excellence in loops - some reflections

7/24/2019 Excellence in Loops - Some Reflections

1/3

L

J

In

d Orthod

Soc

2006;

39:20-22

CLI

NICAL

Excellence in Loops - Some Reflections

A.Sivakumar, MOS.

Assistant Professor.

Ashima Valiat han aDS . DDS. MS (Orthodontics ,

Professor and Head

Depanment

of orthodontics ,

Manipal

Co

ll

ege

of Dental Sciences Manipa l

Abstract

The

sc

ience of any ortho

dontic me

cha

nic

s demands a good

co

ntrol over intended tooth

moveme

nt

at

no expe

nse of

dental arch distorti

on.

Ne

ve

rth

el

ess, th

e

'Smart

Materials'

in

orthodontics

have

appreciably

red

u

ce

d

many

co

mpl

ex

wire

bending

in

vo

l

ved

during

treatment,

but

at

ahigher

pri

ce of being less cost effective. This article highlights

he

use of

fail-safe l

oops

in

th

e co

rrection of

positiona l di

sc

repancies

and

median diastema closure.

Keywords

Box loop,

closed

loop,

median

diaste

ma

, 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

o

undesirable side effects u

se

d in

treatment. ' The three dimensional contro l o a

ma lalign

ed

tooth is a common cha llenge for

th

e

or

th

odonti

st.

A

successful

out

co

me is

depend

a

nt

on a

thorough clinica l diagnosis and carefully

exec

uting a

detailed plan based on biomechanica l

co

n

ce

ptions.

Posi tional di

screpa

ncies of a single too th

ca

n be treat

ed

by bending box loops into

.0

14 or .0 16 or

.018

.025

stainless stee l wire in .022 slot depending on the nature

of

the

problem,

as

a way of

ga

ining gr

ea

ter spr

in

g

in

ess

in

th

e

area

wh

ere it was

m

ost

n

ee

d

ed.

Th

e

sa

me side

effects that any continuous w ire would produce

occ urred with th is

type

of loop,

but the

movement of

the teeth

adjace nt

to the

di

sp

laced one was minimi

zed

by the rel

at

i

ve st

i ffn

ess

o the wire in that area

compared with the stiffness within

th

e loop. '

When all or nearly all

th

e crowing is in one

pl

ace,

what is needed is an arch wire that is rigid when they

are

al

ready

a

li

gned a

nd

quite

springy

when th

ey are

not.

Nothing

in this

world isunmi

xed blessing

a

nd

the

ext

reme sprin gi ness of a supere lastic wire m

ea

ns

th

at

i it is tied into an asy

mm et ri

ca lly mala

li

gned

arc

h,

teeth

distant

to the

site of mala

li

g

nm

ent will be

moved

.

20

In co

ntr

ast, the bo

x

lo

op en

ables the

orthodontist

to

generate

we

ll defined force systems

that

lead

to

highly

co nt ro lled tooth m

oveme

nt. The co rrect ion of positional

discrepancies of si ngle teeth is highly predictable and

any

und es

ired s

id

e

effects can be

minimized.] When

activated,

the

arch wire loop dis

torts

from its ori

gina

l

co

nfig

ur at

ion,

as the

tooth mov

es, the

loop g

radu

ally

ret

urn

s

o

theundisto rted pos ition delivering

the energy

stored at

the

time of

act

ivat io

n. (Figure 1 .

1

4 8

5

-

Distal

Mesia

3

2

6

7

Figure 1: Sc

hematic

repres

e

ntation of

the

box

l

oop.

Section

4-5 crosses

the bracket

of

th

emol

ar to be

upri

ghted.

The

bend

s h

ave

been numb

ere

d. 1 through S,

starting from the disal.

Indi

c t

ions

1. For

th

e initial alig

nm

ent of

asymme

tric crowding

in the ea

rl

y permanent dentition.

2. For root

para ll

eling dur

in

g finishing

3.

For

uprighting tipped mol

ar, as

a

form

of

adj un

ctive

orthodontic treatment.


2/3

/

/

>

Case

Report

A 25 yea r o

ld

female displ

aye

d a straight profile and a

brachycepha lic growth type. Her chief complaint

was

gap between front teeth. Th e patient h

ad

a class I

ma

locclusion

with

ex treme dee p bite and median

diastema of 3.5 mm. All th e fo ur l

ate

ral in cisors were

co

n

ge

nitally missing

(F

igure 2a) .

Th

e treatme

nt

plan

involved closure of med ian diastema and reduction of

overbite depth.

Th

e tre atme

nt

commen

ce

d with .022

slot edgewise full strap up. Th e bit e opening was

accompli sh

ed

by combi ned effect

of

tip back bends

Fig

ure 2a, 2b, 2c : The

rig

hl upper canine

was

uprighled

u

si

ng

Ihe box

lo

op m

ec

ha

ni

cs.

Sivakuma rel al

in corporated in .01

6

stainless st

ee

l Australian arch wire

and reverse curve of spee in th e lower arch wi re and

exagge

ra

te

d cur

ve

of

spee in

th

e upper arch wir

e.

