Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 5, August, p. 829–833

doi: 10.17219/acem/61349

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Orthodontic intrusion of periodontally-compromised maxillary incisors: 3-dimensional finite element method analysis

Liwia E. Minch1,A,B,C,D, Michał Sarul1,B, Rafał Nowak2,B, Beata Kawala1,E,F, Joanna Antoszewska-Smith1,C,E,F

1 Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Poland

2 Department of Maxillofacial Surgery, Wroclaw Medical University, Poland


Background. Loading of the compromised periodontium with orthodontic forces produces different results than those achieved in patients with healthy periodontal support. Determining the force value at a level preventing further deterioration of the patient’s periodontal status, thus delivering the most precisely individualized “dose” of loading, seems to be crucial for the successful intrusion of teeth with reduced periodontal support.
Objectives. The aim of the study was to determine the range of force values efficiently intruding maxillary incisors without further compromising the initially-impaired periodontal status. Finite element analysis (FEA), allowing estimation of the stress and strain distribution, was the method of choice.
Material and Methods. The CT scans of a periodontally-compromised patient were segmented using InVesalius software. A model – based on NURBS surfaces – was adjusted to the CT scans in order to obtain both smooth and natural curvatures of each model segment. All relevant tissues were modeled as separate volumes. The geometric model was discretized in order to create a numerical model for applying Ansys software (v. 15.07) and using APDL. The central incisors were loaded with external intrusive forces, ranging from 0.1 to 0.4 N.
Results. The simulation, performed iteratively, showed that even the lowest force value – 0.1 N – causes stress changes in the alveolus and on the root surfaces, with a tendency of stress increasing towards the bottom of the alveolus and root apex. It is also notable that during the application of forces of equal magnitude, the stress/strain distribution was significantly higher around tooth 21, which displayed the highest range of PDL reduction. Application of the same force level created a higher stress-strain response around tooth 21, and the characteristics were less homogenous.
Conclusion. A force value of 0.1 N applied in vivo might produce the most effective tooth intrusion and bone modeling which favors bone defect regeneration.

Key words

FEM, intrusion, PDL, bone defect, orthodontic forces

References (30)

