Comparison of changes in irregularity and transverse width with nickel-titanium and niobium-titanium-tantalum-zirconium archwires during initial orthodontic alignment in adolescents: A double-blind randomized clinical trial

Comparison of alignment efficiency of different sizes of superelastic nickel-titanium archwires in the initial phase of fixed orthodontic treatment: A single-center, double-blind randomized clinical trial

INTRODUCTION

This 3-arm parallel, double-blind study aimed to evaluate the alignment efficiency of 3 different diameters of superelastic nickel-titanium (NiTi) archwires during the initial phase of orthodontic treatment.

METHODS

Ninety-three patients with nonextraction treatment in the mandibular arch (using 0.022-in Roth prescription brackets) were randomly allocated into 3 groups: 0.012-in NiTi (group 1), 0.014-in NiTi (group 2), and 0.016-in NiTi (group 3). The alignment change was measured using the modified Little's irregularity index before archwire placement and every 4 weeks. The alignment efficiency of the 3 groups was analyzed.

RESULTS

Ninety patients were analyzed (group 1: n = 29, group 2: n = 31, and group 3: n = 30; overall mean age, 16.6 years). The overall Wald test analysis revealed that wire type was not statistically significant (P = 0.91), whereas time exhibited significance as expected (P <0.001). Furthermore, the interaction between wire type and time was not significant (P = 0.93). The time-adjusted estimated difference between 0.014-in and 0.012-in was -0.49 (95% confidence interval, -2.83 to 1.85; P = 0.68). The time-adjusted estimated difference between 0.016-in and 0.012-in was -0.45 (95% confidence interval, -2.95 to 2.05; P = 0.72). No harm was observed.

CONCLUSIONS

The clinical performance of 3 different sizes of NiTi archwires was similar. In addition, 0.014-in and 0.016-in NiTi archwires demonstrated better performances in aligning any irregularities because of a greater number of wire deformations in the 0.012-in group.

REGISTRATION

IR.TBZMED.REC.1395.1039.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

None.

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.

Load Deflection Characteristics of Orthodontic Gummetal® Wires in Comparison with Nickel-Titanium Wires: An In Vitro Study

The aim of this study was to investigate the load deflection characteristics of Gummetal® wires in comparison to nickel-titanium (NiTi) wires. Four different NiTi wires and one Gummetal® archwire were analyzed in two dimensions (0.014″ (0.36 mm) and 0.016″ × 0.022″ (0.41 mm × 0.56 mm)) and in two different orientations (edgewise and ribbonwise) using three-point bending tests at T = 37 °C. Force-displacement curves were recorded and analyzed. The Gummetal® 0.014″ wires exhibited higher forces compared to the NiTi wires at 2.0 mm deflection. At 1.0 mm deflection, the opposite pattern was observed. For the 0.016″ × 0.022″ Gummetal® wires, the forces were within the force interval of the NiTi wires at 2.0 mm deflection. At a deflection of 1.0 mm, no residual force was measurable for the Gummetal® wires. All the NiTi wires investigated showed hysteresis and a superelastic plateau. However, the Gummetal® did not form a plateau, but hysteresis was present. An easier plastic deformability compared to the NiTi wires was observed for all the tested geometries.

Effect of low-level laser therapy on orthodontic dental alignment: a systematic review and meta-analysis

The aim of this study is to systematically summarize the available evidence regarding low-level laser therapy (LLLT) speed-up effect on dental alignment in comprehensive orthodontic treatment. An extensive electronic search was conducted in PubMed, ScienceDirect, Cochrane, Web of Science, and Scopus up to February 20, 2023. The Cochrane risk of bias tool and the Newcastle-Ottawa Quality Assessment Form were used by two authors independently to assess the risk of bias (RoB). Statistical analysis was performed by Review Manager 5.3. The eight eligible trials were reviewed and included in qualitative synthesis. Four studies reported the overall time of leveling and alignment (OLAT, days), enabling a synthesizing of the data. The meta-analysis results showed that LLLT significantly reduced the overall time of leveling and alignment compared to control group (MD=-30.36, 95% CI range -41.50 to -19.22, P<0.0001), with moderate heterogeneity (χ2=4.10, P=0.25, I2=27%). Based on the data available, statistically significant evidence with moderate risk of bias suggests that LLLT may have a positive effect on accelerating dental alignment. However, due to the differences in intervention strategy and evaluating method, the conclusions should be interpreted with caution.

