American

Journal

of ORTHODONTICS
Volume 75, Number 4

ORIGINAL

A key to the understanding

extraoral forces

April, 1979

ARTICLES

of

Alex Jacobson, D.M.D., M.D.S., MS., Ph.D.

Birmingham,

Ala.

umerous commercially marketed extraoral assemblies are available for use

by orthodontists to assist in effecting orthopedic jaw correction and/or orthodontic tooth
movement. Selecting a suitable appliance can be confusing. However, an understanding
of the basic functional mechanical principles of the appliance and a knowledge of the force
actions involved in their respective designs readily obviate this shortcoming.
From a clinicians standpoint, the usual questions asked are: What are the orthodontic
effects of various headgear assemblies on molar teeth? Will the specific type of assembly
used intrude teeth, and to what degree? Will the headgear tip the roots or crowns of
molars, and how can such movements be controlled? Which type of head- or neckgear
assembly is best suited to moving molars distally without extruding them? Which asymmetric face-bow design is most effective in unilateral molar movement? This article will
try to answer such questions. The article will not include fully banded arches, only upper
molars. Fully banded arches may change the position of the center of resistance.
Extraoral orthodontic appliances generally comprise an inner and an outer bow soldered together near their respective centers. When eccentric forces are desired, the inner
and outer bows of the headgear appliances are attached to each other asymmetrically.
Extraoral force is delivered by means of springs, elastics, or stretchable material, attached
to a neck or headgear assembly usually constructed of pliable material.
The ends of the inner bow engage in tubes attached buccally to bands on the teeth to
which force is applied. Stops are placed on the inner bow mesial to the buccal tubes. The
force applied to the outer bow is transferred to the attached inner bow, which acts upon the
molar teeth. Ideally, the metal section (solder or bar) attaching the inner and outer bows
should be located comfortably in the embrasure between the upper and lower lips.
The length of the outer bow varies and may be conveniently described as (1) short, in
which the outer bow is shorter than the inner bow; (2) medium, in which the outer bow is
approximately the same length as the inner bow; or (3) long, in which the outer bow is
longer than the inner bow (Fig. 1).
Before we proceed toward an understanding of the effects of extraoral forces on molar
From

the School

OC02-9416/79/040361+26$02.60/O

of Dentistry,
0

University

of Alabama

1979 The C. V. Mosby Co.

361

LONG

:.-. *,
., ,I
,:

X8
I,
Jr
MEDIUM

Fig.

1. Diagram

illustrating

face-bow

with short,

medium,

and

I,

,--I
, :: t
, t .y
r/

long outer

bow

lengths

teeth, certain mechanical principles need to be understood and defined. This is essential
since the key to an understanding of the effects of extraoral forces on a molar tooth is an
appreciation of the relationship of the line of action of a,force to the center of resistance of
a tooth.
The mechanical principles that need to be defined include the following:
A force. A force is that which changes or tends to change the position of rest of a body
or its uniform motion in a straight line. The forces used in orthodontics are created by
elastic or spring traction.
Center of resistance. Teeth may be moved by tipping or translation. In tipping, the
center of rotation for any tooth must be located between the neck of the tooth and its apex,
its exact position being unknown.3 Most investigators. I3 agree that the fulcrum of the
tipping movements is in the region between the middle and apical thirds of the root portion
of the tooth. In discussions of tipping or translatory tooth movements, the terms center of
rotation and center of resistance are sometimes not clearly differentiated4 and tend to be
used loosely. Since one is a fixed point and the other movable: the points warrant
definition.
The center of resistance of a body is that point through which the resultant of the
constraining forces acting upon it may be considered to act. The center of resistance of a
single-rooted tooth with a parabolic shape is at a point 0.4 times the distance from the
alveolar crest to the apex.* In the maxillary first molar the center of resistance is estimated
to be in the middle third of the root near the junction of the cervical third, or approximately at the trifurcation of the roots. The center of resistance of a tooth cannot be
changed by external force application.
Center of rotation. The center of rotation of a body is a point around which the body
will rotate or tip. The center of rotation, unlike the center of resistance, can be changed,
the latter being dependent upon external force application. When a force is applied to a
tooth and its line of action does not pass through the center of resistance, then tipping of
the tooth will occur around a center of rotation which may be located anywhere between
the center of resistance of the tooth and infinity. No tipping wili occur when the force

Volume 15
Number 4

Extraoral

Fig.

2. The three

planes

of space

in which

a tooth

may

forces

363

be moved.

application is such that its line of action results in the centers of resistance and rotation
coinciding.
Force resolution. Forces may be resolved into component vectors which, in a single
plane of space, are at right angles to each other. The extraoral force application to molars
is considered to be the resultant force which, in the discussion, are resolved into its
components in the various planes of space.
Line ofaction. The line of action of a force is usually represented by an arrow and is
the direction in which the force acts.
Clinical application of above principles
Teeth can be moved in only three planes of space: sagittal, coronal, and transverse
(Fig. 2). One or more planes of space may be involved in orthodontic tooth movement.
However, to facilitate understanding of the mechanical principles involved in extraoral
force application, each will be discussed separately, under the following headings:
(1) sagittal plane, (2) coronal plane, and (3) transverse plane.
Sagittal plane. The extraoral force applied to the molars is the resultant force. This
force has direction, in which the line of action of a force is that line connecting the point of
origin of the force (head- or neckgear assembly hook) to the point of attachment (hook) on
the outer bow. The resultant force component acting on the banded molar tooth is the

Fig. 3. C, Center

of resistance.

