Two.

-Couple Orthodontic Appliance Systems

Unhty Arches: A Two-Couple
Intrusion Arch
Moshe Davidovitch and.Joe Rebellato

The utility arch is a two-couple intrusion arch wire used for control of an-
terior deep overbite. It is similar to a one-couple intrusion arch in that it is
commonly made with rectangular wire, attached to the teeth only at the
molars and the incisors and is activated for incisor intrusion by a molar tip
back bend. It differs from a one-couple intrusion arch by the insertion of the
incisor segment into the incisor brackets. This results in a fixed point of
application of the intrusion force anterior to the incisors and, therefore,
incisor rotation by the moment of the force. In addition, insertion of the
rectangular wire into the incisor brackets usually creates a third-order cou-
ple for incisor rotation. Depending on how it is used, the moment of this
couple may be activated in either direction and the resulting associated
equilibrium forces will either supplement or reduce the vertical equilibrium
forces created by the activation bends at the molars.
Copyright © 1995 by W.B. Saunders Company

r ' f ~ h e utility arch, as p o p u l a r i z e d by Rick- T h e relative contributions o f incisor intru-

J . etts, 1 '"') has been r e c o m m e n d e d tor the res-
olution of a variety of clinical conditions. :~ Per-
haps the most f r e q u e n t application has been
for leveling the Curve o f Spee and reduction
of overbite (OB) t h r o u g h incisor intrusion.
Overbite, d e f i n e d as the a m o u n t o f vertical
overlap o f the m a n d i b u l a r incisor by the max-
illary incisor, is resolved clinically by one or a
combination o f three d i f f e r e n t mechanisms.
Although the goal often is intrusion o f incisors,
actual intrusion only occurs when it can be oh-
served that the center o f resistance (CR,.~) o f
the incisors has been intruded. Alternatively,
incisor OB can also be r e d u c e d t h r o u g h both
increased incisor inclination or m a n d i b u l a r au-
torotation resulting f r o m posterior tooth ex-
trusion without c o m p e n s a t o r y vertical growth
of the condyle.
From the Department c~j Orthodontics, School ~ DentLstry,
Medical College of Virginia, Vir~nia Commonwealth University,
Richmond, VA.
Address reprint requests to Moshe Davidovitch, DDS, MMSc,
Department of Orthodontics, School of Dentistu, Medical College
of Virginia, Virginia Commonwealth University, PO Box
980566, Richmond, VA 23298-0566.
Copyright © 1995 by W.B. Saunders Company
1073-8746/95/0101-000355.00/0
sion, increased incisor inclination and poste-
rior tooth extrusion in reducing OB should be
determined through differential treatment
planning and not dictated by tile limitations o f
a specific m e c h a n o t h e r a p y . 4 T h e relative con-
t r i b u t i o n s o f incisor i n t r u s i o n a n d m o l a r /
p r e m o l a r extrusion in OB reduction has re-
ceived attention r e g a r d i n g the stability o f OB
c o r r e c t i o n :~ ~ Case reports based on cephalo-
metric analysis o f utility arch OB reduction,
have r e p o r t e d 1 to 5.5 m m o f incisor intrusion,
with a stability rate o f 75% to 100% claimed for
these clinical outcomes. 'i'm Given these types
o f responses, it is o f great interest to analyze
this appliance f r o m a biomechanical stand-
point to better u n d e r s t a n d its capabilities.
T h e utility arch is usually fabricated f r o m a
continuous rectangular stainless steel arch wire
inserted into the edgewise brackets on the in-
cisors and the maxillary or m a n d i b u l a r molars.
As a m a t t e r o f convenience and c o m f o r t it is
stepped in a gingival direction between the in-
cisors and molars to bypass the buccal occlu-
sion (Fig 1). Avoiding e n g a g e m e n t o f the pre-
molars and canines results in i m p r o v e d load
deflection properties because o f the length o f
free wire existing b e t w e e n the segments at

Seminars in Orthodontics, Vol l, No 1 (March), 1995: pp 25-30 25

26 Davidovitch and RebeUato
Figure 1. Schematic illuslration of an uncinched
utility arch engaged in the incisor brackets. The ac-
tivation and potential tooth movements resulting
cannot be completely ascertained from an arch wire
inserted into the brackets.
each end o f the appliance. T h i s c o m p e n s a t e s
t o t tile relatively stiff n a t u r e o f the arch wire
and permits the delivery of a m o r e physiologk:
level of force over a longer period o f time. T h e
stepping of the appliance away f r o m the occlusal
plane in the buccal segment also reduces the risk
of d e f b r m a t i o n d u r i n g mastication. T h e utility
arch is activated for incisor intrusion by placing
tip-back bends mesial to the molar tubes.
