Effect of orthodontic forces on human dental pulp: A systematic review
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Published:
Oct 21, 2020
Keywords:
Orthodontic force, Tooth movement, Dental pulp, Pulpal blood flow, Pulpal reaction, Human
Main Article Content
Abstract
Introduction: Orthodontic force application stimulates a biological response of the dental pulp. The pulpal response to orthodontic force involves cell damage, inflammation, and wound healing. The pulpal reparation rate, pulpal obliteration by secondary dentin formation, root resorption, and pulpal necrosis have all been associated with orthodontic treatment
Objective: The aim of this systematic review was to investigate the influence of orthodontic force on human pulpal reaction.
Methods: Electronic search was made until July 15, 2016. Additional studies were identified by hand search of reference list of relevant articles from the electronic search. Search terms were the following keywords: “orthodontic force”, “tooth movement”, orthodontic treatment”, “pulpal blood flow”, “vitality loss”, “necrosis”, “pulpal reaction”, “pulpal cellular response”, “pulpal alteration”, and “inflammatory response”. Two independent reviewers assessed the eligibility for inclusion, extracted the data, apply quality indicators, and grade level of evidence.
Results: Forty-one studies matched the inclusion criteria. The outcome concerned the effect of orthodontic force on pulpal blood flow (PBF) in 9 studies, the influence of orthodontic force on human pulpal cellular responses in 23 studies, and the pulpal reaction of orthodontic force on previously traumatized teeth in 5 studies.
Conclusion: There is a lack of high-quality scientific evidence to prove that orthodontic forces affect in alteration of human dental pulp. However, applying orthodontic force on traumatized teeth is considered a risk factor for vitality loss of dental pulp.
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1.
Tantipanichkul K- on, Nimcharoensuk K, Luppanapornlarp S, Tangjit N. Effect of orthodontic forces on human dental pulp: A systematic review. M Dent J [Internet]. 2020 Oct. 21 [cited 2024 Nov. 18];37(2):243-62. Available from: https://he02.tci-thaijo.org/index.php/mdentjournal/article/view/246860
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Original articles
References
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2. Krishnan V, Park Y, Davidovitch Z. Biology of orthodontic toth movement: an overview. In: Krishnan V, Davidovitch Z, editors. Biology mechanisms of tooth movement. Chichester, UK: Wiley-Blackwell; 2009. p. 19-43.
3. Krishnan V, Davidovitch Z. Cellular, molecular, and tissue-level reactions to orthodontic force. Am J Orthod Dentofacial Orthop. 2006;129(4):469 e1-32.
4. Meikle MC. The tissue, cellular, and molecular regulation of orthodontic tooth movement: 100 years after Carl Sandstedt. Eur J Orthod. 2006;28(3):221-40.
5. Hamersky PA, Weimer AD, Taintor JF. The effect of orthodontic force application on the pulpal tissue respiration rate in the human premolar. Am J Orthod. 1980;77(4):368-78.
6. Stenvik A, Mjor IA. Pulp and dentine reactions to experimental tooth intrusion. A histologic study of the initial changes. Am J Orthod. 1970;57(4):370-85.
7. Bondevik O. Tissue changes in the rat molar periodontium following application of intrusive forces. Eur J Orthod. 1980;2(1):41-9.
8. Melsen B, Agerbaek N, Eriksen J, Terp S. New attachment through periodontal treatment and orthodontic intrusion. Am J Orthod Dentofacial Orthop. 1988;94(2):104-16.
9. Murakami T, Yokota S, Takahama Y. Periodontal changes after experimentally induced intrusion of the upper incisors in Macaca fuscata monkeys. Am J Orthod Dentofacial Orthop. 1989;95(2):115-26.
10. Gazelius B, Olgart L, Edwall B, Edwall L. Non-invasive recording of blood flow in human dental pulp. Endod Dent Traumatol. 1986;2(5):219-21.
