External Root Resorption Research Articles

Accelerated Canine Retraction by Using Mini Implant With Low-Intensity Laser Therapy.

Background The continuous increase in demand for reduced treatment times has led researchers to think in terms of "accelerated orthodontics." Generally, the duration for fixed orthodontic treatment is around two to three years. Prolonged use of braces leads to external root resorption, a high risk of caries, and decreased patient compliance. Therefore, finding an optimal supplementary approach to achieve faster tooth movement is still considered a subject of interest. Low-intensity laser therapy (LILT) is one of the non-invasive surgical techniques in the field of accelerated orthodontics. Low-level laser therapy (LLLT) has demonstrated faster healing, less bleeding, and biostimulation and anti-inflammatory effects. According to all studies, it accelerates tooth movement, thereby reducing braces treatment time. It is simple, safe, and minimally invasive. Despite these pieces of evidence, studies have shown variable findings in low-level laser therapy. This study evaluates the effect of LLLT on accelerated orthodontics in comparison with conventional canine retraction. An aluminum gallium arsenide-type diode laser with a wavelength of 940 nm has been used in this study. Methodology This study was conducted using the split-mouth method, which included 20 patients with permanent dentition who required first premolar extractions. A miniscrew implant was placed on both the right and left sides for maximum anchorage. Irradiation doses were applied on days 0, 3, 7, and 14 of the first month. Subsequently, irradiations were given every 15 days until the canine's retraction was complete in the test group. Results The study results three months after the canine retraction in the test and control groups (M1) were 0.81 ± 0.03 mm/month and 0.74 ± 0.04 mm/month, respectively, indicating a significantly higher rate of canine retraction in the test group than in the control group (P < 0.0001). The average increase in the amount of tooth movement at three months was 40.1% and 36.3% in the test and control groups, respectively. However, the average increase in the amount of movement of teeth following canine retraction was 100% in the test group and 68.2% in the control group. There were significant variations in the pain score between Day 1 and Day 3 (P = 0.003) in the test group; however, there was no analytic variation in the pain score between Day 1 and Day 30 in the test group (P = 0.18). The pain score between Day 3 and Day 30 was significantly lower. Conclusions It was concluded that the rate of canine retraction increases when it is combined with LILT-assisted accelerated orthodontics in comparison to conventional canine retraction. Although LLLT does not provide immediate pain relief, it relieves the sensation of pain after 24-72 hours. LILT is an innovative, non-invasive technique that allows rapid orthodontic tooth movement. The rate of canine retraction increases when it is combined with LILT-assisted accelerated orthodontics in comparison to conventional canine retraction using mini-implants.

Comparative cone-beam computed tomographic evaluation of maxillary incisor intrusion and associated root resorption: Intrusion arch vs mini-implants

Various literature has verified that apical root resorption is a common adverse effect of orthodontic treatment, particularly intrusion. Conventional radiographic techniques underestimated root lengths and overestimated tooth lengths. Cone-beam computed tomography (CBCT) is a useful diagnostic tool to detect orthodontically induced external apical root resorption. This prospective study aimed to compare maxillary incisor intrusion and associated root resorption via CBCT. Thirty patients aged 16-23 years, having a deepbite of 6-8 mm and excessive gingival display on smiling, were divided into 2 groups: group 1, with 15 patients who were treated with Burstone intrusion arch, and group 2 with 15 patients who were treated with mini-implants applying 100 g of intrusive force for 4 months with activation done every 4 weeks. During this 4-month study period, no treatment was performed other than the intrusion of incisors. CBCT scans were obtained before and after the intrusion phase of treatment to compare the amount of intrusion and associated root resorption among both groups. No significant difference was found in mean incisor intrusion between groups 1 and 2 (P= 0.772), with slightly more proclination of incisors in group 1, resulting in a significant (P= 0.018) increase in the vertical change of incisal edge in group 1. A statistically significant difference was found in root resorption among both groups (P= 0.004), with more root resorption in group2. The results of this study indicate intrusion with both the intrusion systems using appropriate intrusive forces is effective in opening the bite with slightly more external apical root resorption in the mini-implant group.

Inactivation of Sufu in cementoblasts accelerates external tooth root resorption.

