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ORIGINAL ARTICLE
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 60-64
Arch expansion efficiency of coaxial tubular superelastic nickel-titanium in comparison to single-stranded superelastic nickel-titanium while relieving mandibular anterior crowding: A randomized controlled study


1 Department of Orthodontics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
2 Department of Orthodontics, Alpha Orthodontics and Dental Care, Kottayam, Kerala, India
3 Department of Orthodontics, Vettiyil Dental Clinic, Kottayam, Kerala, India

Date of Submission06-Oct-2018
Date of Acceptance15-Nov-2018
Date of Web Publication14-Feb-2019

Correspondence Address:
Dr. Joe Joseph
Department of Orthodontics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jispcd.JISPCD_352_18

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   Abstract 

Aim: The aim of the study is to compare the efficiency of six-stranded coaxial tubular superelastic nickel–titanium (NiTi) archwire and a single-stranded wire in relieving anterior mandibular crowding.
Materials and Methods: This double-blind randomized study included 40 patients, categorized into two groups: Sentalloy round group and Speed tubular supercable group (20 each). After taking alginate impressions, the allocated archwire was engaged. With a digital caliper, intercanine, interpremolar, and intermolar width were recorded on the study models, immediately and at 4, 8, and 12 weeks stages. The Statistical Package for the Social Sciences (SPSS) version 20 was used for analysis.
Results: The measured parameters were increased in both the groups, with the difference being insignificant statistically.
Conclusion: Superelastic coaxial NiTi wires show better efficiency in relieving anterior crowding than single-stranded NiTi wire.


Keywords: Anterior crowding, digital caliper, intercanine width, nickel–titanium wire, superelastic coaxial nickel–titanium wire


How to cite this article:
Joseph J, Ninan VS, Abraham ME, John J, Cherian KK, Thomas RM. Arch expansion efficiency of coaxial tubular superelastic nickel-titanium in comparison to single-stranded superelastic nickel-titanium while relieving mandibular anterior crowding: A randomized controlled study. J Int Soc Prevent Communit Dent 2019;9:60-4

How to cite this URL:
Joseph J, Ninan VS, Abraham ME, John J, Cherian KK, Thomas RM. Arch expansion efficiency of coaxial tubular superelastic nickel-titanium in comparison to single-stranded superelastic nickel-titanium while relieving mandibular anterior crowding: A randomized controlled study. J Int Soc Prevent Communit Dent [serial online] 2019 [cited 2019 Oct 18];9:60-4. Available from: http://www.jispcd.org/text.asp?2019/9/1/60/252268



   Introduction Top


Inadequate arch width or arch perimeter is one of the major causes for crowding of teeth. The intermolar width and intercanine width are considered as clinical indicators for measuring arch expansion and can be easily measured.[1] To achieve arch expansion, either of conventional fixed appliances or rapid maxillary expansion appliances are usually employed. In a few cases, archwires are used for expansion.[2] The properties that influence the clinical performance of wires are low modulus of elasticity, flexibility, resilience, high spring back, corrosion resistance, ease of bracket engagement, and biocompatibility.

Many varieties of archwires are available, each having their own pros and cons when compared to the other. They are available in different configurations, solid, multistranded, looped, or tubular. Each one imparts a distinctive force level, due to variation in elastic modulus. Studies have shown that for initial stages of treatment, nickel–titanium (NiTi) wires are ideal, due to their low stiffness, which produces low-intensity forces. They can be employed as single-stranded archwires or as multistranded archwires, the later showing increased flexibility and reduced load deflection rate.[3],[4]

Recently, speed six-stranded coaxial tubular superelastic NiTi is introduced into the market. It has advantage over single-stranded superelastic NiTi in many ways such as shortening of treatment time, increased spring back, deformation resistance, and low-force delivery.[3],[4],[5]

Our study aims to clinically assess the expansion effectiveness of six-stranded coaxial tubular superelastic NiTi-speed tubular super (STS) cable and single-stranded superelastic NiTi Sentalloy by measuring the change in intermolar width and intercanine width at 4-, 8-, and 12-week interval.


   Materials and Methods Top


This double-blind study included 40 patients, between 12 and 18 years reported to the Department of Orthodontics and Dentofacial Orthopaedics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala. Ethical committee clearance was attained from the institution (Ethical Committee No: PCDS/IEC/S20/12/14) and informed consent was obtained from the participants. Sample size was determined from similar studies using the formula: . With a confidence interval of 95% and power of 95% for the study, a sample size of 40 was obtained. The mandibular anterior crowding was assessed based on Little's Irregularity Index.[6]

The selected patients were divided into two groups, that is, Sentalloy round (SR) group (Light Archform, Dentsply-GAC, International) and STS cable group (Speed System Orthodontics, Ontario, Canada), 20 in each group. The allocation of archwire was randomized by means of computer software created numbers. Envelops were used to assign archwire for the two groups, thus concealing both the investigator and the participant. Bracket bonding and archwire placement were done by the same orthodontist. No other archwires were used.

