RETRACTION
Introduction
Historical Perspective
Biomechanics
Classification of canine retraction
Friction mechanics
Frictionless mechanics
Recent Advances
Conclusion
Introduction
Retraction of the canines represents a
fundamental stage in a considerable number of
orthodontic treatments. Correct positioning of the
canine after retraction, recognized to be of
uppermost importance for function, stability, and
esthetics, can be obtained either by uprighting
after uncontrolled tipping or by means of
biomechanically predetermined and controlled
movement.
Historical Perspective
Late in 19th Century
As extraction were done in the late 19 th century
finger springs or other methods were employed
for the simple pushing back of canine teeth. This
often resulted in tipping and elongation of teeth.
Tweed
He placed coil springs along the continuous .016
round arch and push cuspid from one side to the
other meanwhile tying back the arch to the
molar which were employed as anchors.
Ricketts
In 1980, Ricketts employed push coil springs in
order to obtain Sectional Cuspid retraction.
Biomechanics
The principles for retraction currently used can
be described as either (a) a "frictional" system in
which the canine, through application of a force,
is expected to slide distally along and is guided
by a continuous arch wire or (b) a nonfrictional
system with forces and couples built into the
loops of an arch section.
Center of resistance
Every object or free body has one
point on which it can be perfectly
balanced. This point is known as the
center of gravity.
The movement of a free body depends
upon the relationship of the line of
action of the force to the center of
gravity
In a restrained body, such as a tooth,
a point analogous to the center of
gravity is used; this is called the
center of resistance. By definition, a
force with a line of action passing
through the center of resistance
produces translation. The center of
resistance of a single-rooted tooth is
on the long axis of the tooth, probably
between one third and one half of the
root length apical to the alveolar
crest. i.e. 66% of root length from the
apex towards the alveolar crest
Center of rotation
Effects of forces
Equivalent Systems
M/F
10/1
5/1
0/1
12/1
Force Constancy
The most desirable type of tooth movement is
produced by a relatively constant force in an
optimal range. It is important to design the
active components of an appliance such that it
has the following properties.
Low LDR
LDR depends on Wire Cross Section, length,
material and configuration
Frictionless System
To achieve constant force and moment levels
sliding frictional forces should be reduced, that
impedes the movement of teeth, also these
forces alter the predictability of the desired
forces on the teeth during retraction process.
Scope of Retraction
1.
Friction
1.
ELASTIC MODLE WITH LIGATURE
2.
ELASTOMERIC CHAINS OR POWER CHAIN
3.
INTRA (OR) INTER MAXILLARY ELASTICS
TO KOBAYASHI LIGATURES
4.
COIL SRINGS
1. STAINLESS STEEL
2. NITI
5.
J-HOOK HEADGEAR
6.
SLIDING JIG AND TRACTION
7.
MULLIGANS V BEND SLIDING
MECHANICS
2.
Frictionless
1.
RICKETTS MAXILLARY & MANDIBULAR
CUSPID RETRACTION SPRINGS
2.
POUL GJESSING SPRING
3.
BURSTONE T-LOOP RETRACTION AND
ATTRACTION SPRINGS
4.
MARCOTTE SPRING
5.
MODIFIED LINGUAL LEVER ARM
Friction
Mechanics
Physical
1.Archwire.
a. Material
b. Cross-sectional shape/size
c. Surface texture
d. Stiffness
2. Ligation of archwire to bracket
a. Ligature wires
b. Elastomerics
c. Method of ligation:method of tying, bracket
designs to limit force of ligation, self ligating
brackets
3. Bracket
a. Material
b. Manufacturing process : cast or sintered
stainless steel
c. Slot width and depth
d. Design of bracket : single or twin
e. First-order bend(in-out)
f. Seond-order bend(angulation)
g. Third-order bend(torque)
4. Orthodontic appliance
a. Interbracket appliance
b. Level of bracket slots between adjacent teeth
c. Forces applied for retraction
B. Biological
1. Saliva
2. Plaque
3. Acquired pellicle
4. Corrosion
EFFECT OF BRACKET
Sintered stainless steel brackets produce significantly
lower friction than cast stainless steel brackets. Poly
crystalline ceramic gives more friction than ceramicreinforced composite with metal slot insert. Ceramicreinforced composite without metal slot insert,
exhibited very less friction.
