Bioengineering Principles in Orthodontics / Orthodontic Courses by Indian Dental Academy

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BIOENGINEERING PRINCIPLES IN ORTHODONTICS
CONTENTS
INTRODUCTION
PERIODONTAL LIGAMENT
ALVEOLAR BONE
TOOTH MOVEMENTS 1. PHYSIOLOGICAL
2. ORTHODONTIC
THEORIES OF TOOTH MOVEMENTS
EFFECTS OF FORCE MAGNITUDE
FACTORS EFFECTING ORTHODONTIC TOOTH
MOVEMENT
EFFECT OF DRUGS ON RESPONSE TO
ORTHODONTIC FORCES.

DELETERIOUS EFFECTS OF ORTHODONTIC
FORCES
TYPES OF TOOTH MOVEMENTS
MECHANICAL PRINCIPLES IN FORCE CONTROL
PROPERTIES OF ELASTIC MATERIALS
FACTORS AFFECTING ELASTIC PROPERTIES
FORCE,MOMENT AND COUPLES IN TOOTH
MOVEMENT
SYSTEM EQUILIBRIUM
SEGMENTED AND CONTINUOUS ARCH
MECHANICS
CONCLUSION.

INTRODUCTION
Orthodontic therapy depends upon the reaction
of the teeth, and more generally the facial
structures to gentle but persistent force. The
main purpose of presenting a discussion on the
biophysical principles of tooth movement is to
know the facts and histological findings that
have a bearing on practical orthodontics.
In the orthodontic context,
biomechanics is commonly used in
discussions of the reaction of the dental
and facial structures to orthodontic force,

whereas mechanics is reserved for the
properties of the strictly mechanical
components of the appliance system.
Tissue consciousness is a vital prerequisite
to mechanics. There are available today potent
tooth-moving appliances that can accomplish
almost any desired change, but if their use is not
controlled by a profound respect for the
biological media in which they work, then
tremendous harm can be done.

The forces are applied to the teeth with the
objective of getting desired tooth movement, in
the desired direction, in the desired amount of
time. Thus it is obvious that a sound biological
understanding of the orthodontic tooth
movement is a must.
PERIODONTAL
LIGAMENT

The pdl is the soft specialized connective tissue
situated between the bone forming the socket wall
and the cementum covering the root surfaces.

It ranges in width from 0.15 to 0.38mm, with its
thinnest portion around the middle third of the root.
Like any other connective tissue it consists of cells
and an extra cellular compartment of fiber and
ground substance.
The cells include
Osteoblasts and osteoclasts
Fibroblasts
Epithelial cells of malasses
Macrophages
Undifferentiated mesenchymal cells
Cementoblasts

The extra cellular compartment:
collagen and
oxytalan fibers
embedded in ground substance consisting
mainly of glycosaminoglycans,
glycoproteins and glycolipids
The vast majority of the collagen fibrils in the
periodontal ligament are arranged in definite
and distinctive fiber bundles. These fiber
bundles are arranged in groups and are
sometimes called the principal fibers of the
ligament.
At either end all the principal collagen fiber
bundles of the pdl are embedded into cementum
or bone. The embedded portion of the fibers is
called the Sharpeys fibers.

The alveolar crest fibers: attached to the cementum just
below the CEJ and running downward and outward to
insert into the rim of the alveolus.
The horizontal group: occurring just apical to the
alveolar crest group and running at right angles to the long
axis of the tooth from cementum to bone just below the
alveolar crest.
The oblique group: by far the most numerous in the
ligament and running from the cementum in an oblique
direction to insert into bone coronally.
The apical group: radiating from the cementum around
the apex of the root to the bone, forming the base of the
socket.
The inter-radicular group: found only between the roots
of multirooted teeth and running from the cementum to
the bone forming the crest of the inter radicular septum.
FUNCTIONS OF THE PDL
Physical functions:
Transmission of occlusal forces to the bone
Attachment of teeth to the bone
Maintenance of the gingival tissues in proper
relationship to the teeth
Resistance to the impact of occlusal forces
Provides a soft tissue housing to protect the
vessels and nerves from injury by
mechanical forces.
Formative functions:
The undifferentiated cells in the pdl
serve as precursors for the cementum and bone
forming cells. In fact they play a key role in
bone remodeling.

Nutritional functions:
By the way of blood vessels that
traverse, the pdl supplies nutrients to the
cementum, bone and gingival for their metabolic
activities. It also provides lymphatic drainage.
Sensory functions:
The innervations of the pdl provide
propioceptive and tactile sensation, which detect and
localize external forces acting upon individual teeth
and serve an important role in neuromuscular
mechanism controlling the masticatory musculature.
Other functions:
Through the formation, cross linkage and
maturational shortening of collagen fibers, it helps
in eruption of teeth.
The metabolic activities occurring within the pdl
maintain the teeth in position even though the
forces acting from extraoral and intraoral muscles
are not balanced.

ALVEOLAR BONE

The alveolar process is that bone of the jaws
that contains the sockets (alveoli) for the teeth
and consists of outer cortical plates, a central
spongiosa and bone lining the alveolus.

