|Year : 2022 | Volume
| Issue : 3 | Page : 536-539
Comparative evaluation of transverse dental arch width changes with conventional and self-ligating brackets
Nivethigaa Balakrishnan, Aravind Kumar Subramanian
Department of Orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
|Date of Submission||10-Apr-2020|
|Date of Decision||08-Dec-2021|
|Date of Acceptance||14-Jun-2022|
|Date of Web Publication||2-Nov-2022|
Dr. Aravind Kumar Subramanian
Department of Orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Aim: This study aims at comparing the transverse width changes during leveling and aligning phase with conventional and self-ligating brackets. Materials and Methods: The study consisted of twenty samples. The sample was split into two groups. Group 1 consisted of ten samples treated with conventional brackets and ten samples treated with self-ligating brackets. Pretreatment and leveling aligning cast were used for the study. Measurement of transverse dimension was taken at two different regions, premolar and molar. Reference points were chosen according to the Pont's model analysis. In the premolar region, measurements were made from the distal pit of the first premolar on either side, and in the molar region, measurements were made from the mesial pit on either side. The overall values are compiled and compared among both the bracket groups. Results: The results of the study showed that there were changes in the interpremolar and intermolar arch width during leveling and aligning phase in both the bracket types. Conclusion: Since the arch width changes can affect the stability in the posttreatment phase, an orderly use of custom-made archwires from the very beginning is advised. The amount of arch width changes that occur with the treatment is irrespective of the bracket type, provided that other factors are maintained to be constant. Both conventional metal-ligated brackets and dual-activation self-ligating brackets provide an equal amount of changes in the dental arch transverse dimensions.
Keywords: Conventional brackets, metal-ligated brackets, self-ligating brackets, stability
|How to cite this article:|
Balakrishnan N, Subramanian AK. Comparative evaluation of transverse dental arch width changes with conventional and self-ligating brackets. J Datta Meghe Inst Med Sci Univ 2022;17:536-9
|How to cite this URL:|
Balakrishnan N, Subramanian AK. Comparative evaluation of transverse dental arch width changes with conventional and self-ligating brackets. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Jan 28];17:536-9. Available from: http://www.journaldmims.com/text.asp?2022/17/3/536/360175
| Introduction|| |
Diagnosing a case is very important in planning for a proper treatment process. Dental cast is a three-dimensional representation of the oral hard tissues and the soft tissues.,,, It provides complete oral anatomy of a patient so that an orthodontist can hold a model in hand and visualize the occlusion three dimensionally. The size and shape of the dental arches could be affected due to many factors such as heredity, growth of bone, inclination and eruption of teeth, race, and environmental factors such as muscle function.,,
Several authors put forth model analysis to determine the treatment plan which includes decision regarding need for extraction or expansion treatment if any and the amount of exact malocclusion that is present. Many forms of dental arch discrepancies might exist. Constricted dental arch is one such which requires expansion that creates some additional space within the arches. When deciding about the need for expansion, the basal bone serves to be a valid landmark since any change in the dental arch does not affect the underlying basal bone. Evaluation of the basal bone anatomy is an essential feature before going into any treatment plan.
Dental arch form is an overall reflection of the underlying bone morphology. Mandibular intercanine width is established at 8 years of age after the eruption of the incisor teeth in the mandibular arch. The findings from few studies were conclusive that the arch width undergoes changes from birth till mid-adulthood. After the eruption of permanent dentition, the clinician can expect minimal or no changes to occur physiologically to increase the arch width.,,
The mandibular dentition is considered to be more reliable and hence can be useful in treatment planning. The arch width is measured in the intercanine, interpremolar, and intermolar regions of the dental arches. Apart from expansion occurring with expansion appliances, some amount of iatrogenic expansion also happens with orthodontic-fixed appliance treatment. When not properly planned, such appliance might inadvertently increase the arch width and such results have chance of relapse than a well-maintained arch form.,,
The average size of dental arch width in males is greater than females from near 0.5 mm at the lateral incisors to 3 mm in the molar region. With the transition from deciduous to permanent dentition, about 1 mm mean change was noted.
Passive expansion occurs with the fixed appliance therapy, especially with self-ligating brackets. This effect is said to be stable because the expansion occurring at a slower pace is said to maintain the equilibrium effect but still moves the tooth buccal within the basal bone., However, this is questionable when it happens outside the limits of the basal bone.
