Cannon Brackets

Cannon Brackets
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The design of orthodontic brackets should not dictate the final torques and angulations of the teeth, but rather enable their establishment.
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The Cannon Ultra Bracket System is the first bracket system which enables the orthodontist to easily treat mild to moderate apical base class II and III cases. This is accomplished by utilizing the interactive slot which allows for dental compensation. The interactive slot opens to the gingival. The archwire is held securely in the interactive slot by utilizing the same elements as with the edgewise slot; "0" ring, power chain and steel ligature tie. There is also a preadjusted edgewise slot for the treatment of apical base class I cases. Bodily en masse retraction of the anterior teeth can be easily accomplished in extraction cases by utilizing an archwire in both slots simultaneously. When utilizing a .018 steel archwire in the interactive slot with bilateral 25 degree "V" bends in the middle of the extractions sites in conjunction with a .018 x .025 nickel titanium archwire in the pre-adjusted slot, proper moment to force ratio is established so as to bodily retract the anterior teeth and enhance anchorage so that no external anchorage is required. You are invited to explore our website and learn more about how this new concept in orthodontic bracket design can make treatment easier and faster while improving your quality of orthodontic treatment.
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Cannon Brackets
Patent Pending on the Cannon Ultra Bracket System
James L. Cannon, DDS, MS 5297 Cleveland Highway Clermont, Georgia 30527 770-983-7633 Telephone 770-983-7884 Fax
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Cannon Brackets | Founder and Philosophy
Founder and Philosophy
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James L. Cannon DDS, MS

