Computers in Biology and Medicine 69 (2016) 112–119

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Computers in Biology and Medicine

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Optimum force system for intrusion and extrusion of maxillary central

incisor in labial and lingual orthodontics
Abhishek M. Thote a,n, Rashmi V. Uddanwadiker a, Krishna Sharma b, Sunita Shrivastava b
a
Department of Mechanical Engineering, Visvesvaraya National Institute of Technology, Nagpur, Maharashtra, India
b
Department of Orthodontics, Sharad Pawar Dental College, Wardha, Maharashtra, India

art ic l e i nf o a b s t r a c t

Article history: Background: The objective of the present study was to specify an optimum force system for intrusion and
Received 3 November 2015 extrusion of maxillary central incisor and to compare the effects of bracket positioning at different
Received in revised form heights from the incisal edge in Labial Orthodontics (LaO) and Lingual Orthodontics (LiO).
17 December 2015
Methods: A mathematical model of maxillary central incisor with normal inclination was developed.
Accepted 19 December 2015
Four cases of heights of bracket slot from incisal edge were considered both in LaO and LiO viz. 3 mm,
4 mm, 5 mm and 6 mm. Based on a mathematical model, an optimum force system consisting of an
Keywords: intrusive or extrusive force (F) and a moment (M) was devised and moment (M) to force (F) ratio (M:F
Intrusion ratio) was estimated in each case. Then, three-dimensional Computer Aided Design (CAD) models of
Extrusion
incisor and surrounding structures were prepared. To validate an optimum force system, finite element
Maxillary central incisor
analysis was carried out and force system with derived M:F ratio was applied in each case.
LaO
LiO Results: In finite element analysis, results were shown in the form of vector graph of nodal displace-
Mathematical model ments along with undeformed and deformed models. The desired intrusion or extrusion of incisor was
Finite element analysis observed. Thus, force system devised from a mathematical model was validated with finite element
analysis in each case.
Conclusion: To achieve intrusion or extrusion, M:F ratios required in LaO were same i.e. 8:1 for afore-
mentioned heights of bracket slot from incisal edge but different in LiO i.e. 0:1, 1:1, 2:1 and 3:1 for the
heights of 3 mm, 4 mm, 5 mm and 6 mm respectively.
& 2015 Elsevier Ltd. All rights reserved.

1. Introduction Biomechanical principles of Lingual Orthodontics (LiO) are

Tooth displacement is an outcome of continuous orthodontic
force system due to remodeling of the surrounding bone structure.
For the best orthodontic treatment, an optimal external force
system should be determined so that tooth movement can be
estimated and controlled [1–4]. Accurate application of basic bio-
mechanical principles in orthodontic treatment simplifies the
force system. It improves the efficiency of the orthodontic appli-
ance and obviates any side effects. Thus, more predictable tooth
movement can be achieved [1].
Emphasis should be given to the significance of tooth mor-
phology. Accurate position and orientation of the maxillary and
mandibular incisors is a crucial factor for stability, function and
esthetics purpose [5–9]. The most discernible teeth in the oral
cavity are the maxillary central incisors that can be easily dis-
tinguished from the other teeth [10,11].
n
Corresponding author. Tel.: þ 918446640525.
E-mail address: abhi.thote8@gmail.com (A.M. Thote).
different from Labial Orthodontics (LaO). If a particular force sys-
tem produces bodily displacement of tooth in LaO, crown tipping
will occur in LiO and vice-versa [12]. Further, LiO is more esthetic
orthodontic technique than LaO [13]. In case of vertical forces, the
Center of Resistance (Cres) of the tooth is closer in LiO. Besides
providing good esthetics, this biomechanical advantage demands
lesser force or moment values, which will be more within the
biological limit.
Finite element analysis has been established as an effective
tool for the simulation and analysis of tooth structures [11–20]. It
is a quick, accurate and inexpensive method to apply bio-
mechanical forces and analyze results. The main steps in finite
element analysis are pre-processing, processing and post-
processing [15]. Pre-processing involves three-dimensional geo-
metric modeling of a structure, meshing i.e. discretization into
smaller elements connected by nodes, assigning appropriate
material properties, loads and boundary conditions. Processing
involves solving a set of simultaneous equations with numerous
variables to converge the solution. The last step post-processing

