This document discusses the relationships between endodontics and orthodontics. It covers topics like how orthodontic forces can affect the tooth pulp and cause inflammation or necrosis. It also addresses endodontic considerations for working length determination and access preparation when teeth are undergoing orthodontic movement. The document describes combined endodontic-orthodontic procedures like forced eruption and ankylosis of primary teeth to provide anchorage. It emphasizes the need for periodic monitoring of teeth during orthodontic treatment to check for any root resorption or periapical lesions.
Endodontic - orthodontic relation /certified fixed orthodontic courses by Indian dental academy
1. ENDODONTIC –
ORTHODONTIC
RELATIONSHIPS
INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
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2. CONTENTS
INTRODUCTION
EFFECT OF ORTHODONTICS ON THE TOOTH
BEING MOVED
ENDODONTIC CONSIDERATIONS RELATED
TO ORTHODONTICS
COMBINED ENDO - ORTHO THERAPY
CONCLUSION
REFERENCES
3. INTRODUCTION
Orthodontic treatment
The expanding role of endodontics
Two major areas where Endodontics &
Orthodontics share
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4. EFFECT OF ORTHODONTICS ON THE
TOOTH BEING MOVED
CAUSES AND EFFECT OF
ORTHODONTIC FORCES ON PULP
Degenerative or inflammatory
responses in the dental pulp
Impact of the tooth movement on the
pulp
5. CAUSES OF PULP NECROSIS
Heavy continuous force
Distal tipping of incisor
Heat generated by grinding during
removal of ceramic brackets
Labiolingual expansion appliance
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6. EFFECT ON PULP
Degree of dentinogenic activity
depends on the respiratory role of pulp
cells
Pulp changes appear to be more
severe with greater orthodontic force
Alternation in pulpal vasculature with
subsequent alternation in metabolism of
pulpal cells
Pulp is very resilient, has greater
potential for healing
7. EVIDENCE OF PULP INVOLVEMENT
Increased sensitivity
Decreased pulp space
Periapical radiolucency
Internal resorption
9. EXTENT OF TOOTH MOVEMENT
Directly proportional to the distance
through roots are moved.
TREATMENT DURATION
Directly related to the treatment
duration
ROLE OF NEUROPEPTIDES
Sensory A – delta, C-fibres and
sympathetic neurons
10. ROLE OF PHARMACOLOGICAL AGENTS
NSAID’s
Alcohol
Corticosteroids
ENDODONTIC TREATMENT &
ORTHODONTIC ROOT RESORPTION
Tooth with root canal treatment
Previously traumatized or avulsed tooth
Teeth that have been managed by
surgical endodontic procedure
11. TYPE OF CEMENTUM
Acellular and cellular
AGE
Resorption found more in older children
than in younger children
TYPE OF APPLIANCE
Fixed appliances are more detrimental
to the roots
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12. MAGNITUDE OF FORCE
Continuous heavy forces cause
resorption
DIRECTION OF FORCE
Prolonged tipping or intrusion
movement www.indiandentalacademy.com
13. ENDODONTIC CONSIDERATIONS
RELATED TO ORTHODONTICS
WORKING LENGTH DETERMINATION
Apical constriction destroyed
Resorption on buccal and lingual
aspect
RADIOGRAPHIC INTERPRETATION
Reflect osseous changes
ACCURACY OF PULP TESTING
Presence of full metallic bands
14. TOOTH ISOLATION
Tooth isolation compromised
ACCESS TO ROOT CANAL
Alternation in access
DENS-IN DENTIN
Internal resorption during orthodontic
movement
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15. RISK OF RESORPTION
Risk of external apical resorption
during movement of any teeth
PRECAUTIONS DURING ORTHODONTIC
TREATMENT
Periodical periapical radiographs
Incases of severe resorption
Rest periods of 2 – 3 months
If resorption persists
16. ENDODONTIC – ORTHODONTIC
COMBINED THERAPY
FORCED ERUPTION
Angle 1900
Revised by Heithersay and Ingber
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17. INDICATIONS
Teeth with advanced caries
Traumatic destruction of clinical crown
Lateral root perforation
External and internal root resorption
near alveolar crest
Over zealous tooth preparation
Isolated infrabony defects
18. Eliminates the need for periodontal
surgery
Extrusion – easiest orthodontic
movement to achieve
20 – 30gram force required
Preferred only in anteriors and
premolars www.indiandentalacademy.com
19. BASIC PERIODONTAL
PRINCIPLE FOR FORCED
ERUPTION
Biological width -
combined dimension of
supra alveolar gingival
connective tissue and
junctional epithelium –
2.04mm
When the margin of
restoration being placed,
very important to
maintain the health and
integrity of biological
20. Distance from alveolar crest to the
coronal extent of the tooth
structure should be > 4mm
Biological width moves with the tooth
as the tooth moved under control
orthodontic force
End results of forced eruption
contributes more cosmetic and
physiological restoration compared to
periodontal surgery
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21. BASIC ENDODONTIC PRINCIPLES FOR
FORCED ERUPTION
Teeth that require endodontic therapy
should have treatment prior to initiation of
tooth movement
Teeth with subalveolar fracture may have
endodontic therapy through the clinical
crown.
