ORIGINAL ARTICLE

Comparison of the orthodontic load systems created with elastomeric power chain to close extraction spaces on different rectangular archwires
Catherine Kroczek,a Katherine Kula,b Kelton Stewart,c James Baldwin,d Tie Fu,e and Jie Chenf Indianapolis, Ind Introduction: The 3-dimensional load system (forces and moments) was quantied at the canine bracket during space closure with sliding mechanics with elastomeric chain on dry and wet stainless steel and beta-titanium 0.019 3 0.025-in archwires. Methods: A custom-made maxillary dentoform simulating rst premolar extractions was attached to an orthodontic force tester. The canine was attached to a load cell through an adaptor with silicone simulating the periodontal ligament. The orthodontic force tester simultaneously measured the entire load system produced at the canine bracket by an elastomeric chain. The effects of archwire material, time (activation and 1 hour), and lubrication were analyzed by using 3-way repeated measures analysis of variance (ANOVA, a 5 0.05). Results: Stainless steel provided a greater (P 5 0.001) load system than did beta-titanium. The force was greatest on the canine in the lingual axis. The greatest moment was about the y-axis. The moment-to-force ratio, the most critical ratio, was greater for beta-titanium than stainless steel; however, both were close to the ideal 10:1. Conclusions: With a stainless steel archwire for retraction sliding mechanics, a canine will experience a greater load system in all 3 dimensions than with a beta-titanium wire. Both archwires produced a moment-to-force ratio adequate for translation. (Am J Orthod Dentofacial Orthop 2012;141:262-8)

he methods used to retract canines into an extraction space typically use sliding mechanics or closing loops. Although several studies1-3 have evaluated moments and forces on abutment teeth with various loops, there is little information on these load systems in

a Resident, Department of Orthodontics and Oral Facial Genetics, School of Dentistry, Indiana University, Indianapolis. b Professor and chair, Department of Orthodontics and Oral Facial Genetics, School of Dentistry, Indiana University, Indianapolis. c Assistant professor, Department of Orthodontics and Oral Facial Genetics, School of Dentistry, Indiana University, Indianapolis. d Professor, Department of Orthodontics and Oral Facial Genetics, School of Dentistry, Indiana University, Indianapolis. e Postdoctoral fellow, Department of Mechanical Engineering, Purdue University, Indianapolis. f Professor and chair, Department of Mechanical Engineering, Purdue University, Indianapolis, Ind; joint appointment, Department of Orthodontics and Oral Facial Genetics, School of Dentistry, Indiana University, Indianapolis. The authors report no commercial, proprietary, or nancial interest in the products or companies described in this article. Reprint requests to: Katherine Kula, Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, 1121 W Michigan St, Indianapolis, IN 46202; e-mail, kkula@iupui.edu. Submitted, December 2010; revised and accepted, September 2011. 0889-5406/$36.00 Copyright 2012 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2011.09.007

3 dimensions when elastomeric power chain is used to produce sliding mechanics on a continuous archwire in the wet and dry states.1,4,5 The use of sliding mechanics continues to increase in popularity, and so a better understanding of the 3-dimensional effect on the load system at the level of the bracket is needed. The use of sliding mechanics ideally involves the best combination of archwire material, archwire size, and force to permit the tooth to translate along the archwire with minimal friction and minimal loss of anchorage.6 The size and cross-sectional geometry of the archwire are key components in sliding mechanics. As the size of the archwire increases, the forces required to overcome friction for a bracket to slide also increase.7 According to Kojima and Fukui,8 the tipping of the canine and the movement of the anchor teeth decreased when the wire size increased. The ideal archwire size would minimize unfavorable side effects from sliding mechanics to achieve the best translation of teeth into extraction sites. Another variable when using sliding mechanics for canine retraction is the unpredictability of frictional forces.9 Frictional forces are generally greater with

