Documente Academic
Documente Profesional
Documente Cultură
orthodontics* 5
T. Eliades, W. Brantley
5.1 Introduction
Recent developments in science and technology have permitted the introduction of a
plethora of new orthodontic products at a dramatically increasing rate starting in the
early 1980s, an event which inevitably provoked the necessity for the orthodontist
to have a relatively comprehensive exposure to the eld of dental materials science.
Lately, the progression of research in this eld has led to the development of some
new products that are distinguishable from their predecessors based on novel compo-
sitions. Even though training in the eld of orthodontic dental materials is part of the
accreditation standards of graduate orthodontic curricula for European and US pro-
grams, the advanced education seems to have largely failed to follow the rapid pace
of advances in this eld, essentially depriving the orthodontist of the required funda-
mental background knowledge in this area. In the words of an industry leader quoted
by Matasa,1 . for the manufacturer it is always amazing to see how noncritical the
orthodontist can be .
During the last 25 years an abundance of information has been reported on both
the static and kinetic frictional forces developed in the bracket-wire complex during
in vitro studies simulating orthodontic tooth movement with varying levels of reli-
ability. Despite the availability of relevant information, there is a notable lack of
consensus concerning the uctuations of friction during sliding of wires on bracket
slot surfaces. This discrepancy may derive from the multiplicity and inefciency of
research protocols adopted for the study of the phenomenon. The objective of this
chapter is to summarize the criticism of laboratory friction protocols appearing in
the last two decades through a critique of the research protocols employed, assess-
ment of the clinical relevance of the results reported, and analysis of the main fac-
tors. From this summary, use of the in vitro approach is precluded as a reliable
method for clarication of the impact of research ndings at the clinical level.
To this end, an analysis of the methodological approaches employed for the inves-
tigation of frictional effects during bracket sliding on wires raises a number of
issues.
*
Based on material previously published in Orthodontic Materials: Scientic and Clinical Aspects (Brantley
WA and Eliades T, editors), Thieme 2001, as well as several publications by the authors.
2. actual simulation of sliding at a given distance with the use of a mechanical testing machine
or custom-made assemblies, under various bracket-wire engagement modes.
The rst category involves the use of scanning electron microscopy or laser spec-
ular reectance spectrometry. Despite the accuracy and sensitivity furnished by these
analyses the study of the surface prole is limited to the vicinity of the relatively small
area examined. In general, microscopic techniques lack a quantication scale to facil-
itate the estimation of surface roughness, which imposes a barrier to elucidating the
variability of friction relative to the surface smoothness. However, studies have sup-
ported the lack of a relationship between the surface texture and frictional forces,
revealing the presence of unanticipated interactions among the variables involved in
this complex phenomenon.7,8
In the second mode of investigation, multiple aws associated with the process of
simulating clinical conditions appear to render its use invalid. There are several com-
ponents to be considered at length:
1. The movement rate is chosen ad lib, resulting in a nonstandardized parameter in several
studies that makes comparison of the results impossible. Nonetheless, when a standard
rate is chosen, fundamental discrepancies between the clinical situation and the research envi-
ronment arise. As Reitan has shown in his pioneering work the plot of tooth movement (mm)
against time (days) is a highly individualized, complex curve that is generally characterized
by a wide plateau at 15e30 days, followed by a peak at days 35e 40.9 Therefore the incor-
poration of movement rates indiscriminately described by rst order kinetics is inappropriate.
In as much, examining the implicated parameters in this phenomenon, Kusy and Whitley have
noted a dependence of friction on the velocity gradients.10 This observation contradicts the
elementary laws of friction, whereby frictional forces depend only on the vertical component
of the applied force, the properties of the surface involved, and the medium in contact with
the moving element. These investigators explained the striking discrepancy by postulating a
dynamic relationship between the formation and detachment of oxides during movement and
arising from the wear of the surfaces involved. Hence, at low sliding velocity the formation of
oxides prevails and, as a result, the rate of frictional changes over time increases. When the
velocity exceeds a critical value the detachment of oxides from the surface per time unit sur-
passes the rate of their formation, leading to a decrease in friction. The fact that decreased
friction has been associated with increased number of sliding repetitions for the same spec-
imens strongly supports the validity of the hypothesis proposed by these authors. Additional
evidence related to the structure and morphology of retrieved nickeletitanium archwires, and
indicating the presence of adsorbed KCl crystals along with prominent island-like formations
arising from the dissolution of nickel,6 provides further substantiation to the model suggested
by Kusy and Whitley.