http://dx.doi.org/10.1016/j.compbiomed.2015.12.014
0010-4825/& 2015 Elsevier Ltd. All rights reserved.
 A.M. Thote et al. / Computers in Biology and Medicine 69 (2016) 112–119 113

involves graphical representation of analysis results to compare

the stress–strain variations, undeformed and deformed structure
at nodes and elements.
Application of simply intrusive or extrusive force causes
uncontrolled crown tipping of tooth. This uncontrolled tipping
should be prevented so that intrusion or extrusion of tooth will
occur. Clinically, application of labial and lingual appliances has
different effects on tooth movement. However, very few studies
have compared intrusion and extrusion of incisors between LaO
and LiO [1,2].
For this study, maxillary central incisor was considered as it is
the most prominent tooth in the oral cavity. In this study, a
mathematical model of maxillary central incisor was developed
taking various factors into consideration i.e. normal inclination of
incisor, position of center of resistance (Cres), distance of labial
bracket slot from tooth surface, distance of lingual bracket slot
from tooth surface and height of bracket slot from incisal edge.
Four cases of height of bracket slot were considered, i.e. 3 mm,
4 mm, 5 mm and 6 mm. If any of the above factors is not con-
sidered, then it will affect the calculated value of distance (D)
between point of force application (Pf) on bracket slot and Cres.
Hence, it will alter the values of required force system. So, con-
sideration of all these factors is necessary to devise an optimum
force system. To the best of our knowledge, no study has been
performed to establish an optimum force system for intrusion and
extrusion of maxillary central incisor both in LaO and LiO con-
sidering the aforementioned factors. Thus, this study provides a
unique optimum force system.
Fig. 1. Mathematical model of right maxillary central incisor with distances of
The aim of the present study was to specify an optimum force labial and lingual bracket slots as viewed from the distal side [all length dimensions
system for intrusion and extrusion of maxillary central incisor and are in mm].
to compare the effects of bracket positioning at different heights
from the incisal edge in LaO and LiO. The force system devised The normal inclination of long axis of maxillary central incisor was
from a mathematical model was compared and validated with taken as 22.5° with respect to vertical plane [3]. The position of
finite element analysis in each case. Cres was taken approximately 0.77 of the root length from the apex
on the long axis [22]. The force system was applied on the bracket
slot. So, the horizontal distance between the bracket slot and tooth
2. Materials and methods surface was considered to be 1.2 mm for labial and 3 mm for lin-
gual side respectively [1]. The height of bracket slot from the
There are two permanent maxillary central incisors viz. right and incisal edge (I) i.e. perpendicular to Occlusal Plane (OP) was varied
left. The maxillary central incisors are the neighboring teeth in the from 3 to 6 mm at an interval of 1 mm. In this way, a mathematical
maxilla with their mesial surfaces in contact with each other. Ana- model of maxillary central incisor was developed (Fig. 1).
tomically, these teeth are identical. Hence, they perform similar Several points were defined on the model i.e. points along the
functions. In this study, right maxillary central incisor was selected. long axis of tooth and points along a line parallel to the OP that
passes through the labial and lingual bracket slots. The points
2.1. Mathematical model defined on the long axis of the tooth were, I ¼incisal edge,
Cres ¼center of resistance, J ¼point joining crown and root on long
The equivalent force system at Cres due to single intrusive or axis of tooth, A¼ root apex. The points on the lines parallel to OP
extrusive force (F) i.e. at a distance (D) from Cres is a force and a are shown in Table 1.
moment developed due to force. Hence, single intrusive or In mathematical model,
extrusive force (F) produces intrusion or extrusion respectively Length of Crown, Lcrown ¼ IJ ¼ 10:5 mm
along with uncontrolled crown tipping. To prevent this tipping, Length of Root, Lroot ¼ AJ ¼ 13 mm
counter-acting moment (M) along with force (F) was applied on The horizontal distance between bracket slot and tooth surface
the bracket slot so that equivalent force system at the Cres was only was considered as 1.2 mm and 3 mm in LaO and LiO respectively.
single intrusive or extrusive force. Thus, the force system at the In LaO, ɑɑ’ ¼ bb’ ¼ cc’ ¼ dd’ ¼ 1:2 mm
bracket slot was a single intrusive or extrusive force (F) and a In LiO, ee’ ¼ ff ’ ¼ gg’ ¼ hh’ ¼ 3 mm
moment (M) i.e. clockwise or counter-clockwise. This force system The horizontal distances within tooth i.e. between tooth sur-
was applied in a proper Moment to Force (M:F) ratio according to face and long axis of tooth at different heights of bracket slot were
the position of brackets in LaO and LiO to obtain intrusion or determined graphically with enlarged scale as, ɑ0 x3 ¼ 2:9 mm,
extrusion of tooth. To calculate M:F ratio, a mathematical model of 0 0
b x4 ¼ 3:3 mm, c0 x5 ¼ 3:7 mm, d x6 ¼ 4:1 mm,
maxillary central incisor was developed. The point on bracket slot 0 0 0 0
e x3 ¼ 0:9 mm, f x4 ¼ 1:5 mm, g x5 ¼ 2:1 mm, h x6 ¼ 2:7 mm
where force was applied is also called as point of force application The basic trigonometric equations were applied to calculate M:
(Pf). F ratio.
The basic anatomic and geometric features of the right per-
manent maxillary central incisor were taken from Wheeler's 3 4 5 6
I x3 ¼ ; Ix ¼ ; Ix ¼ ; Ix ¼
dental anatomy; physiology and occlusion [21]. The cervico-incisal cos ð22:51Þ 4 cos ð22:51Þ 5 cos ð22:51Þ 6 cos ð22:51Þ
length of crown and root were 10.5 mm and 13 mm respectively. ð1Þ
114 A.M. Thote et al. / Computers in Biology and Medicine 69 (2016) 112–119

