Tooth alignment and pain experience with A-NiTi versus Cu-NiTi: a randomized clinical trial

A pilot study analyzing the influence of the material and the size of the orthodontic archwire on the level of pain and anxiety in adult patients in treatment with brackets: A prospective triple-blind randomized clinical trial

Background

The objective was to investigate the influence of the material and dimensions of the orthodontic archwire on the pain and anxiety in adult patients in orthodontic treatment with brackets.

Material and Methods

A randomized prospective triple-blind clinical pilot study was conducted at the Dental Clinic of the University of Salamanca. The study sample comprised 30 adult patients who started orthodontic treatment with brackets. This sample was divided into two groups: the NiTi group (n=15) and Cu-NiTi group (n=15). Pain was analyzed with a visual analogue scale (VAS) and anxiety with the State-Trait Anxiety Inventory (STAI). Anxiety was assessed at the start of treatment (T0) and after one month (T1). Pain was analyzed at the start of treatment (T0), at different time points at the start (T01), and after 4 (T02), 24 (T03), and 48 hours (T04); these measurements were also recorded one month after starting orthodontic treatment (T11, T12, T13, and T14).

Results

The mean age of patients was 31.3 (± 6.05) years old. The highest level of pain, at the beginning of treatment, was observed after 48 hours (5.57 ± 1.72) and at one month after starting treatment at 24 hours (5.13 ± 1.89), with no significant differences between the two groups. When analyzing anxiety, no differences were observed between groups; the anxiety levels were higher one month after starting treatment compared to the start. Regarding the correlation between pain and anxiety, the NiTi group showed a greater direct relationship (<0.05) between these two variables at the start of treatment in the anxiety trait in relation to pain at T02 and T03 and after a month in T12, T13, and T14.

Conclusions

In the sample studied, there was no significant influence of the size or material of the orthodontic archwire on pain and anxiety levels. Key words:Orthodontics, Brackets, Archwire, Pain, Anxiety, NiTi, Cu-NiTi.

Initial arch wires used in orthodontic treatment with fixed appliances

BACKGROUND

Initial arch wires are the first arch wires inserted into fixed appliance at the beginning of orthodontic treatment. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which are most efficient and which cause the least amount of root resorption and pain during the initial aligning stage of treatment. This is the third update of a Cochrane review 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

We searched Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, Embase, and two ongoing trials registries on 4 July 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of different initial arch wires used to align teeth with fixed orthodontic braces. We included people with full-arch fixed orthodontic appliances on the upper arch, lower arch, or both arches.

DATA COLLECTION AND ANALYSIS

Two independent review authors were responsible for study selection, data extraction, and assessment of risk of bias in included studies. We contacted corresponding authors of included studies to obtain missing information. We resolved disagreements by discussion between the review authors. Our main outcomes were alignment rate (movement of teeth in mm), root resorption, time to alignment, and intensity of pain measured on a 100-mm visual analogue scale (VAS). We pooled data from studies with similar interventions and outcomes using random-effects models. We reported mean differences (MDs) with 95% confidence intervals (CIs) for continuous data, risk ratios (RRs) with 95% CIs for dichotomous data, and alignment rate ratios with 95% CIs for time-to-event data. Two independent review authors assessed the certainty of evidence. We resolved disagreements by discussion between the review authors.

