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)