Biology of tooth movement

Presented by: Nada Emad ElHossiney

Supervised by
Introduction
The nature of orthodontic tooth movement :
• It has a bio – mechanic nature.
• Solely based upon stress- strain occurs in the PDL environment
• The orthodontic tooth movement results from forces delivered to the
teeth
• Knowledge of the mechanical principles governing forces is necessary
for the control of orthodontic treatment
• The proper application of biomechanics principles increases
treatment efficiency through improved planning and delivery of care.
1 . Center of resistance.
• All objects have a center of mass.
• This is the point through which an applied
force must pass for a free object to move
linearly without any rotation, - i.e., the
center of mass is an object’s “balance point
• Analytic studies have determined that the
center of resistance for single-rooted teeth
with normal alveolar bone levels is about 1/4
to 1/3 the distance from the cementoenamel
junction (CEJ) to the root apex.
• Location of the center of resistance depends on the alveolar bone
height and root length .
• Location of the center of resistance with alveolar bone loss
• with a shortened root
 Force
2 - Forces
• they are actions applied to bodies
• they equals ( mass X acceleration) F =ma
• in clinical orthodontics its unit is Grams
• forces has the characteristics of vectors i. e magnitude & direction
• Is applied by appliances induces
• Tipping
• Translation
• Intrusion
• Extrusion and / or
• rotation

the force vectors characteristics – magnitude , point of origin & direction

• 2 vectors could added by placing one vector at the head of the another
i.e sum of them called resultant
• a vector could be resolved into components along x , y & z axes
• Clinically the determination of the horizontal, vertical, and transverse
components of a force improves the understanding of the direction of
tooth movement
• An important point of view that the orthodontic tooth movement is not
applied on the center of rotation of the tooth as it is usually delivered
through the tooth crown
• as the orthodontic forces are delivered through the tooth crown they will
not produce a pure linear movement ,, some rotational movement will
be present ,, those rotational movements are called Moment of the force
• The moment of the force is the tendency for a force to produce rotation.
• Its direction is found by following the line of action around the center
of resistance toward the point of origin
• It is determined by multiplying the magnitude of the force by the
perpendicular distance of the line of action to the center of resistance
• The importance of the moment of a force is often not recognized in clinical
orthodontics, but awareness of it is needed to develop effective and efficient
appliance designs

• Clinical examples of moments of the forces

3 – Couple
- A couple is two parallel forces of equal magnitude acting in opposite
directions and separated by a distance (i.e. different lines of action)
- The magnitude of a couple is calculated by multiplying the
magnitude of force(s) by the distance between them

• Translation of teeth occurs in response to appropriate force

couples.
• Couples result in pure rotational movement about the center of
resistance
• clinical examples of couples
4 – Torque
• Torque is a common synonym for moment
(both moments of forces and of couples)
• Torque is erroneously described in terms of degrees by many
orthodontists.
• The appropriate unit for the applied torque is gram/millimeters (force ×
distance). It is the description of the moments that more accurately
describes the rotational components of a force system and appliance
design
Equivalent Force systems
• A useful method for predicting the type of
tooth movement that will occur with
appliance activation is to determine the
equivalent force system at the tooth’s center
of resistance
• The force system at the center of resistance
accurately reflects the type of movement
• eg. Intrusion arch force system
• Types of tooth movement :
1 – tipping ( controlled & uncontrolled)
2 – translation ( bodily )
3 – root movement
4 - rotation
5 - intrusion & extrusion
• The relationship between the applied force system and the type of movement
can be described by the moment/force ratio
• The movement that occurs is dependent on the (moment/force ) ratio #and#
the quality of the periodontal Support
1- Tipping :
• simplest orthodontic movement
• controlled occurs about the tooth apex
• uncontrolled occurs about CER
• Force needed is about 50 – 75 gm.

Controlled tipping
2. Translation :
• all PDL is uniformly loaded with the force
• Force needed is about 100 – 150 gm.

3 – Rotation :
• needs high force
• occurs around the CER
• Force needed is about 50 – 100 gm.
4 – Extrusion :
• needs to produce tension in the PDL ligaments
• Force needed is about 50 gm.
5. Intrusion :
• forces are nearly at the apex
• needs minimum force application
• Force needed is about 15 – 25 gm.
6- Root movement :
• usually expressed as torque
• the crown is held stationary and the root moves
• CER is the bracket itself
• done by increasing the Moment/Force ratio
Moment / Force ratios needed for different kinds of tooth movement :
1 – tipping
* controlled 5:1
* uncontrolled 7 : 1
2 – translation 10 : 1
3 – root movement 12 : 1
• Types of orthodontic forces acc. to Duration
• - continuous
• - interrupted
• - intermitted
• Threshold --- 6 hrs per day.
• No tooth movement if forces are applied less than 6 hrs/d.
• From 6 to 24 hrs/d, the longer the force is applied, the more the
teeth will move.
- Continuous force :
- achievable via fixed orthodontics
- Never declines to zero.

- Interrupted force :
* force starts heavy then decline to optimal after that may reach zero .
*achievable via removable appliance.
* produces some kind of undermining resorption .
• reactivated every specific time .

-Intermittent forces :
* declines to zero
* very high force 250 – 500 gm.( anch – dist )
* achievable via extraoral appliance
* needs at least 12 hrs/day to be effective
-Force level :
• Light, continuous forces are currently considered
to be most effective in inducing tooth movement.
• Osteoclasts found
• Removing lamina dura
• Tooth movement begins
• This process is called “FRONTAL RESORPTION”(remodeling process)
• Heavy forces cause damages and fail to move the teeth.
• B.V of PDL is totally occluded –
then
• causes cellular necrosis within the bone –
then
• hyalinization i.e undermining resorption occur
• N.B. Optimal force : “High enough to stimulate cellular activity without
Tooth movement (mm)

Time (Arbitrary Unit)

Phase 3 Phase 2 Phase 1
• Tooth movement (mm) Phase 3 Phase 2 Phase 1 Time (Arbitrary Unit)
-Phases of orthodontic tooth movement :-
* Displacement - no clinical movement
- instantaneous
Delay – no clinical movement
- short ( partial B.Vs occ. ) or long 1-2 weeks ( more B.Vs occ. )
• Acceleration – rapid tooth displacement
- differs among individuals
• Orthodontic tooth movement adverse effects :
* Pulp - transient inf. response , can cause loss of vitality
- in cases of compromised tooth ,, heavy force ,, wrong mech.
* Root - usually repaired by cementum during rest periods
- resorption may occur up to 2 mm. in permanent cases
- At risk : thin roots ,, heavy force ,,
• Finally :
• Optimal force is the lightest force that will move a tooth to a desired
position in the shortest possible time without iatrogenic effects
• So ,,, we should think optimal ,, it is orthodontics so we ( work
smarter not harder )
Schwarz concluded-
The forces delivered as part of orthodontic treatment should not exceed the capillary
bed blood pressure –
20-25 g/cm2 of root surface.
If exceeding this pressure, compression could cause tissue necrosis by- ““Suffocation of
the strangulated periodontium.”
 Early theories of tooth movement
 Farrar
 Angle
 Breitner
 Sandstedt
 Sicher& Wienmann
 Theories of Orthodontic Mechanisms
Orthodontic tooth movement has been defined as the result of a biologic response to
interference in the physiologic equilibrium of the dentofacial complex by an externally applied
force.
• Two main mechanisms were proposed
• Pressure Tension Theory.
• Bone Bending Theory.

Pressure Tension theory. Sandstedt(1904),Oppenheim(1911), Schwarz(1932).

• Hypothesized that a tooth moves in the periodontal space by generating a “pressure side” and a
“tension side.”
• On the pressure side, the PDL displays disorganization and diminution of fiber production. Here,
cell replication decreases seemingly due to vascular constriction.
•  On the tension side- Stimulation is produced by stretching of PDL fiber bundles. Results in an
increase in cell replication. Due to this enhanced proliferative activity it eventually leads an
 Theories of tooth movement
Orthodontic
 STAGES OF PRESSURE-TENSION THEORY force
1.Alterations in blood-flow.
2.Formation or/and release of chemical messengers.
3.Activation of cells. Tooth

Areas of Areas of
tension pressure

Bone Bone
deposition resorption
Pressure zone
Changes in pressure zone2 Force

PDL fluid expressed

compression of principal fibers

Compression of blood vessels

Partial ?
Complete ?
Decreased oxygen level
Dies?
Cellular response Lives ?
• BONE RESORPTION :
• FRONTAL
Application of ideal orthodontic force.
The resorption seen during tooth movement at the pressure site. Here ,osteoclasts resorbs
the bone
• UNDERMININ
Application of heavy force (continuous).
Blood vessels occlude.
Results in sterile necrosis at the compression site.
The cells disappear.
Forms an avascular area.
Termed as hyalinized zone.
It does not form hyalinized tissue.
Devoid of cells & appears plain.
• Remodeling of bone adjacent to the necrotic area has to occur.
• Achieved by deriving cells from the adjacent undamaged areas.
• The cellular elements from the undamaged adjacent area include the
necrotic ( Hyalinized) area.
• This invasion of osteoclasts from the under side of lamina- dura is
termed as undermining resorption.
• Blood vessels3 Light force Heavy force Partial compression Complete
occlusion Blood flow patent Blood flow cut off Chemical mediated cell
response Necrosis Frontal resorption Undermining resorption O2 O2
• Frontal resorption Undermining resorption
• PDL Os.cl Marrow Os.cl HFLF Cell action Cell
Tension zone
Changes in tension zone
Force

Stretching of periodontal fibers

Dilatation of blood vessels

Osteoblastic activity

Bone formation
• Force Tension zone Bone formation Osteoblastic activity
Pressure-Tension hypothesis...reconsidered.
PDL is a continuous hydrostatic system with distinct fluid
compartments:
a. cells of PDL
Bien b. vascular & lymph channels
c. interstitial fluids
In keeping with Pascal’s Law, any force would be distributed evenly
throughout the system.
 Pressure – Tension hypothesis reconsidered
• Experiments to disprove :
By Nanda & Heller:
• Systemically administered lathyritic agents to rats
• They disrupt collagen metabolism & function
• Histological response of alveolar bone to orthodontic force normal
By Baumrind: proposed an alternate hypothesis
• Studied the rates of cell proloferation & collagen metabolism
• No striking difference b/w tension & pressure sites
• Crown of the 1st molar displaced 10 times more than the reduction in
PDL width.
Few highlights . .
• PDL is viscous & rubbery rather than watery.
• No objective evidence for the “squeezing out” of tissue fluids on pressure side
• PDL is a continuous system. Fluid if squeezed out in one area will squeeze out
from other areas too.
The alternative hypothesis . . .
•  In accordance with universally operating physical laws, each of the 3 structure,
is deformed.
• The amount of deformation produced is a function of elastic property of the
material.
• The elastic property of the teeth is not been studied. Of the other 2 materials,
bone deforms far more readily than the PDL.
 L
Recent theories2
P D
i n s
ra in al Pressure -Tension
St n
is g
al
ic
em
Ch Bioelectric n a ls
si g
t r ic on e
e c
El in in b
S tr a
FLUID DYNAMIC THEORY
Physiologic tooth movement
• Dental drift & tooth eruption.
• Slow process
• Occurs mainly in buccal direction into cancellous bone or
• Due to growth into cortical bone.
FLUID DYNAMIC THEORY
• Proposed by Bien
• This theory is also called the blood flow theory.
• Tooth movement occurs as a result of alterations in fluid dynamics in
the periodontal ligament.
• The contents of Periodontal ligament create unique hydrodynamic
condition.
Bioelectric Theory Force

Bone bending

Piezoelectric current

Cell signal

Cell activation

pt Bone remodeling
n ce
co
he Tooth movement
T
BONE BENDING AND PEIZOELECTRIC
THEORY:
• Phenomenon observed in many crystalline materials.
• Deformation of crystals produces a flow of electric
current.
• When a force is applied to a crystalline structure (like
bone or collagen), a flow of current is produced that
quickly dies away.
• When the force is released an opposite current flow is
observed.
• * The piezoelectric effect results from migration of
electrons within the crystal lattice.
 2p
ro
Piezoelectricity pe
r tie
s
Quick decay though force is maintained
Produce equal & opp. signal on force release
Sustained force or Rhythmic force
 Is pressure zone a pressure zone?
Demonstrations of Epker & Frost

Compression Zone in alv. bone Tension zone in alv. bone

Convergence of the two theories.
Biologic Pathways9
Orthodontic forces

Bone bending Tissue injury

Piezoelectricity PGs Inflammation

Matrix charge polarization Hydrolytic enzyme

Os.clast-os.blast cAMP Collagenase

Remodelling
 Cell
Cell membrane
Cytoplasm
Nucleus & nucleolus
Mitochondria
Granular & smooth ER
Centrioles
Ribosomes
Lysosomes
Microtubules
• Microfilaments
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ovement-63834728
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movement-31068216
 BASIC PRINCIPLES OF ORTHODONTIC TREATMENT

• The teeth and their supporting tissues show life-long ability to reposit themselves and adapt to functional demands.
It is illustrated by the phenomenon of physiological migration. It is well known that the teeth of the side segments
tend to migrate in a mesial direction. There is also a tendency for continued eruption if a balance is not established
with the antagonistic tooth, or if the balance is lost. By these means , eruption and migration, throughout life the
teeth will seek to establish the best possible relationship between the jaws.

• These continuous physiological processes are affected by the growth of the craniofacial skeleton and are sensitive to
any type of pressure ( pressure from muscles, soft tissues, occlusal and functional factors or direct external forces ).
The great potential for dentoalveolar modification is due to: an extraordinary ability of the periodontal membrane to
remodel itself and an adaptability of supporting alveolar structures in response to movement of the teeth What is
more, the basal parts of the jaws show adaptive reactions to stimuli directed at growth zones.

