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American

Journal

of ORTHODONTICS

Volume 80, Number I July, 1981 ORIGINAL ARTICLES Dr. Burstone
Volume 80,
Number
I
July,
1981
ORIGINAL
ARTICLES
Dr. Burstone

Traditionally, orthodontists have

varied

the size of

the wire

in order

to produce a

range of light to heavy forces. A

new approach to force

control

is presented which

allows wire size to remain relatively constant and the material of the wire is selected on the basis of clinical requirements. When the material instead of the cross section is varied, superior orientation should be achieved with fewer wires during tooth alignment, and bracket-wire play becomes independent of the forces needed. Since wire sttrness is determined by wire cross section and material, a simpltjied numbering

system is described which aids clinicians in evaluating any orthodontic wire.

Key words: Modulus of elasticity, wire stiffness, constant-cross-section therapy, preferential orientation, wire-stiffness numbers, leveling

  • I n the past the usual method of regulating the magnitude of force from an orthodontic appliancewas variation in the cross sectional dimensions of the wires used. Although configurations such as loops have been used to lower forces, the primary determinantof force magnitudehas been the size of the wire used. Hence, traditional orthodontics may be describedas variable-cross-sectionorthodontics where small wires were used for light forces and large wires for heavier ones. Variable-modulusorthodon- tics, on the other hand, will take advantageof different materials while maintaining the same or similar cross sections. As will be seen, there are definite advantagesin using wires of varying materials in optimizing control of tooth movement.

From the University of Connecticut School of Dental Medicine, Department of Orthodontics. This study was supported by Research Grant DE03953 from the National Institute of Dental Re- search. National Institutes of Health, Bethesda, Md.

OOOZ-9416/81/07ooO1+16$01.M)/0

0

1981

Tbe

C.

V.

Mosby

Co.

1

2 Burstow
2 Burstow
2
Burstow
2 Burstow

EXCESSIVE

OPTIMAL

Fig. 1. Varying force levels produced during deactivation of a wire: excessive, optimal, s&optimal, and subthreshold. During treatment the optimal zone is present only over a small range.

Optimal

forces

and wire stiffness

If a simple, plain

wire is insertedinto bracketsfor the purposeof alignment, the force

is not constantas the teeth move. Fig. 1 showsa premolarbeing moved buccally with an alignment arch. One could differentiate four zones of force magnitudeas the force is dissipatedduring deactivationof the wire. At full engagementthe forces may well be excessive,leading to underminingresorption and concomitant tissue damage,including a lowering of pain thresholds.As the force is reducedwith further buccal tooth movement of the premolar, the force rangesbecome optimal, with direct boneresorption proceeding and minimal lowering of pain thresholds.If the wire is left in place, the forces will be further reducedand a suboptimalzone is reachedin which tooth movementwill continue

but ratesof

tooth movementwill be smaller andless efficient. Finally, in the fourth zone,

becauseof

dissipation of force, a threshold has been reachedand below it, in a sub-

threshold zone, no tooth movement whatsoeveroccurs. A straight alignment arch pro-

ducesa rangeof force valuesand in many situationsfrom excessiveto subthreshold.In the

exampledescribed when simple tipping is

required,very low forces arecapable of produc-

ing movementsince the thresholdis very low. On the other hand, in translationof teeth, suboptimaland subthresholdzones become clinically more significant. Becauseof the changing force values as an appliance works out, and becauseof changinggeometries as well, a clinician will notice that a light alignmentarch may move the teethonly partly to their final position. A typical solution to this problem has beento

use a series of increasingly heavier alignment or leveling archesto complete the tooth movement(for example,0.016 inch followed by 0.018 inch followed by 0.018 by 0.025 inch). What the orthodontistis accomplishingmight be called a “replacementapproach, ”

which is nothing more than varying the force at the time of insertion by using wires with

increasing stiffnesses,that is, increasingthe load-deflectionrates in

sequentialwires. I

haverecommended another approach in which one wire is usedwith a low load-deflection rate, so that the force magnitudeis delivered more constantly.‘-” This allows the orth- odontist to approachoptimal force magnitudesand to negateexcessive and subthreshold force zones. This is shown diagrammatically in Fig. 2, in which a wire with a low load-deflectionrate is formed beyondwhere the final position of the tooth shouldbe. Note that it would be possiblefor the force zonesto vary only from optimal to suboptimaland the tooth movementwould be stoppedbefore a subthresholdzone was reached.

Volume 80

Number

I

Variable-modulus

orthodontics

3

OPTIMAL

SUBOPTIMAL

SUBTHRESHOLD

Fig. 2. Overbant wire with low load-deflection rate. Tooth will reach desired position before sub- threshold force zone is reached. Replacement of wires is not required in “constant” force approach.

This

approachto alignmentcould be referredto as the “constant-forceapproach. ” It

can be achievedwith either plain wires or loopedconfigurations.

Regardlessof the solutionto the dissipationof force in an orthodonticappliance, either by a replacementor a constant-forceapproach, traditionally the orthodontisthas varied the

crosssection of wires usedand has usedthe samematerial, namely,

stainlesssteel.

