What is orthodontic tooth movement?
A unique process where a solid object (tooth) is made to move through a solid medium (bone). Orthodontic tooth movement occurs due to the pressure that is transmitted to the clinical crown of the tooth, down to the root, and ultimately to the periodontal ligament (the tissue that attaches the tooth to the bone) and alveolar bone surrounding the root.
On the surface of the tooth in the direction where the tooth is being moved, the periodontal membrane is squeezed, resulting in compression of the periodontal fibers within the membrane. The bone surface contacting the periodontal membrane begins to resorb due to the activation of cells called osteoclasts.
On the surface of the root from which the tooth moves, the periodontal membrane becomes stretched. This activates cells called osteoblasts. These cells regenerate new alveolar bone in the area where the tooth was once located. That is why teeth may be slightly loose during orthodontic treatment. Once the movement has stopped, the ligaments are no longer stretched or squeezed and the bone regenerates and fills in around the periodontal ligament, causing the tooth to be more secure in the bone.
The following article shows that daily coffee consumption enhances orthodontic tooth movement, and consequently can shorten the duration in which patients have to wear braces.
The Study
Caffeine has been shown to affect bone metabolism through regulation of osteoclast, osteoblast, and calcium balance. This study investigated the effects of drinking coffee on orthodontic tooth movement (OTM). Drinking coffee, as a daily habit of many people, can be an effective accelerator of tooth movement with little side effects. Caffeine can break the calcium balance in bone tissue and directly inhibit the development of osteoblasts, leading to temporary decreased bone mineral density and consequently inducing faster orthodontic tooth movement.
Why is it important?
Developing new methods to enhance orthodontic tooth movement and shorten the duration of treatment has always been desired. However, to date, no therapies have been widely used in clinics. Much effect has been made to explore therapies to shorten the orthodontic treatment period with limited success. Daily coffee consumption may be a promising approach to enhance orthodontic tooth movement for its reversible effect on bone mineral density and calcium balance.
The setup
30 male Wistar rats were randomly divided into two groups:
- regular OTM = rO
- coffee + OTM = cO
At 5 weeks of age, the cO rats began receiving daily intragastric administration of coffee according to body weight.
At 13 weeks of age, the left maxillary first molar of the both groups was moved mesially with a nickel-titanium coil spring
After 3 weeks, the OTM amount was measured.
How was it measured?
The alveolar bone mineral density (BMD) was analyzed with micro-computed tomography (uCT).
Immunohistochemical staining was done for TRAP and RANKL expression in the periodontium. The periodontal ligament (PDL) tissue model was established through 3D culturing human PDL cells in poly lactic-co-glycolic acid (PLGA) scaffolds.
What did they find?
Compared with rO, the cO rats had significantly larger tooth movement. Meanwhile, the cO had significantly lower alveolar BMD, indicated decreased bone mineralization. Moreover, in the compression periodontium, the cO had significantly more TRAP+ osteoclasts and higher RANKL expression, indicating increased osteoclastogenesis.
Summary
This study found that drinking coffee accelerates OTM, probably through the effects of caffeine on osteoclastogenesis enhancement via RANKL elevation. This research was supported by the National Nature Science Foundation of China.
Click here to read the study.
Click on this link to read another study about how carbonated soft drinks DECREASES the rate of orthodontic tooth movement. "The role of soft drinks in decreasing tooth movement might be related to its effects on bone metabolism."
How can orthodontics help you?
If your teeth are in poor alignment, you could be facing a functional or cosmetic problem. Orthodontics (braces) can eliminate that problem for you. One of the first things people notice about you is your smile and how your teeth look. You don't have to be a dentist to notice poorly positioned, crooked teeth. In today's culture, crooked teeth are not regarded as attractive or desirable. Most people, when asked, say that they would like to have straight teeth. Straight, white teeth are the cosmetic dental improvements patients most request.
Braces may also be
suggested to correct a specific dental problem that only affects one or
several teeth. This is not a cosmetic tooth repositioning, but rather a
functional tooth movement. Occasionally, in order to properly finish an
orthodontic case, the orthodontist may ask the dentist to adjust the
enamel of some teeth or bond a resin to some teeth to improve the
occlusion (bite alignment) or to enhance cosmetics. This will be
discussed with you as soon as it becomes apparent.
When should you see an orthodontist?
The need for orthodontics is best discovered when you are young. A dentist will have a good indication of whether or not your teeth will be straight when he sees you as a child 6 to 8 years of age. Most treatment would not begin until a patient is 8 years old, although in some cases, orthodontics can be started earlier.
It is easier to direct the movement of teeth in a child. Early tooth guidance is a very important phase of orthodontic care, which can take place even though all the permanent teeth are not yet in place. Certain problems are much easier to correct at this stage of a "mixed dentition" of baby and permanent teeth. An average case can last from 18 to 24 months.
