V Cacciafesta The rectangular loop:

B Melsen
Biomechanical principles and
clinical applications in
three-dimensional control of
single-tooth discrepancies

Authors’ affiliations: Abstract: The three-dimensional control of single teeth

Vittorio Cacciafesta, Birte Melsen, The Royal exhibiting severe positional anomalies is a common challenge
Dental College, Department of Orthodontics, for the orthodontist. A thorough clinical diagnosis, careful
University of Aarhus, Aarhus, Denmark treatment planning and appropriate appliance design is
necessary if a successful outcome is to be achieved.
Correspondence to: Superelastic wires, elastic threads and chain elastics have
Dr Vittorio Cacciafesta made the straight-wire appliance (SWA) technique very efficient
Royal Dental College for the correction of minor discrepancies. Characteristically, the
Department of Orthodontics wire-bracket angulation determines the force systems
University of Aarhus developed. Consequently, significant undesired side-effects
Vennelyst Boulevard occur often while correcting major discrepancies. In contrast,
DK-8000 Aarhus-C the segmented arch approach enables the orthodontist to
Denmark generate well-defined force systems that lead to highly
Tel: + 45 89424037 controlled tooth movement. By segmenting the appliance, an
Fax: +45 86196029 optimal force system can be applied to the active unit and to
E-mail: vcacciafesta@odont.aau.dk the teeth to be moved, while the reactive forces are
transferred to an anchorage unit consolidated to withstand the
undesirable forces. Correction of positional discrepancies of
single teeth is highly predictable, and any undesired
side-effects can be minimised. A low load-deflection rate
enables the clinician to deliver relatively constant forces and
moments throughout the orthodontic treatment, and allows
tooth movement to proceed without frequent monitoring and
appliance adjustments. When maximum control of tooth
movement is desired, rectangular loops are the first choice for
intrasegmental alignment, due to their simplicity and large
range of activation.

Key words: biomechanics; rectangular loops; segmented arch

technique; three-dimensional control of single teeth

To cite this article:

Prog. Orthod. 1, 1999; 23 – 36
Introduction
Cacciafesta V, Melsen B:
The rectangular loop: Biomechanical principles and
The straight-wire appliance (SWA) concept was developed
clinical applications in three-dimensional control of
single-tooth discrepancies to obtain complete three-dimensional (3-D) control on all
Copyright © Munksgaard 1999 teeth. Unfortunately, not all the irregularities within indi-
ISSN 1399-7513 vidual segments of a dental arch can be corrected by a
Cacciafesta and Melsen. The rectangular loop
straight wire inserted into the brackets of malaligned
teeth. An odd combination of forces and moments, such
as an inconsistent force system where moments are desir-
Fig. 1. Different points of force application produce different combina-
tions of forces and moments. The point of dissociation (loop in the
middle) is the same for both sagittal (Fig. 1) and occlusal planes (Fig. 2).
Fig. 2. Different points of force application produce different combina-
tions of forces and moments. The point of dissociation (loop in the
middle) is the same for both sagittal (Fig. 1) and occlusal planes (Fig. 2).
Fig. 3. The desired combination of forces and moments can also be
reached by angulating the horizontal branch of the loop.
24 2Prog Orthod 1, 1999/23–36
Fig. 4. Importance of the loop orientation in order to achieve the
desired combination of forces and moments.
Fig. 5. TMA 0.017 × 0.025/0.018 in. composite loop. Depending on the
point of welding, this will displace the point of dissociation from the
geometrical centre of the loop.
able, yet forces detrimental, or vice versa, may develop.
Minor bends, such as step and ‘V’ bends, have been
recommended with the purpose of delivering the desired
moment-to-force ratio on one side of the bend. As the
wire is always in a state of equilibrium, a balancing force
system acts on the other side of the bend. The creative
bend involves only a minimum amount of wire. Conse-
quently, the spring-back and the activation range of these
bends are low, and the load-deflection rate high. In addi-
tion, the slightest change in tooth position will lead to a
change in the desired force system. Only minor discrepan-
cies, therefore, should be corrected by using such bends.
The simultaneous correction of major discrepancies in all
three planes of space requires an appliance that delivers a
specific force system (a predefined moment to force ratio),
which is relatively constant and within a large range of
activation. This can be obtained by loops individually
designed for the correction of specific irregularities (1).

