MBT Prescription Research Articles

Comparative evaluation of anchorage reinforcement between orthodontic implants and conventional anchorage in orthodontic management of bimaxillary dentoalveolar protrusion

BackgroundIncreased upper lip procumbency is commonly associated with maxillary dentoalveolar protrusion with the major goal of reducing maxillary dentoalveolar protrusion. The treatment plan usually includes extraction of the maxillary first premolars, followed by retraction of anterior teeth with maximum anchorage. Dental implants have been widely accepted as successful adjuncts for obtaining maximum anchorage in orthodontic treatment. Methods50 subjects between the ages of 13 and 17 years having bimaxillary dentoalveolar protrusion were included in the study. The patients were divided into two groups. Both groups received treatment with 0.022″ MBT prescription preadjusted edgewise appliance system. In addition, subjects of Group ‘I’ received the Nance button and lingual arch as anchorage reinforcement in the upper and lower arches, respectively. Subjects of Group ‘II’ received self-drilling titanium OI for anchorage reinforcement. ResultsSignificant retraction was achieved in all cases with good vertical control. Anchor loss was observed in both groups. Anchor loss was much higher in Group I compared to Group II, and an intergroup comparison for anchor loss was highly significant. ConclusionImplants as anchorage, for en masse retraction, can be incorporated into orthodontic practice. The use of orthodontic implants for anchorage is a viable alternative to conventional molar anchorage.

Assessment of dimensional accuracy of preadjusted metal injection molding orthodontic brackets.

the aim of this study is to evaluate the dimensional accuracy of McLaughlin, Bennett, and Trevisi (MBT) brackets manufactured by two different companies (American Orthodontics and Ortho Organizers) and determine variations in incorporation of values in relation to tip and torque in these products. In the present analytical/descriptive study, 64 maxillary right central brackets manufactured by two companies (American Orthodontics and Ortho Organizers) were selected randomly and evaluated for the accuracy of the values in relation to torque and angulation presented by the manufacturers. They were placed in a video measuring machine using special revolvers under them and were positioned in a manner so that the light beams would be directed on the floor of the slot without the slot walls being seen. Then, the software program of the same machine was used to determine the values of each bracket type. The means of measurements were determined for each sample and were analyzed with independent t-test and one-sample t-test. Based on the confidence interval, it can be concluded that at 95% probability, the means of tip angles of maxillary right central brackets of these two brands were 4.1-4.3° and the torque angles were 16.39-16.72°. The tips in these samples were at a range of 3.33-4.98°, and the torque was at a range of 15.22-18.48°. In the present study, there were no significant differences in the angulation incorporated into the brackets from the two companies; however, they were significantly different from the tiP values for the MBT prescription. In relation to torque, there was a significant difference between the American Orthodontic brackets exhibited significant differences with the reported 17°, too.

Improvised tie backs for the preadjusted appliance

The paper describes modified tiebacks for space closure with the MBT prescription preadjusted appliance. This modification solves the problems associated with the original design.

Comparison of frictional resistance between various bracket types and archwire materials ligated with low-friction and conventional elastic ligatures

Background: Friction plays a very crucial role in our daily life and orthodontics is no exception. Various materials possess friction of varying intensity, which ultimately affects tooth movement. Aim: The aim was to compare the frictional resistance (FR) between various bracket types and archwire materials when ligated with low-friction and conventional elastic ligatures so as to obtain best bracket-archwire combination possessing least FR for clinicians in achieving optimal mechanotherapy. Materials and Methods: Study consisted of three types of preadjusted edgewise brackets including ceramic, stainless steel (SS) and self-ligating brackets (0.022 slot, MBT prescription), two types of archwire materials, 0.019 × 0.025 SS and 0.019 × 0.025 Teflon coated (TC) and two types of ligatures including low-friction and conventional elastic ligature. A total of 10 combinations were formed with the above mentioned material. Each combination was tested 10 times on universal testing machine for FR. The data was statistically analyzed using one-way ANOVA and unpaired t-tests. Results: Self-ligating brackets exhibited least FR (2.35 ± 0.15N) followed by metal brackets. Ceramic brackets showed the highest FR (7.32 ± 0.10N). In general, the mean value for TC wire was less than that of SS wire indicating low FR possessed by TC wires. Results also showed that low-friction ligatures produce lower-friction when compared with conventional elastic module (P > 0.05). Conclusion: The study demonstrated that self-ligating brackets with TC wire showed the least FR and ceramic brackets with SS wire when ligated with conventional elastic ligature showed the highest FR.

