ORIGINAL ARTICLE Center of resistance of anterior arch segment

Shigeyuki Matsui, DDS, PhD,a A. A. Caputo, PhD,b Spiro J Chaconas, DDS, MS,c and Hiroshi Kiyomura, DDS, DMScd Saitama, Japan, and Los Angeles, Calif It is important to know the location of the center of resistance (CR) to control tooth movement. In this study, photoelastic techniques were used to determine the center of resistance. The photoelastic model included the anterior 4 maxillary teeth, which were interconnected firmly with 6 mm of space between lateral incisors and canines. Determination of the CR for the anterior arch segment was based on considerations of a wide variety of load conditions that generated the more uniform stresses in the supporting alveolar bone simulant. For the arch having the anterior 4 teeth connected, the CR was located within the mid-sagittal plane, 6-mm apical and 4-mm posterior to a line perpendicular to the occlusal plane from the labial alveolar crest of the central incisor. (Am J Orthod Dentofacial Orthop 2000;118:171-8)

rthodontic treatment is often achieved more efficiently when the tipping of teeth is minimized. By definition, a force with a line of action passing through the center of resistance (CR) of a tooth produces pure translation without rotation of the tooth.1 Further, the tooth subjected to such a force is more resistant to movement.2 Therefore, tipping will be less for forces directed near the CR. For normal conditions of periodontal tissues, the CR for a single root tooth exists two thirds of the distance from the alveolar crest to the apex.3 If a force were applied with a line of action passing through the CR, the tooth would undergo bodily movement. During canine retraction, tipping can be eliminated by applying a force and moment combination to the crown that produces a resultant force that passes through the CR. In the case of a tooth with multiple roots, such as a maxillary first molar, the CR is located near the furcation. With these teeth, bodily movement may be obtained by using a headgear appliance with the outer bow adjusted so that the resultant force passes through the furcation area. Therefore, the orthodontist always considers the relationship between the location of the CR and the applied force vector.

aAssistant Professor, Department of Orthodontics, School of Dentistry, Meikai University, Saitama, Japan. bProfessor and Chairman, Section of Biomaterials Science, School of Dentistry, University of California, Los Angeles. cProfessor Emeritus, Section of Orthodontics, School of Dentistry, University of California, Los Angeles. dProfessor Emeritus, Department of Orthodontics, School of Dentistry, Meikai University, Saitama, Japan. Reprint requests to: Shigeyuki Matsui, Department of Orthodontics, School of Dentistry, Meikai University, 1-1 Keyakidai, Sakado City, Saitama, Japan 35002; e-mail, matsui@dent.meikai.ac.jp Submitted, October 1998; Revised and accepted, August 1999. Copyright 2000 by the American Association of Orthodontists 0089-5406/2000/$12.00 + 0 8/1/103774 doi:10.1067/mod.2000.103774

A number of investigators have reported on the location of the CR for single root teeth, determined by various theoretical and experimental methods. For example, Haack and Weinstein3 considered the effects of forces on the motion of a 2-dimensional model of an incisor. They concluded that pure translation was obtained by a single force passing through the CR, or by a combination of a single force and an appropriate moment applied at the bracket. Burstone4 reported that the CR was located at 33% of the distance of the root length apical to the alveolar crest for an idealized upper incisor. Using a holographic measuring technique, Burstone and Pryputniewicz5,6 found that the CR of the upper incisor was located slightly more occlusal when compared with the theoretical one.2 More recently, Tanne et al7 used a 3-dimensional finite element analysis to determine displacements of teeth with various root lengths and alveolar bone heights conditions. They concluded the location of the CR shifted apically as the alveolar bone height was reduced. In the case of maxillary molars, bodily movement was obtained when the traction line of a cervical headgear passed through the trifurcation areas. It was concluded that the CR of the upper first molar was located at this area.8 Burstone et al9 stated that the CR of mandibular molars was between 30% and 40% of the distance from the alveolar crest to the apex. Pederson et al10 also studied mandibular molars, by using displacement transducers on human autopsy material. They described the relationship between a force system and the resulting tooth movement by the position of the center of rotation, the CR, and the angle of rotation. It was concluded that the CR location depended on tooth anatomy and the shape and amount of bony support. On the other hand, significantly less attention has been given to the CR of a segmented arch. Dermaut and
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Fig 1. Test setup. Shaded area represents framework fixing 4 anterior teeth. Note 6-mm space between lateral incisor and canine representing a stage of orthodontic treatment in extraction case.

