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ORTHODONTICS BY MBT TECHNIQUE

The straight wire concept


The birth of a new concept is never an all or none phenomenon. It
is a slow evolution with contributions from many. A new principle is
an inexhaustible source of new views
Nothing in education is more astonishing than the amount of
ignorance it accumulates in the form of inert facts.. However , it is
the amalgamation of these inert facts, put forward by the genius of
our profession, that has led to the high standard of the Preadjusted
Appliance system which it has acquired today
The beauty of this concept is that a more consistent, more ideal
result can be obtained with less physical and mental drain on the
operator in less overall time and minimal discomfort to the patient.

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The Straight Wire Concept


The straight wire concept is not a product of serendipity,
but is a poetry in design. It is an appliance fully
programmed to combine simplicity and effectiveness
required for the road to success
The genesis of the straight wire appliance was not a
result of a single stray discovery, but rather the result of
numerous experiments. Many individual innovations
were distilled and combined to form this intricate design.

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BUILDING TREATMENT INTO


EDGEWISE BRACKETS

HOLDAWAY (1952)
PUBLISHED A LANDMARK ARTICLE IN 1952 DESCRIBED 3
USES OF BRACKET ANGULATION
AIDS IN PARALLELING ROOTS ADJACENT TO EXTRACTION
SITES

METHOD OF SETTING UP POSTERIOR ANCHORAGE

TO OBTAIN CORRECT AXIAL INLINATIONS.

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HOLDAWAY

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BUILDING TREATMENT INTO


EDGEWISE BRACKETS

JOHN STIFTER
(1958)
BRACKETS WITH MALE AND
FEMALE ATTACHMENT

IVAN LEE(1960)
BRACKETS OF UPPER
ANTERIORS AND LOWER
POSTERIORS HAD TORQUED
SLOTS

JARABACK (1962)
SUGGESTED THAT UPPER
ANTERIORS BE TORQUED
AND
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ANGULATED

BUILDING TREATMENT INTO


EDGEWISE BRACKETS
LAWRENCE F. ANDREWS STRAIGHT
WIRE APPLIANCE (1976)
2 PRESCRIPTIONS
STANDARD (NON EXTRACTION)
TRANSLATION (EXTRACTION)

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CONCEPT OF THE PEA


APPLIANCE

THE CONCEPT OF THE PEA APPLIANCE EVOLVED


FROM A SERIES OF 5 STUDIES CONDUCTED BY L.F.
ANDREWS.
EXAMINATION OF POST TREATMENT OCCLUSION
STUDY OF NATURALLY OCCURING OPTIMAL
OCCLUSION
THE SIX KEYS TO OPTIMAL OCCLUSION
CROWN MEASUREMENTS
COMPARISON OF TREATED AND NATURAL
OCCLUSION
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EXAMINATION OF POST TREATMENT


OCCLUSION
The

first experiment was conducted in


1960
Study models of hundreds of treated
cases submitted to the ABO, E. H. Angle
Soc and Tweed Foundation considered to
be the state of the art in static occlusion in
the US.

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EXAMINATION OF POST TREATMENT


OCCLUSION

All models showed some common trendsMolars were in Class I relationship


Incisors were not rotated
No overjet/ crossbite

But there were several inconsistencies like Articulation?


Long axes of teeth adjacent to extraction sites
Inclinations and angulations varied
2nd molar not included
Interdental spacing due to incomplete treatment
Rotation of teeth requiring translation
No mounting to check functional occlusion
Co-Cr coordination
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STUDY OF NATURALLY
OCCURING OPTIMAL
2 experiment, 1964, Help of
OCCLUSION
A.G.Brodie
(Univ of Illinois)
nd

With the presumption that


naturally occuring optimal
occlusion is worth emulating.
120 casts of patients with
following featuresNever had undergone
orthodontic treatment
Well aligned teeth, pleasing
appearance
Excellent occlusion
Would not benefit from
orthodontic treatment
The facial axis and mid point of
clinical crown of each tooth
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was marked

