MINI-IMPLANT SUPPLEMENT Journal of Orthodontics, Vol.

41, 2014, S15–S23

Biomechanics of incisor retraction with mini-

implant anchorage
Madhur Upadhyay, Sumit Yadav and Ravindra Nanda
University of Connecticut, Health Center, Farmington, CT, USA

Mini-implants have been successfully incorporated into orthodontic practice all over the world. One of the most
popular applications of mini-implant anchorage is to facilitate retraction of the anterior teeth. This article reviews
the mechanics involved in anterior tooth retraction with mini-implant supported anchorage. An attempt has been
made to synthesize information available in the literature and present it in a manner that is easily understandable
from a clinical perspective. We discuss the fundamental differences mini-implant based incisor retraction has when
compared to conventional techniques, mechanical factors affecting this process and provide a step-by-step analysis
of incisor retraction. In addition, various models of space closure are discussed that have evolved through careful
evaluation of in vitro and in vivo experiments.

Key words: Mechanics, mini-implants, incisor retraction

Received 8 April 2014; accepted 8 June 2014

Introduction closure. The shift is seen not only in the anchorage demand
The extraction of premolar teeth and labial segment between the two techniques but also in the biomechanics
retraction is generally indicated when there is obvious involved. When using conventional mechanics, force appli-
protrusion. In the presence of a full unit class II cation is usually parallel to the occlusal plane and hence,
malocclusion or class I bimaxillary protrusion, ancho- the orthodontist is only required to analyze force in one
rage control is important because maintenance of plane. However, because MIs are usually placed apical
posterior buccal segment position is critical. A loss in to the occlusal plane into the bone between the roots of
molar anchorage not only compromises correction of teeth, the force applied is always at an angle (notably, the
the anterior–posterior discrepancy, but also affects the preferred location for MI placement is between the roots
overall vertical dimension of the face (Upadhyay et al., of the second premolars and first molars close to the
2008a,b; 2010). The application of mini-implant (MI) mucogingival junction; care should be taken that the MIs
supported anchorage can circumvent these anchorage are not inserted too far apically in the movable mucosa,
reinforcement issues and help maintain molar position since this can lead to failure due to persistent inflammation
whilst establishing a class I canine relationship. around the insertion site). This angulated force lends itself
The science behind the use of MIs and their effect on to be broken into two components by the law of vector
the dentition has undergone a paradigm shift since the resolution (Upadhyay et al., in press): a horizontal
introduction of these appliances into clinical orthodon- retraction force (r) and a vertical intrusive force (i). The
tics almost two decades ago. Through this paper we force applied with MIs in such a setup is also closer to the
intend to highlight the evolution of the biomechanics Centre of Resistance (CRES) of the anterior unit.
involved in incisor retraction with MI anchorage and Therefore, the MF (Moment due to the Force) is
how the scientific evidence is constantly evolving this significantly less, compared to that generated in
process. conventional mechanics (Upadhyay et al., 2008a,b;
2009; 2010; 2012). Clinically it translates into a
decreased tendency for the teeth to tip (Figure 1).
Mechanical differences in incisor retraction between With conventional mechanics, the posterior segment
MIs and conventional techniques usually serves as the passive anchor unit, while the anterior
The use of MIs for the retraction of anterior teeth presents teeth act as the active unit. The force system is there-
a paradigm shift from conventional methods of space fore differentially expressed in the active unit and the

Address for correspondence: Madhur Upadhyay, University of

Connecticut, Health Center, Farmington, CT, USA.
Email: madhurup@yahoo.com
# 2014 British Orthodontic Society DOI 10.1179/1465313314Y.0000000114
 S16 Upadhyay et al. Mini-implant Supplement JO September 2014

