To cite this article: Wu Z-, et al. Lever arm on bracket vs.

lever arm on archwire: A 3D finite element method study of mechanics of

miniscrew-supported lingual en-masse retraction of maxillary anterior teeth. International Orthodontics (2023), 10.1016/j.
ortho.2023.100791
International Orthodontics 2023; xx: xxx

Websites:
www.em-consulte.com
www.sciencedirect.com

Original Article
Lever arm on bracket vs. lever arm on
archwire: A 3D finite element method study
of mechanics of miniscrew-supported lingual
en-masse retraction of maxillary anterior
teeth

Zhe-min Wu 1, Bo-xiu Li 2, Dong-cai Wang 3, Yun-feng Liu 3, Xing-tao Dong 3, Xian-feng Jiang 3

Available online: 1. Department of Dentistry, Sir Runrun-Shaw Hospital of Zhejiang University, College
of Medicine, Zhejiang University, 310016 Hangzhou, China
2. Department of Orthodontics, Second Affiliated Hospital of Zhejiang University,
College of Medicine, Zhejiang University, Hangzhou, China
3. College of Mechanical Engineering, Zhejiang University of Technology, Key
Laboratory of E&M (Zhejiang University of Technology), Ministry of Education &
Zhejiang Province, 310023 Hangzhou, China

Correspondence:
Yun-feng Liu, College of Mechanical Engineering, Zhejiang University of Technology,
Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education &
Zhejiang Province, 288, Liuhe Road, 310023 Hangzhou, China.
liuyf76@126.com

Keywords Summary
Lever arm
Lingual bracket Objective > To compare the deformation of the main archwire and 3D movements of maxillary
Finite element anterior teeth during miniscrew-supported en-masse retraction with the lever arm on the archwire
Biomechanics and on the brackets in lingual orthodontic treatment in finite element analysis (FEM) simulation.
Archwire Material and methods > A 3D dental-alveolar model with bonded 0.018  0.025-inch slot lingual
brackets and a 0.017  0.025-inch dimension stainless-steel archwire was created. Four FEM
models were created based on a 3D dental-alveolar model: in Models A and C, the lever arms were
attached to the lingual bracket, while in Models B and D, the lever arms were attached to the
archwire. Meanwhile, in Models A and B, the miniscrews were placed in between the molars,
while in Models C and D, the miniscrews were positioned on the palatal roof. After a 1.5N retraction
force was applied from the miniscrew to the end of the lever arm, the initial movements in the
sagittal, transversal, and vertical planes were recorded and analysed for maxillary anterior teeth.
Results > In Models B and D, smaller deformation of the main archwire and less prominent bowing
effect were noticed in both sagittal and vertical directions compared to their counter groups. In
Models C and D, the central incisors showed less torque loss in the sagittal direction and more
canine intrusion vertically.

tome xx > 000 > xx 2023

10.1016/j.ortho.2023.100791
© 2023 Published by Elsevier Masson SAS on behalf of CEO.