R, Center

of rotation.

7, Line of action

C* 1
l3

Fig. 4. C, Center

of resistance.

of force.

M
T, Tension

(line

of action

of force).

P, Perpendicular

distance.

M,

Moment.

relationship of the line of action to the center of resistance of the tooth. The center of
resistance of the tooth remains constant. The variables are, therefore, (a) the distance of
the line of action from the center of resistance and, (b) the inclination (or steepness) of the
line of action.
D~STANCEOFTHELINEOFACTIONFROM
THECENTEROFRESISTANCE.
Whenthelineof
action passes through the center of resistance of a tooth, no tipping will occur. Tipping,
however, will occur if the line of action does not pass through the center of resistance
(C). The tipping takes place around a center of rotation (R) (Fig. 3). The center of rotation
varies and is dependent upon the relationship of the line of action to the center of
resistance of the tooth.
Should the line of action (T) pass occlusally through the center of resistance, the
crown of the tooth will tip distally (and the root apex mesially). The farther the line of
action is from the center of resistance of a tooth, the greater is its tipping effect.
This principle is easily analyzed by applying the simple formula
M=TxP
M representsthe moment producing the tipping
T representsthe tension (extraoral traction)
P representsthe perpendicular distancefrom the center of resistanceto the line of action.

Volume 15
Number

Extraoral forces

366

Fig. 5. Types of extra-oral anchorage. P, Parietal. 0, Occipital. C, Cervical.

If the line of action (T) passes through the center of resistance, P must be zero, in
which case no tipping moment will occur. In other words, the line of action and the center
of resistance of the tooth are in a straight line (Fig. 4, A).
On the other hand, if the line of action is moved farther away (above or below) from
the center of resistance of the tooth (Fig. 4, B and C), P is increased. Since M = T X P,
the tipping moment is proportionately increased. Thus, the control of tipping force to a
molar tooth based on the above principle is readily applicable.
THE INCLINATION
OF THE LINE OF ACTION.
The inclination or steepness Ofthe line Of
action can be varied and is dependent upon (1) The point of origin of the force and (2) The
point of attachment of the force.
The poinr of origin of the force is dependent upon the type of assembly that is used.
The numerous extraoral assemblies available may be grouped conveniently into three
major categories (Fig. 5): namely:
Cervical:
Anchorage obtained from the nape of the neck.
Occipital:
Anchorage obtained from the back of the head.
Parietal:
The upper part of the back of the head is used as anchorage.
The point of attachment of the force is the hook on the outer bow of the extraoral
assembly. In the sagittal plane the point of attachment of the force (outer bow hooks)
could be located anteroposteriorly anywhere along the AP axis, where point A represents
the point of attachment anteriorly of a short outer bow and point P represents the point of
attachment posteriorly of a long outer bow (Fig. 6).
Vertically, in the same sagittal rectangle, the location of the outer bow hook could
extend anywhere along the V V, axis, where points V and V, represent vertical extremities of points of attachment above and below the first molar teeth created by angulating the outer arms of the face-bow.
Theoretically, therefore, the points of attachment of a force (outer bow hooks) in the
sagittal plane could be located anywhere within the confines of a rectangle formed by the
AP and V Vi axes.

,1',I / Orrhod
4rwrl 1979

Fig.

6. Sagittal

and

VV, axes.

rectangle.

Theoretically,

the outer

bow

hooks

could

be located

anywhere

along

the AP

The shape of the outer bow is of no consequence and has no effect on the application
of force to molar teeth, provided the relationship of the point of attachment (outer bow
hook) to the site of origin of the force remains unaltered, namely, D1 = D, (Fig. 7). This
contention applies only if it is assumed that the arms of the headgear are rigid.
The points of attachment of the outer bow hooks are variable and may be altered to fit
anywhere in the sagittal rectangle by (1) varying the length of the outer bow, (2) varying
the angle between the inner and outer bows, and (3) varying the length and the angle of the
outer bow.
The inclination or steepness of the line of action is dependent upon the location of its
points of origin and attachment. The location of the point of origin of the force is
dependent upon the type of assembly that is being used, that is, whether it is cervical,
occipital, or parietal. The point of attachment of the force must be located within the
sagittal rectangle and is dependent upon the length of the outer bow and its angular
relationship with that of the inner bow.
Extrusive and intrusive force components. Essential in extraoral force application in
orthodontics is a knowledge of whether the force during treatment is designed to intrude or
extrude molar teeth.
The determinant of whether the vertical force component upon a tooth is extrusive or
intrusive is the location of the origin of the line of action. Should the origin of the line of
action be below the center of resistance of the tooth, as in cervical traction, the most
widely used type, an extrusive component of force will be present in its clinical applications. Should the point of origin of the line of action be located above the center of

Volume 15
Number

Extraoral forces

367

Fig. 7. The shape of the outer bow is of no consequence and has no effect on force application to molar
teeth, provided the distances of the points of attachment (0, and Or) to the midline axis are equal.

