저작자표시-비영리-변경금지 2.0 대한민국 이용자는 ... - S-Space

(1)

저작자표시-비영리-변경금지 2.0 대한민국 이용자는 아래의 조건을 따르는 경우에 한하여 자유롭게

l 이 저작물을 복제, 배포, 전송, 전시, 공연 및 방송할 수 있습니다. 다음과 같은 조건을 따라야 합니다:

l 귀하는, 이 저작물의 재이용이나 배포의 경우, 이 저작물에 적용된 이용허락조건 을 명확하게 나타내어야 합니다.

저작권법에 따른 이용자의 권리는 위의 내용에 의하여 영향을 받지 않습니다. 이것은 이용허락규약(Legal Code)을 이해하기 쉽게 요약한 것입니다.

Disclaimer

저작자표시. 귀하는 원저작자를 표시하여야 합니다.

비영리. 귀하는 이 저작물을 영리 목적으로 이용할 수 없습니다.

변경금지. 귀하는 이 저작물을 개작, 변형 또는 가공할 수 없습니다.

(2)

㋲⯲㧳₯╆# 㧳⮞ᘖῒ#

Effects of Rewinding the Coil on the Reverse Direction

of Nickel-Titanium Closed-Coil Springs on the Force-Deflection Characteristics

Ql0Wl#Forvhg#Frlo#Vsulqj ⩪▶# # Frlo# ⃃㨿⯞# ₲រᳶ# ᢲႪᜮ# ᄝⰎ#

⯫Ჿ0⅚㪯# ᆚᅞ⩪# ₒ㋲ᜮ# ⪛㨿#

#

534< ᗞ# ; ⭮#

#

▶⭒រ㧳ᇪ# រ㧳⭪#

㋲⯲ᆖ㧳ᆖ# ㋲ᆖᇪⲯ㧳# Ⲟᆏ#

₯# 㫲# 㪯#

(3)

Effects of Rewinding the Coil on the Reverse Direction

of Nickel-Titanium Closed-Coil Springs on the Force-Deflection Characteristics

#

⹚ᡞᇪ⚲# ⃋# ❓# 㧳#

Ⰾ# ᘖῒ⯞# ㋲⯲㧳₯╆# 㧳⮞ᘖῒ⯖ᳶ# Ⲷ㈶㨂#

#

534< ᗞ# 9 ⭮# #

#

▶⭒រ㧳ᇪ# រ㧳⭪#

㋲⯲ᆖ㧳ᆖ# ㋲ᆖᇪⲯ㧳# Ⲟᆏ#

₯# 㫲# 㪯#

#

₯㫲㪯⯲# ₯╆㧳⮞ᘖῒ⯞# Ⱂ⶚㨂#

534< ᗞ# : ⭮# #

⮞ # # # ⭪ # # # ⰿ # # # # # # # # # # # # # # # # # # +Ⱂ,#

√# # ⮞# # ⭪# # ⰿ# # # # # # # # # # # # # # # # # +Ⱂ,#

⮞# # # # # # # # # # ⭪# # # # # # # # # # # # # # # # # +Ⱂ,#

(4)

ABSTRACT

Effects of Rewinding the Coil on the Reverse Direction

Hwan-Hyung Park, DDS, MSD

Department of Orthodontics, Graduate School, Seoul National University

(Directed by Professor Seung-Hak Baek, DDS, MSD, PhD)

Objectives: To investigate the effects of rewinding the coil on the reverse direction of nickel-titanium closed-coil springs (NiTi-CCSs) on the force-deflection characteristics.

Materials and Methods: The samples were comprised of two commercially available

conventional NiTi-CCS groups (force: 100 g; total length: 8.5-9.0 mm) and two reverse- wound NiTi-CCS groups (Ormco-Conventional group vs. Ormco-Reverse group; GAC- Conventional group vs. GAC-Reverse group; n = 20 per group). Ormco-Conventional group exhibit the force-deflection characteristics of un-preactivated springs while GAC- Conventional group exhibit those of preactivated springs. The reverse-wound NiTi-CCSs were directly made from the corresponding conventional NiTi-CCSs by rewinding the coil on the reverse direction. Tensile tests were performed for each group in a

(5)

temperature-controlled acrylic chamber (37 ± 1 °C). After measuring the force level, the range of the deactivation force plateau (FP) and the amount of mechanical hysteresis (MH), statistical analyses were performed.

Results: The Ormco-Reverse group exhibited a significant shift of the deactivation FP end point toward the origin point (2.3 to 0.6 mm), an increase in the force level (1.2 to 1.3 N), and an increase in the amount of MH (1.0 to 1.5 N) compared to the Ormco- Conventional group (all P < 0.001), which indicated that force could be constantly maintained until the end of the deactivation curve. Also, as a result of reversing procedure, the force-deflection characteristics of the un-preactivated springs (Ormco-Conventional group) changed to those of preactivated springs (Ormco-Reverse group). In contrast, the GAC-Reverse group exhibited a significant shift of the deactivation FP-end point away from the origin point (0.2 to 3.3 mm), a decrease in the force level (1.1 to 0.9 N), and a decrease in the amount of MH (0.6 to 0.4 N) compared to the GAC-Conventional group (all P < 0.001), which may hinder the maintenance of force until the end of the deactivation curve. Also, as a result of the reversing procedure, the force-deflection characteristics of the preactivated springs (GAC-Conventional group) changed to those of un-preactivated springs (GAC-Reverse group).

Conclusions: The two commercially available NiTi-CCS groups exhibited different patterns of change in the force-deflection characteristics when the coiling direction was reversed. As a result of the reversing procedure, the force-deflection characteristics of the un-preactivated springs changed to those of preactivated springs (from the Ormco- Conventional group to the Ormco-Reverse group) and vice versa (from the GAC- Conventional group to the GAC-Reverse group).