Table 1
Nomenclature of points on the lines parallel to OP through different heights of bracket slots.

Height of bracket slot Points on the lines parallel to OP

from incisal edge (mm)
Point on bracket Point on tooth Point intersecting long Point on bracket Point on tooth Point intersecting vertical
slot in LaO surface in LaO axis of tooth slot in LiO surface in LiO line through Cres

3 ɑ ɑ’ x3 e e’ z3
4 b b’ x4 f f’ z4
5 c c’ x5 g g’ z5
6 d d’ x6 h h’ z6

Table 2
M:F ratios calculated from a mathematical model of maxillary central incisor.

Bracket slot height from incisal edge (mm) Values of M:F ratio

Intrusion Extrusion

LaO LiO LaO LiO

3 8:1 M – CW, F – UP 0:1 F – UP 8:1 M – CCW, F – DOWN 0:1 F – DOWN

4 8:1 M – CW, F – UP 1:1 M – CCW, F – UP 8:1 M – CCW, F – DOWN 1:1 M – CW, F – DOWN
5 8:1 M – CW, F – UP 2:1 M – CCW, F – UP 8:1 M – CCW, F – DOWN 2:1 M – CW, F – DOWN
6 8:1 M – CW, F – UP 3:1 M – CCW, F – UP 8:1 M – CCW, F – DOWN 3:1 M – CW, F – DOWN

