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Retraction Loops in Orthodontics

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 Chapter 1: Introduction

Space closure is one of the most challenging processes in Orthodontics. The ability to
close spaces, especially those resulting from tooth extraction, is an essential skill
required during orthodontic treatment. Orthodontic tooth movement during space
closure is brought about by two types of mechanics. The first type, sectional or
segmental arch mechanics involves closing loops incorporated in either a full or
sectional arch wire and the teeth move through activation of the wire loop.1

The second type, sliding mechanics involves sliding the arch wire through bracket slot
or tubes or moving the bracket along the arch wire. One of the main differentiating
features between these two mechanics is friction. Sectional mechanics as they involve
no friction are also called as Friction-free or Frictionless mechanics. On the contrary as
friction plays a significant role in sliding mechanics, they are called friction mechanics.1

Friction (sliding) and frictionless (loop) mechanics are used for space closure. In sliding
mechanics, the wire and position of the bracket give control of tooth movement,
whereas in a loop-spring system, control is built into the spring. In spite of the variety
of appliance designs available to the orthodontist, either method has its own advantages
and disadvantages or the methods complement each other.

One of the major advantages of frictionless mechanics is that a known force system is
delivered to teeth because there is no dissipation of force by friction. So, in this case it
is possible to determine forces that are being delivered to the tooth segments on the
basis of the geometry and material properties of the spring alone. 2

The three primary characteristics of a retraction spring are

1. The M/F ratio which determines the centre of rotation of tooth during its movement.
2. The greatest force at yield that can be delivered from a retraction spring without
permanent deformation.
3. Force to deflection rate.3

A number of springs have been designed that use the differential moment
strategy for anchorage control. The selection of one spring or another depends largely

1
on individual preferences. The management of extraction site must be under the control
of the clinician to ensure that the teeth will ultimately reside in predetermined
positions.1, 2

Optimum control of tooth movement requires the application of specific orthodontic

force system. Therefore, knowledge of the mechanics of orthodontic appliance is
essential to achieve desirable and predictable treatment results. The application of the
forces that are continuous in activity on as many areas of the denture as possible and
working in the direction in which the teeth are to move, with maximum comfort to the
patient, is a condition that fulfil the requirements of treatment efficiency.

The resiliency of a semi-rigid or a so called heavy arch wire as well as the lighter gauge
wires may be increased by incorporating various loop designs. All this can be
accomplished successfully by the precise application of different size, shape and types
of loops having a control on the distribution, direction, degree and duration of forces
applied. Considerable research has already been done both analytically and
experimentally to describe the specific resulting force systems that are delivered by
various orthodontic appliances.

This dissertation, therefore, is to compile the various types of loops and helices, their
mechanism of action, configuration, amount of force delivered and the mechanical
behaviour exhibited. This could provide a better understanding of the mechanics
involved, the forces applied and the expected movements in all the three planes of space
and for an improved approach to clinical orthodontics.

2
 Chapter 2: Basic Concepts of Friction

2.1 Terminologies

A. Mechanics

“It is an area of study within the physical sciences, which deals with the state of
rest or motion of bodies under the action of forces.”1

The fundamental principles of the practical mechanics, as understood today, were

initially formulated by Sir Isaac Newton.1 These Newtonian mechanics were further
divided into Static and Dynamic. Statics are those which treat bodies at rest and under
action of force, and Dynamics are those which deal with moving bodies. Dynamics is
further divided into two

1. Kinematics which is the study of motion itself

2. Kinetics, in which relationship between the force systems and the characteristics
of body motion are studied.1, 4

B. Force

Force is defined as “an act upon a body that changes or tends to change the state of
rest or the motion of that body.”1

Forces are associated with the areas or volumes of the bodies, with which they directly
interact, and contact forces are associated with the surface areas over which the contact
exists. So, if the contact area is small in comparison with the total surface area of the
body the force is considered to be exerted on a surface point or particle of the body and
is termed as the Concentrated or Point force. On the contrary if the contact area is
relatively large, the pattern of the force intensity over the area may be an important
consideration and therefore the force is termed as Distributed force.1, 4

3
C. Friction

When two bodies touch one another, they share a contact area. “The resistance to
movement tangent to the contact area of one body relative to the other is known
as friction.”

Friction may exist between two solid surfaces, at a solid- liquid interface or between
two fluid layers. The friction between solids may be rolling or sliding, depending upon
the form of movement attempted. The resistance that precludes actual motion is termed
as static friction and that which exists during motion is called as dynamic friction. Both
these static and dynamic forms of sliding friction are of orthodontic interest.1

D. Segmental arch mechanics (sectional mechanics)

Segmental arch mechanics is defined as, “Orthodontic mechanotherapy in which not

all teeth within an arch are included in the same arch wire, but rather anchorage
and active segments are created by consolidating teeth together using wire
segments.” 4

Various orthodontic loops and springs and different types of arches are used to generate
the force systems required for movement of the active segments. According to Charles
Burstone “Segmented arch should not be confused with a sectional arch which simply
contains portion of a continuous arch wire that are not joined in any way to form an
integral system”5 E.g. a separate canine retraction with any spring without any wire in
the incisor segment comes under sectional arch.

E. Frictionless mechanics

It is defined as “the use of strategies or appliances that do not involve friction

between arch wire and bracket during tooth movement.”4 It involves closing loops
fabricated either in a full or sectional arch wire. Here the tooth moves through activation

4
of the wire loop which can be designed to provide a low load deflection rate and
controlled moment to force ratio.

2.2 Laws of friction

Fundamental laws of friction were evolved from the efforts of Amontons and Coulomb
as early as the 17th and 18th centuries. The five laws of friction are as follows

1. When an object is moving, the friction is proportional and perpendicular to the

normal force.

2. Friction is independent of the area of contact so long as there is an area of contact.

3. The coefficient of static friction is slightly greater than the coefficient of kinetic
friction.

4. Within rather large limits, kinetic friction is independent of velocity.

5. Friction depends upon the nature of the surfaces in contact.

2.3 Factors Affecting Friction

Frictional force between bracket and wire is affected by a large number of factors.1
They are listed as follows

I. PHYSICAL

A. Archwire

a. Wire Material

b. Cross sectional shape /size

c. Role of Wire Stiffness

5
B. Ligation Techniques of arch wires to brackets

a. Ligature wires

b. Elastomeric

c. Method of ligation

d. Self-ligating brackets

C. Brackets

a. Material

b. Manufacturing process

c. Slot width and depth

d. Design of bracket

e. First order, second order and third order bends.

D. Orthodontic appliance

a. Inter-bracket distance

b. Level of bracket slot between adjacent teeth

c. Forces applied for retraction.

II. BIOLOGICAL

A. Saliva

B. Plaque

C. Acquired pellicle

D. Corrosion

6
I. PHYSICAL

A. Effect of orthodontic arch wires on friction

a) Wire material

It is evident from most of the studies that stainless steel wire is associated with least
amount of friction and Beta titanium with the most.6 A greater magnitude and more
frequent variation in frictional force per unit distance of bracket travel over arch wire
have been noticed with NiTi and beta titanium wires than with stainless steel or cobalt-
chromium wires.7

Specular reflectance studies by Kusy and Whitley (1988) have shown that stainless steel
wires have the smoothest surface, followed by Co-Cr, beta-titanium and NiTi wires in
increasing order of surface roughness.8 They also investigated the correlation between
surface roughness and frictional characteristics of various wire materials and found that
stainless steel wire demonstrated the smoothest surface and had the lowest coefficient
of friction. But as beta titanium had the most friction and was not the roughest, they
concluded that one can’t use surface roughness as an indicator of the frictional
characteristics. With the nickel titanium and beta titanium there is no correlation
between surface roughness and coefficient of friction.

Prososki et al. (1991) also found no correlation between surface roughness and
coefficient of friction although stainless has smoothest surface. It has higher friction
than cobalt chromium.9

b) Cross-sectional shape /size

Increase in wire size is associated with increased bracket wire friction.6 In general
rectangular wires produce more friction than round wires. But this might not be true for
bracket wire angulations that result in binding. At greater angulations of the bracket,
the determining factor is the point at which the wire contacts the edge of the bracket.
With round wires, the bracket slot can bind into the wire at a point causing an
indentation in the wire. However, with the rectangular wire the force is distributed over
a larger area resulting in less pressure and therefore less resistance to movement. This

7
is also in accordance with the findings by Bednar and Gruendeman (1991) that a 0.020”
wire is associated with more friction than the 0.017” x 0.25” arch wire.10

c) Role of wire stiffness

Force applied to on the orthodontic arch wires causes a deflection which is reversible
if it is within the elastic limit of the wire. On a force-deflection curve slope of the elastic
portion is proportional to the stiffness of the wire i.e. in other words stiffer wires are
less springy and deflects less with a greater amount of force. Stiffness of the wire is
influenced by the diameter, the cross-section of the wire and length.

Doubling the diameter of the round wire supported at one end results in the

1. Stiffness increasing by a factor of sixteenth,

2. Strength increasing eight times and
3. Range decreasing to half.

Doubling the length of the cantilevered wire beam decreases stiffness by a factor of
eight. During canine retraction in a premolar extraction case, the increased inter-bracket
span of the unsupported wire over the extraction space decreases the stiffness of the
wire therefore increasing the chance of deflection of the wire while retraction. Such
deflection in the wire increases friction and chances of bracket binding. So, to overcome
this diameter of the wire should be increased to compensate for the decrease in the
stiffness.10

Stiffness of the wire is also dependent on the cross-sectional dimension of the

rectangular wires in the direction of bending. Drescher et al. (1989) stated that vertical
dimension of the wire is an important factor in frictional resistance.11 The direction of
deformation of a rectangular wire is in the direction of the cross-sectional height, i.e.
0.016” side of 0.016” x 0.022” wire. They found that 0.016” and 0.016” x 0.022” wires
generated significantly lower frictional forces than 0.018” x 0.025” wires.

Stiffness of the wires is also affected by whether it is cantilevered or supported at its

both ends. A cantilevered wire is more flexible than a wire supported at its both ends.
Rigidly supporting a wire at both ends increases stiffness four times thus minimizing
the deflection and resultant friction.
8
Clearance between the bracket and the wire also influence the friction so adequate
clearance should be provided between the bracket and the arch wire to prevent the
binding. Play of the wire in second order depends on a combination of slot size, bracket
width and arch wire size. Third order play for rectangular wires in a 0.018” slot ranges
between 16.7o for 0.016” x 0.016” wire to 4.5o for 0.017” x 0.025” wire. Similarly, for
0.022” slot third order play ranges between 27.4o for 0.016” x 0.022” wire to 2o for
0.0215” x 0.028” wire. So, to reduce the friction during space closure and canine
retraction it is recommended that wire slot combination should have adequate clearance
i.e. use of 0.018” wire in 0.022” slot. 11

B. Ligation Techniques of arch wires to brackets

a) Ligature wires and elastomeric

Variable force exerted by the different ligatures has a significant role in determining
the frictional resistance developed within the bracket slot and arch wire. Most of the
studies have estimated this force to be between 50 to 300gms.This wide variation in the
frictional force is due to the facts that elastomeric modules are adversely affected by
the oral environment. They undergo stress relaxation with time and exhibit great
individual variations among different manufacturers.1

Force exerted by the stainless-steel ligatures varies with the need of the clinician,
depending on the technique used. So, they may be tied either too tight or too loose.
Bednar et al. (1994) conducted a study for comparison of frictional forces between
orthodontic brackets and arch wires ligated with elastomeric, steel and self-ligation.10
They found that lightly steel tied steel brackets had less friction than other bracket
type/ligation technique group.

The elastomeric-ligated GAC ceramic brackets demonstrated the greatest statistically

significant friction. For the 0.016” × 0.016” wire size, the range of friction values for
all bracket type/ligation technique groups was smaller than for wire of any other size.
They also found that the mean friction values for the elastomeric-ligated steel bracket
and the elastomeric-ligated ceramic bracket, combining all wire sizes, were 258.55 gm
and 358.34 gm, respectively. The mean friction value for the self-ligated steel bracket,
combining all wire sizes, was 290.30 gm. These findings were then supported by the
9
study conducted by Edwards et al (1995) to compare the effects of four ligation
techniques i.e. elastomeric ligatures tied conventionally and in figure 8 pattern, stainless
steel ligatures and Teflon coated ligatures.12 Elastomeric ligatures tied in figure 8
pattern had greatest mean static frictional forces and Teflon coated ligatures produced
the lowest mean static frictional forces. But they found no significant differences in the
frictional resistance offered by conventionally tied elastomeric module and stainless
ligatures.

A further study by Dowling et al. (1998) investigated the mean frictional forces of
differently coloured, shaped and manufactured modules when sliding a 0.018 X 0.025-
inch SS wire through a premolar bracket. The clear modules exhibited significantly
lower friction than the other modules types.13,14

Silicone-impregnated modules have been shown to reduce static frictional resistance by

23% to 43% compared with non-lubricated ligatures.15,16 Three bracket designs limiting
the force of ligation on the arch wire thereby reducing the friction were introduced -
American friction free brackets, GAC shoulder brackets and the RMO Synergy
brackets. These brackets generated lower mean frictional forces than conventionally
ligated brackets.

b) Self-Ligating brackets

These brackets have inbuilt feature of self-ligation with a highly resilient spring clip.
An in vitro study conducted by Berger (1990) to compare the level of force required to
move four distinct arch wires a similar distance, on six occasions, through four ligated
bracket systems and the self-ligated SPEED bracket.17

The results consistently demonstrated a significant decrease in the force level required
for the SPEED bracket with all four arch wires when compared with elastomeric and
steel-tie ligation in both metal and plastic bracket systems. This could explain the claim
that SPEED system is a faster treatment modality.

A study by Khambay and his co-workers (2004) evaluated different methods of arch
wire ligation on frictional resistance and concluded that the use of passive self- ligating
brackets is the only method of almost eliminating friction.14

10
C. Brackets

Today we have multiple of options for selecting the brackets. No doubt the most popular
bracket material remains the stainless steel however the sintered variety has overcome
the conventional cast stainless steel. When esthetics comes to play a significant role
ceramic brackets which are available in the monocrystalline and polycrystalline forms.1

Titanium alloys are also being tested for a material with minimum friction and ultimate
strength. Also available are the plastic brackets with and without ceramic reinforcement
and metal slot inserts. 1 Edgewise bracket design they are available in variables of slot
size, bracket width, number of wings, prescription in preadjusted designs, ligation
capabilities etc.1

Effect of bracket material and design on friction

a) Conventional Stainless-steel Brackets

Studies on frictional forces shown that the mean frictional forces with the conventional
cast stainless steel brackets ranged between 40 to 336 gm. (Table 1).10,11

Bracket Wire Frictional force

0.016” SS wire in narrow 49 gm

single bracket
0.018” stainless-steel
brackets 0.017” x 0.025” β-Ti wires in 336 gm
wide twin brackets

0.018” SS wire in narrow 40 gm

bracket
0.022” stainless steel
brackets 0.019” x 0.025” NiTi wire in 222
wide brackets

Table-1: Mean frictional forces with the conventional cast stainless steel brackets. (Taken
from Drescher D, Bourquel C, Schumacher HA. Frictional force between bracket and arch
wire. Am J Orthod Dentofac Orthop 1989; 96(5):397-404)

11
Several stainless-steel bracket wire combinations generated low level of frictional
forces, less than 110g. Incorporation of additional design features in brackets e.g.
bumps on the bracket slot walls and floor, can also reduce friction significantly as it
reduces the surface contact with wire.

Tip Edge brackets have 200 wedges cut out from the bracket slot on diagonally opposite
corners. With this bracket design when a tooth tips on retraction, the binding of the wire
at the edges of the bracket is reduced and frictional resistance is thus reduced.

b) Sintered stainless steel brackets

For most wire sizes the sintered stainless-steel brackets produced significantly lower
friction than cast stainless steel brackets. For the 0.018” slot size, the friction of the
sintered stainless-steel brackets is 38 % to 41 % less than the friction of the cast stainless
steel brackets.12 Similarly, for 0.022” slot size the friction of the sintered stainless-steel
brackets is approx. 44% less than the friction of cast stainless steel brackets. This
difference in the frictional forces is attributed to the smoother surface texture of the
sintered stainless-steel brackets.

Kinetic frictional forces for sintered stainless brackets and different bracket wire
combinations are given in Table 2.

Bracket Wire Mean Frictional force

0.016” Co-Cr wires 45.8 gm

0.018” sintered stainless 0.016” x 0.016” NiTi 156.6 gm

Steel brackets wires

0.018” ss wire 30.1 gm

0.022” sintered stainless 0.017” x 0.025” β- Ti wire 168.3gm

Steel brackets

Table-2: Kinetic frictional forces for sintered stainless brackets and different bracket wire
combinations. (Taken from Edwards GD, Davies EH. The ex vivo effect of ligation technique on
static frictional resistance of stainless-steel brackets and arch wires. Br J Orthod 1995; 22:145-
153)

12
c) Ceramic brackets

Ceramic brackets demonstrated significantly higher frictional forces than with stainless
steel brackets with most of the wire size and alloy combinations in both 0.018” and
0.022” slots. This difference in friction is attributed to the characteristics of the ceramic
bracket material or slot surface texture. Ceramic brackets have granular, pitted surface
as seen on the scanning electron micrographs. The monocrystalline alumina brackets
observed to be smoother than polycrystalline one, but their frictional characteristics
were comparable.

