BIOLOGY OF TOOTH

MOVEMENT

By:
Dr shabeel pn
 Introduction
Orthodontic tooth movement is a unique
process where a solid object (tooth) is made
to move through a solid medium (bone).
Orthodontic treatment is possible due to the
fact that whenever a prolonged force is
applied on a tooth,bone remodelling
occurs around the tooth resulting in its
movement.
Bone subject to pressure as a result of
compression of periodontal ligament
resorbs. While, bone forms under tensile
force, as a result of stretching of
periodontal ligament.The bony response
is mediated by the periodontal ligament,
Tooth movement is primarily a
periodontal ligament phenomenon.
 Structure of periodontal
ligament:
The PDL occupies a space approximately 0.5mm
in width around all parts of roots.
Major component of the ligament are:-
1. Network of parallel collagenous fibers.

2. Cellular elements along with vascular and

neural elements.
3. Tissue fluids.
 The cellular element and fluid play an
important role in normal function and in
making orthodontic tooth movement possible.
 I.Physiologic Tooth Movement
 Naturally occurring tooth movements that
take place during and after tooth eruption.

This include:
 A)Tooth Eruption.

 B)Migration or drift of teeth.

 C)Changes in tooth position during mastication.

 TOOTH ERUPTION:
 Tooth eruption is the axial movement of tooth from
its development position in the jaw to its final
position in the oral cavity.
 The following are some theories which explains the
eruption process.
 a)Blood pressure theory:
According to this theory,the tissue around
the developing end of the root is highly
vascular.This vascular pressure is believed to cause
the axial movement of teeth.
b)Root Growth:
 According to this theory,the apical growth of
roots result in an axially directed force that brings about the
eruption of teeth.
 This theory was rejected because:

The tooth moves at a greater distance than the root length.

Onset of root growth and eruption do not coincide.
Teeth without roots also erupt.
c)Hammock ligament theory:
 According to Sicher, a band of fibrous tissue
exists below the root apex spanning from one side of alveolar
wall to other. This fibrous tissue appears to form a network
below the developing root and is rich in fluid droplets.the
developing root forces itself against this band of tissue, which
in turn applies an occlusally directed force on tooth.
 d)Periodontal traction theory:
This theory states that the
periodontal ligament is rich in fibroblasts
that contain contractile tissue.The
contraction of these periodontal fibers
(mainly the oblique group of fibers)
results in axial movement of the tooth.
 B) Migration or drift of teeth:
 Refers to the minor changes in tooth position
observed after eruption .
 Human dentition shows a natural tendency to
move in a mesial & occlusal direction.
 Usually a result of proximal and occlusal wear
of teeth,
 They move in a mesial and occlusal direction
to maintain inter-proximal and occlusal
contact.
C)Tooth movement during mastication:

 During mastication ,the teeth and

PDL structures are subjected to
intermittent heavy forces which
occurs in cycles of one second or less
and may range from 1-50 kg based
on the type of food being masticated.
 Physiologic response to heavy pressure
against a tooth:-
 <1 sec – PDL fluid incompressible, alveolar

bone bends, piezoelectric effect.

 1-2 sec – PDL fluid compressed, tooth moves

within the PDL space.

 3-5 sec – PDL fluid squeezed out, tissue

compressed, immediate pain.

 II.Orthodontic Tooth Movement
 It is a pathological process from which the tissue
recovers.

Histology of tooth movement:

 Orthodontic movement bring about areas of
pressure and tension around the tooth. The
histologic changes seen during tooth movement
vary according to the amount and duration of force
applied.
 Changes following application of
mild forces:
 Classically the movement of teeth has
been explained via the pressure:tension
hypothesis in which PDL tissues in
pressure side results in bone resurption ,
while placing the PDL tissues under
tensile force lead to bone deposition.
Changes on pressure side:
 The PDL in direction of tooth movement gets
compressed to almost 1/3rd of it’s original thickness.
 A marked increase in the vascularity of PDL on this
side is observed due to increase in capillary blood
supply.
 This increase in blood supply helps in mobilization
of cells such as fibroblasts and osteoclasts.
 Osteoclasts are bone resorbing cells that lie in
Howship’s lacunae .
 when forces applied are within physiologic limits,the
resorption is seen in alveolar plate immediately
adjacent to the ligament.This kind of reorption is
called frontal resorption.
Changes on tension side:
 PDL stretched

 Distance between alveolar process & tooth

is widened.
 Increased vascularity.

