Mechanical environment change in root, periodontal ligament, and alveolar bone in response to two canine retraction treatment strategies

The effects of different types of periodontal ligament material models on stresses computed using finite element models

INTRODUCTION

Finite element (FE) method has been used to calculate stress in the periodontal ligament (PDL), which is crucial in orthodontic tooth movement. The stress depends on the PDL material property, which varies significantly in previous studies. This study aimed to determine the effects of different PDL properties on stress in PDL using FE analysis.

METHODS

A 3-dimensional FE model was created consisting of a maxillary canine, its surrounding PDL, and alveolar bone obtained from cone-beam computed tomography scans. One Newton of intrusion force was applied vertically to the crown. Then, the hydrostatic stress and the von Mises stress in the PDL were computed using different PDL material properties, including linear elastic, viscoelastic, hyperelastic, and fiber matrix. Young's modulus (E), used previously from 0.01 to 1000 MPa, and 3 Poisson's ratios, 0.28, 0.45, and 0.49, were simulated for the linear elastic model.

RESULTS

The FE analyses showed consistent patterns of stress distribution. The high stresses are mostly concentrated at the apical area, except for the linear elastic models with high E (E >15 MPa). However, the magnitude varied significantly from -14.77 to -127.58 kPa among the analyzed patients. The E-stress relationship was not linear. The Poisson's ratio did not affect the stress distribution but significantly influenced the stress value. The hydrostatic stress varied from -14.61 to -95.48 kPa.

CONCLUSIONS

Different PDL material properties in the FE modeling of dentition do not alter the stress distributions. However, the magnitudes of the stress significantly differ among the patients with the tested material properties.

Doppler ultrasound assessment results at stages of orthodontic treatment

Relevance. A modern diagnostic complex when planning orthodontic treatment is impossible without assessing the condition of periodontal tissues.

Purpose. To evaluate the changes in periodontal tissues during orthodontic treatment.

Material and methods. Blood velocity and flow rate in the anterior mandible were compared before and after the orthodontic treatment.

Results. Blood velocity and volumetric blood flow rate significantly increased 6 ± 2 months after the beginning of orthodontic treatment.

Conclusion. Orthodontic movement of crowded teeth using aligners proceeds without excessive pressure, which allows for a smooth and gradual change in the blood velocity and volumetric blood flow rate, pulsation index and peripheral resistance index.

Orthodontically induced root resorption: A critical analysis of finite element studies' input and output

INTRODUCTION

Orthodontically induced inflammatory root resorption (OIIRR) constitutes an undesirable risk connected to orthodontic treatment. Finite element analysis (FEA) is a powerful tool to study the risk of OIIRR. However, its efficiency in predicting OIIRR depends on the insertion of the correct inputs and the selection of an output coherent with the clinical failure mechanism.

METHODS

By combining a systematic review with a 3-dimensional FEA, this article discusses which are the implications of using certain periodontal ligament (PDL) properties (linear and nonlinear models) and failure criteria. Six orthodontic loading regimes were simulated in a maxillary premolar: pure intrusion, buccal tipping, and their combination applied with either a light (25 cN) or a heavy (225 cN) force. Three stress parameters in the PDL were compared: von Mises stress, minimum principal stress_, and hydrostatic stress (σ_H).

RESULTS

The comparison between linear and nonlinear models showed notable differences in stress distribution patterns and magnitudes. For the nonlinear PDL, none of the light-force models reached the critical compressive hydrostatic stress of 4.7 kPa, whereas all the heavy-force models reached it. In addition, the regions of critical compressive σ_H matched with the regions with resorption craters in clinical studies. In linear models, the σ_H critical value of 4.7 kPa was reached even in the light-force scenario.

CONCLUSIONS

Only compressive hydrostatic stress in PDL satisfied the requirements to be used as an FEA indicator of OIIRR. However, the requirements were satisfied only when a nonlinear PDL model was considered.

Mechanical environment for lower canine T-loop retraction compared to en-masse space closure with a power-arm attached to either the canine bracket or the archwire

OBJECTIVES

To assess the mechanical environment for three fixed appliances designed to retract the lower anterior segment.

MATERIALS AND METHODS

A cone-beam computed tomography scan provided three-dimensional morphology to construct finite element models for three common methods of lower anterior retraction into first premolar extraction spaces: (1) canine retraction with a T-loop, (2) en-masse space closure with the power-arm on the canine bracket (PAB), and (3) power-arm directly attached to the archwire mesial to the canine (PAW). Half of the symmetric mandibular arch was modeled as a linear, isotropic composite material containing five teeth: central incisors (L1), lateral incisor (L2), canine (L3), second premolar (L4), and first molar (L5). Bonded brackets had 0.022-in slots. Archwire and power-arm components were 0.016 × 0.022 in. An initial retraction force of 125 cN was used for all three appliances. Displacements were calculated. Periodontal ligament (PDL) stresses and distributions were calculated for four invariants: maximum principal, minimum principal, von Mises, and dilatational stresses.

