 Since the first extended reports at the end of the 19th century (

Kingsley, 1880 ; Angle, 1900 ), there have been tremendous

developments in the field of orthodontics. The acquired knowledge is
being used to treat an increasing number of subjects with
malocclusions that seek orthodontic solutions for their psychosocial,
functional, or dental problems ( Proffi t, 2000 ).
 A law in orthodontics is that a tooth can be moved through the alveolar
bone when an appropriate orthodontic force is applied.
 This is based on the principle that a change in mechanical loading of a
biological system results in strain, which subsequently leads to cellular
responses aiming at adaptation of the system to the changed
conditions.
 As a result of this principle, remodeling of the periodontal ligament
(PDL) and the alveolar bone around a tooth takes place during
orthodontic force application
 In orthodontics, the two sides of a tooth during tooth movement are
normally called the pressure and tension side.
 The term ‘ pressure ’ suggests a loading of the PDL and the bone by the
orthodontic force. However, this is not what occurs.
The apparent contradiction can be explained by two phenomena.
 First, the presence of collagen fibers of the PDL that connect the tooth
with the alveolar bone.
 At the so-called pressure side, these fibers are unloaded leading to
unloading of the alveolar bone, resulting in its resorption.
 The model demonstrates the main processes taking place
after the application of an orthodontic force.
 In this model, the force is assumed to be exerted on a single
tooth leading to bodily tooth movement.
 A period of arrest in movement often takes place after application of a
force, caused by local tissue necrosis.
 Tooth movement through the bone can only start after the removal of
this necrotic or hyalinized tissue by phagocytic cells such as
macrophages, foreign body giant cells, and possibly osteoclasts.
The theoretical model describes four stages in the induction of tooth
movement. These stages are as follows:
 (1) Matrix strain and fluid flow. Immediately after the application of an
external force, strain in the matrix of the PDL and the alveolar bone
results in fluid flow in both tissues.
 (2) Cell strain. As a result of matrix strain and fluid flow, the cells are
deformed.
 (3) Cell activation and differentiation. In response to the deformation,
fibroblasts and osteoblasts in the PDL as well as osteocytes in the bone
are activated.
 (4) Remodeling. A combination of PDL remodeling and the localized
apposition and resorption of alveolar bone enables the tooth to move.
The model (on the following slide) describes four different stages in the
induction of tooth movement.
 Frame (a) represents matrix strain and fluid flow,
 (b) cell strain,
 (c) cell activation and differentiation, and
 (d) remodeling of the periodontal ligament (PDL) and bone
 The specific underlying role of the periodontal ligament in tooth
movement is not well-understood, but its unique biomechanical,
cellular, and molecular natures are undoubtedly important.
 From a biomaterials perspective, the periodontal ligament is a
complex, fiber-reinforced substance that responds to force in a
viscoelastic and non-linear manner (Jonsdottir et al., 2006).
 This response is characterized by an instantaneous displacement,
followed by a more gradual (creep) displacement that reaches a
maximum after 5 hrs (van Driel et al., 2000), suggesting that fluid
compartments within the periodontal ligament may play an important
role in the transmission and damping of forces acting on teeth.
 The strains that are created in the periodontal ligament by
force application clearly have biological consequences for the
tissue itself, and possibly also for the other tooth-supporting
tissues (i.e., alveolar bone and cementum).
 Periodontal ligament cells respond to force by increases in cell
proliferation and apoptosis.
 The relative extent to which these two competing processes
occur controls the various cell populations in the periodontal
ligament and reflects the specific biomechanics.
Orthodontic tooth movement occurs as a result of a force being placed on
a tooth. It is composed of three phases:
 initial tipping,
 lag phase and
 progressive tooth movement.
 When the force is placed on the crown of the tooth, initial tipping
occurs.
 The periodontal ligament (PDL) is compressed adjacent to the alveolar
bone on the side toward which the force is directed.
 On the opposite side, away from the force direction, the PDL is
widened, experiencing tension.
 The center of resistance of the tooth is defined as the point at which a
direct force would cause the tooth to move completely linearly in the
direction of the applied force.
 Because the force is applied at the crown of the tooth, away from this
center of resistance, the tooth tips.
 The location of the center of resistance changes depending on the
length of the root and amount of periodontal bone support, thus
changing the exact type of movement that occurs.
 These factors, in addition to the PDL width and force magnitude,
affect the amount of initial tipping that occurs.
 Controlled – centre of rotation is at its apex
 Uncontrolled tipping – centre of rotation is very close or at the
centre of resistance.
 The lag phase represents a delay in movement, which reflects
recruitment of cells and the establishment of a microenvironment that
will allow the PDL and bone to remodel.
 This is when osteoclasts are recruited to the area and osteoblasts are
activated.
 The length of this phase is partially dependent on the amount of force
applied. If excessive forces are applied, the root approaches the
alveolar wall more closely on the compression side, and the
vasculature to the area is compromised. As a result, a cell-free zone or
hyalinized area is formed.
 The hyalinized tissue must be removed for tooth movement to occur.
This occurs via undermining resorption, where osteoclasts present
within the adjacent bone marrow spaces and resorb bone adjacent to
the cell free area.
 This lag phase can last from several days to several weeks.
 The use of light forces can minimize the appearance of hyalinized
tissue and therefore reduce the length of this phase.
 The final phase represents the actual remodeling of bone, consisting of
bone formation in the areas of tension and resorption in the areas of
compression.
 This process results in the movement of the tooth, reduction of the
applied strain, and appliance deactivation. In summary, bone
resorption occurs on the side of compression in the PDL while
formation occurs on the side of tension.
 An acute inflammatory response is typically present in the
early phase of orthodontic tooth movement.
 Cytokines, which are secreted by mononuclear cells, are
chemical mediators that may interact directly or indirectly
with bone cells.
 Cytokines, such as IL-1, can evoke the synthesis and secretion
of numerous substances, including prostaglandins and a
variety of growth factors.
 Prostaglandins have been shown to stimulate bone resorption
and increase the rate of orthodontic tooth movement
 Translation – bodily movement

