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Continuous arch and rectangular loops for the correction of consistent and
inconsistent load systems in extruded and tipped maxillary second molars

Article  in  American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American
Board of Orthodontics · March 2018
DOI: 10.1016/[Link].2017.07.021

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ORIGINAL ARTICLE

Continuous arch and rectangular loops

for the correction of consistent and
inconsistent load systems in extruded
and tipped maxillary second molars
Ricardo Lima Shintcovsk,a Lidia Parsekian Martins,b Luegya Knop Shintcovsk,c Orlando Motohiro Tanaka,d
and Renato Parsekian Martinse
Araraquara, S~ao Paulo, Salvador, Bahia, and Curitiba, Paran!
a, Brazil

Introduction: The aim of this research was to compare the load systems produced by rectangular loops and
continuous arches for the correction of extruded second molars with a mesial inclination (inconsistent system)
and a distal inclination (consistent system). Methods: The maxillary first molar of an acrylic model of a patient, with
passive brackets and tubes bonded, was connected to a 3-dimensional load cell of an orthodontic force tester, and
the second molar was replaced by its respective tube bonded to a second load cell. The second molar tube was
moved 2.5 mm occlusally and tipped 20! mesially and distally, creating an inconsistent force system and a
consistent force system. For each situation, ten 0.017 3 0.025-in beta-titanium, 8 3 10-mm rectangular loops
were compared with 10 0.014-in nickel-titanium continuous arches. The vertical forces—F(z)—and tipping
moments—M(x)—were compared using 4 t tests, at 5%. Results: In the inconsistent group, the rectangular
loop produced a larger M(x) in both molars: 2.11 [Link] in the second molar compared with the "0.15 [Link] of
the continuous arches. On the first molar, the rectangular loops produced "5.58 [Link] against "2.08 [Link] pro-
duced by the continuous arches. The F(z) values produced at the second molar with each system were similar,
whereas on the first molar they were different; the rectangular loops produced 0.41N, and continuous arches pro-
duced 0.53N. In the consistent group, the rectangular loops produced smaller M(x) values at the second molar
("3.06 [Link]) than did the continuous arch ("4.25 [Link]) (P 5 0.01), as well as a smaller F(z) value ("0.52
vs "0.92 N, respectively). At the first molar, the rectangular loops produced smaller M(x) values ("2.32 [Link])
than did the continuous arch ("4.18 [Link]), as well as a smaller F(z) value (0.59 vs 1.10 N). Conclusions: In
the inconsistent group, only the rectangular loop produced a system of force that could correct the
second molar. In the consistent system, both group mechanics produced a system of force compatible with the
correction of the second molar, but the continuous wire produced larger moments. Both groups showed a tendency
for mesial crown tipping of the first molar. (Am J Orthod Dentofacial Orthop 2018;153:396-404)

M
axillary permanent second molars frequently
a
Private Practice, Salvador, Bahia, Brazil. extrude when their antagonist teeth are lost
b
Department of Pediatrics and Orthodontics, Faculdade de Odontologia de Ara- or damaged, and their correction with contin-
raquara, Universidade Estadual Paulista, Araraquara, S~ao Paulo, Brazil. uous arch mechanics may not be adequate depending
c
Private Practice, Salvador, Bahia, Brazil.
d
Graduate dentistry program in orthodontics, Pontif!ıcia Universidade Cat!olica do on the position of the brackets and tubes.1 When the
Paran!a, Curitiba, Paran!a, Brazil. force system (or load system) produced by a continuous
e
Private practice, Araraquara, S~ao Paulo, Brazil; Program of Orthodontics, Facul- arch is incompatible with the direction of the force or
dade de Odontologia de Araraquara, Universidade Estadual Paulista, Araraquara,
S~ao Paulo, Brazil. moment required for tooth correction, it is called an
All authors have completed and submitted the ICMJE Form for Disclosure of Po- inconsistent load system, and a different strategy
tential Conflicts of Interest, and none were reported. from the conventional continuous arch is required.2
Address correspondence to: Renato Parsekian Martins, Rua Carlos Gomes, 2158,
14801320, Araraquara, S~ao Paulo, Brazil; e-mail, dr_renatopmartins@hotmail. Rectangular loops,3,4 temporary anchorage devices,5
com. or surgery6 may prove useful for correcting these ortho-
Submitted, February 2017; revised and accepted, July 2017. dontic problems when the load system is inconsistent.
0889-5406/$36.00
! 2017 by the American Association of Orthodontists. All rights reserved. However, there are situations when the direction of
[Link] forces and moments produced by a straight wire match
396

