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ABSTRACT
During the last decades, a variety of alloys has been
used in orthodontics to manufacture wires. The orthodontic clinician is called to select from a large number
of materials that meet the biomechanical requirements of the clinical case to be treated.
Mechanical properties of orthodontic wires are
assessed by different laboratory tests, such as tensile,
torsional, and bending tests. Although wire characteristics determined by such tests cannot be directly
linked with their clinical application, they provide a
basis for useful comparisons. The "ideal" wire characteristics have been specified by a number of authors.
However, each wire may be considered ideal or not,
depending on the targeted clinical outcome on each
case. The clinician should know the properties and biomechanical behavior of available wires in order to
choose the appropriate wire depending on the targeted outcome in different orthodontic treatment phases.
The aim of this literature review is to summarize
orthodontic wire properties and demonstrate their
clinical applications as shown by their general properties. Stainless steel, cobalt-chromium, nickel-titanium,
beta-titanium and multistranded wires are studied.
Moreover, the so-called "aesthetic" wires are
reviewed, as well as their potential development
expected in the near future.
Key words: Orthodontic wires, mechanical properties,
applications
Hell Orthod Rev 2011;14:45-66.
Received: 31.03.2011 Accepted: 10.05.2011
45
.
: O , ,
2011;14:45-66.
: 31.03.2011 : 10.05.2011
EIAH
.
.
, ,
(Houston
., 1996), /
0,15-5N (Shetty
., 1994; Holberg ., 2008). (Reitan, 1967; Van Leeuwen .,
2010).
(Leach ., 2001).
.
.
(Rudolph ., 2001). ,
.
, . 1930
.
46
INTRODUCTION
During orthodontic treatment, the aim is to move the
teeth to a targeted position usually by applying forces to
them. An ideal force is the one that produces rapid tooth
movement without damage to the teeth or periodontal
tissues. Although it is difficult to precisely determine the
value of the ideal force since different biological and other
factors such as the type of movement and tooth size
should be considered (Houston et al., 1996), orthodontic/orthopedic forces usually range from 01.5-5N (Shetty
et al., 1994; Holberg et al., 2008). Studies have shown that
the application of lower forces produces the optimal
results. Application of excessive force exceeding vascular
blood pressure reduces cellular activity in periodontal tissues and slows down or stops tooth movement at least
for a period in time (Leach et al., 2001).
The ability to apply lower forces and achieve a wider
range of movements between sessions is of major importance to improve both the quality and performance of
treatment. The primary method to apply forces to the
teeth during orthodontic treatment using fixed appliances
is the orthodontic wire. The wire releases the energy
stored upon its placement by applying forces and torque
to the teeth through the appliances placed on them
(Rudolph et al., 2001). Therefore, knowledge of the biomechanical behavior and clinical applications of orthodontic wires is required to properly apply the treatment
plan.
The progress made in recent decades in orthodontic with
technology has resulted in a large variety of wires with a
wide range of properties. Up until 1930 all orthodontic
wires available were made of gold. Nowadays, these wires
are rarely used mostly due to their high cost compared to
that of alternatives. The use of stainless steel to produce
orthodontic wires was introduced in 1929. Stainless steel
quickly gained popularity over gold due to its improved
mechanical properties and lower cost. Since then several
other alloys exhibiting particular properties, as required,
have been introduced in clinical practice. These include
cobalt-chromium, nickel-titanium, beta-titanium and multistranded stainless steel wires.
No wire is appropriate for all treatment stages and no wire
is ideal. The clinician should consider a variety of wire
parameters and characteristics as necessary. The selection
of an appropriate wire size and type for each treatment
stage may, in theory, lead to a reduced number and duration of sessions, and possibly treatment as well, in cases
where the wire acts throughout the time period between
consecutive sessions, thus resulting in a higher-quality and
more predictable treatment outcome.
The properties of orthodontic wires are determined by different types of laboratory tests investigating wire behavior in terms of tension, bending, and torsion (Kapila and
.
1929
. ,
,
.
-, -, -
.
.
.
,
.
,
, (Kapila Sachdeva, 1989).
,
.
1 2 .
, 3 .
, , ,
(Kusy Greenberg, 1981;
Asgharnia Brantley, 1986).
.
Sachdeva, 1989). Although these tests do not fully simulate the clinical setting where wires are used, they provide
a basis for comparison of wires. Bending tests provide
some information on wire behavior when they are subjected to 1st or 2nd order bends. Similarly, torsional test
results reflect, to a certain degree, wire behavior in 3rd
order bends. It should be noted that tension, bending, and
torsion are completely different stress states investigating
different characteristics related with wire performance,
respectively (Kusy and Greenberg, 1981; Asgharnia and
Brantley, 1986). Therefore, wire characteristics determined
under these three stress states should be assessed independently.
