Volume 1979 Sep (588 - 594): Common Sense Mechanics: Part 1

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Common Sense Mechanics 1

THOMAS F. MULLIGAN, DDS
The title "Common Sense g Mechanics" is based on the simple fact that no
appliance exists which will allow an orthodontist to treat orthodontic problems without
adding the necessary ingredient of "Common Sense" to the mechanics instituted for
correcting the malocclusion. Appliances are being refined and will continue to
improve with the passage of time. This is good, but the danger lies with the individual
who fails to recognize that the refinement of appliances may reduce the physical effort
put forth in treatment, but will not eliminate the need for the orthodontist to think,
understand, and apply basic principles of mechanics in a common sense manner. This
means that regardless of how well we understand mechanics and regardless of how
much the appliance is refined, we are dealing with a biologic environment whose
variation in response will continue to challenge the orthodontist in many ways. If we
are to meet this challenge, we must gather as much information as possible that will
allow us to treat the patient in a practical or realistic manner, rather than treating in a
textbook fashion. The textbook, for example, may help us to determine how equal and
opposite forces are produced, but such forces do not necessarily produce equal and
opposite responses (Fig. 1).

figure 1
Since it is the response we seek, we separate ourselves from those professionals
who deal with pure physics and enter the exciting and challenging arena of biophysics
where we take many principles into account, mix them with common sense, and
proceed to treat the problem in a more predictable and efficient manner with a higher
level of confidence. Instead of learning through trial and error, and instead of
repetitive error year after year with the same problems, we can avail ourselves of the
opportunity to predict such errors before they ever occur, so that our common sense
approach to the application of mechanical principles will not only help us to solve the
problems at hand, but will permit us to avoid those problems we so often introduce
into the treatment procedures.
1

Common Sense is such an important part of applying basic mechanics that

without it, even the most sophisticated knowledge of the subject offers one little in
attaining his treatment goals. Perhaps it is a lack of a combination of the two
knowledge of mechanics and common sense application that has led to the
desire on the part of many orthodontists to seek an appliance which does the
thinking. If such is the case, there will be many frustrations which will persist. In no
way is this statement intended to be critical of any appliance. It only points out the fact
that orthodontists cannot escape the need to understand the appliance of choice and the
various force systems which will enter the treatment picture, either as our "friends" or
as our "enemies".

Visual Inspection
Before proceeding into a discussion of useful mechanics, experience has proven
to the author that it is first necessary to dispel one of the methods so frequently used
by a majority of orthodontists in determining what forces are present once an archwire
is fully engaged into a bracket or tube. During various seminars, it has been quite
apparent that this method, which I will refer to as the "visual inspection method", is
what often confuses the orthodontist in attempting to determine with reliability what
forces are present.

figure 2
If, for example (Fig. 2), the orthodontist inserts an archwire into the molar tubes
and observes that prior to placement of the archwire into the incisor brackets, the wire
lies in the mucolabial fold, it is often concluded that this means there must be
produced an anterior intrusive force upon engagement. This may very well be true, but
likewise, it may be very untrue. There not only may be no force present, but there
might even be present an anterior extrusive component of force. Have you found
yourselves at times watching overbites increase at the very time overbite correction is
being attempted? Have you waited for month after month for certain overbites to "go
away" because of the "known" intrusive force present for correction, only to see the
overbite persist? Have you ever surprisingly observed the return of overbite for no
apparent reasons after having spent months on correction? Well, sadly enough, the
answer often lies in the fact that the force thought to be present is never there, and
sometimes the exact opposite force is present.
2

The visual method seems to be so obvious, but it is this method that so often
leads us down the road to faulty conclusions. It is so important not to be misled by
determining forces present through the visual inspection method, that I would
therefore like to present a number of "two teeth" illustrations and permit you to make a
quick visual determination of the forces present.

Clinically, such determination is usually made instantly, so don't spend time

trying to figure out the answer. Since you will be observing only two teeth, and since
you will only be attempting to determine forces, not moments, you should find
yourself dealing with a much greater degree of simplicity and accuracy than you
actually do with your everyday patients. If you find, in the end, you have erred on
occasion, then you can assume your degree of error is much higher on multibanded
teeth or full strapups. It would indicate that the visual inspection method is not a
reliable method and often accounts for many problems. So, let us proceed to determine
what forces, if any, are present on the particular tooth in question. Disregard the
moments altogether and ask only whether there will be an intrusive or extrusive force
present or no force at all.
The correct answers to the illustrations are provided at the bottom of each page.
Cover these answers and circle your choice of force determination under each
illustration. Then check your choices with mine.

figure 3
In Figure 3, the archwire is inserted into the cuspid bracket. Although we would
normally insert the wire into the molar tube first, it makes no difference, since we are
concerned only with the total force system that exists when the archwire is fully
engaged in all brackets and tubes. Visually, what force, if any, do you predict would be
present on the molar? What force would occur on the cuspid? Disregard any moments.
Keep your observation simple.

figure 4
In Figure 4, the archwire is again inserted into the cuspid bracket. Upon
insertion into the molar tube, what force would exist on the molar? What force would
exist on the cuspid? Are you certain that such forces even exist?

figure 5
In Figure 5, what force will be produced on the lateral incisor upon archwire
insertion? What force would exist on the central incisor?

figure 6
In Figure 6, the question remains the same. What force do you feel would
become present on the lateral incisor and what force would you expect to find on the
central incisor?

At this point, the questions must appear to be very boring and the answers quite
obvious, but please exercise patience and continue with the questions.

figure 7
In Figure 7, what force would become present on the cuspid when the archwire
is inserted into the cuspid bracket? How about the molar?

figure 8
In Figure 8, what force will be produced on the cuspid? What force might
become present on the molar?

figure 9
In Figure 9, what force will be produced on the central incisor? What would be
produced on the lateral incisor?

FINALLY, in Figure 10, what force would be produced on the central incisor and what
force would be produced on the lateral incisor?
If you haven't already quit in boredom and disgust, please notice that the last
eight illustrations we discussed really involved only four situations, since whenever
the wire was shown in one bracket or tube, it was again shown in the other bracket or
tube. Thus, a given situation utilized two illustrations, but the force system would be
totally unaffected. Furthermore, note that one-half the illustrations involved the buccal
plane of space while the other half involved the anterior plane of space. In other
words, the same questions were simply repeated in a different plane of space, which
did not change the problem.
Actually, all we have done is to look at two archwire bends. One bend was
centrally located while the other bend was located off center. It was located either
against the bracket or the tube. Each time the bend was located in the center, the
answer was constant, and each time the bend was located off center, the answer was
constant. So we only dealt with two problems. Visual inspection might have led us to
believe there were more. DID IT? Were your answers consistent? Did they change
with the planes of space? Did they vary according to which bracket or tube received
the wire first? They shouldn't it makes no difference.
There is only one force system that can exist for each of the two problems
presented. When the bend was located exactly in the center, there were no forces
present. How does this compare with your answer? Actually, the centered bend
produced only equal and opposite moments, but no forces not a bad situation when
we wish to parallel roots following space closure, or rotate teeth equally and
oppositely. How about the off-centered bend? Well, the off-centered bend produced
equal and opposite forces, but the moments were no longer equal. They became
unequal when the bend moved away from center. I realize moments are aside from the
subject of forces. Moments will be discussed in the next installment.
What does all of this mean? Well, it means that in a given plane of space, WE
can determine or recognize the forces present by noting the location of the

bend. Once we have attained bracket alignment, further force systems can be
determined by the orthodontist instead of by the malocclusion.

A Simple Rule
Let me present an oversimplified, but practical and usable rule which can help
you in your practice immediately. Later, I will present material on wire/bracket
relationships in an easy to understand form, and prove to you why these forces must
exist, regardless of what visual inspection might lead you to believe.
First, if the bend is located off center, there will be a long segment and a short
segment. When the short segment is engaged into the bracket or tube, the long
segment will point in the direction of the force produced on the tooth that will receive
the long segment. If you refer back to Figure 7, you will notice that the long segment
points apically to the cuspid, meaning cuspid intrusion and therefore, molar
extrusion. Another way to think of it is this: The short segment points in the opposite
direction of the force that will be produced on the tooth that receives the short
segment. In Figure 3, the short segment points apically to the molar, so the force on
the molar is extrusive, meaning that the cuspid will receive an intrusive force. This is
certainly different than visual inspection might lead us to believe.
Next, if the bend is in the center, there no longer exists a long or short segment.
Therefore, no force is produced. This is difficult for some to believe, as there can be
tremendous forces involved in getting the wire into the bracket or tube, but as we will
see later, these forces cancel each other upon archwire engagement, leaving pure
moments. Worthwhile mentioning is the fact that because we deal with forces in
various planes of space which, of necessity, are equal and opposite, anytime we
incorrectly determine one of these forces, we introduce additional error with its
opposite.
It must be said at this point that common sense must always be present.
Determining the presence and direction of a force is an important part of efficient
mechanics, but by itself does not describe or predict tooth movement. Obviously, an
ankylosed tooth would not respond to the force. Likewise, we must consider other
factors such as forces of occlusion, cusp height,
habits, etc.; but regardless of these other factors, if we can reliably know the force
present and its direction, we
know most likely where the teeth WILL NOT move and can concentrate on where we
wish to position the teeth.
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Now that the fallacy of the visual inspection method has been discussed, and
simple, but useful, rules presented concerning the use of centered and off-centered
bends, let us move from the buccal and anterior planes of space and proceed to ask
questions similar to those before. But this time, disregard the use of visual inspection
and adhere to the simple rules governing centered and off centered bends. See if it
helps you solve the problem in an instantaneous and non-confusing manner.

figure 11
In Figure 11, the wire is inserted into the molar tube. What force would exist on
the cuspid upon archwire insertion, and what force would occur on the molar?

figure 12

figure 13

figure 14
In Figures 12, 13, and 14, ask yourself the same questions. We are simply trying
to determine whether the forces involved are buccal or lingual, or even present. Can
you begin to see the ease and accuracy in using a method that eliminates visual
inspection? Isn't it comforting to know that you can look at Figure 12 and predict a
buccal force rather than a lingual force? Isn't it just as comforting to look at Figure 13
and know the cuspid will not move lingually because there is no force acting on the
tooth?
Remember, that at this point we are looking at "two teeth" illustrations only. The
picture becomes more complex, but we will attempt to deal with these complexities as
we go along. In the material thus far presented, it has only been my intention to
introduce the subject and, hopefully, to create an awareness that we cannot reliably
determine force systems by "visualizing" the relationship of archwire to tube or
bracket. In this material, forces have been discussed. Next, moments will be discussed,
and we will then look at what really occurs when we start placing different kinds of
8

bends into the same archwire. It will be interesting to see what effects lingual root
torque and labial root torque produce on incisors. It will be interesting to begin to
observe what happens at both ends of the archwire instead of just one, as is so often
the case. You may even begin to sense a new excitement in YOUR mechanics as we
move along.

Volume 1979 Oct (676 - 683): Common Sense Mechanics: Part 2

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Common Sense Mechanics 2

THOMAS F. MULLIGAN, DDS

Forces and Moments

We all know what a force is, but sometimes we tend to confuse the relationship
between force and moment. Both are extremely important to us as they produce the
movements we seek, as well as those we consider undesirable. Simply stated, a force
is nothing more than a "push" or "pull," and acts in a straight line (Fig. 15).
figure 15

fifure16a

figure 16b
Whenever this line of force passes through the center of a body in
orthodontics we refer to the Center of Resistance there is no moment produced and
therefore no rotational tendency (Fig. 16A). When a force acts away from the center, a
moment is produced and a rotational tendency occurs (Fig. 16B).

figure 17A moment is the product of force

times distance. If the line of force does not pass through the center of resistance of the
10

tooth, then there is a distance between this line of force and the center. It is the
perpendicular distance from this line of force to the center that causes the moment on
the tooth, resulting in rotational tendencies (Fig. 17). Although I don't care to use
numbers or specific magnitudes in tooth movement, the magnitude of the moment is
determined by this force times the perpendicular distance to the center. We could
double the force and cut the distance in half, or double the distance and cut the force in
half, and in both cases we would produce the same moment or rotational tendency
(Fig. 18).

What does all of this mean? First of all, the orthodontist cannot think of forces
and torques (moments) as being the same. You can "sense" a force when you bend a
wire, but you cannot "sense" torque. Because the latter is simply a product of force
times distance, as previously discussed, the distance (length) is just as effective as the
force. If the force passes through the center of resistance, no perpendicular distance is
involved. Therefore, regardless of the magnitude of the force, there is no moment (Fig.
19). Force times zero distance always equals zero. We might use a lot of force and
produce no moment or a small moment, while a small force might produce a large
11

moment due to the distance involved (Fig. 20). So, beginning right now, it is important
to get used to treating the two as separate entities. One is a product of the other.
Because all of this is going to become essential, later, when we discuss differential
torque for anchorage and nonanchorage problems, and because ultimately you will see that the clinical application
is simple, fast, and easy to understand, it is critical that the groundwork be laid
beforehand.
I am going to go through a step-by-step discussion of what I have, over the
years, referred to as the "Cue Ball Concept." If we can think of things in a way that
relates to some of our personal experiences in life, I think you will find it much easier
to understand and ultimately apply. After all, if it cannot be applied, then this is strictly
academic and a waste of your valuable time.

Cue Ball Concept

Anyone who has had the experience of playing pool has held a cue stick and
applied a force on the cue ball. Experience taught the individual where to strike the
cue ball in order to produce a given response. If we desired English, we applied a
force off center (Fig. 21). We produced left or right English at will, simply by deciding
to apply the force to either the left or right side of center on the cue ball.

If we only wished to "translate" the cue ball move it in a straight line with no
left or right English we applied the force right through the middle of the cue ball
(Fig. 22). By the way, with a tooth we use the term Center of Resistance, whereas, in a
free body we use the term Center of Mass. Obviously the ball rotated or rolled forward
due to the friction of the table, but the response was predictable. A force applied
through the center resulted in straight line movement with no left or right English
(moment). Since we know from experience, therefore, how to predict a response based
on the point of force application, let us take a step-by-step look at the reasons behind
this predictability.

Translation
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Again, if we apply a force through the center of the cue ball, it will move
forward in a straight line (Fig. 23). Unlike the tooth, this is a free body with a set of
rules we will discuss. Whenever a force passes through the center of such a body, the
body will translate. There will be no rotation other than the forward roll due to the
friction of the table itself. The reason there is no rotation (moment) is that the line of
force has no perpendicular distance to the center; the force is passing through the
center. So, we can make the statement that a force acting through-the center of such a
body produces translation without rotation. This is a predictable response based on a
known point of force application.

Rotation and Translation

If we take exactly the same force and apply it on the same body, but instead of
applying it through the center, apply it off center, then we create a situation where the
line of force has a perpendicular distance from the "Center of Mass" (a free body
expression). This means that we now produce not only translation, but also rotation, as
a result of the moment produced (Fig. 21). As we know from experience, this is
exactly what happens when we decide to strike a cue ball to the left or right of center.
A force applied on a body, but not through the center of that body, results in translation
and rotation.

Pure Rotation (Couple)

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Although when we play pool, we do not apply two forces on a cue ball at the
same time, we could do it to prove a point. If we were to apply two forces on the cue
ball, equal and opposite, in the same plane of space, the ball would not translate in any
direction. Instead, it would simply maintain its position and "spin" (rotate) (Fig. 24).
The reason for this is that the two forces cancel each other out, but leave a net moment
(rotation) due to the fact that each of these "Lines of Force" acts at a perpendicular
distance from the center of the ball. Now that we have "played" the game of pool
together, I hope we can see the reasoning behind our experiences and from this learn
that it is possible to predict a response based on a known point of force application.

Forces and Moments Acting on Teeth

With some of these basics behind us, let us take a look at tooth movement when
we attempt to accomplish more than one type of tooth movement at a time. In the
previous material, it was shown how the force and direction can be determined by
whether the bend is in the center or off center. Therefore, if we use a tipback bend for
overbite correction, as is done in a number of techniques today, we can certainly
recognize that when the short segments are placed into the molar tubes, the long
segments, prior to bracket engagement, lie in the muco-labial fold (Fig. 25A). From
this we can see that the long segment points apically in the incisor area and therefore
indicates an incisor intrusive force while the molars have an extrusive force present.

But, there is more to it than just these forces. What about the moments? When
the wire is brought down from the mucolabial fold for insertion into the incisor
brackets (Fig. 25B), the force required acts at a perpendicular distance from the center
of resistance in the molar (Fig. 25C), thus producing mesial root torque or distal crown
thrust on each of the molars involved. When the wire is engaged into the incisor
brackets, the intrusive force acts in a straight line and usually passes labial to the
14

center of resistance in the incisors (Fig. 26). This produces a smaller moment that on
the molar, because in spite of the fact the forces are equal, the distances involved are
radically different.

So, when the archwire is tied into place and tied back at the molar tubes, we
have significantly different (relatively) magnitudes of torque (Fig. 27) which we can
refer to as "differential torque". If we do not tie the archwire to the molar tubes, and if
friction does not accomplish the same by causing binding at the tubes, the anterior and
posterior moments may be permitted to respond independently of each other. If tied
back, the system behaves as a whole, and the "tug of war" is apparent with the molar
having the obvious mechanical advantage with the larger moment. The clinical
applications of differential torque will be discussed later .

15

Thus far, we see a force system as illustrated in Figure 28. But, again, that is not
all that is taking place. Let us take a look at a distal view of the molar teeth and keep
the cue ball concept in mind (Fig. 29). If the wire is round, instead of rectangular, and
permitted to "roll" inside the tubes, the extrusive force present on the molar teeth then
acts at the molar tubes which lie, usually, buccally to the center of resistance in these
teeth. This force times distance results in molar lingual crown torque. So we can begin
to see that such torque is not
necessarily dependent on the use of rectangular wire. Torque is simply a product of
force times distance and does not recognize the type of wire involved. Incidentally, if a
wire were very rigidly attached to the tubes, the applied force would pass lingual to
the center of resistance, thereby inducing buccal crown torque instead .
When one observes an effect, he should be able to interpret the cause and vice
versa. We should also begin to recognize that such force systems should not be
routinely considered as undesirable side effects except for the orthodontist who is
unaware of their presence and therefore is not prepared to prevent undesirable effects
as well as to utilize the systems effectively when indicated. If lingual crown torque is
desired, it should be permitted to act. If undesirable, it can be prevented with a lingual
arch, a rectangular wire, or whatever means the operator chooses.
So, looking at the force system, thus far, we recognize molar extrusive forces,
incisor intrusive forces, molar mesial root torque significantly (relatively) larger than
the incisor lingual root torque, and molar lingual crown torque. Does this seem
complicated? It might for anyone used to concentrating only on the single force or
moment desired, but the entire system exists, whether we like it or not not just the
portion with which we are concerned. In any case, awareness of the entire system will
afford us many exciting opportunities as we will see later. We will discover that there
are means available for utilizing parts of the system while overcoming other parts,
because we will be dealing with such matters as forces of occlusion, cusp heights, wire
size and lengths, etc., whereby we can learn to control force magnitudes so that
although an extrusive component of force might be present on a molar and considered
to be undesirable, it can be prevented from acting and therefore not become a threat.
Force systems will always be present, but not all phases will be permitted to respond.
16

Lingual Root Torque

Now, after all of the previous discussion which involved a tipback bend, we are
able to become reasonably familiar with the force system involved. Let us take a look
at other bends in the same archwire that begin to affect the force system. If we place
lingual root torque into the incisor section, we produce a long segment and a short
segment (Fig. 30), just as was the case with the tipback bend. The long segment
indicates a molar intrusive force and therefore an extrusive force on the incisors. We
can also see that the torque produced on the incisors is a result of force times distance,
since the long segment has to be brought down to the molar tube, and the force
required to bring it down acts at a perpendicular distance to the incisors (Fig. 31). If
the long segments from the tipback bends maintain the same angular relationship as
the long segments from the incisor torque bend, the vertical forces cancel each other
and only moments remain. Therefore, no overbite correction may occur even though
17

we might expect it. The anterior lingual root torque introduces a vertical component of
force that must be considered .
If the long segments just discussed are unequal in angular relationship, then the
one producing the greater angle relative to t he level of the archwire will determine the
net force
present. For example, if lingual root torque produces the greater angle as shown in
Figure 32, the net forces will be intrusive on the molar and extrusive on the incisor.
Therefore, if we are hoping for overbite correction, but increased our lingual root
torque to this point, we can expect our overbite to increase instead of decreasing. So,
we might decide, if we know this beforehand,
to either increase the molar tipback bend, decrease the amount of lingual root torque
on the incisor segment, or a combination of each, in order to assure ourselves of a net
intrusive force on the incisor segment for overbite correction.
Recognition of the problems and intelligent decision making will only follow a
thorough understanding of the underlying principles.