(6)

Key words: nickel-titanium closed-coil spring, range of the force plateau, amount of mechanical hysteresis, force-deflection characteristics, rewinding the coil on the reverse direction

Student number: 2015-31277

(7)

Effects of Rewinding the Coil on the Reverse Direction

Hwan-Hyung Park, DDS, MSD

Department of Orthodontics, Graduate School, Seoul National University (Directed by Professor Seung-Hak Baek, DDS, MSD, PhD)

Ql0Wl#Forvhg#Frlo#Vsulqj ⩪▶# # Frlo# ⃃㨿⯞# ₲រᳶ# ᢲႪᜮ# ᄝⰎ# #

⯫Ჿ0⅚㪯# ᆚᅞ⩪# ₒ㋲ᜮ# ⪛㨿#

▶⭒រ㧳ᇪ# រ㧳⭪# ㋲⯲ᆖ㧳ᆖ# ㋲ᆖᇪⲯ㧳# Ⲟᆏ#

+⹚ᡞᇪ⚲=# ⃋# ❓# 㧳,#

₯# 㫲# 㪯#

-CONTENTS- I. INTRODUCTION

II. REVIEW OF LITERATURE III. MATERIALS AND METHODS IV. RESULTS

V. DISCUSSION VI. CONCLUSIONS VII. REFERENCES

(8)

I. INTRODUCTION

Nickel-titanium (NiTi) materials can exert a consistent force regardless of the amount of deflection within the range of the deactivation force plateau (FP).^1-5 Due to this characteristic, NiTi closed-coil springs (NiTi-CCSs) have been applied to extraction space closure, individual tooth movement (retraction or protraction), or forced eruption of an impacted tooth.^6,7 However, as the deflection of the springs reaches the end of the deactivation FP, the force level decreases rapidly (Figure 1). Once the springs can no longer maintain an adequate force, they must either be replaced with another set of short- length springs or they must be reactivated to accomplish complete tooth movement.⁸ In this respect, it would be advantageous for clinical use if the deactivation FP of NiTi-CCSs could be extended to the end of the deactivation curve (Figure 1).

Wichelhaus et al.¹ compared the mechanical characteristics of 24 commercially available NiTi-CCSs and classified them into preactivated and un-preactivated groups, where the term “preactivation” refers to the torsional bias stress applied to the springs by manufacturers during the manufacturing process.¹ In that study, the preactivated group consisted of springs in which the deactivation FPs extended until the springs were almost fully deactivated, while the un-preactivated group included springs in which the deactivation FPs ended 3 to 5 mm before the springs were fully deactivated.¹ Upon evaluation, the preactivated springs had a distinct advantage over un-preactivated springs in that they could maintain a consistent force for even small deformations, thus allowing tooth movement to be completed without requiring reactivation of the springs.¹ Although

(9)

clinicians can also activate NiTi-CCSs by straining them before use, this has been reported to have no clinically significant effect on the force generated by NiTi-CCSs.^2,9,10 Since NiTi materials exhibit nonlinear force-deflection characteristics, previous studies^1,11,12 have suggested methods for calculating the range of the FP using the ratio between the maximum and minimum slopes of the force-deflection curve. However, as such methods are based on the relative ratio of slopes within a single NiTi material, it is desirable to develop an objective method based on mathematical calculations for determining the range of the FP.

Recently, a method of rewinding the coil on the reverse direction of NiTi coil springs has been introduced in the field of engineering.^13,14 This method is reported to provide an initial tension to the springs and extend the end point of the deactivation FP to almost the end of the deactivation curve.^13,14 It would be advantageous in clinical use if the end point of the deactivation FP of orthodontic NiTi-CCS could be extended to the origin point by applying this method.¹ Therefore, the purpose of this study was to investigate the effects of rewinding the coil on the reverse direction in conventional NiTi- CCSs on the force-deflection characteristics. The null hypothesis of this study was that rewinding the coil on the reverse direction of NiTi-CCSs would not produce significant changes in the force-deflection characteristics including the FP range, force level, and amount of mechanical hysteresis.

(10)

II. REVIEW OF LITERATURE

1. Characteristics of NiTi materials - Force plateau

In orthodontic treatment, NiTi materials have been widely used because they can exert a consistent force with a wide range of deformation.^1-5 This characteristic is due to phase transformation of the crystallographic structure between a martensitic and an austenitic phase, which can be induced by temperature changes and/or mechanical stress.² When NiTi materials are in phase transformation by mechanical stress, they exhibit the non-elastic force-deflection region that produce a nearly constant force, called the force plateau (FP).^1-5Due to this characteristic, NiTi-CCSs have been used for various orthodontic tooth movements.^6,7

However, when the deflection of the springs reaches the end point of the deactivation FP, the force decreases rapidly and adequate constant force to ensure complete space closure cannot be maintained.⁸ In this point of view, NiTi CCSs with the wide range of deactivation FP that extends until the springs are almost fully deactivated would be clinically advantageous.¹

2. Preactivation of NiTi-CCSs

In general, preactivation of the orthodontic materials refers to the strain given by clinicians before use. It has been reported that preactivation of the elastic modules can prolong the continuity of the forces.¹⁰ In contrast, preactivation (prolonged strain before

(11)

use) in NiTi-CCSs was reported to reduce the predictability of force generated by springs⁹ and produce clinically insignificant effects on the force.^2,9,10

Wichelhaus et al.¹ investigated the mechanical characteristics of 24 commercially available NiTi-CCSs and introduced the new concept of preactivation. This term “preactivation” is related to the bias torsional stress applied to the springs by manufacturers during manufacturing process¹ and is different from the repeated elongation that clinicians apply before using the springs which was discussed above.

