See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/348431549

A REVIEW ON DOUBLE KEYHOLE LOOP

Article · January 2018

CITATION READS
1 1,324

5 authors, including:

Mukesh Kumar Manish Goyal

Teerthanker Mahaveer University Teerthanker Mahaveer University
108 PUBLICATIONS   87 CITATIONS    113 PUBLICATIONS   8 CITATIONS   

SEE PROFILE SEE PROFILE

Ashish Kushwah Sonika Sharma

People’s college of dental sciences and research centre Institute for Integrated Learning in Management
30 PUBLICATIONS   5 CITATIONS    26 PUBLICATIONS   428 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

orthodontics View project

https://www.researchgate.net/publication/347192014_Analysis_of_stress_distribution_in_lingual_orthodontics_system_for_effective_en-
masse_retraction_using_various_combinations_of_lever_arm_and_mini-implants_A_finite_element_method_study?_sg=yiwXDbssCj50nmRV0-
fIuuDHnly4gVRQVPpNbfoCyvq_mXlY5tPGKzcx59MYj_x-7I5dUDkQbSDdShKB18VI5COf9t8yKzY0W8Xd_4bQ.36yfDiS1pMa0zv7jep3rvD34lr6fbtgcPin78FLDPPFV871ea7n-
4le5TQnHyZ05hKFRQPaQuuMH7sGiCQdnOA View project

All content following this page was uploaded by Manish Goyal on 13 January 2021.

The user has requested enhancement of the downloaded file.

Review Article

A REVIEW ON DOUBLE KEYHOLE LOOP

Mukesh Kumar 1, Manish Goyal 2, Ashish Kushwah 3, Sonika4
Professor , 1 Professor & Head 2, Post Graduate Student
1-4-Department of Orthodontics and Dentofacial Orthopedics. TeerthankerMahaveer Dental College & Research Center, Moradabad

Abstract
Closure of extraction space in orthodontic is an important stage of orthodontic treatment. Sound knowledge and
basic understanding of biomechanics is required for space closure. Extraction space can be closed either by
frictionless or friction mechanics. Friction mechanics having simplicity as comparison to frictionless mechanics but
the friction between bracket and arch wire decreases rate of space closure, decreases the delivery of required force
level, causes loss of anchorage and also associated with uncontrolled tipping and deep bite like undesirable side
effect. Simplicity of Friction mechanics or sliding mechanics makes it attractive. In friction mechanics elastics or
coil springs used for close the space site and brackets slides over the orthodontic arch wire. Loop bends are used to
generate force for space closure in frictionless mechanics. Different activation force and pre activation bends
generate different force -moments ratio in the active and reactive units, which decide amount of anchorage. In
frictionless mechanics we used many loops for different purposes. Basic structure and mechanics of double keyhole
loop in space closure has been discussed in this article.
Key words: Double keyhole loop, DKL, Frictionless Mechanics, John Parker.

INTRODUCTION
Development of Frictionless mechanics occur from In Double Keyhole Loop arch, the dental arch having two
simple loops to more complex loop design. This loops posterior and one anterior sector Extraction sites present
help to generate better moment-force(M/F) ratio and between two posterior and one anterior sector. includes
delivered a constant and continuous force.1,2,3,4,5 Incisors and canine are the part of Anterior sector and
The moment / force ratio is affected by the vertical height premolar and molars forms the posterior sector. First
of the loops,2 horizontal length of loop,2 loops premolar includes in anterior sector In case of second
positioning,2,6,7,8 extent of activation,1,2,9,10 properties and premolar extraction . Figure 2
thickness of wire11,12 used.
Profitt, advocated the preferred location of the loops to
be at the spot that would be the centre of embrasure when
the space is closed for a ‘fail safe’ closing.13
John Parker of Almeda, California introduced Double
keyhole loop (DKL) in Roth treatment mechanics.
Usually 0.019” X 0.025” rectangular stainless steel
archwire used for fabrication of DKL. This loop
resembles a champagne bottle which is a mixed vertical
and horizontal loop Figure 1. This loop is integrated in
continuous arch wire. When spaces are present mesial as Figure 2: A and C – Posterior sector, B –Anterior
well as distal to canines, this DKL loop are used and sector
closed by front backward or back forward .During Dimensions of DKL:
retraction DKL has better canine control. DKL doesn’t DKL having two symmetrical loops on each side near the
permit the canine to rotate during extraction space canines that resemble key eyelets with 7 mm of height.
closure .In DKL arch wire 2 loops were formed on each Distance between two loops of same side is approximate
side of a stainless steel wire. DKL has good control of 8 mm (Figure. 1A); Leaving approximately2 mm of wire
the involved dental groups when performs a broad range on each side of the slot of the canine bracket for the
of movements. activation. Themesio-distal width of the incisors decide
the distance between two mesial loops. Both mesial and
distal loop having equal distance from the brace of each
canine.
On the basis of mesio-distal width of incisors preformed
DKL arches are also available. Commercially available
DKL in various dimensions are ample for different dental
arches. Scale (Figure. 3): 22 , 24 , 26 , 28 , 30 , 32 , 34,
36 , 38 , 40 , 42 , 44 , 46 (in millimetre).
Figure 1: (A) and (B) Double keyhole loop

