American Journal of ORTHODONTICS and DENTOFACIAL ORTHOPEDICS Founded in 1915
Vohvne 99 Number 2
February 1991
Copyright © 1991 by Mosby-Year Book, Inc.
CASE REPORTS
Enamel fracture caused by ceramic brackets M. Toufic Jeiroudi, DDS, MS* Loma Linda, Calif.
I n the past few years orthodontists have given more attention to the esthetic aspect o f the appliances they use to achieve tooth movement, especially brackets. Recently, the demand for esthetic appliances has been answered by the introduction o f translucent and transparent alumina brackets.' Ceramic brackets (single crystal and polycrystalline) are now being marketed primarily because o f their esthetic properties. 2 This is a report on enamel damage o f the facial surface o f two maxillary incisors that were bonded with polycrystalline sapphire ceramic brackets.
CASE REPORT A 21-year-old man, who is an amateur skier, came to my private practice for treatment of his malocclusion. The ex*Assistant professor. Depa.rtraentof Orthodontics,Loma Linda University Schoolof Dentistry. 814115075
amination revealed a dolichofacial pattern, Class II molar relationship with Class I canine relationship, open bite, and 54[45 missing 4--4~--(Fig. l). In November 1988 ceramic brackets were placed on 66 321 1235" 123 Bands were placed on ~@66,and initial wires were 5321 placed on both arches (0.015 2-inch Twist Flex). In January 1989 upper and lower 0.016 Nitinol wires were tied in. In February 1989 the patient had an accident while he was competing in a downhill ski qualifying race for the U.S. Olympic team. He was hit in the mouth by his ski pole. Three brackets came off the upper right canine, and lateral and central incisors with the wire still attached to the brackets. The three brackets were still intact with no evidence of any fractures. However, clinical examination of the teeth surfaces revealed enamel damage to the labial surfaces of the upper right central and lateral incisors in the form of cavities (Figs. 2 and 3). The labial surface of the canine was undamaged. Examination
B Fig. 1. Photographs taken before (A) and after (B) the accident. 97
98 Jeiroudi
Am. J. Orthod. Dentofac. Orthop.
Februa~' 1991
Fig. 2. A, Intraoral photographs taken after the accident. B, Same photograph outlining the damage.
Fig. 3. Intraoral radiographs taken before (A) and after (B) the incident showing extensive damage to teeth surfaces.
Volume 99 Number 2
Case report
"i'
99
\
B Fig. 4. A and B, Photographs of brackets with fractured enamel still bonded to the brackets.
of the bracket surfaces showed evidence of enamel debris still bonded to the surfaces of the central and lateral brackets (Fig. 4). There was no sign of pulpal damage. This incident suggests that the sudden impact may have caused failure in the more brittle enamel rather than in the polymeric bonding agent. It is my opinion that ceramic brackets are here to stay; however, more testing and improvement of the bonding procedure is needed. Furthermore, the clinician should be more selective and should warn his patients about the limitations of the product.
REFERENCES !. Flores DA. The fracture strength of ceramic brackets: a comparative study [Thesis]. Loma Linda, California: Loma Linda University, 1988. 2. Swartz ML. Ceramic brackets. J Clin Orthod 1988;22:82-8. Reprint requests to:
Dr. M. Toufic Jeiroudi Director, Undergraduate Program Department of Orthodontics Loma Linda University School of Dentistry Loma Linda; CA 92350
Vohvne 99 Number 2
February 1991
Copyright © 1991 by Mosby-Year Book, Inc.
CASE REPORTS
Enamel fracture caused by ceramic brackets M. Toufic Jeiroudi, DDS, MS* Loma Linda, Calif.
I n the past few years orthodontists have given more attention to the esthetic aspect o f the appliances they use to achieve tooth movement, especially brackets. Recently, the demand for esthetic appliances has been answered by the introduction o f translucent and transparent alumina brackets.' Ceramic brackets (single crystal and polycrystalline) are now being marketed primarily because o f their esthetic properties. 2 This is a report on enamel damage o f the facial surface o f two maxillary incisors that were bonded with polycrystalline sapphire ceramic brackets.
CASE REPORT A 21-year-old man, who is an amateur skier, came to my private practice for treatment of his malocclusion. The ex*Assistant professor. Depa.rtraentof Orthodontics,Loma Linda University Schoolof Dentistry. 814115075
amination revealed a dolichofacial pattern, Class II molar relationship with Class I canine relationship, open bite, and 54[45 missing 4--4~--(Fig. l). In November 1988 ceramic brackets were placed on 66 321 1235" 123 Bands were placed on ~@66,and initial wires were 5321 placed on both arches (0.015 2-inch Twist Flex). In January 1989 upper and lower 0.016 Nitinol wires were tied in. In February 1989 the patient had an accident while he was competing in a downhill ski qualifying race for the U.S. Olympic team. He was hit in the mouth by his ski pole. Three brackets came off the upper right canine, and lateral and central incisors with the wire still attached to the brackets. The three brackets were still intact with no evidence of any fractures. However, clinical examination of the teeth surfaces revealed enamel damage to the labial surfaces of the upper right central and lateral incisors in the form of cavities (Figs. 2 and 3). The labial surface of the canine was undamaged. Examination
B Fig. 1. Photographs taken before (A) and after (B) the accident. 97
98 Jeiroudi
Am. J. Orthod. Dentofac. Orthop.
Februa~' 1991
Fig. 2. A, Intraoral photographs taken after the accident. B, Same photograph outlining the damage.
Fig. 3. Intraoral radiographs taken before (A) and after (B) the incident showing extensive damage to teeth surfaces.
Volume 99 Number 2
Case report
"i'
99
\
B Fig. 4. A and B, Photographs of brackets with fractured enamel still bonded to the brackets.
of the bracket surfaces showed evidence of enamel debris still bonded to the surfaces of the central and lateral brackets (Fig. 4). There was no sign of pulpal damage. This incident suggests that the sudden impact may have caused failure in the more brittle enamel rather than in the polymeric bonding agent. It is my opinion that ceramic brackets are here to stay; however, more testing and improvement of the bonding procedure is needed. Furthermore, the clinician should be more selective and should warn his patients about the limitations of the product.
REFERENCES !. Flores DA. The fracture strength of ceramic brackets: a comparative study [Thesis]. Loma Linda, California: Loma Linda University, 1988. 2. Swartz ML. Ceramic brackets. J Clin Orthod 1988;22:82-8. Reprint requests to:
Dr. M. Toufic Jeiroudi Director, Undergraduate Program Department of Orthodontics Loma Linda University School of Dentistry Loma Linda; CA 92350