THE SIX KEYS TO OPTIMAL


OCCLUSION

The third and most important experiment in the


development of the preadjusted appliance
The 6 keys individually were not new but put together
were of special value asComplete set of indicators of optim al occlusion.
Judged by tangible landmarks
Judged from facial/ occlusal view

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TERMINOLOGY
Andrews

Clinical

Plane

Crown

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TERMINOLOGY
Crown

Angulation

Crown

Inclination

FACC
FA Point
Class
Type
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Six Keys

Key 1
Molar Interarach
relationship

Mesiobuccal cusp of the permanent


maxillary molar occludes in the buccal
groove of the perm mand molar
Distal marginal ridge of the upper 1 st molar
occludes with the mesial marginal ridge of
the lower 2nd molar
Mesiopalatal cusp of the upper 1st molar
occludes in the central fossa of the lower ist
molar
Buccal cusps of upper premolars in the
embrasures of the lower premolars
Palatal cusps of upper premolars in a cuspfossa relationship with lower pms
Upper canines in cusp embrasure with
lower canines
Upper anteriors overlap the lower anteriors

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Six Keys
Key

2
Crown Angulations

Essentially all crowns have


positive angulation
Gingival potion of FACC distal
to occlusal portion
All crowns of tooth type have
similar angulations
Tip pattern is consistent for all
individuals
Important esp anteriorly

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Six Keys
Key

3Crown Inclination

Maxillary incisors have positive


inclination
Mandibular incisors have slight
negative inclination
Interincisal angle<180*
Max incisor +ve inclination >
mand incisor ve incl
Upper Central> Lateral
Upper 345 ve
Upper 67 more ve
Mand= progresively -ve
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Six Keys
Key

4Absence of rotations
Key 5Tight contacts
Key 6slight to flat curve of
spee
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CROWN MEASUREMENTS

4th study involved the


measurement of crowns
in the sample for-

Bracket area of tooth type


Vertical crown contour
Crown angulation
Crown inclination
Maxillary molar offset
Horizontal crown contour
Facial prominence
Depth of Curve of Spee

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CROWN MEASUREMENTS
Upper
Angulation
Inclination
Prominence
Molar Offset
Lower
Angulation
Inclination
Prominence
Curve of Spee

1
5
7
2.1

2
9
3
1.65

3
11
-7
2.5

1
2
-1
1.2

2
2
-1
1.2

3
5
-11
1.9

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4,5
2
-7
2.4

6
5
-9
2.9
10*
4,5
6
2
2
-17,-22 -30
2.35
2.5
0-2.5

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COMPARISON OF TREATED AND


NATURAL OCCLUSION
The

5th study compared 1150 treated


cases with the measurements and the six
keys.
KEY 1- Most

cases showed Angles Class I molar relationship.


However,
The distal marg ridge of upper 6 x mmr of lower 7
Pms and canines didnt show a cusp- embrasure
relationship
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COMPARISON OF TREATED AND


NATURAL OCCLUSION

KEY 2-

Values= +/- 2 was considered incorrect


91% of cases had 1 or more teeth with incorrect angulation
Upper laterals and canines showed ve ang
Upper 6 ranged from -ve in non ext to +ve in ext cases

KEY 3-

Values +/- 2 was considered incorrect


Interincisal angle on FACC > 180* in 78% cases
Upper 456 not always -ve
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COMPARISON OF TREATED AND


NATURAL OCCLUSION

KEY 4-

Rotational errors were measured using angle between


contact points and arch form.
Values= +/- 2 was considered incorrect
67% of cases had rotations esp. teeth that were translated

KEY 5-

47% showed spacing due to incorrect angulation

KEY 656% showed excessive curve of spee


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PRINCIPLES

ALL TEETH OF SAME TYPE WERE SIMILAR IN SIZE


AND SHAPE
SIZE OF CROWN HAS NO EFFECT ON ANGULATION,
INCLINATION OR PROMINENCE
MOST PEOPLE HAVE NORMAL TEETH REGARDLESS
OF OCCLUSION
JAWS MUST BE CORRECTLY RELATED FOR
OPTIMAL OCCLUSION
DENTITIONS WITH NORMAL TEETH IN JAWS THAR
ARE/ CAN BE CORRECTLY RELATED CAN BE
BROUGHT TO OPTIMAL OCCLUSION
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SHORTCOMINGS OF THE
STANDARD EDGEWISE
APPLIANCE
1.

