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T
ooth movement to close space is one of the most observation of the amount of tipping and rotation will
desired goals of orthodontic treatment. For years, depend on the amount of space closure. A greater amount
orthodontists have searched for an efficient force of space closure will yield greater degrees of side effects. The
system that can work quickly, accurately, and effectively to amount of space requiring correction can vary depending on
close extraction spaces. Orthodontic tooth movement is the severity. Less than 2-mm of spacing can be categorized
the result of the controlled application of mechanical forces as minor, greater than 2-mm but less than 4-mm is moder-
to the teeth and periodontium. The stimulus provided by ate, while anything greater than 4-mm is severe. Large spaces
activated orthodontic appliances provides the necessary need good anchorage control over the desired tooth move-
mechanical force to elicit a biological response. This pertur- ment (i.e., effectively managing the unwanted moments
bation temporarily disrupts the physiological equilibrium of [causing tipping and rotation] created during space closure).
the dentofacial complex and causes tooth movement in the With efficient mechanical appliances and sound applica-
direction of the net force, resulting in the closure of space. tion of the fundamentals learned in Chapter 4, almost any
To carry out such movements, orthodontic tools should desired tooth movement can be obtained. In a nutshell, the
be chosen on the basis of the biological responses of nature of tooth movement can be controlled by applying a
the periodontium surrounding the teeth (not yet an exact counteracting moment (MC) to the MF. In Figure 6-1, the
science) and their biomechanical properties as well as the tipping showed can be controlled by this MC. The easiest way
appliances being used to move them (a much more exact to generate this MC is to place a straight wire in the tipped
science), rather than on the basis of anecdotal reports of brackets (Fig. 6-2). This ratio of moment to force (MC/F
success (since failures are rarely described). Therefore in this ratio) at the orthodontic bracket can bring about various
chapter we refrain from showing many clinical cases (which types of tooth movement. However, the type of tooth move-
many orthodontists have in plenty) and instead describe the ment seen during space closure also depends on the tooth
science behind orthodontic space closure. and the objectives of the overall treatment. For example,
canines and molars usually need to be translated while the
FUNDAMENTALS OF SPACE CLOSURE anterior teeth or incisors can do well with simple tipping.
Root movement is frequently required for final alignment of
Before embarking on the details of the mechanics involved the roots, especially during finishing. All these movements
in space closure it is important to comprehensively analyze require different MC/F ratios as we will see in the next section.
the basic tenets of the approach to this orthodontic problem.
Moment to Force (M/F) Ratio
The Basics The M/F ratio is a good way to describe or predict the quality
In space closure the objective is simple: to bring together of tooth movement. In the literature it has been stated that
opposing teeth or segments of teeth by applying a force an M/F ratio of 5 : 1 is required for tipping, of 7 : 1 is required
between them. This force is usually applied on the bracket for controlled tipping, of 10 : 1 is required for translation, and
attached to the crown of the teeth (Fig. 6-1) and is occlusal of 12 : 1 is required for root correction. However, these ratios
and buccal to the center of resistance (CRES) of the units cannot be applied universally for all teeth and in all situa-
experiencing the force. This generates moments (moment tions. For example, for translation the ratio of 10 : 1 applies
due to force, or MF), which cause tipping and rotation of for a single rooted tooth where the distance of the bracket or
the teeth in the direction of the applied force. The clinical the point of force application is 10-mm from the CRES of the
108
CHAPTER 6 Biomechanical Basis of Extraction Space Closure 109
MC
f
MF MF
M F MF d
f
F F F F
A A
f MC
F F
MF MF
d f
F F
B MF MF
Figure 6-1 Basic dynamics of space closure. A, The magnitude of force for
both teeth is equal (F = F′) but the moment due to force (MF) is
not necessarily equal (MF ≠ MF′). For the definition of MF, see Chapter 4.
