The Straight-Wire Appliance 17 Years Later

VOLUME 21 : NUMBER 09 : PAGES (632-642) 1987

RONALD H. ROTH, DDS, MS, FACD, FICD

The Straight-Wire Appliance as invented by Andrews is the only true Straight-Wire Appliance currently
available, in that it has the design features necessary to place the teeth in desired positions and at the
same time have the bracket slots line up around the arch parallel to each other and to the occlusal plane
while providing tip, torque, rotation, and in/out (Fig. 1).

There is no perceived difference in the minds of most orthodontists between pretorqued and
preangulated edgewise brackets and Straight-Wire brackets. Yet there is a difference, and it does make
a difference in the results in terms of tooth positioning if one is to treat without putting offset bends
into the archwires (Fig. 2).

In this article, when I refer to the Straight-Wire Appliance, I am referring to the Andrews Straight-Wire
Appliance and none other, and I will abbreviate the term as SWA.

Experience with SWA

I began using the SWA in my practice in 1970 when Andrews gave me the first set of prototype brackets
that were welded onto pinched band material and had been machined at great expense. The first set of
brackets was an upper 5 x 5 set (Fig. 3).

By mid-1973, I switched my entire practice over to the SWA and rebanded all the active patients who
still had pretorqued and preangulated edgewise brackets (about 30% of my practice at that point). My
practice has been totally SWA since that time.

The extraction brackets had counter-tip and counterrotation built in to offset relapse, and to keep teeth
from rotating and tipping into the extraction sites as they were being moved along a rectangular wire. In
other words, the brackets were constructed to allow translation of teeth as much as possible and to
offset any relapse tendency by overcorrection.
Andrews later introduced different series and sets of brackets for different combinations of extractions,
ANB differentials, and anchorage requirements. He developed a special classification of malocclusions
and prescribed various bracket series for treatment of each, to allow translation of teeth without the
need for bending offsets and also to allow for overcorrection in view of relapse tendencies.

As the various extraction brackets became available, it became apparent to me that inventory was
becoming a problem because the brackets were only available on bands (at that time there was no
bonding). Since my mechanics were not concerned with translation per se, I began to wonder if it would
be possible to come up with a prescription for a special set of overcorrection brackets that would be
applicable to most cases.

The Roth Prescription

This was the beginning of the Roth Prescription. I had noticed that to achieve desired tooth positions
with the standard SWA , it was necessary to finish the mechanotherapy phase of treatment by placing
compensating and reverse curves in the upper and lower archwires, respectively. I had also noticed that
with the standard SWA, it was necessary to be careful with anchorage control, especially on extraction
cases, because the mesial inclination of the teeth in the buccal segments would tend to make those
segments drift mesially during treatment.

I have never seen a case with fixed appliances in which the teeth did not move or "settle" into occlusion
after appliance removal. The issue then is, "Where should the teeth be at the time of appliance removal
so that the most likely thing to occur would be for them to settle into the non-orthodontic normal tooth
positions?" Overcorrection is obviously necessary, but how much and where?

My reasoning went like this: If teeth tend to relapse back whence they started, and if counter-tip,
counter-rotation, counter-torque, and leveling of the curve of Spee were applied to the SWA in every
possible direction, then it should be possible to use primarily one prescription for most cases, and to
finish to an "end of appliance therapy" goal in which all tooth positions are slightly overcorrected and
from which the teeth will most likely settle into non-orthodontic normal positions (Fig. 4).
Overcorrection

I naturally started with the concept of overcorrection when designing a comprehensive prescription
using then-available Andrews extraction brackets. This started a clinical trial-and-error evaluation that
lasted several years. Cases were evaluated by the use of intraoral photographs and mounted study
models for tooth positions during treatment, at the end of appliance therapy, and into settling. I found it
was practical in the vast majority of cases to use a single prescription with overcorrection in all planes of
space and still meet the objectives of the "Six Keys to Normal Occlusion"

The Tru-Arch Form was developed to play a role in this overcorrection concept, because archform
affects the rotational positioning of the teeth as well as the brackets (Fig. 5).

