Retraction Hooks of Different Lengths for Maxillary Whole Arch Distalization with Miniscrew Anchorage: A Finite Element Analysis
Objectives: To evaluate the von Mises stress distribution in the periodontal ligament and the displacement pattern of maxillary whole arch distalization applied to retraction hooks of different lengths with miniscrew anchorage and to determine the optimal length of retraction hook, using a finite element method.
Methods: A finite element model of maxillary teeth with periodontal ligament and alveolar bone was constructed. The miniscrews were placed bilaterally 6 mm above the buccal cemento-enamel junction at the modified infrazygomatic crest site. The distalization force of 200 g was applied to 0-, 2-, 4-, 6-, 8-mm-length retraction hooks located between the lateral incisors and canines. The stress distribution in the periodontal ligament and the displacement of the teeth were analyzed. The optimal length of retraction hook for maximal distal movement of the maxillary whole arch along the occlusal plane was investigated.
Results: The von Mises stress in the anterior teeth was greater than in the posterior teeth with all hook lengths. When using the short hooks, the areas of high stress were in the lateral incisor, canine and second molar. When using the long hooks, the areas of high stress were in the anterior teeth. With the 0-mm and 2-mm lengths, the anterior teeth were extruded and tipped palatally; the posterior teeth were intruded and tipped distally. With the 4-mm length, all maxillary teeth were distalized along the occlusal plane with minimal movement in the vertical direction. The anterior teeth were slightly tipped labially; the posterior teeth were slightly tipped distally. With the 6-mm and 8-mm lengths, the anterior teeth were intruded and tipped labially; the posterior teeth were extruded and tipped distally. The optimal length in this study was found to be 4 mm.
Conclusions: Different lengths of retraction hooks resulted in different patterns of stress distribution in the PDL and in different patterns of displacement of the maxillary teeth in whole arch distalization. The optimal length of retraction hook was 4 mm for maximal distal movement of the maxillary whole arch along the occlusal plane.
1. Park HS, Kwon TG, Sung JH. Nonextraction treatment with microscrew implants. Angle Orthod 2004; 74(4): 539-549.
2. Janson G, Barros SEC, Simão TM, Freitas MRD. Relevant variables of Class II malocclusion treatment. Dental Press J Orthod 2009; 14(4): 149-157.
3. Burstone CJ, Choy K. The biomechanical foundation of clinical orthodontics. Hanover Park: Quintessence Publishing; 2015: 580.
4. Proffit WR, Fields HW, Sarver DM. Mechanical principles in orthodontic force control. Contemporary orthodontics. 5th ed. St.Louis: Mosby Elsevier; 2013: 312-336.
5. Chen G, Teng F, Xu TM. Distalization of the maxillary and mandibular dentitions with miniscrew anchorage in a patient with moderate Class I bimaxillary dentoalveolar protrusion. Am J Orthod Dentofacial Orthop 2016; 149(3): 401-410.
6. Choi YJ, Lee JS, Cha JY, Park YC. Total distalization of the maxillary arch in a patient with skeletal Class II malocclusion. Am J Orthod Dentofacial Orthop 2011; 139(6): 823-833.
7. Lee KJ, Park JY, Park YC. En-masse distalization of upper dentition for correction of Class II using dual orthodonic miniscrews. J Dent Assoc Thai 2006; 5: 33-38.
8. Wu X, Liu H, Luo C, Li Y, Ding Y. Three-dimensional evaluation on the effect of maxillary dentition distalization with miniscrews implanted in the infrazygomatic crest. Int J Implant Dent 2017; 27(1): 22-27.
9. Liu H, Wu X, Yang L, Ding Y. Safe zones for miniscrews in maxillary dentition distalization assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2017; 151(3): 500-506.
10. Fayed MM, Pazera P, Katsaros C. Optimal sites for orthodontic mini-implant placement assessed by cone beam computed tomography. Angle Orthod 2010; 80(5): 939-951.
11. Noorollahian S, Alavi S, Shirban F. Bilateral en-masse distalization of maxillary posterior teeth with skeletal anchorage: a case report. Dental Press J Orthod 2016; 21(3): 85-93.
12. Lin JJJ. New method of distalization of the maxillary dentition using the infrazygomatic crest mini-screws. Creative orthodontics: blending the Damon system and TADs to manage difficult malocclusions. 2nd ed. Taipei: Yong Chieh Enterprise 2010: 187-208.
13. Lin JJJ, Roberts. Guided infrazygomatic screws: reliable maxillary arch retraction. Int J Orthod Implantol 2017; 46: 4-16.
14. Bechtold TE, Kim JW, Choi TH, Park YC, Lee KJ. Distalization pattern of the maxillary arch depending on the number of orthodontic miniscrews. Angle Orthod 2013; 83(2): 266-273.
15. Tekale PD, Vakil KK, Vakil JK, Gore KA. Distalization of maxillary arch and correction of Class II with mini-implants: A report of two cases. Contemp Clin Dent 2015; 6(2): 226.
16. Nanda RS, Tosun YS. Biomechanics in orthodontics principle and practice. 1st ed. Hanover Park: Quintessence Publishing; 2010: 1-145.
17.Knop L, Gandini LG, Shintcovsk RL, Gandini MR. Scientific use of the finite element method in orthodontics. Dental Press J Orthod 2015; 20(2): 119-125.