ORTHO-100791
Z- Wu, B- Li, D- Wang, Y- Liu, X- Dong, X- Jiang
Conclusions > For the same lever arm-miniscrew retraction configuration, the lever arm on the
bracket showed less deformation of the main archwire and more body movement of the teeth
than the lever arm on the archwire group. With the same level arm height, the transverse and
vertical bowing effect is reduced when the lever arm was placed distal to the central incisor and
the miniscrews placed next to the palatal suture.
Introduction
There are various methods of applying retraction force to max-
illary anterior teeth during en-masse retraction in extraction
orthodontic cases. Among the commonly used techniques,
the lever arm-miniscrew system with a lingual bracket is not
only aesthetic but also biomechanically superior to labial appli-
ance [1,2]. In lingual orthodontic treatment, the mechanics
provided by the positions of the lever arm and miniscrew are
the essential parameters. With the action line of force close to
the centre of resistance of six maxillary anterior teeth, the
required body movement can be performed and less torque
is lost. It results in better torque control of maxillary incisors
during retraction [3]. It is also reported that adverse transversal
and vertical bowing effects were reduced with the lever arm-
miniscrew system [4,5].
With the presence of the lever arm and miniscrew system, lever
arms are usually located on the lingual archwire between
central and lateral incisors [6] or between lateral incisors and
canines [3], as well as distal to canine [7]. Additionally, the lever
arm varies in length [8]. Conversely, miniscrews are usually
placed in between the first and the second molars palatally
[4] or on the palatal roof, in or near the median palatal suture
[6,7]. Different combinations of the lever arm location, its
length, and the positions of miniscrews allow experts to attain
various directions of the retraction force, resulting in different
movement patterns of anterior teeth, especially in space-closing
[3,5,9].
In the typical lever arm-miniscrew lingual retraction system, the
lever arm is soldered or clamped on the archwire. The retraction
force is applied to the tip of the level arm, causing the defor-
mation of the archwire. Then, the deformed archwire passes the
force mesially and laterally to the adjacent brackets, causing the
teeth to move. However, with the clearance gap (a play)
between the archwire and the bracket slot, the bracket rotates
insufficient than designed, which could be considered a type of
uncontrolled tipping [10]. Meanwhile, the longer the lever arm
is, the greater cantilever effect is detected on the archwire,
causing the twist and deformation of the latter [11]. Moreover,
the frictional force between the bracket and the archwire can
influence the force transmitted to the teeth, thus reducing the
accuracy and efficiency of the orthodontic tooth movement [12].
To overcome the above-mentioned drawbacks, some ortho-
dontists suggested the "double cable'' technique; i.e., retracting
2
Original Article
the anterior teeth from both lingual and buccal sides [11], or the
"double archwire'' technique; i.e., both ribbon-wise and edge-
wise archwires in the anterior teeth's section [13], along with
the other methods determined to minimize the undesired teeth
movement. In this study, a novel technique was proposed as an
alternative method of performing retraction: the lever arm was
placed on the lingual bracket rather than on the archwire. This
study aimed to analyse the movement pattern of the maxillary
anterior teeth in the lever arm on the bracket versus the lever
arm on the archwire using the three-dimensional (3D) finite
element analysis. By identifying the differences between them,
valuable information on the biomechanical behaviour of teeth
during en-mass retraction for clinical application could be pro-
vided [14,15].
Material and methods
One adult patient was included in this study per the following
criteria:
 complete permanent dentition with normal tooth morphol-
ogy, well-aligned teeth, and a symmetric arch without skeletal
deformities;
 no dental caries, no periodontal disease, and no previous
orthodontic treatment. Written informed consent was
obtained from the patient. The cone-beam computed tomog-
raphy data of this subject were obtained using the Morita X550
(Morita, Japan) device with 0.15 mm scan slice thickness and
exported to Mimics 17.0 (Materialize, Belgium) for the recon-
struction of 3D models. The right side of the maxilla was the
mirror image of the left side for the bilateral symmetric model.