11. Chambers IG. The role and methods of pulp testing in oral diagnosis: a review. Int Endod J. 1982;15(1):1-15.
12. Han G, Hu M, Zhang Y, Jiang H. Pulp vitality and histologic changes in human dental pulp after the application of moderate and severe intrusive orthodontic forces. Am J Orthod Dentofacial Orthop. 2013;144(4):518-22.
13. Ramazanzadeh BA, Sahhafian AA, Mohtasham N, Hassanzadeh N, Jahanbin A, Shakeri MT. Histological changes in human dental pulp following application of intrusive and extrusive orthodontic forces. J Oral Sci. 2009;51(1):109-15.
14. Sano Y, Ikawa M, Sugawara J, Horiuchi H, Mitani H. The effect of continuous intrusive force on human pulpal blood flow. Eur J Orthod. 2002;24(2):159-66.
15. Gordon NS. Effects of orthodontic force upon replanted teeth: a histologic study. Am J Orthod. 1972;62(5):544.
16. Graupner JG. The effects of orthodontic force on replanted teeth: a radiographic survey. Am J Orthod. 1972;62(5):544-5.
17. Malmgren O, Goldson L, Hill C, Orwin A, Petrini L, Lundberg M. Root resorption after orthodontic treatment of traumatized teeth. Am J Orthod. 1982;82(6):487-91.
18. Bauss O, Roehling J, Meyer K, Kiliaridis S. Pulp Vitality in Teeth Suffering Trauma during Orthodontic Therapy. Angle Orthod. 2009;79(1):166-71.
19. Bauss O, Roehling J, Rahman A, Kiliaridis S. The effect of pulp obliteration on pulpal vitality of orthodontically intruded traumatized teeth. J Endod. 2008;34(4):417-20.
20. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34.
21. Bondemark L, Holm AK, Hansen K, Axelsson S, Mohlin B, Brattstrom V, et al. Long-term stability of orthodontic treatment and patient satisfaction. A systematic review. Angle Orthod. 2007;77(1):181-91.
22. NHS Centre for Reviews and Dissemination. Undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews. York: University of York, 2001 CRD Report 4.
23. Barwick PJ, Ramsay DS. Effect of brief intrusive force on human pulpal blood flow. Am J Orthod Dentofacial Orthop. 1996;110(3):273-9.
24. Ersahan S, Sabuncuoglu FA. Changes in Maxillary Canine Pulpal Blood Flow During Dentoalveolar Distraction Osteogenesis. J Craniofac Surg. 2016;27(3):789-94.
25. Ikawa M, Fujiwara M, Horiuchi H, Shimauchi H. The effect of short-term tooth intrusion on human pulpal blood flow measured by laser Doppler flowmetry. Arch Oral Biol. 2001;46(9):781-7.
26. Sabuncuoglu FA, Ersahan S. Changes in maxillary molar pulp blood flow during orthodontic intrusion. Aust Orthod J. 2014;30(2):152-60.
27. Sabuncuoglu FA, Ersahan S. Changes in maxillary incisor dental pulp blood flow during intrusion by mini-implants. Acta Odontol Scand. 2014;72(7):489-96.
28. Sabuncuoglu FA, Ersahan S. Comparative evaluation of pulpal blood flow during incisor intrusion. Aust Orthod J. 2015;31(2):171-7.
29. Sabuncuoglu FA, Ersahan S. Changes in human pulp blood flow during canine retraction. Acta Odontol Scand. 2016:1-10.
30. Babacan H, Doruk C, Bicakci AA. Pulpal blood flow changes due to rapid maxillary expansion. Angle Orthod. 2010;80(6):1136-40.
31. Veberiene R, Latkauskiene D, Racinskaite V, Skucaite N, Machiulskiene V. Aspartate aminotransferase activity in the pulp of teeth treated for 6 months with fixed orthodontic appliances. Korean J Orthod. 2015;45(5):261-7.
