Lingual Bracket Placement Simulation

Rationale

Lingual bracket placement position is very important for successful SureSmile wire bending and wire insertion. Use the patient's approved SureSmile diagnostic model to simulate bracket positions at the end of conventional (alignment and derotation) treatment, just prior to insertion of the first custom SureSmile archwire. Provide this simulation or a report of the simulated bracket positions to the lab tech making your IDB trays.* The jig height and mesial-distal locations for each bracket allow the lab tech to position the brackets in such a way that bracket collisions and interferences are avoided.

*Note: Since lingual bracket placement may vary based on tooth morphology, indirect bonding is strongly recommended. If you bond brackets directly you run the risk of having to reposition brackets at mid-treatment.

Recommended Bracket Placement Strategies

Lingual bracket placement, upper arch - To prevent bracket-tooth collisions in the final position (overbite greater than 2 mm), place brackets in the upper arch as gingivally as possible, otherwise you can have a bracket/tooth collision similar to the one shown below. Maintain a minimum of 1 mm space between the gingival rim and the bracket base to allow for appropriate hygiene.

Lingual bracket placement, lower arch - The main challenge when selecting and placing brackets in the lower arch is the very small inter-bracket distance between the front teeth. An inter-bracket distance that is too small means the SureSmile robot cannot fabricate the SureSmile lingual custom wire. Therefore, it is important to bond the brackets as incisally as possible. We recommend a distance of 1 mm between the incisal edge and the upper border of the bracket base. This puts the bracket where the mesiodistal dimension of a lower front tooth is anatomically the largest (see below). Keep in mind, however, that this minimum placement height could adversely affect aesthetics. This is particularly true when teeth are extremely protruded. Bracket placement should always consider the clinical crown height and the contour of each tooth.