Torque differences according to tooth morphology and bracket placement: a finite element study

Torque moments and stress analysis in two passive self-ligating brackets across different incisor inclinations: A 3-dimensional finite element study

Objective

To compare torque expression characteristics between rectangular slot (0.022″ x 0.028″) Damon Q passive self-ligating brackets (Ormco, Glendora, Calif) and square slot (0.021″ x 0.021″) Pitts 21 brackets (OC Orthodontics) using 0.019″ x 0.025″ Stainless Steel and 0.020″ x 0.020" Titanium Molybdenum alloy wires at various incisal inclinations using finite element analysis. The null hypothesis was that there were no differences in torque expression in both tested groups.

Methods

Reporting guidelines for in-silico studies using finite element analysis in medicine (RIFEM) were used. Damon Q and Pitts 21 brackets were scanned and 3D models generated. Brackets were placed on a 3-D model of a maxillary central incisor with its long axis inclined at 0⁰,5⁰,10⁰,15⁰ and 20⁰ to the occlusal plane. Final 0.019″ x 0.025″ SS and 0.020″ x 0.020" TMA archwires were inserted into slots of both tested brackets. Geometric models were converted into finite element models. Material properties were assigned for involved structures with automatic meshing performed by software. Torque movements were simulated with the FE program Ansys Space claim R 22.

Results

Torque moment values, torque expression and Von - Mises stress was higher in Pitts 21 than Damon Q at all inclination angles. There was a gradual increase in the magnitude of values with decrease in incisal inclination.

Conclusion

Square slot passive self-ligating brackets show superior torque expression characteristics as compared to rectangular wire-rectangular slot combinations. The FEM results should be validated with in-vivo studies in order to confirm the findings.

Clinical expression of programmed maxillary buccal expansion and buccolingual crown inclination with Invisalign EX30 and SmartTrack aligners and the effect of 1-week vs. 2-week aligner change regimes: A retrospective cohort study

Objective

: This retrospective cohort study aimed to assess and compare the accuracy of 3 different Invisalign® treatment regimens in terms of variations of aligner change frequency and type of aligner material in achieving maxillary dental buccal expansion.

Methods

: Altogether, 120 adult patients whose treatment involved maxillary dental expansion with Invisalign® were included. The patients were divided into 3 groups, with each group comprising 40 patients as follows: SmartTrack® 1-week changes (ST1), SmartTrack® 2-week changes (ST2), and EX30® 2-week changes (EX2). The groups were assessed by comparing actual changes achieved with those prescribed by ClinCheck®. The rates of clinically significant inaccuracies (CSI) observed for buccal expansion (≥ 0.5 mm) and buccolingual inclination (≥ 2°) during expansion were then determined.

Results

: In terms of expansion, the ST1 group demonstrated the highest CSI rate at all tooth levels, whereas the ST2 group had the lowest rate of CSI and the lowest mean inaccuracy for each tooth level. In terms of buccolingual inclination, the ST1 group had the highest CSI rate across all tooth levels, whereas the EX2 group had the lowest CSI rate at all tooth levels except for the canine level where the ST2 group had the lowest CSI rate. A tendency toward overexpression of buccal crown inclination, and underexpression of buccal expansion was observed at all tooth levels.

Conclusions

: Two-week aligner change regimens offer improved accuracy compared with 1-week aligner changes. SmartTrack® 2-week changes were the most accurate for buccal expansion, whereas EX30® 2-week changes were the most accurate for buccolingual inclination.

A Hypothesis Testing of Archwire Rounding for the Efficacy of Torque Springs in Orthodontics: A Finite Element Study

BACKGROUND

Achieving the proper buccolingual inclination of teeth is a cornerstone in orthodontic treatment, directly impacting the attainment of ideal occlusal relationships and long-term stability. A practical torque expression that moves the tooth in its proper position across all three planes is imperative to finish orthodontic cases optimally. The primary focus of this research is to investigate Burstone's hypothesis about Warren torque springs when applied to the rectangular wire. Additionally, it examines the hypothesis of rounding these wires in between the bracket wings of the target tooth to be moved. This study aims to determine whether the rounding of wires, in conjunction with the use of torque springs, influences orthodontic outcomes, addressing a notable gap in current literature and resolving controversies in orthodontic practice.

