Long-term Complications of Previously Successful Regenerative Endodontic Procedures after Orthodontic Movement - A Report of 3 Different Complications after 4, 8, and 11 Years

Oct 14, 2026

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Long-term complications of regenerative endodontic procedures after orthodontic forces remain insufficiently documented. This report describes three cases of previously successful regenerative endodontic treatment with extended follow-up, each developing distinct late complications. After orthodontic movement, outcomes included severe external invasive cervical resorption requiring extraction, symptomatic apical periodontitis, and perforating internal resorption. The findings emphasize cautious orthodontic management with careful monitoring, possible exclusion of orthodontic loading, and consideration of preventive endodontic care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Case Reports and Outcomes

Case 1: Intruded tooth after spontaneous repositioning

Case 2: Lateral luxation injury and orthodontic treatment

Case 3: Perforating internal resorption after orthodontic forces

Clinical Significance and Recommendations

CASE REPORT/CLINICAL TECHNIQUES Long-term Complications of Previously Successful Regenerative Endodontic Procedures after Orthodontic Movement: A Report of 3 Different Complications after 4, 8, and 11 Years ABSTRACT There is a paucity of literature on late complications of regenerative endodontic procedures. The aim of this article was to report 3 cases of previously successful regenerative endodontic procedures with long-term follow-up that developed different complications after the application of orthodontic forces. In the ﬁrst case, an 8-year-old female patient received a regenerative endodontic procedure in her previously intruded tooth (tooth no. 21) that had been rendered necrotic after a successful spontaneous repositioning procedure. The 5-year follow-up revealed uneventful healing, continuous root development, dentinal wall thickening, and regaining of pulp vitality for tooth no. 21. Four years later, the patient received orthodontic treatment with mild forces that lasted 2 years. The 11-year follow-up revealed severe external invasive cervical resorption, and the tooth had to be extracted. In the second case, a 6-yearold female patient suffered a lateral luxation injury in tooth no. 11. Six months after the injury, the tooth developed symptoms and discoloration and tested negative in pulp vitality testing. Single-step regenerative endodontic procedures were applied, and successful continuous root development, dentinal wall thickening, and apical closure were achieved at the 3-year follow-up. Two months after the initiation of orthodontic treatment, the tooth developed symptomatic apical periodontitis. Root canal treatment was performed to treat the disease, and the orthodontic treatment was continued. In the third case, a previously published successful regenerative endodontic procedure developed a perforating internal resorption 6 months after the application of orthodontic forces. The internal resorption was arrested with root canal treatment, the resorptive defect was repaired with bioceramic obturation, and the orthodontic treatment plan was modiﬁed. Previously successful regenerative cases might develop external invasive cervical resorption, regenerative tissue necrosis, or internal resorption after the application of orthodontic forces. Best practice/evidence-based guidelines on the appropriate orthodontic management of successful regenerative endodontic therapy teeth are lacking. Whenever possible, careful monitoring and partial or complete exclusion off orthodontic treatment might be necessary. In some cases, preventive root canal treatment before the initiation of orthodontic movement might be considered. (J Endod 2022;48:951–960.) KEY WORDS Complications; necrosis; regenerative endodontic procedures; resorption; traumatic dental injuries Occasionally, traumatic dental injuries or carious lesions in children and adolescents may render the pulp of the developing teeth necrotic. In necrotic immature permanent teeth, conventional endodontic treatment procedures might be challenging to follow1. The thin dentinal walls, the shortened root length, Antonis Chaniotis, DDS, MDS,* and Anastasia Chanioti† SIGNIFICANCE The effect of orthodontic movement on previously successful REP-treated teeth remains largely unknown. Thereport of different long-term complications might help the development of best practice/ evidence-based guidelines for the orthodontic management of these teeth. External cervical invasive resorption, REP tissue necrosis, or internal resorption might complicate REP cases long after the successful induction of continuous root development and dentinal wall thickening. From *Private Practice; and †Dental School, National and Kapodistrian University of Athens, Athens, Greece Address requests for reprints to Dr Antonis Chaniotis, Private Practice– microEndodontics, 140 El Venizelou Av, Stoa Karantinou, 1st Floor, 176 76 Kallithea, Athens, Greece. E-mail address: [antch@otenet.g

FAQs

What is the main purpose of the article?

To report three long-term complication cases that occurred after previously successful regenerative endodontic procedures when orthodontic forces were applied.

What complications were observed across the three cases?

The cases showed external invasive cervical resorption, symptomatic apical periodontitis, and perforating internal resorption, despite earlier continuous root development and dentinal wall thickening.

What management guidance does the report suggest for orthodontic treatment of successful REP teeth?

It highlights the need for careful monitoring and, when possible, partial or complete exclusion from orthodontic treatment, with some cases considering preventive root canal treatment before orthodontic movement.

Oct 14, 2026

Upload by Mabel