Effect of Bracket width
The narrower the bracket the greater the length of
the inter bracket wire therefore greater the flexibility
of the wire in addition narrow brackets have less
control over rotation and tipping.
Biological effect Saliva and saliva substitute serves
as an excellent lubricant in the sliding of the bracket
along a arch wire.
5.
6.
7.
ELASTIC CHAINS
These were introduced into the dental profession
in the 1960s and are used in many orthodontic
practices for canine retraction, diastema closure,
rotation correction and arch constriction.
Configurations
Elastomeric chains are available in 3
configurations:
1.
2.
3.
Advantages
1.
2.
3.
4.
5.
6.
Inexpensive
Relatively hygienic
Easily applied without archwire removal
Not dependent on patient cooperation
Since molar anchorage is being reinforced,
both palatal and buccal elastic traction may be
applied.
In combination with the direct headgear
system. The headgear wear for anchorage
support does not as a rule need to be so
intensive.
Disadvantages
Prestretching
It is advisable to stretch or work the elastic
module prior to activation to achieve the
desired force levels, to overcome the problem
or rapid force decay rate and provide for a
more constant and consistent force delivery.
Environmental Factors
Tooth movement, pH and temperature changes,
fluoride rinses, salivary enzymes and
masticatory forces have all been associated
with deformation, force degradation and
relaxation behaviour of elastomeric chains.
Force Degradation
Most of the elastomeric chains generally loose
50% - 70% of their initial force during the 1st day
of load application and at 3 weeks retain only 30
40% of their original force.
Some of the chains extended 100% of the original
length produce force levels in excess of 450gms,
leading researches to recommend and extension
of 50% to 70%. Other chains when distracted
100% produce force levels of 300 grams. In view
of the wide variation of initial force levels of
different types of power chains, the prudent
practitioner should employ a force gauge to
determine the desired initial force. When just
applied a power chain produce a force of
approximately 250 300 gms.
b.
c.
d.
ii.
Advantages
1.
2.
3.
4.
Disadvantage
1.
2.
3.
4.
5.
6.
7.
EXTRA-ORAL TRACTION
6.
J-HOOK-HEADGEAR
During retraction of canines, the maintenance of posterior
tooth position has always been a major concern for the
orthodontists, mainly in those cases in which maximum
anchorage is needed.
One of the methods for accomplishing distal movement of
canines without loosing posterior anchorage is J-hookheadgear. It involves the use of headgear with J-hooks
where the hooks attach along a continuous arch wire
mesial to the canines and exert a force over them so that
they will slide along the arch wire. Since it incorporates
extra oral anchorage in canine retraction, it should be
effective in maximum anchorage cases.
Advantages
1.
2.
3.
Disadvantages
1.
2.
3.
4.
Advantages
1.
Disadvantages
The jigs are quite difficult to lubricate and
their length must be correct so that the
canine is free to move back. They can
rotate around the archwire and become
caught under the bracket. They are fairly
bulky and thus act as a food trap and an
irritant to the cheek.
FRICTIONLESS
MECHANICS
3.
4.
5.
6.
Spring Design
The spring design made from 0.016 x 0.022 inch
stainless steel wire. The predominant active element is
the ovoid double helix loop extending 10mm apically
and width 5.5 mm. It is included in order to reduce the
load/deflection of the spring and is placed gingivally so
that activation will cause a tipping of the short
horizontal arm (attached to the canine) in a direction
that will increase the couple acting on the tooth. Height
is limited by practical considerations, so that a double
loop is necessary to incorporate sufficient wire. The
gently rounded form avoids the effect of sharp bends on
load/deflection and, through the use of the greatest
amount of wire in the vertical direction, reduction of
horizontal load/deflection is maximized. At the same
time, minimizing horizontal wire increases rigidity in
the vertical plane. The smaller loop occlusally is
incorporated to lower levels of activation on insertion in
the brackets in the short arm (couple) and is formed so
that activation further closes the loops.
Clinical Application
Alignment of the Buccal
Teeth
The spring is constructed to
resist tendencies for tipping
and rotation during canine
retraction, not to correct
existing rotations or extreme
deviation in inclination.
