You are on page 1of 12

Source: AJO-DO on CD-ROM (Copyright 1998 AJO-DO), Volume 1993 Jul (8 - 20): Straight wire: The next generation

n - Creekmore and Kunik -------------------------------Straight wire: The next generation Thomas D. Creekmore, DDS, and Randy L. Kunik, DDS Houston, Texas Frequently, the anticipated results of treatment are not achieved by using preadjusted appliances and straight wires. This is due to inaccurate bracket placement, variations in tooth structure, variations in the maxillary/mandibular relationships, tissue rebound, and mechanical deficiencies of edgewise orthodontic appliances. Clearly, one preadjusted appliance prescription cannot fit all orthodontic patients. Individualized prescriptions for preadjusted orthodontic appliances can be fabricated once all of these reasons are recognized. From the cephalogram and visual treatment objective, the desired position of maxillary and mandibular incisors can be determined according to the maxillary/mandibular relationships. The torque angle of the labial surface of maxillary and mandibular incisors relative to the arch wire plane can be measured with an incisor torque template. The development and refinement of a system to vary the orientation of the bracket arch wire slot relative to the labial surface of each tooth provides a solution to these problems. Beyond the accuracy or inaccuracy of bracket placement and the fact that brackets are placed away from the center of resistance, orthodontic appliances have two additional significant mechanical deficiencies; play between the arch wire and the arch wire slot, and force diminution. These deficiencies cannot be eliminated from current appliances, however, they can be minimized by using reasonably stiff arch wires approximating the size of the arch wire slots. The amount of play plus the amount of force diminution inherent in your appliance can be added to or subtracted from the torque, tip, rotation, and height parameters for each bracket to deliver the teeth to the desired positions. Therefore treatment goals can be achieved with maximum efficiency. (AM J ORTHOD DENTOFAC ORTHOP 1993;104:8-20.) Andrews1 made extensive measurements on untreated and treated excellent occlusions. He determined the average tip and torque angles and in/out dimensions of the labial surface of each tooth relative to a flat labial arch wire plane.1 These dimensions, representing the goals of individual tooth positions, were then used to fabricate brackets for each tooth. When each bracket was precisely positioned at the midpoint of the facial axis and aligned with the facial axis, they collectively became the Straight wire appliance (A Company, Inc., San Diego, Calif.).1 This, in effect, orients the arch wire slot for a specific tip, torque, and rotation angle, plus height and in/out dimensions to the facial surface of each tooth. Experience with Andrews "prescription" has shown that these goals of individual tooth positions were not always achieved, with straight wires only, and required arch wire bending to achieve ideal results. This is evidenced by the proliferation of additional preadjusted appliances or "prescriptions" from Creekmore,2 Roth,3 Ricketts,4 Root,5 Alexander,6 Hilgers,7 and others,8 which predominately differ in torque values for maxillary and mandibular anterior teeth (Table I). However, these additional preadjusted appliances also require some arch wire adjustments in many cases. There are at least five reasons why current preadjusted orthodontic appliances do not achieve ideal tooth positions with the use of "straight" wires.