The cortical plate and the alveolar plate and the
bone lining the alveolus meet at the alveolar
crest, usually 1.5 to 2 mm below the level of the
CEJ of the tooth it surrounds.
The bone lining the alveolus is specifically called the
bundle bone because it is this bone that provides
attachment for the pdl fibers. It is perforated by many
foramina that transmit nerves and vessels and is
therefore sometimes referred to as the CRIBRIFORM
PLATE. It is also called as the lamina dura because
of its increased radio opacity.
The cortical plate consists of surface layers of fine
fibered lamellar bone supported by compact Haversian
system bone of variable thickness. The trabecular or
spongy bone occupying the central part of the alveolar
process also consists of fine-fibered membrane bone
dispersed in the large trabeculae.
The important part of this complex in term of
tooth support is the bundle bone.
TOOTH MOVEMENT

To a layperson the most rigid thing in the body is his
set of teeth. He accepts the fact that they can wear
down over the years but if they move he expresses
alarm. He knows nothing about the cushioning
connective tissue, the periodontal membrane that is
as vital as any tissue in the body. He does not know
that bone is a vital tissue and also undergoes
constant reorganization; that teeth move constantly
and imperceptibly through out life
Physiological tooth movement
designates primarily, the slight tipping of the
functioning tooth in its socket and, secondarily,
the changes in tooth position that occur in
young persons during and after tooth eruption.
The minor changes in tooth position observed in
growing persons and adults are usually called
tooth migration. Tooth migration in both young
and older persons is always related to definite
tissue changes that can be readily observed in
histological sections
With the wearing away process teeth continue to
erupt. Contacts are worn and contact points
become contact surfaces. Mesial drift compensates
for the space created, and as the tooth moves the
socket shifts with the tooth. Bone is resorbed
ahead of the drifting tooth and deposited behind it.
Resorption is seen as an uneven scalloped margin,
with the presence of osteoclasts. Bone deposition
appears histologically as concentric lamella of
bundle bone laid down in the presence of and with
the aid of the bone-building cells the osteoblasts.
As the alveolus move leaving space for the tooth
and the pdl, bony reorganization outside the
alveolus occurs. Ahead of the moving tooth,
trabaculae show resorption on the side nearest
the moving tooth, deposition of bone on the side
farther away. Behind the moving tooth bone is
deposited on the side away from the tooth to
maintain a constant length of the trabecular
structure.
The osteoblast first lay down an organic matrix known
as the osteoid. This then becomes calcified as calcium
salts are deposited in the matrix. The newly calcified
tissue is called bundle bone and is basophilic in
appearance. The staining properties of bundle bone
are related to its high content of cementing
substance, consisting essentially of highly polymerized
connective tissue polysaccharides.
Cells and fiber bundles will be incorporated in bundle
bone during its life cycle. When it has reached a
certain thickness and maturity, parts of the bundle
bone will reorganize into lamellated bone with fine
fibrils in its matrix. The lamina dura will subsequently
reappear as a somewhat thinner radio opaque line.

This sequence of events is, in principle, the same as
that in bone formation after orthodontic tooth
movement.
It has been established beyond doubt that bone is
biologically plastic and adaptive to developmental and
functional forces, responding to pressure with
resorption and to tension with bone deposition. It is
the property of the teeth to move and reflect various
environmental influences by positional modifications
throughout life that the orthodontist uses to move
teeth to the desired new position. Alveolar bone has
been referred to as the slave of the orthodontist.
The essential processes are there and at work before
he attempts guided tooth movement by mechanical
appliances. The bony response is primarily mediated
by the periodontal ligament, and so the tooth
movement is believed to be primarily a periodontal
phenomenon.
ORTHODONTIC TOOTH
MOVEMENTS
Theoretically it should be possible to bring about
tooth movement without any tissue damage by
using a light force, equivalent to the
physiological forces determining tooth position,
to capitalize on the plasticity of the supporting
tissues.
However most current orthodontic techniques
do not duplicate the ideal situation; most involve
some degree of tissue damage that varies
because the forces applied to move the tooth
are not equally distributed throughout the pdl
The orthodontic response to light, continuous
load is divided into three elements of tooth
displacement:

Initial strain:
occurs in about one week. The displacement
produced is about 0.4- 0.9 mm and is due to the
pdl displacement, bone strain and extrusion. The
fluid mechanics of root displacement in the pdl
probably accounts for about 0.3mm of crown
movement.

Lag phase:
the displacement of the tooth relative to its
osseous support stops in about one week. This
occurs due to areas of the pdl necrosis
(hyalinization). This phase is called the lag
phase. It varies from about 2-3 weeks and
may be as long as 10 weeks. The duration of
the lag phase is directly related to the patients
age, density of alveolar bone and extent of pdl
necrotic zone.

Progressive tooth movement:
after undermining resorption, vitality is restored
to the necrotic areas of the pdl, and the tooth
movement enters the secondary or progressive
tooth movement phase. Frontal resorption in the
pdl, and initial remodeling events in the cortical
bone ahead of the advancing tooth allow for
progressive tooth movement at a relatively rapid
rate
The duration of tooth movement can
be divided into two periods:

Initial stage:
when a constant orthodontic force is maintained on
the tooth, compression of the pdl occurs. This
causes degradation rather than causing
proliferation and differentiation. The tissues reveal
a glass like appearance when viewed in light
microscopy and is termed as Hyalinization.