32. Stenvik A. The effect of extrusive orthodontic forces on human pulp and dentin. Scand J Dent Res. 1971;79(6):430-5.
33. Caviedes-Bucheli J, Moreno JO, Ardila-Pinto J, Del Toro-Carreño HR, Saltarín-Quintero H, Sierra-Tapias CL, et al. The effect of orthodontic forces on calcitonin gene-related peptide expression in human dental pulp. J Endod. 2011;37(7):934-7.
34. Derringer K, Linden R. Epidermal growth factor released in human dental pulp following orthodontic force. Eur J Orthod. 2007;29(1):67-71.
35. Derringer KA, Jaggers DC, Linden RW. Angiogenesis in human dental pulp following orthodontic tooth movement. J Dent Res. 1996;75(10):1761-6.
36. Derringer KA, Linden RW. Angiogenic growth factors released in human dental pulp following orthodontic force. Arch Oral Biol. 2003;48(4):285-91.
37. Derringer KA, Linden RW. Vascular endothelial growth factor, fibroblast growth factor 2, platelet derived growth factor and transforming growth factor beta released in human dental pulp following orthodontic force. Arch Oral Biol. 2004;49(8):631-41.
38. Mostafa YA, Iskander KG, El-Mangoury NH. Iatrogenic pulpal reactions to orthodontic extrusion. Am J Orthod Dentofacial Orthop. 1991;99(1):30-4.
39. Bauss O, Roehling J, Sadat-Khonsari R, Kiliaridis S. Influence of orthodontic intrusion on pulpal vitality of previously traumatized maxillary permanent incisors. Am J Orthod Dentofacial Orthop. 2008;134(1):12-7.
40. Bauss O, Schaefer W, Sadat-Khonsari R, Knoesel M. Influence of Orthodontic Extrusion on Pulpal Vitality of Traumatized Maxillary Incisors. J Endod. 2010;36(2):203-7.
41. Brin I, Ben-Bassat Y, Heling I, Engelberg A. The influence of orthodontic treatment on previously traumatized permanent incisors. Eur J Orthod. 1991;13(5):372-7.
42. Kayhan F, Kucukkeles N, Demirel D. A histologic and histomorphometric evaluation of pulpal reactions following rapid palatal expansion. Am J Orthod Dentofacial Orthop. 2000;117(4):465-73.
43. Lazzaretti DN, Bortoluzzi GS, Torres Fernandes LF, Rodriguez R, Grehs RA, Martins Hartmann MS. Histologic Evaluation of Human Pulp Tissue after Orthodontic Intrusion. J Endod. 2014;40(10):1537-40.
44. Parris WG, Tanzer FS, Fridland GH, Harris EF, Killmar J, Desiderio DM. Effects of orthodontic force on methionine enkephalin and substance P concentrations in human pulpal tissue. Am J Orthod Dentofacial Orthop. 1989;95(6):479-89.
45. Perinetti G, Varvara G, Festa F, Esposito P. Aspartate aminotransferase activity in pulp of orthodontically treated teeth. Am J Orthod Dentofacial Orthop. 2004;125(1):88-92.
46. Perinetti G, Varvara G, Salini L, Tetè S. Alkaline phosphatase activity in dental pulp of orthodontically treated teeth. Am J Orthod Dentofacial Orthop. 2005;128(4):492-6.
47. Stenvik A, Mjor IA. The effect of experimental tooth intrusion on pulp and dentine. Oral Surg Oral Med Oral Pathol. 1971;32(4):639-48.
48. Subay RK, Kaya H, Tarim B, Subay A, Cox CF. Response of human pulpal tissue to orthodontic extrusive applications. J Endod. 2001;27(8):508-11.
49. Taspinar F, Akgul N, Simsek G, Ozdabak N, Gundogdu C. The histopathological investigation of pulpal tissue following heavy orthopaedic forces produced by rapid maxillary expansion. J Int Med Res. 2003;31(3):197-201.
