The Biological Bases of Orthodontic

Therapy
PERIODONTAL LIGAMENT AND
STRUCTURE
Periodontal ligamentt (PDL) is a heavy collagenous
supporting structure that attaches a tooth to
surrounding alveolar bone.
Width=0. 5mm
Structure
1.Cellular Elements
 Connective tissue cells
Synthetic Resorptive
fibroblasts fibroclasts
cementoblasts cementoclasts
osteoblasts osteoclasts
 Neurovascular elements
 Epithelial cell rests
 Immune system cells
2. Periodontal fibres
3. Ground Substance
Collagenous fibres
 Insert into cementum of root
surface on one side and into a
relatively dense bony plate , the
lamina dura on other side.
 Resists the displacement of tooth
during normal function.
 The collagen of PDL constantly
remodel and renew during normal
function.
Cellular Elements
 Includes mesenchymal cells of various type along with
vascular and neural elements.
 These mesenchymal cells can differentiate into fibroblasts
and osteoblasts.
 Fibroblasts form new collagen fibres and osteoblasts form
new bone.
 Blood vessels and nerve endings are also present in PDL.
 Free unmyelinated nerve endings are responsible for
perception of pain.
 Complex nerves associated with pressure and
propioception.
Tissue fluid
Tissue fluid contains O2 , CO2 , sugars, salts, amino
acids, hormones, coenzymes & white blood cells.
Blood Plasma is called Tissue Fluid when it leaves a
blood capillary to deliver O2 and nutrients and goes to
the cells of the body, leaving the large molecules of
plasma proteins in the blood capillaries.
Mechanism of Tooth Movement
Periodontal response and bone response to normal
function
Periodontal response and bone response to orthodontic
force
PDL and bone response to heavy pressure
against a tooth
Masticatory forces are heavy intermittent forces.
Ranging from 1kg-50kg.
When force is applied on tooth, it is transmitted to the
underlying alveolar bone through PDL.
Alveolar bone bends in response, generate
piezoelectric currents.
Piezoelectric currents stimulate bone repair and
regeneration.
PDL and bone response to heavy pressure
against a tooth
Orthodontic Tooth Movement
Piezoelectric theory
Pressure-tension theory
Piezoelectric Theory
When the force is applied on a tooth, the adjacent
alveolar bone bends. This deformation causes bone to
become electrically charged and exhibits a
phenomenon called piezoelectricity.
Piezoelectric Theory
Pressure Tension Theory
 A tooth moves in the periodontal space by creating a
pressure and tension side.
This causes:
 Alterations in blood flow associated with pressure within
the PDL.
 Formation and release of chemical messengers.
 Activation of cells i.e osteoclasts and osteoblasts.
 Bone resorption on compression side and bone deposition
on tension side.
 Tooth moves.
Pressure-Tension Theory
PDL and bone response to sustained
orthodontic force
Types of Resorption
 Frontal Resorption:
 Frontal bone resorption can be defined as painless bone
remodeling of the socket that occur on the lamina dura
adjacent to the affected tooth that lead tooth movement
usually occur in light continuous force.
Undermining Resorption:
 In this, osteoclasts appear within the adjacent bone marrow
spaces and begin an attack on the underside of bone
immediately adjacent to the necrotic PDL area.
Types of Tooth Movement
Tipping 35-60gm
Bodily movement 70-120gm
(translation)
Root uprighting 50-100gm
Rotation 35-60gm
Extrusion 35-60gm
Intrusion 10-20gm
Centre of Resistance of Tooth
 The point a force has to pass
through in order to move an
object freely in a linear manner.
 Forces pass through this point
will result in tooth translation.
 The center of resistance of
single-rooted teeth is found at a
point located at a distance of
33-42% of the root length,
when measured from the
alveolar crest.
Tipping
Simplest form of tooth movement.
Single force against the crown of a tooth.
Produce rotation around center of resistance.
Area of compression : near the root apex on same
side (where force is applied) and at the crest of the
alveolar bone on the opposite side.
Force should be no more than 50gm.
Bodily movement (Translation)
Two forces acting simultaneously on the crown of a
tooth, produces translatory movement (crown and root
move in the same direction the same amount).
Requires twice as much force as tipping.
Area of compression: from alveolar crust to root apex
on the opposite side.
Force should be 100 gm.
Rotation
Rotation is labial or lingual movement of a tooth along
its long axis.
Force require to rotate a tooth is same as tipping.
Area of compression: same as tipping
Force 35-60gm.