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increased wire sizes10 and are inuenced by the properties of archwire material. Stainless steel wires have a lower coefcient of friction than do beta-titanium-molybdenum alloy (beta-titanium) wires regardless of the bracket material.11-14 Increased friction leads to an increase in the force needed for sliding mechanics.15 Stainless steel wires have excellent formability, good corrosion resistance, moderate cost, and high values of stiffness and resilience.16 Stainless steel wires also have a high yield strength and a high modulus of elasticity, but lower maximum elastic strain compared with beta-titanium.16 Beta-titanium wires offer a highly desirable combination of strength, high springback (maximum elastic strain), and formability with low stiffness.13,16 However, many clinicians choose stainless steel wires rather than beta-titanium wires during space closure because the coefcient of friction is lower and the stiffness is greater compared to beta-titanium. The general thought is that stainless steel wires allow less tipping of teeth into the extraction sites. However, Kula et al17 suggested that beta-titanium wires could be as good as stainless steel wires for closing extraction spaces. The use of elastomeric power chain is a possible source of force when using sliding mechanics. However, elastomeric power chain can permanently deform, resulting in a gradual loss of effectiveness over time.18 The signicant force decay in the power chain is a clinical consideration.19,20 The previously mentioned studies examined the properties of elastomeric power chain, stainless steel wire, and beta-titanium wire separately.1-20 However, there is little information concerning the effects of elastomeric power chain and the types of wires in the 3-dimensional load system. When testing friction, another variable is lubrication. In a comparative friction study, the resistance to sliding increased for both stainless steel and beta-titanium wires when tested with articial saliva and whole human saliva.21 The increase in resistance was attributed to the adhesions and attractions among polar materials, water, and other liquids that can increase the friction.22,23 However, the authors of these studies assumed continuous contact between large areas of wires and brackets, not the 2-point contact between brackets and wires that occurs clinically. There appears to be a general lack of information about the 3-dimensional load system concerning sliding mechanics and its many variables. The purpose of this pilot study was to determine the 3-dimensional load system created on a bracket when using sliding mechanics to close space on stainless steel and beta-titanium wires in dry and wet environments.
MATERIAL AND METHODS

Fig 1. The orthodontic force tester with attached dentoform.

The force and moment components were measured on the canine bracket of a custom-made dentoform by

using an orthodontic force tester (Fig 1).1 The orthodontic force tester was designed and built for the load cell to simultaneously measure the moment and force components in the x, y, and z axes acting on the tooth attached to an archwire (Fig 2). The orthodontic force tester had a moment/force load cell (multi-axis force/torque Gama; ATI Industrial Automation, Apex, NC) with resolutions of 6 0.2 N for the force components and 6 0.0025 N-m for the moment components. The canine was cut from a solid, 1-piece dentoform and attached to the load cell with an adaptor. The adaptor consisted of an articial root connecting to the canine, an articial periodontal ligament made of 0.3-mm silicon24,25 (Loctite Gasket Sealant 2; Henkel, Dusseldorf, Germany), and an aluminum socket connected to the load cell. This complex fullled 2 purposes: it connected the canine and the load cell, and it allowed a slight movement similar to that of a natural tooth in bone because of the periodontal ligament. The crown displacement was about 0.12 mm under a 3-N force, which was close to the 0.13 mm reported by Christiansen and Burstone.26 The custom-made dentoform represented an ideal maxillary arch already leveled and aligned, second molar to

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Fig 2. Load cell with the silicone adaptor attached to the canine. A beta-titanium archwire, ligatures, and power chain are in place.

second molar, after the rst premolars were extracted. A Trueform I arch form (G & H Wire, Greenwood, Ind) of 0.019 3 0.025-in stainless steel wire served as the guide for the fabrication of the dentoform. The archwire form was traced and then cut from a piece of 22-gauge steel to form a template to position the brackets. Omniarch 0.022-in brackets with the MBT prescription (GAC International, Bohemia, NY) were used for all teeth and placed onto the steel template. After autopolymerizing acrylic (Duralay; Reliance Dental Manufacturing, Worth, Ill) was placed onto the mesh of each bracket, the steel template with the attached brackets was aligned to the acrylic teeth, and the acrylic was allowed to cure. Once the brackets were cured onto the dentoform, an impression was made with low-viscosity polyvinylsiloxane (Examix NDS; GC America, Tokyo, Japan) along the buccal surfaces of the teeth, and the polyvinylsiloxane was allowed to set. When the polyvinylsiloxane was set, a thin layer of petroleum jelly was applied to its outer layer. A second impression by using medium-viscosity polyvinylsiloxane (Examix NDS; GC America) was made over the initial impression. The initial impression served as a blockout material registering the proper placement of the brackets in addition to permitting easy removal of the impression material without distortion. The low-viscosity impression was removed, and duplicate

