WIRES USED IN LEVELING AND ALIGNING Stainless steel wires Australian stainless steel wires Cobalt-chromium (Elgioy) Beta-titanium (TMA) A-niti M-niti Coaxial wires Braided wires Composite plastics/optical glass

STAINLESS STEEL WIRES Stainless steel wires used in orthodontics, consist of 18% chromium and 8% Nickel with austenitic type of steel. It has tarnish and corrosion resistance due to passivating effect of chromium. The property of stainless steel wires can be controlled reasonably wide range by varying the amount of cold working and annealing during manufacture. This steel is softened by annealing and hardened by cold working. Fully annealed stainless steel wires of soft and highly formable.

AUSTRALIAN STAINLESS STEEL WIRESThe Australian stainless steel wires was produced A.J.Willcock according to specifications. Specified by Dr. Begg, Without which as Dr. Begg, himself says The Begg Technique would not have developed.It has ultra high tensile austenitic stainless steel wire.It comes in different resiliencies.This wires are graded and colour coded depending on the resiliency.Regular with white label.Regular plus with green labelSpecial grade with black label

Special plus with orange label Premium with blue label Premium plus with blue labelSupreme with lavender label The regular grade is least and premium grade is the most resilient of all the wires.For leveling and aligning special plus and above the wires are used.

COBALT CHROMIUM ALLOY WIRES This alloy is colour coded according to their resiliency Blue elgiloy Yellow elgiloyGreen elgiloy Red elgiloy Blue being the least resilient and red being more resilient. A distinct advantage with these wires is that they can be heat treated, so increase the resiliency. Therefore, the clinicians can place accurate bend with easy in preheat treatment wires. After preheat treatment the same wire obtained better spring back properties

NICKEL TITANIUM ALLOY WIRES (NiTiNol) Invented in 1960 by William f. Buehler At novel ordanance laboratory (Nol) in silver springs. Now called navel surface weapon centre. Acronym of elements - Ni NickelTi Titanium Nol - OriginINTRODUCTION TO ORTHODONTICS Introduced by George Anderson in 1971. Clinical use started 1972. Marketed by unitek.

NiTiNol have to remarkable properties Shape memory Super elasticity M-nitiAfter considerable experimentation, nitinol was marketed in the late 1970s for orthodontic use in stabilized martensitic form. It is exceptionally springiness and quite strong but has poor formability.The family of stabilized martensitic alloys now commercially available are reffered as M-niti.

In late 1980s, new nickel titanium wires with an active austenitic grain structure appeared.These wires exhibit the other remarkable property of NiTi alloy- super elasticity.It is reffered as A-niti The wire has spring back 4-4 times that of comparable stainless steel wire and 1.6 times of NiTiNol.At 80% activation average stiffness of NiTi is 73% that of stainless steel and 36% that of NiTiNol.The load deformation rate at small activation is considerably higher that of large activation.Highly suitable wire if large deflection and low stiffness required.A-niti

BETA TITANIUM (TMA) In the early 1980s, after Nitinol but before A-niti, a quite different Titanium alloy, Beta titanium was introduced into orthodontics.

It offers highly desirable combination of strength and springiness as well as reasonably good formability.

This is excellent choice of auxiliary springs and intermediate and finishing arch wires.

Its property is intermediate between stainless steel and M-niti.

MULTI STANDARD/ CO-AXIAL STAINLESS STEEL WIRES The wires available in RoundRectangular Square in cross section According to studies conducted by Kusy & Barrow in 1982.Brided wires have elastic properties similar to nitinol.It can be used as a suitable to nitinol considering the cost of the later.

COMPOSITE PLASTICS Optiflex is a composite structure formed by top coating optical glass fibres (which are pure silicon dioxide) with a hot melt adhesive and a nylon skin. Its advantages are light forces for initial alignment and excellent esthetics.

LEVELING AND ALIGNING Definition The tooth movements needed to achieve passive engagement of a plain, rectangular arch wire of .019/.025 dimension, having standard arch form into correctly placed preadjusted .022 bracket system.

In case of 0.018 bracket system the dimension of arch wire should be 0.016/0.022.

