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Suzan sahana
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Contents
MAJOR TYPES OF TOOTH MOVEMENT 1. Physiologic

Pattern of tooth movement

Periodontal & bone response to normal function 2. 3. Pathologic tooth Migration Orthodontic Periodontal & bone response to orthodontic forces

Theories of tooth movement

Phases of tooth movement Deleterious effects of orthodontic force
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Contents
MECHANICS OF TOOTH MOVEMENT
Principles of biomechanics Types of forces Effects of force magnitude, duration, distribution and force decay
GENERAL PRINCIPLES OF TOOTH MOVEMENT

Anchorage in Orthodontics

Age factor in tooth movement

CONCLUSION REFERENCES
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Physiologic tooth movement

These are naturally occurring tooth movements.
Tooth eruption
Changes in tooth position during function/mastiction Migration or drift of teeth:
Stein & Weinmann (1965) -- molars migrate in a mesial direction Bjork in 1925 described migration of erupting teeth in radiographic studies. They demonstrated that the socket moves as the tooth moves. Although movement is in a single direction remodeling occurs all throughout.
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Physiologic tooth movement

Eruption : Part of the total pattern of physiologic tooth movement. Consists of the following:
Preeruptive tooth movement
Eruptive tooth movement

Posteruptive tooth movement

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Pattern of tooth movement

Physiologic tooth movement

Preeruptive tooth movement:

Histology: whether it involves drifting or growth of the tooth germ, demands remodelling of the bony wall of the crypt that is achieved by selective deposn & removal of bone by osteoblastic & osteoclastic activity.
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Physiologic tooth movement

Permanent molars

Physiologic tooth movement

Eruptive tooth movement:

Tooth moves from its position within the jaw to its functional position in occlusion.
Principal direction of movement axial/ occlusal

FORCES of Tooth Eruption

Root Formation
Bone Remodeling and Dental Follicle Periodontal Ligament

Mechanisms of eruptive tooth movement

Root elongation theory suggests that teeth erupt as a

result of root pushing against

an immovable base (disproved by Marks & Cahill by their work on rootless teeth which erupted by

compensatory bone growth)

Mechanisms of eruptive tooth movement

Periodontal ligament theory suggests the impetus for tooth eruption was derived from the developing periodontal ligament. Moxham & Berkovitz showed that root transection failed to prevent the tooth erupting. This strongly implicates the PDL effect.
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Mechanisms of eruptive tooth movement

Bone remodeling
Apposition & resorption of bone Evidence: when devping tooth is removed without disturbing dental follicle eruptive pathway forms within bone
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dental follicle
1974,1980,1983,1987

Mechanisms of eruptive tooth movement

Control resorption and formation of bone around tooth germ: Cahill & Mark
no dental follicle, no eruption

PDL , alveolar bone and cementum are derivative of Dental Follicle

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Molecular biology of Bone Remodeling

Tooth movement- balance b/w tissue destruction & formn

Influx of monocytes at the onset of eruption

appearance of osteoclasts signaling molecules

Conclusion of FORCES of Tooth Eruption

Multifactorial

(However, Dental Follicle Activity & Bone Remodeling have the Highest Potential)
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Post eruptive tooth movement

Made by the tooth after it has reached its functional position in occlusal plane 3 categories:

i.

Movements to accommodate growing jaws

ii. Those to compensate continued occlusal wear

iii. Those to accommodate interproximal wear

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Accommodation for growth

Readjustment of the position of tooth socket achieved by formn of new bone at alveolar crest & on socket floor. Occurs b/w of 14 & 18 yrs. Apices of teeth move 2-3 mm away from Inf. Dental canal.

Post eruptive tooth movement

Earlier in girls

Post eruptive tooth movement

Compensation for occlusal wear:

Axial movement that a tooth makes to compensate for occlusal wear.
Deposition of cementum at the tooth apex.

