Does the transition temperature of Cu-NiTi archwires affect the amount of tooth movement during alignment?

Comparing the efficacy of heat-activated NiTi (HANT) versus conventional NiTi archwires: A systematic review and meta-analysis

OBJECTIVE

To assess the effectiveness of heat-activated NiTi (HANT) wires compared to NiTi wires during orthodontic alignment, through a systematic review and meta-analysis.

SEARCH METHODS

We comprehensively searched databases up to January 2024, including MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL, without language or date restrictions.

SELECTION CRITERIA

Clinical studies aligning with the PICO question were included, and their bias risk was evaluated using the Cochrane Risk of Bias 2.0 tool.

DATA COLLECTION AND ANALYSIS

Data were collected using custom forms, and a meta-analysis was performed using random-effects inverse variance. Primary outcome was Little's Irregularity Index (LII) changes. Secondary outcomes were pain intensity and root resorption.

RESULTS

Thirteen clinical studies were reviewed, with nine included in the meta-analysis. No significant differences were observed in LII changes during the first four months, with similar findings in the first, second and third months. In the fourth month, NiTi wires exhibited higher reductions. Pain intensity did not differ between groups on the first or the seventh day. No significant difference in root resorption was found between the two groups.

CONCLUSIONS

HANT and conventional NiTi wires showed comparable effectiveness in reducing LII, pain levels, and root resorption during the orthodontic alignment phase. While HANT wires may entail higher costs, their ease of insertion and ligation offer practical advantages. Ultimately, choosing between wire types should consider individual patient needs and clinician preferences.

Qualitative and Quantitative Evaluation of Different Types of Orthodontic Brackets and Archwires by Optical Microscopy and X-ray Fluorescence Spectroscopy

The wear behaviour and chemical composition of orthodontic components influence the mechanical characteristics of a fixed orthodontic treatment. The purpose of this paper is to evaluate the surface alterations of different types of brackets (aesthetic, metallic, and conventional self-ligating) and archwires (superelastic and thermal) subjected to wear tests through optical microscopy and, subsequently, to identify the chemical elements of accessories by X-ray fluorescence. The cycles (5000 for each bracket and 10,000 for each wire) of the tribological test were carried out in dry conditions inside a machine that allows alternating sliding. The results of the study highlighted different wear behaviours even within the same type of brackets and archwires. The monocrystalline sapphire brackets maintain their aesthetic properties despite traces of wear inside the slots and contain minimal amounts of nickel. Superelastic NiTi archwires have a better overall rating than thermal wires, as they do not show significant surface wear alterations.

Influence of different storage temperatures on the mechanical properties of NiTi, Cu-NiTi and SS orthodontic archwires: An in vitro study

OBJECTIVE

Due to their exceptional temperature sensitivity, the mechanical properties of Nickel-titanium and Copper Nickel-titanium wires may be influenced by their storage temperature. This in turn may have clinical implications and may also affect the outcomes. This study analyzed the influence of storage temperatures on the mechanical properties of orthodontic wires in a laboratory setting.

MATERIALS AND METHODS

Stainless steel (SS), Nickel-Titanium (NiTi), and three variants of Copper-NiTi (Cu-NiTi 27°C, 35°C and 40°C), 0.017×0.025 inches in size were analysed using a three-point bending test in a pre-heated chamber at 36°C. The orthodontic wires were stored for twenty-four hours before the mechanical testing at four different temperatures (5°, 22°, 36° and 60°C).

RESULTS

The obtained results showed that the mechanical forces exerted by 27°C Copper-NiTi exhibit the most stable behaviour after having been stored at different temperatures, whereas 35°C Copper-NiTi showed the highest variability. As to be expected, Stainless steel shows no changes in its bending mechanical properties.

CONCLUSION

Furthermore, the results of this investigation reflect the importance of controlling the storage temperature of orthodontic NiTi and Copper-NiTi wires tested in a research environment in order to avoid unexpected bias.

A comparative assessment of clinical efficiency between premium heat-activated copper nickel-titanium and superelastic nickel-titanium archwires during initial orthodontic alignment in adolescents: a randomized clinical trial

Background

To compare the clinical efficiency of premium heat-activated copper nickel-titanium (Tanzo Cu-NiTi) and NT3 superelastic NiTi during initial orthodontic alignment.

