Numeric simulation model for long-term orthodontic tooth movement with contact boundary conditions using the finite element method

Long-term iterative biomechanical analysis of an efficient mandibular dental arch distal tipping method with straight wire technique

BACKGROUND

The efficient mandibular dental arch distal tipping method with straight wire (EDSW) technique is an effective method to release cross bite compared to conventional straight wire (SW) technique. The aim of this study was to investigate the biomechanical features of EDSW technique with a long-term iterative biomechanical analysis (LIBA) method.

MATERIALS/METHODS

A finite element model encompassing the mandibular dentition, periodontal ligaments, SW appliance was constructed. As for the EDSW group, brackets on premolars were removed and the canine bracket was Tip-edged. The same Class III elastics were simulated for both groups. Long-term tooth movement was simulated with LIBA method on an iterative computational method using a supercomputer.

RESULTS

One thousand steps of iterative calculations were performed for each group. The lingual inclinations of the central and lateral incisors in the EDSW group were 3.40 mm and 17.49° and 3.24 mm and 15.22°, respectively, and those for the central and lateral incisors in the SW group were 2.06 mm and 11.49° and 1.93 mm and 10.27°, respectively. The distal tipping of the first molars in the EDSW (2.05 mm, 9.38°) is larger than SW group (1.13 mm, 5.26°).

CONCLUSIONS

Mandibular total arch distal tipping movement could be efficiently achieved with light elastic force during EDSW treatment for skeletal Class III patients compared to SW technique. The Tip-edged canine bracket could help increase the passive range of motion of the slot, which was conducive to the distal tipping of the canine compared to the conventional SW canine bracket.

Biomechanical effects of different initial posterior inclinations during extraction space closure with clear aligners: A finite element analysis

INTRODUCTION

This study aimed to evaluate the biomechanical effects of different initial mesiodistal inclinations of posterior teeth during extraction space closure using clear aligner treatment.

METHODS

Three different finite element models were developed for first premolar extractions, each representing different initial mesiodistal inclinations of the posterior teeth: model 1 with 15° mesial inclination, model 2 with upright posterior teeth, and model 3 with 10° distal inclination. A total of 12 en-masse retraction aligner models with varying posterior antitipping designs (0°, 1°, 2°, and 3°) were constructed to simulate space closure.

RESULTS

From models 1 to 3: Sagittally, posterior teeth increased mesial crown movement but decreased distal root movement; vertically, posterior teeth reduced crown intrusion but enhanced root intrusion; the posterior rotation center shifted distally and apically. Horizontally, model 3 indicated the greatest mesiolingual rotation of posterior teeth across all models. For anterior teeth, model 1 exhibited the most incisor retraction and lingual tipping, whereas model 3 displayed the least incisor retraction and lingual tipping. In addition, the progressive posterior antitipping design gradually diminished both the mesial tipping of posterior teeth and the lingual tipping of anterior teeth.

CONCLUSIONS

Different mesiodistal inclinations of posterior teeth had various biomechanical effects in 3 dimensions during space closure. Careful consideration should be given to the mesiodistal angulation of posterior teeth during extraction space closure with aligners.

The effect of canine lingual attachments during maxillary arch distalization with clear aligner: a 4D finite element analysis and in vitro simulator study

OBJECTIVE

During the maxillary premolar distalization process in clear aligner (CA) therapy, anterior aligner misfit and mesial displacement of the molars are two common challenges. This study aims to propose a novel attachment design to address these issues and to investigate the biomechanical effects of varying canine tipping angles during treatment.

METHOD

A dual-methodological approach was employed: 1) A four-dimensional finite element model (4D FEM) incorporating automated staging simulation was developed, utilizing iterative computations for long-term tooth movement prediction and thermal expansion algorithms for CA morphology adaptation; 2) An electromechanical orthodontic simulator (OSIM) was implemented for in vitro validation. The study analyzed three canine inclination groups in FEM simulations versus eleven groups in OSIM experiments, with particular focus on lingual attachment biomechanics. The A t-test was used to compare the forces and moments of each tooth between the groups with the same canine tipping angle.

RESULTS

The findings from the 4D FEM analysis demonstrated that distally inclined canines provided greater anchorage during premolar distalization (0.27 mm mesial movement for the first molar in -10° group), while mesially inclined canines contributed to more pronounced anchorage loss (0.34 mm mesial movement for the first molar in 10° group). The use of lingual attachments on canines improved the average distalization efficacy of premolars by 1%, 6%, and 7% in the -10°, 0°, and 10° canine tipping groups, respectively. Similarly, the in vitro orthodontic simulator (OSIM) experiment showed a comparable trend in force and moment variations.

CONCLUSION

Both the 4D FEM and OSIM analyses indicted that during the distalization process of premolars, canine lingual attachment significantly reduces the mesial displacement of molars by alleviating the unfitness of CA at anterior teeth area to enhance anterior anchorage. The efficiency of the attachment increased with the greater mesial tipping of canine. Based on the results of this study, it is clinically recommended to place lingual attachments during premolar distalization when the canine mesially tipped more than 4°.

Three-dimensional zone of the centers of resistance of the mandibular incisors and canines: A novel approach by finite element analysis

OBJECTIVES

The distribution and size of the zone of the centres of resistance (ZCR) are critical for accurate orthodontic treatments and minimizing unexpected tooth movements. However, this information remains unclear for mandibular incisors and canines. This study aims to address these gaps in knowledge.