The periodontal ligament (PDL) was set as a uniform layer of
an even thickness of 0.25 mm around the roots. The 3D mo-
dels of the maxilla and dentition, where two upper first
premolars were extracted, were modified in Geomagic12.0
(Geomagic, USA) to simulate the mechanical movement.
The digital images of lingual brackets and molar tubes (Protect,
China) were imported to the model, with 0.018  0.025-inch
slot dimension, while the archwire was 0.017  0.025-inch
ribbon-shaped. Meanwhile, the ligature wire with a cross-sec-
tion of 0.01  0.01 inches was modelled at the mesial and
lateral end of the bracket slot. The width of the lingual brackets
was 2.4 mm for the central incisor, canine, and premolar,
2.0 mm for the lateral incisor, 4.0 mm for the first molar, and
3.5 mm for the second molar. The fabricated lever arm was
tome xx > 000 > xx 2023
 To cite this article: Wu Z-, et al. Lever arm on bracket vs. lever arm on archwire: A 3D finite element method study of mechanics of
miniscrew-supported lingual en-masse retraction of maxillary anterior teeth. International Orthodontics (2023), 10.1016/j.
ortho.2023.100791
International Orthodontics 2023; xx: xxx
Figure 1
Attached level arm on bracket in typodont
customized and wire-bended, with horizontal section under the
occlusal and gingival wings of the lingual bracket, and mesial
and lateral half-circle next to the bracket slot and passes over
the archwire. The end of this lever arm was cemented with
composite resin after being attached to the bracket; therefore, it
could be attached to the bracket before retraction and removed
when necessary (figure 1). For easier calculation, the lever arm
on the archwire was drawn as a bar bonded to the archwire next
to the distal side of lingual bracket in Models A and C, whereas
the lever arm on the bracket was drawn as a bar bonded to the
distal side of lingual bracket in Models B and D. The lever arm
was set as a 0.5-mm stainless-steel square wire that extended
gingivally along the palate with the 0.5 mm distance from the
palatine mucosa, and the tip of the lever arm was 7 mm from
the archwire plane. In Models A and B, the lever arms were
placed distal to the lateral incisor bracket while in Models C and
D, the lever arms were placed distal to the central incisor
bracket. The miniscrews were positioned in two locations
too: the first was between the roots of the first and second
molars, with the line from the miniscrew to the tip of the lever
arm being parallel to the occlusal plane, while the second was
next to the median palatal suture, where the line from the
miniscrew to the distal side of central incisor lingual brackets
was parallel to the mid-sagittal plane. All the appliances were
drawn using Unigraphics NX 10.0 (Siemens PLM Software,
Germany). Then, four working conditions were set based on
the locations of the lever arm and miniscrews (figure 2, table I).
tome xx > 000 > xx 2023
3
Original Article
The constructed STL models were converted into FE models using
3-matic Medical 9.0 (Leuven, Belgium) and then imported into
the FEM platform known as ANSYS 11 (ANSYS, USA). All the
structures in the models were determined as linear elastic,
homogeneous, and isotropic. The types of elements and the
number of nodes and elements in the FEM models are listed in
table II. The material parameters used in this study were cited
from the previous studies listed in table III [16]. The teeth,
alveolar bone, PDL, orthodontic appliances were assembled
to form a complete simulation model, and the volumetric
parameters of these components were created separately in
the model.
The bonded relationships were established between alveolar
bone and PDL, PDL and tooth, and tooth and bracket, with the
displacement of the upper part of the maxilla being restricted
[11]. The contacts were set between tooth and tooth, archwire
and ligature wire, and archwire and bracket, with the coeffi-
cient of friction assumed to be 0.2 [17]. A Cartesian coordinate
system with an x-axis (transverse plane, +left, –right), a y-axis
(sagittal plane, +lingual, labial) and a z-axis (vertical plane,
+apical, –occlusal) was established for this study model [3]. A
retraction force of 1.5N was applied from the top of the
miniscrews to the tip of the level arm in each working condi-
tion. The initial displacement in the three axes of the reference
nodes of 6 maxillary anterior teeth (tip of the root apex, centre
of the incisor edge or cusp) were recorded, analysed, and
compared.
Z- Wu, B- Li, D- Wang, Y- Liu, X- Dong, X- Jiang

