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periodontal ligament under orthodontic tooth

loading

Stephanie R. Toms, DDS, PhD,a,b and Alan W. Eberhardt, PhDa

Birmingham, Ala

The stressed state of the periodontal ligament (PDL) is understood to play a critical role in the tooth

movement initiated by orthodontic treatment. Finite element simulations have been used to describe PDL

stresses for orthodontic loading; however, these models have predominantly assumed linear mechanical

properties for the PDL. The present study sought to determine the importance of using nonlinear mechanical

properties and nonuniform geometric data in computer predictions of periodontal ligament stresses and

tooth movements. A 2-dimensional plane-strain finite element model of a mandibular premolar was

constructed based on anatomic data of transverse sections of tooth, PDL, and bone from a 24-year-old

cadaveric man. A second model was constructed of the same tooth but with a PDL of uniform thickness.

Each of these was prescribed linear or nonlinear elastic mechanical properties, as obtained in our own

experiments. Predictions of the maximum and minimum principal stresses and von Mises stresses in the PDL

were determined for extrusive and tipping forces. The results indicated that biofidelic finite element models

predicted substantially different stresses in the PDL for extrusive loading than did the uniform thickness

model, suggesting that incorporation of the hourglass shape of the PDL is warranted. In addition,

incorporation of nonlinear mechanical properties for the PDL resulted in dramatic increases in the stresses

at the apex and cervical margin as compared with the linear models. (Am J Orthod Dentofacial Orthop 2003;

123:657-65)

A

pplication of light and continuous forces to the Finite element (FE) analyses offer a means of

crown of a tooth is recommended in orthodon- determining stresses in tooth, ligament, and bone struc-

tics. Under low force magnitudes, the peri- tures for a broad range of orthodontic loading scenar-

odontal ligament (PDL) vasculature is partially oc- ios. Stress profiles of the PDL have been quantified for

cluded, and cellular activity within the ligament canines,6-11 maxillary incisors,12,13 premolars,14,15 and

rescaffolds the alveolus by frontal bone resorption. In molars.16 Centers of rotation of teeth have been ana-

contrast, heavy forces are more likely to cause ischemia lytically determined,9,13,17 and the effect of bone loss

and cell death in the PDL and undermine bone resorp- has been investigated.18-20 These computer models

tion.1,2 Whereas light forces cause physiologic and generally incorporated homogeneous, isotropic, linear

steady tooth movement, heavy loads induce abrupt elastic PDL properties. Few studies have assigned

starts and stops of migration synchronous with collapse nonlinear mechanical properties to the PDL10,21,22 or

of necrosed bone and cementum.3 Thus, the stressed

nonuniform PDL geometry.12

condition of the PDL sets the stage for the ensuing

Accuracy of the computer models depends on

favorable or unfavorable tooth movement.4,5 Because

assigned constitutive properties, among other things.

of geometric and mechanical complexities, however,

Whereas the hard tissue properties have been docu-

few studies have related stress in the PDL to the applied

mented,23 a comprehensive mathematical description

orthodontic force. Clinicians therefore tend to rely on

experience when adjusting appliances. of the PDL has not been reported. This lack of

information is a source of error in computer simula-

From the University of Alabama at Birmingham, Birmingham, Alabama. tions of orthodontic tooth movement.10,11,20,24 Al-

Department of Biomedical Engineering. though the mechanical behavior of the PDL is

b

Department of Orthodontics.

Reprint requests to: Alan W. Eberhardt, PhD, HOEHN Room 370, 1075 13th

understood to be nonlinearly elastic,25-28 many in-

Street South, Birmingham, AL 35294-4440; e-mail, Aeberhar@eng.uab.edu. vestigators assign linear mechanical properties be-

Submitted, April 2002; revised and accepted, July 2002. cause of lack of scientific quantitative data.11,24

Copyright © 2003 by the American Association of Orthodontists.

