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Effect of power arm length combined with additional anterior torque on the
axial orientation of the maxillary incisors during en-masse retraction: A finite
element analysis

Article in American Journal of Orthodontics and Dentofacial Orthopedics · October 2023

DOI: 10.1016/j.ajodo.2023.08.016

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ORIGINAL ARTICLE

Effect of power arm length combined

with additional anterior torque on the
axial orientation of the maxillary incisors
during en-masse retraction: A finite
element analysis
Rime Zalaquett,a Richard Karam,b Fouad Kaddah,b Elie Khoury,a Tony El Khoury,a Joseph Ghoubril,a
and Adib Kassisa
Beirut, Lebanon

Introduction: This study aimed to clarify the effect of power arm length combined with additional torque incor-
porated into the archwire on the controlled movement of the anterior teeth using the finite element method.
Methods: An adult patient requiring medium anchorage after extraction of the maxillary first premolars was
selected for this study. The power arms were placed between the lateral incisor and the canine at 3 levels: 3
mm, 6 mm, and 9 mm. A 150 g of retraction force was applied from each height of the anterior hook to the first
molar tube, with 0 , 5 , and 10 of applied lingual root torque on the incisors. Results: A 3-mm hook with 10 of
applied torque, a 6-mm hook with 5 of applied torque, or a 9-mm hook with no extra torque constituted the best
combinations targeted at controlling the inclination of incisors during retraction. Extrusion and distal tipping of the
canine were observed. Moreover, mesial tipping and mesiopalatal rotation of the molar were unavoidable.
Finally, intercanine and intermolar widths were decreased. Conclusions: Adding extra torque on the incisors
or using high torque brackets is recommended for patients with maxillary first premolar extraction. (Am J
Orthod Dentofacial Orthop 2023;-:---)

N
owadays, maxillary first premolar extractions are
well accepted in the treatment of patients with
malocclusion that require the retraction of ante-
rior teeth, such as severe crowding, bimaxillary protru-
sion, Class II malocclusion, convex facial profile, as
well as those with borderline relationships.1
Most orthodontists throughout the world are now
adopting sliding mechanics for space closure. The latter
occurs when brackets slide along a stiff archwire to
achieve anterior retraction. Hence, controlling anterior
a sliding mechanics will occur if the force passes through
Department of Orthodontics, School of Dental Medicine, Saint Joseph Univer-
sity, Beirut, Lebanon.
b
Lebanese Center for Studies and Research of Construction, Faculty of Engineer-
ing, Saint Joseph University, Beirut, Lebanon.
All authors have completed and submitted the ICMJE Form for Disclosure of Po-
tential Conflicts of Interest, and none were reported.
Address correspondence to: Joseph Ghoubril, Department of Orthodontics,
School of Dental Medicine, Saint Joseph University, 650 Damascus Rd, Beirut
11-5076, Lebanon; e-mail, joseph.ghoubril@usj.edu.lb.
Submitted, February 2023; revised and accepted, August 2023.
0889-5406/$36.00
Ó 2023.
https://doi.org/10.1016/j.ajodo.2023.08.016
tooth movement during this treatment phase is quintes-
sential to avoid the lingual tipping of incisors.2
It is important to estimate the location of the center
of resistance (CR) of the anterior teeth during sliding me-
chanics. The relationship between the force system
acting on the tooth and the CR determines the type of
tooth movement.3 Van den Bulcke et al4 found that
the CR shifted apically as the number of anterior teeth
in the dental units increased.4 Hence, the greatest shift
was in the 6-tooth unit after the integration of the ca-
nines into the incisor segment.
The true translation movement of incisors during
the CR. Accordingly, using long anterior retraction hooks
(ARH) attached to the archwire enables the orthodontist to
achieve a controlled movement of the anterior teeth.2 It
has been proved that placing the power arm between
the lateral incisor and the canine allows for better control
during retraction.5 Through the use of the finite element
method, numerous studies in the literature have evaluated
the relationship between the length of the ARH and the
movement of the incisors during sliding mechanics.6,7

