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Meta-Analysis
. 2024 Feb 6;2(2):CD007859.
doi: 10.1002/14651858.CD007859.pub5.

Initial arch wires used in orthodontic treatment with fixed appliances

Chang Liu  1 , Zhi Wei  2 , Fan Jian  2 , Grant McIntyre  3 , Declan T Millett  4 , Wenli Lai  2 , Yan Wang  2
Affiliations
Meta-Analysis

Initial arch wires used in orthodontic treatment with fixed appliances

Chang Liu et al. Cochrane Database Syst Rev. .

Abstract

Background: Initial arch wires are the first arch wires inserted into fixed appliance at the beginning of orthodontic treatment. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which are most efficient and which cause the least amount of root resorption and pain during the initial aligning stage of treatment. This is the third update of a Cochrane review first published in 2010.

Objectives: To assess the effects of initial arch wires for the alignment of teeth with fixed orthodontic braces, in terms of the rate of tooth alignment, amount of root resorption accompanying tooth movement, and intensity of pain experienced by patients during the initial alignment stage of treatment.

Search methods: We searched Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, Embase, and two ongoing trials registries on 4 July 2022.

Selection criteria: We included randomised controlled trials (RCTs) of different initial arch wires used to align teeth with fixed orthodontic braces. We included people with full-arch fixed orthodontic appliances on the upper arch, lower arch, or both arches.

Data collection and analysis: Two independent review authors were responsible for study selection, data extraction, and assessment of risk of bias in included studies. We contacted corresponding authors of included studies to obtain missing information. We resolved disagreements by discussion between the review authors. Our main outcomes were alignment rate (movement of teeth in mm), root resorption, time to alignment, and intensity of pain measured on a 100-mm visual analogue scale (VAS). We pooled data from studies with similar interventions and outcomes using random-effects models. We reported mean differences (MDs) with 95% confidence intervals (CIs) for continuous data, risk ratios (RRs) with 95% CIs for dichotomous data, and alignment rate ratios with 95% CIs for time-to-event data. Two independent review authors assessed the certainty of evidence. We resolved disagreements by discussion between the review authors.

Main results: We included 29 RCTs with 1915 participants (2581 arches) in this review. Studies were generally small (sample sizes ranged from 14 to 200 participants). Duration of follow-up varied between three days and six months. Eleven studies received funding, six received no funding, and 12 provided no information about funding sources. We judged eight studies at high risk of bias, nine at low risk, and 12 at unclear risk. We grouped the studies into six main comparisons. Multistrand stainless steel wires versus wires composed of other materials Six studies with 409 participants (545 arches) evaluated multistrand stainless steel (StSt) wires versus wires composed of other materials. We are very uncertain about the effect of multistrand StSt wires versus other wires on alignment rate (4 studies, 281 participants, 417 arches; very low-certainty evidence). There may be little to no difference between multistrand StSt wires and other wires in terms of intensity of pain (MD -2.68 mm, 95% CI -6.75 to 1.38; 2 studies, 127 participants, 127 arches; low-certainty evidence). Conventional nickel-titanium wires versus superelastic nickel-titanium wires Four studies with 266 participants (274 arches) evaluated conventional nickel-titanium (NiTi) wires versus superelastic NiTi wires. There may be little to no difference between the different wire types in terms of alignment rate (124 participants, 124 arches, 2 studies; low-certainty evidence) and intensity of pain (MD -0.29 mm, 95% CI -1.10 to 0.52; 2 studies, 142 participants, 150 arches; low-certainty evidence). Conventional nickel-titanium wires versus thermoelastic copper-nickel-titanium wires Three studies with 210 participants (210 arches) evaluated conventional Ni-Ti versus thermoelastic copper-nickel-titanium (CuNiTi) wires. We are very uncertain about the effects of the different arch wires on alignment rate (1 study, 66 participants, 66 arches; very low-certainty evidence). There may be little to no difference between conventional NiTi wires and thermoelastic CuNiTi wires in terms of time to alignment (alignment rate ratio 1.30, 95% CI 0.68 to 2.50; 1 study, 60 participants, 60 arches; low-certainty evidence). Superelastic nickel-titanium wires versus thermoelastic nickel-titanium wires Twelve studies with 703 participants (936 arches) evaluated superelastic NiTi versus thermoelastic NiTi wires. There may be little to no difference between superelastic NiTi wires and thermoelastic NiTi wires in alignment rate at four weeks (MD -0.28 mm, 95% CI 0.62 to 0.06; 5 studies, 183 participants, 183 arches; low-certainty evidence). We are very uncertain about the effects of the different wires on root resorption (2 studies, 52 participants, 312 teeth; very low-certainty evidence). Superelastic NiTi wires compared with thermoelastic NiTi wires may result in a slight increase in time to alignment (MD 0.5 months, 95% CI 0.21 to 0.79; 1 study, 32 participants, 32 arches; low-certainty evidence) but are probably associated with a slight increase in intensity of pain (MD 6.96 mm, 95% CI 1.82 to 12.10; 3 studies, 94 participants, 138 arches, moderate-certainty evidence). Single-strand superelastic nickel-titanium wires versus coaxial superelastic nickel-titanium wires Three studies with 104 participants (104 arches) evaluated single-strand superelastic NiTi versus coaxial superelastic NiTi wires. Use of single-strand superelastic NiTi wires compared with coaxial superelastic NiTi wires probably results in a slight reduction in alignment rate at four weeks (MD -2.64 mm, 95% CI -4.61 to -0.67; 2 studies, 64 participants, 64 arches, moderate-certainty evidence). Different sizes of nickel-titanium wires Two studies with 149 participants (232 arches) compared different types of NiTi wires. There may be little to no difference between different sizes of NiTi wires in terms of pain (low-certainty evidence).

