Professional Documents
Culture Documents
t the start of canine retraction mechanics, point is to follow a curvilinear path, but the
A significant space exists distal to the canine; initial conditions imposed enable the reasonably
perhaps the first premolar has been extracted. valid use of a two-dimensional model to analyze
Initially, here, the canine is assumed to be ide- the biomechanics. The appliance c o m p o n e n t
ally oriented; that is, the tooth is not impacted, it providing the distal driving force is to be a
is not tipped or rotated, and its root is not spring or an elastomeric element (eg, the latter
against the facial or lingual cortical plate. In this a module, chain, o-ring, or tied thread). This
instance, the chosen appliance mechanics in- assumption is made simply to imply that the
clude dividing the total distal driving force be- driving force magnitude, while the c o m p o n e n t
tween the facial and lingual crown surfaces to is in place, will decrease--as typically occurs in
eliminate the possibility of significant long-axis the clinical setting--with distal m o v e m e n t of the
rotation of the canine during displacement. canine crown center relative to a posterior den-
From an occlusal perspective, because of the tal unit. A continuous arch wire engages crown
curvature of the dental arch, the crown center
attachments affixed to the facial surfaces of the
teeth. In particular, the wire within an orthodon-
tic bracket attached to the canine crown and
From the Graduate Program in Orthodontics, Centerfor Ad-
vanced Dental Education, Saint Louis University, St. Louis, MO. supported at neighboring posterior and perhaps
Address correspondence to Robert J. Nikolai, PhD, Graduate anterior dental sites is intended to guide the
Program in Orthodontics, Centerfor Advanced Dental Education, tooth during its distal displacement.
Saint Louis University, 2075 Dreiling-MarshaU Hall, 3320 Rutger O r t h o d o n t i c tooth m o v e m e n t occurs as a re-
Street, St. Louis, MO 63104.
Copyright 2001 by W.B. Saunders Company
sult of mechanical force exerted on the crown
1073-8746/01/0703-0006535.00/0 and maintained there over some finite period
doi:l O.1053/sodo. 2001.26693 o f time. This force is transmitted internally
t h r o u g h tile tooth, delivered by the root(s) to displacement potential would be the same,
the periodontium, and r e m o d e l i n g results f r o m whether delivered adjacent to the facial or to the
the superposition of that force (carried into the lingual surface of the crown. Consider a right
ligament and underlying bone) on the ongoing maxillary canine viewed f r o m the facial perspec-
physiologic processes there. Substantial evi- tive. T h e general, crown-delivered force system
dence exists to relate two of three characteristics consists of a distally directed, concentrated
of crown-delivered force and the displacement force, having a clockwise mechanical m o m e n t
f o r m a t of the tooth. More than 30 years ago, a b o u t the center of resistance of the canine, and
Merrifield and Cross 1 emphasized the relation- a mechanical couple with an i n h e r e n t counter-
ship of concentrated force direction to the de- clockwise m o m e n t viewed f r o m the facial per-
sired displacement. T h e i m p o r t a n c e of the loca- spective. Because the mechanical m o m e n t of the
tion of the line of the force to the resulting driving force represents a tendency for distal
displacement is implied by the wide acceptance crown tipping, the m o m e n t of the couple, hav-
of the concept of the center of resistance of a ing the opposite sense, is typically described as
tooth, z O r t h o d o n t i c researchers, though, have countertipping.
