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Review of Superelastic Archwires in Orthodontics

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Review of Superelastic Archwires in Orthodontics

Neetha Pious, Ravindranath V. Krishnan, Vivek Patni, Amol Mhatre
Department of Orthodontics and Dentofacial Orthopedics, MGM Dental College and Hospital, Kamothe, Navi Mumbai, India

Received: 20 May 2020
Accepted: 3 September 2020
Published online: 10 March 2021
Key words: superelastic; nickel
titanium; archwires
Over the last century a plethora of archwires have been introduced into the field of orthodontics. With changing
treatment philosophies and advancement in dental materials, treatment has now become simpler. Nickel titanium
wires has revolutionized the field of orthodontics with its superelasticity and shape memory properties. They have
proved superior compared to other traditional wires. Further improvements have been incorporated into these
wires by modifying the composition and advancement in their manufacturing technology. With the availability of
thermodynamic, superelastic and aesthetic archwires, several options are being presented to clinicians for treatment
of malocclusion. Literature search was performed on electronic databases—PUBMED, ScienceOpen, Lilacs, Google
Scholar, SciELO and Cochrane. This article can shed knowledge on the available improved wires and guide
orthodontist to choose the ideal wire according to the clinical situation.

© (2021) Society for Biomaterials & Artificial Organs #20040920

Introduction levelling and alignment stage of orthodontic treatment. This article

Over the last century, material science has made rapid progress. In
the branch of orthodontics, not only have materials improved
but also the philosophies have changed. Orthodontic wires, which
generate the biomechanical forces through brackets for tooth
movement, are central to the practice of the profession. The
advancement of wire manufacturing technology and the
development of new orthodontic techniques has led to the search
for better quality alloys [1]. Up until the 1930s the only orthodontic
wires available were made of gold and precious metal alloys. Later
austenitic stainless steel, cobalt-chromium and titanium wires
gained popularity and were widely used [2]. The Nitinol alloy was
developed by William F Buehler, a research metallurgist at Naval
Ordinance Laboratory in the year 1960 after which Dr. George
Andreason introduced it in orthodontics where it brought about
a revolutionary change [3]. The initially discovered nitinol was a
martensitic stabilized alloy which showed no superelasticity. Nickel
titanium (NiTi) archwires have been evolving since their initial
development with shape memory and superelastic properties [4].
Superelasticity is a phenomenon wherein the stress remained nearly
constant despite the strain change within a specific range and is
achieved through stress-related martensite-austenite
transformation. This allows a constant force to be delivered over
an extended portion of the deactivation range and is therefore
more likely to generate physiologic tooth movement and greater
patient comfort [5,6]. Thus they can be utilized in the initial
*Coresponding author
E-mail address: neethaortho@gmail.com (Dr. Neetha Pious, MGM Dental College and
Hospital, Kamothe, Navi Mumbai, India)
can shed knowledge on the available improved wires and guide
orthodontists to choose the ideal wire according to the clinical
situation.
Material and Methods
A literature review was performed in PUBMED, ScienceDirect,
Lilacs, Google Scholar and Cochrane. Additional studies were
hand-searched and retrieved from the reference lists of relevant
articles. Data was gathered using the keywords “Superelastic”,
“Nickel Titanium”, “Archwires”. The title and abstract of acquired
articles were analysed and data was extracted by the authors such
that the topic can be adequately summarized in a narrative manner.
The search was limited to articles in English. The reference list of
selected papers was hand searched for further relevant articles. Only
those articles were included which studied various aspects of
superelastic archwires in the field of orthodontics. Articles with
reviews, abstracts, letters to editorials, clinical and in vitro studies
studying properties of superelastic archwires were included, while
articles studying applications of superelastic archwires other than
in the field of orthodontics were excluded. Articles researching on
superelastic materials other than archwires were not considered. A
total of 4354 articles were acquired from the literature search, out
of which 34 articles were selected from which data was extracted,
reviewed and compiled in a correct manner.