Subject and methods

A total of 50 patients were randomly allocated to 1 of 2 different archwire types (group 1, Tanzo Cu-NiTi; group 2, NT3 superelastic NiTi). Eligibility criteria included Class I or Class II malocclusion, moderate maxillary anterior crowding, and healthy periodontal condition. Impressions of the upper arches were taken before archwire placement (T0) and at every 4 weeks (T1, T2, T3, and T4). For T1 and T2 stages, 0.014-in., and for T3 and T4 stages, 0.018-in. archwires were used. The primary outcome was the alignment efficiency assessed using Little’s irregularity index. The secondary outcomes were arch width and incisor inclination changes. Data were analyzed using independent samples t test, repeated measures ANOVA, and Mann-Whitney U test. Marginal models were established for the estimation of coefficients.

Results

The anterior irregularity index reduction was mostly observed between T0 and T2 periods, which were respectively − 7.40 ± 0.50 mm (p < 0.001; 95% CI, − 8.94, − 5.85) and − 6.80 ± 0.55 mm (p < 0.001; 95% CI, − 8.49, − 5.12) for groups 1 and 2 (p < 0.001). With both wires, Little’s irregularity index decreased over time, and the difference between the groups was not significant (p = 0.581; estimated effect size, 0.011). No statistically significant difference was found between the groups in terms of intercanine and intermolar width and incisor inclination changes.

Conclusion

There were no significant between-group differences in alignment efficiency, arch width, and incisor inclination change. There was an increased alignment with 0.014-in. compared with 0.018-in. diameter archwire.

Effect of Clinical Use and Sterilization Process on the Transition Temperature Range of Thermally NiTi Alloys

Background:

Thermally activated nickel-titanium wires have been widely used by orthodontists due to more constant forces, generation over longer activation spans, greater resistance to permanent deformation, superelasticity characteristics when cyclically loaded, better spring-back and less hysteresis.

Objective:

The purpose of this study was to evaluate the influence of clinical use and sterilization process on the Transition Temperature Range (TTR) of thermoset nickel-titanium wires using Differential Scanning Calorimetry (DSC).

Methods:

Sections from four nickel-titanium wires (0.019 × 0.025-inch) belonging to four different brands were assessed in four different states. Two of the wires were assessed in the “as received” state, one after 60 days of clinical use, and one after 60 days of clinical use and subjected to a sterilization process (autoclaving). The segments of each archwire were tested using DSC at temperatures ranging from −80°C to 150°C at a rate of 10°C/min.

Results:

All the nickel-titanium memory thermoset wires presented with desirable property for clinical use. The shape memory property was not influenced by clinical use and sterilization process.

Conclusion:

There was no change in TTR of the nickel-titanium wires after clinical use and sterilization.

Arch Expansion Efficiency of Coaxial Tubular Superelastic Nickel-Titanium in Comparison to Single-Stranded Superelastic Nickel-Titanium While Relieving Mandibular Anterior Crowding: A Randomized Controlled Study

Aim:

The aim of the study is to compare the efficiency of six-stranded coaxial tubular superelastic nickel–titanium (NiTi) archwire and a single-stranded wire in relieving anterior mandibular crowding.

Materials and Methods:

This double-blind randomized study included 40 patients, categorized into two groups: Sentalloy round group and Speed tubular supercable group (20 each). After taking alginate impressions, the allocated archwire was engaged. With a digital caliper, intercanine, interpremolar, and intermolar width were recorded on the study models, immediately and at 4, 8, and 12 weeks stages. The Statistical Package for the Social Sciences (SPSS) version 20 was used for analysis.

Results:

The measured parameters were increased in both the groups, with the difference being insignificant statistically.

Conclusion:

Superelastic coaxial NiTi wires show better efficiency in relieving anterior crowding than single-stranded NiTi wire.

Initial arch wires used in orthodontic treatment with fixed appliances

BACKGROUND

Initial arch wires are the first arch wires to be inserted into the fixed appliance at the beginning of orthodontic treatment and are used mainly for the alignment of teeth by correcting crowding and rotations. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which wire is most efficient, as well as which wires cause least amount of root resorption and pain during the initial aligning stage of treatment. This is an update of the review entitledInitial arch wires for alignment of crooked teeth with fixed orthodontic braces, which was first published in 2010.

