Enter the Next Bracket

Change is difficult for any practice, especially when it comes to new technology. In our practice, we had been using the same brackets for many years, so when we talked about changing to self-ligating brackets, everyone was unnerved. Many times, orthodontists want to use new technology to achieve the very best results for their patients, but the staff is apprehensive to give new technologies a try. It is not intentional for us to feel that way—we are just concerned and sometimes even consumed with the schedule and getting through the day the best way we can. Change shakes our comfort level.

Of course, change can be good. Having been in orthodontics for more than 35 years, I have seen tremendous change. For example, I got involved with orthodontics when we fit bands on every tooth. The change from bands to brackets was great not only for the staff, but also for our patients. Looking back, I know that change is how we provided the best care for our patients and improved over the years.

Carolyn Friedman

When it comes to making the change to self-ligating brackets, I know there have been horror stories about breakage, clip failures, and difficulty working with the brackets themselves. You may have worked with some of the earlier versions of the bracket and don’t want to relive a negative experience. But remember, technology improves with time and the release of newer versions. The idea of changing to the self-ligating bracket in my office was met with great resistance. Today, if we were to try to go back to the regular bracket, we would have a mutiny on our hands.

Making the Transition

When you start using self-ligating brackets, some of your patients will still be in the traditional brackets. Until you get used to the new bracket, you may consider the patients with the self-ligating brackets “problem cases” because you are still unfamiliar with the technology. Obviously, you get used to technology that you deal with constantly; working with something every once in a while makes it difficult. It will take a while to finish the existing cases with the regular brackets, so, when making the transition, place all new patients in self-ligating brackets. In a short time, the benefits will be apparent.

With traditional brackets, some assistants tie arches very securely, while others may tie too lightly. With the self-ligating brackets, when the clip is closed, it closes the same for every assistant, no matter their experience level. I know many assistants who have been working with self-ligating brackets for years, and they feel better at the end of the day because they are not constantly tying wires. Assistants who have been dealing with carpal tunnel love the reduction in pain at the end of the day.

There is a short learning curve when transitioning to self-ligating brackets. At first, you will reach for instruments that you no longer need. Your patients will love the reduced number of instruments in the mouth, which is more comfortable for them. It also means fewer instruments for you to sterilize.

Self-ligating brackets make maintaining oral hygiene easier, too. Imagine how great it is to have your patients coming to appointments without their breakfasts and lunches still attached to their brackets. Sounds too good to be true, but without ties, there is less to catch and hold the food. The hygienists in your area will also love the improved system for oral hygiene. To help increase your referrals, inform your local hygienists that you are using this technology.

Opting for Color

New patients often ask me if we offer “colored braces.” As treatment coordinator, I explain that it is not the braces that are colored but the ties that are placed on each bracket. I say, “We offer the latest in technology in our appliances, which really do not require the ties, and this makes it easier for our patients to do a great job brushing. This also means more comfort, more time between appointments, and less treatment time for our patients.”

If patients want to customize their look, we can put colored ties on the front teeth. This is for decorative purposes only, and you need to explain that if the ties come off, it is not necessary to make an additional visit to have them replaced. If you are going to offer colored ties for this purpose, be sure that you use thin ones. There are many different tie thicknesses, but the thinner ties will fit and stay on without a problem. Many offices only place the ties at an angle across the upper anterior teeth. Using the thin, colored ties and even chains does not slow down treatment.

Reducing Appointments

Using self-ligating brackets has also had a positive impact on the appointment schedule. In the same time it takes to change one arch with traditional brackets, we can now change two arches for patients with self-ligating brackets. Our patients are thrilled and appreciate that they do not have to come back as often between appointments. This also leaves some room in the schedule for practice growth and increased production.

Without the use of wire ties, there is also less to “stick” the patients. This results in fewer emergency appointments, which equates to fewer problems with your schedule.

With the bracket change, many orthodontists will be changing their wire sizes and the sequence of when they want to change the wires. In a very short time, the new sequence will be automatic for you and will also make sense. Many times, there will be fewer wire changes during treatment. Fewer appointments and wire changes make for a more profitable practice.

Changing for the Better

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For patients, self-ligating brackets mean fewer office visits, longer intervals between appointments, and reduced overall treatment time. This equates to an increase in profitability for the practice. Lighter, gentler force lessens the discomfort for the patient. The brackets also look better without ties and are easier to clean. With the new technology built into the brackets, the teeth move in a more constant way that is both more comfortable for the patients and more efficient. I call that a win-win!

Embrace the change to self-ligating brackets, and you will start to see the advantages for the practice, the patients, and the staff. I am for anything that helps make the day easier, more profitable, and satisfying, because we are doing the best for our patients.

Carolyn Friedman is the treatment coordinator/manager for Cliff Campbell, DMD, PA, Tallahassee, Fla. She is also a consultant and the author of the Ortho Assist Training Library. She can be reached at