76 Orthodontic Update July 2010

Niall JP McGuinness

Standard Edgewise
Technique and Its Relevance
in Contemporary Fixed
Appliance Therapy Part 1
Abstract: The edgewise appliance was first described over 80 years ago and has developed into a highly sophisticated technique to achieve
ideal orthodontic treatment results. Bracket systems, wires and other supplies are now prefabricated, making the task of straightening teeth less
tedious. From these, clinicians can pick and choose which combination is ideal for their armentarium. However, there is a tendency to regard
these appliances as being almost foolproof, and there are certain situations where recourse to the techniques used in the original standard
edgewise appliance are necessary. These will be outlined and described in this and two subsequent articles.
Clinical Relevance: Utilizing the techniques taught in Standard Edgewise will allow clinicians to achieve a higher standard of treatment result,
as well as giving them a better understanding of how edgewise appliances work. These principles can be applied to all prescription appliances,
including Straight-Wire.
Ortho Update 2010; 3: 76–80

S
traightening crooked teeth is not
new. It is said that Hippocrates of
Kos (c. 460 BC–c. 370 BC) advocated
the use of a wooden spatula to move
teeth in crossbite into alignment. Pierre
Fauchard (1678–1761) described a
number of expansion devices to relieve
crowding of the dental arches. Norman
Kingsley (1829–1913) was one of the
most prominent dentists in the US in
the 19th century and developed a range
of removable orthodontic appliances.
However, it was not until Edward
Angle (1855–1930) decided to limit his
work exclusively to orthodontics that
any major progress was made in the
development of fixed appliances.1
Angle was originally
a prosthodontist and it was his
observations of the artificial dentition
in full dentures that led him to develop
a number of theories about how the
natural teeth should occlude in an ideal
relationship – the Angle classification of
molar and incisor relationship is still in use
today. He first developed the E-arch, which
was essentially an expansion device, in
1905, but this was crude and could not
position teeth accurately. After further
experimentation, he then developed the
pin and tube appliance (Figure 1), which
consisted of vertical tubes soldered to
bands on the teeth and which engaged
metal pins soldered to a labial archwire.
This gave very good three-dimensional
control over all the teeth, but it was
extremely difficult to adjust, as the pins
had to be re-soldered into new positions
on the wire at every visit. It is said that
only Angle and one of his students ever
mastered this appliance completely. The
next stage of development was to file the
vertical tubes partially so that they were
able to engage a rectangular wire inserted
‘flatwise’ (ie the longest dimension
facing labially) – the result was the
‘ribbon arch’, which was an immediate
improvement on the pin and tube
appliance (Figure 2). However, control
over tooth position was not as good and
finally, in 1928, Angle rotated the ribbon
wire through 90 degrees and built the
bracket around this – the ‘edgewise’
bracket, so called because the narrowest
dimension of the archwire was inserted
into it ‘edgewise’ (Figure 3). This gave
excellent three dimensional control over
tooth position in all planes of space and,
just as importantly, it was much easier
to use.
Angle died in 1930 and it
was one of his last students, Charles
Tweed (1895–1970), of Tucson,
Arizona, who took the newly-invented
appliance home and who put it into
use. After much experimentation,

Niall JP McGuinness, PhD, DDS, MScD, BDS, BA, FDS(Orth) RCPS(Glasg), DOrth, MOrth RCS(Edin), Consultant Orthodontist/Hon Senior
Lecturer, Edinburgh Dental Institute, Lauriston Place, Edinburgh EH3 9HA, UK.

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July 2010 Orthodontic Update 77

Figure 1. The pin and tube appliance. Figure 2. The ribbon arch appliance.

Figure 3. The development of the edgewise appliance from the ribbon arch
appliance. Figure 4. The three orders of bends in edgewise.

