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Evaluation of force systems from a free-end force system

Barbara Lisniewska-Machorowska,a James Cannon,b Stephen Williams,c and Hans-Peter Bantleond Katowice, Poland, Clermont, Georgia, and Wiener Neustadt and Vienna, Austria Introduction: The purpose of this study was to investigate the biomechanical characteristics of a V-bend wire conguration in a free-end system, ie, with 1 end mounted in an orthodontic tube and the other loosely ligated to a bracket. The effects of V-bend position and size, wire dimension, method of ligation, and the inclusion of a second wire in the system were examined. Methods: Samples of various wire congurations were mounted in a bench testing machine to measure moments and forces at both ends in a standardized conguration resembling a 2-premolar extraction clinical case incorporating a special bracket with a second, frictionless slot. The position of the V-bend was altered in 1.0-mm intervals. Results: Moments were created at the posterior end, resulting in intrusive forces anteriorly that induced moments on the anterior block. The sizes of the moments and forces were increased in connection with posterior positioning of the V-bend, increase in the wire dimension and the V-bend sizes, although they were reduced and stabilized by the inclusion of a second nickel-titanium wire. The double wire system created clinically revelant moments and forces. Conclusions: The V-bend in a free-end system can create variable moments and forces that can be used clinically in intrusion and space-closing procedures but should be measured and monitored closely. (Am J Orthod Dentofacial Orthop 2008;133:791.e1-791.e10)

n efcient orthodontic appliance causes a 3-dimensional controlled tooth movement with all parts of the tooth moving in a direction predetermined by the treatment goal.1 Expressed biomechanically, orthodontic movement is the result of the combination of force vectors determining direction and moments that result in rotational movements of the teeth in all planes.2,3 These often act as antitipping moments in connection with forces used for space closure or anchorage preparation. The nature of the tooth movementparallel movement or tippingis the result of the ratio between these 2 factors, the momentto-force (M/F) ratio.4 In the edgewise technique, the creation of moments is facilitated by the engagement of a rectangular wire in the bracket slot (torque). Because of the limitations of this system, techniques have been developed so that additional moments can be added with auxiliary wires5 and by the activation of certain springs.6 In an experimental simulation of the M/F system acting between 2 teeth (or 2 groups of teeth consolia

Head, Department of Orthodontics, Medical University Silesian, Katowice, Poland. b Private practice, Clermont, Georgia. c Private practice, Wiener Neustadt, Austria. d Professor, Department of Orthodontics, University Dental School, Vienna, Austria. Reprint requests to: Stephen Williams, Hauptplatz 29, 2700 Wiener Neustadt, Austria; e-mail, williams@cnet.at. Submitted, August 2007; revised and accepted, November 2007. 0889-5406/$34.00 Copyright 2008 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2007.11.022

dated into units), authors have reported the development of moments by means of V-bends7,8 and described how, if an angled piece of wire is placed between 2 brackets, moments are created on both teeth. If, however, the wire is placed in 1 bracket only and ligated loosely to the other bracket (ie, not inserted into the slot of the bracket), an alternative biomechanical system is created: a free-end force system, whereby moments are created only at 1 end of the system. The resulting imbalance in moments creates forces, at both ends of the system, equally and oppositely directed. The invention of a twin wire system, based on a specially developed bracket (Cannon Ultra, Orthodontic Design and Production Inc [OPD], Vista, Calif) (Fig 1), with the traditional edgewise slot supplemented by a gingivally placed interactive slot, combines a continuous universal auxiliary wire (usually 0.018-in nickel-titanium) with a vertical stabilization wire, basically a steel wire with a V-bend, to create a moment system. The latter wire, empirically determined, should be 0.018-in stainless steel, and a V-bend of 25 is recommended (Fig 2, C). The V-bend should be centered between the rst and second premolars, placed distally into a buccal tube on the rst molar, and ligated loosely in the interactive slot of the brackets, creating a free-end force system and therefore vertical forces.9 The purpose of this study was to investigate experimentally the moment and force systems created by a disassociated biomechanical conguration, based on the Cannon Ultra bracket system. The
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Fig 1. Lateral view of the Cannon Ultra bracket with the steel archwire held in the interactive slot by the steel ligature.

experimental procedure was intended to investigate the following. 1. The size of the vertical forces and moments at the anterior and posterior positions (corresponding to the incisors and buccal anchorage units) by using a standard 0.018-in vertical stabilization wire of stainless steel with a 25 V-bend. The effect of altering the position of the V-bend relative to the posterior block should also be evaluated. 2. The effect of altering the size of the V-bend on the moments and forces created. 3. The effect of altering the diameter of the active wire. 4. The effect of altering the method of ligation on the parameters measured. 5. The effect of the universal auxiliary wire (twin-wire system) on the parameters measured.
MATERIAL AND METHODS Fig 2. A, Bench testing machine used in this study. A and B are the posterior sensors, and C is the anterior sensor. B, Detail showing simulated anterior arch section with brackets soldered to the supporting wire; C, detail showing the V-bend.

