CONTINUING EDUCATION ARTICLE

Effect of ion implantation of TMA archwires on the rate of

orthodontic sliding space closure
Katherine Kula, MS, DMD, MS, FACD,a Ceib Phillips, MPH, PhD,b Anna Gibilaro, BDS, MSc, MOrth,
FDS RCS,c and William R. Proffit, DDS, PhDd
Chapel Hill, NC

A split-mouth randomized clinical trial was used to determine whether ion implantation of β-titanium
archwire would facilitate sliding space closure. After bilateral maxillary first premolar extractions, 0.19 ×
0.025-inch β-titanium archwires, ion-implanted on one half only, were placed in 30 subjects aged 10 to 42
years wearing unimplanted 0.022 inch slot appliances. Nickel-titanium springs (150 g) were placed
bilaterally to close the extraction spaces. Space closure was measured intraorally at monthly intervals until
either the space on one side closed or 6 months had elapsed. The median rates of space closure were not
significantly different between the ion-implanted and the unimplanted sides. The average rate of space
closure on these β-titanium wires, with or without ion implantation, was similar to the rate reported on
stainless steel archwires. (Am J Orthod Dentofacial Orthop 1998;114:577-81)

B eta-titanium archwires (TMA) have an
excellent combination of strength and flexibility. These
properties make them extremely useful as intermediate
wires between the initial alignment and finishing stages
of orthodontic treatment. Laboratory studies indicate
that TMA wires have higher coefficients of friction and
produce significantly greater frictional resistance to
sliding through orthodontic brackets than stainless
steel.1-5 Under laboratory conditions, the surface of the
titanium wire can become cold-welded to stainless steel
brackets,5 making sliding closure of even small spaces
difficult. Implantation of nitrogen ions into the surface
of this wire causes surface hardening and can decrease
frictional force by as much as 70%.6 Although a
decrease in frictional force should allow faster sliding,
it is not known whether ion-implantation facilitates
space closure clinically. The purpose of this prospective
randomized clinical trial was to compare the rate of
space closure on ion-implanted TMA archwire and
unimplanted TMA with a split-wire design.
MATERIAL AND METHODS
Similar to commercially available wires, the TMA
wires were treated (Spire Corporation, Bedford, Mass)
with a single-pass method where two different energies
This study was supported by NIH IR43 DE 08622-01A2.
From the Department of Orthodontics, University of North Carolina Dental
School, Chapel Hill.
aAssociate Professor, University of Missouri-Kansas City.
bResearch Professor.
cVisiting Research Scientist.
dProfessor and Chair.
Reprint requests to: Dr Katherine Kula, Department of Orthodontics, Universi-
ty of Missouri-Kansas City, 650 E. 25th St, Kansas City, MO 64108.
Copyright © 1998 by the American Association of Orthodontists.
0889-5406/98/$5.00 + 0 8/1/88548
of nitrogen ions were implanted into all surfaces of
only one half of the archwire with a focused ion beam.
Fixtures were used to mask the archwire half that was
not to be implanted. Nitrogen ion implantation was
chosen based on the preliminary tests in which friction
forces were reduced significantly after nitrogen
implantation into TMA (Phase I Final Report, Small
Business Innovation Research Program Grant Applica-
tion—IR43 DE 08622). The preliminary testing also
showed that verification of implantation with Knoop
microhardness testing of the surfaces was not feasible
because of the rough surface of TMA wire. However,
changes in microhardness were verified on witness
coupons inserted during each run. On the basis of Spire
Corporation’s experience in ion implantation, color
change in the surface of the wires was used also to indi-
cate that implantation occurred. Each wire supplied for
the clinical study did show a difference in color
between the two halves.
Seventy-four subjects whose treatment was planned
for bilateral maxillary first premolar extraction at UNC
were screened. Of these, 39 patients consented to par-
ticipate and were enrolled; 9 subsequently were
dropped from the study because of lack of cooperation
with appointments, appliance breakage, or length of
time to reach the stage of maxillary space closure. The
final 30 subjects ranged in age from 10 to 42 years; 17
were female and 13 were male.