Variable-cross-section

orthodontics

The selectionof the properwire size shouldbe primarily basedon

the load-deflection

raterequired in the appliance.Secondarily, of course,it is dependentupon the magnitude of the forcesand moments required. Many orthodontistswill selectthe crosssection of the wire on the basisof two factors which, althoughvalid, are not as significant. It may be believed that one reasonthat increasinglyheavier wires are neededin a replacement techniqueis that one is eliminating the play betweenthe wire and the bracket. In an edgewiseappliance the ligaturewire minimizesa greatamount of the play in a first-order

direction sincewires seatfully within the brackets.With

narrow edgewisebrackets play

may be presentin a second-orderdirection, but even there the ligature tie tends to

minimize play, even with smaller cross-sectionwires. One thereforedoes not selectan

0.018 inch wire over an 0.016 inch primarily becauseof the differencein play. A second reasonthat a wire may be selectedis the belief that the smallerthe wire, the greaterwill be the amountof maximumelastic deflection possible. In other words, the smallerthe wire, the more one can deflect it without permanentdeformation. This is true, but maximumelastic deflection varies inversely with the diameterof the wire. An 0.016 inch wire w$uld only have 1.15times asmuch maximum elastic deflection

as an O.Oi8 inch wire; theefore, the differencesare negligible from a clinical

point of

view. If the differencesare two to one, as in 0.010 inch versus0.020 inch, then, of

course,this factor becomesclinically significant. The major reasonthat the orthodontist shouldselect a particularwire size is the stiffnessof the wire or its load-de’flectionrate. In

a replacementtechnique, for instance,one might

begin with an 0.014 inch wire which,

deflectedover 2 mm., could give a desiredforce. After the tooth hasmoved 1 mm., the wire can be replacedwith an 0.018 inch wire which would give approximatelythe same force with 1 mm. of activation. Small changesin crosssection produce large changes in the load-deflectionrate, since the load-deflectionrate varies as the fourth power of the diameter in round wires. In bending,the stiffnessor load-deflectionrate is determinedby ’the momentof inertia of the

Table I. Cross-sectional

stiffness

numbers

(C,)

of

round

wires

 

(Inches)

I

(mm.)

 

0.004

0.102

0.010

0.254

0.014

0.356

0.016

0 406

0.018

0.457

0.020

0.508

0.022

0.559

0.030

0.762

0.036

0.914

Table

II. Cross-sectional

stiffness

numbers

(C,)

of

rectangular

 

Cross section

 
 

Shape

(Inches)

(mm.)

Rectangular

0.010

x

0.020

0.254

X 0.508

Rectangular

0.016

x

0.022

0.406

X 0.559

Rectangular

0.018

X 0.025

0.457

X 0.635

Rectangutar

0.021

x

0.025

0.533

X

0.635

Rectangular

0.0215

x

0.028

0.546

X 0.711

 

Cross section

 
 

Shape

(Inches)

(mm.)

 

Square

0.016

x

0.016

0.406

X 0.406

Square

0.018

x

0.018

0.457

x

0.457

Square

0.021

x

0.021

0.533

x

0.533

I

CA

1.OO

39.06

150.06

256.00

410.06

625.00

915.06

3.164.06

6,561 .oo

and

square

wires

 

C

 

1st order

2nd order

530.52

132.63

1129.79

597.57

1865.10

966.87

217.5. 95

1535.35

3129.83

1845.37

 

C.8

434.60

696.14

1289.69

crosssection of the wire with respectto the neutralaxis. The clinician is interestedin the relative stiffnessesof the wires that he uses,but he hasneither the time nor the inclination to use engineeringformulas to determine these stiffnesses.For that reason, a simple

numbering system has been developed,based on engineeringtheory, which gives

the

relative stiffnessesof wires of different cross sectionsif the material compositionof the

wire is the same.The cross-sectionalstiffness number C, uses0.1 mm. (0.004 inch} round

wire as a base of 1. An 0.006 inch wire has a C, of

5.0, which meansfor the same

activation five times as much force is delivered.Tables I and II list, underthe C, column,

stiffness numbersbased on nominal cross sections.Manufacturing variation

in wires or

mislabelingof wires obviously can significantly alter the C, number.Two C, numbersare neededfor rectangularwires-one for the first-order direction and the other for the second-orderdirection. Wire with a cross sectionof 0.016 inch has a numberof 256, which implies that, for an identical activation, it would deliver 256 times as much force as a 0.004 inch round wire. The cross section numberof 0.018 by 0.025 inch wire in a first-orderdirection is

Volume so

Number

1

Variable-modulus

orthodontics

5

.cO4

a2

x114

a6

.018

.016X

.ol6X

m3x

.Ol&

 

.02211) .022(23 .025(l)

.025(2)

 

Wire

Cross

Section--Inches

 

Fig. 3. Cross-section stiffness numbers (CS) of orthodontic wires. Forces for any given activation are proportional to the number. By varying cross section, stiffnesses can vary as much as 10 or more between wires.

1,865. Since0.016 inch hasa numberof

256, an 0.018 by

0.025 inch wire in a first-order

direction delivers7.3 times as much force for the sameactivation. We are assumingfor

now, for purposesof comparison,that the wire configurationand the alloy that it is

constructedof areidentical and that only tbe crosssection is beingvaried. To compareany

two sectionsof wire for stiffness,one has only to divide the cross-sectionstiffness number

of one into the other.

Fig. 3 showsthe cross-sectionnumbers graphically for 0.014 to 0.018 by 0.025 inch

wires. Although the full spectrumof all availablewire crosssections is not shown, it is

apparentthat one can vary load-deflectionrates by factors of ten or more by using

different-sizedwires if a constantmaterial, such as stainlesssteel, is used.