1
2 Zalaquett et al
Fig 1. Views of finite element model: A, Frontal; B, Lateral.
The finite element method was introduced in dental
biomechanical research in 1973, and since then, it has
been widely applied in the analysis of stress and strain
fields as well as of tooth displacement when subjected
to simulated forces.8 By creating models for biomechan-
ical studies, this method was shown to be highly reliable,
with results closely mimicking histologic observations
and clinical reality.9
The preadjusted bracket systems used in our clinical
practice do not provide an effective and sufficient crown
and root position control in all 3 space planes. To over-
come the issue of play, an additional lingual root torque
must thus be added to the maxillary incisors during
sliding mechanics. The effective torque will equal the
bracket torque and incorporated wire torque minus
torsional play.10
To our knowledge, none of the previous studies have
determined the effect of the anterior torque on the axial
orientation of the maxillary incisors during sliding me-
chanics. This is an important clinical feature that can
facilitate the control of incisor inclination in extraction.
This study aimed to clarify the effect of power arm
length combined with additional torque incorporated
into the archwire on the controlled movement of the
anterior teeth using the finite element method.
MATERIAL AND METHODS
One adult patient was selected as the subject of this
study. The selection criteria were complete maxillary per-
manent dentition, good alignment, maxillary alveolar
protrusion, no restorations, no dental fractures or caries,
and no periodontal disease. A cone-beam computed to-
mography was obtained from the archive of the Depart-
ment of Radiology of the Saint Joseph University of
Beirut, using the NewTom VGi machine (Newtom, Ver-
ona, Italy) at these settings: 110 kVp, 6.14 mA, 0.125-
mm voxel size, 3.6-second scan time, and field view of
24 3 19 cm). The study was approved by the Ethics Com-
mittee of the University of Saint Joseph of Beirut (USJ-
2021-175). The digital imaging and communication in
medicine files were then imported into the Blue Sky
Plan software (BlueSky Plan, Grayslake, Ill) to generate
- 2023  Vol -  Issue - American Journal of Orthodontics and Dentofacial Orthopedics
Table I. Material properties
Young’s
Material Modulus (MPa) Poisson’s ratio
Bone 2000 0.30
Teeth 20,000 0.30
PDL 0.68 0.49
Archwire, brackets, 200,000 0.30
power arms, figure 8
ligature (stainless steel)
the external surface of the bone and teeth using the
gray scale threshold technique. Teeth 14 and 24 were
deleted to simulate the extraction of the first premolars.
The x-ray imaging process cannot detect the peri-
odontal ligament (PDL); thus, modeling was carried
out with the Autodesk Meshmixer (version 3.3; Auto-
desk, San Rafael, Calif). The PDL was deemed to be of
a uniform thickness of 0.2 mm, so teeth were expanded
by 0.2 mm uniformly, and then, the initial teeth were
subtracted to get the PDL. Both the brackets and the po-
wer arms were also modeled with the Meshmixer soft-
ware. To reduce the calculation time, brackets were
considered hexahedral elements connected to the teeth,
with a 0.022 3 0.028-in slot size. The bracket torque
prescription was 17 for the central incisor and 10 for
the lateral incisor. These values were taken from the Vic-
tory Series Low Profile Bracket System (3M Unitek, MBT
prescription).
The 0.019 3 0.025-in stainless steel archwire
was drawn with AutoCAD (Autodesk) using the
3-dimensional (3D) coordinates of the brackets for a
perfect fit. The consecutive interaction surfaces between
the archwire and the slot were not parallel to each other
and the movement direction because the archwire was
discretized into linear elements. This process induces
frictional forces inside the bracket slot during sliding,
even if a frictionless property was used. The 6 anterior
teeth were tied with an 8-figure stainless steel ligature
(diameter, 0.010-in) to minimize the relative movement.
The meshing all the components was done in Mesh-
mixer with a 1-mm target edge length for the bone and
0.5 mm for the teeth and PDL. The resulting
Zalaquett et al 3

Fig 2. The theoretical play between the 0.019 3 0.025-in stainless steel archwire and the 0.022 3
0.028-in slot as based on the dimensions stated by the manufacturers. a, The twisted archwire before
insertion into the slot; b, After insertion.

