CASE REPORT Points & Takeaways Arch forms are enhanced with the proposed arch wire system, but you will need to actively retain the arch form. Don’t believe those that say arch developing or arch retain-ing appliances interfere with the SLB progress. Almost from the very beginning, I used the 3D Wilson Lingual appli-ances to establish and enhance arch forms while providing essential arch retention during sequencing mechanics. Expansion retention and lingual movement of upper and lower molars was particularly problematic. This issue was easily corrected using 3D appliances. Always use Right Arch Form arch wires or similar shapes. You can also use D-LX Arch forms which are comparable to a Damon Arch. These are slightly more wide than standard forms, but are not avail-able in all arch sizes as proposed. Using DM (dimple) arch wires in the early stages reduces drifting or sliding of the wires within the brackets. Begin to integrate stainless steel arch wires as soon as possible because they will best achieve the arch form you need while enhanc-ing torque in the roots of individual teeth. You can also remove 3D Wilson appliances at this stage. The technique is very effective on adults and dramatically reduces overall treatment time. Our clinical experiences showed a 33-50% reduction in adult treatment time. The numbers of appointments were also reduced due to the decreased treatment timeline. Another related benefit was reduced chair time due to not using elastics and less arch wire changes. “Due to the contact of the arch wires upon the inside of the facial metal gate the teeth naturally move more to the facial.” Recommended Arch wires: Initial arch wires are used to begin the leveling, aligning and rotational correction. b Use arch wires that are specific for upper and lower arches. b Most commonly we start with .016 Super Elastic Nitinol (SEN). These are used when minimal deflections are present. b .014 SEN is first used when there are deflections in the 45° range. b Begin with .012 SEN in cases with severe crowding, those having deflections of the wires in the 90° range. b All of the above arch wires are dimpled at the midline (DM) to reduce sliding within the brackets and they come in upper and lower Right Arch forms. b Some clinicians choose the Heat Activated Nitinol with Copper for this initial stage of treatment using the Right Form. Sequence of Initial Arch Wires b The .012 SEN (dimple) often precedes b Initial wires .014 SEN (dimple) b Initial wires .016 SEN (dimple) Length of arch wire usage: b Most arch wires are inserted for the length of time the clinician requires to achieve the desired actions. b SEN, TMA (beta titanium) and (if using) CMA arch wires are all commonly used intraorally for two months per size. b RCS SL Super Elastic Nitinol are almost always in place for two months each. The .016 is followed by the .018 if needed for a slight reverse curve. * Beta Titanium is a nickel free alloy that has similar character-istics of stainless steel with improved memory and gentle force levels. Phase 2 – Interactive Arch Wires Objectives: b Upper and lower finishing or transition from initial wires: complete aligning/leveling, resolve remaining rotation issues, begin torque control, angulations and space consoli-dations in the anterior and continue developing arch forms. Recommended Arch wire: .014 x .025 Thermal Nitinol b Interactive arch wires begin to develop torque in the roots and develop arch width. b To express more torque control and prep for stainless steel arch wires, we use the .017 x .025 TMA. TMA or CMA wires that are Beta Tita-nium arch wires (can be copper) used in the intermedi-ate stage for early torque control with moderate forces. The feature of the wire is in its ability to accept bends. Recommended arch wire sequence: b Interactive .014 x .025 SEN (dimple) b Interactive .017 x .025 TMA Optional Interactive arch wires on the lower only. Phase 1-Initial Arch Wires Objectives: b Initiate tooth movement b Begin aligning/leveling teeth b Correct rotational issues & start to develop arch with 3D fixed appliances www.orthodontics.com Winter 2023 13
Journal of the American Orthodontic Society Winter 2023: Page 13