Tweed developed the appliance further
and described the three orders of
tooth positioning that are essential to
achieving a good final functional and
aesthetic occlusion. These are:
n In-out (first-order bends): bucco-labial
positioning;
n Tip (second-order bends): mesiodistal
root positioning;
n Torque (third-order bends): labio-
lingual root positioning (Figure 4).
Tweed made a considerable
number of other contributions to the
specialty, but it is his development of the
mechanics of the edgewise appliance
that have had the most profound effect
on the development of modern fixed
orthodontic appliances. The Charles H
Tweed Foundation in Tucson, Arizona,
USA, continues to run twice-yearly
courses using the most recent version
of Tweed mechanics (Tweed-Merrifield
technique). This course consists of
11 days of instruction using standard
edgewise typodonts and wirebending
exercises, together with lectures and
seminars. For further information see
www.tweedortho.com
Originally, all edgewise
brackets, for all teeth, were identical, with
no tip, torque or in-out incorporated – all
of these had to be incorporated into the
wire in order to achieve detailing of the
occlusion. This version of edgewise was
known as ‘Tweed edgewise’ or (later)
‘standard edgewise’.2,3 From the 1950s
onwards, with developments in wire and
metal technology, various prescription
brackets began to appear,4 but it was
not until the publication of Laurence
Andrews’ paper ‘The six keys to normal
occlusion’ in 1972 that the concept of
a completely pre-programmed fixed
orthodontic appliance really developed
in a major way.5 After this time, the term
‘straight-wire’ became synonymous
with any prescription bracket system,
although the original Straight-Wire
appliance was first marketed by
A-Company (part of Johnson and
Johnson) with the Andrews prescription.
Today, dozens of different prescription
bracket systems are available, all of
which are variations on the original
Straight-Wire appliance.
Comparisons of standard
edgewise brackets and straight-wire
brackets are shown in Figures 5–7.
Alongside the prescription
appliance, other technological
developments have made the
orthodontist’s task easier: direct bonding
of brackets to teeth with the acid-etch
technique has almost entirely replaced
banding. It was only in 1960 that the
first preformed bands were marketed:
formerly, all bands had to be drawn
up by hand from metal strips and
the attachments welded or soldered
into place. Flexible alloy wires have
developed to allow easier alignment;
and more recent developments, such
as self-ligating brackets and temporary
anchorage devices, seem set to develop
orthodontic treatment to new levels.

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78 Orthodontic Update July 2010

Figure 5. First-order bends (in-out) in edgewise, left, compared with straight- Figure 6. Second-order bends (tip) in edgewise, left, compared with straight-
wire, right. wire, right.

With these developments the

task of bracketing and aligning teeth has
become much less time consuming. With
time, there has also been an increasing
demand for treatment, with even greater
numbers of patients under treatment than
ever before, and from a much wider age
range than Tweed or his contemporaries
could ever have envisaged. While the
advent of prescription appliances has made
contemporary orthodontic treatment very
sophisticated, there are certain situations
that these appliances cannot deal with,
and the orthodontist will have recourse to
adjusting the wires in order to achieve the
required result. In current UK orthodontic
training programmes, trainees are unlikely
to undertake the treatment of patients with
Figure 7. Third-order bends (torque) in edgewise, left, compared with straight-wire, right. exclusively standard edgewise brackets in
place. The teaching of standard edgewise
technique is variable, and often this is
confined to a short course in the induction
phase at the start of the three-year training
period. It will be some considerable time
before the trainees progress to inserting
stainless steel wires, closing spaces and
detailing the occlusion for their patients,
at which point the application of standard
edgewise principles and exercises would be
appropriate.
This paper will examine some
of the principles of standard edgewise
technique and demonstrate how it can
be applied to certain clinical situations
in modern-day straight-wire appliance
therapy.

Tooth positioning
The positioning of the teeth
(‘detailing’) in the final stages of treatment
is performed by inserting a closely fitting
Figure 8. Placing torque in edgewise wire for a single tooth using a pair of torquing pliers.
rectangular stainless steel wire into the

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July 2010 Orthodontic Update 79