Inclusion criteria

  1. Patients between 12 and 18 years with lower anterior crowding and with mandibular irregularity index more than 6
  2. Class I skeletal pattern
  3. Extraction treatment with two first premolars in mandibular arch
  4. Eruption of all mandibular teeth excluding third molars with no spacing between them
  5. Normal medical history
  6. No recent history of intake of drugs such as nonsteroidal anti-inflammatory drugs
  7. No previous active orthodontic treatment.


Exclusion criteria

  1. Developmental anomalies in the dentition
  2. Abnormal root morphology in lower arch
  3. Patients with periodontal disease and loss of attachment.


Sample size determination

Number of participants was calculated to select sample for the present study using the formula: .[2] A sample of 36 was obtained with a confidence interval of 95% and power of 95% for the study. It was decided to select 40 participants, with the expectation of dropouts.

Data collection

For each patient, a high-quality alginate impression of the lower dental arch was obtained at the preexpansion phase after placing bonded attachment and bands. The allocated archwire which came in a sterilized opaque cover was taken and then engaged as fully as possible into the bracket using elastomeric modules. At routine follow-up appointment after 4 weeks, participants were recalled, archwires removed, and alginate impressions were taken and poured immediately with stone, to obtain the study models. The archwires were ligated and activated with elastomeric modules or steel ties. Entire process was replicated another time after 8 and 12 weeks, by a single operator.

Measurement of study cast

With a fine tip digital caliper (Digimatic 0–6 inch, Mitutoyo, Japan), measurements were recorded on the study models [Figure 1]. Individual points were noted for molar width and intercanine width [Figure 2] and [Figure 3]. All the readings were recorded by a single expert operator in a double-blind manner immediately, at 4, 8, and 12 weeks [Figure 4].
Figure 1: Digital caliper for recording measurements

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Figure 2: Measuring intercanine width

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Figure 3: Measuring intermolar width

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Figure 4: Four aligning stages

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Duplicate readings were taken on the cast at the commencement and at the end of the study in ten cases to assess intraoperator reliability to get an idea of measurement error in the study. Statistical Package for the Social Sciences (SPSS) version 20 for Windows software was used for analysis.


   Results Top


On Statistical evaluation, the median values of the intercanine, interpremolar, and intermolar width demonstrated a rise with the progression of time from the 1st week to the 12th week. This was consistently seen in all observations except for the intermolar width in the speed tubular group which showed a decrease [Table 1] and [Table 2].
Table 1: Mean and standard deviation

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Table 2: Median values

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In SR group, a highly significant increase was seen in the intercanine width over the 12-week period (P < 0.001). The transverse expansion in the premolar and the molar regions was not statistically significant [Friedman Test: [Table 3]].
Table 3: Readings recorded in Neo Sentalloy

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In the second group (STS cable), a significant increase in the intercanine and the interpremolar widths (P ≤ 0.001) was recorded, while the intermolar width increased, which was insignificant [Table 4]. Although the wires did demonstrate transverse expansion individually, when the two groups were compared using the Mann–Whitney test, there was no significant variation among two wires in relation to the expansion achieved.
Table 4: Readings recorded in Speed tubular supercable

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   Discussion Top


It has been shown that archwires that give light continuous forces over long areas are most effectual in orthodontics.[7] To decrease the load deflection ratio, many attempts were made which lead to the introduction of multistranded steel wires such as superelastic or austenitic active NiTi wires, true shape memory or martensitic active wires, and nonsuperelastic or martensitic stabilized NiTi wires for initial alignment. Studies did not reveal any significant benefit of these wires but showed multiple advantages such as increased flexibility and a reduced load deflection rate.[8],[9],[10] Berger used a supercable, a seven-stranded round coaxial superelastic NiTi archwire and found this wire exerts only 36%–70% of the force of solid NiTi wires.[5]

In our study, we noticed that with time, there was an increase in intertooth distance, but the variation among the groups was statistically insignificant. Our findings are similar to Biju Sebastian et al., who found a significant difference (P < 0.05) in mean tooth movement between the coaxial superelastic NiTi wire and single-stranded superelastic NiTi in lessening lower anterior crowding.[3]

Serafim et al. and Mahmoudzadeh et al. compared the time required to relieve lower anterior crowding using two types of archwires, conventional NiTi and conventional and NiTi heat-activated wires. They found that heat-activated wires relieved crowding in significantly less time than the conventional one.[11],[12]