No contraindication to complete
endodontic therapy while tooth undergoing
orthodontic movement
Gutta-percha is the filling material of
choice
22. BASIC ORTHODONTIC PRINCIPLES FOR
TOOTH MOVEMENT
Estimate amount of attachment
apparatus remaining at the completion of
tooth movement must be made
No tooth movement should be started –
unless retention and stabilization
Adequate anchorage must be available
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23. Uprighting and correction of axial tooth
position
This movement occurs in a vertical plane
Only light force should be used to
extrude the tooth (20 – 30gm)
Stabilization of forced erupted tooth
prevents root back into the alveolus
Minimum of 6 weeks of stabilization
24. PROCEDURE
If there is excessive destruction of clinical
crown
A snughly fitting customized or
prefabricated post is cemented
25. Brackets with horizontal slots are placed on
multiple teeth
Elastic ligature code tide from the loop to
the rigid arch wire
Anchorage at least two teeth on either side
of the tooth to be erupted
28. REGAINING INTERPROXIMAL SPACE
Described by Reagan
INDICATION
A long standing carious lesion on the
proximal surface results in migration
of adjacent teeth into the void created by
the caries.
29. PROCEDURE
A core or foundation restoration placed
in the tooth requiring restoration
Tooth prepared for a full crown
30. An acrylic crown fabricated, cemented and
then an orthodontic separator inserted into
the proximal space.
At subsequent appointment elastic is
removed and a piece of 0.6mm brass wire
threaded between the teeth apical to contact.
31. Wire is twisted together until the patient
feels pressure
At approximately 1week intervals, wire is
tightened until tooth shows no
movement
Provisional restoration removed and the
crown buildup back into contact with
adjacent tooth.
32. Brass wire reapplied, as the tooth tipped,
it may move upward into the occlusal
plane, as it does adjust occlusally.
Then the full crown as the final
restoration fabricated and cemented
33. THERAPEUTIC ANKYLOSIS OF PRIMARY
TEETH
Kokich first gave the concept
Sheller and Omnell gave detailed
indications
INDICATIONS
In young patients with mild
to moderate retrusion
of the maxilla
34. Anchorage obtained by ankylosing primary
canines
Produces skeletal rather than dental
movement
PROCEDURE
Under LA and mild sedation primary canines
extracted
Endodontic treatment performed extraorally
35. A hook bonded to the labial surface of canine
Before reimplantation periodontal ligament
curetted, apical 2mm cut off, blood clot
removed from the socket
Tooth stabilized for 4-5 weeks
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36. Protraction starts 8 weeks after surgery
Check the occlusion
Retention of ankylosed ranged between 4-36
months
Time required for protraction about 6 months,
ranging from 4 – 12 months
37. CONCLUSION
A major percentage of orthodontic patients
presents a problem in terms of root resorption during
functional and esthetic benefits of the orthodontic
treatment. It is recommended that periodical
radiographic and careful clinical examination should
be done for any incipient periapical lesions and to
verify any unusual changes in pulp.
A combined endodontic – orthodontic therapy
permits placement of a restoration that fulfills the
periodontal and occlusal requirements of the tooth.
38. REFERENCES
Endodontic therapy, Franklin S.Weine, Mosby,
Pub.
Future and advancement in conservative dentistry
and endodontics (FACE 2)
E.M. Al-wal, Internal root resorption from palatal
invagination, JCO, 1989 Dec. 802 – 803.
Wein G et al, Forced eruption – an alternative to
extraction or periodontal surgery. JCO, 1992 Mar.
1-4.
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39. W. Popp et al, Pulpal response to orthodontic
tooth movement, AJO, 1992 Mar. 1-7.
Naphtali et al, Orthodontically induced
inflammatory root resorption, Angle Orthodontist, 2002;
72 : 175 – 184.
Barbara Sheller, Therapeutic ankylosis of primary
teeth, JCO, 1991 Aug. 499 - 502.