According to Wichelhaus et al.¹ “preactivated” NiTi-CCSs referred to the springs showing the extension of the deactivation force plateaus until the springs were almost fully deactivated, while “unpreactivated” NiTI-CCSs referred to the springs where the deactivation force plateaus ended at 3 to 5mm before the springs were fully deactivated.

3. Calculating the range of the force plateau in NiTi materials

Because NiTi materials exhibit nonlinear force-deflection characteristics, it becomes very challenging to analyze the mechanical property of each NiTi material.¹ To compare the superelastic properties of various NiTi archwires, Segner and Ibe¹¹ introduced the concept of the superelastic (SE) ratio, which is the ratio between the maximum (slope at the final part of the deactivation curve) and minimum (slope at the deactivation force plateau) slopes on the deactivation curve. Based on this method, materials were considered as ‘superelastic’ if the ratios were above 8 and as to have

‘superelastic tendencies’ if the ratios were above 2.¹¹

(12)

Bartzela et al.¹² introduced the method for calculating the force plateaus of NiTi archwires based on modified SE ratio which is the ratio between the slope at the initial part of the deactivation curve and the slope at the deactivation force plateau. They defined the ‘SE force plateau’ as the region of which the SE ratio was above 8 and the ‘clinical plateau’ as the region that exhibit ±10% of force of the midpoint force in the SE force plateau.¹²

Wichelhaus et al.¹ investigated the mechanical characteristics of 24 commercially available NiTi-CCSs and modified the definition of the SE and clinical plateaus for NiTi CCSs because of integrated preactivation on some products. Definitions of modified SE and clinical plateaus were as follows: The SE force plateau, the region of which the modified SE ratio was above 2; The clinical plateau, the region that exhibit ±20%

of force of the midpoint force in the SE force plateau.

4. Rewinding the coil on the reverse direction of NiTi springs

Originally, NiTi-CCSs can only expand and further compression is impossible beyond their original state. Jee et al.^13,14 introduced a method for compression of CCSs by rewinding the coil on the reverse direction of springs.

By this method, NiTi-CCSs can be compressed beyond their original state with some compression stress and reverse-wound NiTi-CCSs could have additional initial tension that is exactly same with the compression stress.¹⁴ As a result of this initial tension, immediate increase in force occurs right after the loading of the reverse-wound

(13)

NiTi-CCSs. Also because this initial tension is maintained throughout unloading process, force can be maintained until the springs are almost fully deactivated.

Jee at al.^13,14 also reported that because this reversing procedure simply changes the order of coil elements one by one without large deformation, there would be no plastic deformations in reverse-wound springs.

(14)

III. MATERIALS AND METHODS

Two commercially available conventional NiTi-CCS groups [Ormco NiTi extension spring light force (Ormco Co., Glendora, CA, USA) and GAC coil springs light (GAC International Inc., Bohemia, NY, USA)], each of which had an approximate 100 g of force, a total length of 8.5–9.0 mm, and a coil length of 3.2–3.5 mm, were used as control groups. According to Wichelhaus et al.¹, Ormco NiTi-CCSs exhibit the force- deflection characteristics of un-preactivated springs while GAC NiTi-CCSs exhibit those of preactivated springs.

To investigate the effects of rewinding the coil on the reverse direction on the force-deflection characteristics, experimental groups were directly made from the control groups by a method illustrated in Figure 2-A. Although there was some risk that rewinding the coil on the reverse direction of springs would result in permanent plastic deformation, the probability of this was considered to be very low for the following reasons.¹⁴ First, the reverse coiling procedure was performed at room temperature (about 20°C), which is below the austenite finishing temperature (Af) of the NiTi alloy.¹⁵ Thus, the NiTi alloys of the coil springs were in the transition phase from martensite to austenite, thereby preventing permanent plastic deformation while not allowing the coil to return to its original shape. Second, this procedure was designed to simply change the order of coil element, thus introduce minimal stress by only applying 0.16 mm of deformation which is the diameter of the NiTi wire of coil elements.

Here, the respective groups of commercially available conventional NiTi-CCSs are referred to as control groups and those of the reverse-wound NiTi-CCSs as

(15)

experimental groups. In the experiments, the results of the Ormco-Conventional group were compared to those of the Ormco-Reverse group, while those of the GAC- Conventional group were compared to those of the GAC-Reverse group. Each group contained 20 springs (Table 1 and Figure 3).

A power analysis was performed using a sample size determination program (Version 2.0.1, Seoul National University Dental Hospital, Registration No. 2007-01- 122-004453, Seoul, South Korea) to determine the sample size based on the means and standard deviations derived from a previous study.¹⁶

To investigate the force-deflection characteristics in the control and experimental groups, the tensile tests were performed using a MTS tensile tester (MTS Insight, MTS Systems Corporation, Eden Prairie, MN, USA) equipped with a 25 N static load cell. To eliminate the mechanical play between the eyelet of the NiTi-CCS and the fixture connected to the tensile tester, each specimen was preloaded to a force level of 0.1

± 0.01 N.^1,6 Then, the specimens were activated to a 14 mm displacement and deactivated to the initial pre-loaded displacement at a rate of 20 mm/min in a temperature-controlled acrylic chamber (37 ± 1°C).

The rationale for stretching the springs to 14 mm was as follows. First, in clinical situations, NiTi-CCSs are typically connected from the hook on the first molar tube to the hook on the canine bracket when retracting the canine into the extraction space, and the distance between these hooks is approximately 23 mm.¹⁷ Because the total length of each NiTi-CCS used in this study was about 8.5–9.0 mm, a 14 mm extension was deemed appropriate for simulating an actual clinical situation. Second, this extension was chosen because most NiTi-CCSs exhibit superelasticity when activated to a distance more

(16)

than four times the length of the coil portion (13.2 mm for Groups 1 and 3; 12.8 mm for Groups 2 and 4).¹⁶

After the data on force and displacement were acquired at every interval of 0.04 mm displacement using the Testworks 4 program (MTS Systems Corporation, Eden Prairie, MN, USA), force-deflection curves for each specimen were plotted.