Pandis et al. did not notice any difference in lessening of lower anterior crowding with copper-NiTi and superelastic NiTi wires.[8] Evans et al. also did not observe any significant variation in alignment capability of medium force active martensitic rectangular NiTi wire, multistranded stainless steel wire, and graded force active martensitic NiTi wire.[13] West et al. after comparing superelastic NiTi and multistranded stainless steel found a significantly better alignment with the former one.[14] Jones et al. found a superior mean enhancement in incisal alignment with superelastic NiTi than coaxial stainless steel one.[15]

Thus, all the studies including ours support the view that lower anterior alignment is superior and quicker with coaxial tubular superelastic NiTi archwire than single-stranded wire. The main advantage of the former archwire is better engagement into the bracket, and furthermore, it engages a fairly large archwire with low-force delivery.

Limitations

The limitation of the study is smaller sample size.


   Conclusion Top


Coaxial tubular superelastic NiTi wires showed significant effectiveness than single-stranded NiTi in reducing lower anterior crowding after 4, 8, and 12 weeks. The obtained knowledge regarding the preference of archwire can be utilized for better orthodontic treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Consolaro A, Cardoso MA. Mandibular anterior crowding: Normal or pathological? Dental Press J Orthod 2018;23:30-6.  Back to cited text no. 1
    
2.
Aydın B, Şenışık NE, Koşkan Ö. Evaluation of the alignment efficiency of nickel-titanium and copper-nickel-titanium archwires in patients undergoing orthodontic treatment over a 12-week period: A single-center, randomized controlled clinical trial. Korean J Orthod 2018;48:153-62.  Back to cited text no. 2
    
3.
Sebastian B, Abraham M. Alignment efficiency of superelastic coaxial nickel-titanium. J Community Med Health Educ 2016;6:432.  Back to cited text no. 3
    
4.
Fang CY, Tsai YY, Yu JH. Improved superelastic NiTi wire for the treatment of adult skeletal class III malocclusion in a surgery- first case. Int J Exp Dent Sci 2016;5:133-8.  Back to cited text no. 4
    
5.
Al-Shahrani I. Study cast measurements in the assessment of incisor crowding among patients attending dental clinics in Abha city, Saudi Arabia. J Dent Res Rev 2016;3:5-7.  Back to cited text no. 5
  [Full text]  
6.
Little RM. The irregularity index: A quantitative score of mandibular anterior alignment. Am J Orthod 1975;68:554-63.  Back to cited text no. 6
    
7.
Dalstra M, Melsen B. Does the transition temperature of Cu-NiTi archwires affect the amount of tooth movement during alignment? Orthod Craniofac Res 2004;7:21-5.  Back to cited text no. 7
    
8.
Pandis N, Polychronopoulou A, Eliades T. Alleviation of mandibular anterior crowding with copper-nickel-titanium vs. nickel-titanium wires: A double-blind randomized control trial. Am J Orthod Dentofacial Orthop 2009;136:152.e1-7.  Back to cited text no. 8
    
9.
Ong E, Ho C, Miles P. Alignment efficiency and discomfort of three orthodontic archwire sequences: A randomized clinical trial. J Orthod 2011;38:32-9.  Back to cited text no. 9
    
10.
Kusy RP, Dilley GJ. Elastic modulus of a triple-stranded stainless steel arch wire via three – And four-point bending. J Dent Res 1984;63:1232-40.  Back to cited text no. 10
    
11.
Serafim CM, Gurgel Jde A, Tiago CM, Tavarez RR, Maia Filho EM. Clinical efficiency of two sequences of orthodontic wires to correct crowding of the lower anterior teeth. ScientificWorldJournal 2015;2015:690280.  Back to cited text no. 11
    
12.
Mahmoudzadeh M, Farhadian M, Alijani S, Azizi F. Clinical comparison of two initial arch wires (A-NiTi and heat activated NiTi) for amount of tooth alignment and perception of pain: A randomized clinical trial. Int Orthod 2018;16:60-72.  Back to cited text no. 12
    
13.
Evans TJ, Jones ML, Newcombe RG. Clinical comparison and performance perspective of three aligning arch wires. Am J Orthod Dentofacial Orthop 1998;114:32-9.  Back to cited text no. 13
    
14.
West AE, Jones ML, Newcombe RG. Multiflex versus superelastic: A randomized clinical trial of the tooth alignment ability of initial arch wires. Am J Orthod Dentofacial Orthop 1995;108:464-71.  Back to cited text no. 14
    
15.
Jones ML, Staniford H, Chan C. Comparison of superelastic NiTi and multistranded stainless steel wires in initial alignment. J Clin Orthod 1990;24:611-3.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

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