BIOLOGY OF TOOTH

MOVEMENTS

Siti Syazwani Fickry binti Fickry

101323028
Syarifah Nuratiqah binti Syed
Abdul Halim
101323029
 Learning Objectives

Explain the different types of tooth

movement.

Explain the periodontal tissues and bone

response to orthodontic forces.
 Physiologic
Orthodontic
Types

Blood flow
Pressure tension
Mechani Piezoelectric
sm

Biologic control of tooth movement

Effects of force magnitude
Effects of force ditribution and types of tooth movement
Respons Efffects of force duration and force decay
e Drug effects on the response to orthodontic force
 Types of Tooth Movements

Physiologi Orthodon
c tic

Frontal
Tooth
eruption

Undermini
Migration or ng
drift of teeth
Changes in
tooth position
during
mastication
 Physiologic
Axial or occlusal movement of the tooth from its
Tooth eruption developmental position within the jaw to its functional
position in the occlusal plane

Teeth have the ability to drift through the alveolar

bone
Migration Human teeth have a tendency to migrate in mesial
or drift of
or occlusal direction
teeth
This maintains the inter-proximal and occlusal
contact
Aided by bone resorption and deposition by
osteoclasts and osteoblasts respectively
Normal force of mastication 1 to 50 kg
It occurs in cycles of 1 second duration
Changes
in tooth Teeth exhibit slight movement within the socket
position and return to their original position on withdrawal
during of the force
masticati Whenever the force is sustained for more than 1
on second, periodontal fluid is squeezed out & pain is
felt as the tooth is displaced within the periodontal
 Orthodontic
Accomplished by light orthodontic forces
Least painful
Frontal Least harmful to the periodontium
Most desirable

Caused by heavy orthodontic forces

Painful
Underminin More harmful to the periodontium
g Occurs in a small scale even in the most
careful orthodontic treatment
The dentist should always try to
minimize this
 Phase Of Tooth Movement
INITIAL PHASE:
Rapid tooth movement
over a short distance
and then stops.
Represents
displacement of the
tooth in PDL space
Bending of alveolar
bone
Light and heavy
displace the tooth to
LAG PHASE: the same extent
Little or no tooth movement 0.4- 0.9 mm in 1 week
Formation of hyalinized tissue in pdl
Depends on the amount of force used to move the tooth Light force: area of
hyalinization is small and frontal resorption occurs. Heavy force: area of
hyalinization is large
2-3 weeks
POST LAG PHASE:
Hyalinized zone is removed and bone undergoes resorption rapid
movement
Osteoclasts are found over a large area resulting in direct resorption of
bony surface facing the periodontal ligament.
Mechanisms of Tooth Movements

Pressure
Tension
Blood Theory
Flow
Theory

Piezoelec
tric
Theory
 1. Pressure Tension Theory
Openheim in 1991 & Scharwz (1932) as the author

Whenever a tooth is subjected to an orthodontic

force, it results in areas of pressure and tension

Areas of
pressure =
RESORPTION
Areas of
tension =
DEPOSITION
 2. Blood Flow Theory
Bien

Tooth movement occurs as the result of alterations in fluid dynamics in

the periodontal ligament

Periodontal space contains a fluid system: interstitial fluid, cellular

elements, blood vessels and viscous ground substance

Passage of fluid in and out of this space is limited

Hydrodynamic condition resembling hydraulic mechanism and shock

absorber

Force is removed: Fluid replenish by diffusion from capillary walls and

recirculation of interstitial fluid

Force applied in short period of time: Fluid replenish as soon as force is

removed

Force with greater magnitude: squeeze film effect interstitial fluid

squeezed out and moves towards the apex and cervical margins and
results in decreased tooth movement
 Periodontal Blood
Orthodontic
ligament vessels
force
compression entrapment

Compressed
area has
decreased Aneurysm Stenosis
oxygen level

Favourable
environment Bone
for resorption
resorption
 3. Bone Bending And
Pizoelectric Theories Of Tooth
Movement
Farrar (1876)

Suggest that bone bending maybe a possible

mechanism for bringing about tooth movement

Pizoelectricity is a phenomenon in which a

deformation of the crystal structure produces a
flow of electric current as a result of displacement
of electrons from one part of the crystal lattice to
the other

A small electric current is generated when bone is

mechanically deformed
 Collagen Hydroxyapetite
In bone, collagen exists in Crystalline in form
a crystallized state

Source of
electric
Collagen-hydroxyapetite Mucopolysaccharide
interface fraction of ground
The junction between substance
the collagen and Not crystalline but may
hydroxyapetite crystals possess the ability to
when bent can be source generate current
of pizoelectricity
Crystal structure
deformed

Electrons migrate
from one location
to another

Electric charge
produced

Force released

Crystal returns to
original shape

Reverse flow of
current
Pizoelectric unique characteristics:

1. Quick decay rate: when force is applied, pizoelectric

signal is produced. The electric charge quickly dies
away to zero even though force is maintained

2. Force is released, a reverse electron flow is observed

ORTHODONTIC FORCE

_ + _
+ _
_
_ + _
+ _
+ _ +
_ + _
+ _
+ _ +
_ + _
+
+ +
 Biophysical reactions
Bone deformation
Compression of periodontal
ligament
Tissue injury

Production of first
messenger

on
Inflammati
Hormone(eg; PTH)
Prostaglandins
Neurotransmitter (substance P,
VIP)
Pizoelectric

Bind to receptor of target

responsses

cells
Production of second
messenger
cAMP, cGMP, Calcium

collagenase
of
Activation
+ve Increase in cells of
Resorption
-ve Increase in cells of
Deposition