HYALINISATION
it is an unavoidable phenomenon in the
initial period of tooth movement. It is
partly caused by anatomic and partly by
mechanical factors. It is a sterile necrotic
area and is limited to 1-2 mm in diameter.
The process displays three main stages:

Degeneration:
it starts when the pressure is the highest and
narrowing of the membrane is more pronounced.
There is retardation of blood flow followed by
disintegration of the vessel walls and degradation of
blood elements. Cells rupture, the nuclei breakdown
leaving unidentifiable cellular elements between the
collagen fibrils. In the hyalinised zone, cells cannot
differentiate into osteoclasts and so no resorption
occurs. Tooth movement stops.
Elimination of destroyed tissue:

Elimination of the hyalinised zone occurs by
two mechanisms
1. Resorption of the alveolar bone by
osteoclast
2. Invasion of cells and blood vessels from the
periphery of the compressed zone by which
the necrotic tissue is removed
Re establishment of tooth attachment:

this phase starts by the synthesis of new tissues
as soon as the adjacent bone and degenerated
membrane tissues have been destroyed. The
ligament space is wider than before treatment
and the membranous tissue under repair is rich
in cells. The pdl is reconstructed in the
hyalinised areas.
. Secondary stage of tooth movement:

the pdl is considerably widened. Osteoclasts attack
the bone over a wider area. Further bone
resorption occurs when force is kept constant and
within limits. New periodontal fibers are produced
and the fibrous attachment apparatus is
reorganized. A large number of osteoclasts are
seen along the bone surface and tooth movement
is rapid. Deposition of bone occurs on the alveolar
surface from which the tooth is moving away until
the width of the membrane has returned to normal
limits.
THEORIES OF TOOTH
MOVEMENT

Two main theories that have been proposed and are
accepted to play a part in the biologic control of
tooth movement. They are

The Bioelectric theory that relates the tooth
movement in part to changes in the bone
metabolism controlled by the electric signals that are
produced when alveolar bone flexes and bends.

The Pressure Tension theory which relates tooth
movement to cellular changes produced by chemical
messengers, traditionally thought to be generated by
alterations in blood flow through the pdl.
THE BIOELECTRIC THEORY
The electric signals that bring about initial tooth
movement are piezoelectric. Piezoelectricity is a
phenomenon observed in many crystalline materials
in which a deformation of the crystal structure
produces a flow of electric current as electrons are
displaced from one part of the crystal lattice to
another.
Bone is crystalline in nature and both bone and
collagen exhibit peizoeletric effect.
Piezoelectric signals have two unusual characteristics:
A quick decay i.e.; when a force is applied, a
piezoelectric signal is created in response that
quickly dies away to zero even though the force is
maintained.
The production of an equivalent signal, opposite in
direction, when force is released
When the crystal structure is deformed, electrons
migrate from one location to another and an electric
charge is observed. As long as the force is
maintained, the crystal structure is stable and no
further electric events are observed. When the force
is released, however, the crystal returns to its
original shape, and a reverse flow of electrons is
seen.
With this arrangement, rhythmic activity would
produce a constant interplay of electric signals,
whereas occasional application and release of force
would produce only occasional electric signals.
The action of any force causes minute distortions in a
bone. This leads to regional changes in configuration
involving localised surface concavities and
convexities.A concavity results in compression and a
negative surface charge, and a convexity causes
tension and a positive surface charge. This triggers
bone deposition and resorption, respectively, by the
peizo effect acting on surface cell receptors of
osteoblasts and osteoclasts. The bone thereby
remodels until biomechanical and bioelectric
neutrality is attained.
If an existing concave surface becomes more
concave, the effect is active compression and the
action response thereby depository. If an existing
concave surface becomes less concave, the action is
less compressive and a direction towards tension is
seen, the resultant response is resorption. If a convex
surface becomes either more or less convex, similarly,
the results are believed to be resorption and
deposition, respectively.
A second type of electric signal, which is called the
Bioelectric potential, can be observed in bone that
is not being stressed. Metabolically active bone or
connective tissue cells produce electronegative
charges that are generally proportional to how active
they are. Inactive cells and areas are nearly
electrically neutral.
This potential can be altered by applying an external
electric field.The effects are felt in the cell
membranes. Membrane depolarization triggers nerve
impulses and muscle contraction, but changes in
membrane potentials accompany other cellular
responses as well. The external electric signals
probably affect cell membrane receptors, membrane
permeability, or both.
Experiments indicate that when low voltage direct
current is supplied to the alveolar bone, modifying the
bioelectric potential, a tooth moves faster than its
control in response to an identical spring.

Electromagnetic fields also can affect cell membrane
potentials and permeability, and thereby trigger
changes in cellular activity.
PRESSURE TENSION THEORY

The pressure tension theory, the classic theory of
tooth movement relies on chemical rather than electric
signals as the stimulus for cellular differentiation and
ultimately tooth movement.

In this theory, an alteration in blood flow within the
pdl is produced by the sustained pressure that causes
the tooth to shift position within the pdl space,
compressing the ligament in some areas while
stretching it in others. Blood flow is decreased where
the pdl is compressed, while it usually is maintained or
increased where the pdl is under tension.
Alterations in blood flow quickly create changes in
the chemical environment. For instance, oxygen
levels certainly would fall in the compressed area,
but might increase on the tension side, and the
relative proportions of other metabolites would also
change in a matter of minutes. These chemical
changes, acting either directly or by stimulating the
release of other biologically active agents, would
stimulate cellular differentiation and activity.
In essence, this view of tooth movement
shows three stages:

Alterations in the blood flow associated
with pressure within the pdl,

The formation and\or release of chemical
messengers, and

Activation of cells.

EFFECTS OF FORCE
MAGNITUDE
< 1 sec Pdl fluid incompressible, alveolar
bones bends, piezoelectric signals
generated.

1-2 sec Pdl fluid expressed, tooth move
within the pdl space

3-5 sec Blood vessels within the pdl
occludes on the pressure side.
When heavy pressures are applied:
Mins Blood flow cut off to the
compressed pdl area.

Hours Cell death in the compressed area

3-5 days Cell differentiation in adjacent
marrow spaces, undermining
resorption begins

7-14 days Undermining resorption removes
lamina dura adjacent to compressed
pdl, tooth movement occurs.
When light pressure is applied:
< 1 sec Pdl fluid incompressible,
alveolar bone bends, piezoelectric
signal generated.

