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ORTHODONTICS AND ROOT RESORPTION: A REVIEW

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Pawankumar Tekale Ketan K Vakil

Dnyanita Orthodontic Care Sau. Mathurabai Bhausaheb Thorat Dental College
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ejbps, 2015, Volume 2, Issue 2, 589-595. Review Article

Tekale et al. EuropEan Journal

European of BiomEdical
Journal of Biomedical ISSN 2349-8870
and Pharmaceutical Sciences
Volume: 2
AND Issue: 2
Pharmaceutical sciences 589-595
http://www.ejbps.com Year: 2015

ORTHODONTICS AND ROOT RESORPTION: A REVIEW

Dr. Ketan Ashokrao Gorea, Dr. Ketan K.Vakil b, Dr. Jeegar K. Vakilc,
Dr. Pawankumar D. Tekaled*

a
Senior Resident, Department of Orthodontics, S.M.B.T. Dental College and Hospital,
Sangamner.
b
Professor and Head, Department of Orthodontics, S.M.B.T. Dental college and hospital,
Sangamner.
c
Senior Lecturer, Department of Orthodontics, S.M.B.T. Dental College and Hospital,
Sangamner.
d
Private Practice, Dnyanita Orthodontic care, Aurangabad, Maharashtra.
Article Received on 25/12/2014 Article Revised on 18/01/2015 Article Accepted on 10/02/2015

*Correspondence for ABSTRACT

Author This review describes the literature on the orthodontic tooth movement
Dr. Pawan Kumar D
and root resorption which might occure as an undesirable effect during
Tekale
the course of the treatment. There are different types of root resorption
Dnyanita Orthodontic care,
Aurangabad, Maharashtra having different etiological factors. Concise diagnosis and
implementation of the treatment is important in such consequences. In
most root resorption studies, it is not always possible to compare the results because of
various factors and methods of studies. Further research in this field is necessary.

KEYWORDS: Orthodontic, Root resorption.

INTRODUCTION
Root resorption is a common complication associated with orthodontic treatment. Root
resorption may be pathologic or physiologic in nature and it may also occur in association
with orthodontic tooth movement. Physiological resorption occurs during the exfoliation of
the primary dentition and mesial drifting in the permanent dentition.[1] The mineralized
tissues of the permanent dentition are not normally resorbed.Pathological resorption occurs
subsequent to a traumatic injury, pathological disease process or iatrogenic causes. The
consequences of root resorption range from slight tooth mobility due to small amounts of root
loss to complete tooth loss from excessive amounts of resorption.Radiographically, the
resorption may appear as either an apical root blunting, lateral root resorption or in rare cases

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excessive root loss. Internal root resorption is initiated from within the pulp while external
root resorption arises from the periodontium affecting the external surface of the tooth.

At present, it is unknown how orthodontic treatment factors influence root resorption . The
etiologic factors are complex and multifactorial , but it appears that apical root resorption
results from a combination of individual biologic variability, genetic predisposition, and the
effect of mechanical factors. root resorption is undesirable because it can affect the long-term
viability of the dentition, and reports in the literature indicate that patients undergoing
orthodontic treatment are more likely to have severe apical root shortening. Patient factors
such as genetics and external factors including trauma are also thought to be associated with
increased root resorption.

Orthodontically induced inflammatory root resorption occurs as a result to the inflammatory

process involved in orthodontic tooth movement. It occurs on the cemental surface of the
tooth root. Although cementum is more resistant to resorption relative to bone it is still
possible for both the cementum and dentine to resorb as a result of this inflammatory process.

MECHANISM OF ROOT RESORPTION

Mechanism of root resorption is not completely explored. According to Brudvik and Rygh,
inflammatory root resorption induced by orthodontic treatment is a part of process of
elimination of hyaline zone.[2] It is considered that occurrence of root resorption can be
induced by the strong force through orthodontic treatment and hyalinisation of periodontal
ligaments induced by increased activity of cementoclasts and Osteoclasts.[3] During tooth
movement, areas of compression (where osteoclasts are in action inducing bone resorption)
and areas of tension (where osteoblasts are active inducing bone deposition) are formed. Thus
a tooth moves towards the side of bone resorption. An imbalance between bone resorption
and deposition, losing protective characteristics of cementum may contribute to the
cementoclasts/osteoclasts resorbing areas of the root.[4] When hyaline zone forms, tooth
movement will stop. Upon regeneration of periodontal ligament, hyaline zone is removed by
mononucleus cells similar to macrophages and by multinucleus gigantic cells and a tooth
starts to move again. During removal of hyaline zone an outer tooth root surface consisting of
the layer of cementoblasts may be damaged, exposing the underlying highly dense
mineralized cementum. It is possible that a force occurring during orthodontic treatment may
directly damage outer root surface. Tooth root surface under the hyaline zone resorbes just
after a few days, when a repair process is already happening in the periphery. On the grounds

