Friday, June 7, 2013

ORTHODONTIC WIRES

 Teeth move in response to forces imposed on them i.e. the elasticity of the surrounding tissues, direct action of the remote muscles or external forces like oral habits and dental appliances. 
The position of each teeth, from day to day and minute to minute is determined entirely by the combined effects of environmental forces. 
 Orthodontic tooth movements are brought about by appliances consisting of orthodontic wires. 
 In the 18th and early 19th century gold wires were used. 
The constant search for newer wires with better properties has lead to the development of wires made of different materials which are superior to the gold arch wires. 

TERMINOLOGY 

The commonly used terms are as follows: 
Mechanics: As an area of study with in the physical sciences, is concerned with the state of rest or motion of bodies, subjected to forces. 
Force: Force is defined as an act upon a body that changes or tends to change the state of rest or the motion of that body. 
Stress: Displacing force measured across a given area, it is known as stress (force per unit area, pound/sq. inch) 
Strain: The change in dimension is called a strain change in length / unit length. 
Strain could be 
1) Plastic  
2) Elastic 
Tensile stress: A tensile stress is caused by a load that tends to stretch or elongate a body. It is always accompanied by a tensile strain. 
Compressive stress: If a body is placed under a load that tends to compress or shorten it. the internal resistance to such a load in called compressive stress. It is accompanied by a compressive strain. 
Shear stress: A stress that tends to resist a twisting motion or a sliding of one portion of a body over another, is called as shear or shearing stress. 
The elastic limit of a material is the greatest stress to which a material can be subjected, such that is will return to its original dimensions when the forces are released. 
Proportional limit: If the wire is loaded in tension in small increments until the wire ruptures, with out removal of the load each time and if each stress is plotted on a vertical coordinate and the corresponding strain in plotted on the horizontal coordinate a curve is obtained. 
Hook’s law: The stress in directly proportional to the strain in elastic deformation. 
Yield strength: The yield strength is the stress required to produce the particular offset chosen (plastic strain). 
Modulus of elasticity: If any stress value is equal to or less than the proportional limit is divided by its corresponding strain value, a constant of proportionality will result, this constant of proportionality is known as the modulus of elasticity or Young’s modulus. 
The maximal flexibility is defined as the strain that occurs when the material is stressed to its proportional limit. 
Resilience:  
Can be defined as the amount of Energy absorbed by a structure when it is stressed not to exceed its proportional limits. 
Permanent deformation: The stress strain curve is no longer a straight line above P (proportional limit) but rather curves until the structure fractures. The stress is no longer proportional to strain. If the load is removed at any point prior to fracture. The wire remains bent, stretched or otherwise deformed. 
Strength is the maximal stress required to fracture a structure. It is called tensile strength, compressive strength or shear strength. 
Fatigue: Cyclic loading at stress values well below those determined in ultimate strength measurement can produce about failure of a structure. This type of failure is called fatigue. 
Toughness:Toughness is the property of being difficult to break. It can be defined as the energy required to fracture a material. 
Brittleness:A brittle material is apt to fracture at or near its proportional limit. 
Ductility:The ability of a material to withstand permanent deformation under a tensile load without rupture. 
Malleability: The ability of a material to withstand permanent deformation without rupture under compression, as in hammering or rolling into sheet, is termed malleability. 
Hardness:Surface hardness is the result of the interaction of numerous properties. Among the properties that influence the hardness of a material is its strength, proportional limit, ductility, malleability and resistance to abrasion and cutting because numerous factors influence hardness, hence the term is difficult to define. 
Friction: The materials touching one another share a contact area. The resistance to movement tangent to this area, of one material to the other is known as friction. 

CLASSIFICATION OF ARCHWIRE 

According to material used According to cross-section 
1. Gold archwires 1. Round 
2. Stainless steel archwires 2. Rectangular 
3. Chrom-cobalt archwires 3. Rounded rectangular 
4. Nickel-Titanium archwires 4. Square 
a. Martensitic 5. Braided 
b. Austenitic 6. Stranded 
c. Superelastic 
d. Japans NiTi 
e. Chinese NiTi 
f. Beta titanium – TMA 
g. Alpha NiTi 
h. Reverse curve NiTi 
5. Copper NiTi 
6. Ceramic coated/optiflex archwires 
MECHANICAL PROPERTIES AND CLINICAL APPLICATION OF WIRES  

Optimum orthodontic tooth movement is produced by light, continuous force. It is particularly important that the light forces do not decrease rapidly decaying away either because the material itself loses its elasticity or because a small amount of tooth movement causes a larger change in the amount of force delivered. 
The basic properties of orthodontic materials 
• The elastic behavior of any material is defined in terms of its stress strain response to an external load.  
• Stress is the internal distribution of the load defined as force per unit area, whereas strain is the internal distortion produced by the load, defined as deflection per unit length.  
• Orthodontic archwires and springs can be considered as beam supported either only on one end or on both ends. 
• If a force is applied to such a beam its responses can be measured as the deflection produced by force. 
For orthodontic purpose three major properties of beam material are critical in defining their clinical usefulness i.e. strength, stiffness and range. 
Strength, Stiffness and Range 
• Stiffness and springiness are reciprocal properties springiness = 1/ stiffness 
• Each is proportional to the slope of the elastic portion of the force-deflection curve. The more vertical the slope the stiffer the wire. 
• Range is defined as the distance that the wire will bend elastically before permanent deformation occurs. If the wire is deflected beyond its yield strength, it will not return to its original shape but clinically useful spring back will occur unless the failure point is reached.  
These three major properties have an important relationship. 
Strength = Stiffness x Range 
Resilience  
• Represents the energy storage capacity of the wire, which is a combination of strength and springiness. 
• Formability is the amount of permanent deformation that a wire can withstand before failing.  
An ideal wire material for orthodontic purposes 
Should posses  
1) High strength  
2) Low stiffness  
3) High range  
4) High formability. 
The material should be weldable or solderable, so that hooks or stops can be attached to the wire. It should also be reasonable in cost.  
WIRE CHARACTERISTICS OF CLINICAL RELEVANCE 

Several characteristics of orthodontic wires are considered desirable for optimum performance during treatment. These include a large springback, low stiffness high formability, high stored energy, biocompatibility and capability to be welded or soldered to auxiliaries and attachments. 
1) Springback: This is also referred to as maximum elastic deflection, maximum flexibility, range, Springback is related to the ratio of yield strength to the modulus of elasticity of the material. Higher springback values provide the ability to apply large activations with a resultant increase in working time of the appliance. Springback is also a measure of how far a wire can be deflected without causing permanent deformation or exceeding the limits of material. 
2) Stiffness or load deflection rate: This is the force magnitude delivered by an appliance and is proportional to the modulus of elasticity. Low stiffness or load deflection rate provides: 
• The ability to apply lower forces 
• A more constant force over time as the appliance experiences deactivation. 
• Greater ease and accuracy in applying a given force. 
3) Formability: High formability provides the ability to bend a wire into desired configurations such as loops, coils and stops without fracturing the wire. 
4) Modulus of resilience of stored energy: This property represents the work available to move teeth. It is reflected by the area under the line describing elastic deformation of the wire. 
5) Biocompatibility and environmental stability: Biocompatibility includes resistance to corrosion and tissue tolerance to elements in the wire. Environmental stability ensures the maintenance of desirable properties of the wire for extended period of time after manufacture. 
6) Jointability: The ability to attach auxiliaries to orthodontic wires by welding or soldering provides an additional advantage when incorporating modification to the appliance. 
7) Friction: Space closure and canine retraction in continuous arch wire technique involves a relative motion of bracket over wire. Excessive amount of bracket/wire friction may result in loss of anchorage or binding accompanied by little or no tooth movement. The preferred wire material for moving a tooth relative to the wire would be one that produces the least amount of friction at the bracket wire interface. 
IDEAL ORTHODONTIC ALLOY 

The ideal orthodontic wire for an active member is one that gives a high maximal elastic load and low deflection rate. 
The mechanical properties that determines these characteristics are elastic limit and modulus of elasticity. The ratio between the elastic limit and modulus of elasticity determines the desirability of the alloy. The higher the ratio the better will be the spring properties of the wire. 
For an alloy to be markedly superior in spring properties. It must posses a significantly higher ratio. In the reactive member of an appliance a sufficiently high elastic limit is required and a high modulus of elasticity is also desirable. 
Four other properties of wire should be mentioned in evaluating an orthodontic wire. 
1) The alloy must have a reasonable resistance to corrosion caused by fluids of the mouth. 
2) It should have sufficient ductility so that it will not fracture under accidental loading in the mouth or during fabrication of an appliance. 
3) It is desirable to have a wire that can be fabricated in a soft state and later heat treated to a hard temper. 
4) A desirable alloy is one to which attachments can easily be soldered.
WIRE CROSS SECTION 

