Preadjusted Edgewise Appliance Research Articles

Evaluating orthodontic treatment using par & iotn indices

The objective of this study was to assess the differences between the treatment effectiveness of non extraction cases treated with Begg and Pre Adjusted Edgewise Appliance by PAR and IOTN index. The Pre, Post and 1 year Post treatment records of twenty patients, who were treated in Orthodontic department of the Bapuji Dental College and Hospital, Davangere, were evaluated. The sample was divided into two groups: Group1 comprises of 10 patients treated with PEA Appliance. Group2 comprises of 10 patients treated with Begg Appliance. PEA appliance has performed better than Begg appliance therapy.

Management of Severe Class II Malocclusion With Sequential Fixed Functional and Orthodontic Appliances: A Case for MOrthRCSEd Examination

Fixed functional appliance is an effective way of treating skeletal Class II malocclusion in children and adolescents. The following case report documented a 13-year-old boy with 15 mm overjet treated by a phase I 12-month growth modification therapy using Herbst appliance with Hyrax palatal expander and high pull headgear in a stepwise mandibular advancement protocol followed by a phase II pre-adjusted edgewise appliance therapy. It is one of the cases submitted for the Membership of Orthodontics Examination of the Royal College of Surgeons of Edinburgh.

Comparison of mandibular arch changes during alignment and leveling with 2 preadjusted edgewise appliances

Our objective was to compare the effects of 2 preadjusted appliances on angular and linear changes of the mandibular incisors, and transverse mandibular arch dimensional changes over a minimum of 30 weeks. This was a prospective, randomized, controlled, clinical trial a the Royal London Hospital, School of Dentistry, in London and the Kent and Canterbury Hospital in Canterbury, United Kingdom. Sixty- six consecutive patients satisfying the inclusion criteria were enrolled and randomly allocated to treatment with a self-ligating bracket system (SmartClip, 3M Unitek, Monrovia, Calif) and conventional preadjusted edgewise brackets (Victory, 3M Unitek). Initial study models and cephalograms were obtained within a month of starting the trial. All subjects received treatment with the following archwire sequence: 0.016-in round, 0.017 x 0.025-in rectangular, 0.019 x 0.025-in rectangular martensitic active nickel-titanium archwires, and 0.019 x 0.025-in stainless steel archwires. Final records, including study models and a lateral cephalogram, were collected a minimum of 30 weeks after initial appliance placement. Lateral cephalograms were assessed for treatment-related changes in mandibular incisor inclination and position. Transverse dimensional changes in intercanine, interpremolar, and intermolar dimensions, and the amount of crowding alleviated during the study period were assessed by comparison of pretreatment and posttreatment models. All measurements were made with a digital caliper (150 mm ISO 9001 electronic caliper, Tesa Technology, Renens, Switzerland). Sixty patients completed the study. After adjustment for pretreatment values, duration of treatment, and amount of crowding alleviated during the study period, bracket type had little effect on incisor inclination (P = 0.437) and positional changes (P = 0.35), and intercanine (P = 0.967), inter-first premolar (P = 0.495), and inter-second premolar (P = 0.905) dimensions. However, the self-ligating appliance produced slightly more expansion in the molar region, a difference that was statistically significant (P = 0.009). Pretreatment values for incisor inclination (P = 0.044) and transverse dimensions (P = 0.000) affected inclination and transverse changes, respectively, with proclination less likely when the labial segment was proclined at the outset and expansion unlikely during leveling and alignment in wider arches. Greater alleviation of crowding during the study period resulted in more incisor proclination (P = 0.000) and advancement (P = 0.000). There was little difference overall in the pattern of arch alignment and leveling related to the 2 preadjusted appliances. However, there was a statistically greater increase in intermolar width in the group treated with the self-ligating appliance, although the difference was only 0.91 mm.