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of the literature data it can be stated that the resorption process is completed after removal of
the hyaline zone, and/or when orthodontic force decreases.[2,4]

DIGNOSIS
Following are the various radiographic techniques used as diagnostic aids for assessing root
resorption:
1) Periapical bisecting angle.
2) Periapical paralleling.
3) Orthopantomogram.
4) Cephalogram.
5) Lamiogram.
6) Computed tomography.
7) Cone Beamed Computed tomography.

THE CLINICAL ASPECTS OF ORTHODONTIC ROOT RESORPTION

summary of clinical steps that should be considered by the orthodontist as they relate to
Orthodontically induced inflammatory root resorption.

BEFORE TREATMENT
General considerations. The patient/parents must be informed about the risk of
Orthodontically induced inflammatory root resorption as a consequence of orthodontic
treatment. Root resorption should be discussed during consultation.[5] Every informed consent
form signed by the patient/parents.[6]

Familial considerations. A recent study[7] has confirmed previous results concerning the
strong familial associationof Orthodontically induced inflammatory root resorption. When
treating a new patient whose close sibling was previously treated, orthodontists should try to
obtain the final diagnostic records including the radiographs.

Gender. Most studies have not found a consistent association between gender and
Orthodontically induced inflammatory root resorption In a group of adult (aged .20 years)
orthodontic patients, Baumrind et al [8] found a greater prevalence of Orthodontically induced
inflammatory root resorption in men than in women. In contrast, Kjar found a greater
prevalence of Orthodontically induced inflammatory root resorption in girls than in boys.

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Age. Since all recent studies with the exception of two studies have found no relationship
between Orthodontically induced inflammatory root resorption and chronological age,
chronological age may not be a significant factor in the occurrence of orthodontic root
resorption.

The malocclusion. Dental as well as skeletal malocclusions should be considered cautiously

with respect to Orthodontically induced inflammatory root resorption. No malocclusion is
immune to Orthodontically induced inflammatory root resorption

DURING TREATMENT
1. The new light-force rectangular wires that are used in treatment as initial wires have
[9]
become very popular in the last decade. According to Proffit and Fields , use of these
wires might increase the jiggling movements during the first stage of treatment, exposing
the root to more Orthodontically induced inflammatory root resorption. We therefore
suggested proceeding with this initial step with caution, until more definitive data are
published.

2. Longer intervals between activations remain strongly recommended.

3. Do extractions of teeth serve as an important factor in the occurrence of Orthodontically

induced inflammatory root resorption. Unfortunately, no definitive conclusion has been
drawn in reference to this controversial issue.

4. A possible correlation between the duration of active treatment and the incidence and
extent of orthodontic root resorption is anopen controversy. Most conclusions have been
obtained from clinical studies, whereas a single short-term animal-based study rejected
the association between the duration of active treatment and Orthodontically induced
inflammatory root resorption.[10]

5. After 6 months of treatment, periapical radiographs of the teeth involved in this treatment
should be obtained. Since, in most published papers, the incisors are the teeth that tend to
be most affected, the changes in their root shape might project on the overall
phenomenon. When Orthodontically induced inflammatory root resorption is detected in
the six-month periapical radiograph, treatment should be halted for two to three months
with passive archwires. This suggestion can actually be applied to any extensive
orthodontic procedure on a mandatory basis. Halting treatment for three months in one

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arch while working on the other is a practical solution that can be implemented without
changing the treatment protocol.

6. When the treatment is durable, periapical radiographs should be obtained, with the
following consideration. When minimal Orthodontically induced inflammatory root
resorption is present, the aforementioned procedure is sufficient. However, when severe
resorption is identified, the treatment goals should be reassessed with the patient; for
example, alternative options might include prosthetic solutions to close spaces, releasing
teeth from active arches if possible, stripping instead of extracting, and early fixation of
resorbed teeth. Orthognathic surgery can also be considered in extreme cases, yet it
cannot be relied on to prevent Orthodontically induced inflammatory root resorption.