• Orthodontic treatment may involve :

the control of forces physiologically acting upon the teeth and associated structures or producing and use external
forces. The goal for orthodontic treatment may be limited to preventing or eliminating unwanted impulses ( i.e.
dysplastic muscle function ) by restraining such forces from acting on the teeth or adjacent supporting structures. Such
a change in the equilibrium of forces may lead to considerable positional changes if continued over prolonged period of
time. A tooth can be guided into position during eruption by being subjected to occasional contact with an inclined
plane or a lightly activated element, while more extensive tooth movement may be obtained by subjecting the teeth,
and eventually also the alveolar process, to direct external forces.
• During the physiological tooth migration as the orthodontic therapeutic movement the
characteristic tissue changes take place. The bone in direction which tooth is moving is
resorbed while on the bone wall which the tooth is moving away from an bone apposition
occurs. Among the fundamental problems that require elucidation are following:
• Why is the alveolar bone resorbed during tooth movement whilst the cementum remains intact?
• What protects the root surface?
• It is known that turnover rate of the bone tissue is high
It is known that turnover rate of the bone tissue is high. The bone system acts as a mineral
reservoir for the whole organism and there is permanent circulation of minerals between the
bone system and inside environment of organism. The bone tissue shows high ability to
remodel itself following the functional pressure on it.
• On the other hand the cementum is fully maturated tissue, built up as a permanent
depository of mineral salts. But slow apposition continues on the cementum surface
throughout life.
• This fact is of great importance for the resorptive
mechanism

This fact is of great importance for the resorptive

mechanism. The unmineralized precementum layer has
been considered to be a resorption-resistant coating
layer. It protects the root surface and permit
physiological tooth migration and orthodontic tooth
movement
• The periodontal ligament, the connective tissue which
attaches the teeth to the alveolar bone, has also ability
to remodel itself. However, the turnover rate is not
uniform throughout the ligament. The cells are more
active on the bone side than near the cementum, so
that major remodelling take place near the alveolar
bone.
Physiological tooth migration
• During the physiological migration the resorbing cells, called osteoclasts, are seen in
the scattered lacunae associated with the resorptive surface. Resorptive surface is
the alveolar bone wall towards which the tooth is moving.
• Unlike the osteoclastic resorption of bone to provide the space for tooth movements,
the corresponding remodeling processes of the fibrous attachment is not clearly
understood. There is a meshwork of collagen fibers of small diameter present, which
explains this rapid reorganisation process.
 Physiological tooth migration
• The alveolar bone wall which the tooth is moving away from is characterized by
osteoblasts depositing non-mineralized osteoid which later mineralizes in the deeper
layer.
• The older fibers of the periodontal membrane are surrounded by newly deposited bone
matrix and become embedded in bone. Simultaneously, new collagen fibrils are
produced by the cells on the bone surface. The sites of active lengthening and
rebuilding of the fibrous apparatus lie in the middle of the ligament and near the
alveolar bone side. How this comes about is unknown.
 Orthodontic tooth movement
• Orthodontic forces are usually more powerful than normal
functional forces so response elicited in the periodontal
ligament is more marked and extensive, although it is the
same in principles as than seen during physiological migration.
•  Pressure side: Application of a continuous force on the crown
of a tooth will lead to a tooth movement within the alveolus
that is marked initially by narrowing of the periodontal
membrane, particularly in the marginal area. This
compression will impede the vascular circulation and cell
differentiation. After a few hours a certain reduction in the
number of cells may be observed, indicating a temporary
slowing down of cell renewal.
Pressure side:
• After a few hours a certain reduction in the
number of cells may be observed, indicating
a temporary slowing down of cell renewal.
After a certain period of time, when
conditions are favorable, the cells will
increase in number and differentiate into
osteoclasts and fibroblasts. The width of the
membrane is increased by direct osteoclastic
removal of bone and orientation of the fibers
in the periodontal membrane will change.
• During the critical stage of the initial
application of force, high compression in
some areas may cause degradation of the
cells and vascular structures. The tissue
reveals a glass-like appearance in light
microscopy, which is termed hyalinization. It
represents a sterile necrotic area.
 In a hyalinized zone:
• the cells cannot differentiate into osteoclasts and
• no bone resorption can take place from the periodontal membrane
• tooth movement will stop until the hyalinized structures has been removed and the area
repopulated by cells.
The process displays three main stages :
degeneration
elimination of destroyed tissue and
establishment of the new tooth attachment
The hyalinization may be limited to parts of the membrane or may extend from the root surface to the
alveolar bone. Limited hyalinization is almost unavoidable in the initial period of tooth movement in
clinical orthodontics. However, extended hyalinisation areas may later cause root resorptions which
may lead to permanent root shortening.

The adjacent alveolar bone is removed by indirect resorption by cells which have differentiated into
osteoclasts on the surface of adjacent marrow spaces.
Pressure side:

• When the application of force is favorable, direct resorption of the alveolar

bone is likely to occur. Large number of ostoclasts will be seen along the bone
surface and tooth movement will be rapid. The fibrous attachment apparatus
will to some extent be reorganized by the production of new periodontal fibrils,
These are attached to the root surface and to those part of the alveolar bone
wall where direct resorption is not occurring.
• The main feature is the deposition of new bone on the alveolar surface which
the tooth is moving away from. Cell proliferation is usually seen after hours in
young humans. The original periodontal fibres become embedded in the new
layers of pre-bone, or osteoid, which mineralizes in the deeper parts. New bone
is deposited until the width of the membrane has returned to normal limits,
Pressure side
Tension side
• The main feature is the deposition of new bone on the alveolar surface
which the tooth is moving away from. Cell proliferation is usually seen
after hours in young humans. The original periodontal fibers become
embedded in the new layers of pre-bone, or osteoid, which mineralizes
in the deeper parts. New bone is deposited until the width of the
membrane has returned to normal limits, and the fibrous system is
remodelled.
Tension side
Tension side
• In order to maintain the dimension of the supporting bone tissue,
concomitantly with bone apposition on the periodontal surface on the
tension side, an accompanying resorption process occurs on the
spongiosa surface of the alveolar bone.
• Correspondingly, during the resorption of the alveolar bone on a pressure
side, maintenance of the alveolar lamina thickness is ensured by
apposition on the spongiosa surface.

• These processes are mediated by the cells of endosteum, which cover all
the internal bone surfaces, marrow spaces, Haversion canals and dental
alveoli.
• Extensive remodelling, a reaction which tends to restore the thickness
of supporting bone, takes place in periosteum, in deeper cell-rich layers.
• As regards control of tissue reactions many mechanisms have been
considered responsible for the differentiation of cells incident upon
the application of an orthodontic force.
Orthodontic tooth movement shows local traits of a damage/repair
process with inflammation-like reactions:
• high vascular activity
• many leucocytes and macrophages
• involvement of the nervous and immune systems
• The forces in orthodontics should be very precisely controlled not to damage
periodontal ligament tissue, pulp of the teeth or cementum of the roots.
As a response to high presure and very rapid tooth movement may occur:
 the devitalization of teeth or
 root resorption
Since we wish our terapeutic movements to stay within physiological limits,
knowledge of orthodontic forces needed in terms of magnitude and duration
is very important. The critical question regarding orthodontic tooth movement
is whether direct resorption without hyalinization areas take place on the
alveolar surface
• It has been observed that a light force acting over a certain distance
moves a tooth more rapidly than a powerful one, because there is
no need to eliminate necrotic hyaline tissue.

• What is considered a light or powerful force depends on:

type and anatomy of the tooth to be moved
architecture of the periodontal ligament and the supporting bone
type of the tooth movement and
mode of force application
• The size, form, number and characteristic of the roots will influence the
mechanical resistance to an external force. Thus cuspids or molars require
stronger force to move than incisors or premolars.

• As regards the architecture of the periodontal ligament and alveolar bone, it is

closely related to age. The number of cementoblasts, fibroblasts and osteoblasts
is much higher in young patients than in adults, indicating higher activity.
• The necessary increase in cell numbers during the initial phase of the application
of force in adults occurs more slowly and is more critical than in young
individuals, and the deposition of the osteoid is similarly slower and less
extensive.
• In addition the type of bone through which the tooth is displaced
must be considered in the treatment plan. The alveolar process
consists of :
• the dense outer cortical bone plates and
• spongious or cancellous bone between them
• The movement of the tooth is more difficult and slower in the cortical
dense bone than in spongious bone.
• In general the bone is more dense in side segments than anteriorly,
and in the mandible than in maxilla.
• When a tooth is moved into the reorganizing alveolus of a newly extracted tooth,
remodeling is very rapid, due to the many differentiating cells present and to the
limited amount of bone to be resorbed.
• Despite these facts, individual variations in alveolar bone architecture are considerable

• The magnitude of the force needed depend also on type of the tooth movement
wanted. ( i.e. intrusion or extrusion requires very light forces while bodily movement of
a tooth requires stronger force).
• The mode of application and the mechanical arrangement of the recipient tooth units
are also of importance. A local force intended to move an individual tooth should be
only a small fraction of a force which is applied against full dental arch, where all teeth
are united into a block.
• The magnitude of a force depends also on its duration.
We distinguish:
1. continuous forces
2. continuous, but interrupted after a limited period ( forces working
over a short distance, typicaly exemplified by a tooth ligated to
a labial arch wire)
3. intermittent forces, mainly induced by removable plates
4. intermittent forms of a functional type, induced by functional
appliances, transmitting muscular activity into impulses directed at
the teeth and alveolar processes
• The strong continuous force is unwanted because it may lead to
considerable injury.
• Interupted continuous forces create favourable conditions for further
tissue changes.
• Since the force decreases rapidly, despite inicial hyalinisation, the
tissue will readily be reorganized.
•  In case of intermittent application , frequent discontinuation
provokes increased vascular circulation and cell proliferation
INTRODUCTION
• Orthodontic treatment is based on the principle that if prolonged
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.
• When an orthodontic force is applied, Tooth moves thro the bone
carrying its attachment apparatus (Periodontal ligament) with it , as
the socket of the Tooth migrates.”So before going in detail about the
Tooth movement, it will be appropriate to know the Basis about
periodontal ligament (Attachment apparatus) and the alveolar Bone.
PERIODONTAL LIGAMENT
1. PDL is a connective tissue organ, which attaches cementum of the
Tooth to the alveolar bone.
2. Normally it occupies a space approximately 0.5mm in width around
all parts of the root
3. Thickness of PDL:-Thickness of PDL:- 0.15 -0.38 mm
PERIODONTAL LIGAMENT
COMPOSITION

Cellular Extracellular
elements  matrix
Epithelial
Synthetic Resorptive Ground
rests of Fires
cells cells substance
malassez
Collagen Oxytalan Proteoglycansglycoprotein Mucopolysaccharides

Transseptal fibers

Alveolar crest

Oblique fibers

Horizontal fibers
PERIODONTAL LIGAMENT
STRUCTURES PRESENT
• Blood vessels
• Nerves
• Unmyelinated free Nerve Endings: - pain perception
• Myelinated, complex Nerve Endings: -proprioception (pressure)
• Cementicles
• Lymphatics
FUNCTIONS OF PDL
 SUPPORTIVE
 SENSORY: by nerve supply
 Free nerve endings – pain sensation
 Myelinated fibers – proprioception
 NUTRITION:
 HOMEOSTATIC
• lveolar bone
• Bone consists of about
• 65% inorganic consists of calcium and inorganic orthophosphate in the form of hydroxyapatite crystals
• 35% organic material is type I collagen which lies in the ground substance of glycoprotein and
proteoglycan.
• Composition
• INORGANIC =65%
• ORGANIC = 35%
• COLLAGEN= 88-89%
• NONCOLLAGEN = 11-12%
• GLYCOPROTEINS= 6.5%-10%
• PROTEOGLYCANS = 0.8%
• SIALOPROTEINS = 0.35%
• LIPIDS= 0.4%
 Structure of alveolar process

• As a result of Cortical plate

adaptation to its Alveolar
function , two pats bone proper
of alveolar process Alveolar
Spongy bone,
can be distinguished process Supporting
alveolar
bone
PHYISOLOGICAL CHANGES IN
ALVEOLAR BONE
• The internal structure of Bone is adapted to mechanical stresses. It
changes continuously during growth and alteration of functional
stresses. These changes are correlated to the Growth, eruption,
movements, and loss of teeth.
• Al l these processes are made possible only by a coordination of Destructive and
formative activities.
• The cells responsible for these all
(1) Osteoblasts – formation / Deposition
(2) Osteoclasts – Destruction –Resorption

Structure Of Osteoblast
 Ovoid cells, Basophilic cytoplasm and oval nucleus
Function: secretes organic matrix (osteoid) in the Tension side, which is then
calcified resulting in the Formation of Bone Lamella.
Precursors of osteoblasts are
(1) Fibroblasts in PDL
(2) Perivascular stem cells
Structure of Osteoclasts
• Multinucleated giant cells have 12 / more nucleus Irregularly oval / club shaped with
branching process
• _ Occur in Bay like depressions in Bone called“ Howship's lacunae”
• _ The part of the osteoclasts in contact with the resorbing bone has a ‘Ruffled Border
• Osteoclasts (Bone Resorbing cells) are more in number in the compression side of PDL
How the orthodontic tooth movement differs from physiological dental drift or tooth
eruption
 The former is uniquely characterized by the abrupt creation of compression and tension
regions in the PDL. Physiological tooth movement is a slow process that occurs mainly in the
buccal direction into Cancellous bone or because of growth into cortical bone.
•
 Naturally occurring tooth movements that take place during and after tooth eruption.
This include:
A)Tooth Eruption. Physiological tooth movement
B)Migration or drift of teeth.
C)Changes in tooth position during mastication.

Tooth eruption Migration or drift of teeth During mastication

1. Blood pressure theory

2.Root growth theory

3.Hammock ligament theory

4.Periodontal ligament traction theory

 Orthodontic force application
• Orthodontic force application leads tooth movement.
• Leads to remodelling changes in dental & paradental tissues:
•
•
Pulp
PDL
Periodontal ligament
• Alveolar bone,
• Gingiva.

Compression Tension

Decreased blood supply Increased blood supply

Decreased o supply Rich nutrient supply

Tissue injury Metabolites washed out easily

Production of Ist messenger

Stimulation of progenitor cells

Production of 2nd messenger Osteoblasts

Osteoclasts Bone deposition
Bone resorption
• Law 1 In orthodontics, tooth moves through bone and brings the periodontal ligament
with it.
•  Law 2 Tooth cannot move unless bone apposition and resorption take place.
•  Law 3 There will be no tooth movement unless there is a force.
•  Law 4 Orthodontic tooth movement is not the only type of tooth movement.
•  Law 5 Orthodontic tooth movement cannot occur unless cells are at work.
•  Law 6 Frontal resorption occurs in the PDL, whereas undermining resorption occurs
underneath the lamina dura
•  Law 7 Frontal resorption facilitates orthodontic tooth movement, whereas undermining
resorption impedes orthodontic tooth movement.
• Law 8 Orthodontic tooth movement remains one of the most successful procedures with
predictable outcome in medicine and dentistry.
• Types of Tooth Movement
Eruption
• Active
• Passive
• Lateral drifts
• Physiological
• Due to loss of adjacent teeth
• Orthodontic tooth movement
• Types of Tooth Movement
Intrusion
• Extrusion
• Tipping
• Bodily movement
• Rotation
• Effect of the light force on the PDL
Light, continuous forcesOsteoclasts formedRemoving lamina duraTooth movement beginsThis process is called
“FRONTAL RESORPTION

• 35 “Frontal resorption” because it occurs between the root and the lamina dura.

