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Golež A, Ovsenik M, Cankar K. Effect of orthodontic space closure on dental pulp sensitivity. Prospective clinical trial. Orthod Craniofac Res 2024. [PMID: 38634207 DOI: 10.1111/ocr.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Orthodontic tooth movement (OTM) is a biological process that can influence the function of the pulp, including its innervation. The excitability of the nerve fibres of the pulp may be altered by forces exerted on the nerve fibres or by reduced blood flow to the pulp. The aim of this clinical study was to evaluate the sensitivity of the dental pulp during levelling and during the phase of space closure, to assess the role of certain controlled risk factors. METHODS Twenty-two adolescent participants requiring orthodontic space closure in transcanine sector were enrolled in a prospective clinical study. Patients were observed before OTM, after levelling and 1 month during active space closure. The sensitivity threshold of the pulp was measured using the electric pulp test (EPT). Dental models were obtained using an intraoral scanner, allowing measurement of interdental distances and calculation of OTM speed. The teeth were categorized according to position and tooth type. RESULTS The EPT values increased significantly during orthodontic treatment (one-way RM-ANOVA, P = .014). There was a significant difference in EPT values between the tooth categories. Teeth with a single root adjacent to the residual space had the highest EPT thresholds (two-way RM-ANOVA, P < .001; Holm-Sidak, P < .05). CONCLUSIONS OTM reduced pulpal sensitivity. Pulpal sensitivity during active space closure was similar to sensitivity during the levelling phase. The pulpal sensitivity of molars was less affected by OTM than that of single-rooted teeth, while teeth closer to the gap had a significantly higher pulpal sensitivity threshold during active OTM.
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Affiliation(s)
- Aljaž Golež
- Faculty of Medicine, Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
- Orthos Institute, Ljubljana, Slovenia
| | - Maja Ovsenik
- Orthos Institute, Ljubljana, Slovenia
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ksenija Cankar
- Faculty of Medicine, Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
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Zhu Z. Transient apical breakdown of a discoloured maxillary central incisor during orthodontic treatment: A case report. AUST ENDOD J 2023; 49 Suppl 1:476-480. [PMID: 36807463 DOI: 10.1111/aej.12740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 02/20/2023]
Abstract
Transient apical breakdown (TAB) appears to be a repair process taking place in the pulp and periapical area of traumatised teeth which may display crown discoloration and have no responses to pulp sensitivity tests. Few TAB cases induced by orthodontic forces have been reported so far. Presented is a case report in which TAB occurred on the maxillary right central incisor during orthodontic treatment. The affected tooth suddenly displayed crown discoloration and had no response to pulp testing at 6 weeks after the placement Invisalign Clear Aligner appliances. Condition of the discoloured tooth was monitored by periodic recall examinations without any active treatment. Six months after the occurrence of discoloration, the affected tooth recovered to its original shade and responded normally to pulp sensitivity tests.
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Affiliation(s)
- Zufeng Zhu
- Department of Stomatology, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, China
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Taylor L, Liu L, Goldschmidt S. Success of orthodontic treatment of linguoverted mandibular canine teeth using a direct inclined plane appliance. Front Vet Sci 2023; 10:1224391. [PMID: 37635761 PMCID: PMC10448896 DOI: 10.3389/fvets.2023.1224391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
This study evaluated the success rate of orthodontic treatment of linguoverted mandibular canines in dogs using a directly applied inclined plane device. Medical records were retrospectively evaluated at 11 veterinary dental specialty hospitals from 1999 to 2021. Malocclusion classes included 41.7% in class 1, 47.2% in class 2, 6.9% in class 3, and 4.2% in class 4. The severity of linguoversion was mild in 7.6% of teeth, moderate in 33.9%, and severe in 58.5%. There was complete resolution of linguoversion in 71.2% of teeth, functional resolution in 25.4%, and failure in 3.4%. The median treatment time was 42 (11-174) days. Adjuvant orthodontic treatments were performed at the same time as the inclined plane in 45.7% of teeth, including active force orthodontics, extractions of non-strategic teeth, gingivectomy, and odontoplasty. While the inclined plane was in place, 31.4% of dogs required an anesthetized appliance adjustment, and at the time of appliance removal, complications occurred in 19.4% of dogs. Of the teeth that had initial resolution, 14.4% had rebound movement that required additional treatment. This study supports the idea that an acrylic inclined plane is a good treatment option for linguoverted mandibular canines, with a 96.6% success rate within a median of 6 weeks. Yet, orthodontic retention may be necessary in these cases to avoid the need for additional therapies.
