Endodontic - orthodontic relation /certified fixed orthodontic courses by Indian dental academy


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Endodontic - orthodontic relation /certified fixed orthodontic courses by Indian dental academy

  1. 1. ENDODONTIC – ORTHODONTIC RELATIONSHIPS INDIAN DENTAL ACADEMYLeader in Continuing Dental Education www.indiandentalacademy.com
  3. 3. INTRODUCTION Orthodontic treatment The expanding role of endodontics Two major areas where Endodontics & Orthodontics share www.indiandentalacademy.com
  4. 4. EFFECT OF ORTHODONTICS ON THE TOOTH BEING MOVEDCAUSES AND EFFECT OFORTHODONTIC FORCES ON PULP Degenerative or inflammatoryresponses in the dental pulp Impact of the tooth movement on the pulp
  5. 5. CAUSES OF PULP NECROSIS Heavy continuous force Distal tipping of incisor Heat generated by grinding duringremoval of ceramic brackets Labiolingual expansion appliance www.indiandentalacademy.com
  6. 6. EFFECT ON PULP Degree of dentinogenic activitydepends on the respiratory role of pulp cells Pulp changes appear to be moresevere with greater orthodontic force Alternation in pulpal vasculature withsubsequent alternation in metabolism ofpulpal cells Pulp is very resilient, has greaterpotential for healing
  7. 7. EVIDENCE OF PULP INVOLVEMENT Increased sensitivity Decreased pulp space Periapical radiolucency Internal resorption
  8. 8. RESORPTION DURING ORTHODONTIC THERAPY Orthodontically induced root resorption – surface resorption, inflammatory resorption or rarelyreplacement resorption External apical root resorption (EARR)CAUSES Intrusive or tipping forces www.indiandentalacademy.com
  9. 9. EXTENT OF TOOTH MOVEMENT Directly proportional to the distancethrough roots are moved.TREATMENT DURATION Directly related to the treatmentdurationROLE OF NEUROPEPTIDES Sensory A – delta, C-fibres andsympathetic neurons
  10. 10. ROLE OF PHARMACOLOGICAL AGENTS NSAID’s Alcohol CorticosteroidsENDODONTIC TREATMENT &ORTHODONTIC ROOT RESORPTION Tooth with root canal treatment Previously traumatized or avulsed tooth Teeth that have been managed bysurgical endodontic procedure
  11. 11. TYPE OF CEMENTUM Acellular and cellularAGE Resorption found more in older children than in younger childrenTYPE OF APPLIANCE Fixed appliances are more detrimentalto the roots www.indiandentalacademy.com
  12. 12. MAGNITUDE OF FORCE Continuous heavy forces causeresorptionDIRECTION OF FORCE Prolonged tipping or intrusionmovement www.indiandentalacademy.com
  13. 13. ENDODONTIC CONSIDERATIONS RELATED TO ORTHODONTICSWORKING LENGTH DETERMINATION Apical constriction destroyed Resorption on buccal and lingualaspectRADIOGRAPHIC INTERPRETATION Reflect osseous changesACCURACY OF PULP TESTING Presence of full metallic bands
  14. 14. TOOTH ISOLATION Tooth isolation compromisedACCESS TO ROOT CANAL Alternation in accessDENS-IN DENTIN Internal resorption during orthodonticmovement www.indiandentalacademy.com
  15. 15. RISK OF RESORPTION Risk of external apical resorptionduring movement of any teethPRECAUTIONS DURING ORTHODONTICTREATMENT Periodical periapical radiographs Incases of severe resorption Rest periods of 2 – 3 months If resorption persists
  16. 16. ENDODONTIC – ORTHODONTIC COMBINED THERAPY FORCED ERUPTION Angle 1900 Revised by Heithersay and Ingber www.indiandentalacademy.com
  17. 17. INDICATIONS Teeth with advanced caries Traumatic destruction of clinical crown Lateral root perforation External and internal root resorptionnear alveolar crest Over zealous tooth preparation Isolated infrabony defects
  18. 18.  Eliminates the need for periodontalsurgery Extrusion – easiest orthodonticmovement to achieve 20 – 30gram force required Preferred only in anteriors andpremolars www.indiandentalacademy.com
  19. 19. BASIC PERIODONTAL PRINCIPLE FOR FORCED ERUPTION Biological width -combined dimension ofsupra alveolar gingivalconnective tissue andjunctional epithelium –2.04mm When the margin ofrestoration being placed, very important tomaintain the health andintegrity of biological
  20. 20.  Distance from alveolar crest to the coronal extent of the toothstructure should be > 4mm Biological width moves with the toothas the tooth moved under controlorthodontic force End results of forced eruptioncontributes more cosmetic andphysiological restoration compared toperiodontal surgery www.indiandentalacademy.com
