Original Article

Tooth movement rate and anchorage lost during canine retraction:

A maxillary and mandibular comparison
Andre da C. Moninia; Luiz G. Gandini Jrb; Alexandre P. Viannac; Renato P. Martinsd;
Helder B. Jacobe

ABSTRACT
Objectives: To investigate the canine retraction rate and anchorage loss during canine retraction
using self-ligating (SL) brackets and conventional (CV) brackets. Differences between maxillary
and mandibular rates were computed.
Materials and Methods: Twenty-five subjects requiring four first premolar extractions were
enrolled in this split-mouth, randomized clinical trial. Each patient had one upper canine and one
lower canine bonded randomly with SL brackets and the other canines with CV brackets but never
on the same side. NiTi retraction springs were used to retract canines (100 g force). Maxillary and
mandibular superimpositions, using cephalometric 458 oblique radiographs at the beginning and at
the end of canine retraction, were used to calculate the changes and rates during canine retraction.
Paired t-tests were used to compare side and jaw effects.
Results: The SL and CV brackets did not show differences related to monthly canine movement in
the maxilla (0.71 mm and 0.72 mm, respectively) or in the mandible (0.54 mm and 0.60 mm,
respectively). Rates of anchorage loss in the maxilla and in the mandible also did not show
differences between the SL and CV brackets. Maxillary canines showed greater amount of tooth
movement per month than mandibular canines (0.71 mm and 0.57 mm, respectively).
Conclusions: SL brackets did not show faster canine retraction compared with CV brackets nor less
anchorage loss. The maxillary canines showed a greater rate of tooth movement than the mandibular
canines; however, no difference in anchorage loss between the maxillary and mandibular posterior
segments during canine retraction was found. (Angle Orthod. 2019;89:559–565.)
KEY WORDS: Canine retraction; Anchorage loss; Tooth movement rate; Self-ligating

INTRODUCTION dontist to anticipate treatment duration, and a good

Orthodontists strive to resolve malocclusions efficient-
ly. The orthodontic diagnosis and associated treatment
plan often require retraction of anterior teeth, and in these
cases, premolar extractions are normally performed. The
tooth movement rate is important to enable the ortho-
understanding of the rates of maxillary and mandibular
tooth movement as well as the amount of anchorage loss
is the basis for making treatment more efficient.1
Canine retraction is a common treatment procedure
in orthodontics and can be performed by different

a
Private practice, Goiania, Goias, Brazil.
b
Professor, Department of Orthodontics, Faculdade de Odontologia de Araraquara, Universidade Estadual Paulista, UNESP,
Araraquara, Sao Paulo, Brazil; Adjunct Clinical Professor, Saint Louis University, St Louis, MO, USA.
c
Professor, Department of Orthodontics and Pediatric Dentistry, Universidade Estadual de Feira de Santana, UEFS, Feira de
Santana, Bahia, Brazil.
d
Private practice, Araraquara, Sao Paulo, Brazil; Adjunct Professor, Department of Orthodontics, Faculdade de Odontologia de
Araraquara, Universidade Estadual Paulista, UNESP, Araraquara, Sao Paulo, Brazil.
e
Assistant Professor, Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry,
Houston, TX, USA.
Corresponding author: Dr Helder B. Jacob, The University of Texas Health Science Center at Houston School of Dentistry, 7500
Cambridge St. Suite 5130, Houston, TX 77054
(e-mail: helder.b.jacob@uth.tmc.edu)
Accepted: December 2018. Submitted: June 2018.
Published Online: February 11, 2019
Ó 2019 by The EH Angle Education and Research Foundation, Inc.

