Pseudoelasticity and thermoelasticity of nickel-titanium alloys: a clinically oriented review. Part II: Deactivation forces

Effectiveness of tubular coaxial nickel-titanium and copper nickel-titanium orthodontic aligning archwires: A randomized clinical trial

BACKGROUND

This study aimed to compare tubular coaxial-NiTi and copper-NiTi orthodontic aligning archwires in terms of teeth alignment, patients' pain perception, and root resorption.

SUBJECTS AND METHODS

Orthodontic patients aged 12 years or older, having Little's irregularity index (LII) of 5-9mm were randomly allocated to either the copper-NiTi group or tubular coaxial-NiTi group with a 1:1 allocation ratio. The archwire sequence was 0.014-inch followed by 0.018-inch for the copper-NiTi group and 0.016-inch followed by 0.018-inch for the tubular coaxial-NiTi group. Each archwire was left in place for eight weeks before progressing to the next size. Good quality impression for the lower arch before treatment (T0) and thereafter every 4 weeks up to 16 weeks was taken to measure LII. Evaluation of pain perception was performed using a visual analog scale (VAS) during the first week following each archwire insertion. Assessment of root resorption was undertaken at T0 and after 16 weeks by taking periapical radiographs for mandibular central incisors using the long cone paralleling technique.

RESULTS

A total of 33 patients were randomized and selected for participation. Of those, 31 patients with a mean age of 15.45±2.22 who completed the trial were included in the analyses (15 patients in the copper-NiTi group and 16 patients in the tubular coaxial-NiTi group). In both groups, the irregularity index significantly decreased after 16 weeks of treatment with an overall reduction of 5.22mm for the copper-NiTi group and 6.03mm for the tubular coaxial-NiTi group. However, the difference between the two groups was not statistically significant. Likewise, pain perception and root resorption were not significantly different between the two study groups.

CONCLUSIONS

Both copper-NiTi and tubular coaxial-NiTi archwires were equally effective in terms of teeth alignment, patients' pain perception, and root resorption. Consideration could be given to the cost and clinician preference when selecting an initial archwire.

REGISTRATION

the trial was registered in ClinicalTrials.gov on 26/05/2022 with a registration ID: NCT05391542, https://clinicaltrials.gov/ct2/show/NCT05391542.

Thermal Behavior Changes of As-Received and Retrieved Bio-Active® (BA) and TriTanium® (TR) Multiforce Nickel-Titanium Orthodontic Archwires

Multiforce nickel-titanium (NiTi) orthodontic archwires release progressively increasing forces in a front-to-back direction along their length. The properties of NiTi orthodontic archwires depend on the correlation and characteristics of their microstructural phases (austenite, martensite and the intermediate R-phase). From a clinical and manufacturing point of view, the determination of the austenite finish (Af) temperature is of the greatest importance, as in the austenitic phase, the alloy is most stable and exhibits the final workable form. The main purpose of using multiforce orthodontic archwires is to decrease the intensity of the applied forces to the teeth with a small root surface area, such as the lower central incisors, and also provide forces high enough to move the molars. With the optimally dosed forces of multiforce orthodontic archwires in the frontal, premolar and molar segments, the feeling of pain can be reduced. This will contribute to the greater cooperation of the patient, which is of utmost importance to achieve optimal results. The aim of this research was to determine the Af temperature at each segment of as-received and retrieved Bio-Active^® and TriTanium^® archwires with dimensions of 0.016 × 0.022 inches, investigated by the differential scanning calorimetry (DSC) method. A classical Kruskal-Wallis one-way ANOVA test and multi-variance comparison based on the ANOVA test statistic using the Bonferroni corrected Mann-Whitney test for multiple comparisons were used. The incisor, premolar and molar segments have different Af temperatures, and they decrease from the anterior to posterior so that the posterior segment has the lowest Af. Bio-Active^® and TriTanium^® with dimensions of 0.016 × 0.022 inches can be used as first leveling archwires by additional cooling and are not recommended for use on patients with mouth breathing.

