JCO on CD-ROM (Copyright 1998 JCO, Inc.

), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Common Sense Mechanics

7
THOMAS F. MULLIGAN , DDS

Distalization With Differential Torque

The tipback bend has been discussed and demonstrated and, since the tipback bend is used today
in a number of respected appliance techniques, it is in order to discuss it in greater detail. We know
that the tipback bend is an off-center bend and that the long segment and short segment indicate the
direction in which the forces act. We also know that the moments involved are unequal, thus
resulting in "differential torque". We have observed the "rowboat effect", which is the tendency for
the maxillary teeth to move forward during anterior lingual root torque (Fig. 76A). We have all
experienced this tendency for Class II relapse following headgear or Class II elastics when such
torque is applied. If we can simply understand WHY this occurs, then we can reverse the conditions
and create the opposite tendency, distalization (Fig. 76B).
We already know that when we apply anterior lingual root torque, crown movement tends to
precede root movement. When the archwire is tied to the molar tubes, this "rowboat effect" is
transmitted to all of the teeth. Anterior lingual root torque can be applied in many ways. It makes
little difference whether we use a rectangular wire, or round wire with torquing loops, or whatever
other means one may choose. When a rectangular wire with anterior lingual root torque is engaged
into the molar tubes, anterior lingual root torque is produced (Fig. 77A). Therefore, we can produce
the opposite tendency for tooth movement by placing mesial root torque on the molars using a
tipback bend in a round wire (Fig. 77B).
Keep in mind that if the second bicuspid is engaged, the bend is no longer an off-center bend and
will result in, basically, equal and opposite torque on the molars and bicuspids. We are looking for
unequal or differential torque at the anterior and posterior ends of the archwire. An .016 wire in an
.022 .028 slot is obviously a "loose" fit, but as you will see in time, the slots need not be filled.
Now, when this wire with tipbacks is inserted into the molar tubes and then engaged into the incisor
brackets, mesial root torque will be produced on the molars. But since crown movement tends to
precede root movement, there is a tendency for distal crown movement. If the archwire is tied to the
molar tubes, there is a distalization tendency for the entire upper arch, although teeth do not tend to
move distally with the same ease as they seem to move mesially or labially.
Remember that common sense prevails. If overbite interferes, at the time, with the distal crown
movement (tendency), mesial root movement of the molars will occur. These responses are highly
variable, as are many other responses such as headgear, etc. The most desirable responses occur
where teeth need uprighting, as these are tipping movements rather than bodily movements.
In general, the level of unerupted second molars does not pose the threat of impaction with the
use of a tipback bend (Fig. 78), except with techniques that use excessively high vertical force

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

levels. If the first molars are allowed to extrude as they tip back, they will literally be lifted and
tipped back over the second molar crowns. If the teeth are not permitted to extrude, they will tip
back and literally push the unerupted second molar even further back.
To give you an idea of how easy it is to increase extrusive forces without even realizing it, think
of this. The stiffness (load/deflection rate) of an .016 square wire is nearly twice that of an .016
round wire. Labial root torque increases anterior intrusive forces and therefore increases molar
extrusion. Remember that lingual root torque increases incisor eruption and molar intrusion? Labial
root torque is simply the opposite. This comparison is not intended to be critical of any technique,
but only to keep the orthodontist mindful at all times that many factors are responsible for vertical
force magnitudes, and knowledge of these factors allows steps to be taken to establish corrective or
preventive procedures.
Figure 79 shows the most serious tipback I have ever placed on molars and recommend
strongly that you never do the same. But, as mentioned before, non-banded teeth can provide
excellent information as to what is happening. Note that the unerupted second molars not only were
not impacted, but were pushed back due to the large moment (distal crown torque) on the molars
and erupted in a tipped-back configuration. Also, note that the unbanded bicuspids and cuspids have
tipped back dramatically, relative to mandibular plane. This clearly indicates the direction of thrust
resulting from the differential torque. It is true that an intrusive force with round wire produces
labial crown torque (lingual root torque) on the incisors, but with the archwire tied back, the molar
moments are not only in control, but will cause the incisor crowns to maintain their
anterior-posterior position or retract. Instead of seeing flared incisors, the opposite effect is
experienced. In fact, more often than not, correction of a deep overbite in this manner (2 4) results
in a flattening of the incisors rather than flaring. In spite of an excessive tipback, Figure 80 shows
that the molars returned to a level position following appliance removal. I have not yet failed to see
this occur.
If you can think of how many cases you have treated nonextraction instead of extraction, simply
by starting treatment prior to loss of the second deciduous molars, think of how many more patients
can be included in nonextraction treatment if you could simply gain another 1 to 2 millimeters of
space in each quadrant (Fig. 81). Since differential torque can do this, particularly where molars
require some uprighting, the combination of "E" space with that gained mechanically is significant.
My own feeling is that the tipped-back teeth, while uprighting, are continuing to erupt along a new
longitudinal axis, and thus give me a "net gain" when they finally attain their upright position. I like
to think I easily gain an extra 1-1 millimeters. If you feel that any additional tipping of the molars
beyond a given point will simply be lost as the molars return to a level position, then don't include
such additional amount of arch length in your treatment planning. I credit my treatment planning
with additional arch, length on patients who are still growing vertically, while I credit additional
length with a big ZERO on nongrowers, such as adult patients.
In Figure 82 the same type of space gain is seen on a patient who transferred to my practice
following earlier extraction treatment and eventual relapse. In spite of the significant space opening