The inconsistency of the force system developed by a
SWA can be avoided by using loops. The addition of wire
length into the appliance while maintaining the wire size
reduces the load-deflection rate, thus enabling the clini-
cian to apply a greater constancy of force. The distribu-
tion of the wire with respect to the bracket determines the
moment-to-force ratio, and tooth movement is produced
Fig. 6. Case BPR. a) Full-face, b) intraoral frontal, c) lateral and d) occlusal views before treatment.
Cacciafesta and Melsen. The rectangular loop
by the deactivation of the loop itself; friction is not an
issue. Finally, it is possible to design a loop in such ways
that forces and moments are dissociated to generate many
combinations of moment and force. In such a system,
appliance activation or force levels created do not auto-
matically affect the moments, simply because there is no
mutual dependency between force and moment. The reac-
Prog Orthod 1, 1999/23– 362 25
Cacciafesta and Melsen. The rectangular loop

deliver the appropriate forces (3). It can be safely assumed

that a relatively constant force within an optimal range
produces the most desirable type of tooth movement.
Thus, the active components of an orthodontic appliance
must be designed in such a manner that they possess a low
load-deflection rate and a frictionless force application
system (1). The rectangular loop can be used for first,
second and third order corrections and delivers a force

Fig. 7. a) TMA 0.017 × 0.025 in. reciprocally used rectangular loop to

move the two laterals buccally. b) Differential amount of activation.

tive forces, which may be undesirable, will be transferred

to the reactive unit. The segmented technique does, how-
ever, allow for the establishment of anchorage units able
to resist such force systems (2). Four main types of loops
for intrasegmental alignment have been described: 1) verti- Fig. 8. a,b) After one appointment.
cal loops, 2) L-loops, 3) T-loops and 4) rectangular loops.
This report describes the clinical applications of the
rectangular loop in simultaneous 3-D correction of single-
tooth discrepancies.

The rectangular loop

To achieve the desired tooth movement, application of

the proper force system is of paramount importance. For
a given tooth movement, only one combination of force
and moment can be considered correct. By initially defin-
ing the relationship between force system and tooth Fig. 9. After two appointments. A TMA 0.017 × 0.025 in. continuous
movement, the orthodontic appliance can be designed to wire was inserted in all the brackets.

26 2Prog Orthod 1, 1999/23–36


Fig. 10. a) Full-face, b) intraoral frontal, c) lateral and d) occlusal views after treatment.
system that cannot be achieved by the SWA. Since this
loop is inserted at least in two brackets, it represents a
statically indeterminate system.
The moment-to-force ratio delivered to the active unit
can be determined by the clinician. The direction of
moments generated at the loop depends on the point of
force application in relation to the horizontal dimension
Cacciafesta and Melsen. The rectangular loop
of the ‘box’ (Fig. 1). All combinations of moments and
forces can be produced. The point at which the moment
changes sense is called point of dissociation. At this point,
no relationship exists between moment and force. The
localisation of this point depends on the stiffness of the
wire anterior and posterior to the point of application,
and is thus influenced by the length as well as the dimen-
Prog Orthod 1, 1999/23– 362 27
Cacciafesta and Melsen. The rectangular loop
sion of the wire. If the bracket is tied laterally to this
point, the moment produced will increase due to in-
creased distance from the point of dissociation (4). The
point of dissociation is same for both sagittal and occlusal
planes (Figs. 1 and 2). At the point of dissociation, the
loop delivers a constant moment to force ratio, which can
be used for overcoming the problems of inconsistency
Fig. 11. Case BP. a) Full-face, b) intraoral frontal, c) lateral and d) occlusal views before treatment.
28 2Prog Orthod 1, 1999/23–36
often encountered with a SWA. The rectangular loop can
be activated to release any force and moment ratio at the
anterior bracket: a pure force (geometry IV), a pure
moment or any other combination (2). The desired combi-
nation of moments and forces can be reached by choosing
different points of force application, controlling the hori-
zontal dimension of the loop or by angulating the horizon-
 Cacciafesta and Melsen. The rectangular loop

point of welding, this will displace the point of dissocia-

tion from the geometrical centre of the loop (Fig. 5) (2).
When correcting major rotations or tippings, the com-
posite loops are advantageous as their working range is
large. They can also be designed for a correct force-to-mo-
ment combination. The following sections demonstrate
the clinical application of the rectangular loop in four
different cases.

