Textbook of Orthodontics
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Textbook of
ORTHODONTICS
SRIDHAR PREMKUMAR bds mds
Professor
Department of Orthodontics and Dentofacial Orthopedics
Head
Department of Pediatric Dentistry
Tamil Nadu Government Dental College and Hospital
Chennai
INDIA
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Textbook of Orthodontics, Sridhar Premkumar
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Dedication
In loving memory of Dr TM Graber,
the Godfather of orthodontics whose name means
everything in orthodontics to me
In honor of my mentor
to whom I am indebted, Dr MR Balasubramanian,
who strived to bring the better out of me
In gratitude to my postgraduate teacher
to whom I am grateful, Dr S Rangacharri,
who pushed me for academic excellence
v
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Contributors
Badrinath MDS Poornima R Jnaneshwar MDS
Reader Reader
Department of Orthodontics Department of Orthodontics
Faculty of Dental Sciences SRM Dental College
Sri Ramachandra University Ramapuram, Chennai
Porur, Chennai
Sangeetha Duraiswamy MDS
Balashanmugam B MDS Associate Professor
Professor Department of Orthodontics
Department of Orthodontics SRM Dental College
Tamil Nadu Government Dental College Ramapuram, Chennai
Chennai
Thailavathy V MDS
Krishnaraj Rajaram MDS Senior Lecturer
Professor Department of Orthodontics
Department of Orthodontics SRM Dental College
SRM Dental College Ramapuram, Chennai
Ramapuram, Chennai
Umarevathy Gopalakrishnan MDS
Meera Sravankumar MDS Reader
Reader Department of Orthodontics
Department of Orthodontics Sri Venkateswara Dental College and Hospital
SRM Dental College Thalambur, Chennai
Ramapuram, Chennai
Poornachitra BDS
Dental Surgeon
Private Practice
Chennai
vii
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Preface
Another book on orthodontics? I am sure this is going to extensively. A new chapter ‘Synopsis of Treatment Plan-
be the first thought in the mind of the reader. As knowl- ning for Different Malocclusions’ had been included to
edge and technology changes, so will our technique. enable easy revision for exam preparations.
There is no finish line. Robert Schuller once said, “We go As orthodontics and dentofacial orthopedics con-
from peak to peek.” We must climb to the top of the tinue to progress in various dimensions, it becomes the
peak of the mountain before we can see or peek at the duty of every student, teacher and clinician to update
peaks of all other mountains out there. The art and themselves by preserving their curious learning spirit.
science of orthodontics and dentofacial orthopedics is This book aims to behold its first position in any dentist’s
very complex. It had taken inexplicable evolution in preference and I wish every one of the readers to use
treatment philosophy and methodology over many gen- this book judiciously and gain knowledge for crafts-
erations put forth by various pioneers in orthodontics to manship.
attain the present degree of success in professional ex- I had a diverse readership in mind while writing
pertise. This book differs from competing textbooks by this book. Clearly, my primary readership is students,
trying to uniquely combine different powerful elements: followed by practitioners and researchers in orthodon-
a critical pedagogy integrated with comprehensive text, tics. As anyone who has a professional or academic
the use of authentic clinical situations and the inclusion interest in orthodontics will be aware, the field is a
of the most essential basic concepts in Orthodontics ev- constantly changing, multidisciplinary one that draws
ery student must know. on developments in and insights from medicine, and
This text uses the simple-to-complex approach in other fields of dentistry. For this reason, I have tried
teaching students clinical calculations and is, therefore, to make the reader aware of those multidisciplinary
divided into various sections in a sequential manner and influences.
chapters are organized based on it. The sections Growth Through this column I would like to place my thanks
and Development; Physiology of Stomatognathic Sys- to all the students and faculty for the encouragement
tem; Diagnostic Procedures, Aids and their Interpreta- they had given to me in my writing endeavor. The den-
tion; Tooth Movement Principles and Philosophy; Cor- tal faculties and budding dentists are welcomed to com-
rective Appliances; Treatment Approach to Management municate their queries and feedbacks to my email id:
of Malocclusions had been expanded further into many dr_premsridhar@yahoo.co.in.
chapters with addition of new accepted innovations and
facts. Space Gaining Procedures had been discussed Sridhar Premkumar
ix
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Acknowledgements
Putting together a book such as this is always a collaborative effort, and I was assisted by a number of people along
the way.