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.

Effects of various coating methods on the mechanical, physical, and aesthetic properties of GUMMETAL® archwires: In vitro study

PURPOSE

The objective of this study was to evaluate the mechanical, physical, and aesthetic properties of GUMMETAL® (GM) orthodontic archwires after the application of various aesthetic coating materials.

METHODS

This in vitro study included 180 orthodontic wires: five experimental groups used 0.016×0.022-inch GM as the core-based wire followed by the application of epoxy, polytetrafluoroethylene (PTFE), clear ceramic, white ceramic, or silicone; and four control groups: 0.016×0.022-inch GM, 0.019×0.025-inch GM, 0.016×0.022-inch stainless steel (SS), and 0.019×0.025-inch SS. Frictional forces, force deflection rate, yield strength, aesthetic colour value, corrosive and wear resistance were compared between the experimental and control groups.

RESULTS

Among the coated wires, white ceramic exhibited the highest frictional force (2.06±0.20 N) and silicone showed the lowest values (0.88±0.12 N). There were significant differences in static friction between experimental and control groups (P<0.001). PTFE coating had the highest force deflection rate (9.03±0.12 N/mm) and yield strength (10.0±0.14 N/mm) among coated wires and white ceramic exhibited the lowest values (6.86±0.14 N/mm and 7.74±0.17 N/mm for force deflection rate and yield strength, respectively). Differences in force deflection rate and yield strength between experimental and control groups were statistically significant (P<0.001). All coated wire groups had a clinical difference in colour when compared to A1 shade. Coated and uncoated wires showed good corrosion resistance after one week in corrosive saliva with no detectable loss of mass.

CONCLUSIONS

This study has shown that coating wires can improve some aspects of the wire properties but not all when compared to uncoated GM and SS. Future investigation of the materials used in this study is required to further characterize their properties.

Friction forces generated by aesthetic Gummetal® (Ti-Nb) orthodontic archwires: A comparative in vitro study

OBJECTIVE

The aim of this in vitro study was to compare friction forces generated by the following archwires: rhodium-plated aesthetic Gummetal® (E-GM), Gummetal® (GM), stainless steel (SS) and titanium-molybdenum alloy (TMA), according to bracket-wire angulation and archwire cleanliness.

METHODS

One hundred and ninety-two samples of four orthodontic alloys (E-GM, GM, SS, and TMA) were prepared. The samples were divided into two groups: uncleaned and cleaned using 99% isopropanol in an ultrasonic bath, then subdivided into three subgroups according to bracket-wire angulation: 0°, 5° and 10°. Using a universal testing machine, the wires were pulled through SS maxillary right canine brackets to test static friction forces according to bracket-wire angulation and wire cleanliness. Representative specimens were evaluated to assess surface morphology and roughness.

RESULTS

There were significant differences in static friction forces between archwires when analysed by bracket-wire angulation and cleanliness (P<0.001) except for the 0° uncleaned group. Overall, TMA archwires produced the highest friction while SS wires showed the lowest friction at 0° and 5°. E-GM wires showed comparable friction to SS at 0^o (cleaned and uncleaned), but significantly higher friction than SS at 5^o (uncleaned) and 10° (cleaned). GM wires had comparable friction to SS at 0° (cleaned and uncleaned), but significantly less friction at the 5° (cleaned) and 10° (cleaned and uncleaned). Compared to GM, E-GM had significantly higher friction at 5^o and 10° (cleaned and uncleaned). Cleaning wires reduced surface roughness but increased overall friction.