The Effects of Temperature and Time of Heat Treatment on Thermo-Mechanical Properties of Custom-Made NiTi Orthodontic Closed Coil Springs

Nickel-Titanium (NiTi) springs have been increasingly used in orthodontics; however, no optimum condition of heat treatment has been reported. Therefore, this research was conducted to determine the optimum heat-treatment temperature and duration for the fabrication of NiTi-closed coil springs by investigating their effects on thermo-mechanical properties. As-drawn straight NiTi wires of 0.2 mm diameter were used to fabricate closed coil springs of 0.9 mm lumen diameter. The springs were heat-treated at three different temperatures (400, 450, and 500 °C) with three different durations (20, 40, and 60 min). Electron Probe Micro-Analysis (EPMA) and Differential Scanning Calorimetry (DSC) were used to investigate element composition and thermo-mechanical properties, respectively. Custom-made NiTi closed coil springs composed of 49.41%-Ti and 50.57%-Ni by atomic weight, where their DSC curves of 500 °C presented the obvious endothermic and exothermic peaks, and the austenite finish temperature (A_f) were approximately 25 °C. With increasing temperature, deactivation curves presented decreased plateau slopes generating higher superelastic ratios (SE ratios). At 500 °C, closed coil springs showed superelastic tendency with lower stress hysteresis. The thermo-mechanical properties were significantly influenced by heat-treatment temperature rather than duration. The optimum parameter appeared to be 500 °C for 40 min to produce appropriate force delivery levels, relatively low plateau slope, and lower hysteresis for orthodontic use.

Fluorescence-Aided Identification Technique (FIT) Improves Tooth Surface Clean-Up after Debonding of Buccal and Lingual Orthodontic Appliances

The aim of this study was to evaluate the use of fluorescence inducing light to aid the clean-up of tooth surfaces after bracket removal when using buccal or lingual orthodontic appliances. Two full sets of dental arches using extracted human teeth were assembled, with 14 teeth per arch. All teeth were bonded on their buccal and lingual surfaces. After debonding, a single blinded operator performed the tooth surface clean-up, as commonly performed in clinical practice; without the use of fluorescent light (non-FIT) and with two methods using fluorescent light to identify composite remnants on the tooth surfaces (FIT; OPAL and BRACE). Tooth surfaces were scanned before bonding and after clean-up, and the two scans were superimposed using the best-fit method. The results showed that the debonding method, type of tooth and type of tooth surface had a significant effect on the presence of composite remnants, enamel defects, and on debonding time. Contrary to the non-FIT method, there were no composite remnants after clean-up with the use of fluorescence inducing light. Clean-up time was significantly reduced on the buccal surfaces when using the FIT methods. On the lingual surfaces, the FIT methods resulted in larger enamel defects.

Comparison of two different initial archwires for tooth alignment during fixed orthodontic treatment-A randomized clinical trial

OBJECTIVES:

The aim of the study was to clinically evaluate and compare 0.016-inch superelastic nickel–titanium (NiTi) and 0.016-inch heat-activated nickel–titanium (NiTi) archwires in terms of alignment efficiency, root resorption, and pain intensity.

METHOD:

A total of 20 patients requiring fixed orthodontic treatment, having Little's irregularity index of 5–8, and requiring first premolar extractions were recruited. They were randomly allocated to receive two different archwires (0.016-inch superelastic NiTi or 0.016-inch thermoelastic NiTi). Good-quality impressions were taken of the lower arch before archwire placement (T0) and at every month after that till the alignment was complete. The rate of tooth alignment was measured on casts by determining Little's irregularity index. The pain experienced by the patient was assessed 24 hours and 1 week after the placement of the archwire on a visual analogue scale. Cone beam computed tomographic radiographs of lower anterior teeth were taken before and after alignment to assess root resorption. Data obtained were subjected to statistical analysis using the SPSS software (version 20.0). The level of significance was kept at 5%.

RESULTS:

The repeated measures ANOVA indicated that there was no significant difference in the aligning efficiency of superelastic and heat-activated NiTi wires. (p = 0.45). The Mann Whitney U test showed that superelastic NiTi wires had statistically significant higher VAS scores than heat-activated NiTi at 24 hours and 1-week interval (p < 0.05). Student's t-test indicated greater root resorption with superelastic NiTi but the difference was not statistically significant.

CONCLUSION:

Both the wires showed similar aligning efficiency and resulting root resorption. Superelastic NiTi was observed to produce more pain compared to heat-activated NiTi in the aligning phase.

Can we expect similar behavior among CuNiTi 35°C wires?

Objective:

This paper aims to verify the thermodynamic, mechanical and chemical properties of CuNiTi 35ºC commercial wires.

Methods:

Forty pre-contoured copper-nickel-titanium thermodynamic 0.017 x 0.025-in archwires with an Af temperature of 35°C were used. Eight wires from five different manufacturers (American Orthodontics® [G1], Eurodonto® [G2], Morelli® [G3], Ormco® [G4] and Orthometric® [G5]) underwent cross-sectional dimension measurements, tensile tests, SEM-EDS and differential scanning calorimetry (DSC) tests. Parametric tests (One-way ANOVA and Tukey post-test) were used, with a significance level of 5%, and Pearson’s correlation coefficient test was performed between the Af and chemical elements of the wires. All sample tests and statistical analyses were double-blinded.

