External Root Resorption Research Articles

External root resorption with the self-ligating Damon system-a retrospective study.

BackgroundThe aim of this study was to compare the degree of external apical root resorption (EARR) in patients treated with self-ligating Damon appliances and with conventional preadjusted appliances.MethodsThe sample comprised 52 patients, divided into two groups. Group 1 consisted of 25 patients treated with self-ligating Damon appliances, with an initial age of 16.04 years, final age of 18.06 years, and treatment time of 2.02 years. Group 2 consisted of 27 patients, treated with conventional preadjusted appliances, with an initial age of 16.77 years, final age of 18.47 years and treatment time of 1.70 years. The groups were matched regarding the initial and final ages, treatment time, type of malocclusion, and treatment protocol without extractions. Root resorption was evaluated on periapical radiographs of the maxillary and mandibular incisors at the end of orthodontic treatment with the scores of Levander and Malmgren. Intergroup comparisons of root resorption were performed with Mann-Whitney tests.ResultsNo significant difference in the degree of root resorption between the two groups was found.ConclusionsSimilar degrees of resorption can be expected after non-extraction treatment with Damon self-ligating or conventional preadjusted appliances.

External Root Resorption in Maxilla

We report clinical case of external root resorption in maxilla. The author conducted a search with electronic databases (MEDLINE, PubMed, Scopus, US National Library of Medicine) about frequency of external root resorption in maxilla, similar radiological images and surgical management. A 45 year old male patient presented with a painless swelling of approximately 0.5x0.5 cm in size, on the maxillary left region since 1 week. Clinical signs and symptoms suggested of periapical abscess. Radiographic evidence revealed external root resorption (loss of dentin, cementum and bone). After surgical extraction of maxillary first premolar the postoperative period was without complications.

External root resorption of the second molar associated with mesially and horizontally impacted mandibular third molar: evidence from cone beam computed tomography.

The aim of the present study was to assess the incidence and risk factors of ERR in second molars with mesially and horizontally impacted mandibular third molars using cone beam computed tomography (CBCT) images from patients in a Chinese tertiary referral hospital. A total number of 216 patients with 362 mesially and horizontally impacted mandibular third molars who were treated at our institution from 2014 to 2015 was retrospectively included. The ERR in second molars was identified on CBCT multiplanar images. The associations between incidence of ERR and multiple clinical parameters were statistically analyzed by Chi-square test. Moreover, the risk factors for ERR in second molars were further assessed by multivariate regression analysis. The overall incidence of ERR in second molars was 20.17% (73/362) as detected on CBCT images. The presence of ERR significantly associated with patients age and impaction depth of mandibular third molars. However, no significant relationship was found between ERR severity and impaction depth or ERR location. Multivariate regression analyses further revealed age over 35years and impaction depth as important risk factors affecting the ERR incidence caused by mesial and horizontal impaction of mandibular third molar. ERR in second molar resulted from mesially and horizontally impacted mandibular third molar is not very rare and can be reliably identified via CBCT scan. Given the possibility of ERR associated with third molar impaction, the prophylactic removal of these impacted teeth could be considered especially for those patients with over 35years and mesially and horizontally impacted teeth.

The Effect of Two Different Voxel Sizes on the Diagnosis of External Root Resorption by Planmeca Cone Beam Computed Tomography System: an in vitro study

The Effect of Two Different Voxel Sizes on the Diagnosis of External Root Resorption by Planmeca Cone Beam Computed Tomography System: an in vitro study

Evaluation of laser phototherapy (λ 780 nm) after dental replantation in rats.

