CENTENNIAL SPECIAL ARTICLE

Evolution of treatment mechanics and

contemporary appliance design in orthodontics:
A 40-year perspective
Richard P. McLaughlina and John C. Bennettb
San Diego, Calif, and London, United Kingdom

Until the early 1970s, successful treatment with the Begg technique and the Tweed edgewise technique required
tedious wire bending. The introduction of Andrews' straight wire appliance changed that, and it was one of the
most significant contributions in the history of orthodontics. The straight wire appliance significantly reduced the
amount of wire bending and also brought along other options in treatment mechanics. Retraction of the canines
with elastic chains and ligature wires became more common. Sliding mechanics in place of closing loops
became the method of space closure for a significant number of clinicians. Edgewise force levels were initially
used to close spaces; however, it was soon observed that lighter forces were more effective with sliding me-
chanics. Along with these changes, it became apparent that compensation in the appliance was needed, de-
pending on the type of malocclusion and particularly with varying extraction sequences. Various appliance
designs were developed to accommodate changes in mechanics and force levels. These modifications
improved tooth positions at the end of treatment as long as the brackets were properly placed. These major
changes in appliances, force levels, and treatment mechanics can be traced back to the work of Dr Lawrence
Andrews and the straight wire appliances. (Am J Orthod Dentofacial Orthop 2015;147:654-62)

T
his article presents a 40-year overview of our expe- have been developed, and experience with these has led
rience with treatment mechanics and contempo- to many different appliance designs. This has been the
rary appliance designs. Fortunately, due to the pattern throughout the history of orthodontics. Clini-
periodontal ligament and bone biology, teeth move in cians have established their ideas on treatment me-
every direction. Some of these movements are positive chanics and then have developed or used appliances to
and beneficial for the patient, and some are not. There- complement their mechanics. With these observations
fore, there have been many ideas on how and how not to in mind, it is important to clarify that this article is not
move teeth. Countless methods of treatment mechanics intended to provide criticism of what others have done
with orthodontic appliances, because mechanics have
a
Richard P. McLaughlin is a graduate of the University of Southern California, led to many of their decisions. Instead, it discusses the
Dept. of Orthodontics, and is in private practice in San Diego, California. He is path we chose and how mechanics have driven our appli-
currently President of the Edward H. Angle Society and is the founder of The
McLaughlin Program, a private 2-year postgraduate orthodontic course.
ance modifications.
b
John Bennett is a graduate of the UCL Eastman Dental Institute in London,
England. He was in private practice for many years in London. After a period
of teaching at European University College in Dubai, he has returned to the
PRECURSORS TO THE PREADJUSTED APPLIANCE
UK to resume clinical work. He has authored or co-authored 7 orthodontic text- Before the 1970s, 2 major treatment systems were
books.
Address correspondence to: Richard P. McLaughlin, 2445 Truxtun Road, Suite used in orthodontics: the Begg light-wire technique
104, San Diego, CA 92106; e-mail, [email protected]. with the Begg appliance, and the Tweed technique
Submitted, revised and accepted, March 2015. with the edgewise appliance. These treatment systems
0889-5406/$36.00
Copyright Ó 2015 by the American Association of Orthodontists. were developed in response to an orthodontic philoso-
http://dx.doi.org/10.1016/j.ajodo.2015.03.012 phy of nonextraction treatment in nearly all orthodontic
654
McLaughlin and Bennett 655

