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THE EFFECTS OF THIRD-ORDER TORQUE AND SELF-LIGATING<br />

ORTHODONTIC BRACKET TYPE ON SLIDING FRICTION: A COMPARATIVE<br />

STUDY<br />

Michael J. Chung, D.D.S.<br />

An Abstract Presented to the Faculty <strong>of</strong> the Graduate School<br />

<strong>of</strong> <strong>Saint</strong> <strong>Louis</strong> <strong>University</strong> in Partial Fulfillment<br />

<strong>of</strong> the Requirements for the Degree <strong>of</strong><br />

Master <strong>of</strong> Science in Dentistry<br />

2007


Abstract<br />

Few studies have evaluated the effect <strong>of</strong> wire-slot<br />

<strong>torque</strong> on sliding friction. Apparently, no studies have<br />

been published to date that compare friction across<br />

categories <strong>of</strong> <strong>self</strong>-ligating brackets when <strong>third</strong>-<strong>order</strong><br />

positioning is controlled. <strong>The</strong> purpose <strong>of</strong> this study was<br />

to determine the <strong>effects</strong> <strong>of</strong> wire-slot <strong>torque</strong> <strong>and</strong> type <strong>of</strong><br />

<strong>self</strong>-ligating bracket on the average kinetic friction in<br />

sliding mechanics with a 0.019- x 0.025-inch stainless<br />

steel archwire. Five sets <strong>of</strong> crown-attachments (including<br />

In-Ovation R, Time2, Damon 3MX, SmartClip <strong>and</strong> Victory<br />

brackets) were tested for frictional resistance in a<br />

simulated posterior dental segment with -15, -10, -5, 0,<br />

+5, +10, <strong>and</strong> +15 degrees <strong>of</strong> <strong>torque</strong> placed in the maxillary<br />

right second-premolar bracket.<br />

Increasing the <strong>torque</strong> from 0 to ±15 degrees produced<br />

significant increases <strong>of</strong> frictional resistance in all five<br />

<strong>of</strong> the tested attachment-sets. At 0 degrees <strong>of</strong> <strong>torque</strong>, the<br />

sets with passive <strong>self</strong>-ligating brackets produced less<br />

friction than the sets with active <strong>self</strong>-ligating brackets,<br />

<strong>and</strong> all four <strong>self</strong>-ligating bracket sets produced<br />

significantly less friction than the set with<br />

elastomerically ligated Victory brackets. At ±10 degrees


<strong>of</strong> <strong>torque</strong>, all five attachment sets displayed similar<br />

resistances with the exception <strong>of</strong> the In-Ovation R set at<br />

+10 degrees. At ±15 degrees <strong>of</strong> <strong>torque</strong>, the In-Ovation R<br />

<strong>and</strong> the SmartClip sets produced significantly larger<br />

frictional resistances than the other three sets.<br />

<strong>The</strong> data suggest that the presence <strong>of</strong> <strong>third</strong>-<strong>order</strong><br />

<strong>torque</strong> can influence the kinetic frictional resistances in<br />

posterior dental segments during anterior retraction using<br />

sliding mechanics with <strong>self</strong>-ligating brackets <strong>and</strong> that<br />

frictional resistance will increase at a greater rate when<br />

the <strong>torque</strong> exceeds ±10 degrees with the present combination<br />

<strong>of</strong> sizes <strong>of</strong> slots <strong>and</strong> wire. Furthermore, whether a <strong>self</strong>-<br />

ligated bracket is active or passive may not be clinically<br />

significant regarding friction in the presence <strong>of</strong> <strong>torque</strong><br />

approaching <strong>and</strong> exceeding 15 degrees.


THE EFFECTS OF THIRD-ORDER TORQUE AND SELF-LIGATING<br />

ORTHODONTIC BRACKET TYPE ON SLIDING FRICTION: A COMPARATIVE<br />

STUDY<br />

Michael J. Chung, D.D.S.<br />

A <strong>The</strong>sis Presented to the Faculty <strong>of</strong> the Graduate School <strong>of</strong><br />

<strong>Saint</strong> <strong>Louis</strong> <strong>University</strong> in Partial Fulfillment<br />

<strong>of</strong> the Requirements for the Degree <strong>of</strong><br />

Master <strong>of</strong> Science in Dentistry<br />

2007


COMMITTEE IN CHARGE OF CANDIDACY:<br />

Assistant Pr<strong>of</strong>essor Donald R. Oliver,<br />

Chairperson <strong>and</strong> Advisor<br />

Assistant Pr<strong>of</strong>essor Ki Beom Kim,<br />

Adjunct Pr<strong>of</strong>essor Robert J. Nikolai<br />

i


To my wife, Sahrip, <strong>and</strong> my parents...<br />

Thank you for all your love <strong>and</strong> support.<br />

ii


ACKNOWLEDGEMENTS<br />

<strong>The</strong> author wishes to acknowledge all <strong>of</strong> the<br />

individuals who assisted him with this project. He would<br />

like to thank Dr. Donald R. Oliver, Dr. Robert J. Nikolai,<br />

Dr. Ki Beom Kim, Mr. Joe Tricamo, Dr. Heidi Israel, <strong>and</strong><br />

Dr. Binh Tran.<br />

<strong>The</strong> author would also like to thank Mr. John Sherrill<br />

<strong>and</strong> Ormco Corporation, Mr. Kevin Harrison <strong>and</strong> 3M/Unitek<br />

Corporation, Mr. Ted Reed <strong>and</strong> GAC International, <strong>and</strong> Mr.<br />

Brian Horn <strong>and</strong> American Orthodontics for supplying the<br />

brackets for this study.<br />

iii


TABLE OF CONTENTS<br />

List <strong>of</strong> Tables...........................................v<br />

List <strong>of</strong> Figures.........................................vi<br />

CHAPTER 1: INTRODUCTION..................................1<br />

CHAPTER 2: REVIEW OF THE LITERATURE<br />

Classical friction............................3<br />

Friction in orthodontics......................5<br />

Factors influencing friction .................9<br />

Archwires..................................9<br />

Brackets..................................15<br />

Ligation..................................19<br />

Other factors influencing friction........27<br />

Summary......................................34<br />

References...................................35<br />

Tables.......................................47<br />

CHAPTER 3: JOURNAL ARTICLE<br />

Abstract.....................................48<br />

Introduction.................................50<br />

Materials <strong>and</strong> Methods........................56<br />

Results......................................62<br />

Discussion...................................64<br />

Conclusions..................................70<br />

References...................................72<br />

Tables.......................................80<br />

Figures......................................84<br />

Vita Auctoris...........................................90<br />

iv


LIST OF TABLES<br />

Table 2-1: Partial Overview <strong>of</strong> Self-Ligating<br />

Brackets................................. 47<br />

Table 3-1: Frictional-force means <strong>and</strong> st<strong>and</strong>ard<br />

deviations in grams at seven <strong>torque</strong> angles<br />

at the second premolar from five sets <strong>of</strong><br />

crown-attachments.........................80<br />

Table 3-2: Significance levels (α = 0.05) <strong>of</strong><br />

differences in mean frictional forces across<br />

pairs <strong>of</strong> cells, each cell defined by a<br />

<strong>torque</strong>-angle, from five sets <strong>of</strong> crownattachments...............................81<br />

Table 3-3: Summary from Kruskal-Wallis analyses <strong>of</strong><br />

variance <strong>of</strong> frictional forces for seven<br />

<strong>torque</strong>-angles across five sets <strong>of</strong> crownattachments...............................82<br />

Table 3-4: Mean differences in frictional resistances<br />

in grams <strong>and</strong> significance levels (α = 0.05)<br />

between attachment sets at each <strong>of</strong> the seven<br />

<strong>torque</strong> angles.............................83<br />

v


LIST OF FIGURES<br />

Figure 3-1: Four cylinders mounted in aluminum base<br />

plate <strong>of</strong> the friction testing device......84<br />

Figure 3-2: Bracket-slot positioning template.........84<br />

Figure 3-3: Control <strong>of</strong> the <strong>third</strong>-<strong>order</strong> position <strong>of</strong> the<br />

second premolar bracket-slot..............85<br />

Figure 3-4: SLBUCCAL tube.............................85<br />

Figure 3-5: Damon 3MX bracket.........................85<br />

Figure 3-6: SmartClip bracket.........................86<br />

Figure 3-7: In-Ovation R bracket......................86<br />

Figure 3-8: Time2 bracket.............................86<br />

Figure 3-9: Victory bracket...........................87<br />

Figure 3-10: Friction testing setup mounted to the<br />

Instron Universal Testing Machine.........87<br />

Figure 3-11: Plots <strong>of</strong> mean kinetic frictional force<br />

within the dental segment vs. <strong>torque</strong> angle<br />

at the second premolar from five sets <strong>of</strong><br />

crown-attachments.........................88<br />

Figure 3-12: Cross-section diagrams <strong>of</strong> a 0.019- x 0.025inch<br />

wire. <strong>The</strong> buccolingual dimension <strong>of</strong><br />

the wire when rotated 10 degrees (line BD)<br />

is calculated by multiplying cosΦ2 by the<br />

hypotenuse AB.............................89<br />

vi


CHAPTER 1: INTRODUCTION<br />

<strong>The</strong> specialty <strong>of</strong> orthodontics has been going through a<br />

period <strong>of</strong> considerable research interest in the role <strong>of</strong><br />

friction during tooth movement. Within the past 30 years,<br />

studies have focused on both the contact between the wire<br />

<strong>and</strong> the bracket- or tube-slot as a potential source <strong>of</strong><br />

frictional resistance during sliding mechanics <strong>and</strong> the many<br />

associated factors that can affect that resistance to tooth<br />

movement. <strong>The</strong>se experiments have identified variables in<br />

the archwire, bracket, ligature <strong>and</strong> oral environment as<br />

contributors to frictional forces.<br />

With recent advances in orthodontic technologies, such<br />

as new <strong>self</strong>-ligating bracket designs <strong>and</strong> archwire alloys,<br />

orthodontists have developed systems aimed at maximizing<br />

the efficiency <strong>of</strong> treatment. Today fewer archwires are<br />

placed, <strong>and</strong> treatment phases have been merged that were<br />

previously carried out individually. <strong>The</strong> gaining<br />

popularity <strong>of</strong> sliding mechanics has made further research<br />

on the role <strong>of</strong> friction necessary.<br />

Previous studies have evaluated friction by pulling<br />

the wire through the bracket-slot <strong>and</strong> measuring the force<br />

required to produce the sliding displacement. Many<br />

investigations have examined single brackets with various<br />

1


combinations <strong>of</strong> bracket-slot <strong>and</strong> wire materials, ligature<br />

type, slot-positioning <strong>and</strong> other pertinent parameters.<br />

Research designs have recently attempted to simulate<br />

clinical environments with multiple crown-attachments<br />

placed in series or in an archform.<br />

<strong>The</strong> present research was designed to answer several<br />

timely questions about friction in orthodontics.<br />

Apparently no studies have been published to date that<br />

compare friction across categories <strong>of</strong> <strong>self</strong>-ligating<br />

brackets with <strong>third</strong>-<strong>order</strong> positioning controlled. <strong>The</strong><br />

purpose <strong>of</strong> this study was to determine the effect <strong>of</strong> wire-<br />

slot <strong>torque</strong> on friction in <strong>self</strong>-ligating brackets with an<br />

engaged, 0.019- x 0.025-inch, stainless steel archwire. In<br />

addition, the influence <strong>of</strong> the design <strong>of</strong> various ligating<br />

mechanisms on kinetic friction with active <strong>torque</strong> present<br />

in the wire <strong>and</strong>/or slot was also evaluated.<br />

2


CHAPTER 2: REVIEW OF THE LITERATURE<br />

Classical Friction<br />

In the orthodontic literature, friction was discussed<br />

as early as 1960 when Stoner 1 warned <strong>of</strong> the difficulty in<br />

determining the amount <strong>of</strong> force to be applied to a tooth<br />

because <strong>of</strong> the role <strong>of</strong> frictional resistance. Our current<br />

underst<strong>and</strong>ing <strong>of</strong> friction impairing tooth movement is based<br />

largely on long-st<strong>and</strong>ing theories, not directly related to<br />

orthodontics, by Leonardo Da Vinci, Guillaume Amontons, <strong>and</strong><br />

Charles-Augustin Coulomb. Although Da Vinci’s work was not<br />

published until the other investigators had carried out<br />

friction experiments, he left behind the earliest known<br />

studies on the subject in a collection <strong>of</strong> journals in which<br />

he detailed his research. 2 Collectively, these scientists<br />

are credited with establishing the classical laws <strong>of</strong><br />

friction, or the Amontons-Coulomb laws, which state the<br />

following: 1. Frictional force is proportional to normal<br />

force; 2. Frictional force is independent <strong>of</strong> contact-area;<br />

3. Frictional force is independent <strong>of</strong> sliding velocity. 2,3<br />

Friction is defined as the resistance to motion<br />

when one object moves or tends to move tangentially<br />

relative to another object. 4 <strong>The</strong> total contact-force<br />

3


etween the objects is expressed as two components when<br />

there is attempted or actual relative displacement between<br />

surfaces in contact. One component, the normal force, is a<br />

pushing force with an orientation perpendicular to the<br />

shared contact-surface. <strong>The</strong> frictional force component<br />

impedes the motion between the surfaces <strong>and</strong> is, therefore,<br />

opposite in direction to that <strong>of</strong> intended or actual motion. 5<br />

<strong>The</strong> maximum static or the kinetic frictional force (F)<br />

tangent to the two surfaces is <strong>of</strong>ten hypothesized as<br />

proportional to the normal force, as expressed by the<br />

equation F = µN, where µ is the coefficient <strong>of</strong> friction<br />

between the surfaces, <strong>and</strong> N is the normal-force magnitude<br />

against the contact-surface <strong>of</strong> the object to be displaced. 6<br />

