Original Article

Forces and Moments Generated with Various Incisor Intrusion Systems on

Maxillary and Mandibular Anterior Teeth
Iosif Sifakakisa; Nikolaos Pandisb; Margarita Makouc; Theodore Eliadesd; Christoph Bourauele

ABSTRACT
Objective: To evaluate the comparative intrusive forces and torquing moments in the sagittal
plane generated during anterior intrusion using different incisor intrusion mechanics in the max-
illary and mandibular anterior teeth.
Materials and Methods: Five wire specimens were used for each of the following intrusive arch-
es: non–heat-treated, 0.016 ⫻ 0.016-inch blue Elgiloy utility arch, 0.017 ⫻ 0.025-inch TMA utility

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arch, and 0.017 ⫻ 0.025-inch TMA Burstone intrusion arch. The wires were constructed according
to the specifications given by their inventors and were inserted on bracketed dental arches on
Frasaco models, segmented mesial to the canines. Simulated intrusion from 0.0–1.5 mm was
performed on the Orthodontic Measurement and Simulation System (OMSS), and forces and
moments were recorded at 0.1 mm vertical displacement increments. All measurements were
repeated five times for each specimen, and maximum values recorded at 1.5 mm for all wires
were used for all statistical evaluations. The data were analyzed with two-way analysis of variance
(ANOVA) with forces and moments serving as the dependent variables, separately, and wire type
and jaw as the independent variables. Post hoc multiple comparisons were performed using the
Tukey test (.05 error rate).
Results: The 0.017 ⫻ 0.025-inch TMA Burstone intrusion arch exerted the lowest intrusive forces,
followed by the 0.017 ⫻ 0.025-inch TMA utility and the 0.016 ⫻ 0.016-inch blue Elgiloy utility
arch. The lowest anterior moment in the sagittal plane in this experiment was generated from the
0.017 ⫻ 0.025-inch TMA Burstone intrusion arch.
Conclusions: The intrusive forces, as well as the generated moments, were always higher in the
mandible, where significant differences were observed among the configurations tested. (Angle
Orthod. 2009;79:928–933.)
KEY WORDS: Intrusion; Burstone arch; Utility; TMA; Moments

INTRODUCTION ed arch1–3 and the bioprogressive4,5 techniques. Both

use intrusion arches with anchorage on posterior teeth
Two major orthodontic intrusion techniques for the
anterior dentition have been developed: the segment- but have fundamental biomechanical differences in
their construction/use and consequently in their mode
of action.6 The first is a determinate one-couple force
a
Doctoral candidate, Department of Orthodontics, School of
Dentistry, University of Athens, Athens, Greece. system, with moments and forces that can readily be
b
Private practice, Corfu, Greece. discerned, measured, and evaluated. The utility intru-
c
Associate Professor, Department of Orthodontics, School of sion arch is a two-couple system, created by tying the
Dentistry, University of Athens, Athens, Greece. rectangular wire into the incisor brackets; in this man-
c
Associate Professor, Department of Orthodontics, School of
Dentistry, Aristotle University of Thessaloniki, Greece. ner the precise magnitude of forces and couples can-
e
Professor and Cendres⫹Métaux Endowed Chair, Depart- not be known, especially if torque bends or cinch back
ment of Oral Medicine Technology, School of Dentistry, Univer- are incorporated in the archwire.7 The Burstone intru-
sity of Bonn, Bonn, Germany. sion arch does not require a cinch, since the incisor
Corresponding author: Dr Theodore Eliades, 57 Agnoston Hi-
roon, Nea Ionia 14231, Athens, Greece
inclination can be controlled by the contact point of the
(e-mail: teliades@ath.forthnet.gr) incisor tie.6
Accepted: December 2008. Submitted: December 2008.
Most of the published clinical studies about these
 2009 by The EH Angle Education and Research Foundation, two techniques concerned the extent of root resorp-
Inc. tion8–11 or their side effects on the posterior part of the