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Dr. Cannon received his degree in dentistry from Emory University and his orthodontic degree from the University of Montreal. He presently maintains a private orthodontic practice in Clermont, Georgia. Over the past thirty plus years, he has worked with several orthodontic companies in developing bracket systems. His first effort was with Unitek. He was very instrumental in the development of a system of treatment which utilized the Fourth Stage bracket. He later, with Dr. William J. Thompson co-designed the C.A.T. bracket system for Lancer Orthodontics. He and Dr. Thompson co-authored the technique manual entitled, The Combination Anchorage Technique. He designed and developed the Channel-Edge Bracket System which is marketed by American Orthodontics. He, also authored a technique manual on the Channel-Edge Bracket System. For his unique ideas he has been awarded eight patents by the United States Patent Office. His first patent was for the DualFlex archwire. This archwire was composed of nickel titanium in the anterior and stainless steel in the posterior. The anterior and/or posterior portions could be either round, square or rectangular. He developed the Dual Plane Cephalometric Analysis which clearly points out those cases with a true arch discrepancy. He has lectured extensively on the mechanics of orthodontic treatment and cephalometrics in the United States, Canada, Australia and Europe. His philosophy of treatment might be best summed up by the following statement: The design of an orthodontic bracket should not dictate the final torques, angulations, and the in/out of the teeth, but rather enable their establishment. Combining his years of experience in bracket design with his unique talents, he has developed a bracket system that is truly a new concept in orthodontic bracket design. The following information spells out the philosophy, diagnostic protocols, unique design, and treatment procedures of the Cannon Ultra Bracket System. Philosophy of the Cannon Ultra Bracket System Before Dr. Lawrence F. Andrews introduced the pre-adjusted bracket, first, second and third order bends were placed into the archwires to properly align the teeth. The degree to which these bends were made in the archwires were not governed by fixed angles or distances but rather by what was necessary to properly align and position the teeth in each arch so as to accomplish optimum interdigitation of the teeth upon closure. We applaud Dr. Andrews for his great contribution of the pre-adjusted bracket to orthodontics. Dr. Andrews states on page 181 of his book, STRAIGHT WIRE The Concept and Appliance, the following concerning the maxillary and mandibular incisor, "There must be at least three standard brackets, each with a different base inclination to accommodate one of the three acceptable but different posttreatment inter-jaw relationships." Apical base class I, II and III are the different but acceptable inter-jaw relationships. Dr. Andrew prescription for apical base class II and III cases modifies only the base inclination for the maxillary and mandibular incisors. His prescription is inadequate because the majority of the change in the inclination of the incisors is the distal or mesial movement of the root, not the mesial or distal movement of the incisal edge. His failure to recognize that the angulation angles of the maxillary and mandibular cuspids and bicuspids must be altered to achieve optimum interdigitation of the teeth is another reason, prehaps the primary reason, that his prescription for the treatment of apical base class II and III is inadequate. With apical base class II inter-jaw relationship cases, Dr. Andrews prescribes a decrease of five degrees in the base inclination from his apical base class I prescription for the maxillary central and lateral brackets. He prescribes an increase of five degrees in the base inclination from the apical base class I prescription for the mandibular incisors brackets. A decrease of five degrees in the base inclination of the maxillary incisor brackets will result in only one-half millimeter of distal positioning of the incisal edge of these teeth. A five degree increase in the base inclination of the mandibular incisors will likewise position the incisal edge of these teeth mesially by one-half millimeter. A total of only one millimeter is inadequate
for treating most apical class II cases. The same concept but with the base inclination changes reversed, is utilized in Dr. Andrews prescription for treating apical base class III inter-jaw relationship cases. Illustration 1: Maxillary Central Incisor : How +2, +7 and +12 degrees of bracket base inclination effect the anterior/posterior position of the incisal edge. Point A is the incisal edge. Point B is where the line through the long axis of the tooth intersects the line vertical to the occlusal plane. Notice that point A moves approximately one-half millimeter forward toward the vertical plane for each five degree increase in the inclination of the base.
Illustration 2: Mandibular incisors: How +4, -1 and -6 degrees of bracket base inclination effect the anterior/posterior position of the incisal edge. Notice that point A moves approximately one-half millimeter backward from the vertical plane for each five degree reduction in the base inclination.
The facial lingual rotational force created by the union of the edgewise slot and the rectangular archwire results in the tooth rotating around the facial axis point (FA) of the maxillary and mandibular incisors. The center of the edgewise slot should be located on that point. Even in the maxillary central incisors the distance from the center of the edgewise slot to the incisal edge is usually no more than five millimeters, while the distance from the center of the edgewise slot to the apex of the root is approximately three times that length. Therefore, the apex of the root will move approximately three times the distance as does the incisal edge. A point located five millimeters from the point of rotation, rotating clockwise or counter clockwise five degrees, moves only one half millimeter in a forward or backward direction. Therefore, an increase or decrease of five degrees in the base inclination will have very little effect on the anterior/posterior position of the incisal edge of the maxillary central incisors, and/or the mandibular incisors. Andrews Straight Wire prescription for the maxillary central incisor bracket for an apical base class I is plus seven degrees base inclination, plus two degrees base inclination for apical base class II, and plus twelve degree base inclination for apical base III. The lateral incisors base inclination is four degrees less than the central incisor, minus two degrees, plus three degrees and plus eight degrees respectively. Andrews Straight Wire prescription for the mandibular incisors are as follows: Apical base class I, minus one degree base inclination; Apical base class II, plus four degrees of base inclination; Apical base class III, minus six degrees base inclination. The total dental compensation accomplished with Andrews Straight Wire prescription for apical base class II and III would be approximately one millimeter, one half millimeter from the maxillary incisors and one half millimeter from the mandibular incisors. In other words, the incisal edge of the maxillary incisors would move mesially or distally only one half millimeter, and the incisal edge of the mandibular incisors would move mesially or distally only one half millimeter. One millimeter of dental compensation is not adequate for most apical base class II and III inter-jaw relationships.
What about the "row-boat effect" when the base inclination is increased or decreased in the maxillary or mandibular incisors? Will the lingual or facial rotational force on the maxillary or mandibular incisors roots be of such a magnitude as to move the teeth in the maxillary arch forward or backwards? Because of the apical base class I angulation angles in the brackets of the cuspid and bicuspid brackets, any forward or backward movement of the cuspids, bicuspids and molars would be of a bodily nature. The force from the lingual or facial root torque on the maxillary or mandibular incisors will not be of a magnitude that will move all the teeth forward or backward in the required bodily manner. If the angulation angle in the brackets of the cuspids and bicuspids were increased or decreased as appropriate, some "row-boat effect" might very well occur with the addition of the distal or mesial rotational force on the cuspids and bicuspids roots. Dental compensation in apical base class II and III cases can be accomplished much easier by utilizing tipping of the teeth. With tipping of a tooth, the rotation point is at the approximate junction of the top and middle one-third of the root. The distance from this point to the incisal edge is approximately three times the distance from the middle of the root to the apex of the root. The result is that the incisal edge of the tooth moves approximately three times the distance as does the apex of the tooth. Illustration 3: When the incisors are tipped, A is the approximate location of the point of rotation. The maxillary central is rotated five degrees, from plus seven degrees (solid line) to plus twelve degrees (dotted line). The mandibular incisor is rotated five degrees from minus one degree (solid line) to minus six degrees (dotted line).
Illustration 3 demonstrates how the full clinical crown comes forward approximately 2 millimeters when the tooth is rotated five degrees by a tipping action. Unlike in illustration 1 where the rotation point is the FA point, whereby that portion of the clinical crown above the FA point actually moves backward. In apical base class ll and III cases, dental compensation of four millimeters can be easily accomplished. Two millimeters in the maxillary incisors and two millimeters in the mandibular incisors. Four millimeters of dental compensation is usually adequate to treat apical base discrepancy cases from plus five millimeters to minus five millimeters Wits. Illustration 3 demonstrates dental compensation for apical base class III discrepancies. The same concept is employed for apical base class II case, the difference being, that the maxillary and mandibular incisors would be tipped in the opposite direction as they are for apical base class III cases. A review of five major orthodontic companys catalog reveals the fact that no other orthodontic company recognizes the need for such prescriptions. We in orthodontics must recognize and accept that different inter-jaw relationships require different angles between the long axis of the teeth and the occlusal plane. The major focus of all the major orthodontic companies is to market a single set of preadjusted brackets and claim that their set of brackets will correctly position the teeth for all individuals regardless of the inter-jaw relationship. This concept has been marketed so successfully that it has become dogma. This dogma must be overturned before orthodontics can proceed to a higher quality of treatment. This can only be accomplished by understanding that each individual is unique and most often requires an individualized approach to treatment. In an effort to make the work of the practice of orthodontics easier, we
in orthodontics are constantly looking for a quicker, faster and easier way of treatment. We in orthodontics must protect the "Profession of Orthodontics". We must pass it on to the next generation with higher standards. These standards must produces a quality of treatment higher than when we accepted the profession from the previous generation. To do otherwise is to accepts failure. The concept of the preadjusted bracket is so appealing that it has literally wiped out all competitive systems. However, the pre-adjusted bracket technique is limited in value for many cases and usually requires the bending of wire in treatment for nearly all cases. Its time to admit this, move on, and explore other options that may result in the further evolution of the concept of the pre-adjusted bracket. As we move on we should carry with us the many valuable contributions that those associated with the pre-adjusted bracket have made to orthodontics. FOOD FOR THOUGHT 1. Review the catalog of any of the major orthodontic companies in regard to the number of different pre-adjusted bracket systems. They all claim that their system is the only correct system even though they market several systems that have different base inclinations for the same teeth. 2. When reviewing the catalogs, notice that there are numerous maxillary and mandibular incisors brackets with different base inclinations. Why is the angulation in the cuspids and bicuspids almost uniformly the same? The angulation of the cuspids is a major factor in the anterior posterior positioning of the incisors. The fact is that if the base inclination of the maxillary and mandibular incisors are increased or decreased the angulation of the cuspids and bicuspids should be changed accordingly.
3. Ormco, 3M Unitek and American Orthodontics combined offer approximately 31 different prescriptions for pre-adjusted bracket systems. Only one prescription even mentions the need for a different bracket system when treating apical base class II and III cases. Most of them have a popular orthodontist name attached to them or a catchy name implying that the system is somehow superior to all others. There is an obsession with numbers. The importance of +7 degrees, +12 degrees and +17 degrees torque for the maxillary, for example, is heatedly debated among orthodontist. These same orthodontist seldom if ever utilize a full size archwire to finish a case, and therefore never realize the full torque built into these brackets. 4. One of the major elements in the concept of the pre-adjusted bracket systems is the in/out relationship between the teeth. The more
prominent the crown of a tooth, the smaller the base thickness of the bracket designed for that tooth, and vice versa. The mandibular incisors and the maxillary laterals have brackets with the greatest base thickness due to their smaller crown prominence. In an effort to give the orthodontist what they think they want and need, a low profile bracket system, the in/out between the maxillary centrals, laterals and cuspids and the mandibular cuspids and incisors have been greatly compromised. However, these systems are marketed as fully pre-adjusted bracket systems. 5. Andrews base inclination for the maxillary central incisor in apical base class I case is +7 degrees. Roth, with much fanfare, decided that it should be +12 degrees to have the teeth more forward for a bigger smile. The 5 degree increase in the base inclination resulted in the maxillary central being one-half millimeter more forward. 6. Why have there been a continued increase of the base inclination in the maxillary incisors and at the same time have a continued decrease in the mandibular incisors? Could it possible be to overcome technique problems with the pre-adjusted bracket and has nothing to do with the final positioning of the teeth? 7. Ormco explains, when describing the Damon system that to best utilize the clinical advantages of the passive self-ligation brackets, it is strongly recommended not to exceed .019 x .025 archwire dimension in an .022 x .028 bracket slot, because this needed play allows for seven degrees of torque play in both directions. Ormco further explains that this needed play between the archwire and the slot makes closing space, leveling, arch form changes, closing open bites, and the finishing, settling and detailing of the occlusion much easier. Is Ormco describing Straight Wire or Light Wire? PERSONAL COMMENT: Dr. Andrews concept of Straight Wire is valid in the treatment of apical base class l non-extraction cases. The concept begins to have problems when extractions are necessary even with apical base class I cases, and totally falls apart when treating apical class II and III cases, either extraction or non-extraction. The tendency has been, even in apical base class I extraction cases, to increase the base inclination in the maxillary incisors and decrease the base inclination in the mandibular incisors. This creates better anchorage in the mandible incisors and increases lingual root torque in the maxillary incisors. The changes in base inclination in both the maxillary and mandibular incisors are technique related, not to change the actual final positioning of the teeth. In apical base class II and III cases, it is impossible to alter the base inclinations of the brackets to the extent required for most apical base class II and III cases. The pre-adjusted bracket system, when treating apical base class II and III cases, can actually make treatment more difficult. A bracket system which takes advantage of the great qualities of the pre-adjusted edgewise slot combined with a tipping slot which allows for dental compensation would make orthodontic treatment much easier and give better treatment results. The design of orthodontic brackets should not dictate the final torques, inclinations, and in/out of the teeth, but rather enable their establishment. CENTRIC OCCLUSION AND CENTRIC RELATION Knowing how to determine centric occlusion and centric relation, and understanding their differences is perhaps the most important factors of all diagnostic procedures. Centric occlusion is defined as the relationship between the arches that will, upon closing, results in the maximum interdigitation of the teeth. Centric relation is defined as the relationship between the arches that will, upon closing, results in the head of the condyle being positioned in the most posterior, superior, unstrained position in the glenoid fossa. When centric occlusion and centric relation is different, the most common cause is the anterior positioning of the mandible by the patient so that a