Each <strong>of</strong> two coefficients <strong>of</strong> friction is a constant which is<br />

related to characteristics <strong>of</strong> the contacting surfaces <strong>of</strong><br />

the objects; they are known as the static <strong>and</strong> kinetic<br />

coefficients <strong>of</strong> friction. 7 Ordinarily in static situations,<br />

the frictional force is just large enough to prevent<br />

relative tangential movement. Maximum static friction<br />

refers to the resistance to displacement encountered at the<br />

onset <strong>of</strong> motion; it corresponds to the smallest action<br />

required to initiate motion between surfaces that are at<br />

rest. Kinetic friction is the frictional force that<br />

impedes displacement during sliding motion between the<br />

4


surfaces. 6 <strong>The</strong> magnitudes <strong>of</strong> the coefficients <strong>of</strong> friction<br />

are generally between zero <strong>and</strong> one. 5<br />

Friction in Orthodontics<br />

Because frictional force acts in a direction opposite<br />

to the intended path <strong>of</strong> the object to be displaced, <strong>and</strong><br />

sliding mechanics are commonplace in orthodontic therapy,<br />

an underst<strong>and</strong>ing <strong>of</strong> friction is necessary to achieve<br />

optimal clinical results. Fixed-appliance therapy usually<br />

involves some relative wire-slot displacement in various<br />

phases <strong>of</strong> treatment; hence, the generation <strong>of</strong> friction<br />

during tooth movement can be problematic for the<br />

orthodontist. Because a portion <strong>of</strong> the force for delivery<br />

to a tooth-crown may be necessary to overcome frictional<br />

resistance, the orthodontist must be sure to use a force <strong>of</strong><br />

sufficient magnitude to also initiate a biological response<br />

in the supporting tissues. 7 Frictional resistance is<br />

thought play a role in delayed tooth movement, undesired<br />

movement <strong>and</strong> loss <strong>of</strong> anchorage. 6 Examination <strong>of</strong> its effect<br />

on orthodontic anchorage, however, reveals that, in some<br />

situations, the presence <strong>of</strong> friction at the anchor teeth<br />

can be desirable, because it helps to prevent unwanted<br />

movement <strong>of</strong> those teeth. Even so, a problem lies in the<br />

5


fact that the magnitude <strong>of</strong> resistance is unknown. <strong>The</strong><br />

orthodontist is, then, guessing how much force is needed to<br />

move teeth without straining anchorage. 8<br />

<strong>The</strong> application <strong>of</strong> sliding mechanics in orthodontics<br />

has increased since the introduction <strong>of</strong> the pre-adjusted<br />

edgewise appliance system. 9 <strong>The</strong> process can involve the<br />

guidance <strong>of</strong> a tooth along a continuous archwire or the<br />

movement <strong>of</strong> the wire through crown-attachment slots. In<br />

particular, overjet reduction <strong>and</strong> space closure have been<br />

traditionally accepted applications <strong>of</strong> sliding mechanics.<br />

In a first premolar extraction case, a space is created<br />

between the canine <strong>and</strong> the second premolar. In the<br />

presence <strong>of</strong> maximum anchorage, the canine would first be<br />

retracted bodily with the archwire guiding its<br />

displacement. This single-tooth movement would likely<br />

create unwanted friction that could cause “side <strong>effects</strong>”<br />

such as uncontrolled tipping, loss <strong>of</strong> posterior anchorage,<br />

or deepening <strong>of</strong> the overbite. 10 Forces acting posteriorly<br />

on the anterior portion <strong>of</strong> the archwire would then be<br />

created to retract the incisors into the remaining spaces<br />

while allowing the excess wire to slide through the<br />

posterior brackets <strong>and</strong> tubes. Any friction in the buccal<br />

segments would hinder the movement <strong>of</strong> the incisal segment<br />

<strong>and</strong>, therefore, could delay space closure. 11<br />

6


Since the introduction to orthodontics in the 1970s <strong>of</strong><br />

nickel-titanium alloy archwires, sliding mechanics can also<br />

be present in the initial stages <strong>of</strong> orthodontic treatment.<br />

<strong>The</strong>se very flexible archwires have gradually replaced<br />

multi-loop stainless steel wires for leveling <strong>and</strong> aligning<br />

teeth. Nickel-titanium alloy wires exhibit small load-<br />

deformation rates <strong>and</strong> “superelasticity.” <strong>The</strong>se properties<br />

enable relatively light <strong>and</strong> nearly constant forces over<br />

large deflections without significant permanent deformation<br />

<strong>of</strong> the wire, permitting easy engagement into misaligned<br />

bracket-slots. 12 <strong>The</strong> activated wire can then be left to<br />

guide the teeth into position as it returns to its<br />

original/pre-engagement shape. <strong>The</strong> objective <strong>of</strong> this stage<br />

<strong>of</strong> therapy is to produce simultaneous tooth movements such<br />

as leveling the arch, extruding “high” canines, correcting<br />

tooth rotations <strong>and</strong> modifying archforms. 13 A misaligned<br />

dental arch will require greater lengths <strong>of</strong> wire than a<br />

well-aligned arch to compensate for enlarged interbracket<br />

distances. As the brackets come into alignment, the teeth<br />

move into their correct spatial positions, <strong>and</strong> segments <strong>of</strong><br />

an unstopped archwire that were “reaching” to the<br />

misaligned positions will slide through the adjacent<br />

bracket-slots <strong>and</strong> tubes. 11,14,15 In 1997 Meling et al. 14 found<br />

that friction in a crowded dental arch would reduce the<br />

7


sizes <strong>of</strong> forces delivered to the crowns by the wire during<br />

deactivation, especially with a light leveling wire. <strong>The</strong><br />

authors concluded that careful ligation to minimize<br />

friction was important for delivery <strong>of</strong> expected force<br />

magnitudes. It is as early as placement <strong>of</strong> this initial<br />

wire that friction becomes a concern to the orthodontist.<br />

<strong>The</strong> classical laws <strong>of</strong> friction <strong>of</strong>fer only a partial<br />

explanation <strong>of</strong> friction in orthodontic systems. <strong>The</strong><br />

original theories by Amontons <strong>and</strong> Coulomb were derived from<br />

dry friction mechanics with distinct static <strong>and</strong> kinetic<br />

frictional phases, defined by zero velocity <strong>and</strong> constant<br />

velocity, respectively. Tooth movement in orthodontics,<br />

however, occurs at such low velocities, that these two<br />

phases are clinically interrelated. 3 Although the first two<br />

laws <strong>of</strong> friction would be unaffected by this application,<br />

the <strong>third</strong> law <strong>of</strong> friction may not accurately describe<br />

orthodontic friction in vivo. As the velocity <strong>of</strong> tooth<br />

movement approaches zero, instability in steady sliding is<br />

likely, due to interlocking <strong>and</strong> shearing <strong>of</strong> asperities, the<br />

peaks <strong>of</strong> microscopic surface irregularities. This effect<br />

is evident in the phenomenon known as “stick-slip motion”;<br />

a cycle involves a “stick state” where elastic loading<br />

occurs, <strong>and</strong> a “slip” where sudden sliding <strong>and</strong> stress-<br />

relaxation occur. 3,8 Nonetheless, Rossouw’s group 3 concluded<br />

8


that the application <strong>of</strong> the Amontons-Coloumb laws is<br />

justified in orthodontic in vitro analyses if sliding<br />

velocity is assumed constant.<br />

Factors Influencing Friction in Orthodontics<br />

<strong>The</strong> now frequent presence <strong>of</strong> sliding mechanics in<br />

orthodontic therapy has produced considerable research<br />

interest in friction generated between crown-attachment<br />

slot <strong>and</strong> archwire. Many studies have collectively<br />

identified factors that can contribute to friction within<br />

the fixed orthodontic appliance. Although it is known that<br />

many <strong>of</strong> these influences are interrelated, discussing them<br />

individually perhaps helps to better clarify their<br />

relationships to friction.<br />

Archwires<br />

During the past century, orthodontists have made<br />

selections from a wide range <strong>of</strong> marketed archwires. From<br />

gold wires that dominated early in the twentieth century to<br />

today’s ß-titanium <strong>and</strong> nickel-titanium alloys, the<br />

broadening <strong>of</strong> wire property values has continually changed<br />

the way orthodontics is practiced. 16 A number <strong>of</strong> archwire<br />

parameters have been found to contribute to friction at the<br />

9


interface <strong>of</strong> wire <strong>and</strong> crown-attachment slot. <strong>The</strong>se<br />

parameters are alloy composition, surface-roughness, <strong>and</strong><br />

cross-sectional shape <strong>and</strong> size.<br />

Alloy Composition<br />

At angulations in which second-<strong>order</strong> binding existed<br />

<strong>of</strong> the wire within the bracket-slot, Frank <strong>and</strong> Nikolai 5<br />

found that nickel-titanium alloy wires produced smaller<br />

maximum static frictional forces than did a stainless steel<br />

wire <strong>of</strong> the small size, likely due to the smaller modulus<br />

<strong>of</strong> elasticity <strong>of</strong> the former alloy. One <strong>of</strong> the many<br />

important findings from this study was that, due to<br />

variances in modulus <strong>of</strong> elasticity <strong>and</strong> surface roughness<br />

across as-received wires, archwire-alloy influenced<br />

frictional resistance. Since then, dozens <strong>of</strong> studies have<br />

compared frictional force values generated across wires<br />

differing by alloy. Some experimental studies have<br />

suggested that, typically within stainless steel slots,<br />

stainless steel wires tend to produce less sliding friction<br />

than nickel-titanium alloy wires. 17-30 When testing with<br />

second-<strong>order</strong> angulations that produce binding within the<br />

bracket-slot, however, other studies have reported less<br />

friction with the nickel-titanium alloy wires. 4,5,31-34 This<br />

behavior is related to the modulus <strong>of</strong> elasticity for the<br />

10


archwires. At binding angulations, two contacts form at<br />

the ends <strong>of</strong> the bracket-slot, one on the occlusal face <strong>of</strong><br />

the wire <strong>and</strong> one on the gingival face. As the wire<br />

deflects upon activation, those wires with a greater<br />

modulus <strong>of</strong> elasticity will produce larger normal bracket-<br />

wire contact forces at those contact points. 5,48 Several<br />

investigations have found that ß-titanium alloy wires have<br />

greater resistance to sliding than either stainless steel<br />

or nickel-titanium alloy wires, particularly in the absence<br />

<strong>of</strong> binding. 18,20-24,26,27,29,35,36 Tspelepsis <strong>and</strong> associates 33<br />

failed to detect any such differences across the three<br />

alloys.<br />

Surface Characteristics<br />

Frank <strong>and</strong> Nikolai 5 found that, with small, nonbinding<br />

angulations <strong>and</strong> in stainless steel slots, stainless steel<br />

wires exhibited less sliding frictional resistance than<br />

nickel-titanium alloy wires. This difference was thought<br />

to be related to the roughness <strong>of</strong> the wire-alloy surface.<br />

This property <strong>of</strong> a wire is determined by characteristics <strong>of</strong><br />

the alloy, the manufacturing process, any surface treatment<br />

<strong>and</strong>, for some materials, the shelf-time <strong>and</strong>/or use-time. 5<br />

Other researchers have speculated that the greater friction<br />

produced by titanium alloy wires when compared to stainless<br />

11


steel wires could be a result <strong>of</strong> the relative roughness <strong>of</strong><br />

the contacting wire <strong>and</strong> slot surfaces. 5,18,23<br />

Kusy et al. 37 used a laser-spectrometer <strong>and</strong> the<br />

specular-reflectance technique to measure surface-<br />

roughnesses <strong>of</strong> wires <strong>of</strong> four materials, <strong>and</strong> found the<br />

surface <strong>of</strong> a nickel-titanium alloy wire to be the roughest<br />

followed, in <strong>order</strong>, by wire surfaces <strong>of</strong> ß-titanium,<br />

chromium-cobalt, <strong>and</strong> orthodontic stainless steel alloys.<br />

Using the same procedure, Kusy <strong>and</strong> Whitley 38 assessed the<br />

effect <strong>of</strong> surface topography on coefficients <strong>of</strong> friction<br />

for these alloys, <strong>and</strong> concluded that low wire surface<br />

roughness was not a sufficient condition for a small<br />

frictional coefficient. Prososki, Bagby <strong>and</strong> Erickson 11<br />

showed similar results, finding no statistically<br />

significant correlation between surface-roughness <strong>and</strong><br />

frictional resistance from as-received archwires <strong>of</strong> common<br />

alloys. Although the surface <strong>of</strong> a ß-titanium archwire is<br />

less rough than that <strong>of</strong> nickel-titanium alloys, researchers<br />

have consistently shown greater in-slot frictional<br />

resistance to sliding from the former wire. 11,24,38,39<br />

Burstone <strong>and</strong> Farzin-Nia 40 have suggested that the relative<br />

s<strong>of</strong>tness <strong>of</strong> the ß-titanium alloy wire-surface compared to<br />

the harder stainless steel surface is a reason for the<br />

former’s greater frictional resistance.<br />

12


A phenomenon known as “cold welding” has been proposed<br />

as an explanation for greater friction potentials found<br />

with nickel-titanium <strong>and</strong> ß-titanium alloy wires. As the<br />

fraction <strong>of</strong> titanium in the alloy increases, the reactivity<br />

<strong>of</strong> its surface with other alloy-surfaces increases; nickel-<br />

titanium <strong>and</strong> ß-titanium alloys have titanium contents <strong>of</strong><br />

about 50% <strong>and</strong> 80%, respectively. 41 Kusy <strong>and</strong> Whitley 24 found<br />

adhesions in the bracket-slots from scanning electron<br />

micrographs after drawing ß-titanium alloy wires through<br />

stainless steel bracket-slots in <strong>order</strong> to calculate the<br />

coefficients <strong>of</strong> friction. X-ray spectra <strong>of</strong> this debris<br />

were obtained, <strong>and</strong> they showed elements <strong>of</strong> the ß-titanium<br />

alloy. <strong>The</strong> authors concluded that the primary cause for<br />

high frictional resistance with ß-titanium wires was the<br />

reactivity <strong>of</strong> the titanium content <strong>of</strong> the alloy with<br />

stainless steel, leading to “cold welding” <strong>of</strong> the<br />

contacting surfaces. 20,24,39<br />

<strong>The</strong> effort to reduce friction in the fixed appliance<br />

has led to trials with a process called ion-implantation, a<br />

method <strong>of</strong> increasing the hardness <strong>and</strong> altering the surface-<br />

chemistry <strong>of</strong> an alloy by implanting nitrogen ions into that<br />

surface. In laboratory studies, this process had been<br />

shown to decrease friction significantly. 40,42 Clinical<br />

split-mouth studies, however, did not show a significant<br />

13


difference in rate <strong>of</strong> tooth movement on the side with ion-<br />

implanted ß-titanium alloy wires engaged. 43<br />

Cross-sectional Shape <strong>and</strong> Size<br />

Many studies have suggested that the cross-sectional<br />

size <strong>of</strong> an archwire <strong>and</strong> frictional-resistance potential may<br />

be directly related. 5,23,31,34,36,44,45 In 2003 Smith, Rossouw<br />

<strong>and</strong> Watson 34 found significantly greater friction with<br />

larger archwires than smaller ones, <strong>and</strong> they attributed<br />

this difference to greater flexural stiffnesses <strong>of</strong> the<br />

wires having larger cross-sections.<br />

Rectangular wires permit the orthodontist to exert<br />

<strong>third</strong>-<strong>order</strong> control during treatment. <strong>The</strong>se wires are<br />

stiffer than round wires with similar cross-sectional<br />

dimensions. 46 <strong>The</strong> shape <strong>of</strong> the archwire cross-section<br />

influences its bending characteristics. Changes in shape<br />

from round to square to rectangular (e.g., while<br />

maintaining second-<strong>order</strong> slot-clearance), <strong>and</strong> the<br />

corresponding increases in stiffnesses, can cause increases<br />

in frictional resistance. Frank <strong>and</strong> Nikolai 5 found,<br />

however, that the smaller contact areas between the wire<br />

<strong>and</strong> bracket-slot with binding angulations in 0.020-inch<br />

round wires produced greater friction than the stiffer<br />

rectangular wires. <strong>The</strong>y suggested that the point-contacts<br />

14


<strong>of</strong> round wire with the slot created larger intensities <strong>of</strong><br />

normal force than did the line-contacts <strong>of</strong> the rectangular<br />

wires.<br />

Brackets<br />

Orthodontic brackets are marketed in various designs,<br />

dimensions <strong>and</strong> materials, <strong>and</strong> a wealth <strong>of</strong> information<br />

exists in the literature regarding the effect <strong>of</strong> bracket-<br />

parameters on sliding friction. Influences discussed below<br />

include bracket material composition, slot size, <strong>and</strong><br />

bracket width.<br />

Bracket Material Composition<br />

Clinicians have many choices when selecting the<br />

material composition <strong>of</strong> appliances. Stainless steel is the<br />

most common material <strong>of</strong> orthodontic brackets. <strong>The</strong>se<br />

brackets are available to practitioners as cast or<br />

sintered. Traditionally, stainless steel brackets have<br />

been manufactured as castings; thereafter, specific<br />

surfaces are milled. Sintering is a process within which<br />

the stainless steel particles are compressed at elevated<br />

temperature into the desired shapes. When compared with<br />

previous research 23 using the same apparatus <strong>and</strong> wires,<br />

Vaughan et al. 29 found that the slots <strong>of</strong> sintered brackets<br />