50. Veberiene R, Smailiene D, Danielyte J, Toleikis A, Dagys A, Machiulskiene V. Effects of intrusive force on selected determinants of pulp vitality. Angle Orthod. 2009;79(6):1114-8.
51. Veberiene R, Smailiene D, Baseviciene N, Toleikis A, MacHiulskiene V. Change in dental pulp parameters in response to different modes of orthodontic force application. Angle Orthod. 2010;80(6):1018-22.
52. Walker JA, Jr., Tanzer FS, Harris EF, Wakelyn C, Desiderio DM. The enkephalin response in human tooth pulp to orthodontic force. Am J Orthod Dentofacial Orthop. 1987;92(1):9-16.
53. Juni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282(11):1054-60.
54. Katrak P, Bialocerkowski AE, Massy-Westropp N, Kumar S, Grimmer KA. A systematic review of the content of critical appraisal tools. BMC Med Res Methodol. 2004;4:22.
55. Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007;36(3):666-76.
56. Parfitt GJ. Measurement of the physiological mobility of individual teeth in an axial direction. J Dent Res. 1960;39:608-18.
57. Ten Cate AR. Oral histology: Development structure and function. 3rd ed. St. Louis: CV Mosby; 1989.
58. Miura F. Effect of orthodontic force on blood circulation in periodontal membrane. In: Cook JT, editor. Transactions of the third international orthodontic congress. London: Crosby Lockwood Staples; 1975. p. 35-41.
59. Goz GR, Rahn BA, Schulte-Monting J. The effects of horizontal tooth loading on the circulation and width of the periodontal ligament--an experimental study on beagle dogs. Eur J Orthod. 1992;14(1):21-5.
60. McDonald F, Pitt Ford TR. Blood flow changes in permanent maxillary canines during retraction. Eur J Orthod. 1994;16(1):1-9.
61. Woodside DG, Berger JL, Hanson GH. Self-ligation orthodontics with the speech appliance. In: T.M. G, R.L. V, K.W. V, editors. Orthodontics: current principles and techniques. 4 ed. St Louis: Mosby; 2005. p. 731.
62. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. 94. 4 ed. St. Louis: Mosby; 2007. p. 331-48.
63. Reitan TM, Vanarsdall RL. Biomechanical principles and reactions. In: Graber TM, Vanarsdall RL, editors. Orthodontic principles and techniques. 2 ed. St. Louis: Mosby; 1994. p. 96-192.
64. Zimring JF, Isaacson RJ. Forces Produced by Rapid Maxillary Expansion. 3. Forces Present during Retention. Angle Orthod. 1965;35:178-86.
65. Vandevska-Radunovic V. Neural modulation of inflammatory reactions in dental tissues incident to orthodontic tooth movement. A review of the literature. Eur J Orthod. 1999;21(3):231-47.
66. Cvek M. Endodontic management and the use of calcium hydroxide in traumatized permanent teeth. In: Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and Color Atlas of Traumatic Injuries to the Teeth. Oxford, UK: Blackwell Publishing; 2007. p. 598-657.
2. Krishnan V, Park Y, Davidovitch Z. Biology of orthodontic toth movement: an overview. In: Krishnan V, Davidovitch Z, editors. Biology mechanisms of tooth movement. Chichester, UK: Wiley-Blackwell; 2009. p. 19-43.
3. Krishnan V, Davidovitch Z. Cellular, molecular, and tissue-level reactions to orthodontic force. Am J Orthod Dentofacial Orthop. 2006;129(4):469 e1-32.
4. Meikle MC. The tissue, cellular, and molecular regulation of orthodontic tooth movement: 100 years after Carl Sandstedt. Eur J Orthod. 2006;28(3):221-40.
5. Hamersky PA, Weimer AD, Taintor JF. The effect of orthodontic force application on the pulpal tissue respiration rate in the human premolar. Am J Orthod. 1980;77(4):368-78.
