Investigation of Forces and Moments during Orthodontic Tooth Intrusion Using Robot Orthodontic Measurement and Simulation System (ROSS)

The Robot Orthodontic Measurement and Simulation System (ROSS) is a novel biomechanical, dynamic, self-regulating setup for the simulation of tooth movement. The intrusion of the front teeth with forces greater than 0.5 N poses a risk for orthodontic-induced inflammatory root resorption (OIIRR). The aim was to investigate forces and moments during simulated tooth intrusion using ROSS. Five specimens of sixteen unmodified NiTi archwires and seven NiTi archwires with intrusion steps from different manufacturers (Forestadent, Ormco, Dentsply Sirona) with a 0.012″/0.014″/0.016″ wire dimension were tested. Overall, a higher wire dimension correlated with greater intrusive forces Fz (0.012″: 0.561-0.690 N; 0.014″: 0.996-1.321 N; 0.016″: 1.44-2.254 N) and protruding moments Mx (0.012″: -2.65 to -3.922 Nmm; 0.014″: -4.753 to -7.384 Nmm; 0.016″: -5.556 to -11.466 Nmm) during the simulated intrusion of a 1.6 mm-extruded upper incisor. However, the 'intrusion efficiency' parameter was greater for smaller wire dimensions. Modification with intrusion steps led to an overcompensation of the intrusion distance; however, it led to a severe increase in Fz and Mx, e.g., the Sentalloy 0.016″ medium (Dentsply Sirona) exerted 2.891 N and -19.437 Nmm. To reduce the risk for OIIRR, 0.014″ NiTi archwires can be applied for initial aligning (without vertical challenges), and intrusion steps for the vertical levelling of extruded teeth should be bent in the initial archwire, i.e., 0.012″ NiTi.

Biomechanical simulation of forces and moments of initial orthodontic tooth movement in dependence on the used archwire system by ROSS (Robot Orthodontic Measurement & Simulation System)

OBJECTIVES

Aim of this study was to determine the forces and moments during simulated initial orthodontic tooth movements using a novel biomechanical test setup.

METHODS

The test setup consisted of an industrial precision robot with a force-torque sensor, a maxillary model and a control computer and software. Forces and moments acting on the corresponding experimental tooth during the motion simulations were dynamically measured for two 0.016" NiTi round archwires (Sentalloy Light/Sentalloy Medium). Intrusive (#1), rotational (#2) and angular (#3) tooth movements were simulated by a control program based on the principle of force control and executed by the robot. The results were statistically analysed using K-S-test and Mann-Whitney U test with a significance level of α = 5%.

RESULTS

Sentalloy Medium archwires generated higher forces and moments than the Sentalloy Light archwires in all simulations. In simulation #1 the mean initial forces/moments reached 1.442 N/6.781 Nmm for the Light archwires and 1.637 N/9.609 Nmm for the Medium archwires. In movement #2 Light archwires generated mean initial forces/moments of 0.302 N/-8.271 Nmm whereas Medium archwires generated 0.432 N/-9.653 Nmm. Simulation #3 showed mean initial forces/moments of -0.122 N/8.477 Nmm from the Light archwires compared to -0.300 N/11.486 Nmm for the Medium archwires.

SIGNIFICANCE

The measured forces and moments were suitable for initial orthodontic tooth movement in simulations #2 and #3, however inadequate in simulation #1. Reduced archwire dimensions (<0.016″) should be selected for initial leveling of vertical malocclusions.

Smart Flexible 3D Sensor for Monitoring Orthodontics Forces: Prototype Design and Proof of Principle Experiment

There is a critical need for an accurate device for orthodontists to know the magnitude of forces exerted on the tooth by the orthodontic brackets. Here, we propose a new orthodontic force measurement principle to detect the deformation of the elastic semi-sphere sensor. Specifically, we aimed to detail technical issues and the feasibility of the sensor performance attached to the inner surface of the orthodontic aligner or on the tooth surface. Accurate force tracking is important for the optimal decision of aligner replacement and cost reduction. A finite element (FE) model of the semi-sphere sensor was developed, and the relationship between the force and the contact area change was investigated. The prototype was manufactured, and the force detection performance was experimentally verified. In the experiment, the semi-sphere sensor was manufactured using thermoplastic polymer, and a high-precision mold sized 3 mm in diameter. The change in the contact area in the semi-sphere sensor was captured using a portable microscope. Further development is justified, and future implementation of the proposed sensor would be an array of multiple semi-sphere sensors in different locations for directional orthodontic force detection.