Bone remodelling
Bone deposition
Happens on the tension side

Bloo X X
d
vess X X
el

X X

X X
 Stages of Bone Formation

New bone
Lightly calcified
Osteoid Deeper layers
undergoes
calcification

Fibres of
Bundle periodontal
bone ligament
attached

Mature
Lamellat Reorganizat
ion to
ed bone lamellated
bone
 Bone resorption
Osteoclasts: multinucleated giant cells

Howships lacunae

Derived from:
Activation of previously
Present inactive osteoclasts
Migration from adjacent
bone
Formation of new osteoclasts from local
macrophage of periodontal ligament
Influx of monocytes from blood vessels
 Degradatio
Organic acids: n of matrix Transport of
citric acid, lactid soluble products
acid and H+ Activation of to extracellular
Increase Cathepsin B-1 fluid or blood
(lysosomal acid vascular system
solubility of
protease)
hydroxyapetite
Decalcificat
Transport
ion
 Response of Periodontal
Tissues & Bone to Orthodontic
Force
1. Biologic control of tooth movement

2. Effects of force magnitude

3. Effects of force ditribution and types of

tooth movement

4. Efffects of force duration and force decay

5. Drug effects on the response to

orthodontic force
Bioelectric Theory
1. Biologic control of tooth
movement
Alveolar bone flexes and
bends

Ions in the fluids that Electric signals

bathe living bone

Conduction and Temperature changes

convection electric
signals

Distortion of
crystalline structure

Producing force
That leads to movement
Pressure-Tension Theory
Sustain Release
ed Celllul of Tooth
ar chemical
pressu changes messeng moveme
nt
re ers

Tooth
Compre Alteratio
shiftin ns in Activati
ss and
g in blood on of
stretch cells
PDL flow
PDL
space
 2. Effects Of Force Magnitude

Continuou No pressure
Normal perfusion of blood vessels

s Light
Force
Continuou
s Heavy
Force
Application Of Continuous Light Force

<1
PDL fluid is incompressible, alveolar bone bends,
second piezoelectric signal generated
:

13
PDL fluid expressed & tooth moves within the
seconds socket
:

35 Blood vessels within PDL partially compressed on

second pressure side & dilated on tension side. PDL fibers
s: and cells are mechanically distorted

Minute Blood flow altered & oxygen tension begins to

26
s: change. Prostaglandins and cytokines released

JM
 Tension side
Fibers stretched
& Vessels open
wide

Metabolic changes ocures. Chemical

Hour
messengers affects cellular activity.
s: Enzyme levels change
4 Increased cAMP levels are detectable
Hour & cellular differentiation begins
s: within PDL

:
2
Days
Tooth movement begins as
osteoclasts & osteoblasts remodel
bony socket JM
27
Result of Continuous Light Force

The osteoclasts arrive in 2 waves

wave (larger) from

wave derived from distant areas via
the PDL itself blood flow

FRONTAL
RESORPTION
JM
28
Application of Continuous Heavy Force
PDL fluid is PDL fluid Blood

1 3 seconds

3 5 seconds
< 1 second
incompressi expressed & vessels with
ble, alveolar tooth moves in PDL
bone bends, within the occlude on
piezoelectri socket the pressure
c signal side
generated

JM
29
 Minutes Hours 3 5 Days 7 14 Days

Blood flow Cell death Cell Underminin

gets cut off in differentiati g
to compresse on in resorption
compresse d area adjacent removes
d PDL area marrow lamina dura
spaces; adjacent to
underminin compresse
g d PDL &
resorption tooth
begins movement
occurs
Compressed PDL
after Sterile Necrosis

JM
30
 3. Effects Of Force
Distribution And Types Of
Tooth Movement
Optimum level of orthodontic force Should be just
high enough to stimulate cellular activity without
completely occluding blood vessels
PDL will response as long as pressure is applied.

Single force is applied against a crown

of tooth.
Tooth rotates around its center of
rotation compressing PDL near the
rooth apex.
Minimum pressure at the center of
resistance.
TIPPING
As pressure is applied, the distribution
covers half of the PDL area, therefore
force applied must be little.
 Root apex and crown move in the same
direction and same amount

total PDL area is loaded uniformly

require twice as much force compared

BODILY MOVEMENT
to tipping
 Can be successfully achieved if
very light forces are applied to
teeth

INTRUSION

Produce no area of compression

against PDL, only tension.
Should be about the same magnitude
as those for tipping

EXTRUSION
 4. Effects Of Force Duration And Force
Decay

SUSTAINE ORTHODONTIC
D TOOH MOVEMENTS
FORCE

Force must be present for a

considerable percentage of
time, not necessarily
continuously
required to produce second
messengers needed to
stimulate cellular
differentiation
CONTINUOUS INTERRUPTED INTERMITTENT
CONTINUOUS
INTERRUPTED
INTERMITTENT
5. Drug Effects On The Response
To Orthodontic Force

Enhan
Inhibit
ce TRICYCLIC ANTIDEPRESSANTS
Vitamin D
ANTIARRYTHMIC AGENTS
administration
ANTIMALARIAL DRUGS

TETRACYCLINES
Direct injection of
Prostaglandin into BISPHOSPHONATES
PDL
PROSTAGLADIN INHIBITORS
Synthesis of Prostaglandins

CORTICO
NSAIDS
-STEROIDS

PHOSPHO- ARACHIDONIC PROSTAGLADIN

LIPIDS ACID S

39
Pain killers Do they Inhibit OTM ?

Common analgesics used during treatment

IBUPROFEN
NSAIDS
ASPIRIN
At the dose level they do not impede
tooth movement
Acetaminophen is a better option
centrally acting agent

40
does not reduce inflammation