Varying the material

rather than the cross section

The traditional world of orthodonticsis one in which the crosssection has been varied

to producedifferent stiffnesses.The cross-sectionalstiffness number can be useful in

being more precisein determiningthe stiffnessesof our appliancesonly if the samealloy

is used.The over-all stiffnessof our appliance(S) is determinedby two factors;one factor

relatesto the wire itself, (W,), and the other is the designof the appliance(A,):

S = Applianceload-deflection

rate

S = W, X As

W,

=

Wire stiffness

As

=

Design stiffness factor

In generalterms,

Appliance stiffness = Wire stiffness X Design stiffness

As we changeour appliancedesign by increasingwire betweenbrackets or adding

Table III. Material-stiffness

numbers (M,)

of orthodontic

alloys anal braided steel u ire\-

Alloys

 

Stainlesssteel (ss)

 

I .oo

TMA

 

0.42

 

Nitinol

0.26

Elgiloy blue

 

1.19

Elgiloy blue (heat-treated)

1.22

Braids

 

Twist-flex

0.18

-

0.20

Force-9

0.14

~

0.16

Drect

0.04

-

0.08

 

Respond

0.07

-

0.08

*Based on E =

25 X

106p.s.i.

loops, the stiffnesscan be reducedas the designstiffness factor is changed;however, we

are now concernedonly with ways that we can alter the wire stiffness. Wire stiffness is

determinedby two factors-the

cross section and the material of the wires:

 

W, =

Wire stiffnessnumber

W, =

M, x

Cs

MS= Materialstiffness number

 

C, =

Cross sectional stiffness number

In generalterms,

Wire stiffness = Material stiffness x Cross-sectionalstiffness

Wire stiffnessis determinedby a cross-sectionalproperty, suchas momentof inertia, and

a materialsproperty, the modulusof elasticity.

Previously, since most

orthodontistsused only stainlesssteel with almost identical

moduli of elasticity, it was only the size of the wire that was varied and no concernwas

given to the materialproperty which determineswire stiffness. It is now our intent to show

that one may elect to maintain the samecross section of wire but use different materials

with different stiffnessesto producethe wide range of forces and load-deflectionrates

requiredfor comprehensiveorthodontics.

Just as it was useful to develop a simple numberingsystem to describethe relative

stiffnessof wires

basedon cross section, a similar

numberingsystem is now suggestedto

consider relative

stiffness basedon the material. The material stiffness number (M,) is

baaedon the modulus of the elasticity of the material, which is the property that deter-

mines its

stiffness. Since steel is the most commonly used alloy at this time in orthodon-

tics, its (M,) numberhas been arbitrarily set at 1.O. This is basedon an averagemodulus

of elasticity of 25,000,OOOp.s.i.j, 6 Our studieshave shownthat the modulusof elasticity

can vary from 23,000,OOOto 28,ooO,OOOp.s.i. for orthodontic stainlesssteel wires.

Typical stiffness numbersfor other alloys are given in Table III. The data are basedon

bending tests for wires 0.016 inch in diameter.6 Although the modulus of elasticity is

considereda constant,it should be rememberedthat the history of the wire (particularly

that of the drawing process)may have some influence on the modulus. Furthermore,

differencesin chemistry may make small alterationsin the recordedmodulus. For practi-

cal clinical purposes,however, the material stiffness number(M,) can be used to deter-

mine the relative amountof force that a wire will give per unit activation. Note that TMA

Volume 80

Number

1

0

Variable-modulus

orthodontics

7

Fig. 4. Material-stiffness numbers (MS). Stainless steel has a base number of 1. The numbers for the other alloys and braids denote their stiffness in comparison to stainless steel. By varying the material, a range of stiffnesses is available equivalent to varying the cross section.

has a (M,) number of 0.42, which meansthat, for the sameappliance and wire cross

section, a given activation delivers approximately0.4 as much force as steel. Nitinol

would deliver 0.26 as much force as comparablewires of stainlesssteel. Elgiloy wires

deliver slightly more force than comparablewires of stainlesssteel but, for all practical

purposes,this increasein negligible.

In addition to new alloys, braided wires have been introduced into orthodon

Braids take advantageof smaller cross sectionswhich have higher maximum elastic

deflectionsand, in the process,produce wires that haverelatively low stiffnesses.If one

wereto pretendthat a braid was a solid wire, and if the nominal crosssection were used,

one could establishan apparentmodulus of elasticity.

Basedon apparentmodulus, the

material stiffnessnumbers were found for representativebraided wires and are shownin

Table III. For instance,an 0.018 inch Respondwire braid has a M, of

0.07 and delivers

only 0.07 the force of an 0.018 inch steel wire. The variation in M, numbersis shown

graphically in Fig. 4.

Let us now seehow one could changethe load-deflectionrate and maintainthe same

wire size and vary the load-deflectionrate as significantly as one could by altering the

crosssection. If we wantedto maintaina crosssection of 0.018 by 0.025 inch wire, the

wire stiffness(W,) is shownin Fig. 5. To obtainW, number,the M, was multiplied by the

C, number. For example, in a second-orderdirection for TMA:

W,

=

M,

x

C,

w,

=

.42

x

967

W,

= 406.1

TMA wire with dimensionsof 0.018 by 0.025 inch hasa stiffnessnumber of 406.1, which

is equivalentto an 0.018 inch round steelwire. Nitinol wire with dimensionsof 0.018 by

Stiffness

of

.018’

x

.025’

Wires--Second

Order

Flg. 5. Wire-stiffness numbers (WS) of 0.018 by 0.025 inch wires in second-order direction. Forces for the same activations are proportional to the WSnumbers. A full range of forces is obtained by using a constant cross section, as 0.018 by 0.025 inch in different materials.