better interdigitation of the teeth can be accomplished. There are many different approaches to establish centric relation. Perhaps the simplest procedure is to recline the patient back in the dental chair, get them to relax so that you can freely take control of the opening and closing of the mandible. Place your thumbs end to end on the point B region of the chin, and your fingers anterior and posterior to the angle of the mandible. Exert a light clockwise rotational and distal force on the mandible. Once the mandible can be opened and closed freely, without resistance from the patient, insert a soft bite material and close the mandible until the initial contact is made between the teeth Hold the mandible in that position until the bite material hardens. Always insert the bite between the teeth when taking a cephalometric x-ray and trimming or mounding the models. Upon completion of orthodontic treatment always check to be sure that centric occlusion and centric relation are one and the same. Faulty orthodontic treatment can create a difference in centric occlusion and centric relation when there was no difference at the beginning of treatment. Centric occlusion and centric relation must be one and the same to establish quality orthodontic treatment and to insure tempromandibular health. CEPHALOMETRIC ANALYSIS Cephalometric analysis is used extensively by some orthodontist as a diagnostic tool, while others seriously question its value and seldom, if ever, utilize it in their diagnostic procedures. Perhaps the reason is simply due to the state of utter confusion surrounding cephalometrics. We in orthodontics have used cephalometric landmarks such as sella, nasion, orbitale and etc. to establish linear and angular cephalometric standards that we utilize to evaluate pre and post treated cases. These measurements are not standards or norms. They are simply averages of a selected population . The average height of the American male might be 5 foot 10 inches. You cannot, however, establish 5 foot 10 inches as the standard or norm and proclaim that any American male not 5 feet 10 inches is abnormal. The concept that cephalometric landmarks occupy the same relative position throughout the general population is not valid. These landmarks tend to maintain a somewhat predictable relationship as growth occurs for a single individual, but they do not necessarily start out with the same relative relationships for all individuals, even in selected populations. As a profession, we continue to use measurements that have been shown to be, if not invalid, certainly questionable as to their value for some cases. The continued use of ANB to determine the linear relationship between the arches is one prime example. It has been clearly shown by several authors that the utilization of the ANB angle to determine the linear relationship between the arches can, in many cases, be very misleading. The evidence demonstrates that cases with a short cranial base, and/or a high SN to OP angle, are the type cases where the ANB angle is most leading. In either of these situations, the ANB angle can be of such a magnitude as to falsely suggest a linear discrepancy between the arches. In those cases with both a high SN to OP and where nasion is positioned posteriorly, the ANB angle becomes obviously incorrect. The cephalometric measurements commonly referred to as standards and routinely applied to all cases, have been established through the study of a general population, including without categorizing, convex, concave and straight profile individuals. The field of orthodontics, for some unexplainable reason, long ago decided that the low SN to OP angle straight profile individuals represent the standards that must be approximated in all cases if we are to consider our orthodontic treatment successful. These standards are almost universally used to evaluate treatment results, but seldom, if ever, are the effects of a steepening SN to OP angle or the anterior/ posterior position of nasion taken into consideration when applying these standards. The importance of soft tissue analysis appears to be primarily divided into two groups. One group believes that the soft tissue analysis should be the major tool utilized in determining the treatment plan. Their reasoning is that the "FACE" is what we see, and
therefore, consideration of the soft tissue should take priority over the positioning of the teeth. The other group feels that as the teeth go, so goes the soft tissue. Their reasoning is that the anterior posterior position of the lips is about the only soft tissue that can be effected by orthodontic treatment. The authors position is that neither group is correct. As with all orthodontic treatment, treatment plans must be individualized. There are cases where soft tissue should be the major factor and there are cases where the placement of the teeth take priority. In an article entitled "Integumental Contour And Extension Patterns" by Dr. Charles J. Burstone he explains the manner in which priorty should be placed on soft tissue, and placement of the teeth, in establishing individual treatment plans. The following statement appears in the topic DISCUSSION. "An awareness of integumental extension and contour is an essential element of case analysis. Since considerable variation may occur in the soft tissue mass of the face, treatment based on arbitrary dentoskeletal standards cannot be expected to consistently produce desirable facial form. In many individuals application of an absolute standard will lead to increased facial disharmony or the substitution of one type of disharmony for another. Since the soft tissue as well as dentoskeletal structures demonstrate variations, both should be considered in establishing the anterioposterio-positioning of the denture, and the axial inclination of the anterior teeth." He continues. "In an orthodontic case, esthetics is closely related to stability. Rarely should facial esthetics be achieved at the expense of denture stability. Stability and esthetics need not be separate objectives, for those same muscular imbalances that operate to produce denture instability may also be responsible for disharmony in facial contour." If properly utilized and understood, cephalometric measurements can be a vital tool in establishing certain parameters in orthodontic diagnosis. DETERMINING ARCH DISCREPANCY Before beginning treatment, especially when utilizing a pre-adjusted bracket system, the apical base relationship between the arches must be accurately determined. The utilization of ANB to determine arch discrepancies can be very misleading particularly in high angle cases and patients with prominent or flatten foreheads. The terms skeletal class I, II and III became popular with the introduction of Steiners SNA, SNB and ANB angles. The SNA angle has been used to establish the anterior/posterior relationship between the maxilla and cranial base. The accepted norm for the SNA angle is 82 degrees. The SNB angle has been used to establish the anterior/posterior relationship between the mandible and cranial base. The accepted norm for the SNB angle is 80 degrees. The ANB angle has been used to establish the relationship between the maxilla and the mandible. The accepted norm for the ANB angle is +2 degrees (SNA of 82 degrees minus SNB of 80 degrees = ANB of +2 degrees). An ANB angle of 0 to +5 degrees is considered to be a skeletal class I. An ANB angle of +6 and over is considered a skeletal class II. An ANB of 1 or less is considered a skeletal class III. These averages have been routinely applied to all cases in total disregard of the fact that sella does not necessarily occupy the same relative superior/inferior position for all individuals, nor does nasion always occupy the same anterior/posterior position for individuals, even in a specific population. If nasion is positioned in a abnormal anterior position the ANB angle will be falsely decrease. If nasion is positioned in a abnormal posterior position the ANB angle will be falsely increased, and neither direction would have any effect on the angle formed between the maxillary and mandibular teeth, nor the angle formed between the teeth and the occlusal plane. As the FH-OP angle steepens point B usually rotates down and back. This will result in an increase in the ANB angle, but again will have no effect on the relationship between the maxillary and mandibular teeth to each other or to the occlusal plane. The terms skeletal class I, II and III are defined by differing ANB angles; however, they have absolute nothing to do with the angular relationship between the teeth. They very accurately describe the shape of the profile, but do not necessarily accurately define the jaw relationship.
"Wits" is a measurement which accurately describes jaw relationships. "Wits" describe the jaw relationship as apical base class I, II and III. "Wits" is not effected by a high FH to OP angle or an abnormal positioning of nasion. The terms apical base class I, II and III are defined by differing "Wits" measurements. They accurately define jaw relationships, but make no statement in regard to the shape of the profile. Perhaps what is not recognized is that a person can have a rounded profile, skeletal class II, with an apical base class I jaw relationship. Also, a person can have a straight profile, skeletal class I, with an apical base class III. A rounded profile is no more or no less abnormal than a straight profile, and a straight profile is no more or no less normal than a rounded profile. A retrognathic mandible is not always deficient. If a pre-adjusted bracket system is utilized, ANB should not be the determining measurement to establish jaw relationships. If the above in understood, then it must be understood that as the "Wits" measurement changes the bracket base inclination, needed for optimum treatment results, will need to change appropriately. It should be obvious that a "Wits" measurement of +3mm will require different bracket base inclinations than will a "Wits" measurement of -3mm. Not all orthodontist utilize cephalometrics. Not to use cephalometrics when your appliance is a pre-adjusted bracket system makes no sense. The Cannon Dual Plane Cephalometric Analysis is an analysis developed specifically to determine apical base relationships between the arches and its ramifications on treatment. It places the importance on the occlusal plane that here-to-fore has been placed on the S-N plane. Illustration 4: The effects of variations of cranial base length on ANB and Wits.
Variations in cranial base length alters the ANB angle even though there have been no changes in the relationship between the arches. The Wits measurement is not effected by changes in cranial base length. Illustration 5: The effects of variations of the SN-OP angle and cranial base length on ANB and Wits
The ANB angle is altered by variations in cranial base length due to the abnormal position of nasion, and the steepness of the SN - OP angle; the Wits measurement is not altered. Surprising, there are a relative large number of apical base class III discrepancy cases that have a straight profile. Finishing these cases with the apical base class III discrepancy is necessary since surgical correction would result in unacceptable changes in the profile. It appears that mandibular growth is such that pogonion does not rotate posteriorly and inferiorly, but remains in a forward position. In all these cases the OP-SN angle is well above the accepted norm. It must be concluded that a straight profile does not always result in an apical base class I relationship between the arches. The Wits measurement will usually be -4mm or less. ANB is usually around 0 to 2mm. Again ANB describes the profile and Wits gives the relationship of the arches.
Illustration 6: High OP-SN; straight profile OP-SN = 24 degrees ANB = 0 degrees Wits = -4mm
Since the ANB angle makes no distinction between a deficient mandible and a retrognathic mandible, these two terms have become almost synonymous. Therefore, any mandible that is retrognathic has been generally thought of as being deficient. Convex profiles due to high SN - OP angles quite often have an ANB of at least +6 degrees, but with no apical base discrepancy between the arches. The confusion has resulted from the false idea that by comparing angular measurements of both the maxilla and the mandible to cranial base (SNA, SNB), the linear relationship of the maxilla to the mandible will be represented by the ANB angle. As the SN-OP angle gets steeper the maxillary/mandibular complex rotates in a clockwise direction. Point B rotates with the maxillary/mandibular complex to create a larger ANB angle without changing the relationship between the arches. It must be understood that as the maxillary/mandibular complex rotates clockwise, the relationship between the maxillary teeth and the mandibular teeth do not change. The inter-incisal angle does not change, nor does any angle formed between the teeth and the occlusal plane change.
Illustration 7: High OP-SN; angle convex profile OP-SN = 24 degrees ANB = +6 degrees Wits = 0 mm
Convex profiles due to a high SN-FOP angle are no more or no less abnormal than straight profiles. It also must be concluded that a convex profile does not always indicate a deficient mandible. The Wits measurement is established by drawing a line that is perpendicular to the occlusal plane that originates at point B and proceeds past point A; the distance, in millimeters, between the line and point A is referred to as the Wits. If point A is anterior to the line, the Wits measurement is positive, if posterior to the line, the Wits measurement is negative. If the Wits falls within a +2 to 2 millimeter range, this would indicate an apical base class I. The "torque" and "angulation" angles of the pre-adjusted brackets are adequate to treat the case successfully. If the Wits falls outside the +2 to -2 parameter, this indicates that there is an apical base discrepancy between the arches of such a magnitude that dental compensation is necessary to achieve maximum interdigitation of the teeth. The important factor regarding the Wits analysis is that the functional occlusal plane is utilized to establish the apical base relationship between the maxilla and mandible. Once the teeth are aligned and the arches leveled, the occlusal plane and the plane of the archwire ( archwire inserted into the pre-adjusted slots of the brackets) become parallel. Therefore, the angles created between the teeth and the plane of the archwire inserted into the pre-adjusted slots will be the identical angles formed between the teeth and the functional occlusal plane. Illustration 8: Demonstrates that once the arches are level, the occlusal plane and the archwire, in the edgewise slots, is parallel.
Illustration 9: Wits Analysis as an indicator of the correct angle needed between the long axis of the maxillary and mandibular central incisors to the occlusal plane to accomplish maximum interdigitation between the teeth.
The Wits analysis gives a good indication of what the angle formed between the long axis of the maxillary and mandibular incisors to the occlusal plane should be to achieve maximum interdigitation of the teeth. Illustration 10: Demonstrates apical base class I, (A) II (B) and III (C).
Illustration 11: Dental compensation to achieve maximum dental interdigitation.
Wits = 0mm
Wits = + 4mm
Wits = - 4mm