The variables used in this study are described in Figure 4. The FP was defined as the region in which the slope of the curve was less than 0.1 N/mm. This definition is based on the study of Wichelhaus et al,¹ which reported that the slopes of the FPs of NiTi-CCSs with strong superelasticity were between 0.01 and 0.09 N/mm. The slope of the deactivation curve was calculated using the derivative of each curve at every tested displacement using MATLAB R12 software (The MathWorks Inc., Natick, MA, USA).

The range of the deactivation FP (including the start and end points), the force levels on the activation and deactivation curves, and the amount of mechanical hysteresis were all measured.

Statistical analyses were performed to compare the force-deflection characteristics between the conventional and reverse wound NiTi-CCSs in the same batch.

After performing normality assessments via the Shapiro-Wilk Tests, Mann-Whitney U tests were performed. All statistical analyses were performed using the SPSS program (version 22.0, IBM Corp., Armonk, NY, USA). The level of significance for all tests was P < 0.05.

(17)

IV. RESULTS

Although all groups exhibited typical patterns of the force-deflection curves of NiTi materials, the force-deflection characteristics of the two control groups changed significantly when the coiling direction was reversed. In addition, two control groups exhibited different patterns of changes in the force-deflection characteristics when the coiling direction was reversed.

Compared to the Ormco-Conventional group, the start and end points of the deactivation FP for the Ormco-Reverse group shifted toward the origin point (i.e., the end point of the deactivation curve) (from 10.2 to 6.3 mm and from 2.3 to 0.6 mm, respectively), the range of the deactivation FP decreased (from 7.9 to 5.6 mm), the activation and deactivation force levels increased (from 2.1 to 2.8 N; from 1.2 to 1.3 N, respectively), and the amount of mechanical hysteresis increased (from 1.0 to 1.5 N) (all P < 0.001, Figure 5, Table 2).

Compared to the GAC-Conventional group, the start and end points of the deactivation FP for the GAC-Reverse group shifted away from the origin point (from 9.6 to 11.5 mm; from 0.2 to 3.3 mm, respectively), the range of the deactivation FP decreased (from 9.5 to 8.2 mm), the activation and deactivation force levels decreased (from 1.7 to 1.4 N; from 1.1 to 0.9 N, respectively), and the amount of mechanical hysteresis decreased (from 0.6 to 0.4 N) (all P < 0.001, Figure 6, Table 2).

Although the observed changes in the deactivation force level may be clinically insignificant, the corresponding pattern was opposite between the two groups (Δ0.1 N increase in the Ormco-Reverse group compared to the Ormco-Conventional group; Δ0.2

(18)

N decrease in the GAC-Reverse group compared to the GAC-Conventional group;

Figures 5 and 6, Table 2). The direction of the shift of the end point of the deactivation FP in relation to the origin point was also opposite in the two groups (2.3 mm in the Ormco-Conventional group to 0.6 mm in the Ormco-Reverse group; 0.2 mm in the GAC- Conventional group to 3.3 mm in the GAC-Reverse group; Figures 5 and 6, Table 2).

(19)

V. DISCUSSION

The mechanical properties of NiTi-CCSs are affected by two major factors including the fabrication (composition of the alloy, diameters of wire and lumen, pitch angle, length of springs) and the oral environments (temperature change and mechanical deformation).^1,2,9,10 In the present study, by comparing the mechanical properties of conventional and reverse-wound NiTi-CCSs, we found that the coiling direction may be another factor that significantly affects the force-deflection characteristics of NiTi-CCSs.

The force-deflection characteristics of the two conventional NiTi-CCS groups were not significantly different from those of previous studies.1,6,7,16,18,19,20 The force levels of the deactivation FPs of the Ormco- and GAC-Conventional groups were 1.2 and 1.1 N, respectively (Table 2), which are almost the same as the results of Vieira et al. (1.1 N for Ormco light NiTi-CCS; 1.0 N for GAC light NiTi-CCS).¹⁶ The ranges of the deactivation FPs for the Ormco- and GAC-Conventional groups were 7.9 mm (10.2 mm to 2.3 mm) and 9.5 mm (9.6 mm to 0.2 mm), respectively (Table 2), which are similar to those obtained by Wichelhaus et al. [Ormco: 7.9 mm (11.4 mm to 3.5 mm); GAC: 10.2 mm (10.8 mm to 0.6 mm)].¹ Some of the noted differences in the start and end points of the deactivation FPs seem to have arisen from differences in the methods used to calculate the FP range.

In our testing, the change in the coiling direction resulted in significant changes in the force-deflection characteristics in the conventional NiTi-CCSs. In the Ormco- Reverse group, the entire deactivation FP shifted toward the origin point compared to that in the Ormco-Conventional group. The shift in the end point of the deactivation FP in the

(20)

Ormco-Reverse group (from 2.3 mm to 0.6 mm) may allow a consistent force to be maintained until the springs are almost fully deactivated. However, the shift in the start point of the deactivation FP in the Ormco-Reverse group (from 10.2 mm to 6.3 mm) may result in the application of a relatively high and rapidly decreasing force in the initial stage of spring application. This indicates the NiTi-CCSs in the Ormco-Reverse group would not be appropriate to be used in the initial stage of tooth movement when there is a large deformation of the spring; however, they may be useful when a constant force is required with only a small deformation of the spring (e.g., intrusion of the teeth).

