Experimental determination of the center of resistance of the upper first molar in a macerated, dry human skull submitted to horizontal

headgear traction
L. R. Dermaut, D.D.S., Ph.D.,* J. P. J. Kleutghen, D.D.S., M.D.,** and H. J. J. De Clerck, D.D.S.** Gent, Belgium
Laser speckle interferometry, recently developed for noninvasive measurement of small displacements (microns), was used to study the movement of maxillary molars submitted to extraoral traction. Using an antenna-headgear at different horizontal levels, Ioadings of 700 gm were applied perpendicular to the long axes of these teeth. Bodily movement was observed when the traction line passed s!ightly occlusal to the trifurcation of the roots. Therefore, the center of resistance of the upper molar was experimentally localized at this level. Laser speckle interferometry proved to be a promising technique for dental research. (AMJ ORTHODDENTOFACORTHOP 90: 29-36, 1986.) Key words: Center of resistance, force, orthodontic tooth movement, laser speckle interferometry, headgear

When applying different forces on teeth, actual control of the movement is necessary to assure efficiency in clinical orthodontics. Therefore, the growing interest in biomechanics as an experimental and clinical discipline can be easily observed in the orthodontic literature as simple empiric observations have been explained or overruled by biophysical theories and investigations. In the manipulation of appliances, most orthodontists consider the relationship of the force vector to the center of resistance of a tooth or a group of teeth. Indeed, whether an object will display a tipping or a bodily movement when submitted to a single force is mainly determined by the location of the center of resistance of this object and the distance between the force vector and this center of resistance. 1.14 In most cases the position of the center of resistance within a tooth can neither be influenced by appliance design nor by its activation. Therefore, actual tooth displacement is partially determined by varying the parameters of force application. These parameters are the direction, the duration, and the magnitude of the applied force. Moreover, these factors are influenced by the point of application of the force system on the object under consideration. Nevertheless, accurate force application also re*Chairman, Department of Orthodontics, State University of Gent. **Assistant Professor, Department of Orthodontics.

quires some knowledge of the location of the center of resistance of the object to be moved. The center of resistance 14has been defined as the point of the greatest resistance to the movement of a tooth. It is further defined as the point that allows the tooth to display a pure translation 9 without exhibiting either a rotational tendency or a moment when the force vector, regardless of its direction, passes through it. The center of resistance should not be regarded as a fixed point within a tooth, but rather as the composite point of all factors, 3 offering different components of resistance to a certain force application. Analysis of the resistance to dental movement should therefore take the following parameters into consideration: 1. The tooth anatomy and mass distribution within the tooth 2. The structure of the periodontal attachments 3. The degree of bony surroundings 4. The adjacent teeth Haack and Weinstein 7 studied force distribution in the periodontal ligament s on a two-dimensional model of an incisor with a parabolic-shaped root. Pure translation was obtained when a single force passed through the center of resistance or when a single force, applied at the bracket, was combined with a well-defined moment. Examination of the described experiments leads to the observation that the center of resistance for a single29

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Dermaut, Kleutghen, and De Clerck

Am. J. Orthod. Dentofac. Orthop. July 1986

Fig. 1. A small ribbon-like metal plate glued parallel to the vestibular surface of the left molar just below the headgear tube.

rooted tooth might be found at approximately half the distance of the apex to the alveolar crest. Later, Worms, Isaacson, and Speidel ~6 studied the movements of the upper first molar submitted to cervical headgear traction in 15 patients. To register the type of displacement of the molars, they used cephalometric laminographs through the buccal quadrant taken at regular intervals during the extraoral treatment. In the meantime, routine lateral head plates with the face-bows in activation served to elucidate the actual force vector of the headgear traction. Bodily movement of molars was found in three patients in whom the traction line passed through the trifurcation area. The authors ~6 concluded that the center of resistance of the upper first molar should be located at this level. Studying the displacements of incisors on human subjects in three dimensions (first with dial micrometers and later with double exposure holograms). Burstone and co-workers4'll calculated the location of the theoretic center of resistance. In the two-dimensional representation of a model of the upper incisor, the center of resistance was located at 40% of the distance of the root length apical to the alveolar crest. The same computation was corrected to a value of 33% of the root length when the model was assumed to possess a tridimensional geometry, Experimental determination of the center of resistance was then performed on a 10:1 model of an incisor also with the aid of the holographic measuring techniqu e . Compared to the theoretic location of the center of resistance, it was found to be slightly more occlusal. For a two-dimensional geometry, the theoretic center of resistance was 11.0 mm from the bracket; for a

