【Chris Chang Ortho】427. Clinical Tip: How to Secure the Wire End by Dr. Ashley Huang

Abstract

This patient presented with bilateral long-span edentulous ridges over the mandibular first and second molar area. The mandibular left wisdom tooth was mesially-out rotated. A14x25 CuNiTi wire was selected for third molar de-rotation. However, this soft wire was prone to pop out of the molar tube, resulting in mucosa irritation. One solution was to secure the distal end of the wire with a resin ball but the effect was only short-term. The recommended alternative was to create a cinch back by cutting the wire and leaving a 3-5mm of pigtail, applying heat treatment to the tail end, and bending the terminal. Moreover, a power chain was attached from the third molar to the first premolar. This not only produced a de-rotating force to the third molar, but strained the third molar and the premolar, preventing wire loosening.

When a case is presented with a long-span edentulous ridge, it’s advised to shorten the wire prior to the spaces in the leveling and alignment stage. Generally speaking, a 17x25 TMA wire is used initially to engage the last teeth. But in this case, a soft and flexible 14x25 CuNiTi was used for the de-rotation of the third molar. Thus, a cinch back was created to prevent wire dislodgement.
摘要

此患者缺少下顎雙邊第一與第二大臼齒，同時左下第三大臼齒近心往外旋轉。本次選擇使用14x25 CuNiTi為主線。由於此線較軟，病人進食時很容易造成線彈出molar tube外，主線尾端就會刺傷黏膜。解決方法之一是在主線尾端黏上一個樹脂球，但效用只能維持僅僅幾天。另一方法是將線尾預留3-5mm，將線尾用打火機加熱後彎折(cinch back)。此外，將power chain掛在第三大臼齒到第一小臼齒之間，不僅加強旋轉第三大臼齒回正的力量，更可以固定第三大臼齒到第一小臼齒間的主線，避免主線從molar tube中鬆脫。

當病患口內有很長的缺牙區，我們會在排齊的階段縮短主線長度至缺牙區前方。一般來說，17x25 TMA是第一條選擇穿入缺牙區後方牙齒的主線。但是本病例因為左下第三大臼齒旋轉角度過大，才會提前使用14x25 CuNiTi放進第三大臼齒，並且製造cinch back避免主線脫離。

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