Abstract
Maxillary and mandibular incisors have increased risk for severe orthodontically induced inflammatory root resorption. A patient-related risk factor is aberrant root morphology. This study aimed to assess the frequency of detection of different root morphologies in anterior teeth using dental panoramic tomography (DPT) and long cone periapical radiographs (LCPAs). A retrospective cross-sectional design was used to assess a sample of 50 consecutive pre-treatment radiographic records of patients from a specialist orthodontic practice in Adelaide, Australia. A reference guide was developed that included three previously unreported morphologies: pipette and bent, bent and pointed, bent and blunt. Two trained and calibrated assessors examined each record against the inclusion criteria, then independently assessed each anterior tooth from DPTs and LCPAs to detect the type of root morphology present. Data were analysed using the chi-square statistical test. Radiographic records for 48 patients (48 DPTs and 161 LCPAs) were eligible, with 355 and 426 teeth on DPTs and LCPAs, respectively, included for assessment. Normal root morphology (119 teeth) was commonly observed in DPTs, while bent (154 teeth) was frequently observed using LCPAs. Mandibular incisors often had normal morphology in DPTs but bent in LCPAs. Bent was the most common morphology in maxillary lateral incisors using DPT and LCPAs, although maxillary centrals were mostly normal in DPTs but pointed in LCPAs. Differences using the two image acquisition methods were highly significant (p < 0.01). Aberrant root morphologies are more easily detected in anterior teeth using LCPAs compared to DPTs.
Highlights
Induced inflammatory root resorption (OIIRR) is an undesirable iatrogenic outcome during the course of orthodontic treatment, characterised by a sterile and aggressive inflammatory resorptive process that could involve the outer cemental layers, the outer cemental and dentinal layers, or full resorption of all hard tissues at the apex of a root.[1]
Periapical radiographs were obtained with an intra-oral x-ray machine, whereas dental panoramic tomography (DPT) were performed with a Siemens OP3 machine (Siemens AG, Postfach, Nuernberg, Germany)
Inclusion and exclusion criteria The inclusion criteria stipulated that each set of radiographic records must include a pre-treatment DPT and long cone periapical radiographs (LCPAs) of maxillary and mandibular anterior teeth that were of excellent or diagnostically acceptable quality,[19] which was assessed by the authors prior to commencing the study
Summary
Induced inflammatory root resorption (OIIRR) is an undesirable iatrogenic outcome during the course of orthodontic treatment, characterised by a sterile and aggressive inflammatory resorptive process that could involve the outer cemental layers, the outer cemental and dentinal layers, or full resorption of all hard tissues at the apex of a root.[1]. Severe resorption, defined as greater than 4mm or a third of the original root length,[5,6,7] can jeopardise the outcome of orthodontic treatment,[7] with one of the possible outcomes being increased tooth mobility, on account of the reduction in intra-alveolar root length changing the crown:root ratio, leading to possible tooth loss.[8] Restorative replacement with either removable or fixed prosthodontics, or a single tooth implant, present significant difficulties and limitations,[9,10] which would be marked in the case of a mandibular incisor. A risk assessment for the development of severe OIIRR in a prospective orthodontic patient should include determination of the presence of any abnormal root morphology in anterior teeth. This would ideally be performed radiographically after an initial clinical examination, as part of the diagnosis and treatment planning stage
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