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MAXILLARY AND MANDIBULAR LOADS DURING INTRUSION 929

dentition.12–13 The force magnitude14 and the applica- 0.018 ⫻ 0.025-inch stainless steel archwire was sub-
tion point of the intrusive force15 were also clinically sequently ligated to the two segments, and they were
evaluated for the segmented arch technique. Also, a both mounted on the positioning tables of the OMSS.
limited number of studies dealt with the comparison of An adjustment of the system was conducted with the
the segmented16 or the Ricketts technique17 with a straight wire in place and all forces/moments gener-
continuous archwire technique, whereas one study fo- ated were nullified in this configuration.
cused on incisor intrusion in patients with marginal In the absolute measurement mode, the dental arch
bone loss using both techniques.18 The differential ef- was initially leveled. During the measurement proce-
fect of the intrusion techniques on each jaw is not dure, the anterior segment was gradually extruded up
clear. Goerigk et al11 evaluated the segmented arch to 1.5 mm and afterwards intruded to its initial position.
technique and found a similar rate of intrusion in both The forces/moments generated in the anterior seg-
jaws, but the extent of the intrusive movement and the ment were measured in 0.1 mm steps, and the maxi-
percentage of root resorption were larger in the man- mal values were evaluated statistically.
dible.13 McFadden et al evaluated the bioprogressive
technique and found lesser root shortening in the man- Materials
dible.9 Greater intrusion in mandibular incisors was re-

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ported by Otto et al using the bioprogressive tech- The following arches were evaluated with the ab-
nique8 and by Weiland et al16 using the Burstone tech- solute measurement system, with regard to the forces/
nique. However, comparison of the results of these moments generated in the anterior maxillary and man-
studies is complex because of the variation in the dibular segments:
methods used. —Utility arch 0.016 ⫻ 0.016-inch blue Elgiloy, non–
The aim of this study was to evaluate comparatively heat-treated (Rocky Mountain Orthodontics, Den-
the intrusive forces and torquing moments generated ver, Colo).
during anterior intrusion between the two intrusion —Utility arch 0.017 ⫻ 0.025-inch TMA (Ormco, Glen-
techniques in both jaws. dora, Calif)
—Burstone intrusion arch constructed with a 0.017 ⫻
MATERIALS AND METHODS 0.025-inch TMA (Ormco), ligated distal to the lateral
Experimental Apparatus and Configuration incisors and gingivally of the anterior sectional wire.
The Orthodontic Measurement and Simulation Sys- Five utility and five Burstone intrusion arches were
tem (OMSS) was used for the in vitro evaluation of the fabricated by the first author for each of the above-
different intrusion mechanics.19 The OMSS is based mentioned combinations and for each jaw. All mea-
on the principle of the two-tooth model and allows the surements were performed in quintuplicate.
measurement of all forces and moments acting on two The segmented intrusion arches were constructed
regions simultaneously. For this purpose, the OMSS according to the specifications given by Burstone.3
has two stepping motor-driven positioning tables The 3-mm helix of the intrusion arch was wound and
equipped with force/moment transducers, monitored placed mesial to the molar tube. The diameter of the
by a personal computer that controls the measure- helix was measured with a measuring gauge, and a
ments. Absolute measurements were recorded of the 45⬚ molar tip-back was incorporated in the wire,
forces/moments generated by an orthodontic appli- whereas the intrusion arch was ligated gingivally to the
ance, when the positioning tables are moved along a anterior segmented arch. The posterior segment con-
specified path.20 sisted of both molars and premolars on each side,
An acrylic Frasaco model was constructed for each which were stabilized with a sectional passive 0.018
jaw, with an ideal, leveled, and aligned, dental arch. ⫻ 0.025-inch stainless steel wire. An anterior, passive
The first and second molars on the model were bond- sectional arch from the same wire was fabricated for
ed with 0.018-inch slot tubes with 0⬚ angulation/torque/ the stabilization of the incisors. A palatal/lingual arch
distal offset, and 0.018-inch slot brackets were placed was not deemed necessary since the posterior seg-
on the rest of the teeth (Forestadent, Pforzheim, Ger- ments of the model were united. The utility arches
many). Each model was split into two segments after were fabricated with 45⬚ molar tip-back, as described
bracket placement: the anterior segment, which in- by Ricketts,4,5 without any molar rotation or buccal root
cluded the four incisors and the posterior segment, torque incorporated in the wire, for simplicity. During
which included the teeth from the canine to the second the experimental intrusion, the helix of the Burstone
molar. An appropriate adaptor was fixed on each of archwires was ligated to the tube and the utility arch-
these model segments to make them mountable to the wires were cinched back.
positioning tables of the OMSS (Figure 1). A straight For the objectives of this study, which targeted the

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930 SIFAKAKIS, PANDIS, MAKOU, ELIADES, BOURAUEL

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Figure 1. The acrylic Frasaco model mounted to the positioning tables of the Orthodontic Measurement and Simulation System (OMSS).