B, Occlusal perspective of the same. Tipping will occur in all planes of
space. B
Figure 6-2 Mechanics of uprighting a tipped tooth. A, A simple way to
generate a counteracting moment (MC) is to place a straight wire in tipped
tooth and the amount of force applied is 100 g. A more brackets. The interaction of the MC and moment due to force (MF), or the
moment to force (M/F) ratio, dictates the nature of tooth movement. Note
general way of defining M/F ratio for tooth movement that MF = F × distance from the center of resistance (CRES), while MC = F ×
should follow a qualitative approach, not a quantitative d (distance between the two couple forces). B, Occlusal perspective of the
approach. High, moderate, and low M/F ratios can do this same. Uprighting will occur due to the wire-bracket interaction. Thus the
aptly. quality of tooth movement is an interplay of moment due to a couple (in
As seen in Chapter 4 and in Figure 6-1, a single force red) and the force (in blue).
applied at the bracket of a tooth will produce uncontrolled
tipping with the center of rotation (CROT) slightly apical to
the CRES. Now if a counterbalancing moment (MC) is applied Anchorage
and is high enough, it can perhaps negate the MF. (Note: In As discussed, space closure involves the gradual closure of
Figure 6-2, the MC is generated when the opposite ends and space between two teeth or two segments of teeth when one
corners of the bracket contact the wire placed in the slot.) or both move toward each other. Depending on the needs of
This will result in translation. A further increase will cause the patient, one set of teeth or one tooth can be classified as
root movement into the space. At these relatively high M/F the active unit while the other is classified as the passive or
ratios, stresses reportedly distribute more evenly through the reactive unit. These two units have completely different roles
entire root with minimal changes in the mechanical proper- during tooth movement. The active unit undergoes the
ties during activation; this reduces injuries to teeth and sur- majority of the movement while the passive unit resists any
rounding tissues. A moderate MC will only partially oppose kind of movement and provides the resistance necessary to
the MF, leading to controlled tipping with the apex remaining facilitate the movement of the active unit, thereby serving as
stationary. It is apparent from this discussion that regulating an anchorage. Therefore anchorage can be defined as the
the MC/F (or MC/MF) ratio is key in producing different types resistance offered by the passive unit toward any type of
of tooth movement for space closure. unwanted movement when the active unit is undergoing the
However, it is important to mention that the nature of desired movement. The set of teeth that offers this anchorage
tooth movement can also be regulated by varying the point or resistance is also called the “anchorage unit.” The anchor-
of force application (see Chapter 4 for a detailed discussion age setup for different situations can be broadly classified
on this). into four types (Fig. 6-3):
110 PART 2 Biomechanics
Space closure
Anchorage (molar)
Absolute
Group A Segmental mechanics Sliding mechanics
Group B
Group C Figure 6-4 Methods for space closure.
Pre-treatment
Loop Shape
The shape of a loop is another important factor to adjust the
mechanical properties. The M/F ratio generated by T-loops
is higher than that of vertical loops with the same loop
1 mm
height.7,9 A so-called Opus loop introduced by Siatkowski4,5
has an L shape with a helix in the apical portion of the L to 10 mm
increase the M/F ratio. Siatkowski reported that the Opus 70
loop, with the vertical legs tipped 70 degrees backward, had
a M/F ratio as high as 8.7 mm, which is much higher than
can be obtained by vertical loops or T-loops with similar
1 mm
dimensions. However, L-loops with similar dimensions as
the Opus loop have given the highest M/F ratios to date
(Fig. 6-5).10 Figure 6-5 An L-loop with a helix.
A B
Figure 6-6 A, A typical vertical loop. B, After horizontal activation the two legs are at an angle to each other. This angulation creates a moment opposite in
direction to that created by the moment due to a force (MF).
112 PART 2 Biomechanics
Setup. Let us consider that there is an anteroposterior Activation of the Loop. The final activation of the loop
space of approximately 8-mm to be closed distal to the is done only when it is placed in the bracket slots. The wire
canine. Before space closure can be initiated with a loop, it is pulled distally through the posterior tube and cinched. The
is important to ensure that the teeth or segments of teeth to amount of distal pull is guided by the amount of space to be
be incorporated for tooth movement or anchorage are ade- closed. For an 8-mm extraction space, ideally 8-mm of acti-
quately aligned so that a 0.021-inch × 0.025-inch stainless vation is good. This activation step is necessary to generate
steel wire (in a 0.022-inch slot bracket) can be used to hold the required force and MF for space closure.