1. The most frequent reason is inaccurate bracket placement. Balut et al.9 evaluated the variations in bracket placement by 10 orthodontic faculty members. A mean of 0.34 mm for the vertical discrepancies and a mean of 5.54 for the angular discrepancies were found in placement of orthodontic brackets. since the facial surface of the tooth is curved both mesiodistally and occlusogingivally, misplaced brackets in the mesiodistal plane result in rotational irregularities, whereas those in the occlusogingival plane result in torque, as well as height errors. Brackets not aligned with the long axis of the tooth result in tip variations. 2. Variations in tooth structure, such as irregular facial surfaces, crown-root angulations, and unusual crown shapes require variations in their tip, torque, rotation, and height parameters to achieve optimum results as described by Dellinger,10 Vardimon and Lambertz,11 Germane, Bentley and Isaacson,12 Morrow,13 and Taylor.14 3. Variations in the vertical and anteroposterior jaw relationships require variations in the positions of maxillary and mandibular incisors. Compared with Class I skeletal frameworks, maxillary incisors are more procumbent and mandibular incisors are more upright in Class III skeletal frameworks; whereas, mandibular incisors are more procumbent and maxillary incisors are more upright in Class II frameworks.15 Ross et al.16 have shown that the faciolingual inclinations of the maxillary incisors relative to the occlusal plane can vary as much as 13 between high angle and low angle vertical patterns (Fig. 1). They state: "It is clear that the concept of 'one appliance fits all' defies the normal biologic variation among orthodontic patients." 4. Zachrisson17 showed the correction of rotations of 9/10s by bending the arch wires to achieve rotations of 11/10s or 12/10s. Subsequently, during retention, the teeth rebounded to the desired rotations of 10/10s. Roth18 and Swain19 suggest that overcorrections for tissue rebound or relapse tendencies should not be limited to rotations but should include overcorrections for heights, tips, and torques as well. 5. Edgewise orthodontic appliances have at least three significant mechanical deficiencies: (a) force application to teeth through brackets located away from the center of resistance,20 (b) play between the arch wire and the arch wire slot,18,19,21 and (c) force diminution. a. By necessity, brackets cannot be placed at the center of resistance of a tooth. Consequently, the application of a force to a tooth by an arch wire also produces additional forces on the tooth. For example, teeth distal to an extraction space will tip and rotate mesially, whereas those mesial to the extraction space will tip and rotate distally as the space is reciprocally closed. Andrews1 designed a series of antitip/antirotational brackets specifically for these problems. Protraction or depression forces on incisors produce lingual root torque, whereas retraction or extrusion forces produce labial root torque. These additional forces would have limited effect if our orthodontic appliances were 100% effective, which, unfortunately, they are not. Only by happenstance does a rectangular arch wire become parallel with the rectangular arch wire slot. This discrepancy is due to the play between the arch wire and the arch wire slot and to the diminution of force from a "straight" arch wire. b. Play between the arch wire and the arch wire slot is required if arch wires are to be removed and reinserted. A precise 0.018 0.025-inch arch wire is a very tight fit in a precise 0.018 0.025-inch slot. The wire could not be inserted or removed by hand. wires and slots cannot be made precisely every time. Manufacturing tolerances result in 0.018-

inch slots ranging from 0.0182 to 0.0192 inches, and 0.022-inch slots ranging from 0.0220 to 0.0230 inches. The 0.018-inch dimension in arch wires is actually 0.0178 inches. As a result, an 0.018 0.025-inch arch wire in an 0.018 0.025-inch slot, and an 0.0215 0.028-inch arch wire in an 0.022 0.028-inch slot have about 3 of torquing play in each direction from parallel (Table II), i.e., 6 total play. This means that substantial play exists with "full-sized" arch wires, but it also insures that they are consistently easy to insert and remove. The greatest amount of play in an edgewise appliance is in the torquing plane. Torquing play depends on the size of the rectangular arch wire relative to the size of the rectangular arch wire slot (Table II). Most prescriptions have excessive lingual root torque in the maxillary anterior brackets that may deliver adequate lingual root torque for retraction movements using less than full-sized arch wires. This compensates for play, but only during retraction movements. Brackets with these excessive torques are incapable of delivering labial root torque during protraction movements without extensive reverse torquing bends in the arch wire (Fig. 2). Height or vertical play varies according to the size of the arch wire relative to the size of the arch wire slot. An 0.012-inch stainless