Biomechanics in Clinical Ortho - Part 2-Ortho / Orthodontic Courses by Indian Dental Academy

1.
Mechanics of tooth-movement
2. Mechanics of Orthodontic Appliance
2
nd part

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In orthodontics we use various components
(wires, elastics, etc.) to bring about desired
tooth movement.
Each component is a system by itself, and
produces its own force(s) and couple(s).
The force systems produced by orthodontic
appliance activation must be resolved
separately from the actual forces and moments
that individual teeth will experience at their
respective center of resistance.
It is a simple method used by a majority of
orthodontists.
For determining what forces are present, the
arch wire is fully engaged into a bracket or
tube and possible force system is evaluated
by eyeballing.
This method is based on laws of static
equilibrium and if not understood correctly can
confuse the orthodontists further.
It is this method that so often leads us down
the road to faulty conclusions.
Many a times, it is because we dont apply the
simple concept of static equilibrium.
We know that according to Newtons third
law, every action has an equal and opposite
reaction.
In spite of knowing this, many orthodontists
tend to forget to apply this law in their daily
orthodontic mechanics in a simple and
practical manner.
Three requirements are accomplished
automatically whenever static equilibrium is
established.
They are:
1. The sum of all forces present must equal zero.
2. The sum of all moments present must equal
zero.
3. The sum of all forces and moments (together)
present must equal zero.
Zero
When we engage an arch wire fully, we are
generating unequal moments.
Forces are also generated to keep the system
balanced.
Therefore, all the moments and forces will sum
up to zero (i.e. always results in static
equilibrium).
ZERO
ZERO
ZERO
Looking at the two unequal moments in 2
nd

figure, it appears that the entire unit would
rotate counter-clockwise.
ZERO
But by considering the forces generated we
see that forces by themselves would cause the
unit to rotate clockwise.
Actually these are equal and opposite force
and their sum equals zero.
ZERO
It is impossible to design an appliance that
defies (disobey / confront) the laws of physics.

Now using the simple method of visual
inspection we can classify the orthodontic
appliance into various groups.
Orthodontic appliances can be divided into
following three categories depending on their
biomechanical mode of action (forces and
moments):
No couple appliance system
One couple appliance system
Two couple appliance system
Simplest orthodontic appliance.
An elastic band stretched between two points
of attachment is the best example.
This produces forces of equal magnitude on
either end but opposite in direction.
Elastic band (Orthodontic appliance) is in
equilibrium and no moments are generated.
A
B
C
One end of the appliance experiences couple
(bracket or tube) and other end is tied as a
point contact (which can not produce a
couple).
It is statically determinate because the
magnitudes of the forces and moments
produced can be determined clinically after
the appliance is inserted into the
bracket/tube.
1000 gmmm

50 gm 20mm 50 gm
All over the world, the Begg appliance is giving
way to the new genre of appliances.
In India, we are still churning out a huge
number of Begg cases and all of us are well
aware of the quality of results.
We have managed to make Begg appear so
simple that even non-orthodontists have tried
putting their hand in the Pie (without
knowledge).

Who is to blame for this?
As we understand today the Begg appliance
is a good example of single couple system.
Stage I arch wire
It is not just the base archwire which can be
explained in terms of single couple system, but
other components of Begg appliance works in a
similar fashion, such as
Torquing auxillaries
Up-righting
Rotation springs

Let us see these .

With
1
st
Premolar extraction

2
nd
Premolar extraction
To overcome the problem of uprighting springs it
was suggested to use
Conventional 0.018 or 0.020 special plus
Refined Begg0.018 or 0.020 premium wire

It was thought that such a stiff wire will
prevent bending of archwire, but still it can
rotate the base archwire within the slot of
bracket.
Intrusion forces on the posterior teeth especially the
molars
Intrusion force buccal to center of resistance of these teeth
lead to intrusion of buccal cusps
And transverse expansion of posterior teeth
Incorporation of numerous bends in base
archwire was done to prevent various side
effects of auxillaries.

Upper stage III base archwire

Lower stage III base archwire
In vertical plane
Gable bend distal to canine
Mild anchor bend (in few selective cases)
In transverse plane
Constriction of upper arch
Toe-in bend
Molar offset bend
In sagittal plane
Cinch-back distal to molar tube
WHY?
After we have Understood the advantages and
side-effects of each individual components of
Begg mechanotherapy, let us evaluate the
whole system.
Let us start with

Stage I & Stage II
of Begg mechanotherapy
Bio-mechanically, Begg mechanotherapy is
most efficient in the first two stages.

And I am sure everybody agrees with me!!!
Why So ?
Exceptionally good anchorage control
Couple at molar tube high moment in posterior
segment
Bite opening mechanics
Extrusion of posterior anchorage tooth due to high
moment created
Intrusion forces on anterior segment
Very poor anchorage control
Couple at incisors high moment in anterior
segment
Bite deepening mechanics (Advantageous in
selected patients e.g. open-bite cases)
Side effect extrusion of anterior teeth due to high
moment created by auxillaries
Side effect intrusion forces on posterior segment
Why So ?

Scrutinization of the literature, reveals that
there was little or no consideration provided to
counteract the side effects of the stage III.
For example the commonest problem of flaring
of the molars and their intrusion was given no
consideration.
Hardly anybody has suggested, the use of
anchor bend in the posterior segment in order
to generate higher moments (in opposite
direction) to the moments generated in anterior
region.
This simple bend (the trade mark of Begg
appliance) was forgotten when starting stage
III.
And even to control the proclination of the
upper incisors due to horizontal effects of the
auxillaries, a (mild) Class II elastics was
suggested.
However class II elastic would add up to the
extrusion component of the auxillaries on the
incisors, worsening the bite-deepening effect.

Let us see
Anchor bend was suggested in the lower arch
only in cases where a Class II elastic was to be
used.

What about using anchor bend in upper arch in
stage III?
But first, let us see the effects of anchor bend..
We saw that the moment generated in stage I
and II was in the posterior segment and
therefore excellent anchorage control.
Lets apply this basic knowledge to the stage III
which has all of its moments concentrated in
the anterior region, causing
Proclination of dentition
Extrusion of incisors

Let us see this
Inefficient understanding of Biomechanics
Cook book approach
Dogmatic view
Clinicians inefficiency
..
..
...
.
Forces and couples are applied to teeth to
move them in the desired directions.
Tooth movement is monitored regularly to
assure that treatment proceeds smoothly and
positively.
Unwanted effects are corrected by adjustments
along the way.
The final result is achieved by a series of well-
planned mechanical interventions that initiate
and sustain a controlled biologic reaction.
The components of comprehensive orthodontic
treatment such as,
preliminary alignment,
overbite control,
space closure,
root paralleling, and
finishing,
rely on a series of biomechanical principles and
process which need to be understood.
The choice of appliances and techniques used
by practitioners varies radically among
individuals, but the fundamental forces and
moments they produce are universal.
Appliance will always act according to the
laws of physics.
Understanding the basic biomechanical
principles involved in effective controlled tooth
movement makes the final outcome more
predictable and consistent.
Prof. K. Sadashiva Shetty
Principal & Head
Dept. of Ortho.
Bapuji Dental College
Davangere
It is a simple method used by a majority of
orthodontists.
For determining what forces are present, the
arch wire is fully engaged into a bracket or
tube and possible force system is evaluated by
eyeballing.
Leader in continuing dental education

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