First and second order discrepancies –

incisors

Rectangular loops are useful elements for the correction

of angulation, inclination and rotation of both the central
and lateral incisors. In these cases, the rectangular loop is
reciprocally used, in that there is no reactive unit, and
both extensions of the loop serve as active units. This
configuration includes two symmetrically bent rectangular
loops. The force system produced by a reciprocally used
rectangular loop does not differ from that of a SWA. The
loop can be activated, however, to simulate any of the six

Fig. 12. a) TMA 0.017 ×0.025 in. reciprocally used rectangular loop to
move the two laterals lingually (12a). The loop was used in combination
with a statically determinate utility arch (visible in Fig. 13a) for intrusion
and proclination of the centrals. b) A Quad Helix was used for distal
rotation of the molars and expansion of the upper arch.

tal branch of the loop with respect to the bracket of the

active unit (Fig. 3).
The rectangular loop has a low load-deflection rate and
a large range of activation. The lowest load-deflection rate
is obtained if the tie-in is at its terminal end. Therefore,
the loop orientation should always be taken into account,
so that the desirable combination of forces and moments
is generated when the bracket is tied to the extreme loop
end (Fig. 4). The amount of vertical activation has only a
minor influence on the force system developed. With
increasing vertical displacement, the wire distribution
changes. Therefore, the anterior moment is slightly altered
(4, 5). The loop can be produced in any bendable wire,
but TMA® represents the best wire for fabricating a
rectangular loop as different dimensions can easily be
welded together (6). Differences between the stiffness of
the active and reactive unit can thereby be increased (7), as
when producing composite loops: combining TMA wire
0.017×0.025 in. and a TMA 0.018 in. Depending on the Fig. 13. a,b) After three appointments.

Prog Orthod 1, 1999/23– 362 29

Cacciafesta and Melsen. The rectangular loop
Fig. 14. a) Full-face, b) intraoral frontal, c) lateral and d) occlusal views after treatment.
geometries to produce the desired tooth movement.
Compared to the SWA, the load-deflection rate of the
rectangular loop is much lower and the working range
is larger. This characteristic enables the clinician to
achieve the desired treatment goal within one or two
appointments, without the need for appliance reactiva-
tion. Furthermore, the loop configuration with abundant
wire allows the use of a large wire dimension in addi-
tion to a reduction in the play between wire and
bracket. Consequently, excellent 3-D control of tooth
movement is achieved while a low load-deflection rate is
still produced.
Case BPR is an adolescent with a Class II division 1
malocclusion and crowded upper incisors with labially
placed upper lateral incisors (Fig. 6a – d). A TMA
0.017× 0.025 in. rectangular loop was reciprocally used
in order to move the two laterals buccally, in combina-
tion with a lingually directed force to the central in-
cisors (Fig. 7a). The moments expressed on central
incisors were beneficial for correction of their mesial
rotation. Sufficient space was obtained by a transpalatal
30 2Prog Orthod 1, 1999/23–36
arch with extensions activated for expansion and distal
rotation. The amount of activation was greater for 12,
since this tooth needed more buccal movement than 22
(Fig. 7b). Fig. 8a,b show the patient after one appoint-
ment. After two appointments, the laterals were cor-
rectly placed, which allowed the insertion of a
rectangular wire into all brackets (Fig. 9). Fig. 10a –d
illustrate the patient at the end of the orthodontic ther-
apy.
A reciprocally used rectangular loop can be also em-
ployed to correct buccally placed laterals. Case BP is an
adult with a Class II division 2 malocclusion, gummy
smile and proclined upper laterals (Fig. 11a –d). A TMA
0.017× 0.025 in. rectangular loop was used in combina-
tion with a statically determinate utility arch for intru-
sion and proclination of the centrals and retroclination
of the laterals (Fig. 12a,b, Fig. 13a). A Quad Helix was
used for distal rotation of the molars and expansion of
the upper arch (Fig. 13b). After treatment, the patient
did not show any gummy smile and the incisors were
well-aligned (Fig. 14a –d).

