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PRINCIPLES IN
ORTHODONTICS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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CONTENTS
INTRODUCTION
PERIODONTAL LIGAMENT
ALVEOLAR BONE
TOOTH MOVEMENTS 1. PHYSIOLOGICAL
2. ORTHODONTIC
THEORIES OF TOOTH MOVEMENTS
EFFECTS OF FORCE MAGNITUDE
FACTORS EFFECTING ORTHODONTIC TOOTH
MOVEMENT
EFFECT OF DRUGS ON RESPONSE TO
ORTHODONTIC FORCES.
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INTRODUCTION
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PERIODONTAL
LIGAMENT
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The
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Formative functions:
The undifferentiated cells in the pdl
serve as precursors for the cementum and bone
forming cells. In fact they play a key role in
bone remodeling.
Nutritional functions:
By the way of blood vessels that
traverse, the pdl supplies nutrients to the
cementum, bone and gingival for their metabolic
activities. It also provides lymphatic drainage.
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Sensory functions:
The innervations of the pdl provide
propioceptive and tactile sensation, which detect and
localize external forces acting upon individual teeth
and serve an important role in neuromuscular
mechanism controlling the masticatory musculature.
Other functions:
Through the formation, cross linkage and
maturational shortening of collagen fibers, it helps
in eruption of teeth.
The metabolic activities occurring within the pdl
maintain the teeth in position even though the
forces acting from extraoral and intraoral muscles
are not balanced.
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ALVEOLAR BONE
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TOOTH MOVEMENT
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ORTHODONTIC TOOTH
MOVEMENTS
Theoretically it should be possible to bring about
tooth movement without any tissue damage by
using a light force, equivalent to the
physiological forces determining tooth position,
to capitalize on the plasticity of the supporting
tissues.
However most current orthodontic techniques
do not duplicate the ideal situation; most involve
some degree of tissue damage that varies
because the forces applied to move the tooth
are not equally distributed throughout the pdl
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Initial strain:
occurs in about one week. The displacement
produced is about 0.4- 0.9 mm and is due to the
pdl displacement, bone strain and extrusion. The
fluid mechanics of root displacement in the pdl
probably accounts for about 0.3mm of crown
movement.
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Lag phase:
the displacement of the tooth relative to its
osseous support stops in about one week. This
occurs due to areas of the pdl necrosis
(hyalinization). This phase is called the lag
phase. It varies from about 2-3 weeks and
may be as long as 10 weeks. The duration of
the lag phase is directly related to the patients
age, density of alveolar bone and extent of pdl
necrotic zone.
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Initial
stage:
HYALINISATION
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Elimination
of destroyed tissue:
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THEORIES OF TOOTH
MOVEMENT
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Activation of cells.
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EFFECTS OF FORCE
MAGNITUDE
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When
< 1 sec
1-2 sec
3-5 sec
Mins
Hours
3-5 days
7-14 days
When
< 1 sec
1-2 sec
3-5 sec
destroyed
Mins
Hours
--4 hrs
--2 days
FACTORS INFLUENCING
ORTHODONIC TOOTH
MOVEMENT
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Character of bone
Remodeling processes in bone depend on the activity
of the cells that act on its surfaces. Thus alveolar
bone that is penetrated by numerous canals to
transmit blood vessels and contains cancellous bone
with marrow spaces at its deeper aspect is favorable
for tooth movement.
On the other hand, if the bone involved is compact in
nature, that is cortical bone, then the surface area
where cellular activity can take place is greatly
reduced. Here tooth movement is more difficult and
slower, and the chances of creating over
compression and greater areas of hyalinization are
much higher.
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Physiologic activity
The strong relapse tendency seen after the orthodontic
rotation of teeth is thought to be the result of slow
turn over of the gingival fibers mainly the supraalveolar fiber bundles. Turn over varies from person to
person and depends on a number of variables such as
hormonal balances, age of the patient and health of
the patient. Therefore it is necessary to consider these
variations during treatment planning, especially if the
patient is receiving medications like steroids or anti
epileptics, as the threshold for tissue changes or
cellular reactions will be influenced.
