Chapter 2

Review of Orthodontic Archwires

2.1 Introduction

The archwire, through mechanical interaction with the bracket slots, are designed to move

teeth from malocclusion to a preferred dental occlusion. In order to move teeth, it is necessary

to apply an orthodontic force, which produces a pressure above a dental root film capillary

blood pressure of about 15 g/cm2 and below 20 g/cm2, onto the dental root film (US Patent

5759029). Thus, the magnitude of the optimal orthodontic force required is normally within

the range of 0.5 to 3 N.

This relatively low force should be applied continuously in order to achieve correction of teeth.

Such forces may reduce the potential for patient discomfort, tissue hyalinization and

undermining resorption (Kusy, 1997). Hence, the ideal wire should behave elastically and be

able to produce light and continuous forces over the period of use.

2.2 Characteristics of Clinical Relevance

The desirable characteristics in an archwire for optimum performance are springback,

formability, modulus of resilience, biocompatibility and low friction (Evans et al, 1998).

Moreover, the duration of the use and desired mechanical properties of the wire varies with the

stage of treatment; namely, initial, intermediate and final stages of treatment. As such, it must

be noted that to date, no single archwire is best for all stages.

2.2.1 Springback

Springback, also referred to as the range of activation or working range, is the measure of how

far a wire can be deflected without causing permanent deformation (Burstone and Goldberg,

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 Review of Orthodontic Archwires

1980). Higher springback values provide the ability to apply larger activation with a resultant

increase in working time of the appliance. This would imply that fewer archwire changes or

adjustments are required (Ingram et al, 1986).

2.2.2 Stiffness

Stiffness (or load deflection rate) is the force magnitude delivered by an appliance and is

proportional to the modulus of elasticity. Low stiffness provides (Kapila and Sachdeva, 1989):

a. The ability to apply lower forces,

b. A more constant force over time as the appliance experiences deactivation and

c. Greater ease and accuracy in applying a given force

2.2.3 Biocompatibility

Biocompatibility includes the resistance to corrosion and tissue tolerance to elements in the

wire. Based on these criteria, the requirements for dental material biocompatibility include the

following (Anusavice, 1996):

a. It should not be harmful to the pulp and soft tissues.

b. It should not contain toxic diffusible substances that can be released and absorbed

into the circulatory system to cause a systemic toxic response.

c. It should be free of potentially sensitizing agents that are likely to cause an allergic

response.

d. It should have no carcinogenic potential.

Also the stability in the oral environment ensures the maintenance of desirable properties over

extended periods of time.

In addition to biocompatibility, the wire should also have poor biohostability. The ideal

archwire should neither actively nurture nor passively act as a substrate for micro-organisms

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 Review of Orthodontic Archwires

that smell foul, cause color changes that detract from aesthetics, or remove and/or build up

material that compromise mechanical properties (Kusy, 1997).

2.2.4 Friction

Continuous archwire techniques involve a relative motion of bracket over archwire. Excessive

bracket/wire friction may result in loss of anchorage or binding accompanied by little or no

tooth movement (Kusy and Whitley, 1999). A preferred wire material would be one that

produces the least amount of friction at the bracket/wire interface (Ireland et al, 1991).

2.3 Characterization

The above mentioned mechanical characteristics (stiffness, springback, modulus of resilience)

in the preceding section can be evaluated through a bending test. The mechanical properties of

orthodontic wire are typically determined under bending conditions because this mode of

deformation is considered more representative of clinical use than the conventional tensile test

(Asgharnia and Brantley, 1986). More importantly, it is necessary to know the manner of

bending of an archwire during the unloading process. This simulates the force that the wire

exerts on a tooth as it is moved into the desired dental arch from a position of malocclusion.

The performance and characteristics of conventional metallic archwires have been

predominantly evaluated under bending conditions, such as a 3-point bending test (Asgharnia

& Brantley, 1986; Wilcock, 1989; Oltjen et al., 1997).

2.4 Other influencing parameters

Factors such as inter-bracket distance, wire curvature, direction of activation relative to the

curved arch form, bracket width and dimensions of bracket slot relative to wire size

substantially affect the flexural stiffness of the archwire (Rock and Wilson, 1988; Kusy and

Whitley, 2000). The stage of treatment also dictates the choice of archwire used.

