Severe Root Resorption Research Articles

Biological replacement of maxillary central incisors by transposition of lateral incisors: a 15-year follow-up

Permanent maxillary central incisors are the teeth most frequently affected by traumatic lesions during dentition development. Alterations may occur concurrently with trauma or in the medium- or long-term as a result of posttraumatic complications, ultimately leading to tooth loss due to severe root resorption. Conservative treatment options should be prioritized in these cases with a view to producing a biological response capable of providing growth continuity for the alveolar bone, thereby favoring the functional and aesthetic development of the affected region. This case report describes a patient with congenitally missing mandibular second premolars and severe root resorption of the permanent maxillary central incisors due to traumatic avulsion. The treatment included extraction of the permanent maxillary central incisors and a deciduous second molar, which was then followed by biological replacement by transposition of lateral incisors, mesial movement of posterior segments, and aesthetic and volumetric reconstruction. A 15-year follow-up of the patient is described.

Three-dimensional assessment of impacted canines and root resorption using cone beam computed tomography

The objective of this study was to localize impacted canines in 3 dimensions and determine the most common location of impaction using cone beam computed tomography (CBCT). We also assessed root resorption of adjacent teeth. The cusp tip of each impacted canine was located and digitized using Dolphin 3D imaging, after viewing sagittal, coronal, and axial views. The position on the occlusal plane where the normally erupted canine cusp tip should be located was used as a control reference point. The degree of impaction was defined by the difference between the impacted canine cusp tip and reference cusp tip positions. CBCT scans of 29 consecutive individuals with impacted canines undergoing orthodontic treatment at the UCSF Orthodontic Clinic were included in this study. The average degree of mesial impactions was 10.1 mm, of distal impactions was 4.2 mm, of facial impactions was 4.16 mm, of palatal impactions was 1.8 mm, and of gingival impactions was 10 mm; 40.4% had no root resorption, 35.7% showed slight root resorption, 14.2% showed moderate resorption, and 4% showed severe root resorption of the adjacent lateral incisor. We reliably assessed the position of impacted canines in 3 dimensions using CBCT, thereby improving accuracy of location and facilitating precise surgical and orthodontic management. In our study 40.4% had no root resorption, 35.7% showed slight root resorption, 14.2% showed moderate resorption, and 4% showed severe root resorption of the adjacent lateral incisor. The most frequent location of impacted canines was palatal, mesial, and gingival.

Regional Aggressive Root Resorption Caused by Neuronal Virus Infection

During orthodontic treatment, root resorption can occur unexplainably. No clear distinction has been made between resorption located within specific regions and resorption occurring generally in the dentition. The purpose is to present cases with idiopathic (of unknown origin) root resorption occurring regionally. Two cases of female patients, 26 and 28 years old, referred with aggressive root resorption were investigated clinically and radiographically. Anamnestic information revealed severe virus diseases during childhood, meningitis in one case and whooping cough in the other. One of the patients was treated with dental implants. Virus spreading along nerve paths is a possible explanation for the unexpected resorptions. In both cases, the resorptions began cervically. The extent of the resorption processes in the dentition followed the virus infected nerve paths and the resorption process stopped when reaching regions that were innervated differently and not infected by virus. In one case, histological examination revealed multinuclear dentinoclasts. The pattern of resorption in the two cases indicates that innervation is a factor, which under normal conditions may protect the root surface against resorption. Therefore, the normal nerve pattern is important for diagnostics and for predicting the course of severe unexpected root resorption.

