Controlled retraction of maxillary incisors

Poul Gjessing, DDS*

Aarhus. Denmark

The force characteristics inherent in the prefabricated PG retraction spring have been shown to be
efficient for controlled movement of canines. In the present investigation, this spring was analyzed
with regard to its applicability for controlled retraction of the maxillary incisors. A description of the
required system of moments and horizontal and vertical forces, acting at both the active (alpha) and
reactive (beta) units, is presented. The three-dimensional force system generated by specific
modifications of the spring was registered in a bench testing device mounted with strain gauges, and
the resultant data presented in a graphic. It is concluded that the PG retraction spring can be used
as a module for controlled retraction of both canines and incisors. The magnitude of horizontal and
vertical forces is kept within the anticipated physiologic limits and can be identified by the shape of
the activated spring. Variability of the distance between the anterior and the posterior points of force
attack has no significant influence on the horizontal and vertical forces produced. Only minor clinical
adjustments are needed to modify the retraction spring from canine-to-incisor retraction. (AMJ
ORTHODDENTOFACORTHOP1992;101:120-31 .)

C o r r e c t positioning of the maxillary incisors
is recognized to be essential for function, stability, and
esthetics. Retraction of the maxillary incisors therefore
represents a fundamental and often critical stage in
orthodontic treatment. The resultant movement of the
incisors depends on the tissue reaction produced by the
applied biomechanical force system. A precondition for
accomplishment of the desired incisor movement is re-
modeling of the premaxilla. Though implant studies t
and laminagraphic investigation 2 have shown no evi-
dence of permanent changes in the shape of the anterior
palatal cortex that curves downward from a horizontal
position to the more vertical alveolar process, torquing
the root apex through this part of the palatal cortex
resulted in relapse of the incisor inclination to a more
vertical position and apical root resorption, followed
by reestablishment of the pretreatment structure of the
cortex. 2
Fig. 1 shows a typical result of maxillary incisor
retraction in patients treated with the Begg technique
and analyzed by the laminagraphic method. The overall
treatment and the esthetic result are dominated by a
dramatic extrusion of the incisors. This unwanted side
effect is partially due to the uncontrolled apical tipping
at the beginning of treatment and partially due to ver-
tical forces generated as an adjunct to the moment in-
duced for palatal root torque. 3 Similar findings are also
*Clinical Associate Professor, Department of Orthodontics, Royal Dental
College.
811123137
120
seen in the traditional type of edgewise mechanics,
characterized by the use of continuous arch wires and
by the limited control of vertical forces.
To compensate for this unwanted side effect, cli-
nicians have attempted to change the continuous wire
into the shape in which one would expect intrusional
forces to be induced to the anterior teeth. Unfortunately,
this goal is difficult to achieve. The multiplicity of ac-
tive and reactive forces developed,4 frequently influence
the vertical position of the incisors in an unpredictable
way. Buccal extrusions rather than the expected intru-
sion of the incisors occurs.
Segmentation. The desired optimal distribution of
forces between the anterior and the posterior parts of
the upper arch can be obtained by dividing the arch into
segments2 "6 Each segment is consolidated in a rigid
entity by a section of heavy rectangular arch wire in
tight contact with the bracket slots. One anterior seg-
ment, the active talil, contains the four incisors,
whereas the two posterior segments include the buccal
teeth of each side. The posterior segments are connected
by a transpalatal arch to form one rigid multirooted
entity, the reactive tlnil.
Segmentation allows for the use of prefabricated
springs that are precalibrated to produce the desired
retraction, uprighting, and intrusion of the incisors. The
physical characteristics of the retraction spring should
be determined by the required balance between forces
and couples produced at the points of force application
during a certain amount of activation. Calculation of
this balance is related to the position of the center of
resistance (CR) of the segments.
rob,me 101 Controlled retraction of mcLrillary incisors 121
Number 2

B E G I N - - ST.3 ST. 3 - - END

OVERALL

..j

Fig. 1. Typical result of maxillary incisor retraction in patients treated with Begg technique and analyzed
by laminagraphic technique. The anteroposterior repositioning of the incisors is impeded by the limited
labiooral extent of the occlusal part of the premaxilla. This is commonly seen in Class II cases with
overextruded maxillary front teeth. (From Ten Hoeve A, Mulie RM. J Clin Orthod 1976;10:804-22.)