0.025 inch has a stiffness number of 25 1.4, which is similar

to 0.016

inch steel wire.

Braided wire with dimensions of 0.018 by 0.025 inch (W, = 75.4) is similar to an 0.012

inch steel wire.

One can obtain a full

range of forces by varying the material of the wire

and keeping the cross section the same. Note, in Fig. 4, that the ratio of the smallest wire

stiffness

number to the largest is greater than

10: 1.

W,

numbers for 0.018

inch round

wires of

different materials are shown in Fig. 6.

Advantages of variable-modulus orthodontics

Using the principle of variable-cross-section orthodontics, the amount of play between the attachment and the wire will vary, depending upon the stiffness required. With small low-stiffness wires, excessive play may lead to lack of control over tooth movement. On the other hand, if the principle of variable-modulus orthodontics is employed, the clinician determines the amount of play that is required before selecting the wire. In some in- stances, more play is needed to allow freedom of movement of brackets along the arch wire. In other situations, very little play is required to allow good orientation and effective third-order movements. Once the desired amount of play has been established, the desired stiffness of the wire can be produced by using a material with a proper material stiffness. In this way, the play between the wire and the attachment is not dictated by the stiffness required but is under the full control of the operator. The variable-modulus principle allows for the use of oriented rectangular wires or square wires in light force, as well as heavy force applications and stabilization. A rectangular wire orients in the bracket and hence offers greater control in delivering the desired force system. It is easier to bend since one can carefully check the orientation of the wire and, more important, when placed in the brackets it will not turn or twist so that

Volume

80

Number

1

Variable-modulus

orthodontics

9

SS

TMA

NIT

RES

Stiffness

of ,018 ” Round W ires

Fig. 6. W ires-stiffness numbers (WS) for 0.018 inch round wires. Figs. 5 and 8 show wide stiffness ranges, keeping the occlusogingival wire dimension constant at 0.018 inch.

Volume 80 Number 1 Variable-modulus orthodontics 9 TMA NIT Stiffness of ,018 ” Round W ires

Fig. 7. Ribbon braids, 0.022 by 0.016 inch. W ire has low stiffness labiolingually and higher stiffness occlusogingivally for definite leveling. A, Note labiolingual overcontouring. B, After tie-in. The free ends of the anterior segment allow wire to slide through brackets, further reducing the stiffness and increas- ing efficiency. C, Overcontoured braid to rotate mesial aspect of incisors to the labial.

forces are dissipated in improper directions. If the constant-force principle is used where

wires are overcontoured, this is particularly

significant because turning of wires can

become more apparent than in simple straight wire configurations. Fig. 7 shows a rectan- gular braid (D-rect) which has been overbent and oriented in a ribbon direction. The 0.022 by 0.016 inch braided wire has a wire stiffness number of 29.9 in a first-order direction. This would be the equivalent of a 0.009 inch + round solid stainless steel wire. Since the

10

10

Burstonr

Burstonr

10 10 Burstonr Burstonr Fig. 8. TMA wire, 0.018 by 0.025 inch, with loops for occlusogingival
Fig. 8. TMA wire, 0.018 by 0.025 inch, with loops for occlusogingival Fig. 8. TMA wire,
Fig. 8. TMA wire, 0.018 by 0.025 inch, with loops for occlusogingival
Fig. 8. TMA wire, 0.018 by 0.025 inch, with loops for occlusogingival
alignment. By using a material with
alignment.
By using a material with
a stiffness
a stiffness
.42 of steel,
.42 of steel,
forces
forces
equivalent
equivalent
to
to
an
an
0.018
0.018
inch are
inch are
produced.
produced.
One
One
advantage
advantage
over a round
over a round
wire
wire
is good
is good
orientation
orientation
in the brackets.
in the brackets.
Fig. 9. TMA ribbon
Fig. 9. TMA ribbon
wire, 0.020
wire, 0.020
by 0.016
by 0.016
inch. Small first-order
inch. Small first-order
bends
bends
can
can
be made to overrotate
be made to overrotate
teeth.
teeth.
Ribbon
Ribbon
is more efficient
is more efficient
than
than
edgewise
edgewise
for first-order
for first-order
movement
movement
and orients
and orients
well for torque
well for torque
control.
control.
stiffness stiffness is low, is low, the wire the wire is overbent to assure more constant
stiffness
stiffness
is low,
is low,
the wire
the wire
is overbent to assure more constant delivery
is overbent to assure more constant delivery
of
of
force
force
to
to
the
the
incisor.
incisor.
In
In
Fig.
Fig.
8
8
an 0.018
an 0.018
by
by
0.025
0.025
inch
inch
arch is shown
arch is shown
with
with
loops for second-order
loops for second-order
movement.
movement.
The arch wire
The arch wire
is composed of
is composed of
beta titanium
beta titanium
with
with
a
a
M,
M,
of
of
0.42
0.42
and
and
a
a
W,
W,
number
number
of
of
406.1
406.1
(second-order).
(second-order).
This
This
is
is
slightly
slightly
less than
less than
a solid
a solid
0.018
0.018
inch round
inch round

stainless steel wire with a wire stiffness number of 410.0. The advantage of rectangular

stainless steel wire with a wire stiffness number of 410.0. The advantage of rectangular

over round wire is the good orientation of the wire in the brackets, allowing the forces to

over round wire is the good orientation of the wire in the brackets, allowing the forces to

work out in a proper direction and aiding patient comfort since orientation prevents loops

work out in a proper direction and aiding patient comfort since orientation prevents loops

from turning into the cheek or into the gingiva.

from turning into the cheek or into the gingiva.