Therefore the buccal
segment, including the
canine, second premolar, first
molar and eventually second
molar must be leveled prior
to the insertion of the spring.
Activation
The spring is activated by pulling distal to the
molar tube until the two loops separate. The wire is
secured with the gingival bend in the posterior
extension. Reactivation in the initial spring
configuration should be done every 4 to 6 weeks.
This amount of activation produces the
recommended initial load of 100gms. It is critical to
avoid over activation of the spring, because a few
mm of over activation can result in anchor loss.
Since the average distance from the centers of the
brackets to the CR are identical for the upper and
lower canines, the PG retraction spring works
equally well for canine retraction in either arch.
Advantage
In general it has been found that the spring
tends to tip the maxillary canine distally during
retraction, unless the canine arm is gabled to
approximately 45o. Although gabling by this
amount should theoretically produce an
excessively high N/P ratio during deactivation
which would cause the canine to tip mesially. It
has been found clinically that this does not
occur because the spring distorts on insertion
thereby reducing the gable angle. Excessive
stress relaxation and undesirable large
retraction forces can be produced by over
retraction. For this reason activation should be
confined to 1mm as recommended by Gjessing.
Clinical observation, however, suggests that the
recommended amount of lateral curvature helps
to minimize this tendency.
Disadvantage
The PG spring is bulky, and the depth of the
buccal sulcus limits the height of the pear. It
should be noted that, as with other retraction
components, a reduction in the heights of the
spring will not only significantly decrease the
flexibility but will also reduce the antitilt
moment/force ratio.
Spring Preactivation
Before the spring is inserted in the moth it needs to be
preactivated as follows:
1. Curvature is bent in the occlusal part of the spring.
This part of the spring may deform during activation and
therefore needs to be over bent and followed by a trial
activation. Then remove the excess curvature.
2. Open the ears in the gingival part of the T-spring and
add some angle to the occlusal vertical arms so that the
neutral position is correct. Then trial activate.
3. Recheck the T-spring on the template which is a guide
for the required angulation.
1.
2.
3.
4.
MARCOTTE SPRING
This is a type of minor cuspid retraction spring
and is small, light 0.016 inch closing loop.
This spring extends from the auxiliary tube of the
1st molar bracket to the bracket on the cuspid,
and is activated by being pulled throng the
auxiliary tube and cinched. The buccal segment
feels, then a protractive force and a positive
moment, while the tooth is being walked back
on the wire. Hence are used in Group B or C
Arches. Activation should be limited to 1 2mm.
COMPARATIVE STUDIES
Comparison of NiTi Coil springs Vs. elastics
in Canine retraction Andrew L. Sonis, DMD
J.C.O. 1994 volume XXVIII Numbers
The study was designed to compare the canine
retraction rates of conventional elastics and nickel
titanium coil springs, using a continuous archwire
system.
The ideal force delivery system would meet the
following criteria:
Be economical.
Inference
1. The use of super-elastic nickel titanium coil
springs resulted in a significantly greater and
more consistent rate of space closure than elastic
modules.
2. When examined clinically, there was no
difference in tooth position produced by the two
systems after space closure.
RECENT ADVANCES
1.
Inference
On the basis of maxillary impression taken at
frequent intervals during the course of the
study, the canines retracted with a constant
force moved statistically significantly more
that the control canines during the
experimental period. The average differences
in the mean rates of tooth movement between
the two sides were in the order of 2:1 in
favour of the experimental side. There were
no statistically significant differences in the
changes of angulation (tipping) or rotation
about they axis between the two sides. The
duration of force application seems to be a
critical factor in regulating rate of tooth
movement. Conversely, magnitude of the
applied force did not appear to be of primary
significance.
2.
CONCLUSION
Depending upon the techniques employed a number of
procedures are used for the retraction of canine, in
the treatment of extraction cases.
Some mechanics employed may create compression or
tension and use an arch wire, for control , allowing the
canine to move. Unfortunately with such mechanics,
high moments are produced which can inhibit its
movements.
No single technique suits every situation because each
technique has its limitation. Thus the individual
operator must choose the method preference to treat
malocclusion, which require, bodily movement or
rotation of teeth with minimal time, to produce an
aesthetic and functional and near ideal occlusion as
possible.