Straight wire: The next generation

Thomas D. Creekmore, DDS, and Randy L. Kunik, DDS

Houston, Texas

Frequently, the anticipated results of treatment are not achieved by using preadjusted appliances
and straight wires. This is due to inaccurate bracket placement, variations in tooth structure,
variations in the maxillary/mandibular relationships, tissue rebound, and mechanical deficiencies of
edgewise orthodontic appliances. Clearly, one preadjusted appliance prescription cannot fit all
orthodontic patients. Individualized prescriptions for preadjusted orthodontic appliances can be
fabricated once all of these reasons are recognized. From the cephalogram and visual treatment
objective, the desired position of maxillary and mandibular incisors can be determined according to
the maxillary/mandibular relationships. The torque angle of the labial surface of maxillary and
mandibular incisors relative to the arch wire plane can be measured with an incisor torque
template. The development and refinement of a system to vary the orientation of the bracket arch
wire slot relative to the labial surface of each tooth provides a solution to these problems. Beyond
the accuracy or inaccuracy of bracket placement and the fact that brackets are placed away from
the center of resistance, orthodontic appliances have two additional significant mechanical
deficiencies; play between the arch wire and the arch wire slot, and force diminution. These
deficiencies cannot be eliminated from current appliances, however, they can be minimized by
using reasonably stiff arch wires approximating the size of the arch wire slots. The amount of play
plus the amount of force diminution inherent in your appliance can be added to or subtracted from
the torque, tip, rotation, and height parameters for each bracket to deliver the teeth to the desired
positions. Therefore treatment goals can be achieved with maximum efficiency. (AM J ORTHOD
DENTOFACORTHOP1993; 104:8-20.)

A n d r e w s ' made extensive measurements nately differ in torque values for maxillary and
on untreated and treated excellent occlusions. He mandibular anterior teeth (Table I). However,
determined the average tip and torque angles and these additional preadjusted appliances also re-
in/out dimensions of the labial surface of each quire some arch wire adjustments in many cases.
tooth relative to a flat labial arch wire plane? There are at least five reasons why current
These dimensions, representing the goals of indi- preadjusted orthodontic appliances do not achieve
vidual tooth positions, were then used to fabricate ideal tooth positions with the use of "straight"
brackets for each tooth. When each bracket was wires.
precisely positioned at the midpoint of the facial
1. The most frequent reason is inaccurate
axis and aligned with the facial axis, they collec-
bracket placement. Balut et al. 9 evaluated
tively became the Straight Wire appliance (A Com-
the variations in bracket placement by 10
pany, Inc., San Diego, Calif.)? This, in effect, ori-
orthodontic faculty members. A mean of 0.34
ents the arch wire slot for a specific tip, torque, and
mm for the vertical discrepancies and a
rotation angle, plus height and in/out dimensions to
mean of 5.54 ~ for the angular discrepancies
the facial surface of each tooth.
were found in placement of orthodontic
Experienc e with Andrews "prescription" has
brackets. Since the facial surface of the tooth
shown that these goals of individual tooth positions
is curved both mesiodistally and occlusogin-
were not always achieved, with straight wires only,
givally, misplaced brackets in the mesiodistal
and required arch wire bending to achieve ideal
pIane result in rotational irregularities,
results. This is evidenced by the proliferation of
whereas those in the occlusogingival plane
additional preadjusted appliances or "prescrip-
result in torque, as well as height errors.
tions" from Creekmore, 2 Ruth, 3 Ricketts,' Root, 5
Alexander, 6 H!lgers, 7 and others, 8 which predomi- Brackets not aligned with the long axis of the
tooth result in tip variations.
Copyright 9 1993 by the American Association of Orthodontists. 2. Variations in tooth structure, such as irreg-
0889-5406/93/$l.00 + 0.10 8/1/43553 ular facial surfaces, crown-root angulations,
8
American Journal of Orthodontics and Dentofacial Orthopedics Creekmore and Kunik 9
Volume 104, No. 1

Table I. Prescriptions for torque differ as much as 15 ~ for maxillary anterior teeth

Prescriptions for torques (degrees)

