orthodontic insight

Orthodontic movement in deciduous teeth

Alberto Consolaro1

DOI: http://dx.doi.org/10.1590/2176-9451.20.2.016-019.oin

Deciduous teeth exfoliate as a result of apoptosis induced by cementoblasts, a process that reveals the mineralized
portion of the root while attracting clasts. Root resorption in deciduous teeth is slow due to lack of mediators
necessary to speed it up; however, it accelerates and spreads in one single direction whenever a permanent tooth
pericoronal follicle, rich in epithelial growth factor (EGF), or other bone resorption mediators come near. The latter
are responsible for bone resorption during eruption, and deciduous teeth root resorption and exfoliation. Should
deciduous teeth be subjected to orthodontic movement or anchorage, mediators local levels will increase. Thus, one
should be fully aware that root resorption in deciduous teeth will speed up and exfoliation will early occur. Treat-
ment planning involving deciduous teeth orthodontic movement and/or anchorage should consider: Are clinical
benefits relevant enough as to be worth the risk of undergoing early inconvenient root resorption?

Keywords: Root resorption in deciduous teeth. Orthodontic movement. Exfoliation. Eruption. Anchorage. Orthopedics.

O dente decíduo é esfoliado graças à apoptose em seus cementoblastos, que desnuda a parte mineralizada da raiz e atrai os
clastos. A rizólise é lenta, pois faltam mediadores em quantidade para acelerar o processo, mas ela se acelera e unidireciona
quando se aproxima um folículo pericoronário de dente permanente rico em EGF e outros mediadores da reabsorção
óssea — os responsáveis pelas reabsorções óssea na erupção e dentária decídua na rizólise e esfoliação. Se houver movi-
mentação ortodôntica ou ancoragem em dentes decíduos, aumenta-se, também, o nível local desses mesmos mediadores,
devendo-se estar bem consciente de que haverá uma aceleração da rizólise e, em decorrência, uma antecipação de sua esfoliação.
No planejamento de casos em que dentes decíduos estejam envolvidos na movimentação ortodôntica e/ou ancoragem,
deve-se ponderar: o benefício clínico para o paciente será relevante, a ponto de valer o risco de uma rizólise abreviada e
inconveniente?

Palavras-chave: Rizólise. Movimento ortodôntico. Esfoliação. Erupção. Ancoragem. Ortopedia.

How to cite this article: Consolaro A. Orthodontic movement in decidu-

Full professor, School of Dentistry - University of São Paulo (USP)/Bauru and
1
ous teeth Dental Press J Orthod. 2015 Mar-Apr;20(2):16-9. DOI: http://dx.doi.
School of Dentistry - University of São Paulo (USP)/Ribeirão Preto. org/10.1590/2176-9451.20.2.016-019.oin

Contact address: Alberto Consolaro Submitted: December 01, 2014 - Revised and accepted: January 06, 2015
E-mail: [email protected]
» Patients displayed in this article previously approved the use of their facial
and intraoral photographs.

» The author reports no commercial, proprietary or financial interest in the

products or companies described in this article.

© 2015 Dental Press Journal of Orthodontics 16 Dental Press J Orthod. 2015 Mar-Apr;20(2):16-9
Consolaro A orthodontic insight

Deciduous teeth are preferably termed “tempo- too near the permanent tooth to come (Fig 1). Per-
rary” or “primary” by Anglo-Saxon authors, as they manent tooth pericoronal follicle is rich in growth
consider “deciduous” a popular and rather lay term. factors typical of reduced enamel epithelium and
Nevertheless, it perfectly describes the conditions of dental lamina remnants, both of which are present
such teeth, as it comes from Latin “that which falls!” in connective tissue.
The reduced epithelium has already produced
INDUCTION AND ACCELERATION OF ROOT the enamel and is now tightly attached to it which,
RESORPTION IN DECIDUOUS TEETH in turn, is nourished by capsular connective tissue,
AND TOOTH ERUPTION forming the pericoronal follicle. The major structure
Once deciduous teeth are completely formed, responsible for tooth eruption is the pericoronal fol-
their cells immunohistochemically reveal that they licle rich in epithelial growth factor (EGF). EGF in-
are gradually dying by apoptosis. The latter is the duces epithelial cell proliferation in order to preserve
process of programmed cell death that occurs as a the epithelial tissue — a structure under continuous
result of release of p53 gene which, in turn, initiates renewal. Meanwhile, numerous EGF molecules act
a series of intracellular biochemical phenomena that in the surrounding bone tissue, inducing pericoronal
lead to cytoskeleton breakage, as well as cell nucleus bone resorption and leading the way to the develop-
and membrane degradation. ment of the new tooth into the oral cavity.
Within a few hours or days, the cell releasing the As the pericoronal follicle and its mediators con-
p53 gene shrinks and starts losing fragments as if it trolled by the EGF promote pericoronal bone resorp-
were a flower dropping its petals or a tree losing its tion in the eruption pathway, it speeds up the slow
leaves. As odontoblasts and cementoblasts die here process of root resorption per se whenever it is near
and there, they leave the surface of deciduous teeth a deciduous tooth. For this reason, the process of re-
with little, numerous, growing cell-free areas. Odon- sorption is established in deciduous roots and turned
toblasts and cementoblasts protect odontogenic min- towards the region of the permanent tooth to come.
eralized tissue surface against clasts — typical cells of Whenever permanent and deciduous teeth are
mineralized tissue resorption, regardless of its nature. near each other, the gap between them is filled with
As a result of apoptosis, cementum and dentin follicular tissue adhered to the enamel by means of
receive and fix clasts in surface and cell-free areas, the reduced epithelium on one side, and connective
thereby triggering root resorption in deciduous tissue rich in clasts near the surface of the deciduous
teeth. This process occurs regardless of root region, tooth on the other side. The presence of a permanent
whether apical, medium or cervical (Fig 1). Root tooth to come does not induce root resorption in de-
resorption in deciduous teeth is initially triggered, ciduous teeth, but rather speeds the process up and
induced and caused by apoptosis of deciduous teeth encourages it to spread in one single direction (Fig 1)!
cementoblasts and odontoblasts. In short:
Apoptosis is one of the most exquisite and im- 1) Deciduous teeth exfoliate as a result of cell
pressive mechanisms the body develops to get rid of death by apoptosis which, in turn, is induced
unwanted cells, such as those achieving their high- by cementoblasts and odontoblasts. This pro-
est functional peak and which have already accom- cess reveals the mineralized portion of the root
plished a specific mission, or rebel and defective while attracting clasts. Root resorption in de-
cells willing to acquire autonomy within the body ciduous teeth takes place throughout the en-
and, should they survive, produce cancerous clones. tire root surface. It is a slow process due to lack
All cell tissues are subjected to apoptosis; without it, of mediators necessary to speed it up.
we would have a much briefer life. 2) Root resorption in deciduous teeth accelerates
Although root resorption in deciduous teeth and spreads in one single direction whenever
takes place simultaneously in all root surfaces, in- a pericoronal permanent tooth follicle, rich in
cluding the inside of the root, it is likely to speed up epithelial growth factor (EGF) or other bone
and spread in one single direction in certain regions resorption mediators, come near.