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Shintcovsk et al 397

Fig 1. A, A maxillary second molar extruded with distal-crown tipping. Upon inserting a straight wire
into the second molar tube (black line) and placing a force to engage it to the other brackets (blue
arrow), an intrusive (desired) force with a mesial-crown tipping tendency (desired) is expected to occur.
Because the estimated load system matches the one desired to correct the tooth, the load system is
called consistent. B, A maxillary second molar extruded with mesial-crown tipping. Upon inserting a
continuous arch into the second molar tube (black line) and placing a force to engage it to the other
brackets (blue arrow), an extrusive force (unwanted) with a distal-crown tipping tendency (desired)
is expected to occur. Since the estimated load system does not match the desired one to correct the
second molar, the load system is termed inconsistent.

the ones desired for correction and are said to produce to any patient model to investigate different mechanics
consistent load systems.2 In those situations, the cor- for the solution of a clinical problem.8-17
rect bonding of the appliance and any leveling wire Therefore, the aim of this study was to compare the
should be enough to correct the orthodontic problem, 3-dimensional load system produced by a rectangular
at least in theory. loop and a continuous arch in 2 situations of an
When maxillary permanent second molars extrude, extruded maxillary permanent second molar, one with
they may tip either crown mesially or crown distally mesial-crown tipping and one with distal-crown tipping
due to their eruption pattern or dental migration. De- (inconsistent and consistent systems of forces, res-
pending on their position, the load system produced pectively), to determine which approach would be the
by a continuous arch may be estimated as consistent most appropriate for each orthodontic problem.
or inconsistent (Fig 1) according to a well-known or-
thodontic rationale.2 Therefore, the most appropriate MATERIAL AND METHODS
solution for these 2 problems of mesial or distal tipping A maxillary model of a patient was poured in acrylic
with extrusion might not be the same. When a resin and had 0.018-in MBT prescription brackets and
second molar is extruded and tipped crown mesially, tubes (Opal Orthodontics, Sandy, Utah) passively bonded
a rectangular loop is thought to be a more suitable so- with epoxy glue (JB Weld, Sulfur Springs, Tex), from
lution than a continuous arch, which may not be able to second molar to second molar, using a 0.017 3 0.025-in
produce the load system required for the correction. On stainless steel wire guide.
the other hand, when an extruded second molar is tip- The model was secured to an orthodontic force tester
ped crown distally and the load system is consistent, a custom-made table. One load cell (Multi-axis force/tor-
continuous arch may correct the second molar in a que Nano17; ATI Industrial Automation, Apex, NC) was
simpler manner. attached to the left first molar (later released from the
However, these 2 strategies have never been objec- model), and the other one was connected to an articu-
tively compared to determine whether one would be bet- lated device that replaced the left second molar. The
ter than the other for consistent or inconsistent load articulated device had a second molar tube bonded to
systems in a specific clinical situation. A reliable way to it and was placed in the same position as the left
compare the system of forces required for a clinical second molar, after it was removed from the model
situation is with an orthodontic force tester,7 which is (Fig 2, A). The distance between both molar tubes was
an orthodontic force measurement system composed 7 mm, the same intertube distance before the removal
of 2 three-dimensional load cells that can be adapted of the second molar (Fig 2, B).

