Are aligners capable of inducing palatal bodily translation or palatal root torque of upper central incisors? A biomechanical in vitro study.

OBJECTIVES: Previous studies have shown that aligners have limited ability to control root movements. The purpose of this study was to investigate which modification geometry and foil thickness are optimal for generating the force-moment (F/M) systems required for palatal root torque of maxillary central incisors. MATERIALS AND METHODS: Tooth 11 was separated from a maxillary acrylic model and connected to a movement unit via a 3D F/M sensor. Different modification geometries (crescent, capsular, double-spherical) with different depths were digitally implemented in the labio-cervical region of tooth 11 to induce an increased contact force. We evaluated the F/M systems exerted by aligners with thicknesses of 0.4-1.0 mm. F/M measurements were taken with tooth 11 in the neutral position and during palatal displacement of tooth 11 (simulating its initial clinical movement). RESULTS: The mechanical requirements of palatal root torque are a palatally directed force (- Fy) and a palatal root torquing moment (- Mx). These requirements were reliably achieved with modification depths > 0.5 mm. The modification depth and foil thickness had a significant influence on - Fy magnitudes (linear mixed-effect models, p < 0.01). With the 0.75-mm aligners combined with 1.5-mm deep modifications, the palatal root torque range (palTR) started after an initial palatal crown displacement of 0.09, 0.12, and 0.12 mm for the capsular, crescent, and double-spherical modification geometries, respectively. CONCLUSIONS: A relatively early start of the palatal torque range (after a 0.1-mm palatal crown displacement) and appropriate - Fy magnitudes were achieved with 0.75-mm-thick aligners containing 1.5-mm deep capsular or crescent pressure regions. Subsequent clinical trials are required to confirm the clinical effects of these modifications. CLINICAL RELEVANCE: In vitro testing indicated that modified aligners are capable of generating the F/M components required for palatal root torque of upper central incisors.

Mechanical loads exerted by different configurations of Burstone's 3-piece segmented mechanics during a simulated intrusion of the mandibular incisors.

INTRODUCTION: Burstone's segmented intrusion arch technique allows variable incisor intrusion with lingual or labial tipping, depending on the position and direction of the force vectors exerted by the intrusion springs. To date, systematic biomechanical studies are lacking. This in vitro study aimed to determine the 3-dimensional force-moment systems applied to the 4 mandibular incisors and the deactivation behavior of the appliance by different configurations of the 3-piece intrusion mechanics. METHODS: The experimental setup consisted of a mandibular model segmented into 2 buccal and 1 anterior segment mounted on a 6-axis Hexapod to simulate different incisor segment malpositions. Active elements were bilateral 0.017 × 0.025-in titanium-molybdenum alloy intrusion springs. Nine geometric appliance configurations at different superpositions of the anterior segment between 4 and 0 mm were evaluated. RESULTS: For 3-mm incisor superposition, mesiodistal variation of the contact of the intrusion spring at the anterior segment wire resulted in labial tipping moments between -0.11 and -1.6 Nmm. Variation of the height of force application at the anterior segment showed no significant influence on the tipping moments. During the simulated intrusion of the anterior segment, a force reduction rate of 21% per mm intrusion was observed. CONCLUSIONS: This study contributes to a more detailed and systematic understanding of the 3-piece intrusion mechanics and confirms the simplicity and predictability of the 3-piece intrusion. According to the measured reduction rate, the intrusion springs should be activated once every 2 months or 1-mm intrusion.

Force decay of polyethylene terephthalate glycol aligner materials during simulation of typical clinical loading/unloading scenarios.