stereolithography files were imported into Abaqus Table II. Displacement of the incisors according to the
(version 6.13; Dassault Systems Simulia Corp, Minneap- applied anterior torque when the length of the hook
olis, Minn) and assembled to create the 3D finite element was 3 mm
model (Fig 1). 4
Displacement (10 mm)
After meshing the geometric field, the nodal
displacement of the tooth was evaluated according to Model, tooth, and node X Y Z
the 3 planes of space (ie, x, y, and z) representing move- H3T0
ments in the horizontal, sagittal, and vertical planes, 11
Occlusal 2 29 11
respectively.11 A positive value indicates the mesial Apical 0 4 9
x-axis, posterior y-axis, and upward z-axis. 12
The final model consisted of 1,001,748 elements and Occlusal 18 30 13
191,133 nodes. As for the boundary conditions, the Apical 1 1 5
translational degrees of freedom on the upper side of H3T5
11
the model were blocked. Material properties were Occlusal 4 11 0
defined for bone, teeth, PDL, brackets, archwire, power Apical 1 3 4
arms, and 8-figure ligatures. They were assumed to be 12
homogeneous and isotropic linear elastic materials. Occlusal 23 22 9
Young’s modulus and Poisson ratio are defined in Apical 1 2 5
H3T10
Table I.12-14 11
The power arms were placed between the lateral Occlusal 6 9 12
incisor and the canine at 3 levels: 3 mm, 6 mm, and 9 Apical 2 11 0
mm.2 A 150 g of retraction force was applied from 12
each height of the anterior hook to the first molar tube Occlusal 24 4 2
Apical 1 4 3
to simulate en-masse retraction of the 6 anterior teeth
with a nickel-titanium closed coil spring. With each level
of traction, 0 , 5 , and 10 of applied lingual root torque from the torque loss in this study because manufacturers
were incorporated into the archwire into the incisor tend to enlarge the size of the slots and decrease the sec-
segment. En-masse retraction in our study means tion of the archwires relative to the reported size.18 The
retracting the 6 anterior teeth (the incisors and the ca- Victory Series slot used in our study was oversized by
nines) after extracting the maxillary first premolars. 6%.19 The net effective torque on each tooth was intro-
The simulation was conducted because the play be- duced in the finite element model as a physical moment
tween the archwire and the brackets exists as it influ- represented by a couple of forces.
ences the effective torque on each tooth.15-17 The A total of 9 models were obtained after the modifica-
theoretical torque loss illustrated in Figure 2 differed tion of both the length of the power arm and the applied

American Journal of Orthodontics and Dentofacial Orthopedics - 2023  Vol -  Issue -

4 Zalaquett et al

Table III. T Displacement of the incisors according to Table IV. Displacement of the incisors according to
the applied anterior torque when the length of the the applied anterior torque when the length of the
hook was 6 mm hook was 9 mm
4 4
Displacement (10 mm) Displacement (10 mm)

Model, tooth, and node X Y Z Model, tooth, and node X Y Z

H6T0 H9T0
11 11
Occlusal 3 19 3 Occlusal 5 9 5
Apical 1 1 8 Apical 1 5 7
12 12
Occlusal 23 15 3 Occlusal 29 1 7
Apical 1 4 5 Apical 1 7 5
H6T5 H9T5
11 11
Occlusal 6 1 8 Occlusal 8 9 15
Apical 1 7 4 Apical 2 11 3
12 12
Occlusal 28 7 1 Occlusal 34 9 12
Apical 1 5 5 Apical 2 8 5
H6T10 H9T10
11 11
Occlusal 8 19 20 Occlusal 10 29 28
Apical 2 15 0 Apical 3 19 1
12 12
Occlusal 29 11 12 Occlusal 34 27 22
Apical 1 7 4 Apical 1 10 4