Andrews ] Roth Alexander Hilgers

Maxillary
1/1 + 7 + 12 + 14 + 22
2/2 +3 +8 +8 +14
3/3 -7 -2 -3 +7
54/45 -7 -7 -7 -7
6/6 - 9 - 14 - 10 - 10
Mandibular
21/12 - 1 - 1 -5 - I
3/3 -11 -11 -7 +7
4/4 -17 -17 -ll -11
5/5 - 22 - 22 - 17 - 22
6/6 - 26 - 30 - 22 - 27

and unusual crown shapes require variations least three significant mechanical deficien-
in their tip, torque, rotation, and height pa- cies: (a) force application to teeth through
rameters to achieve optimum results as de- brackets located away from the center of
scribed by Dellinger, 1~ Vardimon and Lam- resistance, ~~ (b) play between the arch wire
bertz, n Germane, Bentley and Isaacson, 1~ and the arch wire slot, ~8.19,21 and (c) force
Morrow, ~3 and Taylor. 14 diminution.
3. Variations in the vertical and anteroposte- a. By necessity, brackets cannot be placed at
rior jaw relationships require variations in the center of resistance of a tooth. Con-
the positions of maxillary and mandibu- sequently, the application of a force to a
lar incisors. Compared with Class I skeletal tooth by an arch wire also produces addi-
frameworks, maxillary incisors are more tional forces on the tooth. For example,
procumbent and mandibular incisors are teeth distal to an extraction space will tip
more upright in Class III skeletal frame- and rotate mesially, whereas those mesial
works; whereas, mandibular incisors are to the extraction space will tip and rotate
more procumbent and maxillary incisors are distally as the space is reciprocally closed.
more upright in Class II frameworks, is Ross Andrews ~ designed a series of antitip/
et al. 16 have shown that the faciolingual in- antirotational brackets specifically for
clinations of the maxillary incisors relative to these problems. Protraction or depression
the occlusal plane can vary as much as 13~ forces on incisors produce lingual root
between high angle and low angle vertical torque, whereas retraction or extrusion
patterns (Fig. 1). They state: "It is clear that forces produce labial root torque. These
the concept of 'one appliance fits all' defies additional forces would have limited ef-
the normal biologic variation among orth- fect if our orthodontic appliances were
odontic patients." 100% effective, which, unfortunately, they
4. Zachrisson j7 showed the correction of rota- are not. Only by happenstance does a
tions of 9/10s by bending the arch wires to rectangular arch wire become parallel
achieve rotations of 11/10s or 12/10s. Subse- with the rectangular arch wire slot. This
quently, during retention, the teeth re- discrepancy is due to the play between the
bounded to the desired rotations of 10/10s. arch wire and the arch wire slot and to the
Roth ~ and Swain ~ suggest that overcorrec- diminution of force from a "straight" arch
tions for tissue rebound or relapse tenden- wire.
cies should not be limited to rotations but b. Play between the arch wire and the arch
should include overcorrections for heights, wire slot is required if arch wires are to be
tips, and torques as well. removed and reinserted. A precise
5. Edgewise orthodontic appliances have at 0.018 x 0.025-inch arch wire is a very
10 Creekmore and Kunik American Jours~alof Orthodontics and Dentofacial Orthopedics
July 1993

N
S High

U1

MP
I !.4 ~

L1

Fig. 1. Spatial relationships of mandibular plane (MP), occlusal planes (OP), upper incisor (U1), and
the lower incisor (1_1), superimposed on cranial base. Values represent mean Inclinations. (From
Ross et al., AM J ORTHOD DENTOFACORTHOP 1990.TM)

Table Ih T o r q u i n g play f r o m parallel.* tight fit in a precise 0.018 x 0.025-inch

A m o u n t the arch wire can r o t a t e in the slot slot. T h e wire could not b e inserted or
in either direction f r o m a parallel position. r e m o v e d by hand. Wires and slots cannot
Delivered labial or lingual r o o t torque be m a d e precisely every time. Manufac-
equals t o r q u e in the slot plus or minus turing tolerances result in 0.018-inch slots
play, respectively ranging from 0.0182 to 0.0192 inches, and
0.022-inch slots ranging from 0.0220 to
Bracket slot size 0.0230 inches. T h e 0.018-inch dimension
Arch wire
size 0.018 x 0.025"[" 1 0.022 • 0.028r in arch wires is actually 0.0178 inches. As
a result, an 0.018 • 0.025-inch arch wire
16 x 16w 12.5 ~ Rotates in an 0.018 • 0.025-inch slot, and an
16 • 22 11.8 ~ 34.3 ~
0.0215 • 0.028-inch arch wire in an
17 • 22 7.3 ~ 27,9 ~
17 x 25 5.9 ~ 21.0 ~
0.022 • 0.028-inch slot have about 3~ of
18 x 181[ 5.5 ~ Rotates torquing play in each direction from par-
18 • 22[[ 3.8 ~ 23.1 ~ aUel (Table II), i.e., 6 ~ total play. This
18 • 2511 3.1~ 17.7~ m e a n s that substantial play exists with
19 • 25 12.8~ "full-sized" arch wires, but it also insures
21 x 25 5.2~
215 x 28 2.9" that they are consistently easy to insert
and remove.
Calculations based on midrange values. T h e greatest a m o u n t of play in an edge-
*Data courtesy 3M/Unitek, wise appliance is in the torquing plane.
~'0.018 t o l e r a n c e s 0.0182 to 0 . 0 1 9 2 m i d r a n g e 0.0187.
:1:0.022 t o l e r a n c e s 0.0220 to 0.0230 m i d r a n e 0.0225.
Torquing play depends on the size of the
w x 0.016 d i m e n s i o n a c t u a l l y 0.01625 • 0.01625. rectangular arch wire relative to the size
110.018 d i m e n s i o n a c t u a l l y 0.0178. of the rectangular arch wire slot (Table
American Journal of Orthodontics and Dentofacial Orthopedics Creekmore and Kunik 11
Volume 104, No, 1