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Affiliation(s)
- Leah Taylor
- Texas Veterinary Dental Center, Stafford, TX, United States
| | - Lan Liu
- School of Statistics, University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Stephanie Goldschmidt
- Department of Surgical and Radiologic Sciences, University of California, Davis, Davis, CA, United States
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Duarte PHM, Weissheimer T, Michel CHT, Só GB, da Rosa RA, Só MVR. Do orthodontic movements of traumatized teeth induce dental pulp necrosis? A systematic review. Clin Oral Investig 2023; 27:4117-4129. [PMID: 37335397 DOI: 10.1007/s00784-023-05102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Usually, orthodontic movements encompass children and young adult patients, which are more susceptible to the occurrence of traumatic dental injuries. It is necessary to understand whether the effects of orthodontic movements on traumatized teeth could induce pulp necrosis. The aim of this study was to answer the following question: "Do orthodontic movements of traumatized teeth induce dental pulp necrosis?". MATERIAL AND METHODS Searches were performed for studies published up to May 11, 2023, in the MEDLINE/PubMed, Cochrane Library, Scopus, SciELO Citation Index, Web of Science, EMBASE, and Grey Literature Report databases, without restriction for language or year of publication. The revised Cochrane risk of bias tools for nonrandomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS Of 2671 potentially relevant studies, five were included. Four were classified as having a moderate risk of bias and one as a serious risk of bias. It was reported a higher susceptibility to pulp necrosis in teeth subjected to orthodontic movements with history of trauma involving periodontal tissues. Additionally, orthodontic movements of traumatized teeth with total pulp obliteration had an increased risk of pulp necrosis. GRADE analysis presented a moderate certainty of evidence. CONCLUSIONS An increased risk for pulp necrosis when traumatized teeth are subjected to orthodontic movements was verified. However, this is based on evaluations performed with subjective tests. Further well-designed studies are necessary to confirm this trend. CLINICAL RELEVANCE Clinicians must be aware of the possibility of pulp necrosis. However, endodontic treatment is recommended when verified signs and symptoms of pulp necrosis.
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Affiliation(s)
- Pedro Henrique Marks Duarte
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Department of Conservative Dentistry, Federal University of Rio Grande Do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, Rio Grande Do Sul, RS, 90035-003, Brazil.
| | - Carolina Horn Troian Michel
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriel Barcelos Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
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Parashos P. Endodontic-orthodontic interactions: a review and treatment recommendations. Aust Dent J 2023; 68 Suppl 1:S66-S81. [PMID: 37961018 DOI: 10.1111/adj.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Abstract
The literature is replete with articles describing the many and varied interactions between endodontic treatment and orthodontic tooth movement (OTM), often reporting conflicting views and findings, which creates confusion for clinicians. Original research and review articles have described aspects such as apical root resorption and potential pulpal complications of teeth related to OTM. Some interactions are of relatively minor clinical significance, whilst others may have adverse consequences. A history of dental trauma before or during OTM further complicates the interactions. This review re-assesses the historical literature on endodontic-orthodontic interactions in light of more recent research and presents guidelines for managing clinical situations involving both disciplines. © 2023 Australian Dental Association.
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Affiliation(s)
- P Parashos
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Alattas MH. Pulp Changes Secondary to Orthodontic Forces: A Review of Literature. Cureus 2023; 15:e40573. [PMID: 37465810 PMCID: PMC10351915 DOI: 10.7759/cureus.40573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
This review article encompasses the literature pertaining to changes in the dental pulp subsequent to forces exerted secondary to orthodontic treatment. The review was conducted at the College of Dentistry, Qassim University, Saudi Arabia, from October 2022 to February 2023. A literature search was conducted on PubMed, Embase, The Cochrane Library and Google Scholar for articles from 2000 to 2023. Keywords and MeSH terms used were 'orthodontic forces', 'pulp changes', 'dental pulpal changes', and 'pulp volume'. Two reviewers went through the titles. After removing irrelevant and duplicate articles, abstracts were assessed for relevant articles. Finally, the reviewers analyzed full-text articles, and a total of five articles including four randomized controlled trials and one retrospective study were selected. It was concluded that managing and minimizing injury to the pulp or supporting tissues is important when using orthodontic mechanics. In order to do so, clinicians must thoroughly understand any change in the pulpal tissue following the orthodontic treatment. Orthodontic tooth movements cause inflammatory changes in the tooth pulp and periodontal ligament which are directly related to the amount, direction, and time duration of force used. Long-term pulp blood flow analysis shows that even though there is a transient uptrend in the flow of blood after the removal of the orthodontic force, it reverts to normal levels three months later. However, pulp volume has been reported to decrease, more prominently in anterior teeth, as orthodontic forces stimulate the pulp to produce tertiary dentin.