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

distal to the first molars, I consider this to be a "zero gain", as the patient is an adult and all
uprighting of the second molars will be accomplished by forward movement of the molar crowns.
Treatment is nothing more than overbite correction and expansion but knowingly and
purposely. The only reason the second molars were banded instead of the first molars, is that the
additional length (Diving Board Concept) significantly reduced the stiffness (load/deflection rate)
and thus permitted use of a larger diameter wire (.020) and less breakage or deformation. Bypassing
teeth does result in more frequent deformation of wire but, in general, I do not consider this to be a
real problem, and can often move up to an .018. The tipback bend can always be reduced in order to
control the vertical forces. Again, common sense must be applied (cusp height, diet, etc.).
The space opening that was created with the tipback bend in the cases shown was accomplished
by gradually increasing the length of the archwires. As clinical evidence showed the tipback effects,
the 360 tie-back loops were gradually unrolled or unwound, which caused the archwire to become
longer and accommodate the additional arch length.
Class II Correction Without Headgear or Elastics
I would like to present a few cases to show some of the variations in response that occurred with
use of the tipback bend during overbite correction. It is important to understand that the Class II
correction is coincidental during overbite correction. This is not a means of eliminating headgear or
elastics. The simple fact is that where headgear is planned, you will be surprised, many times, to
find that the amount of headgear treatment originally planned is either reduced, some times
dramatically, or even eliminated.
The first case (Figure 83) is a girl who exhibited what I refer to as a "Super" Class II or "Double"
Class II malocclusion. Since the Class II malocclusion involves a significant degree of tipping and
the overbite is extremely deep, I consider this the ideal type of case to use differential torque with a
tipback bend. Headgear treatment was instituted prior to the conclusion of treatment, but substantial
progress was achieved prior to the use of any headgear or elastics (Fig. 84). You won't see this type
of case very frequently, but when much molar uprighting is required in such a case, be ready for a
welcome surprise. Also interesting is the fact that tipback bends were used in both arches, and still
Class II correction occurred (Fig. 85). Movement is usually more responsive in the maxillary arch,
although in this case much of the upper movement only required tipping (uprighting).
X-rays show the distal inclination of unbanded teeth, again giving evidence of the direction of
movement produced by differential torque when the large moment (relatively) is placed on the
molars (Fig. 86). For the benefit of the few remaining doubters, incisors can be intruded as
evidenced in Figure 87. The reciprocal teeth during incisor intrusion are the molars. Therefore, the
unbanded cuspids provide good clinical clues as to what is happening.
Figure 88 shows a girl with a mild Class II with only moderate overbite and upper anterior
crowding. There was decalcification present on lower molars, but no appliance was ever placed in
the lower arch. The lower arch was reasonably satisfactory, so only upper incisors and molars were