My sincere thanks go to Dr KSGA Nasser, former Principal, Tamil Nadu Government Dental College and
Hospital, for his constant support.
My special thanks to my friends, Dr K Ravi, Dean and Head, Department of Orthodontics, SRM Dental College
and Hospital, and Dr R Krishnaraj, Professor, Department of Orthodontics, SRM Dental College and Hospital, for
their constant words of encouragement.
Dr PS Haritha, Reader, Sri Ramachandra Dental College and Hospital, needs special mention for providing me
with rare clinical photographs.
A note of thanks to Mr Anand K Jha, Managing Editor for his prodding, patience and understanding and, for
being a beautiful editor; and Ms Nimisha Goswami, for being the shock absorber between the corporate structure
of Elsevier and to this writer.
The task of writing a book is made more manageable when one receives the assistance of others. I particularly
wish to thank Dr Poornachitra for her magisterial level of patience while working on artworks of this book and
providing assistance throughout.
Finally, I have been supported in this endeavor by my wife, Dr Praveena Premkumar, who has been my foremost
pillar for success; my children, Sriram and Srinidhi, for elevating my quality of life with their benevolence; all my
family members for being there for me always and the students for their amazing energy and enthusiasm. I am
grateful to them for their kind words of encouragement during my many months of writing.
xi
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Brief Contents
Section I Section VI
An Introduction to Orthodontics Diagnostic Procedures,
1. Development of a Concept 2 Aids and Their Interpretation
18. Essential Diagnostic Aids: Case History and
Section II Clinical Examination
19. Essential Diagnostic Aids: Study Models and
215
Model Analyses 235
Growth and Development 20. Essential Diagnostic Aids: Essential
2. Prenatal Development of Cranial, Facial and Radiographs and Clinical Photographs 253
Oral Structures 14 21. Supplemental Diagnostic Aids: Cephalometric
3. Principles of Growth and Development 24 and Digital Radiography 265
4. Controlling Factors in Growth of the Skull 31 22. Supplemental Diagnostic Aids: Hand–Wrist
5. Postnatal Growth of Craniofacial Structures 43 Radiographs, Cervical Vertebrae, 3D Imaging
6. Dynamics of Facial Growth 58 and Computerized Cephalometric Systems 300
7. Development of Dentition 23. Supplemental Diagnostic Aids:
and Occlusion 67 Electromyography and Biostatistics 314
8. Normal Occlusion 89
Section VII
Section III
Principles of Orthodontic
Physiology of the Tooth Movement
Stomatognathic System 24. Biological Principles of Tooth Movement 319
9. Functional Osteology 102 25. Biomechanical Principles of Orthodontic
10. Myology 109 Tooth Movement 338
11. Temporomandibular Joint 121
12. Functions of the Stomatognathic System 125
Section VIII
Section IV Treatment Philosophy, Orthodontic
Incidence and Recognition Materials and Care during
of Malocclusion Orthodontic Treatment
13. Epidemiology of Malocclusion 134 26. Orthodontic Treatment Philosophy and
14. Recording of Malocclusion 145 Development of Appliances 353
27. Materials Used in Orthodontics 364
