BBE 207 1–9

biocybernetics and biomedical engineering xxx (2017) xxx–xxx

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1
2
3 Original Research Article

4 Pure intrusion of a mandibular canine with

5 segmented arch in lingual orthodontics:
6 A numerical study with 3-dimensional
7 finite element analysis

8 Q1 Abhishek M. Thote a,*, Krishna Sharma b, Rashmi V. Uddanwadiker a,

9 Sunita Shrivastava b
a
10 Department of Mechanical Engineering, Visvesvaraya National Institute of Technology, Nagpur, Maharashtra, India
b
11 Department of Orthodontics, Sharad Pawar Dental College, Wardha, Maharashtra, India

article info abstract

Article history: Objective: Approximately 50% patients with a deep bite possess anatomically extruded
Received 4 December 2016 mandibular canines. The objective of this study was to specify the required toe (u) of the
Received in revised form vertical segment of a cantilever from the distal aspect to achieve pure intrusion of a
9 March 2017 mandibular canine with a segmented arch in lingual orthodontics. Additionally, the opti-
Accepted 8 May 2017 mum magnitude of the required intrusive force by a cantilever was determined assuming
Available online xxx non-linear, hyper-elastic behaviour of periodontal ligament (PDL).
Methods: The geometrical model of a mandibular canine tooth was developed and the
Keywords: mathematical equation was devised to evaluate u (positive value: toe-in, negative value:
Mandibular canine toe-out) based on certain input parameters. To verify this numerical study by finite element
Pure intrusion analysis (FEA), total eight different positions of point of force application (Pf) on bracket top
LiO (occlusal) surface were considered based on different values of input parameters.
FEA Results: The results were displayed in terms of nature of tooth movement and Von-Mises
(equivalent) stresses generated in the PDL. Additionally, the optimum magnitude of the
required intrusive force within the biological limit of a mandibular canine was determined
from FEA considering the strength of PDL and factor of safety.
Conclusions: The numerical study was developed to compute the value of required toe angle
(u) of the vertical segment of a cantilever for different morphologies of a mandibular canine
as well as different positions of Pf. From FEA, the optimum range of an intrusive force within
the biological limit of a mandibular canine was found to be 20–30 g.
14
© 2017 Nalecz Institute of Biocybernetics and Biomedical Engineering of the Polish
12
13
15 Academy of Sciences. Published by Elsevier B.V. All rights reserved.
16
17 17

* Corresponding author at: Department of Mechanical Engineering, Visvesvaraya National Institute of Technology, Nagpur, Maharashtra,
India.
E-mail addresses: abhi.thote8@gmail.com, abhishek.thote@students.vnit.ac.in (A.M. Thote), drsharma.krishna@gmail.com (K. Sharma),
rashmiu71@gmail.com (R.V. Uddanwadiker), sunitashrivastav92@gmail.com (S. Shrivastava).
http://dx.doi.org/10.1016/j.bbe.2017.05.005
0208-5216/© 2017 Nalecz Institute of Biocybernetics and Biomedical Engineering of the Polish Academy of Sciences. Published by Elsevier
B.V. All rights reserved.

Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005
 BBE 207 1–9

2 biocybernetics and biomedical engineering xxx (2017) xxx–xxx

17 (LiO) from point of force application (Pf) on the bracket. Hence, 51

1. Introduction
lesser moment values are required in LiO keeping them more 52
within the biological limit [11]. In LiO, Pf is generally lingual, 53
18 The continuous orthodontic force system leads to tooth but sometimes may be labial with respect to Cres of the tooth. 54
19 movement owing to remodelling of the alveolar bone Hence, depending on the position of Pf, linguo-labial or labio- 55
20 structure. An optimal force system needs to be devised to lingual component of force is required to apply in addition 56
21 predict and control the tooth movement [1–4]. An accurate to intrusive force to pass their resultant force vector through 57
22 application of basic biomechanics simplifies the required Cres. Indeed, in LiO, the required amount of linguo-labial or 58
23 force system. It improves the efficiency of an orthodontic labio-lingual force is very less as compared to intrusive force. 59
24 appliance by shortening the treatment time and obviates any Thus, in LiO, almost pure intrusion can be achieved while 60
25 side effects [1]. maintaining the bucco-lingual tooth inclination [11]. There- 61
26 Approximately 50% patients with a deep bite possess fore, our study is focused on the optimum intrusion of a 62
27 anatomically extruded mandibular canines [5,6]. The simul- mandibular canine with a segmented arch in LiO. 63
28 taneous intrusion of six mandibular anterior teeth is consid- The aim of this study was to specify the required toe (u) of the 64
29 ered to be undesirable as it affects the anchorage of posterior vertical segment of a cantilever from the distal aspect to 65
30 teeth. Hence, the intrusion of mandibular canines should be achieve pure intrusion of a mandibular canine with a 66
31 achieved with a segmented arch to level the curve of spee [7]. segmented arch in lingual orthodontics. For this purpose, the 67
32 Very few studies have stated the methods to achieve geometrical model of a mandibular canine was developed and 68
33 intrusion of a single canine. Ricketts et al. [8] used the utility the mathematical equation was devised to evaluate the 69
34 arch as a stabilization arch and then tied an elastic band to a required toe angle based on certain input parameters. To verify 70
35 canine bracket from a step-down bypass segment in the utility this numerical study by finite element analysis (FEA), total eight 71
36 arch. But, this method failed to maintain bucco-lingual tooth different positions of Pf were considered based on different 72
37 inclination. Burstone [7] and Marcotte [9] suggested that a values of input parameters. The results of FEA were displayed in 73
38 cantilever should be used from auxiliary tube of the first molar terms of nature of tooth movement and Von-Mises (equivalent) 74
39 to a canine bracket slot. In their study, the cantilever was stresses generated in the periodontal ligament (PDL). Addition- 75
40 inserted into the vertical (occlusal) slot of a canine bracket. But, ally, the optimum magnitude of an intrusive force within the 76
41 insertion of a cantilever in a bracket slot produces an biological limit of a mandibular canine was determined from 77
42 undesirable couple at bracket slot in addition to the intrusive FEA assuming non-linearity of PDL. 78
43 force. Caballero et al. [10] attached the cantilever arm on the
44 top (occlusal) surface of a labial canine bracket to prevent the 79
45 undesirable couple at the canine bracket. As their study was 2. Materials and methods
46 focused on labial orthodontics (LaO), a significant amount of
47 retraction (labio-lingual) force was also applied to the canine Generally, a cantilever has three segments [10] as shown in 80
48 bracket in addition to the intrusive force. Fig. 1A. The distal segment of a cantilever (WX) is fitted into the 81
49 In case of an intrusive (vertical) force, the centre of first molar auxiliary tube and is extended mesially up to the 82
50 resistance (Cres) of a tooth is closer in lingual orthodontics area surrounding the interproximal contact point between 83

Fig. 1 – Appliance setup to achieve pure intrusion of a mandibular canine with a segmented arch in LiO. (A) Lingual aspect
showing three segments of a cantilever and posterior teeth anchorage unit, (B) toe-in and toe-out of the vertical segment of a
cantilever from the distal aspect of a mandibular canine with point of force application (Pf) on lingual bracket top (occlusal)
surface.

Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005
 BBE 207 1–9

biocybernetics and biomedical engineering xxx (2017) xxx–xxx 3

84 canine and first premolar. At this point (X), the cantilever is

85 bent by 908 occlusally as observed from the lingual aspect of a
86 mandibular canine. This forms a vertical segment (XY) which
87 ended up to the level of top (occlusal) surface of a canine
88 bracket. Finally, another 908 bend is given to make a final
89 segment (YZ) which is parallel to the occlusal plane of a
90 mandibular canine. This final segment is tied to the top
91 (occlusal) surface of a mandibular canine bracket and acts as a
92 cantilever attachment point i.e. point of force application (Pf)
93 as shown in Fig. 1B. An anchorage is provided to the posterior
94 teeth (first premolar to second molar).
95 From the distal aspect of a mandibular canine, vertical
96 segment (XY) also makes an angle of 908 with the occlusal
97 plane. This study suggests that if this vertical segment has
98 given a toe i.e. toe-in (towards the lingual surface of a canine)
99 or toe-out (away from the lingual surface of a canine) as viewed
100 from the distal aspect of a mandibular canine (Fig. 1B), then
101 force vector by a cantilever will pass along segment XY and
102 eventually through Cres of a mandibular canine. The amount of
103 toe angle will depend on the position of cantilever attachment
104 (Pf). Thus, the pure intrusion of a mandibular canine will be
105 achieved with a segmented arch. To determine the required
106 toe angle of the vertical segment (XY) from the distal aspect,
107 the geometrical model of a right mandibular canine was
108 developed. Then, the magnitudes of required toe-in or toe-out
109 were computed numerically for different positions of Pf. In the
110 geometrical model, the right mandibular canine was selected Fig. 2 – Geometrical model of a right mandibular canine as
111 for illustrative purpose only. This numerical study is applica- viewed from the distal aspect.
112 ble to any mandibular canine i.e. right or left.

