Mechanobiology and Molecular Regulation of Periodontal Tissue Remodeling During Orthodontic Tooth Movement: From Periodontal Phenotype to Precision Orthodontics-A Narrative Review.

Orthodontic tooth movement has traditionally been planned according to biomechanical principles; however, growing evidence indicates that treatment outcomes are strongly influenced by individual biological responsiveness. This narrative review summarizes current knowledge on the mechanobiological and molecular mechanisms regulating periodontal tissue remodeling during orthodontic tooth movement and discusses their implications for personalized orthodontic treatment. The literature was critically analyzed with particular emphasis on mechanotransduction pathways, including Piezo1, TRPV4, integrin-mediated signaling, Hippo-YAP/TAZ, Wnt/β-catenin, and the RANK/RANKL/OPG axis, together with inflammatory mediators, extracellular matrix remodeling, periodontal phenotype, and emerging molecular biomarkers associated with periodontal susceptibility. Recent advances in cone-beam computed tomography, intraoral optical scanning, STL-CBCT fusion, and artificial intelligence were also reviewed for their potential to improve biologically informed diagnosis and treatment planning. Current evidence indicates that periodontal complications, including gingival recession, alveolar bone loss, and root resorption, arise from complex interactions between orthodontic biomechanics and patient-specific biological characteristics rather than tooth movement alone. Integration of mechanobiology, molecular profiling, advanced imaging, and artificial intelligence provides the foundation for precision orthodontics, enabling individualized risk assessment, biologically guided treatment planning, and improved long-term periodontal stability.