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398 Shintcovsk et al

Fig 2. A, A maxillary acrylic model from a patient fixed to the orthodontic force tester. A load cell is
attached to the left first molar, which will be separated from the model, whereas the second load cell
is fixed to an accessory placed in the position of the second molar. A 0.017 3 0.025-in passive stainless
steel wire was used as a guide to position the brackets and tubes. B, The custom-made accessory
allowed a new second molar tube to be placed exactly in the same position as the original
second molar tube. Its anglulation could also be modified. (Images were inverted vertically and horizon-
tally for clarity.)

The second molar tube was moved 2.5 mm occlusally model using the measurements of forces and moments
from its passive position using a precision rod and a from the orthodontic force tester software. A second
digital dial (Mitutoyo, Aurora, Ill) adapted to the ortho- template for the preactivation of the loops was also
dontic force tester. The articulated device allowed the made in the Loop software as follows. First, the
tube to be tipped 20! in mesial and distal directions, second molar bracket was repositioned virtually in the
enabling data from these 2 angulations to be obtained. Loop software to its desired final position: ie, intruded
Before the data were collected from each situation, tube and with its tipping corrected (a 2! overcorrection was
angulations were assessed by Screen Protractor software needed to ensure a parallel orientation of the wire angle
(Iconico, New York, NY) using a digital image of the of entry to the first molar tube). The loop was then acti-
setup. The orthodontic force tester custom software vated, and the resulting active shape was frozen by an
(Department of Mechanical Engineering, Perdue Uni- option of the Loop software (Fig 3, B), saved, and printed
versity, Indianapolis, Ind) allowed calibration of the in real size.18
load cells, which transferred the origins of the mea- The passive loops were preactivated by bends and
surements from the center of the load cell to the center were stress relieved by trial activation as many times as
of each tube, regardless of the rotation or position of the needed, until the new preactivated shape matched the
load cells. The orientation of the reference grid for mea- printed preactivation template. The center of the box
surements was perpendicular (x- and z-axes) and parallel of the loop was marked with a felt-tip pen to allow its
(y-axis) to the tubes. position to be centralized with the second molar tube.
The extruded second molar tube with a 20! mesial- The loops were inserted into the auxiliary tube of the first
crown angulation was evaluated first, and the rectan- molar and into the second molar tube (Fig 4). Each loop
gular loop and the continuous arch mechanisms were was tested only once, and the orthodontic force tester
compared. The load system was considered inconsistent software recorded the vertical forces (Fz) and tipping
in this group. A scaled digital image allowed the design moments (Mx) of the second and first molars. Also, ten
of a template in the Loop Software (dHAL Orthodontic 0.014-in superelastic nickel-titanium wires (Highland
Software, Athens, Greece) for the bending of ten Metals, Franklin, Ind) were tied to all brackets and tubes
8 3 10-mm rectangular passive loops from of the model with elastic ligatures (GAC International,
0.017 3 0.025-in beta-titanium wires (TMA; Ormco, Islandia, NY). (Fig 5, A and B) to register the load system
Glendora, Calif). The loop was designed with its box produced by continuous arch mechanics. The entire sys-
centralized to the tube of the second molar (Fig 3, A). tem was inserted into a box made of expanded rigid
The passivity of the loops was verified in the physical polystyrene plastic with an external hot-air source

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Shintcovsk et al 399

Fig 3. Loop Software images: A, the design of the passive rectangular loop. The dashed line shows the
alignment of the center of the tube with the loop, and the arrow shows where a felt-tip pen mark was
made on all loops. B, By placing the digital second molar tube in its desired corrected position (with
a 2! overcorrection) activating the loop and freezing its new shape, a preactivation shape was de-
signed. Both images were printed in a scale to serve as templates. (The images were inverted vertically
and horizontally.)

