Severe Apical Root Resorption Research Articles

Root Resorption during Orthodontic Treatment with Clear Aligners vs. Fixed Appliances—A Systematic Review

The external apical root resorption that occurs during orthodontic treatment was the focus of this study, using either fixed appliances (FA) or clear aligners (CA). Using the Boolean keywords “APICAL ROOT RESORPTION” and “CLEAR ALIGNERS”, the study searched PubMed, Scopus, and Web of Science, with a restriction to English-language publications. A total of 50 publications were found by the computerized search, but after eliminating duplicates, completing reviews, and determining eligibility, only 9 papers could be used in the study. In conclusion, apical root resorption (ARR) is a frequent consequence of orthodontic tooth movement that mainly affects the lower incisors, which may compromise the success of the procedure and the health of the patient’s teeth. Several variables, including the type of tooth, have an impact on the severity of ARR.

Assessment of Digital Intraoral Periapical Radiograph for the Detection of Apical Root Resorption in Inflammatory Periapical Pathologies: A Radiovisiography Study.

Introduction Resorption often takes the form of external inflammatory root resorption. Apical periodontitis or an apical cyst is the most typical cause of external inflammatory root resorption. Failure of endodontic treatment can occur if severe apical root resorption occurs.This is due to the difficulty of reaching these sites.Apical root resorption is usually discovered during routine radiographs and is usually in its later stages. If the lesion is advanced, extraction is the only viable solution. An accurate diagnosis of incipient root resorption is essential.This research is designed to analyze the effectiveness of digital intraoral periapical radiographs in assessing apical root resorption (ARR) related to periapical pathologies. Material and methods Thiscross-sectional radiographic observational researchwas conductedin a dental college and hospital in central India. Radiovisiography (RVG) images of 190 patients' teeth with inflammatory periapical pathologies were evaluated to determine the presence or absence of resorption in the apical area of the root. After the radiographic assessment of the apical root resorption, the extraction of the affected teeth was done under all aseptic conditions. The periapical tissue was sent for histological analysis and the extracted tooth sample was examined for the presence or absence of apical root resorption. Results In comparison to apical periodontitis, the proportion of severe root resorption patients was significantly higher in abscess and periapical granuloma. Using Pearson's Chi-square test, the difference in patient proportions according to the kind of resorption in the three radiological diagnosis groups was statistically significant with a p-value of 0.0058. Conclusion It was concluded that on radiographic examination, digital intraoral periapical radiographs were found to be accurate in determining periapical apical pathologies and apical root resorption.

Apical incisor root resorption due to ectopic maxillary canine eruption: Association with time of diagnosis and type of intervention in a retrospective population-based cohort study.

The primary aim was to study upper incisor severe apical root resorption (RR) related to ectopic canine eruption and its association with timing of diagnosis and type of intervention conducted. The secondary aim was to correlate resorption with other dental anomalies. Digital journals and radiographic material of all ectopic maxillary canines registered in 2012 in the regional public paediatric dental clinics in the Council of Aarhus were inspected retrospectively. Data related to 10 variables were retrieved. Post-treatment radiographs were used for evaluation of incisor RR. A total of 260 ectopic maxillary canines were diagnosed in 2012. The majority were found in the 9-13-year-old age group (0.8% prevalence within the total population). In all, 244 canines were assessed for eligibility and 181 had adequate final radiographs for evaluation of RR. Among ectopic maxillary canines, 9.4% caused severe incisor RR to neighbouring teeth. Timely palpation for canine eruption significantly reduced the odds for upper incisor resorption by 80%. Multiple regression showed that when the permanent canine cannot be palpated and the deciduous has been extracted, delaying the first X-rays was associated with a 38% odds ratio increase for RR for each year of delay after the age of 10 years. No significant associations were found between incisor RR and intervention conducted or other dental anomalies. Palpation of erupting maxillary canines is crucial for timely diagnosis of ectopic eruption and initiation of treatment to avoid RR. If the canine cannot be palpated at 10 years of age, radiographic examination is highly recommendable.

Evaluation of Risk Factors for Severe Apical Root Resorption in the Maxillary Incisors Following Fixed Orthodontic Treatment.