ACres ¼ 0:77  Lroot
ICres ¼ ðIJ þ AJÞ  ACres
x3 C res ¼ ICres Ix3 ; x4 C res ¼ ICres  Ix4 ;
x5 C res ¼ ICres Ix5 ; x6 C res ¼ ICres  Ix6
Horizontal distance between x3 and Cres, x4 and Cres, x5 and Cres,
x6 and Cres are given respectively as:
x3 Z 3 ¼ x3 C res  sin ð22:51Þ; x4 Z 4 ¼ x4 C res  sin ð22:51Þ;
x5 Z 5 ¼ x5 C res  sin ð22:51Þ; x6 Z 6 ¼ x6 C res  sin ð22:51Þ
In LaO, horizontal distance between ɑ and Cres, b and Cres, c and
Cres, d and Cres are given respectively as:
0 0
D ¼ az3 ¼ x3 z3  a0 x3 þ aa0 ; D ¼ bz4 ¼ x4 z4  b x4 þ bb ;
0
D ¼ cz5 ¼ x5 z5  c0 x5 þ cc0 ; D ¼ dz6 ¼ x6 z6  a0 x6 þ dd
In LiO, horizontal distance between e and Cres, f and Cres, g and
Cres, h and Cres are given respectively as:
0 0

D ¼ ez3 ¼ ðee0 þ e0 x3 Þ  x3 z3 ; D ¼ f z4 ¼ f f þ f x4  x4 z4 ;
0

0
D ¼ gz5 ¼ ðgg 0 þ g 0 x5 Þ  x5 z5 ; D ¼ hz6 ¼ hh þ h x6  x6 z6
In both the cases of LaO and LiO,
M¼F D
where F¼Intrusive or Extrusive Force applied on the bracket
slot in g,
M¼ Moment (M) applied on the bracket slot in g-mm,
D¼ Horizontal distance between Cres and bracket slot in mm.
M and F were unknown quantities and the distance D was
known for various cases.
M
Hence; ¼ D i:e: M : F ¼ D : 1
F ward (DOWN).
Thus, M:F ratio required for intrusion or extrusion was the
horizontal distance (D) between Cres and bracket slot. The direc-
tion of applied moment (M) was dependent on the direction of
applied force (F) and the side on which force system was applied
viz. labial or lingual.
ð2Þ From a mathematical model of maxillary central incisor, dis-
tance (D) was calculated from Eqs. (6) and (7).
ð3Þ
In LaO; D ¼ ɑz3 ¼ bz4 ¼ cz5 ¼ dz6  8 mm
ð4Þ In LiO; D ¼ ez3  0; D ¼ fz4  1 mm;
D ¼ gz5  2 mm; D ¼ hz6  3 mm
M:F ratio was then estimated from Eq. (9). Table 2 presents M:F
ratios required along with direction of moment and force to be
applied in case of different bracket slot heights from incisal edge in
ð5Þ LaO and LiO. In Table 2, the directions of Moment (M) and Force (F)
as viewed from the distal side are, CW – clockwise, CCW – coun-
ter-clockwise, UP – upward, DOWN – downward.
2.1.1. Intrusion in LaO
For intrusion using a labial bracket, the M:F ratio required in all
ð6Þ the four cases of bracket slot height was 8:1 with direction of
Moment (M) as clockwise (CW) and Force (F) as upward (UP).
2.1.2. Intrusion in LiO
For intrusion using a lingual bracket, the M:F ratio required in
all the four cases of bracket slot height was different. The line
through Cres and perpendicular to Occlusal Plane (OP) passes
ð7Þ through the bracket slot at 3 mm height from incisal edge. Hence,
no Moment (M) was required for intrusion and direction of Force
(F) was upward (UP) with M:F ratio equal to 0:1 in this case. For
ð8Þ other cases of 4, 5 and 6 mm height from incisal edge, the M:F
ratio required was 1:1, 2:1 and 3:1 respectively with direction of
Moment (M) as counter-clockwise (CCW) and Force (F) as
upward (UP).
2.1.3. Extrusion in LaO
For extrusion using a labial bracket, the M:F ratio required in all
the four cases of bracket slot height was 8:1 with direction of
ð9Þ Moment (M) as counter-clockwise (CCW) and Force (F) as down-
2.1.4. Extrusion in LiO
For extrusion using a lingual bracket, the M:F ratio required in
all the four cases of bracket slot height was different. Similarly as
intrusion, no Moment (M) was required for extrusion at 3 mm
 A.M. Thote et al. / Computers in Biology and Medicine 69 (2016) 112–119
Fig. 2. Proportion of Moment (M) and Force (F) values for different heights of bracket slot from incisal edge. (A) Intrusion in LaO, (B) intrusion in LiO, (C) extrusion in LaO,
(D) extrusion in LiO [positive values represent upward (UP) force and clockwise (CW) moment, while negative values represent downward (DOWN) force and counter-