Results:

All wires presented standard dimensions (0.017 x 0.025-in) and superelastic behavior, with mean plateau forces of: G1 = 36.49N; G2 = 27.34N; G3 = 19.24 N; G4 = 37.54 N; and G5 = 17.87N. The Af means were: G1 = 29.40°C, G2 = 29.13°C and G3 = 31.43°C, with p>0.05 relative to each other. G4 (32.77°C) and G5 (35.17°C) presented statistically significant differences between each other and among the other groups. All samples presented Ni, Ti, Cu and Al in different concentrations.

Conclusions:

The chemical concentration of the elements that compose the alloy significantly influenced the thermodynamic and mechanical properties.

A clinical comparison of the effectiveness of two types of orthodontic aligning archwire materials: a multicentre randomized clinical trial

OBJECTIVES

To compare the heat-activated nickel titanium (HANT) with superelastic nickel-titanium (SENT) archwires in terms of their effectiveness of aligning teeth, possibility of inducing root resorption, and perception of pain.

SUBJECTS AND METHODS

Orthodontic patients aged 12 years or over with mandibular anterior crowding of 3-6 mm, who required treatment without extractions were randomly allocated (a simple non-stratified randomization) to the HANT and SENT archwires groups with a 1:1 allocation ratio. The archwire sequence in both groups was 0.014-inch and 0.016-inch, respectively. Each archwire was placed for 4 weeks. The outcome measures included the amount of crowding assessed blindly using Little's irregularity index (LII), apical root resorption, and pain perception. The effectiveness of alignment was tested using 2 × 2 mixed factorial analysis of variance (ANOVA) model, while root resorption and pain perception were tested by the Mann-Whitney U-test and Wilcoxon signed-rank test (P < 0.05).

RESULTS

Thirty-four patients were randomized and recruited from four centres, of those 31 were analysed (15 participants for the HANT and 16 for the SENT groups) with an overall mean age of 19.13 ± 5.73 years. The total reduction in the LII was 2.69 mm and 2.74 mm for the HANT and SENT groups, respectively. This did not reach the level of statistical (P = 0.809) or clinical significance. Similarly, root resorption and pain perception showed non-significant difference between groups. However, there was a slight increase in root resorption with the SENT group.

LIMITATIONS

A long-term evaluation of root resorption is required.

CONCLUSIONS

Both HANT and SENT archwires were equally effective in the aligning stage of orthodontic treatment. Root resorption with SENT wires should be monitored throughout treatment.

REGISTRATION

The trial was registered with ClinicalTrials.gov on 18 September 2019, registration number: NCT04090931.

Impact of passive self-ligation and conventional elastic ligation on orthodontic force in the simulation of a mandibular lateral incisor linguoversion

INTRODUCTION

This study compared three-dimensional forces delivered to the displaced tooth and its adjacent teeth between passive self-ligation (PSL) and conventional elastic ligation (CL) in simulation of mandibular lateral incisor linguoversions.

METHODS

A multisensor system was used to measure three-dimensional forces delivered to brackets attached to the mandibular left central incisor, lateral incisor, and canine (FDI tooth numbers 31, 32, and 33, respectively). Two ligation methods (PSL and CL), 3 nickel-titanium (0.014-inch) archwires similar to the arch form of normal occlusion, and 2 displacements (1 and 4 mm) were tested.

RESULTS

In 1-mm displacement, forces were significantly smaller in CL than in PSL at 32 in the labial direction and larger at 31 in the mesial direction for all 3 types of archwires (P <0.01 for both). For 2 of 3 archwires, forces were larger in CL than in PSL at 33 in the lingual direction (P <0.01). In 4-mm displacement, forces were significantly larger in CL than in PSL at 31 in the mesial direction and significantly smaller in CL than in PSL at 33 in the distal direction for all 3 archwires (P <0.05 and P <0.01, respectively). Mean forces in the vertical direction were small, ranging from -0.05 to 0.05 N.

CONCLUSIONS

Under a small amount of displacement, force magnitude in PSL was smaller than that in CL at the displaced tooth in labial-lingual directions. Under a large amount of displacement, a more "open coil spring effect" was significantly obtained in CL than PSL at both adjacent teeth of the displaced tooth.