Investigations on dry human skulls with the laser

reflection technique and holographic interferometry7"8
have found the CR of the anterior segment to be lo-
calized between the canine and the first premolars at a
horizontal distance of approximately 10 mm from the
center of the lateral bracket. The vertical position was
9 to 10 mm above the level of the bracket slots. The
use of a dry skull in this context has been shown to be
of limited value as far as orthopedic forces are con-
cemed. 9 It is not clear whether the dry skull is a useful
model to evaluate initial orthodontic tooth movements.
A recent study of initial tooth movements based on
human autopsy material demonstrated a position of
CR as shown in Fig. 2 measuring 7 mm distal and 9 to
10 mm gingival to center of the lateral bracket. ~°
By activation of a retraction spring, a complex sys-
tem of forces and couples is transmitted through the
brackets of the segments (Fig. 2). There is one point
of force application on each side of the incisor segment,
the alpha position, and one point at each of the posterior
segments, the beta position. The resultant direction and
magnitude of force H acting at the alpha position is de-
terminant for the movement of the incisors, whereas
the resultant force at the beta position is also influenced
by the force of occlusion.
Analysis of the force system is facilitated by break-
ing down the resultant forces into horizontal vectors,
vertical vectors, and moments. According to this
scheme, the retraction spring is characterized by the (1)
location of the points of force application, (2) magni-
tude of the horizontal force, (3) constancy of the hor-
izontal force (load-to-deflection rate), and (4) magni-
tude and direction of moments acting at the alpha and
beta positions.
iifi!ii:
IOi!i!ii!iiiii!:iiii ili!iiiii
ili!i:iiiiiii
! iiii :
::@.::~.......;'~:!:::i~......
i~ :~-i~:i~::i~~::~i~
;!:: i~::
4
Fig. 2. Theoretical force system generated by retraction spring
monitored for controlled retraction of the maxillary incisor seg-
ment. Anterior point of attachment, lateral bracket; posterior
point of attachment, molar tube.
Calculation of the theoretical force system required
for simultaneous retraction uprighting, and intrusion
of the anterior is exemplified in the following. (See
Fig. 2.)
It is considered that a retraction spring is calibrated
to produced a moment-to-force (M/F) ratio of 9 by a
horizontal retraction force of 100 gm. Accordingly the
moment of the couple (solid arrow) delivered by the
spring through the anterior point of attack (center of
the lateral bracket) is 900 g m / m m . It is further antic-
ipated that an intrusional force of 20 gm is directed
through that point. Since the bracket center is located
in a horizontal distance of 7 mm in front of CR, an
additional moment of the vertical force (dotted arrow)
122 Gjesshlg
is induced to the incisor segment. The magnitude of
this moment is 7 × 20 g m / m m = 140 g m / m m . Thus
the total alpha moment received by the incisor seg-
ment is an addition of the moment of the couple
and the moment of the vertical force = 900 + 140
g m / m m = 1040 g m / m m . The total M / F ratio induced
to each side of the incisor segment at this instant of
activation is 1040:100 = 10. The concomitant force
system acting at the beta position (center of the molar
tube) is characterized by a mesially directed horizontal
force of 100 gin, an occlusally directed force of 20 gm,
and a moment produced by the posterior extension of
the retraction spring. The magnitude of this beta mo-
ment (M beta) can be calculated from the formula
Mt<~ = Malph~ + (F,~lp~ × D).
M,zp,~ = Moment of the couple at the alpha position
(900 g m / m m )
Fv ~p~ = Vertical force at the alpha position (20 gms)
D = The interbracket distance (20 mm)
M~,, = 900 + (20 × 2 0 ) g m / m m = 1300 g m / m m
The point of force application is located at the first
molar tube in a suggested horizontal distance of I0 mm
posterior to the estimated CR of the posterior segment.
