European Journal of Molecular & Clinical Medicine

ISSN 2515-8260 Volume 07, Issue 01, 2020

ASSESSMENT OF TYPE OF RETRACTION

MECHANICS COMMONLY CHOSEN BY
ORTHODONTIC RESIDENTS
Swapna Sreenivasagan1, Aravind S Kumar2,Remmiya Mary Varghese3, Sri Rengalakshmi4
1
Saveetha Dental College,Saveetha Institute of medical and Technical sciences (SIMATS)Saveetha University
Chennai-600 077 ,Tamil Nadu
2
Prof. and Head of the Department,Saveetha Dental College,,Saveetha Institute of medical and Technical
sciences ( SIMATS),Saveetha University,Chennai-600 077,Tamil Nadu
3
Saveetha Dental College,Saveetha Institute of medical and Technical sciences (SIMATS),Saveetha
University,Chennai-600 077 ,Tamil Nadu
4
Saveetha Dental College,Saveetha Institute of medical and Technical sciences ( SIMATS),Saveetha
University ,Chennai-600 077,Tamil Nadu
1
[email protected]
2
[email protected]
3
[email protected]
4
[email protected]

ABSTRACT

This study was designed to understand and evaluate the choice between friction and frictionless mechanics in
extraction space closure. The orthodontics case sheets were evaluated to identify extraction cases. After
examining 428 case sample tabulation of choice between friction and frictionless mechanics were examined.
More female patients underwent orthodontic treatment. More cases were treated by friction mechanics rather
than by frictionless mechanics. Only 55 cases of the whole were treated by loops for retraction and space
closure. More orthodontists preferred retraction using friction mechanics which can be attributed to factors
like being treated by faster mechanics, less cost and lesser demanding skill of clinician. The chair side time
required is reduced.

KEYWORDS: biomechanics; friction ; frictionless;orthodontics; retraction.

INTRODUCTION

There are many methods to canine retraction that are divided according to it being able to produce a distal
driving force, its parts and integral elements. (Burstone and Koenig, 1976; Sonis, 1994; Nattrass, Ireland and
Sherriff, 1998) .Frictional binding and the swing effect are main problems associated with sliding mechanics.
Overcomement of frictional mechanics can sometimes alternatively be overcome by frictionless mechanics
which includes a loop as the source of the applied force (Frank and Nikolai, 1980) .

Frictionless systems fail to produce better results in practice because of complexity of loop forming and
presence of unknown factors. (Ziegler and Ingervall, 1989; Siatkowski, 1997)
While providing absolute anchorage, these devices are used for specific periods of time and rely only on
mechanical retention with the surrounding bone. (Sivamurthy and Sundari, 2016)

Several attempts have been made to determine effectiveness with respect of tooth movement, as static and
dynamic approaches. The initial period of treatment is also a time of acclimatization for patients because they
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experience restrictions concerning the food that can be masticated with a bonded appliance.(Samantha et al.,
2017) Space closure without knowledge can result in failure to achieve an ideal occlusion.The fundamentals
of orthodontics is that teeth move through the alveolar bone when adequate forces are delivered. Various local
and systemic factors like age, nutrition, consumption of drugs, etc seem to affect orthodontic tooth movement.
(Krishnan, Pandian and Kumar S, 2015) The side effects of maxillary dentition as an anchorage unit for
protraction could lead to labio version of maxillary incisors, extrusion of maxillary molars, counter clockwise
rotation of palatal plane and clockwise rotation of mandible (Vikram et al., 2017)

Biomechanical base of base clinicians to determine anchorage and treatment options , reach prognosis ,
specific adjustments can improve the outcomes of care. Regulation of space closure is determined by
anchorage , treatment options , prognosis of various alternatives , and decision specific adjustments to
improve the outcome of care.

Six goals of space closure :

(1) differential space -closure and anchorage control
(2) minimum patient cooperation
(3) Axial inclination control
(4) Control of rotations and arch width
(5) Optimum biological response
(6) Operator convenience (Ribeiro and Jacob, 2016)

Anchorage should be established at the beginning of treatment and its preparation is a very important part of
treatment. (Burstone and Koenig, 1976) The aim of this study is to evaluate the number of extraction cases,
the mechanics used in retraction for space closure whether it is friction or frictionless mechanics.

MATERIALS AND METHODS

The setting of the study is in an online platform in the centre of Saveetha Dental College using the record
keeping software. There is an availability of wide range of data at a given point. The selection bias of
retraction due to fabrication difficulties. Choice of mechanics also depends on patient compliance.

The number of people who are examining this study are the guide and the investigator. The approval obtained
from ethical approval of the university review board.

The sampling was done from a period of June 2019 to March 2020. Evaluation of casesheets that had reported
to the orthodontic clinic , the identification of extraction protocol and the choice of retraction mechanism.
The sample size required is of 400 with using G power analysis assuming power at 90. (Rhee, Chun and Row,
2001)

To minimize the possible non-response bias the treatment decision at the start of the retraction phase was
alone taken into account.

The tabulation of records was done in excel sheets with the variables being friction and frictionless retraction
mechanics.

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RESULTS AND DISCUSSION

Evaluation of 1279 case sheets revealed that 428 patients had undergone therapeutic extraction for the purpose
of orthodontic treatment . More female patients have undergone orthodontic treatment and likewise extraction
mechanics.