Coated nickel titanium archwires and their uncoated counterparts: In-vitro contemporary comparison of unloading forces

OBJECTIVE

To compare the unloading forces between aesthetic nickel titanium (NiTi) wires coated with rhodium and epoxy resin, as well as their uncoated equivalents. Additionally, intragroup comparisons between the different deactivation forces were evaluated, and the inner alloy cores were determined.

MATERIAL AND METHODS

Forty-four 0.018" NiTi wire segments were equally divided into 4 groups: E- NiTi coated with epoxy resin, C- NiTi uncoated, R- heat-activated NiTi coated with rhodium, and T- heat-activated NiTi uncoated. The unloading values were recorded at 0.5, 1, 2, and 3mm using a 3-point bending test, according to the method in ISO Standard 15.841. Cross-sectional scanning electron microscopy was used to assess the inner alloy core thickness of the wires.

RESULTS

The intergroup comparison was successively: at 0.5mm: E (1.21)>C (0.60)=R (0.63)=T (0.58); at 1mm: E (1.30)=C (1.23)>R (0.91)=T (0.80); at 2mm:C (1.93)>E (1.36)=R (1.20) and R (1.20)=T (1.00) and E (1.36)>T (1.00); at 3mm:C (2.44)>R (2.02)>E (1.62)=T (1.68). The intragroup comparisons showed for all groups that the forces were statistically higher at 3mm than the other deactivations (p<0.01). Group E presented a reduced inner alloy core (.0155).

CONCLUSION

The unloading forces demonstrated variability between the wires tested and between the different deactivations. Therefore, depending on the type of movement required and the periodontal conditions, orthodontists should pay attention during archwire selection.

Alignment efficiency of coaxial tubular superelastic nickel-titanium vs single-stranded superelastic nickel-titanium in relieving mandibular anterior crowding in extraction cases: A single-centre randomized controlled clinical trial

OBJECTIVES

To compare the alignment efficiency of coaxial tubular and single-stranded 0.016" superelastic NiTi archwires in relieving mandibular anterior crowding in extraction cases and to evaluate whether alignment efficiency differed as the initial irregularity increased.

SETTING AND SAMPLE POPULATION

Forty female patients aged between twelve and twenty years from the postgraduate orthodontic clinic at the authors' centre.

MATERIALS AND METHODS

All patients in this single-centre, 2-arm parallel trial were randomly allocated in a 1:1 ratio and the mandibular anterior irregularity was measured from the mandibular cast at 0-, 4-, 8- and 12-week intervals using a digital calliper.

RESULTS

All forty patients (mean age, 15.08 ± 2.11) completed the study with either coaxial tubular superelastic NiTi (mean age, 15.30 ± 2.36) or single-stranded superelastic NiTi (mean age, 14.85 ± 1.84). The largest mean irregularity index reduction of -4.88 ± 2.74 and -6.17 ± 2.38 in the single-stranded superelastic NiTi and the coaxial tubular superelastic NiTi groups, respectively (P = 0.122) was at 4 weeks. Student's t test and repeated measures ANOVA indicated that none of the mean comparisons were statistically significant at a 5% level. Pearson's correlation value (r) indicated no statistically significant influence of initial crowding on alignment efficiency.

CONCLUSIONS

There was no statistically significant difference between the alignment efficiency of coaxial tubular superelastic NiTi and single-stranded superelastic NiTi in extraction cases, and the degree of initial crowding had no influence on the alignment efficiency.

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.

Effects of autoclaving versus cold chemical (glutaraldehyde) sterilization on load-deflection characteristics of aesthetic coated archwires

INTRODUCTION

The effect of any sterilization methods (cold [chemical] or hot) on load-deflection characteristics of aesthetic coated archwires has not yet been investigated. Thus, we assessed it.

METHODS

In this experimental in vitro study, 90-coated archwires from 3 brands were purchased. Ten wires from each brand (n=30) underwent cold and 10 underwent hot sterilization, while 10 left unsterilized as negative controls. Load-deflection curves were established for each wire (as five 0.2mm intervals between 1.0 and 1.8mm displacements), using a three-bracket test. After determining the plateau phase that was present in all wires, the averages of plateau phase pertaining to loading and unloading curves and their discrepancies (hysteresis) were calculated for each subgroup (n=10). Average plateau values were compared using two-way ANOVA, Tukey, and independent-samples t-test (α=0.05).

RESULTS

Average loading and unloading values were 906.6±129.7 and 295.9±84.5g respectively (t-test P<0.0001). Comparing loading plateaus, ANOVA indicated significant difference among wire brands (P<0.0001) but not among sterilization types (P=0.4793). Comparing unloading plateaus, ANOVA showed significant differences among wire brands (P<0.0001) and sterilization types (P=0.0008). Tukey showed that only cold sterilization and negative control differed significantly (P<0.001); cold and hot sterilization methods, or control and autoclaving were not significantly different (P>0.05). Comparing hysteresis plateaus, ANOVA indicated difference among wire brands (P<0.0053) but not among sterilization types (P=0.9166).