15


produced about 40% to 45% less friction than slots <strong>of</strong> cast<br />

brackets.<br />

Ceramic brackets are a popular choice for many adults<br />

because <strong>of</strong> their esthetic appearance. Like stainless steel<br />

brackets, ceramic brackets are also available in multiple<br />

designs. Whether they (including the slots) are single-<br />

crystal sapphire, polycrystalline alumina or zirconia,<br />

these brackets have generally been found to produce more<br />

friction than stainless steel brackets with the same wires<br />

at nonbinding angulations. 4,25-27,36,51,54,80-82 Some<br />

investigators have not found a difference in frictional<br />

resistance between stainless steel <strong>and</strong> ceramic brackets. 35,83<br />

In an effort to maintain the esthetic advantages <strong>of</strong><br />

ceramic brackets, but reduce the friction potentials<br />

associated with them, some polycrystalline alumina brackets<br />

are manufactured with metallic slots. One <strong>of</strong> these, with a<br />

stainless steel slot, the Clarity bracket (3M/Unitek<br />

Corporation, Monrovia, CA), was compared by Cacciafesta’s<br />

group 36 with conventional ceramic <strong>and</strong> stainless steel<br />

brackets. <strong>The</strong>y reported that the steel-slot/ceramic<br />

bracket produced less friction than the conventional all-<br />

ceramic bracket, but more than the stainless steel bracket<br />

with stainless steel, nickel-titanium alloy or ß-titanium<br />

alloy wires. Kusy <strong>and</strong> Whitley 84 found that both the Clarity<br />

16


acket <strong>and</strong> the gold-lined Luxi bracket (Rocky Mountain<br />

Orthodontics, Denver, CO) exhibited frictional resistances<br />

similar to that <strong>of</strong> stainless steel brackets. In general,<br />

ceramic brackets with metallic slots were found to be<br />

acceptable alternatives to all-ceramic brackets. 36,84<br />

Orthodontic brackets have been manufactured from other<br />

materials for various reasons. Esthetic plastic brackets<br />

are available with or without metallic inserts. <strong>The</strong>se<br />

brackets have generally been found to produce less friction<br />

than ceramic brackets, although deformation with tight<br />

ligation (i.e., toward <strong>torque</strong> control) has been a problem. 7<br />

Titanium brackets were introduced in response to concerns<br />

about corrosion <strong>and</strong> potential sensitivity to the nickel in<br />

stainless steel. <strong>The</strong>se brackets were found to be very<br />

similar in frictional resistance to stainless steel<br />

brackets. 19,85<br />

Bracket Width <strong>and</strong> Slot Size<br />

<strong>The</strong>re is conflicting information in the literature as<br />

to the effect <strong>of</strong> bracket width on friction in the fixed<br />

appliance. Andreasen <strong>and</strong> Quevedo 44 measured the friction<br />

produced with three brackets <strong>of</strong> different slot widths <strong>and</strong><br />

six wires at four second-<strong>order</strong> angulations <strong>and</strong> found no<br />

significant differences in frictional resistance across the<br />

17


ackets. Peterson’s group 31 also found that bracket width<br />

had no effect on friction. Frank <strong>and</strong> Nikolai, 5 however,<br />

found that frictional force increased as bracket width<br />

increased. This outcome was allegedly due to decreased<br />

interbracket distance <strong>and</strong> to the wider bracket binding at a<br />

smaller angulation. Other researchers found a similar<br />

effect, but thought the cause was the mesiodistal slot<br />

dimension <strong>of</strong> the wider bracket resulting in greater<br />

stretching <strong>of</strong> the ligature, which in turn, lead to<br />

increased normal forces <strong>of</strong> ligation. 23 A <strong>third</strong> group <strong>of</strong><br />

studies found that narrower brackets produced more friction<br />

than wider brackets. 21,22,81 Drescher’s group 22 believed that<br />

the increased tipping seen in narrow brackets resulted in<br />

greater frictional forces. Using biomechanical analysis<br />

<strong>and</strong> mathematical formulations, Schlegal 86 determined that<br />

neighboring brackets had an extraordinary influence on<br />

friction within a bracket, <strong>and</strong>, due to this influence,<br />

single-bracket studies could not accurately determine how<br />

bracket width affected friction. He concluded that<br />

interbracket distance, wire stiffness <strong>and</strong> relative bracket<br />

position must also be considered when determining the ideal<br />

slot width.<br />

Bracket width may have an indirect influence on<br />

friction due to its relationship with interbracket distance<br />

18


<strong>and</strong> wire stiffness. As bracket width increases, the<br />

distance(s) to the adjacent bracket(s) will decrease,<br />

resulting in shorter <strong>and</strong> stiffer sections <strong>of</strong> wire. 5,7 <strong>The</strong><br />

influence <strong>of</strong> bracket width is more pronounced at greater<br />

angulations.<br />

Slot size has not been found to influence frictional<br />

resistance in the fixed appliance. 21,27 Kusy, Whitley <strong>and</strong><br />

Prewitt 27 evaluated several factors, <strong>and</strong> they concluded that<br />

there was no substantial difference overall in frictional<br />

resistance between a 0.018-inch <strong>and</strong> a 0.022-inch bracket-<br />

slot when each is paired with a comparable-sized archwire.<br />

Ligation<br />

Ligation has become a popular topic among researchers<br />

in the field <strong>of</strong> orthodontics. Orthodontic products have<br />

been developed toward reducing friction potential in the<br />

fixed appliance <strong>and</strong> some seemingly have suppressed a major<br />

contributor by augmenting traditional methods <strong>of</strong> ligation<br />

within modern bracket designs. Current, common categories<br />

<strong>of</strong> ligation are 1) small, ductile, stainless steel wire-<br />

segments, 2) elastomeric o-rings <strong>and</strong> ties <strong>and</strong> 3) <strong>self</strong>-<br />

ligation.<br />

19


Conventional Ligation<br />

Orthodontic ligatures existed prior to the use <strong>of</strong> the<br />

modern fixed appliance. In 1728, Fauchard published a book<br />

called “Le Chirurgien Dentiste” in which he described his<br />

“B<strong>and</strong>eau” device. Ligatures were extended from this<br />

horseshoe-shaped device to facilitate simple tooth<br />

movement. Angle’s edgewise appliance was introduced in<br />

1925, <strong>and</strong> the original design has evolved to the most<br />

commonly used orthodontic appliance today. It was the<br />

first fixed appliance to feature ligatures as an essential<br />

part <strong>of</strong> the appliance. Early ligatures were materially<br />

precious metals. 49,50<br />

In modern clinical orthodontics, the conventional<br />

methods <strong>of</strong> tying archwires into bracket-slots are with<br />

either small stainless steel wires or elastomeric ties.<br />

<strong>The</strong>se ligatures, although relatively inexpensive <strong>and</strong> easy<br />

to place, have been criticized with the recent interest in<br />

orthodontic friction. Studies have shown a relationship<br />

between normal forces <strong>of</strong> ligation <strong>and</strong> resistance to<br />

sliding. Using a pneumatically controlled surface to<br />

simulate the force <strong>of</strong> ligation on a sliding wire, Stannard<br />

et al. 17 discovered a proportional increase in friction with<br />

increasing ligating force. Keith, Jones <strong>and</strong> Davies, 51 with<br />

three magnitudes <strong>of</strong> ligating force, found a similar<br />

20


ligation-friction relationship. <strong>The</strong> importance <strong>of</strong> ligating<br />

technique was demonstrated by Frank <strong>and</strong> Nikolai 5 ; they found<br />

ligature-tie force to be the greatest contributor to<br />

friction at small wire-slot angulations. Berger 52 also<br />

concluded that, at nonbinding angulations, ligature-force<br />

was a major contributor to frictional resistance.<br />

Of the two conventional methods <strong>of</strong> archwire-ligation,<br />

elastomeric ligatures have been the more popular because <strong>of</strong><br />

the ease <strong>and</strong> speed at which they can be placed <strong>and</strong> removed.<br />

In addition, patients have enjoyed selecting from the<br />

numerous colors available. In terms <strong>of</strong> their effect on<br />

friction, however, the difference between stainless steel<br />

<strong>and</strong> elastomeric ligation has not been so clear. Some<br />

studies have been unable to show a difference in frictional<br />

forces generated between these two methods <strong>of</strong> ligation. 5,53<br />

Others have reported that elastomeric ties produced less<br />

friction. 45 Another group <strong>of</strong> studies found stainless steel<br />

ligatures to show less friction. 54-57 <strong>The</strong> inability to<br />

obtain consistent results might be blamed on differences in<br />

experimental methods. 56 In addition, it is possible that<br />

the difficulty in controlling <strong>and</strong> maintaining ligating<br />

forces could be another cause <strong>of</strong> the inconsistency. 17<br />

Stainless steel ligating forces have been reported to range<br />

between 0 <strong>and</strong> 300 grams, depending upon how tightly the<br />

21


ligature is wound. 7 <strong>The</strong> force <strong>of</strong> ligation with elastomeric<br />

ties has been estimated to be from approximately 50 grams<br />

to 225 grams with subsequent decay due to “relaxation” <strong>of</strong><br />

the elastomeric material. 34,58<br />

Recently, an alternative type <strong>of</strong> separate ligation has<br />

become available to the orthodontic community, which is<br />

claimed to retain the ease <strong>of</strong> elastomeric ligation<br />

placement <strong>and</strong> removal while reducing the resistance to<br />

sliding. This ligature, called the Slide (Leone Orthodontic<br />

Products, Sesto Fiorentino, Firenze, Italy), is an<br />

injection-molded polyurethane device that hooks onto the<br />

tie wings <strong>and</strong> is placed over the facial surface <strong>of</strong> a<br />

conventional bracket-slot. By ligating across the slot<br />

instead <strong>of</strong> directly over the wire, the Slide places no<br />

normal force <strong>of</strong> ligation, <strong>and</strong> essentially converts the<br />

bracket into a tube. An in vitro study showed that this<br />

ligature produces significantly less sliding friction<br />

compared to conventional ligation techniques. 59<br />

Self-Ligation<br />

In 1933, Boyd filed a patent for the first <strong>self</strong>-<br />

ligating bracket, the “Boyd b<strong>and</strong> bracket,” which featured a<br />

moving bar that passively entrapped the archwire in the<br />

bracket-slot. Since then, more than 40 <strong>self</strong>-ligating<br />

22


designs have been introduced to the orthodontic community.<br />

Many <strong>of</strong> the early designs featured variations <strong>of</strong> three<br />

basic ligating mechanisms: a passive door, a passive “C-<br />

clip” <strong>and</strong> an active spring. 49,60<br />

It was not until the invention <strong>of</strong> the Edgelok bracket<br />

(Ormco Corporation, Glendora, CA) by Wildman in the early<br />

1970s that <strong>self</strong>-ligating designs gained widespread exposure<br />

to orthodontists. Wildman’s design featured a movable cap<br />

that closed over the facial portion <strong>of</strong> the slot to<br />

passively trap the archwire. Because <strong>of</strong> its passive<br />

nature, orthodontists found precise control <strong>of</strong> tooth<br />

movement to be a challenge. Ormco responded by marketing<br />

auxiliary rotational collars to help address the<br />

limitation. 49,60,61<br />

In 1977, clinical trials began on a new <strong>self</strong>-ligating<br />

design called the SPEED bracket (Strite Industries Ltd.,<br />

Cambridge, Ontario, Canada). Developed by Hanson, 62 this<br />

bracket was innovative in that it featured the first<br />

bracket-mounted stainless steel spring-clip which held the<br />

archwire in the slot with a lingually directed force. <strong>The</strong><br />

claimed benefit <strong>of</strong> this active ligation system was improved<br />

rotational control. 60,62<br />

Several modern <strong>self</strong>-ligating bracket designs have been<br />

commercially available for the past 30 years, but until<br />

23


ecently such brackets have had limited sales. <strong>The</strong> design<br />

<strong>of</strong> orthodontic products specifically aimed at minimizing<br />

friction has resulted in the reintroduction <strong>of</strong> <strong>self</strong>-<br />

ligating bracket systems to mainstream orthodontics. Since<br />

the introduction <strong>of</strong> the Damon 2 (Ormco Corporation,<br />

Glendora, CA) <strong>and</strong> the In-Ovation (GAC International,<br />

Bohemia, NY) brackets in 2000, the use <strong>of</strong> <strong>self</strong>-ligating<br />

systems in orthodontic practices has become more common. 63<br />

Most major orthodontic vendors now <strong>of</strong>fer a <strong>self</strong>-ligating<br />

system in addition to traditional, open-slot, bracket<br />

designs. <strong>The</strong>se newer brackets are claimed to reduce<br />

friction, contribute to improved hygiene, lessen anchorage<br />

loss, <strong>and</strong> shorten chair- as well as treatment-time. 55,63-66<br />

Several studies have reported that <strong>self</strong>-ligating brackets<br />

contribute to lessened sliding-friction potential compared<br />

to that from traditionally tied brackets. 9,48,55,57,67-70<br />

Since the recent gain in popularity <strong>of</strong> <strong>self</strong>-ligation,<br />

several new designs have become commercially available to<br />

the orthodontist. In general, these brackets fall into one<br />

<strong>of</strong> two categories based on the design <strong>of</strong> the slot-closure<br />

(Table 2-1). An “active” clip is a resilient spring-clip<br />

that snaps closed <strong>and</strong> reduces the depth <strong>of</strong> the slot to<br />

approximately 0.018 inches. Because this clip can store<br />

energy when it is activated by a lingual malalignment, a<br />

24


otated tooth or a twisted rectangular wire, it has the<br />

potential to deliver lingual force to the wire <strong>and</strong> help<br />

bring the tooth into its proper position. 60 <strong>The</strong> Speed<br />

bracket, the In-Ovation R bracket <strong>and</strong> the Time2 bracket<br />

(American Orthodontics, Sheboygan, WI) all feature active<br />

clips within their designs. It is suggested by product<br />

literature that active ligation helps deliver full <strong>torque</strong><br />

expression when a rectangular wire is engaged <strong>and</strong> pressed<br />

against the base <strong>of</strong> the slot. Critics <strong>of</strong> the clip design<br />

say, however, that introducing an active component into the<br />

ligation unnecessarily increases frictional resistance.<br />

Some investigators have found that any advantage from<br />

decreased friction with active <strong>self</strong>-ligating brackets is<br />

reduced when rectangular wires are placed. 9,48,65,71-74 Other<br />

researchers have found the same to be true for the passive<br />

Damon SL II. 75 It has also been suggested that the<br />

cantilevered clip delivers a diagonally directed force to<br />

the archwire, in effect reducing the torquing efficiency<br />

<strong>and</strong> causing errors in <strong>torque</strong> expression. 63<br />