steel wire of slightly greater stiffness than an 0.018-inch nickel titanium wire will not achieve the same toothto-tooth leveling as the 0.018-inch wire because of archwire/slot play (Fig. 3). The use of full-sized arch wires and varying their modulus of elasticity to control force delivery, as described by Burstone,22 reduces play and thereby eliminates the need for intermediate-sized arch wires. Play in the tipping plane depends on the size of the arch wire, size of the arch wire slot, and overall width of the slot23 (Fig. 4). However, tipping play is much less than torquing play. An 0.016-inch wire in an 0.018 0.025-inch narrow single bracket has only about 3 play that reduces to less than 1 with an 0.018-inch wire. If torquing play is minimized by increasing arch wire size relative to slot size, then tipping play will be minimized regardless of the width of the bracket. Rotational play depends on the length of the rotational lever arm and the quality of the ligation technique to keep the arch wire seated in the bottom of the slot. Ligation force necessary to seat an arch wire increases as the stiffness of the arch wire increases or as the length of the rotational lever arm decreases. Lever arms of 0.100 inch (lower anteriors) require tight ligation in rectangular arch wires to keep rotational play to a minimum. Lever arms less than about 0.075 inch have excessive play and need some type of rotating auxillary to accomplish and maintain rotations. Play can never be eliminated, but it can be minimized in the tipping, torquing, and vertical planes by "filling" the slot as much as possible. Rotational play is minimized by using brackets with adequate rotational lever arm lengths and ligating with sufficient force to keep the arch wire seated in the bottom of the slot. c. Force diminution is the reduction in the force produced by an arch wire, deflected within its elastic limits, as it returns to its original shape. A minimum threshold of force is required to cause tooth movement. The force produced by an arch wire deflected to engage a malpositioned tooth will diminish as the tooth moves until the minimum threshold of force is reached. At this point, tooth movement will stop before the arch wire has completely returned to its original shape (Fig. 5). The straight wire never becomes quite straight. Force diminution occurs in all directions of tooth movement. It is most

evident in leveling an excessive cure of Spee in deep bite cases or in creating a normal curve of Spee in open bite cases. In these situations, although the effect of force diminution from tooth-to-tooth may be very small, the cumulative effect from molars to premolars to anterior teeth results in a significant undercorrection. Instead of bending arch wires, compensation for force diminution can be accomplished by changing arch wire slot heights (Fig. 6), torques, tips, and rotations equal to the effect of force diminution; the exact amount of which is presently unknown. Force diminution "adds on" to play. To our knowledge, the principle of force diminution has not been investigated in the orthodontic literature. It is obvious that the science of current preadjusted appliance fabrication does not address all of these anatomic and biologic variations and mechanical deficiencies. It is still necessary for orthodontists to use their artistic senses and skills to make some first order, second order, and third order bends in the arch wires to move the teeth to the desired positions. However, the number of bends is not nearly the number of bends necessary with standard edgewise appliances. THE SLOT MACHINE AND INDIRECT BONDING Lingual orthodontics necessitated further development of accurate bracket placement and consistent indirect bonding procedures. Immensely improved indirect bonding materials and procedures, plus the development and refinement of a system to optimally position the bracket slot, the Slot Machine (Creekmore Enterprises, Inc., Houston, Texas), have provided a potential solution to the inaccuracies of bracket placement, anatomic and biologic variations, overcorrections for tissue rebound and relapse, and mechanical deficiencies of preadjusted edgewise orthodontic appliances. The Slot Machine (Fig. 7) is not really a bracket placement device in the traditional sense of bracket placement. Rather, it orients the arch wire slot of the bracket relative to the facial surface of each tooth on the model. This is accomplished by holding the arch wire slot stationary while manipulating each tooth to any tip angle, torque angle, rotation angle, and height through the use of orientation templates and a rotation guide (Figs. 8 and 9). Each parameter can be selectively varied independently of the others. Once the labial surface is oriented as desired; the bracket, while being held stationary by the arch wire slot (Fig. 7), is attached to the tooth with bonding material that fills in any gap between the bracket base and the tooth. This customized base maintains the orientation of the arch wire slot when the brackets are transferred to the