Orthodontic tooth movement is a biologically driven process that extends beyond the periodontal ligament and alveolar bone to involve the dental pulp—a highly vascular and innervated tissue essential for tooth vitality. Despite decades of clinical use, the effects of orthodontic forces on pulpal health remain a subject of debate, with concerns ranging from transient circulatory disturbances to irreversible pulpal damage.This systematic review critically examines contemporary human in-vivo evidence on pulpal changes induced by orthodontic forces, integrating findings from clinical, radiographic, vascular, molecular, and sensitivity-based studies. The review synthesizes data on alterations in pulpal blood flow, neural sensitivity, pulp volume, and molecular markers of inflammation and tissue remodeling under various orthodontic mechanics, force magnitudes, and treatment phases.

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