• 36 Light force leading to frontal resorption

Phase 1 – Mechanical compression and tension of the periodontiumPhase Mechanically induced cellular and genetic
responses; no tooth movementPhase Accelerated tooth movement due to frontal bone resorptionPhase 1Phase
3Phase 2Tooth movement (mm)Time (Arbitrary Unit)

• 37 Effects of heavy force on the PDL

Heavy, continuous forcesBlood supply to PDL occludedAseptic necrosisPDL becomes “hyalinized” –
“HYALINIZATION”This process is called “UNDERMINING RESORPTION”.

• 38 “Undermining resorption” because it occurs on the underside of lamina dura, not between lamina dura and the
root.
• Heavy force leading to undermining resorption
Phase 1 – Mechanical compression and tension of the periodontiumPhase
Continuing mechanical compression; little cellular and genetic responses; no
tooth movementPhase Cells recruited from the undermining side of lamina
dura, not within the PDL, to induce undermining bone resorptionPhase
1Phase 3Phase 2Tooth movement (mm)Time (Arbitrary Unit)

• 41 Frontal resorption Undermininging Resorption Time (Arbitrary Unit)

Phase 1Phase 3Phase 2Tooth movement (mm)Frontal resorptionTime
(Arbitrary Unit)UnderminingingResorptionPhase 1Phase 3Phase 2Tooth
movement (mm)Time (Arbitrary Unit)
•  Anchorage Newton’s law: for every action, there is reaction.
Defined as “resistance to unwanted tooth movement.”The “anchorage value” of any tooth is roughly equivalent to its root surface area. Thus, molars and canines generally have higher anchorage values than incisors and
bicuspids.

• 44 Anchorage types Reciprocal anchorage. Reinforced anchorage.

Stationary anchorage.Cortical anchorage.

•B

• 49 Force and Couple Force Couple Is applied by orthodontic appliances.

Induces tipping, translation, intrusion, extrusion and/or rotation.CoupleTwo forces of opposite directions and with non-overlapping points of application.Translation of teeth occurs in response to appropriate force couples.

• 51 Potential Complications of Orthodontic Tooth movement

The pulpRoot resorptionAlveolar bone height

• 52 Orthodontic effects on the pulp

Rare if light, continuous forces are applied.Occasional loss of tooth vitality.History of previous traumaExcessive orthodontic forcesMoving roots against cortical boneEndodontically treated teeth can be moved like natural
teeth, with proper management.

• 53 Root resorptionMore accurately, resorption of root cementum and dentin.Normal ageing process in many individualsLikely occurring in many cases but not to the degree of clinical significance.Root resorption induced by
light orthodontic forces is reversible (by regeneration and repair of cementum and/or dentin).Can lead to tooth mobility in severe cases.

• 55 Generalized Root Resorption

Affects most, if not all, teeth; maxillary incisors more susceptible than other teeth.Could be moderate or severe but commonly in the range of up to 2.5 mm.Etiology largely unknown but predisposing factors include conical
roots with pointed apices, distorted tooth form, or a history of trauma.

• 56 Localized Root Resorption

Can’t always be distinguished from generalized root resorption.Maxillary incisors more susceptible than other teeth.Only in rare cases can the causes, such as heavy orthodontic forces, be pinpointed.Etiology largely
unknown.
• Orthodontics and dentofacial orthopedics requires thorough knowledge in
biology (of bone, cartilage, teeth, muscles, nerves and other soft tissues),
biomechanics, biometrics, material science, clinical skills and practice
management in addition to interpersonal skills.

• 60 Why study tooth movement?

Up to 70% of the Chinese population have malocclusion that warrants
orthodontic correction. Currently, less than 20% of the Chinese patients seeks
orthodontic treatment. However, I believe more and more people will seek
orthodontic with the development of society
Biomechanics of Tooth Movement
• Center of Resistance --- A point on the tooth around which the tooth
shall move. For most teeth, COR is 2/5 way between the apex and the
crest of the alveolar bone.
• Center of Rotation --- The point around which rotation occurs when
an object is being moved.
 Reciprocal anchorage
• Both units move roughly equal distance.
• Exemplified by closing a diastema between two central incisors.

Reinforced anchorage Unit A Unit B

• Unit A has substantially more anchorage value than
Unit B. Thus, Unit A moves little but Unit B moves a lot.
• Exemplified by retracting anterior teeth to close an extraction
space by using posterior teeth as a reinforced anchorage unit.
• Forces alter the PDL vascularity & blood flow
• Results in:-
• Synthesis & Release of key molecules-
• Neurotransmitters, Cytokines, growth factors, colony stimulating
factors & arachidonic acid metabolites.
• These molecules evoke cellular responses by various cell types in &
around teeth.
• Provides favourable microenvironment for tissue deposition or
resorption.
 ORTHOPEDIC FORCE
• Force of higher magnitude in relation to an orthodontic force, when delivered via teeth
for 12 -16 hours/day, is supposed to produce a skeletal effect on the maxillofacial complex.
Orthodontic Mechanotherapy
• Aimed at tooth movement
• By remodeling & adaptive changes in the paradental tissues.
• For this outcome small amount of forces might be required- 20-150gm/tooth.
Craniofacial Orthopedics
• Aimed at delivering higher magnitudes of mechanical forces- > 300gms.
• This attempts to modify the form of craniofacial bones.
• The appliances are called CRANIOFACIAL ORTHOPEDIC DEVICS
• Delivers macroscale mechanical forces
• Produce microstructural sutural bone strain &
THEORIES OF TOOTH MOVEMENT
• Numerous theories have been put forward to explain the mechanism of tooth movement , when
orthodontic force is applied.
• The theories that are accepted and have stood the test of time are
1. Pressure tension theory
Author - Schwarz 1932 whenever a tooth is subjected to an orthodontic force, it results in areas of pressure and tension
• The area of periodontium in the direction of tooth movement is under pressure show “Bone Resorption"
• The area of periodontium opposite the tooth movement is under Tension show “Bone Deposition
• schwarz concluded that the forces delivered as part of orthodontic treatment should not exceed the capillary bed
blood pressure (20- 25 g/cm2 of root surface).
• If one exceeds this pressure, compression Could cause tissue necrosis through“suffocation of the strangulated
periodontium.”
• Baumrind reconsidering the propriety of the pressure-tension hypothesis, pointed out a conceptual flaw in it. He
considered the PDL to be a continuous hydrostatic system and suggested that any force delivered to it would be
transmitted equally to all regions.  He drew support for this concept from Pascal’s law, a basic law in physics.
2. Bone bending piezoelectric theory
3. Blood flow theory
• Current concepts by Massella and meisler (AJO APRIL 2006)
• They are divided into:
1.Molecular genetics of osteoblast differentiation and function
2.neurotransmitters
3.osteoclasts differentiation and function
4.hormonal control of bone formation and resorption
5.intracellular and extracellular environment
6.signal input and genetic output
 2 osteoblasts specific m rna transcripts are known:

Cbfa1 transcription factor Osteocalcinin

Enhancing or supression gene expression Inhibitor of osteoblast function

Mesenchy mal stem cells T f genes cbfa1 Col type 1 BSP
Preosteoblasts T f gene osteocalcinin osteoblasts Bone matrix
secretion inhibit 10 hrs post force 48 hours post force
• NEUROTRANSMITTERS Due to application of physiological orthodontic
force PDL peripheral nerve fiber CGRP SUBSTANCE P DOCKING
OSTEOBLASTS (VASODILATORS) Release of cytokine Orthodontic tooth
movement
• Osteoclasts differentiation and function
• Endocrine regulation of bone physiology
• Mechanical force induced reciprocal communication between 5
microenvironments
• Bone bending theory
• Farrar (1876), First noted deformation / Bending of interseptal
alveolar walls.
• What is piezoelectricity?

e- -e-e-e Small electric current is generated

What is the source of electric current
1.collagen
2.Hydroxyapatite
3.collagen –hydroxyapatite interface
force -e-e -e-e-e-e- force -e-e -e-e-e-e- As long as the force is
maintained ,crystal structure is stable and no further electric effect is
observed Ions in the ECF Streamig potential
• Reassessment of force magnitude in orthodontics
• Ken Yoshikawa, AJO-1985 Sep
Fluid dynamic theory
• (Bien 1966- Arch oral Biology)
• According to this theory
• Tooth movement occurs as a result of alternations in fluid dynamic in
the PDL.

When force is applied Interstitial fluid is squeezed and moved

towards apex and cervical margins known as squeeze film
effect Blood vessels trapped in the fibers Stenosis and
aneurysm(balloons) Decreased o supply(anoxia) Alteration in
the chemical environment Bone remodelling
PHASES OF ORTHODONTIC TOOTH
MOVEMENT
• Tooth movement progress thro three stages:
1.Initial Strain
2.Lag Phase.
3.Progressive Tooth Movement / Post Lag Phase
MELSEN’S HYPOTHESIS
• Acc to this hypothesis the indirect bone resorption at the pressure
side is not a reaction to force but an attempt to remove ischemic
bone lying adjacent to the hyalinized tissue.
• Signaling molecules and metabolites in orthodontic tooth movement
1.Arachidionic acid metabolites
2.Prostaglandins
3.intracellular second messenger system
a. cyclic nucleotide pathway
b. Phosphatidyl inositol (PI) pathway
Arachidonic acid pathway
• Arachidonic acid is the main component of the phospholipids of cell
membrane is released due to the action of phospholipase enzymes.
• Mechanical stimulus Arachidonic acid Cyclo-oxygenase pathway Lipo-
oxygenase pathway PGG2,PGH2 5HETE LECOTRIENS 47.
• Prostaglandins  prostaglandins PGE1 PGE2
•  IST MESENGER PG, CYTOKINES, HORMONES CYTOPLASMIC ATP
CYCLIC AMP CYCLIC GMP 2nd MESSENGERS Interacts with cellular
enzyme Protein synthesis
•  Cyclic nucleotide pathway  Cyclic AMP and Cyclic GMP Activate
enzyme protein kinase c present on the cell membrane Opening of
calcium channels Increase in the ca conc in the cells Trggering a
number of protein phosphorylation agents Protein synthesis
• PI dual signaling pathway
• This pathway was given by Hokin and Hokin in 1953.
• Interest in this system started with the demonstration of an increase
in the phosphate concentration into cell membrane phospholipids

Activation of cell surface receptors PI 4,5 Biphosphate present

in the cell membrane H20 IP3 Release of calcium from the
intracellular stores IP4 Controls the ca entry at plasma
membrane through ca channels
• CALCIUM HOMEOSTASIS
1. Rapid[Instantaneous] flux of calcium from bone fluids[seconds]
2. Short term response of osteoclasts & osteoblasts.[minutes to days]
3. Long term[weeks to months] control of bone turnover
Cytoskeltal-extracellular matrix interactions
• The dental and paradental cellular responses to applied mechanical
loads involve interplay between intra- and extracellular structural
elements, and among biochemical messengers

 ECM includes collagen,proteo glycan,laminin , and fibronectin

transduction Reorganization of cytoskeleton ,secretion of
stored cytokines,ribosomal activation and gene transcription
Integrin receptors Na+ Na+ K+ ,k+
Signaling molecules involved in load induced tissue remodeling
• The PDL is abundantly supplied with 2 kinds of nerve terminals:
• Ruffini-like endings and nociceptive endings.
• Both endings can change their structures in response to external
stimuli, such as orthodontic force
Pain and tooth movement
• Tooth movement-associated tissue remodeling, an inflammatory
process, might induce painful sensations, particularly after activation
of the orthodontic appliance
• After 24 hours of force application Nociceptive endings in PDLare
stimulated Trigeminal subnucleus caudalis C-fos neurons are
stimulated Activate pain control system descending monoaminergic
pathway
 Cytokines in orndian dental acadethodontic tooth movement
• The different types of cytokines which take part in orthodontic bone
remodeling are:-
1. Interteukin - 1 alpha[IL - 1 alpha]
2. 2. Interieukin - 1 beta(lL - 1 beta)
3. Tumor Necrosis Factor – alpha(TNF –alpha) or Cachectin
4. Tumor Necrosis Factor - beta(TNF -beta] or Lymphotoxin .
5. Interieukin - 6[IL-6]
Orthodontic force Distotion of PDL and alveolar bone Distortion
of axonal nerve endings Peripheral release of neurotransmitters
Dilation of PDLcapillaries Extravascular migration of
macrophages and lymphocytes Production of IL-1,IL-
1,TNF,Monokines&PG’s Production of IL-2,other lymphokines
Production of fibroblasts Alveolar bone cell response &bone
remodeling
• Growth factors
• Bone contains the abundant amount of growth factors:
• Fibroblasts like growth factor  Platelet derived growth factor
• Transforming growth factor
• Connective tissue like growth factor

Recent model of tooth movement by Jones et al  stress in any

form—compressive, tensile, or shear—will evoke many
reactions in the cell, leading to the development of strain
K+ K+ k+ Ca2+ Ca2+ Ca2+ stress Activation of phospholipase C
Inositol triphosphate Increased levels Phospholipase A STORES
OF ARACHIDONIC ACID
• Bone remodeling and tooth movement
• MUNDY AND ROODMAN HYPOTHESIS: This is the most widely
accepted hypothesis. According to this hypothesis, osteoclasts are
derived from stem cells in haemopoietic organs, and granulocyte
macrophage colony forming units are the earliest identifiable
precursors of osteoclasts.