First and second order discrepancies –
canines
Fixed appliances have been extensively used to bring
impacted canines into the arch. Both straight-wire or
segmented approaches have been advocated (8–10) for
this endeavour. Typically in a continuous archwire set-up,
chain elastics or elastic threads are employed to deliver an
erupting force to the canine. They are attached to a stiff
Fig. 15. Case JO. a) Intraoral frontal, b) lateral and c) occlusal views
before treatment.
Cacciafesta and Melsen. The rectangular loop
Fig. 16. a) The loop terminal end is engaged into the bracket, distally of
the point of dissociation, in order to produce a counterclockwise
moment for mesial tipping of the canine. b) Composite TMA 0.018/
0.017 × 0.025 in. loop activated for extrusion and mesial tipping of the
canine.
stainless steel archwire, which bypasses the canine. The
disadvantages of this technique include tipping of the
adjacent teeth if the main archwire is not stiff enough and
poor control of the tooth movement. Additionally, there
is a rapid decay of the force delivered by the elastic,
requiring frequent controls.
The straight-wire overlay technique consists of a heavy
stabilising stainless steel archwire that bypasses the canine
for anchorage control and an overlay superelastic wire
tied directly into the canine bracket. The moment-to-force
ratio delivered by the overlay arch, however, is deter-
mined by the original inclination of the canine and in the
hand of the clinician. In contrast, 3-D control during
alignment of an impacted canine can be obtained by a
sequential use of cantilevers followed by rectangular loops
(11). The molars are consolidated by a transpalatal arch
and all the anchorage unit is engaged into a stiff wire
(stainless steel 0.019×0.025 in.). Buccally impacted ca-
nines need to be extruded in order to be aligned into the
Prog Orthod 1, 1999/23– 362 31
Cacciafesta and Melsen. The rectangular loop

arch. This is done with a single extrusive force, with the

correct direction and magnitude, applied to the canine.
Palatally impacted canines need to be extruded and moved
buccally. This can likewise be done with cantilevers deliv-
ering the required force direction as determined by their
preactivation state. Once the crown of the canine is
visible, the cantilever is replaced by a rectangular loop in
order to control the tooth movement in the three planes
of space (11).

Fig. 17. After one appointment. a) The angulation of the canine has been
corrected. The loop configuration is thus changed in order to work at
the point of dissociation and deliver only a pure extrusive force. b)
Composite TMA 0.018/0.017× 0.025 in. loop activated for pure extru-
sion and c) engaged into the bracket slot.

Fig. 19. a) Intraoral frontal, b) lateral and c) occlusal views after treat-
Fig. 18. After two appointments. ment.