A “split-mouth” design was used whereby only
one-half of each .019 × .025 inch TMA archwire
(Ormco, Glendover, Calif) was ion implanted (Spire
Corporation) with nitrogen, whereas the other half
remained in its original state. This design provided bet-
ter control of intersubject variability than would a
design that used different patients for implanted and for
577
578 Kula et al
Table I. Rate of space closure on implanted and unimplanted TMA wire
Maximum
Implanted Molar* –0.082
Premolar* –0.078
Unimplanted Molar* –0.067
Premolar* –0.065
*No significant differences between implanted and unimplanted wire.
unimplanted wires. Some wires were implanted on the
right side and others on the left. The midline of the
archwire was scored by the manufacturer on the gingi-
val side only to allow correct placement. The wires
were coded and randomly assigned to the subject. The
clinician, the subject, and the examiner were blind as to
which half was implanted. All subjects had orthodontic
treatment with a 0.022-inch slot edgewise appliance
with unimplanted stainless steel twin brackets and a
standard prescription (ORMCO, and A-Co, San Diego,
Calif). After alignment and leveling, the test archwire
was placed in the subject’s mouth for 1 month before
beginning space closure. The incisor segment was
retracted after canine retraction in six cases, and
canine-to-canine segments were retracted en masse in
17 cases. In either circumstance, the teeth in the poste-
rior and the anterior segments were tied to each other
with stainless steel ligatures under the archwire. The
teeth were tied individually to the archwire with elas-
tomeric ligatures (ORMCO) to control ligation force.
Nickel titanium coil springs (Sentalloy, GAC Inter-
national, Central Islip, NY), designed to deliver a con-
stant force of 150 g over a 15-mm activation distance,
were stretched bilaterally from hooks on the maxillary
first molars a maximum of 15 mm to the distal wings
of either the maxillary lateral incisors or canines.
Retraction was continued until either one of the spaces
closed or 6 months had elapsed, whichever came first.
Because asymmetric rates of closing could produce
maxillary midline deviations, a deviation of 3 mm or
more was also set as an endpoint. However, a deviation
of this magnitude did not occur. Any supplemental
anchorage (ie, headgear, transpalatal appliance, or elas-
tics) was consistent between sides.
At monthly appointments, two measurements from
the distal of the molar tube to the mesial wing of either
the lateral or the canine bracket were taken on each side
by either of two investigators with an electronic digital
caliper (Max-Cal, Mark III, Fred Fowler Co, Inc, New-
ton, Mass). Additional bilateral measurements were
made from the distal wing of the second premolar
band/bracket to the mesial wing of either the lateral or
the canine bracket in case a molar band became loose.
The additional measurement was also used to verify the
American Journal of Orthodontics and Dentofacial Orthopedics
November 1998
Rate of closing (mm/day)
Q3 Median Q1 Minimum Mean ± SD
–0.045 –0.038 –0.019 –0.004 –0.034 ± 0.017
–0.04 –0.035 –0.016 –0.002 –0.031 ± 0.016
–0.042 –0.029 –0.02 –0.011 –0.033 ± 0.015
–0.039 –0.028 –0.019 –0.01 –0.030 ± 0.014
space closure as measured from the molar and to pre-
vent the loss of a patient from the study for that reason.
If the duplicate measurements were not within 0.10 mm
of each other, a third measurement was taken and the
outlier discarded. A reliability study with extracted
teeth set in plaster established a high degree of consis-
tency within and between the two raters’ measurements
(intraclass correlation coefficients; all r ≥ 0.91).
Following uncoding of the wire assignments, paired
t tests were used to compare the initial spaces of the
ion-implanted and the unimplanted sides to determine
if there was a difference in the amount of available
space between the sides. The time to closure was cal-
culated for each side, but the times were censored
(incomplete) because recording was discontinued as
soon as one side closed or at the 6-month maximum
time of study. The rate of closing was calculated as the
amount of space closed (final space remaining – initial
space available) divided by the time to closure. This
rate represents the rate of closing on each side that
occurred until at least one side closed or 6 months
elapsed. Differences between the rates of closing for
the implanted and the unimplanted sides were analyzed
for significance using a Wilcoxon matched pairs signed
rank test (SAS Software). Differences between the
rates of closing for canine and incisor retraction cases
were also analyzed with the Wilcoxon ranked sum test.
Level of significance was set at 0.05.
RESULTS
Rate of Space Closing
There was no statistically significant difference
(molar, P = 0.83; premolar, P = 0.75) between the
implanted and unimplanted sides in the average initial
space to be closed. The average rate of space closing
(Table I, Fig 1) was –0.03 ± 0.02 mm/day for both
implanted and unimplanted sides. The rates of space
closing for the implanted sides (Table I) ranged from
–0.004 mm/day to –0.082 mm/day when measured
from the molars and from –0.002 mm/day to –0.078
mm/day when measured from the premolars. The rates
of space closing for the unimplanted sides ranged from
–0.011 mm/day to –0.067 mm/day measured from the
molars and –0.01 mm/day to –0.065 mm/day from the
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 114, Number 5
Fig 1. Comparison of rates of space closing between ion-implanted and unimplanted sides (mm/day).
premolars. There were no significant differences in the
rates of closure between the implanted and the unim-
planted sides whether measured from the molars (P =
.90) or from the premolars (P = .98). The rate of clos-
ing for the incisor and the canine groups on the
implanted side was not statistically different at the
molar (P = .35), at the premolar (P = .17), or on the
unimplanted side at the measurement sites (P = .49 and
P = .59 for the molar and the premolar, respectively).