torque. The names of the models were based on these 2
variables. For instance, H6T5 means that the height of
the anterior hook was 6 mm, and the applied torque
on the incisors was 5 .
The displacement of the original nodes was measured
to evaluate the effects of applied torsional forces to
achieve tooth movement. The stress produced in the
PDL of the anterior region was also calculated. Assuming
the model’s symmetry, we only analyzed the results on
the right side.
RESULTS
The evaluation of initial tooth movement in the ante-
rior region displayed the following results. In the sagittal
plane, lingual crown tipping of the central and lateral
incisor was produced in the models H3T0, H3T5, and
H6T0 (Tables II and III). As the height of the retraction
force on the power arm was raised apically from the
bracket slot level, a backward displacement of the roots
was observed. The apex of the central incisor in model
H9T0 started to move slightly backward, but it was
accompanied by a greater retraction of the crown,
thus also leading to the lingual tipping of the tooth
(Table IV). The previous results are confirmed by the
negative values of the rotation of the incisors around
the x-axis, which explains the generation of a clockwise
rotation of the anterior teeth around the occlusal plane
(Figs 3 and 4).
By increasing the torque of the incisors, a translation
movement of the lateral incisor was produced in the
models H3T10 and H6T5 (Tables II and III). Parallel trans-
lation means that the incisor moved while maintaining
the inclination of its axis. Furthermore, controlled lingual
root tipping was observed in the central incisor in the
model H6T5 and the lateral incisor in H9T0 (Tables III
and IV). In these circumstances, the root apex tipped
around the incisal edge, considered the center of rotation.
Progressively, the crown rotated in a reverse direction
(from lingual crown tipping to labial crown movement) in
the models H3T10 for the central incisor and H6T10,
H9T5, and H9T10 for both incisors (Tables II-IV).
This change is confirmed by the positive values of the
rotation of the incisors around the x-axis, which
accounts for the generation of a counterclockwise
rotation of the anterior region (Figs 3 and 4).
Table V shows the maximum principal stress (abso-
lute) distribution in the PDL of the incisors. The calcula-
tions demonstrated that a minimum absolute average of
stress occurred in the models H3T10 and H6T5. Howev-
er, the models H3T0 and H9T10 showed a maximum ab-
solute average. The tensile pressure stresses on the PDL
focused on the labial cervical area and the lingual apical
area in the model H3T0, which indicated the lingual

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Zalaquett et al
Fig 3. Rotation of the central incisor around the x-axis according to the applied anterior torque: A, 3-
mm hook; B, 6-mm hook; C, 9-mm hook.
Fig 4. Rotation of the lateral incisor around the x-axis according to the applied anterior torque: A, 3-mm
hook; B, 6-mm hook; C, 9-mm hook.
tipping. In contrast, tensile stresses were localized in the
lingual cervical and the labial apical areas in model
H9T10, demonstrating labial tipping.
Figures 5-7 show the different movement patterns of
the incisors between the models, going from the highest
lingual tipping in H3T0 to the highest labial tipping in
H9T10.
In the vertical plane, the anterior teeth were both
extruded in the model H3T0. This extrusion of the incisal
edges decreased in the models H3T5 and H6T0 (Tables II
and III). The lateral incisor in the models H3T10 and
H6T5 started to intrude slightly but less than that of
the central incisor. With an increase in the ARH length
and the angle of twist of the archwire, intrusion of the
incisal edges occurred in all the other models (Tables
III and IV). Regarding the apex, increasing the torque
led to a reduced intrusion of the apex of the central
incisor in the z-axis. Consequently, when the torque
was applied in addition to the placement of power
American Journal of Orthodontics and Dentofacial Orthopedics
5
arms, intrusion of the incisal edges and extrusion of
the apex of the central incisor occurred.
In the horizontal plane, mesial tipping of the crowns
of the incisors was observed, as confirmed by the re-
corded positive values on the x-axis, whereas the roots
had remained in place (Tables II-IV).
Table VI shows the 3D movement of the canine.
Increasing the torque led to a reduced distal tipping of
the canine in the y-axis and a reduced extrusion in the
z-axis with 10 of applied torque. However, distal
tipping and extrusion increased when the power arm
was lengthened. In all the models, the increase of the
ARH length and the anterior torque was accompanied
by an increase in the transverse plane (x-axis) of the
contraction of the canine.
The molar showed initial mesial movement accompa-
nied by mesial crown tipping (Fig 8, A) and mesiopalatal
rotation (Fig 8, B) in all the models. A decrease in inter-
molar width was also noted.
- 2023  Vol -  Issue -
6 Zalaquett et al

Table V. Principal stress distribution (maximum absolute)

Principal Stress (kPa)