BRACKET BASES
PERPENDICULAR
TO THE STEM

PROBLEMS IN SLOT
INCLINATION
PROBLEMS IN
OCCLUSO-GINGIVAL
POSITION

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2.

SHORTCOMINGS OF THE
STANDARD EDGEWISE
BRACKETS
NOT
APPLIANCE

CONTOURED
OCCLUSOGINGIVALLY

PROBLEMS IN SLOT
INCLINATION
PROBLEMS IN
OCCLUSO-GINGIVAL
POSITION

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SHORTCOMINGS OF THE
STANDARD EDGEWISE
APPLIANCE
3. BRACKETS NOT
CONTOURED
MESIO DISTALLY

PROBLEMS IN SLOT
SITING

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SHORTCOMINGS OF THE
STANDARD EDGEWISE
APPLIANCE
4. SLOTS NOT
ANGULATED

EACH CROWN HAS


ANGULATION.
WHEN A FULL SIZE
WIRE IS INSERTED
RESULTANT
ANGULATION
INCORRECT.
IF BRACKET
ANGULATED ONLY 2
POINT CONTACT.
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SHORTCOMINGS OF THE
STANDARD EDGEWISE
APPLIANCE
5.

6.

BRACKETS STEMS
OF EQUAL
PROMINENCE
MAXILLARY
MOLAR OFFSET
NOT BUILT IN
IST ORDER BENDS
REQUIRED.
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7.

SHORTCOMINGS OF THE
STANDARD EDGEWISE
ANGULAGTION
APPLIANCE
LANDMARKS DIFFERED
LONG AXIS OF CROWN
NOT VISIBLE
LONG AXIS OF TOOTHNOT VISIBLE
INCISAL EDGETOO FAR AWAY,
MAY BE CHIPPED LATERAL
CURVED
CUSP TIPS?
MARGINAL RIDGES TOO
FAR AWAY
CONTACT POINTS NOT
VISIBLE
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8.

SHORTCOMINGS OF THE
STANDARD EDGEWISE
INCLINATION
APPLIANCE
LANDMARKS
DIFFERED
LONG AXIS OF
CROWN NOT VISIBLE
BRACKET HEIGHT
FRON CUSP TIP

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8.

SHORTCOMINGS OF THE
STANDARD EDGEWISE
APPLIANCE
EXCESSIVE
WIRE BENDING REQUIRED
TO INITIATE/ MAINTAIN TOOTH MOVEMENT
TO COMPENSATE FOR SLOT SITING
ERRORS
TO COMPENSATE FOR ERRORS IN WIRE
BENDING
TO COMPENSATE FOR SIDE EFFECTS
OFWIRE BENDING

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SHORTCOMINGS OF THE
STANDARD EDGEWISE
PRIMARY
BENDS
APPLIANCE
1 ORDER -46 BENDS
ST

2ND ORDER3RD ORDERERRORS- 30 BENDS


SECONDARY BENDS
FOR ERRORS IN
SLOT SITING
WIRE BENDING
JUDGEMENT
TERTIARY BENDS
LOOPS, STOPS ETC
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DESIGN FEATURES OF THE


NEW APPLIANCE
SLOT

SITING FEATURES

CONVENIENCE
AUXILLIARY

FEATURES

FEATURES

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SLOT
SITINGPLANE
FEATURES
TRANSVERSE

MID

THE MID TRANSVERSE PLANE OF THE SLOT, STEM


AND CROWN MUST COINCIDE
BASE SHOULD HAVE SAME INCLINATION AS THE
FACIAL PLANE
BASE CONTOURED OCCLUSO GINGIVALLY TO
MATCH CROWN CURVATURE
THESE FEATURES ELIMINATEDX 2ND ORDER BENDS FOR OCC-GIN DISHARMONY
X 3RD ORDER BENDS FOR INCLINATION
X OTHER BENDS FOR SIDE EFFECTS

