The Importance of Force Levels in Relation to

Tooth Movement
Birte Melsen, Paolo Maria Cattaneo, Michel Dalstra, and
David Christian Kraft

Orthodontic literature is dominated by the pressure-tension theory with

regard to the tissue reaction following mechanical loading of teeth. The
present article discusses the reaction of the alveolar bone to the perturba-
tion generated by different orthodontic force levels. Orthodontists generally
relate the pressure zone to resorption and the tension zone to apposition.
Conversely, orthopedic surgeons know that unloading generates a negative
balance of the ongoing bone remodeling and that loading will result in a
positive balance leading to increased bone density. Research based on
histological analysis of monkey teeth, which were loaded with different
force levels, demonstrated that direct resorption could be a response to a
relatively lower force level. Undermining resorption, on the other hand, is a
repair mechanism attempting to remove the alveolar bone underlying the
ischemic periodontal ligament (PDL). The osteocyte lacunae in this bone appear
empty as a sign of apoptosis or necrosis of the osteocytes. Finite element
analysis (FEA) based on microcomputed tomography (␮CT) and using material
properties reflecting the physiological values of the PDL and alveolar bone
demonstrated that the classical pressure-tension theory could not be corrobo-
rated. However, the studies did confirm that the reaction of the alveolar wall
can be caused by the changes in strain occurring during various types of
loading. The FEA also demonstrated that the localization of the center of
resistance depends not only on the anatomical relationship of the tooth, PDL,
and surrounding bone, but also on the difference in microanatomy at the
different levels of the alveolus as well as the force magnitude that is applied.
(Semin Orthod 2007;13:220-233.) © 2007 Elsevier Inc. All rights reserved.

“ ight and heavy forces” are terms that are
L frequently used in orthodontics and have
been related to the biological reaction to orth-
odontic force systems. It may be reasonable to
Professor and Head, Department of Orthodontics, School of
Dentistry, University of Aarhus, Aarhus, Denmark; Assistant Pro-
fessor, Department of Orthodontics, School of Dentistry, University of
Aarhus, Aarhus, Denmark; Associate Professor, Department of Orth-
odontics, School of Dentistry, University of Aarhus, Aarhus, Den-
mark; Doctoral candidate, Department of Orthodontics, School of
Dentistry, University of Aarhus, Aarhus, Denmark.
Address correspondence to Prof. Dr. B. Melsen, Department of
Orthodontics, School of Dentistry, Vennelyst Boulevard 9, 8000
Aarhus C, Denmark. Phone: ⫹45 8942 4037; E-mail: orthodpt@
odont.au.dk
© 2007 Elsevier Inc. All rights reserved.
1073-8746/07/1304-0$30.00/0
doi:10.1053/j.sodo.2007.08.004
reconsider, from a biological point of view,
whether it is appropriate to discuss force levels.
New evidence points toward a more complex
relationship between forces and tooth move-
ment. In the present article, the significance of
conventional ideas regarding the “pressure-ten-
sion” theory are discussed relative to recent re-
search.
Often, orthodontists refer to teeth being
loaded. Although correct, it should be consid-
ered as a means through which the forces are
transferred to the bone. The bone in turn has to
react with resorption and apposition to allow
for tooth movement. Furthermore, orthodon-
tists have traditionally accepted a relationship
between force magnitude and the rate of tooth
displacement. For example, the same force de-

220 Seminars in Orthodontics, Vol 13, No 4 (December), 2007: pp 220-233

 Alveolar Bone and Orthodontic Force Levels 221

Alveolar Bone Morphology

Figure 1. Mesiodistal cut through the 3D reconstruc-
tion of a mandibular segment of a 19-year-old male
donor made with SR␮CT. Note how the alveolar bone
proper closely adapts to the shape of the roots. Even
minor irregularities as on the root surface of the
molar (to the left) and major ones (the first premolar
to the right) are reflected in the shape of the alveolus.
Also note that the alveolar bone proper varies in
thickness and in some places corresponds to that of
the PDL.
The marginal bone level may vary within an
individual tooth socket. Analysis of the alveolar
wall of dry skulls in which the teeth had been
extracted clearly demonstrated that the number
of fenestrations of the alveolar wall, that is, the
density of the alveolus, varies between the apical
and the marginal areas. In addition, it was shown
that the number of fenestrations increases with
marginal bone loss, possibly reflecting the in-
creased vascularity related to the “inflammation”
causing the bone loss.3 These findings further
call into question the relationship of force mag-
nitude relative to the rate of tooth movement.
The reactive tissue in tooth movement is the
alveolar bone and current knowledge or under-
standing of the alveolar bone is considered to be
limited.
The actual three-dimensional (3D) morphol-
ogy of the teeth and their periodontal tissues can