Element and tooth Labial Lingual Labial Lingual Labial Lingual

H3T0 H3T5 H3T10
11
Cervical 8.62 13.90 3.94 8.23 2.99 2.73
Apical 12.3 3.17 5.09 4.63 4.67 12.00
12
Cervical 18.40 13.60 16.30 12.80 9.69 9.66
Apical 3.51 2.07 2.79 2.75 3.08 4.76
H6T0 H6T5 H6T10
11
Cervical 5.85 11.9 2.09 6.27 6.44 1.28
Apical 10.10 2.80 3.58 8.79 7.33 16.3
12
Cervical 13.30 11.50 11.30 10.8 4.92 7.67
Apical 1.81 4.26 2.51 4.96 6.04 7.02
H9T0 H9T5 H9T10
11
Cervical 3.95 10.20 4.26 4.78 9.90 3.00
Apical 8.40 6.80 2.30 13.10 9.90 20.7
12
Cervical 8.29 9.52 6.34 8.81 2.32 5.71
Apical 4.35 6.56 5.47 7.28 9.02 9.38

DISCUSSION in the clinical context. In this circumstance, an impinge-

Many studies have also simulated en-masse retrac-
tion of the 6 anterior teeth after extracting the maxillary
first premolars, with different vertical heights of the
anterior hook. The latter concluded that clockwise rota-
tion of the anterior dentition decreased with an increase
in the length of the power arm.
Hedayati and Shomali,2 Kim et al,6 Kojima et al7
concluded in their studies that the bodily movement of
the incisors was almost achieved when the lengths of
the power arm were 8 and 9 mm. However, Sung
et al20 concluded in 2010 that, even though the line of
action of the force was applied close to the CR of the 6
anterior teeth with an 8-mm ARH, the central and lateral
incisors were not bodily retracted. This is in agreement
with Tominaga et al21 who reported in 2014 that bodily
movement was not produced when the lengths of the
power arm were less than 11.6 mm. Lately, Suzuki
et al in 201922 and El Khoury et al in 202223 demon-
strated that both extrusion and retrusion of the incisors
were inevitable even though the anterior hook was long.
Based on the results of these studies, we can clearly
state that altering the height of the anterior hook cannot
guarantee the control of the inclination of the incisors in
sliding mechanics.
Moreover, controlled lingual root tipping can only be
obtained with high hooks that are too long to be applied
ment on the buccal mucosa may be produced.
To reduce the negative effects of the long hooks, high
torque brackets were used in this study, and extra torque
was added to the maxillary incisors to find out if the
translation movement of the incisors could be obtained
with shorter hooks. According to Rauch, the term
“torque” describes the moment generated by the torsion
of a rectangular wire in the bracket slot. It also refers to
the labiolingual root angulation.24
A vertical bowing effect was shown in our study in
the models H3T0, H3T5, and H6T0 as a result of the
lingual tipping of the incisors in the y-axis and the extru-
sion of the incisal edges in the z-axis. This indicates that
these combinations of hook and incorporated wire tor-
que are ineffective in reducing the clockwise rotation
of the anterior teeth in intramaxillary retraction. Howev-
er, they can be used in treating Angle Class II Division 1
malocclusion in which lingual crown tipping is recom-
mended. The same conclusion was drawn by Ribeiro
et al25 who demonstrated that when the line of action
of force passes below the CR of the anterior teeth, a
backward moment acts on the incisors, resulting in
tipping and extrusion.
During sliding mechanics, the archwire deflection
plays a crucial role and must be considered.2 In this
study, we placed the power arm between the lateral

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Zalaquett et al
Fig 5. Occlusal view of the incisors and the canine in models showing the decrease in the lingual
tipping of the incisors: A, H3T0; B, H3T5; C, H3T10.
incisor and the canine. When the length of this anterior
hook increased, the line of action of the force became
closer to the CR of the anterior teeth. In addition, a sub-
stantial amount of bending moment was generated at
the portion of the archwire mesial to the canine as a
cantilever effect. This result is in accordance with
Tominaga et al5,21,26 who reported that with long
ARH, the anterior segment of the archwire was raised up-
ward, and a pair of normal forces generated lingual root
tipping moments.
American Journal of Orthodontics and Dentofacial Orthopedics
7
Because the 0.019 3 0.025-in stainless steel archwire
is not fully engaged in the 0.022 3 0.028-in slot system,
a small amount of play exists between the rectangular
archwire and the slot.27 It equals the total freedom of
rotation of the wire in the bracket slot.28 This indicates
that play in the vertical dimension greatly impacts
decreasing the normal forces produced by the hook
and, thereby, the third-order movement of the incisors.
Therefore, the archwire must be twisted before its edges
engage the bracket walls to compensate for losing the
- 2023  Vol -  Issue -
8 Zalaquett et al

