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Orthodontic movement of endodontically

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E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
√ÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ:
™‡Á¯ÚÔÓ˜ ·fi„ÂȘ
πÔ˘Ï›· πˆ·ÓÓ›‰Ô˘-ª·Ú·ıÈÒÙÔ˘,1 ∞Ó‰Ú¤·˜ ∫fiÎη˜,2 °ÂˆÚÁ›· ª¿Úη3
1
∞Ó·ÏËÚÒÙÚÈ· ∫·ıËÁ‹ÙÚÈ·, ∂ÚÁ·ÛÙ‹ÚÈÔ √ÚıÔ‰ÔÓÙÈ΋˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢.
2
√‰ÔÓÙ›·ÙÚÔ˜, ¢È‰¿ÎÙˆÚ √‰ÔÓÙÈ·ÙÚÈ΋˜, ∂ÚÁ·ÛÙ‹ÚÈÔ ∂Ó‰Ô‰ÔÓÙÔÏÔÁ›·˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔÓ›-
΢.
3
∆ÂÏÂÈfiÊÔÈÙÔ˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢.
Orthodontic movement of endodontically treated teeth:
Contemporary views
Ioulia Ioannidou-Marathiotou,1 Andreas Kokkas,2 Georgia Barka3
1
Associate Professor, Department of Orthodontics, Dental School, Aristotle University of Thessaloniki.
2
Dentist, Doctor of Dentistry, Department of Endodontology, Dental School, Aristotle University of Thessaloniki.
3
Senior student, Dental School, Aristotle University of Thessaloniki.
¶EPI§HæH
™∫√¶√™: ªÂ ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË Á›ÓÂÙ·È Ì›·
ÚÔÛ¿ıÂÈ· Û˘ÏÏÔÁ‹˜ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ Û‡Á¯ÚÔ-
ÓˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂÙ·-
ΛÓËÛË ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ.
ª∂£√¢√™: ¶ÚˆÙfiÙ˘· ¿ÚıÚ· Î·È ·Ó·ÛÎÔ‹ÛÂȘ Ô˘
·ÊÔÚÔ‡Ó ÙÔ ı¤Ì·, ·Ó·˙ËÙ‹ıËÎ·Ó ÛÙȘ ‚¿ÛÂȘ ‰Â‰Ô̤-
ÓˆÓ PubMed, Medline, Cochrane, Embase, ηÈ
Scopus, ̤¯ÚÈ ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 2010.
∞¶√∆∂§∂™ª∞∆∞: ∆· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó·
‰fiÓÙÈ· Ê·›ÓÂÙ·È fiÙÈ ÌÂÙ·ÎÈÓÔ‡ÓÙ·È ÂÍ›ÛÔ˘ Î·È ÁÈ· ÙȘ
›‰È˜ ·ÔÛÙ¿ÛÂȘ ¯ˆÚ›˜ Ó· Á›ÓÔ˘Ó ·ÈÙ›· ÁÈ· ÚfiÎÏËÛË
ÂÚÈÛÛfiÙÂÚˆÓ ‰˘ÛÌÂÓÒÓ ·ÓÙȉڿÛÂˆÓ ·' fiÙÈ Ù·
˙ˆÓÙ·Ó¿. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ù¿ ̤ÛÔ fiÚÔ ÌÈÎÚfiÙÂÚË
·ÔÚÚfiÊËÛË Ù˘ ·ÎÚÔÚÚÈ˙È΋˜ ÂÚÈÔ¯‹˜ Û ۯ¤ÛË ÌÂ
Ù· ˙ˆÓÙ·Ó¿, ˆÛÙfiÛÔ Ë ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ ÎÚ›ÓÂÙ·È
·ÍÈÔÛËÌ›ˆÙË Ô‡Ù Û ÛÙ·ÙÈÛÙÈÎfi Ô‡ÙÂ Î·È Û ÎÏÈÓÈÎfi
Â›‰Ô. ∏ ·ÔÚÚfiÊËÛË Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È ÂÚÈÛ-
ÛfiÙÂÚÔ Ì ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Î·È ÙÔ ÛÙ¿‰ÈÔ
‰È¿Ï·Û˘ Ù˘ Ú›˙·˜ ·Ú¿ Ì ÙÔ˘˜ ÔÚıÔ‰ÔÓÙÈÎÔ‡˜ ‹
¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·È. ∆Ô
ÂÌÊÚ·ÎÙÈÎfi ˘ÏÈÎfi ÂÎÏÔÁ‹˜ Û ÂÚ›ÙˆÛË ÂÓ‰Ô‰ÔÓÙÈ-
΋˜ ıÂÚ·›·˜ ‰ÔÓÙÈÒÓ Ì ·‰È¿Ï·ÛÙ· ·ÎÚÔÚÚ›˙È·
Ê·›ÓÂÙ·È Ó· Â›Ó·È ÙÔ Ca(OH)2, fiˆ˜ Î·È Û ‰fiÓÙÈ· ÌÂ
‰È·Ï·Ṳ̂ӷ ·ÎÚÔÚÚ›˙È· Ô˘ ‚Ú›ÛÎÔÓÙ·È ˘fi ÔÚıÔ-
‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÏfiÁˆ Ù˘ ÙÂÎÌËÚȈ̤Ó˘ ‰Ú¿Û˘
ÙÔ˘ ¤Ó·ÓÙÈ Ù˘ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÌÂÓ˘ ·ÔÚÚÔÊ‹ÛÂ-
ˆ˜ ÙˆÓ ÚÈ˙ÒÓ. ™Â ÂÚÈÙÒÛÂȘ ηٷÁÌ¿ÙˆÓ Û˘ÛÙ‹ÓÂÙ·È
‰È¿ÛÙËÌ· ·Ó·ÌÔÓ‹˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 12 ÌËÓÒÓ ÚÈÓ ÙËÓ
¤Ó·ÚÍË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜, ÂÓÒ Ë ÔÚıÔ‰Ô-
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
ABSTRACT
AIM: To collect and assess the contemporary data
referring to orthodontic movement of endodontical-
ly treated teeth.
METHOD: Relevant original and review articles were
retrieved from PubMed, Medline, Cochrane,
Embase, and Scopus databases, until February 2010.
RESULTS: Endodontically treated teeth can be
moved equally well to vital teeth and for the same
distances, without more frequent adverse conse-
quences. They present a smaller degree of apical
resorption in mean values compared to vital teeth,
however this difference is not regarded to be statis-
tically or clinically significant. Root resorption seems
to be related more to the severity of trauma and the
stage of root development rather than orthodontic
or surgical manipulations. The obturating material
of choice in the event of endodontic treatment of
teeth with incomplete apex as well as in cases of
teeth with complete apex under orthodontic move-
ment, seems to be Ca(OH)2, because of the evidence
based action of Ca(OH)2 against the frequently
observed root resorption. In cases of fractures, a 12
month waiting period is suggested before the start
of orthodontic treatment, while in cases with no
radiographic findings treatment can begin relatively
immediately.
CONCLUSIONS: Orthodontic movement of
endodontically treated teeth is feasible without
negative consequences to the apex. Orthodontic
69
∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
ÓÙÈ΋ ÌÂٷΛÓËÛË ÌÔÚ› Ó· ÍÂÎÈÓ‹ÛÂÈ Û¯ÂÙÈο Û‡ÓÙÔ-
Ì· fiÙ·Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·.
™Àª¶∂ƒ∞™ª∞∆∞: ∏ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÂÓ‰Ô-
‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Â›Ó·È ÂÊÈÎÙ‹ ηÈ
¯ˆÚ›˜ ‰˘ÛÌÂÓ›˜ ÂÈÙÒÛÂȘ ÛÙÔ ·ÎÚÔÚ›˙ÈÔ. ∏ Úfi-
ÁÓˆÛË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘ ÂÓ‰Ô‰ÔÓÙÈο
ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ Ù‡Ô, ÙË
‚·Ú‡ÙËÙ· Î·È ÙË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ÙÔ˘ Ô‰ÔÓÙÈÎÔ‡ ÙÚ·‡-
Ì·ÙÔ˜ ·ÏÏ¿ Î·È ·fi ÙË ‰È·¯Â›ÚÈÛË Ù˘ ÔÌ¿‰·˜ ÙˆÓ
ıÂÚ·fiÓÙˆÓ.
§¤ÍÂȘ ÎÏÂȉȿ: ∂Ó‰Ô‰ÔÓÙÈ΋ ıÂÚ·›·, √ÚıÔ‰ÔÓÙÈ΋
ıÂÚ·›·, ∞ÔÚÚfiÊËÛË ÚÈ˙ÒÓ, ¶ÚfiÁÓˆÛË
∂ÏÏ √ÚıÔ‰ ∂Èı 2010;13:69-82.
¶·ÚÂÏ‹ÊıË: 06.04.2010 – ŒÁÈÓ ‰ÂÎÙ‹: 23.07.2010
EI™A°ø°H
∏ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ
‰ÔÓÙÈÒÓ, ·ÔÙÂÏ› Û‹ÌÂÚ· Ì›· Û¯ÂÙÈο Û˘¯Ó‹ ·Ó·ÁηÈfi-
ÙËÙ· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË. ∂›Ó·È ·fiÚÚÔÈ·
·ÊÂÓfi˜, Ù˘ ÌÂÁ¿Ï˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÙÚ·˘Ì¿-
ÙˆÓ Î·Ù¿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ‹ ηٿ ÙËÓ ÂÊ˂›·.
™‡Ìʈӷ Ì ̛· 'ŒÚ¢ӷ ÁÈ· ÙËÓ √‰ÔÓÙÈ΋ ÀÁ›· ÙˆÓ ¶·È-
‰ÈÒÓ' Ô˘ ¤ÁÈÓ ÛÙËÓ ∞ÁÁÏ›· ÙÔ 2003 (Children's Dental
Health Survey), ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ÙÚ·‡Ì·Ù·
ÙˆÓ ÌÔÓ›ÌˆÓ ÙÔ̤ˆÓ ·ÁÁ›˙ÂÈ ÙÔ 5% ÛÙËÓ ËÏÈΛ· ÙˆÓ 8
ÂÙÒÓ, Î·È ÙÔ 11% ÛÙËÓ ËÏÈΛ· ÙˆÓ 12 ÂÙÒÓ (Chadwick ηÈ
Pendry, 2004), ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ԉÔÓÙÈο
ÙÚ·‡Ì·Ù·, ̤۷ ·fi ¤Ó· ÏËı˘ÛÌfi ÔÚıÔ‰ÔÓÙÈÎÒÓ ·ÛıÂ-
ÓÒÓ ·ÁÁ›˙ÂÈ ÙÔ 10.8% (Bauss Î·È Û˘Ó., 2004). ∞ÊÂÙ¤ÚÔ˘,
Â›Ó·È Î·È Â·ÎfiÏÔ˘ıÔ Ù˘ ·˘Í·ÓfiÌÂÓ˘ ÂÈı˘Ì›·˜ ÙˆÓ
ÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÈ˙ËÙÔ‡Ó ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋
ıÂÚ·›· ÁÈ· ·ÔηٿÛÙ·ÛË ÙˆÓ Û˘ÁÎÏÂÈÛÈ·ÎÒÓ ÙÔ˘˜
ÚÔ‚ÏËÌ¿ÙˆÓ (Khan Î·È Horrocks, 1991), Î·È Ô˘ ÂÌÊ·-
Ó›˙Ô˘Ó fiˆ˜ ÚÔ·ÙÂÈ ·fi ÂȉËÌÈÔÏÔÁÈΤ˜ ¤Ú¢Ó˜
ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÂÓ‰Ô‰ÔÓÙÈÎÒÓ ıÂÚ·ÂÈÒÓ
(Ahmed Î·È Û˘Ó., 2009). À¿Ú¯ÂÈ Û˘ÓÂÒ˜ Ì›· ÛÙÂÓ‹
Û¯¤ÛË ÌÂٷ͇ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Î·È ÙˆÓ ÂÓ‰Ô-
‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Ô˘ οÓÂÈ ·Ó·Áη›· ÙËÓ
ÚÔÛ¤ÁÁÈÛ‹ ÙÔ˘˜, ÒÛÙ ӷ ‰È·ÛÊ·ÏÈÛÙ› ÙÔ Î·Ï‡ÙÂÚÔ
‰˘Ó·Ùfi Ì·ÎÚÔÚfiıÂÛÌÔ ·ÔÙ¤ÏÂÛÌ· ÚÔ˜ fiÊÂÏÔ˜ ÙÔ˘
ÌÈÎÚÔ‡ ‹ ÙÔ˘ ÂÓ‹ÏÈη ·ÛıÂÓÔ‡˜.
∞Ó·ÙÚ¤¯ÔÓÙ·˜ Û ÂÎÙÈÌ‹ÛÂȘ ÙÔ˘ ·ÚÂÏıfiÓÙÔ˜, Ê·›ÓÂÙ·È
Ó· ˘¿Ú¯Ô˘Ó ‰È·ÊÔÚÂÙÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ÁÈ· ÙË Û˘ÌÂÚÈÊÔ-
Ú¿ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Î·Ù¿ ÙË
‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜. ŒÙÛÈ, ¿ÏÏÔÈ ‰È·Ù˘-
70
HELLENIC ORTHODONTIC REVIEW
treatment prognosis of endodontically treated teeth
depends on the type, the severity and the timing of
trauma, as well as the management of the case by
the team of therapists.
Key words: Endodontic treatment, Orthodontic treat-
ment, Root resorption, Prognosis
Hell Orthod Rev 2010;13:69-82.
