Biomechanics

of Orthodontic Tooth Movement

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Overview
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: Cortical bone
slow turnover

Metabolic: Trabecular bone

constant turnover

Bone Turnover
Control is by systemic and local factors

Osteclasts
derived from perivascular cells

Osteblasts
derived from monocytes

Bone Metabolic Role (systemic control)

PTH Ca++ Serum Kidney PO4 excretion Ca++ resorption Gut Ca binding Ca absorption Vit D
(1,25 DHCC)

Ca++ Serum

Bone
short term:
Ca++ from bone fluid long term: Resorption Deposition

Local control
Biologic electricity Blood flow Microfractures

Local control
Biologic electricity Blood flow Microfractures
1. Pietzoelectric effect (V. short duration)
Bending of collagen and bone results in e-s moving within crystal lattice No signal = bone atrophy

2. Streaming potential
Movement of ground substance results in a potential difference +ve on compression -ve on tension Affects cell permeability

Local control
Biologic electricity Blood flow Microfractures
Sustained pressure
Alters blood flow in 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 microenivironment

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 Systemic Control

PTH Vit D Calcitonin

Osteoclasts

Force Tooth

Tooth movement
PDL/Bone
Biological electricity Blood flow Microfractures

Osteoblasts (tension) Osteoclasts (compression) 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 1Kg / 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 1Kg / 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 Translation Rotation Extrusion Intrusion
Simplest orthodontic movement
Occurs about centre of resistance (1/3 from root apex) Forces are high at apex and alveolar crest, reduce to zero at centre of resistance

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

Force 50-75g

Orthodontic force
Tipping Translation Rotation Extrusion Intrusion
Bodily movement
All of PDL is uniformly loaded

Orthodontic force
Tipping Translation Rotation Extrusion Intrusion
Bodily movement
All of PDL is uniformly loaded

Force 100-150g

Orthodontic force
Tipping Translation Rotation Extrusion Intrusion
Rotary movement
Theoretically need high force

Orthodontic force
Tipping Translation Rotation Extrusion Intrusion
Rotary movement
Theoretically need high force BUT Tipping occurs = excessive compression of PDL

Force 50-100g

Orthodontic force
Tipping Translation Rotation Extrusion Intrusion
Vertical movement
Need to produced tension in fibres of PDL

Orthodontic force
Tipping Translation Rotation Extrusion Intrusion
Vertical movement
Need to produced 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 15-25g

Orthodontic force duration

Ideal Intermittent Interrupted

Orthodontic force duration

Ideal Intermittent Interrupted
Light continuous force
Achievable with fixed appliances

Orthodontic force duration

Ideal Intermittent Interrupted

Force decays between adjustments

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 Root PDL Bone
Minimal effect transient inflammatory response
can cause loss of vitality: compromised teeth excessive force inappropriate movement

Orthodontic adverse affects

Pulp Root PDL Bone

Some resorption of root occurs usually repaired by cementum

Repairs occur during rest periods BUT permanent damage occurs to root apex commonly lose 1-2mm root length At risk: distorted apices thin roots compromised teeth excess force history of previous idiopathic resorption

Orthodontic adverse affects

Pulp Root PDL Bone

Minimal transient damage Unless:

excess force maintained existing periodontal disease

Orthodontic adverse affects

Pulp Root PDL Bone

Minimal transient damage

BUT : loose -1mm of alveolar crest

When to use what appliance.

Tipping

Bodily movement

Rotation

Intrusion

Extrusion

When to use what appliance.

Tipping
Springs / Screws (Individual or groups of teeth)

Bodily movement

Rotation

Removable

Accidental!!

Intrusion
FABP (Groups of teeth)

Extrusion

When to use what appliance.

Tipping

Bodily movement

Rotation

Fixed

Intrusion

Extrusion

Adv / Disadv
Removable: Adv:
Cheap Oral hygiene Anchorage Simple to use ? Patient co-operation ? Better tolerated ? Limited tooth movements (tipping) NOT simple to use

Fixed: Adv:
All tooth movements possible

Disadv:
Patient co-operation Oral hygiene Anchorage Require skilled operator Cost ?

Disadv:

Summary
Physiology of tooth movement Biomechanics of achieving tooth movement Review of available appliances