Fudamentals of Biomechanics and Biomechanics of Levelling and Aligning (Includes Biomechanics of Molar Control)

1
Fundamentals of
Biomechanics including
Mechanics of Leveling
and Aligning
Dr. Meenakshi Vishwanath
2
Contents
Introduction
Terms and definitions
Principles of biomechanics
One couple system
Two couple system
Leveling and aligning
-Begg and PAE systems

3
Introduction
Mechanics-is the discipline that describes the effect of
forces on bodies.

Biomechanics-study of mechanics as it affects the
biologic systems.

Application of mechanics to the biology of tooth
movement.

4
Introduction
History

Studies concerning the biology of tooth movement -
1930s
The study of mechanics and effect on periodontium-
1950s
Various methods to study mechanics
Laser holography, Photo-elasticity, Complementary
Strain Energy, F E M . .
5
Introduction
Orthodontic tooth movement Force on the teeth.

Knowledge of mechanical principles and governing
forces- necessary for the control of orthodontic
treatment.
Basis of orthodontic treatment-clinical application of
biomechanic concepts

Proper mechanical force system = medications
Treatment success.
6
Centre of Mass- All objects (finite) behave as if the
entire mass is concentrated onto a single point.

Applicable in force - free state
Behaviour- Predictable if forces acting in relation to
this point is known.
7
Centre of Gravity- objects subject to gravitational
force
Cmass / Cg - Balance point

8
Centre of Resistance- analogous to the Cmass for
restrained bodies.
Function of a body in a system of constraints-
supporting tissues.

9
10
Cres depends on-
1. Root length & Morphology
2. Number of roots
3. Level of alveolar bone support

11
Various authors differ in the estimation of Cres.
Methodology.
For single rooted teeth-
At 50% of root length-Proffit,Nikolai
B/w 50%-33% of root length-Smith and Burstone
At 33% of root length-Burstone
B/w 25%-33% of root length-Nanda
The Cres of facial bones, entire arches of teeth, or
segments can also be estimated
12
Multirooted teeth-

Maxillary anterior dentiton
Cres - maxillary anterior teeth-distal to lateral
incisor-Nanda
Incorporation of lateral incisors-small distal
shift,canines-significant distal movement-
Burstone & Sachdeva
Mutirooted-close to bifurcation of the roots
Nanda
Trifurcation-Upper I molar- Worms, Isaacson and
Speidel
13

Cres of -maxilla-slightly inferior to orbitale-Nanda

Postero-superior ridge of the pterygomaxillary fissure
registered on the median sagittal plane-Tanne et al

14
Determination of the centers of resistance of all the
individual teeth and groups of teeth using FEA.
Conclusions-
1. Longer the root, the more apically placed was the
Cres.

2. The Cres of all teeth were slightly apical to the
centroid of the teeth.

3. The Cres of Mand. Premolars lie at the same level,
Cres of I Max. Premolar is more apical to that of the
II premolar.

15
4. The Cres of the maxillary and Mandibular molar lies
at the tri/bifurcation respectively.

5. Intrusive forces on groups of teeth-Cres shifts
posteriorly as more number of teeth were included
in the segment.

6. For retractive forces on groups of teeth-Cres shifts
coronally as more number of teeth were included in
the segment.

16
Precise location-not known, conceptual awareness
needed.

Relationship of force systems to Cres of tooth-type of
tooth movement

17
Centre of Rotation- a point
around which an object
rotates.
-The geometric point about
which no movement occurs

Point around which an object seems to have rotated
as determined from its initial and final positions.
18
Method for determining centre of rotation

19
Can be at any point ON
or OFF the tooth

If there has been no
rotation-infinity

If tooth has followed an
irregular path-several
centers of rotation

20
Scalars and vectors

Force- vector
-a load applied to a object that will tend to
move it to a different position in space

F=mass x acceleration

Newtons or gm.mm/sec
2

Orthodontics- (mm/s
2
)-irrelevant

21

1 Newton=101.937 grams (or) 1 gram=.oo981 N

1 Pound=16 Oz =.4536 Kg

1Oz =28.35 grams
22
Direction and magnitude of force -
Origin/
point of application
Magnitude
Sense/Direction
Line of action
23
Multiple vectors can be combined through vector
addition
Sum of 2 or more vectors- Resultant

24
Different points of application-
Forces can be
combined using the law of
transmissibility of force.

When considering the external effects
of a force on a rigid body the force
may be considered to have a point of
application anywhere along its line
of action

25
Resolving a force into vectors-

26
Moment Rotational tendency of a force that is not
passing through the centre of resistance.

The magnitude of the moment=
Force x
lar
distance of line of action (force) to the Cres
27
Unit - Gram millimeters (Newton millimeters)
28
M=F x D

29
30
Important to distinguish between force and moment.
Cue ball concept
31

Couple consists of two forces of equal magnitude,
with parallel but non-collinear lines of action and
opposite senses.
- Two equal and opposite parallel forces separated by a
perpendicular distance.
-Applied moments
Pure rotation about the centre of resistance

32
Magnitude of a couple=Mag.of 1 force x perpendicular
dist b/w them
Unit-Gram.mm

Translational effects cancel out each other

33
Moment arm of a couple-
34
Couples result in pure rotational movement
regardless of where the couple is applied on the
object.

50 x 10=-500gm-mm
50x30=1500gm-mm

500gm-mm is negative Thus 1000gm-mm just as in
the previous case

35
Clinically
Centre of rotation coincides with the centre of resistance.
36
Forces indicated by-

Moments indicated by-
Moment of force-rotational tendency of a single force
that does not pass though the Cres-(linear movement
occurs)

Moment of couple-two forces that produce pure
rotation (no linear movement)
37

Application of force/couple usually is at the brackets

Predicting the type of tooth movement-determine the
Equivalent force system at the of resistance.

Equivalent force system- Analysis that replaces the
applied force at the bracket with its equivalent at the
at the Cres
38
The 2 extreme situations-
Force exactly at the centre of
resistance-only linear
movement (translation).
Forces that produce pure
rotation.

All situations in between the
two produce some
translatory and some
rotatory movements.

