DECEMBER 2009

CASE REPORT

Introducing the Wireframe DNA Appliance TM

Dr. G. Dave Singh DDSc PhD BDS
BioModeling Solutions, LLC
515 NW Saltzman Road, Suite # 743, Portland, OR 97229, USA

Dr. Gabriela Lipka DDS

206-624 Sixth Street, New Westminster, BC
V3L 3C4, Canada

Dr. Singh earned the following degrees: B.D.S. Dental Surgery: Newcastle University, England, UK, 1983; Ph.D. Craniofacial
Development: Bristol University, England, UK, 1992; and D.D.Sc. Orthodontics: Dundee University, England, UK, 2000.

"Dr Gabriela Lipka trained as a dentist in Slovakia (formerly Czechoslovakia) and came to Canada 1985. Since 1994 she has
been residing in British Columbia, Canada and owns a private general dental practice in New Westminster, BC."

ABSTRACT

rozat was one of the first clinicians to report on the

use of a wire-based appliance for orthodontic
corrections. Later, this idea was further refined by
Nordstroms Advanced Lightwire Appliance (ALF). This
case report represents recent optimizations of removable,
wire-based appliances for orthodontic corrections. Using a
single, upper Wireframe DNA applianceTM in a 15-yearold girl, improvements were achieved in facial symmetry,
maxillo-mandibular relations, lip morphology, as well as
the occlusion in approx. seven months. No pain was
reported during any part of the treatment, and as the
Wireframe DNA applianceTM has six degrees of freedom,
appliance adjustments were made with relative ease. Based
on the Spatial Matrix Hypothesis, we believe that this case
represents an enhancement of craniofacial homeostasis
without the use of any surgery, drugs or injections.

INTRODUCTION

Non-extraction protocols appeal to many clinicians

practicing modern day orthodontic correction, as one way
of reconciling dental and skeletal tissue relationships.
Crozat's goal was to solve crowding by distalization of the
molars, as the dental arch is wider in the posterior regions.
On the other hand, Wiebrecht advocated expansion in molar
and premolar regions using Crozats appliance (Parker,
1985). In either case, expansion of the appliance was
necessary. Thus, McInaney et al. (1980) reported that early
treatment by expansion with Crozat appliances eliminated
the need for extraction of deciduous canines or premolars.
Similarly, Parker (1991) treated a 10-year-old boy over a
period of approx. 5 years, using the Crozat appliance to
establish the correct archform and plane of occlusion. Later,
Bonk (1993) corrected a case with constricted arches,
crowding, posterior crossbite, deep bite, TMJ symptoms
and facial pain. The Crozat appliance developed the arches,

uprighted the posterior segments, and an improvement was

made in the patient's TMJ health. Thus, the Crozat
appliance can be a very effective device. Indeed, it was
introduced as wire-based orthodontic appliance, which
contrasts with other acrylic-based appliances, such as a
Schwarz plate. In fact, the orthodontic wire for the Crozat
appliance has special requirements, including high yield
strength and plastic strain, but a low modulus of elasticity
in order to be bent into a spring with low stress, which
results in forces being transmitted from the wire (Knosp,
1977). These properties as well as the design of the Crozat
appliance make the device somewhat difficult to adjust for
the novice and experienced clinician.

Smith and Ashton (1995) reported that Nordstroms

Alternative Light Force (ALF) appliance represented a
major innovation in orthopedic/orthodontic and TMD
therapy. The ALF appliance is custom-designed and is
capable of correcting various types of malocclusions. It is
also claimed that the ALF appliance corrects cranial base
and cranial distortions; however, the evidence-based
literature is unable to support these claims to date.
Nevertheless, James and Strokon (2003) continue research
into this endeavor. On the other hand, the Wireframe DNA
appliance TM is designed to correct maxillo-mandibular
underdevelopment in both children and adults. The
Wireframe DNA applianceTM is preferred where a bulky,
acrylic-based appliance is not indicated. In some respects it
represents a new generation of Crozat or ALF-type of
appliances but is easier to adjust. It typically has 6 patented,
anterior 3-D Axial SpringsTM, a midline omega loop,
posterior occlusal rests, retentive C-clasps, a wrap-round
labial bow and a midline Suture SpringTM (Fig. 1). The
Wireframe DNA applianceTM is preferentially worn during
the evenings and at nighttime, but not during eating. The
aim of this case study is to report the effects of Wireframe
DNA applianceTM in the first patient that wore it.

