In the clinic we have a cabinet full of our wires. We have them set up from lightest-thickest like shown below. Our standard wire sequence is as followed

R O U N D

In the initial light round wire phase, arch-wires are carefully selected to minimize binding between the "tube" of the passive self-ligating bracket and the archwire. This allows sliding of the teeth and brackets along the wire as they start to level and align.

With the Damon System, the intent of the initial light round archwires is to apply just enough force to stimulate cellular activity without crushing the vascular supply in the periodontium. This has been defined as staying in the "optimal force zone" or biozone. If the appropriate force is applied, the muscles of the face and lips give a "lip bumper" effect on the incisors, minimizing anterior tipping.

The intent of the initial archwire is not to remove all of the rotations, but to align teeth and bracket slots just enough to move to the second phase of archwire progression. This is best accomplished by taking advantage of using a small dimension archwire in the large lumen of the bracket. An analogy of this phase of treatment is a car being driven on both sides of a curving highway to straighten out the bends in the road. This same principle of archwire and tube helps minimize the force and binding friction.

To summarize: The initial phase starts tooth movement, rotation control, leveling, aligning, arch form, and prepares for the second phase of archwire sequencing.

• .013 or .014 (Round): If your patient has never had braces before and has extreme crowding, you would choose the .013 CuNiTi wire U/L. If your patient has never had braces before and has slight crowding, you would choose the .014 CuNiTi wire U/L. 013 is the lightest wire we use. This wire is used only for patients who get their braces on and have extreme crowding. This wire will work out crowding and rotation without too much force. This patient is a perfect example for choosing to use an 013 wire for her upper arch. We probably could've used an 014 but the patient may experience a lot of soreness for the first couple weeks. Both of these wires work out rotation and start the process of straightening and broadening the arches. This wire is placed U6-6 and L5-5 (cinched) and stays in for 10 weeks, moving the teeth the whole time.

• .016 or .018(Round): These wires are the next set of round wires that prepare the transition into rectangular wires. If a patient started out with an .013 wire and went 8-10 weeks until their next appointment, you would most likely choose a .016 rather than the .018. The way you would determine this is how much crowding that patient has when they come back to their second appointment. If there isn't much crowding you could probably skip the .016 and place the .018. If you are unsure, your clinical lead can help you with that decision. If a patient starts out with an 014 but had quite a bit of crowding initially, their second wire would be the .018. This wire does extend upper and lower 7-7 (or 6-6 if second molars are not in) and will only stay in for 6-8 weeks. Because they are a transition wire, they might only need a few weeks to prepare for the rectangular wire.

R E C T A N G U L A R

The second, or high-tech edgewise phase, is the "heart and soul" of the Damon System. This phase starts working on torque, root angulations and levels, completes rotation control, continues arch form development, consolidates space in the anterior segments, and prepares for the third phase of archwire sequencing.

• 14x25 (Rectangular): This wire can be placed either after the .014 wire or after the .018 wire. There are two questions you need to ask yourself and the patient before you decide to skip the .018 and go straight to the 14x25.

1. Ask your patient how much soreness they had after they got their braces on. If they said they were pretty sore for a good week, then you probably shouldn't place the .014x.025CuTi wires. You would place the .018 U/L for 6 weeks and then have them come back for an appointment to place .014x.025CuTi U/L.

2. Another question you need to ask yourself is how much crowding does this patient still have? If the teeth are still overlapping but the patient said they did not have much soreness, you should probably still place the .018 wires. Often times we skip the .018 wires and go straight to the .014x.025CuTi U/L and when engaging the wires the brackets will break (its usually the 4's and 5's that break).

If a patient has a tiny bit of crowding when they first get their braces on, they may go for a full 10-12 weeks and come back in to be ready for the .014x.025CuTi wires. If they come back and are not ready for the 14x25's, you would place .018's for only 6 weeks.

Every patient will get this wire at some point in treatment. This is not a transitional wire. The .014x.025CuTi will start to express torque, continue to rotate/move teeth and start the broadening process to create that beautiful arch shape. This wire will stay in for a full 8-10 weeks.

