{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:55:56Z","timestamp":1781625356428,"version":"3.54.5"},"reference-count":103,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"crossref","award":["SUBZ.B190.25.024"],"award-info":[{"award-number":["SUBZ.B190.25.024"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"crossref","award":["SUBZ.B031.25.011"],"award-info":[{"award-number":["SUBZ.B031.25.011"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"crossref","award":["SUBZ.B033.25.014"],"award-info":[{"award-number":["SUBZ.B033.25.014"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JFB"],"abstract":"<jats:p>Background: Adult patients with a thin buccal cortical plate and fragile periodontal phenotype are at high risk of dehiscence, fenestration and recession during transverse orthodontic expansion. Conventional mechanics often create a cervical compression-dominant environment that exceeds the adaptive capacity of the periodontal ligament (PDL)\u2013bone complex. Objectives: This study proposes an integrative mechanobiological model in which a skeletal-anchorage-assisted loading protocol (Bone Protection System, BPS) transforms expansion into a tension-dominant regime that favours buccal phenotype preservation. Methods: Patient-specific finite element models were used to compare conventional expansion with a BPS-modified force system. Regional PDL stress patterns and crown\/apex displacement vectors were analysed to distinguish tipping-dominant from translation-dominated mechanics. A pilot CBCT proof-of-concept (n = 1 thin-phenotype adult) with voxel-based registration quantified changes in maxillary and mandibular alveolar ridge width and buccal cortical plate thickness before and after BPS-assisted expansion. The mechanical findings were integrated with current evidence on compression- versus tension-driven inflammatory and osteogenic pathways in the PDL and cortical bone. Results: FEM demonstrated that conventional expansion concentrates high cervical compressive stress along the buccal PDL and cortical surface, accompanied by bending-like crown\u2013root divergence. In contrast, the BPS protocol redirected forces to create a buccal tensile-favourable region and a more parallel crown\u2013apex displacement pattern, indicative of translation-dominated movement. In the proof-of-concept (n = 1) CBCT case, BPS-assisted expansion was associated with preservation or increase of buccal ridge dimensions without radiographic signs of cortical breakdown. Conclusions: A tension-dominant orthodontic loading environment generated by a skeletal-anchorage-assisted force system may support buccal cortical preservation and vestibular phenotype reinforcement in thin-phenotype patients. The proposed mechanobiological model links these imaging and FEM findings to known molecular pathways of inflammation, angiogenesis and osteogenesis. It suggests a functional biomaterial-based strategy for widening the biological envelope of safe tooth movement.<\/jats:p>","DOI":"10.3390\/jfb17010047","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T11:39:37Z","timestamp":1768563577000},"page":"47","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Tension-Dominant Orthodontic Loading and Buccal Periodontal Phenotype Preservation: An Integrative Mechanobiological Model Supported by FEM and a Proof-of-Concept CBCT"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5281-0940","authenticated-orcid":false,"given":"Anna Ewa","family":"Kuc","sequence":"first","affiliation":[{"name":"Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5781-6540","authenticated-orcid":false,"given":"Jacek","family":"Kotu\u0142a","sequence":"additional","affiliation":[{"name":"Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3362-216X","authenticated-orcid":false,"given":"Kamil","family":"Sybilski","sequence":"additional","affiliation":[{"name":"Faculty of Mechanical Engineering, Military University of Technology, 00-908 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2021-3743","authenticated-orcid":false,"given":"Szymon","family":"Saternus","sequence":"additional","affiliation":[{"name":"Faculty of Mechanical Engineering, Military University of Technology, 00-908 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1300-8020","authenticated-orcid":false,"given":"Jerzy","family":"Ma\u0142achowski","sequence":"additional","affiliation":[{"name":"Faculty of Mechanical