resistance of a tooth, as in a parietal assembly, the vertical force component to the tooth
will be intrusive.
In occipital traction the point of origin of the force is more or less in line with the
center of resistance of the molar. Under these circumstances, slight intrusive or extrusive
vertical force components may result, depending upon whether the point of origin is
slightly above or below the center of resistance of the tooth.
The magnitude of the intrusive or extrusive vertical components is dependent upon the
inclination or steepness of the line of action of the force. The steeper the line of action, the
more intrusive or extrusive the vertical force component. Horizontal forces will neither
intrude nor extrude molars. The inclination of the line of action of the force is determined
by the point of attachment of the outer bow hook (and this, in turn, is determined by the
type of extraoral assembly that is used) and the location of the point of attachment (outer
bow hook of the face-bow). The location of the latter can be controlled by altering the
length and angle of the outer bow to that of the inner.
Translatory,
crown, or root-tipping
movement. The translatory or bodily movement,
or the crown or root-tipping effect upon the molar teeth of the various extraoral orthodontic appliances is dependent upon the relationship of the line of action to the center of
resistance of these teeth.
If the line of action is in line with the center of resistance of the tooth, it will translate
distally with no tipping effect to either crown or root.
In a cervical type of assembly the point of origin is fixed. The point of attachment, the
outer bow hook of the face-bow, may be adjusted within the confines of the sagittal
rectangle. In Fig. 8, the angle and length of the outer bow hook have been adjusted so that
the line of action passes through the center of resistance of the tooth, in which case the
tooth will translate distally.

Fig. 8. Distal translatory

outer bow hook so that
Cervical
traction.

molar movement
the line of action

may be achieved
passes
through

by adjusting
the length
the center
of resistance

and angle of the

of the tooth. C,

For Figs. 9 to 13, the location of the outer bow hook anywhere in the heavily stippled
area of the sagittal rectangle will cause the crowns of the molar teeth to tip distally, since
the line of action would be below the center of resistance of the tooth. Locating the outer
bow hook in the lightly stippled area of the rectangle (Figs. 9 to 13) would cause the molar
roots to tip distally, since the line of action in this area would be located above the center
of resistance of the molars.
An occipital extraoral assembly type of traction is diagrammatically represented in
Fig. 10. Since the angles and the lengths of the arms in the diagram are adjusted to be in
line with the line of action, the molar teeth will move distally in a bodily manner.
Fig. 12 represents a parietal type of extraoral assembly acting on outer bow hooks
which are adjusted in length and angulation to allow the line of action to pass through the
center of resistance of the tooth, causing the tooth to translate.
Distal force component. From a clinical point of view, in most instances, the magnitude of the distal component is of primary importance. The distal force component is
maximal when the line of action is horizontal, rather than inclined, and passes through the
center of resistance of a tooth. In this situation no extrusive or intrusive components are
present and the magnitude of the distal force on the molars is equal to the magnitude of the
force applied by the extraoral assembly.
The principles of molar extrusion (or intrusion) and of the distal force component are
diagrammatically illustrated in Fig. 14. In Fig. 14, A the line of action (t) is minimally
inclined, in which case the distal force component (d) is relatively much greater than the
intrusive force (i) on the molar tooth.
In Fig. 14, B, the line of action (I) is steeper. The distal force component (d) is reduced
at the expense of the intrusive component (i), which is now considerably increased.
Finally, in Fig. 14, C, the line of action
is very steeply inclined. The effect of the
steeply inclined force of action is that the intrusive force component (i) is almost equal to
that of the distal force (d) on this tooth.
The distal, extrusive, and intrusive effects of various headgear assemblies on molars
(t)

Volume 75
Number 4

Extraoral

Jbrcrs

369

Fig. 9. C, Cervical
traction.
Heavy stippling depicts distal crown tip. Light stippling depicts
distal root tip.
Fig. 10. Since the angles and lengths of the arms in the diagram are adjusted
to be in line with the line of
action, the molar teeth will move distally
in a bodily manner.
0, Occipital
traction.
Fig. 11. 0, Occipital
traction.
Heavy stippling
depicts
distal crown tip. Light stippling
depicts
distal root
tip.
Fig. 12. Diagrammatic
illustration
of parietal type of extraoral
assembly
(P) acting on outer bow hooks
which are adjusted
in length and angulation
to allow the line of action to pass through
the center of
resistance
of the tooth, causing
it to translate.
Fig. 13. P, Parietal

traction.

Heavy

stippling

depicts

distal

crown

tip. Light stippling

depicts

distal

root tip.

370 Jwohwt~

t,

t
c

B
Fig. 14. Diagram
Distal

force

to illustrate the principles

of molar
component.
i, Intrusive
force component.

intrusion
(or extrusion).
t, Line of action of force. d,
(Y, Angle of line of action. obh, Outer bow hook.

can be mathematically calculated. These effects on molars relate to the inclination or the
steepness of the line of action of the force. In analyzing the force system, a parallelogram
of force diagram is used. In Fig. 1.5, the force system is reduced to a right-angled triangle
(ABC) in which a is the adjacent side, o the opposite side, and h the hypotenuse. Angle CY
is formed by the base of the triangle and the line of action of the force. The steeper the line
of action of the force, the greater the angle CX.
The classic formulas are:
(1)

Since=

j+

arid(2)

&sol=+

The parallelogram of force diagram can be applied. The hypotenuse of the triangle is
the line of action of the force T. The steepness of the line of action is measured in degrees
(a). Lines D and I would be the adjacent and opposite sides of the triangle and would
represent the distal and intrusive (or extrusive when applicable) force components.
Application of the formula would be as follows:
A

Sin cy= r

I = T Sin cy

1. If T was constant, the magnitude of intrusion would be directly proportional to the Sin
LY,viz., the steepnessor inclination of the line of action of the force. The extrusive
component is directly related to the steepnessof the line of action. The greater the angle

Volume 75
Number 4

Fig. 15.

