European Journal of Orthodontics 30 (2008) 10–15 © The Author 2008.

thor 2008. Published by Oxford University Press on behalf of the European Orthodontic Society.
doi:10.1093/ejo/cjm098 All rights reserved. For permissions, please email: [email protected].

Initial effect of multiloop edgewise archwire on the mandibular

dentition in Class III malocclusion subjects. A three-dimensional
finite element study
Seung-Hak Baek, Soo-Jung Shin, Sug-Joon Ahn and Young-Il Chang
Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, South Korea

SUMMARY The purpose of this study was to compare the effect of a multiloop edgewise archwire
(MEAW) with a plain ideal archwire (IA) on distal en masse movement of the mandibular dentition. A

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three-dimensional finite element model (3D FEM) of the mandibular dentition, without third permanent
molars, was constructed to include the periodontal membrane (PDM), alveolar bone, standard edgewise
bracket (0.018 × 0.025 inch), stainless steel IA (0.016 × 0.022 inch), and MEAW (0.016 × 0.022 inch). Stress
distribution and displacement of the mandibular dentition were analyzed when Class III intermaxillary
elastics (300 g/side) and 5 degree tip-back bends from the first premolar to the second molar were applied
to the IA and the MEAW for distal en masse movement of the mandibular dentition.
Compared with the IA, the discrepancy in the amount of tooth displacement was less and individual tooth
movement with the MEAW was more uniform and balanced. There was minimal vertical displacement or
rotation of the teeth with the MEAW when compared with the IA. The MEAW seems to have advantages
for distal en masse movement of the mandibular dentition.

Introduction
incorporated in the MEAW together with intermaxillary
The incidence of a Class III malocclusion is predominant in elastics can allow individual tooth movements and make it
Korean orthodontic patients (48%; Yang, 1995) and mandibular possible to upright posterior teeth, to change the inclination
prognathism is one of the most prevalent complaints (Im of the occlusal planes, to correct the occlusal sagittal
et al., 2003). If the skeletal pattern of a Class III malocclusion relationship, and to obtain the correct intercuspation in a
is within the range of orthodontic treatment, fixed orthodontic significantly shorter time (Sato, 1992; Chang et al., 2004).
appliances with a dentoalveolar compensation mechanism Jin et al. (2004) reported that the main change after treat-
can achieve a normal occlusion (Ishikawa et al., 2000; Costa ment with the MEAW technique was dentoalveolar
Pinho et al., 2004; Janson et al., 2005). compensation.
There are numerous studies concerning the characteristics Although there are several studies concerning distal en
of dentoalveolar compensation according to the skeletal masse movement of the maxillary dentition (Chun and
pattern (Downs, 1948; Schudy, 1964; Sassouni, 1969; Nahm, 1991; Lee and Nahm, 1994; Chang et al., 2004),
Bibby, 1980; Casko and Sheperd, 1984; Choi and Yang, research is still required. The purpose of this study was to
1984; Chang and Moon, 1999; Kim et al., 2005). Jacobson investigate the effect of MEAW on initial stress distribution
(1975) suggested that a Class III molar relationship could and displacement for distal en masse movement of the
be changed into a Class I relationship as the occlusal plane mandibular dentition using a three-dimensional finite
would rotate upward and forward with Class III elastics. To element model (3D FEM).
correct an anterior crossbite and Class III molar relationship,
distal en masse movement of the mandibular dentition is
Materials and methods
usually required (Figure 1).
The multiloop edgewise archwire (MEAW, 0.016 × 0.022 A 3D FEM was used to construct the anatomical structures
inch, Permachrome standard, 3M Unitek, Monrovia, and physical characteristics of the mandibular teeth, the
California, USA) could be considered an effective tool for periodontal membrane (PDM), and the alveolar bones,
distal en masse movements (Kim, 1987; Baek and Yang, with restraints 3 mm below the apices of the mandibular
1991; Chun and Nahm, 1991; Sato, 1992; Yang et al., 2001; dentition (Figure 2). The reason for the restraints was to
Chang et al., 2004). In the finishing stages, engagement of permit movement of the teeth in the alveolar bone rather
full-size rectangular stainless steel wires of high stiffness than the basal bone. Fabrication of the 3D FEMs for each
into fully programmed brackets minimizes individual tooth tooth, PDM, alveolar bone, standard edgewise brackets
movement. However, multiple L-loops and tip-back bends (0.018 × 0.025 inch, 3M Unitek) and plain continuous ideal
EFFECT OF THE MEAW ON THE MANDIBULAR DENTITION 11

