An investigation into the placement of force delivery systems and the initial forces applied by clinicians during space closure.

This in vitro investigation was designed to establish not only how clinicians apply forces for space closure when using the straight wire appliance and sliding mechanics, but also to quantify the initial force levels produced. A single typodont, with residual extraction space in each quadrant, was set up to simulate space closure using sliding mechanics. On two occasions, at least 2 months apart, 18 clinicians were asked to apply three force delivery systems to the typodont, in the manner in which they would apply it in a clinical situation. The three types of force delivery system investigated were elastomeric chain, an elastomeric module on a steel ligature, and a nickel-titanium closed coil spring. A choice of spaced or unspaced elastomeric chain produced by a single manufacturer was provided. The amount of stretch which was placed on each type of system was measured and, using an Instron Universal Testing Machine, the initial force which would be generated by each force delivery system was established. Clinicians were assessed to examine their consistency in the amount of stretch which each placed on the force delivery systems, their initial force application and their ability to apply equivalent forces with the different types of force delivery system. The clinicians were found to be consistent in their method of application of the force delivery systems and, therefore, their force application, as individuals, but there was a wide range of forces applied as a group. However, most clinicians applied very different forces when using different force delivery systems. When using the module on a ligature the greatest force was applied, whilst the nickel titanium coil springs provided the least force.