Efficiency of mandibular arch alignment with 2 preadjusted edgewise appliances

The aim of this study was to compare the efficiency of mandibular arch alignment in 3 dimensions with a self-ligating bracket system (SmartClip, 3M Unitek, Monrovia, Calif) and a conventional preadjusted edgewise twin bracket (Victory, 3M Unitek) in nonextraction patients. This was a prospective, randomized, controlled clinical trial at the Royal London Hospital, School of Dentistry, and Kent and Canterbury Hospital, United Kingdom. Sixty-six consecutive patients satisfying the inclusion criteria were enrolled in the study. They were randomly allocated with a computer-generated system to 1 of the 2 bracket systems. Pretreatment mandibular arch irregularity was measured by using a coordinate measuring machine (Merlin II, International Metrology Systems, Gloucester, United Kingdom). A 0.016-in round martensitic active nickel-titanium aligning archwire (3M Unitek) was placed in all subjects. Mandibular arch irregularity was remeasured 8 weeks later. Sixty-five subjects completed the study. Bracket type had little influence on alignment efficiency overall (P = 0.08), or in the buccal (P = 0.173) or labial segments (P = 0.528) after adjustment for pretreatment differences by analysis of covariance (ANCOVA). Alignment efficiency was highly correlated to pretreatment irregularity overall (P <0.001), both in the buccal (P = 0.001) and labial (P <0.001) segments. Increasing age appeared to have a negative effect on alleviation of irregularity, although this effect did not reach statistical significance (P = 0.053). The null hypothesis that efficiency of alignment in the mandibular arch in nonextraction patients is independent of bracket type was accepted. Alignment efficiency is largely influenced by initial irregularity.

Modifications to increase efficiency of the begg orthodontic technique

Background: Orthodontic appliances that deliver results in a shorter time period without sacrificing the quality of the outcome are preferred. A modified fixed appliance, blending the merits of the Preadjusted Edgewise and Begg appliances was tested. Methods: Thirty patients each were randomly assigned for treatment with one of the three fixed appliance techniques after qualifying for the inclusion and exclusion criteria established before the study. Peer assessment rating (PAR) index was used to compare the quality of treated cases. Total time as well as chairside time taken for treatment with the three techniques was also compared. ANOVA and paired student ‘t’ test were used for statistical analysis. Result: There was a significant reduction in PAR scores with all the three appliances. There was no significant difference in the quality of treatment outcome between the Preadjusted Edgewise appliance (PEA) and the modified Begg appliance. These appliances gave a significantly better improvement as compared to the Begg appliance. Chairside and total time taken was the least with the modified Begg appliance followed by the PEA and Begg appliances. Conclusion: The suggested modification of the Begg appliance is efficient and economical as compared to PEA and Begg appliances in the treatment of cases with anterior teeth proclination as one of the elements of malocclusion.

Evaluation of Proximal Alveolar Bone Level Changes During Orthodontic Treatment - A Comparative Clinical Study

The aim of this clinical study was to evaluate the iatrogenic effect of orthodontic treatment on interproximal crestal alveolar bone and to the compare the changes in cases treated by Preadjusted Edgewise Appliance and those treated by the Begg Appliance. Two study groups comprising of 10 patients each were treated with either of the appliances. The radiographic method - Absolute technique as described by Albander et al-was used for quantification of crestal alveolar bone. Two radiographic examinations were performed, one at the start of treatment and second at the end of the orthodontic treatment. Each included two intra-oral periapical (IOPA) radiographs of the maxillary anterior region (right canine to left canine) taken using the paralleling technique. Measurements were made on the IOPA films and the results evaluated.

