Honing Damon System

Mechanics for the Ultimate

in Efficiency
and Excellence
Jeff Kozlowski, DDS
East Lyme, CT

Dr. Kozlowski received his Recently a number of us experienced in Damon System offers a number of torques for upper and lower
DDS degree and certifi-
cate in orthodontics from
Damon® System mechanics gathered to anterior teeth (Figure 1). Matching ideal torque values to your
the State University of share our current protocols and discuss setup – while taking treatment mechanics such as Class II elastics
New York at Buffalo in
how we can enhance treatment to provide into account – allows the roots to begin to upright as bracket
1998. Since graduation,
he has been a managing greater efficiency and higher quality results torque expresses during the light rectangular wire leveling phase.
partner of a four-doctor, for our patients. The consensus of the Differential torque can shorten treatment time and, I feel,
four-office practice until
last year. He is currently in
group was that Damon practitioners can enhances stability by allowing the crowns to spend as much time
the process of opening a make many decisions in treatment plan- as possible uprighted over their roots before the teeth are
new practice and during
ning and the early stages of treatment that debonded. In this manner, we will spend less time in the finish-
this time is active in the
clinical application of will simplify the finishing stage and greatly ing stage of treatment placing selective torque into finishing
newly developing ortho- improve the quality of our case results. wires. For example, clinicians can select high-torque maxillary
dontic products while
getting more than usual
This article summarizes those discussions anterior brackets for Class II, division 2 cases or in Class II,
family time and continu- and includes what I believe are three essen- division 1 cases, high-torque maxillary anterior brackets and
ing his endurance athletic
tial practices to achieving the ultimate in low-torque mandibular incisor brackets to counteract the forces
training. Among other
competitions, he has efficiency and excellence with Damon of Class II elastics (to be addressed a little later in the article).
finished the Ironman System mechanics: using variable torque, To reiterate, applying variable torque fosters earlier initiation
Triathlon five times
and the half-Ironman
disarticulating the occlusion with bite
Triathlon 12 times. turbos and beginning light elastics early Figure 1. Damon Variable Torque Options

in treatment. Torque Type Torq. Ang. Torq. Ang. Torq. Ang.

Upper Centrals Upper Laterals Upper Cuspids

Essential #1 – Begin with High +17º +5º +10º +9º +7º +6º
the End in Mind: Match Standard +12º +5º +8º +9º 0º +6º

Torque Selection to Case Goals Low +7º +5º +3º +9º N/A

Lower Lower Lower 1st

Simulating a patient-specific prescription Anteriors Cuspids Bicuspids

using variable torques is one of the most High N/A +7º +5º N/A
Standard -1º +2º 0º +5º -12º +2º
expedient means of achieving the desired
Low -6º +2º N/A N/A
final positions of teeth and roots. The

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 of torque in the rectangular leveling phase and takes only two edges of a rectangular archwire engag-
maximal expression of palatal root torque prior ing the opposing walls of a lumen for the torque pre-
to the completion of treatment. scription of a bracket – including a passive Damon
self-ligating bracket – to express itself (Figure 2).
Getting Torque in a Passive Self-Ligating
Appliance. To get a better appreciation for the Research that Pandis, et. al., conducted demon- +/- 10.5°

advantages of employing the variable torque strates that Damon passive self-ligating brackets
options available in the Damon System, it is impor- are equally effective in delivering torque to maxil-
tant to review how bracket torque functions. As we lary incisor teeth relative to conventionally ligated
all know, when we engage a rectangular wire of brackets.1 In fact, in the virtually friction-free
Figure 2. The torque prescription
sufficient size into the lumen of a bracket, the environment of the Damon System, torquing of a Damon bracket will express
itself when only two edges of a
torque prescription of that bracket will begin to movement from the angular rotation of a rectan- rectangular archwire engage
express itself. There has long been a misconception gular wire engaging opposing walls of the lumen opposing walls of the lumen.