A comparative study of initial changes in pulpal blood flow between conventional and self-ligating fixed orthodontic brackets during leveling and alignment stage

OBJECTIVES

To evaluate and compare the initial changes in pulpal blood flow (PBF) between conventional and self-ligating fixed orthodontic brackets during leveling and alignment stage using 0.016 × 0.022 NiTi as alignment archwire.

MATERIALS AND METHODS

Twenty-two patients (16 females and 6 males) aged 19.00 ± 2.53 years who presented with mild lower arch crowding were selected to participate in the study. A split mouth study design was applied for each patient. The intervention (self-ligating brackets) was randomly allocated to the right or left side of the patient using the permuted random block size of 2 with 1:1 allocation ratio. Two different fixed appliance brackets were used in the lower arch (self-ligating brackets on one side and conventional brackets on the other side of the same patients. Two alignment archwires; 0.016″ NiTi and 0.016 × 0.022″ NiTi were used in this study. PBF was measured for the lower right and left sides using laser Doppler flowmetry at different time intervals (20 min, 24 h, 72 h, 1 week, and 1 month) RESULTS: PBF started to decrease 20 min after insertion of both archwires using both types of brackets. Maximum decrease was reached after 72 h of archwire insertion. After 1 week of force application, PBF started to increase to restore its original values after 1 month. Differences between the 2 groups were not significant (P > 0.05).

CONCLUSIONS

In both treatment groups, PBF reduced within 48 h. PBF started to increase after 1 week until it reached its original values after 1 month. Changes in PBF at the measured time intervals in the two groups were similar.

CLINICAL RELEVANCE

The use of 0.016 × 0.022″ NiTi immediately after 0.016″ NiTi for alignment does not produce any damaging effect on the teeth.

Impact of passive self-ligation and conventional elastic ligation on orthodontic force in the simulation of a mandibular lateral incisor linguoversion

INTRODUCTION

This study compared three-dimensional forces delivered to the displaced tooth and its adjacent teeth between passive self-ligation (PSL) and conventional elastic ligation (CL) in simulation of mandibular lateral incisor linguoversions.

METHODS

A multisensor system was used to measure three-dimensional forces delivered to brackets attached to the mandibular left central incisor, lateral incisor, and canine (FDI tooth numbers 31, 32, and 33, respectively). Two ligation methods (PSL and CL), 3 nickel-titanium (0.014-inch) archwires similar to the arch form of normal occlusion, and 2 displacements (1 and 4 mm) were tested.

RESULTS

In 1-mm displacement, forces were significantly smaller in CL than in PSL at 32 in the labial direction and larger at 31 in the mesial direction for all 3 types of archwires (P <0.01 for both). For 2 of 3 archwires, forces were larger in CL than in PSL at 33 in the lingual direction (P <0.01). In 4-mm displacement, forces were significantly larger in CL than in PSL at 31 in the mesial direction and significantly smaller in CL than in PSL at 33 in the distal direction for all 3 archwires (P <0.05 and P <0.01, respectively). Mean forces in the vertical direction were small, ranging from -0.05 to 0.05 N.

CONCLUSIONS

Under a small amount of displacement, force magnitude in PSL was smaller than that in CL at the displaced tooth in labial-lingual directions. Under a large amount of displacement, a more "open coil spring effect" was significantly obtained in CL than PSL at both adjacent teeth of the displaced tooth.

Apical root displacement is a critical risk factor for apical root resorption after orthodontic treatment

OBJECTIVES:

To identify risk factors for apical root resorption (ARR) of maxillary and mandibular incisors using mathematical quantification of apical root displacement (ARD) and multiple linear mixed-effects modeling.