0889-5406/2003/$30.00 ⫹ 0 Other investigators have performed parametric anal-

doi:10.1016/S0889-5406(03)00164-1 yses to determine the influence of the PDL linear

657

658 Toms and Eberhardt American Journal of Orthodontics and Dentofacial Orthopedics

June 2003

measurements of the tooth thickness. Stress area (AS)

for extrusive loading was defined as AS ⫽ TP. Stress

was calculated as the applied force/AS, and elongation

(⌬l) was the actuator displacement (Fig 2). Extrusive

shear strain was the angular deformation of the liga-

ment, ␥ ⫽ tan⫺1(⌬l/ WL).29

Fixtures were fabricated to clamp the bony part of

each specimen firmly and allow for extrusive loading of

the specimens immersed in saline solution (Fig 2).

Custom washers were machined to closely approximate

the contour of each PDL section and support as much

bone as possible. The specimens were centered under

an indentor that was attached to the actuator of a

materials-testing machine (MTS 858 Mini Bionix,

MTS, Eden Prairie, Minn). The tissue was cyclically

loaded for 3 cycles to the strain required to produce

0.05 MPa ligament stress. Load-displacement data for

each specimen were taken from at least the third cycle

of loading.29

An FE model was created with commercial soft-

ware (Cosmos/M, version 2.5, Structural Research and

Analysis, Los Angeles, Calif) for each transverse sec-

tion, based on the measured dimensions (Fig 3, A).

Symmetry of the root about the long axis was assumed

Fig 1. A, Isometric view of transverse section of tooth,

in these axisymmetric models. Mechanical properties

PDL, and bone of harvested mandibular premolar. B, for dentin and bone were taken from previous FE

Example of digital photograph of specimen from which studies12 (Table I). Nonlinear mechanical properties

PDL and tooth dimensions were measured. were assigned to the FE model of the PDL based on our

experimental data of applied load as a function of tooth

displacement.29 A detailed explanation of how the

elastic modulus and Poisson’s ratio on the center of nonlinear mechanical properties were developed is

rotation of a canine.9 provided in the Appendix. The FE prediction of load

Recently, we quantified nonlinear elastic and aniso- and displacement were compared for each transverse

tropic stress-strain behavior of the PDL of cadaveric specimen (Fig 3, B), thereby validating the assigned

mandibular premolars for low force.29 In this study, we nonlinear mechanical properties.

sought to incorporate this experimental data of PDL Two-dimensional plane-strain FE models of the

geometry and nonlinear stress-strain characteristics as intact mandibular premolar were then constructed (Fig

input to an FE model of a tooth, ligament, and bone 4) by stacking the models of the transverse sections of

structure to compare stresses and deformations with tooth, PDL, and bone. One model had a nonuniform

models of uniform PDL thickness and linear mechani- PDL thickness based on the geometry of the cadaveric

cal properties. specimen. The PDL thickness was 0.291 mm at the

lingual and buccal cervical margins, 0.204 mm at

MATERIAL AND METHODS midroot, and 0.300 mm at the apex. A second model

A mandibular premolar from a 24-year-old male was developed that had a PDL of uniform (250 m)

cadaver was sliced transversely into sections approxi- thickness, as assumed by other investigators.7,8,30 The

mately 0.85 mm thick (Fig 1, A).29 Digital photographs models had 1674 eight-node quadrilateral elements and

of the specimens (Fig 1, B) were taken from apical and 5205 nodes, with a high density of elements in the PDL,

coronal views, from which tooth perimeter (P) and PDL where large displacement gradients were anticipated.

dimensions were measured with Sigma Scan 4.0 soft- Either linear or nonlinear mechanical properties

ware (Jandel, Chicago, Ill). PDL thickness (WL) for were assigned to the PDL. Linear mechanical proper-

each view was taken as the average of 8 evenly spaced ties of the PDL were calculated as the secant modulus

measurements around the perimeter. Specimen thick- of the elastic stress-strain curves at 0.05 MPa stress for

American Journal of Orthodontics and Dentofacial Orthopedics Toms and Eberhardt 659

Volume 123, Number 6

Fig 2. A, Specimen and test fixture. Downward motion of MTS actuator (MTS 858 Mini Bionix, MTS,

Eden Prairie, Minn) moves indenter through opening in lexan clamping plate, applying load to center

of tooth. B, Magnified view of specimen clamped between lexan and washer for loading in extrusion

before load application, and C, after loading.