Post eruptive tooth movement

Accommodation for interproximal wear:

Compensated by mesial drift

Forces causing mesial drift:

Anterior component of occlusal force Contraction of transseptal ligament Soft tissue pressures

Anterior component of occlusal force

Anterior force- result of mesial inclination of most

Mesial drift

teeth & summation of intercuspal planes.

Billiard ball analogy

Contraction of transseptal ligament

Fibres of PDL draw neighboring teeth close together & maintain them in contact

Mesial drift

Mesial drift is achieved by a contractile Supporting evidence: mechanism associated with transeptal Relapse of orthodontically fibres & enhanced by occlusal forces

moved teeth is reduced if a gingivectomy removing transeptal ligament is perfomed

Soft tissue pressures

Pressures generated by cheeks & tongue may push teeth mesially.

Mesial drift

When such pressures eliminated by constructing acrylic dome over teeth mesial drift occurs.
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Normal forces that affect tooth position & stabilization:

Natural forces generated by muscles
Tooth size & general shape of arches

Primary & residual eruption forces of each tooth

Combined mesial vector of force

Inclination of cusps & occlusal tables

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Natural forces generated by muscles

Forming an envelope of forces surrounding the developing bones of the jaw & face

Muscles of the lips, cheeks, tongue & mastication forms functional matrix of soft tissue

Tooth size & general shape of arches

Harmony b/w tooth size & arch length teeth size--- crowding teeth size--- spacing Tooth shape Peg laterals spacing & migration of teeth

 Serves to keep teeth in normal alignment & allows wear & abrasion to occur

Primary & residual eruption forces of each tooth

In some cases, may result in supraeruption.

Class II

Combined mesial vector of force

The pronounced tendency toward mesial drifting of teeth in both the arches Some rules it seems to follow (Moyers) 1. Mesial vector of force is not strongly present until after

the first perm. Molars erupt.

2. Mesial vector is present only if all teeth in arch are in contact mesial to I perm. Molar. 3. If interproximal contact of teeth is lost, the vector only acts mesially through the area of II bicuspid. In the area of

I bicuspid & cuspid, the vector may act distally

When II primary molar is lost prematurely

Impetus for distal drift : force from active contraction of transeptal fibers in the gingiva pressures from lips & cheeks
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Inclination of cusps & occlusal tables

Deeper the occlusal
table, the more likely teeth will remain in the

same locked position.

Ectopic eruption
abnormal eruption of a

permanent tooth, which is both out of position and causing abnormal root resorption of a primary tooth
May be due to genetic or environmental causes. Most common positional aberration: Upper I perm molar Lower lateral incisor
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Deviation of dental midline in the direction of least resistance

Arrow Rule

Ugly duckling stage

Periodontal and bone response to normal function ( mastication)

PDL space filled with fluid that is derived from vascular system
Fluid filled chamber acts as shock absorber

Physiologic response to heavy pressure against a tooth

During masticatory function-- teeth & periodontal structures subjected to Intermittent heavy forces TIME (seconds) <1 EVENTS PDL fluid is incompressible, alveolar bone bends, piezoelectric signal generated

1-2
3-5

PDL fluid expressed, tooth moves within PDL space.

PDL fluid squeezed out, tissues compressed Immediate pain if pressure is heavy
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Pathologic tooth migration

Refers to tooth displacement that results from the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease. Pathogenesis: health & normal height of periodontium forces exerted on teeth
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Changes in the forces exerted on teeth:

Unreplaced missing teeth Failure to replace I molars:

Pathologic tooth migration

2nd & 3rd molars tilt

premolars move distally, mn incisors tilt lingually

ant. Overbite increased

mx incsors pushed labially & laterally Other causes

TFO
Pressure from tongue Pressure from granulation tissue of 1 periodontal pockets

Orthodontic tooth movement

Orthodontics is based on the

principle that if prolonged

force is applied to a tooth, tooth movement will occur. The force creates pressure that causes the bone around

the tooth to remodel

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Periodontal and bone response to orthodontic force

Heavy force lead to
Rapidly developing pain Necrosis of cellular elements within PDL Undermining resorption of alveolar bone.