pure intrusive and buccolingual torque components of Package for Social Sciences (SPSS Inc, version 15.0,
the intrusion configurations, only the intrusive forces Chicago, Ill).
(Fx) and the moments (My; anterior buccolingual
torque) were used for the final evaluations of simulated RESULTS
intrusion. The remaining force (Fy, Fz) and moment
The Utility archwires recorded mean intrusive forces
(Mx, Mz) components are greatly affected by factors
in the range of 1.33–1.71 N. The utility 0.016 ⫻ 0.016-
such as proper adjustment of the anterior segment rel-
inch blue Elgiloy exerted higher force than the utility
ative to the posterior segment, wire bending, proper
0.017 ⫻ 0.025-inch TMA. The recorded magnitudes
archwire insertion, ligation, and activation. Because all
for the Burstone 0.017 ⫻ 0.025-inch TMA intrusive
of the aforementioned factors introduce unnecessary
arches were 0.99–1.25 N (Table 1). The analysis of
variability and confound the results that are of real in-
terest during anterior maxillary intrusion, the compo-
nents Fy, Fz, Mx, and Mz were adjusted to zero. Table 1. Results of the Anterior Intrusion Forces at 1.5 mm for the
Three Configurations Included in the Study
Statistical Analysis Intrusion Force, N

The results of forces and moments were statistically Maxilla Mandible

analyzed separately by means of two-way analysis of Wire Type Mean* (SD) Mean* (SD)
variance (ANOVA). Forces and moments were the de- Burstone TMA (0.017 ⫻ 0.025) 0.99b (0.11) 1.25a (0.14)
pendent variables and wire type and jaw were the in- Utility Elgiloy (0.016 ⫻ 0.016) 1.43d (0.07) 1.71c (0.10)
dependent variables. Post hoc multiple comparisons Utility TMA (0.017 ⫻ 0.025) 1.33a (0.12) 1.54e (0.13)
were performed using the Tukey test (.05 error rate). * Means with same letters are not significantly different at the .05
Statistical analysis was performed with Statistical level.

Angle Orthodontist, Vol 79, No 5, 2009

MAXILLARY AND MANDIBULAR LOADS DURING INTRUSION 931

Table 2. Analysis of Variance (ANOVA) for Intrusion Force Table 4. Analysis of Variance (ANOVA) for Moments
Type III Type III
Sum of Mean Sum of Mean
Source Squares df Square F Sig Source Squares df Square F Sig
Corrected Corrected
model 7.719 (a) 5 1.544 139.598 .000 model 564.798 (a) 5 112.960 55.814 .000
Intercept 283.873 1 283.873 25,669.680 .000 Intercept 4919.559 1 4919.559 2430.782 .000
Wire 5.319 2 2.660 240.490 .000 Wire 522.441 2 261.221 129.071 .000
Jaw 2.377 1 2.377 214.912 .000 Jaw 36.878 1 36.878 18.222 .000
Wire ⫻ jaw 0.023 2 0.012 1.050 .353 Wire ⫻ jaw 5.478 2 2.739 1.353 .262
Error 1.592 144 0.011 Error 291.436 144 2.024
Total 293.185 150 Total 5775.793 150
Corrected Corrected
total 9.311 149 total 856.233 149

