CC BY 4.0 · European Journal of General Dentistry 2022; 11(03): 173-180
DOI: 10.1055/s-0042-1750088
Original Article

Alignment Efficiency of Nickel-Free Niobium–Titanium–Tantalum–Zirconium Compared to Nickel–Titanium Orthodontic Archwires during Initial Treatment Phase: A Randomized Controlled Trial

Ahmed T. Hussein
1   Department of Orthodontics, Faculty of Dental Medicine (Boys), Al-Azhar University, Cairo, Egypt
Ahmed M. Abouelnour
1   Department of Orthodontics, Faculty of Dental Medicine (Boys), Al-Azhar University, Cairo, Egypt
Farouk A. Hussein
1   Department of Orthodontics, Faculty of Dental Medicine (Boys), Al-Azhar University, Cairo, Egypt
› Author Affiliations


Objective This randomized controlled trial investigated the efficiency of nickel–titanium (NiTi) and nickel-free archwires during the initial leveling and alignment stage.

Materials and Methods A total of 30 patients (mean age, 17.81 ± 1.96 years) were randomly grouped to receive either single-strand or niobium–titanium–tantalum–zirconium (nickel-free Gummetal), or multistrand NiTi archwires. All the patients had moderate anterior crowding and were treated via a nonextraction approach. Three-dimensional digital models were taken at baseline (T0) and 4-week intervals for three months (T1, T2, and T3). The amount and percentage variations in Little's Irregularity Index (LII) scores during the 3-month observation period were used to estimate alignment efficiency and rate.

Statistical Analysis The Analysis of variance (ANOVA) and Kruskall–Wallis tests were used to test the differences between the three archwire groups. The difference between variables within each group at different measurement intervals was assessed using paired t-test.

Results The LII scores were reduced in all the three archwire groups; however, there were insignificant differences in the scores between the tested archwire groups (p < 0.05). For the single-strand NiTi group, the LII scores reduced by 2.15 mm (28.38%) after 4 weeks (T1) by 3.79 mm (47.93%) after 8 weeks (T2), and by 5.61 mm (73.98%) after 12 weeks (T3). The LII scores decreased by 1.90 mm (26.93%) after 4 weeks, 3.59 mm (50.84%) after 8 weeks, and 5.28 mm (74.85%) after 12 weeks with Gummetal archwire. Similar to the other groups, the LII scores for multistrand archwire reduced by 1.82 (27.83%), 3.34 (51.07%), and 4.54 mm (69.38%) at T1, T2, and T3, respectively. There was nonsignificant differences in the alignment rates (mm) and percentage (%) of changes among the groups at all measurement intervals (p > 0.05).

Conclusion All three tested archwires were equally effective for correcting moderate mandibular anterior crowding. Furthermore, all three archwires produced a comparable rate of alignment after 12 weeks of initiating orthodontic therapy.

