Tratamiento de maloclusión de clase III con arco multiloop edgewise arch wire (meaw) reporte de caso clínico / Treatment malocclusion class III with multiloop edgewise arch wire (meaw) case report

Resumen En la actualidad hay diferentes formas de abordar la maloclusión de clase III, todas las formas tienen como objetivo principal solucionar la maloclusión y están encaminadas a diagnosticar y llevar al paciente a una oclusión es table, estética y sobretodo sin daño alguno a los tejidos que conforman el sistema estomatognático. Se muestra en este artículo el manejo de la ma loclusión de clase III con arcos de Multiloop Edgewise Arch Wire (MEAW) como una opción rápida, estable y de excelentes resultados para la solu ción de este tipo de discrepancias. La maloclusión de clase III puede ser tra tada de diferentes formas como el tratamiento temprano, la compensación dental, el camuflaje esquelético y la opción quirúrgica. La compensación dental puede ser de diferentes formas, como por ejemplo: exodoncias de premolares inferiores, torque inferior negativo y positivo superior, con ayuda de anclaje esquelético (mini tornillos) y muchas más que no se enuncian. En los casos que se involucra el perfil o la simetría facial y su origen es de características de ADF (Anomalía Dentocranéo Maxilofacial) requirieran de cirugía ortognatica para su solución, puesto que es de origen esquelético y debido a severidad es no compensable. Este articulo muestra un manejo diferente como opción de compensación de maloclusión de clase III. Es un reporte de caso clínico de un paciente del Posgrado de Ortodoncia de la Universidad Antonio Nariño de la clínica de arco recto manejado con brac kets de prescripción MBT Gemini Unitek 3M slot 0.022"x0.025" los cua les se les coloca arcos de Multiloop Edgewise Arch Wire (MEAW) después de ocho meses de tratamiento, cuatro meses en alineación y nivelación y cuatro meses del uso arcos de Multiloop Edgewise Arch Wire (MEAW) la corrección dentoalveolar se corrige gracias a la retracción canina y molar de 6mm bilateral haciendo rotar el plano de oclusión según la filosofía del tratamiento de Multiloop Edgewise Arch Wire (MEAW) obteniendo las seis llaves de la oclusión de Andrews.

Abstract At present, there are different ways of approaching Class III malocclusion, all of which have the main objective of solving malocclusion and are aimed at diagnosing and bringing the patient to a stable, aesthetic occlusion and above all without any damage to the tissues that make up the Stomatognatic system. This paper deals with the handling of Class III malocclusion with Multiloop Edgewise Arch Wire (MEAW) as a fast, stable and excellent choice for solving this type of discrepancy. Class III malocclusion can be treated in different ways such as early treatment, den tal compensation, skeletal camouflage and surgical option. The dental compensation can be of different forms, as for example: extractions of lower premolars, negative inferior torque and superior positive, with the aid of skeletal anchorage (TAD) and many more that are not stated. In cases, involving facial profile or symmetry and its origin is the characteristics of ADF (Maxillofacial Dentocranial Anomaly) require orthognathic surgery for its solution, since it is of skeletal origin and due to severity is not compensable. This article shows a different management as an option for class III malocclusion compensation. It is a clinical case report of a patient of the Orthodontics Postgraduate of the Antonio Nariño University of the straight arch clinic handled with MBT Gemini Unitek 3M slot 0.022 "x0.025" brackets which are placed with Multiloop Edgewise Arch arcs Wire (MEAW) after eight months of treatment, four months in alignment and leveling, and four months of use Multiloop Edgewise Arch Wire (MEAW) correction is corrected by bilateral canine and molar retraction by rotating the plane Of occlusion according to the philosophy of the treatment of Mul tiloop Edgewise Arch Wire (MEAW) obtaining the six keys of the Andrews occlusion.