We in orthodontics must accept the fact that the concept of the pre-adjusted bracket is impractical in apical base class II and III cases. Even if the base inclination of the incisors could be of such angles that the needed dental compensation could be achieved, the angulation angles in the cuspids and bicuspids must be addressed. Bracket inventory would be unmanageable, and where is the crystal ball that determines which bracket is used and on each tooth.
A bracket sytem with the pre-adjusted edgewise slot, and also a slot which allows for the controlled tipping of the individual tooth is needed. The Cannon Ultra bracket is such a bracket. Summary
1. The Straight Wire concept is not adequate when treating apical base discrepancy cases. The pre-determined angles between the teeth and the occlusal plane must be customized by utilizing dental compensation for the individual case. 2. The Wits Analysis gives a much clearer picture of arch discrepancies than does the ANB angle. 3. A convex profile, due to a high FH - OP angle, is no more or no less abnormal than a straight profile. 4. All retrognathic mandibles are not deficient. 5. A straight profile does not always indicate harmony between the arches. 6. Harmony between the arches can occur with a convex profile. 7. The shape of the profile is not a valid indicator on whether or not the pre-adjusted bracket system is adequate to establish optimum treatment results.
Cannon Brackets | Bracket Design
Bracket Design
GENERAL BRACKET DESIGN
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Dr. Charles Burstone has clearly explained the adverse effects that can occur on adjacent teeth as a result of placing a continuous archwire in the edgewise slot of brackets on tipped teeth. There are three major factors that control the magnitude of force exerted on the adjacent teeth. The three factors are as follows; the dimension of the vertical opening of the archwire slot, the mesial-distal width of the slot and the degree of tipping of the tooth. Illustration 1: Adverse forces
http://www.cannonbrackets.com/index.php?id=3&type=design (1 of 22)6/20/2007 10:08:54 AM
A . 016 archwire in .018 slot of a typical narrow edgewise bracket Width .050 - There can only be approximately 1 degree of tip of the tooth before adverse forces effect adjacent teeth when a continuous archwire is placed in the arch. B . 016 archwire in .022 slot of a typical narrow edgewise bracket Width .050 - There can be approximately 7 degrees of tip of the tooth before adverse forces effect adjacent teeth when a continuous archwire is placed in the arch. C . 016 archwire in an archwire slot with a .035 vertical opening. Width .050 - There can be approximately 20 degree of tip of the tooth before adverse forces effect adjacent teeth when a continuous archwire is placed in the arch The vertical dimension of the edgewise slot, the width of the edgewise slot, and the size of the archwire determine how far the tooth can be tipped before adverse forces are exerted on the adjacent teeth when a continuous archwire is inserted in the arch. Illustration 2: Bite closure due to extrusive force on anterior teeth due to tipped cuspid
Increasing the vertical dimension of the edgewise slot would make it necessary to increase the vertical dimension of the archwire to take advantage of the pre-adjusted quality of the edgewise slot. Also, reducing the mesial distal dimension of the bracket would make it more difficult to correct and hold rotations. Therefore, there would be no net gain in solving bracket related treatment problems. Illustration 2 demonstrates what happens when a continuous archwire is inserted into an arch where the cuspids and bicuspids are already tipped. Illustration 3: Angulation angles as relates to Apical base class I, II and III
Apical Base Class I
Apical Base Class II
Apical Base Class III
Before the maxillary bicuspid and cuspid axial inclinations can altered when utilizing the standard angulation in the cuspid and bicuspid brackets, the incisors must be intruded, and the first molar must be extruded. In the mandibular arch the opposite would need to occur. That is, before the cuspid and bicuspid axial inclination can be altered the incisors would need to be extruded and the first molar intruded. The same concept applies when treating apical base class II cases.
Optimum interdigitation of the teeth can be establish in apical base class II and III cases through dental compensation. Dental compensation is easily accomplished by utilizing the interactive slot. Modifying the axial inclination of the maxillary and mandibular incisors alone is not adequate when treating moderate apical base class II and III cases.
Cannon Ultra Bracket System Illustration 4: Mid-line cross-sectional view of a bracket
Notice that without the steel ligature tie in place the archwire is easily inserted into the interactive slot. However, once the archwire is inserted into the interactive slot and the steel ligature is placed, the archwire cannot become disengaged. The steel ligature tie prevents the archwire from coming out of the interactive slot. When used in this manner, the steel ligature tie functions quite differently than the steel ligature tie when used with the pre-adjusted edgewise bracket. With the pre-adjusted slot it is the tensile strength of the steel ligature tie (resistance to stretching) that holds the archwire in the pre-adjusted edgewise slot. The steel wire used as an orthodontic ligature tie is prone to stretching, since it is a small gauge wire that is very ductile and with little temper. When the steel ligature tie is used to hold the archwire in the vertical slot there are no longitudinal (stretching) forces on the steel ligature tie. The force exerted on the steel tie is one of compression. It takes far greater force to compress the steel ligature tie than to stretch it. The exact same principles apply to the use of elastomeric "O" rings and power chains. The interactive slot of the Cannon Ultra bracket is unique in that the archwire is held into the interactive slot utilizing the same elements employed when securing an archwire into the pre-adjusted slot, but with considerable less friction between the archwire and/or the bracket and ligature tie. Illustration 5: Archwire ligation in the interactive slot for reduced friction
(A) Demonstrates the manner in which an archwire is ligated into the interactive slot with a steel ligature tie. It is a figure eight tie with the ligature tie crossing as near the junction of the "T" hook and the stem on the bracket as possible. The stem gets wider as it goes toward the edgewise slot, therefore the ligature tie can not move in an occlusal direction and put pressure on the archwire thereby increasing friction. (B) Shows the side view of the interactive slot with an archwire being held into place with a steel ligature tie. The distance from the steel ligature tie to the tooth side of the interactive slot is of such a dimension that the archwire cannot become disengaged. The archwire is .016. There is considerable distance from the archwire to the steel ligature tie. The steel ligature tie becomes the fourth side to form a .018 x .035 tube. Compare to illustration 4. Illustration 6: Ligature configurations
The maxillary second bicuspid demonstrates a steel ligature tie securing an archwire in both the edgewise slot and the interactive slot. The maxillary first bicuspid shows an "0" ring securing both archwires in place. The mandibular bicuspids shows an "0" ring securing an archwire in the interactive slot. A power chain will secure both archwires in separate slots or a single archwire in either slot. Illustration 7: Low Friction en masse retraction ligature tie configuration
The configuration is that of a continuous figure eight tie. Each time the ligature tie passes the "T" hook wrap the tie around the junction between the "T" hook and the stem. Beginning with the left cuspid wrap the tie around the "T" hook then go under the occlusal tie wings of the left lateral and then go up and wrap the tie around the "T" hook on the left central. Continue with this procedure until the tie is wrapped around the "T" hook of all anterior brackets. The ligature does not need to be excessively tight. This will prevent space from opening between the anterior teeth and reduce friction. The bicuspids have the usually low friction steel ligature tie previously described. Illustration 8: En masse retraction utilizing power chain
Since the initial retraction is primarily tipping of the anterior teeth, friction between the round archwire and the interactive slot is not of primary concern unless it is a maximum anchorage case. Therefore, in most retraction cases a wide power chain from cuspid to cuspid is usually adequate. Always use the low friction steel ligature for the bicuspids.
Illustration 9A: Cannon Ultra Bracket System -- Maxillary Arch -- Left Quadrant
Illustration 9B: Cannon Ultra Bracket System -- Mandibular Arch -- Left Quadrant
I. D. Color Chart for Cannon Ultra Bracket System
Brackets and Buccal Tubes As with the "torque" and "angulation" angles of the pre-adjusted edgewise bracket, there is no single set of measurements that will establish the proper occlusal gingival position of the brackets and buccal tubes for all cases. The occlusal gingival length of the clinical crowns vary for different individuals, therefore bracket and buccal tube placement must be individualized for each case. It is true that there is no single set of measurements that will fit all cases, however there are some guidelines that seem to apply to all cases. The mesial distal center of the bracket should be placed on the mesial distal mid-line of the clinical crown of the teeth. The mesial distal center of the buccal tube, however, is placed over the facial buccal grove. The occlusal-gingival center of the edgewise slot of the brackets and buccal tubes should be placed, as near as possible, to the facial axis point. The facial axis point is that point on the facial axis which separates the gingival half of the clinical crown from the occlusal half. If the brackets are properly
placed in this manner, anterior guidance with cuspid rise will be established. Sequence for Placement of Brackets and Buccal Tubes The buccal tubes for the mandibular first molars are placed first. The design of the buccal tubes is such that the edgewise slot is placed into the most occlusal portion of the buccal tube. This design makes it easy to place the buccal tube in its proper occlusal-gingival position without creating occlusal interference with the maxillary first molar. The buccal tubes are then placed on the maxillary first molars. Maxillary and mandibular bicuspid brackets are placed next. Great care should be taken to make sure that the edgewise slot of the brackets align with the edgewise slot of the buccal tubes. Unlike the brackets, there are no tie wings on the buccal tubes, therefore, visually it might appear that the brackets are placed more occlusally than the buccal tubes. The remaining brackets can be placed in any sequence desired, making sure that the brackets are properly placed as described above. The second molar buccal tubes are placed in the same manner as was the first molar tubes. The key to a successful strap-up is the proper positioning and alignment of the first molar buccal tubes and the bicuspid brackets. Bite Opening: Pre-adjusted edgewise Bracket vs. Cannon Ultra Bracket One of the objectives of the design of the Cannon Ultra bracket system is to have a narrow interactive slot (.050 M/D x .035, O/G) in conjunction with the pre-adjusted edgewise slot, which can be utilized to align and correct rotations of teeth with minimal adverse forces on the adjacent teeth. When correcting rotations the interactive slot gives metal to metal contact between the archwire and the bracket to hold the archwire firmly in the slot. Whereas the pre-adjusted edgewise slot must rely on some type of tie, either steel or elastomeric, to hold the archwire in the slot. The interactive slot is also much more efficient in bite opening procedures than the pre-adjusted edgewise slot. When the reverse curve bite opening archwire is inserted into the narrow deep interactive slot the action of the archwire is exerted on the teeth. When the reverse curve bite opening archwire is inserted into the wide pre-adjusted edgewise slot the action of the archwire is exerted primarily on the brackets. Illustration 10: . 018 reverse curve nickel titanium archwire
A. A .018 reverse curve archwire is engaged into the .018 pre-adjusted edgewise slot of the bicuspid and cuspid brackets. The archwire is not engaged into the pre-adjusted edgewise slot of the central and lateral brackets. Note that there will not be any intrusive force exerted on the centrals and laterals when the archwire is engaged. The wide (.135 M/D x .018 O/G) archwire slots of the bicuspids and cuspids flatten he archwire. The force is exerted on the brackets instead of the teeth. B: A .018 reverse curve archwire is engaged into the interactive slot (.050 M/D x .035, O/G) of the bicuspids. The archwire is not flattened and when engaged into the interactive slots of the cuspids, centrals and laterals the intrusive force will increase in magnitude from the cuspids to the centrals.
En Masse Retraction with the Pre-adjusted Bracket For many years looped archwires have been used extensively with the edgewise appliance when retracting anterior teeth. The advent by Dr. Andrews of the "Fully Programmed Translation Brackets" with anti-tip and anti-rotation built into the placement of the pre-adjusted slot in the brackets was an attempt to replace the looped archwires utilized for anterior retraction. The "Fully Programmed Translation Brackets" were not an overwhelming success. The anti-tip and anti-rotation functions were an attempt to overcome problems associated with retracting anterior teeth utilizing a single straight archwire in the edgewise slots. The anti-tip and anti-rotation functions actually make finishing the case more difficult. They are counterproductive in the final alignment of the teeth.
Looped archwires continue in wide use today for the retraction of the anterior teeth. They are designed so that a force system can be established to retract the anterior teeth bodily. A balance must be accomplished between the "torque" forces and the retraction forces to prevent the anterior teeth from tipping instead of the desired bodily movement. If the forces are not balanced, the anterior teeth will tip distally, the bite will close, and the posterior teeth will move forward and close the extraction site before a class I relationship is achieved. The looped archwires are numerous and vary as to size, shape and complexity. They can be extremely difficult to properly adjust and maintain. A recent article in an orthodontic trade publication advertising looped archwires showed a sampling of looped archwire designs utilized in orthodontics. Illustration 11: Samples of looped archwires
En Masse Retraction with the Cannon Ultra Bracket The Cannon Ultra Bracket System utilizes two archwires simultaneously so that bodily en masse retraction of the six anterior teeth can be accomplished without complicated archwire configurations and/or external anchorage. Once the teeth are aligned so that a .018 steel archwire can be inserted into the interactive slots of the maxillary and mandibular teeth along with a .018 x .025 nickel titanium in the pre-adjusted edgewise slots, retraction of the anterior teeth can begin. A bi-lateral gable bend of approximately 25 degrees is placed into the .018 steel archwire in the middle of each extraction site. Power chain along with elastics, if needed, are used to retract the anterior teeth. The rigidity of the steel archwire with the gable bends, will not allow the nickel titanium archwire to bow in a gingival direction in the extraction regions. In fact, the dental arch and the nickel titanium archwire will take on the shape of the steel archwire. Therefore, the cuspids cannot tip distally, nor can the bicuspids tip mesially beyond the "angulation" angle buit into the pre-adjusted slot of the brackets. The centrals and laterals cannot tip lingually beyond the "torque" angle built into the pre-adjusted slot of the brackets. View step by step treatment procedures in the Case Review heading at Home Page. Illustration 12: Bodily en masse retraction
Customizing "Torques" and "Angulations" The interactive slot of the Cannon Ultra Bracket System is utilized to establish the dental compensation needed to establish optimum interdigitation of the teeth in apical base discrepancy cases.
View step by step treatment procedures in Case Review at Home Page.
Illustration 13: Apical Base Class III; Wits = -7.6mm
Cannon Brackets | Cephalometric Analysis
Cephalometric Analysis
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DualPlane Cephalometric Analysis