Fig 6. Occlusal view of the incisors and the canine in models showing the decrease in the lingual
tipping and the increase in the labial tipping of the incisors: A, H6T0; B, H6T5; C, H6T10.

torsional moment. This is called “the angle of twist” of
the archwire.29
The results of the models H3T10, H6T5, and H9T0 are
in agreement with this theoretical analysis. Translation
and controlled lingual root tipping of the incisors were
produced after the increase in the hook length and/or
the angle of twist of the archwire to compensate for the
torque loss. Moreover, labial crown movement was
observed in the central incisor in the model H3T10
because the bracket torque prescription of the central
incisor (17 ) was higher than that of the lateral.
Conversely, in model H9T0, because the 9-mm hook
was located between the lateral incisor and the canine,
the lingual root tipping amount of the central incisor
was relatively low compared with the lateral incisor. It
can thus be safely concluded that with these combinations
of hook and angle of twist, the orthodontist can control
the inclination of the incisors during sliding mechanics.
As for the models H6T10, H9T5, and H9T10, intru-
sion of the incisal edges, labial crown movement, and

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Zalaquett et al
Fig 7. Occlusal view of the incisors and the canine in models showing the increase in the labial tipping
of the incisors: A, H9T0; B, H9T5; C, H9T10.
counterclockwise rotation of the anterior teeth were
observed; therefore, these combinations are useful in
the treatment of Angle Class II Division 2 malocclusions
in which labial crown tipping is recommended.
Regarding the stress distribution in the PDL of the in-
cisors, a maximum absolute average was shown in the
models H3T0 and H9T10 owing to the highest lingual
and labial tipping moments, respectively. This might in-
crease the risk of periodontal tissue damage, particularly
root resorption.
American Journal of Orthodontics and Dentofacial Orthopedics
9
In the vertical dimension, torque increase led to an
intrusion of the incisal edges and an extrusion of the
apex of the central incisor. After the increase of the ante-
rior torque, extrusive forces act on the incisors because
of unequal anterior and posterior moments.3 In these
circumstances, the clinically observed intrusion of the
incisal edges is not a true intrusion but rather a labial
crown tipping.
Concerning the tip of the anterior teeth, the wagon
wheel concept is a phenomenon first described by
- 2023  Vol -  Issue -
10 Zalaquett et al