Original Article
Figure 2
Assembled four working models with level arms and miniscrews in different location

TABLE I
Different retraction methods for each group

Group Location of the level arm Location of the miniscrew

A Bonded to the archwire and on the distal side of the maxillary lateral incisor Palatally between the roots of the first and second molars

B Bonded to the distal side of the maxillary lateral incisor Palatally between the roots of the first and second molars

C Bonded to the archwire and on the distal side of the maxillary central incisor Next to the median palatal suture

D Bonded to the distal side of the maxillary central incisor Next to the median palatal suture

tome xx > 000 > xx 2023

4
 To cite this article: Wu Z-, et al. Lever arm on bracket vs. lever arm on archwire: A 3D finite element method study of mechanics of
miniscrew-supported lingual en-masse retraction of maxillary anterior teeth. International Orthodontics (2023), 10.1016/j.
ortho.2023.100791
International Orthodontics 2023; xx: xxx

Original Article
TABLE II Results
Types of elements and the number of nodes and elements in the In the sagittal direction (y-axis), after applying a 1.5N retraction
FEM models force to the lever arm, the initial displacements of maxillary
central incisors showed torque loss in all four models, and these
Model No. of nodes No. of element Type displacements were classified as follows: Models C > A > D > B.
PDL 53295 158225 C3D4 For the maxillary central incisors' root tip, the initial displace-
Teeth 60491 209889 C3D4
ments showed labial tipping in Models A, B, and C, while lingual
tipping was detected in Model D. According to the absolute
Alveolar bone 43236 154194 C3D4
values of root displacement, Models A > C > B > D.
Brackets 119492 75435 C3D10M For maxillary lateral incisors, lingual crown tipping was noticed
Archwire 22335 12705 C3D10M in all four models. The displacement in Model A was much
higher than that in Model B, followed by those in Models D
and C. Meanwhile, lingual root tipping was found in Models A, B,
and C, whereas labial root tipping was found in Model D.
TABLE III For the maxillary canine, lingual crown tipping and labial root
Properties of materials used in FEM models tipping were noticed in all four models, with Model B having the
highest crown and root displacement (table IV).
Material Young's modulus (MPa) Poisson's ratio In the vertical direction (z-axis), the maxillary central incisors
PDL 0.05 0.49 showed occlusal crown and apical root movement in all four
5 models. Models A and C had more displacement than Models B
Tooth 2  10 0.30
and D in both crown and root directions. For maxillary lateral
3
Alveolar bone 2  10 0.30 incisors, the crown showed occlusal movement in all four mo-
Bracket 2  10 5
0.30 dels and the apical root's movement in Models A, B, and D. The
5 displacement in Model A was significantly greater than that in all
Archwire/hook 2  10 0.30
other models. For the maxillary canine, the crown showed
5
Miniscrews 1  10 0.33 occlusal root movement in Models A and B, while apical root

TABLE IV
Sagittal initial displacements of the maxillary anterior teeth ( 10S5 m)

Group Central incisor Lateral incisor Canine

Crown Root Crown-root Crown Root Crown-root Crown Root Crown-root

A 6.73 –1.80 8.53 5.66 0.35 5.31 2.25 –0.15 2.4

B 4.82 –1.41 6.23 2.76 1.42 1.34 3.30 –0.82 4.12

C 7.08 –0.34 7.42 2.29 0.38 1.91 1.64 –0.28 1.92

D 6.27 0.59 5.68 2.41 –0.38 2.79 1.56 –0.27 1.83

TABLE V
Vertical initial displacements of the maxillary anterior teeth ( 10S5 m)

Group Central incisor Lateral incisor Canine

Crown Root Crown-root Crown Root Crown-root Crown Root Crown-root

A –3.18 0.92 –4.10 –1.71 0.99 –2.70 –0.06 0.22 –0.28

B –2.67 0.33 –3.00 –0.88 0.10 –0.98 –0.30 1.04 –1.34

C –2.69 0.87 –3.56 –1.08 –0.18 –0.90 0.33 0.59 –0.26

D –2.33 0.38 –2.71 –0.97 0.36 –1.33 0.28 0.74 –0.46

tome xx > 000 > xx 2023

5
Z- Wu, B- Li, D- Wang, Y- Liu, X- Dong, X- Jiang

Original Article
TABLE VI
Transverse initial displacements of the right-sided maxillary anterior teeth ( 10S5 m)

Group Central incisor Lateral incisor Canine

Crown Root Crown Root Crown Root

A –0.26 – 1.65 – 3.49 –

B –0.03 – 4.27 – 0.46 –

C 0.68 – 0.85 – 2.68 –

D 1.04 – 0.55 – 1.21 –

movement was identified in Models C and D. Finally, the canine
root showed occlusal displacement in all four models, with
Model B having the highest value for it (table V).
In the transverse direction (x-axis), in Models A and B, maxillary
central incisors had a slight tendency toward mesial movement,
while in Models C and D, the obvious pattern of lateral shift was
demonstrated for the same teeth. For maxillary lateral incisors,
in Models A and B, lateral incisors had substantially higher
lateral inclination than in Models C and D where mesial move-
ment was defined on the contrary. For maxillary canines, all four
models displayed a mesial movement tendency whereby the
displacement of canines in Models A and C was much higher
than that in Models B and D (table VI).
Visualization reflects the initial movements of the teeth (fig-
ure 3), the von-Mises stress distribution of PDL (figure 4) and the
deformation of the main archwire (figures 5 and 6) that were

Figure 3
Initial displacement of four working models after force applied

tome xx > 000 > xx 2023

6
 To cite this article: Wu Z-, et al. Lever arm on bracket vs. lever arm on archwire: A 3D finite element method study of mechanics of
miniscrew-supported lingual en-masse retraction of maxillary anterior teeth. International Orthodontics (2023), 10.1016/j.
ortho.2023.100791
International Orthodontics 2023; xx: xxx

Original Article
Figure 4
Stress distribution of PDL in four working models after force applied

Figure 5
Sagittal view of the deformation of archwire in four working models after force applied (50  magnification)

tome xx > 000 > xx 2023

7
Z- Wu, B- Li, D- Wang, Y- Liu, X- Dong, X- Jiang

Original Article
Figure 6
Occlusal view of the deformation of archwire in four working models after force applied (50  magnification)

screenshotted from the finite element analysis software with

different colour contours, with each of the former corresponding
to a different value.

