Biomechanical principles of tooth

movement
drg Lina Hadi, Sp. Ort
Why do we need biomechanics
 Dentofacial changes are primarily achieved by the orthodontist
applying forces to teeth, the periodontium, and bone.
 The scientific basis of orthodontics is physics and Newtonian
mechanics applied to a biologic system.
 The “bio” implies the union of biologic concepts with scientific
mechanic principles.
 Those principles are essential to understand in order to control
tooth movements and allow the practitioner to design appliances
and plan treatment that will provide optimal results.
Physical Principles
VECTORS
 A vector = the magnitude of force  shown by length of an
arrow
 When any two points in space are joined, a line of action is
created between these points.  horizontal: applied by
labial arch of removable appliance on labial surface
 When there is movement from one of these points toward
the other, a direction is defined  backward: from
anterior to posterior
 Point of application  the crown
 Vector is defined in a coordinate system
FORCE
 Force is the effect that causes an object in space to change its
place or its shape.
 Optimal force is the amount of force resulting in the fastest
tooth movement without damage to periodontal tissues or
discomfort to the patient.
 To achieve an optimum biologic response in the periodontal
tissues, light, continuous force is important.
 Distribution and duration of force are also important.
 Distribution of force
 Duration of force

Continuous force

Intermittent force

Interrupted force
Continuous force

Continuous force depreciates slowly, but never diminishes to zero

within two activation periods (usually 1 month), thus constant &
controlled tooth movement results.
eg. Fixed orthodontics
Interrupted force

Force reduced to zero shortly after applied until reactivated.

eg. Rapid expansion screw
Intermittent force

Force reduced to zero when the patient removes the appliance. When
it is placed back, it continuous from previous level, reducing slowly.
eg. Extraoral appliances
CENTRE OF RESISTANCE (CR)
 Center of resistance = the point where line of action of the resultant
force vector intersects the long axis of the tooth, causing translation
of the tooth.
 The CR of single-rooted tooth is on the long axis of the root,
approximately 24% to 35% of the distance from the alveolar crest.
 Sometimes confused with the center of mass (a balance point of a
free object in space under the effect of gravity).
 Tooth is a restrained object within periodontal and bony structures
surrounded by muscles forces  CR must be considered a balance
point of restrained objects
CENTRE OF RESISTANCE
 CR is unique  the location depends on the number of
roots, level of alveolar bone crest and length & morphology
of roots.
 CR changes with root resorption or loss of alveolar support
because of periodontal disease
CENTER OF ROTATION
 Center of rotation is the point around which the tooth
rotates.
 The location depends on force system applied to tooth, that
is the moment-to-force (M/F) ratio.
 When a couple of force applied, the point is superimposed
on the center of resistance (ie. The tooth rotates around its
center of resistance)
 In translation it becomes infinite, meaning there is no
rotation
MOMENT
 Moment = the tendency for a force to produce rotation or tipping
of a tooth.
 Determined by multiplying the magnitude of force (F) by the
perpendicular distance (d) from the center of resistance to the line
of action of this force. (M=F x d)
 Forces passes through the center of resistance do not produce a
moment, because the distance to the center of resistance is zero
 tooth does not rotate, it translates.
 It is possible to obtain the same rotational effect by doubling the
distance and reducing the magnitude of force by half.
COUPLE
 A Couple = a system having two parallel forces of equal
magnitude acting in opposite direction.
 Every point of a body to which a couple is applied is under a
rotational effect in the same direction and magnitude.
 No matter where the couple is applied, the object rotates
about its center of resistance– that is, the center of resistance
and the center of rotation superimpose
BIOLOGY OF TOOTH MOVEMENT

DIFFERENT TYPES OF TOOTH

MOVEMENTS

AGE FACTORS IN ORTHODONTIC

TOOTH MOVEMENT
BIOLOGY OF TOOTH MOVEMENT
 Orthodontist goals :

Tooth alignment, bone remodeling and

growth modification

Manipulating Forces
BIOLOGY OF TOOTH MOVEMENT

 Teeth can be repositioned & retained in new position in the

jaw using orthodontic appliances, through the intervention of
the cells of the periodontium.
 Rate of tooth movement depends on the rate at which bone
remodels  knowledge of specific biomechanical pathways
provide a key to predict how well teeth respond to
mechanical forces
BIOLOGY OF TOOTH MOVEMENT
THEORIES OF TOOTH MOVEMENT

