CONTINUING EDUCATION ARTICLE

A clinical study of space closure with nickel-titanium

closed coil springs and an elastic module

R. H. A. Samuels, BDS(Hons), MDSci, FIMLS, FDSRCPS, MOrth,a

S. J. Rudge BDS, FDSRCS, MOrth,b and L. H. Mair, BDS, FDSRCS, FADM, PhDc
Leicester and Liverpool, U.K.

A previous study has shown that a 150-gram nickel-titanium closed coil spring (Sentalloy, GAC
International Inc.) closed spaces more quickly and more consistently than an elastic module
(Alastik, Unitec/3M). This study used the same friction sensitive sliding mechanics of pitting the six
anterior teeth against the second bicuspid and first molars, to examine the rate of space closure of
100-gram and 200-gram nickel-titanium closed coil springs. The results for the three springs and
elastic module were compared. The nickel-titanium closed coil springs produced a more consistent
space closure than the elastic module. The 150- and 200-gram springs produced a faster rate of
space closure than the elastic module or the 100-gram spring. No significant difference was noted
between the rates of closure for the 150- and the 200-gram springs. (Am J Orthod Dentofacial
Orthop 1998;114:73-9.)

The controversial topic of the ideal force

magnitude and duration required to move teeth
most effectively still remains unresolved. Reitan1
believed that to obtain fairly rapid tooth movement,
hyalinized zones were to be avoided or kept to a
minimum, and this was best achieved by using light,
continuous forces. Other factors thought to affect
tooth movement include the type and direction of
tooth movement, the root surface area of the tooth
or teeth, the surrounding area of alveolar bone, and
individual variation. Previous studies on tooth
movement and force magnitude have tended to
produce variable results.
Burstone and Groves,2 looking for the lowest
possible force value to retract anterior teeth by
tipping movement in 22 children, found no thresh-
old value but observed optimal rates between 50 and
75 gm. Smith and Storey,3,4 in their study on tooth
movement in 8 patients, concluded that optimal
lower canine movement occurred in the 150- to
250-gram range. At higher force levels of 400 to 600
From the Department of Orthodontics and Restorative Dentistry, The
Glenfield Hospital, Leicester, and the Departments of Orthodontics and
Restorative Dentistry, Liverpool University Dental Hospital, Liverpool,
United Kingdom.
a
Consultant Orthodontist, Department of Orthodontics and Restorative
Dentistry, The Glenfield Hospital, Leicester.
b
Consultant Orthodontist, Orthodontic Department, Liverpool University
Dental Hospital.
c
Senior Lecturer, Department of Restorative Dentistry, Liverpool Univer-
sity Dental Hospital.
Reprint requests to: R. H. A. Samuels, Consultant Orthodontist, Depart-
ment of Orthodontics and Restorative Dentistry, The Glenfield Hospital,
Groby Road, Leicester, LE3 9QP, United Kingdom.
Copyright © 1998 by the American Association of Orthodontists.
0889-5406/98/$5.00 1 0 8/1/82610
gm, the anchor unit of the second premolar and first
molar moved more than the canine. Hixon et al.,5,6
in their study on mandibular canine movement in 8
patients, found no optimal force but did find that
tooth movement tended to increase with an increase
in force up to approximately 300 gm. They also
found considerable individual variation in the rate
of tooth movement. Andreasen and Zwanziger7
subjected canines and first molars to two ranges of
force, 100 to 150 gm and 400 to 500 gm, in 14 female
patients using sliding mechanics on 0.018-inch con-
tinuous round wires. They found no optimal force
but rather that both teeth moved simultaneously and
moved more with the larger force. Boester and
Johnston8 investigated sectional canine retraction
with four force levels of 55, 140, 225, and 310 gm in
10 children. They concluded that 55 gm produced
slightly less tooth movement than the other force
levels, but that no difference existed between 140,
225, and 310 gm. Andreasen and Johnson,9 in their
study of 16 young adult females, investigated upper
first molar movement with extraoral traction. They
found that 400 gm produced 0.29 mm per week
and 200 gm produced 0.12 mm per week movement
of the upper first molars over a 10-week period.
Owman-Moll et al.10 studied the effects of 50 and
100 gm continuous forces on upper first premolars,
which were moved buccally. They found no signifi-
cant difference in the rates of tooth movement over
a 7-week period. Daskalogiannakis and McLach-
lan11 compared upper canine movement in 6 pa-
tients. The movement was provided by an intermit-
tent segmental force and a continuous magnetic
force. The initial intermittent force was 70 gm,
73
74 Samuels, Rudge, and Mair
Fig. 1. Left (A) and right (B) mirror buccal views at start
of space closure in upper arch of one of the patients in
study. Springs are attached to crimpable ballhook on
arch wire just distal to upper canine at one end and the
hook on upper first molar bracket assembly at other
end. No lingual or palatal arches are in place.
provided by an activated segmental loop, whereas
the continuous magnetic force was 60 gm. The light
continuous magnetic force produced a significantly
greater movement rate of 0.31 mm per week, com-
pared with 0.16 mm per week produced by the