MATERIALS AND METHODS:

Periapical radiographs of maxillary and mandibular incisors and lateral cephalograms of 135 adults were taken before and after orthodontic treatment. ARR was measured on the periapical radiographs, and movement of central incisors was evaluated on the superimposed pre- and posttreatment lateral cephalograms. ARD was mathematically calculated from pretreatment tooth length, inclination change, and movement of the incisal edge. Linear mixed-effects model analysis was performed to identify risk factors for ARR, and standardized coefficients (SCs) were calculated to investigate the relative contribution of the risk factors to ARR.

RESULTS:

Vertical ARD showed the highest SCs for both maxillary and mandibular incisors. Horizontal ARD showed the second highest SC for mandibular incisors but was not significantly correlated with the ARR of maxillary incisors. When horizontal and vertical ARDs were included in the mixed-effects model, the use of self-ligating brackets was significantly correlated with increased ARR of mandibular incisors.

CONCLUSIONS:

ARD is a critical factor for ARR after orthodontic treatment. Careful monitoring of ARR is recommended for patients requiring significant ARD of incisors.

Influence of nicotine on orthodontic tooth movement: A systematic review of experimental studies in rats

OBJECTIVE

The objective of this systematic review was to assess the impact of nicotine administration on orthodontic tooth movement (OTM).

METHODS

A systematic search was conducted in PubMed, Scopus, EMBASE, MEDLINE (OVID) and Web of Knowledge databases and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies evaluating the influence of nicotine on OTM, and with the presence of a control group (OTM without nicotine administration), were included. Quality assessment of the selected studies was performed following the Animal Research Reporting in Vivo Experiment (ARRIVE) guidelines.

RESULTS

Six of the initially identified 108 articles fulfilled the inclusion criteria and were selected. All included studies were performed in male rats, which underwent OTM with or without nicotine administration. Since there was a variation among the included studies regarding nicotine dosage and the duration and magnitude of force application during OTM only a qualitative analysis could be performed. The studies reported that nicotine administration accelerated OTM by inducing alveolar bone resorption around the moving teeth. It was also found that nicotine increased root resorption during experimental OTM. More standardized animal research or clinical studies are warranted to further evaluate the impact of nicotine on OTM.

CONCLUSIONS

On an experimental level, nicotine exposure in rats jeopardizes OTM by increasing alveolar bone loss and root resorption. From a clinical perspective, further studies are needed to assess the impact of habitual use of tobacco products on OTM.

Archwire diameter effect on tooth alignment with different bracket-archwire combinations

INTRODUCTION

Our objective was to evaluate the effect of the diameter of the archwire on tooth alignment with different bracket-archwire combinations.

METHODS

The materials included 2 categories of orthodontic brackets (1) conventional ligating brackets (Victory Series [3M Unitek, Monrovia, Calif], Mini-Taurus [Rocky Mountain Orthodontics, Denver, Colo], and Synergy [Rocky Mountain Orthodontics]) and (2) self-ligating brackets (SmartClip [3M Unitek], a passive self-ligating bracket; Time3 [American Orthodontics, Sheboygan, Wis], an active self-ligating bracket; and SPEED [Strite Industries, Cambridge, Ontario, Canada], an active self-ligating bracket). All brackets had a nominal 0.022-in slot size. The brackets were combined with Therma-Ti 0.014-in and Therma-Ti 0.016-in titanium memory archwires (American Orthodontics). The archwires were tied to the conventional brackets with both stainless steel ligatures (0.010 in) and elastomeric rings. Each bracket-archwire combination was tested 20 times with the orthodontic measurement and simulation system built in a temperature-controlled chamber where the temperature was kept at 37°C (±1°C) during testing. The malocclusion simulated in the study represented a maxillary central incisor displaced 2 mm gingivally (x-axis) and 2 mm labially (z-axis).

RESULTS

The incisogingival corrections achieved by the 0.014-in archwire combined with the brackets used ranged from 40% to 95%; the corrections by the 0.016-in wire were 55% to 95%. The labiolingual corrections achieved by the 0.014-in archwire combined with the brackets used ranged from 10% to 100%, and the corrections of the 0.016-in archwires ranged from 15% to 100%.

