Orthodontic elastics

Dr. Tariq Khalid F.C.P.S Part II Trainee Department of Orthodontics AIDM

Introduction
There are multiple surveys of natural rubber latex (latex) orthodontic elastics and other synthetic elastomeric materials (i.e., elastic ligatures, elastomeric chain), there is limited research on synthetic (nonlatex) orthodontic elastics. The latex and nonlatex elastics were not similar in their behavior. Furthermore, force delivery over time varied with the manufacturer.

 Elastomer is a general term that encompasses materials that, after substantial deformation, rapidly return to their original dimensions. After placement, the elastic chains are generally changed at 3- to 6-week intervals. Once the chains are activated, they begin to permanently elongate, thus decreasing the force that they can exert on the teeth.

Composition
1. Natural rubber Natural rubber may be obtained from hundreds of different types of plants. The major source, however, is the rubber tree (Hevea brasiliensis). The chemical structure of natural rubber is cis1,4 polyisoprene which contains approximately 500 isoprene units in the average natural rubber polymer chain.

2. Synthetic rubber Synthetic rubber polymers, developed from petrochemicals in the 1920s, have a weak molecular attraction consisting of primary and secondary bonds. Elastomeric chains were introduced to the dental profession in the 1960s and have become an integral part of many orthodontic practices. It has been found that they excel in strength and resistance to abrasion when compared with natural rubber. They tend to permanently distort, however, following long periods of time in the mouth and often lose their elastic properties.

Advantage
They are inexpensive, relatively hygienic and easily applied. Placement and removal of chain elastics requires little chair time for the clinician and minimal patient cooperation during application. Rubber bands are also easier for a patient to remove and replace. The material is relatively compatible with the mucosa. Rubber has the particularly valuable quality of a great elastic range, so that the extreme stretching produced when a patient opens the mouth while wearing rubber bands can be tolerated without destroying the appliance. The major useful property of natural latex rubber is its resiliency. This property makes it useful intraorally for the application of tractive forces in the ranges up to 6 or 8 ounces. Greater forces would result in a large increase in the cross-sectional area of the rubber and would be difficult to be placed in orthodontic attachments. High quality latex more or less retains its resilience in water and under optimal conditions displays a minimal force decay.

Disadvantage
Gum rubber, which is used to make the rubber bands commonly used in households and offices, begins to deteriorate in the mouth within a couple of hours, and much of its elasticity is lost in 12 to 24 hours. Although orthodontic elastics once were made from this material, they have been largely superseded by latex elastics, which have a useful performance life 4 to 6 times as long. In contemporary orthodontics, only latex rubber elastics should be used. When extended and exposed to an oral environment, they absorb water and saliva, permanently stain, and suffer a breakdown of internal bonds that leads to permanent deformation. They also experience a rapid loss of force due to stress relaxation, resulting in a gradual loss of effectiveness.11, 12 This loss of force makes it difficult for orthodontists to determine the actual force transmitted to the dentition.

Force delivery and force degradation

Profitt stated that it simply must be kept in mind that when elastomers are used, the force decay rapidly, and so can be characterized better as interrupted rather than continuous.

1. Chains
A) Initial force An initial force loss (Force decay) of 50% to 75% occurred in the first 24 hours. The greatest amount of force loss took place in the first 3 hours. After 24 hours of load, Alastiks suffered a 74% loss of force delivery capability, whereas latex elastics only lost 42%. After the first day, the force degradation declined in a relatively stable manner. Force gauge should be used in a clinical setting to determine initial loads of the chains.

B) Filament shape of chains Short filament chains generally provided higher initial force levels and retained a higher percentage of the remaining force than the long filament chains. The longer filament chains will deliver a lower initial force at the same extension and exhibit a greater rate of force decay under load than the closed loop chain. Initial force level at 100% extension, the initial forces being in the range of 403 to 625 gm. Recommend extending chains to 50% to 75% of their original length to provide the desired force of approximately 300 gm. The most force decay occurs at the first hour, and the greater the initial force, the greater the force decay of all chains.

2. Elastics
Stretching a rubber elastic of 7 mm. diameter to 20 mm. exerts a pressure as high as 168 grams. A 30 mm. stretching gives 243 grams and 40 mm. 350 grams. Most of the relaxation was shown to occur within the first 35 hours after extension, regardless of size, manufacturer, or force level of the elastics.

Factors affecting orthodontic elastics and chains

1. Color When comparing the American Orthodontic elastomeric chains, the remaining forces and the percentage of remaining force of the transparent chains were greater than that of the grey chains. In general, the colored chains of a particular manufacturer behaved similarly to the gray chain of that manufacturer, the exception to this being the Ormco purple and green chains.

 2. Fluoride The physical properties and fluoride releasing capabilities of a recently introduced fluoridecontaining elastomeric chain (Fluor-I-Chain) have been evaluated and compared to those of a standard gray elastomeric chain.

