Orthodontic tooth movement and its effect on the dental pulp

iStock_000002551343XSmall colourful braces on teeth

Orthodontic treatment is based on the principle that if a force is applied to a tooth for a period of time it will move. The applied force produces changes in both the supporting structures and in the pulp of the tooth.  Pathological changes have been reported in the pulp in response to these forces so the aim of this review was to investigate the relationship between orthodontic force level and pulp reaction in humans.

The authors undertook a detailed search of the PubMed/old Medline, Web of Science, Embase, CINAHL and the Cochrane Library databases. They undertook handsearching of key dental journal and reference lists of identified studies.  Studies in humans that quantified, orthodontic force magnitude, type of tooth movement, duration of force application, and description of pulpal reaction were included. Screening of abstracts, data abstraction and quality assessment was conduced independently by two authors.

  •  24 studies of moderate to low-grade quality were included. Five studies reported changes in pulpal blood flow (PBF) and 19 publications dealt with histologic and cell biological reactions
  •  The forces used in human studies ranged from 25–4400 cN.
  • The duration of force application ranged from 20 seconds to 152 days.

The authors concluded

Because of a lack of high-quality studies there is no conclusive scientific evidence for a relation between force level and dental pulp tissue reaction in humans. There is contradictory scientific support for a force-dependent reduction of blood flow.


von Bohl, M,  Ren, Y, Fudalej, PS, Kuijpers-Jagtman AM Pulpal Reactions to Orthodontic Force Application in Humans: A Systematic Review. Journal of Endodontics ; in press ; Vol 38;11, November 2012, Pages 1463–1469





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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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