Kojima 2007
Kojima 2007
Introduction: Uprighting a tipped molar by using an uprighting spring is a fundamental orthodontic treatment
technique. However, mechanical analyses have not been carried out for molar uprighting, and the
mechanism of tooth movement has not been clarified. The purposes of this article were to clarify these
mechanisms and to demonstrate the usefulness of mechanical simulations by which the effects of many
factors on tooth movement can be estimated quantitatively. Methods: A 3-dimensional finite element
method was used to simulate the uprighting of a second molar with a molar uprighting spring. The effects of
a retainer and spring-arm bending on the tooth movements were shown quantitatively. Results: The retainer
was useful to reduce the movement of anchor teeth. The same effect could be achieved by bending the
spring arm in the lingual direction, but the molar was greatly rotated in the occlusal plane and was tipped in
the buccal direction. Conclusions: The usefulness of a mechanical simulation method to predict orthodontic
tooth movement in clinical situations was demonstrated. (Am J Orthod Dentofacial Orthop 2007;132:630-8)
O
ne of the most fundamental orthodontic tech- the effects of many factors on tooth movement can be
niques is to upright a tipped molar by using an estimated quantitatively.
uprighting spring.1,2 In this technique, a ca-
nine and the premolars as the anchor teeth are con-
nected with a wire. To strengthen the anchorage, the MATERIAL AND METHODS
canine and the premolar of the treated side are con- Tooth element and orthodontic tooth movement
nected with a lingual retainer to those teeth of the When the force falls below 1 or 2 N, it can be
opposite side.1 Furthermore, the arm of the uprighting assumed that the teeth and the alveolar bone are
spring is bent toward the lingual side to prevent buccal undeformable, rigid bodies.8 At this level of force, the
movement of the anchor teeth and lingual movement of initial tooth movement is produced by deformation of
the molar.1 Such wire bending has been used in many the periodontal ligament (PDL). In addition, the PDL is
orthodontic tooth movements.3-5 assumed to be a homogeneous elastic film with uniform
However, mechanical analyses have not been car- thickness. Under these assumptions, the action of the
ried out for molar uprighting. The mechanism of tooth PDL is the same as an elastic spring. In other words, a
movement has not been clarified. Also, the effects of tooth supported by the PDL can be represented by a
the retainer and the bent spring arm on tooth movement spring element in a 3-dimensional (3D) finite element
have not been clarified. The main purpose of this article analysis.8 This spring element will be called the “tooth
was to clarify these effects. By using a previously element.” By using the surface model of any tooth, the
proposed method,6,7 the movements of the molar and stiffness matrix of the tooth element can be calculated
the anchor teeth produced by an uprighting spring were easily. The calculation method for tooth elements is
calculated. Another purpose was to demonstrate the shown in the Appendix (1). In this study, the surface
usefulness of such mechanical simulations, by which models of the molar and the anchor teeth were made
a
Associate professor, Department of Mechanical Engineering, Nagoya Institute based on a dental study model (Nissin Dental Products,
of Technology, Nagoya, Japan. Kyoto, Japan). The surface models were divided into
b
Research assistant, Department of Mechanical Engineering, Kanagawa Insti-
tute of Technology, Atsugi, Japan.
small triangular regions as finely as possible. The
c
Professor, Department of Dental Materials Science, School of Dentistry, number of small regions for each tooth was about 2000.
Aichi-Gakuin University, Nagoya, Japan. It was further assumed that the thickness of the PDL
Reprint requests to: Yukio Kojima, Nagoya Institute of Technology, “Shikumi”
College, Department of Mechanical Engineering, Gokiso-cho, Showaku-ku,
was 0.2 mm, Young’s modulus was E ⫽ 0.2 MPa, and
Nagoya, 466-8555, Japan; e-mail, kojima.yukio@nitech.ac.jp. Poisson’s ratio was ⫽ 0.47. With these values, the
Submitted, April 2005; revised and accepted, July 2005. labiolingual and axial mobility values of the maxillary
0889-5406/$32.00
Copyright © 2007 by the American Association of Orthodontists. first premolar calculated by using the tooth element
doi:10.1016/j.ajodo.2005.07.035 were about 15 and 8 m per newton, respectively.