Authors' conclusions: Superelastic NiTi wires probably produce slightly more pain after one day than thermoelastic NiTi wires, and single-strand superelastic NiTi wires probably have a lower alignment rate over four weeks compared with coaxial superelastic NiTi wires. All other evidence on alignment rate, root resorption, time to alignment, and pain is of low or very low certainty in all comparisons. Therefore, there is insufficient evidence to determine whether any particular arch wire material or size is superior to any other. The findings of this review are imprecise and unreliable; well-designed larger studies are needed to give better estimates of the benefits and harms of different arch wires. Orthodontists should exercise caution when interpreting the findings of this review and be prepared to adapt their treatment plans based on individual patient needs.

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Conflict of interest statement

CL: none ZW: none FJ: none GTM: none DTM: none WL: none YW: none

Figures

1
1
Definitions of Little's irregularity index.
2
2
PRISMA flow diagram.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Multistrand stainless steel (StSt) wires versus wires composed of other materials, Outcome 1: Alignment rate (LII reduction; mm): multistrand StSt versus conventional StSt
1.2
1.2. Analysis
Comparison 1: Multistrand stainless steel (StSt) wires versus wires composed of other materials, Outcome 2: Alignment rate (LII reduction; mm): multistrand StSt versus superelastic nickel‐titanium (NiTi)
1.3
1.3. Analysis
Comparison 1: Multistrand stainless steel (StSt) wires versus wires composed of other materials, Outcome 3: Alignment rate (LII reduction; mm): multistrand StSt versus thermoelastic nickel‐titanium (NiTi)
1.4
1.4. Analysis
Comparison 1: Multistrand stainless steel (StSt) wires versus wires composed of other materials, Outcome 4: Pain (100‐mm VAS): multistrand StSt versus superelastic nickel‐titanium (NiTi)
2.1
2.1. Analysis
Comparison 2: Conventional nickel‐titanium (NiTi) wire versus superelastic NiTi wire, Outcome 1: Alignment rate (LII reduction; mm)
2.2
2.2. Analysis
Comparison 2: Conventional nickel‐titanium (NiTi) wire versus superelastic NiTi wire, Outcome 2: Time to working arch wire (months)
2.3
2.3. Analysis
Comparison 2: Conventional nickel‐titanium (NiTi) wire versus superelastic NiTi wire, Outcome 3: Pain (100‐mm VAS)
2.4
2.4. Analysis
Comparison 2: Conventional nickel‐titanium (NiTi) wire versus superelastic NiTi wire, Outcome 4: Pain (analgesic consumption)
3.1
3.1. Analysis
Comparison 3: Conventional nickel‐titanium (NiTi) wire versus thermoelastic copper‐nickel‐titanium (CuNiTi) wire, Outcome 1: Alignment rate (LII reduction; mm)
3.2
3.2. Analysis
Comparison 3: Conventional nickel‐titanium (NiTi) wire versus thermoelastic copper‐nickel‐titanium (CuNiTi) wire, Outcome 2: Alignment rate (change in arch width; mm)
3.3
3.3. Analysis
Comparison 3: Conventional nickel‐titanium (NiTi) wire versus thermoelastic copper‐nickel‐titanium (CuNiTi) wire, Outcome 3: Time to working arch wire (months)
3.4
3.4. Analysis
Comparison 3: Conventional nickel‐titanium (NiTi) wire versus thermoelastic copper‐nickel‐titanium (CuNiTi) wire, Outcome 4: Time to alignment (alignment rate ratio)
4.1
4.1. Analysis
Comparison 4: Superelastic nickel‐titanium (NiTi) wire versus thermoelastic NiTi wire, Outcome 1: Alignment rate (LII reduction; mm)
4.2
4.2. Analysis
Comparison 4: Superelastic nickel‐titanium (NiTi) wire versus thermoelastic NiTi wire, Outcome 2: Alignment rate (change in arch width; mm)
4.3
4.3. Analysis
Comparison 4: Superelastic nickel‐titanium (NiTi) wire versus thermoelastic NiTi wire, Outcome 3: Root resorption (root length reduction until alignment; mm)
4.4
4.4. Analysis
Comparison 4: Superelastic nickel‐titanium (NiTi) wire versus thermoelastic NiTi wire, Outcome 4: Time to working arch wire (months)
4.5
4.5. Analysis
Comparison 4: Superelastic nickel‐titanium (NiTi) wire versus thermoelastic NiTi wire, Outcome 5: Time to alignment (months)
4.6
4.6. Analysis
Comparison 4: Superelastic nickel‐titanium (NiTi) wire versus thermoelastic NiTi wire, Outcome 6: Pain (100‐mm VAS)
4.7
4.7. Analysis
Comparison 4: Superelastic nickel‐titanium (NiTi) wire versus thermoelastic NiTi wire, Outcome 7: Pain (analgesic consumption)
5.1
5.1. Analysis
Comparison 5: Single‐strand superelastic nickel‐titanium (NiTi) wire versus coaxial superelastic NiTi wire, Outcome 1: Alignment rate (LII reduction; mm)
5.2
5.2. Analysis
Comparison 5: Single‐strand superelastic nickel‐titanium (NiTi) wire versus coaxial superelastic NiTi wire, Outcome 2: Alignment rate (change in arch width; mm)
6.1
6.1. Analysis
Comparison 6: Different sizes of nickel‐titanium wires, Outcome 1: Pain (100‐mm VAS): 0.014‐inch versus 0.016‐inch
6.2
6.2. Analysis
Comparison 6: Different sizes of nickel‐titanium wires, Outcome 2: Pain (100‐mm VAS): 0.014‐inch versus 0.018‐inch
6.3
6.3. Analysis
Comparison 6: Different sizes of nickel‐titanium wires, Outcome 3: Pain (100‐mm VAS): 0.016‐inch versus 0.018‐inch
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Alhaija 2021 {published data only}
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Mahmoudzadeh 2018 {published data only}
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Nabbat 2020 {published data only}
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O'Brien 1990 {published and unpublished data}
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Ong 2011 {published data only}
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Pandis 2009 {published data only}
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Phermsang‐Ngarm 2018 {published data only}
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Ren 2016 {unpublished data only}
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Sandhu 2013 {published data only}
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Sebastian 2019 {published data only}
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Ulhaq 2017 {published data only}
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References to studies excluded from this review