0.20
c__.

1
A B C

Fig. 2. Effect of torquing play. An 0.016 x 0.022-Inch arch wire is in an 0.018 x 0.025-inch maxillary
central incisor bracket with a 12 ~ torqued slot. Torquing play is 11.8 ~ A, The arch wire slot Is parallel
to the arch wire. The bonding base (the crown of the incisor) is 12" to a perpendicular to the arch wire
plane. B, With retraction movement, the incisor will "tuck under" until it reaches a torque of 0.2 ~
(torque in the slot minus torquing play). At this point the arch wire will begin to deliver lingual root
torque. C, With protraction or depression movements, the incisor will procline until it reaches a torque
of 23.8 ~ (torque in the slot plus torquing play). At this point the arch wire will begin to deliver labial
root torque.

I I I I I
[--1 I I I 1 I I I

ml Im I I
I I I I
Fig. a. Play in vertical plane results in incomplete bracket-to-bracket leveling.

II). Most prescriptions have excessive lin- Height or vertical play varies according
gual root torque in the maxillary anterior to the size of the arch wire relative to the
brackets that may deliver adequate lin- size of the arch wire slot. An 0.012-inch
gual root torque for retraction movements stainless steel wire of slightly greater stiff-
using less than full-sized arch wires. This ness than an 0.018-inch nickel titanium
compensates for play, but only during re- wire will not achieve the same tooth-to-
traction movements. Brackets with these tooth leveling as the 0.018-inch wire be-
excessive torques are incapable of deliv- cause of archwire/slot play (Fig. 3).
ering labial root torque during protraction The use of full-sized arch wires and
movements without extensive reverse varying their modulus of elasticity to con-
torquing bends in the arch wire (Fig. 2). trol force delivery, as described by Burst-
 American Journal of Orthodosztics and Dentofacial Orthopedics
12 Creekmore and Kunik
July I993

15

o
510
t~
%

Ij
O

. 5o5 o

"~...~ f,,,
E
O

._~ 5
e~
Q.

\oo

.01 inch .015 inch .02 inch

(.254 turn) (.381 ram) (.51 turn)
Arch thickness (inches and millimelers)

Fig. 4. Play In tipping plane approaches 0~ for aIl bracket widths as size of arch wire approaches size
Qf slot. (From Thurow RC, Edgewise Orthodontics, 4th ed. St Louis: CV Mosby, 1982.)

one, 2z reduces play and thereby eliminates of the rotational lever arm and the quality
the need for intermediate-sized arch of the ligation technique to keep the arch
wires. wire seated in the bottom of the slot.
Play in the tipping plane depends on Ligation force necessary to seat an arch
the size of the arch wire, size of the arch wire increases as the stiffness of the arch
wire slot, and overall width of the slot 23 wire increases or as the length of the
(Fig. 4). However, tipping play is much rotational lever arm decreases. Lever
less than torquing play. An 0.016-inch arms of 0.100 inch (lower anteriors) re-
wire in an 0.018 • 0.025-inch narrow sin- quire tight ligation in rectangular arch
gle bracket has only about 3~ play that wires to keep rotational play to a mini-
reduces to less than 1~ with an 0.018-inch mum. Lever arms less than about 0.075
wire. If torquing play is minimized by inch have excessive play and need some
increasing arch wire size relative to slot type of rotating auxiliary to accomplish
size, then tipping play will be minimized and maintain rotations.
regardless of the width of the bracket. Play can never be eliminated, but it can
Rotational play depends on the length be minimized in the tipping, torquing, and
Americtm Journal q[ Orthodontics and Deatofacial Orthopedi('.~
Volume 104. N o . 1 Creekmore and Kunik 13

