A comparative evaluation of nickel-titanium wires and clear aligners in the management of mandibular incisor crowding Ashutosh W, Verghese Y, Mohammed A, Devanna R, Bhardwaj R, Sahu A, Babaji P

ORIGINAL ARTICLE

Year : 2023 | Volume : 12 | Issue : 1 | Page : 21

A comparative evaluation of nickel-titanium wires and clear aligners in the management of mandibular incisor crowding

W Ashutosh¹, Yohan Verghese², Azhar Mohammed³, Raghu Devanna⁴, Rishibha Bhardwaj⁵, Anshu Sahu⁶, Prashant Babaji⁷
¹ Department of Orthodontics, Swami Vivekanand Subharti University, Meerat, Uttar Pradesh, India
² Department of Orthodontics, Saveetha Dental College, Chennai, Tamil Nadu, India
³ Department of Orthodontics and Dentofacial Orthopedics, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, (ABSMIDS), Mangalore, Karnataka, India
⁴ Orthodontic Division, Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
⁵ Department of Orthodontics, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, Saudi Arabia
⁶ Department of Orthodontics, HCDS, Hazaribagh, Jharkhand, India
⁷ Department of Pediatric Dentistry, Sharavathi Dental College and Hospital, Shivamogga, Karnataka, India

Date of Submission	21-Sep-2022
Date of Decision	19-Oct-2022
Date of Acceptance	28-Oct-2022
Date of Web Publication	18-Mar-2023

Correspondence Address:
Azhar Mohammed
Department of Orthodontics and Dentofacial Orthopedics, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, (ABSMIDS), Mangalore, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jos.jos_87_22

Abstract

OBJECTIVES: To compare nickel-titanium (NiTi) wires and clear aligners in the management of mandibular incisor crowding.
METHODS: Seventy-two participants were arbitrarily alienated into two groups with 36 samples in each. Group I participants were treated with NiTi arch wires and group II participants with clear aligners. Malocclusion was evaluated using Little's irregularity index. A questionnaire was applied to record the discomfort levels. Patients were recalled regularly at four weeks, eight weeks, and twelve weeks.
RESULTS: At baseline, the mean score was 2.91 mm and 2.72 mm; at 4 weeks, it was 1.64 mm and1.48 mm; at 8 weeks, it was 0.98 mm and1.0 mm; and at 12 weeks, it was 0.68 mm and 0.52 mm in groups I and II, respectively. The mean change in Little's irregularity index score at 4 weeks was 1.27 mm and 1.24 mm; at 8 weeks, it was 0.66 mm and 0.48 mm; and at 12 weeks, it was 0.30 mm and 0.48 mm in groups I and II, respectively. The disparity was not-considerable (p > 0.05). The mean discomfort score at baseline was 2.8 and 2.5; at 4 weeks, it was 2.4 and 2.0; at 8 weeks, it was 1.8 and 1.4; and at 12 weeks, it was 1.3 and 1.0 for groups I and II correspondingly. The disparity was non-significant (p > 0.05).
CONCLUSION: From the present study, it was found that both NiTi wires and clear aligners were equally effective in managing mandibular anterior crowding cases.

Keywords: Anterior crowding, clear aligners, nickel-titanium

How to cite this article:
Ashutosh W, Verghese Y, Mohammed A, Devanna R, Bhardwaj R, Sahu A, Babaji P. A comparative evaluation of nickel-titanium wires and clear aligners in the management of mandibular incisor crowding. J Orthodont Sci 2023;12:21

How to cite this URL:
Ashutosh W, Verghese Y, Mohammed A, Devanna R, Bhardwaj R, Sahu A, Babaji P. A comparative evaluation of nickel-titanium wires and clear aligners in the management of mandibular incisor crowding. J Orthodont Sci [serial online] 2023 [cited 2023 Mar 25];12:21. Available from: https://www.jorthodsci.org/text.asp?2023/12/1/21/371977

Introduction

The advent of new orthodontics techniques has proved helpful in the management of various orthodontic malocclusions. These treatment options have resulted in improved esthetics and are comfortable for the patient. Factors such as treatment period, cost, appearance after treatment, comfort, etc., determine whether the patients will prefer treatment or not.^[1] Considering better and faster outcomes of treatment, many young adults are preferring to have orthodontic treatment and in the last few years, the number has increased alarmingly. Though adults have an almost equal prevalence of malocclusions as that of children and adolescents, however, they are usually reluctant in wearing orthodontic wires, bands, and brackets due to discomfort or treatment-related pain. Unpleasant odor and tooth discoloration resulting from orthodontic treatment area few reasons behind this.^[2]