Received: 06.04.2010 – Accepted: 23.07.2010
INTRODUCTION
Orthodontic treatment of endodontically treated teeth,
constitutes quite often a necessity in contemporary clin-
ical practice. On the one hand, the increased frequency
of orthodontic treatment of endodontically treated
teeth is due to the increased frequency of dental trauma
in preschool children or adolescents. According to “Chil-
dren's Dental Health Survey” carried out in England in
2003, the percentage of children with permanent incisor
trauma was 5% at the age of 8 and 11% at the age of
12 years old (Chadwick and Pendry, 2004), while the per-
centage of children with dental trauma in an orthodon-
tic patient population was 10.8% (Bauss et al., 2004). On
the other hand, the increased frequency of orthodontic
treatment of endodontically treated teeth is a conse-
quence of the increased desire of adult patients seeking
orthodontic treatment for the rehabilitation of their
occlusal problems (Khan and Horrocks, 1991). According
to epidemiological studies, adult patients demonstrate
an increased frequency of endodontic treatments
(Ahmed et al., 2009). As a consequence of the increased
frequency of orthodontic treatment of endodontically
treated teeth, relevant information indispensable in
order to achieve the best long-term result for the bene-
fit of both children and adult patients.
Different assessments on endodontically treated teeth
behavior during orthodontic treatment can be found in
the existing literature. While some authors suggested
that endodontically treated teeth behave like foreign
bodies and thus have bad prognosis (Steadman, 1942),
others postulated that they move like vital teeth (Malm-
gren et al., 1982). Moreover, different suggestions exist
regarding root resorption in endodontically treated teeth
compared to vital teeth. Other authors suggest that
endodontically treated teeth exhibit greater degree of
root resorption compared to vital teeth (Wickwire et al.,
1974), others suggest that it is less (Remington et al.,
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
ÒÓÔ˘Ó ÙËÓ ¿Ô„Ë fiÙÈ Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó·
‰fiÓÙÈ· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Û·Ó Í¤Ó· ÛÒÌ·Ù· ·fi ÙÔÓ ÔÚÁ·-
ÓÈÛÌfi Î·È ¤¯Ô˘Ó Û˘ÓÂÒ˜ η΋ ÚfiÁÓˆÛË (Steadman,
1942), ÂÓÒ ¿ÏÏÔÈ ‰È·Ù›ÓÔÓÙ·È fiÙÈ ÌÂÙ·ÎÈÓÔ‡ÓÙ·È ÂÍ›ÛÔ˘
Ì ٷ ˙ˆÓÙ·Ó¿ (Malmgren Î·È Û˘Ó., 1982). À¿Ú¯Ô˘Ó
·ÎfiÌË ‰È·ÊÔÚÂÙÈΤ˜ ·ÓÙÈÏ‹„ÂȘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ¿ÏÏÔÙÂ
Ì ÙËÓ ÚfiÎÏËÛË ÌÂÁ·Ï‡ÙÂÚÔ˘ ‚·ıÌÔ‡ ·ÔÚÚfiÊËÛ˘
ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ ÛÂ
Û¯¤ÛË Ì ٷ ˙ˆÓÙ·Ó¿ (Wickwire Î·È Û˘Ó., 1974), ¿ÏÏÔÙÂ
·ÓÙ›ıÂÙ· Ì ÌÈÎÚfiÙÂÚÔ˘ ‚·ıÌÔ‡ (Remington Î·È Û˘Ó.,
1989; Spurrier Î·È Û˘Ó., 1990; Mirabella Î·È Artun,
1995), ‹ ·ÎfiÌ·, Î·È Ì ›‰ÈÔ˘ ‚·ıÌÔ‡ ·ÔÚÚÔÊ‹ÛÂȘ
(Huettner Î·È Young, 1955; ªattison Î·È Û˘Ó., 1984). ∏
‰È·ÊÔÚÂÙÈÎfiÙËÙ· ·˘Ù‹ ÙˆÓ ·ÓÙÈÏ‹„ˆÓ, ·ÔÙ¤ÏÂÛ ΛÓË-
ÙÚÔ ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÂÈηÈÚÔÔ›ËÛ˘ Ù˘ ÁÓÒÛ˘,
Û¯ÂÙÈο ÌÂ: (·) ∆Ë ‰˘Ó·ÙfiÙËÙ· ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘
ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ, (‚) ∆Ô ‚·ıÌfi
·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤-
ÓˆÓ ‰ÔÓÙÈÒÓ Û ۯ¤ÛË Ì ٷ ÌË ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤-
Ó·, Î·È (Á) ∆ËÓ ÚfiÁÓˆÛË ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤-
ÓˆÓ ‰ÔÓÙÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·-
›·˜.
À§π∫√ ∫∞π ª∂£√¢√™
µÈ‚ÏÈÔÁÚ·Ê›· Û¯ÂÙÈ΋ Ì ÙÔ ı¤Ì·, ·Ó·˙ËÙ‹ıËΠ̤۷ ·fi
ÙȘ ·ÎfiÏÔ˘ı˜ ËÁ¤˜: PubMed, Medline ̤۷ ·fi ÙÔ
PubMed, Cochrane Database for Systematic Reviews ηÈ
The Cochrane Central Register of Controlled Trials
(Central) ÛÙÔ Cochrane Library, Embase ÛÙÔ
www.embase.com, Î·È Scopus, ̤¯ÚÈ ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ
ÙÔ˘ 2010.
∞¶√∆∂§∂™ª∞∆∞
H √ÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·¢ -
Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ
Ÿˆ˜ ‰È·ÈÛÙÒÓÂÙ·È ·fi ÙË ÌÂϤÙË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, Ë
·Ï·ÈfiÙÂÚË ·ÓÙ›ÏË„Ë Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· Ù· ÂÓ‰Ô‰Ô-
ÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ·fi ÙÔÓ ÔÚÁ·-
ÓÈÛÌfi Û·Ó Í¤Ó·, ÚÔηÏÒÓÙ·˜ ¯ÚfiÓÈÔ ÂÚÂıÈÛÌfi Ô˘ Ô‰Ë-
Á› Û ·ÔÚÚfiÊËÛË Ú›˙·˜, ‹ Î·È ·Á·ψÛË, Î·È ¤¯Ô˘Ó
η΋ ÚfiÁÓˆÛË ÛÙȘ ÔÚıÔ‰ÔÓÙÈΤ˜ ÌÂÙ·ÎÈÓ‹ÛÂȘ
(Steadman, 1942), Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ÂȂ‚·ÈÒÓÂÙ·È.
ªÂÙ·ÁÂÓ¤ÛÙÂÚ˜ ·ÏÏ¿ Î·È Û‡Á¯ÚÔÓ˜ ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó
ÙfiÛÔ Û ÂÈÚ·Ì·Ùfi˙ˆ· (Huettner Î·È Young, 1955;
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
1989; Spurrier et al., 1990; Mirabella and Artun, 1995),
while others mention the same degree of resorption
between the two group of teeth (Huettner and Young,
1955; ªattison et al., 1984). The abovementioned differ-
ences observed in the relevant literature formed the ini-
tiative to conduct a contemporary survey regarding: (a)
The ability of endodontically treated teeth to be moved
orthodontically, (‚) The degree of root resorption of
endodontically treated teeth compared to vital teeth,
and (c) The prognosis of endodontically treated teeth
during orthodontic treatment.
MATERIALS AND METHODS
Relevant literature was searched in the following
sources: PubMed, Medline via PubMed, Cochrane
Database for Systematic Reviews and The Cochrane Cen-
tral Register of Controlled Trials (Central) via Cochrane
Library, Embase via www.embase.com, and Scopus, until
February 2010.
RESULTS
Orthodontic movement of endodontically treated teeth
As concluded from the literature review, the older con-
cept that endodontically treated teeth are recognized as
foreign bodies, leading to chronic inflammation and root
resorption or ankylosis, and having bad prognosis in
orthodontic movements (Steadman, 1942), is not con-
firmed. Subsequent and contemporary studies conduct-
ed on animals (Huettner and Young, 1955; Mattison et
al., 1984; Mah et al., 1996; de Souza et al., 2006; Gong
et al., 2007; de Souza et al., 2009), as well as on humans
(Wickwire et al., 1974; Remington et al., 1989; Spurrier
et al., 1990; Mirabella and Artun, 1995; Esteves et al.,
2007), lead to the conclusion that endodontically treat-
ed teeth move equally well to vital teeth and for the
same distance.
Successful orthodontic movement has also been report-
ed for teeth treated with surgical endodontic tech-
niques. Failures were attributed to inadequate chemo-
mechanical preparation and obturation of the root
canals, as well as periodontal disease involvement in the
surgical field (Rud and Andreasen, 1972; Rud et al., 1972;
Hamilton and Gutmann, 1999; Kindelan et al., 2008).
Root resorption in endodontically treated teeth
The assessment of the degree of root resorption com-
71
∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
Mattison Î·È Û˘Ó., 1984; Mah Î·È Û˘Ó., 1996; de Souza
Î·È Û˘Ó., 2006; Gong Î·È Û˘Ó., 2007; de Souza Î·È Û˘Ó.,
2009), fiÛÔ Î·È Û ·ÓıÚÒÔ˘˜ (Wickwire Î·È Û˘Ó., 1974;
Remington Î·È Û˘Ó., 1989; Spurrier Î·È Û˘Ó., 1990;
Mirabella Î·È Artun, 1995; Esteves Î·È Û˘Ó., 2007), ˘Ô-
ÛÙËÚ›˙Ô˘Ó ÙËÓ ¿Ô„Ë fiÙÈ Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó·
‰fiÓÙÈ· ÌÂÙ·ÎÈÓÔ‡ÓÙ·È ÂÍ›ÛÔ˘ Ì ٷ ˙ˆÓÙ·Ó¿ Î·È ÁÈ· ÙȘ
›‰È˜ ·ÔÛÙ¿ÛÂȘ.
∂ÈÙ˘¯‹˜ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ¤¯ÂÈ Â›Û˘ ·Ó·ÊÂÚı›
Î·È ÁÈ· ‰fiÓÙÈ· ÙˆÓ ÔÔ›ˆÓ Ë ÚÔÛ¤ÁÁÈÛË ¤ÁÈÓ Ì ÙȘ
Ù¯ÓÈΤ˜ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÂÓ‰Ô‰ÔÓÙ›·˜. ∞ÔÙ˘¯›Â˜ ·Ô‰fi-
ıËÎ·Ó ÛÙËÓ ·ÙÂÏ‹ ¯ËÌÈÎÔÌ˯·ÓÈ΋ ÂÂÍÂÚÁ·Û›· ηÈ
¤ÌÊÚ·ÍË ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ, ηıÒ˜ Î·È ÛÙËÓ ÚÔ-
Û‚ÔÏ‹ ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ‰›Ô˘ ·fi ÙË ÓfiÛÔ Ù˘ ÂÚÈÔ-
‰ÔÓÙ›Ùȉ·˜ (Rud Î·È Andreasen, 1972; Rud Î·È Û˘Ó., 1972;
Hamilton Î·È Gutmann, 1999; Kindelan Î·È Û˘Ó., 2008).
∏ ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ
‰ÔÓÙÈÒÓ
∏ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ‚·ıÌÔ‡ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ
ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Û ۯ¤ÛË Ì ٷ
˙ˆÓÙ·Ó¿, ηٿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ÙÔ˘˜ ÌÂٷΛÓËÛË Î·Ù¤ÛÙË
ȉȷ›ÙÂÚ· ‰‡ÛÎÔÏË. √Ê›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ·Èٛ˜
Ô˘ Ô‰ËÁÔ‡Ó Û ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂÚ·›· Â›Ó·È ÔÏϤ˜ ηÈ
‰È·ÊÔÚÂÙÈΤ˜ fiˆ˜, ·fi ÊÏÂÁÌÔÓ‹ ‹ Ó¤ÎÚˆÛË ÙÔ˘ ÔÏ-
ÊÔ‡ Î·È ÙˆÓ ÂÚÈ·ÎÚÔÚÈ˙ÈÎÒÓ ÈÛÙÒÓ, ·fi ‰È¿ÊÔÚ˜ ÌÔÚ-
ʤ˜ ηٷÁÌ¿ÙˆÓ Ì‡Ï˘, Ú›˙·˜, ̇Ï˘ Î·È Ú›˙·˜, Ô˘ ÌÔ-
Ú› Ó· Â›Ó·È ·Ï¿ ‹ ÔÏÏ·Ï¿, Û‡ÓıÂÙ·, ÔÚÈ˙fiÓÙÈ· ‹
οıÂÙ·, Î·È Ë ÔÚıÔ‰ÔÓÙÈ΋ ÚÔÛ¤ÁÁÈÛË ·Ó¿ÏÔÁË ÁÈ· ÙËÓ
οı ÂÚ›ÙˆÛË. ŒÙÛÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÎÏÈÓÈΤ˜ Ù˘¯·ÈÔÔÈË-
̤Ó˜ ÌÂϤÙ˜ ·ÏÏ¿ Î·È ÁÂÓÈÎfiÙÂÚ· ÌÂϤÙ˜ Ô˘ Ó· ·ÊÔ-
ÚÔ‡Ó ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÂÚÈÙÒÛÂˆÓ Ì ›‰ÈÔ˘ Ù‡Ô˘ ÙÚ·‡-
Ì·ÙÔ˜, ‹ ηٿÁÌ·ÙÔ˜, Ì ¿ÛÎËÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÔÚıÔ-
‰ÔÓÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ ÁÈ· Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÛÙfi¯Ô˘˜ Î·È ÌÂ
ÙȘ ·ÓÙ›ÛÙÔȯ˜ ·ÓÙȉڿÛÂȘ ÙÔ˘ ·ÎÚÔÚÚÈ˙›Ô˘ Û ‚¿ıÔ˜
¯ÚfiÓÔ˘. √È ÏËÚÔÊÔڛ˜ Û˘ÓÂÒ˜ ÚÔ¤Ú¯ÔÓÙ·È Â›Ù ·fi
ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ‹ Û ·ÓıÚÒÔ˘˜, ›Ù ·fi ·Ó·-
ÛÎÔ‹ÛÂȘ Î·È ·ÚÔ˘ÛÈ¿ÛÂȘ Ì›·˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ÂÚÈ-
ÙÒÛˆÓ.