The loops lower the load-deflection rate

The loops lower the load-deflection rate

and minimize

and minimize

side effects. Finally,

side effects. Finally,

it should be pointed out that rectangular wires allow

it should be pointed out that rectangular wires allow

for

for

the delivery

the delivery

of moments as well

of moments as well

as forces, so that during the alignment procedure

as forces, so that during the alignment procedure

better control is maintained over the roots. The ability to produce moments and forces at

better control is maintained over the roots. The ability to produce moments and forces at

the

the

bracket instead of single forces, as with round wires, has a definitive

bracket instead of single forces, as with round wires, has a definitive

advantage in

advantage in

alignment procedures.

alignment procedures.

The possibility

The possibility

of

of

using rectangular

using rectangular

wires that orient

wires that orient

in the brackets with

in the brackets with

stiffness

stiffness

allows

allows

for

for

preferential orientation.

preferential

orientation.

Although

Although

many

many

operators

operators

who

who

varying

varying

use the

use the

edgewise appliance, by habit, place all wires in an edgewise direction,

edgewise appliance, by habit, place all wires in an edgewise direction,

it can be advan-

it can be advan-

tageous to reorient

tageous to reorient

the direction

the direction

of

of

0.020

0.020

by

by

0.016

0.016

inch solid TMA

inch solid TMA

the wire

the wire

so that

so that

a ribbon

a ribbon

arch is used. Fig.

arch is used. Fig.

9 shows an

9 shows an

ribbon

ribbon

wire

wire

from

from

canine to canine. The differential

canine to canine. The differential

stiffness between the second order and first order is 1.6 : 1. The ribbon orientation is useful

stiffness between the second order and first order is 1.6 : 1. The ribbon orientation is useful

if

if

labiolingual

labiolingual

alignment

alignment

is needed with

is needed with

minimal

minimal

occlusogingival

occlusogingival

stepping between

stepping

between

brackets. The greater stiffness in the second-order direction can complete occlusogingival

brackets. The greater stiffness in the second-order direction can complete occlusogingival

leveling. The first-order W, number is 228.2 and the second-order number is 356.5. This

leveling. The first-order W, number is 228.2 and the second-order number is 356.5. This

Volume 80

Number

1

Variable-modulus

orthodontics

11

Volume 80 Number 1 Variable-modulus orthodontics 11 Fig. 10. Preferential orientation. A 0.020 by 0.016 inch

Fig. 10. Preferential orientation. A 0.020 by 0.016 inch ribbon anterior braided segment is twisted 90

degrees into the right lateral to reduce stiffness and increase play in an occlusogingival direction.

Volume 80 Number 1 Variable-modulus orthodontics 11 Fig. 10. Preferential orientation. A 0.020 by 0.016 inch

Fig. 11. Preferential orientation with a segmented arch. Posterior segments, 0.016 by 0.025 inch

edgewise TMA (WS 763, 406). Anterior segment 0.022 by 0.016 inch braided ribbon (WS 30, 41).

Segmented procedures use the principles of varying moduli and orientation in the anterior and posterior

regions. Posterior segments are not changed during treatment. A, Occlusal view. 6, Junction of anterior

and posterior segments.

is equivalent to using an 0.016 inch steel wire for first-order movements and an 0.019 inch

wire for second-order correction. The same principle of differential stiffness will hold for

an 0.022 by 0.016 inch steel wire; the differences are the lower stiffness and higher

maximal elastic deflection of TMA. Wires should be turned in a direction to optimize the

type of tooth movement required. If primarily second-order movement is needed, then

edgewise wire is indicated. If first-order movement, arch-width change, and labiolingual

tooth alignment are required, the choice of a ribbon orientation is preferable. For torque,

orientation direction is not important.

An 0.022 by 0.016 inch braided ribbon wire (D-rect) for alignment of the anterior

segment is shown in Fig. 10. It is twisted 90 degrees mesial to the right lateral incisor to

give reduced stiffness in a second-order direction to correct an occlusogingival discrep-

ancy on the lateral incisor. The same concept can be used in a continuous arch-buccal

segments of edgewise wire and the anterior segment of

ribbon wire. The 0.022 by 0.016

inch ribbon wire has a W, of 29.9 in the first order and 40.7 in the second direction. The

ratio of second order to first order is 1: 3, a smaller differential than found in a solid wire.

Posterior teeth frequently require greater stiffnesses than anterior teeth. Fig. 11 shows

a segmented arch in which

an 0.018 by 0.025

inch TMA

buccal wire

is oriented

in

an

edgewise direction and an anterior 0.022 by 0.016 inch braided wire is placed ribbonwise.

12 Burstone
12 Burstone
12
Burstone
12 Burstone

The differential of stiffness of posterior to anterior segments in a first-order direction is

26.1. Obviously,

this cannot be achieved with

orientation; hence, the need for segmentation.

a continuous arch of one material and

If both first- and second-order movements are required, a round or square cross section

may be indicated, particularly if there are large discrepancies. For alignment by simple

tipping and eruption, 0.0175 inch Respond (W, 25.3), 0.0175 inch Twist-Flex (W, 61.5),

0.016

inch nitinol (W, 66.6), or 0.016 inch Th4A (W,

107.5) wire without loops could be

considered.

 

Over all, the principle of variable-modulus orthodontics reduces the number of arch

wires needed for alignment since bracket play is eliminated. Wires work more efficiently

because of their orientation and their ability to be preferentially oriented and in many cases

because of the increased maximum elastic deflection of the newer alloys that are used.

