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82 Ardiansyah S. Pawinru & Serliawati: Biomechanics of tooth movement

Biomechanics of tooth movement

Biomechanics of tooth movement

1Ardiansyah S. Pawinru,2Serliawati
1Orthodontics Department
2Professional stage students
Faculty of Dentistry, University of Hasanuddin
Makassar, Indonesia
Correspondence author:Serliawati,e-mail:serli_shela@yahoo.com

ABSTRACT
Introduction:Orthodontic treatment results in a tooth movement that aims to correct the abnormal tooth position into a normal and
aesthetic position. The principle of tooth movement that applies pressure produces remodeling which can be seen from a
microscopic.objective:The objective of this article is meant to describe the biomechanics of tooth movement that occurs when using
removable orthodontics.Methods:scientific evidence are taken from literature to support the clear and detailed information.
Conclusion:Orthodontic tooth movement is based on biological principles.The intermittent or continuous forces applied to the teeth,
altering the mechanical system and then limiting the cellular response leading to bone adaptation in a new functional environment.

Key words:orthodontic treatment, tooth movement, removable orthodontics

ABSTRACT
Introduction: Orthodontic treatment results in tooth movement which aims to correct abnormal tooth positions into normal
and aesthetic ones. The principle of tooth movement that applies pressure producesremodelingwhich can be observed
microscopically.Objective: This article is intended to explain the biomechanics of tooth movement that occurs when using a
removable orthodontic appliance.Method: Scientific evidence taken from the literature to support clear and detailed
information.Conclusion: Orthodontic tooth movement is based on biological principles. Intermittent or continuous forces
are applied to the teeth, changing the loading of the mechanical system and then eliciting cellular responses that lead to
adaptation of the bone in the new functional environment.
Keywords: orthodontic treatment, tooth movement, removable orthodontics
Received: 1 November 2020 Accepted:1 January 2021 Published: April 1, 2021

INTRODUCTION Clinically,The relationship between orthodontic

Orthodontics produces tooth movement that aims
to correct its abnormal position to become normal and
aesthetic. Many studies have been conducted regarding
the mechanical strength and movement of teeth. The
principle of gear movement that applies pressure
generatesremodelingwhich can be observed
microscopically. Although many innovative mechanical
devices for tooth movement have been discovered, they
have not been completely successful in preventing
destruction of the periodontal tissues, due to a lack of
understanding about cells. It is very important to
understand the specific remodeling pathways to target
these cells and achieve a perfect prognosis, because
orthodontic tooth movement depends on efficient bone
remodeling. Understanding of the remodeling pathway
helps in designing better tools that target specific cells
for control so that they can move teeth quickly but
safely.1
Orthodontic tooth movement is based on
biological principles. Intermittent or continuous
forces applied to the teeth alter the loading of the
mechanical system, then evoke a response that leads
to the adaptation of the bone in the new functional
environment.2
force intensity and the degree of tooth movement
during the active phase of treatment is currently
considered as a way to identify optimal strength.,
individually. However,most of the libraries state that-
Yes, heavy and light induce the same type of biological
response.The development of dental research-
It can be concluded that the longer the application of
orthodontics, the higher the success in moving the
teeth.3
This article examines the biomechanics of
tooth movement during orthodontic treatment.
LITERATURE REVIEW
To understand the biomechanics of tooth movement, it is
necessary to understand the following points.
Tooth movement phase
Burstone in 1962 stated that there are three phases of
tooth movement, namely 1) the initial phase, which occurs
immediately after the application of force to the teeth.Move-
The decay is rapid due to displacement of the teeth into the
periodontal space.The time for the initial phase to occur is
usually 24-48 hours. Tooth movement occurs within the bone
socket. Forces applied to the teeth include compression and