Root Uprighting
The root moves in the direction of force but the crown
tips in the opposite direction.
Force required: 50 to 100gm.
Extrusion
Extrusive force is the force require to move a tooth
incisally.
Area of compression: none but only tension.
Force require 35-60gm.
Intrusion
Force require to move a tooth gingivally is called
intrusion.
Area of compression: Root apex
Force require 10-20gm.
Types of Orthodontic Forces
Continuous forces:
 Force maintained at some appreciable fraction of the
original from patients’s one visit to the next.
 Light continuous force in fixed appliance therapy.
Interrupted Forces:

 Force level decline to zero between activations.

 The force gradually decreases until it reaches a level at
which it is incapable of producing tooth movement.
 Both continuous and interrupted forces can be produced by
fixed appliances that are constantly present.
Intermittent forces:
 Force level declined abruptly to zero when the appliance is
removed by the patient.
 Examples are all patient activated appliances e.g.
removable appliances, headgear, elastics.
 Forces maintained during normal function like chewing,
swallowing, speaking are also intermittent in nature.
Side effects of Orthodontic force
Mobility and Pain:
 Mobility can develop by combination of a wider ligament
space or disorganized ligament.
 Hyalinization is a condition in which normal tissue
deteriorates into a homogeneous, translucent material.
 This hyalinized area become avascular.
 Causes of pain are hyalinization, mild pulpitis, ischemic
areas in PDL.
Hyalinization
 Effect on the pulp:
 Orthodontic force can cause mild inflammation in pulp.
 However this change is transient and can resolve on its
own.
 Heavy abrupt orthodontic force can sever the blood vessels
and make the tooth non vital.
 Effect on root structure:
 Moderate generalized resorption
 Severe generalized resorption
 Severe localized resorption
Moderate Generalized Resorption
All teeth involved in fixed orthodontic appliance show
slight average shortening of roots.
Shortening of root length of maxillary incisors is
greater than other teeth.
Severe Generalized Resorption
Rarely caused by orthodontic treatment.
Metabolic diseases like thyroid hormone deficiency
can exacerbate resorption of roots of teeth undergoing
orthodontic treatment.
Other etiological factors are conical roots, distorted
tooth form or a history of trauma along with
orthodontic treatment.
Severe Localized Resorption
Orthodontic treatment can cause severe localized
resorption of a few teeth.
Maxillary incisors are most affected teeth.
Use of heavy continuous forces.
Contact of roots with lingual or buccal cortical plates
can cause localized resorption.
Anchorage
Anchorage is defined as resistance to unwanted tooth
movement.
For every action there is an equal and opposite
reaction.
In orthodontics, anchorage is the resistance to that
reactionary force.
Anchorage can be provided by teeth, palate, head or
neck or by miniscrews screwed to the jaw.
Types of Anchorage
 Reciprocal Tooth movement/Anchorage:
50% movement of anchor segment
50% movement of teeth to be moved
 Example: closure of midline diastema between central
incisors.
 Anchorage Value
Anchorage value of a
tooth is equivalent to its
root surface area which
is the same as PDL area.
Larger the anchorage
value of a tooth, larger
is the force required to
move it.
Reinforced Anchorage
 It involves reinforcing the anchorage or resistance area
either by adding more resistance units or by the use of
various adjuncts.
 Example: adding second molar to anchorage unit
(premolar and first molar).
Stationary Anchorage
Stationary anchorage can be obtained by pitting by
bodily movement of one group of teeth against tipping
of other group to differentially retract the anterior
teeth.
Cortical Anchorage
This anchorage can be developed by torquing the roots
of anchor tooth or teeth against the cortical plate of
dento-alveolar bone.
Cortical bone is more resistent to resorption
Skeletal (Absolute) Anchorage
Anchorage taken from the dentoalveolar bone through
mini screws also called temporary anchorage devices.