So what are the forces at the Cres and what type of tooth movement results?
39
Determining the force system at the Cres
1. Place force vector at the Cres (maintain
magnitude and direction)
2. Calculate -moment of force
3. Place M
F
- centre of resistance
4. Applied moment placed at the Cres
5. The M
F
and applied moment added net
moment
6. Resulting force - expected tooth movement
100gm
10mm
1000gmm
1000gmm
40
41
Principles of
biomechanics
42
43
Biomechanics
Bio-mechanics
Cmass /gravity/res
Centre of rotation
Forces and Moments
Couple
Moment of force/Moment of couple
Equivalent force system
44
Equivalent force system-
It is the forces at the centre of resistance that
determine how teeth move.

The force system placed at the bracket is
equated at the Cres to determine the tooth
movement.

Helps in-Prediction of the tooth movement

Equivalent force system- Analysis that replaces the
applied force at the bracket with its equivalent at the
the Cres
45
46
Types of tooth movement-infinite variety but can be
categorized into basic types
uncontrolled
Tipping
controlled
Translation
Root movement
Rotation
47
Each type of tooth movement is due to the variation
in the amount of applied moment and force.

The ratio of the applied counter moment and the
applied force experienced at the Cres is called the
Moment- to- force ratio .

The M/F ratio of the applied force and moment
determines the type of movement at the centre of
rotation.
Unit-millimeters
48
Tipping-
Greater movement of the crown than the root.

Centre of rotation-Apical to the Cres

Uncontrolled tipping Controlled tipping
Between Cres and root apex At the root apex
49
Uncontrolled tipping-
Simplest type of movement often undesirable.

Simple forces-chain elastics, intraoral-arch elastics,
or coil springs used on a round wire.

50
Non uniform stress generated

Maximum-root apex and crown

M/F =0:1 - 5:1
(av.root lengths and 100% alveolar bone height)

Desirable-Cl II div 2 and Cl III patients with
excessively upright incisors that need flaring &
excessively flared Cl II div 1.
51
Controlled tipping
Control or maintenance of the root apex
position.
Desirable type of tooth movement.

52
Stress at root apex is
minimal
Concentration of forces at
the cervical area-timely
tooth movement
Protrusive incisors (Root
apex in a good position)
M/F=7:1

53
Translation (bodily movement)- crown and root
move the same distance in the same direction.

Centre of rotation-infinity

54
For this type of tooth movement-Force-centre of
resistance
Force applied at the bracket.
counter moment applied in such away that-
equivalent force system at the Cres pure force.

55
M/F-10:1
56
Root movement- crown is stationary -force and
moment cause only root movement

Centre of rotation-incisal or bracket
Requires a large moment-M/F ratio at or above 12:1

57
Stress levels high at apex significant amount of bone
resorption required.
Undermining resorption-slow moment
Advantageous-augments anchorage

58
Clinically-
-Upright the incisors, correct the canine roots after
space closure.
-crowns should be ligated to stop them from moving
-Lingual root movement of incisors-large forces may
cause a Row boat effect

59
Rotation requires a
couple
No net force at the Cres
Clinically-rotated teeth.
60
61
True relevance of M/F ratio-
Biologic variations in estimation of Cres
Difference in the M/F ratio of various tooth
movements is small.
Difference in opinion about precise M/F ratios

62
The M/F ratio need not be taken as absolute-
General principles are important-

63
Static equilibrium-

Effort was put to achieve the equilibrium
64
In orthodontics-equilibrium establishes itself

We do not have to achieve static equilibrium but
recognize the forces and moments that have come
into existence to establish the static state.
65
Newtons laws of motion-underlie the fundamental
concept of mechanics.

1.Law of inertia

2.The law of acceleration

3.The law of action and reaction
66
Application of these laws-orthodontics

Wire engaged into poorly aligned teeth-1
st
& 3
rd
laws

A more important application of Law of action and
reaction is static equilibrium.
67
Static equilibrium implies -At any point within a
body, the sum of forces and moments acting on a
body is zero.
The analysis of equilibrium as applied to orthodontics
can be stated as
68
Sum of all vertical forces =0

Anterior intrusion-have to deal with-the balancing
force-molar extrusion.

69

Sum of all horizontal forces=0

Correction of unilateral crossbite-not possible with a
single horizontal force
70
71
Moment acting around any
point must = 0.

Forces produced to maintain
static equilibrium

Magnitude of forces exactly
necessary to produce a
counter rotation.

72
73
Equilibrium situations
Many appliances and bends placed in clinical
situations
Many situations unequal forces and moments
develop.
Additional forces-develop to obtain equilibrium
Determination of complete system in equilibrium-
side effects.

74
The forces and moments that determine a appliances
equilibrium must exist.

If not-Newtons 2
nd
law-teeth will accelerate out of
the mouth!
75
Determinate Vs Indeterminate
force systems
Force systems can be-

Statically determinate (One couple system)
The forces and moments can readily be discerned,
measured and evaluated.

Statically indeterminate (Two couple system)
System is too complex for precisely measuring all
forces and moments involved in equilibrium.
76
Biomechanical classification of
orthodontic appliances

Equal and opposite force system
(No couple appliance system)

One couple appliance system

Two couple appliance system

77
Force systems
Equal and opposite force system-No couple

Elastic band stretched between 2 points
78
Statically determinate
One couple system- Simplest arrangement of an
orthodontic force system.

Couple is created ay one end of the attachment only
force at the other.

One end tube or bracket and point contact at
the other.
79
The direction of moment clinically can be estimated
placing one end of the arch wire over but not inside
the slot.
The wire crosses the bracket at an angle.

80
81
82
Magnitude of forces-measurable

Force multiplied by the distance b/w bracket and
point of attachment=moment-equal and opposite to
Mc at bracket.

Magnitude of forces of couple at the bracket-divide
the magnitude of Mc by the length of bracket.
83
84
High predictability of tooth movement.

Decreased need of appliance reactivation.