On the other hand, in the GAC-Reverse group, the entire deactivation FP shifted away from the origin point compared to the GAC-Conventional group. The shift in the start point of the deactivation FP in the GAC-Reverse group (from 9.6 mm to 11.5 mm) may enable the springs to apply a constant force earlier in the initial stage of tooth movement. However, the shift in the end point of the deactivation FP in the GAC- Reverse group (from 0.2 mm to 3.3 mm) might hinder the maintenance of a consistent force as tooth movement progresses and the deflection of the spring reaches the end point of the deactivation FP.

According to the study of Wichelhaus et al.,¹ the GAC-Conventional and Ormco-Reverse groups exhibited the force-deflection characteristics of preactivated springs, while the Ormco-Conventional and GAC-Reverse groups exhibited those of un- preactivated springs (Figures 5 and 6). This suggests that as a result of the reversing procedure, the force-deflection characteristics of the un-preactivated springs changed to those of preactivated springs (from the Ormco-Conventional group to the Ormco-Reverse group, Figure 5) and vice versa (from the GAC-Conventional group to the GAC-Reverse

(21)

group, Figure 6). In this respect, the application of the reversing procedure in the Ormco- Conventional group may provide a torsional component to the wire,¹ which may produce the effect of preactivation in the springs. On the other hand, the same procedure in the GAC-Conventional group might eliminate the torsional component of the wire¹, thereby negating the preactivation introduced during the manufacturing process.

In NiTi-CCSs, further compression is impossible beyond their original state.

However, by rewinding the coil on the reverse direction, NiTi-CCSs can be compressed further beyond their original state, which can provide an initial tension to the springs. The mechanisms of these changes can be stated as follows. First, an initial tension can increase the amount of force required to extend the springs.¹⁴ Second, this initial tension causes an immediate increase in force right after the start of the activation curve. Third, because this initial tension is maintained until the end of the deactivation curve, a consistent force can be applied until the springs are almost fully deactivated. The changes in the force-deflection curve from the Ormco-Conventional group to the Ormco-Reverse group (Figure 5) suggest that the springs can be compressed and the initial tension can be provided by the reversing procedure. This initial tension could act as a biased torsional stress,¹ which would preactivate the springs. The observed increase in the force level in the Ormco-Reverse group compared to the Ormco-Conventional group (Figure 5) may be a result of the initial tension.

In contrast, the changes in the force-deflection curve from the GAC- Conventional group to the GAC-Reverse group (Figure 6) suggest that the GAC NiTi- CCSs were already in the compressed state and the reversing procedure served to decompress the springs, thus eliminating the initial tension. These changes also indicate

(22)

that reversing preactivated springs may eliminate the biased torsional stress¹ and thereby act to eliminate the effects of preactivation. The observed decrease in the force level in the GAC-Reverse group compared to the GAC-Conventional group (Figure 6) may be a result of eliminating the initial tension.

The mechanical hysteresis of the NiTi-CCSs also changed by rewinding the coil on the reverse direction. After applying the reversing procedure, the amount of mechanical hysteresis increased significantly in the Ormco-Reverse group compared to the Ormco-Conventional group (Δ0.6 N), while it decreased in the GAC-Reverse group compared to the GAC-Conventional group (Δ0.2 N) (Figures 5 and 6, Table 2). These changes also suggest that the Ormco and GAC NiTi-CCSs had undergone different manufacturing process in terms of applying bias stress to the springs.

Since rewinding the coil on the reverse direction of the NiTi-CCSs evaluated in this study affected the force-deflection characteristics, future studies should include other commercially available NiTi-CCSs to more fully elucidate the associated mechanism. In addition, while manufacturers do not normally state whether their NiTi-closed coil springs are preactivated or un-preactivated, this research would benefit from a clear understanding of the coiling direction and any applied preactivation. In addition, the effects of temperature changes and repeated mechanical stresses on the mechanical properties of reverse-wound NiTi-CCSs should be investigated in detail as these occur frequently in the oral cavity. Finally, further studies are needed to determine the likelihood of permanent deformation of NiTi-CCSs during reverse coiling. This can be assessed by measuring the changes in the coil diameter near the end of the CCS or by using differential scanning calorimetry.

(23)

VI. CONCLUSIONS

x The null hypothesis that rewinding the coil on the reverse direction of NiTi-CCS would not produce significant changes in the force-deflection characteristics, including the FP range, force level, and amount of mechanical hysteresis, was rejected.

x Two commercially available NiTi-CCS groups exhibited different patterns of changes in the force-deflection characteristics when the coiling direction was reversed.

x As a result of the reversing procedure, the force-deflection characteristics of the un- preactivated springs changed to those of preactivated springs (from the Ormco- Conventional group to the Ormco-Reverse group) and vice versa (from the GAC- Conventional group to the GAC-Reverse group).

(24)

VII. REFERENCES

1. Wichelhaus A, Brauchli L, Ball J, Mertmann M. Mechanical behavior and clinical application of nickel-titanium closed-coil springs under different stress levels and mechanical loading cycles. Am J Orthod Dentofacial Orthop. 2010;137:671-8.

2. Bezrouk A, Balsky L, Smutny M, Selke Krulichova I, Zahora J, Hanus J, et al.

Thermomechanical properties of nickel-titanium closed-coil springs and their implications for clinical practice. Am J Orthod Dentofacial Orthop. 2014;146:319-27.

3. Burstone CJ, Qin B, Morton JY. Chinese NiTi wire--a new orthodontic alloy. Am J Orthod. 1985;87:445-52.

4. Miura F, Mogi M, Ohura Y, Hamanaka H. The super-elastic property of the Japanese NiTi alloy wire for use in orthodontics. Am J Orthod Dentofacial Orthop. 1986;90:1- 10.

