Although intermaxillary elastics are often used to settle the occlusion during the finishing stage of orthodontic treatment, many Bracket systems do not include hooks for elastics attachment. Kobayashi or custom-made ligature hooks1 tend to bend labially when used with heavy elastics, especially during placement and removal, and elastics can even pop loose from the hooks on mouth opening. We have devised a simple, stiff hook--named the "PGI hook" after our Post-Graduate Institute--for use with intermaxillary elastics in patients bonded with twin brackets.
1. Form a 2mm-diameter bull loop in a segment of .016" x .022" (for .018" slots) or .019" x .025" (for .022" slots) rectangular stainless wire. Place a 90º bend in each leg so that the legs lie flat in the same horizontal plane (A).
2. Place medial bends in the legs, 2-3mm from the neck of the loop, and cut away the excess wire (B).
3. Engage the PGI hook in the bracket slot and ligate it tightly (C).
Since the hook fills the main archwire slot, it can be used only when a main archwire is not in place, and it may be difficult to engage in small brackets with short distances between the mesial and distal tie wings. Still, we have found the PGI hook to be useful in our practice; it is easily fabricated and will not deform under forces from elastics, mastication, or oral hygiene. Patients find it much easier and more comfortable to wear their elastics with the PGI hooks than with conventional ligature hooks.