This results in a moment of the extrusional force with
the magnitude of 10 × 20 g m / m m = 200 g m / m m .
The direction of this moment (dotted line) is opposite
to the moment of the couple (solid line). The com-
bined beta moment induced to each of the buccal
segments is therefore 1300 - 200 g m / m m = 1100
g m / m m . The total M / F ratio induced to each of the
posterior segments at this instant of activation is
1100:100 = 1I.
Standardizhlg the retraction spring. From the cal-
culations in Fig. 2, it becomes obvious that a very
complex force system is required for controlled incisor
retraction. This can be achieved only with a precali-
brated retraction spring. Different incisor inclinations
and interbracket distances may still call for modifica-
tions of the spring design by the operator. Clinical mod-
ifications, however, can easily lead to unexpected dis-
turbances of the force balance. To avoid this, it is de-
sirable to monitor the appliances without changing the
prefabricated structure of the spring.
The following approach to standardization is sug-
gested to optimize the desired force system and to fa-
cilitate clinical manipulation of the spring.
1. The desired incisor inclination should be estab-
lished before and kept constant during retraction. This
allows for standardization of the alpha activation of the
retraction spring to produce translation. In other words,
Am. J. Orthod. Dentofac. Orthop.
February 1992
the force system generated at the alpha position should
be precalibrated to deliver an average M / F ratio of 9
to I0 between subsequent activations of the spring.
2. The beta activation responsible for the intru-
sional force of 12 to 25 gm at each side of the anterior
segment is normally generated by providing the retrac-
tion spring with a V bend mesial to the molar tube (Fig.
3, D). Calculation of the magnitude of this bend is
dependent on the interbracket distance. Standardization
of the beta activation is achieved by replacing the V
bend by an arcial segment (Fig. 3, E). The resultant
curve of the distal leg of the spring should be calibrated
to produce the same level of intrusional force by dif-
ferent interbracket distances.
It was the purpose of the present investigation to
establish rules for calibration of prefabricated canine
retraction springs for controlled translation of the max-
illary incisors.
MATERIALS AND METHOD
The following specifications were required for controlled
incisor retraction:
1. Initial magnitude of the horizontal retraction force:
100 gm each side. (Magnitudes of force are shown
in grams. The load of 1 gm corresponds to the force
of 1 cN. Correspondingly, Newton millimeter is re-
placed by gram millimeter to describe the magnitude
of moments.)
2. Level of the intrusional force acting at the alpha po-
sition: 10 to 25 gm each side.
3. Level of the extrusional forces acting at the beta po-
sition should be noncompatible with the neuromus-
cular forces of occlusion.
4. Minimum influence of the interbracket distance on
magnitude of the vertical forces.
5. Average moment-to-force ratio acting at the alpha po-
sition: 10.
6. Average moment-to-force ratio acting at the beta po-
sition: 11.
7. Identification of the initial retraction force from con-
figuration of the activated spring.
8. Ease of operation with minimum clinical adjustments.
9. Convenient for the patient and clinician.
The experimental design of the present study included
the following basic materials:
1. A pulley mechanism mounted with electronic strain
gauges for registration of forces and couples generated
by activation of the retraction spring.
2. Strain gauge amplifiers monitored as part of a Wheat-
stone bridge for registration of the electronic impulses
received from the strain gauges.
3. The prefabricated PG retraction spring (RM A 516,
A 517) (Rocky Mountain Orthodontics, Denver,
Colo.). This spring was originally designed for con-
trolled retraction of canines u (Fig. 4).
Volume 10t Controlled retraction of ma.rillary hwisors 123
Number 2