5. Miura F, Mogi M, Ohura Y, Karibe M. The super-elastic Japanese NiTi alloy wire for use in orthodontics. Part III. Studies on the Japanese NiTi alloy coil springs. Am J Orthod Dentofacial Orthop. 1988;94:89-96.

6. Maganzini AL, Wong AM, Ahmed MK. Forces of various nickel titanium closed coil springs. Angle Orthod. 2010;80:182-7.

7. Manhartsberger C, Seidenbusch W. Force delivery of Ni-Ti coil springs. Am J Orthod Dentofacial Orthop. 1996;109:8-21.

8. Ravipati RR, Sivakumar A, Sudhakar P, Padmapriya CV, Bhaskar M, Azharuddin M.

An adjustment in NiTi closed coil spring for an extended range of activation. Int J Orthod Milwaukee. 2014;25:21-2.

(25)

9. Vidoni G, Perinetti G, Antoniolli F, Castaldo A, Contardo L. Combined aging effects of strain and thermocycling on unload deflection modes of nickel-titanium closed-coil springs: An in-vitro comparative study. Am J Orthod Dentofacial Orthop.

2010;138:451–7.

10. Alavi S, Haerian A. The effects of aging process and preactivation on mechanical properties of nickel-titanium closed coil springs. Dent Res J (Isfahan). 2015;12:231-4.

11. Segner D, Ibe D. Properties of superelastic wires and their relevance to orthodontic treatment. Eur J Orthod. 1995;17:395-402.

12. Bartzela TN, Senn C, Wichelhaus A. Load-deflection characteristics of superelastic nickel-titanium wires. Angle Orthod. 2007;77:991-8.

13. Jee KK, Kim YB, Han JH. Method to provide initial tension for coil spring and its application, U.S. Patent 8,186,060.

14. Jee KK, Han JH, Jang WY. Improvement of actuating properties of a SMA coil spring by change in coil orientation. Materials Science Forum. 2013;738-739:589-94.

15. Santoro M, Nicolay OF, Cangialosi TJ. Pseudoelasticity and thermoelasticity of nickel-titanium alloys: a clinically oriented review. Part I: Temperature transitional ranges. Am J Orthod Dentofacial Orthop. 2001;119:587-93.

16. Vieira CI, Caldas SG, Martins LP, Martins RP. Superelasticity and force plateau of nickel-titanium springs: an in vitro study. Dental Press J Orthod. 2016;21:46-55.

17. Martins RP, Buschang PH, Gandini LG Jr. Group A T-loop for differential moment mechanics: an implant study. Am J Orthod Dentofacial Orthop. 2009;135:182-9.

18. von Fraunhofer JA, Bonds PW, Johnson BE. Force generation by orthodontic coil springs. Angle Orthod. 1993;63:145-8.

(26)

19. Tripolt H, Burstone CJ, Bantleon P, Manschiebel W. Force characteristics of nickel- titanium tension coil springs. Am J Orthod Dentofacial Orthop. 1999;115:498-507.

20. Vieira CI, Reis JMDSN, Vaz LG, Martins LP, Martins RP. Deformation of nickel- titanium closed coil springs: an in vitro study. Dental Press J Orthod. 2017:22:38-46.

21. Barwart O. The effect of temperature change on the load value of Japanese NiTi coil springs in the superelastic range. Am J Orthod Dentofacial Orthop. 1996;110:553-8.

(27)

FIGURE LEGENDS

Figure 1. Force-deflection characteristics of a nickel-titanium closed-coil spring (NiTi-

CCS). As shown, the deactivation force decreases rapidly (bold solid line) after the end point of the deactivation force plateau. However, if the end point of the deactivation force plateau is extended, the amount of deactivation force can be maintained until the spring is almost fully deactivated (bold dashed line).

G G G G

(28)

Figure 2. Procedure used to rewind the coil on the reverse direction of NiTi-CCSs. A.

Depiction of the reverse coiling procedure. The coiling direction is reversed by changing the order of the coil elements one by one. As a result, the order of “one-white-dot to five- white-dots” is changed into the order of “five-white-dots to one-white-dot.” B. The NiTi- CCS reverse coiling procedure used in this study.

G

(29)

Figure 3. NiTi-CCS groups investigated in this study.

(30)

Figure 4. Variables used in this study. A: deactivation force plateau (FP)-start point (mm);

B: deactivation FP-end point (mm). C: deactivation FP-range (mm), i.e., the distance

from A to B. D: force level at the midpoint (at 7 mm) of the activation curve (N). E: force level at the midpoint (at 7 mm) of the deactivation curve (N). F: amount of mechanical hysteresis (N), i.e., the difference in the force level between D and E.

(31)

Figure 5. Comparison of the force-deflection curves between the Ormco-Conventional and Ormco-Reverse groups.

(32)

Figure 6. Comparison of the force-deflection curves between the GAC-Conventional and GAC-Reverse groups.