Publication History

Article published online:
18 July 2022

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  • References

  • 1 Abdelrahman RSh, Al-Nimri KS, Al Maaitah EF. A clinical comparison of three aligning archwires in terms of alignment efficiency: a prospective clinical trial. Angle Orthod 2015; 85 (03) 434-439
  • 2 Fleming PS, DiBiase AT, Sarri G, Lee RT. Comparison of mandibular arch changes during alignment and leveling with 2 preadjusted edgewise appliances. Am J Orthod Dentofacial Orthop 2009; 136 (03) 340-347
  • 3 Gravina MA, Brunharo IH, Fraga MR. et al. Clinical evaluation of dental alignment and leveling with three different types of orthodontic wires. Dental Press J Orthod 2013; 18 (06) 31-37
  • 4 Riley M, Bearn DR. A systematic review of clinical trials of aligning archwires. J Orthod 2009; 36 (01) 42-51 , discussion 15
  • 5 Gölz L, Papageorgiou SN, Jäger A. Nickel hypersensitivity and orthodontic treatment: a systematic review and meta-analysis. Contact Dermat 2015; 73 (01) 1-14
  • 6 Dalstra M, Denes G, Melsen B. Titanium-niobium, a new finishing wire alloy. Clin Orthod Res 2000; 3 (01) 6-14
  • 7 Suzuki A, Kanetaka H, Shimizu Y. et al. Orthodontic buccal tooth movement by nickel-free titanium-based shape memory and superelastic alloy wire. Angle Orthod 2006; 76 (06) 1041-1046
  • 8 Nordstrom B, Shoji T, Anderson WC. et al. Comparison of changes in irregularity and transverse width with nickel-titanium and niobium-titanium-tantalum-zirconium archwires during initial orthodontic alignment in adolescents: A double-blind randomized clinical trial. Angle Orthod 2018; 88 (03) 348-354
  • 9 Ong E, Ho C, Miles P. Alignment efficiency and discomfort of three orthodontic archwire sequences: a randomized clinical trial. J Orthod 2011; 38 (01) 32-39
  • 10 Rucker BK, Kusy RP. Elastic flexural properties of multistranded stainless steel versus conventional nickel titanium archwires. Angle Orthod 2002; 72 (04) 302-309
  • 11 Sebastian B. Alignment efficiency of superelastic coaxial nickel-titanium vs superelastic single-stranded nickel-titanium in relieving mandibular anterior crowding: a randomized controlled prospective study. Angle Orthod 2012; 82 (04) 703-708
  • 12 Cobb III NW, Kula KS, Phillips C, Proffit WR. Efficiency of multi-strand steel, superelastic Ni-Ti and ion-implanted Ni-Ti archwires for initial alignment. Clin Orthod Res 1998; 1 (01) 12-19
  • 13 Sandhu SS, Shetty VS, Mogra S, Varghese J, Sandhu J, Sandhu JS. Efficiency, behavior, and clinical properties of superelastic NiTi versus multistranded stainless steel wires: a prospective clinical trial. Angle Orthod 2012; 82 (05) 915-921
  • 14 Little RM. The irregularity index: a quantitative score of mandibular anterior alignment. Am J Orthod 1975; 68 (05) 554-563
  • 15 Gok F, Buyuk SK, Ozkan S, Benkli YA. Comparison of arch width and depth changes and pain/discomfort with conventional and copper Ni-Ti archwires for mandibular arch alignment. J World Fed Orthod 2018; 7: 24-28
  • 16 O'Brien K, Lewis D, Shaw W, Combe E. A clinical trial of aligning archwires. Eur J Orthod 1990; 12 (04) 380-384
  • 17 Pandis N, Polychronopoulou A, Eliades T. Alleviation of mandibular anterior crowding with copper-nickel-titanium vs nickel-titanium wires: a double-blind randomized control trial. Am J Orthod Dentofacial Orthop 2009; 136 (02) 152.e1-152.e7 , discussion 152–153
  • 18 Kapila S, Sachdeva R. Mechanical properties and clinical applications of orthodontic wires. Am J Orthod Dentofacial Orthop 1989; 96 (02) 100-109
  • 19 Murakami T, Iijima M, Muguruma T, Yano F, Kawashima I, Mizoguchi I. High-cycle fatigue behavior of beta-titanium orthodontic wires. Dent Mater J 2015; 34 (02) 189-195
  • 20 Niinomi M. Fatigue performance and cyto-toxicity of low rigidity titanium alloy, Ti-29Nb-13Ta-4.6Zr. Biomaterials 2003; 24 (16) 2673-2683
  • 21 Goonewardene RW, Goonewardene MS, Razza JM, Murray K. Accuracy and validity of space analysis and irregularity index measurements using digital models. Aust Orthod J 2008; 24 (02) 83-90
  • 22 Sousa MV, Vasconcelos EC, Janson G, Garib D, Pinzan A. Accuracy and reproducibility of 3-dimensional digital model measurements. Am J Orthod Dentofacial Orthop 2012; 142 (02) 269-273
  • 23 Wiranto MG, Engelbrecht WP, Tutein Nolthenius HE, van der Meer WJ, Ren Y. Validity, reliability, and reproducibility of linear measurements on digital models obtained from intraoral and cone-beam computed tomography scans of alginate impressions. Am J Orthod Dentofacial Orthop 2013; 143 (01) 140-147
  • 24 Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. St. Louis, MO: Mosby Elsevier; 2007
  • 25 Berger J, Waram T. Force levels of nickel titanium initial archwires. J Clin Orthod 2007; 41 (05) 286-292
  • 26 Gordin DM, Ion R, Vasilescu C, Drob SI, Cimpean A, Gloriant T. Potentiality of the “Gum Metal” titanium-based alloy for biomedical applications. Mater Sci Eng C 2014; 44: 362-370
  • 27 Guo Y-y, Cheng M-q, Chen D-s, Xue X-b, Zhang X-l. In vitro corrosion resistance and cytotoxicity of novel TiNbTaZr alloy. Trans Nonferrous Met Soc 2012; 22: s175-s80