patients, as recommended by Edward H. Angle.1 Both P. first- and second-order bends, torque bends (third-order
Raymond Begg2 and Charles Tweed3 proposed that it bends) were placed in the incisor, premolar, and molar
was appropriate to extract teeth when crowding or pro- areas to correct the patient's torque needs. Closing
trusion was present to an extent that nonextraction loop arches with omega loop tie-backs were used to
treatment would lead to instability and potential peri- close spaces. Although the 0.022-in slot was the most
odontal breakdown. They demonstrated numerous popular size during most of the edgewise era, 0.018-in
extraction cases to support their position. Begg recom- slots were later introduced, with the assumption that a
mended a 3-stage approach to treatment using round smaller slot and lighter wires would create lighter forces.
wires. Multiple-loop 0.016-in round wires and light Since forces are also based on wire deflection, this
force levels were used in stage 1 for early alignment. In assumption was questioned by those who used the
stage 2, teeth were tipped into the extraction sites, and 0.022-in slot. It was a significant challenge for Tweed
spaces were closed. Finally, heavier round wires and to achieve his goals with the edgewise brackets and
auxiliaries were used in stage 3 to upright the teeth labor-intensive mechanics. He met this challenge, and
and correct the root positions. Orthodontists needed skill his treatment method significantly influenced the devel-
and experience to achieve good results, and the treat- opment of preadjusted appliances in the future.
ment method was labor intensive.2
Tweed was concerned with the stability of his pa-
tients. The greatest area of concern was the mandibular ANDREWS' STRAIGHT-WIRE APPLIANCE
anterior segment, where bone is the thinnest and multi- It was against this edgewise backdrop that Lawrence
ple forces from all directions are brought to bear on F. Andrews developed the first “fully programmed pre-
these teeth. He proposed that the most stable position adjusted” appliance.4,5 Andrews, an excellent edgewise
for the mandibular incisors was when they were posi- orthodontist, thoroughly understood the nuances of
tioned at 90 to the mandibular plane. Tweed believed edgewise treatment. He began his journey to develop
that the most efficient and effective way to move teeth the appliance by collecting 120 nonorthodontic
was in a bodily manner, especially in extraction patients, normal models. These were models of patients whom
where the potential to tip teeth into the extraction sites Andrews assessed as having ideal occlusions, and who
was the greatest. He further believed that the most effi- had never had orthodontic treatment. He studied these
cient force level and wire shape for bodily movement was models and observed many features but found 6
in the 600-g range with rectangular wires. Edgewise features or “6 keys” that were consistent in all of the
brackets were milled (cut from larger pieces of metal). models. He published these observations in his classic
Their bases were formed at 90 angles to the tooth sur- article “The six keys to normal occlusion.”4 These keys
face, and their rectangular slots, originally at size 0.022 included molar relationship, crown tip, crown torque,
in, were cut at 90 angles. Patients progressed from rotations, lack of spaces, and plane of occlusion, and
round wires to rectangular wires, where major tooth they are an important part of the American Board of
movements were carried out. In the early round-wire Orthodontics grading system used today. He then
stages of treatment, horizontal in-and-out and rota- measured the in-and-out, tip, and torque values for
tional bends (first-order bends) were placed in the maxil- each tooth on the models. He used 3 references to mea-
lary lateral incisors and in the maxillary and mandibular sure these values: the center of the clinical crowns, the
canines and molars. To aid in bodily movement, varying long axis of the center of the clinical crowns, and the
amounts of vertical tip bends (second-order bends) were thickness of the clinical crowns from a designated
placed. “Beauty bends” were placed in the incisor areas position on the teeth to the center of the clinical crowns
for tip control and esthetics. “Gable bends” were used (Figs 1-3). This allowed him to have consistent
in the canine and premolar regions to control tipping, measurements on small and larger teeth. Once these
where extractions most frequently occurred, and tipping data were collected, norms and standard deviations
was the greatest issue. “Tip-back bends” were used in were determined. He then converted this information
the premolar and molar areas to control forward tooth into a “preadjusted” appliance with tip, torque, and in-
tipping and to aid in anchorage control (needed to and-out values built into each bracket for each tooth.
achieve maxillary and mandibular incisor positions). He called it the straight-wire appliance (SWA).5
Once elastic chains became available, they were used Andrews realized that 2 important factors were
for canine retraction in the early round-wire stages of needed to develop the SWA. First, each bracket needed
extraction cases. Omega loops mesial to the first molars a “compound contoured” base, which would fit each
were used to “tie back” the archwires to minimize ante- tooth mesiodistally and occlusogingivally while posi-
rior tooth flaring. In rectangular wires, in addition to tioned at the center of the clinical crown and centered

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656 McLaughlin and Bennett

Fig 1. Andrews defined tip (or angulation) as the angle formed by the facial axis (ie, the long axis) of the
clinical crown and a line perpendicular to the occlusal plane. This definition applied to incisors, canines,
and premolars. He used the buccal groove as a reference for the long axis of molars.

