by Lori Sichtermann

With a passion for efficiency, James TenBrook, DMD, MMSc, created a new self-ligating system

James TenBrook, DMD, MMSc, is a father of two, soccer coach, business owner, inventor, entrepreneur, and globe-trotting public speaker. And, if that weren’t enough, he’s also an orthodontist.

As the wearer of many proverbial hats, TenBrook has dedicated a substantial amount of energy to the field of orthodontics. Since he began practicing nearly 20 years ago, TenBrook has sought ways to better his technique and his practice. When he found success—at one time he owned seven practices—he didn’t stop there. Instead, he set to work identifying ways to improve his practice and the entire orthodontic profession.

The result of TenBrook’s commitment to improvement is what’s known as the TenBrook self-ligating system. The system is a combination of a specialized bracket (designed by TenBrook) and a specific treatment technique (also designed by TenBrook) that enables patients to spend less time in braces and experience, according to TenBrook, virtually no pain.

Although the TenBrook self-ligating system is virtually painless for wearers, the road to its development was anything but for its inventor. The system is the result of many years’ worth of trial, error, setback, and success.

In the Beginning

After earning a bachelor’s degree in biology from Gettysburg College, earning a DMD from the Medical University of South Carolina, and serving a 3-year residency at Harvard’s School of Dental Medicine and the Forsyth Dental Infirmary, TenBrook embarked on his career as an orthodontist.

PRACTICE PROFILE

Practice Name: TenBrook Orthodontics

Location: Millville, NJ

Specialty: Orthodontics

Patients per day: 75-100

Starts per year: 850

Years in private practice:18

Days worked per week: 4 to 5

Web site: TenBrookOrthodontics.com

“Coming out of school I had no money,” TenBrook says. “I found a small location and rented a space that was 600 square feet. It sounds like a story, but I literally had one chair, one cabinet, one desk, one appointment book, one phone, and away we went.”

With his individualized approach to orthodontics, TenBrook quickly established a large patient base. “We specialize in personalized care,” he notes. “We’re known for working from the outside in, meaning we always consider the face first when doing examinations. From there we work from the soft-tissue profile to the bony structures of the face to figure out the diagnosis of where we’re going to place the teeth in a person’s face.”

This approach was a hit with patients, and soon TenBrook’s practice began to grow. “People saw our orthodontics and appreciated the attention we gave them as patients. As a result, we attracted more patients,” TenBrook says. “We attracted customers and families from neighboring towns. I kept track of where patients came from. I then established a threshold to meet before I’d consider opening another practice in an area where we were not located, yet many of our patients lived.”

In only a handful of years, TenBrook expanded his practice from a one-chair start-up to a multioffice orthodontic powerhouse. At one point, he operated seven practices throughout southern New Jersey. But, as business boomed, TenBrook worked to find ways to make his practices even more efficient. Eventually, he would merge two offices, resulting in the five remaining in operation today.

While striving to make his business more efficient, TenBrook also sought ways to tighten his technique, so to speak. “I’m always trying and testing things out in terms of the technology and treatment techniques,” he says.

By way of advances in orthodontic technology, as well as some clever theorizing, he came upon a technique that would not only improve his practice, but also, he hopes, improve the orthodontic industry.

What’s Old is New Again

TenBrook’s specialized bracket is the result of years of development.

In the 2 decades since TenBrook first entered dental school, there have been myriad evolutions in technology within the field. “The industry has changed in terms of technology,” TenBrook notes. “It’s gotten amazingly diverse and fun, and a lot of the things that were developed in other areas of science have been extrapolated into orthodontics. For example, the advent of nickel titanium wires from NASA and the different materials used for brackets today.”

Melding new technology with old is the secret to TenBrook’s success. As he explains, he was a proficient user of Ormco Corp’s Damon bracket technology, which had been available in the orthodontic arena for more than 15 years. TenBrook used the Damon technology in a number of different ways in order to achieve the results he was after.

“My goal was to be extremely efficient in my treatment and optimize the tooth movement in different stages of treatment,” TenBrook explains. “This is better for the patients because they experience less force and relatively no discomfort when their teeth are moved.”

Using the Damon bracket, TenBrook experimented with a variety of wire widths in combination with an .018 slot. “I use a lot of sliding mechanics in tensile, stiff, round wires with an .018 slot, which utilizes the bracket much differently than what’s promoted by the big companies out there,” he notes. “You can be a lot more efficient with an .018 slot. I’m able to move the teeth faster, but with less force and with less friction.”

TenBrook had a working relationship with Ormco via the Damon bracket: At one time the company proclaimed his practice as the largest Damon user. Thus, TenBrook was could have the company manufacture a .018 slot for him to use as he experimented with the technology. “I modified those brackets on my own and tested the different theories on people I knew: my sons, my assistant, etc,” he adds. “I was able to prove a lot of my theories and develop a unique bracket design.”

The path toward developing a more efficient bracket took creativity, perseverance, and good old-fashioned know-how. “Through practicing for 17 years—and I’ve had a very busy practice—I’ve been able to accumulate a lot of experience in clinical orthodontics,” TenBrook explains. “I’ve been able to use and test a lot of different systems, brackets, and wires. That, coupled with my foundation from school—with the basic sciences, physiology, and biomechanics—helped me to develop this system known as the TenBrook treatment system or the TenBrook self-ligating system.”

The New System

TenBrook describes his system as a self-ligating, low-friction system that moves teeth in less time, with minimal pain for the patient. “It’s a true system that applies different wire technologies to a passive tube so that orthodontists can reduce friction,” TenBrook adds. “By reducing friction biomechanically, you can use a lot less force on the teeth. These are things I try to incorporate into the system.”