Tooth replantation is the treatment of choice in cases of avulsion although the outcomes are variable. The teeth can be lost due to external root resorption. The aim of this study was to histologically assess of the effect of laser phototherapy (λ780 nm) on replanted teeth in rats. Sixty Wistar Albinus rats had their maxillary right incisors extracted and were then divided into four groups: G1-absence of storage medium; G2-milk as storage medium; G3-milk as storage medium followed by a laser irradiation of the root surfaces and entrance of the alveolus (λ = 780 nm; P = 70 mW; CW; DE = 21 J/cm2 ); G4-milk as storage medium, laser irradiation as in G3 before replantation. After this procedure, laser irradiation was performed on the buccal and palatal mucosa (8.4 J/cm2 per session) every 48 h for 15 days. The animals were euthanized 15, 30, and 60 days after replantation. The histological results showed that after 15 days, G4 exhibited intense chronic inflammation with the presence of clastic cells and moderate external inflammatory root resorption (P < 0.05) when compared with G3, in which these outcomes were not observed. At the 30th day, G1, G2, and G4 showed chronic inflammation varying from discrete to moderate, as well as intense external inflammatory root resorption. G3 remained without any inflammation and external inflammatory root resorption up to the 60th day. The use of laser phototherapy on the root surface and at the entrance of the alveolus prior to replantation had a positive biomodulative effect on alveolar repair after tooth replantation in rats.

A radiographic study of external apical root resorption in patients treated with single-phase fixed orthodontic therapy

BackgroundExternal apical root resorption (EARR) is one of the most common iatrogenic consequences of orthodontic tooth movement. Many factors like gender, duration, orthodontic force and duration of orthodontic treatment have been implicated to cause EARR. MethodsPre- and post-treatment OPGs of 60 orthodontic patients (30 males and 30 females) who had undergone treatment with a single phase of fixed orthodontic therapy were randomly selected from institutional archives. The root apices were evaluated for EARR by a single operator on an radiograph viewing box at a standardized source of light using a four-grade ordinal scale. Anterior EARR was measured on the maxillary and mandibular canines. Posterior EARR was measured on premolars, mesiobuccal and distobuccal roots of maxillary first molars and mesial and distal roots of mandibular first molars. The results were compiled and subjected to statistical analysis. ResultsThe cases in which the patients underwent therapeutic extraction had a relatively higher amount of EARR compared to the cases in which the patients were treated by non-extraction therapy (P<0.001). Odds ratio indicated that extraction cases had two-fold increased risk of EARR than non-extraction cases (P<0.001). No statistically significant difference was observed in the distribution of EARR based on gender or duration of orthodontic treatment (P>0.05). ConclusionTherapeutic extraction is an important determinant of post-treatment EARR. Gender and duration of orthodontic treatment may not be important variables in the causation of EARR according to the findings of this study. However, longitudinal studies with larger sample size are required to validate the results of this study.

Assessment of apical root resorptions during orthodontic treatment with digital subtraction and geometric reconstruction

ObjectivesTo assess the severity of external apical root resorptions (EARR) in orthodontic patients by using digital subtraction and image reconstruction. Materials and methodsPeriapical radiographs from 34 individuals were obtained on the beginning (T0), after 6–7 months (T1), and after 12–13 months (T2) of treatment. These individuals had Angle Class I and II malocclusion and were treated with standard edgewise full fixed appliances (0.022 × 0.028-in.). The images were registered and subtracted on Regeemy® Image Registration and Mosaicking v.0.2.43-RCB (DPI-INPE, Sao Jose dos Campos, SP, Brazil). After reconstruction, root loss of the upper central incisors was measured on T1 and T2. ResultsThe difference between T1 and T2 was statistically significant for the left central incisor (P < 0.05). No statistically significant differences were found for the variables of the orthodontic treatment (extraction of first premolars, use of intermaxillary rubber bands, or type of malocclusion; P > 0.05). ConclusionsThe EARR was greater during the first 6–7 months of orthodontic treatment. Extraction of premolars, use of intermaxillary rubber bands, and type of malocclusion did not pose a significant influence to the EARR.

Risk Factors and Contemporary Treatment of Orthodontically Induced Apical Root Resorption: A Review

1.1.Aim:External apical root resorption is one of the most common side effects of orthodontic treatment. Some amount of root resorption is inevitable in orthodontic. Most of the times root resorption is not severe and goes unnoticed but in few cases root resorption is severe. The cause of root resorption is multifactorial. Aim of this article is to give an insight of root resorption caused by orthodontic tooth movement. 1.2.Material and method:Articles pertinent to root resorption caused by orthodontic tooth movement were first searched electronically and then hand searched. Relevant article were topic wise critically reviewed by all the reviewers. 1.3.Conclusion:It was concluded that many factors are involved in root resorption. In this article possible method of curbing root resorption have also been described.