Granulocyte macrophage colony forming units promonocytes Early

preosteoclasts Late preosteoclasts osteoclasts MUNDY AND ROODMAN
HYPOTHESIS
• Factors affecting bone remodeling process
• Hormones
• Growth factors
• Cytokines
• Colony stimulating factors
Gingival effects of orthodontic force
• Accordingly, 2 disparate processes occur in the gingiva after transduction of
orthodontic force. First, there is an injury of the gingival connective tissue,
manifested by torn and ripped collagen fibers. second, the genes for both collagen
and elastin are activated, whereas those for tissue collagenases are inhibited.
Biology Of Tooth Movement
CONTENTSCONTENTS
 Introduction
 History
 Normal Structure.
 Bone resorption & deposition.
 Force - Classification
 Effect of forces- Heavy / Light.
 Theories.
 PathwayS Of Tooth Movement.
 Chemical MessengerS.
 Phases of tooth movement.
 Conclusion
 Bibliography
• What does an appliance do?
An Orthodontic appliance transfers mechanical stresses.
• What is the medium? How does it do it?
Through the tooth to the periodontium where they are translated into signals- physical, chemical, and
electrical .
Signals sent to cells that activate tissue remodeling to allow tooth movement.
• What does the clinician do?
The clinician is able to control the quantity and quality of the force system applied to the teeth.
• What does the biologic response do?
The speed and way in which teeth move is ultimately determined by the biological response.
Clinicians Role
 To understand the process of each interface.
 This will enable to interpret the biological responses to activation of any orthodontic appliance.
 There may be the application of molecular and cell biology which is important in medical science, to
the field of orthodontics.
History
• 18th Century Hunter provided the first explanation for orthodontic provided the first explanation for
orthodontic tooth movement
• 1815 Delabbare remarked that pain and swelling of paradental tissues occur following the occur
following the application of orthodontic forces to teeth.
• Delabbare introduced the notion that inflammation is an integral part of orthodontic tooth movement.
• 1888 Farrar hypothesized that tooth movement is due, partly , to bending of alveolar bone by applied
forces.
• 1892 Wolff supported Farrar in that he said internal architecture of bone is dictated by the mechanical
forces that act upon it.
• 1904-05 Sandstedt reported for the first time on the histomorphology of tissues surrounding
orthodonticallyy treated teeth.
• That landmark experiment, which was performed in one dog, concluded that force induced tissue changes are
limited to the PDL and its alveolar bone margin.
• At the end of 3 weeks of treatment. Sandstedt observed:
• No bone growth in the stretched PDL,
• Bone resorption in the area of PDL compression.
• Cell death occurred in the compressed PDL when the applied force was excessive
• The alveolar bone resorbed as a result of osteoclastic activity in adjacent marrow spaces (Undermining resorption).
• Oppenheim reported the experiment on a juvenile baboon
• In contrast to Sandstedt, Oppenheimsaw no demarcation between the old and
new bone.There was seen a trabecular structure. This strongly suggested a
complete transformation of the entire alveolar bone.
• Schwartz (1932) defined orthodontic forces as being “not greater than the
pressure in the blood capillaries (20 to 26 g/cm2 of root surface).
• The PDL and alveolar bone, due to their fluid- fiber composition, can be
deformed elastically by external forces.
• This also evoke cellular activities.
• When the tissue elastic limit is reached, it starts to deformstarts to deform
plastically, with adaptiveproliferation and remodeling reactions.
• Prolonged forces that exceed the bioplastic limit result in biodisruptive deformation, with:
• Ischemia,
• Cell death,
• Inflammation,
• IRepair.
Thus Reitan and Storey’s investigations demonstrated the complexity of the tissue reaction during tooth
movement.
• It was no longer perceived as a simple phenomenon.
• Simple phenomenon being of applied force causing the tooth to move within the PDL,
leading to tension and compression, and subsequent bone formation and resorption.
• They are perceived as a dynamic set of events that involved profound alterations in cellular
functions and changes in matrix composition.
• This enabled other researchers to ask “why” and “how” PDL and Alveolar bone responds to
applied forces
• https://www.slideshare.net/indiandentalacademy/biology-of-tooth-m
ovement-63834728
• https://www.google.com/search?
q=orthodontic+tooth+movment+and+pathway+of+tooth+movement+
%3B+ppt&rlz=1C1HLDY_arSA695SA695&oq=orthodontic+tooth+mov
ment+and+pathway+of+tooth+movement+
%3B+ppt&aqs=chrome..69i57.47191j0j15&sourceid=chrome&ie=UTF-
8
•  . www.indiandentalacademy.comwww.indiandentalacademy.com
• 14. PhysicsPhysics BiologyBiology …the point of convergence… www.indiandentalacademy.comwww.indiandentalacademy.com
• 15. The problem. The goal. The solution ! Tooth movement www.indiandentalacademy.comwww.indiandentalacademy.com
• 16. TheThe Biology.Biology. www.indiandentalacademy.comwww.indiandentalacademy.com
• 17. www.indiandentalacademy.comwww.indiandentalacademy.com
• 18. PERIODONTIUM PDL CEMENTUM ALVEOLAR BONE GINGIVA www.indiandentalacademy.comwww.indiandentalacademy.com
• 19. Alveolar crest group Horizontal group Oblique group Apical group Transseptal group Interradicular group PERIDONTAL LIGAMENT STRUCTURE Principal fibers are divided in 6 groups www.indiandentalacademy.comwww.indiandentalacademy.com
• 20. PDL - Fibers Principal fibers & Sharpey’s fibers Alveolar crest fibres Horizontal fibres Oblique fibres Apical fibreswww.indiandentalacademy.comwww.indiandentalacademy.com
• 21.  Thickness of PDL:-Thickness of PDL:- 0.15 -0.38 mm0.15 -0.38 mm  Principal fibers –Principal fibers – Collagenous .Collagenous . Arranged in bundlesArranged in bundles ..  Follow a wavy course.Follow a wavy course.  Terminal portionTerminal portion inserting into alveolar bone orinserting into alveolar
bone or cementum is termed ascementum is termed as SHARPEY’S FIBERS www.indiandentalacademy.comwww.indiandentalacademy.com
• 22. Periodontal ligamentPeriodontal ligament  Contents ofContents of PDLPDL 1-CELLS  Synthetic cellsSynthetic cells  Resorptive cellsResorptive cells  OsteoblastsOsteoblasts  OsteoclastsOsteoclasts  FibroblastsFibroblasts  CementoblastsCementoblasts  CementoclastsCementoclasts Cellular elements:
Connective tissue cells: Epithelial rests of Malassez. Cells associated with neurovascular elements. Progenitor cellsProgenitor cells OthersOthers Mast cells, Macrophages.Mast cells, Macrophages. www.indiandentalacademy.comwww.indiandentalacademy.com
• 23. 2-Extracellular substance Fibers- 1-collagen 2-oxytalin  Ground substance:Ground substance: ProteoglycansProteoglycans GlycoproteinsGlycoproteins  Blood vessels ,nerves ,lymphaticsBlood vessels ,nerves ,lymphatics www.indiandentalacademy.comwww.indiandentalacademy.com
• 24. What is Collagen? Proteins composed of amino acids- glycine, proline, hydroxyproline & hydroxylysine. Collagen in a tissue can be determined by its hydroxyproline content  Synthesized in fibroblasts,chondroblasts,osteoblasts.  Transverse striations at a periodicity of 640 Angstrom(overlapping of
tropocollagen molecules) www.indiandentalacademy.comwww.indiandentalacademy.com
• 25. Collagen  Tensile strength is greater than that ofTensile strength is greater than that of steelsteel  Principal fibers are composed of mainlyPrincipal fibers are composed of mainly type I collagentype I collagen  CollagenCollagen of PDL is turned over atof PDL is turned over at fastest rate among all
connectivefastest rate among all connective tissues of the bodytissues of the body www.indiandentalacademy.comwww.indiandentalacademy.com
• 26. Alveolar bone... www.indiandentalacademy.comwww.indiandentalacademy.com
• 27. Tooth can be moved through the alveolar boneTooth can be moved through the alveolar bone byby application of appropriate forces.application of appropriate forces. This raises the possibility of anyThis raises the possibility of any orthodontic treatment .orthodontic treatment . The tooth (solid object)
movesThe tooth (solid object) moves through a solid medium.through a solid medium. www.indiandentalacademy.comwww.indiandentalacademy.com
• 28.  Orthodontic force application leads toOrthodontic force application leads to tooth movement.tooth movement.  Leads to remodelling changes in dental &Leads to remodelling changes in dental & paradental tissues:paradental tissues:  PulpPulp  PDLPDL  Alveolar bone,Alveolar bone,  Gingiva.Gingiva.
www.indiandentalacademy.comwww.indiandentalacademy.com
• 29. Orthodontic toothOrthodontic tooth movementmovement Characterized by abrupt creation ofCharacterized by abrupt creation of Compression & Tension regions in theCompression & Tension regions in the PDL .PDL .  Movement can occur rapidly or slowly.Movement can occur rapidly or slowly. Depends on-
Depends on-  The physical characteristics of theThe physical characteristics of the applied force.applied force.  The size & biological response of PDL.The size & biological response of PDL. www.indiandentalacademy.comwww.indiandentalacademy.com
• 30. 1. CONTINUOUS1. CONTINUOUS  Force maintained at someForce maintained at some appreciable fractionappreciable fraction of theof the original from one patient visit to the next.original from one patient visit to the next.  Eg:In case of elastics worn continuously as prescribed.Eg:In case of elastics worn
continuously as prescribed. www.indiandentalacademy.comwww.indiandentalacademy.com
• 31. 2.Interrupted2.Interrupted  Force levelsForce levels decline to zerodecline to zero betweenbetween activations.activations.  Eg: Coil spring, e-chain if not changedEg: Coil spring, e-chain if not changed until patient’s next visit.until patient’s next visit.
www.indiandentalacademy.comwww.indiandentalacademy.com
• 32. 3.Intermittent3.Intermittent  Force levels declineForce levels decline abruptly to zeroabruptly to zero whenwhen appliance is removed.appliance is removed.  Eg:Hawleys plate, headgear etc. whenEg:Hawleys plate, headgear etc. when removed by the patientremoved by the patient..
www.indiandentalacademy.comwww.indiandentalacademy.com
• 33. Type of movementType of movement Force (gms)Force (gms) TippingTipping 50-7550-75 Bodily movementBodily movement 100-150100-150 Root up rightingRoot up righting 75-12575-125 RotationsRotations 50-7550-75 ExtrusionExtrusion 50-7550-75 IntrusionIntrusion 15-2515-25 Optimum forces for
differentOptimum forces for different types of tooth movementstypes of tooth movements www.indiandentalacademy.comwww.indiandentalacademy.com
• 34. EFFECTS OF FORCE MAGNITUDE: Time Event Light Pressure Heavy pressure   < 1 sec PDL fluid incompressible, alveolar bone bends, piezoelectric signals generated   1-2 sec PDL fluid expressed, tooth moves within PDL space 3-5 sec   Blood vessels within PDL partially compressed on pressure side, dilated on
tension side; PDL fibers and cells mechanically distorted Minutes   Bloods flow altered, oxygen tension begins to change; prostaglandin's and cytokines released Hours   Metabolic changes occurring: chemical messengers affect cellular activity, enzyme levels change ~4 hours   Increased cAMP levels detectable,
cellular differentiation begins within PDL ~2 days   Tooth movement beginning as osteoclasts/osteoblasts remodel bony socket   3-5 sec Blood vessels within PDL occlused on pressure side   Minutes Blood flow cut off to compressed PDL area   Hours Cell death in compressed area   3-5 days Cell differentiation in
adjacent marrow spaces, undermining resorption begins   7-14 days Undermining resorption removes lamina dura adjacent to compressed PDL, tooth movement occurs Physiologic response to sustain pressure against the tooth. www.indiandentalacademy.com
• 35.  Aim – Information of histological & chemical changesAim – Information of histological & chemical changes of orthodontic tooth movement.of orthodontic tooth movement.1111  Update on the recent development in cellular,Update on the recent development in cellular, molecular ,tissue & genetic reactions
in response tomolecular ,tissue & genetic reactions in response to orthodontic force application.orthodontic force application.  Process of remodeling in response to orthodonticProcess of remodeling in response to orthodontic force, of –force, of –  Bone, PDL, Gingiva.Bone, PDL, Gingiva.
• The tissues are exposed toThe tissues are exposed to MECHANICAL LOADINGMECHANICAL LOADING They vary in degree -They vary in degree - MAGNITUDEMAGNITUDE FREQUENCYFREQUENCY DURATION.DURATION. Express extensive macro &Express extensive macro & microscopic changes.microscopic changes. www.indiandentalacademy.comwww.indiandentalacademy.com
• 37. ORTHODONTIC FORCEORTHODONTIC FORCE  ““Force applied to teeth for the purposeForce applied to teeth for the purpose of effecting tooth movement , generallyof effecting tooth movement , generally having a magnitude lower than anhaving a magnitude lower than an orthopedic force”orthopedic force” www.indiandentalacademy.comwww.indiandentalacademy.com
• 38. www.indiandentalacademy.comwww.indiandentalacademy.com
• 39. www.indiandentalacademy.comwww.indiandentalacademy.com
• 40. Determinants of Skeletal homeostasis & Bone changes in OTM13  BMP- Bone morphogenic protein.  Cbfa1- Transcription factor ; Earliest marker of osteogenesis.  CGRA- Calcitonin gene related peptide.  ClCN7- Chloride channel 7.  CSF-1- Colony stimulating factor 1.  CTGF- Connective tissue growth factor.  ER- beta- Estrogen receptor beta .  GH – Growth Hormone.  GLAST- Glutamate /Aspartate transporter.  Hoxa 2/Msx-2- Homeobox gene.  IGF - Insulin like growth factor.  LRP 5 - Low density lipoprotein receptor –related protein 5.  NOS – Nitrous oxide synthetase.  OPG - Osteoprotegerin.  PGHS 2- Prostaglandin G/H
Synthetase.  PTH - Parathyroid Hormone.  RANK/RANKL- Receptor activator of nuclear factor kappa-b and Ligand.  S mad - Cytoplasmic signaling molecules.  SOST - Gene for sclerostin.  TGF beta –Transforming growth factor beta-family .  TNF/R - Tumor necrosis factor and receptor. www.indiandentalacademy.comwww.indiandentalacademy.com
• 41. Mechanical force induced 13 reciprocal communication b/w 5 environments of OTM www.indiandentalacademy.comwww.indiandentalacademy.com
• 42.  Forces alter the PDL vascularity & blood flow.Forces alter the PDL vascularity & blood flow.  Results in-Results in-  Synthesis & Release of key molecules-Synthesis & Release of key molecules-  Neurotransmitters, Cytokines, growthNeurotransmitters, Cytokines, growth factors,colony stimulating factors &factors,colony stimulating factors & arachidonic acid metabolites.arachidonic acid metabolites.  These molecules evoke cellular responses byThese molecules evoke cellular responses by various cell types in & around teeth.various cell types in & around teeth.  Provides favourable microenvironment forProvides favourable
microenvironment for tissue deposition or resorption.tissue deposition or resorption.www.indiandentalacademy.comwww.indiandentalacademy.com