Bracket Wire Mean Frictional force

0.016” Co-Cr wire 88.4 gm

0.018” ceramic brackets 0.017” X 0.025” β- Ti wire 405.1 gm

0.016” ss wire 119.0 gm

0.022” ceramic brackets 0.017” X 0.025” β- Ti wire 399.4 gm

Table-3: Mean frictional forces with ceramic brackets and different arch wire combinations.
(Taken from Angolkar Padmaraj, Kapila Sunil, Duncanson Manville, Nanda Ram. Evaluation of
friction between ceramic brackets and orthodontic wires of four alloys. Am J Ortho Dentofac
Orthop 1990; 98:499-506)

Because of the high magnitude of the frictional forces with ceramic brackets greater
force is needed to move teeth in sliding mechanics. So frictionless mechanics is the
better option to preserve the posterior anchorage when ceramic brackets are to be used.

A study by Angolkar and his co-workers determined the frictional resistance offered by
ceramic brackets used in combination with wires of different alloys and sizes. Their
study revealed that wire friction in the ceramic brackets increased as wire size
increased, and rectangular wires produced greater friction that round wires. Beta-
titanium and nickel-titanium wires were associated with higher forces than stainless-

13
steel or cobalt chromium wires. So, wires in ceramic brackets generated significantly
stronger frictional force than did wires in stainless-steel brackets.18

c) Zirconia brackets

In ceramic brackets due to their brittle nature, even smallest surface crack or flow can
propagate rapidly through the material. So, Zirconia brackets have been offered as an
alternative to the ceramic brackets as surface hardening treatments to increase fracture
toughness are available for zirconium oxide.19 Although the frictional coefficients of
Zirconia brackets are found to be greater than or equal to those of the polycrystalline
alumina brackets in both wet and dry states.

II. BIOLOGICAL

A. Saliva

Kusy et al. (1991) in their study to compare the frictional coefficients for selected arch
wire bracket slot combinations in dry and wet states found that saliva could have
lubricous as well as adhesive behaviour depending on which arch wire bracket
combination was under consideration.19 The stainless wire showed an adhesive
behaviour with saliva and the resultant increase in coefficient of friction in wet
conditions. On the contrary kinetic coefficient of friction of the beta titanium arch wire
in wet state was half of the value in the dry state. Therefore, in patients with history of
xerostomia or reduced salivary flow, one should note it as a possible factor in varying
the force required for the desired tooth movement.

B. Corrosion

From the time of manufacturing, the metallic materials used in orthodontic appliances
are under the influence of physical and chemical agents related to their structural
properties and environmental conditions. Corrosion is the change in mechanical
properties and the metal's loss of weight under the effects of various chemical agents.

14
The oral environment, with its ions, carbohydrates, lipids, proteins, amino acids, and
non-ionic elements, is a suitable medium for the surface and deep abrasion of
orthodontic attachments. Chlorine ions and the sulfuric compounds in the presence of
microorganisms can corrode even SS appliances. Food and beverages are effective in
shifting the salivary pH toward acid or alkaline. Long-term accumulation of food
around orthodontic appliances catalyses the corrosion. Metals (restorations, wires,
bands, and brackets) and molecular solids (elastics, cement, adhesive, and acrylics) are
also affected by the oral environment.

Hence, Frictional force between bracket and wire is affected by a large number of
factors including archwire materials and their metallurgical qualities, cross-section of
wires, ligation techniques, bracket systems and biological factors.

15
 Chapter 3: Friction Mechanics v/s Frictionless Mechanics
Retraction mechanics can be broadly classified into two categories:

1) Friction or sliding mechanics

2) Frictionless/Friction free/loop mechanics

The principle difference between the two systems is that in sliding mechanics the wire
and position of the bracket control the tooth movement in contrast in frictionless
mechanics the control is built into the spring.1, 20,21

3.1Friction or sliding mechanics

Friction system is distinguished by the fact that a certain degree of friction exists
between the wire and the bracket.22,23 As already mentioned the level of friction depends
on many factors including the type of orthodontic brackets and the wires used. Stainless
steel brackets slide with relative ease on steel wires, whereas wires that contains certain
percentage of Titanium presents rougher surface and therefore produce more friction.
Also, the ceramic brackets produce more friction than metal brackets. In sliding
mechanics in order to move a tooth along an arc it is necessary to apply a force of much
magnitude to overcome friction and thus start the movement of the tooth. The major
difficulty is that of evaluating how much high such force should be. If the force is too
much the posterior segment inadvertently moves mesially taxing the anchorage.1

3.1.1. Sequence of movement in sliding mechanics: When the retraction forces are
applied, the tooth experiences a moment of retraction force in two planes of space. One
moment causes the mesial out rotation of the tooth and the other causes distal tipping
of the crown.20 (Fig.1)

Fig. 1: Moments of force produced by elastic chain placed at bracket level and not at
center of resistance. A. Crown rotation. B. Crown tipping. (Taken from Staggers JN
and Germane N. Clinical Considerations in the Use of Retraction Mechanics. J Clin
Orthod 1991; 26(6):364 -69.)
16
Mesial out moment is an undesirable side effect but the distal crown moment
contributes to retraction. Eventually the distal tipping causes binding of the arch wire
which produces a moment of couple. This moment results in distal root torque.20 (Fig.2)

Fig. 2: The couple produced by arch wire binding produces distal root torque. (Taken
from Staggers JN and Germane N. Clinical Considerations in the Use of Retraction
Mechanics. J Clin Orthod 1991; 26(6):364 -69.)

As the tooth uprights the moment on the root decreases until no longer the wire binds.
Then the crown slides along the arch wire until the distal crown tipping again causes
binding. The process is repeated until the tooth is retracted or the elastic force is
dissipated. The moment-to-force ratio of the retraction assembly is at its lowest point
during the first few days after placement of the elastic chain, because the magnitude of
force is then at its highest level.20 The magnitude of moment is determined by the width
of the bracket as well as characteristics of the wire e.g. alloy size and shape. Moment/
force ratio changes as tooth moves, and the tooth responds typically progressing from
controlled tipping to translation to root movement. 5, 24 In sliding mechanics, there is no
need to apply a balancing moment for bodily movement. The moments are delivered
via couples, equal and opposite non collinear vertical forces, at the mesial and distal
bracket extremities. The crown of the canine will tip distally until the diagonally
opposite edges of the bracket slot contact and bind with the arch wire. The wire then
produces a couple to upright the root. (Fig 3)

Fig. 3: Sequence of canine movement during retraction with sliding mechanics. (Taken
from Staggers JN and Germane N. Clinical Considerations in the Use of Retraction
Mechanics. J Clin Orthod 1991; 26(6):364 -69.)
17
3.1.2. Clinical Considerations

As teeth are retracted, the moment-to-force ratio improves because the elastic force
dissipates, and because archwire-bracket interaction due to crown tipping produces a
moment. So, to optimize the use of sliding mechanics, sufficient time must be allowed
for the distal root moment to occur. A common mistake is to change the elastic chain
too often, thus maintaining high force levels and a moment-to-force ratio that produces
distal tipping only. Even if extraction spaces are closed by tipping canines distally,
maintaining the space closure will be difficult without also moving the roots distally. 20

In addition, constantly high force levels can cause excessive hyalinization of the
periodontal ligament and inhibit direct bone resorption around the canine. If the stress
distribution in the PDL is such that the canine becomes hyalinized while the posterior
segment is undergoing direct bone resorption, loss of anchorage may ensue.

If inter- or intra-arch elastics are used instead of elastic chain, the force is produced by
the elastics, and the moment caused by arch-wire bracket interaction is the same as
discussed above. Since elastics are changed at least once a day, however, the force they
produce is never allowed to dissipate, and the moment-to-force level will remain low
throughout treatment.

Canines and incisors are often retracted separately to preserve anchorage when using
sliding mechanics. The theory is that by retracting fewer teeth at a time, less stress is
placed on posterior anchorage. But the anchorage is taxed twice with separate canine
and incisor retraction, as opposed to once with en masse retraction. The posterior
segment doesn't know how many teeth are being retracted; it merely responds according
to the force system involved.

The method of anchorage based on the use of different types of tooth movement in the
posterior and anterior segments (translation or root Torquing Vs. controlled tipping)
does not entirely depend on the number of teeth in each segment. Rather, differential
tooth movement is accomplished by having unequal moments on the anterior and
posterior segments. Fewer teeth are sometimes used in the posterior segment to obtain
a larger posterior moment. This idea is opposite to the more common concept of adding
teeth to the posterior segment to enhance anchorage. When teeth are added, the forces
18
are distributed over a larger root-surface area, making individual posterior teeth less
likely to move anteriorly.

Regardless of the method of retraction, there are still certain indications for separate
canine and incisor retraction— for example, cases of moderate-to-severe anterior
crowding. When sliding mechanics is used for canine retraction, the archwire can be
stopped mesial to the first molar to prevent anchorage loss from anterior molar
movement along the wire. During incisor retraction, however, the archwire must be able
to slide through the molar tubes, and therefore no stops should be used or archwire
bends abutted against the posterior brackets or molar tubes.

3.1.3. Advantages of the friction mechanics

There are certain advantages of friction mechanics which are as follows 1, 20

1) A major advantage of friction mechanics is that complicated wire configurations are

usually not needed, making initial wire placement less time-consuming.

2) This can enhance patient comfort and permit more delegation to assistants.

3) Leveling can be performed easily with highly flexible NiTi wires.

4) The whole dental arch can be controlled with only one arch wire.

3.1.4. Disadvantages of Friction mechanics

There are few disadvantages of friction mechanics which include 1, 20

1) The lack of efficiency compared to frictionless mechanics.

2) Longer time required for tooth movement.

3) Heavier forces are required for tooth movement.

4) The composition of brackets also affects sliding mechanics. Ceramic brackets create

more friction than stainless steel brackets.

19
3.2 Frictionless Mechanics

In frictionless mechanics, teeth are moved without the brackets sliding along the
archwire. Retraction is accomplished with loops or springs, which offer more controlled
tooth movement than sliding mechanics.

The force of a retraction spring is applied by pulling the distal end through the molar
tube and cinching it back. The moment is determined by the wire configuration and by
the presence of preactivation or of gable bends, which produce an activation moment.
In general, the more wire gingival to the bracket, the more favourable the activation
moment, and therefore the better the overall M/F ratio. The M/F ratio of a T-loop is
better than that of a vertical loop at all levels of activation.

Increasing the loop height can increase the M/F ratio of the loop. This is much more
significant in T-loops compared with vertical loops and L-loops. In vertical loops,
increasing the ring radius is much more effective than increasing the loop height to
increase the M/F ratio of the loop. Compared with SS, TMA arch-wire loops can
generate a higher M/F ratio due to its lower elastic modulus. Loops with a small cross-
sectional area and high activation force can generate a high M/F ratio. The introduction
of a leg step to loops does not increase the M/F ratio of loops.25

It is difficult to achieve the 10:1 M/F ratio needed for translation with either a vertical
loop or a T-loop unless gable bends are added. These bends can be placed either within
the loop or where the loop meets the arch-wire. The design of the spring influences not
only the M/F ratio, but also the load/deflection rate. The addition of helices lowers the
load/deflection rate without significantly affecting the M/F ratio. A vertical loop with
helices will have a lower load/deflection rate than a vertical loop without helices.

Load/deflection rate can also be altered by changing the wire composition. A loop bent
from wire with a low modulus of elasticity, such as titanium molybdenum, will have a
lower load/deflection rate than a loop of the same configuration made of stainless steel.

20
3.2.1 Concept of open and closed loop

Another design consideration is that of open Vs. closed retraction loops. A closed loop
has essentially the same M/F ratio as an open loop of the same design. The closed loop
has a slightly lower load/deflection rate due to the small amount of wire needed to make
the loop closed.20

The major difference between closed and open loops is in range of activation— the
distance the loop can be activated without becoming permanently deformed.

1) A closed loop will always have a greater range of activation than an open loop of
the same design, because of the additional wire and because of the Bauschinger
effect, which states that the range of activation of a loop is always greatest in the
direction of the last bend.
2) To activate an open loop, the legs of the loop are pulled apart, unbending the loop.
(Fig 4A)
3) To activate a closed loop, the legs are brought together, in the direction of the last
bend of the loop. (Fig 4B)

Fig. 4: (A) With open loop activation unbends loop (B) with closed loop activation in the
direction of last bend increases range of activation. (Taken from Staggers JN and
Germane N. Clinical Considerations in the Use of Retraction Mechanics. J Clin Orthod
1991; 26(6):364 -69.)

There is no real practical advantage in the range of activation of a closed loop, since
loops usually are not activated to the point of permanent deformation. Furthermore, the
range of activation can be increased more by using a wire with a lower modulus of
elasticity than by using a closed loop instead of an open loop.

21
3.2.2. Advantages of the frictionless mechanics

Advantages of frictionless mechanics include 1,20

1) Retraction with spring is more rapid and produces less tipping of the Canine.
2) Frictionless mechanics were shown to be more effective at reducing tipping and
extrusion.
3) Effectively increases moment-to-force ratios by means of loops. This allows for
torque control of anterior teeth during space closure.
4) Lengthens the distance between points of force application, thereby reducing the
wire's load/deflection rate and increasing its working range.
5) Offers more predictable mechanics in which amounts of force and moment are
measurable.

3.2.3. Disadvantages of Frictionless Mechanics

There are certain disadvantages of frictionless mechanics 1,20

1) A good understanding of mechanics is required when using retraction loops or

springs, because minor errors in mechanics can result in major errors in tooth
movement.
2) More wire-bending skill and chair time are required than with sliding mechanics.
3) The retraction loops may be uncomfortable to some patients.
4) Like sliding mechanics, retraction loops produce an undesirable mesial-out moment
when individual teeth are retracted, due to the force of the spring being placed facial
to the center of resistance. (This moment can be minimized by using lingual elastic
as is usually done with sliding mechanics— or by placing an anti-rotational bends
in the retraction loop.)

22
 Chapter 4: Contemporary Frictionless Mechanics

Frictionless mechanics involve bending archwire loops of various configurations,

sectionally (to deliver the desired M/F ratio to an individual tooth) or segmentally or in
continuous arch wire (to deliver the desired M/F ratio to several teeth). An
understanding of the relationships between bioengineering parameters and force
systems can offer a rationale for the design of orthodontic appliances. 26

The mechanical properties generated by loops depend on many confounding factors.

The influence of loop material and shape, end conditions (ligation methods), and
activation render analysis difficult. These influencing factors can be divided into two
groups: one related to loop design and the other related to loop activation. The former
includes loop material, cross-sectional dimensions, and configuration geometry, which
fundamentally determine the delivered force system of the loop.27

Techalertpaisarn and Versluis (2013) showed that the loop properties varied with loop
configuration and position, highlighting that clinicians should understand the specific
characteristics of each loop configuration so as to most effectively exploit them for the
desired tooth movements.28,29,30

According to Proffit different wire sizes in .018” bracket slot edgewise appliance
require a different approach to mechanotherapy.27

4.1 Moderate anchorage situations

I. Moderate anchorage space closure with .018” slot Edgewise system with
closing loops

Although either of the sliding or loop mechanics can be used, Proffit recommends that
the 018” appliance with single or narrow twin brackets on canines and premolars is
ideally suited for use of closing loops in continuous arch wires.

From engineering perspectives performance of a closing loop is determined by three

major characteristics27

23
1. Spring properties (i.e., the amount of force it delivers and the way the force changes
as the teeth move)
2. Moment it generates (Which controls the root positions)
3. Location of loop (i.e. the extent to which it serves as a symmetric or asymmetric V-
bend)

1. Spring properties

These are determined almost totally by wire material, size of the wire and the distance
between the points of attachment.

i. Wire material

Greater the load deflection rate of wire material stiffer it is greater will be the resiliency
and lesser will be the springiness.

Also, stiffness of the wire increase with modulus of elasticity. A loop bent from wire
with low modulus of elasticity such as titanium molybdenum will have a lower load
deflection rate than a loop of same configuration made of stainless steel. So, for any
size of wire or design of loop beta-Ti would produce a significantly smaller force than
steel.

Beta titanium wire has a modulus of elasticity about two fifth that of a stainless-steel
wire of same dimensions. Lower modulus of elasticity provides three clinical
advantages31

1. Greater working range

2. Greater amount of pre-activation possible
3. Simplified loop designs possible

ii. The size of the wire (Wire cross section)

The load deflection rate α 4th power of the diameter of a round wire.

The load deflection rate α 3rd power of the depth of a rectangle wire.5

24
Therefore, reducing the cross section of the wire can significantly reduce the load
deflection characteristics of an orthodontic appliance. The limiting factor in the
reduction of the wire cross section is the maximal elastic strength of the wire. The
maximal elastic force which the spring exerts must be higher than the force applied
during mastication.

iii. The distance between the points of attachment

This is largely determined by the amount of the wire incorporated into the loop but is
also affected by distance between attachments. Closing loops with equivalent properties
can be produced from different types and sizes of wire by increasing the amount of wire
incorporated into the loop as the size of the wire increases, and vice-versa. Wire of
greater inherent springiness or smaller cross-sectional area allows use of simpler loop
designs. (Fig 5)27

Fig. 5: The effect of changing various aspects of a closing loop in an arch wire on the
spring characteristics of a steel closing loop. (Taken from Proffit WR, Fields HW,
Sarver DM. Contemporary Orthodontics. 5th ed. St Louis: Mosby Inc; 2013:465)

In center is an 8mm open vertical loop in .018” X .025” wire with 8mm of interbracket
distance produces 500gm/mm of force which is double to the desired force of

25
250gm/mm. In the periphery are the possibilities to reduce this force to the clinically
acceptable levels. Note that although increasing the leg length greatly reduces the force
but this is limited by the anatomic variations (Vestibular depth).

So, most of the loop range between 6-8 mm of leg length. Among the other factors
changing the size of the wire produces the largest changes in characteristics, but the
amount of wire incorporated (determined by design of the loop and the inter-bracket
span) in the loop is also important. The same relative effect would be observed with
beta-Ti wire.

