P.

AMULYA
CRRI
Introduction
Physiologic tooth movement
Histology of tooth movement
Optimum orthodontic force
Hyalinization
Phases of tooth movement
Theories of tooth movement
Bone deposition and bone resorption
Orthodontic treatment is made possible by the fact that
teeth can be moved through the alveolar bone by
applying appropriate forces.

Orthodontic tooth movement is a unique process where

a solid object(tooth) is made to move through a solid
medium(bone)

Orthodontic treatment is based on the principle that if

prolonged pressure is applied on a tooth, bone
remodelling occurs around the tooth resulting in its
movement
The tooth moves through the bone carrying its
attachment apparatus with it, as the socket of the
tooth migrates.

Because the bony response is mediated by the

periodontal ligament, tooth movement is primarily
a periodontal ligament phenomenon.
Physiologic tooth movements are naturally occurring
tooth movements that take place during and after
tooth eruption.
physiologic tooth movements include:
1)Tooth Eruption
2)Migration or drift of teeth
3)Changes in tooth position during mastication
Tooth eruption is the axial movement of the tooth from
its development position in the jaw to its final
position in the oral cavity.
The following are some of the theories:
a)Blood pressure theory
b)Root growth theory
c)Hammock ligament
d)Periodontal ligament traction
a)Blood pressure theory:
The tissue around the developing end of the root is
highly vascular.
This vascular pressure is believed to cause the
axial movement of teeth
b)Root growth theory:
The apical growth of roots result in an axially
directed force that brings about the eruption of
teeth.
c)Hammock ligament:
According to SICHER, a band of fibrous tissue
exists below the root apex spanning from one side of
the alveolar wall to the other.
This fibrous tissue appears to form a network below
the developing root and is rich in fluid droplets.
The developing root forces itself against this band of
tissue, which in turn applies an occlusally directed
force on the tooth.
d)Periodontal ligament traction:
This theory states that the periodontal ligament is
rich in fibroblasts that contains contractile tissue.
The contraction of these periodontal fibres(mainly
the oblique group of fibres) results in axial movements
of the tooth
Migration refers to minor changes in tooth position
observed after eruption.
Human dentitions shows a natural tendency to move
in a mesial and occlusal direction.
Usually a result of proximal and occlusal wear of
teeth, to maintain inter-proximal and occlusal
contact.
This was pointed out for the first time by STEIN
AND WEINMANN.
Physiologic tooth migration usually is related to
mesiodistal movements.However, the teeth also
exhibit a continued eruption, even after full
emergence, accompanying the growth in height
of the alveolar processes.
Tooth movement during mastication
During matiscation, teeth and pdl structures are
subjected to intermittent heavy forces which
occurs in cycles of one second or less and may
range from 1-50 kilograms based on the type of
food being mastication
Classic histologic research about tooth movement by
sandstedt, oppenheim and schwarz led to the hypothesis
that a tooth moves in the periodontal space by generating
a pressure side and a tension side.

Later ultrastructural studies by Rygh(1972) and Brudvik

and Rygh(1994), gave a very detailed description of
events.

The findings of the above research have been

meticulously summarized by Krishnan and
Davidovitch(2006).
When a tooth is moved due to application of an
orthodontic force, there is bone resorption on the
pressure side and new bone formation on the side of
tension.
The histologic changes seen during tooth movement
vary according to the amount and duration of force
applied.
The histologic changes seen during tooth movement
can de studied under two headings as:
1)Changes following application of mild force
2)Changes following application of extreme force
Changes on pressure side:
-The PDL gets compressed to almost 1/3rd of its
original thickness.
-A marked increase in the vascularity of pdl on this
side is observed due to increase in capillary blood
supply.
-This increase in blood supply helps in mobilization of
cells such as fibroblasts and osteoclasts.
-When forces applied are within physiologic limits,
the resorption is seen in alveolar plate immediately
adjacent to the ligament.This kind of resorption is
called frontal resorption.
Changes on tension side:
-The area of the tooth opposite to the direction of
force is called the tension side.
-On application of orthodontic force, the PDL
membrane on the tension side gets stretched.
-The distance between alveolar process and tooth is
widened.
-Increased vascularity.
-Mobilization of fibroblasts and osteoblasts.
-Osteoid is laid down by osteoblast in PDL
immediately adjacent to lamina dura.
-Lightly calcified bone mature to form woven bone.
Secondary remodelling changes:
-A force is applied to move teeth, the bone
immediately adjacent shows osteoclastic
and osteoblastic activity on pressure and
tension side.
Bony changes also takes place elsewhere to maintain
the width or thickness of alveolar bone.These changes
are called secondary remodelling changes.
For example, if a tooth is being moved in a lingual
direction there is compensatory deposition of new
bone on the outerside of the lingual alveolar bony
plate and also a compensatory resorption on the labial
side of the labial alveolar bone.
This is to maintain the thickness of the supporting
alveolar process.
ON THE PRESSURE SIDE:
-root closely approximates the lamina dura
Compress the pdl and leads to occlusion of blood
vessels
The pdl is hence deprived of its nutritional supply
leading to regressive changes called
HYALIISATION
Undermining resorption occurs n the adjacent marrow
spaces and alveolar plate below ,behind above the
hyalinized zone
ON TENSION SIDE
-over stretched pdl
-Tearing of blood vessels and ischemia
-Extreme forces applied net increase in osteoclastic
activity and tooth loosened in socket
-is the one which moves teeth most rapidly in the
desired direction, which the least possible damage
to tissue and with minimum patient discomfort.

SCHWARZ following extensive studies started the

the optimum force is equivalent to the capillary
pulse pressure ,which is 20-26 gm/sq.cm of root
surface area.
-produces rapid tooth movement
-minimal patient discomfort
-the lag phase of tooth movement is minimal
-no marked mobility of the teeth being moved