Department of Orthodontics & Dentofacial Orthopedics

A FINITE ELEMENT STUDY OF DIFFERENT CANTILEVER INTRUSION SPRING

Dissertation by Dr. Abdul Wahab.Md.

Guide-

Dr. K. Sadashiva Shetty,

Professor & head, Department of orthodontics, Bapuji dental college & hospital.

Dr.T.Ramanujulu, Associate prof., Department of orthodontics, Bapuji dental college & hospital.

CONTENTS

INTRODUCTION AIMS AND OBJECTIVES MATERIALS AND METHOD RESULTS DISCUSSION SUMMARY AND CONCLUSION

INTRODUCTION
Correction of the anterior deep bite in a patient can present challenges to the clinician. It requires thoughtful application of diagnostic knowledge as well as skillful application of the mechanical principles.

 There are basically two approaches that can be used to apply the force system necessary to trigger the biologic phenomena that results in correction of the anterior deep bite: True intrusion of the upper and/or lower anteriors, and Relative intrusion i.e. allowing the posterior teeth to erupt while the anteriors are withheld from further eruption

 However, simultaneously a moment is generated within the posterior segment which adds to the anteroposterior anchorage. Likewise addition of a curvature to the posterior part of the wire (commonly referred to as Reverse Curve of Spee) should presumably perform exactly in the same way as with anchor bend.

 Some of these designs have been tested using analytic equations and/or sophisticated experimental methods; However, since these methods are very lengthy and required a lot of precision they were restricted to study of one or two designs at the most.

 In recent times, the Finite Element Method has been used by some researchers in orthodontics for studying the different cantilevers especially of loop characteristics. Some of these trials, however, were aimed at developing newer archwire / loop configurations.

 Relatively few studies, however, have compared the commonly used intrusion archwire designs. Therefore, this study is planned, to carry out a comprehensive evaluation of the physical characteristics of various intrusion archwire designs. An evaluation of the archwire properties and physical characteristics are also
considered.

Aims & Objectives :

 To study the deformation pattern of activated cantilever intrusion spring. To describe the force system developed by cantilever with different configuration when activated

Material & Methods

 The study was done in the Department of Orthodontics and Dentofacial Orthopedics, Bapuji Dental College and Hospital, Davangere, in association With Bapuji Institute of Engineering Technology, Davangere, Karnataka, India.

Six different cantilever configurations were analyzed

TIP BACK

UTILITY

COMPOSITE LOOP

LOOP

FLAT CURVE

DEEP CURVE

 Youngs Modulus and Poissons ratio for various materials used in this study. Stainless Steel 170GPa Blue Elgiloy 160GPa T.M.A. 75 GPa NiTi 35GPa 0.3 0.3 0.3 0.3

Activation in % or mm 0% 20mm 10% 18mm 20% 16mm 30% 14mm 40% 12mm 50% 10mm 60% 70% 80% 90% = = = = = = = = = = 8mm 6mm 4mm 2mm

100%

0mm

External loading was applied as a forced displacement of the right end tip of the wire in 10 increments of 2 mm.

 A comparison of all these forces, moments and displacement were performed for all the four materials (Stainless Steel, Cobalt Chromium, T.M.A. and Nickel Titanium wires). The results were then tabulated and shown as graphs.

RESULTS

Horizontal Displacement

10 9 8

TipBack

10 9 8

TipBack

Horizontal Deflection (mm)

Utility
Horizontal Deflection (mm)

Utility
7 6

7 6

Loop
5 4 3 2 1 0

Loop
5 4 3 2

Comp Loop

Comp Loop

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

1 0

Flat Curve 0 2 4 6 8 10 12 14 16 18 20 Deep Curve

Vertical Deflection (mm)

TMA
10 9

Deep Curve

Vertical Deflection

SS
10 9 8

TipBack

TipBack

Horizontal Deflection (mm)

8 7 6

Horizontal Deflection (mm)