Relación entre el plano oclusal y discrepancia posterior en pacientes con maloclusión clase II y III con ángulo alto y bajo / Relationship between the occlusal plane and posterior discrepancy in patients with class II and III malocclusion with high and low angle

Objetivos: Relacionar el plano oclusal con la discrepancia posterior aplicando el cefalograma de kim y el análisis del marco dental del Dr. Sato. Material y métodos: El presente estudio se efectuó en radiografías cefalometricas de 80 pacientes entre las edades de 15 a 25 años de ambos sexos, distribuidas en 4 grupos cuyo tamaño fue determinado por formula: 20 radiografías laterales de pacientes con maloclusión clase II ángulo bajo, 20 con ángulo alto, 20 radiografías de pacientes para maloclusión clase III ángulo bajo y 20 con ángulo alto. La técnica de recolección de datos fue la observación radiográfica, la cual se operatizo a través de su respectivo instrumento. El análisis de los datos se realizó mediante la estadística descriptiva e inferencial: X² y correlación Pearson, usando el paquete estadístico SPSS-21. Resultados: En las maloclusiones II ángulo bajo y alto, y en la clase III ángulo bajo mayormente no presentan discrepancia posterior; en la maloclusión clase III ángulo alto si presenta en su mayoría discrepancia posterior. Las maloclusiones clase II alto y bajo muestran un doble plano oclusal, mientras que las maloclusiones III alto y bajo mayormente presentan un solo plano oclusal. En las maloclusiones clase II con ángulo bajo existe relación directa entre la discrepancia posterior, el plano oclusal. Conclusiones: Con ángulo alto no hay relación en la discrepancia posterior y plano oclusal. En la maloclusión clase III con ángulo alto y bajo no se encontró relación estadísticamente significativa entre discrepancia posterior y plano oclusal. (AU)

Objectives: To relate the occlusal plane to the posterior discrepancy by applying the kim cephalogram and the analysis of the dental framework of Dr Sato. Material and methods: The present study was carried out on cephalometric radiographs of 80 patients between the ages of 15 and 25 years of age, divided into 4 groups whose size was determined by formula: 20 lateral radiographs of patients with malocclusion class II low angle, 20 with high angle, 20 xrays of patients for malocclusion class III low angle and 20 with high angle. The technique of data collection was radiographic observation, which was performed through its respective instrument. Data analysis was performed using descriptive and inferential statistics: X² and Pearson correlation, using the statistical package SPSS-21. Results: In the low and high angle II malocclusions, and in the low angle III class, there is no posterior discrepancy; In the class III malocclusion high angle if it presents in its majority later discrepancy. High and low class II malocclusions show a double occlusal plane, while the high and low III malocclusions mostly present a single occlusal plane. In class II malocclusions with low angle there is a direct relationship between the posterior discrepancy, the occlusal plane. With high angle there is no relation in the posterior discrepancy and occlusal plane. Conclusions: In the class III malocclusion with high and low angle there was no statistically significant relationship between posterior discrepancy and occlusal plane. (AU)

Maxillary protraction and multiple loop edgewise arch wire technology in treatment of early mixed dentition skeletal class Ⅲ malocclusion / 中华医学美学美容杂志

Objective To evaluate the orthodontic effect of surgery on mixed dentition period class Ⅲ malocclusion and to investigate the effective therapeutic method of the skeletal class Ⅲ malocclusion.Methods A total of 20 patients aged 8.5 to 9.1 years with early mixed dentition class Ⅲ skeletal malocclusion.The treatment was divided into two phases.During the first phase,the entire stuffy group was treated with a bonded maxillary expansion and protraction.During the second phase,the entire study group received multiple loop edgewise arch wire (MEAW) treatment until an ideal occlusion relationship achieved.Comparison of the pre-and post-orthodontic treatment cephalometric radiographs had been done after maxillary protraction and MEAW were applied for patients.Results In the 20 patients after orthodontic treatment,Class Ⅲ skeletal facial profile was improved,the retraction of anterior teeth was obvious,and there were significant changes in dentition; the profile of soft tissue and satisfactory occlusion relationship were significantly improved,as compared with the changes between pre-treatment and post-treatment.Conclusions Skeletal Ⅲ malocclusion in early mixed dentition can be successfully treated.The results can be satisfied with improved class Ⅲ skeletal and molar relationship,high-angle and profile of soft tissue.