DOI: 10.2319/061318-443.1 559 Angle Orthodontist, Vol 89, No 4, 2019

560
Table 1. Summary of Characteristics of the 25 Subjects
Years of age at the beginning (T1) 23.32 6 5.08
Years of age
Younger subjects
Older subjects
Sex distribution (male/female)
Male
Female
techniques (eg, sliding mechanics or closing loops).2–6
In vitro studies have investigated the frictional resis-
tance between self-ligating (SL) and conventional (CV)
bracket systems and have shown lower friction
associated with sliding mechanics for SL brackets
due to passive configurations between the arch wire
and the bracket slots. 7–10 However, in the oral
environment, studies have shown no difference be-
tween the two types of brackets.11–19 So far, only
Burrow20 has shown differences in the movement rate
in the maxillary canines between the SL and CV
brackets. The studies have shown that canine retrac-
tion rates in the maxilla were greater than the rates
observed in the mandible, but the results were not
consistent because of a small sample size (12
subjects) and the clinical study design.2,4,21
Several studies have evaluated maxillary canine
retraction,3,4,11,20,22–30 but smaller numbers of studies
have analyzed mandibular canine retraction.2,4,5,12,31–33
Therefore, few studies have been done comparing the
rates of maxillary and mandibular tooth move-
ments.2,4,5,12,21 To reconcile existing inconsistencies
and the lack of information, a larger sample size
compared with previous studies is necessary. The aim
of this split-mouth randomized clinical trial study was to
investigate and compare the tooth movement rates
with sliding mechanics using SL brackets and CV
brackets detecting differences between upper and
lower jaws. The second aim was to measure the
mesial movement of the first molars during maxillary
and mandibular canine retraction.
Figure 1. Intraoral photograph during the maxillary and mandible canine retraction phase. (A) Right side and (B) left side of the patient.
Angle Orthodontist, Vol 89, No 4, 2019
MONINI, GANDINI, VIANNA, MARTINS, JACOB
MATERIALS AND METHODS
In this split-mouth randomized clinical trial, 25 adult
17.66 subjects were treated orthodontically (Table 1). Sub-
35.49 jects were selected according to the following criteria:
Class I molar relationship, maxillary and mandibular
9 crowding equal or smaller than 4 mm, bimaxillary
16
dental protrusion requiring four first premolar extrac-
tions, no missing teeth except third molars, good
hygiene, and healthy dentition. This study was
reviewed and approved by the Institutional Review
Board from the Araraquara Dental School, Sao Paulo
State University/UNESP, Araraquara, Brazil. All pa-
tients gave informed consent, as required by the
human subjects committee.
The patients had stainless steel fixed appliances
placed from second molar to second molar in the
maxilla and mandible. All first molars were banded, and
patients had the second molars either bonded or
banded. CV brackets and tubes (Ovation brackets,
0.022-inch slot, GAC, Bohemia, NY, USA), were used.
In a split-mouth design, SL brackets (In-Ovation
brackets, 0.022-inch slot, GAC), were randomly bond-
ed to one maxillary and one mandibular canine in all
patients. Therefore, randomly, each patient had one
maxillary canine and one mandibular canine bonded
with SL brackets but never on the same side (Figure 1).
Leveling and alignment of the arches were per-
formed using 0.014-inch NiTi superelastic archwire,
0.020-inch NiTi superelastic archwire, and 0.020-inch
stainless steel archwire with omega loops flush and
tied to the mesial of the buccal tube on the first molars.
After 4 weeks of stainless steel archwires, the posterior
segment (second molar, first molar, and second
premolar) were tied together using a 0.010-inch
ligature wire forming the anchorage segment, and
extractions were performed. No additional anchorage
system was used in any patient. Performing the
leveling and alignment before the extractions was
necessary to prevent the malocclusion from influencing
the canines.34 Canine retraction began between 7 and
14 days after extractions using GAC Sentalloy retrac-
ANCHORAGE LOST AND CANINE MOVEMENT RATE 561