segmental loop system. Quinn and Yoshikawa12
concluded in their review article on the theories of
force magnitude in orthodontics that the relation-
ship of rate of tooth movement and stress magni-
tude (force per unit area, gm/cm2) is linear up to a
point, but that after this point an increase in stress
causes no appreciable increase in tooth movement.
In our previous study, the rates of space closure
were compared for a nickel-titanium closed coil
spring (medium Sentalloy, GAC International Inc.)
and an elastic module (Alastik, Unitec/3M).13 The
continuous force of the medium (150 gm) nickel-
titanium closed coil spring was found to produce a
greater and more consistent space closure than the
intermittent force of the elastic module. The force
produced by the medium spring when stretched
between 3 and 15 mm is documented by the manu-
facturer as being 150 gm. The same manufacturer,
American Journal of Orthodontics and Dentofacial Orthopedics
July 1998
however, also produces springs of 100 gm (light) and
200 gm (heavy), which could be used for space
closure. In concluding our previous study,13 we
believed, as did Daskalogiannakis and McLachlan,11
that it would be beneficial to examine the rates of
space closure with other continuous force levels.
Thus the 100- and 200-gram springs were tested in a
manner identical to that used for the 150-gram
spring and elastic module so that the data could add
to our knowledge on the rates of space closure with
differing force levels. This paper describes the meth-
ods and presents the data for all four conditions;
elastic module, and the 100-gram, 150-gram, and
200-gram springs.
MATERIAL AND METHODS
Eighteen consecutively treated patients requiring or-
thodontic space closure with fixed appliances were in-
cluded in this study. The patient population comprised 12
girls and 6 boys with a mean age of 15.9 years (range 9.8-
24.10 years). All patients were treated by two operators
and had both first premolars extracted in the arch from
which space closure measurements were taken. All pa-
tients were treated with upper and lower preadjusted
Straight Wire fixed appliances, with a 0.0220 3 0.0280 slot
(Andrews values, A company). Active space closure mea-
surements were taken from the upper arch in 6 patients
and from the lower arch in 12 patients. Space closure was
carried out on 0.0190 3 0.0250 stainless steel arch wires,
with the anchorage balanced between the six anterior
teeth and the second premolar and first molar posteriorly.
Space closure involved both incisor retraction and molar
protraction, to varying degrees, for all patients. Extraoral
anchorage was not used in the treatment of these patients.
The arch wires had been in place for at least 1 month
before the commencement of space closure, to allow
torque expression to begin. At the beginning of space
closure, nickel-titanium closed coil springs of either 100
gm (light) or 200 gm (heavy) force were placed, one in
each quadrant of the arch requiring space closure. The
springs were randomly allocated to the left or the right
side. The springs were stretched between 3 and 15 mm.
Within this range, the manufacturer claims the heavy
springs deliver a consistent force of 200 gm and the light
springs a force of 100 gm. The springs were attached to
the hook on the first molar at one end and a crimpable
ballhook (American Orthodontics) on the arch wire just
distal to the canine at the other end (Figs. 1, 2, 3, and 4).
During space closure, patients were recalled for rou-
tine reviews at regular intervals with a mean time interval
of 49 days (range, 26 to 106 days), up to a maximum of 5
visits. The maximum duration of space closure recording
was 187 days. At each recall, the springs and arch wires
were checked for any damage. The ends of the arch wires
were trimmed to prevent interference and the crimpable
ballhooks checked for slippage. This was carried out by
ensuring that the ballhook had not moved distally from a
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 114, No. 1
Fig. 2. Left (A) and right (B) mirror buccal views of
same patient 3 months after start of space closure.
mark placed just mesial to it on the arch wire at the time of
placement. If a clinically detectable gap was found between
the mark and the ballhook, the reading was excluded.
Upper or lower impressions were taken at each visit,
cast in model stone, and stored until measurement. Space
closure was assessed by measuring on the study models
and by the same operator the distance from a point
between the central incisors to a clear reproducible occlu-
sal landmark on the first molar in each quadrant with a
Reflex microscope (Reflex Measurements Ltd.) linked to
a computer using the software Comp 3D Version 1.2. This
method of measurement was chosen because occasionally
spaces were found anterior to the canines and required
inclusion in the overall assessment of space closure. We
appreciate that this method of measurement slightly un-
derestimates the true amount of space closure, but it
allows comparison of results with those of the previous
study.13 Space closure measurements were discontinued
one visit before the spaces had completely closed on
either side of the arch.
The error of the method was calculated from 10
repeated measurements of the same model performed by