livered to an increased number of teeth, com-

pared with fewer teeth, is therefore expected to
result in slower tooth movement. Based on se-
lected clinical studies, Quinn and Yoshikava,
concluded that a linear relationship exists be-
tween force level and rate of tooth movement.1
Consequently, teeth of the reactive (anchorage)
unit would move slower, as the force per tooth
would be lower due to more teeth being in-
volved in the anchor unit. The reliability of this
conclusion is suspect, however, due to the small
number of patients included in the latter studies
and the great variation in the types of force
systems applied.
In addition, the root surface has traditionally
been used as a reflection of the alveolar bone
displacement during tooth movement, although
only a weak correlation exists between the sur-
face of the root and that of the alveolar wall. Figure 2. Buccolingual aspect through the second
premolar in the same mandibular segment as in Fig 1.
Freeman assigned anchorage values based on Note that the extension of the integration of the
the root surface area and related this to the Begg alveolar bone with the external cortical bone is longer
technique.2 on the buccal than on the lingual side.
222 Melsen et al

be assessed with microcomputed tomography
(␮CT).4 This method has the advantage that it is
noninvasive. Two scanning modalities are avail-
able with ␮CT; the former uses conventional
radiograph systems (tabletop ␮CT systems),
while the latter uses radiation generated in the
storage ring of a synchrotron facility (SR␮CT).5,6
From ␮CT images it becomes evident that the
thickness of the fenestrated alveolar wall varies
and in some places the thickness is not more
than that of the PDL. In these areas the wall is
supported by an intricate network of intercon-
necting trabeculae (Fig 1). The trabeculae are
thinner and more sparsely distributed toward
the apices of the roots. At the cervical aspect, the
alveolar wall merges with the lingual and buccal
cortical shells thus enhancing the mechanical
support7 (Fig 2). The bony support is less in the
mesiodistal direction. With SR␮CT, small, yet
distinct variations in the gray scale values enable
the separation for visualization of blood vessels
within the bone marrow as well as collagen fibers
within the PDL.8 In addition the Haversian canals
within the lingual and buccal cortices can be visu-
alized using this method. The Haversian systems
are orientated parallel to the arch of the jaw. The
many blood vessels penetrating the alveolar wall
provide evidence of biological pathways between
the PDL and the alveolar bone and bone marrow
(Fig 3). The microanatomy of the alveolar wall
indicates that only very light forces should be ap-
plied to avoid ischemia and local necrosis. This
may explain why the copper nickel-titanium (Cu
NiTi) wires with a transition temperature of 40°C
appeared to result in a more rapid dental leveling
than arch wires with a transition temperature of
27°C.9 With a transition temperature of 40°C, low
and intermittent forces are delivered.
The effects of biological activities, such as
bone remodeling and root resorption, can also
be visualized with ␮CT scanning. This is clearly
demonstrated in samples from animal studies,
where the teeth and implants have been sub-
jected to specific orthodontic loading regimes
(Fig 4). The described morphology of the alveolar
wall, apart from the site-dependent variation, is
also subject to an interindividual variation related
to facial morphology and health status of the pe-

Figure 3. Section from the same mandibular segment as in Fig 1. On the left the mineralized tissues are shown, while
in the middle and on the right the embedding material (polymethylmethacrylate) is shown green. The latter
represents the soft tissues, like the root canal, the PDL, and the bone marrow and blood vessels. Note the interaction
between the PDL and the bone marrow through the alveolar wall. (Color version of figure is available online.)
 Alveolar Bone and Orthodontic Force Levels 223

Figure 4. Horizontal section of a mandibular segment of a macaca fascicularis monkey. A dental implant had
been inserted in the region of the first molar and loaded with 50 cN toward the canine in the left of the image.
A part of the root of the canine is shown on the left (A) together with the two roots of the first premolar (B).
Note the increased density of the trabecular bone surrounding the dental implant. The root of the canine is
heavily resorbed; note the distinct pattern of root resorption where it is in close contact to pointed trabeculae.
The distal side of the alveolar bone proper around the first premolar is slightly darker than bone elsewhere
indicating new bone formation.