b e e n engaged in a long-term inquiry toward un- The p r o b l e m at h a n d is biomechanical, but
derstanding the relationship of delivered force the basic laws of Newtonian mechanics apply to
magnitude, that magnitude as some function of the essentially n o n d e f o r m a h l e canine. For this
time, and the resulting displacement rate. Rela- part of the analysis, consider the tooth as iso-
tively few controlled clinical studies of tooth lated f r o m b o t h the appliance and the periodon-
m o v e m e n t in h u m a n s have b e e n r e p o r t e d in the tium. T h e mechanical action is delivered to the
literature, 3-s and the outcomes have b e e n gener- crown (by the appliance) and consists of a force
ally inconclusive toward establishment of an ac- and a couple. To partially characterize the an-
ceptable m o d e l (that would include force mag- ticipated displacement, a mechanically equiva-
nitudes) beyond the three-stage framework lent action, referenced to the center of resis-
p r o p o s e d by Reitan. 9 In recent years, m u c h of tance (cre), may be determined. T h a t equivalent
the tooth m o v e m e n t research has b e e n con- action generally consists of a force at the cre, the
ducted on the cellular level, and these studies force having the same magnitude and distal di-
have primarily c o n c e n t r a t e d on e n h a n c e m e n t s rection as the dri~dng force, and a couple that in
to displacement rate and the widespead concern part compensates for the change in rotational
for root resorption. 1-14 potential associated with relocating the force.
The activated orthodontic appliance will gen- The equivalent action could be a force alone or
erally make a two-part mechanical delivery to the a couple alone, though, d e p e n d i n g on the given
canine crown. A resultant, distally directed force couple-force ratio at the crown center level, the
will be exerted at the occlusoapical level of the force direction r e f e r e n c e d to that of the long
crown center. T h e appliance c o m p o n e n t ( s ) gen- axis of the canine, and the occlusoapical dis-
erating this force will, individually, be oriented tance f r o m the crown center point to the center
and activated mesiodistally to achieve the de- of resistance. This equivalent action is obtained
sired force direction. T h e arch wire assumedly because the direction of the force c o m p o n e n t
engages a canine edgewise bracket. If and when will be the direction of the displacement of the
this wire fully contacts the edgewise slot, that cre and the plane, and the sense of the couple
contact will be split between diagonally opposite will predict the direction of the rotation of the
slot edges, p r o d u c i n g two-point contact f r o m a tooth as a wholeY
facial perspective, and the wire will exert a pair A mechanical response to the crown action
of parallel, equal in magnitude, noncollinear is exerted on the tooth root (by the perio-
forces to f o r m a mechanical couple. (The two dontium). During active orthodontic treatment,
forces will be of the same m a g n i t u d e if the wire, because the tooth moves so slowly, its inertia is
because of its occlusoapical location and that of negligible. As a result, the mechanical response
the bracket, generates no net potential to ex- against the root is almost exactly equal in mag-
trude or intrude the tooth.) The couple will be nitude, but opposite in direction/sense, to the
in the faciolingual plane; the direction of its action f r o m the appliance. This response is ac-
184 RobertJ. Nikolai
Force-Displacement Relationships
T h e retraction process as envisioned begins with
d o the canine in ideal orientation. If the canine
bracket is conventional (ie, not preangulated)
and properly positioned on the facial surface,
Fp a n d if no occlusogingival bends are placed in the
Cp arch wire, before the distal driving force is acti-
vated the engaged wire exerts no force on the
bracket slot. If, in addition, some occlusogingi-
val clearance between slot and wire exists, at
a activation and for some time period thereafter,
no slot-wire contact will be present. Figure 1
depicts a right maxillary canine at activation and
before any displacement has occurred. Orthog-
onal distal (d) and occlusal (o) dental reference-
frame axes are indicated. With no wire-slot con-
tact, the distal driving force (magnitude Fa;
Figure 1. Canine in the ideal start position at the
instant the distal driving force (Fa) is delivered. The where a indicates from the auxiliau) is the sole
resultant response in the form of a force (Fp) and a action c o m p o n e n t . T h e resultant of the distrib-
couple (Cp) is referenced to the center of resistance uted response f r o m the p e r i o d o n t i u m (thus, the
of the tooth. subscripts p) may be expressed as the force-
couple pair shown, referenced to the center of
resistance. (The weight of the tooth is reason-
tually distributed over m u c h of the root sur-
ably assumed to be comparatively negligible; lig-
f a c e - t h a t which is contacting the periodontal
ament-fiber tensions, primarily n e a r the root
ligament and the free gingiva, but it is mechan-
apex, negate the small tendency for extrusion.)
