Comparison of the force levels among labial and lingual self-ligating and conventional brackets in simulated misaligned teeth

The in vitro biomechanics of anterior arch expansion using fixed lingual appliances with coil springs or archwire stops

INTRODUCTION

The presented study investigates differences in the biomechanics of straight and mushroom fixed lingual appliances when implementing coil springs and stops for anterior arch expansion.

MATERIALS AND METHODS

An in vitro orthodontic simulator was used to measure three-dimensional forces and moments on each tooth of a simulated maxillary arch. Mushroom and straight archwire forms of 0.016″ NiTi round archwire were considered, using 0.010″ × 0.030″ NiTi open coils and 0.016″-0.018″ archwire stops (n = 44 per group). Teeth in the anterior dental arch were moved from a neutral to crowded position to replicate anterior crowding of central and lateral incisors. Forces and moments of interest for lateral incisors and first premolars were compared using repeated measures mixed multivariate analysis of variance (α = 0.05).

RESULTS

Three comparisons between straight versus mushroom archwires and two comparisons of coil springs vs. stops were not statistically significant. Overall, it was found that the use of a straight lingual archwire produced larger differences in forces and moments between using stops and coil springs than when using a mushroom archwire. Using stops produced larger forces and moments for both types of archwires as compared to using coil springs. The largest expansion forces were produced using straight archwires with stops, exceeding 3.0 N of force. Straight archwires with coil springs produced the lowest expansion forces on lateral incisors, just exceeding 1.5 N.

CONCLUSIONS

The findings of this study have elucidated significant differences in the biomechanics of transverse arch expansion using straight or mushroom fixed lingual appliances with coil springs or stops.

Conventional and self-ligating lingual orthodontic treatment outcomes in Class I nonextraction patients: A comparative study with the American Board of Orthodontics Objective Grading System

INTRODUCTION

This study aimed to assess and compare the duration and outcomes of orthodontic treatment with conventional and self-ligating lingual fixed appliances with the American Board of Orthodontics (ABO) Objective Grading System.

METHODS

Thirty consecutive patients with a complete dentition and Angle Class I malocclusion treated with a conventional lingual bracket system (STb; Ormco, Glendora, Calif) or self-ligating lingual bracket system (GC Experience-L; GC Orthodontics, Breckerfeld, Germany) were included. The occlusal outcome was assessed with the ABO instrument. The treatment duration and ABO scores of the 2 groups were recorded. Statistical analyses were evaluated using independent-sample t tests.

RESULTS

The conventional group had a mean treatment time of 2.10 ± 0.69 years, and the self-ligating group had a treatment duration of 1.68 ± 0.48 years (P >0.05). The mean posttreatment ABO scores in the conventional group were 20.23 ± 5.13, and the mean posttreatment ABO scores in the self-ligating group were 21.00 ± 5.66. No difference was found between the groups regarding the criteria of ABO (P >0.05). The highest scores were given in the assessment of buccolingual inclinations in both conventional and self-ligating lingual bracket groups.

CONCLUSIONS

The design of the lingual appliances used in this study did not influence the treatment duration and the total ABO scores in treating patients with a Class I relationship in this sample. Both types of lingual brackets were especially deficient in correcting buccolingual inclinations. The strengths were their ability to close spaces and correct anterior rotations and overjet regardless of the bracket types.

influence of inter-bracket distance on load deflection characteristics of nickel-titanium wires

Aim: Aim of this study was to compare and evaluate load deflection characteristic of NiTi wires of different cross-section between labial and lingual straight wire system in aligned and crowded condition. Materials & Methods:  The study was divided into two parts one with the aligned teeth and in other part typodont set was manipulated to simulate the crowded arch. Crowding was created in the anterior region by displacing one central incisor and one lateral incisor 2 mm palataly and canine were rotated in mesio-buccal direction. Typodont was sent to laboratory for lingual setup and CAD-CAM based Avant grade laser sintered 3D lingual brackets were and bonded using Cyanoacrylate by the laboratory. A modified three point bending test simulating the clinical conditions was carried out to investigate load deflection characteristics of Cu-NiTi arch-wires using Instron Universal Testing Machine. Results: Shapiro-wilk test and Kolmogorov-Smirnov test were used to check the normality of the sample and values. Intergroup comparison of LDR of wires between labial and lingual group in aligned and crowded condition showed that LDR of wires in the lingual bracket system was significantly higher as compared to labial bracket system. 

