Orthodontic treatment in immature teeth: A contemporary review of endodontic, periodontal, and biomechanical aspects

Immature permanent teeth, characterised by open apices, thin dentinal walls, short or developing roots, and incomplete maturation of the pulp–periodontal tissues, require particular attention in orthodontic treatment planning. Since orthodontic therapy is most frequently applied during childhood and adolescence, clinicians often encounter vital teeth with incomplete root development, traumatised immature teeth, teeth treated with apexification, or necrotic immature teeth managed with regenerative endodontic therapy. Current literature indicates that controlled orthodontic forces in healthy, vital immature teeth do not invariably arrest root development, and in many cases root maturation continues within normal limits. Conversely, in the presence of trauma, pulp necrosis, apical periodontitis, root resorption, ankylosis, apexification, or regenerative endodontic therapy, the biological effects of orthodontic movement become more complex and less predictable. In particular, the long-term consequences of orthodontic forces applied following regenerative endodontic therapy remain insufficiently evidenced. The purpose of this review is to evaluate orthodontic treatment in immature teeth in relation to root development, pulp biology, periodontal response, root resorption, post-traumatic healing, apexification, and regenerative endodontic therapy in light of contemporary literature.