Alveolar Bone Anatomy Across Growth Stages: Bridging Paediatric and Adult Biology in Orthodontic Tooth Movement – A Narrative Review

Abstract

This narrative review investigated age-related anatomical, histological, cellular, and molecular characteristics of the alveolar bone across growth stages and their influence on orthodontic tooth movement (OTM) and clinical implications. A structured literature search was conducted using PubMed, ScienceDirect, and Google Scholar, published between 2000 and 2026. In accordance with standard narrative review methodology, formal quality assessment and risk-of-bias appraisal were not performed, which is recognized as an inherent limitation of this synthesis. The evidence demonstrates that alveolar bone biology changes substantially throughout growth. Human observational and clinical studies indicate that childhood and adolescence provide favorable remodeling environments, with adolescence representing an optimal biological window for OTM due to robust osteogenic potential, favorable periodontal ligament characteristics, and supportive hormonal milieu. In adulthood, increased cortical bone density, reduced vascularity, and diminished osteogenic progenitor cells impair remodeling efficiency and increase the risk of root resorption, dehiscence, fenestration, and relapse. While cellular mechanisms are strongly supported by preclinical animal models, these findings require cautious translation to human clinical timelines. Overall, age serves as a critical biological determinant of OTM, necessitating age-specific force selection, intervention timing, and retention strategies, while future research should focus on validating age-specific human biomarkers