When used for retraction of the incisor segment, the pos-

terior leg of the spring was inserted in the auxiliary molar
tube. Therefore the posterior curvature, a segment of a circle,
acted as beta activation. When the spring was attached to the A
incisor segment and activated, the intrusional force exerted
to the incisors and the induced beta moment to the posterior
segment was a product of the radius of the circle.
The degree of curvature, kappa (ae), is defined as one
divided by radius of the circle segment (I/r). A sample of
PG retraction springs, randomly selected for experimental
analysis and modified by removal of the horizontal antiro-
ration activation, was provided with varying posterior cur-
vatures corresponding to the following kappa values: 1/3,
1/4, 1/6, 1/8, 1/10, 1/16, and 1/infinity (no curvature).
Reproducibility was secured by means of a template as il-
lustrated in Fig. 5.
B
The test springs were mounted in an electronic bench
testing device consisting of a movable slide placed on a fixed
board (Fig. 6, A and B). The slide and board were polished
and separated by I mm metal balls to minimize friction.
.. i
Horizontal retraction forces of 25 gm, 50 gm, 75 gm, up to i i o

200 gm were induced to the slide by a pulley-and-deadweight 2 = 9- i

l !
system (Fig. 6, C) with the horizontal force vector passing
through the brackets. Each force application was repeated
three times, with the results expressed as an arithmetic average
of the three values.
The experimental setup simulated the unilateral part of a
segmented incisor retraction. The posterior point of attach-
C
ment, located at the sliding part, was a buccal tube with an
inner diameter of 0.026 x 0.022 mm (RM 1152) (Fig.
6, D). The anterior point of attachment was a lateral bracket
with corresponding slot dimension (RM 5077 D (Fig. 6, E).
The bracket was part of the moment transducer in fixed con-
nection with the board (Fig. 6, B and D). The tube-to-bracket : 3 :3:
distance at neutral position, before loading of the spring, was
23 mm.
Alpha moments (M alpha) produced at the bracket were
registered through electronic strain gauges attached to the
transducer (Fig. 6, E and F). The resultant electronic impulses D
were transmitted to strain gauge amplifiers, part of a Wheat-
stone bridge, and converted to digital signals suitable for
computer analysis.
iiiiiiiii!i!i!i!i!!iiiii
.~iii;i:;ii~ii~i!ii~:~!i!!!iiiiiiii:!~ii::~ii!ii~ii~ii;iiiiiiiiiiiiiiiiiii!iil]~i;i

Two strain gauges (S) were placed at distances a and b

from the center of the bracket, and the vertical forces F,=,~
and F, ~,~ and the beta moment, M~,~, were calculated ac-
~-~-~...~" ~ : i ~ :~
cording to the following formulas:

Fig. 3. A, B, and C, Effect of varying placement of a V bend

between anterior and posterior points of attack is shown. D,
E iliil
Placement of the V bend between B and C (redrawn from Bur-
stone CJ, Koenig HA. AM J ORTHODDENTOFACORTHOP1988;
93:59-67.) This position produces vertical forces and moments
desirable for incisor retraction. Also illustrated is resolution of
the V bend in alpha and beta bends. E, Demonstrates replace-
ment of the beta bend by a curvature and shows the alpha bend
as part of a retraction loop.
124 Gjessing Am. J, Orthod. Dentofac. Orthop.
February 1 9 9 2

. . . . . . . . . . . . .

I
5.5mm
I I

| ° °~° o

I I
20ram

Fig. 4. The PG retraction spring.

F. ~,~,, - M alpha relationship between the applied force and the deflection
a - ~ b (identical to Fv beta)
of the transducer. Fig. 7 depicts the amplifier scale
M ~ = F..~. x d + M alpha values received from the two strain gauges plotted
F..,r*.: Vertical force acting at the alpha position against the loading.
Friction between slide and board was tested by mon-
F, ~,~: Vertical force acting at the beta position itoring the strain gauges for registration of horizontal
M,,~,~: Moment resulting from couple acting at the alpha forces. The pulley mechanism was activated with dead-
position weights ranging from 20 to 200 gm in intervals of 20
gm. Each loading was registered with and without the
M~,~:Moment resulting from couple acting at the beta position
slide as part of the traction. The difference between
a and b: Distances from center of strain gauges to center of each two registrations, expressed in percentage, ranged
bracket (E) from 1.73% to 4.26%. Thus the horizontal retraction
d: Tube-to-bracket distance force acting at the brackets was a maximum of 4.26%
smaller than the force measured by deadweight.
RESULTS
Calibration of the test equipment Accuracy reproducibility of the experimental setup
Calibration of the strain gauges by direct loading The reliability of the experimental equipment, mon-
of the transducer with known weights revealed a linear itored with the test spring, was documented by 10 rep-
Voh~me 10I Controlled retraction of maxillary incisors 125
Number 2

16

1 1 1 1 111 1 1 1__
2 3 4 5 6 7 8 10 12 16

I 0

Fig. 5. Template for reproduction of curvatures (kappa values).

