Systemic influences on orthodontic tooth movement: mechanisms and clinical implications

Orthodontic tooth movement (OTM) is a complex biological process involving bone remodeling, which can be significantly affected by systemic diseases and systemic factors. This review comprehensively examines how systemic conditions such as diabetes mellitus, thyroid dysfunction, and osteoporosis impact bone remodeling during orthodontic treatment by modulating the activity of osteoclasts and osteoblasts, thereby altering the rate of tooth movement and the quality of bone tissue remodeling. Additionally, we discuss the regulatory roles of pharmacological agents such as bisphosphonates and glucocorticoids, as well as endocrine hormones including estrogen, parathyroid hormone, and relaxin on bone metabolism and their clinical implications in orthodontics. The article further explores current clinical management strategies to optimize orthodontic care in patients with systemic diseases and reflects future research directions aimed at elucidating molecular pathways and improving therapeutic outcomes. This review aims to provide a theoretical basis and clinical guidance for orthodontists managing patients with systemic conditions to enhance treatment efficacy and safety.