Orthodontic Force Magnitude for Dental Alignment

Overseen By Georgiana Defilio

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: UConn Health

Must not be taking: Bisphosphonates, Oral contraceptives, PTH

Disqualifiers: Poor oral hygiene, Root resorption, Chronic illness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

Duration: 17 weeks

40 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial excludes patients on medications that may alter bone metabolism, such as bisphosphonates, oral contraceptives, or parathyroid hormone. If you are taking these medications, you may not be eligible to participate.

What data supports the effectiveness of the treatment Orthodontic Force Magnitude for Dental Alignment?

Research suggests that using a force of 150 grams for canine retraction results in faster tooth movement and increased biological activity without causing harm, such as root resorption, compared to a 100 gram force. ^{1 2 3 4 5}

Is orthodontic force application for dental alignment safe?

Research indicates that using orthodontic forces, whether heavy or light, for dental alignment is generally safe, as studies have shown no harmful effects like root resorption (loss of tooth root structure) in the tested conditions. ^{1 3 6 7 8}

How does the orthodontic force magnitude treatment differ from other treatments for dental alignment?

This treatment is unique because it uses different magnitudes of force, such as heavy and light forces, to move teeth, which can affect the speed and effectiveness of tooth movement without causing root damage. The choice of force magnitude can be tailored to individual needs, considering factors like tooth position and bone type, to achieve optimal results. ^{1 2 3 5 6}

What is the purpose of this trial?

This study aims to examine the effect of force levels in orthodontic treatment during canine retraction. Force levels refer to the pressure applied by the orthodontic devices to move teeth. Data collection will include gingival fluid, dental molds from a digital scanner, and x-rays of the upper canine region on both sides of the mouth during treatment. The null hypothesis to be tested is that there is no significant difference in the rate of canine movement between the light force and the heavy force levels.

Research Team

Flavio Uribe, DDS

Principal Investigator

UConn Health

Eligibility Criteria

This trial is for individuals with crossbite or tooth crowding who need orthodontic treatment to move their canine teeth. Participants should be healthy enough for dental procedures and willing to provide samples of gingival fluid, undergo digital dental scans, and x-rays.

Inclusion Criteria

Healthy patient, non-smoker

The ability to read and understand English and to provide informed consent

I am between 11 and 16 years old.

Exclusion Criteria

Evidence of poor oral hygiene

Evidence of previous root resorption

Medical issues that affect tooth movement

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo canine retraction with either light or heavy force using NiTi coil springs. Data collection includes gingival fluid, dental molds, and x-rays.

17 weeks

6 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including the measurement of external apical root resorption.

4 weeks

Treatment Details

Interventions

• Heavy Force
• Light Force

Trial Overview The study is testing the effects of two different levels of force applied by Niti coils during orthodontic treatment: a light force (150g) versus a heavy force (400g). The goal is to see if there's a difference in how quickly canine teeth move with these forces.

Participant Groups

Group I: Heavy force (400g NiTi Coil Spring) Experimental Treatment 1 Intervention

One side of the maxillary canines to be retracted will have a heavy force assigned randomly. Patients' participation in the study (T0) will be started at the stage of canine retraction. At this appointment, 0.019 x 0.025-inch stainless steel archwire will be placed; power arms will be fabricated from 17x25-inch stainless steel on the maxillary first molars and canines. The height of the power arm will be matched with the center of resistance of both canines and molars based on the root length measured on the periapical radiographs. The archwire will be engaged in the canine bracket using stainless steel ligature wire. NiTi coil spring calibrated for force magnitude (400g) at oral temperature will be used to deliver the assigned force will be engaged from the first molars to the canine power arms.

Group II: Light force (150g Niti Coil Spring) Active Control 1 Intervention

One of the maxillary canines to be retracted will be assigned to the light force group randomly. Patients' participation in the study (T0) will be started at the stage of canine retraction. At this appointment, 0.019 x 0.025-inch stainless steel archwire will be placed; power arms will be fabricated from 17x25-inch stainless steel on the maxillary first molars and canines. The height of the power arm will be matched with the center of resistance of both canines and molars based on the root length measured on the periapical radiographs. The archwire will be engaged in the canine bracket using stainless steel ligature wire. NiTi coil spring calibrated for force magnitude (150g) at oral temperature will be used to deliver the assigned force will be engaged from the first molars to the canine power arms.

Who Is Running the Clinical Trial?

UConn Health

Lead Sponsor

Trials

218

Recruited

59,100+

Charles Burstone Foundation

Collaborator

Trials

1

Recruited

40+

Findings from Research

In a study involving 9 patients undergoing bilateral canine retraction, it was found that as the distance between brackets decreased, the retraction force dropped significantly, by 30% for every 1 mm reduction in interbracket distance.