2. Moment generated

To close an extraction space while producing bodily tooth movement, closing loop must
generate not only the closing force but also the appropriate moments.

M/F ratio for translation: 10/1 meaning that a canine tooth being retracted with a 100
gm of force must also receive a 1000 gm-mm of moment to move it bodily.

This requirement to generate moment limits the amount of wire that can be incorporated
to make a closing loop springier. Because if the loop becomes too flexible, it will be
unable to generate the necessary moments even though the retraction force
characteristics of the spring are satisfactory. Also placing some of the wire within
the closing loop in the horizontal plane rather than vertical direction improves its ability
to deliver the moments needed for translation. Because of this and because of vertically
toll loops can impinge on soft tissues a closing loop that is only 7-8mm tall and
additional wire incorporated in the loop to make it equivalent to 10mm of vertical
height (e.g. delta, L or T loops) are preferred. If the legs of a closing loop are parallel
before activation, opening the loop would place them at an angle that in itself generates
moments in a desired direction. But this moment is not sufficient and unacceptably tall
loops would be required to generate appropriate moments in this manner. So, this
required additional moments must be generated by gable bends (or their equivalents)
when the loop is placed in the mouth.

An elegant solution to the design of a closing loop that would provide optimum and
nearly constant M: F ratios at variable activations are offered by opus loop.27

26
Recent study by Yongqing (2020) investigated the effects of elastic modulus, cross-
sectional dimensions, loop configuration geometry dimensions, and activation force on
the generated M/F ratio of vertical, L- and T-loops. He concluded that the M/F ratio
and the von Mises stress generated by vertical, L- and T-loops increased linearly with
increases in the loop height. In other words, the higher the loop height, the larger the
M/F ratio generated by the loop.25

3. Location of loops

Because of the gable bends closing loops functions as “V” bend in the arch wire, and
the effect of the V bend is quite sensitive to its position.27

Position of V bend or loop Effect

Center of the span Equal forces and couples

Tooth closer to the loop will be extruded

with greater moment on it bringing root
towards the V bend.

1/3rd of the distance between the adjacent

brackets
Tooth farther away will receive an
intrusive force but no moment.

Closure to one bracket than 1/3rd of the More distant tooth will not be intruded
distance but will receive a moment to move the
roots away from the V bend which is
undesirable.

Table- 4: Position of V bend and their effects. (Taken from Proffit WR, Fields HW,
Sarver DM. Contemporary Orthodontics. 5th ed. St Louis: Mosby Inc; 2013:465.)

For routine use with fail safe loops, the preferred location for a closing loop is at the
spot where the center of the embrasure lies when space will be closed. This means that,
in first premolar extraction cases a closing loop should be placed about 5mm distal to

27
the center of the canine. The effect is to place the loop initially at the one third positions
relative to the canine. Moment on the premolar increases as the space closure proceeds.

Exception to the above rule is the design of the Opus loop which calls for an off-center
position with the loop placed 1.5 mm distal to Mesial (canine) Bracket.

4. Additional design principles

The loop should “fail safe”. Meaning that, although a reasonable range of action is
desired from each activation, tooth movement should stop after a prescribed range of
movement even if the patient does not return for a scheduled adjustment.

The ideal loop design therefore would deliver a continuous, controlled force designed
to produce tooth movement at a rate of approximately 1 mm per month but would not
include more than 2 mm of range, so the movement would stop if patient misses the
second consecutive monthly appointment.

1. The design should be as simple as possible

2. More complex configurations are less comfortable for patients

3. More difficult to fabricate clinically

4. More prone to breakage or distortion

Engineering analysis shows that 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.

A third design factor relates to whether the loop is activated by opening or closing. All
else being equal, a loop is more effective when it is closed rather than opened during
activation. On the other hand, a loop designed to be opened can be made so that its
vertical legs come into contact when it is deactivated completely creating a rigid arch
wire, effectively preventing further movement and producing the desired fail-safe
effect.

28
In contrast a loop activated by closing must have its vertical legs overlap this creates a
transverse step and rigidity and the archwire does not develop the same rigidity when
it is deactivated. The smaller and more flexible the wire from which a closing loop arch
is made, the more important is that the archwire become rigid when the loop is
deactivated.

Clinical recommendations

The above described design considerations indicate that an excellent closing loop for
.018” slot edgewise brackets is,

1. A delta or T shaped loop in .016” x .022” wire with 7mm vertical height that is
activated by opening. Such a wire fits tightly enough in a .018” x .025” bracket slot to
give good control over the root positions. With Additional wire incorporated in the
loop to make it equivalent 10mm vertical height, the force delivery is close to the
optimum, and the mechanism fails safe because contact of the vertical legs when the
loop is deactivated limits movement between adjustments and makes the archwire more
rigid.

2. With .016” x .022” wire and a loop of delta design (so that the mechanism fails safe),
with an activation of 1-1.5mm a gable bend of approx. 200 on each side (total of 40-
450) is needed to achieve an appropriate M/F ratio.

3. Loop placement 4-5mm distal to the center of the canine tooth at the center of the
space between the canine and second premolar when the extraction space closed.

These recommendations certainly are not the only clinically effective possibilities and
optimum M/F ratios can be achieved with several combinations of wire size, loop
configuration and gable angle and can be maintained over a variety of activations at the
cost of design complexity.

29
4.2 Maximum incisor retraction (Maximum anchorage)

Similar to the moderate anchorage treatment mechanotherapy for maximum incisor

retraction varies with the appliance system used so, 018” and 022” slot appliances
require different mechanics for space closure.27

I. Maximum retraction with 018” slot appliance

With the .018” slot appliance retraction of the anterior is usually done by employing
the closing loops. According to Proffit and Henry, to obtain greater retraction of the
anterior teeth, a sequence of steps to augment anchorage and reduce anchorage strain
could be as follows27

1. Add stabilizing lingual arches and proceed with en masse space closure. The
resulting increase in posterior anchorage, though modest, will change the ratio of
anterior retraction to posterior protraction to approximately 2:1.

2. Reinforce maxillary posterior anchorage with extra oral force and (if needed) use
Class III elastics from high pull headgear to supplement retraction force in the lower
arch, while continuing the basic en-masse closure approach. Depending on how
well the patient cooperates, additional improvement of retraction, perhaps to a 3:1
or 4:1 ratio can be achieved.

3. Retract the canines independently, preferably using a segmental closing loop (PG
spring designed by Gjessing is an excellent current design), and then retract the
incisors with a second closing loop either in a continuous arch wire or with
segmented arch approach. Used with stabilizing lingual arches (which are needed
to control the posterior segments in most patients), this technique produces a 3:1
retraction ratio. When this procedure is reinforced with headgear, even better ratios
are possible.

30
 Chapter 5: Conventional Loop Designs

5.1 Terminologies used to describe the loops

1. Open loop

“A loop whose vertical leg separation increases when activated by traction”. Base of
the loop is open. 32

2. Closed loop (Reverse loop)

“A loop bent in such a way that the separation between its vertical legs is reduced when
activated by traction”. The base of the loop remains closed.

3. Closing loop

“Any loop which upon mesiodistal pulling activation, is capable of generating a force
in the direction of the activation”.

a) It can be open or closed.

b) It can have various configurations.
c) It used for space closure.

4. Opening loop

“A loop used to create space in a fashion comparable to an open coil spring”.

5.2 Classification of loops

Loops are commonly classified as 32

a) Open loops

b) Close loops

31
Another classification of loops by Jarabak (1963) is as follows33

a) Vertical loop

b) Horizontal loop

c) Transverse loop

d) Combination loops

5.3 Mode of activation and range of action of a loop

A loop when activated by compression i.e.by approximating the legs (or in other words
in the direction of the final bend) the range and duration of the action increases as
compared to when activated by pulling the legs apart. 32 (Fig 6)

Fig. 6: A. Activation by extension and compression, showing difference in elastic limit.

B and C. open loop and closed loop respectively difference in the direction of force when
activated by compression. (Taken from Stoner Morris. Force control in clinical practice.
American journal of orthodontics.1960;46:3.)
32
1. Closed loop when activated by compression -

Tend to draw the attached extensions of the arch wire towards each other, thus
shortening the arch length.

2. Open loop Activated by compression-

Tend to thrust the attached extensions of the arch wire away from each other thus
Increases the arch length. There the direction of force can be controlled by creating an
open or closed loop activated in the same direction.

5.4 The Bauschinger effect

This effect was first reported by Bauschinger in 1886. It describes the phenomenon
whereby the resistance to further deformation of a wire is greater if the load is applied
in the same direction as the original load than it is if the direction is reversed.34 It is
manifested by lowering the yield strength whenever the direction of applied force is
opposite to that of original deforming force. It is found in most polycrystalline metals.
When loops or springs are to be constructed, they should carry their load in the same
direction as that in which they were wound or formed. Clinicians should use a design
that loads the wire in the direction of forming.

In other words, if we have two different loop designs, when one closure loop is
activated, if all bends are bent in same direction. It provides more resistance to
permanent deformation than is all bends are bent in the opposite direction.35 (Fig.7)

Fig.7 (A)Closing loop with bends in the winding direction.this configuration presents
more resistance to permanent deformation during activation.(B) Closing loop with
bends in unwinding-direction.(Taken from Gerson Luiz Ulema Ribeiro and Helder
Jacob. Understanding the basis of space closure in Orthodontics for a more efficient
orthodontic treatment. Dental Press J Orthod. 2016 Mar-Apr;21(2):115-25.)
33
Polakowski (1966) suggested that the Bauschinger effect is one feature of plastic flow
that results from anisotropy of individual crystal grains and specifically, from variation
of elastic modulus and yield strength with orientation of grains. Dislocation movement
is believed to be the underlying mechanism of the Bauschinger effect.34

7.5 General rules for design and selection of the loops

There are certain set of rules that will be applied to any loop design.32

1) Any loop will reduce force and increase range.

2) Any loop may be contoured as open or closed.
3) Loops are most efficiently activated through compression of the legs.
4) The force of any loop may be reduced by coiling the wire.
5) The force reduction effected by contouring most loops will be in direct proportion
to the increase in the amount of wire between the brackets.

7.6 Conventional loop designs

Over the years, different space closure loop configurations have been developed.32

I. Vertical loop
1. Double vertical loop
2. Modifications of vertical loops
3. Omega loop
4. Tear drop loop
5. Bull’s loop
6. Vertical loop with helices

II. Horizontal loop

1. T loop
2. Double horizontal loop with helices

III. Box loop

34
I. Vertical loops

Strang originally introduced vertical loops into the edgewise appliance during early
1930’s. The vertical loop has two vertical components: Helix and Two Cantilever arms.
It can be contoured as open or closed.32 Height is controlled by anatomical restrictions,
but generally it is 6-8mm. A helix can be incorporated at the apex of the loop if further
force reduction is desired. Similarly, it increases the range of deflection.

Activation: In any plane perpendicular to its plane. So vertical loop cannot be activated
in any direction other than Labio-Lingually or Mesio-distally.

Single open vertical loop

It is most efficient for space opening. In such cases the arch wire is fixed to the brackets,
the loop is activated by compressing the legs, and as the loop assumes its original
position the teeth move apart. It can be used to close the space but less efficiently. Then
it is activated by opening the legs. Also used for added labio-lingual deflections when
rotation of the tooth is desired.36

Single closed vertical loop

Used primarily to close space. It is activated by compressing the legs, and as the loop
expends its force it draws the horizontal extensions of the arch wire together and moves
the attached teeth with them. Due to complexity of design and overlapping of the arch
wire it may bind in the bracket or against itself. So, a good way to remember the
principle application of vertical loop to obtain maximum range of activity is, an open
vertical loop is selected to open the space and a Closed vertical loop is selected to close
the space. (Fig8)

Fig-8 Open and Closed loop (Taken from Stoner Morris. Force control in clinical
practice. American journal of orthodontics.1960;46:3.)

35
1. Double vertical loop

These are contoured on either side of the tooth. (Fig 9)

Fig 9- Double Vertical loop (Taken from Stoner Morris. Force control in clinical
practice. American journal of orthodontics.1960;46:3.)

Uses:

1. To move a labially or lingually displaced tooth into arch through the labio-lingual
spring quality inherent in the horizontal section between the two loops.

2. To rotate a tooth. When tied into the bracket of a rotated tooth the loop on one side
of the tooth will be displaced lingually and the loop on the other side will be
displaced labially causing a reciprocal rotational activity on the bracket.

3. Strang and Downs also describe the use of double vertical loops to move a tooth
bodily in a mesial or distal direction. T This is accomplished by fixing or stopping
the intervening horizontal section to the brackets so that the arch wire cannot slide
and then opening one loop and compressing the other so that the contraction and
expansion of the loops will tend to move the tooth bodily in a mesial or distal
direction.

2. Omega loop

It is also a variation of open vertical loop shaped like a Greek letter ‘Ω’ hence named.36

Advantage:

Tends to distribute stresses more evenly instead of concentrating them at apex.

36
Use:

To apply moment to the last tooth in arch causing bodily root thrust. As an anchorage
device if counterbalance by a crown force to create an even distribution of stresses to
the root of a tooth.

Fig. 10: Omega loop (Taken from Kharbanda OP. Orthodontics- Diagnosis and
management of malocclusion and Dentofacial deformities. 2 nd edition; 2013.)

3. Snail loop

It is a modification of the omega loop introduced by Pawan Kumar. A spiral shaped

loop called a “SNAIL LOOP” design for en-masse space closure of the anterior teeth.37
This loop design allows twice as much activation as it is possible with omega loop.

Design

It is fabricated from .017” x .025” Stainless Steel wire.

Outer portion - Height 8mm & width 6mm
Inner portion – height 6mm & width 3mm
Pre-activation α =25 0, β =350
Miniscrews may be used with the snail loop for additional anchorage.

Fig. 11: Snail loop (Taken from Pawan Kumar. The Snail loop for low friction space
closure J Clin Orthod 2008; 42(4))

37
Advantages

1. Easier fabrication and placement.

2. Greater flexibility in vertical plane.
3. Reduced number of activation and patient visits

4. Tear drop loop

This loop was used by Alexander, in 1983 for retraction of four incisors in maxillary
and en masse retraction in mandibular arch.38 It is similar to the omega loop with height
of approximately 5 mm. Used to close the spaces. (Fig 12)

Fig. 12: Tear drop loop (Taken from Wick Alexander. The Alexander Discipline,
contemporary concepts and philosophies 1986; 211-214.)

Wire size and material

0.018” × 0.025” SS for maxillary arch.

0.016” × 0.022” SS for mandibular arch.

Insertion and activation (maxillary arch)

1. After the maxillary canines have been retracted on the 0.016” round wire with the
power chain, a 0.018” ×0.025” SS closing loop archwire is placed. This archwire is
bent in an ideal arch form with large, teardrop shaped loops just distal to the
maxillary twin lateral bracket.
2. Before the wire is engaged in the mouth, the wire distal to the cuspids is reduced to
approximately 0.016” × 0.022”. The purpose of reducing the posterior portion is so
it can easily slide through the bicuspid brackets and molar tubes when activated.
3. The 0.018” × 0.025” wire completely fills the incisor brackets slots, so that when
these four teeth are retracted, torque control is maintained.
38
4. To activate this wire after it is fully engaged, the wire should extend 5mm distally
from the first molar tube. The distal extension of the archwire is grasped with the
pliers and the wire is pulled through the molar buccal tube, and then tipped distal to
the tube at approximately a 45-degree angle in the superior direction. The closing
loop itself should be activated by 1 mm. It is important to activate only 1 mm per
appointment (every four weeks). If the loop is activated by a larger amount, tipping
and bite closure are more likely to occur as the four incisors are retracted.
5. In a deep bite case, a gable bend is placed at the closing loop site. This bend should
be made at a 20 – 30degree angle in the case which has a deep overbite. This bend
will intrude the maxillary incisors as they are retracted, and will also aid torque
control. This wire is used for four to eight months, depending on the amount of
space to be closed.

Insertion and activation (mandibular arch)

1. All six anterior teeth area retracted concurrently with 0.016” × 0.022” SS wire in
mandibular arch. They are placed distally to the cuspid brackets. In a deep bite case,
a 40degree gable bend is placed at the closing loop site.

2. The terminal position of the wire is different, depending upon whether the most
posterior teeth banded are first or second molars. If second molars are not banded,
then the closing loop wire in the mandibular arch is activated exactly as in the
maxillary arch. If second molars are banded, there is insufficient space distal to the
second molar tubes for pliers to be used in loop activation. In this case, omega loops
are placed in the archwire immediately distal to the first molar attachment. This
placement allows adequate room to activate the closing loops.

3. As in the maxillary arch, the closing loops should be activated approximately 1 mm

per appointment, four months is usually the maximum time period required.

A finite element method study by Haris and his co-workers evaluated biomechanical
properties of four loops at different activation. They concluded that in loops, without
preactivation bends, highest force values were generated by Omega loop and in loops
with preactivation bend, the force was highest in Tear drop loop.39

39
5. Bull’s loop

It is the modification of the vertical loop given by Dr. Harry Bull. He has introduced it
in his “Partial Archwire Technique”. Bull believed that the anchorage preparation,
which is done in anchor teeth by distally tipping them, is not necessary. However, if
these molar & second premolar teeth are in mesial axial inclination, he states that they
should be primarily uprighted by first inserting a complete edgewise arch wire for
effecting this change in axial positions, before extraction are made. So, he always
banded the second molar teeth whenever possible. For anchorage purpose he delayed
the banding of anterior teeth until the complete retraction of canine.