RESULTS

The PDL stress distributions for the four invariants corresponded to the displacement patterns for each appliance. T-loop tipped the canine(s) and incisors distally. PAB rotated L3 distal in, intruded L2, and extruded L1. PAW distorted the archwire resulting in L3 extrusion as well as lingual tipping of L1 and L2. Maximum stress levels in the PDL were up to 5× greater for the PAW than the T-loop and PAB methods.

CONCLUSIONS

T-loop of this type is more predictable because power-arms can have rotational and archwire distortion effects that result in undesirable paths of tooth movement.

Expression of HIF‑1α in cycling stretch‑induced osteogenic differentiation of bone mesenchymal stem cells

During orthodontic treatment, mechanical force is applied to the teeth, and following a series of complex metabolism changes, the position of the teeth in the alveolar bone change. This process is closely associated with primitive bone mesenchymal stem cells (BMSCs), which may differentiate into osteoblasts precursor cell. A hypoxic microenvironment may be caused by orthodontic mechanical forces between the alveolar bone and the root. Hypoxia-inducible factor 1α (HIF-1α) is a specific receptor that adapts to a hypoxic environment. The present study was designed to investigate whether HIF-1α was involved in the osteoblastic differentiation of BMSCs induced by cyclic tensile stress. During this process, HIF-1α mRNA and protein expression were detected using a reverse transcription-quantitative polymerase chain reaction and western blotting. It was revealed that alkaline phosphatase activity increased in a time-dependent manner in three different stretching strength groups, which indicates that cyclic stretch promotes the osteogenic differentiation of BMSCs. The optimal force stage of osteogenesis was an unexpected discovery, which will provide theoretical guidance for selecting the most suitable orthodontic force for tooth movement in clinical orthodontic treatment. Most importantly, all experiments revealed that HIF-1α mRNA and protein were significantly increased following stretching treatment in BMSCs. It was therefore concluded that HIF-1α may be involved in BMSCs modulating osteogenic metabolism during exposure to cyclic stretch and a hypoxic microenvironment, which may prove useful for the reconstruction of a jaw during orthodontic treatment.

Can interfaces at bracket-wire and between teeth in multi-teeth finite element model be simplified?

OBJECTIVE

Finite element (FE) method's correctness depends heavily on modeling method. This study aimed at determining whether the interfaces at bracket-wire and between teeth can be simplified for multi-teeth FE analysis.

METHOD

A three-dimensional FE model of a mandible was created from cone-beam computed tomography scan. Due to symmetry, only a half of the mandible was modeled, which consisted of five teeth (first premolar extraction and only first molar), brackets and archwire, periodontal ligament (PDL), cortical bone, and cancellous bone. All the bone, teeth, and PDL were considered to be isotropic and linear. The En-masse retraction case was simulated. A detailed model, which has contact elements between the bracket and archwire and between teeth, was developed to allow relative motion at the interfaces. A model with simplified interfacial conditions, which does not allow the relative motion, was also created. The stresses and displacements as results of the treatment on these two models were calculated and compared.

RESULTS

The stress and displacement distributions from the detailed model were more close to reality based on the expected displacement pattern of the clinical case than from the simplified model. The maximum stresses from the two methods were also different. The highest stress from the detailed model is twice as high as from the simplified model.

CONCLUSIONS

The detailed model provides much more reasonable results than the simplified model. Thus, the simplified model should not be used to replace the detailed model if the stress magnitude and highest stress location are the expected outcomes.

Ultrasonographic evaluation of periodontal changes during orthodontic tooth movement - work in progress

Background and aim

Orthodontic tooth movement (OTM) is a process whereby the application of a force induces bone resorption on the pressure side and bone apposition on the tension side of the lamina dura. However, only limited data are available on the in vivo behavior of the periodontal tissues. The aim of this study was to assess the changes of periodontal tissues, induced by the orthodontic canine retraction, using 40 MHz ultrasonography.

Methods

Ultrasonographic evaluation of periodontal tissues was conducted in 5 patients with indication for orthodontic treatment. The upper first premolars were extracted bilaterally due to severe crowding, and the canines were distalized using elastomeric chain with a net force of 100 cN. Ultrasonographic scans (US scans) were performed before, during and after retraction, in three distinct areas of the canines buccal surface: mesial, middle and distal. The reference point was the bracket, which appeared hyperechoic on the US scan. Four different dimensions were obtained: D1 (depth of the sulcus), D2 (thickness of the gingiva), D3 (length of the supracrestal fibers), D4 (width of periodontal space).

Results

An increase of D1 was observed in all three areas of the periodontium, during orthodontic treatment. D3 was strongly correlated before and immediately after force delivery only for the mesial area (r=0.828, p<0.05). In total, 228 variables were statistically analyzed using Pearson’s correlation coefficients, in order to demonstrate the relationship between periodontal findings during orthodontic tooth movement.

Conclusion

High-resolution ultrasonography has the capability to obviate changes in periodontal ligament space and free gingiva during orthodontic tooth movement.