Clinical considerations for orthodontic management of regenerative endodontic procedure-treated teeth: From immature necrotic roots to ankylosed space maintainer.

INTRODUCTION

The objective of this study was to synthesize available evidence and propose structured clinical considerations for the orthodontic management of teeth treated with regenerative endodontic procedures (REPs), including necrotic immature teeth and teeth affected by external replacement root resorption (ERRR) or ankylosis.

METHODS

A narrative synthesis of published clinical reports and case series describing orthodontic movement of REP-treated necrotic teeth and patients in whom REP was used as a last-resort approach for ERRR/ankylosed teeth was performed. Biological mechanisms and clinical outcomes were reviewed to define principles of treatment timing, biomechanics, growth-related factors, interdisciplinary care, and long-term monitoring.

RESULTS

Orthodontists are increasingly treating REP-managed teeth. Movement of REP-treated necrotic teeth is feasible when light, controlled, and time-limited forces are applied, preferably with segmental mechanics and close radiographic monitoring. Outcomes appear more favorable in younger patients, particularly before adolescence. In selected patients, REP-treated ERRR/ankylosed teeth may serve as natural space maintainers during growth while adjacent teeth are moved, potentially supporting alveolar preservation and delaying decoronation or prosthetic replacement.

CONCLUSIONS

REP-treated teeth may be incorporated into orthodontic planning once clinical and radiographic stability is confirmed, but require individualized risk assessment and interdisciplinary oversight. Necrotic teeth may be moved with careful force control, whereas ERRR/ankylosed teeth should primarily function as temporary space maintainers until definitive management is indicated. These evidence-informed recommendations provide clinicians with a practical, interdisciplinary framework for integrating REP into orthodontic management.