**There is one other thing you need to know that comes with this wire, *WIRE-TIES ( common tie)* When a 14x25 or greater is placed, a wire tie is always placed 3-3 to prevent spacing as we broaden, UNLESS there is crowding. Wire ties are discussed later in the manual and you will be taught how to place one! If a wire tie is not placed at a 14x25 or greater then it should always be charted why!!**

• 18x25 U/16x25 L (Rectangular): This set of wires are always placed after the 14x25CuTi. This set is never skipped and a patient always has to have this wire at some point in their treatment. The 18x25CuTi is placed on the upper and the 16x25CuTi is placed on the lower. The lower teeth will almost never get an 18x25CuTi. The reason for this is because of torque expression. We have noticed in the past that when we would place this wire in the U/L, they would come back in 8 weeks and their lower arch is almost in cross-bite. So a few years ago we started making it protocol that the lower wire doesn't go greater than a 16x25 (this includes 16x25CuTi 16x25 SS or TMA). Now there are rare occasions that we do want an 18x25CuTi in the lower, but the doctor will specify when that is necessary.

This wire also requires a patient to be wire tied U/L3-3 if they aren't already wire tied. By now mostly all rotations should be worked out so the patient should definitely have a wire tie placed.

This wire is also the wire we would start to close spacing using a power chain. The goal is to have mostly all spacing closed by their next appointment which will be in 8 weeks.

Their next appointment will be in 8 weeks for their pano/reposition visit

• 17x25 Reverse Curve: A Reverse curve archwire is used when the patient has a severe deep bite. This wire is only placed when there is an 18x25 CuNiti in the upper. You would not want to place this wire when the patient has a smaller archwire because you can over expand the lower and put the patient into cross-bite. This wire is most effective when it can be placed lower 7-7, but if the second molars are not in, the reverse curve can still be used.

The reverse curve is typically placed when the 18x25 CuNiti is placed in the upper, before the pano repo visit. It will stay in for 6-8 weeks, but it can stay in as long as needed, you just want to make sure that the patient is coming to for regular visits so we can evaluate the bite and take it out before the bite completely opens up. The doctor will help the assistant evaluate and determine when the reverse curve should be taken out.

Finishing Wires

• 16x25 Upper or Lower (stainless Steel): After the pano repo appointment, the patient will come back in 4-6 weeks to place their finishing wires. The first appointment back they will get a 16x25 stainless steel wire in the upper and lower 7-7. The doctor will widen the arches and coordinate the wires. When these wires are placed the patient will come back every 4 weeks to adjust their finishing wires. In the stainless steel wires the doctor is able to add bends and torque as needed. The main goal of the finishing wires is to get the width of a beautiful frost smile so each time the wires come out, the doctor will broaden and coordinate the wires. We are also able to use stronger elastics in the stainless steel wires if we are working on bringing the bite together, but the elastic size will be determined by the doctor.

• 19x25 Upper Only (Stainless Steel): The 19x25 SS wire is only used in the upper arch! After the 16x25 SS is placed in the upper for the first time, the patient will come back 4-6 weeks later and we will switch out the upper for a 19x25. It will always be placed if we are working with strong elastics, springs, intrusion, etc. The goal is to finish every case in a 19x25 SS in the upper for ideal width, but a 19x25 SS is not place when :

  • • • ***We do not want to fully express the torque! For example, if the patients initial treatment plan was high torque upper 3-3 and now we are in final wires and the teeth are in the ideal position and upright, we would not want to express the high torque brackets with a 19x25 SS wire because it would flare the teeth!

      • ***When the teeth are in the right position as far as torque, but we have to work on major bends or arch width! Bends are a lot more effective when placed in a 16x25 SS. If large bends are placed in a 19x25 SS wire and then engaged, it can break the bracket, ESPECIALLY IN CLEAR BRACKETS! We can also broaden the upper 16x25 SS to get more width without flaring the posterior segments.

• 19x25 TMA(Upper) and 17x25 TMA(lower): This is an alternative finishing archwire to the stainless steel. The TMA wires have more flexibility and allow stronger torque and bends to be made, but do not achieve maximum arch width. These wires are typically used for phase I patients, or in comprehensive cases that we have achieved maximum arch width. TMA wires are also great for patients that have very sensitive teeth and we need lighter forces in the finishing stages. These wires are rarely used in our practice, because for beautiful Frost Smiles stainless steel wires are idea, that is where the doctors make the magic happen! But, we always have TMA wires available to use as needed.