La filosofía MEAW y el rol de los terceros molares en el desarrollo y tratamientos de las mordidas abiertas / MEAW philosophy and the riole of third molars in the development and treatment of openbites

Multiloop Edgewise Archwire Technique es una técnica desarrollada en los años 60 por Young H. Kim, la cual ha tenido un fuerte desarrollo en los países de Asia, especialmente Japón y Corea, por el Prof. Sadao Sato de la Universidad de Kanagawa, Japón. En la experiencia de la filosofía MEAW se ha dado particular importancia al tratamiento no quirúrgico de clases III y mordidas abiertas esqueletales. La discrepancia posterior (CP), concepto nuevo para la ortodoncia occidental, es considerada para determinar la remoción temprana de los terceros molares debido a su importancia como factor coadyuvante en la recidiva de los tratamientos de ortodoncia, especialmente el apiñamiento incisivo y en particular en la orientación del Dr. Sato, debido a su importancia en el desarrollo de la DP, que como se ha mencionado, es un factor etiopatogénico en el desarrollo de las maloclusiones esqueletales y mordidas abiertas antes, durante y postratamiento de ortodoncia.

¿Porqué extraer preventivamente los terceros molares? / Why preventive removal of third molars?

El tema de la extracción preventiva de los terceros molares, ha estado sometido durante mucho tiempo a un extenso debate. Son muchos los artículos basados en la evidencia, que apuntan a no considerar este procedimiento como una maniobra justificada, si no hay sintomatología que lo amerite. Los resultados de las investigaciones, concluyen especialmente que no hay evidencia que sustente que los terceros molares sean causantes de apiñamiento dentario tardío. Dichas investigaciones no han considerado sin embargo las investigaciones del Profesor Sadao Sato referidas al concepto de discrepancia posterior y los terceros molares, y su rol como factor etiopatogénico en el apiñamiento tardío, desarrollo de mordida abierta y recidiva post tratamiento de ortodoncia. En el presente artículo se desarrolla parte del debate y se presenta la filosofía MEAW – Multiloop Edgewise Arch Wire- como un efectivo método de tratamiento de las secuelas de Discrepancia Posterior.

The subject of the preventive extraction of third molars, has been under an extensive debate during long time. The articles based on the evidence are many, that aim not to consider this procedure like a justified maneuver, if there is no symptoms that justify it. The results of the investigations conclude specially that there is no evidence that it sustains those third molars is causes of delayed dental crowding. These investigations have not considered nevertheless the investigations of Professor Sadao Sato referred to the concept of posterior discrepancy and third molars, and it roll like etiopatologic factor in the delayed crowding, development of open bite and post orthodontic relapse. In the present article part of the debate is presented and it developed the MEAW philosophy - Multiloop Edgewise Arch Wire- like an effective method of treatment of the sequels of Posterior Discrepancy.

Stress analysis of multiloop edgewise arch wire with various degree of tip back bend : a study using the finite element method / 대한치과교정학회지

