0.018 Vs 0.

022

When there are two orthodontists in a room there will be at least a minimum of three opinions. There are two slots 0.018 VS 0.022 each of their own pros and cons. This seminar will examine in a unbiased manner the advantages and disadvantages of each of these slots in various stages of PAE. An Edgewise Bracket Design
Edward H. Angle Edgewise arch mechanism.

Angles concept of the line of occlusion.

Metal bracket, rectangular slot-0.022 x 0.028. Rectangular wire of 0.022 x 0.028. Wire was inserted into the bracket in the narrowest or edgewise

positionhence the name EDGEWISE.

EDGEWISE BRACKET DESIGN Single Width Bracket

TWIN BRACKET Junior Twin Standard Twin

Intermediate Twin

Extra Wide

Posterior/ Wide Width

Curved Base Twin

Primary arch wire bend intended for the most direct movement of teeth. Secondary arch wire bends any bend for tooth guidance that are nor primary bends.

- Secondary bends are needed to compensate for slot-siting irregularities caused by bracket design and unreliable bracket-siting techniques, wire bending and wire forming side effects and judgement errors in bendings. Tertiary wire bends one placed for any reason other than guidance. Examples are omega loops for stops, loops for increasing wire flexibility and loops for elastics. Previously the orthodontist, relied on modification in the arch wire in the form of first, 2 n d , 3 r d order bends to detail the teeth. PRIMARY BENDS OF THE ARCH WIRE- EDGEWISE The first order bends The second order bends The third order bends THE ADVENT OF SWA The straight wire appliance was based on keys to normal occlusion(1972) Philosophy an ideal bracket system. an ideal force system. ANDREWS six

Advantages Reduction in wire bending.

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Use of sliding mechanics. Precision and finishing. Flexibility of biomechanics. Multiple bracket design. Siamese Single Mini series Midi series Vertical slot Self ligating

Disadvantages Friction Anchorage demands Deceptive simplicity traps the unwary. VARIOUS PRESCRIPTIONS AVAILABLE: Roth MBT Alexander EDGE- WISE Primary Bends First Order Bends PEA InBuilt Priscription InOut/ Prominence

Pre-adjusted appliances build corrections directly into the brackets. - Labio-lingual position previously placed into the arch wire bends are now programmed with the in out depth of the bracket slots (or) within the bracket bases

EDGE- WISE Primary Bends

PEA In Built Prescription

Tip/ Angulation

Preangualted

slots

in

the

brackets

provide

for

precision

mesiodistal angulation. EDGE- WISE Primary Bends Third Order Bends PEA InBuilt Priscription Torque/ Inclination

Labio-lingual inclination (or) torque previously managed with auxiliary torquing appliances and arch wire adjustments are now provided with accuracy by pre-torqued bracket slot and bases. THE BIFURCATION OF SWA BASED ON SLOT DIMENSIONS 0.018 and 0.022 SLOT SIZE: SLOT HEIGHT & SLOT DEPTH HEIGHT: The SWA is available with slot heights of 0.022 & 0.018.
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SLOT DEPTH: 0.022 x 0.028 0.018 x 0.025 Rectangular wires in torque applications must be seated with their outer working edges fully engaged in the slot. engagement. Slots should be deep enough to ensure full

WIDTH Proffit 0.018 - Narrow brackets.

Rectangular wires,-when they fill the slot in Sliding teeth along arch-wire is relatively

later stages are more effective in large inter-bracket span.

unimportant. 0.022 Wider brackets.

Larger slot provides clearance needed for

sliding

Single width

Double width

Mini Uni - Twin

AUTHORS SUPPORTING THE USE OF 0.022SLOT ROTH

Available both in 0.018 & 0.022 slot brackets His preference is 0.022 slot, based on the type

of mechanics he uses. 0.018 is too restrictive in wire size selection

He prefers 0.022in terms of wire selection arches for as anchor control, units, mainly for in orthognathic the buccal torque

stabilizing surgery& segments. M.B.T.