that an archwire must press firmly against the base on two points creates the desired torque without
of a bracket for it to express the desired bracket the friction from elastomeric ties or the flat sec-
torque; however, discounting the wire-to-lumen tions of the wire being pressed firmly against the
play operating in any bracket system and any base of the slot as in conventionally ligated appli-
offsetting mechanics, such as Class II elastics, it ances. Active self-ligating brackets have similar

Expanding Torque Options Without Further Expanding Inventory

Besides employing the variable torques built will begin to detorque and move labially toward its ideal position. With
into the Damon System appliance, there are this protocol, you no longer need to await the major mechanics phase of
other means of expanding torque options treatment to correct the palatally positioned root. Once the root is in ideal
without expanding bracket inventories. One position in relation to the crown, flip the bracket to its normal position and
such means is to employ reverse torque. rebond (now with +10º) to ensure that the root does not continue to move
labially. Note: When inverting brackets for reverse torque, be sure to keep
When individual teeth have roots that are the brackets on the same side of the arch so the root tip remains the same
not upright under their crowns, treatment mesiodistal. See illustrations A and B. Placing them on the opposite side
will progress more efficiently if you begin of the arch will change the intended root tip (mesial to distal and vice
moving the roots toward their intended final versa). By the way, we use the term "reverse torque" when discussing
position during the rectangular Copper inverting brackets to minimize a patient's fear that we're placing a bracket
Ni-Ti® leveling phase of treatment. If the upside down.
variable torque options available will not
achieve the root torque you want, employ A B When inverting brackets for reverse torque, keep
the brackets on the same side of the arch so the
reverse torque by inverting the bracket in root tip remains the same mesiodistal. For exam-
the same arch to change the torque value ple, when inverting an upper lateral bracket with
9º of distal root tip in the same arch (A), the distal
from negative to positive or vise versa. root tip remains the same (B).

This case is an example of the most com-

Inverting brackets changes torque from positive to negative or vice versa (in this case, on the upper right
monly employed use for reverse torque. As lateral incisor from +10º to -10º), which expands torque options and generates early root torque movement
the light round wire aligns in such a case, in the desired direction upon insertion of the rectangular wire. Case photos courtesy of Dr. Bill Thomas,
Poway, CA.
the crown of the upper right lateral incisor
will come forward, leaving the root in its
palatal position. To combat this “pseudo-
torque,” place an inverted +10º upper right
lateral incisor bracket (now with reverse
torque) to create a -10º torque bracket. Upon
engaging the first rectangular wire, the root

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frictional drawbacks of conventionally ligated brackets. Ni-Ti wire after the panorex/repositioning appointment
Overcoming this friction requires high-force mechanics, if the repositioned brackets are level enough. In such
which Damon System protocols are designed to avoid. instances, the additional palatal root torque will develop
while the final leveling occurs prior to placing the
Prevent Torque Loss from Wire-to-Lumen Play .019 x .025 stainless steel working wire.
and Major Mechanics: Add Wire Torque. There
are two primary means of torque loss: wire-to-lumen
play and major mechanics. Because the cross-section of a
stainless steel working wire can never reach the same size
as the lumen into which it is being engaged, a portion of
the torque that is designed into the bracket will not be
expressed. This loss of torque is often referred to as wire-
to-lumen play2 and can have deleterious effects on the
expressed torque, the axial inclination of teeth and
ultimately the ability of the clinician to effectively finish Pretreatment
treatment. For example, there is approximately +/-10.5º
of play between a .019 x .025 stainless steel wire and a
.022 slot (Figure 2). We all have to take wire-to-lumen
play into consideration when planning torque values for
ideal tooth and root positions.

Major mechanics (e.g., Class II elastics) also attributes

to torque loss in maxillary anterior teeth. It is advisable
to add torque selectively in the stainless steel wire during Initial Bonding

the major mechanics phase of treatment to counteract

the negative effects of such mechanics. The loss of
torque in the maxillary anterior teeth from wire play2 in
combination with the Class II elastics can be easily offset
by placing at least +10º (and up to +20º) of palatal root
torque in the upper incisor region with the .019 x .025
stainless steel archwire.