 Alveolar bone resorption and deposition during orthodontic

tooth movement is a cell- mediated process regulated by
varios factors
 Two possible control elements that form two major theories
of orthodontic tooth movement:
1. Biological Electricity
2. Pressure-Tension in the periodontal ligament (PDL)
BIOLOGY OF TOOTH MOVEMENT
1. The Bio-Electric Theory
The electric signals that are produced when alveolar bone
bends, or flexes, are at least partly responsible for tooth
movement. Electric signals that might initiate tooth
movement initially were thought to be Piezoelectric.
Piezoelectric signals have two unusual characteristics:
1) A quick decay rate– when force is applied, a piezoelectric
signal is created, that quickly dies away to zero even though
the force is maintained
2) The production of an equivalent signal opposite in direction
when force released.
BIOLOGY OF TOOTH MOVEMENT
THEORIES OF TOOTH MOVEMENT
 Ions in the living bone interact with the electric field generated
when the bone bends, causing temperature changes as well as
electric signals.
 The small voltage (streaming potential) though different from
piezoelectric signals in dry material have in common their rapid
onset and alterations  could be generated by the application of
external electricity fields.
 A second type of electric signal can be observed in bone that is not
being stressed (bioelectric potential).
Sustained force of the type used to induce orthodontic tooth
movement does not produce prominent stress generated signals.
BIOLOGY OF TOOTH MOVEMENT
THEORIES OF TOOTH MOVEMENT
 Metabolically active bone produces electro negative changes
that are generally proportional to their activity.
 Cellular activity can be modified by adding exogenous
electric signals, which affect cell membrane receptors,
membrane permeability or both.
 In vivo studies indicated that areas that are electro negativive
were characterized by elevated osteoblastic activity and areas
of electropositivity were characterized by osteoclastic activity
BIOLOGY OF TOOTH MOVEMENT
2. The Pressure Tension Theory
The cellular changes produced by chemical messengers
during tooth movement. This is mainly because of
alteration in blood flow through the PDL
 Alteration in blood flow quickly creates changes in the
environment.
For ex. Oxygen levels would fall in the compressed area but
might increase on the tension side and the relative
proportions of other metabolites would also change in a
matter of minutes.
BIOLOGY OF TOOTH MOVEMENT
OrhanTuncay & Daphane :

Low oxygen tension causes increased cellular proliferation &

decreased Adenosine Triphosphate (ATP) activity and Partial Pressure
of Oxygen (Po2) ;
Hypoxic condition  suppressed cellular proliferation & increased
ATP activity.