Fig 3. Andrews used the term “prominence” to describe

what is known as “in-and-out,” and he measured it from
Fig 2. The term “inclination” was used by Andrews to a line called the “embrasure line.” This was defined as
describe what is commonly known as “torque.” He “an imaginary line at the level of the crown's midtrans-
defined this as “the angle between a line perpendicular verse plane that would connect the most facial portions
to the occlusal plane and a line that is parallel and tangent of the contact areas of all crowns in an arch when they
to the long axis of the clinical crown at its midpoint.” are optimally positioned.”

on the long axis of the clinical crown. Second, if a rec-

tangular archwire was adjusted to the shape of each alignment, Andrews further realized that he needed to
model and positioned along the center of the clinical vary the angles at the bracket bases from 90 to varying
crown, each slot needed to passively accept the rec- amounts of acute and obtuse angles. This resulted in a
tangular archwire. These 2 factors were critical to the feature referred to as “torque in base,” which was
appliance design. patented by Andrews. This required other manufacturers
To achieve these 2 goals, Andrews realized that 3 that did not have the patent to place not only tip, but
points needed to be positioned on the same horizontal also torque, into the face of the brackets. In the SWA,
plane. These were the center of the clinical crown, the tip was properly placed into the face of rectangular
center of each bracket base, and the center of the bracket brackets, and the thickness of the brackets was deter-
slot (Fig 4). This would allow the in-and-out and torque mined by the in-and-out measurements on the models.
values in the appliance to correspond with the in-and- The 0.022-in slot was Andrews' choice of slot size. He
out and torque values measured on the nonorthodontic decided that the best choice in manufacturing these
normal models. To allow this 3-point horizontal brackets was to cast the brackets with stainless steel,

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McLaughlin and Bennett 657

Fig 5. Teeth tended to tip and rotate into the extraction

sites when the chains were overstretched, with associ-
ated bite deepening. This was frequently seen and
became known as the “roller coaster” effect.

Fig 4. To achieve a level slot lineup, Andrews' brackets Fig 6. Sliding mechanics were seldom possible with clos-
were designed with torque in base. This allowed the ing loops because of the posterior interferences of omega
long axis point on the tooth surface (A), the base point loops, molar offsets, and tip-back bends.
(B), and the slot point (C) to be on the same horizontal
plane. More modern bracket systems have been devel-
oped with CAD/CAM, and this allows greater flexibility in teeth tended to tip and rotate into the extraction sites
design. The slots can be placed in the correct alignment, when the chains were overstretched, with associated
but other factors can also be considered, such as bracket bite deepening (Fig 5).
strength and tie wing depth. Methods of space closure: As stated above, before
the SWA, most space closure with the edgewise appli-
ance was accomplished with various types of closing
similar to the casting of crowns or inlays. The difficulty loops. Sliding mechanics were seldom used because of
with casting brackets was that stainless steel had never the posterior interferences of omega loops, molar off-
been cast in this manner. The temperatures to cast stain- sets, and tip-back bends (Fig 6). However, with the
less steel were much higher than for gold. To accomplish SWA, sliding mechanics became a feasible option for
this, he sought out engineers who determined how to the first time. Andrews supported and used sliding me-
carry out this process, and the brackets were con- chanics as the method of choice for space closure. This
structed. This monumental effort by Andrews was one was also chosen as the method of space closure by
of the most significant contributions in the history of or- many orthodontists, and it reduced the need for wire
thodontics. His work created a baseline reference for all bending and the managing of closing loops.
future preadjusted appliances in the specialty. Many other orthodontists continued to use their
familiar closing loop mechanics. Dr Ron Roth,6 a friend
MECHANICS WITH THE SWA: THE NEED FOR and professional colleague of Andrews, chose to use
ADDITIONAL APPLIANCE COMPENSATION double T-loop arches for space closure. Roth was able
A period of mechanics and appliance modification to answer the criticism of gnathologists concerning
followed the introduction of the SWA. These adjust- extraction treatment. The gnathologic position was
ments centered around methods of canine retraction that when premolars were extracted, an ideal functional
and space closure, force levels, and compensation occlusion could not be achieved. Roth studied the work
needed in the appliance. of Drs Stuart and Stallard, the leaders of gnathology. Af-
Canine retraction: In extraction patients, the canines ter carefully reviewing their goals, Roth, as well as
were retracted on round wires using elastic chains. Andrews, treated numerous extraction patients to
Without the overcorrection of additional gable bends, centric relation using the SWA. They demonstrated

