Download 144 root canal calcification and orthodontic treatment

144
ROOT CANAL CALCIFICATION AND ORTHODONTIC TREATMENT
H.M. Ahmed, BDS, MDS;* S.C. Savadi, BD5, MDS**
Hitherto, little attention has been given to the problem of canal calcification following orthodontic tooth
movement. The study of 50 consecutive patients undergoing orthodontic treatment, revealed the development of discrete canal calcification in 12 patients. The possible mechanism of canal calcification and its implications
are discussed.
Introduction
irregular and long treatment. Headgear therapy for
a prolonged period was used in one of the cases.
Orthodontic tooth movement is achieved through
different force systems which move the teeth to predetermined positions. The secondary changes
attributed to orthodontic treatment include root
resorption and periodontal problems which have
received considerable research attention and clinical concern. The effect of variation of therapeutic
forces on the pulp has been studied by very few
researchers. 1 Root canal calcification or dystrophic
mineralization of the pulp, which is a possible side
effect of orthodontic treatment is mentioned in
endodontic literature. 2
The purpose of this study was to evaluate the
effects of orthodontic therapy by removable and
fixed appliances on the pulp of the teeth. Thus,
determines whether canal calcification was just an
isolated problem, or a significant iatrogenic effect
of orthodontic therapy.
Complete canal calcification has been reported by
several authors 3-7 but a history of direct physical
trauma to the tooth could be elicited. Daugherty 8
reported that orthodontic trauma was severe
enough in very few cases to cause secondary
dentine deposition to the extent of obstructing the
entire pulp chamber. In 1982, Delvanis 1 reported
the complete calcification of the root canal in two
of the forty six cases treated by fixed appliances. Three
teeth had evidence of canal calcification to the
extent of canal obliteration. There was a history of
* Consultant Orthodontist,
Najran Dental Center,
NGH,
P.O.Box 508, Najran, Saudi Arabia
**Professor and Head, Department of Orthodontics, G.D.C.,
Bangalore, India
The Saudi Dental Journal, Vol. 2, No. 4, December 1990
Materials and Methods
A total of 50 patients, 18 males and 32 females,
were studied. Removable appliances were used in
35 patients [Fig. 1] and 15 patients were treated
by Begg’s differential force technique [Fig. 2]. All
50 patients were under retention for a minimum
period of six months. The age of the patients ranged
between 13 and 33 years at the time of treatment.
Teeth from central incisors to second bicuspids in
both arches were studied. Two-digit system of
nomenclature proposed by Federation Dentaire
Internationale was used for the sake of convenience.
Radiographic evaluation of the dentition was
performed with intraoral periapical radiographs
using short cone X-ray plant. A standardized procedure was followed to have identical projections
of roentgenograms before and af ter orthodontic
treatment. Distortion of film was kept to minimum.
An exposure of 0.8 sec. was given in all cases.
ROOT CANAL CALCIFICATION AND ORTHODONTIC TREATMENT
145
Figure 1. Photograph of study casts before and after treatment
with removable appliance.
Figure 3.
Intraoral periapical radiograph showing discrete
canal calcification.
Figure 2. Photograph of study casts before and after treatment
with fixed appliance.
Figure 4.
The changes in the radiographs were seen with
the help of a magnifying lens in comparing the pretreatment and post-treatment radiographs. Films
were separately studied by three calibrated individuals and compared only after all opinions have
been tabulated. A majority’s opinion determined
the categor y. Root canal calcification was
categorized into:
tion were four upper right central incisors, followed
by three upper left central incisors, two lower right
central incisors, and one each of lower left central,
lower lef t lateral and lower right lateral incisor
[Table 1]. The incidence of calcification was higher
(10 teeth-1.56%) in patients treated by removable
appliances The teeth affected were four upper right
central incisors, two upper left central incisors, one
lower left central incisor, two lower right central
incisors, and one lower right lateral incisor. Incidence of discrete canal calcification was lower in
fixed appliance treated cases 2 teeth (0.74%), One
upper left central incisor and one left lower central
incisor were affected by discrete canal calcification.
