Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil.
Department of Conservative Dentistry, Federal University of Rio Grande Do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, Rio Grande Do Sul, RS, 90035-003, Brazil.
Clin Oral Investig. 2023 Aug;27(8):4117-4129. doi: 10.1007/s00784-023-05102-2. Epub 2023 Jun 19.
Usually, orthodontic movements encompass children and young adult patients, which are more susceptible to the occurrence of traumatic dental injuries. It is necessary to understand whether the effects of orthodontic movements on traumatized teeth could induce pulp necrosis. The aim of this study was to answer the following question: "Do orthodontic movements of traumatized teeth induce dental pulp necrosis?".
Searches were performed for studies published up to May 11, 2023, in the MEDLINE/PubMed, Cochrane Library, Scopus, SciELO Citation Index, Web of Science, EMBASE, and Grey Literature Report databases, without restriction for language or year of publication. The revised Cochrane risk of bias tools for nonrandomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.
Of 2671 potentially relevant studies, five were included. Four were classified as having a moderate risk of bias and one as a serious risk of bias. It was reported a higher susceptibility to pulp necrosis in teeth subjected to orthodontic movements with history of trauma involving periodontal tissues. Additionally, orthodontic movements of traumatized teeth with total pulp obliteration had an increased risk of pulp necrosis. GRADE analysis presented a moderate certainty of evidence.
An increased risk for pulp necrosis when traumatized teeth are subjected to orthodontic movements was verified. However, this is based on evaluations performed with subjective tests. Further well-designed studies are necessary to confirm this trend.
Clinicians must be aware of the possibility of pulp necrosis. However, endodontic treatment is recommended when verified signs and symptoms of pulp necrosis.
通常，正畸治疗涵盖儿童和青少年患者，他们更容易发生创伤性牙损伤。有必要了解正畸治疗对受伤牙齿的影响是否会导致牙髓坏死。本研究旨在回答以下问题：“正畸治疗受伤牙齿会导致牙髓坏死吗？”。
截至 2023 年 5 月 11 日，在 MEDLINE/PubMed、Cochrane 图书馆、Scopus、SciELO 引文索引、Web of Science、EMBASE 和灰色文献报告数据库中对已发表的研究进行了检索，对发表语言或年份没有限制。使用修订后的非随机干预 Cochrane 偏倚风险工具（ROBINS-I）评估纳入研究的质量。通过推荐评估、制定和评估（GRADE）工具评估证据的总体质量。
在 2671 篇潜在相关研究中，有 5 篇被纳入。其中 4 篇被归类为中度偏倚风险，1 篇为严重偏倚风险。报告称，牙周组织受累的创伤性牙齿在接受正畸治疗后更容易发生牙髓坏死。此外，牙髓完全破坏的创伤性牙齿的正畸治疗也增加了牙髓坏死的风险。GRADE 分析显示证据确定性为中等。
当受伤的牙齿受到正畸治疗时，会增加牙髓坏死的风险。然而，这是基于使用主观测试进行的评估。需要进一步进行设计良好的研究来证实这一趋势。
临床医生必须意识到牙髓坏死的可能性。然而，当证实有牙髓坏死的迹象和症状时，建议进行根管治疗。