JCO , Volume 1979 Nov (762 - 766): Common Sense Mechanics: Part 3
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Common Sense Mechanics 3

18

THOMAS F. MULLIGAN, DDS

Static Equilibrium
In spite of the fact that orthodontists have heard many times over that every
action has an equal and opposite reaction, Newton's Third Law has not really been
understood in such a way as to permit the orthodontist to apply the principles in his
daily orthodontic mechanics in a simple and practical manner. The subject of static
equilibrium is so easy to understand, and yet so very important in orthodontic
mechanics, that the practicing orthodontist cannot afford to ignore the principles
involved. Sometimes, it seems to be the tendency to make simple things seem
difficult, because we are often dealing with difficult subjects. However, in the case of
static equilibrium, the subject matter is so easy to comprehend that a grade school
child finds little difficulty with it. When asked one time to speak on the subject of
statics, I wondered aloud how I could make the subject seem interesting and was
overheard by one of my sons who was in early grade school at the time. He wasted no
time in going to a book titled "Science Puzzlers" to search for the subject as well as a
means of demonstration (Fig. 33).
The experiment consisted of a glass with a coin sitting on the lip of the glass
with two forks suspended on the edge of the coin. Certainly, this seems like an
impossibility to the unaware individual, but it manages to stay in a state of balance
because it meets the requirements for static equilibrium in this situation. Keep in mind
that an effort was put forth to establish equilibrium in this case, but in orthodontics we
have the advantage of equilibrium automatically establishing itself every time we
engage an archwire into the brackets and tubes. We do not, therefore, have to concern
ourselves with how to create static equilibrium, but rather with how to recognize the
forces and moments (torques) that come into existence to establish the static state.
Relating to our own lifetime experiences as we did with the "cue ball
concept" we can recall the teeter-totter, familiar to us as youngsters. When a large
person sat at one end and a smaller person at the other end (Fig. 34), the board was not
in balance until the heavier end struck the ground. If we, as youngsters, desired to
convert this "dynamic" state to a state of statics, we simply shifted either the unequal
weights or the fulcrum point on the board (Fig. 35). Then, we encountered a state of
balance. The question, therefore, is why?

Requirements for Static Equilibrium

19

Three requirements are automatically fulfilled whenever static equilibrium is

established.
The first requirement for static equilibrium is that the sum of all the vertical
forces present must equal zero (Fig. 36). This is why we must deal with extrusive
components of force during overbite correction (Fig. 37). Since we cannot eliminate
these forces, we must learn to control them. Controlling force magnitude will be
discussed later.
The second requirement for static equilibrium is that the sum of all horizontal
forces present must equal zero (Fig. 38). This is why we cannot correct a unilateral
crossbite with a single horizontal force (Fig. 39). We must apply common sense when
treating these problems.
The third requirement for static equilibrium is that the sum of the moments
acting around ANY point must also equal zero (Fig. 40). We may choose any point we
wish it does not matter. We may produce heavy torques in a given area and little or
no torque elsewhere, but when added around any given point, they will equal zero.
The third requirement SEEMS somewhat more confusing than the first two, so
let us discuss this third requirement in a more meaningful and practical way. Rather
than choosing "points" for addition of the moments, think of it in this way: If we have
two moments, one acting at each end of the archwire, and their magnitudes are equal
(Fig. 41A), it seems quite apparent that the system is "balanced". But, if we have the
same situation with unequal magnitudes, it seems that the system is no longer in
balance (Fig. 41B). However, we KNOW that an archwire, when fully engaged,
always results in static equilibrium. Therefore, regardless of the fact that Figure 41B
seems to be unbalanced, forces are introduced to keep the systems balanced .
Looking at the two unequal moments in Figure 41B, it appears that the entire
unit would rotate counterclockwise. But, looking at Figure 41C, we see that forces are
automatically created which by themselves would cause the unit to rotate clockwise.
Actually, these are equal and opposite forces their sum must equal zero
producing what earlier was referred to as a couple or pure rotation. The magnitude of
these forces is exactly whatever is necessary to produce a counterrotation and establish
a balanced state. Isn't it rather interesting that earlier it was shown that torque is a
product of force times distance?
This means that whenever we observe torque, it is simply a question of whether
the total forces involved on specific teeth cancel each other. It was shown that with
anterior lingual root torque applied, a large moment was produced in the anterior with
a resultant eruptive force. In referring back to Figure 41B, we can now see that the
eruptive force exists because it must exist to maintain the state of balance, whereas in
Figure 41A the forces existing with each moment cancel themselves out of the picture,
thus leaving equal and opposite root torque with the absence of vertical forces. Figure
20

42 illustrates a full strapup with a reverse curve of Spee. Note that the vertical forces
add up to zero along the archwire, producing moments at each end resulting in anterior
lingual root torque (labial crown torque) and posterior mesial root torque (distal crown
torque). Unlike Figure 41A, where the forces canceled each other at a given tooth site,
in Figure 42 they equal zero when the entire system is added, but do not cancel each
other at a given site, thereby allowing predictable forces to act at these sites.
We are acquainted with such forces in a reverse curve of Spee, full strapup. In
spite of the fact that we are usually attempting anterior intrusion, we produce anterior
and posterior forces with equal and opposite extrusive forces occurring through the
bicuspid areas. Of course, as was discussed earlier, intrusive forces acting through the
molar tube usually produce buccal crown torque (cue ball effect), while the intrusive
force through the incisor brackets usually produce labial crown torque.

Arch Leveling
When leveling an arch, it has already been shown that in a full strapup, intrusive
forces act through the molar tubes, producing buccal crown torque on the molars. Do
you sometimes observe the posterior teeth moving buccally for no "apparent" reason
during arch leveling?
When a 24 (incisors and molars) strapup is utilized for overbite correction,
such as is often done during late mixed dentition treatment, the force system is not the
same as the one just described. Since intrusion is placed on the incisor segment, and
because the molars then become the reciprocal teeth, they incur eruptive forces,
whereas the full strapup resulted in molar intrusive forces. Since extrusive forces
acting through the molar tubes usually result in lingual crown torque on the molars, we
have the potential for lingual crown movement (lingual "dumping").
Do you sometimes observe the posterior teeth moving lingually for no
"apparent" reason during arch leveling procedures?
During arch leveling procedures, we frequently observe responses that may be
undesirable. They often occur unexpectedly and in various forms. Too often, we tend
to look at all of this as variation occurring in the individuals we treat, when in fact
many of these occurrences are predictable beforehand and therefore avoidable from
the onset.
As we can see, there is a reason for all responses. Whenever we witness
responses for "no apparent reason", we have failed to recognize the cause, and as a
result made our treatment somewhat more difficult. The recognition of causes permits
us to utilize as well as avoid certain types of tooth movement.
JCO, Volume 1979 Dec(808 - 815): Common Sense Mechanics: Part 4
-------------------------------21

Common Sense Mechanics 4

THOMAS F. MULLIGAN, DDS

Crossbites
A discussion of Static Equilibrium pointed out the three requirements which are
automatically fulfilled whenever an archwire is completely engaged in brackets and
tubes. Since the horizontal forces, as discussed, must always equal zero, and because
there are still those few who believe a single force can be applied to a single tooth in
crossbite without an equal and opposite force being applied elsewhere, the subject of
horizontal forces will be discussed at this point, while vertical forces will be discussed
later. By the way, you will notice that the vertical forces are usually kept as light as
reasonably possible, whereas no such attempt is made at the horizontal level. In fact,
the forces used at the horizontal level are often quite high. High magnitudes of force
threaten the vertical dimension, while posing little or not threat to the horizontal
dimension.

Expansion
If we have an individual tooth, such as a molar, in crossbite or an entire
buccal segment we know beforehand that we would like to apply a force in the
necessary direction for correction on those teeth only. But, most of us realize that there
will be an equal and opposite force applied elsewhere as well. Common sense must
enter the picture. First of all, when we observe a buccal segment in crossbite, are we
really observing a unilateral crossbite, or are we witnessing a bilateral crossbite with a
lateral mandibular shift? In my opinion, the latter is almost always the case. Therefore,
we need not fear the fact that there will be equal and opposite horizontal forces present
(whose sum equals zero), as both sides will require the force.

Overlays
The term "overlay" as used here will most often refer to a heavy wire overlaying
the main archwire. It can either be inserted into the headgear tube or be designed with
terminal hooks to engage the archwire (Fig. 43).
Since I use an .045 headgear tube, I prefer the use of an .036 overlay for
expansion, as it provides sufficient binding in the headgear tube when activated, to
provide the desired stability. As mentioned so often already, the force provided will be
equal and opposite not unilateral in direction as might appear to be the case when
22

the overlay is inserted into one tube and observed (Fig. 44). If a segment of the dental
arch has collapsed for any reason, the point of attachment can very well be that
specific area, since the heavy overlay can overcome the resilience of the lighter
archwire (Fig. 45).
Figure 46 illustrates a patient with a bilateral crossbite, but a lateral mandibular
shift which gives the clinical impression of a unilateral crossbite. Figure 47 illustrates
insertion of the .036 overlay, following activation by expansion. Note the midline
discrepancy as a result of the lateral mandibular shift. Also, remember that upon
insertion into both molar tubes, there exists a buccal force on both the left and right
sides. This means the normal side will become "worse", while the opposite side shows
improvement. By the time overcorrection of the side in crossbite is obtained, the
"normal" side is in buccoversion (Fig. 48), but readily "relapses" to its normal
position, while the side originally in crossbite relapses to the point of improved
function and HOPEFULLY this improved function will maintain the position. If not,
the overlay is reinserted. Because of the need to occasionally replace the overlay, it is
never discarded, but rather stored in the patient's model box. Incidentally, the loops
seen in the archwire are rarely used in my office. My practice consists almost entirely
of loop-free archwires except for the small tieback loops. Figure 49 shows the case
with the overlay removed and the teeth allowed to function with additional freedom.
Figure 50 shows the case following treatment and retention.
The next case was treated in the same manner, but involved a unilateral Class II
malocclusion and a unilateral tongue thrust (Fig. 51). The Class II molar relationship
on the right side was corrected with cervical headgear and overlay treatment (Fig. 52).
After overtreatment and removal of the overlay (Fig. 53), note that the normal
side has relapsed to its original position, while the side in crossbite had its first
opportunity for some improvement in function. The lateral opening was still present.
The case was debanded (Fig. 54) and retained, since common sense dictated there was
insufficient lateral function to expect the case to maintain itself. No myofunctional
therapy was ever instituted. After the bite closed on the right side, retainers were
eliminated and, interestingly, the side which was in crossbite now looks better than the
normal side (Fig. 55).

Cosmetic Overlays
Now, let us take a look at a late mixed dentition case where only a single tooth
is in crossbite (Fig. 56). The overbite is mild, as is the lower anterior crowding, but
this is pretty normal at this stage of development. The crossbite could be treated
simply in a number of ways. Use of an .036 overlay and two molar bands provides a
simple solution (Fig. 57). The overlay is referred to as "cosmetic" because it is
designed not to show when the patient smiles. It is, therefore, ideal for the adult
patient who is concerned about the cosmetics of appliance therapy. It can also be
23

removed by the patient, if necessary for any reason such as illness or broken
appointments.
Since the force necessary for crossbite correction will require an equal and
opposite force on the other molar, it can readily be assumed that by the time the
crossbite is corrected, the normal tooth will have moved into buccoversion. But, the
overali movement is very rapid usually about three to six weeks (Fig. 58). The
normal side readily "relapses" to its original position, while we are hoping that the
corrected side will maintain normal position through improved function. Since it is
overtreated, relapse to the point of normal function is desired. But common sense and
experience tell us that not all crossbites maintain normal position when corrected. So,
never discard the expander keep it in the patient's model box. If the tooth (or teeth)
relapses, the expander may be reinserted and the case expanded even further than the
first time.
In the case shown, the maxillary right first molar was overexpanded, resulting in
the normal molar moving into buccoversion. Immediate relapse occurred with removal
of the expander and the corrected side was held with a removable retainer while other
teeth continued to erupt (Fig. 59). Ultimately, the improved molar function, in itself,
stabilized the tooth and no further orthodontic treatment was ever instituted.
Additional improvement was noted after loss of the second deciduous molars (Fig. 60)

Bodily Movement
All of the movements thus far described have been tipping movements only.
The force is heavy and applied at the crown level. If bodily movement is desired, a
rectangular wire may be placed to provide the necessary torque at the root level.
Normally, when we attempt to "bodily expand", we find that buccal root torque in the
archwire causes the crowns to initially move in the opposite direction we intend that
is, they move lingually. This gets back to the old saying, "Crown movement tends to
precede root movement". The overlay overcomes this initial reaction by providing the
necessary force at the crown level.

Reduction of Posterior Arch Width

The same overlays as used for expansion are utilized. Instead of the overlay
being expanded, it is constricted. All of these overlays are much easier to use in the
maxillary arch due to the tendency for occlusal interference in the lower arch, as well
as the fact that the lower arch usually does not contain a headgear tube for
convenience.

24

JCO, Volume 1980 Jan(53 - 57): Common Sense Mechanics Part 5

--------------------------------

Common Sense Mechanics 5

THOMAS F. MULLIGAN, DDS

Controlling Vertical Forces Intraorally

Much has been said and written about vertical dimension and the problems
involved with steep mandibular plane angles and extrusive forces, particularly on the
molar teeth. Likewise, a number of solutions have been offered, including the use of
various types of high pull headgear. But little has been said in terms of controlling
vertical dimension problems by controlling magnitudes of force intraorally in the
vertical plane of space. Since certain appliance techniques become almost routine or
"cookbook" in nature, certain potential advantages of force control are lost. For the
25

most part, the attempt is to prevent overeruption of teeth rather than actually intruding
posterior segments.
Whether the latter should be done may be argued, but in my practice no high
pull headgear is used to intrude posterior teeth. The force MAGNITUDES are
controlled so that posterior teeth are only allowed to erupt to the extent of vertical
growth within a given patient, in which case the teeth would erupt anyway, even
without orthodontic treatment. There is the advantage, also, of allowing the teeth of
choice to erupt. For example, maxillary molars can be permitted to take up most of the
vertical increase or, if desired, the lower molars can be permitted to take up part of the
space. Understand, we are only talking about the total vertical eruption of teeth that
would occur without treatment. We are not talking about additional vertical resulting
from the overeruption of teeth due to the forces of mechanics.

The Diving Board Concept

In an attempt to continue to use examples with which we are familiar, I would
like to discuss what I call "The Diving Board Concept". It is not that we use the diving
board in force control, but the mental image should permit us to recall more vividly
the advantages involved in utilizing the factor of "length" in our archwires. There is a
formula that says that stiffness or load/deflection rate is inversely proportional to
the cube of the length. Formulas of this kind often seem confusing and of little use to
the orthodontist, as well as difficult to remember.
To make all of this useful and a little easier, let us analyze the situation more
closely. First of all, stiffness is the amount of deflection we get from a given load
(force). The formula tells us that if we are dealing with a cantilever (such as a diving
board), by doubling the length stiffness is reduced to one-eighth. By doubling the
length, only one-eighth the force will be required to produce the same deflection or the
same force acting at double the length will produce eight times as much deflection
(Fig. 61).
Looking at a diving board, we can see that one end is attached and the other end
free. If a person were to walk out only halfway on the diving board, the board would
bend or deflect a given distance. Also, the weight (force) of the individual standing at
this halfway point times the perpendicular distance to the point of attachment of the
board produces a moment at the point of attachment (Fig. 62). In orthodontics, we
often refer to this moment as the "critical moment", as it is the largest moment
involved and is often responsible for breakage in an archwire at that particular point.
Since moments are products of force times distance, as stated so frequently thus
far, you will notice that the moment keeps decreasing along the diving board and
finally reaches zero directly underneath the individual (load) standing on the board
(Fig. 63). This is because the distance at that point is zero. Now, as the load moves
forward to the end of the diving board, the critical moment doubles due to the fact that
26

the distance has doubled (Fig. 64). The load is still the same, but force times twice the
original distance produces twice the moment (critical moment). Again, note that the
individual produces only a pure force acting through the point at which the load is
positioned. There is no moment at this point, since there is no distance left in
relationship to the applied force.

Cantilever Principle
What we have just discussed is known as a cantilever system, characterized by a
pure force acting at one end, and an equal and opposite force at the other end
accompanied by a moment. We can utilize this system in orthodontics and make
modifications for practical purposes. The pure force can be used for overbite
correction while the differential torque can be utilized for intraoral anchorage control.
The latter and its application will be discussed later.
To demonstrate the relationship of wire length to load/deflection (stiffness),
fabricate a rectangular segment of wire with a tipback bend (Fig. 65). On your
typodont, insert it into the molar tube and measure the force at the anterior necessary
to raise the wire to bracket level (Fig. 66A). Note the force required and then move
half the distance to the molar and again measure the force necessary to bring the wire
to bracket level (Fig. 66B). This visual demonstration should help you to remember
the significance of "bypassing" teeth as one dramatic means of controlling force
levels.
Thus far, we have discussed loads (forces) and deflections as related to a diving
board. This was done only to permit an easier reflection on some of the points
discussed, as learning by formulas alone can sometimes be monotonous at best. Next,
we will take this "Diving Board Concept" to the patient and apply it in a simple and
effective manner. But, first, I would like to conclude this portion with a discussion
regarding constancy of loads and deflections.

Constant Load versus Constant Deflection

There are those orthodontists who are concerned about precise force levels for
certain types of tooth movement, for various reasons which need not be discussed. On
the other hand, there are those who almost totally disregard the force levels involved
in tooth movement. I would like to discuss, briefly, my personal concept.
To seek an exact force level requires varying the deflection of the archwire (Fig.
67). This means that when we place a given bend, we must determine what angle is
necessary to produce the desired load (force). It also requires that we must know the
length of wire between brackets and tubes. We can resort to reference tables or we can
go through "trial and error" until we arrive at the bend which gives us the force we
27

want. If, instead, we choose to place a "constant" bend (angle), we find that we create
variable loads (forces) (Fig. 68). The problem now, of course, is that some of these
loads might be biologically and physiologically acceptable, while others might be
much too high and introduce additional problems into our treatment procedures,
particularly those cases involving vertical dimension problems.
With all of this in mind, I prefer the application of constant bends (angular)
because they are easy to do, readily reproducible, intraorally activated (light wires
only), and offer low force ranges when the orthodontist is familiar with the "by-pass"
approach to force control. It is necessary to get rid of the idea that "light" wires, by
themselves, produce "light" forces. As we know, small interbracket distances can
produce very high magnitudes of force with the so called "light wires". Bypassing
teeth is one method of increasing interbracket distance. Individuals often use single
wing brackets for this purpose, but when all teeth are banded all of the time and an
archwire engaged in every bracket automatically, there is little alternative for reducing
force levels.
In short, constant bends are VERY practical, easy, useful, and effective IF the
operator understands the various principles governing "force control". Although the
range of force levels will be broad, the entire range can be maintained at a very low
level.

JCO, Volume 1980 Feb(98 - 103): Common Sense Mechanics Part 6

--------------------------------

Common Sense Mechanics 6

THOMAS F. MULLIGAN, DDS

Clinical Application of the Diving Board Concept

If we wish to apply the cantilever principle and its modifications for practical
use in clinical orthodontics, we must understand its characteristics and possess some
means of controlling the force magnitude involved, as these equal and opposite forces,
in the vertical plane of space, threaten our treatment results in various ways. From the
"Diving Board Concept", previously discussed, we recognize that length affects load
(force). If we double the length of wire, we reduce the force per unit of deflection to
one-eighth. Therefore, if we bypass bicuspids and cuspids during overbite correction,
28

and use a wire with tipback bends at the molars, we have in effect created a "diving
board", although certain modifications would be required in the anterior segment in
order to provide a true cantilever system. However, as we will see, the major
advantages of force control can be achieved in a practical manner by deviating from
the true cantilever concept when desired, although we remain free to use the cantilever
approach if we wish.
If the tipback activation is constant, such as a 45 angle, then as the distance
doubles, so does the deflection (Fig. 69). Therefore, although the load per unit of
deflection is reduced to one-eighth, the unit of deflection is doubled, resulting in a net
force of one-fourth (2 1/8 = ). However, it is quite evident that the length of wire is
increasing much more than "twice", and therefore the net intrusive force on the
anterior segment is dramatically reduced. With wire sizes of .016, the magnitudes at
times become so low, you wonder if "anything" will happen with the overbite. It is
common to have forces in the range of 20-30 grams and lower. I do not measure such
forces because the entire range remains low. If we apply a total force on an incisor
segment of 30 grams (intrusion), for example, we produce equal and opposite forces
on the molars. But, one-half goes to each molar, meaning that each molar in this
example would incur only 7 grams of force enough to allow the molars to erupt
during vertical growth, but not enough to overcome the forces of occlusion.