tridimensional representation, a distance 10.2 mm was calculated. The experimental center of resistance was localized at 9.9 mm from the bracket. For multirooted teeth (mandibular molars), Burstone and Pryputniewicz 2 tested a fresh, human-skull specimen replacing the periodontal ligament with silicone rubber. The center of resistance was between 30% and 40% of the distance from the alveolar crest to the root apices, being 1-2 mm apical of the furcation. ~4 Reviewing this data, one must conclude that the center of resistance is always very close to the geometric center (centroid) of the supported tooth mass between the alveolar crest and apices. Theoretically, it should be possible to determine by clinical investigation the center of resistance of the upper molar. But in reality too many parameters interfere, such as the flexibility of the wires, the inconsistency in loading as well as in duration, and the amount and direction of the force. As previously mentioned, Worms, Isaacson, and Speidel ~6 clinically determined the location of the center of resistance of the maxillary molars in the area of the root trifurcation. These findings confirm the hypothetical location of the center of resistance for the upper first molars according to different authors, t.~0.t~Despite this observation, experimental determination is still advantageous because it provides better control of the parameters involved. Precise measurement of "initial" tooth movements should enable an exact determination of tooth position before and after loading while direction and amount of force are kept Perfectly constant. Therefore, possible errors are reduced compared with a method in which superimposition of tracings might be the cause of some inaccuracy. ~ 6

Volume 90
Number l

Determination of center of resistance of upper first molar

31

Fig. 2. Antenna-headgear.

MATERIAL AND METHODS Materials

To approach biologic reality as much as possible, the use of mechanical simulators as experimental models was disregarded mainly because reproduction of the tooth surroundings is practically impossible. Instead of replicas, a macerated, dry human skull was chosen as the test object. Although some differences of biomechanical behavior between this kind of model and the patient may be expected, a sufficient degree of similarity exists to use it as a reliable simulation model. A skull was selected that met specific criteria. Checking the dentition of this skull, a symmetric position (not mesial to the left and right upper first molars) was observed. Simultaneously, the alveolar crest was also found to be within normal limits for both teeth on the vestibular and the palatal sides. Because the skull apparently was derived from an adult, fully erupted second maxillary molars were in contact with the experimental teeth. Dental contact zones with the second premolars were also judged to be normal. In preparation for the experiment, all teeth were carefully removed. During this procedure any damage to the alveolar bone was avoided. The per!odontal ligament had to be replaced by an artificial one. For this purpose, a thin layer of Araldit 208 was injected into the empty sockets: Afterwards the teeth were cautiously repositioned. This special glue, Araldit 208, when mixed with the harder 956 in a ratio of 10 to 1, displays nearly the same elastic properties as the human periodontium according to Dijkman? To evaluate the degree of tipping and bodily movement more accurately, a small ribbon-like metal plate (0.5 cm 2 cm) was glued parallel to the vestibular surface of the left molar just below the headgear tube (Fig. 1). This plate, serving as an extension, enabled measurements to be taken no t only in the center of the