clockwise (CCW) moment].
bracket slot height from incisal edge and direction of Force (F) was
downward (DOWN) with M:F ratio equal to 0:1 in this case. For
other cases of 4, 5 and 6 mm height from incisal edge, the M:F
ratio required was 1:1, 2:1 and 3:1 respectively with direction of
Moment (M) as clockwise (CW) and Force (F) as downward
(DOWN).
Fig. 2 shows bar charts of proportion of M and F values to be
selected for intrusion and extrusion in LaO and LiO. For example,
M:F ratio was 8:1 for 3 mm bracket slot height for intrusion in LaO,
so Moment (M) and Force (F) bars reached to the scale factor of
8 and 1 respectively. It means if F value is selected as 10 g, then M
value should be taken as (10  8) ¼80 g-mm in the aforesaid case.
In Fig. 2, positive values represent upward (UP) force and clock-
wise (CW) moment, while negative values represent downward
(DOWN) force and counter-clockwise (CCW) moment.
2.2. Finite element analysis
Three-dimensional CAD models of maxillary central incisor and
surrounding tissue structures viz. Periodontal Ligament (PDL) and
alveolar bone were prepared. Moreover, labial and lingual brackets
were also modeled.
First, maxillary central incisor was scanned with the high
resolution Cone Beam Computed Tomography i.e. CBCT scan
machine (Kodak 9000 extra-oral imaging system with 3D module
V2.2, Carestream Dental LLC, Atlanta, GA). CT-scan data consisted
of a stack of numerous CT-scan images. Second, CAD model was
generated by volume rendering of CT-scan images with the
MIMICS software (version 10.1, Materialise NV, Leuven, Belgium).
To obtain accurate geometry of tooth, customized thresholding
was done under segmentation function in MIMICS. Tooth surface
115
was then smoothed using smoothening function in MIMICS. Tooth
model generated here consisted of too many triangular surfaces. In
MIMICS, the REMESH module was therefore used to reduce the
amount of triangular surfaces while maintaining the quality of
geometry. As a result, highly smoothed and geometrically accurate
tooth model was generated. The other structures were prepared
using CREO software.
CREO is Computer Aided Design (CAD) software. CREO Para-
metric (version 2.0, Parametric Technology Corporation-PTC,
Needham, Massachusetts, USA) was used in this study. The tooth
modeled using MIMICS was imported in CREO. The CAD models of
PDL, Alveolar Bone and brackets were prepared with the reference
of tooth model in CREO. Fig. 3 shows all the CAD models. The
thickness of PDL was considered to be uniform and equal to
0.2 mm [12]. In CREO, the assemblies of bracket, incisor, PDL and
bone were then created for various cases. Fig. 4 shows cross-
section of assembly of incisor, PDL and bone with labial and lingual
brackets for a particular height from incisal edge. The assemblies
in CREO were saved in STEP (STandard for the Exchange of Product
model data) file format and imported into ANSYS.
ANSYS is computer-aided analysis software which enables
finite element analysis. ANSYS Workbench (version 14.5, ANSYS
Inc., Canonsburg, Pennsylvania, USA) was used for this purpose. In
ANSYS, each assembly model was meshed by 10-node tetrahedron
and 20-node hexahedron elements connected by nodes. To get
more accurate results, mesh refinement was applied on the incisor.
One assembly model consisted of 1,08,508 nodes and 57,853 ele-
ments on average. Force system was applied to the bracket slot of
each assembly which was devised from a mathematical model in
each case. The main purpose of taking bracket into consideration
was to apply the force system at an offset from the tooth surface.
116 A.M. Thote et al. / Computers in Biology and Medicine 69 (2016) 112–119