OBJECTIVES

To assess the effects of initial arch wires for the alignment of teeth with fixed orthodontic braces, in terms of the rate of tooth alignment, amount of root resorption accompanying tooth movement, and intensity of pain experienced by patients during the initial alignment stage of treatment.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 5 October 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 9), MEDLINE Ovid (1946 to 5 October 2017), and Embase Ovid (1980 to 5 October 2017. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of initial arch wires to align teeth with fixed orthodontic braces. We included only studies involving participants with upper or lower, or both, full arch fixed orthodontic appliances.

DATA COLLECTION AND ANALYSIS

Two review authors were responsible for study selection, 'Risk of bias' assessment and data extraction. We resolved disagreements by discussion between the review authors. We contacted corresponding authors of included studies to obtain missing information. We assessed the quality of the evidence for each comparison and outcome as high, moderate, low or very low, according to GRADE criteria.

MAIN RESULTS

For this update, we found three new RCTs (228 participants), bringing the total to 12 RCTs with 799 participants. We judged three studies to be at high risk of bias, and three to be at low risk of bias; six were unclear. None of the studies reported the adverse outcome of root resorption. The review assessed six comparisons.1. Multistrand stainless steel versus superelastic nickel-titanium (NiTi) arch wires. There were five studies in this group and it was appropriate to undertake a meta-analysis of two of them. There is insufficient evidence from these studies to determine whether there is a difference in rate of alignment between multistrand stainless steel and superelastic NiTi arch wires (mean difference (MD) -7.5 mm per month, 95% confidence interval (CI) -26.27 to 11.27; 1 study, 48 participants; low-quality evidence). The findings for pain at day 1 as measured on a 100 mm visual analogue scale suggested that there was no meaningful difference between the interventions (MD -2.68 mm, 95% CI -6.75 to 1.38; 2 studies, 127 participants; moderate-quality evidence).2. Multistrand stainless steel versus thermoelastic NiTi arch wires. There were two studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from the studies to determine whether there is a difference in rate of alignment between multistrand stainless steel and thermoelastic NiTi arch wires (low-quality evidence). Pain was not measured.3. Conventional NiTi versus superelastic NiTi arch wires. There were three studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is any difference between conventional and superelastic NiTi arch wires with regard to either alignment or pain (low- to very low-quality evidence).4. Conventional NiTi versus thermoelastic NiTi arch wires. There were two studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is a difference in alignment between conventional and thermoelastic NiTi arch wires (low-quality evidence). Pain was not measured.5. Single-strand superelastic NiTi versus coaxial superelastic NiTi arch wires. There was only one study (24 participants) in this group. There is moderate-quality evidence that coaxial superelastic NiTi can produce greater tooth movement over 12 weeks (MD -6.76 mm, 95% CI -7.98 to -5.55). Pain was not measured.6. Superelastic NiTi versus thermoelastic NiTi arch wires. There were three studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is a difference in alignment or pain between superelastic and thermoelastic NiTi arch wires (low-quality evidence).

AUTHORS' CONCLUSIONS

Moderate-quality evidence shows that arch wires of coaxial superelastic nickel-titanium (NiTi) can produce greater tooth movement over 12 weeks than arch wires made of single-strand superelastic NiTi. Moderate-quality evidence also suggests there may be no difference in pain at day 1 between multistrand stainless steel arch wires and superelastic NiTi arch wires. Other than these findings, there is insufficient evidence to determine whether any particular arch wire material is superior to any other in terms of alignment rate, time to alignment, pain and root resorption.

Comparative Evaluation of Load-deflection Property of Different Brands of Nickel-titanium Archwires

Context

The tooth alignment and leveling constitute the preliminary clinical phase of any orthodontic procedure with fixed appliances. It has been accepted in orthodontics the principle that light and continuous forces would be desirable for physiologic and controlled tooth movement. For this purpose, it has been suggested that nickel-titanium (NiTi) archwires which offer a force-bending curve with a defined baseline and a larger activation range should be used

Aims

The aim of this study was to evaluate and compare the force versus deflection properties of different brands of NiTi wires available in market.