riodontium. On the basis of the above reported
research, it would seem inappropriate to describe
forces relative to root surface.
The “Optimal” Force
Apart from the variations of the alveolar wall
described previously, “the more teeth against
fewer teeth” hypothesis has never been scientif-
ically supported. In 1967 Weinstein demon-
strated that a few grams of force are sufficient
for the generation of tooth displacement.10 At
the present there is no universal consensus nor
scientific evidence regarding a threshold of
force level that would “switch on” tooth move-
ment.11 A universally accepted standard for
threshold and optimal force values does not
seem to exist. “The force that delivers the high-
est rate of tooth movement with the minimal
damage” has yet to be described. This is evident
from the research performed on dogs12 and hu-
mans13 by the application of different force lev-
els to second premolar teeth. The results of
these studies indicated that the same rate of
tooth movement occurs with the different levels
of force applied. Both studies concluded that
the variation in the rate of tooth displacement
was mainly related to the individual and not to
the force level.
Minimal forces leading to minute changes in
the stress strain distribution within the PDL are
able to start the necessary tissue reaction. This
implies that the higher force levels commonly
used in orthodontic treatments do not necessar-
ily improve tooth movement and that overload-
ing the periodontal tissue can cause negative ef-
fects, such as hyalinization and ischemia thereby
delaying tooth movements.14
The alveolar wall on the pressure side has
traditionally been described as undergoing di-
rect and indirect resorption. Indirect or under-
mining resorption is generally observed in the
initial phase of tooth movement when disrup-
tion in blood flow leads to a “hyalinization” of
224 Melsen et al
the PDL. Only after the hyalinized tissues are
resorbed does direct resorption of the alveolar
wall occur that will lead to an increase in the rate
of tooth movement.
Direct resorption is believed to be the reac-
tion to low force levels and the indirect resorp-
tion to high forces. However both “low” and
“high” force level descriptions are only qualita-
tive words that are of questionable value. It is
more appropriate to consider the relationship to
the tissues loaded. The difference between low
and high force driven tooth movement can in
fact only be possible on the basis of the forma-
tion of hyalinized tissue.12,15 Clinically hyaliniza-
tion will correspond to the phase 2 of tooth
movement, which is a period where no or only
very modest tooth displacement is taking place
because the alveolar wall is not being resorbed.
The ischemia leading to the hyalinization results
in disappearance of the lining cells and as a sign
of apoptosis the osteocyte lacunae in the adja-
cent bone will appear empty16,17 (Fig 5). This
Figure 5. Histological image of a hyalinized zone cov-
ering a bony extension. The osteocyte lacunae adja-
cent to the hyalinized surface appear empty (gift from
Dr. K. Reitan). (Color version of figure is available
online.)
would therefore indicate that undermining re-
sorption should be considered as a continuous
repair process including the removal of necrotic
tissue. This interpretation coincides with that
advanced by Von Böhl and coworkers through
their research.18 Histological studies performed
by Von Böhl and coworkers on dogs revealed
that local hyalinization might explain the indi-
vidual differences in the rate of tooth move-
ment.19 The local hyalinization may well be
caused by the irregularity of the alveolar wall as
identified by ␮CT images (Fig 6).
The Controversy Between Orthodontics
and Orthopedics
Within orthodontics, it is commonly believed
that pressure developed in the direction of the
force generates the resorption necessary for the
tooth movement. This, however, is in contrast to
that within orthopedics where it is accepted that
loading leads to bone formation whereas un-
loading will result in a negative balance of bone
turnover. In orthopedics, the bending of a long
bone will generate compressive strains in the
bone that will react with apposition whereas re-
sorption will take place on the side where the
periosteum is put under tension.20,21
This apparent controversy was addressed
through a histomorphometric study that evalu-
ated the tissue reactions in relation to premolars
and molars of 6 adult macaca rhesus monkeys to
different loading regimens with mesiodistal
forces.16 Following 11 weeks of loading, the
monkeys were euthanized, the jaw excised and
undecalcified serial sections were prepared. The
sections were stained with fast green and a grid
consisting of 3 concentric outlines of the root
cross section intersected by 4 equidistant radii
placed on top of the sections. In this way the
histomorphometric evaluation of the mesial, the
lingual, the distal, and the buccal surface could
be separated. The histomorphometric analysis
was performed as previously described by means
of a Zeiss II integrating reticle.16,22,23 The den-
sity of the bone adjacent to the teeth was as-
sessed in the so-called pressure and tension
zone. The results demonstrated that density in
the direction of the tooth movement (the pres-
sure zone) was significantly increased (Fig 7).
This was more pronounced in relation to both
molars and premolars that had been subjected
 Alveolar Bone and Orthodontic Force Levels 225