Side effects known

85
Applications of one couple systems-
Cantilever spring applications
Canine extrusion springs
Midline springs
Anterior intrusion arches
Anterior extrusion arches

86
Statically Indeterminate
Two couple system-When the free end of the arch
wire-inserted into a second bracket.

For the purpose of establishing the direction of
associated equilibrium forces-sum of 2 successive 1
bracket systems

Couples-each of 2 brackets

87
The entry of wire not accurate estimate of direction
of Mc

When wire placed over bracket-angle of entry
determines-larger/smaller moment

The force systems-depend on wire geometry and
bracket angulation relationships.
88
Applications of two couple systems-
Utility arches
Upside-down Utility arches
Torquing arches
Upside-down torquing arches
Transverse activations
Segmented springs
Transpalatal/lingual arches
89
Description of Force system in 3 bracket wire
situations-
1. Off-Centre V bend
2. Centre V bend
3. Step Bend

4. Straight wire passed through non - aligned brackets

90
Location of the centre of resistance-
91
Off-centered V bends (asymmetric bend
relationship)
Creates unequal and opposite couples.
The net equilibrium forces-intrude one unit,
extrude the other.
Total magnitude of system-not certain, relative
magnitude can be determined.
The larger moment-indicates the direction of
equilibrium forces.

92
93
Magnitude of b-does
not mean stronger
extrusion as the
anchorage value of the
tooth is more.

94
95
1/3
rd
the way along the inter bracket span-no moment
on the distant tooth.

Closure than 1/3
rd
moment generated in the same
direction.
96
Centered V bend
Creates equal and opposite couples at the brackets.

The associated equilibrium forces at each bracket-
equal and opposite cancel each other out.

97
The location of Cres has no effects on the reactions produced
98
Need not be half-way b/w the 2 groups of teeth

If 1 tooth is larger-equal and opposite moments
require-bend to be placed closer to the larger tooth
99
3_D wire will cause torsion and bending to occur.

FEM used-description of forces & couples along the
global co-ordinates.

17 X 25 ss wire

MY1 ,MY2 & associated
equilibriums-FZ1 & FZ2

100
101
2 opinions on location of Cres-

2 teeth as individual units
A single unit -1 Cres
102
Step bends-

Creates 2 couples in the same direction-
regardless of location between brackets.

Location of step bend-no effect on either
magnitude of moments or equilibrium forces.
103
Forces generated are
stronger than the off-
centered V bend situation

If the Cres changes-similar
effect of that seen in Off-
centre V bend .

104
105
106

107
Straight wire placed in a non - aligned
brackets-
Arch wire is placed in mouth-complicated set of
forces on each tooth
Simplest basic unit- two tooth segment of an arch
Series of 2 tooth systems-forces can be found along
the arch.

Force systems in a ideal arch wire-Burstone &Koenig
AJO-1974
108
The force system produced by a straight wire placed
between two attachments-determined by defining the
Wire-attachment geometry.

Interbracket axis-L-connects the 2 centers of
attachment
A & B -angles of attachment respect to interbracket
axis

109
Six basic 2 tooth geometries A/ B
110
Relative force systems-
111
Actual M/F ratios
112
Actual M/F ratios
113
Actual M/F ratios
114
Actual M/F ratios
115
Actual M/F ratios
116
Actual M/F ratios
117
Dogma of ideal arch-wire is bent into a shape one
would like the brackets to be found at the end of
treatment teeth move into that positions on the
ideal arch.

Validity???

Rigid wire-acts as a mould.
118
Each segment of the arch wire (2 tooth) has different
forces and moments generated.

Not under the control of orthodontist.

Sheer chance that desired force system would be
produced!
119
Common sense application of mechanical principles.

Dealing with the biologic environment-variation in
response - challenges the orthodontist.

Understanding of the appliance of choice and the
various force systems.

Treat in a practical & realistic manner.

120
Visual inspection-
Frequently used to determine the forces an arch
wire will produce

May seem obvious-Faulty conclusions.

Determine the forces and moments
121
What force will be produced?
On the molar? Extrusive . Intrusive. None.
On the Cuspid? Extrusive. Intrusive. None.
122
What force will be produced?
On the Central Incisor?
On the Lateral Incisor?
Extrusive. Intrusive. None.
123
All figures described only 4 situations

Archwire bends-centre and off-centre

Can describe the force system by noting the location
of the bend.

124
A Simple Rule.
Bend off center: short and long segment.
Short segment engaged long segment point in
direction of the force produced.
Short segment points in the opposite direction of
the force.

125
Bend at center: no short or long segments- forces as
cancel each other upon engagement leaving only pure
moments.
126
Fundamentals of
and Aligning
127
Biomechanics of leveling and
aligning-Introduction
Usually the first step orthodontic treatment plan.
Division of treatment into stages-Begg, but
reasonably applicable to PAE.
3 major stages in comprehensive treatment plan-
1. Alignment and leveling
2. Correction of molar relation and space closure
3. Finishing

128
Introduction
Goals of I phase of treatment-

To create a harmonious dental arch without
irregularities
&
Correct vertical discrepancies by leveling out
arches.

129
Introduction
Leveling and aligning in PAE - synonymous with the
stage I in Begg.

Proper alignment- one not only brings malposed
teeth into the arch but- control antero-posterior
positions, width of arches and form of dental arches.

Leveling-determine and control-extrusion of
posterior teeth ,intrusion of anteriors or a specific
combination of the 2.

130
Introduction
Types of tooth movement-infinite variety but can be
categorized into basic types
uncontrolled
Tipping
controlled
Translation
Root movement
Rotation

131
Introduction
Uncontrolled tipping-

M/F =0:1 - 5:1
Controlled tipping M/F=7:1
132
Introduction
Translation (bodily movement)-
M/F-10:1
133
Introduction
Root movement- M/F ratio at or above 12:1
Rotation -
134
Alignment
Though generally agreed- Bite before Jet- BUT
treating cases of maligned arches alignment becomes
important.

Once the teeth are aligned-all teeth can be intruded.

Alignment-create space for correcting crowded teeth
or to close excess space if present.

135
Alignment

Depending on individual treatment goals-all teeth
aligned at the same time or some teeth excluded to
avoid round - tripping.

Early alignment-corrections maintained for a longer
time biologic adaptation and enhanced stability.

A combination of labiolingual and mesiodistal
tipping guided by an arch wire is needed.
136
Principles in choice of alignment
arches
Initial arch wires should provide-light continuous force -
50grams

Most often achieved- placing wires with low load
deflection rates and shape memory-NiTi ,multistranded and
small cross-sec SS wires.

Arch wires should freely slide within the brackets-at least
a 2mil clearance B/w arch wire and bracket.
137
arches

Wires should be loosely ligated

Loosely ligated, so that it can slide through the
brackets, it has th the stiffness of a wire that is
tightly ligated.
138
arches
Rectangular wires avoided -(root apices are closure
to the normal position).
Better to tip the crowns into position during initial
alignment.