This study aims at comparing the transverse arch width changes with conventional and dual-activating self-ligating brackets during the initial leveling and aligning phase.
| Materials and Methods|| |
This study comprised analysis of pretreatment and leveling aligning models obtained from patients undergoing orthodontic treatment at Saveetha Dental College, Chennai. For this, they were randomly chosen based on the type of bracket prescription selected for the patient into two groups.
- Group 1: Conventional metal brackets (n = 10)
- Group 2: Dual-activation metal self-ligating brackets (n = 10).
Selection criteria were based on the fact that patients did not have any underlying systemic conditions or local conditions like missing teeth that would affect our study results. Furthermore, these selected patients had a very minimal crowding and no need for expansion of arches and also did not require any special appliances for correction of malocclusion. After initial selection, the fixed appliance therapy was started with 0.016 nickel–titanium (NiTi) archwire.
Pretreatment and leveling aligning models (both maxillae) were taken. With a total of forty models obtained, measurements of transverse dimension were made at premolar and molar regions using a Vernier caliper. Reference points were chosen according to the Pont's model analysis. In the premolar region, measurements were made from the distal pit of the first premolar on either side, and in the molar region, measurements were made from the mesial pit on either side.
Thus, the intercanine and intermolar width in both the bracket groups were summarized and average initial and leveling aligning values for each group was calculated.
| Ethical clearance|| |
The Institutional Ethics Committee of Saveetha Institute of Medical and Technical Sciences, Saveetha University has approved the Research work proposed to be carried out at Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Na. Date : 31st Jan 2018 with Reference no SIMTS/IEC/2018-19/22.
| Results|| |
The results of the study depict that arch expansion was noted with both the bracket types. In the conventional bracket group, an increase from 39.1 to 40.2 mm had occurred in the upper premolar region and 47.8–49 mm in the molar region, whereas in the lower arch, the interpremolar width had increased from 31 to 32.2 mm and the intermolar width had increased from 39.9–41.4 in the molar region.
In the dual-activation self-ligating bracket, an increase from 36.3 to 37.9 mm had occurred in the upper premolar region and 44.6–47 mm in the molar region, whereas in the lower arch, the interpremolar width had increased from 31 to 33.3 mm and the intermolar width had increased from 40.5 to 42.1 in the molar region [Graph 1], [Graph 2], [Graph 3], [Graph 4] and [Table 1].
|Table 1: Arch width changes in the initial and leveling and aligning phase with conventional and dual-activation selfligating brackets|
Click here to view
| Discussion|| |
The study involved the evaluation of arch width changes with conventional and dual-activation self-ligating brackets during leveling and aligning phase. When expansion is tried out with any of the appliances, care should be taken not to exceed beyond the equilibrium zone.
Stability of the final occlusion obtained at the end of orthodontic treatment mainly depends on the muscles balance. When imbalance exists, this could lead to relapse of the malocclusion. More light is focused over the arch width because every orthodontic treatment has in it some part to play with arch width changes.
It had been noted that for every 1 mm increase in the arch width in the canine and molar regions, the arch length increases about 1 and 0.25 mm, respectively. Germane et al. discovered that compared to intermolar width, the increase in intercanine width has more effect over the increase in arch length. Expansion in the mandibular arch was done by three dimensional stimulated models by Motoyoshi et al. who showed that for every 1 mm lateral expansion of the inter, the arch length increased about 0.37 mm. Adkins et al. reported that the increase in the arch width in the anterior teeth had a significant effect over the arch length increase. A study by Amin et al. has shown that the arch width increase in the canine and molar regions had a high positive correlation, whereas the molar width arch length increase had only a week correlation with arch width increase both in the canine and molar regions.
In a study by Lux et al., the maxillary skeletal and dental base width was found to be smallest in Class II div 1 case among both the sexes. The intercanine and intermolar width among Class II div 1 are smaller than those of the Class 1 malocclusion; also, the maxillary molar arch width is found to be greater in Class I skeletal pattern than in Class III skeletal pattern. The intercanine width and the intermolar width are larger in males than in females.