Table 2. Landmarks Used on Oblique Lateral Cephalograms

Landmark Description
HRL Horizontal reference line (occlusal plane)
VRL Vertical reference line (perpendicular to HRL)
1 Anterior fiducial reference point
2 Posterior fiducial reference point
3 Upper posterior fiducial reference point
TU6 Tip of the upper first molar mesiobuccal cusp
TL6 Tip of the lower first molar mesiobuccal cusp
AU6 Apex of the upper first molar mesiobuccal root
AL6 Apex of the lower first molar mesial root
TU3 Tip of the cusp of the upper canine
TL3 Tip of the cusp of the lower canine
AU3 Apex of the upper canine root
AL3 Apex of the lower canine root
Figure 3. Maxillary superimposition obtained from stable anatomic
structures, transferred fiducial points, and measurement method of
tion springs (100 g). Using a Correx gauge (Haag-Streit the upper first molar and upper canine changes.
AG, Koeniz, Switzerland), the retraction springs were
stretched to 17 mm (approximately 2.5 times the initial
superimposing the opposite side, but two radiographs
length) to deliver the correct force necessary to retract
were necessary to evaluate the left and right sides
the canines. Retraction springs were tied from the first
separately. All patients completed the retraction phase
molar tube hook to the canine bracket hook using a
and had a total of two right (T1 and T2) and two left (T1
0.010-inch ligature wire when required to achieve the
and T2) oblique radiographs. The cephalograms were
essential amount of force. Every 4 or 5 weeks, the
traced using mechanical pencil with a 0.3-mm tip on
force delivered by the closed-coil spring was measured
acetate paper, and the eight landmarks and the three
and adjusted to maintain 100 g of retraction force.
fiducial points (Table 2; Figure 2) were digitized by one
Ligature wire (0.012-inch) was used to tie the CV
operator (Dr. Monini). A horizontal reference line used
brackets to the archwire.
the fiducial points one and two that were marked over
Oblique lateral cephalometric radiographs (458 ex-
the occlusal plane line (using first molars and incisors),
posure) of both sides were taken immediately before
and a third fiducial point was marked posterior and
the starting of canine retraction (T1) and at the end of
canine retraction when there was no space remaining superior in the cephalograms. A vertical reference line,
between the canine and second premolar (T2). perpendicular to the occlusal plane line, was drawn
Rotating the patient 458 toward the radiographic film using the third fiducial point.
allowed the image to be focused on one side without Partial superimpositions were performed on the best
fit of the stable structures.35 Maxillary superimposition
was done on the contour of the inner cortical bone of
the anterior part in the canine region of the maxilla from
the contralateral side, posterior contour of the infrazy-
gomatic crest, and orbital contour and nasal floor
(Figure 3). Mandibular superimposition was done on
the inner cortical structure of the inferior border of the
symphysis and the mandibular corpus of the opposite
side and detail structures of the mandibular canal and
foramen (Figure 4). Structures and fiducial points were
transferred from initial cephalograms (T1) to final
cephalograms (T2).
DFPlus software (DentoFacial Planner Software
2.0, Toronto, Canada) was used to digitize the
radiographs and to make the measurements. The
digitization was performed twice, with a 30-day
interval between the first and second digitization, by
the same investigator (Dr. Monini), and measure-
ments were averaged to reduce error. Changes of the
landmarks, amount of canine retraction, and anchor-
Figure 2. Cephalometric landmarks digitized. age loss were measured by the horizontal distance