Association of genetic polymorphism and external apical root resorption

To evaluate the relationship between genetic polymorphism and external apical root resorption. The protocol was prepared and registered on PROSPERO. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies of all relevant articles and textbooks were manually searched. Thirteen studies met the inclusion criteria. Four studies were classified as low-quality studies (score <10), and nine studies were classified as high-quality studies. The results of the present review suggest that, although some authors have reported that genetic polymorphism may play a role in external apical root resorption, others have not supported this association. Future studies should be more consistent in their research methodologies to determine with clarity whether an association exists. Future investigations should include larger sample sizes with matching cases/controls, adjust for confounders, provide power calculation and odds ratios, and report genetic analyses with the Hardy-Weinberg equilibrium. The current investigation suggests guidelines and recommendations for future investigators studying genetic polymorphism in patients undergoing orthodontic treatment.

Effect of laser photobiomodulation on the periodontal repair process of replanted teeth.

Tooth replantation is the optimal treatment in cases of avulsion. However, its success is limited due to the occurrence of external root resorption. The aim of this study was to assess the effect of laser photobiomodulation (LPBM) at λ808 nm and λ660 nm and of storage media on the periodontal repair process of replanted teeth in rats. Sixty maxillary right incisors were extracted from sixty Wistar rats and randomly assigned to six groups (n = 10). Groups consisted of 10 teeth stored in paper napkins (PN), whole milk (WM), and soy milk (SM), for 45 min; and PNL, WML and SML, in which teeth were stored in the same storage media, but the root surface and the alveolus were treated with LPBM at λ808 nm before replantation, and the buccal and palatal mucosa of the alveolus were treated with LPBM at λ660 nm after replantation. Five rats from each group were euthanized after 15 or 30 days. The right hemimaxilla including the replanted incisor was removed and processed for histomorphometric analysis to assess root resorption areas, replacement root resorption, perimeter with ankylosis and periodontal repair, and areas of type I and III collagen deposition, using the ImageJ 1.50b software. Data were analyzed statistically by anova followed by Tukey's multiple comparison test (α = 5%). WM and SM showed smaller root resorption areas and higher collagen deposition in both experimental periods, and SM showed the largest perimeter of periodontal repair. LPBM reduced the occurrence of root resorption only in the PNL group, both at 15 and 30 days, and increased the perimeter of periodontal repair in all groups at 30 days. There was higher collagen deposition in the irradiated groups regardless of the experimental period. The LPBM protocol at λ808 nm and λ660 nm as well as whole milk and soy milk favored the periodontal repair process of replanted teeth in rats.

Retention and Healing Outcomes after Intentional Replantation

IntroductionIntentional replantation is an alternative to tooth extraction and prosthetic replacement when conventional endodontic treatment modalities are unfeasible or contraindicated. This study assessed tooth retention and healing after intentional replantation and explored predictors of these outcomes. MethodsData of intentional replantation procedures performed between March 2000 and December 2010 were collected prospectively, excluding teeth with preoperative periodontal and root defects. A cohort of 159 teeth was followed up for 0.5–12 years. Retention and healed status without complications (periapical radiolucency, external root resorption, ankylosis, signs/symptoms, probing ≥6 mm) was recorded and analyzed with Kaplan-Meier survival analysis and Cox proportional hazard regression model (P < .05). ResultsComplications leading to extraction occurred in 8 of 159 teeth (5%). Kaplan-Meier survival function suggested 93% cumulative 12-year retention. Cumulative healed rates declined from 91% at 6 months to 77% at 3 years. The healed rate was significantly lower for maxillary teeth without preoperative periapical radiolucency, replanted in more than 15 minutes, and root-end filled with ProRoot MTA. Cox regression identified extraoral time ≤15 minutes as predictor of complication-free healing (P < .04; hazard ratio, 2.767; 95% confidence interval, 1.053–7.272). ConclusionsThis prospective cohort study of contemporary intentional replantation suggested a cumulative 12-year retention rate of 93% and healed rate of 77% after 3 years. Healing occurred 1.7 times more frequently in teeth replanted within 15 minutes. Although most complications occurred within 1 year after replantation, follow-up should extend for at least 3 years to capture late complications.