controlled by a digital thermometer maintaining the The same 10 nickel-titanium wires from the same batch
temperature at 37! C 6 1! C. used in the inconsistent situation were side-flipped and
A second clinical setup was used to compare the same similarly tied to all brackets and tubes of the model to
mechanics by altering the 20! of mesial-crown tipping collect the F(z) and M(x) values produced by the contin-
to distal-crown tipping, maintaining the vertical posi- uous arch (Fig 5, D)
tion of the tube. This second situation was assumed to The data collected from the 2 groups were normally
produce a consistent load system. Ten passive rectan- distributed and were compared using 4 independent t tests,
gular loops in this new tube position were hand-bent withasignificancelevelof5%,todetectdifferencesbetween
with the same protocol as in the inconsistent situation the F(z) and M(x) produced by the rectangular loops and
(Fig 5, C) that included the design of 2 new indivi- continuous arch mechanics for the first and second molars
dualized templates (for passive shape and preactivation). in each situation, inconsistent and consistent.

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400 Shintcovsk et al

Fig 4. A, Preactivated rectangular loop; B, activated rectangular loop engaged to the second molar
tube. (The images were inverted vertically and horizontally.)

Fig 5. A, Rectangular loop engaged in the inconsistent group; B, 0.014-in nickel-titanium wire engaged
in the inconsistent group; C, rectangular loop engaged in the consistent group; D, 0.014-in nickel-
titanium wire engaged in the consistent group. (The images were inverted vertically and horizontally.)

RESULTS different for the first molars (P \0.001), where the loops
In the inconsistent simulation, the M(x) values pro- produced 0.41 N against 0.53 N produced by the contin-
duced were different (P \0.001). In the second molar uous arch (Table I).
tube, the loops produced an M(x) value of 2.11 [Link], In the consistent situation, the loops produced
whereas the continuous arch produced "0.15 [Link] smaller M(x) values ("3.06 [Link]) than the continuous
(Table I). In the first molar tube, the loops produced arch ("4.25 [Link]) (Table II) in the second molars as
–5.58 [Link], and the continuous arch produced well as smaller F(z) values ("0.52 and "0.92 N, respec-
"2.08 [Link]. No differences were found for the F(z) pro- tively). In the first molars, the loops also produced
duced in the second molars (P 5 0.118), but they were smaller M(x) ("2.32 [Link]) and F(z) (0.59 N) values