Figure 6. Detail of the alveolar bone-PDL-root interface of the second premolar from the same mandibular
segment as in Fig 1. As in Fig 3 false color (red) have been used to visualize the soft tissues. Note the irregular
surface of the alveolar wall; a uniform deformation of the root and PDL will thus lead to local stress concen-
trations in the alveolar bone. (Color version of figure is available online.)

to the greatest load. This finding may reflect
that the higher strain values generated by the
higher forces were able to generate a more
positive balance in the bone turnover in the
direction of the force than the low force reg-
imen.20 The relationship between force level
and increased density was also seen when the
bone was loaded via forces applied to dental
implants (Fig 8). The bone turnover around
the implants was increased. This was con-
firmed by a decrease in the relative amount of
the resting surfaces in the bone at all sides of
the loaded implants and an increase in the
relative amount of the resorption surface and
appositional surfaces in the bone, although
the latter was not significant due to the large
variation in the measurements.
On the surface of the alveolar wall, in the
force direction, a direct resorption was seen in
relation to all teeth studied (Fig 9). This could
be explained by the fact that the histology im-
aged the situation following 11 weeks of tooth
movement, where the initial hyalinization had
been removed. An increased density in front of
the displacing teeth did indicate that a regional
acceleratory phenomenon (RAP) had taken
place as a response to the initial loading. While
hyalinized, the physical properties of the PDL al-
lowed for the transfer of forces to the underlying
bone. This loading would result in an increased
density of the bone underlying the bony compo-
nents with empty osteocytic lacunae. The direct
resorption was therefore expressing the “fourth
phase” as described by Pilon and coworkers, when
the strain had been relieved.12 The observation
made in this study could confirm that the orth-
odontic loading leads to bone formation in the
direction of the force where forces are transferred
via the hyalinized PDL. The increased density of
woven bone generated due to the RAP may slow
down the rate of tooth movement even when the
direct resorption has started.
The turnover of the bone surfaces whether
endosteal, periosteal, or trabecular is believed to
be monitored by the stress or strain perceived by
the osteocytes.24-26 Against this background it
seems difficult to believe that the remodeling
activity of the alveolar wall has been thought to
be determined exclusively by the reaction of the
periodontal ligament.27-29 The first displace-
ment of tooth is within the periodontal ligament
and only after this does the bone reaction occur.
A cascade necessary for the rebuilding of the
fibrous system of the PDL is started and may be
parallel to the reaction occurring on the alveolar
wall. However, a differentiation toward more os-
226 Melsen et al

Figure 7. Histological image of a molar that has been loaded toward the right with 200 cN for 11 weeks. A direct
resorption is seen of the alveolar wall in the direction of the force. The bone in the direction of the force consists
of woven bone most likely as an expression of RAP phenomenon developed as response to the forces transferred
via the initial hyalinization to the bone. (Color version of figure is available online.)

teogenic phenotypes of cells from the multipo-
tential cell pool of the human PDL is seen fol-
lowing mechanical stretching.27,28
Finite Element Analysis
The stress/strain distribution of the alveolar
bone plays an important role for the modeling
of the alveolus and the change in shape and
position of the alveolus. The stress/strain distri-
bution of the tissues surrounding the orthodon-
tically loaded tooth has been studied by finite
element (FE) analyses. Most of the early pub-
lished FE analyses confirmed the traditional
pressure-tension theory. However, they were per-
formed on models in which the true anatomy
and the physical properties of the periodontium
were not taken into account. The fact that the
PDL is composed of a viscoelastic material that
reacts in a nonlinear way, and the differences in
response under compression and tension forces
were not taken into consideration.30,31 In fact,
most of the earlier FE models made use of ho-
mogeneous, linear elastic, isotropic PDL prop-
erties.32-34 However, recent studies have demon-
strated that the load transfer mechanism from
the teeth through the PDL to the alveolar sup-
port structures is strongly dependent on both
the material properties of the different peri-
odontal tissues and on the (micro)morphology
of the periodontium.35
␮CT datasets have recently been used to in-
corporate detailed morphology of the periodon-
tium into sample-based FE models.35,36 In these
models (Fig 10), the material properties of the
alveolar bone were directly retrieved from the
␮CT datasets, while the true material properties
of the PDL were approximated by using both
experimentally30,31,37 and mathematically deter-
mined relationships.38 The analyses that have
been performed using this approach demon-
strated that, with orthodontic loading, the over-
all stress is not uniformly distributed along the
alveolus. It is related to the trabecular support of
the alveolus and the load transfer from tooth to
the jawbone through the PDL (Fig 11). More-
over a clear differentiation between compressive
and tensile areas in the alveolar bone surround-
 Alveolar Bone and Orthodontic Force Levels 227

