SmartClipTM self-ligating appliance system. Concept and biomechanics (2007)
Author: Trevisi Hugo
Publisher: Elsevier Limited, London, UK
Price: £94.99
ISBN: 978-0-7234-3395-8
In contrast to many other medical specialities, orthodontics still lacks a robust evidence base for most therapeutic decisions. Against this background, new publications that do not provide contemporary evidence for certain treatment concepts do not further our knowledge. When R. P. McLaughlin in the foreword talks about ‘philosophy’, it seems to be a step in the wrong direction. The reader can clearly identify from the title that this book deals with a self-ligating appliance which have recently become popular and most companies have them on offer. However, Unitek was among one of the last manufacturers to introduce a self-ligating bracket. It is therefore surprising that none of the other self-ligating systems or the articles dealing with them are mentioned in this book. Things become even more complicated since this book deals with products from only one company and has been edited by a number of orthodontists who may well have a conflict of interest.
These few introductory remarks clearly show that it was neither the author's intention to write a review on the self-ligating brackets which are currently on the market nor did he intend to support clinical practice with evidence: this book does not contain any investigative statistical data. What it does is to demonstrate what in the eyes of Hugo Trevisi, who is obviously an excellent clinician, is a simple, reliable, and predictive way to achieve good results with the SmartClipTM system.
Each chapter, even the first which is an incomplete historical overview of orthodontic fixed appliances, finishes with at least one clinical case. These patient documentations are excellent in terms of layout, print quality and the clinical photographs, although most buccal photographs do not show the second and third molars.
The second chapter deals with the development of the SmartClipTM system. Though this may not be what a clinician is most interested in, it makes the reader understand why it is called a ‘system’ with defined components. It offers tricks and tips, e.g. how to engage and disengage archwires with the latest disengagement pliers. While other advocates of self-ligating brackets claim that arch width can be drastically expanded, Trevisi, in accordance with the literature, suggests that the patient's individual arch form should be maintained.
Chapter 3 describes customized bracket positioning. Every clinician, irrespective of the brackets that he/she favours, will find valuable hints on where and how to place them ideally. Even experienced orthodontists will find the photographs of the finishing phases inspiring.
Chapter 4 describes most of the mechanics the author uses with SmartClipTM brackets. Though other clinicians claim different mechanics to be as effective as this technique, at least for the presented cases, the Smart ClipTM system worked excellently and this chapter is definitely worth reading. Moreover, it should be positively mentioned that Trevisi does not, as many others, overestimate the friction-reducing effect of self-ligating brackets.
The versatility of the SmartClipTM self-ligating appliance is explained in Chapter 5. Based on clinical examples, there are descriptions of when to bond upper lateral incisors with the brackets rotated 180 degrees and when to use the tubes of lower second/first molars on the upper first and second molars of the opposite side.
The final chapter has little to do with the SmartClipTM system. It covers maxillomandibular relationships, condylar guidance, canine guidance, etc.
In summary, this book is not particularly helpful to an orthodontist looking for criteria to make the best choice among the numerous self-ligating brackets on the market. However, for those who have already decided to use the SmartClipTM system, it provides valuable knowledge, tips, and tricks to achieve the best possible results with the tools at hand.
Though of excellent quality, whether to pay £94.99 for a users manual (e.g. this is something that Microsoft Windows users get for free), is something that every orthodontist must decide for themselves.
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