MBT

CONTENTS :
 Introduction
 Edgewise appliance
 The work of Andrews & Roth
 The work of McLaughlin & Bennett
 The work of McLaughlin , Bennett & Trevisi ,
 MBT treatment philosophy
 Appliance specifications-variations and versatility
 Bracket positioning and case setup
 MBT is the PEA named after the pioneers :

Dr. Richard McLaughlin Dr. John Bennett Dr. Hugo Trevisi

Introduction

• Andrews published his landmark article' in 1972, and

subsequently designed an appliance based on his findings.

• However, soon after the introduction of the preadjusted

appliance,

• it became clear that the bracket system required a whole

new program of treatment mechanics and force levels lo
fully realize its potential.
FUNDAMENTALS OF TREATMENT MECHANICS

Bracket selection Arch wire selection

Bracket positioning Force levels

 Edgewise appliance

• Introduced by Edward H. Angle, provided excellent three-dimensional

control of tooth movements

• Slot was greater in depth (0.028 in.) than the height (0.022 in.) and used
rectangular wires to accomplish the full control.

• Tweed later taught how to use the edgewise appliance effectively and brought
about the discipline of ‘order of bends’ to be built in the archwire.
 First order bends
 Second order bends
 Third order bends
Orthodontics diagnosis and management of malocclusion and dentofacial deformities. Om.P.KHARBANDA 3 rd edition .
 Shortcomings of edgewise appliance

• Brackets bases are perpendicular to bracket stem .

• Brackets bases are not contoured occlusogingivally .
• Slots are not angulated .
• Bracket stems are of an equal faciolingual thickness

Orthodontics diagnosis and management of malocclusion and dentofacial deformities. Om.P.KHARBANDA 3 rd edition.
 The first integrated pre-adjusted appliance system and
philosophy by C. F. Andrews

THE WORK OF ANDREWS

• Andrews' paper was based on the measurement of 120 non orthodontic
normal cases.

• He then used the data as a basis to design a bracket system.

• No special anchorage control measures, such as second order archwire

bends, were employed.

AJO-DO 1972 Sep (296-309): The six keys to normal occlusion - Andrews
 SWA tip Research tip

Original SWA based on measurement of 120 non-orthodontic Normal cases ,

although extra-tip built into anterior brackets.
This is because the tip was lost as torque was added.
The wagon wheel effect

AJO-DO 1972 Sep (296-309): The six keys to normal occlusion - Andrews
 ROLLER COASTER EFFECT

• Difficulties with
increased tip and heavy
forces

AJO-DO 1972 Sep (296-309): The six keys to normal occlusion - Andrews
Systemized orthodontic treatment mechanics textbook. McLaughlin, Bennet, Trevisi. Published in 2001.
 THE WORK OF ROTH

• Following his early experiences with the original SWA, Roth introduced measures to
overcome day-to-day shortcomings which he had found in clinical use

• He recommended a single appliance system, which to manage both extraction and non-
extraction cases.

• He developed the concept of overcorrected tooth position before appliance removal.

• The final tooth positions in Roth philosophy varied slightly than the Andrews prescription to
achieve the functional occlusion goals.

Orthodontics diagnosis and management of malocclusion and dentofacial deformities. Om.P.KHARBANDA 3rd edition.

Systemized orthodontic treatment mechanics textbook. McLaughlin, Bennet, Trevisi. Published in 2001.
• His arch form was wider than Andrews' in order to avoid damage to canine tips
during treatment and to assist in obtaining good protrusive function.
• Use of articulators for diagnostic records.
 THE WORK OF MCLAUGLIN AND BENNETT
BETWEEN 1975 AND 1993:

• They worked mainly with

standard SWA bracket system

• They developed and refined

treatment mechanics based
on sliding mechanics and
continuous light forces .
 THE WORK OF MCLAUGHLIN, BENNETT AND
TREVISI -1993 AND 1997

• This is third generation bracket

system , it is a version of
preadjusted bracket system
specifically for use with light
continuous forces, lacebacks
and bendbacks and it was
designed to work ideally with
sliding mechanics
• Lighter forces were being used in all stages of treatment, this
additional 'anti-tip', or second-order compensation, was not needed.