In our present study, arch width changes have been compared between two different bracket systems; the conventional and dual-activation self-ligating brackets have been compared in the initial and leveling and aligning phase. The values signify that the arch width increases both the groups. Even though the increase is greater in the self-ligating bracket group, it does not show any statistical significance. Furthermore, one other factor to be noted here is the reason that the increase in arch width noted in both these groups could probably be because of the use of preformed NiTi archwires which were constantly maintained in both the groups.
| Conclusion|| |
Since the arch width changes can affect the stability in the posttreatment phase, an orderly use of custom-made archwires from the very beginning can be advised. The amount of arch width changes that occur with the treatment is irrespective of the bracket type, provided that other factors are maintained to be constant. Both conventional metal-ligated brackets and dual-activation self-ligating brackets provide an equal amount of changes in the dental arch transverse dimensions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jacobson A. Color atlas of Dental Medicine. Orthodontic Diagnosis. In: Rakosi T, Jonas I, Graber TM, editors. New York: Thieme Medical Publishers Inc; 1993. p. 1001.
Batool I, Abbas A, Rizvi SA, Abbas I. Evaluation of tooth size discrepancy in different malocclusion groups. J Ayub Med Coll Abbottabad 2008;20:51-4.
Felicita AS, Chandrasekar S, Shanthasundari KK. Determination of craniofacial relation among the subethnic Indian population: a modified approach (vertical evaluation). Indian J Dent Res 2013;24:456-63.
] [Full text]
Balan S, Navaneethan R. Psychology of patients with malocclusion–A questionnaire survey. Int J Pharm Bio Sci 2015;352-5.
Lavelle CL, Foster TD, Flinn RM. Dental arches in various ethnic groups. Angle Orthod 1971;41:293-9.
Björk A, Brown T, Skieller V. Comparison of craniofacial growth in an Australian aboriginal and Danes, illustrated by longitudinal cephalometric analyses. Eur J Orthod 1984;6:1-4.
Hassanali J, Odhiambo JW. Analysis of dental casts of 6-8- and 12-year-old Kenyan children. Eur J Orthod 2000;22:135-42.
Balaji H. Dental arch patterns and its role in orthodontics–A review. Int J Pharm Sci Health Care 2017;2:91-8.
Bishara SE, Jakobsen JR, Treder J, Nowak A. Arch width changes from 6 weeks to 45 years of age. Am J Orthod Dentofacial Orthop 1997;111:401-9.
Papagiannis A, Halazonetis DJ. Shape variation and covariation of upper and lower dental arches of an orthodontic population. Eur J Orthod 2016;38:202-11.
Knott VB. Longitudinal study of dental arch widths at four stages of dentition. Angle Orthod 1972;42:387-94.
Braun S, Hnat WP, Fender DE, Legan HL. The form of the human dental arch. Angle Orthod 1998;68:29-36.
Lee RT. Arch width and form: A review. Am J Orthod Dentofacial Orthop 1999;115:305-13.
Thiradilok S. Changes of the transverse dental arch dimension, overjet and overbite after rapid maxillary expansion (RME). M Dent J 2014;34:301-10.
Lagravere MO, Major PW, Flores-Mir C. Long-term dental arch changes after rapid maxillary expansion treatment: A systematic review. Angle Orthod 2005;75:155-61.
Cattaneo PM, Treccani M, Carlsson K, Thorgeirsson T, Myrda A, Cevidanes LH, et al
. Transversal maxillary dento-alveolar changes in patients treated with active and passive self-ligating brackets: A randomized clinical trial using CBCT-scans and digital models. Orthod Craniofac Res 2011;14:222-33.
Fleming PS, Dibiase AT, Sarri G, Lee RT. Pain experience during initial alignment with a self-ligating and a conventional fixed orthodontic appliance system. A randomized controlled clinical trial. Angle Orthod 2009;79:46-50.
Germane N, Lindauer SJ, Rubenstein LK, Revere JH Jr., Isaacson RJ. Increase in arch perimeter due to orthodontic expansion. Am J Orthod Dentofacial Orthop 1991;100:421-7.
Adkins MD, Nanda RS, Currier GF. Arch perimeter changes on rapid palatal expansion. Am J Orthod Dentofacial Orthop 1990;97:194-9.
Amin F, Bakhari F, Alam R. Relationship among intercanine width, intermolar width and arch length in upper and lower arches. Pak Oral Dent J 2012
Lux CJ, Conradt C, Burden D, Komposch G. Dental arch widths and mandibular-maxillary base widths in Class II malocclusions between early mixed and permanent dentitions. Angle Orthod 2003;73:674-85.
Motoyoshi M, Hirabayashi M, Shimazaki T, Namura S. An experimental study on mandibular expansion: increases in arch width and perimeter. Eur J Orthod. 2002;24:125-30. doi: 10.1093/ejo/24.2.125. PMID: 12001548.