torque, the lingual root force results in lingual move-

Table VI. Three-dimensional movement of the canine
ment of the incisor’s CR. The reciprocal is transmitted
4
Displacement (10 mm) to the canine and molar as a mesial force. This is called
Model and node X Y Z
the rowboat effect, which might probably resist the
H3T0 retraction of the canine.32 In our clinical practice, Class
Occlusal 16 54 41 II elastics are beneficial in this circumstance. Conse-
Apical 10 24 5 quently, without torque control, the amount of retrac-
H3T5 tion will be increased.
Occlusal 22 50 41
Regarding the archwire deformation, our study
Apical 12 23 5
H3T10 showed that increasing the torque to 10 led to a
Occlusal 27 35 34 reduced extrusion of the maxillary canine in the z-axis,
Apical 13 18 2 thus meaning less deformation of the archwire, which
H6T0 is an advantage of adding torque to the archwire.
Occlusal 37 59 61 In the transverse plane, our results showed a decrease
Apical 19 33 1
H6T5 in intercanine and intermolar width, thus necessarily en-
Occlusal 43 54 61 tailing that the orthodontist expands the archwires dur-
Apical 21 31 2 ing sliding mechanics to counteract the inner movement
H6T10 of the canines and the molars.
Occlusal 48 39 54
Moreover, the initial mesial movement of the molar
Apical 22 26 4
H9T0 was accompanied by mesial crown tipping and mesiopa-
Occlusal 58 62 82 latal rotation in all the models. Thus, the orthodontist
Apical 28 41 8 must remove the archwire and counteract these mesial
H9T5 tipping and rotation movements by adding the tip
Occlusal 64 58 81
back and toe in bends to the molar when needed. The
Apical 30 40 8
H9T10 anchorage loss in our results correlated with the findings
Occlusal 70 43 74 mentioned by Graber about retraction with conventional
Apical 32 35 11 methods and molar mesialization.33 Therefore, mini-
implants should be used for intraoral anchorage rein-
forcement when maximum anchorage is needed.34
Andrews in the 70s to represent the relationship between We should be aware that as a tooth is tipped, the rela-
the torque applied on the archwire and the tip of the tionship between the force system and the location of
teeth.30 He stated that adding anterior labial crown tor- the CR of the tooth changes.35 Accordingly, the initial
que on the archwire will increase the mesial tip of the movement in sliding mechanics differs from the ortho-
roots and the distal tip of the crowns, thus increasing dontic movement, in which the anterior teeth move
the interincisal arch perimeter. However, this study bodily, not independently. The results of this finite
showed that the crowns of the incisors tipped mesially element study might not accurately depict the clinical
at a time when the roots remained in place. The antero- reality because the long-term effect of the torque on
superior traction can account for these results; it might the brackets was not evaluated, but they shed light on
counteract the distal tipping of the incisors by the systematic relationships between many factors. In
decreasing the interincisal arch perimeter because the real-life orthodontics, the anisotropic PDL, the saliva,
anterior hook was very close to the lateral incisor. masticatory forces, and habits mediate between activa-
This study needed medium anchorage, so a force was tion and tooth displacement. Consequently, if this
applied on each side with a nickel-titanium coil spring ex- procedure had been applied in vivo, the parallel transla-
tending from the anterior hook to the first molar tube. As tion of the anterior teeth would have been generated
a result, the canine tipped distally, and the posterior an- more reasonably. Furthermore, the brackets were
chor teeth tipped mesially. When a high-level traction modeled in this study without any tipping information,
hook was used, extrusion and distal tipping of the canine as it was deemed that leveling and aligning the teeth
(ie, the tooth behind the hook) increased because of the must adjust their tipping and, thus, straighten the slots.
archwire deformation described by Kim et al31 (Fig 9). Nevertheless, the second-order misalignment will influ-
However, increasing the torque led to a reduced distal ence the effective torque by increasing the friction
tipping of the canine in the y-axis, indicating a correla- between the archwire and the bracket.36
tion between torque increase and anchorage loss. This This study is the first to use a preadjusted bracket sys-
might be because after the increase of the anterior tem with additional torque on the wire in sliding

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Zalaquett et al
Fig 8. A, Mesial tipping of the molar; B, Mesial movement and mesiopalatal rotation of the molar.
Fig 9. Archwire deformation after the application of the retraction force.
mechanics. It demonstrated that the height of the ARH
and the anterior torque have combined effects on labial
crown tipping of the incisors during en-masse retrac-
tion. From a mechanical point of view, it provided new
and judicious results to the existing literature on the
finite element, but they need to be ascertained by future
studies that evaluate the long-term effect of anterior
torque.
CONCLUSIONS
Based on the findings of this study, the following can
be concluded:
1. During en-masse retraction, extrusion of the incisal
edges and lingual tipping of the incisors will occur if
the length of the power arm and the applied torque
on the incisors are not sufficient.
2. H3T10, H6T5, and H9T0 are good combinations of
the ARH and angle of twist of the 0.019 3 0.025-in
stainless steel used to control the axial orientation
of the maxillary incisors.
3. With torque control, extrusion and distal tipping of
the canines decrease.
American Journal of Orthodontics and Dentofacial Orthopedics
11
4. Archwire expansion is recommended to counteract
the inner movement of the canines and the molars.
5. When medium anchorage is needed, tip back and
toe in bends must be added to the molars to prevent
their mesial tip and mesiopalatal rotation.
6. A maximum absolute average of the stress was
shown in models H3T0 and H9T10, which might
add the risk of root resorption during intramaxillary
retraction.
It is hoped that more 3D investigations will be per-
formed to evaluate the long-term effect of the anterior
torque.
AUTHOR CREDIT STATEMENT
Rime Zalaquett contributed to conceptualization and
original draft preparation, Richard Karam contributed to
software, Fouad Kaddah contributed to validation, Elie
Khoury contributed to methodology and manuscript re-
view and editing, Tony El Khoury contributed to inves-
tigation, Joseph Ghoubril contributed to project
administration and manuscript review and editing, and
Adib Kassis contributed to supervision.
- 2023  Vol -  Issue -
 12
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