Fig 3. A, Axisymmetric FE model of transverse section of experimental tooth, PDL, and bone

subjected to extrusive orthodontic loading, using nonlinear mechanical properties of PDL deter-

mined experimentally. B, Load and displacement values predicted by FE model were in agreement

with experimental data.

each section. Nonlinear mechanical properties derived Table I. Mechanical properties for the structural

for the transverse sections were assigned for the non- elements used in the current study

linear analyses.

Models were analyzed to determine (1) the effects Young’s modulus Poisson’s

Material (MPa) ratio

of PDL thickness variations around the buccolingual

plane, (2) linear versus nonlinear elastic behavior of Dentin 19600 0.3

PDL, and (3) load direction (extrusive or tipping) on Bone 13700 0.3

PDL stresses and tooth displacements (Table II). A 1-N PDL (linear elastic)

MP1 0.303 0.45

equivalent line load was delivered in 0.1-N increments MP2 0.208 0.45

to the occlusogingival midpoint of the crown, and the MP3 0.143 0.45

bone was fixed at the base of the mandible. PDL MP4 0.179 0.45

stresses were analyzed at the buccocervical margin, MP5 0.25 0.45

linguocervical margin, and apex for the uniform and PDL (nonlinear elastic) Calculated, see Appendix 0.45

nonuniform thickness models using linear mechanical Properties for the hard tissues were taken from literature. Both linear

properties. Differences in predicted stresses exceeding and nonlinear mechanical properties for PDL were based on experi-

25% were considered substantial. Comparisons were mental data.

made of the maximum and minimum principal stresses

(ie, tension or compression) and von Mises stresses (a

660 Toms and Eberhardt American Journal of Orthodontics and Dentofacial Orthopedics

June 2003

Table II.

parametric analysis of stresses in periodontal

ligament of a mandibular premolar

Study Load Description

uniform PDL

thickness (0.25 mm)

Linear/nonuniform Extrusive Linear elastic PDL,

nonuniform PDL

thickness

Nonlinear/Extrusion Extrusive Nonlinear elastic PDL,

nonuniform PDL

thickness

Nonlinear/Tipping Tip Nonlinear elastic PDL,

nonuniform PDL

thickness

plotted (Fig 6) for the uniform and nonuniform thick-

ness models. At all locations, the stress distributions

across the PDL for the uniform thickness model were

similar to the distributions for the nonuniform thickness

Fig 4. Two-dimensional FE model of mandibular premo- model; however, the curves were not coincident. The

lar subjected to extrusive or tipping orthodontic loading at average stresses across the PDL space were calculated

occlusogingival midpoint on buccal (B) aspect of crown.

(Table III). The average difference in P1 was calculated

PDL thickness in this parametric analysis was either

0.25-mm uniform thickness or nonuniform (not shown).

to be between 17.25% and 35.27% for the 3 regions.

Mechanical properties (MP) of PDL depended on ana- The average difference in P3 varied from 14.14% to

tomic location. Buccocervical margin (BCM), linguocervi- 44.49%, and von Mises varied from 18.05% to 26.63%.

cal margin (LCM), and apex areas are identified. Substantial differences were found in P1 at the lingual

cervical margin (35.27%), in the von Mises stresses at

the apex (26.63%), and in P3 at the buccocervical

measure of 3-dimensional distortional stress) in the margin (44.49%).