them as separate units. The only link between the two units Once the loop has been activated and placed at the desired
should be the loop. location, tooth movement is initiated by “deactivation” of the
loop. Space closure with loops progresses via three distinct
Preactivation of the Loop (Figs. 6-7 and 6-8). Before phases, which can be delineated comprehensively at both
the loop can be inserted into the extraction space, certain the theoretical and the clinical level. The quality and nature
“preactivation bends” must be placed so that the loop gives of tooth movement is primarily determined by the interac-
a V- or U-shaped outline overall. Remember from Chapter tion of the MF and MC generated as the teeth move toward
4 that the mechanics of a loop can be worked out by under- each other.
standing the geometries described. The preactivation bends Phase I (Tipping). In the initial phases of retraction the
spring is fully activated and therefore the force is high, result-
ing in a high moment (MF = F × d, where d is the distance
between the point of application of force and the CRES of the
canine). This condition results in a MC/MF ratio <1, placing
the CROT of the canine close to the apex. The canine therefore
shows considerable crown movement with minimal root
movement (Fig. 6-9, A). This phase represents a classical
example of “differential moments,” described earlier in the
chapter. Due to the nature of movement of the canine versus
the molar (crown tipping of canine versus root tipping of
molar) the anchorage demand on the molars is minimal, or
in other words the chance of “anchor loss” is minimal. Hence,
the anchorage demand from the molar is less. It is important
to remember that if the operator does not place enough
Figure 6-7 The setup for segmental retraction of the canine: 0.021-inch ×
preactivation bends on the loop, this phase might show
0.025-inch stainless steel wires as stabilizing units. Inserting the loop with uncontrolled tipping of the canine with rapid dumping of the
preactivation bends. canine.
10 mm
1 mm
10 mm
1 mm
A B
Figure 6-8 A, T-loop. B, With preactivation bends.
CHAPTER 6 Biomechanical Basis of Extraction Space Closure 113
MF MF
d d
F F
F F
A B
Preactivation for Preactivation for
the T-loop the T-loop
Active T-loop
Active T-loop
MC
MF
F F MFA
MFP
MCA d
d
MCP
F D
C
Figure 6-9 Space closure with loops. A, Phase I of loop deactivation (simple tipping). As MF ≫> MC, there is minimal root movement with more crown
movement. MF = F × d. Note: The stabilizing wires for the passive segments are not shown. B, Phase II of loop deactivation (translation). As MF = MC, there
is equal crown and root movement. Therefore the canine is undergoing bodily movement. (Remember that such a situation rarely exists where the moments
are perfectly balanced.) C, Phase III of loop deactivation (root movement). As MC ≫> MF, there is minimal crown movement and more root movement.
D, Occlusal perspective of the same. The V-bend placed in the T-loop will generate the counteracting moment or moment due to a couple (MC) to oppose
the rotation of the molar and canine. To have no rotation during retraction, MF = MC.
Phase II (Translation). As the canine is distalized and Note that for ease of understanding, the vertical forces gen-
the distance between the two attachments decreases, the erated due to the unequal moments have not been shown in
force levels drop. This causes a reduction in the MF as well. Figure 6-9. Also, all phases will be similar to the one described
At some point, MC = MF (MC/MF = 1). Such a situation will above from an occlusal perspective as well (Fig. 6-9, D).
place the CROT at infinity. At this stage the canine is translat- It is important to remember that the MC/MF ratio is
ing as the moments are cancelled out (Fig. 6-9, B). Here, both responsible for optimizing the quality of canine movement
the molar and the canine tend to translate. However, it is while the force is responsible for the actual distal movement.
important to remember that this will not happen at the same Once the canine has undergone all of these phases of move-
time for the two teeth as the MF values are different for the ment, complete deactivation of the loop has occurred. It now
canine and molar. Also, the probability of anchor loss in this needs to be reactivated and then the canine will undergo the
phase is high, because there is no net moment on the molar same kind of movement described above. Depending on
to reinforce anchorage and there is greater anchorage the initial position of the canine a clinician might not want
demand on the molar due to canine translation. the canine to go through all three phases of distalization. For
Phase III (Root Movement). The force levels continue example, in crowded arches the canine is often mesially
to drop and so does the MF but the MC drop is not that sig- tipped and a simple uprighting of the canine is more than
nificant (as it depends on the elasticity of the wire). Therefore, enough to close the extraction space (Fig. 6-10). Therefore,
at this stage the MC/MF ratio is >1, thereby reversing the net the spring can be removed once it has completed phase I.