  1. Towfighi PP, Brundsvold M, Storey AT, Arnold RM, Willmand DE, McMahan CA. Pathologic migration of anterior teeth in patients with moderate to severe periodontitis. J Periodontol. 1997;68:967–972.
  2. Melsen B. Tissue reaction to orthodontic tooth movement – a new paradigm. Eur J Orthod. 2001;23:671–681.
  3. Romano R, Landsberg CJ. Reconstruction of function and aesthetics of the maxillary anterior region: A combined periodontal/orthodontic therapy. Pract Periodont Aesthetic Dent. 1996;8:353–361.
  4. Fung K, Chandhoke TK, Uribe F, Schincaglia G. Periodontal regeneration and orthodontic intrusion of a pathologically migrated central incisor adjacent to an infrabony defect. J Clinical Orthod. 2012;7:417–423.
  5. Minch L, Chrobak M, Antoszewska L. Interdisciplinary treatment of adult patients: A case report. Dent Med Probl. 2013;50:481–485.
  6. Costopoulos G, Nanda R. An evaluation of root resorption incident to orthodontic intrusion. Am J Orthod Dentofac Orthop. 1996;109:543–548.
  7. Han G, Huang S, Von den Hoff J, Zeng X, Kuijpers-Jagtman AM. Root resorption after orthodontic intrusion and extrusion: An intraindividual study. Angle Orthod. 2005;75:912–918.
  8. Provatidis C. A comparative fem-study of tooth mobility using isotropic and anisotropic models of the periodontal ligament. Med Eng Physics. 2000;22:359–370.
  9. Jones M, Hickman J, Middleton J, Knox J, Volp C. A validated finite element method study of orthodontic tooth movement in the human subject. J Orthod. 2001;28:29–38.
  10. Qian H, Chen J, Katona TR. The influence of PDL principal fibers in 3-dimensional analysis of orthodontic tooth movement. Am J Orthod Dentofac Orthop. 2001;120:272–279.
  11. Cattaneo P, Dalstra M, Melsen B. The finite element method: A tool to study orthodontic tooth movement. J Dent Res. 2005;84:428–433.
  12. Brezniak N, Wasserstein A. Rooth resorption after orthodontic treatment part 2. Literature review. Am J Orthod Dentofacial Orthop. 1993;103:138–146.
  13. Casa MA, Faltin RM, Faltin K, Sander F, Arana-Chavez VE. Rooth resorption in upper first premolars after application of continous torque moment: An intraindividual study. J Orofac Orthop. 2001;62:285–295.
  14. Artun J, Van’t Hullenaar R, Doppel D, Kuijpers-Jagtman AM. Identification of orthodontic patients at risk of severe apical root resorption. Am J Orthod Dentofac Orthop. 2009;135:448–455.
  15. Melsen B, Agerbaek N, Eriksen J, Terp S. New attachment trough periodontal treatment and orthodontic intrusion. Am J Orthod. 1988;94:204–116.
  16. Feng X, Oba T, Oba Y, Moriyama K. An interdisciplinary approach for improved functional and esthetic results in a periodontally compromised adult patient. Angle Orthod. 2005;6:1061–1070.
  17. Kasai A, Wehrbein H, Gortan-Kasai A, Reichert C, Willershausen B, Cases J. Interdisciplinary approach for the treatment of periodontally compromised malpositioned anterior teeth: A case report. Cases J. 2009;2:8568.
  18. Maia LG, de Moraes Maia ML, da Costa Monini A, Vianna AP, Gandini LG. Photoelastic analysis of forces generated by T-loop springs made with stainless steel or titanium-molybdenum alloy. Am J Orthod Dentofacial Orthop. 2011;140:123-128
  19. Burstone CJ, Pruptyniewicz RJ. Holographic determination of centres of rotation produced by orthodontic forces. Am J Orthod. 1980;77:396–409.
  20. Hinterkausen M, Bourauel C, Siebers G, Haase A, Drescher D, Nellen B. In vitro analysis of the initial tooth mobility in a novel optomechanical set-up. Med Engin Physics. 1998;20:40–49.
  21. Cifter M, Sarac M. Maxillary posterior intrusion mechanics with mini-implant anchorage evaluated with finite element method. Am J Orthod Dentofac Orthop. 2011;140:233–241.
  22. Liang W, Rong Q, Lin J, Xu B. Torque control of the maxillary incisors in lingual and labialorthodontics: A 3-dimensional finite element analysis. Am J Ortod Dentofac Orthop. 2009;135:316–322.
  23. Levander E, Malmgren O. Evaluation of the risk of root resorption during orthodontic treatment. A study of upper incisors. Eur J Orthod. 1988;10:30–38.
  24. Cattaneo PM, Dalstra M, Melsen B. Analysis of stress and strain around orthodontically loaded implants: An animal study. Int J Oral Maxillofacial Implants. 2007;22:213–225.
  25. Cattaneo PM, Dalstra M, Melsen B. The finite element method: A tool to study orthodontic movement. J Dent Res. 2005;84:428–433.
  26. Poppe M, Bourauel C, Jager A. Determination of the elasticity parameters of the human periodontal ligament and the location of the center of resistance of single rooted teeth. A study of autopsy specimens and their conversion into finite element models. J Orofac Orthop. 2002;63:358–370.
  27. Provatidis CG. A comparative FEM-study of tooth mobility using isotropic and anisotropic models of the periodontal ligament. Med Engin Physics. 2000;22:359–370.
  28. Frost HM. Some ABC’s of skeletal pathophysiology. Tissuse mechanisms controlling bone mass. Calc Tiss Int. 1991;49:303–304.
  29. Rudolph DJ, Willes MG, Sameshima GT. A finite element model of apical force distribution from orthodontic tooth movement. Angle Orthod. 2001;71:127–131.
  30. Vikram NR, Kumar KSS, Nagachandran KS, Hashir YM. Apical stress distribution on maxillary central incisor during various orthodontic movements by verying cementak and two different periodontal ligament thicknesses: A FEM study. Indian J Dental Res. 2012;23:213–220.