Professional Documents
Culture Documents
bracket systems
Lawrence P. Lotzof, DDS," Howard A. Fine, DMD, MMSc, b and
George J. Cisneros, DMD, MMSc
Bronx, N. Y.
Before the 1970s, Begg and Edgewise appliances were the most commonly used appliances in
orthodontics. With the introduction of preadjusted appliances, many have made claims of
superiority. These claims are often unsubstantiated, as few, if any, have ever been tested in a
controlled, prospective in vivo study. The purpose of this study was to compare the time required to
retract canine teeth by using two different preadjusted bracket systems (Tip-Edge, TP Orthodontics,
LaPorte, Ind., versus A-Company straight wire, Johnson and Johnson, San Diego, Calif.) in a human
sample. Anchorage loss as a result of this movement was also evaluated. A sample of 12 patients
was randomly selected from the new patient pool at the postgraduate orthodontic clinic of
Montefiore Medical Center. All patients required the removal of first premolars in one or both arches
as a part of their orthodontic treatment. The rate of retraction and anchorage loss were evaluated.
Paired t tests were performed separately for the rates of retraction and anchorage loss. The mean
rates of retraction were 1.88 mm per 3-week period and 1.63 mm per 3-week period for the
Tip-Edge and A-Company brackets, respectively. There was no statistically significant difference in
the rates (/9 > 0.05). The mean anchorage loss was 1.71 mm for the Tip-Edge bracket, and 2.33
mm for the straight wire bracket. The difference in the amount of anchorage loss was inconclusive
as the sample size was too small (power was 10%). (Am J Orthod Dentofac Orthop
1996;110:191-6.)
Orthodontic
clinicians t h r o u g h o u t t h e
y e a r s have t o u t e d t h e a d v a n t a g e s o f v a r i o u s a p p l i a n c e systems. 1-9 C e n t r a l to m a n y o f t h e i r a r g u m e n t s
is t h e efficiency o f t o o t h m o v e m e n t intrinsic to t h e
b r a c k e t design. M o r e o v e r , in r e c e n t years, scientific
s t u d i e s have f u r t h e r m i t i g a t e d t h e s i t u a t i o n by
d o c u m e n t i n g t h a t b r a c k e t d e s i g n is o n e o f several
v a r i a b l e s c a p a b l e o f effecting t o o t h m o v e m e n t . 1-13
With the introduction of preadjusted appliances,
few, if any, have ever b e e n t e s t e d in a c o n t r o l l e d
study.
T h e p u r p o s e o f this study was to c o m p a r e t h e
r a t e o f r e t r a c t i o n a n d a n c h o r a g e loss with two
d i f f e r e n t p r e a d j u s t e d b r a c k e t systems ( T i p - E d g e ,
T P O r t h o d o n t i c s , L a P o r t e , Ind., v e r s u s A - C o m p a n y
s t r a i g h t wire, J o h n s o n a n d J o h n s o n , San Diego,
Calif.) in a h u m a n s a m p l e .
From the Montefiore Medical Center-Albert Einstein College of
Medicine.
aln private practice,San Diego, Calif..
bAssistantDirector,Department of Dentistry,Divisionof Orthodontics.
CDirector,Divisionof Orthodontics;AssociateProfessor,Pediatric Dentistry and Orthodontics.
Reprint requests to: Dr. GeorgeJ. Cisneros,Director,Divisionof Orthodontics, Montefiore Medical Center-Albert Einstein College of Medicine, 111 E. 210st St., Bronx, NY 10467-2490.
Copyright 1996 by the AmericanAssociationof Orthodontists.
0889-5406/96/$5.00 + 0 8/1/62496
191
192
Statistics
A sample size of 12 patients assured an 80% statistical power to detect a difference of 0.25 mm per 3-week
period for the rate of retraction. Each subject acted as
their own control. Retraction in either the maxilla or the
mandible counted as one source of data.