Engineering, Military University of Technology, 00-908 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Kuc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University in Bialystok, ul. Kili\u0144skiego 1, 15-089 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4668-0257","authenticated-orcid":false,"given":"Grzegorz","family":"Hajduk","sequence":"additional","affiliation":[{"name":"Chair and Department of Oral Surgery, Medical University of Lublin, Witolda Chod\u017aki 6 Street, 20-093 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Lis","sequence":"additional","affiliation":[{"name":"Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3284-7893","authenticated-orcid":false,"given":"Beata","family":"Kawala","sequence":"additional","affiliation":[{"name":"Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2518-0007","authenticated-orcid":false,"given":"Micha\u0142","family":"Sarul","sequence":"additional","affiliation":[{"name":"Department of Integrated Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4326-8907","authenticated-orcid":false,"given":"Magdalena","family":"Sulewska","sequence":"additional","affiliation":[{"name":"Department of Periodontal and Oral Mucosa Diseases, Medical University in Bialystok, ul. Waszyngtona 13, 15-269 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1590\/S2176-94512010000500023","article-title":"Alveolar bone morphology under the perspective of the computed tomography: Defining the biological limits of tooth movement","volume":"15","author":"Garib","year":"2010","journal-title":"Dent. Press J. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1902\/jop.1981.52.6.314","article-title":"Changes of the marginal periodontium as a result of labial tooth movement in monkeys","volume":"52","author":"Steiner","year":"1981","journal-title":"J. Periodontol."},{"key":"ref_3","first-page":"95","article-title":"The anterior alveolus: Its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae","volume":"66","author":"Handelman","year":"1996","journal-title":"Angle Orthod."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1111\/jcpe.12275","article-title":"Characteristics of periodontal biotype, its dimensions, associations and prevalence: A systemic review","volume":"41","author":"Zweers","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/j.1601-6343.2010.01491.x","article-title":"Orthodontic therapy and gingival recession: A systematic review","volume":"13","author":"Grebenstein","year":"2010","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.14219\/jada.archive.2003.0137","article-title":"The etiology and prevalence of gingival recession","volume":"134","author":"Kassab","year":"2003","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S367","DOI":"10.4103\/jpbs.jpbs_598_22","article-title":"Gingival Biotypes and its Relation to Biologic Width, Alveolar Bone Thickness, Dehiscence and Fenestration in Mandibular Anterior Region: A CBCT Analysis Study","volume":"15","author":"Albughaylil","year":"2023","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1038\/s41432-025-01114-x","article-title":"The influence of the gingival phenotype on implant survival rate and clinical parameters: A systematic review","volume":"26","author":"Castro","year":"2025","journal-title":"Evid. Based Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/jerd.12661","article-title":"Periodontal phenotype: A review of historical and current classifications evaluating different methods and characteristics","volume":"33","author":"Guerrero","year":"2021","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"469.e1","DOI":"10.1016\/j.ajodo.2005.10.007","article-title":"Cellular, molecular, and tissue-level reactions to orthodontic force","volume":"129","author":"Krishnan","year":"2006","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jeon, H.H., Teixeira, H., and Tsai, A. (2021). Mechanistic Insight into Orthodontic Tooth Movement Based on Animal Studies: A Critical Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081733"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.kjms.2018.01.007","article-title":"Orthodontic tooth movement: The biology and clinical implications","volume":"34","author":"Li","year":"2018","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1038\/s41368-017-0004-8","article-title":"RANKL deletion in periodontal ligament and bone lining cells blocks orthodontic tooth