T h e c o n t i n u o u s r e c t a n g u l a r arch and the
activation b e n d s mesial to the molars give this
appliance an a p p e a r a n c e similar to that o f the
intrusion arch previously described. Both arch
wires use a tip back b e n d at the molars to cre-
ate a vertical intrusive force at tile incisors.
H o w e v e r , f u n d a m e n t a l biomechanical differ-
ences do exist between these two arch wires ill
their use and, as a result, in their m o d e o f ac-
tion and t r e a t m e n t outcomes.
O n e i m p o r t a n t d i f f e r e n c e lies in the loca-
tion of the line of vertical force created for
incisor intrusion. I f this line o f ibrce passes
directly t h r o u g h the Cm. ~ of the incisors, the
teeth will be translated as they intrude. I f the
line o f force passes facially to the CR,.~, a ten-
dency for incisor rotation will be created as the
CR~~ intrudes. T h e strength o f this t e n d e n c y
for rotation will be directly related m the per-
p e n d i c u l a r distance b e t w e e n the line of the
force and the C e ~ o f the incisors. T h e utility
arch is inserted directly into the edgewise slots
o f the incisor brackets and, t h e r e t o r e , the line
of force is dictated by the location o f the incisor
brackets. Because the brackets o t the incisors
will almost always be facial to the C ~ , the line
o f force of the utility arch will also be facial to
the CRew, with a t e n d e n c y p r e s e n t for crown
facial/root lingual rotation. In contrast, a one-
couple intrusion arch is attached at the incisor
region as a point contact that allows the line o f
force to be varied a c c o r d i n g to the location o f
the point selected for the tie. T h i s choice dic-
tates w h e t h e r or not rotation is to be present
d u r i n g incisor intrusion.
A second i m p o r t a n t d i f f e r e n c e b e t w e e n the
intrusion arch a n d the utility arch lies in the
n a t u r e o f their a t t a c h m e n t at the incisors. A
utility arch, by inserting directly into the inci-
sor brackets, will usually create a t h i r d - o r d e r
couple at the incisors a n d a two-couple system.
As the t h i r d - o r d e r couple is knowingly or un-
knowingly activated, e q u i l i b r i u m forces are
c r e a t e d . T h e e q u i l i b r i u n l forces a s s o c i a t e d
with the M c at the molar, originally created for
incisor intrusion, will be m o d i f i e d by the equi-
libriunl forces associated with the M(: at the
incisor. This will increase or decrease the in-
trnsive t o r t e at the incisor d e p e n d i n g on the
direction o f the couple created at the incisor.
T h e direction o f the couple at the incisor is not
always clinically a p p a r e n t resulting in less pre-
dictable force systems that m a y i m p e d e desir-
able outcomes. I n contrast, a o n e - c o u p l e intru-
sion arch is tied as a point contact a n d acts as a
single force. T h e r e f o r e , an intrusion arch is a
one-couple system that can be accurately m e a -
s u r e d a n d controlled clinically.
T o a p p r e c i a t e the clinical process o f incisor
intrusion by a utility arch, it is helpful to ex-
a m i n e the c o m p o n e n t s o f the system (Fig 2).
T h e incisor teeth p l a n n e d for o r t h o d o n t i c in-
trusion nlust be t h o u g h t o f as o n e large multi-
r o o t e d tooth. Because these t e e t h a r e coil-
gated they will react as a single tooth f o r m i n g a
mono-unit where imlependent movement of
individual incisors is not possible. In a lower
arch the CI~,~ o f this "tooth" lies in the a n t e r i o r
portion of the tloor o f the m o u t h lingual to the
roots o f the central incisors. T o actually in-
t r u d e this s e g m e n t (or any tooth/teeth) without
rotation, an apically directed force t h r o u g h the
CRc s is necessary.
T h e m o l a r teeth also have their own C~,.~.
