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197]

Original Research

Comparison of WALA Ridge and Dental Arch Dimensions Changes

after Orthodontic Treatment Using a Passive Self‑Ligating System or
Conventional Fixed Appliance

Abstract Tarso Esteves,

Objective: To compare changes in WALA ridge and mandibular dental arch dimensions in Karina Maria
orthodontic patients treated with a passive self‑ligating system and conventional appliances. Salvatore Freitas,
Design: Original paper. Setting: Orthodontic department at Inga University Center, Maringá,
PR, Brazil. Materials and Methods: Pretreatment  (T1) and posttreatment  (T2) dental casts of Darwin Vaz de
60  patients with Class  I malocclusion treated with slight to moderate crowding that were divided Lima1, Paula
into two groups. Group  1:  30  patients treated with a passive self‑ligating system, at a mean Cotrin2, Rodrigo
initial age of 17.68  years and mean treatment time of 2.31  years. Group  2:  30  patients treated Hermont Cançado,
with conventional appliances, at a mean initial age of 19.23  years and mean treatment time of Fabrício Pinelli
2.56  years. Measurements were taken using a digital caliper directly on pre and posttreatment
dental casts to evaluate the transversal dimension behavior of the mandibular dental arch and Valarelli,
the WALA ridge width. Results: Self‑ligating group presented an increase in WALA ridge width Marcos Roberto De
and mandibular transversal dimensions significantly greater than the conventional group, with the Freitas2,
exception of intermolar cusp tip distance and intercanine WALA ridge. There was no statistically Renata Cristina
significant difference between the groups. There was also observed a significantly greater increase
Gobbi de Oliveira
of the transversal buccal axis dimensions in the premolar area when compared to the WALA ridge
Department of Orthodontics,
increase in both groups. Conclusions: Treatment with a passive self‑ligating system resulted in
Inga University Center,
a significantly greater increase of the WALA ridge width and mandibular arch dimensions when Maringá, PR, Brazil,
compared to conventional appliance. 1
Department of Orthodontics,
Darwin Dentistry Institute,
Keywords: Bracket, expansion, tooth movement, wire Cuiabá, 2Department of
Orthodontics, Bauru Dental
School, University of São Paulo,
Introduction (WALA is an acronym that incorporates São Paulo, Brazil
the initials of Will Andrews and Lawrence
The most common objectives of an
Andrews. They suggested the use of an
orthodontic treatment are creation of facial
anatomical reference as a parameter, with
harmony and dental aesthetics as well as
the purpose of centering the roots of
improvement in masticatory function. To
the teeth in the bone at baseline, which
achieve these goals, some factors have
they called WALA ridge[5]). This ridge
to be taken into account when planning
was defined by the band of keratinized
orthodontic treatment, like the size and
soft tissue directly adjacent to the
shape of the dental arches.[1] The dental
mucogingival line and represents the
arch forms and the teeth, bony ridges and
apex of the tooth.[6] Their determination
adjacent soft tissues must be harmoniously Address for correspondence:
sought to address the need to find a stable Dr. Paula Cotrin,
related to each other. Therefore, proper
anatomical structure that determines Department of Orthodontics,
planning and individualized determination
the ideal and individualized contour of University of São Paulo,
of the dental arch forms becomes critical. Alameda Dr. Octávio Pinheiro
the mandibular arch.[5] Other authors[7,8]
Brisolla, 9‑75, Bauru,
There are several studies[2,3] advocating also consider the use of WALA ridge São Paulo 17012‑901, Brazil.
the use of diagrams giving forms and dental diagramming concept a reliable E‑mail: cotrin@hotmail.com
predetermined dental arch and orthodontic methodology to achieve posttreatment
sizes. However, another author[4] uses the stability.
WALA Ridge concept to determine the Access this article online
The advent of self ligating appliances
mandibular dental arch form and size Website: www.ijdr.in
brought with them increased expectations
of certain advantages in orthodontic DOI: 10.4103/ijdr.IJDR_361_18
Quick Response Code:
This is an open access journal, and articles are distributed under
the terms of the Creative Commons Attribution-NonCommercial-
ShareAlike 4.0 License, which allows others to remix, tweak, and How to cite this article: Esteves T, Freitas KM,
build upon the work non-commercially, as long as appropriate Lima DV, Cotrin P, Cançado RH, Valarelli FP, et al.
credit is given and the new creations are licensed under the Comparison of WALA ridge and dental arch dimensions
identical terms. changes after orthodontic treatment using a passive
self-ligating system or conventional fixed appliance.
For reprints contact: reprints@medknow.com Indian J Dent Res 2019;30:386-92.