The research highlighted that changes in canine position and angulation during treatment can lead to increased moment-to-force ratios, suggesting that orthodontic plans may need adjustments and that patients should adhere closely to appointment schedules to avoid complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Load system of segmental T-loops for canine retraction. Xia, Z., Chen, J., Jiangc, F., et al.[2021]

This systematic review analyzed the optimal force magnitude required for effective orthodontic tooth movement using fixed appliances, providing insights into how different force levels can impact treatment outcomes.

The findings suggest that applying the right amount of force is crucial for efficient tooth movement, which can enhance the effectiveness of orthodontic treatments and improve patient comfort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Forces Between 50 and 100 cN May be Best for Mesiodistal Orthodontic Tooth Movements by Fixed Appliances. Flores-Mir, C.[2021]

In a study involving 12 female subjects with class II division 1 malocclusion, applying a force of 150 grams during orthodontic treatment resulted in significantly faster tooth movement (2.10 mm) compared to a 100-gram force (1.57 mm).

The higher force of 150 grams also led to increased alkaline phosphatase (ALP) activity, indicating enhanced bone remodeling, without causing any root resorption in the maxillary canines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Crevicular Alkaline Phosphatase Activity and Rate of Tooth Movement of Female Orthodontic Subjects under Different Continuous Force Applications. Megat Abdul Wahab, R., Md Dasor, M., Senafi, S., et al.[2021]

The review analyzes the relationship between the force applied by orthodontic appliances and the speed of tooth movement, supporting a specific hypothesis that suggests lower stress on posterior teeth can help maintain anchorage while effectively moving anterior teeth.

The findings indicate that using appliances with low load-deflection rates can optimize tooth movement, providing a strategic approach for orthodontic treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A reassessment of force magnitude in orthodontics. Quinn, RS., Yoshikawa, DK.[2022]

The study identifies multiple factors that influence the ideal forces needed for effective canine retraction in orthodontics, including the type of movement (bodily vs. tipping), the anatomical and biological conditions, and personal factors such as age.

Understanding these factors allows orthodontists to tailor the force applied during treatment, potentially reducing complications and improving outcomes by avoiding unnecessary experimentation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The ideal forces for canine retraction]. Markostamos, K., Akli, K.[2020]

In a study measuring the forces produced by 10 orthodontic archwires under simulated clinical conditions, the forces exerted at 1.5 mm deflection ranged from 1.5 to 8.3 N when part of a fixed appliance, indicating significant variability in force generation.

When tested as simple beams, the same wires produced much lower forces, ranging from 0.3 to 3.0 N, suggesting that the behavior of orthodontic archwires in clinical settings cannot be accurately predicted using basic physical principles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Forces exerted by orthodontic aligning archwires. Rock, WP., Wilson, HJ.[2022]

The drum spring (DS) retractor provides a constant and continuous force of 50 g for canine retraction without the need for reactivation, leading to faster tooth movement compared to the traditional pull coil (PC) retractor, which has a diminishing force.

In a study involving 15 patients, the DS retractor demonstrated more effective canine retraction, particularly in adolescents, suggesting potential for broader clinical applications in orthodontics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The drum spring (DS) retractor: constant and continuous force for canine retraction. Darendeliler, MA., Darendeliler, H., Uner, O.[2019]

In a study involving 14 patients over 12 weeks, heavy continuous forces (300 g) increased the rate and amount of canine retraction during orthodontic treatment, but also led to greater loss of control over canine rotation and anchorage.

Light continuous forces (50 g) resulted in a greater percentage of canine retraction with less strain on anchorage, suggesting that while heavy forces can speed up movement, they may cause unwanted side effects that could complicate treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rate of tooth movement under heavy and light continuous orthodontic forces. Yee, JA., Türk, T., Elekdağ-Türk, S., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Load system of segmental T-loops for canine retraction. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Forces Between 50 and 100 cN May be Best for Mesiodistal Orthodontic Tooth Movements by Fixed Appliances. [2021]

3. Egypt pubmed.ncbi.nlm.nih.gov

Crevicular Alkaline Phosphatase Activity and Rate of Tooth Movement of Female Orthodontic Subjects under Different Continuous Force Applications. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

A reassessment of force magnitude in orthodontics. [2022]

5. Greece pubmed.ncbi.nlm.nih.gov

[The ideal forces for canine retraction]. [2020]

6. England pubmed.ncbi.nlm.nih.gov

Forces exerted by orthodontic aligning archwires. [2022]

7. England pubmed.ncbi.nlm.nih.gov

The drum spring (DS) retractor: constant and continuous force for canine retraction. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Rate of tooth movement under heavy and light continuous orthodontic forces. [2022]