10.

5005/jp-journals-10021-1154
RESEARCH ARTICLE
Kunal Rajesh Mehta, Ravindranath B Sable

Comparison of the Amount of Maxillary Canine

Retraction, with T-Loops, using TMA and
Stainless Steel Wires: A Clinical Study
1
Kunal Rajesh Mehta, 2Ravindranath B Sable

ABSTRACT

Introduction: The purpose of this study was to evaluate and compare the efficiency between stainless steel and titanium molybdenum alloy
(TMA), in terms of canine retraction, canine angulation and canine rotation using identical T-loop design and activation over a 4-month period.
Materials and methods: Fifteen subjects were selected for the study. Standardized T-loops in 0.017 × 0.025 inch TMA and 0.016 × 0.022 inch
stainless steel wires for left and right maxillary canines were activated to generate 200 gm of force every month for a period of 4 months.
Results: Greater amount of maxillary canine retraction occurred using the 0.017 × 0.025 TMA T-loop (5.46 mm) as compared to the 0.016 ×
0.022 stainless steel T-loop (4.20 mm). The 0.017 × 0.025 TMA T-loop showed 7.83° tipping, whereas the 0.016 × 0.022 stainless steel T-loop
showed 10° tipping, indicating that the TMA T-loop had better control. The 0.016 × 0.022 stainless steel T-loop (39.44%) offered better rotational
control over the 0.017 × 0.025 TMA T-loop (50.82%).
Conclusion: The 0.017 × 0.025 TMA T-loops offer more canine retraction and tipping control whereas 0.016 × 0.022 stainless steel T-loops offer
better rotational control.
Keywords: Canine retraction, Segmented mechanics, T-loops, Titanium molybdenum alloy wire, Stainless steel wire.

How to cite this article: Mehta KR, Sable RB. Comparison of the Amount of Maxillary Canine Retraction, with T-Loops, using TMA and
Stainless Steel Wires: A Clinical Study. J Ind Orthod Soc 2013;47(4):178-183.

INTRODUCTION molybdenum, 6% zirconium and 6% beta titanium alloy) which

showed twice the amount of deflection and delivered half the
The proper position of canines shares a very important role in
amount of force as compared to stainless steel wires.
oral function and esthetics. Their unique position makes their
Burstone, van Steenbergen, Hanley6 in 1995 mentioned that
orthodontic movement of great clinical importance, especially
T-loops had three important characteristics, i.e. , i.e. anterior
in premolar extraction cases. Segmented arch technique is a
moment or , i.e. posterior moment and a horizontal moment.
modified edgewise orthodontic procedure developed by
Viecilli (2006)7 stated that the effects of steps, angles
Burstone1 in 1962 which consists of multiple wires found in
and vertical forces could be combined to produce an ideal
different portions of arch. The force systems are relatively
T-loop design. According to Proffit (2007),8 segmented
constant and with long ranges of activation and optimum force
retraction of canines with frictionless springs reduces the
levels their resulting movement is predictable, as stated by
strain on posterior teeth and is a readily available approach
Burstone, Baldwin, Lawless.2 Later in 1966, Burstone CJ3
with the modern 18-slot appliance.
stated that moment-to-force ratio, magnitude of force and the
This study was undertaken over a 4-month period at the
constancy of force determine the success of an appliance. The
Department of Orthodontics and Dentofacial Orthopedics,
segmented arch technique has many advantages like better
Bharati Vidyapeeth University, Dental College and Hospital,
control over the forces, more efficient tooth movement over
Pune, for the following:
long distances with light constant forces, as stated by Burstone,
1. To compare the amount of canine retraction using 0.017 ×
Koenig (1976).4 In 1980, Burstone and Goldberg5 introduced
0.025 TMA and 0.016 × 0.022 stainless steel T-loop springs.
beta titanium molybdenum alloy (TMA) wire (11%
2. To compare the change in canine angulation during canine
retraction in both the groups.
1
Senior Lecturer, 2Professor and Head 3. To compare the effect of 0.017 × 0.025 TMA and 0.016 ×
1
Department of Orthodontics, MA Rangoonwala Dental College, Pune 0.022 stainless steel T-loop springs on canine rotation.
Maharashtra, India
2
Department of Orthodontics, Bharati Vidyapeeth University Dental MATERIALS AND METHODS
College and Hospital, Pune, Maharashtra, India
Materials
Corresponding Author: Kunal Rajesh Mehta, Senior Lecturer
Department of Orthodontics, MA Rangoonwala Dental College, Pune Fifteen subjects were selected for the study. Following
Maharashtra, India, e-mail: drkmehtaortho@gmail.com inclusion criteria were used for the selection of subjects in
this study:
Received on: 15/2/13 1. The subjects were in the permanent dentition stage with
Accepted after Revision: 10/3/13 maxillary 2nd molars erupted.