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Esteves, et al.: WALA ridge and dental arch dimensions

treatment when compared to conventional ones. According
to Damon,[9] using low friction brackets associated with
light force wires produces a higher expansion in posterior
arch sites when compared to the conventional brackets.
Other researchers also observed some differences in
treatment with self‑ligating systems with greater dental
arch expansion,[10,11] reduced treatment time and number of
visits besides reduced chair time.[12]
Scott et al.[13] observed no statistically significant difference
between intercanine and intermolar distances between
self‑ligating system and conventional appliances. Moreover,
Chen et al.[14] observed in a systematic review that the
only advantages of self‑ligating systems when compared
to conventional brackets are the reduced chair time and a
mandibular incisor inclination decrease of 1.5º.
Still more research is needed to study the previously
mentioned differences in dental arch dimensional change
brought about by the two bracket systems. There is no
research comparing the WALA ridge dimensional change
with the use of self‑ligating and conventional appliances.
So, the aim of this study was to compare the mandibular
arch transverse dimensional changes of WALA ridge as well
as the intercanine, interpremolar and intermolar distances
in nonextraction orthodontic treatment performed with
conventional appliances and passive self‑ligating system.
Materials and Methods
This research was approved by the Ethics Committee in
Human Research of Inga University Center.
The sample size calculation was obtained based on an alpha
significance level of 5%  (0.05) and beta of 20%  (0.20)
to detect a 0.7mm minimum difference in the distance
obtained from the right mandibular canine to the left
mandibular canine on the WALA ridge measure.[15] The
sample size calculation showed the need of 30 subjects in
each group.
Pretreatment and posttreatment dental casts from 60
randomly treated patients were selected and then divided
into 2 groups, treated with Damon system self‑ligating
or Straight Wire conventional appliance technique. The
following inclusion criteria were used: all subjects must
present all permanent teeth erupted until first molars,
Class  I malocclusion, mandibular irregularity index greater
than 1mm and teeth and alveolar ridge visible in the
dental cast models, compatible with the WALA ridge. The
exclusion criteria had been as follows: no dental extraction,
no incisor stripping and no extra‑oral appliances.
Group  1:  30 subjects  (21  female, 9  male), with mean
pretreatment age of 17.68  years  (s.d  =  7.26), mean
posttreatment age of 19.99  years  (s.d  =  7.36) and mean
treatment time of 2.31  years  (s.d  =  0.54). These subjects
were treated with Damon Self‑ligating System (Damon Mx
and Damon Q (Ormco, Glendora, Calif). Archwire sequence
was: 0.014” Damon Cu‑Ni‑Ti  (Ormco, Glendora, Calif),
followed by 0.014 × 0.025 Damon Cu‑Ni‑Ti  (Ormco,
Glendora, Calif). More crowded cases underwent
0.014 × 0.025 Cu‑Ni‑Ti archwire for a longer period.
In sequence, 0.018 × 0.025 Damon Cu‑Ni‑Ti  (Ormco,
Glendora, Calif), 0.017 × 0.025 TMA and 0.019 × 0.025
stainless steel archwire. The archwire diagram was made
individually after the removal of the 0.014 × 0.025 Damon
Cu‑Ni‑Tiarchwire, using as reference a wax number 7
bite  [Figure  1a]. All archwires were diagrammed and then
transferred to the patient’s chart [Figure 1b].
Group  2:  30 subjects  (20  female, 10  male), with mean
pretreatment age of 19.23  years  (s.d  =  8.47), mean post
treatment age of 21.79 years (s.d = 8.57) and mean treatment
time of 2.56  years  (s.d  =  0.89). Patients were treated with
Straight Wire conventional appliances (A Company).
Archwire sequence was: 0.014” and 0.016”NiTi, 0.018”,
0.020” and 0.019 × 0.025” stainless steel archwires. The
dental arch diagram was performed using the WALA ridge at
pretreatment dental cast how as reference [Figure 1c].
For the axes, points and reference edges demarcation and
also to obtain the measures in dental casts the following
instrumentation were used: black pencil and a digital
caliper (Mitutoyo, Japan). Measurements were made
exclusively by a single operator.
The following anatomical points were used: Cusp tip, dental
buccal axis, WALA ridge points and their demarcations.
In the mandibular dental casts, the following anatomical
points were marked using a visual scale and a black pencil,
in two distinct treatment times  (T1: pretreatment and T2:
posttreatment):
• Cusp tip point  (CP): mandibular canines incisal edge,
mandibular first and second premolars occlusal buccal
cusp tips and mandibular first molar mesiobuccal cusp
point [Figure 2a]
a b
c d
Figure 1: (a) Bite register in a number 7 Wax. (b) Dental diagram transferred
to subjects charts. (c) WALA ridge. (d) Little irregularity index

