Overcoming compact bone resistance to tooth movement

The general boundaries to tooth movement are within the adjacent compact and trabecular bones, gingiva, mucosa, and muscular envelope. Findings from finite element analysis of maxillary posterior teeth distalization against mini-implants suggest that stiff outer and interproximal compact bone resists tooth movement, regardless of bone thickness, and that teeth should be steered away from this bone during orthodontic treatment. However, individual variation in the tooth-bone interface dictates the course and outcome of treatment, offering the basis for inferences on the limits of mini-implant anchorage and the presumed influence of the regional acceleratory phenomenon through decortication and microperforation, 2 modalities advocated to effect faster tooth movement. •Variation in the tooth-bone interface dictates the course and outcome of treatment.•Efficacy of mini-implant anchorage during molar distalization varies.•Localized anatomic barriers in the molar region affect anchorage.•Regional acceleratory phenomenon is likely involved in the healing of decortication.•Acceleration of remodeling around the tooth being moved may be less important.