Settings and Design

Null hypothesis. There is no difference in force-deflection properties between different brands of same dimension NiTi archwires available in market. A cross-sectional study design was planned.

Subjects and Methods

Different companies were identified producing their own version or marketing NiTi archwires of the following sizes: 0.016 inch round and 0.016 × 0.022 inch rectangular were selected because all companies produced or marketed these particular sizes, and in addition, these were selected because these wire sizes are commonly used clinically. The three-point bend test was utilized to test the various wires in accordance with the ISO 15841 standard for orthodontic wires with the exception that the bottom support span was 16 mm rather than 10 mm due to fixture limitations.

Statistical Analysis Used

Data obtained from different brands of wires available in the Indian market Ormco, American Orthodontics, Ortho Organizers, Rocky Mountain Orthodontics 3M and MO which are manufactured in U.S.A, While as Natural, Orthomatix, JJ Orthodontics, Koden, Gdc, Rabbit force, and Optima are manufactered in china. and size 0.016 inch round wire and 0.16x0.022 inch rectangular wires were compared using ANOVA test. Statistical analysis was performed using SPSS 2.1.

Results

In this study, the data show that minimum force during activation of 0.016 inch round wire at 1 mm was 95 ± 10 g whereas maximum was 165 ± 10 g with a difference of 70 ± 20 g. Whereas at 3 mm activation, minimum force generated was 150 ± 10 g and maximum was 225 ± 10 g with a difference of 75 ± 20 g. In 0.016 × 0.022 inch rectangular wire, minimum activation force at 1 mm deflection was 210 ± 10, whereas maximum was 340 ± 10 with a difference of 130 ± 20 g. For deactivation, the minimum force for 0.016 wire at 1 mm deflection was 40 ± 10, whereas maximum force was 125 ± 10 with a difference of 85 ± 20 g, and for the 0.016 × 0.022 wire, the minimum load at 1 mm deflection was 150 ± 10 g, whereas the maximum was 295 ± 10 g with a difference of 145 ± 20 g. The deactivation force in majority of brands (8) at 1 mm deflection was <80 g whereas at 3 mm, majority brands have force levels >150–195 g. The deactivation force at 3 mm deflection in five brands was between 235 and 335 and five other brands between 335 and 445 whereas at 1 mm, deflection majority of brands was between 170 and 200 g.

Conclusion

From this data, a comparative evaluation shows that there is a huge difference in force-deflection properties of same dimension wire from different brands, which means that its making the orthodontic treatment more indeterminate; some wires have shown less and some have shown more force. Wires of the same materials, dimensions, but from different manufacturers do not always have the same mechanical properties. There are significant differences in the activation and deactivation forces among the different manufacturers of NiTi archwires. Improvements should be made in the standardization of the manufacturing testing process of NiTi archwires to provide orthodontists with NiTi archwires that have consistent mechanical properties despite the manufacturing brand that produces them.

Evaluation of the alignment efficiency of nickel-titanium and copper-nickel-titanium archwires in patients undergoing orthodontic treatment over a 12-week period: A single-center, randomized controlled clinical trial

Objective

The aim of this trial was to compare the alignment efficiency and intermaxillary arch dimension changes of nickel-titanium (NiTi) or copper-nickel-titanium (CuNiTi) round archwires with increasing diameters applied sequentially to the mandibular arch.

Methods

The initial alignment phase of fixed orthodontic treatment with NiTi or CuNiTi round archwires was studied in a randomly allocated sample of 66 patients. The NiTi group comprised 26 women, 10 men, and the CuNiTi (27℃) group comprised 20 women, 10 men. The eligibility criteria were as follows: anterior mandibular crowding of minimum 6 mm according to Little's Irregularity Index (LII), treatment requiring no extraction of premolars, 12 to 18 years of age, permanent dentition, skeletal and dental Class I malocclusion. The main outcome measure was the alignment of the mandibular anterior dentition; the secondary outcome measure was the change in mandibular dental arch dimensions during 12 weeks. Simple randomization (allocation ratio 1:1) was used in this single-blind study. LII and mandibular arch dimensions were measured on three-dimensional digital dental models at 2-week intervals.

