
2011-07
2011-08
2012-01
2011-02
2011-07
2011-08
2012-01
Dr. Wu Yuhai
• Female, 35years old
• Chief Complaint : midline deviation
• Medical History: upper left bicuspid was extracted
when orthodontic treatment was taken during
adolescence.
• Clinical Examination : skeletal class III , Class III
relationship, lower first bicuspids missing, midline
deviation, minor crowding in lower arch, upper
arch constricted
Dr. Wu Yuhai
After bonding
In progress (6 months)
12 months
8 March 2013 – 9 months after bonding
Last 2 months
[email protected] +972-54-2666440
E-Brace Lab order form
Patient (Surname) ___Adi_
(First name) ___Shukrun____
Orthodontist_____Mazor ___
Address
Contact (Tel.)
(Fax)
(Email)
Date and time of bonding
Please fully complete the treatment plan
Please mark here for laboratory wire selection
(copy / paste
Set of archwire (6)
Wires required
diameter
(please tick)
012Φ
Ex
Ex
014Φ
SE Ni-Ti
this mark to select)
Maxillary
Mandible
arch
arch


016Φ
016×022 Φ
017×025 Φ
016 Φ
Steel
IPR
016×022 Φ


018×025 Φ
016 Φ
TMA
016X022 Φ


017×025 Φ
018×025 Φ
Ex
Materials sent by the doctor
Ex
Silicone
impressions

Intra-oral &
For an ex-case please indicate space closure or not
Please fill in: Ex= to be extracted;
B=
bracket;
casted
T=tube;
ring=circle
tooth;
H=
X= missing;
leash
hook;
occlusal
surface=shade in
Bracket Series:
Pease Copy/paste those elements as required.
pad
extra-oral
By -mail
photos
plaster
model
X-ray
By e-mail
picture
Remarks:
-
Only upper arch
-
15,25,35,45 extraction
-
Upper expansion – PLS prepare expanded
arches
-
15,25- esthetic composite pontics
-
Please setup the lower model.
It is recommended to print, fill in and attached this lab form to the impressions.
9 months
(2 months in Thailand…)
1 month
Half bracket
3 month
5 month
Time for the new bracket on 22
3 months