The experimental procedure comprised the bench testing of the steel archwire (vertical stabilization) with the built-in V-bend, placed between 2 sections, representing the anterior and posterior sections of an orthodontic space-closing system, assuming that a premolar was extracted bilaterally. A purpose-built bench testing machine (Fig 2, A) was used, and 3 sensors at A, B, and C were used to measure both forces and moments at these points. The relative position of the 3 sensors was adjustable with a computer-aided built-in mechanical

program measuring to an accuracy of 0.1 mm. The posterior centers could be raised and lowered in relation to the anterior centers and the anteroposterior distance between the centers A, B, and C could be altered electronically. The software especially developed for the machinery enabled the measurement and numerical display of forces to 0.1 cN and moments to 0.1 cN millimeter. To simulate 6 anterior teeth (canines and incisors), 6 brackets were soldered on 1.1-mm hardened steel wire (Fig 2, B), in a conguration resembling brackets on anterior maxillary teeth. This bar was soldered to a pin that in turn was connected to the anterior sensor (C). The distance of the bar to the pin was set at 3.5 mm, representing a typical distance of incisor brackets to the center of resistance of an anterior group of maxillary teeth described by Vanden Bulcke et al.10,11 A typical V-bend section to be investigated was mounted in the bench testing machine in Figure 2, C. A hardened 0.018-in steel wire was prepared with a

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V-bend angulation of 25, which was controlled very precisely with a template (insert in Fig 3, A). The posterior segment consisted of a special double molar tube of the type used with the Cannon Ultra system and a bracket of the special Cannon Ultra type at a position corresponding to the second premolar. Before the placement of the wire and the experimental measurement of moments and forces, the measuring system was calibrated to zero. The wire was mounted as in Figure 2, B, and engaged anteriorly by means of elastic ligatures in the interactive slot of all 6 anterior Ultra brackets. The V-bends were placed 4.0 mm mesially of the brackets on the posterior section, corresponding to the mesiodistal midpoint on the (extracted) rst premolars. Since our aim was to evaluate the force system derived from this vertical stabilization wire, no arch was placed in the standard edgewise slot with the exception of 1 in the nal stage of the experiment. Moments and forces were measured at the 3 sensors, initially in the position described above (position 0.0), and the posterior segment was subsequently moved closer to the anterior censor, in 3 stages of 1.0 mm (0 to 3.0 mm in Figs 3-7). The machine was then reset to the original conguration, and the simulated anterior section (sensor C) was pulled anteriorly, away from A and B, in increments of 1.0 mm to a maximum of 3.0 mm. This standard series of measurements was performed for each wire. Since the results for A and B were almost identical, the average of the readings of the 2 sides was used. The entire procedure was carried out at room temperature. Based on this standard series of readings, the following stages of the experiment were performed. 1. The rst part of the experiment was intended to investigate the properties of the standard wire: an 0.018-in stainless steel wire with a 25 V-bend over the range of distances described previously. 2. To evaluate the effect of variation in the size of V-bend, the procedure was repeated with V-bend angulations of 25 (standard), 20, and 30. 3. The effect of variation of the dimension and type of wire was investigated by using 3 wires: an 0.018-in hardened steel wire (standard wire), an 0.018-in Australian wire (A.J. Wilcock, Whittlesea, Victoria, Australia), and a 0.016-in Australian wire (A.J. Wilcock). These 3 types of wire were all shaped with a 25 V-bend and tested through the standard series of positions. 4. Since it was thought that the method of ligation of the active wire to the anterior section could be important, 2 experimental situations were created.