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658 McLaughlin and Bennett

conclusively, using both closing loop mechanics and and maximum anchorage needs. Dr Roth preferred not
sliding mechanics, that extraction patients (as well as to use the larger inventory involved with extraction
nonextraction patients) could be treated to ideal static brackets and chose to use a “single bracket per tooth
and functional goals of occlusion in orthodontics. Roth's philosophy” with Andrews' minimum anchorage extrac-
contributions in the area of functional occlusion were tion brackets as part of his appliance system. For many
also significant to the specialty. Their combined findings orthodontists, this was the state-of-the-art in pread-
and recommendations on static and functional occlu- justed appliance design until the mid-1990s.
sion became a powerful message and a goal of treatment
in orthodontics.
Force levels: Typically with the SWA, leveling and OTHER PREADJUSTED APPLIANCE VARIATIONS
aligning and canine retraction were initiated with round With the awareness of the need for compensation in
wires and elastic chains. These chains have been proven the SWA, and potentially for other preadjusted appli-
to create approximately 400 g of force when stretched to ances, the floodgates were opened in orthodontics for
twice their length, but the force reduces rapidly and variations in preadjusted appliance designs. The goals
becomes half of the initial force after 24 hours.7 Howev- were to determine the most common irregularity for
er, their activation length and continuous force created each tooth relative to the Andrews norms and then to
tipping of teeth into the extraction sites and unwanted determine how much bracket compensation was needed
rotations with level archwires. to correct its position. This was further complicated by
Traditional edgewise forces for space closure were the multiple variations in slot sizes, force levels, wire
approximately 600 g, with single closing loops in rectan- types, and mechanics. Essentially, the top of the bell-
gular archwires. Roth reduced these force levels using shaped curve for each tooth was sought out to establish
double T-loops for space closure. This did reduce the a given appliance design. We had the opportunity to
force levels, but it brought the need for gable bends in work with the various mechanical and appliance options
the extraction areas to counteract the increased flexi- of the SWA for nearly 20 years. Over this time, our
bility. Orthodontists who chose to use sliding mechanics perspective on the 4 factors discussed above (force levels,
were unsure of how much force to use in the process, method of canine retraction, space closure, and
and there was minimal experience to fall back on. compensation needed in the appliance) can be described
Andrews began using stainless steel coil springs with as follows.
carefully controlled 600-g force levels to close spaces, Force levels: With the edgewise appliance and clos-
the similar force levels he had used with edgewise treat- ing loop mechanics, tip bends (beauty, gable, and
ment. These force levels tended to also create some tip-back bends) helped to counteract the 600-g forces
collapse in the extraction sites and some rotational applied to the archwires and brackets. It became
effects in rectangular wires. apparent to us that when using the SWA and sliding
During this period, the nickel-titanium alloy group of mechanics, the heavy force levels and the lengths of acti-
wires was developed, but orthodontists were unsure vation were overpowering the stiffness of the archwires.
about when to use them. The flexibility of these wires Adding additional tip and rotational compensations to
was excellent for individual tooth alignment in many brackets did not seem to be as helpful as reducing the
clinical situations. However, it was not effective when force levels and the activation lengths. Short activation
wire stiffness was needed to retract canines, level arches, lengths and lighter forces in the 200-g range proved
and close spaces. These leveling and aligning and to be more effective with sliding mechanics.
space-closure issues led Andrews to add modifications Canine retraction: The use of elastic chains for
to the SWA. canine retraction without compensating bends proved
Appliance compensation: Rather than modifying the to be too much force in this round-wire stage and caused
force levels or providing compensating bends in the tipping of teeth into the extraction sites. Nickel-titanium
wires to counteract these effects, Andrews chose to wires placed during this stage of treatment compounded
maintain the “straight-wire” effect of the appliance. the tipping problem. Instead, passive figure-eight liga-
He developed a series of “extraction brackets” for the ca- ture wires, referred to as “lacebacks” (Fig 7), were placed
nines and posterior teeth that created additional from the first molars to the canines before archwire
compensating tip and rotational control. He also added placement.8 They provided a short activation length
“power arms” to these brackets to move the forces closer and a rapid reduction in force after initial application.
to the center of resistance. The amount of additional tip The periodontal space was compressed with minor
and rotational control in the extraction brackets was tipping, as initial minimal tightening of the laceback
based on the edgewise concept of minimum, moderate, occurred. The archwire was then placed and had

