Space Closure3 / Orthodontic Courses by Indian Dental Academy

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Space closure typically occurs
more easily in high-angle patterns
with weak musculature than in
low-angle patterns with stronger
musculature. The rate of closure
can be increased, particularly in
high-angle cases, by slightly
raising the force level or using
thinner archwires. However, more
rapid space closure can lead to
loss of control of torque, rotation,
and tip.
Effects of Overly Rapid Space Closure
INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com

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Loss of torque control results in upper
incisors being too upright at the end of
space closure with spaces distal to the
canines and a consequent unaesthetic
appearance. The lost torque is difficult
to regain. Also, rapid mesial movement
of the upper molars can allow the
palatal cusps to hang down, resulting in
functional interferences, and rapid
movement of the lower molars causes
"rolling in"

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Reduced rotation control can be
seen mainly in the teeth adjacent to
extraction sites, which also tend to
roll in if spaces are closed too
rapidly
Reduced tip control produces
unwanted movement of canines,
premolars, and molars, along with a
tendency for lateral open bite. In
high-angle cases, where lower
molars tip most freely, the elevated
distal cusps create the possibility of
a molar fulcrum effect

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In some instances, excessive
soft-tissue hyperplasia
occurs at the extraction sites
,this is not only unhygienic,
but it can prevent full space
closure or allow spaces to
reopen after treatment. Local
gingival surgery may be
necessary in such cases.

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Proper alignment of bracket slots is essential to eliminate
frictional resistance to sliding mechanics. The common
procedure is to use .018" or .020 " round wire for at least one
month before placing .019".025" rectangular wires. Leveling
and aligning continues for at least a month after insertion of the
rectangular wires, and that space closure cannot proceed during
that period.
Inhibitors to Sliding Mechanics
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Therefore the rectangular wires are tied passively for at
least the first month, until leveling and aligning is complete
and the archwires are passively engaged in all brackets and
tubes

Conventional elastic tiebacks are than placed ,In some cases,
this phase takes three months.

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First-order or rotational
resistance
at the mesiobuccal and
distolingual aspects of the posterior
bracket slots is produced by
rotational forces on the buccal
aspects of the posterior teeth.

The most effective way to
counteract this resistance is to
apply intermittent lingual elastic
forces
one month from cuspid to first
molar, the next month from cuspid
to second molar.

There are three primary sources of friction during space closure
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Second-order or tipping resistance

at the mesio-occlusal and distogingival
aspects of the posterior bracket slots is
caused by
excessive and overactivated
tieback forces, which lead to
tipping of the posterior teeth,
inadequate rebound time to
upright these teeth,
and a resultant binding of the system.

The importance of light forces (50-
150g) and minimal activation length (to
provide time for uprighting) cannot be
overemphasized.
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Third-order or torsional resistance
occurs at any of the four areas of the
bracket slot where the edges of the
archwire make contact.
Like tipping resistance, this is produced
mainly by
excessive and overactivated
tieback forces, which cause the upper
posterior lingual cusps to drop down
and the lower posterior teeth to roll in
lingually
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Since forces are directed from the first molars to anterior hooks on the
archwire, small spaces occasionally open between the first and second
molars.

This can be managed in one of three ways:
A damaged lower premolar or first molar bracket, either from careless use
of biting sticks during bonding or from improper diet, can hinder space
closure
Interference from opposing teeth sometimes restricts lower arch space
closure, particularly if bracket placement was incorrect or a full-unit
Class II molar relationship existed.
Problems During Space Closure
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As spaces close, the distal ends of the archwires will protrude
more and more, and these protruding wires will tend to become
bent gingivally by chewing forces
Certain tissue factors can hinder full space closure with any kind
of mechanics. Soft-tissue build-up can result from poor plaque
control or overly rapid space closure. The alveolar cortical plate,
mesial to the lower first molars, tends to narrow after extraction of
the second premolars, especially in lower-angle situations.
Retained roots, ankylosed teeth, and bone sclerosis are other
possible factors to be considered.

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1. Inadequate leveling, resulting in archwire binding
2. Posterior torque such that torquing and sliding cannot occur
simultaneously
3. Blockage of the distal end of the main archwire by a ligature wire
4. Damaged or crushed brackets that bind the main archwire
5. Soft tissue resistance from build-up in extraction sites
6. Cortical plate resistance from a narrowing of the alveolar bone in
extraction sites
7. Excessive force, causing tipping and binding
8. Interferences from teeth or the opposing arch
9. Insufficient force
Constant attention is required to prevent any of the
following inhibiting factors:
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BI OMECHANI CS OF CANI NE RETRACTI ON ON A
CONTI NUOUS ARCHWI RE
ROBERT J NIKOLAI SEMIN ORTHOD 2001
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Friction is a function of the relative roughness of two surfaces in contact. It is
the force that resists the movement of one surface past another and acts in a
direction opposite the direction of motion.
VARIABLES AFFECTING FRICTIONAL RESISTANCE DURING
TOOTH MOVEMENT
PHYSICAL
ARCHWIRE
LIGATION
BRACKET
ORTHODONTIC APPLIANCE
BIOLOGICAL
SALIVA
PLAQUE
ACQUIRED PELLICLE
CORROSSION
NANDA& KULHBERG
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PHYSICAL