The larger slot allows more freedom of movement for the starting wires, keeping the forces light. Later in treatment, the steel rectangular 0.019/0.025 working wires of

have been found to perform well 0.017/0.025.These wires shows greater space closure with sliding

With the 0.018 slot the main working wire is normally 0.016/0.022 or mechanics. deflection & binding during

AUTHORS SUPPORTING THE USE OF 0.018 SLOTS WICK ALEXANDER His concept was that 0.022 slot with heavy rectangular wires was cumbersome for patients. He used 0.018 slot with 0.017 wires lighter forces would result in less patient discomfort . RICKETTS He used the edgewise bracket slot (0.018 x 0.030) to keep the bracket and wire sizes smaller. The deep slot (0.030) permits two light arches to be employed at once (Base archwire for stabilization & the auxillary arch or section for rotation or movement). PLAY (OR) SLOP The clearance between the arch wire and bracket. Four types of play. (Straight wire the next generation AJO 1998) Torquing play Play in the tipping plane

Vertical play Rotational play

Torquing play depends on size of rectangular wire relative to the size of the slot. Most prescriptions have excessive lingual root torque in the maxillary anterior brackets that may deliver adequate lingual root torque for retraction movements using less than full-sized arch wires. Brackets with these excessive torques are incapable of delivering labial root torque during protraction movements, without extensive reverse torquing bends in the arch wire. Play in tipping plane generally depends upon size of the archwire, size of slot and overall width of the slot. Tipping play is less than torquing play. But if torquing play is minimized by increasing the arch wire size relative to slot size, then tipping play will be minimized, regardless of the width of the bracket. Vertical play Play in the vertical plane will result in incomplete bracket to bracket leveling. Rotational play Tendency of the tooth to rotate on its own axis. Rotational play increases narrow bracket, decreases wide brackets. Play can never be eliminated but can be minimized, in the tipping, torquing and vertical planes, by filling the slot as much as possible. Rotational play is minimized by using brackets with adequate rotational lower arm length and ligating with sufficient force to keep the arch wire seated in the bottom of the slot. For every .001 difference between arch wire & slot - 4play.
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0.018 slot with 0.018 Wire 0.022 slot with 0.018 Wire

IN BUILT TORQUE Vs EXPRESSEDTORQUE The area of torque application is small.depends on the twist effect of a relatively small wire compared with the bulk of the tooth. .019/.025 steel wires have a slop about 12 in a 0.022 slot. As a result of the relative inefficiency of pre-adjusted brackets in delivering torque, it was necessary to built in extra torque into the incisor, molar& lower premolar brackets

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EFFECTIVE TORQUE

ASPECTS INCORPORATED TO GET THE FULL EXPRESSION OF TORQUE FILL THE SLOT INCORPORATE TORQUE INTO THE WIRE

THE THREE STAGES OF TREATMENT ALIGNMENT & LEVELING RETRACTION & SPACE CLOSURE FINISHING

ALIGNING &LEVELING 0.018 SLOT Proffit prefers round wires for this stage .Says that rectangular arch wires, particularly those with a tight fit with in the bracket slot,

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so that the position of root apex could be affected, normally should be avoided. The principle is that it is better to tip crowns to position during initial alignment, rather than displacing the root apices, because rectangular arch wire will create unnecessary and undesirable root movement during alignment. 0.014 NITI 0.016 NITI 0.016 HANT 16x22 HANT 0.022 SLOT 0.015 MULTISTRAND 0.0175 MULTISTRAND 0.014 SS 0.016 SS 0.018 SS 0.020 SS 0.016 HANT 19 x 25 HANT RETRACTION Individual canine retraction- friction ,frictionless
Enmasse & Anterior retraction friction, frictionless.

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INDIVIDUAL CANINE RETRACTION

Round wires are preferred than rectangular wires Decrease in the contact surface area less friction

FRICTION 0.018 Slot 0.016 Round SS 16 X 22 SS

0.022 Slot 0.018 Round SS 16 x 22 SS 17 x 25 SS Tip- edge bracket.

FRICTION- LESS
PG SPRING 16 X 22 SS wire - 0.018 /0.022 slots.