In contrast, “passive” ligating mechanisms, like those<br />

<strong>of</strong> the Damon 2, Damon 3 <strong>and</strong> Damon 3MX brackets <strong>and</strong> the<br />

SmartClip bracket (3M/Unitek Corporation, Monrovia, CA), do<br />

not invade the slot <strong>and</strong> place no inherent normal force on<br />

the archwire. <strong>The</strong>se systems feature one <strong>of</strong> two basic<br />

25


designs. <strong>The</strong> passive-slide design <strong>of</strong> the Damon series <strong>of</strong><br />

brackets utilizes a sliding “door” that closes the slot,<br />

effectively transforming the bracket into a tube. <strong>The</strong><br />

SmartClip bracket features a nickel-titanium alloy “C-clip”<br />

lateral to each <strong>of</strong> the mesial <strong>and</strong> distal tie-wings 76 ; an<br />

archwire that is snapped into the bracket-slot may remain<br />

passive in the lumens <strong>of</strong> the clips. <strong>The</strong> claimed benefit <strong>of</strong><br />

passive <strong>self</strong>-ligation is reduced friction with a variety <strong>of</strong><br />

wire sizes, resulting in faster tooth movement. 77 With the<br />

lack <strong>of</strong> a lingually directed force on the archwire,<br />

however, some critics argue that controlling <strong>torque</strong> could<br />

be a problem. 58 In addition, Harradine 63 points out that, in<br />

theory, a passively ligated bracket with an engaged<br />

rectangular wire, having a faciolingual dimension <strong>of</strong> 0.025<br />

inches, could bring a facially displaced tooth only to<br />

within 0.002 inches <strong>of</strong> the adjacent teeth because <strong>of</strong> its<br />

slot depth; usually it is approximately 0.027 inches. An<br />

active clip would, theoretically, not have this problem<br />

because it “squeezes” in the slot an archwire as small as<br />

0.018 inches in the faciolingual dimension. Harradine 63<br />

stated, however, that a remaining, clinically significant<br />

malalignment was unlikely. In two investigations, no<br />

significant difference between either the SmartClip bracket<br />

or the Damon 2 bracket <strong>and</strong> a conventional bracket in regard<br />

26


to incisor irregularity after initial alignment was<br />

found. 78,79<br />

Other Factors Influencing Friction<br />

Saliva<br />

Although the role <strong>of</strong> saliva as a potential lubricant<br />

for the sliding <strong>of</strong> wires through slots has been studied by<br />

several researchers, there has been no clear answer as to<br />

the effect <strong>of</strong> saliva on intraoral friction. In one <strong>of</strong> the<br />

earliest studies, Andreasen <strong>and</strong> Quevedo 44 found no<br />

significant difference in friction between “wet” <strong>and</strong> “dry”<br />

samples. Possible explanations for this finding were the<br />

following: 1. Saliva may not be good lubricant for the slot<br />

<strong>and</strong> wire materials; or 2. Forces at the contact area shared<br />

by the wire <strong>and</strong> bracket-slot were so great that the fluid<br />

was expelled from that area. Tselepis, Brockhurst <strong>and</strong><br />

West 33 found a significant reduction in friction in the<br />

“wet” state. Saunders <strong>and</strong> Kusy 87 similarly found a decrease<br />

in friction when saliva was introduced between two<br />

contacting titanium surfaces. Others have found, however,<br />

some increases in frictional resistance with the addition<br />

<strong>of</strong> saliva. 17,53,83 <strong>The</strong>se conflicting results were suggested<br />

by Kusy, Whitley <strong>and</strong> Prewitt 27 to be related to the surfaces<br />

in contact. <strong>The</strong>y found that the lubricating or adhesive<br />

27


ehavior <strong>of</strong> saliva depended on the material composition <strong>of</strong><br />

the slots <strong>and</strong> wires. For example, when saliva was<br />

introduced in stainless steel slots, it produced decreases<br />

in frictional resistance with ß-titanium alloy wires, but<br />

an adhesive effect with stainless steel wires.<br />

Occlusal Forces<br />

In the human dentition, the deformable periodontal<br />

ligament allows minute movements <strong>of</strong> the teeth to aid in<br />

distribution <strong>of</strong> forces from occlusal function. <strong>The</strong>se<br />

forces, that can arise as a result <strong>of</strong> speaking, swallowing,<br />

or normal masticatory function, are heavy (1 kg to 50 kg)<br />

<strong>and</strong> intermittent, occurring thous<strong>and</strong>s <strong>of</strong> times per day for<br />

one second or less. 8,88 <strong>The</strong>se brief movements <strong>of</strong> the teeth<br />

alter the normal forces between the crown-attachment slot<br />

<strong>and</strong> wire, constantly breaking <strong>and</strong> resetting “friction<br />

locks.” 5 Studies have been conducted to determine the<br />

effect <strong>of</strong> perturbations (extraneous, small actions<br />

simulating mastication, swallowing) on frictional forces in<br />

the orthodontic appliance. Braun’s group, 88 with an in<br />

vitro model, found a reduction in sliding resistance<br />

proportional to the magnitude <strong>of</strong> extraneous forces. Using<br />

a half-arch model, Lingenbrink 89 found an average decrease<br />

in kinetic frictional forces <strong>of</strong> 49% when perturbations were<br />

28


added. Similarly, Bunkall 15 noted reductions in average<br />

kinetic friction <strong>and</strong> maximum static friction <strong>of</strong> 35 to 70%.<br />

Second-Order Angulation, Binding <strong>and</strong> Notching<br />

Several studies have shown that, as second-<strong>order</strong><br />

angulation between the bracket-slot <strong>and</strong> the archwire<br />

increases, friction also increases. 5,21,24,31,33,44,80,90<br />

Classical friction from ligating force is largely<br />

responsible for frictional resistance when the second-<strong>order</strong><br />

angulation is less than the angle at which binding occurs. 5<br />

This angle is called “critical” <strong>and</strong> is defined as the<br />

second-<strong>order</strong> angulation at which the wire just contacts two<br />

diagonally opposing edges <strong>of</strong> the bracket-slot, reducing the<br />

wire-slot clearance to zero. 91 When the angle exceeds the<br />

critical value for the bracket-archwire combination,<br />

binding becomes an influential factor in resistance to<br />

sliding. 92 Factors that affect binding are archwire size,<br />

bracket-slot geometry, <strong>and</strong> interbracket distances. 57<br />

Thorstenson <strong>and</strong> Kusy 93 reported that ligation type seemed to<br />

have an effect on only classical friction because they did<br />

not influence binding when the brackets were positioned at<br />

an angulation beyond the critical contact angle.<br />

If the wire-slot angulation substantially exceeds the<br />

critical contact angle, a physical deformation <strong>of</strong> a round<br />

29


wire at one or both <strong>of</strong> its contact points with the edge <strong>of</strong><br />

the slot, known as mechanical notching, can occur, further<br />

adding to the resistance to sliding. 70,94 In a clinical<br />

study, this damage to the archwire was found to be related<br />

to the design <strong>of</strong> the orthodontic bracket. 95 <strong>The</strong> main effect<br />

<strong>of</strong> archwire-notching on friction is the creation <strong>of</strong><br />

“obstacles” that impede relative wire-slot sliding. 96 It<br />

appears that notching may be a function <strong>of</strong> the materials in<br />

contact. Kusy et al. 30 found that ceramic brackets cause<br />

more notching than stainless steel brackets. Similarly,<br />

Articolo’s group 96 found that notching <strong>of</strong> archwires was<br />

three times more prevalent <strong>and</strong> severe with ceramic brackets<br />

than with stainless steel brackets.<br />

Third-Order Torque<br />

<strong>The</strong> term “<strong>third</strong>-<strong>order</strong> <strong>torque</strong>” in orthodontics pertains<br />

to the rotational control <strong>and</strong> movement <strong>of</strong> a tooth crown or<br />

root faciolingually. This type <strong>of</strong> tooth movement can occur<br />

subsequent to twisting a square or rectangular archwire<br />

along its longitudinal axis, required to place it into the<br />

slot <strong>of</strong> a crown-attachment. In this process, two contact<br />

forces acting on the occlusal <strong>and</strong> gingival walls <strong>of</strong> the<br />

slot by partial archwire deactivation create a <strong>third</strong>-<strong>order</strong><br />

30


couple, resulting in the delivery in the faciolingual plane<br />

<strong>of</strong> torsional forces to the tooth. 97,98<br />

<strong>The</strong> preadjusted edgewise appliance is designed with a<br />

specific amount <strong>of</strong> slot-/pre-<strong>torque</strong> for each tooth in the<br />

arch to aid in achieving optimal crown- <strong>and</strong> root-<br />

positioning. <strong>The</strong>oretically, this <strong>torque</strong> will be expressed<br />

when a full-size archwire is allowed to deactivate<br />

completely over time after being seated in the slot <strong>of</strong> a<br />

properly placed bracket. When a rectangular wire not<br />

completely filling the slot is engaged, a certain amount <strong>of</strong><br />

rotation around the longitudinal axis <strong>of</strong> the wire can occur<br />

before the occlusogingival clearance within the slot<br />

becomes zero <strong>and</strong> <strong>third</strong>-<strong>order</strong> rotational forces are<br />

transmitted to the crown-attachment. This clearance-angle<br />

is known as “slop” or “play,” <strong>and</strong> its magnitude is<br />

primarily dependent on the shape <strong>and</strong> dimensions <strong>of</strong> the wire<br />

<strong>and</strong> slot, as well as the amount <strong>of</strong> edge-bevel in the wire<br />

cross-section. 99-101 <strong>The</strong> difference between the appliance-<br />

<strong>torque</strong> <strong>and</strong> this clearance-angle gives the effective <strong>torque</strong>,<br />

the estimated amount <strong>of</strong> <strong>third</strong>-<strong>order</strong> <strong>torque</strong> that the<br />

bracket-wire combination will express after deactivation <strong>of</strong><br />

the wire. 98 Because most orthodontic treatment is<br />

undertaken with less than full-size archwires, some<br />

preadjusted brackets include accentuated <strong>torque</strong> in the<br />

31


maxillary- incisor brackets so that finishing with 0.019- x<br />

0.025-inch wires will still result in optimal root<br />

positioning. 102<br />

<strong>The</strong> vendor-stated sizes <strong>of</strong> both the wire <strong>and</strong> the slot<br />

are nominal dimensions because <strong>of</strong> manufacturing tolerances<br />

that exist in the fabrication processes. Actual dimensions<br />

are not reported by the vendor. Sebanc et al. 98 measured<br />

dimensions <strong>of</strong> bracket-slots with a traveling microscope <strong>and</strong><br />

the dimension(s) <strong>of</strong> various orthodontic-wire cross-sections<br />

with a micrometer. <strong>The</strong>y found that slot dimensions were<br />

generally larger than their nominal values. Actual wire<br />

dimensions were generally found to be equal to or smaller<br />

than nominal sizes, but all were within 0.0005 inches.<br />

Meling <strong>and</strong> Ødegaard. 100 found a range <strong>of</strong> ±0.0005 inches in<br />

actual wire heights across the wires <strong>of</strong> seven wire-vendors.<br />

Kusy <strong>and</strong> Whitley 94 measured archwires <strong>and</strong> bracket-slots, <strong>and</strong><br />

they found that 30% <strong>of</strong> the wire specimens were larger than<br />

suggested by their nominal dimension(s). Of the bracket-<br />

slots tested, 15% <strong>of</strong> the measurements were smaller than the<br />

vendor-stated values. <strong>The</strong> abilities <strong>of</strong> the manufacturers,<br />

or lack there<strong>of</strong>, to accurately produce wires <strong>of</strong> stated<br />

dimensions can affect the amount <strong>of</strong> <strong>torque</strong> expressed in the<br />

bracket-slots. 101,103<br />

32


Another factor that influences bracket-wire <strong>torque</strong><br />

expression is the elastic modulus <strong>of</strong> the bracket-slot.<br />

Harzer, Bourauel <strong>and</strong> Gmyrek 104 compared slot-deformations,<br />

polycarbonate brackets versus stainless steel brackets, <strong>and</strong><br />

found higher <strong>torque</strong> losses <strong>and</strong> smaller torquing moments in<br />

the plastic brackets. Others found similar results. 105,106<br />

Kapur, Sinha <strong>and</strong> N<strong>and</strong>a 107 compared the structural integrity<br />

<strong>of</strong> titanium brackets with that <strong>of</strong> stainless steel brackets<br />

when both were subjected to torsional forces from an<br />

archwire, <strong>and</strong> concluded that the titanium brackets<br />

demonstrated less deformation.<br />

<strong>The</strong> effect <strong>of</strong> <strong>third</strong>-<strong>order</strong> discrepancies in bracket<br />

alignment on frictional resistance has not been extensively<br />

evaluated in the orthodontic literature. Using an Instron<br />

testing machine, Moore, Harrington <strong>and</strong> Rock 108 discovered a<br />

significant increase in sliding friction with increased<br />

<strong>third</strong>-<strong>order</strong> <strong>torque</strong> in a single-bracket study. Sims <strong>and</strong><br />

colleagues 68 also evaluated friction produced with wires<br />

sliding through three consecutive bracket-slots, with the<br />

middle bracket given predetermined <strong>torque</strong> values. <strong>The</strong>y<br />

reported that, with <strong>third</strong>-<strong>order</strong> activation present, the<br />

<strong>self</strong>-ligating Activa bracket (‘A’- Company, San Diego, CA)<br />

showed consistently less resistance to mesiodistal sliding<br />

than did sets <strong>of</strong> two conventionally ligated brackets.<br />

33


Summary<br />

<strong>The</strong> literature supports the thought that many factors<br />

play a role in the friction generated between the wire <strong>and</strong><br />

bracket-slot in orthodontic treatment. <strong>The</strong>se factors<br />

include properties related to the archwire, bracket,<br />

ligation type, <strong>and</strong> oral environment.<br />

New products, such as low-friction, <strong>self</strong>-ligating<br />

brackets, are being developed to help reduce sliding<br />

resistance associated with tooth movement. To obtain a<br />

thorough underst<strong>and</strong>ing how to best use these products in<br />

clinical orthodontics, it is important to study them in a<br />

simulated dental arch with the variables influencing<br />

friction controlled. It is for this reason, the present<br />

study has been undertaken.<br />

34


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3M-Unitek Publication, Monrovia, CA 2005;23:3-7.<br />

