Journal of the World Federation of Orthodontists 7 (2018) 141e145

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Journal of the World Federation of Orthodontists

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Research Article

In vivo evaluation of the force degradation characteristics of four

contemporarily used elastomeric chains over a period of 6 weeks
Aakash Patel a, *, Bosco Thomas b
a
Post Graduate Student, Department of Orthodontics and Dentofacial Orthopedics, People’s College of Dental Sciences and Research Centre, Bhopal,
Madhya Pradesh, India
b
Professor, Department of Orthodontics and Dentofacial Orthopedics, People’s College of Dental Sciences and Research Centre, Bhopal, Madhya
Pradesh, India

a r t i c l e i n f o a b s t r a c t

Article history: Background: The purpose of this study was to evaluate and compare in vivo force degradation of elas-
Received 13 June 2018 tomeric chains of four different companies over a period of 6 weeks using digital force gauge.
Accepted 20 September 2018 Methods: A total of 25 participants making the total sample size of 100 were included in this split mouth
Available online 28 October 2018
study. Force degradation of four elastomeric chain samples from different manufacturers, Super Slick
Chain (TP Orthodontics), AlastiK (3M Unitek), Dyna-Link elastomeric chain (G&H Orthodontics), and
Keywords:
Memory Chain (American Orthodontics), was evaluated and compared among each other using a digital
Elastomeric chains
force gauge in the intraoral environment at six time intervals (immediate, 1 hour, 24 hours, 1 week,
Force degradation
Elastomers
3 weeks, and 6 weeks). The elastomeric chain samples were stretched to a fixed distance of 16 mm
throughout the study period.
Results: There was a significant difference between the force degradation values of elastomeric chains
supplied by different manufacturers (P < 0.001). Maximum force degradation in all four groups was
recorded in the first hour of placement. After 6 weeks, the force degradation was found to be least with
Super Slick chain (55%  5%) and maximum with Dyna-Link chain (63%  4%).
Conclusions: Three of four elastomeric chains sustained an amount of force that can be considered
adequate for canine retraction. Only one elastomeric chain suffered a major loss of force in such a way
making it difficult to continue the retraction of canine after 6 weeks.
Ó 2018 World Federation of Orthodontists.

1. Introduction compliance. But, these synthetic elastic materials cannot be

Polyurethane elastomeric chains are used extensively as tooth
moving mechanisms due to their effectiveness in closing diastemas,
correcting rotations and shifted midlines, and achieving space
closure [1]. They do so by providing optimum light continuous
forces that can achieve maximum rate of orthodontic tooth move-
ment without tissue damage and minimum patient discomfort.
Elastomeric chains are clinically attractive, as they are inexpensive,
easily applied, and require little chair side time and no patient
Funding: The authors have not declared a specific grant for this research from
any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: Authors have completed and submitted the ICMJE Form
for Disclosure of potential conflicts of interest. None declared.
Provenance and peer review: Non-commissioned and externally peer reviewed.
* Corresponding author: Department of Orthodontics and Dentofacial Orthope-
dics, People’s College of Dental Sciences and Research Centre, Bhopal 462037
Madhya Pradesh, India.
E-mail address: aakashpatel211@gmail.com (A. Patel).
considered ideal elastics, as they are sensitive to prolonged expo-
sure to water, enzymes, and temperature variations [2]. In the oral
environment, they tend to harbor plaque, get discolored, and un-
dergo permanent deformation. One of the major shortcomings of
the elastomeric auxiliaries is their inability to maintain the deliv-
ered force for a significant duration. The force levels decrease at a
very rapid rate, and the reported loss within the first 24 hours was
50% to 70% of the initial value. Thereafter, a more stable polymer
structure has been reported, with only minor changes of 10% to 20%
up to 4 weeks [3].
Baratieri et al. [2] compared conventionally used and enhanced
E-chains and reported that the greater force decrease occurred
within the first hour. The remaining force of the enhanced chains
measured at different time intervals was greater than the conven-
tional one. Buchmann et al. [3] demonstrated influence of initial
strain on the force decay of different elastic chains over time in vitro
and showed that the force levels of chains from different manu-
facturers vary widely, and that the chains that were identified as
having superior characteristics had only 40% loss of force after

2212-4438/$ e see front matter Ó 2018 World Federation of Orthodontists.