MAIN RESULTS

We included 29 RCTs with 1915 participants (2581 arches) in this review. Studies were generally small (sample sizes ranged from 14 to 200 participants). Duration of follow-up varied between three days and six months. Eleven studies received funding, six received no funding, and 12 provided no information about funding sources. We judged eight studies at high risk of bias, nine at low risk, and 12 at unclear risk. We grouped the studies into six main comparisons. Multistrand stainless steel wires versus wires composed of other materials Six studies with 409 participants (545 arches) evaluated multistrand stainless steel (StSt) wires versus wires composed of other materials. We are very uncertain about the effect of multistrand StSt wires versus other wires on alignment rate (4 studies, 281 participants, 417 arches; very low-certainty evidence). There may be little to no difference between multistrand StSt wires and other wires in terms of intensity of pain (MD -2.68 mm, 95% CI -6.75 to 1.38; 2 studies, 127 participants, 127 arches; low-certainty evidence). Conventional nickel-titanium wires versus superelastic nickel-titanium wires Four studies with 266 participants (274 arches) evaluated conventional nickel-titanium (NiTi) wires versus superelastic NiTi wires. There may be little to no difference between the different wire types in terms of alignment rate (124 participants, 124 arches, 2 studies; low-certainty evidence) and intensity of pain (MD -0.29 mm, 95% CI -1.10 to 0.52; 2 studies, 142 participants, 150 arches; low-certainty evidence). Conventional nickel-titanium wires versus thermoelastic copper-nickel-titanium wires Three studies with 210 participants (210 arches) evaluated conventional Ni-Ti versus thermoelastic copper-nickel-titanium (CuNiTi) wires. We are very uncertain about the effects of the different arch wires on alignment rate (1 study, 66 participants, 66 arches; very low-certainty evidence). There may be little to no difference between conventional NiTi wires and thermoelastic CuNiTi wires in terms of time to alignment (alignment rate ratio 1.30, 95% CI 0.68 to 2.50; 1 study, 60 participants, 60 arches; low-certainty evidence). Superelastic nickel-titanium wires versus thermoelastic nickel-titanium wires Twelve studies with 703 participants (936 arches) evaluated superelastic NiTi versus thermoelastic NiTi wires. There may be little to no difference between superelastic NiTi wires and thermoelastic NiTi wires in alignment rate at four weeks (MD -0.28 mm, 95% CI 0.62 to 0.06; 5 studies, 183 participants, 183 arches; low-certainty evidence). We are very uncertain about the effects of the different wires on root resorption (2 studies, 52 participants, 312 teeth; very low-certainty evidence). Superelastic NiTi wires compared with thermoelastic NiTi wires may result in a slight increase in time to alignment (MD 0.5 months, 95% CI 0.21 to 0.79; 1 study, 32 participants, 32 arches; low-certainty evidence) but are probably associated with a slight increase in intensity of pain (MD 6.96 mm, 95% CI 1.82 to 12.10; 3 studies, 94 participants, 138 arches, moderate-certainty evidence). Single-strand superelastic nickel-titanium wires versus coaxial superelastic nickel-titanium wires Three studies with 104 participants (104 arches) evaluated single-strand superelastic NiTi versus coaxial superelastic NiTi wires. Use of single-strand superelastic NiTi wires compared with coaxial superelastic NiTi wires probably results in a slight reduction in alignment rate at four weeks (MD -2.64 mm, 95% CI -4.61 to -0.67; 2 studies, 64 participants, 64 arches, moderate-certainty evidence). Different sizes of nickel-titanium wires Two studies with 149 participants (232 arches) compared different types of NiTi wires. There may be little to no difference between different sizes of NiTi wires in terms of pain (low-certainty evidence).

AUTHORS' CONCLUSIONS

Superelastic NiTi wires probably produce slightly more pain after one day than thermoelastic NiTi wires, and single-strand superelastic NiTi wires probably have a lower alignment rate over four weeks compared with coaxial superelastic NiTi wires. All other evidence on alignment rate, root resorption, time to alignment, and pain is of low or very low certainty in all comparisons. Therefore, there is insufficient evidence to determine whether any particular arch wire material or size is superior to any other. The findings of this review are imprecise and unreliable; well-designed larger studies are needed to give better estimates of the benefits and harms of different arch wires. Orthodontists should exercise caution when interpreting the findings of this review and be prepared to adapt their treatment plans based on individual patient needs.

Effectiveness of laser-engineered copper-nickel titanium versus superelastic nickel-titanium aligning archwires: A randomized clinical trial

Objective

: To compare the effectiveness of laser-engineered copper-nickel titanium (SmartArch) and superelastic nickel-titanium (SENT) archwires in aligning teeth and inducing root resorption and pain experienced by patients.

Methods

: Two-arm parallel groups with a 1:1 allocation ratio were used. The participants were patients aged 11.5 years and older with 5-9 mm of mandibular anterior crowding who were indicated for non-extraction treatment. The primary outcome was alignment effectiveness, assessed using Little's irregularity index (LII) over 16 weeks with a single wire (0.016-inch) in the SmartArch group and 2 wires (0.014- and 0.018-inch) in the SENT group (8 weeks each). Secondary outcomes included root resorption evaluated by pre- and post-intervention periapical radiographs and pain levels recorded by the participants during the first week.

Results

: A total of 40 participants were randomly allocated into 2 groups; 33 completed the study and were analyzed (16 in the SmartArch group and 17 in the SENT group, aged 16.97 ± 4.05 years). The total LII decrease for the SmartArch and SENT groups was 5.63 mm and 5.29 mm, respectively, which was neither statistically nor clinically significant. Root resorption was not significantly different between the groups. The difference in pain levels was not statistically significant for the first 5 days following wire placement; however, there was a significant difference favoring the SENT group in the final 2 days.

Conclusions

: SmartArch and SENT archwires were similarly effective during the alignment phase of orthodontic treatment. Root resorption should be observed throughout the treatment with either wire. SmartArch wires demonstrated higher pain perception than SENT wires.

Alignment efficiency and three-dimensional assessment of root resorption after alignment with conventional and copper-nickel-titanium archwires: A randomized controlled trial

OBJECTIVE

To compare alignment efficiency and root resorption between nickel-titanium (NiTi) and copper-nickel-titanium (CuNiTi) archwires after complete alignment in mandibular anterior region.