ARCHWIRE
crossectional size/shape
material
surface texture
stiffness
LIGATION
ligature wires
elastomerics
self ligating brackets
BRACKET
material
manufacturing process
slot width and depth
first/second/third order bends
ORTHODONTIC APPLIANCE
interbracket distance
level of bracket slots between adjacent teeth
forces applied for retraction
BIOLOGICAL
Saliva
Plaque
Acquired pellicle
Corrosion

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The segmental arch technique as
developed by Burstone utilizes
T loop space closure springs for
anterior retraction, symmetric
closure or posterior protraction.

The segmental T loop as
described by Burstone is one of
the most versatile space closure
devices available.

One of the main principles of the segmental arch technique is considering
the anterior segment and posterior segment as one large tooth
respectively. The right and left buccal units are connected by a
transpalatal arch forming one big posterior unit.

The basic configuration of the TMA loops consists of a .017X.025 TMA
wire.

CHARLES J BURSTONE AJO-DO 1982
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The rate of decay of the force applied by a spring is called
the load-deflection rate, and it averages 33 Gm. per
millimeter in the Burstones T loop.

The low load-deflection rate is important in this spring,
since it enables the orthodontist to deliver optimal
magnitudes of force.

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High-load deflection springs as vertical loops dissipate force rapidly; hence,
one must activate to very high force levels in order to produce any significant
tooth movement.

Since the load-deflection rate is so high, it would be impossible for a
clinician to activate the loop to produce an optimum magnitude of force. To
deliver 200 Gm. of force, the required activation would be 0.2 mm. Not only
is it practically impossible to activate such a small distance, the force of 200
Gm. would be dissipated rapidly over the remaining 0.2 mm. of activation.

Thus, orthodontists who use high-force load-deflection mechanisms must use
high force values that have undesirable sequelae, which include anchorage
loss, pain, and undermining resorption.

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In contrast, a retraction spring with a low load-deflection rate of 33
Gm. per millimeter allows for the delivery of optimal force levels, since
an error in activation of 1 mm. results in an error of only 33 Gm.
Furthermore, as teeth move distally, the reduction in force is small,
giving greater constancy of force at optimal levels.
Early in treatment, the posterior teeth are joined together to form a
posterior anchorage unit.
The anchorage unit consists of the right and left posterior teeth which
are connected by a buccal stabilizing segment and a transpalatal lingual
arch in the maxillary arch and a low lingual arch in the mandibular arch
During space closure, it is to be considered that there are only two
teeth an anterior tooth comprising the incisors and the canines which
have been connected and a posterior tooth which includes molars and
premolars

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.
The attachment on the posterior tooth (segment) is a 0.018 by 0.025 inch
auxiliary tube on the first molar, and the one on the anterior tooth (segment) is
an auxiliary vertical tube on the canine bracket
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STANDARD FORM OF
.017x.025 TMA LOOPS
WITHOUT PREACTIVATION
BENDS
PREACTIVATION FORM OF THE
SPRING DESIGNED TO
PRODUCE EQUAL AND
OPPOSITE ALPHA AND BETA
MOMENTS WHEN POSITIONED
IN CENTERED POSITION
Stanley Braun,. Sjursen, Jr., Legan, AJO-DO 1995
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To understand its design one must
first understand its passive form of
the spring and then its activation.
In the passive state there are no
moments or forces acting on it. In
its active state it applies a force
system on the teeth,
The activation of a spring requires
forces and moments to engage the
spring in its brackets and tubes.
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Neutral position:
The neutral position in an activated
loop is found by applying the
activation moments and without any
horizontal forces. In other words the
ends are twisted to bring the each
attachment to its horizontal position.
in this position the spring has zero
horizontal force
The horizontal force is got by pulling
the spring open from this position.

