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’ .

Fibroblasts .Osteoblasts .Periodontal Ligament • Fibres transmit forces applied to the tooth • Viscostatic damping of force • Cells within PDL .Osteoclasts .Undifferentiated cells .

Structural .Metabolic .Bone • Role of Bone in the body .

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 .

short duration) Bending of collagen and bone results in e-’s moving within crystal lattice No signal = bone atrophy 2. Pietzoelectric effect (V. 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 1.

Local control • Biologic electricity • Blood flow • Microfractures Sustained pressure Alters blood flow in PDL flow in tension flow in compression Affects biochemical environment .

these accumulate affecting the microenivironment .Local control • Biologic electricity • Blood flow • Microfractures Microfractures Occur within bond.

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) .

tooth movement in ‘steps’ – Undermining Resorption .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.

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 .

reduce to zero at centre of resistance Force – 50-75g .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.

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 .

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

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

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 ½ -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 .

Tipping Bodily movement Rotation Fixed Intrusion Extrusion .When to use what appliance….

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 .

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