Utility

Utility
7 6

Loop
5 4 3 2 1 0 0 2 4 6 8 10 12 14 16 18 20

Loop
5 4 3 2

Comp Loop

Comp Loop

Flat Curve

1 0

Flat Curve 0 2 4 6 8 10 12 14 16 18 20 Deep Curve

Vertical Deflection

CCr

Deep Curve

Vertical Deflection

NiTi

Activation Force

80

TipBack

180 170 160 150 140 130

Activation Force (cN)

TipBack

70

60
Activation Force (cN)

Utility

Utility

120 110 100 90 80 70 60 50 40 30

50

Loop
40

Loop

30

Comp Loop
20

Comp Loop

10

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

20 10 0

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

Vertical Deflection (mm)

TMA

Deep Curve

Vertical Deflection (mm)

SS

Deep Curve

170 160 150 140 130 120

Activation Force (cN)

TipBack

40

TipBack

Utility
Activation Force (cN)

30

Utility

110 100 90 80 70 60 50 40 30 20 10 0

Loop

Loop
20

Comp Loop

Comp Loop
10

Flat Curve
0

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

10

12

14

16

18

20

Vertical Deflection (mm)

Ccr

Deep Curve

Vertical Deflection (mm)

NiTi

Deep Curve

Moment at Tube

2500 2250 2000

TipBack

5500 5000 4500

TipBack Utility

Moment at Tube (cN mm)

Utility
Moment at Tube (cN mm)

4000

1750 1500

Loop
3500 3000 2500 2000 1500 1000

Loop
1250 1000 750 500 250 0

Comp Loop Flat Curve Deep Curve

Comp Loop

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

500 0

0 Deep Curve

10

12

14

16

18

20

Vertical Deflection (mm)

TMA

Vertical Deflection

SS
TipBack

5500 5000 4500

TipBack

1000 900

Moment at Tube (cN mm)

4000 3500 3000 2500 2000 1500 1000 500 0

Utility
Moment at Tube (cN mm)

800 700 600 500 400 300

Utility

Loop

Loop

Comp Loop

Comp Loop

Flat Curve 0 2 4 6 8 10 12 14 16 18 20 Deep Curve

200 100 0

Flat Curve

Vertical Deflection

Ccr

0%

Vertical Deflection

10

NiTi
12 14

16

18

20

Deep Curve

Intrusion Force

80

TipBack

160 150 140 130

TipBack

70

60
Intrusion Force (cN)

Utility
Intrusion Force (cN)

120 110 100 90 80 70 60 50 40 30 20 10 0

Utility

50

Loop
40

Loop

30

Comp Loop
20

Comp Loop

10

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

Flat Curve 0 2 4 6 8 10 12 14 16 18 20 Deep Curve

Vertical Deflection (mm)

TMA

Deep Curve

Vertical Deflection

SS

160 150 140 130 120

TipBack

40

TipBack

Utility
Intrusion Force (cN)

30

Utility

Intrusion Force (cN)

110 100 90 80 70 60 50 40 30 20 10 0

Loop

Loop
20

Comp Loop

Comp Loop
10

Flat Curve 0 2 4 6 8 10 12 14 16 18 20 Deep Curve

0

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

Vertical Deflection

Ccr

Vertical Deflection

NiTi

Deep Curve

ACTIVATION FORCE (cN) At 100% activation

180 160 140

TMA NiTi STEEL BLUE ELGILOY

Activation Force (cN)

120 100 80 60 40 20 0

TIP BACK

UTILITY ARCH

LOOP

COMPOSITE FLAT CURVE DEEP CURVE LOOP

MOMENT AT THE TUBE (cNmm) At 100% activation

TMA
5000

NiTi STEEL BLUE ELGILOY

Moment at the tube (cNmm)