• 43. ORTHOPEDIC FORCEORTHOPEDIC FORCE  Force of higher magnitude in relation toForce of higher magnitude in relation to an orthodontic force, when deliveredan orthodontic force, when delivered via teeth for 12 -16 hours/day, isvia teeth for 12 -16 hours/day, is supposed to produce a skeletal effectsupposed to produce a skeletal effect on the maxillofacial complex.on the maxillofacial complex. www.indiandentalacademy.comwww.indiandentalacademy.com
• 44. Orthodontic MechanotherapyOrthodontic Mechanotherapy  Aimed at tooth movementAimed at tooth movement  By remodeling & adaptive changes in theBy remodeling & adaptive changes in the paradental tissues.paradental tissues.  For this outcome small amount of forcesFor this outcome small amount of forces might be required- 20-150gm/tooth.might be required- 20-150gm/tooth. www.indiandentalacademy.comwww.indiandentalacademy.com
• 45. Craniofacial OrthopedicsCraniofacial Orthopedics  Aimed at delivering higher magnitudes ofAimed at delivering higher magnitudes of mechanical forces- > 300gms.mechanical forces- > 300gms.  This attempts to modify the form ofThis attempts to modify the form of craniofacial bones.craniofacial bones.  The appliances are calledThe appliances are called CRANIOFACIAL ORTHOPEDIC DEVICSCRANIOFACIAL ORTHOPEDIC DEVICS Delivers macroscale mechanical forcesDelivers macroscale mechanical forces Produce microstructural sutural bone strain &Produce microstructural sutural bone strain & Induce cellular growth response
in sutures.Induce cellular growth response in sutures. www.indiandentalacademy.comwww.indiandentalacademy.com
• 46. OPTIMAL ORTHODONTICOPTIMAL ORTHODONTIC FORCEFORCE  Mediated (settled /balanced) by coupling boneMediated (settled /balanced) by coupling bone resorption & deposition in compressed &resorption & deposition in compressed & stretched sides of the PDL.stretched sides of the PDL.  Forces alter the blood flow & localizedForces alter the blood flow & localized electrochemical environment.electrochemical environment.  Upsets the homeostatic environment of theUpsets the homeostatic environment of the PDL space.PDL space.  This abrupt alteration initiates biochemical &This abrupt alteration initiates
biochemical & cellular events which reshape the bonycellular events which reshape the bony contours of the alveolus.contours of the alveolus. www.indiandentalacademy.comwww.indiandentalacademy.com
• 47.  Optimum forces moves teeth efficiently inOptimum forces moves teeth efficiently in the desired position ,without causingthe desired position ,without causing discomfort or tissue damage to the patient.discomfort or tissue damage to the patient.  Basis of optimal forces –Basis of optimal forces – PROPER MECHANICAL PRINCIPLESPROPER MECHANICAL PRINCIPLES Enables clinician to move teethEnables clinician to move teeth 1.1. Without Traumatizing structures,Without Traumatizing structures, 2.2. Without moving dental roots redundantlyWithout moving dental roots redundantly (Round tipping) ; or(Round tipping) ; or 3.3.
Into danger zones.Into danger zones. www.indiandentalacademy.comwww.indiandentalacademy.com
• 48.  Schwarz,1932, “the force leading to aSchwarz,1932, “the force leading to a change in tissue pressure thatchange in tissue pressure that approximated the capillary vessel’s B.P.,approximated the capillary vessel’s B.P., thus preventing their occlusion in thethus preventing their occlusion in the compressed PDL.compressed PDL.  Force below optimum produce noForce below optimum produce no reaction .reaction .  Force above leads to Tissue Necrosis,Force above leads to Tissue Necrosis, preventing frontal resorption of thepreventing frontal resorption of the alveolar bone.alveolar bone.
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• 49.  Oppenheim (1942)& Reitan(1957).Oppenheim (1942)& Reitan(1957).  Recommended applying light forces..Recommended applying light forces..  Demonstrated cell free compressedDemonstrated cell free compressed areas in PDL.areas in PDL. www.indiandentalacademy.comwww.indiandentalacademy.com
• 50.  Storey & Smith( 1952).Storey & Smith( 1952).  Studied distal movement of Canine.Studied distal movement of Canine.  Recommended applying light forces..Recommended applying light forces..  When force isWhen force is >> Optimum.---Optimum.---  Rate-Rate-  Tooth movement appeared zero.Tooth movement appeared zero. www.indiandentalacademy.comwww.indiandentalacademy.com
• 51. Current concept ofCurrent concept of Optimum forceOptimum force Viewed as an extrinsic mechanicalViewed as an extrinsic mechanical stimulus, that evokes a cellularstimulus, that evokes a cellular response .response . Aims to restore equilibrium byAims to restore equilibrium by remodeling periodontal supportingremodeling periodontal supporting tissues.tissues. www.indiandentalacademy.comwww.indiandentalacademy.com
• 52.  OPTIMAL is considered hence-OPTIMAL is considered hence-  The mechanical input that leads toThe mechanical input that leads to max. rate of tooth movement withmax. rate of tooth movement with minimal irreversible damage tominimal irreversible damage to tooth, PDL & alveolar bone.tooth, PDL & alveolar bone. www.indiandentalacademy.comwww.indiandentalacademy.com
• 53. Theories of OrthodonticTheories of Orthodontic mechanismsmechanisms  Orthodontic tooth movement has beenOrthodontic tooth movement has been defined as the result of a biologic response todefined as the result of a biologic response to interference in the physiologic equilibrium ofinterference in the physiologic equilibrium of the dentofacial complex by an externallythe dentofacial complex by an externally applied force.applied force.  Two main mechanisms were proposed.Two main mechanisms were proposed.  Pressure Tension theory.Pressure Tension theory.  BONE BENDING THEORY.BONE BENDING THEORY.
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• 54. Pressure Tension theory.Pressure Tension theory. Sandstedt(1904),Oppenheim(1911),Sandstedt(1904),Oppenheim(1911), Schwarz(1932).Schwarz(1932). Hypothesized that a tooth moves in theHypothesized that a tooth moves in the periodontal space by generating aperiodontal space by generating a “pressure side” and a “tension side.”“pressure side” and a “tension side.” On the pressure side, the PDL displaysOn the pressure side, the PDL displays disorganization and diminution of fiberdisorganization and diminution of fiber production.production. Here, cell replication decreasesHere, cell replication decreases seemingly due to
vascular constriction.seemingly due to vascular constriction. www.indiandentalacademy.comwww.indiandentalacademy.com
• 55. On the tension side-On the tension side- Stimulation is produced byStimulation is produced by stretching of PDL fiber bundles.stretching of PDL fiber bundles. Results in an increase in cellResults in an increase in cell replication.replication. Due to this enhanced proliferativeDue to this enhanced proliferative activity it eventually leads to anactivity it eventually leads to an increase in fiber production .increase in fiber production . www.indiandentalacademy.comwww.indiandentalacademy.com
• 56. Schwarz concluded-Schwarz concluded- The forces delivered as part of orthodonticThe forces delivered as part of orthodontic treatment should not exceed the capillary bedtreatment should not exceed the capillary bed blood pressure -blood pressure - 20-25 g/cm20-25 g/cm22 of root surface.of root surface. If exceeding this pressure, compressionIf exceeding this pressure, compression could cause tissue necrosis by-could cause tissue necrosis by- ““Suffocation of the strangulatedSuffocation of the strangulated periodontium.”periodontium.” www.indiandentalacademy.comwww.indiandentalacademy.com
• 57. Early theories of tooth movementEarly theories of tooth movement Farrar Angle Breitner Sandstedt Sicher& Wienmann Brash www.indiandentalacademy.comwww.indiandentalacademy.com
• 58. Recent theoriesRecent theories22 Pressure -Tension Bioelectric Chemical signals Electric signals Strain in bone Strain in PDL FLUID DYNAMIC THEORYwww.indiandentalacademy.comwww.indiandentalacademy.com
• 59. Physiologic tooth movementPhysiologic tooth movement  Dental drift & tooth eruption.Dental drift & tooth eruption.  Slow processSlow process  Occurs mainly in buccal direction intoOccurs mainly in buccal direction into cancellous bone orcancellous bone or  Due to growth into cortical bone.Due to growth into cortical bone. www.indiandentalacademy.comwww.indiandentalacademy.com
• 60. FLUID DYNAMIC THEORY:  Proposed by Bien This theory is also called the blood flow theory.  Tooth movement occurs as a result of alterations in fluid dynamics in the periodontal ligament.  The contents of Periodontal ligament create unique hydrodynamic condition. www.indiandentalacademy.comwww.indiandentalacademy.com
• 61. STAGES OFSTAGES OF PRESSURE-TENSION THEORYPRESSURE-TENSION THEORY  1.Alterations in blood-flow.1.Alterations in blood-flow.  2.Formation or/and release of chemical2.Formation or/and release of chemical messengers.messengers.  3.Activation of cells.3.Activation of cells. www.indiandentalacademy.comwww.indiandentalacademy.com
• 62. Pressure-Tension theoryPressure-Tension theory www.indiandentalacademy.comwww.indiandentalacademy.com
• 63. THEORIES OF TOOTH MOVEMENT: Pressure-Tension Theory.  Schwartz in 1932.  Relies on Chemical rather than electric signals for cellular differentiation and tooth movement TOOTH ORTHODONTIC FORCE AREAS OF TENSION AREAS OF PRESSURE BONE DEPOSITION BONE RESORPTION www.indiandentalacademy.comwww.indiandentalacademy.com
• 64. Pressure-Tension theoryPressure-Tension theory FORCE Pressure sideTension side Changes in fibres Changes in vessels Changes in fibres Changes in vessels www.indiandentalacademy.comwww.indiandentalacademy.com
• 65. Areas of pressure Areas of tension www.indiandentalacademy.comwww.indiandentalacademy.com
• 66. Areas of pressure Areas of tension www.indiandentalacademy.comwww.indiandentalacademy.com
• 67. Pressure zone . . .Pressure zone . . . www.indiandentalacademy.comwww.indiandentalacademy.com
• 68. Changes in pressure zone2 compression of principal fibres Compression of blood vessels Decreased oxygen level Force Cellular response Partial ? Complete ? Dies? Lives ? PDL fliud expressed www.indiandentalacademy.comwww.indiandentalacademy.com
• 69. BONE RESORPTION :BONE RESORPTION :  FRONTALFRONTAL  UNDERMININGUNDERMINING www.indiandentalacademy.comwww.indiandentalacademy.com
• 70. Frontal resorption Application of ideal orthodontic force.Application of ideal orthodontic force. The resorption seen during toothThe resorption seen during tooth movement at the pressure site.movement at the pressure site. Here ,osteoclasts resorbs the bone.Here ,osteoclasts resorbs the bone. www.indiandentalacademy.comwww.indiandentalacademy.com
• 71. Undermining resorption: Application of heavy force (continuous).Application of heavy force (continuous). Blood vessels occlude.Blood vessels occlude. Results in sterile necrosis at the compressionResults in sterile necrosis at the compression site.site. The cells disappear.The cells disappear. Forms anForms an avascularavascular area.area. Termed as hyalinized zone.Termed as hyalinized zone. It does not form hyalinized tissue.It does not form hyalinized tissue. Devoid of cells & appears plain.Devoid of cells & appears plain. www.indiandentalacademy.comwww.indiandentalacademy.com
• 72. www.indiandentalacademy.comwww.indiandentalacademy.com
• 73.  Remodeling of bone adjacent to theRemodeling of bone adjacent to the necrotic area has to occur.necrotic area has to occur.  Achieved by deriving cells from theAchieved by deriving cells from the adjacent undamaged areas.adjacent undamaged areas.  The cellular elements from the undamagedThe cellular elements from the undamaged adjacent area include the necroticadjacent area include the necrotic ( Hyalinized) area.( Hyalinized) area.  This invasion of osteoclasts from the underThis invasion of osteoclasts from the under side of lamina- dura is termed asside of lamina- dura is termed as undermining
resorption.undermining resorption. www.indiandentalacademy.comwww.indiandentalacademy.com
• 74. Blood vessels3 Light force Heavy force Partial compression Complete occlusion Blood flow patent Blood flow cut off Chemical mediated cell response Necrosis Frontal resorption Undermining resorption O2 O2 www.indiandentalacademy.comwww.indiandentalacademy.com
• 75. PDL Os.cl Marrow Os.cl HFLF Frontal resorption Undermining resorption Cell action Cell deathwww.indiandentalacademy.comwww.indiandentalacademy.com
• 76. Tension zone . . .Tension zone . . . www.indiandentalacademy.comwww.indiandentalacademy.com
• 77. Changes in tension zone Stretching of periodontal fibres Dilatation of blood vessels Osteoblastic activity Force Bone formation www.indiandentalacademy.comwww.indiandentalacademy.com
• 78. Force Tension zone Bone formation Osteoblastic activity www.indiandentalacademy.comwww.indiandentalacademy.com
• 79. Pressure-Tension hypothesis...Pressure-Tension hypothesis... reconsidered.reconsidered. www.indiandentalacademy.comwww.indiandentalacademy.com
• 80. PDL is a continuous hydrostatic system with 3 distinct fluid compartments: a. cells of PDL b. vascular & lymph channels c. interstitial fluids Pressure – Tension hypothesis reconsideredPressure – Tension hypothesis reconsidered44 In keeping with Pascal’s Law, any force would be distributed evenly throughout the system. Bien www.indiandentalacademy.comwww.indiandentalacademy.com
• 81. Experiments to disprove : Pressure – Tension hypothesis reconsidered Systemically administered lathyritic agents to rats By Nanda & Heller: They disrupt collagen metabolism & function Histological response of alveolar bone to orthodontic force normal www.indiandentalacademy.comwww.indiandentalacademy.com
• 82. Experiments to disprove Pressure – Tension hypothesis reconsidered 5 Studied the rates of cell proloferation & collagen metabolism By Baumrind: No striking difference b/w tension & pressure sites Crown of the 1st molar displaced 10 times more than the reduction in PDL width. proposed an alternate hypothesis www.indiandentalacademy.comwww.indiandentalacademy.com
• 83. PDL is viscous & rubbery rather than watery.6 No objective evidence for the “squeezing out” of tissue fluids on pressure side PDL is a continuous system. Fluid if squeezed out in one area will squeeze out from other areas too. Few highlights . . . www.indiandentalacademy.comwww.indiandentalacademy.com
• 84. In accordance with universally operating physical laws, each of the 3 structure, is deformed. The amount of deformation produced is a function of elastic property of the material. The elastic property of the teeth is not been studied. Of the other 2 materials, bone deforms far more readily than the PDL.7 The alternative hypothesis . . . www.indiandentalacademy.comwww.indiandentalacademy.com
• 85. Bioelectric TheoryBioelectric Theory www.indiandentalacademy.comwww.indiandentalacademy.com
• 86. Force Bone bending Piezoelectric current Cell signal Cell activation Tooth movement Bone remodeling TheThe concept concept www.indiandentalacademy.comwww.indiandentalacademy.com
• 87. BONE BENDING AND PEIZOELECTRIC THEORY: * Phenomenon observed in many crystalline materials. * Deformation of crystals produces a flow of electric current. * When a force is applied to a crystalline structure (like bone or collagen), a flow of current is produced that quickly dies away. * When the force is released an opposite current flow is observed. * The piezoelectric effect results from migration of electrons within the crystal lattice. www.indiandentalacademy.comwww.indiandentalacademy.com
