Severe external apical root resorption--local cause or genetic predisposition?

Impact of orthognathic surgery on root resorption: A systematic review

OBJECTIVE

This systematic review was performed to assess the potential influence of orthognathic surgery on root resorption (RR).

MATERIAL AND METHODS

An electronic search was conducted using PubMed, Web of Science, Cochrane Central and Embase for articles published up to April 2022. Following inclusion and exclusion criteria, a total of six articles were selected that reported on RR following orthognathic surgery. Risk of bias assessment was performed according to the ROBINS-1 and ROB-2 tools.

RESULTS

The design of five studies was retrospective and one randomized clinical trial was included, with a follow-up period ranging between six months and ten years. The assessment methodologies mostly relied on two-dimensional imaging modalities where only one study used cone-beam computed tomography (CBCT) for objective quantification via linear measurements. The percentage of teeth affected by RR varied between approximately 1 and 36%, where surgically assisted rapid maxillary expansion (SARME) and Le Fort I osteotomy showed the highest percentage of RR followed by bilateral sagittal split osteotomy.

CONCLUSIONS

The present data tend to indicate that specific orthognathic procedures such as SARME and Le Fort I osteotomy may induce or reinforce RR. Yet, considering lack of evidence related to objective quantification of RR following orthodontic and/or orthognathic treatment, further CBCT-based prospective studies are required for an improved understanding of RR following different surgical procedures.

Tooth root resorption: A review

Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.

Orthodontic root resorption

External apical root resorption (EARR) is one of the most frequently reported iatrogenic side effects of orthodontic movement. Nevertheless, no robust and unequivocal scientific evidence is yet available in the literature regarding the clinical and biological factors that trigger EARR. The purpose of the present position paper is to provide clinicians, residents, and investigators a summary of our current understanding about root resorption caused by orthodontic tooth movement, based on up-to-date available scientific evidence. Morphological, structural, biomechanical, and biological differences account for predisposing the apical third to EARR compared to other root surfaces during orthodontic treatment. In addition, a relevant number of patient and treatment-related factors increase risk of EARR. The main patient-related factors are reviewed and discussed: genetic factors, tooth anatomy, demographic factors, malocclusion factors, previous endodontic treatment, medical history, short root anomaly. Similarly, the influence of treatment-related factors are analyzed with regard to the effect of: biomechanical factors, type of orthodontic appliance, adjunctive therapies to accelerate tooth movement, early treatment, maxillary expansion, teeth extractions, the duration of treatment and the amount of apical displacement. Clinical management of EARR from pre-treatment records to the monitoring strategy as well as recommendations for the post orthodontic-treatment period are presented as a guide for the clinician. Despite years of studies, we still do not fully understand EARR, but the future is promising. True three-dimensional imaging with higher resolution and low radiation, and predictive tools towards an earlier detection without radiographs, will mark future developments in the field of EARR in orthodontics.

Inhibitory Effects of 4-Hexylresorcinol on Root Resorption Induced by Orthodontic Tooth Movement

Root resorption during orthodontic tooth movement (OTM) is caused by an imbalance between the bone turnover rate and applied mechanical stress. The administration of 4-hexylresorcinol (4HR) increases the bone turnover rate and factors associated with bone formation. Thus, 4HR may show protective activity against root resorption during orthodontic tooth movement (OTM). A total of 40 rats (male: 20; female: 20) were included in this study, and the mandibular first molar was subjected to excessive orthodontic force. The experimental group (n = 20) received 12.8 mg/kg of 4HR every 2 weeks. The controls (n = 20) received a solvent without 4HR. Both groups had the same sex distribution. On Day 28 after the initiation of OTM, all the animals were sacrificed for micro-computed tomography analysis, Western blot analysis, and immunohistochemistry. The ratios of the root length and root volume to the total volume were significantly higher in the experimental group compared to those in the control group (p < 0.05). The expression levels of OPG, RANKL, alkaline phosphatase, and Runx2 in the experimental group according to Western blotting were significantly higher in the experimental group compared to those in the control group (p < 0.05). Their expression was mainly found in the periodontal ligament area. In conclusion, the administration of 4HR decreased the root resorption caused by OTM and increased the expression levels of OPG, RANKL, alkaline phosphatase, and Runx2.

External apical root resorption after nonextraction orthodontic treatment with labial vs. lingual fixed appliances

OBJECTIVES

The aim of this retrospective study is to compare external apical root resorption (EARR) after labial and lingual fixed orthodontic treatment, as detected with panoramic radiographs.

MATERIALS AND METHODS

Sixty subjects were divided into two groups according to the treatment type: lingual (30 patients) and labial (30 patients) fixed orthodontic treatment. Panoramic radiographs which were obtained at the beginning of treatment (T0) and at the end of the treatment (T1) were evaluated. The maxillary and mandibular central and lateral incisors, as well as canine crown and root lengths were measured for T0 and T1. Crown to root ratios were used to determine EARR. Data were evaluated using analysis of variance and χ² analysis.

RESULTS

In all, 5 patients (16.7%) in the lingual group and 7 patients (23.3%) in the labial group had a minimum of one tooth with severe EARR, while 9 patients (30%) in the lingual group and 14 patients (46.7%) in the labial group had no EARR. A total of 26 teeth (7.2%) in the lingual group and 34 teeth (9.4%) in the labial group developed severe EARR; however, 184 teeth (51.1%) in the lingual group and 202 teeth (56.1%) in the labial group did not reveal any EARR. No statistically significant difference was found for the resorption rates between the treatment groups (p > 0.05). Although not statistically significant, there was a higher percentage of severe EARR in the mandible within the labial group.