METHODS

A three-dimensional set of maxillary teeth was modeled. A 0.022" MiniSprint™ brackets and Stainless steel archwires of 0.019" × 0.025" and 0.017" × 0.025" (Forestadent, Pforzheim, Germany) were generated. Warren torque spring was modeled and used in the simulation on the upper right central incisor. Four case scenarios were simulated. In two scenarios, the archwires were untouched for both archwire sizes. In comparison, in the other two scenarios, each archwire size was rounded for the upper right maxillary incisor bracket area. Stresses in the Warren torque springs were calculated, the root tip displacement in the four scenarios was measured in millimeters, and both were analyzed.

RESULTS

The root tip displacement was highly affected by rounding the archwire. The increase in root tip displacement was 1538% for the Warren torque spring on 0.019" × 0.025" and 783% for 0.017" × 0.025". The amount of root tip displacement was about 18.8 mm for 0.017" × 0.025" with rounding and 12.2 mm for 0.019" × 0.025". The concentration of the stresses in the Warren torque spring was in the neck of the spring next to the coils.

CONCLUSION

Rounding the archwires while using the Warren torque spring on a rectangular archwire will increase the efficiency of the spring and, in turn, will exhibit more torque on the tooth. Smaller dimensions of rectangular archwires will give more torque in conjunction with Warren torque springs compared to larger sizes of archwires.

Leveling the curve of Spee using different sized archwires: a randomized clinical trial of blood flow changes

OBJECTIVES

To compare blood flow (BF) changes of teeth subjected to orthodontic forces during curve of Spee (COS) leveling using different archwires (AW).

MATERIAL AND METHODS

Thirty subjects with COS > 5 mm were randomly assigned (1:1:1) into three groups based on the AW used: group 1: 0.017 × 0.025-inch stainless-steel (SS)AW, group 2: 0.019 × 0.025-inch SSAW, and group 3: 0.021 × 0.025-inch β-titanium (TMA)AW. In the 3 groups, a 5 mm-depth reverse COS was placed in the AWs. A laser Doppler flowmeter was used to measure BF at different time intervals (T0-T4).

RESULTS

In the 3 AWs group, BF of all measured teeth was reduced 20 min after force application. Afterwards, the BF values started to increase until the baseline values were almost restored within 1 week. Differences in BF changes between the extrusion and intrusion subgroups were observed within groups 1 and 3 during the first 20 min of force application (P < 0.05). Similar BF changes were recorded using the 3 different AWs. BF changes were associated with tooth type and the amount of COS depth change.

CONCLUSIONS

During CoS leveling, similar BF changes were recorded using the 3 different AWs. Tooth type and the amount of COS depth change were associated with BF changes within the first 20 min of force application. Greater BF reduction was found in premolars compared to incisors during the first 20 min of AW placement.

CLINICAL RELEVANCE

It is important to select a type of applied forces that minimally affect the BF. Intrusive forces appeared to have lower negative effects on the BF of teeth during COS leveling.

TRIAL REGISTRATION

ClinicalTrial.gov (# NCT04549948).

Comparison of linear and angular changes assessed in digital dental models and cone-beam computed tomography

OBJECTIVE

To compare the three-dimensional (3D) linear displacements and the mesiodistal and buccolingual angulation changes after orthodontic treatment in digital dental models (DDMs) and 3D models derived from cone-beam computed tomography (CBCT).

SETTINGS AND SAMPLE POPULATION

Digital dental model and CBCT scans were selected from 24 adults who had undergone orthodontic treatment for mandibular anterior crowding.

MATERIAL AND METHODS

3D linear displacements and changes in angular measurements (mesiodistal and buccolingual angulation) were assessed in pre- and post-treatment DDM and CBCT images using the software ITK-snap and 3D SlicerCMF. Intra- and inter-rater agreement of measurements in DDM and CBCT were tested using the intraclass correlation coefficient (ICC). DDM and CBCT measurements were compared using the Wilcoxon test (P < .05), ICC and Bland-Altman plots.

RESULTS

Intra- and inter-rater agreement varied from good (ICC > 0.75) to excellent (ICC > 0.90) for both DDM and CBCT measurements. Although no significant difference between DDM and CBCT methods was observed for linear measurements of tooth movement, the angular assessments were different for most measurements. The agreement between measurements from both assessments varied from poor to excellent.

CONCLUSIONS

Longitudinal assessments of tooth movements including 3D linear displacements and mesiodistal and buccolingual angulation are reproducible when using both DDM and CBCT. Changes in angular measurements due to orthodontic treatment are discordant when measured in the digital models (clinical crown) and in the CBCT images (whole tooth).

