Biomechanics + Anchorage

National Orthodontics Programme Module 12b - Biomechanics
British Orthodontic Society 1
National Orthodontics Programme

British Orthodontic Society
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Biomechanics
About the National Orthodontics Programme

The National Orthodontics Programme was launched in December 2004 following a successful British
Orthodontic Society Foundation Award application. A primary aim of the project was to develop a modular
learning resource housed in a Virtual Learning Environment for postgraduates in orthodontics
(www.ole.bris.ac.uk). This consists of 40 online modules and a series of online assessments. The resource
aims to maximize the use of academic staff time and significantly reduce the amount of traveling to teaching
bases by Specialist Registrars.
The resource has been developed by all UK dental schools as authors or coauthors. It is at the discretion of
each dental school as to how the resource is best used in their courses.
We hope you enjoy using this unique and pioneering resource.

Personal Welcome
Welcome to Module 12b. This module reviews the mechanical principles of orthodontic force systems, and
the cascade of biological events that allow orthodontic tooth movement in response to stresses in the
periodontium. I hope you find the module interesting and informative.
For module content support and guidance, please refer to the discussion board for this module available on
Blackboard.
Module Author
Andrew Keating
Peer Reviewers
Jeremy Knox / David Birnie
What You Will Learn

At the end of this module, you will be able to discuss:
• The basic anatomy of the periodontium
• Bone metabolism and the theories on the biological control of tooth movement
• The response to a sustained orthodontic force
• The mechanics of tooth movement
• Determinate and indeterminate force systems
• Anchorage considerations
Assessment
Assessment will be made through a combination of tasks for self-directed learning and shared discussion.
The essay title is:
Describe the ideal properties of bonding and cementing agents used in orthodontics. Discuss
how the changes have been met in the last 10 years.
Timing
The total time required for the Module and Task exercises is 32 hours.
References
References are given at the end of each section.
Section 1 – Anatomy of the Periodontium

The periodontal tissues can be divided into:
• The gingiva
• The periodontal ligament
• The cementum
• The alveolar bone
The Gingiva
The gingiva is that part of the oral mucosa, also known as masticatory mucosa, which surrounds the necks
of the teeth. It is composed of keratinised squamous epithelium and extends apically to the mucogingival
junction covering the alveolar ridges. It can be classified into three distinct zones:
• The free or marginal gingiva – extending from the base of the gingival sulcus to the gingival margin
• The attached gingiva including the junctional epithelium – extending from the base of the gingival
sulcus to the mucogingival junction
• The interdental papilla
Figure 1
Avery JK. Essentials of Oral Histology – A Clinical Approach. Chapter 14.

2000; Mosby Publications.
The Periodontal ligament (PDL)
PDL Structure
Each tooth is attached to and separated from the adjacent alveolar bone by the periodontal ligament. Under
normal circumstances, the periodontal ligament occupies a space approximately 0.15 - 0.38mm in width.
The width is greatest at the mouth of the socket and at the root apices, but this reduces with age.
Most of the periodontal ligament space is taken up with bundles of collagen fibres that are organised into
two main groups:
• The gingival group located around the necks of the teeth
• The dentoalveolar group which surrounds the roots of the teeth
The gingival group consists of:

• Free gingival fibres that arise from the surface of the cementum and pass into the free gingiva,
providing support to the gingiva
• Attached gingival fibres that arise from the alveolar crest and pass into the free and attached gingiva
also providing gingival support
• Circular fibres which run continuously around the neck of the teeth, providing gingival support
• Dentoperiosteal fibres arising from cementum, passing into bone of the alveolar crest
• Trans-septal fibres attaching adjacent teeth together resisting their separation
The major component of the periodontal ligament is the dentoalveolar group of parallel collagenous fibres.
These fibres are inserted into the cementum on the root surface on one side of the ligament space, and into
a dense bony plate, the lamina dura, on the other side. The majority of these fibres run at an angle,
attaching farther apically on the tooth than on the adjacent alveolar bone. This arrangement resists the
vertical displacement of the tooth that occurs during normal function. Between each bundle of fibres is an
interstitial space that contains blood vessels, nerves and lymphatics that help maintain the vitality of the
periodontal ligament and the cementum. There are also networks of finer fibres which cross and support the
dense collagen bundles. Some are again collagenous while others are elastic type fibres and of a structure
different from collagen. These are termed oxytalan fibres.
Apart from the collagenous fibre bundles, two other major components of the periodontal ligament space
include:
The following items should have same level of indent as for bulleted lists
1) Cellular elements:
• Fibroblasts involved in the constant remodelling and renewal of collagen during normal
function
• Cementoblasts and cementoclasts involved in cementum remodelling
• Osteoblasts and osteoclasts involved in bone remodelling
• Epithelial cells
• Macrophages which are important in defence
• Cells from the vascular system; lymphocytes, leukocytes and plasma cells normally seen in
the presence of inflammatory disease (periodontitis)
• Nerve endings, both unmyelinated free endings associated with perception of pain and the
more complex receptors associated with pressure and positional information
(proprioception).
2) Ground substance:
• Amorphous extracellular matrix composed of proteoglycans, glycoproteins and water, which
acts as a shock absorber along with the vascular system.
PDL Function
Normal functions of the periodontal ligament include:

• Tooth support through a physical connection between the tooth to alveolar bone
• Ligament, bone and cementum repair
• Sensory function for pressure, pain and proprioception
• Nutritive function, where the blood supply provides essential nutrients to the cellular
elements of the ligament and to the cementum which is avascular
• Dissipation of dental loads
• Facilitation of tooth movement
Avery JK. Essentials of Oral Histology – A Clinical Approach. Chapter 11. 2000; Mosby
Publications.
Proffit WR. Henry W. Contemporary Orthodontics. Chapter 9. 2000; Mosby

Publications.
Cementum
The chapters in both of these textbooks give a very good summary of the structure and function of
cementum.
Publications.
Proffit WR. Henry W. Contemporary Orthodontics. Chapter 9. 2000; Mosby

Publications.
Alveolar bone
The alveolar processes are those portions of the mandible and maxilla that support the teeth. They develop
in conjunction with the development and eruption of the teeth, and are resorbed if the teeth are extracted
or fail to develop. There are two components to the alveolar bone:
1) Alveolar bone proper, also known as the lamina dura or bundle bone.
• This bone lines the tooth socket and into this the periodontal ligament fibres are inserted.
The lamina dura contains many fenestrations that allow the passage of blood vessels and
nerves into the periodontal ligament space as well as allowing compressed fluid in the
ligament space to be expressed into the marrow spaces. It appears denser, radiographically,
than the adjacent supporting bone.
2) Supporting bone consisting of:
• Dense compact buccal and lingual/palatal cortical plates
• Cancellous/trabecular bone between the cortical plates
The bone itself consists of:

• An inorganic mineral component, calcium, phosphate and carbonate (two thirds by weight).
• An organic matrix (one third by weight) consisting of type I collagen and small amounts of non-
collagenous proteins including:
o Osteonectin
o Proteoglycans
o Osteocalcin and many others
• Four principle cell types:
o Osteoblasts - bone forming cells that produce the matrix, also called osteoid, which then
becomes mineralised. They also produce factors for activation and recruitment of osteoclasts,
and have receptors for most of the bone resorbing hormones.
o Osteocytes - osteoblasts that have become entrapped in bone matrix.
o Bone lining cells - that cover the bone surface and whose function is not well understood.
o Osteoclasts - the main bone resorbing cells of monocyte-macrophage origin. They are large and
multinucleated and can resorb bone. Only have receptors for a few hormones e.g. calcitonin and
retinoic acid.
Publications.
Section 2 – Bone Metabolism

Definitions (Daskalogiannakis 2000):
• Bone modelling is a process involving independent sites of resorption and formation that change
the intrinsic form (shape and/or size) of a bone. It is the dominant process in growth as well as in
adaption to applied loads such as those produced with headgear, rapid palatal expansion and
functional appliances.
• Bone remodelling signifies a specific coupled sequence of resorption and formation events to
replace previously existing bone, as occurs in tooth movement.
Bone Remodelling Cycle
The bone remodelling cycle is a complex process involving the resorption of bone on a particular surface,
followed by a phase of bone formation. The current concept of bone remodelling is based on the hypothesis
that osteoclastic precursors become activated and differentiate into osteoclasts which begins the process of
bone resorption. This step is then followed by a reversal phase and then by osteoblastic bone formation to
repair the defect.
Hill PA. Bone Remodelling. Br J Orthod

1998; 25: 101-107.
Figure 2
The activities of bone formation and resorption (bone remodelling) are regulated by systemic hormones and
local factors, which effect cells of both the osteoclast and osteoblast lineages and exert their effect on:
• The replication of undifferentiated cells
• The recruitment of cells
• The differentiated function of cells
The systemic hormones include:

• Polypeptide hormones
o Parathyroid hormone
o Calcitonin
o Insulin
o Growth hormone
• Steroid hormones
o 1, 25-Dihydroxy vitamin D3
o Glucocorticoids
o Sex steroids
• Thyroid hormones
The local factors are synthesised by skeletal cells and include:

• Growth factors such as
o Platelet derived growth factor (PDGF)
o Insulin like growth factors (IGF-I, IGF-II)
o Fibroblast growth factors (FGF)
• Cytokines, and
• Prostaglandins
Bone Resorption (Meghji 1992, Hill 1998)
Bone resorption involves the removal of both the mineral and organic components of bone matrix by
osteoclasts, aided by osteoblasts. The process involves three steps.
The first step involves the formation of osteoclast progenitors/ precursor cells in the haematopoietic tissues
such as bone marrow, and the development of resting pre-osteoclasts and osteoclasts in the bone itself.
The second step involves the preparation of the bone surface. The osteoblasts facilitate removal of
the unmineralised osteoid layer by
producing a variety of proteolytic
enzymes, such as the matrix
metalloproteinases (MMPs) and
collagenase. This facilitates access of
the osteoclasts to the underlying
mineralised bone. The MMPs may also
be chemotactic for osteoclast
recruitment and function. Although the
osteoclast is the principal bone
resorbing cell, it is the osteoblast that
contains the receptors for the major
bone resorbing agents such as
parathyroid hormone (PTH), cytokines,
prostaglandins, and 1, 25-dihydroxy
vitamin D3. It is the osteoblast that
Figure 3 transmits the resorptive signal to the osteoclast, in turn activating it. This
signal has recently been identified as osteoprotegerin (OPG) and the ligand
(OPGL).
The third step involves the activated osteoclast resorbing the bone. During bone resorption, the clasts
create cavities on the mineralised bony surface and change in morphology so their active surface resembles
a ruffled border consisting of many infoldings of the cell membrane and finger-like projections of the
cytoplasm. This creates an extensive surface area that facilities the exchange of materials between the cell
and the bone. The osteoclast secretes organic acids, which dissolve the hydroxyapatite crystals while the
resorption of the organic matrix is enzymatic, principally by lysosomal enzymes.
Bone Reversal (Hill 1998)
During the reversal phase osteoclast activity stops, the osteoclast cells disappear and macrophage like cells
are seen on the bone surface. These cells may inhibit osteoclast activity and stimulate osteoblasts. They may
also remove residual matrix since they are richer in collagenase than the osteoclast. Also, during this phase
osteoblast precursor cells appear in the area of resorption, which locally proliferate and differentiate into
osteoblasts. The chemotactic attraction of osteoblast precursor cells to the site of resorption, and their
proliferation and differentiation into mature osteoblasts, is most likely mediated by local factors produced
during the resorption process. These factors may include bone morphogenic proteins such as transforming
growth factor beta (TGF-beta) and other growth factors.
Bone Formation (Hill 1998)
The osteoblasts now present in the area of resorption begin to form osteoid which is subsequently
mineralised. Some of the osteoblasts become embedded in the new bone matrix being formed and are then
known as osteocytes. The osteocytes may continue to produce collagen until they are completely embedded.
The cessation of osteoblast activity may be due to negative feedback inhibition or the induction of osteoblast
apoptosis by tumour necrosis factor released from neighbouring marrow cells.
References
Daskalogiannakis J. Glossary of Orthodontic Terms. 2000; Quintessence Publishing.
Davidovitch D. Tooth movement. Crit Rev Oral Biol Med 1991; 2: 411-450.
Dolce C, Malone JS, Wheeler T. Current concepts in the biology of orthodontic tooth movement.
Semin Orthod 2002; 8: 6-12.
Hill PA. Bone Remodelling. Br J Orthod 1998; 25: 101-107.
Meghji S. Bone remodelling. Br Dent J 1992; 172: 235-242.
Roberts WE. Bone physiology, metabolism and biomechanics in orthodontic practice. In: Graber TM,
Vanarsdall RL (eds), Orthodontics: Current Principles and Techniques, 3rd edn. 2000; St. Louis, Mosby.
Roberts-Harry D, Sandy J. Orthodontics. Part 11: Orthodontic tooth movement. Br Dent J 2004; 196: 391-
394.
Section 3 – Biologic Control of Tooth Movement: The Theories