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 Review of Orthodontic Archwires

2.4.1 Stages of treatment

Orthodontic treatment can be separated into three stages: initial, intermediate and final

stages of treatment. Each stage of treatment imposes different requirements of the

archwire.

2.4.1.1 Initial stage

At the beginning of treatment, tooth displacement will be at its greatest. In order to optimize

the biological environment for tooth movement and minimize patient discomfort, the principle

requirements are minimum stiffness and maximum range (Oltjen et al, 1997). This will enable

the archwire to apply force of appropriate magnitude over relatively large distances.

2.4.1.2 Intermediate stage

In this stage, wires of increasing stiffness, offering progressively greater control over tooth

position, replace the highly flexible wires used in the initial stage. The wires have to be

sufficiently stiff to enable the molars to resist unwanted movement.

2.4.1.3 Final stage

When the principle tooth movements have been achieved in the intermediate stage, it is

necessary to complete final detailing of tooth position and then to provide retention. Although

round wires are used in the initial stages, rectangular archwires are required during the final

stages of treatment, because the tight fit of a rectangular slot permits more accurate three-

dimensional control of teeth (Proffit and Fields, 1993). The archwire requirements at this stage

are high stiffness and low range. It can be deduced from above that the stage of treatment does

indeed influence both the physical and mechanical demands of an orthodontic archwire.

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 Review of Orthodontic Archwires

2.4.2 Bracket-wire interaction

The amount of play between bracket and wire is not dictated by the desired wire stiffness but is

under the full control of the clinician. This implies that the orthodontist determines the amount

of bracket/wire play desired before selection of wire.

Low moduli of elasticity of the newer alloys permit the use of light, rectangular wires even

during the early stages of treatment. Rectangular wires are preferable over round wires because

they can be better orientated in the bracket in such a way that forces work out in proper

directions. They also maintain better control over root position by delivering both moments

and forces (Kapila and Sachdeva, 1989). This highlights that the geometry of the wire is an

influencing factor in its use.

2.5 Materials

Almost all the commercially available archwires are metal alloys: stainless steel, cobalt-

chromium, nickel-titanium and beta-titanium. The metallic wires are manufactured by a series

of proprietary steps, typically involving more than one company. Initially the wire alloy is cast

in the form of an ingot, which must be subjected to successive deformation stages, until the

cross-section becomes sufficiently small for wire drawing. Several deformation stages and

intermediate heat treatments are required because considerable work hardening of alloy occurs

during wire manufacturing (OBrien, 1997). In the following sections, the merits and demerits

of each alloy group will be discussed.

2.5.1 Stainless Steel

Up until the 1930s, the only orthodontic wires available were made of gold alloy. Austenitic

stainless steel, with its greater strength, higher modulus of elasticity, resistance to corrosion

and moderate costs was introduced as an orthodontic wire in 1929 (Kapila and Sachdeva,

1989). Stainless steel continues to be a popular wire because of its outstanding combination of

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 Review of Orthodontic Archwires

mechanical properties, corrosion resistance in the oral environment and cost. The stainless

steel types 302 and 304 are most commonly used by the orthodontist in the form of bands and

wires. These are commonly designated as 18-8 stainless steel because of the percentages of

chromium (18%) and nickel (8%) in the alloys. These wires have a relatively higher modulus

of elasticity, stiffness and a lower springback as compared to the other alloys used in

orthodontics.

Higher modulus of elasticity of stainless steel and high stiffness necessitate the use of smaller

wires for alignment of moderately or severely displaced teeth. A reduction in wire size results

in a poorer fit in the bracket and may cause loss of control during tooth movement. However,

high stiffness is advantageous in resisting deformation caused by extra- and intra-oral

tractional forces (Drake et al, 1982).

Lower springback implies that the wires produce higher forces that dissipate over shorter

periods of time, thus requiring more frequent activations or archwire changes. Thus, the high

stiffness and strength of stainless steel wires make it an ideal choice for final stage treatment

where more arch stability and small tooth movements are required.

2.5.2 Cobalt-Chromium (Co-Cr) Alloys

These alloys were originally developed for use as watch springs (Elgiloy), but their properties

are also excellent for orthodontic applications. More importantly, the formability of the alloy

can be modified by heat treatment. The wires are available in four tempers: soft, ductile,

semiresilient and resilient. Soft-temper wires are popular with clinicians because they are

easily deformed and shaped into appliances; then heat treated to increase its yield strength and

resilience. The effect of heat treatment on mechanical properties (Fillmore and Tomlinson,

1979) has been attributed to complex precipitation processes.

