ORIGINAL ARTICLE

A comparison between friction and frictionless mechanics with a new typodont simulation system
Joon-No Rhee, DDS, MSD,a Youn-Sic Chun DDS, MSD, PhD,b and Joon Row, DDS, MSD, PhDc Seoul, Korea This study was designed to explore the differences between friction and frictionless mechanics for maxillary canine retraction with the use of a new typodont simulation system, the Calorific machine system. The unit was designed to observe the whole process of tooth movement and is composed of 3 parts: a temperature regulating system, electrothermodynamic teeth, and an artificial alveolar bone component. The efficiency of maxillary canine retraction was compared with the sliding mechanics (along a .016 .022in stainless steel labial arch and nickel-titanium closed coil spring) and a canine retraction spring. The patterns of tooth movement obtained with both of these mechanics were measured 5 times each. Friction mechanics were superior to frictionless mechanics in terms of rotational control and dimensional maintenance of the arch (P < .0001); frictionless mechanics were shown to be more effective at reducing tipping and extrusion (P < .0001). However, the observed differences between the 2 methods were relatively small in terms of their clinical significance, and no differences were found in anchorage control (P = .2078). In conclusion, this study indicated that friction and frictionless mechanics perform similarly. (Am J Orthod Dentofacial Orthop 2001;119:292-9)

he various canine retraction appliances in clinical use may be grouped according to whether the devices that produce the distal driving force are separate elements1-4 or integral parts5-12 of the appliance. Frictional binding and the swing effect are the main problems associated with sliding mechanics. Theoretically, these can be overcome by the use of a frictionless system, which includes a loop as the source of the applied force.13-16 However, the frictionless system fails to produce better results in practice because of the complexity of loop forming and the presence of unknown factors.17-19 In addition, minor errors can result in major differences in tooth movement, and some patients find the loop uncomfortable. As a result, several attempts have been made to determine the overall effectiveness of the 2 systems with respect to tooth movement, which we classify broadly for clarity, as static and dynamic approaches. The static systems that were examined include those based on experimentation20-24 and those involving purely analytic25-29 methods. These systems rely on rationale based on the initial change of force system (ie, they do not

make allowance for the results of the final tooth movements). Moreover, although a dynamic system exists, the conventional typodont system30 changes in the dimension of the entire alveolar bone part may occur because it must be immersed in warm water to soften the wax. A dynamic evaluation method described by Drescher et al31 in 1991 provides 3-dimensional information on tooth movement. The method involved attaching a sensor to the tooth concerned and represented a significant advance at the time, although it was limited by the accuracy with which the oral environment could be reproduced. For these reasons, it was believed that an experimental unit was required that could overcome these limitations; this work led us to the development of the Calorific machine system. The specific aim of this study was to explore and compare the effectiveness of friction and frictionless mechanics in the case of maxillary canine retraction using the Calorific machine system.
MATERIAL AND METHODS Basic structure of Calorific machine system

From the Department of Orthodontics, Medical College, Ewha Womans University. aFormer resident. bAssociate Professor. cAssociate Professor. Reprint requests to: Youn-Sic Chun DDS, MSD, PhD, Ewha Womans University Hospital, 70 Chongno 6-ka, Chongno-ku, Seoul, Korea 110-126; yschun@mm.ewha.ac.kr. Submitted, February 2000; revised and accepted, August 2000. Copyright 2001 by the American Association of Orthodontists. 0889-5406/2001/$35.00 + 0 8/1/112452 doi:10.1067/mod.2001.112452

The unit is basically composed of 3 parts: a main body that houses the temperature controls, a number of electrothermodynamic (ETD) teeth, and an artificial alveolar bone that holds the ETD teeth. The temperature-regulating system (Fig 1, A) consists of a power supply, rectifier, and thermometer. The power supply unit converts the input voltage of 110 V to 4 to 5 V. This improves safety aspects during operation by allowing heat to be conducted slowly to the experimental teeth, lowering the rate of heat dissipa-