• 88. PiezoelectricityPiezoelectricity 22 2 properties Quick decay though force is maintained Produce equal & opp. signal on force release Sustained force or Rhythmic force www.indiandentalacademy.comwww.indiandentalacademy.com
• 89. Is pressure zone a pressure zone? www.indiandentalacademy.comwww.indiandentalacademy.com
• 90. Tension zone in alv. bone Compression Zone in alv. bone Demonstrations of Epker & FrostDemonstrations of Epker & Frost 88 www.indiandentalacademy.comwww.indiandentalacademy.com
• 91. Convergence of the two theories. www.indiandentalacademy.comwww.indiandentalacademy.com
• 92. Biologic Pathways9 Orthodontic forces Bone bending Tissue injury Piezoelectricity PGs Matrix charge polarization Os.clast-os.blast cAMP Inflammation Hydrolytic enzyme Collagenase RemodellingRemodelling Pressure-Tension www.indiandentalacademy.comwww.indiandentalacademy.com
• 93. Cell www.indiandentalacademy.com
• 94. Cell . . . Mitochondria Nucleus & nucleolus Granular & smooth ER Centrioles Microfilaments Microtubules Cell membrane Cytoplasm Lysosomes Ribosomes www.indiandentalacademy.com
• 95. The molecularThe molecular mechanism . . .mechanism . . . www.indiandentalacademy.com
• 96. Arachidonic acid Prostaglandins Leukotrienes Cyclic nucleotides Cytokines www.indiandentalacademy.com
• 97. • FORCE • E C Matrix • Cell membrane • Cytoplasm • Signals NUCLEUS www.indiandentalacademy.com
• 98. ECM Cell . . . Changes inChanges in ECMECM Changes inChanges in membranemembrane Changes inChanges in organellesorganelles Nuclear changesNuclear changes StimulusStimulus www.indiandentalacademy.com
• 99. What is ECM . . . www.indiandentalacademy.com
• Cell membrane . . . IntegrinsIntegrins PhospholipidsPhospholipids Channel proteinsChannel proteins www.indiandentalacademy.com
• 101. MEMBRANE PHOSPHOLIPID ARACHIDONIC ACID PHOSPHOLIPASE A MECHANICAL / ELECTRIC STIMULI COX LOX PROSTAGLANDINS LEUKOTRIENES AA pathway simplified . . .AA pathway simplified . . . 12,14 www.indiandentalacademy.com
• 102. PROSTAGLANDINS www.indiandentalacademy.com
• 103. Prostaglandins . . . Discovered by Von Euler in 1934 as a product of prostate gland Produced by most cells including PDL cells Vasodilatation, inflammation , metabolic reactions, promotes Ca+ mobilization from bone . . . Stimulate osteoclastic bone resorption www.indiandentalacademy.com
• 104. Prostaglandins 14 . . . action is mediated by cyclic nucleotides intracellularly acts on adenylate cyclase, a membrane bound enzyme PGE2 participates in orthodontic tooth movement studies reveals that they cause bone formation too. www.indiandentalacademy.com
• 105. Enter the cell . . . www.indiandentalacademy.com
• 106. 2 pathways cAMP Phosphoinositide www.indiandentalacademy.com
• 107. Cyclic AMP. . . as 2nd messenger REF: U Sathyanarayana . Biochemistry ; Books & Allied (P) Ltd. second messenger of intracellular signalling discovered by Earl Sutherland (noble prize) membrane bound adenylate cyclase coverts ATP to cAMP. consists of adenine, ribose & a phosphate www.indiandentalacademy.com
• 108. Shape change . . . REF: J.R.Sandy et al. Recent advances in under standing mechanically induced bone remodeling & their relevance to orthodontic theory & practice.AJO 1993;103:212-222 metabolic activity of a cell is also related to its shape change `phorbol esters cause rounding of fibroblasts leading to altered gene expression, causing increased collagenase & decreased collagen. PGs & PTH induce changes in microfilament system REF:J.R.Sandy.Tooth eruption & orthodontic movement. Br Dent J 1992:172;141-149 TGF-ß induces shape change
in osteoblasts (alkaline phosphatase activity) www.indiandentalacademy.com
• 109. Shape change . . . REF: J.R.Sandy et al. Recent advances in under standing mechanically induced bone remodeling & their relevance to orthodontic theory & practice.AJO 1993;103:212-222 mechanical force causes changes in cytoskeleton by reducing tubulin & thus mediates mechanical stress pressure sites has rounded cells & have catabolic effects tension sites has flattened cells & have synthetic effect REF:J.R.Sandy.Tooth eruption & orthodontic movement. Br Dent J 1992:172;141-149 flattened cells synthesize more DNA than rounded cells
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• 110. Summary of events www.indiandentalacademy.com
• 111. 3 messengers.3 messengers. REF:Lee W.Graber.Orthodontics State of the Art Essence of the Science:Mosby; !986;Pg.101-102 2 steps;2 steps; ExtracellularExtracellular signallingsignalling IntracellularIntracellular signallingsignalling Electric / chemical / bothElectric / chemical / both cAMP & CalciumcAMP & Calcium 1 2 Enzymes activated byEnzymes activated by Protein kinasesProtein kinases 3 www.indiandentalacademy.com
• 112. Influencing factors . . . www.indiandentalacademy.com
• 113. Factors affecting tooth movement . . . Heat Vitamins Drugs Hormones www.indiandentalacademy.com
• 114. Heat 18 helical coil springs were used to separate incisors of white rabbits & subjected to heat incisors were seperated a distance nearly twice that of the controls osteoclastic & osteoblastic activity was more in bone disorganization of PDL fibres was more on pressure side in heated animals locally applied heat increases rate of tooth movement www.indiandentalacademy.com
• 115. Vitamins www.indiandentalacademy.com
• 116. Vitamin C REF: StephenF.Litton Orthodontic tooth movement during an ascobic acid deficiency.AJO 1974 65;290-302 essential for hydroylation of proline & lysine hydroxyproline & hydroxylysine is essential for collagen cross linking & fiber strength hydroxyproline & hydroxylysine is essential for collagen cross linking & fiber strength Deficiency reduces rates of tooth movement www.indiandentalacademy.com
• 117. Hormone s www.indiandentalacademy.com
• 118. Calcitriol REF: T.Takano-Yamamoto et al.Effect of rate of tooth movement with local use of 1,25(OH)2D3;J DentRes71(8);1487-1492,Aug,1992 Rapid appearance of multinucleated osteoclasts on the compression side no lag phase faster tooth movement physiologically active form of Vitamin D stimulates Ca uptake by osteoblasts & promotes remodeling www.indiandentalacademy.com
• 119. REF: Gianelly A.a & Schnur,R.M : Parathyroid hormone effects on Orthodontic tooth movement (Abstract).AJO 1971 50;A259 Parathormone PTH causes demineralization of bone by osteoclasts function is to elevate serum Ca stimulates the enzymes pyrophosphatase & collagenase rat experiments reveals that local use of PTH prior to force application enhances tooth movement www.indiandentalacademy.com
• 120. Drugs Biphosphonates Corticosteroids NSAIDs www.indiandentalacademy.com
• 121. biphosphanates inhibits osteoclast – mediated bone formation osteoporesis is a problem in post menopausal females & aged persons of both genders physician consultation to switch over to estrogen therapy in older women is required REF: William R. Profitt. Contemporary Orthodontics ; 3rd ed.Pg.300-301 Biphosphonates are used in the treatment of osteoporesis Biphosphonates www.indiandentalacademy.com
• 122. REF: Lin Liu et al ; Effects of local administartion of clodronate on orthodontic tooth movement & root resorption in rats;EJO 26(2004)469-473 Clodronate is an anti-resorptive & anti – inflammatory drug used in the treatment of metabolic bone disease suppress signs of inflammation , inhibits production & release of cytokines & PGs in osteoblasts local use caused reduction in tooth movement less osteoblasts in injected site ongoing reasearch on its beneficial effects Biphosphonates www.indiandentalacademy.com
• 123. used in treatment of asthma, arthritis, and renal transplantations16 Corticosteroids reduce PGs synthesis by inhibiting production of arachidonic acid REF: William R. Profitt. Contemporary Orthodontics ; 3rd ed.Pg.300-301 www.indiandentalacademy.com
• 124. NSAIDs Aspirin routinely used in cardiac patients prophylactic drug in aged persons to prevent cardiac arrest aspirin inhibits the conversion of arachidonic acid to prostaglandins slows the rate of orthodontic tooth movement www.indiandentalacademy.com
• 125. Indomethacin19 REF: PGs plays an important role in bone resorption during orthodontic tooth movement indomethacin is a PG inhibitor used in arthritis inhibits prostaglandin synthetase, collagenase & phopsphodiesterase oral administration of indomethacin in experimental animals slowed the rate of tooth movement NSAIDs www.indiandentalacademy.com
• 126. Miscellaneous Tricyclic anti-depressents Anti-arrhythmic agents Anti-malarial drugs Methyl xanthines Anti-convulsant drugs Doxycycline PGsPGs OsteoClastsOsteoClasts www.indiandentalacademy.com
• 127. “The two theories are neither incompatible nor mutually exclusive. From a contemporary perspective, it appears that both mechanisms may play a part in the biologic control of tooth movement.” William R. Profitt www.indiandentalacademy.comwww.indiandentalacademy.com
• 128. The application of a force to a tooth can stimulateThe application of a force to a tooth can stimulate the process of alveolar bone resorption by creatingthe process of alveolar bone resorption by creating areas of pressure in the attachment apparatus.areas of pressure in the attachment apparatus. The cellular mechanisms are the same even whenThe cellular mechanisms are the same even when there are two forms of resorption (frontal andthere are two forms of resorption (frontal and undermining) which have been described
andundermining) which have been described and related, in part, to the magnitude of the appliedrelated, in part, to the magnitude of the applied force.force.11 www.indiandentalacademy.comwww.indiandentalacademy.com
• 129. Functions of PDLFunctions of PDL  PhysicalPhysical  Formative & remodellingFormative & remodelling  Nutritional & sensoryNutritional & sensory www.indiandentalacademy.comwww.indiandentalacademy.com
• 130.  Hour glass appearance thinnest in midHour glass appearance thinnest in mid root portionroot portion  This suggests that middle portion is theThis suggests that middle portion is the fulcrum of physiologic tooth movementfulcrum of physiologic tooth movement www.indiandentalacademy.comwww.indiandentalacademy.com
• 131. Alveolar processAlveolar process  It is the portion of maxilla & mandibleIt is the portion of maxilla & mandible that forms and supports the tooththat forms and supports the tooth socketssockets  It consists of ---alveolar bone properIt consists of ---alveolar bone proper (cribriform plate or lamina dura )(cribriform plate or lamina dura ) --external plate of cortical bone--external plate of cortical bone --spongy /cancellous bone filled--spongy /cancellous bone filled between cribriform &cortical platebetween cribriform &cortical plate
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• 132. www.indiandentalacademy.comwww.indiandentalacademy.com
• 133.  CompositionComposition Inorganic –65%Inorganic –65% Organic -35%Organic -35% In organicIn organic Collagen- 90%Collagen- 90% Non collagenous proteins likeNon collagenous proteins like Osteocalcin, osteonectin,Osteocalcin, osteonectin, Bone morphogenetic-protein- 10 %Bone morphogenetic-protein- 10 % Phosphoproteins, ProteoglycansPhosphoproteins, Proteoglycans Lipids - 0.4%Lipids - 0.4%www.indiandentalacademy.comwww.indiandentalacademy.com
• 134.  Bone marrow –Bone marrow – Common locations - maxillary tuberosity,andCommon locations - maxillary tuberosity,and maxillary and mandibular molar & premolar areamaxillary and mandibular molar & premolar area (these areas may be visible radiographically as zones of radiolucency)(these areas may be visible radiographically as zones of radiolucency)  Periosteum & Endosteum –Periosteum has aPeriosteum & Endosteum –Periosteum has a inner layer composed of cells that haveinner layer composed of cells that have potential to
differentiate into osteoblasts &potential to differentiate into osteoblasts & outer layer rich in blood vessels, nerves andouter layer rich in blood vessels, nerves and fibersfibers  Bundles of periosteal collagen fibers penetrateBundles of periosteal collagen fibers penetrate the bone binding periosteum to bonethe bone binding periosteum to bone  Endosteum is composed of single layer ofEndosteum is composed of single layer of osteoprogenitor cells and connective tissueosteoprogenitor cells and connective
tissuewww.indiandentalacademy.comwww.indiandentalacademy.com
• 135. CementumCementum  It is a mineralized dental tissue.It is a mineralized dental tissue.  Covers the anatomic roots of human teeth.Covers the anatomic roots of human teeth.  It furnishes [provides] a medium for the attachment of collagen fibers which binds the tooth to surrounding structures  It is a specialized connective tissue that shares some physical ,chemical and structural characteristics with compact bone ,unlike bone ,cementum is avascular www.indiandentalacademy.comwww.indiandentalacademy.com
• 136. Cementum  Cementum is thinnest at cementoenamel junction - 20-50 mu &  Thickest at the apex 150-200 mu.  More resistant to resorption than bone ,  For this reason the orthodontic tooth movement is possible.  The difference in resistance of bone and cementum to pressure may be caused by the fact that bone is richly vascularized www.indiandentalacademy.comwww.indiandentalacademy.com
• 137. Physiologic Tooth MovementPhysiologic Tooth Movement  It designates slight tipping of functioningIt designates slight tipping of functioning teeth in their socket and also the changes inteeth in their socket and also the changes in tooth position that occur in young personstooth position that occur in young persons during and after tooth eruptionduring and after tooth eruption  New tissue deposited during tooth migrationNew tissue deposited during tooth migration represents various stages of calcificationrepresents various stages of
calcification * osteoid* osteoid ** Bundle boneBundle bone ** Lamellated boneLamellated bone www.indiandentalacademy.comwww.indiandentalacademy.com
• 138.  Osteoid –Osteoid – Appears as white line or outgrowth ,it isAppears as white line or outgrowth ,it is uncalcified and not resorbed byuncalcified and not resorbed by osteoclastsosteoclasts www.indiandentalacademy.comwww.indiandentalacademy.com
• 139.  Bundle bone –Bundle bone – Newly calcified tissue ,as well as ofNewly calcified tissue ,as well as of longer existence .longer existence . It is basophilic ,it is characterized byIt is basophilic ,it is characterized by scarcity of fibrils in the intercellularscarcity of fibrils in the intercellular substance therfore it appears dark insubstance therfore it appears dark in routine hematoxylin & eosin stains .routine hematoxylin & eosin stains . www.indiandentalacademy.comwww.indiandentalacademy.com
• 140.  Lamellated bone –Lamellated bone – Cells & fiber bundles get incorporated inCells & fiber bundles get incorporated in bundle bone during its life cycle .bundle bone during its life cycle . When it has reached a certain thicknessWhen it has reached a certain thickness and maturity , parts of the bundle boneand maturity , parts of the bundle bone will be reorganised into lamellated bone.will be reorganised into lamellated bone. www.indiandentalacademy.comwww.indiandentalacademy.com