crown along the tooth axis, but also on the mesial and distal coronal extremities. In that way three scanning spots were defined for measurements--one on the mesial side, one in the middle, and one on the distal side. At the start a commercially available headgear had been adapted to create a traction line through the trifurcation area. When applying a total load of 700 gin, this appliance showed a significant amount of bending. This effect not only lowered the traction line, requiring readaptation of the inclination between outer and inner bows to a much larger extent, but also caused an unwanted extrusive effect on the molars. This parasitic force-effect could have interfered with the displacement to be tested. Therefore, a special "antenna-headgear" was developed (Fig. 2). Instead of an outer bow to determine the lines of traction, an antenna was soldered to an inner bow that was entirely reinforced except for the segments to be introduced into the molar tubes. At different levels of the antenna, hooks were attached to support a nylon wire running along a neck simulator. Because the latter could also be changed for different vertical levels, traction lines parallel to a certain reference line could be realized. The loading was applied by means of a calibrated spring attached to the nylon wire (Fig. 3). The line, contacting the incisal edge of the canines and the mesiovestibular cusp of the first molar, was chosen as the reference line. This line was fairly Perpendicular to the apico-occlusal axis of the first molars. It was represented by a nylon wire tied to the fixation supports of the skull.
Method

In this study initial displacement of molars was measured by means of speckle interferometry, an optical nondestructive measuring technique. Laser speckle metrology is an optically precise measurement technique designed for registration of small displacements (mi-

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Dermaut, Kleutghen, and De Clerck

Am. J. Orthod. Dentofac. Orthop. July 1986

l
A B C D E F

G
Fig. 3. Indication of level of traction lines. A, Through apices. B, Molar root trifurcation. C, 10 mm above the occlusal level. D, 5 mm above the occlusal level. E, Occlusal level. F, 10 mm below the occlusal level. G, 20 mm below the occiusal level.

Fig. 4. Fixation of the skull by means of three intermediate resin shields attached to a solid metal framework using five metal supports--two for the occipital area, the third on the dorsal side of the parietal bones, and two on the forehead.

crons). Therefore, any source of vibration and all parasitic movements should be strictly banished from the experimental room. Although the standards of vibration-isolation for speckle metrology are generally considered to be less strict than those for holography, they surely may not be underestimated. Thus, the skull was rigidly affixed to a solid metal framework by means of five metal supports--two for the occipital area, the third on the dorsal side of the parietal bones, and two on the forehead (Fig. 4). With massive bolts and nuts, the skull was carefully stabilized between the metal supports avoiding any effect of force by clamping in order to prevent unwanted strain in the skull. The support

zones were further consolidated with three intermediate resin shields. This framework was then firmly clamped to an optical bench, together with all elements of the registration unit. Preceding the experiments, the validity of this stabilization was controlled by real-time holography; afterwards mechanical microcomparators confirmed its reliability. In the experimental situation, a simulator replaced the patient's neck. It consisted of three frictionless pulleys mounted on a flat metal bar. The distance between the pulleys--imitating the transverse dimension of the patient's neck--could be adjusted by means of screws. A specially designed fixation Suppo~ attached to the solid base of the framework enabled us to use different levels of traction by raising or lowering the neck simulator. The following seven traction levels parallel to the occlusal plane (checked on cephalograms) were chosen during loading (Fig. 3): A. Through the apices of the roots B. Area of root trifurcation C. 10 mm above the occlusal level (apical third of the root length) D. 5 mm above the occlusal level, slightly below the cementoenamel junction E. Occlusal level (a plane, connecting the mesiovestibular cusps of the first molars and the incisal edges of the canines) F. 10 mm below the occlusal level G. 20 mm below the occlusal level All traction lines were rigorously checked for parallelism with the reference line during the application of forces. Among the noninvasive optical biometric tech-

Volume 90 Number 1

Determination of center of resistance of upper first molar

33

ANALYSIS UNIT SPECKLESCANNER

~LASER

I
Fig. 5, Analysis unit.

oo0o
MONITOR

I
LASER

,q

"Ill' I

Fig. 6. A, Schematic representation of the creation of Young's fringes when laser beam is passing through two holes in a screen. B, Schematic drawing of the displacement (d) of a speckle pattern on a double-exposedholographic plate due to force application. A laser beam passing through the specklegram creates a fringe pattern (Young's phenomenon), C, The amount of displacement is inversely proportionate with the distance between two fringes (d); the direction of displacement is perpendicular to the orientation of the fringes.