https://doi.org/10.1016/j.ejwf.2018.09.001
142 A. Patel, B. Thomas / Journal of the World Federation of Orthodontists 7 (2018) 141e145
3 weeks. Although the manufacturers claim to produce elastomeric
chains with improved and superior properties in relation to force
degradation, most of the studies that support their claims are
performed in an extraoral environment [1e8]. A few in vivo studies
[2,9e13] were also performed to test the properties of elastomeric
chains in an oral environment but elastomeric chains were taken
out of the oral cavity in these approaches to check the force decay
during subsequent visits. Repeated removal and placement of the
same elastomeric chain in the mouth for measurement purposes
might alter the force values, leading to erroneous results. To our
knowledge, there are no studies that tested the force degradation
characteristics of elastomeric chains in the oral cavity itself. The
present study aimed at evaluating and comparing force degradation
characteristics of contemporarily used elastomeric chains from four
different manufacturers in the intraoral environment.
2. Materials and methods
A total of 25 participants (16 male, 9 female individuals) in the
age group of 15 to 30 years who were undergoing fixed orthodontic
treatment were recruited to the study. During the study, the pa-
tients had their leveling and aligning phase completed and had
0.019  0.025-inch stainless steel archwires in both maxillary and
mandibular arch in 0.022  0.028-inch MBT prescription straight
wire appliance. Two crimpable hooks were attached to the 0.019 
0.025-inch stainless steel archwire in each quadrant. One hook was
placed distal to the canine bracket and the other was placed exactly
16 mm apart from this hook, mesial to the molar tube; 16 mm was
found to be appropriate to fall in the range of distance between the
middle of the buccal surface of the canine and the second premolar,
as it can be the elastomeric chain extension needed for canine
retraction. The following four elastomeric chain manufacturers
were subjected to our study:
1. Group 1: Super Slick Chain (TP Orthodontics, Inc., 100 Centre
Plaza, La Porte, IN 46350, USA)
2. Group 2: AlastiK (3M UnitekOrthodontic Products, 2724 South
Peck Road, Monrovia, CA 91016, USA)
3. Group 3: Dyna-Link Elastomeric Chain (G&H Orthodontics,
2165 Earlywood Drive, Franklin, IN 46131, USA)
4. Group 4: Memory Chain (American Orthodontics, 1714 Cam-
bridge Avenue, Sheboygan, WI 53081, USA).
Three modules of open type of each elastomeric chain sample
were cut from the spools. These four elastomeric chains from each
company were then placed between the two crimpable hooks
randomly in each of the four quadrants and were maintained in the
oral environment for 6 consecutive weeks. The force was measured
in grams with the help of digital force gauge within the oral cavity
at the time of placement (T0), after 1 hour (T1), 24 hours (T2),
1 week (T3), 3 weeks (T4), and 6 weeks (T5), enabling comparison
with results of other studies. For this, the mesial module of the
elastomeric chains was engaged in the hook of digital force gauge
and the chains were stretched to a distance exactly corresponding
to the mesial crimpable hook (16 mm) (Fig. 1).
Fig. 1. In vivo force measurement with digital gauge.
Obtained data were tabulated to generate summary statistics as
well as to perform appropriate statistical analysis. Mean force levels
and percentage force degradation of each elastomeric chain at time
intervals T0, T1, T2, T3, T4, and T5 were calculated, and significance
was assessed using one-way analysis of variance (Table 1). Tukey
and Bonferroni post hoc tests were used for intergroup comparison
between elastomeric chains.
3. Results
At the time of placement (T0) of elastomeric chains, the initial
mean force was maximum for group 1 (304  11 g), followed by
group 2 (285  18 g), and group 4 (276  29 g) and minimum for
group 3 (242  17 g) (Table 1, Fig. 2). After 1 hour (T1) of placement,
the mean residual force followed the same pattern as immediate
(T0), with maximum mean residual force offered by group 1 elas-
tomeric chains (267  18 g) and minimum by group 3 (192  18 g)
(Table 1, Fig. 2). Thus, the greatest percentage force reduction at
1 hour was noticed with group 3 chains (21%  7%), followed by
group 4 (17%  7%) and group 2 (15%  8%). The least amount of
force degradation occurred with group 1, which accounted for only
12%  5% of the original mean force level (Tables 1 and 2, Fig. 3).
At 24-hour interval (T2), the mean residual force for group 1
elastomeric chains was found to be 232  13 g, with percentage
force reduction of 23%  3% followed by group 2 chains, with mean
force of 202  16 g and force degradation by 29%  6%, group 4 with
mean force of 175  17 g, and force degradation of 36%  6%. Group
3 showed maximum force degradation of 39%  6%, with mean
residual force levels of 147  11 g (Tables 1 and 2, Figs. 2 and 3).
After 1 week (T3), the residual force levels followed the same
pattern as T1 and T2, with maximum residual force left with group
1 samples (202  13 g) followed by group 2 (178  13 g), group 4
(145  23 g), and group 3, with residual force value of 128  10 g.
The maximum force degradation from the original value after
1 week was found with group 4 (47%  9%) and the least amount of
force degradation occurred with group 1 (33%  5%) (Tables 1 and 2,
Figs. 2 and 3).
At third week (T4) of the elastomeric chain placement, the re-
sidual force value for group 1 samples was (175  12 g) with force
degradation of 42%  4% and least with group 3 (109  8 g) with
force degradation of 55%  5% (Tables 1 and 2, Figs. 2 and 3).
At 6 weeks (T5), the residual force value for group 1 samples was
(137  13 g) and least for group 3 samples (89  8 g) (Table 1, Figs. 2
and 3).
The data obtained suggested that group 1 samples from TP Or-
thodontics offers maximum initial force value at the time of
placement and sustains greater amount of force even after 6 weeks
as compared with the other 3 groups. Group 3 samples from G&H
Orthodontics delivered the least amount of initial force relative to
the other 3 groups and the level of force decay was also found to be
highest with these samples at different time intervals and at the
end of 6 weeks.
4. Discussion
To overcome the shortcomings of in vitro experiments, in vivo
evaluation of elastomeric chains is considered more appropriate
to determine and study the actual clinical performance in pa-
tients’ mouths. Published studies which evaluated the effects of
prestretching of elastomeric chains before placement [4,8,14],
reduced pH levels [5], temperature changes [8,15], addition of
color pigments in aesthetic chains [16,17], intake of common
beverages [15,18], and fluoride mouth rinses [19] are limited to
in vitro testing. Concerns have also been raised regarding the
quality of the products and whether one company is superior to
 A. Patel, B. Thomas / Journal of the World Federation of Orthodontists 7 (2018) 141e145 143