1-2 sec Pdl fluid expressed, tooth moves
with the pdl space

3-5 sec Blood vessels in the pdl partially
compressed on the pressure
side, dilated on the tension side,
pdl fibers and cells mechanically
destroyed
Mins Blood flow altered, oxygen tension
begins to change, prostaglandin
and cytokines released.

Hours Metabolic changes occurring,
chemical messengers affects
cellular activity, enzyme levels
change

--4 hrs Increased cAMP levels, cellular
differentiation begins within the pdl

--2 days Tooth movement beginning as
osteoclasts\osteoblasts remodel
bony socket.
FACTORS INFLUENCING
ORTHODONIC TOOTH
MOVEMENT
.


Local tissue reactions are influenced by
the anatomic characteristics of the
supporting bone into which the tooth is to
be moved,
the physiologic activity of the tissues that
surround the tooth and
the force application
Character of bone
Remodeling processes in bone depend on the activity
of the cells that act on its surfaces. Thus alveolar
bone that is penetrated by numerous canals to
transmit blood vessels and contains cancellous bone
with marrow spaces at its deeper aspect is favorable
for tooth movement.
On the other hand, if the bone involved is compact in
nature, that is cortical bone, then the surface area
where cellular activity can take place is greatly
reduced. Here tooth movement is more difficult and
slower, and the chances of creating over
compression and greater areas of hyalinization are
much higher.
Thus it is important that when planning orthodontic
treatment, the tooth should remain in spongy bone
during movement.
Extraction spaces contain tissues undergoing
reconstruction, which is rich in cells and vascular
supply. Such an area is ideally suitable for tooth
movement, and due advantage of this should be taken
by commencing treatment as soon as possible
following extraction. Thereby one also avoids atrophy
and narrowing of the alveolar process, resulting in
bone loss and cortical bone formation at the extraction
site.

Physiologic activity
The strong relapse tendency seen after the orthodontic
rotation of teeth is thought to be the result of slow
turn over of the gingival fibers mainly the supra-
alveolar fiber bundles. Turn over varies from person to
person and depends on a number of variables such as
hormonal balances, age of the patient and health of
the patient. Therefore it is necessary to consider these
variations during treatment planning, especially if the
patient is receiving medications like steroids or anti
epileptics, as the threshold for tissue changes or
cellular reactions will be influenced.

Force applications\ applied force
and time
key to orthodontic tooth movement is application of
light and sustained force, which does not mean that
the force must be continuous, but it must be present
for a considerable percentage of time. Experiments
have shown that the threshold for orthodontic tooth
movement in humans is 4-8 hours.
Orthodontic force duration is classified by
the rate of decay as
Continuous
Interrupted
intermittent
Continuous forces
force maintained at some appreciable fraction of the
original from one patient visit to another. Continuous
force leads to gradual compression of the pdl on the
pressure side of the tooth. If the force is within the
limitations where tissue reactions occur,
reconstructional changes of the fibrous element as
well as direct resorption of the alveolar bone wall take
place
Interrupted forces
force levels decline to zero between activations.
Here even if the hyalinised zones are
established, the pdl has the time to become
reconstructed. There is an increase in cell
proliferation, which is suitable for further tissue
changes following reactivation of the force.

Fixed appliances that are constantly present
on the tooth can produce both continuous and
interrupted forces.
Intermittent forces
force levels decline abruptly to zero intermittently,
when the orthodontic appliance is removed by the
patient or when a fixed appliance is temporarily
deactivated. On the pressure side, the circulation will
not be as easily disturbed or hindered unless the force
applied is too high. The intermittent force is thought
to act as an incitement to cell proliferation. Increase in
the cell numbers and direct bone resorptions along the
alveolar bone wall are characteristic of this type of
tooth movement. The periodontal space increases
because the tooth tends to return to its original
position following the removal of the force.
In spite of the favorable condition on the side
where resorption is seen, tooth movement often
will be slower than that seen during application of
continuous force, as the time over which the
appliance is used is a very important factor.
Formation of new tissue and apposition of bone are
seen to occur more rapidly under active or constant
stretching. Therefore, if the tooth is often allowed
to return to its original position, one can expect a
limited amount of apposition to occur.

EFFECTS OF DRUGS ON THE
RESPONSE TO ORTHODONTIC
FORCE

Agents that stimulate tooth movement are rare but
under some circumstances vitamin D administration
can enhance response to orthodontic forces. Direct
injection of prostaglandin into the pdl has shown to
increase the tooth movement, but this is very painful
and not practical.
Two types of drugs are known to depress the
response to orthodontic forces:
Biophosphates- used in treatment of
osteoporosis.

Prostaglandin inhibitors- used in the
treatment of arthritis.

Drugs that affect the prostaglandin activity are
corticoseroids and NSAIDs. These drugs interfere with
prostaglandin synthesis.


DELETERIOUS EFFECT OF
ORTHODONTIC FORCE
Pain
If heavy pressure is applied to a tooth, pain develops
immediately as the pdl is literally crushed.
If appropriate orthodontic force is applied, the patient
feels little or nothing immediately. Several hours later,
patient feels a mild aching sensation which lasts for 2
to 4 days, then disappears until the orthodontic
appliance is reactivated.
The tooth is quite sensitive to pressure. This suggests
inflammation at the apex, and the mild pulpities that
usually appears soon after orthodontic force is applied
probably contributes to the pain
If the source of pain is ischemic areas, strategies to
temporarily relieve pressure and allow blood flow
through the areas should help.
If light forces are used the amount of pain to the
patient can be decreased by having them engage in
repetitive chewing of gum or plastic wafer placed
between teeth during the first 8 hours after the
orthodontic appliance is activated.
Presumably this works by temporarily displacing the
teeth enough to allow some blood flow through the
compressed areas, thereby preventing build-up of
metabolic products that stimulate pain receptors.