√ ‚·ıÌfi˜ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ
ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó Ú·ÁÌ·ÙÔÔÈ-
Ëı›, ‰È·¯ˆÚ›˙ÂÈ ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· Û ‰È·ÊÔÚÂ-
ÙÈΤ˜ ·fi„ÂȘ. ŒÙÛÈ ˘¿Ú¯ÂÈ Ë ¿Ô„Ë, fiÙÈ Ë ÛËÌÂÈÔ‡ÌÂÓË
·ÔÚÚfiÊËÛË Û ˘fi ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÂÓ‰Ô‰Ô-
ÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Â›Ó·È ÂÏ¿¯ÈÛÙË, Î·È ›‰È· ÌÂ
·˘Ù‹ Ô˘ ˘Ê›ÛÙ·ÓÙ·È Ù· ‰fiÓÙÈ· Ì ˙ˆÓÙ·Ófi ÔÏÊfi. ∏
72
HELLENIC ORTHODONTIC REVIEW
pared to vital teeth during orthodontic tooth movement
proved to be particularly difficult. This can be attributed
to the fact that the causes leading to endodontic treat-
ment are many and different. For example endodontic
treatment may be need in cases of inflammation or
necrosis of the pulp and the periodontal tissues or in
cases of different types of crown, root or crown and root
trauma, that could be single or multiple, complex, hori-
zontal or vertical. These cases require different types of
tooth movement depending on the particular situation.
Thus it is not strange to observe a lack of randomized
controlled trials as well as research papers in general
that involve a large number of cases with the same type
of trauma or fracture, in which specific type of ortho-
dontic force to attain specific results is applied and
where the apex reactions can be studied for a period of
time. In consequence, relevant information is coming
either form animal or human studies, or reviews and case
reports.
As can be judged from the limited research conducted,
the scientific community is divided into different opin-
ions. Some scientists believe that the resorption noted in
endodontically treated teeth under orthodontic move-
ment is minimal and essentially the same appearing in
vital teeth. This conclusion was initially formulated from
the assessment of the resorption in endodontically treat-
ed teeth of Macacus monkeys compared to vital ones,
after the termination of orthodontic movement (Huet-
tner and Young, 1955). Histological examination of bone,
the periodontal tissues and the cementum revealed that
the resorption in the root of endodontically treated
teeth is minimal and the same as the one noted in vital
teeth. The researchers regarded that the careful applica-
tion of orthodontic forces, the attainment of an aseptic
environment during endodontic treatment and the intact
periodontal membrane constituted decisive factors in
order to attain these results. Corroborating evidence
were provided by a subsequent study that was conduct-
ed in higher mammals (ªattison et al., 1984). Histologi-
cal investigation showed that the degree of resorption
was negligible in general and encountered with the
same frequency in endodontically treated and vital
teeth. The authors concluded that the orthodontists
should expect that endodontically treated teeth move
equally well to vital teeth without any additional conse-
quences relative to the lack of pulp vitality.
Studies in humans seem to confirm the results from ani-
mal studies. One study involving 25 endodontically
treated incisors, after trauma of mild to moderate sever-
ity and intact periodontal ligament, concluded that the
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
·ÓÙ›ÏË„Ë ·˘Ù‹ ›¯Â ·Ú¯Èο ‰È·Ù˘ˆı› ·fi ÙËÓ ·ÍÈÔÏfi-
ÁËÛË Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ
‰ÔÓÙÈÒÓ Û ۯ¤ÛË Ì ÌË ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ÙÔ˘ Èı‹-
ÎÔ˘ Á¤ÓÔ˘˜ Macacus, ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜
ÙÔ˘˜ ıÂÚ·›·˜ (Huettner Î·È Young, 1955). ∏ ÈÛÙÔÏÔÁÈ-
΋ ÂͤٷÛË ÙÔ˘ ÔÛÙÔ‡, ÙÔ˘ ÂÚÈÔ‰ÔÓÙÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘ ηÈ
Ù˘ ÔÛÙ½Ó˘ ·ÔÎ¿Ï˘„ fiÙÈ Ë ·ÔÚÚfiÊËÛË ÙˆÓ ÂÓ‰Ô‰Ô-
ÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ ‹Ù·Ó ÂÏ¿¯ÈÛÙË Î·È ›‰È· ÌÂ
·˘Ù‹ Ô˘ ˘Ê›ÛÙ·ÓÙ·È Ù· ‰fiÓÙÈ· Ì ˙ˆÓÙ·Ófi ÔÏÊfi. √È
Û˘ÁÁÚ·Ê›˜ ıÂÒÚËÛ·Ó fiÙÈ Î·ıÔÚÈÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ·
Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ·˘Ù¿ ‹Ù·Ó Ë ÂÏÂÁ¯fiÌÂÓË Î·È Ë ÚÔÛÂ-
ÎÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÔÚıÔ‰ÔÓÙÈÎÒÓ ‰˘Ó¿ÌˆÓ, Ë ÂÍ·ÛÊ¿ÏÈÛË
¿ÛËÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ηٿ Ù· ÛÙ¿‰È· ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘
ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Î·È Ë ¿ıÈÎÙË ÂÚÈÔ‰ÔÓÙÈ΋ ÌÂÌ-
‚Ú¿ÓË. ¶·ÚfiÌÔÈ· Û˘ÌÂÚ¿ÛÌ·Ù· fï˜ ÚÔ‹Ïı·Ó ηÈ
·fi ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË Ô˘ ¤ÁÈÓ Û ·ÓÒÙÂÚ· ıËÏ·-
ÛÙÈο (ªattison Î·È Û˘Ó., 1984). ∏ ÈÛÙÔÏÔÁÈ΋ ÌÂϤÙË
¤‰ÂÈÍ fiÙÈ Û˘ÓÔÏÈο, ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·ÔÚÚfiÊËÛ˘ ‹Ù·Ó
·ÌÂÏËÙ¤Ô Î·È ÛËÌÂÈÔ‡ÌÂÓÔ Ì ÙËÓ ›‰È· Û˘¯ÓfiÙËÙ·, ›ÙÂ
·˘Ùfi ·ÊÔÚÔ‡Û ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ›Ù ÌË ıÂÚ·-
Â˘Ì¤Ó· ‰fiÓÙÈ·. √È Û˘ÁÁÚ·Ê›˜ Û˘Ì¤Ú·Ó·Ó fiÙÈ ÔÈ ÔÚıÔ-
‰ÔÓÙÈÎÔ› Ú¤ÂÈ Ó· ·Ó·Ì¤ÓÔ˘Ó fiÙÈ Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·-
Â˘Ì¤Ó· ‰fiÓÙÈ· ÌÂÙ·ÎÈÓÔ‡ÓÙ·È ÂÍ›ÛÔ˘ Ì ÂΛӷ Ô˘ ‰È·-
ÙËÚÔ‡Ó ˙ˆÓÙ·Ófi ÔÏÊfi Î·È ¯ˆÚ›˜ ÂÈÚfiÛıÂÙ˜ ÂÈÙÒ-
ÛÂȘ Ô˘ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·Ô˘Û›· ˙ˆÙÈÎfiÙËÙ·˜ ÙÔ˘
ÔÏÊÔ‡.
ªÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Û ·ÓıÚÒÔ˘˜, Ê·›ÓÂÙ·È Ó· ÂÈ‚Â-
‚·ÈÒÓÔ˘Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÂÈÚ·-
Ì·Ùfi˙ˆ·. ™Â Ì›· Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹-
ıËΠ۠25 ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓÔ˘˜ ÙÔÌ›˜ ·ÛıÂÓÒÓ,
ÌÂÙ¿ ·fi ‹È·˜ ‹ ̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ ÙÚ·‡Ì·Ù·, Ì ·Î¤-
Ú·ÈÔ ÂÚÈÔ‰ÔÓÙÈÎfi Û‡Ó‰ÂÛÌÔ, ‰È·ÈÛÙÒıËΠfiÙÈ ÛÙÔ
¤Ú·˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜, ‰ÂÓ ÂȂ‚·ÈÒÓÂÙ·È Ë
˘fiıÂÛË fiÙÈ Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ÌÂÙ¿
·fi ÙÚ·˘Ì·ÙÈÛÌfi, ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Ù¿ÛË ÁÈ· ·ÔÚÚfi-
ÊËÛË ÚÈ˙ÒÓ Û ۯ¤ÛË Ì ٷ ÌË ÙÚ·˘Ì·ÙÈṲ̂ӷ
(Malmgren Î·È Û˘Ó., 1982). ∆¤ÏÔ˜, Û ۯÂÙÈο ÚfiÛÊ·ÙË
·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË Û ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓÔ˘˜
ÎÂÓÙÚÈÎÔ‡˜ ÙÔÌ›˜ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ·ÛıÂÓÒÓ Ô˘ ÂÚfi-
ÎÂÈÙÔ Ó· ˘Ô‚ÏËıÔ‡Ó Û ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·, ÔÈ
ÂÚÈ·ÎÚÔÚÚÈ˙ÈΤ˜ ·ÎÙÈÓÔÁڷʛ˜ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·-
Â˘Ì¤ÓˆÓ ÙÔ̤ˆÓ Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ˙ˆÓÙ·ÓÒÓ
‰ÔÓÙÈÒÓ ÙÔ˘ ·ÓÙ›ıÂÙÔ˘ ËÌÈÌÔÚ›Ô˘ Ô˘ ÂÏ‹ÊıËÛ·Ó ÚÈÓ
Î·È ÌÂÙ¿ ÙË ıÂÚ·›·, η٤‰ÂÈÍ·Ó fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙ·ÙÈ-
ÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘
Ê·ÈÓÔ̤ÓÔ˘ ·ÔÚÚfiÊËÛ˘ Ú›˙·˜ ·Ó¿ÌÂÛ· Û ÂÓ‰Ô‰ÔÓÙÈ-
ο ıÂÚ·Â˘Ì¤Ó· Î·È ˙ˆÓÙ·Ó¿ ‰fiÓÙÈ·. øÛÙfiÛÔ, fiÛÔÓ
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
hypothesis that endodontically treated teeth after trau-
ma present a greater tendency for root resorption com-
pared to non traumatized teeth is not confirmed (Malm-
gren et al., 1982). Moreover, in a recent retrospective
study involving endodontically treated upper central
incisors that were to be moved orthodontically, the peri-
apical radiographs taken before and after movement of
the treated and the contralateral vital teeth did not
show any statistically significant difference in root
resorption frequency. Vital teeth exhibited greater
resorption of the apical area by 0.22 mm, an amount that
was not significant in a statistical or clinical level (Esteves
et al., 2007).
Other scientists believe that root resorption in endodon-
tically treated teeth is greater compared to vital teeth.
This was initially based on a study comprising mainly of
children that had undergone trauma (plus a fracture in
50% of them) before the initiation of orthodontic treat-
ment (Wickwire et al., 1974). The assessment of the con-
sequences of orthodontic movement of 53 endodontical-
ly treated teeth in a group of 45 patients, concluded that
resorption in endodontically treated teeth is greater than
the one noted in vital teeth. Similar results were
obtained in an animal study and were attributed to the
possible presence of periapical inflammation and not to
orthodontic forces (Mah et al., 1996). A subsequent
experimental study in upper mammals, recorded radi-
ographically and histologically the greater loss of cemen-
tum in endodontically treated teeth compared to vital
teeth (Gong et al., 2007).
A final group of researchers suggests that endodontical-
ly treated teeth exhibit less root resorption compared to
vital teeth. Remington et al. (1989) have supported the
view that endodontically treated teeth are more resis-
tant to resorption compared to vital teeth. The authors
suggested that this finding could be attributed to the
increased dentin density noted in endodontically treated
teeth, which renders them more resistant to resorption
processes. However, these conclusions were reached by
observing three endodontically treated teeth in a gener-
al study involving root resorption during orthodontic
treatment, without a referral to the possible causes.
Later experiments in rats revealed also that endodonti-
cally treated teeth are more resistant to resorption.
Satoh (1990) examined teeth form two groups of rats,
one having undergone pulpectomy of first molars bilat-
erally and one with vital upper molars. Histological
investigation showed a smaller degree of external root
resorption coupled by the presence of odontoclasts in
endodontically treated teeth compared to vital teeth
73
∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
·ÊÔÚ¿ ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·ÔÚÚfiÊËÛ˘, Ù· ˙ˆÓÙ·Ó¿ ‰fiÓÙÈ·
·ÚÔ˘Û›·Û·Ó ηٿ ̤ÛÔ fiÚÔ Ì›· ÂÏ·ÊÚÒ˜ ÌÂÁ·Ï‡ÙÂÚË
·ÔÚÚfiÊËÛË Ù˘ ·ÎÚÔÚÚÈ˙È΋˜ ÂÚÈÔ¯‹˜ Ù˘ ٿ͈˜ ÙˆÓ
0.22 ¯ÈÏÈÔÛÙÒÓ, Ô˘ fï˜ ‰ÂÓ ÎÚ›ıËΠ·ÍÈÔÛËÌ›ˆÙË
Ô‡Ù Û ÛÙ·ÙÈÛÙÈÎfi Â›Â‰Ô fiÛÔ Ì¿ÏÏÔÓ Û ÎÏÈÓÈÎfi
(Esteves Î·È Û˘Ó., 2007).
