The Influence of Bone Density on Stresses in the Periodontal Ligament During Orthodontic Movement—Finite Element Study on Innovative Model

Background: Hydrostatic pressure in the periodontal ligament (PDL) plays a critical role in orthodontic treatment, influencing tooth movement and remodeling of periodontal tissue. The relationship between alveolar cortical bone density and the risk of root resorption due to excessive stress in the PDL has not been clearly defined. Objective: This study aimed to analyze hydrostatic pressure in the periodontal ligament of the tooth roots during en-masse retraction of the maxillary incisors using temporary skeletal anchorage devices (TISADs) after the first premolar extractions, as well as during full arch retraction. Methods: A numerical model was used, varying the Young’s modulus of cortical bone from 12.5 GPa to 27.5 GPa in increments of 3.0 GPa. Extreme values for bone stiffness were derived from the literature. In all the cases analyzed, the hook height was fixed at 6 mm, and the cranial surface was constrained. Results: Doubling the stiffness of the cortical bone approximately reduced the hydrostatic pressure in the PDL by 1.5 times for both full-arch retraction and post-first premolar extraction retraction. A critical hydrostatic pressure of 4.7 kPa was exceeded in full-arch retraction for low Young’s modulus of 12.5 Gpa values at forces as low as 600 g. On the contrary, for cortical bone with a high Young’s modulus of 27.5 GPa, this critical pressure was reached only at forces around 960 g, approximately 1.6 times higher. Conclusions: The density of the alveolar cortical bone significantly influences the hydrostatic pressure in the PDL of most tooth roots during orthodontic treatment. This parameter can be a critical factor in the risk of root resorption when optimal forces are exceeded. Further research is necessary to better understand these dynamics. Individual protocols for orthodontic treatment and CBCT imaging are necessary to minimize complications in the form of root resorption.