The aim of this study was to retrospectively determine the prevalence of severe external root resorption in maxillary inci- sors during fixed orthodontic treatment and to evaluate the possible predisposing factors. The treatment records of 7000 patients who had been treated between 1990 and 2019 at the Department of Orthodontics Faculty of Dentistry Marmara University were examined, and a total of 120 patients with severe root resorption in at least one of their upper incisors were identified. The following data were retrieved from the patients' records and radiographs: gender, root morpholo- gy, overjet, overbite, treatment modality (extraction, non-extraction), treatment duration, buccal and palatal alveolar bone thickness for the maxillary incisors, and amount of movement of the incisal root apices and incisal edges. These data from a group of 90 patients with severe root resorption were compared with the data from a control group of 90 patients with minimal root resorption. The Chi- square test, the Mann-Whitney U-test, and the independent t-test were used for statistical analysis. The prevalence of severe external root resorption was 3.23%, and the results demonstrated significant difference between the groups for the variables of treatment modality (extractions), treatment duration, thickness of the alveolar bone, and amount of incisor movement at the end of the treatment. It can be concluded that extractions, increased treatment duration, thin alveolar bone, and excessive incisor movement represent risk factors for severe root resorption in maxillary incisors following orthodontic treatment.

Comparison of Apical Root Resorption in Patients Treated with Fixed Orthodontic Appliance and Clear Aligners: A Cone-beam Computed Tomography Study

To carry out comparison of apical root resorption (ARR) in the fixed orthodontic appliance and clear aligners with the help of cone-beam computed tomography (CBCT) imaging. The study was conducted on 576 roots in 110 patients. These patients were divided into two groups such that each group consisted of 55 patients. A total of 288 roots were analyzed in each group. One group consisted of patients treated with the conventional fixed orthodontic appliance. Another group consisted of patients treated with clear aligners. Radiographic images were collected with the help of CBCT for each patient. One image was collected before treatment while another image was collected after treatment. The length of the root of the anterior tooth was measured with the help of CBCT images. The ARR was calculated for each tooth by obtaining the difference between the length of the root measured before orthodontic treatment and after orthodontic treatment. The data were recorded, and statistical analysis was carried out with the help of the paired t test and Chi-square test to compare ARR between the two groups. The ARR was more in patients who were treated with fixed orthodontic treatment than in those patients who were treated with clear aligners. The mean value of ARR in fixed orthodontic appliances was 1.51 ± 1.34 mm, whereas the mean value of ARR in clear aligners was 1.12 ± 1.34 mm. The severity of ARR in the clear aligners group (on average) was significantly less than that in the fixed appliances group (on average). It was found that ARR in each individual's tooth included in the study was more in case of the fixed orthodontic appliance as compared with clear aligners (p <0.001). From the present study, it can be concluded that the amount of resorption at the root apex is less among patients who undergo treatment using clear aligners as compared with those treated with conventional fixed orthodontics appliances. ARR found in the orthodontic treatment is a process that causes loss of hard dental tissues such as dentine and cementum at the root apex. Fixed orthodontic appliances are most common method of orthodontic treatment. However, clear aligners are also used commonly for orthodontic treatment.

DISTRIBUTION AND SEVERITY OF APICAL ROOT RESORPTION IN INFLAMMATORY PERIAPICAL PATHOLOGIES AMONGST DIABETIC AND NON DIABETIC PATIENTS – A PILOT STUDY

Distribution and severity of apical root resorption in inflammatory periapical pathologies amongst diabetic and non diabetic

Prevalence and severity of apical root resorption during orthodontic treatment with clear aligners and fixed appliances: a cone beam computed tomography study