the same operator on three separate occasions at least a
week apart. The standard deviation of measurement error
was 0.098 mm, which was similar to the value obtained in
our previous study.13
Samuels, Rudge, and Mair 75
Fig. 3. Left (A) and right (B) mirror buccal views of
same patient 4 months after start of space closure.
To compare the results of the light (100 gm), medium
(150 gm), and heavy (200 gm) nickel-titanium closed coil
springs with those of the elastic module (starting force of
400 gm, which declined to 0 between visits), the data from
our previous study on the medium spring and elastic
module13 were included with those in this study of the light
and heavy springs.
Statistical Tests
Because of the differences in the time intervals be-
tween successive recall visits for each patient, the space
closure was analyzed by a multiple regression analysis.
The analysis calculates the partial regression coefficients
(B1-4) in the following equation:
Space closure 5 B1(time) 1 B2(Condition)
1 B3(Interaction) 1 B4(Arch)
These coefficients relate to time (elapsed since day 1),
condition (module 1 3 springs), the interaction (time 3
condition), and arch (upper and lower).
From the B value, together with the standard devia-
tion of the data, beta coefficients for each of the indepen-
dent variables were calculated. From the beta coefficients,
it was possible to determine the significance of each B
value.14 A significant value for the interaction (condi-
76 Samuels, Rudge, and Mair
Fig. 4. Left (A) and right (B) mirror buccal views of
same patient after removal of fixed appliances.
tion 3 time) indicates that the four conditions (module 1
3 springs) made a significant difference to the amount of
space closure throughout the time of the investigation.
RESULTS
The space closure measurements for each of the
four conditions are shown in Fig. 5. Each chart
shows the regression line together with the slope
value (B) and the coefficient of determination (r2).
The B value gives an indication of the rate of space
closure, whereas the r2 value indicates how close the
individual data points fit to the regression line.
Figure 6 shows the four regression lines together.
The results of the multiple regression analysis are
given in Table I.
The p value for the interaction (0.000) indicates
that a significant difference was found in the rate of
space closure caused by the different conditions (3
springs 1 the module). Figure 6 shows that the
medium and heavy springs caused more space clo-
sure than the other two conditions (light spring and
module). Interestingly, both the B and r2 values for
the medium and heavy springs were similar, which
American Journal of Orthodontics and Dentofacial Orthopedics
July 1998
suggests no apparent difference in their mode of
action. Although the elastic module and the light
spring had similar B values, the r2 value for the
spring was slightly higher, indicating that the data
values for this device had a more linear distribution.
This suggests that the space closure was more
consistent with the light spring than with the mod-
ule. The r2 values for the light spring and module,
however, were much lower than for the medium and
heavy springs, which indicates that the medium and
heavy springs gave a greater and more consistent
movement.
The mean rates of space closure were 0.19
mm/week for the elastic module, 0.16 mm/week for
the 100-gram spring, 0.26 mm/week for the 150-
gram spring, and 0.24 mm/week for the 200-gram
spring.
DISCUSSION
Previous investigations of force magnitude and
tooth movement in humans have tended to look at
tipping or bodily movement of single teeth, either a
canine, premolar, or molar. This makes comparison
of their results with those of this study difficult,
because in this study, six anterior teeth were re-
tracted against four posterior teeth on a continuous
arch wire with friction sensitive sliding mechanics.
This is likely to have included a combination of
tipping and bodily movement.
It has been suggested that forces of approxi-
mately 150 gm may be the ideal physiologic force for
bodily movement of canines in humans3,4,15 and
premolars in dogs.16 Whether this could be applied
to six anterior teeth set against four posterior teeth
is debatable. Because of frictional forces, however,
150 gm is unlikely to have been the eventual force to
which each tooth was subjected with these mechan-
ics. It is more likely to have been lower. Looking at
the results of previous studies,5,6,7 we anticipated
that the 200-gram springs might produce a faster
space closure than the 150-gram springs. The re-
sults, however, indicated that no significant differ-
ence existed in the rates of space closure. It may be
that the rate of tooth movement for this type of
space closing mechanics had reached its theoretical
limit, as suggested by Quinn and Yoshikawa,12 or
alternatively the results may have been influenced to
some degree by the properties of the springs. Re-
cently a study by Manhartsberger and Seiden-
busch,17 which investigated the properties of open
and closed Sentalloy springs, found that there was
little difference between the force delivery curves for
the 150- and 200-gram closed coil springs when
American Journal of Orthodontics and Dentofacial Orthopedics Samuels, Rudge, and Mair 77
Volume 114, No. 1