With both intrusion a n d utility arches the distal
tip bends create a large M c at the m o l a r which
Call only p r o d u c e rotation a r o u n d the (;~,.~. In
a d d i t i o n , the e q u i l i b r i u m forces a s s o c i a t e d
with the M c include an extrusive force at the
molar. Because the s u m total o f any force sys-
t e m m u s t satisfy Newton's T h i r d Law o f Mo-
tion w h e n viewed in each plane o f space, the
first, second, a n d t h i r d - o r d e r m o v e m e n t s m u s t
also a p p l y to the b i o m e c h a n i c a l system im-
 Utility Arches
//
\ activation. W h e n the utility a r c h is i n s e r t e d
\ root mesial rotation. T h e associated vertical
CRES
Figure 2. (A) Estimated location of the CRE S of the
mandibular incisor segment in the saginal plane. (B)
Estimated location of the Car s of the mandibular
incisor segment in the transverse plane.
posed on each molar. With either an intrusion
arch or a utility arch, the molars are subjected
to extrusive forces applied at the m o l a r tubes
lateral to the CRe ~. In the sagittal plane or lat-
eral view this force passes t h r o u g h the CRe s o f
the m o l a r and can only result in vertical tooth
m o v e m e n t s . H o w e v e r , in the frontal or coronal
plane, the vertical force is located lateral to the
CRe s of the molars resulting in a M r or ten-
dency for crown lingual/root facial m o l a r rota-
tion. It is i m p o r t a n t to c o m p r e h e n d the t h r e e
dimensional (3-D) n a t u r e of o r t h o d o n t i c bio-
mechanics.
Component Parts of the Utility Arch
For clinical predictability, it is useful to begin
with a passive arch wire. T h e passive utility
arch is activated by placing a tip-back b e n d me-
27
sial to the m o l a r tube creating an a s y m m e t r i c V
into the m o l a r tubes alone, the a n t e r i o r por-
tion o f the wire will lie gingival to the incisors
in the vestibule. T o e n g a g e the incisor brackets
the a n t e r i o r p o r t i o n is deflected to the occlusal
(Fig 3). T h i s action will g e n e r a t e a couple at
each m o l a r with a m o m e n t f o r crown distal/
equilibrium forces will be extrusive at the mo-
lars a n d intrusive at the incisors (Fig 4).
T h e activation b e n d mesial to the molars re-
sults in the largest m o m e n t at these teeth. It is
the larger m o m e n t that d e t e r m i n e s the direc-
tion o f the associated equilibrium forces acting
on the attached ends o f the arch wire. Because
the utility arch is inserted directly into the in-
cisor brackets, the intrusive force is usually la-
bial to the Cae s a n d will cause, in addition to
intrusion o f the CRes, a M v or t e n d e n c y for the
incisors to rotate crown facial/root lingual.
I n addition, insertion o f the utility a r c h into
the incisor brackets will usually result in the
creation o f a t h i r d - o r d e r couple at these brack-
ets. T h e equilibrium force associated with the
larger M c at the m o l a r will still result in equal
a n d opposite intrusive forces at the incisor a n d
extrusive forces at the molar. H o w e v e r , the
equilibrium forces associated with the smaller
M c at the incisors will either r e d u c e or increase
the m a g n i t u d e o f these forces, d e p e n d i n g o n
the direction a n d m a g n i t u d e o f the M c created
at the incisors. T h e direction o f the M c at the
-- )
Figure 3. A utility arch fabricated of .016" x .022"
stainless steel wire. An activation bend has been
placed mesial to the molar tubes and the wire is
inserted into the molar tubes. The wire is activated
by elevating the anterior segment and inserting it
into the incisor brackets.
28 Davidovitch and Rebellato
F *M
~
MF
f cisor s e g m e n t o f the arch wire mimics m o r e
J
Figure 4. The force system generated by engage-
ment of the utility arch at the incisors and molars.
The box shows the greatest angle of entry and the
larger moment at the molar dictating the direction
of the associated equilibrium forces. The equilib-
rium forces associated with the Mc at the incisor
modify the equilibrium forces associated with the
M c at the molar. Mc is the couple created in the
incisor segment. The direction of the M c at the in-
cisor segment can be clockwise or counterclockwise.
The direction and magnitude of the moment cre-
ated at the incisor brackets are related to the bend-
ing and torsion associated with insertion of the rect-
angular wire in the incisor brackets. The direction
of the Mc cannot be accurately known clinically and
is important because its equilibrium forces modify
the intrusive force at the incisor. (See the article on
3-D mechanics.)
incisors c a n n o t accurately be d e t e r m i n e d clin-
ically. It is related to the location o f the activa-
tion b e n d a n d the p r o p e r t i e s o f the wire (See
the i n t r o d u c t i o n to the article on 3-D m e c h a n -
ics for details).
