Orthodontic Wire Sequences and Treatment Efficiency: A Systematic Review

Abstract

The selection and sequencing of orthodontic wires are crucial to the effectiveness and comfort of orthodontic therapy. This systematic review examines the mechanical properties, clinical outcomes, and patient-reported pain and treatment duration of commonly used orthodontic wires, including nickel-titanium (NiTi), stainless steel (SS), copper-nickel-titanium (Cu-NiTi), and titanium-molybdenum alloy (TMA). The review analyzes several wire sequences, ranging from direct (NiTi to SS) to progressive (NiTi followed by harder wires), and examines their implications on treatment efficiency, arch alignment, occlusal correction, and root resorption. Special emphasis is placed on the effect of wire selection on patient discomfort, with Cu-NiTi wires being frequently associated with less early pain than ordinary NiTi wires. The combination of evidence from randomized controlled trials, cohort studies, and clinical trials highlights the trade-offs between faster alignment and the potential for higher discomfort or root resorption with shorter wire sequences. Despite substantial evidence, the review identifies gaps in our understanding of wire biomechanical properties under various clinical situations, as well as the long-term effects of specific wire sequences. Future research should focus on refining wire selection and sequencing to improve patient outcomes while reducing side effects.