-- 8 -- 8
DEEP SITE -- DEEP BITE
6 -- 6

4 -- 4

O J - - O IDEAL

2 2

4 ~ 4

6 ~ 6
OPEN BITE ~ 8 OPEN BITE
8

5A B
8 8
DEEP BITE DEEP BITE
6 ~ 6

4 ~ 4

2 ~ 2

O IDEAL 0 IDEAL

2 ~ 2

4 ~ 4

6 ~ 6
OPEN BITE OPEN BITE
-- 8 -- 8

6A B
Figs. 5. Force diminution. A. Brackets are positioned at standard heights at position S on schematic
teeth A (deep bite case) and B (open bite case). A straight wire from C to X is deflected 6 units to
engage A or B with the expectation that A or B would move to ideal position X. If the stiffness of the
arch wire produces 1 ounce of force per unit of deflection, it will exert 6 ounces of force when
engaged to move A or B toward position X. As A or B moves toward X the force diminishes 1 ounce
per unit of movement. B. If the minimum threshold of force required to move A or B is 1 ounce, A or
B will move 5 units, stopping 1 unit from X when the force delivered by the arch wire equals the
minimum force required for tooth movement. The arch wire does not return to its original shape. This
is not a permanent set in the arch wire. Double the stiffness of the arch wire to 2 ounces per unit of
deflection and A and B will stop +/2 unit from X. Reduce the stiffness to 1/2 ounce per unit of deflection
and A and B will stop 2 units from X. Thus, the effect of force diminution can be reduced by increasing
the stiffness of the arch wire; i.e., the effect of force diminution is less for an 0.018 x 0.025-inch
stainless steel wire than it is for an 0.018 x 0.025-inch TMA wire, which is less than an
0.018 x 0.025-Inch nickel titanium wire, which is less than an 0.018 • 0,025-Inch braided wire,
Fig. 6. Compensation for force diminution. A, Brackets on schematic teeth A and B have been
moved incisally (I) and gingivally (G), respectively, the amount of the effect of force diminution, The
arch wire must now be deflected 7 units to engage the brackets. B. The arch wire still stops 1 unit
from X, but teeth A and B have moved 6 units and are n o w located at the Ideal position X.

vertical planes by "filling" the slot as ment. The force produced by an arch wire
much as possible. Rotational play is min- deflected to engage a malpositioned tooth
imized by using brackets with adequate will diminish as the tooth moves until the
rotational lever arm lengths and ligating minimum threshold of force is reached.
with sufficient force to keep the arch wire At this point, tooth movement will stop
seated in the bottom of the slot. before the arch wire has completely re-
c. Force diminution is the reduction in the turned to its original shape (Fig. 5). The
force produced by an arch wire, deflected straight wire never becomes quite straight.
within its elastic limits, as it returns to its Force diminution occurs in all directions
original shape. A minimum threshold of of tooth movement. It is most evident in
force is required to cause tooth move- leveling an excessive cure of Spee in deep
14 Creekmore and Kunik American Jourmd of Orthodontics attd Denu~u:ial Orthopedics
Jtdy 1993

Fig. 7. Labial slot machine. The labial surface of individual

teeth is oriented to a stationary arch wire slot position,

bite cases or in creating a normal curve of

Spee in open bite cases. In these situa-
tions, although the effect of force dimiml-
tion from tooth-to-tooth may be very
small, the cumulative effect from molars
Fig. 8. Each orientation template is precisely manufactured to
to premolars to anterior teeth results in a provide specific faciolingual Inclination (torque) tangent at
significant undercorrection. specific height and at specific occlusogingival inclination (tip)
Instead of bending arch wires, compen- relative to stationary arch wire slot. A. Orientation for torque
sation for force diminution can be accom- and height is accomplished by aligning the labial surface with
the curved end of the template and the incisal edge even with
plished by changing arch wire slot heights
the top of the template. B. Tip orientation. The long axis of the
(Fig. 6), torques, tips, and rotations equal crown is aligned with the template.
to the effect of force diminution; the exact
amount of which is presently unknown.
Force diminution "adds on" to play. To
our knowledge, the principle of force dim-
Machine (Creekmore Enterprises, Inc., Houston,
inution has not been investigated in the
Texas), have provided a potential solution to the
orthodontic literature.
inaccuracies of bracket placement, anatomic and
It is obvious that the science of current pread- biologic variations, overeorrections for tissue re-
justed appliance fabrication does not address all of bound and relapse, and mechanical deficiencies of
these anatomic and biologic variations and me- preadjusted edgewise orthodontic appliances.
chanical deficiencies. It is still necessary for orth- The Slot Machine (Fig. 7) is not really a bracket
odontists to use their artistic senses and skills to placement device in the traditional sense of bracket
make some first order, second order, and third placement. Rather, it orients the arch wire slot of
order bends in the arch wires to move the teeth to the bracket relative to the facial surface of each
the desired positions. However, the number of tooth on the model. This is accomplished by hold-
bends is not nearly the number of bends necessary ing the arch wire slot stationary while manipulating
with standard edgewise appliances. each tooth to any tip angle, torque angle, rotation
angle, and height through the use of orientation
THE SLOT MACHINE AND INDIRECT BONDING templates and a rotation guide (Figs. 8 and 9).
Lingual orthodontics necessitated further devel- Each parameter can be selectively varied indepen-
opment of accurate bracket placement and consis- dently of the others. Once the labial surface is
tent indirect bonding procedures. Immensely im- oriented as desired; the bracket, while being held
proved indirect bonding materials and procedures, stationary by the arch wire slot (Fig. 7), is attached
pIus the development and refinement of a system to the tooth with bonding material that fills in any
to optimally position the bracket slot, the Slot gap between the bracket base and the tooth. This
American Journal of Orthodontics and Denttfitcial Orthopedics Creekmore and Kunik 15
Volume 104, No. I