BackgroundFixed appliances have been the mainstream for orthodontic treatment, while clear aligners, such as Invisalign system, have become increasingly popular. The prevalence of apical root resorption (ARR) in patients with clear aligners is still controversial. The aim of this study was to investigate and compare the prevalence and severity of ARR in patients treated with clear aligners and fixed appliances using cone beam computed tomography (CBCT).Materials and methodsA total of 373 roots from 70 subjects, with similar baseline characteristics and the ABO discrepancy index scores (i.e., treatment difficulty), were included into two groups: the clear aligners group (Invisalign, Align Technology, California, USA) and fixed appliances group (Victory Series; 3 M Unitek, California, USA). Root length of each anterior tooth was measured on the CBCT images by two blinded investigators. The ARR on each tooth was calculated as the difference of root length before and after orthodontic treatment. Chi-square test and paired t test was used to compare the ARR between the two groups as well as before and after orthodontic treatments.ResultsPrevalence of ARR in the clear aligners group (56.30%) was significantly lower than that in the fixed appliances group (82.11%) (P < 0.001). The severity of ARR in the clear aligners group (0.13 ± 0.47 mm) was significantly less than that in the fixed appliances group (1.12 ± 1.34 mm) (P < 0.001). The most severe ARR was found on the maxillary canine (1.53 ± 1.92 mm) and lateral incisor (1.31 ± 1.33 mm) in the fixed appliances group; the least ARR was found on the mandibular canine (− 0.06 ± 0.47 mm) and lateral incisor (0.04 ± 0.48 mm) in the clear aligners group (P < 0.001).ConclusionsThe prevalence and severity of ARR measured on CBCT in patients with clear aligners were less than those in patients with fixed appliances.

Effects of loxoprofen on the apical root resorption during orthodontic tooth movement in rats.

Studies have revealed that severe apical root resorption during tooth movement is caused by the noninfective inflammatory reaction of apical root tissues. We hypothesized that loxoprofen can suppress apical root resorption during tooth movement. Cyclic tensile force (CTF) of 10 kPa was applied to the human pulp cells for 48 hours by the Flexcell Strain Unit. Loxoprofen (10 and 100 μM) was added to the culture cells, and expression of cyclooxygenase (COX)-1, COX-2, interleukin (IL)-1β, receptor activator of nuclear factor kappa-B ligand (RANKL), tumor necrosis factor (TNF)-α, and macrophage colony-stimulating factor (M-CSF) were examined. To determine the effects of loxoprofen sodium on apical root reabsorption during tooth movement, the upper first molars of 7-week-old rats were subjected to mesial movement by 10g force for 30 days with or without the oral administration of loxoprofen. Gene expression and protein concentration of COX-1, COX-2, IL-1β, TNF-α, RANKL and M-CSF were significantly higher in the CTF group than in the control group. However, these levels were decreased by loxoprofen administration. After orthodontic tooth movement, the expression of IL-1β, TNF-α, RANKL and M-CSF decreased in the loxoprofen group than in the control group by immunohistochemical staining. In comparison to control group, less number of odontoclasts and a decrease in the amount of apical root resorption was observed in the loxoprofen group. Many osteoclasts became visible on the pressure side of the alveolar bone in the both groups, and the amount of tooth movement did not show a significant difference. These findings demonstrate that severe apical root resorption may be suppressed by loxoprofen administration, without a disturbance of tooth movement.

Radiographic assessment of apical root resorption in inflammatory periapical pathologies

Introduction: Apical root resorption (ARR) is a common condition associated with periapical pathologies which is invariably detected by intraoral periapical radiographs. Although it is common, its distribution in different periapical pathologies has not been assessed so far. The aim of this study was to determine the distribution and severity of ARR in common inflammatory periapical pathologies. Materials and Methods: A cross-sectional radiographic study was conducted on 333 patients who visited SEGi Oral Health Centre in the 6-month period of the study. Digital intraoral periapical radiographs of patients with clinically established periapical pathologies were taken. Data were collected using a structured proforma regarding the type of periapical lesions, presence or absence of ARR. Collected data were analyzed using SPSS version 21 and Chi-square test was applied to check the association between ARR and periapical pathologies. Results: During this study period, 333 patients with inflammatory periapical pathologies were reported. Of which 135 (40.5%) showed definite ARR. Among 135 ARR, 97 (71.9%) were moderate resorption and 38 (28.1%) were severe resorption. ARR was significantly greater in periapical granuloma and cyst (72.8%) followed by periapical abscess (35%) and acute apical periodontitis (18.1%) which was statistically significant (P

Orthodontic Traction of the Impacted Mandibular Third Molars to Replace Severely Resorbed Mandibular Second Molars

Prophylactic removal of impacted third molars is a common procedure in dentistry, but the necessity of routine extraction is still controversial. When impacted third molars caused severe apical root resorption of the second molars, orthodontic traction of the third molars after extraction of the damaged second molars could minimize alveolar bone defect and preserve the patient's natural teeth. By well-planned orthodontic treatment, functional occlusion was established avoiding extraction of the impacted teeth and eliminating the possibility of a large bone defect after extraction.

