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" A Comparative Evaluation of Canine retraction and

Anchorage loss using Self-ligating and conventional


MDT Pre-adjusted edgewise bracket systems
- A Clinical Study"
Authors:

Dr. Vikas Agrawal, B.D.S. (Corresponding author)


Post Graduate Student,
Department of Orthodontics & Dentofac ial Orthopedics,
J. S.S. Denta l Col lege & Hosp ita l,
5.5. Nagar, M ysore (Ka rn atakal - 570015 .
Phone: 0934 1854410.

Dr. B.M.Shivalinga, M.D.S.

Dr. S.M. Shiva linga

Professor,
Dept. of Orthodontics and Dentofacial Orthopedics,
J.S.S. Dental Co ll ege and Hosp ita l,
5.5. Nagar, M ysore (Karnatakal-5 70015.
Phone: 09886844840.

Dr. Raghunath N., M.D.S.


Associate Professor,
Department of O rthodontics & Dentofacia l O rthopedics,
J.S.S. Dental Co ll ege & Hospital ,
Mysore (Karnatakal - 570 015.
Dr. Ra ghunath N

Abstract

The purpose of th is clinica l study was to compare the rate of ca nine retraction between selfligating SmartClip (3M Unitek) and conventional (3M Unitek) MBT preadj usted edgewise bracket
systems. Anchorage loss as a result of this movement was also eva luated. The study sample
consisted of B adolescent or adult patients in w hom first premolar extractions were indicated as
a part of orth odontic treatment. Space closure was achieved o n 0.0 19 x 0.022-inch stai nless
steel w ire w ith 9mm (150gmsl nickel-titanium closed coi l springs (3 M Un itek) . The patients were
recalled after every 4weeks unti l 1 side had complete retraction of ca nine. M easurements were
performed by direct technique f rom stone cast obtained before and at the completion of retraction
with the help of digital vernier ca liper. The rate of retraction and anchorage loss were eva luated.
The resu lts indicated that the mea n rate of retraction w as 1.1717 mm 0.1 3562 m mlinterva l and
1.1209 mm 0. 13298 mmlinterva l for self-ligati ng and conventional M BT preadjusted edgewise
brackets respectively. The average difference in the rates of retraction was 0.0508 mmlinterval.
There was no statistica lly significant difference in the rates between self-ligati ng and conventional
brackets (p=0 .060). The mean anchorage loss was 1.8375 mm 0.44381 mm for self-ligati ng
bracket and 1.9500 mm 0.4559 1 mm for conventional bracket. The mean di fference in
anchorage loss was 0.1 125 mm. The difference in the amount of anchorage loss was also not
statistically significant (p=0.069).

KeyWords

Self-ligating bracket, conventional bracket, rate of retraction, anchorage Loss.

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INTRODUCTION

AIMS AND OBJECTIVES OF THE STUDY:

O rt hodontic treatment with sliding mechanics involves


a relative displacement of wire through the bracket slots
and whenever sliding occurs, fri ctional res istance is
encoun tered .' Fri cti on may stop tooth movement
entirely and/or jeopardize anchorage. The magnitude,
co nt ro l and cl ini cal signifi ca nce of thi s fri cti o nal
res istance are largely unknown .' Up to 60% of the
applied force is dissipated as fri ction w hi ch reduces
the force ava il able for tooth movement, such that an
adequate translating force must be appl ied in order to
overcome the fri ctional force. With increasi ng fri ctional
res istance, proporti onall y greater forces would be
required.'

To determin e the efficiency of self- ligating brackets


during segmental ca nine retraction by compari son of

Rate of canine retraction using self-l igati ng and


co nventi o nal MBT prea dju sted edgew ise
bracket systems tied w ith steel ligature w ire.

An chorage loss after ca nine retraction using


self- ligating and conventional M BT preadjusted
edgewise brac ket systems ti ed w ith steel
ligature w ire.

MATERIALS AND METHODS:


Eight orthodontic patients (5 female and 3 male) w ho
needed first premolar extracti on and ca nine retraction
bilaterall y in the max ill a as a part of orth odontic
treatment were selected . The patients' age ranged from
13 to 25 years. The pati ents selected, were undergoi ng
o rth o donti c trea tm ent in th e D ep art ment of
O rthodonti cs and Dentofacia l O rth opedics, J. S. S.
Dental Coll ege and Hospital, M ysore. Each patient
received two different brackets pl aced on oppos ite
ca nine teeth within the max illary arch. The ca ni ne
brackets used in the study were self-ligating (SmartCi ip)
MBT preadjusted edgewise bracket, (0.022 inch Slot)
on ri ght si de and conventi o nal MBT prea dju sted
edgewise bracket, (0.02 2 inch Slot) on left side ..