Although the advantages of using rectangular wires have been discussed, this should

not imply that there is no role for a round wire. In instances where both Iirst- and

second-order movements are required, the round wire might well be the cross section of

choice. A much lower stiffness is available for similar cross sections. For example, an

0.018

by 0.018 inch square stainless steel wire has a wire stiffness number of 696 versus

410 for 0.018 inch round.

 

The minimization of friction between the arch wire and the bracket is another advan-

tage of round wire in some instances. The major disadvantage, of course, is the lack of

orientation of round wire. Although more complicated, this problem can be solved by the

placing of orientation extensions or loops to prevent rolling.

 

The decision of slot size for the edgewise appliance has been debated over a number of

years. When steel was the only material available it could be argued that a smaller slot

(0.018 inch) would allow the use of wires that orient and have lower stiffnesses. Now,

with the potential of varying the modulus, it appears that the larger slot size (0.022 inch) is

the more desirable since one is no longer dependent on wire size for stiffness. A disadvan-

tage of the 0.018 inch slot is that in many instances insufficient play between the wire and

the bracket is present in applications where a heavier wire is needed. Furthermore, the use

of a larger slot allows for preferential orientation, so that ribbon wires can be employed.

The wire-stiffness number

 

In the past when the orthodontist varied stiffness by cross section with experience, he

developed a feel for the force produced by wires of different sizes. The selection of the

proper wire

was much simpler since only one material (steel) was used. Even if the

clinical feel was somewhat inaccurate, 0.018 inch wire always produced more force than

0.016

inch

wire.

Now,

since the clinician

can vary

both cross section and material,

selection of a wire becomes much more difficult. We have discussed examples of large

cross sections delivering much lighter forces than smaller cross sections. It was because of

this difficulty that the numbering system presented in this article was developed. The

stiffness of an orthodontic appliance or a component of an appliance is determined by the

wire itself and the appliance design. The stiffness of the wire is determined by two

factors-the modulus of elasticity and the cross-sectional geometry of the material. Both

of these values could be given to

modulus of elasticity of steel is 25

the clinician in engineering terms. For example, the

x

lo6 p.s.i. and the moment of inertia is 3.22 X 1OV

in.4 (0.016 inch round wire). The product EI = 8.05 x lo-* in.-lb. represents the stiff-

Vdume so

 

Number I

Table

 

IV.

M,,

 

Cross section

 

Wire type

 

(inches)

S.S.

 

0.009

S.S.

0.012

S.S.

0.014

S.S.

0.016

S.S.

0.018

S.S.

0.020

TMA

0.016

Nitinol

0.016

TMA

0.018

Nitinol

0.018

TMA

 

0.016

X 0.020

TMA

0.016

X 0.020

TMA

0.016

x

0.022

TMA

0.016

X 0.022

S.S.

0.018

x

0.025

S.S.

0.018

X 0.025

TMA

0.018

X 0.025

TMA

0.018

X 0.025

Nitinol

0.018

x

0.025

Nitinol

0.018

X 0.025

EB

0.018

X 0.025

EB

0.018

X 0.025

Es*

0.018

X 0.025

Es*

0.018

x

0.025

S.S.

 

0.021

x

0.025

S.S.

0.021

X 0.025

*Heat-treated.

 

S.S.

=

Stainless steel.

 

Ee

=

Elgiloy

blue.

Variable-modulus

orthodontics

13

W,

Order

M,

C*

CM, x

cd

C,, andW, numbersof solid wires

Cross section

(mm.)

 

0.229

  • - 25.63

    • 1.00 25.63

@.305

  • - 81.00

    • 1.00 81.00

0.356

  • - 150.06

    • 1.00 150.06

0.406

  • - 256.00

    • 1.00 256.00

0.457

  • - 410.06

    • 1.00 410.06

0.508

  • - 1.OO

625.00

625.00

0.406

  • - 256.00

    • 0.42 107.52

0.406

  • - 256.00

    • 0.26 66.56

0.457

  • - 410.06

    • 0.42 172.23

0.457

  • - 410.06

    • 0.26 106.62

0.406

x

0.508

1st

  • 0.42 848.83

356.51

0.406

x

0.508

2nd

  • 0.42 543.15

228.16

0.406

X 0.556

1st

  • 0.42 1129.79

474.5 1

0.406

X 0.556

2nd

  • 0.42 597.57

250.98

0.457

x

0.635

1st

  • 1.00 1865.10

1865.10

0.457

X 0.635

2nd

  • 1.00 966.87

966.87

0.457

X 0.635

1st

  • 0.42 1865.10

783.34

0.457

X 0.635

2nd

  • 0.42 966.87

406.08

0.457

x

0.635

1st

  • 0.26 1865.10

484.93

0.457

X 0.635

2nd

  • 0.26 966.87

251.38

0.457

X 0.635

1st

  • 1.19 1865.10

2219.47

0.457

x

0.635

2nd

  • 1.19 966.87

1150.57

0.457

X 0.635

1st

  • 1.22 1865.10

2275.42

0.457

X 0.635

2nd

  • 1.22 966.87

1179.58

0.533

x

0.635

1st

  • 1.00 2175.95

2175.95

0.533

x

0.635

2nd

  • 1.00 1535.31

1535.31

nessof the wire. In a similar manner, in torsion G = 1.O x IO7p.s.i., J = 6.43 x 10eg

in.4, and GJ = 6.43 X 10e2in.-lb.

