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Do orthodontic tooth movements induce pulp necrosis? A systematic review
T Weissheimer1, E J N L Silva2,3, K P Pinto3
1Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, Brazil.
International Endodontic Journal
|March 29, 2021
Summary
Orthodontic tooth movements do not appear to cause pulp necrosis, according to this systematic review. However, the evidence quality is low to very low, indicating a need for further research on dental pulp vitality during orthodontic treatment.
Area of Science:
- Dental science
- Orthodontics
- Endodontics
Background:
- Orthodontic forces may affect dental pulp status.
- Previous reviews had limited studies using reliable pulp assessment methods.
- New evidence necessitates an updated systematic review.
Purpose of the Study:
- To determine if orthodontic tooth movements can induce pulp necrosis.
- To evaluate the scientific evidence on pulp vitality changes during orthodontic treatment.
Main Methods:
- Systematic search of multiple databases (PubMed, Web of Science, etc.) until June 2020.
- Included randomized clinical trials (RCTs), nonrandomized clinical trials (nRCTs), and longitudinal studies.
- Assessed pulp status using laser Doppler flowmetry or pulse oximetry.
- Evaluated study quality using Cochrane risk of bias tools and GRADE.
Main Results:
- Twelve studies (5 RCTs, 1 nRCT, 6 prospective) met inclusion criteria.
- Most RCTs had unclear or high risk of bias; nonrandomized studies had moderate to serious risk of bias.
- Overall quality of evidence was assessed as low to very low.
Conclusions:
- Significant limitations in randomization and confounder control were found in included studies.
- Current evidence suggests orthodontic movements do not induce pulp necrosis.
- Low to very low certainty of evidence highlights the need for higher-quality research.
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