A SEMINAR ON BONE, ITS FORMATION, ITS ROLE, ITS STRUCTURE, AND VARIOUS REASONS AS TO WHAT HAPPENS WHEN A TOOTH MOVES, WHEN IT IS EASY , WHY IT IS EASY

1. BONE
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY
Dr.Kapil Saroha
BDS, MDS
Orthodontics and dentofacial orthopedics

2. BONES ARE THE UNITS OF THE
SKELETAL SYSTEM.
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

3. ORTHODONTICS IS A BONE MANIPULATIVE THERAPY &
FAVOURABLE CALCIUM METABOLISM IS AN IMPORTANT
CONSIDERATION. BECAUSE OF THE INTERACTION OF
STRUCTURE & METABOLISM,A THROUGH
UNDERSTANDING OF THE OSSEOUS STRUCTURE &
FUNCTION IS FUNDAMENTAL TO PATIENT SELECTION,RISK
ASSESSMENT,TREATMENT PLANNING & RETENTION OF
DESIRED DENOFACIAL RELATIONSIPS.
ORTHODONTICS:CURRENT PRINCIPLES &
TECHNIQUE
T.M. GRABER & R.L.VANARSDALL
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4. HOWEVER IF THE METABOLIC PROBLEMS (PARTICULARLY –VE CALCIUM
BALANCE) ARE
RESOLVED WITH MEDICAL TREATMENT, THESE PATIENTS CAN BE TREATED
ORTHODONTICALLY ASSUMING SUFFICIENT SKELETAL STRUCTURE
REMAINS.
NO AGE LIMIT IS SPECIFIED FOR ORTHODONTIC TREATMENT; HOWEVER THE
CLINICIAN MUST CAREFULLY ASSESS THE PROBABILITY OF METABOLIC BONE
DISEASE.IN ADDITION TO OSTEOPOROSIS ORTHODONTIST MUST BE
PARTICULARLY VIGILANT FOR OSTEOMALACIA AND RENAL
OSTEODYSTROPHY.
ORTHODONTICS:CURRENT PRINCIPLES &
TECHNIQUES
T.M. GRABER & R.L. VANARSDALL;225,3RDED
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY
Orthodontics is contraindicated in patients with active metabolic bone
disease because of excessive resorption and poor bone formation.

5. CLINICAL CONSIDERATIONS
IS IT EASIER TO MOVE TEETH IN YOUNGER PATIENTS?
THE ALVEOLAR BONE IN YOUNG PERSONS WHO COMPRISE THE
MAJORITY OF OUR PATIENTS IS NOT VERY DENSE. IT
CONTAINS LARGE MARROW SPACES. SINCE TOOTH
MOVEMENT IS FACILITATED BY THE FORMATION OF
RESORPTIVE CELLS,WHOSE NUMBER AGAIN INCREASES
ACCORDING TO THE NUMBER OF MARROW SPACES, THE
ANATOMIC CONDITION CAN HARDLY BE MORE FAVOURABLE
THAN IN THE SUPPORTING STRUCTURES OF MAJORITY OF
THE YOUNG ORTHODONTIC PATIENTS. Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

6. CLINICAL CONSIDERATIONS
IS IT EASIER TO MOVE TEETH IN
YOUNGER PATIENTS?
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

7. CLINICAL CONSIDERATIONS
WHY DOES CORTICAL BONE OFFER GOOD
ANCHORAGE?
THE MARROW SPACE CONTAINS A LARGE SURFACE AREA FOR
CELLULAR ACTIVITY WHICH IS
INDISPENSABLE FOR TOOTH MOVEMENT.ON THE OTHER HAND IF
BONE INVOLVED IN TOOTH MOVEMENT IS OF A COMPACT CHARACTER
THE SURFACE AREA WHERE THE CELLULAR REACTION CAN TAKE
PLACE IS GREATLY REDUCED.
WHEN ONE IS PLANNING ORTHODONTIC TREATMENT ,THE TOOTH
SHOULD REMAIN IN SPONGY BONE DURING MOVEMENT.ON THE
OTHER HAND WHEN TEETH ARE PITTED AGAINST CORTICAL BONE
THEY CAN BE USED TO OUR ADVANTAGE TO PROVIDE MORE
ANCHORAGE.
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