6. Stenvik A, Mjor IA. Pulp and dentine reactions to experimental tooth intrusion. A histologic study of the initial changes. Am J Orthod. 1970;57(4):370-85.
7. Bondevik O. Tissue changes in the rat molar periodontium following application of intrusive forces. Eur J Orthod. 1980;2(1):41-9.
8. Melsen B, Agerbaek N, Eriksen J, Terp S. New attachment through periodontal treatment and orthodontic intrusion. Am J Orthod Dentofacial Orthop. 1988;94(2):104-16.
9. Murakami T, Yokota S, Takahama Y. Periodontal changes after experimentally induced intrusion of the upper incisors in Macaca fuscata monkeys. Am J Orthod Dentofacial Orthop. 1989;95(2):115-26.
10. Gazelius B, Olgart L, Edwall B, Edwall L. Non-invasive recording of blood flow in human dental pulp. Endod Dent Traumatol. 1986;2(5):219-21.
11. Chambers IG. The role and methods of pulp testing in oral diagnosis: a review. Int Endod J. 1982;15(1):1-15.
12. Han G, Hu M, Zhang Y, Jiang H. Pulp vitality and histologic changes in human dental pulp after the application of moderate and severe intrusive orthodontic forces. Am J Orthod Dentofacial Orthop. 2013;144(4):518-22.
13. Ramazanzadeh BA, Sahhafian AA, Mohtasham N, Hassanzadeh N, Jahanbin A, Shakeri MT. Histological changes in human dental pulp following application of intrusive and extrusive orthodontic forces. J Oral Sci. 2009;51(1):109-15.
14. Sano Y, Ikawa M, Sugawara J, Horiuchi H, Mitani H. The effect of continuous intrusive force on human pulpal blood flow. Eur J Orthod. 2002;24(2):159-66.
15. Gordon NS. Effects of orthodontic force upon replanted teeth: a histologic study. Am J Orthod. 1972;62(5):544.
16. Graupner JG. The effects of orthodontic force on replanted teeth: a radiographic survey. Am J Orthod. 1972;62(5):544-5.
17. Malmgren O, Goldson L, Hill C, Orwin A, Petrini L, Lundberg M. Root resorption after orthodontic treatment of traumatized teeth. Am J Orthod. 1982;82(6):487-91.
18. Bauss O, Roehling J, Meyer K, Kiliaridis S. Pulp Vitality in Teeth Suffering Trauma during Orthodontic Therapy. Angle Orthod. 2009;79(1):166-71.
19. Bauss O, Roehling J, Rahman A, Kiliaridis S. The effect of pulp obliteration on pulpal vitality of orthodontically intruded traumatized teeth. J Endod. 2008;34(4):417-20.
20. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34.
21. Bondemark L, Holm AK, Hansen K, Axelsson S, Mohlin B, Brattstrom V, et al. Long-term stability of orthodontic treatment and patient satisfaction. A systematic review. Angle Orthod. 2007;77(1):181-91.
22. NHS Centre for Reviews and Dissemination. Undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews. York: University of York, 2001 CRD Report 4.
23. Barwick PJ, Ramsay DS. Effect of brief intrusive force on human pulpal blood flow. Am J Orthod Dentofacial Orthop. 1996;110(3):273-9.
24. Ersahan S, Sabuncuoglu FA. Changes in Maxillary Canine Pulpal Blood Flow During Dentoalveolar Distraction Osteogenesis. J Craniofac Surg. 2016;27(3):789-94.
25. Ikawa M, Fujiwara M, Horiuchi H, Shimauchi H. The effect of short-term tooth intrusion on human pulpal blood flow measured by laser Doppler flowmetry. Arch Oral Biol. 2001;46(9):781-7.
26. Sabuncuoglu FA, Ersahan S. Changes in maxillary molar pulp blood flow during orthodontic intrusion. Aust Orthod J. 2014;30(2):152-60.