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Moga RA, Olteanu CD, Botez M, Buru SM. Assessment of the Maximum Amount of Orthodontic Force for Dental Pulp and Apical Neuro-Vascular Bundle in Intact and Reduced Periodontium on Bicuspids (Part II). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1179. [PMID: 36673936 PMCID: PMC9859427 DOI: 10.3390/ijerph20021179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 06/01/2023]
Abstract
This study examines 0.6 N-4.8 N as the maximum orthodontic force to be applied to dental pulp and apical NVB on intact and 1-8 mm reduced periodontal-ligament (PDL), in connection with movement and ischemic, necrotic and resorptive risk. In addition, it examines whether the Tresca finite-element-analysis (FEA) criterion is more adequate for the examination of dental pulp and its apical NVB. Eighty-one (nine patients, with nine models for each patient) anatomically correct models of the periodontium, with the second lower-premolar reconstructed with its apical NVB and dental pulp were assembled, based on X-ray CBCT (cone-beam-computed-tomography) examinations and subjected to 0.6 N, 1.2 N, 2.4 N and 4.8 N of intrusion, extrusion, translation, rotation, and tipping. The Tresca failure criterion was applied, and the shear stress was assessed. Forces of 0.6 N, 1.2 N, and 2.4 N had negligible effects on apical NVB and dental pulp up to 8 mm of periodontal breakdown. A force of 4.8 N was safely applied to apical NVB on the intact periodontium only. Rotation and tipping seemed to be the most invasive movements for the apical NVB. For the dental pulp, only the translation and rotation movements seemed to display a particular risk of ischemia, necrosis, and internal orthodontic-resorption for both coronal (0-8 mm of loss) and radicular pulp (4-8 mm of loss), despite the amount of stress being lower than the MHP. The Tresca failure criterion seems more suitable than other criteria for apical NVB and dental pulp.
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Affiliation(s)
- Radu Andrei Moga
- Department of Cariology, Endodontics and Oral Pathology, School of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Str. Motilor 33, 400001 Cluj-Napoca, Romania
| | - Cristian Doru Olteanu
- Department of Orthodontics, School of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Str. Avram Iancu 31, 400083 Cluj-Napoca, Romania
| | - Mircea Botez
- Department of Structural Mechanics, School of Civil Engineering, Technical University of Cluj-Napoca, Str. Memorandumului 28, 400114 Cluj-Napoca, Romania
| | - Stefan Marius Buru
- Department of Structural Mechanics, School of Civil Engineering, Technical University of Cluj-Napoca, Str. Memorandumului 28, 400114 Cluj-Napoca, Romania
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Huokuna J, Loimaranta V, Laine MA, Svedström-Oristo AL. Adverse effects of orthodontic forces on dental pulp. Appearance and character. A systematic review. Acta Odontol Scand 2022; 81:267-277. [PMID: 36436210 DOI: 10.1080/00016357.2022.2137232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To comprehensively assess recent data on the effects of orthodontic forces on the dental pulp and to critically evaluate, whether any of the changes are permanent. MATERIALS AND METHODS Articles published between 2/2009 and 2/2022 were searched electronically on the PubMed, EMBASE and SCOPUS databases. The initial search retrieved 780 publications and, applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 relevant articles were identified. Twenty articles fulfilled the requirements for high (n = 1) or moderate (n = 19) methodological quality and were included. All assessments were made independently by three researchers. RESULTS Orthodontic forces appeared to cause a reduction in pulpal blood flow and a reduction in tooth sensibility, as indicated by increased response thresholds and increased amounts of negative responses to tooth sensibility tests. In addition, there were increases in the expression or activity levels of enzymes and neuropeptides associated with hypoxia and inflammation. Fibrotic tissue formation in the pulp was also reported. CONCLUSIONS Except for some histological and morphological alterations, the observed pulpal changes were in most cases only temporary, appearing within days of initiating the treatment and usually lasting for weeks. There were no clear signs of permanent damage.