Incisal Apical Root Resorption Evaluation after Low-Friction Orthodontic Treatment Using Two-Dimensional Radiographic Imaging and Trigonometric Correction.

Root resorption shall be taken into consideration during every orthodontic treatment, and it can be effected by the use of different techniques, such as the application of low friction mechanics. However, its routinely assessment on orthopantomography has limitations related to distortions and changes in dental inclination. The aim of this investigation was to evaluate the severity of apical root resorption of maxillary and mandibular incisors after low-friction orthodontic treatment, using the combination of panoramic and lateral radiographs, and applying a trigonometric correction. A hospital based Retrospective study at the orthodontic Department (Dental School, University of Brescia, Spedali Civili di Brescia, Brescia, Italy). Ninety-three subjects (53 females and 40 males; mean age, 14 years) with mild teeth crowding were treated without extractions by the same operator using a low-friction fixed appliance following an integrated straight wire (ISW) protocol. The pre- and post-treatment tooth lengths of the maxillary and mandibular incisors were measured on panoramic radiographs. A trigonometric factor of correction for the pre-treatment length was calculated based on the difference between the pre and post-treatment incisal inclination on lateral cephalograms. The changes in lengths were investigated using the Student's t-test for paired values (p<0.05). Maxillary central incisors showed no changes (0.3%, 0.6%), maxillary lateral incisors showed a small increase (1.4%, 1.8%) that was attributed to the completion of root development in younger patients, mandibular central and lateral incisors underwent slight resorption (-3.1%, -3.4%). A statistically significant difference was found for the mandibular incisors but not for the maxillary ones. In patients with mild crowding and consequent low amount of root movement, a low-friction orthodontic treatment can lead to slight apical root resorption, mainly involving lower incisors. The use of a trigonometric correction in the panoramic radiograph analysis may reduce the limitations of this 2D evaluation.

Extent and prognosis of apical root resorption due to orthodontic treatment

Background Root resorption is the most common side effect of orthodontic treatment and usually occurs within the first 6 months of treatment. Circumferential apical root resorption represents full resorption of the apical hard tissue components and evident root shortening. Although rarely serious it is a devastating event when recognized radiographically. The purpose of this article is to provide the dental practitioner with the results of studies on the extent of apical root resorption detected with clinical radiographs in patients treated with fixed appliances during or after orthodontic treatment and to provide the answers to the following questions: which teeth are most affected by apical root resorption, what happens to the resorbed tooth and what does the prognosis look like? The results could provide the best available evidence for clinical decisions to minimize the risk and severity of apical root resorption.

Detection of apical root resorption after orthodontic treatment by using panoramic radiography and cone-beam computed tomography of super-high resolution

Apical root resorption is an adverse side effect of orthodontic treatment. We compared panoramic radiography (OPT) with cone-beam computed tomography (CBCT) in evaluating orthodontically induced apical root resorption. The study sample comprised 275 teeth in 22 patients near the end of orthodontic treatment with fixed appliances. Two calibrated examiners assessed blindly the presence or absence and the severity of apical root resorption on the OPT images after treatment and the corresponding reconstructed CBCT images. Resorption was evaluated as no, mild, moderate, severe, and extreme. On the OPT images, 17 teeth (6.2%) could not be evaluated. Statistically significant differences were found between the 2 methods: 56.5% and 31% of the teeth showed no resorption by OPT and CBCT, respectively; 33.5% and 49% of the teeth showed mild resorption, whereas 8% and 19% showed moderate resorption by OPT and CBCT, respectively. Severe resorption was found in only 2 teeth by CBCT. Apical root resorption after orthodontic tooth movement is underestimated when evaluated on OPT. CBCT might be a useful complementary diagnostic method to conventional radiography, to be applied when a decision on continuation or modification of the orthodontic treatment is necessary because of orthodontically induced root resorption.