Bull (1951) advocated the use of sectional arches, 0.0215 X 0.025 inch, to be placed in
the brackets of canines, 2nd premolars and molars. The sectional arch is provided with
a tie-back loop well forward of the 2nd molar tube, and a closed loop situated midway
between the canines and 2nd premolars. (Fig 13A) The anterior end of the wire is bent
gingivally so as to engage the mesial surface of the canine bracket. By tying back to the
molars, the canines will be moved bodily in a distal direction. Use of a biteplate is
recommended in order to avoid intermaxillary interference. After distal movement of
canines, the anterior teeth should be banded and new thin round labial arches are used
for correction of the curve of Spee. This is followed by insertion of edgewise arches for
the final completion of the treatment.40

(A) (B)

Fig. 13: Bull loop (Taken from Salzmann JA. Practice of Orthodontics. 1st ed. Vol-2.
JB Lippincott company: Philadelphia and Montreal (1943) :32;902.)

When it is desired to obtain reciprocal movement in space closure, or if the second

premolars and molars are to be moved mesially, vertical loops are inserted in the
rectangular arch wire distal to the canines. The posterior end of the loop is bent higher

40
(0.5 to 1mm) occlusally than th anterior section to keep the anterior teeth depressed.
(Fig 13B)

6. S Loop

The “S” loop is simply a modification of an open or close vertical loop. It develops
similar force activity without the undesirable occlusal or gingival thrust sometimes
exhibited by the vertical loop.32

II. Horizontal loops

In 1960, Stoner introduced a horizontal loop, formed in such a manner that its active
legs were parallel to the archwire, to effect force reduction in the occluso-gingival
direction. Similar to vertical loops these can be open or closed. The principle value of
horizontal loops is that it enhances the reduction of forces in the vertical plane or
occluso-gingival direction.

Fig. 14: Horizontal loop. When horizontal loop is seated; loop should overly less erupted
tooth to permit activation by compression. (Taken from Stoner Morris. Force control
in clinical practice. American journal of orthodontics.1960;46:3.)

Advantage: Immediate bracket engagement.

It is effective when it is necessary to open the bite or to elevate or depress the anterior
or posterior segment. As with any loop, the most efficient range of activity is obtained
when the legs of horizontal loop are compressed. So, to make certain that legs are
compressed, contour of the loop is such that its legs overly the shorter tooth.

There is an exception to the above rule i.e. if a tooth is severely displaced lingually and
extruded the loop cannot be made to overly the shorter tooth and while doing so the
loop will bind against the more prominent tooth. Compression in such cases can be
obtained by contouring the closed horizontal loop in the opposite direction over the
41
more lingually placed tooth. (Fig. 15) Open horizontal loop generally preferred unless
binding or interference will occur and, in such cases, a closed horizontal loop can be
used.

Fig. 15: Closed horizontal loop (Taken from Stoner Morris. Force control in clinical
practice. American journal of orthodontics.1960;46:3.)

1. Double horizontal loop

This loop is most efficient when working on an individual tooth. Used to elevate,
depress, or for tipping of a tooth. For tipping of a tooth, the loop is activated in such
manner that one loop is will tend to elevate and the other depress. (Fig 16)

Fig. 16: A. Variations of the double horizontal loops. B. Double horizontal loop used for
tipping movement. (Stoner Morris.Force control in clinical practice. American journal
of orthodontics.1960;46:3.)

2. Horizontal “T” Loop

The horizontal “T” loop, named for its shape, is employed to get double the force
reduction available in a single horizontal loop. This loop eliminates the undesirable
occlusal or gingival deflection of the arch wire when activated, which may produce
undesirable tipping. The “T” loop will elevate or depress in a true vertical plane.

Fig.17 Horizontal T-Loop (Taken from Stoner Morris. Force control in clinical
practice. American journal of orthodontics.1960;46:3.)
42
III. Box loop

Box loop is a combination of vertical and horizontal levers designed in such a manner
as to have a horizontal section of wire unattached at the mesial and distal surfaces of a
tooth. (Fig 18) 32
This free horizontal section is inclined to the bracket slot in such a manner that, when
engaged, it moves the root of a tooth in a mesial or distal direction. When it is used to
tip the root of a tooth, the crown of the tooth to be moved must be tied directly to the
tooth behind it to prevent undesirable movement, in an opposite direction which would
tend to open space between the teeth.

Fig. 18: Box loop (Taken from Stoner Morris. Force control in clinical practice.
American journal of orthodontics.1960;46:3.)

Force value of box loop depends on the plane in which it is activated.

Occluso-gingival plane = Amount of wire in the horizontal plane and bending at the
corners of the loop.

Labio-lingual plane = Total amount of wire contained in the loop.

Additional wire may incorporate into the horizontal plane by extensions at the top of
the box which increases the deflection in the occluso-gingival and Labio-Lingual plane.
Box loop increases the total amount of wire between the brackets to such an extent that
it may be deflected to a great distance with greater force reduction and greater range of
action than can be had with any other loop. This permits immediate bracket engagement
on severely malposed teeth.

When employed for root tipping three important considerations are

1. A rectangular wire should be used to avoid bucco-lingual displacement of the apex

and to develop rigidity in the anchor areas.

43
2. Anterior legs of the loop should be shorter than the posterior legs when uprighting
a canine, to prevent undesirable elevation of the incisor teeth.
3. The crown of the tooth to be moved should be tied directly to the tooth behind it
in order to prevent it moving in an opposite direction to the root movement.

Anchorage for box loop:

Because of relative rigidity of the continuous wire between adjacent brackets and
increased wire in interbracket span sufficient anchorage usually is developed without
appreciable displacement of the adjacent teeth.

OTHER LOOPS

Torquing loop

The torquing loop is a compressed vertical loop which may be seated between twin
brackets or adjacent to single brackets.

Fig.19 Torquing loop (Taken from Morris. Force control in clinical practice. American
journal of orthodontics.1960;46:3.)

It is contoured to press against the gingival surface of the crown and is activated by
ligating the brackets. When the buccal segments are established it tends to exert lingual
root thrust. When used in round wire, it also stabilizes vertical loops and prevents their
impinging on the gingival mucosa. Begg recommended the application of torquing
auxiliaries in the third stage of his treatment. These are prefabricated in .012’’ (.305
mm) Australian wire. Ackerman recommends the use of warren springs for the torquing
of anterior teeth. All these are modification of torquing loop.

44
Double Key hole Loop

These were introduced by John Parker of Alameda, California. They are made of
round edge rectangular wires, usually 0.019” x 0.026”. They used in extraction cases,
but when there are slight spaces in non-extraction cases, these double key hole loops
are employed. (Fig 20)

Fig.20 Double key hole loop. (Taken from Roth RH. Treatment mechanics for Straight
wire appliance. Graber TM, Swain BF. Orthodontics: Current principles and
techniques. St. Louis: C.V Mosby (1985): 6b9)

They are used along with Asher face bow which is an appliance that connects directly
to the arch wire and applies force directly to the anterior teeth. It is used for intrusion
and retraction of anterior teeth. The Asher face bow is preferred as it is comfortable and
looks like a Kloehn face bow. When the patient is wearing it, nothing touches the face.
The upper Asher face bow is used with a high pull head cap and 12 to 15 ounces of pull
is utilized. It can be used with a long outer bow and a neck strap to retract both the
upper and lower anterior teeth directly.

The concept behind the use of Double key Hole loop arch wire mechanics is41

a. To allow the operator the luxury of complete space closure with one set of arch
wires.
b. Allow a reasonably happy medium between severe tipping and sliding mechanics.
c. Allow the operator to select how the space will be closed from front backward or
from forward and how much of which.

45
Clinical applications of the loops

The conventional loop designs described above have specific applications and when
properly employed produce effective responses.32

REQUIRED LOOPS EMPLOYED

MOVEMENT

Labial Double vertical – open loop

Lingual Double vertical – open loop

Intrusion Double horizontal or Box loop

Extrusion Double horizontal or Box loop

Rotation Double vertical – open or Box loop

Root tipping Box or double horizontal (with Rectangular wire only)

Table 4: Clinical application of loops (Taken from Stoner Morris. Force control in clinical
practice. American journal of orthodontics.1960;46:3.)

These loops are usually included in the initial alignment arch wire to attain bracket
alignment however, loops also may be used in other stages of treatment, such as space
opening and closing and bite opening. The specific loops employed are,

1. Mesial or distal Double vertical loop against bracket activated by

movement (Midline tying back or compression. Combination of open
correction) and closed vertical loops.

2. Space closure Closed vertical loop tied back.

3. Space opening Open vertical loop, with stops.

4. Bite opening ‘T’ loops mesial to the canines with reverse curve
to the archwire in the anterior section to transmit
the pressure equally to all four incisors.

Table 5: Loops employed in different stages of treatment. (Taken from Stoner Morris. Force
control in clinical practice. American journal of orthodontics.1960;46:3.)

46
 Chapter 6: Poul Gjessing Retraction Spring

Poul Gjessing (PG) canine retraction spring was introduced to the orthodontic
profession way back in 1985 by Poul Gjessing42; it was not widely used till, interest in
was renewed in recent years because of its adaptability to the now commonly used
0.018" pre-adjusted edgewise appliance system. The efficient design as well as the
relatively rigid stainless-steel wire, lends good stability to this retraction spring for use
in frictionless orthodontic mechanics. Although basically designed for canine
retraction, in 1994 Gjessing adopted it for en-mass retraction of four incisors after
canine retraction. (Fig. 21)43

Fig. 21: PG Universal Retraction Spring can be adjusted for canine retraction (A), up
righting of canine (B), or incisor retraction (C). (Taken from Gjessing PA. Universal
retraction spring. J Clin Orthod 1994; 28:222-42)

The PG retraction system has been designed to facilitate segmented treatment of

extraction cases. The basic element of the system, which is available in right and left
versions, is a prefabricated, highly standardized, stainless steel retraction spring that is
adjustable to fit both .018" and .022" edgewise appliances.

The PG Universal Retraction Spring is designed for controlled retraction of either

canines or upper incisors. No clinical alteration of the spring is needed, and the force
system produced is independent of inter-bracket distance.
47
The spring is pre-calibrated to deliver predictable moment-to-force ratios in three
planes of space. The magnitude of the force delivered, which is kept within desirable
physiological limits, can be identified by "reading" the morphology of the spring during
activation.

I. Construction

1. The PG spring is made in 0.016"x.022" stainless steel rectangular wire.

2. It has gingivally directed overlapping double helices, ovoid in Shape, 10mm in
height and 5.5mm at its widest part (Fig - 19).
3. It also has a small occlusal helix 2mm in diameter. The wire is bent in such a way
that the smaller end of the wire is continuous with the occlusal helix. This portion
is the canine/incisor part and would fit into the canine/lateral incisor bracket. As it
comes out of the occlusal helix, it is given a 15° gingival turn.
4. After forming the gingivally directed double helices, the longer arm of the wire is
the one which is meant for engaging the premolar bracket and the molar tube; this
being the molar portion.
5. This posterior molar arm as it exits from the double ovoid loops is turned gingivally
such that the wire makes an angle of 12° till approximately the second premolar
bracket and then turned up at an increased total angulation of 30° as shown in Fig
22.

Fig. 22: Right upper PG spring (palatal view) (Taken from Gjessing PA. Biomechanical
design and clinical evaluation of a new canine retraction spring. Am J Orthod Dentofac
Orthop 1985; 87:353- 62.)

This portion is also given an anti-rotation bend of 60° towards the canine tooth and then
this bend after traversing the width of the spring is curved back in an exactly opposite
direction of the initial bend decreasing this to a final 35° (Fig- 23).
48
 Fig. 23: Right upper PG spring (occlusal view) (Taken from Gjessing PA.
Biomechanical design and clinical evaluation of a new canine retraction spring. Am J
Orthod Dentofac Orthop 1985; 87:353- 62.)

The curvature of the posterior extension of the spring is incorporated to produce a

moment to the anchorage teeth. This so-called beta moment is a desirable complement
to the alpha moment, since it counteracts the extrusive forces exerted by the alpha
moment at the canine/incisor segment.

The double ovoid loop is the predominant active element. It is included in order to
incorporate wire, to reduce the load deflection of the spring and is placed gingival so
that activation will cause a tipping of the short horizontal arm (attached to the canine)
in a direction that will increase the couple acting on the tooth. The gently rounded forms
avoid the effects of sharp bends on load deflection through the use of the greatest
amount of wire in the vertical direction, reduction of horizontal load/ deflection is
maximized. At the same time, minimizing horizontal wire increases rigidity in the
vertical plane.42

II. Canine retraction

Canine retraction is a very important step in most orthodontic procedures involving

extraction of premolar teeth and is usually carried out by two methods43

1) Retracting canines by sliding along a base wire (Frictional mechanics)

2) Retracting the canine with a specially designed spring attached to it without any base
arch wire for the canine to slide on (Frictionless mechanics)

According to Proffit, PG spring is the most efficient current design for frictionless
canine retraction. Rectangular stainless-steel wire with overlapping ovoid loops

49
provides good stability, required moment-force ratio and good load deflection rates. It
is constructed in the readily available 0.016"x 0.022" stainless steel wire and can be
easily placed in the routinely used 0.018" brackets. Construction and placement are easy
and so is the activation. Its advantage as compared to other retraction springs is the fact
that it can be economically made and used within the routine inventory of an average
orthodontic clinic. Disadvantages are the same as in any retraction spring, in not being
failsafe in case of accidental distortion and being liable to irritate the sulcular mucosa
at least in the initial few days.

A) Fundamental biomechanics

If a pure translational movement of the tooth is desired, the moment of a force applied
to the tooth must be neutralized. This can be done by calibrating the retraction spring
to produce a couple at the canine bracket. An anti-tip moment of the couple (Mc) can
be created of equal magnitude and opposite direction to the moment of force: MF = -
Mc = F´d, which can be expressed as M/F = d.43 Thus, translation is obtained if the
moment-to-force ratio produced at the canine bracket is equal to the distance between
the bracket and its center of resistance (CR).

In the horizontal plane, a pure distal force directed through the canine bracket results in
distal rotation of the tooth (Fig 24). This distal rotation can be prevented by calibrating
the retraction spring to produce an antirotation moment: Mc = F*d. In this formula, d
represents the horizontal distance from Center of resistance to the center of the bracket.

Fig. 24: Pure horizontal force directed through canine bracket results In combination
of translation and rotation around CR. (Taken from Gjessing PA. Universal retraction
spring. J Clin Orthod 1994; 28:222-42)

The average bracket-to-CR distance of upper or lower canines with average root lengths
and normal marginal bone levels is 11mm when measured in the sagittal plane, and
50
4mm when measured in the horizontal plane. Therefore, bodily movement of a normal-
size canine can be produced by a retraction spring calibrated to produce an antitip M/F
ratio of 11 and an antirotation M/F ratio of 4 (Fig - 25).

Fig. 25: Antitip and antirotation moment-to-force ratios required to produce

translation of canine assuming conical root of average dimensions. (Taken from
Gjessing PA. Universal retraction spring. J Clin Orthod 1994; 28:222-42)

However, clinical experience has shown that the antirotation M/F value should be
increased to 7 to compensate for deviations in root morphology and differences in
buccal inclination of the roots (Fig- 26).

Fig. 26: Relationship between buccal canine inclination and horizontal distance
between bracket and CR. (Taken from Gjessing PA. Universal retraction spring. J Clin
Orthod 1994; 28:222-42)

The optimum orthodontic force is one that provides a maximum desirable biological
response, resulting in rapid tooth movement with little or no clinical discomfort.
Increasing the load beyond this level can result in iatrogenic tissue damage, unwanted
alteration of the M/F ratios, and anchorage loss.

51
The PG spring was designed to avoid unwanted side effects and tissue damage by
keeping the force magnitude within a low range— 100g in the initial activation.

At the time of activation, the M/F ratio is 9. Since the M/F ratio required for
translational canine movement is 11, the initial movement is a controlled tipping.
However, after only about 0.3mm of deactivation, the anti-tip M/F ratio increases to
10-11. From this point on, the canine movement is translation followed by up righting.

The vertical force produced by the posterior curvature of the spring should be of a
magnitude to neutralize the extrusive force generated by the alpha moment and to
produce a slight intrusive tendency at the canine bracket.

According to physical laws, this modest intrusive force will be accompanied by a

similar extrusive force at the posterior segment. However, the posterior extrusive force
is counteracted by masticatory forces, thus avoiding undesired extrusion of the molars
and an increase in lower facial height.

B) Clinical applications

The clinical application of the universal retraction spring are43

1. Alignment of the buccal teeth.

The spring is constructed to resist tendencies for tipping and rotation during canine
retraction— not to correct existing rotations or extreme deviations in inclination.

Therefore, the buccal segment, including the canine, second premolar, first molar, and
eventually second molar, must be leveled prior to insertion of the spring.

2. Adjustment of faciolingual loop inclination.

The correct faciolingual position of the spring is obtained by adjusting the anterior and
posterior extensions before insertion.

3. Bracket engagement.

The anterior extension of the spring is engaged in the canine bracket.

52
The posterior extension must be engaged in both the premolar and the molar brackets
to obtain optimum transverse control of the canine and alignment of the canine,
premolar, and molar. The anterior extension is pulled mesially until the small circular
helix contacts the distal aspect of the canine bracket and the wire is secured by bending
the anterior extension gingivally.

4. Activation.

The spring is activated by pulling distal to the molar tube until the two loops separate
(Fig 27).

Fig. 27: Activated spring (Taken from Gjessing PA. Universal retraction spring. J Clin
Orthod 1994; 28:222-42)

The wire is secured with a gingival bend in the posterior extension. Reactivation to
the initial spring configuration should be done every four to six weeks.

This amount of activation produces the recommended initial load of 100g. It is critical
to avoid over activation of the spring, because a few millimeters of over activation will
result in reduced M/F ratios and thus unwanted tipping and rotation.