Apical root resorption during orthodontic treatment

To investigate the incidence and severity of root resorption during orthodontic treatment by means of cone beam computed tomography (CBCT) and to explore factors affecting orthodontically induced inflammatory root resorption (OIIRR). CBCT examinations were performed on 152 patients with Class I malocclusion. All roots from incisors to first molars were assessed on two or three occasions. At treatment end, 94% of patients had ≥1 root with shortening >1 mm, and 6.6% had ≥1 tooth where it exceeded 4 mm. Among teeth, 56.3% of upper lateral incisors had root shortening >1 mm. Of upper incisors and the palatal root of upper premolars, 2.6% showed root shortenings >4 mm. Slanted surface resorptions of buccal and palatal surfaces were found in 15.1% of upper central and 11.5% of lateral incisors. Monthly root shortening was greater after 6-month control than before. Upper jaw teeth and anterior teeth were significantly associated with the degree of root shortening. Gender, root length at baseline, and treatment duration were not. Practically all patients and up to 91% of all teeth showed some degree of root shortening, but few patients and teeth had root shortenings >4 mm. Slanted root resorption was found on root surfaces that could be evaluated only by a tomographic technique. A CBCT technique can provide more valid and accurate information about root resorption.

Root resorption diagnosed with cone beam computed tomography after 6 months of orthodontic treatment with fixed appliance and the relation to risk factors

To investigate root resorption after 6 months of active orthodontic treatment and its relation to possible risk factors. Ninety-seven patients (10-18 years) with a Class I malocclusion and crowding treated with fixed appliance and premolar extractions were examined with cone beam computed tomography before and after 6 months of active treatment. The exposure covered all teeth from first molar to first molar in both jaws. The Malmgren index was used to evaluate the degree of root resorption. Irregular root contour (score 1) was seen in most teeth already before active treatment, and therefore resorptions were registered only as score 2 (<2 mm, minor resorption) or higher. Minor root resorption was noted in 10% of the patients and severe root resorption, >2 mm (score 3) was found in four patients. Root resorption was more frequently seen in the upper jaw, especially the incisors. There was no statistically significant correlation of root resorption with any of the selected risk factors. After 6 months of treatment, clinically significant resorption was diagnosed in 4% of the patients, ie, in 96% of the patients the radiographic examination did not reveal any significant information. The selected risk factors did not have any impact on the amount of resorption after 6 months of active treatment.

Association between root resorption incident to orthodontic treatment and treatment factors

The purpose of this study was to clarify the prevalence and degree of root resorption induced by orthodontic treatment in association with treatment factors. The files of 243 patients (72 males and 171 females) aged 9-51 years were randomly selected from subjects treated with multi-bracket appliances. The severity of root resorption was classified into five categories on radiographs taken before and after treatment. The subjects were divided into extraction (n = 113 patients, 2805 teeth) and non-extraction (n = 130 patients, 3616 teeth) groups and surgical (n = 56 patients, 1503 teeth) and non-surgical treatment (n = 187 patients, 4918 teeth) groups. These subjects were also divided into two or three groups based on the duration of multiloop edgewise archwire (MEAW) treatment, elastic use, and total treatment time: 0 month (T1; n = 184 patients, 4831 teeth), range 1-6 months (T2; n = 37 patients, 994 teeth), more than 6 months (T3; n = 22 patients, 596 teeth); range 0-6 months (n = 114 patients, 3016 teeth) more than 6 months (n = 129 patients, 3405 teeth); range 1-30 months (n = 148 patients, 3913 teeth) and more than 30 months (n = 95 patients, 2508 teeth). The prevalence of overall and severe root resorption evaluated by the number of subjects and teeth was compared with a chi-square test. A Student's t-test for unpaired data was used to determine any statistically significant differences. The prevalence of severe root resorption based on the number of teeth was significantly higher in the group with extractions (P < 0.01). Longer use of a MEAW appliance and elastics also produced a significantly higher prevalence of root resorption (P < 0.05). On the other hand, the prevalence of severe root resorption was not significantly different between the subjects treated with or without surgery, but there was a significant increase when treatment time was prolonged (P < 0.05). A significant difference was found in the amount of root movement of the upper central incisors and the distance from their root apices to the cortical bone surface (P < 0.05). These are regarded as essential factors in the onset of root resorption. These results indicate that orthodontic treatment with extractions, long-term use of a MEAW appliance and elastics, treatment time, and distance of tooth movement are risk factors for severe root resorption.