Table I. Mechanical

properties of simulant materials

E (MPa) 2931 207 7 v 0.36 0.42 0.40

Materials Tooth Alveolar bone Periodontal membrane Epoxy resins (PLM-1) Epoxy resins (PL-2) Urethane (Solithane)

visual access to stresses in various locations, including mediolateral directions, is enhanced. Therefore, it was the purpose of this investigation to determine the CR of a maxillary anterior arch segment based on observations of stress distributions around teeth in simulated periodontal tissues of a photoelastic model.
MATERIAL AND METHODS Photoelastic Materials and Frame Work

E(MPa), Modules of elasticity v Poissons ratio.

Bulcke11 used the laser reflection technique and holographic interferometry in testing 2 types of segmented arches on a macerated human skull. When the 6 anterior teeth were incorporated in a sectional wire, they found that the CR was located more to the distal side of the canines; however, it was more difficult to define the CR of the 4 incisors. They concluded it was situated just distal to the lateral incisors. Pedersen et al12 also determined the location of the CR of various consolidated units of maxillary anterior teeth on human autopsy material by means of a displacement measuring device. The units studied consisted of 2 central incisors, 4 incisors, and 6 anterior teeth, and they described the changes of the location of the CR for each of the arch segment units. The results of these studies are not in complete agreement on the location of the CR in segmented arch units. None of these techniques makes any estimations of internal stress within the supporting structures around the teeth that would lead to biologic alterations. When the induced stresses are uniform, biologic changes take place that lead, in time, to translational motion.13 In this study, the quasi-3-dimensional photoelastic technique was used.14 This modeling technique allows for visualization of internal stresses developed within the model around the loaded teeth. By rotating the model,

A compound photoelastic 3-dimensional model of a maxilla was used in this study. Impressions were made of a maxilla and maxillary teeth by using a silicone mold material. Different plastic simulants were used to fabricate the individual components of the model. As shown in Table I, PL-1 (Photolastic Division, Measurements Group, Raleigh, NC) was used for the teeth, PL-2 (Photolastic Division) for alveolar bone, and Solithane (Uniroyal Chemical Co, Inc, Middlebury, CT) for the periodontal membrane.14-16 After being assembled, the model was fixed firmly, with epoxy resin, to a supporting plate at the zygomatic and frontal processes. As shown in Figs 1 and 2, the model had 6-mm spaces between the lateral incisors and canines. The model simulated the treatment stage of an extraction case after the canine retraction was completed. The wax pattern for the framework was directly fabricated on the model. Small pins were attached on the vertical part of the framework every 5 mm from the level of the alveolar crest to the apex on each side. The wax pattern of the framework was made as symmetrical as possible. After casting the wax pattern in a chrome-cobalt alloy, the framework was the firmly connected to the 4 anterior teeth with a resin cement.
Load Conditions

The model was loaded by dead weights connected to the framework with nylon lines (Fig 3). A 1-pound (454

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Fig 2. Photoelastic model used: (a) anterior segment; (b) chromium-cobalt frame; (c) pulley.

Fig 3. Diagrammatic representation of directions of pull applied to arch segments. A, Distal load. The arrrow shows an example of direction of pull 2.0-A. B, Vertical load.

gm) weight was applied to each side of the arch. Various directions of pull were obtained by altering the position of pulleys affixed posterior to the model, as shown in Fig 3, and the location of the hooks to which the lines were connected. Loads were applied to the framework in a posterior direction at various angles to the occlusal plane. These force directions were obtained by adjusting the position of the line on the framework from A to D, and by changing the pulley location from 2.0 to 4.0. Fig 3A, shows an example of direction 2.0-A, which means that the position of the line on the frame is A, and pulley location is 2.0. Vertical loads also were applied perpendicular to the occlusal plane at 2-mm increments from the anterior alveolar ridge of the central incisor (Fig 3B).

Photoelastic Experiment

All loading was performed in the field of a circular polariscope, with the model immersed in a tank of mineral oil to facilitate isochromatic fringe observation (Fig 4). These isochromatic fringes are distributed 3-dimensionally in response to the intensity of internal stress. Stress is high in an area when many lines are seen and concentrated when distance between fringes is small. Presentation of the photoelastic data was facilitated by schematic representations of the stress distributions. In these diagrams, areas of high stress concentration are denoted by the darkest shading and lower stresses are shown with light shading. Further, since there was almost com-

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Fig 4. Circular polariscope arrangement for visualization of isochromatic fringes. LS, Light source; D, diffuser; P, polarizer; M, model; Q, quarter-wave plate.