Composition and Manufacturing Process
Nickel and titanium are most commonly manufactured into nickel
titanium alloy by the process of vacuum induction melting,
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 N. Pious, R.V. Krishnan, V. Patni, A. Mhatre / Trends Biomater. Artif. Organs, 35(1), 91-94 (2021)
electron beam melting, plasma arc melting or vacuum arc melting
process [7]. Several re-melts are often needed to improve the
homogeneity of nickel titanium alloy. Alloy is converted into a
powdered form. The process of hot isostatic processing is used by
the manufacturer to form the powders into wires. The present
invention provides a nickel-titanium-palladium superelastic alloy
material of a composition consisting of, by atomic percent, 34 to
49% nickel, 48 to 52% titanium, and 3 to 14% palladium. Optionally,
a part of nickel and/or titanium of this alloy is replaced with one
or more elements selected from a group of chromium, iron, cobalt,
vanadium, manganese, boron, copper, aluminium, niobium,
tungsten and zirconium, such that these elements to be replaced
amount to 2% or less in total (by atomic percent) [8]. The alloy is
hot worked followed by a final heat-treatment after which wires
obtain their final shape by the process of drawing or rolling.
Types of superelastic archwires
Chinese NiTi archwires
They were developed by originally by Dr. Hua Cheng Tien and
colleagues at research institute for non-ferrous metal in Beijing
(China) in 1978. Chinese NiTi wires possess superelasticity and
shape memory. At mouth temperature, this wire is work hardened
martensite and hence does not rely on shape memory characteristics
in clinical applications. It’s very high springback and low stiffness
characteristics have won wide clinical acceptance for initial tooth
alignment. The stiffness of this wire is 73% that of stainless steel
wires and 36% that of conventional nitinol. It can be deflected 1.6
times as far as nitinol wire or 4.4 times as far as stainless steel wire
without appreciable permanent deformation [9,10]. It has a high
range of action and spring back properties. Chinese NiTi is
applicable clinically where large defection for uprighting, labial and
lingual tooth movements is needed.
Japanese NiTi archwires
In 1978 Furukawa Electric Co. Ltd. of Japan discovered a new type
of NiTi alloy which was reported by Miura et al in 1986 [5]. They
are austenitic active NiTi alloys. It displays superelasticity which is
achieved by stress-induced martensitic transformation (SIM) [11].
Clinically they provide light continuous force for physiologic tooth
movement and greater patient comfort. Japanese NiTi is marketed
as Sentalloy [12].
NeoSentalloy archwires
They are new superelastic NiTi and rectangular wires. They can be
used with extremely light force in the initial phase of treatment
rather than using round wires in the initial treatment. Three-point
bending and torque tests have shown the wire to exert light,
continuous force regardless of deflection or wire size [13]. Its
advantages include good three-dimensional tooth control which
can be effected at the same time as horizontal, vertical leveling and
root torquing. They also provide greater archwire flexibility and less
patient discomfort than conventional NiTi wires.
Copper NiTi archwires
Copper NiTi was developed by Rohit Sachdeva and Suchio Miyasaki
in 1994. They represent the next generation of both superelastic
and shape memory wires by reducing hysteresis and by providing
precise transformation temperature. When compared to
conventional nickel titanium wires copper NiTi develops
approximately 20% less loading force [12]. This permits easier
engagement in the bracket slot since the wire can be manipulated
with less difficultly and it creates less trauma and discomfort to the
patient. Around the rest position, however, the decrease of force
92
generated by copper NiTi is less than that of NiTi alloys. This
explains the clinical efficiency of copper NiTi to continue working
as teeth near their intended positions. The additional copper
element in the composition made it is possible to build in, precise
transformation temperature characteristics during the
manufacturing process. This built-in precision is designed to put
the clinician in control especially during the early stages of treatment,
like no other force delivery system currently available. These wires
are set at four transformation temperatures for four distinct force
levels, enabling clinicians to deal with specific clinical situations and
are classified as follows.
Type I: (150C)
It has not been used frequently in clinical situations because it
generates very heavy forces and clinical indications are few.
Type II: (270C)
This wire generates higher forces compared to type III and IV. It is
best used in patients who have an average or higher pain threshold,
normal periodontal health.
and where rapid tooth movement is required and the force system
generated by the orthodontic archwire is constant.
Type III: (350C)
This wire generates forces in mid-range and is useful in patients
who have low to normal pain threshold, where periodontium is
normal to slightly compromised and when relatively low forces are
desired.
Type IV: (400C)
These wires generated tooth driving forces only when the mouth
temperature exceeds 400C. These forces are intermittent in nature.
The indication for use of this alloy includes patients who are
sensitive to pain, with compromised periodontal conditions or
where tooth movement is deliberately slowed down (e.g. when the
patient may not be able to visit the orthodontist regularly, or the
co-operation is very poor).
