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Endodontic-orthodontic interactions: a review and treatment recommendations
Abstract
The literature is replete with articles describing the many and varied interactions between endodontic treatment and orthodontic tooth movement (OTM), often reporting conflicting views and findings, which creates confusion for clinicians. Original research and review articles have described aspects such as apical root resorption and potential pulpal complications of teeth related to OTM. Some interactions are of relatively minor clinical significance, whilst others may have adverse consequences. A history of dental trauma before or during OTM further complicates the interactions. This review re-assesses the historical literature on endodontic-orthodontic interactions in light of more recent research and presents guidelines for managing clinical situations involving both disciplines. © 2023 Australian Dental Association.
... The apical foramen, located at the root tip, plays a crucial role in maintaining pulp vitality by allowing the passage of blood vessels and nerves that provide signals, oxygen and nutrients while also removing metabolic byproducts [5]. ...
... Physiologically, the dental pulp is a highly active tissue that requires a constant blood supply to support its cellular functions and repair mechanisms. The neurovascular bundle passing through the apical foramen plays a critical role in maintaining this supply, providing the pulp with essential nutrients and facilitating waste removal [5]. When orthodontic forces are applied to the tooth, they can momentarily impair this circulation, leading to reduced blood flow and hypoxia (lower oxygen levels) within the pulp [6]. ...
... When orthodontic forces are applied to the tooth, they can momentarily impair this circulation, leading to reduced blood flow and hypoxia (lower oxygen levels) within the pulp [6]. This can disrupt normal cellular activity and alter the pulp's ability to respond to external stimuli [5] [6]. ...
... 16 In summary, while some reviews report insufficient evidence of increased risk of pulp necrosis with OTM of traumatised teeth, 9,10,11 those reviews were based on literature with significant methodological problems. 2,7,17 Therefore, there is indeed some evidence to suggest that a history of previous trauma may predispose a tooth to pulpal necrosis after OTM and it may be influenced by the type and severity of orthodontic forces. 13,14,15,16 ...
... The term pulp canal calcification (PCC) reflects a more accurate radiographic representation of the biological process than the term pulp canal obliteration. 2 Historically, 'calcified obliteration of the pulp-chamber' was first reported in 1905. 44 However, complete calcification of the pulp chamber subsequent to trauma and OTM was first reported in 1950. ...
... 49 The calcification was suggested to be a sequel to revascularisation and/or reinnervation of the entire traumatised pulp or parts of it. 50,51 A recent literature review discusses the possible mechanisms leading to PCC. 2 Pulp necrosis subsequent to PCC is an uncommon complication, with a prevalence in the range of 1-27.2% 52,53 over observation periods of 3.4-16 years, 53 This prevalence seems to increase over time. 48,54,55 Possibly because of the continuing PCC, subsequent injuries may sever the vascular supply at the narrowing apical foramen. ...
The interpretation of the clinical signs and symptoms arising from the interdisciplinary relationship between orthodontics and endodontics becomes more complicated when superimposed by dental trauma. A history of dental trauma before or during orthodontic tooth movement may have implications for pulpal health and clinical outcomes. An understanding of the biology is essential for appropriate treatment planning. This review and treatment recommendations will assist dental practitioners in managing orthodontic-endodontic interactions.
... And even after 12 months signs of complete healing might not be present, and complete healing may require up to four years [10]. One study by Delivanis and Sauer investigated the effect of orthodontic forces on teeth with recent endodontic treatment [11]. They found that when orthodontic forces were applied immediately after endodontic treatment, there was a higher risk of root resorption compared to when a healing period was allowed [11]. ...
... One study by Delivanis and Sauer investigated the effect of orthodontic forces on teeth with recent endodontic treatment [11]. They found that when orthodontic forces were applied immediately after endodontic treatment, there was a higher risk of root resorption compared to when a healing period was allowed [11]. The study concluded that it is crucial to give the apical periodontal ligament enough time to heal before initiating orthodontic movement to minimize the risk of root resorption [11]. ...
... They found that when orthodontic forces were applied immediately after endodontic treatment, there was a higher risk of root resorption compared to when a healing period was allowed [11]. The study concluded that it is crucial to give the apical periodontal ligament enough time to heal before initiating orthodontic movement to minimize the risk of root resorption [11]. The potential for root resorption should also be taken into account when determining the timing of orthodontic movement after endodontic treatment. ...
Research on the connection between endodontic therapy and orthodontics is lacking. This overview of the literature synthesizes the findings from the fields of orthodontics and endodontics and explains how they are related. Beginning with the diagnosis, treating the patient at the appropriate time, moving endodontically treated teeth and traumatized teeth, resorbing roots by orthodontic mechanics, and managing traumatized teeth with orthodontic therapy.
Multiple electronic databases were utilized including (PubMed, Scopus, Science Direct, and Web of Science) to perform manual literature searches. A total of 31 articles were reviewed and summarized in this paper in keywords like "Endodontically Treated Teeth and Orthodontic Treatment," "Endodontically Treated Tooth and Orthodontic Movement," "Orthodontic Treatment in RCT Teeth," "Root Canal Treatment with Orthodontic Movement," "Trauma with Orthodontic Movement," "Orthodontic and Endodontic."
Orthodontic treatment of endodontically treated and traumatized teeth is a subject of controversy. The lack of research on the topic makes it a hard decision to make when to treat these teeth. Especially given that both orthodontic and endodontic treatments have multiple consequences on each other’s outcomes. Thus, it is crucial for clinicians to understand how they integrate and have a guideline to refer to during decision-making.
Successful orthodontic tooth movement could be carried out immediately after endodontic treatment. However, traumatized teeth need a follow-up period before initiating orthodontic movement, which ranges from three months to 12 months depending on the type of trauma and severity. Careful radiographic and clinical follow-up should be done during the healing period. Collaborative teamwork is important between orthodontists and endodontists for the success of treatment, and to achieve satisfactory outcomes.
... , who suggested that post-endodontic dentinal changes contribute to reduced stress transmission. In a review by Parashos they provides clinical guidelines for managing endodonticorthodontic interactions, addressing complications like apical root resorption and pulpal issues to aid effective treatment planning [13]. Overall, the study underscores the importance of multidisciplinary planning between endodontists and orthodontists. ...
The relationship between endodontics and orthodontics focusing on root canal-treated teeth under orthodontic forces is of interest. Lower root resorption rates in treated teeth compared to vital teeth were observed. Stress distribution and complications varied, emphasizing the need for careful multidisciplinary treatment planning. Regression analysis identified orthodontic force, treatment duration and obturation quality as critical predictors. The findings guide clinicians in optimizing outcomes for combined endodontic and orthodontic treatments.
... Our study reveals that OIRR is more weaker in RFT than VPT, following previous meta-analyses [6,11,12,27]. And it aligns with some literature [19,28] suggesting a modified response to orthodontic forces in RFT due to the absence of vital pulp, which could potentially affect the resorption process. ...
Background
Orthodontically induced root resorption (OIRR) is a common side effect of orthodontic treatment. This study compares the degree of OIRR between root-filled teeth (RFT) and vital pulp teeth (VPT), and analyzes relevant study variables.
Methods
We conducted a retrospective study on 69 patients who had undergone orthodontic treatment. Using Cone-beam computed tomography (CBCT), we measured changes of root length before and after treatment through a unique method involving three-dimensional (3D) image registration and superimposition. Factors related to the OIRR such as gender, type of treatment, tooth type, age, duration of treatment and distance of root movement were considered.
Results
The sample included 55 females and 14 males aged 27.19 ± 6.08 years. On the basis that there was no significant difference in the root movement distance between RFT and VPT, RFT showed significantly less OIRR than VPT ( P < 0.05). Gender did not significantly impact on OIRR for either RFT or VPT group ( P > 0.05). In women specifically, RFT displayed less resorption than VPT ( P < 0.05). For treatment type, extraction cases demonstrated a lower degree of OIRR in RFT than VPT ( P < 0.05), and notable greater OIRR in with-extraction group compared to no-extractions group was found in RFT ( P < 0.05), but not in VPT ( P > 0.05). Tooth type did not yield significant differences in OIRR overall; however, upper teeth and premolars experienced lower resorption in RFT than in VPT ( P < 0.05). Cases treated with fixed appliance had higher OIRR in both RFT and VPT than those with clear aligners ( P < 0.05). Age did not correlate significantly with OIRR for either group ( P > 0.05). And duration of treatment positively correlated with OIRR for both types (RFT: r = 0.5506, P < 0.0001; VPT: r = 0.4371, P = 0.0002), so did root movement distance (RFT: r = 0.2955, P = 0.0140; VPT: r = 0.2790, P = 0.0206).
Conclusions
RFT exhibit significantly less OIRR than VPT after orthodontic treatment. Treatment type, appliance type, duration of treatment and root movement distance are significant factors influencing OIRR. Personalized orthodontic treatment plans and vigilant monitoring are crucial to mitigate OIRR risks.
... They believe that the semipermanent and prolonged interposition of plastic material of the aligner and the effect of muscular strength caused this intrusion [31]. Our study provides another possible direction that the endodontic-orthodontic interactions may be the source of it [32,33]. Moreover, the gingival margin of aligners can affect the biomechanics of CAT. ...
Background
Prosthetically guided orthodontics (PGO) can correct the malocclusion for better prosthetic rehabilitation in esthetic rehabilitation. Unlike conventional orthodontic treatment, only minor tooth movement is designed in PGO according to the requirement of subsequent restoration. For better appearance during the treatment, PGO is often performed with clear aligners, which have no metal brackets. It has been proven that the PGO with clear aligners can achieve generally satisfactory outcomes. However, its risk has not been fully known due to the paucity of relevant studies.
Case presentation
Three patients who needed esthetic rehabilitation with mild malocclusion were included in this study. After evaluation, a prosthetic solution alone was considered insufficient to provide optimal outcomes. Thus, they were treated using PGO with clear aligners (Invisalign Go, Align Technology, Santa Clara, California, USA) and accomplished prosthetic rehabilitation subsequently. Dental history and X-ray examination revealed that endodontically treated teeth (ETT) existed in all the cases. Intraoral photographs were collected to compare the pre-treatment and post-treatment dentition. After PGO, posterior ETT did not maintain their position as scheduled and lost occlusal contacts, while all the anterior teeth, including anterior ETT, were moved to the designed position. Corresponding prosthetic rehabilitation was used to solve it after consulting with the patients.