WIRE CHARACTERISTICS OF CLINICAL RELEVANCE
There are different characteristics considered desirable for
a wires good behavior depending on the clinical case,
such as aesthetics, resiliency, elasticity, a large spring-back,
low stiffness, high formability, high stored energy, biocompatibility, and stability in use, low friction, and the
capability to be welded with biomechanical attachments
(Kapila and Sachdeva, 1989; Kusy, 1997).
The maximum spring-back (range) is also referred to as
maximum elasticity, range of deflection or range of activation or working range, and it is the property related
with the ratio of yield strength to the modulus of elasticity of the material (YS/E). The yield strength is the stress
required to obtain 0.2% deflection of the wire after it is
unloaded. A large range of activation enables the clinician
to achieve larger activations resulting in the wires
increased working time (Ingram et al., 1986; Zufall and
Kusy, 2000a).
Stiffness or load deflection rate is the force magnitude
delivered by an appliance and is proportional to the modulus of elasticity (E) (Goldberg et al. 1983). Low wire stiffness provides the ability to apply lower forces, a more constant force overtime as the appliance experiences deactivation, and greater accuracy in applying a given force (Burstone and Goldberg, 1980).
Formability is the specific property allowing to easily form
the wire without breaking it or significantly altering its
characteristics.
Stored energy or resilience is the property of a material to
store energy while deflected and produce this energy
while unloaded. This feature represents the work available to move teeth.
Biocompatibility (or biohostability) includes resistance to
corrosion and tissue tolerance to wire elements. Ideally,
the wire should neither favor nor be a substrate for developing microorganisms and allergies.
The capability to be welded (or soldered) with biomechanical attachments is important in wires and may be
achieved through electric welding or by using a binding
47
, ,
, , (spring-back), , ,
,
,
(Kapila Sachdeva,
1989; Kusy, 1997).
(spring-back, range),
,
-,
(yield strength) (modulus of elasticity) (YS/E).
0,2%.
(Ingram ., 1986; Zufall Kusy,
2000a).
(stiffness or load deflection rate)
(E) (Goldberg
., 1983).
,
(Burstone Goldberg,
1980).
(formability)
.
(stored energy or resilience)
.
.
(biocompatibility, biohostability)
. ,
,
.
(welding or soldering)
48
agent.
Low friction is a major property when attempting to relatively move a tooth/bracket along a wire.
TYPES OF ORTHODONTIC WIRES
.
(friction)
- .
Cobalt-chromium wires
Cobalt-chromium wires are commercially available in
grades based on their ability to store energy for a given
force. These wires have very good formability prior to heat
treatment, which takes place once they are configured,
thus increasing their stored energy and functionality
(Kusy, 1997). With only a few exceptions, non-heat treated cobalt-chromium wires have a smaller spring-back than
stainless steel wires of the same section (Ingram et al.,
1986). However, once subjected to heat treatment in a
dental oven (482 C for 7-12 minutes), this property is
improved (Ingram et al., 1986). Heating causes the accelerated hardening of the alloy, increasing its resistance to
deformation (Filmore and Tomlinson, 1979), and as a
result, the wire has mechanical properties similar to those
of stainless steel. High formability combined with
increased elasticity and yield strength following heat
treatment by 10% and 20-30%, respectively, has made
Blue Elgiloy, a cobalt-chromium wire type, popular in clinical practice.
Other properties of these wires show significant similarities to those of stainless steel wire properties (Meling and
Odegaard, 1998a; Kusy et al., 2001). Therefore, in most
cases, these wires may be replaced by stainless steel wires
of the same section, but of lower cost, which explains
their declining use in orthodontic clinical practice (Kusy
and Greenberg, 1981; Kusy et al., 2001). Moreover, with
regard to torque control, Meling and Odegaard (1998b)
49
(Bock ., 2008).
,
.
,
(House ., 2008). ,
, .
,
(liades Athanasiou,
2002; Mikulewicz Chojnacka, 2010).
-
piercing (Kolokitha ., 2008).
-
(Kusy Whitley, 1990; Kapila
., 1990; Krishnan Kumar, 2004a),
(Redlich ., 2008)
Australian Wires
(resiliency). 18/8
, (Pelsue .,
2009) 10
(
0,20%). , ,
(Pelsue ., 2009).
' , , .
,
(super stainless steels) ,
.