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Makassar Dental Journal 2021; 10(1): 82-87, p-ISSN:2089-8134, e-ISSN:2548-5830
stretching of the periodontal ligament leading to extravasation
of blood vessels,chemoattractioninflammatory cells and
recruitment of progenitor osteoblasts and osteoclasts.
2) the lag phase, tooth movement is minimal or sometimes
there is no movement at all.During this phase, hyalinization
of the compressed periodontal ligament occurs-
si.Movement will not occur until the necrotic tissue is
removed by cells, removal of the necrotic tissue of the
LPD and its surroundings is carried out by osteoclasts
and macrophages. During the lag phase, tooth
movement stops for 20-30 days; all necrotic tissue is
removed along with resorption of the surrounding bone
marrow. Necrotic bone tissue and compressed LPD are
removed by macrophages and osteoclasts; 3) post lag
phase, tooth movement gradually or suddenly increases
and is usually seen after the initial 40 days of
orthodontic force application. During tooth movement,
development and removal of necrotic tissue occurs
continuously.1
Tooth movement theory
Orthodontic forces applied to the tooth structure
result in a tooth movement by deposition and resorption
of alveolar bone which is referred to as remodeling..
Orthodontic power given on the morning-
gi is converted to biological activity. Although this is
not fully understood there are three possibilities-
tooth movement anterior,4namely theorybone-bending,
theorybiological electricity, and the theory of stresses.
Theorybone-bending;when orthodontic force is
applied to a tooth, the force is transmitted to all the
surrounding tissues.Strength-This force compresses the
bones, teeth, and LPD. Figures 1 and 2 present the effect
of forces applied to the periosteum and endosteum.
Bone is deposited by the periosteum/endosteum;stored
in the periosteum and absorbed in the endosteum to
prevent it from becoming too thick.Osteoblasts play a
role in bone deposition on the tension side and
osteoclasts play a role in bone resorption on the
compression side.
Figure 1Groove effect force applied to the
periosteum.1
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83
Figure 2Flow effect force applied to the
endosteum.1
This theory was confirmed by baumrind experiments in
rats and in humans. When an orthodontic appliance is
activated, the force received by the tooth is transmitted
to all tissues around the tooth, pressing against the
bone, tooth,and LPD solid structure.Reorganization takes
place not only in the alveolar lamina dura but also on the
surface of each trabeculum in the bony corpus..4
Theorybiological electricity; proposed by Bassett
and Becker in 1962, that whenever the alveolar bone
is compressed it will release an electrical signal and
cause tooth movement.Initiallydiang-
gap as a piezo-electric signal. The characteristics
of these signals are 1) to have a fast decay rate
that begins when a force is applied and at the
same time dissipates rapidly even at a constant
strength; 2) produce the same signal on the
opposite side when the power is removed.1
Periodontal fibers generate stress on the bone during
which orthodontic forces are applied.Can be concluded-
right that the area with a positive electronegative charge-
daiby increased levels of osteoclastic activity and
electropositively charged areas characterized by
increased levels of osteoblastic activity.According to
Davidovitch,et al,exogenous electric currents
together with orthodontic forces accelerate tooth
movement.This suggests that the piezoelectric
response caused by bone compression may serve as
the "cell's first message".1
Figure 3.Bio-electric theory of tooth movement.1
84 Ardiansyah S. Pawinru & Serliawati: Biomechanics of tooth movement
The theory of stresses orpressure-tension;
histological studies by Sandstedt, Oppenheim,
and Schwarz, stated that a moving tooth creates
a pressure and tension side (Table 1). This
causes changes in blood flow to the periodontal
ligament, i.e. less oxygen levels on the stressed
side due to pressure on the periodontal
ligament. Tuncay et al. states that low oxygen
levels cause a decrease in the activity of
adenosine triphosphate (ATP).Schwarzmeng-
correlation of tissue response between the amount of
force and capillary blood pressure. A literature says
that the force that can be applied is around 20-25 g/
cm2root surface, but a study also suggested that the
force that can be applied is normally 30-50 g, and if
the normal pressure is more, then tissue necrosis can
occur due to the compressed periodontium.1
This theory explains that on the pressure side, the
LPD shows disorganization and reduced fiber
production. On this side, cell replication is reduced due
to narrowing of blood vessels. Schwarz hypothesized
that the LPD is a chamber with hydrostatic pressure-
continuous tick which will comply with Pascal's law,
namely pressure is transmitted equally to all areas of the
LPD. On the pressure side, cell replication is said to
decrease as a result of constriction of blood vessels,
resulting in bone resorption. On the tension side,cell
replication increases due to the stimulation that
occurs by stretching the LPD fiber bundles, so that
new bone is formed in the area. In terms of fiber
content, the LPD on the pressure side shows
disorganization and reduced fiber production,while
on the tension side, fiber production is stimulated.4
The causes of dental loading in the area of tension and
compression of the LPD are related to the nerve endings and vessels-
rah. LPD nerve endings associated with blood vessels-
rah. When the nerve endings are distorted, they release the neu-
vasoactive rotransmitters, such as substance P and
CGRP, which interact with vascular endothelial cells
causing vasodilation and increased permeability with
plasma leakage. Endothelial bundles are activated and
circulating leukocytes,monocytes,and macrophages to
LPD,indicates the onset of acute inflammation.Leu-
Figure 4Areas of compression and tension due to orthodontics.5
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cocytes, cytokines, and prostaglandins promote tissue
remodeling. After several days, the inflammation transitions