Discussion
In this study, the lever arm was on the bracket rather than on the
archwire, such that when the force was applied to the tip of the
lever arm, the retraction force was transmitted to the lingual
bracket directly without any loss. The target bracket and the
tooth moved first, then the adjacent teeth followed as the force
was transmitted through the deformed archwire. Considering
the archwire play in the bracket slot and the friction between
the archwire and bracket, the force-lever arm-bracket retraction
system in this study is more efficient than the force-lever arm-
archwire-bracket retraction system. Meanwhile, the lever arm
on the bracket was designed as a "bottle opener''; with the
occlusal and gingival bars working under the occlusal and gin-
gival wings, respectively, of the lingual bracket, applying a
positive torque to the target tooth during retraction (figure 7).
Theoretically, this method could reduce undesired teeth move-
ment, and our FEM was designed to confirm our hypothesis.
For easy comparisons, in our study, the end of the level arm was
set as 7-mm apical to the archwire, which showed fewer tipping Figure 7
patterns for maxillary anterior teeth during retraction [13,18]. Schematic drawing biomechanic principle of level arm on bracket
When longer lever arms are used, the flexibility of the lever arm during retraction (sagittal view)
archwire combination increases and it gets easily deflected
under the applied load. Therefore, placing the lever arm
between the incisors was preferred [3,6,8]. However, in this
study, the lever arm was set next to the distal sides of lateral and lever arm distal to the bracket could also prevent the unaesthetic
central incisors, so the location of the lever arm bonded to the space between the anterior teeth during retraction. With two
bracket was similar to the lever arm bonded to the archwire in locations of miniscrew, the direction of retraction force is parallel
corresponding counter groups. In clinical practice, placing the to the occlusal plane in Models A and B, whereas parallel to the