anchorage or passive unit within the same arch. In

contrast, when MIs are incorporated as the third part,
precise movement of the anterior and posterior segments is
possible. Accurate planning for the amount of desired
tooth movement is thus a prerequisite before active
treatment can be initiated. The clinical observation of the
amount of tipping will depend on the amount of space
closure. A greater amount of space closure will yield
greater side effects or in this case, tipping. With conven-
tional techniques, part of the space is taken up by molar
mesialization. Previous research has shown that in contrast
to MI supported anchorage; conventional methods show
2–3 mm of anchorage loss in a typical extraction case
(Upadhyay et al., 2008a,b; 2009; 2010). This implies that
the anterior teeth during space closure with MIs are
Figure 1 Biomechanical design of the force system automatically predisposed to more tipping and ‘dumping’
involved during en masse retraction of anterior teeth. as they have to be distalized a greater distance in order to
The vector of force varies between conventional
mechanics (FO) and implant-based mechanics (FI) for close the extraction space (Figure 2). Therefore, greater
space closure. Here, FI..r.i, (F5total force, i5intrusive degrees of torque control might be warranted for space
component and r5retractive component). Also the closure utilizing skeletal anchorage.
moment created by the implant will be significantly less These and other differences have lead to a gradual
than that created by conventional mechanics (Force
evolution of MI-based mechanics in orthodontics. How-
application with implants is closer to the CRES and
M5F6distance to the CRES). Note: with the conventional ever, before exploring this further, the mechanics of space
approach there is no intrusive force generated closure is discussed in more detail.

Figure 2 Anterior teeth that have to be distalized a greater distance (a) and will be automatically predisposed to
greater degrees of tipping than those requiring less distalization (b) (Note: the molar represents the posterior
segment while the incisor represents the anterior teeth)
 JO September 2014 Mini-implant Supplement Fundamentals of the mechanics involved S17

Figure 3 Basic mechanics of tooth movement. Here, F5

retraction force, MF5moment due to the force, MC5
counterbalancing moment Figure 4 Altering the line of force application can
change Centre of rotation and/or the type of tooth
movement. Orange: Uncontrolled tipping, Blue: Con-
Basic models for space closure trolled tipping, Pink: Translation, Purple: Root move-
ment, Green: Root movement with crown moving
During the process of incisor retraction, the objective is to forward. (Red dot: centre of resistance, other dots: centre
apply a force between the incisor and the posterior of rotations corresponding with the line of force)
segment in order to close the space that exists between
them. This force is usually applied on the brackets
attached to the crowns of the teeth (Figure 3) and is rotation as a rotation axis (Kojima et al., 2012; Kojima
occlusal and buccal to the CRES of the units experiencing and Fukui, 2014; Sia et al., 2009; Tanne et al., 1988;
the force. This generates MF, which causes tipping and Tominaga et al., 2009). Figure 4 shows the centre of
rotation of the teeth in the direction of the applied force rotation for every level of force. Notably, this model only
(Smith and Burstone, 1984; Upadhyay et al., 2012). Here applies for maxillary incisors and measures only initial
it is easy to see that by simply controlling the MF, different tooth movement.
types of tooth movement can be achieved (tipping, This approach is easier to execute with skeletal anchor-
translation, etc.). However, how can we manipulate the age because MIs are usually placed between the roots of
MF? In orthodontics there are only two broad mechanical the molar and premolar. Here, the height of both the
pathways to achieve this: (1) changing the line of force power arm and MI can be varied, depending upon the
application (or reducing the magnitude of MF) or (2) line of force required. It works well for both multiple
counterbalancing the MF (adding another moment in the and individual teeth (Figure 5). However, for movements
opposite direction). requiring greater degrees of control, such as translation or
root movement, this method possesses certain problems.
Changing the line of force application The ‘long’ arms can be a source of irritation to the patient,
A simple way of accomplishing this is to apply the force by extending high into the vestibule and/or impinging
closer to the CRES of the anterior teeth. A rigid attachment, on the gingiva and cheeks. Additionally, the arms are
often called a power arm, can be attached to the bracket on sometimes not rigid enough and can undergo some degree
the crown of the tooth or on the wire itself. Force can then of flexion under the applied force. Therefore, retraction of
be applied to this power arm. In this way, the line of force is incisors is often performed without the use of a power
moved to a different location, thereby altering its distance arm. However, without the power arm the ability to
from the CRES. This also causes a change in the moment of reduce the MF is also lost. In this situation, how do we
the force. For example, if the power arm can be made long control the tooth movement? How do we bring about the
and rigid to extend to the CRES of the tooth, MF can be desired tooth movement, which can be so easily achieved
entirely eliminated, as the applied force will pass through with power arms?
the CRES (Moment5Applied force6distance from the
CRES). Based on theoretical calculations, in vitro and in Counterbalancing the MF (sliding mechanics with MIs)
vivo experiments, and with certain assumptions, we have The en masse retraction described at the beginning of the
proposed a model (Figure 4), which describes various article outlined the forces and moments during the initial
types of tooth movement, depending upon the line of force stages of space closure (representing only the beginning
application and by the location of the tooth centre of phase of retraction). What happens later? It is well known
 S18 Upadhyay et al. Mini-implant Supplement JO September 2014

