Successful Treatment Outcomes Using 3M™ Clarity™ Ultra Self-Ligating Brackets Bonded with a Digital Flash-Free Bonding Technique

Accurate bracket placement is fundamental to achieve a beautiful result in a short time. Research has shown 3D printed bonding trays to accurately reproduce virtual bracket positioning done on digital models¹. This method provides confidence that brackets will be positioned on the patient’s teeth as intended to achieve treatment goals¹. It also helps ensure that finishing procedures are simpler and faster. In this case, Digital Flash-Free Bonding was performed by positioning brackets on digital models using Ortho Analyzer™ (3Shape) software and then by 3D-printing a bonding transfer tray with bracket wells.

3M™ APC™ Flash-Free Adhesive Coated Brackets were loaded into the tray on the day of bonding and kept in a light-proof box until the bonding appointment time. 3M™ Clarity™ Ultra Self-Ligating Brackets with 3M™ Unitek™ Lateral Development Archwires permitted first phase application of light forces in order to orthodontically develop both the upper arch and, to a lesser extent, the lower arch (uprighting movement).

Nevertheless, in the second phase of treatment, with Beta-Titanium and Stainless Steel archwires it was possible to perfectly control of the final tooth position. Aesthetics has become very important nowadays and with Clarity Ultra Brackets it was possible to satisfy the patient’s aesthetic request without renouncing the advantages of a self-ligating appliance.

• A 14-year-old male patient with Class II skeletal bases (ANB 6°) on an average angle pattern (SN-mandibular plane angle 26°) and with Class II molar and canine relationship. There was an upper midline shift of 2 mm to the left and a deep overbite (6 mm) with lower incisors at -1 mm to the APog line but with an increased inclination relative to the mandibular plane (100°). Canine and premolar torques were too negative in both arches creating dark buccal corridors. The upper right canine was more extruded than the contralateral canine (pupillary line as reference) introducing risk of canting of the upper arch after leveling and aligning procedures with a conventional straight-wire appliance.
• Fig. 1A-O, Facial photos at start of treatment.
• Fig 1, P-U, Additional intraoral photos at start of treatment.
• Fig 2-3, Table 1, Initial panoramic and cephalometric x-ray analysis

We planned to open the bite principally through lower incisor absolute intrusion, avoiding premolar and molar extrusion, in order not to rotate the mandible in a clock-wise direction. Reducing profile convexity and increasing chin projection were necessary to improve the facial appearance of this patient. For this reason, we chose a self-ligating appliance (light forces) and we planned to build occlusal build-ups only on posterior teeth. We decided, in agreement with the patient, to correct the dental Class II by using light Class II elastics. Taking into account the patient’s favorable growth pattern, we planned to accurately control the vertical dimension by limiting posterior dental extrusion in order to allow a favorable sagittal growth response.³

Fig. 7-8, Initial bonding intraoral photos.

• Active treatment time was 10 months. No brackets were inadvertently debonded. Ideal occlusion ⁵^,⁶ was achieved and the deep bite was corrected. ANB decreased by 2° improving lip fullness and profile appearance. Upper occlusal plane was parallel to the pupillary line. Negative buccal corridors were reduced

• Fig. 12, A-O, Facial photos at end of treatment.

• Fig. 12, P-T, Intraoral photos at end of treatment.

• Fig. 13-14, Table 2, Final panoramic and cephalometric x-ray analysis.

• Fig. 15, A-E, Final digital models.

The most significant results in this case were the improvement in smile aesthetics and the complete Class II correction in a short treatment time. Accurate orthodontic planning aided by the use of digital bonding software was of great help in obtaining the final result.

Precise control of the final tooth position was obtained with accurate positioning of Clarity Ultra Ceramic Brackets. This appliance also provided great torque and rotation control. Hi-tech Lateral Development archwires permitted application of light forces during the arch development phase and Beta III Titanium archwires were of great help in the final detailing. The patient was very satisfied with both the aesthetics of the orthodontic appliance used and the final result of treatment.

References

1 Duarte MEA, Gribel BF, Spitz A, Artese F, Miguel JA. Reproducibility of digital indirect bonding technique using three-dimensional (3D) models and 3D-printed transfer trays. Angle Orthod 2020;90:92-99.

2 Palone M, Spedicato GA, Lombardo L. Analysis of tooth anatomy in adults with ideal occlusion: A preliminary study. Am J Orthod Dentofacial Orthop 2020;157:218-227.

3 Liu SS, Buschang PH. How does tooth eruption relate to vertical mandibular growth displacement?Am J Orthod Dentofacial Orthop 2011;139:745-51.

4 Vela-Hernández A, López-García R, García-Sanz V, Paredes-Gallardo V, Lasagabaster-Latorre F. Nonsurgical treatment of skeletal anterior open bite in adult patients: Posterior build-ups. Angle Orthod 2017;87:33-40.

5 Andrews LF. The six keys to normal occlusion. Am J Orthod 1972;62:296-309.

6 Casko JS, Vaden JL, Kokich VG, et al. Objective grading system for dental casts and panoramic radiographs. American Board of Orthodontics. Am J Orthod Dentofacial Orthop. 1998;114:589–599.

Case photos provided by Dr. Riccardo Riatti.
A special thanks to Mr. Stefano Negrini (digital orthodontic technician).

Dr. Riatti received his Dental Degree from the University of Parma and his Orthodontic Degree from the University of Cagliari. Since 2008, he has been Visiting Professor at the School of Specialization in Orthodontics at the University of Trieste. He is a diplomate of the Italian Board of Orthodontics (IBO) and a diplomate of the European Board of Orthodontists (EBO). His teaching topics are esthetics, self-ligating appliances and aligners. Dr. Riatti maintain a private practice in Reggio Emilia, Italy.