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Straight-wire appliances: standard versus individual prescription

Article  in  Progress in Orthodontics · February 2009

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1 Straight-wire appliances: standard versus individual prescription

Straight-wire appliances:
standard versus individual prescription

Giampietro Farronato*, Giulia Periti**, Lucia Giannini**, Davide Farronato***, Cinzia Maspero****

* MD, DDS, Full Professor and Chairman, Director of the Department of Orthodontics ICP.
** DDS, Department of Orthodontics, University of Milan, Orthodontic Department, Italy.
*** DDS, PhD Department of Surgery, University of Milan, Orthodontic Department, Italy.
**** MD, DDS, Department of Orthodontics, University of Milan, Orthodontic Department, Italy.

Correspondence to:
Prof. Giampietro Farronato
University of Milan, Via Commenda 10, 20100 Milano,
Ph. +39 (0)55032520,
E-mail address: [email protected]

In this article the individual patient (IP) appliance is described. It con-

sists of 250 appliance options with 10 times the bracket and band va-
Introduction
riations as the straight wire appliances. Increasing the bracket capa-
bilities means using an increasing number of brackets, each with a spe-
Orthodontics has strived to control
cific design created for a treatment situation. The objective of IP ap-
tooth movements in all planes of
pliance is to eliminate wire bending from orthodontic treatment and
space to obtain the ideal occlu-
improve the treatment results. To manage this computer software is nee-
sion: the results of this research ha-
ded; the internet offers significant possibilities in managing this on a
ve lead to the evolution of the ed-
patient by patient basis. The clinician is required to make the diagnosis
gewise appliance1,2.
and treatment plan before ordering the appliance. Two clinical cases
The Andrews appliance was pro-
are described with the aim to present the advantages of this technique.
grammed with the aim to avoid
wire bending; moreover it was clai-
med to be more precise and give
a reduction in chairside adjust-
ment. This was to allow the clini-
cian to focus on the diagnosis and
treatment objectives. The SW ap-
pliance was available on the mar-
ket in 1970.
The tip, torque, in and out values,
which are inserted in the SW brac- G. Farronato, G. Periti, L. Giannini, D. Farronato, C. Maspero. Straight-wi-
kets, are defined as the prescrip- re appliances: standard versus individual prescription. Prog Orthod
2009;10(1):00-00.

84 PROGRESS in ORTHODONTICS 2009;10(1):00-00

 Straight-wire appliances: standard versus individual prescription 2

tion of the appliance3-6. With the the particular condition of every occuring in the first stage of treat-
standard prescription, it is possible single tooth, will permit to a plan- ment and in finishing and detai-
to reach a precise position only of ned therapeutic solution which can ling stages to obtain excellent ae-
the teeth of an average patient. It be the best to solve the problems of sthetics and occlusions17,18.
is very difficult to find an ideal po- the single patient. McGann has proposed a new
sition for the teeth which are diffe- Several authors have proposed so- SW appliance with an individual
rent from the normal and often me variation in the SW original prescription (IP): this can indivi-
found in everyday practice7- 9. appliance prescription to find new dualize the orthodontic treatment
In the last decades, orthodontists clinical solutions and improve the with the overall purpose of impro-
have tried to define the parameters appliance results14-16: in fact the ving the quality of care to the pa-
of an ideal occlusion and to en- SW appliance is a standard me- tient and the practice of each or-
hance and improve the SW ap- thod which can adapt to the oc- thodontist19.
pliance. This has given a very im- clusion of the single patient only The orthodontist must make a com-
portant role to the task of the indi- by utilizing some particular strategy plete diagnosis and biomechanical
vidualization of orthodontic the- in brackets positioning and com- plan in order to achieve a detailed
rapy10-13. pensation bends to the archwire. individualized prescription. It is ne-
An accurate clinical and radiolo- Wire bending prevents the known cessary to decide the derotation
gical exam, which can describe unwanted tooth movements from and tip and torque prescriptions to
reach an ideal occlusion20-22. Mo-
reover it is very important to iden-
tify the quantity of the movements of
the teeth in the working phase;
??????????????????????????????????????????????????????????????
such as the closure of the extrac-
??????????????????????????????????????????????????????????????
tions spaces, the overjet reduction
????????????????????????????????
and the overbite correction. The
computer is used to create a treat-
MANCA TRADUZIONE ITALIANO
ment appliance with expanded ca-
pabilities from the current SW ap-
pliances. For this purpose the IP
System has a diagnosis confirma-
tion and treatment plan system that
every specialist can access through
computer software (PoSoft). The
most up-to date diagnosis and
treatment planning assistance is
available for the individual case
situation, directly in the individual
practice, when the information is
needed19.
In this article the IP appliance is de-
scribed presenting two clinical ca-
ses23,24, in order to underline the
Key words: Straight wire, Individual appliance, Roth prescription. advantages of an individual pre-
scription.