,
50
Beta-titanium wires
The use of beta-titanium alloys as orthodontic wires has
been introduced in 1979 (Goldberg and Burstone, 1979;
Burstone and Goldberg, 1980). These wires are also
known as titanium-molybdenium alloy () (ORMCO,
Orange, CA, USA) or Titanium Niobium (ORMCO, Orange,
CA, USA), since they were the first ones to be manufactured and the only ones commercially available for several years.
These wires have a modulus of elasticity lower than half
of stainless steel wires and almost twice that of Nitinol
(Verstrynge et al., 2006; Juvvadi et al., 2010). A beta-titanium wire can be deflected almost twice as much as a similar stainless steel wire (Goldberg and Burstone, 1979; Burstone and Goldberg, 1980). Moreover, it delivers half the
amount of force applied compared to a stainless steel wire
of similar section (Goldberg and Burstone, 1979; Burstone
and Goldberg, 1980).
These wires demonstrate good formability, but should not
be strongly bent for there is a risk of breaking (Burstone
and Goldberg, 1980). Electrical welding of biomechanical
attachments is possible, but it should be made within a
specific voltage range (Nelson et al., 1987) using wide
electrodes (Donovan et al., 1984), so that wire properties
are not altered since overheating makes it brittle (Burstone and Goldberg, 1980; Nelson et al., 1987). According
to a recent study, beta-titanium wires are better in terms
of joinability than stainless steel wires since they demonstrate higher resilience and better surface and structural
characteristics, which indicates only a minor change in
wire properties after welding (Krishnan Kumar, 2004b).
Controversy over biocompatibility for beta-titanium wires
is reduced due to the absence of nickel, although their
resistance to corrosion is similar to that of cobalt-chromium and stainless steel wires. Their resistance to corrosion
is due to the formation of a surface passivation oxide layer
(Kim and Johnson, 1999), whereas it should be noted that
exposure to fluoride agents often used by orthodontic
patients leads to the degradation, subsequent corrosion,
and qualitative alteration of the wires surface (Walker et
al., 2007). Experimental studies have shown that this negatively affects the mechanical properties of deactivation of
(Oh ., 2003).
-
-
.
,
, (Kusy, 1997).
,
(Ingram ., 1986).
,
(482 C 7-12 ) (Ingram ., 1986).
, (Filmore Tomlinson, 1979)
. ,
10% 20-30% ,
-
lue Elgiloy .
(Meling Odegaard, 1998a;
Kusy ., 2001). ,
,
(Kusy
Greenberg, 1981; Kusy ., 2001). ,
(torque), Meling
Odegaard (1998b)
- , , ,
,
(torque) . ,
,
(Filmore Tomlinson, 1976). ,
51
(Kapila Sachdeva, 1989).
-
- 1979 (Goldberg Burstone, 1979;
Burstone Goldberg, 1980).
titanium-molybdenium alloy
() (ORMCO, Orange, CA, USA) Titanium Niobium
(ORMCO, Orange, CA, USA),
.
o Nitinol (Verstrynge .,
2006; Juvvadi ., 2010). -
(Goldberg
Burstone, 1979; Burstone Goldberg, 1980). ,
(Goldberg Burstone, 1979; Burstone Goldberg,
1980).
,
(Burstone
Goldberg, 1980). , (Nelson ., 1987)
(Donovan ., 1984)
,
(Burstone
Goldberg, 1980; Nelson ., 1987).
, -
,
,
(Krishnan Kumar, 2004b).
- ,
- . H
(Kim
Johnson, 1999),
,
, -
52
, (Walker .,
2007).
NiTi (Kwon ., 2005; Walker ., 2005;
Walker ., 2007). , .
(Ogawa .,
2004). ,
in vitro
.
in vivo (Fragou Eliades, 2010).
-
(Kusy Whitley, 1989;
Kapila ., 1990; Cash ., 2004; Krishnan
Kumar, 2004a), ,
(Kusy ., 2004).
- TiMolium (TP Labs).
Krishnan Kumar (2004a),
( , )
-.
- Ni-Ti
- (Nitinol) Andreasen
Hileman 1971. NiTi '' '',
.
(transitional
temperature range, TTR) (Andreasen ., 1985).
Andreasen . (1985) ''''.
, , ''plateau''
(ijima .,
53
2002).
(
) (Meling
Odegaard, 2001).
1985 Burstone . NiTi (Ormco, Orange, CA, USA) 4,4
1,6
Nitinol
(Bradley
., 1996).
Miura . (1986), NiTi (Sentalloy
DENTSPLY GAC International, Bohemia, NY) (Brantley ., 1997). ,
90 GAC
(NeoSentalloy)
CuNiTi Ormco (Gioka Eliades,
2002).