CONCLUSION

E-GM wires generate higher frictional resistance forces compared to GM and SS, especially at higher bracket-wire angulations and when cleaned. GM friction forces are comparable to SS and thus could be used for space closure with sliding mechanics. However, E-GM wires are not ideal for the same purpose.

Comparison of retraction efficacy of titanium-molybdenum and titanium-niobium alloy wires – A prospective split-mouth study

Objectives:

The study aimed to compare the efficacy of Titanium-Molybdenum (Ti-Mo) and Titanium-Niobium (Ti-Nb) alloy wires as retraction springs, by comparing: The amount and rate of canine retraction, the degree of canine rotation, the change in axial inclination of canines, and the associated anchorage loss.

Material and Methods:

All 17 participants (age: 18–25 years) to be treated with the first premolar extraction approach by canine retraction were assigned Ti-Mo and Ti-Nb alloy T-loop springs to either of the upper quadrants randomly. Digital intraoral 3-D scans and panoramic radiographs orthopantomagram (OPG) were taken before (T0) and after (T1) the study period (4 months). 3-D superimposition was performed and using the digital models and OPG, changes in canine position, angulation, and anchorage loss were compared between the two groups.

Results:

There was no significant difference between the two treatment groups for all the parameters pertaining to maxillary canine retraction, that is, canine retraction (P = 0.72), change in axial inclination of canines (P = 0.71), rotation of canines (P = 0.74), and anchorage loss (P = 0.13) as well as extraction space closure (P = 0.74).

Conclusion:

Ti-Nb and Ti-Mo alloy wires show a similar potency for use in retraction mechanics for orthodontic space closure.

Orthodontic treatment for crowded teeth in children

BACKGROUND

Crowded teeth develop when there is not enough space in the jaws into which the teeth can erupt. Crowding can affect baby teeth (deciduous dentititon), adult teeth (permanent dentition), or both, and is a common reason for referral to an orthodontist. Crowded teeth can affect a child's self-esteem and quality of life. Early loss of baby teeth as a result of tooth decay or trauma, can lead to crowded permanent teeth. Crowding tends to increase with age, especially in the lower jaw.

OBJECTIVES

To assess the effects of orthodontic intervention for preventing or correcting crowded teeth in children. To test the null hypothesis that there are no differences in outcomes between different orthodontic interventions for preventing or correcting crowded teeth in children.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 11 January 2021 and used additional search methods to identify published, unpublished and ongoing studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that evaluated any active interventions to prevent or correct dental crowding in children and adolescents, such as orthodontic braces or extractions, compared to no or delayed treatment, placebo treatment or another active intervention. The studies had to include at least 80% of participants aged 16 years and under.

DATA COLLECTION AND ANALYSIS

Two review authors, independently and in duplicate, extracted information regarding methods, participants, interventions, outcomes, harms and results. We resolved any disagreements by liaising with a third review author. We used the Cochrane risk of bias tool to assess the risk of bias in the studies. We calculated mean differences (MDs) with 95% confidence intervals (CI) for continuous data and odds ratios (ORs) with 95% CIs for dichotomous data. We undertook meta-analysis when studies of similar comparisons reported comparable outcome measures, using the random-effects model. We used the I2 statistic as a measure of statistical heterogeneity.