Maxillary incisor root resorption induced by ectopic canines

To evaluate the long-term clinical and radiographic effects of maxillary incisor root resorption in cases of ectopic canines treated during the late 1970s and 1980s in Jönköping, Sweden. The material comprised 55 incisors in 38 subjects. The posttreatment follow-up time was 13 to 28 years. All subjects underwent intraoral radiography, 33 were referred for computed tomography or cone beam computed tomography, and 24 also underwent clinical examination. The severity of incisor root resorption was correlated with clinical characteristics. Radiographs of the resorptive lesions were documented in detail and compared with intraoral radiographs taken immediately posttreatment. Four incisors in three subjects had been lost, in part because of root resorption. Of the 36 incisors with root resorption, the lesions were unchanged in 26 teeth, improved in three teeth, and exacerbated in seven. In one case the resorption had progressed to pulpal exposure, necessitating endodontic treatment. For most of the incisors, the periodontal ligament was more clearly defined and the lamina dura showed improved trabeculation. The clinical characteristics of the incisors with resorption were not significantly different from those of sound incisors. In this long-term follow-up, most cases of incisor root resorption induced by ectopic maxillary canines did not progress and teeth with root resorption showed no clinically relevant symptoms. The prognosis for long-term survival of teeth with resorbed roots is good, but in cases where extraction is indicated, lateral incisors with severe root resorption should be extracted in favor of healthy premolars.

Severe root resorption and orthodontic treatment: Clinical implications after 25 years of follow-up

Stability and prognosis of teeth with severe root resorption is problematic in orthodontics. Because severe root resorption, when it occurs in orthodontic patients, is an iatrogenic consequence of treatment, periodic analysis for all patients is encouraged. This article reports a case of severe root resorption 25 years after the completion of orthodontic treatment. The root resorption did not exhibit significant progression and the patient had a healthy periodontal status. Orthodontic patients with sharp, pointed roots who require premolar extraction might have a greater risk of severe root resorption.

Apical Root Resorption Is Associated With Comprehensive Orthodontic Treatment but Not Clearly Dependent on Prior Tooth Characteristics or Orthodontic Techniques

SYSTEMATIC REVIEW CONCLUSION: Increased incidence and severity of external apical root resorption (EARR) occurred in patients undergoing comprehensive orthodontic therapy, especially when therapy involved higher levels of force than those commonly used for orthodontic tooth movement. CRITICAL SUMMARY ASSESSMENT: Results from a high-quality systematic review of 11 randomized clinical trials (RCTs) suggests that EARR has a multifactorial etiology; is associated with comprehensive orthodontics; supports the clinical use of light forces, especially during intrusion of teeth; and requires higher-quality research. EVIDENCE QUALITY RATING: Limited.

Clinical management of severe external root resorption and immature open apex with MTA and calcium hydroxide - A case report

External apical root resorption in permanent dentition is usually pathological. Local factors are the most frequent causes of resorption, especially excessive pressure and inflammation. Depending upon the type of resorption and etiology, different treatment regimens have been proposed. This case demonstrates external root resorption arrest and formation of an apical barrier by conventional endodontic therapy combined with calcium hydroxide dressing and a mineral trioxide aggregate (MTA) apical plug. The upper left central incisor exhibited severe external root resorption along with open apex in both right and left central incisors which received pulp space therapy combined with calcium hydroxide dressing. MTA apical plug backfilled with gutta-percha was performed and the access cavity was restored with composite resin. The patient has been regularly recalled every 6 months, and no symptoms or signs have been noted. Radiography the apical lesion healed and the external root resorption has been arrested after 1 year.