brackets were placed in this custom guide. With this guide, the secondary impression was placed over the initial impression, and tooth-colored autopolymerizing acrylic was poured into the impression. After polymerization of the teeth, the remainder of the impression was lled with a pink, gingiva-colored, autopolymerizing resin and allowed to set under pressure to minimize further dimensional changes. The 1-piece dentoform, with brackets, was removed from the impression after polymerization. To allow room for the load cell, some acrylic was removed from the rst premolar to the lateral incisor. The canine was then cut entirely from the dentoform after the apical base was attached to the load cell through the adaptor, which ensured alignment of the canine with the rest of the teeth. Two types of 0.019 3 0.025-in preformed archwires were chosen for this study: Trueform I OrthoForce stainless steel and Trueform I Orthoforce BT3 beta titanium (beta-titanium) (G & H Wire), with each material type from the same lot. These wires were chosen after visual comparison between the arch forms for stainless steel vs beta-titanium. G & H wires had the greatest consistency between the 2 wire materials and the chosen arch form when compared with similar arch forms from GAC and Ormco (Glendora, Calif). Ten stainless steel and 10 beta-titanium wires were tested in the dry state, and 10 stainless steel and 10 beta-titanium wires were tested in the wet state, for a total of 40 wires. Before each wire was tested, the orthodontic force tester was reset to clear previous readings. The moments and forces on the canine were evaluated upon initial activation and after 1 hour. Lubricant was placed only on the canine bracket and wire by using a medical dropper to dispense 2 drops of the distilled water at initial placement and 1 hour. Since the use of cleaners to remove saliva residues could affect the sensor, distilled water was chosen over articial or human saliva because of the sensitivity of the load cell. Similar to a clinical situation, the rst molar and the second premolar were ligated together by using 0.010-in stainless steel ligatures over the archwire to provide anchorage for the posterior movement of the canine. The mesial wings of the canines were also tied with 0.010-in stainless steel ligatures over the archwire. Elastomeric power chain (Alastik; 3M Unitek, Monrovia, Calif), 2 modules in length, was ligated from the mesial wing of the second premolar bracket to the distal wing of the canine bracket (Fig 2). This form of ligature was chosen because it has been a choice of some clinicians. The force was measured by using a tension gauge (Dontrix 16-oz; E.T.M., Monrovia, Calif). The 2 links provided 3.33 N of force upon initial activation. The tension was not measured after 1 hour of activation.

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Fig 3. The coordinate system used to evaluate the force (F) components in each direction: mesiodistal (Fx/1Fx), buccolingual (1Fy/Fy), and incisal/gingival (1Fz/Fz).

The initial placement and 1-hour time intervals were determined after evaluation of the preliminary studies. The preliminary data showed consistency of the transducer readings within the specied resolutions during a 3-hour period without a load. However, additional studies showed that the transducer was the most consistent when readings were taken within an hour. This testing duration was sufcient to evaluate changes caused by sliding mechanics.
Statistical analysis

Fig 4. The coordinate system used to evaluate the moment (M) components in each direction at the level of the bracket: A, moments about the x-axis caused movement in the buccolingual direction (Mx/1Mx); B, moments about the y-axis caused movement in the mesiodistal direction (My/1My); C, moments about the z-axis caused movement in the mesial in/distal in direction (1Mz/Mz).