Since the average distances from the centers of the brackets to CR are identical for
upper and lower canines, the PG spring works equally well for canine retraction in
either arch.

Deviations in anatomy or root inclination or improper clinical manipulation of the

spring may result in a steepening of the mesiodistal inclination of the retracted canine.
This can be corrected by up righting the tooth after retraction. The spring is modified
in the mouth by placing a V-bend in the buccal loop with a three-prong plier (Fig 28),

53
thus increasing the alpha moment to about 1,500g/mm, which appears to be ideal for
up righting.

Fig. 28. Adjustment of PG spring for canine up righting by placing V-bend in buccal
loop with three-prong plier. (Taken from Gjessing PA. Universal retraction spring. J
Clin Orthod 1994; 28:222-42)

Without additional anchorage support, the second premolar and first molar can be
expected to migrate mesially about half as far as the canine is retracted. Such mesial
migration of the anchorage unit is often desirable, but in critical anchorage situations,
it may be necessary to use a transpalatal arch and extra oral traction.

III. Controlled Incisor Retraction

As with canine retraction, a segmented approach provides the necessary three-

dimensional control of the incisors to be moved. The PG Universal Spring can be
calibrated to optimize biological reactions of the anterior teeth and to prevent unplanned
side effects in the posterior segments.43

A) Fundamental biomechanics

Class II cases frequently have a deep bite caused by over eruption of the incisors.
Orthodontic repositioning of the maxillary incisors therefore requires an upward and
backward force vector.

During retraction, the four incisors are united to form the anterior segment (active unit).
From a biomechanical point of view, this segment can be considered a single tooth with
four roots. The anterior segment is pitted against the two posterior, reactive units, each
comprising the canine, second premolar, first molar, and eventually second molar. The
force is delivered by a retraction spring connecting the lateral incisor bracket to the
gingival molar tube. A pure force directed through the CR of the four incisors will result

54
in a translation of the anterior segment. The CR is located an average distance of 9-
10mm gingivally and 7mm distally from the center of the lateral bracket (Fig.29).

Fig. 29: Location of CR of anterior and posterior segments. (Taken from Gjessing PA.
Universal retraction spring. J Clin Orthod 1994; 28:222-42.)

If a pure force F is directed distally through the lateral incisor brackets, a distal tipping
movement will occur. This can be eliminated by adding an anti-tip moment to the force
system. Bodily translation of the anterior segment occurs when the moment-to-force
ratio equals the distance between the center of the lateral incisor bracket and CR (M/F
= d), i.e. when the M/F ratio is 9-10.

The combined root surface area of one maxillary central and one maxillary lateral
incisor is close to that of a single canine. Therefore, the same magnitude of horizontal
force can be applied for retraction of incisors and canines. So, the PG system uses 100g
as the initial horizontal force for both.

To produce the necessary upward and backward force vector, a vertically directed
intrusive force must be added to the force system acting at the lateral incisor bracket
(Fig. 30). The intrusive force must be sufficient to overcome the extrusive force
generated by the up-righting moment and also to produce an intrusion of the incisors.

Fig. 30: Upward and backward translation of anterior segment is obtained by applying
force with balance between horizontal driving force vertical intrusive force and up
righting moment. (Taken from Gjessing PA. Universal retraction spring. J Clin Orthod
1994; 28:222-42.)
55
Because the magnitude of intrusive forces produced at the anterior segment are
determined by the posterior curvature of the spring this curvature was adjusted to
deliver the required force magnitude of 10-25g per side producing optimum biological
reaction. The resulting curve is close to the original design used for equal distribution
of the beta moment through the premolar bracket and molar tube during canine
retraction. Therefore, only minor changes are necessary to optimize the spring for both
incisor and canine retraction.

As with canine retraction, the initial activation is determined by the configuration of

the spring. Initially, the horizontal force is 100g and the vertical force 9 g. Four to five
weeks later, after about 1.2mm of space closure, the horizontal force decreases to 30g
and the intrusive force increases to 23g.

At the time of activation, the M/F ratio at the lateral bracket is 8. Since the M/F ratio
required for translation is 9-10, the initial movement is a controlled tipping. After about
0.3mm of space closure, the M/F ratio increases to 10, and the anterior segment begins
to translate and upright.

B) Clinical Application

The clinical application of PG Universal spring for incisor retraction are43

1. Alignment of the incisors.

The PG Universal Retraction Spring can be used with any edgewise system, but triple
tubes at the upper first molars are required. The occlusal tube is used for canine
retraction. During the final sequence of canine retraction, the upper incisors are aligned
with arch wires engaged in the incisor brackets, bypassing the canine and premolar
brackets (occupied by the canine retraction spring), and proceeding through the gingival
molar tube.

After removal of the canine retraction spring, the canines are tied back to avoid
reopening the extraction spaces. If necessary, maxillary arch form can be corrected with
a continuous archwire engaged in the brackets of all three segments. A vertical step is
added distal to the lateral incisors to compensate for differences in the vertical level of
the buccal and over erupted incisor segments.
56
2. Consolidation of the segments.

Alignment of the incisors is followed by stabilization of the buccal and anterior

segments with heavy rectangular wires. The wire cross-section should be large enough
to minimize play between wire and bracket slot. To avoid interdental spacing, the
stabilizing arches, which pass through the occlusal molar tubes, are bent close to the
mesial and distal aspects of the terminal brackets and tubes. These bends are occlusally
directed so as not to interfere with the sliding of the retraction spring.

3. Adjustment of the spring for incisor retraction.

Before engagement, the spring is modified by making a 90° twist in the anterior
extension, 3mm in front of the small circular loop. The twisted extension should be
angulated 105° to allow for a 15° play between the wire and the vertical slot (Fig-31).

Fig. 31: A. 90° twist placed in anterior extension 3mm anterior to small circular loop.
B. Twisted extension angulated 105° (90° plus play between wire and Broussard-type
vertical slot) (Taken from Gjessing PA. Universal retraction spring. J Clin Orthod
1994; 28:222-42.)

The anterior and posterior points of force application are the centers of the lateral incisor
bracket and the triple molar tube, respectively. The posterior extension of the spring is
always inserted in the gingival auxiliary molar tube (Fig -32), but the anterior extension
can be attached to the lateral bracket in several ways.

Fig. 32: PG spring adjusted for incisor retraction and inserted in gingival molar tube.
(Taken from Gjessing PA. Universal retraction spring. J Clin Orthod 1994; 28:222-
42.)
57
The most practical is to use .018" x .025" lateral incisor brackets with vertical
Broussard-type slots (Fig- 33). These accommodate the .017" x .022" PG springs.

Fig. 33: Minor horizontal adjustment of PG spring to fit Broussard-type lateral incisor
bracket. (Taken from Gjessing PA. Universal retraction spring. J Clin Orthod 1994;
28:222-42.)

Although a vertical slot provides excellent control of the spring's inclination, it is not a
necessity. The anterior extension can be placed behind the tie wings of a standard
edgewise lateral incisor bracket and tied to the sectional arch mesial and distal to the
bracket. A gingivally directed bend in the anterior extension prevents the activated
spring from sliding distally.

The anterior toe-in of the spring, as calibrated for rotational control in canine retraction,
establishes a good relationship between the anterior portion of the spring and the lateral
incisor bracket. Horizontal adjustments for fitting the anterior extension in the vertical
slot and the posterior extension in the molar tube have no significant effect on the
sagittally and vertically directed force system. The faciolingual inclination of the
double helix is adjusted as for canine retraction.

4. Bracket engagement.

The posterior extension is placed in the gingival auxiliary tube of the molar bracket
(Fig. 34). The anterior extension is placed in the vertical slot of the lateral incisor
bracket, pulled as far occlusally as possible, and locked with a mesial bend.

5. Activation.

The spring is activated by pulling the posterior extension distally until the double helix
is distorted. The activation of the spring follows the same principles as for canine
retraction with an initial horizontal force of about 100g. The posterior extension is
58
secured with a gingival bend distal to the molar tube. The spring is reactivated every
four to six weeks by returning the double helix to its initial configuration.

IV. Advantages of the PG retraction system

Advantages of the PG retraction system includes42

1. Three-dimensional control in the retraction of anterior teeth.

2. As the spring is precalibrated planned tooth movements can be carried out to

produce the required force system.

3. It can be used for translational movement of both canines and incisors, without
changing the basic morphology of the spring.

4. The force system is independent of the distance between the anterior and posterior
points of force application.

5. The initial magnitude of driving force is identified from the configuration of the
activated spring.

6. Undesirable changes in the occlusal plane are avoided.

7. Any side effects in the buccal segments are insignificant and are neutralized by the
forces of occlusion.

59
 Chapter 7: 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.44

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”).44

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, depending 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 (1997) 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.

60
On the basis of mean tooth dimensions from Wheeler, the M/F required achieving
translation for individual teeth and groups of teeth assuming no marginal bone loss
are summarized in Table 6.44

Table-6: Moment/force ratios (M/F) required achieving translation for individual teeth
and groups of teeth of mean dimensions assuming no marginal loss.( Taken from
Siatkowski Raymond. Continuous arch wire closing loop design, optimization, and
verification. Part I. Am J Orthod Dentofac Orthop 1997; 112:393-402)

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).
61
Adding these residual moments has several disadvantages44

1. The teeth must cycle through controlled tipping to translation to root movement to
achieve net translation (lower Young's Modulus 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.

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 no varying translatory M/F can be delivered by closing loops in a continuous
arch.44

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 Castigliono’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.”

I. Wire size and material

Opus loop can be fabricated from45

1. 0.016” × 0.022” S.S wire

2. 0.018” × 0.025” S.S wire

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3. 0.017” × 0.025” TMA wire.

Wire size and Young's modulus have little effect on M/F ratio although both have
major impact on load-deflection rate.

II. Appliance design

Opus loops is an L shaped loop 10 mm high, 10 mm long, with 1mm of distance

between the legs and a 0.5 mm radius helix in the inner angle of the L configuration.45

Fig. 34: Dimensions of the standard Opus 700 loop. (Taken from Siatkowski RE.
Continuous arch wire closing loop design, optimization and verification Part II. Am J
Orthod Dentofac Orthop 1997; 112:484-95.)

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.

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.

So, Opus 900 loop: The legs are perpendicular to the plane of the brackets.

Opus 700 loop the legs are angled at 70 degrees to the plane of the brackets.

III. Position of loop and M/F ratio

Different loop positions and moment to force ratio are as follows45

63
1. When a opus 900 loop is centered in the interbracket distance, the M/F ratio at the
bracket connected to the helix end of the loop always exhibited at least three times
the M/F ratio of the other end.

2. M/F ratio is equal at both ends when the opus 700 loop is centered in the inter-
bracket distance.

3. The M/F ratio 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.

4. The greatest negative impact on M/F ratio in the off-centered position is crossing
the loop leg and decreasing loop height.

5. Decreasing the loop angulation decreases M/F ratio (Opus 700, 12 mm long vs. 12
mm long at 640: 8.7 to 7.2 mm).

6. Dropping the anterior end of the loop decreases M/F ratio (Opus 700 vs. Opus 700,
end 9 mm high: 8.7 to 7.6 mm).

7. Increasing loop length beyond 10 mm does not increase M/F ratio, contrary to
theoretical prediction, but decreasing loop length decreases M/F ratio.

8. Placing “lingual” comfort bends in the anterior of the loop, putting the end out of
plane, does not degrade M/F ratio or F/D ratio.

9. In contrast to the other loops the Opus 700 loop maintains M/F within the desired
range at all activation force levels without residual moments (again, there is little
difference between Opus 700 loops with 0.016” × 0.022” S.S, 0.018” × 0.025” S.S,
and 0.017” × 0.025” TMA.)

10. The Opus 700 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.

11. Activation force levels above 170 gm may need to be avoided at the beginning and
the very end of space closure with this loop. (Table 7)

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 Force (gm) Activation (mm)

0.016” × 0.022” S.S 0.018” × 0.025” S.S 0.017”× 0.025” 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

Table- 7: Activation (mm) necessary to achieve various activation forces for the Opus
700 loop formed in 0.016” × 0.022” S.S, 0.018” × 0.025” S.S, and 0.017” × 0.025” inch
TMA (Taken from Siatkowski Raymond. Continuous arch wire closing loop design,
optimization, and verification. Part II. Am J orthod Dentofac Orthop 1997; 112:487-
95.)

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 7.

Various chosen cinch-back activations can shift relative movement rates between
anterior and posterior teeth and therefore meet desired anchorage requirements.

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
35.46

65
 Fig. 35: 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. (Taken from Siatkowski RE.
En masse space closure with precise anchorage control. Seminar Orthod 2001; 7: 141-
149.)

The desired M/F ratio 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 extremely difficult to bend by hand in TMA. A jig to
do that for this alloy has been successfully developed.46

66
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.

IV. En Masse Space closure with precise anchorage control

Tooth movement thresholds for precise anchorage control.46

A) 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 34A). 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 36A).
There is minimal movement of the posteriors mesially compared with the amount of
the anteriors' lingual movement (Fig 36B).

67
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 34A, the posterior maximal rate would fall, and net mesial
movement of the posteriors would be lessened.

Fig. 36: 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. (Taken from Siatkowski RE. En masse space
closure with precise anchorage control. Seminar Orthod 2001; 7: 141-149.)

B) 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 37A, As a consequence, the stress level in the PDL of the
anterior, though higher, still remains on that plateau. Therefore, the rates of tooth
movement of the anteriors and posteriors are nearly identical.
68
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 37B, a view of the rate versus time axes as if seen from the far right of Figure
37A.

Fig. 37: 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.(Taken from Siatkowski RE. En
masse space closure with precise anchorage control. Seminar Orthod 2001; 7: 141-149.)

C) 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 38A.
Additional force is applied to the posteriors only, via intermaxillary elastics/ springs or
an overlay TP 256 auxiliary.

69
The additional posterior force is sufficient to drive the stress level in the PDL of the
posterior teeth onto the plateau of the osteologic curve as shown in Figure 38A, Figure
38B shows a view of the rate versus time axes of Figure 38A as if seen from the far
right of that figure.

Fig. 38: 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.(Taken from Siatkowski RE. En masse space
closure with precise anchorage control. Seminar Orthod 2001; 7: 141-149.)

The use of intermaxillary elastics 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 39).47

Fig.39 Torquing auxiliary overlay providing additional mesial protraction force to the
maxillary posteriors. (Taken from Siatkowski RE. Torquing auxiliary for posterior
protraction. J. Clin Orthod 2000; 34:156-157)
70
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.

According to Proffit 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 loop has not been
widely adopted.27

71
 Chapter 8: K-SIR Loop

Retraction of the six anterior teeth under the edgewise system is usually carried out in
two distinct steps: canine retraction followed by incisor retraction. In the Begg and Tip-
Edge bbretraction has the disadvantages of increased treatment time and the creation of
an unesthetic space distal to the incisors. The rationale for separate retraction in the
edgewise technique is that molar anchorage is conserved. Burstone and Nanda have
demonstrated molar anchorage control, using non-frictional loop mechanics for en
masse retraction of the anterior teeth, that compares favourably with that of
conventional edgewise sliding mechanics.21

An appliance for simultaneous intrusion and retraction of the six anterior teeth should
ideally control48

ƒ Magnitude of forces and moments

ƒ Moment-to-force ratio
ƒ Constancy of forces and moments
ƒ Friction

I. Appliance Design

The K-SIR (Kalra Simultaneous Intrusion and Retraction) archwire is a modification

of the segmented loop mechanics of Burstone and Nanda. It is a continuous .019" X
.025" TMA archwire with closed 7mm X 2mm U-loops at the extraction sites.

Fig.40 K-SIR archwire: .019" × .025" TMA archwire with closed U-loops 7mm long
and 2mm wide. (Taken from Varun Kalra. Simultaneous Intrusion and Retraction of
the Anterior Teeth. Journal of Clinical Orthodontics 1998;35(9):535-540)
72
To obtain bodily movement and prevent tipping of the teeth into the extraction spaces,
a 90° V-bend is placed in the archwire at the level of each U-loop. (Fig 41)

Fig.41 A. 90° bends placed in archwire at level of U-loops. B. Centered 90° V-bend
creates two equal and opposite moments (red) that counter tipping moments (green)
produced by activation forces. (Taken from Varun Kalra. Simultaneous Intrusion and
Retraction of the Anterior Teeth. Journal of Clinical Orthodontics 1998;35(9):535-540)

A 60° V-bend located posterior to the center of the interbracket distance produces an
increased clockwise moment on the first molar (Fig. 42), which augments molar
anchorage as well as the intrusion of the anterior teeth.

Fig. 42 A. Archwire with off-center 60° V-bend placed about 2mm distal to U-loop. B.
Off-center Vbend creates greater moment on molar, increasing molar anchorage and
intrusion of anterior teeth. (Taken from Varun Kalra. Simultaneous Intrusion and
Retraction of the Anterior Teeth. Journal of Clinical Orthodontics 1998;35(9):535-540)

To prevent the buccal segments from rolling mesiolingually due to the force produced
by the loop activation, a 20° antirotation bend is placed in the archwire just distal to
each U-loop. (Fig 43)

73
 Fig. 43. 20° antirotation bends placed in archwire just distal to U-loops. (Taken from
Varun Kalra. Simultaneous Intrusion and Retraction of the Anterior Teeth. Journal of
Clinical Orthodontics 1998;35(9):535-540)

II. Activation

A trial activation of the archwire is performed outside the mouth (Fig. 44).48 This trial
activation releases the stress built up from bending the wire and thus reduces the
severity of the V-bends (Fig. 44).