630
American Journal of Orthodontics and Dentofacial Orthopedics Kojima, Mizuno, and Fukui 631
Volume 132, Number 5
RESULTS
Without both the retainer and spring-arm bending
When hooking the anterior end of the spring arm to
the anchor wire, an upward force of 0.66 N was
necessary. This eruptive force and the moment tending
to upright (0.66 N · 22 mm ⫽ 15 N · mm) acted on the
second molar. The reaction force, an intrusive force of
0.66 N, acted on the anchor wire. With the uprighting
of the second molar, the initial elastic deformation of
the spring gradually returned to its original state, and
the forces acting on the teeth gradually decreased.
Figure 3 shows the teeth at an early stage of tooth
movement (CT ⫽ 25 m/kPa). This figure is based on
the results of our calculations. The position of the teeth
and the configuration of the wires were calculated by Fig 4. Position of teeth after sufficient time elapsed (CT ⫽
using the finite element model (Fig 2). The stress 500 m/kPa), without the retainer and spring-arm bend-
distribution in the PDL of the teeth was calculated by ing. Initial position of the teeth and passive position of the
using each surface model. Both results are shown spring are indicated by hidden red lines. a, Occlusal view:
together in Figure 3. The beam elements (anchor wire anchor teeth moved in the buccal direction. b, Sagittal
and spring) and brackets are represented by rectangular view: anchor teeth intruded and tipped.
blocks. The distribution of mean stress, m, in the PDL
is indicated by color contours. The initial position of Figure 3, the force acting on the anchor wire was 0.5 N.
the teeth and the passive position of the spring are On the buccal surface of the anchor teeth, a compres-
represented by hidden red lines. At the stage shown in sive stress was produced in the upper area with a tensile
American Journal of Orthodontics and Dentofacial Orthopedics Kojima, Mizuno, and Fukui 633
Volume 132, Number 5
the buccolingual direction was not produced, so the results are necessary to make quantitative comparisons
molar did not tip in that direction. Buccolingual tipping with experimental results. When calculated results do
of the second molar depends on the loading position, L, not agree with experimental results, we will examine
and not on the bracket position, B. As a result of this the assumptions and improve the calculation method.
calculation, buccolingual tipping of the second molar is Since tooth movements under clinical conditions can be
not a problem. simulated by this method, the simulation results can be
compared directly with the clinical results. However,
Effects of the retainer the data required for the calculation could not be found
When the left canine and the first premolar were in previous studies. Hence, confirmation of the tooth
connected to the right ones by the retainer, the right movements predicted by our results must be left for the
teeth supported part of the intrusive force acting on the future.
anchor wire. The stress acting on the left anchor teeth
(Fig 5) was less than that without the retainer (Fig 3). CONCLUSIONS
Also, the buccal movement and the tipping angle of the The 3D finite element method was used to simulate
anchor teeth (Fig 6) was only about one third of that uprighting of the second molar with a molar uprighting
without the retainer (Fig 4). On the other hand, the spring. The effects of a retainer and spring-arm bending
movement of the molar (Fig 6) was similar to that on the tooth movements were shown quantitatively.
without the retainer (Fig 4). Thus, the effects of the The retainer was useful in reducing the movement of
retainer, recommended for clinical treatments,1 were the anchor teeth. The same effects could be achieved by
confirmed quantitatively. When the root length of the bending the spring arm in the lingual direction, but this
anchor teeth is shorter, the retainer will be especially greatly rotated the molar in the occlusal plane and
useful in preventing movement of the anchor teeth. tipped it in the buccal direction. The usefulness of such
mechanical simulations to predict orthodontic tooth
Effects of bending the spring arm movement in clinical situations was demonstrated.
When the spring arm was bent toward the lingual
side before activation, the initial activation produced a
force tending to move the anchor teeth in the lingual REFERENCES
direction. This force produced a moment in the oppo- 1. Proffit WR. Contemporary orthodontics. St Louis: Mosby; 1986.
site direction of that produced by the intrusive force. 2. Williams JK, Cook PA, Isaacson KF, Thom AR. Fixed orthodon-
tic appliances—principles and practice. Oxford: Butterworth-
These moments canceled each other out, and the stress
Heinemann; 1995.
of the anchor teeth (Fig 7) became less than that 3. Mulligan TF. Common sense mechanics. J Clin Orthod 1979;13:
without wire bending (Fig 3). The movement of the 588-94, 676-83, 762-6, 808-15; and 1980;14:53-7, 98-103,
anchor teeth became smaller (Fig 8) than that without 180-9, 265-72, 336-42, 412-6, 481-8, 546-53, 637-47, 716-23,
bending (Fig 4). The buccal movement of the anchor 788-95.