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C
Fig 1. Basic structure of Calorific machine system. A, Diagram of Calorific machine system. B, ETD tooth. C, Artificial alveolar bone component.

tion, and reducing the experimental error because of the sudden conduction of heat. The rectifier converts alternating current to direct current. To observe the movements of the ETD teeth successfully, the degree of softening of the wax needs to be measured and accurately controlled. To achieve this, a series of digital thermometers is used to accurately measure the temperature at the root of the ETD teeth. The ETD teeth (Fig 1, B) were anatomically correct32 and made from artificial teeth produced by Nissan Dental Products Inc. The crowns were used as supplied, but the root that was to be positioned into the artificial alveolar bone was cast in chrome-cobalt alloy. To conduct heat evenly and slowly around the root, a hair-thick heating coil was wound around the metal root surface.

To account for the increased tooth dimensions caused by this winding, the outer root surface was ground, except the cervical junction and root apex area, before metal casting to reduce its thickness by 1 mm. After the casting, a heating coil was wrapped around the appropriate area, and the original shape of the tooth was thus maintained. To prevent damage to the exposed coil from repeated experiments and to prevent the flow of unwanted current, the heating coil was covered with a lacquer film. The ends of the heating coils were exposed on the occlusal side of the crown to provide an electrical connection. To maintain a constant energy supply to the root, a thermosensor (PSB-S7; Shibaura Electronic Company) was embedded in the center portion of the root, and its 2 thermosensor connecting wires were pulled out onto the occlusal sides of the crown.

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To improve accuracy further, the midsagittal surface of the wax model was smoothly trimmed and radiograph-opaque ball implants (diameter, 0.5 mm) were shallowly embedded in both sides of the base of the model. These were used as reference markers when occlusal radiographic images that represented before and after tooth movements were superimposed.
Experimental model setup

B
Fig 2. Initial experimental model setup. A, Friction method. B, Frictionless method.

Three ETD teeth were placed in the right artificial alveolar model (Fig 2). The bracket system used in this study was a .018 .022in system with Roth prescription (Ormco), which was bonded by the passive bracketing method. The artificial alveolar bone part was separated into right and left halves to achieve a flat surface and ensure a constant sagittal orientation during radiography. In the case of both friction and frictionless mechanics, canine retraction was performed on the right side of the experimental model only; but in the case of friction mechanics, the labial arch was extended to the left canine and the first molar to maintain the archwire continuity. After the completion of canine retraction, the left side of the model was detached, and only the right side of the model was used for radiographic imaging. No transpalatal arch was used.
Canine retraction method

Thus, 2 heating coils and 2 thermosensor connecting wires were exposed on the upper part of the occlusal side of the crown. Before the ETD teeth were placed into the artificial alveolar bone part, the temperature of each part of the ETD teeth was checked by electric current flow. No differences were found at the root apex, midpoint, or cervical area. For the present experiment, the right maxillary canine, second premolar, and first molar and the left maxillary canine and first molar were fabricated. In the absence of a material that is recognized as a standard for the purpose, a sticky wax (Kerr Co) was chosen. The sticky wax is composed of 37.6% bees wax, 62.4% resin (hydrocarbon natural), and 0.1% colorant and has the characteristic of a maximum 5% flow at 30C and a 90% flow at 43C. An experimental model of a first premolar extraction case was constructed with a maxillary arch typodont. To maximize experimental accuracy, the maxillary model was divided into right and left components. The right model was used to simulate both mechanics, and the left model was used only for friction mechanics (Fig 1, C).