The most critical factor in the design of an orthodontic appliance is the cross section of the wire to be used. Small changes in cross section can dramatically influence both the maximal elastic load and load deflection rate. 
The maximal elastic load varies directly as the third power of the diameter of round wire, and the load deflection rate varies directly as the fourth power of the diameter. 
Hence for an active member the wire should be of a smaller diameter but with a safety factor so that permanent deformation doesn’t occur. 
This holds vice versa for rigid reactive members of the appliance. 
Flexible member: 
1) Multidirectional activation: 
 The optimal cross section for a flexible member for multidirectional activation in which the structural axis is bent in more than one plane, is a circular cross section (round wires).. 
 Disadvantage of round wires is if it is not properly oriented activation may not operate in the bracket and if certain loops are incorporated into the configuration, these can then roll into either the gingiva or the cheek. 
2) Unidirectional activation  
 Flat wire is the cross section of choice.  
 Advantages of flat wires:  
 Low deflection rate without permanent distortion because more energy can be absorbed into spring made of flat wire than of any other cross section. 
 Flat wire can be anchored into a tube or a bracket so that it will not spin during deactivation of a given spring. 
 Greater tooth movement is achieved 
 Reactive member: square or rectangular wire is preferred because of ease of orientation and multidirectional rigidity. 
Wire length 
• The length of a member may influence the maximum elastic load and the load deflection in a number of ways depending on the configuration and loading of the spring.  
Effects of length and attachment: 
• If the length of the beam is doubled. 
Cantilever type: 
• Strength: bending strength reduces to by ½ 
• Springiness: increases 8 times  
• Range: increases 4 times 
Supported beam: 
If a beam is rigidly attached, it is twice as strong and I/4 springy and ½ the range.  
Increasing the length of the cantilever reduces the load deflection rate, yet maximum elastic load is not radically altered. Since load deflection rate varies linearly with the length. Adding length with in the practical confines of the oral cavity is an excellent way to improving spring properties. 
The length of the wire can be increased by the addition of loops or helices in the wire. 
Direction of loading: 
If a straight piece of wire is bent so that permanent deformation occurs and an attempt is made to increase the magnitude of the bend, bending in the same direction as had originally been done, the wire is more resistant to permanent deformation than if an attempt had been made to bend in the opposite direction.  
When a wire is bend so that it permanently deforms and an increase in the bend is desirable it should be done in the original direction of bending and twisting (has the greatest elastic load). This is term as the Bauschinger effect. 
Hence the operator should be sure of the last bend made in the archwire is in the same direction as the bending produced during its activation. 
Prevention of fatigue failure: 
 Minute scratches or surface flaws leads to excess load in the metal around the defect leading to failure. 
 During arch designing: wire must not be marked or notched with a file or other sharp instruments. 
 Smooth beaked pliers to be used so that marking of the wires are avoided. 
 Sharp bends to be avoided: causes increase in the work hardening leads to failure. 
 Repeated bending at the same spot is to be avoided. 
 Adjustments to be made away from high stress areas and bends at soldered joints to be avoided.  
Work hardening or strain hardening: 
In polycrystalline metal, dislocations tend to build up at the grain boundaries. The barrier action to slip at the grain boundaries causes the slip to occur on the intersecting slip planes leading to point defects and the grain is distorted. 
Greater stress is required to produce further slip and the metal becomes stronger and harder, 
This is known as work hardening or strain hardening. 
Work softening or reverse straining or bauschinger effect: 
Wires straightened by the process of reverse straining which is the flexing in a direction opposite to that of the original bend the yield point decreases. 
This is known as work softening or reverse straining. 
Pulse straightening of the wire is carried out which permits even the wires with the highest tensile strength to be straightened without loss of yield strength. 
Pulse straightened wires are costly. 
GOLD WIRES 
• Precious metal alloy was used before 1950’s due to it stability in intraoral conditions. 
• In modern dentistry wrought gold alloy is used. Gold in its pure state is very soft, malleable and ductile. 
Composition:  
• ADA specification no.7 for gold wires. 
Type I: High precious metal alloy containing atleast 75% of Au and Pt. 
Type II: low precious metal alloys containing atleast 65% of Au and Pt. 
• Basic composition: Au, Pt, Pd, Ag, Cu, Ni and Zn. 
• Gold alloys work harden much more slowly and to a lesser degree than steel. 
• Hence lesser intermediate anneals are required to the orthodontist.  
Nowadays usage is reduced due to alloy being soft for orthodontic appliances, high cost and low yield strength.  
Chrom cobalt nickel alloy - archwires 
 Cobalt-chromium-nickel alloys drawn into wire were first marketed for use in orthodontic appliances during the 1950s and these were originally developed for use as watch springs (Elgiloy). 
 They are available commercially as Elgiloy, Rocky mountain orthodontics, Azura and multiphase. 
 Composition:  
Cobalt : 40% Manganese : 2% 
Chromium : 20% Carbon : 0.5 % 
Nickel : 15% Beryllium : 0.4% 
Molybdenum : 7% Iron : 1.5% 
 They are heat treated before being supplied to the user and are available in several degrees of hardness: soft, ductile, semi resilient and resilient. 
 Heat treatment: increases yield strength and decreases ductility. 
 The wires are colour-coded for the clinicians convenience as follows: 
 Soft – Blue  
 Ductile – Yellow  
 Semiresilient – Green  
 Resilient – Red  
 The most widely used is the soft temper (Elgiloy Blue) which is easily manipulated and is then heat treated to achieve increased resiliency. Clinicians can easily perform heat treatment using an electrical resistance welding apparatus and a special paste provided by the manufacturer to indicate the optimum period of time. Alternatively, furnace heat treatment at approximately 4800C for 7 to 12 min can be employed. 
Physical properties: 
1) Tarnish and corrosion resistance is excellent. 
2) Hardness, yield strength and tensile strength is comparable to 18-8 stainless steel. 
3) Ductility : Greater in soft compared to 18- 8. 
Lesser in hardened condition. 
Mechanical properties: 
1) Greater resistance to fatigue and distortion 
2) Non heat treated co-cr wire have smaller spring back than stainless steel wires of comparable size. 
3) The mechanical properties of co-cr wires are very similar to those of stainless steel wires.  
4) The high modulus of elasticity of co-cr: deliver twice the force of Beta Titanium wires and four times the force of Nitinol wires for equal amount of activation. 
5) Therefore, this would lead to faster rate of mesial movement of posterior teeth: therefore increase on intra and extraoral anchorage. 
6) Co-cr wires have good formability and can be bent into many configurations relatively easily.  
7) Care to taken during soldering attachments since high temperature cause annealing with loss in yield and tensile strength (Low fusing solder is recommended). 
8) Resistance to tooth movement in relation to frictional forces between brackets and co-cr wires is comparable to stainless steel wires.  
RECENT ADVANCES: 

1) G & H Wire company: 
Nickel cobalt wires can be heat treated in bent areas and easily soldered without annealing. They have good ductility and strength, highly flexible and resistant to fatigue and corrosion. The wire also offers reduced bracket friction and greater spring efficiency than typical stainless steel wires. 
2) Masal orthodontics, inc. 
Heat-treatable blue Masiloy chrome cobalt Arches can accept sharp, intricate bends with out breaking. Heat treatment increases the resiliency by 20 percent. 