 Pure rotation – indicates movement of point of a tooth along the arc of a circle

 Combination
 If the line of action of an applied force passes through the
center of resistance of a tooth, the tooth responds by
translation in the direction of line of action to pure bodily
movement.
 Law of transmissibility of forces = external effect of force on a rigid body may be considered to have
a point of application anywhere along its line of action.
 It occurs as the result of the condyles rotating in the lower
compartments of the temporomandibular joints within a 10-
to 13-degree arc, which creates a 20- to 25-mm separation of
the anterior teeth.
 This movement occurs in the sagittal plane when the mandible in centric relation makes a purely
rotational opening and closing border movement around the transverse horizontal axis, which
extends through both condyles.
 This type of tooth movement is a combination of translation
and rotation types of tooth movement.
 Orthodontic tooth movement is a process in which the application of a
force induces bone resorption on the pressure side and bone
apposition on the tension side.
 Thus, conventional tooth movement results from biological cascades
of resorption and apposition caused by the mechanical forces.
 The term physiological tooth movement primarily refers to
the slight tipping of the tooth in its socket and secondarily to
the changes in tooth position that occur during and after
tooth eruption.
 Basically, no significant difference exists between the tissue reactions
observed in physiological tooth movement and those in orthodontic
tooth movement.
 However, because the teeth are moved more rapidly during treatment,
the tissue changes elicited by orthodontic forces are more marked and
extensive.
 Classically, the typical rate of orthodontic tooth movement depends on
magnitude and duration of force applied, number and shape of roots,
quality of bony trabeculae, individual response, and patient
compliance. Presumably, application of force will result in hyalinization
from both anatomical and mechanical factors.
 Angle E H 1900 Treatment of malocclusion of the teeth and fractures of
the maxillae. Angle’s system. 6th edn . S S White Dental Manufacturing
Co. , Philadelphia
 Handbook of Orthodontics, Martin T. Cobourne, Andrew T. DiBiase
 Kingsley N W 1880 Treatise on oral deformities as a branch of
mechanical surgery. Appleton , New York
 Proffi t W R 2000 Contemporary orthodontics . Mosby , St Louis
 Reitan, K., The initial tissue reaction incident to orthodontic
tooth movement as related to the influence of function, Acta
Odont. Scand., Suppl. 6, 1951.
 S. Henneman , J. W. Von den Hoff and J. C. Maltha
Department of Orthodontics and Oral Biology, Radboud
University Nijmegen Medical Centre, The Netherlands
 Zeev Davidovitch, Department of Orthodontics, The Ohio
State University College of Dentistry, Columbus, Ohio