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Continuous forces
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Interrupted forces
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Intermittent forces
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PRE-ERUPTIVE TOOTH
MOVEMENTS
These are made by both the deciduous and the
permanent tooth germs within the tissues of the
jaw before they begin to erupt.
The deciduous teeth germs are extremely small
and have enough space in the developing jaw. But
as they grow rapidly, they become crowded
together. This is alleviated by the lengthening of
the jaws, permitting the second molar tooth germs
to move backwards and anterior tooth germs
forward.
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BONES STRUCTURAL
ADAPTATIONS TO
MECHANICAL USAGE
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b)
Lamellar and woven bones serve somewhat
different purposes and can respond differently to
mechanical and nonmechanical influences.
c)
Modeling drifts and remodeling BMUs (basic
multicellular units) can each result in bone turn
over, alter the shape and size of bone.
Each can also respond in its own way to aging,
hormones, disease, drugs and mechanical
influences.
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Bone modeling:
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LATEST CONCEPTS
OF FORCE MAGNITUDE
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-Prostaglandin inhibitors:
Since prostaglandins play an important role in
chemical mediation of tooth movement, inhibitors of
its activity would affect movement. Drugs that affect
the PG activity fall into two main categories:
1.Corticosteroids
and NSAIDs
2.Agents
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DELETERIOUS EFFECT OF
ORTHODONTIC FORCE
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Pain
If heavy pressure is applied to a tooth, pain develops
immediately as the pdl is literally crushed.
If appropriate orthodontic force is applied, the patient
feels little or nothing immediately. Several hours later,
patient feels a mild aching sensation which lasts for 2
to 4 days, then disappears until the orthodontic
appliance is reactivated.
The tooth is quite sensitive to pressure. This suggests
inflammation at the apex, and the mild pulpities that
usually appears soon after orthodontic force is applied
probably contributes to the pain
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Mobility
Effects on pulp
Although pulpal reactions to orthodontic treatment are
minimal, there is probably a moderate and transient
inflammatory response within the pulp, which
contributes to the discomfort that the patients feel for
the first few days after appliance activation.
There are occasional reports of loss of tooth vitality
during ortho treatment. If a tooth is subjected to
heavy continuous force, there is a sequence of abrupt
movements, which could sever the blood vessels as
they enter.
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TYPES OF TOOTH
MOVEMENTS
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PURE TRANSLATION
It occurs when all points on the tooth move
an equal distance in the same direction. This
is brought about when the line of action of an
applied force passes through the center of
resistance of the tooth.
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translation of the
teeth along its long axis in an
apical direction
EXTRUSION:
translation of
teeth along its long axis in an
occlusal direction
They are axial type of
translation and the center of
rotation lies at infinity.
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Intrusion
Intrusion is primarily done for anterior teeth. More
rapid intrusion is obtained by light continuous
forces than other types of tooth movement.
Forces applied must not act for excessively long
period if root shortening is to be avoided. A
carefully measured intruding force may cause root
resorptions, but there may be no visible
shortening of the roots. Each anterior tooth may
be intruded by forces as light as 20 to 30 gms.
This light force produces very short hyalinization
period and the teeth will intrude rapidly.
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Extrusion
Extrusion of the tooth involves the
more prolonged stretch and
displacement of supra alveolar fiber
bundles than of the principle fibers
of the middle and apical thirds.
Some of the principle fibers groups
may be subjected to stretch for a
certain time as the tooth is moved,
but these will rearrange after a short
retention period(4 to 5 months).
Only the supra alveolar fibers remain
stretched for longer, leading to a
certain degree of relapse.
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BODILY
MOVEMENT:
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PURE ROTATION
A
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2.
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b) TORQUE :
This can be considered as
a reverse tipping
characterized by lingual
movement of the root. The
tooth moves about a center
of rotation at or close to the
incisal edge. Much bone
undergoes resorption during
this type of tooth
movement and so root
movements require lots of
time.
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Torque
During the initial movement of
torque, the pressure area is
close to the middle region of
the root. This occurs because
the pdl is normally wider in
the apical third than in the
middle third. After resorption
of the bone areas
corresponding to the middle
third, the apical surface of the
root will gradually begin to
compress adjacent pdl fibres
and a wider pressure area will
be exerted.