BACKGROUND: This in vitro study investigated the effect of three distinct daily loading/unloading cycles on force delivery during orthodontic aligner therapy. The cycles were applied for 7 days and were designed to reflect typical clinical aligner application scenarios. MATERIALS AND METHODS: Flat polyethylene terephthalate glycol (PET-G) specimens (Duran®, Scheu Dental, Iserlohn, Germany) with thicknesses ranging between 0.4 and 0.75 mm were tested in a three-point-bending testing machine. Measurements comprised loading/unloading intervals of 12 h/12 h, 18 h/6 h, and 23 h/1 h, and specimens were exposed to bidistilled water during loading to simulate intraoral conditions. RESULTS: A very large decay in force for the PET­G specimens could already be observed after the first loading period, with significantly different residual force values of 24, 20, and 21% recorded for the 12 h/12 h, 18 h/6 h, and 23 h/1 h loading/unloading modes, respectively (Mann-Whitney U test, p < 0.01). In addition, further decays in force from the first to the last loading period at day 7 of 13.5% (12 h/12 h), 9.7% (18 h/6 h), and 8.4% (23 h/1 h) differed significantly among the three distinct loading modes (Mann-Whitney U test, p < 0.01). CONCLUSION: Although the initial material stiffness of PET­G is relatively high, the transmission of excessive forces is attenuated by the high material-related force decay already within a few hours after intraoral insertion.

Experimental friction and deflection forces of orthodontic leveling archwires in three-bracket model experiments.

OBJECTIVE: In vitro testing of archwires in a multibracket model may provide estimates of force-moment (F/M) systems applied to individual teeth in a realistic geometry. Such investigations have mostly been performed by continuous wire deflection, leading to frictional forces biasing the pure deflection forces. Aim of this study was to quantify this bias and the pure deflection forces for leveling archwires. MATERIALS AND METHODS: Three nickel-titanium (NiTi) and two multistranded wires were tested in a three-bracket model simulating vertical movement of an upper incisor with a typical interbracket distance of 8 mm (intercenter). To determine pure deflection forces, the middle bracket was first leveled incrementally from its vertical malposition to neutral position with repeated wire insertion at each step (so-called "static leveling mode"). For comparison, forces at the middle bracket were also determined during dynamic leveling with or without ligation of the wire at the lateral brackets by either elastic, tight or loose steel ligatures. RESULTS: The dynamic mode resulted in significantly lower mean leveling forces for all the tested wires (ANOVA [analysis of variance], p < 0.01) compared to the static mode. Expressed in numbers, dynamic wire unloading resulted in mean force underestimation of 53 ± 9% (loose steel ligatures), 56 ± 11% (elastic ligatures) or 91 ± 29% (tight steel ligatures). CONCLUSIONS: Orthodontic tooth movement is quasi-static. This concerns the initial hyalinization phase in particular. Thus, especially static testing of archwires provides valid reference data for the peak forces exerted directly after clinical insertion of a leveling wire. In dynamic wire testing, significant underestimation of actual forces exerted on individual teeth may occur due to experimental friction, which might considerably differ from that occurring during clinical therapy. This aspect has to be taken into account in the interpretation of published stiffness values for orthodontic wires, and in the selection of the appropriate archwire for leveling of the present tooth malposition, respectively.

Forces and moments applied during derotation of a maxillary central incisor with thinner aligners: An in-vitro study.

INTRODUCTION: Recent studies have shown that therapeutic loads applied to individual teeth by aligners may substantially exceed recommended values. The primary purpose of this study was to quantify force and moment components during derotation of a maxillary central incisor when 0.3-mm-thick or 0.4-mm-thick polyethylene terephthalate glycol aligners were used instead of conventional polyethylene terephthalate glycol aligners with a minimum thickness of 0.5 mm. METHODS: The test setup consisted of an acrylic model of a maxilla with a separated right central incisor mounted on a 3-dimensional force and moment sensor. The force and moment components were recorded for aligners with thicknesses ranging from 0.3 to 0.75 mm during ±10° rotation and derotation of the separated incisor. RESULTS: Moments exerted by the thinnest aligner currently available, 0.5 mm, were 73.57 Nmm for the 10° mesiorotation. In comparison, the corresponding moments with the 0.4-mm and 0.3-mm aligners were 41.08 and 17.84 Nmm, respectively. Moment values for derotation of the maxillary right central incisor into neutral position showed nonlinear return curves indicating viscoelastic material behavior. CONCLUSIONS: A significant load reduction can be achieved with the new thinner aligners. Because of the form instability of the 0.3-mm aligner during handling, we suggest the novel sequence 0.4, 0.5, and 0.75 mm for aligner systems based on sequentially increased material thickness. This sequence combines sufficiently low initial aligner stiffness and steady load increases in single setup steps. The viscoelastic behavior of polyethylene terephthalate glycol aligners observed during incisor derotation should lead to a reduction of the high initial load exerted directly after intraoral aligner insertion.