Conclusions
Occlusal contact loss of posterior ETT is a potential risk in PGO with clear aligners, affecting the orthodontic result.
... An interdisciplinary approach between oral maxillofacial, restorative, prosthodontic, and periodontal specialists is often necessary when treating adult patients. [25][26][27][28][29][30] Orthodontic treatment is becoming more common for patients presenting with periodontal issues, whether or not they require tooth extraction. A multidisciplinary approach is necessary to ensure optimal patient hygiene care conditions and effective rehabilitation. ...
Objectives
An assessment of orthodontic treatment duration and results allows for measurable outcomes, goal-setting, and the establishment of patient management standards. It is important information that can be utilised for educational purposes in an orthodontic postgraduate program. The aim of this study was to determine correlations of the parameters within and between the Objective Grading System (OGS), Discrepancy Index (DI) and Treatment Complexity Index (TCI) and identify those factors associated with treatment outcomes and duration.
Materials and methods
This retrospective cohort study involved a consecutive sampling of 242 pre- and post-treatment patient records from the postgraduate orthodontic clinic between 2013 and 2017. The cases were assessed using the DI, OGS, and TCI pre-treatment. Treatment outcomes were assessed using the OGS. Spearman’s Rank Correlation Coefficients were computed within and between the indices. Multiple and logistic regressions were used to evaluate associations between treatment outcomes and duration, respectively.
Results
Within DI, significant correlations ( p < 0.05) were observed between overjet-overbite, overjet-occlusal relationship, overjet-crowding, overbite-anterior open bite, overbite-crowding, anterior open bite-lateral open bite, anterior open bite-crowding, lingual posterior cross bite-crowding. Within pre-OGS, significant correlations ( p < 0.05) were observed between alignment-marginal ridge, alignment-occlusal relationship, alignment-root angulation, overjet-interproximal contact, marginal ridge-buccolingual inclination, marginal ridge-overjet, marginal ridge-occlusal contact, marginal ridge-occlusal relationship, overjet-occlusal contact, overjet-occlusal relationship, overjet-root angulation, occlusal relationship-root angulation, interproximal contact-root angulation. Within TCI, functional appliance correlated with orthognathic surgery ( p < 0.001), rapid palatal expansion (RPE) ( p = 0.005) and multidisciplinary collaboration ( p = 0.001). Pre-OGS correlated with DI ( p < 0.001) and TCI ( p = 0.026). Cephalometric ( p = 0.002) and other conditions ( p = 0.031) were associated with treatment outcomes. RPE was associated with extended treatment duration ( p = 0.014).
Conclusions
DI, OGS, and TCI exhibited weak correlations within and between indices. Cephalometric values, clinical conditions, and RPE use should be carefully considered during treatment planning.
This retrospective study evaluated the impact of orthodontic treatment on endodontically treated teeth. 32 teeth from 25 patients were analyzed, focusing on CBCT evaluations. All endodontic treatments utilized EDTA and 5.25% NaOCl in conjunction with Er:YAG laser-activated irrigation. Post-treatment assessment revealed that 21 teeth (66%) had root canal fillings of correspondent length, while 10 teeth (31%) were insufficient, and 1 tooth (3%) was uncertain. In terms of density and homogeneity, 25 teeth (78%) were classified as correspondent, 5 teeth (16%) as inadequate, and 2 teeth (6%) as uncertain. The periapical bone destruction probability index (PRI) demonstrated a significant increase in periapical destruction following orthodontic treatment. Specifically, the odds ratios for bone destruction were 1.67 (90% CI: 1.16–2.49, P=0.008) for present versus absent and 1.77 (90% CI: 1.11–2.85, P=0.031) for present versus uncertain. The proportion of teeth without periapical destruction decreased from 15 (14.9%) during treatment to 14 (23.9%) post-treatment. These findings highlight the critical relationship between endodontic quality and treatment outcomes, emphasizing the need for meticulous endodontics during orthodontic therapies.
RESUMEN El movimiento ortodóntico no cambia la biología pulpar desde el punto de vista morfológico. El tratamiento endodóntico de la misma manera no interfiere en los fenómenos celulares y tisulares del movimiento dentario. Es por ello por lo que desde el punto de vista biológico y correlacionando la información sobre biología pulpar y movimiento ortodóntico, la aplicación de fuerzas se puede realizar a los pocos días de finalizado el tratamiento endodóntico. Presentamos el caso clínico de un paciente de 12 años que presenta en la pieza 3.5 el diagnóstico pulpar de necrosis pulpar y periapical de absceso apical crónico donde se realizó el tratamiento de conductos con ápice abierto (estadío de Nolla 8) y lesión apical PAI 4, se decidió colocar tapón apical biocerámico para luego ser sometida a movimiento ortodóntico después de 1 mes de haber culminado el tratamiento endodóntico. En el control radiográfico a los 2 años se observa reparación del proceso periapical sin influir en su movimiento dentro del plan ortodóntico. Palabras clave: ápice del diente, endodoncia, materiales de obturación del conducto radicular, ortodoncia. ABSTRACT Orthodontic movement does not change the pulp biology from a morphological point of view. Endodontic treatment does not interfere with the cellular and tissue phenomena of tooth movement. Therefore, from a biological point of view and correlating the information on pulp biology and orthodontic movement, the application of forces can be carried out a few days after the endodontic treatment is finished. We present the clinical case of a 12-year-old patient who presents in tooth 35 the pulp diagnosis of pulp necrosis and periapical chronic apical abscess where the root canal treatment was performed with open apex (Nolla stage 8) and apical lesion PAI 4. It was decided to place a bioceramic apical plug and then subject the patient to orthodontic movement after 1 month of having completed the endodontic treatment. The radiographic control at 2 years showed repair of the periapical process without influencing its movement within the orthodontic plan.
Background
Calcification in the tooth pulp cavity occurs in response to various factors, including dental trauma and chronic irritation. Systemic lupus erythematosus (SLE) is the most common type of lupus, causing widespread inflammation and tissue damage in the affected organs. The SLE condition is generally managed by long-term use of drugs, including glucocorticoids (GCs).
Objective
This study aimed to assess the association of pulp cavity calcification in SLE patients with long-term use of GCs and to present endodontic perspectives on the issue.
Case Presentation
A female SLE patient with a history of long-term use of GCs visited our hospital for an oral surgery examination due to an accident. The crown of tooth 11 was visibly fractured. The tooth was sensitive to cold stimulus, while tooth 21 was mobile. Various examinations (including electric pulp test and panoramic radiography) pointed to the diagnosis of chronic pulpitis in the affected teeth (11 and 21), and cone beam computed tomography (CBCT) revealed that the pulp cavities in all teeth were almost completely calcified. Thus, the root canal treatment (RCT) was attempted and followed by crown restoration for the affected teeth. The involvement of GCs in the pulp cavity calcification was assessed.
Conclusion
According to this case and a series of related studies, long-term use of glucocorticoids is associated with the incidence of pulp cavity obliteration (PCO). More frequent dental examinations and appropriate adjustments in medication use (dose and duration) should be considered and implemented.
The aim of this study is to evaluate if single nucleotide polymorphisms (SNPs) in WNT6 and WNT10A are associated with the risk of dental pulp calcification in orthodontic patients. This cross-sectional study followed the “Strengthening the Reporting of Genetic Association Studies” (STREGA) guidelines. Panoramic radiographs (pre- and post-orthodontic treatment) and genomic DNA from 132 orthodontic patients were studied. Dental pulp calcification (pulp stones and/or pulp space narrowing) was recorded in upper and lower first molars. The SNPs in WNT6 and WNT10A (rs7349332, rs3806557, rs10177996, and rs6754599) were assessed through genotyping analysis using DNA extracted from buccal epithelial cells. The association between pulp calcification and SNPs were analyzed using allelic and genotypic distributions and haplotype frequencies (p<0.05). Prevalence of dental pulp calcification was 42.4% in the 490 studied molars. In the genotypic analysis, the SNPs in WNT10A showed a statistically significant value for molar calcification (p = 0.027 for rs1017799), upper molar calcification (p = 0.040 for rs1017799) (recessive model), and molar calcification (p = 0.046 for rs3806557) (recessive model). In the allelic distribution, the allele C of the SNP rs10177996 in WNT10A was associated with molar calcifications (p = 0.042) and with upper first molar calcification (p = 0.035). Nine combinations of haplotypes showed statistically significant value (p<0.05). The findings of this study indicates that SNPs in WNT10A and WNT6 are associated with dental pulp calcification in molars after orthodontic treatment and may be considered as biomarkers for dental pulp calcification.
Objectives:
To compare the performance of the Malmgren index on 2D and 3D radiographs.
Methods:
Patients with a panoramic radiograph and a cone beam computed tomography (CBCT) taken at an interval of <3 months and presenting root resorption (RR) on at least one incisor and/or canine were retrospectively included. RR was scored twice by two observers using the Malmgren index in both the 2D and 3D sets, and intra-class correlation coefficient (ICC) was calculated.
Results:
155 teeth were analyzed. The ICC was the lowest in 2D, followed by overall, transversal and sagittal 3D. Malmgren scores were systematically higher in 2D, which overestimated RR, especially in the transversal plane on all incisors and canines and in the sagittal plane on the maxillary incisors. 2D respectively leads to 28.0-34.8% of false positives and negatives when discriminating between RR or not. The early stages of RR are often misdiagnosed in 2D, while later stages are more accurate.
Conclusions:
The original Malmgren index is not suited for 3D images, especially axial, where using dichotomized values (resorption yes/no) leads to overestimation of RR. A low-dose CBCT of the upper incisors could detect RR with high diagnostic accuracy in the early stages of orthodontic treatment, especially in patients with dental trauma or familial RR history.
Background:
The application of orthodontic forces causes root resorption of variable severity with potentially severe clinical ramifications.