patient's teeth by current indirect bonding procedures. For example, a standard edgewise canine bracket that has 0 torque, 0 tip, and 0 rotation can be oriented with a Roth prescription orientation template and the rotation guide to produce the slot oriented with 13 tip, 2 torque, and 4 antirotation. In contrast to traditional bracket placement, the bracket base is not permitted to become tangent to the facial surface of the tooth. Therefore the tip, torque, and rotation parameters of the arch wire slot built into the bracket will not be oriented to the tooth the same as it would be with bracket placement by hand. ADVANCED PREADJUSTED APPLIANCE FABRICATION The Slot Machine gives the orthodontist the capability to accurately vary the orientation of the arch wire slot for each tooth in each individual case according to the tooth movements required by the treatment plan to correct the malocclusion. Fabrication of the advanced preadjusted appliance begins with a standard prescription with specific heights of the arch wire slot from the incisal edges or cusp tips (Fig. 10, Tables I and III). It is

from this standard appliance that variations are made according to the treatment plan. The actual amount of variation in the orientation of the arch wire slot needed to compensate for play and force diminution will vary with the appliance and arch wires used in treatment. An 0.018 0.025-inch Mini Uni-Twin (3M Unitek, Monrovia, Calif.) appliance with 0.018-inch and 0.018 0.025-inch nickel titanium intermediate arch wires and 0.018 0.022-inch stainless steel finishing arch wires was used to provide the specific recommendations in this article. Torque. According to Andrews findings,1 the average faciolingual inclinations of the crowns relative to the arch wire plane is 7, 3, 7, and 1 for maxillary centrals, laterals, canines, and mandibular incisors, respectively. These data provide excellent goals for the faciolingual inclination of anterior teeth in average vertical and anteroposterior skeletal patterns. With the use of an Incisor Torque Template (Creekmore Enterprises, Inc., Houston, Texas) (Fig. 11), actual measurements of the angulation of maxillary and mandibular central incisors relative to their arch wire plane can be made on the cephalogram and the visual treatment objective to provide more accurate torque requirements for that person. Once these goals are determined, increasing or decreasing the actual torques in the custom pad by 4 is usually adequate to compensate for play and force diminution. Roth's prescription (12, 8, and 2) is used for extraction cases or cases that require the delivery of lingual root torque of the anterior teeth (Table I, Fig. 10). These torques would deliver finished torques of approximately 8, 4, and 2. Andrew's prescription (7, 3, and 7) for torque on maxillary anterior teeth and Alexander's prescription ( 5) for torque on mandibular anterior teeth are used for nonextraction cases or cases that require the delivery of labial root torque. These torques would deliver finished torques of approximately 11, 7, 3, and 1. Torque variations need not be limited to these available prescriptions; greater or lesser torques can be used as needed. Different prescriptions can be mixed to achieve the desired root torques. In cases with lingually displaced mandibular lateral incisors, 1 torque for the central incisors and 5 torque for the lateral incisors will usually bring the roots of the lateral incisors forward to equalize the torques of the central incisors (Fig. 12). With Class II, Division 2 maxillary anterior teeth, Roth torques on central incisors (12), which need lingual root movement, and Andrews torques on lateral incisors (3), which need labial root movement, should be used. Class I or Class III nonextraction cases with maxillary lateral incisors palatally displaced need Andrew's central incisor torque (7) and lower incisor torque ( 1) on the lateral incisors. These examples illustrate the manner in which the torques of the slots can be individualized to deliver the required torque depending on the direction of tooth movement. Tip angulations can be varied on posterior teeth according to anchorage requirements11 and adjacent to extraction sites (Fig. 13). Variations of 2 to 4 are usually adequate to assure root paralleling. Tips can also be altered to accommodate morphologic variations and overcorrections. Rotation angles can be accurately measured with the use of the rotation guide (Fig. 9). Overrotations and antirotations can be predictably varied producing the desired corrections. Two degrees of overrotation insures 10/10ths corrections. This amount of overrotation is barely noticeable, whereas 4 of overrotation is obvious (Fig. 14). Four degrees of antirotation is recommended adjacent to extraction sites (Fig. 13). Rotations