Supercable archwires
It was discovered by Hanson in 1993. It is a seven stranded round
coaxial superelastic NiTi which increases the flexibility and minimizes
the force delivery of the wire [14]. These wires can be engaged in
extremely crowded teeth with ease. Its advantages include improved
anchorage control, less patient discomfort and use of fewer wires
for treatment. Its disadvantages include the tendency of wire ends
to fray, break and unravel in extraction spaces and the inability to
accommodate bends, steps, or helices in the wires.
Biotwist NiTi archwires
They are 0.021"x 0.025" pre-form rectangular archwires They are
formed with multiple strands of titanium superelastic wires. They
display low force and low stiffness along with excellent flexibility
[15]. The rectangular shape allows significant engagement of the
slot. Bio twist wires have been indicated for use at the beginning of
treatment during the leveling and aligning while also controlling
torque.
BioForce archwires
They were introduced by GAC International (New York, United
States). They are aesthetic and belong to the first and only family
of biologically correct archwires. They are graded thermodynamic
nickel titanium archwires. These wires can produce variation in
 N. Pious, R.V. Krishnan, V. Patni, A. Mhatre / Trends Biomater. Artif. Organs, 35(1), 91-94 (2021)
archwire force by variable transition temperatures along the length
of the wire [16]. Variable heat treatment of the wire allowed a
single wire size to have three different force levels. The optimal
super elastic wire now offered light forces in the anterior section,
medium force in the bicuspid area and a heavier force in the molar
region.
BioForce with ionguard archwires
For reducing the frictional resistance, GAC International (New York,
United States) created a Nickel-Titanium wire which underwent an
Ion implantation process but did not affect the unique superelastic
properties of BioForce. At low temperature, a high energy beam
of ions is used to modify the surface structure and chemistry. Ion
implantation is not a layer on the surface therefore, it does not alter
the dimensions or properties of the archwire. Ion implantation
improves wear resistance, surface hardness, resistance to chemical
attack, and most importantly reduces friction. BioForce with
Ionguard showed a smoother surface and generated less frictional
force compared to untreated NiTi [17].
SmartArch® multi-force super-elastic archwires
SmartArch® (S-A) is a new generation of multi-force laser-
conditioned Copper NiTi wires. Its properties are based on the
optimal compressive stress in the periodontal ligament (PDL) to
achieve rapid tooth movement with minimal necrosis and patient
discomfort. These latest wires were discovered by Dr. W. Eugene
Roberts, Dr. Jeffery A. Roberts, Dr. Stephen Tracey and Dr. David
M. Sarver. They were manufactured by Allesee Orthodontic
Appliances (Sturtevant, Wisconsin, United States) using multiple
memory material technologies [18], which precisely program
transition zones as narrow as 0.001” in a cross-section of shape-
memory alloy wire. Wires are programmed to deliver an ideal
physiologic load on each tooth based on each tooth’s PDL
compressive stress value. They are unique archwires that are available
in a 0.016-inch round and 0.018 x 0.025 inch rectangular
configurations.
Orthocosmetic elastinol archwires
These were manufactured by Masel Orthodontics (Carlsbad, United
States). They are epoxy coated, esthetic high performance NiTi
superelastic archwires that blend exceptionally well with ceramic or
plastic brackets. They don’t stain, discolour, and also resist cracking
or chipping [19].
Marsenol archwires
Marsenol is a tooth coloured nickel titanium wire and was
manufactured by Glenroe technologies (Florida, United States).
They are elastomeric poly tetra fluroethyl emulsion (PTFE) coated
nickel titanium archwires. It exhibits all the same working
characteristics of an uncoated superelastic nickel titanium archwires
[20]. The coating adheres to the wire and remains flexible. They
deliver constant force over long periods of activation and is fracture
resistant.
Nitanium tooth toned archwire
They are superelastic NiTi wires marketed by Ortho Organizers
Organizers (Carlsbad, United States). They have special plastic and
friction-reducing tooth coloured coatings that blend with natural
dentition, ceramic, plastic, and composite brackets, and maintain
their original colour. These wires deliver gentle force but the coated
white coloured wires have shown to succumb to forces of
mastication and enzyme activity of the oral cavity. They are available
in round 0.014”, 0.016”, 0.018” and rectangular 0.016” x 0.022”
sizes [19].
Nitinol total control: A new orthodontic alloy
Nitinol Total Control (NTC) is a new pseudo-superelastic nickel
titanium alloy. They accept specific first, second, and third order
bends while maintaining its desirable superelastic properties. NTC
combines the ability of superelastic NiTi to deliver light, continuous
forces over the desired range with the flexibility required to account
for variations in the arch form [21]. It reduces the archwire inventory
without compromising treatment mechanics. These wires apply
lower forces that are generally associated with less patient discomfort.