A Three-Dimensional Finite Element Analysis: Maxillary Dentition Distalization with the Aid of Microimplant in Lingual Orthodontics

Aim

To analyze the movement of anterior teeth by changing the height of the power-arm and changing the force application points during whole maxillary dentition distalization with the aid of micro-implants in lingual orthodontics to set a biomechanical reference for effective clinical use of lingual orthodontic appliance.

Methods

A three-dimensional finite element model of the maxillary teeth with lingual appliance and the associated support tissue was established. Maxillary dentition with the force of 200g was distalized using implant as anchorage, then the movement of anterior teeth was analyzed by changing the length of power-arm (1mm, 3mm, 6mm, 9mm) and by changing the force location from lingual side to buccal side.

Results

During whole maxillary dentition distalization with aid of the implants in lingual orthodontics: when the height of power arm was 1mm, the anterior teeth rotated clockwise, with the increasing of the height of power-arm, the anterior teeth rotated counterclockwise gradually. When the height of power-arm was 9mm, all anterior teeth rotated counterclockwise. Central incisor and lateral incisor rotated counterclockwise and canine rotated clockwise when the buccal side force was applied.

Conclusion

With the increase of the height of the power-arm, the movement pattern of the upper anterior teeth is different. The canine is more sensitive to the height of the power-arm than the central incisor and the lateral incisor. When the height of the power-arm reaches 9mm, the upper anterior teeth are displayed as crown tipping buccally movement. Compare with lingual side force, the buccal side force do better in preventing the loss of anterior tooth torque. If the upper anterior teeth are up-right or lingually tipped before treatment, it is preferable to use longer power-arm or buccal side traction force. If the anterior teeth are already tipped buccally, then short power-arm or lingual side force is advised.

Vertical and Orovestibular Forces Generated by Beta-Titanium and Stainless-Steel Rectangular Wires in Labial and Fully Customized Lingual Bracket Systems

This study aimed to investigate the force values exerted from rectangular wires when combined with conventional labial and fully customized lingual appliances under predefined, idealized activation. Fully customized lingual brackets of two brands Incognito™ (3M Unitek, Monrovia, CA, USA) and WIN (DW Lingual Systems, Bad Essen, Germany) and labial brackets of another brand, discovery® MIM and discovery® smart systems (Dentaurum, Ispringen, Germany), were chosen. Stainless-steel and beta-titanium wires of 0.018" × 0.025" were examined. For IncognitoTM, 0.0182" × 0.025" beta-titanium wires were tested. Intrusion/extrusion and orovestibular movements were performed in a range of 0.2 mm, and the forces were recorded for each 0.1 mm of the movement. Mean values and standard deviations were calculated for all measurements, and ANOVA was performed for statistical analysis. Slight differences were observed between the forces generated from beta-titanium and stainless-steel wires. The same wire generated in some cases 5-53% higher forces with the lingual appliance due to the vertical orientation of the long walls during intrusion/extrusion and increased wire stiffness at the anterior region. Beta-titanium and stainless-steel 0.018" × 0.025" wires can generate similar force values during the final stages of the orthodontic therapy; thus, possibly only one of the two alloys could be used in each orthodontic wire sequence.

