When we think about clothes, we basically all agree that custom/tailor made clothes are in general of superior quality with respect to the average boutique S / M / L / XL size dress. This does not mean that we cannot properly dress with standard clothes, but we are aware that a tailor-made suit that fits correctly at any part of the body, after the tailor have carefully measured all of them, will probably look better on us rather than a standard suit.
When it comes to brackets we are fully immerged in a market environment full of S / M / L / XL that can be translated into Andrews / Damon / MBT / Rickets prescription just to cite the most famous of them. All these prescriptions are well conceived appliances that can lead successfully teeth towards a standard/average alignment with average tip, torque, rotation, and in-out values. Our profession will be eternally grateful to Dr Andrews that made our life much. Anyway, his valuable work is based on the personal opinion of one of us selecting a bunch of naturally good-looking occlusions and assuming the average values of this group as the gold standard to align the teeth of all the rest of the world (not to cite a lack of variation measures, as only average values were reported and are available on the literature). All the other prescriptions are conceived as a modification of the Andrews one, according to personal observation and philosophies of the inventor/s of the prescription. Sometimes the difference among them is minimal like a few degrees of torque on a couple of teeth over twenty-eight. Furthermore, not so many colleagues, not to say almost no-one, use to work with .021x.028 SS wire that fully expresses the values of the prescription. Needless to say, that the wire/torque play between slot and wires, for wires smaller than the full size one, plays a major role in making at least questionable the difference between the values of all of these prescriptions.
What I am willing to say is that the S / M / L / XL way of working as orthodontics is actually good, it works. But the difference between the different “sizes”/prescriptions does probably not matter that much. I am personally allergic to philosophies and school of thought, and I have always found it difficult to answer to the question “which technique do you use?”. My answer had always been “The more appropriate, according to the case need”. No technique tags, not any faith in any specific prescription. That’s why when I perceived the opportunity to use something completely customized on each patient case, I immediately thought that it was worthy to test it, in particular the Insignia system, that is by now the only true brackets and wire customized system. In an orthodontic world that is striving to customization on any appliance, I feel nice to provide to my patients a tailor-made appliance.
Is it worth? The literature is already giving us some answers and the clinic will give other inputs. We’ll see them together in the next weeks.
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