(33)

Table 1. Characteristics of the nickel-titanium closed-coil springs (NiTi-CCSs) used in this study. Group Manufacturer Product name and catalog number Amount of force suggested by manufacturer

Length Total length from eyelet to eyelet Coil portion length Ormco NiTi-CCS

Ormco-Conventional Ormco Co. (Glendora, CA, USA)

NiTi extension spring light 222-5610 Not given 9.0 mm 3.3 mm Ormco-Reverse*- - - GAC NiTi-CCS

GAC-Conventional GAC International Inc. (Bohemia, NY, USA)

Coil springs light 10-000-03 100 g8.5 mm 3.2 mm GAC-Reverse* - - - * The Ormco-Reverse group was directly made from the Ormco-Conventional group by rewinding the coil on the reverse direction. Similarly, the GAC-Reverse group was made from the GAC-Conventional group. G GG G G G G G

(34)

Table 2. Comparison ofthe force-deflection characteristics between conventional and reverse-wound NiTi-CCS. Mann-Whitney U test was performed. ***, P < 0.001G

Measurements

Ormco NiTi-CCS groupsGAC NiTi-CCS groups Ormco-conventional group (N=20) Ormco-Reverse group (N=20)p-valueComparison GAC-conventional group (N=20)

GAC-Reverse group (N=20)p-valueComparison MeanSDMeanSDMeanSDMeanSD Deactivation force plateau

Start point (mm) 10.17 0.27 6.26 0.92 < 0.001 *** Ormco-Reverse< Ormco-Conventional 9.63 0.23 11.51 0.18 < 0.001 *** GAC-Conventional< GAC-Reverse End point (mm) 2.26 0.21 0.62 0.54 < 0.001 *** Ormco-Reverse< Ormco-Conventional 0.16 0.04 3.30 0.23 < 0.001 *** GAC-Conventional< GAC-Reverse Range (mm) 7.91 0.34 5.64 0.93 < 0.001 *** Ormco-Reverse< Ormco-Conventional 9.47 0.21 8.21 0.29 < 0.001 *** GAC-Conventional> GAC-Reverse Force level at the midpoint (7 mm)

Activation curve (N)2.10 0.05 2.77 0.12 < 0.001 *** Ormco-Reverse> Ormco-Conventional 1.67 0.04 1.38 0.04 < 0.001 *** GAC-Conventional> GAC-Reverse Deactivation curve (N)1.15 0.08 1.27 0.08 < 0.001 *** Ormco-Reverse> Ormco-Conventional 1.06 0.03 0.94 0.04 < 0.001 *** GAC-Conventional> GAC-Reverse Mechanical hysteresis (N)0.95 0.06 1.50 0.14 < 0.001 *** Ormco-Reverse> Ormco-Conventional 0.61 0.03 0.44 0.03 < 0.001 *** GAC-Conventional> GAC-Reverse

(35)

ሇ

ሇῒㆢ᳷#

#

Ni-Ti Closed Coil Spring ⩪▶# #

Frlo# ⃃㨿⯞# ₲រᳶ# ᢲႪᜮ# ᄝⰎ# ⯫Ჿ0

⅚㪯# ᆚᅞ⩪# ₒ㋲ᜮ# ⪛㨿#

#

₯# 㫲# 㪯#

▶⭒រ㧳ᇪ# រ㧳⭪# ㋲⯲ᆖ㧳ᆖ# ㋲ᆖᇪⲯ㧳# Ⲟᆏ#

+⹚ᡞᇪ⚲=# ⃋# ❓# 㧳,#

# #

ὃⲛ=# →# ⪊ሆ⯲# ὃⲛ⯚# ᝢ㎢# 㞊㕚᜞# forvhg# frlo# vsulqj# +QlWl0FFV,⩪▶#

frlo# ⃃㨿⯞# ₲រᳶ# ᢲႪᜮ# ᄝⰎ# ⯫Ჿ0⅚㪯ᆚᅞ⩪# ₒ㋲ᜮ# ⪛㨿⯞# ⴊ╆㧲ᜮ#

ᄝⰎ⩢᝾1#

#

⃃ℯ=# ⪊ሆរ╛⯚# ❶㞪ⶫⰒ# ᣪ# ⴟᷲ⯲# QlWl0FFVሊ# +㰲=# 433j># ㆷ# ዒⰎ=#

;180<13# pp,ᆖ# ⪇⃃㨿⯖ᳶ# Ⴊዎ# ᣪ# ⴟᷲ⯲# QlWl0FFVሊ⯖ᳶ# ሆ○ᢲ⩢᝾#

+Rupfr0Frqyhqwlrqdo# jurxs# yv1# Rupfr0Uhyhuvh# jurxs/# JDF0 Frqyhqwlrqdo# jurxs#yv1#JDF0Uhyhuvh# jurxs/#q@53#shu#jurxs,1# Rupfr0 Frqyhqwlrqdo# jurxs⯚# ╆Ⲟ# 㫶○㫮# ᢲ⹚# ⧤⯚# QlWl0FFV⯲# ⯫Ჿ0⅚㪯#

㝓○⯞# ↎⪚⯖Ἂ/# JDF0Frqyhqwlrqdo# jurxs⯚# ╆Ⲟ# 㫶○㫮# ᢶ# QlWl0FFV⯲#

⯫Ჿ0⅚㪯# 㝓○⯞# ↎⪚᝾1# ⪇⃃㨿⯖ᳶ# Ⴊዎ# QlWl0FFVᜮ# ዊⴎ# QlWl0FFV⯲#

frlo# ⃃㨿⯞# ₲រᳶ# ᢲႪ⧞# ⲶⰫᢲ⩢᝾1# ሆႯ# ᕎ# ⫂ᡞ# +6:# 佳# 4佻F,ᳶ# ⮺⹚ᢶ#

dfu|olf# fkdpehu# ᕎ⩪▶# ႛ# ሊ⩪# រ㨎# Ⱂⰿ# ❶㩲⯞# ⚲㨣㧲⪚᝾1# ႛ# ሊ⩪▶#

㕢㧲ⶫ# ❶# irufh# sodwhdx⯲# ℮⮞# ₩# 㰲⯲# 㔆ዊ/# k|vwhuhvlvḖ# ㊻ⲯ㧶# 㭞#

㙏ᅞ∞▷⯞# ❶㨣㧲⪚᝾1#

(36)