2. An inherent aw associated with the described experimental approaches is the measurement
of force magnitude over some distance, presumably to derive information about the extent of
the obstacles to movement.11,12 An alternative strategy would be to determine the energy
dissipated during the movement under the conditions studied. Because the magnitude of
force does not remain constant over the distance set in the experiments, it is difcult to mea-
sure force uctuations under real time conditions. Therefore the rate of movement is techni-
cally accelerated to facilitate the extrapolation of values.
3. The complexity of this issue is further increased when the interference of the force decay
occurring in the applied load is considered. Application of retracting forces with the use
of elastomeric modular chains is associated with force relaxation that occurs at a varying
extent. This degradation may reach levels of up to 50% during the rst 24 h.13 Thus the
100 Orthodontic Applications of Biomaterials
bracket-wire biomechanical model constructed in vitro is far from simulating the clinical
analogue.
4. In addition the majority of the published reports lacks the modeling of the bracket-wire
play. Research in this eld has shown14 that this variable depends on the slotearchwire
dimensional relationship, reaching values of the order of I4 . This parameter also derives
from the manufacturing processes for the brackets and wires. It has been estimated that
the discrepancy between the theoretically derived and measured play differs considerably
because of precautions taken by the manufacturers to ensure the engagement of terminal-size
archwires in the bracket slot. For example the actual size of archwires differs from the re-
ported one in that they are actually smaller, and slot sizes are usually marginally larger to
facilitate proper engagement in spite of dimensional variations arising from the
manufacturing processes. Research with predetermined inclination variants has veried the
adverse effect on the rate of simulated tooth movement.15 Nonetheless, others have found
that the relative dimensions of the bracket slot and archwire cross section have no effect
on friction.16
5. In most studies the use of stainless steel or cobaltechromium, beta-titanium, and NiTi wires,
coupled with ceramic brackets, were found to be associated with increased friction in the
described order.17e19 However, a limited number of investigations adopting identical
research protocols has shown that this sequence may be reversed.10,20 In the wet state the
use of stainless steel wires on stainless steel slot surfaces presented higher friction compared
to beta-titanium wires,5 while multistrand wires consistently presented decreased friction.16
is vastly different from maintaining continuous contact between the wire and the
bracket slot walls. Thus the development of friction is exaggerated in laboratory set-
tings. Moreover, during routine clinical conditions, patients masticate or speak, and
the bolus of food or opposing teeth come in contact along with the movement of
the tongue. In orthodontically treated teeth, this may generate an important factor,
namely vibrational forces during movement. As these have mainly a vertical direction,
perpendicular to the path of movement, they disturb the effect of friction between the
bracket and archwire. Evidence supporting this notion has been provided by a study
projecting a notable decrease of frictional forces in vivo as a result of the interference
of complex occlusal loads.26
104 Orthodontic Applications of Biomaterials
Lastly, since the tooth movement rate presents an upper limit determined by biolog-
ical variables, the clinical impact of accelerating the rate of a canine retraction by a
fraction of the biologically optimum is doubtful.
The Table 5.1 summarizes the reported ndings from a large number of friction
studies.27 It can be seen that there were many conicting observations, further casting
doubt on in vitro investigations of friction.
References
1. Matasa CG. Is some orthodontists thinking antiquated? Orthod Mater Insid 1997;I0:8.
2. Pratten DH, Popli K, Germane N, Gunsolley JC. Frictional resistance of ceramic and
stainless steel orthodontic brackets. Am J Orthod Dentofac Orthop 1990;98:398e403.
3. Stannard JG, Gau JM, Hanna MA. Comparative friction of orthodontic wires under dry and
wet conditions. Am J Orthod 1986;89:485e91.
4. Eliades T, Bourauel C. Intraoral aging of orthodontic materials: the picture we miss and its
clinical relevance. Am J Orthod Dentofac Orthop 2005;127:403e12.
5. Kusy RP, Whitley JQ, Prewitt MJ. Comparison of the frictional coefcients for selected
archwire-bracket slot combinations in the dry and wet states. Angle Orthod 1991;61:
293e302. Erratum in: Angle Orthod 1993;63(3):164.