ically equivalent for the p r o b l e m at h a n d of a
In the absence of occlusion, the driving force is
single force and a couple that may be referenced
the only significant action, and the response all
to the canine's center of resistance. (In general,
but offsets or balances that action. T h e transla-
inertia has two c o m p o n e n t s , one translational
and the other rotational. In the absence of sig-
nificant inertia, the action a n d responsive force
systems virtually balance one another. If b o t h d
force systems are r e f e r e n c e d to the cre of the
canine, then essentially the paired c o m p a r a b l e
c o m p o n e n t s are mechanical opposites of one 0
another.) Accordingly, characteristics of the ex- Fp
pected displacement of the canine, indicated
Cp
earlier, may be related to the opposites of the
associated characteristics of the responsive force
system. Also relevant h e r e is the application of
the general action-reaction law of mechanics at
the contacting interface of the root and peri- Cw
odontium. T h e p e r i o d o n t i u m with its response
against the root attempts to prevent tooth move-
ment. Also existing is an equal and opposite
distributed force system exerted by the root on
/
the p e r i o d o n t i u m , a n d it is this force system
Figure 2. Canine at a later point in time after tipping
that, when m a i n t a i n e d over time, catalyzes peri- has caused the initial clearance between the arch wire
odontal r e m o d e l i n g that permits orthodontic and bracket-slot to disappear. Wire-slot contact pro-
tooth m o v e m e n t . duces the counter-tipping couple (Cw).
Canine-Retraction Biomechanics 185
tional potential of F~ is nearly negated by Fp, and sire c o m p o n e n t s with the direction and sense
its rotational potential (the m o m e n t of F a a b o u t shown indicate that distal crown tipping should
the cre) is o p p o s e d by the resultant couple Cp. (still) be the displacement format, though the
From previous c o m m e n t s regarding mechanics cro has now progressed apically (or is apical) of
analysis, partial displacement predictions origi- the known simple-tipping location for a single
nate with the cited responsive components. T h e rooted tooth. (With regard to m a g n i t u d e associ-
cre will move distally (opposite in direction to ations, for each sketch two i n d e p e n d e n t rela-
that of Fp), and the tooth will rotate clockwise tionships exist. O n e relationship says that the
(opposite in sense to that of Cp) a b o u t a facio- two force magnitudes must be virtually equal,
lingual axis. This c o m b i n a t i o n suggests a center and the o t h e r that the m o m e n t s of the active
of rotation (cro) located apical of the cre and a and responsive forces and couples a b o u t the cre
distal crown tipping overall f o r m a t as the retrac- must virtually balance because the translational
tion-displacement begins. and rotational inertias, respectively, of the ca-
Figure 1 is the first of four sketches of the nine are negligible. To estimate all c o m p o n e n t
canine to a u g m e n t explanations of the mechan- magnitudes at an instant of time, then, one or
ics. Each figure represents an instant of time two of the three or four magnitudes must be
during the retraction process. T h e force system measurable at that timepoint.)
shown is exerted on (not by) the canine; accord- T h e m a g n i t u d e of C w is, principally, directly
ingly, the symbols for the delivered force and the related to the local b e n d i n g of the guiding arch
couple partially represent their displacement wire at the canine bracket site. The size of C w is
potentials. Because a mechanical couple can by also, to a m u c h lesser extent in context, associ-
itself only p r o d u c e rotation, the curved arrow ated with the location of the canine bracket
notation that defines a plane and a sense is relative to support sites mesial and distal to it. 15
appropriate. To clarify, two action systems exist This b e n d i n g is a localized rotation of the wire in
in this problem: (1) the force system delivered the faciolingual plane; this rotation is the differ-
by the appliance to the tooth crown; and (2) the ence between the a m o u n t of tipping and the
force-system exerted by the tooth root on the initial occlusogingival/rotational clearance, if
periodontium. The second results f r o m and is any. With a p r e a n g u l a t e d bracket slot, the initial
the mechanical equivalent of the first. T h e latter clearance is likely zero with some local second-
is the action-reaction c o u n t e r p a r t of the respon- o r d e r rotation required to engage the wire in
sive force system shown in the sketch. the slot. If this is the case, C w exists f r o m the start
In Figure 2, the canine is shown slightly of the retraction process. Also note that, as Cw
tipped such that the a f o r e m e n t i o n e d clearance appears, some frictional resistance to these slid-
has b e e n eliminated. Arch wire-slot contact ing mechanics arises, but is assumed to be small.