Evoluţia resorbţiei radiculare externe inflamatorii de cauză traumatică. Caz clinic

Endodontic treatment is indicated for dental trauma associated with inflammatory root resorption. Within this context, we describe both the evolution and the therapeutic behavior of the two types of root resorption present in the same patient. The aim of endodontic treatment is to stagnate active resorption eliminating the infection and inflammation, thus allowing bone regeneration. Early diagnosis is crucial in the management of external root resorption, so that the earlier the endodontic treatment is applied the less severe the long term consequences of resorption will be.

Horizontal kök kırığı olgusunda uzun süreli splint kullanımı sonrası prognoz: olgu bildirimi

INTRODUCTION: Root fracture of the incisors is a rare condition in dental trauma. It can be treated successfully by stabilizing the repositioned tooth fragments. In splint applications it is recommended to use flexible or semi-rigid splints for 4 weeks; use of splints for extended durations may increase the risk of external root resorption. CASE REPORT: A 12-year-old male patient who had had a dental trauma 10 months earlier consulted the Department of Pediatric Dentistry, Faculty of Dentistry at Gazi University. In his intraoral examination, mobility was detected in the mandibular right central incisor tooth. After clinical and radiographic examination, the patient was diagnosed with horizontal root fracture and the fractured tooth was splinted. The patient did not attend the scheduled follow-up visits, but re-appeared 2 years later for the removal of the splint. One year after the removal of the splint, healing with calcified tissue was observed. CONCLUSION: Although it is known that long-term splint causes root resorption, in this case it was observed that no pathology developed, and healing with calcified tissue occurred after splint use for an extended period. This is contrary to what has been argued in the literature.

Scanning electron microscopy reveals severe external root resorption in the large periapical lesion.

The present study was designed to investigate the relationships between clinicopathological findings and the resorptive conditions of root apices of teeth with periodontitis. The samples included 21 root apices with large periapical radiolucent lesions. The preoperative computed tomography (CT) and intraoperative findings were correlated with the presence, extension, and the progression pattern of periapical resorption using a scanning electron microscope. The subjects' age, gender, chief complaint, type of tooth, percussion test results, size of periapical lesion using CT, and intraoperative findings were recorded. All apicoectomies were performed under an operative microscope for endodontic microsurgery. A significant large size was observed in cystic lesions compared with granulomatous lesions. The cementum surface at the periphery of the lesion was covered with globular structures (2-3 μm in diameter). Cementum resorption started as small defect formations at the surface. As the defect formation progressed, a lamellar structure appeared at the resorption area, and the size of globular structures became smaller than that of globules at the surface. Further resorption produced typical lacuna formation, which was particularly observed in fracture cases. The most morphologically severe destructive pattern of dentin resorption was observed in large cystic lesions. This study is the first report to elucidate the relationships between three clinical types of undesirable periapical lesions: (1) undertreatment, (2) periapical fracture, (3) macro-level resorption, and the microstructure of external root resorption including from small defects at the cementum surface to a significant destructive pattern inside the dentin. Microsc. Res. Tech. 79:495-500, 2016. © 2016 Wiley Periodicals, Inc.

Regeneration and Repair in Endodontics-A Special Issue of the Regenerative Endodontics-A New Era in Clinical Endodontics.