Identification of orthodontic patients at risk of severe apical root resorption

Current information suggests that the major variation in orthodontic root resorption can be explained by differences in individual predisposition. Our aim was therefore to test the predictive value of the amount of maxillary incisor resorption about 6 and 12 months after bracket placement for the resorption at appliance removal. We measured tooth length of the maxillary incisors on digitally converted periapical radiographs, adjusted for projection errors, made before treatment (T1), about 6 months (T2) and 12 months (T3) after bracket placement, and at the end of active treatment (T4) of 267 prospectively enrolled orthodontic patients, and interpreted reduced tooth length as apical root resorption. Anatomic and occlusal parameters were scored on the T1 radiographs and study models. Anamnestic and treatment parameters were collected from standardized recordings in the charts. The Spearman R for resorption of each incisor ranged from 0.61 to 0.76 at T2 vs T4, and from 0.77 to 0.88 at T3 vs T4 (P <0.001). Only 0.6% of the patients with no incisors with >1.0 mm of resorption at T2 and 0.5% of those with no incisors with >2.0 mm of resorption at T3 had at least 1 incisor with >5.0 mm of resorption at T4. Amount of resorption at T3 and maxillary tooth extraction were included in the final prediction model for resorption of the most severely affected central and lateral incisors at T4, with explained variances of 0.71 and 0.67, respectively. Treatment duration and time with square wires was not related to resorption (P >0.05). Patients at risk of severe apical root resorption can be identified according to the amount of resorption during the initial treatment stages.

Orthognathic treatment case after severe root resorption in the early treatment stage

This article presents an orthognathic treatment case after severe apical root resorption of maxillary anterior teeth using anterior segmental osteotomy. This case involved a 20-year-old female with the chief complaint of maxillary protruding and irregularly aligned mandibular anterior teeth. Her medical history showed no allergies or medical problems. The overbite was +3.0 mm, and the overjet +3.0 mm. After extraction of the four first premolars, a multi-bracket treatment was started. A severe root resorption of the maxillary anterior teeth was found 12 months after active treatment. The maxillary anterior segmental osteotomy was chosen as the compensatory treatment. The total treatment period was 2 years and 7 months. The post-retention panoramic radiograph showed no developmental root resorption.

Substance P increases production of proinflammatory cytokines and formation of osteoclasts in dental pulp fibroblasts in patients with severe orthodontic root resorption

The objective of this study was to determine the extent to which substance P (SP) increases proinflammatory cytokine production and osteoclast formation of human dental pulp fibroblasts (HDPF) in patients with severe orthodontically induced inflammatory root resorption (OIIRR). HDPF were obtained from 5 patients with severe apical root resorption after orthodontic treatment. The levels of interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha were determined after 24 hours by using ELISA kits. Furthermore, culture supernatants were added to cultured human osteoclasts, and osteoclast formation was observed after tartrate-resistant acid phosphatase (TRAP) staining and the formation of resorption cavities. Stimulation with SP increased the levels of IL-1beta, IL-6, and TNF-alpha, in a time- and concentration-dependent manner, although the increase was greater in the severe root resorption (SRR) group than in the nonresorption (NR) group (P < 0.001, 3-way repeated measures ANOVA). As for osteoclast formation, the numbers of TRAP-positive multinucleate cells and resorptive pits were significantly increased in the SRR group compared with the NR group (P < 0.001, 2-way repeated measures ANOVA). These results suggest that HDPF stimulated with SP might be deeply involved in the progress of inflammation in pulp tissue and the incidence of SRR during orthodontic treatment.