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Comparison of the Amount of Maxillary Canine Retraction, with T-Loops, using TMA and Stainless Steel Wires: A Clinical Study

2. In all subjects, the maxillary 1st premolar on both sides

had been extracted for orthodontic treatment.
3. Subjects were already undergoing orthodontic treatment
with 0.018 inch MBT preadjusted appliance system.
However, canine retraction had not been started.
4. Prior to the study, maxillary dentition of all the subjects
were in the alignment and leveling stage.
5. All maxillary canines were aligned. The canines were
bilaterally symmetrically placed and upright.
Following stage records were made for all patients:
1. Intraoral photographs at the start (T0) and end (T4) of the
study.
2. Linear and angular measurements of right and left maxillary
canines using jigs, occlusal splint, digital caliper and Fig. 1A: Intraoral occlusal view

protractor at the start (T0), mid (T1, T2, T3) and end (T4)
of the study.
3. Lateral cephalograms at the start (T0) and end (T4) of the
study.
4. Maxillary arch study models and occlusal photographs of
the study models at the start (T0) and end (T4) of the study.
Preparation
The four incisors, 2nd premolars and 1st molars were made
into one rigid unit by using a 0.016 × 0.022 inch stainless
steel customized continuous base archwire. Nance holding
arch was used for stabilizing the molars (Fig. 1A). The maxillary
dentition was aligned and leveled, and canines uprighted using
0.016 × 0.022 inch NiTi wire (Figs 1B and C) prior to Fig. 1B: Intraoral right side view
placement of the 0.016 × 0.022 inch stainless steel
customized continuous base archwire.
Fabrication of T-Loop
The T-loops were fabricated of 0.017 × 0.025 inch TMA wire
for left maxillary canine and 0.016 × 0.022 inch stainless steel
wire for right maxillary canine (Fig. 2). The T-loops were
placed in the center of the 1st premolar extraction spaces.
Standardization of Force Generated by T-loop Springs
Reitan (1957)9 advocated 150 to 250 gm force for continuous
bodily movement of maxillary canines. In 1972 Brandt and
Burstone10 stated 150 to 200 gm as a reasonable force value
for tipping canines. Ricketts et al (1979)11 in bioprogressive
therapy quoted Lee (1965), who carried out a study on canine Fig. 1C: Intraoral left side view

retraction and proposed that 200 gm was the optimum force

for efficient canine retraction.
Both the T-loops were fabricated in a dental stone assembly
and a dial type dynamometer (Somfy Tec, France) and millimetric
scale were used to note the amount of force generated on opening
of the vertical legs of both the T-loops (Fig. 3). To generate 200
gm of force, the TMA T-loop spring had to be activated by 4 mm
and the stainless steel T-loop by 2 mm.