Figure 8. Histological image of 2 implants that have been loaded with 100 cN in the direction of the arrows for
3 months. As a result of the loading an increased density of the bone surrounding the implants can be
appreciated. (Color version of figure is available online.)

ing the root could not be detected, and there-
fore the load transfer mechanism cannot be
described in simple terms of compression and
tension.
In the case of tipping a tooth the “traditional”
compression and tension zones were not simply
symmetrically distributed around the root as
previously described,39 but followed a more
complex pattern (Fig 12). During both tooth
tipping and translation, tension was more pre-
dominant than compression; indeed the alveo-
lar bone situated in the traditional “compres-
sion” areas was overall loaded significantly less
than the bone on the “tension” side. This may
indicate that direct bone resorption in front of
the roots along the direction of movement is a
consequence of a hypophysiological loading,
where the strain values stay below the minimum-
effective strain (MES) as defined by Frost.20
Therefore, the simple yet still generally accepted
concept, which suggests that bone resorption is a
consequence of compression and bone formation
a consequence of tension, is questionable. For
these reasons loading/nonloading of the alveolar
support structures seems to be a more reasonable
model. These analyses have demonstrated that to
be able to precisely describe the transfer mecha-
nism of orthodontic loads, morphologically accu-
rate and physically correct 3D FE models must be
used. In addition, the finite element analysis
(FEA) based on the microanatomy also provide
the basis for decreasing wire dimensions, and
thereby the force levels, in relation to the applica-
tion of self-ligating brackets.40
In addition to the calculation of the stress and
strain fields, the detailed 3D FE models of the
alveolus also make it possible to:
1. determine the displacement of a tooth for a
given force level;
228 Melsen et al

Figure 9. Histological image of a tooth that has been displaced with 200 cN for 11 weeks. Note the pronounced
resorption in the direction of the displacements toward the dense woven bone (A). The alveolar wall is now
characterized as a direct resorbing zone (B). (Color version of figure is available online.)

2. calculate the position of the center of resis-
tance (CR); and
3. determine the type of tooth movement (the po-
sition of the center of rotation, the CRot).
The amount of deflection that a tooth is expe-
riencing when an orthodontic force is applied at
the bracket is not linearly correlated to the ap-
plied load (Fig 13). In the first part of the curves,
a relative small increment of the force is fol-
lowed by relative large deflection of the tooth.
On the contrary, above a force level of about 15
cN the slope of the curve gradually diminishes as
the force magnitude increases. It follows that the
application of higher forces will generate only a
moderate increment in the initial displacement
of the tooth. This could explain why some au-
thors report an increased mean rate of tooth
movement seen only in the low force level range
(10 to 25 cN), while the mean rate of tooth
movement will not be augmented by further
increasing the force magnitude.12,41
Mathematically the center of resistance (CR)
of a single-rooted uniformly supported tooth
with an ellipsoidal shaped root is located at one-
third of its root’s length. In vivo holographic
experiments have shown that in reality the CR is
 Alveolar Bone and Orthodontic Force Levels 229

Figure 10. Single-slice ␮CT image (top left) and corresponding section from the FE-model (bottom left); note
the close resemblance of the trabecular and cortical bone structures in both images. An exploded view of the
entire FE model is depicted on the right.

closer to 40% of the root length and this was the location of the CRot relative to the CR for an
always attributed to the fact that actual roots are incisor in 3D. They compared their results with
not perfectly ellipsoid.42 However, a nonuni- those of a 2D parabolic section and found that
form support from the alveolar bone also plays a the center of resistance was slightly more gingi-
role. Initial results from FEA based on the true val in the 3D than in the 2D model.42
anatomy and optimized physical properties of
the alveolar tissues suggest that the direction
and magnitude of loading also influences the
localization of the CR. This means that, contrary
to the generally accepted idea, the CR cannot be
regarded as a static entity.43 At present, studies
are being performed by the first 3 authors of this
article to examine whether this “displacement”
of the CR is such that it should be taken into
account when designing an appliance for a par-
ticular type of tooth movement.
The position of the CR is crucial in the pre-
diction of the type of displacement the tooth will
undergo when an orthodontic loading system is
applied at the bracket. By means of laser holog-
raphy, Burstone and Pryputniewic established
the localization of both the center of rotation
(CRot) and the center of resistance (CR) in an
in vitro experiment in which they loaded a
model of an upper central incisor. By applying Figure 11. Distribution of the sigma-X component
200 g of force perpendicular to the long axis (lingual-buccal stress) in the PDL of a canine when a
force of 100 cN and an M/F ratio of 11 are applied at
of the tooth at different levels replicating the bracket. Note that tension—red—is by far more
different moment-to-force ratios (M/F) ap- predominant that compression— blue. (Color version
plied to the bracket, they were able to establish of figure is available online.)
230 Melsen et al