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Shintcovsk et al 401

Table I. Average values of vertical force F(z) and

tipping moments M(x), with standard deviations in
parenthesis, measured at the tubes of the second
and first molars in the inconsistent force system
(extruded second molar with mesial-crown tipping)
Group Mx ([Link]) Fz (N)
Second molar Rectangular loop 2.11 (0.45) "0.41 (0.11)
0.014-in "0.15 (0.06) "0.35 (0.02)
nickel-titanium wire
Significance P \0.001 P 5 0.118
Fig 6. Inconsistent load system tested in this investiga-
First molar Rectangular loop "5.58 (1.34) 0.41 (0.11) tion. The intersection of the 2 passive wires points to a
0.014-in "2.08 (0.55) 0.53 (0.01) larger moment acting on the first molar tube because it
nickel-titanium wire is closer to the intersection of the wires. Thus, a passive
Significance P \0.001 P 5 0.007 wire inserted in the first molar tube should be used to es-
Positive values depict extrusive forces and crown-distal tipping ten- timate the direction of the vertical forces of equilibrium,
dency. The values given in Newtons and [Link] can be con- rather than a wire inserted into the second molar tube.
verted to gram-force and [Link] by multiplying them
by 102.
intrusive force and crown-mesial tipping. This can be ex-
plained by the relative position between the tubes,1 where
the moment ratio (0.07) between the second molar
Table II. Average values of vertical force F(z) and
("0.15 Nmm) and first molar ("2.08 Nmm) points closely
tipping moments M(x), with standard deviations in
to Class IV geometry (when the ratio would be 0) (Table I).
parenthesis, measured at the tubes of the second
An incorrect estimation of the direction of vertical forces
and first molars in the consistent force system
(Fig 1, B) occurred because the wrong passive wire was
(extruded second molar with distal crown tipping)
used for that estimation. An appropriate estimation of
Group Mx ([Link]) Fz (N) the vertical forces produced between 2 tubes can be easily
Second molars Rectangular loop "3.06 (1.25) "0.52 (0.09) done by inserting a piece of straight wire into each tube
0.014-in "4.25 (0.16) "0.92 (0.03) and observing where those wires intersect (Fig 6). The
nickel-titanium wire tube closest to the intersection will be the one subjected
Significance P 5 0.015 P \0.001
First molars Rectangular loop "2.32 (1.41) 0.59 (0.10)
to the greater moment and will dictate the direction of
0.014-in "4.18 (0.39) 1.10 (0.03) the equilibrium forces in each tube.19 The estimation of
nickel-titanium wire vertical forces (Fig 1, A) should have been done with
Significance P 5 0.002 P \0.001 the wire inserted into the first molar tube, rather than in-
Positive values depict extrusive forces and crown-distal tipping ten- serted into the second molar, because it was closer to the
dency. The values given in Newtons and [Link] can be con- intersection of the 2 wires (Fig 6).
verted to gram-force and [Link] by multiplying them The rectangular loop produced a different load system
by 102.
than the continuous arch in the inconsistent situation.
The loop produced an intrusive force and a distal-crown
compared with the continuous arch mechanics tipping tendency, which was required for the correction
("4.18 [Link] and 1.10 N). of the second molar. It appears that the rectangular loop
is the only alternative to correct the problem compared
DISCUSSION with the continuous arch. Other loops, such as the L-
When the maxillary second molar was tipped crown- loop20-22 or the T- loop,21,22 would produce similar load
mesially, the load system (Fz and Mx) produced by the systems to the continuous arch and would not correct
continuous arch was inconsistent because it produced the second molar. Those loops cannot disassociate the
an undesired mesial-crown tipping tendency in the intensity and direction of the moment produced from its
second molar tube along with the desired intrusive force. vertical activation, which dictates them. The rectangular
Therefore, a continuous nickel-titanium wire would not loop, due to its design, has the ability to disassociate the
correct the second molar. Although the load system was direction of moments produced from the direction of
expected to be inconsistent, the predicted directions of vertical activation, as has already been demonstrated in
the forces and moments were incorrect. In the nonpreactivated rectangular loops using a 2-bracket sys-
second molar tube, an extrusive force and a distal crown tem.22-24 Moreover, the possibility of individually
tipping tendency were expected (Fig 1, B) rather than an preactivating the loops, as done in this study, may allow