METHODS

Finite element models of four incisors and canines from four individuals were created. Four centres of resistance (CRs) under four orthodontic directions (0° ∼ 45° ∼ 90° ∼ 135° to the sagittal plane in the horizontal plane) were assessed by a novel method. The height of the CRs was normalized to a percentage of the long axis, and the offsets were expressed as a distance value after normalization. The ZCR was obtained by fitting a 90% confidence sphere of the CR distribution. Validation was conducted to find the perturbations when the positions out of the zone were applied.

RESULTS

The maximum variation of CR in the heights under four directions was 5.17% and 3.70% for the incisors and canines, respectively. The maximum offset between the CR and long axis was 0.14mm in incisors and 0.99mm in canines. The height of the zone in the incisor and canine was 57.75% and 59.72%, and the radius of the zone was 0.60mm and 0.65mm, respectively. The force-acting point outside the zone produced a large rotation, which was unexpected.

CONCLUSIONS

The ZCR of mandibular incisors located slightly lower than that of canines, but they were almost the same size. The ZCR was recommended as the "gold reference" for orthodontics to reduce unexpected movement.

Comparative Evaluation of LED Light Application and Heat Generation with Three Different Wavelengths of Frequency on Soft Tissues in Bringing Faster Orthodontic Tooth Movement: A Finite Element Model Study

Background

The duration of orthodontic treatment is often a significant deterrent for patients when considering conventional mechanics, which can be time-consuming. Photobiomodulation (PBM) utilizes visible red to near-infrared wavelengths of light frequencies to expedite orthodontic treatment time.

Objective

To investigate the effect of three Light Emitting Diode (LED) frequencies and their heat generation on soft tissues in accelerating tooth movement through Finite Element Method (FEM) study.

Material and Methods

In this FEM study, a three-dimensional FEM model of the skull of a male patient with mild to moderate crowding in the maxilla, and mandible. The dentitions were scanned using a Computed Tomography (CT). A static force of 70 gm on the anterior region of the maxilla and mandible was applied from the labial sides, and a second static analysis was carried out by using both a 70 gm of force and thermal load with three different frequencies of 740, 850, and 940 nm on the 1st and 3rd quadrants. The effect of LED application and heat generation was assessed on soft tissues in bringing faster orthodontic tooth movement.

Results

Increased tooth movement with combined loading case in the 1st and 3rd quadrants when compared with the 2nd and 4th quadrants. The temperature distribution was higher at 940 nm followed by 740 & 850 nm of frequency.

Conclusion

Faster movements were observed in the combined loading case in the 1st and 3rd quadrants compared to static loading in other quadrants. Heat generation was higher with 940 nm frequency followed by 740 and 850 nm.

Mechanical effect of different patterns for preparation of orthodontic appliances: An experimental study

Archwire bending is the key to orthodontic treatment, and multi-time bendings are inevitable during manual and robotic automated bending. The purpose of this paper is to quantitatively evaluate the mechanical effects of the different preparation modes and to compare the mechanical properties of the orthodontic loops in one and multiple bends. Three types of typical stainless steel orthodontic loops (vertical loop, T-loop, and L-loop) were used to quantify the mechanical effect of patterns for preparation by experimental comparison between loops with different bending times by using an orthodontic force tester (OFT). The results were statistically analyzed by t-test. The fracture test of the stainless steel archwire was also carried out, and the bending times at fracture were recorded. Results of the tests indicate that one-time and multi-time bending have a significant mechanical effect on orthodontic appliances. Multi-time bending causes significant mechanical decreases and can damage the appliances.

Biomechanical effect of dual-dimensional archwire on controlled movement of anterior teeth compared with rectangular archwire: A finite element study

INTRODUCTION

This study aimed to determine and compare the effectiveness of the use of the dual-dimensional archwire and conventional rectangular archwire on tooth movement patterns when combined with various lengths of power arms.

METHODS

Displacements of the maxillary central incisor and the deformation of the wire section were calculated when applying retraction forces from different lengths of power arms using the finite element method.

RESULTS

Torque control of the incisor could be carried out more effectively when using the dual-dimensional archwire combined with long power arms than with the rectangular archwire. The use of the dual-dimensional archwire produced bodily movement of the central incisor at height levels of the power arm between 8 and 10 mm and lingual root tipping at the level of 10 mm.

CONCLUSIONS

The use of the dual-dimensional archwire provided better-controlled movement of the incisor, including bodily movement or root movement, than the rectangular archwire.

Effects of different intrusion patterns during anterior teeth retraction using clear aligners in extraction cases: an iterative finite element analysis

Background

Overtreatment design of clear aligner treatment (CAT) in extraction cases is currently primarily based on the clinical experience of orthodontists and is not supported by robust evidence on the underlying biomechanics. This study aimed to investigate the biomechanical effects of overtreatment strategies involving different maxillary anterior teeth intrusion patterns during anterior teeth retraction by CAT in extraction cases.

Materials and methods

A finite element model of the maxillary dentition with the first premolar extracted was constructed. A loading method of clear aligners (CAs) based on the initial state field was proposed. The iterative method was used to simulate the long-term orthodontic tooth movement under the mechanical load exerted by the CAs. Three groups of CAs were utilized for anterior teeth retraction (G0: control group; G1: incisors intrusion group; G2: anterior teeth intrusion group). Tooth displacement and occlusal plane rotation tendency were analyzed.