 Mobilization of fibroblasts & osteoblasts.

 Osteoid is laid down by osteoblast in PDL

immediately adjacent to lamina dura.
 Lightly calcified bone mature to form
woven bone.
Secondary remodelling changes:
 Bony changes also takes place
elsewhere to maintain the width or thickness of
alveolar bone.These changes are called secondary
remodeling changes.
For eg:-If a tooth is being moved in a lingual
direction there is compensatory deposition of new
bone on the outerside of the lingual alveolar bony
plate and also a compensatory resorption on the
labial side of the labial alveolar bone.
This is to maintain the thickness of the
supporting alveolar process .
 Change following application of
extreme forces:
On the pressure side :-
 Root closely approximates the lamina dura .
 Compresses the PDL and leads to occlusion of
blood vessels.
 The PDL is hence deprived of its nutritional
supply leading to regressive changes called
hyalinization .
 Underminig/Rearward resorption occurs in the
adjacent marrow spaces and alveolar plate
below, behind & above the hyalinized zone.
On the tension side:-
 Over stretched PDL .
 Tearing of blood vessels & ischaemia.
 Extreme forces applied net increase in
osteoclastic activity and tooth loosened in
socket.
 Optimum orthodontic force:
 Is one which moves teeth most rapidly in the desired
direction ,with the least possible damage to tissue and
with minimum patient discomfort.
 Schwarz proposed the classic concept of the optimal
force. He defined optimal continuous force as the
force leading to a change in tissue pressure ,that
approximated the capillary vessel & blood
pressure.Thus preventing their occlusion in the
compressed PDL.
 Below the optimal level cause no reaction in PDL.
 Forces exceeding optimal level would lead to areas of
tissue necrosis ,preventing frontal bone resorption.
 Schwarz’s definition was slightly modified
by Oppenheim who advocated the use of
lightest force capable of bringing about
tooth movement.

 Oppenheim and Schwarz following

extensive studies state that the optimum
force is equivalent to the capillary pulse
pressure which is 20-26gm/sq.cm of root
surface area.
 From a clinical point of
view,Optimum orthodontic force has
the following characteristics:
 Produce rapid tooth movement.
 Minimal patient discomfort.

 The lag phase of tooth movement is

minimal.
 No marked mobility of the teeth being
moved.
 From a histological point of view the
use of optimum force has the
following characteristics:-

 The vitality of the tooth and supporting

PDL is maintained.
 Initiates maximum cellular response.

 Produces direct or frontal resorption

 Hyalinization:
 Form of tissue degeneration characterized by
formation of a clear, eosinophilic homogenous
substances
 Denotes a compressed and locally
degenerated PDL.
 Reversible process.
 Occurs in almost all forms of orthodontic
tooth movement but the areas are wider when
the force applied is extreme.
 Changes observed during formation
of hyalinized zone are:
 Gradual shrinkage of PDL fibres.
 Cellular structures become indistinct

 Collagenous tissues gradually unite into a more

or less cell free mass.
 changes also occur in the ground substance.

 break down of blood vessel walls leading to

spilling of their contents.
 Osteoclasts are formed after a period of

20-30 hrs.
 The presence of hyalinised zone indicates
that the ligament is non-functional and
therefore bone resorption cannot
occur.The tooth is hence not capable of
further movement until the local
damaged tissue has been removed and
the adjacent alveolar bone resorbs .
 Elimination of hyalinised tissue
 2 mechanism:-
1. By osteoclasts differentiating in the peripheral
intact PDL membrane and in the adjacent
marrow spaces.
2. Invasion of cells and blood vessels from the
periphery of the compressed zone by which
necrotic tissue is removed. The invading cells
penetrate the hyalinized tissue and eliminate
unwanted fibrous tissue by enzymatic action
and phagocytosis.
 Forces & Hyalinization
 Greater the forces wider is the area of
hyalinization. Thus larger areas of the
ligament becomes functionless ,thereby
showing larger areas of rearward resorption
 If lighter forces are used,the hyalinised zone is
smaller and a larger area of functioning
ligament is available and frontal resorption
predominates.
 The location and extend of hyalinised tissue
largely depends upon nature of tooth
movement.
 A-Tipping –close to
alveolar crest

 B-Excessive force
during tipping-two
areas,one on apical
region and other in
marginal area.