PROGRESS in ORTHODONTICS 2009;10(1):00-00 85

3 Straight-wire appliances: standard versus individual prescription

Materials and Methods dual appliance from the 250 choi- and II to clarify the problems of
ces available in the IP appliance every clinical case: every ortho-
The aim of this clinical research system19. dontic problems is transformed by
was to evaluate quality of an indi- The system allows to have 250 the IP software in a prescription or-
vidual prescription by IP system, possible variations of brackets and der (Tab. 1).
the biomechanics, the speed and bands, 102 variation of ceramic The software program asks the or-
the precision of the appliances, brackets, and 18 different varia- thodontist the following questions:
the patient comfort and the simpli- tions in form and dimension for all skeletal patters, identification of ro-
city of use for the clinician. orthodontic archwires. tations, overbite, dental class, in-
The patients were evaluated with The IP software has also a tutor func- cisor inclination, facial surface of
an orthodontic check up which tion to confirm the clinical efficacy of the upper incisor relative to the fo-
was comprehensive of medical the decisions to help the orthodontist: rehead, curve of Spee, posterior
and dental history, clinical exami- the tutor function has 150 possible and anterior crossbite, teeth bloc-
nation, study models, radiographs sample therapies to test the single in- ked out to the labial or lingual, pre-
(panoramic film, lateral and frontal dividual prescription. sence of crowns or bridges, mis-
cephalometric films), cephalome- The PoSoft has a default prescrip- sing or unerupted teeth, positions of
tric analysis and intraoral and ex- tion which is the Roth standard with the molars, shape of the maxilla
traoral photographs25-27. second molars included if any dif- and the mandible.
The individual characteristics of ferent prescription is specified. The clinician must indicate all mis-
each patient, the diagnosis and Moreover it has also a clinical que- sing teeth, the need of ceramic
treatment plan, plus the treatment stion test as described in table I brackets, the arch form and di-
objectives are all considered when
selecting the appliance that will
create the desired results. The IP
appliance is designed after the dia- ??????????????????????????????????????????????????????????????
gnosis and treatment plan has ??????????????????????????????????????????????????????????????
been chosen. In the evaluation of ????????????????????????????????
each patient, the orthodontist is re-
quired to classify the characteri- MANCA TRADUZIONE FRANCESE
stics of the individual malocclusion.
The discrepancies from the ideal Traduit par Maria Giacinta Paolone
are noted, creating a list of treat-
ment goals to obtain the most ideal
treatment result. In the IP appliance
system the identification of cha-
racteristics has been expanded for
the purpose of creating an ap-
pliance that will address the noted
variations from the ideal. These
characteristics are identified and
charted in computer software. The
software programming registers the
appliance variation that is needed
for each characteristic for the best
treatment result, editing the indivi-