One could use the valuesfor E,

I, G, and J and the productsEI and GJ to denotethe

stiffness of orthodontic wires. To simplify and to make available to the clinician the

information required,a more meaningfuland practical numberingsystem was established.

Normalization is based on giving the average stainless steel modulus of elasticity

(25 x 106p.s.i.)aM,of 1.Themomentofinertiaof0.004inch(0.1 mm.)isalsogivena

C, of 1. In this system the orthodontist is comparing any existing or new alloy with

stainlesssteel, which he is familiar with by experience,in applying the M, number. In a

similar manner, the C, numberrelates to an 0.004 inch wire.

Normalizing the values has a considerableadvantage for the clinician. The numbers

are smaller than EI and are unitless. For an 0.016 inch round stainlesssteel wire,

W, = M, x C,

W, = 1 x 256 = 265

By normalizing the values, one finds that 256 applies in tension, bending, and torsion,

which is a further advantageand simplification. In most of the materials that we use in

14 Burstonr
14 Burstonr
14
Burstonr
14 Burstonr

Table

V.

M,,

C,,

W,

numbers

of

braided

wires

 

-

 

Cross

section

Cross

section

Wire

type

(inches)

(mm.)

Order

M,

c,

D-rect

0.016

X 0.022

0.406 x

0.559

1St

0.036

1129.79

D-rect

0.016

x

0.022

0.046

x

0.559

2nd

0.050

597.57

D-rect

0.018

X 0.025

0.457 X 0.635

I St

0.048

1865.10

.

D-rect

0.018 x

0.025

0.457 X 0.635

2nd

0.078

966.87

D-rect

0.019

x

0.025

0.483

x 0.635

1St

0.056

1968.71

D-rect

0.019

x

0.025

0.483

X 0.635

2nd

0.069

1137.13

D-rect

0.021

x

0.025

0.533 X 0.635

1st

0.060

2175.35

D-rect

0.021

X 0.025

0.533

x

0.635

2nd

0.065

1535.35

Respond

 

0.0175

0.4445

-

0.069

366.36

Respond

0.0195

0.4953

 

0.082

564.80

Respond

0.0215

0.5461

 

-

0.068

834.69

Force-9

 

0.019

x

0.025

0.483

x

0.635

1st

0.162

1968.71

Force-9

0.019

x

0.025

0.483

x

0.635

2nd

0

135

1137.13

Hi-T Twist-Flex

 

0.015

0.381

-

0.175

197.75

Hi-T Twist-Flex

0.0175

0.4445

 

0.168

366.36

Hi-T Twist-Flex

0.0195

0.4953

0.153

564.80

Hi-T Twist-Flex

0.0215

0.5461

 

-

0.204

834.69

---

W$

CM,

x

C.J

40.67

29.88

89.52

75.41

110.25

78.46

130.56

99.80

25.28

46.31

56.76

318.93

153.51

34.61

61.55

86.41

170.28

orthodontics,there is a constantrelationship between different materialsin their stiffnesses

in the tension,bending, and torsion. In usingthe materialstiffness and the cross-sectional

stiffnessnumbers, one makesa meaningfulcomparison to a base(steel and 0.004 inch),

which givesgreater meaning to the stiffnessnumber. Tables IV and V give representative

M,, C,, and W, numbersfor commonly usedorthodontic wires.

Note that very different

c&s sectionsdeliver similar forces for any given activation. Wire-stiffnessnumbers

under50 include0.009 inch stainlesssteel (W, 26), 0.0175 inch Respond(W, 25), 0.015

inch Twist-Hex (W, 35), and 0.016 by 0.022 inch Drect (41, 30). It would seemadvan-

tageousthat the wire-stiffnessnumber be placedon packagesof orthodonticwires that are

distributedfor clinical use.This would allow the orthodontistto know exactly what might

be expectedfrom a wire. It is not enoughto label a wire 0.018 inch since0.018 inch wires

of steel, TMA, and nitinol and braided wires (Respond)may have respectivewire-

stiffnessnumbers of 410, 172, 107, and 25. Since there may be considerablevariation

betweenthe nominal crosssection of the wire (the size listed on the package)and the

actual cross section, it would be helpful to use actual cross sectionsto determinethe

wire-stiffnessnumber.

Although the introductionof new materialsadds to the complexity of orthodontics,a

new potentialis availablewhich may allow the clinician to achieveresults that may have

been more difficult before. The use of a standardizednumbering systemmay help to

simplify and avoid someof the confusioninherent in the proliferation of both new cross

sections,alloys, and braidedwires.

Selecting

the

proper

wire

Three factors determinethe selection of a proper wire for a clinical application:

stiffness,maximum force or moment,and maximum elastic deflection. In developingthe

Volume

80

Number

1

Variable-modulus

orthodontics

15

Table

VI. Levelingsequences

for edgewiseappliance

therapy (Twin brackets, 0.022 inch

slot, W, numbersin parentheses)

 

First wire

Final

wire

1.

0.018 inch Respond

(25)

0.018

by 0.025 inchedgewise TMA (783,406)

 

0.020

by 0.016 inch irbbon TMA

(228, 356)

2.

0.022 by 0.016 inch D-rect ribbon (30, 41)

0.018

by 0.025 inch edgewise TMA (893,406)

 

or

 

0.020

by 0.016 inch ribbon TMA

(228, 356)

3.

0.018 by 0.025 inch D-rect (90, 75)

0.018 by 0.025 inch edgewise TMA (783,406)

 

or

 

0.020 by.0.016

inch ribbon TMA

(228, 356)

4.