Orthodontic Treatment Combined with Mandibular Distraction Osteogenesis and Changes in Stomatognathic Function

We performed an orthodontic treatment combined with mandibular distraction osteogenesis in a 15-year-old patient who wanted a correction of a chin deficiency and a protruding upper lip. The patient had an Angle Class II division 1 malocclusion with mandibular retrusion, a low mandibular plane angle, and scissors bite. First, a quad-helix appliance was applied to the mandibular dentition to correct the scissors bite in the bilateral premolar region. Later, a preadjusted edgewise appliance was applied to the maxillary and mandibular teeth. After 3 days, a mandibular distraction osteogenesis was performed. During and after the distraction, the open bite between the upper and lower dental arches was corrected using up and down elastics. The total treatment time with the edgewise appliance was 14 months. A skeletal Class I apical base relationship, good facial profile, and optimum intercuspation of the teeth were achieved with the treatment. The jaw-movement pattern on the frontal view did not change during gum chewing. However, the maximum gap without pain increased. The electromyographic (EMG) activity of the masseter and anterior temporalis muscles, and maximum occlusal force increased. The present case report suggests that an orthodontic treatment combined with mandibular distraction osteogenesis in a patient with mandibular retrusion in the late growth period might be effective for improving stomatognathic function.

Treatment of Skeletal Class III Malocclusion with Reverse Pull Headgear and Preadjusted Edgewise Appliance

Treatment of Skeletal Class III Malocclusion with Reverse Pull Headgear and Preadjusted Edgewise Appliance

The SPEED System: An Overview of the Appliance and Clinical Performance

The SPEED appliance (Strite Industries Ltd., 298 Shepherd Ave., Cambridge, Ontario, N3C 1V1 Canada), invented by Dr. G. Herbert Hanson in the early 1970s, is a miniaturized self-ligating bracket with an active spring clip. This fully preadjusted edgewise appliance, which is available in both 0.018″ and 0.022″ slot size, has been in clinical use since 1977 and commercially available since 1980. During the past 25 years, the SPEED design has been highly refined. Refinements include the incorporation of a superelastic nickel titanium spring clip for greater precision of tooth movement throughout treatment, a "labial window" that enhances ease of opening the spring clip, and a horizontal auxiliary slot in the bracket body that facilitates segmental archwire mechanics. Although the SPEED bracket is compatible with virtually any archwire selection, specific archwires have been designed to fully exploit SPEED's inherent benefits. These include Supercable (Strite Industries Ltd.), a seven-stranded coaxial nickel titanium archwire, Hills Dual-Geometry archwire (Strite Industries Ltd.), and SPEED archwires. Whether traditional or specialty archwires are used, SPEED, with its highly flexible spring clip, creates a unique mechanical system that is ideally suited for ultra-precise orthodontic tooth movement.

Effects of Continuous and Interrupted Orthodontic Force on Interleukin-1β and Interleukin-8 Secretion in Human Gingival Crevicular Fluid

The purpose of this study was to compare levels of human IL-1β and IL-8 secretion during tooth movement using a nickel-titanium closed coil spring (NTCS) and an elastic c-chain (EC). Data were obtained from twenty healthy orthodontic patients treated with a pre-adjusted edgewise appliance with all first premolars extracted. In each subject, one maxillary canine received continuous force with a NTCS. The opposite maxillary canine received an interrupted force with an EC. Gingival crevicular fluid (GCF) was collected from distal sides of the canines before bracket placement, before canine retraction (baseline), at 24 hours, and at 1 and 2 months after canine retraction. IL-1β and IL-8 levels were measured. The amount of canine movement was measured from the models using the third palatal rugae as the reference point. IL-1β and IL-8 levels at each time point were compared to the baseline by analysis of variance (ANOVA) for repeated measures. A paired t-test was used to determine any significant differences of IL-1β and IL-8 levels between the groups at each time point and to compare the rate of canine movement between groups. The results demonstrated that IL-1β and IL-8 levels in both groups showed a significant elevation at 24 hours, and then declined. IL-1β and IL-8 levels in the NTCS group were significantly higher than the EC group at 24 hours, and 1 and 2 months after force application (p<0.001). The rate of canine retraction in the NTCS group was significantly higher than that of the EC group (p<0.001). In conclusion, the NTCS gave higher rate of canine retraction, which correlates with IL-1β and IL-8 levels.