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402 Shintcovsk et al

shorter loops to be used when a patient has a shallow

vestibule.
The load system that allows the correction of the
second molar given by the rectangular loop does not
come without the side effect of a mesial inclination ten-
dency on the maxillary first molar tube. This is because
the positive moment that would correct the tipping of
the second molar needs to be counterbalanced. That holds
true even in the load system given by the continuous arch, Fig 7. Image of continuous mechanics tested. The black
line shows the estimated deflection of the archwire if it is
which will not correct the second molar. The orthodontic
not tied to the brackets; the white line shows the deflection
literature has extensively explored the principles of equi-
(exaggerated for comprehension) of the wire when it is
librium in situations between 2 brackets, similar to the tied. This deflection is too small to be perceived by the
one demonstrated here, with unleveled brackets and a naked eye, but it is enough to produce the forces
straight wire1,25 or with active bends in leveled described in this investigation.
brackets.26,27 The use of the loop without proper control
of the moments produced in the first molar tube is not
advisable because of the side effects that may result interproximally between both molar tubes in the consistent
from this movement, such as an undesired change of situation compared with the inconsistent situation (Fig 5,
the anteroposterior relationship. Therefore, the use of a B and D), which produced larger forces and moments.
transpalatal bar for the distribution of this moment to This effect can be explained by the relative angular posi-
more teeth,4 or even Class II elastics with a cursor, applying tion, or geometry, between the tubes as has already been
a distal force directly to the first molar, is recommended. In shown: equilibrium of different angular positions between
this latter example, even a light force (1 N, which is 2 brackets, even when they are leveled, can produce
approximately 102 gf) placed below the molars' axis of different vertical forces.1 Different from the nearly Class
resistance (about 6-8 mm) could produce a crown distal IV geometry produced by the continuous arch in the incon-
moment high enough (6-8 [Link]) to counteract the sistent system (Table I), the ratio between the moments
crown mesial tipping moment produced by the loop. produced (1.02) by the second and first molars (Table II)
In the consistent situation, where the extruded maxil- was close to Class I geometry in the latter situation, with
lary second molar had distal-crown tipping, the loop and greater vertical forces to equilibrate the system.
the continuous arch operated similarly. Both systems Another unexpected result was the difference be-
showed a load system that could produce the desired tween the vertical forces produced in both molars
correction: ie, an intrusive force with a crown-mesial ("0.35 and 0.53 N) when the continuous arch was
tipping tendency. This result was not unexpected, for it tested, something that did not occur with the loops.
is well known in orthodontics that consistent load systems Although this may seem to be a load cell error, because
only require a resilient wire to produce the required forces of the same intensity were expected, it can be ex-
result.2 However, the larger moment produced by the plained by the wire deflection. The angle of entry of the
continuous arch in the second molar tube was unex- wire in the mesial extremity of the first molar tube pro-
pected. This may allow greater efficiency for the correc- duces a supplemental extrusive force on both molars,
tion of the second molar in the consistent situation, reducing the net intrusive force on the second molar,
possibly resulting in a faster correction of its tipping, in while increasing it on the first (Fig 7). The classic articles
a simpler and less laborious way. Like the inconsistent that dealt with continuous arch mechanics only used a
load system, moments of high magnitude were recorded 2-bracket system1,26,27 and did not detect this effect.
on the first molar tube, producing a mesial-crown tipping When full multibracket appliances were investigated,
tendency, in both mechanics. As mentioned, this high vertical forces in the opposite direction to what was
tipping moment of the first molars needs to be controlled expected could be detected on brackets far from the
to prevent side effects. tooth to be corrected, as we observed.28-30
The intrusive forces produced in the inconsistent and The continuous arch produced greater vertical forces.
consistent groups were different, except for those acting They depend on 2 factors: the relative position of the
on the second molar in the inconsistent group. In general, tubes1 and the modulus of elasticity of the wire used,31
the vertical forces produced in the consistent group were leaving the orthodontist with few options to adjust the
greater, even though the second molar tube was displaced force, if desired. On the rectangular loop, however, the
the same (2.5 mm) in both situations. This possibly force can be changed by adjusting the vertical activation
occurred because of the larger deflection of the wire regardless of the moments produced. Its disassociation