Mobility
Orthodontic tooth movement requires both remodeling of
bone and reorganization of the pdl itself. Fibers become
detached from the bone and cementum, then reattach
later. Radiograpically it can be observed that the pdl
space widens during ortho tooth movement leading to
some mobility.
A moderate increase in mobility is an expected response
to orthodontic tooth movement. The heavier the force,
greater the amount of undermining resorption expected,
greater the mobility that will develop. If a tooth becomes
extremely mobile during treatment, it should be taken out
of occlusion and all forces should be discontinued until
the mobility decreases to moderate levels.
Effects on pulp
Although pulpal reactions to orthodontic treatment are
minimal, there is probably a moderate and transient
inflammatory response within the pulp, which
contributes to the discomfort that the patients feel for
the first few days after appliance activation.
There are occasional reports of loss of tooth vitality
during ortho treatment. If a tooth is subjected to
heavy continuous force, there is a sequence of abrupt
movements, which could sever the blood vessels as
they enter.

Effects on root structure
When ortho forces are applied, there is usually an
attack on the cementum of the root, just as there
is an attack on the adjacent bone, but repair of
the cementum also occurs.
Rygh and co-workers have shown that the
cementum adjacent to the hyalinsed areas of the
pdl are attacked by the clast cells and can lead to
severe root resorption. It is seen that if cementum
is removed from the root surface, then it is
restored in the same way that the alveolar bone is
removed and then replaced.
Repair of the damaged root restores its original
contours; unless the attack on the root surface
produces large defects at the apex that eventually
become separated from the root surface. Once an
island of cementum or dentin has been cut totally
free from the root surface, it will be resorbed and
will not be replaced.
Permanent loss of root structure after ortho
treatment appears primarily at the apex. Sometimes
there is a reduction in the lateral aspect of the root
in the apical region.

Effects on height of alveolar bone
Another effect of orthodontic treatment might be loss
of alveolar bone height. Since the presence of
orthodontic appliances increases the amount of
gingival inflammation, even with good hygiene, this
side effect might seem even more likely. Fortunately,
excessive loss of crestal bone height is almost never
seen as a complication of ortho treatment. The reason
is that the position of the tooth determines the
position of the alveolar bone. When teeth erupt or are
moved, they bring alveolar bone with them.
TYPES OF TOOTH
MOVEMENTS
Theoretically tooth movement is divided into
three types, viz,

Pure translation
Pure rotation
Combination of translation and rotation
Before we go into details about the various types of
tooth movement possible, a few concepts and
definitions have to be understood
FORCE: a load applied to an object that will
tend to move it to a different position in space.
Force has both direction and magnitude.

CENTER OF ROTATION: it is the point around
which the body seems to have rotated. The
center of rotation is not a fixed point and can
be changed by the manner of force application.
CENTER OF RESISTANCE: a point at which
resistance to movement can be concentrated
for mathematical analysis. For an object in free
space, the center of resistance is the same as
the center of mass. For an object, which is
partially restrained, the center of resistance will
be determined by the nature of the external
restraints. The center of resistance for a tooth
is approximately the midpoint of the embedded
portion of the root.
MOMENT: is force acting at a distance. It is
defined as the product of the force times the
perpendicular distance from the point of force
application to the center of resistance. If the
line of action of an applied force does not pass
through the center of resistance a moment is
created. Not only will the force tend to
translate the object to a different position, it
will also tend to rotate the object around the
center of resistance.
COUPLE: two forces equal in magnitude and
opposite in direction. A couple will produce
pure rotation, spinning the object around its
center of resistance. The combination of force
and couple can change the way an object will
rotate while it is being moved
PURE TRANSLATION
It occurs when all points on the tooth move
an equal distance in the same direction. This
is brought about when the line of action of an
applied force passes through the center of
resistance of the tooth.

Pure translation can be of
three types:

INTRUSION: translation of the
teeth along its long axis in an
apical direction
EXTRUSION: translation of
teeth along its long axis in an
occlusal direction
They are axial type of
translation and the center of
rotation lies at infinity.

BODILY MOVEMENT:
translation of teeth in
mesio-distal or labio-lingual
direction. Bodily movement
of a tooth is usually
produced from two-point
contact of the applied force.
It involves moving the tooth
parallel to its long axis.
Therefore the force is
distributed over relatively
large areas of the alveolar
bone wall.
When small forces are used, the
hyalinised zones that occur will
generally be of shorter duration
than those seen during tipping
movements. The reason for this is
that the local forces in these
hyalinised zones are smaller, thus
allowing resorption of the alveolar
bone wall to occur. The tooth
movement following such applied
forces is quite favorable since
there is steady bone resorption as
well as steady pdl fibers on the
tension side.