tome xx > 000 > xx 2023

8
 To cite this article: Wu Z-, et al. Lever arm on bracket vs. lever arm on archwire: A 3D finite element method study of mechanics of
miniscrew-supported lingual en-masse retraction of maxillary anterior teeth. International Orthodontics (2023), 10.1016/j.
ortho.2023.100791
International Orthodontics 2023; xx: xxx
mid-sagittal plane in Models C and D. Of course, there are
countless combination of lever arm-miniscrew system based
on different lever arm length, lever arm location and miniscrew
location. Different combinations are required in different clinical
situations during en-mass retraction. However, the results of the
four models in the experiment were enough to demonstrate our
hypothesis.
During en-masse retraction with lingual technique, archwire
deformation results in mainly two types of bowing, i.e., trans-
verse bowing effect and vertical bowing effect. Based on the
result of FEM, we noticed that in Models A and C, where the
lever arm was on the archwire, upon the application of force,
greater deformation and archwire twisting archwire occurred
than in their counter groups. The farther the tooth is from the
lever arm, the smaller the displacement is, as the canine dis-
placement in Models C and D. The height of the lever arm and
the position of the miniscrew also have an effect on body
movement, whereas there is a positive correlation between
these two parameters [19]. Therefore, the placement of min-
iscrews in the indicated groups can also explain the obtained
results. Meanwhile, when the lever arm was placed on the
bracket, the teeth showed smaller displacement; however,
more body movement occurred than when the lever arm
was on the archwire, as the lateral incisors in Models A and
B and the central incisors in Models C and D. We assumed that
the deformation of the archwire caused some undesired
moment of the target tooth, and, obviously, the lever arm on
the bracket could reduce this effect.
The von-Mises stress distribution showed that when the lever
arm was on the archwire, concentrated stress distribution was
noticed in the mesial crown side of the lateral incisor and the
mesial PDL in Model B due to its rotation. However, the move-
ment of the central incisor showed a more even and balanced
stress distribution in Model D than in Model C, which can be also
linked to the position of the miniscrew. However, when the lever
arm was on the bracket, minimal stress was noticed in Models B
and D. In addition, the von-Mises stress values for the PDL in all
models are far below the ultimate tensile strength of the PDL
(2.4 MPa) [20], which means both the alveolar bone and the
PDL were safe during the en-masse retraction of anterior teeth.
The results of this study confirmed our hypothesis that the lever
arm on the lingual bracket is helpful in preserving the shape of
the archwire and reducing undesired movement of the maxillary
anterior teeth.
This study also had some unexpected results. Firstly, in Models C
and D, with long lever arms and high miniscrews, the applied
action force was supposed to move the anterior teeth with
retraction and intrusion. However, in the study, the direction
of displacement of teeth did not coincide with the direction of
the force, as only the intrusion displacement was displayed for
the canines (but not the incisors). We suppose that the line of
the force of this lever arm-miniscrew system was occlusal to the
tome xx > 000 > xx 2023
9
Original Article
centres of resistance of six maxillary anterior teeth, and that the
intrusion of canines was due to the bending of the archwire in
the vertical direction. Secondly, when the lever arm was bound
to the bracket, the applied force caused the teeth to rotate, as
did the lateral incisor in Model B. However, less rotation of the
central incisor was noticed in Model D compared to Model C. We
believed that the rotational force of the central incisor was
reciprocally decreased, which is considered better for clinical
practice.
Some limitations of this study include the fact that the finite
element analysis was only a simulation. Besides, many details
of the bracket and lever arm were not taken into account, which
could have affected the final result in reality. Finally, our study only
investigated the initial displacements rather than the continuous
teeth movement. Although the findings of this study are only
theoretical, they provide experts with valuable information for
clinical reference and expand the scope of the lever arm-miniscrew
retraction system in lingual orthodontic appliance therapy. Future
FEM studies on continuous displacement and in vivo studies are
recommended to verify the results of this study.
Conclusion
For the same lever arm-miniscrew retraction configuration, the
lever arm on the bracket showed less deformation of the main
archwire than the lever arm on the archwire group.
More body movement was noticed when the force is applied to
the lever arm on the bracket than to the lever arm on the
archwire on the target tooth.
With the same level arm height, the transverse and vertical
bowing effect is reduced when the lever arm was placed distal
to the central incisor and the miniscrews placed next to the
palatal suture.
Acknowledgement: This work was supported by the National Natural
Science Foundation of China (No. 52175280 and 51775506), the Zhejiang