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Shintcovsk et al 403

ability enables the moments produced to be varied inde- REFERENCES

pendently of vertical activation, and one can be increased 1. Burstone CJ, Koenig HA. Force systems from an ideal arch. Am J
without proportionally influencing the other; this is Orthod 1974;65:270-89.
different from the continuous arch, where the moment 2. Marcotte MR. Biomechanics in orthodontics. Philadelphia: BC
and force are produced proportionally.22 Decker; 1990.
3. Cacciafesta V, Melsen B. The rectangular loop: biomechanical
In this simulation, we used 0.018-in slot brackets for
principles and clinical applications in three dimensional control
the evaluation of both mechanics, a 0.014-in nickel- of single-tooth discrepancies. Prog Orthod 1999;1:23-36.
titanium wire, and a 0.017 3 0.025-in beta-titanium 4. Crismani AG, Freudenthaler JW, Bernhart T, Hofshneider UB,
rectangular loop. Although the continuous archwire Kole EG. Rectangular loops in inconsistent force systems. J Orofac
might be the first choice of initial wire for most ortho- Orthop 2002;63:105-12.
5. Chang YJ, Lee HS, Chun YS. Microscrew anchorage for molar intru-
dontists, not all use 0.018-in brackets. Whereas most
sion. J Clin Orthod 2004;38:325-30.
auxiliary tubes in the first molar tubes are 0.018 in, 6. Schoeman R, Subramanian L. The use of orthognathic surgery to
even if the main slot is 0.022 in, some clinicians might facilitate implant placement: a case report. Int J Oral Maxillofac
use 0.022-in tubes in the second molars. We believe Implants 1996;11:682-4.
that this will not change the load system in both me- 7. Chen J. Apparatus and method for measuring orthodontic force
applied by an orthodontic appliance. United States patent number
chanics because the calculated second order clearances
6.120.287.
will be only slightly larger (1.76! ) on the second molar 8. Yadav S, Chen J, Upadhyay M, Roberts E, Nanda R. Three-dimen-
tube, due to its length (about 3.3 mm).32 sional quantification of the force system involved in a palatally
The results of this study describe the immediate load impacted canine using a cantilever spring design. Orthodontics
system produced by 2 mechanics, as correction, or wors- (Chic.) 2012;13:22-33.
9. Viecilli RF, Chen J, Katona TR, Roberts WE. Force system generated
ening, of the malpositioned teeth occurs, the geometry be-
by an adjustable molar root movement mechanism. Am J Orthod
tween the brackets alters, changing the whole load system. Dentofacial Orthop 2009;135:165-73.
Whereas finite element models have been used to estimate 10. Yadav S, Chen J, Upadhyay M, Jiang F, Roberts WE. Comparison of
changes of the load system that will occur with tooth the force systems of 3 appliances on palatally impacted canines.
movement, it is still unknown whether those estimates Am J Orthod Dentofacial Orthop 2011;139:206-13.
11. Gajda S, Chen J. Comparison of three-dimensional orthodontic
will match the biologic responses; they should be further
load systems of different commercial archwires for space closure.
studied.33-36 Nonetheless, in that regard, rectangular Angle Orthod 2012;82:333-9.
loops allow individual reactivation and adjustment to the 12. Mittal N, Xia Z, Chen J, Stewart KT, Liu SS. Three-dimensional
new position of the teeth as the patient returns for quantification of pretorqued nickel-titanium wires in edgewise
adjustments, whereas in the continuous arch, the load and prescription brackets. Angle Orthod 2013;83:484-90.
13. Xia Z, Chen J, Jiangc F, Li S, Viecilli RF, Liu SY. Load system of
system will still be dictated by the brackets and out of
segmental T-loops for canine retraction. Am J Orthod Dentofacial
the orthodontist's control. Orthop 2013;144:548-56.
14. Almeida L, Ribeiro A, Parsekian Martins R, Viecilli R, Parsekian
Martins L. Nickel titanium T-loop wire dimensions for en masse
CONCLUSIONS retraction. Angle Orthod 2016;86:810-7.
15. Katona TR, Isikbay SC, Chen J. Effects of first- and second-order
According to the 2 simulations performed in this inves-
gable bends on the orthodontic load systems produced by T-
tigation, when the second molar tube was extruded 2.5 mm loop archwires. Angle Orthod 2014;84:350-7.
and tipped crown-mesially or distally by 20! creating, 16. Kroczek C, Kula K, Stewart K, Baldwin J, Fu T, Chen J. Comparison
respectively, an inconsistent or a consistent load system: of the orthodontic load systems created with elastomeric power
chain to close extraction spaces on different rectangular archwires.
1. In the inconsistent system, the rectangular loop pro- Am J Orthod Dentofacial Orthop 2012;141:262-8.
duced a load system compatible with the correction 17. Chen J, Isikbay SC, Brizendine EJ. Quantification of three-
of the second molar, producing intrusion and a dimensional orthodontic force systems of T-loop archwires. Angle
Orthod 2010;80:566-70.
distal-crown tipping tendency, whereas the contin-
18. Halazonetis DJ. Understanding orthodontic loop preactivation.
uous arch could not. Am J Orthod Dentofacial Orthop 1998;113:237-41.
2. In the consistent system, both mechanics produced 19. Isaacson RJ, Lindauer SJ, Davidovitch M. The ground ruler for arch
a load system compatible with the correction wire design. Semin Orthod 1995;1:3-11.
required, but the continuous arch produced a larger 20. Raboud D, Faulkner G, Lipsett B, Haberstock D. Three-dimensional
force systems from vertically activated orthodontic loops. Am J Or-
tipping moment favoring the correction.
thod Dentofacial Orthop 2001;119:21-9.
3. In both load systems, the mesial-crown tipping ten- 21. Menghi C, Planert J, Melsen B. 3-D experimental identification of
dency on the first molar tube was detected as a force systems from orthodontic loops activated for first order cor-
side effect. rections. Angle Orthod 1999;69:49-57.