78. Miles PG. SmartClip versus conventional twin brackets<br />

for initial alignment: is there a difference? Aust Orthod J<br />

2005;21:123-127.<br />

79. Miles PG, Weyant RJ, Rustveld L. A clinical trial <strong>of</strong><br />

Damon 2 vs conventional twin brackets during initial<br />

alignment. Angle Orthod 2006;76:480-485.<br />

80. Ho KS, West VC. Friction ... Friction resistance<br />

between edgewise brackets <strong>and</strong> archwires. Aust Orthod J<br />

1991;12:95-99.<br />

81. Omana HM, Moore RN, Bagby MD. Frictional properties <strong>of</strong><br />

metal <strong>and</strong> ceramic brackets. J Clin Orthod 1992;26:425-432.<br />

82. Popli K, Pratten DH, Germane N, Gunsolley JC.<br />

Frictional resistance <strong>of</strong> ceramic <strong>and</strong> stainless-steel<br />

orthodontic brackets. J Dent Res 1989;68:245.<br />

83. Downing A, McCabe JF, Gordon PH. <strong>The</strong> effect <strong>of</strong><br />

artificial saliva on the frictional forces between<br />

orthodontic brackets <strong>and</strong> archwires. Br J Orthod 1995;22:41-<br />

46.<br />

84. Kusy RP, Whitley JQ. Frictional resistances <strong>of</strong> metallined<br />

ceramic brackets versus conventional stainless steel<br />

43


ackets <strong>and</strong> development <strong>of</strong> 3-D friction maps. Angle Orthod<br />

2001;71:364-374.<br />

85. Kapur R, Sinha PK, N<strong>and</strong>a RS. Comparison <strong>of</strong> frictional<br />

resistance in titanium <strong>and</strong> stainless steel brackets. Am J<br />

Orthod Dent<strong>of</strong>acial Orthop 1999;116:271-274.<br />

86. Schlegel V. Relative friction minimization in fixed<br />

orthodontic bracket appliances. J Biomech 1996;29:483-491.<br />

87. Saunders CR, Kusy RP. Surface topography <strong>and</strong> frictional<br />

characteristics <strong>of</strong> ceramic brackets. Am J Orthod<br />

Dent<strong>of</strong>acial Orthop 1994;106:76-87.<br />

88. Braun S, Bluestein M, Moore BK, Benson G. Friction in<br />

perspective. Am J Orthod Dent<strong>of</strong>acial Orthop 1999;115:619-<br />

627.<br />

89. Lingenbrink JC. <strong>The</strong> effect <strong>of</strong> extraneous intra-oral<br />

force on wire-slot friction potentially impeding leveling<br />

<strong>and</strong> aligning during orthodontic therapy. Master’s <strong>The</strong>sis.<br />

Center for Advanced Dental Education. <strong>Saint</strong> <strong>Louis</strong><br />

<strong>University</strong>. St. <strong>Louis</strong>, MO. 2006.<br />

90. Ogata RH, N<strong>and</strong>a RS, Duncanson MG, Jr., Sinha PK,<br />

Currier GF. Frictional resistances in stainless steel<br />

bracket-wire combinations with <strong>effects</strong> <strong>of</strong> vertical<br />

deflections. Am J Orthod Dent<strong>of</strong>acial Orthop 1996;109:535-<br />

542.<br />

91. Kusy RP, Whitley JQ. Assessment <strong>of</strong> second-<strong>order</strong><br />

clearances between orthodontic archwires <strong>and</strong> bracket slots<br />

via the critical contact angle for binding. Angle Orthod<br />

1999;69:71-80.<br />

92. Thorstenson GA, Kusy RP. Comparison <strong>of</strong> resistance to<br />

sliding between different <strong>self</strong>-ligating brackets with<br />

second-<strong>order</strong> angulation in the dry <strong>and</strong> saliva states. Am J<br />

Orthod Dent<strong>of</strong>acial Orthop 2002;121:472-482.<br />

44


93. Thorstenson GA, Kusy RP. Effects <strong>of</strong> ligation type <strong>and</strong><br />

method on the resistance to sliding <strong>of</strong> novel orthodontic<br />

brackets with second-<strong>order</strong> angulation in the dry <strong>and</strong> wet<br />

states. Angle Orthod 2003;73:418-430.<br />

94. Kusy RP, Whitley JQ. Influence <strong>of</strong> archwire <strong>and</strong> bracket<br />

dimensions on sliding mechanics: derivations <strong>and</strong><br />

determinations <strong>of</strong> the critical contact angles for binding.<br />

Eur J Orthod 1999;21:199-208.<br />

95. Hansen JD, Kusy RP, Saunders CR. Archwire damage from<br />

ceramic brackets via notching. Orthod Rev 1997;11:27-31.<br />

96. Articolo LC, Kusy K, Saunders CR, Kusy RP. Influence <strong>of</strong><br />

ceramic <strong>and</strong> stainless steel brackets on the notching <strong>of</strong><br />

archwires during clinical treatment. Eur J Orthod<br />

2000;22:409-425.<br />

97. Nikolai RJ. Bioengineering analysis <strong>of</strong> orthodontic<br />

mechanics. Philadelphia: Lea & Febiger, 1985:pp 53-56.<br />

98. Sebanc J, Brantley WA, Pincsak JJ, Conover JP.<br />

Variability <strong>of</strong> effective root <strong>torque</strong> as a function <strong>of</strong> edge<br />

bevel on orthodontic arch wires. Am J Orthod 1984;86:43-51.<br />

99. Johnson E. Relative stiffness <strong>of</strong> beta titanium<br />

archwires. Angle Orthod 2003;73:259-269.<br />

100. Meling TR, Odegaard J. On the variability <strong>of</strong> crosssectional<br />

dimensions <strong>and</strong> torsional properties <strong>of</strong><br />

rectangular nickel-titanium arch wires. Am J Orthod<br />

Dent<strong>of</strong>acial Orthop 1998;113:546-557.<br />

101. Meling TR, Odegaard J, Meling EO. On mechanical<br />

properties <strong>of</strong> square <strong>and</strong> rectangular stainless steel wires<br />

tested in torsion. Am J Orthod Dent<strong>of</strong>acial Orthop<br />

1997;111:310-320.<br />

45


102. McLaughlin RP, Bennett JC, Trevisi HJ. Systemized<br />

orthodontic treatment mechanics. Edinburgh, Scotl<strong>and</strong>,<br />

Mosby, 2001.<br />

103. Gioka C, Eliades T. Materials-induced variation in the<br />

<strong>torque</strong> expression <strong>of</strong> preadjusted appliances. Am J Orthod<br />

Dent<strong>of</strong>acial Orthop 2004;125:323-328.<br />

104. Harzer W, Bourauel C, Gmyrek H. Torque capacity <strong>of</strong><br />

metal <strong>and</strong> polycarbonate brackets with <strong>and</strong> without a metal<br />

slot. Eur J Orthod 2004;26:435-441.<br />

105. Feldner JC, Sarkar NK, Sheridan JJ, Lancaster DM. In<br />

vitro <strong>torque</strong>-deformation characteristics <strong>of</strong> orthodontic<br />

polycarbonate brackets. Am J Orthod Dent<strong>of</strong>acial Orthop<br />

1994;106:265-272.<br />

106. Sadat-Khonsari R, Moshtaghy A, Schlegel V, Kahl-Nieke<br />

B, Moller M, Bauss O. Torque deformation characteristics <strong>of</strong><br />

plastic brackets: a comparative study. J Or<strong>of</strong>ac Orthop<br />

2004;65:26-33.<br />

107. Kapur R, Sinha PK, N<strong>and</strong>a RS. Comparison <strong>of</strong> load<br />

transmission <strong>and</strong> bracket deformation between titanium <strong>and</strong><br />

stainless steel brackets. Am J Orthod Dent<strong>of</strong>acial Orthop<br />

1999;116:275-278.<br />

108. Moore MM, Harrington E, Rock WP. Factors affecting<br />

friction in the pre-adjusted appliance. Eur J Orthod<br />

2004;26:579-583.<br />

46


Tables<br />

Table 2-1: Partial Overview <strong>of</strong><br />

Self-Ligating Brackets.<br />

Year Bracket<br />

47<br />

Mode <strong>of</strong><br />

Action<br />

1933 Boyd b<strong>and</strong> bracket Passive<br />

1933 Ford lock Passive<br />

1952 Russell appliance Passive<br />

1953 Schurter device Passive<br />

1957 Rubin device Passive<br />

1966 Branson Passive<br />

1972 SPEED System Active<br />

1972 Edgelok bracket Passive<br />

1979 Mobil-Lock bracket Passive<br />

1986 Activa bracket Passive<br />

1995 Time bracket Active<br />

1996 Damon bracket Passive<br />

1998 Twinlock bracket Passive<br />

2000 In-Ovation bracket Active<br />

2000 Damon 2 bracket Passive<br />

2002 In-Ovation R bracket Active<br />

2004 Time2 bracket Active<br />

2004 Damon 3 bracket Passive<br />

2005 SmartClip bracket Passive<br />

2006 Damon 3MX bracket Passive<br />

Modified from Woodside, Berger <strong>and</strong> Hanson, 2005 60


CHAPTER 3: JOURNAL ARTICLE<br />

Abstract<br />

Few studies have evaluated the effect <strong>of</strong> wire-slot<br />

<strong>torque</strong> on sliding friction. Apparently, no studies have<br />

been published to date that compare friction across<br />

categories <strong>of</strong> <strong>self</strong>-ligating brackets when <strong>third</strong>-<strong>order</strong><br />

positioning is controlled. <strong>The</strong> purpose <strong>of</strong> this study was<br />

to determine the <strong>effects</strong> <strong>of</strong> wire-slot <strong>torque</strong> <strong>and</strong> type <strong>of</strong><br />

<strong>self</strong>-ligating bracket on the average kinetic friction in<br />

sliding mechanics with a 0.019- x 0.025-inch stainless<br />

steel archwire. Five sets <strong>of</strong> crown-attachments (including<br />

In-Ovation R, Time2, Damon 3MX, SmartClip <strong>and</strong> Victory<br />

brackets) were tested for frictional resistance in a<br />

simulated posterior dental segment with -15, -10, -5, 0,<br />

+5, +10, <strong>and</strong> +15 degrees <strong>of</strong> <strong>torque</strong> placed in the maxillary<br />

right second-premolar bracket.<br />

Increasing the <strong>torque</strong> from 0 to ±15 degrees produced<br />

significant increases <strong>of</strong> frictional resistance in all five<br />

<strong>of</strong> the tested attachment-sets. At 0 degrees <strong>of</strong> <strong>torque</strong>, the<br />

sets with passive <strong>self</strong>-ligating brackets produced less<br />

friction than the sets with active <strong>self</strong>-ligating brackets,<br />

<strong>and</strong> all four <strong>self</strong>-ligating bracket sets produced<br />

48


significantly less friction than the set with<br />

elastomerically ligated Victory brackets. At ±10 degrees<br />

<strong>of</strong> <strong>torque</strong>, all five attachment sets displayed similar<br />

resistances with the exception <strong>of</strong> the In-Ovation R set at<br />

+10 degrees. At ±15 degrees <strong>of</strong> <strong>torque</strong>, the In-Ovation R<br />

<strong>and</strong> the SmartClip sets produced significantly larger<br />

frictional resistances than the other three sets.<br />

<strong>The</strong> data suggest that the presence <strong>of</strong> <strong>third</strong>-<strong>order</strong><br />

<strong>torque</strong> can influence the kinetic frictional resistances in<br />

posterior dental segments during anterior retraction using<br />

sliding mechanics with <strong>self</strong>-ligating brackets <strong>and</strong> that<br />

frictional resistance will increase at a greater rate when<br />

the <strong>torque</strong> exceeds ±10 degrees with the present combination<br />

<strong>of</strong> sizes <strong>of</strong> slots <strong>and</strong> wire. Furthermore, whether a <strong>self</strong>-<br />

ligated bracket is active or passive may not be clinically<br />

significant regarding friction in the presence <strong>of</strong> <strong>torque</strong><br />

approaching <strong>and</strong> exceeding 15 degrees.<br />

49


Introduction<br />

Friction is defined as the resistance to motion when<br />

one object moves or tends to move tangentially relative to<br />

another object. 1 <strong>The</strong> total contact-force between the<br />

objects may be expressed as two components when there is<br />

attempted or actual relative motion between surfaces in<br />

contact. One component, the normal force, is a pushing<br />

force with an orientation perpendicular to the shared<br />

contact-surface. <strong>The</strong> frictional force component impedes<br />

movement between the surfaces <strong>and</strong> is, therefore, opposite<br />

in direction to that <strong>of</strong> intended or actual motion. 2 <strong>The</strong><br />

maximum static or the kinetic frictional force (F) tangent<br />

to the two surfaces is <strong>of</strong>ten hypothesized as proportional<br />

to the normal force, as expressed by the equation F = µN,<br />

where µ is a coefficient <strong>of</strong> friction between the surfaces,<br />

<strong>and</strong> N is the normal force at the shared contact surface <strong>of</strong><br />

the objects. 3 <strong>The</strong> coefficient <strong>of</strong> friction is a constant<br />

which is related to characteristics <strong>of</strong> the contacting<br />

surfaces <strong>of</strong> the objects. 4<br />

Because frictional force acts in a direction opposite<br />

to the intended path <strong>of</strong> the object to be displaced, <strong>and</strong><br />

sliding mechanics are commonplace in orthodontic therapy,<br />

an underst<strong>and</strong>ing <strong>of</strong> friction is necessary to achieve<br />

50


optimal clinical results. Fixed-appliance therapy involves<br />

at least some relative (mesiodistal) wire-slot displacement<br />

in various phases <strong>of</strong> treatment; hence, the generation <strong>of</strong><br />

friction during tooth movement can be problematic for the<br />

orthodontist. Because a portion <strong>of</strong> the force for delivery<br />

to a tooth-crown to be displaced may be necessary to<br />

overcome frictional resistance, the orthodontist must be<br />

sure to use a force <strong>of</strong> sufficient magnitude to also<br />

initiate a biological response in the supporting tissues. 4<br />

<strong>The</strong> application <strong>of</strong> sliding mechanics in orthodontics<br />

has increased since the introduction <strong>of</strong> the pre-adjusted<br />

edgewise appliance system. 5 <strong>The</strong> process can involve the<br />

guidance <strong>of</strong> a tooth along a continuous archwire or the<br />

movement <strong>of</strong> the wire through the crown-attachment slot(s).<br />

In particular, overjet reduction <strong>and</strong> space closure have<br />

been traditionally accepted applications <strong>of</strong> sliding<br />

mechanics. In a first premolar extraction case, a space is<br />

created between the canine <strong>and</strong> the second premolar. When<br />

maximum anchorage is desired, the canine would first be<br />

retracted bodily with the archwire guiding its<br />

displacement. This single tooth movement would likely<br />

create unwanted friction that could cause “side <strong>effects</strong>”<br />

such as uncontrolled tipping, loss <strong>of</strong> posterior anchorage,<br />

or deepening <strong>of</strong> the overbite. 6 Forces acting posteriorly on<br />

51


the anterior portion <strong>of</strong> the archwire would then be created<br />

to retract the incisors into the remaining spaces while<br />

allowing the excess wire to slide through the posterior<br />

brackets <strong>and</strong> tubes. Any wire-slot friction in the buccal<br />

segments would hinder the movement <strong>of</strong> the anterior segment<br />