archwire (IA, 0.016 × 0.022 inch, 3M Unitek), and MEAW were considered to have linear elasticity and isometric
(0.016 × 0.022 inch) were followed using the protocol of properties of the same quality. Young’s modulus (Kgf/mm2)
Chang et al. (2004). and Poisson’s ratio for the tooth (2.0 × 103, 0.3), PDM
Briefly, 3D FEMs of the teeth were constructed according (6.8 × 10−2, 0.49), alveolar bone (1.4 × 103, 0.3), and
to Wheeler (1965), Choi and Yang (1984), and Kim et al. bracket and wire (21.4 × 103, 0.3) were allocated according
(1992). The maxillary and mandibular dentitions were to Tanne et al. (1987) and Chang et al. (2004). The 3D
aligned according to the Tru-arch form (medium size, FEMs for the teeth and standard edgewise brackets were
Ormco Co., West Collins Orange, California, USA). The 3D made with 3D quadrangular and hexagonal elements, the
FEMs of the PDM were constructed to fit outside of the root PDM with thin shell elements, and the IA and MEAW with
with a thickness of 0.25 mm (Coolidge, 1937) and those for 3D beam elements. The number of 3D elements was 9585,
the alveolar bone of the mandible to fit the PDM (Singh and the nodes of the IA and MEAW, 2175 and 2750,
et al., 1998, 2000). 3D FEMs of 0.018 × 0.025-inch standard respectively.
edgewise brackets (3M Unitek) were made and attached to Using an imaginary line that passed through the FA point

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the facial axis (FA) point of the clinical crown so that the of the crown parallel to the occlusal plane, displacements
centre of the bracket slot coincided with it (Andrews, 1972). could be measured at each point. The co-ordinate system
The 3D FEMs of posted IA and MEAW were designed consisted of X, Y, and Z axes perpendicular to one another.
according to Tru-arch form (medium size, Ormco Co.). The The X axis represented the mesiodistal direction, the Y axis
posts in the IA were positioned between the brackets of the the labiolingual or buccolingual direction, and the Z axis
mandibular lateral incisor and canine for Class III elastics. the vertical direction (Figure 3). It was possible to evaluate
After including 5 degree tip-back bends from the first tipping, bodily displacements, vertical displacements, and
premolar to the second molar, Class III elastics were applied rotations in three dimensions.
to the posts of the IA and the first L-loop of the MEAW When a Class III elastic force (300 g/side) was applied
between the mandibular lateral incisor and canine. The into the IA and MEAW with 5 degree tip-back bends, initial
amounts of torque in the IA and MEAW were adjusted to be displacement was simulated and measured in the 3D FEM.
passive in the bracket slot, as the aim of this study was to The computer system used in this study was an Indigo O2
investigate only distal en masse movement of the mandibular (R5500 Silicon Graphics, Mountain View, California,
dentition. USA) and the 3D FEM program, ANSYS (version 5.3,
Although the PDM is known to be a non-linear visco- Swanson Analysis System Inc., Canonsburg, Pennsylvania,
elastic material, the mechanical properties of 3D FEMs USA).

Figure 1 Biomechanics of the fixed orthodontic appliance treatment for

Class III malocclusions.

Figure 2 Oblique view of the three-dimensional finite element model of

the lower right dentition. The model consists of the teeth, periodontal Figure 3 The reference co-ordinate system. X axis, mesiodistal direction;
membrane, alveolar bone, and brackets. Y axis, labiolingual direction; Z axis, vertical direction.
12 S.-H. BAEK ET AL.

Results extrusion and intrusion was higher with the IA than with
the MEAW. However, there was no significant vertical
The IA showed that stress was concentrated on specific
displacement of the whole mandibular dentition with the
distal areas such as the mandibular canine and first premolar
MEAW (Figure 5E).
adjacent to the posts, where Class III elastics were applied
For the MEAW, distolingual rotations of the lateral
(Figure 4A). However, MEAW revealed relatively even
incisor and canine were prominent due to flexibility of the
distribution of stress throughout the whole dentition in spite
archwire between first L-loop and the adjacent teeth. In
of Class III elastics (Figure 4B).
contrast, rotation of posterior teeth was not observed with
The initial lingual and distal bodily displacements and
the MEAW (Figure 5F).
lingual tipping movements were concentrated on the anterior
part of the mandibular dentition (Figure 5A–C). However, the
amounts of these bodily displacements and tipping movements Discussion
with MEAW were lower and more uniform than with the IA.
Class III malocclusions can be corrected with a combination
For mesiodistal tipping movements, IA showed that distal