PURE ROTATION
A displacement of the body produced by
a couple, characterized by the center of
rotation coinciding with the center of
resistance, i.e;
the movement of points of the tooth
along the area of a circle, with the center
of resistance being the center of the circle.
Pure rotation can be divided into two types:
TRANSVERSE ROTATIONS: tooth displacements
during which the long axis orientation changes:
a) TIPPING: the simplest type of tooth movement
in which the crown moves in one direction and the
root in the opposite direction. If a force is applied
against the crown of the tooth, and if this force has a
one-point contact, then a tipping affect is produced.
Tipping tends to concentrate compression on a small
periodontal area. Its greatest effects are seen usually
at the marginal root area. Local pressure zones and
areas of hyalinization are a common occurrence in the
marginal regions of the pdl during tipping movements.
The compressive forces generated at the root apex
can cause extensive hyalinization and therefore
increase the risk for apical root resorption.
In clinical situation, tipping movements are often
used when moving teeth in a labiolingual direction.
The labial and lingual bone plates consist of dense
cortical bone and compensatory apposition of bone at
these sites following initial tipping movements is
comparatively slow.

Tipping movements can be further divided into
controlled and uncontrolled tipping:

1. Uncontrolled tipping: this describes a movement that
occurs about a center of rotation that lies close to or
apical to the center of resistance. Here the crown
moves in one direction and the root in the opposite
direction.
2. Controlled tipping:this type of movement occurs
when a tooth tips about a center of rotation at its
apex. Here the crown moves in one direction but the
root is prevented from moving in the opposite
direction.

b) TORQUE :
This can be considered as
a reverse tipping
characterized by lingual
movement of the root. The
tooth moves about a center
of rotation at or close to the
incisal edge. Much bone
undergoes resortion during
this type of tooth
movement and so root
movements require lots of
time.
LONG AXIS
ROTATION:
here the orientation of the
long axis is not altered. The
tooth rotates about its center
of resistance. Here the center
of rotation is the long axis of
the tooth.

COMBINATION OF BOTH
Any movement that is not pure rotation or
translation can be termed a combination of
both translation and rotation. This type of
movement is often seen in routine clinical
practice.
OPTIMAL FORCES FOR
ORTHODONTIC TOOTH MOVEMENTS
Type of movement force( gms)

Tipping 35-60
Translation 70-120
Root uprighting 50-100
Rotation 35-60
Extrusion 35-60
Intrusion 10-20
MECHANICAL
PRINCIPLES IN FORCE
CONTROL
An orthodontic appliance can be considered to have
active and reactive members. Active member is the
part concerned with the tooth movement and
reactive members functions for purposes of
anchorage of teeth that are not being displaced.
We are interested in three important characteristics
that involve active and passive members. They are
1] The moment force ratio
2] The load deflection rate
3] Maximum force or moment of any component of
an appliance.

MOMENT FORCE RATIO

To produce different types of tooth movement it is
necessary that the ratio between the applied
moment and force on the crown be altered. As the
moment force ratio is altered so the center of
rotation will be changed. There are few instances in
which desirable types of tooth movement can be
produced by single forces applied to the crown
alone. If this is done, the root will move in the
opposite direction. The moment / force is not only
important in the active member but also significant
in the reactive member.

The m/f determines the control that an
orthodontic appliance will have the both active
and reactive units.
LOAD DEFLECTION RATE
The second characteristics of an ortho appliance, the
load deflection or torque twist rate, are involved in the
delivery of a constant force. By definition the load
deflection rate gives the force produced per unit
activation. For a tooth moving under a continuous force,
as the load-deflection rate becomes lower the change in
force value is reduced. With regard to active members a
low load-deflection rate is desirable for two important
reasons.
A mechanism with low L-D rate will maintain a more
desirable stress level in the pdl, since the forces on the
tooth will not radically change magnitude every time
the tooth has been displaced. Also a low L-D rate
member offers greater accuracy in control over force
magnitude
If a low L-D rate is desirable for an active member then
the opposite is true for the reactive member. The
reactive member should be relatively rigid; that is it
should have a high L-D rate. The anchorage potential
of a group of teeth can be enhanced if the teeth
displace as a unit. If individual teeth in the reactive
tend to rotate around separate centers of rotation,
then higher stress distributions will be produced in the
pdl and therefore the teeth can be more easily
displaced.
MAXIMAL ELASTIC MOMENT

The last characteristic of an orthodontic appliance that
must be evaluated is the maximal elastic load or
maximal elastic moment. The maximal elastic load or
moment is the greatest force or moment that can be
applied to a member without producing permanent
deformation. Active and reactive members must be so
designed that they will not deform if activations are
made so optimal force levels are reached.

All three of these important characteristics are found
within the elastic range of an orthodontic wire and
hence may be termed spring characteristics.
Beyond this range will be found the plastic changes
that can occur in a wire up to the point of fracture.
There are a number of features that influence the
spring characteristics of an appliance and that are
under the control of the designer. To understand
them better, lets have a brief discussion on the basic
properties of an elastic material.

ELASTIC MATERIALS
the elastic behavior of any material is defined
in terms of its stress-strain response to an
external load. Both stress and strain refer to
the internal state of the material being studied.

STRESS: is the internal distribution of the load,
defined as force per unit area,

STRAIN: is the internal distortion produce by the
load, defined as the deflection per unit length.

When a force is applied to an appliance, its
response can be measured as deflection produced
by the force, which is bending or twisting.

For orthodontic purposes three major
properties of materials are critical in
defining their clinical usefulness:

1. Strength
2. Stiffness/springiness
3. Range.

Strength
Three different points on a stress-strain diagram can
be taken as representatives of the strength of a
material.
1. Proportional limit: the point at which any permanent
deformation is first observed.

2. Yield strength: the point at which a deformation of
0.1% is measured.

3. Ultimate tensile strength:
the maximum load the wire can sustainthis point
is reached after the permanent deformation and is
greater than the yield strength.

