Biologic Basis Tooth Movement-Ortho / Orthodontic Courses by Indian Dental Academy

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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
Biologic basis of Orthodontic Treatment
Biologic basis of Orthodontic Treatment
State of equilibrium
Classification of Orthodontic Forces
Theories of Tooth Movement
Types of Orthodontic tooth movement
Orthopedic effects of Forces
Iatrogenic effects of Orthodontic forces
Why do teeth not move under normal circumstances?

--- Equilibrium theory, which states that the forces
from the extraoral and the intraoral areas balance
each other, aided additionally by the periodontium.
THE BASIS OF ORTHODONTIC TOOTH MOVEMENT

ORTHODONTIC TREATMENT IS BASED ON THE PRINCIPLE
THAT IF PROLONGED PRESSURE IS APPLIED TO A TOOTH,
TOOTH MOVEMENT WILL OCCUR AS THE BONE REMODELS.

BONE IS SELECTIVELY REMOVED IN SOME AREAS AND
ADDED IN OTHERS.

THE TOOTH MOVES THROUGH THE BONE CARRYING
ITS ATTACHMENT APPARATUS WITH IT,AS THE
SOCKET OF THE TOOTH MIGRATES.
THIS BONY RESPONSE IS MEDIATED BY THE
PERIODONTAL LIGAMENT, TOOTH MOVEMENT IS
PRIMARILY A PERIODONTAL PHENOMENON.

Forces applied to the teeth can also affect the pattern of
bone apposition and resorption at sites distant from the
teeth, viz sutures of the maxilla and bony surfaces of the
TMJ

Thus, the biologic response to orthodontic treatment
includes not only the response of the PDL, but also the
growing areas distant from the dentition.
Theories of tooth movement
Pressure-tension theory
Piezo-electric theory
Pressure-tension theory: This is the most accepted
theory. According to this theory, whenever
pressure and tension zones exist, chemical
messengers are released which will bring about
recruitment of osteoblasts and osteoclasts
Pressure-tension theory: Can be divided into
three overlapping stages which include
a) Alterations in Blood flow associated with
pressure
b) Formation and /or release of chemical mediators
c) Activation of cells
Alterations in Blood flow associated with pressure
a) Increasing pressure on the tooth results in
reduction of blood flow.
If the force application continues, a zone of sterile
necrosis results Zone of Hyalinization
The second stage involves the release of chemical
messengers
--- Primary messengers: Cytokines, Prostaglandins

---- Secondary messengers: Cyclic AMP

Prostaglandin E2 has the property of stimulating both
osteoblastic as well as osteoclastic activity
After a delay of several days, cellular elements
from adjacent undamaged areas of PDL begin to
invade the necrosed area.
Osteoclasts appear within adjacent bone marrow
Spaces & begin an attack on the underside of the
Bone immediately adjacent to PDLundermining
Resorption, since the attack is from the underside
Of lamina dura.
These osteoclasts arrive in two waves
-First wave-derived from local cell population
-Larger second wave-are brought in from distant
Areas via blood flow. These cells attack the adjacent
lamina dura removing bone in the process of
Frontal resorption.
Tooth movement begins thereafter.At the same
time,osteoblasts recruited from PDL form bone on
the tension side & begin remodeling activity.

Two types of resorption patterns are seen
whenever forces are applied to move teeth.
a) Frontal Resorption
b) Undermining resorption
a) Frontal Resorption: This is a favourable resorption
pattern which depends on:
-- Magnitude of force
-- Duration of force
In this type of resorption, Howship lacunae are seen
adjacent to the PDL in the frontal aspect of the
lamina dura.

b) Undermining resorption : This is a resorption
pattern seen whenever heavy forces are applied,
which compress the PDL beyond half its original
size.
Due to obstruction of the blood flow, osteoclasts
cannot be recruited onto the frontal aspect of the
lamina dura.
b) Undermining resorption :
Instead, a resorption wave is initiated from the
underside of the Lamina dura known as
Undermining resorption
Responsible for jumpy pattern of tooth movement,
often seen with fixed appliances
The Piezo-electric theory
According to this theory, whenever stresses are
applied to bone, it deforms and bends.
Charges are produced on the inside and outside,
which stimulate either deposition or resorption
The Piezo-electric theory
Limitations:
a) Does not explain how the chemical mediators act
b) Piezo-electricity exists only for a short period.
Classification of Orthodontic forces
According to Schwarz :
a) First degree of efficiency:These are forces lower
than the threshold of stimulation to activate
Orthodontic tooth movement.
---Short duration and low force balanced by the
compensatory mechanisms
c) Third degree of Efficiency: The forces in this
category tend to interrupt circulation in the PDL
(20-50 gm/sq.cm)
b) Second degree of efficiency:This refers to force
levels most effective in achieving Orthodontic
tooth movement. (Optimum Orhtodontic force).
Characterised by low but continuous forces
(roughly 15-20 gm/sq.cm over the compressed
PDL)
d) Fourth degree of Efficiency: The force levels in
this group are so excessive that they crush the
PDL between the tooth and the alveolar bone in
the areas of pressure. If continuous, they can
cause extensive, irreparable damage.
According to Proffitt :
a) Continuous Forces
b) Interrupted forces
c) Intermittent forces
Factors affecting tooth movement

a) Age of the patient and in turn, the viability of
supporting structures
b) Magnitude, duration and type of forces applied
c) Chemical agents action of certain drugs
THE ORTHODONTIC FORCE DURATION IS CLASSIFIED-

1) CONTINUOUS

2 ) INTERRUPTED-

3 ) INTERMITTENT-

Continuous and interrupted forces are produced by Fixed
appliances, while the intermittent forces are produced by
removable appliances

Factors affecting tooth movement

a) Age of the patient and in turn, the viability of
supporting structures
b) Magnitude, duration and type of forces applied
c) Chemical agents

Types of Orthodontic tooth movement

a) Tipping
b) Translation (Sagittal)
c) Intrusion
d) Extrusion
e) Rotation
EFFECTS OF FORCE MAGNITUDE

THE HEAVIER THE SUSTAINED PRESSURE,GREATER
SHOULD BE THE REDUCTION IN BLOOD FLOW THROUGH
COMPRESSED AREAS OF PDL,VESSELS ARE TOTALLY
COLLAPSED NO FURTHER BLOOD FLOWS.

WHEN LIGHT BUT PROLONGED FORCE IS APPLIED-
Blood flow decreases
Partially compressed PDL
Tooth moves in the socket

Harmful effects of Orthodontic Forces
Heavy forces often result in extensive damage to the PDL
as well as root surfaces.

a) Crushing of the PDL causing pain as well as mobility
b) Reversible resorption of bone
c) Apical Root Resorption

Orthopedic forces and their effects
a) On the maxilla Maxillary growth stimulation
or restraint is facilitated because of the presence of sutures
in the naso-maxillary complex.

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