CONCLUSIONS

Increasing the diameter from 0.014 to 0.016 in increased the correction achieved by up to 15% in certain bracket-archwire combinations, but it decreased the correction by up to 25% in other combinations.

Effect of archwire cross-section changes on force levels during complex tooth alignment with conventional and self-ligating brackets

INTRODUCTION

Our objective was to investigate the effect of archwire cross-section increases on the levels of force applied to teeth during complex malalignment correction with various archwire-bracket combinations using an experimental biomechanical setup.

METHODS

The study comprised 3 types of orthodontic brackets: (1) conventional ligating brackets (Victory Series [3M Unitek, Monrovia, Calif] and Mini-Taurus [Rocky Mountain Orthodontics, Denver, Colo]), (2) self-ligating brackets (SmartClip, a passive self-ligating bracket [3M Unitek]; and Time3 [Rocky Mountain Orthodontics, Denver, Colo] and SPEED [Strite Industries, Cambridge, Ontario, Canada], both active self-ligating brackets), and (3) a conventional low-friction bracket (Synergy [Rocky Mountain Orthodontics]). All brackets had a nominal 0.022-in slot size. The brackets were combined with 0.014-in and 0.016-in titanium memory wires, Therma-Ti archwires (American Orthodontics, Sheboygan, Wis). The archwires were tied to the conventional brackets with both stainless steel ligatures of size 0.010-in and elastomeric rings. A malocclusion of the maxillary central incisor displaced 2 mm gingivally (x-axis) and 2 mm labially (z-axis) was simulated.

RESULTS

The forces recorded when using the 0.014-in archwires ranged from 1.7 ± 0.1 to 5.0 ± 0.3 N in the x-axis direction, and from 1.2 ± 0.1 to 5.5 ± 0.3 N in the z-axis direction. When we used the 0.016-in archwires, the forces ranged from 2.6 ± 0.1 to 6.0 ± 0.3 N in the x-axis direction, and from 2.0 ± 0.2 to 6.0 ± 0.4 N in the z-axis direction. Overall, the increases ranged from 16.0% to 120.0% in the x-axis and from 10.4% to 130.0% in the z-axis directions.

CONCLUSIONS

Increasing the cross section of the wire increased the force level invariably with all brackets. Wires of size 0.014 in produced relatively high force levels, and the force level increased with 0.016-in wires.

Effect of archwire qualities and bracket designs on the force systems during leveling of malaligned teeth

OBJECTIVES

The force systems during multiband treatment are influenced by the selection of the bracket-archwire combinations. Resin models replicated from casts reflecting the pretreatment intraoral situation of a patient's mandible were used to explore how different bracket systems and archwire qualities would affect the force systems developing during simulated orthodontic leveling of several malaligned teeth.

MATERIALS AND METHODS

Leveling movements of the malaligned teeth 32, 33, and 34 were simulated using the orthodontic measurement and simulation system (OMSS). Two bracket types and three archwire qualities were compared, the former featuring a slot width of 0.022" (0.56 mm) and including one conventional (Freedom MIM Roth by ODS) and one passive self-ligating (Carriere MBT by ODS) design. Both were combined with three NiTi round 0.014" (0.36 mm) archwire products, two of them standard products (CuNiTi by Ormco; EuroArch by ODS) and one being a low-cost (NiTi Superelastic by Modern Arch) product. Measured parameters included force, torque, translation, and rotation.

RESULTS

Archwire qualities are critical to the force systems developing in the leveling stage. On the other hand, the finding that lower force/torque values result in less tooth movement is not primarily due to wire selection. Our most striking result was that the ODS EuroArch wire resulted in very low force and torque values both with the conventional and with the self-ligating brackets. Almost identical patterns with these two bracket designs were found, and none of the measured parameters revealed a significant advantage for any of the bracket-archwire combinations over the others.

CONCLUSION

In our experimental simulations of tooth leveling, wire-quality selection was found to be a key modifier of force, torque, translation, and rotation. Clearly, however, neither the wire qualities nor the bracket designs made a decisive difference to the amounts of leveling movement induced to malaligned teeth; other factors like tooth class or nature of the malalignment seem to be more important in this regard. A therapeutic benefit of self-ligating over conventional brackets was not demonstrable.