Fig. 5. Four graphs showing individual regression lines for module (elastic), light spring
(100 gm), medium spring (150 gm), and heavy spring (200 gm). 1,2 5 number and position
of observed data points; B 5 slope of the regression line; r2 5 coefficient of determination.

stretched between 1 and 10 mm. A greater differ-
ence appeared to exist, however, between the 100-
and the 150-gram springs. This may be the reason
why there was little difference between the 150- and
200-gram results in the current study.
Manhartsberger and Seidenbusch17 also recom-
mended that clinicians select a narrower activation
range than that suggested by the manufacturer to
produce a more accurate force delivery and be
aware that the springs seem to lose some activity
after 4 weeks because of a relaxation phenomenon.
Melsen et al.18 recently tested closed coil springs
produced by several different manufacturers. They
found that only the light and medium GAC springs
exhibited true super elastic properties at room tem-
perature. However, they also found that there was
some variation in the force provided by the same
batch of springs. This variation and individual vari-
ation between patients are likely to have contributed
to the variance of the results for each of the springs.
It is interesting to compare the rates of tooth
movement from other studies with those observed in
this study, even though the mechanics were differ-
ent. Andreasen and Johnson,9 who studied upper
first molars, found 400 gm produced movement of
0.29 mm/week, whereas 200 gm produced 0.12 mm/
week. Daskalogiannakis and McLachlan11 used a
continuous magnetic force of 60 gm to the upper
canine and recorded movement of 0.31 mm/week.
With an intermittent force of 70 gm, they recorded
movement of 0.16 mm/week. In this study, we found
the continuous 100-gram spring gave 0.16 mm/week
space closure, the intermittent 400-gram elastic
module gave 0.19 mm/week, the continuous 150-
gram spring gave 0.26 mm/week, and the continuous
200-gram spring gave 0.24 mm/week. Because the
78 Samuels, Rudge, and Mair American Journal of Orthodontics and Dentofacial Orthopedics
July 1998

Fig. 6. Regression lines for the three springs and elastic module combined in one graph.

