Neelesh K Banjare

8/8/2019 Neelesh K Banjare

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Dr. K. K. SARAF(H.O.D.)

Dept. of Conservative &Endodontics

Govt. Dental College Raipur(C.G.)

Submitted By

NEELESH

K

BANJARE

(Intern 2010)


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Definition of Endodontic and orthodontic.

Concise Relationship between Endodontic and orthodontic.

Orthodontic tooth movements impact on the viability of the

dental pulp.

Apical root resorption that may occur during tooth

movement (orthodontics Treatment on vital tooth and root

canal treated tooth.


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The role of previous tooth trauma on orthodontic & endodontic

treatment.

The role of orthodontic treatment on endodontically treated

tooth.

Ongoing orthodontic treatment effect the provision and

outcome of endodontic treatment.

Orthodontic and Endodontic combined therapy for toothretention.

Differential Radiographic Diagnosis & Treatment.


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Endodontics :- Endodontic is the branch of

the clinical dentistry associated with the

preventions, diagnosis and treatment of

the pathosis of the dental pulp and their

sequelae.


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Orthodontics :- Orthodontic includes the

study of the growth and development ofthe jaw and face particularity, and the

body generally, as influence the position of

the teeth the study of action and reaction

of enternal and external influence on thedevelopment and the prevention and

correction of arrested and perverted

development.


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Endodontic and Orthodontic

RelationshipThese are two major area where orthodontic and

endodontic share common ground

(1) One is etiology :- Because orthodontic treatment

affects the tooth being moved and same of the

response may be noted in the pulp tissue.

(2) Second is combined therapy: - Where orthodontic

treatment is necessary to gain a desirableendodontic result.


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Orthodontic tooth movement can causedegenerative and inflammatory response in the dental

pulp of tooth with complete apical formation.


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The response induce in there pulps may

impact on the initiation and perpetuation of

apical root remodeling or resorption duringtooth movement.

The incidence and severity of these pulpal

changes may be influence by previous insultto the dental pulp such as Trauma or caries.


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Pulps in teeth with incomplete apical foramen, whilst not

immune to adverse sequelae during tooth movement have areduce risk for these response.

Teeth with previous root canal treatment (RCT) exhibit less

propensity for apical root resorption during orthodontic tooth

movement.

This outcome will depend on the absence of coronal leakage or

other avenues for bacterial ingress.


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If there is a evidence of pulpal demise on

previous traumatized tooth, appropriate

endodontic management is necessary before

orthodontic treatment. If tooth has been

severely traumatized (Intrusive, Luxetion,

avulsion) there may be a greater chance ofresorption with tooth movement.


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Endodontic tooth movements impacts on

the viability of the dental pulp

During rapid teeth movement pulpal injury

may occur, due to alteration in the blood

vessels in the apical periodontium and those

entering the pulp.


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Clinically the teeth may have altered

sensation to stimuli.

The pulpal changes and their consequences

appear to be proportionally more severe with

greater orthodontic (Basically tipping motion in

the apical 3rd of root)

Ex- Appliances such as labiolingual expansion

appliances.


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The lack of Collateral Circulation to the pulp during tooth

movement as being the major etiological factor for pulpal

degeneration.The impact of the tooth movement on the pulp is primarily

focused on the neurovascular system in which the released of

specific neurotransmitters (Neuropeptides) can influence both

blood flow and cellular metabolism.


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There responses enduced in these pulp may

impact on the initiation and perpetuation ofapical root remodeling as resorption during

tooth movement.


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Definition Root Resorption: - A condition

associates with either a physiological or a

pathological process resulting in a loss of

dentin cementum and bone.

Orthodontics treatment causes: - Enternal

apical root resorption.


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Root resorption following orthodontic

treatment is considered as surface resorptionor transient inflammatory resorption.

Morphologically and radiologically it may

present or a slightly blunted or round apex to a

grossly resorbed tooth


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These specifice causes of external apical

root resorption reffered to as periapical

replacement resorption.