28. Complications Encountered and Dental Care
Section V during Orthodontic Therapy 397
Etiology of Malocclusion
15. Etiology of Malocclusion: General Factors 175
16. Etiology of Malocclusion: Local Factors 191
17. Unfavorable Sequelae of Malocclusion 206
xiii
xiv BRIEF CONTENTS
Section IX Section XI
Early Orthodontic Treatment Surgical Orthodontics
29. Preventive Orthodontics 408 37. Minor Surgical Procedures 595
30. Interceptive Orthodontics 428 38. Major Surgical Orthodontics 606
31. Serial Extraction 459 39. Cleft Lip and Palate and Orthodontics 626
Section X Section XII
Limited Corrective Orthodontics Approach to Management of Malocclusion
32. Removable Appliances 472 40. Treatment Planning: General Considerations 646
33. Functional Appliances 509 41. Space Gaining Procedures 656
34. Extraoral Appliances 549 42. Treatment of Malocclusions 676
35. Fixed Appliances: Basic Techniques 562 43. Retention after Orthodontic Therapy 710
36. Expansion Appliances 580 44. Synopsis of Treatment Planning for Different
Malocclusions 722
Detailed Contents
Contributors vii
Preface ix
Acknowledgements xi
Section I An Introduction to Orthodontics
1. Development of a Concept 2
■ History of Orthodontics 2 ■ Definitions and Divisions of Orthodontics 2 ● Tissue Systems 5 Goals of
Orthodontics 9 ● Changing Paradigms of Goals of Orthodontics 10 ● Health-Related Quality of Life 10
● Psychosomatic Norm 10
Section II Growth and Development
2. Prenatal Development of Cranial, Facial and Oral Structures 14
■ Differences Between Growth and Development 14 ■ Prenatal Development of Cranial, Facial and Oral
Structures 15 ● Period of the Ovum 15 ● Embryonic Period 15 ● Fetal Period 18 ■ Growth of the Palate 19
■ Growth of the Tongue 20 ■ Growth of the Mandible 21 ■ Growth of the Cranium 22 ■ Growth of the
Temporomandibular Joint 22
3. Principles of Growth and Development 24
■ Bone Growth 24 ● Endochondral Bone Formation (Synonyms: Indirect Ossification/Cartilaginous Bone
Formation) 24 ● Intramembranous Bone Formation (Synonyms: Direct Ossification/Membranous Bone Formation) 25
■ Features of Craniofacial Growth 26 ● Cephalocaudal Growth 26 ● Growth Pattern 27 ● Scammon’s Growth
Gradient 27 ● Remodeling 27 ● Growth Movements 28 ● The ‘V’ Principle 28
4. Controlling Factors in Growth of the Skull 31
■ Controlling Factors of Craniofacial Growth 31 ■ Site vs Center 31 ■ Theories of Growth 32 ● Genetic
Theory by Allan Brodie 33 ● Van Limborgh Hypothesis 33 ● Sutural Theory by Sicher and Weinmann 33 ● Scott
Hypothesis/Nasal Septum Theory/Cartilaginous Theory/Nasocapsular Theory 34 ● Functional Matrix Hypothesis
(FMH)—Melvin Moss 35 ● Functional Matrix Revisited 38 ● Van Limborgh’s Composite Hypothesis 38
● Servosystem Theory 39
5. Postnatal Growth of Craniofacial Structures 43
■ Postnatal Growth of Cranial Vault/Brain Case 43 ● Fontanelles 43 ● Formation of Diploe and Frontal
Sinus 44 ● Increase in Width, Length and Height of Cranium 44 ● Deposition and Resorption Sites in Cranial Vault
Growth 45 ■ Growth of the Cranial Base 45 ● Functions of Cranial Base 45 ● Mechanisms of cranial base
growth 45 ● Growth of Anterior Cranial Fossa 45 ● Growth of Middle Cranial Fossa 46 ● Growth of Posterior Cranial