are accomplished early in treatment with the initial round arch wires and maintained throughout treatment. A bracket does not have to be in the center of the tooth to produce the desired rotation. The center of the rotational force of a single bracket with rotation wings is not in the center of the tooth as it is with a twin bracket, yet the single bracket is very effective in the rotation of teeth. Twin brackets that cannot be positioned in the center of a tooth because of overlapping teeth can be offset laterally as long as the floor of the slot is properly oriented for rotation (Fig. 15). Proper rotation will be achieved, and the bracket will not have to be repositioned in the future. This principle is especially beneficial for lingual treatment. Height measurements for each tooth are made vertically from the arch wire slot to the incisal edge or cusp tip with the labial surface at a specified torque angle tangent at this point (Fig. 8, A). With the use of the Slot Machine, much more precise height measurements are possible. Recommended standard heights are 4.5 mm, 4.25 mm, and 4.75 mm for maxillary central incisors, lateral incisors, and canines, respectively (Table III and Fig. 10). The clinically important factor for bracket height is the height of each bracket relative to all of the other brackets rather than the actual height on the tooth. Since the Slot Machine holds the bracket by the arch wire slot, changing bracket height will not change the torque. For short or long clinical crowns, all the brackets can be raised or lowered uniformly simply by inserting a spacer 0.375 mm (0.015 inch) or 0.625 mm (0.025 inch) in thickness under the bracket holder or under the orientation template. Bracket heights on quadrants of teeth or on individual teeth, relative to adjacent teeth, can also be precisely varied as little as 0.25 mm to compensate for the small, cumulative effect of force diminution (Figs. 16 and 17). Fabrication of advanced preadjusted appliances require planning before the placement of brackets on the teeth. The most efficient time for this planning is during the formulation of the treatment plan when all of the records are being studied. As individual tooth movements are determined to achieve the goals of treatment, the prescription for individualized tip, torque, rotation, and height parameters for each bracket can be entered into the patient's chart to be used by the laboratory technician at the time brackets are positioned on the models for indirect bracket placement. The orthodontist maintains quality control by inspecting the bracket placement for errors before fabrication of the transfer tray. Arch wire slot orientation and indirect bonding techniques require more training and laboratory time for auxillary personnel than the training and time required for direct bonding. However, the benefits gained in quality control, simplicity of treatment, reduced treatment time, and reduced chair time more than off-set this additional expense and effort (Fig. 18). SUMMARY Frequently, the anticipated results of treatment are not achieved by using preadjusted appliances and straight wires. This is due to inaccurate bracket placement, variations in tooth structure, variations in the maxillary/mandibular relationships, tissue rebound, and mechanical deficiencies of edgewise orthodontic appliances. Clearly, one preadjusted appliance prescription cannot fit all orthodontic patients. Individualized prescriptions for preadjusted orthodontic appliances can be fabricated once all of these reasons are recognized. From the cephalogram and visual treatment objective, the desired position of

maxillary and mandibular incisors can be determined according to the maxillary/mandibular relationships. The torque angle of the labial surface of maxillary and mandibular incisors, relative to their arch wire plane, can be measured with an incisor torque template. The development and refinement of a system to optimally position the bracket slot provides a solution to these problems. Beyond the accuracy or inaccuracy of bracket placement and the fact that brackets are placed away from the center of resistance, orthodontic appliances have two additional significant mechanical deficiencies; play between the arch wire and the arch wire slot, and force diminution. These deficiencies cannot be eliminated from current appliances, but they can be minimized by using reasonably stiff arch wires approximating the size of the arch wire slots. The amount of play plus the amount of force diminution inherent in your appliance can be added to or subtracted from the torque, tip, rotation, and height parameters for each bracket to deliver the teeth to the desired positions. Therefore treatment goals can be achieved with maximum efficiency. 