À¿Ú¯ÂÈ Ì›· ¿ÏÏË ·ÓÙ›ÏË„Ë, ηٿ ÙËÓ ÔÔ›· ıˆÚÂ›Ù·È fiÙÈ
Ë ·ÔÚÚfiÊËÛË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·-
Â˘Ì¤Ó· ‰fiÓÙÈ· Û ۯ¤ÛË Ì ٷ ˙ˆÓÙ·Ó¿. µ·Û›ÛÙËΠ·Ú¯È-
ο Û ÌÂϤÙË Ô˘ ·ÊÔÚ¿ ηٿ ÏÂÈÔÓfiÙËÙ· ·È‰È¿ Ô˘
›¯·Ó ˘ÔÛÙ› Ô‰ÔÓÙÈÎfi ÙÚ·‡Ì·, ÂÎ ÙˆÓ ÔÔ›ˆÓ Ù· ÌÈÛ¿
·fi ·˘Ù¿ ›¯·Ó Â›Û˘ ˘ÔÛÙ› οٷÁÌ· ÚÈÓ ÙËÓ ¤Ó·ÚÍË
Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ (Wickwire Î·È Û˘Ó., 1974).
∞ÍÈÔÏÔÁÒÓÙ·˜ ÙȘ ÂÈÙÒÛÂȘ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓË-
Û˘ 53 Û˘ÓÔÏÈο ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ ÛÂ
Ì›· ÔÌ¿‰· 45 ÔÚıÔ‰ÔÓÙÈÎÒÓ ·ÛıÂÓÒÓ, ÔÈ Û˘ÁÁÚ·Ê›˜
‰È·ÈÛÙÒÓÔ˘Ó fiÙÈ Ë ÛËÌÂÈÔ‡ÌÂÓË ·ÔÚÚfiÊËÛË ÛÙ· ÂÓ‰Ô-
‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛ-
ÓË Ô˘ ÛËÌÂÈÒıËΠÛÙ· ‰fiÓÙÈ· Ì ˙ˆÓÙ·Ófi ÔÏÊfi.
ªÂÁ·Ï‡ÙÂÚË ·ÔÚÚfiÊËÛË Â›Û˘ ‰È·ÈÛÙÒıËΠ۠¤Ú¢-
Ó· Ô˘ ¤ÁÈÓ Û ÂÈÚ·Ì·Ùfi˙ˆ·, ÁÂÁÔÓfi˜ Ô˘ ·Ô‰fiıËÎÂ
ÛÙËÓ Èı·Ó‹ ·ÚÔ˘Û›· ÂÚÈ·ÎÚÔÚÚÈ˙È΋˜ ÊÏÂÁÌÔÓ‹˜ ηÈ
fi¯È ÛÙȘ ÔÚıÔ‰ÔÓÙÈΤ˜ ‰˘Ó¿ÌÂȘ Ô˘ ·Û΋ıËÎ·Ó ÛÙ·
‰fiÓÙÈ· ·˘Ù¿ (Mah Î·È Û˘Ó., 1996). ªÂÙ·ÁÂÓ¤ÛÙÂÚË ÂÈÚ·-
Ì·ÙÈ΋ ÌÂϤÙË Û ·ÓÒÙÂÚ· ıËÏ·ÛÙÈο, η٤ÁÚ·„ Â›Û˘
·fi ·ÎÙÈÓÔÁÚ·ÊÈο Î·È ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÌÂÁ·Ï‡ÙÂ-
ÚË ·ÒÏÂÈ· ÔÛÙ½Ó˘ ÛÙ· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó·
‰fiÓÙÈ· Û ۯ¤ÛË Ì ٷ ˙ˆÓÙ·Ó¿ (Gong Î·È Û˘Ó., 2007).
∆¤ÏÔ˜, ˘¿Ú¯ÂÈ Ë ·ÓÙ›ÏË„Ë fiÙÈ Ë ·ÔÚÚfiÊËÛË Â›Ó·È
ÌÈÎÚfiÙÂÚË Û ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Û ۯ¤ÛË
Ì ٷ ˙ˆÓÙ·Ó¿. ∂›¯Â ·Ï·ÈfiÙÂÚ· ˘ÔÛÙËÚȯı› ˆ˜ Ù·
ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ηٿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋
ÙÔ˘˜ ÌÂٷΛÓËÛË, ‰Â›¯ÓÔ˘Ó Ó· ·Óı›ÛÙ·ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ
ÛÙËÓ ·ÔÚÚfiÊËÛË Û ۇÁÎÚÈÛË Ì ٷ ˙ˆÓÙ·Ó¿
(Remington Î·È Û˘Ó., 1989). √È Û˘ÁÁÚ·Ê›˜ ıÂÒÚËÛ·Ó
fiÙÈ ÙÔ ÌÂȈ̤ÓÔ Ì¤ÁÂıÔ˜ ·ÔÚÚfiÊËÛ˘ Ô˘ ·Ú·ÙËÚ‹-
ıËÎÂ, ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·˘ÍË̤ÓË ˘ÎÓfiÙËÙ·
Ô‰ÔÓÙ›Ó˘ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·¢-
̤ӷ ‰fiÓÙÈ·, Ë ÔÔ›· Ù· ηıÈÛÙ¿ ÈÔ ·ÓıÂÎÙÈο ÛÙȘ ‰ÈÂÚ-
Á·Û›Â˜ ·ÔÚÚfiÊËÛ˘. ∆· Û˘ÌÂÚ¿ÛÌ·Ù· ·˘Ù¿ ˆÛÙfiÛÔ
·Ó·Ê¤ÚÔÓÙ·Ó ÛÂ Â˘Ú‹Ì·Ù· 3 ÌfiÓÔÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·-
Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ, ¯ˆÚ›˜ ·Ó·ÊÔÚ¿ ÛÙ· ·›ÙÈ·, ̤۷ ·fi
Ì›· ÁÂÓÈÎfiÙÂÚË ¤Ú¢ӷ Ô˘ ·ÊÔÚÔ‡Û ÙȘ ·ÔÚÚÔÊ‹ÛÂȘ
ÙˆÓ ‰ÔÓÙÈÒÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ-
΋˜ ıÂÚ·›·˜.
ªÂÙ·ÁÂÓ¤ÛÙÂÚ· ÂÈÚ¿Ì·Ù· Û Â›Ì˘Â˜ Ê·Ó¤ÚˆÛ·Ó Â›Û˘
fiÙÈ Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ·Óı›ÛÙ·ÓÙ·È
74
HELLENIC ORTHODONTIC REVIEW
that happened at a later time point.
Another study involving 43 patients with one or more
anterior endodontically treated teeth without a history
of fracture before orthodontic treatment concluded that
vital teeth are more prone to resorption than endodonti-
cally treated teeth (Spurrier et al., 1990). Vital teeth pre-
sented a greater amount of root resorption both in terms
of relative percentage and absolute in mm root length
reduction (mean difference 2.74% and 0.77 mm, respec-
tively). However, the authors regarded that these differ-
ences were in clinical level insignificant, suggested that
endodontically treated teeth should be dealt like vital
teeth and that in patients with a history of resorption
improved prognosis should be anticipated for endodon-
tically treated teeth as they maintain a greater amount
of their original length and were proved statistically to
be less prone to root resorption. A subsequent study
confirmed the finding of increased resistance of
endodontically treated teeth to root resorption com-
pared to vital teeth (Mirabella and Artun, 1995). These
authors expressed the opinion that an eventual greater
root resorption during orthodontic treatment is associat-
ed with an incomplete endodontic treatment rather than
with orthodontic treatment per se.
The tendency for increased root resorption in teeth treat-
ed with surgical endodontic techniques can be attributed
to the uncovered dentin in the region of root dissection
(Hamilton and Gutmann, 1999).
Finally, citations for the extent of resorption of endodon-
tically treated teeth, are reported in cases of horizontal
fractures (Clark and Eleazer, 2000; Erdemir et al., 2005),
cervical fractures (Canoglu et al., 2007), complex frac-
tures (Dominguez-Veilleux, 2004; Aggarwal et al., 2009),
or after orthodontic treatment of teeth under trauma,
with intrusion, extrusion, avulsion or/and tooth ankylo-
sis (Bender et al., 1997; Takahashi et al., 2005; Canoglu
et al., 2007). However, as these findings are based on
reports of one or two cases, they have particular clinical
interest but cannot confirm or negate the extent of root
resorption in endodontically treated teeth compared to
vital ones.
Prognosis of orthodontic movement of endodontically
treated teeth
The prognosis of endodontically treated teeth seems to
be particularly difficult to foresee and constitutes a sig-
nificant element of uncertainty in planning orthodontic
treatment. In these cases prognosis depends on various
factors such as the type, the severity and the timing of
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
ÂÚÈÛÛfiÙÂÚÔ ÛÙȘ ·ÔÚÚÔÊ‹ÛÂȘ. ∞fi ÙËÓ ÂÊ·ÚÌÔÁ‹
‰˘Ó¿ÌÂˆÓ Û ‰‡Ô ÔÌ¿‰Â˜ Â›Ì˘ˆÓ Ô˘ ‰È·¯ˆÚ›ÛÙËηÓ
ÛÙËÓ ÔÌ¿‰· Ô˘ ˘¤ÛÙË ÔÏÊÂÎÙÔÌ‹ ÙˆÓ ÚÒÙˆÓ ÁÔÌ-
Ê›ˆÓ Î·È ÙˆÓ ‰‡Ô ËÌÈÌÔÚ›ˆÓ, Î·È ÛÙËÓ ÔÌ¿‰· fiÔ˘ ‰È·-
ÙËÚ‹ıËÎÂ Ë ˙ˆÙÈÎfiÙËÙ· ÙÔ˘ ÔÏÊÔ‡ ÙˆÓ ¿Óˆ ÁÔÌÊ›ˆÓ, Ë
ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ fiÙÈ Â͈ÙÂÚÈ΋ ·ÔÚÚfiÊËÛË
ÚÈ˙ÒÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÚÔ˘Û›· ÔÏ˘‡ÚËÓˆÓ
Ô‰ÔÓÙÔÎÏ·ÛÙÒÓ ÛËÌÂÈÒıËÎ·Ó ÛÙ· ıÂÚ·Â˘Ì¤Ó· Ì ÔÏ-
ÊÂÎÙÔÌ‹ ‰fiÓÙÈ· Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi Î·È Ì¿ÏÈÛÙ· Î·È ÛÂ
ÌÂÙ·ÁÂÓ¤ÛÙÂÚÔ ¯ÚfiÓÔ Û ۯ¤ÛË Ì ٷ ˙ˆÓÙ·Ó¿ (Satoh,
1990).
™ÙËÓ ‰È·›ÛÙˆÛË fiÙÈ Ù· ‰fiÓÙÈ· Ì ˙ˆÓÙ·Ófi ÔÏÊfi ›ӷÈ
ÈÔ ÂÈÚÚÂ‹ ÛÙËÓ ·ÔÚÚfiÊËÛË ·'fiÙÈ Ù· ÂÓ‰Ô‰ÔÓÙÈο
ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜
ıÂÚ·›·˜, η٤ÏËÍÂ Î·È Ì›· ¿ÏÏË ÌÂϤÙË Ô˘ ·ÊÔÚ¿ 43
·ÛıÂÓ›˜ Ì ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ÚfiÛıÈ· ıÂÚ·Â˘Ì¤Ó·
‰fiÓÙÈ· ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ηٿÁÌ·ÙÔ˜ ÚÈÓ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋
ıÂÚ·›· (Spurrier Î·È Û˘Ó., 1990). ∆fiÛÔ Ë Â› ÙȘ ÂηÙfi
ÔÛÔÛÙÈ·›· ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË fiÛÔ Î·È Ë Ì¤ÙÚËÛË ÛÂ
¯ÈÏÈÔÛÙ¿ Ù˘ ·ÔÚÚfiÊËÛ˘ ¤‰ÂÈÍ·Ó, fiÙÈ Ù· ˙ˆÓÙ·Ó¿
‰fiÓÙÈ· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û·Ó Ì¤ÙÚÔ Û‡ÁÎÚÈÛ˘ ÁÈ·
Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó·, ·ÚÔ˘Û›·Û·Ó Û ÌÂÁ·Ï‡-
ÙÂÚÔ ÔÛÔÛÙfi ·ÔÚÚfiÊËÛË Î·È Ì›ˆÛË Ì‹ÎÔ˘˜ Ù˘ Ú›˙·˜,
Ì ̛· ̤ÛË ‰È·ÊÔÚ¿ Ù˘ ٿ͈˜ ÙˆÓ 2.74% Î·È 0.77
¯ÈÏÈÔÛÙ¿, ·ÓÙÈÛÙÔ›¯ˆ˜. √È Û˘ÁÁÚ·Ê›˜ ˆÛÙfiÛÔ ıˆÚÔ‡Ó
fiÙÈ ÔÈ ‰È·ÊÔÚ¤˜ ·˘Ù¤˜ Û ÎÏÈÓÈÎfi Â›Â‰Ô ‹Ù·Ó ·Û‹Ì·ÓÙ˜,
Î·È fiÙÈ Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Ú¤ÂÈ ÛÙËÓ
ÎÏÈÓÈ΋ Ú¿ÍË Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·Ó¿ÏÔÁ· Ì ÂΛӷ
Ô˘ ¤¯Ô˘Ó ˙ˆÓÙ·Ófi ÔÏÊfi. £ÂˆÚÔ‡Ó Â›Û˘ fiÙÈ Û ·ÛıÂ-
Ó›˜ Ì ÈÛÙÔÚÈÎfi ·ÔÚÚfiÊËÛ˘, ı· Ú¤ÂÈ Ó· ·Ó·Ì¤ÓÂÙ·È
ηχÙÂÚË ÚfiÁÓˆÛË ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ
‰ÔÓÙÈÒÓ ÂÊfiÛÔÓ ·˘Ù¿ Ê·›ÓÂÙ·È fiÙÈ ‰È·ÙËÚÔ‡Ó ÌÂÁ·Ï‡ÙÂ-
ÚÔ Ì¤ÚÔ˜ ÙÔ˘ ·Ú¯ÈÎÔ‡ ÙÔ˘˜ Ì‹ÎÔ˘˜, Î·È Û ÛÙ·ÙÈÛÙÈÎfi
Â›Â‰Ô ·Ô‰ÂÈÎÓ‡ÔÓÙ·È ÏÈÁfiÙÂÚÔ ÂÈÚÚÂ‹ ÛÙËÓ ·ÔÚ-
ÚfiÊËÛË Ú›˙·˜ ·fi fiÙÈ Ù· ‰fiÓÙÈ· Ì ˙ˆÓÙ·Ófi ÔÏÊfi. ™Â
ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË ‰È·ÈÛÙÒıËΠÂ›Û˘ fiÙÈ Ù· ÂÓ‰Ô-
‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ÚfiÛıÈ· ‰fiÓÙÈ· ‹Ù·Ó ÈÔ ·ÓıÂÎÙÈο
ÛÙȘ ·ÔÚÚÔÊ‹ÛÂȘ Û ۯ¤ÛË Ì ٷ ˙ˆÓÙ·Ó¿ (Mirabella
Î·È Artun, 1995). √È Û˘ÁÁÚ·Ê›˜ ıˆÚÔ‡Ó, fiÙÈ ÂӉ¯fiÌÂ-
ÓË ·Ú·Ù‹ÚËÛË ÌÂÁ¿Ï˘ ·ÔÚÚfiÊËÛ˘ Ú›˙·˜ ηٿ ÙË
‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Û¯ÂÙ›˙ÂÙ·È Ì ̛·
·ÙÂÏ‹ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂÚ·›·, ·Ú¿ Ì ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋
ıÂÚ·›· ·˘Ù‹ ηı'·˘Ù‹.