Results

In G0, CAT caused lingual tipping and extrusion of the incisors, distal tipping and extrusion of the canines, mesial tipping, and intrusion of the posterior teeth. In G1, the incisors showed minimal extrusion, whereas the canines showed increased extrusion and distal tipping tendency. G2 showed the smallest degree of posterior occlusal plane angle rotation, while the inclination tendency of the canines and second premolars decreased.

Conclusion

1. In CAT, tooth displacement tendency may change with increased wear time. 2. During anterior teeth retraction, the incisor intrusion pattern can provide effective vertical control for the lateral incisors but has little effect on the central incisors. Anterior teeth intrusion patterns can alleviate the inclination of canines and second premolars, resulting in partial relief of the roller-coaster effect.

Effect of power arm length combined with additional anterior torque on the axial orientation of the maxillary incisors during en-masse retraction: A finite element analysis

INTRODUCTION

This study aimed to clarify the effect of power arm length combined with additional torque incorporated into the archwire on the controlled movement of the anterior teeth using the finite element method.

METHODS

An adult patient requiring medium anchorage after extraction of the maxillary first premolars was selected for this study. The power arms were placed between the lateral incisor and the canine at 3 levels: 3 mm, 6 mm, and 9 mm. A 150 g of retraction force was applied from each height of the anterior hook to the first molar tube, with 0°, 5°, and 10° of applied lingual root torque on the incisors.

RESULTS

A 3-mm hook with 10° of applied torque, a 6-mm hook with 5° of applied torque, or a 9-mm hook with no extra torque constituted the best combinations targeted at controlling the inclination of incisors during retraction. Extrusion and distal tipping of the canine were observed. Moreover, mesial tipping and mesiopalatal rotation of the molar were unavoidable. Finally, intercanine and intermolar widths were decreased.

CONCLUSIONS

Adding extra torque on the incisors or using high torque brackets is recommended for patients with maxillary first premolar extraction.

Effect of Different Anchorage Reinforcement Methods on Long-Term Maxillary Whole Arch Distalization with Clear Aligner: A 4D Finite Element Study with Staging Simulation

The objective of this study was to examine how various anchorage methods impact long-term maxillary whole arch distalization using clear aligners (CAs) through an automated staging simulation. Three different anchorage reinforcement methods, namely, Class II elastics, buccal temporary anchorage device (TAD), and palatal TAD, were designed. Orthodontic tooth movement induced by orthodontic forces was simulated using an iterative computation method. Additionally, the automatic adjustment of the CA was simulated through the application of the thermal expansion method. The results indicated that the palatal TAD group had the largest retraction of incisors, followed by the buccal TAD group and the Class II elastic group, while the least was in the control group. The largest distal displacements and efficiency of molar distalization for the first and the second molars were noticed in the palatal TAD group. Arch width increased at the molar and premolar levels in all groups. The FEM results suggested palatal TAD had the best performance considering anterior teeth anchorage maintenance, both sagittally and vertically. However, attention should be paid to the possible increasement of arch width.

The crucial role of periodontal ligament's Poisson's ratio and tension-compression asymmetric moduli on the evaluation of tooth displacement and stress state of periodontal ligament

The hydrostatic stress in the periodontal ligament (PDL) evaluated by finite element analysis is considered an important indicator for determining an appropriate orthodontic force. The computed result of the hydrostatic stress strongly depends on the PDL material model used in the orthodontic simulation. This study aims to investigate the effects of PDL Poisson's ratio and tension-compression asymmetric moduli on both the simulated tooth displacement and the PDL hydrostatic stress. Three tension-compression symmetric and two asymmetric PDL constitutive models were selected to simulate the tensile and compressive behavior of a PDL specimen under uniaxial loading, and the resulting numerical results were compared with the in-vitro PDL experimental results reported in the literature. Subsequently, a tooth model was established, and the selected constitutive models and parameters were employed to assess the hydrostatic stress state in the PDL under two distinct loading conditions. The simulated results indicate that PDL Poisson's ratio and tension-compression asymmetry exert substantial influences on the simulated PDL hydrostatic stress. Conversely, the elastic modulus exhibits minimal impact on the PDL stress state under the identical loading conditions. Furthermore, the PDL models with tension-compression asymmetric moduli and appropriate Poisson's ratio yield more realistic hydrostatic stress. Hence, it is imperative to employ suitable Poisson's ratio and tension-compression asymmetric moduli for the purpose of characterizing the biomechanical response of the PDL in orthodontic simulations.

Comparison of stainless steel and titanium-molybdenum alloy closing loop archwires using numeric simulation model based on finite element method

INTRODUCTION

The objective of this study was to determine and compare the moment-to-force (Mc/F) ratio and the type of tooth movement generated in the anterior and posterior segments in orthodontic space closure with stainless steel and titanium-molybdenum alloy loop archwires.

METHODS

Three-dimensional model of the maxilla from which the first premolar was extracted, 18 × 25-mil slot stainless steel brackets, and 16 × 22-mil stainless steel and β titanium-molybdenum alloy (TMA) closing loop archwires with anterior gable bend of 15° and posterior gable bend of 25° were constructed. The archwires were engaged in the brackets, and 1-mm activations were carried out, which were repeated 5 times. The anterior and posterior segment Mc/F ratio and the type of tooth movement generated by the 2 wires were compared.

RESULTS

It was found that the Mc/F ratio for the anterior segment was approximately 5 mm, and for posterior teeth was approximately 10 mm for both stainless steel and TMA closing loop archwire. The anterior teeth exhibited controlled tipping, whereas the posterior teeth showed bodily tooth movement, which was in accordance with the Mc/F ratio that was obtained.

