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An Evaluation of The Shape of Some Popular Nickel Titanium Alloy Preformed Arch Wires
An Evaluation of The Shape of Some Popular Nickel Titanium Alloy Preformed Arch Wires
Stanley Braun, DDS, MME,a William P. Hnat, PhD,b Reena Leschinsky, DDS,c and Harry L. Legan, DDSd
Nashville, Tenn, Louisville, Ky, and Chicago, Ill
The mathematical Beta function is shown to be an accurate planar representation of the natural human
arch form defined by the spacial coordinates of the labial and buccal dental/bracket interfacing surfaces
in the maxillary and mandibular arches. Graphic planar representations of the corresponding bracket
base spacial coordinates of 33 popular preformed nickel titanium arch wires and bracket assemblies
were superimposed on each of the relevant maxillary and mandibular natural forms. The arch forms of
the preformed nickel titanium arch wires and bracket assemblies did not emulate the natural human arch
form. The average mandibular natural human arch form first molar/canine width ratio is 2.38/1; the same
preformed arch wire/bracket ratio is 1.87/1. These ratios for the maxillary arch are 1.92/1 and 1.54/1,
respectively. The average canine width exceeded the natural canine width by 5.95 mm in the mandibular
arch and 8.23 mm in the maxillary arch. The corresponding mandibular first molar and maxillary first
molar widths exceeded the natural human first molar arch width by 0.84 mm and 2.68 mm, respectively.
These findings have implications with respect to posttreatment stability and facial esthetics. “Round
tripping” teeth resulting from subsequent change to stainless steel arch wires to restore a more natural
human arch form and size may result in deleterious tissue effects. (Am J Orthod Dentofacial Orthop
1999;116:1-12)
W ith the advent of nickel titanium highly cessful treatment outcome is to be achieved. Many
elastic preformed arch wires, the clinician is often able believe that arch form and size are unique for each
to introduce larger cross-section wire in the early stages individual and are principally controlled by the form of
of “leveling and alignment.” This type of arch wire has the basal bones initially and by the balance of energy
become popular for it is believed to provide “greater imparted to the teeth in all planes of space.6 Arch form
efficiency” during this stage of treatment.1 Because of and size should be recognized as part of a morpholog-
the metallurgic composition of these arch wires, the ic human pattern.7-9
clinician is unable to adjust their form or size to a given Recently planar projections (occlusal views) of
patient. The principal clinical factors that affect a untreated human dental arches in Angle Class I occlu-
patient’s dental arch form and dimensions are: dental sion have been described by the mathematical Beta
perimeter (sum of mesiodistal widths), cross-arch function with an average correlation coefficient of 0.98
width, and arch depth. By using nickel titanium pre- for the mandible and 0.97 for the maxilla.10 This earli-
formed arch wires, the clinician fails to recognize the er study revealed a variation in only dental arch size
uniqueness of arch form and size required for a partic- related to the Angle classification of occlusion. With
ular patient. This may be a significant factor in con- these considerations in mind, an investigation was
tributing to posttreatment problems.2-4 Boone5 has sug- undertaken to evaluate the dental arch form and size
gested that the individuality of a patient’s arch form and determined by several popular brands of nickel titani-
dimensions must be recognized and respected if a suc- um preformed arch wires and related bracket systems
compared with the untreated Angle Class I human arch
aClinical Professor of Orthodontics, Vanderbilt University Medical Center, and form and size described mathematically by the Beta
Marquette University. function. The Class I arch form was chosen because the
bAssociate Professor of Mechanical Engineering, Speed Scientific School, Uni-
preponderance of malocclusions are corrected to this
versity of Louisville.
cResident in Orthodontics, Vanderbilt University Medical Center. Angle classification.