In the rst, the vertical stabilization wire was ligated to all 6 brackets: from maxillary canine to canine and, in the second. ligated only at the central incisors. 5. In the nal part of the study, we considered the effect of placement of the universal auxiliary wire (100 g nickel-titanium, Sentalloy, GAC) in the standard edgewise slot, as recommended in the instruction manual.9 For this part of the study, recordings were made with an 0.018-in stainless steel wire with a 25 V-bend (standard wire). All readings in every conguration were repeated, and the averages of the rst and second readings were used in the statistical analysis of the results. All results were entered manually in an Excel (version 6.0, Microsoft, Redmond, Wash) le, and calculations and graphic representations of the results were made with this program.
RESULTS

The results of the experiment are shown in Figures 3 through 7. The results will be reviewed in the order of the stages of the investigation stated in the introduction. The moments and forces created as a result of the V-bend in a free-end force system situation with a standard wire are shown in Figure 3. In the zero position, the posterior moment was on average 1598.80 cN millimeter, resulting in a vertical force of 191.30 cN intrusively on the anterior section and extrusively on the posterior section. (In a state of equilibrium, the force on the posterior section is always equal and opposite to the force on the anterior section; for the sake of brevity, only the force acting on the anterior section will be described.) The vertical force again created an anterior moment of 1532.80 cN millimeter. As the V-bend was brought closer to the posterior segment, the size of the posterior moment increased to 2226.70 cN millimeter, increasing the vertical force to a maximum of 312.03 cN and the anterior moment to 3277.70 cN millimeter. The opposite was seen when the anterior segment was pulled away from the posterior segment in 1.0-mm intervals; the posterior moment fell to 1070.60 cN millimeter, with a decrease in vertical force to 96.59 cN and an anterior moment of 561.50 cN millimeter. For the effect of variation in the angulation of the V-bend on the sizes of the vertical forces and moments involved, the results are shown in Figure 4. It can be seen that the greater the V-bend, the greater the moment. In the zero position at the 25 V-bend, an average moment of 1598.80 cN millimeter was recorded, which was reduced to 1328.50 cN millimeter

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Fig 3. A, Vertical forces with standard wire with variable V-bend position relative to the posterior segment (standard procedure); B, moment anteriorly and posteriorly with variable V-bend position relative to the posterior segment (standard procedure).

with the V-bend at 20 and increased to 1778.40 cN millimeter with a 30 V-bend. Figure 4 shows clearly the resulting changes in vertical forces (at 30, a maximum of 402.70 cN; at 20, a maximum of 231.06 cN) and corresponding anterior moments (at 30, a maximum of 3731.40 cN millimeter; at 20, a maximum of 2414.30 cN millimeter). The effect of variation in wire dimension is shown in Figure 5. The results show clearly that the thicker (stiffer) the wire, the greater the forces and moments. Comparing the steel wire (hardened steel, 0.018 in) with the same dimension of Australian wire, both moments and forces seem to be lower in the Australian wire (posterior moment steel, 1598.80 cN millimeter; Australian wire, 193.50 cN millimeter; vertical force steel, 191.30 cN; Australian wire, 128.45 cN; anterior

moment steel, 1532.80 cN millimeter; Australian wire, 151.70 cN millimeter). Comparing 2 slightly different dimensions (0.016 and 0.018 in) of a similar material, it can be seen that, even for this small change in dimension, a clear mechanical difference can be measured. The posterior moments (average) in the zero position are reduced from 1193.50 cN to 727.65 cN millimeter with a difference in the force range in the thicker dimension from 55.49 to 239.43 cN, whereas in the thinner dimension the range was 32.91 to 143.00 cN. The parallelism of the lines in Figure 5, A, demonstrates that the difference is clear irrespective of the position of the V-bend. The results of the 2 methods of ligation are shown in Figure 6. Ligating the vertical stabilization wire at the incisors alone, making the free length of wire

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Fig 4. A, Vertical forces with variable V-bend size during standard procedure; B, moments anteriorly and posteriorly with variable V-bend size during standard procedure.

effectively longer, reduced the moment and force levels. The posterior moments in the zero position were 1118.70 cN millimeter when the wire was ligated at the central incisors and 1254.15 cN millimeter when ligated to all brackets. The vertical force created in the zero position when only the central incisors were ligated was 96.95 cN, but this increased to 152.30 cN when ligated to all teeth. Variations in moments and forces related to the position of the V-bend relative to the posterior segment showed the same pattern as described previously. The nal topic was the effect of a light nickeltitanium wire in the main edgewise slot as suggested by the manufacturer.9 The results showed clearly reduction and stabilizing of both moments and forces (Fig 7). For the standard 0.018-in wire with a 25 V-bend in the zero position, the posterior moments were reduced

from 1598.80 to 1076.11 cN millimeter, with a reduction of the vertical force from 191.30 to 72.43 cN. The variation in moments and forces as a result of the anteroposterior adjustment of V-bend position was negligible.
DISCUSSION