Torque (º) Tip (º) Base Torque Tip (º) Base Torque Tip (°) Base Torque Tip (°) Base
Andrews Andrews Height (º) Roth Roth Height (º) MBT MBT Height (º) BP BP Height
(mm) (mm) (mm) (mm)
UPPER ARCH
Central incisor +7 +5 2.1 +12 +5 1.0 +17 +4 1.00 +22 +5 1.01
Lateral incisor +3 +9 1.6 +8 +9 1.27 +10 +8 1.27 +14 +8 1.24
Canine -7 +11 2.5 -2 +13 0.71 -7 +8 0.76 +7 +7 0.76
First premolar -7 +2 2.4 -7 0 0.86 -7 0 0.86 0 / -7 0 0.78
Second premolar -7 +2 2.5 -7 0 0.86 -7 0 0.86 0 / -7 0 0.78
First molar -9 +5 2.9 -14 0 0.42 -14 0 0.42 -10 +8 0.42
Second molar -9 +5 2.9 -14 0 0.42 -14 0 0.42 -10 +8 0.42
LOWER ARCH
Central incisor -1 +2 1.2 -1 +2 0.86 -6 0 1.37 0 0 1.37
Lateral incisor -1 +2 1.2 -1 +2 0.86 -6 +3 1.37 0 0 1.37
Canine -11 +5 1.9 -11 +7 0.86 -6 +3 0.76 +7 +5 0.68
First premolar -17 +2 2.35 -17 -1 0.71 -12 0 0.89 -11 0 0.78
Second premolar -22 +2 2.35 -22 -1 0.71 -17 0 0.89 0 / -17 0 0.78
First molar -30 +2 2.5 -30 -1 0.42 -20 0 0.42 -27 0 0.42
Second molar -33 +2 2.5 -33 -1 0.42 -10 0 0.42 -27 0 0.42
Table 1. Comparison of tip, torque and in-out values for Andrews, Roth, MBT and Ricketts Bioprogressive (BP) appliances.

brackets on the teeth. Depending on the
closeness of the fit between wire and
bracket, the brackets will express the
in-out, tip and torque. The largest wire that
can be inserted into an 0.022” x 0.028” slot
is an 0.0215” x 0.028” wire which almost
(but not quite) fills the slot. Such a wire
will achieve almost full expression of the
bracket prescription, but there is always a
degree of angular discrepancy between the
wire and the internal architecture of the
slot (‘slop’) owing to the difference between
the bracket and wire sizes. With a 0.019”
x 0.025” stainless steel wire, the degree of
‘slop’ can be as much as 9.6 degrees and,
in cases where this is the final wire to be
inserted, the torque (especially of the upper
incisors) may not be fully expressed. In
marked Class II division 1 malocclusions,
for example, retraction of the upper labial
segment may result in retroclination of the
incisors: currently this can be counteracted
by high-torque brackets on the upper
incisors (such as in the MBT system, where
the torque of the upper central incisors
is 17 degrees, compared to 12 degrees
for the Roth system and 7 degrees for the
Andrews – Table 1). However, in cases like
these, there may be a need for extra torque
to be placed in the upper labial segment.
In this case, the torque will be palatal root
torque: this is where the roots need to be
moved palatally without moving the incisal
edges. This places considerable anchorage
demands on the posterior teeth, and the
anchorage may need reinforcement.
The three orders of wire bends
that need to be placed in a wire will be
described in the order in which they are
placed in the archwire during construction.
Torque (third-order bends) is usually placed
first, then in-out (first-order bends), with tip
(second-order) being placed last.
Torque (third-order bends)
Torque, in orthodontics, is most
simply defined as a rotational force to a
tooth in a labio-lingual or bucco-lingual
direction. The main effect is on the root of
the tooth. Andrews5 defines the ‘third key’
torque (or crown inclination) as follows:
n Incisors: crown inclination is sufficient to
prevent overuption of anterior teeth and
sufficient to allow proper positioning of

a b

Figure 10. Effect of placing buccal root torque to the upper left central incisor. (a) The root is torqued
palatally. Buccal root torque was placed in the wire and, after a few visits, the position of the incisor has
Figure 9. Torque in a section of edgewise wire. improved (b).