CONCLUSIONS

The Mc/F ratio and the type of tooth movement exhibited by stainless steel and TMA closing loop archwires were similar in both anterior and posterior segments.

Effect of 125 Hz and 150 Hz vibrational frequency electric toothbrushes on the rate of orthodontic tooth movement and prostaglandin E2 levels

Objective

To evaluate the effects of an electric toothbrush with vibrational frequencies of 125 Hz and 150 Hz on the orthodontic tooth movement (OTM) rate and the production of prostaglandin E2 (PGE2).

Methods

Out of thirty patients (aged 18-25 years; 16 females and 14 males), ten patients each formed Group A and B, who used electric toothbrushes with 125 Hz and 150 Hz vibrations, respectively. The remaining ten patients (Group C) served as the control group and did not use electric toothbrushes. The rate of OTM and levels of PGE2 using microcapillary pipettes were calculated before the start of retraction (T0), on the 30th day (T1), on the 60th day (T2), and on the 90th day (T3) from the start of retraction in all the groups.

Results

There was a statistically significant difference in the mean OTM values and PGE2 levels in all three groups at different time intervals, with the maximum difference seen in Group B compared to Group A and least in Group C at T1, T2 and T3.

Conclusions

The rate of OTM and levels of PGE2 were highest in patients who used an electric toothbrush with 150 Hz mechanical vibration compared to those who used an electric toothbrush with 125 Hz mechanical vibration and least in patients who did not use an electric toothbrush. Mechanical vibration led to an increase in the PGE2 levels and accelerated the OTM.

The effect of maxillary molar distalization with clear aligner: a 4D finite-element study with staging simulation

INTRODUCTION

Long-term simulation of tooth movement is crucial for clear aligner (CA) treatment. This study aimed to investigate the effect of maxillary molar distalization with CA via an automatic staging simulation.

METHOD

A finite-element method (FEM) model of maxillary dentition, periodontal ligaments, attachments, and corresponding CA was established, and a prescribed 2-mm distalization with 0.1 mm each step of the second molar was simulated. The long-term tooth movement under orthodontic force was simulated with an iterative computation method. The morphologic changes of CA during staging were simulated with the thermal expansion method.

RESULTS

Twenty steps of molar distalization were simulated. Significant distal tilting of the second molar was revealed, along with the proclination of anterior teeth, which caused the 'reversed bow effect'. For the second molar, 4.63°distal tilting at the 20th step was revealed. The intrusion of the incisors and the second molar were 0.43 mm, 0.39 mm, and 0.45 mm, respectively, at step 20. All the anterior teeth showed a proclination of approximately 1.41°-2.01° at the 20th step. The expression rate of the designed distalization of the second molar was relatively low (approximately 68%) compared to the high efficacy of interdental space opening between molars with CA (approximately 89%).

CONCLUSION

A novel method of simulating long-term molar distalization with CA with FEM was developed. The FEM results suggested distal tilting of the second molar and the proclination of anterior teeth during the molar distalization.

Accumulated biomechanical effects of mandibular molar mesialization using clear aligners with auxiliary devices: an iterative finite element analysis

BACKGROUND

The biomechanics generated by the clear aligner (CA) material changes continuously during orthodontic tooth movement, but this factor remains unknown during the computer-aid design process and the predictability of molars movement is not as expected. Therefore, the purpose of this study was to propose an iterative finite element method to simulate the long-term biomechanical effects of mandibular molar mesialization (MM) in CA therapy under dual-mechanical systems.

METHODS

Three groups including CA alone, CA with a button, and CA with a modified lever arm (MLA) were created. Material properties of CA were obtained by in vitro mechanical experiments. MM was conducted by the rebound force exerted by CA material and the mesial elastic force (2N, 30° to the occlusal plane) applied to the auxiliary devices. Stress intensity and distribution on periodontal ligament (PDL), attachment, button and MLA, and displacement of the second molar (M2) during the iterations were recorded.

RESULTS

There was a significant difference between the initial and cumulative long-term displacement. Specifically, compared to the beginning, the maximum stress of PDL decreased by 90% on average in the intermediate and final steps. The aligner was the main mechanical system at first, and then, the additional system exerted by the button and MLA dominated gradually. The stress of attachments and auxiliary devices is mainly concentrated on their interfaces with the tooth. Additionally, MLA provided a distal tipping and extrusive moment, which was the only group that manifested a total mesial displacement of the root.

CONCLUSIONS

The innovatively designed MLA was more effective in reducing undesigned mesial tipping and rotation of M2 than the traditional button and CA alone, which provided a therapeutic method for MM. The proposed iterative method simulated tooth movement by considering the mechanical characteristic of CA and its long-term mechanical force changes, which will facilitate better movement prediction and minimize the failure rate.

Mesial or distal to canine: Which is better for the position of closing loops? Analysis of tooth movements based on numerical simulation

INTRODUCTION

Although many studies investigating the mechanical behavior of loop mechanics have focused on loop designs to produce a higher moment-to-force ratio, few studies have clarified the effect of loop position on the force system and resultant tooth movements. This study aimed to simulate orthodontic tooth movements during space closure and to compare the effects of loop position in association with different degrees of gable bend on tooth movements using the finite element method.

METHODS

Two finite element models of the maxillary dentition were constructed, with the loop placed mesial or distal to the canine. Tooth movements during loop activation were simulated while varying the degree of gable bend.

