Effect of orthodontic treatment on the periapical radiolucency of endodontically treated teeth: a CBCT analysis

Abstract

Background This study aimed to evaluate periapical radiolucency of endodontically treated teeth before and after orthodontic treatment using cone-beam computed tomography (CBCT). Methods Patients who underwent orthodontic treatment at Wonkwang University Daejeon Dental Hospital between January 2009 and June 2022 were included based on the following criteria: root canal treatment, and availability of CBCT images taken before and after orthodontic treatment with an interval of > 1 year between both scans. Patients with primary teeth or orthodontic tooth extractions were excluded. The size of the periapical radiolucency (SPR) of the endodontically treated tooth was evaluated using CBCT. Pre-orthodontic treatment CBCT images and the latest post-orthodontic treatment CBCT images were analyzed. The selected teeth were further categorized based on the orthodontic duration, CBCT interval, the patient sex and age, the tooth type and position (maxilla or mandible), and quality of root canal obturation. Statistical analyses were performed to evaluate changes in SPR using the paired t-test and multiple regression analysis. Results In total, 115 teeth (37 anterior teeth, 22 premolars and 56 molars) from 61 patients (age, 14–54 years) were included, with 39 teeth from male patients and 76 teeth from female patients. The age was ranged between 14 and 54 years old, and mean age was 25.87 years old. The mean CBCT interval and orthodontic treatment period were 43.32 months and 36.84 months, respectively. Seventy-five teeth showed good obturation quality, 80 were not used as anchors during orthodontic treatment, and 71 were maxillary. The SPR size increased after orthodontic treatment for 56 teeth and decreased for 59 cases. The average change in SPR was -0.102 mm and the difference was not significant. Significant decrease of SPR were observed between female patients (p = 0.036) and maxillary teeth (p = 0.040). Conclusion Orthodontic treatment had no significant impact on the changes in the SPR in endodontically treated teeth in most categories. However, there was a significant difference among females and the maxillary teeth. In both categories, the size of radiolucency decreased significantly.

Orthodontics and Endodontics Clinical Practice Correlation: A Narrative Review

“…Also, proper oral hygiene education and reinforcement throughout orthodontic treatment prevent the accumulation of plaque and bacteria, which can contribute to periapical inflammation and infection [ 22 ]. Additionally, regular monitoring of the periapical region during orthodontic treatment through radiographic evaluations to detect any changes or progression of existing periapical lesions [ 23 ]. Avoiding excessive forces during orthodontic treatment to minimize the risk of inflammation and trauma to periapical tissues [ 16 ].…”

“…This collaborative approach allows for timely referral for endodontic treatment if periapical disease is present or suspected and enables effective communication and coordination of treatment to prevent the exacerbation of periapical disease during orthodontic movement [ 21 ]. The periapical disease can have significant implications for orthodontic treatment [ 23 ]. Orthodontists should be aware of the potential risks and take preventive measures to minimize the impact on periapical health [ 23 ].…”

“…The periapical disease can have significant implications for orthodontic treatment [ 23 ]. Orthodontists should be aware of the potential risks and take preventive measures to minimize the impact on periapical health [ 23 ]. This includes conducting thorough examinations, promoting proper oral hygiene, monitoring the periapical region during treatment, applying controlled force, and collaborating with endodontists to provide comprehensive care [ 16 , 21 - 23 ].…”

“…Orthodontists should be aware of the potential risks and take preventive measures to minimize the impact on periapical health [ 23 ]. This includes conducting thorough examinations, promoting proper oral hygiene, monitoring the periapical region during treatment, applying controlled force, and collaborating with endodontists to provide comprehensive care [ 16 , 21 - 23 ]. In conclusion, periapical disease can have an impact on orthodontic treatment due to the potential for increased inflammatory reactions, root resorption, and delayed healing [ 23 ].…”

“…This includes conducting thorough examinations, promoting proper oral hygiene, monitoring the periapical region during treatment, applying controlled force, and collaborating with endodontists to provide comprehensive care [ 16 , 21 - 23 ]. In conclusion, periapical disease can have an impact on orthodontic treatment due to the potential for increased inflammatory reactions, root resorption, and delayed healing [ 23 ]. Table 1 is a summary of the type of endodontic treatment and the suggested time to start or resume orthodontic teeth movement.…”