Fig. 3. CAD Models. (A) Maxillary Central Incisor, (B) periodontal ligament [PDL], (C) alveolar bone, (D) labial bracket, (E) lingual bracket.
Fig. 4. Cross-section of assembly of incisor, PDL, bone and bracket. (A) Assembly
with labial bracket, (B) assembly with lingual bracket.
Fig. 5. Force system on bracket slot for a particular case.
Hence, the force application site was selected solely on anatomical
basis, without considering variables such as the type of bracket or
slot size. The force system on bracket slot consisting of a force and
a moment is shown for a particular case in Fig. 5. The value of force
was kept fixed i.e. 40 g and moment was varied according to M:F
ratios derived from a mathematical model. For the boundary
conditions, the upper and lateral surfaces of the simulated bone
region holding the maxillary incisor were kept fixed. Then, solu-
tion command was executed to get the results of finite element
analysis. Thus, MIMICS, CREO and ANSYS Workbench were
sequentially used for preprocessing and only ANSYS Workbench
was used for processing and post-processing.
Brackets were considered to be made of stainless steel. All of
the materials were considered to be isotropic and linearly elastic,
with their respective properties as reported in Table 3.
Table 3
Material properties of Tooth, PDL, alveolar bone and bracket.
No. Material Young's modulus Poisson's Reference
[MPa] ratio
[1] Tooth (Incisor) 19,600 0.30 Liang et al. [12]
[2] PDL 0.667 0.45 Liang et al. [12]
[3] Alveolar Bone 13,700 0.26 Liang et al. [12]
[4] Bracket (Stainless 200,000 0.30 Kim et al. [3]
Steel)
3. Results
The M:F ratios derived from a mathematical model were used
for simulation in ANSYS. The results of tooth movement from
ANSYS were compared with intrusion or extrusion, which was
desired to happen. Figs. 6 and 7 show vector graph of nodal dis-
placements for intrusion of incisor with undeformed (d1) and
deformed (d2) models in LaO and LiO respectively.
Similarly, Figs. 8 and 9 show vector graph of nodal displace-
ments for extrusion of incisor with undeformed (d1) and deformed
(d2) models in LaO and LiO respectively.
From the vector graph as well as position of undeformed and
deformed models, it was clear that when Moment (M) and Force
(F) were applied in a specific ratio as mentioned in Table 2,
respective intrusion or extrusion of tooth model was observed in
various cases. Thus, M:F ratios derived from a mathematical model
of maxillary central incisor were compared with finite element
analysis and hence validated.
4. Discussion
Orthodontic intrusion is a common treatment practice for the
correction of deep overbite and gummy smile [23–25]. Ortho-
dontic extrusion, also known as forced eruption is necessary to
correct apical recession of gingival soft tissues, infrabony defects
due to periodontal disease, insufficient crown length after tooth
restoration, etc. [26–28]. In other case, tooth may be inherently
intruded or extruded in some patients. So, in this study, an opti-
mum force system was proposed to correct aforementioned dental
problems.
This study was focused on maxillary central incisors as they are
the most prominent and distinguishable teeth in the oral cavity.
The principal biomechanics of tooth movement is the change of
PDL structure. Tooth movement within PDL is called as initial
displacement. The nature of tooth movement in initial displace-
ment is same as in total tooth displacement due to bone resorption
[2]. Hence, tooth movement within PDL was observed during finite
element analysis. The use of light force is suggested to produce
appropriate pressure within PDL as the force is concentrated at the
apex during intrusion or extrusion [29]. The light continuous force
 A.M. Thote et al. / Computers in Biology and Medicine 69 (2016) 112–119 117