dProfessor and Chairman, Department of Orthodontics, Vanderbilt University
Table II. Correlation of each bracket coordinates relative to the Beta function
Class I: Mandibular arch
Measured values Curve fit values Correlation coefficient
Cast Depth (mm) Width (mm) Depth (mm) Width (mm) r
corresponding X, Y, and Z coordinates automatically to The Beta function was subsequently tested as to fit
a computer file. Fourteen points were recorded for each of these planar coordinates for each of the function
maxillary and mandibular cast. A planar projection of points for each of the 15 maxillary and 15 mandibular
each dental arch was subsequently obtained by reduc- casts. Using the average correlation coefficient as a
ing the Z coordinate of each landmark to zero. All mea- measure of fit, each maxillary and mandibular arch
surements were made by the same individual. A repro- was measured and found to be 0.96 and 0.97, respec-
ducibility study using one cast (14 points, 42 coordi- tively (see Table II). Thus, the mathematical Beta
nates) was conducted to evaluate the variation in the function is an accurate representation of the arch
measurements. On the basis of the actual measure- forms of the maxillary and mandibular dentitions at
ments in each of the three coordinate axes, it revealed the interfaces with any preformed arch wire and
the accuracy to be equivalent to the study cited earli- bracket system.
er.10 This outcome was less than 0.5%. The ‘A’ Company (San Diego, Calif), Ormco
4 Braun et al American Journal of Orthodontics and Dentofacial Orthopedics
July 1999
Table III. Canine width and first molar width comparisons between arch wire/bracket assemblies and the Beta function
Mandibular arch: Beta function (width = 58.81 mm, depth = 43.60 mm)
Wire no. Wire Beta Difference Wire Beta Difference Wire ratio Beta ratio Ratio difference
(Glendora, Calif), and Unitek (Monrovia, Calif), in this way to each maxillary and mandibular pre-
donated several of their more popular nickel titanium formed arch wire tested. Points on each of the brack-
preformed arch wires and related bracket systems for et mesh surfaces were identified that corresponded to
this study. The appropriate brackets were permanent- the points previously marked on the dental casts.
ly affixed to the preformed arch wires using instant Next, the arch wires and appropriate bracket systems
glue (Borden Co., Columbus, Ohio). This procedure were placed in the Brown and Sharp Micro Val mea-
eliminates any relative motion at the bracket/arch suring machine and the X, Y, and Z coordinates for
wire interfaces. Each bracket was located along the each bracket/dental interface points were recorded as
arch wire in the appropriate anatomic position as described previously. A specially designed aluminum
determined by teeth ideally arranged in a typodont in fixture, seen in Fig 2, 6 inches square by 1/2 inch
Class I occlusion. Fourteen brackets, from second deep, supported the arch wire/bracket assemblies
molar to second molar, were positioned and attached during measurement. A thin layer of wax, 4 inches
American Journal of Orthodontics and Dentofacial Orthopedics Braun et al 5
Volume 116, Number 1
Fig 3. Graphic representation of selected Ormco preformed arch wires/bracket assemblies contrasted
to the Beta function.
RESULTS
square by 1/8 inch deep, secured the test arch
wire/bracket assembly to the fixture without deform- The planar projections of each of the 33 nickel
ing its initial shape. The arch wire/bracket assemblies titanium arch wire/bracket systems were superim-
were easily changed by heating the wax layer. After posed on X and Y axes of symmetry passing through
the Z coordinates were zeroed, a planar projection the contacts of the central incisors for each of the rel-
(occlusal view) of the resulting arch form was evant maxillary and mandibular planar projections of
obtained for comparison to the natural human arch the natural human arch form. These superpositions
form described previously. are seen in Figs 3 through 10. This allows for differ-
6 Braun et al American Journal of Orthodontics and Dentofacial Orthopedics
July 1999
Fig 4. Graphic representation of selected ‘A’ Company preformed arch wires/bracket assemblies con-
trasted to the Beta function.
ences in form and size to be readily observed. Table III width by 5.95 mm in the mandibular arch and 8.23 mm
lists the canine and first molar width differences in the maxillary arch. The corresponding mandibular
between each of the 16 mandibular arch wire/bracket first molar and maxillary first molar widths exceeded
assemblies and 17 maxillary arch wire/bracket assem- the natural human arch width by 0.84 mm and 2.68
blies as compared to the natural human arch form. The mm, respectively. First molar/canine width ratios were
average canine width exceeded the natural canine also calculated to quantitate the arch form of the arch
American Journal of Orthodontics and Dentofacial Orthopedics Braun et al 7
Volume 116, Number 1
Fig 5. Graphic representation of selected Unitek preformed arch wires/bracket assemblies contrasted
to the Beta function.