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Esteves, et al.: WALA ridge and dental arch dimensions
• Buccal axis point  (BA): Point on the buccal axis of the
clinical crown which splits the clinical crown in two
halves: gingival half and occlusal half. This demarcation
was made with the pencil in the crowns of mandibular
canines until the first molars, and in the molars the long
axis of the mesiobuccal cusp [Figure 2b]
• WALA ridge  (WR): Mandibular buccal outer edge
surface marked by sliding a tangential line with the
pencil over perpendicular dental cast, so delimiting a
row [Figure 2c]
• WALA ridge Point  (WR): BA point projection over
the WALA ridge line from mandibular canines to
mandibular molars [Figure 2d].
The following linear measurements  (mm) were performed
directly on the mandibular dental casts:
• Mandibular intercanine distance between their incisal
edges (CP 3x3); buccal axis points (BA 3x3) and WALA
ridge points  (WR 3x3): distance between mandibular
right and left canines in their respective points: CP, BA
and WRs
• Mandibular inter first premolars distance between cusp
points (CP 4x4), buccal axis points (BA 4x4) and WALA
ridge points  (WR 4x4): distance between mandibular
right and left first premolars in their respective points:
CP, BA and WR
• Mandibular inter second premolars distance between
cusp points  (CP 5x5), buccal axis points  (BA 5x5)
and WALA ridge points  (WR 5x5): distance between
mandibular right and left second premolars in their
respective points: CP, BA and WR
• Mandibular intermolar distance between cusp points (CP
6x6). Buccal axis points  (BA 6x6) and WALA ridge
points  (WR 6x6): distance between mandibular right
and left first molars in their respective points: CP, BA
and WR
• Little Irregularity index[16]  [Figure  1d]: This technique
involves measuring the linear distance from anatomic
contact point of mandibular anterior teeth, the sum of
five measurements representing the Irregularity Index.
a b
c d
Figure 2: (a) Cusp tip point. (b) Buccal axis point. (c) WALA ridge. (d)
WALA ridge point
388
Error study and statistical analysis
The error of the method was calculated using all variable
measurements of 15 randomly selected dental casts from
each study phase  (T1 and T2), within a 30‑day interval.
The random error was calculated according to Dahlberg’s
formula[17] and the systematic error with dependent t‑test
with significance level of 5% (P > 0.05).
Normality was verified by Kolmogorov‑Smirnov tests.
To check the intergroup comparability of pretreatment and
posttreatment ages, number of visits, treatment time and
Little index, independent t‑tests were used.
Dependent t‑tests were used to compare pretreatment and
posttreatment stages of each group separately.
The intergroup comparison of pretreatment and
posttreatment stages and treatment changes, independent
t‑tests were used.
Comparison treatment changes of buccal axis and WALA
ridge distances were performed with independent tests.
Results were considered statistically significant for P < 0.05.
All statistical analyses were performed on Statistica software
(Statistica for Windows 6.0; Statsoft, Tulsa, Okla).
Results
Error study showed statistically significant systematic error
for the second premolar inter caste tip distance. Random
errors varied from 0.07 mm for intersecond premolar
buccal axis distance to 0.38 mm for the intercanine cusp
tip distance.
Groups were comparable regarding pre and posttreatment
ages, treatment time and Little irregularity index [Table 1].
The number of visits was significantly greater for
conventional group than in the self‑ligating group [Table 1].
Treatment with self‑ligating system caused significant
increase in all transversal measurements of the WALA
ridge, cusp tips and buccal axis [Table 2]. Cases treated with
conventional appliances presented increases in interpremolar
and intermolar distances (BA and CP) [Table 2].
Intergroup comparison of pretreatment and posttreatment
stages showed no statistically significant difference between
the groups [Table 3].
Self‑ligating group presented greater increases in WALA
ridge and dental arch dimensions than conventional groups,
except the intermolar cusp tip distance and intercanine
WALA ridge dimension [Table 4].
Comparison of WALA ridge and buccal axis dimensions
showed differences in inter first and second premolars
distances for all sample and for the two groups separately,
and in intermolar for the conventional group  [Table  5].
The buccal axis distances showed greater increase in the
premolar region than the WALA ridge [Table 5].
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Esteves, et al.: WALA ridge and dental arch dimensions

