MECHANISM OF

BONE
ORTHODONTICS
Presented by:
Dr. AKASH A
M PG 1ST YEAR
Dept of Orthodontics &
Dentofacial Orthopaedics
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 CONTENTS
• Introduction
• Composition
• Functions of bone
• Structure of bone
• Classification of bone
• Gross histology of bone
• Microscopic structure of bone
• Modelling and Remodelling
• Frost mechanostat theory
• Bone ossification
• Nutritional effects on bone
• Hormonal effects on bone
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• Factors affecting bone growth/ mineralization
• Bone metabolism
• References

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INTRODUCTION
• Bone is a dynamic structure
• Mechanical adaptation of the bone
is the physiologic basis of
orthodontics and dentofacial
orthopedics.
• A detailed knowledge of the dynamic
nature of the bone physiology and
bio mechanics is essential to
enlighten
clinical practice.
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 Bone

67% 33%
Inorganic Organic

Hydroxyapatite 28% 5%

Collagen Osteocalcin
Sialoprotein
Phosphoprotein
Osteonectin
Bone-specific protein
• Bone is extremely important to the
dental practitioner, in sofar as all
his treatment procedures can be
successful only if the bony support
remains intact.

• The success of orthodontic

treatment is particularly
dependent on the degree of
stability that the underlying bone
can maintain.
 FUNCTIONS OF BONE :

1. Support : serves as the structural framework for

the body

2. Protection

3. Assistance in movement : Because skeletal

muscles attach to bones, when muscles contract,
they pull on bones. Together, bones and muscles
produce movement.
4. Mineral homeostasis : On demand, bone releases minerals
into the blood to maintain critical mineral balances
(homeostasis) and to distribute the minerals to other parts
of the body.

5. Blood cell production

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6. Triglyceride storage. Triglycerides stored in the adipose cells of yellow
bone marrow are an important chemical energy reserve.
In the newborn, all bone marrow is red and is involved in hemopoiesis.
With increasing age, much of the bone marrow changes from red to
yellow
STRUCTURE OF BONE
ARTICULAR CARTILAGE

• The articular cartilage is a

thin layer of hyaline
cartilage covering the
epiphysis.
• Articular cartilage
reduces friction, absorbs
shock at freely movable
joints.
 PERIOSTEUM
• Sheath of connective tissue that
sums the bone surface wherever it
is not covered by articular cartilage.
• Inner layer - osteogenic cells
,rich in vasculature
• Outer layer – fibrous
• The periosteum contains bone-
forming cells that enable growth
in diameter
• It also assists in fracture repair
• Nourish bone tissue
• Attachment point for ligaments
and tendons.
• The medullary cavity -
space within the diaphysis
that contains fatty yellow
bone marrow .

• The endosteum -
membrane that lines the
medullary cavity. It
contains a single layer of
bone-forming cells.
Classification of bone
 CLASSIFICATION

ACCORDING TO POSITION

AXIAL
APPENDICULAR
bones forming the
axis of the body, bones forming the
eg:skull,ribs,sternum skeleton
of the limbs

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ACCORDING TO SIZE AND SHAPE

• Long bones
• Short bones
• Flat bones
• Irregular bones
• Pneumatic bones
• Sesamoid bones

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ACCORDING TO STRUCTURE

• Compact bone
-the dense outer
surface layers of mature
bone.

• Cancellous bone
(Trabecular or spongy
bone)---the interior
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of mature bones.