According to TenBrook, the system is based on the geometry of the slot in the specialized TenBrook bracket. It optimizes the archwire’s performance so that an orthodontist is able to utilize thermal nickel titanium wire, with its shape-memory capabilities and relatively constant force levels.

The TenBrook self-ligating system is the result of three distinct treatment philosophies. One philosophy involves self-ligating brackets. The second involves the use of BEGG light-wire mechanics in the treatment, and the third is the use of straightwire Edgewise. “I try to extract the best of all three of these techniques and synergize them all into one technique,” TenBrook adds. “This optimizes the teeth movement in all three stages of treatment.”

With the technology developed, tried, and tested, it was time to turn the rendering into a reality. TenBrook wanted to bring his ideas out of his practice and into the orthodontic arena. To do that, he needed the help of a large-scale company. Thus, he approached Ortho Classic to help create his customized bracket.

“We went behind closed doors and literally sat at a table for 5 hours as I explained everything I wanted to see in this bracket and why,” TenBrook recalls. “I sat with the engineers and planned out the specifics of the new design: different measurements in terms of widths and in-outs and what prescription the wire needed to be, etc. They were very receptive to the whole idea.”

TenBrook convinced the engineers at Ortho Classic, and the company came on board to manufacture the bracket. The next (and possibly most challenging) step was to convince the public—both orthodontists and patients —about the benefits of the TenBrook self-ligating system.

Appealing to Patients and Practitioners

TenBrook’s system is designed to decrease treatment time and the pain that patients experience during treatment.

For patients, the bottom line is that TenBrook’s system is designed to allow them to make fewer visits to the orthodontist. “Historically, an average treatment might take anywhere from 2 to 3 years. My system requires patients to be in braces for only 12 to 15 months,” TenBrook explains. “The advancements in these technologies have allowed me, as a practitioner, to decrease the amount of time that people are in braces by almost half.”

Also cut in half—if not eliminated completely—is the pain factor often associated with wearing braces. “I’m able to use a lot less force,” TenBrook notes. “Because of the relative frictionless nature of the appliance, I’m able to move teeth more quickly with less force; it’s more physiologic. For nearly 90 percent of patients who have undergone treatment with the TenBrook self-ligation system, we’ve moved their teeth below the pain threshold.”

According to TenBrook, his self-ligating system offers a whole host of benefits to orthodontists as well. TenBrook is adamant about sharing with his peers the efficiency that his technology provides. “When I talk with doctors about the technology, I tell them, ‘Hey, you really have to take a look at this,’ ” TenBrook says. ” ‘It can decrease the time that a patient spends in braces by half. It can do it with a lot less force. It can save you money because you don’t have to buy as many braces and wires. And, you can be really efficient and have a happy patient.’ ”

Taking to the Streets … and the Skies

When you have great news, you want to tell the world about it. Such is the case with TenBrook and his collaboration with Ortho Classic. Before taking on the world, TenBrook wanted to share his technology with his stateside peers. However, the US market is vast, ultracompetitive, and oftentimes unreceptive to change. “We always knew that it was going to be a bit more of a challenge domestically because it’s a big competitive market with a lot of big orthodontic companies,” TenBrook notes. “It’s a huge corporate world now. Subsequently, these corporations have a lot of marketing dollars to promote their products. And, that’s something we just don’t have.”

Ortho Classic unveiled the TenBrook technology a year and a half ago, and since then, TenBrook has energetically promoted his system to folks in the industry, taking his efforts on a grass-roots voyage around the globe. “I’ve done a lot of traveling in the past year to promote the bracket and the treatment system,” he says. “I’ve been to 10 countries so far this year, and we’re on track to do 10 to 12 next year.”

As TenBrook explains, the global market is more responsive to change and more responsive to American knowledge and American doctors in general. “I’m giving a lot of free lectures across the country and the globe,” TenBrook adds. “I get into discussions with orthodontists from all over the world and promote this as something that is good for their practice.”

TenBrook is enthusiastic about his technology, but his motives for sharing it with the industry are selfless. “We’re not a big company that is looking at profits and looking to get into a certain market because we’re here to make money off of orthodontics,” he explains. “I’m here as an orthodontist who designed a system. Our goal is to make orthodontics better for orthodontists and their patients. We really feel like we have a special thing to offer.”


Lori Sichtermann is a contributing writer for Orthodontic Products. For more information, contact

The Search for Quality Orthodontics

For TenBrook, the decision to enter the field of orthodontics came at an early age. “I always wanted to practice in my hometown of Millville, New Jersey,” he explains. “It’s a blue-collar town, and I remember growing up knowing that a lot of kids couldn’t afford braces. I knew these kids had to live with crooked teeth. That made a big impact on me. I wanted to open a practice in my hometown and provide quality orthodontic services to the people living there.”

The concept of quality would be something that TenBrook would learn early and carry with him throughout his career. “I always quote my clinical professor at Harvard. He said to me: ‘If you always do your best at taking care of your patients, everything else will come after that,’ ” TenBrook explains. “He was very good at advising me to make sure I always did my very best in terms of quality orthodontics and never to cut corners.”

TenBrook’s dedication to quality extends to his partnership with Ortho Classic. “We’re proud of the fact that we’re American-made,” TenBrook notes. “We’re proud of the fact that we’re smaller and quality-oriented. Our interest is to have the best bracket and self-ligating system on the market.”

As the TenBrook self-ligating technology continues to take hold around the world, TenBrook looks on with pride for a job well done. “It’s reinspired me,” he admits. “In my 17 years of practice, I’ve treated well over 14,000 people. That’s a lot of treatment and clinical experience jammed into a 17-year period. I’m able to draw on those experiences, and that’s where this system was developed. I’m very oriented to helping the patients and advancing the profession.”