Nowadays, esthetic orthodontic appliances such as esthetic labial appliances, e.g., plastic brackets, ceramic brackets, esthetic coated arch wires, lingual appliances, and clear aligners are very popular among patients which are out comes of new advances in orthodontics.^[3] Among recent advancements, clear aligners are frequently used in patients having allergies to nickel which is a component of stainless steel wires and brackets. In cases of mild to moderate malposition, constricted arches of non-skeletal one, spacing, and in relapsed cases, after fixed appliance therapy, clear aligners can be indicated. These aligners demand less oral hygiene because these can be easily removed by patients themselves and hence cleaning is not the issue.^[4]

Nickel-titanium (NiTi) wires are indicated in cases with lower anterior teeth crowding. These are very efficient as compared to stainless steel wires and they save time. These are placed labially and are useful in the alignment of teeth.^[5]

Atik et al. evaluated the experimental success of heat-stimulated copper nickel-titanium (Tanzo Cu-NiTi- American Orthodontics, Sheboygan, WI, USA) and NT3 superelastic NiTi (NT3-SE®, American Orthodontics, Sheboygan, WI, USA) during the early orthodontic arrangement. There was no statistically important dissimilarity observed among the groups by means of intermolar width, and inter canine and incisor inclination alteration. They concluded that there was no considerable difference among group, in position, effectiveness, incisor inclination alteration, and arch width.^[6] Yunyan et al. in their systemic review on the treatment efficiency of clear aligners compared to fixed appliances concluded that braces and clear aligners were efficient in malocclusion treatment.^[7] Zheng et al. did a systemic review related to competence, usefulness, and constancy of treatment results with clear aligners in contrast with treatment with usual brackets. They concluded that clear aligners are effective significantly compared to conventional systems.^[8] Buschang et al. evaluated the time competence of aligner therapy (ALT) with conventional edgewise braces (CEB). They concluded that ALT requires considerably superior material expenses and more total dentist time than the usual one.^[9]

The present study compared NiTi wires and clear aligners in the management of mandibular incisor crowding.

Materials and Methods

The current prospective clinical research was performed in the orthodontics department, after attaining the approval from institutional ethics committee Ref. No.SDC/IEC/2018/568 (10). All patients were informed regarding the study and written consent was obtained.

Sample size selection

The sample size was calculated using the following formula: n= [(zα+zβ)]. With a confidence interval of 95% and power of 95% for the study, a sample size of 72 was obtained. A minimum of 35 sample size should be considered adequate for a P value less than 0.05. Hence, in the present study, 36 samples in each group were considered for significance.

Inclusion and exclusion criteria

Inclusion criteria were adult patients >18 years of both genders, patients with mild to moderate mandibular anterior crowding, and exclusion criteria were patients with poor periodontal health, lower anterior teeth replacement with a prosthesis, skeletal irregularity, and those not giving consent for the study.

The demographic profile of all patients was recorded. A thorough oral examination was done on all patients. Dental impressions were made and casts were prepared. Extra oral radiographs such as cephalogram and panoramic radiographs were taken and photographs were made. A total of 72 patients with mandibular anterior crowding of both genders were equally and randomly divided by a lottery method with 36 samples in each group by a person who is not involved in the study. Group I patients were treated with the same initial NiTi arch wires for all subjects and group II patients were with clear aligners. Crowding was assessed using Little's irregularity index. The linear horizontal linear dislocation of the anatomic contact points of mandibular anterior teeth is measured and added, which denotes the total irregularity score. A caliper was used for the study and measurement was done in millimeters. Measurement 0 indicates great alignment, l–3-nominal irregularity, 4–6-modest irregularity, 7–9-severe malposition, and 10-very severe irregularity. A questionnaire was used to record the discomfort levels using a 7-point Likert scale where score 5 was no pain and score 75 was worst pain. The average distress scores were measured using the same method as Mandall et al.^[10] Patients were recalled regularly at four weeks, eight weeks, and twelve weeks for evaluation of the effectiveness of both procedures. The whole procedure was done by a trained single investigator.

Statistical evaluation

Results were expressed in mean ± SD (mm) and were analyzed statistically using IBM, Statistical Package for the Social Sciences (SPSS) version 21.0 of Chicago, USA with ANOVA test. A P value lower than 0.05 was measured as considerable.