MAIN RESULTS

Our search identified 24 RCTs that included 1512 participants, 1314 of whom were included in analyses. We assessed 23 studies as being at high risk of bias and one as unclear.  The studies investigated 17 comparisons. Twenty studies evaluated fixed appliances and auxiliaries (lower lingual arch, lower lip bumper, brackets, archwires, lacebacks, headgear and adjunctive vibrational appliances); two studies evaluated removable appliances and auxiliaries (Schwarz appliance, eruption guidance appliance); and two studies evaluated dental extractions (lower deciduous canines or third molars). The evidence should be interpreted cautiously as it is of very low certainty. Most interventions were evaluated by a single study. Fixed appliances and auxiliaries One study found that use of a lip bumper may reduce crowding in the early permanent dentition (MD -4.39 mm, 95% CI -5.07 to -3.71; 34 participants). One study evaluated lower lingual arch but did not measure amount of crowding. One study concluded that coaxial nickel-titanium (NiTi) archwires may cause more tooth movement in the lower arch than single-stranded NiTi archwires (MD 6.77 mm, 95% CI 5.55 to 7.99; 24 participants). Another study, comparing copper NiTi versus NiTi archwires, found NiTi to be more effective for reducing crowding (MD 0.49 mm, 95% CI 0.35 to 0.63, 66 participants). Single studies did not show evidence of one type of archwire being better than another for Titinol versus Nitinol; nickel-titanium versus stainless steel or multistrand stainless steel; and multistranded stainless steel versus stainless steel.  Nor did single studies find evidence of a difference in amount of crowding between self-ligating and conventional brackets, active and passive self-ligating brackets, lacebacks added to fixed appliances versus fixed appliances alone, or cervical pull headgear versus minor interceptive procedures. Meta-analysis of two studies showed no evidence that adding vibrational appliances to fixed appliances reduces crowding at 8 to 10 weeks (MD 0.24 mm, 95% CI -0.81 to 1.30; 119 participants). Removable appliances and auxiliaries One study found use of the Schwarz appliance may be effective at treating dental crowding in the lower arch (MD -2.14 mm, 95% CI -2.79 to -1.49; 28 participants). Another study found an eruption guidance appliance may reduce the number of children with crowded teeth after one year of treatment (OR 0.19, 95% CI 0.05 to 0.68; 46 participants); however, this may have been due to an increase in lower incisor proclination in the treated group. Whether these gains were maintained in the longer term was not assessed. Dental extractions One study found that extracting children's lower deciduous canines had more effect on crowding after one year than no treatment (MD -4.76 mm, 95 CI -6.24 to -3.28; 83 participants), but this was alongside a reduction in arch length. One study found that extracting wisdom teeth did not seem to reduce crowding any more than leaving them in the mouth (MD -0.30 mm, 95% CI -1.30 to 0.70; 77 participants).

AUTHORS' CONCLUSIONS

Most interventions were assessed by single, small studies. We found very low-certainty evidence that lip bumper, used in the mixed dentition, may be effective for preventing crowding in the early permanent dentition, and a Schwarz appliance may reduce crowding in the lower arch. We also found very low-certainty evidence that coaxial NiTi may be better at reducing crowding than single-stranded NiTi, and that NiTi may be better than copper NiTi. As the current evidence is of very low certainty, our findings may change with future research.

Impact of the prefabricated forms of NiTi archwires on orthodontic forces delivered to the mandibular dental arch

BACKGROUND

Although preformed archwires with a variety of arch forms are currently commercially available, the effects of variation in the shape of these archwires on the orthodontic force at each tooth are not well understood. Therefore, we evaluated the forces delivered by various types of commercially available preformed nickel-titanium alloy (NiTi) archwires in a simulated mandibular dental arch.

METHODS

Sixty-three types of 0.019 × 0.025-inch preformed NiTi archwires from 15 manufactures were selected for analysis. The intercanine width (ICW) and intermolar width (IMW) of each archwire were measured at the mean canine and first molar depths of 30 untreated subjects with normal occlusions. Each archwire was placed in a multi-sensor measurement system simulating the mandibular dental arch of subjects with normal occlusions, and orthodontic forces in the facial-lingual direction at the central incisors, canines, and first molars were measured. Correlations between the ICW, IMW, and ICW/IMW ratio of archwires and the delivered forces were analyzed. The archwires were classified into the following four groups according to the ICW and IMW: Control group, ICW and IMW are within the means ± standard deviations of the normal ranges; Ovoid group, narrow ICW and IMW; Tapered group, narrow ICW; and Square group, narrow IMW. The forces were compared among these groups for each tooth.

