Numerical and biomechanical analysis of orthodontic treatment of recovered periodontally compromised patients.

Objective: Generate a finite element (FE) model to simulate space closure and retraction mechanics for anterior maxillary teeth in periodontally compromised dentition, and compare the biomechanical effect of initial force systems with varying magnitude.

Materials And Methods: The geometry of an idealized finite element model (FEM) of a maxilla was adapted such that the teeth showed reduced periodontal support together with extruded and flared incisors. In a first step, leveling and alignment of the front teeth were simulated. In a second step, force systems for orthodontic space closure of residual spaces on both sides distal to the lateral incisors were simulated. A combined intrusion and retraction cantilever was modeled, to simulate en masse retraction mechanics with segmented arches and elastic chains. A commercial FE system was used for all model generations and simulations.

Results: Results of the simulations indicated that a force of 1.0 N is too high for space closure of flared front teeth in periodontally damaged dentition, as extreme strains may occur. En masse retraction using cantilever mechanics with lower forces showed a uniform intrusion and retraction movement and thus proved to be a better option for treating patients with a periodontally compromised dentition.

Conclusion: The outcome of this study indicates that increased periodontal stresses resulting from severe attachment loss should be seriously considered by careful planning of the orthodontic mechanics and reduction of the applied forces is suggested. The presented cantilever mechanics seems to be an appropriate means for en masse retraction of periodontally compromised extruded front teeth.