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143]

Review Article

Forces generated with the use of intrusion arches in

orthodontics – A review of literature
ABSTRACT
In routine orthodontic practice, Class II malocclusions are the most customary treated cases. The cardinal objective and radical challenge of
Class II treatment is the correction of deep overbite. Correction of deep overbite should be carried out prior to retraction of teeth. Various treatment
protocols are used for correction of deep overbite, in which intrusion arches are more elementary to use for correcting deep bite by true intrusion
or by pseudo‑intrusion. This review paper contains various intrusion arches and related studies along with the key functions which are sketched
out in the form of table. Individual forces produced by intrusion arches on teeth for all tooth movements are also categorized and tabulated.

Keywords: Deep overbite, extrusion, incisors, intrusion, utility arch

INTRODUCTION around its centroid produces pseudo‑intrusion which is

helpful in correction of Class II Division 2.[1] Intrusion of
Deep overbite is one of the most prevalent malocclusions seen both anterior and posterior teeth are possible
in children as well as in adults.[1] It is one of the paramount 2. Extrusion of teeth – The correction of deep overbite
challenges of Class II treatment, which is characterized by is produced by the extrusion of posterior teeth, which
the vertical overlap in the anterior region.[2,3] Deep overbite is is seen to be the greatest success in patients with
recurrent in adult patients either by their growth pattern or by mandibular growth[2]
dental‑related factors, such as loss of the posterior teeth.[4,5] 3. Combination – The correction of deep overbite is also
In most instances, the correction of overbite is produced by by the combination of the above two.
the extrusion of posterior teeth as with the greatest success
seen in growing patients.[2] Orthodontic mechanics to treat
deep overbite can be performed by maxillary and mandibular
tooth extrusion or intrusion, maxillary clockwise rotation, Stuti Raj, Pratik Chandra1, Ragni Tandon1,
Nikhil Asok2, Abhimanyu Vikram Singh3
and curve of spee flattening,[4,5] however, intrusion arch is
Senior Lecturer, Department of Orthodontics, Bhojia Dental
the most commodious method.
College, Buddh, Baddi, (Affiliated from- Himachal Pradesh
University, Shimla) Himachal Pradesh, 1Professor, Department
TYPES OF DEEP OVERBITE CORRECTION of Orthodontics, Saraswati Dental College, Lucknow,
2
Consultant orthodontist, Millennium Dental Clinic, Thrissur,
1. Intrusion of teeth – The movement of the geometric Kerala, 3Assistant Professor, Department of Orthodontics, Babu
center of the root (centroid) is called intrusion, which is Banarsi Das Dental College and University, Lucknow,
apical in respect to the occlusal plane or a plane based Uttar Pradesh, India
on the long axis of centroid. Labial tipping of an incisor
Address for correspondence: Dr. Stuti Raj,
Senior Lecturer, Department of Orthodontics, Bhojia Dental
College, Buddh, Baddi (Affiliated from Himachal Pradesh
Received: 03-Sep-2021    Revised: 28-Sep-2021 University, Shimla) Himachal Pradesh, India.
Accepted: 29-Sep-2021    Published: 12-Nov-2021 E‑mail: [email protected]

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DOI:
How to cite this article: Raj S, Chandra P, Tandon R, Asok N, Singh AV.
10.4103/ijor.ijor_17_21 Forces generated with the use of intrusion arches in orthodontics – A review
of literature. Int J Orthod Rehabil 2021;12:121-5.

© 2021 International Journal of Orthodontic Rehabilitation | Published by Wolters Kluwer - Medknow 121
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Raj, et al.: Intrusion arches – A review of literature

MATERIALS AND METHODS researches based on previously invented intrusion arches

• Finite element studies on intrusion arches.
• We collected data according to the Preferred Reporting
Items for Systematic Reviews and Meta‑analysis To identify all the studies to find out the intrusion arches for
guidelines for reporting systematic reviews of health deep overbite correction, a literature survey was done. The
sciences interventions.[6] One hundred and forty‑one types of malocclusion were not restricted. To avoid multiple
searched along with three intrusion arches from two biases, we chose a table which represents articles on new
books were included to find the intrusion arches to appliance with independent study with different authors,
correct the deep overbite under different titles, or in different journals and books.
• To identify all studies that examined the correction of
deep overbite with the help of only intrusion arches, Data were collected and included according to these
a literature survey was done from library and Google headings:
Scholar from the year 1977–2019 and used the Medical • Author name, journal name
Subject Headings term “orthodontics” and was crossed • Year of introduction
with a combination of the following term: intrusion • Appliance introduced
arches, intrusion arches for deep overbite correction, and • Functions
forces produced by intrusion arches on tooth movements • Type of movement.
• All articles which were written in English were included
• Data were collected from only original invention articles Sixteen intrusion arches were included in this review article
and books. The flow diagram of data search is shown in for the correction of deep overbite[2,7‑15] [Table 2]. Forces
Figure 1]. generated by intrusion arches in all the three planes that are
sagittal, transverse, and vertical are explained [Tables 3‑5].
The exclusion criteria were as follows [Table 1]:
• Studies dealing with deep overbite correction by other RESULTS
methods
• Case reports on intrusion arches Correction of deep overbite can be accomplished by intrusion
• Clinical trials, comparative studies, reviews, and of anteriors, extrusion of posteriors, or by combination of
both. Intrusion arches can intrude the incisors, extrude the
Additional records identified
Records identified through molars by tip back, or can also perform both at the same
Identification