niques, laser speckle metrology ~2-~3was chosen as the experimental procedure for two reasons. In the first place, the amount of displacement induced by extraoral forces corresponds with the measurement range of this optical technique. In the second place, not only the amount of the movements, but also their direction can

be recorded immediately when restricted to a two-dimensional field. ~3 Procedures of speckle interferometry When an expanded laser beam illuminates a diffuse reflecting object, a random distribution of bright and

34 Dermaut, Kleutghen, and De Clerck

Am. J. Orthod.Dentofac.Orthop. July 1986

Table I. Statistical evaluation of data (calculated to check reliability of experimental procedure)

Angular measurements(o) Scanning spots (N=I3)
Mesial Median Distal MEAN PERCENTAGE OF ERROR

Linear measurements (ram) Mean[SD[%oferror

11% 6% 8% 8% 41.65 40.76 39.65 5.05 1.30 3.41 12% 3% 4% 6%

Mean[SD[%oferror
16.8 28.15 39.6 1.85 1.70 3.41

Loading = 700 g m during 1.5 minutes with intervals of 3 minutes relaxation. Procedure was performed 13 times for each scanning spot.

Table II. Direction and amount of displacement of the three scanning points on the metal plate

Distal Traction level

A B C D E F G

Median dl
12 ixm 17 ~ m 20 p~m 29 ~ m 43 p~m 49 I~m 50 p~m

Mesial d2
11 txm 17 I~m 22 ixm 32 ixm 46 p,m 52 p,m 51 p~m

~j
-37 -25 - 25 - 12 -7 - 5 + 1

~2
-26 -22 - 28 - 19 - 16 - 17.5 - 17

fl~
-17 -21 - 29" -24 -23 - 28 -32

d3
11 Izm 17 ~ m 22 ~ m 34 ~ m 50 I~m 54 i~m 55 Ixm

Degree of tipping a
-16 -4 + 3" +32 +59 + 86 + 123

The direction (13) of the three displacement vectors is measured in degrees ( - = extrusion; + = intrusion). The a m o u n t of displacement (d) is calculated in microns. In the last column the degree of tipping is shown by means of the angle et multipled by 103 (see Fig. 7). A negative sign stands for a distal root tipping; a positive sign indicates a distal crown tipping.

dark spots superimposed on the object surface can be observed. These "speckles" are associated with the object surface so that when the object is displaced, the speckle pattern moves in an identical manner. Registration of two speckle patterns, one before and one after object displacement, is realized on the same photo. For our experiment, two working units were constrncted-a registration unit and an analysis unit. The registration unit consisted of the metal framework supporting the skull with the headgear, neck simulator, and weight carder. The surface of the metal plate, glued to the left molar, is illuminated by a diverged laser beam. The reflected speckle pattern is registrated twice (once before and once after force application) on a photographic plate in a camera placed perpendicular to the optical axis. After processing, the photographic plate, called speckle-gram, is affixed in the "speckle scanner" of the analysis unit (Fig. 5). By manipulating two sliding screw shafts, one horizontal and one vertical, the "speckle-gram" can be displaced in a plane orthogonally to the laser beam. Keeping the laser beam steady and moving the frame in X-Y direction to the beam, any chosen point on the speckle-gram can be selected for measurement. At a certain distance behind the speckle scanner, a primary screen is fixed to the optical

bench. A well-focused laser beam passing through the selected point on the photograph interferes with the correlated speckle-patterns of the emulsion, creating an image divided by fringes (Fig. 6). The appearance of these interference fringes is based on the optical phenomenon advocated by Young.~7 The fringes are projected on the screen and this image is then captured by a video camera connected to a monitor. The distance between two fringes is inversely proportionate to the amount of displacement to be measured. Simple mathematic calculation gives the exact values in micrometers. A rotating transparent disc with calibrated angulation readout is attached over the monitor screen. The direction of the object displacement is perpendicular to the fringe inclination. Measurement of the angle of the fringes on the monitor not only allows the determination of the direction of object displacement, but also creates the possibility of resolution of vector components (Fig. 6, C). This procedure is very important for the stress analysis of extraoral orthodontic forces because it indicates lateral and dorsal force components. In this way it is possible to determine the displacement vectors and their components for the three points on the metal plate, which is glued to the moving upper first molar.