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SLOT SITING FEATURES

MID SAGGITAL PLANE


THE MID SAGGITAL PLANE OF THE SLOT, STEM AND CROWN
MUST COINCIDE
THE PLANE OF BASE AT BASE POINT SHOULD BE IDENTICAL
TO FACIAL PLANE AT FA POINT
BASE CONTOURED MESIODISTALLY TO FIT EACH TOOTH
VERTCAL COMPONENTS PARALLELTO EACH OTHER
THESE FEATURES ELIMINATEDX 1ST ORDER BENDS FOR MOLAR OFFSETS AND M-D SLOT
SITING
X 2ND ORDER BENDS FOR OCC-GIN DISHARMONY AND
ANGULATION
X SECONDARY BENDS FOR SIDE EFFECTS

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SLOT
SITINGPLANE
FEATURES
MID
FRONTAL
THE

MID FRONTAL PLANE OF EACH


SLOT MUST SUPERIMPOSE ON ITS
CROWNS PROMINENCE PLANE
ALL SLOTS SHOULD HAVE SAME
DISTANCE FROM EMBRASURE LINE
THESE FEATURES ELIMINATEDX 1ST ORDER BENDS
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CONVENIENCE FEATURES

GINGIVAL TIE WINGS


LATERAL TO SEA

NO GINGIVAL IMPINGEMENT
EASY LIGATION

STEMS OF LOWER 456


GINGIVAL

NO OCCLUSAL INTERFERENCES

FACIAL SURFACES OF
UPPER 123 PARALLEL
TO BASES IN TURN
PARALLEL TO CROWN
FACE

LIP COMFORT
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BUCCOLINGUAL
TIP IN UPPER 6S
AUXILLIARY
FEATURES

COUNTER
COUNTER

MESIODISTAL TIP
COUNTER ROTATION
TRANSLATION BRACKETS
MAX TRANSLATION BRACKETS
MEDIUM TRANSLATION BRACKETS
MIN TRANSLATION BRACKETS
POWER ARM

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STAGES OF TREATMENT
ANCHORAGE

CONTROL
LEVELLING AND ALIGNING
OVERBITE/ OVERJET CONTTROL
SPACE CLOSURE
FINISHING

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ANCHORAGE CONTROL
WITH

THE INCREASE IN THE TIP THERE IS A


GREATER TENDENCY OF THE ANTERIORS
TO PROCLINE
UPPER>LOWER
SOLUTIONS
OMEGA LOOP STOPS
MOLAR TIE BACKS
TPA, LINGUAL ARCH, HG
CLASSIII ELASTICS
ARCH WIRE BENT DISTALLY BEHIND MOLAR
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LEVELLING AND ALIGNING


TWO

PROBLEMS
ASSOCIATED WITH
THE PEA
ROLLER COASTER
EFFECT
NEED FOR
OVERCOMPENSATI
ON

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OVERBITE CONTROL

A.

B.

DEEP BITE DUE


TO CANINE TIP
WHEN CANINES
WERE UPRIGHT /
DISTALLY TIPPED
ROLLER COASTER
EFFECT

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SPACE CLOSURE
MOST

SIGNIFICANT
SLIDING POSSIBLE BECAUSE OF THE
STRAIGHT WIRE

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FINISHING

FINISHING REQUIRED MINIMAL WIRE BENDING TO


COMPENSATE FOR VARIATIONS IN TOOTH SHAPE,
SIZE, ERRANEOUS BRACKET POSITIONING OR
OVERCORRECTION
TIP CONTROL- ADJUSTMENT MAY BE NEEDED
TORQUE CONTROL-NEEDED IN UPPER AND LOWER
INCISORS.
LOWER MOLARS -VE TORQUE, UPPER MOLARS+VE ROOT TORQUE
ARCH WIDTH ADJUSTMENTS
ROTATIONAL CONTROL
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CORRECTION

Dr Lawrence F. Andrews developed


the straight wire appliance in mid
1970 based on 6 keys
It was a radical step ,offering dual
advantage of less wire bending and
better quality of finish

Initial results of SWA were


disappointing
Old mechanics and heavy
force levels ,developed for
standard edgewise brackets
simply did not transfer to the
new system
ROLLER COASTER effect
was seen
Premolars and canines tended
to tip and rotate in the
extraction sites

FRICTION

Friction is the resistance to motion that exists when a solid


moves tangentially with the respect to the surface of
another solid.

