CURRENT CONCEPTS IN THE BIOLOGY OF ORTHODONTIC TOOTH

MOVEMENT: A BRIEF OVERVIEW

Dr, Sneha Kashyap *
ABSTRACT- Mysteries of OTM have haunted clinicians and orthodontists since the interception of
the speciality.

The understanding of OTM is now no longer restricted to bone-PDL-level and an indepth

Tooth movement by orthodontic force
molecular- genetic- cellular intervention have been evolved. This underlying mechanism between
application is characterized by remodeling
genes and transcription factors have given a new insight to OTM helping us better understand the
unseen areas of OTM, utilizing the knowledge for better tooth movement and furtherance of
changes in dental and paradental tissues,
speciality.

Keywords- Bone modelling, neurotransmitters, chemical mediators

K
INTRODUCTION-
Biology of orthodontic tooth movement including dental pulp, periodontal ligament
has always been an interesting field of (PDL), alveolar bone, and gingiva.2
orthodontist.1

Orthodontic treatment is based on the ORTHODONTIC FORCE APPLICATION

principle that if prolonged pressure is

applied to a tooth, tooth movement will
Mineralized tissue Assosiated tissue Non mineralized tissue
occur as the bone around the tooth response(Bone response (blood vessel response (pdl and
remodelling) and neural elements) gingiva)
remodels. Bone is selectively removed in
some areas (pressure side) and added in
others (tension side) leading to tooth
movement through the bone.1 Orthodontic force induced strains

Alter PDL's Vascularity and blood flow

Synthesis and release of neurotransmitters, cytokines,

growth factors, Colony stimulating factors, Arachidonic acid
metabolites
* Post Graduate student

