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.

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

8. RESORPTION DURING ORTHODONTIC
THERAPY
 Orthodontically induced root resorption
– surface resorption, inflammatory
resorption or rarely
replacement resorption
 External apical root
resorption (EARR)
CAUSES
 Intrusive or tipping forces
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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

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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.

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