Orthotown May 2020 - 38
Fig. 2a
Fig. 2b
tapered clinical crowns of her lateral
incisors with some mild excess
tissue interproximally (Figs. 2a and
2b). Her smile arc, however, was
consonant and her upper incisors
followed her lower lip well.
Because she exhibited 2-3mm
of gingival maxillary tissues, I
suggested laser gingival recontouring. We frequently use the
Gemini diode laser in our office
for simple soft-tissue exposures,
operculectomies and gingival
recontouring.
Treatment
Fig. 3
Fig. 4
38
After our data gathering
and treatment presentation, I
initiated treatment by bonding
upper and lower 7-7 with 0.022
Ormco Symetri Clear brackets
MBT prescription (Fig. 3). The
brackets are much smaller and
less bulky than other clear twin
brackets and are very low-profile and tend
to interfere less with the opposing dentition.
The low profile doesn't hinder the ability
to double-tie as needed (e.g., elastic thread
and powerchain, or powerchain and single
tie, etc.). The Symetri brackets are strong
and durable.
This patient had mild to moderate
rotations of her LR3 and UR2. This tends
to be somewhat difficult to fully tie in a
light wire with a steel tie, because most fear
fracturing a tie-wing or debonding the entire
clear bracket. (In my experience, Symetri
seems to be as strong as our metal twin
brackets, and we did not have any fracture
or debonding issues in this case or any of
our other cases.)
My wire sequence and treatment:
1. 0.014 CuNiTi U/L, early Class II
"shorty" elastics (5/16 inch, 2 oz.).
2. 16x16 CuNiTi U/L, transition to
Class II elastics (5/16 inch, 3 oz.).
3. 18x25 CuNiTi U/L, followed by a
pan/repo appointment, switched to
delta elastics (3/16 inch, 3.5 oz.).
4. 19x25 TMA U/L, followed by
aesthetic finishing bends as needed,
while wearing the same deltas.
After 10 months of active treatment,
her appliances were removed (Fig. 4).
When removed, Symetri brackets debond
in one piece and don't fracture. Speaking
to several colleagues, bracket fracture is
the main reason that most prefer aligner
therapy over clear brackets. If, however, the
brackets can be removed just as easily as a
metal twin bracket, there's no other reason
to sidestep clear brackets.
In my offices, we normally provide a
lower fi xed bonded retainer to the lower
canines only. In this case, the family
declined a fi xed retainer; upper and lower
vacuum-formed retainers were provided
instead.
I prefer to wait at least four to six weeks
after braces removal to assess the tissues
MAY 2020 // orthotown.com
OT520_GireBrackets_AG.indd 38
4/27/20 10:57 AM
http://www.orthotown.com
Orthotown May 2020
Table of Contents for the Digital Edition of Orthotown May 2020
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