Affect on Forces and Moments

Because the anterior-posterior arch length varies from patient to patient, when
bicuspids and cuspids are bypassed the length becomes a variable and, thus, so do the
magnitudes of the intrusive and extrusive forces at each end of the archwire, which we
have already seen to be greatly affected by changes in wire length. However, the entire
range of force is so low that low magnitudes of force may pose a greater problem than
attaining higher levels of force. In fact, it may even require going to archwires of
greater diameter to produce a required force and desirable response.
The moment on the molars, however, cannot be ignored, as it is possible to tip
back molars undesirably, if not cautious. Be careful not to use too large a tipback bend
(angle), as this in combination with duration (time) of use can result in excessive
tipback of the molar teeth. However, if molars are tipped back without the use of
forces that cause such teeth to "overerupt", I have yet to see a case where such teeth
have not readily uprighted during retention usually within a period of one year
following appliance removal. If cervical headgear is being worn, this tends to prevent
much of the tipping in the upper arch. In many overbite cases, the correction is
required in the upper arch anyway, due to short lips and "gummy" smiles. In such
cases, a tipback bend need not be applied to the lower molars.

29

Pure Force
A pure force will not occur if the design of the archwires is improper. In a case
where only the molars and incisors are banded/bonded, direct insertion of the archwire
into the incisor brackets, following the placement of a tipback bend at the molar area,
does not produce a pure intrusive force to the incisor teeth. Initially, the wire will cross
the lateral incisor brackets at a slight angle, resulting in a more complex system in
which forces and moments are introduced in combination. The exact force is unknown
and in certain cases might not even exist.
Remember the "Fallacy of Visual Inspection in Force Analysis"? In order to
provide a pure and known intrusive force, a wire segment can be placed into the
incisor brackets and the archwire then used as an "overlay" (Fig. 70). As a practical
matter, I most often insert the archwire into the bracket, but it should be emphasized
that the term "cantilever" is no longer correct in the exact sense.
Notice in Figure 70 that the cantilever is in use with the lower arch. An anterior
segment has been placed with an archwire overlay containing a tipback bend. But the
upper archwire has been inserted directly into the incisor brackets and, as a result, a
pure force is no longer introduced at the bracket level . Instead, intrusive forces in
combination with moments are introduced and the system is therefore not a cantilever
system. Notice the effect of the moments on the lateral incisors. This is routinely seen
when the archwire containing a tipback bend is inserted directly into the incisor
brackets. But it is practical, the forces remain light, and the lateral incisor inclination is
easily corrected following correction of the overbite.
The name of this series involves "Common Sense", and it is good to know what
is technically correct, but at the same time what is practical and works. There is
nothing that says we must adhere to a certain method derived from a given principle.
We are free to modify any method in any way that gives us the end result we seek.
Each orthodontist may choose his preferred method. The underlying principles offer
him an intelligent choice. In any case, the force magnitudes in the non-cantilever
system remain light, and this is our primary concern.
Figure 71 shows a case which was treated with light forces using a
noncantilever approach and bypassing bicuspids and cuspids (Fig. 72). In addition to
providing light forces, the bypassing allows erupting teeth to adjust to their
environment without direct interference from an appliance. Again, the effect of the
moments can be seen on the lateral incisors. Remember, it was pointed out earlier that
there is a large moment produced on the molar teeth from the tipback bend. When the
archwire is tied securely to the molar tubes, this moment tends to tip all of the teeth
distally, as they are forced to "follow" the molars. This "distalization" tendency is easy
to check simply by observing the unbanded cuspids and their change in axial
30

inclination. The cuspid crowns tip distally as they are forced back as a result of the
thrust being received at the crown level.
Following treatment, with bands removed and removable retainers placed, note
the improvement occurring as the distobuccal cusps of the maxillary molars begin to
"seat" themselves (Fig. 73). This is a regular occurrence when molars have been
tipped back without the use of excessive forces. Nothing more than a 24 appliance
(incisors and molars) was used in this case, and it can be seen that the cuspids still
have a distal crown inclination.
Headplates are taken regularly on all patients, but will purposely be avoided
during this series, as it is intended to introduce as many "common sense" approaches
as possible into determining what is happening and why, on a practical and clinical
level.
Unbanded teeth frequently provide much information as to what is happening,
as they do not serve as reciprocal units. Such teeth (unbanded) are affected by
directions of movement and often permit us to verify clinically that what is happening
is what we predicted should happen. If not the case, something is wrong. But
remember that "common sense" is a very necessary ingredient in this matter of
interpretation. For example, distal crown torque on an upper molar could turn out to be
mesial root torque or a combination of the two. If a deep overbite is present and the
archwire tied securely to the molar tubes, distal crown movement of the molars may
become impossible with a tipback bend, and instead the molar roots may come
forward. If not inhibited by such interferences, remember crown movement tends to
precede root movement. So we do have an overall advantage if we apply common
sense. In fact, in most Class II malocclusions, the molars require some degree of
tipping (uprighting) .
Since overbite would normally be required with the use of a tipback bend, and
since tipback bends are sometimes desired in cases having little or no overbite for a
number of reasons many yet to be discussed the intrusive components of force
can be eliminated by the use of "up and down" elastics in the anterior of the mouth.
These elastics do not erupt teeth unless their extrusive components exceed the
intrusive components in the archwire. When balanced properly, the extrusive
components of force from the elastics simply cancel out the intrusive components of
force from the two archwires, upper and lower, when tipback bends are used in both
arches. At the same time, if it is desired to erupt anterior teeth in one arch, but not the
other (certain types of openbites), a tipback can be used in the arch where teeth are not
to be erupted. The tipback produces an anterior intrusive force which can be utilized in
that arch, to offset the extrusive force, from the up and down elastics.
Figure 74 shows a case with some interesting sidelights. Because of the large
moment produced at each molar, during overbite correction it is not uncommon to see
"distalization" of an entire arch. Non-banded teeth, as mentioned earlier, make useful
31

reference points on a clinical level. When the archwire is tied back at the molar tubes,
the incisor segment is "forced" to follow the molars as they tip back if the molar
crowns are allowed to tip back rather than the roots moving forward (some
combination would normally be expected). Note the position of the lower incisors
relative to the cuspids. Also note that the unbanded lower cuspids are tipping distally
quite significantly during the overbite correction. At the same time, teeth are erupting
nicely.
The final case (Fig. 75) involves severe crowding. This patient was treated
nonextraction. Only the incisors and molars were banded until the very end of
treatment when cuspid bands were added. Using a minimal appliance for as long as
possible and not letting the appliance do your thinking has its benefits. The expression,
"trade-off", may well apply, as the orthodontist is able to think more and work less.

JCO, Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

--------------------------------

Common Sense Mechanics 7

THOMAS F. MULLIGAN, DDS

Distalization With Differential Torque

The tipback bend has been discussed and demonstrated and, since the tipback
bend is used today in a number of respected appliance techniques, it is in order to
discuss it in greater detail. We know that the tipback bend is an off-center bend and
that the long segment and short segment indicate the direction in which the forces act.
We also know that the moments involved are unequal, thus resulting in "differential
torque". We have observed the "rowboat effect", which is the tendency for the
32

maxillary teeth to move forward during anterior lingual root torque (Fig. 76A). We
have all experienced this tendency for Class II relapse following headgear or Class II
elastics when such torque is applied. If we can simply understand WHY this occurs,
then we can reverse the conditions and create the opposite tendency, distalization (Fig.
76B).
We already know that when we apply anterior lingual root torque, crown
movement tends to precede root movement. When the archwire is tied to the molar
tubes, this "rowboat effect" is transmitted to all of the teeth. Anterior lingual root
torque can be applied in many ways. It makes little difference whether we use a
rectangular wire, or round wire with torquing loops, or whatever other means one may
choose. When a rectangular wire with anterior lingual root torque is engaged into the
molar tubes, anterior lingual root torque is produced (Fig. 77A).
Therefore, we can produce the opposite tendency for tooth movement by
placing mesial root torque on the molars using a tipback bend in a round wire (Fig.
77B).
Keep in mind that if the second bicuspid is engaged, the bend is no longer an
off-center bend and will result in, basically, equal and opposite torque on the molars
and bicuspids. We are looking for unequal or differential torque at the anterior and
posterior ends of the archwire. An .016 wire in an .022 .028 slot is obviously a
"loose" fit, but as you will see in time, the slots need not be filled. Now, when this
wire with tipbacks is inserted into the molar tubes and then engaged into the incisor
brackets, mesial root torque will be produced on the molars. But since crown
movement tends to precede root movement, there is a tendency for distal crown
movement. If the archwire is tied to the molar tubes, there is a distalization tendency
for the entire upper arch, although teeth do not tend to move distally with the same
ease as they seem to move mesially or labially.
Remember that common sense prevails. If overbite interferes, at the time, with
the distal crown movement (tendency), mesial root movement of the molars will
occur. These responses are highly variable, as are many other responses such as
headgear, etc. The most desirable responses occur where teeth need uprighting, as
these are tipping movements rather than bodily movements.
In general, the level of unerupted second molars does not pose the threat of
impaction with the use of a tipback bend (Fig. 78), except with techniques that use
excessively high vertical force levels. If the first molars are allowed to extrude as they
tip back, they will literally be lifted and tipped back over the second molar crowns. If
the teeth are not permitted to extrude, they will tip back and literally push the
unerupted second molar even further back.
To give you an idea of how easy it is to increase extrusive forces without even
realizing it, think of this. The stiffness (load/deflection rate) of an .016 square wire is
33

nearly twice that of an .016 round wire. Labial root torque increases anterior intrusive
forces and therefore increases molar extrusion. Remember that lingual root torque
increases incisor eruption and molar intrusion? Labial root torque is simply the
opposite. This comparison is not intended to be critical of any technique, but only to
keep the orthodontist mindful at all times that many factors are responsible for vertical
force magnitudes, and knowledge of these factors allows steps to be taken to establish
corrective or preventive procedures.
Figure 79 shows the most serious tipback I have ever placed on molars and
recommend strongly that you never do the same. But, as mentioned before, nonbanded teeth can provide excellent information as to what is happening. Note that the
unerupted second molars not only were not impacted, but were pushed back due to the
large moment (distal crown torque) on the molars and erupted in a tipped-back
configuration. Also, note that the unbanded bicuspids and cuspids have tipped back
dramatically, relative to mandibular plane. This clearly indicates the direction of thrust
resulting from the differential torque. It is true that an intrusive force with round wire
produces labial crown torque (lingual root torque) on the incisors, but with the
archwire tied back, the molar moments are not only in control, but will cause the
incisor crowns to maintain their anterior-posterior position or retract. Instead of seeing
flared incisors, the opposite effect is experienced. In fact, more often than not,
correction of a deep overbite in this manner (2 4) results in a flattening of the
incisors rather than flaring. In spite of an excessive tipback, Figure 80 shows that the
molars returned to a level position following appliance removal. I have not yet failed
to see this occur.
If you can think of how many cases you have treated nonextraction instead of
extraction, simply by starting treatment prior to loss of the second deciduous molars,
think of how many more patients can be included in nonextraction treatment if you
could simply gain another 1 to 2 millimeters of space in each quadrant (Fig. 81).
Since differential torque can do this, particularly where molars require some
uprighting, the combination of "E" space with that gained mechanically is significant.
My own feeling is that the tipped-back teeth, while uprighting, are continuing to erupt
along a new longitudinal axis, and thus give me a "net gain" when they finally attain
their upright position. I like to think I easily gain an extra 1-1 millimeters. If you feel
that any additional tipping of the molars beyond a given point will simply be lost as
the molars return to a level position, then don't include such additional amount of arch
length in your treatment planning. I credit my treatment planning with additional arch,
length on patients who are still growing vertically, while I credit additional length with
a big ZERO on nongrowers, such as adult patients.
In Figure 82 the same type of space gain is seen on a patient who transferred to
my practice following earlier extraction treatment and eventual relapse. In spite of the
significant space opening distal to the first molars, I consider this to be a "zero gain",
as the patient is an adult and all uprighting of the second molars will be accomplished
34

by forward movement of the molar crowns. Treatment is nothing more than overbite
correction and expansion but knowingly and purposely. The only reason the
second molars were banded instead of the first molars, is that the additional length
(Diving Board Concept) significantly reduced the stiffness (load/deflection rate) and
thus permitted use of a larger diameter wire (.020) and less breakage or deformation.
Bypassing teeth does result in more frequent deformation of wire but, in general, I do
not consider this to be a real problem, and can often move up to an .018. The tipback
bend can always be reduced in order to control the vertical forces. Again, common
sense must be applied (cusp height, diet, etc.).
The space opening that was created with the tipback bend in the cases shown
was accomplished by gradually increasing the length of the archwires. As clinical
evidence showed the tipback effects, the 360 tie-back loops were gradually unrolled
or unwound, which caused the archwire to become longer and accommodate the
additional arch length.

Class II Correction Without Headgear or Elastics

I would like to present a few cases to show some of the variations in response
that occurred with use of the tipback bend during overbite correction. It is important to
understand that the Class II correction is coincidental during overbite correction. This
is not a means of eliminating headgear or elastics. The simple fact is that where
headgear is planned, you will be surprised, many times, to find that the amount of
headgear treatment originally planned is either reduced, some times dramatically, or
even eliminated.
The first case (Figure 83) is a girl who exhibited what I refer to as a "Super"
Class II or "Double" Class II malocclusion. Since the Class II malocclusion involves a
significant degree of tipping and the overbite is extremely deep, I consider this the
ideal type of case to use differential torque with a tipback bend. Headgear treatment
was instituted prior to the conclusion of treatment, but substantial progress was
achieved prior to the use of any headgear or elastics (Fig. 84). You won't see this type
of case very frequently, but when much molar uprighting is required in such a case, be
ready for a welcome surprise. Also interesting is the fact that tipback bends were used
in both arches, and still Class II correction occurred (Fig. 85). Movement is usually
more responsive in the maxillary arch, although in this case much of the upper
movement only required tipping (uprighting).
X-rays show the distal inclination of unbanded teeth, again giving evidence of
the direction of movement produced by differential torque when the large moment
(relatively) is placed on the molars (Fig. 86). For the benefit of the few remaining
doubters, incisors can be intruded as evidenced in Figure 87. The reciprocal teeth
during incisor intrusion are the molars. Therefore, the unbanded cuspids provide good
clinical clues as to what is happening.
35

Figure 88 shows a girl with a mild Class II with only moderate overbite and
upper anterior crowding. There was decalcification present on lower molars, but no
appliance was ever placed in the lower arch. The lower arch was reasonably
satisfactory, so only upper incisors and molars were banded and the case treated with
an .016 archwire with a tipback bend. Anterior alignment in itself could be expected to
result in overjet, but with no headgear or elastics ever utilized, and only a total of six
bands placed (Fig. 89), treatment was concluded successfully (Fig. 90). It is common,
in this type of case, to see this response.
In the next case (Fig. 91), no headgear or elastics were ever used, and you can
see the need for anterior lingual root torque following overbite correction (Fig. 92).
The molars are tipped back at the conclusion of treatment, but they upright during
retention (Fig. 93), usually within one year following appliance removal. Note the
excellent facial esthetics post-treatment in this case (Fig. 94). This case is shown to
demonstrate, on a clinical level, the tipping back of incisor crowns with this force
system, as opposed to the labial flaring seen in the traditional full strapup with the use
of an archwire containing a reverse curve of Spee.
With a reverse curve of Spee, the incisors do flare, but the force system is not the same
as that of a tipback. There is no differential torque and, thus, the intrusive force acting
through the incisor brackets produces labial crown torque on the incisor segment with
resultant flaring. With the tipback, this anterior torque is "overwhelmed" by the molar
moment, and the molars are favorites to win the "Tug of War" that follows. If this
mechanism is to be criticized, it should be because the incisors are too often upright by
the time the overbite is corrected and require anterior lingual root torque to correct
this. But, correction of overbites with a round wire (.016 or .018) need not result in
anterior flaring, as claimed by so many.

Summary
The tipback is not a substitute for headgear or elastics. However, because of the
characteristics of the force system, variations in correction will take place. Common
sense helps to predict which cases are most likely to be involved. Since the system
works "with" the headgear and elastics and not "against" them, progress is often made
even with lack of cooperation. Also, because Class II elastics tip an occlusal plane
downward, use of a tipback in an upper arch only, does just the opposite, and can
permit the use of Class II elastics in such cases without affecting the upper occlusal
plane. As in any treatment with round wire, the other effects must be guarded against
as discussed earlier in this series.

36

JCO, Volume 1980 Apr (265 - 272): Common Sense Mechanics Part 8
--------------------------------

Common Sense Mechanics 8

THOMAS F. MULLIGAN, DDS

Wire/Bracket Relationships

This discussion will appear to be academic at first, and of little use to the
clinically oriented orthodontist, but be patient. The content will increase your
appreciation for the treatment procedures that follow, which will utilize this
information on a clinical level in an uncomplicated manner. The relationship of the
archwire to the brackets and tubes, prior to engagement, offers valuable and
interesting information. If a straight wire is placed over angulated brackets, a certain
37

angular relationship develops between the wire and the plane of the bracket slot (Fig.
95). The brackets might be angulated as a result of the malocclusion or purposely
angulated to permit overrotations, etc. In any case, a straight wire overlying these
brackets, prior to insertion of the wire into the brackets, gives us clues regarding tooth
movement. We cannot eliminate "common sense": however, since identical force
systems can produce different responses due to the biologic nature of the environment.
Teeth extrude more readily than they intrude. Certain rotations occur more easily than
others in different planes of space.
These force systems can become quite complex when more than two teeth are
involved. However, because we have thus far confined our mechanics to relatively
simple situations involving minimal placement of bands (brackets), and will soon be
moving into extraction treatment involving a greater number of bands, it seems
appropriate at this time to go into a greater degree of "exactness". For, if we can
understand what is exact, we can then deviate from exactness and begin to know the
value of applying the same principles in "nonexact" terms, in order to achieve our
objectives in a practical way. In other words, we will avoid producing a complex
appliance to satisfy academic needs. Instead, we will keep the appliance simple and
"read" the relationships involved adjacent to the archwire bends as though only two
teeth were involved. Disregarding the other teeth will still allow us to get our results,
as the forces transmitted to these "distant" teeth with relatively light wires requires
time, and we are more interested in the short-term movements.
Now that we know the emphasis will be on "practicality", let us not get lost with
details that do not pose a "clinical" threat. The following is presented only to create an
awareness of what happens when wire/bracket relationships change. As multiple
brackets enter the picture, the system becomes complex to apply, as it is then
necessary to add the systems at the various brackets to determine the net effect. This
can be time-consuming, inexact, and impractical. If you will read an article titled,
"Force Systems from an Ideal Arch" by Burstone and Koenig (AJO, March 1974), you
will appreciate the true complexity of force systems in orthodontics. At the same time,
I think you will want to utilize what you can in an efficient and simple manner, even if
it means sacrificing the details involved in exactness, particularly since teeth seldom
respond in an exact fashion.
Basically, we deal with various wire/bracket relationships created by the
malocclusion, archwire bends, or both. For practical reasons, I prefer to attain bracket
alignment regardless of the force systems produced in the process. Once this is
accomplished, desirable force systems can be attained by placing bends at specific
points along the archwire. In other words, we then determine what we want by
creating our own relationships. We have already seen this accomplished during our
discussion on vertical forces and tipback bends.