This study have been carried out to find out the mechnical effect of Multiloop Edgewise Arch Wire(MEAW) making use of the finite element method. The tip back bend of MEAW taken in this analysis is 5degrees,12degrees and 15degrees. In addition, Class II or up & down elastic is applied to find out stress distribution and their values in PDL. A adult male of normal was selected to create the models of teeth and PDL. And the model of MEAW was also created using commercial finite element code (ANSYS version 5.2). The MEAW is forcibly engaged with a class II or up & down elastic, to determine the initial stress generated in PDL. Comparing the compressive and tensile stress at each reference-planes, following results are obtained. 1. When a MEAW of 5degrees, 10degrees, 15degrees tip back bend was engaged with Class II or up & down elastic, the distribution of compressive, tensile stress in entire PDL is similar in each case. 2. The values of compressive and tensile stress in PDL is higher in 15degrees tip back bend case than in 10degrees or 5degrees tip back bend case. 3. In the distal PDL of 1st and 2nd molar, compressive stress appears. The compressive area is more wide and its values is higher in PDL 2nd molar than those in 1st molar. The compressive area and its values become more wide and higher according to the increase of the tip back bend. 4. The value of compressive stress are comparatively smaller in PDL of molars than those in premolars. 5. Comparing class II and up & down elastic case, tensile stress values in anterior teeth PDL are smaller and their distribution is more wide in up & down elastic case than class II elastic case. On another hand, there is no difference in distribution and stress values in PDL of posterior teeth between two cases. 6 Comparing the tensile area in PDL of anterior teeth, tensile stress values are maximum in PDL of canine.

An experimental study of the regional load deflection rate of multiloop edgewise arch wire / 实用口腔医学杂志

Objective:To compare the regional load deflection rate(LDR) of multiloop edgewise arch wire(MEAW) in the individual interbracket span,to understand the mechanical properties of MEAW.Methods:The stainless steel wire of 0.41 mm?0.64 mm was bent with single L-loop of 5 different sizes as described by Kim.The LDR of each L-loop at the individual interbracket span when loading and unloading was measured by using the Instron at a crosshead speed of 1 mm/min and maximum deflection of 1.0 mm at room temperature.Five specimens were tested under each experimental condition to eliminate the possibility of changes in the physical properties of the wires as a result of the stress from repeated measurements.The date were analysed by SPSS 11.0.Results:L-loops of MEAW had different LDRs regionally,except the regional LDRs between the canine and the first premolar and that between the first and second premolar were identical and moderate,a high value for the anterior segments and a low value for the posterior segments,the difference was statistically significant(P

Regional load deflection rate of multiloop edgewise archwire / 대한치과교정학회지

This study was conducted in order to analyze the mechanical characteristics of multiloop edgewise archwire(MEAW). The purposes were 1) to compare load deflection rate(LDR) of MEAW with that of various other archwires in the individual interbracket span, 2)to compare the wire stiffness in the interbracket span with that in the multi-L-loop region (the span from distal border of the bracket of the lateral incisor to the mesial border of the buccal tube of second molar), and 3) to verify the experimental results with theoretically derived formula. The single L-loops five different horizontal lengths and multi-L-loops for the upper and lower arches were made out of .016 X .022 permachrome stainless steel wire. Straight segment of plain stainless steel, TMA and NiTi wire of the same dimension were prepared. The LDR was measured using Instron model 4466 with the load cell of 50N capacity at cross head speed of 1.0mm/min, and maximum deflection of 1.0mm. Five specimens were tested under each experimental condition. The wire stiffness number for each interbracket region and multi-L-loop region was calculated from the LDR and the interbracket spans. By dividing the theoretical model of multi-L-loop into 35 linear segments, the energy stored in each segment was obtained. Then the LDR and wire stiffness of single L-loop and multi-L-loop were calculated and compared. The findings were as follows : 1) The average LDR of MEAW in the individual interbracket region was 1/1.53 of that of the NiTi, 1/247 of TMA and 1/5.16 of the plain stainless steel wire. 2) The wire stiffness of MEAW in the multi-L-loop region was 1.53 times larger than that in the interbracket region, and the LDR was almost twice as large as that of NiTi in that region. 3) According to the theoretically derived equation, the wire stiffness of the single L-loop was lower than that of multi-L-loop. The results of this study suggest that MEAW has the unique mechanical property which could allow individual tooth movement and transmit elastic force effectively through the entire arch wire.