RESULTS

Significant correlations between the measured archwire width and force to each tooth were found, except between IMW and forces at the central incisors and canines. Significant differences in the forces were found among all groups, except between the Ovoid and Tapered groups at all teeth and between the Ovoid/Tapered and Control groups at the first molar. Significantly greater orthodontic forces in the facial direction were delivered at the central incisors by the archwires in the Ovoid and Tapered groups when compared with the archwires in the other groups.

CONCLUSION

These findings suggest that there is a possible risk of a clinically significant level of unfavorable orthodontic force being delivered to the mandibular incisors in labial inclination when using a preformed archwire with an ICW that is narrower than the dental arch.

Duration of tooth alignment with fixed appliances: A systematic review and meta-analysis

INTRODUCTION

A key goal of orthodontic treatment with fixed appliances is alignment of the dentition, and this remains a commonly selected outcome in clinical studies investigating orthodontic tooth movement. This systematic review has evaluated treatment duration to achieve alignment of the mandibular dentition using fixed appliances.

METHODS

Systematic literature searches without restrictions were undertaken in 9 databases for randomized clinical trials (RCTs) assessing duration and rate of tooth alignment using fixed appliances with or without treatment adjuncts published up to January 2021. After duplicate study selection, data extraction, and risk of bias assessment according to Cochrane, random-effects meta-analyses of aggregate data, and individual patient data were conducted.

RESULTS

Thirty-five trials were included with 2258 participants (39% male; mean age 17.8 years), giving a pooled duration to achieve whole-arch alignment of the mandibular dentition of 263.0 days (4 trials; 95% confidence interval [CI], 186.7-339.4 days) and incisor alignment in the mandibular arch of 100.7 days (9 trials; 95% CI, 84.1-117.4 days). Surgical-assisted orthodontics was associated with reduced duration of incisor alignment: mean difference of 44.3 days less (4 trials; 95% CI, 20.0-68.9 days; P <0.001; high quality of evidence), whereas subgroup and meta-regression analyses indicated significant effects of baseline crowding and premolar extractions. Individual patient data analysis from 3 RCTs indicated that for each additional participant age year, whole-arch alignment of the mandibular dentition took 13.7 days longer (3 trials; 95% CI, 7.7-17.7 days; P <0.001) and for each additional mm of irregularity, 17.5 days more were needed (2 trials; 95% CI, 9.8-25.2 days; P <0.001).

CONCLUSIONS

Patient and treatment-related characteristics can significantly affect the duration of tooth alignment and should be taken into account both clinically and when designing trial outcomes. Future research studies investigating rates of orthodontic tooth alignment would benefit from adequate sample sizes and a more consistent methodology in outcome assessment. Data in this systematic review provides a basis for appropriate trial design for future RCTs investigating the rate of orthodontic tooth alignment with fixed appliances.

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

Background

Nickel-titanium (NiTi) archwires are routinely used for initial leveling and alignment of teeth in orthodontic treatment. This study aimed to clinically compare the level of pain and tooth alignment in orthodontic treatment with A-NiTi versus Cu-NiTi archwires.

Methods

In this parallel randomized clinical trial, 88 orthodontic patients (12–25 years) with an irregularity index > 2 mm in the anterior site of the lower dental arch who required non-extraction orthodontic treatment of the lower arch were randomized into two age- and sex-matched groups (n = 44) for treatment with A-NiTi and Cu-NiTi initial archwires. Each archwire was used for 6 weeks. After 6 weeks, the irregularity index was measured, and the level of pain was scored using the Modified McGill pain questionnaire (MPQ) and visual analog scale (VAS) according to the time of onset and duration of pain, and analgesic intake. Data were analyzed by paired t test, independent samples t test, and Chi-square test (P < 0.05).