2) Improving Incisor Torque Control with Nickel Titanium Torque Bars CHRISTOPHER K. KESLING, DDS, MS JCO VOL-33 ISSUE- 4 YEAR-1999 3) Loss of Anterior Torque Control Due to Variations in Bracket Slot and Archwire Dimensions RAYMOND E. SIATKOWSKI, DMD JCO VOL-33 ISSUE-9 YEAR 1999 4) Torquing Auxiliary for Posterior Protraction RAYMOND E. SIATKOWSKI, DMD JCO VOL-34 ISSUE-3 YEAR2000 Ajo 1995 dec ceramic brackets Ajo 1997 sep fem bonding brackets 5) Source: AJO-DO on CD-ROM (Copyright 1998 AJO-DO), Volume 1959 Nov (817 - 830): Torque and its application to orthodontics - Rauch J Source: AJO-DO on CD-ROM (Copyright 1998 AJO-DO), Volume 1988 May (363 379): Combination anchorage technique - Thompson -------------------------------he CAT bracket design has proved to be clinically excellent for both light wire and straight wire treatments. It is comfortable and esthetically pleasing to the patient. It has a 0.022 0.035-inch gingival or ribbon arch slot and either a 0.018 0.025-inch or 0.022 0.028-inch straight wire edgewise slot. The CAT bracket retains the three-dimensional edgewise capability of the earlier combination brackets. However, maxillary incisor brackets now can be obtained with varying degrees of torque, and maxillary canine torque has been reduced to 0. This change produces less prominence of the canine roots on the labial plate and it positions the lingual surface for a gentle rise in lateral excursions as desired with mutually protective occlusion. Torque on the lower premolar has been changed from 17 on the first premolar and 20 on the second premolar to a standard of 19 for both (Fig. 2). This

change, which was suggested by many clinicians, reduces both inventory requirements and identification problems, and does not adversely affect positioning or intercuspation Cat treatment can be modified to reduce the round tripping, reduce labial root prominence, and shorten or eliminate Stage III Maintenance of the bite opening, anterior and posterior root torquing, and axial alignment of teeth such as uprighting and paralleling can be accomplished by the use of two tandem arch wires, one in the straight wire slot and the other in the light wire slot (Fig. 5). The tandem technique involves the placement of an 0.018-inch round stainless steel arch wire in the gingival slot to control the bite opening. This rigid steel base wire, which is called the vertical stabilizing arch wire, has slight bite-opening bends mesial to the molar and distal to the canines. These bends control the vertical position of the incisors and prevent their extrusion while the nickel-titanium tandem wire seated in the straight wire slots is used to upright and to initiate torque. The Dual Flex arch wires are multisegment wires with round 0.016-inch stainless steel in the posterior section and round 0.016-inch nickel-titanium (Titanal) in the anterior section. The rigid steel wire will assist in bite opening and in molar control, while the flexible anterior section is used for (1) rapid alignment, (2) leveling, and (3) retraction of the anterior teeth (see Fig. 9). In cases that require heavy anterior resistance to minimize lingual movement of anterior teeth, a Dual Flex 2 wire can be used. This wire has a round 0.018inch stainless steel posterior segment and 0.016 0.022-inch nickel-titanium anterior segment from canine to canine. The steel posterior segment is seated in the gingival slot where the resistance is minimal and the 0.016 0.022-inch segment is used in the anterior edgewise The light, flexible rectangular wire features greater bracket engagement, increased frictional resistance and lingual root torque, and is used to establish increased anterior resistance and facilitate incisor control as posterior teeth are moved mesially in the light wire slot. Modification of the Dual Flex wire is needed when the arch wire passes from the edgewise to the gingival slot; such changes include step-up or step-down bends and in-and-out bends to facilitate bracket engagement. Phase lll: Uprighting and torquing l. Bite opening and all the objectives achieved in Phases I and II are maintained. 2. An 0.018-inch stainless steel arch wire with bite-opening bends is placed in the gingival slots. Tandem nickel-titanium arch wires are placed in the edgewise slots for uprighting and torque. These can be a 0.016-inch nickel-titanium, 0.01 8-inch square nickeltitanium, or 0.016 0.022-inch, nickel-titanium arch wires, depending on the relative parallelism of the edgewise slots. Three- to 4-ounce Class II elastics are continued as needed. Phase IV: Detailing and finishing 1. Ideal arch wires are placed in the edgewise slots. Usually a series of nickeltitanium wires ranging in size from 0.016 0.022 inch to 0.018 0.025 inch are used. Anterior torque should be evaluated and if necessary additional torque placed in the arch wire or obtained with torquing auxiliaries. The arch wires should be relatively straight if the bracket placement and tooth positioning have been correct. Vertical offset bends in the arch wire usually are necessary to overcome bracket height discrepancies and, in the mandibular arch, a reverse curve of Spee may be used for optimum leveling of the occlusal plane