movement","volume":"10","author":"Yang","year":"2018","journal-title":"Int. J. Oral Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e4005","DOI":"10.31661\/gmj.vi.4005","article-title":"The Interaction Between Orthodontics and Periodontal Tissue Remodeling","volume":"14","author":"Abasi","year":"2025","journal-title":"Galen Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"297","DOI":"10.11005\/jbm.2023.30.4.297","article-title":"Mechanisms of Osteoclastogenesis in Orthodontic Tooth Movement and Orthodontically Induced Tooth Root Resorption","volume":"30","author":"Nakai","year":"2023","journal-title":"J. Bone Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.ajodo.2003.12.026","article-title":"Factors of importance for the development of dehiscences during labial movement of mandibular incisors: A retrospective study of adult orthodontic patients","volume":"127","author":"Melsen","year":"2005","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.ajodo.2025.08.011","article-title":"CBCT analysis of maxillary buccal bone thickness and height after conventional orthodontic treatment with standardized archwires: A retrospective study","volume":"168","author":"Hobani","year":"2025","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.cjtee.2014.09.004","article-title":"Effect of the same mechanical loading on osteogenesis and osteoclastogenesis in vitro","volume":"18","author":"Guo","year":"2015","journal-title":"Chin. J. Traumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19919","DOI":"10.1038\/s41598-023-47386-0","article-title":"Periodontal ligament and alveolar bone remodeling during long orthodontic tooth movement analyzed by a novel user-independent 3D-methodology","volume":"13","author":"Rizk","year":"2023","journal-title":"Sci Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/ocr.12646","article-title":"Changes in alveolar bone structure during orthodontic tooth movement in adolescent and adult rats: A microcomputed tomography study","volume":"26","author":"Xu","year":"2023","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wang, J., Huang, Y., Chen, F., and Li, W. (2024). The age-related effects on orthodontic tooth movement and the surrounding periodontal environment. Front Physiol., 15.","DOI":"10.3389\/fphys.2024.1460168"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1359\/jbmr.2002.17.2.210","article-title":"Periodontal ligament cells under mechanical stress induce osteoclastogenesis by receptor activator of nuclear factor kappaB ligand up-regulation via prostaglandin E2 synthesis","volume":"17","author":"Kanzaki","year":"2002","journal-title":"J. Bone Miner. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.joms.2009.04.095","article-title":"Accelerated osteogenic orthodontics technique: A 1-stage surgically facilitated rapid orthodontic treatment","volume":"67","author":"Wilcko","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kuc, A.E., Kulgawczyk, M., Sulewska, M.E., Kuc, N., Kawala, B., Lis, J., Sarul, M., and Kotu\u0142a, J. (2024). The Effect of Corticotomy-Assisted Orthodontic Therapy (CAOT) or Periodontally Accelerated Osteogenic Orthodontics (PAOO) on Bone Remodeling and the Health of Periodontium: A Systematic Review of Systematic Reviews. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195726"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kuc, A.E., Sybilski, K., Stankiewicz, M., Kotu\u0142a, J., Kuc, N., Hajduk, G., Ma\u0142achowski, J., and Sarul, M. (2025). The Influence of Bone Density on Stresses in the Periodontal Ligament During Orthodontic Movement-Finite Element Study on Innovative Model. Materials, 18.","DOI":"10.3390\/ma18040776"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.ajodo.2006.05.038","article-title":"Moment-to-force ratio, center of rotation, and force level: A finite element study predicting their interdependency for simulated orthodontic loading regimens","volume":"133","author":"Cattaneo","year":"2008","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1631\/jzus.B1700195","article-title":"A biomechanical case study on the optimal orthodontic force on the maxillary canine tooth based on finite element analysis","volume":"19","author":"Wu","year":"2018","journal-title":"J. Zhejiang Univ. Sci. B"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"563","DOI":"10.2319\/110416-794.1","article-title":"Types of tooth movement, bodily or tipping, do not affect the displacement of the tooth\u2019s center of resistance but do affect the alveolar bone resorption","volume":"87","author":"Kondo","year":"2017","journal-title":"Angle Orthod."