© 2015 Dental Press Journal of Orthodontics 17 Dental Press J Orthod. 2015 Mar-Apr;20(2):16-9
orthodontic insight Orthodontic movement in deciduous teeth

A B

Figure 1. Despite the absence of a permanent tooth to come, in A, root resorption slowly occurs in deciduous teeth. Due to being too near the pericoronal follicle, in B,
numerous mediators accumulate and, as a result, speed up and cause mineralized tissue resorption to move in one single direction, including deciduous teeth roots.

3) Pericoronal follicle mediators are responsible compressed, stress and/or inflammation are induced.
not only for root resorption during eruption, Both processes are characterized by local accumu-
but also for deciduous teeth root resorption lation of bone resorption mediators on periodontal
and exfoliation. alveolar bone surface.
Mediators, such as cytokines, growth mediators
ORTHODONTIC MOVEMENT and prostaglandins, excite local bone resorption as
RELIES ON MEDIATORS they meet, attach or interact with membrane receptors
Whenever 0.25-mm thick periodontal ligament in osteoblasts, macrophages and clasts. Together, these
of which 50% volume is composed by vessels, is cells are known as BMU or bone modeling units.

© 2015 Dental Press Journal of Orthodontics 18 Dental Press J Orthod. 2015 Mar-Apr;20(2):16-9
Consolaro A orthodontic insight

Cementoblasts covering the root surface of per- macrophages organized in BMU are encouraged to
manent teeth lack receptors of local and systemic attach to exposed root surfaces of the deciduous tooth.
mediators of bone resorption. Thus, the tooth At this point, the root surface of completely formed
moves amidst bone structures, inducing resorption deciduous teeth are destitute of cementoblasts, as the
while remodeling periodontal tissues without caus- latter died by apoptosis. Mineralized structures di-
ing root resorption. rectly exposed to the connective tissue attract or pro-
In short,1 permanent teeth have their roots pre- mote chemotaxis of clasts, especially when excited by
served by cementoblasts destitute of receptors of re- mediators of bone resorption accumulated as a result
sorption mediators: cementoblasts protect the root against of compression of vessels and hypoxia. This process is
tooth resorption. Mediators are present, but do not in- typical of orthodontic movement.
teract with cementoblasts, only with osteoblasts and Root resorption of deciduous teeth is expected
associated cells. to speed up when orthodontic movement takes
That is the reason why teeth do not undergo place. Importantly, the former is inherent to the lat-
root resorption when forces do not fully compress ter. Whenever a physiological structure, such as the
the vessels at the site where they act on periodon- permanent tooth pericoronal follicle permeated by
tal ligament. Meanwhile, whenever movement is mediators of bone resorption, is too near deciduous
induced by extremely concentrated intense forces, roots lacking cementoblasts, root resorption will
cementoblasts might die by anoxia. Additionally, be inevitably sped up (Fig 1). Likewise, whenever
root surfaces will be subjected to resorption, even orthodontic movement takes place, deciduous teeth
if temporarily. periodontal ligament will present with great local
concentration of mediators of mineralized tissue re-
ORTHODONTIC MOVEMENT IN sorption on both surfaces: bone and root.
DECIDUOUS TEETH!
In an orthodontic and/or orthopedic context, FINAL CONSIDERATIONS
applying forces of any nature over deciduous peri- Should there be an opportunity or need to subject
odontal ligament promotes stress and inflammation, deciduous teeth to orthodontic movement or anchor-
as observed in permanent periodontal ligament. age for orthopedic purposes, one should be fully aware
Likewise, there will be accumulation of mediators that root resorption will speed up and exfoliation will
and bone resorption will take place on the periodon- early occur.
tal surface of alveolar bone. Treatment planning involving deciduous teeth
Nevertheless, as bone resorption mediators ac- orthodontic movement and/or anchorage should con-
cumulate on periodontal ligament compressed un- sider: Are clinical benefits relevant enough as to be worth the
der stress and/or inflammation; osteoblasts, clasts and risk of undergoing early inconvenient root resorption?

REFERENCES

1. Consolaro A. Reabsorções dentárias nas especialidades clínicas. 3ª ed.

Maringá: Dental Press; 2012.

© 2015 Dental Press Journal of Orthodontics 19 Dental Press J Orthod. 2015 Mar-Apr;20(2):16-9