<strong>and</strong>, therefore, could delay space closure. 7<br />

<strong>The</strong> popularity <strong>of</strong> sliding mechanics in orthodontics<br />

has produced considerable research interest in frictional<br />

forces generated between bracket-slot <strong>and</strong> archwire. Many<br />

studies have identified multivalued factors that can<br />

contribute to or affect friction within the fixed<br />

orthodontic appliance. <strong>The</strong>se parameters include alloy-<br />

composition, 1,8-27 surface-roughness, 2,7,9,14,15,28-31 archwire<br />

cross-sectional shape <strong>and</strong> size, 2,14,22,25,27,32-34 ligation<br />

method, 2,4,5,8,25,34-46 bracket/slot material surface<br />

properties, 1,10,16-18,20,27,35,37,47-52 bracket width, 2,4,12,13,22,33,49<br />

lubrication, 8,18,24,53-55 extraneous occlusal forces, 56-58<br />

second-<strong>order</strong> angulation, 2,12,15,22,24,33,46-48,59,60 <strong>and</strong> <strong>third</strong>-<strong>order</strong><br />

<strong>torque</strong>. 44,61<br />

Several modern <strong>self</strong>-ligating bracket designs have been<br />

commercially available for the past 30 years, but until<br />

recently such brackets did not have widespread use. <strong>The</strong><br />

design <strong>of</strong> orthodontic products specifically aimed at<br />

minimizing friction has resulted in the reintroduction <strong>of</strong><br />

52


<strong>self</strong>-ligating bracket systems to mainstream orthodontics.<br />

<strong>The</strong>se newer brackets are claimed to reduce friction,<br />

contribute to improved oral hygiene, lessen anchorage loss,<br />

<strong>and</strong> shorten chair- time as well as treatment-time. 38,62-65<br />

Several studies have reported that <strong>self</strong>-ligating brackets<br />

generate less sliding friction than elastomerically tied<br />

brackets. 5,38,40,42-46<br />

In general, <strong>self</strong>-ligating brackets fall into one <strong>of</strong><br />

two categories based on the design <strong>of</strong> the slot-closure. An<br />

“active” design features a resilient spring-clip that snaps<br />

closed <strong>and</strong> reduces the faciolingual slot depth to<br />

approximately 0.018 inches. Because this clip can store<br />

energy when it is activated by a lingual malalignment, a<br />

rotated tooth or a twisted rectangular wire, it has the<br />

potential to exert lingual force on the wire <strong>and</strong> help bring<br />

the tooth into its proper position. 66 Critics <strong>of</strong> the clip-<br />

design say, however, that introducing an active component<br />

into the ligation unnecessarily increases frictional<br />

resistance. 67 Some investigators have found that any<br />

advantage from decreased friction with active <strong>self</strong>-ligating<br />

brackets is reduced when rectangular wires are<br />

placed. 5,43,63,68-71 It has also been suggested that the<br />

asymmetric design <strong>of</strong> the cantilevered clip delivers a<br />

diagonally directed force to the archwire, in effect<br />

53


educing the torquing efficiency <strong>and</strong> causing errors in<br />

<strong>torque</strong>-expression. 64<br />

In contrast, a “passive” ligating mechanism does not<br />

reduce the depth <strong>of</strong> the slot <strong>and</strong> places no inherent normal<br />

force on the archwire. <strong>The</strong>se systems have one <strong>of</strong> two basic<br />

designs. <strong>The</strong> passive-slide design utilizes a sliding<br />

“door” that closes the slot, effectively transforming the<br />

bracket into a tube. 67 Another passive ligation design<br />

features a nickel-titanium alloy “C-clip” mechanism lateral<br />

to each <strong>of</strong> the mesial <strong>and</strong> distal tie-wings 72 ; an archwire<br />

that is snapped into the bracket-slot may remain passive in<br />

the lumens <strong>of</strong> the clips. <strong>The</strong> claimed benefit <strong>of</strong> these<br />

passive <strong>self</strong>-ligation systems is reduced friction with all<br />

wire sizes, resulting in faster tooth movement. 73 With the<br />

absence <strong>of</strong> a lingually directed force against the archwire,<br />

however, some critics argue that the inability to control<br />

<strong>torque</strong> could be a problem. 41 For this reason, passive <strong>self</strong>-<br />

ligating brackets are manufactured with a faciolingual<br />

slot-dimension as small as 0.027 inches, instead <strong>of</strong> the<br />

traditional 0.028 inches minimum.<br />

In orthodontics, friction arises when there is contact<br />

<strong>and</strong> a tendency for mesiodistal sliding <strong>of</strong> an archwire<br />

relative to the slot. When a small rectangular wire not<br />

completely filling the slot is engaged, some amount <strong>of</strong><br />

54


unconstrained rotation around the longitudinal axis <strong>of</strong> the<br />

wire can occur. If <strong>and</strong> when the occlusogingival clearance<br />

within the slot becomes zero, <strong>third</strong>-<strong>order</strong> rotational forces<br />

are created to be transmitted to the crown-attachment<br />

through direct contact with the slot. Moore, Harrington,<br />

<strong>and</strong> Rock 61 measured friction in two different brackets with<br />

predetermined tip <strong>and</strong> <strong>torque</strong>. <strong>The</strong> group discovered a<br />

significant increase in friction in the presence <strong>of</strong> active,<br />

<strong>third</strong>-<strong>order</strong> <strong>torque</strong>. Using an Instron testing machine, Sims<br />

<strong>and</strong> colleagues 44 also evaluated friction produced with wires<br />

sliding through bracket-slots positioned to input specific<br />

<strong>torque</strong> values. <strong>The</strong>y reported that, with torsion, the <strong>self</strong>-<br />

ligating Activa bracket (‘A’ Company, San Diego, CA) showed<br />

consistently less resistance to sliding than the two<br />

conventionally ligated brackets.<br />

Apparently no studies have been published to date that<br />

compare friction across categories <strong>of</strong> <strong>self</strong>-ligating<br />

brackets when <strong>third</strong>-<strong>order</strong> positioning is controlled. <strong>The</strong><br />

purpose <strong>of</strong> this study was to determine the effect <strong>of</strong> wire-<br />

slot <strong>torque</strong> on friction in 0.022-inch crown-attachment sets<br />

that included <strong>self</strong>-ligating brackets with a 0.019- x 0.025-<br />

inch stainless steel archwire engaged. <strong>The</strong> effect <strong>of</strong> the<br />

design <strong>of</strong> the various ligating mechanisms on kinetic<br />

55


friction with active <strong>torque</strong> present in the wire <strong>and</strong>/or slot<br />

was also evaluated.<br />

Materials <strong>and</strong> Methods<br />

<strong>The</strong> posterior maxillary right quadrant with a first<br />

premolar extracted <strong>and</strong> canine retracted was simulated to<br />

evaluate the friction produced in a buccal segment during<br />

retraction <strong>of</strong> the half-incisal segment; <strong>third</strong>-<strong>order</strong> <strong>torque</strong><br />

was generally activated at the second premolar position. A<br />

0.019- by 0.025-inch stainless steel wire was selected for<br />

this study because it is frequently selected as the<br />

retraction archwire. <strong>The</strong> two independent variables<br />

controlled in this study were the bracket ligation design<br />

<strong>and</strong> the <strong>third</strong>-<strong>order</strong> <strong>torque</strong> angle at the second premolar<br />

bracket. <strong>The</strong> dependent variable was the kinetic friction<br />

generated in the appliance when a wire was slowly pulled<br />

posteriorly through the crown-attachments.<br />

<strong>The</strong> friction testing device is described in the<br />

Master’s thesis by Bunkall. 58 <strong>The</strong> device consists <strong>of</strong> a<br />

series <strong>of</strong> aluminum cylinders (“teeth”) mounted into a base-<br />

plate in an archform representing a maxillary quadrant.<br />

Through each cylinder is an adjustable stainless steel rod<br />

with an attached brass faceplate that simulates the facial<br />

56


surface <strong>of</strong> a tooth-crown. <strong>The</strong> construction <strong>of</strong> the cylinder<br />

subassembly allows the faceplate to be positioned in all<br />

three dimensions <strong>of</strong> space. <strong>The</strong> mechanism was fabricated to<br />

enable the control <strong>of</strong> multiple bracket-slot locations <strong>and</strong><br />

orientations. In the present study, four aluminum<br />

cylinders, representing the maxillary right canine, second<br />

premolar, first molar <strong>and</strong> second molar, were inserted into<br />

the four posterior mounting holes in the aluminum base-<br />

plate (Figure 3-1). <strong>The</strong> stainless steel rod <strong>and</strong> knuckle-<br />

joint set-screw were rotated 90 degrees on each “tooth” to<br />

aid in the <strong>third</strong>-<strong>order</strong> positioning <strong>of</strong> the 0.022-inch<br />

brackets <strong>and</strong> tubes. Crown-attachments were bonded to the<br />

brass faceplates.<br />

Seven bracket-positioning templates were fabricated<br />

from 0.022-inch-thick steel plates. Each template was<br />

prepared to enable control <strong>of</strong> the positions <strong>of</strong> the slots <strong>of</strong><br />

the four crown-attachments; the slots were temporarily<br />

“engaged” <strong>and</strong> “filled” by the working edge <strong>of</strong> the template.<br />

At the site <strong>of</strong> the second-premolar bracket-slot, a<br />

rectangular section <strong>of</strong> the steel plate was cut away, 0.025<br />

inches from the working edge <strong>of</strong> the template. <strong>The</strong> cutout<br />

left a 0.022- by 0.025-inch cross-section within each <strong>of</strong><br />

the six templates; the small “bar” was inelastically<br />

rotated along its central longitudinal axis to one <strong>of</strong> six<br />

57


specific angles relative to the plane <strong>of</strong> the template to<br />

enable <strong>torque</strong>-placement in the second-premolar slot (Figure<br />

3-2). <strong>The</strong> seventh template was left uncut to place zero<br />

degrees <strong>of</strong> <strong>torque</strong> at the second premolar. Each template as<br />

a whole was initially flat <strong>and</strong> shaped to place the canine<br />

<strong>and</strong> first-molar attachment-slots in zeroed first- <strong>and</strong><br />

second-<strong>order</strong> positions, while also controlling the location<br />

<strong>of</strong> the second-premolar bracket-slot (Figure 3-3). <strong>The</strong><br />

second-molar tube was aligned with a 0.021- by 0.025-inch,<br />

straight wire-segment cantilevered from the three adjacent<br />

attachment-slots set at zero degrees <strong>of</strong> <strong>torque</strong>.<br />

Each “test specimen” consisted <strong>of</strong> two brackets, two<br />

molar tubes <strong>and</strong> a stainless steel archwire. Affixed at the<br />

first-molar site was a <strong>self</strong>-ligating first-molar tube with<br />

a facial slide mechanism <strong>and</strong> a 0.022-inch slot (SLBUCCAL,<br />

Ormco Corporation, Glendora, CA; Figure 3-4). This crown-<br />

attachment can be opened like a st<strong>and</strong>ard converted molar-<br />

tube; it permitted the insertion <strong>of</strong> the slot-positioning<br />

template, <strong>and</strong> the slide was closed during testing to enable<br />

its functioning as a st<strong>and</strong>ard unconverted four-walled<br />

buccal tube. <strong>The</strong> second-molar attachment was a 0.022-inch<br />

slot, maxillary single tube (Part Number 68-172-82; GAC<br />

International, Bohemia, NY). <strong>The</strong> archwires were 0.019- by<br />

58


0.025-inch NuBryte St<strong>and</strong>ard Arch stainless steel wires<br />

(Part Number 03-925-51; GAC International, Bohemia, NY).<br />

Because transmission <strong>of</strong> <strong>third</strong>-<strong>order</strong> <strong>torque</strong>-forces is<br />

directly influenced by wire size, ten percent <strong>of</strong> the test-<br />

wires (21 wires) were arbitrarily chosen <strong>and</strong> measured with<br />

a digital micrometer (Model APB-2D, Mitutoyo Corporation,<br />

Kanagawa, Japan). <strong>The</strong>ir average cross-sectional dimensions<br />

were calculated toward <strong>third</strong>-<strong>order</strong> clearance estimates.<br />

Five different pairs <strong>of</strong> canine <strong>and</strong> second-premolar<br />

brackets, all with 0.022-inch slots, were selected for this<br />

study. <strong>The</strong> “passive” <strong>self</strong>-ligating attachments were Damon<br />

3MX brackets (Ormco Corporation, Glendora, CA) with passive<br />

facial slides (Figure 3-5) <strong>and</strong> SmartClip brackets<br />

(3M/Unitek Corporation, Monrovia, CA) with passive C-clips<br />

(Figure 3-6). <strong>The</strong> “active” <strong>self</strong>-ligating attachments were<br />

In-Ovation R brackets (GAC International, Bohemia, NY;<br />

Figure 3-7) with sliding spring-clips <strong>and</strong> Time2 brackets<br />

(American Orthodontics, Sheboygan, WI; Figure 3-8) with<br />

rotating spring-clips. <strong>The</strong> traditional crown-attachments<br />

were the Victory-series MBT brackets (3M/Unitek<br />

Corporation, Monrovia, CA; Figure 3-9); wires were tied in<br />

the slots with silver Unistick elastomeric ligatures (Part<br />

Number 854-262; American Orthodontics, Sheboygan, WI).<br />

59


Individual test-subsamples had the second-premolar<br />

bracket-slot oriented at <strong>third</strong>-<strong>order</strong> <strong>torque</strong> values <strong>of</strong> -15,<br />

-10, -5, 0, +5, +10, <strong>and</strong> +15 degrees; the other three slots<br />

were fixed at zero <strong>torque</strong>. (A negative/positive <strong>torque</strong>-<br />

angle should produce lingual/facial tooth-crown tipping.)<br />

One set <strong>of</strong> four crown-attachments was used for testing at<br />

all <strong>torque</strong> values. <strong>The</strong> <strong>order</strong> <strong>of</strong> <strong>torque</strong> values during the<br />

testing <strong>of</strong> each set was r<strong>and</strong>omized to reduce the bias due<br />

to slot-wear on the results. <strong>The</strong> research design consisted<br />

<strong>of</strong> all combinations <strong>of</strong> the five crown-attachment/ligation<br />

sets <strong>and</strong> seven <strong>torque</strong> values. Based on previous results, 44<br />

six replications for each bracket-<strong>torque</strong> combination (210<br />

total tests) were anticipated to be sufficient.<br />

Brackets <strong>and</strong> molar tubes were affixed to the brass<br />

faceplates with cyano-acrylate adhesive (Loctite Super Glue<br />

Gel, Henkel Consumer Adhesives, Gulph Mills, PA). <strong>The</strong><br />

brackets <strong>and</strong> tubes were positioned, collectively aligned,<br />

with the slot-positioning templates <strong>and</strong> the previously<br />

mentioned wire-segment. A new archwire was engaged in the<br />

attachment-slots <strong>and</strong> ligated for each test. New<br />

elastomeric ligatures were placed prior to each test with<br />

Victory brackets using a Straight Shooter ligature gun (TP<br />

Orthodontics, LaPorte, IN) to produce the same amount <strong>of</strong><br />

short-term prestretch in all elastomeric ties. With the<br />

60


test-archwire in place <strong>and</strong> ligated, the simulated dental<br />

segment was mounted to the fixed head <strong>of</strong> a universal<br />

testing machine (Model 1011, Instron Corporation, Canton,<br />

MA) with the posterior, held end <strong>of</strong> the archwire oriented<br />

vertically. A custom attachment was fastened to the<br />

moveable head <strong>of</strong> the Instron testing machine (Figure 3-10),<br />

equipped with a ten-pound load transducer. This attachment<br />

was fabricated with a four-pronged “pencil chuck,” by which<br />

one posterior end <strong>of</strong> the test-wire was grasped. <strong>The</strong><br />

testing machine <strong>and</strong> an attached chart rec<strong>order</strong> (Model 2310-<br />