Figure 5 Power arm based space closure. (a) En masse retraction of anterior teeth shows controlled tipping. (b)
Translation of the canine using a power arm

that space closure is a dynamic process and things change Phase I: This initiation of incisor retraction. A single
as teeth move. Considerable research in this area has force (F) is applied in an upward and backward/distal
provided us with a more detailed representation of the direction (Figure 6a). This force produces a moment
incisor movement and its effect on the entire dentition (MF) acting at the CRES of the incisor segment, causing it
(Barlow and Kula, 2008; Josell et al., 1997; Kojima and to tip as it is being distalized. Since there is some degree of
Fukui, 2010; Kojima et al., 2012; Kojima and Fukui, 2014; play between the archwire and the bracket slot at this
Moore and Waters, 1993; Sia et al., 2009; Tominaga et al., stage, the tooth is free to tip in the mesio-distal direction
2009) Based on the evidence gathered from this pool of in an uncontrolled manner, creating a centre of rotation
research, we have further refined the mechanical model of (CROT) slightly apical to the CRES (Kojima et al., 2012;
incisor retraction with MIs. Essentially, incisor retraction Kojima and Fukui, 2014; Sia et al., 2009; Tominaga et al.,
can be divided into four phases (Figure 6): 2009) (Figure 4). This can also be referred to as the
 JO September 2014 Mini-implant Supplement Fundamentals of the mechanics involved S19

Figure 6 Mechanics of incisor retraction with MIs (Red dot: centre of rotation). (a) Phase I (The unsteady state/
uncontrolled tipping). The archwire-bracket play allows for uncontrolled tipping of the incisor. Note: Due to the
play there is no MC (moment due to a couple) generated. (b) Phase II (The controlled state/controlled tipping).
The archwire-bracket play does not exist anymore. There are signs of initial contact between the archwire and the
bracket edges giving rise to MC. However still MF..MC. (c) Phase III (Restorative phase/root uprighting due to
decreasing force). There is a decrease in the force levels causing a decrease in MF. Here MF,,MC. Note the
deflected wire now springs back as the retraction force is reduced causing a reduction in the moment. (d) Phase
IV (Continuous/heavy force). Permanent deflection of the archwire due to the continuous/heavy F making the MC
ineffective in creating any root correction. Here again MF..MC

‘unsteady state’ of incisor retraction, characterized by deflection, as we will see later) and the CROT moves
uncontrolled tipping. Here it is easy to see that the greater apically, creating controlled tipping of the incisors. This
the play the more tipping occurs or in other words the can also be called the ‘steady state’ of incisor retraction.
smaller the size of the archwire the greater the tipping. From this point onwards, the movement of the teeth will
Phase II: The incisor is now tipped to the extent that depend upon the nature of the retraction force, i.e. a
the clearance (or play) between the bracket slot and the steady continuous force or a force decreasing with time.
wire has been eliminated. Figure 6b depicts the incisors This at the clinical level is a very relevant supposition.
somewhat later in time relative to Figure 6a. Archwire– Phase III (decreasing force): For space closure to enter
bracket slot contact now exists. This two-point con- this phase, it must be assumed that the distal driving force
tact by the archwire creates a moment in the opposite is undergoing a constant decay through the retraction
direction of MF resulting in less tipping of the incisors process. This is often seen with an elastomeric chain
when compared to phase I. This is the ‘counterbalancing or active tiebacks. (Barlow and Kula, 2008; Josell et al.,
moment’ or ‘moment due to a couple’ (MC). As the 1997) As the force decreases, so does the MF; however,
wire further deflects, MC continues to increase (Force a because of the angulated bracket and the local bending
 S20 Upadhyay et al. Mini-implant Supplement JO September 2014