The Cannon DualPlane Cephalometric Analysis uses two planes: 1. Occlusal plane (as defined by Jacobson), draw a line that joins the midpoint of the overlap of the mesio-buccal cusp of the first molar and the buccal cusp of the first premolar). 2. A line joining A point to Pogonion . The occlusal plane is used in establishing the linear, apical base, relationship between the maxillary and mandibular arches, and the facial lingual inclination of the maxillary and mandibular incisors. The A point - pogonion plane is use to establish the anterior posterior position of the maxillary and mandibular incisors, the relationship of the soft tissue to the dental arches, and the relationship of the middle face to the lower face. It must be remembered that the average given for all cephalometric measurements are just averages, not standards. It is always better, when evaluating cephalometric measurements, to compare the variances from their average rather than just comparing all the actual measurements. In narrowly defined populations all like angles, and like linear measurements are not always the same. Any properly selected sample of individuals will be distributed along the Bell curve. When the average is established is is possible that no single individuals measurement of any
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angle or any linear distance will be the same as the average of all the individuals in the selected population. The diagnostic measurements of the Cannon DualPlane Cephalometric Analysis are divided into three categories; Skeletal, Dental and Soft Tissue. Illustration1: Tracing of a cephalometric xray utilizing the Cannon DualPlane Analysis
Skeletal 1. Wits The Wits Analysis is used to establish the apical base relationship between the maxillary and the mandibular arches as measured along the Jacobson occlusal plane. The Wits measurement is established by drawing a line from A point and B point, that proceeds perpendicular to the Jacobson occlusal plane. If the B point line
intersects the occlusal plane posterior to the A point line the Wits measurement is postive. If the B point line intersects the occlusal plane anterior to the A point line the Wits measurement is negative. The millimeter distance between the lines is the Wits measurement. Zero to plus one millimeter Wits is considered ideal. A Wits of minus 2 to plus 2 millimeters is considered as apical base class I. Over plus two, Wits is considered as apical base class II. Less than minus two, Wits is considered as apical base class III. Since the vertical overbite is not arbitrarily bisected as with the Downs occlusal plane, a more accurate evaluation as to the cause of the abnormal overbite can be established. ( Note: If the first bicuspid is not present, use the first primary molar). The Wits lets you know if the case can be finished utilizing the predetermined angles of the pre-adjusted appliance or if it is necessary to modify these angles through the utilization of the vertical slot or if the discrepancy is so great that surgery is necessary. If the SN - Mp angle is low to average and the Wits is as much as a negative 4 millimeters, surgery might be indicated. However, if the SN - Mp angle is high and the Wits measurement is as much as a negative four millimeters, surgery might be contraindicated since more than likely the patient will already have a straight profile. 2. Frankfort horizontal to Occlusal plane This angle indicates the spatial relationship of the maxillary/mandibular complex to the total face. 3. A point - pogonion to Frankfort Horizontal This measurement is the superior posterior angle formed between the intersection of the Frankfort Horizontal and the A point - pogonion plane. This measurement gives the relationship between the middle and lower face. If the Frankfort plane is considered the true horizontal plane of the face, then the ideal measurement would be 90 degrees. As this angle increases above 90 degrees the convexity of the face increases. As the angle decreases below 90 degrees the face becomes more concave. This measurement should react with the Wits measurement. As Wits increases this measurement should increase and vice versa. The exception to this general rule is in high SN to Mp angle cases where the profile is straight. The Wits can be considerably above the average and have an average A point - pogonion to Frankfort Horizontal angle. In these cases the linear measurement of Porion to B point will be unusually high. 4. Sella turcica - Nasion 5. Porion - Nasion 6. Porion - A point
These three linear measurements establish the relationship of the maxilla to cranial base. In apical base discrepancy cases, these measurements help to establish whether or not the maxilla is contributing to the discrepancy by being improperly developed and/or positioned. If Frankfurt horizontal is accepted as the true horizontal plane of the face, and if Pr - Na and Pr - point A are of equal length, then Na and point A must occupy the same anterior/posterior vertical plane. If Pr - point A is shorter than Pr - Na with Na positioned properly, then the maxilla is positioned posterior to Na. If Wits is a minus three millimeters or less, this would strongly suggest a deficient maxilla. If Wits is plus one millimeter or greater, perhaps Na is simply positioned anteriorly and the maxilla is therefore not deficient. 7. Pr - B point This measurement establishes the length of the mandible without consideration as to the direction of growth or the anterior/posterior position of pogonion. A straight profile does not necessarily indicate that the mandible and maxilla are balanced. Mandibular length and the shape of the profile are not necessarily related. Pr - B point can be used in conjunction with Wits, the SN - Mp angle to evaluate convex profiles. As previously stated, convex profiles as a result of a high SN - Mp angle usually have a Wits measurement of such a dimension that it would indicate an apical base class I between the arches. In these cases, the Pr - B point measurement should have the same variance from its average as does the Pr - A point measurement. Convex profiles, as a result of a deficient mandible, should have a Pr - B point measurement with a variance from its average greater than the variance of the Pr - A point measurement from its average. Variance being defined and expressed as the plus or minus difference between any linear measurements of a given patient, when compared to its appropriate average as established from a like population Since people of the same age and sex are not necessarily all equal in size, cephalometric comparisons of linear measurements to averages for a given population are limited in value. If, however, we compare the variances to each other, a more accurate comparison of the linear measurements of a single individual can be accomplished. Therefore, when evaluation S - Na, Pr - Na, Pr - point A, and Pr - point B, do not compare their actual lengths, but rather, compare their variances. Note: Dual Plane cephalometric measurements, seven, eight, nine and ten above, were derived in an unpublished study, by calculating the average of these measurements taken from lateral head plates of 250 patients. These patients were categorized by age and sex. All the patients were considered to have a good anterior/posterior balance between nasion, A point and pogonion. The anterior/posterior relationship between nasion A point and pogonion was established as follows: A vertical line perpendicular to Frankfurt horizontal that passes through A point was drawn. If both nasion and pogonion were within plus or minus two millimeters to this line, the patient was considered to have a good anterior/posterior balance between nasion, point A and
Pogonion. It appears that a straight profile is considered more aesthetically pleasing than a convex profile; however, this does not mean that all convex profiles are abnormal. Successful orthodontic treatment many times shall and will result in a convex profile.
Dental 1. UI - LI 135 degrees is considered ideal. 2. UI - OP 60 degrees is considered ideal.