Fig. 10. Extraction case Immediately after removal of Roth

prescription appliance. Standard heights position slots of max-
illary lateral incisors and canines 0.25 mm shorter and
0.25 mm longer, respectively, than the central incisors, which
are 4.5 mm from the incisal edges.

T a b l e III. Standard bracket heights are determined

by the orientation templates. Height
adjustment spacers (shims) placed under the
bracket holder or u n d e r the orientation
templates position the brackets m o r e
incisally or gingivally, respectively, the
thickness of the spacer
Fig. 9. Rotation guide. The center line is parallel to the floor of
the stationary arch wire slot. The other two lines diverge at 4 ~ Bracketheights (mm)
A, Orientation for 0~ rotation, B. Orientation for overrotation
of 4 ~ Deepbites 1 Standard [ Openbites
Maxillary
1/1 3.9 4.5 5.1
customized base maintains the orientation of the 2/2 3.62 4.25 4.87
3/3 4.37 4.75 5.12
arch wire slot when the brackets are transferred to 4/4 4.5 4.5 4.5
the patient's teeth by current indirect bonding 5/5 4.5 4.5 4.5
procedures. For example, a standard edgewise ca- 6/6 3.75 3.75 3.75
nine bracket that has 0 ~ torque, 0 ~ tip, and 0 ~ Mandibtt lar
rotation can be oriented with a Roth prescription 21/12 3.37 4.0 4.62
3/3 3.87 4.25 4.62
orientation template and the rotation guide to 4/4 4.0 4.0 4.0
produce the slot oriented with 13 ~ tip, - 2 ~ torque, 5/5 3.75 3.75 3.75
and 4~ antirotation. In contrast to traditional 6/6 3.5 3.5 3.5
bracket placement, the bracket base is not permit-
ted to become tangent to the facial surface of the
tooth. Therefore the tip, torque, and rotation pa-
rameters of the arch wire slot built into the bracket arch wire slot for each tooth in each individual case
will not be oriented to the tooth the same as it according to the tooth m o v e m e n t s required by the
would be with bracket placement by hand. treatment plan to correct the malocclusion. Fabri-
cation of the advanced preadjusted appliance be-
ADVANCED PREADJUSTED APPLIANCE
gins with a standard prescription with specific
FABRICATION
heights of the arch wire slot from the incisal edges
The Slot Machine gives the orthodontist the or cusp tips (Fig. 10, Tables I and Ill). It is from
capability to accurately vary the orientation of the this standard appliance that variations are m a d e
 America..Iournal t( Ortlmdonticw and Deotofacial OrthtqJedica
16 C r e e k m o r e and Kunik July 19t~3