It has been stated that fri cti on was determin ed mostl y


by the nature of ligati on and not by dimensions of
diiferent archw ires. Friction is related to the appl ied
norm al force, w hich is influenced by the degree of
tension of the ligature engaging the archw ire into the
slot and the coeffi cient of fri ction between the ligatu re
and the arch w ire materi aL'
An approach to reduci ng fri ction has been to avoid
using any form of ligation. Th is has been achi eved by
Self-ligating bracket systems.' The first Se lf-li gatin g
bracket, the Ru ssell attachment, was developed by a
New York O rthodontic pioneer, Dr.Jacob Stolzenberg,
in the earl y 1930s,. The mechanism of thi s revolutionary
bracket was in sta rk contrast to the traditional approach
oi tying steel ligatures tightly aroun d each bracket. It
had a i lat head sc rew seated snugly in a circular,
threaded opening in the face of the bracket.'

SElECTION CRITERIA:
Inclusion Criteria:

Self-ligating brackets are ligature less bracket systems


that have a mechani ca l device, an acti ve clip or a
pass ive slide built into the bracket to close off the
edgewise s10t. 5 D ifferent bracket types w ith adjustable
labial covers (Self- l iga t io n brac kets) have been
ma nu fa ctured that suggest such brackets generate less
fri ction, and allows for faster sliding mechanics beca use
the labia l cover may not contact the arch w ire and
therefore elimi nate one source of the normal force
caused by pressure from conventio nal steel ties or
elastomeri c ligatures ' It would than be expected that
the Se lf- l iga ting bracket may redu ce th e overall
trea tment time.

Subj ec ts w ho nee ded sepa rate ca nin e


retraction and first premolar extraction as a part
of orth odonti c treatment.

Subjects w ith perm anent dentition and w ho


demonstrated Class I and/or class II division 1
molar relationship.

Ca nine retraction of atleast 3 mm was required.

No previous orth odonti c treatment has been


taken by any of the subjects.

Exclusion Criteria:

Patients w ith oral mani festations of disease or


a chronic debilitating di sease.

Peri odontally compromi sed patients.

DETERMINING RATE OF RETRACTION:

To assess the effi ciency and to examine the more recent


bracket systems, thi s clin ica l stud y was conducted to
compare and eva luate the rate of canine retraction and
anchorage loss using self-ligating and conventional
MBT pre-adj usted edgewise bracket systems tied w ith
steel ligature w ire.

The rate of retractio n was ca lculated as the distance


traveled divided by the time required to complete space
cl osure. Thi s was recorded in millimeters per interval.
An interval was defined as a 4-weeks peri od ! The
ca nines were retracted w ith Class 1 mechanics usi ng
9mm (150gms) Nickel-Titanium (N iTi) Closed coil
30

spring (3 M Unitek) extending from the first molar to


the ca nine brac ket in max ill ary arch.

Pearson's correlation coeffi cient tests were applied to


the results.

Pati ents were seen at 4-w eeks interva l until retraction


was co mpl eted . A co ntinu o u s, pass ivel y fitt ed
0. 01 9 x 0.02 5 inch stainless steel arch wire was used
for canine retraction. Initi al leveling and aligning was
done as required and measurements of retraction and
anchorage loss w ere not made until leveling procedure
was completed in all patients. When the working arch
w ire (0.019 x 0 .025 inch stainl ess steel) had been in
pl ace for atleast 4 weeks, prior to ca nine retraction,
max ill ary arch impress ion (TO) was taken of eac h
pa ti ent. It wa s no t kn ow n ex actl y w hen ca nin e
retraction was compl eted w ithin an interva l. Thus the
midpoint of the last interva l was decla red as the end
point of retractio n and aga in maxi Ilary arch impression
(T1 ) was taken of each patient. '

Results:
Rate of retraction of the canine: (Table I and Graph s I)
The maximum rate for the self-ligating bracket was 1.36
mm/ interva l and for the conventi onal bracket it was
1.24 mm/ interva l. The min imum rate was 1.0 mml
interval for the self- ligating brac ket, and 0.9 1 mml
interva l for the conventional bracket. The mea n rate of
retraction was 1.1 71 7 mm 0.13562 mm/ interva l and
1.1 209 0.13298 mm/ interva l respecti ve ly. Th e
average difference in the rates of retraction was 0.0508
mm/ interva l. There was no stati sti ca ll y signifi ca nt
difference in th e rates betwee n se lf-li ga tin g and
conventional brackets (P=0.060).