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 Review of Orthodontic Archwires

Co-Cr orthodontic wires are very similar in appearance, mechanical properties and joining

characteristics to stainless steel. The advantages of Co-Cr wires to stainless steel wires are

greater resistance to fatigue and distortion, and longer function as a resilient spring. It is

recommended for use when considerable bending, soldering or welding is required.

Unfortunately, the true potential of these wires have not been tapped into. Most practitioners

have used these alloys as a direct substitute for stainless steel wires only. Kusy et al (2001)

carried out a study on commercially available Co-Cr wires of the four tempers and found that

though formability varied as expected, resilience and flexibility characteristics were variable

and independent of temper. The as-received wires do not meet their potential as a variably

formable and variably resilient alternative to stainless steel. This could be due to lack of

control of the processing variables. Perhaps this is why Co-Cr wires have never made the

impact that was expected of them when they were first introduced.

2.5.3 Nickel-Titanium Alloys

Nickel-titanium has remained a strong focus of material research in orthodontics since it was

first introduced in 1971. This alloy was originally developed in the Naval Ordanance

Laboratory (USA) and was known as Nitinol. It is based upon the intermetallic compound

NiTi, which has weight percentages of 55% Ni and 45% Ti. Nickel-titanium alloy possesses

two features of considerable importance for clinical orthodontics: good springback and

flexibility, which allow for large deflections but low forces. Compared to stainless steel,

nickel-titanium has a greater recoverable energy when activated to the same amount of

bending or torque. This results in increased clinical efficiency since fewer archwire changes

are required.

Further research into this family of alloy led to the discovery of its shape memory effect and

the study of its response to heat treatment (Andersen and Morrow, 1978). Heat treatment

results in substantial alterations in mechanical properties of the alloy. Changes in

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 Review of Orthodontic Archwires

crystallographic arrangement, a reversible transformation between the austenitic and

martensitic NiTi phases caused by heating, produce this shape-memory effect. This occurs

over a certain transformation temperature range or when the stress is decreased below the

appropriate level.

Andersen and Morrow (1978) described the shape memory phenomenon as the capability of

the wire to return to a previously manufactured shape when it is heated through its transitional

temperature range (TTR). This effect is realized by holding the wire in the desired shape while

undergoing high temperature heat treatment. When subsequently cooled, the wire can be

deformed within certain strain limits, from which it recovers its original shape if heated

through its unique TTR.

Many researchers have tried to harness this property of the alloys. A highly convenient electric

resistance method has been developed for the heat treatment of wires (Sentalloy, GAC) and a

commercial apparatus (GAC International) is available that enables clinicians to heat treat

superelastic nickel-titanium wires as desired for the treatment of individual patients. Nickel-

titanium alloys with shape-memory behavior activated at body temperature have been recently

introduced by manufacturers. Recently, the use of hollow super-elastic nickel-titanium wires

was proposed by Shima et al (2002a, 2002b) as orthodontic wires.

Though much of the research interest for the alloys is focused on its shape-memory effect, the

first wire (Nitinol, Unitek/3M) was not associated with this phenomenon. Currently there is a

wide range of nickel-titanium alloy wires available in the market (Ni-Ti by Ormco/Sybron;

Sentalloy by GAC, Nitinol by Unitek/3M).

However these alloys are not without drawbacks. Low stiffness of nickel-titanium alloys

provides inadequate stability at the completion of treatment. This stability can be attained by

means of stainless steel wire tailored to the desired final occlusion. High cost, relative to other

metallic wires is also its drawback (Baldwin et al; Nakano et al, 1999). Nickel hypersentitivity

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 Review of Orthodontic Archwires

reactions to nickel-titanium wires have been observed in orthodontic patients who are nickel-

sensitive, although such cases are rare (Justin et al, 1993). It is also difficult to place permanent

bends and the wire cannot be bent over sharp edges or into a complete loop. Furthermore, it

cannot be soldered and must be joined by mechanical crimping process. The wires also have a

high bracket/wire friction. However, newer nickel-titanium wires with ion-implanted surfaces

have been developed to obtain reduced bracket friction (GAC International).