How are the mechanical forces placed on tooth roots by an orthodontic appliance transformed into the
cellular events seen during bone remodelling that facilitate the movement of teeth through bone?
How is the stress generated within the periodontal ligament space detected by the cells that affect bone
remodelling? What are the biological control mechanisms?
A number of theories have been proposed as to the biologic control of orthodontic tooth movement:
• The bioelectric theory
• The pressure-tension theory
• Chemical Messengers
The Bioelectric Theory
Piezoelectric signals
Electric signals that might initiate tooth movement initially were thought to be piezoelectric. Bassett (1965)
proposed that the piezoelectric phenomenon (electrical signal generation), which can be detected when dry
bone is strained, may be the signal detected by the cells that bring about bone remodelling.
Piezoelectricity is a phenomenon observed in many crystalline materials in which a deformation of the crystal
structure produces a flow of electric current within the crystalline material, explained by the migration of
electrons. When a force is applied to a crystalline structure and maintained, a flow of current is produced
that quickly dies away. When the force is released, however, an opposite flow of electric current is observed
as the crystal returns to its original shape. Both bone and collagen are crystalline structures that exhibit
piezoelectric properties.
It is thought that the electrical signals, generated when bone is stressed, are important in the general
maintenance of the skeleton as without such signals bone mineral is lost and general skeletal atrophy
ensues. Therefore, signals generated by the bending of alveolar bone during normal chewing and
mastication are possibly important for its maintenance.
The forces generated during orthodontic tooth movement are, however, different. These forces are often
constant and sustained over prolonged periods of time so that only when the force is applied and removed
are brief piezoelectric signals generated. As long as the force is sustained nothing happens electrically. If
these electric signals were of importance in the biological control mechanism of bone remodelling associated
with orthodontic tooth movement, a vibrating application of pressure would be more appropriate in order to
maximise the piezoelectric signals generated. A study conducted by Shapiro (1979) failed to show that the
application of an oscillating force resulted in improved tooth movement.
It appears that stress-generated electric signals, important as they may be for normal skeletal function,
probably have little if anything to do with the biologic control response to orthodontic tooth movement.
McDonald (1993) noted that there are many other sources of electrical potential differences, such as nerves
and striated muscles, and these potentials are of such a magnitude that they would overwhelm any possible
electrical signals generated when bone is strained.
Streaming potentials
Streaming potentials are the electrical currents generated in the fluid surrounding bone during deformation
of it’s crystal structure. Streaming potentials are very similar to piezoelectric signals except they are of
greater magnitude.
Bioelectric potential
The bioelectric potential is an electrical signal that can be observed in metabolically active bone, seen in
areas of active growth or bone remodelling, which is not being stressed. The extent of the electrical signals
generated is proportional to the degree of metabolic bone activity.
Giovanelli (1996) noted that experiments conducted on both animals and humans demonstrated that it is
possible to modify cellular activity when low voltage direct current is applied to the alveolar bone. This
modifies the bioelectric potential such that a tooth moves faster than its control in response to an identical
spring. Cellular activity can, therefore, be modified by introducing exogenous electric signals.
Electromagnetic Fields
Stark and Sinclair (1987), in an animal based study, showed that pulsed electromagnetic fields can increase
the rate and amount of mechanically induced tooth movement. Darendeliler et al. (1995) noted that both
static and pulsed magnetic fields increase the rate of bone formation and accelerate the rate of tooth
movement in animal experiments. It is unlikely though, that the weak magnetic fields produced by small
magnets, sometimes used in moving teeth, could indirectly change the basic biology of response to an
orthodontic force.
Summary
Stress generated piezoelectric signals and streaming potentials appear to be of minor importance in
controlling tooth movement, but bioelectric and electromagnetic forces may be controlling factors on bone
remodelling and, therefore, indirectly affect tooth movement.
The Pressure-Tension Theory
The pressure-tension theory relates tooth movement to stress induced cellular changes, rather than electric
signals, as the stimulus for cellular differentiation and ultimately tooth movement. Displacement of a tooth
within the periodontal ligament space in response to a sustained orthodontic force is suggested to result in
an alteration in blood flow in areas of PDL compression and tension. A decrease in oxygen concentration
may be noted in the compressed areas, as well as the presence of chemical messengers such as
prostaglandins, cyclic AMP, and inositol phosphates. These chemical changes then act either directly, or
stimulate the release of other biologically active agents, to induce cellular differentiation and activation and
ultimately bring about tooth movement.
How do the cells, however, distinguish between tension and compression? It is thought that cytokines such
as interleukins, interferons, and tumour necrosis factors, which are produced locally by mechanically
activated cells, are largely responsible.
Chemical Messengers
Prostaglandins
Prostaglandins are produced due to the action of cyclooxygenase enzyme on arachidonic acid. Arachidonic
acid itself is normally bound to phospholipids within the cell membrane but is released by the action of
phospholipase enzymes when cells are mechanically deformed in response to orthodontic forces (Rodan et
al. 1989). The prostaglandins then bind to receptors on the osteoblast surface resulting in their activation.
The involvement of prostaglandins in mechanically induced bone remodelling has been investigated in a
number of animal and tissue culture models (Yamasaki et al. 1980, Sandy 1992). Animal studies, where
prostaglandins have been injected into bone, resulted in increased bone turnover adjacent to teeth being
moved. Conversely, studies that blocked prostaglandin synthesis, by using non steroidal anti-inflammatory
drugs, reduced the amount of osteoclast activity.
Second Messengers
Second messengers are chemical messengers that are responsible for internal cell signalling systems. They
transmit signals from the cell membrane to the inside of a cell and ultimately to the nucleus. Adenosine 3’ 5’
cyclic monophosphate (Cyclic AMP) and inositol phosphates both fall into this category. These second
messengers evoke a nuclear response which will either result in the production of factors responsible for
osteoclast recruitment and activation, or bone forming growth factors (Sandy and Farndale 1991, Sandy et
al. 1993).
References
Bassett CAL. Electrical effects in bone. Scientific Am 1965; 213: 18-25.
Darendeliler MA, Sinclair PM, Kusy RP. Effects of static and pulsed electromagnetic fields on orthodontic
tooth movement. Am J Orthod Dentofacial Orthop 1995; 107: 578-588.
Davidovitch et al. Electrical currents, bone remodelling and orthodontic tooth movement. Am J Orthod 1980;
77: 33-47.
Davidovitch et al. Neurotransmitters, cytokines and the control of alveolar bone remodelling in orthodontics.
Dent Clin North Am 1988; 32: 411-435.
Eriksson C. Streaming potentials and other water dependent effects in mineralised tissues.
Ann N Y Acad Sci 1974; 238: 321-338.
Giovanelli S, Festa F. Effect of electrical stimulation on tooth movement in clinical application. In

Davidovitch, Z., Norton, L.A. (editors): Biological mechanisms of tooth movement and craniofacial adaption,
1996; Boston. Harvard Society for Advancement of Orthodontics.
McDonald F. Electrical effects at the bone surface. Eur J Orthod 1993; 15: 175-183.
Proffit WR, Fields HW. Contemporary Orthodontics. 3rd edition. 2000; Mosby International Limited.
Rodan GA, Yeh CK, Thompson DT. Prostaglandins and bone. In Norton, L.A. and Burstone, C.J. (editors):
The biology of orthodontic tooth movement. 1989; Boca Raton, CRC Press.
Sandy JR. Tooth eruption and orthodontic movement. Br Dent J 1992; 172: 141-149.
Sandy JR, Farndale RW. Second messengers: Regulators of mechanically-induced tissue modelling. Eur J
Orthod 1991; 13: 271-278.
Sandy JR, Farndale RW, Meikle MC. Recent advances in understanding mechanically induced bone
remodelling and their relevance to orthodontic theory and practice. Am J Orthod Dentofacial Orthop 1993;
103: 212-222.
Shapiro E. Orthodontic movement using pulsating force induced piezoelectricity. Am J Orthod 1979; 73: 59-
66.
Stark TM, Sinclair PM. The effect of pulsed electromagnetic fields on orthodontic tooth movement. Am J
Orthod 1987; 91: 91-104.
Yamasaki K, Miura F, Suda T. Prostaglandin as a mediator of bone resorption induced by experimental tooth
movement in rats. J Dent Res 1980; 59: 1635-1642.
Section 4 – Response to a Sustained Force

Effects of Force Magnitude
There is a difference in the physiological response of the periodontal ligament and the surrounding tissues,
depending on the magnitude of the orthodontic force applied to a tooth. The heavier the sustained pressure,
the greater the reduction in blood flow through the compressed areas of the periodontal ligament, up to the
point where the vessels are totally compressed and blood flow is obstructed.
What happens when a continuous optimal force is applied?
An optimal force is considered one that produces stress within the periodontal ligament that does not exceed
the capillary blood pressure (~ 30mmHg). When such a force is applied, blood flow is decreased but
continues through the partially compressed periodontal ligament, while the periodontal ligament cells and
fibres are mechanically distorted. This alteration in blood flow brings about changes in the chemical
environment within the ligament, (Section 3), and alters the pattern of cellular activity. Within a few days
osteoclasts migrate in from the surrounding blood vessels in the compression areas and remove bone along
the socket wall. This process is known as direct or frontal resorption. On the tension side the periodontal
fibres are stretched, and proliferation of fibroblasts and osteoblasts is followed by an increase in the length
of the periodontal ligament fibres which are subsequently remodelled. Osteoid is deposited on the tension
side by osteoblasts and is then calcified to form woven bone which in turn is remodelled into mature bone.
Osteoblasts also help to remodel resorbed bone in the compression areas.
As these changes are mediated by cells derived from the blood supply, the latter is an important prerequisite
for tooth movement. Therefore, the periodontal ligament vascularity should be maintained so that the
cellular response and tooth movement are maximised.
What happens when a continuous excessive force is applied?
An excessive, continuous force may create sufficient stress within the ligament space to occlude the blood
supply to an area. This results in a sterile avascular necrosis, known as hyalinisation (because of its glassy or
hyaline structureless microscopic appearance). Remodelling of bone bordering the necrotic area of the
periodontal ligament must then be accomplished by cells derived from adjacent undamaged areas. After
several days, osteoclasts begin to appear in the bone marrow spaces of the adjacent alveolar bone
underlying the hyalinized area. Indirect resorption then takes place deep to the hyalinized area from
cancellous bone outwards toward the lamina dura. This is known as undermining resorption, as the
attack is from the underside of the lamina dura. Hyalinization of the periodontal ligament delays tooth
movement due to the increased time required to allow for the differentiation and activation of cells within
the marrow spaces and the thickness of bone that requires removal.
Cellular events in the tension areas are no different to those described in cases where an optimal light force
is used.
The use of optimal forces in orthodontic tooth movement is advocated for a number of reasons including:
• Reduced tooth mobility
• Reduced patient discomfort during tooth movement
• More efficient tooth movement
o No delays in the differentiation and activation of bone cells
• Reduced risk of root resorption
• Less demanding on anchorage
It must be remembered that irregularities in the periodontal ligament space, mean that a theoretically
optimal force may result in small areas of excessive compression and hyalinisation. In clinical practice,
reactivation of an appliance should be at intervals of more than three weeks apart to allow these areas to
repair fully and reduce the risk of root resorption.
Burstone (1962) divided orthodontic tooth movement into three phases:

• The initial phase characterised by rapid tooth movement that lasts 2-3 days. The rapidity of onset
suggests that this response is a product of tooth displacement within the periodontal ligament space
and possible alveolar bone bending.
• The lag phase, where the rate of tooth movement is slow and may be due to areas of periodontal
ligament hyalinisation in response to excessive forces being used or irregularity of the socket wall.
• The post lag phase where the rate of tooth movement again increases in response to
indirect/undermining resorption reaching the periodontal ligament.
Additional information on this topic can be found in:
Proffit WR, Fields HW. Chapter 9. Contemporary Orthodontics, 3rd edition. 2000;
Mosby International Limited.
Ireland A, McDonald F. The Orthodontic Patient: Treatment and Biomechanics.