Fig. 44. Trial activation performed on each loop. B. Archwire after trial activation.
(Taken from Varun Kalra. Simultaneous Intrusion and Retraction of the Anterior
Teeth. Journal of Clinical Orthodontics 1998;35(9):535-540)

However, the shape of the archwire should be maintained in subsequent activations of

the loops. After the trial activation, the neutral position of each loop is determined with
the legs extended horizontally. (Fig 45)

74
 Fig.45 Neutral position of loop determined with mesial and distal legs extended
horizontally. In neutral position, loop is 3.5mm rather than 2mm wide. (Taken from
Varun Kalra. Simultaneous Intrusion and Retraction of the Anterior Teeth. Journal of
Clinical Orthodontics 1998;35(9):535-540)

In neutral position, the U-loop will be about 3.5mm wide.

The archwire is inserted into the auxiliary tubes of the first molars and engaged in the
six anterior brackets. It is activated about 3mm, so that the mesial and distal legs of the
loops are barely apart.(Fig 46 Aand B)

Fig.46 K-SIR archwire in place prior to cinching back. First molar and second
premolar are connected by segment of .019" X .025" TMA wire. B. Archwire cinched
back to activate loop about 3mm, so that mesial and distal legs are barely separated.
(Taken from Varun Kalra. Simultaneous Intrusion and Retraction of the Anterior
Teeth. Journal of Clinical Orthodontics 1998;35(9):535-540)

The second premolars are bypassed to increase the interbracket distance between the
two ends of attachment. This allows the clinician to utilize the mechanics of the off-
center V-bend.

When the loops are first activated, the tipping moments generated by the retraction force
will be greater than the opposing moments produced by the V-bends in the archwire.
75
This will initially cause controlled tipping of the teeth into the extraction sites. As the
loops deactivate and the force decreases, the moment-to-force ratio will increase to
cause first bodily and then root movement of the teeth. The archwire should therefore
not be reactivated at short intervals, but only every six to eight weeks until all space has
been closed. The archwire is typically in place for four to five months.

III. Control of the reactive units

Off-center V-bends will generate an extrusive force on the molars, which is usually
undesirable. One of the keys to preventing unwanted side effects of an appliance is to
keep the reactive forces at a minimum while exerting an optimum level of force on the
teeth to be moved.48

The K-SIR archwire exerts about 125g of intrusive force on the anterior segment and a
similar amount of extrusive force distributed between the two buccal segments--
generally the first permanent molars and the second premolars, connected by segments
of TMA wire. The force of 125g is effective for intrusion of the anterior teeth, while
the reactive extrusive force on the buccal segments is countered by the forces of
occlusion and mastication.

Another way to reduce the effects of the reactive force is to add teeth to the anchorage
unit. Including the second molar will, of course, also increase anchorage in the
anteroposterior direction. If even more anchorage is needed to resist both anterior
movement and the extrusive force on the buccal segments, a high-pull headgear can be
added to the molars.

IV. Indications
1. The main indication for the K-SIR archwire is for the retraction of anterior teeth in
a first-premolar extraction patient who has a deep overbite and excessive overjet,
and who requires both intrusion of the anterior teeth and maximum molar
anchorage.

76
2. The archwire can be modified to close extraction spaces in moderate and minimum
anchorage situations with varying degrees of overbite.

V. Advantages

Advantage of the K-SIR appliance, compared to archwires that provide similar

mechanics are48

1. Simple design with a minimal amount of wire in the loop configuration

2. Easy to fabricate, comfortable for the patient and less likely to cause tissue
impingement.
3. The .019" X .025" TMA provides sufficient strength to resist distortion, as well as
enough stiffness to generate the required moments.
4. the design of the archwire and the material properties of TMA combine to produce
relatively low forces, a low load-deflection rate, and a range of activation that
allows the appliance to continue closing space over an eight-week period.
5. The presence of the offcenter V-bend, which acts like an anchor bend, molar
anchorage control is excellent, even without headgear. The clinician is thus less
dependent on patient cooperation for a successful result in a maximum anchorage
situation.
6. Because the intrusion of the six anterior teeth occurs at the same time as their
retraction, and because the canines and incisors are retracted as a unit, the K-SIR
archwire shortens treatment time compared to conventional edgewise mechanics.
7. In addition, the en masse retraction of the six anterior teeth prevents the appearance
of an unsightly space distal to the incisors, which occurs if the canines are retracted
separately.

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 Chapter 9: T-Loop

Effective space closure is challenging and can be optimized when there is control and
predictability of the force system. The simplest way to determine and visualize the force
system is utilizing two groups of teeth, to obtain one centre of resistance and one centre
of rotation in each unit. This is possible using segmental arch approach.Moreover, the
greater interbracket distance and smaller load deflection rates of the loops are
favourable to the dental movement biology. Pre-calibrated loops, as the T-loop, are an
important part of this technical approach.49,50

The T-Loop as described by Burstone is a space closure spring used in rationale

application of orthodontic biomechanics.

I. Composite Retraction Spring

This retraction spring consists of a 0.018” round TMA T- loop welded to a 0.017” X
0.025” TMA base arch wire.21

Fig. 47: Composite retraction spring (Taken from Burstone CJ. Segmented arch
approach to space closure. Am J Orthod Dentofac Orthop 1982; 82:361-378.)

The Configuration of the basic T-loop spring uses 0.017” X 0.025” TMA. (Fig 48)

Fig. 48: Configuration of basic T-loop spring. (Taken from Kuhlberg AJ, Burstone CJ.
T-loop position and anchorage control. Am J Orthod Dentofac Orthop 1997; 112:12-8.)

78
General concepts for segmented T loop use

Understanding an appliance design requires recognition of the passive form of a spring

and its activation.51

1. Standard form of the spring: In this form no preactivation bends are placed. Both
the alpha and beta arms are parallel to each other. (Fig 49A)

2. Passive form (Preactivation form): There are no forces or moments acting on the
spring in passive form. (Fig 49 B)

Fig. 49: Spring design of .017 x .025" TMA segmented T-Loops. A - is the standard
form, without the preactivation bends. B - is the preactivation form of the spring. This
spring is designed to produce equal and opposite alpha and beta moments during space
closure when in a centered position. ( Taken from Kuhlberg AJ, Burstone CJ. T-loop
position and anchorage control. Am J Orthod Dentofac Orthop 1997; 112:12-8.)

3. Neutral position: An essential concept in understanding the use of T-loops for

space closure is the neutral position. (Fig 50A) This position is formed by applying
the activation moments (The moment produced by a retraction spring during
activation is called the activation moment).

4. To the spring without any horizontal forces. The anterior and posterior
extensions of the spring are "twisted" to bring each level to its respective attachment
on the occlusal plane. In this position the spring has zero horizontal force. Moment
at the neutral position is referred to as residual moments. When the proper preacti-
vation bends are placed, the spring is designed such that the spring forms a "T" in
the neutral position. (Fig 50B)

5. The activation of the spring requires the application of forces and moments to
engage the spring in the brackets or tubes. The spring exerts a force system on the
teeth in its active from. (Fig 50C)
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 Figure.50: A; shows a T-Loop inserted passively into the auxiliary molar tube,B;
demonstrates the neutral position of this spring, and C; depicts the full activation and
insertion of the spring.(Taken from Kuhlberg AJ, Burstone CJ. T-loop position and
anchorage control. Am J Orthod Dentofac Orthop 1997; 112:12-8.)

6. The horizontal activation is produced by pulling the "T" open from neutral position.
The activation of the spring is always considered with respect to the neutral position,
and this can be evaluated only by the application of the activation moments.

7. Differential anchorage is obtained by the application of unequal alpha and beta

moments (Gabling). Without gabling the M/F ratios may not be high enough to
affect translation. Moment produced by gabling at neutral position is known as
residual moment.

8. The differential moments are obtained by applying the concepts of the off center
V bend. The closes the V bend to a tooth or set of teeth, the higher the applied
moment. Higher moment is applied to the anchorage teeth.

9. Centering the T loop equally between the anterior and posterior tubes produces
equal and opposite moments. Positioning the loop slightly off center relative to the
anterior and posterior attachments generates unequal moments.

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II. Differential force systems- variable moments and forces:

According to Nanda and Kohlberg, the force system of an orthodontic appliance

determines the type of tooth movement expressed.52The forces act in all the three planes
of space (transverse, sagittal and vertical). Most space closure concerns are second
order or the sagittal direction. The components of any force system in this view are:

1. Alpha moment: This is the moment acting on the anterior teeth.

2. Beta moment: This is the moment acting on the posterior teeth. Tip-back bends
placed mesial to the molars produce an increased beta moment.

3. Horizontal forces: These are the mesio-distal forces acting on the teeth. The distal
forces acting on the anterior teeth always equal the mesial forces acting on the posterior
teeth. According to the Newton’s third law any force acting on the anterior teeth must
be opposed by equal and opposite forces acting somewhere else, typically on the
posterior teeth or head / neck via headgear or the implant.

4. Vertical forces: These are intrusive-extrusive forces acting on the anterior or

posterior teeth. These forces generally result from imbalanced alpha and beta moments.

When the beta moment is greater than the alpha moment, an intrusive force acts on the
anterior teeth while extrusive forces act on the posterior teeth. When the alpha moment
is greater than the beta moment, extrusive forces act on the anterior teeth while intrusive
forces act on the posterior teeth. The magnitude of the vertical forces is dependent on
the difference between the moments and the interbracket distance. (Fig. 51)

Fig. 51: Components of the space closure force system. Alpha moment is shown smaller
in magnitude than beta moment, thus vertical forces are intrusive on the anterior and
extrusive on posterior teeth. If the alpha moment were greater than beta, the vertical
forces would be in the opposite direction. (Taken from Nanda R. Biomechanics &
Esthetic strategies in clinical orthodontics. 2005, Elsevier Inc.)
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III. V –Bend Principle and its clinical applications

The differential moments are obtained by applying the concept of the off-center V-
bend. A V bend placed along an arch wire between the two attachments radically alter
the force system depending on the mesiodistal positioning of the apex of the V bend.53,54

A convenient measure of the mesiodistal placement is the a/L ratio

Where,

a= Distance from posterior attachment to the apex of V bend.

L= Distance between the two attachments.

When Apex of the V bend is centered = Moment at each attachment are equal and
opposite. Table 8 shows the force systems from the different positions of V bend.

a/L Ratio M2/M1 Vertical forces

0.10 +0.4 XXXX

0.20 +0.3 XXX

0.33 0.0 XX

0.40 -0.3 X

0.50 -1.0 None*

Table- 8. Force systems from different positions of V bend. (Taken from Burstone CJ.
Creative wire bending – Force system from step and V bends. Am J Orthod Dentofac
Orthop 1988; 93: 59-67.)

Where, M1 and M2 Moment on posterior segment and anterior segment respectively.

+ = moments have same direction.

- = Moments act in opposite direction.

*When V bend is centered no vertical forces act on either segment.

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The moment to force ratio can determine the quality of tooth movement.55,56,57,58,59

Clinical applications

Let’s consider an arch in which attachments have been placed on the four incisors and
the first molars. When apex of the V bend is placed 1/3 rd the distance from the molar
tube to the incisor bracket (a/L=0.33) (Fig 52).

Fig. 52: A Mesiodistal placement of V bend between molars and incisors. Bend placed
off-center posteriorly (a/L=0.33) (Taken from Burstone CJ. Creative wire bending –
Force system from step and V bends. Am J Orthod Dentofac Orthop 1988; 93: 59-67.)

A single intrusive force is produced on the incisors and on the molars both an extrusive
force and a moment tending to the roots forward and crowns back. This could lead to
incisor intrusion, molar tip-back and if arch wire is tied back possible retraction of the
upper incisors.

If one decides to place the Apex of ‘V’ bend even further posteriorly the force system
will change and this configuration will produce a moment on the incisors tending to
place a labial root torque on them. This moment produced on the central incisors could
be useful in preventing flaring of the upper incisors during intrusion. However, in other
situations it could be an unfavorable side effect moving the root labially. When the V
bend is placed off center posteriorly (a/L =less than 0.33) the more the degree of bend
is increased, both the intrusive force and the labial root moment on the incisor will
increase.

Another situation when the V bend is placed in the center between the molar tube and
the bracket (Fig 53); equal and opposite couples are generated. If the arch wires are tied
back so that the anteroposterior forces are created. This wire could be used to move the
roots of incisors lingually. The molar roots would also move mesially but this can be
prevented by increasing the number of teeth in anchor unit or using the head gear.
83
 Fig. 53: Mesiodistal placement of V bend between molars and incisors. Bend centered.
(a/L=0.5) (Taken from.Burstone CJ. Creative wire bending – Force system from step
and V bends. Am J Orthod Dentofac Orthop 1988; 93: 59-67.)

In situation where the V bend is positioned off-center closer to the central incisor
bracket (Fig 54. a/L= 0.66), instead of an intrusive force, an extrusive force is expressed
on the incisors with a lingual root torque. An intrusive force on molars is also exerted.
By moving the V bend forward, we have a root spring for the incisors, provided the
wire is tied back to prevent anterior flaring of the incisors.

Fig. 54: Mesiodistal placements of V bend between molars and incisors. Bend off-
centered anteriorly. (a/L=0.66) (Taken from Burstone CJ. Creative wire bending –
Force system from step and V bends. Am J Orthod Dentofac Orthop 1988; 93: 59-67.)

The segmented T-loop approximates a "V" shape. Centering the T-Loop equally
between the anterior and posterior tubes produces equal and opposite moments. Posi-
tioning the loop slightly off center relative to the anterior and posterior tubes generates
unequal moments. The spring is positioned closer to the anchorage teeth. Clinically, the
spring usually needs to be 1 to 2 mm closer to one side than to the other to obtain a
moment differential.

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Kuhlberg and Burstone (1997) measured the effect of off-center positioning of
segmented 0.017” x 0.025” TMA T-loops on the force system produced.51A T-loop was
designed to produce equal and opposite moments in the centered position. The spring
was tested in seven positions, centered, 1, 2, and 3 mm toward the anterior attachment,
and 1, 2, and 3 mm toward the posterior attachments.

The horizontal force, vertical force, and alpha and beta moments were measured over
6 mm of spring activation. The results showed that the alpha/beta moment ratio was
dependent only on the spring position, and independent of spring activation. Eccentric
positioning of T-loop springs effectively produces a consistent moment differential
through the range of spring activation. It is important that one properly positions the
springs to achieve predictable and desirable treatment results. Subtle changes in the
position of the V-bend can result in significant changes in the moment magnitudes,
especially with small interbracket distances.

One advantage of the segmented T-loop is the use of a larger interbracket distance,
reducing the relative effect of minor errors in spring position. For instance, a 1 mm
error is a smaller proportion of a 20 mm interbracket distance than a 10 mm interbracket
distance.

The T-loop described here is designed for an activation of up to 6 mm. At a full 6 mm

activation, tooth movement occurs in three phases-tipping, translation, and root
movement (Fig 55). For a symmetric, centered spring, the initial force system applies a
M/F ratio of about 6/1 to the teeth. This results in tipping movement of the anterior and
posterior teeth into the space.

With about 2 mm of deactivation or space closure (spring activation = 4 mm), the M/F
ratio increases toward 10/1, resulting in bodily tooth movement or translation. With one
to two more millimeters of space closure (spring activation = 2-3 mm), the M/F ratio
increases to 12/1 and higher. The high M/F ratio results in root movement. In typical
clinical application, the spring does not need reactivation until all three phases of tooth
movement have been expressed.

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 Fig. 55: Phases of tooth movement with segmented T-loop space closure. A, Tipping. B,
Translation. C, root movement. The spring needs reactivation only after root movement
has been obtained. (Taken from Kuhlberg AJ, Burstone CJ. T-loop position and
anchorage control. Am J Orthod Dentofac Orthop 1997; 112:12-)

Space closure considerations

Space closure with segmented arch mechanics can be done by:

a) Retraction of all six anterior teeth (En-mass retraction)

b) separate retraction of the canines followed by retraction of incisors

Although it seems that the later method is less detrimental to the anchorage, it is not
necessarily true in all instances. Adequately designed appliances, based on the desired
biomechanics, permit en-mass retraction of all six anterior teeth in a single stage. This
also significantly reduces the treatment time. So separate canine retraction can be
reserved for those situations where one needs to alleviate anterior crowding. Once
anterior alignment is achieved remaining space closure can be brought by en-mass
retraction.

According to Burstone CJ it is convenient to classify an extraction arch by the

differential space closure required between the anterior and the posterior teeth.

En -mass symmetric space closure

It is the simplest form of space closure. Requirement for space closure includes equal
translation of the anterior and posterior segments. A centered 0.017” X 0.025” TMA T-

86
loop between anterior and posterior attachments is used.

Centered position of the spring is found by the formula,

Distance = Interbracket distance ― Activation

Where,

Distance = the length of the anterior or posterior arm (as they are of equal length) In
other words, distance from the center of the T loop to either the anterior or posterior
tubes)

Interbracket distance = the distance between the molar and canine brackets.

Activation = the millimeters of activation of the spring (usually 6 mm).

IV. Spring preactivation

Before the T- spring is placed in mouth it needs to be preactivated in order to deliver

the required moments for translation (M/F =10-12/1)60

Pre-activation is done by placing six bends in the loop from its neutral position shape.
(Fig. 56)

Fig.56: T-Loop pre-activation bends. (Taken from Marcotte MR. Biomechanics in

orthodontics, Inc1990 Philadelphia, Pennsylvania)
87
This will result in about 190-2000 of moment pre-activation in both the alpha and beta
legs.

Bend 1st and 2nd: At the corners of the T Approximately 450

Bend 3rd and 4th: With small round tip of the plier at the base of the T. The legs are bent
upwards until they actually touch the corners of the of the T- loop; they will spring back
a little.