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 COMPACT BONE
• Also called as cortical bone
or haversian bone
• It is the dense outer shell
of the skeleton
• Comprises 85% of the
total bone in the body.
• Has Haversian systems
• Outer surface lined
by periosteum
• Inner surface lined by
endosteu 1
 Osteon
• It is unit of structure consisiting of
concentric lamella surrounding an haversian
canal
• Long cylinder parallel to long axis of diaphysis
• Consists of:
− Concentric lamellae
– Haversian canal runs down centre
– Volkmann’s canals at right angles to long axis
– Osteocytes occupy small cavities (lacunae)
– Canaliculi connect lacunae with each other
and with haversian canal

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CANCELLOUS BONE
• Trabecular or
spongy bone
• Found in
marrow cavity
• No Haversian systems
• Surface lined
by Endosteum

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BASED ON ARRANGEMENT OF MATRIX

• Woven bone

• Bundle bone / Lamellar bone

• Composite bone

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 WOVEN BONE
• Relatively weak, disorganised and poorly
mineralized. ( Immature Bone )

• First bone formed in response to orthodontic loading.

• Serves a crucial role in wound healing

• Rapidly fills the osseous defects
• Provides initial continuity for fractures
and osteotomy segments
• Strengthen the bone weakened by surgery or
trauma

• Not found in adults in normal steady state

• Compacted to form composite bone
• Remodeled to lamellar bone
• Rapidly resorbed if prematurely loaded

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 LAMELLAR BONE
• Strong, highly organised and
well mineralized tissue
• 99% of adult human skeleton
• When a new lamellar bone is formed, a
portion of a mineral content is
deposited by osteoblast during primary
mineralization.
• Secondary mineralization is a
physical process that require many
months to complete the process.
• Relative strength
Mature lamellar > new lamellar > woven

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 BUNDLE BONE
• Functional adaptation of
lamellar structure to allow
attachment of tendons
and ligaments
• Major
distinguishing
feature
• Perpendicular striations
called ‘Sharpeys fibres’
• Usually seen adjacent to
the periodontal
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ligament

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 COMPOSITE BONE

• Formed by the deposition of lamellar bone

within a woven bone lattice called Cancellous
Compaction
• Important intermediary type of bone in
physiologic response to orthodontic
loading
• Is the predominant osseous tissue for
stabilizing during early phases of retention
or post operative healing.

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 According to Developmental origin

• Intramembranous (mesenchymal
or dermal bone) - formed by direct
transformation of condensed
mesenchyme.

• Intracartilaginous (cartilage or
Endochondral bone)-formed
by replacing a preformed
cartilage model.
GROSS HISTOLOGY OF BONE

Characteristic of all bones are a

dense outer sheet of compact
bone and a central medullary
cavity. In living bone the
cavity is filled with either red
or yellow bone marrow.
• Bone is not completely solid but
has many small spaces between
its cells and matrix components.
• Depending on the size and
distribution of the spaces, the
regions of a bone may be
categorized as compact or
spongy
• Overall, about 80% of the
skeleton - compact bone
• 20% is spongy bone.
CELLS OF THE BONE

• Osteoprogenitor cells
• Osteoblasts
• Osteocytes
• Osteoclasts
• Bone lining cells
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OSTEOPROGENITOR CELLS

• These are stem cells

of mesenchymal
origin
• They can proliferate
and convert into
osteoblasts
• Resemble fibroblasts
• Found in large no. in
the foetus
• In adults present over
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bone surfaces

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 OSTEOBLASTS

• Uninucleated cells

• Found in margins of
growing bone

• Derived from a multipotent

mesenchymal cell because
they are incapable of cell
division

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 OSTEOBLASTS

• Ovoid cells with

basophilic cytoplasm

• Oval nucleus

• OSTEOID
• Newly synthesized but
not calcified matrix near
osteoblas 3
the

osteoblas 3
 OSTEOBLASTS
• Responsible
for
mineralization

• Mineralize the newly

formed bone matrix

• It initiates calcification-
enzyme alkaline
phosphatase

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 FUNCTIONS
• Osteoblasts are responsible for production
of the proteins of bone matrix type I and IV
collagen and other non collagenous proteins
like osteocalcin,phosphoproteins, bone
sialoprotein and osteonectin.

• Osteoblasts secrete the growth factors which

are stored in bone matrix such as
transforming growth factor , bone
morphogenetic protein, platelet – derived
growth factor and the insulin – like growth
factor.