Table 1: Intergroup comparability results of mean pre‑ and post‑treatment age, treatment time, number of visits and
mandibular anterior crowding measured by little irregularity index (independent t‑tests)
Variables Group 1 Group P
Damon (n=30) Conventional (n=30)
Mean SD Mean SD
Pretreatment age T1 (years) 17.68 7.26 19.23 8.47 0.456
Posttreatment age T2 (years) 19.99 7.36 21.79 8.57 0.386
Treatment time (T2‑T1) (years) 2.31 0.54 2.56 0.89 0.202
Number of visits 17.16 5.25 29.58 9.26 0.000*
Little irregularity index (mm) 3.94 3.54 3.06 1.91 0.236
*Statistically significant for P<0.05. SD=Standard deviation

Table 2: Results of pre and posttreatment stages of Damon and conventional groups (dependent t‑tests) (n=30)
Variables Damon group Conventional group
(mm) Pretreatment T1 Posttreatment T2 P Pretreatment T1 Postreatment T2 P
Mean SD Mean SD Mean SD Mean SD
BA 3‑3 28.81 2.51 29.88 1.75 0.001* 29.28 1.80 29.41 1.74 0.462
BA 4‑4 38.06 2.35 39.64 1.95 0.000* 38.87 2.27 39.71 1.96 0.000*
BA 5‑5 43.97 2.71 46.03 2.32 0.000* 45.07 2.67 46.14 2.29 0.000*
BA 6‑6 49.85 3.06 51.60 2.77 0.000* 50.75 3.11 51.38 2.75 0.025*
CP 3‑3 25.63 2.79 26.97 1.73 0.002* 25.96 1.90 26.31 1.39 0.159
CP 4‑4 33.46 2.50 35.31 1.76 0.000* 34.35 2.06 35.23 1.83 0.000*
CP 5‑5 39.20 2.44 41.31 2.27 0.000* 40.11 2.54 40.96 2.10 0,007*
CP 6‑6 44.09 2.83 45.76 2.81 0.000* 44.97 3.08 45.83 2.98 0.013*
WR 3‑3 29.67 2.80 30.53 2.01 0.005* 30.06 2.01 30.26 1.89 0.282
WR 4‑4 39.54 2.71 40.11 2.50 0.003* 40.12 2.38 40.13 1.99 0.929
WR 5‑5 47.00 3.21 47.95 2.76 0.000* 47.86 2.51 48.14 2.06 0.221
WR 6‑6 54.05 3.02 55.40 3.17 0.000* 55.25 2.76 55.16 2.58 0.647
*Statistically significant for P<0.05. BA=Buccal axis point, CP=Cusp tip point, WR=WALA RIDGE point, SD=Standard deviation