Fossa 47 ■ Growth of the Facial Skeleton 48 ● Nasomaxillary Complex 49 ● Growth of Maxilla with Regards to
Sutural and Cartilaginous 51 ● Growth of Maxilla and Functional Matrix Theory 52 ■ Mandible 53 ● Mandibular
Growth in First Year of Life 53 ● Condylar Growth 53 ● Mandibular Growth after the First Year of Life 53 ● Growth
of Mandible with regards to Functional Matrix Theory 56 ● The Chin 56 ■ Temporomandibular Joint 56
6. Dynamics of Facial Growth 58
■ Differential Growth 58 ■ Increments and Order of Completion of Growth 58 ● Order of Completion of
Growth 58 ● Amount of Growth 58 ■ Growth Spurts 59 ■ Clinical Implications 60 ● Safety Valve Mechanism 60
● Timing of Orthodontic Treatment 60 ■ Measurement of Growth 62 ● Craniometry and Anthropometry 63 ● Vital
Staining 64 ● Implant Radiography 64 ● Impressions and Study Casts 64 ● Photographs 65 ● Radioautographs 65
● Radiographs 65 ● Serial Cephalometric Radiography and Implantation 66
xv
xvi DETAILED CONTENTS
7. Development of Dentition and Occlusion 67
■ What is Occlusion? 67 ■ Stages of Development of Occlusion 67 ● Predental/Gum Pads Stage 67 ● Primary
Dentition 69 ● Mixed Dentition Stage—The Transitional Years (6–12 Years of Age) 74 ■ Eruption of Teeth 82
● Stages of Eruption 82 ● Mechanisms of Tooth Eruption 83 ● Theories of Tooth Eruption 83 ● Factors Affecting
Eruption of Teeth 84 ■ Clinical Applications of Growth and Development Data 85 ● Arch Expansion
Considerations 85 ● Space Considerations 85 ● Growth and Tooth Eruption 86 ● Ugly Duckling Stage/Broadbent
Phenomena/Physiologic Median Diastema 86 ● Overbite and Molar Relation 86
8. Normal Occlusion 89
■ Transient Malocclusions 90 ■ Development of the Concept of Occlusion 90 ● Fictional Period 90 ● Hypothetical
Period 91 ● Factual Period 92 ● Andrew’s Six Keys to Normal Occlusion 93 ■ Dynamic Occlusion 96 ● Compensating
Curves 97 ● Roth’s Keys of Occlusion 98 ● Ramjford’s Three Components of Occlusion 98 ● Functional Occlusion
Concept by Donald Rinchuse 99 ● Forces of Occlusion 99 ● Stomatognathics 101 ● Components 101
Section III Physiology of the Stomatognathic System
9. Functional Osteology 102
■ Facts about Bone 102 ■ Bone Turnover 102 ● Bone Modeling and Remodeling 103 ● Regulatory Factors in
Bone Turnover 103 ■ Mechanically Mediated Bone Adaptation Theories 104 ● Trajectorial Theory of Bone
Formation 104 ● Law of Orthogonality and Law of Transformation of Bone 104 ● Roux’s Observations 105 ● Stress
Trajectories/Benninghoff Lines 105
10. Myology 109
■ Types of Muscle 109 ● Skeletal Muscle 109 ● Smooth Muscle 109 ● Cardiac Muscle 110 ■ Properties of
Muscle 110 ● Elasticity 110 ● Contractility 110 ● Principle of Electromyogram 111 ■ Jaw Reflex Types 111
■ Buccinator Mechanism 112 ■ Tongue 113 ■ Equilibrium Theory 114 ■ Functional Movements 115
● Opening of Mandible 115 ● Mandible Closure 115 ● Mandible Protraction 115 ● Mandible Retrusion 115
● Lateral Movement 115 ● Bennett Movement 116 ● Bennett Angle 116 ■ Positions of Mandible 116
● Postural Resting Position (Postural Vertical Dimension) 116 ● Centric Relation 117 ● Initial Contact 117