from acute to chronic and is proliferative involving
fibroblasts,endothelial cells, osteoblasts and osteoclasts;
Osteoclasts play a role in the compression zone. Tooth
movement begins after necrotic tissue is removed by
osteoclasts, then osteoblasts make osteoid with new
periodontal fibers embedded in the alveolar bone wall and
root cementum.5
Table 1Factors affecting tooth movement
according to theorypressure-tension.1
Factors affecting tooth Side Side
movement pressure voltage
Blood flow Decrease Increase
oxygen level Decrease Increase
Carbon dioxide levels Increase Decrease
Cell replication Decrease Increase
Fiber production Decrease Increase
Optimum pressure of the active components of removable orthodontic
appliances
Activation is intended to move the teeth that
want to be corrected;movement requires pressure-
an, which when applied to the teeth should not cause
undermining resorption. The following shows the activation of a
removable orthodontic active component with pressure that is
still being received by the tissues around the teeth.1.11
The labial bow is a component of a removable
orthodontic appliance that functions to retract the will-
also the retention function of maintaining the dental
arch consists of 2 U-loops, arch wire (horizontal bow)
and retentive arm. The diameter of the wire used is
0.7 mm.U-loopshas a length of 10-12 mm, with a
width of 5 mm.Arch wirelocated at 1/3 of the incisor
incisors. To get normal pressure,Activationlabialbow
done by shrinkingU-loopsby 1mm,
so thatarch wirefrom the labial bow will move
1 mm palatally.6
U-loops
Arch wire(horizontal bows)
Figure 5Labial bow.7
Fingersprings are often used on removable
appliances to guide the teeth mesiodistally.
Components of a finger spring include the active arm,
retentive arm, and coil (minimum coil diameter of 2.5
mm). Activation is performed by moving the active
arm mesiodistal 1/3 of the driven tooth. According to
Schwarz in the application of the device, the optimal
force that can be applied is 20-25 g/cm2surface
Makassar Dental Journal 2021; 10(1): 82-87, p-ISSN:2089-8134, e-ISSN:2548-5830
root.Meanwhile, according to Zietsman, normal
pressure is applied to the teeth,ie 30-50g, with an
activation of about 3 mm at a loading/deflection rate
of 15 g/mm.6
Active arm
coil
Retentive arm
Figure 6Finger Springs.12
The veer bumper serves to move individual
teeth in a labial or buccal direction.The wire size
commonly used is 0.5-0.6 mm. The way to activate it
is by opening the loop of the device.
Lup
Retentive arm
Figure 7Veer bumper.11
Effects of heavy and light pressure orthodontics
According to Schwarz in the application of orthodontic
appliances, the optimal force that can be applied is 20-25 g/
cm2root surface.1If the applied pressure is light, it will cause
1) LPD fluid is not compressed, compressing the alveolar
bone, a piezoelectric signal is generated that occurs in less
than 1 second; 2) PDL fluid is secreted, thus causing gear
shift into the LPD space; 3) blood vessels in the LPD are
compressed on the pressure side and stretched on the
tension side, the LPD fibers and cells experience distortion
that occurs within 3-5 seconds; 4) blood flow changes,
oxygen pressure begins to change; prostaglandins and
cytokines are released which occurs in be-
how many minutes later; 5) meta changes occur-
bolic: cell effects and changes in enzyme levels that
occur in the following hours; 6) osteoclast and
osteoblast activity that occurred after two days of
orthodontic application.9
However, according to Schwarz, if the force
given is too light then it will not give any
reaction. Meanwhile, applying heavy pressure
will result in 1) in less than 1 second, the LPD
liquid is not depressed, the bending of the
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85
langalveolar, a piezoelectric signal is generated;2)
LPD fluid is secreted, causing gear shift into the
PDL space which occurs within 1-2 seconds; 3) the
blood vessels in the PDL are blocked on the
tension side which occurs within 3-5 seconds; 4)
blood flow stops on the pressure side that occurs a
few minutes later; 5) cell death on the pressure
side that occurs a few hours later.9
Happenundermining resorptionwithin 3-5
days after application, due to lack of nutrition,
tissue deterioration occurs,cell-Periodontium cells
and fibers will disappear and undergo hyaline
degeneration.
DISCUSSION
The inflammatory process is very important for
orthodontic tooth movement,irregular or severe inflammation-
more will cause problems.Orthodontically induced
root resorption and tissue remodeling must occur-
control.However,15% of orthodontic patients show
excessive root resorption, with a loss of more than
4 mm or one-third of the natural root length.
Applying too much force can causeundermining
resorptionin the alveolar bone because there is no
nutrition, there is a decline in tissue, cells and
fibers of the periodontium will disappear and
experience hyaline degeneration. Teeth that are
moved with excess pressure can cause the teeth to
not move.Inflammation is necessary for
orthodontic tooth movement, but if uncontrolled
will cause tooth decay due to osteoro role.-
increased class while the role of osteoblasts
decreased, so that between zonescompression
withzone tensionwalk unbalanced and the
results will cause teeth to shake.5
If excessive pressure is applied then on the
pressure side there will be 1) blockage of blood
vessels; 2) LPD will lose nutrient intake, causing
a regressive change called hyalinization which is
a cell-free area; and 3) excessive bone
resorption.12
Whereas on the tension side, excessive
pressure will cause 1) the LPD to stretch even
more which causes tearing of blood vessels; 2)
increased osteoclast activity compared to
osteoblast activity which plays a role in bone
formation, so that the teeth become loose in their
sockets and cause the teeth to become loose; and
3) cause gingival hyperemia and pain.8
Fixed removable orthodontic appliance pressure
The key to achieving orthodontic tooth movement
is the continued application of force, meaning that the
force must be present for a long period of time.
86 Ardiansyah S. Pawinru & Serliawati: Biomechanics of tooth movement