variance indicated significant differences for both wire

arches that were measured were in that range. With

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type and jaw variables, whereas the interaction term
respect to the lower incisors, both authors agree that
was insignificant (Table 2). Significant difference be-
the force should be approximately half the amount
tween the maxilla and the mandible was observed,
used for the upper incisors.
and for the same wire type, the forces were always
Nevertheless, a recent clinical study demonstrated
higher in the mandible.
that 0.4 N of force could intrude the four maxillary in-
The highest moment value was recorded for the
cisors with the same rate as those of double the mag-
lower utility 0.017 ⫻ 0.025-inch TMA (7.79 Nmm), and
nitude.14 In light of this evidence, the force magnitudes
the lowest for the upper Burstone 0.017 ⫻ 0.025-inch
of the biomechanical configurations tested in this ex-
TMA intrusion system (2.47 Nmm). Significant differ-
periment are exceedingly high. The lowest values
ence between the maxilla and the mandible was ob-
were recorded for the upper 0.017 ⫻ 0.025-inch TMA
served, and for the same wire type, the moments were
Burstone intrusion arch, since the moduli of elasticity
always higher in the mandible (Tables 3 and 4).
of beta-titanium wires are around 40% of that of stain-
less steel,23 in contrast to Elgiloy wires, whose moduli
DISCUSSION
of elasticity are similar to stainless steel.24 Accordingly,
Orthodontic intrusion of the incisors is indicated for beta-titanium wires deliver about half the amount of
the management of deep bite, especially in cases force compared with that of stainless steel25 or cobalt-
where bite opening with eruption of posterior teeth is chromium wires23 of comparable cross section and
contraindicated. The decision whether to intrude the equal amounts of activation. Although a 3-mm helix
maxillary or the mandibular anterior teeth is made by was incorporated in the Burstone intrusion archwire,
the functional evaluation of the upper gingival line in the 45⬚ molar tip-back produced 0.99 N in the upper
relationship with the upper lip.21,22 The proper force and 1.25 N in the lower anterior segment.
magnitude for the four upper incisors was initially sug- The 0.016 ⫻ 0.016-inch Elgiloy exerted about 10%
gested by Burstone to be around 1 N3, and as the re- more force than the 0.017 ⫻ 0.025-inch TMA. Gen-
sults of the present study indicate, a maxillary 0.017 erally, a 0.017 ⫻ 0.025-inch cantilever is about 86%
⫻ 0.025-inch TMA Burstone intrusion arch, exerted stiffer than a 0.016 ⫻ 0.016-inch cantilever from the
forces within this range. On the other hand, Ricketts5 same material,26 but in the case of a rectangular sup-
proposed a magnitude of 1.2–1.6 N, and the utility ported beam, its properties are primarily determined
by the dimension in the direction of bending. Addition-
ally, if the ends are tightly anchored, ie, not free to
Table 3. Results for the Anterior Moments at 1.5 mm for the Three
Configurations Included in the Study slide, the beam is stronger and less flexible.7 In this
simulation, the intrusive forces were always higher in
Moment, Nmm
the mandible, since the length of the buccal bridge of
Maxilla Mandible the mandibular utility arches, calculated as the dis-
Mean* (SD) Mean* (SD) tance between the anterior and posterior vertical
Burstone TMA (0.017 ⫻ 0.025) 2.47b (1.44) 3.86a (2.22) steps, was 25 mm, 3 mm shorter than in the maxillary
Utility Elgiloy (0.016 ⫻ 0.016) 5.92c (0.96) 7.02cd (1.02) arches. For the same reason, the points of contact in
Utility TMA (0.017 ⫻ 0.025) 7.31d (1.28) 7.79d (1.24) the maxillary Burstone intrusive arches were more an-
* Means with same letters are not significantly different at the .05 teriorly located, in comparison to the mandibular arch-
level. es. The length of the moment arm is of great impor-

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932 SIFAKAKIS, PANDIS, MAKOU, ELIADES, BOURAUEL

tance for the determination of the force magnitude, aging and saliva. Furthermore, it has not yet been pos-
and it is recommended to do initially as much retrac- sible to predict the center of resistance of the four in-
tion as possible to decrease this length.27 cisors, and the intrusion of these teeth should be care-
The results of this experiment encourage the use of fully monitored to avoid side effects.
a force gauge in order to evaluate the intrusive arch-
wires used in clinical practice. This measurement re- CONCLUSIONS
flects closely the intrusive force in case of a Burstone
intrusive archwire. Additionally, the force magnitude of • The 0.017 ⫻ 0.025-inch TMA Burstone arch exerted
such an archwire for a given activation could be mea- the lowest forces, followed by the 0.017 ⫻ 0.025-
sured from the force-deflection graphs, provided for inch TMA utility and the 0.016 ⫻ 0.016-inch non–
different arch lengths.3 In a two-couple utility arch sys- heat-treated blue Elgiloy utility arch. According to re-
tem, the load required to bring the incisor segment of cent clinical research, a 45⬚ molar tip-back in the
the wire to the incisor brackets does not accurately mandibular intrusion arches of rectangular cross
reflect the intrusive/extrusive load acting at the teeth.6 section, produces forces beyond the biologically suf-
In this system, the torque bends or cinch back, which ficient level, especially in case of a utility arch.
are probably required additionally to the activation • The lowest anterior moment in the sagittal plane in

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bends, change the biomechanical geometry, and un- this experiment was generated from the 0.017 ⫻
der these circumstances, it is difficult to be certain 0.025-inch TMA Burstone intrusion arch, followed by
which of the moments will prevail or whether the intru- the 0.016 ⫻ 0.016-inch non–heat-treated blue Elgi-
sion force is appropriate.7 According to the results of loy utility and the 0.017 ⫻ 0.025-inch TMA utility
this experiment, a 45⬚ molar tip-back in the mandibular arch.
intrusion arches tested, produces forces beyond the
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