DECEMBER 2009

9
hint of lower third molar tooth buds. Lateral cephalometry
revealed a cervical maturation stage of 6 (indicating that the
peak of mandibular growth ended at least two years ago).
The nasopharyngeal airway appeared to be adequate but
there was deficiency in the retroglossal region. After
obtaining informed consent, it was agreed that the patient
would be treated with a Wireframe DNA applianceTM for
correction of the deep overbite.

CLINICAL PROTOCOL

Figure 1 - The Wireframe DNA applianceTM in some

respects it represents a new generation of Crozat or
ALF-type of appliances. It typically has 6 patented,
anterior 3-D Axial SpringsTM, a midline omega loop,
posterior occlusal rests, retentive C-clasps, a wrapround labial bow and a midline Suture SpringTM.

Polyvinylsiloxane impressions were taken and the bite

registration was recorded with the anterior teeth in an edge-toedge relationship. The Wireframe DNA applianceTM was
fabricated and fitted. The patient was instructed to wear the
Wireframe DNA applianceTM for 12-16hrs during the
evening and at nighttime, but not while eating (Fig. 4). The
patient was advised to use a retainer cleaner (Polident retainer
tablets) to keep the Wireframe DNA applianceTM clean, but
not with a toothbrush. Minimal adjustments were made
periodically to keep the appliance in balance for the patient.

RESULTS

Figure 2 - In the pre-treatment photograph (left), note

the facial asymmetry with the lateral canthus of the left
eye at a lower level than the medial canthus. In
addition, the left ear appears to be at a lower level when
compared to the right. In the photograph on the right,
note the improvements in facial symmetry 8 weeks after
treatment was commenced.

CASE HISTORY

A 15-year-old girl reported for dental/orthodontic

treatment. The chief complaint was irregularity of the upper
teeth and a deep bite). The medical history was
unremarkable with no serious conditions, medications or
treatment. In the dental history taking, nothing abnormal
was detected. Extra-oral examination revealed evidence of
facial asymmetry with the lateral canthus of the left eye at
a lower level than the medial canthus. The inter-canthal
angle was -100. In addition, the left ear was at a lower level
when compared to the right (Fig. 2, left). In lateral profile,
there was some evidence of a forward head posture. There
were no TMD symptoms detected.
Intra-oral examination revealed a healthy dentition with
no evidence of caries and no periodontal disease. However,
a deep overbite with reduced overjet was noted, with slight
anterior crowding in both arches (Fig. 3, left). A pan-oral
radiograph revealed unerupted upper third molars, with a

The patient reported that the Wireframe DNA

applianceTM was most comfortable and no pain was
experienced while wearing it. After the first eight weeks, a
remarkable change in the occlusion was detected (Fig. 3,
right). As well, there appeared to be improvements in facial
symmetry (Fig. 2, right). In addition, there appeared to be
enhancement of lip morphology (Fig. 5, right). In lateral
profile, the jaw line appeared to be more robust (Fig. 6,
right) by seven months.
DISCUSSION

Advances in technology and molecular genetics provide

new approaches to orthodontic care in the 21st century for
both adults and children. Molecular biology and molecular
genetics have allowed human facial growth and
development to be studied and understood in ways that
were not available previously. Thus, information on how
natural developmental processes can be harnessed for
clinical orthodontic corrections is beginning to emerge. For
example, new research on tooth movement indicates tissue
behavior that was not envisaged previously. By
understanding and appreciating developmental mechanisms
and the sites and modes of tissue interactions, the natural
processes of jaw growth and tooth movement can be
mimicked for the benefit of the orthodontic patient.