Three dimensional finite element analysis of the phenomenon during distal en masse movement of the maxillary dentition / 대한치과교정학회지

This study was designed to analysis the displacement and stress distribution of individual tooth by orthodontic force during distal en masse movement of the maxillary dentition. In this study, three dimensional finite element analysis was used. Author made the finite element model of maxillary teeth, periodontal ligament, alveolar bone and bracket with anatomic and physiologic characteristics on computer. Author analysed and evaluated the displacement and stress distribution of individual tooth when extraoral force, Class II intermaxillary elastics, ideal arch wire, MEAW and tip back bend were used for distal en masse movement of the maxillary dentition. These analyses were also applied in the case of the maxillary second molar were not extracted. Author compared the results of the cases which maxillary second molar were extracted or not. The results were expressed quantitatively and visually. Author obtained following results, 1. When anterior headgear was applied, the posterior translation, posterior tipping, and vertical displacement of teeth were produced more in the anterior segment of the dentition. 2. When Class II intermaxillary elastics were applied in the ideal arch wire, the teeth disp acement were usually produced in the anterior segment. But when tip back bend were added in the ideal arch, the orthodontic force produced by elastics were transmitted to the posterior segment. As increasing the tip back bend, posterior translation and lingual tipping of anterior teeth were decreased, posterior translation and tipping displacement of posterior teeth were increased, and extrusion of anterior teeth by Class II elastics were decreased. 3. When MEAW and Class II elastics were applied, the teeth movement were similar with the case of ideal arch wire and Class II elastics, but more small and uniform teeth displacement were produced. Compared with the ideal arch wire, posterior tipping of the posterior segment were more produced than lingual tipping displacement of the anterior segment. 4. When the maxillary second molar without orthodontic appliance existed, the displacement of maxillary first molar were decreased.

The diagnosis and treatment of anterior openbite malocclusion / 대한치과교정학회지

There are varieties of severe malocdusions, which can be treated orthodontically, but with a great deal of effort. Anterior openbite, in particular, is one malocclusion thought to be more difficult to treat, and therefore, most of them have to be corrected by means of surgical intervention. To solve these problems, numerous studies pertinent to treatment modalities have been introduced with controversies on the effectiveness of treatment. Suggested treatment-modalities for anterior openbite are based directly or indirectly on the neuromuscular and morphological features and on the etiologic and/or the environmental factors. Even though the vertical relationship of the face is increased due to the growth variation, the normal occlusal relationship can be achieved by the adequate dentoalveolar compensatory mechanism, but in the case of inadequate or negative dentoalveolar compensation, openbite is likely to be present. If the skeletal dysplasia is too severe to be solved by orthodontic treatment alone, combined treatment with surgery should be done to restore the function and the esthetics of the orofacial complex. In many cases, however, orthodontic alteration of the dentition pertinent to the given skeletal pattern with the proper diagnosis and treatment planning can bring satisfactory results. The treatment changes with the Multiloop Edgewise- Archwire(MEAW), therapy occurred mainly in the dentoalveola~ region and showed a considerable similarity to the natural dentoalveolar compensatory mechanism. In other words, the MEAW technique allows orthodontists to produce the natural dentoalveolar compensation orthodontically. Even if an openbite is corrected by the orthodontic dentoalveolar compensation suitable for the skeletal pattern, relapse may still occur by the persisting etiologic factors which originally prohibited the natural dentoalveolar compensation. The etiologic factors should be determined at the time of initial diagnosis and should be controlled during treatment and retention.

A photoelastic study of the stress distribution on the multiloop edgewise arch wire / 대한치과교정학회지

This study was designed to investigate the stress distribution, intensity and force mechanism derived from the MEAW by photoelastic stress analysis of the artificial teeth and surrounding bone composed of photoelastic(material/ PL-3 ). The findings of this study were as follows: 1. In case of no elastic on the MEAW with tip back, the moderate stress was observed on the molar and canine area, and the light stress was observed on the other area. 2. In case of the vertical elastic on the plain A.W. and the MEAW without tip back, the great stress was observed on the lateral incisor area, but on the MEAW with tip back, the moderate stress was observed on the anterior area and molar area. 3. In case of the C II elastic on plain A.W., the stress was concentrated on the anterior area hanged by elastic but on the MEAW without tip back, the stress was transmitted equally from the anterior area to the posterior teeth area, On the MEAW with tip back, the great stress was observed on the anterior and molar area. 4. In case of the C III elastic on the plain A.W., the stress was concentrated on the posterior area hanged by elastic but on the MEAW without tip back, the stress was transmitted equally from the posterior area to the anterior area. On the MEAW with tip back, the great stress was observed on the posterior area and the moderate stress was observed on the anterior area.

