TOOTH MOVEMENT : the principle change in tooth position from

such force is seen within the dentoalveolar system

 Optimal ortho. Force > induce a maximal cellular response >
establish stability the tissue
 Unfavorable force > does not result in a precise biological
response > may initiate adverse tissue reactions
Biology of tooth movement :
 Ortho treatment is made possible by the fact that if prolonged
pressure is applied to the tooth, tooth movement will occur as
the bone around the tooth remodels
 Osteoblastic and osteoclastic activities
 Also, the tooth moves through the bone, carrying its
attachment apparatus with it, as the socket of the tooth
migrates
 Further, the movement of the tooth is mediated by the PDL,
and hence tooth movement is primarily a PDL phenomenon
 There are different kids of tooth movement: physiologic,
pathologic , orthodontic
Physiologic tooth migration :
 Eruption of teeth : to occlusal contact is an even that covers
only a short period in life
 However, the teeth and their supporting tissues have a
lifelong ability to adapt to functional demands and hence
drift through the alveolar process, a phenomenon called
physiologic tooth migration. Also well known clinically is that
any change in the equilibrium of occlusal pressure, such as
loss of a neighboring or antagonistic tooth, may induce
further tooth movement
The remodeling processes that occur during the physiologic
migration
 Osteoclasts are seen in Scattered lacunae (howship lacunae)
associated with the resorptive surfaсe along the alveolar wall,
toward which the tooth is moving; the number of cells is more
numerous when tooth migration is rapid.
 The alveolar bone wall from which the tooth is moving away
(depository side) is characterized by osteoblasts depositing
non mineralized osteoid, which later mineralizes.
 Biology of tooth movement : physiologic These are naturally
occurring tooth movements that take place during and after
tooth eruption. • Tooth eruption • Migration or drift of teeth •
Changes in tooth position during mastication

Also 1. Preeruptive 2.eruptive 3. Post.eruptive

 1. Pre-eruptive :Both primary and permanent tooth germs
move within the jaws after their differentiation and these
movements are facilitated by the jaw growth.
 These movements help the teeth to occupy their preparatory
positions within the jaws prior to their eruption.
 2. Eruptive : Axial or occlusal movement of the tooth from its
developmental position within the jaw to its functional position
in the occlusal plane.
 Eruptive movement generally begins when about 2/3rd portion
of the root is formed.
 Theories ... 1. Bone remodeling 2. Root formation 3. Vascular
pressure Activate Windows 4. PDL traction theory (the most
accepted one)
 3. Posteruptive : Occlusal and mesial movements throughout
life.
 A compensatory mechanism for occlusal and proximal wear by
continuous deposition of 2ry cementum around the apices of
the roots of teeth.
 Migration or drift of teeth :
 Mesial - due to proximal caries (loss of tooth structure)
 Occlusal - Due to premature exfoliation or absence of opposing
tooth (supra-eruption)

 changes in tooth position during mastication

 Normal force of mastication -1 to 50 kg
 It occurs in cycles of 1 second duration
 Teeth exhibit slight movement within the socket and return to
their original position on withdrawal of the force
 Whenever the force is sustained for more than 1 second,
periodontal fluid is squeezed out & pain is felt as the tooth is
displaced within the periodontal space

