Clinical comparison of three aligning arch wires in relieving mandibular anterior crowding – A randomized controlled trial

Contemporary orthodontic treatment involves use of both fixed and removable appliances. Alignment and levelling of teeth generally constitute the most important preliminary clinical phase of any orthodontic treatment with appliances. Levelling is the process in which incisal edges of anterior teeth and buccal cusps of posterior teeth are placed on same horizontal level and alignment is lining up of teeth of an arch in order to achieve normal contact point relationship. Process of levelling can be orthodontically preferred by means of different techniques. Fixed orthodontic appliance include a wide variety of arch wires used as a means of delivering forces on

the teeth. Ideally arch wires are designed to move the teeth with light continuous forces, which reduce patient discomfort, tissue hyalinization and root resorption. The aligning arch wires are intended to be inserted into the fixed orthodontic appliance at the beginning of treatment, mainly to correct crowding and dental rotations. The success of the orthodontic treatment may depend on the selection of the aligning archwires. As there are a variety of available archwires, it is important to know which is the most efficient during the initial aligning stage of the treatment. In order for the orthodontist to select the most appropriate archwire, it is important to understand the optimal characteristics for all of the available archwires. Light and continuous forces are desirable to achieve physiologic tooth movement with minimum pathological effect on the teeth and their surrounding structures.1 Clinically, this means that we need the optimal force with which to produce the fastest tooth movement with the least root resorption and/or pain for the patient. The forces delivered by the archwires depend largely on the physical properties and dimensions of the wire material. An ideal aligning archwire should have a good formability, spring-back, stiffness biocompatibility, low friction, Join ability, and cost. The use of NiTi archwires in orthodontics was first described by Andreasen and Hilleman; these wires were manufactured as Nitinol wires. Since their introduction, wires made out of NiTi alloys have become an important part of orthodontic treatment. First NiTi alloy archwires were marketed by Unitek corporation who are now known as 3M Unitek. These alloys have low stiffness, superelasticity, high springback, large elastic range and were brittle.3 In 1994 Ormco corporation introduced Copper nickel titanium alloy. This alloy was developed with the help of Rohit Sachdeva and Suchio Miyaski. Initially, it was available in three temperature transition forms. Addition of copper leads to better defined transition temperature in this alloy.  Smart archwire(S-A) is a new generation of multiforce archwire introduced recently that has differential superelastic properties based on advanced concepts in material science, and periodontal ligament physiology. These are laser conditioned CuNiTi wires with a differential force profile that is based on the optimal compressive stress

in the periodontal ligament.

Pandis et al clinically evaluated mandibular anterior crowding alleviation performed with CuNiTi and NiTi wires. Their results did not find significant differences between wires with regard to alignment efficiency and treatment duration. Moreover, a recent systematic review was unable to show which is the most effective archwire sequence for levelling and aligning the teeth, due to the lack of in vivo studies. Thus, it becomes necessary to compare the clinical performance of conventional alloys, such as standard NiTi and CuNiTi archwires with newer one such as the Smart archwire in regards to their alignment efficiency in crowded teeth.

AIM

To compare the alignment efficiency of standard NiTi, CuNiTi with smart arch wire in relieving mandibular anterior crowding

. OBJECTIVES

• To evaluate  the alignment efficiency of standard NiTi arch wire.

• To evaluate the alilgnment efficiency of CuNiTi arch wire.

• To evaluate the alignment efficiency of SMART ARCHWIRE.

• To compare the alignment efficiency of SMART ARCHWIRE  with standard NiTi and CuNiTi in relieving mandibular anterior crowding