STAINLESS STEEL WIRES 
 Steels are iron based alloys that contain less than 1.2 percent carbon.  
 When approximate 12 percent to 30 percent chromium is added to iron the alloy is commonly called stainless steel. 
 Pure iron at room temperature has a body centered cubic (BCC) structure called as ferrite. This phase is stable upto 9120C (16740F). 
 At temperatures between 9120C and 13940C the stable form of iron is a face centered cubic, structure called austenite.  
 If the austenitic alloy is cooled very rapidly it will undergo a spontaneous, diffusionless transformation to a body centered tetra gonal (BCT) structure called ‘Martensite’. This lattice is highly distorted and strained, resulting in a very hard, strong, brittle alloy. 
Austentic alloy:  
On slow cooling from high temperature, the excess carbon forms iron carbide. This hard brittle phase adds strength to the relatively soft and ductile ferrite and austenitic forms of iron.  
Therefore, there are three types of stainless steels, on the basis of lattice arrangement of iron: 
1) Ferritic stainless steel: 
a) Provides good corrosion resistance 
b) Low cost 
c) Has less strength  
d) Not hardenable by heat treatment 
e) Not readily work hardenable 
Hence, finds little application in dentistry.  
2) Martensitic stainless steel: 
a) High strength 
b) Can be heat treated 
c) Decrease corrosion resistance 
d) Decrease ductility  
Used for surgical and cutting instruments. 
3) Austenitic stainless steel: 
a) Most corrosion resistant of the stainless steel. 
b) Composition: 
Chromium – 18% 
Nickel – 8% 
Carbon – 0.15% 
AISI 302 is the basic type. Type 304 has similar composition the chief difference is in the carbon content which is limited to 0.08%. This is the most commonly used type.  
Austenitic stainless steel is preferable to the ferritic alloys because of: 
1) Greater ductility and ability to undergo more cold work without breaking. 
2) Substantial strengthening during cold working. 
3) Greater ease of welding 
4) The ability to fairly readily overcome sensitization 
5) Comparative ease in forming.  
Disadvantages: 
Annealing temperatures: In the soldering and welding temperature ranges hence, low fusing silver solders are recommended for soldering purpose. 
Clinical implication: 
• Cold working and carbon interstitial hardening leads to high yield strength, high modulus of elasticity and hardness. 
• Residual stresses present in the wire due to bending need to be eliminated hence heat treatment essential for stress relief. After bending the wire into arch, loops or coils heat treatment is carried out. 
• Funk has suggested that straw coloured wire indicates that optimum heat treatment has been achieved. 
• High stiffness of stainless steel wires leads to usage of smaller diameter of wire. 
• The yield strength to elastic modulus ratio indicates decreased spring back of stainless steel compared to newer titanium alloys.  
• Therefore, stainless steel wires produce higher forces that dissipate over shorter periods than nitinol wires, thus requiring more frequent activation or arch wire changes. 
• Lower levels of friction between bracket- wire: offers lower resistance to tooth movement than other orthodontic alloys. 
Intergranular corrosion of stainless steel 
Carbon is an undesirable impurity in austenitic stainless steel, but it is difficult to remove it completely. Carbon does not enter into the physical structure of these steels except in the formation of a small amount of martensite in cold-working, but at temperatures between 8000 and 12000 F it starts a chain of corrosion which can result in actual physical failure of the metal. At these temperatures carbon reacts with chromium to form chromium carbide. This reaction is called sensitization. A temperature above the 12000 F range chromium carbide breaks up into the component elements. Below sensitizing temperatures, the reaction between carbon and chromium cannot take place, thus at either higher or lower temperature, the reaction between carbon and chromium cannot take place, the metal is safe from sensitization. 
Chromium carbide is harmless in itself but chromium tied up as the carbide cannot contribute to the corrosion resistance in the metal. 
Prevention of intergranular corrosion 
This is the most important problem in manipulating stainless steel at high temperature. This can be prevented by: 
1) Keeping out of the sensitizing temperature range (8000 to 12000 F) 
2) Controlling the carbon content. 
Controlling temperature to prevent intergranular corrosion:  
Speed in handling the metals in the sensitizing temperature range, as during soldering can be very effective means of minimizing sensitization. 
Stainless steel should always be quenched immediately after soldering to bring it down to a safe temperature as rapidly as possible. 
If the metal is cooled rapidly from annealing to room temperature, there is no opportunity for chromium carbide to form. 
With the usage of a low temperature silver solder the objective is to heat to soldering temperature, solder, and then quench as quickly as possible. 
High temperature solder also can be used, but only if the entire piece of steel can be heated to this high temperature. The metal is then above the sensitizing range while it is being soldered, and thus it is perfectly safe. It is a must that it be quenched immediately after soldering. 
Stabilization to prevent intergranular corrosion: 
The second possibility for control of intergranular corrosion is not making carbon available for the sensitizing reaction. 
This is done at the time that the alloy is manufactured, either by keeping the carbon content exceptionally low or by adding other metals which tie up in other compounds. These compounds include niobium or titanium plus tantalum which form carbide precipitates in preference to chromium. Stainless steel that have been treated in this manner are said to be stabilized. Columbium and titanium are commonly used for this purpose.  
Triple stranded stainless steel arch wire: 
• Beside single standard round, square and rectangular wires there are now multistandard wires of varying size, shape and number are available. 
• The separate strands may be as small as 0.178 mm. 
• Significance:  
o These wires sustain large elastic deflection in bending. 
o These wires apply low forces for a given deflection compared to solid stainless steel wires.  
Theory for the general multistranded arch wires: 
Classic mechanical theory shows that as the diameter of a wire strand is reduced, the stiffness decreased as a function of the fourth power, and the range increased proportionally. 
To improve the strength and at the same time to maintain the desirable stiffness and range properties many small wires are twisted together and even swagged or spot welded. The result is an inherently high elastic modulus material behaving as a low – stiffness member because of its co-axial spring like nature.  
These wires deliver higher forces per unit of activation over a greater distance. 
AUSTRALIAN HEAT TREATED ARCH WIRES 
One of the outstanding properties or characteristics of the Australian wire is its resilience or ability to spring back after having been deflected. 
Variations in the types of wires is made by fluctuations in the rate at which the wire passes the heat source. 
Australian wires are available in the following forms 
Color code 
1) Regular grade White 
2) Regular plus grade Green  
3) Special grade Black 
4) Special plus Orange 
5) Extra special plus Blue  
6) Supreme Blue 
Regular grade: 
Lowest grade and easiest to bend . It is used for practice or forming auxiliaries. It can be used for arch wires when distortion and bite opening is not a problem. 
Regular plus grade: 
• Relatively easy to form, yet more resilient than regular grade.  
• Used for auxiliaries and arch wires when more pressure and resistance to deformation is desired.  
• Available in sizes 0.014”, 0.016”, 0.018”, 0.020”. 
Special grade: 
• Highly resilient yet can be formed into intricate shapes with little danger of breakage.  
• The 0.016” is often used for starting arches in many techniques. 
• Available in sizes 0.014”, 0.016” 0.018” and 0.020”. 
Special plus grade: 
• Special plus wire is routinely used by experienced operators.  
• Hardness and resiliency of 0.016” size are excellent for supporting anchorage and reducing deep overbites.  
• Wire must be bent with care. 
• Available in sizes 0.014”, 0.016”, 0.018” 0.020” and 0.022”. 
Extra special pulse grade 
• This grade is unequaled in resilience.  
• It is more difficult to bend and more subject to fracture. However many orthodontists feel that the ability of this wire to move teeth, open deep overbites and resist deformation far outweighs the inconvenience caused by an occasional breakage while bending.  
• This wire can be easily broken it not bend properly, there is no margin for bending errors. 
• Available in size of 0.016” only. 
Supreme grade: 
• This wire is also referred to as premium plus in Australia.  
• Primarily used only in treatment of rotations, alignment and leveling.  
• Though supreme grade exceeds the yield strength of extra special plus it is intended for use in either short sections or full arches where sharp bends are not required.  
• Available in 0.010”, 0.012” and 0.016”.  
Newer grades of Australian wires 
• During the last two decades, 3 more grades have been introduced namely Premium, Premium Plus and Supreme (P, P+ and S) in an order of increasing yield strength. 
• Increase in the yield strength: by work hardening and material with the appropriate composition and properties. 
Properties: 
• Have a greater springback property due to increase yield strength. 
• Resiliency: Shows greater resiliency thereby greater resistance to permanent deformation.  
• These wires have the ability to deliver over long periods a constant force when subjected to an external load. 
• Formability: Greater resiliency leads to lesser formability and therefore they are more brittle than lower grade wires.  
Clinical usage of newer grades: 
1) High load deflections rate required 
a) Relatively larger forces in stage I: 0.016” OR 0.018” PREMIUM OR PREMIUM PLUS WIRES INDICATED. 
b) Relatively large resistance to deformation required i.e. for maintenance of the arch form 0.018” P and P+ OR 0.020” P indicated. 
2) Low load deflection rate is required 
a) Generating smaller forces (alignment). 0.014”P or Special plus wire is used or sectionals in 0.012” P+ wires can be used. 
b) High springback and resiliency (root torquing and uprighting) 
c) 0.012” Premium Plus or smaller diameter Supreme wires can be used.  
Wire size: they are available as follows. 
Premium : .008”, .009”, .010”, .011”, .012”, .014”, .016”,.018” ,.020” 
Premium plus: .008”, .009”, .010”, .011”, .012”, .014”, .016”,.018”  
Supreme : .008”, .009”, .010”, .011” . 
Due to extreme hardness of A. J. Wilcock Australian wire special attention must be given to bend it successfully. 
a. Pre-warm the wire by sliding between the thumb and forefinger. Do not attempt to straighten the wire by stripping betweens the plier breaks. 
b. Hold pliers very lightly when bending the wire. Do not squeeze or pull the wire. Pliers must have smooth breaks, carbide tips are not recommended. 
c. Bend the wire very slowly pressing with the thumb or fore finger, do not rotate the pliers while bending loops and circles should be formed against the square beak and beaks should be apart slightly.  
d. Never pinch the wire with the pliers before or during bending. 
e. Do not scratch the wire to locate bends. 
Australian wire becomes hard from bending hence there is no need for heat treating and no margin to permit back bending to correct mistakes.  
They are difficult to bend and they are stiffer than stainless steel wires even after months in the oral cavity.  
NICKEL TITANIUM ALLOY 
Nitinol was invented in the early 1960’s by William F. Buehler, a research metallurgist at the Naval ordinance. 