• Osteoblast may be required for normal bone

resorption to occur
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 OSTEOCYTES

• Cells of the mature bone

• As osteoblasts secrete bone matrix,
some of them become entrapped
in
lacunae and are then called
osteocytes

• Eosinophilic in contrast to osteoblasts

• Present mainly in young bone
• Decrease with age
• Young osteocytes are round in shape
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 FUNCTION
• Maintenance of bone matrix
• Release of calcium ions –
Osteocytes may have the
capacity to transfer
calcium ions from bone
mineral to the blood
plasma.
• Maintain the integrity of
the lacunae and canaliculi
• Keep open the channels for
diffusion of nutrition
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through bone

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 OSTEOCYTE WITH CYTOPLASMIC
EXTENSIONS
• Osteocytes can initiate membrane action
potentials capable of transmission through
interconnecting gap junctions. Hence it
transmits extracellullar physical stimulus to a
receptor cell which transduces it into an
intracellular signal Mechanotransduction.
(Moss 1997)
•All bone cells, except osteoclasts, are
extensively interconnected by gap
junctions that form an OSSEOUS
CONNECTED CELLULAR NETWORK (CCN).
• All osteoblasts are similarly interconnected
and form extensive communications between
osteons , interstitial regions and
osteocytes(through cytoplasmic extensions).
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 OSTEOCLASTS

• Osteoclasts are multi nucleated

giant cells which resorb bone.
• They occupy shallow pits called
‘Howship’s lacunae’ on flat
bone surfaces.
• Their cytoplasm shows
numerous mitochondria and
lysosomes containing acid
phosphatase.

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• The part of an osteoclast that is
directly responsible for carrying
out bone resorption is a
transitory and highly motile
structure called its ruffled
border

• Their lifespan is uncertain,

though it may be as long as 7
weeks.
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Bone removal can be stimulated by
factors secreted by
• Osteoblasts,
• Macrophages,
• Lymphocytes
• Parathyroid hormone.
It is not certain whether
osteoclasts are formed by fusion
of several monocytes or by
repeated division of the
nucleus, without division of
cytoplasm.
 BONE LINING CELLS
• Cells form a continous epithelium like
layer on bony surfaces where there is
no active bone deposition or removal
• Are remnants of osteoblasts that
previously laid down bone
matrix
• Cells are flattened
• Present on periosteal as well
as endoosteal surface
• Also line the spaces and canals
within the bone
formation is called 4
• Can change to osteoblasts where bone

formation is called 4
 MICROSCOPIC
STRUCTURE OF BONE

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STRUCTURES PRESENT

• Haversian canal
• Lamellae
• Lacunae
• Canaliculi

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 HAVERSIAN CANAL
• It is a canal present in the
centre of each haversian
system
• About 50μm in diameter
• Runs parallel with the long
axis of bone
• Each canal contains a small
artery, vein, lymphatics,
thin nerve fibres and
supporting areolar tissue.
• Blood vessels nourish
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the surrounding
lamellae.

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 LAMELLAE
• Thin plates of bone tissue
• Consists of ground
substance or matrix and
collagen fibres
• These lamellae are
arranged concentrically
• Adjacent lamellae are
held together by
interchange of fibres.

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• Interstitial lamellae:
– These lie in the angular
interval between
typical haversian
systems
– Lie more or less parallel
with the surface .

• Circumferential lamellae:
– Found at the outer and
inner periphery of cortex

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 LACUNAE

• Small spaces between lamellae

• Each lacunae contains a bone cell

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 CANALICULI
• Fine radiating channels
which connects lacunae to
each other and the
central haversian canal.

