Opus closing loop
It is often desired to move malposed teeth via translation to avoid
localized areas of high stress and strain that can produce traumatic resorption
of tooth roots and investing structures. Tipping and root movement produce
localized high stress areas.
Two approaches can be used to apply the force systems necessary to
trigger the biologic phenomena that result in space-closing movement of
individual teeth or groups of teeth (“en masse”).
The first approach involves supplying the appropriate moments
to the teeth via a continuous arch wire that passes through orthodontic
brackets (delivering the moments via couples, equal and opposite
noncollinear vertical forces, at the mesial and distal bracket extremities); the
appropriate force is applied via elastomeric modules or coil springs, for
which various alloys are available. The resulting instantaneous moment-to-
force ratio (M/F) can increase or decrease, dependent on the arch wire
configuration. Therefore, the M/F changes as the tooth moves, and the tooth
responds, typically progressing from controlled tipping to translation to root
movement.
Wire-bracket friction is a variable factor as the moving teeth displace
along the arch wire with this approach, making it difficult to accurately
predict M/F.
The second approach involves bending arch wire loops of
various configurations, sectionally (to deliver the desired M/F to an
individual tooth) or segmentally or in a continuous arch wire (to deliver the
desired M/F to several teeth). An essential characteristic of closing loops for
orthodontic space closure is that they are free of friction as they act. Groups
of teeth can therefore be moved with more accurately defined force systems
for more precise anchorage control to achieve treatment goals more readily
than methods in which friction plays a role.
According to Siatkowski presently available designs, having
insufficient inherent M/F, are clinically difficult to apply with sufficient
accuracy to achieve these goals when placed in a continuous arch.
On the basis of mean tooth dimensions from Wheeler, the M/F required to
achieve translation for individual teeth and groups of teeth assuming no
marginal bone loss are summarized in Table 14 .
To achieve net translation, orthodontists have had to add residual moments
to the closing loop arch wire with angulation bends (gable bends) anterior
and posterior to the loop, a posterior gable bend and angulations within the
loop, or a posterior gable bend and anterior wire-bracket twist (anterior root
torque). Adding these residual moments has several disadvantages:
1. The teeth must cycle through controlled tipping to translation to root
movement to achieve net translation (lower Young's Modulus
Table 14: Moment/force ratios (M/F) required to achieve translation for individual teeth and
groups of teeth of mean dimensions assuming no marginal loss.
materials go through fewer of these cycles for a given distance of
space closure).
2. The correct residual moments are difficult to achieve precisely in
linear materials.
3. The resulting ever-changing PDL stress distributions may not yield the
most rapid, least traumatic method of space closure.
If a closing loop design capable of achieving inherent, constant M/F
of 8.0 to 9.1 mm without residual moments were available, en masse space
closure with uniform PDL stress distributions could be achieved. Such a
mechanism would be less demanding of operator skill to apply clinically and
might provide more rapid tooth movement with less chance of traumatic side
effects.
Dr.R.E. SIATKOWSKI designed such a closing loop in the year
1997 as the output of his study to systematically derive and verify a closing
loop design capable of delivering the required M/F inherently, without
adding residual moments, so that more
precise force systems with nonvarying
translatory M/F can be delivered by closing
loops in a continuous arch.
Dr. R.E. Siatkowski
He used Castigliano' s theorem to derive equations for M/F to produce
tooth movement by translation without adding any gable bends and verified
the loop design by FEM study.
After initial consultations with Haack(who first applied the Castigliano's
theorem in orthodontic spring design in 1963), the use of this method as an
optimizing tool (maximizing M/F for any given loop configuration) was
undertaken. Detailed perusal of the mathematical trends suggested a new
design, the “Opus loop.”
For equal loop heights, theory predicts increased inherent M/F for a
T-loop configuration and even more for an L-loop configuration. This trend
suggested placing a helix somewhere in the apical portion of the “L” further
increase the M/F.
“Opus loops” is an L shaped 10 mm high, 1 mm wide loop with a 0.5 mm
radius helix in the inner angle of the L configuration.
Wire size and material :
Opus loop can be fabricated from
0.016× 0.022 inch ss wire
0.018 ×0.025inch ss wire
0.017 ×0.025inch TMA wire.
0.019 x 0.025 inch and 0.021 x 0.025 inch TMA wire 34.
Wire size and Young's modulus have little effect on M/F although both have
major impact on load-deflection rate.33
Appliance design :
Opus loops is an L shaped loop 10 mm high, 10 mm long, with 1mm of
distance between the legsand a 0.5 mm radius helix in the inner angle of
the L configuration.
The ascent of the leg ascending from the anterior teeth, must begin
within 1.5 mm posterior to the most distal bracket of the anterior segment
being retracted, and the spacing between the ascending legs and
especially the apical loop legs must be 1 mm or less. All these
dimensions are critical to the performance of the arch wire;dimensional
deviations degrade its performance.34
Clinically practical comfort bends are not critical.