• 141. Fills gap between fibers and cells Two main components: 1 Glycoaminoglycans : Hyaluronic acid and proteoglycans. 2 Glycoproteins: Fibronectin and leminin 3 High water content GROUND SUBSTANCEGROUND SUBSTANCE www.indiandentalacademy.comwww.indiandentalacademy.com
• 142. On application of even greater forceOn application of even greater force levelslevels There is physical contact between teethThere is physical contact between teeth and bone.and bone. Leading to –Leading to – 1.Resorption in areas of pressure &1.Resorption in areas of pressure & 2.Undermining resorption or2.Undermining resorption or hyalinization inhyalinization in adjacent marrow spaces.adjacent marrow spaces. www.indiandentalacademy.comwww.indiandentalacademy.com
• 143. Histologic Studies ofHistologic Studies of Periodontium.Periodontium. Postulates that the width changes in thePostulates that the width changes in the PDL cause changes in cell population.PDL cause changes in cell population. There is increases in cellular activity.There is increases in cellular activity. There is an apparent disruption ofThere is an apparent disruption of collagen fibers in the PDL.collagen fibers in the PDL. Evidence of cell and tissue damage.Evidence of cell and tissue damage.
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• 144. Hyalinization is seen. There is the presence of pyknotic nuclei in cells, followed by areas of acellularity, or cell-free zones. www.indiandentalacademy.comwww.indiandentalacademy.com
• 145. undermining resorptionundermining resorption The problem is resolved when cellular elements such as macrophages, foreign body giant cells & osteoclasts invade the necrotic tissue. They invade from adjacent undamaged areas. These cells resorb the underside of bone just adjacent to the necrotic PDL area. Remove it together with the necrotic tissue. This process is undermining resorption www.indiandentalacademy.comwww.indiandentalacademy.com
• 146. frontal resorptionfrontal resorption Osteoclasts line up in the margin of the alveolarOsteoclasts line up in the margin of the alveolar bone adjacent to the compressed PDL, &bone adjacent to the compressed PDL, & produce direct bone resorption.produce direct bone resorption. This is known asThis is known as frontal resorptionfrontal resorption www.indiandentalacademy.comwww.indiandentalacademy.com
• 147. According to authors: When an orthodontic appliance is activated, forces delivered to the tooth are transmitted to all tissues near force application. These forces bend bone, tooth, and the solid structures of the PDL. Bone was found to be more elastic than the other tissues . Bends far more readily in response to force application. www.indiandentalacademy.comwww.indiandentalacademy.com
• 148. The active biologic processes thatThe active biologic processes that follow bone bending involve:follow bone bending involve: Bone turnover &Bone turnover & Renewal of cellular and inorganicRenewal of cellular and inorganic fractions.fractions. These processes are accelerated whileThese processes are accelerated while thethe bone is held in the deformed position.bone is held in the deformed position. www.indiandentalacademy.comwww.indiandentalacademy.com
• 149. Authors further stated that:Authors further stated that: ““reorganization proceeds not only at thereorganization proceeds not only at the lamina dura of the alveolus, but alsolamina dura of the alveolus, but also onon thethe surface of every trabaculumsurface of every trabaculum within thewithin the corpus of bone.”corpus of bone.” The force delivered to the tooth isThe force delivered to the tooth is dissipateddissipated throughout the bone by development ofthroughout the bone by development
ofwww.indiandentalacademy.comwww.indiandentalacademy.com
• 150. Further force application becomes aFurther force application becomes a stimulus for altered biological responses ofstimulus for altered biological responses of cells lying perpendicular to the stress lines.cells lying perpendicular to the stress lines. The altered activity of cells in turn modifiesThe altered activity of cells in turn modifies the shape and internal organization of bone,the shape and internal organization of bone, to accommodate the exogenous forcesto accommodate the exogenous forces acting on it.acting on it.
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• 151. With this this theory, & fromWith this this theory, & from Wolff’sWolff’s law,these authors could explainlaw,these authors could explain certain facts.certain facts. www.indiandentalacademy.
• 1-The relative slowness of en-masse tooth1-The relative slowness of en-masse tooth movementmovement {Here much bone flexion is needed for the rapidity of{Here much bone flexion is needed for the rapidity of alignment of crowded teeth, and when thinness makesalignment of crowded teeth, and when thinness makes bone flexion easier}.bone flexion easier}. 2- The rapidity of tooth movement toward an extraction2- The rapidity of tooth movement toward an extraction site &site & 3-The relative rapidity of tooth movement in children,3-The relative rapidity of tooth movement in
children, who have less heavily calcified and more flexiblewho have less heavily calcified and more flexible bones than adults.bones than adults. www.indiandentalacademy.comwww.indiandentalacademy.com
• 153. Zengo et al (1974),Bassett and BeckerZengo et al (1974),Bassett and Becker (1962)(1962) & Pollack et al (1984) demonstrated that& Pollack et al (1984) demonstrated that orthodontic canine tipping, bends theorthodontic canine tipping, bends the alveolaralveolar Bone.creating on it concave and convexBone.creating on it concave and convex surfaces identical to those generated insurfaces identical to those generated in bentbent long bones.long bones. www.indiandentalacademy.comwww.indiandentalacademy.com
• 154. In areas of PDL tension, the interfacingIn areas of PDL tension, the interfacing bone surface assumes a concavebone surface assumes a concave configuration.configuration. Here the molecules are compressed.Here the molecules are compressed. In zones of compressed PDL, the adjacentIn zones of compressed PDL, the adjacent alveolar bone surface becomes convex.alveolar bone surface becomes convex. There is no contradiction between theThere is no contradiction between the response of alveolar bone and other partsresponse of alveolar bone and other parts ofof the skeleton to
mechanical loading.the skeleton to mechanical loading. www.indiandentalacademy.comwww.indiandentalacademy.com
• 155. There lies some confusion due toThere lies some confusion due to usage of same descriptions forusage of same descriptions for different tissues.different tissues. Orthodontic tension refers to the PDL,Orthodontic tension refers to the PDL, an orthopedist might say that thean orthopedist might say that the area is under compression, becausearea is under compression, because the bone near the stretched PDL hasthe bone near the stretched PDL has become concave.become concave. www.indiandentalacademy.comwww.indiandentalacademy.com
• 156. Bioelectric signals inBioelectric signals in orthodontic toothorthodontic tooth movementmovement Bassett and Becker (1962) proposed that, inBassett and Becker (1962) proposed that, in response to applied mechanical forces,response to applied mechanical forces, there is generation of electric potentials inthere is generation of electric potentials in the stressed tissues.the stressed tissues. These potentials might chargeThese potentials might charge macromolecules that interact with specificmacromolecules that interact with specific sites in cell membranes or mobilize ionssites in cell
membranes or mobilize ions across cell membranes.across cell membranes. www.indiandentalacademy.comwww.indiandentalacademy.com
• 157. Zengo et al (1974) measured theZengo et al (1974) measured the electric potential in mechanicallyelectric potential in mechanically stressed dog alveolar bone during in-stressed dog alveolar bone during in- vivo and in-vitro experiments.vivo and in-vitro experiments. www.indiandentalacademy.comwww.indiandentalacademy.com
• 158. It has been proposed by Davidovitch etIt has been proposed by Davidovitch et al that a physical relationship existsal that a physical relationship exists between mechanical and electricalbetween mechanical and electrical perturbation of bone.perturbation of bone. www.indiandentalacademy.comwww.indiandentalacademy.com
• 159. Bending of bone causes 2 classes ofBending of bone causes 2 classes of stress-generated electrical effects.stress-generated electrical effects. Their experiments with exogenousTheir experiments with exogenous electrical currents in conjunction withelectrical currents in conjunction with orthodontic forces demonstrated :orthodontic forces demonstrated : -enhanced cellular activities in the PDL-enhanced cellular activities in the PDL -alveolar bone, as well as rapid tooth-alveolar bone, as well as rapid tooth movement.movement.
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• 160. These findings suggest that bioelectricThese findings suggest that bioelectric responses (piezoelectricity andresponses (piezoelectricity and streaming potentials) which arestreaming potentials) which are propagated by bone bending in relationpropagated by bone bending in relation to orthodontic force application mightto orthodontic force application might function as pivotal cellular firstfunction as pivotal cellular first messengers.messengers. www.indiandentalacademy.comwww.indiandentalacademy.com
• 161. Piezoelectricity is a phenomenon observedPiezoelectricity is a phenomenon observed in many crystalline materials, in which ain many crystalline materials, in which a deformation of a crystal structure producesdeformation of a crystal structure produces a flow of electric current as electrons area flow of electric current as electrons are displaced from 1 part of the lattice todisplaced from 1 part of the lattice to another.another. www.indiandentalacademy.comwww.indiandentalacademy.com
• 162. The 2 unusual properties of piezoelectricity, whichThe 2 unusual properties of piezoelectricity, which seem to not correlate well with orthodontic toothseem to not correlate well with orthodontic tooth movement are:movement are: 1-A quick decay rate,1-A quick decay rate, (where the electron transfer from 1 area to another, after force application(where the electron transfer from 1 area to another, after force application reverts back when the force is removed This is not desirable once orthodonticreverts back when the force is removed This is not desirable once orthodontic treatment is
over.)treatment is over.) 22-Production of an equivalent signal in the opposite-Production of an equivalent signal in the opposite direction upon force removal.direction upon force removal. www.indiandentalacademy.comwww.indiandentalacademy.com
• 163. When mechanical forces are applied, theseWhen mechanical forces are applied, these respond concomitantly, resulting in tissuerespond concomitantly, resulting in tissue remodeling:remodeling: Cells &Cells & Extracellular matrix of the PDL and alveolarExtracellular matrix of the PDL and alveolar bone.bone. At early phases of tooth movement, PDL fluids areAt early phases of tooth movement, PDL fluids are shifted.shifted. Produces:Produces: Cell and matrix distortions.Cell and matrix distortions. Interactions between these tissueInteractions between these tissue
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• 164. In response to these physicochemicalIn response to these physicochemical events and interactions,there is release of-events and interactions,there is release of- Cytokines,Cytokines, Growth factors,Growth factors, Colony-stimulating factors,&Colony-stimulating factors,& Vasoactive neurotransmitters.Vasoactive neurotransmitters. This initiates and sustains the remodelingThis initiates and sustains the remodeling activity.activity. This facilitates tooth movement.This facilitates tooth movement. www.indiandentalacademy.comwww.indiandentalacademy.com
• 165. PHASES OF TOOTHPHASES OF TOOTH MOVEMENTMOVEMENT Burstone (1962)Burstone (1962) If the rates of tooth movement wereIf the rates of tooth movement were plotted against time, there wouldplotted against time, there would be 3 phases of tooth movement—be 3 phases of tooth movement— Initial phase,Initial phase, Lag phase, andLag phase, and Postlag phase.Postlag phase. www.indiandentalacademy.comwww.indiandentalacademy.com
• 166. Initial phaseInitial phase Characterized by rapid movement or toothCharacterized by rapid movement or tooth Occurs immediately after the application of forceOccurs immediately after the application of force This rate can be largely due to the displacement of theThis rate can be largely due to the displacement of the tooth in the PDL space.tooth in the PDL space. www.indiandentalacademy.comwww.indiandentalacademy.com
• 167. LAG PHASELAG PHASE Immediately after the initial phase, there is a lagImmediately after the initial phase, there is a lag period, with relatively low rates of tooth displacementperiod, with relatively low rates of tooth displacement or no displacement. It has been suggested that the lagor no displacement. It has been suggested that the lag isis produced by hyalinization of the PDL in areas ofproduced by hyalinization of the PDL in areas of compression. No further tooth movement occurs untilcompression. No further tooth movement occurs until cells complete the removal of all necrotic
tissues.cells complete the removal of all necrotic tissues. www.indiandentalacademy.comwww.indiandentalacademy.com
• 168. postlag phasepostlag phase  The third phase of tooth movementThe third phase of tooth movement follows the lag period.follows the lag period.  The rate of movement gradually orThe rate of movement gradually or suddenly increases.suddenly increases. www.indiandentalacademy.comwww.indiandentalacademy.com
• 169. Recent studies have proposed a newRecent studies have proposed a new time/displacement model for toothtime/displacement model for tooth movement.movement. Beagles.Beagles. Divided the curve of tooth movementDivided the curve of tooth movement intointo 4 phases4 phases.. The first phase lasts 24 hours to 2The first phase lasts 24 hours to 2 days and represents the initialdays and represents the initial movement of the tooth inside itsmovement of the tooth inside its bony www.indiandentalacademy.comwww.indiandentalacademy.com
• 170. Followed by a second phase:Followed by a second phase: Tooth movement stops for 20 to 30Tooth movement stops for 20 to 30 days.days. After theAfter the removal of necrotic tissueremoval of necrotic tissue formedformed during the second phase, tooth movementduring the second phase, tooth movement is accelerated in the third phase andis accelerated in the third phase and continues into the fourth phase.continues into the fourth phase. www.indiandentalacademy.comwww.indiandentalacademy.com
• 171. The third and fourth phases compriseThe third and fourth phases comprise most of the total tooth movementmost of the total tooth movement during orthodontic treatment.during orthodontic treatment. Cellular and tissue reactions start inCellular and tissue reactions start in the initial phase of tooth movement,the initial phase of tooth movement, immediately after force application.immediately after force application. www.indiandentalacademy.comwww.indiandentalacademy.com
