Self-ligating brackets increase treatment efficiency

Deflection of tandem archwire in a specific self-ligating metal bracket system: an in vitro study

The aim of this study was to quantify the force exerted by tandem archwires in a specific system of passive self-ligating bracket. Forty-eight thermo-activated nickel-titanium orthodontic archwires were separated into four groups (n = 12): G1 - two .014" + .014" round archwires; G2 - two .014" + .016" round archwires; G3 - .014" x .025" rectangular archwire; and. G4 - .016" x .022" rectangular archwire. Brackets were fixed onto teeth 1.5 to 2.5 using a device that represented the upper teeth, maintaining an interbracket distance of 6.0 mm. The deflection tests were performed using the structure representative of tooth 1.1 as support on the Instron testing machine at a speed of 2.0 mm/min. The archwires were evaluated at deflections of 0.5 mm, 1.0 mm, and 1.5 mm. The data were analyzed by a generalized linear model, considering values at different deflections as repeated measurements in the same experimental unit (α = 0.5%). At 0.5 mm, higher forces were observed in G2 and G3, which did not differ significantly (p > 0.05). The lowest force was observed in G4 (p < 0.05). At 1.0 mm and 1.5 mm, the highest force was observed in G3, followed by G4 and G2 (p < 0.05). The lowest force was observed in G1 (p < 0.05). In general, tandem archwires (same or different calibers) in a specific passive self-ligating bracket exerted lower force when compared with rectangular archwires.

An in vivo and in vitro study on the force degradation and surface morphology of the orthodontic elastic ligatures

INTRODUCTION

The objective of this study was to investigate the characteristics of force degradation and surface morphology of 9 brands of elastic ligatures over 6 weeks, both in vivo and in vitro, to provide some reference for clinical selection of appropriate elastic ligatures and determination of appropriate follow-up visit time.

METHODS

Choosing 9 kinds of brands of elastic ligatures (American Orthodontics, Ormco, 3M Grey, TP Orthodontics, Xihu, Yahong, Creative, Protect, 3M dusty blue), which are common in the market. For the in vivo study, 9 volunteers (5 males, 4 females, aged 22-26 years) were chosen to wear elastic ligature fixators, which were made to fix the elastic ligature in the mouth without bonding brackets on the teeth. The residual force and percentage of force degradation of elastic ligatures were estimated after 0, 1 hour, 2 hours, 8 hours, 1 day, 2 days, 1 week, 2 weeks, 4 weeks, and 6 weeks processed in vivo and in vitro (25°C dry air condition, 37°C artificial saliva, pH = 6.7 and oral environment); A 1-way analysis of variance and t test were used to identify statistical significance (P <0.05). The surface morphology of the initial state and after a 6-week process in vivo and in vitro were observed separately.

RESULTS

The characteristics of force degradation and surface morphology of 9 brands of elastic ligatures were different over 6 weeks; With the extension of time, the tensile force declined, and the percentage of force degradation of all groups decreased sharply by about 9.1%-32.3% in the first day, then the rate reduced steadily. In addition, during the first day, the percentage of force degradation declined most sharply in the first hour (4.4%-16.5%). The percentage of force degradation of 9 elastic ligatures was reduced by about 11.3%-37.3% over 6 weeks in all groups. At the same time, the characteristics of force degradation in the same brand are that in vivo > artificial saliva > air (P <0.05). After a 6-week process, the surface morphologic defects were aggravated under a scanning electron microscope, corresponding to the change of mechanical properties in each brand.

CONCLUSIONS

The mechanical properties of elastic ligatures are reduced with time extension and decreased greater in vivo than in vitro; According to the characteristics of force degradation of different brands of elastic ligatures, clinicians can choose the proper elastic ligatures at different stages of treatment, and adjust the follow-up visit time appropriately. For example, in alignment and leveling, the elastic ligatures with slow force degradation, such as Ormco, TP, and so on, maybe more suitable to ensure close contact between the archwire and the bracket. In the space-closing stage, the elastic ligatures with fast force degradation may be more appropriate to reduce the friction between the archwire and the bracket, such as 3M Grey, Yahong, Protect, and so on.