Orthodontic tooth movements

 No great difference exists between the tissye reaction
observed in physiologic toot migration and those observed
in orthodontic tooth movement
 Because the teeth are moved more rapidly during treatment,
the tissue changes obtained by orthodontic forces are more
significant and extensive
 Histologic changes :
 Changes vary according to the magnitude and duration of
force application
 These changes are:
 Changes following application of mild orthodontic force
 Changes following application of excessive orthodontic force
 Optimum orthodontic force:
 The force which moves teeth rapidly in the desired direction
with least possible damage to the surrounding tissues &
minimal patient discomfort.
 If such result is to be obtained, PDL fibers must be
compressed only to a certain extent with little or no
hyalinization.
 No underlying resorption
 Minimal lag phase
 The tooth being moved does not become loosened in its
socket
 Optimum force: is equivalent to the capillary pulse pressure
of 20-26 gm / sq, cm of root surface area
 Type  Force(gm)
 Tipping  35-60
 Bodily(translation)  70-120
 Root uprighting  50-100
 Rotation  35-60
 Extrusion  35-60
 Intrusion  10-20
 The force depends on the size of the root
---------------------------------------------------------------
 Mild force
 Pressure & Tension
 Areas of pressure are formed in the direction of intended
tooth movement
 Areas of tension form in the opposite direction of intended
tooth movement
 Tension side >> bone deposition
 Pressure side >> bone resorption
 PRESSURE SIDE :::::::::: force >>>>> Compression of PDL
about 1/3" of its original thickness >>> Compression of PDL
fibers>>> Vascular constriction >>> Decreased level of
oxygen>>> Cellular response >>> Mobilization of
Fibroblasts & Osteoclasts >>> Osteoclasts start bone
resorption
 Frontal Resorption/ Direct resorption :
 Is seen in the alveolar bone proper immediately adjacent to
the PDL.
 Resorption occurs at the advancing front.
 TENSION SIDE :::::::::::: Force>>>> Stretching of PDL>>>>
Increased vascularity>>>>> Cellular response
>>>>Mobilization of Fibroblasts & Osteoblasts>>>>>
Osteoid/bone matrix is laid down by osteoblasts adjacent
to lamina dura>>>>> Remodeling & reattachment of PDL
fibers followed by calcification of osteoid into mature bone
 HISTOLOGICAL CHANGES :: SHOOOFO EL SOOORA BL SLIDE
 HEAVY FORCE : IT MIGHT APPEAR LOGICAL TO THINK THAT
HEAVIER FORCES CAN BRING ABOUT FASTER TOOTH
MOVEMENT
---------------------------------------------
 SECONDARY REMODELLING CHANGES :
 The compensatory remodeling occurring in the width and
thickness of the alveolar bone in the outer cortical plate.
 The maintenance of the thickness of the supporting alveolar
process by these secondary compensatory structural
alterations helps the tooth to be moved orthodontically over
a distance several times greater than the original thickness.
 ------------------------------------------
 HEAVY FORCE : TENSION SIDE
 Overstretching of the PDL>>>> Rupture/Tearing of blood
vessels and ischemia>>>>
 When excessive force is applied, there is an increased
osteoclastic activity as compared to osteoblastic activity and
thus the tooth become loosened in its socket.
 In addition, pain & hyperemia of the gingiva may occur due
to application of extreme fores due orthodontic tooth
movement.
 PRESSURE SIDE :
 Heavy Force>> Crushing/total compression of PDL>>
Occlusion of BV>> Blood flow is cut off >>PDL becomes
empty of nutrition supply >>Necrosis>> Hyalinization
>>>Macrophages & osteoclasts invade the necrotic tissue
 Necrosis>>> Hyalinization >>Macrophages & osteoclasts
invade the necrotic tissue >> Resorption occurs in the
adjacent marrow spaces & In the alveolar plate (below,
behind & above) the hyalinized area >>> Resorption occurs
deep in the hyalinized area from cancellous bone towards
lamina dura of PDL
 UNDERMINING RESORPTION/windows Indirect resorption/
Rearward resorption to Settings
 IF THE FORCES ARE grossly excessive, REsorption of the root
surfaces may also occur . & Nonvitality and ankylosis of the
tooth are other possible sequences of extreme orthodont
forces.