4. Burstone CJ, Koenig HA. Creative wire bending—the force
teeth, ␦, became 0 at the bending angle of  ⫽ 28°
system from step and V bends. Am J Orthod Dentfacial Orthop
(Fig 9). 1988;93:59-67.
On the other hand, the initial activation of the 5. Siatkowski RE. Force system analysis of V-bend sliding mechan-
spring produced a force tending to move the second ics. J Clin Orthod 1994:28:539-46.
molar in the buccal direction. This force produced a 6. Kojima Y, Fukui H. A numerical analysis of tooth movement by
orthodontic forces. J Jpn Soc Dent Mat Device 2002;21:40-8.
moment tending to rotate the molar in the occlusal
7. Kojima Y, Fukui H. Numerical simulation of canine retraction by
plane. This force and moment produced stress distribu- sliding mechanics. Am J Orthod Dentofacial Orthop 2004;127:
tion on the buccal surface of the molar; ie, compressive 542-51.
stress in the upper mesial area and tensile stress in the 8. Kojima Y, Takano S, Fukui H, Mizutani N, Hasegawa J. A
lower distal area (Fig 7). This stress distribution rotated simple method for calculating the initial tooth mobility and stress
the molar in the occlusal plane and moved the crown in distribution in the periodontal ligament. J Jpn Soc Dent Mat
Device 1999;18:210-6.
the buccal direction. The rotational angle of the molar, 9. Goto T. Experimental study on the physiological mobility of the
␣, reached about 70% of the bending angle of the tooth. Shikwa Gakuho 1971;71:1415-44.
spring arm,  (Fig 9). These movements are unfavor- 10. Tanne K, Sakuda M, Burstone CJ. Three-dimensional finite
able for molar uprighting. However, when an initially element analysis for stress in the periodontal tissue by orthodon-
rotated molar is being corrected, this technique can be tic forces. Am J Orthod Dentofacial Orthop 1987;92:499-505.
11. Jeon PD, Turley PK, Moon HB, Ting K. Analysis of stress in the
used to advantage. periodontium of the maxillary first molar with a three-dimen-
The tooth movements shown here are considered sional finite element method. Am J Orthod Dentofacial Orthop
from a mechanical point of view. However, calculated 1999;115:267-74.
American Journal of Orthodontics and Dentofacial Orthopedics Kojima, Mizuno, and Fukui 637
Volume 132, Number 5
12. Chang YI, Shin SJ, Baek SH. Three-dimensional finite element
analysis in distal en masse movement of the maxillary dentition
with the multiloop edgewise archwire. Eur J Orthod 2004;26:
339-45.
13. Jeon PD, Turley PK, Ting K. Three-dimensional finite element
analysis of stress in the periodontal ligament of the maxillary first
molar with simulated bone loss. Am J Orthod Dentofacial Orthop
2001;119:498-504.
14. Puente MI, Galban L, Cobo JM. Initial stress differences between
tipping and torque movements. A three-dimensional finite ele-
ment analysis. Eur J Orthod 1996;18:329-39.
15. Isacson RJ, Lindauer SJ, Conley P. Responses of 3-dimensional
arch wires to vertical v-bends: comparisons with existing 2-di-
mensional data in the lateral view. Semin Orthod 1995;1:57-63.
16. Bourauel C, Vollmer D, Jager A. Application of bone remodeling
theories in the simulation of orthodontic tooth movements. J
Orofac Orthop 2000;61:266-79.
17. Schneider J, Geiger M, Sander FG. Numerical experiments on
long-time orthodontic tooth movement. Am J Orthod Dentofacial
Orthop 2002;121:257-65.
18. Toms SR, Lemons JE, Bartolucci AA, Eberhardt AW. Nonlinear
stress-strain behavior of periodontal ligament under orthodontic
loading. Am J Orthod Dentofacial Orthop 2002;122:174-9.
