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 Normal width 0.25 mm or 250 micrometers.

 Cells, fibers, ground substance.


 Fibroblasts
 Osteoblasts, osteoclasts
 Cell rests of Malassez
 Mesenchymal stem cells
 They all proliferate at different stages of tooth movement.
 You must know what functions each has in tooth movement.
 Collagen and oxytalan
 Some of them are stretched, torn and
ruptured, whereas others are compressed
and undergo aseptic necrosis
 Proteoglycans and other proteins
 Their contents and expression are
altered upon tooth movement
 Water squeezed in and out during
tooth movement
 Thin cortical bone and porous (lamina dura)
 Fluid pumped in and out of the PDL

 Trabecular bone underneath

 Must remodel before teeth can be moved


C:Cell
F:Fiber
AB: Alveolar
bone
G:Gingivity
CE:
Susan M. Ott
Univ of Washington
 The force must have the right characteristics such as the
magnitude and duration ---- it must meet certain threshold.
 Light, continuous forces
 Never declines to zero.
 Interrupted forces
 Declines to zero
 Intermittent forces
 Declines to zero
 In the range of 10 to 200 grams.
 Varies with the type of tooth movement.
 Light, continuous forces are currently considered to be
most effective in inducing tooth movement.
 Heavy forces cause damages and fail to move the teeth.
 Threshold --- 6 hrs per day.
 No tooth movement if forces are applied less than 6 hrs/d.
 From 6 to 24 hrs/d, the longer the force is applied, the more the
teeth will move.
 Bio-electric Theory

 Pressure-Tension Theory
Prolonged Force

Electric Signals
Piezoelectric Theory

Deformation in Bone Metabolism


crystal structure

Electrons move from one


part of lattice to other
Tooth Movement
Electric Signal
Force Application

Pressure Tension zones

Pressure Zone Tension Zone


Alteration in blood flow

PDL Compresses PDL Stretches Chemical Messenger

Blood Vessels Blood Vessels


Cellular changes
Compresses Dilates

B/F decreases Increases Tooth Movement


Light Pressure Events

< 1 sec Piezoelectric Theory

1-2 Sec PDL fluid expresses,,tooth moves within PDL Space

3-5 sec Pressure-Tension zones

Minutes Blood flow altered, oxygen tension begins to change,


PDE, Leukotrenes, Cytokines (TGF β, IGF-1 IGF-II, PDGF AA,
FGF β),

Hours Metabolic changes occur

4 Hours Increased cyclic AMP, ,cellular differentiation

2 days Tooth movement (osteoclastic & osteoblastic activity)


Light Pressure Events

< 1 sec Piezoelectric Theory

1-2 Sec PDL fluid expresses,,tooth moves within PDL Space

3-5 sec B/V within PDL occludes on pressure side

Minutes Blood flow cut off to compressed side

Hours Cell death on compressed side (Hyalinization)

3-5 days Cell differentiation in adjacent narrow space,


undermining resorption begins (Osteoclast)

7-14 days Undermining resorption removes lamina dura adjacent


to compressed PDL, tooth movement occurs
 Piezoelectric Theory woks initially

 Then Pressure Tension Theory works


 Tipping 35-60 gm

 Translation 70-120 gm

 Torque & root uprighting 50-100 gm

 Rotation 35-60 gm

 Extrusion 35-60 gm

 Intrusion 10-20 gm
 Light continuous Force

Force maintained at some appreciable fraction of the original form during two
visits

 Interrupted continuous force

Force levels decline to zero b/w visits

 Intermittent force
Force level declines abruptly to zero ( Removable Appliances, Headgears)
 Intrusion
 Extrusion
 Tipping
 Bodily movement
 Rotation
 Piezoelectric theory.
 Pressure-tension theory.
 “High enough to stimulate cellular activity without
completely occluding blood vessels in the PDL” (Proffit et al.
2000).
 Actively being investigated in a scientific field known as
mechanotransduction.
 Force --- fluid flow --- cell-level strain
 Deformation of cell membrane leading to cytoskeletal changes
 Second messenger pathways
 Gene upregulation in fibroblasts, osteoblasts and osteoclasts
 Light, continuous forces
 Osteoclasts formed
 Removing lamina dura
 Tooth movement begins
 This process is called “FRONTAL
RESORPTION
resorption” because it occurs
 “Frontal
between the root and the lamina dura.
 Phase 1 – Mechanical compression and tension of the periodontium
 Phase 2 --- Mechanically induced cellular and genetic responses; no tooth
movement
 Phase 3 --- Accelerated tooth movement due to frontal bone resorption

Tooth movement (mm)

Phase 3
Phase 2
Phase 1

Time (Arbitrary Unit)


 Heavy, continuous forces
 Blood supply to PDL occluded
 Aseptic necrosis
 PDL becomes “hyalinized” – “HYALINIZATION”
 This process is called “UNDERMINING
RESORPTION”.
“Undermining resorption” because it occurs on the underside of
lamina dura, not between lamina dura and the root.
 Phase 1 – Mechanical compression and tension of the periodontium
 Phase 2 --- Continuing mechanical compression; little cellular and genetic
responses; no tooth movement
 Phase 3 --- Cells recruited from the undermining side of lamina dura, not
within the PDL, to induce undermining bone resorption

Tooth movement (mm)

Phase 3
Phase 2
Phase 1

Time (Arbitrary Unit)


Tooth movement (mm)

Phase 3
Phase 2
Phase 1 Frontal resorption
Time (Arbitrary Unit)

Undermininging
Tooth movement (mm)

Resorption
Phase 3
Phase 2
Phase 1

Time (Arbitrary Unit)


 The pulp
 Root resorption
 Alveolar bone height
 Rare if light, continuous forces are applied.
 Occasional loss of tooth vitality.
 History of previous trauma
 Excessive orthodontic forces
 Moving roots against cortical bone
 Endodontically treated teeth can be moved like
natural teeth, with proper management.
 More accurately, resorption of root cementum and dentin.
 Normal ageing process in many individuals
 Likely occurring in many cases but not to the degree of
clinical significance.
 Root resorption induced by light orthodontic forces is
reversible (by regeneration and repair of cementum and/or
dentin).
 Can lead to tooth mobility in severe cases.
 Affects most, if not all, teeth; maxillary incisors more
susceptible than other teeth.
 Could be moderate or severe but commonly in the range of up
to 2.5 mm.
 Etiology largely unknown but predisposing factors include
conical roots with pointed apices, distorted tooth form, or a
history of trauma.
 Can’t always be distinguished from generalized root
resorption.
 Maxillary incisors more susceptible than other teeth.
 Only in rare cases can the causes, such as heavy
orthodontic forces, be pinpointed.
 Etiology largely unknown.
 Up to 70% of the Chinese population have malocclusion that
warrants orthodontic correction.
 Currently, less than 20% of the Chinese patients seeks orthodontic
treatment. However, I believe more and more people will seek
orthodontic with the development of society