T h u s the incisors are subjected to two sep-
arate possible forces for rotation a n d changes
in inclination. T h e line of the intrusive force
facially to the CRe~ creates a MF that will almost
always result in a t e n d e n c y for crown facial/
root lingual rotation. T h e site o f location o f
this force c a n n o t be altered with a utility arch.
In addition, the t h i r d - o r d e r couple at the inci-
sors creates a M c that can be positive or nega-
tive in direction d e p e n d i n g on the direction o f
the couple at the incisor brackets. T h e direc-
tion o f the t h i r d - o r d e r couple at the incisors
can be assured by i n t r o d u c i n g a twist or torque
into the incisor s e g m e n t o f the utility arch.
I f a twist or torque for crown lingual/root
facial rotation is i n t r o d u c e d into the incisor
s e g m e n t o f the utility arch, a m o m e n t is cre-
ated at the incisor acting in the same direction
as the m o m e n t at the molars. T h e r e f o r e , the
e q u i l i b r i u m forces associated with the m o -
m e n t s at b o t h teeth are in the same direction
a n d are additive. T h i s increases the m a g n i t u d e
o f the intrusive force at the incisors. T h i s is
analogous to placing a step b e n d between the
molars a n d the incisors (Fig 5).
P e r f o r m i n g the converse o p e r a t i o n by plac-
ing a crown facial/root lingual b e n d in the in-
closely a symmetrical V-bend. Recall that sym-
metrical V-bends g e n e r a t e opposite m o m e n t s
with associated equilibrium forces acting in op-
posite directions. T h e r e f o r e , the net incisor in-
trusive force derived f r o m the equilibrium as-
sociated with the Mc at the m o l a r is r e d u c e d by
the equilibrium force associated with the M c at
the incisor (Fig 6). W h e n the crown facial/root
lingual m o m e n t at the incisor equals the mo-
m e n t for distal tip at the molar, no vertical
equilibrium forces r e m a i n at the m o l a r or in-
cisor.
In a two-couple utility arch system the load
r e q u i r e d to b r i n g the incisor s e g m e n t o f the
wire to the incisor brackets does not accurately
reflect the intrusive load acting at the incisor
teeth. T h e m a g n i t u d e o f the intrusive force
p r e s e n t at the incisors is not only derived f r o m
the equilibrium associated with the m o l a r acti-
Mc~ Mc
UZ/u
Figure 5. Schematic illustration of an uncinched
utility arch with a V-bend for crown lingual/root
facial rotation in the incisor segment (labial root
torque). The second-order couple at the molar and
the third-order couple at the incisor are in the same
direction and the associated equilibrium forces act-
ing at both teeth are additive. The intrusive forces at
the incisor are doubled, and the incisor proclination
will be reduced.
 Utility Arches
i
°c Mc T~F
\
Figure 6. Schematic illustration of an uncinched
utility arch with a V-bend tot crown facial/root lin-
gual rotation in the incisor segment. The couple at
the molar and the couple at the incisors are in op-
posite directions. Therefore, their equilibrium
forces are also in opposite directions reducing the
vertical forces acting at the molars and incisors.
ration bend. T h e m a g n i t u d e of the intrusive
force at the incisor is the net force derived
f r o m a combination o f the equilibrium associ-
ated with both the M c at the moIar and the
equilibrium associated with the M c at the inci-
sor.
Placement o f t h i r d - o r d e r couples at the in-
cisors has a second effect on overbite correc-
tion. A p a r t f r o m the m a g n i t u d e o f the intru-
sive force present, the M c at the incisor brack-
ets affects overbite reduction by changes in the
inclination o f the teeth. I f an increased intru-
sive force is sought, and crown lingual/root fa-
cial rotation is placed in the utility arch, the
decreased incisor inclination will also tend t o
d e e p e n the bite. I f a lesser force is desired and
crown facial/root lingual rotation is applied, a
tendency for m o r e overbite reduction will oc-
cur by increased incisor inclination. In con-
trast, a one-couple intrusion arch controls in-
cisor inclination simply by the point o f the
force application. T h e intrusive force can be
increased or decreased without necessarily af-
fecting the incisor inclination.
T h e inseparable side effect o f changes in
incisor inclination associated with the utility
arch intrusion seems to be controlled by cinch-
ing or tying back the utility arch. However, re-
straining arch perimeter by cinching back will
a d d a new h o r i z o n t a l force system (Fig 7).