through other Google Scholar

library and Index Copernicus time like in two‑couple system. All intrusion arches are
(n = 3 intrusion arches) (n = 141 articles)
summarized along with their functions in Table 2. Out of all
the intrusion arches, Burstone was first to introduce utility
arch in the year 1977 for the correction of Class II deep
Records excluded
Studies dealing with
overbites. He introduced intrusive utility arch for applying
Records screened
(n = 144) deep overbite intrusive force on anteriors, selective intrusion and canine
Screening

correction by
other methods intrusion, and passive utility arches for passively holding
(n = 50) the arch. Burstone also introduced retraction utility arch
Full-text articles for retraction and intrusion of flared maxillary incisors and
Full-text articles books excluded, with 5 case protraction utility arch for protrusion and flaring of maxillary
assessed for eligibility reports. 67 Clinical
trials, comparative incisors in Class II Division 2 cases.[2] After this, Ricketts in
(n = 94)
studies, reviews and
Eligibility

researches based on
previous invented Table 1: The exclusion criteria and the number of articles
intrusion arches. 6 excluded
Finite element studies
(n = 78) The exclusion criteria Number of
Studies included with
articles excluded
original invention
(n = 16) Studies dealing with deep overbite 50
correction by other methods
Included

Case reports on intrusion arches 5

Studies included in
quantitative synthesis Clinical trials and comparative studies 67
(meta-analysis) and reviews and researches based on
(n = 0) previously invented intrusion arches
Finite element studies on intrusion arches 6
Figure 1: Flow diagram of data search according to the Preferred Reporting
Items for Systematic Reviews and Meta‑analysis Total 128

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Raj, et al.: Intrusion arches – A review of literature

Table 2: List of intrusion Arches

Author and book/journal Year of Appliance introduced Function Type of
introduction movement
Burstone. Am J Orthod[2] 1977 Intrusive utility arch Selective intrusion and canine intrusion Intrusion
Burstone. Am J Orthod[2] 1977 Passive utility arch For stabilization and space holding Passive
movement
Burstone. Am J Orthod[2] 1977 Retraction utility arch For retracting and intruding incisors in cases of maxillary Intrusion
incisor flaring and
retraction
Burstone. Am J Orthod[2] 1977 Protrusion utility arch Used for flaring and intruding incisors in cases of Class II Intrusion
malocclusion and
protraction
Rickets et al. Bioprogressive 1979 Ricketts utility arch This was used as the starting appliance in deep bites or Intrusion
Therapy Book[7] with crowded mandibular anterior conditions
Ricketts et al. Bioprogressive 1979 Contraction utility arch Retract mandibular incisors optimally with very light Intrusion
Therapy Book[7] forces
Mulligan. J Clin Orthod[8] 1980 Mulligan utility arch Cuspid intrusion takes place and molar extrusion Combination
McNamara. J Clin Orthod[9] 1986 Intrusion utility arch Intrusion and possible torquing of the lower incisors as Intrusion
well as a tipping back of the lower molars
McNamara. J Clin Orthod[9] 1986 Retrusion utility arch Used in cases of dentoalveolar anterior crossbite in which Intrusion
there was slight proclination and spacing of the lower
incisors. Retraction and intrusion both were possible
McNamara. J Clin Orthod[9] 1986 Protrusion utility arch This can be used during the mixed‑dentition period Intrusion
prior to functional jaw orthopedic appliance therapy for
intruding and protracting molars
Marcott. Biomechanics in 1990 Marcotte intrusion arch Intrusion of anteriors and extrusion of posterior teeth Combination
Orthodontics. Toronto[10]
Shroff et al. Am J Orthod 1997 Three‑piece intrusion arch Intrusion of incisors and extrusion of molars Combination
Dentofacial Orthop[11]
Kalra. J Clin Orthod[12] 1998 Simultaneous intrusion Retraction and intrusion of anterior teeth Intrusion
and retraction arch
Nanda et al. J Clin Orthod[13] 1998 Connecticut Intrusion Arch Intrusion of anterior teeth Intrusion
Nanda and Kuhlberg. Biomechanics 2005 Connecticut New Intrusion Intrusion of anterior teeth Intrusion
and Esthetic Strategies in Clinical Arch
Orthodontics Book[14]
Ranjitbhai et al. Int J Orthod 2017 Modified three‑piece En masse retraction and intrusion Intrusion
Rehabil[15] intrusion arch