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.archoralbio.2016.02.012","article-title":"Biomechanical investigation into the role of the periodontal ligament in optimising orthodontic force: A finite element case study","volume":"66","author":"Liao","year":"2016","journal-title":"Arch. Oral Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/s41368-021-00125-5","article-title":"Biomechanical and biological responses of periodontium in orthodontic tooth movement: Up-date in a new decade","volume":"13","author":"Li","year":"2021","journal-title":"Int. J. Oral Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/j.1601-6343.2009.01443.x","article-title":"Osteoclast polarization and orthodontic tooth movement","volume":"12","author":"Holliday","year":"2009","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/ejo\/cjl001","article-title":"The tissue, cellular, and molecular regulation of orthodontic tooth movement: 100 years after Carl Sandstedt","volume":"28","author":"Meikle","year":"2006","journal-title":"Eur. J. Orthod."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"171","DOI":"10.2319\/060220-504.1","article-title":"Buccal alveolar bone changes following rapid maxillary expansion and fixed appliance therapy","volume":"91","author":"Sperl","year":"2021","journal-title":"Angle Orthod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/ocr.12374","article-title":"Is the buccal alveolar bone less affected by mini-implant assisted rapid palatal expansion than by conventional rapid palatal expansion?\u2014A systematic review and meta-analysis","volume":"23","author":"Copello","year":"2020","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Solano Mendoza, P., Aceytuno Poch, P., Solano Reina, E., and Solano Mendoza, B. (2022). Skeletal, Dentoalveolar and Dental Changes after \u201cMini-Screw Assisted Rapid Palatal Expansion\u201d Evaluated with Cone Beam Computed Tomography. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164652"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Chun, J.H., de Castro, A.C.R., Oh, S., Kim, K.H., Choi, S.-H., Nojima, L.I., da Cunha Goncalves Nojima, M., and Lee, K.-J. (2022). Skeletal and alveolar changes in conventional rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE): A prospective randomized clinical trial using low-dose CBCT. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02138-w"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Alan, A., Kaya, Y., and Sancak, K. (2025). Mid-facial skeletal and soft tissue changes after maxillary skeletal expander application: A retrospective CBCT study. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-06569-z"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1177\/154405910508400506","article-title":"The finite element method: A tool to study orthodontic tooth movement","volume":"84","author":"Cattaneo","year":"2005","journal-title":"J. Dent. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.jbiomech.2004.08.026","article-title":"Cyclic strain increases fibroblast proliferation, matrix accumulation, and elastic modulus of fibroblast-seeded polyurethane constructs","volume":"39","author":"Webb","year":"2006","journal-title":"J. Biomech."},{"key":"ref_40","first-page":"3","article-title":"A 2003 update of bone physiology and Wolff\u2019s Law for clinicians","volume":"74","author":"Frost","year":"2004","journal-title":"Angle Orthod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/00003086-198901000-00038","article-title":"The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation","volume":"238","author":"Ilizarov","year":"1989","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Kuc, A.E., Sulewska, M., Sybilski, K., Kotu\u0142a, J., Hajduk, G., Saternus, S., Ma\u0142achowski, J., Bar, J., Lis, J., and Kawala, B. (2026). Mechanobiological Regulation of Alveolar Bone Remodeling: A Finite Element Study and Molecular Pathway Interpretation. Biomolecules, 16.","DOI":"10.3390\/biom16010150"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Kuc, A.E., Kotu\u0142a, J., Nawrocki, J., Szel\u0105g, E., Kawala, B., Lis, J., and Sarul, M. (2023). Morphological Evaluation of the Incisive Canal in the Aspect of the Diagnosis and Planning of Orthodontic Treatment\u2014CBCT Study. Appl. Sci., 13.","DOI":"10.3390\/app132112010"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s10735-016-9687-y","article-title":"Wnt5a mediated canonical Wnt signaling pathway activation in orthodontic tooth movement: Possible role in the tension force-induced bone formation","volume":"47","author":"Fu","year":"2016","journal-title":"J. Mol. Histol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3109\/00016357.2015.1090011","article-title":"Expression of Wnt3a, Wnt10b, \u03b2-catenin and DKK1 in periodontium during orthodontic tooth movement in rats","volume":"74","author":"Lu","year":"2016","journal-title":"Acta Odontol. Scand."