Clinical Pearls

Tips on choosing and using wire

Customized Mechanics
Al E. Atta DDS, MSD, MBA
Deerfield, Ill
It is a false reality to assume that there are universal, preshaped smart wires that can be used to initiate treatment for all malocclusions. Any initial wire must be customized to treat one problem at a time, and in sequences.

My customized mechanics use an active initial wire that has a built-in secondary moment. For example, it might have a tip-back bend at the molars and a secondary moment mesial or distal to the cuspid, depending on the type of tooth movement needed. This must be monitored and adjusted during the process. The wire must have a customized archform and hold the secondary moment.

I start my extraction cases using a .018 wire in a .022 bracket so that there is less binding and friction. I use customized tip-back bends distal to the cuspids, bypassing the bicuspid area. This allows for a low load-deflection rate for applying gentle, controlled force during tooth movement. This is reinforced with chain elastic from molar to cuspids.

In nonextraction cases I start with .016 wire with bite-opening mechanics, and engage more teeth as I go. I only bond the bicuspids after most of active treatment had been completed. This is the time to start bracket alignment with high-flex smart wire followed by stabilizing wire (.016 x .022 or .018 x .022).

Customized mechanics are designed to vary with the type of malocclusion and patient desires. They ensure the outcome with comfort and therefore encourage compliance.

Picking the Right Wire
Jerry R. Clark, DDS, MS
Greensboro, NC
As a practicing orthodontist, I choose my archwires carefully to have the greatest effect on tooth movement over the longest period of time with the least discomfort for my patients. Also, from a business standpoint, the patient chairtime necessary to treat a case is a significant factor in choosing which archwires to use. I want to use wires that will provide the best results for my patients with the least chairtime required. Most of the time, my wire of choice is a nickel titanium, heat-activated archwire. I also want an archwire that does not exert just one force but provides just the right amount of force to most efficiently move anterior teeth while gradually increasing in force to most effectively move bicuspids and molars.

Retracting Upper Incisors
Howard A. Fine, DMD, MMSc
Mount Kisco and Katonah, NY
A 2 x 4 setup is a common treatment modality in the mixed dentition, as in the example below where retraction of the upper incisors is the plan (Figure 1). However, in the initial leveling stages, with light wire such as nickel titanium, the wire can easily be displaced out of the molar tube, causing unnecessary emergency visits. By placing 256-Begg brackets on the deciduous teeth (Figure 2), the problem is eliminated. These brackets are extremely cost-effective, so you will not deplete your inventory of expensive straightwire brackets. In addition, the wire does not fit tightly in the slot of the bracket, so movement is not inhibited. The wire can be tied into these brackets with bracket-specific brass pins as shown—or can simply be ligated with ligature wire.