20-Week Progress
Use Pre-Torqued Wires to Assist Torque
Expression. Proper selection of variable torque bracket Figure 3. Anterior bite turbos unlock the malocclusion and allow anterior alignment
and arch development. Note: Given the lingual position of the upper lateral incisors,
options will allow the rectangular leveling wires to pro- it may have been wise for me to employ reverse torque by inverting the brackets.
vide torque delivery early in treatment. There are times,
however, when the .018 x .025 Copper Ni-Ti archwire
will not provide sufficient palatal root torque to the
maxillary anterior teeth even with the ideal bracket Essential #2 – Unlock the
torque. In these instances, it is often advisable to use a Malocclusion: Disarticulate the Arches
.019 x .025 pre-torqued Ni-Ti® (20º of torque) wire to
with Bite Turbos
assist in developing the ideal maxillary anterior palatal
root torque. The pre-torqued wire can be used in place Clinicians who use bite turbos normally place them on
of a .018 x .025 Copper Ni-Ti archwire if the arch is the lingual surfaces of upper anterior teeth in deep-bite
sufficiently level, or it can be used as an additional level- cases to bond both arches at once (Figure 3). As we’re all
ing wire to ensure proper palatal root torque before aware, bite turbos benefit treatment in numerous ways:
progressing to the .019 x .025 stainless steel wire. In cases 1. Protect the enamel from bracket wear / debonding.
that require additional palatal root torque for the maxil- 2. Improve the effect of light wires on arch
lary incisors, I often place a .019 x .025 pre-torqued development.

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 3. Improve the effect of early light elastics for A/P, light posterior vertical elastics will extrude poste-
vertical and transverse corrections. See rior teeth and correct a low-angle deep bite by
Essential #3. posterior eruption.
4. May have an impact on correction of excessively
low or high mandibular plane angles (brachy- Dr. Stuart Frost shared his idea of using flowable
facial or dolichofacial patients). resin to correct posterior crossbites when placing
bite turbos in the anteriors is difficult (Figure 4).
In my practice, a bite turbo has come to mean any He flows a transparent pink resin (Triad® Gel
resin bump that unlocks the malocclusion for Flowable, Dentsply, York, PA) into the occlusal
greater freedom of movement. Using bite turbos grooves of lower first molars to make a flat plane,
more creatively, however, can have far-reaching which fosters crossbite correction in conjunction
treatment implications. with early light crossbite elastics by allowing free-
dom of interarch movement. The pink color of the
Bite turbos can also assist directionally in Class III resin makes the bite turbo easy to see during place-
cases. For such cases, I often form bite turbos ment and removal and its transparency shows the
(Mini-Mold starter kit, Ortho Arch, Schaumberg, occlusal surface through the turbo. Note: It may be
IL) on the lingual surfaces of the lower incisors in necessary to air cool the Triad Gel because it warms
such a way that they have an incline designed to up during the curing process.
allow the upper incisors to slide down it toward a
Class I position. For all anterior bite turbos, I use Essential #3 – Be Creative:
Blugloo™ two-way color change adhesive, which
Use Early Light Elastics for Early
turns from clear to blue during bonding and
Interarch Correction
debonding, making it easy to see during placement
and removal. If the turbo debonds during treat- In combination with bite turbos, using light elastics
ment, the adhesive will turn blue, easing the where applicable (Figure 5) early in treatment to
patient’s mind that it is not a tooth fragment. begin correcting A/P, vertical and transverse issues
is yet another important tool that improves the
I try to select bite turbo locations to enhance the quality and enhances the efficiency of Damon
direction of the treatment goals. While this is an
admittedly simplistic approach, I generally choose
Figure 5. Light Elastics for Early Dental Base
posterior bite turbos for high-angle cases and ante- Movement
rior bite turbos for low-angle cases. For example, in
Elastic Type Size Weight
high-angle cases, using bite turbos in the posterior
Quail 3/16" 2 oz
can cause intrusion of the posterior teeth that helps
close down the high-angle. In low-angle cases, Parrot 5/16" 2 oz

anterior bite turbos in conjunction with early

Figure 4. Flowing resin

into the occlusal grooves
of lower first molars to
make a flat plane fosters
directional crossbite
correction. Case photo
courtesy of Dr. Stuart
Frost, Mesa, AZ.

