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Case Report

K-Sir arch for simultaneous intrusion and retraction of the

maxillary anterior teeth-A case report
ABSTRACT
This case report shows the management of Angle’s Class II division 1 Malocclusion with tooth size‑arch length
discrepancy of − 10 mm in maxillary arch and mandibular arches, proclined upper and lower anteriors, and crowding in
relation to lower anteriors. Clinical evaluation revealed Class II dental and skeletal pattern, low mandibular plane angle,
incompetent lips, increased overjet and overbite. Simultaneous intrusion and retraction of upper anterior teeth using
Kalra Simultaneous Intrusion and Retraction arch was decided due unaesthetic excessive maxillary incisor showing at
rest and to provide maximum space for the retraction of anterior teeth. Posttreatment changes were good and stable.

Keywords: Class II Malocclusion, Deep bite, Kalra Simultaneous Intrusion and Retraction ARCH

INTRODUCTION simultaneous intrusion and retraction of anterior teeth as

in this case which had deep bite (40%) and proclined upper
Malocclusions are considered in sagittal, transverse, and and lower anteriors.
vertical plane. The maxillary dental arch overlaps the
mandibular dental arch so does the maxillary anteriors Diagnosis
over mandibular anteriors in both sagittal and vertical A 17‑year‑old female  presented with a chief complain
planes.[1,2] This sagittal overlap is called as overjet and of forwardly placed upper front teeth and lower incisor
the vertical overlap is called overbite. This is normal crowding. Extraoral examination revealed convex profile,
finding in human dentition. While patients presenting with incompetent lips, and acute nasolabial angle [Figure 1].
unwarranted vertical overlap of the lower anteriors by Intraoral examination revealed deep bite (40%), lower
upper anteriors is called as deep bite. This deep overbite midline shift to right side, proclined upper and lower
is a orthodontic problem that may give rise to periodontal anteriors, and crowded lower anteriors. The molar and
problems, functional problems, temporomandibular joint canine relationships were end on both the right side and
problems, improper chewing, and excessive tooth wear left side. Model analysis revealed tooth size‑arch length
resulting in early loss of teeth. [3,4] Hence, correcting discrepancy of ‑10 mm in maxillary arch and mandibular
deep bite is one of the prime objectives of orthodontic arches [Figure 2].
treatment. Correction of this excessive vertical overlap
requires sound diagnosis, a proper treatment plan and an
effective appliance to achieve treatment results. One of Sankalp Agnani, Kamal Bajaj1
the available options is Kalra Simultaneous Intrusion and Department of Orthodontics, Pacific Dental College, Udaipur,
Retraction (K‑SIR) ARCH which is used for cases requiring
1
Department of Orthodontics and Dentofacial Orthopedics,
Mahatma Gandhi Dental College, Jaipur, Rajasthan, India

Received: 25‑Feb‑2020   Revised: 31-May-2020 Address for correspondence: Dr. Sankalp Agnani,

413, Adarsh Nagar, Jaipur ‑ 302 004, Rajasthan, India.
Accepted: 12-Jun-2020    Published: 09-Jul-2020
E‑mail: agnanisan@gmail.com

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DOI:
How to cite this article: Agnani S, Bajaj K. K-Sir arch for simultaneous
10.4103/ijor.ijor_5_20 intrusion and retraction of the maxillary anterior teeth-A case report. Int J
Orthod Rehabil 2020;11:88-92.

88 © 2020 International Journal of Orthodontic Rehabilitation | Published by Wolters Kluwer - Medknow

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Agnani and Bajaj: K-SIR-Arch for simultaneous intrusion and retraction

Treatment objectives can be done simultaneously, easy to fabricate, cost‑effective