2003; Oxford University Press.
Mitchell L. Chapter 15. An Introduction to Orthodontics. 2001; Oxford University

Press, 2nd edition.
Orthodontic Forces
Orthodontic tooth movement depends on a variety of factors including:

• Force magnitude
• Force distribution and type of tooth movement
• Root surface area
• Duration of the applied force and force decay
• Other factors
Optimal Force Magnitude
The primary consideration during the prescription of orthodontic force systems is the delivery of a force to
the clinical crown of the tooth that will deliver an optimal periodontal ligament stress or force per unit area.
However, it is very difficult to measure stress within the periodontal ligament of loaded teeth directly, as the
root surface area is difficult to quantify, the stress distribution along the root surface is almost always non-
uniform, and the type of tooth displacement varies greatly.
Based on their analysis of experimental observations of tooth movement, Quinn and Yoshikawa (1985)
reviewed 4 hypotheses describing the relationship between the rate of tooth movement and the magnitude
of force applied. Their four hypotheses assumed that the applied force should exceed a certain threshold
level before tooth movement occurs i.e. there is a minimal force threshold below which tooth movement will
not occur.
Theory (A) - once the magnitude of force exceeds the minimum force threshold required for tooth
movement a fixed rate of tooth movement is observed and increasing the magnitude of force further does
not increase the rate of tooth movement. This theory is supported by evidence from studies by Owman-Moll
et al. (1996a) and Iwasaki et al. (2000).
Theory (B) - once the magnitude of force exceeds the minimum force threshold required for tooth
movement the rate of tooth movement increases linearly with force magnitude i.e. increasing amounts of
force would move teeth faster. Studies supporting this theory include those by Andreasen and Johnson
(1967) and Owman-Moll et al. (1996b).
Theory (C) - once the force magnitude exceeds the minimum force threshold the rate of tooth movement
increases with force magnitude up to a point, after which the rate plateaus and then decreases or ceases as
the force levels continue to increase. There is therefore an optimal force for maximal tooth movement. Lee
(1995) has published evidence supporting this theory.
Theory (D) - the rate of tooth movement increases linearly with force up to a point where the response is
constant despite further increases in force magnitude. This theory is support by evidence put forward by
Boester and Johnston (1974) and King et al. (1991).
It remains unclear which, if any, of the 4 theories correctly describes the relationship between the rate of
tooth movement and magnitude of applied force. Quinn and Yoshikawa (1985) concluded that the fourth
theory was the one most supported by experimental and clinical data. It must also be remembered that
rates of tooth movement can vary greatly both within and between individuals.
Figure 4
More recently, Ren et al. (2003) systematically reviewed the literature concerning the optimal force or range
of forces for orthodontic tooth movement. They found that there was neither universal consensus nor sound
scientific evidence regarding specific numeric values of optimal force magnitude. The main problems
encountered with the various studies looked at, were related to the inability to estimate stresses or stress
distribution in the periodontal ligament, the lack of control of bodily or tipping movement, the variation in
follow up periods, and large individual variations. They concluded that better controlled clinical studies and
animal experiments would be required to provide more insight into the relationship between the applied
force and the rate of tooth movement.
Following their literature review in 2003, Ren et al. (2004) tried to develop a mathematical model to describe
the relationship between the magnitude of an applied force and the rate of orthodontic tooth movement,
from experimental studies in beagle dogs. They found that the maximum rates of tooth movement in
humans (0.29mm/week) and dogs (0.27mm/week) were not significantly different. They proposed a force
velocity curve as outlined below.
The relationship between the magnitude of an

applied force and the rate of orthodontic tooth
movement as described by Ren et al. (2004)
Figure 5
The rate of tooth movement increases linearly with force magnitude in the very low force range i.e.
increasing amounts of force would move teeth faster. Then a small plateau is reached representing the
optimum force magnitude to obtain the maximum rate of tooth movement. This is followed by a decrease in
the rate of tooth movement as the force magnitude continues to increase. They could not define a force
threshold that would switch on tooth movement but noted that tooth movement was possible with just
minute forces nor could they estimate the maximum force at which tooth movement would cease
completely.
Regardless of the magnitude of force used to move teeth, there will always be a tendency for more rapid
tooth movement in children for the following reasons (Mitchell 2001):
• Physiological tooth movement is greatest when the teeth are erupting
• The periodontal ligament is more cellular, and therefore there are more cells available for resorption
and remodelling
• The alveolar bone has a greater proportion of osteoclasts
• The cellular response in reaction to an applied force is quicker
• The width of the periodontal ligament is increased in newly erupted teeth, and so a greater force
can be applied before constriction of the blood vessels occurs
• Growth can be utilised
Read the following two papers to find out more on the various theories regarding the
relationship between the rate of tooth movement and the magnitude of force applied.
Ren Y, Maltha JC, Kuijpers-Jagtman AM. Optimal force magnitude for orthodontic
tooth movement: A systematic literature review. Ang Orthod 2003; 73: 86-92.
Ren Y, Maltha JC, Van’t Hof MA, Kuijpers-Jagtman AM. Optimal force magnitude for
orthodontic tooth movement: A mathematic model. Am J Orthod Dentofacial Orthop
2004; 125: 71-77.
Effects of Force Distribution and Types of tooth movement
The periodontal ligament response is not only determined by the magnitude of force used during orthodontic
treatment, but also by the force distribution as determined by the direction of the applied force. The
direction of the applied force is important as it will affect the amount of force being applied to a particular
area of the root and periodontal ligament.
There are five basic types of tooth movement:

• Tipping
• Rotation
• Axial movement
o Intrusion
o Extrusion
• Bodily movement
• Torque
Tipping
This is perhaps the simplest type of tooth
movement. Any tipping movements of a tooth will
result in stress concentrations at the root apex on
the same side as the point of force application, and
the alveolar crest on the opposite side of the point
of force application. This creates an increased risk
of hyalinisation and undermining resorption in
these areas. Therefore, forces used to tip teeth
must be kept low (35-60g) as the pressure in the
two areas where it is concentrated is high in
relation to the force applied to the crown. In a
single rooted tooth the centre of rotation is most
frequently located in the middle third of the root.
The tipping tendency can be reduced slightly by
applying a point force as far cervically as possible.
Figure 6
Rotation
Pure rotational movement should result

in an even stress distribution within the
periodontal ligament. It can be
accomplished by applying two forces
that are equal in magnitude but opposite
in direction to opposing surfaces of the
crown of a tooth, the objective being to
rotate the tooth around its long axis.
However, rotational vectors invariably
result in some tipping and forces should
therefore be limited to 35-60g.
Figure 7
Extrusion and Intrusion
Extrusive movement of a tooth would ideally produce pure tensile forces and no areas of compression within
the periodontal ligament. However, extrusive forces applied to buccal attachments will result in tipping and
stress concentrations in areas of the periodontal ligament. Therefore, forces need to be light, 35-60g.
Intrusive forces concentrate stress at the root apex. As this is of very small surface area the forces used
need to be very light, 10-20g. In order to achieve true intrusion the forces need to be directed through the
centre of resistance of the tooth, along its long axis. This is difficult to achieve due to the point of force
application being buccal to the long axis and some tipping movements must also be expected, unless force
couples are introduced (Section 7).
Bodily movement/translation
Bodily tooth movement describes the complete translation of a tooth through bone where all parts of the
tooth (crown and root) are moving an equal distance in
the same direction. It results in the periodontal
ligament being loaded uniformly from alveolar crest to
root apex, requiring the application of a 100-150g force
to achieve and optimal PDL stress. A concurrent
couple, producing a moment to force ratio of at least
8:1 is also required at the bracket wire interface to
overcome the undesirable tipping effect of the
100/150g force applied to the crown of the tooth
(Section 6). True bodily translation is difficult to
achieve clinically and a series of tipping and uprighting
movements is most commonly achieved.
Figure 8
Torque
Torque describes the differential movement of

one part of a tooth, usually the root, whilst
physically restraining any movement of the
crown. It is achieved by applying a force
couple (Section 6) to the crown of the tooth,
only in this instance the moment to force ratio
must be greater than 8:1.
Figure 9
Root surface area
The force per unit area (stress) within the periodontal ligament decreases for a given applied force as the
root surface area increases. Therefore, for a given force application, the magnitude of force transmitted to
the surrounding cells in the case of a large
multirooted tooth is less than that for a small
single rooted tooth, in which the force is
concentrated over a smaller surface area.
The precise root surface area of any given
tooth or group of teeth cannot be accurately
determined in vivo without the use of three-
dimensional computerised tomography
scanning (3D-CT Scan) technology
(Nakagima et al 2005). This is clinically
impractical and inappropriate. Instead root
surface area of teeth in both upper and lower
arches can be estimated in mm2 using
average data (Jepsen 1963).
Figure 10
Effects of Force Duration and Force Decay
Animal experiments have shown that a sustained force of at least 4 hours duration is required to stimulate
the production of second messenger chemicals, cellular differentiation and tooth movement. Clinical
experience suggests that there is a threshold for force duration in humans of 4-8 hours, and that
increasingly effective tooth movement is produced if forces are maintained for longer durations (Proffit and
Fields 2000).
The delivery of a continuous, orthodontic force, of sustained optimal magnitude has long been a clinical
objective. However, no matter how little the teeth move in response to that force some decline in force
magnitude, known as force decay is noted.
The force delivered by a deflected wire is determined by:
Force = EdI E = Young’s Modulus of Elasticity

l3 d = deflection
I = second moment of inertia
l = length of wire
For a round cross section wire, I = πr4