18. Marya A, David G, Eugenio MA. Finite element analysis and its role in orthodontics. Dent Oral Health 2016; 2(2): 5-6.
19. Konda P, Tarannum S. Basic principles of finite element method and its applications in orthodontics. J Pharm Biomed Sci 2012; 16(16): 1-8.
20. Cho SM, Choi SH, Sung SJ, Yu HS, Hwang CJ. The effects of alveolar bone loss and miniscrew position on initial tooth displacement during intrusion of the maxillary anterior teeth: finite element analysis. Korean J Orthod 2016; 46(5): 310-322.
21. Mo SS, Kim SH, Sung SJ, et al. Factors controlling anterior torque with C-implants depend on en-masse retraction without posterior appliances: biocreative therapy type II technique. Am J Orthod Dentofacial Orthop 2011; 139(2): 183-191.
22. Seong EH, Choi SH, Kim HJ, Yu HS, Park YC, Lee KJ. Evaluation of the effects of miniscrew incorporation in palatal expanders for young adults using finite element analysis. Korean J Orthod 2018; 48(2): 81-89.
23. Song JW, Lim JK, Lee KJ, Sung SJ, Chun YS, Mo SS. Finite element analysis of maxillary incisor displacement during en-masse retraction according to orthodontic mini-implant position. Korean J Orthod 2016; 46(4): 242- 52.
24. Sung EH, Kim SJ, Chun YS, Park YC, Yu HS, Lee KJ. Distalization pattern of whole maxillary dentition according to force application points. Korean J Orthod 2015; 45(1): 20-28.
25. Sang SJ, Jang GW, Chun YS, Moon YS. Effective en-masse retraction design with orthodontic mini-implant anchorage: a finite element analysis. Am J Orthod Dentofacial Orthop 2010; 137(5): 648-657.
26. Hemanth M, Lodaya SD. Orthodontic force distribution: a three-dimensional finite element analysis. World J Dent 2010; 1(3): 159-162.
27. Mohammed SD, Desai H. Basic concepts of finite flement analysis and its applications in dentistry: An overview. J Oral Hyg Health 2014; 2(5): 156-160.
28. Desai SR, Harshada SH. Finite element analysis: basics and its applications in dentistry. Indian J Dent Sci 2012; 4(1): 60-65.
29. Geramy A, Sodagar A, Hassanpour M. Three-dimensional analysis using finite element method of anterior teeth inclination and center of resistance location. Chin J Dent Res 2014; 1: 37-42.
30. Jagota V, Sethi APS, Kumar K. Finite element method: An overview. Walailak J Sci & Tech 2013; 10(1): 1-8.
31. Jeong GM, Sung SJ, Lee KJ, Chun YS, Mo SS. Finite-element investigation of the center of resistance of the maxillary dentition. Korean J Orthod 2009; 39(2): 83-94.
32. Toms SR, Eberhardt AW. A nonlinear finite element analysis of the periodontal ligament under orthodontic tooth loading. Am J Orthod Dentofacial Orthop 2003; 123(6): 657-665.
33. Tanne K, Sakuda M, Burstone CJ. Three-dimensional finite element analysis for stress in the periodontal tissue by orthodontic forces. Am J Orthod Dentofacial Orthop 1987; 92(6): 499-505.
34.Huang H, Tang W, Yan B, Wu B. Mechanical responses of periodontal ligament under a realistic orthodontic loading. Procedia Eng 2012; 31: 828-833.
35. Jing Y, Han X, Cheng B, Bai D. Three-dimensional FEM analysis of stress distribution in dynamic maxillary canine movement. Chinese Science Bulletin 2013; 58(20): 2454-2459.
36. Yu IJ, Kook YA, Sung SJ, Lee KJ, Chun YS, Mo SS. Comparison of tooth displacement between buccal mini-implants and palatal plate anchorage for molar distalization: a finite element study. Eur J Orthod 2014; 36(4): 394-402.
37. Chen YC, Tsai HH. Use of 3D finite element models to analyze the influence of alveolar bone height on tooth mobility and stress distribution. J Dent Sci 2011; 6(2): 90-94.
38. Aungkatawiwat T, Patanaporn V, Rungsiyakull C. Maxillary posterior teeth distalization with miniscrew anchorage relative to force vectors applied to different lengths of retraction hook, analyzed using the finite element method. CM Dent J 2018; 39(2): 77-89.
39. Meriam JL, Kraige LG. Engineering Mechanics: Statics 7th ed. New york: John Wiley & Sons, Inc.; 2004: 523.
40. Anthony P. The anatomy and physiology of the healthy periodontium. In: Panagakos F, editor. Gingival diseases - Their atiology, prevention and treatment. Rijeka: InTech; 2011: 1-22.
41. Tomizuka R, Shimizu Y, Kanetaka H, et al. Histological evaluation of the effects of initially light and gradually increasing force on orthodontic tooth movement. Angle Orthod 2007; 77(3): 410-416.
42. Böhl MV, Jagtman AMK. Hyalinization during orthodontic tooth movement: a systematic review on tissue reactions. Eur J Orthod 2009; 31(1): 30-36.
43. Tajima K, Chen KK, Takahashi N, Noda N, Nagamatsu Y, Kakigawa H. Three-dimensional finite element modeling from CT images of tooth and its validation. Dent Mater J 2009; 28(2): 219-226.