Med ian diastema was clo sed using sliding mechanics.

The maxil lary right ca nine with mes ially incl

in

ed root

was attend

ed

during fini shing sta ge using box loop

m

ec

hani

cs

(Figure 2b) . Notab l

y,

a longer ra n

ge of

action

was

n

ee

d

ed

than co uld be delive red by eve n

th e most flex ib le 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 des ired

flex ib ili ty. At weeks, th e ca nine root was uprighted

and the spa ce be tween the ca nine and ce ntral incisor

was

man

aged

by placing an artificial tooth along w ith

the retainer applian

ce

(

Fi

gure

2e).

Summary

In the

case

pr

ese

nted here, the box lo

op was

u

sed

to

upright th e ca nine root. Th e same ca n be utilized for

the ext

ru

si

ve or

intrusive movement

of

any t

ee

th in

the dental arch. A low load-deflection rate enables th e

clinician to deli ver rel ati ve ly co nstant

fo

r

ces

a

nd

mome

nts

throughout the orthodontic tr

ea

tment , and

allows tooth movement to pro

cee

d without freq uent

monitoring

and appli ance a

djustm

ent s. When

ma

ximum control of tooth mo

ve

me

nt

is desired, box

loops are the first choice for intrasegmental alignm e

nt

,

due to their simp licity and large

ran

ge of ac tivation.

A Single losed

Loop

for Median Diastema

losure

For an efficient closure of median dias tema, bodily

move ment

of

the reciproca ting t

ee

th is a pr ime

requisite. One of the common

es

t

ca

uses of median

diastema is the tooth size - arch length di

scre

pan

cy.

Dec reas ing th e arch length and simultaneous ly closing

th

e median diaste

ma

using sliding m

ec

ha

ni

cs

may not

be a viable option in this situation. Furthermore, th e

treat ment time is prolonged, as th e mechanics does

not target th e problematic ar

ea

.

We, therefore, de vised th e fo llowing method of us

in

g

a single closed loop in dec reasing the arch length and

thereby closing the median diastema. Th e closed loop

is one in whi ch the sid

es of

Ih e loop

are

clo

se

together.

Obviously, it

ca

n only be ac tivated by pulling them

apart.

It

is a

ve

ry efficient tension fo rce when used in

arch shortening mec hanics.'

2


3/3

JL

s

Proce dure

A single

close

d l

oo

p of 3/8 leng

th

was

be

nt

us

in

g l

oop

f

orm

ing plier in a 019 0

25

stainless stee l arch wire.

The s

ides

of

th

e l

oo

p

we

re n

early

a

pproxi

mat

e. Th

e

l

oo

p was pos itioned in

th

e ce

ntr

e of

th

e space and the

arch wire

was liga

ted

to th

e

brac

kets.

Th

e l

oo

p was

Fig

ure

3a, 3b

:

Si

ngle

clos

ed l

oo

p

fo

r med

ia

n di

as

tema

closur

e and s

ub

seque

nt

arch sho

rt

e

nin

g.

) Ind Orthod Soc 2006;

39:20-2

2

ac ti

va

ted by pulling

th

e arch wire th rough molar tube

and cinched back. 1mm openin g of the loop

wa

s

considered a d

es

ira

bl

e

ac

ti

va

ti on in a s

in

gle

a

pp

ointm e

nt

(Fig

ur

e 3a). Fo

ur

wee ks later,

th

e second

ac

ti

va

tion of th e loop w

as

done. Onl y median

di

as

temas up

to 5mm

can be

co

rrected usng

thi

sarch

sho

rt

ening mec

hani

cs

(Fig

ur

e 3b).

Th

e s

in

gle clo

se

d l

oo

p

ha

s p

rove

n to be an effec t

ive

,

effi cient and pa

ti

ent - fri endly method for ar

ch

shortening and subsequent med ian

di as

tema closure.

It

works

in

both

th

e

upp

er a

nd

l

owe

r

arc

hes.

Gab

le

bend s may be in

co

rporated for rend ering a suffi

ci

ent

mome

nt

-

to- fo

r

ce

r

atio.

Communications

Dr. Ashima Valiathan,

BOS

,

DDS

, MS

Professor and Head,

Depa

rtm

e

nt

of

orthod

o

nti cs

and dentof

acia

l

orthopedics,

Manipal College of

Dental

Sciences,

Ma

nip

al-5

76

104 ,

India.

E-mail: sivlalith2004

@ya

h

oo.co

.in

References

1. Marco

tt

eMR .

Bi

om

ec

hani

cs

in Orth

odo

nt

ics

. 1 ed .

Phil

adelphi

a:

B

.C.

D

ec

ker Inc, 1

990.

2.

Pr

offit WR , Felds

HW,

Conte

mp

orary Orthodo

nti

cs.

ed.

St.L

ouis: Mosby,2

00

0, p.

532-533

, 580

3.

Khouw FE , Norton LA . The mechani sm of fi

xed

mol ar

upri

ghting applian

ces.

J

Pr

os

th

et De

nt

1

972

;

27: 3

81 -3

8

9.

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excellence in loops - some reflections

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