Two-Couple Orthodontic Appliance

Systems: Activations in the

Transverse Dimension
Joe RebeUato

Partially bracketed arch wires can be activated in the transverse dimension

to produce first-order rotations of the molars and constriction or expansion
of intermolar width. A 2 x 6 arch wire is ideal for such activations because of
the minimal side effects to the anterior teeth. As with other two-couple
o r t h o d o n t i c appliance systems, symmetrical V-bends, a s y m m e t r i c a l
V-bends and step bends are used to generate moments of the couples
whose associated equilibrium forces can be used to produce desired tooth
movement.
Copyright © 1995 by W.B. Saunders Company

A 2 × 6 arch wire is a partially bracketed, Symmetrical V-bends, asymmetrical

two-couple appliance system that can be
activated in the transverse dimension, result-
ing in first-order rotations o f the molars and
c o n s t r i c t i o n or expansion of intermolar width,
with minimal side effects to the anterior teeth
and premolars. Although wire bends in other
dimensions are certainly possible, this section
will deal exclusively with couples, m o m e n t s o f
the couples (Mcs) and their associated equilib-
rium ibrces g e n e r a t e d in the occlusal plane.
Partially bracketed appliance systems such
as the torquing arch and the utility arch 1'2 (di-
agrammatically r e p r e s e n t e d as two-bracket sys-
tems) have the advantage of long wire spans
resulting in low load deflection rate properties
and a wide range of activeness. T h e long span
facilitates a m o r e accurate placement o f bends
in the wire to create dissimilar couples, that is,
couples whose associated equilibrium forces
will not cancel each o t h e r out. Although the
associated equilibrium forces can be the source
o f clinical surprises if not p r o p e r l y u n d e r -
stood, they can be harnessed in long span ap-
pliances to p r o d u c e desired tooth movement.
From the Department of Orthodontics, School of DentistTy,
Medical College of Virginia, Virginia Commonwealth University,
Richmond, VA.
Address reprint requests to Joe Rebellato, DDS, Department of
Orthodontics, School o["Dentistu, Medical College of Virginia,
Virginia Commonwealth University, PO Box 980566, Rich-
mond, VA 23298-0566.
Copyright © 1995 W.B. Saunders Company
1073-8746/95/0101-000555.00/0
V-bends and step bends are the three basic cate-
gories o f wire bends used in p r o d u c i n g couples
in a two-bracket o r t h o d o n t i c appliance system.
T h e s e principles apply to a 2 × 6 arch wire
because it is a two-couple system. :~ A rectangu-
lar wire is used and, in this case, bends are
made in the transverse (occlusal plane) dimen-
sion to generate couples at the molar and ca-
nine brackets. T h e r e s u h a n t Mcs are for first-
o r d e r rotations and their associated equilib-
rium forces are transversely o r i e n t e d in the
occlusa] plane. Because o f the fact that the
transverse force systems are applied coronally
to the Cae ~, a t h i r d - o r d e r rotation is always cre-
ated. Some molar t h i r d - o r d e r control is inher-
ent because of the edgewise nature o f the arch
wire but, if m o r e torque control is required,
the transpatatal arch may be a better choice.
However, if the molar bands are not e q u i p p e d
with lingual sheaths, the 2 x 6 arch wire is still
a good option.
T h e 2 x 6 arch wire can be used in a fully
b r a c k e t e d dentition by placing c o n v e n i e n c e
bends to bypass the p r e m o l a r brackets. T h e s e
bends should remain passive as the appliance is
inserted and will not contribute toward the
generation o f couples or forces by the active
appliance.
T r a n s v e r s e activations can be placed in a 2
x 2 or 2 x 4 orthodontic appliance system.
However, the best feature of the 2 x 6 arch
wire is the ability to control molar first-order
rotations and intermolar width with minimal

Seminars in Orthodontics, Vol 1, No 1 (March), I995: pp 37-43 37

38 Joe Rebellato

side effects to the a n t e r i o r teeth. This is be-

cause the 2 x 6 arch wire has an a n t e r i o r seg-
~ m

m e n t of six teeth that can be visualized as one

large tooth. 4'5 T h e r e d u c e d wire tlexibility in
the short i n t e r b r a c k e t distances between the
4-m