NiTi,
. NiTi ()
NiTi () .
, R,
(Gioka Eliades,
2002).
, As Af
. in vivo ( NeoSentalloy)
Af
. (),
( Nitinol), Af 37 C
. - (Copper Ni-Ti) Af, 27, 35 40C. ,
27C ,
35C 40C
.
, ,
54
Multistranded wires
Multistranded wires are made of a varying number of
stainless steel wire strands coaxially placed or coiled
around each other in different configurations. The stiffness of a triple-stranded 0.0175-inch wire is comparable to
that of a single-stranded 0.010-inch stainless steel wire,
whereas the triple-stranded is more resilient by 25%.
Moreover, a triple-stranded 0.0175-inch wire has similar
stiffness to that of a 0.016-inch nickel-titanium wire,
although the nickel-titanium wire can accept more than
50% greater activation than the multistranded one. Furthermore, the triple-stranded wire is 50% less stiff than a
0.016-inch beta-titanium wire (Kusy and Dilley, 1984). The
elastic behavior of coiled multistranded wires resembles
more the behavior of a single strand than of a set of
strands (Rucker and Kusy, 2002a,b,d). Multistranded wires,
such as nickel-titanium wires, have a spring-back, which is
rather independent of the wires size, as opposed to multistranded stainless steel wires (Ingram et al., 1986; Kusy
and Dilley, 1984; Kusy, 1981).
Taneja et al. (2003), following a laboratory study of different multistranded stainless steel wires concluded that
although the arrangement, section, and number of
strands should in theory greatly affect the range of forces
applied in a given deflection (Rucker and Kusy, 2002d), in
practice, this only occurs in deflections over 2 mm. Additionally, these investigators observed that coiled wires
deliver higher forces than coaxial wires.
Low forces developed by multistranded wires, low stiffness and a high spring-back are characteristics similar to
those of the more expensive titanium alloys (Wilkinson et
al., 2002; Rucker Kusy, 2002a), and could be an economically advantageous alternative (Kusy and Dilley,
1984; Kusy and Stevens, 1987). However, multistranded
wires do not always deliver low and rather constant forces
when unloaded, particularly after significant deflection
(Taneja et al., 2003). With regard to friction, multistranded stainless steel wires develop higher bracket-wire friction than NiTi wires and approximately more than 30%
greater friction than single-stranded stainless steel wires
(Rucker and Kusy, 2002c).
CLINICAL APPLICATIONS OF ORTHODONTIC WIRES
The proper selection of the type and size of wire can maximize efficiency of the clinical applications of orthodontic
wires in a way that all clinical requirements are fulfilled.
The wire sequence that is followed in the course of treatment is depended on the treatment technique (i.e., segmental or straight wire technique) and can be accordingly
modified. Knowledge of basic wire properties and biomechanical aspects can help the orthodontist select the wire
.
( Nitinol SE) , in vivo
(Brantley, 2001).
NiTi
, (Wilkinson ., 2002; De Santis
., 2008).
(Meling
Odegaard 1998a; Airoldi ., 1997; Sakima
., 2006; Kusy Whitley, 2007). Kusy Whitley (2007), Orthonol (Rocky
Mountain Orthodontics, Denver, CO, USA)
Cu-Ni-Ti Nitinol
TMA
. Cu-Ni-Ti,
.
Ni-Ti
Cu-Ni-Ti (Pandis ., 2009). ,
, Cu-Ni-Ti 40C
Cu-Ni-Ti 27 (Wilkinson ., 2002; Kusy Whitley,
2007). ,
. ,
(Gross
., 2002).
.
NiTi
, (Andreasen Morrow, 1978;
Burstone ., 1985). ,
(Drake ., 1982;
Brantley, 2001). , ,
-
55
. ,
NiTi (Nakano
., 1999). Sakima . (2006)
NiTi 0,019 x 0,025 ,
Copper NiTi 40C
NeoSentalloy 200 gr. ,
35C '
.
.
. ,
(Andreasen Morrow, 1978),
(Lopez ., 1979). , (Brantley, 2001).
-
-,
(Kapila ., 1990).
NiTi ( )
( )
. ,
Ni Ti (Huang ., 2003).
Eliades . (2000),
NiTi
. , ,
(Gioka Eliades, 2002). (stress)
NiTi - /
iTi
(Segal ., 2009). ,
- , -
56
(Bourauel ., 2008).
in vivo
NiTi (Meling Odegaard,
1998a,b; Brantley, 2001).
. 0,0175
0,010 ,
25% . ,
0,0175
- 0,016
- 50%
. ,
50% - 0,016 (Kusy Dilley, 1984).