Fig 5. A comparison of stresses generated by 2 pull directions. The width of the periodontal ligaments in the diagram is exaggerated to facilitate presentation of fringes. Note nonuniform stress distributions.

plete symmetry of the stress fields about the midline, only the right-side data are presented. From all of the test conditions, the load was sought that produced a relatively uniform stress distribution pattern in order to determine the general area of the CR. Because of the symmetry of the model and the applied loads, the location of the CR can be expected to lie in the mid-sagittal plane.
RESULTS

Examination of the unloaded model in the circular polariscope revealed an almost stress-free condition (less than one-half fringe order maximum). Consequently, the stress patterns observed on load application were due to the effects of the applied loads.

In general, the various force vectors applied to the framework produced different degrees of lingual crown tipping, as manifested by nonuniform fringe patterns within the periodontal membranes and alveolar bone simulants. Fig 5 shows the comparison of the stress distributions for 2.0-A loading (distal, parallel to the occlusal plane) on the left, with loading 2.0-D (distal, toward the occlusal plane) on the right. Load 2.0-A concentrated stress at both sides of the central incisor root, being higher on the distal. Stress also was localized distally along the lateral incisor and the mesial part of the canine root. These high-stress areas were toward the crestal one-third of the roots. This stress distribution reflects lingual crown tipping.

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Fig 6. Stresses resulting from 4.0-BC direction of pull. Note uniformity of stress distribution.

Fig 7. Comparison of stress distributions of different locations of vertical pull. A, Load ; B, load ; C, load ; D, location of vertical directions of pull.

A different distribution resulted from 2.0-D loading. Here, the highest stress concentrations occur along the middle half of the distal aspect of the root of the central incisor. This distribution is indicative of labial crown tipping and is in contrast to the lingual effects of load 2.0-A. A relatively uniform distribution pattern was observed when the position of the pulleys was 4.0 and

the lines for loading were attached between B and C of the framework, as shown in Fig 6. This uniform stress distribution indicates that the vertical location of the CR exists close to this axis. Fig 7 shows the stress distributions resulting from forces applied vertical to the occlusal plane. When a load was applied at the anterior region (Fig 7A),

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Fig 8. Estimated position of the CR. The CR for the 4-tooth segment was located within the midsagittal plane, approximately 6-mm apical and 4-mm posterior to a line perpendicular to the occlusal plane from the labial alveolar crest of the central incisor.

stress concentrations were found at the distal parts of the roots of the anterior teeth. When a load was applied at the posterior part of the anterior segment (Fig 7, C), higher stress concentrations were observed at the distal parts of the roots of the lateral incisors and within the alveolar crest between laterals and canines. The stresses generated by load midway between and are shown in Fig 7, B. This load produced high stresses uniformly distributed to the middle one third of the distal aspect of the central incisor root, the distal of the lateral incisor, and to the distal part of the canine. Therefore, the horizontal location of the CR exists close to this direction of pull. Fig 8 shows the estimated position of the CR. The CR was located at the intersection of the vertical force that produced more uniform stresses (force ) with the distally directed force that also produced a more uniform stress field (force 4.0-BC). This intersection, and thus the CR, is located within the mid-sagittal plane approximately 6-mm apical and 4-mm posterior to a line perpendicular to the occlusal plane from the labial alveolar crest of the central incisor.
DISCUSSION Selection of Photoelastic Technique

The photoelastic technique was selected for this investigation because: (1) 3-dimensional and compli-

cated shapes can be reproduced and modeled in materials that provide individual simulation of orofacial structure and that provide visualization of stresses under load, and (2) stresses throughout the entire model (whole-field observation) can be examined. However, the materials used as simulants are isotropic in nature, and it is not possible to perfectly model all characteristics of the mechanical properties. It should be noted that finite element analysis (FEA) and laser holography also have the characteristic of whole-field observation. Further, FEA has the capacity of including anisotropic mechanical properties in the analysis,7 while laser holography has the potential for in vivo examinations.17,18 While these techniques have the potential for high accuracy, their application is not an easy matter. For example, the anisotropic input data of the individual elements of the orofacial complex, which is required for utilization of the strengths of the FEA, are not known. On the other hand, laser holography, while inherently extremely accurate in measuring displacements, is complicated to apply in vivo because of the difficulty in fixating the head. In addition, this technique cannot predict any internal effects. Consequently, each of these techniques is seen to possess inherent advantages and disadvantages. The ideal situation would be to apply all of the techniques to all biomechanics problems in orthodontics, which is generally not accomplished because of practicality.