of the archwire, the MC remains constant. Therefore,

MC.MF (Figure 6c). This results in restoration of the
axial inclination of the incisors (uprighting or root cor-
rection). This can be called the ‘restorative phase’ of
incisor retraction and can be clinically referred to as
the third-order torquing of the incisors. With the reactiva-
tion of the elastomeric chain the process resumes from
phase I.
Phase IV (Continuous force or heavy force): Incisor
retraction enters this phase if the retraction force is either
constant or heavy to begin with. Examples can be: nickel
titanium closed coil springs or heavy elastomeric chain.
Here, due to the heavy retraction force MF always being
.MC, there is anterior bending or deflection of the arch-
wire and tipping of the incisors continues (Figure 6d).
Clinically, the incisors might appear as ‘dumped’ or
retroclined (loss of torque) with a deep bite, sometimes
accompanied with a lateral open bite, with the molars Figure 7 Biomechanical design for the force system
tipped forward due to a similar wire deformation. This involved after space closure. Retraction of the upper
deformation is accompanied by an increase in friction anterior teeth still in progress. Note the increase in the
and/or binding at the wire-bracket interface, making angulation of the total force relative to the occlusal
tooth movement slow. It is important to mention here plane (Here, F..r<i). Such a mechanical configuration
has important implications for vertical control and
that at any point if MC5MF, the incisors would theore- Class II correction
tically undergo translation. However, this almost never
happens, as it is very difficult to maintain such a delicate
balance between the moments for any measurable period plane angle and in some situations, even resulting in
of time. intrusion of the posterior teeth and consequent upward
and forward rotation of the mandibular plane. (Upadhyay
Sequela of phase IV: distalization effect of MI- et al., 2008a,b; 2010; Hee Oh et al., 2011)
assisted retraction
It has been reported that MI-assisted retraction of the Mechanical factors affecting incisor retraction
incisors has the potential to distalize the whole arch It is evident from the previous discussion that the archwire-
en masse (Upadhyay et al., 2008a,b; 2009; 2010; 2012). bracket clearance is a very important factor in determining
This can occur primarily in two situations, which are not the type of anterior tooth movement in sliding mechanics.
necessarily mutually exclusive. At the end of phase IV, The greater the degree of play between the archwire and
there is increased binding and inter-locking of the archwire the bracket, the greater will be the tipping as the incisor
to the bracket. This causes the upward and backward brackets can rotate into that space, causing the roots to
retraction force to be transmitted to the posterior segment move labially (Tominaga et al., 2012). In other words, the
through the archwire. The stiffer and thicker the archwire, incisors will undergo a prolonged phase I space closure.
the more pronounced this effect will be. A similar effect is Table 1 shows the approximate values of play between
seen when the space between the anterior and posterior archwires and a 0.02260.028 inch bracket slot (Dellinger,
teeth is completely closed, but the retraction force is 1978; Joch et al., 2010; Schwaninger, 1978). Needless to
continued for closing residual anterior spaces. This results
in transmission of the total force to the posterior segments Table 1 Archwire-bracket clearance angle (play) for various
through the interdental contacts, producing a distal and archwires when placed in a 0.02260.028 inch bracket slot
intrusive force on the posterior teeth and a moment on the
entire arch (Figure 7). These mechanics have often been Wire size (inches) Amount of play (u)
employed to correct class II molar relationships without
0.01660.022 16–18
extractions. (Hee Oh et al., 2011; Park et al., 2005)
0.01760.025 12–14
Distalization with MIs also helps with efficient control of
0.01960.025 6–8
the vertical dimension by preventing extrusion of the
0.02160.025 2–3
molars (Figure 7), thereby maintaining the mandibular
 JO September 2014 Mini-implant Supplement Fundamentals of the mechanics involved S21

between the two attachments (here it can be assumed

between the molar and the incisors), D is the flexural
rigidity described above, K is a constant that reflects the
stiffness of the beam and is dependent upon the brackets
supporting it. Please note, this equation is more suitable
to describing tooth movement that mimics a ‘three point
bending test’ or a cantilever beam with the load con-
centrated at the free end.

