ORIGINAL ARTICLE

Numerical experiments on long-time orthodontic tooth movement

Jrgen Schneider, PhD, Dipl-Phys,a Martin Geiger, Dipl-Phys,a and Franz-Gnter Sander, DDS, PhDb Ulm, Germany In orthodontic treatment, teeth are moved by the use of specific force systems. The force system used depends on the patients orthodontic situation characterized by the geometry of the tooth and the surrounding alveolar bone, which defines the position of the center of resistance. Therefore, the simulation of bone remodeling could be helpful for the treatment strategy. In this study, the optimal force system for bodily movement of a single-root tooth, with an orthodontic bracket attached, was determined. This was achieved by the use of the numerical finite element method, including a distinct mechanical bone-remodeling algorithm. This algorithm works with equilibrium iterations separated in 2 calculation steps. Furthermore, a parametric 3dimensional finite element model, which allows modifications in the root length and its diameter, is described. For different geometries, the ideal moment-by-force ratios that induce a bodily movement were determined. The knowledge of root geometry is important in defining an optimal force system. (Am J Orthod Dentofacial Orthop 2002;121:257-65)

he use of numeric finite element (FE) calculations by orthodontic researchers has increased in recent years. One of their aims is to provide more information on the behavior of tooth movement under orthodontic rehabilitation. Tanne et al1-6 used FE simulations to show that initial tooth movement depended on the geometry of the tooth and the alveolus. Middleton et al7 used a 3-dimensional (3-D) FE model to investigate the initial biomechanical response of a canine. On the basis of FE calculations, Geramy8 also demonstrated how the initial mobility of a tooth changes when bone loss occurs. Bourauel et al9,10 discussed different bone remodeling theories for the simulation of long-term tooth movement in comparison with experimental investigations. In addition, some experimental investigations are found in the literature.11-15 Burstone and Pryputniewicz16 examined the position of the center of rotation dependent on orthodontic force systems by means of holography. The active processes during tooth movement are biologic. In orthodontics, mechanical loads can influence cellular mechanisms. Bone tissue consists of 4 different types of bone cells. In vitro cell culture investiFrom the Department of Orthodontics, University of Ulm, Germany. aResearch assistant. bDepartment head and professor. Reprint requests to: Martin Geiger, University of Ulm, Department of Orthodontics, ZMK4, 89081 Ulm, Germany; e-mail, martin.geiger@medizin. uni-ulm.de. Submitted, December 2000; revised and accepted, August 2001. Copyright 2002 by the American Association of Orthodontists. 0889-5406/2002/$35.00 + 0 8/1/121007 doi:10.1067/mod.2002.121007

gations show that the bone cells respond to different mechanical loads by increasing their division or activity.17-19 The complete implementation of these biologic and biochemical processes into a mechanical calculation model is almost impossible. So far, different boneremodeling theories have been introduced. The inclusion of cell biologic aspects is described by Hart et al20 in a closed automatic control loop. Huiskes,21 Huiskes et al,22 and Weinans et al23 described the bone remodeling by a change in bone density and an adjustment of the anisotropy, and Cowin et al24,25 described bone remodeling in a thermodynamic manner. These versatile investigations were executed with theoretical as well as experimental methods. In this study, the numerical realization of a bone-remodeling algorithm based on strains in the alveolar tissue is done in a finite element method (FEM) code. The FEM allows for variations in geometry, in the material parameters of the biologic tissue involved, and in the parameters of the bone-remodeling function. In this study, mechanical loads were analyzed in the initial phase, and a resultant biologic stimulus was calculated. With this stimulus, the conformational change of bone under tooth movement is solved in a calculation program. With this method, it will be possible to study not only the initial tooth mobility, but also the long-time orthodontic movement of teeth. With these FE simulations, we can test different orthodontic force systems by evaluating all components of movement throughout the treatment. Parameter studies, characterizing the movement of an anterior tooth, were carried out. The variation of the moment/force (M/F) ratios of tipping and rotation is discussed on the basis of the resulting tooth movement. Vari257

