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Orthodontics archwaire & treatment plan
- 1. Orthodontic Archwires & Treatment plan Jumana Almaghrabi Dental Intern Introduction Definition Requirement Wires Types Techniques instrument Treatment plan
- 2. Introduction: A successful orthodontic therapy depends not only on manual skills and knowledge but also on choice of materials used. One of the major components of fixed orthodontic therapy is the choice of wires. Orthodontic wires are defined as devices conforming to the dental arch, which is used as an anchorage for correcting irregularities in the position of teeth.
- 3. Defintion: • Orthodontic wires are used to carry out the necessary tooth movements as part of orthodontic treatment. • A variety of materials like metals, alloys, polymers and composites are used to produce orthodontic wires. • The properties of orthodontic wires are evaluated by various laboratory tests like tensile, torsional, and bending tests.
- 4. Requirments: Biological: nontoxic. Chemical: resistant to corrosion and tarnish. Mechanical: Modulus of elasticity, Formability, Spring back (elastic deflection) and Resilience should be high, Ductility should be sufficient to allow fabrication of appliance, Stiffness should be lower, and least friction at bracket – wire interface. Other: Should maintain the desirable properties for extended period of time after manufacture, inexpensive and easy to handle.
- 5. Types of Orthodontic Wires: Precious metal Alloy Stainless Steel (SS) Wires Cobalt-chromium wires Beta-titanium wires Nickel-titanium (Ni-Ti) wires Esthetic wires
- 6. PRECIOUS METAL • Used in the first half of twentieth centaury • Gold alloy with platinum, palladium, copper were used Advantage: High ductility, Inert nature and corrosion resistance, Variable stiffness- by heat treatment, High resilience and Ease of soldering. Disadvantages: Less Elastic force delivery, Greater cost, Have minimal use currently after introduce SS.
- 7. Stainless Steel (SS) Wires • Stiff wire It can be bent to any desirable shape. • The austenitic 18-8 stainless steel type is most commonly used. of approximately It contains chromium and nickel content 18% and 8%, respectively. • its high resistance to corrosion, but releases nickel and chromium in fewer amounts and may induce hypersensitivity reactions. • Stainless steel wires produce higher forces applied during shorter time. • lower bracket-wire friction so it ideal for space closure. • Its moldability and strength make it a material of choice to fabricate appliances such as a Nance or Forsus. • Recently, super stainless steels have been developed with a lower nickel content, higher corrosion resistance, and improved mechanical properties.
- 8. Nickel-titanium (Ni-Ti) wires • Also known as Nitinol (Nickel-Titanium naval ordinance laboratory) • introduced in 1972. • Usually used in the initial stages of treatment • Types: • NeoSent alloy wires and Copper-Nickel-Titanium alloy (Cu-Ni-Ti) wires were developed in early 1990s. • Nitinol SE (Nitinol Super Elastic) wires are superplastic. • The Advantage: • its high resiliency, shape memory, pseudoelasticity or superelasticity( This wire generates almost the same amount of force regardless of the amount of deflection), low forces, and their corrosion resistance. • The disadvantages: • low formability Cannot be bent or welded easily, they are expensive, The friction develops at bracket-wire interface is more with Nitinol wires. • Nitinol wires are more likely to fail due to normal wear.
- 9. Cobalt- chromium wires • known as elgiloy • Similar to NiTi wires, but with the addition of Copper in the alloy makes the wire react to different temperatures. • It's easier to place in the brackets on severely crowded teeth. • available in wire and band forms. • usually color-coded, High spring tempers (red), semispring temper (green), soft or ductile tempers (yellow). • They are easy to bend. • They can be heat hardened at 482° C for about 7 minutes after manipulation to increase hardness (strength). • These wires have excellent resistance to tarnish and corrosion. • It is inexpensive and can be soldered (fluoride fluxes are used) and welded.