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McLaughlin and Bennett 659

Fig 7. Passive figure-eight ligature wires, called “lace-

backs,” were placed from the first molars to the canines
before archwire placement. It was important to avoid
overtightening them.
Fig 8. With lacebacks, the periodontal space was com-
pressed with minor tipping. The archwire was then placed
adequate time (4-6 weeks) to upright the teeth (Fig 8). and had adequate time (4-6 weeks) to upright the roots.
Gentle tightening of the lacebacks at 4- to 6-week inter- The lacebacks were adjusted at 4- to 6-week intervals
vals led to bodily movement of the canines and the pre- to take up any slack.
molars into the extraction sites.9
Methods of space closure: Lower forces during space
closure (200-g range) were eventually used, creating less
tipping force against the archwires and, in turn, less
archwire deflection. This reduced friction in the system
and allowed for more effective space closure. The
200-g forces were created using “tiebacks.”8 The tieback
was a single elastic module and a ligature wire attached
between hooks on the archwires and the first molars
(Fig 9). Nickel-titanium wires were not used during
space closure.
Appliance compensation: Because of these mechan-
ical changes to lighter forces, as well as other clinical
observations, when the opportunity arose to develop a Fig 9. A, The tie-back was used for space closure. It was
a single elastic module and a ligature wire attached from
new preadjusted appliance, 5 changes were introduced
the molar to the hook on the archwire. B, Another option is
to the appliance as follows. to attach the module from the hook on the archwire to the
Modified tip in the maxillary and mandibular molar hook.
anterior segments: Over time with the SWA, the force
levels with sliding mechanics were reduced from the
600-g range to the 200-g range. Therefore, we deter- for space closure. However, this 0.019 3 0.025-in wire,
mined that it was unnecessary to add compensating with the SWA incisor torque values, did not provide
tip to the anterior brackets of the newly developed pre- adequate palatal root torque for the maxillary incisors
adjusted appliance.10 Because of the reduced forces or labial root torque for the mandibular incisors. Some
used, the anterior tip values collected from Andrews' patients were left with inadequate overjet and overbite.
nonorthodontic normal models proved to be adequate Others finished with slight Class II buccal segments or
in combination with these lighter forces. By using these with extraction spaces in the maxillary arch that could
values, the anchorage needs of each patient were signif- not be closed and could not be explained by a tooth-
icantly reduced, since the apices of the anterior roots did size discrepancy. It was concluded that these clinical sit-
not have to be retracted as far. uations were due to the 10 of play with the
Modified torque in the maxillary and mandibular in- 0.019 3 0.025-in rectangular wire in the 0.022-in slot.
cisors: The rectangular wire of choice for us has been a Accordingly, additional palatal root torque was recom-
0.019 3 0.025-in stainless steel wire. It provided a bal- mended for the maxillary incisors and additional lingual
ance between a larger wire that was difficult to place crown torque for the mandibular incisors.10
and did not slide well and a smaller wire that provided Modified torque in the mandibular posterior
less tooth control and showed deflection when activated segment: There were concerns about patients being

