Accelerated healing of endodontically treated teeth with a periapical lesion as a result of orthodontic extrusion: evaluation and rationale

Resolution of a periapical periodontal lesion as determined by radiographic examination may take a year or longer. Orthodon-tic movement is known to have a positive effect on the bone topography and morphology. The literature presents no infor-mation about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treat-ment. The aim of this report was to present the use of ortho-dontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving end-odontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predict-able crown fabrication or replacing a hopeless tooth more safely with an implant-supported crown. In all cases presented, signs of radiographic healing were demonstrated in a relatively shorter time than is considered acceptable, following the ex-trusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical le-sions presented positive radiographic healing signs along with no clinical symptoms of pain and mobility and a positive effect on marginal bone level and soft tissues, at a faster rate than was expected. This report may assist in supporting a clinical decision to apply vertical extrusive forces on compromised endodonti-cally treated teeth presenting with a periapical lesion. Healing signs may be observed within a shorter time period, which may allow better prediction for the prosthetic phase. (Quintessence Int