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ORTHODONTIC TREATMENT
The teeth and their supporting tissues show lifelong ability to reposit themselves and adapt to
functional demands.
It is ilustrated by the fenomenon 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 , eruptiom and migration,
throughout life the teeth will seek to establish the
best possible relationship between the jaws.
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 alveolous that is
marked initially by narrowing
of the periodontal
membrane, particularly in the
marginal area. This
compresion 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
favourable, 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 fibres in the periodontal
membrane will change.
Pressure side:
Pressure side:
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 favourable, 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.
Pressure side:
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 30-40
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, and the
fibrous system is
remodelled.
Tension side
Tension side
Tension side
Tension side
Tension side