now exists, and the countertipping couple (Cw; The instantaneous m a g n i t u d e of F a then be-
where w denotes wire) has appeared. This sketch comes the difference between the size of the
depicts the canine somewhat later in time, rela- force originating with the auxiliary and the mag-
tive to Figure 1. Alternatively, if the long axis was nitude of the opposing frictional force. Without
parallel to the occlusoapical axis, the mechanics invalidating the current model, frictional resis-
immediately after activation with the guiding tance is h e r e assumed to be a relatively small
arch wire engaged in a p r e a n g u l a t e d bracket slot perturbation on the auxiliary-force magnitude. 1G
would be shown. In these sketches of the isolated At some point in time after initial activation,
canine, the relative length of the force symbol r e m o d e l i n g of the p e r i o d o n t i u m begins to con-
and the d i a m e t e r of the couple symbol are in- tribute to the displacement prediction. In addi-
dicative of relative magnitudes. With reference tion, in time the distal driving force c o m p o n e n t
to Figure 1 then, in Figure 9 the driving force of the appliance mechanics may be replaced
c o m p o n e n t has deactivated slightly, Fp has be- a n d / o r reactivated. For now, discussion of these
c o m e smaller, and the a p p e a r a n c e of Cw--simi- contributions is deferred. T h e assumption is
lar to Gp also c o u n t e r c l o c k w i s e - - h a s contrib- temporarily m a d e that (1) the appliance compo-
uted to a lessened responsive couple. T h e n e n t that activates the mechanics is left in place
continued (or initial) existence of both respon- for a between-appointments period of perhaps
186 Robert J. Nikolai
senting frictional resistance within the sliding tipping has eliminated the initial clearance,
mechanics as negligible, 16 but the m o d e l argu- the displacement f o r m a t continues as distal
ably does not invalidate its reasonable applica- crown tipping. Flexibility of the guiding arch
bility within the clinical setting. The intent was wire, e n h a n c e d in particular by characteristic
also to present a p r o c e d u r e by which the dy- lengths mesial and distal to the canine
namic process of tooth m o v e m e n t may be exam- bracket, enable the driving force to domi-
ined by partitioning it, considering a sequence nate, and tipping continues (occurs) because
of views of the force systems at notable time of local (elastic) wire b e n d i n g at the canine
points, and extrapolating forward f r o m one bracket site.
characteristic state to the next. T h e laws/princi- 3. Decrease in the driving force magnitude be-
ples of mechanics, appropriately applied, serve cause of distal displacement of the canine's
to help describe the overall displacement in crown center and increase in the countertip-
steps. T h e matter of displacement rate, associ- ping couple m a g n i t u d e directly related to
ated with the m a g n i t u d e of appliance-delivered long-axis angulation can cause the crown me-
force as a function of time and the biomechani- chanics to reach a state for which the mo-
cal response in the individual patient, is not part ments offset one a n o t h e r and the displace-
of the present discussion. m e n t f o r m a t m o m e n t a r i l y becomes bodily
Distal displacement of the canine is consid- movement.
ered as two or three subprocesses, the begin- 4. With the countertipping couple magnitude
nings and ends of which are defined by three or maintained by the angulation of the canine,
four instantaneous views of the mechanics. Seg- further d e g e n e r a t i o n of the driving force
ments of the displacement within the subpro- m a g n i t u d e would transform the displace-
cesses are predicted f r o m the mechanically m e n t f o r m a t toward that of second-order
equivalent actions at their starts, referenced to torquing.