Dental auto-transplantation to anterior maxillary sites

To investigate the indications for, and the outcome of auto-transplantation of teeth to the anterior maxillary region. From 1978 to 1994, 41 teeth in 31 subjects were transplanted to anterior maxillary sites at the Department of Oral Surgery, Stavanger University Hospital, Norway. All transplantations were performed by one oral surgeon (B.G.). Relevant information was collected from patients' files, including radiographs of the tooth graft, the recipient site and follow-up radiographs. The mean observation period was 55.1 months (range 1-158 months). The age of the patients at the time of the auto-transplantation ranged from 10 to 30 years (mean 14.8 year). The most common indications for auto-transplantation were aplasia (41.5%), sequelae of trauma (36.6%) and impacted or ectopic teeth (17.1%). Eight teeth were judged to be failures; five had been extracted because of severe root resorptions and periodontal infection and three were judged as failures owing to severe ongoing root resorption but remained in the alveolus. Trauma is as common indication as aplasia for transplantation. From a biological point of view, dental auto-transplantation to the anterior maxillary region has a high success rate. Hence, auto-transplantation is an important treatment option for missing or lost maxillary anterior teeth where preservation of the alveolar bone is important during growth and development in adolescents. The major reason for failure was various types of root resorptions, some of which were detected late.

Root resorption associated with ectopically erupting maxillary permanent canines: a computed tomography study

The aims of this retrospective computed tomography (CT) study were to determine the occurrence of severe root resorption involving the pulpal canal of adjacent permanent teeth associated with ectopically erupting canines, and to verify the existence of related factors. The sample consisted of 255 consecutive patients (159 females and 96 males, mean age 18.4 and 16.8 years, respectively). Three hundred and thirty-four ectopic maxillary canines and adjacent teeth were analysed using CT images. Statistical significance was evaluated with chi-square and Fisher's exact tests. The results showed that severe root resorption of adjacent permanent teeth occurred in 17.7 per cent of ectopic canines and was equally common in females and males. Severe root resorption affected 12.6 per cent of the lateral incisors, 4.8 per cent of the first premolars, and 2.1 per cent of the central incisors. No relationship was found between the type or side of ectopic eruption, inclination of the longitudinal axis of the ectopic canine and the occurrence of severe root resorption. A significant relationship was found between a bucco-lingual position of the ectopic canine and root resorption (P < 0.05). Root resorption mainly occurred in the apical third (57.6 per cent) and apical and middle thirds (27.1 per cent). A significant relationship existed between the occurrence of root resorption and complete loss of space for the erupting canine (P < 0.05). No association was found between alignment of the upper permanent incisor and root resorption. A widened dental follicle occurred in 15 per cent of ectopic canines but did not cause root resorption of the adjacent permanent teeth. Since root resorption is asymptomatic, early detection by radiographic examination is essential for correct diagnosis and treatment.

Management of trauma‐induced inflammatory root resorption using mineral trioxide aggregate obturation: two‐year follow up

Inflammatory root resorption is a serious complication of dental trauma, which leads to progressive loss of the root structure. This report describes the treatment a previously traumatized young maxillary lateral incisor, severely affected by inflammatory root resorption. An 11-year-old boy presented with pain and mobility in his maxillary incisors which experienced fall trauma 2 years earlier. Radiographic examination revealed incomplete root development of the right central incisor, associated with advanced inflammatory root resorption and a periapical lesion. Following removal of a prior long-term calcium hydroxide dressing, the root canal was submitted to a 2-week irrigation regimen involving 1.25% sodium hypochlorite and 2% chlorhexidine gluconate. Thereafter, the entire root was filled with mineral trioxide aggregate. The radiographic follow up at 6 months showed arrest of root resorption and initiation of periapical healing in the absence of clinical symptoms and mobility. This was followed by advanced osseous regeneration and re-establishment of the periodontal space at 12 and 24 months. From the present case, it can be concluded that mineral trioxide aggregate obturation can be a viable option that can improve the healing outcomes in cases of severe inflammatory root resorption in young permanent teeth.