FRICTIONAL FORCE FFR : Is parallel but opposite to the


direction of force (F) causing motion.

The frictional force produced is proportional to the force


with which the contacting surfaces are pressed together and
is affected by the nature of the surface at the interface.

MECHANISM OF ACTION OF FRICTION


MECHANICS :

To move a tooth bodily, the force applied has to


pass through the center of resistance of the tooth.
However as the force is applied at the bracket level
of the crown, the concerned tooth experiences both
force and moment.

MECHANISM OF ACTION OF FRICTION


MECHANICS :
Moment of force is created in 2 planes of space. One
moment tends to rotate the canine mesial out as the force
application is buccal to the center of resistance and the
other tends to cause distal tipping of the tooth as the point
of force application is occlusal to the center of resistance.

MECHANISM OF ACTION OF FRICTION


MECHANICS :

The wire bracket interaction tends to counteract this


moment by applying an opposite moment. When
distal tipping of the crown takes place the M/F ratio
will be around 7:1, the tooth slides along the
archwire till binding occurs between the archwire and
the bracket. This produces a COUPLE at the bracket.

FORCE DELIVERY SYSTEMS IN SLIDING


MECHANICS

1. Elastic module with ligature

2. E - chains

3. closed coil springs

4. J - hook head gear

5. Mulligans V - bend sliding mechanics (JCO 1980


July 1994 Sep)

6. Employing Tip-edge Bracket on canines

METHODS OF CANINE RETRACTION IN


SLIDING MECHANICS

There are two ways in which anterior teeth are


retracted.
1. By retracting the canine first followed by retraction of
other four anteriors enmasse.
2. Enmasse retraction of six anterior teeth.

Among the above mentioned force delivery system,


commonly used are the elastomeric materials and the
closed coil spring.

They are either attached directly to attachments on the teeth


(canine hooks) or more usually to hooks on the archwire
Methods of applying traction to the archwire include

Fabricated tie back loops (in shape of boot or inverted boot)

Soldered brass hooks (0.7mm)

Stainless steel hooks (0.6mm)

Crimpable hooks

Kobayashi hooks
Preposted archwires are also available

FORCE DELIVERY SYSTEM :


ELASTOMERICS:
Composition and structure
Elastomeric modules and E-chains are polyurethanes,
which are thermosetting polymers. The polymers
posses rubber like elasticity and have long chain
which are lightly cross-linked. The cross-links
between chains must be relatively few to facilitate
large extension with no rupture of primary bonds.

2. E CHAIN (ELASTOMERIC CHAINS)

It was introduced in 1960 and used in orthodontics


for canine retraction, diastema closure, rotation
correction and arch constriction.

Most of the elastomeric chains generally lose 50% 70% of their initial force during the 1st day of load
application and at 3 weeks retain only 30 40% of
their original force.

2. E CHAIN (ELASTOMERIC CHAINS)

In view of the wide variation of initial force levels of


different types of power chains, a force gauge should
be used to determine the desired initial force.

To overcome the problem of rapid force decay


rate and provide for a more constant and consistent
force delivery, prestreching of elastomeric chains has
been suggested.

CONFIGURATIONS
Elastomeric chains are available in 3
configurations

Closed loop chain

Short filament chain

Long filament chain :

- generally deliver a lower initial force


and exhibit a greater rate of force
decay at the same extension.