I conpurzR I
Fig. 6. The bench testing device. A, Movable slide; B, fixed board; C, pulley mechanism; D, buccal
tube; E, lateral bracket; F, moment transducer; S, strain gauges. A and B, Bracket-to-strain gauge
distances.

iications of a series of horizontal forces generated by
deadweights ranging from 25 to 150 gm.
Table I illustrates the average magnitude of moment
and vertical force registered at the alpha position by
each level of horizontal load. The percentage of max-
imum error is indicated in relation to each mean value.
Varying the posterior curvature of the spring
The posterior curvature of the spring is identified
by its kappa value (Fig. 5). The relations between ver-
tical forces and alpha moment-to-force ratios by dif-
ferent kappa values and various horizontal loads are
graphically illustrated in Fig. 8.
The load-to-deflection curves (Fig. 8, A) demon-
strate that the magnitude of intrusional force increased
in inverse relationship to the declining horizontal re-
traction force. As expected, the vertical force was neg-
ative (extrusional) by small kappa values. Increasing
the posterior curvature resulted in a proportional in-
crease in the intrusional force level.
By the kappa value of 1/6 (Fig. 9), the retraction
spring produced the most acceptable balance between
intrusional force and M / F ratio at horizontal forces after
an initial activation to 100 gm.
Numerical parameters of the force system delivered
by the spring at the alpha and beta positions are listed
in Table II.
Moment of the vertical forces
The anterior point of force application at the lateral
bracket and the posterior point of force application at
the molar tube were located at a certain horizontal dis-
tance from the CR of the anterior and the posterior
segments. Therefore the vertical forces acting at the
points of application induced additional moments to the
anterior and the posterior segments. As the lateral
126 Gjessing A,,. J. Orthod.Demofac. Orthop.
February 1992

gm

250
A
200

150

100

50

100 500 1000

Fig. 7. Linearity of test equipment. X axis: Amplifier scale values. Y axis: Load. Curves illustrate signals
received from strain gauges A and B.

Table I. Average magnitude of moment and vertical force registered at alpha

Hor~ontal Mean of Maximum error inpercent [ Mean ofM-alpha Maximum error in percent
load (gm) F, gm ofmean F, [ (gm mm) ofmean M-alpha

25 26.9 3.35 403.1 3.2

50 21.9 4.11 484 3.47
75 18.1 4.98 593.7 3.66
100 11.3 il.51 617.6 10.63

Table II. Parameters of the force system delivered by the spring at alpha and beta
Alpha position Beta position

Horizontal Vertical [ Moment M Vertical Moment M Distance of action

force (F gm) force [ (gm mm) M/F (gin) (gm ram) MIF (ram)

25 24 472 19 - 24 1082 43 0.4

50 20 585 12 - 20 1101 22 0.8
75 15 658 9 - 15 1051 14 1.2
100 9 719 7 -9 958 10 1.6
125 4 802 6 -4 910 7 2.0
150 0 857 6 0 857 6 2.4
175 -2 963 6 2 -907 5 2.8
200 -7 996 5 7 - 799 4 3.2

bracket was located at an assumed distance of 7 mm
anterior to the CR of the incisor segment, a moment of
intrusional force was added to the moment of couple.
Fig. 9 illustrates in a graph the combined alpha M / F
ratio induced to the anterior segment during continuous
activation of the spring.
The posterior point of force application was located
at an assumed distance of I0 mm posterior to CR of
the posterior segment. The moment of the extrusional
force, acting at the beta position was directed opposite
to the moment of the couple (Fig. 2). Following this,
the combined beta moment induced to the posterior
segment was calculated by subtraction.
Varying the interbracket distance
Table III describes the interrelation of tube-to-
bracket distance and intrusion force by a constant load
of 100 gm. It was demonstrated that varying the inter-
bracket distance between 17 and 25 mm resulted in
vertical forces ranging from 10 to 13 gm.
Volume 101 Controlled retraction of mcL~;illaryincisors 127'
Number 2