Anchorage loss of molar: (Tabl e II and Graph II)

Measurements were performed by direct techniqu e


fro m sto ne ca sts obtain ed before (TO ) and at th e
compl etion (Tl ) of retraction with the help of d igital
verni er ca liper. Verni er ca liper w as used to measure
the max imum di stance between the cusp tip of the
canine to the central fossa of the first perm anent molar
at TO and T1 . The difference between the initial (TO)
and fin al (T1 ) measurements w as ca lculated to give
the distance of retracti on, and this was divided by the
num ber of interva ls (mo nth s) to give th e rate o f
retraction in millimeters per interval. Thi s measurement
was repea ted th ree times and the mea n va lue was
taken.'

The self-ligating brackets max imum anc horage loss was


2.2 0 mm w ith a minimum of 0.8 mm and a mean of
1.8375 0.44381 mm. The convent ional bracket had
a max imum anchorage loss of 2.4 5 mm, a minimum
loss of 1.0 mm, and a mea n loss of 1.9500 0.4 559 1
mm. The mea n difference in anchorage loss between
self-ligating and conventional bracket was 0.11 25 mm.
The difference in the amount of anchorage loss w as
also not stati sti ca ll y signi fica nt (P=0.069).

Correlation of rate of retraction and anchorage loss


for the self-ligating and conventional brackets.
Th ere was no st ati sti ca ll y signifi ca nt co rr elat ion
between anchorage loss and the rate of retracti on for
se lf-li ga ting (p= O.8 87) and con ve nt io nal bracket
systems (P=O. 82 0).

DETERMINING ANCHORAGE LOSS:


A nc ho rage loss was reco rd ed as th e amount o f
movement in millimeters that occurred in the direction
opposite to th e d irecti on of th e applied resistance.
D irect cas t meas urements were used rather than
radi ographs. Thi s method was considered to be easier
and accurate, and did not subject pati ents to excessive
radiation exposure. To measure the movement o f each
mo lar, an acryli c palatal plug w as made o n each
max ill ary arch. This plug could thus be transferred from
initial cast (TO) to the fin al cast (Tl ) on the same pati ent.
The plug was fabricated from acryli c w ith reference
w ires (0 .0 19 x 0.025 inch stainless steel) embedded in
the acry lic that extended to the cusp tip o f the ca nine
and to the central fossa of the first mo lar. The initial
model (TO) was used to make the plug, w hich was then
fitted to the fin al model (T1 ) o n the compl eti o n of
re tr ac ti o n o f b o th ca nin es. (Fi g- 1,2,3). Thi s
superimpositio n all owed for the direct observati on of
the amount of molar protracti on (a nchorage loss). ' .'

DISSCUSION:
Self-li ga tin g brac kets have bee n developed in an
attempt to better approx imate the idea l properti es by
overcoming the limitati on o f steel and elastomeri c
li gatures in term s of comfort, efficiency, ease of use,
di scol ouration, p laqu e accumulation and fri cti on.
Num ero us in -v itro studi es have de mo nstrated a
dramatic decrease in fri ction for Self- liga ting brackets,
compared to conventional bracket des igns, 1.J.4.'11 w ith
passi ve Self-ligating brackets showing less fri cti on than
acti ve Self-liga ting brackets. " " Such a redu ction in
fri c ti on ca n help short er overall trea tment tim e,
especia lly in extraction cases w here tooth translation
is achi eved by sliding mechani cs.
Interpreting the result of the present stud y, showed that
there is small clini ca I difference in the rate of retracti on
betw ee n pass i ve se lf-li ga tin g and co nve nti o nal
preadjusted edgewise bracket tied w ith stainless steel

The data obtained were subjected to stati sti ca l analys is.