TMU J Dent. Vol. 5 Issue 3. July- September 13

 for the resorption and apposition process. The palatal or
lingual portion of the incisors alveolar socket and the
distal portion of the canine alveolar socket are the zones
that first absorb the activation forces of the DKL,
resulting in retro inclination of these teeth. In the canine,
this upright inginclines mesially and incisally the slot of
the braces, guiding the arch in this direction and
incrementing the arching of the Spee curve with intrusion
of the lateral section and the extrusion of the anterior
sector. This creates a posterior open bite and an anterior
Figure 3 : Scale in millimeter
deep bite, due to it magnitude of its root surface, the
canine tooth will take more time to recover its correct
Indispensable requisites for installation of DKL:14, 15,16
inclination.15
1. The anterior sector should be diastema free and
It should activates after 45 to 60 days. When right time,
consolidate with ligature wire to maintain close
activation must be done observed clinically .The two
proximal contact.
references are:
2. A DKL arch, placed on well aligned dental arches
• Any occlusal curving must not be present in DKL.
and previous arch wire sequence fully expressed
• Correct inclination of the canine is required. The arch
torque on each tooth.
should not be activated again if there is a curvature or the
3. Dimension of DKL must be similar to previous
canine inclined distally. We must wait until both the
rectangular arch wire to allow an easy insertion and
situations become normal. The second phase of the
perfect sliding of the arch in the slots of the braces.
movement of the incisors will not occur if the activations
are more frequent.15
ACTIVATION:
B. Activation with retroligature (Figure. 5) : A ligature
Two different mechanical concepts followed by DKL
wire tie in between hook of the molar buccal tube
arch for space closure:
andthe distal loop of the DKL arch wireto activate this
1. Use of the arch as a spring
arch is another way. AWeingardt plier used for opening
When we use DKL arch as a spring, extraction space
the loops and consolidated this activation with the
close by loops activation by opening the loops. Loops try
ligature wire. Bending of theend of the wire behind the
to come back its original form, so its generate a constant
molar tube is not recommended . Theposition assumed by
and continuous closure force. This activation can be done
the anterior portion of the arch is the main
in two ways:
differencebetween these two activation modes. Thedistal
A. Activation by distal traction of the arch (Figure. 4):
loop of DKL expresspalatal root torque and having
By pulling the arch for opening the loops from behind the
gingival inclination of the anterior sector. Ligature wire
molar tube for activation. Activation of loops should not
used for applying traction forcein the distogingival
be more than 1 mm. Cinching the arch wire behind the
angleof the distal loop.15
molar tube the scheme is completed and this way we
maintain this activation.15

Figure 5: Activation with retro ligature

Figure 4: Activation by distal traction of the arch This has many advantages:
• The upper incisors torque recovery has improved.
The activation response by cinching the arch is exhibited • It avoids extrusion of anterior sector.
in two time periods; a crown retro inclination occurs at • Minimizing the crown retroinclining effect.
the anteriors (incisors and canine) level in the first period The activation of DKL arch with retro ligature is more
and in the second period torque of incisor and canine appropriate. When a lot of dental retraction is needed.
torque are regain. For this recuperation we must prolong
the time between activations.15 2. Use as anchorage for auxiliary elements Figure 6
The tension accumulated in the loops are absorb by the In posterior sector migration (anchorage loss) type of
perio dontium of teeth which are widened in orthodontic special cases we used DKL arch as anchorage for
treatment which aggravating fast loop closure. The auxiliary elements. The DKL arch must remain passive in
persistence of the stimuli required on the periodontium