1. To achieve normal inclination of upper and lower as compared to TADs, and requires minimum amount of the
anteriors patient cooperation.
2. To achieve normal overjet and overbite
3. To achieve Class I molar, incisor, and canine relationship Treatment progress
4. To achieve Class I skeletal pattern After extractions of premolars, anchorage control was done
5. To achieve good facial profile. by lace backs for canine control, bend backs for incisor
control; Nance palatal arch in upper and lingual holding arch
Treatment plan in lower for molar control was given. After initial alignment
Therapeutic extraction of 14, 24, 35, 45 teeth followed and leveling was achieved with 0.016” NiTi, 0.017 × 0.025”
by fixed appliance therapy with 0.022 MBT prescription NiTi wire, 0.019 × 0.025” SS wire was placed. In lower
Preadjusted Edgewise Appliance. K‑SIR arch [Figure 3] was arch en‑masse retraction was continued using type I active
used for simultaneous intrusion and retraction of upper tie back and in upper arch individual canine retraction was
anteriors after individual canine retraction in upper arch. done using type I active tie backs. After achieving Class
Here, K‑SIR arch was selected as both intrusion and retraction I canine relation, K‑SIR arch was placed in upper arch for

Figure 1: Pretreatment extraoral photographs

Figure 2: Pretreatment intraoral photographs

Figure 3: KSIR arch for simultaneous intrusion and retraction after individual canine retraction in upper arch

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Agnani and Bajaj: K-SIR-Arch for simultaneous intrusion and retraction

simultaneous intrusion and retraction of upper anteriors and Retention protocol

0.019”×0.025” stainless steel was placed in the lower arch Retention protocol for this patient was accomplished
for torque expression and space closure. Class II elastics were with removable wrap around retainer in upper arch with
given to correct Class II skeletal pattern. No complications instructions for full time wear during the first 6 months,
were encountered during use of K‑SIR arch, apart from a first followed by 6 months night time wear. Bonded lingual
7 days for patient getting used to loops and slight tissue retainer was given in lower arch.
impingement which was sorted early.
DISCUSSION
Activation of Kalra Simultaneous Intrusion and Retraction
Arch Usually in edgewise system, retraction of the six anterior
As in K‑SIR arch, stresses built due wire bending are released teeth is carried out in 2 steps: first canine retraction is
by doing a trial activation of the springs. The legs of each of done and then incisor retraction.[5] However, in Tip‑Edge
the springs are extended horizontally to determine the neutral and Begg techniques, En masse retraction of six anterior
position and the U loop will be 3.5 mm wide in this position. On teeth is done.[4] The reason for individual retraction in the
activation of 3 mm, the distance between the medial and distal edgewise technique is that molar anchorage is preserved.
legs is significantly reduced. On initial activation, the retraction However, Burstone and Nanda have proven molar anchorage
force creates larger tipping moments in comparison to the control, using nonfrictional loop mechanics for en masse
opposing moments generated by the V bends. This brings retraction of the anterior teeth and producing results at par
about a controlled tipping of the teeth into the extraction with conventional edgewise sliding mechanics. In this case a
space and once deactivation of the loops occur the moment
Table 1: Pre‑ and post‑treatment of cephalometric variables
to force ratio increases causing bodily movement of the teeth
followed by root movement. This allows for the activation to Variables Norms Pretreatment Posttreatment
SNA 82° 83° 82°
be done after every 6–8 weeks till the space is closed.
SNB 80° 78° 79°
ANB +2 5° 3°
Treatment results
Na perpendicular to pt A 1.1 mm 2 mm 1 mm
The Class I canine and molar relationship were established, N‑Pog (facial angle) 87.8° (82‑95) 86° 87°
and the spaces were closed. All treatment objectives were GoGn‑SN 32° 25° 26°
achieved including established occlusion. Upper and lower Y‑AXIS 53‑66° 60° 60°
arches showed good alignment with the upper and lower Facial axis 90±3° 90° 90°
midline centered. Facial profile of the patient was significantly Gonial angle 128±7° 112° 120°
improved after the treatment [Figures 4 and 5]. Jaraback index, % 62‑65 67.5% 67.3%
Interincisal angle 135° 114° 138°
Upper incisor to NA 22°, 4 mm 31°, 8 mm 20°, 3.5 mm
Treatment assessment
Lower incisor to NB 25°, 4 mm 29°, 6 mm 24°, 4 mm
All the treatment objectives were achieved by the end
Upper incisor to SN 102° 113° 100°
of 20 months. Angle’s Class II malocclusion was changed Lower incisor to A‑Pog 2.7 mm 3 mm 2 mm
to Class I relation. Comparison of pretreatment and IMPA 90° 105° 97°
posttreatment cephalometric variables and lateral S‑line 0 mm U=3 mm U=−0.5 mm
cephalometric superimposition was done between pre and L=5 mm L=0 mm
post treatment [Table 1 and Figure 6]. Nasolabial angle 102° 82° 107°