10 ~

-6 ~

,6 o
Fig. 13. Second premolar has 2 ~ mesial root angulation and
4 ~ distal overrotation to compensate for adverse effects of
space closure.
Fig. 11. Incisor torque template. The torque angle of the lanai
surface of maxillary and mandibular incisors, relative to their
arch wire plane, can be measured directly on the cephalogram
or on the cephalometric tracing or visual treatment objective. Torque Template (Creekmore Enterprises, Inc.,
Houston, Texas) (Fig. 11), actual measurements of
the angulation of maxillary and mandibular central
incisors relative to their arch wire plane can be
made on the cephalogram and the visual t r e a t m e n t
objective to provide more accurate torque require-
ments for that person. Once these goals are deter-
mined, increasing or decreasing the actual torques
in the custom pad by 4 ~ is usually adequate to
compensate for play and force diminution. Roth's
Fig. 12. Lingually displaced lateral incisors need 4 ~ additional
prescription (12 ~ 8 ~ and - 2 ~ is used for extrac-
labial root torque relative to central incisors to compensate for tion cases or cases that require the delivery o f
play and force diminution. lingual root torque of the anterior teeth (Table I,
Fig. 10). These torques would deliver finished
torques of approximately 8~, 4~, and 2 ~. Andrew's
according to the treatment plan. The actual prescription (7 ~ 3~ and - 7 ~ for torque o n maxil-
amount of variation in the orientation of the arch lary anterior teeth and Alexander's prescription
wire slot needed to compensate for play and force ( - 5 ~ for torque on mandibular anterior t e e t h are
diminution will vary with the appliance and arch used for nonextraction cases or cases that require
wires used in treatment. An 0.018 x 0.025-inch the delivery of labial root torque. These torques
Mini Uni-Twin (3M Unitek, Monrovia, Calif.) ap- would deliver finished torques of approximately
pliance with 0.018-inch and 0.018 x 0.025-inch 11~ 7 ~ 3 ~ and - 1~ Torque variations need not be
nickel titanium intermediate arch wires and limited to these available prescriptions; greater or
0.018 x 0.022-inch stainless steel finishing arch lesser torques can be used as needed.
wires was used to provide the specific recommen- Different prescriptions can be mixed to achieve
dations in this article. the desired root torques. In cases with lingually
Torque. According to Andrews findings, ~ the displaced mandibular lateral incisors, - 1 ~ torque
average faciolingual inclinations of the crowns rel- for the central incisors and - 5 ~ torque for the
ative to the arch wire plane is 7 ~ 3~ - 7 ~ and - 1~ Iateral incisors will usually bring the roots of the
for maxillary centrals, laterals, canines, and man- lateral incisors forward to equalize the torques of
dibular incisors, respectively. These data provide the central incisors (Fig. 12). With Class II, Divi-
excellent goals for the faciolingual inclination of sion 2 maxillary anterior teeth, Roth torques on
anterior teeth in average vertical and anteroposte- central incisors (12~ which need lingual root
rior skeletal patterns. With the use of an Incisor movement, and Andrews torques on lateral incisors
 American Journal o] Orthodontics and I)entqfacial Orthopedics
Creekmore and Kunik 17
Volume 104, No. I

(3~ which need labial root movement, should be

used. Class I or Class III nonextraction eases with
maxillary lateral incisors palatally displaced need
Andrew's central incisor torque (7 ~) and lower
incisor torque ( - 1 ~ on the lateral incisors. These
examples illustrate the manner in which the
torques of the slots can be individualized to deliver
the required torque depending on the direction of
tooth movement.
Tip angulations can be varied on posterior teeth
according to anchorage requirements I' and adja-
cent to extraction sites (Fig. 13). Variations of 2~ to
4~ are usually adequate to assure root paralleling.
Tips can also be altered to accommodate morpho-
logic variations and overcorrections.
Rotation angles can be accurately measured with
the use of the rotation guide (Fig. 9). Overrotations
and antirotations can be predictably varied produc-
ing the desired corrections. Two degrees of overro-
tation insures 10/10ths corrections. This amount of
overrotation is barely noticeable, whereas 4 ~ of over-
rotation is obvious (Fig. 14). Four degrees of antiro-
tation is recommended adjacent to extraction sites
(Fig. 13). Rotations are accomplished early in treat-
merit with the initial round arch wires and main-
tained throughout treatment.
~
A bracket does not have to be in the center of
the tooth to produce the desired rotation. The Fig. 14. A. Overrotations of 4 ~ were applied to left central
center of the rotational force of a single bracket incisor and right and left lateral incisors. B. Overrotations were
accomplished with initial round wires and maintained through-
with rotation wings is not in the center of the tooth
out treatment,
as it is with a twin bracket, yet the single bracket is
very effective in the rotation of teeth. Twin brack-
ets that cannot be positioned in the center of a change the torque. For short or long clinical crowns,
tooth because of overlapping teeth can be offset all the brackets can be raised or lowered uniformly
laterally as long as the floor of the slot is properly simply by inserting a spacer 0.375 mm (0.015 inch)
oriented for rotation (Fig. 15). Proper rotation will or 0.625 mm (0.025 inch) in thickness under the
be achieved, and the bracket will not have to be bracket holder or under the orientation template.
repositioned in the future. This principle is espe- Bracket heights on quadrants of teeth or on indi-
cially beneficial for lingual treatment. vidual teeth, relative to adjacent teeth, can also be
Height measurements for each tooth are made precisely varied as little as 0.25 mm to compensate
vertically from the arch wire slot to the incisal edge for the small, cumulative effect of force diminution
or cusp tip with the labial surface at a specified (Figs. 16 and 17).
torque angle tangent at this point (Fig. 8, A). With Fabrication of advanced preadjusted appliances
the use of the Slot Machine, much more precise require planning before the placement of brackets
height measurements are possible. Recommended on the teeth. The most efficient time for this
standard heights are 4.5 ram, 4.25 mm, and 4.75 planning is during the formulation of the treatment
mm for maxillary central incisors, lateral incisors, plan when all of the records are being studied. As
and canines, respectively (Table Ill and Fig. 10). individual tooth movements are determined to
The clinically important factor for bracket height is achieve the goals of treatment, the prescription for
the height of each bracket relative to all of the individualized tip, torque, rotation, and height pa-
other brackets rather than the actual height on the rameters for each bracket can be entered into the
tooth. Since the Slot Machine holds the bracket by patient's chart to be used by the laboratory techni-
the arch wire slot, changh~g bracket height will not cian at the time brackets are positioned on the
18 Creekmore and Kunik Amerir Jou/'ltal of Or/hodonlh','; and De,,Ih~ftu.'ia/ Orlhopedic.~
,bdy 1993