Friction method. The labial arch was made of .016 .022in stainless steel wire with a 10-accentuated curve. It involved the right first molar, second premolar, and canine and the left canine and first molar. The retraction force was derived from the nickel-titanium (NiTi) closed-coil spring with a lumen of 0.36 in and a diameter of 0.10 in (Tommy), which was engaged only on the right side of the model. The retraction force of the coil spring was approximately 160 to 200 g, which was measured with a Correx force gauge. Before the power switch was turned on, a NiTi closed-coil spring was engaged between the first molar tube hook and the power arm of the canine bracket. Tooth movement commenced when the power was turned on. During canine retraction, movement was observed with a monitor that displayed a grid, which was connected to a camcorder. When no further tooth movement was observed for a period of 1 hour, the unit was switched off, and the ETD teeth were allowed to cool. When the wax hardened, the NiTi closed-coil spring was disengaged, and the ligature wire was tied tightly from the first molar to the premolar. Tooth movement was performed again under the rope tie condition to give a rebound time for the uprighting of the ETD teeth. The rebound time of the study was approx-

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Table I. Comparison

between friction and frictionless methods

Friction method Frictionless method Mean SD P value

Measurement Mesiodistal movement of crown (mm) Canine Premolar Molar Vertical movement of crown (mm) Canine Premolar Molar Buccolingual movement of crown (mm) Canine Premolar Molar Tooth axis change () Canine Premolar Molar Rotation () Canine Premolar Molar
**P

Mean

SD

5.97 1.25 2.92 0.46 0.22 0.24 3.83 0.24 0.09 9.08 3.95 6.90 13.20 8.70 8.73

0.33*** 0.21*** 0.25*** 0.17*** 0.07*** 0.08*** 0.35*** 0.11*** 0.08*** 2.33*** 1.28*** 1.77*** 1.42*** 1.36*** 1.90***

5.74 1.19 3.01 0.23 0.18 0.15 2.41 0.25 0.14 6.23 2.53 4.35 20.03 8.78 13.63

0.37*** 0.30*** 0.21*** 0.10*** 0.10*** 0.30 0.15*** 0.20*** 0.48 1.41*** 0.99*** 0.89*** 1.64*** 0.94*** 2.00***

NS NS NS
*** ***

NS
*** ***

NS
*** ** *** ***

NS
***

< .001, ***P < .0001.

imately 60 to 70 minutes. The power was then switched off; the wax was allowed to harden, and the NiTi closed-coil spring was reengaged. When this procedure had been repeated 6 or 7 times, the extraction space was closed, and the canine retraction was complete. Frictionless method. A Poul Gjessing type (PG spring) canine retraction spring was set up according to the manufacturers instructions for a retractive force on the canine. The desired spring-applied force level was 160 g, which was obtained when the spring was separated by 1 mm from the 2 sections of the double helix. Activation was performed with the bend in the spring behind the molar tube. The spring had an antirotation moment-to-force ratio of 4:1 and an antitip moment-toforce ratio of 11:1.7-9 The experimental procedure was almost identical to that of the friction method, and the extraction space was closed by reactivating the spring 7 times.
Evaluation of tooth movement

Standardized occlusal radiographs were taken to record the positional changes of each ETD tooth in the sagittal and occlusal direction before and after the experiment. For standardized radiographs, the film focus distance was maintained at 20 cm; kilovolt peak was 65 at 10 mA; and exposure time was 0.4 second. In both types of mechanics, radiographs were taken of the right side of the model only, and the central x-ray

beam was passed perpendicularly through the midpoint between the 2 metal ball implants in the sagittal and occlusal directions. Two occlusal radiographs were taken before and after each experiment, and the 2 metal ball implant images were superimposed as reference points. Two base axes were drawn on the occlusal radiographs. The x-axis was drawn as a horizontal line that connected the right and the left metal ball implant images; the y-axis was drawn perpendicularly to the xaxis on the left implant image. The minimum distance of each landmark from the x- and y-axes was measured to assess positional changes. The root apex of each ETD tooth and the mesioocclusal wing of the bracket or tube were used as landmarks. The amounts of change of tooth axis and rotation were measured. Rotation was measured with the fiducial point as a rotation center,33 and the measurement was performed according to the method of Reuleaux (in 1875) as the intersection of the perpendicular from the midpoint of the translation vectors of 2 body points. It was difficult to measure the change of the torqueinduced movement of each tooth because the images of the teeth overlapped in the frontal radiograph. The linear and angular measurements involved in tooth axis change, mesiodistal movement and vertical movement in the sagittal view, and rotation and buccolingual movement in the occlusal view were recorded. Intra- and interexaminer agreement, 98.36% and

