Guiding Template for Direct Bracket Placement: A Hybrid Technique

Review Article

Austin J Dent. 2019; 6(1): 1127.

Guiding Template for Direct Bracket Placement: A Hybrid Technique

Eduardo Yugo Suzuki and Boonsiva Suzuki*

¹Department of Orthodontics, Bangkok Thonburi University, Bangkok

*Corresponding author: Boonsiva Suzuki, Department of Orthodontics, Faculty of Dentistry, Thonburi University, Taweewattana, Bangkok

Received: January 30, 2019; Accepted: March 04, 2019; Published: March 11, 2019


A simple technique is proposed to transfer the bracket positioning planningfrom the dental model to the patient’s mouth: Guiding Template for Direct Bracket Placement. Bracket positioning guidelines that arecarefully drawn on dental models are accurately transferred to a highly transparent thermoplastic material.Small slots are then created on the guiding templateto allow enough space for bracket placement in the desired position. The custommadeguiding template is then placed in the patient’s mouth to guide the precise direct bracket placement, therefore facilitating appliance fixation and reducing chair time. Moreover, it has advantages over indirect bracket transfer trays since it allows freedom to the orthodontist to perform any additional bracket positioning adjustments when necessary and to carefullyclean upadhesive remnants. In this procedure, the direct bonding technique is completely under the Orthodontist’s control.


Precise bracket placement is mandatory with pre-adjusted appliances, since different prescriptions andall the information required to position the teeth in the three axes,are built into the bracket [1-3]. Moreover, correct bracket positioning during bonding results in lessbrackets repositioning, and minimizes additional archwire bending during the subsequent phases of orthodontic treatment, thus increasing the predictability of results [3-5]. Therefore, several types of bracket-positioning gauges have been developed and recommended to improve accurate and reproducible bracket positioning [3-9]. However, precise bracket placement still relies on the professional’s individual skills and the accuracy of bonding procedures [1-3]. Moreover, considering inexperienced students in the beginning of their orthodontic clinical training, the accurate direct bracket placement procedure can be even more challenging, strenuous and time-consuming than for experienced orthodontists.

In order to achieve a more precise bracket positioning, several indirect bonding techniques have been proposed [10-13]. The main advantage of indirect bonding techniques over direct bonding techniques is to allow a precise and controlled preparation of bracket positioning in a laboratory setting. Individualized transfer trays are fabricated from a wide range of materials, such as vacuum-formed thermoplastics and silicone impression materials, and optimize bracket placement in the clinical setting, therefore reducing significantly chairtime [2-8]. The process is laborious and requires an experienced laboratory technician or a computer operator to allow the correct bracket positioning [6-8]. Moreover, indirect bonding technique still cannot be considered a gold standard for correct bracket placement because of numerous variable factors that might compromise the final accurate placement [10]. Any distortion or misalignment of brackets in the transfer tray or incorrect tray fit or lack of stability in the patient’s mouth might cause errors in the final bracket positioning [11,12]. However, indirect bonding is not the most desirable technique to be used in an academic orthodontic program with students in the beginning of their clinical training.

Therefore, in order to obtain improved accuracy in bracket positioning, as observed in the indirect bonding technique, and to simplify direct bonding procedures, the authors have developed a hybrid technique: guiding template for direct bracket placement. The guiding template incorporates all features of the planned vertical and horizontal bracket positioning guidelines that are carefully drawn on the working models and accurately transferred to a highly transparent thermoplastic material. This guiding template technique allows for precise direct bracket placement in the previously-planned position, therefore offering a valuable tool for inexperienced students in the beginning of their clinical orthodontic training.

Detailed step-by-step information regarding the preparation of the proposed guiding template for direct bracket placement is presented.

Guiding Template Fabrication

Laboratory setting

• Maxillary and mandibular working models of a patient are obtained. All defects and imperfections are removed.

• Bracket positioning guidelines, including vertical and horizontal reference lines are carefully drawn on the working models using a sharp pencil. The vertical reference guideline must coincide with the tooth long axis (Figure 1). The accuracy of these vertical guidelines can be obtained by assessing panoramic radiographs. Horizontal guidelines or bracket slot height positions are drawnusing gauges and bracket positioning charts (Figure 2).