Results

No statistically significant difference was observed between NiTi and CuNiTi according to LII (p > 0.05). Intercanine and intermolar arch perimeters increased in the CuNiTi group (p < 0.001). Inter-first premolar width showed a statistically significant interaction in week × diameter × application (p < 0.05).

Conclusions

The effects of NiTi and CuNiTi round archwires were similar in terms of their alignment efficiency. However, the intercanine and intermolar arch perimeters, and the inter-first premolar width changes differed between groups.

Mechanical properties of NiTi and CuNiTi shape-memory wires used in orthodontic treatment. Part 1: stress-strain tests

OBJECTIVE

This research aimed to compare, through traction tests, eight types of superelastic and heat-activated NiTi archwires, by six trade companies (GAC, TP, Ormco, Masel, Morelli and Unitek) to those with addition of copper (CuNiTi 27°C and 35°C, Ormco).

METHODS

The tests were performed in an EMIC mechanical testing machine, model DL10000, capacity of 10 tons, at the Military Institute of Engineering (IME).

RESULTS

The results showed that, generally, heat-activated NiTi archwires presented slighter deactivation loadings in relation to the superelastic ones. Among the archwires that presented deactivation loadings biologically more adequate are the heat-activated by GAC and by Unitek. Among the superelastic NiTi, the CuNiTi 27°C by Ormco were the ones that presented slighter deactivation loadings, being statistically (ANOVA) similar to the ones presented by the heat-activated NiTi archwires from Unitek. When compared the CuNiTi 27°C and 35°C archwires, it was observed that the 27°C presented deactivation forces of, nearly, ⅓ of the presented by the 35°C.

CONCLUSIONS

It was concluded that the CuNiTi 35°C archwires presented deactivation loadings biologically less favorable in relation to the other heat-activated NiTi archwires, associated to lower percentage of deformation, on the constant baselines of deactivation, showing less adequate mechanical behavior under traction, in relation to the other archwires.

A systematic review and meta-analysis of experimental clinical evidence on initial aligning archwires and archwire sequences

The aim of the study was to assess treatment effects and potential side effects of different archwires used on patients receiving orthodontic therapy. Electronic and manual unrestricted searches were conducted in 19 databases including MEDLINE, Cochrane Library, and Google Scholar until April 2012 to identify randomized controlled trials (RCTs) and quasi-RCTs. After duplicate study selection, data extraction, risk of bias assessment with the Cochrane risk of bias tool, and narrative analysis, mean differences (MDs) with confidence intervals (CIs) of similar studies were pooled using a random-effects model and evaluated with GRADE. A total of 16 RCTs were included assessing different archwire characteristics on 1108 patients. Regarding initial archwires, meta-analysis of two trials found slightly greater irregularity correction with an austenitic-active nickel-titanium (NiTi) compared with an martensitic-stabilized NiTi archwire (corresponding to MD: 1.11 mm, 95% CI: -0.38 to 2.61). Regarding archwire sequences, meta-analysis of two trials found it took patient treated with a sequence of martensitic-active copper-nickel-titanium (CuNiTi) slightly longer to reach the working archwire (MD: 0.54 months, 95% CI: -0.87 to 1.95) compared with a martensitic-stabilized NiTi sequence. However, patients treated with a sequence of martensitic-active CuNiTi archwires reported general greater pain intensity on the Likert scale 4 h and 1 day after placement of each archwire, compared with a martensitic-stabilized NiTi sequence. Although confidence in effect estimates ranged from moderate to high, meta-analyses could be performed only for limited comparisons, while inconsistency might pose a threat to some of them. At this point, there is insufficient data to make recommendations about the majority of initial archwires or for a specific archwire sequence.

Initial arch wires for tooth alignment during orthodontic treatment with fixed appliances

BACKGROUND

Initial arch wires are the first arch wires to be inserted into the fixed appliance at the beginning of orthodontic treatment and are used mainly for the alignment of teeth by correcting crowding and rotations. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which wire is most efficient, as well as which wires cause the least amount of root resorption and pain during the initial aligning stage of treatment. This is an update of the review 'Initial arch wires for alignment of crooked teeth with fixed orthodontic braces' first published in the Cochrane Database of Systematic Reviews 2010, Issue 4.