38

So, to get a further insight as to the force systems created by wire/bracket

relationships, let us consider the variations. If we begin by using a constant
interbracket width (any width) and a center bend, it can be seen in Figure 96 that the
relationship can be created by the bend in the wire or by the malocclusion. In either
case, the force system is the same. As already said, I prefer aligning the brackets and
then determining my own systems by placing the bends where needed. If we now look
at Figure 97, we can see that the bend has been moved off center, but still remains
identical to the relationship created by the malocclusion. Again, in either case the force
system is the same. Finally, in Figure 98 we see that two off-center bends have been
placed, the second being inverted, but placed equidistant from the bracket. Yet the
relationship is no different than the one produced by the malocclusion and a straight
wire, so the force systems are identical. Now, if we go back and look at Figures 96, 97,
and 98, and concentrate on the angulated brackets only, we can see what caused the
change in the wire/bracket relationships. The bracket on the left in each case remained
constant in angular relationship with the archwire, while the bracket on the right was
slowly rotated clockwise. Therefore, we can readily accomplish the same by placing
bends instead, once the brackets have been aligned.
Thus far, we have been talking about center and off-center bends only and,
therefore, only need be concerned with Figures 96 and 97. But, for the sake of
discussion, and so that later we can prove that the force systems we have so far
discussed in these two bends are really the case, let us become familiar with Figure 98.
After all, everything that lies between the relationships in Figures 96 and 98 is merely
a transitioning of force systems.
In my graduate school days, Dr.Charles Burstone referred to Figure 96 as a
symmetric bend relationship. I have adopted the term center bend or gable bend. He
referred to Figure 97 as an asymmetric bend and Figure 98 as a step relationship. I
refer to the asymmetric bend as an off-center bend. Since the step relationship has its
place in mechanics, but because I seldom utilize it (purposely), you will not hear me
refer to this relationship in my discussion of Common Sense Mechanics as it pertains
to clinical treatment.
If we can see what forces and moments MUST exist in the two extremes under
discussion (Figs. 96 and 98), then we can accept the systems that exist "in between". If
you are really interested in every detail, please refer to the published material I have
mentioned.

Center Bend Force System

Let us begin to determine the forces and moments present in the two extremes
of the wire/bracket relationships the center bend and the step by applying the
requirements for static equilibrium. Once we can prove these systems are present, by
39

necessity, we can resume our discussion of mechanics on a practical level. But it is

only fair that you see, first, what occurs technically.
Looking at Figure 99, a center bend, we can see that forces must be applied at
four separate points for wire/bracket engagement. Since three requirements
(previously discussed) MUST be met and ARE met to establish the static equilibrium
that will and DOES exist, we can go through each step in order. Let us start by
"assuming" all four forces are equal. We don't know, yet, if they are, but we must start
somewhere. Only when all three requirements of static equilibrium are met, will we
have discovered what the actual forces are. We are not interested in any actual figures,
but only relative magnitudes.
If all four forces (activational) are equal, then the first requirement for static
equilibrium is fulfilled. That is, the sum of the vertical forces must equal zero. Since
there are no horizontal forces necessary to engage the wire into the brackets, the
second requirement is automatically fulfilled. That is, the sum of the horizontal forces
must equal zero. Since the third requirement says that the sum of all the moments,
measured from ANY point must also equal zero, let us choose the center point for
convenience (Fig. 99).
Now we will determine the moments produced around this point by each force
(line of force) acting at a perpendicular distance to such point. Force A produces a
clockwise moment (activational), equal and opposite to the magnitude of the
counterclockwise moment produced by Force D. Now, Force B produces a
counterclockwise moment smaller in magnitude, because it acts at a smaller distance
from this point. Force C, acting at the same distance, produces the same magnitude,
but the moment is clockwise. When we add the four moments produced around this
point, the sum is zero. Therefore, we have met all three requirements for static
equilibrium, and the orginally "assumed" forces are proven to be correct. So, we can
now determine the activational force system at each bracket.
Since Forces A and B produce a couple (pure moment) which is clockwise, and
since Forces C and D produce a counterclockwise couple (Fig. 100A), we have now
arrived at the net activational force system two moments, equal and opposite in
magnitude. Tooth movement occurs as the result of deactivation, as in Figure 100B.
From now on we can refer to this system when we discuss the center bend and know
that it must exist in order to conform with the requirements of static equilibrium.

Step Bend Force System

40

Now, if we go to the step relationship, which is the other extreme under

discussion, we will go through the same analysis, again using aligned brackets with
the bends placed in the wire (Fig. 101A). Since we must start somewhere, we will
again "assume" that the four activational forces shown are equal. If so, the sum of the
vertical forces equals zero and the first requirement for static equilibrium has been
fulfilled. Next, the horizontal forces equal zero because there are none, so the second
requirement is, likewise, fulfilled. All that remains now is to determine that all the
moments produced around a common point also equal zero, the third and final
requirement. Using the same center point, we can readily see that Force A produces a
clockwise moment, the same as that produced by Force D. Both are clockwise and
both are equal in magnitude. However, although the moments produced by Forces B
and C are equal to each other and counterclockwise, they are smaller in magnitude
than Forces A and D, because they are produced at smaller distances. Therefore, the
sum of the moments does not equal zero. Since ALL THREE requirements are not
fulfilled, the original assumption that all activational forces were equal was incorrect.
Figure 101B shows the ONLY system that meets all three requirements. First,
although Forces A and D (equal) are smaller than Forces B and C (equal), the sum of
the vertical forces can be seen to equal zero. The horizontal sum remains zero, as there
are no horizontal forces. But, the third requirement is finally met, because Force A and
Force D each produce clockwise moments equal in magnitude and opposite in
direction to the counterclockwise moments produced by Forces B and C. In spite of
the fact that Forces B and C act at smaller distances, balance is maintained due to their
greater magnitudes of force. The important thing to realize is that the net activational
forces at each bracket are unequal, unlike the center bend. If we now take the forces in
Figure 101B, which have been proven to be correct, we can analyze the individual
brackets for the net activational force system. Forces A and B produce a clockwise
moment at the left bracket and a net force, as shown in Fig. 102A. At the right bracket,
Forces C and D form a clockwise moment also, with the magnitudes being the same,
as well as a net force equal and opposite to the force at the left bracket. Now that the
net activational system has been determined at each bracket, simple reversal (Fig.
102B) gives the force system acting on the teeth (deactivation).
Variations between these two extremes were shown during the discussion of
tipback bends and will be shown in the next articles dealing with extraction
mechanics. It will be seen that as the wire/bracket relationship (between the center and
step configurations) undergoes angular change relative to the archwire, clockwise
moments will transition to zero and, if the relationship change continues beyond the
zero point, finally become counterclockwise. All of this simply means that there is
"Law and Order" to all of this. It is my desire that this can be useful in an everyday
practice.

Clinical Demonstrations
41

If you look ONLY at the two teeth mentioned, Figure 103 illustrates various
center bend relationships produced by the malocclusion itself. Anterior-posterior
relationship must also be considered, as demonstrated in Figure 103 with full
wire/bracket engagement, such as with a rectangular wire.
Figure 104 illustrates step relationships when applying the same approach. The
single off-center bend (as opposed to the step bend which actually contains two offcenter bends) has already been demonstrated many times. Figure 105 shows a rotated
central incisor. A wire tied only into the two central incisors would automatically
create the off-center relationship. But, to keep matters simple, all of the relationships
mentioned and formed by the malocclusion are, for the most part, disregarded in
obtaining INITIAL bracket alignment. In some cases, however, it would be foolish to
disregard them.
The force system in the single off-center bend lies somewhere in between the
center bend and step relationships, depending on the EXACT wire/bracket angular
relationship (Fig. 106). In spite of the fact that using a constant bend, as already
discussed, with variable interbracket distances produces moments that vary, as seen in
Figure 106B, the complication is taken out of it by utilizing the differential in the
system, as demonstrated with use of the tipback bend in overbite correction, and as
will be demonstrated in extraction treatment for anchorage control.

Summary
Do not let this portion of the series on Common Sense Mechanics drive you
away. It was presented to help you appreciate the need for deriving that which can be
modified and made useful in a busy practice. As you will see, the application will not
be complex, but rather quite simple
JCO, Volume 1980 May(336 - 342): Common Sense Mechanics Part 9
--------------------------------

Common Sense Mechanics 9

THOMAS F. MULLIGAN, DDS

Extraction Mechanics
Earlier, in the "Fallacy of Visual Inspection in Force Analysis", it was shown
that a wire with a bend off center is clearly different than one with a bend in the center,
since one produces net forces at the bracket, while the other does not. A center bend
involves no net forces, but only equal and opposite moments with full wire/bracket
engagement in any plane of space.
42

The tipback bend is an off-center bend. The long segment indicates the direction
of the force produced, while the short segment points in the opposite direction to the
force it produces (Fig. 107). In the tipback, two moments are also produced, but they
are unequal. The larger moment lies at the bracket or tube containing the short
segment (Fig. 108). The smaller moment lies at the bracket or tube containing the long
segment. This smaller moment may, at times, be clockwise; and at other times
counterclockwise; and even disappear, producing the cantilever effect, because only a
pure force would exist at that bracket (Fig. 109). These various results are dependent
on the angle at which the wire crosses the bracket.
The important thing to remember is simply that regardless of the presence,
absence, or direction of the smaller moment the two moments are unequal and
therefore, result in differential torque dominated by the larger moment. Even if we do
not recognize the smaller moment as being clockwise, counterclockwise, or absent, it
is still the larger moment that produces the net result. If, for example, the larger
moment is counterclockwise and the smaller moment is clockwise (Fig. 109A), the net
effect is still counterclockwise. If the smaller moment is counterclockwise (Fig.
109B), the net effect is also counterclockwise, although more strongly so. If no
moment is present (Fig. 109C), the obvious net effect is, likewise, counterclockwise.
The resilient characteristics of the wire can complicate our interpretations, as
archwire activation often produces a different wire/bracket relationship, initially, than
might be anticipated (Fig. 110).
Practical Interpretation of Forces and Moments
Thus far, most examples used for center and off-center bends have involved
only two teeth or two units of teeth. Since we are going to be dealing with many teeth
during the treatment of various malocclusions, it might be wondered how complicated
all of this is going to become. Well, it doesn't have to become any more complicated
than working with only two teeth.
There are techniques today that create a "single tooth" by segmenting a number
of individual teeth. In a sense, this was demonstrated when the cantilever principle
was discussed. Four incisors were treated as a single unit by the placement of an
anterior segment of wire, and then an overlay archwire was used to apply the desired
force. However, we are not going to be using segments for treatment. As a practical
measure, we will be treating the two teeth on either side of the bend, even though we
are using a continuous archwire and multiple banding/bonding. Often, we will be
discussing "segmented tooth movement", but on a continuous archwire. When dealing
with multiple teeth, the teeth adjacent to the bend will be discussed, while teeth farther
away from such bend will be temporarily ignored. Naturally, all of the teeth are
ultimately affected, as the forces and moments are transmitted along the wire. But,
43

initially, the force system acts on the adjacent teeth most effectively. Therefore, as a
practical matter, we will not discuss the system in an unnecessarily complex manner.
Please understand clearly the technique shown in this discussion will depart
from exactness; but, in a practical sense, it works. It is simple, easy, orderly, hygienic,
reduces the need for patient cooperation, and will make your work more enjoyable,
because you can think rather than follow a "cookbook", and vary your procedures to
fit your schedule planned and unplanned. I am not advocating this technique, but
will simply be using one treatment approach to demonstrate the application of
principles of mechanics in a practical way. Naturally, you are free to apply such
principles in any way you feel will be better or enjoy doing more. The "fun" in
orthodontics, I believe, lies in treating common or similar problems in a variety of
ways.

Cuspid Retraction
Figure 111 shows a crowded condition in which four first bicuspids were
removed. We are not discussing whether or not teeth should be removed, and we are
not discussing cephalometrics. This series will concentrate on a practical clinical
approach in which principles of mechanics will help us to predict and interpret tooth
movement. Complete orthodontic records, including cephs are taken and studied for
all full treatment procedures, but we are attempting to discuss only the mechanics
following treatment decision and statement of objectives.
The typical extraction strapup involves the banding/bonding of cuspids, second
bicuspids, and first molars (Fig. 112). Many prefer to band second molars for
anchorage purposes as well as for gnathological considerations.
Others band second molars for alignment and control. As we move along, I will
discuss some of my reasons for not routinely banding second molars. Obviously, there
are situations when they MUST be banded. Remember, that as far as intraoral
anchorage is concerned, we will be talking about the effectiveness of differential
torque as a means of control. Keep in mind, there is no such thing as PERFECT
intraoral anchorage, so we are seeking a method which offers the optimum for control.
Those who band second molars to increase anchorage are saying, in effect, that
three teeth (considering total root area, etc.) will tend to resist moving as much as a
single opposing tooth will tend to move, and therefore, during cuspid retraction, the
cuspid will undergo the greatest movement. However, experience has taught that this
is not always reliable. Sometimes, the anchor unit serves well, while at other times it
readily seems to move forward.

44

Since the forces during retraction are equal and opposite on the two units
anchor unit and non-anchor unit the multibanded unit actually receives the lesser
amount of force per unit area (stress) along the periodontal membrane while the nonanchor unit (cuspid) receives the greater. This could be one of the causative factors in
the variations that occurs. We will be discussing moments (differential torque) as a
means of controlling the anchor unit instead of purely by force distribution. Again, this
is not meant to imply that differential torque is an ideal means of anchorage control.
Extraoral means are always available, but not always desired.
In the cases being demonstrated, the appliance happens to be edgewise with .
022 .028 slots and .045 headgear tubes. The initial wires are only .016
(occasionally .018). But this is not a discussion of appliances, so mentally convert the
various applications to the appliance and wire sizes of your choice, but don't lose sight
of the principles.
In Figure 112, you can see that anti-rotational ties are placed next to the
extraction sites, unless such rotations are indicated. The malocclusion usually results
in initial archwire activation, due to the fact the brackets are not yet aligned. The
periodontal response that occurs is permitted to improve bracket alignment and level,
prior to placing any bends in the archwire. If total arch length is to be reduced in the
final result, the 360 tieback loops are placed "short" of the molar tubes as shown.
Also, anytime teeth are being retracted, there is a mesial force at the molar tubes. Toein bends should be placed early, so as to initiate a counterrotation, so that we do not
produce a mesiolingual rotation of the molars when retraction is begun. Remember the
"Cue Ball Concept". Of course, many will offset this rotational tendency with lingual
elastics. However, I do not use ANY lingual attachments.
Next (Fig. 113), we see the placement of bends intraorally. If bends are placed
intraorally, they cannot .be placed against the brackets completely, due to the width of
the Tweed loop plier that is used. Therefore, the differential torque produced on the
teeth adjacent to the extraction spaces is reduced. This is because, as mentioned
numerous times now, the closer a bend gets to the center, the more equal become the
moments; and when placed directly in the center, the moments are equal and opposite.
Again, these statements are not exactly precise, as the molars are included in the
partial strapup. But, as emphasized before, exactness is sacrificed so that we can
utilize a "workable" clinical approach. Likewise, regardless of how far we place bends
off center, smaller interbracket distances result in bends being relatively close to
center. In fact, second bicuspids are sometimes temporarily not banded to increase the
distance and therefore the differential torque. Remember the importance of the toe-in
bends or lingual elastics to offset the tendency for mesiolingual rotation of the molars.
Figure 114 shows the retracting elastics in place. I now utilize power chains and
tie the cuspid directly to the molar, while the second bicuspid is tied individually with
an "O" Ring. This allows a greater range of force. In order to evaluate the
45

effectiveness of anchorage control, on a clinical basis, observe the two units. The
anchor unit should remain relatively upright, while the non-anchor unit should
undergo tipping until archwire binding occurs. Once binding occurs, the roots will
respond to the moments produced by the archwire, until binding stops and crown
movement is resumed. Remember, the anchor side is located closest to the bend while
the non-anchor side is furthest from the bend. As cuspids continue to move distally,
the bend automatically "approaches" the center of the wire, until finally, when the
extraction sites are closed, the bend is centered. So you can see that as the off-center
bend moves toward the center during space closure, the differential torque begins to
gradually disappear, and becomes equal and opposite torque when the bend is finally
centered. This is interesting, because we utilize the differential when we need it most
and, since tipping occurs with the non-anchor unit, the root parallelism begins to take
effect as the bend approaches center. By center, of course, we are not referring to the
center of the entire archwire, but to the center of the wire lying between the bicuspid
and cuspid brackets. Do not expect to see the anchor unit "tip back" as the mesial force
on this unit from the retraction elastic will offset the distal crown thrust that was
observed in nonextraction treatment. However, the net force on the cuspid is distal in
direction.
Since we are considering differential torque rather than multibanded anchor
units for "bulk", it may be difficult to get used to the idea of banding LESS teeth for
anchorage. For example, if the second bicuspid is not banded (Fig. 115), the off-center
bend can be placed more distant from center. Remember that as we move away from
center, the differential torque increases, whereas at the center point the moments are
equal and opposite and, therefore, there is no differential torque. The clinical guide to
effective anchor control is to look at the unbanded bicuspids and observe them for
mesial tipping. They will only tip mesially, if the molars come forward. Because of the
mesial root torque on the molars from the off-center bend, the molar itself will tend to
move bodily, while the cuspid is permitted to tip to a limited degree, as it experiences
a smaller moment. Once the spaces are closed, a centered bend will not be present, as
the bend has been placed against the molar. Therefore, to produce equal and opposite
moments for root paralleling, it is not necessary to place a new archwire and relocate
the bend, as a bend can be placed immediately distal to the cuspid bracket (Figure
116), and the moment becomes equal and opposite to the moment on the molar.

Summary
When the initial archwire is placed, the periodontal response will most often be
initiated by the malocclusion, which produces brackets that are angulated relative to a
straight wire. When reasonable alignment takes place, the bends may be placed. If
anchorage is required, then the bend is off-center. The tooth located closest to the bend
indicates the anchor side. The opposite is the non-anchor side. The anchor side
requires a bodily type movement for displacement, whereas the non-anchor side tips
somewhat due to the lesser moment. As space closure occurs, the bend becomes more
46

and more centered, meaning the moments become more and more equal. When finally
centered, they are equal and opposite and root paralleling occurs. Toe-in bends or
lingual elastics should be in use for the duration of space closure and, in fact, should
be placed prior to initiating space closure, so that a countermoment is produced to
prevent mesiolingual rotation of the molars during space closure. Since round wire is
being used, one must remain conscious of the "Cue Ball Concept", and not depend
entirely on the concept of "rigidity for control".

JCO, Volume 1980 Jun(412 - 416): Common Sense Mechanics Part 10

--------------------------------

Common Sense Mechanics 10

THOMAS F. MULLIGAN, DDS

Extraction Mechanics
During the discussion on cuspid retraction, it was pointed out that : there are
various anchorage concepts, including multiple banding/bonding on the anchorage
side of the extraction site. Obviously, there are different types of extraoral anchorage,
but we are discussing intraoral anchorage, with the orthodontist choosing a method of
47

control. In addition to the method of multiple banding to form large resisting units, it
was shown that anchorage can be instituted by banding a lesser number of teeth and
locating archwire bends in such a manner as to produce "differential torque". When
the bend is placed off center, the tooth (bracket or tube) located closest to the bend
contains the largest moment and, therefore, indicates the anchor side.
It was also shown earlier, that these unequal moments are important in terms of
their "net difference". The smaller moment can sometimes be in the same direction
depending on the angular relationships of the wire to the bracket. But, we are not
concerned about determining exactly what these specific relationships are, as it would
unnecessarily complicate the approach to utilizing differential torque. We simply know
that if the unequal moments are in the same direction, their additive effect increases
the effectiveness of the anchorage (Fig. 117). In those cases where the smaller moment
is opposite in direction to the larger moment (Fig. 118), there is still a "net difference"
in favor of the anchorage side. However, as the interbracket distance becomes smaller,
the bend is closer to center and, therefore, the two moments are more nearly equal,
which reduces the effectiveness of the anchorage. By recognizing these factors, we
can keep treatment simple and practical.
Since differential torque considers the effectiveness of a net moment, total root
area in the anchor unit is not the primary consideration. As a result, bicuspid retraction
can be considered in the same way as cuspid retraction. Bicuspid retraction with
severe anchorage requirements can be performed on one side, while the same wire can
be utilized to perform molar protraction on the opposite side of the same arch. In fact,
protraction is accomplished in the same manner by locating the bend off center.
However, protraction will simply utilize the non-anchor side of the bend. In other
words, the bend is moved "away" from the teeth to be protracted as will be shown in
the following case.