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Fig 1. Reference FE tooth model consisting of 1576 solid elements. Coordinate system and directions of forces and moments applied to schematic bracket are shown.

ations of diameter and length are executed by the use of a parametric geometry model. The aim is a successfully calculated bodily movement for all different geometric models. The morphology is relevant for the M/F ratios. After performing these simulations, qualitative predictions about these geometric dependencies can be made.
MATERIAL AND METHODS

The FE analysis we carried out solved complex structure-mechanical equation sets by numerical methods. In contrast to analytic procedures, nearly all geometric problems can be calculated. In orthodontics, most published calculation studies have solved the problem of initial tooth movement to evaluate the distribution of stress or strain in the jaw bone or the periodontal ligament (PDL). The calculations presented here, instead, work with a bone-remodeling algorithm and a parameterized model.
FE model

In this study, a model tooth was built with variable geometric parameters. The model was divided lengthwise into different segments, with the crown comprising 2 segments and the root comprising 7 segments. The cross-section area of a segment was described by ellipse functions, whereby both ellipse diameters are responsible for the shape of the tooth. Perpendicularly to the

ellipses used, the form was outlined by splines. The model in Figure 1, called the reference model, needs to be a realistic figure of the anterior tooth root because its morphology influences the movement of the tooth. A schematic bracket built of beam FEs was fixed at the crown. Beam elements offer the advantage of easy modification of the brackets size, and the force system has an effect only at 1 point. This point is positioned in the half height of the crown, with a perpendicular offset of 2.5 mm to the surface of the crown. It is possible to apply orthodontic M/F systems directly in the calculation model. In Figure 1, the reference geometry model, already composed of FEs, is shown. The bracket designed in beam elements is clearly visible. Boundary conditions applied during the simulation are the acting orthodontic force system at the bracket and the zero displacements to the exterior border of the mandible. Simplified considerations describe the alveolar bone, because, for a separation into cortical and spongy tissue, geometric information is missing. For this reason, modeling of the mandibular bone, which is not yet differentiated between spongy and cortical bone, was generated with identical linear material parameters according to cortical bone (Table). Differentiation of bone material would require a more detailed bone-remodeling algorithm that could realize the connection between internal and external bone remodeling.

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Fig 2. Two complete calculation models. Initial reference geometry with coordinate and force systems is shown (left). Complete model consists of 7509 finite elements. Model after 400 bone remodeling iterations (right). At My/Fx ratio of -12.2 Nmm, the tooth bodily moved. Corresponding translation and rotation values are shown in Figs 3 and 4.

The complex structure of the PDL is basically integrated26,27 with a uniform thickness and with linear elastic material properties (Table). These aspects will not represent the real behavior of the PDL. Tanne et al28 noticed that, during bone remodeling, the response of the PDL on mechanical loading shows a bigger deformation than at the beginning. In addition, Bourauel et al9 and Hinterkausen et al29 postulated a bilinear material law of the PDL. In the future, an enhanced material law will describe the PDL more functionally, because the strain distribution in the alveolar bone is influenced by the behavior of this material.30 The tooth and the bracket used for numerical simulation were modeled in rigid material. All components of translations and rotations were analyzed in the root apex. The 3 different parameter variations are presented: (1) Modification of My/Fx and Mz/Fx ratios is realized with a constant geometry (Figs 1 and 2). This model also stands as the reference for the following variations in geometry. The model shows the dimension of a typical anterior tooth. The root height is 16 mm,

Table. Material

parameters of involved tissues

Youngs modulus Poisson ratio 0.35 0.45

Jawbone Periodontal ligament

1 GPa 1 MPa

and a value of 10 mm is used as the crown height. The model tooth profile is like the profile of a real tooth. Therefore, a diameter of 6 mm at the alveolar crest was used. With these dimensions, the different My/Fx and Mz/Fx ratios were modified (Fig 2). The resulting components of movement are represented corresponding to the M/F ratio in the following graphs. In addition, geometric variations of length and diameter of the tooth were used. This analysis represents the My/Fx relationship required for a bodily movement, depending on different geometric dimensions. (2) The root length was varied on the basis of a constant crown length. The root length was changed from

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Fig 3. Translation of tooth in all components. Major magnitude of translation is in X-direction, same as direction of acting force. All other components are so small as to be ignored.