• Therefore, when designing the MBT" bracket system,

• it was decided to base the anterior tip on the original research

values.
 THE WORK OF MCLAUGHLIN ,BENNETT,AND TREVISI
BETWEEN 1997 and 2001

It became necessary to address the subjects of arch wire selection and force levels

New range of MBT Ovoid, tapered, square

brackets arch wire selection

Bracket position with the help Updated light force

of gauge level & Sliding
mechanics
 OVERVIEW OF MBT TREATMENT PHILOSPHY

• Bracket selection Range of brackets,

• Versatility Controlled inventory & less wire bending

• Accuracy of bracket positioning Gauges & bracket positioning charts

• Light continuous forces

• The .022 versus .018 inch slot

.022 slot allows more freedom of movement for the starting archwires and helps to keep force light.
 • Anchorage control early in treatment

LACEBACKS : used to assist in control of canine crowns

during leveling and aligning.

Bendbacks.
• Group movement

• The use of three arch forms ovoid, tapered, or square forms

• One size of rectangular steel wire

.019/.025 steel rectangular working wires are more rigid

than .016/.022 or .017/025 wires.
• Arch wire ligation

• Elastomeric module

• Stainless steel ligature

• Awareness of tooth size discrepancies

• Persistence in finishing
 Appliance specifications - variations and versatility

 Design features of a modern bracket system

• RANGE OF BRACKETS

 Standard size metal brackets.

 Mid-size metal brackets.
 Esthetic brackets.

o The original i.d. system of dots and dashes has been

superseded by laser numbering of standard size metal
brackets .
o colored dots continues to be used for midsize and
esthetic brackets.
The original standard SWA brackets Rhomboidal shape brackets
 Torque in base- The CAD factor

• Allows more flexibility of design to place

the slots in the correct position in the
brackets
• Enhance bracket strength and features
such as depth of tie wing and labio-
lingual profile
 IN-OUT SPECIFICATION

• The in-out feature of preadjusted brackets is 100% fully expressed,

because the archwire lies snugly in the slot.
• Labio-lingual movement rapid

UPPER SECOND PREMOLARS

• Upper Second Premolars have small crowns

 TIP SPECIFICATION

• For all molars, a 0° tip bracket is

recommended. If placed parallel to the
buccal cusps of the molars, a 0° tip bracket
will deliver 5° of tip for the uppers and 2° of
tip for the lowers.
TORQUE SPECIFICATION:
 Incisor torque

• There is generally a need for

greater palatal root torque of the
upper incisors and from more
labial root torque of the lower
incisors.
• For these reasons, the authors
recommend +17° of torque for the
upper central incisors,+10° of
torque for the upper lateral
incisors, and -6° of torque for the
lower incisors
CANINE TORQUE

Three torque options for upper arch

Three torque options for lower arch

 When should the three canine options be used?

1-Arch form
2- Canine prominence

7 upper & -6 lower canine

torque not recommended
for prominent canines, or
canine gingival recession
at the start of treatment
3- Extraction decision

• 0  torque for use with canine retraction

mechanics

• Carries a hook

• Maintains canine roots in cancellous

bones
 4-Overbite

5- Rapid palatal expansion cases

• 0° or +6° lower canine brackets are recommended to assist this
favorable change.
 Upper premolar and molar torque

• upper premolar torque - -7°

• The -9° of the original SWA has proven to

be inadequate.
• Increased buccal root torque helps
reducing possibility of palatal cusp
interference
LOWER PREMOLAR AND MOLAR TORQUE
 THE VERSATILITY OF BRACKET SYSTEM

1.Options for palatally displaced upper lateral incisors (-10°).

2. Three torque options for the upper canines (-7°, 0°, and +7°).
3. Three torque options for lower canines (-6°, 0", and +6").
4. Interchangeable lower incisor brackets - the same tip and
torque.
5. Interchangeable upper premolar brackets - the same tip and
torque.
6. Use of upper second molar tubes on first molars in non-
HGcases.
7. Use of lower second molar tubes for the upper first and second
molars of the opposite side, when finishing cases to a Class II
molar relationship.
PALATALLY DISPLACED LATERAL INCISOR:
Interchangeable lower incisor brackets
Interchangeable upper premolar brackets
IN NON-HG CASES - Use of upper second molar tubes on first
molars
FINISHING TO A CLASS II MOLAR RELATIONSHIP
 BRACKET POSITIONING AND CASE SET UP

• Setting up of the case is the most important aspect of the

treatment, after correct diagnosis and treatment planning.