Bicuspid Retraction
In Figure 119, the malocclusion includes a deep overbite with a Class I molar
relationship, but a missing lower left second bicuspid with the second deciduous
molars still in place. The lower left first bicuspid is almost in contact with the
mandibular lateral incisor and tissue blanching can be seen as a result of the unerupted
permanent cuspid lying labial to the lateral incisor and first bicuspid. If the first
bicuspid is not retracted following removal of the second deciduous molar, the patient
is almost certainly faced with the need for a replacement, as well as the loss of the
permanent cuspid. In spite of the fact that I would normally like to wait a little longer
before initiating treatment, due to the lack of eruption in the upper arch, treatment was
instituted with the removal of the lower second deciduous molars, the lower right
second bicuspid, and the upper first bicuspids.
48

Only a minimum appliance was placed and treatment began with an .016
archwire in the lower arch. Because the molar was to serve as the anchor unit, a bend
was placed mesial to the tube, thus producing the largest moment on this tooth. An
elastic was used to retract the first bicuspid (Fig. 120). Clinically, the non-anchor tooth
(first bicuspid) is observed tipping, while the molar remains relatively upright. This
verifies the anchorage and non-anchorage sides due to the unequal moments present.
As the bicuspid continues to move distally, it gradually approaches the off-center bend
lying mesial to the molar tube. As this happens, the two moments gradually become
more and more equal (decreasing differential), but opposite in direction. This gradual
equalization provides the root paralleling that is necessary due to the initial tipping.
When the bicuspid is completely retracted, the marginal ridge discrepancy, as a result
of the tipping, is evident. This assumes, of course, correct bracket and tube placement.
As space closure is completed, the bend becomes a centered bend, and the resulting
equal and opposite moments will parallel the roots, as can be verified clinically by
levelling of the marginal ridges in time.

Molar Protraction
Next, the lower right cuspid and bicuspid are banded to begin molar protraction
on the right side (Fig. 121). All of this could have begun with the initial archwire, but I
prefer keeping as many bands off as many teeth for as long as is reasonable, and time
is not critical in this case, because it will be necessary to wait for upper tooth eruption.
The upper wire, for overbite correction, was initially an .016 followed by an .018. The
intrusive and extrusive forces, are light due to the bypassing of teeth (unerupted in this
case) as discussed earlier. The lower archwire has been designed to serve as a space
maintainer on the lower left side for the unerupted cuspid by incorporating a "stepdown", and a center bend was placed between the retracted first bicuspid and molar to
allow the roots to continue to parallel themselves.
On the lower right side, there is no tieback loop mesial to the molar as this tooth
is to be protracted into the second bicuspid extraction site. The wire is usually an .018
followed by an .020 on occasion, as the tipping tendency for molars is too great with a
lighter wire in an .022 .028 tube.
If mesiolingual molar rotation is desired and most often it is not no bend
need be placed, as a mesial force acting at the molar tube during protraction produces
the rotation as a result of the "Cue Ball" effect. If the opposite rotation is indicated, a
sharp toe-in bend must not be placed, as it will interfere with protraction by binding at
the molar tube. A gentle curve can be placed instead. It will produce the same required
moment, as it still produces the same wire/tube relationship (Fig. 122).
In this case, since the molar is to be protracted, it belongs on the non-anchor
side, and therefore, furthest from the bend. The opposite side becomes the anchor side,
49

so the bend is placed immediately distal to the first bicuspid bracket. Differential
torque is again produced, just as occurred on the left side, except the directions of
movement are reversed because the locations of the bends are reversed.
So, you can begin to see that all of this is not so complicated after all. No matter
how fancy or sophisticated an appliance, in the end teeth only move as a result of
moments and forces, and we can utilize principles of mechanics that will allow for use
of a simple appliance in an acceptable and efficient manner. But I do wish to
emphasize again, that ultimately the teeth located distant from these bends will
encounter the effects of the TOTAL force system. It is a practical, but useful, method
to think in terms of "two units", even though we technically sacrifice preciseness.
In the case shown, the lower right first molar required a mesiolingual moment,
and this was automatically accomplished by the mesial force from the protracting
elastic. A mesial force acting at the molar tube produces a mesiolingual moment.
After space closure has been accomplished (Fig. 123), the bend located distal to
the bicuspid bracket is no longer an off-center bend. The centered position between
molar tube and bicuspid bracket, again, produces equal and opposite moments for root
paralleling. In the meantime, the space maintainer (step-down) on the left side has
permitted cuspid eruption, while the first bicuspid and molar roots were being
paralleled at the same time.
Teeth continued to erupt in the maxillary arch (Fig. 124) during lower tooth
movement and overbite correction. Admittedly, a case like this involves delay, but the
need to get the lower left cuspid into position dictated the starting time. At least the
patient is subject only to a minimal appliance for a long period of time.
A year following band removal (Fig. 125), the teeth have erupted except for the upper
right second bicuspid which is completing its eruption.

Summary
This is not an exceptionally difficult case, but is shown to emphasize that the
concepts discussed are not difficult to understand and apply. We can see that once we
understand a given system, we can learn to put it in reverse with no added
complications. If we understand, for example, the force system associated with lingual
root torque, then under the same conditions, labial root torque will result in a reversal
of the system. We just saw that a bend located at the mesial side of an extraction site
produces a net movement in one direction, while locating the bend at the distal site
reverses the direction of this movement.
Now that cuspid retraction, bicuspid retraction, and molar protraction have been
discussed, all involving the application of differential torque applied by the simple
location of a bend, it will be shown that the same relatively simple concept can be
50

applied to the simultaneous retraction of bicuspids and cuspids using only single
molars as anchorage units. Again, there is no such thing as perfect intraoral anchorage,
but there is such a thing as providing maximal intraoral anchorage with mechanical
principles that provide greater reliability and consistency.

JCO, Volume 1980 Jul (481 - 488): Common Sense Mechanics Part 11
--------------------------------

Common Sense Mechanics 11

THOMAS F. MULLIGAN, DDS

Simultaneous Cuspid and Bicuspid Retraction

During the discussions on cuspid retraction, bicuspid retraction, and molar
protraction, it was seen that location of the bend in the extraction site determined the
anchorage side. It was also emphasized that as the interbracket distances become
smaller, the bend in effect becomes located closer to center, even if placed
51

immediately against either bracket (tube) adjacent to the extraction site. The closer the
bend is to the center, the lesser the differential torque. If the bend is placed in the
center, the moments are equal and opposite. So, the more critical the anchorage, the
more distant the bend should be from center. Even temporarily avoiding banding of
the second bicuspids, during cuspid retraction, was discussed and demonstrated.
The case in Figure 126 presented in my practice following removal of the upper
first bicuspids only. She had a Class II malocclusion with lower anterior crowding. I
had the lower second bicuspids removed and planned on maximizing lower intraoral
anchorage until sufficient space was gained following cuspid and bicuspid retraction,
at which time I would align the lower anteriors. In the upper arch, there were no
anchorage problems, so the plan was to retract the cuspids only enough to break the
contacts between the anterior teeth for alignment and space closure in the extraction
site.
A minimal appliance was placed (Fig. 127), involving only the first molars,
bicuspids, and cuspids. An .016 archwire was placed, and it can be seen that
wire/bracket engagement resulted in activation due to the malocclusion itself. This
automatically produces the initial periodontal response for tooth movement. It can also
be seen that the bracket ties were not placed next to the extraction sites on the lower
first bicuspids, as rotation during space closure was desired.
Figure 128 shows placement of the bends intraorally. Note in the upper arch that
the bends were placed in the center, because this produces equal and opposite
moments with no effective anchorage. Some deformation can be seen. This
deformation will tend to occur if the archwire bends are placed prior to attaining
reasonable bracket alignment. When this does occur, the Tweed loop pliers can be
placed over such bend at the following visit, and the bend reactivated.
In the lower arch, notice that the bends are located toward the molar tubes,
indicating that this is the anchor side of the extraction site. If desired, the bend can be
placed in the archwire outside of the mouth, thereby permitting closer placement to the
molar tubes and thus a greater distance from the center of the wire lying across the
extraction sites. You might notice and wonder why the 360 tieback loops are bent in
the direction shown, since good spring design calls for a wire to continue bending in
the same direction as formed, when it is activated by wire/bracket engagement. The
answer simply is that this is not the ideal design. But it is easy, practical, and works. It
can be any loop you wish, made in any manner you choose.
The occlusal views (Fig. 129) show the minimal strap-up in this case. I would
like to again emphasize the importance of putting in toe-in bends at this point to create
a counterrotation for space closure, as the terminal teeth (molars) will attempt to
undergo a mesiolingual rotation. For a long time, I was guilty of this error, and I can
assure you it is a lot nicer not to produce an undesirable molar rotation than it is to
52

correct one with the archwire only, especially since I use no lingual attachments and
therefore no lingual elastics. If you use lingual elastics, you are not faced with the
same problem. I used to place my toe-in bends after beginning space closure, but
strongly recommend placement prior to this time. It is not necessary to worry about
overrotation, as this situation can easily be corrected simply by engaging an elastic
from the molar tube to the bicuspid bracket at the end of treatment. The archwire, in
such case, would be fully engaged in the bicuspid bracket and would also terminate at
this point. Simply cut off the wire distal to the bracket.
In Figure 129, notice that the lower crowding occurs all the way from bicuspid
to bicuspid. It probably SEEMS ridiculous to even consider the idea of retracting
cuspids and bicuspids against first molars, but it will be done. This is in direct contrast
to those who guard anchorage so closely, that only a single tooth is retracted at a time.
Also note that the bicuspids are rotated, as any distal force applied at the bicuspid
brackets will cause such teeth to rotate in this case, desirably. Since the "Cue Ball
Concept" can be applied here, it makes sense to retract the bicuspids first, thus
obtaining needed space and accomplishing the rotations at the same time.
As we follow the lower progress (Fig. 130), we can see that retraction elastics
are placed from the bicuspids to the first molars. I no longer use an elastic thread, but a
power chain instead. Whatever provides the necessary force is fine and the choice is
yours. The cue ball concept tells us that since the force (distal) is being applied at the
bracket which is located off center (buccal) from the crowns, the bicuspids ("cue
balls") should rotate and move in a line distally. Figure 131 shows that this occurs.
Now that the bicuspids have been partially retracted and rotated, the bicuspids and
cuspids will be retracted simultaneously to gain further space for the incisors. Note the
crowding that existed from the start, so that we can CLINICALLY evaluate the
response. In Figure 132, the elastics are attached from the molars to the cuspids.
As the maxillary cuspids are retracted, using only a center bend, it can be
observed that the contact areas are separating (Fig. 133). No attempt is made to
conserve anchorage.
Observe in Figure 134 that the upper extraction spaces have been almost closed.
The center bend continues to produce equal and opposite torque for root paralleling,
and the space closing elastics prevent the extraction spaces from reopening.
Remember, the equal and opposite moments from the archwire tend to bring roots
"together" and crowns "apart". If you will look at the original malocclusion (Fig. 126),
you will note basically the same molar relationship. Remember, no attempt was made
to restrain maxillary molars from moving forward some. But, since we are analyzing
movement by clinical observation, we must apply "common sense". The lower molars
COULD be moving forward and thus be deceiving our clinical interpretation. You can
see that the lower first molars are maintaining a reasonably upright condition, while
the lower bicuspids and cuspids are tipping.
53

Today, at this point, since the cuspid relationship is now Class I, I would
normally bond the incisors and begin lower molar protraction. But, I decided for
photographic purposes to continue retracting the bicuspids and cuspids. This means
that since the upper extraction spaces are closed, further change in cusp relationships
will tell us clinically what is taking place in the lower arch. We can also relate these
changes to the remaining spaces and the original crowding and arrive at further
supportive conclusions.
Next (Fig. 135), further retraction is observed and significant lower anterior
spacing has occurred. The molar relationship remains pretty much the same, but the
lower cuspids have now been retracted into a Class II relationship. When the molar
starts to exhibit tipping, as seen on the lower right side, too much force is being used.
The tooth should be allowed to upright before continuing further space closure.
In Figure 136 there remains significant extraction space on the patient's lower
left side in spite of all the space gained in the anterior. The lower left molar is a good
example of what I mean when I say it is necessary to place an early toe-in bend for
counterrotation. Lingual elastics could prevent this mesiolingual molar rotation, but I
do not use lingual attachments for reasons I will later discuss. Keep in mind that we
started with differential torque, and this differential is gradually diminishing as the
interbracket distance continues to become smaller.
After space closure was completed, the incisors were banded and the anterior
spaces closed (Fig. 137), and then the mechanics were reversed with Class II elastics.
This was not the original plan, remember. It was first planned to protract lower molars
after retracting the cuspids into a Class I relationship, and the plan was altered for
photographic purposes. But, at the same time, you can see that a "cookbook" routine
does not have to be followed.
The occlusal views at this stage (Fig. 138), show that toe-in bends are still being
used for rotation, and for the FIRST TIME, spaces are observed distal to the lower
first molars as a result of reversing mechanics with Class II elastics.
Following appliance removal and during night retention (Fig. 139), the
anchorage effects can still be observed. On completion of space closure, the anchor
bend (off-center) became a center bend and resulted in equal and opposite moments
producing root parallelism between first molars and first bicuspids. The lower cuspid
roots, however, did not receive the "direct" effects of these moments as evidenced by
their inclination. This is why I say we can be "practical" when we think of only the
teeth adjacent to the extraction site, as the force system has its most direct effect here.
Eventually, other teeth are affected, but I think the effect of the molar moment, here is
quite obvious. Since the anterior-posterior position of the maxillary incisors remained
unchanged, zero overjet before and after treatment is additional clinical evidence of
the net movement in the lower arch.
54

Summary
I realize the word "clinical" has been used frequently. This is in no way intended
to be opposed to the taking of routine progress headfilms, etc. Because there are many
ways to treat cases, and many variations in interpretation of headfilms, it seems only
logical to me that we should have the additional tool of "clinical judgment". Some
seem to possess this attribute from birth, but it can be learned if one possesses the
important tool of "common sense". There are many changes occurring each day before
our very eyes as we treat our patients. Realistically, we are not going to take a progress
headfilm everytime a patient comes through the door. By the time the film is
developed, traced, and analyzed, the patient has usually left the office and the
appliance is back at work. I think we should be capable of deciding what the appliance
should do BEFORE the patient leaves the office.

JCO, Volume 1980 Aug (546 - 553): Common Sense Mechanics Part 12
--------------------------------

Common Sense Mechanics 12

THOMAS F. MULLIGAN, DDS

Applying Principles to Total Treatment

Since extraction and nonextraction mechanics have been demonstrated, utilizing
the various principles discussed since the beginning of this series, I believe we can
have a little fun at this point by taking a few cases and observing treatment methods in
an unconventional manner. That is, we will avoid the "cookbook" approach of doing
step-by-step procedures in each case and, instead, institute any number of procedures
55

already discussed, as the individual needs arise. Needless to say, we must have a
defined objective from the start, so that we know at all times where we are headed. It
is not the purpose of this series to define such objectives at any length or to present the
diagnosis and treatment planning for cases presented. As you are already aware,
headplate tracings are not being presented and discussed, as it is the purpose to keep
this series as clinical as possible and to present principles of mechanics only. There is
nothing wrong with the so-called "cookbook" approaches to orthodontic. treatment,
but it can become quite routine and even boring at times. Being able to vary
procedures according to the time available and the tooth movement desired at the time
lends itself to more excitement, in my opinion, as well as ease of manipulation on the
part of the operator.

Class I Nonextraction
Let us begin by taking a Class I malocclusion with considerable crowding in the
mandibular arch and moderate overbite with linguoversion of the lower right bicuspids
(Fig. 140). I feel much information can be derived from the occlusal views of the
malocclusion. When I observe the need for change in posterior arch width, I feel that
observation of lingual cusp height on the molars offers significant clues as to which
teeth should be moved buccally and which should be moved lingually. Looking at the
maxillary molars, it can be seen that all of the lingual cusps are high (occlusal) relative
to the general maxillary plane of occlusion. Looking at the mandibular first molars, it
can be seen that both molars are buccal to the second molars and also exhibit "high"
lingual cusps. You might argue that the second molars are lingual, but I believe the
vertical height of the lingual cusps indicates which teeth are tipped from their normal
position in the arch and in which direction they are tipped. Some orthodontists feel
they can best obtain such information from a frontal headfilm. I don't argue the point,
but am simply saying that there are other means available for consideration.
Since the first molars are in a Class I relationship in the original malocclusion
and since I have determined, correctly or incorrectly, that the molars require lingual
movement, then correction in the lower arch will result in temporary "buccoversion"
of the maxillary molars, until they are constricted. Also, it can be observed that the
lower right bicuspids do not require rotation, but only simple buccal forces at the
crown level. Remember that torque is a product of force times distance, as described
earlier.
If we apply a simple lingual force at the molar tube level, we have created
lingual crown torque. Therefore, to provide a molar with lingual crown torque, a
rectangular wire may be used, but is not absolutely necessary in many cases. A simple
lingual force passing through the tube and crown of the tooth (line of force) lies
occlusal to the center of resistance of the tooth, so that the force times distance results
in lingual crown torque. To go even a step further, we can provide lingual crown
56

torque for the second molar without even placing a band on the tooth, if nothing more
is required. A simple distal extension of the archwire through the first molar tube can
be utilized to provide a point force through the second molar crown and thus also
produce lingual crown torque. So, it simply is not necessary to band/bond teeth all of
the time to obtain a given type of movement.

Treatment
Based on profile requirements, it was decided to treat this boy on a
nonextraction basis, in spite of the amount of crowding in the mandibular arch. You do
not have to agree or disagree on the treatment plan, as we are only concerned in this
discussion with the mechanics instituted to obtain the end result. We have already
discussed mechanics that will enable us to obtain some additional lower arch length
without anterior expansion. This means we can avoid expansion altogether, in many
cases, while keeping expansion to a minimum in others. Looking at the occlusal view
of the lower arch, I think you would agree that simply gaining arch length by pure
expansion would result in flaring of the incisors that would be clinically obvious.

Appliance
For the reasons mentioned before, only a minimal appliance need was
anticipated. Upper and lower 24 (incisors and molars) were placed, with initial .016
archwires (Fig. 141), and tipback bends in the lower arch. The tipback produced light
intrusive forces on the incisors, while the eruptive forces were shared by the molars
resulting in each molar receiving only one-half of an already light force. The eruptive
force acting through the molar tube produced lingual crown torque, as explained
earlier in this series. The resulting lingual movement produced a temporary
buccoversion of the upper molars.
If you desire second molar movement lingually, distal extensions can be
provided to the archwire passing through the first molar tubes, and can be cut off when
no longer needed. The large molar moments, producing distal crown thrust as a result
of the tipback bends, are allowed to thrust the molar crowns distally, permitting a gain
in lower arch length as the 360 tieback loops are gradually unwound to permit this
effect to occur. Since the archwire is tied to the molar tubes, the incisor segment is not
allowed to move forward, unless, of course, we exceed reasonable limits. We cannot
tip a molar crown indefinitely or unwind a 360 loop too quickly and beyond reason.
That is, it can only be unwound to the extent that a millimeter or so of arch length can
be gained at a time as the molar crowns "upright" and then tip back. You alone can
decide on how far to tip back a molar, but I don't think it is wise to try to be too heroic,
as I have done in the past. I, personally, would be satisfied with a gain of maybe two
millimeters per side, but even this amount can be dramatically increased, if the molars
are tipped forward from the start, which has already been demonstrated.
57

In Figure 142, the lower right bicuspids, which were in linguoversion and
required only a buccal force at the crown level, have been ligated to the archwire. At
the same time, this causes an additional lingual force on the molar crown, resulting in
more lingual crown torque. Do not be fooled by overbite "correction". It is necessary
to recognize temporary cuspal interferences from tipback movements that produce this
illusion.
Figure 143 would lead one to believe that everything is out of control, if one
were not aware of the force systems and predictable responses. The temporary
buccoversion of the upper molars is increasing, particularly on the right side, as the
lower right first molar responds to both the tipback bend and reciprocal movement
resulting from the buccal forces on the bicuspids. This view shows the lingual cusp
height of the maxillary molars, whose arch width up to this point has remained
unaffected. However, the upper tipback bends provide anterior intrusion with
reciprocal extrusive forces on the molar tubes, producing lingual crown torque on
these teeth, just as occurred with the lower molars. Granted, the case does not look
pretty at this stage, but presents no problem if one remains aware of what is
happening. One of the problems encountered, however, is the sudden transfer of a
patient at such a stage. The new orthodontist is likely to wonder what is happening and
why, and arrive at conclusions that might be unwarranted.
Figure 144 shows the space gained in the lower arch. The archwire was
removed, as is frequently done, to allow the teeth to seek their natural position in an
environment whose function has been altered. One of the variations that may occur is
buccal movement of a molar crown. As explained in an earlier part of this series, an
anterior intrusive force actually produces an extrusive molar force on the lingual side
of the tooth. Therefore, whenever a rigid wire or binding occurs in the tube, the crown
actually undergoes buccal crown torque. But most of the time, with round wire, the
crown will move lingually, as the wire makes contact with the molar tube on
activation, but "slips" and, therefore results in a net force at the tube.
In Figure 145, a heavier wire has been placed in the lower arch, usually an .020.
Note the amount of molar uprighting that occurred with the archwire left out. This
enables the orthodontist to see what is happening and to note how much of the space
gained in the arch is lost, and in what manner. Simply stated, the teeth have been free
to respond as they wish.
Earlier we discussed .036 overlays and demonstrated their use in the upper arch
for expansion. It was pointed out that the .036 overlay can be used for either expansion
or constriction of arch width. In this case, the upper first molars are now ready for an .
036 overlay constriction arch, designed with an anterior vertical loop and then
constricted (Fig. 146). Since only equal and opposite forces can occur, don't be led
into thin king such an overlay can be used to produce a one-sided force. In Fig. 147,
58

the overlay is inserted into the molar tubes and the loop placed lingual to the archwire.
The archwire bend labial to the cuspids produces a "long arm" indicating lingual
forces on the molars. These bends are not necessary, as the forces produced from the
overlay will easily overcome the archwire resiliency. However, it keeps the operator
conscious of what is being attempted in terms of tooth movement and direction. When
the patient arrives at the following visit, the bends indicate what is being attempted
and thus serve as a "treatment card" reference.
When the maxillary molars have been constricted, all wires are removed (Fig.
148), to allow function to perform its role. Wires are reinserted, when indicated, to
control or produce additional rotations (Fig. 149).
Following appliance removal (Fig. 150), the molars upright, and normal
function is established. Adjustments for minor rotations can be made with a removable
appliance (Fig. 151 ) by applying the cue ball concept. By applying a force at a given
point, the response can be predicted. A distolingual rotation can be accomplished by
applying a lingual force at the distobuccal cusp and relieving the distolingual portion
of the retainer to permit the rotation to occur. Obviously, the most effective rotations
can be accomplished with the fixed appliance still in place.
The facial profile picture (Fig. 152), taken later during retention, justifies the
nonextraction approach to treatment in my opinion.

