Chapter -07 Orthodontic Tooth Movement

By Dr Danesh Kumar – JSMU (03312415069)

Periodontal and Bone Response to Normal Function
▪ Orthodontic movement of teeth is based on the observation that if
prolonged light pressure is applied to a tooth, tooth movement will occur
as the bone around the tooth remodels.
▪ Bone is selectively removed in some areas and added in others.
▪ In essence, the tooth moves through the bone carrying its attachment
apparatus with it, as the socket of the tooth migrates.
▪ Because the bony response is mediated by the periodontal ligament (PDL),
tooth movement is primarily a PDL phenomenon.
▪ Forces applied to the teeth can also affect the pattern of bone apposition
and resorption at sites distant from the teeth, particularly the sutures of
the maxilla and bony surfaces on both sides of TMJ.
▪ Biologic response to orthodontic therapy includes not only the response of
the PDL but also the response of growing areas distant from the dentition.
Periodontal Ligament Structure and Function
▪ Each tooth is attached to and separated from the adjacent alveolar bone by
a heavy collagenous supporting structure= PDL.
▪ PDL occupies a space approximately 0.5 mm in width.

(Diagrammatic representation of periodontal structures)

▪ Components of PDL:
1) PDL cellular element
2) Nerve fibers – proprioception
3) Blood supply
4) Collagen fibers
5) PDL fluid

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 1

 ▪ Major component of the ligament is a network of parallel collagenous
fibers, inserting into cementum of the root surface on one side and into a
relatively dense bony plate, the lamina dura, on the other side.
▪ These supporting fibers run at an angle, attaching farther apically on the
tooth than on the adjacent alveolar bone.
▪ The principal cellular elements in the PDL are undifferentiated
mesenchymal cells and their progeny in the form of fibroblasts and
osteoblasts.
▪ The collagen of the ligament is constantly being remodeled and renewed
during normal function.
▪ Fibroblasts in the PDL have properties similar to those of osteoblasts, and
new alveolar bone probably is formed by osteoblasts.
▪ PDL is not highly vascular, it does contain blood vessels and cells from the
vascular system.
▪ Nerve endings are also found within the ligament, both the unmyelinated
free endings associated with perception of pain and the more complex
receptors associated with pressure and positional information
(proprioception).
▪ PDL space is filled with fluid. This fluid is the same as that found in all other
tissues, ultimately derived from the vascular system. A fluid-filled chamber
with retentive but porous walls is a description of a shock absorber, and in
normal function the fluid allows the PDL space to play just this role.

Principles of Tooth Movement:

▪ When pressure is applied, tooth movement occurs as the Bone around the
tooth remolded.
▪ Tooth Movement through PDL as the socket of tooth migrate.
▪ Tooth Movement= PDL phenomenon with light & continuous force.

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 2

Normal Functional response:
▪ During masticatory function, the teeth and periodontal structures are
subjected to intermittent heavy forces.
▪ Tooth contacts last for 1 second or less; forces are quite heavy, ranging
from 1 or 2 kg while soft substances are being chewed to as much as 50 kg
against a more resistant object, PDL space is prevented by the
incompressible tissue fluid.
▪ The body of the mandible bends as the mouth is opened and closed, even
without heavy masticatory loads. On wide opening, the distance between
the mandibular molars decreases by 2 to 3 mm.
▪ Bone bending in response to normal function generates piezoelectric
currents that appear to be an important stimulus to skeletal regeneration
and repair.

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 3

Bone remodelling
▪ Bone is a dynamic tissue, with resorption and deposition continually
occurring and being closely linked and regulated. This process produces
remodelling of the skeleton, in simple terms by osteoblastic deposition and
osteoclastic resorption.
▪ However, the situation is complex and in addition to their direct role in
bony deposition, several osteoblastic responses have been identified that
indirectly facilitate osteoclastic resorption.

▪ Osteoblasts lining the bone represent a physical barrier to resorption and

their retraction provides access for bone-resorbing osteoclasts;
▪ Osteoblasts remove unmineralized collagen or osteoid that lines the bone
surface, which also acts as a physical barrier to osteoclasts; and
▪ Osteoblasts release a soluble activating factor, which has a direct action on
osteoclasts.
Role of the PDL in Eruption & Stabilization of the Teeth:
▪ The phenomenon of tooth eruption makes it plain that forces generated
within the PDL itself can produce tooth movement.
▪ Produce not only eruption of the teeth under appropriate circumstances
but also active stabilization of the teeth against prolonged forces of light
magnitude.

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 4

 ▪ Active stabilization also implies a threshold for orthodontic force, because
forces below the stabilization level would be expected to be ineffective.
▪ Resting pressure from lips , cheeks, & tongue is not equal.
▪ In mandible, anterior tongue pressure is greater than lip pressure.
▪ In maxilla, anterior lip pressure is high.

Frontal Resorption:
▪ When light forces are applied to the tooth, blood flow in partially occluded
on the pressure side in the PDL, cellular activity begins within the
compressed area tooth movement occur as osteoblast or osteoclast remold
bony socket.
▪ It’s usually painless or little pain.
▪ Smooth progression of tooth movement.
▪ Good
Undermining Resorption:
▪ When heavy forces applied blood flow cut off to the compressed area and
cell death occur so cellular differentiation or osteoclast appear within the
adjacent Marrow space and begin to attack on outside of the necrosis area.
▪ Painful
▪ Bad
▪ Stepwise fashion of tooth movement
Theories of Tooth Movement;
1) Piezoelectric Theory:
▪ When pressure is applied this generate electric signals that alters bone
metabolism due to applied force, crystal structure of bone are deformed so

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 5

 that the electron move from one location to another so the electric current
flow is observed.
▪ Quick decay rate.
▪ When force is released, the crystal structure returns to it’s original shape so
it means production of equivalent signals but opposite in direction.

