CC417. Clinical Tip Wire Management

Summary
This presentation will show you tips to avoid emergency appointments due to mucosa irritation by arch wires during leveling and alignment, and space closure.

During the leveling and aligning stage, when a fine and flexible wire(0.014, 0.016, 0.018) is used, the wire tends to loosen and causes irritation. In the first case where the two molars are almost aligned, one can extend the wire until the first molar and apply heat treatment and bending to the terminal before securing it with a resin ball. In the second case where the first molar is missing, simply place the wire until the edentulous area. Once a 0.014x0.025NiTi wire is used, insert a crimpable hook before the last molar tube and combine the crimpable hook and the hook of the molar tube with an O-ring to prevent wire dislodgement.

During the space closure stage when a stiff stainless steel wire is used, the wire may come out of brackets as space is closing. In the presented case when the patient has a long gap between appointments in this stage, one can shorten the arch wire until the first molar and simply use elastics to close spaces. To avoid distal rotation of the first molar, bond buttons on the lingual side to apply buccal-lingual mechanics.
摘要
在療程中我們盡量避免病人的頰側黏膜被最後方突出的主線刺傷而回診。接下來要介紹在排齊階段(leveling and aligning stage)及關空間期（space closing stage）兩種情況下如何來避免這種情形。

在排齊階段的主線是較軟的NiTi round wire（0.014、0.016、0.018），所以隨著牙齒排齊造成線變長，主線就容易刺傷黏膜。在第一個病例中當兩顆大臼齒原本排列蠻整齊的情形下，我們可以只將主線穿到第一顆大臼齒的矯正器，將線尾加熱後彎折，並糊上樹脂球來防止脫落。在第二個病例中缺少第一大臼齒，這時我們僅需將第一條主線放置缺牙區前一顆牙齒即可（此案例中即第二小臼齒）。待換至0.014x0.025NiTi時可以夾一個crimpable hook在最後一顆molar tube前，用o-ring把crimpable hook跟molar tube的hook綁在一起預防主線脫落。

第二種情況是space closing stage，這時的主線是硬的鋼線, 所以刺激黏膜的主因是空間關閉造成線變長。若是像第三個案例剛好遇到患者有一段長時間不能來看診時，我們可以將主線剪至第一大臼齒，加上請病人配合配戴橡皮筋， 治療一樣可以順利進行。若是擔心第一大臼齒產生distal-out rotation，那就在舌側黏上button來使用buccal-lingual mechanics。

Видео CC417. Clinical Tip Wire Management канала 【Chris Chang Ortho】