The ‘hybrid model’ of space closure with MI

Figure 8 The amount of play between the bracket and anchorage.
archwire depends on the size of the archwire The hybrid approach combines the two methods of
controlling anterior teeth retraction, applying a counter-
say, a 0.01660.022 inch wire will show more tipping than balancing moment and changing the line of force
a 0.01960.025 inch wire (Figure 8). application (Figure 9). In this approach, a power arm
However, in the previous section it has been assumed is soldered on to the archwire mesial to the canine,
that the orthodontic wire in question acts as a ‘rigid bilaterally. In this way the clinician can choose the line
beam’. In reality this is not the case. An important of force application from the CRES through the power
mechanical aspect to consider is the flexural rigidity of the arm to the MI. This will help in controlling the MF from
archwire, which is critical in regulating wire deformation. the beginning of space closure. Remember, the closer
Flexural rigidity (D) is denoted by EI, where E is Young’s the line of force to the CRES the lesser is the moment due
modulus of the archwire material, and I is the moment of to force (Figure 4). Additionally, the retraction force
inertia of the cross-sectional area. It is defined as the from the power arm causes the upward deformation
wire’s ability to resist deformation under load. Once the and the torsion of the anterior segment of the archwire.
tipping of incisors has occurred and there is no wire This torsion of the archwire produces a couple, which
works as an anti-tipping moment to the anterior teeth
bracket clearance, the flexural rigidity of the archwire or
(Figure 10) as the available play is reduced by the wire
the archwire deformation under the applied load (retrac-
twisting within the bracket slot and creating a moment
tion force) will largely determine the type of tooth
due to a couple in the opposite direction of MF. In other
movement (Kojima and Fukui, 2010; Adams et al.,
words, this couple has a lingual root tipping effect on
1987). If the wire undergoes elastic deformation, the
the incisors. Longer power arms are more effective in
incisors will keep on tipping in spite of the ‘zero’
minimizing archwire deflection than shorter ones as the
clearance between the archwire and bracket (phase IV
MF is reduced. Also, thicker wires will provide better
of incisor retraction). The amount of archwire defor-
torsional control than lighter wires as we saw in the
mation can be estimated depending on both the flexural
preceding section. Additionally, it is important to begin
rigidity of the archwire and net force acting on the
with an optimal force level (light not heavy) for retraction,
incisors. As a rule, smaller sized and less stiff archwires which preferably decays with time (as is seen with an
show increased flexion when subjected to retraction elastic chain) so that any deformation or deflection of
forces (Ouchi et al., 1998). Therefore, it is advisable to the archwire can be restored. In other words, every effort
carry out ‘en masse’ space closure with rigid stainless should be made to confine incisor retraction to Phase III
steel archwires, as opposed to the more flexible nickel- as discussed previously.
titanium based archwires.
The mechanical factors described in the preceding
section can be put together to form an equation to Summary and conclusions
illustrate the mechanics of a wire under a load (Adams MIs are currently one of the best modalities to maintain
et al., 1987; Brantley et al., 2001): ‘absolute’ anchorage. However, by themselves they do not
guarantee a well-defined and controlled retraction within
FL3
D~ the anterior teeth. Side effects are bound to happen. An
KD understanding of the basic tenants of space closure via
sliding mechanics can help prevent these unwanted side
Here, D is the amount of deflection of the archwire effects. Line of force application, amount of force, force
under the applied load F from its original position (as decay and constancy, archwire-bracket play and archwire
shown in Figure 6c and d), L is the length of the archwire deflection (regulated primarily by the archwire properties)
 S22 Upadhyay et al. Mini-implant Supplement JO September 2014