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of clockwise rotation of the mandible, counterclockwise
tipping movements occurred at the anterior teeth and mesial
rotation of the occlusal plane, and dentoalveolar
tipping movements at the mandibular premolars and first
compensation with distal en masse movement of the lower
molar (Figure 5D). Although mesiodistal tipping movements
dentition (Baek, 2006) (Figure 6). Chang et al. (2004)
with the MEAW demonstrated the same tendency as with
reported that the MEAW had the advantages of less
the IA, the values were lower and individual tooth movement
discrepancy in the amount of tooth displacement and
was more uniform with the MEAW than the IA (Figure
relatively more even distribution of stress throughout the
5D).
whole dentition than an IA. This means that distal en masse
For vertical displacements with the IA, extrusions
movement of the entire mandibular dentition could be more
occurred at the mandibular central incisor, premolars, and
easily carried out with the MEAW. The reason for these
first molar, with slight intrusion at the lateral incisor and
phenomena is due to the relatively lower load-deflection
canine (Figure 5E). The discrepancy in the amount of
ratio in the posterior segments of the MEAW, which
originates from the longer horizontal length of the L-loops
(Yang et al., 2001).
In addition, Jin et al. (2004) reported that the main change
after treatment of Class III malocclusions using the MEAW
technique was dentoalveolar compensation. They also found
that improvement in molar relationship and overjet was
achieved with upright and distal movement of the lower
posterior teeth. Therefore, it can be considered that MEAW
is more efficient for distal en masse movement than the IA.
If the IA cannot efficiently upright the lower molars distally,
the lower incisors have to be extruded and excessively
lingually tipped to rotate the mandibular occlusal plane
counterclockwise. This could negatively affect the stability of
the treatment result. However, the MEAW can effectively
upright the lower molars distally and minimize extrusion of
the lower incisors (Figure 5). Therefore, correction of a Class
III malocclusion will be relatively easier with the MEAW
than with the IA.
Long-term use of Class III elastics can result in extrusion
of the upper molars and labioversion of the upper incisors.
In patients with Class III malocclusions with hyperdivergent
facial patterns and labioversed upper incisors, it is not
desirable to use Class III elastics from the upper molar to the
lower anteriors. With the recent development of miniscrews,
Class III elastics from a miniscrew, inserted in the posterior
buccal gingival area of the upper arch, to a MEAW in the
lower arch can prevent these side-effects (Baek, 2006).
In order to evaluate the true relationship between tooth
Figure 4 Comparison of initial stress distribution of the mandibular
dentition between a continuous plain ideal archwire (A) and multiloop movement and orthodontic force, it is necessary to quantify
edgewise archwire (B). not only the force system applied to the teeth but also the
EFFECT OF THE MEAW ON THE MANDIBULAR DENTITION 13

Figure 5 Comparison of displacement, tipping, and rotation between the ideal archwire (IA) and the multiloop edgewise archwire (MEAW) with 5 degree Downloaded from https://academic.oup.com/ejo/article/30/1/10/474375 by guest on 09 August 2023
tip-back bends and Class III elastics. (A) Labiolingual bodily displacement; +, lingual displacement; –, labial displacement. (B) Mesiodistal bodily
displacement; +, mesial displacement; –, distal displacement. (C) Labiolingual tipping; +, crown lingual tipping; –, crown labial tipping. (D) Mesiodistal
tipping; +, crown mesial tipping; –, crown distal tipping. (E) Vertical displacement; +, intrusive translation; –, extrusive translation. (F) Rotation; +,
mesiolingual rotation; –, distolingual rotation. 1, right central incisor; 2, right lateral incisor; 3, right canine; 4, right first premolar; 5, right second premolar;
6, right first molar; 7, right second molar.

periodontal stress and strain generated by the orthodontic Chun and Nahm, 1991; McGuinness et al., 1992; Cobo et al.,
forces. Since periodontal stress is transferred to the alveolar 1993, 1996; Hwang and Suhr, 1994; Puente et al., 1996;
bone and induces bone remodelling and tooth movement, the Chang et al., 2004). However, these studies have some
amount of stress and strain in the PDM have been calculated limitations because only the initial movements that occur in
to quantify simulated orthodontic tooth movement using the PDM were calculated with the mathematical model. This
computer-based programs (Williams and Edmundson, 1984; initial movement should be differentiated from secondary
Tanne et al., 1987; Fotos et al., 1990; Andersen et al., 1991; movements that are mediated by continuous bone resorption
14 S.-H. BAEK ET AL.

the IA. The MEAW produced less extrusive vertical

displacement and rotation of each tooth compared with the
IA. Therefore, the MEAW might be a more suitable tool for
distal en masse movement of the mandibular dentition for
correction of Class III malocclusions.

Address for correspondence

Young-Il Chang
Department of Orthodontics
School of Dentistry
Seoul National University
Yeonkun-dong #28

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Jongro-ku
Seoul 110-768
South Korea
E-mail: [email protected]

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