● Centric Occlusion (Occlusal Vertical Dimension) 117 ● Most Retruded Position (Terminal Hinge Position) 117
● Maximum Opening of Mouth 118 ● Most Protruded Position 118 ● Posterior Tooth Relationship during Lateral
Excursions 118 ● Habitual Resting Position 118 ● Habitual Occlusal Relation (Occlusal Vertical Dimension) 119
11. Temporomandibular Joint 121
■Anatomy of Temporomandibular Joint 121 ■ lubrication of TMJ 123 ■ Response of TMJ to
Abnormalities 124
12. Functions of the Stomatognathic System 125
■ Development of Reflexes 125 ■ Respiration 125 ■ Mastication 126 ● Stages of Mastication 126 ● Child
and Adult Chewing Patterns 127 ■ Swallowing or Deglutition 127 ● Suckling 127 ● Infantile Swallow 128
● Mature Swallow 128 ● Stages of Deglutition 129 ■ Speech 130 ● Subsystems of Speech 130 ● Types of
Speech 130
Section IV Incidence and Recognition of Malocclusion
13. Epidemiology of Malocclusion 134
■ Prevalence of Malocclusion 134 ● Ethnic Variations in Malocclusion 134 ■ Arch Form 135 ● Bonwill Arch
Form 135 ● Bonwill–Hawley Arch Form 135 ● Izard Arch Form 136 ● Catenary Curve Arch Form 138 ● Brader
Arch Form 139 ■ Variations in Size, Form, Number and Position of Teeth 139 ● Size of Teeth 140 ● Form of
Teeth 141 ● Number of Teeth 142 ● Tooth Position 143
DETAILED CONTENTS xvii
14. Recording of Malocclusion 145
■ Glossary of Terms Concerning Malposition 145 ■ Dysplasias 145 ● Dental Dysplasias/Dental Malocclusions
147 ● Skeletal Dysplasias/Skeletal Malocclusions 147 ■ Recording of Malocclusions 148 ● Method of
Classification of Malocclusion 148 ● Need for Classification 148 ● 1. Qualitative Methods of Classification 148
● Simon’s Classification 149 ● Angle’s Method of Classification 150 ● Dewey’s Modification of Angle’s
Classification 163 ● Ackerman–Proffit Classification System 164 ● British Standards Institute Classification
(1983) 165 ● 2. Quantitative Methods of Classification 166 ■ Index of Malocclusion 166 ● Irregularity
Index 168 ● Treatment Priority Index 168 ● Index of Orthodontic Treatment Need 170 ● PAR Index (An Index of
Treatment Outcome) 170 ● Index of Complexity, Outcome and Need (ICON) 172
Section V Etiology of Malocclusion
15. Etiology of Malocclusion: General Factors 175
■ Methods of Classification of Etiologic Factors 175 ● Moyers’ Classification 175 ● Graber’s Classification 176
■ General Factors 177 ● Heredity 177 ● Genetic Studies 177 ● Molecular Basis of Heredity 177 ● Heredity and
Specific Dentofacial Morphologic Characteristics 178 ■ Congenital Defects 178 ● Cleft Lip and Palate 178 ● Other
Congenital Defects 180 ■ Environment 182 ● Prenatal Influences 182 ● Postnatal Influences 184 ■ Predisposing
Metabolic Climate and Disease 184 ■ Dietary Problems (Nutritional Deficiency) 185 ■ Abnormal Pressure
Habits/Functional Causes 185 ● Head Posture 186 ● Finger Sucking Habit 186 ● Tongue Posture 186 ● Tongue
Thrusting 186 ● Mouth Breathing 187 ● Other Functional Causes 187 ● Psychogenic or Idiopathic Functional
Aberrations: Clenching and Bruxism 188 ● Adenoids and Tonsils 188 ● Tongue Size 188 ■ Posture 189 ■ Accidents
or Trauma 189
16. Etiology of Malocclusion: Local Factors 191