Abdelrahman 2015 {published data only}
    1. Abdelrahman RSh, Al-Nimri KS, Al Maaitah EF. A clinical comparison of three aligning archwires in terms of alignment efficiency: a prospective clinical trial. Angle Orthodontist 2015;85(3):434-9. [CENTRAL: CN-01215594] [DOI: 10.2319/041414-274.1] [PMID: ] - DOI - PMC - PubMed
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Atik 2018 {published data only}
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References to studies awaiting assessment

Kumar 2016 {unpublished data only}
    1. Kumar N, Micheal RJ, Sundari S. Decrowding efficiency between tubular coaxial niti and super elastic niti arch wires in mandibular crowding - a randomized control trial [Conference Abstract]. In: IADR/APR General Session. Seoul, Korea, 2016:Final Presentation ID 0625. [AVAILABLE FROM: https://iadr.abstractarchives.com/abstract/16iags-2472493/decrowding-eff...]
Schwartz 2021 {unpublished data only}
    1. Schwartz R, Carey C, Minick G, Newman S, Tilliss T, Shellhart W. Pain after archwire placement with three types of nickel-titanium archwires [Conference Abstract]. In: IADR/AADR/CADR General Session. Virtual Experience, 2021:Final Presentation ID 2413. [AVAILABLE FROM: iadr.abstractarchives.com/abstract/21iags-3578010/pain-after-archwire-pl...

References to ongoing studies

CTRI/2021/05/033728 {unpublished data only}
    1. CTRI/2021/05/033728. Evaluation of root resorption of mandibular anterior teeth at the end of post alignment stage with three different alignment archwires - A CBCT study. trialsearch.who.int/?TrialID=CTRI/2021/05/033728 (first received 21 May 2021). [CENTRAL: CN-02327490]
CTRI/2021/09/036859 {unpublished data only}
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CTRI/2021/12/038836 {unpublished data only}
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NCT05391542 {unpublished data only}
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References to other published versions of this review

Jian 2013
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