Treatment of Class II Maxillary Retrusion Case Using Miniscrew (Nonextraction Treatment of Adolescent Patient)

ABSTRACT Objective: This case report describes the protocol employed in the treatment of a patient with Class II subdivision malocclusion, with sagittal, transverse, and occlusal disharmonies. Materials and Methods: Treatment included the expansion of the maxilla with a banded Hyrax appliance over a period of 14 days. After a retention period, the device was removed and a stainless steel transpalatal arch was attached. The maxillary arch was bonded with MBT prescription brackets, and distalization of the left maxillary first molar commenced on a 0.016 × 0.022-inch stainless steel archwire supported by a miniscrew for indirect anchorage. After 4.7 mm of molar distalization, a Nance appliance with a bite plane was placed, and the mandibular arch was bonded to continue treatment, which lasted 18 months. Mandibular and maxillary fixed retainers were placed at the end of active treatment. Results: Pretreatment and posttreatment records showed that vertical and sagittal skeletal cephalometric findings were stab...

Evaluation of efficacy of the MBT appliance in expressing inbuilt tip and torque values: Using torque angulation device

Objectives: Several studies on faciolingual inclination have been published and a few statistical investigations have been performed with regard to the preadjusted edgewise appliances, but there is lack of studies which have evaluated the inbuilt characteristics of the MBT preadjusted appliance. This retrospective study was conducted to evaluate the efficacy of the MBT appliance system in terms of expressing its inbuilt characteristics of tip and torque values. Materials and Methods: The study sample consisted of 30 subjects who received full fixed appliance treatment involving four 1 st premolar extractions using the MBT appliance. Pretreatment and posttreatment study models of these subjects were measured for the tip and torque using Torque Angulation Device. Treatment changes were analyzed statistically and the posttreatment measurements were compared with the MBT prescription values. Results: The posttreatment angulation and inclination values when compared with MBT prescription a mean difference of ±2.1° for the tip and ±11.9° for torque. Tip was almost fully expressed in all teeth except for the maxillary 2 nd premolar, 1 st molar, mandibular canine, 2 nd premolar, 1 st and 2 nd molar, where the discrepancy was more than 1°. Torque was under expressed in maxillary central incisor by 1.8°, 1 st molar by 1.5° and 2 nd molar by 11.9°. Torque was over expressed in maxillary lateral incisor by 2.1°, canine by 2.4° and mandibular central and lateral incisor by 4.9° and 4.6°, canine by 4.8°. Torque was sufficiently expressed in maxillary 2 nd premolar, 1 st and 2 nd molar and mandibular 2 nd premolar, with a discrepancy between 0.5°. Conclusion: Tip was almost fully expressed in all teeth except for the maxillary-2 nd premolar, 1 st molar, mandibular- canine, 2 nd premolar, first and 2 nd molar, where the discrepancy was only around 1°. Torque was sufficiently expressed in maxillary-2 nd premolar, 1 st and 2 nd molar and mandibular- 2 nd premolar, where the discrepancy was between 0° and 0.5°. Torque was under expressed in maxillary-central incisor, 1 st molar and 2 nd molar. Torque was over expressed in maxillary- lateral incisor, canine and mandibular-central, lateral incisor and canine. Deviation around the mean measurements was found for all the parameters in all teeth. Keeping in account of individual bracket positioning errors it would be fair to anticipate that MBT appliance would result in reasonably optimal tooth positioning at the end of the treatment without any manual archwire adjustments. Tip was comparatively better expressed when compared to torque.

Residents' journal review

Residents' journal review

The Effect of Various Ligation Methods on Friction in Sliding Mechanics

Aim: To evaluate the effect of ligation method on friction and the efficacy of the new slick elastomeric modules (TP Orthodontics, USA) and slide elastomeric modules (Leone Orthodontics, Italy) which claim to reduce friction at the module/wire interface. Materials and methods: Slick and slide modules were compared with regular modules, modules tied in figure of eight fashion, tight stainless steel ligatures, and loose stainless steel ligatures. Brackets used for the study were 0.022 × 0.028 maxillary first premolar twin brackets (MBT Prescription, Gemini series, 3M Unitek USA.) The effect of bracket width on friction produced with four different methods of ligation was also studied using 0.022 × 0.028 maxillary first premolar single width brackets (Alexander prescription, Leone Co. Italy). Results: When considering tooth movement along a 0.019 × 0.025 in stainless steel archwire, Super slick module produce less friction when compared to regular module, module tied in ‘figure of 8’ pattern and tight SS ligation produced more friction when compared to loose SS ligation and slide module. Slide modules produce least friction when compared to other available methods of ligation. Modules tied in a ‘figure of 8’ pattern generate highest friction. Conclusion: Slide modules produce least friction followed by loose SS ligation, slick modules, regular modules, tight SS ligation and highest friction was produced by regular modules tied in a ‘figure of 8’ pattern. Width of bracket had no influence on friction produced.