Bend 5th and 6th: With small three prong plier each leg is bend so that it actually touches
the corners of the T-loop. Thus, after the placement of these preactivation bends alpha
leg is about 190-2000 from the vertical tube position and the spring is ready for trial
activation.

Several ways of preactivation have been suggested in the literature, such as

preactivation by gable bends, curvature and concentrated bends.61

V. Trial activation

Grasp the spring with two pliers just posterior to bend 6 and anterior to the bend 5 (Fig.
57).

Moment pre-activation is done by twisting the alpha and beta arms so as to bring them
in a proposed horizontal bracket level.60 (Vertical legs may overlap each other) Force
pre-activation is done by separating the legs to 6-7mm. After trial activation spring is
ready to be inserted, neutral position of the vertical legs of the T loop should be 0mm
(Just touching). So, it is very important to place the angulation bends properly, since
neutral position of the spring can be affected. This applies not only to the spring
assemblies of segmented arch technique but to any loop. If a gable or angulation bend
is placed in a loop, the loop will tend to cross when it is engaged in the adjacent brackets
and the resultant magnitude of force will be greater than anticipated.

To aid the clinician in achieving the proper angulation, templates are used. Rather than
to measure the angles, it is more convenient to duplicate the shape of the spring from a
template.

88
 Fig. 57: Trial activation of T loop for translation (Taken from Marcotte MR.
Biomechanics in orthodontics, Inc1990 Philadelphia, Pennsylvania)

When the 0.017” X 0.025” attraction spring is activated as above, the T loop will be
centered between the buccal segment and the anterior segment.

When reactivation of the spring is needed both the anterior and posterior arms can be
shortened if the T- loop is to be centred.

The spring is placed centrally between the two auxiliary tubes for two reasons.

1. The most important is that it allows the same rate of change of the moment-to-
force ratio in both the alpha and the beta positions.
2. Furthermore, it is simpler to place a symmetrical angulation in the spring. A
typical angulation is shown in Figure 58, and the force system of this spring is
given in Table 9.

Fig. 58: Typical angulation required for the 0.017” x 0.025” attraction spring. A 0.018”
or 0.020” TMA wire is welded anteriorly for insertion into the canine vertical tube.
(Taken from Burstone CJ. Segmented arch approach to space closure. Am J Orthod
Dentofac Orthop 1982; 82:361-378.)

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 Table 9: Force system produced by attraction spring TMA 0.017” X 0.025” centered
(Taken from Burstone CJ. The segmented arch approach to space closure. Am J
Orthod Dentofac Orthop 1982; 82:361-378.

At the neutral position, there are relatively equal moments in the alpha and beta
positions, with the alpha moment 1,362 Gm-mm and the beta moment 1,410 Gm-mm.
Let us now follow what happens to the spring beginning with the force system at 7 mm
of activation. At 7 mm, the alpha and beta moments are approximately equal— 2,349
Gm-mm and 2,368 Gm-mm respectively. 21

The moment-to-force ratio is 7.0 in both the alpha and the beta positions, and hence the
teeth would be expected to undergo controlled tipping near their apices.

90
The centers of rotation that are described here are only representative; nevertheless, the
trend in change of these centers applies to any clinical situation. The actual moment-to-
force ratios required for different centers of rotation will vary, depending on the teeth
and their support. As the teeth move 1 mm, the moment-to-force ratio is 8.0.

The center of rotation has moved slightly past the root apex in an apical direction. After
the teeth have moved 2 mm (M/F = 9.2), translation begins; after 3.5 mm of movement
(M/F= 12), root movement is initiated; and at 4 mm, it is continuing. The moment-to-
force ratio is increased over 3 mm of tooth movement (deactivation) but, unlike the
simple vertical loop, this change is gradual. With the vertical loop this change is rapid
with tipping, translation and root movement occurring over a deactivation of 0.2mm. 21

The greater constancy of the moment-to-force ratio of the TMA attraction spring
simplifies the determination of the force system and gives a better biologic response.

Nevertheless, one still must carefully observe the progress of space closure and, on the
basis of this monitoring; determine the appropriate time for reactivation. Progress of
the space closure is assessed by the amount of the remaining space, axial inclinations
of the anterior and posterior teeth, and the occlusally relationship.

During the first stages of space closure, some tipping of the posterior and anterior
segments will be noticed and the anterior and posterior occlusal planes angles towards
each other. This angulation corrects during the root movement. The spring should not
be reactivated and should be left in place until the axial inclinations are correct and
occlusal parallelism is regained. The amount of reactivation of the spring should be
based on the space closure requirements at that time. Normally, this means that no new
activation is required until approximately 3 mm. of space closure has been produced.

If one leaves the spring in place after 3 mm. or so of space closure, no further space
will close; if it is left in place too long, exaggerated root correction would be observed,
followed by increased space in the extraction site.

During space closure, the loop of the spring should be maintained centrally between the
two auxiliary tubes.

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A welded vertical pin (0.018” or 0.020” TMA) is welded anteriorly for insertion into
the vertical tube of the canine. The posterior part of the assembly is bent distal to the
first molar.

Symmetric T loop is commercially available in two heights;

a) A regular or long height and

b) A short height used when vestibular depth is a critical factor.

c) This short spring is activated to 3mm to 4mm. and is fabricated from 0.016” X
0.022” TMA wire.

VI. ANCHORAGE SYSTEMS

Space closure in different anchorage situations as explained by Burstone21

A) Group A space closure (critical anchorage situations)

Group A arches tend to be of two types

In one the anterior teeth are badly crowded, and separate canine retraction is indicated.
In the other the anterior teeth have adequate arch length, and the movement that is
needed is en masse space closure of all six anterior teeth.

In patients with Group A arches, little anterior displacement of the posterior teeth is
allowed, so to accomplish anterior retraction while preserving anchorage, anterior
segment undergoes controlled tipping while the posterior anchorage unit undergoes
translation or root movement.

In the first phase the anterior segment is tipped with a center of rotation near the apex
of the incisors, followed by a second phase of root movement where the center of
rotation is moved occlusally to the bracket or the incisal edge (en masse root
movement).21

In Group A arches, two stages of space closure are accomplished (Fig 59: C and D). 21

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 Fig. 59: Types of segmental en masse space closure. A, Blocks represent anterior and
posterior segments. B, One-stage translation. C and D, Two-stage space closure. The
anterior segment is initially tipped around a center of rotation near the apices of the
incisors. Root movement follows with a center of rotation near the incisor bracket.
(Taken from Burstone CJ. Segmented arch approach to space closure. Am J Orthod
Dentofac Orthop 1982; 82:361-378.)

In the first phase the anterior segment is tipped with a center of rotation near the apex
of the incisors, followed by a second phase of root movement where the center of
rotation is moved occlusally to the bracket or the incisal edge (en masse root
movement).

Two types of retraction methods can be used to affect this type of tooth movement,

x Composite retraction spring

x Standard T spring with off-center position.

Composite TMA spring comprising two different cross sections of wire, a 0.018-inch
round TMA T loop welded to a 0.017” x 0.025” TMA base arch (Figure 60).

93
 Fig. 60: a) 0.018-0.017 X 0.025 inch composite anterior retraction spring (upper arch).
Premolars will be extracted at this stage in treatment. Retraction spring inserts into the
vertical tube on the canine and the horizontal tube on the first molar. b) Neutral form
of the spring.(Taken from Burstone CJ. Segmented arch approach to space closure. Am
J Orthod Dentofac Orthop 1982; 82:361-378.)

The alpha and beta pre activation bends are placed into the spring by bending the spring
to a template and as in other springs, one must over bend and then carry out trial
activation. After trial activation the spring configuration should approximately match
the template. The trial activation serves to decrease or eliminate any permanent
deformation that may occur upon placement in the mouth. By performing trial
activation, activation will be in the direction of the last bend which helps resist
permanent deformation upon activation.

Force system

Horizontal forces

Distal activation of this spring is 4mm which produces around 160gm of force. At an
activation of 3 mm, a horizontal force of 118g is generated. The Mα/F 5.8 while the
Mβ/F is 10.2. At this activation, the anterior segment is undergoing controlled tipping
while the posterior anchorage unit undergoes translation or root movement. As this
spring deactivates 1 mm further during space closure, the Mβ/F ratio increases to 13.8,
the spring should be reactivated at the time. Important point to note that Mα/F ratio
during the range of activation (here from 4mm to 2mm) remains relatively constant so
for all practical purposes center of rotation remains relatively constant.

The load deflection rate of the spring averages 33gm per millimeter. Thus, as the space
closes initially the posterior segment would translate forward or the roots would move

94
slightly forward if there is movement at all. After some space is closed Mβ/F ratio
increases to a point where the spring produces a definite tip back action on the buccal
segment. Thus, one could recoup any space loss produced during the beginning of the
space closure.21

Vertical forces

Because the beta moment is greater than the alpha moment, a vertical intrusive force
acts on the anterior segment and an extrusive force on posterior segment. These vertical
forces vary around 37 gm during the range of recommended activation for a 23mm
inter-bracket(tube) distance. During en-mass retraction intrusive forces may produce
some actual intrusion and will serve to hold any intrusion achieved previously. The
posterior extrusive forces may get counteracted sufficiently by the forces of occlusion.21

Force system given by any spring depends upon a typical spring shape and the tube
geometry, the inter attachment distance and the range of activation. However it may be
necessary to modify the force system depending upon the individual patient needs e.g.
in an open bite situation, one might not place any beta angulation in the base arch and
instead rely on an occipital headgear posterior to the center of resistance to develop the
necessary moment to prevent the posterior segment from tipping forward. This must be
taken into consideration in the β angulation.

In addition, the moment to force ratios needed are dependent upon the geometry of
teeth, particularly the root length and the nature of the periodontal attachment. It is
important for the clinician to monitor the patient carefully and to modify the M/F ratio
in both the alpha and beta positions whenever required e.g. the space closure in
periodontal involved teeth where the alveolar crest has been lost requires larger M/F
ratios, since the center of resistance will be located further apically. 21

Standard T spring with off-center position

A standard T spring produces the same alpha and beta moments, when used in the
centered position, however for Group A anchorage, or critical posterior anchorage, the
mesial forces acting on the posterior teeth must be minimized or neutralized. According
to Newton's third law, any forces acting on the anterior teeth must be opposed by equal
and opposite forces acting somewhere else, typically the posterior teeth, the head, or
95
the neck (via full-time headgear use). If intraoral dental anchorage is used, the forces
and moments will be inevitable on the posterior teeth. So, to obtain differential tooth
movement (i.e., anchorage control) biomechanical strategies must be incorporated into
the appliance design.

According to Nanda and Kuhlberg the strategy for the Group A space closure is the
differential M/F ratio i.e. a relative increase in the posterior M/F ratio (reducing F
results in a higher M/F) and/or a decrease in the anterior M/F ratio (increasing F results
in a lower M/F ratio). But within a single intra-arch appliance, the mesio-distal forces
must be equal (rules of static equilibrium). Although headgear or intermaxillary elastics
can be used to relatively increase or decrease the force their use is dependent on patient
compliance and also is not without other side effects. So, this differential is achieved
by application of a higher moment on the posterior compared to the applied moment on
the anterior teeth (figure 61).

Fig 61: A biomechanical strategy for Group A space closure using differential moments.
(Taken from Kuhlberg AJ, Burstone CJ. T-loop position and anchorage control. Am J
Orthod Dentofac Orthop 1997; 112:12-8.)

This can be done by a standard 0.017” × 0.025” TMA T spring with the T loop placed
off center posteriorly. (Fig 62)

Fig. 62: T-Loop positioned off center for Group A space closure. A, The force system
for Group A space closure, with greater beta moment. Note that there are vertical forces
in conjunction with a moment difference. B, The length of the beta “arm” is shorter (by
about 2mm) than the length of the alpha “arm”. The activation of spring is 4mm. C,
The fully inserted spring for group A space closure. (Taken from Kuhlberg AJ,
Burstone CJ. T-loop position and anchorage control. Am J Orthod Dentofac Orthop
1997; 112:12-8.)

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According to Proffit W R, to obtain greater retraction of the anterior teeth, a sequence
of steps to augment anchorage and reduce anchorage strain could be as follows:

1. Add stabilizing lingual arches and precede with en masse space closure. The
resulting increase in posterior anchorage, though modest, will change the ratio of
anterior retraction to posterior protraction to approximately 2:1.
2. Reinforce maxillary posterior anchorage with extra oral force and (if needed) use
Class III elastics from high pull headgear to supplement retraction force in the lower
arch, while continuing the basic en masse closure approach. Depending on how well
the patient cooperates, additional improvement of retraction, perhaps to a 3:1 or 4:1
ratio can be achieved.
3. Retract the canines independently, preferably using a segmental closing loop, and
then retract the incisors with a second closing loop arch wire. Used with stabilizing
lingual arches (which are needed to control the posterior segments in most patients),
this technique reinforced with headgear, achieves even better ratios.

From Table-10 at 3.5mm activation of T spring with the spring position approximately
2mm towards the beta position a horizontal force of +216gm is generated with Mα/F
ratio of 7.4 and Mβ/F ratio 9.6 resulting in controlled tipping of the anterior segment
and translation of the posterior segment.

Table-10: Force system produced by Standard T spring with posterior spring

position. (Taken from Kuhlberg AJ, Burstone CJ. T-loop position and anchorage
control. Am J Orthod Dentofac Orthop 1997; 112:12-8.)

97
The spring has to be reactivated after it has deactivated to 1.5mm. At that activation the
Mα/F ratio is 13.5 and Mβ/F ratio is 15.9 resulting in translation or root movement of
the anterior segment and root movement of the posterior segment. Practically an initial
activation of 4-4.5mm would give a greater range of activation. Placing the T spring
further off-center will give a greater differential between Mα and Mβ.

B) Group C space closure (maximum anterior anchorage)

Posterior protraction is the most difficult space closure procedure. The biomechanical
principle reverses the approach to Group A space closure. The alpha moment is
increased relative to the beta moment.

There are basically three methods by which the buccal segments can be protracted:

1. Protraction headgear alone

2. Using an asymmetric T loop with alpha moment > beta moment

3. Using a centered T loop with intermaxillary elastics or protraction headgear

Protraction headgear

With the headgear force directed through the center of resistance of the buccal
segments, the posterior teeth can be translated forward. Unfortunately, cooperation with
a reverse headgear is usually not good.

Asymmetric angulated T loop

A differential between Mα and Mβ moments can be produced by two different

approaches. The asymmetric angulation approach uses the T loop with the loop
placed off center and a V bend anteriorly.

The distal activation is 4mm, which produces a horizontal force of 309 g. Unlike the
symmetrical T loop shape, note more angulation is in the alpha position. Remember to
over bend the spring and perform trial activation.

The loop has been posteriorly positioned (one third of the interbracket distance from

98
the molar tube) and the angulation bends are increasingly larger as one approaches the
alpha position. (Fig 63)

Fig. 63: Shape of 0.017” x 0.025” TMA attraction spring used for protraction of
posterior teeth. Loop is placed off center to the distal aspect. Angulation bends are
increased as the position is approached. Anterior part of spring is to the left. (Taken
from Burstone CJ. Segmented arch approach to space closure. Am J Orthod Dentofac
Orthop 1982; 82:361-378.)

The force system that is produced is given in Table 11.

Table-11: Posterior protraction TMA 0.017” x 0.025” posterior positioned (Taken from
Burstone CJ. The segmented arch approach to space closure. Am J Orthod Dentofac
Orthop 1982; 82:361-378.)

At the neutral position, very little moment is produced in the beta position (214 Gm-
mm) and a very large moment in the alpha position (2,574 Gm-mm). At 4 mm of
activation, 309 Gm is produced. Comparison between the moment-to-force ratios
between the alpha and beta positions following 4 mm of activation shows that at the 4
mm. activation, the beta moment-to-force ratio is 4.4. Since the auxiliary tube lies 1
99
mm. apical to the bracket slot, one might anticipate tooth movement approaching
controlled tipping around the apices of the posterior teeth.

As the spring deactivates over 2.5 mm, the moment-to-force ratio will rise slightly to
5.9. Thus, controlled tipping with a relatively constant beta moment-to-force ratio is
present throughout 2.5 mm of space closure. The alpha moment-to-force ratio at the 4
mm activation is 8.0. The anterior segment might retract initially a small amount;
however, after 1 mm. of space closure, the ratio is 10.9, and if the anterior teeth move
at all, they would tend to translate lingually.

After 2 mm of deactivation, the alpha ratio is 16.6. In this range, as the spring continues
to work out, any anterior movement would be reflected by crown flaring and lingual
root movement. Differential mechanics are in effect; thereby allowing the posterior
teeth to move forward by controlled tipping and the anterior teeth (if they move at all)
to move slightly labially. A side effect is possible anterior extrusion because of the
vertical extrusive force on the incisors.

This spring is designed to encourage posterior protraction by utilizing the following

principles21

(1) The loop is placed off center; this produces a more constant center of rotation in the
beta position. By contrast, in the alpha position, the moment-to-force ratio rapidly
increases so that if these teeth move at all, they will tend to move forward rather than
posteriorly.

(2) The force is kept under 300 Gm to minimize anterior retraction or root movement.

This protraction spring is allowed to close 2.5 to 3 mm before reactivation is considered,

otherwise the frequent activations will not only tip the posterior segment forward but
will also translate the anterior segment back. If the space closure desired is through
posterior protraction alone, the alpha moments of the attraction spring must be large
enough to prevent lingual tipping of incisors. However, if the incisors tend to flare, it is
sign that more distal force is needed.

When using greater α than β moments for posterior protraction, vertical forces are
introduced that may be clinically significant, especially in cases of deep overbite. The
100
anterior teeth will feel a net extrusive force, extrusion of these teeth may occur further
deepening the bite, and hence this approach is not indicated if intrusion of these teeth
is required.

