Biomekanik Pergerakan Gigi Ortodonti

Dr. I.B.Narmada. drg., Sp.Ort(K)

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

Removeable Appliances

Periodontal applied to the tooth Ligament Fibres transmit forces

Viscostatic damping of force
Cells within PDL

Fibroblasts

Osteoblasts
Osteoclasts Undifferentiated cells

The Periodontium
Orthodontic force Changes in the supporting structure. Periodontium is a connective tissue organ covered by

epithelium, that attaches the teeth to the bones of the jaws and provides a continually adapting apparatus for support of teeth during function. 4 connective tissues
Two fibrous

- Lamina propria of the gingiva. - Periodontal ligament

Two mineralized

-Cementum -Alveolar bone

Gingiva

Circular Dentogingival Dentoperiosteal Transseptal fibres (Accesory fibres)

9

PDL
Connective tissue interface

separating the tooth from the supporting bone. Heavy collagenous supporting structure- 0.5mm around Apart from fibres Cellular elements-

mesenchymal, vascular & neural Tissue fluids

PDL
1.

Constant remodeling- fibres, bone & cementum. Principal fibres Alveolar crest group Horizontal group Oblique group Apical group Transseptal group

2.
3. 4. 5.

Role of PDL

Physiologic tooth migration

Migration- teeth carry fibre

system
Remodeling of PDL and

alveolar bone.
Resorptive surface &

depository surface

Bone Bone in the body Role of

Structural
Metabolic

Alveolar bone
Surrounds the tooth CEJ-Lamina dura Bundle bone- alveolar bone proper. Volkmanns canals vascular communication with

marrow spaces. Renewed constantly functional demands. Age- size & number of marrow spaces Mesial & distal movement spongiosa: extraction space- Rapid Labially- lingually- caution

Bone
Structural: Cortical bone slow turnover

Metabolic: Trabecular bone constant turnover

Bone by systemic and local factors Turnover Control is

Osteclasts
derived from perivascular cells

Osteblasts
derived from monocytes

Bone - Metabolic Role (systemic control)

Kidney P04 excretion Ca++ resorption

PTH
Ca++ Serum Gut Ca binding Ca absorption

Ca++ Serum

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 Blood flow
1. Pietzoelectric effect (v. short duration) Bending of collagen and bone results in e-'s moving within crystal lattice 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

Microfractures

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 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 PTH vit D Calcitonin

Osteoclasts

Systemic Control

Force

Tooth movement
Tooth
PDL/Bone

Biological electricity Blood flow Microfractures

Osteoblasts (tension) Osteoclasts (compression) Resorption and Deposition of bone

Line of Force

Theories of tooth movement

Pressure- Tension theory Fluid Dynamic theory Bien Squeeze- Film effect Oxygen tension Bone bending theory

Neither incompatible nor mutually exclusive

Pressure-tension
Sandstedt (1904), Oppenheim (1911),and Schwarz (1932).

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 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

Force distribution & Type of tooth movement

Optimal force-The amount of force& the area of

distribution The force distribution varies with the type of tooth movement Tipping -

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

Force distribution & Type of tooth movement

Bodily tooth movement-uniform loading of the teeth is

seen.

To produce the same pressure-same biologic response-

force required is twice Intermediate forces- part tipping/translating

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 - 50g

Force distribution & Type of tooth movement

Intrusion-very light forces-concentrated in a small area
Stretch- principal fibres

Extrusion-Only areas of tension Light forces- could loosen teeth considerably

Optimum forces for various tooth movements-Proffit

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 1-2 mm root length
At risk: distorted apices thin roots compromised teeth excess force history of previous idiopathic resorption

Orthodontic adverse affects

Pulp Root PDL Bone

Minimal transient damage Unless: 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....

Tipping
Bodily movement Rotation

Intrusion

Extrusion

When to use what appliance....

Tipping
Bodily movement
Springs / Screws (Individual or groups of teeth)

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 ?

Fixed:
Adv:
All tooth movements possible

Disadv:

Patient co-operation Oral hygiene 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