Caries is the most common cause of pulp-periapical disease. When the pulp tissue involved in caries becomes irreversibly inflamed and progresses to necrosis, the treatment option is root canal therapy because the infected or non-infected necrotic pulp tissue in the root canal system is not accessible to the host's innate and adaptive immune defense mechanisms and antimicrobial agents. Therefore, the infected or non-infected necrotic pulp tissue must be removed from the canal space by pulpectomy. As our knowledge in pulp biology advances, the concept of treatment of pulpal and periapical disease also changes. Endodontists have been looking for biologically based treatment procedures, which could promote regeneration or repair of the dentin-pulp complex destroyed by infection or trauma for several decades. After a long, extensive search in in vitro laboratory and in vivo preclinical animal experiments, the dental stem cells capable of regenerating the dentin-pulp complex were discovered. Consequently, the biological concept of ‘regenerative endodontics’ emerged and has highlighted the paradigm shift in the treatment of immature permanent teeth with necrotic pulps in clinical endodontics. Regenerative endodontics is defined as biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as the pulp-dentin complex. According to the American Association of Endodontists’ Clinical Considerations for a Regenerative Procedure, the primary goal of the regenerative procedure is the elimination of clinical symptoms and the resolution of apical periodontitis. Thickening of canal walls and continued root maturation is the secondary goal. Therefore, the primary goal of regenerative endodontics and traditional non-surgical root canal therapy is the same. The difference between non-surgical root canal therapy and regenerative endodontic therapy is that the disinfected root canals in the former therapy are filled with biocompatible foreign materials and the root canals in the latter therapy are filled with the host's own vital tissue. The purpose of this article is to review the potential of using regenerative endodontic therapy for human immature and mature permanent teeth with necrotic pulps and/or apical periodontitis, teeth with persistent apical periodontitis after root canal therapy, traumatized teeth with external inflammatory root resorption, and avulsed teeth in terms of elimination of clinical symptoms and resolution of apical periodontitis.

Resorption of maxillary incisors after orthodontic treatment--clinical study of risk factors.

External apical root resorption (EARR) is one of the major problems associated with orthodontic treatment. Such lesions represent an iatrogenic risk that must be detected as early as possible, with regular radiological follow-up and appropriate therapeutic precautions. The causes and mechanisms leading to susceptibility to root resorption following the application of an orthodontic force are often not clear and are generally said to be of multifactorial origin. The aim of this clinical study was to analyze the factors linked to the occurrence of moderate to severe resorption (MSR) of upper incisors during orthodontic treatment in a group of Moroccan patients treated in the Dento-Facial Orthopedic Department of the Dental Consultation and Treatment Center (Centre de consultation et de traitements dentaires [CCTD]) in Rabat. A total of 82 patients (28% males, 72% females) aged between 12 and 27, with various malocclusions, who had been treated with fixed appliances for at least 1 year and for whom panoramic X-rays at the start, during and at the end of treatment were available, were selected randomly. The reduction in maxillary incisor root length was evaluated using resorption scores. The factors studied in relation to the risk of occurrence of MSR were: age, sex, treatment duration, extraction or non-extraction, type of malocclusion (Class I arch-length discrepancy, Class II, Class III), the vertical diagnosis (normal, supraocclusion, open bite), presence of dysfunction, impacted canines and root morphology. Statistical analysis was performed using SPSS software, version 18.0. Statistical tests used were: Kaplan-Meier analysis and the univariate and multivariate Cox models for the study of factors associated with MSR. The threshold of significance adopted was 0.05. The factors that were significantly associated with the occurrence of MSR at the level of the upper incisors were: tooth type, with a greater risk for the lateral incisor (HR=3.2 95% CI [2.3-4.5] P<0.001), treatments with extraction (HR=1.64 95% CI [1.16-2.33] P<0.05), the presence of supraocclusion (HR=2.17 95% CI [1.33-3.53] P<0.05) or open bite (HR=3.12 95% CI [1.66-5.86] P<0.001) and root malformation (HR=1.5 95% CI [1.09-2.07] P<0.05). Age, sex, type of malocclusion, dysfunction and impaction of canines were not associated at a statistically significant level with the risk of occurrence of MSR of the upper incisors. EARR is difficult to avoid; the orthodontist's role remains crucial in identifying risk factors so as to adopt a treatment strategy taking these factors into account. In our population, the risk of MSR in the upper incisors appeared to increase in treatments with extraction, situations of supraocclusion or open bite, and in the presence of root abnormalities. Finally, clinical recommendations for the prevention of the occurrence of MSR of the maxillary incisors are proposed, taking into account all the risk factors identified.

Circulating dentinal antigen-antibody immune complexes during orthodontic tooth movement in rats.