27. Sabuncuoglu FA, Ersahan S. Changes in maxillary incisor dental pulp blood flow during intrusion by mini-implants. Acta Odontol Scand. 2014;72(7):489-96.
28. Sabuncuoglu FA, Ersahan S. Comparative evaluation of pulpal blood flow during incisor intrusion. Aust Orthod J. 2015;31(2):171-7.
29. Sabuncuoglu FA, Ersahan S. Changes in human pulp blood flow during canine retraction. Acta Odontol Scand. 2016:1-10.
30. Babacan H, Doruk C, Bicakci AA. Pulpal blood flow changes due to rapid maxillary expansion. Angle Orthod. 2010;80(6):1136-40.
31. Veberiene R, Latkauskiene D, Racinskaite V, Skucaite N, Machiulskiene V. Aspartate aminotransferase activity in the pulp of teeth treated for 6 months with fixed orthodontic appliances. Korean J Orthod. 2015;45(5):261-7.
32. Stenvik A. The effect of extrusive orthodontic forces on human pulp and dentin. Scand J Dent Res. 1971;79(6):430-5.
33. Caviedes-Bucheli J, Moreno JO, Ardila-Pinto J, Del Toro-Carreño HR, Saltarín-Quintero H, Sierra-Tapias CL, et al. The effect of orthodontic forces on calcitonin gene-related peptide expression in human dental pulp. J Endod. 2011;37(7):934-7.
34. Derringer K, Linden R. Epidermal growth factor released in human dental pulp following orthodontic force. Eur J Orthod. 2007;29(1):67-71.
35. Derringer KA, Jaggers DC, Linden RW. Angiogenesis in human dental pulp following orthodontic tooth movement. J Dent Res. 1996;75(10):1761-6.
36. Derringer KA, Linden RW. Angiogenic growth factors released in human dental pulp following orthodontic force. Arch Oral Biol. 2003;48(4):285-91.
37. Derringer KA, Linden RW. Vascular endothelial growth factor, fibroblast growth factor 2, platelet derived growth factor and transforming growth factor beta released in human dental pulp following orthodontic force. Arch Oral Biol. 2004;49(8):631-41.
38. Mostafa YA, Iskander KG, El-Mangoury NH. Iatrogenic pulpal reactions to orthodontic extrusion. Am J Orthod Dentofacial Orthop. 1991;99(1):30-4.
39. Bauss O, Roehling J, Sadat-Khonsari R, Kiliaridis S. Influence of orthodontic intrusion on pulpal vitality of previously traumatized maxillary permanent incisors. Am J Orthod Dentofacial Orthop. 2008;134(1):12-7.
40. Bauss O, Schaefer W, Sadat-Khonsari R, Knoesel M. Influence of Orthodontic Extrusion on Pulpal Vitality of Traumatized Maxillary Incisors. J Endod. 2010;36(2):203-7.
41. Brin I, Ben-Bassat Y, Heling I, Engelberg A. The influence of orthodontic treatment on previously traumatized permanent incisors. Eur J Orthod. 1991;13(5):372-7.
42. Kayhan F, Kucukkeles N, Demirel D. A histologic and histomorphometric evaluation of pulpal reactions following rapid palatal expansion. Am J Orthod Dentofacial Orthop. 2000;117(4):465-73.
43. Lazzaretti DN, Bortoluzzi GS, Torres Fernandes LF, Rodriguez R, Grehs RA, Martins Hartmann MS. Histologic Evaluation of Human Pulp Tissue after Orthodontic Intrusion. J Endod. 2014;40(10):1537-40.
44. Parris WG, Tanzer FS, Fridland GH, Harris EF, Killmar J, Desiderio DM. Effects of orthodontic force on methionine enkephalin and substance P concentrations in human pulpal tissue. Am J Orthod Dentofacial Orthop. 1989;95(6):479-89.
45. Perinetti G, Varvara G, Festa F, Esposito P. Aspartate aminotransferase activity in pulp of orthodontically treated teeth. Am J Orthod Dentofacial Orthop. 2004;125(1):88-92.