Forces and moments delivered by novel, thinner PET-G aligners during labiopalatal bodily movement of a maxillary central incisor: An in vitro study.

OBJECTIVE: To evaluate whether overloading of teeth can be avoided by utilizing aligners with reduced thicknesses of 0.4 mm or 0.3 mm. MATERIALS AND METHODS: The experimental setup included an acrylic maxillary jaw model with tooth 11 separated and fixed via a 3-D force-moment transducer to a hexapod for experimental movement. Aligners tested were fabricated on duplicate stone models using commercially available polyethylene terephthalate glycol (PET-G) foils with thicknesses between 0.5 and 0.75 mm, and novel 0.4-mm- and 0.3-mm-thick foils. With the test aligner seated, 11 was bodily displaced in a labiopalatal direction in the range of ±0.25 mm while all six force-and-moment components exerted on this tooth were registered. RESULTS: With the thinnest commercially available 0.5-mm aligner, median forces of -7.89 N and 8.37 N were measured for the maximum 0.25-mm movement of 11 in a labial and palatal direction, respectively. In comparison, force values were 35% and 71% lower for the novel aligners with a thickness of 0.4 mm and 0.3 mm, respectively. CONCLUSIONS: Novel "leveling" aligners with reduced thickness may reduce overloading of individual teeth during aligner therapy. Due to form instability of 0.3-mm aligners, we suggest a novel sequence of 0.4-0.5-0.75 mm for aligner systems using several foil thicknesses for load graduation within single setup steps. This would combine low stiffness of the initial aligner and relatively constant load increases throughout the treatment.

Forces and moments delivered by PET-G aligners to an upper central incisor for labial and palatal translation.

OBJECTIVES: Aligners made of polyethylene terephthalate glycol (PET-G) were tested in an experimental study for labial and palatal translation of an upper central incisor to quantify the forces and moments thus delivered and to biomechanically evaluate the capability of bodily movement. MATERIALS AND METHODS: Using a resin model of the upper dentition, tooth 21 was separated and connected to a 3D force/moment (F/M) sensor to record the forces and moments delivered by aligners for labial and palatal displacement. An impression was taken with tooth 21 in its neutral position to obtain casts for standardized thermoplastic fabrication of aligners varying in make and foil thickness (Duran® 0.5/0.625/0.75 mm; Erkodur® 0.5/0.6/0.8 mm; Track-A® 0.5/0.63/0.8 mm). Upon placing each aligner over the teeth of the resin model, the separated tooth was subjected to 0.01 mm increments of labial and palatal translation by 0.25 mm in either direction. RESULTS: The mean forces delivered by the thinnest (0.5 mm) aligners for 0.25 mm of palatal displacement of tooth 21 were 3.01 ± 0.07 N (Duran®), 5.31 ± 0.89 N (Erkodur®), and 3.69 ± 0.81 N (Track-A®). The thickest (0.75 or 0.8 mm) aligners delivered 4.49 ± 0.16 N (Duran®), 7.22 ± 0.45 N (Erkodur®), and 5.20 ± 0.68 N (Track-A®). The mean forces for palatal as compared to labial displacement were higher by a mean of 48% with the Erkodur® and by 23% with the Track-A® aligners but were smaller by 37% with the Duran® aligners. The moment-to-force (M/F) ratios, calculated in relation to the center of resistance of the separated measurement tooth, ranged from -9.91 to -12.22 mm, thus, approaching the value of -8.80 mm for uncontrolled tipping of this tooth. CONCLUSION: Manufacturers of PET-G aligners have recommended setup increments of 0.5-1 mm, which appears excessive based on our results. PET-G aligners not featuring modifications (e.g., reinforcing ribs or composite attachments bonded to the teeth) are unsuitable for bodily movement of upper central incisors in labial or palatal directions.