■ Anomalies in Number of Teeth 191 ● Extra Tooth/Hyperodontia/Supernumerary Tooth/Supplemental Tooth 191
● Missing Teeth 193 ■ Anomalies of Tooth Size 194 ■ Anomalies of Tooth Shape 196 ■ Abnormal Labial
Frenum 196 ■ Premature Loss of Deciduous Teeth 197 ■ Prolonged Retention and Abnormal Resorption
of Deciduous Teeth 199 ■ Delayed Eruption of Permanent Teeth/Dentitio Tarda 199 ■ Abnormal Eruptive
Path 201 ■ Ankylosis 202 ■ Dental Caries and Improper Dental Restorations 203
17. Unfavorable Sequelae of Malocclusion 206
■ Malocclusion and Unfavorable Psychological and Social Behavior 207 ■ Poor Appearance 208 ■ Interference
with Normal Growth and Development 208 ■ Improper or Abnormal Muscle Function 208 ● Adaptation 208
● Associated Muscle Habits 209 ● Bruxism 209 ■ Improper Mastication 209 ■ Speech Defects 209 ● Effects
of Malocclusion on Speech 210 ● Effects of Cleft Lip or Palate 210 ■ Dental Caries and Malocclusion 210
■ Periodontal Disease and Malocclusion 210 ■ Temporomandibular Joint Disorders 210 ■ Accidents and
Malocclusion 211 ■ Impacted Unerupted Teeth 211 ■ Complications in Prosthetic Rehabilitation 212
● Essential Diagnostic Criteria 214 ● Supplemental Diagnostic Criteria 214
Section VI Diagnostic Procedures, Aids and Their Interpretation
18. Essential Diagnostic Aids: Case History and Clinical Examination 215
■ Essential Diagnostic Criteria 215 ● Case History 215 ● Clinical Examination 217
19. Essential Diagnostic Aids: Study Models and Model Analyses 235
■ Plaster Study Casts 235 ● Impression Technique 236 ● Wax Bite Records 237 ● Study Cast 237 ● Information
Obtainable from Study Casts/Uses of Study Casts 241 ■ Mixed Dentition Analyses 243 ● Moyers’ Mixed Dentition
Analysis 244 ● Tanaka–Johnston’s Prediction Method 244 ● Radiographic Method 245 ● Staley and Kerber’s
Analysis 245 ■ Permanent Dentition Analyses 246 ● Bolton’s Tooth Size Analysis 246 ● Ashley Howe’s
Analysis 247 ● Pont’s Index/Pont’s Analysis 248 ● Linderhearth’s Analysis 248 ● Carey’s Analysis 249 ● Diagnostic
Setup/Kesling’s Diagnostic Setup 249 ■ Digitization of Study Models 250 ● Occlusogram 250
xviii DETAILED CONTENTS
20. Essential Diagnostic Aids: Essential Radiographs and Clinical Photographs 253
■ Intraoral Radiographs 253 ■ Panoramic Radiography 254 ● Principle of Panoramic Radiography 254
● Digital Panoramic Radiography 255 ● Interpretation of Panoramic Radiograph 255 ■ Facial Photographs 256
■ Digital Photography in Orthodontic Practice 260 ● Principle of Digital Photography 260 ■ Analysis of
Smile 261 ● Components of Smile11 262 ● Types of Smile 262 ● Analysis of Smile in the Frontal Dimension14 262
● Analysis of Smile in Oblique Dimension 263 ● Analysis of Smile in Sagittal Dimension 263
21. Supplemental Diagnostic Aids: Cephalometric and Digital Radiography 265
■ Cephalometric Radiography 266 ● Technique of Cephalometric Radiography 266 ■ Applications of
Cephalometric Radiographs 266 ● Growth and Development 266 ● Craniofacial Abnormalities 267
● Classification of Malocclusion 267 ● Prediction of Growth and Treatment Changes 268 ● Study of Post-treatment
Changes by Superimposition 268 ■ Cephalometric Landmarks 269 ● Hard-tissue Landmarks 269 ● Soft-tissue