ŸÛÔÓ ·ÊÔÚ¿ Ù· ‰fiÓÙÈ· ÙˆÓ ÔÔ›ˆÓ Ë ÚÔÛ¤ÁÁÈÛË ¤ÁÈÓÂ
Ì ÙȘ Ù¯ÓÈΤ˜ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÂÓ‰Ô‰ÔÓÙ›·˜, ·Ó·Ê¤ÚÂÙ·È
ˆ˜ Ë ·ÔÎ·Ï˘Ì̤ÓË Ô‰ÔÓÙ›ÓË ÛÙÔ ÛËÌÂ›Ô ÂÎÙÔÌ‹˜ ›Ûˆ˜
·ÔÙÂÏ› ·ÈÙ›· ÁÈ· ÌÈ· Ù¿ÛË ·˘ÍË̤ÓÔ˘ ÌÂÁ¤ıÔ˘˜ ·ÔÚ-
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
trauma as well as the manipulations performed by treat-
ment providers.
It has been reported that the prognosis for orthodontic
treatment of a tooth having undergone dental trauma of
mild to moderate severity, where the periodontal mem-
brane is intact and the situation is checked radiographi-
cally every 4-5 months, is not influenced at all and is
expected to be the same to a non traumatized tooth. On
the contrary, the more severe and unfavorable the trau-
ma is, the poorer the prognosis of the endodontically
treated tooth at the end of orthodontic treatment.
Moreover, dental traumas that lead to inflammatory root
resorption that is of moderate extent and is treated on
time, do not seem to influence the good prognosis of the
tooth (Zachrisson and Jacobsen, 1975; Malmgren et al.,
1982; Malmgren et al., 1994; Drysdale et al., 1996; Mah
et al., 1996; Andreasen et al., 2004; Flores et al., 2007;
Day et al., 2008; Kindelan et al., 2008). Traumatic tooth
intrusion and the consequences on the apex from ortho-
dontic extrusion were assessed in an experimental study
in upper mammals (Turley et al., 1984). The authors
found out that mild case of traumatic intrusion behave
satisfactorily, while the more severe the intrusion is the
more the tooth becomes ankylosed and resists in extru-
sion movements. A later study in humans, based in 61
permanent incisors, confirmed the greater frequency of
resorption in teeth with more severe intrusion, as well as
the statistically significant relationship between resorp-
tion and the stage of root development, with the greater
degree of resorption observed in teeth with developed
root (Al-Badri et al., 2002). Moreover, the researchers
suggested that the frequency of root resorption is not
related to surgical or orthodontic manipulations for root
extrusion.
In cases of traumatic tooth avulsion, partial or complete,
it seems that significant factors in prognosis are the time
outside the oral environment and the conditions under
which the tooth is preserved (Hines, 1979; Drysdale et
al., 1996; Steiner and West, 1997).
Regarding the prognosis of orthodontic treatment of
teeth treated with surgical endodontic techniques, it has
been suggested that crucial factors to be taken into
account are the quality of endodontic treatment, the
material of root filling and the assessment of the condi-
tion of dental and periodontal tissues of the area (Hamil-
ton and Gutmann, 1999). The quality of endodontic
treatment constitutes another factor to be taken into
account when considering tooth prognosis. It has been
mentioned that radiographic findings of total healing of
a periapical lesion should be anticipated one year after
75
∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
ÚfiÊËÛ˘ ÛÙËÓ ÂÚÈÔ¯‹ ·˘Ù‹ (Hamilton Î·È Gutmann,
1999).
∆¤ÏÔ˜, ·Ó·ÊÔÚ¤˜ ÁÈ· ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ·ÔÚÚÔÊ‹ÛˆÓ
ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ, ηٷÁÚ¿ÊÔÓÙ·È ÛÂ
ÂÚÈÙÒÛÂȘ ÔÚÈ˙ÔÓÙ›Ô˘ ηٿÁÌ·ÙÔ˜ (Clark Î·È Eleazer,
2000; Erdemir Î·È Û˘Ó., 2005), ·˘¯ÂÓÈÎÔ‡ ηٿÁÌ·ÙÔ˜
(Canoglu Î·È Û˘Ó., 2007), Û‡ÓıÂÙˆÓ Î·Ù·ÁÌ¿ÙˆÓ
(Dominguez-Veilleux, 2004; Aggarwal Î·È Û˘Ó., 2009), ‹
ÌÂÙ¿ ·fi ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· ‰ÔÓÙÈÒÓ Ô˘ ˘¤ÛÙËÛ·Ó
ÙÚ·‡Ì·, Ì ÂÓÛÊ‹ÓˆÛË, ˘ÂÚ¤ÎÊ˘ÛË, ÂÎÁfiÌʈÛË ‹/ηÈ
·Á·ψÛË ÙÔ˘ ‰ÔÓÙÈÔ‡ (Bender Î·È Û˘Ó., 1997;
Takahashi Î·È Û˘Ó., 2005; Canoglu Î·È Û˘Ó., 2007). øÛÙfi-
ÛÔ Ù· Â˘Ú‹Ì·Ù· ·ÊÔÚÔ‡Ó ·Ó·ÊÔÚ¤˜ ÌÈ·˜ ‹ ‰‡Ô ÂÚÈÙÒ-
ÛˆÓ, Û˘ÓÂÒ˜ ÔÈ ÏËÚÔÊÔڛ˜ Ô˘ ·Ú¤¯Ô˘Ó ¤¯Ô˘Ó ȉÈ-
·›ÙÂÚÔ ÎÏÈÓÈÎfi ÂӉȷʤÚÔÓ ·ÏÏ¿ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÈ‚Â-
‚·ÈÒÛÔ˘Ó ‹ Ó· ·Ó·ÈÚ¤ÛÔ˘Ó ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·Ú·ÙËÚÔ‡-
ÌÂÓ˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ
‰ÔÓÙÈÒÓ Û ۯ¤ÛË Ì ٷ ÌË ıÂÚ·Â˘Ì¤Ó·.
¶ÚfiÁÓˆÛË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘ ÙˆÓ ÂÓ‰Ô‰Ô -
ÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ
∏ ÚfiÁÓˆÛË ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ
Ê·›ÓÂÙ·È Ó· Â›Ó·È È‰È·›ÙÂÚ· ‰‡ÛÎÔÏÔ Ó· ÚÔ‚ÏÂÊı› ηÈ
·ÔÙÂÏ› ¤Ó· ÛËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô ·‚‚·ÈfiÙËÙ·˜ ÛÙÔ Û¯Â-
‰È·ÛÌfi Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜. ∂Í·ÚÙ¿Ù·È ·fi ‰È¿-
ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ô Ù‡Ô˜, Ë ‚·Ú‡ÙËÙ· Î·È Ë ¯ÚÔ-
ÓÈ΋ ÛÙÈÁÌ‹ ÙÔ˘ Ô‰ÔÓÙÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ ·ÏÏ¿ Î·È ·fi ÙÔ˘˜
¯ÂÈÚÈÛÌÔ‡˜ ÙˆÓ ıÂÚ·fiÓÙˆÓ.
∞ӷʤÚÂÙ·È fiÙÈ ‹ÈÔ ‹ ̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ Ô‰ÔÓÙÈÎfi ÙÚ·‡-
Ì· Ô˘ ÂϤÁ¯ÂÙ·È ·ÎÙÈÓÔÁÚ·ÊÈο ÁÈ· 4-5 Ì‹Ó˜, Ì ¿ıÈÎÙË
ÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ÌÂÌ‚Ú¿ÓË, ‰ÂÓ ÂËÚ¿˙ÂÈ Î·ıfiÏÔ˘ ÙËÓ
ÚfiÁÓˆÛË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ‰ÔÓÙÈÔ‡ ÁÈ· ÔÚıÔ‰ÔÓÙÈ΋
ıÂÚ·›· Ë ÔÔ›· ·Ó·Ì¤ÓÂÙ·È Ó· Â›Ó·È ›‰È· Ì ·˘Ù‹ Ô˘
¤¯ÂÈ Î¿ı ¿ÏÏÔ ÌË ÙÚ·˘Ì·ÙÈṲ̂ÓÔ ‰fiÓÙÈ. ∞ÓÙ›ıÂÙ·, fiÛÔ
ÈÔ ÛÊÔ‰Úfi Î·È ‰˘ÛÌÂÓ¤˜ Â›Ó·È ÙÔ ÙÚ·‡Ì·, ÙfiÛÔ ÈÔ
ÊÙˆ¯‹ ı· Â›Ó·È Î·È Ë ÚfiÁÓˆÛË ÙÔ˘ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·-
Â˘Ì¤ÓÔ˘ ‰ÔÓÙÈÔ‡ Ì ÙÔ ¤Ú·˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·-
›·˜. ∂›Û˘, Ù· Ô‰ÔÓÙÈο ÙÚ·‡Ì·Ù· Ô˘ Ô‰ËÁÔ‡Ó ÛÂ
ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ, Â¿Ó ·˘Ù¤˜ ‰ÂÓ ÂÎÙ›-
ÓÔÓÙ·È Û ÌÂÁ¿ÏË ¤ÎÙ·ÛË Î·È ÂÊfiÛÔÓ ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó
¤ÁηÈÚ· Î·È ÛˆÛÙ¿, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ
ηϋ ÚfiÁÓˆÛË ÙÔ˘ ‰ÔÓÙÈÔ‡ (Zachrisson Î·È Jacobsen,
1975; Malmgren Î·È Û˘Ó., 1982; Malmgren Î·È Û˘Ó.,
1994; Drysdale Î·È Û˘Ó., 1996; Mah Î·È Û˘Ó., 1996;
Andreasen Î·È Û˘Ó., 2004; Flores Î·È Û˘Ó., 2007; Day ηÈ
Û˘Ó., 2008; Kindelan Î·È Û˘Ó., 2008).
76
HELLENIC ORTHODONTIC REVIEW
endodontic treatment. If the lesion persists then the
quality of endodontic treatment should be reconsidered
and in cases where imperfections are observed,
endodontic treatment should be repeated so as to
ensure better prognosis for the particular tooth (Magura
et al., 1991; Drysdale et al., 1996; Gutmann and Lovdahl,
1997).
The more appropriate material to be used for root canal
obturation is a matter of differing opinions. It has been
suggested that calcium hydroxide [Ca(OH)2] should be
used as the material for root canal obturation during
orthodontic treatment and that permanent filling with
gutta-percha should be deferred until the end of ortho-
dontic tooth movement even if it involves teeth with
completely formed roots (Malmgren et al., 1994). How-
ever, Drysdale et al. (1996), seems to differentiate from
this opinion and stated the aforementioned selection of
Ca(OH)2 was based only on the authors' clinical experi-
ence and is lacking scientific basis. In addition they sug-
gested that taking into account the complete develop-
ment of the apical region, Ca(OH)2 does not seem to pre-
sent any particular advantage and that root canal obtu-
ration should be performed with the final material
before the start of orthodontic treatment.
Regarding Ca(OH)2, it has been mentioned that it can
stop the resorptive phenomena and take part in healing
of the area of resorption (Tronstad, 1988). A subsequent
study involving only two cases, confirmed that the
resorption noted during orthodontic tooth movement is
inhibited by Ca(OH)2 (Bender et al., 1997). Its alkaline
nature affects bone cell biology by impeding osteoclastic
and cementoclastic resorption (Bender et al., 1997). The
cessation of the resorptive phenomena and the good
healing of periodontal tissues after temporary obtura-
tion with Ca(OH)2 is mentioned in a more recent case
report presenting root resorption due to orthodontic
treatment and extensive periapical lesion (Ballal et al.,
2008), as well as in a retrospective study with a mean
follow-up of 4 years (Wigen et al., 2008).