The immunogenic potential of dentin has been reported through dentin-reactive autoantibodies detection in human and animal model. This study aimed to investigate the formation and diagnostic value of immune complexes formation after autoantibodies production, and soluble dentin antigens levels associated to root resorption, in the course of orthodontic tooth movement, in rat experimental model. Forty Wistar rats (n = 8 for each group) were submitted to orthodontic tooth movement, in which the maxillary right first molar was mesially moved by applying of 55 g of force for 3, 7, 14, or 21 days. Untreated group was used as control. Circulating autoantibodies to rat dentinal extract, immune complexes, and soluble dentinal antigen levels were determined by immunoenzyme assays. Additionally, dentinal antigens were analyzed by immunoblot. Higher serum dentin-reactive IgG and immune complex levels were detected in the 14- and 21-day groups (p < 0.05 and p < 0.001 respectively) but not in circulating dentinal antigen levels (p > 0.05), as compared to the control group. Reactivity was found to dentinal components with molecular mass (MM) ~120 and ~150 kDa, by immunoblot. This work represents the first evidence of immune complexes formation and circulating soluble dentin antigens associated to root resorption in orthodontic tooth movement. Immune complexes formation could be used to early diagnosis of external root resorption.

Accuracy in the diagnosis of vertical root fractures, external root resorptions, and root perforations using cone-beam computed tomography with different voxel sizes of acquisition.

Aim:The aim of this study is to assess the accuracy of images acquired with cone-beam computed tomography (CBCT) in the identification of three different root alterations.Materials and Methods:Forty human premolars were allocated to four experimental groups (n = 10): sound teeth (control), vertical root fracture (VRF), external root resorption (ERR), and root perforation (RP). After the root alterations had been produced, four teeth were randomly assembled into 10 macerated mandibles and submitted to CBCT. Images were acquired with five voxel sizes (0.125, 0.200, 0.250, 0.300, and 0.400 mm) and assessed by three experienced dental radiologists. Sensitivity, specificity, positive and negative predictive values, and the areas under the receiver operating characteristic curve (accuracy) were calculated. The accuracy of imaging in different voxel sizes was compared with Tukey exact binomial test (α=5%).Results:Accuracy with voxel sizes 0.125, 0.200, and 0.250 mm was significantly higher in the detection of ERRs and VRFs than voxel sizes 0.300 and 0.400 mm. No statistical difference was found in terms of accuracy among any of the studied voxel sizes in the identification of RPs.Conclusions:Voxel size 0.125 mm produced images with the best resolution without increasing radiation levels to the patient when compared to voxel sizes 0.200 and 0.250 mm. Voxel sizes 0.300 and 0.400 mm should be avoided in the identification of root alterations.

Apical External Root Resorption and Repair in Orthodontic Tooth Movement: Biological Events.

Some degree of external root resorption is a frequent, unpredictable, and unavoidable consequence of orthodontic tooth movement mediated by odontoclasts/cementoclasts originating from circulating precursor cells in the periodontal ligament. Its pathogenesis involves mechanical forces initiating complex interactions between signalling pathways activated by various biological agents. Resorption of cementum is regulated by mechanisms similar to those controlling osteoclastogenesis and bone resorption. Following root resorption there is repair by cellular cementum, but factors mediating the transition from resorption to repair are not clear. In this paper we review some of the biological events associated with orthodontically induced external root resorption.

Management of External Cervical Root Resorption in Mandibular Molar

ABSTRACT External root resorption of teeth takes its origin from periodontal tissues but is often an endodontic enigma. A combined endoperio management is required if the external resorption involves both entities. This article describes the management of an external resorption in mandibular first molar by intentional reimplantation using cone-beam computed tomography (CBCT) as an adjunctive diagnostic aid. Following atraumatic extraction of 36, endodontic treatment was performed extraorally, followed by sealing of the resorptive site using Biodentine. The periodontal procedures included guided tissue regeneration using a bioresorbable membrane and placement of osseograft for bone regeneration. After a follow-up period of 10 months, the patient was totally asymptomatic. Intentional reimplantation is a viable treatment option for external root resorption of inaccessible sites. How to cite this article Kavitha M, Shobana S. Management of External Cervical Root Resorption in Mandibular Molar. J Oper Dent Endod 2016;1(1):39-45.