86 PROGRESS in ORTHODONTICS 2009;10(1):00-00

 Straight-wire appliances: standard versus individual prescription 4

mension. The program has a scan- line: a mesial rotation correct a me- of tip. The program permits the
ner function in which the ortho- sial rotated tooth. When using the choose of auxiliary appliances.
dontist can scan study models to IP appliance, rotations are identi- In this way a single series of brackets
choose among an ovoid, tapered fied when the appliance is desi- for every single patient is designed
and square arch forms (Fig. 1,2). gned, the proper bracket with over- to solve any individual problems ac-
The dimension of the arch is com- correction incorporated into the cording to the treatment plan.
pared to the prefabricated arch bracket slot must be bonded to the A reparation kit is also available:
forms to determine the need of ex- center of the tooth. it is made of two brackets for every
pansion, constriction or maintai- Moreover the rotational IP brackets clinical choice and it is used to
ning of the original arch. have a 4°degree rotation added substitute damaged or lost brac-
The IP software can also select a making it possible to correct rota- kets. Similarly an achwire repair
standard wire progression or can tions without any bracket reposi- kit is sent with two archwires for
evaluate every wire choice for a tion. A correction of tip and torque every possible size and shape.
single patient. is similarly obtained and each brac- Another kit is available to choose the
The program can control every ket has the information for tip and right size of bands of molars and
bracket prescription to have a the- torque ideal for the tooth to which premolars to facilitate the positio-
rapeutic solution for every case. it is bonded. ning and the fitting of the bands,
The derotation need can be se- Brackets with added or reduced lin- while trying to select the right size.
lected between mesial or distal, gual or labial root torque are avai- Blank bands with prewelded sea-
comparing the vestibular axis of lable for each tooth as to are brac- ting eyelets are inventoried for this
the tooth to the frontal dental mid- kets with added or reduced values purpose. Bands are available with
every kind of need (lingual cleats,
single, double, triple tube).
Also the bracket positioning must
?????????????????????????????????????????????????????????????? be extremely accurate and can be
?????????????????????????????????????????????????????????????? defined by the program, and even-
???????????????????????????????? tually confirmed by the clinician to
transfer this information at the mo-
MANCA TRADUZIONE SPAGNOLO ment of bonding the appliance;
the IP appliance comes together
Traducido por Santiago Isaza Penco with an holder to correctly orient
the bracket.
This solution also permits to save ti-
me and to have a better precision
in positioning the brackets.
In this clinical research all the study
models were carefully evaluated
for every single tooth utilizing the
POSoft software for the individual
prescription of brackets, arches
and auxiliaries.
The orthodontic plan was sent by
internet to a dental IP center, which
assemble every appliance for
every single case (Tab. 3).

PROGRESS in ORTHODONTICS 2009;10(1):00-00 87

5 Straight-wire appliances: standard versus individual prescription

Tab.1. Computer IP software (PoSoft). Steps required to design the IP appliance.

IP appliance’s features
Tooth Description Band Height Instruction Size Number
11 MESIAL 11 M 4 0 1
12 12 Dla 3,5 0 1
13 DISTAL 13 D 4,5 0 1
14 DISTAL 14 D 4 0 1
15 15 R 4 0 1
16 16 R 4 0 1
17 17 R 3 0 1
18 EXTRACTED
21 MESIAL 21 M 4 0 1
22 DISTAL 22 D 3,5 0 1
23 23 R 4,5 0 1
24 24 R 4 0 1
25 25 R 4 0 1
26 26 R 4 0 1
27 27 R 3 0 1
28 EXTRACTED
31 31 R 4 0 1
32 32 R 4 0 1
33 DISTAL 33 D 4,5 0 1
34 34 R 4 0 1
35 MESIAL 35 M 4 0 1
36 36 R 4 0 1
37 37 R 3,5 0 1
38 EXTRACTED
41 MESIAL 41 M 4 0 1
42 MESIAL 42 M 4 0 1
43 DISTAL 43 D 4,5 0 1
44 44 R 4 0 1
45 45 R 4 0 1
46 46 R 4 0 1
47 47 R 3,5 0 1
48 EXTRACTED

Tab.2. Questions the clinician must respond to design the IP appliance.

UPPER ARCH LOWER ARCH

Medium Square Medium Square

STANDARD PROGRESSION
UPPER ARCH LOWER ARCH
1 016N 014ss 1 016N 1 014ss
018N 016ss 018N 016ss
019X025N 1 018ss 019X025N 1 018ss
1 018X025N heat 020ss 1 018X025N heat 020ss
019X025 keyHole 021X25ss 019X025 keyHole 021X25ss
019X025 T-LOOP 1 019X025ss 019X025 T-LOOP 1 019X025ss

22 UPPER: millimetres length of distance 2-2 for keyhole arch 22 LOWER: millimetres length of 2-2 for keyhole arch
UPPER: millimetres length of distance 2-2 for T-looped LOWER: millimetres length of 2-2 for T-looped

88 PROGRESS in ORTHODONTICS 2009;10(1):00-00

 Straight-wire appliances: standard versus individual prescription 6

The patients were treated by the sa-

me operator after a careful dia-
gnosis and treatment plan and
every patient was banded with a
strategic and indirect bonding; a
monthly check up was arranged
for every single patient.