The effect of tooth morphology and vertical bracket positioning on resultant stress in periodontal ligament - a three dimensional finite element study

Introduction

The purpose of this study is to evaluate the effect of change in vertical placement of bracket and effect of tooth morphology on stress developed on periodontal ligament with the help of three dimensional finite element modeling.

Methods

A three-dimensional model of the maxillary bone, maxillary right central incisor, lateral incisor and canine was designed based on the average dimensions of the anatomy and morphology given by Wheeler's and standard edgewise bracket with Slot of 0.022″ X 0.028″ inch was designed using the finite element method. Brackets were placed on each tooth, on the mentioned labial surface at variable distances from the cusp tip, and a full size archwire was virtually engaged into the bracket, then optimum orthodontic load of 2N is applied and PDL stress were calculated.

Results

The lowest stress values were measured as bracket position changes from crest of teeth to the apical direction. By displacing the bracket gingivally from 1.5 to 6 mm, a 16.2% decrease in stress level for central incisor, for lateral incisor the stress level decrease by 25.8% and for canine the stress level decrease by 21.6% thus our study confirms that variation in vertical bracket position results in change in resultant stress in PDL.

Conclusion

It can be concluded that the variation in the vertical position of the bracket osn different tooth can have an important effect on the stresses developed in the PDL.

The crown-root morphology of central incisors in different skeletal malocclusions assessed with cone-beam computed tomography

Background

To determine the discrepancy of crown-root morphology of central incisors among different types of skeletal malocclusion using cone-beam computed tomography (CBCT) and to provide guidance for proper torque expression of anterior teeth and prevention of alveolar fenestration and dehiscence.

Methods

In this retrospective study, a total of 108 CBCT images were obtained (ranging from 18.0 to 30.0 years, mean age 25.8 years). Patients were grouped according to routine sagittal and vertical skeletal malocclusion classification criteria. The patients in sagittal groups were all average vertical patterns, with Class I comprised 24 patients—14 females and 10 males; Class II comprised 20 patients—13 females and 7 males; and Class III comprised 22 subjects—13 females and 9 males. The patients in vertical groups were all skeletal Class I malocclusions, with low angle comprised 21 patients—12 females and 9 males; average angle comprised 24 patients; and high angle comprised 21 patients—11 females and 10 males. All the CBCT data were imported into Invivo 5.4 software to obtain a middle labio-lingual section of right central incisors. Auto CAD 2007 software was applied to measure the crown-root angulation (Collum angle), and the angle formed by a tangent to the central of the labial surface of the crown and the long axis of the crown (labial surface angle). One-way analysis of variance (ANOVA) and Scheffe’s test were used for statistical comparisons at the P < 0.05 level, and the Pearson correlation analysis was applied to investigate the association between the two measurements.

Results

The values of Collum angle and labial surface angle in maxillary incisor of Class II and mandibular incisor of Class III were significantly greater than other types of sagittal skeletal malocclusions (P < 0.05); no significant difference was detected among vertical skeletal malocclusions. Notably, there was also a significant positive correlation between the two measurements.

Conclusions

The maxillary incisor in patients with sagittal skeletal Class II malocclusion and mandibular incisor with Class III malocclusion present remarkable crown-root angulation and correspondingly considerable labial surface curvature. Equivalent deviation during bracket bonding may cause greater torque expression error and increase the risk of alveolar fenestration and dehiscence.

Coordinating bracket torque and incisor inclination : Part 3: Validity of bracket torque values in achieving norm inclinations

PURPOSE

To analyze common values of bracket torque (Andrews, Roth, MBT, Ricketts) for their validity in achieving incisor inclinations that are considered normal by different cephalometric standards.

METHODS

Using the equations developed in part 1 (eU1_(BOP) = 90° - BT_(U1) - TCA_(U1) + α₁ - α₂ and eL1_(BOP) = 90° - BT_(L1) - TCA_(L1) + β₁ - β₂) (abbreviations see part 1) and the mean values (± SD) obtained as statistical measures in parts 1 and 2 of the study (α₁ and β₁ [1.7° ± 0.7°], α₂ [3.6° ± 0.3°], β₂ [3.2° ± 0.4°], TCA_(U1) [24.6° ± 3.6°] and TCA_(L1) [22.9° ± 4.3°]) expected (= theoretically anticipated) values were calculated for upper and lower incisors (U1 and L1) and compared to targeted (= cephalometric norm) values.