moment (Fig. 6-9, C). This results in more root movement
than crown movement, paving the way for root correction Incisor Retraction
(as in phase I the canine had tipped). The canine therefore Retraction of incisors will proceed in a similar way as that
is undergoing root tipping or root uprighting while the molar described above. However, from an anchorage perspective it
shows predominantly crown tipping. Therefore this phase is places less demand on the posterior teeth or the anchor
vulnerable to showing some molar mesial movement (anchor units. This can be largely attributed to the nature of move-
loss). Anchorage reinforcement may be needed. ment desired for the incisors. Usually the incisors have to
114 PART 2 Biomechanics
A B
C D
Figure 6-10 A reverse loop for canine retraction. A and B, As the lower canines were mesially tipped the loop was only used for phase I and phase II of
retraction. C and D, Once the retraction was complete, continuous wires were placed.
A B C
D E F
Figure 6-11 A mushroom loop for en masse retraction of the incisor and canine. Note the offset placement of the loop to preserve anchorage of the posterior
segment. A–C, At the beginning of retraction. D–F, After space closure.
undergo only tipping for extraction space closure, with Preactivation for
minimal translation and in only rare circumstances root the T-loop
uprighting. In terms of mechanics it means placing a high Active T-loop
moment (MC) on the posterior/anchor unit while consider- MCa
ably less moment is needed for the incisors. Therefore phase MCp
I is generally more than sufficient to complete the space
closure process when incisors are being retracted. In terms MF
of loop mechanics, more moment (MC) must be created for
the posterior unit (MCp ≫> MCa). This can easily be done by
using any of the techniques described previously but the
most common and easiest approach is the offset placement
of the loop (Figs. 6-11 and 6-12). In this case the offset will F
be closer to the posterior segment. The moments and the
forces created will follow the same rules as the V-bends dis- Figure 6-12 Mechanics of incisor retraction (simple tipping). As MF ≫>
cussed in Chapter 4. MC , there is minimal root movement and more crown movement. Note
From a theoretical standpoint segmental mechanics is that the loop is placed toward the posterior segment to create a greater
moment (MCp ≫> MCa) on it than on the anterior teeth.
arguably the most efficient way to move teeth. However, due
to its overreliance on the operator’s skills in terms of loop
CHAPTER 6 Biomechanical Basis of Extraction Space Closure 115
fabrication, positioning, preactivation bends, activation, etc., retraction process. The force system shown is exerted on
segmental mechanics is highly technique sensitive. The clini- (not by) the canine; accordingly, the symbols for the deliv-
cian should be extremely careful in using this technique. On ered force and the couple partially represent their displace-
the other hand, sliding mechanics is less sensitive to tech- ment potentials.
nique but follows the same principles described above for
space closure. Phase I. This is the initiation of canine retraction. A single
force (F) is applied on the canine bracket in a distal direction
Sliding Mechanics (Fig. 6-13, A). This force produces a moment (MF) acting at
Ever since the Andrews straight-wire appliance13 was intro- the CRES of the canine, causing it to tip as it is being distalized.
duced there has been a gradual but paradigm shift from Since there is some degree of play between the archwire and
closing loop mechanics to sliding mechanics. The objective the bracket slot, the tooth is free to tip in the mesiodistal
is simple: to create a force system that can work efficiently direction in an uncontrolled manner, creating a CROT slightly
and shorten the orthodontic treatment period. Sliding apical to the CRES (from Chapter 4). This can also be referred
mechanics contributes to achieving more control during to as the “unsteady state” of canine retraction, as it is under-
space closure (i.e., fewer side effects such as tipping and rota- going uncontrolled tipping.
tion), improving patient comfort, and preventing excessive
force application. Phase II. The canine is now tipped to the extent that the
By definition, in sliding mechanics force is applied aforementioned clearance (or play) between the bracket slot
between two teeth or segments of teeth such that they move and the wire has been eliminated (Fig. 6-13, B). The sketch
or slide on a straight wire inserted in the respective brackets in Figure 6-13, B depicts the canine somewhat later in time
of the two segments so that a significant amount of friction relative to Figure 6-13, A. Archwire–bracket slot contact
is generated between the wire and the bracket surfaces. now exists. This two-point contact by the archwire exerts a
With the closing loop mechanics, activated loop create force pair of parallel, equal in magnitude, noncollinear forces to
only at the bracket level, and control is created by generat- form the MC. (The two forces will be of the same magnitude
ing moments (via preactivation bends) whereas in sliding if the wire, because of its occluso-apical location and that of
mechanics, retraction forces can be transferred to any height the bracket, generates no net potential to extrude or intrude
level on a power arm to move the teeth in a preprogrammed the tooth.)