This loop can be constructed with the angle between the legs and the
bracket plane ranging between 700 to 900. 32
So, Opus 90 loop : The legs are perpendicular to the plane of the brackets
Opus 70 loop the legs are angled at 70 degrees to the plane of the
brackets .
POSITION OF LOOP AND M/F RATIO :
When a opus 90 loop is centered in the interbracket distance, the MIF
at the bracket connected to the helix end of the loop always exhibited at
least three times the M/F of the other end.
M/F is equal at both ends when the opus 70 loop is centered in the inter-
bracket distance.
The M/F increased as the loops are positioned closer to one bracket than
the other (the V-bend effect), more where the helix end is closer than
the other end .
The greatest negative impact on M/F in the off-centered position is
crossing the loop legs and decreasing loop height.33
Decreasing the loop angulation decreases M/F (Opus 70, 12 mm long vs.
12 mm long at 64 degrees: 8.7 to 7.2 mm).
Dropping the anterior end of the loop decreases M/F (Opus 70 vs. Opus
70, end 9 mm high: 8.7 to 7.6 mm).
Increasing loop length beyond 10 mm does not increase M/F, contrary to
theoretical prediction , but decreasing loop length decreases M/F.
Placing “lingual” comfort bends in the anterior of the loop, putting the
end out of plane, does not degrade M/F or F/D.
In contrast to the other loops the Opus 70 loop maintains M/F within the
desired range at all activation force levels without residual moments
(again, there is little difference between Opus 70 loops with 0.016 ×
0.022 inch s.s., 0.018 × 0.025 inch s.s., and 0.017 × 0.025 inch TMA.)
The Opus 70 loop exceeds the “safe” maximum for Moment beyond 170
gm activation force. The total moment exceeds the safe maximum only
when the activation force is 200 gm and the IBD is greater than 9 mm.
Activation force levels above 170 gm may need to be avoided at the
beginning and the very end of space closure with this loop.
Fig 62:Dimensions of the standard Opus 70 loop.
Table 15 :Activation (mm) necessary to achieve various activation forces for the Opus
70 loop formed in 0.016 × 0.022 s.s., 0.018 × 0.025 s.s., and 0.017 × 0.025 inch TMA
wires.
Activation (mm)
Force (gm)
0.016 × 0.022 0.018 × 0.025 0.017 × 0.025
s.s. s.s. TMA
50 0.8 0.5 1.8
100 1.6 1.0 3.1
150 2.4 1.5 4.4
200 3.1 2.0 5.6
250 3.8 2.5 7.0
Because there are no residual moments induced in this loop via gable
or other bends or twists, the loop's neutral position, the position at which
there is no activation force exerted, is exactly the spacing of the vertical legs
as bent. The position of the loop when it is tied-in is the same as that of the
unactivated loop before it is tied into the brackets It is therefore possible to
achieve precisely the defined activation force desired by simply increasing
that horizontal spacing by the activation amount in millimeters as shown in
Table 15 Various chosen cinch-back activations can shift relative movement
rates between anterior and posterior teeth and therefore meet desired
anchorage requirements.34
This is in contradistinction to loops requiring residual moments, where
it is extremely difficult for the clinician to judge the amount of activation
force being delivered after the arch wire is tied in.
Suggested cinch back activations of Opus closing loops for various
anchorage situations for clinically useful sizes of arch wires in stainless steel
and TMA are shown in Fig 63.
Fig 63: Initial (maximum) activations of the Opus Loop arch wire for the three groups
of anchorage requirements encountered in clinical practice. If second molars are fully
erupted, they should be included in the posterior segment. 34
The desired M/F will be delivered throughout the activation range and
anchorage requirements will be met as long as the suggested maximum
activation distances are not exceeded. This simplifies the activation regimen
considerably over previously available closing loops, and the clinician can
safely increase the appointment intervals during space closure without
concern for loss of anchorage control as long as the patient can be trusted to
report any damage to appliances if it occurs between appointments.
The large activations possible in 0.017" X 0.025" TMA arch wires
should be noted: appointment intervals can be extended and appointments
involve mere monitoring during this stage of treatment with this arch wire.
Unfortunately, a full arch wire with sufficient anterior lingual twist is
xtremely difficult to bend by hand in TMA. A jig to do that for this alloy has
been successfully developed.34
Group B Anchorage (Moderate Anchorage)
For Group B Anchorage cases, the force system applied is just
enough to drive the stress in the PDL of the posteriors onto the plateau of the
osteologic curve (150-200 gm/side). This is shown in Figure 64A, As a
consequence, the stress level in the PDL of the anteriors, though higher, still
remains on that plateau. Therefore, the rates of tooth movement of the
anteriors and posteriors is nearly identical. Because the area under each
curve represents the physical movement of the teeth, both anteriors and
posteriors move equally to close the available space. This is further shown
in Figure 64B, a view of the rate versus time axes as if seen from the far
right of Figure 64A.