Cementum has been empirically regarded as an antiresorptive barrier against tooth roots. However, little is known about the factors of homeostasis and resistant mechanisms of tooth roots against resorption. Here, we investigated cementum factors and their interaction against resorption using transgenic mice exhibiting external cervical root resorption (ECRR). Ectopically thickened cervical cementum caused by functional inactivation of ectonucleotide pyrophosphotase/phosphodiesterase 1 (Enpp1) was susceptible to ECRR with aging. In addition, the inactivation of the suppressor of fused (Sufu), a Hedgehog signaling inhibitor, in cementoblasts led to ECRR. Interestingly, concurrent inactivation of Sufu and Enpp1 in cementoblasts remarkably exacerbated ECRR with higher Rankl expression. Cellular and molecular analyses using cementoblasts and bone marrow-derived macrophages indicated that Dickkopf-related protein 1 (Dkk1) induced by the inactivation of Sufu in cementoblasts has roles in the acceleration of ECRR triggered by Enpp1 inactivation. Using compound mutant mice for concurrent Wntless and Enpp1 inactivation, this synergistic cooperation of Dkk1 and Npp1 for resorption found in double mutant Sufu and Enpp1 mice was confirmed by the reproduction of amplified ECRR. On the basis of these findings, we conclude that proper Npp1 function and sustained Wnt activity in the cervical cementum are essential for the homeostasis of tooth roots against resorption in a physiological state.

External root resorption in mandibular second molars associated with mesial, impacted third molars on CBCT images

Objectives: The study aimed to investigate the condition of the external root resorption (ERR) of the distal surface of the root of the second molars when the third molar are impacted, mesial on CBCT images and the relationship between the ERR and the morphological characteristics of third molars Methods: A descriptive cross-sectional study was performed on a sample consisting of 215 CBCT images of the third molars impacted of 145 patients who visited and treated at the Department of Odonto-Stomatology, University of Medicine and Pharmacy. Ho Chi Minh City from March 2016 to June 2022. On the CBCT image, the morphological characteristics of third molars were examined, including: mesial angulations, vertical and horizontal positions, impaction depth, degree of root formation, contact position between second and third molars. ERR of the distal surface of the root of the second molars assessed according to the Ericson and Kurol criteria. Results: The rate of ERR on the distal surface of the second molar was 21.39%, in which the cervical was the most frequent position, followed by the middle of the root and finally the apex; most of the cases were slight resorptions. There was no statistically significant difference between the rate, location and degree of ERR by age and sex. There was no statistically significant relationship between the rate of ERR and the morphological characteristics of third molars except the vertical position of third molars. Conclusion: The second RCL root resorption related to impacted third molars is not uncommon and can be accurately determined by CBCT.

Treatment options for external inflammatory root resorption

Was to compare the efficacy of various treatment options for external inflammatory root resorption according to literature data. Literature was searched in electronic databases «eLibrary» and «PubMed» for key words «external inflammatory resorption treatment», «external inflammatory resorption management». Inclusion criteria comprised publications in Russian or English, clinical and experimental studies, full description of treatment protocol and obtained results. Studies with no full text, describing root resorption of orthodontic origin, clinical cases and clinical case series were excluded from the study. The problem of external inflammatory root resorption is poorly described in the Russian scientific literature. There are no registered protocols for its prevention and treatment or therapeutic agents with proved efficacy available in Russia. The only accessible approach for external inflammatory root resorption remains timely pulp extirpation after dental trauma which importance is underlined by all authors involved in the field of dental trauma studies. MTA and calcium hydroxide being popular as intracanal medications still have significant inconveniences as they potentially provoke root dentine fractures or replacement resorption. There is a need for elaboration and implementation of new prevention and treatment options for external inflammatory root resorption after dental trauma.