AFTER TREATMENT
1. Final records including radiographs are recommended and are even mandatory. If
orthodontic root resorption is present on the final radiographs, the patient/parents should
be informed. Final records and radiographs will be useful for the future orthodontic
treatment of siblings.[11]

2.
For teeth with severe resorption, follow-up radiographic examinations are recommended
until Orthodontically induced inflammatory root resorption is no longer evident. In cases
of extreme resorption, endodontic treatment may be considered as well. It should be noted
that cemental repair or termination of the active processes of Orthodontically induced
inflammatory root resorption occurs naturally after the removal of bands and
brackets.[12, 13]

3. Several anecdotal reports have demonstrated the stability of teeth with severe resorption
over the years. However, the use of teeth with severe resorption as abutment teeth should
be reconsidered.[14]

4. Retaining the teeth with fixed appliances should be done with caution. Occlusal trauma of
the fixed teeth or segments might lead to extreme Orthodontically induced inflammatory
root resorption.[15]

CONCLUSION
After orthodontic treatment, all permanent teeth may show microscopic root resorption that is
clinically insignificant and radiographically undetected. Root resorption of permanent teeth is

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a probable consequence of orthodontic force and active tooth movement. The incidence of
reported root resorption during orthodontic treatment varies widely among investigators.
Most studies agree that the root resorption process ceases once the active treatment is
terminated.Root resorption of the deciduous dentition is a normal, essential, and physiologic
process. Permanent teeth have the potential to clinically undergo significant external root
resorption when affected by several stimuli. This resorptive potential varies in persons and
among different teeth in the same person. This throws doubt on the role of systemic factors as
a primary cause of root resorption during orthodontic treatment. Tooth structure, alveolar
bone structure at various locations, and types of movement explain these variations. The
extent of treatment duration and mechanical factors definitely influence root resorption. In
most root resorption studies, it is not always possible to compare the results because of
various factors and methods of studies. Further research in this field is necessary. The
question if there is any ideal (optimal) force to move teeth without root resorption and
whether root resorption is predictable remains unanswered.

REFERENCES
1. Hartsfield JK Jr, Everett ET, Al-Qawasmi RA: Genetic factors in external apical root
resorption and orthodontic treatment. Crit Rev Oral Biol Med, 2004; 15:115-122
2. Brezniak N. Orthodontically inducted inflammatory root resorption. Part I: The basic
science aspects. Angle Orthod 2002; 72:175-9.
3. Travess H. Orthodontics. Part 6: Risks in orthodontic treatment. Br Dent J 2004;196:71-7.
4. Healey D. Root resorption. 2004. Available from:
URL: www.orthodontists.org.nz/root_resorption.htm
5. Brezniak N, Wasserstein A. Root resorption after orthodontic treatment: Part 1. Literature
review. Am J Orthod Dentofac Orthop. 1993;103:62–66.
6. Machen DE. Risk management concept. Am J Orthod Dentofac Orthop. 1989; 95:
267–268.
7. Bednar JR, Wise RJ. A practical clinical approach to the treatment and management of
patients experiencing root resorption during and after orthodontic therapy. In:
Davidovitch Z, Mah J, eds Biological Mechanisms of Tooth Eruption, Resorption and
Replacemen by Implants. Boston, Mass: Harvard Society for the Advancement of
Orthodontics; 1998:425–437.
8. Baumrind S, Korn EL, Boyd RL. Apical root resorption in orthodontically treated adults.
Am J Orthod Dentofac Orthop. 1996; 110:311–320.

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9. Proffit WR, Fields HW. The first stage of comprehensive treatment: alignment and
leveling. In: Contemporary Orthodontics. 3rd ed. St Louis, Mo: CV Mosby; 2000:527–
529.
10. King GJ. Effect of timing of orthodontic appliance reactivation on osteoclast and root
resorption. In: Davidovitch Z, Mah J, eds. Biological Mechanisms of Tooth Eruption,
Resorption and Replacement by Implants. Boston, Mass: Harvard Society for the
Advancement of Orthodontics; 1998:451–458.
11. Harris EF, Kineret SE, Tolley EA. A heritable component for external apical root
resorption in patients treated orthodontically. Am J Orthod Dentofac Orthop.
1997;111:301–309.
12. Owman-Moll P, Kurol J, Lundgren D. Repair of orthodontically induced root resorption
in adolescents. Angle Orthod. 1995;65(6): 403–408.
13. Owman-Moll P, Kurol J. The early reparative process of orthodontically induced root
resorption in adolescents—location and type of tissue. Eur J Orthod. 1998;20:727–732.
14. Levander E, Malmgren O. Long term follow-up of maxillary incisors with severe apical
root resorption. Eur J Orthod. 2000;22:85–92.
15. Roberts WE. Bone physiology, metabolism, and biomechanics in orthodontic practice. In:
Graber TM, Vanarsdall RL, eds. Orthodontics: Current Principles and Techniques. St
Louis, Mo: CV Mosby; 2000;231–234.

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