Results

[Table 1] shows that at baseline, the mean score was 2.91 mm and 2.72 mm; at 4 weeks, it was 1.64 mm and 1.48 mm; at 8 weeks, it was 0.98 mm and 1.0 mm; and at 12 weeks, it was 0.68 mm and 0.52 mm in groups I and II correspondingly. The disparity was not-considerable (p > 0.05). [Table 2] shows that the mean change in Little's irregularity index score at 4 weeks was 1.27 mm and 1.24 mm; at 8 weeks, it was 0.66 mm and 0.48 mm; and at12 weeks, it was 0.30 mm and 0.48 mm in groups I and II correspondingly. The disparity was not-considerable (p > 0.05). [Table 3] shows that the mean discomfort score at baseline was 2.8 and 2.5; at 4 weeks, it was 2.4 and 2.0; at 8 weeks, it was 1.8 and 1.4; and at 12 weeks, it was 1.3 and 1.0 for groups I and II correspondingly. The disparity was non-significant (p > 0.05).

Table 1: Evaluation of Little's irregularity index at different time intervals in both the groups

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Table 2: Change of Little's irregularity index score in both groups at different time intervals

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Table 3: Discomfort score in both groups at different time intervals

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Discussion

Fixed orthodontics has been used extensively in the management of malocclusions. Over a couple of years, there has been advancement in the field of orthodontics making it patient-friendly in terms of the short treatment periods, better treatment outcomes, reduction in relapse, and improvement in esthetics.^[11] NiTi wires are superelastic wires having higher torsional strength and stress constancy. In comparison to other wires, their physiological shape, memory, compatibility, dynamic interference, and wear resistance hysteresis are superior. All these properties make these wires useful in shorter inter bracket spans, such as for mandibular lower incisors.^[12]

With the advancement of computer design of tooth movement and material, the indication of clear aligners has been significantly blown up.^[13] Successful corrections of mild to severe malocclusions have been achieved with the use of clear aligners. Better esthetics, oral hygiene, and comfort are advantages of clear aligners; however, clear aligners had some shortcomings in controlling the movement of teeth. Thus, the choice of treatment option is solely based on the decision of the orthodontist.^[14] The present study compared NiTi wires and clear aligners in the management of mandibular incisor crowding.

In the present study, the recruitment of 72 patients was done with mandibular lower crowding which was haphazardly categorized into two groups of 36 each.

Bhatia et al.^[15] included 20 patients who had mild to moderate crowding which were separated into two groups; the aligner group and the NiTi group. Records were taken at 4-week intervals until 12 weeks in both groups. Results showed that over a fixed time, the mean for Little's irregularity index scores, the disparity was found to be statistically considerable for both groups. The maximum change in the score was observed between baselines to 4 weeks of treatment or both modalities, which is similar to our results. Ong et al.,^[16] in their study, divided 132 patients into three arch wire sequence groups; 3M Unitek (3M™ Unitek™, USA), GAC international (SENTALLOY® - GAC International, Switzerland), and Ormco corporation (Ormco Corp. USA). Discomfort level was recorded at 4h, 24h, three days, and seven days after the insertion of every arch wire. There was no significant variation in the decrease of irregularity among the arch wire progression at any time point or in the time to attain the working arch wire. No considerable disparities were observed in the overall uneasiness scores among the arch wire sequence.

We found that the discomfort score with a clear aligner was comparatively less than NiTi wires; however, the difference was non-significant. Catia et al.^[17] in their study on 45 patients used four different wires for resolution of lower crowding and concluded that nickel titanium wires were most effective in the group. West et al.^[18] compared two arch wires of 0.0155-inch diameter multiple-stranded stainless steel wire and 0.014-inch diameter NiTi alloy wires in 74 arches. The amount of initial arrangement found with the two wires was alike over this six-week phase. The lower labial segment showed some difference in inter bracket span, which was regularly reduced, and where the super elastic NiTi wire was setup to provide enhanced position. No chances of crowding were observed where one arch wire executed superior to the other.

Gu et al.^[19] compared Invisalign™ system (Invisalign™, Align Technology, Inc. California, USA) with conventional fixed appliances in participants with mild to moderate crowding. Results concluded that both treatment modalities were successful in the management of malocclusion and that Invisalign™ was faster in the correction of simple malocclusions.

The World Health Organization (WHO) considers malocclusion to be one of the most serious oral health issues. Its prevalence is highly variable, with estimates ranging from 39% to 93% in children and adolescents.^[20] Class III malocclusion was found to be most common in adult males (67.1%) and adult females (37.3%) in the Malaysian population.^[21] It has been reported that the prevalence of clinically significant malocclusion among adults in the United States is greater than 60%.^[22] Hence, there is a need for correction of malocclusion.

Clear aligners are gaining importance nowadays and various studies have shown that clear aligners are equally effective compared to NiTi wire.^{[7],[8],[9],[16],[19]} We found that both NiTi wires and clear aligners were equally effective in managing mandibular anterior crowding. Clear aligners are useful in patients with esthetic concerns.