Nitinol: Ni for Nitinol and Ti for titanium and nol for Naval ordanance laboratory.  
Composition: 
Nickel – 54% 
Titanium – 44%  
Cobalt – 02%  
• The wire has low stiffness in combination with moderately high strength which leads to large elastic deflection or working range. 
• The alloy has limited formability. 
• Alloy can exist in various crystallographic forms. At high temperature body centered cubic lattice (BCC) referred to as the austenitic phase. 
• Appropriate cooling induces transformation to a close packed hexagonal martensitic lattice. 
• This transition can also be induced by stress. 
• Austenitic NiTi is the high-termperature, low stress form, and martensitic NiTi is the low-temperature, high stress form. 
• Transformation occurs by a twinning process, which is reversible below the elastic limit. 
• This transition leads to two potential properties shape memory, and super elasticity or pseudoelasticity.  
Shape memory: 
• Shape memory refers to the ability of the material to ‘remember’ its original shape after being plastically deformed while in the martensitic form.  
• Hence wire is set into the desired shape and held while undergoing a high temperature heat treatment near 4820C.  
• Then cooled and formed into a second shape.  
• Subsequent heating through a lower transition temperature i.e. near mouth temperature leads to returning of the wire to its original shape.  
• Inducing the austenitic to martensitic transition by stress can produce superelasticity a phenomenon – NiTi wires. On a stress sufficient to induce the phase transformation there is a significant increase in strength referred to as superelasticity which occurs due to a volumetric change in crystal structure. 
• At the completion of the phase transformation, behavior reverts to conventional elastic and plastic strain with increasing stress. 
• Unloading results in reverse transition and recovery.  
• Therefore, NiTi alloy can be produced with either austenitic or martenstic structure with varying degrees of cold work and variations in transition temperature. 
• NiTi has low modulus value and larger working range. Less formability and can neither soldered nor welded. 
• Crimpable hooks and stops like clinchback distal to molar buccal tube is recommended. Clinchback is performed by flame annealing which leads to making the wire dead soft and it can be bent into the preferred configuration. 
• Dark blue colour indicates the desired annealing temperature.  
Clinical application: 
• High springback, flexibility, low constant forces ,shape memory and elasticity are the important and advantageous properties for clinical applications of NiTi. 
• Frictional forces are higher than stainless steel and lower than those with beta-titanium. 
Uses: 
1) Crossbite correction 
2) Uprightening impacted canines 
3) Opening the bites  
The primary criteria is the amount of malalignment of the teeth from the ideal arch from. Greater malpositions results in Niti wires being advantages over stainless steel 
Problems encountered in Nickel titanium arch wires 
1) The difficulty of placing bends, steps and stops in the majority of the wires. 
2) Brittleness and breakage of the wire especially when subjected to biting force. 
3) Tendency of archwire to slide from side to side sometimes causing them to stick out beyond a terminal molar. Annealing the ends to allow bending appeared to be an unsatisfactory solution to the last problem because the ends often frayed or broke. 
4) Not self limiting – frequent visits necessary. 
5) High cost.
BETA – TITANIUM ALLOY 
In 1960 a high temperature form of titanium alloy which above 16250F rearranges into a body centered cubic lattice, referred to as the beta phase, with the addition of elements as molybdenum or columbium was developed. These titanium based alloys are referred to as beta-stabilized titanium. 
Composition: 
Titanium – 79% 
Molybdenum – 11% 
Zirconium – 06%  
Tin – 04% 
Mechanical properties:  
• Has low modulus of elasticity therefore lighter forces with large deflections. 
• Modulus of elasticity of beta-titanium is approximately twice that of nitinol and less then one half that of stainless steel.  
• Greater spring back property and good formability due to their ability to be highly cold worked and because of the BCC structure of the beta phase. 
• Heat treatment is not recommended for the current orthodontic beta titanium wires. 
• Has good corrosion resistance it can be joined by welding.  
Clinical application: 
• Deflection approximately twice of stainless steel therefore greater range of action for either initial tooth alignment or finishing arches. 
• Beta-titanium is ductile hence loops and complicated bends can be given  
• Gentle delivery of forces with edgewise wire.  
• Larger activation is possible due to low forces produced. 
• Beta-titanium has higher co-efficient a friction due to the increase surface roughness as compared to stainless steel and Elgiloy wires.  
• Nitrogen ion – implantation techniques employed by the manufacturer has lead to decrease in the bracket section for beta titanium orthodontic wire. 
CHINESE NiTi ARCHWIRE 
A new nickel-titanium alloy was developed specially for orthodontic applications by Dr. Tien Hua Cheng and associates. Its parent phase is austenite and work hardening yield mechanical properties that differ significantly from Nitinol wire. 
Mechanical properties: 
1) Chinese NiTi wire has 1.4 times the springback of nitinol wire and 4.6 times the springback to stainless steel wire for 800 of activation, at 400 of activation NiTi wire has 1.6 times the springback of Nitinol wire. 
2) Stiffness – At 800 of activation of the average stiffness, Chinese NiTi wire is 73% that of stainless steel wire and 36% that of nitinol wire.  
Temperature: 
The Chinese NiTi wire have much load transition temperature than Nitinol wire. The stiffness is approximately the same between room temperature at 220C and mouth temperature at 370C. At a temperature at 600C, the loading curve is slightly higher and the unloading curve loses its ‘S’ shape and exhibits greater permanent deformation and less springback. 
Time dependent effects: 
Although NiTi wires show some time – dependent effects, these are insignificant at room temperature.  
Clinical significance: 
• Indicated were large deflections are required. 
• Straight wire procedures with extensive malalignment of teeth.  
• Appliances designed to deliver constant forces during major stages of tooth movement. 
JAPANESE NiTi ARCHWIRES 
In 1978, Furukawa Electric Co. Ltd. produced a new type of the Japanese NiTi alloys, possessing all three properties. 
• Excellent springback 
• Shape memory 
• Super elasticity  
Mechanical properties: 
Shape memory is the phenomenon occurring in the alloy that is soft and readily amenable to change in shape at a low temperature, but it can easily be reformed to its original configuration when it is heated to a suitable transition temperature. 
Superelastic property:  
When the strain was increased from 2% to 8% there was an increase in the stress values.  
When the strain is reduced 8% to 2% the stress did not reduce proportionally as compared to stainless steel and nitinol wires. 
There exists no permanent strain when the stress reaches zero. 
This is called as superelastic property  
Heat treatment: 200 degrees C–300 degrees C no significant change was observed in the mechanical properties of wire but at 500 degrees C treated for 120 minutes wire had a superelastic portion of approx 50 g load along with the gradual removal of the load.  
Clinical applications: 
Superelasticity properties are to be used as an advantage to enhance the efficiency of the multibracketed technique.  
ALPHA TITANIUM ARCH WIRE 
It is the recent alloy in the family o titanium alloy. 
Composition: 
Titanium – 90% 
Aluminum – 6% 
Vanadium – 4% 
• Molecular structure is the alpha phase with a closely packed hexagonal lattice.  
• It possesses fewer slip planes thereby this wire is difficult to deform. Hence it is less ductile than beta-titanium.  
Clinical significance: 
1) Rectangular wires in the sizes of 0.022” x 0.018” (ribbon mode) or 0.020” x 0.020” (square) are recommended by Mollenhauer for the finishing stage. 
2) Alpha titanium combination wire with an anterior ribbon (0.022” x 0.018”) and posterior round (0.018”) sections in second stage of Begg treatment. 
COPPER – NiTi ARCHWIRE 
It was introduced by Rohit Sachdeva and Suhio Mriyasaki in 1994. 
Composition: 
wt % Atomic wt % 
Titanium 42.99 48.08 
Nickel 49.87 45.39 
Chromium 0.50 0.96 
Copper 5.64 5.57  
Properties: 
1) Copper NiTi generates a more constant force over long activation spans and very small activations as compared to nickel titanium alloys. 
2) Copper NiTi more resistant to permanent deformation compared to nickel titanium alloys. 
3) Exhibits better spring back characteristics. 
4) Exhibits a smaller drop in unloading force. 
5) The addition of copper combined with more sophisticated manufacturing and thermal processes make possible the fabrication of four different copper NiTi archwires with precise and consistent transformation temperatures 150C, 270C, 380C and 400C. This enables the clinician to select archwires on a case-specific basis. 
Load deflection characteristics: 
• In comparison to the superelastic NiTi wires the cu-NiTi wires shows a significant lower hysteresis which can be clearly seen in the load deflection curves. 
• Unloading forces more closely approximate loading forces which means that the wire delivers more constant forces especially for small activations compared to superelastic wires. 
• It makes possible the insertion of larger size wires, and better bracket slot engagement early in treatment without causing pain and patient discomfort.  
Classification: 
Depending on austenitic finish temperatures they are classified into. 
Type I Af = 150C 
Type II Af = 270C 
Type III Af = 350C 
Type IV Af = 400C 
Variable transformation temperature thermo-mechanics: 
• One of the most important markers is the material’s austenitic finish temperature.  
• To exploit superelasticity to its fullest potential, the working temperature of the orthodontic appliance should be greater than the Af temperature. 
• It is the differential between the Af temperature and mouth temperature that determines the force generated by nickel titanium alloys.  
Type I is not used for clinical applications due to the high force level. 
Type II produces the highest force and is indicated in normal patients. 
Type III is indicated in patients with a low to normal threshold of pain, and also in periodontally compromised patients. 
Type IV produces the lowest level of force and are good in patients highly sensitive to pain and are periodontally compromised. 
A simple clinical trick is to apply ice to a section of the arch wire and it can be nudged into the bracket easily.  
CERAMIC ARCH WIRES 
Optiflex archwire: 
Optiflex is a recent new orthodontic archwire designed by Tallas. It combines unique mechanical properties with a highly esthetic appearance. It is made of clear optical fiber, it comprises of three layers. 
1) A silicon dioxide core that provides the force for moving teeth. 
2) A silicone resin middle layer that protects the core from moisture and adds strength. 
3) A strain resistant nylon outer layer that prevents damage to the wire and further increases its strength. 
Properties: 
• Shape: Round or Rectangular  
• Has wide range of action  
• Ability to apply light continuous forces 
Clinical application: 
• Sharp bends to be avoided 
• It is a highly resilient archwire that is especially effective in the alignment of crowded teeth.  
• Lee White Wire is tooth coloured, epoxy-coated archwire that has superior wear resistance and stability of six to eight weeks. 
• A unique heat treatment bakes on the epoxy coating and makes it possible to offer a wide variety of sizes. 
• The preformed wires are designed in a natural archform.