Fig. 6. Vector graph of nodal displacements for intrusion in LaO with undeformed (d1) and deformed (d2) models for different heights of bracket slot from incisal edge.
(A) 3 mm, (B) 4 mm, (C) 5 mm, (D) 6 mm.

Fig. 7. Vector graph of nodal displacements for intrusion in LiO with undeformed (d1) and deformed (d2) models for different heights of bracket slot from incisal edge.
(A) 3 mm, (B) 4 mm, (C) 5 mm, (D) 6 mm.

Fig. 8. Vector graph of nodal displacements for extrusion in LaO with undeformed (d1) and deformed (d2) models for different heights of bracket slot from incisal edge.
(A) 3 mm, (B) 4 mm, (C) 5 mm, (D) 6 mm.

moves the tooth quite rapidly and comfortably. Thus, the damage
of PDL tissues is prevented due to excessive loading. Therefore, the
force levels were kept within biological limit in this study and light
force value of 40 g was used [30]. While, in practical application,
dentist can apply any light force value viz. 10 g, 20 g, 30 g, etc. But,
correspondingly, equivalent amount of moment should be applied
to maintain the required M:F ratio. Additionally, linear elastic
behavior was assumed for all of the materials to simplify the finite
element analysis. This hypothesis appears to be reasonable as this
study was focused on nature of tooth displacement [12].
Geron et al. [1] considered the distance of bracket slot from
tooth surface in their mathematical model of maxillary central
incisor in LaO and LiO. But, the above study was limited to theo-
retical approach only and finite element analysis was not per-
formed. Lombardo et al. [2] performed finite element analysis for
intrusion of a central lower incisor in LaO and LiO. But, distance of
118 A.M. Thote et al. / Computers in Biology and Medicine 69 (2016) 112–119
Fig. 9. Vector graph of nodal displacements for extrusion in LiO with undeformed (d1) and deformed (d2) models for different heights of bracket slot from incisal edge.
(A) 3 mm, (B) 4 mm, (C) 5 mm, (D) 6 mm.
Fig. 10. Horizontal distance (D) between Center of Resistance (Cres) and bracket slot
i.e. point of force application (Pf). (A) Incisor with labial bracket, (B) incisor with
lingual bracket.
bracket slot from tooth surface was not considered by them. Also,
an optimum force system for intrusion or extrusion of tooth was
not specified in aforesaid two studies. Kim et al. [3] considered the
distance of bracket slot from tooth surface in their study of parallel
translation of maxillary anterior teeth with finite element analysis
in LaO. But, they focused on retraction of maxillary anterior teeth.
Hence, in this study, an optimum force system was devised for
intrusion and extrusion of maxillary central incisor considering
the distance of bracket slot from tooth surface. Firstly, a mathe-
matical model of maxillary central incisor was developed and
then, the devised force system was validated with finite element
analysis in each case.
To achieve intrusion or extrusion of tooth, single intrusive or
extrusive force (F) should pass through Cres of tooth. But, when a
single vertical force is applied on the bracket slot, it may not pass
through the Cres. In such a case, it produces the effect of uncon-
trolled crown tipping. To avoid this tipping, a mathematical model
of maxillary central incisor was developed and M:F ratios were
estimated for different heights of bracket slots from incisal edge.
Only in case of 3 mm height of bracket slot in LiO, Moment (M)
was not required as intrusive or extrusive force vector (F) passes
through the Cres. This simplifies the required force system and
makes the tooth movement easier. This agrees with the findings of
Jost-Brinkmann et al. [31] and Hong et al. [32] that lingual vertical
forces produce more effective tooth movement.
This study provides simplified 2-D force system i.e. combina-
tion of Moment (M) and Force (F) only to obtain intrusion or
extrusion of tooth. In finite element analysis, value of intrusive or
extrusive force (F) was kept fixed. Moment (M) was calculated and
applied according to M:F ratios in different cases. So, only deter-
mining factor was Moment (M) applied on the bracket slot. Hence,
M:F ratio plays an important role to carry out intrusion or extru-
sion. In ANSYS, the results of tooth movement were obtained in
the form of vector graph of nodal displacements along with
undeformed and deformed models. The desired intrusive or
extrusive tooth movement was obtained and verified with finite
element analysis.