Figure 8. (A) no pressure, dark area indicates blood flow, (B) light pressure, slightly thinned dark
area indicates reduced blood flow, (C) heavy pressure, almost disappears
Dark areas show very little or no blood flow, and are said to be hyaline
because it is similar to hyaline cartilage.9

long enough, that is, hours not minutes every after corrected.According to Moyers,Relapse is a
day. A study conducted on animals showed term used for a loss of correction that has been
that only after strength was maintained- achieved during orthodontic treatment.10
about 4 hours long,the level of cyclic nucleotides in
LPD increases,demonstrated that the duration of
stress is required to produce the second messenger
required to stimulate cell differentiation.9
One study showed that water has a threshold
duration of strength in humans, namely 4-8 hours and
more effective tooth movement results if stiffness is-
strength is maintained for a longer duration. The
relationship between duration and efficiency of tooth
movement can be seen in Figure 9.9
Strengthcontinuousproduced by fixed Figure 9.Relationship between duration and
orthodontics, while removable orthodontics causes pe- efficiency of tooth movement. Strengthcontinuous24
reduction of the time fraction resulting in a decrease hours per day shows a higher efficiency of tooth
in the amount of tooth movement. The duration of movement, but successful tooth movement can also
be obtained in a short duration, namely 6 hours per
force has another aspect, related to how the change
day, but the longer the duration of the application of
in force forces a tooth to respond to the change in
force, the higher the efficiency level.9
force by moving. The duration of orthodontic force is
classified based on the rate at which tissue damage
occurs,namely 1)continuous forceis active
orthodontic pressure whose magnitude decreases
slightly between two treatment visits; 2)interrupted
force is the orthodontic pressure that is not active at
the time interval between two treatment visits. The
pressure is generally great, and decreases to zero at
intervals to allow time for the tissue to recover until it
is reactivated; pressurecontinuousAndinterruptedis
the pressure generated by the fixed orthodontic Figure 10pressurecontinuousremain awake between two
appliance; 3)intermittent force-the power level drops activation times.9
abruptly to zero intermittently when the device is
disconnected,released by the patient and return to
their original level a few moments later when the
device is replaced.9