4
For a rectangular wire, I= bd3 (where b & d are the wire dimensions)
12
For materials with linear load deflection curves (where Hooke’s law applies) the force delivered by the wire
will reduce as the tooth moves and wire deflection decreases. Similarly, the force decay observed with
elastomeric materials results in the delivery of sub-optimal forces within the appliance activation interval.
Orthodontic force duration can therefore, be classified by its rate of decay into three types:
• Continuous – where forces are maintained at some appreciable fraction of the original force
between appliance activation appointments
• Interrupted – where force levels decline to zero between activations
• Intermittent – where force levels decline rapidly to zero intermittently e.g. when a removable
appliance is removed or intermaxillary elastics are removed or break. The intermittent force can also
become interrupted between appliance activations.
The non-linear force deflection characteristics of the superelastic nickel titanium aligning archwires and
closing springs, theoretically offers the delivery of a fairly continuous force over an extended range.
Evidence from the literature would suggest that using continuous forces results in more rapid tooth
movement (Samuels et al. 1998, Dixon et al. 2002) although there may be an increased risk of root
resorption (Weiland 2003). The latter maybe related to the fact that without a period of rest during tooth
movement there is less chance of repair if root resorption has already taken place. Appliances that depend
upon patient compliance or activation e.g. removable appliances, headgear and intermaxillary elastics,
produce intermittent forces.
Other factors
Occlusal interferences
This includes interferences not only from an opposing tooth but

also an attachment such as an orthodontic bracket on an
opposing tooth.
Figure 11
Notice the wear on the distal aspect of the cusp tip of the upper canine from the opposing bracket. This type
of occlusal interference will slow tooth movement and may lead to loss of anchorage.
Bracket/wire interactions
Mechanical and biological factors affecting friction at the bracket/wire interface include:
• Brackets
o Material
o Bracket width
o Bracket/archwire angulation
• Archwires
o Material
o Surface roughness
o Archwire shape
o Torque
• Ligation
o Ligation material
o Force of ligation
• Biological
o Saliva
o Plaque/acquired pellicle (Downing et al 1994.)
Friction will be covered again in more detail in Module 24 – Fixed appliances.
Drug Effects on the response to Orthodontic Force
Two types of drugs are known to depress the response to orthodontic force. They are the bisphosphonates
used in the treatment of osteoporosis, and prostaglandin inhibitors e.g. corticosteroids and nonsteroidal anti-
inflammatory drugs (NSAID).
Osteoporosis is a condition mainly confined to older patients and bisphosphonates used in its treatment act
as specific inhibitors of osteoclast mediated bone resorption. Therefore the bone remodelling necessary for
tooth movement is slower in patients on this medication. Oestrogen is an alternative drug treatment option
for females and has little or no impact on orthodontic tooth movement.
Prostaglandins, formed from arachidonic acid play an important role in the signalling system that leads to
tooth movement (Section 3). Corticosteroids reduce prostaglandin synthesis by inhibiting the formation of
arachidonic acid, while NSAIDs inhibit the conversion of arachidonic acid to prostaglandins. NSAIDs used at
dose levels sufficient to relieve pain associated with orthodontic treatment have little or no inhibiting effect
on actual tooth movement. Other classes of drugs that affect prostaglandin levels include:
• Tricyclic antidepressants
• Anti-arrhythmic agents
• Anti-malarial drugs
• Phenytoin
• Some tetracyclines
Downing A, McCabe J, Gordon P. A study of frictional forces between orthodontic brackets

and archwires. Br J Orthod 1994; 21: 349-357.
Proffit WR, Fields HW. Chapter 9. Contemporary Orthodontics. 2000; 3rd edition. Mosby
International Limited.
Sims AP, Waters NE, Birnie DJ, Pethybridge RJ. A comparison of the forces required to
produce tooth movement in vitro using two self-ligating brackets and a pre-adjusted
bracket employing two types of ligation. Eur J Orthod 1993; 15: 377-385.
References
Andreasen G, Johnson P. Experimental findings on tooth movement under two conditions of applied force.
Angle Orthod 1967; 37: 9-12.
Boester CH, Johnston LE. A clinical investigation of the concepts of differential and optimal force in canine
retraction. Angle Orthod 1974; 44: 113-119.
Burstone CJ. Biomechanics of tooth movement. In: Kraus, B.S., Reidel, R.A. (eds): Vistas in Orthodontics.
1962; Philadelphia, PA: Lea & Febiger, pp 197-213.
Dixon V, Read MJF, O’Brien KD, Worthington, HV, Mandell NA. A randomised controlled trial to compare
three methods of orthodontic space closure. J Orthod 2002; 29: 31-36.
Iwasaki L, Haack JE, Nickel JC, Morton J. Human tooth movement in response to continuous stress of low
magnitude. Am J Orthod Dentofacial Orthop 2000; 117: 175-183.
Jepsen A. Root surface measurement and a method for x-ray determination of root surface area. Acta
Odontol Scand 1963; 21, 35-46.
King GJ et al. Measuring dental drift and orthodontic tooth movement in response to various initial forces in
adult rats. Am J Orthod Dentofacial Orthop 1991; 99: 456-465.
Lee BW. The force requirements for tooth movement part I: Tipping and bodily movement. Aust Orthod J
1995; 13: 238-248.
Lindauer SJ, Britto AD. Biological response to biomechanical signals: Orthodontic mechanics to control tooth
movement. Semin Orthod 2000; 6: 145-154.
Nakagima A. Terajima M, Mori N. Three-dimensional computer generated head model reconstructed from
cephalograms, facial photographs, and dental cast models. Am J Orthod Dentofacial Orthop 2005; 127: 282-
292.
Owman-Moll P, Kurol J, Lundgren D. The effects of a four fold increased orthodontic force magnitude on
tooth movement and root resorption. An inter-individual study in adolescents. Eur J Orthod 1996a; 18: 287-
294.
Owman-Moll P, Kurol J, Lundgren D. Effects of a doubled orthodontic force magnitude on tooth movement
and root resorption. An inter-individual study in adolescents. Eur J Orthod 1996b; 18: 141-150.
Quinn RS, Yoshikawa DK. A reassessment of force magnitude in orthodontics. Am J Orthod 1985; 88: 252-
260.
Samuels RH, Rudge SJ, Mair LH. A clinical study of space closure with nickel titanium closed coil springs and
an elastic module. Am J Orthod Dentofacial Orthop 1998; 114: 73-79.
Weiland F. Constant verses dissipating forces in orthodontics: The effect on initial tooth movement and root
resorption. Eur J Orthod 2003; 25: 335-342.
Section 5 – Iatrogenic effects of orthodontic tooth movement
There are a number of adverse effects of tooth movement and these include:
• Tooth mobility and pain
• Alveolar bone loss
• Root resorption
• Gingival recession
• Effects on the pulp
These will be covered in more detail in Module 18 – Iatrogenic effects of orthodontic treatment.
Section 6 – Mechanics of Tooth Movement

It is extremely important that clinicians understand the mechanical principles and concepts that are universal
to all orthodontic appliances so that their clinical relevance can be fully understood and the most appropriate
appliance design used to achieve the desired treatment effects. It is important the orthodontist understands
the meanings of terms such as:
• Scalars
• Vectors
• Forces
• Resultants and components
• Centre of resistance
• Moments
• Centre of rotation
• Couples
• Moment-to-force ratios
Without an understanding of the mechanics of force systems acting on a tooth or group of teeth and their
possible adverse effects, their impact on the cells and tissues will be difficult to comprehend.
Essentially there are only two possible ways to apply a force system to a tooth (Smith and Burstone 1984).
The first is by using a single force which is normally applied to the crown of the tooth. This force will not act
through the centre of resistance of the tooth and will produce a tipping effect and displacement of the
centre of resistance. The second approach is through the application of a couple, a pair of non-colinear,
parallel forces, equal in magnitude and opposite in direction. All appliance systems must therefore bring
about tooth movement through one of these mechanisms, either alone or in combination. These force
systems will now be discussed in detail.
Scalars, Vectors and Forces
Scalars are physical properties, including weight and temperature that do not have a direction and are
completely described by their magnitude. Vectors, on the other hand, have both magnitude and direction.
Forces may be represented by vectors, and by convention are represented as arrows. A force vector is
characterised by four features:
• Magnitude
• Point of application, the point of contact between the body being moved and the applied force
• Direction/line of action, the line along which the force is active irrespective of orientation
• Sign/Sense, the sense of a vector shows the orientation to which the vector acts and is connoted by
an arrowhead
Figure 12
Forces are normally expressed in units of Newtons (N) but in orthodontics they are more commonly
expressed in grams (g). The conversion factor for grams to Newtons is:
1g = 0.00981 N
1 N = 101.937 grams
Almost every force applied in clinical conditions will have effects in three planes of space making the
mechanical principles of tooth movement extremely complex.
Resultants and Components
Often there is greater than one force acting on a tooth or group of teeth with their movement determined by
the net effect of all the forces. The resultant force is the name given to the single force representative of
the individual component forces acting on the tooth/teeth. The resultant force is the single force that can
substitute the individual forces but yet produce the same net effect. It is expressed as the vector sum of all
the components and is determined by combining the individual component forces in a process known as
force composition which is undertaken as follows:
Two component forces with a common point of application (Smith and Burstone 1984)
• Consider the two component forces to be the sides of a parallelogram (black)

• Complete the parallelogram using the dashed lines (blue)
• The resultant force is the diagonal of the parallelogram (red)
To determine the resultant of more than two component forces that have a common point of force
application, a series of parallelograms is constructed such that each time the resultant of any two
component forces is determined, it is used to construct the next parallelogram. The sequence in which the
forces are combined does not make a difference.
Figure 13
Two component forces with different points of application (Smith and Burstone 1984)
Determining the resultant force from individual component forces that have different points of application
uses the law of transmissibility of force. It states that when combining forces a point of application may be
selected anywhere along the line of action of the force. The resultant force is determined as follows:
• Two forces with different points of application are applied to an upper canine tooth (black)
• First extend the lines of action of the individual component forces until they intersect (black
dashed lines)
• These two lines are then considered to be two sides of a parallelogram.
• Complete the parallelogram using the dashed lines (blue)
• The resultant force is the diagonal of the parallelogram (red)
• The resultant is then moved along its line of action so that the point of application is on the tooth.
Figure 14
Force resolution
Force resolution is the reverse of force composition,

so rather than combining two or more forces to
produce a resultant force, a single force is broken up
into its individual component forces at right angles to
each other, by reversing the parallelogram
procedure. With this technique a single force can be
considered as the diagonal of the parallelogram
(red) and the individual component forces making
up the single force can then be drawn along the
orthogonal axes (blue). The objective being to
determine how much force is being delivered
perpendicular and parallel to the occlusal plane,
Frankfort plane, or the long axis of the tooth.
Figure 15
Centre of Resistance
The centre of resistance is the point in a body at which resistance to movement can be considered
concentrated, for mathematical analysis. For an object in free space, the centre of resistance coincides with
the centre of mass. However, for a partially restrained object, as is the case of a tooth that is partially
embedded in bone, the centre of resistance is determined by the mass, shape and form of the tooth, as well
as by the characteristics of the supporting structures, the bone and the periodontal ligament (Pryputniewicz
and Burstone 1979). The greater the loss in periodontal support, as seen in patients with periodontal
disease, the more apically positioned the centre of resistance becomes (Melsen 1988).
The centre of resistance of a tooth has also been defined as the point in the tooth on which the application
of a single force will produce movement of all points of the tooth, the same amount in the same direction,
along the line of force i.e. translation or bodily movement.
The location of the centre of resistance of a single rooted tooth is at the approximate midpoint of the
embedded portion of the root on its long axis i.e. about half way between the root apex and the crest of the
alveolar bone (Burstone and Pryputniewicz 1980). For a multi-rooted tooth, the centre of resistance is
estimated to be at the furcation area or 1-2 mm apical to the furcation, assuming that the periodontal
support is intact (Burstone et al. 1981).
Moment of a Force
When a force is applied to a free body but does not act through the centre of resistance of that body, the
force not only causes the body to translate (in the direction of the force) but it will also rotate the body
around the centre of resistance. Rotation is the movement of a body whereby no two points on the body
move the same amount in the same direction. This tendency to rotate is measured in moments and is called
the moment of a force. The magnitude of the moment is equal to the magnitude of the force multiplied by
the perpendicular distance from the point of force application to the centre of resistance. It is normally
measured in units of gram/millimetres (g/mm) or Newtons/millimetres (N/mm). Increasing the magnitude of
the force or the perpendicular distance from the point of force application to the centre of resistance will
increase the moment/tendency for rotation. On the other hand the shorter the moment arm, the smaller the
moment of a force and therefore the less tipping/rotation movement and greater translation. Forces are
indicated by straight arrows but moments are classically symbolised by curved arrows. The direction of the
moment of a force can be determined by continuing the line of action of the force around the centre of
resistance (Smith and Burstone 1984).
Figure 16
As with forces there is only one single net moment acting about a tooth, which can be calculated by
summing the individual moments.
Centre of Rotation
The centre of rotation may be defined as a point about which a body appears to have rotated, as
determined from its initial and final positions. A force with a single point contact, not at the centre of
resistance, will produce rotation of the body around the centre of resistance. The centre of rotation can
however be positioned at variable points on or off the body and in orthodontics this is controlled by varying
the moment to force ratio at the bracket/archwire interface (discussed later).
When the centre of rotation is positioned at the incisal edge the root moves (A), when it is at the root apex
the crown tips (B). When the centre of rotation is positioned at any other point along the crown/root, both
the crown and root will tip in opposite directions (C). The more nearly translational the movement the
farther apically the centre of rotation would be located where with perfect translation (bodily tooth
movement), the centre of rotation can be defined as being an infinite distance away (D).
Figure 17
Types of movement Position of centre of rotation