Apical root resorption after orthodontic treatment a retrospective study

The purpose of the study was to compare the incidence and severity of apical root resorption in patients treated with different orthodontic appliances and to evaluate the effect of treatment duration on the degree of apical root resorption. A further aim was to analyse the degree of apical root resorption in different tooth groups in patients presenting with root resorption. The sample consisted of 625 patients (269 males, 356 females) aged 8-16 years at the beginning of treatment. Active removable plates and fixed appliances were used most frequently. Following exclusion of poor quality radiographs, the final sample included 601 patients (348 females, 253 males). Root resorption in all tooth groups, except third molars, was evaluated from pre- and post-treatment panoramic radiographs. The correlation of root resorption with treatment modality and duration was studied using multinomial logistic regression analysis. Of the tooth groups, maxillary incisors showed apical root resorption most frequently, followed by the mandibular incisors. Root resorption was significantly correlated with fixed appliance treatment (P < 0.001). In addition, the duration of fixed appliances treatment was found to contribute significantly (P < 0.01) to the degree of root resorption. The mean duration of treatment in patients without root resorption was 1.5 years, whereas in those with severe resorption was 2.3 years. The most severe resorption was seen in the maxillary incisors and premolars. It is concluded that with a long duration of fixed appliance treatment, the risk of severe resorption increases. In patients where treatment is prolonged, a 6-month radiographic follow-up is recommended.

Oral Aspects of Gaucher's Disease: A Literature Review and Case Report

Gaucher's disease (GD) is a lysosomal storage disease with a high incidence in Ashkenazi Jews. The disease is caused by an autosomally recessive inherited deficiency of the lysosomal enzyme glucocerebrosidase, leading to the accumulation of glucocerebroside in macrophages. The lipid-laden macrophages, called Gaucher cells, can be detected in liver, spleen, and bone marrow tissues. A case report of periodontal treatment of a 47-year-old female patient with GD with recurrent gingival hemorrhage and toothache is presented. Periapical radiographs revealed cyst-like lesions in the mandibular premolar-molar regions accompanied by severe apical root resorption, enlargement of the periodontal ligament and bone-marrow spaces, and loss of trabecular structure and radiopaque appearance of bone. An abnormally narrow and sharp coronoid process and effacement of the cortical borders of the mandibular canal were noted. The patient was diagnosed as having generalized severe chronic periodontitis. Treatment included oral hygiene motivation and instructions, scaling, root planing, and access flap therapy, resulting in resolution of periodontal signs and symptoms and a marked improvement in the patient's feeling of well being. Periodontal treatment can be effective in patients with GD. Oral findings may lead to early detection of GD, especially in the absence of clinical symptoms. Dentists should be aware of possible oral and radiographic manifestations of the disease and the role of periodontal treatment in improving patient's oral health and quality of life.

Is mild dental invagination a risk factor for apical root resorption in orthodontic patients?

The purpose of this retrospective study was to assess if dental invagination is a risk factor for root resorption during orthodontic treatment. The sample consisted of 91 patients (32 males, 59 females) with a mean age of 13.1 years (range 9.3-32.1 years) with complete orthodontic records, including periapical radiographs of the maxillary incisors before and after treatment. Forty-nine patients had at least one maxillary incisor invaginated, whilst the remaining 42 patients were free of dental invaginations. Variables recorded for each patient included gender, age, Angle classification, extraction or non-extraction therapy, ANB angle, overjet, overbite, trauma, habits, agenesis, tooth exfoliation, treatment duration, Class II elastics, body-build, general factors, impacted canines, and root form deviation. Crown and root length of the maxillary incisors were measured on pre- and post-treatment long cone periapical radiographs corrected for image distortion. The percentage of root shortening and root length loss in millimetres was then calculated. Most of the invaginated teeth were minor type 1. Statistical analysis revealed no significant difference in the severity of apical root resorption between invaginated and non-invaginated incisors in patients without dental invaginations, nor was the extent of dental invagination related to the severity of apical root resorption. However, invaginated teeth had malformed roots more often than non-invaginated teeth. Dental invagination, and particularly type 1, cannot be considered a risk factor for apical root resorption during orthodontic tooth movement.

Restoration and retention of maxillary anteriors with severe root resorption

The authors describe the treatment of three patients who had severe apical root resorption of maxillary lateral incisors caused by ectopically erupting canines. Ectopically erupting canines derive from a normal path of eruption and may cause resorption of the adjacent teeth. The authors present the three cases of severe root resorption caused by ectopically erupting canines. They then discuss various prosthetic options; the indications, advantages and disadvantages of various treatment modalities; the long-term retention and esthetic concerns of the patients; and the inherent limitations of restorative treatment. Increased tooth mobility and long-term retention are significant concerns in cases of patients who have severe root resorption. Attaining stability with lingual splinting can cause esthetic problems. An interdisciplinary approach is necessary to provide optimal care for the patient.