direction (e.g., controlled tipping, translation). This MC opposes the MF, resulting in less tipping of the
Two methods have been used for extraction space closure. canine when compared to phase I. As the wire further
The first method is two-step retraction, which involves deflects, MC continues to increase and the CROT moves to the
canine retraction followed by incisor retraction. The second apex of the canine, creating controlled tipping of the canine.
method is “en masse” retraction of the six anterior teeth. This can also be called the “controlled state” of canine retrac-
tion. With a preangulated bracket slot the initial clearance
Canine Retraction can be zero with some local second-order rotation required
A continuous archwire engages the brackets affixed to the to engage the wire in the slot. If this is the case, MC exists
facial surfaces of the teeth. In particular, the wire within the from the start of the retraction process. Also note that, as MC
bracket attached to the canine crown and supported at appears, some frictional resistance to these sliding mechan-
neighboring posterior and perhaps anterior dental sites is ics arises but is assumed to be small. The magnitude of MC
intended to guide the tooth during its distal displacement. is, principally, directly related to the local bending of the
To begin, let us assume that the teeth have been leveled guiding archwire at the canine bracket site and therefore is
and aligned to a degree that the archwire chosen for retrac- intricately associated with the wire properties, such as stiff-
tion sits passively through the bracket slots. Typically, for ness and resiliency. The size of MC also, to a much lesser
canine retraction the method used to provide the distal force extent, is associated with the location of the canine bracket
(F) is a spring or an elastomeric element (module, chain, relative to support sites mesial and distal to it.
O-ring, or tied thread). Orthodontic tooth movement occurs
as a result of mechanical force exerted on the crown and Phase III. As distal crown tipping continues, the magni-
maintained there over some finite period of time. It is impor- tude of MC increases directly with the local wire bending
tant to mention that this distal driving force will typically deformation. (Presumably the archwire maintains its elastic-
decrease with time if an elastomeric element is involved. ity throughout the retraction process.) With the accompany-
For the ease of understanding the details involved in ing distal displacement of the crown and relaxation of
this seemingly continuous and smooth process, we have the driving component (elastomeric) of the appliance, F
divided it into four distinct phases as we did for segmental decreases in magnitude. The possibility then arises that the
mechanics in the previous section. The beginning and end couple to force (MC/F) ratio may be reduced to nearly equal
of each phase are defined by four instantaneous views of the the distance between the crown center (where the bracket is
mechanics involved. Each phase represents a characteristic placed) and the CRES of the canine. In other words, here
movement pattern distinct from the other three. Each part MC = MF. Therefore the net moment acting on the canine
of Figure 6-13 represents an instant of time during the has decreased to zero, signifying that the CROT has migrated
116 PART 2 Biomechanics
MF MF
MC Initial contact
between the
Archwire-bracket bracket edges
play and the wire.
F F
d
A B
MC MF
MC MF
Local bending
of the archwire.
F
F
C
D
Figure 6-13 Mechanics of canine retraction with sliding mechanics. A, Phase I (the unsteady state/uncontrolled tipping). The archwire-bracket play allows
for uncontrolled tipping of the canine. Note: Due to the play, no MC is generated. B, Phase II (the controlled state/controlled tipping). The archwire-bracket
play no longer exists. There are signs of initial contact between the archwire and the bracket edges giving rise to MC. Here, MF ≫> MC. C, Phase III (the steady
state/translation). The contact between the archwire and the bracket edges has increased, leading to an increase in the MC. Simultaneously there can be a
decrease in the force levels, causing a decrease in MF. Here MF = MC. D, Phase IV (the restorative state/translation). There is a pronounced decrease in the
force levels, causing a decrease in MF. Here, MF ≪ MC.
