Ted Rothstein, DDS, PhD
Specialist in Orthodontics for Adults and Kids since 1973
How the jaws are wired together (Photos A-F below...click on pic to enlarge):
May 3, 2006:
A new method to wire the jaws together that allows postioning the jaws at
any dimension of mouth opening
[See the method]
JANUARY 8, 2004
Introduction: The wire used is Rocky Mountain .014 "dead soft" ligature wire (E-126). It comes in other sizes: .015 (E-127) and .016 (E-128). The instruments needed include a wire cutter and a "back-locking" hemostat or any instrument that can grab the two ends of the wire to twist them together. I prefer to use a 5½" Mathieu Needle Holder, see photo. Placing the wire can be done in 1-2 minutes. Patients can be shown the method on a demonstration mold with brackets which the dentist/orthodontist can make with ease. Typically the premolars and canines are bracketed simple because it is easier for a patient to rewire themselves if need be. However, one could just as well opt to bracket the first molars and the second and first premolars, where the patient would be highly displeased with having a brackets show on the upper right and left canines, which would tend more to be displayed when smiling.
The patient must be shown how to keep the teeth together as gently as possible. The patient must NOT EVER clench tightly.
For convenience use a piece about 9" long. In the diagram below I have indicated the mid-point of the wire by drawing it thicker (see tooth marked 1)... the upper right 2nd premolar... dentists know this tooth as number 4 in the dental arch.
Place the wire around 1 (Fig A) and temporarily move the upper strand upward out of the way. Begin wrapping the lower strand into the notch of the bracket. (Brackets of every kind have some kind of notch on them.) The sequence of wrapping the lower strand of wire is as follows: tooth 1,2,3 and lastly tooth number 6.
Then begin wrapping the upper wire: its sequence is 1, 4, 5 and lastly 6 where it then joins with the lower wire. See figure F.
The two strands are crossed about 1/4" from tooth number 6 in the direction of "5 0'clock." The strands of the wire are then taken in the beaks of a back-locking hemostat and twisted about 4-6 times
The provider must emphasize that the patient feel comfortable at all times.
The final twists of the wire (twist 5, or 6, and ?7?) should done in conjunction with the patient's experience of pressure which should be NONE AT ALL. A wire cutter is used to remove the excess wire and the tail of 1/4" or less which remains is tucked upward under the upper tooth.
When the twisting is complete the patient should be able to move their jaws about 1mm. in all directions (less than 1/16").
I advise you now show the patient how to cut the wire so as to remove it and have them do it If only to show them how easy it can be done.
Now
Finally. use the same wire wrapping sequence on the left side, making sure the patient feels evenly wired on the right and left sides.
Instruct the patient to carry wire cutters on AT ALL TIMES.
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