How Orthodontic Inflammation Aids Treatment

To most people, orthodontics is about creating a perfect smile, and while this is partly true, there are other biological and health components to orthodontic tooth movement. In order to safely and properly shift teeth into the correct positions, pediatric and general dentists must understand how tooth movement heavily relies on both bone resorption and remodeling of alveolar bone and periodontal ligament. 

Without this knowledge, dentists may move teeth to seemingly correct positions, but in reality, there may be damage to the roots and alveolar bone that can create serious dental implications in the future. 

In order for orthodontic tooth movement to be successful, there is a sequential immune response that needs to happen. Orthodontic wires and appliances exert forces on the periodontium to begin this pathway for tooth movement, and it is a complex cycle that relies heavily on inflammation. 

When most people think of inflammation, they negatively associate it with illness, necrosis, or resorption. While inflammation sometimes has a negative role, it is a necessary part of orthodontic tooth movement. 

This is one of the top reasons why taking orthodontic courses with the American Orthodontic Society is vital to understanding who is a good candidate for orthodontics. Learning how to diagnose patients for orthodontic treatment is important, but understanding how to interpret diagnostic imaging is key to providing safe, effective patient care. 

The Role of Orthodontic Inflammation Tooth Movement

Orthodontic tooth movement triggers inflammation by initiating an immune response that releases inflammatory markers that correlate with periodontal ligament changes, bone resorption and remodeling, and vascular changes. Orthodontic forces cause a biological response that alters blood flow and the electrochemical environment of the periodontal ligament space. In turn, cellular changes like inflammatory mediators alter the bone and periodontal ligament in order for the tooth to shift even a millimeter. 

This type of inflammation is not considered harmful or toxic when it is performed slowly. Light, continuous orthodontic forces allow for a healthy inflammatory process. Alternatively, heavy, continuous forces can cause root resorption, necrosis, and eventual tooth loss. A comprehensive ortho course will teach you how to correctly and safely treat malocclusion with braces. 

Inflammation also plays a role in orthodontics because patients generally take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. NSAIDs are designed to block enzymes responsible for inflammation and slow the process to prevent discomfort. Acetaminophen is known to have less of a negative impact on slowing orthodontic movement than ibuprofen; therefore, it is recommended to take acetaminophen to prevent slower tooth movement. 

When Orthodontic Inflammation Is Harmful in Tooth Movement 

Orthodontic tooth movement relies on an inflammatory process that expresses numerous biological markers to allow for bone and tissue remodeling. Without this remodeling process, tooth movement cannot occur. However, when the inflammatory process is uncontrolled, it can cause orthodontic-induced root resorption (OIRR), leaving excessive resorption and a less-than-ideal crown-to-root ratio. This has a significant clinical impact on a tooth’s long-term prognosis. 

OIRR is associated with increased osteoclastic bone resorption and elevated levels of inflammatory markers linked to bone breakdown in the gingival crevicular fluid. When the homeostatic balance between bone resorption and bone remodeling is compromised, it can lead to tooth destruction. This concept is important to understand because there is constant interest in shortening orthodontic treatment time, but this could be detrimental for adults seeking treatment. 

Patients at greater risk for this complication include those suffering from periodontal disease since their periodontium is already compromised from bone and tissue loss. Therefore, taking an accurate medical and dental history prior to orthodontic treatment is crucial. 

The Role of Bone Remodeling in Orthodontic Tooth Movement 

Dentists who understand the bone resorption and remodeling process can in turn design treatment plans that speed up treatment without causing harmful side effects. 

Orthodontic tooth movement is dependent upon bone resorption and new bone formation. Osteoclast cells are associated with bone breakdown. Osteoblasts are expressed to create new alveolar bone and aid in this formation around 48 hours after application of orthodontic forces. 

Learning which biological markers are associated with osteoblast and osteoclast cells is useful to determine the balance of bone formation and breakdown. Both types of cells are needed for orthodontic tooth movement to happen successfully.

Why is understanding osteoblast and osteoclast activity important for dentists? Orthodontic treatment is a combination of biological and technical skills. Understanding the science behind the tactile treatment is what makes someone an educated clinician. 

Patients undergoing orthodontic treatment will have higher levels of biological markers when there is bone resorption. For example, patients with orthodontic tooth movement exhibit levels of inflammatory markers lactate dehydrogenase and aspartate aminotransferase. However, these markers are also seen in patients with periodontal disease. 

How Inflammation Can Direct New Orthodontic Therapies

Clinicians are always looking for ways to increase efficiency of treatment and improve treatment techniques for patient care. Decreasing orthodontic treatment time is always a focus of dentists because adult patients want a straight smile in minimal time. 

However, there is a delicate balance between accelerating orthodontic tooth movement and not increasing a patient’s risk of root resorption and pain. 

When you take an ortho course with the American Orthodontic Society, the comprehensive didactics will review the biology behind orthodontics. Using the knowledge of biological markers and how they impact orthodontic inflammation, bone resorption and formation, and tooth movement, it can alter how dentists direct treatment and patient outcomes. Visit our website for more information and a list of upcoming courses.