center of the PDL as predicted by the models. In The nonlinear, nonuniform model with an extrusive

addition, instantaneous centers of rotation of the man- load predicted the highest P1 stresses at the apex (111

dibular premolar were calculated for each 0.1-N incre- kPa), but much smaller magnitudes (⬍26.4 kPa) for the

ment of loading, as done previously.13 midroot and cervical margin locations on both buccal

and lingual aspects (Fig 5, A). The P3 stresses were

RESULTS lowest at the linguocervical margin (7.98 kPa) (Fig 5,

For the cases of extrusion, maximum principal B). The von Mises stresses were highest at the apex

stresses (P1) and minimum principal stresses (P3) for (29.3 kPa) and near zero in the midroot regions;

the uniform and nonuniform linear models followed however, they increased at the buccocervical margin

similar curves for all regions along the root. As indi- (8.99 kPa) and linguocervical margin (3.82 kPa) (Fig 5,

cated in Figure 5, A, P1 values were less than 38.6 kPa C).

at all locations and were highest at the apex. P3 values The nonlinear, nonuniform model with a tipping

were likewise lowest at the linguocervical margin load predicted the greatest P1 stresses at the buccocer-

(⫺11.6 kPa) (Fig 5, B). The von Mises stress curves vical margin (73.5 kPa) (Fig 5, A). The model predicted

were similar for the uniform and nonuniform thickness the lowest P3 stresses immediately adjacent to the apex

models; however, the peak stresses occurred approxi- on the buccal side (⫺117 kPa) and at the linguocervical

mately midroot on the buccal aspect (17.7 kPa for margin (⫺71.5 kPa) (Fig 5, B). The von Mises stresses

nonuniform and 14.8 kPa for uniform thickness) (Fig 5, were greatest at the lingual and buccocervical margins

C). (24.9 kPa) (Fig 5, C).

Stresses (P1, P3, and von Mises) across the PDL The instantaneous center of rotation (ICR) for the

thickness from the tooth to the bone at the linguocer- linear, nonuniform model was located on the midline of

American Journal of Orthodontics and Dentofacial Orthopedics Toms and Eberhardt 661

Volume 123, Number 6

Fig 5. A, Maximum principal stresses; B, minimum principal stresses; and C, von Mises stresses in

PDL predicted by FE models of mandibular premolar subject to orthodontic force.

Average stress across the PDL from tooth to bone as predicted by FE models with uniform PDL

Table III.

thickness and nonuniform PDL thickness

Linguocervical margin Apex Buccocervical margin

Uniform ⫺2.6932 ⫺11.6090 7.7574 36.9586 28.4971 8.0320 13.2804 1.2330 10.4613

Nonuniform ⫺1.9910 ⫺9.4540 6.4919 31.5214 24.9671 6.3430 11.0600 0.8533 8.8620

Difference ⫺35.27 ⫺22.79 ⫺19.49 ⫺17.25 ⫺14.14 ⫺26.63 ⫺20.08 ⫺44.49 ⫺18.05

the tooth approximately 4.3 mm from the apex and did the midline to the lingual side of the root during load

not move during extrusive load application (Fig 7, A). application, approximately 3.8 mm from the apex (Fig

The ICR for the nonlinear, nonuniform model started at 7, B).

this point but was displaced off the midline 0.0025 mm

to the buccal side and 1 mm toward the apex during DISCUSSION

load application from 0 to 0.7 N. Additional loading As hypothesized, stresses predicted in the PDL by

redirected the ICR back to the midline of the root but to computer simulations depended on assigned mechani-

a more apical location. The nonlinear model subjected cal properties and PDL geometry. Predicted stresses

to a tipping force predicted movement of the ICR from using a uniform thickness PDL were substantially

662 Toms and Eberhardt American Journal of Orthodontics and Dentofacial Orthopedics

June 2003

Fig 6. Stresses across PDL at A, linguocervical margin; B, apex; and C, buccocervical margin.

Node 0 is at tooth and PDL interface, and node 8 is at PDL and bone interface. VON, von Mises

stresses.

Fig 7. A, ICR of mandibular premolar during application of 1 N extrusive loading in 0.1-N increments

(inset) assuming linear and nonlinear mechanical properties (MP) of PDL. B, ICR during application

of 1 N extrusive and tipping forces in 0.1-N increments (inset), assuming nonlinear mechanical

properties for PDL. Tooth is approximately 24 mm in length, and root tip is at origin. Center of

rotation deviates from long axis of tooth when nonlinear mechanical properties are used for PDL.