While orthodontic therapy is admittedly easier in the child patient, you are never too old to begin orthodontics. The number of adults seeking orthodontic treatment has risen dramatically during the past decade. As long as you have healthy bone support for your teeth, you can have orthodontic therapy. Most adult cases take 18 to 24 months to complete.
What are retainers?
Once braces are removed, it is usually necessary to wear a retainer. After your braces come off, your orthodontist will make a mold of your mouth and produce a set of retainers. This retainer will maintain the new tooth alignment until the teeth have had a chance to become firmly set in their new positions. This retainer may be either removable or fixed in place. Aside from a permanent bonded retainer, there are two other types that most people get.
A Hawley Retainer is made of acrylic and metal. The acrylic goes behind your teeth and up against your upper palate; the metal is in front of your teeth. This is the most reliable refinements that still need to be done to your teeth.
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| Orthodontic Toothbrush |
An Essix Retainer is clear plastic and looks like an Invisalign aligner tray. Many people want this type of retainer, but it has its disadvantages. Many orthodontists feel that because it covers the biting surface of your teeth, they do not "settle" properly after treatment. For this reason, sometimes orthodontists give a patient both types of retainers: an Essix Retainer to wear during the day when they are people-facing, and a Hawley Retainer to wear at night when they are home sleeping.
No matter what type of retainer you get, the most important thing is to wear it exactly as the orthodontist tells you. Most people need to wear their retainers 24/7 for at least 6 months, then switch to wearing it only at night when sleeping.
How do I keep clean teeth with braces on?
While orthodontic treatment is in the active phase, that is, while the braces are on your teeth, you must be very diligent about keeping your teeth clean. This will be more difficult than and somewhat different from cleaning your teeth without braces. You will be instructed in the use of any cleaning aids needed. These may include dental floss threaders, orthodontic toothbrushes, an oral irrigator to flush out debris, proper brushing habits, fluoride mouth-rinses, and periodontal aids. You must follow your proper oral self-care routine each night to prevent decay, decalcification of the teeth, and gum disease. You also should not use a whitening toothpaste when you have braces. It could cause you to have "two tone" teeth after the brackets are removed. Another thing to remember is that although a device like a Waterpik is great for gum stimulation and dislodging food, it is not a substitute for flossing. You still need to floss daily.
The traditional and stereotypical movie, television, and commercial vision of orthodontic treatment is one of yards of metal wire tied down to teeth so covered with silver bands and brackets that the whites of the teeth are barely visible. With today's advanced dental technology, this picture is far from accurate.
Tooth Alignment:
Changes in tooth alignment can be accomplished in several different ways. When appropriate, upper and lower arch expanders can be used to increase the curvature of the tooth-bearing supporting structures. These expanders are usually cemented into place and are not able to be removed by the patient. The expanders are often a prelude to fixed metal bands. They can be cemented to the teeth as well as longitudinal arch wires and springs and still be used to move teeth.
The look:
Some time ago, the desire of patients to show less metal resulted in the development of bonded tooth-colored and clear brackets (as opposed to the metal bands that completely surround a tooth). These brackets cover only about 25% of the tooth surface and are bonded into place. The trade-off with the more esthetic bonded brackets is a higher percentage of dislodgement of the bracket, requiring additional office visits for repair and replacement. The wires and springs are changed periodically to accomplish the various stages of movement. The metal components stay in place until the tooth movement is finished. Some dental conditions mandate the use of this traditional orthodontic process.
Removable:
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| Tooth-colored Braces |
It is not always necessary to use fixed devices to move teeth. Less aggressive tooth movement can additionally be done with patient-removable appliances. Some are made of a gum-colored pink acrylic material with metal wires and springs embedded in them. These are worn by the patient except when he or she is eating, brushing, and flossing. The metal and plastic appliances do not show as much metal so they are somewhat more acceptable. The trade-off with removable appliances is that they only work when they are in the patient's mouth, making proper patient compliance a big issue. If you do not wear them, the teeth will not move as planned. The metal and plastic appliances are used in what is called minor tooth movement. Many orthodontic cases are not appropriate for removable appliance therapy.
Invisalign:
Several years ago, a new type of removable appliance therapy was developed and patented. Align Technology has a product called Invisalign. Clear, thin plastic aligners (positioners) are sequentially placed to move the teeth in a precise fashion. The aligners are left in the mouth as much as possible and removed only for eating, drinking, and cleaning the teeth. Again, if you do not wear them, the teeth will not move. The aligners are almost invisible when in place and are extraordinarily acceptable esthetically. They are indicated for adults and patients older than 14 years who have all permanent teeth in including fully erupted second molars. They can be used to treat simple to fairly extensive misalignment problems. Most cases are completed in about 12 months. Research is still in progress to determine the limits of this process.
The doctor who will be performing the orthodontic treatment will take these different modalities into consideration and develop a treatment plan best suited to your needs. Age of the patient, number of teeth involved, and extent of movement are primary factors in the decision-making process. Please be sure to ask why or why not one technique rather than another was suggested.
If you have any questions about your orthodontic treatment, please feel free to ask us.