THE OBJECTIVE OF LEVELING AND ALIGNING The objective in leveling and aligning can be divided into Short term objectivesLong term objectives Short Term ObjectivesIn the opening months of treatment, will be to achieve proper leveling and aligning into passive rectangular wire. Long Term ObjectivesTo be achieved by the end of the treatment, will be to achieve an ideal dentition, showing in the six keys to normal occlusion, and with the dentition properly positioned in the facial profile.

Any attempt to rush the achievement of short term objectives by taking short cuts and using heavy forces, cause unwanted changes to the take place. These make achievement of long term objectives more time consuming and difficult.

So we have choose carefully about the leveling and aligning wires.

If we choose properly, it will safely and smoothly take as to both our short term and long term goals.

THE PRINCIPLES IN THE CHOICE OF LEVELING AND ALIGNING WIRES The initial arch wires for alignment should provide light continuous force to produce the most efficient tipping tooth movement.The arch wire should move freely, with minimal binding, within the bracket slot.Sliding teeth along an arch wire requires atleast 0.002 of clearance and 0.004 would be ideal. During initial alignment, it is better to position the crowns than to cause root displacement. Although a highly resilient wire such as 0.017 x 0.025 A-niti could be used during this stage it is not advisable because it will create unnecessary and desirable root movements which delay the alignment process and possibility of root resorption.

ARCH WIRE MATERIALS The wires used for initial alignment purpose require a combination of excellent strength, springiness and long range of action.Ideally there should be an a almost flat-load deflection curve with the wire delivering about 50gm of force of almost any degree of deflection.The titanium based arch wire both NiTi and TMA offer a better combination of strength and springiness than stainless steel wires.The NiTi wires are particularly useful in first stage of treatment, remarkably flat load deflection curve of A-niti make it the wire of choice for leveling and aligning.

SIZE OF THE WIRES Changing the diameter of a wire greatly affects its properties for initial leveling and aligning the smallest diameter wire that has adequate strength would be proffered.When the diameter of wire is doubled, The strength increases by 8 times.The springiness decreases by 16 times.Range decrease by half.

DISTANCE BETWEEN THE BRACKETSAs the distance increases between the point of attachment of a beam, strength decreases rapidly while springiness increases even more rapidly.

The bit of the bracket is an important factor.

The wider the individual bracket, the smaller the interbracket span.

So gaining increased springiness and the range of action, withiout sacrifying too much strength.

LEVELING AND ALIGNING ARCH WIRE SEQUENCE ARCH WIRE SEQUENCE FOR .018 SLOT BRACKETSSelection of initial alignment wires The principle that there should be .002 of clearance for initial wires means that .016 round wire is the largest that should be considered for initial alignment in the .018 slot.The three major possibilities for alignment arches are Multi standard stainless steel wires Nickel titanium wires Single standard steel wires

MULTISTANDARD WIRES Its excellent properties, .0175 multistandard stainless steel wire is too large for effective use .018 slot bracket.

The difficulty of sliding the teeth along with .0175 wires in .018 slot brackets is compounded irregular surface of the twisted strands, which can be bind against the corner of brackets.

A .015 wire gives adequate clearance but its physical properties are inferior, so this wire is can be eliminated as impractical.

NICKEL TITANIUM WIRES In contrast to steel wires that tend to be too stiff and not strong enough for good alignment.niti wires have outstanding properties of springiness and range and also good strength.M-niti does provide good formability. In clinical practice, it has tendency to break and permanently distorted if stressed to the same extent. A-niti wires of the same diameter of .016 can have different force deflection curve, with these wires, the appropriate choice for initial alignment is the wire delivers 50 gms along its unloading curve.The great advantage is that the wire will deliver this optimum force over a large range.

STAINLESS STEEL WIRES WITH LOOPS Excellent performance in alignment also can be obtain by using .014 or .016 stainless steel wires incorporating loops if necessary.The primary indication choosing loop in a .014 steel wires, when the arch is well aligned except at one spot, where the tooth badly mal positioned tooth, there is risk for distorting arch form.In such situation arch wire should be reasonably stiff except at the spot where springiness needed and loops will produced just that effect..014 stainless steel wire used to align the teeth further. After a lapse of 1-6 weeks .016 round stainless steel wire is ligated. Finally .016 x .022 stainless steel wire is ligated to complete the phase of leveling and aligning.