According to Dr Nanda, Kuhlberg and Dr Burstone Group C space closure can also be
performed using standard angulation 0.017” X 0.025” TMA T spring with loop placed
anteriorly 2mm.

It is important that the anterior wire segment achieve full bracket engagement;
otherwise, the play within the brackets reduces the effectiveness of the moment
differential.

A full activation of 4mm will result in a Mα / F of 9.2 and M β/ F of 6.9 resulting in

translation of the anterior segment and controlled tipping of the posterior segment. The
spring should be reactivated after every 2mm of deactivation.

Like asymmetrical angulation approach similar vertical forces are generated with this
method therefore this spring is not used in deep bite cases.

Centered T loop with either intermaxillary elastics or protraction headgear

The TMA attraction spring is centrally placed between the auxiliary tube of the first
molar and the vertical tube of the canine. Typical angulation is placed as in previously
described Group B arches where en masse translation is desired. The spring is activated
4 mm.

By addition of the intermaxillary elastic the Mβ/F ratio are altered from those seen in
the symmetric T loop without elastics.

Since Mα =Mβ, no vertical forces are introduced by the attraction spring and its use is
indicated, where no anterior extrusion is required. However, there is small vertical force
introduced by the elastic which may or may not be of clinical significance.

Class II elastics from the mandibular first molar to the maxillary canine further increase
the force on the lower buccal segment. Class III elastics aid in protracting upper buccal
segments. Alternatively, protraction headgear may be used to the upper buccal
segments, although compliance may be questionable. Tables 12 & 13 give the force

101
system, in its entirety, for elastics of two different strengths (100 Gm and 150 Gm).

Table-12: Posterior protraction attraction spring TMA 0.017” x 0.025” centered with 100
gm. Elastic. (Taken from Burstone CJ. The segmented arch approach to space closure.
Am J Orthod Dentofac Orthop 1982; 82:361-378.)

For 150 gm elastic, during 3 mm of deactivation starting from 4 mm activation, the beta
moment-to-force ratio will increase from 6.0 to 7.9. Over this distance, the posterior
teeth will tip forward with a center of rotation apical to the apices of the roots.

The alpha moment-to-force ratio at 4 mm is 10.9, implying translation or lingual root

movement, and increases to 31 after 3 mm of space closure. Overall, during space
closure, the incisors will tend to come forward and/or their roots will move lingually.

By reducing the elastic force to 100 gm, slightly higher β moment-to-force ratios can
be produced, so that after space closure less posterior root correction is required.

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 Table-13: Posterior protraction attraction spring TMA 0.017” x 0.025” centered with
150 gm elastic. (Taken from Burstone CJ. The segmented arch approach to space
closure. Am J Orthod Dentofac Orthop 1982; 82:361-378.)

In comparing the two strategies for posterior protraction, with and without
intermaxillary elastics, the choice depends upon the treatment objectives. By placing a
loop off center, one can produce a differential moment-to-force ratio; however, this
produces vertical extrusive forces on the anterior segment. Hence this method is not
indicated in cases with deep bite or where bite has been opened.

The use of intermaxillary elastics may alter the plane of occlusion, and particularly
Class II elastics may undesirably steepen a plane of occlusion, erupting incisors in a
Class II patient.

This undesirable side effect can be minimized or eliminated by the use of a headgear to
the upper arch which would produce a moment with respect to the center of resistance
that flattens the plane of occlusion.

103
Control of mechanical side effects (segmental approach)

Recognition of the three-dimensional nature of the force system is of critical importance

to efficient, predictable treatment.

First order side effects

The major side effect during space closure is the rotation of the molars and / or canines.
The horizontal forces act buccally to the centres of resistance on the molar and canines.
Thus, there is a moment of the force tending to rotate the first molar mesial in and
canine distal in. (Fig 64)

Fig. 64: First order side effects seen with extraction space closure. (Taken from
Marcotte MR. Biomechanics in orthodontics, Inc1990 Philadelphia, Pennsylvania)

Control of the molar rotation may be easily accomplished with a palatal or lingual arch
negating the rotational effect. (Fig 65)

Fig. 65: Transpalatal arch for control of molar rotations (Taken from Marcotte MR.
Biomechanics in orthodontics, Inc1990 Philadelphia, Pennsylvania)

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Rotation of the canines can be controlled by various techniques.

1) For en-mass space closure, a rigid wire of anterior segment reduces rotational
tendency.

2) A canine bypass, an anterior segment connecting the canines but bypassing the
incisors, is useful for separate canine rotation.

3) Antirotation bends (Creating V bend geometry) into the spring design. This design
adds a mesial in moment to the canines and a mesial out rotation to the first molars.
(Fig 66)

Fig 66: First order view of a T loop spring with a V bend incorporation for rotational
control. (Taken from Marcotte MR. Biomechanics in orthodontics, Inc1990
Philadelphia, Pennsylvania)

Side effects in vertical plane:

With asymmetric space closure, vertical forces are produced which may produce -
undesirable intrusive or extrusive tooth movements. These vertical forces also produce
unwanted third-order (Buccal-lingual) side effects. (Fig -67)

Fig. 67: Third order side effects from Group-A space closure. Vertical forces act
buccally to the center of resistance. (Taken from Marcotte MR. Biomechanics in
orthodontics, Inc1990 Philadelphia, Pennsylvania)
105
Palatal or lingual arches help control the third order side effects on molars provided that
these arches should have third order control i.e. fabricated from rectangular or square
wire. (Fig. 68)

Fig. 68: The transpalatal arch for the control of third-order side effects. (Taken from
Marcotte MR. Biomechanics in orthodontics, Inc1990 Philadelphia, Pennsylvania)

Third order control of the canine is primarily a concern in group A space closure
because the intrusive force on the canine will tend to tip the crown buccally. This
increases the overjet and/or the intercanine distance. This also retards the eruption of
the highly placed canines. These movements are opposite to the desired direction of
movement.

To avoid this alternative appliance designs are indicated. Possible treatment approaches
include the use of intermaxillary elastics to aid in canine eruption or a symmetric,
centered T loop spring with concurrent headgear anchorage control.

Canine retraction – segmental approach

Separate canine retraction can be reserved for situations in which one needs to alleviate
anterior crowding. The force system that is used for retraction of the canine is similar
to that for en masse space closure.

Anti-rotation bends are placed in the retraction assemblies to prevent the canine from
rotating as it retracts.The angulation and distal activations are usually identical to those
used for en masse space closure.

VII. Continuous arch T loop Space closure

106
Segmental T loop space closure principles can also be applied to space closure on a
continuous arch. The force system is not as well defined as with segmental T springs,
but careful use of alpha and beta moments helps to achieve comparable results,
especially for group B and C anchorage problems. For Group A anchorage cases, high
pull headgear is necessary to control the posterior tooth position.

Wire size and material- Preformed arch wire 0.017” × 0.025” TMA or 0.016” × 0.022”
SS

Position: One on each side of the arch wire distal to the cuspids.

Appliance design

1. T loop are made of 6-7 mm high and 10 mm wide. (Fig-69A)

2. Desired alpha and beta moments are placed anterior and posterior to the T loop
vertical legs (Fig. 65B). Recommended beta activation for A, B and C anchorages
are 40°, 30°, and 20° respectively.

3. Before insertion trial activation should be done.

4. The wire is inserted into the auxiliary tube and ligated to the anterior teeth. If the T
loops are not passive, all adjustments should be made outside the mouth. It is
advisable to connect the buccal segments with a palatal or lingual arch. With this
configuration, the beta end of the T loop bypasses premolar brackets and is not
inserted into any posterior brackets except the molar tube.

Fig. 69: T loop in continuous arch wire for space closure. A, T loop configuration B,
Placement of preactivation bends for alpha and beta moments. C, Arch wire insertion
with activation for space closure. (Taken from Burstone CJ. Segmented arch approach
to space closure. Am J Orthod Dentofac Orthop 1982; 82:361-378.)

Activation
107
1. For TMA arches, the T loop can be activated 3mm distal to the molar tube. It
delivers a force in the range of 250 - 300 g.

2. For Stainless steel wire arches the activation can be reduced by 50%.

The patient should be monitored once a month, but no further activations are necessary
for 2-3 months. This allows for root correction as well as space closure to occur. Too
frequent reactivation of the T loop causes an excessive tipping with little root
correction.

The following are common side effects of space closure using continuous arch T loops
and their possible solutions. (Table 14)

SR.NO SIDE EFFECT CORRECTION

1. Tipping of the anterior and Increase the alpha and beta

posterior segments into the moments
extraction site

2. Flaring of the anterior teeth Reduce the alpha moment or

increase distal activation

3. Mesial in rotation of the buccal Mesial out rotation in archwire,

segments palatal arch or lingual arch

4. Excessive lingual tipping of Increase the alpha moments

anterior teeth

Table-14: Common side effects of space closure using continuous arch T loops (Taken
from Kuhlberg AJ, Burstone CJ. T-loop position and anchorage control. Am J Orthod
Dentofac Orthop 1997; 112:12-8.)

108
VIII. Broussard System and Asymmetric T Loop Arch Wire

It consists of a continuous arch wire used for intrusion of the incisors with simultaneous
anterior space closure, when a deep bite exists because of upper incisors extrusion. It
enables all the desirable movements in space closure including forces to actively torque,
intrude and retract the anterior teeth to take place simultaneously. In addition, this
archwire extrudes and seats the buccal segments.

The Broussard system uses a combination closing and bite-opening loop that creates a
step between the anterior and posterior segments. (Fig. 70) This acknowledges that with
brackets placed at the same relative height on all the teeth, a step up is required between
the cuspids and the incisors if the buccal segments are to be properly seated in a Class
I relationship and the incisors placed in an overcorrected, end-to-end overbite during
the finishing phase.

Fig. 70: Broussard combination closing and bite opening loop with step between
anterior and posterior segments. (Taken from Hilgers JJ, Farzin-Nia F. Adjuncts to
Bioprogressive therapy: the asymmetrical “T” arch wire. J Clin Orthod 1992; 26:81-6)

The stainless-steel Broussard archwire allows the horizontal loop to be compressed by

the step between the anterior and posterior segments, and the vertical loop to be
activated to retract the upper incisors. The system works quite well, but it is
mechanically inefficient because the vertical loop is being opened.57

Hilgers modification

Hilgers modified the Broussard arch wire and made the vertical component into a
crossed "T", allowing a smaller loop size and greater mechanical efficiency, since the
vertical portion is closed on activation (Fig. 71).

109
 Fig. 71: Hilgers modification with reduced loop size for patient comfort and crossed
"T" for greater mechanical efficiency. (Taken from Hilgers JJ, Farzin-Nia F. Adjuncts
to Bioprogressive therapy: the asymmetrical “T” arch wire. J Clin Orthod 1992; 26:81-
6)

Disadvantages

x Both arch wires take time to bend and are cumbersome in the mouth, often
compromising patient comfort and hygiene.

x In addition, stainless steel wire does not have the working range required for
either loop design to work optimally.

Asymmetrical T arch wire

Asymmetric T arch wire developed by James J. Hilgers as an adjunct to Bioprogressive

therapy and has been proved to be effective in achieving the same tooth movements
produced by the Broussard system.62 (Fig 72)

Fig. 72: Asymmetric "T" archwire made of TMA wire, with 5mm vertical step, 2mm
anterior loop, and 5mm posterior loop. (Taken from Hilgers JJ, Farzin-Nia F. Adjuncts
to Bioprogressive therapy: the asymmetrical “T” arch wire. J Clin Orthod 1992; 26:81-
6.)

i. Wire size and material

It can be fabricated from 0.016” × 0.022” TMA (for 0.018” slot brackets) or 0.019” ×
0.025” TMA (0.022” slot brackets).

110
 ii. Appliance design

This asymmetric T arch wire has a loop that is placed distal to the upper lateral incisors.
The vertical portion of the loop should be 5mm, the anterior loop 2mm, and the
posterior loop 5mm. The archwire should have an exaggerated reverse curve of Spee
and strong distal molar rotation. Bend the loop slightly inward to prevent irritation of
the cheek, and curve the distal ends of the archwire outward to allow easy insertion into
a pre-rotated molar tube (Fig. 73). Trim off the curved ends after final placement and
activation of the wire.

Fig. 73 A. Reverse curve of Spee accentuated with Hollow shop arch-contouring plier.B.
Distal end curved outward to allow easy insertion into pre rotated molar tubes. C. Final
contour of arch wire before preactivation. (Taken from Hilgers JJ, Farzin-Nia F.
Adjuncts to Bioprogressive therapy: the asymmetrical “T” arch wire. J Clin Orthod
1992; 26:81-6.)

iii. Fabrication

To bend the loop into a preformed TMA archwire, use the rounded tip of either a small,
tapered bird-beak plier or a small optical plier. The optical plier produces a more
compact loop. Using the rounded tip prevents nicking the wire, which with TMA can
result in fracture. TMA is resilient enough that it will not twist even when bending a
rectangular wire around the conical plier tip. Exaggerated reverse curve of Spee is

111
accentuated with hollow shop arch contouring plier.

iv. Preactivation

Because of the resiliency of the TMA wire, the shorter, mesial portion of the loop can
be closed and the longer, distal portion opened to create a step between anterior and
posterior segments that allows simultaneous bite opening and anterior space closure.
(Fig 74)

Fig. 74: Preactivation of Asymmetric "T" loop. A. Short mesial loop compressed. B.
Long distal loop opened. C. Loop after preactivation. (Taken from Hilgers JJ, Farzin-
Nia F. Adjuncts to Bioprogressive therapy: the asymmetrical “T” arch wire. J Clin
Orthod 1992; 26:81-6.)

v. Intraoral activation

1. Once the continuous Asymmetric "T" archwire has been placed, it can be
activated intra orally to advance the upper incisors during the initial phase of
treatment, or to increase torque during retraction.

2. The shape memory of the wire and the loop configuration make this a
multipurpose system that can be incorporated into a continuous arch wire.

112
3. In the initial phase of Class II, division 2 treatment, where the upper incisors are
extruded and in linguoversion, the loop acts to advance the upper incisors and
to add to the torque that is already incorporated in the incisor brackets.

4. The reverse curve of Spee accentuates the leveling process and creates overjet,
making the lower incisors accessible for bracketing.

5. This advancing/torquing moment can be achieved by pinching a small, inverted

gable bend at the top of the closing loop with a tapered optical or three-loop tier
plier (Fig75)

Fig. 75: Intraoral activation made with inverted optical plier at top of loop. Gable
bend opens loop at base and adds torque, thus advancing and intruding incisors.
(Taken from Hilgers JJ, Farzin-Nia F. Adjuncts to Bioprogressive therapy: the
asymmetrical “T” arch wire. J Clin Orthod 1992; 26:81-6.)

6. The intraoral activation opens the loop at its base, which tends to advance the
upper incisors; it also adds lingual root torque through the upward gable bend,
which enhances bite opening.

7. A gable bend is not appropriate when closing anterior space, because opening
the loop at its base detracts from the activation space needed to retract the
anterior teeth.

8. If increased torque is desired during space closure, use the optical plier to place
a small gable bend or "V" in the mesial vertical step of the closing loop (Fig.
76). This affords almost full space closure by not opening the loop at the base.

113
 Fig.76: Intraoral activation placed in mesial vertical step. Base of loop is still relatively
closed, allowing addition of torque without affecting space closure. (Taken from Hilgers
JJ, Farzin-Nia F. Adjuncts to Bioprogressive therapy: the asymmetrical “T” arch wire.
J Clin Orthod 1992; 26:81-6.)

9. The ability to add torque while the archwire is fully engaged to be particularly
helpful when using ceramic brackets. Lingual root torque can be placed without
having to deflect the wire into the slot, which can fracture a fragile ceramic
bracket.

114
 Chapter 10: Conclusion
This dissertation attempted to highlight the various uses of Loop designs and its
mechanics in orthodontics and previous research findings that may have relevance
to orthodontics.

Over the years, different loop configurations for closing spaces have been
developed and are used in both continuous and segmented arches to provide tooth
movement. The use of loops for closing spaces in orthodontics requires the
professional to know the force systems offered by the orthodontic treatment
mechanics.

Loop mechanics or frictionless mechanics uses loop bends to generate force to close
the space site, allowing differential moments in the active and reactive units, leading
to better anchorage control. The drawback of sliding mechanics in terms of
overcoming the amount of friction generated between the bracket and the wire
interface, before bringing effective tooth movement, can be avoided in
frictionless/loop mechanics. Loops provide the required M/F ratio with great
predictability and versatility. The spring characteristics of the loops are mainly
determined by some factors, such as the wire material, arch-wire cross section,
interbracket distance, configuration and position of the loop.

In contemporary orthodontics, different space closure loop configurations have

been developed such as vertical closing loop, teardrop loops, T-loops, omega loop,
L- loops, opus loop, keyhole loop, K-SIR loop etc. Some designs have more
advantages than others. When all are considered, T- loop is one of the most versatile
loop designs.

A truism of life is: “the more things change, the more they remain the same”. The
same, certainly holds true for orthodontics. For as much as we believe we are
revolutionizing the speciality, we are only modifying and improving that we have
seen in earlier years. Certain modifications in the loop designs have allowed
simultaneous intrusion with retraction so as to achieve space closure in addition to
correction of bite. For example, K-SIR loop.

115
In conclusion, our findings are that, when applied with skill and professional
judgment, loop designs and its mechanics represents a significant improvement over
conventional orthodontics mechanics and is a valuable addition to the orthodontist’s
practice. As the age advances, we will definitely get better wires and new loop
designs, so now it depends on us how we use the basic biomechanics principles to
improve the orthodontic treatment time and better results.

116
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