4000

3000

2000

1000

TIP BACK

UTILITY ARCH

LOOP

COMPOSITE FLAT CURVE DEEP CURVE LOOP

Deactivation-Intrusion Forces (cN) At 100% activation

180 160 140

TMA NiTi STEEL blue elgiloy

Intrusion Forces (cN)

120 100 80 60 40 20 0

TIP BACK

UTILITY ARCH

LOOP

COMPOSITE FLAT CURVE DEEP CURVE LOOP

Intrusion : Moment Ratio At 100% activation

TIP BACK COMPOSITE LOOP UTILITY ARCH FLAT CURVE LOOP DEEP CURVE

0.04

Intrusion : Moment Ratio

0.03

0.02

0.01

TMA

NiTi

STEEL

BLUE ELGILOY

DISCUSSION

 For the purpose of simplification the discussion can be carried out under two parts: Part One: Investigation of the six different cantilever configurations considering material property of T.M.A. wire only. Part Two: Comparison between the six cantilevers employing different archwire materials.

Part One
Here the investigation of the six different cantilever configurations considering material property of T.M.A. wire was carried out. The material i.e. TMA was kept as a constant in order to ensure that the results obtained would not vary due to the differences in the material of the wire.

 The purpose of this part of the study was to evaluate the effects of the different cantilever configurations on the forcedeflection characteristics viz. horizontal displacement, activation force, moment at the tube, vertical (intrusive) and horizontal (retraction / protraction) deactivation forces.

a) Horizontal Displacement
The largest forward horizontal displacement in Y-axis was found for the deep curved bend and lowest for the utility arch.

It is interesting to note that the maximal forward horizontal displacement in Y-axis value for different cantilever designs except for the two curved bends occurred at either 60% (utility) or 80% (tip-back, loop and composite loop) of activation, while that of deep curve bend and flat curve bend occurred at 100%.

All trajectories, except for the two curved bends, showed a maximal forwar horizontal displacement in Y-axis before reaching their final activation.

Horizontal Displacement
10 9 8

TipBack

Utility
Horizontal Deflection (mm)

7 6

Loop
5 4 3 2 1 0

Comp Loop

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

Vertical Deflection (mm)

Deep Curve

b) Activation Force
When comparing the activation forces it was found that the tip back bend requires the highest forces in the y axis. The curved bends too needed high forces (almost like the tip-back bend) followed by the utility arch and composite loop. The loop configuration exhibited the least amount of requirements for its activation in the y axis.

Activation Force
80

TipBack

70

60
Activation Force (cN)

Utility

50

Loop
40

30

Comp Loop
20

10

Flat Curve
0 2 4 6 8 10 12 14 16 18 20

Vertical Deflection (mm)

Deep Curve

d) Deactivation forces
The force system generated during deactivation was largely dependent on the activation force. It should also be noted that the deformation of various configurations during activation has a significant influence on the direction of the intrusion forces. As can be seen in each one of the configurations has a different deformation pattern, especially at the free end of the cantilever that can be measured easily. This positioning of the free end of the cantilever will determine the direction of the intrusion force (i.e. either intrusion-protrusion or intrusion-retrusion forces).

TIPBACK

COMPOSITE LOOP

UTILITY

FLAT CURVE

LOOP

DEEP CURVE

 In the considered loading mode for the FE analysis the activation force was directed purely vertically. This force can be resolved into a force component perpendicular to the wire and a pulling force in the wire itself.

After fixing the wire in its deformed state only the reaction force the Fperp can be used during the deactivation process. Consequently, the vertical and horizontal components of Fperp represent the intrusion/extrusion and protrusion/retraction components respectively. The nature of the horizontal component of force depends on the deformed shape of the cantilever.

