Curve of Spee: Speed of Leveling Using Different Orthodontic Arch Wire Size and Material- A Randomized Clinical Trial

Title: Curve of Spee: Speed of Leveling Using Different Orthodontic Arch Wire Size and Material- A Randomized Clinical Trial

Abstract:

Aims: To evaluate the efficiency of 3 different rectangular archwires in the correction of curve of Spee (COS), to record the time needed to level excessive COS in the mandibular arch using the 3 archwire sizes, to investigate the changes in intercanine and intermolar widths and arch length during leveling, to measure the arterio-posterior and vertical movement for the lower incisors and lower molars, and to detect the root resorption in the lower anterior teeth associated with leveling excessive COS using the 3 different archwires.
Subjects and Methods: Fifty-one subjects with excessive COS were included in this study. The subjects were randomly divided into three groups; Group one (17 patients): leveling of COS using 0.017X0.025-inch stainless steel archwire. Group two (17 patients): leveling of COS using 0.019X0.025-inch stainless steel archwire. Group three (17 patients): leveling of COS using 0.021X0.025-inch Titanium molybdenum archwire. In the three groups, a 5mm depth reverse COS was inserted. Records consisted of lateral cephalograms (pre-treatment, at T0 and post-treatment), peri-apical radiographs (at T0 and T5), study casts (pre-treatment and at each time point during the study). Patients were followed up on monthly visits without removing leveling archwires where alginate impressions were taken for the lower arch. Pain scores during the first week of leveling were recorded using a visual analogue scale (VAS). The amount of COS correction, changes in intercanine, intermolar and arch length, pain scores, and lower incisors root resorptions were measured.
Results: The overall COS leveling was on average reduced by 3.93±0.77 mm, 4.87±0.73 mm and 4.04±0.88 mm in groups 1, 2, and 3, respectively (P<0.001). Duration of excessive COS leveling was on average 6.07±0.47months, 5.73±0.45months and 6.25±0.22 months in groups 1, 2, and 3 respectively. For A-P arch length, group 2 showed an increase of 2.80 mm compared to 2.46 mm in group 3 and 2.29 mm in group 1. For ICW, group 2 showed an increase of 2.73mm compared to 2.69mm in group 3 and 2.29mm in group 1. For IMW the effect of leveling was detected the most in group 3 followed by group 2 and group 1, and after leveling, IMW increase was the same in all studied groups (P>0.05). Root resorption was detected in the lower right central incisor and canine mostly in group 3 subjects with the differences between groups were at (P<0.05). For the perception of pain, less pain was reported in group 1, and the difference in pain scores was significant (P<0.05) within 48 hours between groups 1 and 3. For MMPA angle have the most significant effect in group 3 subjects (P≤0.001). Lower incisors were most proclined in group 2 subjects, with a difference in group subjects (P<0.01). Lower incisors were intruded in all groups with no significant difference (P>0.05). Extrusion for lower first molar happened in all group’s subjects with a significant difference between groups 2 and 3 (P<0.01). The forward movement happened in lower incisors crown and root to all group’s subjects at (P>0.05). Molar crowns moved mesially during leveling in group 1 (0.30±0.93), whereas molar crown distal tipping was detected in groups 2 and 3 -0.33±0.57mm, -0.24±0.99 respectively, also molar root moved mesially during leveling average 0.04±0.70mm, 0.06±0.97mm, 0.02±0.94mm for groups 1, 2 and 3.
Conclusion: 0.019X0.025 SS archwire was the most efficient archwire in leveling COS with less time than the other 2 archwires. Arch length, intercanine, and intermolar width were increased in all groups. Root resorption of lower right central incisor and canine when 0.021X0.025 TMA archwire was used for leveling. Pain scores were higher within 48 hours of COS leveling using 0.019X0.025 SS archwire and the least using 0.017X0.025 SS archwire. Leveling COS was done in all groups by incisor intrusion, molar extrusion, and incisor proclination on different levels.

Biography:

Yousef Nasrawi graduated from Jordan University of Science and Technology in 2015 and was among the top 10% of the batch. In the following two years, in 2016 Yousef Nasrawi received a membership in the Royal College of Surgeons – Ireland, and in 2017 Yousef Nasrawi received another membership in the Royal College of Surgeons and Physicians – Glasgow. In 2020 he have finished his Master's degree in Orthodontics from Jordan University of Science and Technology, and in the same year, he had obtained the American Dental Board. He is working currently in both clinical practices and in Jordan University of science and technology as a lecturer. His main interests are in orthodontics generally and in contributing to the advanced technological methods in biomechanics specifically.