0.018

inch Nitinol

(107)

0.018

by 0.025 inch edgewise TMA (783,406)

 

or

 

0.020

by 0.016 inch ribbon TMA

(228, 356)

5.

  • 0.018 (172)

inch TMA

 

0.018 by 0.025 inch edgewise TMA (783,406)

 

or

 

0.020

by 0.016 inch ribbon TMA

(228, 356)

6.

  • 0.018 by 0.025 inch TMA (783, 406)*

No final wire needed

or

  • 0.020 by 0.016 inch TMA

ribbon (228, 356)

*For minor discrepancies.

variable-modulusconcept of treatment,I havediscussed only stiffness. Although wires

may be comparablein stiffness(W, numbers),they may vary considerablyin the amount

of total forcethat canbe delivered.Many of the new alloys andbraids may be activatedat

leasttwice the amountof stainlesssteel wires, sothat higherforce ranges can be produced

thanis possiblewith steelwire of the samestiffness. Furthermore, an 0.018 by 0.025inch

Drect wire could efficiently align irregularitiesby eruptionand simpletipping but would

not deliver 2,000to 3,000G m./mm. for canineroot movement.An 0.018by 0.025inch

TMA wire, for example,could work efficiently in this range.

Becauseof the larger maximal elastic deflectionof the newer wires, it is usually

possibleto completealignment procedures with oneor two wires. A schemeof leveling

(alignment)possibilities is given in Table VI. W, numbersare listed after eachwire;

the

first numberis first

orderand the secondis

secondorder. Dependingon the amountof

the

discrepancy,initial

wires arechosen on the basisof stiffness.A largediscrepancy requires

W, numbersunder 50. Using the constantforce approachby overcontouringwires, one

may eliminatethe needfor an intermediatewire or retying the arch. Note that stiffnesses

increasewith the initial levelingwire from sequence1 through6. Ribbonwire suggestions

aregiven where preferential orientation is

desirable,favoring first-order movement. These

recommendationsare basedon useof an 0.022 inch slot which allows sufficientplay for

toothmovement with 0.018inch occlusogingivallydimensioned wires andadequate orien-

tation with an edgewisewire. The 0.022 inch slot also allows the useof ribbonwires for

16 Btrr-storw
16 Btrr-storw
16
Btrr-storw

more efficient first-order corrections. If less play

is required for torque delivery on in-

cisors, the final wire can be larger (0.021 by 0.025 inch) or inserted as a ribbon (0.020 by

0.016 inch). Heavier steel wires

can be indicated

if

more rigidity

is required,

as in

a

stabilizing arch or when higher forces or moments are required. One example of the latter

is a root spring delivering over 4,000 Gm. /mm., which is used to purposefully displace an

arch forward. Normally, the rigidity of steel edgewise

wires is not required and, if used,

should be relatively

passive. A

perusal of Table IV

will

show the high stiffness of steel

edgewise wires, particularly in the first-order direction.

Summary

The introduction of new alloys and braided wires into orthodontics offers a new

approach in controlling the magnitude of forces used for tooth movement. In the past,

stiffness was varied by using different cross sections of wire. In fact, appliances many

times were identified by

wire size. This article has presented a new approach which bases

force-magnitude control on varying primarily the material rather than the cross section of

the wire. A full range of stiffnesses equivalent to what was previously produced by

changing wires sizes can be achieved. The advantages of variable-modulus orthodontics

includes better control over the amount of play between attachment and wire, orientation

of wires for directional distribution of forces, preferential orientation of rectangular wires,

and over-all reduction in the number of wires used for treatment.

Because of the great number of variables involved in the selection of the wire, both

cross section and material, a simplified numbering system which denotes the stiffness of

the wire

and describes the contribution of both the material &d the cross section to the

stiffness is presented.

It is now possible to have wires that are capable of deliv&ng the full range of forces

from light to heavy, which can fully engage attachments and also control accurately the

play between wire and attachment for the various clinical ap&eations. These wires can be

simple in design, so-called “straight wires, ” or more complicated in configuration, incor-

porating loops. The variable-modulus concept gives the orthodontist one more tool in the

efficient design and use of his appliances.

REFERENCES

I.

Burstone,C.

J.: Mechanicsof the segmentedarch technique,Angle Orthod. 3Q: 99-120, 1966.

Burstone,C.

  • 2. J.:

The rationaleof the segmentedarch,

AM. J. ORTHOD.48: 805-821,

1962.

  • 3. Burstone,C. J., Baldwin,J. J., and Lawless,D. T.: The applicationof continuousforce to orthodontics, AngleOrthod. 31: l-14,

1961.

  • 4. Burstone,C. J.: TheBiomechanics of toothmovement. In Kraus,B. S., andRiedel, R. A. (editors):Vistas in orthodontics,Philadelphia, 1962, Lea & Febiger,pp. 197-213.

  • 5. Yoshikawa,D. K., Burstone,C. J., Goldberg,A. J., and Morton, J.: FJexuremodulus of orthodontic stainlesssteel wires, J. Dent.Res. 60:

  • 6. Goldberg,A. J., and Burstone,C. J.: press.)

139-145, 1981

Determinationof the modulusof elasticityby flexural testing.(In

  • 7. Burstone,C. J.: Applicationof bioengineeringto clinicalorthodontics. In Graber,T. M. (editor):Current orthodonticconcepts and techniques, ed. 2, Philadelphia,1975, W. B. SaundersCompany, pp. 230-258.