Fig 64: Group B moderate anchorage curves The rate versus time curves of Figure A, as
if viewed from the extreme right of that figure (B). Both anteriors, curve 1, and
posteriors, curve 2, move equally to close the space.
Group C Anchorage (Minimal Anchorage)
In Group C Anchorage, the level of force delivered by the Opus Loop
arch wire (75 gm/side) results in a calculated stress of 0.22 g/mm2,
somewhat below the threshold stress level necessary for any tooth
movement (by definition because 75 gm/side results in no tooth movement
of the anteriors). This is shown as point 4 in Figure 65A. Additional force is
applied to the posteriors only, via intermaxillary elastics/ springs or an
overlay TP 256 auxiliary. That additional posterior force is sufficient to
drive the stress level in the PDL of the posterior teeth onto the plateau of the
osteologie curve as shown in Figure 65A, Figure 65B shows a view of the
rate versus time axes of Figure 65A as if seen from the far right of that
figure.
Fig 65 : Group C minimal posterior anchorage curve .The rate versus time curve of
Figure A, as if viewed from the extreme right of that figure (B). Posteriors protract: curve
1; anteriors do not move: point 4
The use of intermaxillaryelastics to deliver an additional 150 gm/side
presupposes that the opposing arch has a stiff rectangular stainless steel arch
wire in place. Instead, a TP 256 torquing auxiliary (0.012" auxiliary
torquing wire on 0.020"arch wire); can be overlaid over the closing loop
arch wire to provide additional protraction force to the posterior teeth .(Fig
66) The overlay should be recinched as the posterior teeth move mesially,
but the interval between these reactivations is not critical.
Fig 66:256-Begg Two-Arm Prewound on Stage III Archwire.
The use of a TP 256 overlay to provide the additional protraction force to the
posteriors has several advantages:
(1) The clinician is free to perform other treatment steps in the opposing
arch;
(2) Undesired vertical forces from intermaxillary elastics are not a factor;
(3) Posterior arch width increases from intermaxillary elastics are not a
factor when using TMA arch wires.
4) It reliably delivers an additional 150g/side of mesial force while
controlling the incisors’ axial inclinations and maintaining their
anteroposterior positions.
Group A Anchorage (Maximum Anchorage)
The level of force delivered by the Opus Loop arch wire in Group A
cases is selected (100-150 gm/side) so that the stress level in the PDL of the
anteriors is just at the beginning of the plateau (curve 2, Fig 67A). Because
the surface area of the posteriors exceeds that of the anteriors, the PDL stress
level is less for the same applied force, and though exceeding the threshold,
remains well below the plateau (curve 3, Fig 67A). There is minimal
movement of the posteriors mesially compared with the amount of the
anteriors' lingual movement (Fig 67B).
Fig 67: Group A maximum posterior anchorage curves.. The rate versus time curves
of Figure A, as viewed from the extreme right of that figure (B). Anteriors retract: curve
2; minimal posterior protraction: curve 3.
If the anchorage unit were to incorporate additional teeth in Group A cases,
the PDL stress level in the posterior teeth would fall, curve 3 would shift
farther to the left in the osteologic curve in Figure 67A, the posterior
maximal rate would fall, and net mesial movement of the posteriors
would be lessened.
The advantage of having the loop formed in 0.017" X 0.025" TMA is that it
provides a relatively long range of activation . Unfortunately, there
are three clinical disadvantages to having the full closing loop arch wire in
TMA:
1. It is difficult to bend the TMA arch wire with sufficient incisor twist to
eliminate wire-bracket play. With insufficient incisor root-lingual twist,
incisor axial inclination control is lost.
2. It is difficult for clinicians to contour the looped TMA arch wire for
patient comfort on one side without affecting the contours of the anterior
portion and that of the opposite side.
3. Ten different anterior circumference-sized wires in 3-mm increments are
necessary to have on hand to cover the range of all possible tooth sizes in
both arches.
These three disadvantages can be overcome by joining an anterior wire of
Niti alloy with two separate 0.017" X 0.025" TMA posterior wire portions
containing the Opus Loops. A schematic drawing of this approach is shown
in Figure 68.
Fig 68: Schematic drawing of TMA loop and posterior wire joined to Niti anterior wire
via Forestadent cross tubes *Size to fill the brackets: 0.0215 X 0.028 for 0.022 slots;
0.018 X 0.025 for 0.018 slots.
According to Proffit22 although Opus loop produces best control of moment
to force ratios throughout the range of activation but the possibilities of
clinical problems from increased complexity of its design always must be
balanced against the potentially greater efficiency of more complex design.
Because of this Opus has not been widely adopted.