CONCLUSIONS

Cold sterilization might reduce unloading plateau of orthodontic wires, but sterilization in general might not affect loading or hysteresis plateaus. Different brands had different plateaus of loading, unloading and hysteresis.

Comparison of the superelasticity of different nickel-titanium orthodontic archwires and the loss of their properties by heat treatment

The aim of this work is to describe and compare mechanical properties of eight widely used nickel-titanium orthodontic wires under uniform testing conditions and to determine the influence of the heat treatments on the loss of the superelasticity. Ten archwires from two batches from eight different manufacturers were evaluated. A three-point bending test was performed, in accordance with ISO 15841:2006, on 80 round nickel-titanium archwire segments of 0.016 inch. To obtain a load-deflection curve, the centre of each segment was deflected to 3.1 mm and then unloaded until force became zero. On the unloading curve, deflection at the end of the plateau and forces delivered at that point, and at 3, 2, 1 and 0.5 mm of deflection, were recorded. Plateau slopes were calculated from 3 and from 2 mm of deflection. Data obtained were statistically analysed to determine inter-brand, intra-brand and inter-batch differences (P < 0.05). The results show that at 2 mm of deflection, maximum differential force exerted among brands [Nitinol SuperElastic (1.999N)-Sentalloy M (1.001 N)] was 0.998 N (102 gf). The Nitinol SuperElastic plateau slope (0.353 N/mm) was the only one that was statistically different from 2 mm of deflection, as compared with the other brand values (0.129-0.155 N/mm). Damon Optimal Force described the gentlest slope from 3 mm of deflection (0.230 N/mm) and one of the longest plateaus. Titanol and Orthonol showed the most notable intra-brand differences, whereas inter-batch variability was significant for Nitinol (Henry Schein), Euro Ni-Ti and Orthonol. Superelasticity degree and exerted forces differed significantly among brands. Superelasticity of Nitinol SuperElastic was not observed, while Damon Optimal Force and Proclinic Ni-Ti Superelástico (G&H) showed the most superelastic curves. Intra-brand and inter-batch differences were observed in some brands. In all cases, the heat treatment at 600 °C produces precipitation in the matrix. The precipitates are rich in titanium and this fact produce changes in the chemical composition of the matrix and the loss of the superelasticity. At 400 °C these precipitates are not produced and the forces delivered by the wires are very similar with wires untreated.

Superelasticity and force plateau of nickel-titanium springs: an in vitro study

OBJECTIVE

This paper analyzed whether nickel-titanium closed coil springs (NTCCS) have a different superelastic (SE) behavior according to activation and whether their force plateau corresponds to that informed by the manufacturer.

METHODS

A total of 160 springs were divided into 16 subgroups according to their features and activated proportionally to the length of the extensible part (NiTi) of the spring (Y). The force values measured were analyzed to determine SE rates and force plateaus, which were mathematically calculated. These plateaus were compared to those informed by the manufacturer. Analysis of variance was accomplished followed by Tukey post-hoc test to detect and analyze differences between groups.

RESULTS

All subgroups were SE at the activation of 400% of Y length, except for: subgroups 4B and 3A, which were SE at 300%; subgroups 4E and 4G, which were SE at 500%; and subgroup 3C, which was SE at 600%. Subgroup 3B did not show a SE behavior. Force plateaus depended on activation and, in some subgroups and some activations, were similar to the force informed.

CONCLUSIONS

Most of the springs showed SE behavior at 400% of activation. Force plateaus are difficult to compare due to lack of information provided by manufacturers.

An in vitro assessment of the mechanical characteristics of nickel-titanium orthodontic wires in Fluoride solutions with different acidities

Objectives:

The aim was to evaluate the in vitro effects of fluoride solutions with different acidities on load-deflection characteristics of nickel-titanium (NiTi) orthodontic wires.

Materials and Methods:

In this study, which lasted 30 days, 36 (3 cm long, 0.016 × 0.022 inches, SENT 1622, G & H wire Company, Greenwood, Indiana, USA) NiTi wires, were divided into three experimental groups of 12 each. Two groups were subjected to 0.05 topical fluoride mouthwash with different acidities (G1, pH 4; G2, pH 6.6) for 90 s, twice a day, and kept in normal saline after that. The third group (G3, the control group) was kept in normal saline only. Load and unload forces were measured with three bracket bending test in a universal testing machine (Testometric Co, Rochdale, UK). Loading and unloading plateaus and hysteresis were also recorded. Data were then analyzed using analysis of variance and honestly significant difference Tukey at P < 0.05.

