“size and shape matters” In the new individual patient (IP) system, 18 shapes and sizes of archwires are now available to make our treatment more effective and efficient. No matter what bracket system you are using, this system can be applied immediately to improve the treatment of your current patients. When evaluating the need to change archwires in your current patients, compare the archwire that you have used to that patients’ starting lower study model, considering the treatment plan chosen. Start your evaluation with your extraction cases. If an expanded archform was used to prevent incisor advancement, making for more non-extraction cases, it is time to change. In extraction cases, expanded archwires create many problems, including:
increasing the space to be closed,
labial cortical bone engagement, slowing extraction space closure,
arch coordination problems when the lower arch does not fully expand to the archwire size, due to cortical bone resistance. This arch coordination problem results in class II posterior finishes, as the protrusive interference of the incisors prevents the upper incisor retraction. The same protrusive interference also makes class II elastics ineffective.
The new shapes and sizes are designed to offer a selection of wires that may be used in the many treatment situations. In non-extraction cases, you may still choose an expanded archform. In extraction cases, you may choose an archwire to maintain the arch, consistent with graduate orthodontic training where archwires were bent for every patient. In posterior crossbite cases, you may choose a constricted lower arch and an expanded upper arch. In other words, the archwire shape and size may now be determined by the patients’ characteristics and the treatment plan.
There are now 9 shapes and sizes for the lower arch, with another 9 matching archforms to coordinate with these lower forms. The inventory includes nickel-titanium wires, stainless steel wires, and looped archwires, totaling 525 different wires!
The total inventory in your practice would be very expensive and difficult to manage within the private practice setting. For this reason, IP appliance inventory centers have been formed in California and Spain to service the needs of your individual patient. You may now order a set of wires for each patient, as you need them! Some choose to inventory the most common archwires (ovoid-small and ovoid-medium), ordering patient-by-patient for the less common.
To manage the loss, deformation, breakage, and mistakes made during treatment, you will need an “archwire repair kit”. This kit contains 2 wires of each possible size and shape, and is the only inventory you need in your practice. Large volume practices may choose to have an additional repair kit to service the many patients that may need repairs during a typical day of work. Reordering of wires used in the repair kit may be added to the next patient order.
It is logical to match the dental archform shape to the shape of the mandible. By doing this, tooth movement is more efficient, as the teeth are maintained consistent with the limiting cortical bone labial and lingual. A new discovery was made by viewing computer scans of lower arches. The shape of the mandible can be clearly seen by viewing the “shadow” lingual to the lower teeth. Although this system is best when using computer software, the same shape can be seen on study models, allowing for the “manual” IP archwire system.
Choose the shape (ovoid, tapered, or square) for each individual case using the provided template, comparing with the shape of the mandible.
Step 2: Determine the arch size for the chosen shape (lower arch)
Using the template showing the available preformed archwires, view the wires compared to the buccal-labial surfaces of the lower teeth, adding some space for the brackets. The diagnosis chosen for the case is considered as the possible shapes are compared to the actual model. Ask yourself if you wish to maintain the current arch size, expand, or constrict? There is no need to discard your previous archwires, since these wires may be altered to the desired shape when the archwire repair kit is empty for that wire. Use the acetate templates to reshape these archwires.
Step 3: “Confirm” the arch size for the upper arch
In most cases, you will want to use coordinated archwires, upper and lower, for your case. There is NO NEED in these cases to examine the template with the upper teeth. Just order the coordinated archwire set based on your lower arch determination.
But in cases with transverse problems, you may want to choose an upper wire that is larger than the lower. In these cases, you may want to compare the available upper archforms, choosing a larger size in the upper arch than the lower for the majority of treatment. You have the choice of selecting coordinated upper/lower archwires in the finishing stage if you wish.
Step 4: Determine the wire progression for your individual case treatment
It is possible for you to create a custom wire progression for each case, as you wish. To help you create the list, standard wire progressions for example treatments have been listed on the IP archwire order form. Additions or subtractions from these standard progressions may be made in the initial order, or by using wires in your archwire repair kit. Wires not used during treatment of a patient are placed into the archwire repair kit for future inventory. The repair kit gives you flexibility!
Note that 012N and 014N are not in the 18 shapes and sizes as these wires do not affect the archform. Your practice will continue to inventory these wires as before.
Measure the size of the teeth upper and lower 2-2 for cases using keyhole or T loops to get the proper width between the loops.
Step 5: Place your IP tm archwire order
When using IPSoft computer software, connect to the internet and place your order. The list of wires will be automatically created for you with pricing calculated. The set of archwires will arrive within 7 calendar days of your order.
In the manual system, you must fax the order form to the central inventory location. A set of wires will be assembled for your individual patient, with the name of the patient indicated on the packaging. You can still expect the set of wires to arrive in 1 week or less.
Add any replacement wires needed for your archwire repair kit.
Instructions for using the IPSoft 3.0 Archwires tab:
Do this for both upper and lower arch:
Click the arch shape (ovoid, tapered, or square), then click one of the sub-selections such as small, medium, large etc. Each time you do so, the other selections become unavailable:
After using the templates and the study models to determine the shape of the mandible and the archform that you wish, then you are ready to enter the wire progression you wish for that individual patient. For a starting point, you may use one of the categories of case treatments. When one of these is selected, you will see a number “1” appear by the archwires commonly used in this type of treatment.
If you want to add an archwire, indicate this by placing a number 1 next to the desired archwire. If you do not want an archwire, change the 1 to a “0”. If you need an extra archwire to replenish your repair kit, then add these wires to your order, changing a 1 to a 2 if a wire is already selected for the patient.
On the lower right, you will notice two buttons. When clicked, either will produce an ordering window.
Clicking “Add to Order” will add archwires to an existing order.
Clicking “Order Archwires Only” will first clear, then add archwires.