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Affiliation(s)
- Jukka Huokuna
- Institute of Dentistry, University of Turku, Turku, Finland
| | | | - Merja A. Laine
- Institute of Dentistry, University of Turku, Turku, Finland
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Moga RA, Buru SM, Olteanu CD. Assessment of the Best FEA Failure Criteria (Part II): Investigation of the Biomechanical Behavior of Dental Pulp and Apical-Neuro-Vascular Bundle in Intact and Reduced Periodontium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315635. [PMID: 36497708 PMCID: PMC9738171 DOI: 10.3390/ijerph192315635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/01/2023]
Abstract
The aim of this study was to biomechanically assess the behavior of apical neuro-vascular bundles (NVB) and dental pulp employing Tresca, Von Mises, Pressure, S1 and S3 failure criterions in a gradual periodontal breakdown under orthodontic movements. Additionally, it was to assess the accuracy of failure criteria, correlation with the maximum hydrostatic pressure (MHP), and the amount of force safe for reduced periodontium. Based on cone-beam computed tomography, 81 3D models of the second lower premolar were subjected to 0.5 N of intrusion, extrusion, rotation, tipping, and translation. A Finite Elements Analysis (FEA) was performed. In intact and reduced periodontium apical NVB, stress (predominant in all criteria) was significantly higher than dental pulp stress, but lower than MHP. VM and Tresca displayed identical results, with added pulpal stress in translation and rotation. S1, S3 and Pressure showed stress in the apical NVB area. 0.5 N seems safe up to 8 mm periodontal breakdown. A clear difference between failure criteria for dental pulp and apical NVB cannot be proved based only on the correlation quantitative results-MHP. Tresca and VM (adequate for ductile materials) showed equivalent results with the lowest amounts of stress. The employed failure criteria must be selected based on the type of material to be analyzed.
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Affiliation(s)
- Radu Andrei Moga
- Department of Cariology, Endodontics and Oral Pathology, School of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Str. Motilor 33, 400001 Cluj-Napoca, Romania
| | - Stefan Marius Buru
- Department of Structural Mechanics, School of Civil Engineering, Technical University of Cluj-Napoca, Str. Memorandumului 28, 400114 Cluj-Napoca, Romania
| | - Cristian Doru Olteanu
- Department of Orthodontics, School of Dental Medicine, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Str. Avram Iancu 31, 400083 Cluj-Napoca, Romania
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Guo R, Yu Q, Lin Y, Li J, Huang Y, Li W. Pulp blood flow changes in maxillary and mandibular anterior teeth after orthodontic retraction: a prospective study. BMC Oral Health 2022; 22:508. [PMCID: PMC9670555 DOI: 10.1186/s12903-022-02559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Previous studies of pulpal blood flow (PBF) changes in anterior teeth have been limited in the early phase of orthodontic treatment; less is known about the blood supply of anterior teeth in bimaxillary protrusion patients after orthodontic retraction.
Methods
Fifty bimaxillary protrusion patients (25 orthodontic patients ready for debonding and 25 non-orthodontic patients) were selected as study participants. The PBF of maxillary and mandibular anterior teeth were measured using laser Doppler flowmetry. For orthodontic patients, the PBF was measured at 1 day (T1), 1 month (T2), and 3 months (T3) after fixed appliance removal. Non-orthodontic patient PBF was measured as a control. Cone-beam computed tomography (CBCT) examinations before and after orthodontic treatment were performed for orthodontic patients to measure the root resorption. The anterior teeth in orthodontic group were further divided into subgroups according to root resorption and patient age.
Results
At T1 and T3, PBF changes did not differ significantly between the orthodontic and non-orthodontic groups. Maxillary lateral incisor, maxillary central incisor, and mandibular lateral incisor PBFs at T2 were significantly higher in the orthodontic group (P = 0.048, P = 0.04, and P = 0.021). No significant difference in PBF was found between the root resorption and non-resorption subgroups at any time point. Adolescent patients showed a higher PBF in the maxillary lateral incisor at T2 (12.23 ± 3.48) relative to that at T1 (9.10 ± 3.76) and T3 (9.81 ± 2.80) with statistically significant difference (P = 0.020).