Reducing Friction in Orthodontic Brackets: A Matter of Material or Type of Ligation Selection? In-Vitro Comparative Study

(1) Background: Orthodontic appliances have changed and improved with the increasing demand for orthodontic treatment of the general population. Patients desire for shorter orthodontic treatments and for the wearing of more aesthetic devices has led to the technological development of orthodontic brackets; these were manufactured from aesthetic materials (ceramics, composite polymers) and presented different designs regarding the way archwires are ligated to the bracket. The aim of this study was to determine whether there were any differences between the static frictional forces generated by stainless steel (metallic) and polycrystalline alumina (ceramics) conventional and self-ligating brackets. (2) Methods: Static friction assessment was carried out in vitro with a universal testing machine, HV-500N-S (Schmidt Control Instruments, Hans Schmidt & Co. GmbH), intended for measuring compression and traction forces. (3) Results: The study revealed significant differences in static frictional forces at the bracket-archwire interface between the tested brackets. Stainless steel brackets produced lower static friction forces than polycrystalline alumina and self-ligating brackets generally produced lower static frictional forces than conventional brackets. The reduction of frictional forces was noticeable in the first stages of treatment, when thin, flexible orthodontic archwires (0.016” NiTi) are used. Engaged with large rectangular stainless steel archwires, (0.019 × 0.025” SS), the frictional forces produced by conventional and self-ligating metal brackets were similar, no significant differences being observed between the two types of metallic design. However, in the case of tested ceramic brackets, the results showed that the self-ligating type allows a reduction in frictional forces even in advanced stages of treatment compared to conventionally ligation. (4) Conclusions: From the perspective of an orthodontic system with low frictional forces, metal brackets are preferable to aesthetic ones, and self-ligating ceramic brackets are preferable to conventional ceramic brackets.

Concentration of dentin sialoprotein at the initial stage of orthodontic treatment using self-ligating and conventional preadjusted brackets: A pilot study

OBJECTIVES:

This study evaluated differences in concentration of dentin sialoprotein (DSP) in gingival crevicular fluid (GCF) relating to orthodontically induced inflammatory root resorption (OIIRR) at the initial stage of orthodontic treatment using self-ligating and conventional preadjusted brackets.

MATERIALS AND METHODS:

Eighteen patients were assigned to three groups of equal size. Two experimental groups received non-extraction orthodontic treatment using passive self-ligating or conventional preadjusted bracket. The control group included patients without orthodontic treatment. GCF was collected from five proximal sites of maxillary anterior teeth at subsequent intervals: immediately prior to orthodontic treatment (T0), and at three and 12 weeks after initiation of treatment (T1 and T2). DSP concentration was evaluated by enzyme-linked immunoabsorbent assay and the differences in DSP levels were analyzed between and within groups.

RESULTS:

There were no significant differences in DSP levels within both experimental groups and the control group during T0-T1-T2 (P ≥ 0.05). A significant difference of DSP concentration was found between the conventional preadjusted bracket and the control group at T2 (P = 0.038). However, it was thought to be clinically insignificant.

CONCLUSION:

The study showed no significant difference in DSP concentration at the initial stage of orthodontic treatment with either self-ligating or conventional preadjusted bracket.

Friction evaluation of an elastic chain positioned under or over the wire in self-ligating brackets

Objectives:

This study aimed to evaluate the frictional resistance produced by active and passive self-ligating brackets on stainless steel archwires in the absence or presence of elastomeric chains under or over the wire.

Materials and Methods:

Four types of self-ligating brackets were used: Two active and two passive. For each commercial brand, five brackets were bonded to an acrylic plate and the frictional resistance was evaluated with 0.018” and 0.019” × 0.025” stainless steel wires in three situations: Without elastomeric chain, with elastomeric chain placed under and over the wire.

