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September's Tip: Nustar Self Ligating Brackets & Archwire Sequencing

By: Dr. Jay Gerber

If you have used or are considering using passive self-ligating brackets, please read the following for some great tips. Here at the Center for Occlusal Studies we have used six or more types of SLBs. Currently the bracket of choice is the Nustar Passive Self Ligating bracket from OrthoArch. The recommended Rx is the MBT which exhibits excellent anterior torqueing and possess superior up-righting capability for the lower posteriors. As you can see in the photo above it is very small and retails for around $5-6 per bracket. We began using this bracket upon its introduction earlier this year and has proven to be a workhorse. The opening and closing is maybe the most simplistic possible and the small size and low profile makes you want to use more. This specific Rx enhances the effect of vertical up-righting on posterior lowers 5-6-7 when using the RCS SL arch wires. This Rx can be used in open, deep and neutral bites. Molar bands are available in the Rx as well. The same upper and lower molar bands are used with all of the mini-twin, SLB bracket systems and clear brackets.

Archwires and sequential archwires -. I suggest the following when using Nustar SLB brackets. Upper Initial activation - start using the .012 or .014 depending on the degree of horizontal and or vertical deflections for correction of individual tooth rotations and or leveling In cases where individual teeth are deflected excessively on the horizontal or vertical planes. Deflections of near 90 to 45 degrees are treated using the .012 and .014 respectably. Both these Nitinol thermal wire sizes need to be in the Right Arch Form and have a mid-line Dimple to prevent excessive sliding in the brackets. Most of these flexible Nitinol wires require transpalatal and sometimes lower lingual arches for arch form support or enhancement. The Right Form archwire shape is a wider and thus more anatomic in shape, which is essential in our "functional" concepts. Intermediate Wire - the.014 x .025 heat activated Nitinol with dimple. This wire begins to develop root torque and preserve the arch form. Additional Upper Intermediate wires include the .016 x .022 stainless. This wire really gets into the torqueing of individual teeth. These wires must be coordinated with lower arch forms. Upper and Lower Finishing wires are the .018 x .025 stainless (posted if case requires Pletcher Springs) followed by the .021 x .025 braided (a new eight strand wire). Lower arch sequence is essentially the same as the upper except after initial rotational correction (if needed) leveling of the occlusal plane is next. That would be the placement of the .016 and .018 Reverse Curve of Spee (Straight Leg) Super Elastic Nitinol. These are placed immediately after most rotations are finished. Of course these wires (my design) are used in conjunction with (if needed) Incisal Blocks and 2nd Molar Stops. The remaining lower sequence is the same as the upper.