Effects of Continuous and Interrupted Orthodontic Force on Interleukin-1.BETA. and Interleukin-8 Secretion in Human Gingival Crevicular Fluid

The purpose of this study was to compare levels of human IL-1β and IL-8 secretion during tooth movement using a nickel-titanium closed coil spring (NTCS) and an elastic c-chain (EC). Data were obtained from twenty healthy orthodontic patients treated with a pre-adjusted edgewise appliance with all first premolars extracted. In each subject, one maxillary canine received continuous force with a NTCS. The opposite maxillary canine received an interrupted force with an EC. Gingival crevicular fluid (GCF) was collected from distal sides of the canines before bracket placement, before canine retraction (baseline), at 24 hours, and at 1 and 2 months after canine retraction. IL-1β and IL-8 levels were measured. The amount of canine movement was measured from the models using the third palatal rugae as the reference point. IL-1β and IL-8 levels at each time point were compared to the baseline by analysis of variance (ANOVA) for repeated measures. A paired t-test was used to determine any significant differences of IL-1β and IL-8 levels between the groups at each time point and to compare the rate of canine movement between groups. The results demonstrated that IL-1β and IL-8 levels in both groups showed a significant elevation at 24 hours, and then declined. IL-1β and IL-8 levels in the NTCS group were significantly higher than the EC group at 24 hours, and 1 and 2 months after force application (p<0.001). The rate of canine retraction in the NTCS group was significantly higher than that of the EC group (p<0.001). In conclusion, the NTCS gave higher rate of canine retraction, which correlates with IL-1β and IL-8 levels.

Scientific Evidence for Pre-adjusted Edgewise Mechanics

The aim of this paper is to present scientific evidence for treatment mechanics with the pre-adjusted edgewise appliance. We have summarized findings from randomized and controlled clinical trials following a search of Medline and the Cochrane Clinical Trials Register (CCTR) 1970-June 2005. Evidence was available to support our choice of archwires, use of canine lacebacks and method of space closure, thus providing the beginning of a scientific basis for our day-to-day management of fixed appliance mechanics.

Dual Segmental Distraction Osteogenesis of the Midface in a Patient with Apert Syndrome

To present orthodontic treatment combined with dual segmental distraction osteogenesis in a patient with Apert syndrome. A 15-year-old boy exhibited severe midfacial hypoplasia with retruded and hypoplastic maxilla and anterior open bite. The patient was treated with a rigid external distraction II system for distraction osteogenesis, a preadjusted edgewise appliance, and a modified maxillary protraction headgear. The concave profile with midfacial hypoplasia was improved. A tight occlusal relationship between maxillary and mandibular teeth was achieved. Postoperative treatment results have been stable for 1 year.

Treatment of a high-angle Class I malocclusion with severe crowding and dental midline deviation: Soft tissue oriented treatment planning

This case report describes orthodontic treatment of a 20-year-old female patient having a high-angle Class I malocclusion with severe anterior crowding and a convex soft tissue profile. In this case, orthodontic diagnosis and treatment planning has been based on “soft tissue paradigm”. The preadjusted edgewise appliances were placed after the upper and lower first premolars were extracted. After active treatment, a good facial profile and occlusion were achieved. Occlusion remained stable during 2 years of follow-up.

Anterior retraction using a preadjusted edgewise appliance with interrupted orthodontic force generated by a screw device

The objectives of the present study were to determine the usefulness of interrupted orthodontic force in anterior retraction and to identify its problems. Subjects were three patients (maxillary protraction, bimaxillary protrusion, and mandibular protrusion). As a multi-bracket appliance, the 0.022 preadjusted edgewise appliance was used. After attaching a 0.019 in. × 0.025 in. stainless steel wire, the screw device was placed. With regard to the screw adjustment, each patient was instructed to turn the screw clockwise 360° every three days. In all three patients, anterior retraction was completed in a period of only three months. Cephalograms showed that the tooth axis of the anterior teeth was tilted lingually. When superimposing curves expressed as quartic polynomials at initial examination and during retention, marked constriction at the second premolar region, lateral expansion in the molar region were seen for both the maxilla and mandible. Panoramic radiography did not reveal root resorption. No radiographic abnormalities were seen in the periodontal membrane or dental root. Therefore, the screw device appeared to properly control physiological tooth movement and shorten the duration of orthodontic therapy.