The weakness of the present research is a smaller sample size, and different wires were not compared. Further researches are needed to be carried out on larger samples size in different geographic areas.

Conclusion

Clear aligners are useful in patients with esthetic concerns. From the present study, it is concluded that both NiTi wires and clear aligners were equally effective in managing mandibular anterior crowding cases. Clear aligners are new in orthodontics and may be useful in patients who are more esthetically concerned.

Ethical clearance

Obtained with Ref. No. SDC/IEC/2018/568(10).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Melsen B. How has the spectrum of orthodontics changed over the past decades. J Orthod. 2011;3 8:134-43.
2.	Buttke TM, Proffit WM. Referring adult patients for orthodontic treatment. J Am Dent Assoc. 1999; 30:73-9.
3.	Boyd RL, Miller RJ, Vlaskalic V. The Invisalign system in adult orthodontics: Mild crowding and space closure cases. J Clin Orthod. 2000; 34:203-12.
4.	Sergl HG, Klages U, Zentner A. Pain and discomfort during orthodontic treatment: Causative factors and effects on compliance. Am J Orthod Dentofacial Orthop. 1998; 114:684-91.
5.	Djeu G, Shelton C, Maganzini A. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Am J Orthod Orofac Orthop. 2005; 128:292-98.
6.	Atik E, Gorucu-Coskuner H, Akarsu-Guven B, Taner T. A comparative assessment of clinical efficiency between premium heat-activated copper nickel-titanium and superelastic nickel-titanium arch wires during initial orthodontic alignment in adolescents: A randomized clinical trial. Prog Orthod. 2019;20:46.
7.	Yunyan K, Yanfei Z, Min Z. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019; 19:1-10.
8.	Zheng M, Liu R, Ni Z, Yu Z. Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta-analysis. Orthod Craniofac Res. 2017; 20:127-33.
9.	Buschang PH, Shaw SG, Ross M, Crosby D, Campbell PM. Comparative time efficiency of aligner therapy and conventional edgewise braces. Angle Orthod. 2014; 84:391-6.
10.	Mandall N, Lowe C, Worthington H, Sandler J, Derwent S, Abdi-Oskouei M, et al. Which orthodontic arch wire sequence? A randomized clinical trial. Eur J Orthod. 2006; 28:561-6.
11.	Akram AJ. An overview of aesthetic solutions in orthodontics. Dent Nurs. 2012; 8:270-3.
12.	Patel D, Mehta F, Mehta N. Aesthetic orthodontics: An overview. Orthod J Nepal. 2014; 4:38-43.
13.	Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B. How well does invisalign work. Am J Orthod Dentofac Orthop. 2009; 135:27-35.
14.	Gravina MA, Brunharo IHVP, Fraga MR, Artese F, daSilva Campos MJ, Farinazzo Vitral RW, et al. Clinical evaluation of dental alignment and leveling with three different types of orthodontic wires. Dental Press J Orthod. 2013; 18:31-7.
15.	Bhatia S, Singh G, Izhar A, Goyal V, Singh R, Gupta N. To evaluate and compare the aligning efficiency of clearaligners and nickel titanium arch wires in unraveling lower anterior crowding-A prospective study. J Contemp Orthod. 2019; 3:20-5.
16.	Ong E, Ho C, Miles P. Alignment efficiency and discomfort of three orthodontic arch wire sequences: A randomized clinical trial. J Orthod. 2011; 38:32-9.
17.	Catia CAQ, Jones ML, Menezes ML, Koo D, Elias CN. A prospective clinical to compare the performance of four initial orthodontic arch wires. Korean J Orthod. 2005; 35:381-7.
18.	West AE, Jones ML, Newcombe RG. Multiflexver super-elastic: A randomized clinical trial of the tooth alignmentability of initial arch wires. Am J Orthod Dentofac Orthop. 1995; 108:464-71.
19.	Gu J, Tang JS, Skulski B, Fields JrHW, Beck FM, Firestone AR, et al. Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index. Am J Orthod Dentofac Orthop. 2017; 151:259-66.
20.	Cenzato N, Nobili A, Maspero C. Prevalence of dental malocclusions indifferent geographical areas: Scoping review. Dent J. 2021; 9:1-10.
21.	Elfseyie M, Abu Hassan MI, Abdullah Al-Jaf NM. Prevalence of malocclusion and occlusal traits of Malay adults (18-23 years) in Shah Alam, Malaysia. Int J Dent Res. 2020; 5:81-6.
22.	Asiri SN, Tadlock LP, Buschang PH. The prevalence of clinically meaningful malocclusion among US adults. Orthod Craniofac Res. 2019; 22:321-8.