Volume 90 Number I

Determination of center of resistance of upper first molar

35

I S T
A

[ ,,~/ ! v . . / f ~1 )" ; I

-,

E S I
A

--....
"
. . . . ",

"-1= -l's

-F

~ B .

Fig. 7. Schematic representation of the degree of tipping. Fig. 8. Average degree of tipping per level of traction line. Ordinate = Level of traction lines. Abscissa = Degree of tipping (a). Numbers to the left of the ordinate represent distal crown tipping; numbers to the right indicate distal root tipping. Point of intersection represents bodily movement without rotation.

Reliability of the m e t h o d

Reliability and reproducibility of the procedure were checked by successively applying the same loading amount (700 gm) 13 times. The applications were made during 13 time periods of 1.5 minutes duration with intervals of 3 minutes for relaxation. Previously, two "dry runs" had been performed on the same time schedule. For these loadings, traction-level A was maintained. Listed in Table I are the means and standard deviations of the measurements used to check the reliability. The three scanning spots--one on the mesial aspect, one in the middle of the molar axis, and one on the distal aspect--were evaluated for the direction of the displacement (represented by the angulation of the fringes) and for the magnitude of the movement as measured in millimeters (fringe interdistance). Comparison of the accuracy between angular and linear measurements confirmed the normal expectation that errors are more reduced for linear than for angular registrations (as the mean percentages of error indic a t e d - 8 % for angular and 6% for linear measurements). The accuracy differences for both kinds of measurements between the mesial versus the median and distal scanning spots could eventually be explained by a small divergence of the rectangular metal specimen to the optical axis of the registrating camera. In fact, this metal surface should be perfectly oriented perpendicular to the axis of the camera.
FINDINGS

To locate the center of resistance for the upper first molars of this skull, the model was subjected to a loading of 700 gm at the seven traction levels (Fig. 3). For each level, two dry runs were performed followed by three force applications for actual measurement using the same time schedule as that for the reliability test. The averages of these tests are represented in Table II.

For each of the displacement vectors of the three scanning points, the angle of displacement (~1, ~2, [33) and the amount of displacement (dl, d2, d3) were enumerated (Fig. 7). Comparing the amount of displacement in the traction levels, it became apparent that displacement increased when the level of traction was lower. From level D to G, the traction line passed through the molar crown and the amount of displacement increased remarkably. The difference between level D and E was most striking; however, this gradient was not continued at the same rate for F and G (Table II). All registrations displayed an extrusive vector component (negative sign of angle 13) except for the distal spot at level G. The degree of tipping, identified in Table II as cx was calculated starting from the values of amount and direction of the three vectors of displacement. Two lines connecting the three points before and after force application were substituted (Fig. 7). The angle a between both lines was defined as the "degree of tipping." Negative signs were obtained for traction levels A and B, and positive signs for all other traction levels with increasing amount from level C to G (Table II). The registered degree of tipping has been transferred to the diagram in Fig. 8. On the ordinate are the levels of traction. The values of tilting are represented on the abscissa. Negative values indicate a distal root tilting; positive signs stand for distal crown tipping. Bodily movement without rotation would be realized when the line connecting the data for tipping intersects the ordinate.
CONCLUSIONS

Reviewing the data of Table II, the increments in the amount of displacement of the upper molar could,

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Dermaut, Kleutghen, and De Clerck

