Bracket placement made simple – start with the lower 6 and place the bracket as gingival as possible (unless it is a huge tooth with plenty of bite clearance and then just put it below the height of contour). Make sure the distance from the mesial of the bracket to the occlusal plane is the same as the distance from the distal of the bracket to the occlusal plane. Put it in the middle of the tooth. Make sure the part of the pad of the 6 bracket that pokes out sits in the vertical groove on the molar. You can feel it as well as see it when you gain experience. Placing the bracket as gingivally as possible on most teeth is to help get it out of the bite and keep it from being bitten on and broken. Place both lower premolars at the same height as the molar – meaning the same distance from the occlusal plane – in the middle of the tooth mesio-distally with the mesial of the bracket the same distance as the distal of the bracket from the occlusal plane. Place the canine bracket just a little more gingivally than the premolars and with the middle of the bracket centered on the junction of the mesial third of the tooth with the distal two thirds. This more mesial placement will help make sure the mesial of the 3 lines up with the distal of the 2 since they are differently shaped teeth and will require an out bend in detailing otherwise. Place the lower incisor brackets in the center of the tooth, aligned with the long axis (lined up with the root which you can usually see by the prominence in the bone and gums with practice) – don’t trust worn incisal edges. Place the lower incisor brackets at the same height as the molar and premolars (so just a little incisal to the height of the canine). So basically you have all the teeth on the lower arch with the brackets placed at the same distance from the occlusal/incisal of the teeth EXCEPT the canines which are more mesial and more gingival. This will tend to flatten the natural curves that occur in the occlusal plane and give you a canine rise but occlusal, tongue and cheek forces will shape the final result as much as bracket placement does. You won’t believe me now because you think you have total control but give it a couple decades and let’s discuss then…

On the upper arch place the 6 bracket in the middle of the tooth with the pokey part of the pad in the vertical groove and make sure the distal and mesial of the bracket are the same distance from the occlusal plane then repeat placement on all the teeth the same as you did in the lower. Premolars at the same height as the molars, canines a little more gingival and a little mesial (usually not quite as relatively mesial as the lower molars since upper canines don’t need as much mesio-labial rotation to line up with the upper laterals), place upper incisors in the center of the teeth at the same distance from the occlusal plane as the premolars – so a little more incisal than the canine. If you want to mess around with making the maxillary laterals shorter than the centrals then go for it but make it just a tiny bit and not a bugs bunny look. The shorter lateral is how we did it back in the day but these days most people want the upper laterals and centrals the same height – of course this is patient preference and may vary by region.

Keep in mind that this is just a general guide and every mouth is different and every tooth is different and people are not symmetrical and teeth are not the same on one side vs. the other but this is a solid, easy guide to get very good bracket placement most of the time. I never had anything near this simple taught to me when I was learning and it made things tougher than they had to be. Also remember that no one is perfect and sometimes we mess up or get fooled by incisal edges and especially upper laterals so we repo or detail depending on the severity of the mistake. I realize that everyone has their way of doing bracket placement and everyone thinks everyone else who does it differently is stupid and I get that. This is the main reason I rarely give clinical advice or even comment.

This guide for bracket placement is not THE way it’s just A way that I’ve found that makes bracket placement easier. It’s how I teach associates and advise any doctors who want insight on how I think about bracket placement and it’s what I’m thinking about when I place brackets.

Try not to make the mistake of over valuing having and looking at the panoramic x-ray when placing brackets. A pano is a two dimensional representation of a 3D object and not terribly helpful in terms of absolute root position. Panos are useful for assessing relative root position but looking at the teeth, their shape, the root prominence and knowing tooth anatomy and the variations thereof very well is a much better guide to assessing where the bracket needs to go. Oh and there is only one way to get better at bracket placement… experience! Put on tons of brackets and pay attention to what you see when they come back. Try to avoid making the same mistake over and over. It’s hard to do. Most of us orthodontists tend to have an unintentional signature (it’s usually a habitual mistake) that you can recognize like a tell in poker if you see enough of their cases. My peculiar defect is a tendency to make the upper right lateral too short. I know this. I watch for this. I guard against this. But dammit I still do it sometimes! My second issue is not getting the lower canine brackets mesial enough to cause the canine to rotate mesio-labially enough so the mesial of the canine and the distal of the lateral line up. I’m working on it…

Hope this is useful to you. FWIW