From a mathematical model of maxillary central incisor, it was
observed that M:F ratio was dependent on the horizontal distance
(D) between Cres and bracket slot. Indeed, it was the horizontal
distance between Cres and point of force application (Pf). The dis-
tance D was different in LaO and LiO. As the distance (D) was
greater in LaO (Fig. 10A) than in LiO (Fig. 10B), the required M:F
ratio was grater in LaO. The value of D was considered to be
dependent upon incisor inclination i.e. inclination of long axis of
incisor, position of Cres, distance of bracket slot from tooth surface
and height of bracket slot from incisal edge.
From this study, it was observed that the distance between
bracket slot and tooth surface should be considered as it affects the
required M:F ratio. In LaO, it was found that the height of bracket
slot from incisal edge did not affect M:F ratio owing to fixed per-
pendicular distance (D) between bracket slot and Cres. But, the
lingual tooth morphology is more variable than labial one. Hence,
M:F ratios for various heights of bracket slot were found to be
different in LiO. Consequently, in LiO, it is more important to
control M:F ratio to achieve intrusion or extrusion for a particular
height of bracket slot. Thus, there are biomechanical differences
between LaO and LiO in case of vertical forces.
Numerical study (mathematical model) gives a clear idea that
how force system can be applied on tooth with accurate prediction
of nature of tooth movement. Hence, numerical study (mathe-
matical model) has a great significance from the biomechanics
point of view. Additionally, the numerical data obtained can form
the basis for future technological innovation.
However, this study was limited to control of single tooth only.
Continuous arch mechanics of all the teeth and its collective
response warrants future investigation. In future prospective stu-
dies, the approach used in this study (developing a mathematical
 A.M. Thote et al. / Computers in Biology and Medicine 69 (2016) 112–119
model and validation by finite element analysis) will provide a
strong platform to devise an optimum force system. In future, we
have planned to devise an optimum force system for continuous
and segmental arch mechanics. Thus, the devised optimum force
system to achieve any tooth movement will have a mathematical
proof and validation by finite element analysis.
5. Conclusion
To achieve intrusion or extrusion of maxillary central incisor, an
optimum force system consisting of an intrusive or extrusive force
(F) and a moment (M) was devised for different heights of bracket
slot from incisal edge in LaO and LiO. Four cases of heights of
bracket slot were considered both in LaO and LiO viz. 3 mm, 4 mm,
5 mm and 6 mm. Hence, the biomechanical differences of M:F
ratio on the maxillary central incisor were analyzed between LaO
and LiO. The differences were found to be significant. The high-
lighting points showing the differences between LaO and LiO are
as follows:
 First, the horizontal distance (D) between Cres and bracket slot
i.e. point of force application (Pf) was found to be same in LaO
and but different in LiO. The factors required to determine D
were considered to be incisor inclination i.e. inclination of long
axis of incisor, position of Cres, distance of bracket slot from
tooth surface and height of bracket slot from incisal edge.
 Second, the main parameter affecting the M:F ratio was the
distance D. Consequently, for different heights of bracket slot
from incisal edge, M:F ratios required in LaO were same but
different in LiO. In LaO, M:F ratio was 8:1 in each case of height
of bracket slot from incisal edge and in LiO, it was 0:1, 1:1, 2:1
and 3:1 for the height of 3 mm, 4 mm, 5 mm and 6 mm
respectively.
 Third, the lingual tooth morphology is complicated. So, the
required M:F ratio was greatly affected by changing the bracket
position at various heights from the incisal edge in LiO. Thus,
precise moment control is a key factor in LiO.
If this study is established as a methodology and recommended
as a new dental treatment plan, it is anticipated that intrusion or
extrusion of maxillary anterior teeth will be achieved more
effectively.
Conflict of interest statement
The authors declare no conflict of interest.
Acknowledgments
We would like to thank Genesis Dentofacial Imaging Labora-
tory, Nagpur, Maharashtra, India for valuable contributions.
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