Results:

The bracket type, cross-section of the wire, and type of ligation had significant interactions with each other; the frictional resistance was significantly lower with the use of passive self-ligated brackets, while no difference was found when a 0.018” wire was tested. Moreover, the frictional resistance in the absence of an elastomeric chain, or when the chain was under the wire, was significantly lower in comparison with the values obtained when the chain was placed on the wire.

Conclusion:

Frictional resistance of passive and active self-ligated brackets is influenced by the ligation methods and the cross-sectioning of archwires.

Does observational study on the effectiveness of the Twin Blocks overestimate or underestimate the results? A comparative analysis of retrospective samples versus randomized controlled trial

BACKGROUND AND OBJECTIVES

Class II malocclusion is one of the most common orthodontic problems. The Twin Block appliance has proven to be the most popular appliance for the correction of these malocclusions. Although randomized controlled trials (RCTs) on the Twin Block appliance have reported the changes to be mainly dentoalveolar, several nonrandomized studies have reported a significant skeletal improvement in these patients. Hence, the aim of this study was to compare the effectiveness of Twin Block appliance evaluated using an RCT or retrospectively selected cases (RSC) for the treatment of Class II Division 1 malocclusion in an adolescent population.

METHODS

This was a retrospective study. The results for an RCT were selected from a UK Class II multicenter study. Sixty-three patients from the trial were included. This group was matched with retrospectively selected Class II cases treated with a Twin Block functional appliance and their results submitted for Membership in Orthodontics examination in the United Kingdom, from four centers. The primary outcome was skeletal measurement ANB (A point, nasion, B point). Secondary outcomes included final peer assessment rating (PAR) scores and final overjet. Intrarater reliability of measurements was assessed. Independent samples t-test was carried out to look at the difference between the groups.

RESULTS

The reliability assessment showed excellent agreement for all measurements. The data were normally distributed. There was a statistically significant difference favoring the RSC group for final overjet (mean difference [MD] = 1.068, 95% confidence interval [CI] -0.67 to 1.47, P = 0.000) and final PAR (MD = 4.0, 95% CI -0.79 to 5.5, P = 0.000). There was no significant difference in the scores for final ANB (MD = 0.34, 95% CI -0.39 to 1.07, P = 0.33).

CONCLUSION

The RSCs show significantly improved overjet and PAR scores at the end of treatment and no statistically significant difference for skeletal change. The study raises the question of a potential role of observational studies in evaluating the effect of an intervention in orthodontics.

Cytokine profile changes in gingival crevicular fluid after placement different brackets types

OBJECTIVE

The aim of this study was to examine the relationship between bracket design and ratio of five proinflammatory cytokine, in gingival crevicular fluid (GCF), and bacterial adhesion without tooth movement influence.

DESIGN

The sample was comprised of 20 participants, aged 11 to 15 years old (mean age: 13.3 years±1.03). A conventional Gemini™ metallic bracket and two self-ligating brackets, In-Ovation^®R and SmartClip™, were bonded to the maxillary incisors and canines. GCF was collected using a standard filter paper strip before and 60days after bonding. The cytokine levels (IL-12, IL-1α, IL-1β, IL-6 and TNF-α) were performed by the LUMINEX assay. The levels of the red and orange bacterial complexes were analyzed by the Checkerboard DNA-DNA hybridization. The data of cytokine and bacterial complexes were carried out using the non-parametric tests at 5% of significance level.

RESULTS

Increased cytokine levels were observed. However, only the SmartClip™ group showed a significantly increased level of TNF-α (p=0.046). The SmartClip™ brackets group presented higher levels of red complex bacteria.

CONCLUSIONS

The bracket design affected cytokine levels and bacterial adhesion since it was observed that the proinflammatory cytokines released in GCF to the SmartClip™ group showed an increase in the TNF-α levels associated with higher bacterial levels, which possibly represents greater inflammatory potential. Thereby, the bracket design should be considered in patients with risk of periodontal disease and root resorption.

Comparison of the force levels among labial and lingual self-ligating and conventional brackets in simulated misaligned teeth

Background/objective

The aim of this study was to evaluate force levels exerted by levelling arch wires with labial and lingual conventional and self-ligating brackets.