(A) Root movement Incisal (occlusal) edge
(B) Controlled tipping Closer to apex
(C) Uncontrolled tipping At or slightly apical to the centre
of resistance
(D) Translation Infinity
Intrusion/Extrusion Perpendicular to the long axis of
the tooth
Since all the forces on a tooth can be summed to one single net force, and all the moments to one single net
moment, it follows that a single force plus a single moment can produce any type of tooth movement. If the
net effect on the tooth at the centre of resistance is a force only, the centre of rotation will be at infinity and
the tooth will be moved bodily (translation). If there is a net moment only, the centre of rotation will be at
the centre of resistance and the tooth will rotate. However, the only means of producing a moment with no
net force is with a couple and this will now be discussed.
Rotation and Couples
A couple describes a pair of non-colinear (not acting along the same line), parallel forces, equal in
magnitude and opposite in direction applied to a body resulting in its rotation. The moment of a couple (its
tendency for rotation) is a vectorial quantity that produces a tendency to pure rotation (no translation)
around the centre of resistance, since the translatory effect of the forces, which are equal and opposite,
cancel each other out i.e. rotation is the only tooth movement possible with a couple as there is an absence
of a net force. The centre of rotation is coincident with the centre of resistance and hence no net movement
of the centre of resistance occurs. The magnitude of the couple is equal to the product of the magnitude of
one of the two forces, times the perpendicular distance between the two forces and is measured in units of
Newtons/mm or grams/mm.
Figure 18
A couple can be described by applying equal and

opposite forces on either side of a premolar tooth,
using elastic chain from buccal and palatal
attachments, to rotate the tooth around its centre
of resistance.
Application of a couple (in the absence of a net force) anywhere on a rigid body will create the same
rotational effect, as the net moment produced by the two individual force components making up the
couple will always be the same. Put another way the centre of rotation resulting from the moment of the
couple is always coincident with the centre of resistance of the body irrespective of its point of application.
The irrelevance of position is why the moment of a couple is said to be a “free vector”.
Figure 19: Net moment of a couple “Free Vector” (From Smith and Burstone 1984)
Now can you work out, how engaging an archwire in an edgewise bracket
slot can achieve:
• A first-order couple?
• A second-order couple?
• A third-order couple?
Not clear here if first-order refers to type of couple or type of tooth
movement - so ‘a couple to produce first order tooth movement etc
Suggested answer in Appendix at end of module.
Bishara SE. Chapter 15. Textbook of Orthodontics. 2001; WB Saunders Company.
Hocevar RA. Understanding, planning, and managing tooth movement: orthodontic

force system theory. Am J Orthod 1981; 80: 457-477.
Mulligan TF. Common sense mechanics. 2. Forces and moments. J Clin Orthod
1979; 13: 676-683.
Proffit WR, Fields HW. Chapter 10. Contemporary Orthodontics. 3rd edition. 2000;
Mosby International Limited.
Forces, Moments and Couples in Tooth Movement
For the most part, single forces are applied to the crowns of teeth and, therefore, act at a distance from the
centre of resistance, producing a large moment and tooth tipping. Tooth tipping can be overcome by
applying a moment, equal in magnitude and opposite in direction to the original moment, through the use of
auxiliary springs or the interaction of a rectangular archwire in a rectangular bracket slot. Here the
countervailing moment must be generated across the two points of contact of the rectangular wire with the
bracket slot. The moment arms of the couple are, therefore, very small demanding large forces to achieve
the moment required and high modulus materials.
Bodily tooth movement requires both a force to move the tooth in the desired direction, and a couple to
produce the necessary counterbalancing moment negating the rotational effect of the applied force. The
heavier the force, the larger the counterbalancing moment must be to prevent tipping and vice-versa. The
couple is the unique force delivery system characteristic of almost all current fixed appliance systems on the
market today.
Moment-to-force (M/F) Ratios
Following on from the descriptions and definitions discussed already it can be seen that the type of
movement exhibited by a tooth is determined by the ratio between:
• The magnitude of the moment from the applied couple, and
• The force applied to the tooth (Burstone and Pryputniewicz 1980)
The ratio of applied force, to the anti-rotational/counterbalancing moment at the bracket of a tooth, is often
referred to as the moment to force ratio. The counterbalancing moment is usually the moment of a couple,
created by the interaction between the archwire and the bracket slot in a fixed appliance system. In terms of
direction, the moment of the couple is almost always opposite to that of the moment of the force relative to
the centre of resistance.
The moment of the force applied to the tooth is the force magnitude applied at the bracket times the
perpendicular distance from line of force to the centre of resistance. For most teeth this is 8-10 mm. The
moment of the force will therefore be 8 to 10 times the force. A force of 100gm applied to a tooth will,
therefore, require an anti-rotational/counterbalancing moment of 800-1000gm/mm to obtain bodily
movement/translation of that tooth.
Moment-to-force (M/F) Ratios required for various types of tooth movement

(Smith and Burstone 1984, Lindauer 2001)
M/F = 0 – when only a force is applied at the bracket of a tooth (no counterbalancing moment) tooth
movement will be uncontrolled tipping with the centre of rotation at or just apical to the centre of resistance.
M/F < 8/1 – by increasing the moment to force ratio the centre of rotation moves progressively closer to
the root apex, increasing the counterbalancing moment, and reducing the tendency of the tooth crown to tip
in the direction of the force, but not negate it completely. The resulting tooth movement is controlled
tipping.
M/F 8/1 to 10/1 – with an average distance of 10mm from the bracket to the centre of resistance, the
centre of rotation will approach infinity as the M/F ratio reaches 10:1, resulting in bodily
movement/translation (equal movement of crown and root).
M/F > 10/1 – the moment of the couple is now greater than the moment from the applied force which will
put the centre of rotation nearer the incisal edge, resulting in the root apex moving further than the crown
in the direction of the applied force (root torque).
M/F = 12/1 or 13/1 – the centre of rotation will be at the incisal edge resulting in mainly root movement.
M/F > 20/1 – the centre of rotation moves just incisal to the centre of resistance approaching pure
rotation.
Summary: By varying the ratio of moment to force applied to a tooth, the type of tooth movement
produced can be regulated by the orthodontist.
Note: Moment to force ratios will require adjustment where the normal 8-10mm distance from the point of
force application to the centre of resistance varies due to changes in:
1) Root length
2) Amount of alveolar bone support
3) Point of force application
To complicate matters further the force and its associated moment and the moment of a couple are subject
to load deflection rates such that as the desired tooth movement is being achieved the deflection of the wire
reduces, which in turn will diminish the magnitude of the force being applied. As the decay rates of the force
and its moment and the moment of the couple differ, the ratio between them constantly changes. This
means that the centre of rotation is constantly changing and instead, bodily translation is likely to occur by a
series of tipping and uprighting movements (Isaacson et al. 1993, Burstone 1982).
Lindauer SJ, Britto AD: Biological Response to Biomechanical Signals: Orthodontic

Mechanics to Control Tooth Movement. Semin Orthod 2000, 6: 145-154.
Bracket dimensions and Moments
It is the interaction between the bracket slot and archwire that generates the moments necessary to control
mesiodistal root movement, the magnitude of the moments varying depending on the bracket dimensions.
As can be seen from the diagram below, the moment of the couple produced at (A) is greater than that
produced at (B) due to the greater perpendicular distance between the two forces at (A). If the same
magnitude moment was required at (B) the force would have to be proportionally increased to compensate
for the reduced distance between the applied forces.
Siamese brackets with good bracket width offer greater mesiodistal control of root position versus single
wing brackets that often require auxiliary springs in a vertical slot to deliver second order prescription.
Figure 20
References
Burstone CJ. The segmented arch approach to space closure. Am J Orthod 1982; 82: 361-378.
Burstone CJ, Pryputniewicz RJ. Holographic determination of centres of rotation produced by orthodontic
forces. Am J Orthod 1980; 77: 396-409.
Burstone CJ, Pryputniewicz RJ, Weeks R. Centres of resistance of the human mandibular molars (abstract).
J Dent Res 1981; 60: 515.
Christiansen RL, Burstone CJ. Centres of rotation within the periodontal space. Am J Orthod 1969; 55: 351-
369.
Lindauer SJ. The basics of orthodontic mechanics. Semin Orthod 2001; 7: 2-15.
Melsen B. Adult orthodontics: Factors differentiating the selection of biomechanics in growing and adult
individuals. Int J Adult Orthod Orthognath Surg 1988; 3: 167-177.
Pryputniewicz RJ, Burstone CJ. The effect of time and force magnitude on orthodontic tooth movement.
J Dent Res 1979; 58: 1754-1764.
Smith RJ, Burstone CJ. Mechanics of tooth movement. Am J Orthod 1984; 85: 294-307.
Yoshikawa K. Biomechanical principles of tooth movement. Dent Clin North Am 1981; 25: 19-26.
Section 7 – Determinate and indeterminate force systems

The physical laws of statics are governed by Newton’s first law, which states that when a body is subject to
a set of forces and moments but remains in the same position, then the forces and moments must be in
balance or equilibrium i.e. their sum must be equal to zero. The laws of static equilibrium can also be applied
to orthodontics, as when orthodontic appliances are activated and inserted they do not initially move. It can
be assumed, therefore, that the sum of the forces and the sum of the moments (the net force system
produced) must equal to zero, and the force system is in static equilibrium.
Force systems can be termed as statically determinate and statically indeterminate. A statically
determinate force system is one where it is possible to calculate the applied forces and moments, and
therefore, predict to a certain extent the resulting tooth movement. This is done by considering the force
system at one specific time point and by assuming that it is in static equilibrium at that time. For example
where a wire connects two segments of teeth, where each segment is tied together in a manner such that
they can be assumed to be rigid bodies and therefore their centres of resistance estimated, then specific
forces and moments can be calculated allowing a description of the force system at work to be estimated,
and an approximate prediction of the type of tooth movement that would occur. A determinate force system
normally describes a situation where a couple and force are created at one end of an attachment and only a
simple force (no couple) is created at the other.
A statically indeterminate force system on the other hand is where the moments and forces are too
complex for precise measurement and evaluation. Such a situation exists where continuous wire mechanics
is used. Here the forces and moments acting on each tooth will interact with the force systems on the
adjacent teeth making it extremely difficult to evaluate the resulting net forces and moments.
One couple statically determinate and two couple statically indeterminate force systems will now be
described.
One-couple statically determinate systems (Lindauer and Isaacson 1995)
A one couple statically determinate force system is where an appliance is inserted into a bracket or tube at
one end, where both a couple and force are created, and is tied to a single point of contact at the other,
where a simple force is applied without a couple. There is normally a long inter-bracket span between both
points of attachment. Examples of such appliances include:
• Extrusion springs
• Midline springs
• Anterior intrusion arches
• Anterior extrusion arches
Extrusion springs
Extrusion springs are used to bring severely displaced or impacted teeth into the line of the arch, such as
maxillary canines. The diagram below demonstrates that as the extrusion spring is activated a couple is
generated in the molar tube along with an intrusive force, while an extrusive force is applied to the displaced
tooth. As the sum of the extrusive and intrusive forces, which are equal in magnitude and opposite in
direction, is zero and the moment produced by the extrusive and intrusive forces is equal in magnitude and
opposite in direction to the couple generated in the molar tube, the force system is said to be in static
equilibrium.
Some undesirable effects of this force system include:

• The tendency to rotate the canine tooth palatally as the point of force application (extrusive) is
buccal to its centre of resistance.
• The tendency to rotate the molar tooth buccally as the point of force application (intrusive) is buccal
to its centre of resistance. However, where the canine tooth lies palatal to the molar tooth in the
frontal plane, as the spring is activated it will be rotated palatally, creating a moment to rotate the
crown of the molar tooth palatally.
Figure 21
The unwanted canine tooth movement can be overcome by tying the appliance directly into a bracket on the
canine tooth rather than tying it as a point contact and incorporating some lingual root torque into the
archwire. This, however, produces a two couple statically indeterminate force system. The unwanted molar
tooth movements can be minimised by supplementing the appliance system with a rigid transpalatal arch
or/and by adding buccal stabilising sections by bonding the premolar teeth as is commonly done with a
Ricketts utility intrusion arch (see later).
Can you think of another way of aligning a severely displaced/impacted tooth other
than using an extrusion spring? What types of mechanics are involved?
Suggested answers in Appendix at end of module.
Anterior Intrusion arch
An anterior intrusion arch is probably the most common application of a one couple force system where it is
used to intrude the upper labial segment teeth. Originally described by Burstone in 1977, this appliance
consists of an archwire inserted into tubes on the right and left molar teeth (the anchorage unit) at one end
and is then tied to a single point of contact on the labial segment teeth. When the wire is passive it lies
apical to the brackets on the labial segment teeth. It is activated by pulling the anterior segment of the wire
incisally and tying it at the level of the incisor brackets. As it is not engaged into an orthodontic bracket, the
end that is tied as a point contact cannot produce a couple but only a simple force (Isaacson et al. 1993a).
The end which is engaged in the bracket slot produces both a force and a couple.
The labial segment teeth are normally tied together with a base archwire to which the intrusion arch is
attached at any point. This base wire helps to maintain the vertical positions of the labial segment teeth
relative to each other as they intrude. An extrusive force acts on the molar teeth as does a couple tending to
tip the crowns of the molar teeth distally and the roots mesially. Tip back of the upper molar teeth may be a
favourable outcome in Class II cases as it will help improve the buccal segment relationships.

• Rotation of the labial segment teeth labially as they intrude, increasing the arch length. This occurs
if the line of action of the intrusive force is labial to their centre of resistance. It can be overcome by
tying the intrusion arch behind the lateral incisor brackets such that the intrusive force is through
the centre of resistance of the labial segment teeth, thereby reducing the moment to rotate these
teeth labially. Cinching the archwire back behind the molar tubes so the wire cannot slide forwards
also restrains labial movement of these teeth the effect being lingual root torque instead (Isaacson
et al. 1993b).
• The extrusive force at the molar teeth is acting buccal to their centre of resistance resulting in a
tendency for these teeth to tip palatally as a result of the moment of that force. Placing a
transpalatal arch will help stabilise the molar teeth. Use of high pull headgear will counteract the
extrusive force if it is undesirable.
The magnitude of force used with an intrusion arch is approximately 60g for four upper incisors, 15-20g per
tooth (Burstone 2001) and 50g for four lower incisors, 12.5g per tooth (Bishara 2001). Heavier forces than
these will increase the tendency for molar extrusion.
Figure 22
Anterior Extrusion arch
An anterior extrusion arch, which is used for the closure of anterior open bites, is simply an inverted
intrusion arch with all of its force systems inverted.
Advantages of a one couple force system
There are many advantages of a one couple orthodontic force system:

• Relatively simple design
• Ease with which tooth movement can be predicted
• Can be designed to move single or blocks of teeth
• Does not require attachments on all teeth
• Large range of activation so there is a reduced need for appliance reactivation
• Good control of force magnitude
• Ability to limit unwanted side effects through additional intraarch, interarch, or extra-oral mechanics
Burstone CJ. Biomechanics of deep overbite correction. Semin Orthod 2001; 7: 26-
33.
Isaacson RJ, Lindauer SJ. Closing anterior open bites: The extrusion arch. Semin
Orthod 2001; 7: 34-41.
Lindauer SJ, Isaacson RJ. One-couple orthodontic appliance systems. Semin Orthod
1995; 1: 12-24.
Two-couple statically indeterminate systems
A two-couple statically indeterminate force system is where an appliance is inserted into a bracket or tube at
both ends of the dental arch creating two couples. Such a complex system makes it difficult to evaluate
precisely all the forces and moments at work. Examples of such appliance systems include:
• The utility arch (Ricketts 1976, Ricketts et al. 1979)
• Torquing arches
• Transpalatal arch
• A 2 x 6 appliance
Ricketts Utility Intrusion arch
Ricketts utility intrusion arch has been used with much success to level an increased Curve of Spee by
intrusion of the labial segment teeth (Engel et al. 1980, Dake and Sinclair 1989). It consists of a rectangular
archwire, which engages the brackets of the incisor teeth anteriorly, and the molar teeth posteriorly. The
molar teeth act as the anchorage unit. It does not engage the premolar or canine teeth and is stepped in an
apical direction in this region. Placing tip back bends mesial to the molar tubes activates the wire such that
when it is passive the anterior aspect of the archwire lies apical to the labial segment brackets. It is a classic
example of a two-couple force system. Raising the anterior aspect of the archwire, which is tied into the
labial segment brackets, results in an intrusive force on the labial segment teeth and a couple, while there is
an extrusive force of the same magnitude on the posterior teeth as well as a couple. The moment of the
couple will tend to tip the crowns distally.

• As the line of action of the intrusive force on the labial segment teeth is facial to their centre of
resistance there is a tendency for a moment to tip the crowns facially. This line of action cannot be
varied as the archwire is tied into the bracket slots (unlike the case with an intrusion arch). It must
also be remembered that there is an additional moment created by the couple within the brackets of
the incisor teeth. The moment of this couple cannot be known (indeterminate) but is important as it
affects the magnitude of the intrusive force on the incisor segment. The direction and magnitude of
this moment being dependent on the location of the activation bend and the properties of the wire
(Davidovitch and Rebellato 1995)
• There is an extrusive force acting on the molar teeth which is buccal to their centre of resistance
tending to roll these teeth lingually and tip them distally. Any adverse molar tooth movement can
however be minimised by using buccal stabilising sections, but does not always work to ones
advantage as illustrated in the photograph below.
Figure 23: Buccal stabilising sections in place

to minimise any adverse molar tooth movement.
Figure 24: Ricketts utility arch in place. Note

extrusion of canines and premolars on stabilising
sections (relative intrusion of incisors)
Preventing the labial tipping of the crowns of the incisor teeth can be achieved by:
• Incorporating lingual crown torque into the anterior segment of the utility arch, which will create a
moment of the same direction as that acting at the molars. This will however increase the
magnitude of the intrusive force on the labial segment teeth while at the same time increase the
magnitude of the extrusive force and couple on the molar teeth, possibly tipping the balance of
tooth movement towards extrusion of the posterior teeth.
• Applying a force to retract the incisors by cinching the archwire, thereby creating a lingual force at
the incisor brackets restraining labial tipping of the incisor teeth. The incisor inclination will continue
to increase, due to lingual root movement, as the intrusive force is still acting labial to the centre of
resistance of the incisor teeth. Cinching the archwire will also create a force that tends tip and move
the molar tooth mesially, a movement that is normally undesirable.
It is also normal to place buccal root torque in the archwire where it is tied into the molar tubes. This places
the roots of the molar teeth in contact with the buccal cortical plates thereby increasing the anchorage value
of these teeth in resisting unwanted mesial movement.
How else can the labial segment teeth be intruded for the correction of a deep bite?
What types of tooth movement are achieved? Are there any adverse effects of using
this type of appliance system and if so how can they be overcome?
Suggested answers can be found in the Appendix at the end of the module.
Davidovitch D, Rebellato J. Utility arches: A two couple intrusion system. Semin

Orthod 1995; 1: 25-30.
Proffit WR, Fields HW. Contemporary Orthodontics. Chapter 10. 2000; Mosby
Publications.
Torquing arch
The torquing arch is an appliance system designed to place simultaneous, same directional third order
(torque) couples on one or more incisors, while treating all of these teeth as one big tooth and one big
bracket. The second couple is created where the appliance is inserted into the molar tubes posteriorly. It is
an effective system for delivering anterior root torque.
Isaacson RJ, Rebellato J. Two-couple orthodontic appliance systems:

Torquing arches. Semin Orthod 1995; 1: 31-36.
Transpalatal Arches
The traditional transpalatal arch consists of a rigid stainless steel wire, of 0.9mm diameter, that extends
from the palatal aspect of one maxillary first molar band to the band on the maxillary first molar on the
opposite side of the arch. It follows the contour of the palate but yet lies 2-3mm away from the palatal
mucosa, and has a U-loop in the midline to allow for adjustment. It is soldered to the maxillary molar bands.
The traditional transpalatal arch has many uses including:
• Anchorage reinforcement
• Space maintenance, and
• Retention of maxillary arch expansion post rapid maxillary expansion
The removable transpalatal arch is of a different design to the more traditional soldered type. It consists
of a removable palatal bar that engages molar sheaths soldered to the palatal aspects of the upper molar
bands, thereby allowing it to be removed, adjusted, and inserted, without removing the bands. Burstone and
Manhartsberger (1988), and Burstone (1989) described using a 0.032 x 0.032” titanium molybdenum alloy
palatal bar for its flexibility during active tooth movement and a rigid 0.032 x 0.032” steel palatal bar to
stabilise the molar teeth when they had reached their desired positions. A removable transpalatal arch can
easily be dislodged during function so it is securely tied in using elastomerics or steel ligatures. It is another
example of a two-couple statically indeterminate force system as the molar sheaths effectively behave as a
two bracket system. Despite this, it can be activated to move maxillary molars with reasonable predictability
in all three dimensions, and has been extensively described by Rebellato (1995a) and Ingerrall et al. (1995).
The transpalatal arch can be used to expand the intermolar width by activating the midline U-loop. On its
own this will only produce expansion by tipping as the points of force application are occlusal to the centre
of resistance of the molar teeth (area of bifurcation), thereby creating a moment to tip the crowns buccally
and roots palatally. Bodily expansion is however more desirable and less likely to relapse. This can be
achieved using the removable type transpalatal arch by placing bilateral toe-ins in the frontal plane, where
the transpalatal arch engages the molar sheaths. These toe-in bends create bilateral couples whose
moments will tend to buccally torque the molar roots as the intermolar width expands. This type of
appliance activation is also very useful in uprighting buccally tipped molars where previous expansion has
largely resulted in molar tipping, but it must be noted that the moment of the couple must be greater than
the moment of the expansion force where net buccal root torque is required, otherwise one moment will
completely cancel out the other.
Figure 25: Expanding the intermolar width using a transpalatal arch with bilateral toe-ins.
Early loss of the upper second primary molars (E’s) often results in the mesial rotation of the upper first
molars around their palatal roots. Appropriate activation of the transpalatal arch is an effective means of
derotating these teeth such that the mesiobuccal cusp of the upper molar moves distofacially. Also because
of their rhomboidal shape, maxillary molar derotation is a highly efficient way of gaining arch length in non-
extraction treatments as it may open up space mesial to the molars. Derotation may also be a necessary
requirement prior to the use of headgear, to allow passive insertion of the inner face bow into the headgear
tubes. Molar derotation is achieved using a removable transpalatal arch by placing bilateral toe-in bends, in
the occlusal plane, which will result in equal and opposite couples being applied to the molars such that they
rotate around their respective centres of resistance to bring the mesiobuccal cusp facially.
Figure 26: Unilateral toe-in in the occlusal plane to derotate a maxillary molar tooth.
Other tooth movements possible with a removable transpalatal arch include;

