Utility Arches JAMES A. MCNAMARA, DDS, PHD The utility arch has multiple uses in vari ‘ous stages of orthodontic treatment. This aux. iliary archwire has been developed according to biomechanical principles described by Bur- stone'# and refined for incorporation into Bio- progressive therapy. Although it is a complete arch extending ‘across both buccal segments, the utility arch ‘engages only the first molars and the four in- cisors. It originally was developed to provide a method of leveling the curve of Spee in the mandible, but it has been adapted to perform ‘many more functions than just lower incisor intrusion. With an 018” appliance, the recommended wire for the mandibular arch is 016” x 016" or 016” x.022” Blue Elgiloy (not heat-treated). For most maxillary arches, .016" x .022" Blue Elgiloy is recommended. With an .022" app ‘ance, .019” x .019” Blue Elgiloy can be used in either arch. When using utility arches in combination with full arch appliances, it is necessary to have auxiliary tubes in a gingival position on the first molar bands. In a pre-orthopedic phase of treatment when the buccal segments are not banded, the main buccal tube or bracket on the first molar can be used to anchor the utility arch posteriorly. Passive Utility Arch The passive utility arch can be used for stabilization or space holding. It is ideal in the mixed dentition, when it permits eruption of the canines and premolars. A passive utility arch by definition is not activated and should not move teeth in any direction. ‘i MeNamarasProfessorol DenlatyOnodontcs), Professor of ‘natomy and(all Biology, ana Research Scion at the Cente for Homan Growth and Development, ™e Univeraty of Michigan, Ann ‘tor He ein the private practice a eaogeniesn An Arb. 482 A passive utility arch (Fig. 1) originates in the auxiliary tube on the first molar. The molar segment of the archwire is cut flush with the distal aspect of the auxiliary tube. Immediate- ly anterior to the tube, a 90° bend is placed with a 142 arch-forming plier, and a posterior vertical step, usually 3-4mm long, is formed. Another right-angle bends then placed in the wire, so that the horizontal or vestibular segment travels anteriorly parallel to the oc- clusal plane. At the embrasure between the canine and the lateral incisor, another right- angle bend redirects the wire toward the oc: clusal surface. After an anterior vertical step of 58mm, a final 90° bend creates the incisal segment, which should lie in the brackets of the lower anterior teeth. Any irregularities in the position of the lower anterior teeth are usually cor- rected with a sectional leveling arch before a utility arch is placed. The archwire continues in a similar fashion to the opposite molar. Intrusion Utility Arch The intrusion utility arch is designed similarly to the passive arch, but itis activated to intrude the lower anterior teeth.* After ac tivation, a light continuous force is delivered by the long lever arm from the molars to the in- cisors. As with the passive arch, the intrusion arch is stepped down at the molars, passes through the buccal vestibule, and is stepped up at the incisors to avoid distortion from oc: clusal forces. Engaging the utility arch will produce ap: proximately 25g of force on each of the lower incisors—a force level considered ideal for lower incisor intrusion? The overall effect is an intrusion and possible torquing of the lower in- cisors, as well as a tipping back of the lower molars (Fig. 2). Molar rotation and expansion JCONMULY 1986Fig. 1 Passive utility arch, with posterior vertical step fitting snugly against auxiliary tube on lower first molar. >on Fig. 2 Effect of intrusive foree on mandibular incisors: incisors are intruded and torqued while molar is tipped posteriorly. VOLUME Xx NUMBER 7 483UTILITY ARCHES Fig.3 Intrusion utility arch, with posterior vertical step 58mm anterior to auxiliary ube on upper first molar, allow ing slight retrusive activation. Fig. 4 Retrusion utility arch. The loop anterior to the anterior vertical step Is activated while the molar segment i retruded. Fig. 5 Protrusion utility arch, with posterior vertical step fitting flush against auxiliary molar tube. 454 SCONJULY 198or contraction of molar width can be achieved by activating the molar section of the arch. Figure 3 shows an intrusion utility arch designed for the maxilla. Here there is a 5mm ‘space between the anterior border of the aux Ilary tube and the posterior vertical step of the. utllity arch. This allows a slight retrusive ac: tivation of the arch to be made by pulling the wire posteriorly and then twisting the end of the arch gingivally. Any type of utility arch can be activated for an intrusive movement by placing an oc- clusally directed gable bend in the vestibular segment. A loop-bending plier can be used for this activation during a routine office visit, Retrusion Utility Arch ‘The usefulness of a retrusion utility arch (Fig. 4) in retracting and intruding incisors is ‘obvious in cases of upper incisor flaring. How- ever, this type of mechanics is also helpful in retracting the four anterior teeth as a unit, par- ticularly in the maxilla. The retrusion utility arch can close interproximal spaces while in- truding and aligning the upper anterior teeth and correcting midline discrepancies. The retrusion arch originates in the aux- lary tube on the molar, and 5-8mm of wire should protrude anteriorly before a posterior vertical step of 3-4mmis placed. The vestibular segment extends anteriorly to the interprox- mal region between the lateral incisor and the canine. At this point, a 90° bend is placed with 142 arch-bending plier. A