Rectangular wire useful-torque expression right from
start-root positions not favorable-
Instanding laterals
Soon after arch expansion

139
Properties of alignment arch wires
Combination of strength, springiness and long range
of action.

The variables in selecting appropriate arch wires for
alignment-
Arch wire material
Cross-section
Distance between attachments
140
Arch wire material
Titanium based wires NiTi and TMA offer
better combination of springiness and strength.
NiTi wires-better (springier and stronger) than TMA-
preferred.
Remarkably -Low-load deflection.

If steel is used in this stage-Multistranded wires or
loops.

141
Size of wire
Strength changes as a cubic fn of the ratio of the 2
cross sections.
Springiness-4
th
power
Range-direct proportion

As the wire size increases though strength increases
rapidly, springiness decreases even more.

The smallest diameter wire (springy) of adequate
strength can be used.
142
Size of wire
Multistanded wire- They are composed of specified
numbers of thin wire sections coiled around each
other to provide round or rectangular cross section

On bending - individual strands slip over each other ,
making bending easy.

Result - high elastic modulus wire behaving like a
low stiffness wire

143
Distance B/w attachments
Increase the length of the wire-
Loops

Proportionate decrease in strength, but the
stiffness will decrease as a cubic function

The width of bracket determines the beam length if a
continuous wire is used.

144
Arch wire -materials
145
Space creation
In case of crowding , space required for alignment
can be obtained in the following ways-

Proclination
Canine distalization
Arch expansion
Interproximal reduction

146
Aligning in Begg
Stage-I
SUB-STAGE I-A SUB-STAGE I-B
Objectives of substage I-A
1.Create space
2.Alingment of anterior teeth-Labio-lingual
displacements & rotations,anterior crossbites
3.Improve incisor inclination-+/- 10 of normal
147
Aligning in Begg
4.Rotations ,bucco-lingual positions of molars-
crossbites
5.Premolar rotations
6.Upper arch form corrected-0.016

Completion of substage I-A-full engagement of plain
arch wire-intrusive -forces applied to all teeth.
Inclinations are improved-true intrusion & controlled
tipping is achieved.

148
Aligning in Begg

Alignment best carried out-flexible wires low load
deflection rate.
Easy engagement
Light constant forces-long distances
Permit sliding
149
Aligning in Begg
Multilooped archwire-though made of stiff wire-loops
incorporated-anterior area

Disadvantages-
Inadequate bite opening
Labial flaring of incisors
Loss of control over molar positions & anchorage
Difficulty in construction and adjustment
Difficulty in maintaining the arch form

150
Aligning in Begg
Alignment without multilooped wires-
0.016 canine distalization-sliding along the arch
wire.
Flexible wires-steel base wire.

Thus choice made between various sizes of steel,
multistranded wires and NiTi-singly or combinations.

151
Aligning in Begg
Full length NiTi can be used-
Highly placed canine-class II elastics (ultra light)-
bite does not deepen as extrusive component of
elastic is negated.
Open bite situations

If bite already deep-and elastics given-combination of
flexible and steel wire-(anchor bend is given )-can be
used

152
Aligning in Begg
If canine has to be distalized for space creation-the
SS wire 0.014 or 0.016 is to be used.
Minimal crowding-cuspid circle positions can be
altered ;offset bends can be given in the wire-partially
active.

More crowding-canines slide along the wire-elastics.

153
Aligning in Begg
Rotational correction-bracket slot should be filled

Larger diameter NiTi are better

If small diameter steel used-Exaggerated
horizontal offsets have to be given.
154
Aligning in Begg
Flexible sectionals are used-
Only after canine distalization and there is
sufficient space for decrowding.
NiTi,Co-ax or supreme wires used as-sectionals
with a base wire to prevent adverse effects.
Base wires are given offsets to keep away from
brackets.
155
Aligning in Begg
Anchorage considerations in stage I
Very efficient control- sagittal direction-stationary
anchorage
Anchorage loss-heavy elastic force
Anchorage conserved-
TPA
Anchor bends
Stiff wires-molar stops
Lip bumpers

156
Aligning in PAE
Pre adjusted edgewise system-

The tooth movement needed to achieve passive
engagement of a steel rectangular wire of .019/.025
dimension and of suitable arch form, into a correctly
placed preadjusted .022 bracket system.

157
Aligning in PAE
Anchorage control gains importance-

Successful alignment depends on recognizing
unwanted tooth movements - occur early in the
treatment built in tip in the brackets.

Final treatment goal-kept in mind

Anchorage requirement changes-case to case-
most cases do require some form
158
Aligning in PAE
Reduce anchorage needs-
Arch wire forces-very light
E-chains to be avoided
Lace backs to be given-restrict canine tipping-
mainly used premolar extraction cases

159
Aligning in PAE
Bendbacks for antro-posterior control
160
Aligning in PAE
Wire sequencing
161
Aligning in PAE
Vertical control of incisors-built in tip-increases the
overbite
Canine distally tipped-extrusion of incisors

162
Biomechanics of aligning
Biomechanics-Continuous arch/Segmented arch

Special situations-
Impacted canine
Midline correction
Diastema closure
Molar rotations
163
Biomechanics in a continuous arch-
164
165
To avoid undesirable force-
Bracket fewer teeth-sectional arch system

Segmented arch technique-
Concept-the arch is divided into segments
Better control and favorable force levels
Well defined units of teeth-anchorage and
movement segments clearly defined

166
In segmented mechanics-TPA/lingual arches used;
stabalizing wire segments

Stabilization requires-most rigid wire-.022 edwiese
slot preferred

21 x25 anchor segments

167
Segmented arch treatment-
Initial alignment within antero-posterior segments
Once teeth within segments-aligned, each treated
as 1 large multi-rooted tooth
Creation of appropriate-anchorage and tooth
moving segment
Vertical correction and space closure with
differential movement of anterior& posterior
segments
Friction almost avoided
168
Vary the cross section of wire-
Segmentation allows-use of different cross-sec
wires at different locations in same arch.