Department of Orthodontics, Modern Dental

College & Research Centre, Indore.
Cellular response

NJDSR Volume I number 4 January 2016 28

This article aims to understand the
relationship between these cellular
responses generated and their outcome on
orthodontic tooth movement.
PHASES OF TOOTH MOVEMENT
There are three phases of tooth movement
are1:
Initial phase - The initial phase is
characterized by rapid movement
immediately after the application of force
to the tooth. This rate can be largely
attributed to the displacement of the tooth
in the PDL space.1
Lag phase - Immediately after the initial
phase, there is a lag period, with relatively
low rates of tooth displacement or no
displacement. It has been suggested that
the lag is produced by hyalinization of the
PDL in areas of compression. No further
tooth movement occurs until cells
complete the removal of all necrotic
tissues.1
Post lag phase - The third phase of tooth
movement follows the lag period, during
which the rate of movement gradually or
suddenly increases1.
THEORIES OF ORTHODONTIC
MECHANISMS
There are two main proposed mechanisms
for tooth movement as follows:
1. The application of pressure and tension
to the PDL.
2. Bending of the alveolar bone.
The Pressure-Tension Theory2
When force is applied orthodontically on a
tooth a pressure side and a tension side is
created.
NJDSR Volume I number 4 January 2016
On the pressure side the PDL displays
disorganization and diminution of fiber
production. Cell replication decreases
seemingly due to vascular constriction
causing bone resorption1.
On the ‘tension side’, cell replication is
said to increase because of the stimulation
afforded by the stretching of the fiber
bundles of the PDL, thus causing bone
deposition.
The Bone-Bending Theory2
(Farrar;1888)
When an orthodontic force is applied,to
the tooth it is transmitted to all tissues near
force application. These forces bend the
bone, tooth and the solid structures of the
PDL.2
CASCADE OF EVENTS THAT
FOLLOW AFTER APPLICATION OF
ORTHODONTIC FORCE
The primary stimulus such as that of the
orthodontic force may elicit its response to
cells of PDL and bone in the form of
release of-
a.) Bioelectric signals produced on account
of bone bending.
b.) Chemical mediators such as
prostaglandins, cytokines, Nitric oxide
(NO) etc
c.) Release of neurotransmitters.
29
 Orthodontic force
Movement of PDL fluids from areas of
compression into areas of tension.
Development of strain in cells and ECM in
involved paradental tissues.
Direct transduction of mechanical forces
to the nucleus of strained cells through
the cytoskeleton,leading to activation of
specific genes
Release of neuropeptides (nociceptive
and vasoactive) from paradental afferent
nerve endings
Interaction of vasoactive neuropeptides
with endothelial cells in strained
paradental tissues
Adhesion of circulating leukocyte to
activated endothelial cells
Plasma extravasation from dilated blood
vessels.
Migration by diapedesis of leukocytes into
the extravascular space.
Synthesis and release of signal
molecules by the leukocytes that have
migrated into the strained paradental
tissues.
Interaction of various types of paradental
cells with the signal molecules released by
the migratory leukocytes.
Activation of the cells to participate in
the modelling and remodeling of the
paradental tissues.
When Orthodontic force is applied-
Primarily, alteration in the blood flow
results in reduced oxygen level at
compressed area (pressure area), and there
might be an increased oxygen level at
tension side1
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Secondly, generation of Piezo electric
signal, which is now stated more
appropriately as bioelectric potential in the
form of small voltage of current, is
released due to bending of bone and
deformation of crystal structure1.
Thirdly, neuro transmitters (examples
Substance P, Vasointestinal polypeptide
VIP, calcitonin gene related peptide
CGRP) are possibly released on account of
physical distortion imposed by peripheral
forces on paradental tissues such as nerve
fibers and terminals. Thus, the primary
stimulus such as that of the orthodontic
force may elicit its response to cells of
PDL and bone in the form of release of
Bioelectric signals produced on account of
bone bending1.
Chemical mediators such as
prostaglandins, cytokines, Nitric oxide
(NO) etc., Release of neurotransmitters
has been proved that cells in PDL such as
fibroblasts and bone cells such as
osteoblasts possess receptors for these
substances, and all these are highly
interacting and interconnected, presenting
number of possibilities of transducing
mechanical force acting on cells and
their adjacent matrices. These interactions
lead to transient increase in the
intracellular levels of second messengers
such as CAMP (Cyclic Adenosine
Monophosphate, CGMP (Cyclic
Guanosine Monophosphate), IP3 (Inositol
phospatase), Ca+, etc. These second
messengers advance signals to the nucleus
through series of kinases. In the nucleus of
each cell, different second messengers
account for the differential patterning,
protein synthesis and Gene expression.
Such recently identified Immediate Early
Gene expression [lEG] transcription
factors include Cfos, Cjon mRNA, egr-I,
SPl growth differentiation factor 9B and
extracellular GLA protein1.
The transcription factors seems to increase
when cells are exposed to mechanical
30
stimulation, cytokines and growth factors.
These transcription factors can produce
either cellular proliferation or cellular
differentiation leading to osteoblastic bone
formation or osteoclastic bone resorption.1
CONCLUSION-The elucidation of the
molecular basis that attempt to explain the
cell-cell communication during
mechanically induced remodelling is an
extremely complicated process.
Many questions still remain regarding the
relationship between mechanical stimuli
and cellular mediators hormones,
neurotransmitters, prostaglandins and
cytokines.
5. G.E. Wise, G.J. King. Mechanisms of
Tooth Eruption and Orthodontic
Tooth Movement. J Dent Res. 2008
May ; 87(5): 414–434.
6. Calogero D, Malone J.S, Wheeler
T.T. Current Concepts in the Biology
of Orthodontic Tooth Movement.
Semin Orthod 2002;8:6-12.
Corresponding Author:
Dr. Sneha Kashyap
Post Graduate Student
Department of Orthodontics &
Dentofacial
Orthopedics
Modern Dental College and research
centre, Indore (M.P.)
Email:- dr.snehakashyap@gmail.com

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