Parallelogram
of force
line of action. I, Intrusive
force

Fig. 16.
Center

Extraoral forces

diagram.
o, Opposite
side. h, Hypotenuse.
a, Adjacent
component.
T, Line of action of force. D, Distal force

side. LY, Angle

component.

371

of

Intrusive
force in a coronal
plane acting on the buccal tube of a molar, causing
it to roll. C,
of resistance
of tooth. P, Perpendicular
distance
of buccal tube to center of resistance
line.

or the steeperthe inclination of the line of action, the greater the extrusive effect on the
tooth.
2. If angle cywas constant, I would be directly proportional to T. In other words, if the
angle of the line of action of the force was constant, the magnitude of the intrusive force
I would be directly proportional to the magnitude of the applied force.
In sum, therefore, the amount of distal or intrusive (or extrusive) force that is clinically
applied to molars with the use of extraoral appliances is dependent upon the steepness of
the line of action of the extraoral force. The steeper the line of action, the greater the
intrusive (or extrusive) force. A horizontal line of action exerts maximal distal force to
molars with no extrusive or intrusive force. As the line of action steepens, so do the
extrusive or intrusive forces at the expense of reducing the distal force component to the
molars.
Coronal plane
In the coronal plane, molar teeth can be moved vertically (intruded or extruded) and/or
laterally or medially.

Fig. 17. Palatal

bar

soldered

to molar

bands

will cause

teeth

to intrude

bodily

on

intrusive

force

application.

Extrusion or intrusion. If the origin of the line of action of the force is located above
the center of resistance, as in parietal headgear, the effect on the molar will be to intrude
it. Locating the origin of the line of action below the center of resistance of a tooth, as in
cervical gear, will tend to extrude the tooth.
The inner bow of the extraoral appliance fits snugly into the buccal tube of the molar
tooth. This means that the line of action does not pass through the center of resistance of
the tooth which is located somewhere along its midline between the root apex and the
alveolar crest (Fig. 16). Since the line of action of the force during intrusion or extrusion
passes buccally to the center of resistance of the molars, these teeth will tend to roll.
The crowns of these teeth will rotate buccally (and the roots lingually) during intrusion
and palatally (and the roots buccally) during extrusion. The moment, or rotation effect, is
dependent upon the perpendicular distance of the buccal tube to the center of resistance.
Clinically, this distance, albeit small, will cause molars to roll during extended periods
of extrusive or intrusive activity, particularly if the line of action of the force is steep.
Soldering a palatal bar to the lingual aspect of both molars can obviate this effect. This
will cause both teeth to translate vertically with intrusive or extrusive force application
(Fig. 17).
Lateral or medial action. Lateral movement of both molars can be achieved by
expanding the inner bow of the face-bow and inserting its end in the buccal tubes of the
molars. Medial movements can be similarly achieved by contracting the inner arch of the
face-bow.
Since the buccal tubes of the molars are located below the center of resistance of the
teeth, any expansion or contraction of the inner arch of the face-bow will cause the crowns
of these teeth to tip buccally or palatally, respectively, and their roots to move in the
opposite direction to the crowns (Fig. 18). Since the ends of the inner arch of face-bows
are round and these, in turn, are inserted into round tubes, molar teeth can only be tipped
buccally or palatally by means of headgear. Translatory buccal or palatal movements of
molars using only headgear could be achieved if square, rectangular, or ovoid arches were
slotted into similarly shaped buccal tubes.
Transverse

plane

In the transverse plane teeth can be moved distally and/or medially or laterally. Since
round tubes on molar teeth snugly receive the distal ends of the inner arch of headgear,
these teeth are prevented from rotating in the transverse plane with any force application to
the face-bow. Expansion or contraction of the inner arch of the face-bow will translate the

Volume 75
Number

Extranral

jot-cm

373

Contraction

Fig. 18. Buccal

or lingual crown tip in the coronal
plane caused
arch of face-bow.
C, Center
of resistance.
P, Perpendicular
resistance
of tooth.

by expansion
or contraction
of inner
distance
of buccal
tube to center
of

crowns of the molars laterally or medially, respectively, in this plane (but not necessarily
in the coronal plane). Likewise, the long tubes which receive the inner arch of the
face-bow cause it to act as a fixed unit, thereby obviating any rotation effect or moment to
molars on distal force application.
In other words, distal or lateral force application to molar teeth with conventional
extraoral face-bows will cause these teeth to translate distally and/or medially and laterally in the transverse plane. The force application to the molars is generally of the same
magnitude if symmetrical extraoral assemblies are used. However, there are many clinical
situations which require a greater force delivery on one side of the arch. In these instances,
face-bows of the asymmetric or unilateral type are used.
Unilateral face-bows
To achieve asymmetric molar force delivery to molar teeth, various face-bows have
been designed, many of which have been mathematically shown to be effective., I In
computing the effects of extraoral forces by mathematical means, many variables have
had to be ignored. Among these are the indeterminate characteristics of bone and teeth,
both of which exhibit a certain amount of flexibility. Add to this the flexibilities of the
geometry of the face-bow which cause the line of action to vary with the amount of pull
and degree of flexibility of the material. Together, these produce a myriad of variables
which make the practicability of computing the results of force application to molar teeth
in three planes of space by mathematical means almost impossible.
Because of these inherent difficulties and interpretations in calculating molar forces, it
was deemed desirable to design and construct a mechanical device which would measure
the magnitude and direction of the forces transmitted to the molars by various extraoral
face-bows.
Method and materials
To test mechanically the effect of various extraoral appliances on molars in a transverse plane, a model comprising a number of frictionless pulleys located between two
sheets of % inch acrylic plastic was constructed (Figs. 19 and 20). The pulley system was
designed to measure the various force applications to the outer and inner bows of the