In the first case that was treated with the Wireframe DNA
applianceTM, diagnostic clinical facial features highlighted
a need for midfacial development. However, rather than
conventional mechanics, the utilization of craniofacial
growth and developmental processes was envisaged - using
wire for signal transduction. Indeed, discernible changes
were noted in the face, jaws and teeth. We believe these
changes equate to an increased level of craniofacial

DECEMBER 2009

10

Figure 3 - Note the pre-treatment deep overbite with reduced overjet in the pretreatment photograph (left). There are remarkable improvements in the overbite 8
weeks after treatment was commenced (right).

Figure 4 - The Wireframe DNA applianceTM in situ. Patients are instructed to wear
the Wireframe DNA applianceTM for 12-16hrs during the evening and at nighttime,
but not while eating during the day.

Figure 5 - The pre-treatment photograph is on the left. Note the enhancement in lip
morphology and smile esthetics 8 weeks after treatment was commenced in the
photograph on the right.

Figure 6 - The jaw line appears retrusive in the pretreatment photograph is on the left. Note how the jaw
line appears to be more robust seven months after
treatment was commenced in the photograph on the right.

DECEMBER 2009

11
homeostasis, in accord with the Spatial Matrix Hypothesis
(Singh, 2004; Singh and Krumholtz, 2009). However, Vargo
et al. (2007) investigated treatment effects and relapse
potential of slow maxillary expansion, combined with a
mandibular banded Crozat/lip bumper. They concluded that
increases in arch dimensions subsequently undergo mild-tomoderate relapse. Thus, it is possible that the case reported
here might undergo a similar developmental fate.

On the other hand, Griffin (1979) used rapid maxillary

expansion with simultaneous increase in mandibular width
with a Crozat appliance. This procedure is somewhat
similar to that reported here in that simultaneous maxillomandibular correction was one aim of the treatment plan.
While our preliminary results are noteworthy, further
research is warranted on the approach reported here.
Nevertheless, these early results abide by principles under
the new concept of Foundational correction which takes
facial growth and epigenetics into account for stable
functional corrections associated with an enhanced level of
craniofacial homeostasis.
ACKNOWLEDGEMENTS

The Wireframe DNA applianceTM is the trademark and

property of BioModeling Solutions, LLC, and has US and
international patents pending.

REFERENCES

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Bonk RT. Case report. Adult Class II malocclusion with
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Smith GH, Ashton H. Alternative lightwire functionals
(ALF). Funct Orthod. 1995;12(4):35-8.
Funct Orthod. 1996 Nov-Dec;13(5):4-6, 8.
Nordstrom D. Positive alveolar and gingival effects of the
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James GA, Strokon D. The significance of cranial factors in
diagnosis and treatment with the advanced lightwire
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Baccetti T, Franchi L, McNamara JA. The Cervical
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Parker WS. A perspective of the Crozat appliance with case

reports of its present use. Am J Orthod. 1985;88(1):1-21.

Singh GD, Krumholtz JA. Epigenetic orthodontics in adults.

The Appliance Therapy Group, Chatsworth, CA, USA, 2009.

Knosp H. The Crozat technic--considerations of materials

and instrument mechanics. Dtsch Zahnarztl Z.
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Vargo J, Buschang PH, Boley JC, English JD, Behrents RG,

Owen AH 3rd. Treatment effects and short-term relapse of
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dentition. Am J Orthod Dentofacial Orthop.
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Hannemann M, Minarski P, Lugscheider E, Diedrich P.

Materials science studies on the soldering of different
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AAGO Mission Statement

The teaching of the technique of using physiologically compliant, soldered wire appliances to uncrowd and reposition
teeth in order to preserve the natural dentition and avoid permanent tooth extractions. -

The educating of members of the dental profession in the art of developing the maxilla and mandible three
dimensionally by integrating gentle forces in harmony with the normal functioning of the orofacial complex.

The promotion of a better understanding and awareness within dentistry and amongst the general public of the etiology,
diagnosis and treatment of dental orthopedic and orthodontic problems and their effects on growth and development.

The enhancement of the health, appearance and occlusal function of patients by the use of the Crozat and other
orthopedic/orthodontic appliances, to create a dentition consistent with accepted gnathological principles.