apically and the tipping displacement has potentially trans- interface, resulting in the relocation of the CROT gingival to
formed into bodily movement. This mechanical configura- the CRES anywhere between the bracket and the CRES. Remem-
tion is shown in Figure 6-13, C. This situation can be attained ber that if the distal force does not show decay, this phase is
either by a reduction in MF or by an increase in MC. It is never reached; instead, the canine might be relegated to just
important to remember that the relative values matter more the first two phases (i.e., tipping only).
than the absolute values. If this delicate balance of forces and In a similar evaluation form, the occlusal view, the bracket
moments is maintained, the canine will continue translating. is labial to the CRES and hence a distal force will again create
This phase is also called the “steady state.” However, this a MF that will rotate the canine distally inward. This will be
phase is at best only a theoretical possibility and for all prac- phase I (the unsteady state). Until the point play exists
tical reasons is impossible to attain. between the wire and the bracket from an occlusal view, the
canine is free to rotate. During phase II (the controlled state)
Phase IV. For the canine distalization to enter this phase the archwire begins to deflect as the diagonally opposite ends
it must be assumed that the distal driving force is undergoing of the bracket contact the archwire. A MC is generated, which
a constant decay through the retraction process. As dis- minimizes the MF. In phase III (the steady state) the moments
cussed, the bodily displacement format may exist only are equally balanced and there is no change in the position
momentarily. As the F decreases, so does the MF; however, of the canine from an occlusal perspective. In phase IV (the
because of the angulated bracket and the local bending of the restorative state) the rotated canine starts derotating because
archwire, the MC does not decrease as readily as the MF. MC exceeds MF in magnitude.
Therefore in this phase MC ≫ MF and the MC/F ratio is
greater than in the previous phase (Fig. 6-13, D). This results Force Transmitted to the Anchor Teeth
in restoration of the axial inclination of the canine (upright- The setup for canine retraction described above is a “friction-
ing or root correction). This can be called the “restorative based” system in which the canine, through the application
state” of canine retraction and can be clinically referred to as of a force, is made to slide distally guided by a continuous
the second-order torquing of the canine. A tremendous archwire that connects the incisors to the molars. The canine
amount of frictional force is generated at the wire-bracket is the link between the posterior teeth (premolars and
CHAPTER 6 Biomechanical Basis of Extraction Space Closure 117
Incisor Retraction
During space closure the incisors also follow the same phases
of retraction as the canine. The dominant phases in incisor
retraction are phases I and II (i.e., tipping).
Although clinically incisor retraction is similar to canine
retraction, at the mechanical level there are a few differences.
F When tipped back, the bracket of a canine undergoes a
second-order interaction with the archwire; in contrast, due
to its position an incisor bracket has a third-order interac-
tion. This third-order interaction lends itself to a greater
degree of play compared to the second-order interaction of
the canine. Therefore the dominant phases in incisor retrac-
Figure 6-14 Incisor extrusion during canine retraction. Note the deflec- tion are phases I and II (i.e., tipping), as the greater degree
tion of the archwire. of play allows for more tipping. The questions that arise in
such a situation are: What if we do not want this tipping? Or
what if we are looking for more control on incisor retraction
molars) and anterior teeth (incisors). Therefore it is not dif- from the initiation of retraction? To achieve these goals we
ficult to imagine that any change in its position might have want to introduce an MC in the first phase of retraction.
a direct effect on the incisors and the molars. Let us consider Some common ways of doing this are:
carefully what those side effects might be. 1. Bending the wire (V-bend, as discussed in Chapter 4)
2. Placing a curve in the main archwire
Effect of Canine Retraction on the Incisors. An 3. Torquing the archwire (twisting the wire)
implicit advantage of canine retraction on a continuous arch 4. Increasing the stiffness and size of the archwire
system lies in limiting the possibility of unpredicted canine Another method of minimizing the tipping movement of
movement (e.g., flaring or rotation). Despite the advantages the incisors and canine is by decreasing the MF produced
of sliding mechanics, canine retraction does present its own without compromising the magnitude of force. This can be
set of problems. When pure forces generated from springs achieved by changing the point of force application relative
or elastics are induced at the canine, especially when an to the CRES of the teeth. This can be easily achieved by using
archwire with a low load-deflection rate is being used or the a “power arm” (Fig. 6-15). The effects of such mechanics on
force levels are too high, the wire tends to deform with unde- the incisor tooth are described in detail in Chapter 4.