OBJECTIVES

To assess the effects of initial arch wires for alignment of teeth with fixed orthodontic braces in relation to alignment speed, root resorption and pain intensity.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 2 August 2012), CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE via OVID (1950 to 2 August 2012) and EMBASE via OVID (1980 to 2 August 2012). We also searched the reference lists of relevant articles. There was no restriction with regard to publication status or language of publication. We contacted all authors of included studies to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of initial arch wires to align teeth with fixed orthodontic braces. Only studies involving participants with upper and/or lower full arch fixed orthodontic appliances were included.

DATA COLLECTION AND ANALYSIS

Two review authors were responsible for study selection, validity assessment and data extraction. All disagreements were resolved by discussion amongst the review team. Corresponding authors of included studies were contacted to obtain missing information.

MAIN RESULTS

Nine RCTs with 571 participants were included in this review. All trials were at high risk of bias and a number of methodological limitations were identified. All trials had at least one potentially confounding factor (such as bracket type, slot size, ligation method, extraction of teeth) which is likely to have influenced the outcome and was not controlled in the trial. None of the trials reported the important adverse outcome of root resorption.Three groups of comparisons were made.(1) Multistrand stainless steel initial arch wires compared to superelastic nickel titanium (NiTi) initial arch wires. There were four trials in this group, with different comparisons and outcomes reported at different times. No meta-analysis was possible. There is insufficient evidence from these trials to determine whether or not there is a difference in either rate of alignment or pain between stainless steel and NiTi initial arch wires.(2) Conventional (stabilised) NiTi initial arch wires compared to superelastic NiTi initial arch wires. There were two trials in this group, one reporting the outcome of alignment over 6 months and the other reporting pain over 1 week. There is insufficient evidence from these trials to determine whether or not there is any difference between conventional (stabilised) and superelastic NiTi initial arch wires with regard to either alignment or pain.(3) Single-strand superelastic NiTi initial arch wires compared to other NiTi (coaxial, copper NiTi (CuNiTi) or thermoelastic) initial arch wires. The three trials in this comparison each compared a different product against single-strand superelastic NiTi. There is very weak unreliable evidence, based on one very small study (n = 24) at high risk of bias, that coaxial superelastic NiTi may produce greater tooth movement over 12 weeks, but no information on associated pain or root resorption. This result should be interpreted with caution until further research evidence is available. There is insufficient evidence to determine whether or not there is a difference between either thermoelastic or CuNiTi and superelastic NiTi initial arch wires.

AUTHORS' CONCLUSIONS

There is no reliable evidence from the trials included in this review that any specific initial arch wire material is better or worse than another with regard to speed of alignment or pain. There is no evidence at all about the effect of initial arch wire materials on the important adverse effect of root resorption. Further well-designed and conducted, adequately-powered, RCTs are required to determine whether the performance of initial arch wire materials as demonstrated in the laboratory, makes a clinically important difference to the alignment of teeth in the initial stage of orthodontic treatment in patients.

Alignment efficiency of superelastic coaxial nickel-titanium vs superelastic single-stranded nickel-titanium in relieving mandibular anterior crowding: a randomized controlled prospective study

OBJECTIVE

To clinically evaluate the alignment efficiency of 0.016-inch coaxial superelastic nickel-titanium (NiTi) and 0.016-inch superelastic NiTi in the lower anterior region over a period of 12 weeks.

MATERIALS AND METHODS

A sample of 24 patients requiring lower anterior alignment were included in this single-center, single-operator, double-blind clinical trial and were randomly allocated into two groups of 12 patients. The type of wire selected for each patient was not disclosed to the provider or to the patient. Comparison of pretreatment characteristics of the archwire groups revealed no discrimination between two samples, thus verifying the random allocation of the intervention. An initial alginate impression of the lower arch was followed by impressions at 4-, 8-, and 12-week intervals. Casts were measured using the coordinate measuring machine to denote the degree of alignment. Duplicate readings of the cast series were taken to assess measurement variation.

RESULTS

A statistically significant difference (P < .05) in the mean values of tooth movement demonstrated the superior aligning efficiency of coaxial superelastic NiTi over single-stranded superelastic NiTi in relieving lower anterior crowding. The measurement error recorded was within acceptable limits, with range values within 95% limits of agreement.

