Effect of Orthodontic Forces on Teeth with Compromised Pulpal Status: A Clinical Study

Abstract

Background: Orthodontic tooth movement is achieved through the application of controlled mechanical forces that trigger adaptive biological changes within the periodontal ligament and surrounding alveolar bone. Nevertheless, the behavior of teeth with compromised pulpal conditions under orthodontic loading remains a clinical concern because of the possible risk of pulpal damage or necrosis.

Aim: To assess the clinical and radiographic response of teeth with compromised pulpal status subjected to orthodontic forces during fixed appliance therapy.

Materials and Methods: This clinical investigation involved 48 patients receiving fixed orthodontic treatment. A total of 72 teeth with compromised pulpal status—including previously traumatized teeth, teeth with extensive restorations, and endodontically treated teeth—were evaluated and compared with 72 contralateral teeth with normal pulp serving as controls. Light continuous orthodontic forces not exceeding 100 g were applied. Periodic assessments were conducted at baseline, 3 months, 6 months, and 12 months using clinical examination, pulp vitality tests, and periapical radiographs. Data analysis was performed using the Independent Student’s t-test and Chi-square test, with the level of statistical significance set at p < 0.05.

Results: No statistically significant difference was observed in the rate of orthodontic tooth movement between compromised pulp teeth (1.12 ± 0.21 mm per 6 months) and control teeth (1.18 ± 0.24 mm per 6 months) (p = 0.37). Alterations in pulp vitality were noted in 6.9% of teeth with compromised pulp and 4.2% of control teeth, with no significant intergroup difference (p = 0.48). Radiographic findings demonstrated comparable periapical status between both groups (p = 0.62). Importantly, no instances of irreversible pulpal necrosis related to orthodontic force application were detected.

Conclusion: Teeth with compromised pulpal status can undergo orthodontic tooth movement safely when light and controlled forces are used. Careful patient selection combined with regular clinical and radiographic follow-up minimizes the risk of unfavorable pulpal or periapical outcomes.