December’s Tip

The humble stainless-steel Ligature Tie is one of the least appreciated and most underutilized peripheral in the contemporary Straight Wire System. With the advent of CuNiTi arch wires, self-ligating brackets, and the current philosophy (low force/low friction) the aim is application of sub-threshold (32 grams) force. Therefore, there is no desire to wire tie the bracket to the arch wire.  However, if the clinician uses twin (Siamese) bracket, the elastomeric Safe-T-tie (doughnut) creates more friction than the ligature tie.

 Applications of stainless-steel Ligature Tie:

1. Tying the arch wire into the twin (Siamese) brackets, either to the single wing or both wings
2. Tying the arch wire into the self-ligating brackets, when the latch breaks off or it cannot be closed
3. As a Kobayashi hook for attachment of elastics, Elastomeric chains, or Closing coil springs
4. As a Lace-back (under-tie) for closing spaces
5. As an Anchor-tie for the tooth mass anchorage
6. As an attachment for eruption of impacted teeth, where the resiliency of the arch wire precipitates movement

Ligature Ties are made of dead-soft stainless-steel wire, and they are available as a Shorty Ligature Twist and a Preformed Ligature Wire. The author prefers size a.010. For elevation of an impacted tooth, the author suggests size a.012.  They are also available tooth-coloured.

Kobayashi hooks are also made of dead soft stainless-steel wire, and they are available as Shorty Koby Twists and Kobayashi Ligature Tie Hooks. The author prefers size a.014. They are also available tooth-coloured.

The most efficient instruments for tying the stainless-steel Ligature Ties are the surgical Needle Holder or Mathieu Wide Tip Forceps.  However, there is a Shorty Twist Holder available for tying Shorty Ligature Twists and Shorty Koby Twists.

Spooled Dead Soft Ligature Wire is available in one pound spool, for the clinicians who prefer to fabricate their own ligatures.

While tying the arch wire, it is paramount to finish the twist (pig tail) occlusally (close to the arch wire) in the maxilla and gingivally (close to the arch wire) in the mandible.  Then tuck it firmly under the arch wire. If the twist (pig tail) is placed under the bracket (occlusally or gingivally), it has to be tucked under the bracket.  It may become loose, and it is unsightly.  Therefore, finish the twist (pig tail) in such fashion

References:

1. Rondeau Seminars, Level I, Session 2; 118 – 119
2. Cerum Ortho Organizers Catalogue; 155 – 156
3. Palencar A. J., Personal PP presentations