169
Special situations- Aligning
Canine extrusion spring- High facially placed
Wire bent passive to occlusal
to canine

Wire activated-2
nd
order
couple created

Equilibrium forces develop

170
If continuous wire were used-incisor intrusion-anterior open
bite
171
Effects extrusive force-
Third order moment created
Canine-crown lingual ;root-facial
Force passes facial to Cres

Wire inserted into the bracket-lingual root torque
applied-side effect labial root torque on molar.
Statically indeterminate system
Care taken-no 2
nd
order activation at the canine

172
173
Canine extrusion spring- Palatally placed
Similar activation as previous
situation

Third order couple created at
molar-passive TPA
174
Palatal to facial canine movement
1
st
order couple at molar
tube

Equilibrium forces-Facial
canine movement

TPA- molar
175
176
Midline springs
Wire lateral to incisors
in direction in which
movement required

Force system-similar to
previous situation
177
178
Diastema closure
179
Molar rotations-Transverse corrections
Can be done on a 2 x 2/4

2x6 anterior segment visualized as one large
tooth.

Predominantly molar movement

180
Symmetrical V bends
Molar mesial- out rotations

Molar mesial- in rotations
181
Moments-Bilateral
toe-in
Canine -distal out
Molar mesial out
Anterior segment-large
tooth-cancel each other

Increases arch perimeter

Correction of class II
malocclusion
182
Bilateral toe-outs
Mesial-in molar
rotations
Correction of molar
rotation

Decrease the arch
perimeter
183
Asymmertrical V bends

Larger angle of entry-
determines direction and
not magnitude of
equilibrium forces

Premolar should not be
engaged

184
185
Molar mesial-out
rotations-
Molar M-out rotations and
intermolar expansion
186
Molar mesial in
rotations
Reversal of situations

Bilateral molar M-in rotations
and constriction of inter molar
width
187
Molar constriction
Bend-closure to canine
Little or no molar
rotation

Constriction of intermolar width
with minimum molar rotations
are desired
188
Molar expansion

Molar expansion-
minimal rotations
189
Step bends

Magnitude of the 2 M of
couple need not be
equal-but associated
equilibrium forces are
always equal
190
Molar expansion-
Toe-out

M-out rotations &
enhanced expansive
equilibrium forces.
191
Molar constriction-
Toe-in

M-out rotations and
greater constrictive forces
192
Fundamentals of
and Aligning
193
Biomechanics of leveling-
Introduction
Goals of I phase of treatment-

To create a harmonious dental arch without
irregularities
&
Correct vertical discrepancies by leveling
out arches.

194
Introduction
Overbite- vertical overlap of the incisors.

Lower incisal edges contact the lingual surface of the
upper incisors at or above the cingulum.

Normal overbite-2-3mm

Deep bite-increased to more than 3mm -1oo% bite
Open bite-no vertical overlap of the teeth.

195
Introduction
Etiologic classification of deep bite-
Developmental
Skeletal deep bite
Dentoalveolar deep bite supraeruption of
incisors (interocclusal clearance-small)-pseudo-
deep bite

196
Introduction
Acquired deep bite-
Lateral tongue thrust-infraocclusion of posterior
teeth-large freeway space-class II div 2.-true
deep bite
Premature loss of deciduous teeth or early loss of
permanent molars
Wearing away of occlusal surface

197
Introduction
Etiologic considerations of open bite-
Epigenetic factors-
Posture, morphology and size of tongue
Skeletal growth pattern of maxilla and mandible
Vertical relation of jaws

198
Introduction
Environmental factors-
Abnormal respiration

199
Introduction
The development of vertical problems-
The anterior teeth continue to erupt until contact
is made with opposing anterior teeth.

If increased jet-continue to erupt-touch palate

200
Introduction
Stop erupting if mechanical obstruction-
thumb/tongue restricts

Unrestricted eruption of lower 2
nd
permanent molar-
posterior part of curve of spee.
201
Tooth movements of bite opening
Bite opening can mainly be done by-
Absolute intrusion
Relative intrusion
Extrusion of posterior teeth/distal tipping
Proclination of incisors
Combination

202
Criteria for the mode of bite opening-
Age of patient- amount of growth left
Growth pattern-horizontal/vertical
Incisor exposure at rest-
upper incisor exposure more than 2 - 3mm
Upper exposure normal-deep curve of spee-lower
incisor intrusion.
203
Tooth movements of bite opening-
1.Absolute intrusion of incisors-
Required when hyperdivergent growth pattern
204
Adult patients-molar extrusion is not
compensated by vertical ramal growth.

205
2.Relative intrusion of incisors- kept where they are,
mandible grows and posterior teeth erupt.
Eruption of posterior teeth is a normal molar
vertical change in a growing individual-stable

206
Increase in vertical face height-accommodates if
any orthodontic extrusion occurs leveling the
COS, intermaxillary elastics

207
3-a Extrusion of posterior teeth-not compensated in
adults-
Low mandibular plane angle-not stable-
musculature resists extrusion
High angle cases-weaker musculature-teeth may
remain stable-opening of the mandibular plane-
undesirable
208
3-b Distal tipping of posterior teeth-similar to the
previous situation
209
4.Proclination of incisors- retroclined incisors-deep
bite.
210
Combination of the above-
Ex-Bite plate effect-
Proclination

Incisor intrusion

Posterior extrusion
211
The importance of 2
nd
molars-
Early banding esp. in low angle and deep bite
cases.
Inclusion of 2
nd
molars-lever for extrusion of
premolars and assists molar intrusion.

212
Principles for intrusion
Burstones important principles for intrusion-
Light constant force
Single point of force application
Sequential intrusion
Good anchorage control
Analysis of forces and moments in each
biomechanical situation
213
Leveling by intrusion
Bypass mechanics -
Begg bends and modifications
Cetlins intrusion arch
2x 4 mechanics
Utility arch

214
Segmented mechanics-
Burstones intrusion arch
3-piece intrusion arch
Connecticut intrusion arch

215
Leveling by extrusion (relative
intrusion)
Continuous arch-
COS
Kamedas modification
Anchor curve
K-SIR archwire

216
Bypass Arches
Begg mechanics-
Conventional Begg-mainly resulted in molar
extrusion.

Heavy elastics and not so rigid base wires.

