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The Effects of Elastic Size and Archwire Type on 3-Dimensional Force Systems When Using Class II Interarch Elastics

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The Effects of Elastic Size and Archwire Type on 3-Dimensional Force Systems When Using Class II Interarch Elastics The Effects of Elastic Size and Archwire Type on 3-Dimensional Force Systems When Using Class II Interarch Elastics by Joseph Stanley A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science Medical Sciences – Orthodontics University of Alberta ©Joseph Stanley, 2017 Abstract Objectives: An orthodontic simulator (OSIM) device was used to compare the force systems generated by class II elastics on a ½ cusp class II malocclusion using four combinations of two elastic types and two archwire types. Methods: 3-dimensional forces and moments due to class II elastics were measured individually for each tooth (7-7) using Damon Q brackets on the maxillary and mandibular arches. Four test groups (n=44) were compared, each of a different combination of two elastic types (3/16", 2oz and 4.5oz) and two archwire types (0.014" nickel titanium and 0.019" x 0.025" stainless steel). Results: Only the upper canines and lower first molars recorded clinically significant forces (0.3N) and moments (5Nmm). 2oz and 4.5oz class II elastics produced clinically significant vertical extrusive forces and horizontal forces along the archwire to normalize a class II malocclusion. Stainless steel archwire minimized the extrusive forces of the 4.5oz elastics compared to nickel titanium archwire Conclusions: 2oz and 4oz class II elastics produced clinically significant vertical extrusive forces and horizontal forces along the archwire. Archwire type had no effect on 2oz class II elastics whereas 0.019" x 0.025"stainless steel significantly reduced the vertical extrusive effects of the larger 4.5oz elastics. ii Dedication To Jennifer, this was a tag team effort. Without you none of this would be possible. To Isaac, Elsa and Maud, you guys are my greatest accomplishment. I hope you can read this someday and be inspired to follow your dreams. To Mom and Dad, your love and support over the years is immeasurable. I am forever grateful. iii Acknowledgement Dr. Paul Major Dr. Daniel Romanyk Dr. Tarek El-Bialy Dr. Giseon Heo Dr. Jason Carey iv Table of Contents Chapter 1 – Introduction and Literature Review ................................................................. 1 1.1 Statement of the problem ..................................................................................................1 1.2 Introduction ......................................................................................................................1 1.2.1 Forces .......................................................................................................................................... 2 1.2.2 Center of Resistance, Center of Rotation and Moments ............................................................. 2 1.2.3 Couples ........................................................................................................................................ 7 1.2.4 Force Systems ............................................................................................................................. 9 1.2.5 Class II Malocclusion ................................................................................................................ 10 1.3 Significance ........................................................................................................................... 11 1.4 Research Aims ...................................................................................................................... 12 1.5 Hypothesis ............................................................................................................................. 12 1.6 Literature Review ................................................................................................................. 12 1.6.1 Class II Elastics ......................................................................................................................... 12 1.6.2 Quantitative and Qualitative Measurement of Force Systems .................................................. 17 1.7 Conclusion ............................................................................................................................ 24 1.8 References ............................................................................................................................. 25 Chapter 2: The Treatment of Class II Malocclusion Using Conventional Interarch Class II Elastics: A Systematic Review ............................................................................................ 32 2.1 Introduction .......................................................................................................................... 32 2.2 Methods ................................................................................................................................ 33 2.3 Results ................................................................................................................................... 35 v 2.4 Discussion.............................................................................................................................. 41 2.5 Conclusions ........................................................................................................................... 46 2.6 References ............................................................................................................................. 47 Chapter 3 - The Effects of Elastic Size and Archwire Type on 3-Dimensional Force Systems When Using Class II Interarch Elastics ............................................................................. 50 3.1 Introduction .......................................................................................................................... 50 3.2 Materials and methods .......................................................................................................... 51 3.2.1 Experimental design .................................................................................................................. 51 3.2.2 Materials and Equipment .......................................................................................................... 52 3.2.3 Preparing the OSIM .................................................................................................................. 53 3.2.4 Testing ....................................................................................................................................... 57 3.2.5 Statistical Analysis .................................................................................................................... 57 3.3 Results ................................................................................................................................... 58 3.3.1 Minimum Clinical Threshold for Tooth Movement .................................................................. 58 3.3.2 Maxillary Canines ..................................................................................................................... 59 3.3.3 Mandibular First Molars ............................................................................................................ 64 3.4 Discussion and Clinical Implications ..................................................................................... 69 3.5 Limitations of Study .............................................................................................................. 73 3.6 Conclusions ........................................................................................................................... 75 3.7 References ............................................................................................................................. 76 Chapter 4 – General Discussion ......................................................................................... 80 4.1 Final Discussion .................................................................................................................... 80 4.2 Recommendations and Future Research ............................................................................... 81 vi 4.3 References ............................................................................................................................. 83 Bibliography....................................................................................................................... 84 Chapter 1 References .................................................................................................................. 84 Chapter 2 References .................................................................................................................. 91 Chapter 3 References .................................................................................................................. 94 Chapter 4 References .................................................................................................................. 98 Appendix A – Search Strategy for Systematic Review. ...................................................... 99 Appendix B – Sample Size Calculation ............................................................................ 100 Appendix C- Descriptive data for the maxillary arch for NitiH, NitiL, SSH and SSL groups for all measured outputs (Fx, Fy, Fz, Mx, My and Mz). ....................................... 101 Appendix D- Pairwise Comparisons for the Maxillary Teeth for NitiH, NitiL, SSH and SSL Groups for all Measured Outputs (Fx, Fy, Fz, Mx, My and Mz) ...................................... 109 Appendix E- Descriptive Data for the Mandibular
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