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. Orthodontic movement is known to have a positive effect on the bone topography and morphology. The literature presents no information about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treatment. The aim of this report was to present the use of orthodontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving endodontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predictable 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 extrusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical lesions 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 endodontically 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.