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LONG
AXIS
ROTATION:
Here the orientation of the
long axis is not altered. The
tooth rotates about its center
of resistance. Here the center
of rotation is the long axis of
the tooth.
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COMBINATION OF BOTH
Any movement that is not pure rotation or
translation can be termed a combination of
both translation and rotation. This type of
movement is often seen in routine clinical
practice.
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Tipping
Translation
Root uprighting
Rotation
Extrusion
Intrusion
force( gms)
35-60
70-120
50-100
35-60
35-60
10-20
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MECHANICAL
PRINCIPLES IN FORCE
CONTROL
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FORCE
Force is the load applied to an object that will tend to
move it to a different position in space. It is the
application of a force that will bring about orthodontic
tooth movement. A force is a vector, and is defined by
the characteristics of a vector. Vectors have both
magnitude and direction. Magnitude represents its size
and the direction its line of action, sense and point of
origin.
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SIGN CONVENTION
Mesial
Labial or buccal
Anterior
Lateral
Extrusive direction
A negative sign to
Distal
Lingual or palatal
Posterior
Medial
Intrusive movements
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EQUIVALENT FORCE
SYSTEMS
The application of forces and couples in orthodontics
is at the brackets and not at the center of resistance.
It is impractical to place forces and moments at the
centers of resistance, instead an equivalent force
system can be placed on the tooth at the brackets or
tube.
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Mc/Mf = 0
Pure tipping
0<Mc/Mf < 1
Controlled tipping
Mc/Mf = 1
Bodily movement
Mc/Mf > 1
Torque
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SYSTEM
EQUALIBRIUM
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1.Symmetric V bends,
which creates equal and opposite couples at the
brackets. The forces at each bracket are equal and
opposite, and therefore cancel each other out. A
symmetrical V bend is not necessarily half way
between two teeth or two groups of teeth.
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2. Asymmetric V bend,
which creates unequal and opposite couples, and net
equilibrium forces that would intrude one unit and
extrude the other. Although the absolute magnitude of
the forces involved cannot be known with certainty,
the relative magnitude of the moments of the
associated equilibrium forces can be determined.
The bracket with the larger moment will have a
greater tendency to rotate than the bracket with the
smaller moment, and this will indicate the direction of
equilibrium forces.
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3. Step bend
which creates two couples in
the same direction regardless of
its location between the two
brackets. The location of a V
bend is a critical variable in
determining its effect, but the
location of a step bend has little
or no effect on either the
magnitude of the moments or
the equilibrium forces.
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ELASTIC MATERIALS
properties
and
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Strength
Three different points on a stress-strain diagram can
be taken as representatives of the strength of a
material.
1. Proportional limit: the point at which any permanent
deformation is first observed.
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Range
is defined, as the distance the wire will bend elastically
before permanent deformation occurs. It is measured
in millimeters or any length units.
If the wire is deflected beyond its yield strength, it will
not return to its original shape, but clinically useful
spring back will occur unless the failure point has been
reached.
In many cases orthodontic wires are deformed beyond
their elastic limit. Their spring back properties in the
portion of the load- deflection curve between the
elastic limit and the ultimate strength are important in
determining the clinical
performance.
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FACTORS AFFECTING
ELASTIC PROPERTIES
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Material
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orthodontic
else could
introduction
the use of
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w Beta-Titanium:
In the early 1980s, after nitinol but before A-NiTi,
Beta-Ti material (TMA) was developed primarily
for orthodontic use. It offers a highly desirable
combination of strength and springiness as well as
reasonably good formability. This makes it an
excellent choice for arch wires, especially rectangular
wires, for the late stages of edgewise treatment.
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Diameter:
doubling the diameter of the wire increases its
strength by 8 times, i.e; the large wire can resist 8
times as much force before permanently
deformed,or can deliver 8 times as much force.
Doubling the diameter, however, decreases
springiness by a factor of 16 and range by a factor
of 2.
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CONCLUSION
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THANK YOU
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Uncontrolled tipping
0:1 to 5:1
Controlled tipping
7:1
Translation
10:1
12:1
Rotations
Thank you
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