RESULTS

For U1, there was no overlapping between the ranges of expected and targeted values, as the lowest targeted value of (58.3°; Ricketts) was higher than the highest expected value (56.5°; Andrews) relative to the bisected occlusal plane (BOP). Thus all of these torque systems will aim for flatter inclinations than prescribed by any of the norm values. Depending on target values, the various bracket systems fell short by 1.8-5.5° (Andrews), 6.8-10.5° (Roth), 11.8-15.5° (MBT), or 16.8-20.5° (Ricketts). For L1, there was good agreement of the MBT system with the Ricketts and Björk target values (Δ0.1° and Δ-0.8°, respectively), and both the Roth and Ricketts systems came close to the Bergen target value (both Δ2.3°). Depending on target values, the ranges of deviation for L1 were 6.3-13.2° for Andrews (Class II prescription), 2.3°-9.2° for Roth, -3.7 to -3.2° for MBT, and 2.3-9.2° for Ricketts.

CONCLUSIONS

Common values of upper incisor bracket torque do not have acceptable validity in achieving normal incisor inclinations. A careful selection of lower bracket torque may provide satisfactory matching with some of the targeted norm values.

Coordinating bracket torque and incisor inclination : Part 2: Reproducibility and statistical measures of the torque coordination angle (TCA)

PURPOSE

To determine the reproducibility and statistical measures of the torque coordination angle (TCA).

METHODS

A total of 107 final cephalograms and corresponding casts were included, all reflecting treatment outcomes that met high qualitative standards, one of them being a Peer Assessment Rating (PAR) score of ≤3. Based on these records, the TCA was measured as a parameter to identify differences related to tooth morphology and bracket position between the torque-relevant reference plane at the bracket base and the long axis of a tooth. All measurements were performed on upper and lower central incisors (U1 and L1).

RESULTS

Several reproducibility assessments for the TCA measurements yielded good results, including objectivity at 1.26 ± 0.81° (U1) or 1.41 ± 1.18° (L1), examiner reliability at 1.30 ± 0.97° (U1) or 1.25 ± 0.82° (L1), and method reliability at 1.80 ± 1.13° (U1) or 1.53 ± 1.07° (L1). The statistical measures revealed a high degree of interindividual variability. With bracket placement 4.5 mm (U1) or 4.0 mm (L1) above the incisal edge, the differences between the maximum and minimum TCA values were similarly large in both jaws (21.0° for U1 or 20.0° for L1), given mean TCA values of 24.6 ± 3.6° (U1) or 22.9 ± 4.3° (L1). Moving the bracket placement from 3.5 to 5.5 mm (U1) or from 3.0 to 5.0 mm (L1) changed the mean TCA values by 4.5° (U1) or 3.2° (L1).

CONCLUSIONS

The TCA is a suitable cephalometric parameter to identify differences related to tooth morphology and bracket placement. Given its high interindividual variability, the fixed torque value of a specific bracket system should not be expected to produce the same incisor inclinations across patients.

Torque differences due to the material variation of the orthodontic appliance: a finite element study

Background

Torque of the maxillary incisors is crucial to occlusal relationship and esthetics and can be influenced by many factors. The aim of this study was to assess the relative influence of the material of the orthodontic appliance (adhesive, bracket, ligature, and wire) on tooth displacements and developed stresses/strains after torque application.

Methods

A three-dimensional upper right central incisor with its periodontal ligament (PDL) and alveolus was modeled. A 0.018-in. slot discovery® (Dentaurum, Ispringen, Germany) bracket with a rectangular 0.018 x 0.025-in. wire was generated. The orthodontic appliance varied in the material of its components: adhesive (composite resin or resin-modified glass ionomer cement), bracket (titanium, steel, or ceramic), wire (beta-titanium or steel), and ligature (elastomeric or steel). A total of 24 models were generated, and a palatal root torque of 5° was applied. Afterwards, crown and apex displacement, strains in the PDL, and stresses in the bracket were calculated and analyzed.

Results

The labial crown displacement and the palatal root displacement of the tooth were mainly influenced by the material of the wire (up to 150% variation), followed by the material of the bracket (up to 19% variation). The magnitude of strains developed in the PDL was primarily influenced by the material of the wire (up to 127% variation), followed by the material of the bracket (up to 30% variation) and the ligature (up to 13% variation). Finally, stresses developed at the bracket were mainly influenced by the material of the wire (up to 118% variation) and the bracket (up to 59% variation).

Conclusions

The material properties of the orthodontic appliance and all its components should be considered during torque application. However, these in silico results need to be validated in vivo before they can be clinically extrapolated.

Electronic supplementary material

The online version of this article (doi:10.1186/s40510-017-0161-5) contains supplementary material, which is available to authorized users.