Preactivation of T-loop Spring

In the TMA T-loop spring, each preactivation bend was 30°,
thus the total of six preactivation bends was 180°. In both the
T-loops, antirotation bends of 35° each were placed in the
anterior and posterior legs. The antirotation bends were kept Fig. 2: Schematic diagram of T-loop

The Journal of Indian Orthodontic Society, October-December 2013;47(4):178-183 179

Kunal Rajesh Mehta, Ravindranath B Sable

Fig. 3: Force measured by opening the T-loops using a dynamometer Fig. 5: Stainless steel jigs
on dental stone assembly

to a minimum to prevent impingement of the T-loops and

reduce patient discomfort (Fig. 4).

Method of Measurement of Linear and Angular

Changes in Canines during and after Retraction
Indirect Measurements
To measure the angulation changes in the canines during
retraction, stainless steel wire jigs with triangular ends for
left canine (0.016 × 0.022 inch rectangular stainless steel)
and round ends for right canine (0.6 mm round stainless steel)
respectively were fabricated. The jigs were 15 mm in height
(Fig. 5). Stainless steel jigs were placed in between the tie
wings of the canine brackets (triangular jig in the left and round
Fig. 6: Intraoral view of stainless steel jigs
jig in the right canine bracket respectively) and secured into
place using elastomeric modules (Fig. 6).
Lateral cephalograms were made during stages T(0) and
T(4). Right and left canines were identified by the shadow of
the jigs (Fig. 7). The left and right canine crown angulations
were measured at stage T(0) and T(4) by measuring the
posteroinferior angles formed by the stainless steel jigs and
FH, SN and palatal plane (Fig. 8).

Direct Measurements
Intraorally the initial canine position was recorded using
angular and linear measurements.

Fig. 7: Lateral cephalogram with stainless steel jigs

1. Angular measurements were made by orienting the base

of the customized protractor assembly (Fig. 9) to the
horizontal arm of the customized base archwire and
equating the movable stainless steel marker of the
protractor to the center of the canine bracket.
2. Customized occlusal splint in acrylic with embedded
hooks was used for linear measurement of retracted
canines. The 1 mm stainless steel hooks were embedded
Fig. 4: Antirotation bends of 35° in each leg of the T-loops into the splint corresponding to the distal margin of the

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Comparison of the Amount of Maxillary Canine Retraction, with T-Loops, using TMA and Stainless Steel Wires: A Clinical Study

Fig. 10: Intraoral view with occlusal acrylic splint

Fig. 8: Tracing of lateral cephalogram depicting angles formed by long

axis of both canines and SN, FH and palatal planes

Fig. 11: Linear measurement with digital caliper

Fig. 9: Protractor with stainless steel marker

lateral incisor bracket on either side (Fig. 10). The linear

measurements were made by using a digital caliper from
the embedded hooks on the splint plate to the center of
the canine bracket using a digital caliper (Fig. 11).
The 0.017 × 0.025 inch TMA T-loop on the left side was
activated by 4 mm and the 0.016 × 0.022 inch stainless steel
T-loop on the right side was activated by 2 mm thus delivering
a force of 200 gm force on each side. The T-loops were
reactivated every month till the end of the 4 months study
(Figs 12A to C).
Rotation of the canines during retraction was evaluated by Fig. 12A: Intraoral occlusal view of same subject after completion of
making occlusal photographs of the study models at the start 4 months of canine retraction
of retraction and at the end of the study (Fig. 13). To evaluate
the canine rotation, the angle formed by a line passing through
the central incisors and median raphe and the line through the
mesial and distal edges of the left and right canines was traced
and measured on tracing paper (Fig. 14).