Source: AJO-DO on CD-ROM (Copyright 1998 AJO-DO), Volume 1996 Dec (575 589): Our experience in combining mechanics Jose' L. Zuriarrain, MD, DS, Jos M. Echeverra Tandem arch wires are also used. These consist of two arch wires that are used simultaneously on the same dental arch. They are formed by a flexible nickel-titanium tandem arch wire located in the horizontal slot and a vertical stabilizing arch wire inserted in the gingival wing slot. The flexible Titanal tandem wire can be made of round 0.016, square 0.018 0.018, or rectangular 0.016 0.022-inch. The second arch wire is a round 0.018-inch Australian steel arch wire, with intrusive bends at the molar and distal to the canine. These multiple arch wires are used to progressively align and torque the crowns and roots (achieved with the flexible Titanal arch wire in the straight wire slots), while, simultaneously, the arch form and vertical position of the molars and incisors are maintained by a rigid steel arch wire in the gingival slots, Source: AJO-DO on CD-ROM (Copyright 1998 AJO-DO), Volume 1993 Jul (8 - 20): Straight wire: The next generation - Creekmore and Kunik -------------------------------The torque angle of the labial surface of maxillary and mandibular incisors relative to the arch wire plane can be measured with an incisor torque template. Incisor Torque Creekmore Template measures the angulation of maxillary and mandibular central incisors relative to their arch wire plane on the cephalogram and the visual treatment objective to provide more accurate torque requirements for that person. Once these goals are determined, increasing or decreasing the actual torques in the custom pad by 4 is usually adequate to compensate for play and force diminution. Source: AJO-DO on CD-ROM (Copyright 1998 AJO-DO), Volume 1997 Jul (50 - 57): Normal faciolingual inclinations of tooth crowns compared with treatment groups of standard and pretorqued brackets Tlin Ujur and Filiz Yukay The torque angle according to Andrews was measured was formed by the intersection of a line perpendicular to the occlusal plane and a line tangent to the midpoint of the labial or buccal long axis of the clinical crown. To measure such an angle, it is necessary to measure the angle between the tangent that passes through the bracket point and the occlusal plane. This angle is termed the facial surface angle. It is assumed that the amount of each twist is dependent on the angulation of that portion of the tooth surface lying directly beneath the bracket. Thus, based on the assumption that brackets are placed at 90 on the crown surface, the torque value can be calculated by subtracting 90 from facial surface angle Source: AJO-DO on CD-ROM (Copyright 1998 AJO-DO), Volume 1995 Dec (575 582): Ceramic bracket design with FEM Ghosh, Nanda, Duncanson, and Currier -------------------------------Six commercially available ceramic brackets of twin bracket design for the permanent maxillary left central incisor of Allure -GAC, Ceramaflex -TP Orthodontics, Contour -Class One, Lumina Ormco and Transcend Unitek and monocrystalline bracket

Starfire -"A" Company were studied. All brackets had a 0.022-inch slot with positive 12 palatal root torque and positive 5 mesial crown angulation. The sites of highest stress for the brackets was at the mesiogingival outer point on the wire-slot The site of highest stress for the Contour bracket (P-C) was at the midgingival isthmus point The stresses from the wire slot gradually decreased, moving toward the base of the tying slots The Starfire showed high stresses and irregular stress distribution, because it had sharp angles, no rounded corners, and no isthmus Holt states that the whole incisal half of the bracket broke off frequently with torsional forces could be explained by the finding that stresses concentrated at the base of the wire slot on the incisal, from where they radiated toward the base of the incisal tying slot and base of the bracket, causing vulnerability of the incisal half. On the other hand, stresses seemed to dissipate over a larger area on the gingival half. The results of this study also support the findings of the laboratory experiment conducted by Aknin who studied the resistance to fracture of ceramic brackets manufactured after 1989, when subjected to torsional forces and also found the incisal half of the bracket to be more prone to fracture. Source: AJO-DO on CD-ROM (Copyright 1998 AJO-DO), Volume 1981 Jun (591 609): Begg and straight wire - Thompson -------------------------------One such treatment approach might involve light, rapid tipping forces to correct gross changes in tooth position at one stage in treatment, while more rigid and precise appliances are used later in treatment to produce maximum tooth detailing and occlusal intercuspation. Such a combination of treatment capabilities enables the practitioner to achieve selectively or collectively, in an optimum way, the various goals for the denture, patient, and doctor. Begg clinicians have frequently confirmed the fact that the mechanics in Stage I and Stage II are the keys to success in Begg treatment, since they determine the effective bite opening, the optimum anteroposterior positioning of incisors, and stability of the molars. It must be realized at this point that these favorable characteristics of Begg treatment occur in the early periods of treatment, during unraveling, bite opening, and anterior retraction, when physiologic tipping of teeth is desired and most effective The most difficult part of Begg