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BIOLOGY OF TOOTH MOVEMENT

Submitted by; Yasmin Moidin III rd Year BDS

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INTRODUCTION
Orthodontic tooth movement (OTM) is a complex biomechanical process which is initiated by the clinician with the application of a force. The applied force moves the tooth beyond its range of physiologic tooth movement. Several factors affect and modify the nature and amount of orthodontic tooth movement. The most2/15/13significant

PHYSIOLOGIC TOOTH MOVEMENT Physiologic tooth movement designates primarily the slight tipping of the functioning tooth in its socket and secondarily,the changes in tooth position that occur in young persons during and after tooth eruption.It is of three types:
1. 2.

Movement during mastication Eruption of tooth

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MOVEMENT DURING MASTICATION

Tooth movement during masticatory function depends upon the location of neutral axis of the functioning tooth. Neutral axis is located between the middle and apical regions of the roots in an adult tooth. For younger persons,the neutral axis is either located in the marginal region or closer to the middle of the root ,if the root is fully developed. During chewing , the teeth tips slightly around the neutral axis as fulcrum. Tooth is displaced because of bending of the alveolar process Movement during mastication is transient. Once the occlusal load 2/15/13 is removed, it reverts back to normal position

ERUPTION OF TOOTH
Different

teeth move in different directions during eruption eruption, upper molar teeth move mainly in mesial direction molar teeth show variations in direction of movement. Sometimes even a distal direction of movement is observed 2/15/13

During

Lower

MIGRATION OF TEETH
Migration

of teeth is a slow tooth

movement
Direction

of movement is usually mesial and occlusal corresponds to the adult equilibrium stage of tooth eruption movements take place to compensate interproximal2/15/13 attrition and

This

These

PERIODONTAL LIGAMENT STRUCTURE AND FUNCTION

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Click icon to add picture

STRUCTURE OF PERIODONTAL LIGAMENT

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COMPONENTS OF PERIODONTAL LIGAMENT

1. 2. 3.

Collagen fibres Cellular elements Tissue fluids

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COLLAGEN FIBRES
The

major component of the PDL is a network of parallel collagenous fibers, inserting into cementum of the root surface on one side and into a relatively dense bony plate, the lamina dura,on the other side supporting fibers run at an angle, attaching farther apically on the tooth 2/15/13 than on the adjacent alveolar bone

These

CELLULAR ELEMENTS
The

principle cellular elements in the PDL are undifferentiated mesenchymal cells and their progeny in the form of fibroblasts and osteoblasts endings are found within the ligament, both the unmyelinated free endings associated with perception of pain and the more complex receptors 2/15/13 associated with pressure and positional

Nerve

TISSUE FLIUDS
The

PDL space is filled with fluid and is derived from the vascular system fluids acts as a shock absorber

Tissue

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RESPONSE TO NORMAL FUNCTION During masticatory function, the teeth and periodontal structures are subjected to intermittent heavy forces. Tooth contact lasts for one second or less, forces are heavy and tooth is subjected to heavy loads, quick displacement of the tooth within the PDL space is prevented by the incompressible tissue fluid and the force is transmitted to2/15/13 alveolar the

PHYSIOLOGIC RESPONSE TO HEAVY PRESSURE AGAINST A TOOTH TIME (SECONDS) LESS THAN 1 EVENT PDL fluid incompressible, alveolar bone bends, piezoelectric signal generated PDL fluid expressed, tooth moves with in PDL space PDL fluid squeezed out, tissues compressed;immediate pain if pressure is heavy
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1-2 35

ROLE OF PDL IN ERUPTION AND STABILISATION OF THE TEETH

The

phenomenon of tooth eruption makes it plain that forces generated within the PDL itself can produce tooth movement eruption mechanism appears to depend on metabolic events with in the PDL including but perhaps not limited to formation, cross-linkage and 2/15/13 maturational shortening of collagen

The

THEORIES OF TOOTH MOVEMENT Two major theories are:

1. 2.

The bioelectric theory The pressure-tension theory

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BIOELECTRIC THEORY The bioelectric theory relates tooth movement at least in part to changes in bone metabolism controlled by the electric signals that are produced when alveolar bone flexes and bends. This bending and flexing generates electric signals that alter the metabolism of bone.
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ELECTRICAL SIGNALS GENERATED ARE:

1.

PIEZOELECTRICITY STREAMING POTENTIAL BIOELECTRIC POTENTIAL

2.

3.

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PIEZOELECTRICITY It is a phenomenon observed in crystalline materials in which deformation of a crystal structure produces a flow of electric current as electrons from one part of the crystal lattice are displaced to another. Bone and collagen and stress generated potentials in dried bone specimens have piezoelectricity
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FEATURES OF PIEZOELECTRICITY
1.

Quick decay rate:- When a force is applied a piezoelectric signal is created in response that quickly dies away to zero even though the force is maintained The production of an equivalent signal, opposite in direction when the force is released
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2.

Click icon to add picture

+ OFF chang e

ON

2 Seconds

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STREAMING POTENTIAL Ions in the fluids that bathe living bone interact with the complex electric field generated when the bone bends, causing temperature changes as well as electric signals. The small voltages that are observed are called streaming potential.

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BIOELECTRIC POTENTIAL
Application

of orthodontic force by the appliance will cause physical distortion of the alveolar bone which is accompanied by bending of bone . Bone which is deformed by stress becomes electrically charged surfaces take a negative polarity and convex surfaces a positive 2/15/13 polarity

Concave

PRESSURE TENSION THEORY

Alterations

in blood flow associated with pressure with in the periodontal ligament and/or release of chemical messengers of cells
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Formation

Activation

Orthodontic force Tissue trauma Release of Ist messengers (PG) (Extracellular signals are activated) Conversion into intracellular signals by 2 pathways Synthesis of cAMP IInd messengers Protein kinase enzymes within the cell Cellular changes Remodeling of bone Activation of Ca++
IIIrd messengers

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TISSUE REACTIONS TO ORTHODONTIC FORCES Tissue reactions to orthodontic forces were first described by Sandstedt in 1904,1905 and later by Oppenheim in 1930,1935,1936

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Sequence of changes orthodontic force

Light continuous force Compression of blood vessels + PDL Blood flow altered Prostaglandins (Ist messenger) are released Synthesis of cyclic AMP activation of Ca++ Metabolic activity Activation of osteoclasts

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TISSUE CHANGES AT PRESSURE ZONE

The

bone was deposited on the tension side of the tooth both with heavy and light forces while on the pressure side with light forces alveolar bone was resorbed directly by multinucleated osteoclast cells called frontal resorption or direct resorption the application of heavy forces, 2/15/13 the periodontal tissues are compressed

With

 In

hyalinised areas ,resorption of the alveolus takes place far from the cell free zone in the bone marrow spaces and is called undermining resorption or rear resorption movement is delayed because of hyalinization and undermining resorption 2/15/13

Tooth

TISSUE CHANGES AT TENSION ZONE

Cellular

activity is delayed in areas of tension when compared to pressure zones takes 30 hours for increased cellular activity to be seen in tension zone
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It

CONCLUSION Orthodontic tooth movement consequent to application of force is outcome of complex chains of events ,eventually leading to bone resorption and bone formation

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REFERENCES

Contemporary Orthodontics Fourth Edition WILLIAM R PROFFIT Orthodontics Diagnosis and Management of Malocclusion and Dentofacial Deformities OM PRAKASH KHARBANDA Orthodontics Exam Preparatory Manual for Undergraduates Second 2/15/13

THANK

YOU !

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