ARCH WIRE SEQUENCE FOR .022 SLOT MULTISTANDARD WIRES With a .022 slot, there is optimum clearance for .0175 twisted arch wires and this wires can be excellent choice of initial alignment arch wire, if mal aligned is not severe.Although .0195 twisted wire also would fit well within the bracket slot but this wire is undesirably stiffer..0195 co-axial wire has similar springiness that of .0175 twisted wire, and is better choice if some reason a large diameter wire is desired.Because coaxial wires cost more than twisted wires.

NICKEL TITANIUM WIRES Both .016 and .018 diameter NiTi can be used initial arch wires with .022 slot brackets..018 M-niti undesirably stiffer and should be avoided.A-niti is readily available in .016 diameter. Although there will be .008 clearance within the brackets with such wires does not cause clinical problems.Since the stiffness of .0175 twisted wires and .016 NiTi wires is quite similar at small deflections.It make good economic sense to use the twisted wires initially .022 slot.When the teeth reasonably well aligned initially and use .016 NiTi when greater range needed.

STAINLESS STEEL WIRE WITH LOOPS .014 stainless steel wires usually the best choice.But .016 stainless steel wires can also be used.But the wire fits better in .022 slot, but its greater stiffness requires more complex loop design.Once the initial alignment is achieved, the diameter of wire progressively increased to .016, .018, .020 round wires.And finally .0195 x .025 rectangular stainless steel wire is placed to complete the leveling and aligning.BENNET and MC LAUGHLIN advice the following sequence of arch wire in .022 slot..015 twist flex.0175 twist flex

.014 stainless steel round wires .016 stainless steel round wires .018 stainless steel round wires .020 stainless steel round wires .019 x .025 rectangular stainless steel wire The exact sequence of arch wire varies with the complexity of mal occlusion.In difficult cases a particular size may be maintained for more than one month.In initial cases, it is often possible to skip a wire size.BENNET and MC LAUGHLIN did not discourage the use of NiTi wires, he says the NiTi wires disadvantages The cost, the flexibility, difficulty to place bend back

Anchorage control in the PEA system is very important, because of the features built in the appliances, which tend to proclaine the teeth. During the leveling and aligning will have the following meaning The maoeuvers used to restrict undesirable changes during the opening phase of treatment, so that leveling and aligning is achieved without key features of the malocclusion becoming worse.BENNET and MC LAUGHLIN emphases the need to consider anchorage in all the three plane of space Horizontal plane Vertical plane Transverse plane (Lateral) ANCHORAGE CONTROL DURING LEVELING AND ALIGNING IN PEA

Horizontal plane Anchorage control means limiting the mesial movement of the posterior segments while encouraging distal movement of the anterior segments.When the posterior mesialize and the anterior procline, anchorage is being lost in the horizontal plane. Vertical plane Vertical anchorage control involve the limitation of the vertical skeletal and dental development in the posterior segments and the limitation of the vertical eruption of (or) even intrusion of the anterior segments. Transverse (Lateral) anchorage controlIt comprises maintenance of expansion procedure, primarily in the upper arch, and the avoidance of tipping (or) extrusion of posterior teeth during expansion.

Control of anchorage in the horizontal plane Anchorage control in the horizontal plane includes the achievement of the correct antero posterior position of the teeth at the end of the treatment. It often involves limiting the mesial movement of the posterior teeth while encouraging the distal movement of the anterior teeth.This can be divided into Anchorage control of anterior segmentsAnchorage control of posterior segment

Anterior control of anterior segments The first difference between the standard edge wise appliance and the PEA is the tendency for the anterior teeth to incline forwards during the initial phase of leveling and aligning.This result from the tip built in the anterior brackets which is more in the upper arch compared to the lower arch.

To eliminate or minimize this effect by connecting anterior segments to the posterior segments with elastic forces.In the elastic force were greater than the leveling force of the arch wire, there was tendency for anterior teeth to tip and rotate distally, and increasing the curve of spee, deepening the bite. This phenomenon is known as ROLLER COASTER.This was particularly evident in first premolar extraction cases.

This ROLLER COASTER effect is minimized by Andrews and later by ROTH.They introduce features into the bracket system to prevent unwanted changes.Extra torque was built into incisor bracket Anti tip, antirotation features built into canine, premolar and molar brackets.Power arms were added to some brackets to bring the forces closer to the centre of resistance of each tooth.