Множинна ідіопатична апікальна зовнішня резорбція кореня: огляд даних літератури

Introduction. Domestic literature characterized with deficiency of publications regarding prevalence, diagnosis and treatment of multiple idiopathic external apical root resorption, on the other hand in the foreign literature, according to the data available for analysis, only one systematic review and a small number literature reviews dedicated to this topic were verified, while the predominant share of information presented in the form of clinical case reports. Objective. To systematize data regarding distribution and prevalence, clinical manifestations, and treatment approaches of multiple idiopathic external apical root resorption. Methodology/Methods. The primary identification of publications associated with the purpose of this study was carried out in the PubMed database (NCBI) (https://www.ncbi.nlm.nih.gov/pubmed/) using the following search descriptor: "multiple[All Fields] AND idiopathic[ All Fields] AND external[All Fields] AND apical[All Fields] AND ("root resorption"[MeSH Terms] OR ("root"[All Fields] AND "resorption"[All Fields]) OR "root resorption"[All Fields] Fields])". Results and Discussion. The most typical characteristics of multiple idiopathic external apical root resorption include: absence of clinical signs of periodontal tissues damage; the level of bone tissue in the area of affected teeth can be characterized by the normal values; absence of periradicular area inflammation signs; the possibility of pathology verification both in the area of vital and endodontically treated teeth; absence of local etiological factors; asymptomatic course, except for cases of severe forms of pathology; bilateral symmetrical pattern of development. Conclusions. Multiple idiopathic apical root resorption is a diagnosis of exclusion. The course of idiopathic external apical multiple resorption is usually asymptomatic, so the identification of the disease takes place during X-ray examinations. In the course of previous studies, sufficient evidences were not identified regarding the relationship between hidden pulpal lesions and the development of multiple idiopathic apical root resorption, so endodontic treatment is not recommended for clinical cases of the above mentioned disorder if pulpitis or periodontitis symptoms are absent. Data from individual publications indicate a genetic predisposition to the development of multiple idiopathic apical root resorption, based on the results of pathology verification among family members and among monozygotic twins.

Radiolucencies Associated with the Second Molar Adjacent to the Impacted Third Molar in the Maxilla in Comparison to the Mandible

OBJECTIVES To find the frequency radiolucencies associated with the second molar adjacent to an impacted third molar in the maxilla as compared to the mandible. METHODOLOGY A cross-sectional descriptive study was conducted on 385 Orthopantomograms (OPG) of patients visiting Sharif Medical and Dental College (SMDC), Services Institute of Medical Sciences (SIMS) and Institute of Dentistry, CMH, Lahore Medical College, Lahore over a period of three months from December 2020 to February 2021. Patients above the age of 21 years were included in this study. Grossly carious third molars with inadequate tooth structure to be evaluated and patients with missing maxillary and mandibular third molars were excluded from the study. RESULTS The association between periapical radiolucencies (p=0.140), pericoronal radiolucencies (p=1.000) and external root resorption (p= 0.157) with the arch type (mandible/ maxilla) were not statistically significant but that of caries with the arch was significant (p≤0.001). CONCLUSION The periapical and pericoronal radiolucencies, caries and external root resorption associated with the second molar in the presence of an impacted third molar were higher in the mandible as compared to the maxilla.

Alignment efficiency and three-dimensional assessment of root resorption after alignment with conventional and copper-nickel-titanium archwires: A randomized controlled trial.

To compare alignment efficiency and root resorption between nickel-titanium (NiTi) and copper-nickel-titanium (CuNiTi) archwires after complete alignment in mandibular anterior region. In this two-arm parallel single-blind randomized controlled trial, forty-four patients with Class I malocclusion with mandibular anterior crowding were recruited form orthodontic clinic of All India Institute of Medical Sciences (Jodhpur, India). Patients were randomly allocated into NiTi and CuNiTi groups, with a 1:1 allocation. Alignment was performed using 0.014-in, 0.016-in, 0.018-in, 0.019x0.025-in archwire sequence in the respective groups, which terminated in 0.019 x 0.025-in stainless-steel working archwire. The primary outcome was alignment efficiency, measured on study models from baseline (T0) to the first, second, third, fourth and fifth-month (T5). Secondary outcome was root resorption, measured from CBCT scans taken at T0 and T5. Mixed-factorial ANOVA was used to compare Little's Irregularity Index (LII). For assessing the proportion of patients with complete alignment at the end of each month, Kaplan-Meier survival curve was built and time to treatment completion was compared between groups using log rank test. Paired t-test was used to assess external apical root resorption (EARR) within groups, whereas independent t-test was used to evaluate LII and EARR between the groups. Twenty-two patients were recruited in each group. One patient was lost to follow-up in the CuNiTi group. No statistically significant differences were observed in alignment efficiency between the groups (p>0.05). Intergroup comparison revealed that the changes in root measurement in three-dimensions were not statistically significant (p>0.05), except for mandibular right central incisor, which showed increased resorption at root apex in NiTi group (p<0.01). The two alignment archwires showed similar rate of alignment at all time points. Root resorption measurement did not differ between the NiTi and CuNiTi groups, except for the mandibular right central incisor, which showed more resorption in NiTi group.

