Self-ligating bracket systems are currently one of the hottest topics in orthodontics. There are many of these systems on the market however, the Damon bracket system is perhaps the best known and widely used of these systems in the world.
The 1st generation of the Damon system was released in 1996 with a relatively small distribution and user base. The first Damon Forum for users was held shortly thereafter with a handful of users sharing ideas and their experiences with this low force, passive ligating system. By 2000 the second generation bracket, the Damon 2, was released with significant design modifications. As important as the modifications in bracket design was the establishment of recommended treatment protocols for the Damon system itself. These treatment protocols served as an important guide for doctors using the system and addressed the changes in chair-side mechanics that must be employed to maximize the benefits of the Damon system. In 2004 and 2005 respectively, the Damon 3 hybrid and Damon MX brackets was released to offer an alternative for patients desiring the esthetic appearance of ceramic brackets and durability of traditional stainless steel appliances.
As with any new bracket system, the first doctors implementing the system had to rely on sharing their experiences and trials with the system with other doctors to learn how to maximize the benefits of this system. The inaugural Damon Forum was established for just this purpose. Since that first meeting and the establishment of Damon treatment protocols, the Damon Forum has grown rapidly to well over 1,000 attendees at the 2007 meeting. Clinical research has also been completed showing the benefits of the Damon system.
Damon System Timeline:
1996- 1st Generation Damon SL (Self-ligating) bracket released
2000- 2nd Generation Bracket – Damon 2 released
Initial Damon treatment protocols established
2002- Clinical Studies released regarding efficiency of Damon Bracket system and archwires
2004- Damon 3 hybrid bracket released
2005- Damon 3MX Bracket released
2007- Damon Forum (over 1000 doctors in attendance)
Inaugural Damon Advanced meeting
Damon System Theory
The Damon philosophy is not centered around the Damon bracket itself, but a treatment planning concept that focuses on facial esthetics as the critical foundation for diagnosis. In short, it’s not all about the “plaster”. After all, what good is it to achieve an excellent occlusion at the expense of facial esthetics? The Damon system is simply a tool to employ this shift in treatment planning philosophy.
For those who still get hung up on the extraction vs. non-extraction debate it should be noted that this concept is not a “non-extraction” philosophy. In fact, the Damon lectures many of the speakers will show patients treated to excellent occlusions using the Damon system with extraction of permanent teeth as part of the treatment plan. The facially-driven treatment planning concept is again emphasized in that these patients were treatment planned for extractions to achieve a desired change in facial esthetics. Dr. Dwight Damon and Dr. Alan Bagden often spend time discussing the concept of “therapeutic diagnosis” with regard to treatment planning extractions of permanent teeth.
Initial leveling and aligning of the arches will allow clinician and patient to determine whether an extraction or non–extraction treatment plan should be embarked upon to deliver the desired dental and facial treatment results. Many will argue that that this “therapeutic diagnosis” results in needless “round-tripping” of the incisors, however, by leveling the arches using the technology available in the Damon system, a passive ligation system and low force copper NiTi , wiresthis can be done without excessively proclining incisors into an unstable position. Again reason must be exercised by the experienced clinician in selecting these cases, but the Damon system certainly offers an excellent option for those borderline extraction patients.
A second important concept stressed with the Damon system is that the forces applied to the biological system (teeth, periodontal ligament, vasculature, and supporting musculature) should be the lightest forces possible to stimulate tooth movement. Traditional bracket systems rely on stainless steel or latex ligature ties to hold the wire into the bracket. These ties bind up the wire creating friction for the system to overcome before tooth movement may be achieved. The literature documents very clearly that heavy forces applied to a tooth cause hyalinization within the supporting periodontal ligament. This brings the active process which allows tooth movement – osteoclastic/osteoblastic alveolar remodeling- to a screeching halt. Lighter forces in turn allow the supporting periodontium to respond optimally to the forces producing, in theory, optimal tooth movement. By eliminating the previously mentioned points of friction in the appliance biologically compatible tooth movement may be achieved more efficiently.
In summary, the Damon system and philosophy employ the concept of biological adaptation to not only facially driven treatment planning, but also to individual tooth movement. This paradigm shift in philosophy may challenge reasoning previously taught to us by our previous generations of orthodontists. At a minimum it should make the diligent clinician step momentarily out of his/her comfort zone to carefully consider what options may be available to achieve optimal facial and dental treatment results.
The Damon Bracket Design
Often times we hear someone hail a bracket/appliance as the next panacea for whatever problem ails us in our day to day clinical experience. It should be noted that the Damon bracket has one thing in common with every other bracket available in that it is simply a tool to achieve desired treatment results. That being said, here are the critical aspects of the Damon 3 bracket as they apply to the previously discussed treatment Damon treatment concepts:
- Materials- The combination of clear composite and stainless components to the bracket allow achieving maximum esthetics during treatment. Edges of the bracket are rounded to maximize patient comfort.
- All metal slot-The bracket slot of the D3 Bracket remains a four walled stainless steel component to minimize any friction with archwires during tooth movement.
- Passive sliding mechanism- The metal slide mechanism of the D3 bracket ensures full engagement of each wire and maximum expression of wire properties. With no active mechanism to clip/lock the wire into place friction is minimized within the system. The analogy of “driving down the road with your brakes on” is commonly applied to enhance the understanding between active and passive ligation systems.
Continuing Education/Advances
Without question the most critical variable in determining the success one has with the Damon System is the clinician himself. Simply utilizing Damon brackets but employing the same traditional mechanics will allow for only partial benefits of the passive ligation system to be realized. There is a full complement of bracket torque selections, wire selections as well as additional auxiliaries which allow the clinician to utilize the system to its full extent. The most important component of the system is however, the education of the doctor in understanding the shift in mechanics and treatment philosophy of the Damon System.
Ormco offers a wealth of continuing education classes for the beginner implementing the Damon System. While these meeting are not required to become a user of the system they are invaluable in allowing the doctor to initially critically evaluate the appliance. The Damon Forum is also offered annually where Damon speakers lecture on a variety of topics ranging from treatment concepts, chair-side mechanics, marketing ideas, staff training, advances to the system/bracket, and clinical research. Additionally, in 2007, the first Advanced User meeting was held in Las Vegas to share advanced treatment concepts unique to the Damon System.