Wear of enamel against both metal and ceramic brackets (abrasion) may occur. It is common on upper canine tips during retraction as the cusp tip hits the lower canine brackets (Fig. 5). It may also be seen on the incisal edges of upper anterior teeth where ceramic brackets are placed on lower incisors.17 Ceramic brackets are very abrasive and therefore contraindicated for the lower anterior teeth where there is any possibility of the brackets occluding with the upper teeth, bearing in mind that the overbite may
Fig. 2 Cavitation at the gingival margin of the lower right canine and first premolar requiring restoration
increase in the early stages of treatment. Any enamel erosion must be recorded prior to treatment commencing and appropriate dietary advice given to minimise further tooth substance loss. Carbonated drinks and pure juices are the commonest causes of erosion and should be avoided in patients with fixed appliances.
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