Table 1
Distribution of force delivered by elastomeric chains at different time periods

T0 (immediately T1 (1 h), T2 (24 h), T3 (1 wk), T4 (3 wk), T5 (6 wk),

after placement), Mean  SD, g Mean  SD, g Mean  SD, g Mean  SD, g Mean  SD, g Mean  SD, g
Group 1 304  11 267  18 232  13 202  13 175  12 137  13
Group 2 285  18 243  26 202  16 178  13 151  11 122  11
Group 3 242  17 192  18 147  11 128  10 109  8 89  8
Group 4 276  29 228  30 175  17 145  23 128  9 110  9
F value 40.84 45.32 156.61 112.211 204.30 91.68
P value <0.0001a (HS) <0.0001a (HS) <0.0001a (HS) <0.0001a (HS) <0.0001a (HS) <0.0001a (HS)
a
Significance: P < 0.05.

another in efficacy or cost-effectiveness. This led many in-
vestigators to test the difference in elastomeric chains manufac-
tured by different brands [1,2,8,15], which suggested that there
exists a significant difference in force decay properties of elas-
tomeric chains provided by different manufacturers and this
should be tested in an in vivo environment.
Orthodontic elastomeric chains with enhanced properties
that are claimed to provide greater efficacy during mechanics
have been introduced. Better memory elastic properties were
introduced in the early 1990s (Memory Chain; American Ortho-
dontics) with claims of providing a lighter, yet longer-lasting
force. A different type of elastomeric chain was introduced in
2000 (Super Slick; TP Orthodontics Inc.) with metafasix tech-
nology. A water-insoluble, hydrogel-polymer coating, which, in
contact with moisture, transforms the polyurethane-based elas-
tomeric surface into a highly smooth surface, is claimed by the
manufacturer to decrease friction [2]. Because it is evident that
elastomeric chains supplied by different manufacturers have
significant differences in their force decay levels at different time
periods, our study was aimed at evaluating and comparing the
force degradation of four contemporarily used elastomeric chains
that are commonly used by orthodontists and to judge whether
the self-claimed enhanced properties by manufacturers hold true
for their products.
Although the initial force levels determined for canine retraction
have a wide range of controversy, previous studies [20,21] have
recommended forces between 100 and 300 g for retracting the
same. With reference to those published reports, this study chose to
have the initial force during the placement of elastomeric chain
close to 300 g achieved with 3 lumens of each elastomeric chain
placed at a fixed distance of 16 mm. The results of our study showed
that elastomeric chains of different companies deliver different
force decay characteristics during the period of 6 weeks of experi-
mentation. The obtained results are in concordance with several
brand comparison studies [1e3,8,15]. Our results suggest that all
elastomeric chains undergo a loss of force with time and that the
greatest loss of force after placement of elastomeric chains occurs
within the first hour.
In general, the force decrease after 1 hour of placement was
approximately 12% to 20%; however, the magnitude of loss may
differ with different elastomeric chains. This loss of force in the
initial hour was like that of the in vivo studies conducted by
Bousquet et al. [10] (15%e20% force degradation using initial
force of 200 g) and Baratieri et al. [2] (14%e23% of force degra-
dation using initial force of 180 g). Studies performed with initial
heavy force application, more than 300 g, reported greater per-
centage of force decay within 1 hour. Kim et al. [22] used initial
force of approximately 350 g and found a decrease of 28% to 33%
after 1 hour, whereas Lu et al. [6] observed a decrease in force of
27%, 24%, and 13% with initial forces of 370, 302, and 240 g,
respectively. Difference in findings observed in these studies and
that of ours could be attributed to different methodological dif-
ferences, selection of different elastomeric chains, and initial
forces, environment conditions, and different apparatus for force
measurement.
The force degradation characteristics of elastomeric chains vary
according to the environment in which they are placed, with more
pronounced decline in the in vivo environment when compared
with in vitro experiments [15]. Ash and Nikolai [11] found that the
effect of oral environment significantly alters the relaxation pattern

