Biology Of Tooth Movement


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Biology Of Tooth Movement

  1. 1. BIOLOGY OF TOOTH MOVEMENT By: Dr shabeel pn
  2. 2. Introduction Orthodontic tooth movement is a unique process where a solid object (tooth) is made to move through a solid medium (bone). Orthodontic treatment is possible due to the fact that whenever a prolonged force is applied on a tooth,bone remodelling occurs around the tooth resulting in its movement .
  3. 3. <ul><li>Bone subject to pressure as a result of compression of periodontal ligament resorbs . While, bone forms under tensile force, as a result of stretching of periodontal ligament.The bony response is mediated by the periodontal ligament , Tooth movement is primarily a periodontal ligament phenomenon. </li></ul>
  4. 4. Structure of periodontal ligament: <ul><li>The PDL occupies a space approximately 0.5mm in width around all parts of roots. </li></ul><ul><li>Major component of the ligament are:- </li></ul><ul><li>Network of parallel collagenous fibers . </li></ul><ul><li>Cellular elements along with vascular and neural elements. </li></ul><ul><li>Tissue fluids . </li></ul><ul><li>The cellular element and fluid play an important role in normal function and in making orthodontic tooth movement possible. </li></ul>
  5. 5. I.Physiologic Tooth Movement <ul><li>Naturally occurring tooth movements that take place during and after tooth eruption . </li></ul><ul><li>This include: </li></ul><ul><li>A) Tooth Eruption . </li></ul><ul><li>B) Migration or drift of teeth. </li></ul><ul><li>C) Changes in tooth position during mastication . </li></ul>
  6. 6. TOOTH ERUPTION: <ul><li>Tooth eruption is the axial movement of tooth from its development position in the jaw to its final position in the oral cavity. </li></ul><ul><li>The following are some theories which explains the eruption process. </li></ul><ul><li>a) Blood pressure theory : </li></ul><ul><li>According to this theory,the tissue around the developing end of the root is highly vascular.This vascular pressure is believed to cause the axial movement of teeth. </li></ul>
  7. 7. <ul><li>b)Root Growth : </li></ul><ul><li>According to this theory,the apical growth of roots result in an axially directed force that brings about the eruption of teeth. </li></ul><ul><li>This theory was rejected because: </li></ul><ul><li>The tooth moves at a greater distance than the root length. </li></ul><ul><li>Onset of root growth and eruption do not coincide. </li></ul><ul><li>Teeth without roots also erupt. </li></ul><ul><li>c)Hammock ligament theory: </li></ul><ul><li>According to Sicher, a band of fibrous tissue exists below the root apex spanning from one side of alveolar wall to other. This fibrous tissue appears to form a network below the developing root and is rich in fluid droplets.the developing root forces itself against this band of tissue, which in turn applies an occlusally directed force on tooth. </li></ul>
  8. 8. <ul><li>d)Periodontal traction theory: </li></ul><ul><li>This theory states that the periodontal ligament is rich in fibroblasts that contain contractile tissue.The contraction of these periodontal fibers (mainly the oblique group of fibers) results in axial movement of the tooth. </li></ul>
  9. 9. B) Migration or drift of teeth: <ul><li>Refers to the minor changes in tooth position observed after eruption . </li></ul><ul><li>Human dentition shows a natural tendency to move in a mesial & occlusal direction. </li></ul><ul><li>Usually a result of proximal and occlusal wear of teeth, </li></ul><ul><li>They move in a mesial and occlusal direction to maintain inter-proximal and occlusal contact. </li></ul>
  10. 10. C) Tooth movement during mastication: <ul><li>During mastication ,the teeth and PDL structures are subjected to intermittent heavy forces which occurs in cycles of one second or less and may range from 1-50 kg based on the type of food being masticated. </li></ul>
  11. 11. <ul><li>Physiologic response to heavy pressure against a tooth :- </li></ul><ul><li><1 sec – PDL fluid incompressible, alveolar </li></ul><ul><li>bone bends, piezoelectric effect. </li></ul><ul><li>1-2 sec – PDL fluid compressed, tooth moves </li></ul><ul><li>within the PDL space. </li></ul><ul><li>3-5 sec – PDL fluid squeezed out, tissue </li></ul><ul><li>compressed, immediate pain. </li></ul>