Materials/methods

The tested orthodontic brackets were of the 0.022-in slot size for labial and 0.018-in for lingual brackets and were as follows: 1. Labial brackets: (i) conventional bracket (GAC-Twin, Dentsply), (ii) passive self-ligating (SL) brackets (Damon-Q®, ORMCO; Ortho classic H4™, Orthoclassic; FLI®SL, Rocky Mountain Orthodontics) and (iii) active SL brackets (GAC In-Ovation®C, DENTSPLY and SPEED™, Strite). 2. Lingual brackets: (i) conventional brackets (Incognito, 3M and Joy™, Adenta); (ii) passive SL bracket (GAC In-Ovation®LM™, Dentsply and (iii) active SL bracket (Evolution SLT, Adenta). Thermalloy-NiTi 0.013-in and 0.014-in arch wires (Rocky Mountain Orthodontics) were used with all brackets. The simulated malocclusion represented a maxillary central incisor displaced 2 mm gingivally (x-axis) and 2 mm labially (z-axis).

Results

Lingual bracket systems showed higher force levels (2.4 ± 0.2 to 3.8 ± 0.2 N) compared to labial bracket systems (from 1.1 ± 0.1 to 2.2 ± 0.4 N). However, the differences between SL and conventional bracket systems were minor and not consistent (labial brackets: 1.2 ± 0.1 N for the GAC Twin and 1.1 ± 0.1 to 1.6 ± 0.1 N for the SL brackets with 0.013-in thermalloy; lingual brackets: 2.5 ± 0.2 to 3.5 ± 0.1 N for the conventional and 2.7 ± 0.3 to 3.4 ± 0.1 N for the SL brackets with 0.013-in Thermalloy).

Limitations

This is an in vitro study with different slot sizes in the labial and lingual bracket systems, results should be interpreted with caution.

Conclusions/implications

Lingual bracket systems showed higher forces compared to labial bracket systems that might be of clinical concern. We recommend highly flexible nickel titanium arch wires lower than 0.013-in for the initial levelling and alignment especially with lingual appliances.

Dimensional accuracy of ceramic self-ligating brackets and estimates of theoretical torsional play

OBJECTIVE

To ascertain the dimensional accuracies of some commonly used ceramic self-ligation brackets and the amount of torsional play in various bracket-archwire combinations.

MATERIALS AND METHODS

Four types of 0.022-inch slot ceramic self-ligating brackets (upper right central incisor), three types of 0.018-inch ceramic self-ligating brackets (upper right central incisor), and three types of rectangular archwires (0.016 × 0.022-inch beta-titanium [TMA] (Ormco, Orange, Calif), 0.016 × 0.022-inch stainless steel [SS] (Ortho Technology, Tampa, Fla), and 0.019 × 0.025-inch SS (Ortho Technology)) were measured using a stereomicroscope to determine slot widths and wire cross-sectional dimensions. The mean acquired dimensions of the brackets and wires were applied to an equation devised by Meling to estimate torsional play angle (γ).

RESULTS

In all bracket systems, the slot tops were significantly wider than the slot bases (P < .001), yielding a divergent slot profile. Clarity-SLs (3M Unitek, Monrovia, Calif) showed the greatest divergence among the 0.022-inch brackets, and Clippy-Cs (Tomy, Futaba, Fukushima, Japan) among the 0.018-inch brackets. The Damon Clear (Ormco) bracket had the smallest dimensional error (0.542%), whereas the 0.022-inch Empower Clear (American Orthodontics, Sheboygan, Wis) bracket had the largest (3.585%).

CONCLUSIONS

The largest amount of theoretical play is observed using the Empower Clear (American Orthodontics) 0.022-inch bracket combined with the 0.016 × 0.022-inch TMA wire (Ormco), whereas the least amount occurs using the 0.018 Clippy-C (Tomy) combined with 0.016 × 0.022-inch SS wire (Ortho Technology).

From conventional to self-ligating bracket systems: is it possible to aggregate the experience with the former to the use of the latter?