Fig. 2. Force delivery characteristics by different brands of elastomeric chains at different time periods.
144 A. Patel, B. Thomas / Journal of the World Federation of Orthodontists 7 (2018) 141e145

Table 2 However, the force decay varied significantly for different products.
Percentage reduction of elastomeric chains at different time intervals The percentage of force degradation of our study after 6 weeks is
T1 T2 T3 T4 T5 like that of the in vitro study conducted by Pires et al. [23], who
Group 1 12  5 23  3 33  5 42  4 55  5 reported 63.2% of force reduction in Memory chain and 64.0% force
Group 2 15  8 29  6 37  5 47  4 57  4 reduction in Plastic chain after 6 weeks. In contradiction, the study
Group 3 21  7 39  6 47  5 55  5 63  4 conducted by Santos et al. [24] reported that the remaining force
Group 4 17  7 36  6 47  9 53  4 60  4
after 6 weeks in elastomeric chain supplied by American Ortho-
F value 7.39 40.98 27.34 41.66 17.32
P value <0.0001 <0.0001 <0.0001 (HS) <0.0001 <0.0001 dontics was 48.1% and that of TP Orthodontics was 37.4% of the
(HS) (HS) (HS) (HS) initial value. A greater loss of force in our study after 6 weeks when
compared with the in vitro study by Santos et al. [24] can be
because a more adverse environment impeded on the elastomeric
of elastomeric chains as compared with the in vitro environment. chain samples in the oral environment.
After 1 hour, the rate of force decay remained nearly constant over While comparing the intergroup relations, at the time of
the period investigated, and the residual force left in elastomeric placement, maximum initial mean force was delivered by Super
chains after 6 weeks ranged from 54% to 63% of the original value. Slick chains from TP Orthodontics (304 g), followed by Alastick

Fig. 3. Force degradation characteristics by different brands of elastomeric chains at different time periods.
 A. Patel, B. Thomas / Journal of the World Federation of Orthodontists 7 (2018) 141e145
from 3M Unitek (285 g) and Memory Chain from American Or-
thodontics (276 g). The least initial mean force was delivered by
Dyna-Link (G&H Orthodontics) (242 g). At the end of 6 weeks, slick
chains from TP Orthodontics retained a mean force of 137 g
experiencing a force reduction of 54.73% from the initial value.
Considering the force value of 100 to 300 g appropriate for the
movement of teeth, it can be observed that TP can sustain a reli-
able amount of force even after 6 weeks. Alastick by 3M Unitek
showed a mean force of 122  11 g at the end of 6 weeks, and force
reduction of 56.97% from the original value. Super slick ties had
higher initial force levels as well as higher retained force after
6 weeks as compared with Alastick elastomeric chains, which was
found to be a statistically significant difference in force decay
patterns. Memory chains from American Orthodontics retained
110  9 g of force at the end of 6 weeks, with a force degradation of
60%  4% showing that product is delivering not enough force to
retract canines over the period. Dyna-Link elastomeric chains
from G&H Orthodontics had the least amount of retained force (89
 8 g) and a maximum amount of force degradation (63%) after
6 weeks. This suggests that this group was unable to maintain
force levels required to meet the demand of canine retraction after
6 weeks.
5. Conclusions
The present study evaluated and compared the force decay
characteristics of four contemporarily used elastomeric chains
in vivo for a period of 6 weeks. The findings were as follows:
1. The greatest amount of force reduction was observed 1 hour
after initial placement.
2. The force decreased in nearly a constant manner until the end
of 6 weeks.
3. It was observed that there exists a significant difference in loss
of force that occurred within each elastomeric chain of different
companies.
4. Three of four elastomeric chains (Super Slick by TP Orthodon-
tics, Alastick by 3M Unitek, and Memory chain by American
Orthodontics) sustained an amount of force that can be
considered adequate for canine retraction. Only one elasto-
meric chain (Dyna-Link by G&H Orthodontics) suffered a loss of
force so major that it was not able to continue the retraction of
canines after 6 weeks.
It is suggested that selection of an elastomeric chain should be
based on its force delivery as well as degradation properties in
clinical conditions. Furthermore, the clinician can measure the force
levels via digital dynamometry before use and during follow-up so
that the treatment time and patients’ visits to the clinic can be best
optimized.
145
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