Orthodontics Assignment

Lecturer: Dr. Mazen Sbeih

Student’s name: Tasneem Saleem Rajabi
Student’s number: 21512116
Section: 20, Group 12

Discuss briefly the differences movement of the tooth when using high force
compared to low force magnitude.

Orthodontic movement of teeth is based on the observation that if prolonged light pressure
is applied to a tooth, tooth movement will occur as the bone around the tooth remodels.
Bone is selectively removed in some areas and added in others. The tooth moves through
the bone carrying its attachment apparatus with it, as the socket of the tooth migrates.
Because the bony response is mediated by the periodontal ligament (PDL), tooth movement
is primarily a PDL phenomenon.

In order for the teeth to produce any orthodontic movement you need to have, tooth, PDL,
bone, a force that will be sustained for a certain period of time.

Forces applied to the teeth can also affect the pattern of bone apposition and resorption at
sites distant from the teeth.

 To remind you about the structure of the PDL:

1. The PDL occupies a space approximately 0.5 mm in width around all parts of the root.
2. A network of parallel collagenous fibers resists the displacement of the tooth
expected during normal function.
3. The cellular elements, including undifferentiated mesenchymal cells …etc.
4. The tissue fluids.
5. Blood vessels and cells from the vascular system.
6. Nerve endings are also found within the ligament, both the unmyelinated free
endings associated with perception of pain and the more complex receptors
associated with pressure and positional information (proprioception).

 Remodelling and recontouring of the bony socket and the cementum of the root is also
constantly being carried out, during physiological movement of the bone and the teeth
as a response to normal function:
o New alveolar bone is formed by osteoblasts and cementoblasts.
o Bone and cementum are removed by specialized osteoclasts and cementoclasts.
During masticatory function, the teeth and periodontal structures are subjected to
intermittent heavy forces. Tooth contacts last for 1 second or less; forces are quite heavy,
ranging from 1 or 2 kg while soft substances are being chewed to as much as 50 kg against a
more resistant object. When a tooth is subjected to heavy loads of this type, quick
displacement of the tooth within the PDL space is prevented by the incompressible tissue
fluid. Resistance provided by tissue fluids allows normal mastication, with its force
applications of 1 second or less, to occur without pain.

Physiologic response to heavy pressure against a tooth

Time (seconds) Event
PDL fluid incompressible, alveolar bone bends, piezoelectric signal
<1
generated
1-2 PDL fluid expressed, tooth moves within PDL space
PDL fluid squeezed out, tissues compressed, immediate pain if pressure is
3-5
heavy

 The response to sustained force against the teeth is a function of force magnitude:
o Heavy forces lead to rapidly developing pain, necrosis of cellular elements within the
PDL, and the phenomenon of “undermining resorption” of alveolar bone near the
affected tooth.
o Lighter forces are compatible with survival of cells within the PDL and a remodelling
of the tooth socket by a relatively painless “frontal resorption” of the tooth socket.

 The biologic control mechanisms lead from the stimulus of sustained light force to the
response of alveolar bone remodelling that allows tooth movement. Two possible
control elements, biologic electricity and pressure–tension in the PDL that affects blood
flow, are contrasted in the two major theories of orthodontic tooth movement:

a) Biologic-Electricity theory, relates tooth movement at least in part to changes in bone

metabolism controlled by biologic electricity that are produced by light pressure
against the teeth.

b) Pressure–Tension theory, relates tooth movement to three stages:

1. Initial compression of tissues and alterations in blood flow associated with pressure
within the PDL
2. The formation and/or release of chemical messengers
3. Activation of osteoblasts and osteoclasts, leading to remodelling of alveolar bone.

The electricity and chemical messenger theories are neither incompatible nor mutually
exclusive, and it appears that both mechanisms may play a part in the biologic control of
tooth movement, but chemical messengers play a dominant role.
 Effects on the response to orthodontic force:
The heavier the sustained pressure the greater should be the reduction in blood
flow through compressed areas of the PDL, up to the point that the vessels are totally
collapsed and no further blood flows.

Physiologic response to sustained pressure against a tooth

Time
Light force Heavy force Event
<1 second PDL fluid incompressible, alveolar bone bends,
piezoelectric signal generated
1-2 seconds PDL fluid expressed, tooth moves within PDL
space
3-5 seconds Blood vessels within PDL partially compressed
on pressure side, dilated on tension side; PDL
fibers and cells mechanically distorted
Minutes Blood flow altered, oxygen tension begins to
change; prostaglandins and cytokines released
Hours Metabolic changes occurring: chemical
messengers affect cellular activity, enzyme
levels change
-4 days Increased cAMP levels detectable, cellular
differentiation begins within PDL
-2 days Tooth movement beginning as osteoclasts and
osteoblasts remodel bony socket
3-5 seconds Blood vessels within PDL occluded on pressure
side
Minutes Blood flow cut off to compressed PDL area
Hours Cell death in compressed area
3-5 days Cell differentiation in adjacent narrow spaces,
undermining resorption begins
7-14 days Undermining resorption removes lamina dura
adjacent to compressed PDL, tooth movement
occurs

The optimum force levels for orthodontic tooth movement should be just high enough to
stimulate cellular activity without completely occluding blood vessels in the PDL.
The amount of force delivered to a tooth and the area of the PDL over which that force is
distributed are important in determining the biologic effect.

The PDL response is determined not by force alone, but by force per unit area, or pressure.
Because the distribution of force within the PDL, and therefore the pressure, differs with
different types of tooth movement.
 Optimum forces for orthodontic tooth movement
Type of movement Force (gm.)
Tipping 35-60
Bodily movement (translation) 70-120
Root up-righting 50-100
Rotation 35-60
Extrusion 35-60
Intrusion 10-20

 Force duration is classified by the rate of decay as:

1. Continuous: force maintained at some appreciable fraction of the original from one
patient visit to the next, can be produced by fixed appliances.
2. Interrupted: force levels decline to zero between activations, can be produced by
fixed appliances
3. Intermittent: force levels decline abruptly to zero intermittently, produced by all
patient-activated appliances such as removable plates, functional appliances,
headgear, and elastics.

The key to producing orthodontic tooth movement is the application of sustained force,
which does mean that the force must be present for a considerable percentage of the time,
certainly hours rather than minutes per day. 4 to 6 hours to produce a response correlates
rather well with the human response to removable appliances. If a removable appliance is
worn less than 4 to 6 hours per day, it will produce no orthodontic effects. Above this
duration threshold, tooth movement does occur.

Heavy continuous forces are to be avoided, heavy intermittent forces, although less
efficient, can be clinically acceptable.
The more perfect the spring in the sense of its ability to provide continuous force, the more
careful the clinician must be that only light force is applied.

References:
Proffit, W. R., Fields, H. W., & Sarver, D. M. (2007). Contemporary orthodontics (6th edition). St. Louis,
Mo: Mosby Elsevier.