LOAD TO DEFLECTION
alpha position

25o g m
200 j '

150

100
.J
50 f

-50
0 1 2 4

mm
Horiz.force ~ kappa=l/Int. * kappa=l/16 ,u kappa~l/lO
x kappa=l/8 0 kappa=l/6 x kappa=l/3
A
MOMENT TO FORCE
alpha position
M/F
25

20

15

10

5"

0
0 1 2 3

mm
J kappa-l/Inf. ~ kappa=l/16 ,a kappa=l/tO -x kappa=l/8
g o kappa=l/6 ~- kappa=l/4 x kappa=l/8

Fig. 8. A, Load to deflection curves showing magnitude of horizontal and vertical forces (Y axis) plotted
against distance of spring activation, which is equivalent to distance of horizontal tooth movement
(X axis). B, Moment-to-force curves showing the M/F ratio plotted against the distance of spring
activation, equivalent to the distance of horizontal tooth movement.
128 Gjessing Am. J. Orthod. Dentofac. Orthop.
February 1992

MOMENT TO FORCE
alpha position

M/F
30

25

20
\
15

10

0
0 1 2 3 4
mm

- S p r i n g car. ~ Vert, f o r c e

kappa = 1/6
Fig. 9. Graphic illustration of total M/F ratio induced to incisor segment at a certain instant of activation.
1, Moment of the couple delivered by the spring. 2, The additional moment of the vertical force. (Both
divided by the magnitude of F.)

Table Ill. Interrelation of tube-to-bracket and A 517) was analyzed for its applicability for re-
distance and intrusion force traction of the maxillary incisors. The load-to-deflection
Vertical force at and moment-to-force ratios inherent in this spring con-
Interbracket distance alpha-position stitute a force system that has shown to be efficient for
(ram) (gin) controlled movement of canines, t''t3 It was hypothe-
sized that the spring, when attached to the auxiliary
17 10
19 13 molar tube and the lateral incisor bracket (Fig. 5),
21 13 would produce a lower M / F ratio at the alpha position
23 13 because of the increased interbracket distance as com-
25 12 pared with the canine-to-second premolar distance.~4
The experimental analysis of the original canine-
retraction spring did not provide data on the vertical
Clinical application forces; nor were descriptions of the beta moment af-
The use of upper lateral brackets provided with a fecting the posterior segment as a whole included. How-
vertical slot (Broussard, RM 5077 D) makes the clinical ever, the spring was induced with an experimentally
application of the spring very easy and time saving. derived curvature of the posterior extension to distribute
The prefabricated spring is inherent with the prescribed the beta moment equally through the second premolar
posterior curvature of kappa = 1/6. Thus the required bracket and the molar tube. The present experiment
modifications of the spring are limited to the adjustment provides data de~:ribing moments and horizontal and
of the anterior leg extension to make it fit into the vertical forces acting at both the active (alpha) and the
vertical slot of the lateral bracket (Fig. 10). reactive (beta) units.
DISCUSSION Magnitude of the horizontal force
The force system generated by the standardized, The literature provides information on the optimum
prefabricated PG canine-retraction spring t2 (RMOA 516 magnitude of force required for translation of canines
 1,1olume101 Controlled retraction of maxillary incisors 129
Number 2