Auxiliary attachments were added to the brackets, such as double and triple tubes for headgears and lip
bumpers and rectangular auxiliary tubes for Burstone or Bioprogressive mechanics. Additional hooks on
each bracket evolved for the use of short Class II or Class III elastics,

Maxillary Prescription

The Roth Prescription has extra torque in the maxillary incisors (5° more than normal). There is
correspondingly less negative torque in the upper canines to offset the reciprocal effect of building more
positive torque into the incisors. The upper canines have 2° more distal tip, because they are being
retracted in most treatment.

There is a "Super Torque" set of maxillary anteriors for cases like Class II, division 2, where an extreme
amount of torque may be needed.

The increase in torque and tip of the upper incisors makes them occupy more space in the arch, as does
the mesial rotation of the upper first molars, due to the 0° rotation brackets on those teeth.

Mandibular Prescription

In the mandibular arch, the incisor brackets are the same as the non-orthodontic normals. These teeth
settle more mesially than the uppers and simultaneously rotate mesially, thus necessitating extra distal
rotation. The torque in the lower buccal segments remains normal, because overcorrection in this plane
only leads to problems and interferences.

Archwires
The archwires are relatively flat around the incisors (both upper and lower), curve more tightly around
the cuspids and bicuspids, and then curve gently toward the distal through the entire buccal leg. The
most prominent point in the front curvature of the arch is the first bicuspid; the most prominent and
widest point in either arch is at the mesiobuccal cusps of the first molars.

One must remember that the archwire does not fit at the cusp tips and incisal edges, but at the
approximate middle of the crowns. If one looks at the arch from the occlusal and notices where the
bracket slot is in relation to the tips of the cuspids, it is easy to see why the archwire has to be shaped in
the form that we use.

According to Lee and Lundeen's work with mandibular movement, 6 a fairly broad anterior archform
would be required on 73% of our population! Of the remaining 27%, half would require an even broader
anterior archform, and only 14% would require the commonly used "orthodontic" narrow anterior
archform.

Root Positions

If one looks at the root positions of a set of extracted teeth with the Roth Prescription in place, it
becomes apparent that there is a lot of overcorrection in the appliance and some in the archform, but
this is what it takes to get the teeth in the desired positions (Fig. 6).

The Roth Prescription was introduced in 1976, and the values have remained unchanged since that time.

Appliance Configuration

The configuration of the appliance has changed since its introduction. The original standard SWA was
introduced with single-wing brackets, and shortly thereafter Siamese brackets were introduced. The
molar tubes were bulky and were "capped" to form tubes. Later the brackets were made smaller, and
power arms were cast as integral parts of the brackets designed by Andrews to place the force at the
centroids of the teeth and effect translatory movement.

Because the brackets had to be cast rather than machined to be cost-effective and still have the
contours and torque in the bracket bases, the early Roth Prescription also included power arms (Fig. 7).
At first the brackets were available welded to special bands that were designed to get the bracket to fit
on the middle of the clinical crown. Later, as direct bonding became a reality, the appliance was made
available on coined bases and then on flexible mesh pads. Ultimately a brazed micromesh became an
integral part of the bracket base itself. The effect, of course, has been to diminish the size of the
appliance as much as possible for esthetics and patient comfort.

Later versions of the Roth - available only with twin brackets.

In 1984 the Attract brackets were introduced (Fig. 8). These were single-width brackets that had
rounded contours and micromolar tubes. The base of the bracket slot was the width of a twin bracket,
and with the use of the new nickel titanium wires it was possible to rotate teeth while maintaining
minimum size for esthetics and patient comfort. These brackets were also made with short ball hooks in
the Roth Prescription.

The latest version of the SWA is a perfectly clear bracket (Starfire) containing an agent that is chemically
bonded to the bracket base and will also chemically bond with standard direct bond adhesives (Fig. 9).
These brackets are the same size as the metal twin brackets and do not require the bulk of ceramic
brackets to provide sufficient strength. They are grown from 100% pure liquid alumina (sapphire) into a
single crystal, which gives the unique crystal-clear appearance. Sapphire is the second-hardest material
next to the diamond.