Effect of orthodontic appliance release without retention

Sudden device release without retention-
cause the movement of the corrected tooth to return to its
previous state, namely the state before the malposition
correction was carried out or what is commonly known as a
relapse. According toBritish Standards Institute,relapse is a Figure 11Pressureinterruptedreaches zero between the two
return to the original form of malocclusion activation times.9

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Makassar Dental Journal 2021; 10(1): 82-87, p-ISSN:2089-8134, e-ISSN:2548-5830 87

Retainers are passive orthodontic parts that help

Figure12Pressureintermittentreaches zero when the device is
removed and returns to normal when it is plugged in again.9
According to Bhalajhi,several factors that can be-
cause relapse,among others 1) pull on the LPD;
when the teeth are moved orthodontically,The LPD
and gingiva that surrounds the teeth will stretch,
then shortens, potentially causing a relapse.The
LPD network adapts to its new position quickly.
The main network will be reconstructed within 4
weeks.On the contrary,The gingivasupra-alveolar
tissue takes 40 weeks to adjust to its new position,
making it easy to relapse. After comprehensive
orthodontic treatment,retention should be
continued for 4-5 months to allow time for the LPD
to reconstruct, then retention should be continued
for another 7-8 weeks to allow time for the gingiva
to adapt to its new position;
2) bone adaptation: teeth that have just been moved
will be surrounded by slightly calcified osteoid bone,
so that the teeth are not stable enough and tend-
rung to return to its original position.The trabecular bones
are usually arranged perpendicular to the tooth axis, na-
however during orthodontic treatment the position is parallel to
the direction of pressure. During the retention period,the teeth
can return to their original position.
stabilize teeth for a long time to provide
opportunities for structural reorganization.-receipt-
supporting tour after the active stage. Basically retention
prevents relapse or in other words prevents teeth from
returning to their initial position from malocclusion.10
The main reasons retention is needed are 1) the
gingiva and periodontal tissues are affected by tooth
movement and require time to reorganize after the
appliance is removed.;2) the possibility of the tooth in an
unstable position after treatment,so that soft tissue
pressure can cause relapse.10
The most frequently used retainer is a removable
retainer which is a passive device that can be removed
and installed by the patient himself. Patient compliance
greatly determines the success of this tool
Figure 13Removable Retainers.10
The Hawley retainer was designed by Charles Hawleypa-
da in 1920 which is the most commonly used removable
retainer. The classic type consists of clamers on the
molars and a labial arch that extends from canine to
canine withloopswhich can be arranged.10
It was concluded that orthodontic tooth movement is
based on biological principles.Intermittent or continuous
force is applied to the teeth, changing the loading of the
mechanical system and eliciting a cellular response that
leads to the adaptation of the bone to its new function.

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