Lighter forces are compatible with: Survival of cells within the PDL Remodelling of tooth socket by frontal resorption.

Theories of tooth movement

Pressure tension theory Blood flow theory The piezoelectric theory

Pressure tension theory

(Schwarz 1932)

Acc. To schwarz, when a tooth is subjected to an orthodontic force, it results in areas of pressure and tension
Areas of pressure resorption Areas of tension deposition bone bone
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Fluid dynamic theory

Blood flow theory by Bien (1966).
PDL space is a fluid system acc. to this theory. An alteration in blood flow within PDL space causes tooth to shift position, compressing the ligament in some areas while stretching it in others.

Blood flow where PDL is compressed

where PDL is under tension
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Fluid dynamic theory

Alterations in blood flow create changes in chemical environment. Oxygen levels fall in compressed area but increase on tension side
Blood vessels of PDL get trapped b/w principal fibers Anuerysms & vascular stenosis

Favourable local environment for resorption

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Bone bending & piezoelectric theory of tooth movement

Faraar (1876) noted deformation or bending of interseptal alveolar walls. Electric signals are produced when the alveolar bone

bends or flexes.
Piezoelectricity is a phenomenon of a crystalline

material which when deformed produces a a flow of

electric current due to the displacement of electrons from one crystal lattice to another.
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 Sources
Hydroxyapatite Collagen

Collagen-hydroxyapatite interface
Mucopolysaccaride fraction of ground substance

Properties
Quick decay

Equivalent and opposite in direction

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Phases of Tooth movement (Burstone)

Initial phase
Very rapid tooth movement Short distance Bending of bone

Lag phase
Little / no tooth movement Hyalinization

Post lag phase

Rapid tooth movement
1 Direct resorption seen over large areas of bone

Biochemical reaction to orthodontic tooth movement

Biomechanics
Mechanics: branch of engineering science that describes the effect of force on a body. Every body continues in its state of rest or of uniform motion in a straight line, unless it is compelled to change that state by forces impressed on it (Sir Isaac Newton) & teeth are no exception.
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Fundamental mechanical concepts

Center of resistance: Equivalent balance point for restraint bodies.
Defined as that point on tooth when a single force is passed through it, would bring about its translation along the line of action of the force.
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In free space

Fundamental mechanical concepts

Force actions applied to bodies A vector having both magnitude & direction Units: newton or gram mm/sec2 Common means of producing orthodontic forces: deflection of wires activation of springs

elastics

Force systems
Biological effect = magnitude + frequency + Direction + constancy + range of activation + functional modification
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Effects of force magnitude

When light force is applied Blood flow through PDL Within few hrs change in chemical environment produces a diff pattern of cellular activity Levels of cyclic AMP appears after 4 hrs This correlates well with the human response to removable appliances
If a removable appliance worn less than 4-6 hrs per day, no Orthodontic effects produced Above this duration threshold, movement does occur 1

Effects of force magnitude

When forces applied are within physiological limits
Monocytes within PDL area are stimulated to form osteoclasts. First appear within 36-72 hrs Osetoclasts attack adjacent lamina dura removing bone--frontal resorption Tooth movement begins
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If forces are great enough Total occlusion of blood vessels Sterile necrosis ensues Avascular areahyalinized After several days, cellular elements from other areas of PDL invade necrotic area Ie osteoclasts diff from adjacent bone marrow & attack on the underside of bone adjacent to necrotic PDL 1 area---- undermining resorption

Effects of force magnitude

When hyalinization & undermining resorption occur ---inevitable delay in tooth movement
Delay in stimulating differentiation of cells within the marrow spaces A considerable thickness of bone must be removed from underside before tooth movement begins

Effects of force distribution

Sustenance of force required for the action of the second messenger In humans effective tooth