2.5.4 Beta-Titanium (beta-Ti)

The last major alloy to have an impact on orthodontics is beta-titanium alloy, introduced in

1980. This alloy is commercially available as titanium-molybdenum alloy (TMA, Ormco). The

nominal composition of TMA is 77.8% titanium, 11.3% molybdenum, 6.6% zirconium and

4.3% tin.

The presence of molybdenum causes the elevated temperature body-centered cubic beta

polymorphic phase of titanium to be metasable at room temperature, rather than the hexagonal

close-packed alpha phase. This results in its excellent formability or capability for permanent

deformation. It is also the only orthodontic wire alloy that possesses true weldability (Nelson

et al., 1987).

Beta-Ti has a modulus of elasticity less than that of stainless steel and about twice that of

nickel-titanium. This makes its use ideal in situations in which forces less than those of

stainless steel are necessary and in instances in which a lower modulus material such as nickel-

titanium alloy is inadequate to produce the desired force magnitudes (Burstone and Goldberg,

1980). A beta-titanium wire can be deflected almost twice as much as stainless steel without

permanent deformations. It has a corrosion resistance comparable to stainless steel and Co-Cr

alloys (Goldberg and Burstone, 1988).

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 Review of Orthodontic Archwires

Beta-titanium was almost a perfect wire except for a fundamental drawback. Beta-titanium

wires demonstrate higher levels of bracket/wire friction than either stainless steel or Co-Cr

wires. Its coefficients of friction were the worst of any of the orthodontic alloys (Kusy and

Whitley, 1989), and consequently its ability to accommodate the sliding of teeth was limited

(Kusy and Whitley, 1990).

It can be inferred from the above discussions that even the conventional metallic wires differ in

mechanical properties and hence their effective use varies with the stage of treatment. Table

2.1 summarizes the mechanical properties of these four alloy groups.

Table 2.1: Mechanical Properties of four main groups of alloys used as archwires
Modulus of elasticity Yield Strength
Wire alloy
(GPa) (MPa)

Stainless steel 160-180* 1100-1500*

Cobalt-chromium alloy
160-190 830-1000
(sotf-temper)

Beta-Titanium (TMA) 62-69 690-970

Nickel-titanium (nitinol) 34 210-410

*Data from Asgharnia and Brantley, 1989 and Drake et al, 1982.

2.6 Aesthetic Wires

Recently, orthodontic treatment has become more common in adult patients, and the demand

for improvement in the aesthetics quality of braces has been increasing. Many individuals

regard metallic braces as unsightly when placed in the mouth. Although aesthetic brackets

have brought a dramatic improvement in the appearance of appliances, metal archwires are still

visible. This limitation in the improvement in appearance has led many manufacturers and

researchers to attempt to produce durable aesthetic archwires. These wires have to be visually

unobtrusive and at the same time perform the essential function of aligning teeth.

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 Review of Orthodontic Archwires

2.6.1 Coated metallic wires

The first attempt to make aesthetic wires was to camouflage the archwire by covering it with a

plastic layer. Polymer-coated metallic wires (Rocky Mountain Teflon-coated stainless steel

wires) were introduced in the 1970s. Although the appearance of the wires was greatly

improved, experience with the Teflon-coated archwires showed that the coating tend to stain

and split with usage, revealing the underlying metal. Another alternative is using a spray-coat,

which has the advantage of adding only a thin layer to the archwire, but the coat tends to have

a rather grey tinge and often chips off with use (Postlethwaite, 1992).

2.6.2 Optiflex

The first, completely non-metallic archwire was introduced into the orthodontic market, called

a totally aesthetic labial archwire. The commercial name is Optiflex (Ormco/Sybron). The

wire comprises of three layers: a silica core, which is surrounded by a moisture protection

silicone resin middle layer and a stain-resistant nylon outer layer. The outer layer has the dual

purpose of preventing damage to the archwire and further increase the strength of the archwire.

This wire was aesthetically very pleasing.

However, its orthodontic force is too light for clinical use (Lim et al, 1994). Further

improvement in the stiffness and resilience of Optiflex would be needed in order for the

archwire to be clinically efficient.

