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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 121-125

Forces generated with the use of intrusion arches in orthodontics – A review of literature


1 Senior Lecturer, Department of Orthodontics, Bhojia Dental College, Buddh, Baddi, (Affiliated from- Himachal Pradesh University, Shimla) Himachal Pradesh, India
2 Professor, Department of Orthodontics, Saraswati Dental College, Lucknow, Uttar Pradesh, India
3 Consultant orthodontist, Millennium Dental Clinic, Thrissur, Kerala, India
4 Assistant Professor, Department of Orthodontics, Babu Banarsi Das Dental College and University, Lucknow, Uttar Pradesh, India

Date of Submission03-Sep-2021
Date of Decision28-Sep-2021
Date of Acceptance29-Sep-2021
Date of Web Publication12-Nov-2021

Correspondence Address:
Dr. Stuti Raj
Senior Lecturer, Department of Orthodontics, Bhojia Dental College, Buddh, Baddi, (Affiliated from Himachal Pradesh University, Shimla) Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijor.ijor_17_21

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  Abstract 


In routine orthodontic practice, Class II malocclusions are the most customary treated cases. The cardinal objective and radical challenge of Class II treatment is the correction of deep overbite. Correction of deep overbite should be carried out prior to retraction of teeth. Various treatment protocols are used for correction of deep overbite, in which intrusion arches are more elementary to use for correcting deep bite by true intrusion or by pseudo-intrusion. This review paper contains various intrusion arches and related studies along with the key functions which are sketched out in the form of table. Individual forces produced by intrusion arches on teeth for all tooth movements are also categorized and tabulated.

Keywords: Deep overbite, extrusion, incisors, intrusion, utility arch


How to cite this article:
Raj S, Chandra P, Tandon R, Asok N, Singh AV. Forces generated with the use of intrusion arches in orthodontics – A review of literature. Int J Orthod Rehabil 2021;12:121-5

How to cite this URL:
Raj S, Chandra P, Tandon R, Asok N, Singh AV. Forces generated with the use of intrusion arches in orthodontics – A review of literature. Int J Orthod Rehabil [serial online] 2021 [cited 2021 Dec 4];12:121-5. Available from: https://www.orthodrehab.org/text.asp?2021/12/3/121/330340




  Introduction Top


Deep overbite is one of the most prevalent malocclusions seen in children as well as in adults.[1] It is one of the paramount challenges of Class II treatment, which is characterized by the vertical overlap in the anterior region.[2],[3] Deep overbite is recurrent in adult patients either by their growth pattern or by dental-related factors, such as loss of the posterior teeth.[4],[5] In most instances, the correction of overbite is produced by the extrusion of posterior teeth as with the greatest success seen in growing patients.[2] Orthodontic mechanics to treat deep overbite can be performed by maxillary and mandibular tooth extrusion or intrusion, maxillary clockwise rotation, and curve of spee flattening,[4],[5] however, intrusion arch is the most commodious method.


  Types of Deep Overbite Correction Top


  1. Intrusion of teeth – The movement of the geometric center of the root (centroid) is called intrusion, which is apical in respect to the occlusal plane or a plane based on the long axis of centroid. Labial tipping of an incisor around its centroid produces pseudo-intrusion which is helpful in correction of Class II Division 2.[1] Intrusion of both anterior and posterior teeth are possible
  2. Extrusion of teeth – The correction of deep overbite is produced by the extrusion of posterior teeth, which is seen to be the greatest success in patients with mandibular growth[2]
  3. Combination – The correction of deep overbite is also by the combination of the above two.



  Materials and Methods Top


  • We collected data according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines for reporting systematic reviews of health sciences interventions.[6] One hundred and forty-one searched along with three intrusion arches from two books were included to find the intrusion arches to correct the deep overbite
  • To identify all studies that examined the correction of deep overbite with the help of only intrusion arches, a literature survey was done from library and Google Scholar from the year 1977–2019 and used the Medical Subject Headings term “orthodontics” and was crossed with a combination of the following term: intrusion arches, intrusion arches for deep overbite correction, and forces produced by intrusion arches on tooth movements
  • All articles which were written in English were included
  • Data were collected from only original invention articles and books. The flow diagram of data search is shown in [Figure 1]].
Figure 1: Flow diagram of data search according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis

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The exclusion criteria were as follows [Table 1]:
Table 1: The exclusion criteria and the number of articles excluded

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  • Studies dealing with deep overbite correction by other methods
  • Case reports on intrusion arches
  • Clinical trials, comparative studies, reviews, and researches based on previously invented intrusion arches
  • Finite element studies on intrusion arches.