treatment is the finishing period. Control of buccolingual torque on posterior teeth is difficult in the Begg system and requires special auxiliaries to achieve good occlusal position. The forces are capable of opening spaces, tipping teeth, and generally producing undesirable movements which frequently require additional appointments and adjustment procedures to obtain the optimum occlusal finish. straight wire: These are principally related to the precision type of bracket and arch wire design. The wider twin bracket with the shorter interbracket distance used in some systems increases the rigidity of the continuous straight wire. It tends to increase the forces applied interdentally, increases the friction, and places positive three-dimensional forces and couples on the teeth. The rigidity of the straight wire, although having the potential of a more precise appliance with closer tolerance or fitting, has certain mechanical disadvantages in early alignment and leveling procedures. The inflexibility

and friction of the appliance are magnified in the initial arch wire sizes because of the significantly greater angular position of the slots produced by the malposition and tipped teeth in the original malocclusion. The continuous leveling arch wires in the greatly angulated straight wire slot sequence set up extraneous forces among the teeth which tend to produce leveling by forward movement of anterior teeth. Unlike the single-point Begg bracket, the teeth cannot tip freely into extraction sites, and the typical intrusion and lingual tipping of incisors seen in the Begg treatment are not evident. In addition, anchorage support from an extraoral or intraoral appliance is frequently recommended to control the diversified forces generated in the irregular-slot brackets as alignment or retraction of teeth is performed. Bite opening in conventional straight wire mechanics is not as rapid as it is in the Begg system, where bite opening is effectively undertaken early in treatment by molar elevation and incisor intrusion which occur simultaneously with the en masse retraction of incisors. In spite of the apparent difficulties that can arise during the early periods of treatment with the straight wire appliance, it has been shown to produce fine precision and quality of occlusion in the finishing of treatment.13,22 The ability to place teeth closer to proper occlusal position with preangulated and pretorqued brackets with less arch wire manipulation is a definite treatment advantage. The heavier forces produced over shorter interbracket distances with precisely fitting rectangular wires in a rectangular slot establish excellent positive control in three dimensions, provide precise movements, and eliminate the undesirable tipping frequently seen during finishing procedures in a Begg system. In addition, the three-dimensional capability of the rectangular wire does provide a more accurate means of achieving total coordination of arch wires in both arches to provide optimum occlusal intercuspation. The Begg system is rapid in early treatment but becomes more cumbersome in the finishing stages. The straight wire system is prone to complications in early periods of treatment but is efficient in the final finishing adjustments . When the occlusal relationship and treatment objectives are ready for Stage III, the severe tipping of the buccal segments and incisors, which is typical and characteristic of Begg therapy, produces a very irregular pattern to the angulated rectangular slots. The angulation is so severe in some cases that placement of leveling wires is contraindicated. Short interbracket distance between the edgewise slots increases force values and leveling forces. A common difficulty is the tipping of teeth mesially into a more bimaxillary relationship as seen in routine edgewise leveling procedures with full appliancing and no elastics or coil springs. The unwanted movement can be eliminated by undertaking adequate uprighting in Stage III to level the straight wire slots before a straight wire is placed stage III should be carried out with 0.020 inch base wires, constricted in the maxillary arch, and having reduced anchor bends in a typical Begg program. All Begg uprighting springs and torquing auxiliaries can be placed in the Begg slot with no difficulty. The Stage III mechanics should be continued until the occlusion approaches a fairly level plane and the edgewise slots are almost parallel. This is a subjective decision by the orthodontist, but clinically it seems to be within 5 degrees of the horizontal. When the alignment has reached this degree of leveling and uprighting, the Begg portion of treatment has ceased. The Begg wires and springs are removed and the remaining

treatment is done in the rectangular slot with a straight arch wire. The new wires may be braided round, braided rectangular, nitinol, routine round, or edgewise wires up to 0.018 by 0.025 inch. Usually one braided or small round wire series is needed before a rectangular wire can be placed for final torque control.

You might also like