RESULT AND DISCUSSION

Mean and standard deviations, for the linear and angular
intraoral measurements carried out at stages T(0), T(1), T(2),
T(3), T(4), angular measurements which were carried out on
lateral cephalograms at stages T(0) and T(4), and canine
rotation measurements on study models, carried out at stages Fig. 12B: Intraoral view of right side of same subject after completion of
T(0) and T(4) were calculated and compared. 4 months of canine retraction with 0.016 × 0.022 stainless steel T-loop

The Journal of Indian Orthodontic Society, October-December 2013;47(4):178-183 181

Kunal Rajesh Mehta, Ravindranath B Sable

Fig. 12C: Intraoral view of left side of same subject after completion of
4 months of canine retraction with 0.017 × 0.025 TMA T-loop

Fig. 14: Diagrammatic representation of measurement of canine

rotation

Table 1: Comparison of the means of intraoral linear measurements

between TMA and SS groups at stage T(4)

Stage Group Mean (mm) Standard t-value p-value

deviation

T(4) TMA 5.4658 0.86041 3.924 0.001

SS 4.2050 0.70630

Fig. 13: Study model

In this study the mean canine retraction by the TMA

T-loop was more (5.46 mm) as compared with the mean
Graph 1: Means of intraoral linear measurements by stage
retraction by the stainless steel T-loop (4.20 mm) (Table 1). comparison between TMA and SS
The linear measurements using the TMA T-loop were observed
to be greater in T(1), T(2) and T(3) and T(4) stages as compared
to the stainless steel T-loop. This is because of low load- were also seen in the stainless steel T-loop where canine
deflection rate, high M/F ratio and constant force delivery by tipping of 4.92° occurred in the first month, which went on
the TMA wire (Graph 1). increasing by approximately 1 to 1.5° each month, for the next
It was seen that canine tipping by TMA T-loop was 4.35° 4 months (Table 2 and Graph 2). This type of more crown
in the first month, which went on increasing by approximately tipping than that of the root could be because of inadequate
1° each month, for the next 4 months. Similar observations M/F ratio to upright the root along with crown movement or
Table 2: Comparison of the means of intraoral angular measurements between TMA and SS groups at stages
T(0), T(1), T(2), T(3) and T(4)

Stages Groups Mean (degrees) Standard deviation t-value p-value

T(0) TMA 94.00 4.612 0.000 1.000

SS 94.00 4.411
T(1) TMA 98.25 2.454 0.557 0.583
SS 98.92 3.343
T(2) TMA 100.50 3.261 0.619 0.543
SS 101.42 3.965
T(3) TMA 100.67 4.163 1.121 0.274
SS 102.58 4.209
T(4) TMA 101.83 6.132 0.944 0.356
SS 104.00 5.063

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Comparison of the Amount of Maxillary Canine Retraction, with T-Loops, using TMA and Stainless Steel Wires: A Clinical Study

steel T-loops in terms of canine retraction, canine tipping and

canine rotation. After weighing the pros and cons, segmented
T-loop mechanics could be commonly used in cases requiring
faster and individualized canine retraction and less taxing on
posterior anchorage. It also provides us with options in material
and wire size in fabrication of the T-loops.

