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Do orthodontic movements of traumatized teeth induce dental pulp necrosis? A systematic review

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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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Authors and Affiliations

  1. Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil

    Pedro Henrique Marks Duarte, Theodoro Weissheimer, Carolina Horn Troian Michel, Gabriel Barcelos Só, Ricardo Abreu da Rosa & Marcus Vinicius Reis Só

  2. 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

    Theodoro Weissheimer

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  1. Pedro Henrique Marks Duarte
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Pedro Henrique Marks Duarte and Theodoro Weissheimer. The first draft of the manuscript was written by Pedro Henrique Marks Duarte. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Theodoro Weissheimer.

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Duarte, P.H.M., Weissheimer, T., Michel, C.H.T. et al. Do orthodontic movements of traumatized teeth induce dental pulp necrosis? A systematic review. Clin Oral Invest 27, 4117–4129 (2023). https://doi.org/10.1007/s00784-023-05102-2

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