Introduction

Orthodontics, just as any other science, has undergone advances in technology that aim at improving treatment efficacy with a view to reducing treatment time, providing patients with comfort, and achieving the expected, yet hardly attained long-term stability. The current advances in orthodontic technology seem to represent a period of transition between conventional brackets (with elastic ligatures) and self-ligating brackets systems. Scientific evidence does not always confirm the clear clinical advantages of the self-ligating system, particularly with regard to reduced time required for alignment and leveling (a relatively simple protocol), greater comfort for patients, and higher chances of performing treatment without extractions - even though the number of extractions is more closely related to patient's facial morphological pattern, regardless of the technique of choice. Orthodontics has recently and brilliantly used bracket individualization in compensatory treatment with a view to improving treatment efficacy with lower biological costs and reduced treatment time.

Objective

This paper aims at presenting a well-defined protocol employed to produce a better treatment performance during this period of technological transition. It explores the advantages of each system, particularly with regards to reduced treatment time and increased compensatory tooth movement in adult patients. It particularly addresses compensable Class III malocclusions, comparing the system of self-ligating brackets, with which greater expansive and protrusive tooth movement (maxillary arch) is expected, with conventional brackets Capelozza Prescription III, with which maintaining the original form of the arch (mandibular arch) with as little changes as possible is key to yield the desired results.

Mandibular changes during initial alignment with SmartClip self-ligating and conventional brackets: A single-center prospective randomized controlled clinical trial

Objective

To test the null hypothesis that SmartClip self-ligating brackets are more effective than conventional brackets for initial mandibular alignment and identify influential factors.

Methods

Fifty patients were randomly allocated to two equal treatment groups by using an online randomization program: self-ligating group (SmartClip brackets) and conventional group (Gemini brackets). The archwire sequence was standardized. Changes in anterior irregularity index, intercanine width, and intermolar width were assessed on plaster models at 8th and 16th weeks. Changes in incisor position and inclination were assessed on lateral cephalometric radiographs at 16 weeks. Intragroup and intergroup comparisons were performed with paired t-test and Student's t-test, respectively. Multiple linear regression was performed to identify variables affecting improvement in anterior ambiguity.

Results

Data of 46 patients were analyzed; those missing an appointment (n = 2) or showing bracket breakage (n = 2) were excluded. Incisor inclination (p < 0.05), intercanine width (p < 0.05), and intermolar width (p > 0.05) increased at 8 and 16 weeks in both the groups; no significant intergroup differences were noted (p > 0.05). Initial anterior irregularity index and intercanine width change were significantly associated with improvement in anterior irregularity (p < 0.001).

Conclusions

The null hypothesis was rejected. Bracket type has little effect on improvement in anterior ambiguity during initial mandibular alignment.

Effects of third-order torque on frictional force of self-ligating brackets

OBJECTIVE

To investigate the effects of third-order torque on frictional properties of self-ligating brackets (SLBs).

MATERIALS AND METHODS

Three SLBs (two passive and one active) and three archwires (0.016 × 0.022-inch nickel-titanium, and 0.017 × 0.025-inch and 0.019 × 0.025-inch stainless steel) were used. Static friction was measured by drawing archwires though bracket slots with four torque levels (0°, 10°, 20°, 30°), using a mechanical testing machine (n  =  10). A conventional stainless-steel bracket was used for comparison. RESULTS were subjected to Kruskal-Wallis and Mann-Whitney U-tests. Contact between the bracket and wire was studied using a scanning electron microscope.

RESULTS

In most bracket-wire combinations, increasing the torque produced a significant increase in static friction. Most SLB-wire combinations at all torques produced less friction than that from the conventional bracket. Active-type SLB-wire combinations showed higher friction than that from passive-type SLB-wire combinations in most conditions. When increasing the torque, more contact between the wall of a bracket slot and the edge of a wire was observed for all bracket types.

CONCLUSIONS

Increasing torque when using SLBs causes an increase in friction, since contact between the bracket slot wall and the wire edge becomes greater; the design of brackets influences static friction.