8. CLINICAL CONSIDERATIONS
HOW SOON AFTER EXTRACTION CAN WE
START TREATMENT ?
EXTRACTION SPACES CONTAIN TISSUE UNDERGOING
RECONSTRUCTION WHICH IS RICH IN CELLS & VASCULAR
SUPPLY.SUCH AN AREA IS IDEALLY SUITABLE FOR TOOTH
MOVEMENT & DUE ADVANTAGE SHOULD BE TAKEN OF THIS
BY COMMENCING TREATMENT AS SOON AS POSSIBLE
FOLLOWING EXTRACTION. THEREBY ONE AVOIDS ATROPHY
& NARROWING OF THE ALVEOLAR PROCESS,RESULTING IN
BONE LOSS & CORTICAL BONE FORMATION AT THE
EXTRACTION SITE. Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

9. CLINICAL CONSIDERATIONS
WHY DO TEETH MOVE FASTER IN THE UPPER ARCH?
A COMMON EXAMPLE IS SPACE CLOSURE IN A CLASS I FOUR
PREMOLAR EXTRACTION CASE.IT IS OFTEN NECESSARY
TO USE HEADGEAR ON THE MAXILLARY 1ST MOLARS TO
MAINTAIN THE CLASS I RELATIONSHIP.THE RELATIVE
RESISTANCE OF THE MANDIBULAR MOLARS TO MESIAL
MOVEMENTS IS WELL KNOWN.
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

10. CLINICAL CONSIDERATIONS
WHY DO TEETH MOVE FASTER IN THE UPPER ARCH?
WHY ARE MANDIBULAR MOLARS MORE DIFFICULT TO MOVE
MESIALLY THAN MAXILLARY MOLARS ?
2 PHYSIOLOGIC FACTORS HOLD THE ANSWER:
• THIN CORTICES & TRABECULAR BONE OF THE MAXILLA
OFFER LESS RESISTANCE TO RESORPTION THAN THICK
CORTICES & MORE COARSE TRABECULAE OF THE MANDIBLE.
• THE LEADING ROOT OF MANDIBULAR MOLARS BEING
TRANSLATED MESIALLY FORMS BONE THAT IS FAR MORE
DENSE THAN THE BONE FORMED BY TRANSLATING
MAXILLARY MOLARS MESIALLY.WHY THIS OCCURS IS NOT
KNOWN.
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

11. CLINICAL CONSIDERATIONS
WHY DO I HAVE TO BE CAREFUL WITH CASES
SUFFERING FROM PERIODONTITIS?
MOVING TEETH WHEN PROGRESSIVE PERIODONTAL DISEASE IS PRESENT
INVITES DISASTER.
OSTEOCLASTS THRIVE IN THE DISEASED TISSUE ENVIRONMENT.
ON THE OTHER HAND OSTEOBLAST HISTOGENESIS IS SUPPRESSED
BY INFLAMMATORY DISEASE.
WHEN TEETH ARE MOVED IN THE PRESENCE OF ACTIVE PERIODONTAL DISEASE
RESORPTION IS NORMAL OR EVEN ENHANCED & BONE FORMATION
INHIBITED.THIS MAY EXACERBATE THE DISEASE PROCESS,RESULTING IN A RAPID
LOSS OF SUPPORTING BONE.
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

12. CLINICAL CONSIDERATIONS
WE NEED HEALTHY BONE FOR ADEQUATE RETENTION..
TEETH THAT HAVE BEEN MOVED RECENTLY ARE
SURROUNDED BY LIGHTLY CALCIFIED WOVEN BONE.THUS
THE TEETH ARE NOT ADEQUATELY STABILIZED & HAVE A
TENDENCY TO MOVE TO THEIR ORIGINAL
POSITION.DURING RETENTION PHASE THE BONE
MATURES.
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY

13. TBY –
DR. KAPIL SAROHA
BDS, MDS
DENDEN ISTIST
Monday, July 31, 2017WWW.DRDENTISTE.COM DR.DENTISTE DENTAL ACADEMY