RESULTS

When the loop was placed distal to the canine, the incisor showed uncontrolled tipping even with the gable bend. Placement of the loop mesial to the canine produced controlled tipping or root movement of the incisor, depending on the degree of gable bend.

CONCLUSIONS

Placement of the closing loop mesial to the canine in combination with the incorporation of a gable bend into the archwire distal to the canine could provide better control of incisor movements, such as controlled tipping or root movement, as compared with placement of a gable bend into the loop located distal to the canine.

Computer-aided finite element model for biomechanical analysis of orthodontic aligners

OBJECTIVES

To design a finite element (FE) model that might facilitate understanding of the complex mechanical behavior of orthodontic aligners. The designed model was validated by comparing the generated forces - during 0.2-mm facio-lingual translation of upper left central incisor (Tooth 21) - with the values reported by experimental studies in literature.

MATERIALS AND METHODS

A 3D digital model, obtained from scanning of a typodont of upper jaw, was imported into 3-matic software for designing of aligners with different thicknesses: 0.4, 0.5, 0.6, 0.7 mm. The model was exported to Marc/Mentat FE software. Suitable parameters for FE simulation were selected after a series of sensitivity analyses. Different element classes of the model and different rigidity values of the aligner were also investigated.

RESULTS

The resultant maximum forces generated on facio-lingual translation of Tooth 21 were within the range of 1.3-18.3 N. The force was direction-dependent, where lingual translation transmitted higher forces than facial translation. The force increases with increasing the thickness of the aligner, but not linearly. We found that the generated forces were almost directly proportional to the rigidity of the aligner. The contact normal stress map showed an uneven but almost repeatable distribution of stresses all over the facial surface and concentration of stresses at specific points.

CONCLUSIONS

A validated FE model could reveal a lot about mechanical behavior of orthodontic aligners.

CLINICAL RELEVANCE

Understanding the force systems of clear aligner by means of FE will facilitate better treatment planning and getting optimal outcomes.

Anchorage effects of ligation and direct occlusion in orthodontics: A finite element analysis

BACKGROUND AND OBJECTIVE

During orthodontic treatment, the figure-of-eight ligature and the physiological occlusion play an important role in providing anchorage effects. However, their effects on reaction forces of tooth and stress state in periodontal ligament (PDL) have not been quantitatively evaluated yet. In this study, we presented a finite element analysis process for simulating posterior molar ligature and direct occlusion during orthodontics in order to quantitatively assess their anchorage effects.

METHODS

A high precision 3D biomechanical model containing upper and lower teeth, PDL, brackets and archwire was generated from the images of computed tomographic scan and sophisticated modelling procedures. The orthodontic treatment of closing the extraction gap was simulated via the finite element method to evaluate the biomechanical response of the molars under the conditions with or without ligation. The simulations were divided into experimental and control groups. In the experimental group, orthodontic force of 1 N was first applied, then direct occlusal forces of 3 and 10 N were applied on each opposite tooth. While in the control group, occlusal forces were applied without orthodontic treatment. The tooth displacement, the stress state in the PDL and the directions of the resultant forces on each tooth were evaluated.

RESULTS

In the case of molars ligated, the maximum hydrostatic stress in the molars' PDL decreases by 60%. When an initial tooth displacement of several microns occurs in response to an orthodontic force, the direction of the occlusal force changes simultaneously. Even a moderate occlusal force (3 N per tooth) can almost completely offset the mesial forces on the maxillary teeth, thus to provide effective anchorage effect for the orthodontics.

CONCLUSIONS

The proposed method is effective for simulating ligation and direct occlusion. Figure-of-eight ligature can effectively disperse orthodontic forces on the posterior teeth, while a good original occlusal relationship provides considerable anchorage effects in orthodontics.

Difference in the alveolar bone remodeling between the adolescents and adults during upper incisor retraction: a retrospective study

The purpose of this study was to compare the difference of alveolar bone remodeling between the adolescents and adults in the maxillary incisor area during retraction. This retrospective study included 72 female patients who needed moderate anchorage to correct the bimaxillary protrusion. Subjects were further divided into the minor group (n = 36, 11-16 years old) and adult group (n = 36, 18-35 years old). Digital lateral cephalography and cone beam CT scanning were taken in each patient before (T0) and after treatment (T1). Cephalometry was conducted to assess incisor retraction, while alveolar bone thickness (ABT), alveolar bone distance (ABD), and alveolar bone area (ABA) were detected to assess changes in the alveolar bone. No difference in the inclination of upper incisors was observed at both T0 and T1 between two groups. Changes in the alveolar bone showed a similar tendency with bone apposition on the labial side and bone resorption on the palatal side in both groups. Less increase in the labial ABT (T1-T0) and more decrease in the palatal ABT (T1-T0) was found in the adult group, leading to less total ABT in the adult group. Higher reduction in ABD (T1-T0) was found in the adult group. Moreover, more decrease in the ABA (T1-T0) was found in the adult group. Adult patients have less alveolar bone support after treatment when compared with young adolescents. Orthodontists should take the age into consideration to reduce the potential periodontal risks during the treatment planning.