Orthodontic movement of single teeth or tooth groups is based on the establishment of an optimal M/F ratio,4 which is related to the concept of the center of resistance.12 Orthodontic forces, being usually applied at the bracket at a distance from the center of resistance, give rise to tipping moments which must be counteracted by moments generated in the appliance itself. The relevance of the M/F ratio is clear in cases requiring space closure, often after extraction, when

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Fig 5. A, Vertical forces observed with active wires of variable wire dimension and type during standard procedure; B, moments observed with active wires of variable wire dimension and type during standard procedure.

high moments prevent tooth tipping and assist in controlling the anchorage units.13 In the edgewise system and the many techniques derived from it, torque moments are generated by the activation of rectangular wire in a well-tting slot. Alternatively, closing loops, among which the T-loop is well documented, have been designed to create moments, both in connection with the original shape (residual moment) and their activation (activation moments).14,15 Despite their careful construction, experiments have shown that these springs can rarely create M/F ratios large enough for parallel tooth movement, and the performance of these springs is poor at large activations.13,16 In most cases, moments are created with vertical forces that must be controlled if unwanted extrusion of tooth groups is to be avoided.

On the experimental level it has been demonstrated that moments and forces created when a straight wire was placed in brackets angulated in relation to each other were directly related to the angle formed between bracket slot and wire.17 At the same time, it was shown that when the sum of the moments at the 2 brackets (which could also represent 2 consolidated groups of teeth) was not zero, forces would be created (the law of static equilibrium). A similar force system is created if a V-bend is placed between 2 parallel teeth or a step is placed in the wire.7 In these cases, the size of the moment depends on the angulation of the V-bend, or step, and the relative sizes of the moments at the 2 ends of the system depend on the centering of the V-bend, or step, between the centers of resistance of the 2 teeth. These ndings and principles also apply to the T-loop.

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Fig 6. A, Vertical forces during standard procedure related to method of ligation; B, moments observed during standard procedure related to method of ligation.

The majority of experiments on V-bends consider the situation where the wire is placed in brackets at either end of the system creating a moment and force system at each end. If the wire is inserted into the bracket only at 1 end of the system and simply bound to the bracket (a loose joint such as a ligature wire), a so-called free-end force system with a moment at only 1 end of the system is created, and, since the sum of the moments at both ends is not zero, forces are created. This mechanism forms the basis of the intrusion system (base arch) described by Burstone.18 The double-slot bracket in the Ultra system facilitates the creation of a free-end moment and force system, where the forces acting on the anterior teeth will be in an intrusive direction. Since this force vector is anterior to the center of resistance of the incisors or the anterior tooth group, a palatal tipping moment will

be created that can be used with anterior tooth retraction or to create an anterior anchorage unit. To this end, the Ultra system has an 0.018-in Australian wire with a 25 V-bend, acting in a separate, frictionless (interactive) slot. Although basically simple, the biomechanical system uses the sophisticated biomechanical principles of the V-bend. The aim of this article was to test experimentally the properties of this clinical setup, conrming the nature and direction of the forces and moments created, quantifying the forces and moments, as well as evaluating the effects of modication of the dimensions of the wire and the V-bend and the positioning of the V-bend relative to the posterior teeth. The bench testing machine was the same as used in other studies of this type, and the experimental setup with brackets wire and ligation was made to resemble a typical clinical situation in a 2-premolar-extraction patient with

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Fig 7. A, Vertical forces during standard procedure when 0.018-in steel interactive wire was combined with 0.018 0.025-in nickel-titanium wire; B, moments observed during standard procedure when 0.018-in steel interactive wire was combined with 0.018 0.025-in nickel-titanium wire.

spaces to be closed. Since the anterior teeth (brackets) were connected by stiff wire, they should be considered biomechanically as consolidated (ie, 1 tooth), thus simplifying the interpretation of the results. A reproducibility study showed that, although there was some variation in double determination readings, the method itself was suitable to demonstrate the factors intended.19 The rst stage of the study conrmed the hypothesis that the creation of moments in a 2-ended free-end force system would lead to the creation of intrusion forces on the anterior section (balanced by extrusion forces on the posterior section). The vertical forces were well in excess of the values normally accepted for clinical incisor intrusion (15-20 g per tooth),18 but both moments and forces were sensitive to changes in position of the V-bend

relative to the anchorage section. These ndings corroborate those of Kuhlberg and Burstone14 for the T-loop and Faulkner et al6 for the stepped straight wire. Posterior moments increased as the V-bend approximated the posterior section, which, in a clinical situation, would imply that, as incisors are retracted, posterior anchorage is increased and intrusive forces on the incisors increase. Force levels were reduced to approximately 60% over the 6-mm anteroposterior distance through which the standard experimental procedure was run, although they were always relatively high compared with recommended clinical values. The actual size of the posterior-directed moments at what would be the anchorage section clinically compared favorably with those suggested by Romeo and Burstone.20