- 10. Beta-titanium wires • These wires are also known as titanium-molybdenium alloy (TMA) or Titanium-Niobium • It introduced in 1979. • properties between Stainless Steel and NiTi. • It has the highest friction with braces that makes it the last choice for space closure. • Modulus of elasticity of these wires is lower than half of stainless steel wires and almost twice that of Nitinol. It can be bent easier than stainless steel wire, but should not be strongly bent for there is a risk of breaking. • Resistance to corrosion. • biocompatible material due to the absence of nickel. So, It can be used in patient known as nickel allergy. • Alpha-beta titanium alloy has been introduced recently. also called as TiMolium, it has stiffness and other characteristics (such as elasticity and yield strength) are between the values set for stainless steel and beta-titanium wires.
- 11. Esthetic wires • Fiber-reinforced composite arch wires • Teflon coated stainless steel arch wires • Bioforce wires • Optiflex • Marsenol • Lee White wire
- 12. Cross Section: Round: These wires are usually more flexible Rectangular: These wires are generally stiffer
- 13. Multistranded wires • Multistranded wires are made of a varying number of stainless-steel wire strands coaxially placed or coiled around each other in different configurations. • The important characteristics of these wires are development of low forces, low stiffness and a resilience, and these wires are inexpensive. They develop higher friction at bracket- wire interface. • Can be used during initial leveling aligning.
- 14. Size: It usually refers to the dimension of the cross section. The measurement unit is in inches. Round wires are measured by their radius, so one number represents their size .014, .018, .020 are common sizes. Rectangular wires are represented by two sets of numbers, one for length and one for width .016 x .022, .019 x .025 are common sizes.
- 15. Simple Technique for Choosing the Right Arch Form 1. After initial alignment, total the collective mesio-distal widths of the upper anterior six teeth. 2. Using the reference diagram, select the appropriate upper arch form radius for the patient gradation (R28, R26 or R24). -Based on the upper arch form radius, select the appropriate lower archwire.
- 16. Example: This case displays a consolidated width of 44.8 mm, indicating consideration of arch forms R26 upper and R24 lower. Consolidated width 3 2 1 1 2 3 indicates arch form size: - Less than 40 mm = Customize R24 - 40 mm - 45 mm = R26 Upper and R24 Lower - 45 mm - 50 mm = R28 Upper and R26 Lower - More than 50 mm = Customize R28
- 17. Instruments: Mathieu Needle Holder Ligature Wire Universal Separating Pliers Buccal Tubes Posterior Band Removing Pliers
- 18. Instruments: Appliance Wire Insertion Instrument Bracket Debonding Instrument Appliance Wire Disengagement Instrument Arch Bending Pliers Bracket Placement Instrument
- 19. Instruments: Universal Cutter End Cutter (Distal) Wire Cutter Weingart Utility Pliers How Utility Pliers
- 20. INSTRUMENT C-1 Short Chain Coil Springs C-2 Long Chain CK Continuous Chain Power ChainO- rings
- 21. Treatment plan • Initial Phase(Getting Organized) leveling, tipping, rotating • Necessary Wire Criteria - low forces - long working range - low modulus - low friction • Intermediate Phase(Working the Big Picture) space closure, arch form correction, occlusal plane leveling • Necessary Wire Criteria - medium forces - medium working range - medium modulus - medium malleability - low friction • Finishing Phase(Getting Down to Details) vertical detailing, space closure, refine interdigitation, retention • Necessary Wire Criteria - medium forces - short working range - high modulus - high malleability
- 22. Wire Placement
- 23. Conclusion Metals, alloys, polymers and composites are the materials used for producing orthodontic wires, Each type of material has its advantages over the other. However, the practitioner should have a thorough knowledge of the mechanical and physical properties of wires to determine their clinical behavior and to achieve a satisfactory and predictable outcome.
- 24. Refrences: • Ravichandra S et al, Rama K et al, An Overview of Orthodontic Wires, research gate online, Trends Biomater. Artif. Organs, 28(1), 32-36 (2014). • William R et al, Proffit, contemporary orthodontics, fifth edition, eElsevier,canada, 2013. • Chaconas SJ, Caputo AA, Harvey K. Orthodontic force characteristics of open coil springs. Am J Orthod Dentofacial Orthop 1984;85(4):494-97.