069, Instron Corporation) were turned on simultaneously.<br />

<strong>The</strong> wire was pulled posteriorly through the crown-<br />

attachments at a rate <strong>of</strong> one millimeter per minute for 90<br />

seconds while the chart rec<strong>order</strong> produced a force-versus-<br />

displacement plot. Testing was performed in the dry state<br />

<strong>and</strong> at room temperature. <strong>The</strong> load range was set at 0 to<br />

1000 grams. <strong>The</strong> testing machine was initially calibrated<br />

<strong>and</strong> checked after changes <strong>of</strong> crown-attachment sets. From<br />

each test the mean load, which was virtually equal to the<br />

frictional-force magnitude, was determined from ten plot-<br />

points taken at six-second intervals between the 30-second<br />

<strong>and</strong> 90-second marks on the plot.<br />

61


Results<br />

<strong>The</strong> data were analyzed using SPSS s<strong>of</strong>tware, version<br />

14.0 (SPSS, Inc., Chicago, IL). <strong>The</strong> mean frictional<br />

resistances <strong>and</strong> st<strong>and</strong>ard deviations there<strong>of</strong>, associated<br />

with five individual crown-attachment sets <strong>and</strong> each <strong>of</strong> the<br />

seven <strong>torque</strong> values, are shown in Table 3-1. Figure 3-11<br />

displays the mean frictional resistances from each <strong>of</strong> the<br />

crown-attachment sets; the seven means (associated with<br />

<strong>torque</strong>-angles) for an individual set are connected in <strong>order</strong><br />

by straight lines. Significant differences in mean<br />

frictional resistances across pairs <strong>of</strong> <strong>third</strong>-<strong>order</strong> <strong>torque</strong><br />

values from each set were statistically analyzed with the<br />

Mann-Whitney U test (Table 3-2). Kruskal-Wallis one-way<br />

analyses <strong>of</strong> variance <strong>and</strong> post-hoc Tukey comparisons<br />

determined significant differences (p < 0.05) between<br />

frictional resistances across the five crown-attachment<br />

sets at each <strong>of</strong> the seven <strong>torque</strong> angles <strong>and</strong> are presented<br />

in Tables 3-3 <strong>and</strong> 3-4.<br />

Actual test-archwire dimensions were determined to be<br />

equal to their nominal sizes. <strong>The</strong> average width <strong>and</strong> height<br />

<strong>of</strong> the wires were 0.0190 <strong>and</strong> 0.0250 inches, respectively.<br />

Neither +5 nor -5 five degrees <strong>of</strong> <strong>third</strong>-<strong>order</strong> rotation<br />

resulted in significant changes in frictional force from<br />

62


aseline values at 0 degrees <strong>of</strong> <strong>torque</strong> with the exception<br />

<strong>of</strong> the SmartClip set, significantly greater at both the<br />

positive <strong>and</strong> negative <strong>torque</strong>s, <strong>and</strong> the Time2 set, but only<br />

at +5 degrees <strong>of</strong> <strong>torque</strong> (Table 3-1). Increasing <strong>torque</strong><br />

from 0 to ±10 degrees produced significant increases in<br />

frictional resistance from all four sets <strong>of</strong> <strong>self</strong>-ligating<br />

attachments (Table 3-2). Among the <strong>self</strong>-ligating sets, the<br />

In-Ovation R <strong>and</strong> the SmartClip sets showed significantly<br />

more friction from a further increase from both +10 to +15<br />

<strong>and</strong> -10 to -15 degrees <strong>of</strong> <strong>torque</strong>; the Time2 set displayed a<br />

significant increase only from -10 to -15 degrees. <strong>The</strong><br />

elastomerically ligated Victory sets showed the smallest<br />

overall increase in friction when <strong>torque</strong>-angle was<br />

increased, ranging from 303 grams at 0 degrees to 551 grams<br />

at -15 degrees. <strong>The</strong> SmartClip sets displayed the smallest<br />

mean frictional force <strong>of</strong> 55 grams at 0 degrees, but also<br />

provided the greatest resistance increase, producing a<br />

force <strong>of</strong> 744 grams at +15 degrees (Table 3-1).<br />

At +5, 0 <strong>and</strong> -5 degrees <strong>of</strong> <strong>torque</strong>, the Victory crown-<br />

attachment set generally produced significantly more<br />

friction than the four <strong>self</strong>-ligating sets; the single<br />

exception was the Time2 set at +5 degrees (Table 3-4). <strong>The</strong><br />

Damon 3MX <strong>and</strong> SmartClip sets produced the smallest mean<br />

frictional forces at 0 degrees <strong>of</strong> <strong>torque</strong>.<br />

63


<strong>The</strong>re were no significant differences in mean<br />

frictional forces produced across the five attachment-sets<br />

at -10 degrees <strong>of</strong> <strong>torque</strong>. At +10 degrees, however, the In-<br />

Ovation R set produced significantly greater frictional<br />

resistance than each <strong>of</strong> the other four attachment-sets.<br />

At +15 <strong>and</strong> -15 degrees <strong>of</strong> <strong>torque</strong>, the In-Ovation R <strong>and</strong><br />

SmartClip sets generated significantly greater mean<br />

frictional forces than the other three sets; the forces<br />

from each <strong>of</strong> these two sets were statistically equal at<br />

these <strong>torque</strong> angles (Table 3-4). <strong>The</strong> In-Ovation R <strong>and</strong><br />

SmartClip sets produced forces <strong>of</strong> 757 grams <strong>and</strong> 744 grams,<br />

respectively, <strong>and</strong> 752 grams <strong>and</strong> 736 grams, respectively, at<br />

+15 <strong>and</strong> -15 degrees (Table 3-1). <strong>The</strong> Victory, Time2 <strong>and</strong><br />

Damon 3MX sets produced mean frictional forces that were<br />

statistically equal to each other at these angulations.<br />

Effect <strong>of</strong> Torque<br />

Discussion<br />

Increasing <strong>torque</strong> in the second-premolar slot from 0<br />

to <strong>and</strong> beyond ±10 degrees caused increases in frictional<br />

forces from all <strong>of</strong> the tested attachment-sets except the<br />

Victory set from 0 to -10 degrees. This effect was not<br />

seen from most <strong>of</strong> the sets when the <strong>torque</strong>-angle was<br />

64


increased to only five degrees. <strong>The</strong>se observations tend to<br />

support the suggestion 61 that <strong>torque</strong> will not have a<br />

dramatic effect on mesiodisal sliding friction until it<br />

exceeds the <strong>third</strong>-<strong>order</strong> clearance angle <strong>of</strong> the wire-slot<br />

combination. Reportedly, the clearance <strong>torque</strong>-angle for a<br />

fully drawn, 0.019- x 0.025-inch wire in a 0.022-inch open<br />

slot is about 10 degrees. 74 Presently, beyond 10 degrees <strong>of</strong><br />

<strong>third</strong>-<strong>order</strong> rotation, an increase in friction due to the<br />

creation <strong>of</strong> occlusogingival normal forces between the wire<br />

<strong>and</strong> the bracket-slot would be expected because <strong>of</strong> the<br />

torsional couple transmitted from the twisted archwire. 75<br />

In addition, geometric calculations suggest that a 0.019- x<br />

0.025-inch wire rotated 10 degrees in a bracket-slot would<br />

occupy a buccolingual dimension <strong>of</strong> 0.0276 inches (Figure 3-<br />

12). With the Damon 3MX <strong>and</strong> Smartclip brackets having slot<br />

depths <strong>of</strong> 0.027 <strong>and</strong> 0.0275 inches, respectively, the slots<br />

<strong>of</strong> the two passive <strong>self</strong>-ligated brackets are<br />

“buccolingually filled,” implying that the ligating<br />

mechanism can play a role in frictional resistance with<br />

active <strong>torque</strong>s approaching <strong>and</strong> exceeding 10 degrees.<br />

Active <strong>self</strong>-ligating attachments, such as the Time2<br />

<strong>and</strong> the In-Ovation R brackets, may behave differently from<br />

passive brackets when <strong>third</strong>-<strong>order</strong> rotations are introduced.<br />

Each clip is cantilevered occlusogingivally such that it<br />

65


enters the slot asymmetrically, contacting a rectangular<br />

wire along either a gingival or occlusal edge. An engaged<br />

0.019- x 0.025-inch archwire with zero <strong>torque</strong> would be<br />

expected to deflect the clip <strong>of</strong> either bracket. 76 A <strong>third</strong>-<br />

<strong>order</strong> rotation <strong>of</strong> the slot relative to the archwire,<br />

depending upon its sense, could potentially cause more or<br />

less deflection <strong>of</strong> the clip, thereby affecting the<br />

faciolingual normal forces exerted by the wire <strong>and</strong> the<br />

accompanying components <strong>of</strong> the frictional force system.<br />

<strong>The</strong> Time2 set generated larger frictional forces at +5<br />

degrees than at -5 degrees <strong>of</strong> <strong>torque</strong>. When comparing<br />

frictional resistances at +10 degrees <strong>and</strong> -10 degrees <strong>of</strong><br />

<strong>torque</strong>, both the Time2 <strong>and</strong> In-Ovation R brackets showed<br />

greater forces at the positive <strong>third</strong>-<strong>order</strong> angulation.<br />

This finding might be explained by the asymmetrical nature<br />

<strong>of</strong> the clip-designs.<br />

<strong>The</strong> Victory set also produced a larger mean frictional<br />

force at +10 degrees <strong>of</strong> <strong>torque</strong> than at -10 degrees. One<br />

possible explanation could be the occlusogingival asymmetry<br />

<strong>of</strong> the tie-wings <strong>of</strong> the Victory bracket design (Figure 3-<br />

9); when viewed from a mesiodistal perspective, the<br />

occlusal tie-wing apparently extends farther facially than<br />

the gingival tie-wing, suggesting that the elastomeric<br />

module could have been lying across the wire with more<br />

66


tension on one edge <strong>of</strong> the wire <strong>and</strong>/or the direction <strong>of</strong> the<br />

net normal force from the tie was skewed.<br />

Only the SmartClip set showed a significant increase<br />

in friction with every five-degree increase in <strong>torque</strong> (in<br />

either twist-direction). Because 5 degrees <strong>of</strong> <strong>third</strong>-<strong>order</strong><br />

rotation from 0 degrees does not eliminate the wire-slot<br />

clearance with this bracket-wire combination, a possible<br />

reason for the observed increase in friction could be the<br />

contact <strong>of</strong> the nickel-titanium-alloy “C-clips” with the<br />

wire during testing. Any contact <strong>of</strong> the wire with the<br />

clips during sliding could have produced a notable<br />

contribution to frictional resistance; a previous<br />

orthodontic-materials study found nickel-titanium-alloy<br />

wire to have a relatively large kinetic frictional<br />

coefficient when paired with a stainless steel bracket. 18<br />

Effect <strong>of</strong> Bracket Design<br />

At zero degrees <strong>of</strong> <strong>torque</strong>, the results <strong>of</strong> this study<br />

were similar to those from a previous research-effort 46 that<br />

evaluated friction in both <strong>self</strong>-ligating <strong>and</strong> traditionally<br />

ligated brackets. In the present study, with no <strong>torque</strong><br />

imposed, mean frictional resistance was found to be<br />

significantly less from each <strong>of</strong> the four <strong>self</strong>-ligation sets<br />

when compared to that from the Victory set (brackets tied<br />

67


with elastomeric ligatures). Friction values obtained from<br />

both passive <strong>self</strong>-ligating sets at ±5 degrees remained<br />

significantly smaller than the friction produced by the<br />

Victory set, likely due to the absence <strong>of</strong> any other than<br />

incidental contact from ligation within these <strong>self</strong>-ligating<br />

bracket-slots.<br />

With the exception <strong>of</strong> the In-Ovation R set <strong>and</strong><br />

positive angles, increasing the <strong>torque</strong> from ± 5 to ±10<br />

degrees brought the frictional resistances from the <strong>self</strong>-<br />

ligating attachment-sets to magnitudes similar to those<br />

from the Victory sets. This finding contrasted outcomes<br />

from a previous study 44 that found <strong>self</strong>-ligating brackets to<br />

produce smaller frictional forces than traditionally<br />

ligated brackets with <strong>torque</strong> placed. In the present<br />

research, interaction <strong>of</strong> the wire with the slot walls, as<br />

well as with the ligating mechanism, would be expected to<br />

occur when approaching ±10 degrees <strong>of</strong> <strong>torque</strong>, possibly<br />

tempering the alleged advantage <strong>of</strong> smaller frictional<br />

resistance that is commonly associated with <strong>self</strong>-ligating<br />

brackets. <strong>The</strong> marked increase in friction found in the<br />

<strong>self</strong>-ligating (but not in the Victory) sets when increasing<br />

the <strong>torque</strong> from ±5 degrees to ±10 degrees suggest that<br />

there were faciolingual force additions from substantial<br />

contacts with the ligating mechanisms. <strong>The</strong> In-Ovation R<br />

68


set, when the <strong>torque</strong> angle was increased from +5 to +10<br />

degrees, displayed substantially higher frictional<br />

resistance, possibly a result <strong>of</strong> increased normal forces<br />

due to its “active” <strong>self</strong>-ligation <strong>and</strong> the asymmetrical clip<br />

design.<br />

When the <strong>torque</strong> was increased beyond the <strong>third</strong>-<strong>order</strong><br />

clearance values to ±15 degrees, the friction associated<br />

with the SmartClip <strong>and</strong> the In-Ovation R sets grew to<br />

significantly larger magnitudes than the values displayed<br />

by the other three sets. This finding may be related to<br />

properties <strong>of</strong> the individual ligating mechanisms <strong>of</strong> these<br />

brackets. Interactions <strong>of</strong> the archwires with the clips in<br />

both brackets were likely because <strong>of</strong> the faciolingual<br />

dimensions <strong>of</strong> the ligated slots. Bunkall 58 attributed<br />

larger frictional forces from SmartClip brackets with<br />

first-<strong>order</strong> wire-slot discrepancies to flexure <strong>of</strong> the<br />

nickel-titanium-alloy clips contributing to normal forces<br />

as well as the relative roughnesses <strong>of</strong> the nickel-titanium-<br />

alloy surfaces. <strong>The</strong> clip integral to the In-Ovation R<br />

bracket is made <strong>of</strong> a cobalt-chromium alloy which has been<br />

reported to have a greater frictional potential related to<br />

surface-roughness than stainless steel, 13 <strong>and</strong> it may also<br />

have contributed to the relatively greater resistance<br />

displayed in this study.<br />

69


<strong>The</strong> design <strong>of</strong> this study does not entirely represent<br />

what might occur in clinical situations. Because teeth<br />

tend to tip <strong>and</strong> rotate during tooth movement, 6 the <strong>effects</strong><br />