Results:

During the loading phase, there was a significant difference between deflections (P < 0.001); but there was no interaction effect (P = 0.191) and no significant difference among three groups (P = 0.268). In the unloading phase, there was a significant difference between deflections (P < 0.001) and an interaction effect was also observed (P = 0.008). Further, significant differences noted among three groups (P = 0.037). Only in the unloading phase, at deflections of 2.2 through 0.2 mm, significant differences between the mean force values of the G1 and G3 groups were observed (P = 0.037).

Conclusion:

Based on this in-vitro study, compared to neutral fluoride solution, daily mouthwash with a fluoride solution with more acidic pH of 4 affected the NiTi wires load-deflection characteristics during the unloading phase. This finding may have clinical implications and can be further validated by in-vivo studies.

Self-ligating brackets: where are we now?

The current situation regarding self-ligating brackets is reviewed. Recent developments, clinical advantages, and remaining imperfections are described. The question of active versus passive ligation is scrutinized. The evidence regarding treatment efficiency is reviewed. Suggested clinical tips and changes of treatment mechanics are summarized and illustrated. Self-ligating brackets have reached a stage of design and production control, where the advantages are significantly greater than the remaining imperfections.

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.

Comparative study of frictional forces generated by NiTi archwire deformation in different orthodontic brackets: In vitro evaluation

INTRODUCTION: The purpose of this study was to compare the frictional forces between 0.014-in NiTi wires (Aditek) with 4 mm horizontal deflection and brackets with different archwire ligation systems. METHODS: Four types of self-ligating brackets (Damon MX, Easy Clip, Smart Clip and In-Ovation), a triple bracket (Synergy) and a twin bracket with 8-shaped ligature (Tecnident) were tested. Twin brackets with conventional elastomeric ligatures (Morelli) were used as control group. Tests were repeated 10 times for each bracket/archwire combination. Frictional forces were measured in an Instron universal tensile machine at 3 mm/minute speed and a total displacement of 6 mm. Statistical analysis comprised ANOVA and Dunnett's multiple comparison post hoc test. RESULTS: Deflection-induced frictional (DIF) forces increased in the following order: Synergy, Damon, 8-shaped Ligature, Easy Clip, In-Ovation, Smart-Clip and conventional ligatures. The differences among groups were significant, with the exception of the 8-shaped ligature groups which was equal to the Damon and Easy Clip groups. CONCLUSIONS: Compared to conventional ligatures, all ligation systems tested reduced frictional forces. However, such reduction varied according to the ligation system employed.

Comparison of deactivation forces between thermally activated nickel-titanium archwires

OBJECTIVE

The aim of the present study was to investigate and compare load-deflection characteristics of commercially available thermally activated nickel-titanium archwires using a three-point bending test.

MATERIALS AND METHODS

Sixty thermally activated 0.019×0.025-inch nickel-titanium archwires from six different manufacturers were investigated. The superelastic properties of these archwires were evaluated by conducting a three-point bending test under identical testing conditions. Forces generated at deactivation for a deflection of 0.5, 1, 2 and 3 mm at a temperature of 37° C were selected for statistical comparison of the data. The results of forces of deactivation at all deflections applied were compared by two-way analysis of variance and the Tukey test.

RESULTS

Statistical differences (P<0.05) were found at all force levels during deactivations. The results showed that the range of forces displayed great variation in quantitative behaviour. None of the archwires showed permanent deformation after the three-point bending test.

CONCLUSIONS

This study revealed significant differences in deactivation forces among the six types of thermally activated nickel-titanium archwires tested. NiTinol Termoativado (Aditek) and NeoSentalloy F200 (GAC) produced the least amount of force in all four deactivation categories.

Load-deflection and surface properties of coated and conventional superelastic orthodontic archwires in conventional and metal-insert ceramic brackets

Background:

Properties of coated archwires, which have been introduced for esthetic demands during orthodontic treatments, along with the use of tooth-colored brackets, are not clear. The aim of this study is to compare the load-deflection and surface properties of coated superelastic archwires with conventional superelastic archwires in conventional and metal-insert ceramic brackets.

