ORIGINAL ARTICLE

Photoelastic stress analysis of mandibular

molars moved distally with the skeletal
anchorage system
Atsushi Nakamura,a Tsuyoshi Teratani,b Hidemi Itoh,c Junji Sugawara,d and Hiroyuki Ishikawae
Fukuoka and Sendai, Japan

Introduction: The purpose of this study was to analyze photoelastically the stress distribution around teeth
in the simulated distal movement of mandibular molars with the skeletal anchorage system. Methods: Two
types of the photoelastic mandibular dentition models were used, 1 before and 1 after distal movement of the
second molar. The experiment was performed with 3 forms of traction—first-molar single traction,
second-molar single traction, and simultaneous first- and second-molar traction. The direction of traction
was set parallel to the occlusal plane and at an angle of 30° downward to the occlusal plane. Results: In the
first-molar single traction model, extremely high stress was generated around the first molar with traction
parallel to the occlusal plane. With the traction 30° downward to the occlusal plane, all models showed the
stress around the molars extended distally and downward. Conclusions: Simultaneous traction of the first
and second molars might be preferable to the sequential traction of each molar to prevent the unfavorable
distal tipping of the first molar. Regardless of whether simultaneous or sequential traction is used, the
downward traction to the occlusal plane seems to induce intrusion of the molars as well as their distal
movement. (Am J Orthod Dentofacial Orthop 2007;132:624-9)