METHODS

In this two-arm parallel single-blind randomized controlled trial, forty-four patients with Class I malocclusion with mandibular anterior crowding were recruited form orthodontic clinic of All India Institute of Medical Sciences (Jodhpur, India). Patients were randomly allocated into NiTi and CuNiTi groups, with a 1:1 allocation. Alignment was performed using 0.014-in, 0.016-in, 0.018-in, 0.019x0.025-in archwire sequence in the respective groups, which terminated in 0.019 x 0.025-in stainless-steel working archwire. The primary outcome was alignment efficiency, measured on study models from baseline (T0) to the first, second, third, fourth and fifth-month (T5). Secondary outcome was root resorption, measured from CBCT scans taken at T0 and T5. Mixed-factorial ANOVA was used to compare Little's Irregularity Index (LII). For assessing the proportion of patients with complete alignment at the end of each month, Kaplan-Meier survival curve was built and time to treatment completion was compared between groups using log rank test. Paired t-test was used to assess external apical root resorption (EARR) within groups, whereas independent t-test was used to evaluate LII and EARR between the groups.

RESULTS

Twenty-two patients were recruited in each group. One patient was lost to follow-up in the CuNiTi group. No statistically significant differences were observed in alignment efficiency between the groups (p>0.05). Intergroup comparison revealed that the changes in root measurement in three-dimensions were not statistically significant (p>0.05), except for mandibular right central incisor, which showed increased resorption at root apex in NiTi group (p<0.01).

CONCLUSION

The two alignment archwires showed similar rate of alignment at all time points. Root resorption measurement did not differ between the NiTi and CuNiTi groups, except for the mandibular right central incisor, which showed more resorption in NiTi group.

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.

A comparison between two orthodontic archwire sequences in terms of speed of alignment and root resorption: a randomized controlled clinical trial

OBJECTIVES

To compare between two archwire (AW) sequences in terms of alignment speed and root resorption (RR).

MATERIALS AND METHODS

Fifty-four patients (14 males, 40 females) requiring orthodontic treatment were randomly allocated into two groups; in group A (mean age 18.3) treatment started with 0.014″ nickel titanium (NiTi) followed by 0.019″×0.025″ NiTi AW while group B (mean age 18.9) the AW sequence was 0.014″ NiTi, 0.018″ NiTi, 0.016″×0.022″ NiTi, 0.019″×0.025″ NiTi. The primary outcome was to compare the alignment speed of the crowded upper and lower teeth between the two different AW sequences. The secondary outcome was to assess the magnitude of upper and lower incisors' root resorption (RR) measured by digital periapical radiographs taken at the start of treatment and 1 month after the placement of the working AW. t-test was used to compare the alignment speed and RR between the two groups. Statistical significance was predetermined at the P ≤ 0.05 level for all tests.

RESULTS

The 54 patients were randomized in a 1:1 ratio to either group. Seven patients were excluded and complete data were obtained for 47 patients; 24 and 23 patients in group A and group B, respectively. There was no significant difference between the two groups in the alignment speed in the lower arch (P>0.05, mean difference=-0.44, 95% CI=-0.9 to 0.03) and root resorption (P>0.05). Alignment of upper arch was faster in group A (P < 0.0001, mean difference= - 0.9, 95% CI =-1.4 to -0.5).

CONCLUSIONS

There is no significant difference between the two groups in the alignment speed in the lower arch and incisors' RR. Upper arch alignment was faster in group A.

TRIAL REGISTRATION

Not registered.

The scientific evidence for pre-adjusted edgewise attachments and mechanics

Introduction Fixed orthodontic appliance systems continue to evolve with a wealth of evidence emerging to underpin these refinements.Aims To present the evidence from comparative prospective research informing the selection of fixed appliance design and mechanics.Design Detailed literature review.Materials and methods An electronic search to identify randomised controlled trials and clinical controlled trials was undertaken using pre-defined search terms.Results Based on high-level evidence, no one bracket system has been proven superior in terms of efficiency or outcome. Similarly, a clear advantage associated with one wire type or dimension has not been shown. The effect of lacebacks in terms of anchorage management appears to be limited, while elastomeric chain and nickel titanium closing coils are associated with similar rates of space closure.Discussion A wealth of high-quality recent evidence to support the selection of fixed appliance attachments, archwires and auxiliaries, including lacebacks and space closing mechanics, was identified.Conclusions There has been a considerable increase in the amount of high-quality evidence informing the choice of pre-adjusted edgewise mechanics in recent years. This information can be used to make evidence-based decisions in the selection and manipulation of fixed appliances during daily practice.