Materials and Methods:

In this experimental study, 3 types of archwires including ultraesthetic polycoated, ultraesthetic epoxyresin coated and conventional (uncoated) superelastic nickel-titanium (NiTi) archwires were used in each of 2 types of brackets including conventional and metal-insert ceramic. To simulate oral environment, all specimens were incubated in artificial saliva using thermocycling model and then were tested in three-bracket bending test machine. Loading and unloading forces, plateau gap and end load deflection point (ELDP) were recorded. Archwires were investigated with a stereomicroscope before and after the experiment. Two-way ANOVA and Tukey tests were used at P<0.05.

Results:

Epoxyresin archwires produced lower forces (19 to 310 gr) compared to polycoated (61 to 359 gr) and NiTi (61 to 415 gr) (P<0.0001). The maximum ELDP (0.43 mm) was observed in epoxyresin archwires (P<0.001). Coatings of some epoxyresin wires were torn and of polycoated wires peeled off. Conventional ceramic bracket produced higher loading forces with polycoated and NiTi archwires and lower unloading forces with all 3 types of archwires compared to metal-insert type (P<0.05).

Conclusion:

Epoxyresin-coated archwire had the lowest force and highest ELDP. Coatings were not durable in these experimental conditions. Conventional ceramic bracket produced higher frictional force compared to metal-insert type.

Aesthetic nickel titanium wires--how much do they deliver?

The purpose of this study was to evaluate and compare the force levels of aesthetic Ni-Ti wires to regular Ni-Ti wires of the same dimension and evaluate their mechanical properties. Aesthetic and regular maxillary superelastic Ni-Ti wires (0.016 × 0.022) from four different manufacturers (G&H Wire Company, TP Orthodontics, GAC International, and Ortho Organizers) were selected and grouped I-IV. The loading and unloading values were compared using a three-point bending test. The unloading end values were also recorded to evaluate the recovery of archwires after each deflection. The unloading values were recorded at 0.5, 1.5, and 2.5 mm after loading deflections of 1, 2, and 3 mm, respectively. Cross-sectional scanning electron microscopy was used to assess the coating thickness of aesthetic wires. The results, statistically analysed, showed a significant decrease in force values for the aesthetic wires in groups I, III, and IV (P < 0.001) as compared to regular Ni-Ti wires of the same dimension from the same manufacturer. There was no significant difference in force values for group II wires. A statistically significant decrease in force values of epoxy-coated wires was observed in groups I, III, and IV only. This is of obvious clinical significance during wire selection. The group II coated wires, however, exhibited forces comparable to their regular Ni-ti wires with a difference that was statistically insignificant. The end values of aesthetic wires showed almost complete recovery for groups I, II, and III after 2 and 3 mm deflections.

Force levels of 23 nickel-titanium open-coil springs in compression testing

INTRODUCTION

Open-coil springs are commonly used auxiliaries in fixed orthodontic appliance therapy. Space opening for impacted or heavily crowded teeth as well as distalization of molars all require specific force levels. It is the aim of the current study to present an overview of the mechanical properties of currently available nickel titanium (NiTi) closed coil springs.

MATERIAL AND METHODS

Twenty-three NiTi open-coil springs were compressed by 25% and 50% of their original length at a controlled temperature of 36°C. Force deflection diagrams were registered using an Instron 3344 (Instron Corp, Wilmington, De). Five samples of each coil spring were measured and evaluated for their mean force as well as their superelastic characteristics.

RESULTS

Almost all coil springs showed a linear behavior in the force deflection diagram. Only a few open-coil springs (GAC light, medium, and heavy [Dentsply GAC, Bohemia, NY] and RMO 12 × 45 [Rocky Mountain Orthodontics, Denver, Colorado]) showed a superelastic behavior with a clear force plateau, also indicated by their high ratio of variance. The results of the tested open-coil springs allow the clinician to choose springs with mean forces between 0.25 N (3M Unitek light; 3M Unitek, St. Paul, Minn) and 1.3 N (GAC heavy) for a compression of 25% and 0.64 N (3M Unitek light) to 2.9 N (OrthoOrganizers 14 × 37 [OrthoOrganizers, Carlsbad, Calif], Dentaurum Rematitan strong [Dentaurum, Ispringen, Germany]) for a compression of 50%.

CONCLUSIONS

Superelastic behavior was rarely observed with open-coil springs. The clinician can therefore not rely on the force range indicated without considering the amount of compression of the coil spring.

Combined aging effects of strain and thermocycling on unload deflection modes of nickel-titanium closed-coil springs: an in-vitro comparative study

INTRODUCTION

There are no reports on the aging effects of thermocycling of nickel-titanium (NiTi) based coil springs, and few studies have investigated their superelasticity phases in full. In this study, we compared the mechanical properties of NiTi-based closed-coil springs after the combined aging effects of prolonged strain and thermocycling, as a reflection of the clinical situation.