More emphasis true incisor intrusion

Various methods of incisor intrusion and different
arch wire modifications for improving efficacy of
incisor intrusion.
217
Bypass Arches
Begg mechanics-
All 6 anteriors are intruded together -Anchor bend

Anchor bend-

218
Bypass Arches
Round wire derives its bite opening force-anchor
bend.
Force passes labial to Cres
Labial flaring of incisors-undesirable
Class II elastics
219
Bypass Arches
Class II elastics-horizontal and vertical component-

Vertical component-Dec the efficacy of intrusive force
Horizontal component-influences the net resulting
force.
220
Bypass Arches
Interplay b/w intrusive force and retractive (elastic)
force-
Begg technique controls the vertical dimension-
planned imbalance between archwire and elastic
force.
Optimal intrusive force-15-30 grams/upper incisor

221
Bypass Arches
Kesling

Bite opening bends-1.5-1.2 oz midlines

Class II extrusive force-I oz

Net intrusive force-0.5 oz

222
Bypass Arches
14 g for 3 teeth-below optimal force
Lower incisors-1.2 oz-30 grams
Upper incisors should receive -60-70 g net force.

Class II elastic force-very light forces to be used (reqd
for tipping)
Yellow (5/16) or road runner (3/8)-5 g

223
Bypass Arches
Exact estimate of force value not possible
Higher intrusive archwire force and light extrusive
force
Arch wire size-table
224
Bypass Arches
Mollenhauer -0.18 ss (PP)-50
Severe tip of the anchor molars

Distal elastics wire ends

Molar tubes on both 1
st
and 2
nd
molars-vertical
anchorage -2 molars on either side

Bite opening curve

225
Bypass Arches
Direction of resultant force-
Teeth move in direction of resultant-intrusive and
elastic force.
Resultant ideally - pass thro the Cres.

Resultant depends on -interplay B/w,

Magnitude of intrusive force (direction-constant)

226
Bypass Arches
Magnitude and direction of elastic force-

Different inclinations of anterior teeth-different
combination of forces

227
Bypass Arches
Teeth - very proclined-low intrusive force & light
class II-intrusion and retraction

As proclination decreases -increase amount of
intrusive force-inc. bend /change wire
228
Bypass Arches
Change in vertical orientation becomes progressively
smaller for same increments of inc. in intrusive force-
Class II force-less magnitude

Class I-inclination improves
(Reinforce anchorage)
229
Bypass Arches
Elastics from a higher point of attachment

Direct high pull headgear-inc in force level-damage
the roots
230
Bypass Arches
Incisors-retroclined-no elastic force initially

231
Bypass Arches
Location of bite opening bends-different sites of
bends-actions different

232
Bypass Arches
Conventional anchor bend-3mm mesial to molar
tube-bowing of the archwire-more intrusion of
upper canines

233
Bypass Arches
Gable bend-distal to canine-maintain intrusion-
relative extrusion of canines

Hocevars modification-bend on either side of canine-
only centrals intruded-canine and laterals extruded.
234
Bypass Arches
Modifications for uniform intrusion-6 anteriors-
requiring significant amount of intrusion.
Gingival curve-Swain

235
Bypass Arches
Vertical step-up-augments intrusive action. Intrusive
force applied higher offsets extrusive action of
gingival curve on canines-uniform intrusion 6 teeth

236
Bypass Arches
Cuspid circles anterior incisal-prevents extrusion
237
Bypass Arches
Elastics from TPA (Palatal elastics) Dr.Jayade
Direction of elastic has to be changed.

Hooks soldered line with lateral incisors.
Oval shaped wire-soldered at the centre-lower
from palate-neutralize extrusive component on
molars.

238
Bypass Arches
Manipulating mechanics of palatal elastics-
Neutralizes proclining effect of arch wire
Augments intrusive force
239
Bypass Arches
Cephalogram used to find resultant-labially
acting-intrusive force and palatal elastic (barium
coated)

240
Bypass Arches
241
Bypass Arches
Power arms-Dr. Jyothindra kumar
0.018 x 0.025 hooks formed and soldered to the
buccal aspect of upper molars
242
Bypass Arches
Cetlinss intrusion arches-
Progressive /sequential intrusion-

243
Bypass Arches
Normally inclined incisors-
Rectangular sectional on incisors

244
Bypass Arches
Intrusion arch tied to sectional wire-b/w central
and lateral
Light(2 oz) force-counter labial tipping
245
Bypass Arches
Labially inclined-PFA moved distally
Rectangular-0.018x 0.025 inch/0.021 x 0.025
Wire extended distally-2 helices bent-Rt. angles to
intrusion arch

246
Bypass Arches
Helices=PFA-slightly in front of Cres.
Light elastic force

247
Bypass Arches
Lingually inclined-PFA moved front
Rigid rectangular -0.018 x 0.025/0.021 x 0.025-
sectional on centrals
248
Bypass Arches
Wire bent forward and upward-hooks bent
Inserted into intrusion arch
Light elastic force

249
Bypass Arches
2 x 4 mechanics- 2 molars banded & 4 brackets on
incisors.
Analysis of the 2 x 4 appliance system-
Incisors considered as 1 unit -1 centre of
resistance

Only molars and incisors bracketed-couples
created and stored in the wires-larger with higher
range than fully bracketed appliance system
250
Bypass Arches
The essence of activating a 2 x 4 create and control
moments and their equilibrium forces.
2 x 4 one couple
251
Bypass Arches
252
Bypass Arches
2 x 4 two couple
253
Bypass Arches
254
Bypass Arches
Mulligans 2 x 4 can be used in the Begg set up-

Upper molars do not require tipping-helix bent into arch
wire- 2-3mm mesial
Anchor bend ,continuation of the helix
No cuspid circles required

Rowing effect-moments at molars- retract incisors

255
Bypass Arches
256
Bypass Arches
Utility arches- one of the most versatile auxiliary
arch wires-
Developed according to biomechanical principles
described by Burstone and popularized by
Ricketts.
Originally developed-to level the curve of Spee.
Through the incorporation of loops performs
more functions than intrusion.

Passive, intrusion, retraction, protraction utility
257
Bypass Arches
Basic components of utility arches-
Wire material- -blue elgiloy
- in .018 slot .016 x .022- slot (maxilla) & .016 x .016-
mandibular
- in .022 slot-.019 x .019
Continuous rectangular steel wire-bypass mechanics
258
Bypass Arches
Intrusion utility-
Stepped gingivally at the molars
5mm space between anterior border of auxiliary
tube and post. vertical segment.