• Bracket positioning is most important mechanical

procedure in the treatment of the patient

• Banding and bonding should therefore not to be delegated

and should be managed by the orthodontist, to ensure
accuracy of appliance placement.
 FULL OR PARTIAL SET-UP?

 In some situations, listed below, it may be beneficial to consider

partially setting up the case, leaving individual teeth, and in some
instances groups of teeth, without attachments.

 Blocked-out teeth

 Deep-bite cases :
upper arch treatment should be started first.
  Enamel reduction cases

• It is normally necessary to carry out

enamel reshaping in cases with
triangular-shaped incisors.
• Treatment mechanics can be easier if
lower incisors of a triangular shape are
re-shaped before bracket placement..

 Sliding jig cases and mixed dentition cases

• Upper bicuspids and sometimes upper canines are normally not
bracketed when starting cases where a sliding jig
THEORY OF BRACKET POSITIONING - AVOIDING ERRORS

 With the original edgewise appliance:

• Bracket placement was normally carried out using gauges
and standard millimeter measurements from the incisal or
occlusal edge of each tooth, irrespective of tooth size.

• Brackets placed more incisally in large incisors than

patients with small teeth.

• Brackets were positioned at different curvature : variations in the

amount of torque and in-out produced by the brackets.
  Andrews :

• introduced the concept of the 'middle of the clinical crown

 Bracket wings parallel to the long axis of the clinical crown.

• overcame the shortcomings of the original edgewise method

concerning variations in the amount of torque and in-out
produced by the brackets.

 MBT
• Advocate the use of gauges, but with individualized bracket-
positioning charts
 Horizontal accuracy during bracket positioning

 Horizontal and
 Horizontal accuracy in  If brackets are placed to
vertical accuracy
the canine, premolar, the mesial or distal of the
can be checked
and molar regions vertical long axis of the
from the buccal
should be checked clinical crown, improper
aspect.
with a mouth mirror. tooth rotation can occur.
 Rotated incisors Axial accuracy Vertical accuracy

• On a rotated tooth, • Bracket wings need • Vertical accuracy is the

the bracket can be to be parallel to the most difficult aspect of
bonded slightly long axis of the tooth. bracket positioning.
more mesially or • errors will cause • Done using gauges
distally incorrect tip position and individualized
of teeth bracket positioning
chart.
 Clinical Use of gauges

canine and premolar regions,

incisor region

molar regions,

Systemized orthodontic treatment mechanics textbook. McLaughlin, Bennet, Trevisi. Published in 2001.
 Chart individualized in de e p bite a n d open bite cases.

• It can be helpful to place the incisor and canine brackets 0.5 mm

more occlusally in deep-bite cases.
• In open-bite cases, they should be 0.5 mm more gingival.

Systemized orthodontic treatment mechanics textbook. McLaughlin, Bennet, Trevisi. Published in 2001.
 Chart individualization in cases with abnormal incisal edges

• Barrel-shaped teeth: bracket placement

should be done 0.5 mm more gingivally.

• This upper right lateral incisor edge

should be reshaped before
treatment, or else the bracket should
be placed 0.5 mm more gingivally.
Pr e mo l a r extraction cases
 PLACING MOLAR BANDS

SEPARATION

• Elastic separating modules or Metal separator can be used

Upper Molar Band Placement

Systemized orthodontic treatment mechanics textbook. McLaughlin, Bennet, Trevisi. Published in 2001 .
Lower molar band placement
• Lower molar non-convertible tubes are often
preferable to convertible tubes, because they are
less bulky. They are stronger, more comfortable,
and cause fewer interferences.
 DIRECT BONDING OF BRACKETS

After cleaning of the enamel surface, etching, and application of primer, the
positioning and bonding of the bracket are carried out in five stages:

1- Positioning at the estimated mid-

point of the clinical crown, with
bracket wings parallel to the long
axis of the crown.

Systemized orthodontic treatment mechanics textbook. McLaughlin, Bennet, Trevisi. Published in 2001.
2- Removal of excess bonding agent.

3- Checking vertical positioning

4 - Re-checking axial and horizontal
positioning

5- Light-curing after removal of any

additional excess bonding material.
REFERENCES

 Orthodontics diagnosis and management of malocclusion and dentofacial

deformities. Om.P.KHARBANDA 3rd edition.

 AJO-DO 1972 Sep (296-309): The six keys to normal occlusion - Andrews

 Systemized orthodontic treatment mechanics textbook. McLaughlin, Bennet,

Trevisi. Published in 2001.