12 mm to 22 mm for bone-remodeling simulation. The cross-section areas and the position of the brackets construction with regard to the crown as well as the crowns dimensions never change. (3) For modification of the root diameter, the 2 ellipse axes were proportionally changed, compared with the reference tooth. These parameter values were increased or reduced by 30%. Because of the change of the crowns diameter, the antirotational torque must be adapted throughout the calculation. The distances between the root segments were not changed; thus the root length remained constant.
Bone-remodeling algorithm

An equilibrium iteration in remodeling here consists of 2 different calculation steps. In the first calculation, the impact of an orthodontic force system to the alveolar bone was analyzed. On the basis of these results, the local function of biomechanical stimuli was calculated. The bone-remodeling algorithm calculated the biomechanical stimuli from the strain field in the mandibular bone of the initial tooth movement.24,31 The immediate relationship between the mechanical stimuli of strain and the stimuli in the FE model defines the evolution equation. Different functions for the evolution equation looked appropriate.22 Instead, a bilinear function that scaled bone apposition and bone deposition differently was implemented here. For compression (i < 0, i means X-, Y-, and Z-coordinates), the loaded fraction in the bone tissue is resorbed, and, for extension (i > 0), bone tissue is generated. The scale factors for bone deposition are twice the scale factors for bone apposition and are the gradients of the bilinear function.

Provatidis32 analytically demonstrated the unrealistic deformation of the alveolus if the stimuli for bone remodeling do not depend on the orientation. Therefore, stimuli are computed according to the evolution equation from the results of the first calculation stepthe 3 oriented principal strains.33 In the second computational step, the stimuli act as components of load for each node in the bone tissue. In this step, a new tooth position was calculated that results from the stimulis function. This new geometry was then the new model for a further initial calculation. This procedure with 2 successive calculation steps, whereby the tooth is definably loaded and the movement results of the bone remodelling algorithm, corresponds with the natural behavior of a tooth loaded with constant displacement. Detailed information of the function has been published.34
RESULTS

(1) In these calculations, a constant force Fx of 1 N in X-direction was applied on the tooth. The variation concerns the M/F conditions with the antitipping My and the antirotational Mz moments. The tipping moments My were modified from -14 Nmm to -10 Nmm. For the antirotational moments Mz, associated values from -6 Nmm to -4.9 Nmm were used. If a value of 12.2 Nmm was used as the antitipping moment, the rotation around the Y-axis is almost zero (Figs 3 and 4). With an increase of the tipping moment My to -14 Nmm, the root was moved forward. In the case of a decrease to -10 Nmm, the root moved backward. The bodily movement occurred only by 1 corresponding My/Fx condition. With the rotation around the Z-axis, the influence of the

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Fig 4. Behavior of tipping angle in dependency of My/Fx ratio is indicated. Ideal My/Fx ratio for bodily tooth movement is -12.2 Nmm.

Fig 5. Behavior of rotation angle in dependency of Mz/Fx ratio is shown. No tooth rotation around Z-axis occurs at Mz/Fx ratio of -5.12 Nmm.