 C-Bodily-closer to
middle portion of root
 Phases of tooth movement
Burstone categorize the stages as:-
 Initial phase

 Lag phase

 Post lag phase

 Initial phase:
 Rapid tooth movement is observed over a short
distance which then stops.
 Represents displacement of tooth in PDL
membrane space and probably bending of
alveolar bone .
 Both light and heavy forces displace the tooth to
same extent .
 Between 0.4 to 0.9mm usually occurs in a weeks
time.
 Both light & heavy forces displace the tooth to
the same extent during this phase.
 Lag phase:
 Little or no tooth movement occurs .
 Formation of hyalinized tissue .

 Extent upto 2-3 weeks .

 Post lag phase:
 Tooth movement progresses rapidly as the
hyalinized zone is removed and bone
undergoes resorption .
 Osteoclasts are found over a larger surface
area .
 Theories of tooth movement:
1. Pressure tension theory by Schwarz.
(classic theory)
2. Fluid dynamic theory by Bien/ blood flow
theory:
3. Bone bending & piezoelectric theory:
 Pressure tension theory by Schwarz.
(classic theory)
 Schwarz(1932) - author of this theory .
 According to him ,whenever a tooth is
subjected to an orthodontic force it results
in areas of pressure and tension .
 Areas of pressure show bone resorption
while areas of tension show bone
deposition.
 Fluid dynamic theory by Bien/ Blood
flow theory
 According to this theory tooth movement
occurs as a result of alternations in fluid
dynamics in PDL located in periodontal
ligament space.
 PDL space contains a fluid system made up of
interstitial fluid, cellular elements , blood
vessels and viscous ground substances in
addition to PDL fibres.
 It is a confined space and passage of fluid in &
out of this space is limited.
 The contents of PDL creates a unique
hydrodynamic condition resembling a hydraulic
mechanism & shock absorber .
 When force is removed, the fluid is replenished
by diffusion from capillary walls & recirculation
of interstitial fluids.
 Squeeze film effect by Bien .
 When orthodontic force applied,the compression
of ligament results.Blood vessels of PDL gets
trapped between the principle fibres & this
results in stenosis.
 Vessels above the stenosis then balloons resulting
in formation of an aneurysm
 Stenosis + Aneurysm  blood gases to
escape into interstitial fluids, creating
favourable local environment for
resorption.
 Bone bending & piezoelectric
theory:
 Farrar in 1876, first noted deformation or
bending of interseptal alveolar bones.
 suggest that bone bending may be a possible
mechanism for bringing about tooth movement.
 Piezo-electricity is a phenomenon observed in
many crystalline materials in which deformation
of the crystal structure produces a flow of
electric current as a result displacement of
electrons from one part of the crystal lattice to
the other.A small electric current is generated &
bone is mechanically deformed.
The possible source of electric current
are :-

1. Collagen.
2. Hydroxyapetite.
3. Collagen hydroxyapetite interface.
4. Mucopolysaccharide.
 As long as the force is maintained ,The
crystal structure is stable & no further
electric effect is observed.
 When the force is released the crystals
return to their original shape &
reverse flow of electrons is observed.
 This rhythmic activity produces a
constant interplay of electric signals .
 Piezoelectric signals have two
unusual characteristics.
 Quick decay rate:
 When the force is released electrons flow in the
opposite direction.

On application of a force on a tooth ,

 Areas of concavity  negative charges  bone
deposition.
 Areas of convexity  +ve charges and  bone
resorption.
 Bone deposition:
 On the tension side.
 Increase in number of osteoblasts .
 Osteoblasts are ovoid cells with basophilic
cytoplasm and a oval nucleus.
 Osteoblast increase in number by proliferation
of their precursor cells.
 The PDL fibers readapt to new position of the
tooth by proliferation of intermediate zone.
 Bone resorption:
 By OSTEOCLASTS
 Multi-nucleated giant cells and may have 12 or
more nuclei.
 They are irregularly and or club shaped with
branching processes .
 They lie in bay like depressions called
Howship’s lacunae.
 The part of osteoclast in contact with resorbing
bone has a ruffled border.
Osteoclasts derived from:-

 Activation of previously present

inactive cells.
 Migration from adjacent bones.

 Formation of new osteoclasts from

local macrophages of PDL.
 Influx of monocytes from blood vessels.
During bone resorption three processes
occur:

1. Decalcification.
2. Degradation of matrix.
3. Transport of soluble products to the
extracellular fluid or blood vascular
system
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