Teeth undergoing orthodontic tooth movement may require endodontic treatment which could be related or unrelated to orthodontic treatment.
However, it is always preferable to try to foresee and treat the tooth endodontically prior to beginning orthodontics for some of the following reasons:
- Pulpal or periradicular pain can be masked by discomfort associated with that of tooth movement.
- Once fixed appliances are placed on teeth, rubber dam isolation can be difficult.
- Creating endodontic access preparations can be confusing as the long axis of the tooth may be difficult to determine.
- Working lengths or finding apical stops may be compromised by root resorption at the apex.
- Apical root resorption will also complicate obturation of the tooth.
- The response of pulp tissues to pulp stimuli may also be altered by orthodontic tooth movement.
Source: Endodontics, 4th Edition, Elsevier 2014.
I did not check into this reference but in my opinion these recommendations may not be very helpful to the general dentist and may lead to some or many unnecessary endodontic treatments.
First of all what is meant by ‘foresee and treat the tooth endodontically prior to…”? Often, endodontic diagnoses can be very challenging and decision making can be difficult due to the complexity of pulpal symptoms Nevertheless a diagnosis should be made based on a good clinical examination and the decision to treat or not should be made based on that diagnosis. There is no universally predictable way to foresee the future status of a pulp. I would propose that in the case of orthodontic care if one is unsure of the endodontic status of a tooth a “watch and see” approach would be preferable.
Rubber dam isolation can normally be achieved with some ingenuity despite the orthodontic hardware in place .
Determining the long access of a tooth is a minor to moderate challenge with any inclined or rotated teeth and an experienced clinician should have no problem with this.
As for the working length being affected by root resorption, consider this: if root resorption does occur during the course of orthodontic treatment (and this too is very unpredictable) on a root filled tooth one would end up with an “overextension” of the root filling after as the root filling itself would not be resorbed along with the root. This normally wouldn’t be of great concern but if one is performing endodontic treatment preventively with the goal of providing ideal filling of the root, one should reconsider the benefits of such preventive treatment in these cases.
Root filling of an open or resorbed apex is a fairly routine procedure and I don’t feel that one should routinely recommend endodontic treatment of a tooth with a questionable pulp status in order to avoid this procedure. Remember that many orthodontically treated teeth have young pulps that may respond favourably to vital pulp therapy.
Best Regards,
Dr. tom Iwanowski, D.D.S., Dip. Endo