
Ever wondered how a piece of plastic can move a solid tooth through bone? We explore osteoclasts, osteoblasts, and the biology of orthodontics.
It seems like magic. You wear a thin, clear piece of plastic, and your teeth move. But underneath your gums, a complex biological symphony is taking place. Understanding this helps you realise why wearing your aligners for 22 hours is non-negotiable.
Pressure and the Periodontal Ligament
Your tooth isn't fused to the bone. It sits in a socket, suspended by millions of tiny elastic fibres called the Periodontal Ligament (PDL). When an aligner pushes on a tooth, it squashes the PDL on one side and stretches it on the other.
The Bone Remodelling Cycle
This pressure cuts off blood flow slightly to the squashed side. The body sends a signal: "Hey, we need space here!"
- Osteoclasts (The Eaters): These cells arrive on the pressure side and eat away the bone to make room for the tooth to move.
- Osteoblasts (The Builders): On the other side (tension side), these cells arrive to build new bone to fill the gap left behind.
This process takes about 10-14 days per stage. That is why you change aligners every two weeks. If you change too fast, the bone doesn't have time to rebuild, and the tooth becomes loose.
⏱ The 22-Hour Rule Explained
If you take your aligners out for 4 hours, the pressure stops.
The biological signal turns off.
It takes 4-6 hours of constant pressure for the signal to start again.
Dr Yasha Shirazi's Science Note:
"Pain usually happens in the first 2 days of a tray because that's when the inflammatory signal is highest. Taking ibuprofen can actually slow down tooth movement because it reduces inflammation! Paracetamol is better for aligner soreness."
Why "Chewies" Matter
Plastic is flexible. If there is a tiny air gap between the aligner and your tooth, the force isn't delivered to the PDL. Using "Chewies" (rubber cylinders you bite on) forces the aligner down, engaging the plastic fully and ensuring the biological signal is sent loud and clear.
Written by Pro Aligners Team
Medically reviewed by Dr Yasha Shirazi • GDC: 195843