W h e n the larger s e c o n d - o r d e r couple at the
29
FT ~ ~ .-, MF_+Mc
F - - ~ ~ ~ F
Figure 7. An activated utility arch inserted in the
brackets at the incisors and molars. The arch has
been cinched introducing a new force system acting
in a mesial direction at the molar and a lingual di-
rection at the incisor. The new force system does not
act through the CR,,~at either location which creates
a new M~. at both teeth. The molar and incisor will
have a combination of the M v from the cinch and
the Mc from the utility arch present.
molar is restrained from distal crown rotation
by a cinch, the molar root will continue to ro-
tate mesially with a distal force against the
cinch. This wilI resuh in the CReS o f the m o l a r
moving mesially also. T h e distal force o f the
crown at the cinch is transmitted t h r o u g h the
arch wire as a lingual force at the incisor brack-
ets which restrains the incisor crown f r o m fa-
cial movement. Because the intrusive force at
the incisor continues to act facial to the incisor
CR,,~, the result is an increased incisor inclina-
tion, but the increased inclination is all accom-
plished by lingual root movenmnt. T h e Ck,, ~ o f
the incisor moves both intrusively a n d lin-
gually. This action is the same for both cinched
utility arches and cinched intrusion arches.
T h e major difference is the utility arch needs
to be tied back to control incisor inclination. In
contrast, the one-couple intrusion arch can be
tied back if desired, but does not require a
cinch because the incisor inclination can be
controlled by the point o f application o f the
incisor tie.
F a b r i c a t i n g the utility a r c h f r o m r o u n d
r a t h e r than r e c t a n g u l a r wire has been sug-
gested as a m e t h o d o f negating the t h i r d - o r d e r
couple created at the incisor brackets. A r o u n d
wire lacks the capacity to create t h i r d - o r d e r
couples and the result is a o n e - c o u p l e system
identical to an intrusion arch tied at the incisor
brackets. However, with a r o u n d wire utility
arch the apically directed force for incisor in-
30 Davidovitch and RebeUato
t r u s i o n c o n t i n u e s to b e facial to t h e i n c i s o r CRe s
at t h e i n c i s o r b r a c k e t s a n d r e s u l t s in a M v t h a t
c a n n o t b e c o n t r o l l e d as it c a n b e w i t h a n i n t r u -
sion a r c h . I n a d d i t i o n , a r o u n d w i r e o f f e r s n o
t h i r d - o r d e r r e s i s t a n c e to t h e e x t r u s i v e f o r c e
a c t i n g l a t e r a l l y to t h e CRe~ o f t h e m o l a r a n d its
associated tendency toward crown lingual/root
facial m o l a r r o t a t i o n .
P u r p o s e f u l l y left o u t o f this d i s c u s s i o n is t h e
effect of the second-order movement of the
m o l a r s o n i n c i s o r p o s i t i o n w h e n a r c h l e n g t h is
r e s t r i c t e d (ie, t h e r e v e r s e r o w - b o a t effect). T h e
e x t e n t to w h i c h a d i s t a l m o l a r t i p e f f e c t s i n c i s o r
i n c l i n a t i o n is a n o t h e r f a c t o r w h i c h m a y o r m a y
n o t i n f l u e n c e t h e s y s t e m . F u r t h e r m o r e , t h e im-
p a c t o f tip b a c k b e n d s o n m o l a r p o s i t i o n w i t h
r e g a r d to a n c h o r a g e c o n s i d e r a t i o n s h a s n o t
b e e n d o c u m e n t e d . L a c k i n g clinical d a t a a n d
a n y scientific f o r m u l a f o r t h e p r e d i c t a b i l i t y o f
this as a t r e a t m e n t m o d a l i t y w e a k e n s a r g u -
m e n t s (eg, s e t t i n g u p a n c h o r a g e as in T w e e d
m e c h a n i c s ) f o r this m e c h a n i s m . O r t h o d o n t i c
tools s h o u l d be c h o s e n o n t h e basis o f t h e bio-
logical r e s p o n s e s ( n o t a n e x a c t s c i e n c e yet) to
t h e i r b i o m e c h a n i c a l p r o p e r t i e s (a m u c h m o r e
e x a c t science), r a t h e r t h a n a n e c d o t a l r e p o r t s o f
success ( f a i l u r e s a r e r a r e l y d e s c r i b e d ) .
References
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