the canine's center of resistance, argued as also 5. R e m o d e l i n g of the p e r i o d o n t i u m reduces the
essentially equal to the cre referenced results o f capability of the countertipping couple to de-
the distributed forces exerted by the root on the crease in m a g n i t u d e when, for example, the
periodontium. A single activation and an elastic distal driving force c o m p o n e n t is disengaged
or viscoelastic periodontal response are initially before r e p l a c e m e n t or reactivation.
assumed; subsequently the likely occurrences of 6. T h e four sketches r e p r e s e n t the mechanics of
disengagements and reactivations and the effect the retraction process at subsequent points in
of periodontal r e m o d e l i n g are a d d e d to the time, assuming that the distal driving compo-
m o d e l analysis. n e n t remains in place to the state o f Figure 4
With respect to the dental reference f r a m e and perhaps beyond. D i s e n g a g e m e n t of this
and with the initial position and orientation of c o m p o n e n t at some timepoint to reactivate
the canine, the idealized intent is that the net or replace it effectively takes the shown pro-
displacement of the canine be distal bodily gression of tooth m o v e m e n t backward slightly
m o v e m e n t (translation). Modeling eliminates in relative time, and the displacement restarts
the tendency for long-axis rotation to be a con- with reactivation.
voluting part of the displacement, and such po-
tential may be substantially r e d u c e d by using T h e following conclusion can be drawn. Even
driving force sites adjacent to the facial and though late in the sequence of subprocesses the
lingual crown surfaces. Subsequent to the fore- displacement f o r m a t can b e c o m e that tending
going analysis, the following summarizing state- toward root m o v e m e n t , a net bodily m o v e m e n t
ments may be made: displacement is impossible practically with the
chosen appliance mechanics. T h e driving force
1. T h e displacement begins as simple distal must d o m i n a t e to displace the center of resis-
crown tipping if any occlusogingival clear- tance of the canine distally. T h e greater the
ance initially exists between wire and bracket b e n d i n g stiffness of the guiding arch wire,
slot. the m o r e upright it will keep the tooth during
2. If no clearance exists at the start or after some the displacement. Increasing the wire stiffness
Canine-Retraction Biomechanics 189
has the effect of decreasing the magnitude of tip unduly deteriorate, lest Cw dominate and the
together with the time period between Figure 1 crown center reverse its displacement direction.
(or 2) and Figure 4, but the overriding factor is If the force is derived from a spring, the spring
different origins of the crown force (Fa) and should have a low stiffness so that its action is
couple (Cw). A first displacement objective continuous. If the force is obtained from an
would be to achieve the desired crown center elastomeric c o m p o n e n t , because of relaxation
location. Seemingly, the best ending for the pro- potential the c o m p o n e n t should be replaced
cess would be with the net F a b e c o m i n g near periodically--in the case of o-ring use with a
zero, with the couple still existing because of cooperative patient, every day. Without ques-
some, however small, long-axis angulation. The tion, advantage should be taken of the opportu-
process would then finish with the center of nity to replace or reactivate the distal driving
rotation at or near the cre, and the crown center c o m p o n e n t at each appointment. Also, perhaps
moving mesially, defeating the first objective. the initial magnitude of distal driving force
The appliance delivering force to the canine should be increased somewhat at the second
crown, in the problem m o d e l e d into two dimen- retraction process a p p o i n t m e n t with the aim to
sions, consists of two principal deformable com- enhance the displacement rate after the peri-
ponents. The driving force c o m p o n e n t and the o d o n t i u m has b e c o m e accustomed to the inva-
guiding arch wire act independently of one sive effect of the superimposed mechanical
another. Assumedly, from the time of the first force.
