BOOK REVIEW
appointment and sliding mechanics seem to have
Biomechanics in orthodontics
Giorgio Fiorelli and Birte Melsen; Wollerau, Switzerland:
International Orthodontic School and Services; http://www.
ortho-biomechanics.com/en/; price varies by time purchased.
Reviewed by Jean-Marc Retrouvey
T his electronic book is appropriately entitled Biome-
chanics in orthodontics. It is a comprehensive,
667–Web-page book, written by Birte Melsen and
Giorgio Fiorelli, that is well illustrated and includes
over 200 Flash animations and videos.
Sold as a subscription, this e-book is constantly
updated by the authors so that, upon log in, the
reader always has access to the most current
content—a significant advantage over conventional
textbooks. Reading about biomechanics is a daunting
task, since the concepts are somewhat hard to grasp in
a static environment, but the animations and feedback
in this interactive medium greatly increase the
comprehension of the interactions between force
application and tooth movement.
Twenty highly referenced chapters on biomechanics,
ranging from physics to treatment planning, are used to
explain all the biomechanical concepts that are developed
in the e-book. A nice feature is that each reference is
hyperlinked, and the respective abstracts are readily acces-
sible on the publisher's site for immediate consultation.
The first 5 chapters cover the basic force systems used
in orthodontics. All definitions are clearly explained and
illustrated or animated, making this review useful as a
refresher course. The most important principles, such
as forces, force systems, and mechanics of tooth move-
ments, are presented in a logical manner from simple to
complex, and relevant references are provided to rein-
force and validate the scientific bases of the didactic
content. Short quizzes are also offered to allow the par-
ticipants to test and practice the material presented.
These 5 chapters are the backbone of the book and are
alone worth the price to any orthodontist wishing to
fully understand the mechanics of tooth movement.
The following chapters present more complex biome-
chanical concepts. The segmented arch technique and
the rationale for using loops in orthodontic wires vs
the use of the straight wire system are well explained
and should be of great interest for the orthodontist look-
ing for maximum efficiency and outcome for any type of
orthodontic movement. Many postgraduate curriculums
have reduced the amount of time allocated to teaching
in-depth biomechanical principles. The introduction of
the use of the straight wire at the first bonding
134
become the preferred approach to orthodontic care. Or-
thodontic biomechanical principles introduced by many
clinicians and perfected by Dr Burstone are extensively
presented in this e-book. It demonstrates that this in-
depth knowledge is still relevant and should be an inte-
gral part of any modern orthodontic residency curricu-
lum.
The extensively explained segmented arch technique
addresses several complex procedures such as space clo-
sures and vertical control of malocclusions. Different
types of loops are described, and their indications as
well as mode of activation are well illustrated. The ad-
vantages of using specific loop configuration over others
for a specific tooth movement are all explained and
simulated with short videos.
A whole chapter is devoted to cantilevers. Cantilever
mechanics is of great interest because its efficiency and
capacity to precisely move a single tooth or segments of
a dental arch in the 3 planes of space with light forces
applied in the correct direction are invaluable, especially
in adult orthodontics. The use of these cantilevers in
molar uprighting, control of occlusal plane cants, and
differential intrusion or extrusion mechanics is abun-
dantly illustrated.
In the second part of the book, the undesirable side
effects of oversimplified orthodontic techniques are
illustrated and explained. Remedial mechanics to over-
come these undesirable effects are also addressed with
numerous illustrations and animations.
The last part of the e-book relates more to treatment
planning, and over 100 clinical situations are presented.
An introduction to 2-dimensional and 3-dimensional
occlusograms is provided. It allows the reader to design
the most appropriate force system for a given clinical
situation. Animated short videos describing the proper
use of the correct mechanical setup for a specific
situation reinforce the knowledge acquired in preceding
chapters and add relevant clinical applications to this
e-book.
What could be improved? First, the interface could be
somewhat improved by filling in more of the blank
spaces of several pages. Fewer mouse clicks should
also be considered with mouseovers and more “modern”
navigation. Some pages could be grouped together to
make the reading experience even more enjoyable.
Despite these minor shortcomings, the main point is
that the content is extremely useful and well presented
in a logical manner for the seasoned clinical practitioner
and the future orthodontist alike. The short videos ex-
plaining the effects and side effects of the different me-
chanical forces are invaluable. More detailed and
Book review
extended explanations of complicated concepts would
be welcomed for the orthodontic resident and the ortho-
dontist not having had the opportunity to benefit from a
strong training in biomechanics. In some instances, the
content is a bit difficult to follow from 1 click to another.
The authors are so knowledgeable about biomechanics
that they sometimes tended to overlook steps in their ex-
planations, making the material more arduous to follow
for the reader.
The occlusogram section is now being revamped to
take advantage of 3-dimensional technologies and
more up-to-date software.
Incorporating printable exercises with step-by-step
corrections especially in the first part of the book would
be most welcomed, since mastering these concepts is
mandatory to fully benefit from the subsequent chap-
ters. Printable exercises would allow students to better
practice and monitor their progress through self-
correcting quizzes. A far-fetched wish would be to
have Drs Melsen and Fiorelli explain difficult concepts
with longer videos, because I was a bit lost sometimes
in some of the more technical chapters.
This e-book is highly recommended for any ortho-
dontist who desires to fully understand and master the
fundamental biomechanical principles that are the
cornerstone of our specialty. It should be used exten-
sively in every orthodontic postgraduate program, since
it covers all of the most important biomechanical con-
cepts of modern orthodontics in a well-organized and
sequential manner. Some orthodontic program schools
may now be relying too much on single simplified tech-
niques and ignoring the immense benefits of mastering
American Journal of Orthodontics and Dentofacial Orthopedics
135
in-depth biomechanical orthodontic knowledge. This e-
book has truly opened my mind to the importance of
acquiring a much broader comprehension and apprecia-
tion of the complexity of the optimum force system-
tooth movement interactions in orthodontics and not
solely to rely only on preprogrammed orthodontic appli-
ances and wire sequencing.
This e-book will absolutely enhance and reinforce the
comprehension of simple to complex biomechanical
principles for every orthodontist and improve his or her
treatment skills dramatically.
One of the main benefits of having spent the time
going through this material and applying it in my prac-
tice is the vast improvement in the management of
several of my patients who were not progressing as
planned. This benefit associated with my renewed
enthusiasm for biomechanics totally justified once again
the price of admission.
I am extremely thankful to Drs Fiorelli and Melsen for
their passionate commitment to quality orthodontics
and for undertaking such a monumental task. This great
reference should be consulted on a regular basis by all
orthodontists, because it is the reference for biome-
chanics and is constantly updated.
This e-book is truly international and is offered in En-
glish, Italian, Spanish, Portuguese, and Bosnian/Serbian/
Croatian. Chinese and French versions are in preparation.
Am J Orthod Dentofacial Orthop 2017;152:134-5
0889-5406/$36.00
Ó 2017 by the American Association of Orthodontists. All rights
reserved.
http://dx.doi.org/10.1016/j.ajodo.2017.04.010
July 2017  Vol 152  Issue 1