Results

The irregularity index significantly decreased in both groups after 6 weeks of treatment (P < 0.001). However, the difference in this respect was not significant between the two groups (P > 0.05). Pain perception (P = 0.487), duration of pain (P = 0.546), and analgesic intake (P = 0.102) were not significantly different between the two groups either.

Conclusion

Both A-NiTi and Cu-NiTi archwires are equally effective for tooth alignment in the anterior site of the lower dental arch and have no significant difference with regard to the level of pain experienced by patients.

Trial registration number: IRCT20190705044102N1 and Name of the registry: Iranian registry of clinical trials (https://irct.ir/) Date of registration: September, 26, 2019

Clinical Features and Physical Properties of Gummetal Orthodontic Wire in Comparison with Dissimilar Archwires: A Critical Review

Objective

Gummetal is a novel multifunctional alloy which possesses distinctive properties with the potential to refine and amend the efficacy of orthodontic treatment. The objective of this critical literature review was to investigate scientific evidence concerning the mechanical and clinical features of this recently manufactured beta-titanium orthodontic wire.

Materials and Methods

Electronic databases: PubMed, PMC, Google Scholar, Ovid, and Cochrane Library were searched. Studies investigating the properties of Gummetal orthodontic wire including in vitro and clinical studies were selected, validity was assessed, and data was extracted. The risk of bias was assessed by the Cochrane risk of bias Tool 2.0 in a randomized clinical trial. Results and Discussion. Among 322 papers, 13 papers were selected and divided into two groups: prospective double-blinded randomized clinical trial and in vitro studies.

Conclusions

The results of this review should be interpreted with caution because of the heterogeneity of the studies. Only single clinical trial paper was found in the literature. The studies reported different characteristics obtained by various methods; thus, it was difficult to objectively compare the results. Low bending strength, low fatigue limit, and high resilience have been confirmed. Gummetal provides lower force than Nitinol and TMA but higher than Supercable wire. Plastic deformation of Gummetal questions its superelasticity. Friction of Gummetal wire is comparable to SS and CoCr wires. Because of its nontoxic chemical composition, Gummetal might be useful in the initial phase of orthodontic treatment for patients suffering from nickel allergy. Further studies are necessary to assess the usefulness of Gummetal in the clinical practice.

Comparison of Mechanical and Structural Properties of Nickel-titanium Alloy with Titanium-molybdenum Alloy and Titanium-niobium Alloy as Potential Metals for Endodontic Files

Introduction

The objective of this study was to compare the mechanical and structural properties of the nickel-titanium (Ni-Ti) alloy already used in endodontics with titanium-molybdenum (Ti-Mo) and titanium-niobium (Ti-Nb) alloys to determine if these can be suggested in the manufacture of endodontic files.

Methods and Materials

Orthodontic wires made of the different alloys were used. The previously mentioned alloys were characterized by energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD) and torsion tests. Cyclic fatigue tests were performed on a simulated canal with a curvature of 86° to 375 rpm. The fractured surfaces of the wires were observed by means of scanning electron microscopy (SEM). A Kruskal-Wallis test and U Mann Whitney test were used to determine significant differences in cyclic fatigue between groups.

Results

In the mechanical tests, similar values of torsion were found for the three alloys. In XRD, the Ti-Nb showed less structural changes. In the cyclic fatigue test, Ti-Nb was found to be significantly more resistant with respect to Ni-Ti and Ti-Mo.

Conclusion

Based on our in vitro study, Ti-Nb is suggested as a possible alloy for the manufacture of rotary files due to its impressive properties.