two-point, wire-slot contact, the countertipping The suggestions in the previous paragraph
couple exists continuously until the entire re- are just that, proposed e n h a n c e m e n t s to the
traction process has been completed, despite clinical regimen that emerge from a detailed,
several potential intermediate patient appoint- hypothetical examination in this article of the
ments. The direct relationship between couple orthodontic mechanics of canine retraction on
magnitude and long-axis angulation depends a guiding arch wire. These suggestions may be
primarily on the second-order rotational bend- controversial to some, and they might preface a
ing stiffness of the arch wire at the bracket site. proposal for hypothesis testing within a n e e d e d
Absolute magnitudes of force system compo- extensive, in vivo study of the process.
nents are not part of the current discussion, n o r
is the factor of wire-slot frictional resistance
(which may or may not be a significant influence References
on the delivered net distal driving force), so no l. Merrifield LL, CrossJJ. Directional forces. AmJ Orthod
c o m m e n t regarding selection of guiding arch 1970;57:435-464.
2. Smith RJ, Burstone CJ. Mechanics of tooth movement.
wire or canine bracket is appropriate here. AmJ Orthod 1984;85:294-307.
Despite the fact that the c o m p o n e n t s exerting 3. Andreasen G, Johnson P. Experimental findings on
the distal driving force and the countertipping tooth movementsundcr two conditions of applied force.
couple are physically independent, to control Angle Orthod 1967;37:9-12.
4. Hixon EH, Atikan H, Callow GE, et al. Optimal force,
the character of the displacement they together
differential force, and anchorage. AmJ Orthod 1969;55:
produce, the two c o m p o n e n t s should likely be 437-457.
matched to an extent. Because the countertip- 5. Hixon EH, Aasen TO, Mango J, et al. On force and
ping couple will be continuous, an interrupted tooth movement. AmJ Orthod 1970;57:476-489.
driving force may be contraindicated; the inter- 6. Boester CH, Johnston LE. A clinical investigation of the
rupted driving action would apparently provoke concepts of differential and optimal force in canine
retraction. Angle Orthod 1974;44:113-119.
a sequence of cyclic, rotational perturbations (as 7. Andreasen GF, ZwanzigerD. A clinical evaluation of the
the Cw magnitude oscillated) on the primary differential force concept as applied to the edgewise
displacement format. The magnitude of the bracket. Am J Orthod 1980;78:2540.
countertipping couple will generally be increas- 8. KulaK, Phillips C, Gibilaro A, et al. Effectof ion implan-
ing with or maintained over time, governed by tation of TMA archwires on the rate of orthodontic
sliding space closure. Am J Orthod Dentolac Orthop
the angulation of the canine's long axis with the 1998;114:577-580.
occlusoapical reference. The magnitude of the 9. Reitan 1~ Some factors determining the evaluation of
distal driving force should not be permitted to forces in orthodontics. AmJ Orthod 1957;43:32-45.
190 Robert J. Nikolai
10. Davidovitch Z. T o o t h m o v e m e n t . Crit Rev Oral Biol Med a n d duration. A clinical a n d histological investigation in
1991;2:411-450. adolescents. Swed D e n t J 1995;105:1-45 (suppl).
11. Davidovitch A, Finkelson MD, Steigman S, et al. Electric 14. Detrich PR. Guided tissue regeneration associated with
currents, bone remodeling, a n d orthodontic tooth orthodontic therapy. Semin O r t h o d 1996;2:39-45.
m o v e m e n t lI. A m J O r t h o d 1980;77:33-47. 15. Nikolai RJ. Bioengineering Analysis of O r t h o d o n t i c Me-
12. K h a r b a n d a OP, Mohapatra PK. Role of m e s s e n g e r sys- chanics. Philadelphia, Lea & Febiger, 1985, p 250.
tem in orthodontic tooth m o v e m e n t . Indian J Dent Res 16. Braun S, Bluestein M, Moore B K et al. Friction in perspec-
1995;6:1-12. five. Am J Orthod Dentofac Orthop 1999;115:619-627.
13. Owman-Moll P. O r t h o d o n t i c tooth m o v e m e n t a n d root 17. Isaacson RJ, L i n d a u e r SJ, Davidovitch M. O n tooth
resorption with special reference to force m a g n i t u d e m o v e m e n t . Angle O r t h o d 1993;63:305-309.