Modelling and evaluating periodontal ligament mechanical behaviour and properties: A scoping review of current approaches and limitations

This scoping review is intended to synthesize the techniques proposed to model the tooth-periodontal ligament-bone complex (TPBC), while also evaluating the suggested periodontal ligament (PDL) material properties. It is concentrated on the recent advancements on the PDL and TPBC models, while identifying the advantages and limitations of the proposed approaches. Systematic searches were conducted up to December 2020 for articles that proposed PDL models to assess orthodontic tooth movement in Compendex, Web of Science, EMBASE, MEDLINE, PubMed, ScienceDirect, Google Scholar and Scopus databases. Although there have been many studies focused on the evaluation of PDL material properties through numerous modelling approaches, only a handful of approaches have been identified to investigate the interface properties of the PDL as a complete dynamical system (TPBC models). Past reviews on the analytical and experimental determination of the PDL properties already show a concerning range in reported output values-some nearly six orders of magnitude in difference-that strongly suggested the need for further investigation. Surprisingly, it has not yet been possible to determine a narrower range of values for the PDL material properties. Moreover, very few scientific approaches address the TPBC as an integrated complex system model. In consequence, current methods for capturing the PDL material behaviour in a clinical setting are limited and inconclusive. This synthesis encourages more systematic, pragmatic and phenomenological research in this area.

Digital Photoelastic Analysis of TAD-Supported Maxillary Arch Distalization

The objective of this study was to determine whether the distribution of compressional and tensional stress around tooth roots is influenced by the position of a temporary anchorage device and the length of the retraction hook during the distalization of the maxillary dentition. A photoelastic orthodontic model was made of photoelastic epoxy resin. Six combinations of three retraction hook lengths and two posterior Temporary skeletal anchorage devices (TAD) positions were established. Stress was applied through an elastic chain for each of the combinations. Digital photoelastic stress analysis measured the compression, tensional stress, and direction around the tooth root. Using this novel photoelastic model, we found that the distribution of compressional and tensional stress during the retraction of the maxillary dentition was significantly influenced by the position of the TAD and the length of the retraction hook.

Effect of Class II elastics on different mandibular arch preparation stabilized with aligners and stainless-stseel wires: a FEM study

Finite Element Models that simulate the effects of Class II elastics on the mandibular arch in six different scenarios, using various immobilization methods of the posterior dentition, were studied. Per-element distribution of linear elastic stress-strain and total displacement were computed. Maximum strain on the PDL, and maximum stress on alveolar bone increased with posterior tip-back, and with the use of archwires vs. aligners. The configuration of the dentition affects the performance of aligners. They perform best on an un-leveled mandibular arch. Applying Class II elastics results in vertical side effects that can be modulated by various mandibular stabilization methods. This is likely to be clinically relevant for high-angle patients, and may explain the differing effects on the facial profile observed using various treatment modalities. 1- Increasing mandibular molar tip-back generally resulted in less eruption tendencies, with mandibular anchorage preparation resulting in the least amount of calculated vertical displacement. 2- Unexpectedly, with Class II forces the use of aligner technology on an un-leveled curve of Spee resulted in improved vertical control when compared to aligner use on a leveled dentition. 3- Generally, using an archwire results in better transmission of stresses to adjacent teeth than the use of aligners. 4- Simulating interarch elastics requires implementing a medial component/orientation of the forces to better emulate clinical situations. 5- A hypothetical configuration: 15o tip-back of the mandibular second molar and aligner stabilization displayed the least amount of vertical movement and the most forward horizontal movement of the 2nd molar.

A new protocol to accurately track long-term orthodontic tooth movement and support patient-specific numerical modeling

Numerical simulation of long-term orthodontic tooth movement based on Finite Element Analysis (FEA) could help clinicians to plan more efficient and mechanically sound treatments. However, most of FEA studies assume idealized loading conditions and lack experimental calibration or validation. The goal of this paper is to propose a novel clinical protocol to accurately track orthodontic tooth displacement in three-dimensions (3D) and provide 3D models that may support FEA. Our protocol uses an initial cone beam computed tomography (CBCT) scan and several intra-oral scans (IOS) to generate 3D models of the maxillary bone and teeth ready for use in FEA. The protocol was applied to monitor the canine retraction of a patient during seven months. A second CBCT scan was performed at the end of the study for validation purposes. In order to ease FEA, a frictionless and statically determinate lingual device for maxillary canine retraction was designed. Numerical simulations were set up using the 3D models provided by our protocol to show the relevance of our proposal. Comparison of numerical and clinical results highlights the suitability of this protocol to support patient-specific FEA.

Simulation of orthodontic tooth movement during activation of an innovative design of closing loop using the finite element method

INTRODUCTION

Although many attempts have been made to study the mechanical behavior of closing loops, most have been limited to analyses of the magnitude of forces and moments acting on the end of the closing loop. The objectives of this study were to simulate orthodontic tooth movement during the activation of a newly designed closing loop combined with a gable bend and to investigate the optimal loop activation condition to achieve the desired tooth movement.

METHODS

We constructed a 3-dimensional model of maxillary dentition reproducing the state wherein a looped archwire combined with a gable bend was engaged in brackets and tubes. Orthodontic tooth movements were simulated for both anterior and posterior teeth while varying the degree of gable bend using the finite element method.

RESULTS

The incorporation of a 5° gable bend into the newly designed closing loop produced lingual crown tipping for the central incisor and bodily movement for the first molar. The incorporation of 10° and 15° gable bends produced bodily movement and root movement, respectively, for the central incisor and distal tipping for the first molar.

CONCLUSIONS

Torque control of the anterior teeth and anchorage control of the posterior teeth can be carried out effectively and simply by reducing by half the thickness of a teardrop loop with a height of 10 mm and a 0.019 × 0.025-in cross-section, to a distance of 3 mm from its apex, and by incorporating various degrees of gable bend into the loop corresponding to the treatment plan.