},{"key":"ref_46","first-page":"123","article-title":"Biomechanical behavior of the periodontium before and after orthodontic tooth movement","volume":"65","author":"Tanne","year":"1995","journal-title":"Angle Orthod."},{"key":"ref_47","first-page":"388","article-title":"Inflammation in periodontal tissues in response to mechanical forces","volume":"53","author":"Yamaguchi","year":"2005","journal-title":"Arch. Immunol. Ther. Exp."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Kitaura, H., Ohori, F., Marahleh, A., Ma, J., Lin, A., Fan, Z., Narita, K., Murakami, K., and Kanetaka, H. (2025). The Role of Cytokines in Orthodontic Tooth Movement. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26146688"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1093\/ejo\/cju073","article-title":"Gingival labial recessions and the post-treatment proclination of mandibular incisors","volume":"37","author":"Renkema","year":"2015","journal-title":"Eur. J. Orthod."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1302\/2046-3758.81.BJR-2018-0060.R1","article-title":"Effects of mechanical forces on osteogenesis and osteoclastogenesis in human periodontal ligament fibroblasts: A systematic review of in vitro studies","volume":"8","author":"Li","year":"2019","journal-title":"Bone Jt. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1113\/jphysiol.2007.136325","article-title":"HIF-1alpha and HIF-2alpha play a central role in stretch-induced but not shear-stress-induced angiogenesis in rat skeletal muscle","volume":"583","author":"Milkiewicz","year":"2007","journal-title":"J. Physiol."},{"key":"ref_52","first-page":"918","article-title":"Effects of cyclic tension on the expression of angiogenic factors in human periodontal ligament fibroblasts","volume":"83","author":"Kim","year":"2012","journal-title":"J. Periodontol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1002\/JPER.19-0647","article-title":"Cyclic tensile forces enhance the angiogenic properties of HUVECs by promoting the activities of human periodontal ligament cells","volume":"92","author":"Wang","year":"2021","journal-title":"J. Periodontol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s10059-010-0139-3","article-title":"Wnt\/\u03b2-catenin signaling enhances osteoblastogenic differentiation from human periodontal ligament fibroblasts","volume":"30","author":"Heo","year":"2010","journal-title":"Mol. Cells."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1177\/00220345211062585","article-title":"Axin2+ PDL Cells Directly Contribute to New Alveolar Bone Formation in Response to Orthodontic Tension Force","volume":"101","author":"Wang","year":"2022","journal-title":"J. Dent. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1002\/jor.1100150520","article-title":"Assessment of cell proliferation in regenerating bone during distraction osteogenesis at different distraction rates","volume":"15","author":"Li","year":"1997","journal-title":"J. Orthop. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"494378","DOI":"10.1155\/2014\/494378","article-title":"Mechanical stress stimulates the osteo\/odontoblastic differentiation of human stem cells from apical papilla via erk 1\/2 and JNK MAPK pathways","volume":"2014","author":"Mu","year":"2014","journal-title":"Biomed Res. Int."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1839627","DOI":"10.1155\/2019\/1839627","article-title":"Mechanical Stretch Promotes the Osteogenic Differentiation of Bone Mesenchymal Stem Cells Induced by Erythropoietin","volume":"2019","author":"He","year":"2019","journal-title":"Stem Cells Int."