The anterior component of occlusal force

Part 2. Relationship with dental malalignment

Thomas E. Southard, DDS, MS,* Rolf G. Behrents, DDS, PhD,** and Elizabeth A. ToileT, PhD***
Memphis, Tenn.

The objective of this study was to determine the relationship between the anterior component of
occiusal force and malalignment of the mandibular anterior teeth. The anterior component of occlusal
force that resulted from axially loading the second molars was measured in 15 subjects with varying
degrees of mandibular anterior dental malalignment. Malalignment of the mandibular anterior teeth
was found to be related to the magnitude of the anterior component of occlusal force and to the
tightness of interproximal contacts in the mandibular posterior segments. (AM J ORTHODDENTOFAC
ORTHOP 1990;97:41-4.)

T h e anterior component of occlusal force
(ACF) is believed to arise as a result of the mesial axial
inclination of the permanent teeth.~'2 Because of this
inclination, forces of occlusion are dissipated axially
and toward the front of the mouth, through the proximal
tooth contact points.
The primary interest surrounding ACF has centered
on its possible role in causing mesial migration of
teeth T M and subsequent dental malalignment. ~-9 The
first suggestion that malalignment could be directly at-
tributed to this force was reported by Stallard. 3
Newcomb ~ and Waldron 7 hypothesized that without har-
monious arch form and proper proximal tooth contact,
ACF could not be resisted and malalignment would
result. The collapse of many orthodontically treated
cases was attributed to ACF, with the first relapse in-
dication being the tendency of the mandibular incisors
to rotate, s However, these reports were largely based
on conjecture; ACF was never measured. The existence
of a relationship between ACF and dental malalignment
remains unknown. The objective of this study was to
determine whether such a relationship exists.
METHODS AND MATERIALS
Three groups of five volunteer subjects were se-
lected on the basis of the extent of mandibular anterior
malalignment. Group 1 consisted of three men and two
women with a mean age of 26 years (SD = 1) and an
Irregularity Index ~°< 2 mm; group 2 included three men
From the University of Tennessee.
*Assistant Professor, Department of Orthodontics, College of Dentistry.
**Professorand Chairman, Departmentof Orthodontics, College of Dentistry.
***Assistant Professor, Department of Biostatistics and Epidemiology.
8/I/10439
and two women with a mean age of 27.6 years
(SD = 2.3) and an Irregularity Index > 2 mm but
< 4 ram, and group 3 included two men and three
women with a mean age of 24.2 years (SD = 1.5)
and an Irregularity Index of > 4 mm. All subjects
were in good health and had intact dentitions with
healthy periodontal tissues and no signs or symptoms
of temporomandibular joint dysfunction. All subjects
of group 1 and three subjects of group 2 had received
fixed orthodontic treatment several years previously.
None of these subjects had worn a retainer in the past
2 years and only one had worn a retainer in the past 5
years. None of the group 3 subjects had received ortho-
dontic treatment.
For each subject, we measured the interproximal
contact force (IPF) for all contacts mesial to the first
molars. The IPF was measured while the subject was
biting on the left second molar with approximately 20
pounds of force and again while the subject was not
biting. The ACF resulting from this biting force at each
contact and the ACF dissipated by each tooth into its
supporting periodontium were calculated from IPF val-
ues. The technique used to measure IPF (biting) and
IPF (not biting) and to calculate ACF and ACF dissi-
pation is described in Part 1 of this article (AM J OR-
THOD DENTOFAC ORTHOP 1989;96:493-500).
Dental models were made for each subject. Using
calipers calibrated to tenths of a millimeter, we mea-
sured the anatomic contact point displacements between
each of the mandibular anterior teeth. These displace-
ments were summed to provide the Irregularity Index. *°
Statisitical analyses were performed with the SAS
statistical software package.t1 For each subject, we used
the nonlinear, least-squares procedure to estimate the-
oretical exponential spatial decay constants for ACF in
41
42 Southard, Behrents, and Tolley Am. J. Orthod. Dentofac. Orthop.
JanuaO, 1990

Table I. Estimates of correlation coefficients relating mandibular anterior contact point displacement to the
anterior component of occlusal force (ACF), the dissipation of this force (DIS), and the interproximai
contact force (IPF)i in the mandibular left posterior segment (n = 15)
Contact point displacement

Midline Left [ Left

Force 1-1 1-2 I 2-3 Sum~

ACF
Left 3-4 0.32 0.41 0.26 0.40
Left 4-5 0.61" 0.14 0.52* 0.54*
Left 5-6 0.19 0.37 0.16 0.30
DIS
Left 3 0.04 0.76* -0.28 0.44
Left 4 0.65* 0.17 0.67* 0.63*
Left 5 -0.09 0.33 -0.08 0.05
IPF
Left 3-4 0.59* 0.14 0.46 0.50
Left 4-5 0.57* -0.20 0.05 0.15
Left 5-6 0.53* - 0.05 0.29 0.32

*0.01 < p < 0.05

IIPF when not biting.
:[:Sum of displacements at midline 1-1, left 1-2, and left 2-3 contacts.