TMU J Dent. Vol. 5 Issue 3. July- September 14

this case with the closed loops. Distal loop of DKL arch DISCUSSION
used as anchorage for auxillary elements. A retrusion force exert on the anterior sector by anterior
keyhole when the DKL is activated, and a mesialization
force work on the cuspid simultaneously a distalization
force exert on the canine and a on the posterior sector a
mesialization force acted by the second key. Same
strength and opposite direction forces exerted on the
canine , so they dissolve each other , therefore the
amount of force experienced on the canine is zero. For
the mesial movement of the posterior sector 300 g force
should translate, but in reality due to the resistance force
(364 g) of both molars (1st and 2nd molar)this does not
Figure 6: Use of the arch as anchorage for auxiliary elements
occur. Resistance force ismore in amount as comparison
DKL ARCH MODIFICATIONS FOR to the mesialization force of the key loop so 64g retrusion
RETRACTION WITHOUT TORQUE force is resultant force.15,16
The management of the DKL varies when the retraction If we use a wrong sized DKL diastemas appear in the
movement has to be accomplished without torque. In this anterior sector. If we used a bigger arch instead of
condition, movement is seldom planned for the upper required size arch the mesial loop will bend over on the
dental arch, but, for the lower arch, minimal or nil torque cuspid bracket. If only the distal loop open and the
expression is planned during the retraction of the mesial loop still remain its neutral position after
anterior sector. To achieve this, the arch in the anterior activation of loop then resultant force on canine is not
sector must be wear off so that we can smoothen the zero and canine will distalize separately. This will create
edges to diminish the torque.15 a spacing between the canines and the lateral incisors.15
DKL modifications allow mesial migration of the Tábitha found in his study that mechanical force waves
posterior sectors: in cases where the posterior sectors generated in arch wire after activation of loop were run
must be mesialized especially in those where a retrusion from the posterior loop to anterior loop and they met
of the incisor is necessary. The DKL arch must not each other at the central portion of arch and then returned
express a negative torque as it has an impact on the and focused on the two loops, mainly in the posterior
anchorage. It can be achieved by wearing off the arch loop during the first phase of activation. So distal loop
wire on the distal portions of the loops to avoid the sharp clearly having greater storage of forces., The study also
edges of the wire that will in turn reduce the negative shows that the amount of force increase in the anterior
torque expression and friction. This activation is made portion as the test progresses towards the end Figure. 7.17
from the first molar. Another modification is available
for the same purpose by placing 15 degree positive
torque in the posterior segments. This will place the
molar roots onto trabecular bone. Reinforce the inferior
incisor anchorage when an important inferior molar
mesial movement is going to be done. A 0.021" x 0.025"
DKL arch can be used to increase anterior torque. The
edges of the posterior segment of the arch will be wear
off. If we give positive torque in a higher caliber wire it .
increases friction and mesial molar migration become
more difficult.15 Figure 7: Frontal view showing Stress is concentrated in the
loops.
When to use a two or four-loop arch? Dr. Alfredo Bass16 et al found in his study that the
The simple two loops arch and the DKL arch were used stainless steel wire required more force to open the loops
to close extraction space. All those cases in which first than in TMA wire because of hardness of steel. The
we want to distalize canines not more than 350 g force Hooke law followed by simple and DKL TMA arches.
apply with closed coils or with power chain and later on The amount of force exert by TMA arch was 300 g after
by opening the loops (not more than 1mm) retrude the 1 mm of activation of DKL and amount of force exert by
four incisors by the use of Simple two loops arches. stainless steel arch was 500g after similar activation as
Posterior maximum anchorage cases these simple arches TMA arch.
are recommended. When extraction space closure should According to Halazonetis, experimentally evaluated
required in a single step the DKL arches are used, loops were computerized simulated and compared their
retruding en-masse the six anterior teeth the loops are response with the results and check the accurateness of
activated more than 1 mm with posterior anchorage loss, the computer simulation of various loops. Various factors
or, if we required maximum anterior anchorage and of orthodontic loop design are visualized by computer
minimum posterior anchorage.15 simulation. This computer software has special features