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mechanics (Table I). No statistical differences were found between the 2 mechanics (canine, P = .0490; first molar, P = .2078). It should be noted that all of the aforementioned measurements include the amount of rotation because the reference point was set at a point on the bracket with good radiopacity, in terms of measuring the displacement of the crown. Therefore, the sum of the amounts of canine retraction and anchorage loss was greater than the 8-mm width of the maxillary first premolar.

Tipping

As shown in Table I, the tooth axis change in the friction method was 9.08 in the canine and 6.90 in the first molar. But in the frictionless method, the tooth axis change was 6.23 in the canine and 4.35 in the first molar (Fig 3), which demonstrated that the friction method was slightly more prone to tipping (P < .0001).
Extrusion

As shown in Table I, the friction method caused more crown extrusion of the canine and the second premolar (Fig 3). However, no difference existed between the 2 methods in the first molar extrusion (P = .2030).

B
Fig 3. Representative superimposed radiograph of sagittal views. A, Friction method. B, Frictionless method.

Rotation

97.67%, respectively, were examined to estimate the error of measurement; agreement did not change significantly in 5 series of measurements. The significance of the differences between the results of the 2 types of retraction mechanics were tested with the paired t test.
RESULTS

The average rotation of the canine was 13.20 in friction mechanics and 20.03 in frictionless mechanics. The average rotation of the first molar was 8.73 in friction mechanics and 13.63 in frictionless mechanics (Table I; Fig 4). The frictionless method caused significantly greater levels of rotation of the canine and the first molar (P < .0001).
Arch dimensional maintenance

The results of this study are shown in Table I. The sign convention used in the table is such that distally, extrusively, and bucally directed movement and clockwise rotations are treated as positive. Comparisons between before and after canine retraction are statistically significant in most cases, with some exceptions. No statistical significance was found between the amounts of vertical and buccolingual movement of the crown of the first molar in frictionless mechanics.
The amounts of canine retraction and anchorage loss

In buccolingual movement of the crown, the canine and the second premolar moved more toward the lingual side in the frictionless method, as is shown in Table I and Fig 4. However, in the case of the first molar, no difference was found between the 2 methods (P = .6025).
DISCUSSION

The total amount of canine retraction was 5.97 mm in friction mechanics and 5.74 mm in frictionless mechanics. The average anchorage loss was 2.92 mm in friction mechanics and 3.01 mm in frictionless

Over the years, there have been many debates concerning the relative merits of friction and frictionless mechanics. However, much of this could not be resolved without knowledge of the optimal force levels involved. Storey and Smith34 developed the concept of optimal force as the minimum force that results in the maximum rate of tooth movement within the limits of biologic response. However, the realization of the optimal force to secure the movement of individual teeth has proved difficult. Quinn and Yoshigawa35 con-