• They are occupied by the

protoplasmic processes
of the bone cells

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Canaliculi between Osteocytes

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VOLKMANN’S CANALS
• Run at right angles to
the long axis of the bone
• Contain blood vessels,
nerves and lymphatics
and connect haversian
canals with the
medullary cavity and the
surface of the bone
• These canals are not
surrounded by
concentric lamellae of
the bone.
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MODELING AND REMODELING

• Both trabecular and

cortical bones grow, adapt
and turnover by means two
mechanisms
• In bone modeling:-
independent sites of
resorption and formation
change the form of a
bone
• In remodeling:- a specific,
coupled sequence of
resorption and formation
occurs to replace
previously existed bone
• Biomechanical response to tooth
movement involves an
integrated array of bone
modeling and remodeling
events.
• Bone modeling is the dominant
process of facial growth and
adaptation to applied loads such
as head gear, RME and functional
appliances
• Modeling changes can be seen on
cephalometric tracing but
remodeling changes are apparent
at the microscopic levels

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• Both modeling and remodeling
are controlled by an interaction
of metabolic and mechanical
signals
• Bone modeling is directly
under the integrated
biomechanical control of
functional applied loads and
under harmonal influence.
• Remodeling response to
metabolic mediators such as
rate of bone
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PTH and estrogen is by varying
the

rate of bone
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 Bone turnover/Remodeling

Fusion of osteoclast with bone matrix

causing resorption

As the osteoclast moves through the bone the

leading edge of resorption termed the
CUTTING CONE, characterized in cross section
by a scalloped array of howship’s lacunae.

Remnants of unresorbed osteon becomes

an interstitial lamella

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• Migration of mononucleated precursor
cells (osteoblasts) behind the cutting cone.

• Produce a coating termed as CEMENT/REVERSAL

line (Demarcation b/w the old bone and new
bone to be secreted )

• On the top of the cement line osteoblast begin

to lay down new bone matrix.
• The entire area of osteon where active
bone formation occurs –FILLING CONE.

• As formation proceeds some osteoblasts

become osteocytes

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SIGNIFICANCE OF REMODELING

• To renew the fabric of the

skeleton continuously so
that its biomechanical
properties are not
compromised by daily wear
and tear.

• The release of mineral ions

during bone turnover
helps in the maintenance
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of mineral homeostasis.

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 MECHANOSTAT CONCEPT OF FROST

• Functional stimulation (stress or

mechanical loading) is necessary
to maintain a skeletal system.
But it should be in a certain
physiological Frosts
“Mechanostat” theory explains
this quantitatively in this way.
• Mechanical Peak load
in Microstrain
• a. Disuse atrophy <200
• b. Bone maintenance 200-2500
• c. Physiological
Hypertrophy 2500-
4000
• d. Pathological overload >4000
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 OSSIFICATION
• The 2 main forms
of ossification are:

– Intramembranous
ossification

– Endochondral ossification

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Intramembranous Ossification

• Also called dermal ossification:

– because it occurs in the dermis
– produces dermal bones such
as mandible and clavicle

• There are 3 main steps in

intramembranous
ossification

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Intramembranous
Ossification: Step 1
• Mesenchymal cells aggregate:
– differentiate into osteoblasts
– begin ossification at
the ossification center
– develop projections called
spicules

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Intramembranous Ossification

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Intramembranous
Ossification: Step 2

• Blood vessels grow

into the area:
– to supply the osteoblasts
• Spicules connect:
– trapping blood
vessels inside bone

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 Intramembranous
Ossification: Step 3

• Spongy bone develops and

is remodeled into:
– osteons of compact bone
– periosteum
– creating marrow cavities

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ENDOCHONDRAL OSSIFICATION

• Ossifies bones that originate

as hyaline cartilage
• Most bones originate as
hyaline cartilage
• Growth and ossification of
long bones occurs in 6 steps

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ENDOCHONDRAL OSSIFICATION
1. Development of the cartilage model
2. Growth of the cartilage model
3. Development of the
primary ossification center
4. Remodeling creates marrow cavity
5. Development of the
secondary ossification center
6. Formation of articular cartilage
and the epiphyseal plate

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 Endochondral
Ossification: Step 1

• Chondrocytes in the center

of hyaline cartilage:
– enlarge
– form struts and calcify
– die, leaving cavities in cartilage