A 3-way repeated-measures analysis of variance (ANOVA) was performed to evaluate the effects of the wires (beta-titanium and stainless steel), time (0 and 1 hour), and wet vs dry states on each outcome. Pairwise comparisons between treatment combinations were adjusted for multiple comparisons by using the Tukey procedure, assuming an overall signicance level of alpha 5 0.05. Analyses were performed on the ranks of the measurements to convert to a nonparametric test.
RESULTS

The coordinate system for the forces and moments at the bracket are shown in Figures 3 and 4, respectively. The results for each force and moment component of each archwire material, duration, and lubrication are shown (Tables I-III). All outcomes were analyzed with 3-way ANOVA. When interactions between factors (wire type, duration, and lubrication) were not signicant, the results were presented as an overall effect. However, when the interactions were signicant, the comparisons were examined at the levels of the other factors involved.

All force (F) and moment (M) components at the bracket were statistically greater for stainless steel than for beta-titanium (P \0.001) (Table I). The percentage differences between stainless steel and beta-titanium ranged from 22% (1Fx) to 34% (Fz) for force, and from 14% (1Mz) to 66% (Mx) for the moments. The greatest force was measured in the lingual direction (Fy), and the greatest moment was about the y-axis in the mesial direction (My). The differences due to time and lubrication on some force and moment components (Tables II and III) were statistically signicant. Most differences were not clinically signicant because of their low magnitudes. The maximum differences in any force component were 0.17 N from the effect of time and 1.17 N from lubrication. The maximum differences for the moment component were 1.19 N-mm from the effect of time and 1.75 N-mm from lubrication. Evaluation of the moments in the buccolingual direction in relation to the force in the buccolingual direction (Mx/Fy) (Table IV) shows that Mx/Fy was greater for stainless steel than for beta-titanium (P 5 0.0001), less for 0 hour than for 1 hour (P 5 0.009), and greater for dry than wet (P 5 0.008). The means ranged from 0.04 mm for beta-titanium in the wet state at initial activation to 0.91 mm for beta-titanium in the dry state at 1 hour of activation. Evaluation of the moments in the mesiodistal direction in relation to the force in the distal direction (My/ Fx) (Table V) shows that My/Fx was less for stainless steel

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Table I. The effect of archwire material on the mean (6 SE) on force and moment components
Stainless steel (mean 6 SE) Beta-titanium (mean 6 SE) Difference % difference P value Fx (N) 2.09 (0.03) 1.63 (0.04) 0.46 (0.08) 22 0.0001 Fy (N) 5.29 (0.08) 3.79 (0.08) 1.49 (0.21) 28 0.0001 Fz (N) 1.88 (0.09) 1.24 (0.07) 0.64 (0.08) 34 0.0001 Mx (N-mm) 3.52 (0.28) 1.19 (0.28) 2.33 (0.51) 66 0.0001 My (N-mm) 20.10 (0.28) 16.84 (0.35) 3.26 (0.85) 16 0.0003 Mz (N-mm) 10.11 (0.11) 8.65 (0.19) 1.46 (0.45) 14 0.0002

Table II. The effect of time on the mean (6 SE) on force and moment components
0 hour (mean 6 SE) 1 hour (mean 6 SE) Difference % difference P value Fx (N) 1.95 (0.05) 1.78 (0.04) 0.17 (0.01) 9 0.0001 Fy, stainless steel (N) 5.31 (0.11) 5.26 (0.11) 0.05 (0.01) 1 0.0001 Fy, beta-titanium (N) 3.79 (0.12) 3.79 (0.11) 0.00 (0.01) 0 0.99 Fz (N) 1.55 (0.09) 1.56 (0.09) 0.01 (0.01) 1 0.0063 Mx (N-mm) 1.92 (0.25) 2.79 (0.37) 0.87 (0.32) 45 0.0166 My (N-mm) 19.07 (0.36) 17.88 (0.38) 1.19 (0.13) 6 0.0001 Mz (N-mm) 9.36 (0.18) 9.40 (0.18) 0.05 (0.08) 0 0.47

than for beta-titanium (P 5 0.019), usually signicantly less for 0 hour than for 1 hour (P 5 0.015), and greater for dry than wet (P 5 0.0004). The means ranged from 9.47 mm for stainless steel in the wet state at initial activation to 11.86 mm for beta-titanium in the dry state at 1 hour of activation.
DISCUSSION