3. LI - OP 75 degrees is considered ideal. Note: These are the pre-determined "torque" angles that are established when finishing cases with full size rectangular archwires while utilizing the so called Roth Torque. These angles vary according to which "Straight Wire" prescription is utilized. It must be understood that these predetermined angles are best suited for apical base class I cases. In apical base class II and III, UI - OP and LI - OP must be customized. In cases that finish with an apical base class II relationship, the lower incisor to OP angle will be less than 75 degrees with the upper incisor to OP increasing above 60 degrees. The reverse of this would be true in cases that finish with an apical base class III relationship. The upper incisor to the lower incisor should remain approximately 135 degrees. 4. UI - A point - pogonion plane (Maxillary incisor protrusion) Plus three to four millimeters are considered as being ideal. With apical base class II ands III cases, the angle formed between the long axis of the UI and OP might be a better indicator. 5. LI to A point - pogonion plane (Mandibular incisor protrusion) Plus two to three millimeters are considered ideal. Apical base class I cases, treated with lower incisor placement within two to plus three millimeters of the plane demonstrate maximum stability. This measurement is used to determine the degree of retroversion or protrusion of the lower incisors. In apical base class II and class III cases, this measurement can be misleading. This is due to the change in the anterior/posterior relationship between pogonion and A point. In apical base class II ands III cases, the angle formed between the long axis of the LI and OP might be a better indicator. Variances in the size of the chin button can also affect this measurement. 6. Incisor vertical overbite When utilized in conjunction with Jacobsons occlusal plane, it establishes which incisor teeth need to be intruded in those case where bite opening should be accomplished by intrusion of the anterior teeth. 7. Incisor horizontal overbite This measurement establishes the horizontal overbite between the maxillary and mandibular incisors, and
should be related to the difference in the maxillary and mandibular incisor protrusion measurement. Soft Tissue 1. Upper lip to A point - pogonion 2. Lower lip to A point - pogonion 3. Soft tissue pogonion to A point - pogonion 4. Superior labial sulcus to A point - pogonion These four measurements establish the relation of the soft tissue to the A point - pogonion plane. Again, the best procedure is to establish the the variance of each measurement from its average and compare the variances. These measurements are not affected by convex or concave profiles nor large or small chin buttons or noses. Hopefully, the Cannon DualPlane Cephalometric Analysis will help to point out that some assumptions that are routinely made in orthodontics are false assumptions. For example: (1) straight profiles always result in linear balanced arches; (2) all cases with an ANB of plus six degrees must have deficient mandibles; and (3) all convex profiles are abnormal.
Cannon Brackets | Treatment Procedures
Treatment Procedures
Introduction to Treatment
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It is not the intent of the author to set forth a procedure manual on edgewise orthodontic treatment. The intent is to suggest procedures utilizing an interactive archwire slot that will augment the pre-adjusted edgewise slot during treatment of particular problems. It is assumed that the practitioner will be well versed in edgewise mechanics utilizing the pre-adjusted bracket system. The interactive slot is unique in that the archwire is held into the interactive slot utilizing the same elements (steel ligature tie, "O" rings and power chain) employed when securing an archwire in the pre-adjusted edgewise slot. The following is a discussion on when, where and how the interactive slot can be utilized to make orthodontic treatment faster and simpler. TREATMENT The objective of the Cannon Ultra Bracket System is to add to the pre-adjusted edgewise bracket an interactive slot which will make existing concepts of treatment easier and enable new concepts of treatment
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not possible with the pre-adjusted edgewise slot alone. With the addition of the interactive slot the following can be accomplished; 1. Leveling of the arch and alignment of tipped teeth is accomplished without exerting adverse forces on the adjacent teeth, and/or bite closure. 2. The interactive slot opens toward the gingiva. Rotational corrections are corrected much faster because the rotational force of the archwire is generate by non-yielding metal to metal contact between the archwire and the bracket. Insertion of the archwire into the interactive slot is easy and once inserted, unlike the edgewise slot, it tends to stay in place making ligation of the archwire easy. 3. Bite opening can be accomplished more efficiently by utilizing the interactive slot. The narrow mesial distal dimension (.050) and the wide vertical dimension (.035) of the interactive slot allow effective intrusive force to be placed on the six anterior teeth. 4. Bodily en masse retraction of the anterior teeth in extraction cases without external anchorage and /or complicated archwire configurations can be easily accomplished. 5. Differential resistance between the maxillary arch and the mandibular arch or within the same arch can be established by utilizing the pre-adjusted edgewise slot in the arch or teeth needed for anchorage and the interactive slot in the arch or teeth where retraction or protraction is needed. 6. Dental compensation needed to establish maximum interdigitation of the teeth in apical base class II and III discrepancy cases can be easily accomplished.
Mechanics of Bite Opening
Reverse curve archwires are commonly used in bite opening procedures. However, their effectiveness is degraded by the narrow vertical dimension and wide mesial/distal dimension of the edgewise slot. Their effectiveness is further degraded if the cuspids are distally tipped. The wider and the more vertically narrow
the edgewise slot, the more of the action of the archwire is exerted on the bracket itself, instead of the teeth. The only portion of the archwire that works on the teeth is the arch-length between the brackets. The length of the archwire engaged in the edgewise slot acts on the slot, not the teeth. Illustration 1: Bite Opening
.016 reverse curve archwire in .018 pre-adjusted slots The reverse curve .016 nickel titanium archwire exerts little or no intrusive force on the incisors and/or cuspids when placed in the pre-adjusted edgewise slots. The narrow vertical opening of the edgewise slot in conjunction with the wide mesial distal dimension flattens out the archwire. The slight distal tip of the cuspids further flattens out the anterior bow of the reverse curve archwire. Note: The archwire is not touching the brackets on the centrals and laterals.
.016 reverse curve archwire in .035 interactive slots The reverse curve .016 nickel titanium archwire placed in the interactive slot clearly exerts an intrusive force on the incisors and the cuspids. The interactive slot is narrow mesial/ distal (.055) and the vertical opening is .035. The distally tipped cuspid has no effect on the archwire. Illustration 2 : When a greater magnitude of force is needed. A .016 steel archwire is used in the interactive slot with bi-lateral gable bends in the archwire between the cuspid and the bicuspid, as near to the bicuspid as possible. This archwire will produce an extrusive force on the posterior teeth and an intrusive force on the six anterior teeth. No rotating force on canines. Bite opening and cuspid class II correction is accomplished much faster. The same archwire configuration can be used in the mandibular arch. A .016 or .018 steel archwire can be used depending upon the forces required to open the bite.
Illustration 3: Bite Opening with the interactive slot.
Maxillary Arch: .016 steel archwire inserted into interactive slots with bi-lateral gable bends between bicuspids and cuspids, initial archwire placement. Mandibular Arch: Flat .014 nickel titanium archwire in edgewise slot. Six weeks Later
Bite Opening: Correcting Anterior Rotations In those cases where there is minimal horizontal overbite with significant vertical overbite, bite opening should be accomplished first before proceeding with rotational corrections in the mandibular anterior teeth. Both the maxillary and mandibular anterior teeth are thicker in the labial-lingual dimension at the gingival junction than they are at the incisal edge. Many times just opening the bite gives the necessary space to align the mandibular anterior teeth. Illustration 4: Bite Opening and Rotation Corrections
A. Closed Bite with no anterior-posterior space to properly align mandibular anterior teeth. B. Opening bite generates anterior-posterior space between the facial surface of the mandibular incisors and the lingual surface of the maxillary incisors. Arch Leveling: As Relates to "Torque" (Base inclination) The bite should be leveled to the point whereby a straight archwire will pass through the edgewise slot of the bicuspids, cuspids, laterals and centrals in both arches without being deflected in an occlusal direction. If a .018 x 25 archwire must be deflected toward the incisal to engage into the brackets on the central and laterals, the full base inclination built into the central and lateral brackets by the manufacturer will not be realized. Illustration 5: Arch leveling and "Torque"
There is 10 degrees of "torque" not realized due to the arch not being level. Lines C and D are parallel. If the archwire is deflected toward the gingival, the "torque" angle would be increased in proportion to the degree the archwire is deflected. The flexible nickel titanium archwire is a good addition to the types of archwires available to the practitioner when correcting rotated or maligned teeth. However, due to its flexibility the nickel titanium archwire is not the archwire of choice for arch leveling. The use of a steel archwire in the interactive slot with gable bends between the cuspids and bicuspids, in conjunction with a nickel titanium archwire in the pre-adjusted slot can be used to leveling the arch. Rotational Corrections The advent of the new more flexible archwires has open up new possibilities in the mechanics of rotating teeth. The more flexible ones have made it easier to engage the archwire into the edgewise slot. However, the major problem associated with correcting rotated teeth with the edgewise slot has not changed. The major problem has not been the engagement of the archwire into the bottom of the edgewise slot of the bracket on the rotated tooth, but rather keeping it there. Steel ligatures are very often used to hold the wire in the edgewise slot, but more often than not the pressure against the tie by the archwire results in the tie
stretching so that the archwire does not stay at the bottom of the edgewise slot. Elastomeric "O" rings are not usually strong enough to hold the archwire in the bottom of the edgewise slot. Too often, the bracket on the rotated tooth is dislodged in the effort to set up a force system to align the rotated tooth. Illustration 6: .016 nickel titanium in the interactive slot
Initial archwires .016 nickel titanium
Ten weeks later with .018 nickel titanium
The Cannon Ultra Bracket System establishing a force system to align a rotated tooth by inserting a flexible, small gauge archwire in the interactive slot of the brackets and buccal tubes. This process is much easier than employing steel ties, rotating wedges or springs. With metal to metal contact between the archwire and the bracket there is no possibility of the rotating force dissipating due to the stretching of the steel tie or the "O" ring. Power chain was added to speed up rotation. Differential Resistance
It is generally accepted that it requires considerable more force to move a tooth in a bodily fashion, than it does to tip a tooth. The greater force required for bodily movement will present a greater drain on the anchorage system. The greater force needed is due in part to the friction of the bracket against the archwire. Since the Cannon Ultra Bracket System has both a pre-adjusted edgewise slot for bodily movement and a interactive slot for tipping, differential resistance can be set up by simply selecting the edgewise slot for the anchorage teeth and selecting the interactive slot for the teeth to be moved. Differential resistance being defined as two separate units being acted upon by the same force and the result being that one unit is the primary movement unit. This can be accomplished either intra-arch or inter-arch. An example of intra-arch differential resistance would be in an extraction case where the anterior teeth need to be retracted posteriorly. The archwire is engaged into the edgewise slot in the posterior teeth and into the interactive slot in the anterior teeth. An example of inter-arch differential resistance would be in a case where the maxillary teeth need to be distalized but with little or no anterior movement of the teeth is desired in the mandibular arch. The mandibular teeth would have the archwire engaged into the edgewise slot and the maxillary arch would have the archwire engaged into the interactive slot. Still another example would be a case where the maxillary posterior teeth need to be moved forward. Non-Extraction Treatment These are usually very simple cases to treat. The important thing is to determine why the cuspids are in a class II relationship. The mandibular anterior teeth could be in retro-version or the maxillary anterior teeth could be flared, or a combination of both. Illustration 7: Combination of flared maxillary anterior teeth and retro-version of the mandibular anterior teeth. Molar class I, Cuspids class II Apical base class I (Wits = -2mm to +3mm)
The initial archwires were .016 nickel titanium inserted into the interactive slots to correct rotations and and align in the facial/lingual plane. The second set of archwires were .016 steel inserted into the pre-adjusted edgewise slots in the maxillary arch and in the interactive slots in the mandibular arch. The .016 steel archwire in the mandibular arch has bi-lateral gable bends between the cuspids and bicuspids to open the bite by intruding the mandibular incisors. Class II elastics were employed at this stage of treatment. The third set of archwires were .018 x .025 nickel titanium inserted into the pre-adjusted slots in both arches to finish the case. Light class II elastics were continued.
Molar Class II; Cuspids class II or non-erupted Apical base class I (Wits = -2mm to +3mm) These type cases usually present with molar class II as a result of the maxillary molars being positioned anteriorly. The canines can be non-erupted or crowded out to the labial or, if the four incisors are flared, there can be sufficient arch length for the canines to be fully erupted but class II. The teeth in the mandibular arch are usually in rather good alignment. The key to successful treatment is the distal movement of the maxillary posterior teeth, thereby making enough arch space for the proper alignment of the maxillary anterior teeth and establishing a class I occlusion. Great care should be taken not to move the mandibular teeth anteriorly. Anchorage Preparation in the Mandibular Arch
The arch should be leveled with all teeth up-righted and all rotations corrected. A .018 x .025 archwire should be placed in the pre-adjusted edgewise slots in the mandibular arch. The mandibular arch will become the anchorage arch. Once the above is accomplished, up to 4 oz. of class II elastic force can be utilized bilaterally, in association with a sliding yoke on the maxillary archwire, to move the maxillary posterior teeth distally without forward movement of the mandibular teeth. Procedures for the Maxillary Arch Brackets are placed only on the four incisors with buccal tubes only on the first molars. If the cuspids are fully erupted brackets should also be placed on them. While preparing the mandibular arch as the anchorage arch, align the maxillary arch so that a .018 steel archwire can be inserted into the interactive slot of the brackets and into the occlusal component of the buccal tubes. The .018 archwire is inserted through the eyelets of the sliding yokes and then the assembly is placed in the maxillary arch. (See illustrations 7 and 8) The archwire is allowed to project out from the distal surface of the buccal tubes as much as possible without causing irritation once turned in toward the molar. Depending on the amount of distal movement of the molars it may be necessary to replace the .018 archwire to allow for more distal movement of the molars. If the canines are erupted but crowded out to the labial adjust the .018 archwire is shaped to allow for the maligned canines. The distal movement of the molars will not be bodily. Some degree of tipping occurs. Over-correction of molar class I is necessary to allow for slight mesial movement of the crowns of the molars later in treatment. Approximately 4 oz of bilateral elastic force is attached from the elastic hook on the buccal tube to the hook on the sliding yoke to distalize the molars. Once the molars have been distalized to an over-corrected class I, the brackets are placed on the bicuspids and canines, if erupted, and begin the finishing alignment of the maxillary arch. Care should be taken to insure that the maxillary molars are not tipped but up-right and in a good class I relationship. Cases with flared anterior teeth usually presents with considerable horizontal overbite. Not only do the molars and bicuspids have to be move distally, the anterior teeth have to be move distally as well. The sliding yokes, along with the .018 steel archwire, are used in the same manner as discussed previously to distalize the maxillary molars. As the molar move distally the transseptal fibers tend to move the bicuspids distally as well. Do not try to move the anterior teeth distally at the same time as moving the molars. Once the molars are in an over-corrected class I, reduce the bi-lateral elastic force on the sliding yokes to two ounces of force and place an equal amount of force on the anterior teeth. This can be accomplished by holding the anterior teeth together with a wide power chain and hooking the elastic to the canine T hooks. Once the canines are in class I and the horizontal overbite is corrected, place the brackets on the bicuspids and proceed with finishing the case.