These chemical changes acting directly or by stimulating the release

of other biologically active agents then would stimulate cellular
differentiation and activity.
BIOLOGY OF TOOTH MOVEMENT
Tooth movement shows 3 stages:
1. Alteration in blood flow in the PDL
2. The formation and/ or release of chemical messengers
3. Cell response
BIOLOGY OF TOOTH MOVEMENT
Two biologic pathways generated by orthodontic forces:
Pathway I : Represents a more physiologic response that may
be associated with normal growth and remodeling
Pathway II: Represents the production of a tissue
inflammatory response generated by the Orthodontic
Force
BIOLOGY OF TOOTH MOVEMENT
Pathway I
Orthodontic force creates pressure and tension leading to bone
bending. Since collagen fibers possess piezoelectric properties,
the primary response to orthodontic force is the generation of
tissue bioelectric polarization in response to bone bending.
Somjen et al. : bone cells maintained in culture release
prostaglandins in response to pressure
BIOLOGY OF TOOTH MOVEMENT
Pathway II
The tissue injury generated by Orthodontic Force elicits a
classic inflammatory response. Inflammatory processes are
triggered along with the classic vascular and cellular
infiltration. Lymphocytes, monocytes & macrophages invade
the inflamed tissue and in all likelihood contribute to
prostaglandin release and hydrolic enzyme secretion.
Local inflammatory response stimulate osteoclastic activity.
BIOLOGY OF TOOTH MOVEMENT
Formation of resorption of bone depends on:
1. The cytokines produced locally by mechanically activated
cells and
2. The functional state of the available target cells
DIFFERENT TYPES OF TOOTH
MOVEMENT
1. Tipping
1) Uncontrolled tipping
The movement of the crown and apex in opposite directions,
which is clinically undesirable.
2) Controlled tipping
The movement when the center of rotation moves apically
and the tooth tips around a circle of a greater radius, causing
the tooth tips distally. This movement is clinically desirable.
2. Translation (bodily movement).
Translation is the movement of any straight line on that
body without changing angle .The center of rotation no
longer exists. All points on the body move the same
distance and have the same velocity. This is desirable
movement, but hard to achieve and maintain.
3. Rotation
Rotation of a body is the movement any straight line on
that body by a change in the angle. If the body rotates about
its center of resistamce, it is called pure rotation
 M/F ratio concept is vital to clinician in controlling tooth
movements.
 It determines the types of movement or the location of
the center of rotation.
 M/F ratio equals the distance (d)
Optimization of tooth Movement and
Anchorage
 The application of correct forces and moments is necessary
for full control during tooth movement, influencing rates of
movement, potential tissue damage and pain response.
 Equally important as active tooth movement is the control
over other teeth, reffered as anchorage. so that they do not
exhibit undesirable movements (anchorage loss)
 Force systems and “dosage” determine not only tooth or
bone displacement with its accompanying remodeling;
unwanted physiologic changes involving tissue destruction
can also occur.
 Root resorption, tissue destruction, alveolar bone loss and
pain are common undesirable events during treatment
What is needed?
 TOOTH
 HEALTHY PERIODONTAL LIGAMENT
 BONE
 APPLIED FORCE

Tooth movement is dependent upon physiology of the Periodontal

Ligament & Bone – ie. Turnover
TOOTH
 Means of force application/delivery
 Otherwise “inactive”

PERIODONTAL LIGAMENT
 Fibres transmit forces applied to teeth
 Viscostatic damping of force
BONE
 Role of bone in the body

 CORTICAL BONE
slow turnover
 TRABECULAR BONE
constant turnover
 Bone Turnover
 Control is by systemic and local factors
Osteoclasts Osteoblasts
derived from perivascular cells derived from monocytes
 Local control
 Biologic electricity
 Blood flow
Prostaglandins
 Microfractures Cytokines
Cyclic amp

Osteoblasts Osteoclasts
 Local control (+systemic)
 Biologic electricity
 Blood flow
Prostaglandins
 Microfractures Cytokines
Cyclic amp

Osteoblasts Osteoclasts

PTH
Systemic Control Vit D
Calcitonin
 Biologic electricity
 Blood flow
 Microfracture
WHAT HAPPENS DEPENDS ON
1. Level of force 2. Duration of force
 ORTHODONTIC FORCES

Excessive = pain + undermining resorption

Ideal= socket remodeling

In reality – some undermining

resorption occurs
ORTHODONTIC FORCE
 Tipping
 Translation
 Rotation
 Extrusion
 Intrusion
 Tipping
 Translation
 Rotation
 Extrusion
 Intrusion
AGE FACTORS IN ORTHODONTIC TOOTH
MOVEMENT
Age Factors in Orthodontic Tooth
Movement
 Age  indicator of remaining growth and development of
face and jaw and body generally
 American Associations of Orthodontist (AAO) recommends
every child first visit an orthodontist by age seven or earlier if
a problem is detected by parents, family dentist or physician.
 No definitive border line of age is found to start an
orthodontic.
 Adult orthodontics requires a different approach to the
treatment than treatment for growing adolescent individuals
due to varied reasons.
Age Factors in Orthodontic Tooth
Movement
 Lack of growth potential makes growth modification
procedures not applicable to adults and imposes limitation to
certain tooth movements.
 Periorestorative problems, multiple extractions, other oral
diseases, systemic problems, aging of the tissues, different
psychosocial factors need to be considered
ORTHODONTIC ADVERSE EFFECTS

Pulp Root

PDL Bone
Pulp
Root
PDL
Bone
THANK YOU