According to studies performed on experimental ani-
mals, calcium hydroxide [Ca(OH)2] presents advantages
in cases of external inflammatory root resorption
(Dumsha and Hovland, 1995; Trope et al., 1995). More
recent studies have also noted the containment of the
intensity and the extent of the inflammation and the
regeneration of the periodontal ligament (de Souza et
al., 2006; de Souza et al., 2009). The authors observed in
an animal experimental study the deposition of a new
layer of cementum on the resorptive surface with com-
plete healing of the area, high percentage of biological
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
∏ ÂÓÛÊ‹ÓˆÛË ÙÔ˘ ‰ÔÓÙÈÔ‡ ηÙfiÈÓ ÙÚ·‡Ì·ÙÔ˜, Î·È ÔÈ
Û˘Ó¤ÂȘ ÛÙÔ ·ÎÚÔÚÚ›˙ÈÔ ·fi ÙËÓ Â·Ó·ÊÔÚ¿ ÙÔ˘ ÌÂ
ÔÚıÔ‰ÔÓÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, ·ÍÈÔÏÔÁ‹ıËÎ·Ó Û ÂÈÚ·-
Ì·ÙÈ΋ ÌÂϤÙË Û ·ÓÒÙÂÚ· ıËÏ·ÛÙÈο (Turley Î·È Û˘Ó.,
1984). √È Û˘ÁÁÚ·Ê›˜ ‰È·›ÛÙˆÛ·Ó fiÙÈ ÔÈ ‹Ș ÂÚÈÙÒ-
ÛÂȘ ÂÓÛÊ‹ÓˆÛ˘ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÈηÓÔÔÈËÙÈο, ÂÓÒ
fiÛÔ ÈÔ ÛÔ‚·Ú‹ Â›Ó·È Ë ÂÓÛÊ‹ÓˆÛË, ÙfiÛÔ ÙÔ ‰fiÓÙÈ ·Á΢-
ÏÒÓÂÙ·È Î·È ·Óı›ÛÙ·Ù·È ÛÙȘ ÎÈÓ‹ÛÂȘ Â·Ó·ÊÔÚ¿˜. ªÂÙ·-
ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË Û ·ÓıÚÒÔ˘˜, ‚·ÛÈ˙fiÌÂÓË Û 61 ÌfiÓÈ-
ÌÔ˘˜ ÙÔÌ›˜, ÂȂ‚·ÈÒÓÂÈ ÙËÓ ‡·ÚÍË ÌÂÁ·Ï‡ÙÂÚ˘
Û˘¯ÓfiÙËÙ·˜ ·ÔÚÚfiÊËÛ˘ Ú›˙·˜ ÛÙ· ‰fiÓÙÈ· Ô˘ ›¯·Ó
˘ÔÛÙ› ÙË ÛÔ‚·ÚfiÙÂÚË ÂÓÛÊ‹ÓˆÛË, ηıÒ˜ Î·È ÙË ÛÙ·ÙÈ-
ÛÙÈο ÛËÌ·ÓÙÈ΋ Û¯¤ÛË ÌÂٷ͇ ·ÔÚÚfiÊËÛ˘ Î·È ÙÔ˘
ÛÙ·‰›Ô˘ ·Ó¿Ù˘Í˘ Ù˘ Ú›˙·˜, Ì ÌÂÁ·Ï‡ÙÂÚË ‚·ıÌÔ‡
·ÔÚÚfiÊËÛË ÛÙ· ‰fiÓÙÈ· Ì ·ÓÂÙ˘Á̤Ó˜ Ú›˙˜ (Al-Badri
Î·È Û˘Ó., 2002). √È Û˘ÁÁÚ·Ê›˜ ˘·ÈÓ›ÛÛÔÓÙ·È ·ÎfiÌË fiÙÈ
Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÔÚÚfiÊËÛ˘ Ù˘ Ú›˙·˜, ‰ÂÓ Û¯Â-
Ù›˙ÂÙ·È Ì ÙÔ˘˜ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ ‹ ÔÚıÔ‰ÔÓÙÈÎÔ‡˜ Ì˯·ÓÈ-
ÛÌÔ‡˜ Â·Ó·ÊÔÚ¿˜ ÙÔ˘.
™Â ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ Ô‰ÔÓÙÈÎfi ÙÚ·‡Ì· ÚÔηϤÛÂÈ ÙË
ÌÂÚÈ΋ ‹ Ï‹ÚË ÂÎÁfiÌʈÛË ÂÓfi˜ ‰ÔÓÙÈÔ‡, Ê·›ÓÂÙ·È fiÙÈ
ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÚfiÁÓˆÛ˘ Â›Ó·È ÙÔ ¯ÚÔÓÈÎfi ‰È¿-
ÛÙËÌ· ÂÎÙfi˜ ÛÙfiÌ·ÙÔ˜ Î·È Ë ‰È·ÛÊ¿ÏÈÛË ÙˆÓ Û˘ÓıËÎÒÓ
‰È·Ù‹ÚËÛ˘ ÙÔ˘ ‰ÔÓÙÈÔ‡ (Hines, 1979; Drysdale Î·È Û˘Ó.,
1996; Steiner Î·È West, 1997).
ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÁÓˆÛË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜
ÙˆÓ ‰ÔÓÙÈÒÓ Ô˘ ıÂÚ·‡ÙËÎ·Ó Ì ÙȘ Ù¯ÓÈΤ˜ Ù˘ ¯ÂÈ-
ÚÔ˘ÚÁÈ΋˜ ÂÓ‰Ô‰ÔÓÙ›·˜, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÎÚ›ÛÈÌÔÈ ·Ú¿ÁÔ-
ÓÙ˜ Ô˘ Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘fi„Ë ÌÂٷ͇ ¿ÏÏˆÓ Â›Ó·È
Ë ÔÈfiÙËÙ· Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂÚ·›·˜, ÙÔ ˘ÏÈÎfi ¤ÌÊÚ·-
͢ Î·È Ë ÂÎÙ›ÌËÛË Ù˘ ηٿÛÙ·Û˘ ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ
Î·È Ô‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Ù˘ ÂÚÈÔ¯‹˜ (Hamilton ηÈ
Gutmann, 1999).
∏ ÔÈfiÙËÙ· Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ ·ÔÙÂÏ› ¤Ó·
·ÎfiÌ· ·Ú¿ÁÔÓÙ· Ô˘ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚfiÁÓˆÛË ÙÔ˘
‰ÔÓÙÈÔ‡. ∞ӷʤÚÂÙ·È fiÙÈ ·ÎÙÈÓÔÁÚ·ÊÈο ÛËÌ›· Ï‹ÚÔ˘˜
ÂԇψÛ˘ Ì›·˜ ÂÚÈ·ÎÚÔÚÚÈ˙È΋˜ ·ÏÏÔ›ˆÛ˘ Ú¤ÂÈ Ó·
·Ó·Ì¤ÓÔÓÙ·È ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜
ıÂÚ·›·˜. ∂¿Ó Ë ‚Ï¿‚Ë ÂÌ̤ÓÂÈ ÙfiÙ ı· Ú¤ÂÈ Ó· Â·-
Ó·ÍÈÔÏÔÁËı› Ë ÔÈfiÙËÙ· Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ ηÈ
Û ÂÚÈÙÒÛÂȘ Ô˘ ‰È·ÈÛÙˆıÔ‡Ó ·Ù¤ÏÂȘ Ó· Á›ÓÂÈ Â·-
Ó¿ÏË„Ë ·˘Ù‹˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÛÊ·ÏÈÛÙ› Ë Î·Ï‡ÙÂÚË
ÚfiÁÓˆÛË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ‰ÔÓÙÈÔ‡ (Magura Î·È Û˘Ó.,
1991; Drysdale Î·È Û˘Ó., 1996; Gutmann Î·È Lovdahl,
1997).
∆· ˘ÏÈο ¤ÌÊڷ͢ ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ Ô˘ ·ÔÙÂÏ›
Â›Û˘ ·Ú¿ÁÔÓÙ· ÚfiÁÓˆÛ˘ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·-
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
obturation of the apical foramen with newly formed
cementum, diminished intensity and extent of the chron-
ic inflammatory infiltration and better organization of
the periodontal ligament. The release of calcium ions
[Ca2+] for a long period of time (at least 105 days) after
Ca(OH)2 placement was the result of a recent experimen-
tal study in rats (Narita et al., 2010). According to the
authors, the release of calcium ions [Ca2+] from Ca(OH)2,
proves and interprets the mechanism of osteoblast min-
eralization induced by Ca(OH)2.
Kindelan et al. (2008), suggested that the long term use
of Ca(OH)2 inside the root canal is indicated for apexifi-
cation in incisors with non-developed apical region and is
accordance with Trope et al. (1995) suggestions, than
Ca(OH)2 presents advantages in cases of external inflam-
matory root resorption. The placement of Ca(OH)2 inside
the root canal for 12 weeks is more effective that the
short-term placement for 1 week before the final obtu-
ration, and promotes the healing of the root surface with
cementum deposition.
Ca(OH)2 use can also cause many complications, espe-
cially in long-term treatments. It has been mentioned
that the risk for cervical root canal fracture is increased
in non-completely developed teeth treated with Ca(OH)2
after dental trauma for a long period of during apexifi-
cation. However, the increased likelihood of fracture in
these cases can be attributed to the thinned teeth struc-
tures of the necrotized teeth with the non-developed
apex, leading to more fractures in the cervical area com-
pared to fully developed teeth (Cvek, 1992). In vitro
studies have shown that long-term treatment with
Ca(OH)2 can lower tooth resistance to fractures, whereas
treatment up to 30 days does not exert an effect
(Andreasen et al., 2002; Doyon et al., 2005; Rosenberg et
al., 2007).
Finally, an important factor that can affect the prognosis
of orthodontic movement of endodontically treated
teeth is the magnitude of the applied force. Mild forces
of 50-100 gr, applied on a central incisor, are regarded
capable of moving an endodontically treated tooth
(Hines, 1979; Mattison et al., 1984; Drysdale et al., 1996;
Kindelan et al., 2008). Moreover, the duration of the
applied forces can affect the prognosis of endodontical-
ly treated teeth because in these cases treatment lasts
longer than usual as the orthodontist tries to avoid over-
burdening these teeth that are seen with caution from
the beginning (Wickwire et al., 1974; Malmgren et al.,
1982; Brin et al., 1991; Drysdale et al., 1996). It has been
suggested that the endodontically treated teeth to be
moved should be checked clinically and radiographically
77
∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÓÙÈΛÌÂÓÔ ·ÓÙÈÁÓˆ-
ÌÈÒÓ. ø˜ ˘ÏÈÎfi ¤ÌÊڷ͢ ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ Î·Ù¿ ÙË
‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Û˘ÛÙ‹ÓÂÙ·È ÙÔ
˘‰ÚÔÍ›‰ÈÔ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ [Ca(OH)2], ÂÓÒ Û˘ÛÙ‹ÓÂÙ·È Ë
·Ó·‚ÔÏ‹ Ù˘ ÔÚÈÛÙÈ΋˜ ¤ÌÊڷ͢ Ì ÁÔ˘Ù·¤Úη ÁÈ· ÌÂÙ¿
ÙÔ ¤Ú·˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘ ·ÎfiÌË Î·È Â¿Ó
ÚfiÎÂÈÙ·È ÁÈ· ‰fiÓÙÈ· Ì Ï‹Úˆ˜ ‰È·Ï·Ṳ̂ÓË Ú›˙·
(Malmgren Î·È Û˘Ó., 1994). √ Drysdale Î·È Û˘Ó. (1996),
Ê·›ÓÂÙ·È ˆÛÙfiÛÔ Ó· ‰È·ÊÔÚÔÔÈÂ›Ù·È ·fi ÙËÓ ·ÓÙ›ÏË„Ë
·˘Ù‹ Î·È ‰È·Ù˘ÒÓÂÈ, fiÙÈ Ë ÚÔ·Ó·ÊÂÚı›۷ ‰È·¯Â›ÚÈÛË
ÙˆÓ ‰ÔÓÙÈÒÓ Ì ˘ÏÈÎfi ÂÎÏÔÁ‹˜ ÙÔ Ca(OH)2 ‚·Û›ÛÙËÎÂ
ÌfiÓÔ ÛÙËÓ ÎÏÈÓÈ΋ ÂÌÂÈÚ›· ÙˆÓ Û˘ÁÁڷʤˆÓ, Î·È ÛÙÂÚ›-
Ù·È ÂÈÛÙËÌÔÓÈ΋˜ ÙÂÎÌËÚ›ˆÛ˘. ¢È·Ù›ÓÂÙ·È fiÙÈ ‰Â‰Ô̤-
Ó˘ Ù˘ ÔÏÔÎÏËڈ̤Ó˘ ‰È¿Ï·Û˘ ÙÔ˘ ·ÎÚÔÚÚÈ˙›Ô˘, ÙÔ
Ca(OH)2 ‰Â Ê·›ÓÂÙ·È Ó· ÏÂÔÓÂÎÙ› Î·È ÚÔÙ›ÓÂÈ Ó· Á›ÓÂ-
Ù·È Ë ¤ÌÊÚ·ÍË ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ Ì ÙÔ ÙÂÏÈÎfi ˘ÏÈÎfi
¤ÌÊڷ͢ ÚÔÙÔ‡ ÍÂÎÈÓ‹ÛÂÈ Ë ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·.