Fig. 19. Model

(see text).

of device

used

to mechanically

test

effects

of force

application

to various

face-bows

headgear appliance by attaching aluminum containers which could be weighted by adding

lead shot. Dental handpiece ballbearing assemblies were used in the construction of the
pulley wheels to minimize friction.
The ends of the inner arch of the extraoral appliance were accurately fitted into slots
drilled into two L-shaped flat pieces of acrylic plastic. The two free-floating pieces of
acrylic plastic represented the left and right molar teeth, ML and MR. Fig. 21 presents a
diagrammatic representation of the pulley principle of the apparatus.
Equally weighted containers A and A, were attached to the outer bow hooks of the
headgear appliance. These weights represented the extraoral force application of
headgear. The effect of adding weights to the outer bow of the headgear would be to move
molars ML and MR vertically downward.
To counteract the downward movement of molars ML and MR, containers 5 and B 1
were loaded with lead shot.
Since pulley friction was minimal in a symmetrical type of face-bow, it was anticipated that weights A and AI and B and B r would be of equal magnitude. In effect, the total
force application to the outer bow would be transmitted via the solder joint to the inner
bow and to the molars.
In an effort to determine whether any lateral displacing forces on molar teeth are
introduced with the use of headgear, two additional pulley systems were added to each
molar attachment ML and MR (Fig. 22). The amount of lateral or medial displacement
could be measured by loading the appropriate receptacles with lead shot. For example, if
the effect of the force application to the outer bow was to move ML laterally, receptacle R
would drop downward and Q would be elevated. To counteract this lateral force, lead shot
could be added and the amount of weight measured to receptable Q until ML was in its
original position and balanced. The medial and lateral forces on MR may be similarly
measured by loading receptacles S and T.

Volume 15
Number

Fig. 20. Pulleys

back

Extraoral

of neck.

N and N, adjusted
Without
the addition

to simulate
line of action of force from outer bow hooks
of these pulleys,
the line of action would be vertical.

forces

375

to tangent

to

Finally, to simulate the direction of pull of the elastic traction from the outer bow
hooks to the back of the neck, pulleys N and N, were added to the apparatus. Without the
addition of these pulleys, the traction forces (line of action) would always be vertical and
not tangent to the back of the neck (Fig. 20).
Findings

1. The first exercise involved determining whether a force applied to the outer bow of
a symmetrical headgear could exert an expansion force in the molar region of the inner
bow. The possibility of obtaining a lateral force is based on the premise that if relatively
lightweight legs supporting a heavy body or weight (W) were parallel, no lateral forces or
widening effect of the legs on a flat surface would be produced (Fig. 23 A). However, if
the legs were divergent as in B, they would tend to splay. The more divergent the legs, the
greater the splaying effect. On the other hand, if the legs were rigid as in diagram C, they
would not splay with weight application in spite of being divergent.
Two symmetric headgears were tested, the first having a narrow inner arch with more

Fig. 21. Diagrammatic

representation
of distal force pulley system.
A and A,, Force application
to outer
bow hooks. ML and MR, Left and right molar
teeth.
B and B,, Containers
for lead shot required
to
counteract
force application
to A and A,,

or less parallel distal ends and the second having a wide inner arch with divergent distal
ends. The inner bows were contoured to conform to dental arches which would be
considered as being particularly narrow and wide, respectively.
Face-bows in which the anterior section of the inner arches were stiffened or reinforced by the addition of tubing or constructed of thicker material showed no discernible
molar expansion with the application of up to 3 pounds of force on either side. This
finding applied to both wide and narrow inner arches.
Inner arches constructed from uniform 0.045 inch (diameter) steel evinced considerable expansion or lateral forces in the molar region, particularly in the wide arch. Fortunately, inner arches of commercially marketed face-bows now usually are reinforced
anteriorly, making them adequately rigid.
2. The next exercise entailed testing a face-bow
in which the solder joint was offset.
The face-bow
was designed to exert more distal molar force on the side of the solder joint.
On applying a force of 16 ounces on each side to the outer bow hooks, the forces
transmitted to the molars were 18 ounces on the side of the solder joint and 14 ounces on
the opposite side (Fig. 24).
The 4 ounce discrepancy in the molar reading is ascribed to the flexibility of the outer
bow arms and not to the offset solder joint. This is not shown here. Theoretically, if the
outer bow arms were constructed of a rigid, nonyielding material, the forces to the molar
teeth in this type of headgear would be identical to that of a symmetric type.
The rationale of the unequal force distribution to the molars relates to the distance of
the outer bow hooks to the midsagittal plane. In the model tested, the distance between the
outer bow hooks to the midsagittal plane in a nonstressed face-bow was 70 mm. on each

Volume 75
Number 4

Extruoral

Fig. 22. Diagram

to illustrate
method
of measuring
lateral forces to molars.
molar (ML). R, Lateral force to left molar (ML). S, Medial force to right molar
right molar (MR).