Root resorption during orthodontic treatment

Medline, Embase, LILACS, The Cochrane Library (Cochrane Database of Systematic Reviews, CENTRAL, and Cochrane Oral Health Group Trials Register) Web of Science, EBM Reviews, Computer Retrieval of Information on Scientific Project (CRISP, www.crisp.cit.nih.gov), On-Line Computer Library Center (www.oclc.org), Google Index to Scientific and Technical Proceedings, PAHO (www.paho.org), WHOLis (www.who.int/library/databases/en), BBO (Brazilian Bibliography of Dentistry), CEPS (Chinese Electronic Periodical Services), Conference materials (www.bl.uk/services/bsds/dsc/conference.html), ProQuest Dissertation Abstracts and Thesis database, TrialCentral (www.trialscentral.org), National Research Register (www.controlled-trials.com), www.Clinicaltrials.gov and SIGLE (System for Information on Grey Literature in Europe). Randomised controlled trials including split mouth design, recording the presence or absence of external apical root resorption (EARR) by treatment group at the end of the treatment period. Data were extracted independently by two reviewers using specially designed and piloted forms. Quality was also assessed independently by the same reviewers. After evaluating titles and abstracts, 144 full articles were obtained of which 13 articles, describing 11 trials, fulfilled the criteria for inclusion. Differences in the methodological approaches and reporting results made quantitative statistical comparisons impossible. Evidence suggests that comprehensive orthodontic treatment causes increased incidence and severity of root resorption, and heavy forces might be particularly harmful. Orthodontically induced inflammatory root resorption is unaffected by archwire sequencing, bracket prescription, and self-ligation. Previous trauma and tooth morphology are unlikely causative factors. There is some evidence that a two- to three-month pause in treatment decreases total root resorption. The results were inconclusive in the clinical management of root resorption, but there is evidence to support the use of light forces, especially with incisor intrusion.

Orthodontic rehabilitation for anterior teeth lost due to trauma with crowding malocclusion

Herein, we describe orthodontic management for an adolescent girl with traumatic loss of the upper central incisors and maxillary protrusion. The central incisors were immediately replaced and fixed with application of a semi-rigid splint for 12 days, then endodontically treated. Severe root resorption and degeneration of periodontal tissue were noted after 4 years and the teeth were extracted, while the patient had also developed maxillary protrusion with severe crowding in the lower arch. The treatment objectives were to close the spaces by mesial movement of the buccal segment in the upper arch and eliminate crowding by extraction of the lower bicuspids. Favorable occlusion was achieved as was substitution with the lateral incisors for the lost central teeth.

Root resorption associated with orthodontic tooth movement: A systematic review

This systematic review evaluated root resorption as an outcome for patients who had orthodontic tooth movement. The results could provide the best available evidence for clinical decisions to minimize the risks and severity of root resorption. Electronic databases were searched, nonelectronic journals were hand searched, and experts in the field were consulted with no language restrictions. Study selection criteria included randomized clinical trials involving human subjects for orthodontic tooth movement, with fixed appliances, and root resorption recorded during or after treatment. Two authors independently reviewed and extracted data from the selected studies on a standardized form. The searches retrieved 921 unique citations. Titles and abstracts identified 144 full articles from which 13 remained after the inclusion criteria were applied. Differences in the methodologic approaches and reporting results made quantitative statistical comparisons impossible. Evidence suggests that comprehensive orthodontic treatment causes increased incidence and severity of root resorption, and heavy forces might be particularly harmful. Orthodontically induced inflammatory root resorption is unaffected by archwire sequencing, bracket prescription, and self-ligation. Previous trauma and tooth morphology are unlikely causative factors. There is some evidence that a 2 to 3 month pause in treatment decreases total root resorption. The results were inconclusive in the clinical management of root resorption, but there is evidence to support the use of light forces, especially with incisor intrusion.