The clinicians goal when using sliding mechanics is to achieve pure translation of the tooth, not just to tip the crown into the extraction space. A single force passing through the center of resistance can produce translation of a tooth along its line of action.11,27,28 Alternatively, a proper force and counter-moment at the bracket of a tooth might have the same effect. A force at the bracket creates a moment (Mf), about the center of resistance that will tip the tooth.11,28 An appropriate counter-moment can cancel the Mf, resulting in translation. Thus, the tooth displacement pattern can be controlled by proper adjustment of the force and applied counter-moments. The results are reliable. The parameter that affects the load system is the amount of crown, or, specically, the bracket displacement. The amount of displacement depends on not only the thickness of the periodontal ligament but also its material properties. We built the complex and adjusted the material properties and the periodontal ligament thickness so that the crown displacement behaved similarly to a human tooth; thus, the measurement was accurate. To be efcient at this procedure, the load system needed to be evaluated in all 3 dimensions to best counteract any negative effects during this process. This pilot study was a rst step in the evaluation of this process

and examined the effects of different archwire materials, lubrication, and duration. Due to activation of the elastomeric power chain, the forces placed on the canine were in the distal, lingual, and gingival directions. The greatest force was in the lingual direction (Fy, Fig 3), followed by the distal and then the gingival directions. This can be explained as the following. The load system sensed by the tooth is the result of multiple factors. In addition to the crown displacement, it is also determined by the stiffness of the archwire, the activation force from the elastomeric chain, friction, ligation, and the interplay of the archwire and the bracket. The stiffness of the archwire plays a major role in the level of lingual force, and the friction from ligation affects the distal force greatly. We measured the resultant force and moment on the tooth. Considering 2 extreme cases, assume that we have a rigid archwire, and there will be no lingual force on the tooth; or, if we have rigid ligation on a rigid archwire, there will be no distal force on the tooth even with a large distal force on the bracket because the force is absorbed by the archwire. Therefore, the activation force is not the determining factor. Our system has a exible wire; thus the load system reported on the tooth is possible. The moment components created at the canine bracket were Mx, a moment about the x-axis causing tipping in the buccolingual direction; My, a moment about the y-axis causing tipping in the mesiodistal direction; and Mz, a moment about the z-axis causing mesiodistal rotation. The greatest moment component, My, caused mesial tipping that counteracted the moment resulting from the distal force, Fx. The high distal force, 1Fx, probably led to deection of the wire at the bracket. The resulting contacts between the wire and the bracket created a couple, which was the moment, My. Similarly, the Mx was also due to interplay

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Table III. Effects of lubricant on the mean (6 SE) on force and moment components
Dry (mean 6 SE) Wet (mean 6 SE) Difference % difference P value Fx (N) 1.75 (0.07) 1.90 (0.04) 0.15 (0.08) 9 0.34 Fy (N) 4.68 (0.19) 4.47 (0.13) 0.21 (0.20) 4 0.4 Fz (N) 2.33 (0.08) 1.17 (0.05) 1.17 (0.08) 50 0.0001 Mx (N-mm) 3.42 (0.50) 1.68 (0.28) 1.75 (0.52) 51 0.006 My (N-mm) 18.69 (0.59) 18.41 (0.40) 0.28 (0.81) 1 0.51 Mz (N-mm) 9.44 (0.31) 9.32 (0.15) 0.12 (0.43) 1 0.28

Table IV. Comparison* of moment to force ratios for stainless steel vs beta-titanium wire (P 5 0.0001) under wet vs

dry conditions (P 5 0.009) at 0 and 1 hour (P 5 0.008)

Moment-to-force ratio Mx/Fy Mx/Fy Mx/Fy Mx/Fy Mx/Fy Mx/Fy Mx/Fy Mx/Fy

Wire Stainless steel Stainless steel Beta-titanium Beta-titanium Stainless steel Stainless steel Beta-titanium Beta-titanium

Time elapsed (h) 0 1 0 1 0 1 0 1

Mean (mm) 0.76 0.86 0.37 0.91 0.44 0.67 0.04 0.22

SE 0.07 0.21 0.08 0.35 0.07 0.10 0.10 0.11

*Three-way ANOVA with P 5 0.05 as signicant.