Q, Medial force to left

(MR). T, Lateral force to

Fig. 23. A, Parallel lightweight

legs supporting
heavy body
under the effect of weight of a body (W). C, Rigid divergent
application.

forces

377

(W). B, Divergent
lightweight
legs splaying
legs exhibit no splaying
effect with weight

side. On applying forces (weights) to the outer bow hooks and counterbalancing there, the
distance of the outer bow hooks (A and B) to the midsagittal plane was reduced to 69 and
65 mm., respectively. The flexibility of the longer arm allowed the outer bow hook on that
side to be located nearer the midline (midsagittal plane), thus reducing the force on the
molar on that side. What determines the different distal molar forces is the line of action of
the force to the outer bow hook. This is discussed later. As you can see in comparing Figs.
24 and 25, we are not incorporating the neck pad shift that might occur in a patient.
3. The next test entailed measuring the forces upon molars using a symmetrically
soldered outer bow, the arms of which were of different lengths. The second part of this
experiment involved bending the longer arm away from the contour of the cheek and
measuring the effect of applying extraoral force to these hooks in this manner.

Fig. 24. Testing of face-bow with offset solder joint. Note flexibility of arm on side opposite solder joint.
(See text.)

On applying a force of 16 ounces on each side to the outer bow hooks, it was found
that forces of 8 ounces and 24 ounces were transferred to the molars of the shorter and
longer sides, respectively. This configuration introduced considerable lateral force on both
molars. When the longer arm was extended away from the cheek, it was found that an
even stronger lateral force component was introduced. The amount of lateral force required to counterbalance the outer bow force was 5 ounces on each side, a total of 10
ounces (Fig. 25).
The lateral force component cannot be disregarded in clinical procedures. This component is dependent upon the direction of pull of the line of action of the force (the elastic
stretching between the outer bow hook on the longer arm and the point of attachment) of
the neck and headgear assembly. The amount of distal or lateral forces on the molars does
depend on the lengths of the outer arms of the headgear. It is dependent on the angulation
of the line of action of the force from the outer bow hooks. If the outer bow arms were of

Volume 75
Number 4

Extraoral

forces

379

-I

24

< Angle of
Lim of Action

Fig. 25. Testing of face-bow with symmetricalty soldered joint but with arms of different lengths. In one
experiment the longer arm was bent outward. (See text for findings.)

different lengths, but the line of action of the forces (elastic traction) on either side were
parallel (Fig. 26), the force application to the molars would be the same. Bending the
larger arm outward locates the outer bow hook laterally. The origin of the line of action of
the force is thus moved outward. From here the line of action of the force is directed
toward a tangent to the back of the patients neck (Fig. 25). The line of action on the
longer arm side is thus considerably angulated, whereas the line of action of the short arm
side is minimally angulated as it passes toward the back of the neck.
If the line of action of the extraoral force to the outer bows (the line of traction of the
elastics of the extraoral assembly) was parallel to the midsagittal plane, its angulation
would be 0 degrees to this plane. Angulating the line of action of the force (by bending the
other bow laterally) increases the molar force on that side, but it also introduces a lateral
component. If the angulation of the elastic pull (line of action) was 30 degrees, the amount
of lateral force exerted on the molar on that side would be reduced by as much as 50 percent of the total force. If the line of action were reduced to 20 degrees, the amount of force
on the molar would be 34 percent of the total pull on that side. The amount of force to the

i
16

c6

Fig. 26. Illustration

to show that if the outer bow arms were of different
lengths,
but the line of action of
the forces on the outer bow hooks was parallel, the force application
to the molars would be the same
on either side.

I. Relation of reduction in magnitude of total molar tooth force to angle of line

of action of face-bow

Table

Angle

of line of action
(degrees)

0
10
15
20
25
30

to midline

axis

Percentage
I

reduction
of total
to molar

distal force

0
17
26
34
42
50

molars can be mathematically computed by relating it to the angle of the line of force to
the midline axis. Table I relates the amount of force to the molar relative to the line of
action.
In its clinical application, lengthening the arm of a symmetrical face-bow within
certain limits will increase the force application to the molar tooth on that side. Consider-

Volume 75
Number 4

Fig. 27. A swivel asymmetric

ment only in the transverse

Extraoral forces

type
plane.

of extraoral
Outer bow

face-bow
of excellent
arms are of different

design
lengths.

(insert),

permitting

381

move-

able reduction in length of the one arm of the face-bow and some lengthening of the other
will introduce a difference in the line of action of the extraoral forces on both sides. The
effect will be much the same as bending one arm of the face-bow outward. The effect is
that of increasing the force to the molar tooth on the side of the lengthened or laterally bent
arm. Accompanying angulated extraoral line-of-force actions is the lateral force component which has been shown to be quite considerable.
A mild expansion of the inner bow of the appliance will counteract the lateral force
component on the lengthened side and increase the lateral force on the molar tooth of the
opposite side. This could be useful for correction of specific cross-bites. Contracting the
inner bow will have exactly the opposite effect. There is no way that the lateral forces on
both molars can be neutralized with the use of this type of headgear.

