Mechanobiology in orthodontic tooth movement: update on knowledge and clinical implications

Orthodontic tooth movement (OTM) represents a dynamic biological response to mechanical forces, where specialized cellular sensors convert mechanical stimuli into biochemical signals that drive site-specific bone remodeling. This process underlies both the efficiency of tooth displacement and associated risks such as root resorption. Excessive force application disrupts physiological equilibrium, leading to tissue hyalinization, sterile inflammation, and increased odontoclast activity that compromises root integrity. Conversely, emerging biological strategies enable acceleration of OTM through surgically facilitated techniques like micro-osteoperforations that induce regional accelerated phenomenon (RAP), or through non-invasive adjuncts including photobiomodulation that enhance cellular responses. Given significant individual variability in biological response, personalized treatment approaches utilizing optimized force regimens and targeted interventions are essential for balancing treatment efficiency with periodontal safety. Future advances may incorporate biomarker-guided force adjustment and localized biological modifiers to further refine tooth movement control. Integration of these mechanobiological principles into clinical practice promises to transform orthodontics into a more predictive, efficient, and biology-driven discipline.