Cases report

The clinical documentation of two

cases has been used to present
this methodology.
Fig. 1,2: IP archwire template.
Tab.3. Orders are realized through internet.

IP appliance’s features IP
Tooth Description Band Height Instruction Size Number
11 11 Li 4 0 1
12 12 MLi 3,5 0 1
13 13 R 4,5 0 1
14 14 R 4 0 1
15 15 R 4 0 1
16 16 R 4 0 1
17 0
18 EXTRACTED
21 21 Li 4 0 1
22 22 MLi 3,5 0 1
23 23 R 4,5 0 1
24 24 M 4 0 1
25 25 M 4 0 1
26 26 M 4 0 1
27 0
28 EXTRACTED
31 31 M 4 0 1
32 32 R 4 0 1
33 33 D 4,5 0 1
34 34 R 4 0 1
35 35 R 4 0 1
36 36 R 4 0 1
37 0
38 EXTRACTED
41 41 R 4 0 1
42 42 R 4 0 1
43 43 R 4,5 0 1
44 44 R 4 0 1
45 45 D 4 0 1
46 46 R 4 0 1
47 0
48 EXTRACTED

PROGRESS in ORTHODONTICS 2009;10(1):00-00 89

7 Straight-wire appliances: standard versus individual prescription

Fig. 3,4: pre-treatment facial frontal

and profile photographs.

Figs. 5-10: pre-treatment intraoral photographs.

90 PROGRESS in ORTHODONTICS 2009;10(1):00-00

 Straight-wire appliances: standard versus individual prescription 8

Fig. 11: pre-treatment panoramic radiograph. Fig. 12: pre-treatment cephalometric

radiograph.

Fig. 13: individualized prescription

form.

Case 1

The patient was a 14 year old girl;

the medical and dental history we-
re unremarkable.
The facial clinical examination sho-
wed a mesomorph subject, without
any asymmetries and a harmonious
profile (Figs. 3,4).
The intraoral examination demon-
strated a dental class I on the right
side and a dental class II on the left
side; the upper dental midline was
deviated on the left side; the tooth
23 was blocked in vestibular posi-
tion; the tooth 12 was palatally po-
sitioned; the upper dental arch had
a V shaped and the lower dental
arch a U shape (Figs. 5-11).
The cephalometric analysis revea-
led a slight skeletal class II with a
skeletal deep-bite (Fig. 12).
It was decide to proceed with an
orthodontic treatment with an IP
appliance.

PROGRESS in ORTHODONTICS 2009;10(1):00-00 91

9 Straight-wire appliances: standard versus individual prescription

Fig. 14: individual archwire progres-

sion.

Fig. 15-17: Post-treatment facial photographs.

Fig. 18-23 : Post-treatment intraoral

photographs.

92 PROGRESS in ORTHODONTICS 2009;10(1):00-00

 Straight-wire appliances: standard versus individual prescription 10

Fig. 24: Post-treatment panoramic radiograph. Fig. 25: Post-treatment cephalometric

radiograph.

Fig. 26,27: pre-treatment facial frontal

and profile photographs.

The study case was performed on obtained, with a good overbite of a deciduous upper left canine,
the clinical examination, the study and overjet, a correct midline and crowding in both dental arches,
models and cephalometric tracings no rotations (Figs 18-25). Maxil- slight midline discrepancies and a
which allowed the exact bracket lary and mandibular archforms we- class I molar occlusion on both si-
prescription to be identified for each re coordinated. des (Figs 28-34).
tooth, according to the diagnosis The stability of the clinical result The cephalometric analysis sho-
and the expected result (Fig 13). was maintained during the follow wed a skeletal class I with a nor-
Archwires form and progress was up period. mal vertical dimension (Fig. 35).
also planned (Fig. 14). The PoSoft A non extraction therapy was pro-
software permitted to choose and grammed to avoid the worsening
confirm the prescription and to di- Case 2 of the profile.
rectly order by internet. It was planned a fixed appliance
After one week the appliance was The patient was a 14 years old fe- therapy IP prescription in both ar-
received. male presenting with a concave ches to create space to recover
After 12 months of treatment the fa- profile (Figs 26,27). that lost of the impacted upper left
cial balance (Figs 15-17) and a The intraoral examination showed permanent canine and to obtain
correct occlusal relationship were an anterior cross-bite, the presence a correct intraoral relationship.

