Intrabracket space & Interbracket distance:

Critical factors in clinical orthodontics

Schudy GF and Schudy FF, Am J Orthod Dentofac Orthop. 1989;96:281-294 .

Introduction
Intrabracket space
Loose wire bracket combination
Make chairside operations easier Promote patient comfort Compromise control and undermine the pretorquing precision

Introduction
Bimetric principle
Differential slot sizing
0.016-inch bracket in anterior segment 0.022 or 0.018-inch bracket in posterior segment Smaller buccal tube in terminate area The rationale and the actual quantitative impact of such a mechanical arrangement??

Introduction
This article
Discuss orthodontic appliance in relationship to the desirable wire characteristics Report on the computer study of the impact of intrabracket space on the function of orthodontic wires Show the effect of intrabracket space and interbracket distance on the efficiency of the various edgewise appliances

Appliance designs in relation to desirable wire characteristics

Uncomplicated, easy to fabricate Full mechanical potential Integrated treatment functions

Appliance designs

Uncomplicated, easy to fabricate

Looped arch wires
Decrease force Increase range of the wire Consume chair time to bend Fabrication requires a skilled technician Hygiene and tissue tolerance problems

Appliance designs

Uncomplicated, easy fabricate to fabricate Uncomplicated, easy to

Conventional ways to minimize phase where good edgewise control is not possessed 1. A series of round wires >> prolong treatment phase 2. Largest slotted bracket with round wires or small rectangular wires >> lack of torque control 3. Small wires >> too much intrabracket space 4. Nickel titanium wires >> bending poorly and high cost 5. Single bracket appliance >> longer span, more flexible

Appliance designs

Uncomplicated, easy fabricate to fabricate Uncomplicated, easy to

2 efficient ways to minimize the number of multilooped arches
Use an appliance that automatically has a maximum amount of working wire or interbracket distance Use smaller wires where a lack of control is acceptable and take advantage of the maximum intrabracket space

Appliance designs

Full mechanical potential

Two conditions must exist: 1. In the act of "seating" the wire, it must not be stressed past its elastic limits.
Depend on
Inherent wire properties Mechanical environment

2. The wire must deliver a force that is compatible with the physiology of tooth movement.

Appliance designs

Full mechanical potential

Inherent wire properties
Small wires: more flexibility
17% more flexible than 0.017x0.022-inch wire It is necessary to make use of 38% more flexible than 0.018x0.025-inch wire 70% more flexible than whenever smaller wires 0.022x0.028-inch wire possible 0.016x0.022-inch wire is

Large wires: limits mechanical efficiency hurt the patient additional arch wires

Appliance designs

Full mechanical potential

Mechanical environment
The narrow brackets
least limiting effect on the action of wire

The wide bracket

Severe limitation the greater the dead area the less active or working area

Appliance designs

Integrated treatment functions

Integration of

Anterior alignment Space closure Leveling Torquing

make treatment easier, more efficient and usually shorter

Appliance designs

Integrated treatment functions

To achieve more integrate treatment:
1. use sectional arches on the lower arch in extraction case to take advantage of physiologic drift

2. advance to a rectangular wire early in Tx

Appliance designs

Integrated treatment functions

Differential mechanical environment
1. use small rectangular wires 2. as much interbracket distance as possible 3. as much intrabracket space as possible

4. use of two different sized bracket slots in one appliance :

0.016 inch on anterior teeth , 0.022 inch on posterior teeth

Computer Comparison of Popular Edgewise Appliance

To know precisely what effect the loose fit in the posterior brackets has on wire capacities To compare single- and double-bracketed appliances in 0.016, 0.018 and 0.022-inch slots with each other and then with the bimetric appliance

Materials and Methods

Bracket widths: 0.050, 0.100 and 0.175 inch Buccal slot length :0.018 inch obtain from Blacks text on dental anatomy (medium size) Mesiodistal tooth sizes: Wire: stainless steel no.303

Materials and Methods

Test: Behavior of wire in bending in six different edgewise appliances:
1. 0.022-inch twin brackets 2. 0.022-inch single brackets 3. 0.018-inch twins 4. 0.018-inch singles 5. 0.016-inch singles
0.022x0.028 0.019x0.025 0.018x0.025 0.018x0.025 0.017x0.022 0.016x0.022 0.016x0.022 0.015x0.019 0.014x0.018

6. Bimetric appliance
(0.016-inch ant. 0.022-inch post.)

Results
General facts (within the same slot size) Less force and greater range:
From the use of smaller wires With single bracket When intrabracket space is increased

Results
Wire size

tight-fit condition

Force falls dramatically when wire size is smaller

0.022x0.028 (in 0.022-slot) = 8.58 lb

40.2%
0.018x0.025 (in 0.018-slot) = 5.13 lb

30.6%
0.016x0.022 (in 0.016-slot) = 3.56 lb

Results
Range tight-fit condition

Range increases as the wire size is smaller

0.022x0.028 (in 0.022-slot) = 0.216 mm

22.2%
0.018x0.025 (in 0.018-slot) = 0.264 mm

12.5%
0.016x0.022 (in 0.016-slot) = 0.294 mm

Results
Interbracket distance tight-fit condition

Single-slot: Force decrease, range increase

Schudy GF and Schudy FF, Am J Orthod Dentofac Orthop. 1989;96:281-294.