2)Pressure Tension Theory:

▪ It relies on chemical signals rather than electrical signals as stimulus for
cellular differentiation tooth movement .
▪ Sustained pressure against a tooth causes the tooth to shift position within
the PDL space, compressing the ligament in some areas while stretching it
in others.

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 6

 Compression Side Pressure Side
Decreased blood flow Increased blood flow
Decreased O2 levels Increased O2 levels
Increased CO2 levels Decreased CO2 levels
Osteoclasts activity Osteoblasts activity
Bone resorption site Bone remodeling
▪ So in this theory, tooth movement shows 03 stages:
▪ Initial compression of tissues & alterations in blood flow.
▪ The release of chemical messengers.
▪ Activation of cells.

Effects of Force:
▪ If appliance work less than 4-6 hours/ day, it will produce no orthodontic
effects, the threshold for force duration is 4-8 hours.
▪ Prostaglandins E (PgE) is an important moderator of cellular response.
▪ Concentration of RANKL & osteoprotegron (OPG) in gingival cervicular fluid
increase during tooth movement.
▪ Prostaglandins have ability to stimulate osteoclast & osteoblasts cells.
▪ Heavy forces causes undermining Resorption & light & continuous force
produce frontal Resorption.
Hyalinization Area:
▪ A necrotic area, or a vascular area in PDL is called hyalinized area.
▪ It’s histological appearance & cause delay in tooth movement.

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 7

Types of tooth movement:
▪ Physiological ( eruptive, migration/ drifting, change in tooth position during
mastication).
▪ Pathological ( trauma, periodontitis, extraction)
Orthodontics Movements
Tipping:
▪ 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.
▪ When this is done, a tipping moment is created, and the tooth rotates
around its center of resistance, a point located about halfway down the
root.
▪ Center of rotation is the point around which the rotation actually occurs &
moment (F×D) is measure of tendency to rotate an object around some
point.
▪ PDL compressed near root apex & crest of alveolar bone so Force is kept
low.
▪ 02 types- controlled (Mc< 0& Mf<1) = center of rotation at apex & &
uncontrolled tipping= center of rotation is v close to center of resistance.

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 8

Bodily Movement/ Translation:
▪ If two forces are applied simultaneously to the crown of a tooth so that
there is no net tipping moment, the tooth can be moved bodily
(translated).

▪ The root apex and crown move in the same direction the same amount.
In this case, the total PDL area is loaded uniformly.
▪ More force required than tipping.

(Translation or bodily movement of a tooth requires that the periodontal

ligament space be loaded uniformly from alveolar crest to apex, creating a
rectangular loading diagram. Twice as much force applied to the crown of

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 9

 the tooth would be required to produce the same pressure within the
periodontal ligament for bodily movement as compared with tipping.)
Rotation:
▪ When the tooth rotate around it’s long axis in this situation, some tipping
Movement also occurs equal & opposite force is required.
▪ Forces to produce rotation of a tooth around its long axis could be much
larger than those to produce other tooth movement.

Extrusion:
▪ When the tooth moves in occlusal direction.
▪ Migration of tooth away from the apical area, some sort of tipping also
occurs,both required equal force.

Intrusion:
▪ The tooth submerged into bone.
▪ Tooth move towards apical area.
▪ Light force are required.
▪ When a tooth is intruded, the force is concentrated over a small area at the
apex.

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 10

Root uprighting:
▪ Mesio distal movement particularly of root .
▪ Irequire application of force couple to the crown in such a way that the
fulcrum lies within the crown.

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 11

Center of Resistance:
▪ A point at which resistance to Movement can be concentrated for
mathematical analysis.
▪ Factors affecting center of resistance ( number of roots, degree of alveolar
bone loss, degree of root resorption.)
Center of rotation:
▪ The point around which rotation actually occurs when an object is moved.
Orthodontics Forces;
▪ According to magnitude – heavy & light forces
▪ According to duration – continuous , interrupted & intermittent
Continuous force:
▪ Force maintained at some fraction of original from one patient visit to next.
▪ Light continuous forces are good but heavy continuous forces are quiet
destructive.
▪ Example – fixed appliances, springs
Interrupted Forces:
▪ Forces decline to zero between activation.
▪ Examples – fixed appliances
Intermittent forces-
▪ Forces level abruptly to zero intermittently.
▪ Example – removable appliances, headgear, elastics

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 12

Drugs Effect in Orthodontics:
Drugs increase tooth movement Drugs decrease tooth movement
Prostaglandins Prostaglandins inhibitors/ indo
methacin
Relaxin Corticosteroids
Vitamin D NSAID
Bisphosphonates
TCA- doxepin
Anti arrhythmic drugs- procaine
Anti malarial
Anti convulsants – phenytoin
Consequences of Orthodontics Forces:
▪ Tooth mobility= in response to orthodontic force because of PDL space
widening & disorganization of ligaments.
▪ Pain = due to heavy pressure, hyalinized area in PDL & mild pulpitis, Pain
last for 2-4 days ,Acetaminophen for orthodontic pain relief.
▪ Root Resorption—most common in maxillary Incisors.
▪ Allergic reaction – due to appliances mostly by Ni-Ti, erythema & swelling
develop within 1-2 days, alternative= Titanium
▪ Alveolar bone loss- between 0.5-1

Orthodontics Notes by Dr Danesh Kumar – JSMU (03312415069) 13