• Unilateral distal movement of an upper molar using a unilateral toe-in bend in the occlusal plane on
the side where no distal molar movement is required. This can be useful in correcting a unilateral
Class II buccal segment relationship and is most effective where there is no tooth present distal to
the tooth being moved.
• Bilateral or unilateral mesiolingual molar rotation which is useful where there is an excess of space
remaining in the upper buccal segments due to a tooth size discrepancy or in upper arch only
extraction cases.
• Mesiodistal molar tipping where the molar teeth require uprighting.
• Unilateral molar extrusion, by placing a unilateral toe-in bend in the frontal plane on the side where
no molar extrusion is required.
For a more detailed review on the various molar movements possible with
removable transpalatal arches and how they are achieved read the following
article.
Rebellato J. Two-couple orthodontic appliance systems: Transpalatal arches.

Semin Orthod 1995a; 1: 44-54.
Dahlquist A, Gebauer U, Ingervall B. The effect of a transpalatal arch for

correction of first molar rotation. European Journal of Orthodontics 1996; 18:
257-267.
How can the more traditional soldered type transpalatal arch be activated to produce
buccal root torque and how can its design be modified so it can be used effectively to
derotate maxillary molars?
Can you think of any other appliance that can be used to achieve simultaneous
maxillary arch expansion and maxillary molar derotation? What would its design be
and how would it be activated?
Suggested answers can be found in the Appendix at the end of the module.
2 x 6 Appliance
A 2 x 6 appliance is an example of a partially bracketed, two couple statically indeterminate appliance

system, consisting of a rectangular archwire engaged into brackets attached to the six anterior teeth (canine
to canine) and both first molars. The appliance can be activated in the transverse dimension, resulting in
constriction or expansion of intermolar width and first order molar rotations (Rebellato 1995b). The system
is useful in that both symmetric and asymmetric expansion and constriction can be achieved with minimal
movement of the anterior teeth (Burstone 1962, 1966).
Using this system the anterior teeth provide the anchorage unit, while the archwire itself should ideally
bypass the premolars. This provides a long span of free wire with low load deflection properties and a large
range of activation, while facilitating the desired force levels and moments required for molar tooth
movement.
An outward bend a few millimetres behind the canine bracket results in expansion of the molar with little or
no rotation. An outward bend behind the canine combined with a toe-in bend at the molar will allow
expansion and mesial out rotation of the molar tooth.
For a more detailed review on the various molar movements possible with a 2 x 6
appliance and how they are achieved read the following article.
Rebellato, J. (1995b)
Two-couple orthodontic appliance systems: Activations in the transverse dimension.
Seminar in Orthodontic, 1, 37-43.
References
Bishara SE Textbook of Orthodontics. 2001; W.B. Saunders Company.
Burstone CJ. Rationale of the segmented arch. Am J Orthod 1962; 48: 805-822.
Burstone CJ. The mechanics of the segmented arch techniques. Angle Orthodontist 1966; 3: 99-120.
Burstone CJ. Deep overbite correction by intrusion. Am J Orthod 1977; 72: 1-22.
Burstone CJ. Precision lingual arches: Active applications. J Clin Orthod 1989; 23: 101-109.
Burstone CJ, Koenig HA. Force systems from an ideal arch. Am J Orthod 1974; 65: 270-289.
Burstone CJ, Manhartsberger C. Precision lingual arches: Passive applications. J Clin Orthod 1988; 22: 444-
452.
Dake ML, Sinclair PM. A comparison of the Ricketts and Tweed type arch levelling techniques. Am J Orthod
Dentofacial Orthop 1989; 95: 72-78.
Engel G, Cornforth G, Damerell JM, et al. Treatment of deep bite cases. Am J Orthod 1980; 77: 1-13.
Ingerrall B, Gollner P, Gebauer U, Frolich K. A clinical investigation of the correction of unilateral molar
crosssbite with a transpalatal arch. Am J Orthod Dentofac Orthop 1995; 107: 418-425.
Isaacson RJ, Lindauer SJ, Rubenstein LK. Activating a 2 x 4 appliance. Angle Orthod 1993a; 63: 17-24.
Isaacson RJ, Lindauer SJ, Rubenstein LK. Moments with the edgewise appliance: Incisor torque control. Am
J Orthod Dentofac Orthop 1993b; 103: 428-438.
Lindauer SJ. The basics of orthodontic mechanics. Semin Orthod 2001; 7: 2-15.
Ricketts RM. Bioprogressive therapy as an answer orthodontic treatment needs, part II. Am J Orthod 1976;
70: 241-268.
Ricketts RM, Bench RW, Gugino CF. et al. Bioprogressive Therapy. Book 1. 1979; Denver, CO: Rocky
Mountain Orthodontics, 93-126.
Rebellato J. Two-couple orthodontic appliance systems: activations in the transverse dimension. Semin
Orthod 1995b; 1: 37-43.
Section 8 – Anchorage
Whenever tooth movement is attempted there will be an equal and opposite reaction to the force(s) applied
by the active components of the appliance (Newton’s third law of motion). This equal and opposite force is
known as anchorage and has been defined as:
• The source of resistance to the forces generated in reaction to the active components of an
appliance (Mitchell 2001)
• The resistance to unwanted tooth movement (Proffit 2000), which can occur in all three planes;
o Anteroposterior
o Transverse
o Vertical
Anchorage value of a tooth can be described as its resistance to movement and is a function of its root
surface area, e.g. an upper first molar would have a greater anchorage value than an upper lateral incisor as
the larger the root area the greater the area over which a force can be distributed.
Principles of anchorage include:

• Incorporate as many teeth as possible into the anchorage unit e.g. band/bond second molars
• Utilise teeth with the maximum root surface area to act as the anchorage teeth
• Increase the anchor value of the anchor teeth by restricting them to bodily movement only
• Use light forces, which are well below the optimal force required for movement of the anchor unit
• If possible tip the teeth that are to be moved as it is less anchorage demanding than bodily tooth
movement. This is the strategy used with the Begg/Tip-Edge appliance systems – tip the incisors
back first to close space, then upright them later. Split up a “block” of teeth that are to be moved by
moving them individually, thereby reducing the forces involved in active tooth movement. Those
teeth may then be incorporated into the anchorage unit providing increased root surface area for
anchorage purposes
• Avoid torquing movement of the teeth as such movements are anchorage demanding
• Utilise teeth which are distally inclined to provide more anteroposterior anchorage than teeth which
are upright which in turn provide more anchorage than teeth which are mesially inclined
Types of anchorage
Simple
Compound
Tooth Reciprocal
Stationary
Differential
Intra-oral Soft tissue e.g. lips (lip bumper)
Palatal Vault
Bone Cortical bone anchorage
Ankylosed teeth
Implants
Extra-oral Headgear (see Module 23)
Intra-oral anchorage can also be classified as:

• Intraarch/intramaxillary, derived from teeth within the same arch, and
• Interarch/intermaxillary, derived from teeth in the opposing arch.
Simple anchorage
Here the reactionary force occurring from the force applied to one tooth is pitted against another tooth. Both
teeth experience the same degree of force and if they have the same root surface area will experience the
same stress in the periodontal ligament. If both teeth are of unequal root surface area then the levels of
stress experienced in the periodontal ligament will also be unequal and there will be a differential rate of
tooth movement.
Compound anchorage
There is greater than one tooth in the anchorage unit so the force is spread over a greater root surface area
resulting in less stress within the periodontal ligament so the anchor teeth are less likely to move.
Reciprocal anchorage
An equal force is applied to teeth or groups of teeth of equal root surface area resulting in reciprocal
movement towards or away from each other, e.g.
• When closing a midline diastema by pulling two central incisors together using powerchain
• Expanding the upper arch using a quad-helix
• Opening space between equivalent groups of teeth using pushcoil
Figure 27: Reciprocal anchorage is used to close a

midline diastema where two teeth with the same root
surface areas move by the same amount towards each
other.
Stationary anchorage
This is defined as pitting bodily movement of the anchor teeth against tipping movement of the teeth to be
moved. It is a form of anchorage which has found popularity in the Tip-Edge technique, but it is extremely
difficult to prevent movement of the anchor teeth altogether.
Differential anchorage
This principle relies on the theory that it is possible to apply very high levels of force to a tooth unit of low
root surface area thus decreasing its rate of possible movement due to periodontal ligament hyalinisation.
The effect would be to bring the stress produced in the teeth of high root surface area towards the optimum
for tooth movement. This type of anchorage is not recommended as it is associated with root resorption of
the teeth with less root surface area.
Bone anchorage
Palatal vault
The palatal vault is used in removable appliance treatment as an effective source of anchorage, resisting
anteroposterior forces. These tissues can also be utilised in fixed appliance treatment by the provision of a
Nance button. A Nance button consists of a heavy palatal wire (normally 0.9mm diameter) soldered to the
palatal aspect of the first molar bands. The wire from the molars is directed anteriorly and is embedded in
an acrylic button that rests against the most superior anterior aspect of the palatal vault. Its effect is
greatest in patients with a high palatal vault due to the greater buttressing effect. In the case of a shallow
vaulted palate it will simply tend to slide down the inclined plane of the palate.
Cortical anchorage
Cortical bone provides greater resistance to tooth movement than cancellous bone due to its reduced
vascularity and increased density, a finding that can be put to good use in reinforcing anchorage. A
transpalatal arch would theoretically bring the roots of the upper molars into contact with cortical bone if
they were forced to move mesially, which would supplement their anchorage value. It does not however
prevent mesial tipping of the molar teeth.
Cortical bone anchorage can also be achieved by intentionally buccally torquing the roots of the molar teeth
into contact with the buccal cortical plates of bone. A technique first described by Ricketts (1976) for use
with the utility intrusion arch in the bioprogressive technique, to increase the anchorage value of the molar
teeth.
Figure 28: The roots of the lower molar

torqued into the buccal cortical plate to
increase anchorage
Over zealous torque can produce root resorption or in extreme cases cortical bone perforation.
Figure 29: Notice how, in this Ricketts

treatment case, the lower molar roots hove
been torqued buccally into the buccal cortical
plate.
Ankylosed teeth
Ankylosed teeth are a source of absolute anchorage as the absence of a periodontal ligament means these
teeth are not subject to the normal physiological response of an applied force, making these teeth
impossible to move. Kokich et al. in (1985) described a technique to intentionally ankylose deciduous
maxillary canines in a patient with severe maxillary retrusion. The ankylosed teeth were then used as
abutments to deliver an anteriorly directed intermittent extra-oral force.
Implants
Apart from being an excellent means of supporting prosthesis, implants can act as a valuable source of
absolute anchorage. As they integrate with the surrounding bone and do not therefore have a periodontal
ligament they behave as ankylosed teeth. The anchorage they provide is termed absolute as these devices
cannot be moved, unless of course they have been poorly placed or infected.
Implants used for anchorage purposes have been classified into a number of different types:
• Mid Palatal implants – first described by Triaca et al. in 1992.
o Similar to a standard implant but smaller and placed in the midline of the palate.
• Onplants – first described by Block and Hoffman 1995.
o Consist of an 8-10mm subperiosteal disc with a textured hydroxyapatite coating for
integration with the palatal bone.
• Miniscrews – first described by Kanomi in 1977.
o Titanium screws of varied length and diameter that do not osseointegrate with bone.
• Standard implants in the line of the arch.
o Used initially for anchorage and subsequently used to support a restoration.
A good overview on the use of osseointegrated implants for anchorage purposes is:
Travess, H.C., Williams, P.H. and Sandy, J.R. (2004)