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Fig 9. Comparison of the position of the CR with fixation of 4 anterior teeth: (a) present study; (b) Vanden Bulcke et al study19,20; (c) Pedersen et al study.12

Photoelasticity has had a long history of applications in dentistry and has been shown to be predictive of many clinically observed phenomena.
CR Determination and Location

In this study, a photoelastic technique was used to determine the CR of a maxillary anterior arch segment based on observations of stress distributions around teeth in simulated periodontal tissues of a photoelastic model. The location of the CR was determined by observing isochromatic patterns. If an applied force produces a relatively uniform fringe pattern in the periodontal membrane and surrounding tissues, the force must pass close to the CR. Therefore, the CR was established as the point of intersection of the lines of action of the forces, both perpendicular and inclined to the occlusal plane, that produced uniform stress distributions around the teeth. A pure translation of teeth would occur if the stresses around the periodontal tissues and surrounding bones were uniform.13 The CR is located within the mid-sagittal plane, approximately 6-mm apical and 4-mm posterior to a line perpendicular to the occlusal plane from the labial alveolar crest of the central incisor. These findings are different from those found by Pedersen and colleagues12 and Vanden Bulcke et al.19,20 Fig 9 compares the locations of the CR determined by these investigators with the CR determined in this study. A major difference was in the configuration of the arches studied. The model used in the present study had 6-mm spaces between the lateral incisor and canines and filled with simulated alveolar bone, which represented an orthodontic treatment stage just before the retraction of the 4 incisors in extraction case. The situation considered by the above-mentioned investigators did not include a comparable orthodontic treatment stage. Further, these

investigators used techniques that monitor the displacement of the crowns of teeth of human skulls, either dried or fresh autopsy material. These techniques cannot ensure the development of uniform stresses that is essential for pure translation of the teeth to occur.13 An advantage of the photoelastic approach, used in this investigation, is the ability to observe the stresses generated around the teeth during loading. Consequently, it is expected that the position of the CR as determined in this study can be used as a clinical guideline.
Effect of Framework Stiffness

A chrome-cobalt alloy was selected for the framework because of its high modulus of elasticity. If the frame to fix teeth is not stiff enough, the teeth will move individually and an accurate determination of the CR becomes almost impossible. This experimental difficulty was recognized by Vanden Bulcke and associates.11,19,20 Because of the stiffness of the framework used in the present investigation, this problem was obviated and a good estimate of the CR for the arch segment was obtained. Clinically, when 4 anterior teeth are to be moved, it is most often desirable to move them bodily. To accomplish this bodily motion, it is necessary to use the stiffest wire possible and zero wire-slot clearance. If the wire selected is not sufficiently stiff, the CR of the segment will not be uniquely defined, because each tooth moves separately. When this situation occurs, control of the anterior segment is lost. On the other hand, as the stiffness of the wire increases, the position of the CR of the 4 teeth becomes stable and control of the segment will be achievable.
CR Application

Many factors make the precise understanding of the CR difficult. In the clinical situation, it is almost

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impossible to keep the direction and the amount of applied force constant. In addition, factors that alter the position of the CR of 4 anterior teeth are the shape of surrounding bone, root morphology, position of each tooth, and structure of the periodontal attachment. Since these factors generally will be different for each patient, the location of the CR of anterior arch segments in these patients also will be different. One of the advantages of the model system used in this study is the fact that all these variables are kept constant. Thus, the experimental results will give us a specific position of the CR for this configuration. The values from this investigation may not be extrapolated directly to a particular clinical situation, but they will provide a guideline for determining the CR of the anterior arch segment for each case.
CONCLUSION

7.

8.

9. 10.

11.

12.

A 3-dimensional photoelastic model of a maxilla with individual simulants for teeth, bone, and periodontal ligament was used to determine the CR of a 4tooth anterior arch segment. The CR was specified from the forces that produced more uniform stresses around the teeth. The CR for the 4-tooth segment was located within the mid-sagittal plane, approximately 6-mm apical and 4-mm posterior to a line perpendicular to the occlusal plane from the labial alveolar crest of the central incisor.
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