Introduction
Orthodontic tooth movement is carried out, by engaging successively increasing sizes of archwires in brackets, which are bonded to the teeth. Traditionally, brackets as well as archwires were manufactured with Stainless steel or Chrome-Cobalt alloy. Titanium and its alloys have also found their application in this field. With the steady increase in the number of adults undergoing orthodontic treatment, there has been a corresponding increase in demand for more aesthetic orthodontic appliances. Ceramics and polycarbonates have been used to produce tooth colored brackets, and research is under way to produce a suitable archwire material, which will combine aesthetics with the required mechanical properties.
Desirable tooth movement can best be achieved by producing an optimal force system, which has the following biomechanical characteristics: Moderate to low force magnitude, which will allow rapid and relatively painless tooth movement, with minimal tissue damage. Constant force level over time, as the appliance experiences de-activation, in order to provide maximum tissue response and the ability of the appliance to undergo large deflections without deformation.
Historically, the force magnitude applied to teeth has been controlled, by varying the cross-section of the wire used in the appliance. Small wires have been used to achieve large deflections while applying low forces on the teeth. On the other hand, larger wires that fit well into the bracket slots have been used to carry out precise and controlled tooth movement.
Teflon coated stainless steel arch wires
Teflon coating imparts to the wire a hue which is similar to that of natural teeth. The coating is applied by an atomic process that forms a layer of about 20-25μm thickness on the wire. This layer then undergoes a heating process and acquires a surface with excellent sliding properties and substrate adhesion14. Materials used for wire coating should fulfill the requirements of being easily applied in thin layers, resistant and having a low friction coefficient. They should also be biocompatible, pleasantly aesthetic and consistent with the translucency of aesthetic brackets and the different hues of the teeth17. Manufacturers of orthodontic materials are currently investing in the search for the ideal wire coating, one that would combine aesthetics and mechanical efficiency. The different types of coatings can change some wire properties, such as friction. It should also be noted that Teflon coating protects the underlying wire from the corrosion process. However, since this coating is subject to flaws that may occur during clinical use, corrosion of the underlying wire is likely to take place after its prolonged use in the oral cavity.
Titanium –Niobium Wires
A new ‘finishing wire’ made from a nickel free Titanium – Niobium alloy (Ti-Nb) was introduced.  According to manufacturer’s product information, Ti- Nb is soft and easy to form, yet it has the same working range of stainless steel.  Its stiffness is 20% lower than TMA and 70% lower than stainless steel. Ti-Nb wire has a larger plastic range, similar activation and deactivation curves and relatively low spring back. Bending stiffness corresponding to 48% lower than that of stainless steel and a spring back 14% lower than that of stainless steel. The clinician can easily make creative bends and avoid excessive force levels of a steel wire. The stiffness of Ti-Nb in torsion is only 36% of steel, yet the springback of Ti-Nb in torsional mode is slightly higher than stainless steel , this property makes it possible to utilize the Ti-Nb wire for even the major third order corrections.
Timolium Titanium  Wire
Timolium archwires combine the flexibility, continuous force and springback of nickel titanium with the high stiffness and bendability of stainless steel wire. When compared to Nickel Titanium or Beta Titanium wire, Timolium outperforms in the following: More resistant to breakage, smoother for reduced friction, brightly polished and aesthetically pleasing, Nickel free for sensitive patients, Easier to bend and shape, Can be welded.
Loops and bends can be made without breakage. Timolium wire is excellent for all phases of treatment. During initial treatment, it is excellent for space closure, tooth alignment, leveling and bite opening. Early torque control can begin during intermediate treatment because of the moderate forces delivered. Total control during detailing makes Timolium the wire of choice during the final treatment phase.
Bioforce Wires
It is possible to produce variation in arch wire force delivery between archwires of identical dimension by specifying transition temperatures within given ranges. These are graded thermodynamic arch wires. The manufacturers have taken this process are step further, by introducing variable transition temperatures within the same archwire.  BioForce is aesthetic and is part of the first and only family of biologically correct archwires. The NiTi Bioforce wires apply low, gentle forces to the anteriors and increasingly stronger forces across the posteriors until plateauing at the molars. “Bioforce archwires’ are one arch wires introduced by GAC.  Beginning at approximately 100 grams and increasing to approximately 300 grams, Bioforce provides the right force to each tooth, reducing the number of wire changes and providing greater patient comfort. The level of force applied is therefore graded throughout the arch length according to tooth size.
Super-Cable
In 1993, Hanson combined the mechanical advantages of multistranded cables with the material properties of superelastic wires to create a superelastic nickel titanium coaxial wire. This wire, calledSupercable, comprises seven individual strands that are woven together in a long, gentle spiral to maximize flexibility and minimize force delivery. JCO 1998 ,BY- JEFF BERGER
Supercable wires 0.016″ and 0.018″ were the only ones that tested at less than 100g of unloading force over a deflection range of 1-3mm. Supercable thus demonstrates optimum orthodontic forces for the periodontium, as described by Reitan and Rygh.
Relatively large archwire like 0.18” can be placed at the starting of treatment. When cutting Supercable, always use a sharp distal end cutter (No. 619). A dull cutter tends to tear the component wires and thus unravel the wire ends.
Advantages
•         Improved treatment efficiency.
•          Simplified mechanotherapy.
•          Elimination of archwire bending.
•          Flexibility and ease of engagement regardless of crowding.
•          No evidence of anchorage loss.
•         A light, continuous level of force, preventing any adverse response of the supporting periodontium.
•          Minimal patient discomfort after initial archwire placement.
•          Fewer patient visits, due to longer archwire activation.
Disadvantages
•         Tendency of wire ends to fray if not cut with sharp instruments.
•          Tendency of archwires to break and unravel in extraction spaces
•          Inability to accommodate bends, steps, or helices.
•          Tendency of wire ends to migrate distally and occasionally irritate soft tissues as severely crowded or displaced teeth begin to align.
Optiflex
Optiflex is a non metallic orthodontic arch wire designed by Dr. Talass and manufactured by Ormco.  It has got unique mechanical properties with a highly aesthetic appearance made of clear optical fiber. It comprises of 3 layers.
1)      A silicon dioxide core that provides the force for moving tooth.
2)      A silicon resin middle layer that protects the core form moisture and adds strength.
3)      A strain resistant nylon outer layer that prevents damage to the wire and further increases strength.
Advantages:
1)      It the most aesthetic orthodontic archwire.
2)      It is completely stain resistant, and will not stain or loose its clear look even after several weeks in mouth.
3)      Its effective in moving teeth using light continuous force
4)      Optiflex is very flexible , it has an extremely wide range of actions, when indicated it can be tied with electrometric ligatures to severely malaligned teeth without fear of fracturing the arch wire.
5)      Due to superior properties optiflex can be used with any bracket system
Precaution’s while using optiflex archwires :
1)      Optiflex archwires should be tied into brackets with elastomeric ligatures.  Metal ligatures should never be used since they will fracture the glass core.
2)      Sharp bends similar to those placed in a metal wire should never be attempted with optiflex, as these bends will immediately fracture the glass core.
3)      Using instruments with sharp edges, like the scalers etc should be avoided instead a gentle finger pressure is used to insert the archwire into the slot.
4)      To cut the end of the archwire distal to the molar, it is recommended to the use the mini distal end cutter which is designed to cut all 3 layer’s of optiflex.
5)      Optiflex should not be cinched back as a cinch back is actually not needed since friction between elastomeric ligature and the outer surface of the archwire will eliminate unwanted sliding of the archwire.
Optiflex and clinical applications:
1)      It is used in adult patients who wish that their braces not be really visible for reasons related to personal concern’s or professional consideration.
2)      Can be used as initial archwire in cases with moderate amounts of crowding in one or both arches.
3)      It should be used in cases to be treated without bicuspid extraction.  Opti-flex is not an ideal archwire for major bicuspid retraction.
4)      Optiflex can be used in presurgical stage in cases which require orthognathic intervention as a part of the treatment.  Optiflex is available in a pack of ten 6 inch straight length wires of .017” and  .021” sizes.
Marsenol
Marsenol is a tooth coloured nickel titanium wire . It is an elastomeric poly tetra fluroethyl emulsion(ETE) coated nickel titanium.  It exhibits all the same working characteristics of an uncoated super elastic Nickel titanium wire.  The coating adheres, to wire and remains flexible.  The wire delivers constant force on long periods of activation and is fracture resistant.
Lee White Wire
Manufactured by LEE pharmaceutical is a resistant stainless steel or Nickel titanium archwire bonded to a tooth colored epoxy coating. Suitable for use with ceramic and plastic brackets. The epoxy coating is completely opaque does not chip, peel, scratch or discolor.
Composite Wires
Manufacturing the composite wire in the photo pultrusion prorcess, fibres are drawn into a chamber where they are uniformly spread, tensioned and coated with the monomer.  The wetted surfaces are then reconstituted into a profile of specific dimensions via a die from which they then exit into a curing chamber.
As photons of light (ultra violet) polymerize the structure quickly into a composite the morphological features of the vertical processes are revealed. Fibers preferentially reinforce the periphery of the profile and any shrinkage voids are replenished by gravity.  If these are the final dimensions of the desired profile, the cure is completed, and the material is taken up on a large spool.  If further shaping of size of the profile of the wire the composite is only partially cured, and this is further processed using a second die and staged into the final form.
In the photo pultrusion process these last 2 stages represent the difference between fabricating circular V/S rectangular profiles, respectively or straight V/S preformed profiles respectively.  This system was used to form silicate glass fiber reinforced composites with varying degrees of conversion, by photo pultruding over a range of pulling speeds.
Composites with matrix solubility’s above 10 wt % could be swaged after photopultrusion to change the cross section from circular to rectangular before thermal processing. Circular /  rectangular cross section may be varied during manufacturing without any change in wire slot engagement by pultrusion, in which the relative proportions of the fibers and matrix materials are adjusted approximately and cured by electromagnetic radiation. Comparison of composite wire in bending mechanical tests show that wires are elastic until failure occurs. Moreover, when failure finally does occur, the wire loses its stiffness, but it remains intact.
Combined Wires
The key to success in a multi attachment straight wire system is to have the ability to use light tipping movements in combination with rigid translation and to be able to vary the location of either, at any time the need arises during treatment.
They used three specific combined wires for the technique; Dual Flex-l, Dual Flex-2, and Dual Flex-3 (Lancer Orthodontics). The Dual Flex-1 consists of a front section made of 0.016-inch round Titanal and a posterior section made of 0.016-inch round steel. The flexible front part easily aligns the anterior teeth and the rigid posterior part maintains the anchorage and molar control by means of the “V” bend, mesial to the molars. It is used at the beginning of treatment.
The Dual Flex-2 consists of a flexible front segment composed of an 0.016 ´ 0.022-inch rectangular Titanal and a rigid posterior segment of round 0.018-inch steel. The Dual Flex-3, however, consists of a flexible front part of an 0.017 ´ 0.025-inch Titanal rectangular wire and a posterior part of
0.018 square steel wire. The Dual Flex-2 and 3 wires establish anterior anchorage and control molar rotation during the closure of posterior spaces. They also initiate the anterior torque.  All wires have elastic hooks.
Organic Polymer Wire(QCM)
Organic polymer retainer wire made from 1.6mm diameter round polytheline terephthalate. This material can be bent with a plier, but will return to its original shape if it is not heat–treated for a few seconds at temperature less than 230°C(melting point). In prefabricating the QCM retainer wires, the anterior portion of the wire and the “wave” portion are heat-treated at about 150°C immediately after bending. Patients who have worn aesthetic ceramic or plastic brackets during orthodontic treatment are likely to want aesthetic retainers after treatment, so these wires are used for aesthetic maxillary retainers. Wire after heat-treated it displayed little deformation. More shrinkage during heating was observed in the posterior segment of the arch wire.
New Version of Aesthetic Retainer (QMC)
The New aesthetics organic polymer is easy to fabricate and fit to the  dental arch.
It consists :
-  Anterior plastic part
- A flat organic polymer wire with 10° labial torque is attached to 0.032” stainless steel posterior arms, each 11cm long. Plastic portion comes in three intercanine widths, with or without activating omega loops in the posterior arms.
There have been efforts to produce aesthetic orthodontic wires to complement the ceramic brackets. A transparent non metallic orthodontic archwire with a silica core, a silicon resin middle layer, and a stain resistant outer layer (Optiflex, Ormco) was described by Tallas .  Although the brittle core prevents the placement of sharp bends by the orthodontist this composite wire is highly resilient
Future of orthodontic wires
Kusy reported that a fluorocarbon-coated, white colored, tripe stranded stainless steel wire (Eastman Dental, NJ , USA) does not withstand the mechanical forces and enzyme activity in the oral environment.
Kusy and his colleagues have developed an archwire containing S2 glass fibers (Owens Corning, Toledo O.H, USA) embedded in a polymeric matrix formed from Bis-GMA and TEGDMA, benzoin ethyl ether is present as a UV (Photoinitiator) .  By adjusting the ceramic / polymer properties , these wires can be manufactured in a wide range of clinically relevant levels of elastic stiffness, using the technique of photopultrusion with ultra violet light illumination to cure the polymer matrix.