Objective:
To systematically review reports on the pathophysiological mechanisms of orthodontically induced inflammatory root resorption (OIIRR) and the associated risk factors based on in vitro, experimental, and in vivo studies.
Search methods:
We undertook an electronic search of four databases and a separate hand-search.
Selection criteria:
Studies reporting on the effect of orthodontic forces with/without the addition of potential risk factors on OIIRR, including (1) gene expression in in-vitro studies, the incidence root resorption in (2) animal studies, and (3) human studies.
Data collection and analysis:
Potential hits underwent a two-step selection, data extraction, quality assessment, and systematic appraisal performed by duplicate examiners.
Results:
One hundred and eighteen articles met the eligibility criteria. Studies varied considerably in methodology, reporting of results, and variable risk of bias judgements.In summary, the variable evidence identified supports the notion that the application of orthodontic forces leads to (1) characteristic alterations of molecular expression profiles in vitro, (2) an increased rate of OIIRR in animal models, as well as (3) in human studies. Importantly, the additional presence of risk factors such as malocclusion, previous trauma, and medications like corticosteroids increased the severity of OIIRR, whilst other factors decreased its severity, including oral contraceptives, baicalin, and high caffeine.
Conclusions:
Based on the systematically reviewed evidence, OIIRR seems to be an inevitable consequence of the application of orthodontic forces-with different risk factors modifying its severity. Our review has identified several molecular mechanisms that can help explain this link between orthodontic forces and OIIRR. Nevertheless, it must be noted that the available eligible literature was in part significantly confounded by bias and was characterized by substantial methodological heterogeneity, suggesting that the results of this systematic review should be interpreted with caution.
Registration:
PROSPERO (CRD42021243431).
Introduction
Usually, orthodontic movements encompass children and young adult patients, which are more susceptible to the occurrence of traumatic dental injuries. It is necessary to understand whether the effects of orthodontic movements on traumatized teeth could induce pulp necrosis. The aim of this study was to answer the following question: “Do orthodontic movements of traumatized teeth induce dental pulp necrosis?”.
Material and methods
Searches were performed for studies published up to May 11, 2023, in the MEDLINE/PubMed, Cochrane Library, Scopus, SciELO Citation Index, Web of Science, EMBASE, and Grey Literature Report databases, without restriction for language or year of publication. The revised Cochrane risk of bias tools for nonrandomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.
Results
Of 2671 potentially relevant studies, five were included. Four were classified as having a moderate risk of bias and one as a serious risk of bias. It was reported a higher susceptibility to pulp necrosis in teeth subjected to orthodontic movements with history of trauma involving periodontal tissues. Additionally, orthodontic movements of traumatized teeth with total pulp obliteration had an increased risk of pulp necrosis. GRADE analysis presented a moderate certainty of evidence.
Conclusions
An increased risk for pulp necrosis when traumatized teeth are subjected to orthodontic movements was verified. However, this is based on evaluations performed with subjective tests. Further well-designed studies are necessary to confirm this trend.
Clinical relevance
Clinicians must be aware of the possibility of pulp necrosis. However, endodontic treatment is recommended when verified signs and symptoms of pulp necrosis.
Background and objectives: Investigation into the impact of dental trauma on the results of orthodontic treatment is crucial because it can have a major influence on patient care. However, there has not yet been a thorough review or meta-analysis of the available data, which is inconsistent and scant. Therefore, the goal of this systematic review and meta-analysis is to investigate the impact of dental trauma on orthodontic parameters. Search methods and criterion of selection: Major online databases were searched (beginning from the year 2011) for relevant articles using a properly defined search strategy. Analysis protocol: Risk of bias (RoB) and the Cochrane risk of bias tool were utilized for the purposes of bias evaluation within the individual studies and within the review, respectively. Results: Out of the six clinical trials selected, a significant impact of trauma was observed in individuals in all but one paper. Gender predilection varied across studies and could not be conclusively determined. The follow-up period ranged from two months to two years in the trials. The odds ratio (OR) 0.38 [0.19, 0.77] and the risk ratio (RR) 0.52 [0.32, 0.85] indicated that both the odds as well as the relative risk of experiencing dental trauma were lower in the group with negligible impact compared to the group with noticeable impact. Conclusion and further implications: The findings show that dental trauma significantly affects orthodontic parameters, with lower risk and likelihood of suffering dental trauma in the group with negligible impact than in the group with noticeable impact. However, given the substantial heterogeneity among the studies, it is advised to exercise caution when extrapolating the findings to all populations. Registration and protocol: Registration in the PROSPERO database was carried out before initiating the investigation [CRD42023407218].
Objective:
This retrospective study was aimed at determining the incidence of dental pulp stone formation during fixed orthodontic treatment.
Materials and methods:
A total of 100 patients who received fixed orthodontic treatment were included in this study. Pre- and posttreatment panoramic radiographs of the patients were examined to identify pulp stones. The data were analyzed using McNemar's and Pearson's chi-square tests to investigate the correlations between having a dental pulp stone and gender, age, treatment type, and duration.
Results:
Dental pulp stones were detected in 17% of patients on pretreatment panoramic radiographs and 35% of patients on posttreatment panoramic radiographs. The incidence of pulp stones sharply increased in the pre- and posttreatment radiographs (38%) (P < 0.001). In addition, there were associations between age, treatment duration, and the incidence of pulp stones (P < 0.05). Nevertheless, no associations were found between treatment type, gender, and the presence of pulp stones. Dental pulp stones were most frequently observed in first molars (62%), followed by second molars (36%).
Conclusion:
Fixed orthodontic treatment may trigger pulp irritation and calcification, resulting in the formation of pulp stones. Although pulp stones have no serious consequences, an orthodontist must consider the probability of pulp stone formation because it can cause difficulties in endodontic treatment.
Objectives:
Orthodontic tooth movement (OTM) is a process that's initiated by orthodontic forces. As a consequence, the forces could restrict pulpal blood supply, possibly affecting dental pulp. The study aimed to review the available evidence on the short and long-term effects of orthodontic tooth movement on dental pulp sensitivity and to identify clinically relevant risk factors.
Sources:
PubMed, Embase, Scopus, and Web of Science were searched for papers from 1990 to the end of December 2021.
Study selection:
The studies that evaluated dental pulp sensitivity of teeth undergoing OTM were included in the systematic review. Randomized, nonrandomized and case-controlled studies were included in the analysis. Risk of bias in each study was assessed using the ROBINS-I tool.
Data:
The systematic search yielded an initial sample of 1110 studies, 17 were included in qualitative analysis. Most studies were classified as moderate risk of bias, however only limited long-term evidence with a higher risk of bias exists. Electric pulp test (EPT) sensitivity threshold during active OTM was increased by 4.25 SD (P < 0.001) and the relative risk (RR) of pulpal non-sensitivity was 13.27 (P < 0.001) higher compared to pre-orthodontic baseline status. Significant differences were between subgroups associated with the type of OTM. A positive relationship between pulpal non-sensitivity and mean patient age was discovered (P = 0.041). After OTM the risk of pulpal non-sensitivity remained 5.76 times higher (P < 0.001) in the long term.
Conclusions:
Evidence showed that OTM could affect dental pulp sensitivity. The type of OTM and patients' age were identified as clinically relevant risk factors.
Clinical significance:
Orthodontic tooth movement negatively impacts the sensitivity of dental pulp during active treatment and to a lesser degree in the long term. Pulpal sensitivity tests during active OTM should therefore be interpreted with caution. Data indicates younger patients have a lower risk of negative pulpal sensitivity during orthodontic treatment.
Objectives
To compare blood flow (BF) changes of teeth subjected to orthodontic forces during curve of Spee (COS) leveling using different archwires (AW).
Material and methods
Thirty subjects with COS > 5 mm were randomly assigned (1:1:1) into three groups based on the AW used: group 1: 0.017 × 0.025-inch stainless-steel (SS)AW, group 2: 0.019 × 0.025-inch SSAW, and group 3: 0.021 × 0.025-inch β-titanium (TMA)AW. In the 3 groups, a 5 mm-depth reverse COS was placed in the AWs. A laser Doppler flowmeter was used to measure BF at different time intervals (T0–T4).
Results
In the 3 AWs group, BF of all measured teeth was reduced 20 min after force application. Afterwards, the BF values started to increase until the baseline values were almost restored within 1 week. Differences in BF changes between the extrusion and intrusion subgroups were observed within groups 1 and 3 during the first 20 min of force application (P < 0.05). Similar BF changes were recorded using the 3 different AWs. BF changes were associated with tooth type and the amount of COS depth change.
Conclusions
During CoS leveling, similar BF changes were recorded using the 3 different AWs. Tooth type and the amount of COS depth change were associated with BF changes within the first 20 min of force application. Greater BF reduction was found in premolars compared to incisors during the first 20 min of AW placement.
Clinical relevance
It is important to select a type of applied forces that minimally affect the BF. Intrusive forces appeared to have lower negative effects on the BF of teeth during COS leveling.
Trial registration
ClinicalTrial.gov (# NCT04549948).
Objective
To comprehensively assess recent data on the effects of orthodontic forces on the dental pulp and to critically evaluate, whether any of the changes are permanent.
Materials and methods
Articles published between 2/2009 and 2/2022 were searched electronically on the PubMed, EMBASE and SCOPUS databases. The initial search retrieved 780 publications and, applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 relevant articles were identified. Twenty articles fulfilled the requirements for high (n = 1) or moderate (n = 19) methodological quality and were included. All assessments were made independently by three researchers.
Results
Orthodontic forces appeared to cause a reduction in pulpal blood flow and a reduction in tooth sensibility, as indicated by increased response thresholds and increased amounts of negative responses to tooth sensibility tests. In addition, there were increases in the expression or activity levels of enzymes and neuropeptides associated with hypoxia and inflammation. Fibrotic tissue formation in the pulp was also reported.
Conclusions
Except for some histological and morphological alterations, the observed pulpal changes were in most cases only temporary, appearing within days of initiating the treatment and usually lasting for weeks. There were no clear signs of permanent damage.
Background
Previous studies of pulpal blood flow (PBF) changes in anterior teeth have been limited in the early phase of orthodontic treatment; less is known about the blood supply of anterior teeth in bimaxillary protrusion patients after orthodontic retraction.