2
Strength is measured in stress units (gms/cm )
Stiffness and springiness
are reciprocal properties. Each is
proportional to the slope of the elastic
portion of the force-deflection curve. The
more horizontal the slope, the springier
the wire, and the steeper the slope, the
stiffer the wire.

Range
is defined, as the distance the wire will bend elastically
before permanent deformation occurs. It is measured
in millimeters or any length units.
If the wire is deflected beyond its yield strength, it will
not return to its original shape, but clinically useful
spring back will occur unless the failure point has been
reached. In many cases orthodontic wires are
deformed beyond their elastic limit. Their spring back
properties in the portion of the load- deflection curve
between the elastic limit and the ultimate strength are
important in determining the clinical performance.
These three majorcharacteristics are related by the
formula
Strength = Stiffness x Range.

Two other characteristics of clinical importance can
also be described on the stress- strain:
Resiliency: is the area under the stress- strain diagram
upto the proportional limit. It represents the energy
storage capacity of the wire, which is a combination of
strength and springiness.
Formability: is the amount of permanent deformation
that a wire can withstand without before failing. It
represents the amount of permanent bending the wire
will tolerate before it breaks.

FACTORS AFFECTING
ELASTIC PROPERTIES
Material
Precious metal alloys :

are the first used materials for orthodontic
purposes, primarily because nothing else could
tolerate the intra-oral conditions. The introduction
of stainless steel in the 1970s made the use of
precious alloys obsolete.

Stainless steel and cobalt chromium alloys :

both these metals have considerable higher strength
and springiness along with equivalent corrosion
resistance compared to the precious metal alloys
and so replaced them in orthodontic practice. The
properties of these steel wires can be controlled over
a reasonably wide range by varying the amount of
cold working and annealing during manufacture.
Stainless Steel is softened by annealing and
hardened by cold working.
Elgiloy, the cobalt-chromium alloy, has the
advantage that it can be supplied in a softer and
therefore more formable state, and then can be
hardened by heat treatment after being shaped.

w Nickel-titanium (NiTi) alloys.
Has proved very useful in clinical orthodontics
because of its exceptional springiness. Niti alloys have
two remarkable properties that are unique in dentistry---
shape memory and super elasticity. Both shape memory
and super elasticity are related to phase transitions
within the niti alloy between the martensitic and
ausetenitic forms that occur at a relatively low transition
temperature. Shape memory refers to the ability of the
material to remember its original shape after being
plastically deformed while in the martensitic form.

Nitinol was marketed in the late 1970s for
orthodontic use in a stabilized martensitic form,
with no application of phase transition effects.
Nitinol is exceptionally springy and quite strong but
has poor formability.

Stabilized martensitic alloys now
commercially available are referred to as M-NiTi
In the late 1980s new nickel-titanium wires with an
active austenitic grain structure appeared. These wires
exhibit the other remarkable property of niti alloys-
super elasticity which is manifested by very large
reversible strains and a non-elastic stress-strain or
force-deflection curve. This group subsequently is
referred to as A-NiTi.

Over considerable range of deflection, the force
produced by A-Niti hardly varies. This means that an
initial arch wire would exert about the same force
whether it was deflected a relatively small or a large
distance, which is a unique and extremely desirable
characteristic.

The unique force-deflection curve for A-NiTi wire
occurs because of a phase transition in grain structure
from austensite to martensite, in response not a
temperature change but to applied force.
The transition is a mechanical analogue to the
thermally induced shape memory effect.
w Beta-Titanium:
In the early 1980s, after nitinol but before A-NiTi,
Beta-Ti material (TMA) was developed primarily
for orthodontic use. It offers a highly desirable
combination of strength and springiness as well as
reasonably good formability. This makes it an
excellent choice for arch wires, especially rectangular
wires, for the late stages of edgewise treatment.

Effects of size and shape
Each of the major elastic properties strength,
stiffness and range-is substantially affected by the
change in the geometry of a beam. Both the cross
section and the length are of great significance in
determining its properties. Changes related to size
and shapes are independent of the material.
Diameter:

doubling the diameter of the wire increases its
strength by 8 times, i.e; the large wire can resist 8
times as much force before permanently
deformed,or can deliver 8 times as much force.
Doubling the diameter, however, decreases
springiness by a factor of 16 and range by a factor
of 2.

Length and attachment:
If the length of a cantilever spring is doubled, its
bending strength is cut in half, but its springiness
increases 8 times and its range 4 times. Length
changes affect torsion quite differently from bending:
springiness and range in torsion increase
proportionally with length, while torsional strength is
not affected by length.

The way in which a beam is attached also affects its
properties. An arch wire can be tied tightly or loosely,
and the point of loading can be any point along the
span. A supported beam like an arch wire is 4 times as
springy if it can slide over the abutments rather than if
the beam is firmly is attached. With multiple
attachments, as with an arch wire tied to several teeth,
the gain in springy from loose ties of an initial arch
wire is less dramatic but still significant.

FORCES, MOMENTS, AND
COUPLES IN TOOTH
MOVEMENTS
A moment is a measure of the tendency to rotate. A
moment is produced in one of two ways. If a single
force is applied to a body that does not act through
the center of resistance, the force causes the tendency
for the body to rotate. This moment, the moment of
force (Mf), is quantitatively equal to the magnitude of
the applied force times the perpendicular distance
between the line of the applied force and center of
resistance.
Mf is increased equally by either applying a larger
force to the tooth or applying the force further away
from the center of resistance.