varying from 75 to 260 gm. ~5~9 However, no scientific INCISOR RETRACTION

proof for the exact level of optimum force range has as
yet been presented. Include vertical sl0t a.m.
It is an open question whether constancy or change Broussard in lateral incisor
bracket
in force magnitude delivers the most favorable stimu-
lation to the biochemical, bioelectric, and cellular re-
actions responsible for tooth movements. :° Change is Twist anterior leg 90 ° 3 mm
a reality in segmented retractions since decay of force o~-.__"~ ~ in front of the circular helix
is taking place between activations of the retraction to make it fit in vertical tube
springs. It seems reasonable to determine the hfitial
magnitude of horizontal force, and it seems important Place a 75 ° bend
that the operator be allowed to control the initial force (90 °- bracket play) 3 mm in
magnitude. This can be achieved by registering the front of the circular helix
shape of the spring at a specific instant of activation.
The present investigation resulted in selection of Make anterior and posterior
100 cN, corresponding to the load of 100 gm at each segments. Bend mesial and
side as the initial magnitude of force. The choice was distal wire extensions oc-
based on analysis of M / F ratios and vertical forces clusally.
Place poster!or extension of
produced at different magnitudes of retraction force as
the spring in the auxilliary
demonstrated in the following. buccal tube.
Adjust the horizontal antiro-
Magnitude and direction of couples acting at the tation angu/ation for best fit
alpha and beta positions in the vertical slot of lateral
Alpha and beta moments are induced to the anterior bracket.
and the posterior segments by couples generated at the
anterior and the posterior points of force application. Place the anterior leg in verti-
In theory, the moments can be produced by placing a cal slot of the lateral bracket,
V bend in a wire extending from the anterior to the pull downward and bend
posterior point of force application. As demonstrated mesially.
in Fig. 3, the mesiodistal positioning of the V bend has
a large impact on the distribution of forces and moments
to the segments. Fig. 3 illustrates that to obtain the The spring is activated by pull-
required uprighting and slight intrusion of incisors the ing distal to the tube until the
i double helix has assumed a
V bend must be placed slightly off center toward the ,j' displacement as illustrated.
posterior segment. By this configuration the pro-
The V bend can be resolved in two bends, the an- duced magnitude of force is
teriorly placed alpha activation and the posteriorly lo- approximately 100 gm.
Reactivate to the perscribed
cated beta activation (Fig. 3, D). The alpha activation
configuration of the double
of the retraction spring is an integrated part of a loop helix every 4-6 weeks.
precalibrated to deliver the M / F ratio required for con-
trolled movement of the anterior segment. The beta
activation is induced to produce a specific magnitude
of intrusion force at the alpha position. It is influenced Estimated treatment time:
5-6 months on average.
by the force system delivered at the alpha position and
by the interbracket distance.