Rectangular cross section and preformed archwires can be fabricated and the surface chemistry can be modified to provide enhanced biocompatibility and low coefficients of sliding friction.  Poly (Chloro-P-Xylyene) coatings have been found to minimize glass fiber release during manipulation of the wires.  This group has also developed a composite ligature wire consisting of ultra high molecular weight poly ethylene fibers in a poly (n-butyl methacrylate) matrix. Watanabe et al have described a polyethylene terepthalate wire for maxillary retainers.
Burstone and Kuhlberg have described the clinical application of a new fiber reinforced composite called “Splint-It” which incorporates S2 glass fibers in a bis GMA matrix [7]. This is available in various configurations such as rope, woven strip and unidirectional strip. These materials are only partly polymerized during manufacture (pre-pregs), which makes them flexible, adaptable and easily contourable over the teeth. Later they are completely polymerized and can be bonded directly to teeth They can be applied for various purposes such as post treatment retention, as full arches or sectional arches, and to reinforce anchorage by joining teeth together. A particular advantage is that due to direct bondability to teeth, they can obviate the need for brackets in specific situations. In addition, they are highly aesthetic, and could thus be an effective alternative to lingual appliances.

ENDODONTIC DIAGNOSIS

                                            ENDODONTIC DIAGNOSIS

                    Accurate and efficient diagnosis is the cornerstone of endodontic therapy. Patient’s chief complaint and history of illness are the first, and arguably the most, important pieces of the diagnostic puzzle. Some investigators view history of moderate-to-severe pain as a good indicator of irreversible pulpal pathosis. Nonetheless, clinical signs and symptoms alone are not accurate predictors of pulp and periradicular diseases. Thermal (cold and heat) and electrical pulp testing (EPT) are simple tests but are not completely reliable. Heat as a pulp test has a relatively high sensitivity but is the least accurate overall of the three common pulp tests owing to low specificity. Cold testing with tetraflouroethane, ethyl chloride or carbon dioxide (CO2) snow is relatively reliable and generally more accurate than heat. Cold testing is presumed to be more reliable than EPT in teeth with incomplete root formation. Since thermal tests are not 100 percent accurate, EPT is especially useful for confirming a questionable pulpal diagnosis.
                            A major limitation of thermal testing and EPT is that these tests measure only pulpal nerve response, not pulpal blood flow. Since the true measure of pulp vitality is blood flow, laser Doppler flowmetry (LDF) and pulse oximetry devices have been adapted for experimental use in assessing pulp vitality. These devices seem particularly well-suited for evaluating the vitality of traumatized teeth and for evaluating teeth in areas that may require orthognathic surgery.
                          Some investigators have attempted to identify biological factors that may determine the health status of the pulp tissue more accurately. Identification of the 20,000 to 25,000 genes of the human genome has paved the way for association of specific genes with known pathological findings. Microarray technology has enabled researchers to identify and study a large array of Genes and proteins those are affected during disease formation and healing.

Commonly used methods of endodontis diagnosis :
1) VISUAL AND TACTILE AND INSPECTION
2) PERCUSSION
3) PALPATION
4) MOBI L ITY AND DEPRESSIBILITY TESTS
5) PERIODONTAL TESTS
6) THERMAL TESTS
7) ANAESTHETIC TESTS
8) TEST CAVITY
9) TRANSILLUMINATION
10) BITING
11) STAINING
12) GUTTA-PERCHA POINT TRACING
13) ELECTRIC PULP TESTING
14) RADIOGRAPHS

Recent methods of endodontic diagnosis
  1. LASER DOPPLER FLOWMETRY
  2. HEAT STIMULATION BY LASER INSTEAD OF HOT GUTTA-PERCHA
  3. PULSE OXIMETERS
  4. HUGHES PROBEYE CAMERA / INFRA RED THERMOGRAPHY
  5. ELECTRONIC THERMOGRAPHY
  6. LIQUID CRYSTAL TESTING
  7. ELECTRIC PULP TESTERS
  8. TRANSMITTED-LIGHT PHOTPLETHYSMOGRAPHY
  9. FOTI    
  10. DIGITAL RADIOGRAPHY (RVG)
  11. DIGITAL SUBTRACTION RADIOGRAPHY
  12. COMPUTERISED TOMOGRAPHY
  13. TACT
  14. COMPUTERIZED EXPERT SYSTEM
  15. TACT
  16. ULTRASONOGRAPHY (echography).
  17. XENON-133 WITH RADIOLABELLED MICROSPHERES.
  18. DUAL WAVE LENGTH SPECTROPHOTOMETRY.
  19. ELECTROMAGNETIC FLOWMETRY
  20. DETECTION OF INTERLEUKIN-1 BETA IN HUMAN PERIAPICAL LESION.
  21. MICROBIOLOGICAL DIAGNOSIS
    • TRADITIONAL
    • CULTURE
    • MICROSCOPY
    • IMMUNOLOGIC METHODS
    • RECENT
               1) MOLECULAR GENETIC METHODS
 