An In Vitro Evaluation of Frictional Characteristics of Labial and Lingual Self-ligating Brackets with Various Archwire Alloys

Background: An understanding of bracket slot–archwire interface is imperative for biomechanical effectiveness in orthodontic sliding mechanics and hence the aim of the study is to evaluate frictional properties of lingual self-ligating brackets comparing with conventional lingual and labial self-ligating brackets using three different archwire alloys in various environments.

Materials and Methods: This in vitro study compared the frictional force of labial and lingual self-ligating and conventional lingual brackets with stainless steel, TMA, and Cr-Co alloy archwires of 0.017” × 0.025” dimension in dry and wet conditions. Frictional forces were evaluated in a simulated half arch fixed appliance using a testing machine. Static and kinetic friction were measured and analyzed by one-way analysis of variance (ANNOVA) test and post hoc Duncan multiple range test. The effects of brackets and archwires in dry and wet conditions were analyzed by three-way variance (ANNOVA) test.

Result: The maximum frictional forces were observed with labial self-ligating brackets followed by lingual conventional brackets and the least by lingual self-ligating brackets. Of all the wires tested, TMA wires had the maximum frictional forces followed by Co-Cr and stainless steel. In both conditions, the values were non-significant with all bracket–wire combinations except with Co-Cr and TMA wires.

Conclusions: Varied amount of frictional force was shown by the brackets and wires with highest by labial self-ligating bracket, followed by lingual conventional and lingual self-ligating brackets. TMA wires experienced higher friction followed by Co-Cr and stainless steel with minimum friction.

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.

In-vitro investigation of the mechanical friction properties of a computer-aided design and computer-aided manufacturing lingual bracket system under diverse tooth displacement condition

Objective

The purpose of this study was to compare the static (SFF) and kinetic frictional forces (KFF) of a computer-aided design and computer-aided manufacturing lingual bracket (CAD/CAM-LB) with those of conventional LB (Con-LB) and Con-LB with narrow bracket width (Con-LB-NBW) under 3 tooth displacement conditions.

Methods

The samples were divided into 9 groups according to combinations of 3 LB types (CAD/CAM-LB [Incognito], Con-LB [7th Generation, 7G], and Con-LB-NBW [STb]) with 3 displacement conditions (no displacement [control], maxillary right lateral incisor with 1-mm palatal displacement [MXLI-PD], and maxillary right canine with 1-mm gingival displacement [MXC-GD]; n = 6/group). While drawing a 0.016-inch copper or super-elastic nickel-titanium archwire with 0.5 mm/min for 5 minutes in a chamber maintained at 36.5℃, SFF and KFF were measured. The Kruskal-Wallis method with Bonferroni correction was performed.

Results

The Incognito group demonstrated the highest SFF, followed by the 7G and STb groups ([STb-control, STb-MXLI-PD, Stb-MXC-GD] < [7G-MXC-GD, 7G-MXLI-PD, 7G-control] < [Incognito-MXLI-PD, Incognito-control, Incognito-MXC-GD]; p < 0.001). However, there were no significant differences in SFF among the 3 displacement conditions within each bracket group. Within each displacement condition, the Incognito group demonstrated the highest KFF, followed by the 7G and STb groups ([STb-control, STb-MXLI-PD] < Stb-MXC-GD < 7G-MXLI-PD < [7G-control, 7G-MXC-GD] < [7G-MXC-GD, Incognito-MXLI-PD, Incognito-control] < [Incognito-control, Incognito-MXC-GD]; p < 0.001). MXC-GD exhibited higher KFFs than MXLI-PD in the same bracket group.

Conclusions

The slot design and ligation method of the CAD/CAM-LB system should be modified to reduce SFF and KFF during the leveling/alignment stage.

Comparison of the efficacy of tooth alignment among lingual and labial brackets: an in vitro study

Background/objective

The aim of this study was to evaluate the efficacy of tooth alignment with conventional and self-ligating labial and lingual orthodontic bracket systems.