  21. 21. BASIC ENDODONTIC PRINCIPLES FORFORCED ERUPTION Teeth that require endodontic therapyshould have treatment prior to initiation of tooth movement Teeth with subalveolar fracture may have endodontic therapy through the clinical crown. No contraindication to completeendodontic therapy while tooth undergoingorthodontic movement Gutta-percha is the filling material ofchoice
  22. 22. BASIC ORTHODONTIC PRINCIPLES FORTOOTH MOVEMENT Estimate amount of attachmentapparatus remaining at the completion oftooth movement must be made No tooth movement should be started – unless retention and stabilization Adequate anchorage must be available www.indiandentalacademy.com
  23. 23.  Uprighting and correction of axial tooth position This movement occurs in a vertical plane Only light force should be used toextrude the tooth (20 – 30gm) Stabilization of forced erupted toothprevents root back into the alveolus Minimum of 6 weeks of stabilization
  24. 24. PROCEDUREIf there is excessive destruction of clinical crown A snughly fitting customized or prefabricated post is cemented
  25. 25. Brackets with horizontal slots are placed on multiple teeth Elastic ligature code tide from the loop to the rigid arch wireAnchorage at least two teeth on either side of the tooth to be erupted
  26. 26. www.indiandentalacademy.com
  27. 27. REGAINING INTERPROXIMAL SPACE Described by ReaganINDICATION A long standing carious lesion on the proximal surface results in migrationof adjacent teeth into the void created by the caries.
  28. 28. PROCEDURE A core or foundation restoration placed in the tooth requiring restoration Tooth prepared for a full crown
  29. 29.  An acrylic crown fabricated, cemented andthen an orthodontic separator inserted intothe proximal space. At subsequent appointment elastic isremoved and a piece of 0.6mm brass wirethreaded between the teeth apical to contact.
  30. 30.  Wire is twisted together until the patient feels pressure At approximately 1week intervals, wire is tightened until tooth shows nomovement Provisional restoration removed and the crown buildup back into contact withadjacent tooth.
  31. 31.  Brass wire reapplied, as the tooth tipped, it may move upward into the occlusalplane, as it does adjust occlusally. Then the full crown as the finalrestoration fabricated and cemented
  32. 32. THERAPEUTIC ANKYLOSIS OF PRIMARY TEETH Kokich first gave the concept Sheller and Omnell gave detailedindicationsINDICATIONS In young patients with mild to moderate retrusion of the maxilla
  33. 33.  Anchorage obtained by ankylosing primary canines Produces skeletal rather than dentalmovementPROCEDURE Under LA and mild sedation primary canines extracted Endodontic treatment performed extraorally
  34. 34. 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 www.indiandentalacademy.com
  35. 35. Protraction starts 8 weeks after surgery Check the occlusionRetention of ankylosed ranged between 4-36 monthsTime required for protraction about 6 months, ranging from 4 – 12 months
  36. 36. CONCLUSION A major percentage of orthodontic patientspresents a problem in terms of root resorption duringfunctional and esthetic benefits of the orthodontictreatment. It is recommended that periodicalradiographic and careful clinical examination shouldbe done for any incipient periapical lesions and toverify any unusual changes in pulp. A combined endodontic – orthodontic therapypermits placement of a restoration that fulfills theperiodontal and occlusal requirements of the tooth.
  37. 37. 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 palatalinvagination, JCO, 1989 Dec. 802 – 803. Wein G et al, Forced eruption – an alternative toextraction or periodontal surgery. JCO, 1992 Mar.1-4. www.indiandentalacademy.com
  38. 38.  W. Popp et al, Pulpal response to orthodontictooth movement, AJO, 1992 Mar. 1-7. Naphtali et al, Orthodontically inducedinflammatory root resorption, Angle Orthodontist, 2002;72 : 175 – 184. Barbara Sheller, Therapeutic ankylosis of primary teeth, JCO, 1991 Aug. 499 - 502.
  39. 39. www.indiandentalacademy.com