 The initial force levels of Fluor-I-Chain and gray chain when stretched by 100% their original length were 316g and 280g respectively. After 1 week, Fluor-IChains force level had degraded to 43 g or 14% of its original force. This force level would not be adequate to retract a canine.

Gray chain at one week had a force level of 107 g which remained fairly constant through the remaining 2 weeks. The force delivery level of the standard gray chain remained adequate over the entire three-week test period.

3. Air Exposure of latex to air was found to cause a loss of force. 4. Ozone The most significant limitation of natural latex is its enormous sensitivity to the effects of ozone or other free radical generating systems such as sunlight or ultraviolet light that produces cracks. This sharply limits the shelf life of the latex elastics. Out-of-date elastics may break after a few elongation-relaxation cycles.

5. Disinfection and sterilization

Exposure to gluteraldehyde solution affected the strength and the distention required to deliver a force of 500g of certain elastomeric chains. However, the resultant changes were relatively small and are probably insignificant in the clinical setting.

6. pH
Oral pH almost certainly has a significant influence on the decay rate of orthodontic polyurethane chain elastics. All the test products yielded a significantly greater force-decay rate in the basic (pH 7.26) solution than in the acidic (pH 4.95) solution over 4 weeks.

7. Mastication
The forces of mastication and the intraoral environment cause natural rubber to break down by formation of knotty tearing mechanisms.

8. Staining
The foods appeared to fall into three distinct categories.. A. No staining (Coca-Cola even after 72 hours and, presumably, most colorless foodstuffs) B. Gradual staining (chocolate drink, Lea & Perrins sauce, red wine, tomato ketchup) C. Rapid staining (coffee produced severe staining after only six hours, tea)

Uses and Clinical applications

1. Elastic ligatures Elastic ligatures of light, medium and heavy thickness may be used for separating teeth before fitting bands, rotating teeth, space closure, tooth alignment, canine retraction and for bringing teeth into the line of occlusion. The elastic ligature is drawn through the interproximal space of the teeth with a fine ligature wire and tied under tension.

2. Elastomeric separators
a) Elastomeric ring Elastomeric ring ("doughnuts"), which surround the Contact point and squeeze the teeth apart over a period of several days. b) Safe-T-Separators These Safe-T-Separators have knobs on either side of each ring. These extend beyond the inter-proximal area out past the gingiva. Their presence prevents this separator from submerging into the subgingival area. c) Dumbbel Separators White, individual rubber separators can be stretched and slipped between contacts for in-office separations. Contracting action of separators achieves ample separation for banding within minutes.

d) Stick Separators

e) Durasep Separators

3. Elastomeric module
Elastomeric modules are used to ligate archwires to brackets

4. Elastomeric chains
In orthodontics, polyurethane elastomeric chains are used extensively as tooth-moving mechanisms. Polyurethane chain elastics are commonly used in orthodontics for intra-arch tooth movement. They are used to generate light continuous forces for canine retraction, diastema closure, rotational correction, and arch constriction.

5. Derotation
A. Derotating a Tooth with a Lingual Rotation Tie B. Correction of Individual Tooth Rotations with Elastomeric Ligatures C. Rotation Wedges( Elastic-Rotator)

6. Rubber bands
Rubber bands were used from the beginning, in orthodontics to transmit force from the upper arch to the lower.

7. Dental Crossbite
In cross bite rarely is one tooth alone tipped. In most cases, its antagonist in the opposite arch is out of position also. Thus, the maxillary first molar may be tipped lingually and the mandibular first molar is tipped slightly buccally, so both teeth must be moved.

8. Midline discrepancies

9. Impacted Canines
a) Placing a Straight Wire in a High Buccal Canine or a Palatal Canine.

b) Palatally impacted canines

10. Canine Retraction

In Rocky Mountain clear chain, 40 mm stretch length was optimal for clinic use. The effective canine retraction may be no more than 3 weeks, meaning that it may be changed about 3 weeks during clinical usage.

11. Deep bite

Class II elastics may cause extrusion of the upper incisors, they also attempt to overerupt lower molars. The use of an anchorage bend in the upper jaw as well as in the lower jaw in combination with Class II elastics may cause overeruption of the molars and may help to correct a dental deep bite.

12. Open bite

Anterior vertical elastics used with light arch-wires to close a mild anterior open bite at the end of the treatment. A 16 mil round wire with a curve of Spec is used in the lower arch, where most of the tooth movement should occur. A full dimension rectangular wire often is preferred in the upper arch. For this patient, two small elastics are being used on the right and left sides. An alternative is to use single larger elastic in an anterior box configuration.

13. Molar Correction with Inter-arch Elastics

Without extraction, Class II elastics produce molar correction largely by mesial movement of the mandibular arch, with only a small amount of distal positioning of the maxillary arch.

XIV. References
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