F intrusion F perp

F protraction

The force system was separated into intrusive and retraction / protraction components.

for example for a tip back configuration, the Fperp (the force perpendicular to the arch wire) is further resolved into two forces. One force, which acts in vertical plane considered as true intrusion force (F intrusion) & another smaller force in horizontal plane. This horizontal force, depending on its direction, could be either a retractive force (F retraction when arrow facing towards the tube) or a protrusive force (F Protrusion when arrow facing away from the tube). It is interesting to note that the horizontal forces may be retractive (ve value) or protrusive (+ve value) at different levels of activation. The tip-back bend, for example, at 100% activation shows an intrusive force of 69.1 cN and a protrusion force of 24.3 cN. However, it takes only four increments of upward displacement before protrusion turns into retraction.

 This shift also occurs for the other bends with the exception of the curved bends, which have solely retraction forces the magnitude of this retraction forces, however, is strongly dependent on the amount of curvature. The magnitude of protrusion at 100% activation is highest with tip-back, followed by utility, composite loop and then loop configuration. The utility arch has the least amount of retraction forces for at any given level of deactivation when compared to other cantilever configuration. The deep curve has the maximum amount of retractive forces at any level of deactivation.

The results obtained in this study were in agreement with the

e) Intrusion : Moment (I:M)

A three piece intrusion arch can be considered one couple appliance system. Here a couple is generated within the tube, where the spring makes contact at the mesial and distal ends. At the mesial end of the spring there is a single point contact and there by no couple is generated. Whenever true intrusion is intended it is always preferable to minimize the extrusion of the posteriors. This extrusion is directly proportional to the amount of moment created in the auxillary molar tube. Thus it would be said that a design which gives maximum intrusive forces with least amount of moment created posteriorly would be the most favorable one. Therefore the design that has the highest intrusive to moment (I:M) ratio would

 It was found that of all the designs at 100% activation utility arch shows the highest I:M ratio followed by composite loop. The least desirable I:M ratio was seen with deep curve. The tip-back and flat curve, showed almost a similar I:M ratio which was slightly less than the loop design. This pattern was seen up to the 30% of activation .The pattern, however, changes at 20% and 10% which is clinically not significant.

Part Two

Here, comparison between the six cantilevers employing different archwire materials was carried out. The materials employed are those which are most commonly used as arch wires, i.e. Stainless steel, Blue Elgiloy, T.M.A (B-titanium), Nickel Titanium.

Horizontal Displacement :

For a given design the horizontal displacement remained the same, irrespective of the material used. It could be, therefore, said that the deformation characteristic of a given cantilever is independent of the material. In other words, whether a utility arch is fabricated with stainless steel or Niti, it will show the same amount of horizontal displacement at every level of activation / deactivation.

Activation Force:
Activation force was maximum for stainless steel, followed by Blue Elgiloy, TMA and NiTi` for any given configuration. The activation forces for that of the TMA was almost half of SS, while the activation forces of the NiTi was almost half of the TMA wire. Blue Elgiloy was showing a slightly lower forces than that of the SS. In conformation of the first part of the study each material required maximum activation force for the tip back bend and minimal for the utility arch.

Moment at the Tube:

Moment at the tube followed a similar pattern to the activation force, i.e. stainless steel generates the highest moment followed by Blue Elgiloy, TMA and NiTi in descending order. The highest moment generated was recorded for the SS wire with the tip-back design (5030.76 cNmm) and least was for the NiTi wire with composite loop configuration (428.85 cNmm).

Deactivation
This deactivation force (F perpendicular), as explained in the first part of the discussion, can be resolved into two components. These are F intrusion and F protrusion /F retraction.

 These force vectors generated depend on two things: Activation force: Greater the activation force, greater will be the deactivation force. Configuration: The design of the cantilever

 For any given configuration, the activation force required for stainless steel is the greatest and so the reactionary force generated is the highest when compared to the other materials used in this study. The deactivation force kept on decreasing in Blue Elgiloy, TMA, NiTi, in descending order. However, the forces generated by the SS wire were much higher than those considered as desirable in the literature. For example, the tip-back configuration which was made up of the stainless steel generated an intrusion force of 156.1 cN (roughly 160 gms). In other words, it means that lateral and central incisor in a 3 piece intrusion arch, will receive an intrusion force of approximately 80 cN each.