Evaluation of pH and Calcium Ion Diffusion from Intracanal MTA and Bioaggregate to Simulated External Resorption Cavities Through Dentinal Tubules

Purpose: This in vitro study compared the effects of mineral trioxide aggregate (MTA), BioAggregate and calcium hydroxide on calcium and hydroxyl ion diffusion through dentinal tubules to the root surfaces without cementum in various root levels. Materials &amp;amp; Methods: The study consisted of 120 mature single-rooted mandibular premolar teeth. The teeth were decoronated and instrumented using Protaper Universal rotary files. To simulate external root resorption, artificial defects were created in cervical-middle-apical thirds of root surfaces. The teeth were divided into four main groups: Control (1), calcium hydroxide (2), MTA (3) and BioAggregate (4). In control group, root canals of specimens left empty. Other root canals of specimens filled with calcium hydroxide, MTA or BioAggregate. Each specimen was immersed in a vial containing 10 mL distilled water. Calcium concentrations and pH of the immersion media was measured at 1, 3, 7, 14, 21 and 28 days. Statistical analysis was accomplished by Kruskal–Wallis H and Mann–Whitney-U tests. Results: This study indicated that intracanal placement of both calcium hydroxide, MTA and BioAggregate resulted in the diffusion of calcium and hydroxyl ions across dentine. The results showed greater calcium and hydroxyl ions released by calcium hydroxide groups than MTA and BioAggregate groups (p&amp;lt;0.05). MTA and BioAggregate groups showed similar properties and there were no differences between these groups in whole study period (p&amp;gt;0.05). Conclusion: MTA and BioAggregate may be preferable for external root resorption cases because of their stimulation of hard tissue formation and ion releasing ability.

Marginal logistic regression with a cure fraction in a cluster design: An application in dental traumatology

Logistic regression model is the first option to deal with binary outcomes in cross-sectional health studies. However, some conditions, such as the presence of a cure fraction, characterized when an unknown portion of the population is no longer at risk of developing the event of interest, can lead to the non-adequacy of the model. Therefore, the presence of a cure fraction requires an extension in the standard form of the logistic regression model or the use of an alternative one. The present work aims to identify risk factors for the presence of External Inflammatory Root Resorption (EIRR) using a real application. The data set consisted in replanted permanent teeth referred to treatment at the Dental Trauma Clinic of the School of Dentistry from the Federal University of Minas Gerais (DTC-SD-UFMG) after emergency care at the Metropolitan Hospital Odilon Beherns in Belo Horizonte, Brazil. A logistic regression type model is considered to study the association between clinical and radiographic factors and the presence/absence of EIRR, measured radiographically at the first patient appointment at DTC-SD-UFMG. Considering that EIRR is only expected in those cases where the root canal become infected following pulp necrosis, those teeth whose pulp healing is favorable are not at risk of developing EIRR. However, pulpal status usually can only be defined in the long term, such that information is not available at the time of data collection, characterizing the presence of a latent cure fraction. Moreover, in the present sample some patients contributed with more than one replanted tooth, forming clusters of correlated measurements. In the present work we followed the methodology proposed by Hall &amp; Zhang (2004) in which they used an adaption of the EM (expectation-maximization) algorithm, called ES (Expectation-Solution) algorithm combined with GEE (Generalized Estimation Equations) to accommodate the cluster (individual) multivariate response in a logistic cure fraction model.

Management of transverse root fractures in dental trauma.

The management of complex dental trauma can be modulated according to the emergencies that may arise over time. Clinical management of transverse root fractures may require different therapies based on situations, such as delay and error in the treatment of an avulsion trauma associated with apical third root fracture, patient's poor compliance, or external and internal root resorption. The primary aim of this article was to review studies regarding root fractures in the permanent dentition and root fracture management. The secondary aim was to present the inflammatory reaction and the complications (i.e., infections) that may occur if the International Association for Dental Traumatology (IADT) guidelines are not followed. In addition, a scenario is devised in which endodontic surgery, despite the baseline patient's conditions and negative prognosis, can help to inhibit the inflammatory root resorption and allow the preservation of soft and hard tissues within a long follow-up from the injury, for the purpose of demonstrating the next possible implant-prosthetic rehabilitation.