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Endochondral
Ossification: Step 2
• Blood vessels grow
around the edges of the
cartilage
• Cells in the perichondrium
change to osteoblasts:
– producing a layer of superficial
bone around the shaft which
will continue to grow and
become compact bone
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(appositional growth)

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Endochondral
Ossification: Step 3

• Blood vessels enter

the cartilage:
– bringing fibroblasts
that become
osteoblasts
– spongy bone develops at the
primary ossification center

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 Endochondral
Ossification: Step 4

• Remodeling creates a
marrow cavity:

– bone replaces cartilage

at the metaphysis

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Endochondral
Ossification: Step 5

• Capillaries and
osteoblasts enter the
– creating secondary ossification centers
epiphysis:

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 Endochondral
Ossification: Step 6

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 Appositional vs. Interstitial
• Appositional = bone growth on pre-
existing bone surface
– Note that bone tissue only undergoes appositional
• Interstitial = bone growth via new cartilage
formation within pre-existing cartilage
mass
– Note that it is cartilage that undergoes interstitial
• Long Bone Growth:
– WIDTH --> Appositional (bone)
– LENGTH --> Interstitial (cartilage)
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NUTRITIONAL EFFECTS ON BONE
• Normal bone growth/maintenance
cannot occur w/o sufficient dietary
intake of calcium and phosphate
salts.
• cholecalciferol (Vitamin D) which may
be synthesized in the skin or obtained
from the diet is needed for active
absorption
of calcium from gut
• Vitamins C, A, K, and B12 are all
necessary for bone growth as
well
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 HORMONAL EFFECTS ON BONE
• At puberty, the rising levels of sex hormones
(estrogens in females and androgens in males) cause
osteoblasts to produce bone faster than the epiphyseal
cartilage can divide. This causes the characteristic
growth spurt as well as the ultimate closure of the
epiphyseal plate.
• Estrogens cause faster closure of the epiphyseal
growth plate than do androgens.
• Estrogen also acts to stimulate osteoblast activity.

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• Growth hormone, produced
by the pituitary gland, and
Thyroxine, produced by the
thyroid gland, stimulate
bone growth.
– GH stimulates protein
synthesis and cell
growth throughout the
body.
– Thyroxine stimulates cell
metabolism and increases
the rate of osteoblast
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activity.

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• Parathyroid hormone and calcitonin
are 2 hormones that antagonistically
maintain blood [Ca2+] at
homeostatic levels indirectly affect
bone.

• Other hormones that affect

bone growth include
insulin and the glucocorticoids.
– Insulin stimulates bone formation
– Glucocorticoids inhibit
osteoclast activity.

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Factors influencing bone mineralization/growth

Local factors

• Collagen :
Provides support
for newly formed
mineral crystals.

• Non collagenous
molecule

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 SYSTEMIC FACTORS
Parathyroid hormone
• PTH acts on both bone resorbing and
forming cells but predominantly on
bone formation
• Action is mediated by IGF-I,TGF-B
Administerd continuously

Osteoclastic bone

resorption Bone formation

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 Low doses intermittently

Bone formation without major effect

on resorption

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• 1,25-Dihydroxy calciferol/Calcitriol

Causes osteoclastic bone resorption

and Increases serum calcium level

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Calcitonin
• Inhibits osteoclastic
bone` resorption.
• Acts on osteoclast by
enhancing adenylate
cyclase and cAMP
accumulation
• Supresses
osteoclastic
resorption
• Calcitonin also stimulates
osteoblast activity which
means calcium will be taken
from the blood and
deposited as bone matrix.
 REFERENCES
• Orthodontic current principles and technique –
Graber Vanarsdall
• Oral Histology: Development, structure and
function: Ten cate; 10th Ed
• Oral histology Cell Structure and Function- Walter Davis
• Textbook of Orthodontics - Samir E Bishara
• Contemporary Orthodontics – William R Proffit
•Essentials of Growth – Enlow
• Human histology- Inderber Singh

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