  12. 12. II.Orthodontic Tooth Movement <ul><li>It is a pathological process from which the tissue recovers. </li></ul><ul><li>Histology of tooth movement: </li></ul><ul><li>Orthodontic movement bring about areas of pressure and tension around the tooth. The histologic changes seen during tooth movement vary according to the amount and duration of force applied. </li></ul>
  13. 14. Changes following application of mild forces: <ul><li>Classically the movement of teeth has been explained via the pressure:tension hypothesis in which PDL tissues in pressure side results in bone resurption , while placing the PDL tissues under tensile force lead to bone deposition. </li></ul>
  14. 15. <ul><li>Changes on pressure side: </li></ul><ul><li>The PDL in direction of tooth movement gets compressed to almost 1/3rd of it’s original thickness. </li></ul><ul><li>A marked increase in the vascularity of PDL on this side is observed due to increase in capillary blood supply. </li></ul><ul><li>This increase in blood supply helps in mobilization of cells such as fibroblasts and osteoclasts. </li></ul><ul><li>Osteoclasts are bone resorbing cells that lie in Howship’s lacunae . </li></ul><ul><li>when forces applied are within physiologic limits,the resorption is seen in alveolar plate immediately adjacent to the ligament.This kind of reorption is called frontal resorption. </li></ul>
  15. 16. <ul><li>Changes on tension side: </li></ul><ul><li>PDL stretched </li></ul><ul><li>Distance between alveolar process & tooth is widened. </li></ul><ul><li>Increased vascularity. </li></ul><ul><li>Mobilization of fibroblasts & osteoblasts. </li></ul><ul><li>Osteoid is laid down by osteoblast in PDL immediately adjacent to lamina dura. </li></ul><ul><li>Lightly calcified bone mature to form woven bone. </li></ul>
  16. 17. <ul><li>Secondary remodelling changes: </li></ul><ul><li>Bony changes also takes place elsewhere to maintain the width or thickness of alveolar bone.These changes are called secondary remodeling changes. </li></ul><ul><li>For eg :- If a tooth is being moved in a lingual direction there is compensatory deposition of new bone on the outerside of the lingual alveolar bony plate and also a compensatory resorption on the labial side of the labial alveolar bone. </li></ul><ul><li>This is to maintain the thickness of the supporting alveolar process . </li></ul>
  17. 19. Change following application of extreme forces: <ul><li>On the pressure side :- </li></ul><ul><li>Root closely approximates the lamina dura . </li></ul><ul><li>Compresses the PDL and leads to occlusion of blood vessels. </li></ul><ul><li>The PDL is hence deprived of its nutritional supply leading to regressive changes called hyalinization . </li></ul><ul><li>Underminig/Rearward resorption occurs in the adjacent marrow spaces and alveolar plate below, behind & above the hyalinized zone. </li></ul>
  18. 20. <ul><li>On the tension side:- </li></ul><ul><li>Over stretched PDL . </li></ul><ul><li>Tearing of blood vessels & ischaemia. </li></ul><ul><li>Extreme forces applied net increase in osteoclastic activity and tooth loosened in socket. </li></ul>
  19. 22. Optimum orthodontic force: <ul><li>Is one which moves teeth most rapidly in the desired direction ,with the least possible damage to tissue and with minimum patient discomfort. </li></ul><ul><li>Schwarz proposed the classic concept of the optimal force. He defined optimal continuous force as the force leading to a change in tissue pressure ,that approximated the capillary vessel & blood pressure.Thus preventing their occlusion in the compressed PDL. </li></ul><ul><li>Below the optimal level cause no reaction in PDL. </li></ul><ul><li>Forces exceeding optimal level would lead to areas of tissue necrosis ,preventing frontal bone resorption. </li></ul>
  20. 23. <ul><li>Schwarz’s definition was slightly modified by Oppenheim who advocated the use of lightest force capable of bringing about tooth movement. </li></ul><ul><li>Oppenheim and Schwarz following extensive studies state that the optimum force is equivalent to the capillary pulse pressure which is 20-26gm/ of root surface area. </li></ul>