Fig. 15. A. Bracket could not be positioned in center of right canine because of malocclusion. B.
Bracket was offset mesially, but the floor of the slot was properly oriented for rotation. C. Correct
rotation was achieved without repositioning the bracket or bending the arch wire,

Fig. 16. A. Adult patient with Class II malocclusion with very deep overbite and excessive curve of
8pee, B. Canine and incisor brackets were shimmed 0,375 mm and 0,625 ram, respectively, incisal
to their standard heights. Standard heights were used on the premolars and molars. The initial arch
wire is an 0.018-inch Nitinol. C. Second and final arch wire is 0.017 x 0.022-inch stainless steel
straight wire that leveled the curve of Spee and opened the bite with no other adjustments.
American Journal e~"Orthodontics and Dentofiwhzl Orthopedics
Creekmore and Kunik 19
Vohtme 104, No. I

Fig. 17. A. Adult mild open bite with reverse curve of Spee. B. Mandibular canine and incisor
brackets were shimmed 0.375 mm and 0.625 mm, respectively, gingival to standard heights while
maintaining standard heights on premolars and molars. C. Maxillary central and lateral Incisors were
shimmed gingivally 0.375 mm and 0.625 ram, respectively. Finishing arch wires are O.017 x 0.022-
inch stainless steel straight wires. 13. Roth torques were used on all maxillary anterior teeth except on
the left lateral incisors that had Andrews torque to provide additional labial root torque.

Fig. 18. A. Adult with congenital absence of maxillary second premolars and mandibular Incisor.
Second deciduous molars were extracted, and the space closed. B. Arch wires used with
0.018 • 0.025-inch Roth prescription Transcend appliance were maxillary-0.0155-inch braided,
0.018-inch Nitinol, 0.018 • 0.025-inch Nitinol, 0.017 x 0.022-inch stainless steel closing arch wire,
0.017 • 0.022-inch stainless steel finishing arch wire, and mandibular-same arch wire sequence
except no closing arch wire was required. All were straight wires. C. Treatment time: maxillary 21
months, mandibular 19 months.
 American Journal of Orthodontics and Dentofacial Orthopedics
20 Creekmore and Kunik
July 1993

