Endodontic complications associated with orthodontic treatment: A systematic review

Abstract

Background: Orthodontic tooth movement produces biological responses within the periodontal ligament and dental pulp that are usually transient and reversible; however, in certain situations these changes may progress to irreversible endodontic complications such as pulp necrosis or external root resorption.Aims and Objectives: To systematically evaluate the types, frequency, mechanisms, and clinical determinants of endodontic complications associated with orthodontic treatment. Methodology: A search was conducted in line with the 2020 PRISMA guidelines. Human clinical studies on pulpal or periapical effects of orthodontic treatment were retrieved using electronic searches in PubMed, Scopus, Web of Science and the Cochrane Library. Observational, cohort, case-control and randomized clinical studies were considered for inclusion while animals, in vitro and secondary review papers were excluded. Reviewers conducted study selection, data collection and risk of bias in duplicate. Due to methodological variability, results were integrated in a qualitative synthesis.Results: Fifteen primary clinical research pieces were integrated. The most common complication was external apical root resorption, which correlated with duration of orthodontic therapy, amount of the force and tooth shape as well as periodontium trauma. Pulp necrosis and calcific transformation were rare events only observed in previously traumatized or biologically challenged teeth. In general, transient and reversible pulpal reactions during orthodontic therapy did occur.Conclusion: Orthodontic treatment is generally biologically safe for pulpal and periapical tissues when appropriate diagnosis, controlled biomechanics, and periodic radiographic monitoring are employed. Nevertheless, careful individual risk assessment and further well-designed prospective studies are required to clarify long-term endodontic outcomes.