Fabrication of Sliding Yoke The sliding yoke is fabricated from .022 stainless steel wire. An eyelet is formed at one of the wire. The eyelet is then bent at a 90 degree angle from the long axis of the wire. A second eyelet is formed a measured distance from the first eyelet. The distance from the mesial end of the first molar buccal tube to the canine region and the distance between the two eyelets should be the same. The second eyelet is then bent 90 degrees from the long axis of the wire to the same side as the first eyelet. After the second eyelet is fabricated, continue bending the wire to form a hook in the shape of a fish hook. The shaft of the hook should be as long as possible without causing occlusal interference and the end of the hook should be bent in such a fashion as to accept an elastic without causing tissue irritation. The hook is positioned to the facial side of the sliding yoke. Therefore, there are left and right sliding yokes. The fabrication of the sliding yoke is such that the elastic hook is positioned near the occlusal plane not gingival to the canine bracket. This design will greatly reduce the vertical component of force of the class II elastics and thereby reduce the extrusion force on both the mandibular molars and the maxillary anterior teeth. Illustration: 8: Sliding Yoke
Illustration 9: Yoke in place
Pre-distalization
Post-distalization
APICAL BASE DISCREPANCY CASES Apical base discrepancy cases can present with a concave profile, a convex profile, or even a straight profile. The parameters for apical base discrepancy is; a Wits of more than + 3 mm is considered an apical base class II, and a Wits of less than - 2 mm is considered an apical base class III. A secondary measure helpful in determining apical base relationships is the linear distance between Porion and Pt B, compared to the linear distance between Porion and Pt A. If Porion to Pt B is less than 8 mm longer than Porion to Pt A, this would be further evidence of an apical base class II. If Porion to Pt B is as much as 14 mm longer than Porion to Pt A, this would be further evidence of an apical base class III. With apical base class III cases, it appears that the steepness of the OP - SN angle is a major determining factor as to the shape of the profile. The low OP SN angle cases usually present with a prognathic mandible, concave profile, and generally require surgery to correct the apical base class III. Surprisingly, a large number of high OP - FH angle cases present with basically a straight profile which precludes surgery, since going from a straight profile to a convex profile would be unacceptable to the patient. In the straight profile apical base class III cases, modification of the predetermined angles of the pre-adjusted edgewise brackets must be done to produce quality orthodontic treatment results. The case demonstrated in illustration 9 is of a case where quality orthodontic treatment was achieved without surgery or extractions by simply establishing custom "torques" for the maxillary and mandibular incisors, and custom "angulations" for the maxillary and mandibular canines and bicuspids (dental compensation). This case was treated exclusively with continuous archwires in the interactive slot/tube. Segmental archwires were
utilized in the edgewise slots of the brackets on the maxillary and mandibular four incisors to correct angulations. Pre-treatment: UI - FOP = 61 degrees and LI - FOP = 83 degrees. Post-treatment: UI - FOP = 55 degrees and LI - FOP = 79 degrees. Illustration 10: Apical base class III discrepancy Wits = minus 4.0 mm Porion to Pt A/Pt B difference = 15 mm
In illustration 9 dental compensation was utilized to accomplish maximum interdigitation between the teeth in this case, however, it is up to the practitioner to decide how far to carry the concept of dental compensation. In general, the higher the OP - FH angle, the higher negative Wits can be treated by dental compensation in apical base class III cases. The ability to easily utilize dental compensation to treat borderline apical base class II and III cases is definitely an advantage. Also, perhaps in conjunction with extractions, it gives the possibility to at least greatly improve those cases where surgery is the preferred treatment, but the family simply cannot afford the cost of surgery. DENTAL COMPENSATION FOR APICAL BASE DISCREPANCY The concept of using pre-adjusted edgewise brackets that establish a single set of predetermined angles between the teeth and the functional occlusal plane simply is not adequate for apical base class II and III discrepancy cases. These predetermined angles are adequate for cases that finish with an apical base class I relationship between the arches. However, in cases that finish with either an apical base class II or III discrepancy between the maxilla and the mandible, these predetermined angles of the pre-adjusted edgewise bracket systems must be customized. Not only does the "torque" in the brackets for the maxillary and mandibular four incisors need customizing, but the "angulation" in the brackets for the cuspids and bicuspids need to be customized for individual cases as well. This can be accomplished by the utilization of the interactive slot/tube component of the brackets and buccal tubes. The interactive slot has no predetermined "torques" and/or "angulations" built into the slot. By utilizing an archwire in the interactive slots of
the maxillary and mandibular arches, in conjunction with appropriate triangular elastics, class II or III, dental compensation can be easily accomplished. The dental compensation can occur primarily in one arch or in both arches. Illustration 11: Apical base class III, Wits = -4.6
UI - FOP = 58 deg. / LI - FOP = 80 deg. UI - FOP = 50 deg. / LI - FOP = 76 deg.
EXTRACTION TREATMENT Bodily en masse retraction of the anterior teeth with the pre-adjusted edgewise appliance can be difficult, requiring sophisticated closing loop configurations and external anchorage. If a retraction force, in conjunction with a continuous archwire, is used at such a magnitude that results in the gingival bowing of the archwire in the extraction site, the maxillary cuspids will tip distally, the second bicuspids will tip mesially and the maxillary incisors will be extruded proportionally to the degree of the tipping of the cuspids. The bowed archwire will actually decrease the torque angle of the centrals and laterals incisors and extrude them which will close the bite. Illustration 12: Effects of a gingival bowing archwire in the extraction sites
En Masse retraction with the Cannon Ultra System Utilizing the interactive slot in conjunction with the pre-adjusted edgewise slot, bodily en masse retraction of the six anterior teeth can be accomplished with the Cannon Ultra Bracket System without the mesial tipping of the bicuspids and the distal tipping of the cuspids which results in bite closure. Illustration 13A: Typical archwire setup for bodily en masse retraction
Note: The same archwire setup is used in both the maxillary and mandibular arches. Illustration 13 demonstrates a typical en masse retraction archwire set up for a dental class I bi-maxillary protrusion case with second molar attachments for anchorage. Second molar attachments are usually needed only in extreme bi-maxillary protrusion cases. Before beginning the retraction of the anterior teeth, the teeth in both arches should be aligned so that a .018 x .025 nickel titanium archwire can be inserted into the pre-adjusted edgewise slots and a .018 steel archwire into the interactive slots of the Cannon Ultra System. The .018 steel archwire is referred to as the Vertical Stabilization (VS) archwire. It has a gable bend distal to each cuspid to a degree that if laid on a flat surface the apex of the gable bent projects approximately three to four millimeters above the surface, approximately 25 degree bends. The steepness of the gable bends can be adjusted for individual cases. If during en masse retraction, the bite begins to close, the steepness of the gable bends should be increased. If during en masse retraction the bite becomes open, the steepness should be decreased. The VS archwire is always inserted into the interactive slots/tubes of the Cannon Ultra Bracket System. During en masse retraction of the anterior teeth the VS archwire is used in conjunction with a .018 x.25 nickel titanium archwire that is inserted into the pre-adjusted edgewise slots of the Cannon Ultra Bracket System. This .018 x .025 nickel titanium archwire is referred to as the Universal Auxiliary (UA) archwire. The function of the VS archwire is to maintain the bite open during any procedure that results in extrusive forces being exerted on the anterior teeth. It also prevents distal tipping of the cuspids and mesial tipping of the bicuspids and first molars. The function of the UA archwire is to establish and/or maintain the proper "torques" and "angulations" of the teeth during tooth movement. As previously stated, if the cuspids tip distally the four incisors will extrude. The VS
archwire with the gable bends will nullify any extrusive force on the incisors.
Illustration 13 B: Demonstrates the bowing action of the VS archwire on the UA archwire. A. Flat UA archwire B. Bowing of the UA archwire by the VS archwire C. Degree of bowing
Since the steel VS archwire is more rigid than the nickel titanium UA archwire, the arch will take on the shape of the VS archwire. As the arch takes on the shape of the VS archwire the softer UA archwire will be deformed into a rocking chair shape. As the anterior and posterior portions of the UA archwire bend upwards in a gingival direction, there will be a distal root torque exerted on the six anterior teeth, and a distal crown
torque on the posterior teeth. This torque force prevents the retraction force from tipping the six anterior teeth distally, thereby resulting in bodily movement. The distal crown torque on the posterior teeth improves anchorage, and prevents excessive loss of posterior anchorage. Power chain is used from molar to molar as the retraction force. Class II or III elastics can be used if needed to maintain a class I relationship between the arches.
Illustration 14: En masse retraction completed.
Illustration 15: Bodily en masse retraction for bi-maxillary protrusive, dental class I, apical base class I cases.
Step by step treatment can be view in Case Review at the Home Page
EN MASSE RETRACTION CONTROLLED TIPPING IN MAXILLARY ARCH Illustration 16: Four second bicuspid extractions Dental class II; Apical base class I
No external anchorage was employed. The second molars had not erupted. The only anchorage was the mandibular first molars. The anchorage arch was a .018 x .018 steel archwire with bi-lateral gable bends, approximately 20 to 25 degrees, between the first bicuspids and the first molars. The archwire was inserted into the pre-adjusted edgewise slots. The controlled tipping arch in the maxillary arch was a .016 steel archwire with bi-lateral gable bends, approximately 25 to 30 degrees, between the first bicuspids and the first molars. The archwire was inserted into the vertical slots. This case is a prime example of Differential Resistance (Previously discussed).
In dental class II cases with severe maxillary anterior protrusion the cuspids can become distally tipped while establishing a cuspid class I relationship. If this occurs, the initial VS archwire can be as small as .016 steel and the initial UA archwire could be as small as .016 nickel titanium; however, to establish proper "torques" and "angulations" the finishing VS archwire must be .018 steel. The finishing UA must be .018 x .025 nickel titanium. The controlling factor that determines the size of the initial UA archwire is the degree that the bicuspids and/or cuspids are tipped. Illustration 17: Vertical stabilization archwire to prevent bite closure
Step by step treatment procedures can be view in Case Review at Home Page.
Summary The discussion has been about four common types of malocclusions which have an apical base class I relationship between the arches. Non-extraction; Molar Class I, Cuspid Class II What must be determined is why are the cuspids in class II? If the maxillary anterior teeth are flared, the
mandibular arch should be the anchorage arch. That is, the archwires should be inserted into the preadjusted edgewise slots in the mandibular arch, and get to a .018 x .025 archwire as soon as possible. The maxillary anterior teeth need to be retracted. This is eaisly accomplished by the utilization of a .016 steel archwire in the interactive slots in conjunction with light class II elastics. If the bite needs opening place a 20 degree bi-lateral gable bend between the cuspids and first bicuspids. If the mandibular anterior teeth are in retro-version, the maxillary arch becomes the anchorage arch and the anterior teeth in the mandibular arch are the teeth that needs to be moved in a labial direction. In many cases just correction the crowding and rotations will bring the mandibular anterior teeth forward into position. If not, insert a .016 steel archwire in the interactive slots and utilize light class II elastics. If the bite needs opening place bilateral gable bends in the .016 archwire between the cuspid and first bicuspid. Non-extraction; Molar Class II, Cuspid Class II or non-erupted There are two very important points to establish before beginning treatment on these type cases. The case must be an apical base class I and the molar class II correction must be accomplished by distalization of the maxillary posterior teeth. The mandibular arch is the anchorage arch. The anchorage archwire should be a .018 x .025, either nickel titanium or steel. Approximately 4 oz. bilateral class II elastic pressure. The molar class II correction must be over corrected. There will be some mesial movement of the first molar crown when finishing the case due to some distal tipping of the first molar. There are several devices that will correct molar class II by distalizing the maxillary molars; however, they all require additional work and are not an integral part of the conventional orthodontic strap-up.
Four Bicuspid Extraction; Molar and Cuspid Class I In bi-maxillary protrusion cases the anterior teeth usually require either a .016 or .018 nickel titanium archwire to aligned the anterior teeth. Once the teeth are aligned or if a .016 steel archwire can be inserted initially, utilize a .016 steel archwire for the retraction of the anterior teeth until a good visual axial inclination is achieved. This is accomplished with a .016 steel archwire in the interactive slot utilizing power chain. The cuspid brackets are good guides. When the pre-adjusted slot of the cuspids appear to be parallel with the occlusal plane insert the .018 steel VS archwire in the interactive slots in conjunction with a .018 x .025 nickel titanium in the pre-adjusted edgewise slots. Utilize power chain to close the remaining extraction sites. If needed elastics, either class II or III can be used to maintain a class I relationship between the teeth. Once the extraction spaces have been closed, remove the .018 steel archwire and finish with the .018 x .025 nickel titanium archwire.
Four Bicuspid Extraction; Molar and Cuspid Class II All rotations are corrected utilizing small gauge archwires inserted into the interactive slots. In the mandibular arch, once all rotations are corrected, the archwire placement should transition to the pre-adjusted edgewise slots. If the cuspids are tipped distally a VS archwire of at least .016 steel should be inserted into the interactive slots in conjunction with a .018 x .018 nickel titanium archwire in the pre-adjusted edgewise slots. The VS archwire will prevent the bite from closing and will enhance anchorage. If the mandibular anterior teeth are flared power chain from first molar to first molar can be utilized. In the maxillary arch a .016 steel archwire with bi-lateral gable bends of 20 to 25 degrees between the cuspid and bicuspid should be inserted into the interactive slots for the controlled distal tipping of the maxillary anterior teeth. These archwire configurations should establish a cuspid and molar class I relationship between the arches. In the mandibular arch, the cuspids should not be tipped distally, therefore the VS archwire can be removed and finish the case in the pre-adjusted edgewise slots. There should be very little or no extraction space remaining. In the maxillary arch, watch the pre-adjusted edgewise slot of the cuspids. When the pre-adjusted edgewise edgewise slot becomes parallel with the occlusal plane stop the controlled tipping of the maxillary anterior teeth. By this time, in most cases, a cuspid class I relationship has been established. If the extractions spaces are closed or within 2mm of being closed and a molar class I relationship has been achieved, finish case in pre-adjusted edgewise slots with standard rectangular archwires. If the extraction space is greater than 2mm, insert a .018 x .018 steel archwire into the pre-adjusted edgewise slots with a bilateral gable bend of 20 degrees between the cuspid and the bicuspid and close remaining extraction space. In those cases with severe horizontal overbite, the cuspids may become tipped distally by the time a cuspid class I relationship is established. If this occurs, use a .016 VS steel archwire, .018 if possible, in the interactive slots in conjunction with an .018 x .018 nickel titanium archwire in the pre-adjusted edgewise slots. This will allow the cuspids to upright without bite closure. Class II elastics should be utilized. Once the cuspids have uprighted finish the case in the pre-adjusted edgewise slots.
Cannon Brackets | Case Review
Case Review
||Cases
Case 1 click on picture to view case
Four First Bicuspid Extraction; Apical Base and Dental Class I
Case 2
click on picture to view case
Four First Bicuspid Extraction; Apical Base and Dental Class I
Case 3
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Four Second Bicuspids Congential Missing. Apical Base and Dental Class I.
Case 4
Apical Base Class I -- Dental Class II -- Maxillary and Mandibular anterior teeth are protrusive -- Four second bicuspid extraction case
Case 5
Non-Extraction; Apical Base Class I; Dental Class II, Div I
Case 6
Non-Extraction; Apical Base Class III discrepancy
Case 7
Non-Extraction; Apical base class III discrepancy
Case 8
Four First Bicuspid Extraction; Apical Base Class I and Dental Class I
Case 9
Apical base Class III discrepancy Wits = -4.9mm ANB = 0.8 degrees
Case 10
Apical Base Class I Bi-Maxillary Protrusion. Non-extraction TRANSFER CASE. Four second bicuspids were extracted.
Case 11
Apical Base Class I High Angle Bi-maxillary Protrusion Four First Bicuspid Extraction
Cannon Brackets | Locate Dealer
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Fairfield Orthodontics, LLC--- Area of Sales --- Domestic and International 410 Surf Avenue Stratford, CT 06615 Toll Free 1-800-321-0331 International- 203-610-8283 International Fax- 203-610-6957
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Web Address www.FairFieldOrthodontics.com