loop-bending plier is then used to place ‘loop in which the anterior leg crosses behind the posterior leg. After a 5-8mm anterior ver- tical step, another right-angle bend then car- ries the wire across the anterior teeth. A gentle anterior contour is placed in the wire to simulate the arch form, (On the other side of the arch, the anterior vertical step Is again created in the interprox- imal area between lateral incisor and canine. The retraction loop is again placed with the loop-bending plier, and then the loop-bending VOLUME Xx NUMBER 7 MCNAMARA plier (instead of the arch-forming plier) is used to create the 90° bend to the horizontal, vestibular segment. This then extends to the posterior vertical step at the middle of the sec- ond premolar. ‘As with the intrusion utility arch, there are two possible types of activation. First, a Weingart plier can be used to grasp the exten- sion of the utility arch posterior to the auxiliary tube. The wire is pulled 2-3mm posteriorly and, then bent upward at a 90° angle. Care must be taken that this protruding end of the utility arch does not impinge on the gingiva or cheek. ‘Second, an occlusally directed gable bend in the vestibular segment can be used to produce Intrusion. Protrusion Utility Arch The protrusion utility arch is useful for proclining upper and lower incisors. It is most ‘commonly used for flaring and intruding max- illary incisors in Class il cases (Fig. 5). In contrast to the retrusion utility arch, the posterior vertical step of the protrusion arch must be flush with the auxiliary tube. The vestibular segment traverses anteriorly to the interproximal region between the canine and lateral incisor. A loop-bending plier is then used to place a loop distal to the anterior ver- tical step and occlusal to the vestibular seg- ment. The anterior leg of the loop should be positioned mesially, thus providing some canine offset. The anterior vertical step is 58mm long, depending on patient tolerance. The incisal segment runs through the incisor brackets, and the utility arch is completed in a similar fashion on the other side. When the protrusion utility arch is passive, the anterior segment should lie ap- proximately 2mm anterior to its expected posi- tion in the incisor brackets. The protrusive force is produced by tying the anterior seg- ment of the utility arch into the anterior brackets. An occlusally directed gable bend in the vestibular segment can be used for intru- 455UTILITY ARCHES. sion. ‘The protrusion arch is activated by remov. ing the anterior segment from the brackets, bending the posterior vertical step forward from 90° to 45°, and replacing the archwire in the brackets. Other adjustments can be made in both the anterior and posterior vertical steps to produce further activation. Other Considerations While the above material represents the types of utility arches used clinically by the author, other clinicians have mentioned various modifications of these archwires. Hone is concerned about unwanted pos- terior tipping of the molar, this can be reduced significantly by placing torque in the auxiliary tube so the roots of the molars are tipped bue- cally into the buccal cortical plate.** This so- called “cortical anchorage” is reported to be Particularly effective in the mandible, Utility arches can be designed differently for extraction and nonextraction cases.®# In extraction cases, the forces generated on the molars are often directed mesially and oc- clusally. A distolingual bend in the molar seg- ment of the utility arch can prevent this mesial rotation of the first molars. Such a bend may not be necessary in nonextraction cases. A utility arch can incorporate a tipback bend of 30-45° at the junction of the posterior vertical step and the molar segment. This allows an automatic intrusive activation as the archwire is engaged in the brackets. When the utility arch is engaged passively in the aux- iliary tube, the anterior segment usually lies in the vestibule. The tipback bend may or may not be placed during initial fabrication; a similar effect can be gained with the vestibular gable bend after appliance placement. 486 Conclusion The utility arch is an integral part of in- terceptive as well as comprehensive orthodon- tic treatment. Itis efficient in intruding upper and lower incisors and is especially effective in protruding and retruding anterior teeth. One of the major difficulties in correcting anteroposterior discrepancies (particularly in Class || malocclusion) is an impairment of anteroposterior tooth movement by anterior vertical interference. Utility arches can be used—both in orthopedic and orthognathic surgical therapy—to move upper and lower in- cisors gingivally so that tooth position can be properly corrected. ACKNOWLEDGMENTS: Illustrations by Mr. William L. Brudon, REFERENCES 1. Burstone, C.0.: Mechanics of the segmented arch technique, Angie Orthod. 6:99-120, 1956 2, Burstone, C.D: Deep overbite correction by intrusion, ‘Amer. J Orthod, 7211.22, 1977 3. Bench, R.W.; Gugino, C.F. and Hilgers, J.J Bioprogressive Therapy, Part Vit The utilty and seo tional arches in Biopcogressive therapy mechanics, J Glin. Orthod, 12192207, 1978, 4, Ricketts, RIM; Bench, LW. Gugino, C.F; Hilgers, J and Schuthof, Rid: Biopragrassive Therapy, Rocky Mountain Orthodontics, Denver, 1979, 5. Otto, FLL; Anholm, J.M.N. and Engel, GA: A com: parative analysis of intrusion of incisor teeth achieved In aduits and children according to facial type, Amer (Orthod. 77:437-446, 1980. Department of Orthodontics 1027 Kellogg Dental Building School of Dentistry The University of Michigan ‘Ann Arbor, Mi 48109 JCONULY 1986