models for indirect bracket placement. The orth- 2. Creekmore TD. The new torqued appliance. J Clin Orthod
odontist maintains quality control by inspecting the 1973;7:553-73.
3. Roth RH. Roth straight wire appliance philosophy. San
bracket placement for errors before fabrication of Diego, Californla: " A " Company, Inc., 1979.
the transfer tray. 4, Kicketts RM. Bioprogressive therapy as an answer to orth-
Arch wire slot orientation and indirect bonding odontic needs. Part L AM J OKTI-IOD 1976;70:241-67.
techniques require more training and laboratory 5. Root TL. The level anchorage system. In: Graber LW, ed.
time for auxiliary personnel than the training and Orthodontics state of the art essence of the science. St
Louis: CV Mosby, 1986.
time required for direct bonding. However, the 6. Alexander RG. The varisimplex discipline. Part 1. Concept
benefits gained in quality control, simplicity of and appliance design. J Clin Orthop 1983;17:380-92.
treatment, reduced treatment time, and reduced 7. Hanson GH. Prescriptions for the Speed appliance. San
chair time more than off-set this additional expense Clemente, California: OREC, 1989:6.
8. The Prescription Analyzer. Glendora, California: Ormco,
and effort (Fig. 18).
1983:I-2.
9. Balut N, Klapper L, Sandrik J, Bowman D. Variations in
SUMMARY
bracket placement in the preadjusted orthodontic appliance.
Frequently, the anticipated results of treatment AM J ORTHOD DENTOFAC ORTHOP 1992;102:62-7.
are not achieved by using preadjusted appliances 10. Dellinger EL. A scientific assessment of the straight-wire
appliance. AM I OR'nlOD 1978;73:290-9.
and straight wires. This is due to inaccurate bracket
11. Vardimon AD, Lambertz W. Statistical evaluation of torque
placement, variations in tooth structure, variations angles in reference to straight-wire appliance (SWA) theo-
in the maxillary/mandibular relationships, tissue ries. AM J ORTHOD 1986;89:56-66.
rebound, and mechanical deficiencies of edgewise 12. Germane N, Bentley BE, isaacson RJ. Three biologic vari-
orthodontic appliances. Clearly, one preadjusted ables modifying faciolingual tooth angulation by straight-
appliance prescription cannot fit all orthodontic wire appliances. AM J ORTHOD DENTOFAC ORTHOP 1989;
96:312-9.
patients. Individualized prescriptions for pread- 13. Morrow JB. The angular variability of the facial surfaces of
justed orthodontic appliances can be fabricated the human dentition: an evaluation of the morphological
once all of these reasons are recognized. From the assumptions implicit in the various "straight-wire tech-
cephalogram and visual treatment objective, the niques" [Thesis.] St Louis: St Louis University, 1978.
desired position of maxilIary and mandibular inci- ~4. Taylor RMS. Variation in form of human teeth. I. Art
anthropologic and forensic study of maxillary incisors.
sors can be determined according to the maxil- J Dent Res 1969;48:173-82.
lary/mandibular relationships. The torque angle of 15. Root TL. The level anchorage system. In: Graber LW, ed.
the labial surface of maxillary and mandibular Orthodontics state of the art essence of the science. St
incisors, relative to their arch wire plane, can be Louis: CV Mosby, 1986.
measured with an incisor torque template. The 16. Ross V, Isaacson ILl, Germane N, Rubenstein LK. Influence
of vertical growth pattern on faciolingual inclinations and
development and refinement of a system to opti- treatment mechanics. AM J ORTHOD DENTOFAC ORTHOP
mally position the bracket slot provides a solution 1990;98:422-9.
to these problems. Beyond the accuracy or inaccu- 17. Zachrisson BU. Interview on excellence in finishing. Part 2.
racy of bracket placement and the fact that brack- I Clin Orthod 1986;20:536-56.
ets are placed away from the center of resistance, 18. Roth RH. Treatment mechanics for the Straight Wire
appliance. In: Graber TM, Swain BF, eds. Orthodontics:
orthodontic appliances have two additional signifi- current principles and techniques. St Louis: CV Mosby,
cant mechanical deficiencies; play between the arch 1985.
wire and the arch wire slot, and force diminution. 19. Swain BF. Straight wire design strategies: five-year evalua-
These deficiencies cannot be eliminated from cur- tion of the Roth modification of the Andrews straight wire
rent appliances, but they can be minimized by using appliance. In: Graber LW, ed. Orthodontics state of the art
essence of the science. St Louis: CV Mosby, 1986.
reasonably stiff arch wires approximating the size 20. Nagerl H, Burstone C.1, Becket B, Kubein-Messenburg D.
of the arch wire slots. The amount of play plus the Centers of rotation with transverse forces: an experimental
amount of force diminution inherent in your appli- study. AM J ORTHOD DENTOFAC ORTHOP 1991;99;337-45.
ance can be added to or subtracted from the 21. Creekmore TD. Interview on torque. J Clin Orthod 1979;
torque, tip, rotation, and height parameters for 13:305-10.
22. Burstone CJ. Variable-modulus orthodontics. AM J
each bracket to deliver the teeth to the desired ORTHOD 1981;80:1-16.
positions. Therefore treatment goals can be 23. Thurow RC. Tipping freedom. In: Edgewise orthodontics.
achieved with maximum efficiency. St Louis: CV Mosby, 1966.
Reprint reqttests to:
REFERENCES Dr. Thomas D. Creekmore
1620 Fountainview
1. Andrews LF. Straight wire the concept and appliance. San
Houston, TX 77057
Diego, California: LA Wells, 1989.