A new idea and method of tooth movement using a ratchet bracket

Abstract

Since ideally effective tooth movement in orthodontics should occur without causing damage to the periodontal ligament (PDL), a new bracket with a ratchet-locking system, the 'Ratchet Bracket', was designed to produce tooth movement while maintaining blood circulation. To define the mechanism of the appliance, a histological study was carried out on four Beagle dogs (9 months old) and a clinical study on five female patients (11 years to 38 years 10 months of age). Five upper canines in the dogs were moved 1.82 mm per month. On light microscopic observations, vascular forms showed a round-oval shape, without undermining bone resorption. No root resorption was observed in the compressed PDL at days 1, 14, and 35 of the experimental period. On fluorescent images at day 46, distinctive bone formation was apparent at the tension side. In the clinical investigation, nine upper canines in the five female patients were moved 1.92 mm per month. A wide and long alveolar hard line was seen only on the tension side of the canines on dental radiographs, indicating bodily tooth movement, without obvious signs of root resorption in all subjects. Neither spontaneous pain nor pain during biting were reported. The findings indicate that use of the ratchet bracket could result in rapid and pain-free tooth movement with vascular clarity to maintain blood circulation in the PDL.