Biomechanical

tooth movement

DR.Mieke Syllvia MAR.,drg.,Ms.,SpOrt.

 Physiology/Anatomy
Movement/Forces Orthodontic
force Appliances
What is needed?
 What is needed?

• Tooth
• Healthy periodontal
ligament
• Bone
• Applied force
Tooth movement is dependant upon physiology of
the Periodontal ligament and Bone - i.e. Turnover
 Tooth

• Means of force application /

delivery
• Otherwise ‘inactive’
 Periodontal Ligament
• Fibres transmit forces applied to the tooth
• Viscostatic damping of force
• Cells within PDL
Fibroblasts
Osteoblasts
Osteoclasts
Undifferentiated cells
 Bone
• Role of Bone in the body
– Structural
– Metabolic
 Bone

Structural: Metabolic:
Cortical bone Trabecular bone
slow turnover constant turnover
 Bone Turnover
Control is by systemic and local factors
• Osteclasts • Osteblasts
derived from perivascular cells derived from monocytes
Bone - Metabolic Role (systemic control)
•Kidney -
↑ P04 excretion
↑ Ca++ resorption
↑PTH
↓ Ca++ ↑ Ca++
Gut -
Serum
↑Ca binding Serum
↑Ca absorption

↑Vit D
(1,25 DHCC)
Bone –
short term:
↑ Ca++ from bone fluid
long term:
↑ Resorption
↓ Deposition
 Local control
• Biologic electricity
• Blood flow
• Microfractures
 Local control

• Biologic electricity 1. Pietzoelectric effect (v. short duration)

Bending of collagen and bone
• Blood flow results in e-'s moving within
crystal lattice
• Microfractures No signal = bone atrophy
2. StreamUg potential
Movement of ground substance
results in a potential difference
+ve on compression
-ve on tension
Affects cell permeability
 Local control

• Biologic electricity Sustained pressure

• Blood flow Alters blood flow in
• Microfractures PDL
↑ flow in tension
↓ flow in
compression
Affects biochemical
environment
 Local control

• Biologic electricity
• Blood flow
• Microfractures

Microfractures
Occur within bond, these accumulate
affecting the microenvironment
 Local control

• Biologic electricity
• Blood flow
• Microfractures
Prostaglandins
Cytokines
Cyclic amp

Osteblasts Osteoclasts
 Local control (+systemic)
• Biologic electricity
• Blood flow
• Microfractures
Prostaglandins
Cytokines
Cyclic amp

Osteblasts Osteoclasts

PTH
Systemic Control vit D
Calcitonin
Force
Tooth movement
Tooth

PDL/Bone

Biological electricity
Blood flow
Microfractures
Osteoblasts (tension)
Osteoclasts (compression)

Line of Force
Resorption and Deposition
of bone
What happens depends on:
• Level of force
• Duration of force
What happens depends on:
• Level of force
• Duration of force
Heavy force/short duration
1-50Kg / less than 1 sec
Force absorbed by bone bending = Pain
(Pietzoelectric effect)
What happens depends on:
• Level of force
• Duration of force
Heavy force/short duration
1-50Kg / less than 1 sec
Force absorbed by bone bending - Pain
(Pietzoelectric effect)
Heavy force/long duration
1-50Kg / continuous
1-2 secs -PDL fluid displaced
2-3 secs - PDL tissues compressed – pain
Hours-days - cellular necrosis within bone
- hyalanised (acellular layer)
Removed by osteoclasts, tooth movement in
‘steps’ - Undermining Resorption
What happens depends on:
• Level of force
• Duration of force
Light force/short duration
less than 1 Kg / less than 1 sec

Force absorbed by PDL - no effect

(PDL is actively stable - 5-10g)
What happens depends on:
• Level of force
• Duration of force
Light force/short duration
less than 1 Kg / less than 1 sec

Force absorbed by PDL - no effect

(PDL is actively stable - 5-10g)

Light force/long duration

less than 1Kg / continuous

Progressive tooth movement occurs

What happens depends on:
• Level of force
• Duration of force
Orthodontic forces
Excessive = pain + undermining resorption
Ideal = socket remodeling