a n t e r i o r teeth tends to k e e p the canines f r o m

m o v i n g i n d e p e n d e n t l y o f the segment. T h e r e -
fore, the o r t h o d o n t i c effects o f the 2 x 6 arch
wire involve p r e d o m i n a n t l y m o l a r m o v e m e n t .
This is particularly true if identical bends are
placed bilaterally on the 2 x 6 arch wire be-
cause equal and opposite Mcs a n d / o r forces on
the left a n d right canine will tend to cancel out
if the a n t e r i o r s e g m e n t is visualized as o n e
large tooth. Clinically, some side efl'ects to the
canines can still be observed because the wire
in the a n t e r i o r s e g m e n t retains some tlexibility
despite the short i n t e r b r a c k e t distances.
T h e 2 x 6 arch wire systems discussed in
this section will assume the canine a n d m o l a r
bracket slots are collinear, a n d the wire be-
tween is a straight s e g m e n t b e l o r e activation.
Mc
Each activation o f the 2 x 6 arch wire will in-
volve identical and bilateral bends, and the sys- Figure 1. Placing a 2 x 6 arch wire with a symmet-
tem will be analyzed according to the princi- rical V-bend over the brackets in which it will be
inserted will reveal opposite but equal angles of wire
ples o f static m e c h a n i c s . A l t h o u g h f o r c e s entry at the two brackets.
p r e s e n t in two-bracket systems are statically in-
d e t e r m i n a t e , ~; clinical analysis is still possible to when the 2 x 6 arch wire is inserted (Fig 2).
d e t e r m i n e the l a r g e r m o m e n t p r e s e n t a n d , T h e left and right canine will both [eel D-out
t h e r e f o r e , tile direction of the net associated m o m e n t s o f the couples but these will tend to
equilibrium forces present in the wire at time cancel each o t h e r out if we visualize the ante-
point zero (ie, b e f o r e the teeth begin to move). rior s e g m e n t as o n e large tooth. Because the
equilibrium forces associated with the Mcs at
Symmetrical V-Bends tile canines a n d molars also cancel each o t h e r
out, only m o l a r M-out rotations remain.
W h e n a 2 x 6 arch wire with a symmetrical
V-bend is placed over the canine a n d m o l a r Clinical Uses
bracket slots, equal but inverse angles o f wire T h i s activation o f the 2 × 6 appliance is useful
entry are o b s e r v e d (Fig 1). T h e Mcs at both when bilateral M-out rotations o f the molars
brackets will also be equal in m a g n i t u d e but are desired without e x p a n s i o n o f i n t e r m o l a r
opposite in direction. T h e i r associated equilib- width (as m e a s u r e d at the CR~.~). T h e Cm.s o f
r i u m forces will cancel each o t h e r out a n d both maxillary molars has b e e n postulated to be lin-
teeth will only feel a t e n d e n c y to rotate a r o u n d gual to the c e n t r a l fossa f r o m an occlusal
their centers o f resistance ((;R~) in opposite s t a n d p o i n t and, b e c a u s e o f the r h o m b o i d a l
directions. shape o f m o l a r crowns, arch p e r i m e t e r is in-
creased a n d m o l a r M-out rotations help to-
Molar Mesial-Out Rotations w a r d the correction o f Class I I malocclusions. 7

