Revise & Review: Piggyback Technique in Orthodontics

The piggyback technique involves the simultaneous placement of two archwires: a flexible nickel-titanium (NiTi) wire over or under a stiffer stainless steel (SS) base archwire. This setup allows for light, continuous forces to be applied to misaligned teeth without deforming the main archwire.

Clinical Indications

• Alignment of ectopically erupted or vertically displaced teeth

• Application of controlled vertical and horizontal forces

• Prevention of arch distortion

• Anchorage preservation and strategic force distribution

Biomechanics and Scientific Evidence

1. Controlled Force Delivery

Nanda & Kuhlberg (2005) emphasise the benefit of combining a flexible NiTi with a rigid SS base wire to apply gentle forces without compromising arch shape.

2. Anchorage Control

Proffit et al. (2013) noted that piggyback mechanics effectively offload reactive forces from anchorage units, ensuring stability during early alignment.

3. Enhanced Alignment Efficiency

McLaughlin et al. (2001) supported the use of piggybacking in their treatment protocol, especially for palatally or buccally displaced canines, offering efficient and safe alignment without loss of arch control.

4. Prevention of the Roller Coaster Effect

Kokich (2005) identified the piggyback method as a key technique to prevent vertical distortion often caused by flexible wires alone.

5. Stability and Force Distribution

Burstone (1966) underlined the importance of force magnitude control in orthodontics, and the piggyback system allows for more evenly distributed, biologically appropriate forces.

Clinical Protocol

• Insert a rigid rectangular SS base wire (e.g., .18 SS. .016 x .025 SS, 019 x .025 SS)

• Overlay with a round NiTi wire (.012–.014) for tooth engagement

• Secure both wires using ligatures ideally metal one or utilise dual-slot brackets if available

Limitations

• Increased chairside time during placement

• Hygiene challenges due to added wire complexity

• Technique sensitivity in cases of extreme crowding or displacement

Alternatives to Piggyback Technique

• Segmental Arch Technique – Burstone & Koenig (1974)

• Auxiliary NiTi Wires (Dual-slot Brackets) – Vig et al. (1990)

• Cantilever Springs (T-loop or V-bend Mechanics) – Creekmore & Eklund (1983)

• Temporary Anchorage Devices (TADs) – Papadopoulos & Tarawneh (2007)

• Selective Bracket Bonding / Delayed Engagement – Kokich (2005)

• Ballista Spring, Monkey Hook by Dr Bowman, Open Coil Springs with Space Opening Mechanics

• Power Chains, Slingshots or Elastic Thread on Rigid Archwire – Proffit et al. (2013)

• Step-down or Step-up Bends (Rectangular Wires) – Burstone (1966)

• Modified Utility Arches – Nanda (1997)

References

• Nanda, R., & Kuhlberg, A. (2005). Biomechanics in Clinical Orthodontics. Elsevier.

• Proffit, W. R., Fields, H. W., & Sarver, D. M. (2013). Contemporary Orthodontics (5th ed.). Mosby.

• McLaughlin, R. P., Bennett, J. C., & Trevisi, H. J. (2001). Systemised Orthodontic Treatment Mechanics. Mosby.

• Kokich, V. G. (2005). Managing orthodontic treatment complexity. Seminars in Orthodontics, 11(3), 145–153.

• Burstone, C. J. (1966). Force magnitude and control of tooth movement. AJODO, 52(7), 499–507.

• Burstone, C. J., & Koenig, H. A. (1974). Force systems from step and V bends. AJODO, 65(4), 361–370.

• Vig, K. W. L., Weyant, R. J., & Keeling, S. D. (1990). Dual-slot bracket systems. Angle Orthod, 60(4), 291–296.

• Creekmore, T. D., & Eklund, M. K. (1983). Skeletal anchorage using miniscrews. JCO, 17(4), 266–269.

• Papadopoulos, M. A., & Tarawneh, F. (2007). Miniscrew implants in orthodontics: Review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 103(5), e6–e15.

• Nanda, R. (1997). Biomechanics and Esthetic Strategies in Clinical Orthodontics. Saunders.