In reality - some undermining resorption occurs

Orthodontic force
• Tipping Simplest orthodontic movement
• Translation Occurs about centre of resistance
(1/3 from root apex)
• Rotation
Forces are high at apex and alveolar crest,
• Extrusion reduce to zero at centre of resistance

• Intrusion
Orthodontic force
• Tipping Simplest orthodontic movement
• Translation Occurs about centre of resistance
(1/3 from root apex)
• Rotation
Forces are high at apex and alveolar crest,
• Extrusion reduce to zero at centre of resistance

• Intrusion

Force - 50-75g
Orthodontic force
• Tipping
• Translation Bodily movement
All of PDL is uniformly loaded
• Rotation
• Extrusion
• Intrusion
Orthodontic force
• Tipping
• Translation Bodily movement
All of PDL is uniformly loaded
• Rotation
• Extrusion
• Intrusion

Force : 100-150g
Orthodontic force
• Tipping
• Translation
• Rotation Rotary movement
Theoretically need high force
• Extrusion
• Intrusion
Orthodontic force
• Tipping Rotary movement
Theoretically need high force
• Translation BUT
Tipping occurs =
• Rotation excessive compression of PDL

• Extrusion
• Intrusion

Force - 50-100g
Orthodontic force
• Tipping
• Translation
• Rotation
• Extrusion Vertical movement
Need to produced
• Intrusion tension in fibres of
PDL
Orthodontic force
• Tipping
• Translation
• Rotation
• Extrusion Vertical movement
Need to produced
• Intrusion tension in fibres of
PDL

Force - 50g
Orthodontic force
• Tipping
• Translation
• Rotation
• Extrusion
• Intrusion Vertical movement
Forces concentrated at root apex
Orthodontic force
• Tipping
• Translation
• Rotation
• Extrusion
• Intrusion Vertical movement
Forces concentrated at root apex

Force - 50g
Orthodontic force duration

• Ideal
• Intermittent
• Interrupted
Orthodontic force duration

• Ideal Light continuous force

• Intermittent Achievable with fixed appliances

• Interrupted
Orthodontic force duration

• Ideal
• Intermittent Force decays between adjustments
• Interrupted e.g. Removable appliance springs
Initially force is too high, decays to ideal,
then to zero
Results in undermining resorption, which
repairs between visits
Orthodontic force duration

• Ideal
• Intermittent
• Interrupted Force only present when appliance worn
e.g. Headgear
Heavy force used, needs at least
12hours/day for tooth movement to occur.
Optimal 14-16 hours/day
250g/side for anchorage
450g/side for distal movement
Orthodontic adverse affects

• Pulp
• Root
• PDL
• Bone
Orthodontic adverse affects

• Pulp Minimal effect

transient inflammatory response
• Root
• PDL can cause loss of vitality:
compromised teeth
• Bone excessive force
inappropriate movement
Orthodontic adverse affects

• Pulp
• Root Some resorption of root occurs
usually repaired by cementum
• PDL
Repairs occur during ‘rest’ periods
• Bone BUT permanent damage occurs to root apex
commonly lose 1-2 mm root length

At risk: distorted apices

thin roots
compromised teeth
excess force
history of previous idiopathic resorption
Orthodontic adverse affects

• Pulp
• Root
• PDL Minimal transient damage
Unless:
• Bone excess force maintained
existing periodontal disease
Orthodontic adverse affects

• Pulp
• Root
• PDL
• Bone Minimal transient damage
BUT: loose 1/2 -1 mm of alveolar crest
When to use what appliance....
Springs / Screws
(Individual or groups of teeth)
Tipping

Bodily movement Rotation

Removable Accidental!!

Intrusion Extrusion
FABP
(Groups of teeth)
When to use what appliance....

Tipping

Bodily movement Rotation

Fixed

Intrusion Extrusion
 Adv / Disadv
Removable: Fixed:
Adv: Adv:
• Cheap • All tooth movements possible
• Oral hygiene
• Anchorage Disadv:
• ‘Simple to use’? • Patient co-operation
• Patient co-operation ? • Oral hygiene
• Better tolerated ? • Anchorage
Disadv: • Require skilled operator
• Limited tooth movements (tipping) • Cost ?
• NOT ‘simple to use’
 Summary

• Physiology of tooth movement

• Biomechanics of achieving tooth movement
• ‘Review’ of available appliances