Assessment of clinical outcomes of Roth and MBT bracket prescription using the American Board of Orthodontics Objective Grading System

Background:There is always a need to assess whether small changes in bracket prescription can lead to visually detectable differences in tooth positions. However, with little clinical evidence to show advantages of any of the popularly used bracket systems, orthodontists are forced to make clinical decisions with little scientific guidance.Aim:To compare the orthodontic cases finished with Roth and MBT prescription using American Board of Orthodontics-Objective Grading System (ABO-OGS).Settings and Design:Department of Orthodontics, Post-graduate dental college, retrospective cross-sectional study.Materials and Methods:Forty patients selected were divided into two groups of 20 patients each finished with straight wire appliance using Roth and MBT prescription, respectively. The examiner ability was assessed and calibrated by one of the ABO certified clinician to grade cases using the OGS.Statistical Analysis:Unpaired student t-test was used and P < 0.05 was accepted as significant.Results and Conclusions:MBT bracket group had a lower score of 2.60 points in buccolingual inclination and lower score of 1.10 points in occlusal contact category that was statistically significant when compared with Roth group. The difference in total ABO-OGS score was 2.65 points showing that the outcome for the MBT prescription was better than that of the Roth prescription, which is statistically significant, but with little or no clinical significance. It can be concluded that use of either one of the Roth and MBT bracket prescriptions have no impact to the overall clinical outcome and quality of treatment entirely depends on clinician judgment and experience.

Anterior maxillary intrusion and retraction with corticotomy-facilitated orthodontic treatment and burstone three piece intrusive arch.

An adult patient with proclination and spacing was performed orthodontic treatment combined with corticotomy and the burstone three piece intrusive arch who desired a shortened treatment period. The patient had Angle's Class I malocclusion with flaring of the maxillary and mandibular incisors. Pre adjusted edgewise appliance (MBT prescription) was fixed to the maxillary and mandibular teeth. Then corticotomy was performed on the cortical bone of the buccal sides in the maxillary anterior regions. Intrusion and retraction initiated immediately after the corticotomy. The intrusive arch was adjusted once in every 2 weeks. The total treatment time for intrusion was 5 months. Cephalometric superimpositions showed no anchorage loss, and panoramic radiographs showed neither significant reduction in the crestal bone height nor marked apical root resorption. A corticotomy-facilitated orthodontic treatment shortened treatment period without any anchorage loss or adverse effects.

Is nickel titanium superior to multistranded stainless steel wire in aligning crowded lower anteriors? A comparative in-vivo study.

Introduction: One of the most perplexing phenomenons in orthodontics is the crowding of anterior teeth, which brings the patient to the orthodontist seeking remedy because of its aesthetic and functional consequences. The present study was aimed to clinically evaluate and compare the efficiency of NiTi and multistranded stainless steel wire during initial levelling and aligning of crowded lower anteriors. Material and methods: 30 subjects aged between 14 -20 were chosen for the study and divided in to two groups. All the subjects were fully explained about nature, purpose and treatment. Both groups were bonded with 0.022” MBT prescription brackets. After bonding, for Group A patients 0.016” NiTi arch wire was placed and secured with elastomeric modules, similarly for Group B patients 0.0155”multistranded (SS) wire was placed and secured .Time period needed for decrowding of each group was calculated. Result: Average number of days taken by nickel titanium wire in de-crowding mandibular anteriors is 89.67 days while multistranded SS wire took 113.2 days to de-crowd. Even though multistranded wire has low stiffness, because of its shape memory and super elasticity, nickel titanium wire is clinically efficient in decrowding severely crowded lower anteriors. To conclude, a marginal advantage of NiTi wire exists in accordance to the time period taken to decrowd mandibular anteriors.