CONCLUSION

Coaxial superelastic NiTi wire proved superior to single-stranded NiTi in its efficiency in relieving lower anterior crowding over a 12-week period.

Tooth movement - clinical implications

The tissue-based phenomena and the tissue interactions responsible for tooth displacement can be modulated by varying the intensity of the applied forces or by means of medicated molecules absorbed by the patient or prescribed by the orthodontist. However, harmful side-effects such as inflammatory root resorption or replacement resorption (ankylosis) can occur requiring appropriate management on the part of the practitioner.

Initial arch wires for alignment of crooked teeth with fixed orthodontic braces

BACKGROUND

The initial arch wire is the first arch wire to be inserted into the fixed appliance at the beginning of orthodontic treatment and is used mainly for correcting crowding and rotations of teeth. With a number of orthodontic arch wires available for initial tooth alignment, it is important to understand which wire is most efficient, as well as which wires cause the least amount of root resorption and pain during the initial aligning stage of treatment.

OBJECTIVES

To identify and assess the evidence for the effects of initial arch wires for alignment of teeth with fixed orthodontic braces in relation to alignment speed, root resorption and pain intensity.

SEARCH STRATEGY

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (30th November 2009), CENTRAL (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to 30th November 2009) and EMBASE (1980 to 30th November 2009). Reference lists of articles were also searched. There was no restriction with regard to publication status or language of publication. We contacted all authors of included studies to identify additional studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of initial arch wires to align crooked teeth with fixed orthodontic braces were selected. Only studies involving patients with upper and/or lower full arch fixed orthodontic appliances were included.

DATA COLLECTION AND ANALYSIS

Two review authors were responsible for study selection, validity assessment and data extraction. All disagreements were resolved by discussion amongst the review team. Corresponding authors of included studies were contacted to obtain missing information.

MAIN RESULTS

Seven RCTs, with 517 participants, provided data for this review. Among them, five trials investigated the speed of initial tooth alignment comparing: 0.016 inch ion-implanted A-NiTi wire versus 0.016 inch A-NiTi versus 0.0175 multistrand stainless steel wire; 0.016x0.022 inch medium force active M-NiTi wire versus 0.016x0.022 inch graded force active M-NiTi wire versus 0.0155 inch multistrand stainless steel wire; 0.016 inch superelastic NiTi wire versus 0.016 inch NiTi wire; 0.014 inch superelastic NiTi wire versus 0.0155 inch multistrand stainless steel wire; 0.016 inch CuNiTi wire versus 0.016 inch NiTi wire. The other two studies investigated pain intensity experienced by patients during the initial stage of treatment comparing: 0.014 inch superelastic NiTi wire versus 0.014 inch NiTi wire; 0.014 inch superelastic NiTi wire versus 0.015 inch multistrand stainless steel wire. Data analyses were often inappropriate within the included studies.

AUTHORS' CONCLUSIONS

There is some evidence to suggest that there is no difference between the speed of tooth alignment or pain experienced by patients when using one initial aligning arch wire over another. However, in view of the general poor quality of the including trials, these results should be viewed with caution. Further RCTs are required.

A systematic review of clinical trials of aligning archwires

OBJECTIVES

This review aimed to identify the evidence for the efficacy of archwires used in the alignment stage of orthodontic treatment by undertaking a systematic review of the literature.

DATA SOURCES

MEDLINE, the Cochrane Central Register of Controlled trials (CENTRAL), EMBASE, and the meta Register of Controlled Trials were searched up to July 2008. Reference lists of identified articles and relevant review articles were checked for further possible studies.

REVIEW METHODS

Controlled clinical trials and randomised clinical trials that compared aligning archwires and reported objective measures of alignment were selected for inclusion. Validity and quality assessment were undertaken to identify studies with a low risk of bias. Details of the study methodology and the reported results were then abstracted.

RESULTS

100 studies were identified by the searches and 7 of these were identified as meeting the selection criteria. Four studies were deemed, after quality assessment, to have a low risk of bias and data was extracted from these. No two studies shared a common methodology or common reporting of outcome. Meta-analysis was therefore not possible.

CONCLUSIONS

There is insufficient data in these studies to make clear recommendations regarding the most effective archwire for alignment. Recommendations on future study design have been made.