Methods
Fifty bimaxillary protrusion patients (25 orthodontic patients ready for debonding and 25 non-orthodontic patients) were selected as study participants. The PBF of maxillary and mandibular anterior teeth were measured using laser Doppler flowmetry. For orthodontic patients, the PBF was measured at 1 day (T1), 1 month (T2), and 3 months (T3) after fixed appliance removal. Non-orthodontic patient PBF was measured as a control. Cone-beam computed tomography (CBCT) examinations before and after orthodontic treatment were performed for orthodontic patients to measure the root resorption. The anterior teeth in orthodontic group were further divided into subgroups according to root resorption and patient age.
Results
At T1 and T3, PBF changes did not differ significantly between the orthodontic and non-orthodontic groups. Maxillary lateral incisor, maxillary central incisor, and mandibular lateral incisor PBFs at T2 were significantly higher in the orthodontic group ( P = 0.048, P = 0.04, and P = 0.021). No significant difference in PBF was found between the root resorption and non-resorption subgroups at any time point. Adolescent patients showed a higher PBF in the maxillary lateral incisor at T2 (12.23 ± 3.48) relative to that at T1 (9.10 ± 3.76) and T3 (9.81 ± 2.80) with statistically significant difference ( P = 0.020).
Conclusion
For bimaxillary protrusion patients with four premolars extraction, PBF in the maxillary anterior teeth increased transiently after orthodontic appliance removal and then returned to non-orthodontic levels 3 months later. This effect was more pronounced in adolescents. The PBF of anterior teeth after orthodontic retraction may not be influenced by root resorption.
Purpose:
To identify and assess any changes in the pulp tissue complex following orthodontic force application.
Materials and methods:
Published and unpublished literature was searched in seven databases until 9 August 2022 for randomised controlled trials (RCTs) and prospective trials (nR-PCT). Representative key words included 'pulp response', 'pulp tissue', 'orthodontic force', and 'tooth movement'. Study selection, data extraction, risk of bias and certainty of evidence assessment were conducted independently by two reviewers. Random effects meta-analyses with respective confidence intervals (95%CIs) were conducted where applicable.
Results:
A total of 363 records were screened, a final number of 24 articles were eligible for qualitative synthesis, while 8 of those contributed to meta-analyses. There was evidence that pulpal blood flow (PBF) decreased after 3 weeks of tooth movement compared to no force application (4 studies, mean difference: -1.68; 95% CI: -3.21, -0.15; p = 0.03). However, this was not the case after 6 months of treatment (p = 0.68). A rise in the activity of aspartate aminotransferase (AST) was detected after 7 days of treatment, but combining 2 studies, this was not statistically significant (p = 0.25). Other outcomes were assessed through single studies. Risk of bias was within the range of 'some concerns/moderate to high/critical overall', while certainty of evidence was low to very low according to GRADE.
Conclusions:
As a short-term effect, PBF decreased upon initiation of orthodontic force application, while enzymatic and peptide activity within the pulp was transiently affected. Further long-term evidence of improved quality and certainty is needed.
Abstract
Background: The purpose of this study was to quantify the effect of moderate and severe orthodontic forces on Calcitonin gene-related peptide (CGRP) expression in the healthy human periodontal ligament (PDL) and its possible relationship with the human dental pulp. Material and Methods: Ninety human periodontal ligament samples were obtained from healthy premolars where extraction was indicated for orthodontic reasons. Prior to extraction, teeth were divided in 3 groups of 30 samples each: I) Untreated teeth control group; II) Moderate force group: A 56 g force was applied to the premolars for 24 hours; and III) Severe force group: A 224 g force was applied to the premolars for 7 days. All periodontal ligament samples were processed and CGRP was measured by radioimmunoassay.Results: Greater CGRP expression was found in the severe force group, followed by the moderate force group. The lower CGRP values were for the untreated teeth. Kruskal-Wallis test showed statistically significant differences between groups (p<0.001). LSD post hoc tests showed statistically significant differences in CGRP expression between the untreated teeth and the severe forces group (p<0.001). Differences between the moderate and severe force groups were statistically significant (p<0.001). There was no statistically significant differences between the untreated teeth and the moderate forces group (p<0.261). Conclusions: CGRP expression in human periodontal ligament increases when teeth are submitted to severe orthodontic forces. This elevated expression of CGRP, which is proportional
Orthodontic treatment could lead to undesirable effects such as external apical root resorption (EARR). Moreover, trauma to both the face and teeth can predispose to EARR. On the other hand, the practice of combat sports results in increased maxillofacial injuries. Consequently, our objective was to determine if there is a statistically significant difference in the EARR of the patients undergoing fixed orthodontic treatment who practice combat sports and controls. Our null hypothesis was that there is no difference in the EARR between patients undergoing orthodontic treatment who practice combat sports and the patients under the same treatment that do not practice combat sports. An observational, descriptive, and prospective case-control pilot study was designed. The exposed group consisted of patients that practice combat sports. Whereas the control group was conformed of patients that do not practice combat sports without a previous history of facial trauma and without face trauma during the orthodontic treatment. EARR of the maxillary and mandibular anterior teeth was measured using cone-beam computed tomography (CBCT). The CBCT scans were obtained from all patients prior to the beginning of the orthodontic treatment and 1 year later. At the end of the follow-up for the maxillary right central and lateral incisors of the exposed group, the EARR was significantly higher than the homologous teeth of the control group (p < 0.05). As a consequence, the patients treated orthodontically who practice combat sports could be more susceptible to EARR.
Traumatic dental injuries (TDIs) are injuries affecting the teeth, periodontium, and surrounding soft tissues. A significant percentage of candidates for orthodontic treatment suffer from previous TDIs to their permanent incisors that mostly remained untreated. Orthodontic treatment of such teeth might be associated with an increased risk of further pulpal and periodontal consequences, especially in teeth with a previous onset of root resorption that has occurred following the trauma. Orthodontic treatment planning can also be challenging for previously endodontically treated teeth. Clinicians should be aware of the techniques and the appropriate time to proceed with orthodontic tooth movement of traumatized and endodontically treated teeth, whether it was secondary to deep carious lesions or TDIs, and about the risks involved.
This review was done in order to provide an evidence-based approach regarding the orthodontic management of traumatized and endodontically treated teeth and the current recommendations for orthodontic tooth movement of such teeth.
Objectives
To compare changes in root length of maxillary incisors with and without dental trauma throughout orthodontic treatment.
Materials and method
Patients younger than 18 years, with trauma on at least one maxillary incisor, undergoing orthodontic treatment between 2017 and 2021 were included, using the contralateral side as control without trauma when available. Periapical radiographs were taken pre-treatment and at 6 months intervals, and root/crown ratio was calculated. Linear mixed models were used to describe the evolution of root length at the different time points and to compare trauma and control values. Differences between central and lateral incisors and between treatment modalities were additionally explored.
Results
A total of 1768 measurements were performed on 499 teeth (201 with trauma) in 135 patients. Incisor root length significantly decreased during orthodontic treatment in teeth with and without trauma. Lateral incisors with trauma were more susceptible to root resorption than those without trauma and central incisors. No significant decrease in root length was observed with removable appliances, which never exceeded 15 months of treatment. Treatment with fixed appliances led to gradually increasing, significant root length shortening in teeth with and without trauma.
Conclusion
Treatment duration directly correlated with root length shortening both in teeth with and without trauma history. Teeth with trauma showed significantly more root resorption after treatment with fixed appliances while removable appliances had no significant influence on root length.
Clinical relevance
Previous history of dental trauma is no absolute contra-indication to start orthodontic treatment, as long as treatment duration is kept as short as possible.
Introduction
This study aimed to systematically review the current evidence on the occurrence of pulp changes as side effects from orthopedic rapid maxillary expansion (ORME) or surgically assisted rapid maxillary expansion (SARME).
Methods
An electronic search was performed in eleven databases. The eligibility criteria included clinical studies assessing vitality, sensibility, or dimensions of the pulp chamber of permanent teeth before and after ORME or SARME, without restrictions on publication year or language. The risk of bias was analyzed with the NIH “Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group" and the “JBI for quasi-experimental studies" tool. The GRADE tool was used to assess the certainty of evidence.
Results
The initial search resulted in 1,197 records, from which only seven before-after studies were included. There was a change in the pulpal blood flow (PBF) of maxillary incisors and canines up to five days after SARME, which gradually returned after seven days to three months. After ORME, one study observed an increased PBF and one study observed a reduced PBF, which gradually returned after the end of expansion. Two studies observed that both ORME and SARME caused temporary changes in pulp sensibility. Three studies observed a significant reduction in the pulp chamber after ORME or SARME. The outcomes presented a very low certainty of evidence.
Conclusions
Although limited, the evidence shows that ORME and SARME caused temporary changes in pulp vitality and sensibility, with the possibility of inducing a reduction in pulp chamber dimensions.
Background and Objectives: This systematic review aimed to assess the literature focusing on the clinical management of traumatized teeth with Pulp Canal Obliteration (PCO) and propose an updated clinical decision-making algorithm. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. Only anterior permanent teeth with PCO due to dental trauma were included. Regarding clinical approaches, only teeth managed with a “watchful waiting” approach, tooth bleaching or root canal treatment (RCT) were included. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Results: Twenty case reports were selected, resulting in a total of 27 patients. The number of traumatized teeth diagnosed with PCO was 33. The “watchful waiting” approach was the most implemented clinical strategy. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The prevalence of pulp necrosis (PN) was 36.4%. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. Guided endodontic technique was performed in six of those teeth. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms.
Objectives: Pulp stone is a focal calcification in dental pulp, which is often detected on conventional dental radiographs. Pulp stones can complicate easy access to the root canal and pulp chamber in root canal treatment. Orthodontic treatment may be associated with the formation of pulp stones. Therefore, this study examined the number of pulp stones pre- and post-orthodontic treatment.