Primary pulpotomies - what should we be using?

Introduction A systematic review and meta-analysis of the effectiveness of Biodentine compared to formocresol for pulpotomies in the deciduous dentition.Data sources and study selection Four electronic data bases were searched (Medline, Embase, Cochrane Central Register of Controlled Trials and Web of Science). Randomised controlled trials (RCTs) which compared the use of Biodentine with formocresol were included in the screening. Two reviewers screened the titles and abstracts of the RCTs independently for inclusion in the review and a third reviewer was consulted in the case of any disagreements. Thirteen articles were used for full-text reading and nine were included in the review. Two investigators assessed risk of bias (RoB) by allocating a score of either high, low or unclear, in line with the Cochrane handbook for systematic reviews of interventions. Failure to blind practitioners paired with a lack of standardised application protocol results in high RoB.Data extraction and synthesis Data was extracted from the included studies using customised forms, including: sample size, patient ages, treatment and clinical and radiographic follow-up and results. Meta-analysis of the results was completed using ReviewManager version 5.4.0.Results In total, 626 children were assessed in the RCTs. All teeth were restored with a preformed metal crown placed directly after the procedure, except for two studies, which placed them 24 and 48 hours later. The primary outcomes of clinical failure were defined as pain, tenderness to percussion, swelling, abscess, fistula and pathological tooth mobility at 12 months. These showed that Biodentine had significantly lower failure rates (RR 0.16; 95% CI 0.003-0.87; N = 394). Radiographic failure rates defined as either internal or pathological external root resorption, furcation radiolucencies or a widened periodontal ligament showed significantly lower failure rates (RR 0.19; 95% CI 0.08-0.49; N = 393). However, the results showed no significant difference for secondary outcomes which assessed the teeth both clinically and radiographically at intervals up to 48 months. Outcomes were assessed using GRADE; this showed all results to be of low certainty due to the high RoB.Conclusions Biodentine may be the superior material to formocresol for pulpotomy in the deciduous dentition. However, the results for both primary and secondary outcomes have a very low to low GRADE rating due to high RoB; therefore, robust future studies should be completed to further substantiate these findings.

Npp1 prevents external tooth root resorption by regulation of cervical cementum integrity

Tooth roots embedded in the alveolar bone do not typically undergo resorption while the bone continues remodeling in its physiological state. In this study, we analyzed genetically modified mice with the functional inactivation of nucleotide pyrophosphatase 1 (Npp1), encoded by ectonucleotide pyrophosphatase/phosphodiesterase 1 (Enpp1). This mutation leads to the formation of ectopic cervical cementum vulnerable to external tooth root resorption. Cementoblasts with the inactivation of Enpp1 extensively expressed non-collagenous matrix proteins enriched with bone sialoprotein (Bsp), dentin matrix protein 1 (Dmp1), and osteopontin (Opn), which have roles in mineralization through nucleation and in cell adhesion through the Arg-Gly-Asp (RGD) motif. In cementoblasts with the inactivation of Enpp1, β-catenin was significantly activated and induced the expression of these non-collagenous matrix proteins. In addition, adenosine triphosphate (ATP), which is the most preferred substrate of Npp1, accumulated extracellularly and autocrinally induced the expression of the receptor activator of nuclear factor κB ligand (Rankl) in cementoblasts with inactivated Npp1. Consequently, these results strongly suggest that functional Npp1 preserves cervical cementum integrity and supports the anti-resorptive properties of tooth roots through ATP homeostasis in the physiological state of cervical cementum.