Figure 12. Stress distribution in a buccolingual section of the alveolar bone when a tipping loading regimen
is applied at the bracket. The Von Mises stresses are higher on the lingual side (the “traditional” tension
side) than on the buccal side (top right). The first principal stresses (bottom left) show that the highest
tensile stresses are present at the lingual side due to the bending of the alveolar bone and by the pulling
action of the PDL fibers in the lingual-cervical and buccal-apical regions. The third principal stresses
(bottom right) show that the highest compressive stresses are present at the lingual-cervical region and
along the buccal wall. Note that the presence of tensile stresses does not exclude the presence of
compressive stresses in the same area and vice versa. (Color version of figure is available online.)

The results were shown in a graph illustrating
the relationship between the moment-to-force
ratio at the bracket and the location of the cen-
ter of rotation. With the FEA it is possible to
redraw these graphs for each sample-specific FE
model. In this way it is possible to determine the
influence of both the morphology of the roots
and of the height and quality of the alveolar
bone on the displacement resulting from dif-
ferent moment-to-force ratios applied to the
bracket. From preliminary results, it could be
anticipated that to achieve a translatory move-
ment in the buccolingual direction of a mandib-
ular canine, premolar, and first mandibular mo-
lar, an M/F ratio of, respectively, 11, 8, and 10.5
would be needed.36
Conclusion
Based on recent research, the existence of an
optimal force level rendering the maximum
 Alveolar Bone and Orthodontic Force Levels
Figure 13. Force-displacement curves for the first mandibular molar calculated at the cuspid, furcation, and
apices of both roots. Note that a linear relationship between force and displacement is not present especially for
low forces.
tooth movement with a minimum of adverse
effect can be questioned. No direct relationship
between the magnitude of the orthodontic load
and the rate of tooth movement has yet been
determined indicating that a change in force
level will not necessarily result in a change in the
rate of tooth movement. The pressure-tension
theory, as it relates to alveolar bone remodeling,
is similarly questionable as changes in strain,
rather than pressure and tension, release the
cascade of biological reactions leading to the
tooth movement.
Due to intra- and interindividual variations in
the anatomy of the alveolar support structures,
orthodontic forces with the same magnitude will
generate widely different stress and strain distri-
butions in these tissues in different individuals.
Due to both the nonlinear mechanical proper-
ties of the tissues as well as the varied mechan-
ical support of the teeth in different individu-
als, the load transfer through the alveolar
tissues is complex and for these reasons only
very small orthodontic forces should be ap-
plied to the teeth to avoid ischemia and local
necrosis of the tissues.
231
The latest FEA has indicated that certain bio-
mechanical maxims of orthodontic loading that
were previously assumed to be correct, such as
the position of the CR and the position of the
CRot for a given M/F ratio, may not be so, and
are in fact dependent on both the magnitude
and the direction of the applied force. The
FEA also demonstrated that areas of alveolar
bone loaded with high tension are generally
also loaded with high compression simulta-
neously. This means that the generated inter-
nal stress from orthodontic loading of a tooth
will create both areas of tension and compres-
sion, which cannot be easily demarcated as
described in the pressure-tension hypothesis.
The local stress density created in a specific
area of alveolar bone can be considered as an
interplay between both tension and compres-
sion components. Often the tensile and compres-
sive components are acting simultaneously, thus
amplifying the total stress and making it diffi-
cult to find areas that are exclusively tensile or
compressive. Therefore, the simple pressure-
tension theory cannot be corroborated by any
of the observations made in the studies re-
ported here. To augment the discussion, a
232 Melsen et al
Figure 14. Diagram of the cellular reactions related to the different stages of an orthodontic tooth movement.
Courtesy of Raman Aulakh. (Color version of figure is available online.)
diagram of tooth movement is presented in
Fig 14.
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