 Though the least intrusion force value among the various designs in stainless steel material was shown by composite loop configuration, it generated an intrusive forces of 70.2 cN (i.e. central and lateral incisors each will experience 35 cN of force).

The desirable intrusion forces, however, was shown by both the loop configurations when made up of the TMA material and when tip-back, utility, flat and deep curve configuration made up of the NiTi wire (the intrusion forces ranged from approximately 40 to 25 cN i.e. central and lateral each would experience only 12 to 20 cN).

 Different cantilever designs showed a shift from protractive to retractive forces at different levels of deactivation. This shift does not vary with different materials using the same design. Similarly in deep curved bends the initial horizontal vector is retractive in all the four materials. Because of the inherent property of the material the horizontal vector of force generated would decrease significantly from stainless steel to NiTi.

e) Intrusion: Moment (I:M) Ratio

As mentioned previously, whenever true intrusion is intended it is always preferable to minimize the extrusion of the posteriors. This extrusion is directly proportional to the amount of moment created in the auxillary molar tube. Thus it would be said that a design which gives maximum intrusive forces with least amount of moment created posteriorly would be the most favorable one. Therefore the design that has the highest intrusive to moment (I:M) ratio would be the most suitable. In the present study we compared the I:M ratio generated for all the materials. With this we were able to study the best combination of the material and archwire design for an intrusion arch.

 It was found that of all the materials, the utility arch showed the highest I:M ratio at 100% activation. For the next positions, there was no proper sequence as different materials showed different ratios for different designs. However the variation between the loop, comp. loop, tip-back and flat curve designs were small (0.031 and 0.035). Irrespective of the material, the least ratio was seen with the deep curve, especially with NiTi wires which showed only 0.0079. In short a clinical situation may demand retraction or protrusive forces be generated along with the intrusive forces. Thus, it can be seen that using a combination of different materials and cantilever designs we can get the desired vector of forces.

In summary following conclusions can be listed:

The configuration of the cantilever is crucial for the direction of the force delivered. The results demonstrated that the curved cantilevers behaved fundamentally differently from other designs. When fully activated (100%) the cantilevers with a curvature would be capable of delivering a retractive force in combination with intrusion. In all other configurations, the tip back, utility, loop and composite loop the horizontal force component at 100% activation was generating a forward directed force, leading to a protrusion of the anterior unit, however after some deactivation, it reversed into a retraction force. The turning point between protrusion and retraction forces depended on the configuration.

 The addition of length to the wire by bending a loop or a step, in a utility shaped cantilever lowers the stiffness of the configuration and results in lower deactivation forces.

Of all the materials, the force generated by stainless steel was almost more than the double of those of TMA wire. And the forces generated by TMA wire were slightly more than the double of the NiTi wires. The force generated by blue elgiloy wires were 10% less than SS wires.

 The forces generated by the SS wire for all the six configurations were much higher than those considered as desirable in the literature. The desirable intrusion forces, however, was shown by both the loop configurations when made up of the TMA material and when tip-back, utility, flat and deep curve configuration made up of the NiTi wire. When the intrusion forces were compared to the amount of the moment generated at the molar tube and I:M ratio was considered, it was found that the utility design generated the best ratio, where as the deep curve showed the worst I:M ratio.

 In patients where a combined retraction and intrusion is desired, the use of a curved cantilever made up of NiTi wire can be recommended, as this design further contributes an additional horizontal force component. If protrusion is desirable then a tip-back design of NiTi wire should be used, as it can deliver the desired combination of protrusive and intrusive forces efficiently. If extrusion of posterior teeth is desired the deep curve design should provide the right combination of maximum intrusion of the incisors and high moment at the molar tubes. However, the best combination of the material and design for intrusion of incisors would be a utility arch constructed with a NiTi wire.

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