The effectiveness of laceback ligatures: A randomized controlled clinical trial

To evaluate the effects of laceback ligatures on the anteroposterior and vertical position of lower incisors and the mesial position of the lower first molars. Randomized controlled trial. Patients under treatment in the Department of Orthodontics, Royal Bournemouth Hospital, Dorset, during a 6 month period from November 1999 to March 2000. Sixty-two adolescents (mean 13.7 years, range 11.2-16.8 years) with similar malocclusions, requiring extraction of all first premolars, were randomly assigned to experimental (laceback: 30; 12 male, 18 female) and control (non-laceback: 32; 14 male, 18 female) groups. Treatment using upper and lower fixed appliances following extraction of four premolars. One group had lacebacks placed, whilst the control group had no lacebacks. The participants were examined clinically and radiographically, and lateral cephalograms with radio-opaque tooth markers and lower study casts records were taken when lower fixed appliances were placed (T1) and following sufficient leveling with a 0.018 inch stainless steel round wire (T2). Linear measurements were recorded following digitization of the lateral cephalograms and using a vernier caliper on the study casts. A Student t-test was used to examine differences between the two groups following assessment for normality. In both groups the lower incisors retroclined during T1-T2; (Mean+/-SD: Experimental -0.53+/-1.9 mm, Control -0.44+/-1.29 mm). There was no statistical significance between the two groups (p = 0.84). The lower incisors extruded in both groups; 0.47+/-0.98 mm in the experimental group and 0.44+/-0.87 mm in the control group. There was no statistical difference between the groups (p = 0.9). The lower first molars showed 0.83 mm greater mesial movement in the experimental group, which was statistically significant (p < 0.05). Labial segment crowding decreased in both groups (experimental -3+/-1.6 mm, control -2.67+/-2.28 mm), the difference between the groups being non-significant (p = 0.51). Arch length decreased in both groups (experimental -2.08+/-2.82 mm , control -2.9+/-3.06 mm), but the difference between them was not significant (p = 0.28) In first premolar extraction cases, the lower labial segment does not procline during the leveling stage with the pre-adjusted edgewise appliance and the use of laceback ligatures conveys no difference in the anteroposterior or vertical position of the lower labial segment. Furthermore, the use of laceback ligatures creates a statistically and clinically significant increase in the loss of posterior anchorage.

Maurice Berman Prize 2003

A crowded, high angle Class II case is presented and illustrated with stage clinical photographs. It was successfully treated with modified Twin Blocks and high pull headgear, extraction of all four first premolars, and upper and lower pre-adjusted edgewise appliances.

Changes in mandibular incisor position in Class II Division 1 malocclusion treated with premolar extractions

The aim of this study was to investigate the magnitude of mandibular incisor retraction to be expected during full fixed appliance mechanotherapy in Class II Division 1 malocclusions treated with premolar extractions when mandibular incisor retraction was not part of the treatment plan. The material consisted of pretreatment and posttreatment cephalometric films and dental casts of 70 Class II Division 1 malocclusion patients (33 males and 37 females) treated with the preadjusted edgewise appliances. The mandibular first premolars were extracted in 31 subjects, and the mandibular second premolars were extracted in 39. The pretreatment factors that suggested a basis for the extraction choice in the mandibular arch in these patients were found to include the ratio between posterior and anterior facial heights, the maxillary-mandibular plane angle, and the residual space in the mandibular arch. The mandibular incisors were retracted in only 65% of the patients. On average, the mandibular incisors were retracted by 1.02 mm relative to the nasion-pogonion line; there was no significant difference between the 2 extraction groups. Multiple regression analysis showed that the change in the mandibular incisor position is significantly correlated with the residual space in the mandibular arch, the initial distance between the mandibular incisor and the nasion-pogonion line, maxillary-mandibular angle, and the duration of crown labial torque in the mandibular incisors. In combination, these 4 factors could explain 61% of the change in the mandibular incisor position.

