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Endo Ortho Query

11 year old child undergoing ortho treatment. Came in with an acute alveolar abscess. Non surgical Retreatment of mandibular first molar. First visit removed all old filling material, second visit, cleaned, shaped and filled. No intra canal medicament. 3-month recall shows good healing. Ortho treatment stopped for 3 months because orthodontist wants to see the lesion heal.

Question: how soon can an endodontically treated teeth with an apical lesion be moved orthodontically? Is there really a need to wait? Opinions please

Teeth with previous root canal treatment exhibit less propensity for apical root resorption during orthodontic tooth movement. Minimal resorptive/remodelling changes occur apically in teeth that are being moved orthodontically and that are well cleaned, shaped, and three-dimensionally obturated. This outcome would depend on the absence of coronal leakage or other avenues for bacterial ingress.

International Endodontic Journal
Volume 32 Issue 5 Page 343 - September 1999
doi:10.1046/j.1365-2591.1999.00252.x

Review
Endodontic-orthodontic relationships: a review of integrated treatment
planning challenges
R. S. Hamilton* & J. L. Gutmann1

Literature review There is a paucity of information on the concise relationship between endodontics and orthodontics during treatment planning decisions. This relationship ranges from effects on the pulp from orthodontic treatment and the potential for resorption during tooth movement, to the clinical management of teeth requiring integrated endodontic and orthodontic treatment. This paper reviews the literature based on the definition of endodontics and the scope of endodontic practice as they relate to common orthodontic-endodontic treatment planning challenges. Literature data bases were accessed with a focus on orthodontic tooth movement and its impact on the viability of the dental pulp; its impact on root resorption in teeth with vital pulps and teeth with previous root canal treatment; the ability to move orthodontically teeth that were endodontically treated versus nonendodontically treated; the role of previous tooth trauma; the ability to move teeth orthodontically that have been subjected to endodontic surgery; the role of orthodontic treatment in the provision for and prognosis of endodontic treatment; and, the integrated role of orthodontics and endodontics in treatment planning tooth retention.

Orthodontic tooth movement can cause degenerative and/or inflammatory responses in the dental pulp of teeth with completed apical formation. The impact of the tooth movement on the pulp is focused primarily on the neurovascular system, in which the release of specific neurotransmitters (neuropeptides) can influence both blood flow and cellular metabolism. The responses induced in these pulps may impact on the initiation and perpetuation of apical root remodelling or resorption during tooth movement. The incidence and severity of these changes may be influenced by previous or ongoing insults to the dental pulp, such as trauma or caries. Pulps in teeth with incomplete apical foramen, whilst not immune to adverse sequelae during tooth movement, have a sreduced risk for these responses. Teeth with previous root canal treatment exhibit less propensity for apical root resorption during orthodontic tooth movement. Minimal resorptive/remodelling changes occur apically in teeth that are being moved orthodontically and that are well cleaned, shaped, and three-dimensionally obturated. This outcome would depend on the absence of coronal leakage or other avenues for bacterial ingress.A traumatized tooth can be moved orthodontically with minimal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treatment. If a previously traumatized tooth exhibits resorption, there is a greater chance that orthodontic tooth movement will enhance the resorptive process. If a tooth has been severely traumatized (intrusive luxation/avulsion) there may be a greater incidence of resorption with tooth movement. This can occur with or without previous endodontic treatment. Very little is known about the ability to move successfully teeth that have undergone periradicular surgical procedures. Likewise, little is known about the potential risks or sequelae involved in moving teeth that have had previous surgical intervention. Especially absent is the long-term prognosis of this type of treatment.

During orthodontic tooth movement, the provision of endodontic treatment may be influenced by a number of factors, including but not limited to radiographic interpretation, accuracy of pulp testing, patientsigns and symptoms, tooth isolation, access to the root canal, working length determination, and apical position of the canal obturation. Adjunctive orthodontic root extrusion and root separation are essential clinical procedures that will enhance the integrated treatment planning process of tooth retention in endodontic-orthodontic related cases.


Some useful information

1: J Endod. 2003 Mar;29(3):170-5.

A new solution for the removal of the smear layer.

Torabinejad M, Khademi AA, Babagoli J, Cho Y, Johnson WB, Bozhilov K, Kim J,
Shabahang S.

Department of Endodontics, School of Dentistry, Loma Linda University, CA 92350,
USA.

Various organic acids, ultrasonic instruments, and lasers have been used to
remove the smear layer from the surface of instrumented root canals. The purpose
of this study was to investigate the effect of a mixture of a tetracycline
isomer, an acid, and a detergent (MTAD) as a final rinse on the surface of
instrumented root canals. Forty-eight extracted maxillary and mandibular
single-rooted human teeth were prepared by using a combination of passive
step-back and rotary 0.04 taper nickel-titanium files. Sterile distilled water
or 5.25% sodium hypochlorite was used as intracanal irrigant. The canals were
then treated with 5 ml of one of the following solutions as a final rinse:
sterile distilled water, 5.25% sodium hypochlorite, 17% EDTA, or a new solution,
MTAD. The presence or absence of smear layer and the amount of erosion on the
surface of the root canal walls at the coronal, middle, and apical portion of
each canal were examined under a scanning electron microscope. The results show
that MTAD is an effective solution for the removal of the smear layer and does
not significantly change the structure of the dentinal tubules when canals are
irrigated with sodium hypochlorite and followed with a final rinse of MTAD.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 12669874 [PubMed - indexed for MEDLINE]