What is the difference between endodontics and orthodontics

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In summary Fig 1 , we may say that:. Occlusal forces are abrupt, have moderate intensity and short duration, but are very repetitive. Forces of dental trauma, which are very intense, abrupt and have an extremely short duration, are highly damaging to periodontal and tooth tissues.

Orthodontic forces are not comparable with those of occlusal and dental trauma in all aspects and parameters. They are markedly lighter and dissipating, even though they might be called heavy or intense in an orthodontic context or environment. Orthodontic forces applied to the periodontal ligament slightly compress vessels and induce metabolic cellular stress by hypoxia. This stress is added to the mechanical cell stress that results from cytoskeletal deformation.

In case of cellular stress, cells and tissues preserve their normal morphology under light microscopy, as this is not a disease or a case of tissue disorganization, but, rather, a differentiated stage of normal tissue with greater metabolic activity. In everyday life, tissues alternate from homeostasis to stress when performing their functions.

Induction of cellular stress in the periodontal ligament by orthodontic forces promotes a greater release of mediators, particularly those associated with bone resorption, such as some cytokines and prostaglandins.

The purpose of this tissue reaction is to enlarge the space for cells, which was reduced by periodontal tissue compression. As a result of that, teeth will be moved. Cementum covers the root surface and closes dentinal tubules externally. Periodontal fibers are inserted into the cementum. Cementum and dentin physiologically separate the pulp from the periodontal ligament so that pulp structures and functions are fully preserved, as demonstrated in several experimental studies that evaluated ligament changes induced by orthodontic movement.

Periodontal tissues are microscopically normal when there are pulp changes or even necrosis. True endodontic-periodontic lesions are those that require both endodontic and periodontic treatment approaches, as they are lesions initially independent from each other, but that progress together along time. In other words, there is no efficient communication between the pulp chamber and the periodontium through the dentin and cementum wall, except in the case of lateral canals. When a root canal is filled, the material used does not affect the antigenic composition of the dentin or the cementum Fig 2.

It is not possible to say whether endodontic treatment increases or decreases orthodontically induced resorption. There is no methodological basis for such claims and, therefore, teeth that have been adequately treated endodontically should be considered orthodontically normal teeth in clinical practice.

In the apical periodontal ligament continuous with the pulp at the margins of the cemental canal, repair in vital tooth pulpectomy begins as soon as filling is completed. In the interface between filling material and periodontal connective tissue, there is acute inflammation with edema and neutrophils. As there are no aggressors there, particularly no bacteria, this inflammation is reabsorbed and migrates to other areas Fig 2 in hours.

After this short time, macrophages are predominant and participate actively in repair and the return to normality, as they phagocytize cellular debris that may have been produced by instrumentation. Depending on the type of filling material used, neighboring cementoblasts may proliferate and gradually migrate into the interface with adjacent tissues.

There they may form cementoid material and result in the insertion of collagen fibers Fig 3. This interface also has fibrous connective tissue without fiber insertions, but does not have any residual or persistent inflammation. Macrophages can phagocytize, or try to phagocytize, some of the materials used for filling, gathering in their interfaces and forming a foreign body granuloma Fig 4. If there are no microorganisms or sources of toxicity that may kill cells, this process remains there indefinitely, with no symptoms or detrimental effects to apical periodontal physiology.

After the endodontist eliminates the cause of pulp necrosis, particularly when it is induced by microbial agents, microbial products, such as enzymes and toxins, as well as lipopolysaccharides LPS , are no longer expected to be found in periapical tissues. Endodontic treatments also eliminate microbial biofilm from the cemental canal and in the areas of root resorption of the cemental canal. This may result from mechanical action or the use of medications placed in the canal.

Periapical repair, which includes the bone and cementum, initiates as soon as aggressors are eliminated Figs 3 and 5. Mean microbial survival time is 20 minutes for each generation.

Therefore, between hours, macrophages complete the phagocytosis of tissue and microbial residues. Exudate absorption is being completed by venous and lymphatic vessels. Therefore, cytotoxic microbial products, such as toxins, enzymes and LPS, are about to be fully eliminated. However, this may not occur in all cases, as there may be failures even when the treatment is adequate. In some cases, microbial biofilm forms on the external surfaces of the apex, or even in more profound areas of external inflammatory resorptions.

In addition to teeth with infected pulp necrosis still restricted to the root canal, there are also cases of infected pulp necrosis and chronic periapical lesions, particularly immunogenic periapical granulomas Figs 3, 4 and 5.

In practically all teeth with a chronic immunogenic periapical granuloma, external inflammatory resorptions are somehow intense, which makes it difficult to remove bacteria from within the dentinal tubules or from the surface irregularities in the area. In teeth with chronic periapical lesions, microbial biofilm out of the cemental canal is more frequent and larger.

There are also more free bacteria and microbial clusters inside the lesion. This complicates instrumentation and bacterial elimination by canal medications. In these cases, periapical lesions may persist and stabilize or grow along time, in which case they require endodontic retreatment or surgery. There will be no repair because of the persistence of aggressors, that is, bacteria and their products, particularly in microbial biofilm. No microorganisms are involved in aseptic pulp necrosis Fig.

Adequate endodontic treatment of these cases usually leads to periapical and bone repair similar to that found in cases of vital tooth pulpectomy. After adequate root filling, a rapid acute inflammatory response initiates in hours, soon leading to repair, because the main aggressor was in the products of aseptic pulp necrosis, which are considerably less aggressive to tissues and are previously eliminated.

Orthodontic forces are light, dissipating and not applied abruptly Fig 1. These forces should partially compress the periodontal ligament, at a thickness of 0. They should be light so that they produce tooth movement effectively. If forces are excessive, the connective tissue of the ligament hyalinizes, and osteoclasts and other cells do not resorb bone, nor, therefore, move teeth.

This means that excessive force will not be effective. Women who practice poor oral health care and have gum disease develop a much higher risk of giving birth to premature babies as well as babies with low birth weights. Good oral health care is not possible unless you see your dental professional two times a year.

Joel Gluck has practiced orthodontics since when he opened his own office in Nashville. He earned his undergraduate degree at Washington University in St.

Louis, and his dental degree at the University of Tennessee. Gluck then completed an orthodontic specialty residency at the University of Michigan, one of the top five orthodontic training residencies in the country. He also wrote an original thesis and received a Master of Science degree.

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