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.1002\/jcp.24972","article-title":"Phosphorylation of Runx2, induced by cyclic mechanical tension via ERK1\/2 pathway, contributes to osteodifferentiation of human periodontal ligament fibroblasts","volume":"230","author":"Ren","year":"2015","journal-title":"J. Cell Physiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.exger.2014.05.010","article-title":"The role of cellular senescence on the cyclic stretching-mediated activation of MAPK and ALP expression and activity in human periodontal ligament fibroblasts","volume":"57","author":"Konstantonis","year":"2014","journal-title":"Exp. Gerontol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/1475-925X-11-80","article-title":"Mechanical strain promotes osteoblast ECM formation and improves its osteoinductive potential","volume":"11","author":"Guo","year":"2012","journal-title":"Biomed Eng. Online"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.3892\/ijmm.2015.2354","article-title":"Cyclic stretch enhances bone morphogenetic protein-2-induced osteoblastic differentiation through the inhibition of Hey1","volume":"36","author":"Zeng","year":"2015","journal-title":"Int. J. Mol. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1038\/s41419-018-0279-5","article-title":"Mechanical stretch-induced osteogenic differentiation of human jaw bone marrow mesenchymal stem cells (hJBMMSCs) via inhibition of the NF-\u03baB pathway","volume":"9","author":"Chen","year":"2018","journal-title":"Cell Death Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.actbio.2013.10.010","article-title":"Multifunctional role of osteopontin in directing intrafibrillar mineralization of collagen and activation of osteoclasts","volume":"10","author":"Rodriguez","year":"2014","journal-title":"Acta Biomater."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Kostina, D., Lobov, A., Klausen, P., Karelkin, V., Tikhilov, R., Bozhkova, S., Sereda, A., Ryumina, N., Enukashvily, N., and Malashicheva, A. (2022). Isolation of Human Osteoblast Cells Capable for Mineralization and Synthetizing Bone-Related Proteins In Vitro from Adult Bone. Cells, 11.","DOI":"10.3390\/cells11213356"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/S0889-5406(99)70212-X","article-title":"Gingival response to orthodontic force","volume":"116","author":"Redlich","year":"1999","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_67","first-page":"139","article-title":"Ultrastructural changes of collagen and elastin in human gingiva during orthodontic tooth movement","volume":"32","author":"Franchi","year":"1989","journal-title":"Bull Group Int. Rech. Sci. Stomatol. Odontol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Li, Z., Yu, M., Jin, S., Wang, Y., Luo, R., Huo, B., Liu, D., He, D., Zhou, Y., and Liu, Y. (2019). Stress Distribution and Collagen Remodeling of Periodontal Ligament During Orthodontic Tooth Movement. Front. Pharmacol., 10.","DOI":"10.3389\/fphar.2019.01263"},{"key":"ref_69","first-page":"18","article-title":"The Role of Periodontal Ligament Remodeling on Orthodontic Tooth Movement","volume":"3","year":"2023","journal-title":"Int. J. Med. Sci. Clin. Res. Stud."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Kuc, A.E., Sybilski, K., Kotu\u0142a, J., Hajduk, G., Sulewska, M., Saternus, S., Kulikowska-Kulesza, J.E., Kotarska, M., Kawala, B., and Ma\u0142achowski, J. (2025). Corticotomy Depth as a Modulator of Orthodontic Tooth Movement and PDL Stress\u2014A Finite Element Study. Materials, 18.","DOI":"10.3390\/ma18235290"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Du, Y., Zheng, J., Xu, B., Peng, C., and Yang, K. (2025). Piezo1 participates in the tension-driven osteogenic differentiation of periodontal ligament stem cells. BMC Oral Health., 25.","DOI":"10.1186\/s12903-025-06427-y"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s10735-017-9748-x","article-title":"Tension force-induced bone formation in orthodontic tooth movement via modulation of the GSK-3\u03b2\/\u03b2-catenin signaling pathway","volume":"49","author":"Mao","year":"2018","journal-title":"J. Mol. Histol."},{"key":"ref_73","first-page":"7872","article-title":"Cyclic tension promotes osteogenic differentiation in human periodontal ligament stem cells","volume":"7","author":"Shen","year":"2014","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2174824","DOI":"10.1155\/2018\/2174824","article-title":"Cyclic Stretch Enhances Osteogenic Differentiation of Human Periodontal Ligament Cells via YAP Activation","volume":"2018","author":"Yang","year":"2018","journal-title":"Biomed Res. Int."