259
Bypass Arches
Activation-2 ways
Bench (1988) tip back bend in molar
Posterior tipping of molars seen
260
Bypass Arches
Gable bend-unwanted posterior tipping avoided

261
Bypass Arches
Similar to intrusion arch-biomechanics differ

Line of force in utility arch dictated by the location
of the bracket-always be facial
In one couple-point contact-line of force varied.

Third order couple created-equilibrium forces
modified

262
Bypass Arches
263
Bypass Arches
If torque introduced-
264
Bypass Arches
Cinching back the wire-new horizontal
system

Molar root-mesially- Cres of moves mesially
Lingual force at incisor brackets-restricts flaring
Lingual root movement
265
Fundamentals of
and Aligning
266
Bite opening can mainly be done by-
Absolute intrusion
Relative intrusion
Extrusion of posterior teeth/distal tipping
Proclination of incisors
Combination

267
Bypass mechanics -
Begg bends and modifications
Cetlins intrusion arch
2x 4 mechanics
Utility arch

268
Segmented mechanics-
Burstones intrusion arch
3-piece intrusion arch
Connecticut intrusion arch

269
Leveling by extrusion (relative
intrusion)
Continuous arch-
COS
Kamedas modification
Anchor curve
Leveling by Extrusive mechanics

270
Segmented mechanics
Initial alignment within antero-posterior segments
Once teeth within segments-aligned, each treated
as 1 large multi-rooted tooth
Creation of appropriate-anchorage and tooth
moving segment
Segmented arch technique not only has advantages
when aligning or space closure is required; but
produces genuine intrusion of anterior teeth

271
Segmented mechanics
Burstones intrusion arch-

The basic mechanism for intrusion in segmented
arch consists of 3 parts-

1. Posterior anchorage unit
2. An anterior segment
3. Intrusive arch spring

272
Segmented mechanics
Posterior teeth aligned and joined together-buccal
stabilizing unit at least -0.018 x 0.018 (0.022).
Right and left segments joined together-TPA / low
lingual arch

273
Segmented mechanics
No need of continuous adjustments-single
multirooted tooth
To increase stability-0.018 x 0.025 or 0.021 x 0.025
can also be placed in the posterior segment
Intrusive springs-auxiliary tube -.018 x .025

Standardized regardless of slot dimension of strap up
274
Segmented mechanics

The tooth to tooth adjustments are not made-only
adjustments required - b/w auxiliary tube on molar
and anterior segment.

275
Segmented mechanics
The intrusion arch-
.018 x .025 edgewise wire
3mm helix wound - 2 times placed mesial to
auxiliary tube.

276
Segmented mechanics
Curvature placed so that incisal portion lies gingival
to incisors.
Arch - tied to level of the incisors
In order that arch length does not increase during
activation-gentle curvature given

277
Segmented mechanics
Curvature increases as one approaches the helix
Activated wire-appears straight
As arch length decreases during intrusion-no labial
flaring produced

278
Segmented mechanics
Intrusive spring is not directly engaged into the
incisor bracket
An anterior alignment arch 0r anterior segment wire-
in incisor brackets
Intrusive wire is placed either labially, incisally,or
gingivally to the wire.

279
Segmented mechanics
280
Segmented mechanics
Canine intrusion spring-
Canine is bypassed during intrusion-
100 grams / side required-intrusion of incisors
and canines

If perpendicular distance-30mm-3000 gm.mm of
moment on the posterior segment

Headgear required
281
Segmented mechanics
2 situations requiring separate canine intrusion-
Canine lies (bilaterally) occlusal to premolar
Canines have not erupted symmetrically

Canine intrusion spring- .018 x.025-auxiliary tube
Labial flaring prevented-constructive force in the
spring

282
Segmented mechanics
If molar auxiliary tube not available-most anterior
premolar tube used

Canine root spring-simultaneously retract the root
and intrude the canine
283
Segmented mechanics
Three piece intrusion (base) arch-
Simultaneous correction of deep bite correction
and space closure in patients with flared incisors.
Intrusive force and its direction-effectively
controlled.
Simultaneous control in vertical &
anteroposterior planes
Low load deflection rate- constant force
Statically determinate force system

284
Segmented mechanics
Intrusion arch developed-True intrusion of either
upper or lower anteriors
In a case with flared incisors-continuous arch wire-
worsens the axial inclinations of anterior teeth.

285
Segmented mechanics
1 solution-distal extensions
286
Segmented mechanics
Using segmented arch technique-precise and
predictable force system

Pure intrusion and axial inclination control
anteriors

Well controlled moment-posteriors

Constant levels of force maintained

287
Segmented mechanics
Right and left buccal segments-aligned-.017 x .025 SS

TPA-.032 x.032 SS

Canines may be retracted separately included in the
buccal segments or left in initial positions

Anterior segment-aligned-low stiffness wire

288
Segmented mechanics
Assessment of location of Cres

Lateral cephalogram

4 incisors usually estimated-half way b/w crest of
alveolar bone and root apex of lateral incisor-sagittal
plane

289
Segmented mechanics
The intrusion arch-
.018 x .025 or .021 x .25 SS wire with distal
extensions below Cres placed passively-anterior
brackets
Distal extensions-end 2-3 mm distal to Cres
Anterior segment-stepped around the canines
290
Segmented mechanics
Bilateral tipback spring -.017 x.025 TMA

291
Segmented mechanics
Biomechanics
Intrusive force perpendicular to distal extension
-through Cres intrude incisor segment
Change in the net intrusive force-small distal force
Force-lingual to Cres
Line of force-parallel to long axis

292
The force-lingual to Cres-combination of intrusion
and tipback of anterior teeth
Line of action-made parallel-appropriate distal force
Line of action-through Cres-point of force application
anterior-close to distal end of lateral bracket.

293
Segmented mechanics
Intrusive force-placed distally-moment generated
tip back of anterior teeth
Distal force-low-redirect the intrusive force

294
Segmented mechanics
Clinical applications-

Simultaneous intrusion and tip back-space closed
b/w canines and incisors.

Distal movement of canines-as anteriors retract

If canines-distalized first-included in buccal
segment

295
Tip back moment molar-900 gm.mm

296
Segmented mechanics
Redirection of force-reduces the moment on the
molar

Headgear not required
297
Segmented mechanics
Resulting force system-modified by changing
magnitudes, point of application of intrusive and
distal forces with respect to Cres.