Figure 4: Posttreatment extraoral photographs

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Agnani and Bajaj: K-SIR-Arch for simultaneous intrusion and retraction

Figure 5: Posttreatment intraoral Photographs

The second premolars are bypassed to increase the

interbracket distance between the two ends of attachment.
This allows the clinician to utilize the mechanics of the
off‑center V‑bend. The archwire should be reactivated every
6–8 weeks until all space has been closed.[6]

As the name suggests prime indication for the K‑SIR

archwire is simultaneous intrusion and retraction of
anterior teeth, so it is to be used in deep overbite and
excessive overjet cases. Hence, patients requiring both
intrusion and retraction of anterior teeth can be treated
using K‑SIR archwire.

The 0.019” ×0.025” TMA has enough strength and stiffness

Figure 6: The pre- and post-treatment lateral cephalometric superimposition to resist distortion and produce required moments. It also
on S-Na
produces relatively low forces and a low load‑deflection
rate. TMA can be activated twice as much as stainless steel
combination of both was used as individual canine retraction
without undergoing lasting deformation and it produces half
was done using type I active tie backs in upper arch and then
the force per unit activation.
K‑SIR arch was used for simultaneous intrusion and retraction
of upper anteriors.
CONCLUSION
K‑SIR archwire is a modification of the segmented loop
By understanding the biomechanics involved using K‑SIR
mechanics of Burstone and Nanda. It is a continuous 0.019”
arch, we can achieve simultaneous movements and successful
× 0.025” TMA archwire with closed 7 mm × 2 mm U‑loops at
outcome.
the extraction sites. To obtain bodily movement and prevent
tipping of the teeth into the extraction spaces, a 90° V-bend is Declaration of patient consent
placed in the archwire at the level of each U-loop. This V-bend, The authors certify that they have obtained all appropriate
when centered between the first molar and canine during patient consent forms. In the form the patient(s) has/have
space closure, creates two equal and opposite moments to given his/her/their consent for his/her/their images and other
counter the moments caused by the activation forces of the clinical information to be reported in the journal. The patients
closing loop. A 60° V-bend located posterior to the center of understand that their names and initials will not be published
the interbracket distance produces an increased clockwise and due efforts will be made to conceal their identity, but
moment on the first molar, which augments molar anchorage anonymity cannot be guaranteed.
as well as the intrusion of the anterior teeth. To prevent the
buccal segments from rolling mesio‑lingually, 20° anti‑rotation Financial support and sponsorship
bend is placed in archwire just distal to each U‑loop. Nil.
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Agnani and Bajaj: K-SIR-Arch for simultaneous intrusion and retraction

Conflicts of interest W.B. Saunders; 1972.

There are no conflicts of interest. 3. Proffit  WR, Field  HW, Ackerman  JL, Bailey  LT, Tulloch  JF.
Contemporary Orthodontics. 3rd ed. St. Louis:C.V. Mosby Co.; 2000.
4. Jayade VP. Refined Begg’s for Modern Times. 1st ed. Karnataka State,
REFERENCES India: Mrs. Anuradha V. Jayade, Hubli; 2001.
5. Bennett  JC, McLaughlin  RP. Management of deep overbite with a
1. Graber  TM, Swain  BE. Orkthodontics: Current Principles and preadjusted appliance system. J Clin Orthod 1990;24:684‑96.
Techniques. St. Louis: Mosby Co.; 1985. 6. Kalra  V. Simultaneous intrusion and retraction of the anterior teeth.
2. Graber TM. Orthodontics: Principles and Practice. 3rd ed. Philadelphia: J Clin Orthod 1998;32:535‑40.

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