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ducted a critical review of the theories that relate orthodontic force to tooth movement and concluded that the rate of tooth movement increases with increasing force up to a point, after which increasing the force further no longer results in an appropriate increase in tooth movement. They stated that there is an optimal range of force that allows maximum tooth movement. Nikolai36 defined optimum orthodontic force as that which produces the most desirable biologic response with minimum tissue damage and results in rapid tooth movement with little or no clinical discomfort. In a more specific way, Smith and Storey37 suggested a force of 150 to 200 g as being optimal for the translation of human mandibular canines; Reitan38 advocated 250 g, and Lee39 recommended 150 to 260 g, whereas Ricketts et al40 prescribed 75 g. However, in the total range of orthodontic forces, the issue of the existence of optimum forces seems to remain unresolved in the minds of many practitioners. In the frictionless method, a PG spring delivered relatively constant force, and approximately 160 g was obtained when the 2 sections of the double helix were separated by 1 mm. A force of 160 g was judged as optimal for canine retraction. In the friction method, a NiTi closed-coil spring with a force of 160 to 200 g was used instead of the elastomeric module because the spring delivers a relatively constant force. However, the NiTi closed-coil springs are temperature sensitive and are known to produce force variations.2-4 Nevertheless, in this study, there was no evidence that the heated root influenced the force delivered by the coil spring to the bracket bonded to the tooth crown. The most striking finding to be drawn from the results was that no difference of anchorage loss was found between the 2 methods. Ziegler and Ingervall17 demonstrated little anchorage loss using both mechanics, which was in agreement with another publication.41 The reason must be the continuous use of headgear during treatment. However, in this study, which involved a comparative evaluation, special anchorage reinforcement (such as a transpalatal arch and headgear) was not used. It is worth noting that rotational movement occurred before the other movements, such as tipping. Therefore, the prevention of rotation must be taken into consideration in maximum anchorage cases. As can be seen from Table I, tipping and extrusion were less pronounced when the canine was retracted with the PG spring rather than by sliding mechanics. Based on the results, 1 of the reasons for this was that the labial guiding arch was not engaged to the anterior teeth, although it was extended to the left canine and the first molar during canine retraction in the friction

B
Fig 4. Representative superimposed radiograph of occlusal views. A, Friction method. B, Frictionless method.

method. In the clinical application of sliding mechanics, compensatory bend or antitip bend42,43 on the labial arch can prevent the tipping tendency (to some degree) and severe extrusive tendencies. On the other hand, the PG spring proved to be less effective than sliding mechanics in terms of the degree of rotation during retraction; the average rotation was approximately 20.03 for the spring and 13.2 for the sliding mechanics. Therefore, the intentional antirotation bend built into the spring to achieve a more optimal moment would seem to be insufficient. In buccolingual movement of the crown, lingual movement of the canine and second premolar were greater with the frictionless method than with the friction method, and this may be due to this rotational tendency. To date, there has been no experimental model that has adequately reproduced bone remodeling, including the method presented here. The sticky wax used in this study has the capacity to yield on the pressure side but has no capacity of apposition on the tension side. Perhaps tooth movement was influenced by this shortcoming of the sticky wax. Although this study was limited in terms of its

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inability to allow tooth movement to be recorded in the frontal plane because of the overlap of teeth in the image, this study is relevant in terms of the comparison of the relative effectiveness of the 2 retraction methods under similar conditions. Although it is inadvisable to apply these results directly to in vivo situations, these results provide valuable clinical reference data. Some significant differences between the friction and frictionless modalities were found but were not sufficiently large to be of clinical value.
CONCLUSIONS

Friction mechanics were superior to frictionless mechanics for rotational control and arch dimensional maintenance. Frictionless mechanics were more effective than friction mechanics at reducing the tipping and extrusion. There was no significant difference in anchorage loss between the 2 methods. This study could not establish the superiority of 1 of the 2 methods over the other. We thank Dr Moon-Suk Suh for his financial support and Mr Byung-Chun Kwon and Mr Pal-Suck Yang for their technical assistance in this study.
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38. Reitan K. Some factors determining the evaluation of forces in orthodontics. Am J Orthod 1957;43:32-45. 39. Lee B. Relationships between tooth movement rate and estimated pressure applied [abstract]. J Dent Res 1965;44:1053. 40. Ricketts RM, Bench RW, Gugino CF, Hilgers JJ, Schulhof RJ. Bioprogressive therapy. Rocky Mountain Orthodontics 1979;6: 93-109.

41. Paulson RC, Speidel TM, Isaacson RJ. A laminagraphic study of cuspid retraction versus molar anchorage loss. Angle Orthod 1970;40:20-7. 42. Raymond ES. Force system analysis of V bend sliding mechanics. J Clin Orthod 1994;28:539-45. 43. Romeo PA, Burstone CJ. Tip-back mechanics. Am J Orthod 1977;72:414-21.