The Biologic Basis of Orthodontic

Tooth Movement
Assistant Professor
Mohammed Reyad Jaradat
BDS,
MSc(ortho)
Pal.Board-Ortho
Jord.Board-Ortho
Dean for faculty of dentistry
Lecture outline
• Introduction
• Types of tooth movement
• Theories of tooth movement
• Factors affecting orthodontic tooth movement
Physiologic tooth movement
• Naturally occurs during and after tooth eruption

1. Tooth eruption
2. Migration or /drifting of teeth
3. Changes in tooth position during mastication
M 2 ND
OL
AR
2- Pathologic tooth movement
it is a common complication of moderate to
severe periodontitis.

Prevalence of PTM among periodontal patients

has been reported to range from 30.03% to
55.8%.
Periodontal bone loss appears to be a major
factor in the etiology of PTM

Gingival overgrowth caused by severe

inflammation or drugs such as phenytoin is
known to cause PTM
 • It is a periodontal ligament phenomenon
3- Orthodontic • Tooth moves through the bone carrying its attachment apparatus with it
(Socket migrates).
tooth movement
• Teeth move through alveolar bone by applying orthodontic forces.
• Orthodontic tooth movement is a unique process because a solid
object (tooth) is made to move through a solid medium (bone).
It is a periodontal ligament phenomenon
Can we move Endo-treated teeth?
Orthodontic tooth movement
Theories of tooth movement
• Piezoelectric theory
• Pressure tension theory
Force
2-Pressure - tension theory te d
ce p
ac
• Whenever a tooth is subjected to an orthodontic force, it results in
areas of pressure and tension.
• At the pressure side….the alveolar bone will resorp.
• At the tension side….New alveolar bone is deposited.
Ortho.
Force

buccal Lingual

Tension Pressure
side side
 Stages of tooth movement

1. initial compression of tissues

2. alterations in blood flow

3. formation and/or release of chemical messengers

4. activation of cells.
Heavy Force application

• if the sustained force against the tooth

is great enough to totally occlude blood
vessels and cut off the blood supply to
an area within the PDL.
• When this happens, rather than cells
within the compressed area of the PDL
being stimulated to develop into
osteoclasts, a sterile necrosis ensues
within the compressed area.
Adverse effects of excessive force
1. Pain
2. Mobility:
• Undermining resorption widens PDL
• PDL becomes disorganised
3. Increased chances of root resorption
Force
Decay
Continuous interrupted

intermittent
orthodontic force duration
From this perspective, orthodontic force duration is classified by the
rate of decay as:
1. Continuous—force maintained at some appreciable fraction of the
original from one patient visit to the next
2. Interrupted—force levels decline to zero between activations
3. Intermittent—force levels decline abruptly to zero intermittently,
when an orthodontic appliance or elastic attached to a fixed
appliance is removed by the patient, and then return to the original
level some time later.
• Intermittent forces are produced by all patient-activated appliances

such as removable plates, headgear, and elastics

Optimum Force
1- Tipping movement

force
Tipping
Tipping movements
• The simplest form of orthodontic movement is tipping.
• Tipping movements are produced when a single force (e.g., a spring
extending from a removable appliance) is applied against the crown of a
tooth.
• The tooth rotates around its “center of resistance,”
• When the tooth rotates in this fashion, the PDL is compressed near the root
apex on the same side as the spring and at the crest of the alveolar bone on
the opposite side from the spring .
• Maximum pressure in the PDL is created at the alveolar crest and at the root
apex. Progressively less pressure is created as the center of resistance is
approached, and there is minimum pressure at that point.
Bodily movement
the root apex and crown move in the same
direction the same amount
• If two forces are applied simultaneously to the crown of a tooth, the
tooth can be moved bodily (translated), that is, the root apex and
crown move in the same direction the same amount. In this case, the
total PDL area is loaded uniformly .
• It is apparent that to produce the same pressure in the PDL and
therefore the same biologic response, twice as much force would be
required for bodily movement as for tipping.
De-Rotation
intrusion
intrusive forces cause more severe root resorption than
extrusive forces of the same magnitude in the same
individual.
Optimum Force
 Force
Duration
 Duration Threshold
• This amount of time to produce a response correlates rather well
with the human response to removable appliances.
• If a removable appliance is worn less than 4 to 6 hours per day, it will
produce no orthodontic effects. Above this duration threshold, tooth
movement does occur.
• Animal experiments have shown that increased levels of (cAMP)
appear after about 4 hours of sustained pressure

6 Hours Threshold
Pain and orthodontic
movement
The decrease in the rate of OTM may be related to the effect of these
drugs on osteoclastic differentiation or in stimulating their activity
inhibition of the inflammatory reaction produced by prostaglandins tends to
slow orthodontic tooth movement (Diravidamani et al., 2012)
• It has a direct effect on calcium homeostasis thereby affecting the
bone metabolism, thus having an inhibitory effect on orthodontic
treatment and tooth movement (Adachi et al., 1997).
• Bisphosphonates are used in the management of bone diseases such
as osteoporosis, Paget’s disease and bone metastasis.
• The half-life of Bisphosphonates is 10 years, therefore they continue
to affect bone metabolism even after completion of therapeutic dose
(Bartzela et al., 2009).
• Low-intensity laser therapy is a good option to
reduce treatment duration and pain.
• Low Level Laser Therapy (LLLT): Also known as cold laser, LLLT irradiation
does not increase tissue temperature by more than 1 degree C.
• It initiates a cascade of events that culminates in an increase in the cellular
metabolic processes: Osteoblastic and osteoclastic activity is increased and
collagen production is stimulated.
• For this reason, it was hypothesized that LLLT could accelerate tooth
movement during orthodontic therapy.
• Yet few papers have investigated its efficacy related to orthodontic tooth
movement, and the results are ambiguous. Some studies, including animal
models, concluded that LLLT could accelerate movement and reduce
orthodontic treatment time by up to 30%.
 corticotomy
• consists of cuts or perforations in the cortical bone, without the need
to penetrate the medullary bone.

• A recent systematic review concluded that “combining conventional

orthodontic treatment with corticotomy reduces the duration of
orthodontic treatment by accelerating tooth movement.

Fernández-Ferrer L, Montiel-Company JM, Candel-Martí E, Almerich-Silla JM, Peñarrocha-Diago M, Bellot-Arcís C.

Corticotomies as a surgical procedure to accelerate tooth movement during orthodontic treatment: A systematic
review. Med Oral Patol Oral Cir Bucal. 2016;21:e703–e712.
References
• Contemporary orthodontics,William Proffit, chapter 8
• Text book of orthodontics-G-Singh- chapter 19