In the early 2000s, Dr Thomas Pitts and Dr Dwight Damon worked together to create the DAMON self-ligating braces, which at the time were cutting-edge technology.
This new generation of braces produced better results while eliminating the need to extract teeth (e.g. Premolars), which was a technique that used to be used for a wider smile.
One of the benefits of no longer needing to tie each brace is saving time – treatment became 40% shorter for patients.
However, the two doctors eventually parted ways. While the DAMON technique stopped at that juncture, the PITTS technique saw surprising developments.
Thomas Pitts’ ambitions
After going his separate way, Dr Pitts approached OC Orthodontics,a small US-based braces manufacturer. He proposed a new generation of brackets, free of the weaknesses of the Damon generation.
As revolutionary as self-ligating bracket technology was, replacing the elastic ties with a sliding mechanism to hold the wires in place was not a flawless solution… Indeed, a problem remained that required orthodontists to replace the brackets at the end of treatment.
Additionally, the archwire never completely filled the brackets’ slot, which causes some looseness that made it difficult to control tooth finish.
But the system of multiple passive self-ligating braces was an innovation in the field of orthodontics. It brought about incomparable comfort for patients due to the more gentle forces used to move the teeth and shorter treatment time than in the past.
But for Dr Thomas Pitts, the improved protocol and mechanics of the Damon passive self-ligating braces was more necessary than ever, for the beginning of treatment, torsion control and to shorten treatment time.
Emergence of H4 brackets
In 2015, Pitts worked with OC Orthodontics to create the first generation of one-piece brackets, H4, by making smaller bracket sizes (down to 22-26 from the traditional 22-28).
The most important aspect of H4 brackets is not only their smaller size, but the considerably reduced archwire thickness. Unlike the traditional sequence with 6 archwires, H4 braces only use 4 archwires: .014” thermal, .018” x .018” universal thermal, .020” x .020” thermal and .020” x .020” beta titanium.
Reduced archwire use means less time in the chair for the patient and eliminates resorption, bone loss and pain caused by the powerful forces of thick archwires.
Doctor Thomas Pitts had successfully made the treatment more pleasant, shorter and less painful.
Unfortunately, placing archwire 25 of 26 produced much too strong forces. After successive cycles, the doors were becoming increasingly loose.
Characteristics of the H4 brackets
Smaller size: 22-26 in order to avoid looseness of archwire 25.
One-piece base: For optimal connection between the base and the tooth and better bonding resistance, which leads to less breakage of the base and detachment.
Less slot depth: Less slot depth provides better rotation control, unlike archwires that create torsion to tilt the tooth forwards and backwards only.
Comfort: In order to continually improve patient experience and treatment, H4 brackets have smooth round edges for maximum comfort.
Torque in the base: For precise tooth placement and a better finish.
The Pitts 21 innovation
Dr Pitts still had further ground to cover in his search for the ideal brackets…
This is when he created the Pitts 21 passive self-ligating orthodontic brackets with smaller than ever square slots, with a depth of 0.21 x 0.21, as suggested by their name.
Pitts 21 is more than a set of brackets – it is a whole new method with specific protocols to create wide, beautiful 12-tooth smiles, as opposed to narrow 6-tooth smiles.
In particular, reducing the slot to 21 instead of 26 has created 4 contact points with the archwires, eliminating bracket door related issues and providing better rotation control.
Pitts 21 bracket features
Pitts 21 self-ligating braces provide undeniable aesthetic and functional benefits to patients as well as orthodontists, in particular:
In 95% of cases, no tooth extraction required during treatment: Pitts technology makes it possible to treat patients without tooth extraction in 95% of cases where tooth extraction or jaw surgery would have been required.
Shorter treatment duration: With up to 250% increased precision in tooth movement, treatment length can be halved.
Comfortable to wear: Thanks to the smaller bracket size, the adjustment period is only 3-to-5 days, and even long-term wear becomes more comfortable. There is lower pain during treatment and decreased odds of side effects.
4 contact points: Contact between the walls of the slot and the square archwire exerts bracket rotation forces on the tooth it is attached to, to guide tooth incline.
Flawless result: Thanks to the protocols and technical configuration, achieving similar results with other methods is impossible.
Doctor Pitts’ objective:
Shorter treatment duration with Pitts 21 brackets:
Slots are filled very early on in the treatment process, starting in the 3rd month, unlike the traditional approach, with a 22-28 slot that required a 0.12, 0.14, 0.16, 0.18 archwire, which was too thin to completely fill the slot and happened very late in the treatment process, with very strong forces for a very short amount of time.
Pitts 21 fills the entire slot with very gentle forces for a very long period, making the experience healthier and more organic.
The best comfort for the patient:
Patient follow-up requires much less time in the chair.
The most beautiful smile with the Pitts 21 bracket
A balanced smile must have beautiful teeth, good occlusion and symmetrical lips.
Tom Pitts is the first orthodontist to require that smile analysis be based on pictures of the smile rather than plaster castings.
This facial driven technique revolutionised patient follow-up protocols, since treatment planning is based on the face and in particular on the smile.
Upper bracket positioning to protect or improve smile arc is now known as SAP bracket positioning.
“Orthodontics is the art of the possible rather than the science of the improbable”. Bracket positioning for Smile Arc Protection (SAP) is an innovation that blends the art of contemporary aesthetics with the science behind three-dimensional control of tooth position, making superior aesthetic results attainable and more predictable during orthodontic treatment.
Although bracket positions are individualized to meet each patient’s aesthetic needs, the upper incisor brackets are generally placed more gingivally than the canine brackets. The lower posterior brackets are placed somewhat gingivally to avoid occlusion, while the lower anterior brackets are placed somewhat incisally to optimize overbite.