A study of holographic interferometry on the initial reaction of maxillofacial complex to the intermaxillary forces on the orthodontic archwireS / 대한치과교정학회지

This study was performed to evaluate the initial reaction of maxillofacial complex to the Class II intermaxillary and the anterior vertical elastic forces on the six types of arch wires including multiloop edgewise arch wires(MEAW). A human dry skull was used for this purpose and this investigation was done by holographic interferometry. Based on such investigation, the fringe pattern and the number of fringes of each condition were compared and analyzed. The findings of this study were as follows: 1. As the orthodontic forces increased, the amount of displacement increased. 2. As the orthodontic forces were applied, the fringes were shown not only in the teeth and the maxilla but also in the adjacent bones, i.e., temporal bone, zygomatic bone, nasal bone, frontal bone and sphenoid bone. And the direction of fringe pattern and the number of fringes were different from each other by the sutures. 3. As the long Class II elastic forces were applied, the backward-downward displacements of the anterior teeth and the maxilla were shown, and backward displacements of the former were greater than those of the latter. And backward displacements were greater by the long Class II elastic forces than by the short Class II elastic forces. 4. As the anterior vertical elastic forces were applied, downward displacements of the anterior teeth and the maxilla were shown, and the downward displacements of the former were greater than those of the latter relatively. 5. The downward displacements of the anterior area to the anterior vertical elastic forces of the MEAW were greater than those of other arch wires. In addition, the more tip-back bend was applied, the more displacement was seen. 6. As the Class II intermaxillary forces and the enough anterior vertical elastic forces were applied on the MEAW with tip-back bend, there was an intrusive effect of the posterior teeth.

A cephalometric evalauation of anterior openbite malocclusions treated by multiloop edgewise archwire technique / 대한치과교정학회지

The purpose of this study was to evaluate the change of before and after treatment of anterior openbite malocclusions treated by Multiloop Edgewise Archwire technique. The openbite sample consisted of 4 male and 12 female adults, treated with nonextraction or third molar extraction. The normal sample consisted of 58 subjects, which have pleasing facial profile and normal occlusion and no experience of orthodontic or prosthodontic treatment. The 58 subjects of normal sample were subdivided by cephalometric vertical relationship of face. The 40 subjects, cephalometric vertical relationship of face was in normal range, classified as Normal Sample group 1. The 18 subjects, increased cephalometric vertical relationship of face, classified as Normal Sample group 2. The computerized cephalometric analysis was accomplished with 50 reference points for 22 skeletal measurements, 46 dentoalveolar measurements, 8 soft tissue measurements. Statistical analysis of the data was carried out with paired t-test, Student's t-test, and DUNCAN test using SAS(PC version). The results were as follows: 1. There were no statistically significant differences in skeletal measurement between before and after treatment. The major changes were in dentoalveolar region. 2. After treatment, the long axis of maxillary and mandibular posterior teeth were distally tipped-back, and uprighted to bisected occlusal plane. The interincisal angle was increased. 3. There were no statistically significant increase in the upper posterior dental height and statistically significant decrease in the lower posterior dental height. The upper anterior dental height was increased, but there was no statistically significant increase in the absolute upper anterior dental hight. The lower anterior dental height was increased. 4. After treatment, the maxillary occlusal plane to palatal plane angle and the mandibular occlusal plane to mandibular plane angle were statistically significant increased. Then, there were no statistically significant difference between after treatment group and normal sample group 2. 5. After treatment, the percentage of upper lip length to upper anterior dental height was decreased. Then, There were no statistically significant difference between after treatment group and normal sample group 2.