<strong>of</strong> first- <strong>and</strong> second-<strong>order</strong> angulations on slot-wire<br />

friction should not be ignored when selecting a set <strong>of</strong><br />

crown-attachments. <strong>The</strong> research design <strong>and</strong> execution did,<br />

however, help to highlight <strong>and</strong> evaluate factors associated<br />

with friction in attachment-designs. Observations from<br />

this study lead to the recommendation that measures should<br />

be taken to reduce the amount <strong>of</strong> <strong>torque</strong> in the buccal<br />

segments before beginning en masse retraction <strong>of</strong> the<br />

anterior teeth. Future studies evaluating the collective<br />

contributions <strong>of</strong> tip, rotation <strong>and</strong> <strong>torque</strong> in a multiple<br />

crown-attachment setup could be helpful in determining<br />

optimal treatment-mechanics in certain clinical situations.<br />

Conclusions<br />

<strong>The</strong> results <strong>of</strong> this study confirmed that the presence<br />

<strong>of</strong> <strong>third</strong>-<strong>order</strong> <strong>torque</strong> can contribute to kinetic frictional<br />

resistance in the buccal segments during anterior<br />

retraction using sliding mechanics with crown-attachment<br />

sets including <strong>self</strong>-ligating brackets. At small <strong>torque</strong><br />

angles, friction will tend to be less with passive than<br />

70


with active, <strong>self</strong>-ligating sets. <strong>The</strong> findings suggest that<br />

a noticeable effect from friction will be seen when the<br />

<strong>torque</strong> reaches <strong>and</strong> exceeds the <strong>third</strong>-<strong>order</strong> clearance-angle<br />

<strong>of</strong> the wire-slot combinations. Furthermore, variations in<br />

bracket-ligation design can influence the amount <strong>of</strong><br />

friction produced, particularly at <strong>torque</strong>-values beyond the<br />

clearance-angle. When there is no <strong>torque</strong> present in the<br />

second premolar slot, attachment-sets with either passive<br />

or active <strong>self</strong>-ligating brackets will generate less<br />

friction than sets that include elastomerically ligated<br />

brackets. As <strong>torque</strong> increases toward the clearance-angle,<br />

however, differences in frictional resistances across<br />

crown-attachment sets generally lessen. Beyond this <strong>torque</strong><br />

value, the differences in frictional resistance may not<br />

depend upon the category <strong>of</strong> ligation, but, instead, upon<br />

the basic design <strong>of</strong> the ligation mechanism.<br />

71


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3. Rossouw PE. Friction: An overview. Sem Orthod<br />

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Orthop 1986;90:199-203.<br />

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12. Tidy DC. Frictional forces in fixed appliances. Am J<br />

Orthod Dent<strong>of</strong>acial Orthop 1989;96:249-254.<br />

13. Drescher D, Bourauel C, Schumacher HA. Frictional<br />

forces between bracket <strong>and</strong> arch wire. Am J Orthod<br />

Dent<strong>of</strong>acial Orthop 1989;96:397-404.<br />

14. Kapila S, Angolkar PV, Duncanson MG, Jr., N<strong>and</strong>a RS.<br />

Evaluation <strong>of</strong> friction between edgewise stainless steel<br />

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Dent<strong>of</strong>acial Orthop 1990;98:117-126.<br />

15. Kusy RP, Whitley JQ. Coefficients <strong>of</strong> friction for arch<br />

wires in stainless steel <strong>and</strong> polycrystalline alumina<br />

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Orthop 1990;98:300-312.<br />

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determinations <strong>of</strong> the critical contact angles for binding.<br />

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brackets. J Clin Orthod 1990;24:29-31.<br />

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Orthod 1998;32:44-53.<br />

69. Henao SP, Kusy RP. Evaluation <strong>of</strong> the frictional<br />

resistance <strong>of</strong> conventional <strong>and</strong> <strong>self</strong>-ligating bracket<br />

designs using st<strong>and</strong>ardized archwires <strong>and</strong> dental typodonts.<br />

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Br J Orthod 1997;24:309-317.<br />

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orthodontic brackets <strong>and</strong> archwires in the buccal segments.<br />

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properties <strong>of</strong> square <strong>and</strong> rectangular stainless steel wires<br />

tested in torsion. Am J Orthod Dent<strong>of</strong>acial Orthop<br />

1997;111:310-320.<br />

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76. Thorstenson GA, Kusy RP. Effect <strong>of</strong> archwire size <strong>and</strong><br />

material on the resistance to sliding <strong>of</strong> <strong>self</strong>-ligating<br />

brackets with second-<strong>order</strong> angulation in the dry state. Am<br />

J Orthod Dent<strong>of</strong>acial Orthop 2002;122:295-305.<br />

79


Tables<br />

Table 3-1: Frictional-force means <strong>and</strong> st<strong>and</strong>ard deviations in grams at<br />

seven <strong>torque</strong> angles at the second premolar from five sets <strong>of</strong> crownattachments.<br />

Torque (degrees)<br />

-15 -10 -5 0 +5 +10 +15<br />

Victory 551 ± 36 329 ± 84 339 ± 52 303 ± 63 363 ± 84 471 ± 32 549 ± 59<br />

In-Ovation R 752 ± 128 440 ± 34 205 ± 8 221 ± 14 236 ± 35 623 ± 32 757 ± 79<br />

Time2 562 ± 103 407 ± 74 186 ± 50 196 ± 17 335 ± 22 517 ± 50 529 ± 79<br />

Damon 3MX 498 ± 110 358 ± 113 120 ± 17 149 ± 31 165 ± 89 440 ± 81 496 ± 69<br />

SmartClip 736 ± 26 433 ± 73 149 ± 44 55 ± 24 151 ± 47 427 ± 87 744 ± 38<br />

80


Table 3-2: Significance levels (α = 0.05) <strong>of</strong> differences in mean<br />

frictional forces across pairs <strong>of</strong> cells, each cell defined by a<br />

<strong>torque</strong>-angle, from five sets <strong>of</strong> crown-attachments.<br />

Bracket<br />

Victory In-Ovation R Time2 Damon 3MX SmartClip<br />

Torque (degrees) Significance<br />

-15 -10 .004 .004 .025 NS .004<br />

-5 .004 .004 .004 .004 .004<br />

0 .004 .004 .004 .004 .004<br />

+5 .006 .004 .004 .004 .004<br />

+10 .006 NS NS NS .004<br />

+15 NS* NS NS NS NS<br />

-10 -15 .004 .004 .025 NS .004<br />

-5 NS .004 .004 .004 .004<br />

0 NS .004 .004 .006 .004<br />

+5 NS .004 NS .016 .004<br />

+10 .025 .004 .025 NS NS<br />

+15 .004 .004 .025 NS .004<br />

-5 -15 .004 .004 .000 .004 .004<br />

-10 NS .004 .004 .004 .004<br />

0 NS NS NS NS .006<br />

+5 NS NS .004 NS NS<br />

+10 .004 .004 .004 .004 .004<br />

+15 .004 .004 .004 .004 .004<br />

0 -15 .004 .004 .004 .004 .004<br />

-10 NS .004 .004 .006 .004<br />

-5 NS NS NS NS .006<br />

+5 NS NS .004 NS .006<br />

+10 .004 .004 .004 .004 .004<br />

+15 .004 .004 .004 .004 .004<br />

+5 -15 .000 .004 .004 .004 .004<br />

-10 NS .004 NS .016 .004<br />

-5 NS NS .004 NS NS<br />

0 NS NS .004 NS .006<br />

+10 NS .004 .004 .004 .004<br />

+15 .025 .004 .004 .004 .004<br />

+10 -15 .006 NS NS NS .004<br />

-10 .005 .004 .025 NS NS<br />

-5 .011 .004 .004 .004 .004<br />

0 .001 .004 .004 .004 .004<br />

+5 NS .004 .004 .004 .004<br />

+15 NS .006 NS NS .004<br />

+15 -15 NS NS NS NS NS<br />

-10 .004 .004 .025 NS .004<br />

-5 .004 .004 .004 .004 .004<br />

0 .004 .004 .004 .004 .004<br />

+5 .025 .004 .004 .004 .004<br />

+10 .020 .006 NS NS .004<br />

*Not Significant (NS)<br />

81


Table 3-3: Summary from Kruskal-Wallis analyses <strong>of</strong> variance<br />

<strong>of</strong> frictional forces for seven <strong>torque</strong>-angles across five<br />

sets <strong>of</strong> crown-attachments.<br />

Torque (degrees)<br />

-15 -10 -5 0 +5 +10 +15<br />

Chi-square 17.957 7.920 22.774 24.951 22.249 17.044 21.174<br />

df 4 4 4 4 4 4 4<br />

Asymp. Sig. .001 NS* .000 .000 .000 .002 .000<br />

*Not Significant (NS)<br />

82


Table 3-4: Mean differences in frictional resistances in grams <strong>and</strong> significance levels (α = 0.05) between<br />

crown-attachment sets at each <strong>of</strong> seven <strong>torque</strong>-angles.<br />

Torque (degrees)<br />

-15 -10 -5 0 +5 +10 +15<br />

(a) (b) (a-b) † Sig. (a-b) Sig. (a-b) Sig. (a-b) Sig. (a-b) Sig. (a-b) Sig. (a-b) Sig.<br />

Victory In-Ovation R -201 .006 -111 NS 134 .000 82 .003 127 .011 -152 .002 -208 .000<br />

Time2 -11 NS* -78 NS 153 .000 107 .000 28 NS -46 NS 20 . NS<br />

Damon 3MX 53 NS -29 NS 219 .000 154 .000 198 .000 31 NS 53 NS<br />

SmartClip -185 .013 -104 NS 190 .000 247 .000 213 .000 44 NS -195 .000<br />

In-Ovation R Victory 201 .006 111 NS -134 .000 -82 .003 -127 .011 152 .002 208 .000<br />

Time2 190 .010 33 NS 19 NS 25 NS -99 NS 106 .043 228 .000<br />

Damon 3MX 254 .000 82 NS 85 .006 72 .010 71 NS 183 .000 261 .000<br />

SmartClip 16 NS 7 NS 56 NS 166 .000 86 NS 196 .000 13 NS<br />

Time2 Victory 11 NS 78 NS -153 .000 -107 .000 -28 NS 46 NS -20 NS<br />

In-Ovation R -190 .010 -33 NS -19 NS -25 NS 99 NS -106 .043 -228 .000<br />

Damon 3MX 64 . NS 49 NS 66 .045 47 NS 170 .001 77 NS -33 NS<br />

SmartClip -174 .022 -26 NS 37 NS 141* .000 185 .000 90 NS -215 .000<br />

83<br />

Damon 3MX Victory -53 NS 29 NS -219 .000 -154 .000 -198 .000 -31 NS -53 NS<br />

In-Ovation R -254 .000 -82 NS -85 .006 -72 .010 -71 NS -183 .000 -261 .000<br />

Time2 -64 NS -49 NS -66 .045 -47 NS -170 .001 -77 NS 33 NS<br />

SmartClip -238 .001 -75 NS -29 NS 94 .001 14 NS 13 NS -248 .000<br />

SmartClip Victory 185 .013 104 NS -190 .000 -247 .000 -213 .000 -44 NS 195 .000<br />

In-Ovation R -16 NS -7 NS -56 NS -166 .000 -86 NS -196 .000 -13 NS<br />

Time2 174 .022 26 NS -37 NS -141 .000 -185 .000 -90 NS 215 .000<br />

Damon 3MX 238 .001 75 NS 29 NS -94 .001 -14 NS -13 NS 248 .000<br />

*Not Significant (NS)<br />

†<br />

Mean difference in frictional resistance between a <strong>and</strong> b in grams.


Figures<br />

Figure 3-1: Four cylinders mounted in aluminum base<br />

plate <strong>of</strong> the friction testing device.<br />

Figure 3-2: Bracket-slot positioning<br />

template.<br />

84


Figure 3-3: Control <strong>of</strong> the <strong>third</strong>-<strong>order</strong> position <strong>of</strong> the<br />

second premolar bracket-slot.<br />

Figure 3-4: SLBUCCAL tube<br />

Figure 3-5: Damon 3MX bracket<br />

85


Figure 3-6: SmartClip bracket<br />

Figure 3-7: In-Ovation R bracket<br />

Figure 3-8: Time2 bracket<br />

86


Figure 3-9: Victory bracket<br />

Figure 3-10: Friction testing setup<br />

mounted to the Instron Universal Testing<br />

Machine.<br />

87


Friction (grams)<br />

800<br />

700<br />

600<br />

500<br />

400<br />

300<br />

200<br />

100<br />

0<br />

-15 -10 -5 0<br />

Torque (degrees)<br />

+5 +10 +15<br />

Figure 3-11: Plots <strong>of</strong> mean kinetic frictional force within the dental segment vs. <strong>torque</strong><br />

angle at the second premolar from five sets <strong>of</strong> crown-attachments.<br />

88<br />

Victory<br />

In-Ovation R<br />

Time2<br />

Damon 3MX<br />

SmartClip


Figure 3-12: Cross-section diagrams <strong>of</strong> a 0.019- x 0.025-inch wire. <strong>The</strong><br />

buccolingual dimension <strong>of</strong> the wire when rotated 10 degrees (line BD) is<br />

calculated by multiplying cos Φ2 by the hypotenuse AB.<br />

89


VITA AUCTORIS<br />

Michael Ji Hoon Chung was born on December 23, 1975 in<br />

Hollis, New York to Ye Hyun <strong>and</strong> Eun Soon Chung. In 1994,<br />

he received his high school diploma from the Horace Mann<br />

School in Riverdale, New York. From there he went to New<br />

York <strong>University</strong> <strong>and</strong> received a Bachelor <strong>of</strong> Arts degree in<br />

Psychology in May, 1998. From 1999 to 2003, he attended<br />

dental school at Columbia <strong>University</strong> in New York. He was<br />

awarded a Doctor <strong>of</strong> Dental Surgery degree in 2003. <strong>The</strong><br />

following year, Dr. Chung studied as a resident in the<br />

Advanced Education in General Dentistry program at Columbia<br />

<strong>University</strong>. In 2004, he began his graduate studies in<br />

orthodontics at the Center for Advanced Dental Education at<br />

<strong>Saint</strong> <strong>Louis</strong> <strong>University</strong> in <strong>Saint</strong> <strong>Louis</strong>, Missouri, where he<br />

is currently a c<strong>and</strong>idate for the degree <strong>of</strong> Master <strong>of</strong><br />

Science in Dentistry. He expects to graduate in January <strong>of</strong><br />

2007.<br />

Dr. Chung was married to Sahrip Kim in July, 2002.<br />

After graduation, they plan to return to the New York<br />

metropolitan area.<br />

90

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