Landmarks 270 ■ Cephalometric Planes 271 ■ Cephalometric Analyses 272 ● Limitations and Drawbacks of
Cephalometrics 274 ● Steiner’s Analysis 274 ● Wits Appraisal 277 ● Tweed’s Analysis/Tweed’s Diagnostic
Triangle 278 ● Ricketts’ Analysis 281 ● McNamara’s Analysis 286 ● Soft-Tissue Analysis 289 ● H Angle 291
● Functional Analysis 292 ● Sassouni Analysis 293 ● Jarabak Ratio 293 ● Indian Cephalometric Norms 293
■ Other Special X-Ray Views 293 ● The 45° Lateral Projections 293 ● Frontal Cephalometrics 296 ● Occlusal
Intraoral Film 296 ■ Digital Radiography 296 ● Principle of Digital Radiography 297 ● Direct Digital
Imaging 297 ● Digitization 298
22. Supplemental Diagnostic Aids: Hand–Wrist Radiographs, Cervical Vertebrae, 3D Imaging
and Computerized Cephalometric Systems 300
■ Types of Age 300 ■ Hand–Wrist Radiograph 301 ● Principle of Bone Age Assessment 301 ● Anatomy of
Hand–Wrist Region 302 ● Björk, Grave and Brown Method 303 ● Hagg and Taranger Method 305 ■ Cervical
Vertebrae Maturation As Skeletal Maturity Indicator 306 ● Clinical Application of Skeletal Maturity
Indicators 307 ■ Basal Metabolic Rate and Other Endocrine Tests 308 ■ Three-Dimensional Imaging 308
● Computed Tomography 308 ● Cone Beam Computed Tomography 308 ● Magnetic Resonance Imaging (MRI) 311
■ Computerized Cephalometric System 311 Components of Computerized Cephalometric System 311
23. Supplemental Diagnostic Aids: Electromyography and Biostatistics 314
■ Electromyographic Examination 314 ● Procedure 314 ● Orthodontic Interpretations 314
■ Biostatistics 315 ● Types of Data 315 ● Types of Biostatistics 316 ● Steps in Statistical Testing 316
Section VII Principles of Orthodontic Tooth Movement
24. Biological Principles of Tooth Movement 319
■ Basic Principles of Tooth Movement 319 ■ Physiologic Tooth Movement 320 ● Movement During
Mastication 321 ● Eruption of Tooth 321 ● Migration of Teeth 321 ● Response to Physiologic Forces 321
■ Orthodontic Tooth Movement 321 ● Role and Structure of the Periodontal Ligament 322 ● Theories of Tooth
Movement 323 ● Pathways of Tooth Movement 326 ● Optimal Orthodontic Force 327 ● Tissue Response to
Orthodontic Force 327 ● Stages of Tooth Movement 331 ● Types of Force Based on Magnitude and Force
Decay 331 ● Role of Genes on Orthodontic Tooth Movement 332 ● Root Resorption and Deleterious Effects of
Orthodontic Tooth Movement 333 ● Age Factor in Tooth Movement 335 ● Orthopedic Force 336 ● Effects of
Drugs on the Response to Orthodontic Force 336
25. Biomechanical Principles of Orthodontic Tooth Movement 338
■ Definition of Anchorage 338 ■ Types of Anchorage 339 ● Simple Anchorage 339 ● Stationary
Anchorage 339 ● Reciprocal Anchorage 340 ● Intraoral Anchorage 340 ● Extraoral Anchorage 340
● Intramaxillary Anchorage 341 ● Intermaxillary Anchorage 341 ● Multiple Anchorage 342 ● Cortical Bone/
Cortical Anchorage 342 ● Muscular Anchorage 342 ■ Implant as Anchorage Units/Absolute Anchorage/
Temporary Anchorage Devices (TADs) 342 ■ Biophysical Considerations 343 ● Spring Characteristics 346
● Activation and Deactivation Systems 347 ■ Types of Tooth Movement 347 ● Tipping 348 ● Pure
Translation 349 ● Root Movement 349 ● Rotation 350