Summary
The case discussed would not be considered a difficult case for any orthodontist,
and treatment might be approached in a number of ways. The approach described is
not meant to be one of choice, but, rather, it illustrates the fact that different concepts
may be introduced into our treatment procedures. Each orthodontist must decide
which approach is preferred and proceed from that point to treat the case. But, no one
should feel forced to have all teeth banded/bonded at every stage of treatment,
regardless of the type of problem. There are advantages and disadvantages, and it is
entirely up to the operator to choose an approach which offers the greatest advantages,
after such considerations as skill, knowledge, and experience are taken into account.

59

JCO, Volume 1980 Sep(637 - 647): Common Sense Mechanics Part 13

--------------------------------

Common Sense Mechanics Part 13

THOMAS F. MULLIGAN, DDS

Applying Principles to Total Treatment (Continued)

Thus far, we have observed treatment procedures involving various
malocclusions, including Class I extraction and nonextraction cases and a Class II
extraction case. We have looked at Class I and Class II extraction cases requiring good
anchorage and have seen that it can be obtained in an uncomplicated manner. Earlier,
nonextraction cases were discussed that involved deep overbites. Actually, regardless
of the classification of the malocclusion, we should recognize at this point that when
60

we are dealing with "dental" malocclusions (versus "skeletal" malocclusions), there

really are little differences in treating one type as compared to another. We are trying
to move teeth from one specific point to another, and deciding which bends and which
locations will encourage such movements. As long as we have the means to control
magnitudes, we really don't have to worry about whether the mandibular plane is flat
or steep. In fact, if anything, we might have to concern ourselves with the forces being
too light, particularly in a flat mandibular plane case. The easiest thing in the world of
orthodontics is to increase force levels. The more challenging aspect is to minimize
force magnitudes, and we really don't have a major problem, if we reflect on some of
the things that have been said regarding force control.
In the last article, it was explained that lingual crown torque can be produced on
an unbanded molar by applying a simple lingual force at the crown level. This may be
accomplished by placing an archwire with a distal extension through the molar tubes.

Class II, Dlvision 2 Malocclusion

I did not have the opportunity to finish the next case as planned. But, in spite of
inadequate lingual root torque in the "finished" result, there are lessons to be learned.
The patient is a young female adult with a serious Class II, division 2
malocclusion (Fig. 153). It is very important that you take notice of the buccoversion
of the maxillary second molars. The lingual cusps contact the buccal surfaces of the
mandibular molars. Complete correction will be accomplished without banding these
teeth. Also, note the "concave" bicuspid areas in the occlusal view of the maxillary
teeth, so as not to later interpret this as "collapse" due to the use of light wire
mechanics.
It is very interesting to look at a case Like this, as one might suspect that an
intrusive force through the incisor brackets would result in the line of force passing
lingual to the center of resistance, but the tracings (Fig. 154) show this not to be the
case.
Upper first bicuspids have been extracted and treatment initiated with an .016
spiral arch and no extractions in the lower arch (Fig. 155). The case will, therefore, be
treated to a Class II molar relationship, and maxillary labial crown torque will be
required to produce the necessary overjet to permit alignment of the mandibular
incisors. Note the buccoversion of the unbanded maxillary second molars.
Intrusion in the upper arch only is accomplished, until such time as the lower
incisor bands/brackets can be placed (Fig. 156).
In Figure 157, you can see the off-center bend located mesial to the bicuspid
brackets. This bend provides the intrusive force to the incisors, while the distal crown
61

thrust on the bicuspids enhances the anchorage during space closure. The eruptive
force acting on the bicuspids provides, in addition, an "interlocking" tendency with the
unbanded lower bicuspids.
In Figure 158, you can again see the upper second molars, which will require
some lingual crown torque. Note the high lingual cusps. The lower incisors are
purposely being expanded, due to the facial profile and cephalometric data.
Cuspid bands were placed and the cue ball concept applied (Fig. 159). In
progress pictures (Fig. 160), again note the upper second molars. The space created by
lower distal crown movement of the molars "doesn't count". The patient is a nongrower, so any space created by distal molar crown movement is not credited to arch
length.
The lower archwire was segmented and the molars "set free" (Fig. 161). In
Figure 162, the molars have uprighted and the spaces have disappeared. Additional
anterior intrusion was gained with an .018 cantilever overlay (Fig. 163). The anterior
segment does not have to be removed, unless desired for some reason.
An .018 archwire, with distal extensions, was prepared for lingual crown
movement of the maxillary second molars (Fig. 164). The archwire was inserted (Fig.
165) with the extensions in contact with the second molars. Choose the point of force
application based on any rotation that might be required on these teeth. Intraoral
activation was obtained with a Tweed loop pliers (Fig. 166). A center (gable) bend was
placed intraorally in the extraction sites (Fig. 167). Because of the full strapup in the
upper arch excluding second molars this center bend caused the archwire to
behave as a reverse curve of Spee and, therefore, intrusion occurred at both ends of the
archwire, unlike the tipback bend. Figure 168 shows the amount of overbite correction
at this point in treatment.
The distal extensions were cut off after sufficient lingual crown movement of
the maxillary second molars occurred (Fig. 169), and function was permitted to
accomplish the remainder.
A rectangular arch, .019 .025, was fabricated (Fig. 170) for the anterior
lingual root torque and placed (Fig. 171). Appliances were removed prematurely at the
request of the patient who was leaving the city (Fig. 172). Everything was satisfactory
at this point, except for the needed lingual root torque. Six months later, the patient
returned (Fig. 173).

Summary
The increase in overbite and inadequate lingual root torque are not happy
components of the end result. But, I hope that the various treatment procedures
illustrated will justify presenting this case. Obviously, under the right circumstances,
62

treatment could be continued to a satisfactory conclusion, as the most difficult aspects

of treatment had already been accomplished. At any rate, it can be seen that the
maxillary second molars are successfully occluded with the lowers and that the lower
anterior expansion is justified, based on the patient's profile (Fig. 174). Rhinoplasty
was recommended to the patient following treatment, but not desired by patient or
parents.
When teeth are banded throughout the arch, the force system is different than
that presented in overbite correction utilizing only a 24 appliance. Instead of
extrusive forces on the terminal teeth (molars), intrusive forces occur, as can be seen
in the occlusal pictures. Keep in mind that the second molars were not banded. The
final headplate tracing established no growth during the period of treatment, and
absolutely zero increase in vertical dimension.
Something can be learned from almost any case, including those that do not
meet the intended objectives. Hopefully, that is the case here.

Class II Open Bite, Extraction

This might be a good time to discuss an open bite case requiring anchorage
conservation, as it will demonstrate that the concepts really don't change. We simply
apply whatever concepts are necessary to produce the desired force systems. I won't
go into great length in this case, as much of the discussion would prove to be
repetitive.
This case presented with the right side in Class I and the left side in Class II
(Fig. 175). As you can see, the teeth were already decalcified, and in addition, she had
had root canal therapy on the upper right first molar. These are the cases that seem to
so often work against your efforts, but I believe such a case can offer a valid test for
the mechanics, as the mechanics do not recognize the problems mentioned only
application and response. Needless to say, the causative factor in an open bite must be
eliminated, if the result is to be satisfactory and stable.
Due to the midline discrepancy, asymmetrical extractions were done. The upper
first bicuspids, lower right first bicuspid, and lower left second bicuspid were
extracted. Asymmetries have already been demonstrated and corrected with
asymmetrical mechanics, such as retraction on one side of an arch with protraction
occurring on the opposite side of the same arch at the same time. Asymmetrical
extractions, I find, present a very good means of correcting many asymmetries, and
such extractions, combined with asymmetrical mechanics, enhance such treatment
even more, at times.
Figure 176 shows the amount of anterior space gained, using the same
mechanics as described in the section on cuspid and bicuspid retraction, except that in
this case, the cuspid and bicuspid on the lower left side were retracted only part way
63

and the molar protracted the remainder of the distance. This is accomplished by use of
a center bend in which neither side becomes the anchor side. The other three cuspids
were retracted individually.
The occlusal views (Fig. 177), again, point out the importance of placing toe-in
bends early. This case was treated at a time when I waited too long and had to make
the correction toward the end of treatment. It is much easier to maintain and even
overrotate the molars than to have to correct the mesiolingual rotations later. Figure
178 shows an extraction case with toe-in bends placed early to provide the
counterrotation needed by the molars. Notice in the lower occlusal view (Fig. 177) that
the right first and second molars are in contact, while on the left side space has
developed between the molars. Clinically, this verifies the effectiveness of the
intended anchorage on the right side and the intended first molar protraction (partial)
on the left side.

Closing the Bite

In Figure 179, the anterior teeth have been banded and the spaces closed. In this
case, up-and-down anterior elastics were used to close the bite. They were used in a
rectangular fashion. For a short period of time, rectangular up-and-down elastics were
used on the right side, but triangular Class II elastics were used on the left side for
some additional Class II correction, in addition to the maxillary and mandibular teeth
being brought together.
There are different methods of closing the bite, which have already been
mentioned. In extraction treatment involving open bites, the anterior segment can be
purposely tipped back so that the application of lingual root torque later will provide
an intraoral vertical extrusive force, thus eliminating or minimizing the use of any
elastics. Also, when tipback bends are used, elastics can be worn to erupt teeth in the
arch of choice, while countering the intrusive force produced by the tipback bend in
the opposite arch. In other words, in spite of the fact that up-and-down elastics
produce extrusive forces in both arches, extrusion can be limited to the arch of choice.
The occlusal view (Fig. 180) shows the toe-in bend present on the maxillary
molars. This should not be required at this point, if placed early enough. Figure 181
shows the case two years following treatment, and Figure 182 shows profile
photographs before and after treatment.

Summary
Thus far, it can be seen that basically the same concepts have been applied to
different malocclusions, including open and closed bites and extraction and
nonextraction cases. In the case just described, no wires were ever used other than
64

round wires. It is not the purpose in describing the various types of treatment to
suggest what should or should not be used, but rather to let the individual choose for
himself that which he feels will achieve his objective.

JCO, Volume 1980 Oct (716 - 723): Common Sense Mechanics Part 14
--------------------------------

Common Sense Mechanics 14

THOMAS F. MULLIGAN, DDS

Applying Principles to Total Treatment (Continued)

There are basically three general types of Class III malocclusion, if we don't get
too technical. One would be purely dental, including mandibular displacements on
closure, while the other two would comprise dental/skeletal and purely skeletal
problems. The latter requires surgical treatment, whereas the first two can be treated
orthodontically without surgery; although the dental/skeletal type treated by
orthodontics, without surgery, will involve compromise. There are many reasons for
65

accepting a non-surgical approach in the dental/skeletal types, including economic

considerations. Since orthodontic treatment alone is therefore applied in such cases, it
is reasonable to include this type of case in the discussion of "Common Sense
Mechanics".

Class III (Atypical), Mandibular Displacement

We will begin by discussing a dental Class III malocclusion (atypical) involving
a slight forward displacement of the mandible during closure and a severe midline
discrepancy. Obviously, such a case looks worse than it really is (Fig. 183). The
patient in this case was almost able to bite "end on" with the incisors when asked, but
not quite. Unlike most such cases in my practice, I elected to have four first bicuspids
removed. The purpose of this entire presentation, as mentioned, is to discuss
mechanics, not the reasons for electing to extract teeth except as it might pertain
directly to the mechanics, such as gaining arch length with a tipback bend and thus
converting a possible extraction case to nonextraction treatment.
Maxillary cuspids were retracted until sufficient space was gained to align the
six anterior teeth (Fig. 184). An off-center bend is used to assure sufficient anchorage,
but once the space has been gained, the mechanics are reversed so as to produce
buccal protraction of the maxillary molars. It was intended, as part of the treatment
plan, to maintain the anterior/posterior position of the maxillary incisors and to retract
the lower anterior segment sufficiently to eliminate the mandibular shift and establish
a Class I occlusion. Lower retraction is accomplished with an off-center bend to
maintain anchorage on the molar side of the extraction site. Such details have thus far
been described so frequently, that their description is not repeated. In most
nonextraction cases, I find myself expanding the upper anterior segment for such
correction and frequently there is a good lower arch in these cases. Notice the heavy
lingual frenum. The patient disliked having these occlusal pictures taken due to the
discomfort, and yet refused any surgical correction. The lateral views show root
paralleling taking place with center (gable) bends. Figure 185 is an occlusal view of
the upper prior to appliance removal.
The case is shown in retention (Fig. 186) shortly after completing the treatment.
The retainer has been relieved to allow a distolingual rotation of the upper right first
molar. The final pictures (Figs. 187 and 188) were taken 4 months later.
When dealing with tooth movement, there is not a whole lot of difference in
treating the various classifications of malocclusions, as has been seen. Understanding
forces and moments, and how they operate, as well as controlling magnitudes in the
vertical plane of space, allows the orthodontist to treat various problems with almost
the same degree of ease.

66

Class III, Dental/Skeletal

Unlike the previous case, this girl presented a difficult Class III malocclusion.
There was no displacement on closure of the mandible, meaning the entire dental
relationship would require correction purely by tooth movement (Fig. 189). Ideal
correction in a case such as this would require surgery because of the skeletal
contributions to the malocclusion. But this case was treated by orthodontics alone,
meaning that compromise must be part of the end result. In such cases, I anticipate
certain problems during retention, including partial Class III relapse and a tendency
toward open bite or lack of sufficient overbite.
Notice the crossbite in the buccal segments in addition to the anterior crossbite.
Merely correcting the crossbite in the buccal segments will worsen the Class III
anterior relationship. There is also lower anterior collapse present, meaning that
correction in this area will worsen the anterior relationship. The unerupted upper left
cuspid is completely blocked out of the arch, but this really isn't a problem, as the
anterior teeth will purposely be moved forward to correct the malocclusion. Note the
facial profile and the typical "dished in" middle third (Fig. 190). I feel this type of case
requires certain compromises to be established beforehand, such as the willingness to
leave "some" lower rotations, which will encourage more overbite and overjet
following treatment.

Treatment
Nonextraction treatment was instituted, with the clear intent to expand the
maxillary teeth and to correct the molar relationship as much as possible with Class III
elastics. In spite of the seriousness of this malocclusion, you might find it interesting
to observe the amount of dental correction obtained using only 24 appliances in each
arch. Nothing more than an .036 overlay was used to correct the buccal segment
crossbite.
After placing 24 appliances, a maxillary archwire was placed using coil springs
to advance the incisors (Fig. 191). Note that aligning the mandibular incisors at this
time would make the problem even worse. They are aligned later. There is no "shift"
present in this case, so all changes shown are due to tooth movement.
Six and one-half months later, a mild overbite has been established and space
opened for the upper left cuspid (Fig. 192). The molars have moved distally as a result
of the prolonged distal forces at the molar tubes. This seems to occur readily in a
dental/skeletal Class III malocclusion. The lower anterior segment is being aligned at
this time.

67

In Figure 192, the upper left cuspid is making its appearance into the available
space. An .036 overlay to correct the crossbite was used in the manner described
earlier (Fig. 193). Class III elastics are worn throughout this period to prevent Class III
reoccurrence in the anterior segment during expansion of the buccal segments. Note
the correction observed two months later (Fig. 194) and how much has been
accomplished with only the use of 24 appliances and an overlay expansion arch.
Bends have been placed distal to the lateral incisors to produce lingual forces on the
molars as indicated by the long arms that are produced. Whenever forces on the
molars are obtained in this manner, it is wise to use a heavier wire such as an .020, as
bypassing teeth reduces force magnitude as has been demonstrated earlier in this
series. I like light forces during vertical movement and accept heavy forces during
horizontal movement. The .036 overlay is certainly a heavy force and should never be
activated for any type of vertical movement. Figure 195 shows the case prior to band
removal, twenty-two months following the start of treatment. Bonding would have
hurried the eruption of the upper left cuspid, but I didn't bond at the time, although all
of my cases are now bonded. Figure 196 shows the profile at the time of appliance
removal.
One year after appliance removal (Fig. 197), the expected type of relapse has
taken place. The occlusion is not ideal by any means and shows a Class III tendency.
Frankly, I consider myself lucky to be able to maintain this amount of overbite and
feel that it might be a mistake to preserve lower anterior alignment, if the overbite
begins to disappear in a case of this nature. For this particular patient, the overbite
managed to maintain itself.

Summary
Minimal appliances are not the answer to all of our problems, quite obviously.
But I think, sometimes, full appliances can add to our problems. Reciprocal effects
cannot be selective and forces cannot be as reliably controlled. Often, it may be best to
complete the vertical requirements in treatment prior to placing the remainder of the
appliance. Taking certain advantages of the use of minimal appliances for some stages
of orthodontic treatment does not deny the operator the opportunity to finish treatment
with a full appliance.

68

JCO, Volume 1980 Nov(788 - 795): Common Sense Mechanics Part 15

--------------------------------

Common Sense Mechanics 15

THOMAS F. MULLIGAN, DDS

Variations in Anterior Crossbites

Class III malocclusions have been discussed in which the anterior crossbite
components were treated differently. In one case, teeth were extracted and the
mandibular incisor segment retracted, while another case was treated nonextraction

69

and the maxillary incisor segment moved labially. Only the mechanics of tooth
movement are under discussion, however.
I would now like to discuss, briefly, anterior crossbite variations in the young
patient and the mechanics which normally are quite simple anyway. But, even so,
there is a tendency to automatically band teeth in given cases, and I would simply like
to illustrate that even in the simple cases, minimal appliances might not be as minimal
as they could be. The orthodontist should think in terms of the required force system
on the teeth to be relocated, and then place the appliance necessary to produce this end
no more, no less.
Let us begin by showing a young boy with an incisor crossbite that I think we
would all agree should be corrected in the mixed dentition (Fig. 198). When I look at a
case like this, I can see no reason to expect the need for later treatment following
correction, although we all recognize that any normal situation can become abnormal
with the passage of time, for various reasons. I always make a point to clarify this
possibility when treating any such case early.
In looking at this case, as simple as it is, we should determine our force system
needs by asking ourselves what is necessary for labial movement of the incisors. The
answer is ridiculously obvious a labial force. The reciprocal force will therefore be
distal, if we consider the only remaining permanent teeth at this time the first
molars. In Figure 199, an upper 24 appliance has been placed and an .016 archwire
tied in for expansion. As seen in Figure 200, correction is readily obtained; and in
Figure 201, the anterior spacing is consolidated. Following correction and appliance
removal (Fig. 202), normal development is taking place. Nothing unusual has been
presented in this case. It involved no variation in mechanics, compared to what would
normally be done by most orthodontists. I rarely use bite plates during crossbite
correction. The patient is instructed to keep the lower teeth "out of the way", which is
easy to do as the mandible is simply displaced forward until such time as the patient
"discovers" that the lower teeth fall behind the upper teeth when normally closing.