Over the years, thanks to technological advances, the appliance has become smaller, more comfortable,
and more esthetic. The bracket configurations currently available are twin, single, Attract, Steiner, and
Lang--bondable, on bands, and in a variety of prescriptions.

Treatment Time

"Has the SWA in fact fulfilled its promise of better, faster, and more consistent results with less time and
effort on the part of the orthodontist?" In this author's opinion, the answer is, unquestionably and
emphatically, "Yes!"

primarily in the nonextraction case with relatively mild dentoalveolar malocclusion, In most such cases,
proper placement of the SWA brackets and use of nickel titanium wires will reduce treatment time to six
to 12 months.
In more severe cases or when full extraction sites must be closed, the treatment time saved might more
realistically be three to six months. However, in all cases the chairtime saved for the orthodontist is
significant. has decreased to 20%.

Advantages of SWA

The SWA will not diagnose cases, it will not set up the treatment plan, and it will not figure out the
mechanics needed to correct the malocclusion. But a properly placed SWA will detail the tooth positions
better, more consistently, and faster than one can by bending offsets into the archwires. The key is to get
the brackets properly placed; if they are not properly placed, they must be reset.

When the SWA is properly placed, archwire changes need not be scheduled. Archwires can be changed
on a routine checkup appointment, because it takes so little time to bend or place an archwire with only
archform in it.

There is less trauma to the tissues, less jiggling and roundtripping of teeth, and less root resorption.

Cases that have been treated with the SWA over the past 17 years have stood up well both in stability of
tooth positions and in periodontal health. The tooth positions have been esthetic and have allowed a
good settling of the occlusion as well as the attainment of functional occlusal goals (Figs. 10,11,12).

The Straight-Wire Appliance has been of great benefit to the patients and to that percentage of
orthodontists who have been perceptive enough to realize its benefits. •

Figures
Fig. 1 Contours and torque needed in bracket bases to attain level slot lineup when teeth are in desired finished position

Fig. 2 Difference between pretorqued edgewise (A) and Andrews Straight-Wire (B) appliances. (Courtesy of "A"-Company

Fig. 3 Case with first commercially available Straight-Wire Appliance.

Fig. 4 Case immediately after removal of Roth Prescription SWA brackets, showing "end of appliance therapy" tooth posi
Fig. 5 A. Extracted teeth with SWA brackets and Tru-Arch Form. Note normal shape of dental arch, which necessitates ex
extracted teeth in A.

Fig. 6 A. Extracted teeth with Roth Prescription SWA brackets and full-size rectangular wire, showing overcorrection built
positions.
Fig. 7 Case treated with Roth Prescription SWA. A. First archwires. B. Second archwires. C. Third archwires. D. Fourth arch
after complete settling of occlusion. Note that standard SWA brackets have level slot lineup, indicating attainment of non

Fig. 8 Roth Prescription Attract brackets.

Fig. 9 Roth Prescription Starfire sapphire brackets.

Fig. 10 Case shown in 1976 article (see reference 1).

Fig. 11 Finished case from Figure 10 immediately after retention.

Fig. 12 Case from Figure 10 nine years out of retention, demonstrating stability. Note how roots of anterior teeth have su
References

1. Roth, R.H.: Five Year Clinical Evaluation of the Andrews Straight-Wire Appliance, J. Clin. Orthod. 10:836-850, 1976.

2. Andrews, L.F.: The Straight-Wire Appliance, AAO Film Library.

3. Andrews, L.F.: The Straight-Wire Appliance, PCSO Bull., 1970.

4. Andrews, L.F.: The Six Keys to Normal Occlusion, Am. J. Orthod. 62:296-309, 1972.

5. Andrews, L.F.: The Straight-Wire Course Syllabus.

6. Lee, R.L.: Mandibular Border Movements Engraved in Plastic for Articulator Controls, Part 1, J. Prosth. Dent., 1969.

7. Roth, R.H.: Treatment Mechanics for the Straight Wire Appliance, in Orthodontics: Current Principles and Techniques,