Response to the letter by Dr. Felix H. Blankenstein regarding "Orthodontic appliances and their diagnostic impact to brain MRI".

OBJECTIVE: To evaluate the diagnostic impact of fixed orthodontic appliances on brain MRI under clinically realistic conditions, and to clarify the scope and focus of our Technical Note in response to commentary MATERIALS AND METHODS: Common orthodontic appliances, including brackets, archwires, molar bands, and transpalatal arches, were assessed in vivo during brain MRI. The analysis was designed as a Technical Note, with emphasis on empirical diagnostic imaging rather than detailed metallurgical characterization RESULTS: For most orthodontic configurations, brain MRI images remained interpretable across standard sequences. Severe artifacts were observed primarily in the presence of a transpalatal arch, especially in SWI and DWI sequences. These findings provide actionable insights for radiologists and orthodontists CONCLUSION: While theoretical alloy-based compatibility assessments remain valuable, empirical MRI data are indispensable in clinical practice, where detailed material information is often unavailable. Our study confirms that standard orthodontic appliances usually allow interpretable brain MRI, with specific exceptions CLINICAL RELEVANCE: The study offers practical guidance for imaging patients with fixed orthodontic appliances. It highlights the need for interdisciplinary collaboration to establish standardized classifications of MRI-compatible products, building on both clinical imaging data and metallurgical analyses.