To identify all the studies to find out the intrusion arches for deep overbite correction, a literature survey was done. The types of malocclusion were not restricted. To avoid multiple biases, we chose a table which represents articles on new appliance with independent study with different authors, under different titles, or in different journals and books.

Data were collected and included according to these headings:

  • Author name, journal name
  • Year of introduction
  • Appliance introduced
  • Functions
  • Type of movement.


Sixteen intrusion arches were included in this review article for the correction of deep overbite[2],[7],[8],[9],[10],[11],[12],[13],[14],[15] [Table 2]. Forces generated by intrusion arches in all the three planes that are sagittal, transverse, and vertical are explained [Table 3], [Table 4], [Table 5].
Table 2: List of intrusion Arches

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Table 3: Forces in anteroposterior movements (mesiobuccal surface of buccal segment and labiolingual surface of anteriors)

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Table 4: Forces in transverse movements (buccolingual surface of buccal segment and mesiobuccal surface of anteriors)

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Table 5: Forces in intrusion and extrusion of teeth

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  Results Top


Correction of deep overbite can be accomplished by intrusion of anteriors, extrusion of posteriors, or by combination of both. Intrusion arches can intrude the incisors, extrude the molars by tip back, or can also perform both at the same time like in two-couple system. All intrusion arches are summarized along with their functions in [Table 2]. Out of all the intrusion arches, Burstone was first to introduce utility arch in the year 1977 for the correction of Class II deep overbites. He introduced intrusive utility arch for applying intrusive force on anteriors, selective intrusion and canine intrusion, and passive utility arches for passively holding the arch. Burstone also introduced retraction utility arch for retraction and intrusion of flared maxillary incisors and protraction utility arch for protrusion and flaring of maxillary incisors in Class II Division 2 cases.[2] After this, Ricketts in 1979 introduced utility arch which was used as starting appliance for deep overbite correction and for intrusion of mandibular incisors in crowding cases. He also introduced contraction utility arch to retract mandibular incisors with light continuous force.[7] Mulligan again in the year 1979 introduced Mulligan utility arch which focuses on intrusion of extruded canines and extrusion of molars.[8] In the year 1986, McNamara introduced intrusion, retrusion, and protrusion utility arches. McNamara intrusion utility arches also have the property of torquing mandibular incisors and tipping mandibular molars apart from intrusion. Retrusion utility arch was used for correction of dentoalveolar anterior crossbite in which there was proclination and spacing in the lower anteriors. Protrusion utility arch was used in mixed-dentition period prior to functional jaw orthopedic appliance therapy for intruding and protracting molars.[9] Marcotte introduced Marcotte intrusion arch (1990)[10] and Bhavna Shroff introduced three-piece intrusion arch (1997),[11] both were used for intrusion of anteriors and extrusion of posteriors. Three-piece intrusion arch with a good anchorage control used for correction of flared incisors and their axial inclinations. Simultaneous intrusion and retraction arch was designed by Varun Kalra in 1998 to perform both the movements of anterior teeth simultaneously.[12] Connecticut Intrusion Arch (1998)[13] and Connecticut New Intrusion Arch (2005)[14] both were introduced by Nanda et al. for intrusion of anterior teeth. There was also an introduction of modified three-piece intrusion arch in the year 2017 by Ranjitbhai et al. for en masse retraction and intrusion of anteriors.[15]


  Discussion Top


Intrusion of teeth is based on mechanism which consists of three parts: (1) anchorage unit, (2) an anterior segment, and (3) an intrusive arch spring. The intrusion arch is placed in the auxiliary tube of the first molar attachment. It is important to use the lowest magnitude that is capable of intruding incisors. If the magnitudes of forces are too high, the rate of root resorption will increase not the rate of intrusion. An intrusive force placed through the center of resistance which is geometric center of the roots of the incisors to be intruded will intrude the teeth without producing any labial or lingual rotation of the teeth. Bench et al. in 1978 stated that utility arch should be activated for light continuous force of 60–100 g for the intrusion of mandibular incisors.[2] The utility arch is a two-couple intrusion archwire which is usually made with rectangular wire, and is activated for incisor intrusion by a molar tip-back bend.[16] Utility arch can be designed differently for extraction and nonextraction cases. In extraction cases, the forces on molar are generated mesially and occlusally, with a distomolar bend preventing the molar from moving mesially.[9]