6. Oshida Y, Sachdeva RC, Miyazaki S. Microanalytical characterization and surface modi-
cation of Ti-Ni orthodontic archwires. Biomed Mater Eng 1992;2:51e69.
7. Kusy RP, Whitley JQ. Coefcients of friction for arch wires in stainless steel and poly-
crystalline alumina bracket slots. I. The dry state. Am J Orthod Dentofac Orthop 1990;98:
300e12. Erratum in: Am J Orthod Dentofacial Orthop 1993;104(4):26.
8. Ho KS, West VC. Friction... Friction resistance between edgewise brackets and archwires.
Aust Orthod J 1991;12:95e9.
9. Graber TM, Swain BF. Orthodontics d current principles and techniques. St Louis:
Mosby; 1985. p. 199e201.
10. Kusy RP, Whitley JQ. Effects of sliding velocity on the coefcients of friction in a model
orthodontic system. Dent Mater 1989;5:235e40.
11. Garner LD, Allai WW, Moore BK. A comparison of frictional forces during simulated
canine retraction of a continuous edgewise arch wire. Am J Orthod Dentofac Orthop 1986;
90:199e203.
12. Drescher D, Bourauel C, Schumacher HA. Frictional forces between bracket and arch wire.
Am J Orthod Dentofac Orthop 1989;96:397e404.
13. von Fraunhofer JA, Coffelt MTP, Orbell GM. The effects of articial saliva and topical
uoride on the degradation of the elastic properties of orthodontic chains. Angle Orthod
1992;62:265e74.
14. Sebanc J, Brantley WA, Pincsak J, Conover JP. Variability of effective root torque as a
function of edge bevel on orthodontic archwires. Am J Orthod 1984;86:43e51.
15. Tselepis M, Brockhurst P, West VC. The dynamic frictional resistance between orthodontic
brackets and arch wires. Am J Orthod Dentofac Orthop 1994;106:131e8.
16. Schumacher HA, Bourauel C, Drescher D. The effect of the ligature on the friction between
bracket and arch. Fortschr Kieferorthop 1990;51:106e16 [In German].
17. Angolkar PV, Kapila S, Duncanson Jr MG, Nanda RS. Evaluation of friction between
ceramic brackets and orthodontic wires of four alloys. Am J Orthod Dentofac Orthop 1990;
98:499e506.
In vitro friction assessment in orthodontics 105
18. Tanne K, Matsubara S, Shibaguchi T, Sakuda M. Wire friction from ceramic brackets
during simulated canine retraction. Angle Orthod 1991;61:285e90. Discussion 291e2.
19. Downing A, McCabe J, Gordon P. A study of frictional forces between orthodontic brackets
and archwires. Br J Orthod 1994;21:349e57.
20. Ireland AJ, Sherriff M, McDonald F. Effect of bracket and wire composition on frictional
forces. Eur J Orthod 1991;13:322e8.
21. Taloumis LJ, Smith TM, Hondrum SO, Lorton L. Force decay and deformation of ortho-
dontic elastomeric ligatures. Am J Orthod Dentofac Orthop 1997;11:1e11.
22. Adams Jr WP, Robinson Jr JB, Rohrich RJ. Lipid inltration as a possible biologic cause of
silicone gel breast implant aging. Plast Reconstr Surg 1998;101:64e8.
23. Bednar JR, Gruendeman GW, Sandrik JL. A comparative study of frictional forces between
orthodontic brackets and arch wires. Am J Orthod Dentofac Orthop 1991;100:513e22.
24. Bazakidou E, Nanda RS, Duncanson Jr MG, Sinha P. Evaluation of frictional resistance in
esthetic brackets. Am J Orthod Dentofac Orthop 1997;112:138e44.
25. Sims AP, Waters NE, Birnie DJ, Pethybridge RJ. A comparison of the forces required to
produce tooth movement in vitro using two self-ligating brackets and a pre-adjusted bracket
employing two types of ligation. Eur J Orthod 1993;15:377e85.
26. Jost-Brinkmann P, Miethke RR. The effect of physiological tooth mobility on the friction
between the bracket and the arch. Fortschr Kieferorthop 1991;52:102e9 [In German].
27. Eliades T, Brantley WA. Friction: on the edge of ction. A critique of bracket-archwire
friction research protocols and their clinical signicance. Hel Orthod Rev 1999;2:17e29
[Greek and English].