T
he distal movement of mandibular molars is
often required to reduce mandibular anterior
crowding and to retract protruded anterior teeth
without extracting premolars. Several orthodontic ap-
pliances have been used to move the mandibular molars
distally, including headgear,1,2 the lip bumper,3,4 the
Jones jig,5 and the Franzulum appliance.6 However,
effectiveness of these appliances can be compromised
by limited patient cooperation or reciprocal forces that
cause inappropriate anchor-tooth movement.
Recently, Sugawara7,8 and Daimaruya et al9,10 de-
veloped the skeletal anchorage system (SAS) that uses
pure titanium anchor plates and screws as orthodontic
anchorage units. The SAS permits rigid anchorage via
osseointegration of both anchor plates and screws.
a
Postgraduate student, Division of Orthodontics, Department of Oral Growth
and Development, Fukuoka Dental College, Fukuoka, Japan.
b
Instructor, Division of Orthodontics, Department of Oral Growth and Devel-
opment, Fukuoka Dental College, Fukuoka, Japan.
c
Assistant professor, Division of Advanced Prosthetic Dentistry, Graduate
School of Dentistry, Tohoku University, Sendai, Japan.
d
Associate professor, Division of Orthodontics and Dentofacial Orthopedics,
Graduate School of Dentistry, Tohoku University, Sendai, Japan.
e
Professor and chairman, Division of Orthodontics, Department of Oral Growth
and Development, Fukuoka Dental College, Fukuoka, Japan.
Reprint requests to: Atsushi Nakamura, Division of Orthodontics, Department
of Oral Growth and Development, Fukuoka Dental College, 2-15-1, Tamura,
Sawara-ku, Fukuoka, 814-0193, Japan; e-mail, atussy@college.fdcnet.ac.jp.
Submitted, July 2005; revised and accepted, November 2005.
0889-5406/$32.00
Copyright © 2007 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2005.11.041
624
Clinical reports described the distal movement of the
mandibular molars with anchor plates placed at the
anterior border of the mandibular ramus or the man-
dibular body.11-16 Preferable ages for SAS treatment
were not indicated. However, the SAS is used mostly
for adult patients because osseointegrated implants can
inhibit surrounding bone growth in children.17,18 For
mandibular molar distalization, extraction of the third
molars is frequently required to create sufficient space
behind the second molar.15
Although the SAS is becoming popular in orth-
odontic practices, few published studies have focused
on distal movement of the mandibular molars in SAS
treatment.15,16 Furthermore, no biomechanical studies
have demonstrated the stresses produced in the peri-
odontal tissues around teeth from SAS use. The pur-
pose of this study was to photoelastically analyze the
initial stress distribution around the teeth in the simu-
lated distal movement of mandibular molars with the
SAS to increase our understanding of its likely effects
in the clinical setting.
MATERIAL AND METHODS
Two photoelastic models of a mandibular dentition
were used in this study, 1 simulating the position of
the second molar before its distal movement, and the
other simulating its position after distal movement. The
photoelastic models was fabricated as follows. First, a
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 132, Number 5
Table. Physical properties of each component material
of the model
Material E (MPa)
Tooth Epoxy resin 2,930
Surrounding tissue Urethane (solithane) 6.9
E, Young’s modulus; ␷, Poisson’s ratio.
Fig 1. Two photoelastic mandibular dentition models:
a, before distal movement of second molar, and b, after
distal movement.
plaster model of a mandible with dentition (P10-SB.1;
Nissin, Kyoto, Japan) was created by using a silicon
impression (Duplicone; Shofu, Kyoto, Japan). The plas-
ter models were then set up to simulate the postleveling
stage with no crowding, spacing, or flattening of the
curve of Spee. In 1 model, the second molar was
positioned distally to simulate its completed distal
movement. An impression was then taken by using
silicon impression material, and anatomic models of
the mandibular teeth (B2-306; Nissin) were adapted
to the impression surface. Finally, urethane (Soli-
thane C113-300; Thiokol Chemical Corporation, Tren-
ton, NJ) was infused into the impression with the model
teeth. The fabricated photoelastic models were divided
on the left side in the sagittal plane to permit stress
evaluation. The models were fixed on an acrylic plate,
and it was confirmed that no initial stress had been
induced. The physical properties of each component
material of the model are shown in the Table.
Figure 1 shows the 2 photoelastic mandibular den-
tition models, 1 before and 1 after distal movement of
the second molar. A preformed 0.019 ⫻ 0.025-in
stainless steel archwire was adapted to the mandibular
dentition model, and 0.022 ⫻ 0.028-in preadjusted
edgewise brackets were fixed to each archwire with
elastic modules. The brackets were then bonded to the
model teeth with light-curing adhesive. The distal ends
Nakamura et al 625
of the archwire were adjusted to be less than 1 mm
behind the molar tube.
␷
A bar was fixed behind the model to vary the direction
of the distalizing forces. The force was applied to a tooth
0.36 through a coil spring, by using an elastic chain extend-
0.40 ing from the bar (Fig 2). The experiment was per-
formed with 3 forms of traction—first-molar single
traction, second-molar single traction, and simulta-
neous first-and-second molar traction. First-molar sin-
gle traction was performed on the model, simulating the
second molar position after its distal movement. The
other tractions simulated the second molar position
before its distal movement. The direction of traction
was set parallel to the occlusal plane and at an angle of
30° downward to the occlusal plane (Fig 3). A force of
250 g was selected because this is similar to that used
in a clinical situation for single molar traction,7 and it
provided a suitable response in the model without
causing undue deformation.
In this study, a quasi 3-dimensional technique was
used for the photoelastic observations. Figure 4 shows
the circular polariscope arrangement used to observe
isochromatic fringes. In an area of stress, the fringe
appears as a repeated pattern of yellow, blue, and red.
A cycle from yellow to red is called 1-fringe order, and
it is used as an index to judge the level of stress. The
isochromatic fringes occur 3-dimensionally in response
to the intensity of the internal stress generated in the
model. When the overall isochromatic fringe pattern is
considered, interpretation is based on the following
principles: (1) the more fringes, the higher the stress
intensity; and (2) the closer the isochromatic fringes are
to each other, the higher the stress concentration.17 To
observe isochromatic fringes easily by preventing light
reflection and refraction, the model was soaked in a
mineral oil with a refractive index equal to that of the
model material.18
RESULTS
In the photoelastic analysis of the first-and-second
molar simultaneous traction model (Fig 5), when the
force was applied parallel to the occlusal plane, stress
was generated along the mesial and distal root surfaces
of the first and second molars. In the second molar, the
stress was distributed along the entire root surface,
whereas, in the first molar, the stress was concentrated
on the cervical half of the mesial root surface and along
the apical half of the distal root surface (Fig 5, a).
With the traction 30° downward to the occlusal
plane, the stress was generated along the distal root
surface of the first and second molars, and extended
distally and downward (Fig 5, b).
626 Nakamura et al American Journal of Orthodontics and Dentofacial Orthopedics
November 2007

Fig 2. Mandibular molar distalization on photoelastic model: a, sliding hook; b, open coil spring; c,
ligature wire; d, elastic chain.

Fig 3. Direction of traction: a, parallel to occlusal plane; b, 30°downward to occlusal plane.

Fig 4. Circular polariscope arrangement used to observe isochromatic fringes. Ls, Light source; D,
diffuser; P, polarizer; Q, quarter-wave plate; M, model.