The use of osseointegrated implants in orthodontic patients: 2. Absolute anchorage.
Dental Update, 31, 355-362.
Also Higachi? Book on implants and orthodontics

Also Seminars in Orthodontics vol 11 pg 3-56 is devoted to the use of “Temporary
Anchorage Devices” – devices temporarily fixed to bone for the purpose of enhancing
orthodontic anchorage. These articles give a more detailed description of some specific
implant anchorage systems that are currently available as well as brief explanations
about the surgical procedures involved in implant placement and removal and possible
complications. Definitely worth a look!
Methods of reinforcing Anchorage
In some situations the amount of anchorage provided by the conventional intra-oral means may not be
sufficient to carry out the desired tooth movements without compromising the amount of space available. In
these cases anchorage should be supplemented or reinforced. Anchorage can be reinforced both intra-orally
and extra-orally.
Intra-oral reinforcement:
• Alter the extraction pattern, e.g. in a Class II div 1 case to reduce the overjet, extraction of the
upper first premolars places the anchorage more favourably towards the back of the mouth
• Include more teeth in the anchor unit, band/bond second or even third molars
• Utilise anchor units in the opposing arch, use intermaxillary elastics
• Adding lingual or palatal arches, Nance arches, stopped archwires etc.
• Bone anchorage by placing temporary anchorage devices
• Create occlusal interferences by altering the extraction pattern, upper first premolars and lower
second premolars
Extra-oral reinforcement;
• Headgear (see Module 23)
Monitoring Anchorage
Anchorage can be monitored during treatment by using the untreated arch in single arch treatments as the
reference source and then evaluating changes in overjet, canine and buccal segment anteroposterior
relationships. The monitoring of anchorage in patients with upper and lower fixed appliances is more difficult
due to the absence of stable reference points with which to compare tooth movement. In these situations
taking a Lateral Cephalogram during treatment to compare with a pre-treatment Cephalogram is justified as
a means of evaluating anchorage requirements.
Loss of anchorage
There are several reasons for the undesirable movement of the anchorage teeth during active treatment.
These include:
• Poor appliance design
• Poor appliance adjustment
• Poor patient cooperation
• Failure to fully appreciate the anchorage requirements
• Occlusal interferences to tooth movement e.g. when retracting an upper canine check the lower
canine tooth or bracket is not preventing movement of the upper canine
• High angle patients
Birnie, D and Harradine, N. (2004)

Anchorage. Chapter 13.
Excellence in Orthodontics Lecture Course Manual.
Roberts-Harry, D. and Sandy, J. (2004)

Orthodontics. Part 9. Anchorage control and distal movement.
References
Bench RW, Gugino CF, Hilgers JJ. Bioprogressive therapy 1-12. J Clin Orthod 1977-78; 11: 616-627, 661-
682, 744-763, 820-834. 12, 48-69, 123-139, 192-207, 279-298, 334-357, 427-439, 505-521, 569-586.
Block MS, Hoffman DR. A new device for absolute anchorage for orthodontics. Am J Orthod Dentofac Orthop
1995; 107: 251-258.
Kanomi R. Mini-implant for orthodontic anchorage. J Clin Orthod 1997; 34: 397- 402.
Kokich VG, Shapiro PA, Oswald R, Koskinen-Moffett L, Clarren SK. Ankylosed teeth as abutments for
maxillary protraction. Am J Orthod 1985; 88: 303-307.
Mitchell L. An Introduction to Orthodontics. 2001; Oxford University Press, 2nd edition.
Proffit WR, Fields HW. Contemporary Orthodontics. Mosby Publications 2000
Ricketts RM. Bioprogressive therapy as an answer to orthodontic needs. Parts 1 and 2. Am J Orthod 1976;
70: 241-268, 359-397.
Triaca A, Antonini M, Wintermantel E. Ein neues Titan-Flaschrauben-implantat zur orthodontischen

Verankerung am anterion Gaumen. Int Ortod Kieferorthop 1992; 24: 251-257.
Appendix
Suggested answers to Tasks in Section 6
Question: How does engaging an archwire in an edgewise bracket slot achieve:

• A first-order couple?
• A second-order couple?
• A third-order couple?
Suggested answer
Most commonly in orthodontics, couples are applied by engaging an archwire (light grey line) in an edgewise
bracket slot (represented by small squares).
Figure 30: A first order couple is achieved

by tying an archwire into a bracket where the
tooth has slightly rotated off the archwire.
A second order couple is created by tying an

archwire with a gable bend into a bracket.
A third order couple is achieved by placing torque

into a segment of archwire and then engaging it
in the bracket slot.
(Lindauer 2001)
Suggested answers to Tasks in Section 7
Question: Can you think of another way of aligning a severely displaced/impacted tooth other than using
an extrusion spring? What types of mechanics are involved?
Suggested answer
Figure 31: Continuous arch mechanics using a

round NiTi arch wire. Round tripping the lateral incisor
and premolar teeth.

rectangular steel base archwire with an occlusal offset in
the canine region for anchorage purposes. Elastic thread
provides the active extrusive force. Spring coil in place to
allow control of the extrusive force vector.
Figure 33: Extrusion spring attached to gold chain

via steel ligature.

rectangular steel base archwire for anchorage purposes.
Piggyback NiTi archwire to canine tooth providing
continuous extrusive force.
Question: How else can the labial segment teeth be intruded for the correction of a deep bite (apart from
using the Ricketts utility arch and intrusion arch already described)? What types of tooth movement are
achieved? Are there any adverse effects of using the appliance systems you have suggested and if so how
can they be overcome?
Suggested answer
1) Continuous stainless steel archwire with a reverse Curve of Spee in the lower arch +/- continuous
steel archwire in the upper arch with accentuated Curve of Spee. Intrusion of the labial segment
teeth pitted against extrusion of the posterior segment teeth. May see proclination of the labial
segment teeth as a side effect. This can be overcome by:
• Using concurrent intraarch mechanics
• Using Class III interarch elastics
• Cinching the archwire posteriorly
• Placing lingual crown torque in the archwire
• Use a bracket prescription with built in lingual crown torque (MBT prescription +6°)
2) Reverse curve continuous nickel titanium archwires. May see proclination of the labial segment teeth
and molar rotation and premolar expansion due to horizontal curvature of the archwire. Monitor
these patients carefully.
3) Simply band the second molars.
4) High pull headgear to the upper labial segment teeth.
Question: How can the more traditional soldered type transpalatal arch be activated to produce buccal
root torque and how can its design be modified so it can be used effectively to derotate maxillary molars?
Suggested answer
Before cementing the appliance orientate the transpalatal arch as it would be in the mouth, then by rotating
the molar bands buccally using digit pressure this will activate the arch such that it may deliver some buccal
root torque to the upper first molars.
Asking the laboratory to place a coil in the arch adjacent to the molar tooth requiring derotation will increase
the flexibility of the appliance allowing molar derotation.
Question: Can you think of any other appliance that can be used to achieve simultaneous maxillary arch
expansion and maxillary molar derotation? What would its design be and how would it be activated?
Suggested answer
The quad-helix appliance. Have a look at the following article as it has great illustrations on how a quad-
helix should be activated (using a triple beak pliers) to achieve various types of tooth movements. Its in
Spanish but you will not need a translation to understand the line diagrams!
Cervera-Sabater A, Simon-Pardell M. Quad-helix. Biomecanica basica. Rev

Esp Ortod 2002; 32: 253-262.
Also have a look at:
Bench RW. The quad-helix appliance. Seminars in Orthodontics 1998; 4:

231-237.
Remember if derotating a molar using a quad-helix it is best to have the premolar arm on the side you are
derotating passive initially.
Visit the discussion board to discuss any of the thoughts outlined above.
Congratulations - You have now

completed Module 12b.
Please remember to complete the module
assessment so we can keep improving the
module content.

Biomechanics + Anchorage

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National Orthodontics Programme Module 12b - Biomechanics

British Orthodontic Society 1

National Orthodontics Programme

About the National Orthodontics Programme

We hope you enjoy using this unique and pioneering resource.

What You Will Learn

Section 1 – Anatomy of the Periodontium

Avery JK. Essentials of Oral Histology – A Clinical Approach. Chapter 14.

The Periodontal ligament (PDL)

The gingival group consists of:

Normal functions of the periodontal ligament include:

Proffit WR. Henry W. Contemporary Orthodontics. Chapter 9. 2000; Mosby

Proffit WR. Henry W. Contemporary Orthodontics. Chapter 9. 2000; Mosby

The bone itself consists of:

Section 2 – Bone Metabolism

Bone Remodelling Cycle

Hill PA. Bone Remodelling. Br J Orthod

The systemic hormones include:

The local factors are synthesised by skeletal cells and include:

Bone Resorption (Meghji 1992, Hill 1998)

Bone Reversal (Hill 1998)

Bone Formation (Hill 1998)

Daskalogiannakis J. Glossary of Orthodontic Terms. 2000; Quintessence Publishing.

Hill PA. Bone Remodelling. Br J Orthod 1998; 25: 101-107.

Meghji S. Bone remodelling. Br Dent J 1992; 172: 235-242.

Section 3 – Biologic Control of Tooth Movement: The Theories

The Bioelectric Theory

The Pressure-Tension Theory

Bassett CAL. Electrical effects in bone. Scientific Am 1965; 213: 18-25.

Giovanelli S, Festa F. Effect of electrical stimulation on tooth movement in clinical application. In

Section 4 – Response to a Sustained Force

What happens when a continuous optimal force is applied?

What happens when a continuous excessive force is applied?

Burstone (1962) divided orthodontic tooth movement into three phases:

Additional information on this topic can be found in:

Ireland A, McDonald F. The Orthodontic Patient: Treatment and Biomechanics.

Mitchell L. Chapter 15. An Introduction to Orthodontics. 2001; Oxford University

Orthodontic tooth movement depends on a variety of factors including:

Optimal Force Magnitude

The relationship between the magnitude of an

Effects of Force Distribution and Types of tooth movement

There are five basic types of tooth movement:

Pure rotational movement should result

Extrusion and Intrusion

Torque describes the differential movement of

Effects of Force Duration and Force Decay

The force delivered by a deflected wire is determined by:

Force = EdI E = Young’s Modulus of Elasticity

For a round cross section wire, I = πr4

This includes interferences not only from an opposing tooth but

Friction will be covered again in more detail in Module 24 – Fixed appliances.

Drug Effects on the response to Orthodontic Force

Downing A, McCabe J, Gordon P. A study of frictional forces between orthodontic brackets

Section 5 – Iatrogenic effects of orthodontic tooth movement

Section 6 – Mechanics of Tooth Movement

Scalars, Vectors and Forces

Resultants and Components

• Consider the two component forces to be the sides of a parallelogram (black)

Force resolution is the reverse of force composition,

Types of movement Position of centre of rotation

Rotation and Couples

A couple can be described by applying equal and