1. Orthodontic Endodontic Relationship Dr.Deema Ali Al-Shammery BDS,MSc Lecturer in Orthodontics,Riyadh colleges of Dentistry and Pharmacy

3. OUTLINE:  Introduction  Case  Orthodontics consideration  Summary  Acknowledgment

4. Introduction:  There is lack of information on the relationship between endodontics and orthodontics during treatment planning decisions.  This relationship ranges from :  Effects on the pulp from orthodontic treatment  The potential for resorption during tooth movement,  Clinical management of teeth requiring integrated endodontic and orthodontic treatment.

5. Introduction:  Orthodontic tooth movement can cause degenerative and/or inflammatory responses in the dental pulp of Teeth.  Primarily on the neurovascular system.  Orthodontically induced inflammatory root resorption is one of complications induced by orthodontic treatment.

6. Introduction:  Do you believe that root restoration is unavoidable during orthodontic treatment?

7. Introduction:

9.  Microscopic root resorption is characteristic to all permanent teeth during orthodontic treatment.  It is clinically insignificant and radiologically invisible, orthodontic teeth movement couldn’t occur without this resorption.

10. Introduction:  Severe root resorption during orthodontic treatment (more than ¼ of the root length, >5 mm) occurs very rarely, just in 1-5 % of patients Nigul K, Jagomagi T :2006

11. Case A 12-year-old girl was referred from orthodontic department, for severe pain and abscess related to maxillary right central incisor. The medical history was unremarkable. The dental history revealed history of previous trauma and orthodontic treatment two years ago.

12. Case  Treatment:  Revascularization procedure.  is a likely near-term dental treatment that will bring widespread application of tissue engineering principles to regenerative dentistry (Murray et al. 2007; Sloan and Smith 2007; Huang 2008).

13. Case  It is attempt to preserve the potentially remaining dental pulp stem cells and mesenchymal stem cells of the apical papilla can result in canal revascularization and the completion of root maturation Sonoyama et al. 2006; Huang et al. 2008)  It has been evidence indicating that regeneration is a better alternative to conventional calcium hydroxide apexification exists in immature permanent teeth exhibiting periapical pathology. Shah et al. 2008 )

14. Case  1 year after regeneration therapy shows thickening of dentinal walls with a reestablishment of the periodontal ligament space and lamina dura was observed. Root maturation is visible and resolution of periapical radiolucency are evident.

15. Case  Continuo the orthodontic treatment for #11 again

16. Case 2 years post operative follow up

17. Case

18. Orthodontic consideration:  A traumatized tooth can be moved orthodontically with minimal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treatment. Hamilton & Gutmann :1999

19. Orthodontic consideration: Orthodontic management of teeth with open apex?

20. Orthodontic consideration:  No contraindication to perform orthodontic treatment in conjunction with apexification procedures. 10-14 days later tooth movement can be resumed Donald R, 1986

21. What about Endodontic Regeneration and Active Orthodontic Treatment? photo copy.PNGphoto copy.PNG

22. Orthodontic consideration:

23. 

25.  Discontinuous force application produced significantly less RR than. Continuous force.  All studies found that light forces produced significantly less RR than heavy forces.  Pause during the treatment: studies showed that the amount of RR was significantly less in patients treated with a Pause than in those treated with continuous forces without a pause. Weltman et al 2010

26. Orthodontic consideration:  Progress radiographs obtained after 6 to 12 months might detect early OIIRR.

27. Orthodontic consideration:  If severe resorption is identified, the treatment plan should be reassessed with the patient.  Alternative options might include prosthetic solutions to close spaces, releasing teeth from active archwires if possible, stripping instead of extracting, and early fixation of resorbed teeth. Harris EF, et al 1997

28. Summary  Understanding of the orthodontic endodontic relationship is essential for the success of the treatment.  Successful treatment can’t be provided without proper communication and team work.

29. Acknowledgment: Dr.Musaed Al-Tammami, Endodontic resident, Saudi Board Of Endodontics.

30. Thank You