METHODS

Ninety NiTi-based closed-coil springs were used, 30 each of the following types: (1) Nitinol (3M Unitek, Monrovia, Calif), (2) Ni-Ti (Ormco, Glendora, Calif), and (3) RMO (Rocky Mountain Orthodontics, Denver, Colo); all had similar dimensions (length, 12 mm). In each sample group, 2 equal subgroups of 15 coil springs were extended by either 50% (to 18 mm) or 150% (to 30 mm), immersed in artificial saliva, and kept at 37°C for 45 days. All springs underwent sessions of 1000 thermocycles (1 minute long) from 5°C to 55°C on days 22 and 45. Unload deflection curves from both the 50% and 150% extensions (according to their strain subgroups) were recorded by using a universal testing machine before the strain (baseline) and at both 22 and 45 days, immediately after thermocycling.

RESULTS

At baseline, the loads exerted by the NiTi-based coil springs varied from 99.8 to 245.1 gf for the RMO (50% strain) and Ni-Ti (150% strain) groups. Statistically significant, although small, differences were seen at each time point in both the 50% and 150% strain subgroups; generally, the highest and lowest values were recorded in the Ni-Ti and Nitinol groups (all, P <0.001). Only the Nitinol coil-spring group showed an acceptable superelasticity phase. The strain and thermocycling did not dramatically change the deactivation forces of any coil springs.

CONCLUSIONS

NiTi-based closed-coil springs might not have a superelasticity phase, and prolonged strain and thermocycling do not produce clinically relevant alterations in their deactivation forces.

Forces of Various Nickel Titanium Closed Coil Springs

Objective: To compare the forces generated by 14 different 9 mm springs supplied by five different companies.

Materials and Methods: Five replicates of 14 different 9 mm springs were evaluated, resulting in 70 total specimens. Each was extended once from its resting length to 12 mm and then was deactivated. All tests were performed in a 37°C water bath. Forces were recorded at the 12 mm extension and deactivation distances of 9 mm, 6 mm, 3 mm, and 1 mm using an MTS force gauge. Data were collected with Testworks software, version 4.0, and were analyzed by analysis of variance (ANOVA) with one factor alternated.

Results: Mean peak load forces at 12 mm were significantly different between springs, and these forces varied from 147 to 474 grams. Mean unload forces measured at 9 mm, 6 mm, and 3 mm of deactivation values were highly variable, and only 6 of the 14 springs exhibited a “physiologic” mean unload force of 50 grams or less over the total deactivation range.

Conclusions: Few springs tested exhibited physiologic peak load forces and constant deactivation forces. This study suggests that labeling of nickel titanium closed coil springs is confusing and misleading.

Stiffness and frictional resistance of a superelastic nickel-titanium orthodontic wire with low-stress hysteresis

INTRODUCTION

Stress-induced martensite formation with stress hysteresis that changes the elasticity and stiffness of nickel-titanium (Ni-Ti) wire influences the sliding mechanics of archwire-guided tooth movement. This in-vitro study investigated the frictional behavior of an improved superelastic Ni-Ti wire with low-stress hysteresis.

METHODS

Improved superelastic Ni-Ti alloy wires (L & H Titan, Tomy International, Tokyo, Japan) with low-stress hysteresis were examined by using 3-point bending and frictional resistance tests with a universal test machine at a constant temperature of 35 degrees C, and compared with the former conventional austenitic-active superelastic Ni-Ti wires (Sentalloy, Tomy International). Wire stiffness levels were derived from differentiation of the polynomial regression of the unloading curves, and values for kinetic friction were measured at constant bending deflection distances of 0, 2, 3, and 4 mm, respectively.

RESULTS

Compared with conventional Sentalloy wires, the L & H Titan wire had a narrower stress hysteresis including a lower loading plateau and a higher unloading plateau. In addition, L & H Titan wires were less stiff than the Sentalloy wires during most unloading stages. Values of friction measured at deflections of 0, 2, and 3 mm were significantly (P <.05) increased in both types of wire. However, they showed a significant decrease in friction from 3 to 4 mm of deflection. L & H Titan wires had less friction than Sentalloy wires at all bending deflections (P <.05).

CONCLUSIONS

Stress-induced martensite formation significantly reduced the stiffness and thus could be beneficial to decrease the binding friction of superelastic Ni-Ti wires during sliding with large bending deflections. Austenitic-active alloy wires with low-stress hysteresis and lower stiffness and friction offer significant potential for further investigation.