Angle Orthodontist, Vol 89, No 4, 2019

562
Figure 4. Mandibular superimposition obtained from stable anatomic
structures, transferred fiducial points, and measurement method of
the first lower molar and lower canine changes.
perpendicular to the vertical reference line. Differenc-
es between the initial and final cephalograms (T2–T1)
were used to calculate the amount of change during
space closure. Monthly rate changes were divided by
the time necessary to close the space between canine
and premolar completely.
Power analysis was performed (G-Power software,
version 3.0.22.). Based on an estimated difference
between groups of 0.35 mm/month for lower canine
retraction rates and a standard deviation of 0.6 mm
taken from a previous study,12 a sample size of 25
patients/group was needed (5% significance level and
a power of 80%). A priori sample size calculation for a
paired t-test to detect a medium size effect (which
would be clinically relevant) requested 20 pairs for
comparison. Dahlberg’s formula36 was used to deter-
mine the error and standard deviation of the variables.
The linear measurement error was found to be less
than 0.43 mm, while the angular measurement error
was less than 1.678. The measurements were
transferred to SSPS software (version 16.0, SPSS,
Chicago, IL, USA) for statistical analyses. The
skewness and kurtosis statistics indicated normal
Table 3. Descriptive Statistics and Statistical Comparisons Between Bracket Types
Self-Ligating
Jaw Measurement Mean
Maxilla Anchorage loss (mm) 1.28
Canine retraction rate (mm) 0.71
Space closure duration (month) 10.86
Mandible Anchorage loss (mm) 1.28
Canine retraction rate (mm) 0.54
Space closure duration (month) 13.93
Angle Orthodontist, Vol 89, No 4, 2019
MONINI, GANDINI, VIANNA, MARTINS, JACOB
distributions. Paired t-tests were used to compare
side and jaw effects.
RESULTS
SL and CV brackets did not show differences related
to monthly canine movement and anchorage loss rates
in the maxilla and in the mandible (Table 3). Since no
significant different characteristics were observed
between bracket groups, they were combined in the
same jaw to evaluate differences between upper and
lower arches (Table 3).
Maxillary canines showed a greater amount of tooth
movement per month than mandibular canines (0.71
mm and 0.57 mm, respectively). Another difference
was noticed in the duration of total canine retraction
(Table 4). Upper canines were retracted 3 months
faster (10.78 months) than lower canines (13.74
months). The anchorage loss between the maxilla
and mandible was not significant (Table 4).
DISCUSSION
The SL and CV brackets had no effect on the rate
and treatment time of canine retraction. Even though
no difference was found between the bracket systems,
the SL bracket rate movement was up to 10% slower
than that of the CV brackets, requiring approximately
1.5% and 2.8% more time than the CV brackets to
retract the canines completely in the maxillary and
mandibular premolar spaces, respectively. Although
studies performed in vitro showed that SL brackets had
smaller coefficients of friction, clinical studies have
shown that bracket type had no influence on rate of
tooth movement between SL and CV brack-
ets.11,12,20,37,38 It is important to note that canine
retraction was performed with the force occlusal to
the center of resistance, allowing tipping that may have
caused binding. The binding-release phenomenon is
about the same independent of bracket type.39
Maxillary canines moved faster than mandibular
canines. Maxillary canines had a 25% greater rate of
tooth movement than mandibular canines. Previous
studies have shown inconsistencies.2,4,5,12 Those stud-
ies had small sample sizes that led to insufficient
Conventional
SD Mean SD Probability
1.10 1.24 1.36 .919
0.29 0.72 0.26 .965
3.32 10.70 3.34 .788
0.87 1.30 0.86 .880
0.13 0.60 0.20 .069
3.27 13.55 3.88 .337
ANCHORAGE LOST AND CANINE MOVEMENT RATE
Table 4. Descriptive Statistics and Statistical Comparisons Between Maxillary and Mandibular Canine Retractiona
Maxilla
Measurement Mean
Amount of anchorage loss (mm) 1.27
Canine retraction rate (mm/month) 0.71
Amount of canine retraction (mm) 6.95
Total space closure duration (month) 10.78
a
Bold font indicates a significant change over time (P < .05).
power to rule out a difference between upper and lower
jaws. Some were not able to show differences between
maxillary and mandibular canine movement rates,2,4,5
although Dinçer and Is can21 showed greater lower
canine movement rates. Differences in bone density
and remodeling rate between the maxilla and mandible
may explain the smaller tooth movement rate in the
lower arch.40,41 Also, the occlusion could have inter-
fered with canine movement. All patients were Class I,
and the lower canine could have been blocked by the
occlusal contact of the upper canine. Using a bite
raiser could be an option to relieve the occlusion, but
this procedure does not seem to be clinically neces-
sary.
Anchorage loss was the same between SL and CV
brackets during canine retraction, and no difference
was found between the upper and lower jaws.
Maxillary and mandibular anchorage losses represent-
ed approximately 15% of the premolar space. Less
anchorage loss is expected when smaller forces are
applied.30,33,42 The present study showed smaller
anchorage loss than other studies that used only teeth
as anchorage.2,4,5,12 Previous studies showed greater
amounts of anchorage loss ranging from 1.6 to 2.5 mm
but no difference between maxillary and mandibular
posterior segments.21,43,44 The current study design,
which included second molars in the posterior anchor-
age segment combined with the incisors,45 as well as
lighter forces applied to retract the canines,30,33,42 could
explain the results found. Orthodontists must control
the amount of mesial movement of the posterior
segment according to the patient’s treatment plan.
Although the literature has used different amounts of
force to provide canine retraction, there is no consen-
sus about the optimal force required for retraction. In
this study, canine retraction was obtained using a NiTi
coil spring that provided 100 g of force. Studies have
shown canine retraction using forces as low as 18 g.46
Hixon and coworkers32,46 did not demonstrate an
optimal force, but the rate of tooth movement increased
as the force increased until 300 g. Heavier forces were
used, but no difference between maxillary canine and
mandibular canine rates of movement was shown.2,5
Because reports have shown effective tooth movement
with light forces,2,4,42 100 g force was applied with
563
Mandible
SD Mean SD Probability
1.23 1.29 0.86 .916
0.27 0.57 0.17 .002
1.72 7.34 1.48 .225
3.30 13.74 3.56 <.001
nickel-titanium closed-coil springs in this study for
retraction of the canines. Another reason to have used
light force in this study was that higher force
magnitudes can lead to anchorage loss in the posterior
segment, because the force per unit area (stress) may
be too high to move the canine but could be optimum to
move the posterior teeth due to root area differences.
CONCLUSIONS
 Canine retraction with SL brackets and CV brackets
showed the same monthly rates of tooth movement.
 Maxillary canine retraction showed greater monthly
rates of tooth movement then mandibular canine
retraction.
 There was no difference in anchorage loss between
maxillary and mandibular posterior segments during
canine retraction.
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