CLINICAL CONSIDERATIONS WHEN USING


ELASTICS FOR RETRACTION OF CANINES

A common mistake is to change the elastic chain or


module too often, thus maintaining high force levels and
a moment to force ratio that produces distal crown
tipping only. This also causes excessive mesial out
rotation of the canines. Constantly high force levels can
cause excessive hyalinization of the periodontal
ligaments and inhibit direct resorption around the canine.

CLINICAL CONSIDERATIONS WHEN USING


ELASTICS FOR RETRACTION OF CANINES

If the posterior segment undergoes direct bone


resorption at the same time, loss of anchorage may
result. It is therefore recommended that elastic
modules or chain should be changed at an intervals
of 4-6 weeks to optimize sliding retraction of the
canine.

Advantages

Disadvantages

Inexpensive,

Relatively hygienic,

Can be easily applied


without arch wire
removal

absorb water and saliva and


permanent staining takes place.

Stretching causes permanent


deformation.

The loss of force (FORCE


DECAY) with time leads to
variable forces levels during the

No patient co-operation
required.

treatment, this results in


decreased effectiveness.

3. CLOSED COIL SPRINGS

Coil springs were introduced to the orthodontic world as early


as 1931. During the manufacturing process, the material is
subjected to winding that includes tensional and torsional
components and hence spring properties may be slightly
different from the wires made from the same material. The
various materials that have been used for making springs are

Stainless steel

NiTi

Co-Cr Ni alloy

b. NiTi closed coil springs

Nickel titanium alloys were introduced to the


dental profession by William. P. Bleur in the
1960's. He demonstrated the unique
combination of properties of shape memory and
super elasticity in addition to low modulus of
elasticity, moderately high strength, high
resilience and less corrosion.

b. NiTi closed coil springs

The force degradation is very less due to the low load


deflection rate. They deliver constant amount of force
till they reach the terminal end of deactivation stage
and generally close space with single activation. They
are available in lengths of 9 mm and 11 mm.

ADVANTAGES OF NITI COIL


SPRINGS

Can be easily placed and removed without


archwire removal
Do not need to be reactivated at each appointment
Patient co-operation not required.

DISADVANTAGES
Relatively unhygienic compared to elastic force
systems.

EFFECTS OF OVERLY SPACE


CLOSURE:

Space closure typically occurs more easily in


high angle patterns with weak musculature. The
rate of closure can be increased either by
increasing the force or using thinner arch wire.
However more rapid space closure leads to
loss of control of torque,
rotation or
tip

Loss of control of torque

results in upper incisors being too upright at the end of


space closure with the spaces distal to the canines and a
consequent unesthetic appearance. The lost torque is
difficult to regain. Also, rapid mesial movement of the
upper molars can allow the palatal cusps to hang down,
resulting in functional interferences, and rapid
movement of the lower molars causes rolling in .

Loss of control of torque

Reduced rotation control

can be seen mainly in


the teeth adjacent to
extraction sites, which
also tend to roll in if
spaces are closed too
rapidly.

Reduced tip control

produces unwanted movement of canines, premolars, and


molars, along with a tendency for lateral open bite. In highangle cases, where lower molars tip most freely, the elevated
distal cusps create the possibility of a molar fulcrum effect. In
some instances, excessive soft-tissue hyperplasia occurs at the
extraction sites. This can prevent full space closure or allow
spaces to reopen after treatment. Local gingival surgery may be
necessary in such cases.

INHIBITORS TO SLIDING MECHANICS

1. Occlusal interference - To prevent this proper aligning


and leveling of the arches is required.

2. Friction and binding between bracket and archwire


may place heavy demand on anchorage.

3. Poor canine control can be a problem : Doing canine


retraction on heavier arch wire reduces the problem.

INHIBITORS TO SLIDING MECHANICS

4. Cortical plate resistance (Narrowing of alveolar bone in extraction


sites)

5. Excessive forces causes lower molar tipping and extrusion of


distal cusps

6. Soft tissue build up in the extraction site can prevent space closure
(or) reopen spaces after treatment.

7. Rotation of canines mesio-bucally and molar mesiopalatally.This


occurs due to the use buccal traction. It can be prevented
simultaneous palatal traction using lingual cleats or buttons.

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