Figure 9 Clinical application of power arm soldered on 0.01960.025 SS archwires for space closure. The blue arrow
shows the root movement obtained

are critical factors for controlling incisor retraction with increases in friction/binding forces leading to stagnation
MI-supported anchorage. It is imperative to regulate or slowing of tooth movement.
these factors in order to minimize archwire deflection for Various models describing incisor retraction have been
unwanted side effects, including loss of torque control on proposed in this paper. These suggestions are a culmination
the incisors, resulting deep bite and/or lateral open bite of numerous research papers published in the litera-
caused by tipping of the anterior and posterior teeth and ture regarding sliding mechanics and the theoretical

Figure 10 Sliding mechanics with power arm. (a) Moment (blue) due to retraction force. (b) Moment (red)
generated by the torsional effect of the archwire
interpretations of mechanical laws guiding tooth move- Kojima Y, Kawamura J, Fukui H. Finite element analysis of the effect of force
directions on tooth movement in extraction space closure with miniscrew
ment as we understand them at the University of sliding mechanics. Am J Orthod Dentofacial Orthop 2012; 142: 501–
Connecticut. 518.
Moore JC, Waters NE. Factors affecting tooth movement in sliding mechanics.
Eur J Orthod 1993; 15: 235–241.
Disclaimer statements Ouchi K, Watanabe K, Koga M, Isshiki Y, Kawada E, Oda Y. The effect of
Funding None. retraction forces applied to the anterior segment of orthodontic archwires:
differences in wire deflection with wire size. Bull Tokyo Dent Coll 1998; 39:
Conflicts of interest None. 183–188.
Park HS, Lee SK, Kwon OW. Group distal movement of teeth using microscrew
Ethics approval None. implant anchorage. Angle Orthod 2005; 75: 602–609.
Schwaninger B. Evaluation of the straight archwire concept. Am J Orthod 1978;
74: 188–196.
Sia SS, Shibazaki T, Yoshiyuki K, Yoshida N. Experimental determination of
Acknowledgements optimal force system required for control of anterior tooth movement in
sliding mechanics. Am J Orthod Dentofacial Orthop 2009; 135: 36–241.
Madhur Upadhyay is thankful to all the past and Smith RJ, Burstone CJ. Mechanics of tooth movement. Am J Orthod 1984; 85:
present residents of the University of Connecticut for 294–307.
being very actively involved in his weekly lectures and Tominaga J, Chiang PC, Ozaki H, Tanaka M, Koga Y, Bourauel C, et al. Effect
of play between bracket and archwire on anterior tooth movement in
discussions on ‘Mechanics of tooth movement.’ A large sliding mechanics: A three-dimensional finite element study. J Dent
part of this paper comes from those discussions. Biomech 2012; 3: 1–8.

References
Adams DM, Powers JM, Asgar K. Effects of brackets and ties on stiffness of an
archwire. Am J Orthod Dentofac Orthop 1987; 91: 131–136.
Barlow M, Kula K. Factors influencing efficiency of sliding mechanics to close
extraction space: a systematic review. Orthod Craniofac Res 2008; 11: 65–73.
Brantley WA, Eliades T, Litsky AS. Mechanics and mechanical testing of
orthodontic materials: In Nanda R. 2nd edn. Orthodontic Materials:
Scientific and Clinical Aspects, Stuttgart: Georg Thieme Verlag, 2001. pp
28–47.
Dellinger EL. A scientific assessment of the straight-wire appliance. Am J Orthod
1978; 73: 290–299.
Hee Oh Y, Park HS, Kwon TG. Treatment effects of microimplant-aided sliding
mechanics on distal retraction of posterior teeth. Am J Orthod Dentofacial
Orthop 2011; 139: 470–481.
Joch A, Pichelmayer M, Weiland F. Bracket slot and archwire dimensions:
manufacturing precision and third order clearance. J Orthod 2010; 37:
241–249.
Josell SD, Leiss JB, Rekow ED. Force degradation in elastomeric chains. Semin
Orthod 1997; 3: 189–197.
Kojima Y, Fukui H. Numerical simulations of en masse space closure with
sliding mechanics. Am J Orthod Dentofacial Orthop 2010; 138: 702.e1–
702.e6.
Kojima Y, Fukui H. A finite element simulation of initial tooth movement,
orthodontic movement, and the center of resistance of the maxillary teeth
connected with an archwire. Eur J Orthod 2014; 36: 255–261.