BENNET and MC LAUGHLIN took a different root, They introduce lace backs to reduce or minimize this side effects. The lace backs are constructed by 0.009 (or) 0.0010 ligature wires and tied in figure of eight fashion. They extend from the most distally banded molars to the canine in all quardrants and have proven effective in controlling the canine during leveling and aligning.The lace back prevent the cuspids from the tipping forward and can also be used for distalizing (or ) retracting the canines.

WALKING CANINES

BEND BACKS Bending the arch wire immediately behind the most distally banded posterior tooth is called chinching. It serves to minimize forward tipping of incisors.

IN SUMMERY The primary methods of anterior anchorage control during leveling and aligning include:Using lace backs to minimize the forward tipping of the canines and effectively retract them when indicated.Using bend backs to minimize forward tipping of incisors.

ANCHORAGE CONTROL IN THE UPPER POSTERIOR SEGMENTIn certain cases it may be necessary to limit or prevent the posterior segment from moving forward, maintain their position, (or) even distalize them.Posterior anchorage requirements normally greater upper arch than in lower arch.Because of the following reason.The upper anterior segments has longer than lower.The upper anterior brackets have greater amount of built in tip.The upper incisors require more torque control and bodily movement than lower arch.The upper molar usually move mesially more readily than the lower arch

Because of these factors, extra oral force normally the most effective way to provide posterior anchorage control in the upper arch. BENNET and MC LAUGHLIN favour a combination of head gear (occipital and cervical pull). The force levels used for combination of head gears are 150 250gms.Keeping the force directed slightly above the occulusal plane and minimize the tendency for vertical extrusion of the upper posterior teeth, while simultaneously allowing effective distalization of molar.

The length of the outer bow of the head gear is important to avoid unwanted molar tipping.

A secondary method of anchorage support in the upper posterior segments is palatal bar. This is normally placed when the upper molars has been properly rotated and or situated c-1 molar relation. The palatal bar can be constructed of heavy .045 (or) .051 round wire, extending from molar to molar with a loop placed in the middle of the palate and the arch wire above (2mm) from the roof of the palate and its soldered to the molar hook.

ANCHORAGE CONTROL OF POSTERIOR SEGMENTS IN LOWER ARCHWhen extra anchorage support is needed in the lower posterior segments, we can use Lingual archC-111 elastics Lip bumper

ANCHORAGE CONTROL IN VERTICAL PLANEThere are two important areas of anchorage control in the vertical plane Incisor control In PEA produce a transitional deepening of anterior over bike during leveling and aligning.Mainly due to tip of the canine brackets. If canines are tipped distally, the mesial aspect of the canine bracket slot. Directed in the occlusal direction.

This effects avoided either by not initially bracketing the incisor (or) by not tying the arch wire into the incisor bracket, until the canine roots have been uprighted and moved distally under control of lace back.

It is important to avoid early arch wire engagement of high label canines. So that unwanted vertical movements of lateral incisors and premolar does not occur.

MOLAR VERTICAL CONTROL The following methods of vertical molar control can be considered when treating higher angle cases.Early banding of the second molar is to be avoided if banded, the tube has to be positioned more occulusally to prevent extrusion If the upper first molar require expansion, an attempt is made to achieve bodily movement rather than tipping, to avoid extrusion of palatal cusps. It is accomplished by fixed expanded.

3. If palatal bars are used, they are designed to lie away from the palate by approximately 2mm. So that the tongue can exert a vertical intrusive effect on these teeth. 4. In some cases upper and lower posterior by plate in the molar region is helpful to minimize extrusion of molars.

ANCHORAGE CONTROL IN THE LATERAL PLANE Anchorage control in the lateral (or) transverse plane involves the maintenance expansion procedure mainly upper arch, and to avoidance of tipping and extrusion of the posterior teeth during the expansion phase.MAINTAINING INTERCANINE WIDTH During the treatment, the intercanine width should not be altered to a great extent.Expansion of the arches should be controlled to prevent relapse and care should be taken to ensure that crowding is not relieved by uncontrolled expansion of the upper and lower arch.

MOLAR CROSS BITE Care should be needed to avoid arbitrary correction of molar cross bite by tipping movement This allows extrusion of palatal cusp and unwanted opening of the mandibular plane angle in the treatment of high angle cases.