• 172. By the compression and stretch of fibersBy the compression and stretch of fibers and cells in PDL pressure and tensionand cells in PDL pressure and tension areas,areas, respectively,the complex process ofrespectively,the complex process of recruitment of osteoclast and osteoblastrecruitment of osteoclast and osteoblast progenitors, as well as extravasation andprogenitors, as well as extravasation and chemoattraction of inflammatory cells,chemoattraction of inflammatory cells, begins.begins. www.indiandentalacademy.comwww.indiandentalacademy.com
• 173. In the second phase, areas of compression areIn the second phase, areas of compression are easilyeasily recognized by the distorted appearance of therecognized by the distorted appearance of the normalnormal PDL fiber arrangement. The disruption in bloodPDL fiber arrangement. The disruption in blood flowflow due to this distortion leads to the developmentdue to this distortion leads to the development ofof hyalinized areas and the arrest of toothhyalinized areas and the arrest of tooth movement,movement, which can last from 4 to 20 days.which can last from 4 to 20 days.
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• 174. On removal of necrotic tissue andOn removal of necrotic tissue and bone resorption from adjacentbone resorption from adjacent marrow spaces (indirect resorption)marrow spaces (indirect resorption) and from the direction of the viableand from the direction of the viable PDL (undermining resorption) allowPDL (undermining resorption) allow the resumption of tooth movement.the resumption of tooth movement. www.indiandentalacademy.comwww.indiandentalacademy.com
• 175. This process requires recruitment ofThis process requires recruitment of phagocytic cells –phagocytic cells – Macrophages,Macrophages, Foreign body giant cells,Foreign body giant cells, OsteoclastsOsteoclasts -From adjacent undamaged areas-From adjacent undamaged areas of the PDL.of the PDL. -Alveolar bone marrow cavities.-Alveolar bone marrow cavities. These cells remove necrotic tissues fromThese cells remove necrotic tissues from compressed PDL sites and adjacent alveolar bone.compressed PDL sites and adjacent alveolar bone.
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• 176. areas of PDL tensionareas of PDL tension Here quiescent osteoblasts (bone surfaceHere quiescent osteoblasts (bone surface lininglining cells) are enlarged.cells) are enlarged. Start producing new bone matrix.Start producing new bone matrix. (osteoid)(osteoid).. New osteoblast progenitors are recruitedNew osteoblast progenitors are recruited from the fibroblast-like cells (pericytes)from the fibroblast-like cells (pericytes) around PDL capillaries.around PDL capillaries. www.indiandentalacademy.comwww.indiandentalacademy.com
• 177. These PreosteoblastsThese Preosteoblasts -Proliferate-Proliferate -Migrate-Migrate toward the alveolar bone surface, alongtoward the alveolar bone surface, along the stretched Sharpey’s fibers.the stretched Sharpey’s fibers. Simultaneously, PDL fibroblasts in tensionSimultaneously, PDL fibroblasts in tension zones begin multiplying and remodeling theirzones begin multiplying and remodeling their surrounding matrix.surrounding matrix. www.indiandentalacademy.comwww.indiandentalacademy.com
• 178. acceleration and linearacceleration and linear phasesphases 33rdrd & 4& 4thth Phase.Phase. Acceleration and Linear phases .Acceleration and Linear phases . Start about 40 days after the initialStart about 40 days after the initial force application.force application. The pressure sides of teeth exhibitThe pressure sides of teeth exhibit collagen fibers without propercollagen fibers without proper orientation.orientation. www.indiandentalacademy.comwww.indiandentalacademy.com
• 179. Here, irregular bone surfaces areHere, irregular bone surfaces are found, indicating direct or frontalfound, indicating direct or frontal resorption.resorption. www.indiandentalacademy.comwww.indiandentalacademy.com
• 180. Some report presented data onSome report presented data on hyalinization zones at the pressure areashyalinization zones at the pressure areas even during this stage, especially in areaseven during this stage, especially in areas where high forces were applied.where high forces were applied. This finding suggests that the developmentThis finding suggests that the development and removal of necrotic tissue is aand removal of necrotic tissue is a continuous process during toothcontinuous process during tooth displacement, not a single event.displacement, not a single event.
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• 181. Melsen’s hypothesis supports this-Melsen’s hypothesis supports this- ““indirect bone resorption at the pressure side is notindirect bone resorption at the pressure side is not a reaction to force but an attempt to removea reaction to force but an attempt to remove ischemic bone lying adjacent to the hyalinizedischemic bone lying adjacent to the hyalinized tissue.tissue. The direct bone resorption could be considered partThe direct bone resorption could be considered part of the remodeling process.”of the remodeling process.” The tension sides in the third and fourth phasesThe tension
sides in the third and fourth phases clearly show bone deposition.clearly show bone deposition. www.indiandentalacademy.comwww.indiandentalacademy.com
• 182. SIGNALING MOLECULES AND METABOLITES INSIGNALING MOLECULES AND METABOLITES IN ORTHODONTIC TOOTH MOVEMENTORTHODONTIC TOOTH MOVEMENT Early phase of orthodontic tooth movementEarly phase of orthodontic tooth movement involves an acute inflammatory response.involves an acute inflammatory response. Characterized by:Characterized by: Periodontal vasodilatation and ,Periodontal vasodilatation and , Migration of leucocytes out of the capillaries.Migration of leucocytes out of the capillaries. These migratory cells produce various cytokines.These migratory
cells produce various cytokines. They are local biochemical signal molecules, thatThey are local biochemical signal molecules, that interact directly or indirectly with the entireinteract directly or indirectly with the entire population of native paradental cells.population of native paradental cells. www.indiandentalacademy.comwww.indiandentalacademy.com
• 183. Cytokines evoke the synthesis andCytokines evoke the synthesis and secretion of numerous substances bysecretion of numerous substances by their target cells, includingtheir target cells, including prostaglandins, growth factors,prostaglandins, growth factors, and cytokines.and cytokines. www.indiandentalacademy.comwww.indiandentalacademy.com
• 184. These cells comprise the functionalThese cells comprise the functional units that remodel the paradentalunits that remodel the paradental tissues and facilitate toothtissues and facilitate tooth movement.movement. www.indiandentalacademy.comwww.indiandentalacademy.com
• 185. Arachidonic acid metabolitesArachidonic acid metabolites Arachidonic (eicosatetraenoic) acid,Arachidonic (eicosatetraenoic) acid, the main component of phospholipidsthe main component of phospholipids of the cell membrane, is released dueof the cell membrane, is released due to the action of phospholipaseto the action of phospholipase enzymes.enzymes. www.indiandentalacademy.comwww.indiandentalacademy.com
• 186. Prostaglandins in toothProstaglandins in tooth movementmovement Von Euler introduced this term.Von Euler introduced this term. Yamasaki et al found an increase inYamasaki et al found an increase in osteoclast numbers after a localosteoclast numbers after a local injection of prostaglandins intoinjection of prostaglandins into paradental tissues.paradental tissues. www.indiandentalacademy.comwww.indiandentalacademy.com
• 187. Role of prostaglandins (PGE1 andRole of prostaglandins (PGE1 and PGE2) in stimulating bonePGE2) in stimulating bone resorption are identified.resorption are identified. Direct action on osteoclasts inDirect action on osteoclasts in increasing their numbers .increasing their numbers . www.indiandentalacademy.comwww.indiandentalacademy.com
• 188. The cAMP pathwayThe cAMP pathway Internal signaling systems are thoseInternal signaling systems are those that translate many external stimulithat translate many external stimuli to a narrow range of internal signals orto a narrow range of internal signals or second messengers .second messengers . cAMP and cGMP arecAMP and cGMP are 2 second messengers associated with bone2 second messengers associated with bone remodeling.remodeling. www.indiandentalacademy.comwww.indiandentalacademy.com
• 189. This signaling molecule plays a keyThis signaling molecule plays a key role in synthesis of nucleic acids androle in synthesis of nucleic acids and proteins as well as secretion ofproteins as well as secretion of cellular products.cellular products. www.indiandentalacademy.comwww.indiandentalacademy.com
• 190. The Phosphoinositide[PI] dual signaling systems There is another Second-messenger systemThere is another Second-messenger system reviewed extensively in relation toreviewed extensively in relation to orthodontic tooth movement- Phosphoinositideorthodontic tooth movement- Phosphoinositide pathway.pathway. www.indiandentalacademy.comwww.indiandentalacademy.com
• 191. This reaction in turn leads to a release ofThis reaction in turn leads to a release of calcium ions from intracellular stores.calcium ions from intracellular stores. Phosphorylation of inositol triphosphatePhosphorylation of inositol triphosphate yields Ins P4.yields Ins P4. This controlsThis controls calcium entrycalcium entry at the plasmaat the plasma membrane through calcium channels.membrane through calcium channels. Inositol triphosphate is a mediator ofInositol triphosphate is a mediator of mitogenesis in mechanically deformedmitogenesis in mechanically deformed tissues through an
increase in DNAtissues through an increase in DNAwww.indiandentalacademy.comwww.indiandentalacademy.com
• 192. •The importance of the second-The importance of the second- messenger conceptmessenger concept to orthodonticsto orthodontics The second-messenger hypothesis postulatesThe second-messenger hypothesis postulates thatthat target cells respond to external stimuli,target cells respond to external stimuli, chemical or physicalchemical or physical,, by enzymatic transformation of certain membrane-bound and cytoplasmic molecules to derivatives capable of promoting the phosphorylation of cascades of intracellular enzymes.
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• 193. Hence , temporal increases in the tissue or cellularHence , temporal increases in the tissue or cellular concentrations of second messengers are generallyconcentrations of second messengers are generally viewed as evidence,viewed as evidence, that an applied extracellular first messenger,such asthat an applied extracellular first messenger,such as an orthodontic force, has stimulated target cells.an orthodontic force, has stimulated target cells. There are significant elevations in the concentrationsThere are significant elevations in the concentrations of intracellular second messengers in
paradentalof intracellular second messengers in paradental cells after exposure to appliedcells after exposure to applied mechanical forces.mechanical forces. www.indiandentalacademy.comwww.indiandentalacademy.com
• 194. Vitamin D and diacylglycerolVitamin D and diacylglycerol An important factor in orthodontic toothAn important factor in orthodontic tooth movement ismovement is 1, 25,dehydroxychloecalciferol (1, 25, DHCC). A biologically active form of vitamin D.A biologically active form of vitamin D. Has a potent role in calcium homeostasis.Has a potent role in calcium homeostasis. www.indiandentalacademy.comwww.indiandentalacademy.com
• 195. Potent stimulator of bone resorption .Potent stimulator of bone resorption . Induces differentiation of osteoclasts from their precursors.from their precursors. Implicated inImplicated in increasing the activity ofof existing osteoclasts.existing osteoclasts. Has bone-resorbing activity.Has bone-resorbing activity. Stimulates bone mineralization andand osteoblastic cell differentiation.osteoblastic cell differentiation. Vitamin D and diacylglycerolVitamin D and diacylglycerol www.indiandentalacademy.comwww.indiandentalacademy.com
• 196. ConclusionsConclusions 1.1. The osteoblast is now perceived as the cell thatThe osteoblast is now perceived as the cell that regulatesregulates bothboth the formative and resorptive phases of the bone remodeling cyclethe formative and resorptive phases of the bone remodeling cycle in response to hormonal and mechanical stimuli.in response to hormonal and mechanical stimuli. 2. To date PGs have been the only chemical mediators of orthodontic tooth movement to have been used clinically. Lipoxygenase products may have a similar role.Lipoxygenase products may have a similar role.
3. Cytokine production by mechanically deformed tissues may account3. Cytokine production by mechanically deformed tissues may account for many cellular effects associated with orthodontic toothfor many cellular effects associated with orthodontic tooth movement.movement. www.indiandentalacademy.comwww.indiandentalacademy.com
• 197. 4. Second messenger involvement in orthodontic4. Second messenger involvement in orthodontic tooth movement is unlikely to be restricted totooth movement is unlikely to be restricted to cAMP.cAMP. The phosphatidy-lino-sitol pathway is likely toThe phosphatidy-lino-sitol pathway is likely to account for a number of cellular events seen inaccount for a number of cellular events seen in mechanically deformed tissues.mechanically deformed tissues. 5. Cytoskeletal matrix interactions associated5. Cytoskeletal matrix interactions associated with a change in cell shape trigger a series ofwith
a change in cell shape trigger a series of cell responses that are highly relevant tocell responses that are highly relevant to orthodontic tooth movement.orthodontic tooth movement. www.indiandentalacademy.comwww.indiandentalacademy.com
• 198. 1. K Utley, Activity of alveolar bone incident to orthodontic tooth movement; AJO 1968; Mar; Pg.167-201 .. 2. William R. Profitt. Contemporary Orthodontics ; 3rd ed.Pg.298-301 3. A. Gianelly, Force induced changes in vascularity of PDL .AJODO 1969;Jan;pg.5-11 4. J.R. Sandy.Tooth eruption & orthodontic movement. Br Dent J 1992:172;141-149. 5. J.R. Sandy et al. Recent advances in understanding mechanically induced bone remodeling & their relevance to orthodontic theory & practice ;AJO 1993;103:212-222. 6. Sheldon Baumrind. A reconsideration of the propriety of the pressure-tension
hypothesis; AJO-DO;Jan;1969. 7. S. Baumrind. A reconsideration of the propriety of the pressure-tension hypothesis; AJO-;Jan;1969. 8. Fred M. Grimm. Bone bending, a feature of orthodontic tooth movement AJO-DO;vol.62;No.4;1972. 9. Yehya A.Mostafa. Orchestration of tooth movement; AJODO,1983;March:245-250. 10. Graber, T. M.: Orthodontic principles and practice, Philadelphia, 1961, W. B. Saunders Company, pp. 405-438. 11. Vinod Krishnana and Ze’ev Davidovitch ,Cellular, molecular, and tissue-level reactions to orthodontic force,AJODO,2006;469e.1-469e.32. 12. R. Sandy. Recent adv.
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