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Differential moments are obtained by the principle of off center V bends
which results in unequal moments. the closer the V bend is to the tooth
the higher the moment. the segmented T loops approximated a V bend.
Clinically the spring needs to be positioned at least 1-2mm closer to one
side than another to obtain a moment differential.
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With the introduction of beta-titanium wire (TMA), it has been
possible to simplify the design so that a T loop by itself will have
a relatively low load-deflection rate and a large maximum
springback. The heavier base arch which fits into the auxiliary
tube of the first molar is important, since it allows positive
orientation of the spring and, more significantly, it is capable of
withstanding, without permanent deformation, the higher
moments that are needed for anchorage control. Furthermore, the
use of a heavier base arch tends to increase the moment-to-force
ratio on the anterior teeth, since any bending in the occlusally
positioned part of the spring tends to minimize this ratio.
To aid the clinician in achieving the proper angulation, templates
are used. Rather than to measure the angles, it is more
expeditious to duplicate the shape of the spring from a template.
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The T loop described in
Biomechanics by Nanda is designed
for an activation upto 6 mm.at full
6mm activation tooth movement
occurs in three phases: tipping,
translation and root movement.
For a symmetric centered spring an
initial activation produces a M/F
ratio of 6/1 which results in tipping
movement of the teeth into the
extraction space.
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With 2mm deactivation or spring
activation = 4mm the M/F ratio is
10/1 which results in translation of
the segments towards each other.
With 1-2mm space closure (spring
activation =2mm) the M/F ration
increases to 12/1 and higher
resulting in tooth movement.
Clinically the spring should not be
re activated till all three phases are
complete.

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This demonstrates another method
that may be used for controlling the forces
and moments produced by segmented
0.017 0.025-inch TMA T-loop springs or
closing loops in general.
Previously, the approach described for
achieving differential alpha/beta moments
with segmented T-loops used asymmetric
angulations of the preactivation bends.

However, with this method the
moment differential does not remain
constant with spring activation, i.e., the
moment differential is dependent on both
spring activation and the differences in the
preactivation angulations.

OFF CENTERED T LOOPS
Andrew Kuhlberg, Charles J. Burstone AJO-DO 1998
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Off-center positioning maintains
the constancy of the moment
differential throughout the range of
spring deactivation (space closure).
This concurs with Burstone and
Koenig who demonstrated a
moment differential and vertical
forces with off-center vertical
loops.

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The effect of off-center placement of T-loops with a standard
shape at a standardized activation and interbracket distance.
A centered T-loop produces equal and opposite moments with
negligible vertical forces.
Off-center positioning of a T-loop produces differential
moments. More posterior positioning produces an increased
beta moment. More anterior positioning produces an increased
alpha moment.
A standard shaped T-loop can be used for differential
anchorage requirements by altering the activation and mesial-
distal position of the spring.
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The center position of the spring can be found by:
distance =(interbracket distance activation)/ 2

where distance = length of the anterior and posterior arms (distance from the center
of the T loop to either the anterior or posterior tubes)

interbracket distance=distance between the canine and molar brackets.

Activation= millimeters of activation of the spring
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With the use of a vertical tube at
the canine a 90 degrees gingival
bend at the calculated distance
eases placement and monitoring
throughout space closure
The T loop is places in the
molar auxiliary tube and then
inserted into the canine bracket.
The distal end is pulled back
until it is the desired length
which results in the desired
activation.

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Force systems related to type A, B, and C extraction site closure
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The T loop is positioned closer to the
posterior segment
(1-2 mm off centering) is sufficient .
activation of 4 mm is necessary.
This reduces the horizontal forces
without altering the moment
differential.
The force system acting on the anterior
segment favors tipping. The moment
difference remains as the space closes
and the spring deactivates.
The spring must be re activated when 2
or less mm of activation remains.
MAXIMUM POSTERIOR ANCHORAGE:
(Group A anchorage)

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Because the beta moment is greater
than the anterior moment a vertical
intrusive force acts on the anterior
teeth which can exaggerate the
tipping tendency and steepen the
occlusal plane. Similarly the posterior
occlusal plane can be steeped buy the
extrusive force. Maintaining adequate
horizontal force helps to reduce this
effect. A High pull headgear can also
be used to control the posterior
occlusal plane.
It is likely that root correction will be
required at the end of space closure.

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TPA
FIRST ORDER VIEW OF A T-LOOP SPRING WITH A
V-BEND INCORPORATED FOR ROTATIONAL CONTROL
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This is the most difficult of all
space closures. The increased
alpha moment has a tendency to
deepen the overbite.

The loop must be placed 1-
2mm closer to the anterior teeth.

Care must be taken that the
wire segment achieves full
bracket engagement because play
can reduce the moment
differential.

Space closure with tipping of
the buccal segments will occur.
MAXIMUM ANTERIOR ANCHORAGE :( Group C anchorage)
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the activation must be around 4mm and should be
activated every 2mm.

The major side effects are loss of anchorage and
extrusion of the anteriors.

Class III elastics or protraction headgear may help
in the protration of the upper buccal segments.

For mandibular molars class II elastics may help.

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Segmental T loop space closure principles can also be applied to space
closure on a continuous arch.

the force system is not as well defined a the segmental but careful use of
the alpha and beta moments helps to achieve comparable results especially
for group B and C anchorage cases.