BURSTONE T-Loop0.017 x 0.025 TMA wire 0.018/0.022. MARCOTTE SPRING 0.016 SS wire 0.018 /0.022slots. ENMASSE & ANTERIOR RETRACTION 0.018 Slot 16 x 22 SS 17 X 23 SS 0.022 Slot 18 x 25 SS 19 x 25 SS

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FINISHING 0.018 Slot 17 x 25 NiTi 17 x 25 SS 17 x 25 beta Ti 17 X 25 Ti Niobium 0.022 Slot 21 x 25 NiTi 21 x 25 beta Ti 21 x 25 M- NiTi 21 X 25 Ti Niobium SURGICAL ORTHODONTICS Normally it is said that 0.022 slot is preferred for surgical cases, but William proffit & Raymond P. White

0.018slot or 0.022 slot can be used Rigidity of a 17 x 25 SS wire stabilization in a 0.018is adequate for

One exception where 0.022 is advantageous when segmented arch mechanics are needed,-particularly in patients with severe periodontal breakdown.

In a 0.022slot 21 x 25 TMA / SS

0.018 SLOT

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Martin .B. Epstein (AO. Vol.72. 2002) Advantage

The capacity to fill the slot allows for a greater use of the

prescription built into the bracket. Disadvantage Fewer choices of arch wire dimensions. 0.022 SLOT Martin .B. Epstein (AO. Vol.72. 2002) Advantages
Using undersized archwires, one can facilitate free sliding of the

archwire through the slot. Hence less frictional resistance or binding at the bracket wings. Larger wires are also useful Large wires provide increased stiffness & facilitate to keep the teeth upright during space closure & retraction mechanics.

Robert P. Kusy & John Whitley (EJO 1999) Smaller brackets requires that the clinician be as much as 25% more precise in the initial stage or else binding will occur. This outcome suggests that inexperienced clinicians will find the 0.022 slot more suitable for sliding mechanics. To accomplish that best case scenario, most easily within the strength & stiffness requirements of the appliance, the bracket

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width & wire size should be small, & the bracket slot should be large. Disadvantages Martin .B. Epstein (AO. Vol.72. 2002) Disadvantage may be encountered when filling the slot.
Full sized rectangular wires becomes markedly reduced in

springiness and range,-thereby severly limiting the ability to place effective torque & finishing bends. VIEWS OF AUTHORS Raymond E. Siatkowski. (JCO / Sep. 1999) Bracket slot & arch-wire dimensions have caused unpredictable failures of formerly reliable mechanics,-especially those that depend on protracting posterior teeth. This has resulted in lingual tipping of incisors & in general loss of incisor axial inclination control. Robert P. Kusy (AJO. Apr. 2002)
In reality manufactures do not provide discrete slot sizes, but

rather a spectrum of slot sizes 0.0178 to 0.0237.

Angles generation necessitated

0.022, where he used gold

wire.
The SS wires, which displaced gold, permitted the slot to shrink

to 0.018. All might have turned okay if technology had not made a hair pin bend and come full circle to offer a titanium molybedneum arch wire alloy with a stiffness close to that of gold.
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As a result of which the world according to its preference split into two United States-0.022 slot and Europe 0.018slot. Resolution of the slot size issue would simplify biomaterials & biomechanics instruction for graduate residents too. Lets not once again follow that well worn path as was done for gold and S.S rather lets walk the less trodden path that leads to higher grounds. Change never comes easy, but this modification is worth every bit and effort.So lets pick up one slot size, whatever it is & make it metric. CONCLUSION Sheldon Peck. (AO 71. 2001) Experience with earlier manufacturing advances in other fields shows that the company first to offer a progressive new standard, becomes the king of the road, miles ahead of the latecomers trying to jump on the bandwagon. With reference to these views of the different authors, I believe that it would have reached the ears of manufacturers too, who might have this spark of universal metric system in the pipe line. Understanding biomechanics is the matter; it is not the slot dimension which in debate.

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