Orthodontic uprighting of severely impacted mandibular second molars

The prevalence of impacted second molars is low, varying from 0% to 2.3%. The etiology of an impaction can involve systemic, local, and periodontal factors, as well as a developmental disruption of the tooth germ. A number of surgical and orthodontic treatment options have been suggested in the literature, including leaving the tooth in situ, removing the impacted second molar, orthodontic uprighting, and autotransplantation. Removal of third molars has been suggested as an adjunct for space creation. This article presents the treatment of a girl with bilateral severely impacted mandibular second molars as well as an ectopic maxillary left canine and severe crowding affecting both the maxillary and mandibular arches. Her treatment was successfully completed with fixed preadjusted edgewise appliances (0.022 × 0.028-in slot size) and MBT prescription (APC precoated Gemini Brackets; 3M Unitek, St. Paul, Minn), along with the removal of 4 first premolars. The maxillary left canine and the mandibular second molars were surgically exposed. The treatment mechanics show that even severely impacted second molars can be uprighted by routine straight-wire techniques, which are easy to apply. The center of rotation of the second molar lies in the bifurcation of the roots of this tooth, and this biomechanical property was used to its full advantage. The techniques applied comprised bracket repositioning, bypass of brackets, conversion of molar tubes to brackets, thermoelastic copper-nickel-titanium archwires, and a push-coil spring. Other orthodontic treatment mechanics, which require complex sectional or segmental techniques, auxiliaries, or artistic wire bending, that have been suggested in the literature were not used here. The third molars were not removed.

Three-dimensional quantification of pretorqued nickel-titanium wires in edgewise and prescription brackets

To quantify the three-dimensional moments and forces produced by pretorqued nickel-titanium (NiTi) rectangular archwires fully engaged in 0.018- and 0.022-inch slots of central incisor and molar edgewise and prescription brackets. Ten identical acrylic dental models with retroclined maxillary incisors were fabricated for bonding with various bracket-wire combinations. Edgewise, Roth, and MBT brackets with 0.018- and 0.022-inch slots were bonded in a simulated 2 × 4 clinical scenario. The left central incisor and molar were sectioned and attached to load cells. Correspondingly sized straight and pretorqued NiTi archwires were ligated to the brackets using 0.010-inch ligatures. Each load cell simultaneously measured three force (Fx, Fy, Fz) and three moment (Mx, My, Mz) components. The faciolingual, mesiodistal, and inciso-occluso/apical axes of the teeth corresponded to the x, y, and z axes of the load cells, respectively. Each wire was removed and retested seven times. Three-way analysis of variance (ANOVA) examined the effects of wire type, wire size, and bracket type on the measured orthodontic load systems. Interactions among the three effects were examined and pair-wise comparisons between significant combinations were performed. The force and moment components on each tooth were quantified according to their local coordinate axes. The three-way ANOVA interaction terms were significant for all force and moment measurements (P < .05), except for Fy (P > .05). The pretorqued wire generates a significantly larger incisor facial crown torquing moment in the MBT prescription compared to Roth, edgewise, and the straight NiTi wire.

Comparison of sagittal and vertical dental changes during first phase of orthodontic treatment with MBT vs ROTH prescription

The present study was to evaluate and compare anchorage loss in sagittal, vertical dimension in incisal, molar segments and distal tipping of upper canine after first phase of orthodontic mechanotherapy utilizing MBT and ROTH philosophies. Thirty patients with class I dentoalveolar malocclusion requiring extraction of all first premolars were randomly assigned into group I and group II. Set of two lateral cephalograms (T1) and (T2) were obtained with appliance in place and after sufficient leveling and aligning respectively. Linear measurements were recorded on the tracings using Pancherz analysis. A Wilcoxon t-test was use to assess the linear changes. In group I sample, upper and lower incisors retroclined during T1 - T2; by mean (SD) value of 2.267 (1.0032) mm, 2.4 (0.98) mm, respectively. Group II sample showed upper incisor proclination by -0.4 (1.404) and lower incisal retroclination by 0.06 (1.48). Upper and lower molars in group I remained stationary and group II upper and lower molars moved mesially by -1.133 (0.351) and -0.002 (0.005). In group I, upper and lower incisors extruded by -0.867 (0.611) and -0.67 (0.703), respectively, and group II the upper and lower incisors extruded by -0.9 (0.507) and -0.133 (0.639). Upper canine tipped distally during T1 - T2 in group I by -0.33° (2.609) and group II there was a change in distal tip of upper canine by -3° (3.184). Results from this random clinical trial showed that MBT technique effectively addressed perceived inadequacies of ROTH philosophy.

Are torque values of preadjusted brackets precise?

