Biomechanics of Space

Closure

Meena K Das
Mubassar Fida
Therapeutic Space Closure
• Extraction spaces
• Missing teeth
• Generalized spacing
Extraction
• to improve dental occlusion,
• to reconcile arch length deficiencies,
• to purposefully alter the facial profile,
• to optimize surgical-orthodontic
correction of jaw discrepancies, and
• to improve function
Force Systems
• Minimal to no tissue resorption
• Move teeth with optimal velocity
• Cause minimal patient discomfort
• Extended range of activation
• Relatively constant force system
Force Systems
Mechanical characteristics:
• provide appropriate levels of force and M/F
ratios to achieve the tooth displacement desired.
• be able to undergo a reasonable range of
activation/deactivation in which the appliance
delivers relatively constant forces and moments.
• small enough to fit comfortably in the space
available for intraoral treatment
• End result should be upright well aligned
teeth with ideal root angulations and
position
Forces and Moments
• Application of differential moments between teeth is
recognized as an effective means for achieving desired
tooth movement.

• Alpha moments for the anterior and beta moments for

posterior teeth

• Variation in the force and moment magnitude and the

M/F ratio are important determinants of the resulting
tooth movement
Forces and Moments
Difference in M/F ratio acting on the anterior
versus the posterior teeth is produced by either
applying:

• unequal moments (a moment differential)

• unequal forces (i.e., use of a headgear or
intermaxillary elastics)
Anchorage
3 types of controlled closure of extraction sites:

• Type A refers to those sites where the anterior teeth will

occupy most or all of the extraction space (critical
posterior anchorage)
• Type B refers to equal occupation of the extraction site
by the anterior and posterior teeth;
• Type C, the extraction site is closed by the posterior
teeth occupying most or all of the extraction site.
(critical anterior anchorage)

Burstone CJ. The segmented approach to space closure. Am J Orthod 1982;82:361-78.

Anchorage
• If an extraction site is closed with a translatory
force system (M/F approx 10) applied equally to
the posterior teeth and anterior teeth, type B
closure will occur
Anchorage
• Maximum Anchorage

- Extraoral
- Interarch elastics
- Tipping canines before uprighting
- Retracting canines separately
Anchorage
• Minimum incisor retraction

- Extraction of second premolar

- Lingual root torque
- Breakdown of posterior anchorage
- Extraoral force
Factors effecting tooth movement
during space closure

• Amount of crowding
• Anchorage
• Axial inclination of canines and incisor
• Midline discrepancies and left and right symmetry
• Vertical dimension
Precise control of tooth movement
during closure of extraction spaces

• control of the anchorage units

• vertical forces
• root positions
• rotations

J. Kuhlberg T-loop position and anchorage control.

Am J Orthod Dentofacial Orthop. July 1997
• To translate a tooth or a group of teeth, it has
been repeatedly shown that a moment-to-force
ratio applied at a bracket should be equal to the
perpendicular distance from the bracket to the
center of resistance of an individual tooth or
group of teeth.
• Burstone CJ. The biophysics of bone remodeling during orthodontics—optimal
force considerations In: Norton LA, Burstone CJ. The biology of tooth
movement. Boca Raton: CRC Press, 1989.

Braun S, Winzler J, Johnson BE. An analysis of orthodontic force systems

applied to the dentition with diminished alveolar support. Eur J Orthod 1993;
15:73-7.
1. Segmented arch technique
2. Continuous arch technique
Segmented arch technique
• No Fail Safe mechanism
• Arch form not maintained
• Canine can become displaced during its
retraction
Space Closure

• En masse retraction of six anterior teeth

• Two step procedure

En masse Retraction
• Shortened treatment time
• Sliding mechanics preferred
• Good posterior anchorage required

• The center of resistance of the anterior

segment, including the canines, has been
shown to be about 3.5 mm apical to the
palatal bone level at the incisor region
• Moment at molar counteracts mesial reactive force
in anchor unit.
• Law of static equilibrium --- MD forces
must be equal within the same arch.

• Forces can be altered only by utlizing

extraoral traction or the opposite arch.
Additional force on anterior teeth can be increased
by
• Class II elastics
• J Hook HG

Posterior teeth
• HG
Canine Retraction
• As force level decreases, moment increases

Tipping translation uprighting

Therefore, the M/F changes as the tooth moves, and the tooth
responds, typically progressing from controlled tipping (center of
rotation at the root apex) to translation to root movement.

Raymond E. Siatkowski (Am J Orthod Dentofac Orthop 1997;112:393-402.)

Friction
• Resists movement
• Loss of anchorage
• Slows tooth movement
Friction
• Studies have shown that the portion of
the applied force lost due to the friction
can range from 12% to 60%

Kusy RP, Whitley JQ. Friction between different wire-bracket configurations and
materials. Sem in Ortho 1997;3:166-77
Canine Retraction

• Ideal force to retract a a canine is 150gm

• 50 gm will be used to overcome friction
Sliding Mechanics

• Teeth move along the archwire

• Simplicity
• Occlusal plane maintained

• Friction and binding

• ‘Stick-slip action’--- intermittent movement
• Uncontrolled tipping
• Deepening of bite
• Loss of anchorage
Sliding mechanics
• Elastic chains
- inexpensive
- significant force decay over time
* water absorption
* tooth movement resulting in decrease stretch

• NiTi springs
- more consistent space closure
- rapid movement??
- high resistance to permanent deformation
Sliding mechanics
• NiTi coil springs and elastics close space at a
similar rate.

*Dixon V, Read MJ, O’Brien KD, Worthington HV, Mandell MA. A

randomized clinical trial to compare three methods of orthodontic space closure. J
Orthod 2002; 29: 31–36.

**C. Nightingale. A clinical investigation of force delivery systems for orthodontic space
closure. Journal of Orthodontics, Vol. 30, 2003, 229–236.
Method of ligation
• Loosely tied wire ligatures generate less
friction that standard elastomeric modules

Bednar JR, Gruendeman GW, Sandrik JL. A comparative study of frictional

forces between orthodontic brackets and archwires. Am J Orthod Dentofacial
Orthop 1991;97:219-28.
Closing loops
• more accurately defined force systems for more
precise anchorage
• Teeth move with the archwire
• Continuous movement
• Frictionless forces
Closing loops
These loops may be fabricated as

• independent devices (segmented arch technique)

• incorporated into a continuous arch wire system
Closing loops
• Loop position
• Loop preactivation
• Loop design
• Spring properties (material, size, distance)
• Moment
Closing loops
• Placing some horizontal component improves
its ability to deliver moments needed to prevent
tipping

• The gabled T and vertical loops generate

posterior moments that are in the same direction
as the moments at the anterior ends, whereas the
Opus 70 loop's posterior moment is in the
opposite direction
Effects of helices
• The addition of the single apical helix has the
overall effect of reducing the levels of both the
force and the moment for any given activation.
There is a greater reduction in the force than in
the moment, so that the M/F ratio increase is
slightly greater than that of the standard
• The lateral helices have a considerably
different overall effect. While they lower both
the force and moment magnitudes at any
activation, they have a greater reducing effect on
the moment and, as a result, the M/F ratio is
actually lower than that of the standard system
Closing loops
Effects of Preactivation gable bends

• This procedure increases the moment, while it

has little effect on the force-deflection
relationship during activation
OPUS LOOP
OPUS LOOP
• Opus loops do have the potential to
steepen the cant of occlusal plane
T-Loop
T-Loop
Mushroom Loops
Closing Loops
• It is important for treatment results to be
under the control of the clinician. This
can only be achieved by the application of
predictable, controlled force systems.
Thank you