Orthodontic and endodontic treatments often intersect in clinical practice, requiring careful planning to ensure optimal outcomes. While orthodontic forces can successfully move endodontically treated teeth, their biomechanical properties, response to movement, and risk of complications differ from vital teeth. Recent research also suggests that root canal-treated teeth may be less prone to orthodontically induced root resorption (OIRR).
This blog explores key considerations when incorporating endodontically treated teeth into orthodontic treatment plans.
1. Response to Orthodontic Forces (Liu et al., 2020)
• Root canal-treated teeth can be moved orthodontically, but their reduced dentin elasticity makes them more prone to fractures.
• Careful force application is necessary to prevent structural damage.
• Studies suggest that non-vital teeth respond similarly to orthodontic forces but may require adjustments in force levels.
2. Risk of Root Resorption (Mah & Prasad, 2018)
• Root resorption is a potential risk during orthodontic treatment.
• Endodontically treated teeth may be less susceptible to resorption compared to vital teeth.
• However, excessive forces can still lead to damage, requiring close radiographic monitoring.
3. Periapical Healing and Infections (Krishnan & Davidovitch, 2021)
• Any existing periapical infection must be fully resolved before initiating orthodontic movement.
• Active infections can worsen with orthodontic forces, leading to poor healing and complications.
• Regular radiographic follow-ups are essential to monitor periapical health throughout treatment.
4. Timing of Orthodontic Treatment After Root Canal Therapy (Nixon & Waterhouse, 2019)
• A 3–6 month waiting period is recommended after endodontic treatment to allow periapical healing before orthodontic movement.
• Moving the tooth too early may interfere with healing and increase the risk of complications.
5. Considerations for Restored Teeth (Papageorgiou et al., 2022)
• Many endodontically treated teeth require crowns or posts for reinforcement.
• If orthodontic movement is planned, restorations should be delayed until after tooth movement is complete.
• Excessive forces can loosen crowns, debond posts, or even cause root fractures.
6. Orthodontic Treatment of Traumatized Teeth (Andreasen et al., 2019)
• Teeth that needed a root canal due to trauma require special attention before orthodontic movement.
• Delayed orthodontic treatment ensures proper healing of both pulpal and periodontal structures.
• Ankylosed teeth may not respond to orthodontic forces and may require alternative treatments, such as prosthetic rehabilitation or orthodontic camouflage.
7. Orthodontically Induced Root Resorption in Endodontically Treated vs. Vital Teeth
A recent study by Liu et al. (2025), published in Progress in Orthodontics, used CBCT imaging to compare orthodontically induced root resorption (OIRR) in endodontically treated teeth (RFT) and vital pulp teeth (VPT). Their findings showed that RFT experienced significantly less OIRR than VPT, suggesting that root canal-treated teeth may be more resistant to resorption during orthodontic treatment. Gender was not a significant factor, though females had lower resorption in RFT. Extraction cases showed less OIRR in RFT than in VPT, and upper teeth and premolars in RFT were less affected. Fixed appliances caused more resorption than clear aligners, while longer treatment duration and greater root movement increased OIRR in both groups. These findings highlight the importance of personalised force application and regular monitoring to minimise resorption risks.
Conclusion
Endodontically treated teeth can be successfully incorporated into orthodontic treatment plans with careful planning. They may be less prone to root resorption, but considerations such as force levels, periapical health, treatment timing, and restoration stability must be addressed. Interdisciplinary collaboration between orthodontists and endodontists is essential to achieving optimal results while minimising complications.
Dr Mo Almuzian
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