Materials/methods

We tested labial brackets (0.022″ slot size) and lingual brackets (0.018″ slot size). The labial brackets were: (i) regular twin brackets (GAC-Twin [Dentsply]), (ii) passive self-ligating brackets including (Damon-Q® [ORMCO]; Ortho classic H4™ [Orthoclassic]; FLI®SL [RMO]), and (iii) active self-ligating brackets (GAC In-Ovation®C [DENTSPLY] and SPEED™[Strite]). The lingual brackets included (i) twin bracket systems (Incognito [3M] and Joy™ [Adenta]), (ii) passive self-ligating bracket system (GAC In-Ovation®LM™ [Dentsply]), and (iii) active self-ligating bracket system (Evolution SLT [Adenta]). The tested wires were Thermalloy-NiTi 0.013″ and 0.014″ (RMO). The archwires were tied to the regular twin brackets with stainless steel ligatures 0.010″ (RMO). The malocclusion simulated a displaced maxillary central incisor in the x-axis (2 mm gingivally) and in the z-axis (2 mm labially).

Results

The results showed that lingual brackets are less efficient in aligning teeth when compared with labial brackets in general. The vertical correction achieved by labial bracket systems ranged from 72 to 95 per cent with 13″ Thermalloy wires and from 70 to 87 per cent with 14″ Thermalloy wires. In contrast, the achieved corrections by lingual brackets with 13″ Thermalloy wires ranged between 25-44 per cent and 29-52 per cent for the 14" Thermalloy wires. The anteroposterior correction achieved by labial brackets ranged between 83 and 138 per cent for the 13″ Thermalloy and between 82 and 129 per cent for the 14″ Thermalloy wires. On the other hand, lingual brackets corrections ranged between 12 and 40 per cent for the 13″ Thermalloy wires and between 30 and 45 per cent for the 14″ Thermalloy wires.

Limitation

This is a lab-based study with different labial and lingual bracket slot sizes (however they are the commonly used ones in clinical orthodontics) and study did not consider saliva, periodontal ligament, mastication and other oral functions.

Conclusions

The effectiveness of lingual brackets in correcting vertical and anteroposterior displacement achieved during the initial alignment phase of orthodontic treatment is lower than that of the effectiveness of labial brackets.

Comparison of force loss due to friction of different wire sizes and materials in conventional and new self-ligating orthodontic brackets during simulated canine retraction

AIMS

The aim of this study was to compare force loss due to friction (Fr) during simulated canine retraction using different archwire dimensions and materials between conventional and new self-ligating brackets.

METHODS

The tested brackets were (1) conventional brackets (Victory series, GAC twin and FLI twin), (2) self-ligating brackets (Damon-Q, FLI-SL, new/improved FLI-SL (I FLI-SL), SPEED, GAC innovation (R) and Ortho Classic) and (3) a low-friction bracket (Synergy). All brackets had a 0.022″ slot size. The tested archwires were stainless steel (0.018″; 0.016″x0.022″; 0.017″x0.025″; 0.018″x0.025″ and 0.019″x0.025″); nickel titanium (NiTi; 0.016″x0.022″; 0.017″x0.025″; 0.018″x0.025″ and 0.019″x0.025″) and titanium molybdenum alloy (TMA; 0.016″x0.022″; 0.017″x0.025″; 0.018″x0.025″ and 0.019″x0.025″). Canine retraction was experimentally simulated in a biomechanical set-up using a NiTi coil spring that delivered a force of 1 N. The simulated retraction path was up to 4 mm. Force loss due to friction was compared between groups using the Welch t‑test.

RESULTS

Force loss due to friction increased with increasing archwire size. Also, TMA showed the highest and stainless steel the lowest force loss due to friction. FLI-SL brackets showed the lowest Fr (31%) and Ortho Classic showed the highest (67%).

CONCLUSIONS

Increasing wire size generally showed increasing force loss due to friction. FLI-SL brackets showed the lowest, while Ortho Classic showed the highest friction.