Spacially intrusive and tipping force and

commonly implicated for there type of

resorption from orthodontic treatment.


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Devitalized root acts as a foreign body

causing chorine irritation and root resorption.

Teeth with root canal treatment (RCT)

moved as readily as teeth with vital pulp withminimum apical root resorption.


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The teeth with previous root canal treatment

(RCT) exhibits less propensity for apical root

resorption during orthodontic treatment.

The role of neuropeptides in tooth movement

that causes minimum resorptive / remodeling

changes occur apically in teeth that hasWellcleaned, shaped and three dimensionally

obturated.


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ForVital tooth :- To Prevent therisk of TARR during the movement of

any tooth it is recommended that teethrequiring root canal treatment :- Beinitially cleaned and shaped followed by

the interim placement of Calciumhydroxide and should be maintainduring the active phase of the tooth

movement with the final canalobturation occurring upon completion oforthodontic treatment.


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A traumatized tooth can be moved orthodontic with

minimum risk of resorption, provided the pulp has not

been reversely compromises (Infected or necrotic).

A role of previous tooth trauma play in the

orthodontic tooth movement of the tooth with vital

pulps or previous root canal treatment


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If there is evidense of pulpal demise

appropriate endo-dontic management isnecessary prior to orthodontic treatments.


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If a previously traumatized tooth exhibits

resorption there is a greater chance that orthodontic

tooth movement, will enhance the resorptive process.


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If a tooth has been severely traumatized

(Intrusive, Luxation / avulsion) there may be

greater incidence of resorption with or without

Root canal treatment (RCT)


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During orthodontic tooth movement the provision

of endodontic treatment may be influenced by a

number of factor such as (1) Radiographic interpretation.


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(3) Patient sign and symptom.

(2) Accuracy of pulp testing.


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(4)Tooth Isolation.

(5) Access to the root canal.


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(6)Working length determination.

(7) Apical position of the canal alteration.


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Common Indication for this Combination

Fracture tooth margin below crystal bone level.

Deep carious margins in tooth requiring root

canal treatment.


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Resorptive perforation.

Post space preparation perforation.


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Aberrant coronal accessed opening.

Some isolate infrabony defect.


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Adjunctive orthodontic root extrusion and

root separation are essential clinical procedurethat will enhance the integrated treatment

planning process of tooth retention in

endodontic orthodontic related cases.

ORTHODONTIC EXTRUSION Is an

aesthetes alternative to surgical crownlengthening and lowering of the alveolar crest 2

3 mm.


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Distinguishing internal verses external rootresorption by radiographic mean afterrequiring use of two Radiograph.

(M B D Rules)

(1) 1st taken perpendicular to the tooth.

(2) 2nd taken mesial to the on the Perpendicularsame Horizontal plane.


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EXTERNAL ROOT RESORPTION INTERNAL ROOT RESORPTION

If the lesion is an external

root resorption, the

image will shift & the

root canal system can beclearly seen in the film

superimposed on the

external lesion.

Lesion is apically placedthe apex will appear

shortened blunted,

lesion will be irregular.

The lesion will not move in

relation to the root

canal system. In there

case the Root canalsystem will enlarge at

the site of the root

resorption.

The root canal system hasan in large area the

margin of lesion are

sharp, smooth clear but

size is variable.


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1. Apicocectomy

2. If the area is broad and on lateral surface

curettage and filling of resorted area shouldbe carried out.

3. The use of bleaching agent specially H2O2

and sodium per borate on cervical aberration.

4. The use of Calcium Hydroxide {Ca(OH) 2}

in the canal will half any resorption process

and promote heating.


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ENDODONTIC THERAPY

Franklin S. Weine

R. S. Hamilton & J.L. Gutman

Department of restorative Science

Graduate endodontic, College of dentistryDallas Texas USA


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Neelesh K Banjare