32 2Prog Orthod 1, 1999/23–36


Fig. 20. Case BM. a) Intraoral lateral and b) occlusal views before
treatment.
Case JO is an example of alignment of impacted canines
with cantilevers followed by rectangular loops. The patient
is a child with Class II malocclusion, crowding of upper and
lower arches and impacted upper canines (Fig. 15a –c). After
surgical exposure, extrusion of the canines was initiated
with a cantilever, which was later replaced by a composite
TMA 0.018/0.017 ×0.025 in. rectangular loop for produc-
Fig. 21. TMA 0.017 × 0.025 in. cantilever activated for extrusion of the
canine.
Cacciafesta and Melsen. The rectangular loop
Fig. 22. After one appointment. The canine is erupting with a distal
rotation.
ing mesial tipping and extrusion of the tooth (Fig. 16a,b).
After one appointment, the configuration of the loop was
changed in order to work at the point of dissociation and
deliver only a pure extrusive force (Fig. 17a –c). At the next
appointment, the desired movement was completely per-
formed (Fig. 18). Fig. 19a –c show the final result after
treatment.
As described above for the incisors, rectangular loops can
also be used for correction of canine rotations. Case BM
is a young adult patient with a Class II malocclusion and
23 impacted (Fig. 20a,b). After surgical exposure, a TMA
0.017× 0.025 in. cantilever ligated to a lingual button
bonded onto the canine surface was activated for extrusion
(Fig. 21). After one appointment, it was evident that the
canine was erupting with a distal rotation (Fig. 22). In order
to correct it, a TMA 0.017×0.025 in. rectangular loop was
activated for mesial rotation (Fig. 23a,b). After one appoint-
ment, the canine rotation was overcorrected (Fig. 24). Fig.
25a,b illustrate the final result after debonding.
Prog Orthod 1, 1999/23– 362 33
Cacciafesta and Melsen. The rectangular loop
Fig. 23. TMA 0.017 × 0.025 in. rectangular loop activated for a) mesial rotation and b) fully engaged into the bracket slot.
Discussion
TMA 0.017×0.025 in. rectangular loops have been
shown to be effective in the 3-D control of single-tooth
discrepancies. By looking at the preactivated form, the
clinician can easily predict the combination of forces and
moments in the three planes of space.
For correction of rotations and tippings, composite
TMA 0.018/0.017 × 0.025 in. rectangular loops have the
advantage of a large working range and allow for a better
differentiation between active and reactive unit.
Compared to the rectangular loop, the often recom-
mended use of intramaxillary elastics has several disadvan-
tages. The working range of the elastics is short, the
moment generated by the elastic is small and friction plays
an important role. Consequently, frequent controls are
needed. Differentiation between the force system deliv-
ered to the active and reactive units requires a specific
layout of the wire relative to the brackets. This can only
34 2Prog Orthod 1, 1999/23–36
be done with the addition of loops bent into the wire
between the two units. Confronted with the loop in its
activated and deactivated form, the clinician can predict
the combination of the developed force and moment.
The bypass mechanics represents another alternative.
The wire can be placed directly into the bracket of a
highly impacted canine, but significant and predictable
side-effects will often occur on the adjacent teeth in the
SWA system (12). Specifically, the premolar will tip
mesially and the lateral distally combined with their intru-
sion will lead to lateral open bite. Vertical elastics, often
used to counteract this side-effect, require patient compli-
ance and careful monitoring of the occlusal plane. Besides
producing undesired side-effects, all the above-mentioned
techniques do not provide optimal control of the tooth
movement and do not enable the clinician to apply the
proper direction of force.
The control of unwanted side-effects during intraseg-
mental alignment is achieved by a segmented approach

Fig. 24. After one appointment.
with rectangular loops. In this system, the need for appli-
ance activation is minimised as TMA has a low load-
deflection rate. A large range of activation of these wires
results in tooth movement without frequent monitoring
and appliance adjustments (13).
Conclusions
TMA rectangular loops are particularly effective in the
correction of single-tooth discrepancies in all three planes
of space. They allow for maximum control of tooth
movement and transfer the undesirable forces and mo-
ments to the anchorage unit.
Riassunto
Il controllo tridimensionale di singoli denti che presentano gravi
anomalie di posizione é spesso problematico per l’ortodontista. Un’ac-
curata diagnosi clinica, un attento piano di trattamento ed un ade-
. labus, Aarhus: Aarhus University Press; 1996. pp. 90–1.
Cacciafesta and Melsen. The rectangular loop
Fig. 25. a) Intraoral lateral and b) occlusal views after treatment.
guato design dell’apparecchiatura sono necessari se si desidera ottenere
risultati soddisfacenti. Archi superelastici, moduli elastici e catenelle
elastiche hanno reso la tecnica straight wire (SWA) molto efficiente
per la correzione di discrepanze minori. Tuttavia é l’angolazione filo
ortodontico-bracket a determinare il sistema di forze sviluppato e
spesso significativi effetti indesiderati vengono prodotti nella cor-
rezione di discrepanze maggiori. L’approccio dell’arco segmentato con-
sente all’ortodontista di generare sistemi di forze ben definiti che
producono movimenti dentari estremamente controllati. Grazie alla
segmentazione dell’apparecchiatura é possibile applicare il sistema di
forze migliore all’unitá attiva, i denti che devono essere spostati, men-
tre le forze reattive vengono trasferite all’unitá di ancoraggio consoli-
data a contrastare le forze indesiderate. La correzione di discrepanze di
posizione di singoli denti é altamente prevedibile ed ogni effetto in-
desiderato puó essere minimizzato. Un ridotto rapporto carico/defles-
sione consente all’ortodontista di produrre forze e momenti
relativamente costanti per tutta la durata del trattamento ortodontico,
e permette al movimento dentario di procedere senza frequenti moni-
toraggi e riattivazioni dell’apparecchiatura. Quando si desidera il mas-
simo controllo del movimento dentario, le anse rettangolari
rappresentano la prima scelta per l’allineamento intrasegmentale, grazie
alla loro semplicitá ed al grande range di deattivazione.
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