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 404 Shintcovsk et al

22. Vanderby R Jr, Burstone CJ, Solonche DJ, Ratches JA. Experimen- 30. Fok J, Toogood RW, Badawi H, Carey JP, Major PW. Analysis
tally determined force systems from vertically activated orthodon- of maxillary arch force/couple systems for a simulated high
tic loops. Angle Orthod 1977;47:272-9. canine malocclusion: part 2. Elastic ligation. Angle Orthod
23. DeFranco JC, Koenig HA, Burstone CJ. Three-dimensional large 2011;81:960-5.
displacement analysis of orthodontic appliances. J Biomech 31. Burstone CJ. Variable-modulus orthodontics. Am J Orthod 1981;
1976;9:793-801. 80:1-16.
24. Koenig HA, Vanderby R, Solonche DJ, Burstone CJ. Force systems 32. Thurow RC. Edgewise orthodontics. Islandia, NY: GAC Interna-
from orthodontic appliances: an analytical and experimental com- tional; 2001.
parison. J Biomech Eng 1980;102:294-300. 33. Kojima Y, Fukui H. Numerical simulations of canine retraction with
25. Lindauer SJ, Isaacson RJ, Britto D. Three dimensional force sys- T-loop springs based on the updated moment-to-force ratio. Eur J
tems from activated orthodontic appliances. Semin Orthod 2001; Orthod 2012;34:10-8.
7:207-14. 34. Roberts WE, Viecilli RF, Chang C, Katona TR, Paydar NH. Biology
26. Ronay F, Kleinert W, Melsen B, Burstone CJ. Force system devel- of biomechanics: finite element analysis of a statically determinate
oped by V bends in an elastic orthodontic wire. Am J Orthod Den- system to rotate the occlusal plane for correction of a skeletal Class
tofacial Orthop 1989;96:295-301. III open-bite malocclusion. Am J Orthod Dentofacial Orthop 2015;
27. Burstone CJ, Koenig HA. Creative wire bending—the force sys- 148:943-55.
tem from step and V bends. Am J Orthod Dentofacial Orthop 35. Kojima Y, Fukui H. A finite element simulation of nickel-titanium
1988;93:59-67. movement, orthodontic movement, and the centre of resistance of
28. Major PW, Toogood RW, Badawi HM, Carey JP, Seru S. Effect of the maxillary teeth connected with an archwire. Eur J Orthod
wire size on maxillary arch force/couple systems for a simulated 2014;36:255-61.
high canine malocclusion. J Orthod 2014;41:285-91. 36. Kojima Y, Kawamura J, Fukui H. Finite element analysis of the ef-
29. Fok J, Toogood RW, Badawi H, Carey JP, Major PW. Analysis of fect of force directions on tooth movement in extraction space
maxillary arch force/couple systems for a simulated high canine closure with miniscrew sliding mechanics. Am J Orthod Dentofa-
malocclusion: part 1. Passive ligation. Angle Orthod 2011;81:953-9. cial Orthop 2012;142:501-8.

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