 HYALINIZATION :
 - A form of tissue degeneration characterized by formation
of clear homogenous substance free of cellular elements.
 Hyalinization of PDL indicates a compressed & locally
degenerated PDL. Hyalinization is a reversible process.
 The presence of hyalinized zone indicates that the ligament
is non-functional & therefore bone resorption cannot occur.
 The tooth is not capable of further movement until the local
degenerated tissue has been removed & adjacent alveolar
bone resorbed.
 Hyalinization of PDL on the pressure side occurs in some
areas during all forms of orthodontic tooth movement, but
the areas are wider when the force applied is extreme.
 ELIMINATION OF HYALINIZATION :
 Resorption of the alveolar bone through osteoclasts
differentiating in the peripheral intact periodontal ligament
and in the adjacent marrow spaces.
 The invading osteoclast cells penetrates the hyalinized tissue
& eliminate the unwanted fibrous tissue by secrete
lysosomal enzyme (Collagenase - enzyme action) and
phagocytosis (Digest collagen).
 Hyalinized areas are normally removed after 3-5 weeks.
 Hyalinization is unavoidable in initial stages of orthodontic
treatment
 Greater the forces, wider the area of Hyalinization
 HYALINIZATION PHASE :
 During the initial application of force, compression in limited
areas of the PDL frequently impedes vascular circulation and
cell differentiation, causing degradation of the cells and
vascular structures rather than proliferation and
differentiation.
 The tissue reveals a glasslike appearance in light microscopy,
which is termed hyalinization.
 ‫شوفو الصور‬
 It is caused partly by anatomic (high bone density) and partly
by mechanical factors (Force applied) and is almost
 unavoidable in the initial period of tooth movement in
clinical orthodontics.
 Hyalinization represents a sterile necrotic area.
 In hyalinized zones, the cells cannot differentiate into
osteoclasts and no bone resorption can take place from the
periodontal membrane.
 Tooth movement stops until the adjacent alveolar bone has
been resorbed, the hyalinized structures are removed, and
the area is repopulated by cells.
 A limited hyalinized area occurring during the application of
light forces may be expected to persist from 2 to 4 weeks.
 It is characterized by three main stages: 1. degeneration, 2.
elimination of destroyed tissue, and 3. establishment of a
new tooth attachment.
 @Movement of anterior teeth by a removable appliance (70
to 100 g): A cell free area existed from the fifth to the
eleventh day. Note the short hyalinization period.
 ‫شوفو التشارت‬
 When bone density is high, the hyalinization period is
longer.
 The adjacent alveolar bone is removed by indirect resorption
by cells that have differentiated into osteoclasts>
undermining resorption.
 Reestablishment of the tooth attachment in the hyalinized
areas starts by synthesis of new tissue elements as soon as
the adjacent bone and degenerated membrane tissue have
been removed.
 The ligament space is now wider than before treatment
started, and the PDL under repair is rich in cells,
 Hyalinized Zone and Root Resorption A side effect of the
cellular activity during the removal of the necrotic hyalinized
tissue is that the cementoid layer of the root and osteoid
 layer of the bone are left with unprotected surfaces in
certain areas that can readily be attacked by resorptive cells.
 Resorptive Fibroblast, Osteoclast, Cementoclast Origin:
Mononuclear/multinuclear cells from blood
 Osteotiast and Cementoclast/Odontoclast
 Osteoclasts & Cementoclasts show considerable variation in
size and shape ranging from mononuclear (monocyte) to
multinuclear (macrophage) cells.
 Both contain lysosomes that are rich with acid phosphatase
enzyme.
 The resorption concavities on the alveolar bone and
cementum surface is termed as Howship's lacunae.
 HYALINIZED ZONE AND ROOT RESOPRTION :
 Root resorption then occurs around this cell-free tissue,
starting border of the hyalinized zone.
 Which indicated an association between root resorption and
active removal of the hyalinized necrotic tissue.
 Soora
 Phases of tooth movement •
 Is immediate, after the application of force.
 Very rapid tooth movement is observed over a short
distance & stops.
 Movement of the tooth within the available PDL space.
 Both light & heavy forces displace the tooth to the same
extent during initial phase.
 Tooth movement is b/w 0.4 mm to 0.9 mm occurs in a
week's time.
 Very little or no tooth movement.
 Formation of hyalinizod tissue in PDL, which has to be
resorbed before movement can occur.
 Duration is shorter if light forcos are used - frontal
resorption.
 Duration is longar if heavy forces aro usad - undarmining
resorption. Usually extends for 2 -3 weeks, but may at times
be as long as 10 weeks

 A number of factors determine the duration of lag phase
including the following:
 V Amount of force. V Duration of force. V Type of tooth
movement and type of tooth. V Density of alveolar bone. V
Age of the patient. V Extent of hyalinization.
 Tooth movement is rapid as hyalinized zone is removed &
bone has undergone
 -
 -

 Pressure/Tension theory Schwartz (1932)
 Whenever a force is applied on a tooth to bring about
orthodontic movement areas of pressure & tension are
formed around the proximity of the tooth
 Areas of pressure are formed in the direction of intended
tooth movement.
 Areas of tension form in the opposite direction of intended
tooth movement.
 -
 Blood flow / Fluid dynamic theory Bein - 1966
 Tooth movement occurring as a result of alteration in fluid
dynamics in the PDL space.
 Force of shorter duration-Mastication-the fluid escapes &
replenishes through capillary walls as soon as the force is
removed.
 Force of greater duration-Orthodontic tooth movement-the
fluid moves towards apex & cervical margins and is called as
“squeeze film effect
 When orthodontic force is applied, it causes compression of
periodontal ligament on the pressure side. The blood vessels
of the periodontal ligament gets compressed between the
principal fibers of the ligament and results in their stenosis.
The blood vessels beyond the area of stenosis balloon up
forming "aneurysms."
 The formation of aneurysms causes the blood gases to
escape into the interstitial fluid, there by creating a
favorable local environment for resorption.
 Bien suggested that the chemical environment at the side of
the vascular stenosis is altered due to a decreased oxygen
level in the compressed areas. Such an environment with
decreased level of oxygen is favorable for bone resorption
 -
 Piezo electric / Bone bending theory :
 Force >>>Bending of bone >>>Deformed lattice
>>>Migration of electrons >>>Piezoelectric current >>>Cell
signal & activation>>> Remodeling of bone >>>Tooth
movement