  21. 24. From a clinical point of view,Optimum orthodontic force has the following characteristics: <ul><li>Produce rapid tooth movement. </li></ul><ul><li>Minimal patient discomfort. </li></ul><ul><li>The lag phase of tooth movement is minimal. </li></ul><ul><li>No marked mobility of the teeth being moved. </li></ul>
  22. 25. From a histological point of view the use of optimum force has the following characteristics:- <ul><li>The vitality of the tooth and supporting PDL is maintained. </li></ul><ul><li>Initiates maximum cellular response. </li></ul><ul><li>Produces direct or frontal resorption </li></ul>
  23. 26. Hyalinization: <ul><li>Form of tissue degeneration characterized by formation of a clear, eosinophilic homogenous substances </li></ul><ul><li>Denotes a compressed and locally degenerated PDL. </li></ul><ul><li>Reversible process. </li></ul><ul><li>Occurs in almost all forms of orthodontic tooth movement but the areas are wider when the force applied is extreme. </li></ul>
  24. 27. Changes observed during formation of hyalinized zone are: <ul><li>Gradual shrinkage of PDL fibres. </li></ul><ul><li>Cellular structures become indistinct </li></ul><ul><li>Collagenous tissues gradually unite into a more or less cell free mass. </li></ul><ul><li>changes also occur in the ground substance. </li></ul><ul><li>break down of blood vessel walls leading to spilling of their contents. </li></ul><ul><li>Osteoclasts are formed after a period of </li></ul><ul><li>20-30 hrs. </li></ul>
  25. 28. <ul><li>The presence of hyalinised zone indicates that the ligament is non-functional and therefore bone resorption cannot occur.The tooth is hence not capable of further movement until the local damaged tissue has been removed and the adjacent alveolar bone resorbs . </li></ul>
  26. 29. Elimination of hyalinised tissue <ul><li>2 mechanism:- </li></ul><ul><li>By osteoclasts differentiating in the peripheral intact PDL membrane and in the adjacent marrow spaces. </li></ul><ul><li>Invasion of cells and blood vessels from the periphery of the compressed zone by which necrotic tissue is removed. The invading cells penetrate the hyalinized tissue and eliminate unwanted fibrous tissue by enzymatic action and phagocytosis. </li></ul>
  27. 30. Forces & Hyalinization <ul><li>Greater the forces wider is the area of hyalinization. Thus larger areas of the ligament becomes functionless ,thereby showing larger areas of rearward resorption </li></ul><ul><li>If lighter forces are used,the hyalinised zone is smaller and a larger area of functioning ligament is available and frontal resorption predominates. </li></ul><ul><li>The location and extend of hyalinised tissue largely depends upon nature of tooth movement. </li></ul>
  28. 31. <ul><li>A- Tipping –close to alveolar crest </li></ul><ul><li>B- Excessive force during tipping-two areas,one on apical region and other in marginal area. </li></ul><ul><li>C- Bodily -closer to middle portion of root </li></ul>
  29. 32. Phases of tooth movement <ul><li>Burstone categorize the stages as:- </li></ul><ul><li>Initial phase </li></ul><ul><li>Lag phase </li></ul><ul><li>Post lag phase </li></ul>
  30. 33. Initial phase: <ul><li>Rapid tooth movement is observed over a short distance which then stops. </li></ul><ul><li>Represents displacement of tooth in PDL membrane space and probably bending of alveolar bone . </li></ul><ul><li>Both light and heavy forces displace the tooth to same extent . </li></ul><ul><li>Between 0.4 to 0.9mm usually occurs in a weeks time. </li></ul><ul><li>Both light & heavy forces displace the tooth to the same extent during this phase. </li></ul>
  31. 34. Lag phase: <ul><li>Little or no tooth movement occurs . </li></ul><ul><li>Formation of hyalinized tissue . </li></ul><ul><li>Extent upto 2-3 weeks . </li></ul>
  32. 35. Post lag phase: <ul><li>Tooth movement progresses rapidly as the hyalinized zone is removed and bone undergoes resorption . </li></ul><ul><li>Osteoclasts are found over a larger surface area . </li></ul>
  33. 37. Theories of tooth movement: <ul><li>Pressure tension theory by Schwarz.(classic theory) </li></ul><ul><li>Fluid dynamic theory by Bien/ blood flow theory: </li></ul><ul><li>Bone bending & piezoelectric theory: </li></ul>
  34. 38. Pressure tension theory by Schwarz.(classic theory) <ul><li>Schwarz(1932) - author of this theory . </li></ul><ul><li>According to him ,whenever a tooth is subjected to an orthodontic force it results in areas of pressure and tension . </li></ul><ul><li>Areas of pressure show bone resorption while areas of tension show bone deposition. </li></ul>
