New Straight Wire: Strategies and Mechanics for a Programmed Approach to Orthodontic Treatment

Francesco Pedetta, MD, DDS, 2020, Quintessence Publishing Co.

Dr. Francesco Pedetta, a devotee of Dr. Larry Andrews, has assembled in this paperback opus an amazingly large collection of excellent illustrations to guide readers in understanding this new approach to the use of the Straight Wire Appliance^© (SWA). The instrumentation has not changed; that is, the bracket metrics, antirotational additives, power arms, and extraction anti-tipping features still exist as originally planned. What has changed is the diagnosis and treatment planning that it now relies upon — a variant of the venerable Steiner Box, which mathematically clarifies the space available and space needed for resolving malocclusions.

The New Straight Wire relies on establishing an optimum position for the maxillary incisor by relying on the glabella line, an idea that Dr. Andrews began developing 4 decades ago. A line drawn from glabella perpendicular to the Frankfort horizontal plane ostensibly touches the facial surface of the maxillary central incisor, establishes an optimal position for the maxillary incisor, and subsequently creates the anterior limitation for the entire dentition. Dr. Pedetta contends this measurement is the same for all races.

Although the brackets do not differ in the New Straight Wire, the recommended wires greatly differ as it uses more round wires to tip the teeth rather than move them bodily with edgewise wires. Seemingly, this avoids putting the roots of the teeth against the cortical plates of their osseous confinements and reduces root resorption. When this technique advocates the use of edgewise wires, it commends .018 x .025 dimensioned wires in a .022 bracket, which allows 18° of rotation and thus little three-dimensional control.

Dr. Pedetta believes that the bulk of Class II corrections must come from retraction of the maxilla, and he subsequently advocates the use of extraoral traction via the headgear supplemented during the day with Class II elastics so as to keep a continuous force against the teeth. He contends that teeth must have continuous force to move.

Dr. Pedetta displays some misunderstandings regarding functional therapy by stating it started with Frankel’s work in 1969. Functional appliances preceded that date by more than a half century. Further, Dr. Pedetta states that while these appliances work, they do so entirely by restricting maxillary growth and are indicated only in patients with maxillary protrusions. This belief varies considerably from the work by Pancherz, DeVincenzo, Valant, and many others.

This beautifully illustrated text offers what readers have come to expect from Quintessence Publishing Co. — that is, thick durable pages, readable fonts, and impressive artwork with clear and unequivocal narratives. It suffers from a lack of bibliographies and clinical therapies that could validate the theory of the New Straight Wire.

Review by Dr. Larry White.