Table 3: Forces in anteroposterior movements contraction utility arch to retract mandibular incisors with
(mesiobuccal surface of buccal segment and labiolingual light continuous force.[7] Mulligan again in the year 1979
surface of anteriors)
introduced Mulligan utility arch which focuses on intrusion
6 5 4 3 2 1 Equivalent of extruded canines and extrusion of molars.[8] In the year
Maxillary teeth
1986, McNamara introduced intrusion, retrusion, and
Root surface 1.20 0.55 0.75 0.75 0.40 0.50 4.15
area (cm2) protrusion utility arches. McNamara intrusion utility arches
Forces (g/cm2) also have the property of torquing mandibular incisors and
200 240 110 150 150 80 100 830 tipping mandibular molars apart from intrusion. Retrusion
150 180 85 110 115 60 75 625 utility arch was used for correction of dentoalveolar anterior
100 120 55 75 75 40 50 415 crossbite in which there was proclination and spacing in
Mandibular teeth the lower anteriors. Protrusion utility arch was used in
Root surface 1.10 0.60 0.60 0.75 0.25 0.25 3.55
area (cm2)
mixed‑dentition period prior to functional jaw orthopedic
Forces (g/cm2) appliance therapy for intruding and protracting molars.[9]
200 220 120 120 150 50 50 710 Marcotte introduced Marcotte intrusion arch (1990)[10] and
150 175 90 90 115 40 40 550 Bhavna Shroff introduced three‑piece intrusion arch (1997),[11]
100 110 60 60 75 25 25 355 both were used for intrusion of anteriors and extrusion of
posteriors. Three‑piece intrusion arch with a good anchorage
1979 introduced utility arch which was used as starting control used for correction of flared incisors and their axial
appliance for deep overbite correction and for intrusion of inclinations. Simultaneous intrusion and retraction arch
mandibular incisors in crowding cases. He also introduced was designed by Varun Kalra in 1998 to perform both the
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Raj, et al.: Intrusion arches – A review of literature

Table 4: Forces in transverse movements (buccolingual surface tip‑back bend.[16] Utility arch can be designed differently
of buccal segment and mesiobuccal surface of anteriors) for extraction and nonextraction cases. In extraction cases,
7 6 5 4 3 2 1 the forces on molar are generated mesially and occlusally,
Maxillary teeth with a distomolar bend preventing the molar from moving
Root surface area (cm2) 1.05 1.35 0.50 0.50 0.70 0.65 0.70 mesially.[9]
Forces (g/cm2)
150 155 205 75 75 105 100 105
Six principles must be pondered upon incisor or canine
100 105 135 50 50 70 65 70
Mandibular teeth
intrusion: (1) the use of optimal magnitudes of force and
Root surface area (cm2) 0.95 1.05 0.60 0.60 0.70 0.50 0.50 constantly delivering this force with low load‑deflection
Forces (g/cm2) springs; (2) in the anterior region, single‑point contact should
150 140 155 90 90 105 75 75 be used; (3) the point of force application with respect to
100 95 105 60 60 70 50 50 the center of resistance of the teeth to be intruded should
be selected cautiously; (4) the geometry of anterior tooth
Table 5: Forces in intrusion and extrusion of teeth forms the basis of selective intrusion; (5) reactive units
7 6 5 4 3 2 1 are controlled by formation of a posterior anchorage unit;
Maxillary teeth and (6) the posterior teeth eruption should be inhibited and
Root surface area (cm2) 0.70 0.80 0.30 0.30 0.45 0.30 0.40 undesirable eruptive mechanics are avoided.[2]
Forces (g/cm2)
150 105 120 45 45 65 45 60 The optimum pressure for the tooth movement proposed
100 70 80 30 30 45 30 40 by Brian Lee in his work is 200 g/cm2 of enface root surface
Mandibular teeth
exposed to tooth movement. Pressure is defined as force per
Root surface area (cm2) 0.75 0.85 0.30 0.30 0.35 0.20 0.20
unit area. The magnitudes of force vary depending upon the
Forces (g/cm2)
150 110 130 45 45 50 30 30
planned direction of movement and size of the root surface
100 75 85 30 30 35 20 20 involved. The forces per unit area are listed in all the three
movements[7] [Tables 3‑5].
movements of anterior teeth simultaneously.[12] Connecticut
CONCLUSION
Intrusion Arch (1998)[13] and Connecticut New Intrusion
Arch (2005)[14] both were introduced by Nanda et al. for
This paper enumerates all the types of intrusion arches
intrusion of anterior teeth. There was also an introduction
and their function and types. The paper also differentiates
of modified three‑piece intrusion arch in the year 2017 by
forces on teeth in all movements which helps the clinician in
Ranjitbhai et al. for en masse retraction and intrusion of
application of precise force on the tooth movements. The list
anteriors.[15]
of intrusion arches helps the clinician to choose the suitable
intrusion arch wherever required in a substantially reduced
DISCUSSION time and also helpful in research purposes.

Intrusion of teeth is based on mechanism which consists Financial support and sponsorship
of three parts: (1) anchorage unit, (2) an anterior segment, Nil.
and (3) an intrusive arch spring. The intrusion arch is
placed in the auxiliary tube of the first molar attachment. Conflicts of interest
It is important to use the lowest magnitude that is capable There are no conflicts of interest.
of intruding incisors. If the magnitudes of forces are too
high, the rate of root resorption will increase not the rate REFERENCES
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