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JL S
CLI NICAL

Ind Orthod Soc 2006; 39:20-22

Excellence in Loops - Some Reflections

A.Sivakumar, MOS.
Assistant Professor.

Ashima Valiathan aDS. DDS. MS (Orthodontics),

Professor and Head,
Depanment of orthodontics,

Manipal Co llege of Dental Sciences, Manipa l.

Abstract

Keywords

The science of any orthodontic mechanics demands a good control over intended tooth
movement at no expense of dental arch distortion. Nevertheless, the 'Smart Materials' in
orthodontics have appreciably reduced many complex wire bending involved during
treatment, but at a higher price of being less cost effective. This article highlights the use of
fail-safe loops in the correction of positional discrepancies and median diastema closure.
Box loop, closed loop, median diastema, uprighting.

Box Loop: Versatility in the correction of

positional discrepancies of a single tooth .
There is no room for the "one step forward, two steps
backward" type of treatment mechanics. If there is an
orthodontic secret, it is this: minimi zing or eliminating
the number of undesirable side effects used in
treatment. ' The three dimensiona l co ntro l of a
ma lali gned toot h is a commo n cha ll enge for th e
orthodonti st. A successful outcome is dependant on a
thorough clinica l diagnosis and carefully executing a
detailed plan based on biomechanica l conceptions.
Positional discrepancies of a si ngle tooth can be treated
by bending box loops into .014" or .016" or .018" .025"
stainless steel wire in .022" slot depending on the nature
of the problem, as a way of gaining greater springiness
in the area where it was most needed. The same side
effects that any co ntinuous w ire would produce
occurred with th is type of loop, but the movement of
the teeth adjacent to the disp laced one was minimi zed
by the relat ive st iffness of the wire in th at area
compared with the stiffness wi thin the loop.'
When all or nearly all the crowi ng is in one place,
what is needed is an arch wire that is rigid when they
are already aligned and quite springy when they are
not. Nothing in this world is unmixed blessing and the
extreme springi ness of a superelastic wire means that
if it is tied into an asymmetri call y malaligned arch,
teeth distant to the site of malalignment will be moved.

20

In contrast, the box loop enables the orthodontist to

generate well defined force systems that lead to highly
controlled tooth movement. The correction of positional
discrepancies of si ngle teeth is highly predictable and
any undesired side effects can be minimized.] When
activated, the arch wi re loop distorts from its origina l
configuration, as the tooth moves, the loop gradu ally
returns to the undistorted position delivering the energy
stored at the time of activation. (Figure 1).

Distal

4 8
Mesia

2
6

Figure 1: Schematic representation of the box loop. Section

4-5 crosses the bracket of the molar to be uprighted.
The bends have been numbered. 1 through S,
starting from the distal.

Indi cation s
1. For the initial alignment of asymmetric crowding
in the earl y permanent dentition.
2. For root para lleling during finishing
3. For uprighting tipped molar, as a form of adj uncti ve
orthodontic treatment.

,/

,/

2>
Case Report
A 25 year old female di spl ayed a strai ght profile and a
brachycepha li c growth type. Her chief complaint was
gap between front teeth. The patient had a class I
ma loccl usion with extreme deep bite and medi an
diastema of 3.5 mm. All th e four lateral incisors were
congenitall y missing (F igure 2a). The treatment plan
involved closure of med ian diastema and reduction of
overbite depth . The treatment commenced w ith .022
slot edgewise full strap up. The bite ope ning was
accompli shed by combi ned effect of tip back bends

Sivakumar el al

incorporated in .016" stainless steel Australian arch wire

and reverse curve of spee in th e lower arch wi re and
exaggera ted curve of spee in th e upper arch w ire.
Median diastema was closed using sliding mechanics.
The maxil lary ri ght canine w ith mesially incl ined root
was attended during fini shing sta ge using box loop
mechani cs (Figure 2b) . Notab ly, a longer ra nge of
action was needed than could be delivered by even
th e most flex ible co ntinuous arch w ire. The root
uprighting was accomplished by bending a box loop
into a .018" .025" arch w ire to provide Ihe desired
fl ex ibility. At 4 weeks, th e canine root was uprighted
and the space between the ca nine and central incisor
was managed by placing an artifi cial tooth along w ith
the retainer appli ance (Figure 2e).
Summary
In the case presented here, the box loop was used to
upright th e ca nine root. The same can be utilized for
the ext ru sive or intrusive movement of any teeth in
the dental arch. A low load-deflection rate enables th e
clinician to deli ver rel ati ve ly co nstant fo rces and
moments throughout th e orthodontic treatment, and
allows tooth movement to proceed w ithout freq uent
monitoring and appli an ce adjustm ent s. When
maximum control of tooth movement is desired, box
loops are the first choice for intrasegmental alignment,
due to their simp licity and large range of activati on.

A Single Closed Loop for Median Diastema

Closure
For an efficient closure of median diastema, bodily
move ment of th e recipro ca tin g tee th is a pr im e
requisite. One of the commonest ca uses of medi an
diastema is the tooth size - arch length discrepancy.
Decreasing th e arch length and simultaneously closing
th e median diastema using sliding mechanics may not
be a viable option in this situation . Furthermore, th e
treatment time is prolonged, as th e mechanics does
not target th e problematic area .

Figure 2a, 2b, 2c : The righl upper canine was uprighled

usi ng Ihe box loop mechanics.

We, therefore, devised th e fo llowing method of using

a single closed loop in decreasi ng the arch length and
thereby closin g the median diastema. The closed loop
is one in w hi ch the sides of Ihe loop are close together.
Obviously, it can only be activated by pulling them
apart. It is a very efficient tension fo rce w hen used in
arch shortening mechanics.'

21

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JL s

) Ind Orthod Soc 2006; 39:20-22

Procedure
A single closed loop of 3/8" length was bent using loop
forming plier in a 019" 025" stainless steel arch wire.
The sides of the loop were nearly approximate. The
loop was positioned in the centre of the space and the
arch wire was ligated to the brackets. The loop was

activated by pulling the arch wire through molar tube

and cinched back. 1mm opening of the loop was
co nsid ered a des irabl e acti va ti on in a sin gle
appointment (Figure 3a). Four weeks later, the second
acti va tion of th e loop was done. Onl y medi an
diastemas up to 5mm can be corrected using this arch
shortening mechanics (Figure 3b).
The single closed loop has proven to be an effective,
effi cient and pati ent - fri endl y method for arch
shortening and subsequent median di astema closure.
It works in both the upper and lower arches. Gable
bends may be incorporated for rendering a sufficient
moment-to-force ratio.

Communications
Dr. Ashima Valiathan, BOS, DDS, MS,
Professor and Head,
Department of orthodontics and dentofacial
orthopedics,
Manipal College of Dental Sciences,
Manipal-576104, India.
E-mail: sivlalith2004@yahoo.co.in

References

Figure 3a, 3b : Si ngle closed loop fo r median diastema

closure and subsequent arch shortening.

1. Marcotte MR. Biomechanics in Orthodontics. 1" ed.

Philadelphia: B.C.Decker Inc, 1990.
2. Proffit WR, Fields HW, Contemporary Orthodontics.
3 ~ ed. St.Louis: Mosby,2000, p.532-533, 580
3. Khouw FE, Norton LA. The mechani sm of fixed
molar uprighting appliances. J Prosthet Dent 1972;
27: 381 -389.

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