ObjectiveThe aim of the present study was to verify the torque precision of metallic brackets with MBT prescription using the canine brackets as the representative sample of six commercial brands. Material and MethodsTwenty maxillary and 20 mandibular canine brackets of one of the following commercial brands were selected: 3M Unitek, Abzil, American Orthodontics, TP Orthodontics, Morelli and Ortho Organizers. The torque angle, established by reference points and lines, was measured by an operator using an optical microscope coupled to a computer. The values were compared to those established by the MBT prescription. ResultsThe results showed that for the maxillary canine brackets, only the Morelli torque (-3.33º) presented statistically significant difference from the proposed values (-7º). For the mandibular canines, American Orthodontics (-6.34º) and Ortho Organizers (-6.25º) presented statistically significant differences from the standards (-6º). Comparing the brands, Morelli presented statistically significant differences in comparison with all the other brands for maxillary canine brackets. For the mandibular canine brackets, there was no statistically significant difference between the brands. ConclusionsThere are significant variations in torque values of some of the brackets assessed, which would clinically compromise the buccolingual positioning of the tooth at the end of orthodontic treatment.

Treatment of Space Loss Caused by Submerged Mandibular Second Primary Molar

Submersion is a clinical term describing a tooth depressed below the occlusal plane. In this case report, we present treatment of a patient who had totally submerged primary maxillary second molar, which caused impaction of the second premolar and space loss in the maxillary arch due to tipping of adjacent teeth. A 19 yr old female was referred to the Department of orthodontics. Intraoral examination revealed left mandibular second primary molar was localized lingually being almost covered by gingiva and adjacent teeth inclined closing the space of the related tooth completely. Panaromic radiograph demonstrated that mandibular second premolar was impacted. Based on clinical and radiographic findings mandibular primary second molar was extracted. A pre- Adjusted Edgewise appliance (MBT prescription 022” slot) was used for creating space for the impacted second premolar. Eruption began spontaneously 6 months later.

The use of fixed appliances in the UK: a survey of specialist orthodontists

To investigate the use of fixed appliances in the UK. Prospective postal questionnaire. UK. All members of the General Dental Council Specialist List in Orthodontics still in active practice and not in training posts. A preemptive letter of explanation was sent inviting orthodontists to participate in the survey. The questionnaire was subsequently posted to 935 specialists. Data analysis investigated differences in clinical practice related to varying provider groups, level of operator experience and geographical region. The response rate achieved was 66.3%. A majority of orthodontists routinely used the 0.022 inch pre-adjusted edgewise system, standard size Siamese pattern stainless steel brackets, conventionally ligated and bonded using standard etch and light cured composite. Nickel titanium and stainless steel were the most popular archwire materials. Anchorage was supported routinely by palatal and lingual arches in up to 25% and by headgear in over a third of respondents. Newer innovations showed variable popularity. Self-etching primer was used routinely by one-third of respondents with 11% use of self-ligating brackets. Banding of first molars was preferred by over 60% of clinicians. Bone screw implants were used by only 0.2% of respondents. Clinicians with less than 10 years experience used more headgear, light curing, MBT prescription and molar bonding. Operators with over 20 years experience used more chemically cured bonding, Roth prescription, banded first molars, 0.018 inch slot size and Tip-Edge(TM), with less use of headgear. Fixed appliance use differed from that reported in the US with lower use in the UK of standard edgewise and Roth systems, aesthetic, miniaturised and 0.018 inch slot brackets and rapid maxillary expansion. Most UK orthodontic specialists routinely used the 0.022 inch pre-adjusted edgewise system with standard size Siamese steel brackets bonded using standard etch and light cured composite with conventional ligation. Variations were seen between different provider groups, types of treatment funding, levels of operator seniority and geographical regions. Differences were noted particularly in the use of bracket prescription and design, types of molar attachment and anchorage control.

SmartClip versus conventional twin brackets for initial alignment: is there a difference?

Abstract Objective: To compare the effectiveness of SmartClip brackets and conventional twin brackets for initial alignment of the lower arch. Methods: Fifty-eight patients participated in this prospective trial. The patients were assigned alternately to either a group treated with SmartClip MBT prescription brackets or a group treated with conventional MBT twin brackets. Lower anterior irregularity was measured at the start of treatment, 10 weeks later at the first archwire change and 20 weeks after the start of treatment at the second archwire change. Results: There was no difference in irregularity at the start of treatment. At 10 weeks subjects treated with conventional brackets had a lower irregularity index than subjects treated with SmartClip brackets (Mean difference: 0.7 mm; p = 0.005). After 20 weeks there were no statistically significant differences in irregularity between the two groups (Mean difference: 0 mm; p = 0.82). Conclusion: The SmartClip bracket was no more effective at reducing irregularity during the initial stage of treatment than a conventional twin bracket ligated with elastomeric modules or stainless steel ligatures.