Table 3: Intergroup comparison results of WALA ridge and dental arches dimensions changes at pre and
posttreatment (T1) (independent t‑tests)
Variables Pretreament Postreatment
(mm) Group 1 Group 2 P Group 1 Group 2 P
Damon (N=30) Conventional (N=30) Damon (N=30) Conventional (N=30)
Mean SD Mean SD Mean SD Mean SD
BA 3‑3 28.81 2.51 29.28 1.80 0.411 29.88 1.75 29.41 1.74 0.309
BA 4‑4 38.06 2.35 38.87 2.27 0.180 39.64 1.95 39.71 1.96 0.884
BA 5‑5 43.97 2.71 45.07 2.67 0.118 46.03 2.32 46.14 2.29 0.849
BA 6‑6 49.85 3.06 50.75 3.11 0.261 51.60 2.77 51.38 2.75 0.758
CP 3‑3 25.63 2.79 25.96 1.90 0.594 26.97 1.73 26.31 1.39 0.111
CP 4‑4 33.46 2.50 34.35 2.06 0.137 35.31 1.76 35.23 1.83 0.851
CP 5‑5 39.20 2.44 40.11 2.54 0.161 41.31 2.27 40.96 2.10 0.536
CP 6‑6 44.09 2.83 44.97 3.08 0.254 45.76 2.81 45.83 2.98 0.917
WR 3‑3 29.67 2.80 30.06 2.01 0.532 30.53 2.01 30.26 1.89 0.596
WR 4‑4 39.54 2.71 40.12 2.38 0.389 40.11 2.50 40.13 1.99 0.969
WR 5‑5 47.00 3.21 47.86 2.51 0.254 47.95 2.76 48.14 2.06 0.768
WR 6‑6 54.05 3.02 55.25 2.76 0.116 55.40 3.17 55.16 2.58 0.749
*Statistically significant for P<0.05. BA=Buccal axis, CP=Cusp point, WR=WALA ridge, SD=Standard deviation

Discussion casts was corroborated with Moura’s[18] study, which

In this present study was evaluated the WALA ridge
changes as well the mandibular dental arch dimensions
changes in dental casts pre and post orthodontic treatment.
The accuracy of using these measurements in dental
compared the WALA ridge measurements from dental
casts, radiographs and volumetric CT scans and found no
statistically significant difference between them. Although
we evaluated WALA ridge and dental dimensional changes
in outlined dental casts, they were produced in a single

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Esteves, et al.: WALA ridge and dental arch dimensions