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"5957","DOI":"10.2147\/IJGM.S368394","article-title":"Effect of Tensile Frequency on the Osteogenic Differentiation of Periodontal Ligament Stem Cells","volume":"15","author":"Wang","year":"2022","journal-title":"Int. J. Gen. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"50200","DOI":"10.1039\/C7RA09308J","article-title":"Osteocytes regulate osteoblast differentiation and osteoclast activity through Interleukin-6 under mechanical loading","volume":"7","author":"Hao","year":"2017","journal-title":"RSC Adv."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Du, J., Yang, J., He, Z., Cui, J., Yang, Y., Xu, M., Qu, X., Zhao, N., Yan, M., and Li, H. (2020). Osteoblast and Osteoclast Activity Affect Bone Remodeling Upon Regulation by Mechanical Loading-Induced Leukemia Inhibitory Factor Expression in Osteocytes. Front. Mol. Biosci., 7.","DOI":"10.3389\/fmolb.2020.585056"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s00223-010-9407-7","article-title":"Inhibition of Osteoclastogenesis by Mechanically Loaded Osteocytes: Involvement of MEPE","volume":"87","author":"Kulkarni","year":"2010","journal-title":"Calcif. Tissue Int."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.ajodo.2012.11.019","article-title":"Dimensional changes of upper airway after rapid maxillary expansion: A prospective cone-beam computed tomography study","volume":"143","author":"Chang","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"799","DOI":"10.2319\/090214.1","article-title":"Alveolar bone changes after asymmetric rapid maxillary expansion","volume":"85","author":"Akin","year":"2015","journal-title":"Angle Orthod."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"314","DOI":"10.4041\/kjod.2020.50.5.314","article-title":"Short-term treatment effects produced by rapid maxillary expansion evaluated with computed tomography: A systematic review with meta-analysis","volume":"50","author":"Giudice","year":"2020","journal-title":"Korean J. Orthod."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"83","DOI":"10.4041\/kjod.2013.43.2.83","article-title":"Evaluation of alveolar bone loss following rapid maxillary expansion using cone-beam computed tomography","volume":"43","author":"Baysal","year":"2013","journal-title":"Korean J. Orthod."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e2219299","DOI":"10.1590\/2177-6709.27.2.e2219299.oar","article-title":"Alveolar defects before and after surgically assisted rapid palatal expansion (SARPE): A CBCT assessment","volume":"27","author":"Romano","year":"2022","journal-title":"Dental Press J. Orthod."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Tunca, Y., Kaya, S., Bilen, S., and Tunca, M. (2025). Evaluation of bone thickness, presence of dehiscence and fenestration in maxillary and mandibular anterior teeth of individuals with various malocclusions: A cone-beam computed tomography study. BMC Oral Health., 25.","DOI":"10.1186\/s12903-025-07157-x"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.jcms.2005.07.003","article-title":"Growth factor expression following clinical mandibular distraction osteogenesis in humans and its comparison with existing animal studies","volume":"33","author":"Knabe","year":"2005","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1054\/bjps.1999.3157","article-title":"Expression of growth factors in the mandibular distraction zone: A sheep study","volume":"52","author":"Tavakoli","year":"1999","journal-title":"Br. J. Plast. Surg."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1359\/jbmr.1999.14.7.1084","article-title":"Mechanical tension-stress induces expression of bone morphogenetic protein (BMP)-2 and BMP-4, but not BMP-6, BMP-7, and GDF-5 mRNA, during distraction osteogenesis","volume":"14","author":"Sato","year":"1999","journal-title":"J. Bone Miner. Res."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Liu, P., Tu, J., Wang, W., Li, Z., Li, Y., Yu, X., and Zhang, Z. (2022). Effects of Mechanical Stress Stimulation on Function and Expression Mechanism of Osteoblasts. Front. Bioeng. Biotechnol., 10.","DOI":"10.3389\/fbioe.2022.830722"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1002\/jor.21218","article-title":"Mechanical loading increased BMP-2 expression which promoted osteogenic differentiation of tendon-derived stem cells","volume":"29","author":"Rui","year":"2011","journal-title":"J. Orthop. Res."