An in vitro assessment of the influences of different wire materials and bracket systems when correcting dental crowding

A recently developed orthodontic wire alloy known as GUMMETAL® is claimed to deliver more physiological forces to correct dental mispositioning. However, its mechanical characteristics have not been fully characterized yet. This study aimed to determine and compare the elastic properties of different wire alloys, such as nickel-titanium (NiTi), stainless steel (SS), and GUMMETAL®, and assess their unloading forces when combined with either conventional or self-ligating brackets (CL and SL) when correcting dental crowding. All wires had a 0.016″ cross-section diameter. A three-point bending test was performed to assess the maximum deflection of each wire. Then, a subsequent analysis measured the unloading force for each wire/bracket system in a dental crowding clinical simulation device. The test was carried out in a universal testing machine with a cross-speed displacement of 0.5 mm/min. Data were recorded in different ranges and statistically evaluated using two-way analysis of variance. GUMMETAL® displayed higher unloading mean forces in SL brackets (2228.78 cN) than CL brackets (1967.38 cN) for the 1.6-3.0 deflection interval (p = 0.018). Within this interval, NiTi showed higher forces when used with CL brackets (2683.06 cN) than with SL brackets (1179.66 cN) (p < 0.0001). For the CL bracket systems, SS wires showed higher forces (2125.31 cN) in the 1.0-1.6 deflection interval than the other two wire alloys (NiTi, 1541.52 cN and GUMMETAL®, 852.65 cN) (p < 0.0001). SS wires also displayed lower forces with SL brackets (1844.01 cN) than in CL brackets (2125.31 cN) (p = 0.049). Thus, only GUMMETAL® revealed to be an optimal choice for SL brackets, whereas NiTi for CL brackets.

Effectiveness of two thermal activated orthodontic archwire sequences based on transition temperature range during alignment: A randomized non-controlled comparative study

INTRODUCTION

It has been suggested that heat-activated NiTi archwires (HANT) speed up crowding alleviation. HANT wires are available with different austenite finish temperatures.

OBJECTIVE

The aim of the present study was to compare the effectiveness of two alignment sequences using thermally activated archwires with different austenite activation temperatures for the correction of mandibular anterior crowding.

MATERIAL AND METHODS

The following NiTi archwire sequence was used for both groups: 0.012 in (conventional NiTi), 0.018 in (heat-activated NiTi archwires), 0.016×0.022 in (heat-activated NiTi archwires) and 0.019×0.025 in (conventional NiTi). The conventional NiTi used for both groups belongs to the same commercial brand. Two different austenite activation temperatures (35°C and 37°C) were used for the heat-activated archwires. The primary outcome was the degree of crowding correction measured on study models. The secondary outcome was crowding survival time over a six-month period. This RTC included fifty-four patients that were randomly allocated to the two different archwire sequences. A Mann-Whitney test was used to compare the groups regarding crowding alleviation. A survival curve was created using the Kaplan-Meier method to illustrate the reduction of crowding over time. A Mantel-Cox log-rank test was used to compare survival times (until correction of crowding).

RESULTS

No differences in crowding alleviation were identified between both groups (log-rank test; P=0.77).

CONCLUSIONS

The two alignment sequences with different thermal activated archwires at 35°C and 37°C achieved similar clinical results during the correction of mandibular anterior crowding.

Outcome of photodynamic therapy on orthodontic leveling and alignment of mandibular anterior segment: A controlled clinical trial

BACKGROUND

Photodynamic therapy (PDT) is a non-invasive approach that has drawn attention to accelerate orthodontic tooth movement (OTM). However, no studies have been published that evaluates the outcome of PDT on orthodontic leveling and alignment. Therefore, the present study aimed to evaluate outcome of PDT on orthodontic leveling and alignment of mandibular anterior segment.