Dual-section versus conventional archwire for en-masse retraction of anterior teeth with direct skeletal anchorage: a finite element analysis

BACKGROUND

The aim of this study is to compare the biomechanical effects of the conventional 0.019 × 0.025-in stainless steel archwire with the dual-section archwire when en-masse retraction is performed with sliding mechanics and skeletal anchorage.

METHODS

Models of maxillary dentition equipped with the 0.019 × 0.025-in archwire and the dual-section archwire, whose anterior portion is 0.021 × 0.025-in and posterior portion is 0.018 × 0.025-in were constructed. Then, long-term tooth movement during en-masse retraction was simulated using the finite element method. Power arms of 8, 10, 12 and 14 mm length were employed to control anterior torque, and retraction forces of 2 N were applied with a direct skeletal anchorage.

RESULTS

For achieving bodily movement of the incisors, power arms longer than 14 mm were required for the 0.019 × 0.025-in archwire, while between 8 and 10 mm for the dual-section archwire. The longer the power arms, the greater the counter-clockwise rotation of the occlusal plane was produced. Frictional resistance generated between the archwire and brackets and tubes on the posterior teeth was smaller than 5% of the retraction force of 2 N.

CONCLUSIONS

The use of dual-section archwire might bring some biomechanical advantages as it allows to apply retraction force at a considerable lower height, and with a reduced occlusal plane rotation, compared to the conventional archwire. Clinical studies are needed to confirm the present results.

Biomechanical analysis of reinstating buccally flared maxillary 2nd molars using 3D printing anchorage supports: a 3D finite element study

The buccally flared maxillary 2nd molar has certain consequences on oral function and health. However, existing methods have some degree of disadvantages, such as invasion, complexity and side effects. The objectives of this study were to design anchorage systems to correct buccally flared maxillary 2nd molars and analyze their biomechanical effects by 3-dimensional (3D) finite element analysis. Finite element (FE) models of the 3D tanspalatal arches (TPAs) and 3D splints with different thicknesses and force points were constructed. The stress distribution on teeth, the hydrostatic pressure on periodontal ligaments and the initial displacement of teeth were analyzed. A total of 18 FE models were constructed and analyzed. The stress concentrated on a single anchorage tooth, and the hydrostatic pressure and initial displacement of the anchorage tooth were greater than those of the malposed 2nd molar in the 3D splint anchorage system. The stress spread on all anchorage teeth and the hydrostatic pressure and initial displacement of the anchorage tooth were less than those of the malposed 2nd molar in the 3D TPA anchorage system. Theoretically, the 3D TPA was better than the 3D splint as an anchorage to correct the buccally flared 2nd molar. A combination of 0.8 mm of thickness and mesial force point provided the optimal conditions for the 3D TPA. Further clinical studies should be conducted to verify the effects of 3D appliances.

Three-dimensional coupling between orthodontic bone remodeling and superelastic behavior of a NiTi wire applied for initial alignment

PURPOSE

NiTi wires are considered as the most appropriate wires to be used during the initial phase of orthodontic treatment. This work presents a numerical method to simulate the coupling between the orthodontic appliance and bone remodeling, which are the two mechanisms responsible for the orthodontic tooth movement.

METHODS

The superelastic behavior of a NiTi wire was integrated in a three-dimensional simulation model to reproduce the long-term bone remodeling coupled with tooth alignment using the finite element method. The orthodontic load was derived by deforming the superelastic wire in order to adopt itself to the original position of irregular teeth. Root form was extracted from cone beam tomography imaging files.

RESULTS

As a result, the teeth were aligned while the wire was recovering its initial shape. The canine was intruded by 0.53 mm, while the neighboring teeth were extruded by 0.44 and 0.46 mm. When the wire was loaded, it generated a load of 4.6 N on the bracket bonded on the canine. This force was active during the first day of the treatment. Then, the force continued to decline until the end of the correction period. The decreasing load delivered from the wire affected the teeth displacements as observed in real situations.

CONCLUSION

Despite the complexity of the presented numerical simulation, this procedure allowed the analysis of the orthodontic forces that were generated in the clinical experiments and of the biomechanical response of the periodontal support elements when using this kind of wire.

Efficacy of different designs of mandibular expanders: A 3-dimensional finite element study

INTRODUCTION

Nonsurgical mandibular expansion has been increasingly performed in recent years because it can effectively expand the mandibular dental arch. However, many types of mandibular expanders have been used in previous studies. No relevant studies have compared the biomechanical responses of different designs of mandibular expansion appliances with screws. Therefore, the purpose of this study was to analyze the stress distribution and displacement of the dentoalveolar structures according to different designs of mandibular screw expanders.

METHODS

Cone-beam computed tomography scans were used for 3-dimensional reconstruction of the mandibular finite element model. Four different designs of mandibular expanders, 1 removable expander (type A) and 3 fixed expanders (types B, C, and D), were added to the finite element models. Expanders were activated transversely for 0.2 mm. The initial tooth displacement and von Mises stress distribution were evaluated.

RESULTS

All the expanders enlarged the arch dimensions. In types A and B, the stress was mainly concentrated in the region of the anterior teeth, along with greater tooth displacement, whereas in types C and D, greater stress and displacement occurred in the region of the posterior teeth. Type A showed the greatest amount of transverse displacement. Type D was more efficient in the region of the posterior teeth.

