6/24/2011

Biology of Orthodontic
Tooth Movement
Dr. Owais Khalid Durrani

Cellular Elements of PDL

6/24/2011

Osteoclatsts/Cementoclasts

Osteoclast

6/24/2011

Osteoblasts/Cementoblasts

Fibroblast
3

6/24/2011

Extra

Time
< 1 sec

Fibers
Cellular
VesselsElements
Nerves
Fluid

Event
PDL fluid incompressible, alveolar bone
bends, piezoelectric signal generated

Physiologic Response of a Tooth

to Force
PDL fluid expressed, tooth moves
1-2 sec
within the PDL space

3-5 sec

PDL fluid Squeezed out, tissues

compressed; immediate pain if pressure
is heavy

6/24/2011

Theories of Orthodontic
Tooth Movement
Bioelectric / Piezoelectric theory
Pressure-Tension Theory

Deformation of the crystal structure

produces a flow of electric current as
electrons are displaced from one part of the
Theory
lattice Piezoelectric
to the other
These stress generated signals are
important for maintenance of the skeleton
by skeletal regeneration and repair
Atrophy of bone in astronauts

6/24/2011

Peizoelectric Effect

++++++++
-----------

---------+++++++

Piezoelectric Effect
Quick decay rate
Production of equivalent signal opposite in direction when the force is released

C
h
a
r
g
e

Seconds

6/24/2011

Relies on chemical rather than electric signals

This theory explains the course of events
reasonably well.
Pressure-Tension Theory
Divided into following stages
1.
2.
3.
4.
5.
6.
7.

BV

Application of orthodontic force

Alterations in blood flow
Formation and release of chemical messengers
Activation of cells
Resorption/deposition of bone and cementum
Remodeling of PDL fibers
Movement of tooth

Light Continuous Force

PGs/Cytokines
Osteoclast

Osteoblast

6/24/2011

Light Continuous Force

Heavy Continuous Force

6/24/2011

Osteoporosis
Bisphosphonates
Estrogen

Drugs Effecting Orthodontic

Tooth Movement

Prostaglandin E2
Corticosteroids
NSAIDs
(Indomethacin)

Tissue
Phospholipids
Corticosteroids

X
Arachidonic
Acid

NSAIDs

X
Prostaglandin

6/24/2011

Several other drugs can reduce the PG levels

and can effect orthodontic tooth
movement
Antidepressents (tricyclic)
Antiarrythmatic (procaine)
Antimalarial (chloro/quinine)
Anticonvulsants (phenytoin)
Antibiotics (tetracyclines)

10

6/24/2011

Mobility & Pain

Deleterious
Effects
of
Effects on the
Pulp
Orthodontic
Force
Effects
on the Root Structure
Effects on Alveolar Bone

Mobility is seen in every patient due to

remodeling of fibers and alveolar bone.
Heavier Mobility
the force, more
undermining
& the
Pain
resorption more the mobility.
Heavier forces cause immediate pain.
Normal forces produce pain on pressure
after several hours and last for 2-4 days
after activation

11

6/24/2011

Mobility & Pain

Pain is due to areas of ischemic
hyalanization within the PDL
Control of pain
Light forces
Chewing gum

Allergic Reactions
Latex
Stainless steel
Nickel-Titanium

Mild pulpitis might occur which may contribute

to pain after activation, no long term effects
Heavy abrupt forces may cause severance of
Effects
onthePulp
blood vessels
as they enter
tooth
Inappropriate force direction can push the apex
out of the alveolar bone
No Effects on Endo treated teeth, CaOH only
required for traumatically intruded teeth

12

6/24/2011

Remodeling of cementum occurs with

orthodontic forces, With restoration of
root anatomy
Effects
on Root
Structure
Root
loss occurs
primarily
at the apex,
once a chunk of the cementum /dentin is
removed completely that portion of the
root will not heal.
Moderate generalized resorption is a
norm, most root loss occurs in max
incisors

Severe generalized resorption is rare

Cause unknown
High
risk Patients;
Effects
on Root Structure
History of resorption
Conical & Dilacerated roots
History of trauma are high risk factors

13

6/24/2011

Effects on Alveolar bone

0.5-1mm crestal bone height loss
Position of the teeth determines the
position of the alveolar bone

Erupting teeth
Enucleation
Extrusion
Intrusion

Next Lecture
Basics of
Biomechanics

14