Tuesday, June 4, 2013

DENTAL COLLEGES IN INDIA

LIST OF DENTAL COLLEGES IN INDIA 1. PA.B. Shetty Memorial Institute of Dental Sciences, 2. -A.J. Institute of Dental Sciences, 3. Adesh Institute of Dental Sciences & Research, 4. Adhiparasakthi Dental College & Hospital 5. Aditya Dental College, 6. Ahmedabad Dental College & Hospital, 7. Al Ameen Dental College & Hospital 8. Al-Azhar Dental College 9. Al-Badar Rural Dental College & Hospital Gulbarga 10. AMC Dental College, Ahmedabad 11. AME’s Dental College & Hospital 12. Amrita School of Dentistry 13. Annasaheb Chudaman Patil Memorial Dental College 14. Annoor Dental College & Hospital 15. Army College of Dental Sciences 16. Asan Memorial Dental College & Hospital, Kancheepuram 17. Avadh Institute of Dental Sciences, Lucknow 18. Awadh Dental College & Hospital, 19. Azeezia College of Dental Sciences & Research 20. B.R.S. Institute of Medical Sciences Dental College & Hospital 21. Baba Jaswant Singh Dental College Hospital & Research Institute, Ludhiana 22. Babu Banarasi Das College of Dental Sciences 23. Bangalore Institute of Dental Sciences & Hospital 24. Bapuji Dental College & Hospital 25. Best Dental Science College, 26. Bhabha College of Dental Sciences 27. Bharati Vidyapeeth Dental College & Hospital 28. Bharati Vidyapeeth Dental College & Hospital, Pune 29. Bharati Vidyapeeth Dental College & Hospital,Navi Mumbai 30. Bhojia Dental College & Hospital 31. Buddha Institute of Dental Sciences & Hospital 32. Burdwan Dental College 33. C.K.S. Teja Institute of Dental Sciences & Research 34. Career Institute of Dental Sciences & Hospital, Lucknow 35. Century International Institute of Dental Science & Research Center 36. Chandra Dental College & Hospital 37. Chatrapati Shahu Maharaj Shikshan Sanstha’s Dental College & Hospital 38. Chattisgarh Dental College & Research Institute 39. Chettinad Dental College & Research Institute, 40. Christian Dental College 41. College of Dental Sciences & Hospital,Indore 42. College of Dental Sciences and Research Centre, Ahmedabad 43. College of Dental Sciences, Amargadh 44. College of Dental Sciences,Davangere 45. College of Dentistry- Indore 46. Coorg Institute of Dental Sciences 47. CSI College of Dental Sciences & Research 48. D.A. Pandu Memorial R.V. Dental College 49. D.A.V. Centenary Dental College 50. D.J. College of Dental Sciences & Research, Modi Nagar 51. Darbhanga Dental College 52. Darshan Dental College & Hospital 53. Dasmesh Institute of Research & Dental Sciences 54. Daswani Dental College & Research Centre 55. Dayanand Sagar College of Dental Sciences 56. Dental College Azamgarh, 57. Dental College, Medical College Campus, Kozhikode 58. Dental Wing, S.C.B. Medical College, 59. Desh Bhagat Dental College `& Hospital 60. Dharmsinh Desai University, Faculty of Dental Science 61. Dr. B.R. Ambedkar Institute of Dental Sciences & Hospital 62. Dr. D.Y. Patil Dental College & Hospital, Pune 63. Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital 64. Dr. Hedgewar Smruti Rugna Seva Mandals Dental College & Hospital 65. Dr. R. Ahmed Dental College & Hospital 66. Dr. S.M. Naqui Imam Dental College & Hospital 67. Dr. Syamala Reddy Dental College, Hospital & Research Centre 68. Dr. Ziauddin Ahmad Dental College, Aligarh 69. Drs. Sudha & Nageswara Rao Siddhartha Institute of Dental Sciences 70. Educare Institute of Dental Sciences 71. Eklavya Dental College & Hospital 72. ESIC Dental College, 73. Faculty of Dental Sciences, Institute of Medical Sciences, 74. Faculty of Dental Sciences, Lucknow 75. Faculty of Dentistry, Jamia Millia Islamia 76. Farooqia Dental College & Hospital 77. G. Pulla Reddy Dental College & Hospital, Kurnool 78. Gandhi Dental College 79. Genesis Institute of Dental Sciences & Research 80. Gian Sagar Dental College & Hospital, 81. Gitam Dental College & Hospital 82. Goa Dental College & Hospital 83. Goenka Research Institute of Dental Sciences, Gandhinagar 84. Government Dental College & Hospital, RIMS Kadapa 85. Government Dental College & Research Institute, Bellary 86. Govt. Dental College, Medical Campus, Rohtak 87. Govt. Dental College & Hospital, Afzalganj 88. Govt. Dental College & Hospital, Near T.B. Hospital, 89. Govt. Dental College & Hospital,Andhra Pradesh 90. Govt. Dental College & Hospital,Gujarat 91. Govt. Dental College & Hospital,Patiala 92. Govt. Dental College & Hospital- Mumbai 93. Govt. Dental College & Hospital-Nagpur 94. Govt. Dental College And Hospital-Aurangabad.(MS) 95. Govt. Dental College and Research Institute, Bangalore 96. Govt. Dental College Hospital, Jamnagar 97. Govt. Dental College, Medical Campus, Trivandram 98. Govt. Dental College, Srinagar 99. Govt. Dental College,Chhattisgarh 100. Govt. Dental College,Gandhinagar 101. Guardian College of Dental Sciences & Research Centre 102. Guru Gobind Singh College of Dental Science & Research Centre 103. Guru Nanak Dev Dental College & Research Institute 104. Gurunanak Institute of Dental Science & Research,Kolkatta 105. H.K.D.E.Ts Dental College, Hospital & Research Intitute, 106. H.K.E. Societys, S. Nijalingappa Institute of Dental Sciences & Research 107. H.P. Govt. Dental College & Hospital 108. Haldia Institute of Dental Sciences and Research, 109. Harsarn Dass Dental College, 110. Hazaribag College of Dental Sciences and Hospital 111. Hi-Tech Dental College & hospital 112. Himachal Dental College 113. Himachal Institute of Dental Sciences 114. Hitkarini Dental College & Hospital 115. I.T.S. Centre for Dental Studies & Research, Ghaziabad 116. I.T.S. Dental College, Hospital & Research Centre 117. Inderprastha Dental College & Hospital 118. Indira Gandhi Government Dental College, Jammu 119. Indira Gandhi Institute of Dental Sciences, 120. Indira Gandhi Institute of Dental Sciences, Kothamangalam 121. Institute of Dental Education & Advance Studies (IDEAS) 122. Institute of Dental Sciences, Bhubaneswar 123. Institute of Dental Sciences, Sehora 124. Institute of Dental Sciences,Uttar Pradesh 125. Institute of Dental Studies & Technology, Modinagar 126. Jaipur Dental College 127. Jamanlal Goenka Dental College & Hospital 128. Jan Nayak Ch. Devi Lal Dental College 129. JKK Natrajah Dental College & Hospital 130. Jodhpur Dental College & General Hospital 131. JSS Dental College & Hospital 132. K.D. Dental College, Mathura 133. K.G.F. College of Dental Sciences & Hospital 134. K.M. Shah Dental College & Hospital 135. K.S.R. Institute of Dental Science & Research 136. K.V.G. Dental College & Hospital 137. Kalinga Institute of Dental Sciences, 138. Kalka Dental College & Hospital, Meerut 139. Kamineni Institute of Dental Sciences 140. Kannur Dental College 141. Karnavati School of Dentistry 142. Karpaga Vinayaga Institute of Dental Sciences, 143. KLE Society’s Institute of Dental Sciences,Bangalore 144. KLE Vishwanath Katti Institute of Dental Sciences,Belgaum 145. KMCT Dental College 146. Kothiwal Dental College & Research Centre 147. Krishna Dental College 148. Krishnadevaraya College of Dental Sciences & Hospital 149. Late Shri Yashwantrao Chavan Memorial Medical & Rural Development Foundation's Dental College & Hospital 150. Lenora Institute of Dental Sciences 151. Luxmi Bai Institute of Dental Sciences & Hospital 152. M.A. Rangoonwala College of Dental Sciences & Research Centre 153. M.N.D.A.V. Dental College & Hospital 154. M.R.A. Dental College & Hospital 155. M.S. Ramaiah Dental College 156. Maaruti College of Dental Sciences & Research Centre 157. Madha Dental College & Hospital, 158. Maharaja Ganga Singh Dental College & Research Centre 159. Maharana Pratap College of Dentistry & Research Centre 160. Maharana Pratap Dental College & Hospital 161. Maharashtra Institute of Dental Sciences & Research (Dental College) 162. Maharishi Markandeshwar College of Dental Sciences & Research 163. Mahatma Gandhi Dental College & Hospital, Sitapura, Jaipur 164. Mahatma Gandhi Missions Dental College & Hospital 165. Mahatma Gandhi Post Graduate Institute of Dental Sciences, 166. Mahatma Gandhi Vidya Mandir’s Dental College & Hospital 167. Mahe Institute of Dental Sciences & Hospital 168. Maitri College of Dentistry and Research Centre 169. Malabar Dental College & Research Centre 170. Mamata Dental College 171. Manav Rachana Dental College 172. Manipal College of Dental Sciences, Manipal 173. Manipal College of Dental Sciences, Mangalore 174. Mansarover Dental College 175. Manubhai Patel Dental College & Dental Hospital & SSR General Hospital 176. Mar Baselios Dental College 177. Maratha Mandal’s Dental College & Research Centre 178. Maulana Azad Dental College & Hospital 179. Meenakshi Ammal Dental College & Hospital 180. Meghna Institute of Dental Sciences 181. MES Dental College 182. Mithila Minority Dental College & Hospital 183. MNR Dental College 184. Modern Dental College & Research Centre 185. Nair Hospital Dental College 186. Narayana Dental College & Hospital 187. Narsinhbhai Patel Dental College & Hospital 188. National Dental College & Hospital 189. Navodaya Dental College 190. New Horizon Dental College & Research Instiute 191. NIMS Dental College 192. Noorul Islam College of Dental Sciences 193. North Bengal Dental College 194. NSVK Sri Venkateshwara Dental College & Hospital 195. P.M.N.M. Dental College & Hospital, Bagalkot 196. Pacific Dental College & Hospital 197. Padmashree Dr. D.Y. Patil Dental College & Hospital, Navi Mumbai 198. Pandit Dindayal Upadhyay Dental College, 199. Panineeya Mahavidyalaya Institute of Dental Sciences & Research Centre 200. Pariyaram Dental College,Academy of Medical Sciences 201. Patna Dental College & Hospital 202. Pb. Govt. Dental College & Hospital, Amritsar 203. PDM Dental College & Research Institute 204. People’s Dental Academy 205. Peoples College of Dental Sciences & Research Centre 206. PMS College of Dental Science & Research 207. Priyadarshini Dental College & Hospital 208. PSM College of Dental Sciences & Research 209. Purvanchal Institute of Dental Sciences 210. Pushpagiri College of Dental Sciences 211. R.R. Dental College & Hospital, Udaipur 212. R.V.S. Dental College & Hospital 213. Ragas Dental College & Hospital 214. Rajah Muthiah Dental College & Hospital,Annamalai University, 215. Rajarajeswari Dental College & Hospital 216. Rajas Dental College & Hospital 217. Rajasthan Dental College & Hospital 218. Rama Dental College, Hospital & Research Centre 219. Rayat Bahra Dental College, Mohali 220. Regional Dental College 221. Rishi Raj College of Dental Sciences & Research Centre 222. RKDF Dental College & Research Centre 223. Royal Dental College 224. Rungta College of Dental Sciences & Research 225. Rural Dental College 226. S.B. Patil Dental College & Hospital 227. S.J.M. Dental College & Hospital 228. S.M.B.T. Dental College & Hospital 229. S.R.M. Dental College 230. S.R.M.M.M.T.’s Sharad Pawar Dental College & Hospital 231. Santosh Dental College & Hospital 232. Saraswati Danwantri Dental College & Hospital, 233. Saraswati Dental College 234. Sardar Patel Post Graduate Institute of Dental & Medical Sciences 235. Sarjug Dental College 236. Sathyabama University Dental College and Hospital 237. Saveetha Dental College & Hospital 238. School of Dental Sciences, Greater Noida 239. School of Dental Sciences, Krishna Institute of Medical Sciences 240. SDM College of Dental Sciences & Hospital 241. Seema Dental College & Hospital 242. Shaheed Kartar Singh Sarabha Dental College & Hospital 243. Sharavathi Dental College & Hospital 244. Shree Bankey Bihari Dental College & Research Centre 245. Sibar Institute of Dental Sciences 246. Sinhgad Dental College & Hospital 247. Sree Balaji Dental College & Hospital. 248. Sree Sai Dental College & Research Institute 249. Sri Govind Tricentenary Dental College, Hospital & Research Institute 250. Sri Aurobindo College of Dentistry 251. Sri Guru Ram Das Institute of Dental Sciences & Research 252. Sri Hasanamba Dental College & Hospital 253. Sri Mookambika Institute of Dental Sciences 254. Sri Rajiv Gandhi College of Dental Sciences & Hospital 255. Sri Ramachandra Dental College & Hospital 256. Sri Ramakrishna Dental College & Hospital 257. Sri Sai College of Dental Surgery 258. Sri Sankara Dental College 259. Sri Siddhartha Dental College 260. Sri Venkata Sai Institute of Dental Sciences 261. Sri Venkateswara Dental College & Hospital, 262. SRM Kattankulathur Dental College & Hospital 263. St. Gregorios Dental College 264. St. Joseph Dental College 265. Subharati Dental College, Meerut 266. Sudha Rustagi College of Dental Sciences & Research,Faridabad 267. Surendra Dental College & Research Institute 268. Swami Devi Dyal Hospital & Dental College 269. Swargiya Dadasaheb Kalmegh Smruti Dental College & Hospital 270. Tagore Dental College & Hospital, 271. Tamil Nadu Government Dental College & Hospital, 272. Tatyasaheb Kore Dental College & Research Centre 273. Teerthanker Mahaveer Dental College & Research Centre 274. Terna Dental College & Hospital, 275. Test Demo College 276. Thai Moogambigai Dental College & Hospital 277. The Oxford Dental College 278. Triveni Institute of Dental Sciences, Hosptial & Research Centre 279. Uttaranchal Dental College & Medical Research Institute 280. V.S. Dental College, Bangalore 281. Vaidik Dental College and Research Centre, 282. Vananchal Dental College & Hospital, 283. Vasantdada Patil Dental College and Hospital 284. Vidarbha Youth Welfare Society’s Dental College & Hospital 285. Vidya Shikshan Prasarak Mandal’s Dental College & Research Centre 286. Vinayaka Mission’s Sankarachariyar Dental College 287. Vinayaka Missions Dental College 288. Vishnu Dental College 289. Vivekanandha Dental College for Women 290. Vyas Dental College & Hospital 291. Vydehi Institute of Dental Sciences & Research 292. Yamuna Institute of Dental Sciences & Research, Yamuna Nagar 293. Yenepoya Dental College & Hospital 294. Yerala Medical Trust & Research Centre’s Dental College & Hospital 295. Yogita Dental College & Hospital