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660 McLaughlin and Bennett

Fig 10. As Roth had done with his version of the SWA, we added an additional 5 of buccal root torque
to the maxillary molar brackets to avoid hanging palatal cusps and the resulting interferences. Upright-
ing torque was added progressively to the mandibular posterior segments to prevent the curve of Wil-
son from becoming too steep during treatment.

finished with an excessive curve of Wilson in the occlu- mandibular canine roots were more labially or lingually
sion, causing hanging palatal cusps and resulting in in- displaced. In summary, canines are difficult to align,
terferences during lateral excursions. Correction of these and 2 canine brackets with 3 torque options has been
orthodontically required additional lingual crown torque the most effective way to manage these teeth.9
and uprighting of the mandibular posterior teeth. This Metal injection molding, computer-aided design/
uprighting torque was added progressively to the computer-aided manufacturing (CAD-CAM), and
mandibular posterior segments of the new appliance.10 torque in base: In the mid to late 1980s, metal injection
Modified torque in the maxillary posterior segment: molding became the process of choice by the major or-
As Roth had done with his version of the SWA, we added thodontic companies in making brackets. Although it
an additional 5 of buccal root torque to the maxillary is efficient for the production of brackets, the construc-
molar brackets to avoid hanging palatal cusps and the tion of the bracket molds was expensive, so changes in
resulting interferences (Fig 10). However, the difficulty bracket design were limited for cost reasons. Also,
of inadequate buccal root torque in this area was when these brackets cooled, they reduced in size, which
frequently due to narrowing of the maxillary posterior influenced slot size. Tolerances were set so that the
segments relative to the mandibular posterior segments. brackets were not allowed to be less in slot size than
Many times, this was observed along with a posterior the 0.022-in or 0.018-in traditional sizes. Thus, metal
dental crossbite. More frequently, there was skeletal nar- injection molded brackets varied in sizes greater than
rowing of the maxilla relative to the wide mandibular 0.022 and 0.018 in.11 However, decisions on tip, torque,
skeletal base. In these patients, if the maxilla was and in-and-out in appliances were made based on the
expanded early in treatment and retained until the rec- numbers of 0.022 and 0.018 in.
tangular wires were placed, adequate buccal root torque About the same time, the major orthodontic companies
in the maxillary posterior segment was often achieved were designing their brackets on computers, and program-
with relative ease.10 ming machines to construct the brackets. This process was
Torque options in the maxillary and mandibular referred to as CAD/CAM. In addition, by the mid 1990s, the
canine brackets: The canines, both maxillary and patents on torque in base expired, and more companies
mandibular, are frequently out of position. The standard began making brackets with torque in base.
maxillary canine bracket that we used featured 7 of Self-ligating appliances: In the 1990s, self-ligating
torque, creating labial root torque, and tucking in the brackets became popular in orthodontics, along with
crowns of these teeth. Inverting this bracket to 17 of promises of great efficiency and effectiveness. These
torque was helpful for maxillary canines with very prom- were produced in both “passive” and “active” types. In
inent roots. As another option, 0 of torque for the the early stages of treatment, these brackets were effective
maxillary canine brackets was useful in extraction pa- in the initial alignment of the crowns of teeth. The small
tients to keep the roots away from the cortical plate initial wires in a larger “closed slot” provided effective
and in cancellous bone during retraction. Since mandib- movement due to reduced friction (Fig 11). They were
ular canines are most commonly inclined lingually also popular with staff members in the initial wires stages
because of contact with the maxillary canines, brackets because elastic modules and ligature ties were largely
with 0 of torque were most commonly used. In some eliminated. However, when larger rectangular wires
cases, brackets with 6 of torque could be used, or were used during the period of major tooth movement,
they could be inverted to give 16 of torque when the the brackets proved to be disappointing. When a