Results
Intrabracket space same wire & different conditions
force decrease and range increase Less effect with twin brackets 0.016x0.022 wire
0.016-slot Force single 3.568 8.6% twin 4.955 4.76% single 0.297 81.14% Range twin 0.145 68.96%

0.018-slot

3.261

4.719

0.538

0.245

Discussion
Light force and greater range Twisted, braided and nickel titanium wires
Less complicated to form Working closer to their full mechanical potential More integrated treatment phases

The basic change need to be in the appliance more than in the wires

Discussion
To receive the greatest range and lightest force:
1. Large interbracket distance Single-width bracket 2. Small wires 3. As much as intrabracket space as possible

Bimetric principle It is necessary to use an appliance that small in front, large in back incorporates differential slot sizing (0.016) (0.022)

Discussion
Popular Edgewise VS Bimetric Edgewise
The bimetric appliance is more mechanically efficient than the traditional edgewise appliances
Deflect farther before permanent set Develop less force over greater range

Discussion
Bimetric Vs 0.018-Single Brackets Tight fit (0.016x0.022 Vs 0.018x0.025) Bimetric : 68% greater range, 36% less force 0.001-play (0.015x0.019 Vs 0.017x0.022) Bimetric : 31% greater range, 42% less force 0.002-play (0.014x0.018 Vs 0.016x0.022) Bimetric : 29% greater range, 45% less force

Discussion
Bimetric Vs 0.018-Twin Brackets
Tight fit (0.016x0.022 Vs 0.018x0.025) Bimetric : 185% greater range, 50% less force 0.001-play (0.015x0.019 Vs 0.017x0.022) Bimetric : 148% greater range, 53% less force 0.002-play (0.014x0.018 Vs 0.016x0.022) Bimetric : 141% greater range, 57% less force

Discussion
Bimetric Vs 0.022-Single Brackets Tight fit wire (0.016x0.022 Vs 0.022x0.028) Bimetric : 108% greater range, 62% less force Working wire(play) (0.014x0.018 Vs0.019x0.025) Bimetric : 60% greater range, 67% less force

Discussion
Bimetric Vs 0.022-Twin Brackets Tight fit wires (0.016x0.022 Vs 0.022x0.028) Bimetric : 247% greater range, 70% less force Working wire(play) (0.014x0.018 Vs 0.019x0.025) Bimetric : 206% greater range, 74% less force

Discussion
Advantages of bimetric appliance
Fewer wires Less complex wires Fewer arch removals Greater control Greater patient comfort they are of particular significance in the treatment of the more difficult malocclusion

Discussion
Clinical Implications of Intrabracket Space intrabracket space has nearly as much impact as does interbracket distance
10 3 2

Single bracket

Twin bracket

Wide twin bracket

Discussion
Clinical Implications of Intrabracket Space
Advantages of intrabracket space
Less patient discomfort Less complex wires Fewer arch wires Fewer arch removals Faster and more efficient leveling Reduction of permanent sets in arch wires due to mastication

Disadvantages of intrabracket space

Compromises the precise and quality-oriented control of the pretorqued appliances

Discussion
Clinical Implications of Intrabracket Space
0.016 Bimetric appliance Finishing wire : 0.016x0.022 inch Anterior torque is seated easily

Loose posterior fit in the 0.022-inch slots

Discussion
Clinical Implications of Intrabracket Space
Advantages of intrabracket space in bimetric appliance

More wire flexibility and range

Reduce friction between the bracket and the wire Allow horizontal shifting Reduce the number of permanent sets in arch wires due to mastication

Discussion
Clinical Implications of Intrabracket Space

Conclusion
3 conditions to maximize wire efficiency:
(1) Narrow brackets to increase interbracket distance and the amount of working wire

(2) Smaller wires with more inherent flexibility

(3) Bracket-wire combinations that provide maximum intrabracket space

Conclusion
For edgewise appliance: The only way to take advantage of both intrabracket space and small wires without compromising the control is to use differential slot sizing with the bimetric principle

Summary
With decreasing size of teeth: The amount of deflection decreases The force imparted to the teeth increases With increasing wire size The amount of deflection decreases The force imparted to the teeth increases For single brackets The amount of deflection is larger than double brackets The force imparted to the teeth smaller than double brackets The bimetric appliance is the most flexible, allowing the most deflection with the smallest force imparted to the teeth The only way to take advantage of smaller wires and deliver maximum resiliency with lighter forces and not loose control is through differential slot sizing

Thank You

Discussion