Center of rotation is stationary when linear mechanical properties are used.

different from stresses predicted using a nonuniform nonlinear mechanical properties were different from

thickness PDL. In addition, predicted stresses using predicted stresses using linear mechanical properties.

American Journal of Orthodontics and Dentofacial Orthopedics Toms and Eberhardt 663

Volume 123, Number 6

Maximum principal stresses in the PDL for the mately 4.3 mm from the apex and did not change

uniform linear model were highest at the apex and during extrusive load application. In contrast, the

tapered more at the linguocervical margin than at the ICR moved during load application for both the

buccocervical margin. This agrees with previous extrusive and the tipping nonlinear models. To our

findings of an asymmetric stress pattern about the knowledge, this is the first report of movement of the

long axis of the root with a 3-dimensional, linearly center of rotation within a tooth under orthodontic

elastic PDL model of a maxillary canine in extru- loading. Because the model is 2-dimensional, a

sion.8 3-dimensional biofidelic rendering of a premolar

The differences in predicted stresses for the FE may provide a better prediction of the motion of the

model with a uniform PDL thickness and nonuniform ICR during load application.

PDL thickness, in which linear mechanical proper- The present FE analyses of a mandibular premolar

ties were applied, were substantial for the linguocer- subjected to tipping and extrusive orthodontic forces

vical margin (P1), apex (von Mises), and buccocer- indicated that the inclusion of nonuniform geometry

vical margin regions (P3). These results were and nonlinear mechanical properties for the PDL sub-

expected, because stress in a mechanical system is a stantially alters predictions of stresses in the PDL.

function of its dimensions and applied load. At the Although the 2-dimensional plane-strain model cannot

apex, the P1 stresses were higher for the uniform accurately represent all aspects of a complex 3-dimen-

thickness PDL than for the nonuniform thickness sional dental structure, it suggests that behavior of the

PDL, likely a result of the narrower PDL thickness

PDL and the tooth under low force depends on the

for the uniform model. P1 stresses were likewise

mechanical properties of the soft tissue and dimensions

higher at the buccal and lingual cervical margins,

assigned to the PDL.

owing to the narrower dimension for the uniform

model. The data suggest that a PDL thickness based

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664 Toms and Eberhardt American Journal of Orthodontics and Dentofacial Orthopedics

June 2003

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American Journal of Orthodontics and Dentofacial Orthopedics Toms and Eberhardt 665

Volume 123, Number 6

Table IV.Piecewise linear mechanical property values describing nonlinear elastic stress–strain behavior of PDL

(values were input to FE model)

MP1 MP2 MP3 MP4 MP5

ε ε ε ε ε

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.0251 0.0008 0.0316 0.0001 0.1963 0.0019 0.1468 0.0025 0.1009 0.0030

0.0473 0.0021 0.0635 0.0004 0.2327 0.0043 0.1850 0.0062 0.1180 0.0049

0.0755 0.0050 0.1285 0.0027 0.2704 0.0098 0.2241 0.0153 0.1353 0.0080

0.1009 0.0102 0.1622 0.0068 0.2782 0.0115 0.2401 0.0218 0.1528 0.0130

0.1266 0.0197 0.1969 0.0172 0.3017 0.0187 0.2562 0.0312 0.1705 0.0212

0.1526 0.0374 0.2203 0.0315 0.3342 0.0359 0.2727 0.0446 0.1884 0.0345

0.1789 0.0706 0.2329 0.0435 0.3509 0.0497 0.2893 0.0639 0.2065 0.0562

0.1883 0.0882 0.2498 0.0664 0.3680 0.0690 0.3063 0.0915 0.2250 0.0914

0.2051 0.1309 0.2706 0.1104 0.3908 0.1057 0.3235 0.1312 0.2437 0.1488

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