Whenever possible molar cross by should be corrected by bodily movement.Minimal molar cross bite can be corrected effectively by expanding the arch wire.

SPECIAL PROBLEMS DURING LEVELING AND ALIGNING Deep overbite correction Cross bite correction Rotation Deep Overbite Moderate deep bite cases get corrected as a result of routine leveling and aligning procedure.Severe deep bite cases require different corrective procedure. Types of Deep Overbite True deep overbite Pseudo deep overbite

True deep bites is mostly due to infra eruption of the posterior teeth.Pseudo deep bite due to supra eruption of anterior teeth. Corruption of deep overbite is accomplished by various tooth movements Extrusion of posterior teeth Uprighting of posterior teethIncreasing the inclination of incisors Intrusion of anterior teeth

EXTRUSION AND UPRIGHTING OF POSTERIOR TEETH This method is indicated in A patient with horizontal growth pattern Growing individuals True deep overbite casesThis method is accomplished by Anterior bite plane- which allows the posterior teeth to supra erupt thereby opening of the bite

Including second molar arch set up Engaging arch wires with an exaggerated curve of spee in the upper and reverse curve of spee in the lower.

INCREASE THE INCLINATION OF ANTERIORSThis procedure should be employed in the patient who has normal skeletal pattern but dentally retroclined (or) crowded anteriors.This can be achieved in PEA by not giving either lace back or bend back.

INTRUSION OF ANTERIOR TEETH Indicated in Vertical skeletal growth pattern Pseudo overbite This is accomplished by Utility arches Burstones segmental arch mechanicsUtility arches The utility arch has multiple uses in various orthodontic treatment.This auxiliary arch wire was developed according to the biomechanical principles described by Burstone and refined by Ricketts for bioprogressive therapy

When a round wire with a reverse curve of spee is engaged in the lower arch to level the curve or spee, it produces mild distal tipping uprighting of the molars, extrusion of the premolars and flaring of the incisors.

In order to restrict this unwanted tooth movements true intrusion of the incisors is required.

Blue elgiloy of 0.016 x or 0.016 or 0.016 x 0.022 dimension in an 0.022 slot is material for fabrication of utility arches.

Utility arch can even be made with 0.014 or 0.018 round wires.

SALIENT FEATURES OF UTILITY ARCH

TYPES OF UTILITY ARCHES Passive utility arch Intrusion utility arch Retrusion utility archProtrusion utility arch Passive utility arch It can be used for stabilization (or) as a space maintainer.It is ideal in the mixed dentition as it permits the eruption of canine and premolars

Intrusion utility arch Retrusion utility arch Protrusion utility arch

TIPBACK SPRINGS (INTRUSION SPRINGS)Originally proposed by Burstone, these springs are made of 0.017 x 0.025 TMA wire. The springs are indicated in Growing patient with forward growth rotation. Very deep curve of spee in the lower arch.Pseudo deep bite cases.

THREE PIECE INTRUSION ARCH This consist of following parts :Posterior anchorage unit The anterior segment with posterior extensionIntrusion cantilevers

ROTATION CORRECTION It is defined as perversion of the tooth around its long axis or any parallel axis.Correction of bilateral molar rotations To correct bilaterally rotated molars (mesial-in, distal out rotation) two equal and opposite moments are applied to the molars.

An alternate way to obtained equal and opposite moments to derotate molars is to use a high pull head gear with an occlusal insertion of the inner bow in the buccal tubes on the molar bands. The force of high pull head gear is directed through the center of resistance of maxillary first molar. The distal force applied through the buccal tube of the molars buccal to the center of resistance and creates a moment that tends to rotate the molars mesial out.

CORRECTION OF UNILATERAL MOLAR ROTATION Unilateral activation is incorporated into the horizontal tab of the transpalatal arch..The opposite molar will experience a tip back moment.If such side effects or not desirable, it is necessary to place 0.017 x 0.025 ss wire from right maxillary molar to the left second premolar for anchorage purpose.

CROSS BITE CORRECTION It is defined as cross bite as an abnormal buccal, labial or lingual relationship of a tooth or teeth of maxilla, the mandible, or both, when the arches are in occlusion. It is corrected byTranspalatal arch Quad-helix Cross elastics Heavy labial expansion arch Expansion screws to move one or two teeth pendulum appliance with screw