A Retrospective Analysis of Endodontic and Extraction Risk after Orthodontic Treatment

Abstract

1.Background/Objectives: To evaluate the risk of root canal therapy and tooth extraction in anterior teeth following orthodontic treatment in adolescents. 2. Methods: This retrospective study analyzed electronic dental records of 186 patients. Permanent anterior teeth (maxillary #6–11, mandibular #22–27) were followed longitudinally. Adverse outcomes included endodontic treatment or tooth extraction. Kaplan–Meier survival analysis and Cox regression were used, with orthodontic treatment modeled as a time-dependent variable. 3. Results: The mean age at treatment initiation was 12.93 ± 1.64 years. Root canal therapy occurred in 3.0% of anterior teeth and extractions in 0.1%. Maxillary central incisors showed the highest failure rate (12.2%) and the lowest 10-year survival (82.04%). Overall survival was 99.52% at 1 year, 97.59% at 5 years, and 95.20% at 10 years. Female patients had a lower risk of adverse outcomes (HR = 0.66, p < 0.001). Orthodontic treatment did not significantly increase overall risk, although a temporary increase in root canal therapy was observed 2–3 years after treatment initiation. 4. Conclusions: Orthodontic treatment in adolescents does not significantly increase severe adverse outcomes in anterior teeth, supporting its clinical safety.