Materials and Methods: In this retrospective cross-sectional comparative study, 222 digital panoramic radiographs collected from private orthodontic offices in Rasht, were divided into two groups: radiographs of patients undergoing orthodontic and non-orthodontic treatment according to the inclusion criteria. The obtained data were analyzed by SPSS via the Wilcoxon and Mann-Whitney tests (P
Background
Orthodontic tooth movements are performed by applying forces on teeth, which may cause alterations within the dental pulp. Previously published systematic reviews on the subject only included a small number of studies that assessed pulp status through reliable diagnostic methods. Since then, new evidence has been published, and a further systematic review on the subject is necessary.
Objectives
To evaluate if there is scientific evidence to support the possibility that orthodontic tooth movements could induce pulp necrosis.
Methods
A systematic search of articles published until June 2020 was performed using MeSH and free terms in the PubMed, Cochrane Library, LILACS, SciELO, Web of Science, EMBASE, Open Grey, and Grey Literature databases. Randomised clinical trials (RCTs), non‐randomised clinical trials (nRCTs), and longitudinal (prospective or retrospective) studies that evaluated the pulp status of teeth subjected to orthodontic movements using laser Doppler flowmetry or pulse oximetry were included. The revised Cochrane risk of bias tools for randomised trials (RoB 2) and non‐randomised interventions (ROBINS‐I) were used to assess the quality of the included studies. Relevant findings were summarised and evaluated. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.
Results
Initial screening of databases resulted in 353 studies. In total, 285 studies were excluded because they were duplicates. Of 68 eligible papers, fourteen met the inclusion criteria and were selected for full‐text reading. Two studies were excluded due to the methods used to evaluate pulp status. Twelve studies (five RCTs, one nRCT, and six prospective) were included. Four RCTs were classified as having an unclear risk of bias and one as having a high risk of bias. The nRCT was classified as having a low risk of bias. Two prospective studies were classified as having a moderate risk of bias and four as having a serious risk of bias. The GRADE analysis demonstrated a low to very low quality of evidence.
Discussion
Significant limitations regarding the randomisation process on the included RCTs, and a lack of control of confounders on most non‐randomised and longitudinal studies were verified.
Conclusions
This systematic review indicates that orthodontic movements do not induce loss of pulp vitality with low to very low certainty of evidence.
Dental trauma is common in the UK, with more than one in ten children having experienced some form of dental trauma. In addition, one in ten patients have been reported to have experienced dental trauma before orthodontic treatment. A recent survey of orthodontists’ knowledge and experience of orthodontic management of traumatised teeth has highlighted large inconsistencies in management of traumatised teeth among UK orthodontists, highlighting the need for further information or training on orthodontic management of traumatised teeth.
Therefore, the following guidelines have been developed in order to provide an evidence based approach to treat this cohort of patients. The following guidance is based on the available literature, expert opinion and UK orthodontists’ consensus drawn from a recent survey.
Although regenerative endodontic procedures (REPs) have become one of the widely accepted treatment modalities for necrotic immature teeth with apical periodontitis, little is known about the long-term outcomes and the effect of orthodontic tooth movement on this procedure. This report presents a case that underwent two REPs and orthodontic treatment over a period of seven years. A 9-year-old male was referred for evaluation of traumatized maxillary central incisors. Based on clinical and radiographic examinations, a diagnosis of pulp necrosis with acute apical abscess was established. REP was performed for both teeth, and the patient was brought in for follow-up annually. Orthodontic treatment was performed during the follow-up period. Annual follow-up visits demonstrated complete resolution of signs and symptoms of disease with the thickening of the roots. At the six-year follow-up visit, the patient presented with a sinus tract and periapical radiolucency. A second REP was performed for both teeth. The one-year recall visit after the second REP revealed complete resolution of clinical symptoms and radiographic signs of healing of apical pathology with further development of the roots. In conclusion, the effect of orthodontic treatment on teeth undergoing REP should be investigated and yearly follow-up visits should be recommended for patients undergoing REP as this case showed signs of deterioration six years after the treatment.
The atrophy of the periodontal ligament places the tooth very close to the bone or another tooth, as occurs in unerupted teeth. The absent interdental bone and the lack of functional periodontal stimulus may lead to the fusion of the appositional layers of cement between the roots of the teeth. Concrescence almost always occurs in the region of the maxillary molars. Asymptomatic, it should always be remembered when the proper response to orthodontic movement is not obtained, and there is no apparent explanation. When surgically extracting a tooth and there is resistance, insisting will not be the best strategy. Moving the teeth with concrescence is not convenient, as it requires very intense forces. Once separated, these teeth can be considered normal for movement. It is possible to separate two teeth presenting concrescence, but it depends on the extension of the area, the surgical access and, especially, the clinical convenience. The tooth to be extracted will be repaired with new cement deposited in the sectioned area. The simple separation with the maintenance of the proximity and the lack of function of one of the teeth will cause a new concrescence. After a period of 1 to 3 months, the separated teeth are biologically prepared to be moved. The most important detail in this separation of teeth presenting concrescence is that the diagnosis should be made in advance, and not at the time of the intervention.
Background:
Trauma-induced adverse reactions may trigger complications when moving teeth orthodontically.
Aim:
The purpose of this study was to evaluate the knowledge of dental practitioners about this topic.
Design:
A questionnaire survey was organized among general dentists, paediatric dentists and orthodontists in Flanders (Belgium). Three clinical cases describing trauma-induced tooth damage (tooth ankylosis, apical root resorption and pulp/root canal obliteration) were presented, followed by a set of questions.
Results:
The questionnaire was completed by 121 general dentists (GD), 47 paediatric dentists (PD) and 99 orthodontic specialists (OS). In the case with ankylosis, impossibility to move the tooth orthodontically was reported as most frequent adverse reaction (82.8% of GD, 95.7% of PD and 100.0% of OS) (P<0.001). In the situation of apical root resorption, the most frequently reported adverse event was progressive apical root resorption (78.9%, 85.7% and 88.8% respectively)(P=0.265). Most frequently mentioned adverse reaction in the case with pulp and root canal obliteration was tooth discoloration (64.1%, 57.1%, 78.3%) (P=0.055), followed by apical root resorption (57.4%, 56.8%, 68.7%) (P=0.283). Orthodontic treatment recommendation differed among specific clinical situations but also among groups of dental practitioners.
Conclusions:
Important knowledge gaps exist regarding the orthodontic managment of traumatized teeth. This topic requires more attention in undergraduate training, specialist training and continuing education.
After injury to periodontal tissues, a sequentially phased healing response is initiated that enables wound closure and partial restoration of tissue structure and function. Wound closure in periodontal tissues involves the tightly regulated coordination of resident cells in epithelial and connective tissue compartments. Multiple cell populations in these compartments synergize their metabolic activities to reestablish a mucosal seal that involves the underlying periodontal connective tissues and the attachment of these tissues to the tooth surface. The formation of an impermeable seal around the circumference of the tooth is of particular significance in oral health since colonization of tooth surfaces by pathogenic biofilms promotes inflammation, which can contribute to periodontal tissue degradation and tooth loss. The reformation of periodontal tissue structures in the healing response centrally involves fibroblasts, which synthesize and organize the collagen fibers that link alveolar bone and gingiva to the cementum covering the tooth root. The synthesis and remodeling of nascent collagen matrices are of fundamental importance for the reestablishment of a functional periodontium and are mediated by diverse, multi-functional fibroblast populations that reside within the connective tissues of gingiva and periodontal ligament. Notably, after gingival wounding, a fibroblast sub-type (myofibroblast) arises, which is centrally involved in collagen synthesis and fibrillar remodeling. While myofibroblasts are not usually seen in healthy, mature connective tissues, their formation is enhanced by wound-healing cytokines. The formation of myofibroblasts is also modulated by the stiffness of the extracellular matrix, which is mechanosensed by resident precursor cells in the gingival connective tissue microenvironment. Here, we consider the cellular origins and the factors that control the differentiation and matrix remodeling functions of periodontal fibroblasts. An improved understanding of the regulation and function of periodontal fibroblasts will be critical for the development of new therapies to optimize the restoration of periodontal structure and function after wounding.
Objectives
This systematic review (SR) aimed to investigate the influence of obturation extent on the final outcome of root canal treatment (RCT), by answering the question “among patients requiring RCT on fully formed permanent teeth, is there an association between obturation extent and the final treatment outcome?”
Materials and methods
Five electronic databases and three gray literature searches were performed. Observational studies investigating the association between obturation extent and RCT outcome in fully formed permanent teeth with a minimum follow-up of 12 months were included. We evaluated the risk of bias (RoB) in with MAStARI for cohort studies. The overall quality of the evidence was assessed with the GRADE-tool.
Results
Twenty-two studies were included, 2 had high RoB, 7 moderate RoB, and 13 low RoB. Underextended obturation demonstrated increased odds of an unfavorable outcome in seven studies, in which the odds varied between 6.94 (95%CI 2.20–21.87) and 1.73 (95%CI 1.02–2.95). Overextended obturation also demonstrated this association in four studies, with odds varying from 1.90 (95%CI 1.23–2.94) to 23.00 (95%CI 5.58–94.75). Due to heterogeneity and the very low level of evidence found in the GRADE analysis, the results from this SR should be interpreted with caution.
Conclusions
Obturation extent seems to influence RCT outcome; overextended and underextended obturations showed higher chance of association with less favorable outcomes than adequate obturation; however, this association was not categorically supported.
Clinical relevance
This SR provides information about obturation extent influence on RCT outcome and guides clinicians to make evidence-based decisions during endodontic practice.
Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.
Aim:
The aim of the present study was to evaluate and compare changes in pulpal blood flow (PBF) as a result of maxillary incisor intrusion achieved by one of two methods (utility arches or mini-implants).
Materials and methods:
Thirty subjects were divided into three groups, the first of which underwent maxillary incisor intrusion using utility arches (UA) and a second group, intrusion via mini-implants (MI). The third group acted as a control. An intrusive force of 100 g was applied to the upper incisors in the treatment groups, whereas no force was applied to the anterior teeth in the control group. A laser Doppler flowmeter (LDF) was used to measure PBF at baseline (T0) and during incisor intrusion at 24 hours (T1), three days (T2), seven days (T3) and three weeks (T4). Statistical changes in PBF were assessed by the Wilcoxon Signed Rank and Mann-Whitney U tests, with significance set at p < 0.05.