ᅊ

ᅊᆖ=# Rupfr0Uhyhuvh# jurxs⯚# Rupfr0Frqyhqwlrqdo# jurxs⩪# ⋞㨎#

㕢㧲ⶫ❶# irufh# sodwhdx⯲# ⴟⲪⰎ# ኒᰲ㦞⯲# ⭪Ⲫ⯞# 㨿㨎# Ⰾᡳ㧲⪚ᅺ/# 㰲⯲#

㔆ዊႚ# ⸷ႚ㧲⪚⯖Ἂ/# k|vwhuhvlvႚ# ⸷ႚ㧲⪚᝾1# Rupfr0Frqyhqwlrqdo#

jurxs⩪▶# Rupfr0Uhyhuvh#jurxs⯖ᳶ⯲# ῖ○# ⅚㫮ᜮ# Ⱆⲯ㧶# 㰲Ⰾ# vsulqjⰎ#

ᄊ⯲# ⫞Ⲟ㰢# 㕢㧲ⶫ# ᢺ# ᧦ዦ⹚# ⮺⹚ᢺ# ⚲# Ⱒ᝾ᜮ# ᄝ⯞# ⯲ₒ㧶᝾1# ᪪㧶/# frlo#

⃃㨿⯞# ₲រᳶ# ᢲႪ⯦⯖ᳶ⠂# ╆Ⲟ# 㫶○㫮# ᢲ⹚# ⧤⯚# ⯫Ჿ0⅚㪯# 㝓○⯞#

↎Ⰾᜮ# QlWl0FFV+Rupfr0Frqyhqwlrqdo# jurxs,ႚ# ╆Ⲟ# 㫶○㫮# ᢶ# ⯫Ჿ0

⅚㪯# 㝓○⯞# ↎Ⰾᜮ# QlWl0FFV+Rupfr0Uhyhuvh# jurxs,ᳶ# ⅚㫮㧲⪚᝾1#

₲រᳶ# JDF0Uhyhuvh# jurxs⯚# JDF0Frqyhqwlrqdo# jurxs⩪# ⋞㨎# 㕢㧲ⶫ❶#

irufh# sodwhdx⯲# ⴟⲪⰎ# ኒᰲ㦞⯲# ⭪Ⲫ⯖ᳶ√㗊# Ớ⩎⹚ᜮ# ⃃㨿⯖ᳶ#

Ⰾᡳ㧲⪚ᅺ/# 㰲⯲# 㔆ዊႚ# Ⴊ☦㧲⪚⯖Ἂ/# k|vwhuhvlvႚ# Ⴊ☦㧲⪚᝾1# JDF0 Frqyhqwlrqdo# jurxs⩪▶# JDF0Uhyhuvh# jurxs⯖ᳶ⯲# ῖ○# ⅚㫮ᜮ# 㕢㧲ⶫ#

❶# Ⱆⲯ㧶# 㰲Ⰾ# ᓷዦ⹚# ⮺⹚# ᢲᜮ# ᄝ⯞# ⃃㨎㧺# ⚲# Ⱒ᝾1## ᪪㧶/# frlo# ⃃㨿⯞#

₲រᳶ# ᢲႪ⯦⯖ᳶ⠂# ╆Ⲟ# 㫶○㫮# ᢶ# ⯫Ჿ0⅚㪯# 㝓○⯞# ↎Ⰾᜮ# QlWl0 FFV+JDF0Frqyhqwlrqdo# jurxs,ႚ# ╆Ⲟ# 㫶○㫮# ᢲ⹚# ⧤⯚# ⯫Ჿ0⅚㪯#

㝓○⯞# ↎Ⰾᜮ# QlWl0FFV+JDF0Uhyhuvh#jurxs,ᳶ# ⅚㫮㧲⪚᝾1##

#

ᅊᳺ=# 5Ⴖ⯲# ❾㩲ሊ⩪▶# QlWl0FFV⯲# frlo# ⃃㨿⯞# ₲រᳶ# ᢲႪ⧲⯞# ᧦# ⯫Ჿ0

⅚㪯ᆚᅞ⩪▶# ᝾Ḓ# ⨫╛⯲# ῖ○# ⅚㫮Ḗ# ↎⪚᝾1# Frlo# ⃃㨿⯞# ₲រᳶ#

ᢲႪ⯦⯖ᳶ⠂/# ╆Ⲟ# 㫶○㫮# ᢲ⹚# ⧤⯚# ⯫Ჿ0⅚㪯# 㝓○⯞# ↎Ⰾᜮ# QlWl0 FFV+Rupfr0Frqyhqwlrqdo# jurxs,ᜮ# ╆Ⲟ# 㫶○㫮# ᢶ# ⯫Ჿ0⅚㪯# 㝓○⯞#

↎Ⰾᜮ# QlWl0FFV+Rupfr0Uhyhuvh# jurxs,ᳶ# ⅚㫮㧲⪚ᅺ/# ╆Ⲟ# 㫶○㫮# ᢶ#

⯫Ჿ0⅚㪯# 㝓○⯞# ↎Ⰾᜮ# QlWl0FFV+JDF0Frqyhqwlrqdo# jurxs,ᜮ# ╆Ⲟ#

㫶○㫮# ᢲ⹚# ⧤⯚# ⯫Ჿ0⅚㪯# 㝓○⯞# ↎Ⰾᜮ# QlWl0FFV+JDF0Uhyhuvh#

jurxs,ᳶ# ⅚㫮㧲⪚᝾1#

#

(37)

#

## # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # ⶖ⬮⩎: ᝢ㎢0㕚Ⰾ㕚᜞# forvhg0frlo#vsulqj/#irufh#sodwhdx⯲# ℮⮞/#

phfkdqlfdo#k|vwhuhvlv⯲# ⨫/# ⯫Ჿ0⅚㪯# 㝓○/#frlo# ⃃㨿⯞# ₲រᳶ# ᢲႪ⯦#

㧳™=#53480645::##