MATERIALS AND METHODS

Thirty patients (18 females and 12 males) were included who had moderate mandibular crowding with average age was 19.23 ± 3.1 years. They were randomly divided into a control group without PDT intervention and a laser group. All patients followed non-extraction approach using one category of fixed appliance and matching NiTi archwire sequence for 3 months. In PDT group, methylene blue mediated gallium aluminum arsenide laser was applied with 635 nm, 6.5 J/cm², for 10 s at 10 points (0.2 J/point) started immediately after first wire then at days 3,7,14 of first month and repeated for additional 2 months. Relief of crowding was assessed by Little`s irregularity index (LII) scores after 4, 8, and 12 weeks through scanned 3-dimensional models via a software.

RESULTS

Both groups showed improvements in mandibular crowding as evidenced by significant decreases (p ≤ 0.001) in LII scores during all observation intervals with no significant differences (p > 0.05). Moreover, the alignment`s rate showed no significant differences between groups.

CONCLUSION

PDT produced a negligible effect concerning alignment of crowded mandibular anterior teeth. Besides, OTM's rate at different observation intervals showed an equivalent pattern either with or without PDT.

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.

Dentoskeletal and soft tissue changes associated with miniscrew anchorage in customized lingual orthodontics

Objectives

The goal of this study was to analyze skeletal, dental, and soft tissue changes of patients treated with customized lingual systems and to evaluate the clinical effectiveness of miniscrew anchorage.

Methods

Nine upper first premolar extraction patients who were treated with customized lingual appliances were included in this study. Miniscrews were used for reinforcement of molar anchorage. Cephalometric films and study models were obtained before treatment (T1), after alignment (T2), and after treatment (T3). Treatment effects were analyzed by cephalometric radiographs and study models.

Results

The upper anterior teeth were retracted significantly at T2 and T3 (4.41 ± 4.14 mm and 5.51 ± 2.48 mm, respectively). During space closure, the upper first molars showed slight mesial movement (1.50 ± 1.97 mm). The intercanine width of the upper arch increased at T2 (1.59 ± 1.81 mm), but decreased at T3 (0.11 ± 1.00 mm). The sella-nasion-A, A-nasion-B, and mandibular plane angles were not significantly changed at T3. The upper lip showed continuous retraction at both T2 and T3 (1.40 ± 1.46 mm and 2.32 ± 2.48 mm, respectively).

Conclusions

By using miniscrew anchorage for lingual orthodontics, patients’ dental and soft tissue changes considerably improved and molar anchorage was reinforced.

Review of Superelastic Differential Force Archwires for Producing Ideal Orthodontic Forces: an Advanced Technology Potentially Applicable to Orthognathic Surgery and Orthopedics

PURPOSE OF REVIEW

Gentle and continuous loads are preferred for optimum orthodontic tooth movement. Nitinol, an alloy of nickel and titanium developed for the aerospace industry, found its first clinical applications in orthodontics because it has ideal load-deflection behavior. The purpose of this review is to elucidate the criteria for effective orthodontic mechanics relative to emerging Nitinol technology. The specialized materials with variable stiffness that were originally developed for orthodontics are increasingly attractive for in the temporomandibular joint, orthognathic surgery, and orthopedics.

RECENT FINDINGS

The evolution of orthodontic archwires is driven by a need to achieve low load-deflection characteristics and Nitinol is the alloy of choice. Scientific knowledge of the biological response to orthodontic forces continues to grow, but definitive guidance on optimal force levels for individual teeth is elusive. Finite element models (FEM) that take into account periodontal ligament (PDL) stresses indicate differential force archwires are needed to realize optimal treatment. However, previous wire fabrication methods, including welding of different materials and selective resistive heating, are limited by poor mechanical performance and spatial resolution. Recently, a novel laser processing technique was developed for precisely programing relative levels of stiffness in a single archwire. FEM was used to estimate the optimal force for each tooth by calculating the 3D bone-PDL surface area. There remains a general consensus that light and continuous forces are desirable for orthodontic treatment. New developments in archwire materials and technology have provided the orthodontist with a complete spectrum of load-deflection rates and differential force options to express these forces with maximized archwire economy. These technologies also appear to have application to orthopedic implant devices.