A moment can also be applied to a tooth with a
couple,called moment of couple (Mc). The magnitude
of Mc is equal to the value of one of the forces of the
couple times the perpendicular distances between
the two parallel forces.
The magnitudes of Mc is increased by either
increasing both of the forces of the couple or
increasing the distance between the two forces
SYSTEM
EQUALIBRIUM
Newtons third law of motion states that for every
action there is equal and opposite reaction. The
single forces and couples of orthodontic appliances
are no exceptions. Static equilibrium requires that
the sum of both the forces and moment acting on
an appliance in any plane must be equal to zero to
maintain the system in equalibrium. Each moment
must be opposed by an equal and opposite
tendency to rotate in the opposite direction.

Force system can be defined as statically
determinate, meaning that the moments and
forces can be readily discerned, measured and
evaluated,

or as indeterminate. Statistically
indeterminate systems are too complex for
precisely measuring all forces and moments
involved in the equilibrium
Determinate systems in orthodontics are those in
which a couple is created at one end of an attachment,
with only a force and no couple at the other.
When the wire is tied into a bracket on both ends, a
statically indeterminate two couple system is created.
The determinate force systems are advantageous in
orthodontics because they provide much better control
of the magnitude of forces and couples.

One couple systems
In orthodontics one couple systems are found when
two conditions are met.
1) A cantilever or auxillary arch wire is placed into a
bracket or tube.
2) The other end of the spring or auxillary arch wire is
tied to a tooth or a group of teeth that are to be
moved, with a single point of force application.
Two couple system
When a wire is placed into two brackets the forces of
equilibrium always act at both brackets. There are
three possibilities for placing a bend in the wire to
activate it.
1.Symmetric V bends,
which creates equal and opposite couples at the
brackets. The forces at each bracket are equal and
opposite, and therefore cancel each other out. A
symmetrical V bend is not necessarily half way
between two teeth or two groups of teeth.
If two teeth are involved but one is bigger than the
other, equal and opposite moments would require
placing the bend closer to the large tooth, to
compensate for the longer distance from the bracket
to its center of resistance.
The same would be true if two groups of teeth had
been created by tying them into the equivalent of a
single large multi-rooted tooth, as when posterior
teeth are grouped into a stabilizing segment and used
for anchorage to move a group of for incisors.

2. Asymmetric V bend,
which creates unequal and opposite coupes, and net
equilibrium forces that would intrude one unit and
extrude the other. Although the absolute magnitude of
the forces involved cannot be known with certainty,
the relative magnitude of the moments of the
associated equilibrium forces can be determined.
The bracket with the larger moment will have a
greater tendency to rotate than the bracket with the
smaller moment, and this will indicate the direction of
equilibrium forces.
As the bend moves closer to one of the two equal
units, the moment increases on the closer unit and
decreases on the distant one, while the forces
increase.
When the bend is located 1\3
rd
of the distance
along the wire between two equal units no moment
is felt at the distant bracket, only a single force.
When the bend moves closer than that to one
bracket, moments at both brackets are in same
direction and equilibrium forces increases further.
3. Step bend,

which creates two couples in the same direction
regardless of its location between the two
brackets. The location of a V bend is a critical
variable in determining its effect, but the location
of a step bend has little or no effect on either the
magnitude of the moments or the equilibrium
forces.


SEGMENTED ARCH MECHANICS
This is considered an organized approach to using
one couple and two couple systems for most tooth
movement so as to obtain both more favorable
force levels and better control. The essence of the
segmented arch system is the establishment of well-
defined units of teeth, so that anchorage and
movement segments are clearly defined.
The desired tooth movement is accomplished with
cantilever springs where possible, so that the
precision of one couple approach is available, or with
the use of two couple systems through which at least
net movements and the directions of equilibrium
forces can be known.

Typical segmented arch treatment would call for
initial alignment within posterior and anterior
segments, the creation of appropriate anchorage
and tooth movement segments, vertical leveling,
space closure with differential movement of
anterior and posterior segments, and perhaps the
use of auxillary torquing arches.

The advantages of the segmented arch approach
are the control that is available, and the possibility
of tooth movements that cannot be achieved with
continues arch wires. The disadvantage is the
greater complexity of the appliance, and the
greater amount of time needed to install, adjust
and maintain it.

CONTINUOUS ARCH MECHANICS
Continuous is one that is tied into the brackets on all
the teeth. An extremely complex multicouple force
system is established when the wire is tied into
place. In general, the mechanical efficiency of a
continuous arch wire system is less than that of a
segmented system, but its fail safe properties are
better.
The advantages and disadvantages are just the
reverse of those with segmented arch approach.
Continuous arch treatment is not as well defined in
terms of forces and moments that will be
generated at any one time. But continuous arch
wires often take less chair time because they are
simpler to make and install, and because they have
excellent fail-safe property in most applications.

CONCLUSION
The design of efficient orthodontic appliance does not
occur by trial and error. Instead, an approach based
on sound biologic and physical principles leads to
development of appliances with predictable actions.
We should be able to define and quantify forces,
moments, couples and equilibriums associated with
appliances. If the force systems acting on a tooth
cannot be defined, their effect on cells and tissues
will be difficult to understand. Biomechanics thus
analyses the reaction of dental and facial structures
to orthodontic forces.
Many variables affect the outcome of orthodontic
treatment. Some are partially or totally out of the
clinicians control such as growth, bone-pdl-gingival
responses, and neuromuscular adaptation to changes
in jaw and tooth positions. Factors that are in the
control of the clinician are the magnitude and
direction of the forces, couples,moments and
moment to force ratio exerted by the appliance. A
thorough understanding of the physical principles
operating in orthodontic appliances eliminates
appliances as an uncontrolled variable affecting the
final result.
Leader in continuing dental education

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