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80 Orthodontic Update
Figure 11. Buccal root torque to upright the root
of the maxillary right canine. The vertical loops
allow a greater range and easier insertion of the
torqued section into the bracket on the canine.
Figure 12. Another view of the wire showing the
torqued and untorqued sections.
Figure 13. The torquing wire in place. The arrow
shows the direction of movement of the root of
the maxillary right canine which was formerly
palatally impacted and brought into the line of
the arch.
Abstract
CANINE RETRACTION RATE WITH SELF-
LIGATING BRACKETS VS CONVENTIONAL
EDGEWISE BRACKETS. Burrow SJ. Angle
Orthodontist 2010; 80: 626–633.
Retraction of canines is a commonly performed
orthodontic procedure. Any method that
speeds this up is likely to be attractive to all
orthodontists. The development of self-ligating
orthodontic brackets that have little or no friction Patients were seen every 28 days.
also includes the suggestion that treatment
times will be reduced. The rate-limiting step in
all orthodontic treatment is how rapidly bone
resorption and deposition occurs, which allows
the teeth to move through the bone, and this is
unlikely to be influenced by friction between the 0.9 mm (SD 0.24 mm, range 0.5–1.3 mm) and
wire and the tooth (or lack of it).
This study examined 43 patients
posterior contacts.
n Upper canines through molars: a
lingual inclination is present, slightly
more pronounced in the molars.
n Lower canines through molars: lingual
crown inclination is present which
increases progressively from front to back.
Torque can be produced
by introducing a twisted wire into a
plain 90° bracket or, alternatively, a flat
wire (‘straight-wire’) into a pre-torqued
bracket.
For individual teeth requiring
extra torque, this can be placed by a pair
of torquing pliers. One must be careful
not to place excessive torque in the
section desired or there may be a risk of
bringing the root apex through the bony
cortex. In practical terms, especially with
a larger dimension rectangular stainless
steel wire, it may be easier to convert
the tubes on the molars into slots, ligate
the torqued sections of the wire into the
teeth that one desires to be torqued first,
place the ends of the wire in the molar
slots, ligate these, then ligate the rest of
the brackets onto the wire. The placement
of torque for an upper central incisor is
shown in Figures 8–10.
Canines that were previously
impacted (especially palatal impactions)
take a long time to treat. Once the crown
of the canine is positioned in the line of
the arch, the roots of these teeth will still
be tipped towards the palatal, so it may
be necessary to apply extra buccal root
torque to these teeth. One way of doing
this is to construct a ‘swinging gate loop’
(Figures 11–13), which allows for much
more flexibility and greater range of
action. In the passive position, the legs
of the swinging gate loop are towards
the buccal direction: when the torqued
requiring maxillary canine retraction into
premolar extraction spaces. Of the patients, 21
had Damon brackets on the test side, and 22
had Smart-Clip, while on the control MBT Victory
brackets were used. All teeth were retracted
using a Sentalloy retraction spring with a force
of 150 grams, with the conventional brackets
tied with a stainless steel ligature. The archwire
used was an 0.018” round stainless steel wire.
It was found that the average tooth
movement over the average period of 28 days
with the conventional bracket was 1.17 mm
(SD 0.28 mm, range 0.6 mm–2.00 mm). Damon
brackets showed an average retraction rate of
Smart Clip a rate of 1.1 mm (SD 0.28 mm, range
0.7–1.7 mm). Overall, the results for the two
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July 2010
section of the wire between the loops
is tied into place in the canine bracket,
the wire will tend to return towards the
buccal, bringing the root of the canine
with it. Once sufficient root uprighting has
been achieved, the loop can be removed
and a plain (flat) archwire substituted.
This principle can be applied
to almost any tooth that is severely
initially displaced (either buccally or
palatally) at the start of treatment. A
common example is the crowded and
instanding upper lateral incisor. One
strategy here is to invert the bracket
on this tooth, thereby changing the
torque from palatal to buccal, thereby
counteracting the tendency for the root
to relapse towards the position from
which it came.
First- and second-order bends,
and archwire fabrication will be described
in the second article in this series.
References
1. Proffit WR. Contemporary fixed
appliances. In: Contemporary
Orthodontics 3rd edn. St Louis: Mosby
Year Book, 2000: 385–416.
2. Tweed CH. Clinical Orthodontics. St
Louis: Mosby, 1966.
3. Vaden J, Klontz H, Dale J. The Tweed
Merrifield Edgewise Appliance. In:
Orthodontics: Current Principles and
Techniques 3rd edn. Graber TM,
Vanarsdall RI, eds. St Louis: Mosby
Year Book, 2000.
4. Bench RW, Gugino CF, Hilgers JJ.
Bioprogressive therapy part 12. J Clin
Orthod 1978; 12: 549–586.
5. Andrews LF. The six keys to normal
occlusion. Am J Orthod 1972; 62:
296–309.
types of self-ligating brackets was 1.0 mm (SD
0.28 mm, range 0.5–1.7 mm). The difference of
0.17 mm retraction between the conventional
bracket and the combined values for the self-
ligating brackets was found to be statistically
significant (p < 0.001).
It was considered that the
reason for the slower retraction with the self-
ligating brackets was due to their narrower
mesio-distal dimension compared with the
conventional brackets. This narrower bracket
resulted in greater tipping and binding/
notching of the archwire and this resistance to
sliding is much more determined by this than
by friction.
Niall McGuinness
Senior Lecturer/Consultant
Edinburgh Dental Institute