The magnitude and direction of vertical forces

With the development of more sophisticated appli-
ances, clinical successful intrusion has been demon-
strated in recent years. 2~ As the intrusion force is con-
centrated over a small area at the root apex, it becomes
obvious that extremely light forces are needed to pro-
duce the optimum biologic reactions within the PDL.
Clinical investigation of a group of patients treated with
Fig. 10. Schematic description of clinical application of PG re-
traction spring during incisor retraction.
a total intrusion force of I00 gm at the maxillary incisors
showed 18% mean resorption of the original root
length.-"- This information makes it reasonable to cal-
culate an estimated intrusion force of approximately 20
130 Gjessbtg
to 50 gm, or 10 to 25 gm on each side. Corresponding
to the apically directed vertical force at the alpha po-
sition, an extrusional force of 10 to 25 gm acts at each
of the buccal segments. This modest magnitude of force
may be neutralized by neuromuscular tensions trans-
mitted through the occlusion.
The amount of intrusional force was dictated by the
curvature of the posterior extension of the spring. As
shown in Table IV, this force magnitude was not sig-
nificantly influenced by changing the distance between
the anterior and the posterior points of force application
(interbracket distance).
The points of the force attack
The segmented arch technique offers freedom in
selection of the points of force application relative to
the CR of the anterior (active) and the posterior (re-
active) units. In other words, the retraction spring can
be monitored to improve the desired movement of the
active unit and reduce unwanted side effects in the
reactive unit as demonstrated in Fig. 2.
The interactions
The load-to-deflection curves demonstrated in Fig.
8 show a uniform decay of horizontal force by different
beta activations--approximately 60 gm/mm of hori-
zontal tooth movement. The magnitude of vertical in-
trusion forces acting concomitantly at the alpha position
is inversely proportional to the magnitude of horizontal
forces. As expected, the alpha moment resulted in neg-
ative values (extrusion) at the incisor segment by minor
beta activations.
The desired positive level of intrusional force is
recognized by a beta activation of I/6 kappa. This is
demonstrated in Fig. 9 and Table II, which show in-
trusion forces at each side of the anterior segment in-
creasing from 9 to 25 gm by retraction forces ranging
from 100 gm initially to 30 gm before reactivation. The
corresponding movement of the incisor segment is
1.2 ram, which is anticipated to take place during a 4-
week treatment period.
The total alpha moment-to-force ratio produced dur-
ing this period is demonstrated in Fig. 9, showing a
M / F ratio of 8 by the initial horizontal force of 100
gm. The initial tooth movement is lingual crown tip-
ping. After a mere 0.4 mm of distal tooth movement,
the M / F ratio increases through 10, and the remaining
part of the 4-week retraction sequence is dominated by
uprighting of the segment.
The force system induced to the posterior segment
at the same time is characterized by horizontal forces
declining from 100 to 30 gm and vertical extrusion
Am. J. Orthod. Dentofac. Orthop.
February 1992
forces identical to the anterior intrusion. The beta mo-
ment increases from 688 to 892 gm ram. Clinical ob-
servations have shown that moments and forces of sim-
ilar modest magnitude, distributed through the five roots
of the posterior segment, are counteracted by the forces
of occlusion.
A certain rigidity of wire material has been incor-
porated in the spring design to secure undisturbed struc-
ture of the activated spring, stability in placement of
the spring in the mucobuccal fold, and resistance
against masticatory functions. Increased rigidity is re-
flected by increased change of the force system pro-
duced by a certain amount of spring activation. How-
ever, small changes of the force system by large dis-
tances of activation are of primary concern in case of
difficulty of identification of the initial magnitude of
retraction force.
The present retraction spring allows the clinician to
determine the initial force with high precision by iden-
tification of the displacement of the loop windings.
CONCLUSION
Data based on electronic strain gauge experiments
have demonstrated the following:
1. The PG retraction spring (RM A 516, A 517)
can be used as a module for controlled retraction
of both canines and incisors.
2. The initial horizontal force of 100 gm suggested
for incisor retraction can be identified by the
shape of the activated spring.
3. The incisor segment intrusion is induced with a
magnitude of 10 to 25 gm on each side between
subsequent activations.
4. Reduced M / F ratio as a result of larger inter-
bracket distance by incisor retraction as com-
pared with canine retraction is compensated by
placement of the points of force application.
5. Unwanted reactive side effects induced to the
buccal segments are of sufficiently low magni-
tude to be counteracted by the forces of oc-
clusion.
6. Variability of the interbracket distance had no
significant influence on the magnitude of intru-
sion force produced by the spring.
7. Only minor clinical adjustments are needed to
modify the retraction spring from canine-to-
incisor retraction.
1 am grateful to M.Sc. Kim Andersen for valuable help
in development of computer programs essential to the inves-
tigation and to Prof. Birte Melsen and Prof. Louis A. Norton
for assistance in the final preparation of the manuscript.
Volume 10l Controlled retraction o f maxillary incisors 131
Number 2

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Reprint requests to:
Dr. Poul Gjessing
Department of Orthodontics
Royal Dental College
DK-8000, Aarhus C
Denmark

AAO MEETING CALENDAR

1992--St. Louis, Mo., May 9 to 13, St. Louis Convention Center
1993--Toronto, Canada, May 15 to 19, Metropolitan Toronto Convention Center
1994mOrlando, Fla., May 1 to 4, Orange County Convention and Civic Center
1995--San Francisco, Calif., May 7 to 10, Moscone Convention Center
(International Orthodontic Congress)
1996--Denver, Colo., May 12 to 16, Colorado Convention Center
1997--Philadelphia, Pa., May 3 to 7, Philadelphia Convention Center
1998--Dallas, Texas, May 16 to 20, Dallas Convention Center
1999~San Diego, Calif., May 15 to 19, San Diego Convention Center