For group A cases high pull headgear is necessary to control tooth position.

T loops one on each side are made using preformed arch wires .017 X .025
TMA
or .016 X .022 Stainless steel arch wire.

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The activations given are for TMA wires and the Stainless
steel wires activation is reduced by half.
The T lops are made 6-7mm tall and 10mm wide and are
positioned distal to the cuspids.
Desired alpha and beta moments are place anterior and
posterior to the T loop vertical legs.
Recommended beta activations for A, B, and C anchorages are
40 degrees, 30 degrees and 20 degrees.

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After the activations are placed the loops should be open
approximately 2mm before placing in the mouth. the wire is inserted into
the molar auxiliary tube and ligated to the anterior teeth. The t loop
bypasses the premolars brackets and is not inserted in them.
For TMA loops the activation can be 3mm distal to the molar tube
which gives it a range of force of 250-300gms.
The patient should be monitored but no further activations are
necessary for 2-3 months. Too frequent reactivation can prevent root
movement and cause excessive tipping
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From the Occlusal view the first order side effect of
rotation of the molars and canines are observed.

Rotation of the molars can be prevented by use of a
transpalatal arch. (rectangular wires only not round wires
TPA)

Control of canine rotation can be achieved by a variety of
techniques.

CONTROL OF THE MECHANICAL SIDE EFFECTS OF SPACE CLOSURE:
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For enmasse retraction a rigid anterior segment can reduce
this tendency. A canine bypass connecting he canines but
bypassing the incisors can also control rotation. thirdly a anti
rotation bend can be incorporated into the spring.

With asymmetric space closure vertical forces may be
produced. these may produce undesired extrusive or intrusive
tooth movements. these vertical forces may also produce
third order side effects.

With group A space closure the third order side effect on the
canine is troublesome the intrusive force causes a buccal
flaring which increases the overjet at the canine and/or
increases the intercanine width.

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CONTROL OF THE SIDE EFFECTS OF SPACE CLOSURE:
Careful monitoring is essential during space closure.
A frequently overlooked side effect of space closure is the first order side
effects.
The mesially directed buccally located force of the molar may lead to the
erroneous supposition that there is anchorage loss.
Distalization is not necessary . A mesially out directed force is all that is
needed to regain the original molar position.
A transpalatal arch provides an excellent mean to prevent this or actively
corrects it.

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CORRECTION OF THE SIDE EFFECTS

Tipping of the anterior and posterior teeth into the extraction space
Increase the alpha and beta moments

Flaring of the anterior teeth
Reduce the alpha moment or increase the distal activation

Mesial in rotation of the buccal segments
Mesial out rotation of the palatal arch, archwire or lingual arch

Excessive lingual tipping of the anterior teeth
Increase the alpha moment

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Rotating moments caused by buccal forces during extraction
site closure.

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The OPUS loop was designed to deliver an inherent M/F ratio
sufficient for enmasse space closure via translation of teeth of
average dimensions with no bone loss.
Because its inherent M/F ratio is high enough no preactivation
bends is needed before insertion
The neutral position is the passive position of the spring as it sits
before insertion.
Simple cinch back activations can take care of the tooth movement
thresholds to meet anchorage objectives.

Raymond E Siatkowski
Semin Orthod 2001
AJO-DO 1997
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No closing loop design previously has been capable of delivering at
constant M/F of 8.0 to 9.1 mm most having inherent M/F of 4-5 mm
or less.
To achieve net translation, orthodontists have had to add residual
moments to the closing loop arch wire with
angulation bends (gable bends) anterior and posterior to the loop,
a posterior gable bend and angulations within the loop,
or a posterior gable bend and anterior wire-bracket twist (anterior
root torque).

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Adding these residual moments has several disadvantages:

1. The teeth must cycle through controlled tipping to translation to
root movement to achieve net translation (lower Young's Modulus
materials go through fewer of these cycles for a given distance of
space closure).
2. The correct residual moments are difficult to achieve precisely in
linear materials.
3. The resulting ever-changing PDL stress distributions may not yield
the most rapid, least traumatic method of space closure.

I f a closing loop design capable of achieving inherent, constant
M/F of 8.0 to 9.1 mm without residual moments were available, en
masse space closure with uniform PDL stress distributions could be
achieved. Such a mechanism would be less demanding of operator
skill to apply clinically and might provide more rapid tooth
movement with less chance of traumatic side effects

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The opus loop achieves a M/F ratio of 8-9.1mm without addition of
activation bends in the loop or archwire itself.
Therefore its neutral position is the same as the inactivated position
before it was tied into the brackets.
Having the loops neutral position accurately allows known forces
systems to be applied to the teeth via simple cinch back activations.
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Thank you

For more details please visit

Space Closure3 / Orthodontic Courses by Indian Dental Academy

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