TMU J Dent. Vol. 5 Issue 3. July- September 15

 which computate the neutral position of loops and the 15.Jorge G, Elisa T, Horacio E. The treatment
shape of preactivated arch wire. 18,19 orthodontic with straight arch. NM Editions. 2003.
In Fig.8 computer program wizard showing neutral 16.Alfredo B, Regina B, Carlota G, Nayre M, Diego L.
Keyhole loop which having alpha and beta arm. Beta arm Comparative study between simple arcs and double
pre activated by 100 and alpha arm pre activated by 250. wrench in steel and TMA And distribution of loads on
Later we activate this loop by 2 mm ,1 mm and 0.5 mm the dental elements. Clinical Orthodontics 2005; 8(1):
respectively in figure 8. 44-49.
17.Bassani TO. Study of Stress and Deformation of
Double Key Loop Orthodontic Archwire on the Finite
Element Method. EC Dental Science 2017;11(2): 63-67.
18.Halazonetis DJ. Design and test orthodontic loops
using your computer. Am J Orthod Dento facial Orthop.
1997;111(3):346–8.
19.Halazonetis DJ. Understanding orthodontic loop
preactivation, Am J Orthod Dento facial Orthop.
(1998).114(3): 237–41.

Figure 8: Computer simulation of Keyhole Loop Corresponding Author:

Dr. Mukesh Kumar
References: Professor,
1.Burstone CJ. The segmented arch approach. Am J Dept. of Orthodontics and Dentofacial Orthopedics
OrthodDentofacialOrthop. (1982). 82(5): 361–78. Teerthanker Mahaveer Dental College &Research
2. Burstone CJ, Koeing HA. Optimizing anterior and Centre, Moradabad
canine retraction. Am J Orthod. (1976). 70: 1–19. Email id- drmukeshortho@yahoo.co.in
3.Gjessing P. Biomechanical design and clinical Phone no-+91 9873453191
evaluation of a new canine retraction spring. Am J
OrthodDentofacialOrthop. (1985). 87: 353–61.
4. Siatkowsky RE. En masse space closure with precise
anchorage control. SeminOrthod. (2001). 7(30): 141–7. How to cite this article: Kumar M, Goyal
5. Smith R, Burstone C. Mechanics of tooth movement. M, Kushwah A, Sonika. A Review on Double
Am J Orthod. (1984). 85: 294–307.10. Keyhole Loop. TMU J DENT 2018;5(3):13-16.
6. Braun S, Morcotte MR. Rationale of the segmented
approach to orthodontic treatment. Am J
OrthodDentofacialOrthop. (1995). 108: 1–8.
7. Braun S, SjursenRc, and Legan HL, On the
management of extraction sites. Am J
OrthodDentofacialOrthop. (1997). 112: 645–55.
8. Kuhlberg AJ, Burstone CJ. T-loop position and
anchorage control. Am J OrthodDentofacialOrthop.
(1997). 112: 12–8.
9. Burstone CJ. Application of bioengineering to clinical
orthodontics. In: Graber T, Vanarsdall R, eds.
Orthodontics: current principles and techniques. 3 rd ed. St
Louis, Mo: Mosby; (2000). 259–92.
10. Hoenigl KD, Freudenthaler J, Marcotte MR, Bantleon
HP. The centered T-Loop- a new way of reactivation.
Am J OrthodDentofacialOrthop. (1995). 108(2):149–53.
11. Burstone CJ, Goldberg AJ. Beta titanium: a new
orthodontic alloy. Am J Orthod. (1980). 77: 121–32.
12. Ferriera M DoA. The wire material and cross-section
effect on double delta closing loops regarding load and
spring rate magnitude: an in vitro study. Am J
orthodDentofacialOrthop. (1999). 115(3): 275–82.
13.Profitt WR. Contemporary orthodontics. 2nd ed. St.
Louis, Mo: Mosby-Year Book Inc. (1993).
14.Pablo E. The retrusion handle in helical closed
"L".Clinical Orthodontics 2002; 5 (3) 145-152.

TMU J Dent. Vol. 5 Issue 3. July- September 16

View publication stats