the mandible (kt) and the maxilla (k2) and for ACF
dissipation in the mandible.(k3) and the maxilla (1<4). A
one-way analysis of variance determined the relation-
ship between the ACF and ACF dissipation decay con-
stant and tooth alignment group 1, 2, or 3 for both
arches.
Correlation analysis was used to quantify the rela-
tionship between all IPF (not biting), ACF, and ACF
dissipation measurements of the left mandibular pos-
terior quadrant with each of the following: (1) anatomic
contact point displacements between each of the man-
dibular anterior teeth; and (2) the sum of the mandibular
anatomic contact point displacements between the left
2-3, left 1-2, and midline 1-1 contacts (interproximal
contact designations are described in Part 1). Investi-
gation was limited to the left quadrant, because the
effects of the ACF would most likely be observed in
the side where this force was generated. An e¢ level of
0.05 was set for the significance of all statistical tests.
RESULTS
The mean Irregularity Index for subjects grouped
according to mandibular anterior crowding was 0.94
mm (SD = 0.65) for group 1, 2.82 mm (SD = 0.85)
for group 2, and 7.1 mm (SD = 2.47) for group 3. No
significant correlation existed between grouping ac-
cording to Irregularity Index and either the ACF rate
constants or the ACF dissipation rate constants. We
found tendencies toward significance between the an-
atomic contact point displacement ol~ the mandibular
central incisors and kl (p = 0.09), ka (p = 0.06), and
k, (p = o. 10).
The estimates of correlation coefficients relating
mandibular anatomic contact point displacements of
subjects to the ACF, the~ACF dissipation, and the IPF
(not biting) in the left mandibular posterior quadrants
are presented in Table I. Significant correlations were
detected between the irregularity of the mandibular an-
terior teeth and a number of these forces. Also noted
was a significant correlation between the magnitude of
the mandibular left IPF (not biting) at contact 5-6 and
all other such forces in the left posterior quadrants of
both arches.
DISCUSSION
A correlation between occlusal forces and dental
m~lalignment was demonstrated. This study also re-
vealed a correlation between interproximal forces when
the subject was not biting (contact tightness) and dental
malalignment. A cause and effect relationship has not
been proved and may not exist. Other unmeasured vari-
ables may actually promote both malalignment and the
forces measured here. However, the results of this study
indicate a relationship between malalignment and these
forces, a relationship anticipated by orthodontic re-
searchers 50 years ago but recently ignored.
It is likely that the ACF can cause dental malalign-
ment in persons who clench, brux, or in any other way
load posterior teeth axially for extended periods of time.
Continuous soft tissue forces as small as 0.0035 pounds
Volume97 Anterior component of occlusal force 43
Number I

are capable of moving teeth, t2 and forces of 0.12 pounds

are routinely used to move teeth orthodontically. ~ As
reported in Part 1, the ACF applied against the canine
teeth during a conservative chewing force on the second
molar is typically 8 to 200 times greater than these
forces. Much higher forces are expected in persons With
greater bite strengths or possibly functional third mo-
lars. Therefore, if these forces are applied for hours
each day in persons who abnormally load their teeth,
then the mandibular canines could tip mesially under
their influence and crowd the mandibular anterior teeth.
If a significant correlation did exist between either
ACF or IPF forces and anterior malalignment, then we
anticipated that it would relate forces acting on the
canine to anatomic displacements of the mandibular left
2-3 contact. As the ACF vector reaches the canine, it
progresses tangentially (ACFt) to the curvature of the
arch (Fig. 1). A lessened component of the ACF con- ACFt
tinues along the arch to affect the incisors. Significant
lateral dissipation of the ACF should occur as the arch
Fig. 1. Progression of the anterior component of occlusal force
turns the corner at the canines, and there should con- tangential (ACFt) to curvature of dental arch,
sequently be an increased likelihood of contact slippage
at that point.
The pattern of dental irregularity found in the man- mand!bular posterior segment contacts measured. The
dibular anterior teeth in this study, which is in agree- ,~ariables that affect the tighmess of these contacts have
ment with that reported by Williams, t4 seemed to con- not been identified, but probably include forces from
firm this belief. There was a general increase in contact the surrounding musculature, periodontium, or the ACF
point displacements proceeding laterally from the mid- itself. It seems likely that if teeth are squeezed together
line. However, analyses revealed that forces acting on through such interproximal forces, the narrow mandib-
and dissipated by the first premolars were more often ular anterior contact s would be the first to slip. Such
correlated with anterior irregularity than were the fmces slippage could be initiated by buccolingual displace-
involving the canines. This may be partially explained ments of the teeth under the in.fluence of ACF. Once a
by the number of s!ipped mandibulrr left 2-3 contacts contact has slipped, the chances of spontaneous realign-
present in the samp!e. Because measurements could not ment would be negligible. The forces that maintain tight
be recorded at these slipped contacts, the number of contacts would only tend to exacerbate the irregularity.
observations of canine force dissipation w.as small Although this investigation demonstrates that man-
(n = 8). This substantially reduced the power of all dibular anterior dental malalignment is related to ACF
statistical analyses involving this force and may have and the tightness Of interproximal contacts, we do not
accounted for the lack Of significant Correlations. recommend that inteiproximal contacts be stripped for
The mandibular canine was the only tooth that dem- the exclusive purpose Of preventing the ACF from
onstrated a significantly increased ACF diss!pation as reaching the anterior teeth or for the purpose of reducing
a result of a widened' gape, as reported in Part 1. There the IPF. However:, the orthodontist should be awa.re of
was a Simultaneous decrease in ACF dissipated by the any paranormal habits exhibited by the pat!ent and in-
lateral incisor. It appears as though, for larger ACF form the pat!ent of the possible deleterious influence
values, the ACF vector has even more of a tendency to these habits cotild have on retention of aligned man-
emerge from the arch at the canines. In such instances, dibular anterior teeth.
the Canines may be tipped out of dental alignment,
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