Orchestration of tooth movement.

Recent advances in the art and mechanics of delivering orthodontic forces have achieved greater precision and control of tooth movement. The exact mechanism by which these forces orchestrate tooth movement is not thoroughly understood. An accurate understanding and precise control over the factors responsible for initiating and carrying out the tissue reaction will ultimately optimize the rate of tooth movement. An integrated hypothetical model for the mechanism of tooth movement is discussed here. This model is based on the most recent body of information available to explain how various stimuli affect bone cells. The roles played by piezoelectric responses, prostaglandin production, and biochemical factors are discussed, with particular emphasis on their importance and contribution in terms of maximizing the rate of tooth movement. The intelligent use of this knowledge will permit us to modify the orthodontic appliance and treatment regimen in order to achieve an optimum tissue response.