PG canine retraction spring

PG canine retraction spring was introduced to the orthodontic profession way back in 1985 by Poul Gjessing; it was not widely used till interest in it was renewed in recent years because of its adaptability to the now commonly used 0.018” pre-adjusted edgewise appliance system. The efficient design as well as the relatively rigid stainless steel wire, lends good stability to this retraction spring for use in frictionless orthodontic mechanics. Canine retraction is a very important step in most orthodontic procedures involving extraction of premolar teeth and is usually carried out by two methods: 1) Retracting canines by sliding along a base wire (Frictional mechanics) 2) Retracting the canine with a specially designed spring attached to it without any base arch wire for the canine to slide on (Frictionless mechanics) Contemporary Orthodontics by Proffit [1] describes the PG spring to be the most efficient current design for frictionless canine retraction. Rectangular stainless steel wire with overlapping ovoid loops provide good stability, required moment-force ratio and good load deflection rates. It is constructed in the readily available 0.016″x0.022″ stainless steel wire and can be easily placed in the routinely used 0.018” brackets. Construction and placement is easy and so is the activation. Its advantage as compared to other retraction springs is the fact that it can be economically made and used within the routine inventory of an average orthodontic clinic. Disadvantages are the same as in any retraction spring, in not being failsafe in case of accidental distortion and being liable to irritate the sulcular mucosa at least in the initial few days. Construction: The PG spring [2, 3, 4] is made in 0.016″x.022″ stainless steel rectangular wire. It has gingivally directed overlapping double helices, ovoid in shape, 10mm in height and 5.5mm at its widest part (Fig 1). It also has a small occlusal helix 2mm in diameter. The wire is bent in such a way that the smaller end of the wire is continuous with the occlusal helix. This portion is the canine part and would fit into the canine bracket. As it comes out of the occlusal helix, it is given a 15° gingival turn. After forming the gingivally directed double helices, the longer arm of the wire is the one which is meant for engaging the premolar bracket and the molar tube; this being the molar portion. This posterior molar arm as it exits from the double ovoid loops is turned gingivally such that the wire makes an angle of 12° till approximately the second premolar bracket and then turned up at an increased total angulation of 30° as shown in Fig 1. This portion is also given an anti-rotation bend of 60° towards the canine tooth and then this bend after traversing the width of the spring is curved back in an exactly opposite direction of the initial bend decreasing this to a final 35° (Fig 2). Fig. 1 Right upper PG spring (palatal view) Fig. 2 Right upper PG spring (occlusal view) Placement and activation: The anterior end emerging out from the smaller helix is placed as close as possible to the canine bracket and the front end is cinched. The posterior end is placed into the second premolar bracket and then into the 1st molar tube. The spring is pulled back till the double ovoid gingival loops open by 1mm and cinched back. This gives an approximate force of 160 grams. A retraction of 1.5 mm is expected in one month. The PG spring in use is shown in Fig. 3, Fig. 4. Fig. 3 PG canine retraction spring before retraction Fig. 4 PG canine retraction spring after retraction The spring induces bodily movement of teeth and anchorage, reinforcement by a Nance button or headgear is needed in moderate to high anchorage cases. A prerequisite before placing this spring is good rotational correction as well as levelling and alignment of the three teeth involved.

The implications of bracket selection and bracket placement on finishing details

It has been widely recognized for many years that accurate bracket positioning is of critical importance in the efficient application of biomechanics and in realizing the full potential of a preadjusted edgewise appliance. Once it is recognized that bracket placement can have a profound and definite impact on the expressed first, second, and third order movements, the importance of accurate bracket placement becomes self-evident. Although brackets can be placed precisely with direct bonding, it has also been recognized for many years that indirect bonding gives us greater precision in orientation and placement for brackets.