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The Effectiveness of Differential Moment Strategies in Anchorage Control During Space Closure" (2000)

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The Effectiveness of Differential Moment Strategies in Anchorage Control During Space Closure University of Connecticut OpenCommons@UConn SoDM Masters Theses School of Dental Medicine June 2000 The ffecE tiveness of Differential Moment Strategies in Anchorage Control During Space Closure Derek N. Priebe Follow this and additional works at: https://opencommons.uconn.edu/sodm_masters Recommended Citation Priebe, Derek N., "The Effectiveness of Differential Moment Strategies in Anchorage Control During Space Closure" (2000). SoDM Masters Theses. 107. https://opencommons.uconn.edu/sodm_masters/107 THE EFFECTIVENESS OF DIFFERENTIAL MOMENT STRATEGIES IN ANCHORAGE CONTROL DURING SPACE CLOSURE Derek N. Priebe B.A., Arizona State University, 1988 D.D.S., University of the Pacific School of Dentistry, 1997 A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Dental Science at the University of Connecticut 2000 APPROVAL PAGE Master of Dental Science Thesis THE EFFECTIVENESS OF DIFFERENTIAL MOMENT STRATEGIES IN ANCHORAGE CONTROL DURING SPACE CLOSURE Presented by Derek N. Priebe, D.D.S. Major Advisor --....-~L.___./r~ Andfel;J. Kuhlberg b Associa~Ad~sor~~~~~~~~~~~~~~~~~~~~~~~~~ Ravindra Nanda ~/_ t.~ Associate Advisor_~~~~_=~Q_-~_-......-_;.~(~~~~~~~~_~~~_~_... I C Eung-Kwon Pae University of Connecticut 2000 ii PREFACE The field of biomechanics has been mindfully applied to the principles of orthodontic appliance design. The assumption, however, that the force system is the determinant factor in treatn1ent response has not been vigorously tested. The relationship between the appliance-delivered stimulus and the biological response, therefore, warrants clinical docllmentation. Analagous to the dose-response model of contemporary medicine, a "stimulus-response" model is useful in determining the effectiveness of the care promoted by our specialty. Because the act of orthodontic space closure typically involves substantial tooth displacement, it invites study of the effects of force system delivery and treatment response. From a clinical perspective, the delivery of appropriate force systems during space closure aims at efficient tooth movements and maintenance of anchorage. From the perspective of force system delivery approaches, the evaluation of pre-determined and preferential tooth movements during space closure will aid in testing a stimulus-response model of orthodontic treatment. Specifically, differential moment strategies for anchorage control hinge on the assumption of a force system stimulus-response model. A clinical study using qualitative force systems during extraction space closure will serve as an ideal arena for evaluating whether biomechanics "works the way it's supposed to." A non-randomized clinical trial was conducted to investigate a force system stimulus - tooth movement response model. Sixteen patients undergoing three months of en masse space closure with concomitant posterior anchorage served as subjects. T-loop retraction springs delivering, at the least, qualitative force systems were used as the iii stimulus. A carefully designed cephalometric approach was used to assess the response. The findings suggest that the force system does in fact predict the dental response. Preferential retraction of six maxillary anterior teeth occurred with little displacement of two maxillary molars serving as anchorage units (p < 0.0001). The physics of the force system are therefore predictive of the resultant dental displacements despite a biologic environment. While the average responses prompt a rejection of the null hypothesis, a substantial amOllnt of intra- and inter-subject variability was documented. Nevertheless, the significance of this investigation is the documentation of a short-term response to a qualitative stimulus without confounding effects of continued treatment. The docllmentation of responses occurring as a result of relatively discrete stimuli enhance the orthodontists' ability to make reasonably predictable in-course corrections. iv ACKNOWLEDGEMENTS The act of research and thesis preparation is analagous to many of life's pursuits; one's endeavors are often characterized by the ebb and flow of progress. Indeed, net success is dependent on careful planning, problem solving, and resolve. Any achievement, however, is impossible without the unselfish support of one's peers, mentors and family ("it takes a village..." so to speak). The production of this investigation is a clear example of the redoubt of collaboration and is ultimately much less a product of the principal author as it is several individuals. DR. ANDREW J. KUHLBERG The execution of this manuscript would have been absolutely impossible if it were not for the lucid support and tutelage