Force duration

movement requires 4-8 hours range

Fixed appliance more effective than removable

PDL response is determined by force per unit area or pressure. 5 basic types of tooth movement: Tipping Bodily Movement Intrusion Extrusion Rotation
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Tipping
Simplest form Single force is applied against the crown of a tooth. Tipping can be of 2 types: Controlled tipping: when a tooth tips about a COR at its apex Uncontrolled tipping: movement of tooth that occurs about a CORot apical to COR. Ex: spring extending from a removable appliance Ideal force 25 to 50 gms
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Bodily movement/ translation

if the line of action of an applied force passes through the COR of a tooth, all the points on the tooth will move an equal distance in the same

direction
forces are applied simultaneously to the crown of tooth Force: 100 to 150 gms
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Intrusion
A translational type of tooth movement parallel to the long axis of the tooth in an apical direction Force: 15 to 20 gms

Extrusion
A translational type of tooth movement parallel to the long axis of the tooth in an occlusal direction Produce only areas of tension

Force: 50 to 100 gms

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Rotation
Labial or lingual movements of a tooth around its long axis Force: 50 to 100 gms

Force decay
After the tooth has moved even a short distance, the force delivered by some mechanisms may drop all the way to zero.

Orthodontic force duration classified by rate of decay

Continuous Interrupted Intermittent
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 Continuous force maintained at same appreciable fraction of the original from one patient visit to the next. Interrupted force levels decline steadily to zero b/w activations. Ex: fixed appliances Intermittent force levels decline

abruptly to zero when the orthodontic

appliance is removed by the patient. Ex: removable plates, headgear & elastics
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Orthodontic appliance not to be reactivated

more frequently than 4 weeks interval

Activating an appliance too frequently short circuits the repair process.

Anchorage
Definition: nature & degree of resistance to displacement offered by an anatomic unit for the purpose of effecting tooth movement. (Graber)

Sources of anchorage
Intraoral sources: Teeth Alveolar bone Basal jaw bone Musculature Extraoral sources: Cranium Back of the neck Facial bones
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Classification of anchorage (Moyers)

Acc. to manner of force application:

Simple anchorage
Stationary anchorage Reciprocal anchorage Acc to jaws involved: Intramaxillary Intermaxillary
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 Acc to site of anchorage:

1.
2.

Intraoral
Extraoral cervical occipetal cranial

facial
3. Muscular single/primary compound
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Acc to number of anchorage units:

multiple or reinforced

Simple anchorage
Planned resistance to a

tipping force that would

change the axial inclination of tooth/teeth serving as anchorage unit Ex: Palatally placed premolar is pushed bucally with the rest of the teeth in the dental arch as anchor units.
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Stationary Anchorage
Planned resistance to a bodily movement that would change the position of an anchorage unit with no tipping involved

Reciprocal anchorage
Planned resistance of 2 dental units to movements secured such that equal & opposite forces tends to move each unit towards a more normal occlusion Ex: Traction forces set up to close ant. Diastema Cross bite elastics
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Dental arch expansion

Muscular anchorage
Perioral musculature employed as resistance units

Ex: Use of lip bumper to distalize molars

Reinforced or multiple anchorage

More than one type of resistance unit is utilized Refers to augmentation of anchorage by various means Ex: Upper anterior inclined plane Transpalatal arch
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Deleterious effects of orthodontic forces

Effects on the pulp: transient inflammatory response
discomfort for few days

moving endo treated teeth-- feasible

Root structure: only at apex

minimal & clinically insignificant

Height of alveolar bone:

gingival inflammation never exceeds 1mm

Pain & mobility: heavy pressure immediate pain

appropriate forces- several hrs later
1 mobility corrects itself

Tooth movement & age

Vitality of tissue:
effectively carried out in young patients vascularity & cellularity of periodontal membrane & bone

Tooth movement & age

Role of growth

Role of apical foramen

Density of bone

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2.

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