CONCLUSIONS

Types A and B should be used with great caution in the clinic because of their incompatible expansion pattern. Type D is the recommended mandibular expansion appliance because of its appropriate expansion pattern.

Effect of archwire stiffness and friction on maxillary posterior segment displacement during anterior segment retraction: A three-dimensional finite element analysis

Objective

Sliding mechanics using orthodontic miniscrews is widely used to stabilize the anchorage during extraction space closure. However, previous studies have reported that both posterior segment displacement and anterior segment displacement are possible, depending on the mechanical properties of the archwire. The present study aimed to investigate the effect of archwire stiffness and friction change on the displacement pattern of the maxillary posterior segment during anterior segment retraction with orthodontic miniscrews in sliding mechanics.

Methods

A three-dimensional finite element model was constructed. The retraction point was set at the archwire level between the lateral incisor and canine, and the orthodontic miniscrew was located at a height of 8 mm from the archwire between the second premolar and first molar. Archwire stiffness was simulated with rectangular stainless steel wires and a rigid body was used as a control. Various friction levels were set for the surface contact model. Displacement patterns for the posterior and anterior segments were compared between the conditions.

Results

Both the anterior and posterior segments exhibited backward rotation, regardless of archwire stiffness or friction. Among the conditions tested in this study, the least undesirable rotation was found with low archwire stiffness and low friction.

Conclusions

Posterior segment displacement may be unavoidable but reducing the stiffness and friction of the main archwire may minimize unwanted rotations during extraction space closure.

Two distalization methods compared in a novel patient-specific finite element analysis

INTRODUCTION

Orthodontic mini-implants aid in the correction of distocclusions via direct anchorage (pull from mini-implant to teeth) and indirect anchorage (teeth pulled against other teeth anchored by the mini-implant). The aim of this study was to compare stress levels on the periodontal ligament (PDL) of maxillary buccal teeth in direct and indirect distalization against orthodontic mini-implants and accounting for individual variation in maxillary anatomy and biomechanical characteristics of the compact bone.

METHODS

A 3D model of the maxilla containing the different components (teeth, PDL, trabecular and cortical bones) was generated from a computed tomographic scan. Cortical bone was divided into several areas according to previously defined zones. Bone stiffness and thickness data, obtained from 11 and 12 cadavers, respectively, were incorporated into the initial model to simulate the individual cortical bone variation at the different locations. Subsequently, a finite element analysis was used to simulate the distalization modalities.

RESULTS

Stresses at the buccal, palatal, mesial, and distal surfaces were significantly different between adjacent teeth under stiffness but not thickness variation. In both distalization modalities, low or no significant correlations were found between stress values and corresponding cortical bone thicknesses. High significant and inverted correlations were observed at the first molar between stress amounts and cortical bone stiffness (direct modality: -0.68 < r < -0.72; indirect modality: -0.80 < r < -0.82; P <0.05).

CONCLUSIONS

With the use of a novel finite element approach that integrated human data on variations in bone properties, findings suggested that cortical bone stiffness may influence tooth movement more than bone thickness. Significant clinical implications could be related to these findings.

Finite Element Analysis of Stress in Maxillary Dentition during En-masse Retraction with Implant Anchorage

The goal of this study was to investigate how the height of the archwire hook and implant anchor affect tooth movement, stress in the teeth and alveolar bone, and the center of resistance during retraction of the entire maxillary dentition using a multibracket system. Computed tomography was used to scan a dried adult human skull with normal occlusion. Three-dimensional models of the maxillary bone, teeth, brackets, archwire, hook, and implant anchor were created and used for finite element analysis. The heights of the hook and the implant anchor were set at 0, 5, or 10 mm from the archwire. Orthodontic force of 4.9 N was systematically applied between the hook and the implant anchor and differential stress distributions and tooth movements observed for each traction condition. With horizontal traction, the archwire showed deformation in the superior direction anterior to the hook and in the inferior direction posterior to the hook. Differences in traction height and direction resulted in different degrees of deformation, with biphasic movement clearly evident both in front of and behind the hook. With horizontal traction of the hook at a height of 0 mm, all the teeth moved distally, but not with any other type of traction. At a height of 5 mm or 10 mm, deformation showed an increase. The central incisor showed extrusion under all traction conditions, with the amount showing a reduction as the height of horizontal or posterosuperior traction increased. The center of resistance was located at the root of the 6 anterior teeth and entire maxillary dentition. The present results suggest that it is necessary to consider deformation of the wire and the center of resistance during en-masse retraction with implant anchorage.

ORTHODONTIC PROCESS SAFETY EVALUATION BASED ON PERIODONTAL LIGAMENT CAPILLARY PRESSURE AND OGDEN MODEL

Taking the lower maxillary incisors as an example and the orthodontic forces along the near–far middle direction, the orthodontic forces along the crown–root direction and the orthodontic moment around the tongue–cheek direction as loading condition, the biomechanical simulation of the tooth is carried out by the method of finite element simulation in this paper. The CT images of the skull are segmented and denoised by Mimics. The solid models of teeth, periodontal ligament (PDL), alveolar bone and brackets are established by Gomagic and Solidworks. The material characteristics of the PDL are defined by the two-order Ogden hyperelastic model. Taking the PDL capillary pressure as a criterion for orthodontic safety, combined with the stress response of PDL, the safe orthodontic force range of mandibular central incisors is obtained by ANSYS finite element software.