Fig 2 illustrates the average rate of closing over the
6-month study period for all subjects in both the
implanted and the unimplanted sides. The rates of clos-
ing for a subject who closed rapidly in each group and
for a subject who closed slowly in each group are also
shown to demonstrate the variation in rate throughout
space closure.
DISCUSSION
The split-mouth design was an excellent method to
determine the clinical relevance of ion-implantation of
TMA wire to space closure because it controlled inter-
subject variability by comparing rates within a subject,
thereby minimizing the influence of numerous inter-
subject factors such as age, sex, anatomic factors, and
bone metabolism on the treatment differences in the
rate of space closing on implanted versus unimplanted
TMA wire. The ion-implanted and the unimplanted
sides were very similar in the amount of initial space to
close. Despite our initial reservations that asymmetric
closing rates could cause clinically significant devia-
tions, only minor deviations occurred and were not
cause for alarm because the rate of closing was similar
between the ion-implanted and the unimplanted sides.
However, similar to other reports on space clos-
Kula et al 579
ing,7-9 the rate of closing on TMA was still variable
among subjects. Although most of this variability is
probably related to biologic differences, differences in
anchorage such as elastics, headgear, or transpalatal
appliances could also contribute to variability. Also,
closed Sentalloy coil springs designed to deliver a con-
stant force of 150 g within a 15-mm activation range
are reported to produce an increasingly greater force
than 150 g when stretched beyond 9 mm.10 Greater
force levels at activation ranges over 9 mm could pro-
duce faster closing initially until the space is closed
enough to reduce the activation range to less than 9 mm
with consequent slowing. The results of our study
show no significant differences in the rate of space
closing between the canine en masse retraction group
and the incisor retraction groups suggesting that the
number of teeth involved in each segment did not con-
tribute significantly to the variability in closing rates.
The split-mouth design allowed us to determine the
range of responses similar to that occurring in private
practice but provided controls by comparing the two
rates within a single patient.
Laboratory testing of orthodontic material is neces-
sary as a preliminary screening of efficacy and toxici-
ty. However, testing in the less controlled but more
realistic clinical setting is mandatory to validate claims
of efficacy based on laboratory data as laboratory data
are not always good predictors of clinical efficacy,
which is well known in the case of composite resin
wear.11 Laboratory data6,12 suggest that ion implanta-
tion of nickel into the surface of a TMA wire will
reduce both static and kinetic coefficients of friction
significantly and, presumably, will facilitate sliding.
However, these reductions are significant only when
580 Kula et al
Fig 2. Average rate of space closing and rate of space closing for a fast and a slow closing subject
on the implanted and the unimplanted sides.
both the wire and the opposing surface are ion implant-
ed.6,13 The requirement that both opposing surfaces be
ion implanted in order to significantly reduce friction
may explain an earlier report in which ion implantation
of brackets alone with chromium yielded no significant
reductions in friction.14 Similar to these laboratory
studies, our study shows that ion implantation of TMA
wire does not clinically enhance the rate of space clos-
ing after extraction of premolars when unimplanted
stainless steel brackets are used. More studies are
required to determine how ion implantation can
increase efficiency of sliding space closure clinically.
Although TMA wire is usually not considered the
wire of choice for closing space because its frictional
resistance is high, the computed monthly rate of clos-
ing on TMA (0.12 to 2.46 mm/month) is surprisingly
similar to the rates of space closing reported on stain-
less steel wire (0.76 to 1.75 mm/month).15 Laboratory
studies16 have almost uniformly shown that the fric-
tional forces and coefficients of friction for TMA wires
are higher than that for other commonly used ortho-
dontic wires such as stainless steel or nickel-titanium;
this suggests that TMA wires would not allow efficient
sliding. Clinically, masticatory function may enhance
sliding by providing the forces to flex the archwires
and break the cold-welds that appear to be significant
factors in frictional resistance in the laboratory. The
relative lack of masticatory forces in the incisor region
as compared with the posterior dental segments could
explain failure of small anterior spaces to close. Thus,
TMA wire may be a reasonable choice for closing
extraction spaces. Additional clinical trials comparing
space closure on TMA and stainless steel wires would
provide more definitive information on the efficacy of
TMA wire during this stage of orthodontics.
American Journal of Orthodontics and Dentofacial Orthopedics
November 1998
CONCLUSIONS
Implantation of 0.019 × 0.025-inch TMA wire with two
energies of nitrogen ion does not significantly enhance space
closure compared with unimplanted TMA wire when unim-
planted stainless steel brackets are used. However, the rate of
closing on TMA wire during this study was similar to the
reported rate of sliding closure on steel wire.
We thank Debbie Price for her computer support.
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