Conclusion
For bimaxillary protrusion patients with four premolars extraction, PBF in the maxillary anterior teeth increased transiently after orthodontic appliance removal and then returned to non-orthodontic levels 3 months later. This effect was more pronounced in adolescents. The PBF of anterior teeth after orthodontic retraction may not be influenced by root resorption.
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Long term complications of previously successful regenerative endodontic procedures after orthodontic movement. Report of three different complications after 4, 8 and 11 years respectively. J Endod 2022; 48:951-960. [DOI: 10.1016/j.joen.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
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de Andrade Vieira W, Oliveira MB, Machado LDS, Cericato GO, Lima IFP, Paranhos LR. Pulp changes from rapid maxillary expansion: A systematic review. Orthod Craniofac Res 2021; 25:320-335. [PMID: 34874608 DOI: 10.1111/ocr.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/06/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aimed to systematically review the current evidence on the occurrence of pulp changes as side effects from orthopaedic rapid maxillary expansion (ORME) or surgically assisted rapid maxillary expansion (SARME). METHODS An electronic search was performed in eleven databases. The eligibility criteria included clinical studies assessing vitality, sensibility or dimensions of the pulp chamber of permanent teeth before and after ORME or SARME, without restrictions on publication year or language. The risk of bias was analysed with the NIH 'Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group' and the 'JBI for quasi-experimental studies' tool. The GRADE tool was used to assess the certainty of evidence. RESULTS The initial search resulted in 1,197 records, from which only seven before-after studies were included. There was a change in the pulpal blood flow (PBF) of maxillary incisors and canines up to 5 days after SARME, which gradually returned after 7 days to 3 months. After ORME, one study observed an increased PBF and one study observed a reduced PBF, which gradually returned after the end of expansion. Two studies observed that both ORME and SARME caused temporary changes in pulp sensibility. Three studies observed a significant reduction in the pulp chamber after ORME or SARME. The outcomes presented a very low certainty of evidence. CONCLUSIONS Although limited, the evidence shows that ORME and SARME caused temporary changes in pulp vitality and sensibility, with the possibility of inducing a reduction in pulp chamber dimensions.
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Affiliation(s)
- Walbert de Andrade Vieira
- Department of Restorative Dentistry, Endodontics Division, State University of Campinas - Unicamp, School of Dentistry of Piracicaba, Piracicaba, SP, Brazil
| | - Millena Barroso Oliveira
- Post-Graduation Program in Dentistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | | | - Graziela Oro Cericato
- Post-Graduation Program in Dentistry, Faculdade Meridional- IMED, Passo Fundo, RS, Brazil
| | - Igor Felipe Pereira Lima
- Post-Graduation Program in Dentistry, Department of Oral Pathology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luiz Renato Paranhos
- Department of Community and Preventive Dentistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
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Association between Orthodontic Force and Dental Pulp Changes: A Systematic Review of Clinical and Radiographic Outcomes. J Endod 2021; 48:298-311. [PMID: 34890594 DOI: 10.1016/j.joen.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Orthodontic force triggers a sequence of biological responses that can affect dental pulp. The aim of this study was to systematically evaluate the clinical and radiographic findings of orthodontic force application on dental pulp. METHODS Two reviewers comprehensively and systematically searched 6 electronic databases (Latin American and Caribbean Health Sciences [LILACS], Embase, Cochrane Library, MEDLINE/PubMed, Scopus, and Web of Science) and the gray literature (Google Scholar, OpenGrey, and ProQuest) until April 2021. According to the PICOS criteria, randomized clinical trials and observational studies that evaluated clinical or radiographic findings compatible with dental pulp changes due to orthodontic force were included. Studies in open apex or traumatized teeth, case series or reports, and laboratory-based or animal studies were excluded. The Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool were used to determine the risk of bias assessment. The overall certainty level was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations tool. RESULTS Twenty-six studies were included. Among the clinical findings, orthodontic force promoted an increased pulp sensibility response and decreased pulp blood flow. Changes in pulp cavity volume and increased incidence of pulp stones were the radiographic findings observed. The studies presented a moderate risk of bias for most of the domains. The certainty of the evidence was considered very low. CONCLUSIONS Orthodontic force promoted changes in the dental pulp, generating clinical and radiographic findings. It is crucial to know these changes so that orthodontic mechanics can be safely performed. The clinician has effective noninvasive methods to assess the health and possible pulp changes during orthodontic treatment.
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