Bilateral toe-in b e n d s m a d e a p p r o x i m a t e l y
halfway b e t w e e n the canine a n d m o l a r brack-
ets will result in m o l a r mesial-out (M-out) cou-
ples a n d c a n i n e d i s t a l - o u t (D-out) c o u p l e s
Molar Mesial-In Rotations
Bilateral toe-out bends made approximately
halfway between the canines and molars will
 Transverse Arch Wire Activations
Mc
Mc
Figure 2. Bilateral toe-ins located halfway between
the molar and canine brackets are symmetrical V-
bends. M-out rotations of the molars will be the pre-
dominant orthodontic effect in this case.
result in a diametrically o p p o s e d situation to
the o n e above with all couples, m o m e n t s and
forces reversed (Fig 3). T h e clinical result will
be bilateral m o l a r mesial-in (M-in) rotations
a r o u n d their respective CR~~.
Clinical Uses
Bilateral M-in rotations of the maxillary molars
to decrease arch p e r i m e t e r are often required
in u p p e r p r e m o l a r extraction cases to c o m p e n -
sate for small-sized maxillary second p r e m o -
lars.
A s y m m e t r i c a l V Bends
W h e n a 2 x 6 arch wire with an asymmetrical
V-bend is placed o v e r the canine and m o l a r
bracket slots, the larger angle o f wire entry
and, hence, the larger M c is shown (Fig 4).
This will d e t e r m i n e the direction but not the
m a g n i t u d e o f the net associated equilibrium
forces acting at each bracket, s-t°
Once again, if the b e n d is located halfway
along the posterior wire s e g m e n t between the
canine and m o l a r brackets, then the net equi-
39
Mc
Figure 3. Bilateral toe-outs located halfway between
the molar and canine brackets are symmetrical V-
bends. M-in molar rotations will occur and although
not intuitively obvious, no molar expansion will oc-
cur.
librium force acting at each bracket is zero be-
cause the two Mcs are equal a n d opposite. As
the b e n d is located progressively closer to the
m o l a r bracket, the m a g n i t u d e o f the net equi-
librium forces increases as the M c at the m o l a r
increases and the M c at the canine decreases.
At one-third the length o f the wire s e g m e n t
away f r o m the molar, the angle o f wire e n t r y at
the canine bracket becomes zero a n d no couple
is g e n e r a t e d 6 ; the only e q u i l i b r i u m f o r c e s
present are those that are associated with the
M c at the molar. As the b e n d is progressively
located closer to the m o l a r bracket f r o m this
one-third point, the couple at the canine be-
gins to increase, but it is now in the s a m e di-
rection as the m o l a r couple. T h e equilibrium
forces associated with the Mcs at the m o l a r a n d
canine will be additive at this point. T h e r e f o r e ,
locating the bends progressively closer to the
m o l a r brackets will, in turn, lead to net associ-
ated equilibrium forces o f g r e a t e r m a g n i t u d e .
T h e same conditions occur as the b e n d is
l o c a t e d p r o g r e s s i v e l y closer to the c a n i n e
bracket f r o m the m i d p o i n t o f the p o s t e r i o r
wire segment. T h e m a g n i t u d e o f the net equi-
40
'-F
Me
Figure 4. The larger angle of wire entry of a 2 x 6
arch wire with an asymmetrical V-bend can be de-
termined by placing the wire over the brackets as
shown. In this case, the larger M c is at the molar
bracket. The equilibrium forces of the smaller Mc
will either enhance or attenuate the magnitude but,
will not change the direction of, the net equilibrium
forces acting at each bracket.
librium forces increases, only this time, their
direction is d e t e r m i n e d by the orientation of
the Mcs at the canines.
Molar Mesial-Out Rotations
Bilateral toe-in b e n d s placed closer to the mo-
lars t h a n the canines will result in a g r e a t e r
angle o f wire entry at the m o l a r bracket and,
consequently, a couple o f g r e a t e r m a g n i t u d e at
the m o l a r on insertion o f the 2 x 6 arch wire
(Fig 5). M-out Mcs at the molars and associated
equilibrium forces that will be facially directed
at the m o l a r a n d lingually directed at the ca-
nine will result. H o w e v e r , all bilateral forces
a n d / o r couples at the canines, being equal and
opposite, will t e n d to cancel out across the stiff
a n t e r i o r arch wire segment.
Clinical Uses
T h i s activation o f the 2 × 6 arch wire is useful
w h e n i n t e r m o l a r e x p a n s i o n is desired along
Joe Rebellato
Me
Figure 5. Toe-in bends closer to the molar than the
canine brackets result primarily in molar expansion
and M-out molar rotations. The orientation of the
smaller M c at the canine will determine whether its
associated equilibrium forces wiI1be additive or sub-
tractive with those associated with the M c at the mo-
lar.
with m o l a r M-out rotations. O n c e again, it is
i m p o r t a n t not to tie the 2 x 6 arch wire into
the p r e m o l a r brackets. I f the 2 x 6 a r c h wire is
tied into the p r e m o l a r brackets, it b e c o m e s an
arch wire with a symmetrical V - b e n d if the toe-
in is located halfway between the p r e m o l a r a n d
m o l a r bracket (Fig 6). No e x p a n s i o n o f inter-
m o l a r width will occur in this case.
Molar Mesial-In Rotations
Bilateral toe-out bends placed closer to the mo-
lars will result in a reversal o f the situation
above with all couples, m o m e n t s a n d forces in
the opposite direction (Fig 7).
Clinical Uses
T h i s activation o f the 2 x 6 arch wire is useful
when constriction o f i n t e r m o l a r width is de-
sired in addition to bilateral m o l a r M-in rota-
tions.
 Transverse Arch Wire Activatior~s