Results:
The mean PBF in the UA and MI groups decreased significantly from T0 to T1 (p < 0.001), slightly increased at T2 and continued to increase gradually at T3. PBF attained levels similar to those measured prior to intrusion at T4. No significant changes in PBF were observed in the control group over the course of the study. The only statistically significant difference between the UA and MI groups were at T1 and T2, at which time the MI group had lower PBF values (p < 0.001).
Conclusions:
Despite slight regressive changes in pulpal tissue observed over the short-term, PBF values tended to return to initial levels within three weeks, indicating that changes observed in PBF with the UA and MI intrusion methods are reversible. Although the changes in PBF could not be directly related to the method of intrusion employed, in general, a more severe drop in PBF was observed in the MI group during the first three days of intrusion.
Background/aim:
Orthodontic treatment of patients with traumatic dental injuries is challenging, with limited evidence of routines and outcomes. The aims of this study were: (i) to describe how orthodontists perceive the information on traumatic dental injuries received by referral from the Public Dental Health Service before orthodontic treatment and (ii) to assess orthodontists' knowledge and working routines in managing traumatic dental injuries.
Materials and methods:
Data were obtained through a survey of all practicing orthodontists registered as members of the Norwegian Association of Orthodontists (n = 203).
Results:
Eighty-three orthodontists were enrolled, most of whom had received their dental degree (73.0%) and specialist orthodontic training (88.5%) in Norway. They reported examining patients with a history of traumatic dental injury at weekly (34.2%) or monthly (38.0%) basis. In 85.5% of cases, they obtained a history of traumatic dental injury from patients. Half of the respondents (51.3%) favoured two-phase early orthodontic treatment for patients with an overjet ≥6 mm. The observation time and treatment strategy showed considerable discrepancies across traumatic dental injury diagnoses. Most (59.1%) orthodontists considered the information on previous traumatic dental injuries provided by the Public Dental Health Services referral 'inadequate', more commonly in cases of mild (83.5%) than severe (57.5%) traumatic dental injuries.
Conclusions:
Orthodontic management of patients with traumatic dental injuries was characterised by lack of uniformity in both recommended observation time before orthodontic treatment and management strategy. The referral routines by the Public Dental Health Services for patients with traumatic dental injuries were perceived as 'inadequate' in terms of frequency and quality. The results indicate the requirement of standardisation of routines related to orthodontic management of traumatic dental injuries and referral routines by the Public Dental Health Services.
Although regenerative endodontic procedures (REPs) have become one of the widely accepted treatment modalities for necrotic immature teeth with apical periodontitis, little is known about the long-term outcomes and the effect of orthodontic tooth movement on this procedure. This report presents a case that underwent two REPs and orthodontic treatment over a period of seven years. A 9-year-old male was referred for evaluation of traumatized maxillary central incisors. Based on clinical and radiographic examinations, a diagnosis of pulp necrosis with acute apical abscess was established. REP was performed for both teeth, and the patient was brought in for follow-up annually. Orthodontic treatment was performed during the followup period. Annual follow-up visits demonstrated complete resolution of signs and symptoms of disease with the thickening of the roots. At the six-year follow-up visit, the patient presented with a sinus tract and periapical radiolucency. A second REP was performed for both teeth. The one-year recall visit after the second REP revealed complete resolution of clinical symptoms and radiographic signs of healing of apical pathology with further development of the roots. In conclusion, the effect of orthodontic treatment on teeth undergoing REP should be investigated and yearly follow-up visits should be recommended for patients undergoing REP as this case showed signs of deterioration six years after the treatment. © 2021 Kare Publishing. All rights reserved.
Introduction:
Pulp calcification (PC) often appears in strong association with nerve fiber bundles, which indicates the important role of dental nerves in the formation of PC. Additionally, given that sensory nerves and calcitonin gene-related peptide (CGRP) secreted from sensory nerve fibers are involved in physiological and pathological bone formation, we aimed to determine whether chronic irritation of sensory nerves can promote the occurrence of PC.
Methods:
A sensory nerve irritation rat model was established via ligation of the inferior alveolar nerve (IAN), and face grooming behavior was analyzed as a measure of pain sensation. Two months post-surgery, PC was determined by imaging and histologic analyses.
Results:
Rats in the IAN-chronic constriction injury (IAN-CCI) group showed spontaneous pain-associated behavior after the operations; and pain tolerance on the sixtieth postoperative day. The imaging and histological analysis showed more calcified particles in the IAN-innervated first and second molars after day 60 of the dental sensory nerve irritation. These calcified masses had a dentin-like structure that contained sparse, irregularly oriented tubules. Compared to the control and sham groups, the odontoblasts located in the periphery of radicular pulp aligned along a thicker layer of predentin; which expressed more nestin with longer and stouter processes in the IAN-CCI group. Additionally, more CGRP-positive nerves were observed in the IAN-CCI group.
Conclusions:
Irritation of sensory nerves promotes PC formation, and the increased density of CGRP-immunolabeled fibers probably contribute to this process. This highlights the significance of dental sensory nerves in the formation of PC.
Introduction
Orthodontically induced external root resorption (OIERR) has been labeled an unavoidable consequence of orthodontic tooth movement (OTM). The objective of this study was to investigate the change in surface area (mm²) and volume (mm³) of endodontically treated teeth (ETT) compared to contralateral teeth with a vital pulp (VPT) following OTM.
Methods
Seventy-six teeth were included in this retrospective analysis: ETT (n=38) and VPT (n=38). All teeth were evaluated using CBCT imaging at two time periods: before OTM (T1) and after OTM (T2). Study teeth were segmented to include all areas contained within the lamina dura and then were converted into a mesh model for data calculation. The surface area (mm²) and volume (mm³) of each tooth was calculated at T1 and T2 based on the number of cubic voxels present within the mesh model. Statistical analysis was performed using a linear mixed-effects model.
Results
The average change in surface area following OTM in ETT was 13.01 mm², and 19.95 mm² in VPT (p<0.05). The average percent change in surface area following OTM in ETT was 2.09%, and 3.38% in VPT (p<0.05). The average change in volume following OTM in ETT was 22.48 mm³, and 32.44 mm³ in VPT (p<0.05). The average percent change in volume following OTM in ETT was 2.62%, and 4.10% in VPT (p<0.05).
Conclusions
The results from this study suggest that ETT are less susceptible to root resorption following OTM than their vital counterparts.
Introduction
There is a paucity of literature on late complications of regenerative endodontic procedures. The aim of this paper is to report three cases of previously successful regenerative endodontic procedures with long term follow up, that developed different complications after the application of orthodontic forces.
Methods
In the first case, an 8-year-old female patient received a regenerative endodontic procedure in her previously intruded tooth 21 that had been rendered necrotic after a successful spontaneous repositioning procedure. The 5-year follow-up revealed uneventful healing, continuous root development, dentinal wall thickening and regaining of pulp vitality for tooth 21. 4 years later, the patient received orthodontic treatment with mild forces that lasted 2 years. The 11 years follow up revealed severe External Invasive Cervical Resorption and the tooth had to be extracted. In the second case, a 6-year-old female patient suffered a lateral luxation injury in tooth 11. 6 months after the injury the tooth developed symptoms, discoloration, and was tested negative in pulp vitality testing. Single step Regenerative Endodontic Procedures were applied, and successful continuous root development, dentinal wall thickening, and apical closure were achieved in the 3 years follow up. 2 months after the initiation of orthodontic treatment the tooth developed symptomatic apical periodontitis. Root canal treatment was performed to treat the disease, and the orthodontic treatment was continued. In the third case, a previously published successful regenerative endodontic procedure developed a perforating internal resorption 6 months after the application of orthodontic forces. The internal resorption was arrested with root canal treatment, the resorptive defect was repaired with bioceramic obturation and the orthodontic treatment plan was modified.
Results
Previously successful regenerative cases might develop external invasive cervical resorption, regenerative tissue necrosis or internal resorption after the application of orthodontic forces.
Conclusions
Best practice/evidence-based guidelines on the appropriate orthodontic management of successful RET teeth are lacking. Whenever possible, careful monitoring and partial or complete exclusion off orthodontic treatment might be necessary. In some cases, preventive root canal treatment prior to the initiation of orthodontic movement might be considered.
Background
Guidelines for orthodontic patients that have experienced mild-to-moderate dental trauma recommend an observation period before beginning or resuming tooth movement, but they appear to be based on limited evidence.
Objectives
This scoping review examines available research on recommended observation periods before beginning or resuming tooth movement for orthodontic patients that have experienced mild-to-moderate dental trauma. The extent of research, methodologies used, outcomes reported, and justification for recommended observation periods were reviewed to identify any gaps in current knowledge.
Design
Online databases were searched to identify papers published from 1950 to September 2021. Two publications, one from Sweden and one from Israel, reported dental outcomes of tooth movement with versus without observation periods for orthodontic patients that had experienced trauma. The risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-1) tool.
Results
One article was published in 1982, and the other in 1991. Both were observational retrospective cross-sectional studies of orthodontic patients with a history of mild-to-moderate trauma to permanent teeth (uncomplicated crown fracture, concussion, subluxation, luxation), ranging in age from 7 to 16 years. The studies listed a variety of outcomes, including clinical exams, electric pulp testing, and analysis of periapical or panoramic radiographs for signs of root resorption.
Conclusions
The identified articles lack sufficient evidence to determine an appropriate observation period after mild-to-moderate trauma before beginning or resuming orthodontic treatment. High-quality research is needed to better define appropriate observation periods before beginning or continuing orthodontic treatment for mildly to moderately traumatized teeth.
Objective
To evaluate the role of nitric oxide synthases (NOS) isoforms influence during tooth movement with different forces.
Settings and sample population
100 male Wistar rats (n=10/group) were divided into a Sham group (animals not submitted to device installation nor Induced Toot Movement [ITM]), Negative Control Group (NCG) (animals submitted to device installation but not to ITM), and three experimental groups (F1, F2, and F3) (submitted to ITM with forces of 25, 50 and 100 gF, respectively).