113 2.1. Geometrical model of a mandibular canine axis [13]. The force system was considered to be applied to the 142
top surface of a canine bracket. 143
114 The basic anatomic and geometric features of a right mandibu- The basic trigonometric equations were applied to calculate 144
115 lar canine were taken from Wheeler's dental anatomy; physio- the required toe of the vertical segment of a cantilever. 145
116 logy and occlusion [12]. Fig. 2 shows the geometrical model of a
h 146
117 right mandibular canine as viewed from the distal aspect. PY ¼ (1)
cosðaÞ
118 Several points were defined on the geometrical model i.e.
119 points along the long axis, points along the line parallel to 148
147
ACres ¼ 0:77Lroot (2)
120 occlusal plane (OP) which pass through lingual bracket top 149
121 surface and points passing through OP. The points defined on 151
150
122 the long axis were, P = cusp of a canine, J = point joining crown PCres ¼ ðLcrown þ Lroot ÞACres ¼ Lcrown þ ð0:23Lroot Þ (3)
152
123 and root, Cres = centre of resistance and A = root apex. The 154
153
124 points defined along the line parallel to OP which pass through YCres ¼ PCres PY (4)
155
125 the lingual bracket top surface were, Pf = point of force 157
156
126 application, Z = point intersecting with vertical line through Horizontal distance between Pf and Y was determined as, 158
127 Cres and Y = point intersecting with long axis. The points
159
128 defined on the line which pass through OP were, E = point Pf Y ¼ xPY 0 ¼ x½htanðaÞ (5)
129 intersecting with vertical line through Cres and Y' = projection 160
161
130 point of Y on OP. Vertical distance between Pf and Cres for any height (h) was 162
131 Every individual has different anatomy of tooth. Hence, determined as, 163
132 some parameters of this geometrical model were kept variable
ZCres ¼ ½PCres cosðaÞh (6) 164
133 called as input parameters. These input parameters were
134 defined as, Lcrown = length of the crown along long axis, Horizontal distance between Y and vertical line E–Cres was 165
166
167
135 Lroot = length of root along long axis, a = inclination of the determined as, 168
136 long axis of a mandibular canine with respect to vertical line
YZ ¼ ZCres tanðaÞ (7) 169
137 through Cres in degrees, x = horizontal distance between Pf on
138 the bracket top surface and cusp of a canine (P) and h = vertical Horizontal distance between Pf and vertical line E–Cres was 170
171
172
139 distance between Pf on the bracket top surface and P (height of determined as, 173
140 bracket top surface from OP). The position of Cres was taken
Pf Z ¼ Pf YYZ (8) 174
141 approximately 0.77 times the root length from apex on the long

Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005
 BBE 207 1–9

4 biocybernetics and biomedical engineering xxx (2017) xxx–xxx

Table 1 – Positions of Pf considered for verification by finite element analysis (FEA) based on different values of input
parameters.
Positions of Input parameters Required toe
Pf (Sr. No.) angle (u) in degrees
Lcrown (mm) Lroot (mm) a (degrees) x (mm) h (mm)
[1] 11 15 188 4 2 28
[2] 11 15 188 5 2 38
[3] 11 15 208 6 3 68
[4] 11 15 208 7 3 118
[5] 10 14 188 4 2 08
[6] 10 14 188 5 2 58
[7] 10 14 208 6 3 98
[8] 10 14 208 7 3 158