19. Coolidge ED. The thickness of the human periodontal mem-
brane. J Am Dent Assoc Dent Cos 1937;24:1260-70. Fig A1. Surface model of tooth used to calculate the
20. Qian H, Chen J, Katona TR. The influence of PDL principal
tooth element. The PDL over the root is divided in
fibers in a 3-dimensional analysis of orthodontic tooth move-
ment. Am J Orthod Dentofacial Orthop 2001;120:272-9.
small triangular regions where stresses are defined as
21. Toms SR, Eberhardt AW. A nonlinear finite element analysis of shown.
the periodontal ligament under orthodontic tooth loading. Am J
Orthod Dentofacial Orthop 2003;123:657-65.
22. Ziegler P, Ingervall B. A clinical study of maxillary canine within the PDL, and 2 and 3 are shearing stresses
retraction with a retraction spring and with sliding mechanics. acting on the inner and outer surfaces of the PDL.
Am J Orthod Dentofacial Orthop 1989;95:99-106. The stiffness matrix of the tooth element shows the
23. Lee BW. Relationship between tooth-movement rate and esti-
relationship between the displacements of the tooth
mated pressure applied. J Dent Res 1965;44:1053.
24. Ren Y, Maltha JC, Kuijpers-Jagtman AM. Optimum force and the forces applied to the tooth. It is calculated by
magnitude for orthodontic tooth movement: a systematic litera- the procedure below.
ture review. Angle Orthod 2003;73:86-92. The position vector of the small triangular region i
from the loading position is denoted by ri. A local
APPENDIX coordinate of 1, 2, and 3 is defined in each region, and
1. Calculation of the stiffness matrix of tooth unit vectors n1i, n2i and n3i are defined along the 1, 2,
elements8 and 3 axes, as shown in Figure A1. Considering a rigid
motion of the tooth, translation u ⫽ (ux, uy, uz) and
The surface model of the tooth used in the calcula-
rotation ⫽ ( x, y, z), the displacement vector at i
tion is shown Figure A1. As an example, a mandibular
can be written as
canine is shown. The tooth element for any tooth can be
calculated by the same procedure. d ⫽ u ⫹ ⫻ ri (A-1)
The thickness of the PDL is denoted by t. The
inner surface of the PDL is bonded to the dentin, and Then the average strains in the region i are assumed
the outer surface is bonded to the alveolar bone. The to be
PDL is divided into small triangular regions, as
1i ⫽ d · n1i ⁄ t, ␥2i ⫽ d · n2i ⁄ t, ␥3i ⫽ d · n3i ⁄ t (A-2)
shown in Figure A1. These regions are not the
elements used in the finite element method. In Figure where ε1i is the normal strain, and ␥2i, and ␥3i are the
A1, the surface of the tooth crown is divided into shearing strains. The deformation of the PDL along
small triangular regions, but these regions are not the tangential directions is constrained by the alveolar
necessary for calculation. Only triangular regions bone and the root of the tooth; ie, normal strains in
over the PDL are necessary. The stresses in each these directions are assumed to be 0, ε2i ⫽ ε3i ⫽ 0.
small region were assumed as shown in Figure A1, The stresses in the small region i are obtained from
where 1, 2, and 3 are normal stresses acting the stress-strain relations as
638 Kojima, Mizuno, and Fukui American Journal of Orthodontics and Dentofacial Orthopedics
November 2007
1i ⫽ E1i, 2i ⫽ 3i ⫽ 1i ⁄ (1 ⫺ ), 2i ⫽ G␥2i, given a unit displacement, ux⫽ 1. Each tooth element
has 1 node, and its degree of freedom is 6 (3 transla-
3i ⫽ G␥3i (A-3) tions and 3 rotations).
E(1 ⫹ ) E
E ⫽ , G⫽ 2. Calculation of orthodontic tooth movement6
(1 ⫹ )(1 ⫺ 2) 2(1 ⫹ )
where E is Young’s modulus and is Poisson’s ratio Denoting the mean stress acting in small region i by
of the PDL. mi (⫽(1i ⫹ 2i ⫹ 3i)/3), the amount of bone
By multiplying the area of the small region Ai by absorption in a small time increment, ⌬T, is ⫺C
these stresses, the force vector ⌬pi for each small mi⌬T, where C is the amount of absorption per unit of