Materials and methods
A daily count of biting and scratching on the vibrissae and the Grimace scale were applied. After 4 (D4) and 11 (D11) days, the molar diastema was measured, and the animals were euthanized for histological (vascular parameters) and immunohistochemistry (iNOS, eNOS and nNOS) in the dental pulp.
Results
On D4, there was significant movement in the F3 group (p=0.001) and on D11 in F1, F2, and F3 (p<0.001). The number of bites (p<0.001) and scratching (p=0.006) were higher in F2-F3 and F3 had higher Grimace-scores (p<0.001) and weight loss (p<0.001). At D4, there was an increase in pulp ectasia in F2-F3 (p=0.021) and a reduction in the number of vessels in F3 (p=0.005). In D4 and D11 there was a significant increase in immunostaining for iNOS and eNOS in F1 (p=0.025 and p<0.001, respectively) and F2 (p=0.007 and p<0.001, respectively). At D4, F2 and F3 showed higher immunostaining for nNOS (p=0.027)
Conclusion
Thus, IDM induced inflammatory changes in the dental pulp reflecting in force-dependent pain/suffering signs.
Introduction
Orthodontic force triggers a sequence of biological responses that can affect dental pulp. The aim of this study was to systematically evaluate the clinical and radiographic findings of orthodontic force application on dental pulp.
Methods
Two reviewers comprehensively and systematically searched six electronic databases (LILACS, EMBASE, Cochrane Library, MEDLINE/PubMed, Scopus, and Web of Science), and grey literature (Google Scholar, OpenGrey, and ProQuest) until April 2021. According to the PICOS criteria, randomized clinical trials (RCTs) and observational studies that evaluated clinical or radiographic findings compatible with dental pulp changes due to orthodontic force were included. Studies in open apex or traumatized teeth, case series or reports, laboratory-based or animal studies were excluded. Newcastle-Ottawa Scale and Cochrane Risk-of-Bias 2.0 tool were used to risk of bias assessment. The overall certainty level was evaluated with the GRADE-tool.
Results
Twenty-six studies were included. Among the clinical findings, orthodontic force promoted increased pulp sensibility response and decreased pulp blood flow. Changes in pulp cavity volume and increased incidence of pulp stones were the radiographic findings observed. The studies presented a moderate risk of bias for most of the domains. The certainty of the evidence was considered very low.
Conclusions
Orthodontic force promoted changes in the dental pulp, generating clinical and radiographic findings. It is crucial to know these changes so that orthodontic mechanics can be safely performed. The clinician has effective non-invasive methods to assess the health and possible pulp changes during orthodontic treatment.
External apical root resorption (EARR) is one of the most frequently reported iatrogenic side effects of orthodontic movement. Nevertheless, no robust and unequivocal scientific evidence is yet available in the literature regarding the clinical and biological factors that trigger EARR. The purpose of the present position paper is to provide clinicians, residents, and investigators a summary of our current understanding about root resorption caused by orthodontic tooth movement, based on up-to-date available scientific evidence.
Morphological, structural, biomechanical, and biological differences account for predisposing the apical third to EARR compared to other root surfaces during orthodontic treatment. In addition, a relevant number of patient and treatment-related factors increase risk of EARR. The main patient-related factors are reviewed and discussed: genetic factors, tooth anatomy, demographic factors, malocclusion factors, previous endodontic treatment, medical history, short root anomaly. Similarly, the influence of treatment-related factors are analyzed with regard to the effect of: biomechanical factors, type of orthodontic appliance, adjunctive therapies to accelerate tooth movement, early treatment, maxillary expansion, teeth extractions, the duration of treatment and the amount of apical displacement. Clinical management of EARR from pre-treatment records to the monitoring strategy as well as recommendations for the post orthodontic-treatment period are presented as a guide for the clinician.
Despite years of studies, we still do not fully understand EARR, but the future is promising. True three-dimensional imaging with higher resolution and low radiation, and predictive tools towards an earlier detection without radiographs, will mark future developments in the field of EARR in orthodontics.
Introduction
Root resorption may occur in traumatized necrotic teeth that have undergone apexification following orthodontic treatment. This study examined the effects of orthodontic treatment on the outcome of apexification.
Methods
This retrospective study included 36 children presenting with anterior permanent traumatized teeth with immature roots, who were treated by apexification and root canal treatment. The Orthodontic group consisted of 17 children with 24 teeth that were subjected to orthodontic treatment after apexification. The Control group consisted of 19 children with 21 teeth that underwent only apexification without orthodontic treatment. Almost half of the teeth in both groups underwent apexification with calcium hydroxide, whereas the other half were treated with mineral trioxide aggregate. The effects of sex, stage of root development, and apexification material on the outcomes of apexification were analyzed and compared between the two groups.
Results
Apexification was successful in 88% of cases after at least 5 years of follow-up. Neither apexification technique nor sex had a significant effect on treatment outcome. The stage of root development had a positive effect on outcome, although it was not statistically significant. Some root resorption (average 0.3 mm) was observed after orthodontic treatment, whereas teeth that underwent apexification without orthodontic treatment exhibited some root elongation (average 0.1 mm). This difference was highly significant.
Conclusions
Minor root resorption was observed in the Orthodontic group compared to a minor increase in root length in the Control group. Orthodontic movement of immature traumatized teeth after apexification appears to be safe.
Background
The primary dentin, secondary dentin, and reactive tertiary dentin are formed by terminal differentiated odontoblasts, whereas atubular reparative tertiary dentin is formed by odontoblast-like cells. Odontoblast-like cells differentiate from pulpal stem cells, which express the neural stem cell markers nestin, S100β, Sox10, and P0. The denticle (pulp stone) is an unique mineralized extracellular matrix that frequently occurs in association with the neurovascular structures in the dental pulp. However, to date, the cellular origin of denticles in human dental pulp is unclear. In addition, the non-collagenous extracellular dentin matrix proteins dentin matrix protein 1 (DMP1), dentin sialoprotein (DSP), and dentin phosphoprotein (DPP) have been well characterized in the dentin matrix, whereas their role in the formation and mineralization of the denticle matrix remains to be clarified.
Methods
To characterize the formation of denticle, healthy human third molars (n=59) were completely sectioned and evaluated by HE staining in different layers at 720 µm intervals. From these samples, molars with (n=5) and without denticles (n=8) were selected. Using consecutive cryo-sections from a layer containing denticles of different sizes, we examined DMP1, DSP, and DPP in denticle lining cells and tested their co-localizations with the glial stem cell markers nestin, S100β, Sox10, and P0 by quantitative and double staining methods.
Results
DMP1, DSP and DPP were found in odontoblasts, whereas denticle lining cells were positive only for DMP1 and DSP but not for DPP. Nestin was detected in both odontoblasts and denticle lining cells. S100β, Sox10, and P0 were co-localized with DMP1 and DSP in different subpopulations of denticle lining cells.
Conclusions
The co-localization of S100β, Sox10, and P0 with DMP1 and DSP in denticle lining cells suggest that denticle lining cells are originated from glial and/or endoneurial mesenchymal stem cells which are involved in biomineralization of denticle matrix by secretion of DMP1 and DSP. Since denticles are atubular compared to primary, secondary, reactionary tertiary dentin and denticle formed by odontoblasts, our results suggest that DPP could be one of the proteins involved in the complex regulation of dentinal tubule formation.
Background:
Root resorption can be considered the most unfortunate complication of orthodontic treatment.
Objective:
To evaluate the available evidence regarding orthodontically induced inflammatory root resorption (OIIRR).
Search methods:
A comprehensive literature search was conducted for the systematic reviews investigating OIIRR published up to 24 May 2020. This was accomplished using electronic databases: MEDLINE via OVID, EMBASE, AMED (Allied and Complementary Medicine Database), PubMed, and Web of Science. Any ongoing systematic reviews were searched using Prospero and a grey literature search was undertaken using Google Scholar and OpenGrey (www.opengrey.eu/). No language restriction was applied.
Selection criteria:
Only studies investigating OIIRR were included.
Data collection and analysis:
Screening, quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)], and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings from moderate and high-quality reviews.
Results:
A total of 2033 potentially eligible studies were identified. After excluding the non-relevant studies, 28 systematic reviews were included. Of which, 20 systematic reviews (71.5%) were of moderate and high-quality level of evidence. The incidence and severity of OIIRR increase with the fixed appliance, especially with heavy force, intrusion, torqueing movements, increased treatment duration, and treatment with extractions or with long apical displacement (particularly for maxillary incisors). There was insufficient evidence regarding most other treatment- and patient-related factors on OIIRR. Following all precautionary measures, pausing treatment and regular monitoring benefits patients with OIIRR.
Conclusions and implications:
There is a limited number of high-quality studies in terms of OIIRR. The influence of fixed appliance on root resorption was noted; however, the cause and effect relationship between OIIRR and orthodontic biomechanics has not been confirmed. Avoiding heavy, continuous forces and a greater amount of apical displacement over a long duration of treatment is recommended. Precautionary measures should be carefully considered when treating patients with a high risk of OIIRR.
Registration:
CRD42020166629.
Root canal stenosis and external inflammatory root resorption are potential consequence of trauma that can occur depending on the severity of the injury. Luxation injuries induce reduced blood supply to the pulp, which leads to calcification/narrowing of root canals leading to root canal stenosis. External inflammatory cervical resorption occurs when there has been the loss of cementum due to damage to the external surface of tooth root during trauma, plus root canal system becoming infected with bacteria. External inflammatory resorption can ultimately lead to loss of tooth if it is not managed in a timely manner. The treatment should aim toward the complete suppression of all tissues undergoing resorption and the reconstruction of the resorptive defect by the placement of a suitable bioactive material. This case report presents the management of root canal stenosis in the maxillary left central incisor in 35-year-old female and management of Class IV external invasive cervical and apical inflammatory resorption in maxillary right central incisor, both of which were diagnosed with the help of cone-beam computed tomography scan. The treatment of external inflammatory resorption included surgical excision of granulation tissue and root reconstruction with Biodentine. Twelve months follow-up showed successful outcomes for both the teeth treated for root canal stenosis and external invasive inflammatory resorption leading retention of the traumatized teeth with otherwise poor prognosis.
