TOOTH MOVEMENT & DENTAL IMPLANTS

Oral Physiology Dent 207

Tooth movement
 Eruption  Lateral tooth movement within the alveolar bone

after full eruption

 

 

Physiological mesial drift Movement of teeth after loss of opposing or neighboring teeth Lateral movement in response to occlusal forces Orthodontic tooth movement

Forces affecting position of teeth

 Opposing forces cancel out each other  Rest position of the mandible  Lips & cheeks vs, tongue  Teeth articulated  Forces of masticatory muscles  Horizontal & vertical vectors at each point of contact  Teeth move into positions to minimize the horizontal force vectors  Small forces are absorbed by the elasticity of PDL  Larger forces lead to
 Bone resorption on the side of PDL compression  Bone deposition on the side of PDL stretching  Deposition of new cementum

Tooth wear
 Occlusal wear  Proximal wear


  

Proximal surfaces rub against each other when they move in function Reduction in mesiodistal width Contact areas broaden Degree of wear related to type of food

Mesial drifting
 Maintains teeth in contact  A result of tension in PDL transseptal bundles  Pass over the interdental bony septum  Maintains a slow turnover of precursor cell compartment

of PDL


 

Maturation of osteoblasts & cementoblasts on the distal tension side Maturation of osteoclasts on mesial compression side Maturation of fibroblasts to breakdown and renew the collagen fiber apparatus

Cellular level of orthodontic tooth movement

 Application of unilateral forces perpendicular to

tooth axis


 

Proliferation of fibroblasts & osteoblasts after 12 hrs with a peak after 24 hrs, at this point. Osteoclasts appear at compression side Osteoblasts lay down osteiod that embed the stretched PDL bundles Cementoblasts lay down cemetum on compression side

Piezo-electric effect
 Deformation & movement of bony crystals  Exerted by the stretched fibers on the alveolar

bone  Generate minute electrical currents  Thought to stimulate the osteoblastic activity  Does not have much evidence

Orthodontic adjustment of tooth position

 Ability of PDL to accommodate tooth movement  Critical factor of success is the blood supply to the PDL


Greater forces on compression side

  

Occlusion of capillary networks on compression side necrosis Blood-borne macrophages digest dead tissue & new bone is laid down Clinically
 Little or no movement until necrotic tissue is removed  Followed by a sudden movement  Followed by a more gradual steady movement

Tension side
  

Blood supply remains no necrosis Cell proliferation greatly increased Alveolar bone surface is rapidly covered with osteoblasts

Dental implants
 Reimplantation of avulsed teeth  Prosthetic dental implants

Reimplantation of avulsed teeth

 Keeping PDL viable and attached to cementum  PDL ligament can survive up to 30 min if kept moist with

a suitable fluid


Periodontal cells participate in reattachment

 Pulp dies immediately RCT is needed at a later stage  Incompletely formed roots may be replaced by granulation

tissue


New odontoblasts may develop

 Replantation after PDL removal / damage bony union

with root root resorbs crown exfoliated  Transplantation of teeth

 

Root shape Immunological rejections

Prosthetic dental implants

 Inert post of titanium or zirconium inserted into a

hole drilled into bone  Tight fitting  Repair process will provide functional union  Does not look like the PDL attachment  Implants are not covered by cementum

Prosthetic dental implants

 Osseointegration


Implant surface covered by a thin layer of calcified material similar to that in resorption or cement lines

 Fibro-osteal integration  Fibrous capsule surrounds the implant and separate it from direct contact with alveolar bone  Occurs when bone is overheated during drilling necrosis

Osseo- & fibro-osteal integration

 No physiological mobility / elasticity

provided by PDL  No possibility of orthodontic movement  Stable point of anchorage for orthodontic appliances

Prosthetic dental implants

 After insertion, blood clot is invaded by leucocytes, then

osteogenic cells  Some ostenonecrosis may occur in the screw threads in the less vascular cortical bone


Dead bone then replaced by new bone

 Clot osteoblasts lay down non-collagenous matrix against

the implant surface  Bone is subsequently laid down in a collagenous matrix  Gingival epithelium proliferates down the side of implant for a short distance to develop a hemi-desmosome type of attachment to a basal lamina secreted on the projecting implant surface (similar to junctional epithelium)