The Damon Bracket system
Dr Dwight Damon (pictured above) is, in my view, one of the world’s most famous orthodontists for his pioneering work in improving the quality and efficiency of clinical orthodontics.
He is recognised for the development of the Damon Bracket system, a passive self-ligation fixed orthodontic appliance. Having trained from the University of Washington in 1970, Dr Damon has dedicated his career to improving treatment quality. He has had an orthodontic clinic in his native Spokane for 40 years. Dr Damon’s son, Paul, is also an orthodontist and lecturer in the Damon System.
The Damon System is a combination of passive self-ligation brackets, and force-calibrated archwires working together to give us a low-friction system. The system is underpinned by the philosophy that using biologically sensible forces improves both tooth position and facial aesthetics.
As a keen follower of his work, I was delighted to have the opportunity of interviewing Dr Damon recently.
RMC: What was the catalyst for developing the Damon Bracket system?
DD: I have always been very motivated to keep learning and improving how I was treating and caring for my patients. Early in my career, I questioned why force levels for clinical mechanics were often based on patient tolerance rather than their positive or negative impact on bone and tissue. It seemed that if teeth did not move, most clinical solutions were to increase the applied force. This was such a direct contrast to what I observed from seeing major tooth movements in response to the incredibly light forces generated from slow growing cysts.
Even though the mechanism for tooth movement is still not totally understood, it has always made sense to me that maintaining vascular supply to alveolar bone and tissues has to have a positive impact on tooth movement and surrounding bone and tissue. I also observed that there was a significant difference in clinical responses when tying initial light-force archwires with elastomerics versus loosely tied wire ligatures. It simply made sense to start cases with very light-force archwires that were allowed to express themselves in a reduced friction and binding environment of the archwire-bracket interface.
RMC: How were you able to balance running a busy orthodontic clinic as well as developing your system?
DD: In today’s world we all know how difficult it is to find time to do everything on our schedules every day. Clinicians are challenged to find a balance between their family lives and running a busy quality practice. For me, the only way I found time to develop new technology was to spend creative time late at night when everyone else was sleeping. I was very fortunate not to require much sleep.
RMC: Why do you think the Damon system has been so widely adopted globally?
DD: What has been so important to its success is that it has not been just a bracket, but a carefully designed system, utilising specific archwire progressions to enhance clinical mechanics and performance. I always tried very hard to take impeccable records before, during, and after treatment followed by long-term retention evaluations and let the results tell the story. I think showing pre-treatment and final 3D CT scans were also a significant help and motivator.
I have always emphasised in my lectures: ‘If you think you can achieve the same results you are seeing on the screen with your current clinical technology…don’t change! But if you are seeing treatment and final results that you currently cannot achieve, I would encourage you to have some sleepless nights thinking about which technology will help produce the best results for your patients.’
It has been very gratifying to see how the system has been accepted worldwide.
RMC: What were some of the key points to growing your very successful practice in Spokane?
DD: Without question I think the main key to building a successful practice is having this goal for any office: ‘Try to exceed your patients and family’s expectations.’ This means to be a great teacher and communicator of what you are doing each day. Don’t be afraid to share your passion for excellence with your patients, families, and your staff. In exams or consultations, some clinicians think their success is based on patient’s acceptance of treatment. I think a far bigger issue is to show patients examples of before and after final results and teach how your goals for treatment are far more than just straightening teeth. This can be done in a very short period of time and can be the greatest builder of a successful practice.
RMC: Is there anyone in particular who has influenced your career pathway?
DD: My father was an outstanding science teacher and deserves the credit for always encouraging me to be curious and not be afraid to ask: ‘Is there a better way?’ I was also very fortunate to spend my high school and college summer years working in a product manufacturing machine shop where I learned how to fabricate and work with metals. It was a fantastic experience improving and developing products.
RMC: Growing up, had you always wished to pursue dentistry?
DD: A physician friend of our family was very encouraging for me to choose a career in healthcare. He wanted me to be a heart surgeon or neurosurgeon and allowed me to witness many surgeries. Even though I realised how valuable and interesting these specialties are for society, it struck me that there was very limited time to establish a relationship with patients. I chose dentistry and orthodontics because patients are treated over time, which often encourages more personal relationships.
RMC: Where is the future of orthodontics heading?
DD: Looking into the future, I think the progressive office will be smaller in size yet incredibly efficient, utilising the best technology and producing very high-quality treatment results. I think patients will continue to desire superb results in a shorter period of time with far fewer appointments. I also think that one of the greatest opportunities for clinical orthodontics is to become a significant player in the treatment and management of airway issues. In the future, I think treatment planning will be greatly influenced by the long-term impact of treatment results, not only on the face, but on final tongue position and airway as well. I think the biocompatible aspects of passive self-ligation, including its effects on posterior arch width, will have a significant impact on positive airway control for many patients.
RMC: What advice would you give a newly qualified dentist today?
DD: In my lectures, I have emphasised that through your early life your performance has usually been judged by others. Initially we are coached and guided by our parents. Later our teachers in school grade us on our performance. Someone is usually there looking over our shoulder. A newly qualified dentist going into practice no longer has this guidance system judging every move. It is time for your own conscience and value system to be your guidance system on how good a practitioner you are going to become.
Doing any clinical procedure, I would encourage clinicians to never say these three words: ‘That’s good enough.’ Using these words as one’s standard, I have often observed the next time one evaluates with these same three words the end product can so easily stop at a lesser level. Over time a clinician can become a very mediocre practitioner. Instead, I encourage everyone to say: ‘I am not going to stop until I have absolutely done my very best.’ This does not mean that everything always turns out perfect, but at least you have pushed yourself to do your very best. Over time, always challenging yourself to the highest standards usually produces a very outstanding and happy clinician.
RMC: What are your plans for the future?
DD: I have found great satisfaction in teaching others. My challenge has always been to try to encourage all clinicians to keep the passion to pursue excellence. I long ago realised that happiness seems to come to those people who are willing to seek excellence in all phases of their life. Hopefully I can help clinicians step forward and encourage their piers to treat their patients to a higher standard.
For more information on the Damon system and courses, please visit www.ormcoeurope.com.