(Rucker Kusy,
2002a,b,d). , -,
, (Ingram ., 1986; Kusy Dilley,
1984; Kusy, 1981).
Taneja . (2003),
, ,
,
(Rucker Kusy, 2002d), 2 ..
,
.
,
(Wilkinson
., 2002; Rucker Kusy, 2002a)
57
(Kusy Dilley,
1984; Kusy Stevens, 1987). ,
,
(Taneja .,
2003). ,
-
NiTi 1/3 (Rucker Kusy,
2002c).
.
(..
straight-wire ). , ,
,
. , NiTi, - (Keim
., 2002). -
2
- 4
(Drake ., 1982).
: strength = stiffness x range
( = x ) (Kusy Greenberg,
1981). (1) strength:
, (2) stiffness: strength
range, (3) range:
. NiTi, -
58
(Zufall Kusy, 2000a).
(strength, stiffness, range)
(),
.
,
.
NiTi
(Ingram ., 1986). ,
. , 50%,
. , - 50%,
(Proffit ., 2007). ,
, ,
. ,
, (Adams .,
1987).
, ,
(torque) . O (torque)
, ,
-
. ,
(edge
bevel) (Sebanc
., 1984; Gioka Eliades 2004; Morina .,
2008). (<12),
(torque)
, Cu-Ni-Ti,
(>24)
1,5-2
2,5-3
Cu-Ni-Ti (Archambault ., 2010).
i-Ti
20 ,
59
. ,
i-Ti
(Partowi .,
2010).
Burstone (1981),
,
(Variablemodulus orthodontics).
(Rucker Kusy,
2002a, b; Garrec ., 2005).
-, , - -
1,2:1:0,42:0,26.
1/25-1/5 (Burstone,
1981).
,
,
. , Kusy (1997), -
.
,
,
,
,
(Burstone, 1985).
(Kusy, 1997). , , (Rucker Kusy,
2002b).
-
(Johnson, 2003). ,
NiTi , , NiTi ,
60
. Ni-Ti
(Andreasen Morrow, 1978; Drake .,
1982; Brantley, 2001),
-. ,
. Andreasen Morrow
(1978) - , , .
'''' ,
.
,
(Proffit ., 2007). ,
Ni-Ti , , , ,
(torque).
, ( utility
Spee),
, (Drake ., 1982).
(Krishnan
Kumar, 2004a; Verstrynge ., 2006).
, ,
.
.
61
-
, (Bartzela ., 2007).
,
NiTi,
, . ,
(Proffit .,
2007).
usy Stevens (1987) 0,015 - .
-
(Quintao
. 2009). , NiTi, NiTi ,
(West ., 1995; Evans ., 1998).
,
-
(Riley
Bearn, 2009; Wang ., 2010).
.
-
,
. ,
- (Kapila Sachdeva, 1989; Kusy,
1997; Johnson, 2003).
- (Kusy,
1997).
-
62
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. ,
(Kapila Sachdeva, 1989; Kusy, 1997).
(Burrow, 2009).
(binding),
,
(Thorstenson Kusy, 2002; Hamdan
Rock, 2008), (notching), ,
(Articolo ., 2000; Burrow, 2009). ,
. , - (bindingand-release)
in vitro (Swartz,
2007; Burrow, 2009). ,
SS
(Peterson ., 1982;
Kusy Whitley, 1990; Kusy Whitley, 1989; Kapila
., 1990; Cash ., 2004; Krishnan Kumar,
2004a)
.
,
,
(torque),
(
-) , , (Kapila Sachdeva, 1989;
Kusy, 1997). ,
-
(Johnson, 2003).
-
.
, (settling),
.
,
63
,
(0,0215
)
(Zachrisson, 2007).
(residual stresses).
-
,
.
(coated)
(fiber-reinforced). ,
,
.
, Teflon
(Elayyan ., 2008;
Elayyan ., 2010). '' ''
in vivo (Kusy, 1997).
(Lim
., 1994). 25%
33
(Elayyan ., 2008). H
- (Husmann ., 2002),
(Elayyan ., 2008).
(Elayyan
., 2010). , (
),
(Elayyan ., 2010).
,
(Zufall Kusy, 2000b; Goldberg
Burstone, 1992).
,
64
/
(Imai ., 1998; Zufall Kusy, 2000b).
(Fallis Kusy., 2000).
(Cacciafesta .,
2008).
,
(Kusy, 1997). ,
, (Lendlein .,
2005). (Eliades, 2007).
()
- . ,
(relaxation). ,
(Goldberg ., 2010).
,
.
, .
,
,
.
.
. ,
,
. -
mater 2004;69B:183-94.
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