Table I. Multiple linear regression statistics for space closure clinical problems of loss of torque, tip, rotation
with the elastic module and three springs control, and excessive gingival hyperplasia in the
Variable B Beta t Pt extraction sites, which have been documented in the
past, were not encountered.19 Problems created by
Time 0.022 0.683 13.20 0.000 occlusal interference and friction are occasionally
Condition 0.026 0.019 0.46 0.643 encountered with sliding mechanics but can be
Interaction 0.004 0.290 4.81 0.000
monitored by simple routine measurements at each
Arch 0.039 0.012 0.43 0.670
visit. A visual study of the orthopantomographs at
Dependant variable, Space closure; B, partial regression coefficient; Beta, the end of treatment showed no clinically significant
beta coefficient; t, t value; Pt, significance of t for each variable; Condition,
difference in the root lengths between the quadrants
module, light, medium, heavy spring; Interaction, condition 3 time.
tested.
Light continuous forces have been suggested for
teeth and mechanics were different in each study, it more ideal physiologic tooth movements and to
is difficult to compare the results reliably. These conserve anchorage.3,4,16 The Sentalloy nickel-tita-
results may suggest, however, that light continuous nium closed coil springs appear to provide light
forces produced a more effective mean rate of tooth continuous forces and have superelastic properties,
movement in two of the studies. but the clinician needs to be aware that some
As in our previous study,13 a clinical evaluation variation will exist in the force provided by the same
of tooth position was undertaken at least 6 months batch of springs. The medium (150 gm) and heavy
after the completion of space closure by examina- (200 gm) springs give a more consistent and faster
tion of study models and orthopantomographs. rate of space closure than the elastic modules or the
These were independently examined by two investi- light (100 gm) spring. The different rates of space
gators, both unaware as to which side the springs closure provided by the light and medium springs
had been placed. No clinically detectable difference could be used to close different amounts of space on
in either the tooth position or angulation produced either side of the same arch. They also could be used
by the two systems was found. During treatment, the to maintain or move the midline when used in the
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 114, No. 1
same arch with different space closure requirements
on either side.
CONCLUSIONS
1. Sentalloy nickel-titanium closed coil springs pro-
duce more consistent space closure than an elastic
module.
2. 150- and 200-gram springs produce a faster rate of
space closure than either the elastic module or the
100-gram spring.
3. No significant difference was found in the rates of
space closure caused by the 150-gram and 200-
gram springs.
We thank Cyril Volp for his assistance with the reflex
microscope, and Professor Malcolm Jones and Dr. Simon
Wigglesworth for allowing us carry out part of the study in
their departments.
REFERENCES
1. Reitan K. Clinical and histologic observations on tooth movement during and after
orthodontic treatment. Am J Orthod 1967;53:721-45.
2. Burstone CJ, Groves MH. Threshold and optimum force values for maxillary
anterior tooth movement. J Dent Res 1961;39:695.
3. Storey E, Smith R. Force in orthodontics and its relation to tooth movement. Aust
Dent J 1952;56:11-8.
Samuels, Rudge, and Mair 79
4. Smith R, Storey E. The importance of force in Orthodontics. Aust Dent J
1952;56:291-304.
5. Hixon EH, Atikian H, Callow GE, McDonald HW, Tacy RJ. Optimal force,
differential force and anchorage. Am J Orthod 1969;55:437-57.
6. Hixon EH, Aasen TO, Arango J, Clark RA, Klosterman R, Miller SS, et al. On
force and tooth movement. Am J Orthod 1970;57:476-89.
7. Andreasen GJ, Zwanziger D. A clinical evaluation of the differential force concept
as applied to the edgewise bracket. Am J Orthod 1980;78:25-40.
8. Boester CH, Johnston LE. A clinical investigation of the concepts of differential
and optimal force in canine retraction. Angle Orthod 1974;44:113-9.
9. Andreasen G, Johnson P. Experimental findings on tooth movements under two
conditions of applied force. Angle Orthod 1967;37:9-12.
10. Owman-Moll P, Kurol J, Lundgren D. Effects of a doubled orthodontic force
magnitude on tooth movements and root resorptions. An inter-individual study in
adolescents. Eur J Orthod 1996;18:141-50.
11. Daskalogiannakis J, McLachlan KR. Canine retraction with rare earth magnets: an
investigation into the validity of the constant force hypothesis. Am J Orthod
Dentofac Orthop 1996;109:489-95.
12. Quinn RS, Yoshikawa DK. A reassessment of force magnitude in orthodontics.
Am J Orthod 1985;88:252-60.
13. Samuels RHA, Rudge SJ, Mair LH. A comparison of the rate of space closure
using a nickel-titanium spring and an elastic module: a clinical study. Am J Orthod
Dentofac Orthop 1993;103:464-7.
14. Norusis MJ. Introductory statistics guide. Chicago: SPSS, 1983:135-74.
15. Lee BW. Relationship between tooth-movement rate and estimated pressure
applied. J Dent Res 1965;44:1053.
16. Fortin J-M. Translation of premolars in the dog by controlling the moment-to-force
ratio on the crown. Am J Orthod 1971;59:541-51.
17. Manhartsberger C, Seidenbusch W. Force delivery of Ni-Ti coil springs. Am J
Orthod Dentofac Orthop 1996;109:8-21.
18. Melsen B, Topp LF, Melsen HM, Terp S. Force system developed from closed coil
springs. Eur J Orthod 1994;16:531-9.
19. Bennett JC, McLaughlin RP. Controlled space closure with a preadjusted appli-
ance system. J Clin Orthod 1990;24:251-60.