46. Perinetti G, Varvara G, Salini L, Tetè S. Alkaline phosphatase activity in dental pulp of orthodontically treated teeth. Am J Orthod Dentofacial Orthop. 2005;128(4):492-6.
47. Stenvik A, Mjor IA. The effect of experimental tooth intrusion on pulp and dentine. Oral Surg Oral Med Oral Pathol. 1971;32(4):639-48.
48. Subay RK, Kaya H, Tarim B, Subay A, Cox CF. Response of human pulpal tissue to orthodontic extrusive applications. J Endod. 2001;27(8):508-11.
49. Taspinar F, Akgul N, Simsek G, Ozdabak N, Gundogdu C. The histopathological investigation of pulpal tissue following heavy orthopaedic forces produced by rapid maxillary expansion. J Int Med Res. 2003;31(3):197-201.
50. Veberiene R, Smailiene D, Danielyte J, Toleikis A, Dagys A, Machiulskiene V. Effects of intrusive force on selected determinants of pulp vitality. Angle Orthod. 2009;79(6):1114-8.
51. Veberiene R, Smailiene D, Baseviciene N, Toleikis A, MacHiulskiene V. Change in dental pulp parameters in response to different modes of orthodontic force application. Angle Orthod. 2010;80(6):1018-22.
52. Walker JA, Jr., Tanzer FS, Harris EF, Wakelyn C, Desiderio DM. The enkephalin response in human tooth pulp to orthodontic force. Am J Orthod Dentofacial Orthop. 1987;92(1):9-16.
53. Juni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282(11):1054-60.
54. Katrak P, Bialocerkowski AE, Massy-Westropp N, Kumar S, Grimmer KA. A systematic review of the content of critical appraisal tools. BMC Med Res Methodol. 2004;4:22.
55. Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007;36(3):666-76.
56. Parfitt GJ. Measurement of the physiological mobility of individual teeth in an axial direction. J Dent Res. 1960;39:608-18.
57. Ten Cate AR. Oral histology: Development structure and function. 3rd ed. St. Louis: CV Mosby; 1989.
58. Miura F. Effect of orthodontic force on blood circulation in periodontal membrane. In: Cook JT, editor. Transactions of the third international orthodontic congress. London: Crosby Lockwood Staples; 1975. p. 35-41.
59. Goz GR, Rahn BA, Schulte-Monting J. The effects of horizontal tooth loading on the circulation and width of the periodontal ligament--an experimental study on beagle dogs. Eur J Orthod. 1992;14(1):21-5.
60. McDonald F, Pitt Ford TR. Blood flow changes in permanent maxillary canines during retraction. Eur J Orthod. 1994;16(1):1-9.
61. Woodside DG, Berger JL, Hanson GH. Self-ligation orthodontics with the speech appliance. In: T.M. G, R.L. V, K.W. V, editors. Orthodontics: current principles and techniques. 4 ed. St Louis: Mosby; 2005. p. 731.
62. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. 94. 4 ed. St. Louis: Mosby; 2007. p. 331-48.
63. Reitan TM, Vanarsdall RL. Biomechanical principles and reactions. In: Graber TM, Vanarsdall RL, editors. Orthodontic principles and techniques. 2 ed. St. Louis: Mosby; 1994. p. 96-192.
64. Zimring JF, Isaacson RJ. Forces Produced by Rapid Maxillary Expansion. 3. Forces Present during Retention. Angle Orthod. 1965;35:178-86.
65. Vandevska-Radunovic V. Neural modulation of inflammatory reactions in dental tissues incident to orthodontic tooth movement. A review of the literature. Eur J Orthod. 1999;21(3):231-47.
66. Cvek M. Endodontic management and the use of calcium hydroxide in traumatized permanent teeth. In: Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and Color Atlas of Traumatic Injuries to the Teeth. Oxford, UK: Blackwell Publishing; 2007. p. 598-657.