moment selection becomes still larger than it is around the Y-axis (Fig 5). With a moment of -5.12 Nmm, the rotation can be ignored, whereas a modification to -6 Nmm causes a rotation of nearly 6 after 400 iterations (Fig 5). In Figure 3, the absolute movements of the tooth are represented. The X-direction is always the main direction of tooth movementthe same as the direction of force. The movements in the other directions are very small compared with the main direction. In the main direction, a movement up to 10 mm is calculated, which is nearly twice the root diameter. (2) Depending on the variation of the root length, the ideal My/Fx condition required for the bodily move-

ment is shown in Figure 6. During these calculations, the cross-sections of the levels remain constant. The form and the size of the crown also remain unchanged. In Figure 6, the ideal force system for antitipping is shown in relation to the root length. (3) With the diameter variation, a constant crown and root length was used. These modifications were executed to adapt the diameters of the ellipse. Because of the diameter modifications, the antirotational component Mz/Fx must also be adapted. This fact will not be discussed in detail because of the constant relationship between Mz/Fx and the root diameter. In Figure 7, the influence of the root diameter on the force system is shown.

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Fig 6. Perfect My/Fx ratio for performing bodily movement corresponding to different root lengths.

Fig 7. Perfect My/Fx ratio for performing bodily movement by different root diameters. Root diameter is varied 30% around reference diameter from wide to narrow.

DISCUSSION

The aim of this research project was to simulate a long-time tooth movement of a particular treatment case to assist the orthodontist in selecting the most appropriate appliance. A bone-remodeling algorithm must be developed to realize this. The first results were presented here. The significance of these results must be discussed, before extensive predictions can be made. These numeric investigations were executed with simple linear material properties for the tissues involved. Simplifications were made because of missing experimental data of materials and missing information of

their morphology. The evolution equation describing the bone remodeling was simplified as a bilinear function. Another approach could be realizedeg, the multilinear approach of Huiskes et al,22 including a dead zone. With this assumption, solving all problems in orthodontics with high accuracy28,30 is not feasible. For a general quantitative extrapolation, this bone-remodeling algorithm must be carefully evaluated in clinical studies. As the calculations in (1) show, the resulting tooth movement strongly depends on the M/F relationship applied. This behavior is well known to orthodontists

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and has been already demonstrated by simulations of initial tooth mobility, but not the change of the morphology of the alveolus throughout the remodeling.28,30 As a result of that, predictions about the position of the center of resistance (CR) are possible only in the beginning or in the physical case of movement. Statements on the entire mode of movement considering the change of morphology of the alveolus can only be made with bone-remodeling simulations. Bourauel et al10 previously performed numerical 3-D simulations of bone remodeling but could not present the bodily movement in their miscellaneous calculations. The results, which emulate the bodily movement of an anterior tooth, correspond to the magnitude used in practice. Sander35 chose an My/Fx ratio between 10 and 12 mm for the retraction of a canine; this ratio corresponds to the values calculated. These simulations represent how exactly the moments must be adjusted to a force to obtain the desired bodily tooth movement. Even for deviations of 2 mm, compared with the ideal My/Fx relationship of 12.2 mm, after a movement of 10 mm, a tipping around the Y-axis up to 10 is calculated (Fig 4). With the rotation around the Z-axis, this connection is also very clear (Fig 5). Therefore, constant M/F conditions must be applied during a complete treatment session.35-37 The distance of translation in these calculations cannot be coupled so far with the orthodontic treatment time, because the movement components achieved depend on the load status. In case of constant force and larger moments, extended movements are then also achieved. This is the direct consequence of the bilinear evolution equation used,34 and this is why it is impossible to compare the number of iteration steps directly with treatment time or other biologic factors. In this state of elaboration, it is possible only to make a motion study of the tooth treated. Throughout the geometry variation, the influences of the root lengths (2) and the diameters (3) are examined (Figs 6 and 7). One result is that the position of the CR strongly depends on the tooth geometry,38 and also the position of the CR receives a shift relative to the alveolar crest. During the model creation, it is ensured that there is a linear relationship between the surface modification of the root and the root length. Throughout the diameter modification, there is a very linear dependency between diameter and My/Fx relation, whereas different gradients during the length variation occur. These are very large modificationsabout 14 to 15 mm. An explanation has not yet been found for this behavior. Choy et al39 studied a number of variations in the geometry of roots in 2 dimensions with analytic methods and found a relationship between the outline of