Table 4: Intergroup comparison results of WALA ridge smaller for the self‑ligating than in conventional
and dental arches dimensions changes between T1 and group  [Table  1]. The ages presented a high standard
T2 (T2‑T1) (independent t‑tests) deviation because ages ranged from 9 to 45  years at
Variables Group 1 Group 2 P pretreatment, and 10 subjects had their age range between
(mm) Damon (n=30) Conventional (n=30) 9 and 12  years old for each group, however all of them
Mean SD Mean SD presented complete permanent dentition. According to
BA 3‑3 1.06 1.68 0.13 0.98 0.011* Bishara[20] in a longitudinal study comparing the dental arch
BA 4‑4 1.57 1.40 0.83 1.18 0.031* widths in subjects with age from 6 months to 45 years old,
BA 5‑5 2.05 1.51 1.07 1.43 0.011* a dental arch width increase should not be expected after
BA 6‑6 1.74 1.95 0.62 1.45 0.014* eruption of complete dentition therefore, the age range did
CP 3‑3 1.33 2.18 0.34 1.32 0.038* not influence the results of the present research.
CP 4‑4 1.85 1.80 0.87 1.29 0.018*
Treatment changes in the passive self‑ligating system
CP 5‑5 2.11 1.72 0.84 1.62 0.004*
group showed a statistically significant increase in all
CP 6‑6 1.66 1.58 0.86 1.78 0.071
WR 3‑3 0.86 1.57 0.19 0.99 0.055
transversal dimensions  [Table  2]. Conventional appliance
WR 4‑4 0.56 0.98 0.01 0.84 0.023*
treatment changes demonstrated statistically significant
WR 5‑5 0.95 1.07 0.28 1.23 0.028* increase in interpremolar and intermolar cusp tip and
WR 6‑6 1.34 1.20 −0.08 1.04 0.000* buccal axis distances [Table 2]. According to this, Pandis[21]
*Statistically significant for P<0.05. BA=Buccal axis point, CP=Cusp observed the same results to intercanine width changes
tip point, WR=WALA ridge point, SD=Standard deviation in the conventional group, meanwhile Fengler[15] found a
WALA ridge expansion that was statistically significant
Table 5: Results of comparing buccal axis point and in patients treated with conventional appliances, but
WALA ridge point point variables changes (T2‑T1) this was not clinically significant. In addition, Conti
(independent t-tests) et al.[5] longitudinally evaluated the dental and WALA
Variables BA (n=30) WR (n=30) P ridge dimensions changes in subjects treated with
(mm) Mean SD Mean SD conventional appliance, where subjects had their dental
All sample 3‑3 0.60 1.44 0.53 1.35 0.787 archwires individually coordinated with WALA ridge as
All sample 4‑4 1.20 1.34 0.28 0.95 0.000* reference. There was no statistically significant difference
All sample 5‑5 1.56 1.54 0.61 1.19 0.000* in the intercanine distance and WALA ridge transversal
All sample 6‑6 1.18 1.80 0.62 1.33 0.055 dimensions between orthodontic pretreatment and 3  years
Damon 3‑3 1.06 1.68 0.86 1.57 0.632 of follow‑up posttreatment, thereby concluding that using
Damon 4‑4 1.57 1.40 0.56 0.98 0.002* the WALA ridge as a reference to coordinate the dental
Damon 5‑5 2.05 1.51 0.95 1.07 0.001* archwires is a favorable tool to reach posttreatment
Damon 6‑6 1.74 1.05 1.34 1.20 0.337 stability.
Conv 3‑3 0.13 0.98 0.19 0.99 0.801
When comparing the intergroup distances measured
Conv 4‑4 0.83 1.18 0.01 0.84 0.002*
in pretreatment and posttreatment stages, it was not
Conv 5‑5 1.07 1.43 0.28 1.23 0.026*
observed a statistically significant difference between
Conv 6‑6 0.62 1.45 −0.08 1.04 0.033*
the groups  [Table  3]. Treatment changes comparison
*Statistically significant for P<0.05. Conv=Conventional brackets,
SD=Standard deviation, BA=Buccal axis point, WR=WALA ridge point
between self‑ligating and conventional groups showed
greater transversal increases in all measurements with the
Dental Radiological Clinic and the photographs were also exception of intermolar cusp tip distance and intercanine
used to promote a visual comparison if the alveolar ridge WALA ridge for the self‑ligating group, when compared to
in the plaster casts was compatible with that displayed in conventional group  [Table  4]. The absence of significance
the photograph thus eliminating the bias. Furthermore, the in pre and posttreatment intergroup comparisons and
WALA ridge used to assess the skeletal base dimensions differences found in treatment changes comparison is
has been shown before to not necessarily remain stable explained because, although not statistically significant, the
during dental tooth movement/expansion, but we tried to variables from passive self‑ligating system group presented
measure the skeletal and dental expansion using WALA slightly lower values at T1 and similar or slightly higher
ridge even knowing that it is not accurate, but it is values in T2, causing treatment  (T2‑T1) changes to be
clinically valid as several studies demonstrate[7,8,19] rather statistically significant.
than the use of CBCT scans, which are often not approved Other authors[21,22] did not find statistically significant
by ethics committees.
differences in the mandibular dentoalveolar expansion in
The groups were comparable regarding pre and cases treated with self‑ligating and conventional appliances;
posttreatment ages, treatment time and Little irregularity however Fleming et al.[22] evaluated only the alignment and
index[16] [Table  1]. The number of visits was significantly leveling phase. It is important to highlight that this current