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McLaughlin and Bennett 661

brackets could not be made thin enough to properly

match the in-and-out values of more narrow incisor
brackets. Esthetic brackets were made stronger and
thicker (at the expense of in-and-out values) to prevent
the fracturing seen in earlier versions of esthetic
brackets. Ceramic materials are much stronger today,
and production of esthetic brackets with proper in-
and-out values is occurring. With self-ligating brackets,
in-and-out values were modified to allow for proper
positioning of gates and clips. All of these issues
were resolved by the introduction of accurate CNC
machines. Another significant feature of CNC bracket
production is the ability to make changes in bracket
design by adjusting the CNC machines, as opposed to
purchasing expensive molds for new bracket designs.
Examples of this are maxillary molar brackets for Class
II molar positioning and maxillary canine substitution
brackets used when the lateral incisors are congenitally
missing. These changes are easily done with CNC ma-
chines. Another improvement that has occurred along
with the CNC machined brackets is the use of heat-
treated wires with greater stiffness. These are used
Fig 11. We found that self ligating brackets were effective with 0.020-in round wires for canine retraction and
in the initial alignment of the crowns of the teeth. The with 0.019 3 0.025 rectangular wires for bite opening
small initial wires in a larger “closed slot” provided effec-
and space closure.
tive movement because of reduced friction. During major
tooth movement with rectangular wires, the brackets
proved to be disappointing. CONCLUSIONS

rectangular wire is initially placed in a conventional Many changes have occurred in appliance design
bracket, the wire does not initially seat fully into each since the edgewise and Begg appliances were designed.
bracket. Between visits, teeth move, and the archwire is This has opened the potential for far more efficient
further seated and eventually can be fully engaged. Arch- treatments with higher-quality results. Attention to
wire bends, if needed during finishing, respond in the diagnosis and treatment planning, bracket positioning,
same manner. However, with self-ligation, the process and efficient mechanics can enhance the results along
of full archwire engagement is “all or nothing.” The with these appliance improvements.
wire must be fully seated so that the gate or clip can be
closed. This creates greater discomfort for the patient REFERENCES
and more difficulty in the finishing stages of treatment. 1. Angle EH. Malocclusion of the teeth. 7th ed. Philadelphia: S. S.
White Dental Manufacturing; 1907.
CURRENT APPLIANCE VARIATIONS 2. Begg PR, Kesling P. Orthodontic theory and technique. 3rd ed.
Philadelphia: W. B. Saunders; 1977.
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the aim of achieving greater bracket accuracy, a comput- 4. Andrews LF. The six keys to normal occlusion. Am J Orthod 1972;
erized milling system was developed. This is called 62:296-307.
5. Andrews LF. Straight wire—the concept and appliance. San Diego:
computerized numerical control (CNC). With this method,
L. A. Wells Co; 1989.
a computer converts the design produced by the CAD 6. Roth R. Gnathological concepts and orthodontic treatment goals.
software into numbers, and sophisticated milling ma- In: Jarabak JR, Fizzell JA, editors. Technique and treatment with
chines accurately cut brackets from a solid piece of metal. light wire appliances. 2nd ed. St Louis: C. V. Mosby; 1972. p.
This allows for a more accurate slot size in each bracket. 1160-223.
7. Taloumis LJ, Smith TM, Hondrum SO, Lorton L. Force decay and
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deformation of orthodontic elastomeric ligatures. Am J Orthod
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brackets created the situation in which the canine to preadjusted appliance systems. J Clin Orthod 1989;23:142-53.

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9. Bennett J, McLaughlin RP. Fundamentals of orthodontic treat- Medical Media; 1997. Republished, Edinburgh, Scotland: Mosby;
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2014. 11. Cash AC, Good SA, Curtis RV, McDonald F. An evaluation of slot
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