Six principles must be pondered upon incisor or canine intrusion: (1) the use of optimal magnitudes of force and constantly delivering this force with low load-deflection springs; (2) in the anterior region, single-point contact should be used; (3) the point of force application with respect to the center of resistance of the teeth to be intruded should be selected cautiously; (4) the geometry of anterior tooth forms the basis of selective intrusion; (5) reactive units are controlled by formation of a posterior anchorage unit; and (6) the posterior teeth eruption should be inhibited and undesirable eruptive mechanics are avoided.[2]

The optimum pressure for the tooth movement proposed by Brian Lee in his work is 200 g/cm2 of enface root surface exposed to tooth movement. Pressure is defined as force per unit area. The magnitudes of force vary depending upon the planned direction of movement and size of the root surface involved. The forces per unit area are listed in all the three movements[7] [Table 3], [Table 4], [Table 5].


  Conclusion Top


This paper enumerates all the types of intrusion arches and their function and types. The paper also differentiates forces on teeth in all movements which helps the clinician in application of precise force on the tooth movements. The list of intrusion arches helps the clinician to choose the suitable intrusion arch wherever required in a substantially reduced time and also helpful in research purposes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lewis P. Correction of deep anterior overbite. A report of three cases. Am J Orthod Dentofacial Orthop 1987;91:342-5.  Back to cited text no. 1
    
2.
Burstone CR. Deep overbite correction by intrusion. Am J Orthod 1977;72:1-22.  Back to cited text no. 2
    
3.
Engel G, Cornforth G, Damerell JM, Gordon J, Levy P, McAlpine J, et al. Treatment of deep bite cases. Am J Orthod Dentofacial Orthop 1980;77:1-13.  Back to cited text no. 3
    
4.
Bennett JC, McLaughlin RP. Management of deep overbite with a preadjusted appliance system. J Clin Orthod 1990;24:684-96.  Back to cited text no. 4
    
5.
Horiuchi Y, Horiuchi M, Soma K. Treatment of severe Class II Division 1 deep overbite malocclusion without extractions in an adult. Am J Orthod Dentofacial Orthop 2008;133:S121-9.  Back to cited text no. 5
    
6.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol 2009;62:e1-34.  Back to cited text no. 6
    
7.
Rickets RM, Bench RW, Gugino CF, Hilgers JJ, Schulhof RJ. Bioprogressive Therapy. Book 1. Denver, CO: Rocky Mountain Orthodontics; 1979. p. 93-126.  Back to cited text no. 7
    
8.
Mulligan TF. Common sense mechanics. J Clin Orthod 1980;14:180-9.  Back to cited text no. 8
    
9.
McNamara JA. Utility arches. J Clin Orthod 1986;20:452-6.  Back to cited text no. 9
    
10.
Marcott MR. Biomechanics in Orthodontics. Toronto: BC Decker; 1990.  Back to cited text no. 10
    
11.
Shroff B, Yoon WN, Lindauer SJ, Burstone CJ. Simultaneous intrusion and retraction using three piece base arch. Am J Orthod Dentofacial Orthop 1997;67:455-62.  Back to cited text no. 11
    
12.
Kalra V. Simultaneous intrusion and retraction of the anterior teeth. J Clin Orthod 1998;32:535-40.  Back to cited text no. 12
    
13.
Nanda R, Marzban R, Kuhlberg A. The Connecticut intrusion arch. J Clin Orthod 1998;32:708-15.  Back to cited text no. 13
    
14.
Nanda R, Kuhlberg A. Biomechanics and Esthetic Strategies in Clinical Orthodontics. Elsevier Health Sciences. Saunders; 2005. p. 131-55.  Back to cited text no. 14
    
15.
Ranjitbhai D, Hegdhe G, Sindhiya K. Modified three piece intrusion arch for Enmasse retraction and intrusion. Int J Orthod Rehabil 2017;8:81-9.  Back to cited text no. 15
    
16.
Davidovitch M, Rebellato J. Two-couple orthodontic appliance systems utility arches: A two-couple intrusion arch. Semin Orthod 1995;1:25-30.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Types of Deep Ov...
Materials and Me...
Results
Discussion
Conclusion
References
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