Paired t tests were performed independently for the
difference of the rates of retraction and anchorage loss.
Significance was determined at the 0.05 level. A power
analysis was performed accessing the sample size.
RESULTS
T a b l e I s u m m a r i z e s t h e t i m e r e q u i r e d for retraction. T h e m a x i m u m t i m e interval for b o t h
b r a c k e t systems was 7.5 intervals a n d t h e m i n i m u m
was 1.5 intervals. T h e m e a n for t h e T i p - E d g e
b r a c k e t was 3.58 intervals, a n d for t h e straight wire
A - C o m p a n y b r a c k e t 3.92 intervals.
Table II summarizes the distance of retraction
L o z t o f Fine, a n d Cisneros
193
REFERENCEPOINTS
Fig. 1. Anchorage loss determination: (A) Initial model with palatal plug and reference wires
extending to cusp tips of canines and to central fossa of molars, (B) Final model with palatal plug
denoting amount of canine retraction and anchorage loss. (C) Enlargement illustrating anchorage
loss as distance between central fossa and reference wire.
Table II. Distance of retraction
Maximum
Median
Minimum
Mean
Variable
Maximurn
Median
Minimum
Mean
TE time (intervals*)
SW time (intervals*)
12
12
7.5
7.5
3.5
3.5
1.5
1,5
3.58
3.92
TE distance (ram)
SW distance (ram)
12
12
8.26
7.92
5.90
5.37
3.30
3.22
5.69
5.58
194
August 1996
4.5
4-
A4.5N
4C
H 3.5O
R 3-
3.5RATE
OF
RETRACTION
32.52-
(mm./interval)
A 2.5G
E 2-
1.510.5-
L
O
Tip Edge
Straightwire
1.5:
1-
S 0.5S
0c
(rnm.)
APPLIANCE TYPE
Tip Edge
Strak htwire
APPLIANCE TYPE
LEGEND
LEGEND
==MEAN
A=MINIMUM
T=MAXIMUM
Fig. 2. Rate of retraction by appliance type. Rate of retraction was faster for Tip-Edge appliance but not statistically significant.
Variable
12
12
12
4.18
3.76
1.27
1.46
1.50
0.19
0.94
0.92
-0.39
Mean
TE rate (mm/interval)
SW rate (mm/interval)
Rate difference (TE
rate - SW rate)
IN=MEAN
&=MINIMUM
T=MAXlMUM
1.88
1.63
0.25
A
n
h
0
Variable
Maximum
I
I
a
Median
Minimum
Mean
T E anchorage
loss (mm)
SW anchorage
loss (mm)
Difference in
10
3.24
1.82
0.29
1.71
10
3.96
2.67
0.00
2.33
10
1.28
- 0.16
- 1.06
0.04
anchor age
loss (ram)
3.02.5-
1.5-
1.0-
0
S
I
m
2.0-
g
e
3.5
0.50.0
0.5
1.0
1.5
2.0
2.5
3.0
Rate
of
3.5
Retraction
DISCUSSION
4.0
3.5-
c
h
3.0-
o
r
a
2.5-
1.5-
1.0-
195
2.0I
0.5-
L
o
s
e
0.0-0.5
I
1.0
'
Rate
I
1.5
of
'
2.0
'
2.5
Retraction
196
The development of preadjusted appliances has dramatically changed the way orthodontics is taught and
practiced today. The appointments are shorter and the
amount of wire bending has decreased dramatically. One
must not fail to realize that we are dealing with a biologic
system, and that each person responds in a variable
fashion, regardless of the type of appliance used. Teeth
do not have the ability to recognize the type of appliance
being used. Manufacturers constantly imply that there
are differences in appliances and claim appliance superiority with no valid research. Preadjusted appliances and
super elastic wires may have revolutionized orthodontics
as we know it today, but we do not seem to alter the
biologic response with these new appliances. In essence,
the body and how it responds to orthodontic manipulation still governs overall treatment time.
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