CONCLUSIONS

Both lingual and labial orthodontic techniques showed statistically similar root resorption rates. EARR is a multifactorial issue and individual predispositions must also be taken into consideration.

Single tooth torque correction in the lower frontal area by a completely customized lingual appliance

Background

Aim of this study was to analyze the efficacy and precision of the completely customized lingual appliance (CCLA) regarding the single tooth torque correction. The study also examined external apical root resorptions as possible side effects of torque correction and the changings of the periodontal situation.

Methods

A case series of three patients were included. The patients showed a single tooth torque problem with a gingival recession and were treated with the CCLA. Plaster casts before and after treatment and plaster casts of the set up were scanned and superimposed. Deviations between the two plaster casts were analyzed at different points of interest. Changes of the gingival recession were compared before and after treatment. Relative root resorptions were measured by the orthopantomograms. Treatment times were assessed by the records of the patients. Results were presented descriptively.

Results

The mean change of the most apical part of the root reached by the orthodontic treatment was 1.8 ± 0.3 mm. The largest deviation between set up and final model was measured on the occlusal surface of the tooth 36 with 0.8 mm. Most measurement points showed a deviation of 0.5 mm or less. The depths of the gingival recession showed a significant reduction of 4.7 mm. The widths of the gingival recession were reduced by 1.1 mm. The average relative root resorption of the corrected teeth was 2.7 ± 1.5%. The average treatment time was 13.8 ± 4.5 months.

Conclusions

This is the first study showing that the CCLA with its high precision is very effective in correcting single tooth torque problems. Orthodontic torque correction resulted in a significant reduction of gingival recessions and caused only negligible root resorptions.

Root resorption, treatment time and extraction rate during orthodontic treatment with self-ligating and conventional brackets

INTRODUCTION

This study determined the amount and severity of EARR (external apical root resorption) after orthodontic treatment with self-ligating (SL) and conventional (Non-SL) brackets. Differences regarding rate of extraction cases, appointments and treatment time were evaluated.

MATERIAL AND METHODS

213 patients with a mean age of 12.4 ± 2.2 years were evaluated retrospectively. The treatments were performed with SL brackets (n = 139, Smartclip, 3 M Unitek, USA) or Non-SL brackets (n = 74, Victory Series, 3 M Unitek, USA). Measurements of the crown and root length of the incisors were taken using panoramic radiographs. Three-factor analysis of variance (ANOVA) was performed for an appliance effect.

RESULTS

There was no difference between patients treated with Non-SL or SL brackets regarding the amount (in percentage) of EARR (Non-SL: 4.5 ± 6.6 vs. SL: 3.0 ± 5.6). Occurrence of severe EARR (sEARR) did also not differ between the two groups (Non-SL 0.5 vs. SL: 0.3). The percentage of patients with need of tooth extraction for treatment (Non SL: 8.1 vs. SL: 6.9) and the number of appointments (Non-SL: 12.4 ± 3.4 vs. SL: 13.9 ± 3.3) did not show any differences. The treatment time was shorter with Non-SL brackets (Non-SL: 18.1 ± 5.3 vs. SL: 20.7 ± 4.9 months).

CONCLUSIONS

This is the largest study showing that there is no difference in the amount of EARR, number of appointments and extraction rate between conventional and self-ligating brackets. For the first time we could demonstrate that occurrence of sEARR does not differ between the two types of brackets.

Apical root resorption during orthodontic treatment with aligners? A retrospective radiometric study

Introduction

Objective of this study was to investigate the incidence and severity of apical root resorptions (ARR) during orthodontic treatment with aligners.

Materials and methods

The sample comprised 100 patients (17–75 years of age) with a class I occlusion and anterior crowding before treatment, treated exclusively with aligners (Invisalign®, Align Technologies, Santa Clara, CA, USA). The following teeth were assessed: upper and lower anterior teeth and first molars. Root and crown lengths of a total of 1600 teeth were measured twice in pre- and post-treatment panoramic radiographs. Afterwards, relative changes of the root length during treatment were calculated by a root-crown-ratio taking pre- and post-treatment root and crown lengths into consideration. A reduction of this ratio was considered as a shortening of the initial root length. Additionally, tooth movements of the front teeth were assessed by lateral cephalograms and the 3-dimensonal set up of each patient.

Results

All patients had a reduction of the pre-treatment root length with a minimum of two teeth. On average 7.36 teeth per patient were affected. 54% of 1600 measured teeth showed no measurable root reduction. A reduction of >0%-10% of the pre-treatment root length was found in 27.75%, a distinct reduction of >10%-20% in 11.94%. 6.31% of all teeth were affected with a considerable reduction of >20%. We found no statistically significant correlation between relative root length changes and the individual tooth, gender, age or sagittal and vertical orthodontic tooth movement; except for extrusion of upper front teeth, which was considered as not clinical relevant due to the small amount of mean 4% ARR.

Conclusions

The present study is the first analyzing ARR in patients with a fully implemented orthodontic treatment with aligners (i.e. resolving anterior crowding). The variety was high and no clinical relevant influence factor could be detected. A minimum of two teeth with a root length reduction was found in every patient. On average, 7.36 teeth per patient were affected.