External root resorption (ERR) and rapid maxillary expansion (RME) at post-retention stage: a comparison between tooth-borne and bone-borne RME

BackgroundThe study aimed to compare external root resorption (ERR) three-dimensionally in subjects treated with tooth-borne (TB) versus bone-borne (BB) rapid maxillary expansion (RME). Forty subjects who received tooth-borne RME (TB group, average age 13.3 years ± 1.10 years) or bone-borne RME (BB group, average age 14.7 ± 1.15 years) were assessed using CBCT imaging before treatment (T0) and after a 6-month retention period (T1). 3D reconstructions of the radicular anatomy of maxillary first molars (M1), first and second premolars (P1 and P2) were generated to calculate volumetric (mean and percentage values) and shape changes (deviation analysis of the radicular models) obtained at each time point. 2D assessment of radicular length changes was also performed for each tooth. Data were statistically analyzed to perform intra-group (different teeth) and inter-group comparisons.ResultsIn both groups, all the investigated teeth showed a significant reduction in radicular volume and length (p < 0.05), with the first molars being the teeth most affected by the resorption process (volume and palatal root length). When volumetric radicular changes were calculated as a percentage of the pre-treatment volumes, no differences were found among the investigated teeth (p > 0.05). Based on the deviation analysis from radicular models superimposition, the areas most affected by shape change were the apex and bucco-medial root surface. Overall, the amount of ERR was significantly greater in the TB group (mm3: M1 = 17.03, P1 = 6.42, P2 = 5.26) compared to the BB group (mm3: M1 = 3.11, P1 = 1.04, P2 = 1.24).ConclusionsDespite the statistical significance, the difference in the amount of ERR of the posterior maxillary dentition between TB-RME and BB-RME remains clinically questionable.

Comparison of the Accuracy of CBCT Images and Apex Locator in Detection of External Root Resorption with Perforation.

Perforation within external root resorption (ERR) lesions dra-matically affects the prognosis of the involved roots. Failure to diagnose perforation under-mines treatment; therefore, early detection of these lesions is of great importance. The cone-beam computed tomography (CBCT) images and electronic apex locators (EAL) are reliably used to detect root perforations. In this in vitro study, we compared the EAL findings with the results obtained by the CBCT images for the detection of perforations within ERR lesions. This cross sectional study included 160 extracted anterior human teeth. The teeth were categorized into four groups including teeth with intact root, teeth with ERR, teeth with ERR and 0.5 mm perforation, and teeth with ERR with 1 mm perforation. The presence of perforations was compared by CBCT images and root EAL. The sensitivity of CBCT scans in detecting 0.5 mm and 1 mm root perforations was 100% and 97.5%, respectively, while the sensitivity of the EAL was 10% and 27.5% in de-tecting 0.5 mm and 1 mm root perforations, respectively( with the ±0.5mm range of error). For detecting intact and teeth with ERR, the specificity of CBCT scans was 100% and 95%, respectively, and for EAL, it was 100% for both. Poor agreement was found between the two techniques (kappa=-0.025). CBCT scans were more sensitive and specific than EAL scans for detecting perforations in non-obturated root canals in this study.

External apical root resorption in orthodontic tooth movement: the risk factors and clinical suggestions from experts' consensus.

External apical root resorption is among the most common risks of orthodontic treatment, and it cannot be completely avoided and predicted. Risk factors causing orthodontic root resorption can generally be divided into patient- and treatment-related factors. Root resorption that occurs during orthodontic treatment is usually detected by radiographical examination. Mild or moderate root absorption usually does no obvious harm, but close attention is required. When severe root resorption occurs, it is generally recommended to suspend the treatment for 3 months for the cementum to be restored. To unify the risk factors of orthodontic root resorption and its clinical suggestions, we summarized the theoretical knowledge and clinical experience of more than 20 authoritative experts in orthodontics and related fields in China. After discussion and summarization, this consensus was made to provide reference for orthodontic clinical practice.

The Effect of Education on the Ability of Dental Students to Detect External Root Resorption of Maxillary Primary Molars

The Effect of Education on the Ability of Dental Students to Detect External Root Resorption of Maxillary Primary Molars