Saturday, August 6, 2011

Rotary endodontics

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Rotary endodontics


Endodontics concerns itself with treating diseases of the dental pulp. The dental pulp is the name given to the soft tissue that runs through the canal or canals in the middle of the root or roots of a tooth. The pulp consists mainly of nerves and blood vessels and its function is to provide nutrition for a developing tooth and to provide sensory feedback for an erupted tooth.

How does the pulp become diseased? The most common cause of pulp
damage is deep decay that reaches the pulp. Other causes of pulp damage include trauma to the teeth, loose fillings resulting in decay, excessive tooth wear and gum disease. These processes can lead to infection and death of the pulp.

The infection may then spread through the opening at the tip of the root to the surrounding bone, resulting in an abscess which may be very painful and cause swelling. Such an abscess may show up on an X-ray of the tooth.

Symptoms of an infected tooth that the patient may be aware of may include pain, especially at night, pain when biting on the tooth and with heat, discoloration of the tooth and swelling and soreness in the gums surrounding the tooth. Sometimes, curiously, there may be no symptoms from an infected tooth at all that the patient is aware of, and this is where regular dental checkups are important in order to identify and treat such teeth before they give rise to symptoms.

Treatment of an infected tooth is by root canal therapy which involves cleaning away of the infected pulp and filling of the root canals permanently. Root canal therapy should be commenced and completed as soon as possible in order to prevent the possibility of the infection around the tooth spreading and causing more widespread and potentially serious infection around the body, manifesting in such things as facial swelling and fever which may occasionally require hospitalization. The localized spread of an abscess is also important and in time, if left untreated, may result in the loss of supporting bone around the root of the tooth and eventually loss of the tooth.

For those patients where swelling and fever are already present, a course of antibiotics may be prescribed. Antibiotics are not a substitute for root canal therapy, for the reason that there is no longer a blood supply to the inside of an infected tooth so that there is no way for the antibiotics to be carried into the inside of such a tooth to eliminate the infection. The purpose of antibiotics is to stop the infection that is outside the tooth from spreading and to help the body fight what is already there.



We use the latest in endodontic techniques


All root canals in the affected tooth must be treated. The front teeth (incisors and canines) and premolars typically have one or two root canals. Molars usually have three or four. Root canal therapy may be done over a number of visits, typically two or three, in the case of teeth with active or long-standing and extensive infection but sometimes it may be possible to complete the treatment in a single visit if the infection is of recent origin and relatively mild in symptoms.

Whatever the choice, Contemporary Smiles is your fully trained and equipped centre for root canal therapy. We have invested heavily in the latest techniques and equipment, such as active variable taper nickel-titanium rotary instrumentation and electronic apex location - fancy words, but cutting-edge designs - ensuring that our success rate in endodontics is equivalent to world's best standard.

Rubber dam isolation of your tooth during treatment, in order to keep the tooth clean and dry so that effective sterilization of the root canals may be accomplished, is a routine at our practice.



The latest in endodontic equipment is in use at Contemporary Smiles


Following root canal therapy, careful restoration of the tooth is of paramount importance. Teeth which have had root canal therapy tend to dry out and become brittle, hence prone to fracture, during chewing. Heavily restored teeth which have had root canal therapy are even more at risk. You have already paid a fair sum for your root canal therapy and the last thing you would want to happen is for such a tooth to break apart during chewing, requiring its removal. The general recommendation is that a tooth which has had root canal therapy and where such a tooth is missing from its structure more than the small access cavity cut for the root canal instrumentation, be restored with a full coverage crown as soon as possible, in order to protect it from fracture.

The patient should not bite on the tooth following the root canal therapy until such a tooth has been restored by a crown. In some cases the root filled tooth may lack sufficient remaining visible tooth structure to support a crown. In such a situation, a post may be inserted into the root canal and a foundation or core built up to support the final crown.

At Contemporary Smiles, when we provide you with a quote for root canal therapy, we also routinely quote for a crown at the same time, so you can have peace of mind knowing that your tooth will have a long life in your mouth.

Is there an alternative to endodontic treatment? The only alternative method of removing the infection is to extract your tooth. Then if you do not have the tooth replaced with an artificial one, the adjoining teeth will shift, interfering with biting, chewing and appearance. Loss of a tooth can lead to many other complex problems in the region including gum disease, decay of other teeth, jaw joint degeneration and jaw muscle problems.

Replacing your tooth, which may have been saved through root canal therapy, with an artificial one, may be a more expensive option than saving the tooth in the first place. Alternatively, the replacement may be less efficient in chewing and biting or it may involve treatment of your adjacent teeth which may harm them. Weighing up the alternatives, you are much better off having the tooth saved through root canal therapy and crowning.



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Tags: endodontia, endodontics, endodontics treatment in india, endodontics in hyderabad, endodontia training, gum disease, decay of other teeth, jaw joint degeneration and jaw muscle problems

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