E-mail- ffdortho@aol.com
Orthodontic Design and Production, Inc --- Area of Sales --- Domestic and International 1370 Decision St. Suite D Vista, CA 92081 Phone 760-734-3995
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Cannon Brackets | Questions
Questions
Posted by: gb on Tuesday August 8, 2006 Details: Describe the setup and elastic forces used for anterior anchorage in minimal to moderate anchorage Reply to this message cases in order to drag posteriors forward. thanks Posted by: Dr. Cannon on Tuesday Subject: Re: Anterior Anchorage August 8, 2006 Details: Align anterior teeth so that a .018 x .018 steel archwire can be placed as follows. Place the archwire in the edgewise slot in the anterior teeth and in the interactive slot in the bicuspids and the more gingival tube on the first miolars. Place a bilateral gable bend just distal of the cuspid brackets of approximately 25 degrees. This will improve anterior anchorge by establishing distal root torque in the anterior teeth and will prevent distal tipping of the anterior teeth. Place standard power chain from first molar to first molar. Up to four ounces of class II or III elastics can also be used if needed. The amount of tipping of the bicuspids and first molars depends upon how much forward movement occurs. If there is minimal tipping of the bicuspids and first molars, usually a .018 x .018 steel archwire can be inserted into the edgewise slot of all teeth with a bilateral gable bend of approximately 15 degrees just mesial of the bicuspid. Utilize standart power chair and class II or III elastics if needed. If more severe tipping occurs, insert a .018 steel archwire in the interactive slot of all teeth with bilateral gable bends just mesial of the bicuspid brackets of approximately 25 degrees and also insert a .018 x .018 nickel titanium in the edgewise slot of all teeth. The steel archwire will aid the nickel titanium archwire in uprighting the molars and bicuspids. Use power chain to keep prevent spaces from opening. Posted by: gb on Tuesday August 8, Subject: Re: Anterior Anchorage 2006 Details: when dragging posteriors forward do you do it enmass or one tooth at a time? what size power chain and how often do you change it? Question # 1 Subject: Anterior Anchorage
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Posted by: Dr. Cannon on Tuesday August 8, 2006 Details: The second bicuspid and first molar are brought forward en masse. Even though there are no attachment on the second molars, there will be some forward movement of the second molars due to the transseptal fibers. After all extraction space is closed, attachments are then placed on second molars and close any space that might be between first and second molars with power chain. I use the standard power chain. That is, there is a small link between the \"0\" rings; however, it is not the wide link. I change the power chain every five weeks. I know that it is generally stated that the power chain should be changed every three weeks, I disagree. Five weeks is my normal time between appointments. If burning anchorage is a common problem for you, I would strongly suggest that you consider the extraction of second bicuspids instead of the first bicuspids in minimum to moderate anchorage cases. I have been doing this for several years and have found that it greatly simplifies treatment. I know that the extraction of the second bicuspids is not the usual and customary procedure. You may have to explain why seconds instead of first to referring dentist. I tell them its to prevent flattening of the profile. That seems to make them understand. Second bicuspid extraction can make treatment procedures much easier and more simple. If you will look at he CASE REVIEW heading on the web site you will see cases where the second bicuspids were extracted instead of the first. One case had second bicuspids conjentially missing. Good luck!! Subject: Re: Anterior Anchorage Question # 2 Posted by: Robert on Friday January 5, 2007 Details: Hello dr. Cannon i\'m one of the persons responsible for the seminar in Poland ,i want to ask You for a Reply to this message contact with me to discuss few problems, thank You Posted by: Dr. Cannon on Friday Subject: Re: seminar in Poland January 5, 2007 Details: Robert There are two contacts. Nick Lulka Fairfield Orthodontics email address ffortho@aol.com Dr. Steven Williams email address williams@cnet.at Regards Jim Cannon Subject: seminar in Poland Posted by: Thomas Braun on Sunday March 4, 2007 Details: I do not routinely band second molars, but when I do I usually use convertable tubes on the first molars. Reply to this message Do you use a convertable tube on the first molars? If not how do you insert a full size steel wire back to the second molars? Posted by: Dr. Cannon on Monday Subject: Re: second molars March 5, 2007 Subject: second molars
Question # 3
Details: I do not routinely place attachments on the second molars either. I do not use convertible first molar tubes. The mandibular first molar attachments usually create occlusal interference with the maxillary first molars. Also, I do not finish with a full size steel archwire. If the second molars are malaligned I place attachments on the second molars and usually begin with a .018 nickel titanium archwire. This archwire will generate adequate forces to correct any rotations or buccal/lingual misalignment of the second molars. I finish with a .018 x .025 nickel titanium archwire. I find that the .018 x .025 nickel titanium archwire generates enough torque and rotational forces to align all teeth. If you are using the .018 x .025 steel archwire to level the arches, I suggest that you level the arches by inserting a .018 steel archwire into the interactive slot with bi-lateral \"V\" bends between the cuspids and bicuspids of approximately 20 degrees in conjunction with the nickel titanium archwire. The steel archwire will level the arches more effectively. The lower forces generated by this approach will be much easier for the patient and you. You will find that both of these archwires can be inserted and ligated in less time than inserting and ligating the .018 x .025 steel archwire. Again, you will find that this approach will reduce your stress level and also reduce the patients discomfort level. Posted by: Svante Moberg on Thursday March 29, 2007 Details: 1.When tying the arch wire in the interactive slot, crossed for minimal friction. Do you use special Reply to this message elastomeric rings for that purpose? ".I can, in your home page see that duoble ligatures are used on cuspids. why? When? Posted by: Dr. Cannon on Thursday Subject: Re: steel ligatures and elatomeric rings March 29, 2007 Details: I use only steel ligature ties for low friction. I cross the steel ligature tie as near to the \"T\" hook as possible. This will prevent the steel ligature from exerting pressure against the archwire. The stem of the \"T\" hook is wider toward the body of the bracket. I do not use elastomertic \"O\" rings when wanting low friction Question # 4 Subject: steel ligatures and elatomeric rings POST A NEW QUESTION
POST A NEW QUESTION

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Patent Pending on the Cannon Ultra Bracket System

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Cannon Brackets | Founder and Philosophy

Founder and Philosophy

James L. Cannon DDS, MS

Cannon Brackets | Founder and Philosophy

Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Founder and Philosophy

Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Founder and Philosophy

Cannon Brackets | Founder and Philosophy

Cannon Brackets | Founder and Philosophy

Cannon Brackets | Founder and Philosophy

Cannon Brackets | Founder and Philosophy

Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Founder and Philosophy

Illustration 11: Dental compensation to achieve maximum dental interdigitation.

Cannon Brackets | Founder and Philosophy

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Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design

Apical Base Class I

Apical Base Class II

Apical Base Class III

Cannon Ultra Bracket System Illustration 4: Mid-line cross-sectional view of a bracket

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Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design

Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design

I. D. Color Chart for Cannon Ultra Bracket System

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Cannon Brackets | Bracket Design

Cannon Brackets | Bracket Design

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Cannon Brackets | Bracket Design