the root and the position of the CR. Taking into account the location of the bracket and the geometry of the reference tooth discussed here, the CR is then located 7.2 mm below the alveolar crest, or at 45% of the root length. For a shorter root with a length of 12 mm, the position of the CR is then 4.2 mm below the alveolar crest, or only at 35% of the root length. The dimensions are comparable with other results published.3,14,39 Geramy8 studied initial tooth movements on the basis of a 3-D numerical model to calculate miscellaneous geometries of bone; he also found a high dependency between geometry and movement. Overall, it is difficult to compare the presented models and the performed parametric studies here with those of articles published in the past because models are sometimes totally different and mostly designed only for calculating initial mobility. Generally, the influence of the geometric parameters on tooth movement is pointed out here. For the simulation of individual tooth movements, individual nonstandard tooth models must be created. Computerized tomography sessions could provide the data for this model.
CONCLUSIONS

1. This study showed that it is possible to integrate a bone-remodeling algorithm in a FEM code and apply it to a realistic 3-D tooth model. 2. With this FE model, it was possible to simulate the bodily tooth movement, and almost any tooth movement, with rotations for a long distance in the mandible. 3. The first results are very close to reality. With the variations shown here, dependencies between the force system and geometrical parameters were analyzed. 4. It was shown that the optimal My/Fx ratio for a bodily movement depends strongly on the tooth geometry. 5. An important consequence is the use of a real model (computerized tomography data) of the individual tooth; this will increase the accuracy of the simulation of treatment significantly.
Outlook

Furthermore, new methods will be developed that allow for the checking and the development of these bone-remodeling algorithms and use the material properties of the tissues involved. The first step is to measure the long-term orthodontic tooth movement free of force in vivo measurements. This will be done with a high resolution with a photogrammetrical system.40 Experimental evaluation of the orthodontic force system will

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be done with special 6-component force-moment sensors before and after treatment.41 With these requirements and a realistic FE model from computerized tomography data sets created before the treatment, it will begin to be possible to evaluate these complex functions in a patient study. Here, the emphasis was on the biologic stimuli and the evolution equation, and, if this is successful, then the material properties of the PDL will be tested with different functions. If all these steps are successful, a calculation of real treatment situations will become possible for the first time. The authors thank the Deutsche Forschungsgemeinschaft DFG for financial support of project Sa-272/1-2.

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35. Sander FG. Biomechanical investigation of the hybrid retraction spring. J Orofac Orthop 2000;61:341-51. 36. Smith R, Burstone C. Mechanics of tooth movement. Am J Orthod Dentofacial Orthop 1984;85:294-307. 37. Burstone CJ, Goldberg AJ. Maximum forces and deflections from orthodontic appliances. Am J Orthod 1983;48:95-103. 38. Osipenko MA, Nyashin MY, Nyashin YI. Center of resistance and center of rotation of a tooth: the definitions, conditions of existence, properties. Russian J Biomech 1999;3:5-15. 39. Choy K, Pae EK, Park Y, Kim KH, Burstone CJ. Effect of root and bone morphology on the stress distribution in the periodontal ligament. Am J Orthod Dentofacial Orthop 2000;117:98-105.

40. Geiger M, Schneider J, Sander FG. Photogrammetrische vermessung der kieferorthopdisch induzierten zahnbewegung: eine methode zur gewinnung von lageparametern fr die FErechnung. Die methode der finiten elemente in der biomechanik, biomedizin und angrenzenden gebieten. ISBN 3-9806183-3-1. Universitt Ulm; 2000. 41. Geiger M, Hempowitz H, Sander FG, Wichelhaus A. Integration of finite element calculated remodeling in a 6-component force/moment measurement system. In: Davidovitch Z, Mah J, editors. Biological mechanisms of tooth eruption, resorption and replacement by implants. Birmingham (Ala): Harvard Society for the Advancement of Orthodontics; 1998. p. 573-8.