Thermal Analysis of As-received and Clinically Retrieved Copper-nickel-titanium Orthodontic Archwires

OBJECTIVE

To compare as-received copper-nickel-titanium (CuNiTi) archwires to those used in patients by means of differential scanning calorimetry (DSC). Also, the thermal or phase properties of 27 degrees C, 35 degrees C, and 40 degrees C CuNiTi archwires were studied to ascertain if their properties match those indicated by the manufacturer.

MATERIALS AND METHODS

Six wires of 27 degrees C, 35 degrees C, and 40 degrees C CuNiTi were tested as-received, and six each of the 27 degrees C and 35 degrees C wires were examined after use in patients for an average of approximately 9 and 7 weeks, respectively. Segments of archwire were investigated by DSC over the temperature range from -100 degrees C to 150 degrees C at 10 degrees C per minute.

RESULTS

There were no significant differences between as-received and clinically used 27 degrees C and 35 degrees C wires for all parameters (heating onset, endset, and enthalpy and cooling onset, endset, and enthalpy), except the 27 degrees C wires exhibited a significant decrease in the heating enthalpy associated with the martensite-to-austenite transition after clinical use. The heating endsets (austenite finish temperatures) of the 27 degrees C and 35 degrees C wires were within 2 degrees C of those claimed by the manufacturer, but the 40 degrees C wires were found to be nearer to 36 degrees C than 40 degrees C.

CONCLUSIONS

Clinical use of CuNiTi wires resulted in few differences when compared with as-received wires analyzed by DSC. Two temperature varieties of CuNiTi are reasonably within the parameters of those identified by the manufacturer.

Thermal and mechanical characteristics of stainless steel, titanium-molybdenum, and nickel-titanium archwires

INTRODUCTION

In recent years, nickel-titanium (Ni-Ti) archwires have been developed that undergo thermal transitions. Before the practitioner can fully utilize these products, the effect of those transitions within the clinical application must be understood.

METHODS

The transitional temperatures and mechanical stiffnesses of 3 archwire alloys--stainless steel, beta-titanium, and Ni-Ti--were investigated were for 7 products. Among the nickel-titanium alloys, 2 were thought to represent classic Ni-Ti products and 3 copper (Cu)-Ni-Ti products. By using 2 techniques, differential scanning calorimetry to measure heat flow and dynamic mechanical analysis to measure storage modulus, transition temperatures were evaluated from -30 degrees C to +80 degrees C.

RESULTS

With regard to the first technique, no transitions were observed for the stainless steel alloy, the beta-titanium alloy, and 1 of the 2 classic Ni-Ti products. For the other classic Ni-Ti product, however, a martensitic-austenitic transition was suggested on heating, and a reverse transformation was suggested on cooling. As expected, the Cu-Ni-Ti 27, 35, and 40 products manifested austenitic finish temperatures of 29.3 degrees C, 31.4 degrees C, and 37.3 degrees C, respectively, as the enthalpy increased from 2.47 to 3.18 calories per gram. With regard to the second technique, the storage modulus at a low frequency of 0.1 Hz paralleled static mechanical tests for the stainless steel alloy (183 gigapascal [GPa]), the beta-titanium alloy (64 GPa), and the Nitinol Classic (3M Unitek, Monrovia, Calif) product that represented a stable martensitic phase (41 GPa). The remaining 4 Ni-Ti products generally varied from 20 to 35 GPa when the low-temperature or martensitic phase was present and from 60 to 70 GPa after the high-temperature or austenitic phase had formed.

CONCLUSIONS

From the clinical viewpoint, the Orthonol (Rocky Mountain Orthodontics, Denver, Colo), Cu-Ni-Ti 27, Cu-Ni-Ti 35, and Cu-Ni-Ti 40 (SDS/Ormco, Glendora, Calif) products increased at least twofold in stiffness as temperature increased, best emulating the stiffness of Nitinol Classic below the transformational temperature and the stiffness of TMA (SDS/Ormco, Glendora, Calif) above the transformational temperature. Of the 3 Cu-Ni-Ti products, the least differences were found between Cu-Ni-Ti 27 and Cu-Ni-Ti 35, thereby questioning the justification for 3 similar products.