Single Tooth in Crossbite

Now, if we take a look at another variation, we can see why our thinking can
vary the appliance used in this case (Fig. 203). Unlike the previous case, this young
boy has only a single lateral incisor in crossbite. Again, the case is not difficult and I
would not predict or expect the need for additional orthodontic treatment following
correction, although there is never any such guarantee. The reason for showing the
previous case and now this one is simply to illustrate that our thinking should consider
what appliance is necessary for the force system needed. Since only a simple labial
force is required on a single tooth, the upper left lateral incisor, the reciprocal effect
can now be passed on to the other three incisors as a lingual force, or to the molars in
terms of a distal force. Since there is no need to place bands that are not required to
70

produce the needed force system, the molars are not considered in the appliance.
Rather, the remaining incisors will serve as reciprocal units. Common sense tells us
that it is more likely that the lateral incisor will move forward than that the other three
incisors will move into lingual crossbite. In arriving at such a conclusion, function,
overbite, and rest position of the mandible are factors to be considered when
predicting the most likely response.
An .016 segment is used to correct the crossbite. In order to produce rapid
movement without wire deformation, proper loop design must be achieved. This case
represents one of the few types of problems in my practice where I would even
consider using a loop. The triangular loop is much better than the vertical loop (Fig.
204), as its activation for crossbite correction involves torsion along a broad base,
whereas the vertical loop involves the same torsion on a very narrow "base", resulting
in less deflective qualities and easy permanent deformation. I therefore restrict the use
of triangular loops to labiolingual types of tooth movement, whereas the vertical loop
can best be utilized for twisting (rotational) movements around the long axis of a
tooth. In the latter situation, the torsion occurs along the legs of the loop, thus
improving the deflective qualities and reducing the likelihood of permanent
deformation. Also, note the terminal stops (loops) on the anterior segments shown.
They can be reversed, if desired, to prevent any twisting tendency of the segment
when tied into place.
Correction has been easily and rapidly obtained, using only four incisor bands
and an .016 segment with a triangular loop activated for labial movement of the upper
left lateral incisor. Following appliance removal, a normal mixed dentition
environment has been created, with no reason to expect the development of further
problems (Fig. 205).
I hope I have not insulted your intelligence by showing these two cases. They
are easy to treat by almost any means, but the idea here is to emphasize the "thinking"
in terms of relating the appliance to the force system required or desired. As you can
see, such thinking can affect the number of bands placed, as well as wire length and
loop design.

Minimal Cases
This series will be concluded with two more cases that involve even less
treatment than presented thus far. I believe they will point out the importance of
keeping some treatment to a minimum for various reasons including hygiene,
cooperation, hardships and a legally oriented society.
The first case (Fig. 206) involves a young man who came to my office with his
father, and presented himself with upper and lower anterior crowding and generalized
tissue recession. Neither the patient nor father were concerned about the problem and
71

only appeared in my office on the recommendation of the family dentist. Does this
sound familiar? Indifference to the problem persisted following discussion. In a suithappy society such as ours, I can assure you that I am not anxious or willing to engage
myself in treating a problem which may become progressively worse in spite of
treatment, and inheriting the blame and liability so often attributed to the orthodontist
by parents, patients, or dentists who feel all future problems are a result of orthodontic
treatment, no matter when it has been performed for that patient in the past. This is
particularly true when such treatment requires extractions. Since parent and patient
were indifferent to treatment, under no conditions was I willing to consider bicuspid
extraction treatment. At the same time, since records and analysis revealed no tooth
size discrepancy, I did not consider the removal of a single mandibular incisor
which I had no desire to do anyway, under the circumstances. The only remaining
treatment procedure other than doing nothing at all was to consider proximal
reduction ("stripping") of the mandibular incisors. I was not interested in any
expansion. Proximal reduction and the use of a removable appliance quickly produced
satisfactory alignment (Fig. 207), and the removable appliance then served as night
retention and future prevention. I could have chosen to do nothing, but I feel I can
"comfortably" deliver a preventive, as well as corrective procedure, in such a case
without inheriting the liabilities of the future change so often blamed on the
orthodontist. Needless to say, the patient is thoroughly informed and accurate written
records are kept.
In the final case, I will present a college girl who wanted treatment badly, but
time was critical. She had a good Class I relationship, but rather severe lower anterior
crowding (Fig. 208). There was no tooth size discrepancy to the extent that a single
lower incisor extraction could be considered.
Again, the case was treated by proximal reduction of the mandibular incisors
and the teeth rapidly aligned with a removable appliance (Fig. 209). Expansion was
avoided, the crowding eliminated, and the future protected by using the removable
appliance on a night basis only. The patient is rewarded with rapid and satisfactory
treatment instead of no treatment at all.
The last two cases, as you realize, were not presented to demonstrate common
sense application of force systems. They were demonstrated to present common sense
PERIOD. In all we seek to do for our patients, the element of common sense
remains such an integral part of our thinking, and thus the reason for my selection of
the title, "Common Sense Mechanics", for this series.

Discussion
Prior to concluding this series a question and answer installment will follow
I would like to say that all treatment demonstrated has involved banding and not
bonding procedures. All of my treatment at this time is done with bonding, with bands
72

only placed on the molars and mandibular second bicuspids when required because
of occlusion. But, the nice thing about "principles" is that they don't change with the
times. Our biologic environment will continue to require that we understand forces
and response, regardless of whether we use banding, bonding, or whatever comes
next.
In Figure 210, brackets have been premounted on a rectangular anterior segment
adapted to the regular study model, and the entire segment is being bonded in
preparation for a cantilever force system. An overlay is then placed over this segment
as earlier described. Figure 211 shows the use of a cantilever system with bonded
brackets, while Figure 212 demonstrates the use of an .036 overlay with bonded
attachments. In Figure 213, Class II elastics are attached directly to the brackets, since
I use no hooks. A cantilever system can be observed in use in the lower arch. Finally,
Figure 214 illustrates the fact that elastics can eliminate the need to use any kind of
loop to bring down "high" cuspids.

Conclusion
It has been my privilege to present this material to the profession. I do not
consider my abilities and my results any more than average and have always
maintained this position. But I remain thoroughly convinced that the orthodontic
profession can improve itself in many ways by becoming more acquainted with the
principles that have been presented and by applying them when the need arises. This
does not require using a different appliance than you are presently using, and it does
not require that you discard your favorite technique. It might mean making certain
modifications at times, but THE CHOICE IS YOURS!

JCO, Volume 1980 Dec(855 - 868): Common Sense Mechanics Part 16

--------------------------------

Common Sense Mechanics 16

THOMAS F. MULLIGAN, DDS

Q/A
Q

Is it your contention that you cannot program treatment sequences, because of

variability of biologic response of the individual patient?
A Negative. In general, I believe in taking care of vertical problems first, followed
by the horizontal problems. An example would be correcting the overbite prior to
73

retracting teeth. However, I have no objection to a "cookbook formula" for tooth

movement other than for me personally. I simply prefer to be able to do whatever I
prefer to do at the time. Often, I like to combine various planes of tooth movement,
such as buccal expansion for crossbite correction at the same time as overbite
correction or retraction of teeth.
Q
Why do equal and opposite forces in the horizontal plane of space produce
equal responses, while in the vertical plane of space they produce unequal response? Is
it cortical plate? Is it root surface?
A
I never said the responses are equal in the horizontal plane of space. I said they
tend to be more equal than in the vertical plane of space. In the vertical plane we have
additional factors to consider, such as the forces of occlusion which may or may not
allow certain teeth to erupt, depending on whether or not the magnitude of the eruptive
forces present will overcome the forces of occlusion. Intrusion is uninhibited by these
same masticatory forces and we thus find that in some individuals we will obtain some
intrusion and no eruption, while in others we may see more eruption than intrusion.
Certainly, root surface, cortical plate, etc. are all part of the total picture, but the series
on Common Sense Mechanics points out that we must know and understand basic
mechanics and then apply such principles in a biologic manner.
Q
If horizontal forces are always in equilibrium, can you get a unilateral force
from headgear, as some believe?
A
Much has been said about various types of headgear by men much more
knowledgeable on the subject than myself. I have tried to restrict my discussion to
intraoral mechanics, as all forces known and unknown affect the alveolar
process. As for headgear, exactly the same equilibrium requirements exist, except that
some of the forces and moments are applied against the skull and thus do not affect
tooth response. Certainly, headgear can be designed to produce unilateral movement,
but not in violation of the equilibrium requirements.
Q
Do you agree with the stereotyped explanation of the action of cervical
headgear? If not, how do you modify its use to accommodate to various situations?
A
Many have condemned the use of cervical headgear for a number of reasons.
One of the more common reasons is overeruption of molars. I do not find this attack
on the use of cervical headgear to be justifiable on a universal basis. First of all,
growth can well make up the difference. I don't use headgear PERIOD with
adults. But I think that many orthodontists blame cervical headgear for their vertical
increases without realizing that the eruptive forces produced are intermittent, while the
archwire often contains continuous eruptive forces in the posterior area of the mouth.
These forces act day and night, whereas such is not the case with typical headgear
wear. If the orthodontist recognizes the forces in the archwire and learns how to
control the magnitudes, I think it will often be found that the effects of cervical
headgear are not all that bad. Many modifications can be made with a cervical
headgear. Generally speaking, I seldom make any modifications. Sometimes I will
74

lower the outer bow to reduce or minimize the eruptive forces. This, however,
increases the distalizing effect of the molar crowns, causing them to tip back more
rapidly. This may or may not be desirable.
Q
Can you consider force systems without taking into account the relative size of
teeth, roots, bone density, cortical plate, etc?
A
Yes. Keep in mind that "common sense" has been emphasized over and over
again. I do not wish to mislead anyone into thinking that all responses to force systems
are exact. But we must first know the forces and moments present before we can
reliably predict the response. By organizing the principles in an orderly delivery
system, as I have attempted to do, factors such as tooth size, root area, bone density,
etc. are not even matters to consider when choosing a desirable system. I didn't say
they don't affect the rate of response. I didn't say equal and opposite forces produce
equal and opposite movement. This was pointed out early in the series. What is
important is to know what is produced by the bends in the wire and how to control the
magnitude of force, so that these systems can be allowed to work for us and not
against us. Eruption occurs more readily than intrusion. But, even knowing this, I have
tried to illustrate methods whereby eruption can be prevented, while allowing the
intrusion to occur. If we want eruption, I think we'll all agree we have no problem. The
solution lies in understanding the principles along with the biology of tooth movement
and then applying common sense which considers all factors. We are not demanding
perfect responses. Rather, we are searching for the best we can expect to find under
the conditions present.
Q
What do you take into account when pitting different teeth against each other? A
central and a lateral? Four anteriors and two molars? Two anteriors against two
molars? Does it pay sometimes to vary the number of antagonists?
A
As demonstrated in the series, I do not use the "numbers system" when pitting
one tooth against another. We know from clinical experience, for example, that when
anchorage is set up for cuspid retraction in a first bicuspid extraction case by banding
the second bicuspids and the first and second molars, we sometimes come out pretty
well, while on other occasions we lose a lot more anchorage than might have been
suspected beforehand. There is a large degree of variation and lack of reliability in
determining the effectiveness beforehand. Personally, I believe this approach is
unreliable for the simple reason that the anchor unit contains the greatest number of
teeth, thus resulting in the greatest area of periodontal membrane. Since the forces in
space closure are equal and opposite by necessity, the stress or force per unit area
along the periodontal membrane contained on the anchor side is less than on the nonanchor side. Many studies have shown that greater rates of response are produced
when the periodontal stresses are reduced. I think, in actuality, the "numbers"
approach often does the exact opposite of what is intended. Sometimes it works and
sometimes it doesn't. As I have already demonstrated, I do not hesitate to retract two
teeth I n a quadrant by utilizing a single molar with differential moments. I have
retracted cuspids, first bicuspids, and second bicuspids into first molar extraction sites
75

using only the second molars for anchorage, and have produced significant spacing of
the incisors, before bonding them, where serious crowding existed prior to retraction. I
do not wish to imply there is any form of perfect intraoral anchorage, as there simply
is not. But I do strongly feel that there are better and more reliable methods than many
of those used today.
Q
Do you believe in the differential force theory a la Begg?
A
That is an interesting question. I believe I answered part of it in the previous
question. It's funny, but I have attended meetings where this concept has been used to
support opposite objectives. I attended an Angle meeting one time where I heard a
paper presented that utilized the same force values, but instead of supporting the molar
during cuspid retraction, the values were presented as being the most ideal for buccal
protraction. I suppose that with the various studies done concerning this subject, I am
not the one to give the proper answer. My own experience would lead me to say there
is tremendous variation in response. Now when you get into the subject of differential
torque, or differential moments, you are talking to a believer whose beliefs have been
enhanced by the clinical behavior of teeth.
Q
How many different ways can you intrude anteriors?
A
From the standpoint of appliance design, I suppose it depends on the
creativeness of the operator. There should be no limit. The important thing is to
produce a known intrusive force and obtain the magnitude desired for the patient
involved. For example, when I correct the overbite on a youngster, a growing
individual, I utilize very light forces, because I am not really intruding the teeth. I am
simply preventing them from their further natural eruption during vertical alveolar
growth. Maybe I shouldn't use the term "intrusive" force in these cases, but I
mentioned earlier in the series that when I use such terms as eruptive and intrusive
forces, I do not mean that the teeth respond in such a manner. In the adult, growth is
not present, so we must not only produce a larger intrusive force, but we must decide
whether we are going to correct the overbite by actual incisor intrusion, posterior
extrusion, or a combination. Actual intrusion requires increasing the force level, in my
experience.
Q
Can your mechanics intrude molars? If so, how do you control incisor
extrusion?
A
If we restrict this discussion to intraoral mechanics, I do not choose to intrude
posterior teeth as a prime objective. The important thing is to recognize the various
types of tooth movement that produce posterior intrusive forces, so that we can choose
to utilize or overcome their effects, depending on whether they are good or bad. There
are a number of ways to handle the anterior extrusive effects intraorally, but let me
answer it this way, because I think I could write a book on this subject. First of all, if
we are dealing with an anterior open bite and have chosen to close it by tooth
movement in one arch only, we can purposely tip these anterior teeth during space
closure, if it is an extraction case. Now we have created the need for lingual root
76

torque, and by using the molars as our reciprocal units, we produce posterior intrusive
and anterior extrusive forces, as described early in the series. The posterior intrusive
forces are there, but not for the primary purpose of intruding molars. The anterior
extrusive forces, in the absence of the causative factors of the open bite, permit closure
of the open bite by an "intra-arch" force system, thus eliminating the need for up and
down elastics and unwanted eruption in the opposing arch. As for posterior intrusive
forces, I like to consider them useful in maintaining vertical dimension or producing
moments for crossbite correction. I don't try to intrude the posterior teeth, although it
certainly occurs. As for overcoming anterior extrusive forces during posterior
intrusion, we must recognize that, intraorally, the vertical forces produced by the
archwire must remain in balance. We would therefore have to shift the anterior
extrusive component of force to another area. An example would be the use of a
reverse curve of Spee in a full strapup. We have intrusive forces acting posteriorly and
anteriorly, but balanced by the extrusive forces between. Remember that the sum of
the vertical forces involved will always equal zero.
Q
Do you attempt to stabilize molars in order to influence the mechanics? With
palatal arches, lingual arches, headgear, bite plate? Do you ever do this in anticipation
of undesirable side effects?
A
No. I do use lots of cervical headgear in my practice, but not for this reason. For
individuals that use lingual arches, plates, etc. there is a "built-in" protection from
undesirable side effects. There is also a "built-in" rigidity that may prevent certain
desirable effects from occurring. For me, personally, I would prefer to accept the
responsibility for knowing the force system in the archwire and utilizing or
overcoming the effects, rather than build in rigidity which has the tendency to make
the operator feel secure, because things tend to "look good" most of the time. There
are many simple ways to overcome side effects. First of all, know what is in the
archwire and therefore what to expect. Since I use no lingual attachments.in my
practice, I resort to various devices, such as distal extensions of the wire through the
tubes, heavier overlay arches, rectangular wire, and bends placed distal to the cuspid
to produce buccal or lingual crown movement of the molars. This is another area
where I think I could write a book.
Q
Doesn't tying back archwires with tipback inhibit distal crown torque and cause
mesial root torque and loss of anchorage?
A
The tipback bend produces a combination of distal crown movement and mesial
root torque, whether or not the archwire is tied back. These movements occur in
various degrees under different conditions but, in general, crown movement tends to
precede root movement, so that there is a biomechanical advantage present in gaining
crown distalization. If the wire is tied back, the distal crown thrust is reduced, as it
must take the incisor segment with it. However, the opposite is also true. If the wire is
not tied back, the distal crown movement will be enhanced, but the incisor segment
will then be free to move forward, due to the intrusive force at the incisor bracket
resulting in labial torque or lingual root torque. When the archwire is tied back, this
77

torque is still present on the incisors, but is overwhelmed by the differential moment
on the molar teeth, which happens to be considerably larger.
Q
Does tying back the archwire tend to prevent flaring of anteriors from anterior
lingual root torque?
A
Yes. In fact, this was just explained in the previous answer.
Q
Why do molars flare on round wire? And, how do you prevent it?
A
Molars flare, or move buccally, for the same reason that molars also move
lingually. Forces are produced at the molar tubes during various types of tooth
movement. Since the buccal tube on a molar band usually lies buccal to the center of
resistance in the molar root, a vertical force passing through this tube will result in a
moment. Remember that any force times the perpendicular distance to this center of
resistance will produce a moment. As discussed in this series, an eruptive force
produces a lingual crown moment, while an intrusive force acting through the molar
tube produces the buccal flaring referred to in the question. We have already discussed
what types of tooth movement, with round wire, produce such forces and therefore
such moments on the molar. Anterior lingual root torque in a 24 strapup results in an
intrusive force at the molar tubes and thus produces the potential for the so-called
buccal flaring of the molars when a round wire or any non-rigid wire passes through
the molar tubes. The same is true when a reverse curve of Spee is used in a full
strapup. I emphasize the word "potential", as common sense requires that one consider
the effects of cusp height, function, and the forces of occlusion. On the other hand,
eruptive forces can be produced at the molar tubes resulting in lingual crown tipping
with the use of round wire. A tipback bend has the potential for doing this. Preventing
all of this is not difficult, if the operator recognizes the presence of such forces, the
moments they produce, the potential effects of these moments, and then takes the
appropriate action to see that the undesirables do not occur. As mentioned before, I
prefer to place other bends in the archwire, distal to the cuspids, to control these
movements. Those who prefer lingual arches, etc. are free to do so. I still believe in
keeping the appliance as simple as possible, as I feel we have enough problems as
matters stand. In my opinion, complex appliances often add more problems than they
solve, particularly if used in my hands. I therefore cannot criticize a complex
appliance, as such criticism may lie in my inability to handle the appliance properly.
Q
A leveling arch depressing incisors can bring molars in lingually. How do you
prevent that?
A
I believe this question has just been answered. Lingual arches, overlays,
removables, rectangular wire, etc. may be used, but I would, generally speaking, place
a toe-out bend distal to the cuspids and bypass the bicuspid brackets, thus producing a
buccal force through the molar crowns. Because this bypass procedure results in a
reduction of force magnitude, dimensions may have to be increased to provide
sufficient force levels for tooth movement. I can't think of a nicer problem to face in
78

orthodontics than having to increase forces to produce tooth movement in a desirable

fashion, since the opposite is usually the case.
Q
Does a full strapup inhibit the forces that intrude and extrude teeth on a 24?
A
It produces a different force system, as well as greater force magnitudes. Both
systems produce anterior intrusive forces, but the full strapup results in posterior
intrusive forces, while the 24 strapup produces posterior extrusive forces and the
potential effects already discussed. A full strapup also results in delayed response,
because of the "binding effect" and the gradual dissipation of forces from tooth to
tooth. It is less direct.
Q
Doesn't a full strapup keep things in general control and permit the forces to
work their way out gradually, without worrying about most side effects?
A
Yes. This is why I do not criticize the concept of using rigidity for control. I
think it is important to recognize that the best approach to orthodontic mechanics is
not what I think or what someone else thinks, but rather how the concepts fit the
training and abilities of the orthodontist. Many orthodontists actually know very little
about the force systems they have been using for years and produce very fine results.
However, they have learned to overcome certain problems by banding everything that
is "white" and utilizing all kinds of auxiliaries, when necessary, to overcome what
otherwise would be problems. But they now need additional patient cooperation,
which in itself leads to additional failure over the long haul. A good knowledge of
mechanics can produce many rewards not miracles. It is a "trade-off". Do you want
to think harder or work harder? The choice is up to each orthodontist, and I have never
been lead into the trap of telling the other person what he or she should do.
Q
Some have said that open bite cases are amenable to a full strapup tie-in,
bringing the anterior teeth to the functional plane of occlusion. Do you agree with
that?
A
If it has been properly decided that the open bite should be closed by tooth
movement and such movement can be attained either in one arch or both arches, as the
situation dictates, and if the orthodontist knows the various means of controlling such
movement, I don't see where it would make any difference.
Q
Doesn't a full strapup intrude overerupted incisors?
A
When you say full strapup, I assume you are also implying that the continuous
archwire is tied into every bracket. Yes, there is an intrusive force on the anterior
segment, but there are also eruptive forces in the bicuspid area. Depending on the
force levels, we must ask ourselves whether we are intruding anterior teeth, erupting
teeth in the buccal segments, or both, in correcting the overbite.
Q
You rely heavily on distalization of molars. Please comment on some
orthodontists saying this cannot be done, and others saying it should not be done.