Am. J. Orthod. Dentofac. Orthop. July 1986

3. Burstone CJ, Pryputniewicz RJ: Holographic determination of centers of rotation produced by orthodontic forces. AM J ORTHOD 77: 396-409, 1980. 4. Christiaensen RL, Burstone CJ: Centers of rotation within the periodontal space. AM J ORTHOD55: 353-369, 1969. 5. Dijkman JFP: Krachtenverdeling bij orthodontische behandeling. Doctoral thesis, University of Nijmegen, The Netherlands, 1969. 6. Haack D, Weinstein S: The mechanics of centric and eccentric cervical traction. AM J ORTHOD44: 346-357, 1958. 7. Haack CD, Weinstein S: Geometry and mechanics as related to tooth movement studied by means of a two-dimensional model. J Am Dent Assoc 66: 157-164, 1963. 8. Kleutghen J, Dermaut LR, Boone PM, De Caluwe M: The analysis of extraoral orthodontic forces on a macerated skull by means of speckle interferometry: A preliminary report. Proceedings of the Society of Photo-Optical Instrumentation Engineers, Edinburgh, 1982. 9. Mulligan TF: Common sense mechanics. 2. Forces and moments. J Clin Orthod 13: 676-683, 1979. I0. Oosthuizen L, Dijkman JFP, Evans WG: A mechanical appraisal of the Kloehn extraoral assembly. Angle Orthod 43: 221-232, 1973. 11. Pryputniewicz RJ, Burstone CJ: The effect of time and force magnitude on orthodontic tooth movement. J Dent Res 58: 17541764, 1979. 12. Pryputniewicz RJ: Laser speckle method for biostereometrics. (International Symposium on Precision and Speed in Close Range Photogrammetry, York, England, 1982.) Int. Archives of Photogrammetry 24: 387-397, 1982. 13. Pryputniewicz RJ, Burstone CJ: A new technique for studies of tooth and bone motion. J Dent Res 61: A926, 1982. 14. Smith RJ, Burstone CJ: Mechanics of tooth movement. AM J ORTHOD 85: 294-307, 1984. 15. Teuscher V: A growth-related concept for skeletal Class II treatment. AM J ORTHOD74: 258-275, 1978. 16. Worms FW, Isaacson RJ, Speidel TM: A concept and classification of centers of rotation and extraoral force systems. Angle Orthod 43: 384-401, 1973. 17. Young TH: Philos Trans R Soc 12: 387, 1802.

by lowering the traction level, be attributed to the resistance caused by the bony surroundings of the roots. By lowering the level of traction, the resistance to the applied forces decreased with a greater tilting on the molar crown. For traction level G, the distal crown tipping was so pronounced that even a small intrusion of the distal scanning point occurred. Examination of Fig. 8 leads to the conclusion that the center of resistance of the upper first molar, when submitted to an extraoral traction of 700 grn directed perpendicular to its long axis, should be estimated to lie somewhat below the trifurcation area. Bodily movement of the molar was realized when a force was applied between levels B and C because the line connecting the tilting values for levels B and C in Fig. 8 intersects the ordinate. This observation confirms the statement of Worms, Isaacson, and Speidel, ~6 who noted that the center of resistance descends in an apico-occlusal direction if a fully erupted second molar contacts the experimental tooth. Furthermore, this experiment proves that speckle interferometry can be estimated as a worthwhile, reliable, and accurate procedure for the experimental analysis of initial orthodontic extraoral forces. This optical technique offers more possibilities for precision measurements (in dental research) than past procedures. Along with holography, it also deserves in this context a fully recognized place among the noninvasive measurement tools.
The authors wish to thank Professor Dr. 1. P. Boone and Mr, M. De Caluwe from the Department of "Resistance of Materials" for their assistance and help during the experiments. They also want to thank Mrs. B. Jouret for typing the manuscript and Mr, G, Dermout for making the tracings and photographs. REFERENCES
1. Burstone CJ: Biomechanics of tooth movement. In Kraus BS, Riedel RA (editors): Vistas in orthodontics, Philadelphia, 1962, Lea & Febiger, pp 197-213. 2. Burstone CJ, Pryputniewicz RJ, Weeks R: Center of resistance of the human mandibular molars. J Dent Res 60: 515, 1981.

Reprint requests to: L. Dermaut Kliniek voor Tand-, Mond- en Kaakziekten Department of Orthodontics Akademisch Ziekenhuis De Pintelaan 185 B-9000 Gent Belgium