Potential and limitations of orthodontic biomechanics: recognizing the gaps between knowledge and practice

The perennial goals of efficient biomechanics are to obtain more controlled and faster movement and using more discrete appliances. The most recent technological advances have buttressed these goals. Temporary anchorage devices have revolutionized orthodontic practice and loom as a solid cornerstone of orthodontic science, along with the use of light forces, facilitated by “smart” archwires for optimal tooth movement. Accelerated tooth movement with decortication has been successful because of decreasing the resistance of cortical bone but micro-osteoperforation has not matched the same results. Clear aligners and preprogrammed regular or lingual appliances reflect the importance of three-dimensional technology in appliance design based on treatment outcome. These mechanical developments have inched the science closer to the traditional goals, but advances lack regarding their enhancement by biomaterials in a system where the physical stimulus is exerted on the teeth but the expression of tooth displacement is through the biological processes within the surrounding tissues. In this article, present tenets, applications, and advances are explored along with the gaps between knowledge and practice and the possibilities to bridge them. Anchorage control remains the major widely used development but slower is the development of faster noninvasive treatment.