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

banded and the case treated with an .016 archwire with a tipback bend. Anterior alignment in itself
could be expected to result in overjet, but with no headgear or elastics ever utilized, and only a total
of six bands placed (Fig. 89), treatment was concluded successfully (Fig. 90). It is common, in this
type of case, to see this response.
In the next case (Fig. 91), no headgear or elastics were ever used, and you can see the need for
anterior lingual root torque following overbite correction (Fig. 92). The molars are tipped back at
the conclusion of treatment, but they upright during retention (Fig. 93), usually within one year
following appliance removal. Note the excellent facial esthetics post-treatment in this case (Fig. 94).
This case is shown to demonstrate, on a clinical level, the tipping back of incisor crowns with this
force system, as opposed to the labial flaring seen in the traditional full strapup with the use of an
archwire containing a reverse curve of Spee.
With a reverse curve of Spee, the incisors do flare, but the force system is not the same as that of
a tipback. There is no differential torque and, thus, the intrusive force acting through the incisor
brackets produces labial crown torque on the incisor segment with resultant flaring. With the
tipback, this anterior torque is "overwhelmed" by the molar moment, and the molars are favorites to
win the "Tug of War" that follows. If this mechanism is to be criticized, it should be because the
incisors are too often upright by the time the overbite is corrected and require anterior lingual root
torque to correct this. But, correction of overbites with a round wire (.016 or .018) need not result in
anterior flaring, as claimed by so many.
Summary
The tipback is not a substitute for headgear or elastics. However, because of the characteristics of
the force system, variations in correction will take place. Common sense helps to predict which
cases are most likely to be involved. Since the system works "with" the headgear and elastics and
not "against" them, progress is often made even with lack of cooperation. Also, because Class II
elastics tip an occlusal plane downward, use of a tipback in an upper arch only, does just the
opposite, and can permit the use of Class II elastics in such cases without affecting the upper
occlusal plane. As in any treatment with round wire, the other effects must be guarded against as
discussed earlier in this series.
(TO BE CONTINUED)

FIGURES

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Fig. 76

Fig. 76 A. "Rowboat effect". Maxillary teeth tend to move forward during anterior lingual root torque. B. Reversing the
mechanics results in distalization.

Fig. 77

Fig. 77 A. Rectangular wire with anterior lingual root torque will produce that movement when engaged in molar tube.
B. Round wire with molar tipback will reverse these mechanics.

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Fig. 78

Fig. 78 First molars (A,B) are tipped back (C,D) without impacting second molars.

Fig. 79

Fig. 79 Extreme tipback of first molars did not impact second molars.

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Fig. 80

Fig. 80 In spite of excessive first molar tipback (A), molars returned to level position following appliance removal (B).

Fig. 81

Fig. 81 Differential torque with molar tipback produces 1 -2mm of space mesial to molars.

Fig. 82

Fig. 82 Space gain through differential torque in an adult.

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Fig. 83

Fig. 83 Case with "Super" Class II malocclusion.

Fig. 84

Fig. 84 Progress on case shown in Figure 83, prior to use of headgear or elastics.

Fig. 85

Fig. 85 Class II correction occurred using tipback bends in both arches.

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Fig. 86

Fig. 86 X-rays of case in Figures 83-85, showing that the unbanded teeth followed the distal inclination of the molars.

Fig. 87

Fig. 87 Incisor intrusion on case in Figures 83-86.

Fig. 88

Fig. 88 Case with mild Class II malocclusion.

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Fig. 89

Fig. 89 Case in Figure 88 treated with upper 2 x 4 appliance only.

Fig. 90

Fig. 90 Case in Figures 88 and 89, following treatment.

Fig. 91

Fig. 91 Case with Class II division 2 malocclusion.

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Fig. 92

Fig. 92 Case in Figure 91 following overbite correction.

Fig. 93

Fig. 93 Case in Figures 91 and 92 a year after appliance removal.

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JCO on CD-ROM (Copyright 1998 JCO, Inc.), Volume 1980 Mar(180 - 189): Common Sense Mechanics Part 7

Fig. 94

Fig. 94 Case in Figures 91-93 before (above) and after (below) treatment.

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