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Esteves, et al.: WALA ridge and dental arch dimensions
study compared not only different orthodontic appliance
types, but different appliance systems including a different
dental arch coordination diagraming method for each
group, where the conventional group had their dental arch
diagramming with pretreatment WALA ridge as reference,
and the passive self‑ligating system group had their dental
arch diagramming according with their recommended
technique, after levelling with 0.014 x 0.025 Damon
Cu‑Ni‑Ti archwire.
The comparison of WALA ridge transversal expansion and
buccal axis transversal dimension changes [Table 5] showed
a higher dentoalveolar expansion that was statistically
significant in mandibular premolar region in both groups and
for the whole sample and in the mandibular molar region in
conventional group. According to Andrews[6] the adjacent
muscular forces can tip the dental crowns after eruption
across their center of resistance but not modifying it. In this
manner, since the WALA ridge is close to them, it will also
remain unchanged when these environmental forces occur.
Therefore, it is expected that the dentoalveolar expansion
overcomes the possible expansion of the WALA ridge.[15]
As shown by the results, the expansion of the dental arch
by the self‑ligating system to relieve dental crowding
was significantly and distinctly greater than the achieved
expansion of the alveolar skeletal base, as assessed by the
WALA ridge. This would mean that the teeth have been
moved to the buccal edge  (cortical bone) of the respective
jaw or perhaps even further if they had been positioned in
the center of the alveolar bone at the beginning. Some might
say that this position, however, is not physiological, since
it is associated with numerous problems such as gingival
recession and periodontal problems, root resorption, relapse
after treatment and dysfunction of the stomatognathic system
by disrupting the equilibrium of muscular forces on the
dental arch. All these problems mentioned above have been
studied by several authors and, according to the studies,
these assumptions can be refuted as follows: Orthodontic
treatment along with patient compliance and absence of
periodontal inflammation can provide satisfactory results
without causing irreversible damage to periodontal tissues.[23]
In addition, this system allows the teeth to move towards the
path of least resistance with little or no friction between the
bracket and the wire,[24] besides providing another alternative
to an already periodontally compromised patient.[25] Recent
studies have shown that insignificant differences were
detected in the periodontal status of adolescents undergoing
orthodontic treatment with either conventional or self
ligating brackets.[26] There was no sigificant difference in
the periodontal response to orthodontic treatment with either
self ligating or conventional bracket.[27] The risk of root
resorption using self‑ligating brackets is not greater than the
conventional ones.[28]
In relation to stability after treatment, it is possible to affirm
that the expansion of the dental arches had not influenced in
the relapse of dental crowding.[29] and in the long term, the
Indian Journal of Dental Research | Volume 30 | Issue 3 | May-June 2019 
increases in transverse dimensions of arches obtained with
self‑ligating brackets remain stable.[30] Finally regarding
the dysfunction of the stomatognathic system brought
about by the change in the muscular equilibrium of forces
on the dental arch, it has long been known that the claim
that orthodontic treatment (even with self ligating brackets)
causes temporomandibular dysfunction is anecdotal, so the
affirmation that self‑ligating systems change the muscular
equibilibrium of forces causing dysfunction of the
stomatognathic system should not be taken too seriously.[31]
Clinical considerations
Dental arch expansion occured mostly due to buccal tipping
mainly in the premolar region for both groups.
The use of different diagrammed dental archwires for
the two groups was crucial to reach this result. In other
words, there was less dental and WALA ridge expansion in
conventional group, where the archwire diagram was based
on the WALA ridge of the pretreatment dental cast while
the archwire design used in passive self‑ligating system
group was determined after dental arch expansion in initial
leveling phase performed with Damon Cu-Ni-Ti archwires.
Thus, it should be highlighted the importance of the
entire system related to the chosen technique, and not
collate the results with appliance choice. If greater dental
arch expansion is desired, passive self‑ligating appliances
can be used, with its unique archwire design and proper
expanded Cu‑Ni‑Ti archwires, providing these effects.
On the other hand, if the aim is to restrict dental arch
expansion, conventional appliance and the method of
arch diagram based on pretreatment dental cast must
be chosen, both using the WALA ridge or using the
predetermined shapes and sizes dental arches diagrams.
Limitations: Both groups had not used the same model or
archwire sequence.
Conclusions
There was a significantly greater increase in the WALA
ridge and mandibular dentoalveolar transversal dimensions
in the passive self‑ligating system group when compared
to conventional group. It was also observed that there was
a greater increase in buccal axis transverse dimensions
in premolar region when compared to the WALA ridge
transversal increase, independent of the appliance used.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Indian Journal of Dental Research | Volume 30 | Issue 3 | May-June 2019