Figure 6. Early light elastics in this Class III case were

worn from bonding day to improve the efficiency of treat-
ment. Case photo courtesy of Dr. Bill Thomas, Poway, CA.

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 System treatment (Figures 6-8). Thanks to Dr. Tom Pitts treatment goals. If Class II correction is the primary con-
(Reno, NV), who has been instrumental in devising this cern, “shorty” Class II elastics will assist in early dental base
protocol, clinicians no longer have to wait for completion movement. (See a discussion of “shorty” Class II elastics
of the leveling stage before initiating bite correction. To later.) If, in a low-angle case, an anterior deep bite is of
determine the direction of early light elastics once the greatest concern, posterior vertical elastics will help extrude
occlusion is unlocked with bite turbos, consider the ultimate the posterior teeth, thereby reestablishing the posterior

Initial Bonding 9-Month Progress

Figure 7. An anterior open bite has

significantly improved in nine months
with early light elastics. Case photos
courtesy of Dr. Stuart Frost, Mesa, AZ.

Pretreatment
Figure 8. This Class III case demon-
strates remarkable progress achieved
with the use of bite turbos placed
lingually on the lower central
incisors – which unlocked the
occlusion and allowed the lower
incisors to slide toward a Class I
occlusion – in conjunction with early
crossbite elastics. Case courtesy of
Dr. Stuart Frost.

Initial Bonding

7-Month Progress

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 occlusion more expediently. If The term “shorty” Class II elastics is used to differ-
there is a combination of con- entiate their attachment from traditional Class II
cerns about the malocclusion, elastics because they have a reduced horizontal pull.
consider combining the horizon- Figure 10 depicts the configurations of “shorty”
tal and vertical vectors, for Class II elastics that clinicians have reported
example, by running posterior success in employing.
triangle elastics with a Class II
Posterior Vertical Box
vector. In summary, you can Conclusion
attach elastics in virtually any There are many decisions the Damon System
position that enhances the practitioner can make in the treatment planning
required correction. Figure 9 and early stages of treatment that will simplify the
demonstrates three basic config- finishing stage of treatment and greatly improve
urations. Types of elastics you the quality of case results. For the clinician looking
should consider are posterior to take their Damon System treatment to the next
vertical box elastics, posterior level, consider employing variable torque options,
triangle elastics, posterior check disarticulate the occlusion with bite turbos at the
Posterior Triangle with Class II vector elastics, pos- initial bonding and start light elastics for direc-
terior crossbite elastics, shorty tional bite correction during the leveling phase of
Class II or Class III elastics, and treatment. Using these three tools together will
other anterior and posterior enhance the efficiency of Damon System treatment
vertical elastics configurations with a focus on clinical excellence.
or any combination of these.

“Shorty” Class II Elastics. References

1Pandis, N, Strigou, S, Eliades, T: “Maxillary incisor torque with
Traditionally, Class II elastics run conventional and self-ligating brackets: a prospective clinical trial,”
from the lower first molar to the Orthod Craniofacial Res 9, 2006; 193-98.
Posterior Check with Class II Vector
post on the upper wire just 2 Meling, TR, Odegaard, J: “The effect of cross-sectional dimen-
Figure 9. Three creative mesial to the upper canine. The main concerns with sional variations of square and rectangular chrome-cobalt archwires
elastic configurations for a on torsion.” Angle Orthod 1998; 68:239-48.
deep-bite case. Note: Bite
placing Class II elastics in such a configuration
turbos are in place. early in treatment is that the horizontal pull would
be so great that the elastics could cause extrusion of
the upper anterior teeth or detrimentally affect the
arch form if they are placed around the anterior
curvature of the archwire. When using light early
elastics on the initial leveling wires, it is important
to reduce their horizontal pull to minimize any
untoward effects on the ability of the wires to level
the arches so different configurations are required.

Figure 10. Depending on the

overall treatment goals of the
case, shorty Class II elastics
can be attached in a number
of configurations early in
treatment without detrimen-
tally affecting treatment
progress. Case photos
courtesy of Dr. Bill Thomas.

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