Fig 6. Graphic representation of selected Ormco preformed arch wires/bracket assemblies contrasted
to the Beta function.
tained, posttreatment stability may be compromised2-4; Because the natural human arch form is
and (2) because a particular patient’s arch length is det- described by the Beta function (r = 0.96 for the
termined by the sum of the mesiodistal widths of all of maxilla, and r = 0.97 for the mandible), Figs 3A
the teeth present in the arch, an increased width will through 10B illustrate that this form is not general-
result in a decreased arch depth. This will subsequent- ly emulated by the popular preformed nickel titani-
ly impact on lip support, and facial esthetics may be um arch wire/bracket systems tested. The pre-
affected.11 formed nickel titanium arch wire/bracket systems
American Journal of Orthodontics and Dentofacial Orthopedics Braun et al 9
Volume 116, Number 1
Fig 7. Graphic representation of selected Ormco preformed arch wires/bracket assemblies contrasted
to the Beta function.
exhibit an average canine width increase of 5.95 same ratio for the natural untreated arch form (see
mm and a lesser (0.84 mm) increase in first molar Table III). This was found to be the case in the
width, when compared with the natural human arch maxillary and mandibular arches. If the clinician
form. The larger arch width increases are confined believes that the arch form and size can subse-
to the anterior portion of the arch wires. This is quently be altered to a predetermined treatment
reflected in the wire ratio (molar width divided by goal for a specific patient by changing to a stainless
canine width) being significantly lower than the steel arch wire, he or she should consider the
10 Braun et al American Journal of Orthodontics and Dentofacial Orthopedics
July 1999
Fig 8. Graphic representation of selected ‘A’ Company preformed arch wires/bracket assemblies con-
trasted to the Beta function.
potential deleterious effects of “round tripping” rent preformed arch wires to approximate the Beta
teeth.12-14 On the other hand, if the arch form and function that more closely emulates the human arch
size determined by the preformed nickel titanium form in Class I occlusion. Thus a more natural arch
arch wire/bracket system is maintained, posttreat- form could be readily designed to accommodate vari-
ment instability may ensue.2-4 ous arch widths, ensuring the uniqueness of each
Manufacturers should consider a redesign of cur- patient’s dental arch size.
American Journal of Orthodontics and Dentofacial Orthopedics Braun et al 11
Volume 116, Number 1
Fig 9. Graphic representation of selected Unitek preformed arch wires/bracket assemblies contrasted
to the Beta function.
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1987;92:478-83. 9. White LW. Individualized ideal arches. J Clin Orthod 1978;11:779-87.
12 Braun et al American Journal of Orthodontics and Dentofacial Orthopedics
July 1999
Fig 10. Graphic representations of selected Ormco preformed arch wires/bracket assemblies contrast-
ed to the Beta function.
10. Braun S, Hnat WP, Fender DE, Legan HL. The form of the human dental arch. Angle 13. Reitan K. Some factors determining the evaluation of forces in orthodontics. Am J
Orthod 1998;68:29-36. Orthod 1957;43:32-45.
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12. Wehrbein H, Fuhrmann RAW, Diedrich PR. Periodontal conditions after facial root tipping tors. Orthodontics: current principles and techniques. St. Louis: CV Mosby;
and mpalatal root torque of incisors. Am J Orthod Dentofacial Orthop 1994;106:455-62. 1985.