  35. 39. Fluid dynamic theory by Bien/ Blood flow theory <ul><li>According to this theory tooth movement occurs as a result of alternations in fluid dynamics in PDL located in periodontal ligament space. </li></ul><ul><li>PDL space contains a fluid system made up of interstitial fluid, cellular elements , blood vessels and viscous ground substances in addition to PDL fibres. </li></ul><ul><li>It is a confined space and passage of fluid in & out of this space is limited. </li></ul>
  36. 40. <ul><li>The contents of PDL creates a unique hydrodynamic condition resembling a hydraulic mechanism & shock absorber . </li></ul><ul><li>When force is removed, the fluid is replenished by diffusion from capillary walls & recirculation of interstitial fluids. </li></ul><ul><li>Squeeze film effect by Bien . </li></ul><ul><li>When orthodontic force applied,the compression of ligament results.Blood vessels of PDL gets trapped between the principle fibres & this results in stenosis. </li></ul><ul><li>Vessels above the stenosis then balloons resulting in formation of an aneurysm </li></ul>
  37. 41. <ul><li>Stenosis + Aneurysm  blood gases to escape into interstitial fluids, creating favourable local environment for resorption. </li></ul>
  38. 42. Bone bending & piezoelectric theory: <ul><li>Farrar in 1876, first noted deformation or bending of interseptal alveolar bones. </li></ul><ul><li>suggest that bone bending may be a possible mechanism for bringing about tooth movement. </li></ul><ul><li>Piezo-electricity is a phenomenon observed in many crystalline materials in which deformation of the crystal structure produces a flow of electric current as a result displacement of electrons from one part of the crystal lattice to the other.A small electric current is generated & bone is mechanically deformed. </li></ul>
  39. 43. <ul><li>The possible source of electric current are :- </li></ul><ul><li>Collagen. </li></ul><ul><li>Hydroxyapetite. </li></ul><ul><li>Collagen hydroxyapetite interface. </li></ul><ul><li>Mucopolysaccharide. </li></ul>
  40. 44. <ul><li>As long as the force is maintained ,The crystal structure is stable & no further electric effect is observed. </li></ul><ul><li>When the force is released the crystals return to their original shape & reverse flow of electrons is observed. </li></ul><ul><li>This rhythmic activity produces a constant interplay of electric signals . </li></ul>
  41. 45. Piezoelectric signals have two unusual characteristics. <ul><li>Quick decay rate: </li></ul><ul><li>When the force is released electrons flow in the opposite direction. </li></ul><ul><li>On application of a force on a tooth , </li></ul><ul><li>Areas of concavity  negative charges  bone deposition. </li></ul><ul><li>Areas of convexity  + ve charges and  bone resorption. </li></ul>
  42. 46. Bone deposition: <ul><li>On the tension side. </li></ul><ul><li>Increase in number of osteoblasts . </li></ul><ul><li>Osteoblasts are ovoid cells with basophilic cytoplasm and a oval nucleus. </li></ul><ul><li>Osteoblast increase in number by proliferation of their precursor cells. </li></ul><ul><li>The PDL fibers readapt to new position of the tooth by proliferation of intermediate zone. </li></ul>
  43. 48. Bone resorption: <ul><li>By OSTEOCLASTS </li></ul><ul><li>Multi-nucleated giant cells and may have 12 or more nuclei. </li></ul><ul><li>They are irregularly and or club shaped with branching processes . </li></ul><ul><li>They lie in bay like depressions called Howship’s lacunae. </li></ul><ul><li>The part of osteoclast in contact with resorbing bone has a ruffled border. </li></ul>
  44. 49. <ul><li>Osteoclasts derived from:- </li></ul><ul><li>Activation of previously present inactive cells. </li></ul><ul><li>Migration from adjacent bones. </li></ul><ul><li>Formation of new osteoclasts from local macrophages of PDL. </li></ul><ul><li>Influx of monocytes from blood vessels. </li></ul>
  45. 50. <ul><li>During bone resorption three processes occur: </li></ul><ul><li>Decalcification. </li></ul><ul><li>Degradation of matrix. </li></ul><ul><li>Transport of soluble products to the extracellular fluid or blood vascular system </li></ul>
  46. 53. THANK YOU