Interactive edgewise mechanisms: Form and function comparison with conventional edgewise brackets

Abstract

As the frequency of use of the interactive twin (I-twin) edgewise mechanisms and techniques become increasingly prevalent, it is important to consider how they compare with conventional twin (c-twin) edgewise bracket systems. Optimum intrabracket and interbracket forces in I-twins balance with capillary blood pressures. An unbiased, experimental in vitro, scanning electromicroscopy and in vivo clinical investigation of 83 patients was conducted to compare the frictional resistance of three different I-twin bracket systems, type A (Sigma, American Orthodontics), type B (Interactwin, Ormco Corp.), and type C (Damon, A-company) with three c-twins counterparts respectively types D, E, and F. The three interactive twin brackets were each self-seating by an integrated arm component and made significant incremental improvements to the conventional twins in three different ways. First, the I-twin types reduced frictional resistance by using arm engagement with a lower coefficient of friction and a reduced seating force against the arch wire. The reduced seating force friction produced initially small interbracket arch wire deflections for biocompatible tooth movement and, combined with a wide twin bracket, produced accurate rotation corrections. Reduced friction within the I-twin bracket consequently permitted the effective use of light forces for flowing biomechanics that maximized anchorage. In evaluating friction, two distinctly different interaction forces acting to seat the arch wire were also identified. Type A demonstrated active interaction with round arch wires that resulted in a low functional seating force responsible for early and complete tooth control in comparison to the high seating force of c-twins. Types B and C both showed passive interaction with seating force friction approximately equal to zero that required large rectangular dimension arch wires for full bracket expression. Second, a significant reduction in the time taken to change arch wires was found, improving clinical time management. Third, I-twins assisted bracket placement with both center-slot identification markers and coordinated bracket and bonding pad reference planes in three dimensions. In addition, they improved bracket hygiene compared with c-twins by minimizing the use of plaque-retentive conventional ligatures. Despite the reduced elastomer use, experimental and clinical results showed I-twins effectively conserved the traditional four tie-wing design for ease of colored elastomer placement where an increase in friction for anchorage was selectively required and to enhance patient acceptance and motivation. Finally, interactive twins could be used by the practitioner as conventional twins without the interactive arms making them fail-safe.