The number of archwire changes required is less, thus NTC allows
the clinician to treat more patients effectively and efficiently. They
display low stiffness and its properties are not temperature-
dependent.
Alignment efficiency of superelastic archwires
Multistranded stainless steel, Nitinol, thermal and superelastic
archwires can be used for levelling and alignment of teeth. The
superelastic archwires exhibit superelasticity and has better mechanical
properties like good springback, low stiffness, high resilience, which
is also present in multistranded stainless steel wires [3]. The load
deflection rate of superelastic archwires is also less than conventional
NiTi and multistranded stainless steel wires [22]. Superelastic NiTi
was found to be superior to multistranded stainless steel and
conventional NiTi in laboratory studies [23]. It has to be noted
that multi-stranded wires be it braided, twisted or coaxial have
similar properties and great potential for use in the early stages of
orthodontic treatment. However, their low elastic limit makes them
susceptible to plastic deformation because of external forces, such
as chewing. Superelastic NiTi is an archwire that produces a similar
level of force at any range of deflection and hence biologically more
acceptable. In few studies [24,25], there was no statistically significant
difference in the tooth alignment and the time taken for alignment
between the superelastic and conventional NiTi wires. Some studies
[26,27] have reported statistically significant differences in the time
taken for alignment between superelastic NiTi and multistranded
stainless steel wires. Other studies [28-30] concluded that there was
no statistically significant difference between superelastic NiTi and
multistranded stainless steel wires in their efficiency in preadjusted
edgewise appliance brackets. A study [31] showed that the degree
of alignment with coaxial superelastic NiTi was greater than with
single-stranded superelastic NiTi.
Recycling of Superelastic archwires
The relatively high cost of these wires has prompted some of the
clinicians to reuse them after sterilization. Many of the clinicians
who recycled these wires indicated that a deterioration in the
mechanical properties of the wires was their major concern. Recycling
involves repeated exposure of the wire for several weeks or months
to mechanical stresses and elements of the oral environment, as
well as sterilization between uses. The combined effects of repeated
clinical use and sterilization may subject, the wire to corrosion and
cold working, with a resultant alternation in its properties. Clinical
recycling increases the loading and unloading forces associated with
these wires and also reduces the superelasticity of these wires. A
study was designed [32] to examine the effects of currently used
infection control procedures on the mechanical properties of
superelastic nickel titanium alloy archwires. No statistically significant
differences were found between the groups (recycled group) or
against an untreated control. One study [33] evaluated the load-
deflection characteristics of three types of superelastic wires and
investigated the effects of recycling on their superelastic properties.
A significant increase in load deflection rate was seen and autoclave
sterilization was recommended for clinicians who tend to reuse
superelastic wires. According to the findings of another study [34],
93
 N. Pious, R.V. Krishnan, V. Patni, A. Mhatre / Trends Biomater. Artif. Organs, 35(1), 91-94 (2021)
it is not possible to recycle and autoclave superelastic NiTi wires
without a significant reduction in their tensile properties and
degradation of surface properties. Clinically, the results of most
studies suggest that orthodontists should avoid recycling and reuse
of the archwires as the efficiency is decreased.
Conclusion
In the last few decades, a plethora of new wires and alloys have
been introduced into orthodontics. These wires demonstrate a
wide spectrum of mechanical properties and have added to the
versatility of orthodontic treatment. Superelastic archwires are a
great asset in the field of orthodontics. The use of superelastic
archwires can enhance patient comfort, reduce chairside time and
the duration of treatment. This will help the clinician in restoring
the smiles of millions faster. Superelasticity and shape memory
wires can help the orthodontist to bring about more efficient tooth
movement. They are capable of producing excellent treatment
results because they deliver a light and constant force for a long
period; which is considered physiologically desirable for tooth
movement. Recycling of superelastic wires should be avoided to
get optimum performance. Even among superelastic archwires,
further improvements have been incorporated to develop superior
wires. In the present day commercialization, SmartArch multi-force
archwire is a new technology that can both accelerate treatment and,
more important, improve clinical efficiency in treating malocclusions.
Treatment will become simpler with customized superelastic
archwires. Many clinicians may be unaware the of several new wires
available in the market. This article gives an overview of several
superior superelastic wires and their properties. It will encourage
clinicians to use the newer superior wires instead of the conventional
wires. The clinician must weigh the requirements of the individual
case at each point in time and make the selection of the archwire
based on the property of wires and clinical needs.
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