175
176
177 For any values of x and h, the angle Pf–Cres–Z is the vertical modelled as a simplistic rectangular block to apply the force by 218
178 segment toe (u) angle of a cantilever as viewed from the distal a cantilever at a certain horizontal distance (x) and height (h) 219
179 aspect of a mandibular canine. from cusp of a canine. All the structures were assembled in 220
CREO Parametric. Total eight assembly models were prepared 221
180 ½Pf Z
u ¼ tan1 (9) representing different positions of Pf. Fig. 3 shows an assembly 222
½ZCres 
model with all the structures, i.e. bracket, mandibular canine, 223
181
182
183 From all the aforementioned equations (Eqs. (1)–(9)), the PDL and alveolar bone. The assemblies in CREO Parametric 224
184 master equation to compute the required toe angle (u) in terms were saved in a STEP file format and imported into ANSYS. 225
185 of input parameters was determined as, ANSYS is computer-aided analysis software which per- 226
8 

  9 forms FEA. ANSYS Workbench (version 14.5, ANSYS Inc., 227
186 > ðLcrown þ ð0:23Lroot ÞÞ
>
<fx½htanðaÞg h tanðaÞ >
>
= Canonsburg, Pennsylvania, USA) was used in this study. To 228
cosðaÞ
u ¼ tan1 mesh each assembly model in ANSYS, 10-node tetrahedron 229
>
> ½½ðLcrown þ ð0:23Lroot ÞÞcosðaÞh >
>
: ;
and 20-node hexahedron elements (connected by nodes) were 230
(10) used. On an average, one assembly model consisted of 78 649 231
187
188 nodes and 45 039 elements. The bonded contact was specified 232
189 The computed value of u can be rounded off to nearer between all the tooth structures in ANSYS Workbench. 233
190 integer value to make it suitable to apply clinically. The The mandibular canine (tooth), alveolar bone and bracket 234
191 positive value of u represents toe-in while negative value of u were assumed to be isotropic and linear elastic in nature, while 235
192 represents toe-out. The different positions of Pf were consid- PDL was assumed to be non-linear, hyper-elastic in nature. 236
193 ered based on values of input parameters to compute the The canine bracket was considered to be made of stainless 237
194 required toe angles (u) which were then used to verify this steel. Table 2 shows material properties of mandibular canine, 238
195 numerical study by FEA. alveolar bone and bracket considered for FEA [11]. 239
The previous studies proved that the assumption of non- 240
196 2.2. Verification of a numerical study by finite element linearity of PDL represents more realistic condition [14–17]. 241
197 analysis Fig. 4 shows the uniaxial non-linear model of PDL in terms of 242

198 When a cantilever is tied to the bracket top surface, it applies a

199 single force on the bracket at a particular point (Pf). Hence, the
200 cantilever considered in this study was not included in FEA.
201 Only the force and its direction of application due to the toe of
202 the vertical segment of a cantilever was considered in FEA. For
203 verification of a numerical study by FEA, total eight different
204 positions of Pf were considered based on different values of
205 input parameters as reported in Table 1. The required toe angle
206 (u) was computed from the numerical study (Eq. (10)) for each
207 position of Pf.
208 In this study, three-dimensional computer aided design
209 (CAD) models of all the structures were prepared using CREO
210 Parametric (version 2.0, PTC, Needham, Massachusetts, USA).
211 Total eight different CAD models of mandibular canine were
212 prepared representing different tooth dimensions and posi-
213 tions of brackets as shown in Table 1. Thus, the morphology of
214 each prepared CAD model of a mandibular canine was
215 different. The CAD models of surrounding tissue structures
216 (PDL and alveolar bone) were also prepared. The thickness of Fig. 3 – An assembly model consisting of bracket,
217 PDL was taken as 0.2 mm [11]. The lingual canine bracket was mandibular canine, PDL and alveolar bone.

Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005
 BBE 207 1–9

biocybernetics and biomedical engineering xxx (2017) xxx–xxx 5

Table 2 – Material properties of mandibular canine, Table 3 – Points picked from stress–strain curve to
alveolar bone and bracket. incorporate in ANSYS Workbench.
No. Material Young's Poisson's Points Stress [MPa] Strain [%]
modulus [MPa] ratio
1 0.175 100
[1] Mandibular 19 600 0.30 2 0.170 77
canine (tooth) 3 0.150 55
[2] Alveolar bone 13 700 0.26 4 0.100 40
[3] Bracket 200 000 0.30 5 0.050 30
(stainless steel) 6 0.025 20
7 0.010 10
8 0.006 8
9 0.003 5
243 stress–strain curve as considered by previous researchers in
10 0.000 0
244 their FEA studies [18,19]. In compression, the curve shows 11 0.002 28
245 values of stresses up to 93% strain level. In tension, values of 12 0.004 55
246 stresses up to 100% strain level were indicated. This non- 13 0.010 80
247 linearity of PDL can be considered as hyper-elasticity [20]. 14 0.030 89
248 While several constitutive models of PDL have been proposed 15 0.100 91
16 0.200 93
249 by previous researchers to characterize its hyper-elasticity, the
250 Mooney–Rivlin hyperleastic model is more appropriate for the
251 aforementioned stress–strain curve as the strain rate is up to
252 100% [21]. command was executed to obtain the results of FEA for each 267
253 Table 3 shows total 16 points which were picked from this considered position of Pf. 268
254 stress–strain curve (encircled in Fig. 4) and incorporated as In FEA, the optimum magnitude of an intrusive force was 269
255 uniaxial test data under the category of hyper-elastic data of determined to keep it within the biological limit. The most 270
256 PDL in ANSYS Workbench. To obtain the best curve fit for delicate structure in a tooth assembly is PDL (soft tissues). It 271
257 the given stress–strain curve, different Mooney–Rivlin means that the stresses acting on the PDL should be within the 272
258 parameter models (parameter 2, 3, 5 and 9) were used. biological limit. There are two types of stresses acting on the 273
259 As the best curve fit was obtained for Mooney–Rivlin PDL: compressive (negative) and tensile (positive). At any 274
260 2-parameter model, it was selected to represent non-linear, point, resultant of stresses along X, Y and Z axes is known as 275
261 hyper-elastic nature of PDL. After solving the curve fit for the Von-Mises (equivalent) stress at that point. Generally, Von- 276
262 Mooney–Rivlin 2-parameter model, the material constants Mises (equivalent) stress parameter is used to determine the 277
263 were obtained as: C10 = 0.1137 MPa and C01 =0.0972 MPa. In pattern of generated stresses [22]. The mechanical strength of 278
264 this way, the material property was assigned to PDL. The PDL of a human canine is generally 1.6 MPa [23]. Typically, the 279
265 boundary conditions were applied by fixing lower and lateral factor of safety for components whose failure could result in 280
266 surfaces of the alveolar bone model. Then, the solution serious injury or death is considered as four [24]. Hence, 281
considering factor of safety as four, the maximum value of 282
Von-Mises (equivalent) stress in the PDL should not exceed the 283
value of [1.6/4] = 0.4 MPa. Hence, the value of Von-Mises 284
(equivalent) stress in the PDL equal to 0.4 MPa was considered 285
as the maximum threshold value for the safety of PDL tissues. 286
For each position of Pf considered for verification by FEA, an 287
intrusive force was applied to the top surface of a canine 288
bracket with computed toe angle (u) to represent the force 289
applied by a cantilever. By trial and error method in ANSYS 290
Workbench, the maximum value of an intrusive force was 291
obtained which corresponds to the Von-Mises (equivalent) 292
stress equal to the 0.4 MPa (threshold). This magnitude of an 293
intrusive force was considered as an optimum value. 294

3. Results 295

In FEA, the results were displayed in the form of instantaneous 296

movement of a mandibular canine due compression and 297
tension of PDL after application of an intrusive force with 298
appropriate toe angle. Fig. 5 shows vectors of nodal displace- 299
ments along with undeformed (d1) and deformed (d2) models 300
for different positions of Pf as reported in Table 1. From the 301
Fig. 4 – Stress–strain curve of uniaxial non-linear model of directions of vectors of nodal displacements as well as the 302
PDL. positions of undeformed and deformed models, it was clear 303

Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005
 BBE 207 1–9

6 biocybernetics and biomedical engineering xxx (2017) xxx–xxx

Fig. 5 – Vectors of nodal displacements along with undeformed (d1) and deformed (d2) models for different positions of Pf (A)
position [1], (B) position [2], (C) position [3], (D) position [4], (E) position [5], (F) position [6], (G) position [7], (H) position [8].