79

Doesn't the vertical dimension increase, often undesirably, by rolling back or

distalizing molars?
A
Wrong! Absolutely wrong! I don't know how many times I have said this. I
consider such movement to be a fringe benefit when using the tipback bend. It is
secondary to other objectives. But, because the total force system produces a distal
crown thrust, it is not uncommon to see the molar crowns move distally very little
in some patients and very much in others. Consider it a "free ride". For those who say
it cannot be done, that is not true. I think what they are saying is that it is useless,
because it cannot be maintained. My personal experience has led me to believe that a
portion of the arch length increase can be maintained. How much, would depend on
the amount of vertical alveolar growth during the treatment period plus the retention
period, during which time the molar teeth are still uprighting. Don't forget that the
molars are still erupting as part of the normal vertical development, but in a distal
direction. Therefore, as they upright by the crowns moving forward, in my opinion
there would remain a net distal position of such teeth in the arch. This has been my
personal clinical experience. I have treated crowded cases in this manner and watched
an increasing amount of space develop in the arch during the uprighting of the molars.
In the many seminars I have given over the years, I have always stated that I may be
entirely wrong. This is based on my reasoning and experience, and I offer the matter
as a good research project. By the way, I usually allow about 1mm of permanent
arch length increase on a growing individual, which certainly increases my percentage
of nonextraction treatment. For those who disagree with me, I have no objections, but
rather the following advice. If you don't feel the same way, don't credit yourself with
an arch length increase. That's a pretty simple decision, isn't it? As for adults, I allow
for no increase in my treatment planning, as all space gained by distalization will be
lost. There is not the vertical growth I feel necessary to make the change permanent.
However, I don't see how anyone can dispute an arch length increase to the extent that
the molars require uprighting from a tipped forward position, as so often seen in Class
II malocclusions and malocclusions with missing first molars, particularly the adults.
But again, I don't normally use the tipback bend for distalization as a primary
objective. I simply welcome it, like dessert that comes with the main meal. I would
assume that everyone understands we are only talking about tipping movements. As
for the part of the question pertaining to an increase in vertical dimension, the
temporary cuspal interference during distalization gives the clinical impression of
"bite opening", but this is not a correct interpretation. Force control with the "Diving
Board" concept prevents eruption of molars and any increase in vertical dimension.
Cuspal interference may temporarily hold the vertical open, but not due to
overeruption of teeth. Frankly, I don't like to see a molar tipped back any more than
anyone else, but I have learned to appreciate the advantages and know with confidence
it will level beautifully, even without a mechanical attempt to do so. I have yet to see
in my 18 years of orthodontic practice, a single case where the molars have not
uprighted. Please understand that I would not apply such a statement to those who are
using heavy forces and literally "lifting" the molars right out of their sockets, and even
impacting second molars in the process.
80

Q
Does the erupted position of the second molar influence timing and what
happens with a molar tipback?
A
I disregard the position of the second molars and am willing to start a case
regardless of its occlusal level. If a tipback is applied properly force control an
unerupted second molar can literally be tipped back right into the ramus. This is
because the light eruptive forces are overcome by the forces of occlusion, leaving only
the moment on each molar. In effect, we have produced a couple, or pure rotation.
This is unlike the heavy force, which translates the tooth vertically and then tips the
first molar right over the second molar crown, resulting in an impaction.
Q
Is the action of the tipback the same on lower molars as on upper molars?
A
The force system is the same. The considerations are different. How far back are
you willing to tip a lower second molar as compared to an upper second molar? Also,
if the lower archwire is tied back, the lower incisors meet no opposition, while in the
case of the uppers, if the archwire is tied back in a deep overbite case, the maxillary
incisor segment will collide with the lower incisor segment, resulting in mesial root
movement of the maxillary molars instead of distal crown movement, and even
collapse of a good mandibular incisor segment at times may result. Adjustment can be
made in the archwire for these problems. It really boils down to "common sense".
Q
How much does the force of occlusion inhibit molar extrusion? Can it be
counted on?
A
It's a matter of how this force relates to the extrusive forces produced by the
archwire. This has been discussed in detail in the series. Force control can be derived
by applying the "Diving Board" concept and is dependable. The molars will, of course,
erupt to the extent of vertical growth just as they would without treatment. In the
nongrower, there will be no supraeruption with force control.
Q
Does the force of occlusion control molar crown torque as well as extrusion?
A
No. Extrusion can be nicely controlled, but the resulting lingual crown torque
will be affected not only by the forces of occlusion, but also by cusp height, function,
and duration. The best procedure, I feel, is to always recognize the presence of the
moment and realize its potential for action. In other words, be ready for appropriate
action if necessary. Do not assume such responses will not occur, because I can assure
you they will.
Q
If a tipback bend is not tied in, does this result in less torque action on anteriors
and molars than if it were tied in?
A
If not tied in, there is no "tug of war" between the anterior and posterior teeth.
The anterior segment and posterior segments are therefore free to behave as
independent systems, each responding according to their forces and moments, and the
response is usually more rapid.

81

Q
Do you make any adjusting bends to control molars and incisors for rotation
and flaring in a 24 setup?
A
Yes, in anticipation of undesirable movement and following undesirable
response. These bends have already been discussed. For example, toe-in bends are
placed immediately in extraction cases, to prevent the anticipated mesiolingual
rotation of the molars that would occur as a result of the mesial force at the molar
buccal tubes during space closure.
Q
Do you have any simple way of measuring or judging tipback and torque bends
to adjust them to the needs of the case?
A
As a matter of simplicity and readability, I like to use a Tweed Loop Pliers
intraorally, as it will produce a constant unit of deflection in the archwire. This happen
to be around 45 or so, but the exact angle is not important. It simply means I can bend
the wire anytime and anywhere and know what I have done to the wire. I only do this
with lighter wires and not rectangular wires.
Q
Does tying a tipback bend into a full strapup confine the action to the molar and
second bicuspid? What happens, force- and moment-wise?
A
From a practical standpoint, because the second bicuspid is included, the bend
is really close to becoming a center bend and therefore will not produce the same
effect. The molar, being the terminal tooth, will tip back, but the full strapup will not
permit the desired reciprocal effects to occur directly on the anterior teeth. The effects
must be transmitted from tooth to tooth, an unrealistic approach and ineffective.
Q
Does binding increase as an off-center bend approaches a center bend? If so,
what is the effect of that?
A
I believe you are referring to retracting, for example, a cuspid along the
archwire, where the original off-center bend becomes more centered as space closure
is accomplished. The tooth that is moving along the archwire the cuspid in this
example will incur a gradually increasing moment as it approaches the bend. The
tipping action gradually reduces as a result. However, during the tipping stage, binding
will occur, but presents no problem, because the moment continues to take place
causing distal root movement. Then, as distal root movement occurs, the binding is
relieved and further retraction occurs. When the space is closed and the bend centered,
there is no binding as no teeth are moving along the archwire. Only root paralleling
occurs, due to the equal and opposite moments now present.
Q
In a 24, does tying rotations on distals of laterals tend to flare molars buccally?
If so, how do you compensate and how much?
A
In theory "yes", but from a practical standpoint the answer would be "no" most
of the time. This should not be a problem, as I no longer see any need in orthodontics
to utilize the archwire for such rotations. Elastics are simple, more effective, and allow
the use of the "Cue Ball" concept. Also, reciprocal teeth can be selected.

82

Q
What system would you get from a tipback on molars and lingual root torque on
anteriors, say in a division 2?
A
If you are referring, not to a full strap up, but only to anterior and posterior
segments, it will depend on the angular relationship produced relative to the plane of
the archwire as it is activated. A tipback bend produces a high anterior arm. Lingual
root torque produces a high posterior arm. This has been illustrated in the series. If
equal activation is applied, the angles will be equal and there will only be equal and
opposite moments present. If the tipback produces a higher angle, anterior intrusive
forces and posterior extrusive forces will develop, while the opposite will occur if the
angle produced by the lingual root torque is greater.
Q
Do you let the moments inherent in the malocclusion work their way out on a
straight or braided archwire before using a tipback?
A
Yes. I obtain bracket level regardless of the force systems of my own choosing.
There are times, however, when it would not be wise to follow such an approach.
Q
A

Do you align before introducing other forces?

Yes, as previously stated with few exceptions.

Q
How many movements do you try to accomplish at one time overbite,
rotation, intrusion, extrusion, torque, space closure, retraction, protraction? Do you
have a sequence of correction for these movements?
A
As many as possible following bracket alignment. However, I only use a single
tube on lower molars and a double tube on upper molars, so this by its very nature
forces me not to try too many movements at one time. The reason I have not chosen to
use auxiliary tubes, at least up until now, is that keeping the appliance simple allows
"reading" it more effectively in terms of the net forces and moments that are being
produced. Basically, my sequence does not involve a series of steps, but rather
attacking the most difficult and timeconsuming movements in order. Generally, this
means taking care of vertical problems first and then the horizontal problems. When I
am dealing, then, with a specific plane of space, I can select any type of movement
that suits the appointment schedule. If I am behind schedule, I can choose to do
something like an intraoral activation, but if there is additional time available for some
reason, I can go to a bonding or whatever I choose all at no sacrifice of progress to
the patient. I never criticize a "cookbook" formula for the other person only for
myself as I enjoy the flexibility of choice.
Q
How much of the basic mechanics is left when the cuspids and bicuspids are
banded?
A
Banding cuspids and bicuspids does not imply that a sacrifice is being made in
terms of good mechanics. I certainly hope I haven't made myself sound critical of full
banding from a qualitative standpoint. What I really am trying to say that is knowledge
of mechanics permits selectivity. When we band all teeth, we usually do so because we
83

plan on placing a continuous archwire tied into all of the brackets. This eliminates
application of the "Diving Board" concept in keeping forces light unless, of course
we bypass cuspids and bicuspids by stepping the wire gingivally to the brackets.
Automatic full banding also frequently eliminates the use and advantages of
differential torque. We must accept all the forces and moments produced and often go
to extraoral help to overcome those we don't like. For example, during overbite
correction it has been shown that a reverse curve of Spee causes incisor flaring. If we
don't want flaring, we can avoid it by not banding all the teeth and using differential
torque during incisor intrusion.
Q
A toe-in bend to counter molar rotation also puts in a strong outward force. Is
the outward movement more pronounced than the counterrotation? How strong an inbend would be indicated? And what, if any, are the side effects of placing exaggerated
contraction or expansion bends in the molar region to limit buccal or lingual
movement of molars?
A
The buccal or outward force is not really what you would necessarily consider
strong. Remember that to produce this force in combination with the moment, an offcenter bend is required. Therefore, we are referring to those situations where the
second bicuspids are not involved with the archwire. The added wire length minimizes
the force by the formula discussed earlier regarding the effects of wire length on
stiffness or load/deflection rate. A heavier wire is often required, if it is desirable to
produce buccal movement from this system. Exaggerated contraction or expansion
bends can help to limit buccal or lingual movement of molars, but to eliminate the
guesswork, the same degree of toe-in or toe-out should be placed distal to the cuspids
as is placed at the molars. The forces then produced can complement each other or
cancel each other, depending on the desires of the operator.
Q
You say that prolonged lingual root torque can cause a recurrence of Class II. Is
that also true in a full strapup?
A
Yes, assuming that opposite torque is not being applied at the other end of the
archwire, such as occurs in a reverse curve of Spee, where there is anterior lingual root
torque at one end and molar root torque at the other end of the archwire.
Q
How about sectionals for retracting cuspids in extraction cases?
A
I prefer segmented tooth movement using a continuous arch for reasons of
control. However, it is a matter of choice. It is not my position to tell someone else
what to use. I like continuous arches, but not in the conventional sense, whereby all
teeth are included. The advantages of sectional arch treatment can be applied using a
continuous arch.
Q
Are your mechanics different for high angle versus low angle cases?
A
No, not from an appliance standpoint only from the standpoint of applying
the principles we have already discussed. I use the "Diving Board" concept for control
84

of vertical forces and thus do not use high pull headgear. It is my objective to prevent
posterior teeth from erupting not to necessarily intrude them, although posterior
intrusion will occur in certain situations as already mentioned.
Q
Do you relate upper incisor position to lip line re gummy smiles? Do you use
headgear on these from the start? High pull? Directly on anteriors?
A
Yes. Headgear is not my primary consideration. What I feel most important is to
decide which teeth to intrude maxillary incisors, mandibular incisors, or both. If we
are dealing with a gummy smile, it doesn't make sense to me to intrude the lower
incisors, thereby reducing the amount of intrusion we are able to produce in the upper
incisor area. I would rather leave a curve of Spee in the lower arch and gain most of
the overbite correction by intrusion in the maxillary arch.
Q
Why do you use twin brackets in preference to single brackets? Why not even
use a Begg bracket or a combination bracket? Would a Universal bracket give more
sophistication to a simple force system?
A
I am acquainted with the pros and cons of the various brackets, but in the final
analysis, I have chosen to use twin brackets knowing the theoretical advantages I have
sacrificed by not using other brackets. I feel I have regained those so called lost
advantages in so many other ways that, for me as an individual, I see no advantages in
going to other brackets. As I always say, let each man use what works best for him.
The choice is not always based on academic advantages and disadvantages.
Q
Doesn't tying into twin brackets on the four incisors create binding and
anchorage on the anteriors, and exagerate the action on the molars; and negate the
location of the bend supposedly determining the anchorage side?
A
It is true that tying the wire into the anterior brackets introduces additional
moments at the brackets, but as a practical matter, the force system still results in
anterior intrusion and differential torque. If it is desired to be "ideal", the archwire
does not have to be tied into the brackets. Instead, a segment can be placed in the
incisor brackets and overlayed with the intrusive archwire, as has been shown in this
series.
Q
Isn't rectangular wire more efficient for torque? What, if any, are the side
effects of using auxiliaries for torque? For uprighting?
A
No, not for torque but it does produce control of the reciprocally involved
teeth, if it is desirable to stabilize them. Torque is a product of force and distance and
doesn't care about the kind of archwire. With round wire and auxiliaries, posterior arch
width can be dramatically increased during lingual root torque, as many have
experienced. This may be bad, but likewise it may be good. When the decision is made
to produce torque, I think the choice of round wire versus rectangular wire should be
considered in each situation. It will be discovered that the so-called undesirable side
effects of round wire or root torquing auxiliaries will, in fact, be helpful in many
cases.
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Q
Doesn't the added wire from loops aid in decreasing force and increasing range
of action?
A
Certainly. That is why they are used. Loops also produce many disadvantages. I
think the days are over for using loops for these reasons. There are too many simple
and efficient ways to accomplish the same thing, today, with loop-free arches and the
use of elastics.
Q
Do you use Nitinol wire? How does Nitinol wire change some of the ideas you
present?
A
I don't use Nitinol Wire, but I don't see why it would conflict with any of the
principles discussed.
Q
How much expansion in molars, bis, cuspids, and incisors do you consider
acceptable? How much relapse do you expect?
A
The answer to this question would be far too long and prejudicial on my part.
Suffice it to say that applying the principles brought forth in this series does not allow
anyone or any appliance to violate any inherent laws of stability or equilibrium.
Q
How much relapse occurs after the various mechanics distalization,
intrusion, extrusion, tipping, torquing, space, closure, expansion?
A
The answer to this is entirely dependent on whether the environment and the
laws of equilibrium have been violated, the amount of tooth movement produced, etc.
Applying biomechanical principles with efficient appliance design does not allow for
greater permanent expansion or less relapse than would occur with any other
appliance, assuming we are referring to the movement of teeth within bone, and not
orthopedics.
Q
Do you believe in overcorrection? Is it a problem to make specific
overcorrections?
A
Yes, but I do not always practice what I preach. Overcorrection of rotations is
simple, because I use elastics for overrotation and not the archwire. I would say the
most difficult overcorrection I encounter is with open bites and Class II malocclusions.
The Class II overcorrection is only a problem when the uncooperative patient is part of
the picture, as in headgear nonextraction treatment. We all know what a fight it often
is just to correct the Class II in the first place with individuals who are not readily
willing to wear headgear as instructed.
Q
Do you experience crowding in lower anteriors following one-arch treatment of
the upper arch?
A
No, not beyond the degree of crowding that tends to occur in later years in the
untreated general population. However, I have caused lower anterior crowding to
occur during treatment in an unbanded lower arch, when I failed to provide relief for

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the upper incisor segment as these teeth were being intruded and retracted with the
large molar moment from the tipback bend.
Q
Please explain Figure 101 some more.
A
Figure 101 simply points out that it takes certain forces to engage an archwire
into a bracket. This determines the force system on the teeth, since the teeth begin to
move as the archwire undergoes deactivation. If all four forces of activation are equal,
such as with a center bend, only equal and opposite moments result. Figure 101 shows
that if the activational forces were equal, the three requirements for static equilibrium
are not met. When the proper forces are determined, we find they are unequal at each
bracket, thereby producing an entirely different force system than was witnessed with
the center bend. In other words, we should realize that the multitude of wire/bracket
relationships that exist in the malocclusions we treat result in a multitude of force
systems. An understanding is necessary, if we are to derive any sense of order.
Q
Do you recommend removing the archwire the first few times one tries intraoral
bends?
A
Yes. Simply to gain the confidence that what you think you put into the
archwire is what you put into the archwire. Sometimes, a better pliers is needed for
intraoral activation.
Q
Early treatment prolongs overall treatment. Isn't this a problem for treatment
and administrative management?
A
Not in my opinion, if it is handled properly. I have been down both roads. I feel
strongly in treating the patient when I can utilize growth, cooperation, conservative
therapy, patient acceptance, and prevention of already existing problems, etc. When I
first got out of school, I was interested in how quickly I could treat a case. I am past
that stage and more happy for it. I like to tell parents, in certain cases, that only two
years of effort will be required, but over a three-year period in order for the patient
to derive the benefits of growth, psychological acceptance, etc. For many
orthodontists, this might be a management problem, but I feel most orthodontists do
not recognize the need to understand "human engineering and, motivation" and, as a
result, spend many of their practicing years on the defensive. I am very involved
outside of the orthodontic profession and delight in taking many nonorthodontic
courses. Personally, I love people and enjoy those aspects of an orthodontic practice
that many men wish never existed. I am thoroughly convinced that if orthodontists
knew how to convert negatives to positives and overcome objections, they would
discover that the practice of orthodontics is just a whole lot more exciting than ever
imagined.
I would like to add just a few closing remarks to this series. A few years ago, I
had the privilege of taking a two day seminar given by Cavett Robert, one of the
country's greatest human engineers. He was a real inspiration to me and resulted in
many changes in my life that have directly affected my practice. I have always been
brought up to believe that God never created a man without some kind of talent. I have
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also been taught the tragedies man inflicts upon himself, when he does not take the
time to discover and apply these talents. Cavett best said it for me when he said, "We
are all born with music. Unfortunately, some of us never discover what that music is,
while others discover it but fail to share it". But the final remark was one I will always
remember, because it is directly responsible for my decision to finally get going with
this series as well as a number of other projects. He said, "I can think of no greater
tragedy in life than for man to take his music to the grave". I would like to thank you
for this opportunity to leave some of my music to the profession if that is what it
might be.
(And, I would like to thank Dr. Mulligan on behalf of JCO and its readers for making
this truly monumental contribution to understanding orthodontic force systems. ELG)

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