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Straight Talk Dr. David Paquette

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A Bracket is a Bracket is a Bracket is… Nonsense
by Dr. David Paquette

For 2010's annual summer meeting, CDABO (College of Diplomates of the American Board of Orthodontics) sponsored a weekend of discussion on self-ligation with presentations by six experts – two academics and four clinicians. After hours of material presented on clinical experience, laboratory data and in-depth literature reviews, it became apparent that the attendees could be divided into the skeptics, the curious and the advocates of self-ligation.

After listening to all these well-prepared presentations, one apparent skeptic in the back row called out "a bracket is a bracket is a bracket." I have to argue that nothing could be further from the truth. For almost everyone who was present at the conference, it became quite clear that each of the bracket systems described had unique biomechanical characteristics. The inflexibility of some in our specialty never ceases to amaze me. One simply needs to look at the wealth of data that the work of Dr. Hisham Badawi at the University of Alberta has provided and the discussion should end. It is one thing to choose to use a bracket and biomechanical system for a well-defined reason that suits the needs of achieving certain treatment goals. It is quite another to make the ridiculous statement that all brackets are the same… especially after the breadth and depth of information that was presented.

To make the unfounded statement that all brackets are the same and are simply a handle on the tooth is akin to saying all tires are the same; that they are simply a method to transfer energy from the axle to the road. If this were the case, then we could expect the same performance from a Formula 1 car whether it was fitted with standard sedan tires or high technology racing tires, and conversely the family sedan would perform like a Formula 1 car if it were equipped with racing tires. Even the most obstinate among us would not draw that conclusion, so why is it such a stretch for some to accept that there are discernable differences in the performance of brackets with different designs? It is equally surprising that after all the information which is now available, some in our specialty still do not accept the fact that along with differences among brackets, the entire biomechanical system chosen to treat an individual patient can and oftentimes does result in entirely different treatment results. Or perhaps they're still trying to convince themselves that they're getting a smoother ride with the Formula 1 tires they put on their Buick.
Author’s Bio
Dr. David Paquette earned his DDS degree from the University of North Carolina at Chapel Hill and his masters in orthodontics from St. Louis University. Prior to orthodontics he earned a pediatric degree and became a Diplomate of the American Board of Pediatric Dentistry. He is also a Diplomate of the American Board of Orthodontics. Dr. Paquette received the Milo Hellman award from the AAO for distinguished research in orthodontics. He has written numerous articles and lectures nationally and internationally on a variety of topics. He is on the Clinical Advisory Board for Align Technology and is a Fellow of the American College of Dentists.
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