The retraction mechanics most frequently done by the residents are friction mechanics - by the use of NiTi
coil spring or E chain taking support either from molars of mini-implants to a retraction hook. Friction
mechanics were adopted in 316 cases.

Frictionless mechanics are usually done by loop formation in 55 cases.There was various loop that the
residents and guides had used, attempts to form new loops were also noted. In 56 cases the type of retraction
mechanics couldnt be applicable to either mechanics.

The orthodontist should have a thorough knowledge about the force applied by the auxiliaries, in order to
predict the outcome of the treatment. Through the careful usage of this force delivering auxiliaries, the
movement of teeth can be controlled and the desired tooth movement can be achieved.(Dinesh et al.,
2013)There are various schools of thoughts concerning the merits of friction and frictionless mechanics.
(Quinn and Yoshikawa, 1985) The ideology of optimal force as minimum force results in maximum rate of
tooth, tooth movement within limits of biological responses. In previous studies conducted that the rate of
tooth movement increases with increasing the force up to a point ,increases force in an appropriate increase in
tooth movement (Quinn and Yoshikawa, 1985) To overcome the side effects of conventional analysis,
establishment of ratios to assess the skeletal, dental and soft tissue relationships by comparing one segment of
the craniofacial complex with other would be more appropriate. This will be useful ascertain discrepancy of
one particular skeletal component when compared to another without having to refer to a population
standard.(Felicita, Chandrasekar and Shanthasundari, 2012) Light forces are delivered over a long time with
definitive results as compared to the not consistent force delivery .(Felicita, 2018)

Optimum orthodontic force as that which produces most desirable biologic response with minimum tissue
damage and results in rapid tooth movement.(Nikolai, 1975)The malocclusion is managed by extraction and
space closure.(Rubika, Felicita and Sivambiga, 2015) It is establish proper facial soft esthetics.(Pandian,
Krishnan and Kumar, 2018) Tooth movement happens by bracket bonded onto enamel of teeth .(Ramesh
Kumar et al., 2011)

The force not of retraction not passing through the centre of resistance an additional moment when rotation
not necessary. Antirotation bends can be placed to prevent rotation during canine retraction by loops.
(Yamaguchi et al., 1996; Kojima, Kawamura and Fukui, 2012).

One of the most common problems after space closure is incisor torque. Round wire or undersized wire can
lead to lingual tipping of crown. Methods to correct undesired incisor , such as twisting the wire or using
special springs.(Felicita, 2017a) Reusing has been the subject of debate within the profession following the
regulations concerning the use and reuse of medical devices.(Kamisetty et al., 2015)There is an evidence that
the genetic determinants play a role.(Viswanath et al., 2015) The optimum force required for en-masse
intrusion and retraction can be calculated by using simple mathematical formulae.(Felicita, 2017b)

A full size wire should be used to provide less play between wire and bracket. High torque activation small
amount of activation and frequent wire adjustment. Impossible to determine the amount of third order bend
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providing enough moment to force ratio. Adjacent bracket side effects can receive equal and opposite
movements.

The incisor will receive the desired moment while undesired vertical force should be avoided using
stabilizing archwire. Bracket has the advantage of easy visualization and measurement of torsional activation.
(Isaacson and Rebellato, 1995)

There is no such thing as the best method of space closure. Some situations require some techniques over
others and orthodontists might have their own preferences.

CONCLUSION
Friction mechanics was most commonly chosen to close space in this space. Friction mechanics were
superior to frictionless mechanics for rotational control and arch dimensional maintenance. Frictionless
mechanics are more effective than friction mechanics at reducing tipping and extrusion. This study wouldn’t
establish superiority of the two methods.

LIMITATIONS OF THIS STUDY

In certain cases retraction mechanics are not specified. Unequal sample size available in mae and female
orthodontic patients. Not all friction mechanics used the same elastic materials. Variation in efficacy and easy
of formability in various loop mechanics.

FUTURE SCOPE

Well designed RCT evaluate the friction and frictionless mechanics to assess the anchorage demand,
necessary and differential moments, biological effects , in relevance of mini-implants, hygiene , operator time
and skill. Differential force delivery systems and versatility in various bracket slots.
AUTHOR CONTRIBUTIONS
All authors have equally contributed for the conduction of this research , writing and formatting of this
manuscript.

CONFLICT OF INTEREST
The authors declare that there has not been any conflict of interest.

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Figure 1: Bar graph showing the comparison between the gender of the cases treated with extraction and
retraction mechanics. X axis represents the gender and Y axis represents the type of retraction mechanics of
which Blue color represents friction mechanics, green color represents the frictionless mechanics whereas
grey color represents that mechanics that can’t be summed up to any one of the mechanics. The inference
from this study is that in both the male and female patients(316) retraction was most commonly done using
friction mechanics. Pearson Chi square value is 4.55 and p value is 0.103 (>0.05) , hence the results of this
study is not significant.

Figure 2 : Bar graph representing the comparison between age and gender amongst the orthodontic cases that
needed retraction. X axis represents the age of the patient where as Y axis represents the gender of which Blue
color represents females and green color represents males. The inference from this chart is that majority of
female patients in the age group of 17- 25 years approached needing to be treated for orthodontic purposes.
Pearson Chi square value is 4.553 and p value is 0.103 (>0.05) , hence the results of this study is not
significant.

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