298
Segmented mechanics
Connecticut intrusion arch- Ravindra Nanda et
al
CTA-fabricated -NiTi alloy
Preformed appropriate bends
2 wire sizes-.016 x .o22 & .017 x .025

299
Segmented mechanics
300
Segmented mechanics
Various applications-
Incisor intrusion
Class II molar correction
Incisor flaring
Correction of minor open bite
Correction of anterior occlusal cant

301
Segmented mechanics
Incisor intrusion-
50 grams
Slight differences in placement-alter force system
during activation
Spring gauges used
1mm-every 6 weeks
Headgear required

302
Segmented mechanics
Point contact-tying the intrusion arch

Excess flaring-tied at lateral incisors

Labial flaring prevented-tight cinch.

303
Segmented mechanics
Steps how CTA is used for incisor intrusion-
1. Insert section of wire-incisor brackets
2. Choose appropriate CTA (long for non - extraction or
short for extraction/mixed dentition)
3. Cut-leaving 3mm/side cinch back
4. Insert posterior legs into auxiliary tubes
5. Tie CTA to anterior segment at lateral incisors & b/w
centrals.

304
Segmented mechanics
305
Segmented mechanics
306
Segmented mechanics
Simultaneous class II molar correction-
v bend distal crown
High-pull headgear outer bow above Cres to
upright the roots
307
Segmented mechanics
308
Segmented mechanics
Incisor flaring-
Either full engagement into bracket
No cinch back
309
Segmented mechanics
Correction of open bite-
CTA inserted upside
down
Anterior portion of wire-
occlusal to incisors
Extrusion of incisors
Mesial tipping moment-
intrusive force molar
High pull headgear
/inclusion of premolars-
counter mesial tipping

310
Segmented mechanics
Correction of anterior
occlusal cant-

Identify the offending
teeth
Tie only those teeth to
be intruded/extruded
Cant-tie only that side
that needs to be
corrected
311
Leveling by relative intrusion-
Continuous arches
Bite opening curves-
MBT-prefer not place in round or rectangular heat
activated wires
Placed only IF necessary after the SS rectangular
wires have been in place for 6 weeks

312
Continuous arches
In upper-bite opening curve increases palatal root
torque-beneficial

Sometimes additional torque-required
313
Continuous arches
Lower-bite opening curve-proclination of lower
incisors
10-15 of labial root torque to be added
Net effect-intrusive and retroclining force
314
Continuous arches
Anchor curve Mollenhauer & Kamedas
design-
Canines and premolars-extruded

Laterals and centrals-progressive intrusion

315
Continuous arches
Extrusion-expresses faster
Leveling more on account of extrusion

316
Continuous arches
Rocking chair NiTi
317
Leveling-posterior extrusion
In cases where deep bite leveled extrusive mechanics-
extrusion arches are used.
Two types
Type-I-
lower arch to level the curve of Spee
Cotinuous/3 piece extrusion arch is used

318
Leveling-posterior extrusion
Type-II
Parallel extrusion of posteriors
Extrusion arch with cervical headgear
Anterior bite plate

319
Knowledge is the antidote to fear.

- Ralph Waldo Emerson
320
References
1. Refined Begg for modern times-V.P.Jayade
2. Contemporary orthodontics
- William.R.Proffit(3
rd
ed.)
3. Dentofacial orthopaedics with functional appliances
-Thomas M.Graber, Thomas Rakosi, Alexandrer
G.Petrovic.

4. Orthodontics current principles and techniques-
T.Graber, R.L.Vanarsdall -3
rd
ed

5.Systemized orthodontic treatment mechanics-
McLaughlin, Bennett ,Trevisi

321
References
6. Orthodontic and orthopedic treatment in the mixed
dentition-J.A. McNamara

7. Biomechanics in clinical orthodontics-Ravindra
nanda

8. Biomechanics and esthetic strategies in orthodontics

9. Biomechanics in orthodontics- Michael R.Marcotte

10. Modern edgewise mechanics and the segmented
arch technique- Charles J. Burstone

322
References
11. Force systems from an ideal arch. Burstone and
Koenig AJO march 1974;65:3; 270-289

12. Deep overbite correction by intrusion. Burstone-
AJO 1977;73;1.1-22

13. Common sense mechanics. Thomas F Mulligan .JCO
1979,80. Article numbers- 1,2, 3,8,13

14. Mechanics of tooth movement- Richard Smith and
Charles Burstone- AJO April 1984 85:4-294-306

323
References
15. Utility arches. James A Mc Namara 1986 JCO.
2o;7;455- 456

16. Equilibrium situations in bend force systems:
Christian Demange - AJO 1990;98:333-9

17. The ground rules for arch wire design
Robert Isaacson- Seminars in orthodontics, vol
1,No1(March),1995

324
References
18. One couple orthodontic appliance systems
Steven j. Lindauer- Seminars in orthodontics, vol
1,No1(March),1995

19.Two couple orthodontic appliance system A Two
couple Intrusion Arch Moshe Davidovitch- Seminars in
orthodontics, vol 1,No1(March),1995

2o. Two couple orthodontic appliance systems: Activations in
the Transverse Dimension
Joe Rebellato- Seminars in orthodontics, vol
1,No1(March),1995
325
References
21. Activating a 2x4 appliance. Isaacson and Rubenstein
AO 1993;63;1. 17-24
22. Segmented approach to simultaneous intrusion and
space closure: Biomachenics of the 3 piece base arch
appliance. Bhavna Shroff, Lindauer, Burstone, Leiss.
AJO 1995; 107;2;136-143
23. Simultaneous intrusion and retraction using e 3 piece
base arch. Bhavna Shroff et al. AO 1997; 67;6; 455-
4622
24. The Connecticut intrusion arch. Ravindra Nanda et
al. JCO 1998. 32;12;708-715.
326
References
25.M.D.S dissertation- Determination of the centers of
resistance of all the individual teeth and groups of
teeth using FEA. -Dr. Sujana chava

Fudamentals of Biomechanics and Biomechanics of Levelling and Aligning (Includes Biomechanics of Molar Control)

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Fudamentals of Biomechanics and Biomechanics of Levelling and Aligning (Includes Biomechanics of Molar Control)

Uploaded by

Copyright:

Available Formats

1

You might also like