Editor's Notes
- Therefore, the aim of the present review was to focus on the differences in the features of wires as well as their working sequence according to the treatment plan.
- However, oral conditions may influence their behaviour and it is important for the clinician to understand the properties of orthodontic wires as well as their clinical implications to turn out optimal results.
- Modulus of elasticity should be high. It enables the wire to apply more force for tooth movement. Formability should be high so as to bend the wire into desired configuration without fracture. Spring back should be high which results in an increase in its range of action. Spring back is the measure of how far a wire can be deflected without causing permanent deformation. It is also called elastic deflection. Resilience should be high. It increases the working range. Stiffness should be lower. It provides the ability to apply lower forces constantly for a lower time. Should provide least friction at bracket – wire interface. Otherwise it leads to undue strain إجهاد لا مبرر له, which limits the tooth movement
- so did not form toxic products with saliva
- 3- by the formation of a passivated oxide layer, which blocks the further oxygen diffusion to the underlying mass. In a study, Kolokitha et al., concluded that orthodontic treatment is not related to an increased likelihood of hypersensitivity reactions to nickel unless there is a history of skin piercing 5-and this friction can be further reduced by using nanotechnology applications. Australian wires are a kind of stainless steel wires available in different grades with gradually increasing stored energy values (resiliency). These wires contain more amount of carbon content that is up to 10 times higher than that in a standard stainless steel orthodontic wire and this results in increased surface roughness, hardness, porosity, and susceptibility for breakage during clinical bending, particularly for higher grades These properties have made these wires to be chosen instead of titanium wires since titanium wires are expensive.
- Nitinol wires are more likely to fail due to normal wear. if they remain in the oral cavity for many days. This kind of wear is more with larger or rectangular section wires than smaller section wires
- High formability combined with increased elasticity and yield strength following heat treatment by 10% and 20- 30%, respectively, have made Blue Elgiloy, a cobalt- chromium wire type, popular in clinical practice.
- It is not as stiff as stainless steel and not as flexible as NiTi Their resistance to corrosion is due to the formation of a surface passivation oxide layer, but exposure to fluoride agents leads to the degradation, subsequent corrosion, and qualitative alteration of the wire’s surface. The duration of wire exposure to fluoride agents appears to play a major role. These wires are highly expensive
- (rounded to nearest 1/10th of a millimeter)
- Posterior band removing pliers: Long, narrow chisel-tip beak facilitates posterior band removal. Universal :provide easy access to difficultto- reach areas. Mathieu:Very useful for placing AlastiK Force Modules. Can also be used with metal ligatures. Buccal tube :the archwire cinched back distal to buccal tube Ligature wire:keep the metal archwire securely tied into the bracket slot.
- Wire insertion:single tip on one end or the double tip on the other end, archwires are engaged into Brackets with a roll of the hand. Wire disengagement: Archwires are removed from Brackets by sliding the instrument’s hooks beneath the archwire and lifting it away from the bracket with a squeeze. Arch bending pliers: Bracket:placing the bracket onto the tooth. seat brackets, Bracket debonding: May be used with or without the archwire engaged in the bracket slot.
- Weingart utility pliers: Securely holds wire or auxiliary at any convenient working angle. Rounded surfaces for patient comfort. Seratted grip How ultity : same but Matching serrated tips. End cutter: 72° angle for very close cut to buccal tube. Universal cutter: (Safety Hold) Holds loose distal ends. Shear-cuts hard wire.
- Open coil: to open spaces to accommodate certain teeth. Cllose : close the spaces Power chain: help close space O ring:single rubber colors we put around the brackets to hold the wire in place
- Often, the clinical examination has to be supplemented with further analyses using extra- and intra oral photographs, study casts (model analysis) and radiographs. The results from the interview, clinical examination and the supplementary analyses will constitute a solid basis for a comprehensive orthodontic diagnosis, which in turn forms a cornerstone for the treatment plan.