Fig. 28. The effects

Fig. 27. (See text.)

on the

molar

teeth

on force

application

to the swivel

type

of face-bow

shown

in

4. The swivel type of unilateral extraoral face-bow tested provided the most satisfactory unilateral force delivery without the usual accompanying lateral components to both
molars. The swivel arrangement comprised a heavy outer bow with a soldered extension
having a vertical pivot section fitting into a vertical tube soldered asymmetrically to the
inner arch of the face-bow (Fig. 27). The particular swivel arrangement was good in that
the appliance permitted movement in only the horizontal plane of space. Flexibility in the
other plane of space was reduced to a minimum by the rigidity of the material from which
the face-bow was constructed.
An application of 16 ounces of force to either side of the outer bow hooks delivered 25
ounces of force to the molar in the swivel side and only 8 ounces to the opposite molar.
Unfortunately, on the face-bow tested, the inner bow was not reinforced anteriorly, in
which case a total expansion force of 10 ounces was delivered to the molars on loading of
the outer bow hooks with a 16 ounce weight on each side.
The design of the face-bow is such that the outer arm on the swivel side is considerably
shorter than that of the opposite side. The application of 16 ounces of force on each of the

Volume 75
Number 4

Extraoral

Fig. 29. Three

of additional

asymmetric

face-bow

designs

forces

383

tested.

outer arms caused the longer, more flexible arm to bend inward whereby a minimal lateral
force component was applied to the molars. The reason for this was that whereas the
distances of the unloaded long and short outer arms to the midline axis were 105 mm. and
57.5 mm., respectively, the loaded arms (16 ounces on each side) positioned themselves
75 mm. and 6.5 mm. from the midline. Thus, the line of action of the forces on each side
were more or less equally angulated relative to the midline axis, thereby minimizing the
lateral force components. Further loading (within limits) of the outer bows would reduce
the distance of the outer bow hooks to the midline discrepancy even more, thereby
reducing the lateral forces to almost zero (Fig. 28).
Reducing the outer arms to the same length from the midline caused the outer arm

384

.Jtrc~ohso~,

opposite the swivel to bend too far inward. The bending would cause the arm to impinge
upon the cheek of the patient during the application of force. Thus, the manufacturers
method of compensating for this (by lengthening the arm on the swivel side) was eminently satisfactory. It was believed that stiffening the inner bow of the face-bow anteriorly
would have added to the efficiency of the design of the appliance.
5. Three additional asymmetric face-bow designs were tested (Fig. 29).
In design A, a fairly heavy bar was soldered eccentrically to the inner arch and
centrically on the outer bow. The effect of loading the outer bow was that the outer arm on
the side opposite the solder joint was more flexible (because of the added length of the bar)
and consequently became positioned closer to the midline axis. The effect of this was the
introduction of a lateral force component to the molars because of the line of action of the
elastic traction.
Designs B and C proved unsatisfactory, inasmuch as the swivel and helix types of
attachment were too flexible and allowed movement in three planes of space in force
application to the face-bow.
6. The final experiment was designed to test the claim that an open coil spring slid on
the inner arch of a symmetric type of face-bow immediately ahead of one or another of the
molar teeth would produce a unilateral distal force on that molar.
On application of 16 ounces of force to each of the outer bow hooks, the measured
force to the molars proved to be identical to the force applied to the outer bow of the
face-bow (in this instance, 16 ounces to each molar). On complete compression of the coil
spring, the compressed coil acts as a solid unit. On partial compression of the coil spring,
the force required to partially compress the coil is balanced by the same amount of force as
the tension to the outer bow hooks of the face-bow. The mechanics of the appliance
clearly illustrate that coil springs applied unilaterally to the inner arch of a face-bow
cannot effect unilateral distal forces to molar teeth.
Discussion
Awareness of the intrusive or extrusive effect on molars cannot be, and has not been,
overlooked by clinicians. 3-. . lo, ii The key to the appreciation of the effects on molar
teeth of the numerous extraoral neck- and headgear appliances marketed is the understanding of the relationship of the line of action of a force to the center of resistance of a tooth.
The center of resistance of a tooth is fixed. The line of action of an extraoral force is
variable and is dependent upon the locations of the outer bow and head- or neckgear
assembly hooks and not the point of attachment. The inclination of this line of action to
the center of resistance of the molars must be analyzed in three planes of space.
In analyzing the effects on the molars of the various symmetric types of extraoral
assembly, it is found that certain generalities are pervasive.
Occipital headgears will tend to intrude molars, whereas cervical assemblies will
extrude these teeth. The degree of intrusion or extrusion is dependent upon the inclination
of the line of action of the force; the steeper the inclination, the greater the intruding or
extruding effect. Tipping root or crown movements are readily controlled if the principle
of relating the line of action to the center of resistance of the molars is borne in mind.
Application of maximum distal force to molar teeth with minimal intrusion or extrusion is achieved with the use of horizontal-pull extraoral assemblies.
Rolling of molars due to the application of intrusive or extrusive orthodontic forces

