Orthodontic space closure is a routine part of treatment, but how does it affect the health of the dental pulp? While it’s well known that orthodontic forces influence periapical pressure, their impact on pulpal blood flow has been less clear. This latest clinical study purports to change that.
A recent clinical trial investigated the effects of space closure on pulpal blood flow, shedding light on the risks to tooth vitality and the factors that influence these changes.
Keep reading our summary to find out what the researchers discovered and what it means for orthodontic treatment planning.
Our Summary
Orthodontic tooth movement relies on controlled forces to reshape surrounding bone, but these forces also exert pressure on the pulp, potentially affecting its blood supply. This study examined how pulpal blood flow changes throughout space closure, identifying which teeth are most at risk and how the rate of tooth movement influences circulation.
Twenty-two patients (aged 11–19 years) undergoing orthodontic space closure in the mandibular arch were included in this prospective clinical trial. Treatment was carried out using sliding mechanics on a 0.019 × 0.025-inch stainless steel wire, and pulpal blood flow was measured at six different time points using Laser Doppler flowmetry.
The study assessed pulpal circulation at baseline, after alignment and levelling, and at the 4th, 7th, 21st, and 28th days of space closure.
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Findings
Results showed that pulpal blood flow decreased after the alignment and levelling phase and continued to decline throughout space closure. However, the extent of this reduction varied depending on tooth position and root structure:
- Teeth closer to the extraction space experienced a more significant reduction in pulpal blood flow.
- Single-rooted teeth were more affected than multirooted teeth.
A higher rate of orthodontic tooth movement was associated with a greater decrease in pulpal blood flow.
Clinical Relevance
These findings suggest that single-rooted teeth near extraction spaces face a greater risk of reduced blood flow, particularly when tooth movement is faster. This has important clinical implications for managing teeth with already compromised pulp vitality. Orthodontists may need to consider adjusting force levels or treatment sequencing to minimise potential damage to the dental pulp.
Study Limitations
While the study provides valuable insights, it had some limitations. There was no control group for comparison, and the research focused exclusively on the mandibular arch, meaning further studies are needed to determine if similar effects occur in the maxilla.
About Dr. Jamal
Dr. Jamal Giri is an orthodontist and associate professor at B.P. Koirala Institute of Health Sciences in Nepal. He obtained his orthodontic training from the Institute of Medicine, Tribhuvan University, Nepal, in 2014.
Currently pursuing a PhD at the University of Adelaide, Dr. Jamal’s research focuses on the genetic and environmental factors influencing malocclusion development. He also holds a postgraduate certificate in clinical education from the University of Edinburgh and a master’s in medical education from the University of Nottingham.Dr. Jamal teaches on the Diploma in Orthodontics and Dentofacial Orthopaedics at the London Dental Institute.
Read More
Golež A, Ovsenik M, Cankar K. Evaluation of pulpal blood flow during orthodontic space closure: Prospective clinical trial. American Journal of Orthodontics and Dentofacial Orthopedics. 2024;166(6):549-60.
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