Introduction:
The objective of this study is to evaluate and compare the initial changes of pulpal blood flow (PBF) using clear aligner and fixed orthodontic treatment.
Methods:
A total of 45 subjects were subdivided into 2 groups: group 1; 25 subjects treated with preadjusted edgewise fixed appliance with 0.014″ nickel titanium as the alignment archwire and group 2; 20 subjects treated using clear aligner. In both groups, PBF was measured for the maxillary right and mandibular left teeth using Laser Doppler flowmetry at different time intervals (20 minutes, 48 hours, 72 hours, and 1 month) after the fitting of the nickel titanium archwire in group 1 and after the delivery of the second aligner in group 2. A repeated-measures analysis of variance and a Bonferroni post-hoc comparison test were applied to determine differences at the various time intervals.
Results:
The PBF decreased in both types of appliances after force application. The maximum reduction in PBF was reached after 72 hours. It returned to its normal values within 1 month. The differences in PBF between the 2 groups did not reach any statistical significance.
Conclusions:
PBF in orthodontically treated teeth decreased 20 minutes after orthodontic force application in both fixed and clear aligner appliances. In both treatment groups, most changes occurred within 48 hours of force application. PBF returned to its normal values within 1 month. Changes in PBF in both treatment groups were comparable.
Background/Aim
There is a lack of research into orthodontic movement and management strategies of traumatised teeth. The aim of this survey was to assess the knowledge of UK based orthodontists in the orthodontic management of traumatised teeth.
Materials/Methods
A 24‐item questionnaire survey was electronically distributed to all members of the British Orthodontic Society.
Results
A total of 213 respondents completed the survey with the majority of these being UK registered specialists in orthodontics. Three responses were excluded as one was not based within the UK and two were orthodontic trainees with less than one year of experience, leaving a total of 210 respondents. The majority had orthodontically treated up to three patients with a history of dental trauma in the preceding three months. Obtaining a trauma history was done by the majority of respondents. A wide variation in times waited by respondents before orthodontically treating teeth with different types of traumatic injuries was observed. Similarly, the preferred orthodontic management strategies of traumatised teeth differed substantially among respondents. Almost all respondents were interested in further training in the management of dental trauma.
Conclusions
The study showed a wide variation in the orthodontic management of traumatised teeth among UK based orthodontists. Further training and national guideline establishment are indicated for orthodontic management of traumatised teeth in the UK.
This article is protected by copyright. All rights reserved.
Background/aim:
Traumatized teeth are more susceptible to complications during orthodontic tooth movement. The aim of this study was to explore current practices among Belgian dental practitioners regarding orthodontic treatment of children with a history of dental trauma.
Material and methods:
A questionnaire survey was organized among general dentists, pediatric dentists, and orthodontists in Flanders (Belgium). Questionnaires were distributed at the occasions of annual meetings or symposia. They consisted of questions regarding exposure to dental trauma and orthodontic treatment approach for patients with a dental trauma history.
Results:
The questionnaire was completed by 121 general dentists, 47 pediatric dentists, and 99 orthodontists. A history of dental trauma influenced referral for orthodontic treatment by general dentists and pediatric dentists moderately (median VAS scores of 5 and 6, respectively, on a scale of 0 (not at all) to 10 (utmost)), indicating uncertainty and doubt. Additional checkups during tooth movement were usually not organized by general dentists in 33.6% and by pediatric dentists in 19.1% of cases (P = 0.006). One-third of the orthodontists (33.3%) experienced tooth loss linked to orthodontic movement of a tooth with dental trauma history in at least one patient. Only a minority of the practitioners knew of the existence of specific guidelines (7.6%, 15.6% and 22.7%, respectively, of general dentists, pediatric dentists, and orthodontists) (P = 0.007). The Dental Trauma Guide was the guideline mentioned most frequently, although this tool does not contain recommendations regarding orthodontic treatment after trauma.
Conclusion:
In the group of Belgian general dental, pediatric and orthodontists surveyed, there was uncertainty regarding the orthodontic management of patients with a history of dental trauma especially among general practitioners. Further educational training is recommended.
Introduction:
The difference in the amount of orthodontic-induced external root resorption (OIERR) of endodontically treated teeth (ETT) compared with vital pulp teeth (VPT) treatment is controversial. This systematic review and meta-analysis assessed the available evidence regarding OIERR of ETT compared with VPT.
Methods:
PubMed, Scopus, MEDLINE, Web of Science, and Cochrane databases were searched up to May 2018 to retrieve relevant studies. The studies were evaluated for eligibility criteria, and the risk of bias was assessed using the Risk of Bias In Non-randomised Studies of Interventions tool (Cochrane Bias Methods Group, Odense, Denmark). Weighted means of OIERR in ETT and VPT were calculated using a fixed effects model, and a random effects model was used to assess the significance of treatment effects.
Results:
Eight studies were identified, from which 7 were included in the meta-analyses. The funnel plot of the random effects model exhibited a symmetrical distribution, which indicates no publication bias of the included studies. Because of the significant heterogeneity between studies, a random effects model was used. Significantly less OIERR for ETT was identified compared with their contralateral VPT.
Conclusions:
Endodontic treatment does not seem to increase OIERR.
We aimed to assess the relationship between age, pulpal blood flow (PBF), and orthodontic treatment outcomes. Decreased blood supply to pulp cells commonly occurs with age and can change the response of pulp to orthodontic tooth movement. This study was conducted in 28 human subjects divided into 2 groups according to age. A laser Doppler flowmeter was used to record blood flow to the teeth prior to and during the course of orthodontic treatment (days 1, 3, and 7; week 3; and month 1). Data were analyzed using Wilcoxon signed-rank and Mann-Whitney U tests. Mean PBF values were significantly higher in the young group compared to the old group at all time points (P < 0.001). The decreased PBF in response to tooth movement was more severe in the old group and was also of longer duration. Pulp in younger patients had significantly higher blood flow values compared to that in older patients at baseline and throughout the course of the study.
Management of non-vital immature permanent teeth in children remains a challenge in paediatric dentistry. The resulting short roots, thin root dentinal walls, and compromised crown root ratios, not only affect the long-term survival of these teeth but also complicate any intended orthodontic treatment. This case report shows a successful orthodontic movement of a traumatised non-vital immature tooth treated using regenerative endodontics.
Summary
Objective
To compare orthodontically induced inflammatory root resorption (OIIRR) and patient perception of pain during orthodontic treatment between 0.018-inch and 0.022-inch slot bracket systems.
Subjects and methods
Eligible participants aged 12 years or above were allocated to treatment with the 0.018-inch or 0.022-inch slot MBT appliance (3M Unitek, Monrovia, California, USA) using block randomization in groups of 10. OIIRR was assessed radiographically using standardized periapical radiographs before and after 9 months from the start of treatment. Patient perception of pain was assessed using a validated patient questionnaire at 6 months from the start of treatment. Parametric tests (t-test) and non-parametric tests (chi-square with Fisher’s exact tests and Kruskal–Wallis test) assessed differences between the groups (P < 0.05). The correlation between severity of OIIRR and abnormal root morphology, history of dental trauma, and pain during treatment was assessed.
Results
Of the 187 participants randomized (1:1 ratio), 34 withdrew or were excluded (protocol deviations or poor cooperation). There were 77 patients in the 0.018-inch slot group and 76 patients in the 0.022-inch slot group (overall mean age: 19.1 years). Baseline characteristics were similar between groups (P > 0.05). There was no significant difference in the severity of the OIIRR nor patient perception of pain between the two study groups (P = 0.115 and P = 0.08 respectively). The correlation between the severity of OIIRR and abnormal root morphology or history of dental trauma was not statistically significant (P = 0.086 and P = 0.313). Moreover, there was no significant correlation between the severity of OIIRR and pain during treatment (R = 0.045, P = 0.617).
Limitations
It was impossible to blind clinicians or patients to allocation, and oral hygiene and periodontal outcomes were not assessed.
Conclusions
The effect of bracket slot size on the severity of OIIRR and patient perception of pain are not significant.
Trial registration
The trial was registered with ClinicalTrials.gov on 5 March 2014, registration number: NCT02080338.
Abstract
Introduction
Although regenerative treatment approaches in teeth with incomplete root formation and pulp necrosis have become part of the suggested therapeutic endodontic spectrum, little is known about the effect of orthodontic movement in the tissue that has been regenerated. Furthermore, as the number of adults undergoing orthodontic treatment increases, there is an increasing need to investigate the changes that these tissues may undergo during orthodontic movement. Here we describe the alterations observed after the application of orthodontic forces in a case of an apically root-fractured necrotic immature root that had been managed with regenerative endodontic procedures in the past.
Methods
A 9-year-old male patient was referred after suffering the third incidence of trauma in the anterior maxilla. Radiographic evaluation revealed a periapical rarefaction associated with an apically root-fractured immature central incisor. Clinical evaluation revealed a buccal abscess and grade 3 tooth mobility. Periodontal probing was within normal limits. The tooth was accessed and disinfected by using apical negative pressure irrigation of 6% NaOCl. Intracanal dentin conditioning was achieved by using 17% EDTA for 5 minutes. A blood clot was induced from the periapical area, and calcium silicate–based cement was placed in direct contact with the blood clot at the same visit. The composite resin restoration was accomplished in the same appointment.
Results and Conclusions
Recall radiographic examination after 24 months revealed healing of the periapical lesion and signs of continuous root development despite the apical root fracture. Clinical evaluation revealed normal tooth development, normal mobility, and a resolving buccal infection. The tooth was subjected to orthodontic treatment because of Class II division 1 malocclusion with an overjet of 11 mm. After completion of the orthodontic treatment, 5.5 years after the initial intervention, the radiographic image revealed marked remodeling of the periapical tissues and repair of the apical fractures, and the buccal infection had resolved completely.
Dental trauma to the permanent dentition can lead to clinical complications and its management may considerably challenge a practitioner. The incidence of pulp canal obliteration following dental trauma has been reported to be approximately 4 - 24%. Attempting to locate canals following calcific metamorphosis and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. This review article describes the possible etiology of Calcific Metamorphosis, its clinical and radiographic features as well as its management.