CONCLUSION
The following conclusions were drawn from the 4-month study:
1. Greater amount of maxillary canine retraction occurred
Graph 2: Means of intraoral angular measurements by stage using the 0.017 × 0.025 TMA T-loop (5.46 mm) as
comparison between TMA and SS compared to the 0.016 × 0.022 stainless steel T-loop
(4.20 mm).
Table 3: Comparison of the means of lateral cephalogram canine angular 2. The 0.017 × 0.025 TMA T-loop showed 7.83° tipping,
measurements with FH plane, between TMA and SS groups at stages
whereas the 0.016 × 0.022 stainless steel T-loop showed
T(0) and T(4)
10° tipping, indicating that the TMA T-loop had better
Stages Group Mean Standard t-value p-value control.
(degrees) deviation
3. The 0.016 × 0.022 stainless steel T-loop (39.44%) offered
T(0) TMA 89.50 8.130 0.621 0.541 better rotational control over the 0.017 × 0.025 TMA
SS 87.83 4.509 T-loop (50.82%).
T(4) TMA 96.42 10.706 0.672 0.509
SS 99.00 7.920
REFERENCES
Table 4: Comparison of the means of angular measurements of canine 1. Burstone CJ. Rationale of the segmented arch. Am J Orthod 1962
rotation, between TMA and SS groups at stages T(0) and T(4), taken on Nov;48(11):805-822.
study model photographs 2. Burstone CJ, Baldwin JJ, Lawless DJ. The application of
continuous forces to orthodontic. Angle Orthod 1961;31:1-14.
Stages Group Relative Standard t-value p-value 3. Burstone CJ. The mechanics of segmented arch techniques. Angle
mean (%) deviation Orthod 1966;36:99-120.
T(4) TMA 50.8231 8.88639 2.117 0.046 4. Burstone CJ, Koenig HA. Optimizing anterior and canine
SS 39.4469 16.35537 retraction. Am J Orthod 1976 Jul;70(1):1-19.
5. Burstone CJ. Goldberg AJ. Beta titanium: a new orthodontic alloy.
Am J Orthod 1980 Feb;77(2):121-132.
due to inadequate time between activations for root uprighting. 6. Burstone, Charles J.; van Steenbergen, Edsard.; Hanley, Kelvin
The intraoral angular readings were in harmony with the angular J. Modern edgewise mechanics and the segmented arch technique.
readings taken with FH plane on the lateral cephalogram USA: Farmington, Conn: University of Connecticut Health Center;
(Table 3). 1995.
It was noted that canine rotation was more for the TMA 7. Viecilli RF. Self-corrective T-loop design for differential space
closure. Am J Orthod Dentofacial Orthop 2006 Jan;129(1):48-53.
T-loop group (50.82%) as compared to stainless steel T-loop 8. Proffit, William R.; Fields, Henry W.; Sarver, David M.
group (39.44%) (Table 4). This rotation was more because Contemporary orthodontics. 4th ed. St. Louis: Mosby; 2007.
TMA had more flexibility as compared to stainless steel 359-394 p.
indicating TMA had a weaker control as compared to stainless 9. Reitan K. Some factors determining the evaluation of forces in
steel which was more rigid. Also rotation occurred in both orthodontics. Am J Orthod 1957 Jan;43(1):32-45.
the loops because of reduced antirotation bends of 35° as 10. Brandt S, Burstone CJ. JCO/interviews Dr Charles J Burstone. J
compared to 90° antirotation bends suggested by Marcotte12 Clin Orthod 1972 Dec;6(12):694-708.
and increased antirotation bends suggested by Nanda,13 Almost 11. Ricketts RM, Bench RW, Gugino CF, Hilgers JJ, Schulhof RJ.
Forces used in bioprogressive therapy. In: Rickets RM, editor.
similar observations were also made by Ziegler and Ingervall14
Bioprogressive therapy. Denver: Rocky Mountain Orthodontics;
in their study on canines which were rotated by 30° during 1979. 93 p.
6 mm of canine retraction by using a PG spring. 12 Marcotte, Michael R. Preliminary bracket alignment. In: Marcotte,
These observations shed light on this very interesting and Michael R, editor. Biomechanics in orthodontics. Toronto: BC
important aspect of segmented loop mechanics and its relation Decker, Inc; 1990. p 66-67.
to the center of resistance, cross-section and material used 13. Nanda R. Biomechanical basis of extraction space closure. In:
Nanda R, editor. Biomechanics in clinical orthodontics.
for fabricating the T-loop. Both groups offered poor rotational
Pennsylvania: WB Saunders Company; 1997. p 181-182.
control of canines. We can suggest more antirotation bends 14. Ziegler P, Ingervall B. A clinical study of maxillary canine retraction
which may reduce this rotation. No other study came across with a retraction spring and with sliding mechanics. Am J Orthod
which compared the efficiency between TMA and stainless Dentofac Orthop 1989 Feb;95(2):99-106.

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