Volume 7s
Number 4

Extraoral

forces

385

may be prevented by connecting the two molar bands with a palatal bar. Soldering a
palatal bar to the molars will thus cause these teeth to translate vertically rather than to
roll.
Inner arches of face-bows of 0.045 inch (1.143 mm.) and less will cause molars to
expand laterally on force application. Fortunately, most commercially available facebows have inner arches which are reinforced anteriorly and prevent this from occurring.
The various eccentric or asymmetric face-bows have been designed to effect unilateral
molar movements. The various designs may be divided conveniently into two basic types,
the fixed and the swivel type, in which the inner and outer arches of the face-bows are
either soldered together or attached by means of a swivel or free-moving attachment.
Haack and Weinstein5 mathematically computed that no matter where the rigid attachment of face-bow to arch wire is placed, as long as the applied forces on the cervical
region are symmetric with respect to the midsagittal plane, the reactionary forces on both
right and left molars should be equal. This report did show a discrepancy of 4 ounces from
side to side. To obtain rigidity, they advocate an outer bow wire 0.075 inch (1.905 mm.)
in diameter since this would be five times as still as a 0.050 inch (1.270 mm.) wire. I agree
with this contention, particularly since they stress a rigid outer bow. The ultimate determinant of molar force application is dependent upon the relationship of the outer bow
hooks to the midline axis. Unless the outer bow is constructed from extremely rigid metal,
the outer bow opposite the solder joint is usually more flexible (being longer), in which
case the outer bow hook tends to be pulled closer toward the midsagittal plane. In clinical
practice the longer arm is frequently bent outward to compensate for its flexibility, but, on
application of traction, the force to the molars tends to be identical in spite of the
asymmetrically soldered inner and outer bows.
Haack and Weinstein5 used strain gauges to demonstrate that the force exerted on the
molar on the side of a long face-bow arm is considerably greater than the force exerted on
the side of the short face-bow arm. Oosthuizen and associates illustrated mathematically
that asymmetric force delivery is achieved by lengthening the one outer arm of the
face-bow.
These researchers were aware of the lateral forces on the molars on application of this
type of face-bow design. Whereas extending one arm laterally or lengthening it does
increase the distal force to the molar on that side, it also introduces a lateral force which
cannot be ignored in clinical situations. The relative force delivered to each side is
dependent upon the angulation of the line of action to the midline axis; the greater the
angle, the greater the lateral force component.
The most effective extraoral face-bow design encountered for effecting a unilateral
distal movement of a molar is that of the swivel-type attachment. The outer arms are of
unequal length and the swivel arrangement is rigid, allowing movement in only one plane
of space. The flexibility and leverage of the arms are such that the lines of action to the
midline axis on both sides are more or less equal on application of traction. The force
delivery to the molar on the swivel side is directed primarily distally with a minimal lateral
component.
Summary

By following certain basic principles, the effects, advantages, and disadvantages of

the wide assortment of extraoral assemblies marketed are easily understood. The key to

this understanding is the appreciation of the relationship of the line of action of the force
application to the center of resistance of the tooth.
These principles are discussed in three planes of space: sagittal, coronal, and transverse. Because
of the many variables
and complexity of mathematically computing the
force effects of unilateral or asymmetric extraoral assemblies on molar teeth, a mechanical
testing apparatus was designed to accommodate the various face-bows. Not all the designs
proved effective, and many of the clinical side effects of the respective face-bow
designs
became manifest on mechanical testing.
I would like to express
my gratitude
to Dr. P. L. Sadowsky.
Assistant
ProfessorIn Orthodontics
at the University
of Alabama
School of Dentistry.
whose assistance
in the mechanical
testing of the
various
face-bows
is greatly
appreciated.
My thanks also to the UAB Orthodontic
Alumni
members
and the Southern
Society
of Orthodontists
who contributed
to the UAB Orthodontic
Research
Fund
which was responsible
for financing
the construction
of the testing apparatus
and the photography.
REFERENCES
1. Armstrong,
M. A.: Controlling
the magnitude,
direction and duration of extraoral
force, AM. J. OKTHOD.
59: 217-243,
1971.
2. Burstone, C. J.: The biomechanics
of tooth movement.
In Kraus, B. S., and Riedel. R. A. (editor):
Vistas
in Orthodontics,
Philadelphia,
1962, Lea & Febiger, pp. 197-213.
3. Gould 1. E.: Mechanical
principles
in extra-oral
anchorage,
AM. J. ORTHOD. 43: 319-333.
1957.
4. Greenspan,
R. A.: Reference charts for controlled
extra-oral
force to maxillary
molars, AM. J. ORPHOD. 58:
486.491,
1970.
5. Haack, D. C., and Weinstein,
S.: The mechanics
of centric and eccentric
cervical
tractions.
AM. J.
ORTHOD.

44: 346-357,

1958.

6. Haaa, A. J.: Palatal expansion:

Just the beginning

of dentofacial

orthopedics,

AM. J. ORTHOD.

57: 219-255,

AM. J. ORTHOD.

41: 601-602,

1970.

7. Huettner,

R. J., and Young,

R. W.: Movability

of vital and devitalized

teeth,

1955.

8. Kloehn, S. J.: An appraisal of the results of treatment of Class II malocclusion

with extra-oral
forces. In
Kraus, B. S., and Riedel, R. A. (editors):
Vistas in orthodontics.
Philadelphia,
1962. Lea & Febiger, pp.
227-258.
9. Massler,
M.: Changes in lamina dura during tooth movement,
AM. J. ORTHOD. 40: 369, 1954.
10. Merrifield,
L. L., and Cross, .I. J.: Directional
forces, AM. J. ORTHOD. 57: 435-475,
lY70.
1 I. Oosthuizen,
L., Dijkman,
J. F. P., and Evans. W. G.: A mechanical
appraisal of the Kloehn extra-oral
assembly.
Angle Orthod. 43: 221-232,
1973.
12. Oppenheim,
A. I.: Biologic orthodontic
therapy and reality, Angle Orthod. 6: 77-81, 1936.
13. Thurow,
R. C.: Periodontal
membrane in function,
Angle Orthod.
15: 20, 1975.
I919

7th AIY.

South (35294)