-M c
Mc
Figure 6. I~igating the 2 x 6 arch wire into premolar
brackets creates a symmetrical V-bend and molar
expansive forces are negated.
Molar Constriction
Bilateral toe-ins placed closer to the canines
t h a n the m o l a r s will result in a g r e a t e r angle o f
Mc
Figure 7. Toe-out bends closer to the molar than
the canine brackets result primarily in molar con-
striction and M-in rotations. The orientation of the
smaller M c at the canine will determine whether its
associated equilibrium forces will be additive or sub-
tractive with those associated with the M c at the mo-
lar,
41
wire entry at the canine brackets and, t h e r e f o r e ,
couples o f larger m a g n i t u d e at the canines o n
insertion o f the 2 × 6 arch wire (Fig 8). D - o u t
Mcs at the canines a n d associated equilibrium
forces that will be facially directed at the canines
a n d lingually directed at the molars will result.
T h e constrictive fbrces at the molars will be en-
h a n c e d as the b e n d is m o v e d progressively closer
to the canines. T h e m o l a r brackets will have a
smaller Me, the m a g n i t u d e a n d direction o f
which will d e p e n d o n w h e r e the V - b e n d is lo-
cated along the wire. It is also possible that the
angle o f entry o f the wire is zero d e g r e e s at the
m o l a r bracket o n insertion o f the 2 x 6 arch wire
a n d that only tile equilibrium forces associated
with the Mcs at tile canines are present. This
would occur only if tile b e n d is placed o n e - t h i r d
o f the length o f the posterior wire s e g m e n t away
f r o m the canine bracket.
Clinical Uses
~l'his activation o f the 2 × 6 a r c h wire allows t b r
constriction o f i n t e r m o l a r width with m i n i m a l
effects o n m o l a r f i r s t - o r d e r rotations.
Figure 8. Toe-in bends close to the canine brackets
result primarily in molar constrictiori with little or
no molar rotation. The smaller M c at the molars will
have associated equilibrium forces that will either
slightly enhance or attenuate the net constrictive
equilibrium forces at the molar brackets.
42 Joe RebelIato
Mo
Me
Figure 9. Toe-out bends close to the canine brackets
result primarily in molar expansion with little or no
molar rotation. The smaller Mc at the molars will
either slightly enhance or attenuate the net expan-
sive equilibrium forces at the molar brackets.
Mc
:5
_5
Me
Figure 10, A 2 x 6 arch wire with step bends will
have angles of wire entry and resultant couples that
are similarly oriented. The magnitudes of the Mcs
do not have to be equal, but their associated equi-
librium forces will always be additive.
Molar Expansion
Bilateral toe-outs placed closer to the canines
will result in a reversal of the previous situation
with all couples, m o m e n t s a n d forces in the
opposite direction (Fig 9).
Clinical Uses
This activation of the 2 x 6 a r c h wire allows for
e x p a n s i o n o f i n t e r m o l a r width with minimal
changes in m o l a r first-order rotations.
Step Bends
W h e n a 2 × 6 arch wire with a step b e n d is
placed over the canine a n d m o l a r bracket slots,
similarly oriented angles o f entry are revealed.
T h e Mcs at the canine and m o l a r brackets will
both be in the same direction with respect to
each o t h e r and their associated e q u i l i b r i u m
forces will always be additive (Fig 10). Locating
the bends progressively closer to the brackets
will result in g r e a t e r angles of wire entry at the
brackets and g r e a t e r Mcs p r e s e n t on insertion.
This in turn, will lead to associated equilibrium
forces o f g r e a t e r m a g n i t u d e .
Mc
Me
Figure 11. Toe-outs at the canines and toe-ins at the
molars result primarily in M-out molar rotations
with enhanced expansive equilibrium forces at the
molars.
 Transverse Arch Wire Activatior~
J,.,,
Mc
Figure 12. T o e - i n s at the c a n i n e s a n d t o e - o u t s at the
molars result p r i m a r i l y in M-in m o l a r r o t a t i o n s with
e n h a n c e d constrictive e q u i l i b r i u m forces at the mo-
lars.
Step Bend for Molar Expansion
Bilateral toe-outs closer to the canines with toe-
ins closer to the molars results in a step b e n d
activation o f the 2 × 6 arch wire and the ca-
nines a n d molars will b o t h feel M-out Mcs
(Fig 1 1). T h e i r associated equilibrium forces
will b o t h be facially d i r e c t e d at the m o l a r
bracket a n d lingually directed at the canine
bracket.
43
Clinical U s e s
This activation o f the 2 x 6 arch wire is useful
w h e n m o l a r M - o u t r o t a t i o n s are r e q u i r e d
along with greater molar expansive forces than
can be obtained with asymmetrical V-bends.
Step Bend for Molar Constriction
Bilateral toe-ins closer to the canines with toe-
outs closer to the molars results in a reverse o f
the previous situation with couples, m o m e n t s ,
and forces in the opposite direction (Fig 19).
Clinical U s e s
This activation o f the 2 x 6 arch wire is useful
w h e n molar M-in rotations are required along
with greater molar constrictive forces than can
be obtained with asymmetrical V-bends.
References
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3. Isaacson RJ, l.indauer SJ, Rubenstein LK. Activating a
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techniques. Angle Orthod t 966;3:99-120.
6. Burstone CJ, Koenig HA. Force systems from an ideal
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339.
9. Smith RJ, Burstone CJ. Mechanics of tooth move-
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movement. Dent CIin North Am i981;25:19-26.