Management of inflammatory root resorption using MTA obturation – a four year follow up

A case report of severe external inflammatory root resorption is presented. The patient reported with a complaint of increased tooth mobility after avulsion and replantation. The case was treated with full root canal obturation with mineral trioxide aggregate. A 48 month follow up review showed arrest of root resorption with satisfactory clinical results. This article discusses the aetiology of inflammatory root resorption and the use of the latest root canal obturation materials in improving healing outcomes.

Severe root resorption in orthodontic patients treated with the edgewise method: Prevalence and predictive factors

Our aims in this study were to assess the prevalence of severe root resorption and identify possible associations in orthodontic patients treated with the edgewise method. The sample included 1049 patients who had periapical radiographs taken for all incisors before and after treatment. The radiographs were examined by 2 orthodontists using an x-ray viewer with standard light intensity. These variables were collected: root shape, overbite, initial resorption, and hypodontia. The patients were classified according to sex, Angle classification, ethnicity, age, duration of treatment, type of dentition (mixed or permanent), and treatment with or without extraction of 4 premolars. Resorption was considered severe when it affected more than a third of the length of the root. Statistical analysis included the chi-square test and both simple and multiple logistic regression (P < or =0.05). Severe root resorption was observed in 14.5% of the sample. Patients treated with exodontia of the first premolars (odds ratio [95% CI] = 6.38 [4.2-9.7]), those who had triangle-shaped roots at the beginning of treatment (odds ratio [95% CI] = 4.67 [3.1-6.9]), and those with initial root resorption (odds ratio [95% CI] = 4.52 [2.7-7.6]) had a greater chance of developing severe root resorption during orthodontic treatment. A high prevalence of severe root resorption was observed in Brazilian patients treated with the edgewise method. The main factors directly involved in severe resorption were extraction of first premolars, triangle-shaped roots, and root resorption before treatment.

Relation of soluble RANKL and osteoprotegerin levels in blood and gingival crevicular fluid to the degree of root resorption after orthodontic tooth movement

The aim of the present study was the determination of the levels of osteoprotegerin and soluble RANKL in blood serum and in gingival crevicular fluid relative to the degree of orthodontic root resorption in a rat model. Blood samples and gingival crevicular fluid were collected from fourteen 6-month-old male Wistar rats weighing 350-500 g. A 25-g closed orthodontic coil spring was inserted between each upper right first molar and the upper incisors. After 21 days of loading, both upper first molars (treated and control) were extracted and studied under microcomputed tomography scanning. Statistical analysis demonstrated a positive linear correlation between the initial concentration of RANKL in blood serum and the degree of root resorption. The ratio of the initial concentrations of osteoprotegerin to RANKL in blood serum proved to be an independent prognostic factor of the degree of root resorption. The initial concentration of RANKL in gingival crevicular fluid showed a negative correlation to the initial concentration of RANKL in blood serum and for a finite range of initial concentrations of osteoprotegerin in gingival crevicular fluid, the dental root seemed protected against extreme external root resorption. Finally, the concentration of osteoprotegerin in blood serum decreased significantly in cases of severe root resorption.

Retreatment of a patient with Marfan syndrome and severe root resorption

This case report describes the retreatment of a patient with Marfan syndrome whose earlier orthodontic and surgical treatment had been unsuccessful. Marfan syndrome is an inherited connective tissue disorder transmitted as an autosomal dominant trait. The disorder results from molecular defects in the fibrillin gene that are responsible for the impaired structural integrity of the skeletal, ocular, and cardiovascular systems. When she sought retreatment, the patient had an open bite, mandibular anterior crowding, severe root resorption, and temporomandibular joint derangement with some resorption of the condyles. The second treatment, which included extractions and surgery, resulted in balanced and harmonious facial proportions, and a Class I occlusion with normal overjet and overbite. There was no further loss of condylar tissue, and the temporomandibular joints were asymptomatic. More root resorption on the mandibular left canine and the left second premolar was evident after the second treatment.