sirable side effects on other teeth (Fig. 6-14). Due to the
tipping of the canine described in phases I to III, a constant MINI-IMPLANT–DRIVEN MECHANICS
stress is created on the wire, resulting in its elastic deflection. OF TOOTH MOVEMENT
This deflection of the wire creates an extrusive force on the
incisors and a moment that tends to cause lingual tipping. Why Do We Need Mini-Implants
This tendency for archwire deflection can be reduced by for Space Closure?
using higher stiffness archwires and/or lighter forces for The extraction of premolars and anterior teeth retraction is
retraction. Auxiliary archwires, such as an overlay intrusion generally indicated when there is obvious protrusion of teeth
arch or cantilever springs, can also help to minimize the and there is a strong esthetic need. While retracting anterior
assumed deflection of the archwire. teeth in a full cusp Class II malocclusion or in a Class I
bialveolar dental protrusion case, anchorage control assumes
Effect of Canine Retraction on the Molars. Accord- profound importance because maintaining the posterior
ing to Newton’s Third Law of Motion, the retraction force on segment in place becomes very critical. A loss in molar
the canine should exert the same force on the molar. This anchorage can not only compromise correction of the
force will create a moment on the molar, causing it to tip anteroposterior discrepancy, but also affect the overall verti-
mesially. The molar will then undergo all four phases of cal dimension of the face. The application of mini-implant–
mesialization as described for the canine. However, the supported anchorage can circumvent the anchorage issues in
degree of movement may vary depending on the surround- such situations, maintaining a Class II molar relationship
ing bone, tooth characteristics, number of additional teeth while establishing a Class I canine relationship for esthetics
ligated to the molar, etc. An important side effect seen quite and functional guidance.
often clinically, especially when heavier forces are used, is the
presence of a lateral open bite due to simultaneous tipping Where to Use Mini-Implants
of the canine and molar crowns with no root correction. This Mini-implants (MIs) serve as anchorage units in situations
can largely be attributed to the increased levels of retraction where there is a need for absolute anchorage.14–18 They are
forces preventing the tooth from entering into phase III or used to generate a constant and predictable force system, so
phase IV of sliding movement. that accurate and precise movement of the active units can
118 PART 2 Biomechanics
A B
L
C D
Figure 6-15 Canine distalization using a “power arm.” A and B, Initiation of retraction. Note that the length of the power arm is approximately close to the
CRES of the canine. C and D, After completion of distalization. No tipping has occurred.
anterior teeth. Additionally, there is a clockwise moment (M) incisors during space closure is the use of power arms. This
on the anterior segment as the total force passes below the can be employed with implants as well (Fig. 6-19). For a
estimated CRES of the anterior teeth. This moment causes the complete list of approximate play for different archwire sizes,
anterior teeth to tip. The degree of tipping will be regulated refer to Table 6-1.
by the thickness and stiffness of the archwire. For example, Once the anterior teeth have tipped by the amount of play
a 0.017-inch × 0.025-inch stainless steel archwire has approx- available between the bracket slot and the wire (clearance),
imately 12 to 14 degrees of play in a 0.022-inch slot, assum-
ing that the wire is completely passive when retraction starts,
while a 0.016-inch × 0.022-inch stainless steel archwire has
16 to 18 degrees of play (Fig. 6-17). Therefore the latter will Greater
play
show greater amounts of tipping and a prolonged phase I and
phase II of retraction compared to the former. A clinician
should judiciously select the archwire for space closure.
For example, if the anterior teeth are flared at the begin-
ning, more tipping is required; hence a thicker wire will be
of limited use, as the effective play will be less. If instead the 0.017-inch x 0.025-inch 0.16-inch x 0.022-inch
teeth are upright and there is a need for more control on the
incisors, a thicker wire should be the choice (Fig. 6-18). As Figure 6-17 The amount of play between the bracket and archwire
discussed, another method of obtaining control over the depends on the size of the archwire.
A B C
D E F
Figure 6-18 En masse space closure with mini-implant–supported anchorage. A–C, The incisors were upright at the beginning of space closure, so a 0.019-
inch × 0.025-inch stainless steel archwire was used. D–F, After space closure. The axial inclination of the incisors was maintained to a large extent.
A B C
D E F
Figure 6-19 Mini-implants with power arms for space closure. A–C, Before. D–F, After.
120 PART 2 Biomechanics