2.6.3 Composite archwires

As composites are displacing metallic alloys as structural components in the aerospace

industry, the expectation is that the attractive properties and characteristics of these aesthetic

composites will capture a significant share of the orthodontic market as well. Currently there

are no composite wires available in the market. However, it has been recognized that an

optimal and aesthetic archwire can be developed using composite technology from continuous

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 Review of Orthodontic Archwires

fibers and polymer matrix to suit the varying degree of stiffness required for each stage of

orthodontic treatment (Goldberg and Burstone, 1992). Currently, two research groups have

developed prototype composite archwires, using two different fabrication methods.

Kusy et al. developed a vertically disposed patented (US Patent 5869178) modified pultrusion

system to produce composite profiles ranging from 0.012 inch (0.3 mm) to 0.025 inch (0.6

mm) in cross-section. In this set-up, the fibers are being pulled through a rigid die of a fixed

cross-section, giving rise to longitudinally straight profiles (Figure 2.1). With this patented

process, prototype glass fiber-reinforced bisphenol A diglycidylether methacrylate (Bis-GMA)

composite wires were developed. The composite wires fabricated were subjected to a 3-point

bending test and a bend stress relaxation to determine their flexural properties and viscoelastic

behavior respectively (Zufall and Kusy, 2000a). It was observed that archwire recovery was

not correlated with reinforcement level but the stress relaxation behaviour was strongly

correlated. Also, the relaxed elastic moduli in bending of the composite wires were similar to

the elastic moduli in bending of several conventional orthodontic archwire materials. A

tribological (friction and wear) study was also designed to determine the effect of coating on

the composite wires (Zufall and Kusy, 2000b). It was observed that although the coating did

increase the frictional and binding coefficients of the wires, it was still within the limits

outlined by conventional wire-bracket couples. In addition, it reduced the risk of glass fiber

release into the oral cavity.

Prototype glass fiber-reinforced poly-methyl methacrylate (PMMA) composite archwires have

also been developed using hot-drawing (Imai et al, 1998) fabrication method, drawing through

a glass die. Mould polymerization method (Watari et al, 1998) was also used to develop glass

fiber-reinforced epoxy wires. These prototype wires were also subjected to a 3-point bending

test to evaluate their mechanical properties. The fiber-reinforced polymer wires showed

sufficient strength and good elastic recovery. The aesthetic in external appearance was evident

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 Review of Orthodontic Archwires

and its range of strength (by varying the volume fraction of fibers) corresponds to conventional

wires.

2.7 Motivation

It can be inferred from the above discussions that even the conventional metallic wires cannot

produce a single wire that can be used throughout all stages of treatment. Moreover, the

current trend in orthodontics is towards developing aesthetic appliances. Metallic wires have

poor aesthetics. Although attempts had been made to coat these metallic wires, the coatings

were not durable in the oral cavity and they increased the friction between the bracket and

wire. Polymers and ceramics are not ideal candidates due to low stiffness (polymer) and

brittleness (ceramics). However, using composite technology with careful selection of the

constituents, it is possible to combine both aesthetics as well as favorable mechanical

properties. As such, in this study the objective was to develop a composite orthodontic wire.

Though attempts have been made by researchers to develop aesthetic composite wires, as

mentioned in Section 2.6.3, there is still room for much improvement.

In all the above mentioned methods, pulling the fibers through a small die induces stresses on

the fibers, causing them to break. This becomes more prevalent if the cross-section is very

small, like that required for an orthodontic wire (0.025 0.014). It also becomes more

difficult to insert fibers into the die. It can be observed by looking at the cross-sections in

Figure 2.2, obtained by the method described in US Patent 5869178, a high fiber volume

fraction would be required for even fiber distribution.

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 Review of Orthodontic Archwires

Figure 2.1: Photo-pultrusion

Furthermore, to shape the profile longitudinally, such as to the dental arch, beta-staging needs

to be carried out. Also, the methods do not produce very smooth surfaces. This roughness will

give rise to friction between the archwire and bracket, not desirable in orthodontic treatment.

Hence it is desirable to develop a novel method that will eliminate pre-stresses on the fibers as

well as fiber breakage, with desired surface finish and mechanical performance.

Most of the prior researches on composite archwires have only focused on varying the

mechanical property of the composite through different volume fraction of reinforcement. No

research has focused on controlling the interface of the composite wires developed. Hence, in

this study, surface modification of fibers and its influence on the mechanical properties of the

composite wire were explored.

26