In the photoelastic analysis of the second-molar
single traction model (Fig 6), with traction parallel to
the occlusal plane, the stress was generated along the
entire distal root surface of the second molar and
extended distally with the intensity of 2-fringe order
(Fig 6, a).
With the traction 30° downward to the occlusal
plane, the stress was generated around the apex and
along the distal surface of the distal root of the second
molar and extended distally and downward (Fig 6, b).
In the photoelastic analysis of the first-molar single
traction model (Fig 7), with traction parallel to the
occlusal plane, extremely high stress was concentrated
on the middle part of the mesial root surface of the first
molar with the intensity of a 3-fringe order. Stress of a
2-fringe order was observed along the apical half of the
distal root surface of the first molar (Fig 7, a).
With the traction 30° downward to the occlusal
plane, the stress was less on the mesial root surface of
the first molar compared with when traction was
applied parallel to the occlusal plane. High stress was
generated around the apex of the first molar and
extended distally and downward (Fig 7, b).
DISCUSSION
Photoelastic stress analysis allows visualization of
internal stresses with colored patterns. In this study, we
used the quasi 3-dimensional photoelastic technique
devised by Caputo and Standlee.19 This technique has
the advantages of using models with good geometric
fidelity and of being able to apply multiple complex
force systems to the models. Moreover, the models can
be used repeatedly because they are not destroyed when
obtaining the photoelastic data. With this technique,
some studies showed stress distributions in the cranio-
facial complex or the periodontal tissues induced by
orthodontic forces.20-32
Using the photoelasticity modeling concept, Caputo
and Standlee19 demonstrated that it is impossible to
model all mechanical properties of a structural element;
American Journal of Orthodontics and Dentofacial Orthopedics Nakamura et al 627
Volume 132, Number 5

Fig 5. First- and second-molar simultaneous traction model: a, parallel; b, 30° downward.

Fig 6. Second-molar single traction model: a, parallel; b, 30° downward.

Fig 7. First-molar single traction model: a, parallel; b, 30° downward.

they proposed that a decision must be made about
which properties are most pertinent to the clinical
question at hand. In the photoelastic model used in this
study, the periodontal membrane and the alveolar bone
were not assembled separately, and the entire periodon-
tal structure was made from urethane with a low elastic
modulus and a high optical sensitivity, so that the
internal stress induced by several hundred grams of
orthodontic force would be easily detectable.
The anchor plate was not assembled directly in the
model to avoid undue deformation of the model and
disturbance of the stress generated around the plate that
could influence stress distribution around the teeth.
In the first-and-second molar simultaneous traction
and the first-molar single traction models, the stress
around the first molar appeared to induce distal tipping
when the force was applied parallel to the occlusal
plane. The intensity and the concentration of the stress
around the first molar were both higher in the first-
molar single traction model than in the 2-molar simul-
taneous traction model, supposedly because of lack of
contact with the second molar in the single traction
model. When the force was applied at an angle of 30°
downward to the occlusal plane in both models, the
stress appeared to induce intrusion of the molars as well
as their distal movement; the horizontal component of
the force appeared to move the molars distally, whereas
the vertical component acted to intrude them via
archwires. The 30° downward traction reduced the
distal tipping effects of the force, and this might be in
part the result of the downward deflection of archwires
occurring at the mesial side of the first molars; this acts
to resist their distal tipping.
In the second-molar single traction model, the stress
appeared to induce bodily movement when the force
was applied parallel to the occlusal plane. A similar
stress distribution was found around the second molar
as in the first-and-second molar simultaneous traction
model. In both models, the distal tipping of the second
molar appeared to be prevented by the posterior part of
an archwire, which was not easily deflected because of
its short length. The 30° downward traction in the
628 Nakamura et al
second-molar single traction model appeared to show
stress distribution with an intrusive effect resulting
from the downward component of the traction force.
For the distal movement of the mandibular molar
with the SAS, there are 2 kinds of procedures: first-
and-second molar simultaneous traction and sequential
traction when the first molar is moved distally after the
second molar has been moved. The stress analysis in
this study suggested that, irrespective of the traction
direction, there are no differences in tooth movement
between simultaneous and sequential traction of each
tooth, except for the distal tipping of the first molar.
Based on these results, the first molar appears to be
susceptible to distal inclination during single traction.
To prevent this, the simultaneous traction of the first
and second molars might be preferable.
The force direction from the anchor plate is subject
to some restriction because traction hooks of the plate
must be positioned to avoid contact with the maxillary
teeth and the gingivae as well as the archwires, and to
prevent injury to the cheek or the gingivae. Thus, the
traction direction for distal movement of the mandibu-
lar molar is likely to be downward to the occlusal plane,
exerting some intrusive force on the molars. This seems
to be advantageous in the treatment of skeletal Class III
open-bite patients requiring distal movement and intru-
sion of the mandibular molars. However, in the treat-
ment of skeletal Class III deepbite patients, we must
consider the intrusive forces generated from the down-
ward traction to the occlusal plane. In such cases, the
parallel traction applied to the occlusal plane must be
attempted by adjusting the position and the figure of the
anchor plate hooks or the sliding hooks on the archwire.
CONCLUSIONS
Quasi 3-dimensional photoelastic stress analysis was
performed for the simulated distal movement of the
mandibular molar with the SAS. First- and second-molar
simultaneous traction might be preferable to the sequential
traction of each molar to prevent the unfavorable distal
tipping of the first molar. Regardless of whether simulta-
neous or sequential traction is used, downward traction to
the occlusal plane seems to induce intrusion of the molars
and their distal movement.
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