Œ¯ÂÈ ·ÎfiÌ· ·Ó·ÊÂÚı› ·Ï·ÈfiÙÂÚ·, ¿ÚÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘
Ù˘ ·ÔÚÚfiÊËÛ˘ Ì ÙË ¯Ú‹ÛË ÙÔ˘ Ca(OH)2 Î·È Èı·Ó‹
Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÛÙËÓ ÂȉÈfiÚıˆÛË ÙˆÓ ÂÚÈÔ¯ÒÓ ·ÔÚ-
ÚfiÊËÛ˘ (Tronstad, 1988). ™Â ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË Ô˘
·ÊÔÚ¿ ˆÛÙfiÛÔ ÌfiÓÔ 2 ÂÚÈÙÒÛÂȘ, ÂȂ‚·ÈÒÓÂÙ·È ˆ˜
Ë ·ÔÚÚfiÊËÛË Ô˘ ÛËÌÂÈÒÓÂÙ·È Î·Ù¿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋
ÌÂٷΛÓËÛË ÙˆÓ ‰ÔÓÙÈÒÓ ·Ó·¯·ÈÙ›˙ÂÙ·È ·fi ÙȘ ȉÈfiÙËÙ˜
ÙÔ˘ Ca(OH)2 ÙÔ˘ ÔÔ›Ô˘, ÔÈ ·ÏηÏÈΤ˜ ȉÈfiÙËÙ˜ ÂËÚ¿-
˙Ô˘Ó ÙË ‚ÈÔÏÔÁ›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÔÛÙÔ‡ ·Ó·¯·ÈÙ›˙Ô-
ÓÙ·˜ ÙËÓ ÔÛÙÂÔÎÏ·ÛÙÈ΋ Î·È ÔÛÙÂ˚ÓÔÎÏ·ÛÙÈ΋ ·ÔÚÚfiÊË-
ÛË (Bender Î·È Û˘Ó., 1997). ¶·‡ÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘
·ÔÚÚfiÊËÛ˘ Î·È Î·Ï‹ ÂԇψÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ
ÈÛÙÒÓ Ì ÚÔÛˆÚÈÓ‹ ¤ÌÊÚ·ÍË Ì Ca(OH)2 ·Ó·Ê¤ÚÂÙ·È Î·È
Û ÈÔ Û‡Á¯ÚÔÓË ·ÚÔ˘Û›·ÛË Ì›·˜ ÂÚ›ÙˆÛ˘ Ô˘ ˘¤-
ÛÙË ·ÔÚÚfiÊËÛË Ú›˙·˜ Û˘Ó¤ÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·-
›·˜ Î·È ÂÎÙÂٷ̤ÓË ÂÚÈ·ÎÚÔÚÚÈ˙È΋ ‚Ï¿‚Ë (Ballal ηÈ
Û˘Ó., 2008), ηıÒ˜ Î·È Û ̛· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ÌÂ
‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ‰ÔÓÙÈÒÓ Î·Ù¿ ̤ÛÔ fiÚÔ 4
¤ÙË (Wigen Î·È Û˘Ó., 2008).
™‡Ìʈӷ Ì ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ·, ˘¿Ú¯Ô˘Ó ÏÂÔ-
ÓÂÎÙ‹Ì·Ù· ÙÔ˘ ˘‰ÚÔÍ›‰ÈÔ˘ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Ca(OH)2 ÛÂ
ÂÚÈÙÒÛÂȘ fiÔ˘ ˘¿Ú¯ÂÈ Â͈ÙÂÚÈ΋ ÊÏÂÁÌÔÓ҉˘
·ÔÚÚfiÊËÛË Ú›˙·˜ (Dumsha Î·È Hovland, 1995; Trope
Î·È Û˘Ó., 1995). ¶ÂÚÈÔÚÈÛÌfi˜ Ù˘ ÂÓÙ¿Ûˆ˜ Î·È ÂÂÎÙ¿ÛÂ-
ˆ˜ ÙˆÓ ÊÏÂÁÌÔÓÒÓ Î·È ·Ó·‰È¿Ï·ÛË ÙÔ˘ ÂÚÈÔ‰ÔÓÙÈÎÔ‡
Û˘Ó‰¤ÛÌÔ˘ ÂÈÛËÌ·›ÓÂÙ·È Î·È ·fi ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜
(de Souza Î·È Û˘Ó., 2006; de Souza Î·È Û˘Ó., 2009). √È
Û˘ÁÁÚ·Ê›˜ ‰È·ÈÛÙÒÓÔ˘Ó Û ÂÈÚ·Ì·ÙÈ΋ ÌÂϤÙË ÙÔ˘˜ ÛÂ
˙Ò·, ÂÓ·fiıÂÛË ÂÎ Ó¤Ô˘ ÔÛÙ½Ó˘ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ·ÔÚ-
ÚfiÊËÛ˘, Ì Ï‹ÚË ·ÔηٿÛÙ·ÛË Ù˘ ÂÚÈÔ¯‹˜, ˘„ËÏfi
78
HELLENIC ORTHODONTIC REVIEW
6 months after active movement and if signs of resorp-
tion are detected then movement should stop for 3
months, leaving time for the periodontal tissues to heal
and re-assess the case before the continuation of ortho-
dontic treatment (Drysdale et al., 1996; Kindelan et al.,
2008).
Besides force application, the timing orthodontic treat-
ment begins is significant for the good prognosis of an
endodontically treated tooth. It has been suggested that
the tooth should be followed up after endodontic treat-
ment so as to assess the therapeutic result and after-
wards begin the application of forces to move the tooth.
The length of the follow-up period varies according to
the case. Malmgren et al. (1994), suggested that
endodontic treatment can start if the quality of
endodontic treatment is good and clinical signs of heal-
ing co-exist. However, if a large radioluscency exists in
the apical region or a history of recent dental trauma,
orthodontic treatment should be postponed for a time
period of 6 months until radiographic signs of healing
can be seen. Drysdale et al. (1996), mention that ortho-
dontic treatment in teeth with pulp necrosis due to
caries can begin immediately after the end of orthodon-
tic treatment. In cases with bone loss, treatment should
be postponed until clinical and radiographic signs of
healing can be observed. In these cases it has been sug-
gested to wait for 6 months before tooth movement. In
cases where endodontic treatment is performed because
of trauma, orthodontic treatment should be postponed
for one year so as to observe healing and exclude clini-
cally and radiographically the possibility of ankylosis.
Finally, is has been mentioned that for root fractures a
follow-up period of 1-2 years, or possibly less if teeth are
symptomless, is needed and that a follow up period of 3
months is adequate for mild damage to the periodontal
tissues, while for moderate or more severe damage a
period of 12 months is needed, as long as no ankylosis is
observed (Kugel et al., 2006; Kindelan et al., 2008). At
this point it is evident that close co-operation between
the orthodontist and the specialized endodontist as well
as the general dentist or the pediatric dentist is crucial
for the effective management of endodontically treated
teeth.
CONCLUSIONS
Based on contemporary data involving orthodontic
movement of endodontically treated teeth, the main
conclusions of the present review are the following:
ñ Orthodontic movement of endodontically treated
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
ÔÛÔÛÙfi ‚ÈÔÏÔÁÈ΋˜ ·fiÊڷ͢ ÙÔ˘ ·ÎÚÔÚÚÈ˙ÈÎÔ‡ ÙÚ‹-
Ì·ÙÔ˜ Ì ÓÂÔÛ¯ËÌ·ÙÈÛı›۷ ÔÛÙ½ÓË, ÌÈÎÚfiÙÂÚË ¤ÓÙ·ÛË
Î·È Â¤ÎÙ·ÛË Ù˘ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈËı‹Ûˆ˜, ηÈ
ηχÙÂÚË ÔÚÁ¿ÓˆÛË ÙÔ˘ ÂÚÈÔ‰ÔÓÙÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘.
∞ÂÏ¢ı¤ÚˆÛË ÈfiÓÙˆÓ ·Û‚ÂÛÙ›Ô˘ Ca2+ ÁÈ· ¤Ó· Ì·ÎÚfi
¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (ÙÔ˘Ï¿¯ÈÛÙÔÓ 105 Ë̤Ú˜) ·fi ÙËÓ
ÙÔÔı¤ÙËÛË Ca(OH)2 ‹Ù·Ó ÙÔ ·ÔÙ¤ÏÂÛÌ· ÚfiÛÊ·Ù˘ ÂÈ-
Ú·Ì·ÙÈ΋˜ ÌÂϤÙ˘ Û Â›Ì˘Â˜ (Narita Î·È Û˘Ó., 2010).
∫·Ù¿ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Ë ‰È¿Û·ÛË ÙˆÓ ÈfiÓÙˆÓ Ca2+ ·fi
ÙÔ Ca(OH)2, ·Ô‰ÂÈÎÓ‡ÂÈ Î·È ÂÚÌËÓ‡ÂÈ ÙÔÓ Ì˯·ÓÈÛÌfi
ÂÓ·Ï¿ÙˆÛ˘ (mineralization) ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ Ô˘ ÂÈ-
ʤÚÂÈ ÙÔ Ca(OH)2.
∏ Kindelan Î·È Û˘Ó. (2008), ‰È·Ù˘ÒÓÂÈ ˆ˜ Ë ¯Ú‹ÛË Â›
Ì·ÎÚfiÓ ÙÔ˘ Ca(OH)2 ÂÓÙfi˜ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ÂӉ›ÎÓ˘-
Ù·È ÁÈ· ·ÎÚÔÚÚÈ˙·fiÊÚ·ÍË Û ÙÔÌ›˜ Ì ·‰È¿Ï·ÛÙÔ
·ÎfiÌ· ·ÎÚÔÚÚ›˙ÈÔ ÂÓÒ ·Ú¿ÏÏËÏ· Û˘ÌʈÓ› Ì ÙÔÓ
Trope Î·È Û˘Ó. (1995), fiÙÈ ÙÔ Ca(OH)2 ÏÂÔÓÂÎÙ› Û ÂÚÈ-
ÙÒÛÂȘ fiÔ˘ ˘¿Ú¯ÂÈ Â͈ÙÂÚÈ΋ ÊÏÂÁÌÔÓ҉˘ ·ÔÚÚfi-
ÊËÛË Ú›˙·˜ ÔfiÙÂ Î·È Ë ·Ú·ÌÔÓ‹ ÙÔ˘ ÁÈ· 12 ‚‰ÔÌ¿‰Â˜
ÂÓÙfi˜ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ Â›Ó·È Ôχ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ-
΋ ·ã fiÙÈ Ë ‚Ú·¯Â›· ·Ú·ÌÔÓ‹ ÙÔ˘ ÁÈ· 1 ‚‰ÔÌ¿‰· ÚÈÓ
ÙËÓ ÙÂÏÈ΋ ¤ÌÊÚ·ÍË, ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ÂԇψÛË Ù˘ ÂÈ-
Ê¿ÓÂÈ·˜ Ù˘ Ú›˙·˜ Ì ÂÓ·fiıÂÛË ÔÛÙ¤ÈÓ˘.
¶·Ú'fiÏ· ·˘Ù¿, ÙÔ Ca(OH)2 ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÔÏϤ˜
ÂÈÏÔΤ˜ ȉȷ›ÙÂÚ· Û ̷ÎÚÔ¯ÚfiÓȘ ıÂÚ·›˜. Œ¯ÂÈ ·Ó·-
ÊÂÚı› ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ηٿÁÌ·ÙÔ˜ Ú›˙·˜ ·˘¯ÂÓÈο
Û ÌË Ï‹Úˆ˜ ‰È·Ï·Ṳ̂ӷ ‰fiÓÙÈ· Ì ԉÔÓÙÈÎfi ÙÚ·‡Ì·,
ÛÙ· ÔÔ›· ¤¯ÂÈ ÙÔÔıÂÙËı› Ca(OH)2 Û ˘ÂÚÂÎÙÂٷ̤ӷ
¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ·ÎÚÔÚÚÈ˙·fi-
Êڷ͢. √È ·˘ÍË̤Ó˜ Èı·ÓfiÙËÙ˜ fï˜ ηٿÁÌ·ÙÔ˜ ÛÂ
·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ, ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È ÛÙ· ÏÂÙfiÙÂ-
Ú· ÂÓ·Ô̤ÓÔÓÙ· ÙÔȯÒÌ·Ù· ÌÂÙ¿ ÙË Ó¤ÎÚˆÛË ÙˆÓ
‰ÔÓÙÈÒÓ Ì ·‰È¿Ï·ÛÙÔ ·ÎfiÌ· ·ÎÚÔÚÚ›˙ÈÔ, Ì ·ÔÙ¤ÏÂ-
ÛÌ· ·˘Ù¿ Ó· Â›Ó·È ÈÔ ÂÈÚÚÂ‹ ÛÙ· ηٿÁÌ·Ù· ÛÙËÓ
·˘¯ÂÓÈ΋ ÂÚÈÔ¯‹ Û ۯ¤ÛË Ì ٷ Ï‹Úˆ˜ ‰È·Ï·Ṳ̂ӷ
‰fiÓÙÈ· (Cvek, 1992). In vitro ¤Ú¢Ó˜ ¤¯Ô˘Ó ·ԉ›ÍÂÈ fiÙÈ
·Ú·ÌÔÓ‹ Â› Ì·ÎÚfiÓ ÙÔ˘ Ca(OH)2 ÌÂÈÒÓÂÈ ÙËÓ ·ÓÙ›ÛÙ·ÛË
ÙˆÓ ‰ÔÓÙÈÒÓ Û ηٿÁÌ·Ù·, ·ÏÏ¿ Ë ·Ú·ÌÔÓ‹ ÙÔ˘ ÙÔ
Ôχ ̤¯ÚÈ ÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 30 ËÌÂÚÒÓ, ‰ÂÓ ÂËÚ¿˙ÂÈ
ηıfiÏÔ˘ ÙËÓ ·ÓıÂÎÙÈÎfiÙËÙ· Û ηٿÁÌ·Ù· (Andreasen
Î·È Û˘Ó., 2002; Doyon Î·È Û˘Ó., 2005; Rosenberg ηÈ
Û˘Ó., 2007).
∆¤ÏÔ˜, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÌÔÚ› Ó· ÂË-
Ú¿ÛÂÈ ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ˘fi ÌÂٷΛÓËÛË ÂÓ‰Ô‰ÔÓÙÈο
ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ, Â›Ó·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÂÊ·ÚÌÔ˙fi-
ÌÂÓˆÓ ‰˘Ó¿ÌˆÓ. ◊Ș ‰˘Ó¿ÌÂȘ ÙˆÓ 50-100 gr, ÂÊ·Ú-
ÌÔ˙fiÌÂÓ˜ Û ÎÂÓÙÚÈÎfi ÙÔ̤·, ıˆÚÔ‡ÓÙ·È ÈηӤ˜ ÁÈ· Ó·
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
teeth is as possible as the movement of vital teeth.
ñ Endodontically treated teeth present in mean values
less resorption of the apical region compared to vital
teeth. However, this difference is not regarded to be
statistically or clinically significant.
ñ Root resorption of endodontically treated teeth
seems to be related more to the severity of trauma
and the developmental stage of the root rather than
the orthodontic or the surgical manipulations.