In the patients affected, no history of physical
trauma prior to orthodontic treatment could be elicited and none of them had prolonged treatment.
1.
Discrete calcification [Fig. 3]: Localized areas
of calcifications in the root canal which were
not sufficient to completely obliterate the root
canal.
2.
Diffuse calcification [Fig.4]: Calcification caused
complete obliteration of the root canal.
Results
A total of 910 teeth (450 in maxilla and 460 in
mandible) were studied. None of the teeth studied
was affected by diffuse calcification. Discrete calcification was seen in twelve teeth, seven in the
maxillary arch and five in the mandibular arch. The
maximum teeth affected by discrete canal calcifica-
The Saudi Dental Journal, Vol. 2, No. 4, December 1990
Illustration showing diffuse canal calcification.
Discussion
The incidence of canal calcification increases
with age 2 and it is also known to occur following
trauma to the teeth. However, in our patients, who
H.M.AHMED AND S.C.SAVADI
146
Table 1. Incidence of canai calcification.
Canal
Calcification
Discrete
Remo- Fixed
vable
appliances are less variable and can be precisely
controlled.
Tooth
Type
Total
No
11
50
4
0:0
4
21
50
2
1
0:0
3
31
50
1
0:0
0:0
1
41
50
2
0:0
0:0
2
12
50
0:0
0:0
0:0
0:0
22
50
0:0
0:0
0:0
0:0
32
50
0:0
1
0:0
1
42
50
1
0:0
0:0
1
13
50
0:0
0:0
0:0
0:0
23
50
0:0
0:0
0:0
0:0
33
50
0:0
0:0
0:0
0:0
43
50
0:0
0:0
0:0
0:0
14
29
0:0
0:0
0:0
0:0
24
29
0:0
0:0
0:0
0:0
34
32
0:0
0:0
0:0
0:0
44
32
0:0
0:0
0:0
0:0
15
46
0:0
0:0
0:0
0:0
25
46
0:0
0:0
0:0
0:0
35
48
0:0
0:0
0:0
0:0
45
48
0:0
0:0
0:0
0:0
450
6
1
0:0
Total Mandibular Teeth 460
4
1
0:0
5(1.09%)
0:0
12(1.32%)
Total Maxil lary Teeth
Grand Total
0:0
910
10(1.09%) 2(0.21%)
* Removable
640
10(1.56%)
**Fixed
270
2(0.74%)
Diffuse
Total
It is possible to diagnose the narrowing of the
canal space by constant monitoring, in the patients
undergoing orthodontic treatment or retention. The
diagnosis of discrete canal calcification during
active treatment or retention calls for the opinion
of a competent endodontist. The endodontic treatment at this stage may be of conservative nature
only. Once complete obliteration of the root canal
has taken place, conservative endodontic treatment is not possible and the tooth becomes discolored and unacceptable to the patient. Surgical
intervention with retrograde amalgam filling 9 and
even extraction with prosthetic replacement may
be necessary.
The importance of early diagnosis of canal calcification during orthodontic treatment is obvious.
The authors feel that constant monitoring of the
patients undergoing active orthodontic treatment
or during retention should become a routine practice. Monitoring will lead to an early diagnosis of
a narrowing canal and save the patient from the
psychological trauma and the orthodontist from
the blame of negligence. The exact cause and ultimate fate of the canal calcification needs to be
studied further.
7(1.56%)
References
1.
2.
were of a young age group, there was no history
of trauma except the orthodontic tooth movement.
As reported by Ingle, 9 the trauma which was insufficient to devitalize the pulp may stimulate it to lay
down reparative dentine eventually obliterating the
entire pulp and root canal. Calcification usually
begins in the coronal portion of the pulp and
extends towards the apex however, it may have an
irregular distribution. 4 The increased incidence of
canal calcification in our patients treated with
removable appliances may be due to the variation
in forces generated by these appliances. On the
other hand, forces generated by the fixed
The Saudi Dental Journal, Vol. 2, No. 4, December 1990
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