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Transient apical breakdown during orthodontic incisor intrusion treated with non-steroidal anti-inflammatory drugs: a case report

British Dental Journal volume 239, pages 774–777 (2025)Cite this article

Abstract

Transient apical breakdown (TAB) may occur during pulp repair after dental traumatic injury, including orthodontic force. Herein, we describe TAB in the maxillary right central incisor of a 24-year-old woman during orthodontic treatment for a severe gummy smile. Eight months after initiating intrusion of the maxillary anterior teeth using temporary anchorage devices, the maxillary right central incisor showed discoloration and was non-responsive to electric pulp tests. The orthodontic force on the maxillary anterior teeth was immediately removed, and loxoprofen sodium, a non-steroidal anti-inflammatory drug (NSAID), was administered three times a day for seven days. Six months after removal of the orthodontic force, the crown colour improved and the tooth regained sensitivity to electric pulp testing. Therefore, orthodontic treatment was resumed and was completed two years after initiation. Obliteration of the root canal of the maxillary right central incisor was observed during a four-year-retention period. The findings in this case suggest that removal of orthodontic force and administration of NSAIDs are possibly useful for improving TAB following traumatic pulp injury due to orthodontic treatment.

Key points

  • Continuous heavy orthodontic forces can lead to pulp traumatic pulp injury.

  • Transient apical breakdown (TAB) sometimes occurs during orthodontic treatment.

  • Removal of orthodontic force is necessary and a non-steroidal anti-inflammatory drug is possibly useful for improving TAB following traumatic pulp injury due to orthodontic treatment.

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Acknowledgements

Thanks to Dr Niki and Dr Iyama who provided the figure data. We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Anatomy and Functional Restorations, Division of Oral Health Sciences, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-0037, Japan

    Masato Kaku & Saiji Shimoe

  2. Department of Medical System Engineering, Division of Oral Health Sciences, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-0037, Japan

    Yuichi Mine & Takeshi Murayama

  3. Department of Oral Biology and Engineering, Division of Oral Health Sciences, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-0037, Japan

    Tsuyoshi Taji & Hiroki Nikawa

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  1. Masato Kaku
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  2. Saiji Shimoe
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  3. Yuichi Mine
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Contributions

MK, SS, YM, TT, TM, HN all made substantial contributions to the manuscript. This includes conceptualisation, methodology, validation, investigation, resources, writing the original draft, reviewing, and editing. All authors have read and approved the final version of the manuscript.

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Correspondence to Masato Kaku.

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The authors declare no conflicts of interest. Written consent for publication of this case was obtained from the patient.

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Kaku, M., Shimoe, S., Mine, Y. et al. Transient apical breakdown during orthodontic incisor intrusion treated with non-steroidal anti-inflammatory drugs: a case report. Br Dent J 239, 774–777 (2025). https://doi.org/10.1038/s41415-025-9103-7

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