ñ Orthodontic movement of an endodontically treated,
non-traumatized tooth could begin relatively directly,
if no radiographic findings exist. In cases of fractures
a period of 12 months is indicated.
ñ The prognosis of orthodontic movement of endodon-
tically treated teeth depends on factors such as the
type or the severity of dental trauma, the obturating
material (gutta-percha or Ca(OH)2 if treatment
involves teeth with incomplete apex or is carried out
at the same time with orthodontic treatment) as well
as the magnitude and the duration of applied ortho-
dontic forces.
ñ Mild forces of 50-100 gr are considered capable of
moving an endodontically treated tooth.
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79
∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
ÌÂÙ·ÎÈÓ‹ÛÔ˘Ó ¤Ó· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓÔ ‰fiÓÙÈ
(Hines, 1979; Mattison Î·È Û˘Ó., 1984; Drysdale Î·È Û˘Ó.,
1996; Kindelan Î·È Û˘Ó., 2008). ∞ÎfiÌË, Ë ‰È¿ÚÎÂÈ· ÙˆÓ
ÂÊ·ÚÌÔ˙fiÌÂÓˆÓ ‰˘Ó¿ÌÂˆÓ ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙËÓ
ÚfiÁÓˆÛË ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ
ηıfiÛÔÓ, ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ë ıÂÚ·›· ÔÏϤ˜
ÊÔÚ¤˜ ‰È·ÚΛ ÂÚÈÛÛfiÙÂÚÔ ·'fiÙÈ Û˘Ó‹ıˆ˜ ÛÙËÓ ÚÔ-
Û¿ıÂÈ· ÙÔ˘ ÂοÛÙÔÙ ÂÂÌ‚·›ÓÔÓÙÔ˜ Ó· ·ÔʇÁÂÈ ÙËÓ
ÂÈ‚¿Ú˘ÓÛË ÙˆÓ ‰ÔÓÙÈÒÓ ·˘ÙÒÓ Ô˘ ¢ı‡˜ ÂÍ·Ú¯‹˜ ·ÓÙÈ-
ÌÂÙˆ›˙ÂÈ Ì ÌÂÁ¿ÏË ÂÈÊ˘Ï·ÎÙÈÎfiÙËÙ· (Wickwire ηÈ
Û˘Ó., 1974; Malmgren Î·È Û˘Ó., 1982; Brin Î·È Û˘Ó.,
1991; Drysdale Î·È Û˘Ó., 1996). ¶ÚÔÙ›ÓÂÙ·È Ù· ˘fi ÌÂÙ·-
ΛÓËÛË ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ·, Ó· ÂϤÁ¯ÔÓÙ·È
ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÁÚ·ÊÈο 6 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÂÓÂÚÁ‹ ÌÂÙ·-
ΛÓËÛ‹ ÙÔ˘˜, Î·È Â¿Ó ·ÔÎ·Ï˘ÊıÔ‡Ó ÛËÌ›· ·ÔÚÚfiÊË-
Û˘ ·˘Ù‹ ı· Ú¤ÂÈ Ó· ‰È·ÎÔ› ÁÈ· 3 Ì‹Ó˜ ÒÛÙ ӷ ÂÈ-
ÙÚ·› Ë ÂԇψÛË ÛÙÔ ÂÚÈÔ‰fiÓÙÈÔ Î·È Ó· ·ÍÈÔÏÔÁËı›
Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ‰ÔÓÙÈÔ‡ ÚÔÙÔ‡ Û˘Ó¯ÈÛÙ› Ë ÔÚıÔ‰Ô-
ÓÙÈ΋ ıÂÚ·›· (Drysdale Î·È Û˘Ó., 1996; Kindelan ηÈ
Û˘Ó., 2008).
¶¤Ú· ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ‰˘Ó¿ÌˆÓ, ÛËÌ·ÓÙÈÎfi Â›Û˘
ÁÈ· Ì›· ηϋ ÚfiÁÓˆÛË ÂÓfi˜ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓÔ˘
‰ÔÓÙÈÔ‡ Â›Ó·È Ô ¯ÚÔÓÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ¤Ó·Ú͢ Ù˘
ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜. ∞ӷʤÚÂÙ·È fiÙÈ ÙÔ ‰fiÓÙÈ Ú¤ÂÈ
Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙËÓ
ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂÚ·›· ÁÈ· Ó· ÂÎÙÈÌËı› ÙÔ ·ÔÙ¤ÏÂÛÌ¿
Ù˘ Î·È ÌÂÙ¿ Ó· ·Ú¯›ÛÂÈ Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ‰˘Ó¿ÌÂˆÓ Ô˘
ı· ÌÂÙ·ÎÈÓ‹ÛÔ˘Ó ÙÔ ‰fiÓÙÈ. ∞˘Ùfi ÙÔ ‰È¿ÛÙËÌ· ·Ú·ÎÔ-
ÏÔ‡ıËÛ˘ ÔÈΛÏÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›ÙˆÛË. √
Malmgren Î·È Û˘Ó. (1994), Û˘ÛÙ‹ÓÂÈ ˆ˜ Ë ÔÚıÔ‰ÔÓÙÈ΋
ıÂÚ·›· ÌÔÚ› Ó· ÍÂÎÈÓ‹ÛÂÈ Â¿Ó Ë ÔÈfiÙËÙ· Ù˘ ÂÓ‰Ô-
‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Â›Ó·È Î·Ï‹ Î·È ÂÊfiÛÔÓ Û˘Ó˘¿Ú¯Ô˘Ó
ÎÏÈÓÈο ÛËÌ›· ÂԇψÛ˘. ∂¿Ó ˆÛÙfiÛÔ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË
·ÎÙÈÓԉȷ‡Á·ÛË ·ÎÚÔÚÚÈ˙Èο, ‹ ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi Úfi-
ÛÊ·ÙÔ˘ Ô‰ÔÓÙÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜, Ë ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·
ı· Ú¤ÂÈ Ó· ·Ó·‚¿ÏÏÂÙ·È ÁÈ· ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 6
ÌËÓÒÓ Ì¤¯ÚÈ Ó· ˘¿ÚÍÔ˘Ó ·ÎÙÈÓÔÁÚ·ÊÈο ÛËÌ›· ÂÔ‡-
ψÛ˘. √ Drysdale Î·È Û˘Ó. (1996), ·Ó·Ê¤ÚÂÈ ˆ˜ Ë
ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Û ‰fiÓÙÈ· Ì ӤÎÚˆÛË ÔÏÊÔ‡
ÏfiÁˆ ÙÂÚˉfiÓ·˜, ÌÔÚ› Ó· ÍÂÎÈÓ‹ÛÂÈ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ
¤Ú·˜ Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂÚ·›·˜. ™Â ÂÚÈÙÒÛÂȘ ÌÂ
·ÒÏÂÈ· ÔÛÙÔ‡, ·˘Ù‹ ı· Ú¤ÂÈ Ó· ·Ó·‚¿ÏÏÂÙ·È Ì¤¯ÚÈ
ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÁÚ·ÊÈο ÛÙÔȯ›· Ó· ˘Ô‰ËÏÒÓÔ˘Ó
ÛËÌ›· ÂԇψÛ˘. ™Â ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ¤¯ÂÈ ÚÔÙ·-
ı› ¤Ó· ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 ÌËÓÒÓ ÚÈÓ ÙË ÌÂٷΛÓË-
ÛË ÙˆÓ ‰ÔÓÙÈÒÓ. ™Â ÂÚÈÙÒÛÂȘ fiÔ˘ ÙÚ·˘Ì·ÙÈο ·›ÙÈ·
Ô‰‹ÁËÛ·Ó ÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ Ó· ıÂÚ·‡ÛÂÈ ÂÓ‰Ô‰ÔÓÙÈο ÙÔ
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HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∂Ó‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Î·È √ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· / Orthodontic movement of endodontically treated teeth
Û˘ÁÎÂÎÚÈ̤ÓÔ ‰fiÓÙÈ, Ë ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· ı· Ú¤ÂÈ
Ó· ·Ó·‚ÏËı› ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó·Ó ¯ÚfiÓÔ ÌÂÙ¿, ÒÛÙ ӷ
‰È·ÈÛÙˆı› ÂԇψÛË Î·È Ó· ·ÔÎÏÂÈÛı› οı ÂӉ¯fi-
ÌÂÓÔ ·Á·ψÛ˘ ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÁÚ·ÊÈο. ∆¤ÏÔ˜, ·Ó·-
ʤÚÂÙ·È fiÙÈ ÁÈ· ηٿÁÌ·Ù· Ú›˙·˜ ··ÈÙÂ›Ù·È ¤Ó· ‰È¿ÛÙËÌ·
1-2 ¯ÚfiÓˆÓ Î·È ›Ûˆ˜ ÏÈÁfiÙÂÚÔ Â¿Ó Ù· ‰fiÓÙÈ· Â›Ó·È ·Û˘-
Ìو̷ÙÈο, ¤Ó· ‰È¿ÛÙËÌ· 3 ÌËÓÒÓ ÁÈ· ‹Ș ‚Ï¿‚˜ ÛÙÔ
ÂÚÈÔ‰fiÓÙÈÔ, ÂÓÒ Û ̤ÙÚȘ ‹ ‚·Ú‡ÙÂÚ˜ ‚Ï¿‚˜ ‰È¿ÛÙË-
Ì· 12 ÌËÓÒÓ, ÂÊfiÛÔÓ ‰ÂÓ ‰È·ÈÛÙÒÓÂÙ·È ·Á·ψÛË
(Kugel Î·È Û˘Ó., 2006; Kindelan Î·È Û˘Ó., 2008). ∂›Ó·È
ÚÔÊ·Ó¤˜ ÛÙÔ ÛËÌÂ›Ô ·˘Ùfi, fiÙÈ Ë ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· ÙÔ˘
ÔÚıÔ‰ÔÓÙÈÎÔ‡ Ì ÙÔÓ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÂÓ‰Ô‰ÔÓÙÈÛÙ‹ fiˆ˜
Î·È Ì ÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ ‹ ÙÔÓ ·È‰Ô‰ÔÓÙ›·ÙÚÔ Â›Ó·È Î·ıÔ-
ÚÈÛÙÈ΋ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ‰È·¯Â›ÚÈÛË ÙˆÓ ÂÓ‰Ô-
‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ.
™Àª¶∂ƒ∞™ª∞∆∞
µ·ÛÈ˙fiÌÂÓÔÈ ÛÙ· ÈÔ Û‡Á¯ÚÔÓ· ‰Â‰Ô̤ӷ Ô˘ ·ÊÔÚÔ‡Ó
ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ
‰ÔÓÙÈÒÓ, ·ÚÈ· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ·fi
ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË Â›Ó·È:
ñ ∏ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο
ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Â›Ó·È ÂÍ›ÛÔ˘ ÂÊÈÎÙ‹ Ì وÓ
˙ˆÓÙ·ÓÒÓ.
ñ ∆· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó
ηٿ ̤ÛÔ fiÚÔ ÌÈÎÚfiÙÂÚË ·ÔÚÚfiÊËÛË Ù˘
·ÎÚÔÚÚÈ˙È΋˜ ÂÚÈÔ¯‹˜ Û ۯ¤ÛË Ì ٷ ˙ˆÓÙ·Ó¿, Ô˘
fï˜ ‰ÂÓ ÎÚ›ÓÂÙ·È ·ÍÈÔÛËÌ›ˆÙË Ô‡Ù Û ÛÙ·ÙÈÛÙÈÎfi
Ô‡ÙÂ Î·È Û ÎÏÈÓÈÎfi Â›‰Ô.
ñ ∏ ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο
ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È
ÂÚÈÛÛfiÙÂÚÔ Ì ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Î·È ÙÔ
‰È·Ï·ÛÙÈÎfi ÛÙ¿‰ÈÔ Ù˘ Ú›˙·˜ ·Ú¿ Ì ÙÔ˘˜
ÔÚıÔ‰ÔÓÙÈÎÔ‡˜ ‹ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘
ÂÊ·ÚÌfi˙ÔÓÙ·È.
ñ ∏ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË ÂÓfi˜ ÂÓ‰Ô‰ÔÓÙÈο
ıÂÚ·Â˘Ì¤ÓÔ˘ ‰ÔÓÙÈÔ‡ Ô˘ ‰ÂÓ ¤¯ÂÈ ˘ÔÛÙ› ÙÚ·‡Ì·,
ı· ÌÔÚÔ‡Û ӷ ÍÂÎÈÓ‹ÛÂÈ Û¯ÂÙÈο Û‡ÓÙÔÌ· fiÙ·Ó ‰ÂÓ
˘¿Ú¯Ô˘Ó ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·. ™Â ÂÚÈÙÒÛÂȘ
ηٷÁÌ¿ÙˆÓ Û˘ÛÙ‹ÓÂÙ·È ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 12
ÌËÓÒÓ.
ñ ∏ ÚfiÁÓˆÛË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘
ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ ÂÍ·ÚÙ¿Ù·È ·fi
·Ú¿ÁÔÓÙ˜ fiˆ˜ Ô Ù‡Ô˜ Î·È Ë ‚·Ú‡ÙËÙ· ÙÔ˘
Ô‰ÔÓÙÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜, ÙÔ Â›‰Ô˜ ÙÔ˘ ÂÌÊÚ·ÎÙÈÎÔ‡
˘ÏÈÎÔ‡, ‰ËÏ·‰‹ ÁÔ˘Ù·¤Úη˜ ‹ Ca(OH)2 ÂÊfiÛÔÓ Ë
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E-mail: ioanidou@dent.auth.gr
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Reprint requests to:

I. Ioannidou-Marathiotou
Department of Orthodontics
School of Dentistry
Aristotle University of Thessaloniki
GR-54124 Thessaloniki
Greece

E-mail: ioanidou@dent.auth.gr

82 HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2

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