of Dr. Andrew J. Kuhlberg. Featured prominently in several contemporary thesis acknowledgements, Andy is the heart and soul of clinical orthodontic research at the University of Connecticut. He demonstrates vision and sagacity well beyond his years. In short, he's a one man "think tank." Without Andy's presence in the department, my education would be a fractional shadow of what it has become. Most importantly, Andy has become my friend with whom I hope to maintain close collaboration over the years to come. DR. RAVINDRA NANDA Just slightly over three years ago, I received a personal phone call from a department chair offering an interview for a spot in the program. That, in itself, nearly concluded a difficult decision. Since then, Dr. Nanda has been like a father to me with a keen perception of life. Dr. Nanda has been a shining light and inspiration to dozens of v orthodontic residents. lowe my current and future career to Dr. Nanda for "taking a chance on me." DR. EUNG-KWON PAE Dr. Pae has always taken the time out of an impossible schedule to listen to the myriad of problems arising during the preparation of this project. His selfless suggestions have been instrumental in improving the research design and statistical methods of this project. DR. STEPHEN GODWIN G-ratitude goes to Dr. Godwin for keeping this project moving along in a timely manner. He's offered both positive support and constructive suggestions. RESIDENTS The difficult task of patient selection was supported admirably by the exceptional residents of the Orthodontics Class of 2001. Notably, this project would have fallen short without the alert help of Drs. Danielle Battisti, Jeff Blasius, and Zack Faber. I also owe thanks to Dr. Sunil "Hey Buddy" Wadhwa for acting as my counselor and friend over the three years of my residency. Thank-you, I'm indebted to you all! MY FAMILY Finally, lowe all my success to the love of my wife Ingvild, my two wonderful children, Annika and Anders, and my parents, Mary and Phil Priebe. My wife especially deserves a medal for being a citadel of support as I've hauled her from one corner of North America to another. Ingvild and Mom and Dad, you've stuck by me over the years and have selflessly offered your love and support at great sacrifice. Annika and Anders, you are my precious little gems! I love you all, and to you I dedicate this work. VI TABLE OF CONTENTS Chapter I INTRODUCTION and REVIEW OF LITERATURE 1 Dental Anchorage Control dllring Space Closure 2 Force Magnitudes and Optimum Orthodontic Forces 9 Force Systems and Biomechanics in Orthodontics 21 Moment-to-Force Ratios and Centers of Rotation 21 Differential Moment Strategies in Anchorage Control 26 Chapter II OBJECTIVES and RATIONALE 32 Hypotheses 33 Chapter III EXPERIMENTAL METHOD 34 Sample 34 Materials and Method 35 T-Loop Force System 36 Recording Technique 39 Superimposition Method 40 Measurement Technique 41 Data Handling 42 Measurenlent Error Method 42 vii Chapter IV RESULTS 43 Observation Period 43 Measllrement Error 43 Total Space Closure 43 Anchorage Maintenance and Anterior Retraction 44 Vertical Response 45 Angular Response 45 Chapter V DISCUSSION 47 Anteroposterior and Angular Responses 48 Vertical Responses 49 Observed Variation 51 Variation as the Fllnction of the Stimulus 52 Variation as the Function of Biologic Factors 53 Variation as a Function of the Measurement Technique 54 Chapter VI SUMMARY 56 CONCLUSIONS 57 BIBLIOGRAPHY 77 viii LIST of TABLES Table I Force System Produced by Asymmetrically Placed T-Loops 74 Table II Error Standard Deviation of Repeat Measurements 75 Table III Variable Means, Standard Deviations, and Ranges 76 IX LIST OF FIGURES Figure 1: Graphic ofGeometric Description ofDifferential Tooth Movement 58 Figure 2: Graphic ofBiologic Description ofDifferential Tooth Movement 59 Figure 3: Differential Moment Force System 60 Figure 4: Pre-fabricated .017" by .025" f3-titanium closing loop arch wire 61 Figure 5: Schematic ofloop position with 2.0 mm off-set 62 Figure 6: Intra-oral photo ofactivated closing loop with 2.0 mm off-set 63 Figure 7: Cephalometric radiograph with TPLDs 64 Figure 8: Tracing superimposition ofT] and T2 films with TPLD images representing dental changes 65 Figure 9: Distribution ofobservation periods 66 Figure 10: Distribution oftotal space closure 67 Figure 11: Distribution ofnormalized anteroposterior tooth movements - Anchorage Loss 68 Figure 12: Distribution ofnormalized anteroposterior tooth movements - canine retraction versus anchorage 69 x Figure 13: Distribution ofmolar vertical response 70 Figure 14: Distribution ofcanine vertical response 71 Figure 15: Distribution ofcanine and molar angular response 72 Figure 16: Graphic illustration ofmean molar and canine anteroposterior, Vertical and angular responses 73 Xl Ie Introduction and Review of Literature The field of biomechanics has been mindfully
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