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A Voice in the Arena: Eyelets–The Magic Bracket by Dr. Chad Foster

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Categories: Orthodontics;
A Voice in the Arena: Eyelets–The Magic Bracket

by Chad Foster, DDS, MS, editorial director


A few times a year on ortho message boards, there will be posts with some very cool and innovative mechanics for how to best bring in a lingually displaced tooth. Often, they involve open-coil springs, slings, auxiliaries, lingual attachments or some other thoughtful planning. I appreciate those posts and the fancy mechanics involved. For certain problems, though, sometimes a simpler answer is the best one. This is definitely the case with eyelets and lingually displaced teeth.


When and how to use eyelets
When you use an eyelet, I have found that it is not necessary to rely on open-coil springs to gain the entire width of the needed space for the tooth. I may use open-coil springs before engaging the lingually displaced tooth if the tooth is so blocked out that there is not even enough space to bond on a skinny eyelet. Generally speaking, though, if the space available for the lingual tooth is about half the size of the tooth or greater, it is ready for the eyelet to be bonded and the tooth to be engaged. When engaged, and even when blocked out to this extent of having only half of the available space for it, in my experience, further use of any open-coil spring is unnecessary.


Why eyelets work
I have made many presentations and posts about eyelets, or what I refer to as “the magic bracket.” Spoiler alert: There is no real magic inherent in the eyelet itself. The magic is that it allows the super part of a superelastic NiTi wire to perform optimally. There is less wire deformation during the engagement of the superelastic NiTi wire compared to a wider bracket, leading to lower force and more efficient movement. It was the great Dr. R.G. “Wick” Alexander, in his book The 20 Principles of the Alexander Discipline, who stated that doubling the inter-bracket distance (or effectively the inter-attachment wire distance) results in an eightfold reduction in the force delivered by the wires. That’s why Alexander favored his very narrow single-wing brackets, and it is for the same biomechanic principle that eyelets are so efficient in their delivery of force and tooth movement.

Importantly, the wire makes a huge difference! Be sure to use a high-quality NiTi wire. If you notice that small-gauge NiTi wires are consistently distorted or kinked when changed or removed after sitting in very crowded teeth for an appointment interval, consider looking for a higher-quality NiTi wire.


Creating space and improving alignment
As the lingual tooth attempts to move forward, despite still being partially blocked out, other important movements are occurring. The facial force on the lingually displaced tooth is countered by a lingual force on the immediate neighboring teeth. As these opposing forces compete, much of this force is expressed in the form of lateral displacement of the neighboring teeth to create space for the blocked-out tooth as it moves forward. Arch length is effectively increased as the lingually displaced tooth gains alignment. The increase in arch length occurs through a combination of dental arch expansion and proclination of the anterior teeth. An additional tip to help tip the scales in favor of lateral expansion over proclination of the anterior teeth is to use broad, wide or expanded-shaped NiTi wires in cases where dental arch expansion is deemed appropriate. In cases where dental arch expansion or anterior proclination must be limited or prevented, alignment of the lingually blocked-out tooth with an eyelet can still be gained by making use of available intra-arch space (extraction spaces or IPR spaces). Eyelets have no philosophical preference for extraction or nonextraction treatment plans, my friends. In that regard they’re both magic and unprejudiced!

There are some other eyelet tips worth mentioning reflected in the photo above:
  • There are many types of eyelets available, but the ones that offer less archwire deformation and lower forces have a larger lumen and a skinny loop.
  • If the mesh base of the eyelet is too big to fit on a blocked-out tooth, you can trim the mesial and distal edges of the base with a straight cutter.
  • Place the eyelet just a bit more gingival than you would place the bracket to position the force on the tooth closer to its vertical center of rotation. This will, to some degree, lessen the inherent tipping effect.
  • I very often pair initial eyelet engagement with light, early IPR.
  • Additionally, I am a big fan of strategic early IPR in certain crowded or periodontally sensitive patients. In cases where controlling force levels and root position within alveolar housing is critical, eyelets can be especially helpful. Please refer to my previous column on the importance of timing IPR in the January/February 2025 issue of Orthotown.
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