Using Overlay and Piggyback Wires in Impaction Patients
When you have a patient with a highly displaced, palatalized tooth, knowing how to tackle these is highly important. In line with this thought, we’re looking at how you may want to approach these difficult cases – and whether overlay or piggyback wires are more appropriate.
If your patient has presented with a palatalized tooth, using overlay or piggyback wires can help provide an effective treatment plan that doesn’t cause negative impacts on the remainder of the teeth. For example, when bracketing each tooth, pulling a single tooth forward buccally could result in the remainder of the teeth collapsing lingually.
There are two main methods for using a piggyback wire in palatalized cases. We typically recommend bracketing each tooth (with the exception of the palatalized tooth) and straightening these, progressing through the wire sequence as usual (from 14, 16, 17, 25, Ni-Ti), and then progress to a heavy Ni-Ti before finally bracketing the displaced tooth. In this way, the base wire is a heavy, stabilizing wire, while the segment over the displaced tooth is a small amount of NiTi. This process can potentially also be expedited by adding an elastic since the heavy wire is also already stabilizing the teeth.
Alternatively, some people prefer to use the “sling” method to address palatalized cases. After working up to a heavy NiTi or a steel wire, a piece of power chain can be looped to the button on the displaced tooth. This is very similar to our preferred method using NiTi, although the sling technique will lose its activity every few weeks, requiring constant reactivation.