Clinical indications, complications, and outcomes of internal bleaching

Different bleaching treatments may be used to try to remove intrinsic stains and more tenacious extrinsic discoloration. Intracoronal tooth whitening, sometimes known as non-vital tooth whitening can be used to whiten teeth. By oxidizing the organic discoloration in the tooth, the bleaching treatment lightens the color of the teeth. The underlying etiology of the discoloration affects the effectiveness and efficacy of tooth bleaching. Internal bleaching is a minimally invasive and cost-effective dental technique that doesn't alter the tooth's size or position on the dental arch. Trauma can cause a tooth to become nonvital and lose its natural color without ever requiring endodontic treatment. In these situations, the first course of treatment should be a root canal. We can move forward with the internal bleaching technique if the tooth has had endodontic treatment. Before placing all ceramic restorations, an interior bleaching may occasionally be required too. Pulp chamber origin discoloration is an indication for internal bleaching. Inflammation-mediated external root resorption known as cervical root resorption can occur after trauma and after intracoronal bleaching. Another internal bleaching issue was the coronal fracture, which is thought to have been brought on by desiccation or changes to the physicochemical properties of the dentin and enamel. The absence or minimal color difference between the treated and untreated teeth has traditionally been considered a sign of immediate treatment efficacy.

A RADIOGRAPHIC ANALYSIS OF EXTERNAL APICAL ROOT RESORPTION (EARR) OF MAXILLARY INCISORS AFTER 6 MONTHS OF INITIATION OF FIXED ORTHODONTIC APPLIANCE THERAPY

Consequences of External apical root resorption (EARR) range from slight tooth mobility due to mild amounts of root resorption to complete loss of teeth due to excessive root resorption. The purpose of this study was to measure the amount of EARR that might occur on the 4 maxillary incisor teeth while using the MBT system and to evaluate its clinical signicance during a 6-month period of active treatment. In addition, the contribution of gender, and how extraction and non-extraction of premolars is related to maxillary incisor EARR was examined. A sample of 40 patients between 12 -20 years of both genders reporting to the Department of Orthodontics &amp; Dentofacial Orthopaedics of KD Dental College was selected for this study. The amount of EARR for the 160 teeth was examined. There was no statistically signicance difference (p&gt;0.05) found between change in root length of Maxillary right Central incisor, Maxillary right lateral incisor, Maxillary left central incisor and Maxillary left lateral incisor. There was no statistically signicant difference was found among male and female with EARR and there was no statistical difference (p&gt;0.05) found in external apical root resorption among participants with premolar extraction and without premolar extraction. This study concludes that all the maxillary incisors in this investigation did not show any kind signicant EARR after the follow-up period of 6months of active orthodontic treatment with MBT treatment techniques, no signicant changes in EARR was observed when comparison was made for gender and also for treatment where premolar extraction was done.

Biomarkers in External Apical Root Resorption: An Evidence-based Scoping Review in Biofluids.

External apical root resorption (EARR), an unwanted sequela of orthodontic treatment, is difficult to diagnose radiographically. Hence, the current scoping review was planned to generate critical evidence related to biomarkers in oral fluids, i.e. gingival crevicular fluid (GCF), saliva, and blood, of patients showing root resorption, compared to no-resorption or physiologic resorption. A literature search was conducted in major databases along with a manual search of relevant articles in the library, and further search from references of the related articles in March 2021. The initial search was subjected to strict inclusion and exclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Following PRISMA guidelines, 20 studies were included in the final review. The studies included human clinical trials and cross-sectional and prospective studies with/without control groups with no date/language restriction. Various biomarkers identified in EARR included dentinal proteins, enzymes, cytokines, and salivary proteins. Severe resorption had higher dentin sialoprotein (DSP) and resorption protein concentrations as well as lower granulocyte-macrophage colony-stimulating factor (GM-CSF) as compared with mild resorption. Increased DSP and dentin phosphophoryn (DPP) expression was found in physiologic resorption. Compared to controls, resorbed teeth showed a higher receptor activator of nuclear factor kappa B ligand/osteoprotegerin (RANKL/OPG) ratio. In contrast, levels of anti-resorptive mediators (IL-1RA, IL-4) was significantly decreased. Differences in force levels (150 g and 100 g) showed no difference in resorption, but a significant rise in biomarkers (aspartate transaminase [AST] and alkaline phosphatase [ALP]) for 150 g force. Moderate to severe resorption in young patients showed a rise in specific salivary proteins, requiring further validation. Limitations of the studies were heterogeneity in study design, biomarker collection, sample selection, and confounding inflammatory conditions. Various biomarkers in biofluids indicate active resorption, while resorption severity was associated with DSP and GM-CSF in GCF, and a few salivary proteins. However, a robust study design in the future is mandated.