Occurrence of dental pulp calcifications after orthodontic treatment: A systematic review

Orthodontic tooth movement has been associated with pulpal alterations, including dental pulp calcifications (PC) such as pulp stones (PS).

This systematic review aimed to evaluate and synthesize the available scientific evidence on the occurrence of dental PC, focusing on PS formation, after orthodontic treatment with fixed appliances (FA) or clear aligners (CA).

Five electronic databases were searched until October 2025, and lists of references from relevant publications were screened to identify relevant studies with no language or date restrictions. Randomized controlled clinical trials, controlled clinical trials, and observational studies evaluating PC after orthodontic treatment were included. Outcomes were assessed using radiographic (cone-beam computed tomography, panoramic or periapical radiographs) or histologic methods. Risk-of-bias was assessed using the RoB 2.0 tool for the randomized trials, ROBINS-I for the non-randomized trials, and Newcastle-Ottawa tool for the observational studies. Due to substantial heterogeneity, a qualitative narrative synthesis was performed.

Of 1406 identified studies, 18 met the inclusion criteria. Radiographic evidence generally showed a higher occurrence of PC, especially PS, after orthodontic treatment than in pretreatment or control groups, although findings were modest and heterogeneous across study designs, tooth types, diagnostic methods, and follow-up periods. Molars were most frequently affected. Some studies linked PS with older age and longer treatment duration, whereas findings for sex, appliance type, and extraction protocols were inconsistent. The only direct FA versus CA comparison found no meaningful difference in PS occurrence. Histologic studies showed force-related microscopic pulpal changes, including vascular congestion, fibrosis, and localized mineralization, without clinical symptoms. GRADE indicated low-to-very-low certainty across main outcomes in the available evidence base.

Orthodontic treatment may modestly increase PC, especially PS, but current evidence is of low to very low certainty and clinically asymptomatic; high-quality prospective studies are needed to clarify underlying mechanisms and clinical relevance.

CRD420251166423.