PROGRESS in ORTHODONTICS 2009;10(1):00-00 93

11 Straight-wire appliances: standard versus individual prescription

Figs. 28-33: pre-treatment intraoral photo-

graphs.

Fig. 34: pre-treatment panoramic radiograph. Fig. 35: pre-treatment cephalometric

radiograph.

The study case was performed on After one week the appliance was possible to obtain the aesthetic im-
the study models and clinical exa- received perfectly assembled. provement of the profile and a ni-
mination which permitted to deci- The strategic placement of brac- ce smile (Figs 38-40).
de the exact bracket prescription kets was used to level and align The intraoral examination showed
for every single tooth, according to both arches. a class I occlusion, the perfect cor-
the diagnosis and the expected re- The standard NiTi and SS round rection of the midlines, correct over-
sult. Archwires form and progress wire progression was utilized fol- jet and overbite (Figs 41-48).
were also planned. The PoSoft soft- low by finishing the case with rec- The patient was then invited to
ware permitted to choose and con- tangular wires to have a complete wear a positioner as a retention:
firm the prescription and to directly expression of torque information. the long distance controls showed
order by internet (Figs 36,37). After 15 months of treatment it was a good stability of the results.

94 PROGRESS in ORTHODONTICS 2009;10(1):00-00

 Straight-wire appliances: standard versus individual prescription 12

Figs. 38-40: Post-treatment facial pho-

Figs. 36,37: individualized prescription form, individual archwire progression. tographs.

PROGRESS in ORTHODONTICS 2009;10(1):00-00 95

13 Straight-wire appliances: standard versus individual prescription

Tab.4. Cephalometric values.

UPPER ARCH LOWER ARCH

Non extractive ovoid Non extractive ovoid

STANDARD PROGRESSION
UPPER ARCH
1 016N 1 014ss
1 0.18N 016ss
019X025N 1 018ss
018X025N heat 020ss
019X025 keyHole 021X25ss
019X025 T-LOOP 1 019X025ss
LOWER ARCH
1 016N 1 014ss
1 018N 016ss
019X025N 1 018ss
018X025N heat 020ss
019X025 keyHole 021X25ss
019X025 T-LOOP 1 019X025ss
22 UPPER: millimetres length of distance 2-2 for keyhole arch
22 LOWER: millimetres length of 2-2 for keyhole arch
UPPER: millimetres length of distance 2-2 for T-looped
LOWER: millimetres length of 2-2 for T-looped

Figs. 41-46: Post-treatment intraoral

photographs.

Results The profile was aesthetically impro- of the arch form as they were cho-
ved with alignment of the incisors. sen individually for the single pa-
Molar and canine Class I rela- The gingival margins were appro- tient case and they were sent co-
tionships were achieved and a priate. ordinated.
functional occlusion was obtained Also the clinical arch form of IP ap- The treatment was completed bet-
in all the treated patients. pliance prevented any correction ween 12 and 18 months.

96 PROGRESS in ORTHODONTICS 2009;10(1):00-00

 Straight-wire appliances: standard versus individual prescription 12

Fig. 47: Post-treatment panoramic radiograph. Fig. 48: Post-treatment cephalometric

radiograph.

The IP appliance brackets were ment; this also helps reducing the It is possible to conclude that the IP
not changed during treatment as treatment time dedicated in finis- appliance is a positive development
the IP prescription was already in- hing the case. of the SWA standard prescriptions,
cluding the information to correct The total treatment period is signi- allowing inclusion in the single ap-
the position of the teeth in a com- ficantly reduced, as well as the pliance of all the individual infor-
plete way avoiding any jiggling chairside time. mation to treat the single case.
movements. Eliminating the finishing stage is The IP appliance make possible
one objective of the IP appliance for the clinician to actually choose
system. The finishing stage is re- among the best individual pre-
Discussiom and conclusions quired with the SW appliance to scriptions for the single patient.
compensate for what the applian-
The aim of this work was to eva- ce does not correct; in addition
luate any significant difference in IP adjustments are usually to optimise References
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