D escripti ve stati sti cs, Paired sa mpl e " t" test and
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ligature; which may be due to the "reduction in friction"


but it was not signi fica nt.

"Anchorage loss" is th e term traditionally used for


mesia l movement of molars in the sagittal plane'" In
the present study anchorage loss was determin ed in
the max illary arch alone because the anterior palata l
vau lt could be used as a stable reference point. In the
present study direct cast measurements were used
rather than radiographs. Th is method was considered
to be eas ier and accurate and did not subject patients
to excess ive radiation exposure.

The results of the present study indicated that there


was variability among the subjects. This was noted with
the time interva ls, th e rate of retract ion and the
anchorage loss. Thi s ca n be attributed due to th e
biologic response, and the individual variation in ti ssue
reaction. The resu lts of the prior studies"'" concl uded
that the individual va ri ation in metabolic response was
so great, that it overwhelmed any differences caused
by the force magnitude. And also there was a large
v;Hiation between patients, whic h precl udes the
formation of simp le theor ies rega rding force and
anchorage. This indicated that the variable in metabolic
respo nse and not th e magnitude of the for ce is
accounted for th e major source of va ri at ion. It is
generall y considered va lid that higher forces produce
more rapid movement than lighter forces, probably only
wi thin the individual pat ient.

The mean differen ce in anchorage loss found in present


st udy between self- li gat ing and conventi onal PEA
bracket was not statistica ll y and clinically signifi ca nt.
Previous studies" has shown that 5% to 50% of the
total extraction space ca n be taken up by an anchor
unit made up of the first molar and the second premolar
when used to retract ca nine.
A correlation test was performed for the anchorage loss
and rate of retraction for both bracket system i.e. selfligating and conventional MBT preadjusted edgewise
bracket system. There was no statistically significa nt
correlation between anchorage loss and the rate of
retraction for either bracket system.

The in iti al force application should be light, because


th is produces desi rable biologi c effects. Thi s lighter
force will produce less extensive hya lini zed tissue that
ca n be readily repl aced by cellul ar elements." It was
estimated that a force between 100 and 200 gms wou ld
be effi cient for ca nine retraction and the duration of
applied force is far more influential than its magnitude,
i.e. that light forces acting for atleast 4-6 hours have
greater effect on the dentition than heavy forces which
arc sustained momentarily. " ." Also it is stated that 150
to 250 gms of force for maxillary ca nines and 100 to
200 gms of force for mandibul ar canines is appropriate
for translatory movement. ' Therefore, in the present
study the force selected for ca nine retraction to close
extraction space was 150 gms with the help of Ni ckelTi tani um (NiTi ) Closed coil springs.

CONCLUSION:
The following conclusion can be drawn from this study:

32

There was no significant difference in the rates


of canine retraction between self-ligating and
co nve ntion al MBT prea dju sted edgew ise
bracket systems .

The difference in anchorage loss between selfligati ng and conventi onal MBT preadj usted
edgewise bra cket sys tems was also not
significant.

LEGENDS OF FIGURES

Fig 1: Initial model with palatal plug and reference wires before ca nine retraction

Fig 2: Final model with palatal plug and reference wires after ca nine retraction

Fig 3: Magnifica tion illustrating anchorage

33

1055

LEGENDS OF TABLES
Table I : Mean rate of retraction
Groups

Minimum
(mm/interval)

Maximum
(mm/interval)

Mean
(mm/interval)

S.D.

Std. error
mean

Self-ligati ng
bra cket

1.00

1.36

1.1 717

0.13562

0.04795

Conventiona l
bracket

0.91

1.2 4

1.1209

0.13298

0.04702

Table II : Mean anchorage loss


Groups

Minimum
(mm)

Maximum
(mm)

Mean
(mm)

S.D.

Std. error
mean

Self-ligating
bracket

0.80

2.20

1.8375

0.44381

0.15691

Conventional
bra cket

1.00

2.45

1.9500

0.45591

0.1611 9

LEGENDS OF GRAPHS
Graph II: Mean anchorage loss self-ligating and
conventional bracket

Graph I: Mean rate of canine retraction self-ligating


and conventional bracket

"

~
L

Conventional
bracket

0.'
08

Self-ligating
bracket

"
02
0
Self-liOating blacket

Conventional bracket

0.'

_.........

1.2

0.8

I~'

34

1.6

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