Download Orthodontic Endodontic Relationship

Orthodontic Endodontic
Relationship
Dr.Deema Ali Al-Shammery
BDS,MSc Lecturer in Orthodontics,Riyadh colleges of Dentistry and Pharmacy
OUTLINE:
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Introduction
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Case
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Orthodontics consideration
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Summary
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Acknowledgment
Introduction:
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There is lack of information on the relationship between
endodontics and orthodontics during treatment planning
decisions.
This relationship ranges from :
Effects on the pulp from orthodontic treatment
The potential for resorption during tooth movement,
Clinical management of teeth requiring integrated
endodontic and orthodontic treatment.
Introduction:
Orthodontic tooth movement can cause degenerative
and/or inflammatory responses in the dental pulp of Teeth.
 Primarily on the neurovascular system.
 Orthodontically induced inflammatory root resorption is one
of complications induced by orthodontic treatment.
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Introduction:

Do you believe that root restoration is
unavoidable during orthodontic treatment?
Introduction:
Introduction:
Introduction:
Microscopic root resorption is characteristic
to all permanent teeth during orthodontic treatment.
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It is clinically insignificant and radiologically invisible,
orthodontic teeth movement couldn’t occur without
this resorption.
Introduction:
Severe root resorption during orthodontic
treatment (more than ¼ of the root length, >5 mm) occurs
very rarely, just in 1-5 % of patients Nigul K, Jagomagi T :2006
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Case
A 12-year-old girl was referred from
orthodontic department, for severe
pain and abscess related to maxillary
right central incisor.
The medical history was
unremarkable. The dental history
revealed history of previous
trauma and orthodontic
treatment two years ago.
Case
Treatment:
 Revascularization procedure.
 is a likely near-term
dental treatment that will
bring widespread application of
tissue engineering principles to regenerative dentistry
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(Murray et al. 2007; Sloan and Smith 2007; Huang 2008).
Case
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It is attempt to preserve the potentially remaining dental pulp
stem cells and mesenchymal stem cells of the apical papilla can
result in canal revascularization and the completion of root
maturation Sonoyama et al. 2006; Huang et al. 2008)

It has been evidence indicating that regeneration is a better
alternative to conventional calcium hydroxide apexification
exists in immature permanent teeth exhibiting periapical
pathology .Shah et al. 2008)
Case
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1 year after regeneration therapy shows thickening of dentinal
walls with a reestablishment of the periodontal ligament space
and lamina dura was observed. Root maturation is visible and
resolution of periapical radiolucency are evident.
Case
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Continuo the orthodontic treatment
for #11 again
Case
2 years post operative follow up
Case
Orthodontic consideration:
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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. Hamilton & Gutmann :1999
Orthodontic consideration:
Orthodontic management of teeth with open apex?
Orthodontic consideration:

No contraindication to perform orthodontic treatment in conjunction
with apexification procedures. 10-14 days later tooth movement can
be resumed
Donald R, 1986
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What about Endodontic Regeneration and
Active Orthodontic Treatment?
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Orthodontic consideration:
Orthodontic consideration:
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Orthodontic consideration:
Orthodontic consideration:
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Discontinuous force application produced significantly
less RR than. Continuous force.
All studies found that light forces produced significantly
less RR than heavy forces .
Pause during the treatment: studies showed that the
amount of RR was significantly less in patients treated
with a Pause than in those treated with continuous forces
without a pause . Weltman et al 2010
Orthodontic consideration:
Progress radiographs obtained after 6 to 12
months might detect early OIIRR.
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Orthodontic consideration:
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If severe resorption is identified, the treatment plan
should be reassessed with the patient.
Alternative options might include prosthetic solutions to
close spaces, releasing teeth from active archwires if
possible, stripping instead of extracting, and early fixation
of resorbed teeth. Harris EF, et al 1997
Summary
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Understanding of the orthodontic endodontic
relationship is essential for the success of the treatment.
Successful treatment can’t be provided without proper
communication and team work.
Acknowledgment:
• Dr.Musaed Al-Tammami, Endodontic
resident, Saudi Board Of Endodontics.
Thank You