Professor (W3) and Medical Director Clinic for Orthodontics
Center for Dental and Maxillofacial Surgery University Hospital of Ulm
Senior physician – Specialist in Orthodontics
Clinic for Orthodontics
Center for Dental and Maxillofacial Surgery
University Hospital of Ulm
Experimental Biomechanical Studies on the Intrusion and Extrusion of Incisors with Aligners
Objective: Because of the tooth morphology, extrusion or intrusion of the incisors with aligners is one of the more demanding movements. This lecture features a biomechanical comparison with the corresponding techniques of multi-bracket therapy as well as the biomechanical evaluation of pseudo-segmented concepts based on aligners.
Forces generated in vitro for both movements and the optimal modifications to optimise these movements.
Materials and methods: In-vitro measurements in our biomechanics laboratory included the extrusion of a single maxillary central incisor separated from a Frasaco® model. Either rectangular or tetrahedral attachment geometries with widths of 3–6 mm and inclinations of 20°, 25°, and 30° in relation to the crown axis were attached to the labial crown surface of the measuring tooth. For comparison, measurements were also carried out without attachments. The extrusive movements were investigated using 0.5-mm-thick PET-G aligners (CA®, Scheu-Dental) with different set-up increments.
For the simultaneous intrusion of teeth 11 and 21, retention attachments were bonded to the posterior teeth according to a pseudo-segmented approach, whereby the attachments extended to different teeth of the anchoring segment (teeth 6-3, 6-4, and 6-5 or 6 only). 0.5-mm- and 0.75-mm-thick aligners as well as single-layer PET-G aligners (CA®, Scheu-Dental) and multi-layer aligners (CA-Pro®, Scheu Dental) were used.
Results: With a set-up step of 0.2 mm, an attachment width of 4 mm, and an active surface inclined by 30°, the extrusive forces were 0.6 N (IQR 0.8) for the rectangular geometry and 0.1 N (IQR 0.4) for the tetrahedral geometry. Regardless of the attachment type or set-up step, the attachments with an inclination of 20° showed only minimal extrusive forces.
With simulated intrusion of teeth 11 + 21 and retention attachments on both 6s and 5s, forces of 7.4 N (IQR 1.2) were measured for the 0.75 mm PET-G aligners with a set-up step of 0.5 mm and forces of 4.7 N (IQR 0.4) for the CA-Pro aligners.
Conclusion: During the extrusion of maxillary incisors, the extrusive forces generated by the rectangular attachment geometry (with the same inclination) were more than twice as high as those generated by the tetrahedral geometry. Extrusion attachments should have an active surface with an inclination of at least 25° to the crown axis in order to generate adequate force levels. In contrast, aligners with attachments on the 6s and 5s can generate effective intrusive forces. This configuration minimises the reciprocal extrusive forces on the canines and reduces distal tipping of the six-year molars because of the blocking of the 5s and 6s.
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