Fig. 6 – Occlusal view of PDL with distribution of generated Von-Mises (equivalent) stresses for different positions of Pf (A)
Q3 position [1], (B) position [2], (C) position [3], (D) position [4], (E) position [5], (F) position [6], (G) position [7], (H) position [8].

Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005
 BBE 207 1–9

biocybernetics and biomedical engineering xxx (2017) xxx–xxx 7

Table 4 – Optimum magnitude of required intrusive force In the study of individual intrusion of a canine by Burstone 346
in grams for different considered positions of Pf. [7] and Marcotte [9], insertion of a cantilever into the accessory 347
Positions Required Optimum tube of the first molar and the canine bracket slot created a 348
of Pf toe angle (u) magnitude of two-couple statically indeterminate system. But, Caballero 349
(Sr. No.) in degrees required intrusive et al. [10] applied the one-couple statically determinate system 350
force (g) by tying a cantilever on the top (occlusal) surface of a canine 351
[1] 28 21 bracket in LaO. 352
[2] 38 22 Jost-Brinkmann et al. [31] and Hong et al. [32] stated that the 353
[3] 68 25 tooth movement is more effective in the case of lingual vertical 354
[4] 118 28 forces as Cres is closer in LiO. Hence, in this study, an intrusion 355
[5] 08 20
of a mandibular canine with a segmented arch in LiO was 356
[6] 58 24
suggested. To achieve this intrusion, one end of a cantilever 357
[7] 98 27
[8] 158 30 was considered to be engaged with the first molar auxiliary 358
tube and the other end was considered to be tied on the top 359
(occlusal) surface of a lingual canine bracket. At the tied end, 360
304 that the desired pure intrusion of a mandibular canine model an intrusive force was considered to be acted by a cantilever. 361
305 was achieved in each case of cantilever attachment. No tipping This created a one-couple statically determinate system. 362
306 of a mandibular canine was observed in FEA. Hence, the bracket slot positioning such as vertical, horizontal 363
307 Additionally, the results were displayed in terms of or axial was not considered in this study as it does not have a 364
308 distribution of Von-Mises (equivalent) stresses generated in significant influence on to the methodology used in this study. 365
309 the PDL. Fig. 6 shows the occlusal view of PDL with distribution Thus, in FEA, the lingual bracket model was kept as a simple 366
310 of generated Von-Mises (equivalent) stresses for all the rectangular block which only represents the position of Pf on 367
311 considered positions of Pf. In Fig. 6, the tag at apex (written bracket top surface according to horizontal distance (x) and 368
312 as 'max') represents the location of maximum Von-Mises vertical distance (h) from cusp of a canine. 369
313 (equivalent) stress. From the distribution pattern, it was clear The one-couple system produces the reactive force as well as 370
314 that the equivalent stress was concentrated at apex which the couple on the molar tube. The couple and the force on molar 371
315 leads to maximum bone remodelling in that region [25–29]. tube try to displace the molar tooth. This can be minimized by 372
316 Hence, it signifies the intrusive nature of mandibular canine engaging an archwire from second molar tube to first molar tube 373
317 movement. Thus, the values of the required vertical segment and extending further through brackets slots of first and second 374
318 toe of a cantilever from the distal aspect of a mandibular premolars to generate posterior teeth anchorage segment as 375
319 canine were verified with FEA. shown in Fig. 1A. Thus, posterior teeth will act as a one complete 376
320 Finally, the results of the optimum magnitude of required anchorage unit, making the effects of couple and reactive force 377
321 intrusive force for different considered positions of Pf were significantly lower than the effect of force on the canine. 378
322 estimated in ANSYS Workbench by trial and error method Additionally, undesirable couples and forces on molars can be 379
323 (Table 4). These are the maximum bearable values of intrusive restricted by using independent counteracting force systems 380
324 force for PDL tissues without any damage to them by such as elastics, transpalatal archwires (TPA), etc. [30]. 381
325 considering mechanical strength of PDL to be 1.6 MPa and In the clinical situation, very few patients with a deep bite 382
326 factor of safety as four. The optimum range of an intrusive have the normal inclination of a mandibular canine. Mostly, 383
327 force within the biological limit of a mandibular canine was such patients show a lingual-tipped canine. It means that the 384
328 found to be 20–30 g. inclination of long axis of a mandibular canine is variable in 385
such patients. Additionally, morphology of the tooth is 386
329 variable among the individuals. Hence, in this study, the 387
4. Discussion
parameters like inclination of long axis (a), length of crown 388
(Lcrown), length of root (Lroot), horizontal distance of Pf from 389
330 The orthodontic appliances produce an accurate and desired cusp of a canine (x) and height of Pf from cusp of a canine (h) 390
331 tooth movement only when they are simplistic from the were kept variable called as input parameters. These param- 391
332 biomechanics point of view [30]. Orthodontic appliances such eters individualized the position of bracket applicable for tooth 392
333 as the cantilever, spring, etc. deliver relatively constant forces of any patient. These parameters were then used to devise the 393
334 owing to the large inter-bracket distance between two points mathematical equation (Eq. (10)) to evaluate the required toe 394
335 of attachment. In a two-tooth system, if an appliance is angle (u) of the vertical segment of a cantilever. 395
336 engaged in the bracket slots of both the teeth, it generates a For verification of a numerical study by FEA, eight different 396
337 force and a couple at both the brackets resulting in a two- positions of Pf were considered based on different values of 397
338 couple statically indeterminate system [30]. But, if an appli- input parameters. From the results of FEA in terms of nature of 398
339 ance is engaged in the bracket slot of one tooth and tied as a tooth movement (Fig. 5), the directions of vectors of nodal 399
340 point of contact on the bracket of another tooth, then this force displacements as well as the positions of undeformed and 400
341 system is called as a one-couple system because a couple acts deformed models showed that the desired pure intrusion of a 401
342 only at the bracket slot where an appliance is engaged. One- mandibular canine was achieved. It is known from previous 402
343 couple system is statically determinate as equal and opposite studies that the amount of bone remodelling (absorption or 403
344 forces act at both the attachment sites (engaged and tied) to apposition) is directly proportional to the mean (equivalent) 404
345 maintain the static equilibrium of an appliance [30]. stress concentrated in PDL [25–29]. Hence, the tooth moves in 405

Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005
 BBE 207 1–9

8 biocybernetics and biomedical engineering xxx (2017) xxx–xxx

406 the direction where stress is concentrated in PDL. Thus, from mandibular canine with a segmented arch in LiO will be 463
407 the results of FEA in terms of Von-Mises (equivalent) stresses achieved quiet efficiently and rapidly. 464
408 (Fig. 6), the stress concentration at apex of PDL also proved that
409 the desired pure intrusion of a mandibular canine was 465
Conflict of interest statement
410 achieved.
411 Previously, the optimum range of an intrusive force for a
412 single tooth was suggested to be 10–20 g [33] which assumed The authors declare no conflict of interest. 466
413 simply linear elastic nature of PDL. In this study, the
414 consideration of non-linear, hyper-elastic nature of PDL enabled
415 the acquisition of more realistic and accurate stress and references 467
416 deformation patterns of PDL. Additionally, all the eight consid-
417 ered positions of Pf showed quite a good range of required toe
418 angle i.e. 28 (toe-out) to 158 (toe-in). Thus, the obtained range of [1] Kim T, Suh J, Kim N, Lee M. Optimum conditions for parallel 468
419 an intrusive force bearable by a mandibular canine (20–30 g) can translation of maxillary anterior teeth under retraction 469
420 be considered as appropriate. For this obtained range, the lesser force determined with the finite element method. Am J 470
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421 magnitude of an intrusive force will result in slower rate of tooth
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422 movement, while higher magnitude can lead to damage of PDL
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423 tissues. Thus, in the clinical situation, this range of an intrusive lingual orthodontics applied on maxillary incisors — a 474
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432 up of a plaque. Apart from these limitations, the lingual Mech Eng A 2004;28(8):1237–44. 484
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Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005
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Please cite this article in press as: Thote AM, et al. Pure intrusion of a mandibular canine with segmented arch in lingual orthodontics: A
numerical study with 3-dimensional finite element analysis. Biocybern Biomed Eng (2017), http://dx.doi.org/10.1016/j.bbe.2017.05.005