Effect of orthodontic force on dental pulp histomorphology and tissue factor expression: A systematic review

Objectives: To evaluate the effects of orthodontic force on histomorphology and tissue factor expression in the dental pulp. Materials and Methods: Two reviewers comprehensively and systematically searched the literature in the following databases: Latin American and Caribbean Health Sciences, Embase, Cochrane, PubMed, Scopus, Web of Science, and Grey literature (Google Scholar, OpenGrey, and ProQuest) up to September 2020. According to the Population, Intervention, Comparison, Outcomes, Studies criteria, randomized clinical trials (RCTs) and observational studies that evaluated the effects of orthodontic force on dental pulp were included. Case series/reports, laboratory-based or animal studies, reviews, and studies that did not investigate the association between orthodontic force and pulpal changes were excluded. Newcastle-Ottawa Scale and Cochrane risk-of-bias tool were used to assess the risk of bias. The overall certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation tool. Results: 26 observational studies and five RCTs were included. A detailed qualitative analysis of articles showed a wide range of samples and applied methodologies concerning impact of orthodontic force on the dental pulp. The application of orthodontic force seems to promote several pulpal histomorphological changes, including tissue architecture, cell pattern, angiogenesis, hard tissue deposition, inflammation, and alteration of the expression levels of 14 tissue factors. Conclusions: Although the included articles suggest that orthodontic forces may promote histomorphological changes in the dental pulp, due to the very low-level of evidence obtained, there could be no well-supported conclusion that these effects are actually due to orthodontic movement. Further studies with larger samples and improved methods are needed to support more robust conclusions. (Angle Orthod. 2021;91:830-842.)

Automated summary

The study evaluated the effects of orthodontic force on histomorphology and tissue factor expression in the dental pulp, finding that orthodontic force may lead to various histomorphological changes in the dental pulp. However, due to the low-level of evidence obtained, it cannot be concluded definitively that these effects are due to orthodontic movement. Further studies with larger samples and improved methods are needed to support more robust conclusions.