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The angulation of the V-bend played an important role; both moment and force sizes demonstrated clear increases as the V-bend activation was increased (2025-30). The increase in posterior moments was accompanied by a modest increase in vertical forces and anterior moments. The differences resulting from the change in V-bend angulation were less signicant as the anteroposterior distance increased; not only did the position of the V-bend to the posterior section change, but also the effective length of the wire was altered. This implies that clinically the V-bend should be placed farther distally where molar anchorage needs to be reinforced, although the resulting increase in intrusive forces on the incisors must be remembered. The effect of wire stiffness expressed as the diameter was likewise clear; the thicker wire created greater moments and forces, and a relatively small change in diameter (eg, from 0.016 to 0.018 in) resulted in virtual doubling of the force and moments. The 0.018-in stainless steel wire gave rise to greater forces and moments than the Australian wire, which is otherwise remarkable for its resilience; this is probably due to the special hardened quality of the steel. The method of ligation (to all 6 anterior brackets or only to 2 incisors) was shown to be relevant, since this factor inuenced the effective length of the wire from the anterior to the posterior sections. The experiment showed that the magnitude of moments and forces was greater when the wire was ligated at all brackets and the effective length of the wire was reduced. The effect of a soft nickel-titanium wire (universal auxiliary wire) in the standard edgewise slot as advocated by the manufacturer9 was a clear reduction in the force and moment levels, as well as stabilization of the forces and moments at levels that, judged empirically, seem clinically relevant. We demonstrated that the mechanical conguration of a twin wire system facilitated the creation and maintenance of a moment that, together with a retracting force, would be suitable for bodily en-masse retraction of anterior teeth. The twin wire system also generated vertical forces in the incisal region that would be ideal for intrusion of the anterior teeth, but care must be taken, since the results showed that even slight alterations in the conguration or position of the V-bend can cause dramatic changes in force levels. This investigation shows clearly that movement of the V-bend as would be expected in front retraction will increase intrusive forces. The quantitation of the factors that individually determine the actual sizes of the moments and forces demonstrated that, in principle, the system can be adjusted to achieve various aims with regard to tooth movement and anchorage preparation. Since space closure requires differential diagnosis and planning, the exibility of the system lends

itself well to the creation of an optimal M/F system though intraoral measurement of moments and forces, the measurement of which can be recommended. Although the center of resistance applies to any tooth or teeth in connection with orthodontic therapy, the exact location of this point is not possible, and tooth movement, even with a well-calibrated biomechanical system, must always be monitored carefully.
CONCLUSIONS

We demonstrated that a V-bend wire when inserted into an orthodontic tube at 1 end only will create moments at that end and vertical forces at the other. The sizes of the moments and the vertical forces are increased when the angle of the V-bend or the thickness of the wire is increased, or the V-bend is placed closer to the orthodontic tube. In a simulated orthodontic situation, the vertical forces, because they were not through the center of resistance of the anterior group, will create moments that can be used to create optimal M/F ratios for space closure and anchorage preparation.
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14. Kuhlberg AJ, Burstone CJ. T-loop position and anchorage control. Am J Orthod Dentofacial Orthop 1997;112:12-8. 15. Hoenigl KD, Freudenthaler J, Marcotte MR. The centered T-loopa new way of preactivation. Am J Orthod Dentofacial Orthop 1995;108:149-53. 16. Ronay F, Kleinert W, Melsen B, Burstone CJ. Force system developed by V bends in an elastic orthodontic wire. Am J Orthod Dentofacial Orthop 1989;96:295-301.

17. Burstone CJ, Koenig HA. Force systems from an ideal arch. Am J Orthod 1974;65:270-89. 18. Burstone CJ. Deep overbite correction by intrusion. Am J Orthod 1977;72:1-22. 19. Williams S, Cannon J. The reproducibility of bench testing of V bend wires. J Dent Res 2008 (in press). 20. Romeo DA, Burstone CJ. Tip back mechanics. Am J Orthod 1977;72:414-21.