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Kopf, J., Petersen, A., Duda, G.N., and Knaus, P. (2012). BMP2 and mechanical loading cooperatively regulate immediate early signalling events in the BMP pathway. BMC Biol., 10.","DOI":"10.1186\/1741-7007-10-37"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1038\/s42003-024-06753-x","article-title":"Temporal regulation of BMP2 growth factor signaling in response to mechanical loading is linked to cytoskeletal and focal adhesion remodeling","volume":"7","author":"Brauer","year":"2024","journal-title":"Commun. Biol."},{"key":"ref_92","first-page":"873251","article-title":"Mechanical strain regulates osteogenic and adipogenic differentiation of bone marrow mesenchymal stem cells","volume":"2015","author":"Li","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2174\/1566524015666150824143830","article-title":"Mechanical Strain Promotes Osteogenesis of BMSCs from Ovariectomized Rats via the ERK1\/2 but not p38 or JNK-MAPK Signaling Pathways","volume":"15","author":"Zhang","year":"2015","journal-title":"Curr. Mol. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.abb.2016.08.015","article-title":"Cyclic tensile strain promotes the osteogenic differentiation of a bone marrow stromal cell and vascular endothelial cell co-culture system","volume":"607","author":"Jiang","year":"2016","journal-title":"Arch. Biochem. Biophys."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1111\/jre.12453","article-title":"Orthodontic tensile strain induces angiogenesis via type IV collagen degradation by matrix metalloproteinase-12","volume":"52","author":"Narimiya","year":"2017","journal-title":"J. Periodontal. Res."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Nowak, R., Olejnik, A., Gerber, H., Fr\u0105tczak, R., and Zawi\u015blak, E. (2021). Comparison of Tooth- and Bone-Borne Appliances on the Stress Distributions and Displacement Patterns in the Facial Skeleton in Surgically Assisted Rapid Maxillary Expansion\u2014A Finite Element Analysis (FEA) Study. Materials, 14.","DOI":"10.3390\/ma14051152"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s11914-023-00826-2","article-title":"Osteocyte Mechanotransduction in Orthodontic Tooth Movement","volume":"21","author":"Seddiqi","year":"2023","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1177\/00220345241264792","article-title":"Engineered 3D Periodontal Ligament Model with Magnetic Tensile Loading","volume":"103","author":"Mulimani","year":"2024","journal-title":"J. Dent. Res."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"20417314231172573","DOI":"10.1177\/20417314231172573","article-title":"Significance of mechanical loading in bone fracture healing, bone regeneration, and vascularization","volume":"14","author":"Ma","year":"2023","journal-title":"J. Tissue Eng."},{"key":"ref_100","first-page":"3","article-title":"The regional acceleratory phenomenon: A review","volume":"31","author":"Frost","year":"1983","journal-title":"Henry Ford Hosp. Med. J."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"e04013","DOI":"10.1016\/j.heliyon.2020.e04013","article-title":"Corticotomy in orthodontic treatment: Systematic review","volume":"6","author":"Apalimova","year":"2020","journal-title":"Heliyon"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Wu, Y.F., and Guo, H.M. (2021). The effect of corticotomy on the compensatory remodeling of alveolar bone during orthodontic treatment. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01492-5"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.joms.2015.10.011","article-title":"Corticotomies and Orthodontic Tooth Movement: A Systematic Review","volume":"74","author":"Patterson","year":"2016","journal-title":"J. Oral Maxillofac. Surg."}],"updated-by":[{"DOI":"10.3390\/jfb17060259","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000}}],"container-title":["Journal of Functional Biomaterials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-4983\/17\/1\/47\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T16:24:29Z","timestamp":1779899069000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-4983\/17\/1\/47"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":103,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jfb17010047"],"URL":"https:\/\/doi.org\/10.3390\/jfb17010047","relation":{},"ISSN":["2079-4983"],"issn-type":[{"value":"2079-4983","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]}}}