Provincial Natural Science Foundation of China (No. LD22E050013), the
Open Foundation of the Key Laboratory of E&M (Zhejiang University of
Technology), Ministry of Education & Zhejiang Province (EM2021120101),
the Open Foundation of the Collaborative Innovation Centre of High-end
Laser Manufacturing Equipment (JGKF-202201) and the 111 Project (No.
D16004).
Consent to participate: Written informed consent was obtained from the
patient.
Declaration of generative AI: No generative AI or AI-assisted technologies
were used in the writing process.
Authors' contribution: Zhemin Wu: writing-reviewing and editing, data
curation.
Boxiu Li: writing-original draft preparation, methodology.
Dongcai Wang: visualization, writing-reviewing and editing.
Xingtao Dong: methodology.
Xianfeng Jiang: methodology.
Yunfeng Liu: supervision.
Xianfeng Jiang: methodology.
Disclosure of interest: The authors declare that they have no competing
interest.
Z- Wu, B- Li, D- Wang, Y- Liu, X- Dong, X- Jiang
References
[1] Lombardo L, Scuzzo G, Arreghini A, Gorgun
O, Ortan YO, Siciliani G. 3D FEM comparison
of lingual and labial orthodontics in en masse
retraction. Prog Orthod 2014;15:38.
[2] Ata-Ali F, Cobo T, De Carlos F, Cobo J, Ata-Ali J.
Are there differences in treatment effects
between labial and lingual fixed orthodontic
appliances? A systematic review and meta-
analysis. BMC Oral Health 2017;17:133.
[3] Feng Y, Kong WD, Cen WJ, Zhou XZ, Zhang W,
Li QT, et al. Finite element analysis of the
effect of power arm locations on tooth move-
ment in extraction space closure with minis-
crew anchorage in customized lingual
orthodontic treatment. Am J Orthod Dentofa-
cial Orthop 2019;156:210–9.
[4] Hong RK, Heo JM, Ha YK. Lever-arm and
mini-implant system for anterior torque con-
trol during retraction in lingual orthodontic
treatment. Angle Orthod 2005;75:129–41.
[5] Geron S. Anchorage considerations in lingual
orthodontics. Semin Orthod 2006;12:167–77.
[6] Kojima Y, Kawamura J, Fukui H. Finite ele-
ment analysis of the effect of force directions
on tooth movement in extraction space clo-
sure with miniscrew sliding mechanics. Am J
Orthod Dentofacial Orthop 2012;142:501–8.
[7] Inami T, Ito G, Miyazawa K, Tabuchi M, Goto
S. Ribbon-wise customized lingual appliance
and orthodontic anchor screw for the treat-
ment of skeletal high-angle maxillary protru-
sion without bowing effect. Angle Orthod
2018;88:830–40.
[8] Mattu N, Virupaksha AM, Belludi A. Com-
parative study of effect of different lever arm
positions and lengths on transverse and ver-
tical bowing in lingual orthodontics – an FEM
study. Int Orthod 2021;19:281–90.
[9] Mohammad G, Beste K. Effects of skeletally
supported anterior en masse retraction with
varied lever arm lengths and locations in
lingual orthodontic treatment: A 3D finite
element study. BioMed Res Int
2021;2021:1–2.
[10] Kojima Y, Fukui H. Numeric simulations of en-
masse space closure with sliding mechanics.
Am J Orthod Dentofacial Orthop 2010;138:702
[e1–6; discussion 702].
[11] Liu D, Yan B, Lei F, Li J, Wang X, Rong Q, et al.
Different sliding mechanics in space closure of
lingual orthodontics: a translational study by
three-dimensional finite element method.
Am J Transl Res 2019;11:120–30.
[12] Kawamura J, Tamaya N. A finite element
analysis of the effects of archwire size on
orthodontic tooth movement in extraction
space closure with miniscrew sliding
mechanics. Prog Orthod 2019;20:3.
[13] Wang D, Li B, Xu Y, Dong X, Jiang X, Wu J,
et al. Biomechanical analysis of maxillary
anterior teeth movements during different
retracting methods with a lever arm minis-
crew system in double-slot lingual brackets: a
finite element method study. Orthod Cranio-
fac Res 2023;26:364–70.
[14] Perillo L, Jamilian A, Shafieyoon A, Karimi H,
Cozzani M. Finite element analysis of minis-
crew placement in mandibular alveolar bone
with varied angulations. Eur J Orthod
2015;37:56–9.
10
Original Article
[15] Liang W, Rong Q, Lin J, Xu B. Torque control
of the maxillary incisors in lingual and labial
orthodontics: a 3-dimensional finite element
analysis. Am J Orthod Dentofacial Orthop
2009;135:316–22.
[16] Tominaga JY, Tanaka M, Koga Y, Gonzales C,
Kobayashi M, Yoshida N. Optimal loading
conditions for controlled movement of ante-
rior teeth in sliding mechanics. Angle Orthod
2009;79:1102–7.
[17] Cai Y. A three-dimensional finite element
analysis of the effect of archwire character-
istics on the self-ligating orthodontic tooth
movement of the canine. Technol Health Care
2019;27(S1):195–204.
[18] Ghannam M, Kamiloğlu B. Effects of skele-
tally supported anterior en masse retraction
with varied lever arm lengths and locations in
lingual orthodontic treatment: a 3D finite ele-
ment study. BioMed Res Int
2021;2021:9975428.
[19] Ruenpol N, Sucharitpwatskul S, Wattana-
wongskun P, Charoenworaluck N. Force
direction using miniscrews in sliding
mechanics differentially affected maxillary
central incisor retraction: finite element simu-
lation and typodont model. J Dent Sci
2019;14:138–45.
[20] Kushwah A, Kumar M, Goyal M, Premsagar
S, Rani S, Sharma S. Analysis of stress
distribution in lingual orthodontics system
for effective en-masse retraction using var-
ious combinations of lever arm and miniim-
plants: a finite element method study. Am J
Orthod Dentofacial Orthop 2020;158:e161–72.
tome xx > 000 > xx 2023