Table V. Comparison* of moment to force ratios for stainless steel vs beta-titanium wire (P 5 0.019) under wet vs dry conditions (P 5 0.015) at 0 and 1 hour (P 5 0.0004)
Moment-to-force ratio My/Fx My/Fx My/Fx My/Fx My/Fx My/Fx My/Fx My/Fx Testing condition Dry Dry Dry Dry Wet Wet Wet Wet Wire Stainless steel Stainless steel Beta-titanium Beta-titanium Stainless steel Stainless steel Beta-titanium Beta-titanium Time elapsed (h) 0 1 0 1 0 1 0 1 Mean (mm) 9.98 10.16 11.69 11.86 9.47 9.73 9.80 9.76 SE 0.42 0.28 0.37 0.39 0.19 0.12 0.23 0.18

*Three-way ANOVA with P 5 0.05 as signicant.

of the wire and the bracket that partially corrected tipping from the high lingual force, Fy. To achieve pure translation, a proper moment-to-force ratio is needed.26 Although the individual components were greater with the stainless steel wires in place compared with the beta-titanium wires, the My/Fx was greater for the beta-titanium wires. The overall averages were 10.78 mm for beta-titanium and 9.83 mm for stainless steel. Both wires had ratios near the ideal moment-to-force ratio of 10:1 needed for translation.28 Evaluation of Mx/Fy shows that all values for both archwires were less than 1; thus, the counter-moment was unable to prevent the lingual tipping from the lingual force. However, this moment-to-force ratio is not as clinically signicant because of the need for some required tipping as a result of change in arch form from initial placement along the

archwire to the nal position of the tooth, assuming maximum posterior anchorage in the dentoform. Although some statistically signicant differences were found because of the effect of time, most of the differences were negligible clinically because of their low magnitudes. Additionally, the use of lubrication had minimal effects. Only 2 components, Fz and Mx, were statistically affected, but these effects were also small. Thus, it is reasonable to state that lubrication has a negligible effect on the force system. The lack of signicance could be due to the 2-point contact of the wire and the bracket that produced the countermoment, reducing resistance to movement from lubrication. However, binding was not specically studied. In this study, we evaluated the 3-dimensional components at the bracket of a canine during retraction

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sliding mechanics; it emphasizes the previously undetermined biomechanics when using sliding mechanics on a continuous archwire. Most biomechanical research and explanations center on 2-dimensional force systems that are extremely simplistic in 3-dimensional clinical situations, leading to false impressions about the actual tooth movement. Clinicians, therefore, should be aware that the previously indeterminate force systems that are attributed to such variables as bone quality and height, friction, other archwire material properties and form, and the reaction of contiguous teeth when using sliding mechanics require additional 3-dimensional study to better explain such reactions as loss of anchorage. Additional 3-dimensional force load studies are needed to evaluate changes based on different ligation methods, type of power chain (closed vs open), and the teeth used for anchorage when using sliding mechanics on a continuous archwire.
CONCLUSIONS

Based on this 3-dimensional pilot study evaluating the load systems created at the canine bracket during sliding mechanics, the following should be emphasized. 1. The clinician should be aware that, when using a stainless steel wire compared with beta-titanium wire during sliding mechanics, the canine at the bracket will have greater forces and moments placed on it in all 3 dimensions. Both stainless steel and beta-titanium archwires produced similar moment-to-force ratios that could cause translation and insufcient ratios to prevent lingual tipping. Some statistically, but not clinically, signicant differences were found from the effects of time and lubrication.

2.

3.

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