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PubMed1989

Legal aspects of orthodontic practice: risk management concepts. Diagnosis, root resorption, and progress monitoring.

In this and succeeding issues of the American Journal of Orthodontics and Dentofacial Orthopedics, factual risk management scenarios will be presented. These scenarios are based on composites of actual court cases that have been tried to verdict or decision. Valuable risk management lessons may be learned from careful analysis of the course of the events described. Please be advised that the standard of care determined in any case is specific for that jurisdiction and that set of facts as established by expert testimony for the prevailing party.

Defensive Medicine↗

PubMed1995

Crown and root resorption of a maxillary permanent first molar by an impacted second premolar: a case report.

A case is described of resorption of the mesial aspect of a maxillary permanent first molar in a 13-year-old boy whose maxillary second premolar was impacted. The premolar was partially erupted in the line of the arch and radiography revealed a radiolucent area involving enamel, dentine and cementum on the mesial aspect of the first molar. The first molar was extracted and the premolar erupted normally. The case emphasizes the importance of early diagnosis of developmental abnormalities.

Bicuspid↗

PubMed2000

Diagnosis of external root resorption using TACT (tuned-aperture computed tomography).

This study compared the ability of the TACT system of imaging and conventional D-speed film to detect simulated resorptive defects in cadaver teeth and jaws. Mandibular human jaw blocks were prepared and then split through the teeth in a mesial to distal direction so that the mandibular halves could be opened and reassembled when necessary. One half of each of 42 teeth was extracted, and areas on the tooth and corresponding bone identified to be studied. The jaws were opened and reassembled after no defects or after defects of different sizes (0.25, 0.5, 1.0, 2.0 mm) were placed in the tooth and the corresponding bone at predetermined evaluation areas. The teeth were imaged after each stage with conventional D-speed film using a standard paralleling technique, and with a modified orthopantomograph OP100 machine using a Schick #2 size CCD sensor as the image receptor. The source images were registered and TACT slices were generated using TACT Workbench Software. Three observers were asked to identify the presence of resorptive defects in the conventional film group and the TACT image group using specific criteria. TACT imaging was statistically superior to conventional radiographs in detecting defects that were present (Wilcoxon matched pairs signed ranks test P = 0.003). This was true for all sizes of defects examined. There was no difference between the two modalities when a defect was not present.

Cadaver↗

PubMed2001

Root resorption in retained deciduous canine and molar teeth without permanent successors in patients with severe hypodontia.

AIMS: The ability to predict the morbidity of retained deciduous teeth with no permanent successors, a characteristic of hypodontia, would be of considerable value in treatment planning, but is hampered by lack of data. METHODS: This problem was studied using 356 orthopantomogram radiographs (OPGs) from the records of 249 patients who had attended a specialist hypodontia clinic, and had retained deciduous teeth with no permanent successors. Due to their clinical importance, canine and molar teeth were chosen for examination. Resorption was assessed subjectively by three experienced clinicians. RESULTS: Un-weighted Kappa values for reproducibility were > 0.8, and for interobserver error 0.60-0.83. Gender related differences were minimal. Regardless of gender or radiographic age, the lower canines appear to show the least amount of resorption and the upper first molars the most. The upper and lower second molars have particularly unpredictable life spans. Whilst the lower first molars have a predictable life span that is poor, the life span for the upper first molars is slightly worse. CONCLUSIONS: Lower canines have a predictable life span that appears to be good, as do upper canines, but of lesser duration than lower canines. Molars have poorer and less predictable life spans.

Adolescent↗

PubMed2004

A calibration method used for volumetric measurement of orthodontically induced root resorption craters.

The aim of this study was to measure the accuracy and reproducibility of volumetric estimations obtained by a commercial software used to measure resorption craters induced by orthodontic forces. Twenty human first maxillary premolars were selected and divided into light and heavy force groups with 25 and 225 g of force applied to the upper-right first premolars, respectively. The contralateral teeth served as controls. Samples were extracted and prepared for SEM stereoimaging after 28 days of force application. Volumetric measurements of these resorption craters were generated by the software. Standardized pyramidal indentations by the Vickers microhardness tester on four solid metallic cylindrical rods (brass, copper, stainless steel, and aluminum) similar to the dimensions of human premolars were used for calibration. Mathematically calculated volumes of these indentations were compared to volumes estimated by the software. The software estimated the errors of volumes of pyramidal indentations of the harder and softer materials to within 11 and 19%, respectively. Non-uniform plastic deformation that occurred in softer materials during indentation distorts the calculated results. The estimates obtained by the software even for distorted indentations caused by non-uniform plastic deformation have high degrees of reproducibility and accuracy.

Bicuspid↗

PubMed2006

Root resorption on torqued human premolars shown by tartrate-resistant acid phosphatase histochemistry and transmission electron microscopy.

OBJECTIVE: To identify clastic cells on the root surfaces of torqued human premolars. MATERIALS AND METHODS: A continuous force of 600 cNmm was applied to upper first premolars in patients 13-16 years of age by using a precise biomechanical model with superelastic wires (NiTi-SE). The 28 teeth in 14 patients were divided into five groups (control [nonmoved], and moved for either 1, 2, 3, or 4 weeks) and processed for tartrate-resistant acid phosphatase (TRAP) histochemistry and transmission electron microscopy. RESULTS: Mononuclear TRAP-positive cells appeared at 2 weeks, where as large multinucleated TRAP-positive cells were numerous at 3 and 4 weeks. Ultrastructural examination revealed many clastic cells in contact with resorption lacunae. In addition, some cementoblast-like cells appeared secreting new cementum over previously resorbed lacunae. CONCLUSIONS: In general, resorption lacunae and the number of clastic cells, which increased with the duration of the applied force, were found on the cementum surface at the pressure areas. Some signs of cementum repair were also noticed, even with the maintenance of the level of the force.

Acid Phosphatase↗

PubMed2004

Root resorption and its association with alterations in physical properties, mineral contents and resorption craters in human premolars following application of light and heavy controlled orthodontic forces.

OBJECTIVES: To study the effect of different orthodontic force levels on cementum, investigating from the point of view of its physical properties, alterations in the mineral components, type and location of the resorption craters and the exploration in 3D of space. DESIGN: In vivo human premolars subjected to heavy and light forces were employed for this study. After a period of movement they were analyzed for hardness and elasticity. Also, the mineral composition measuring Ca, P and F of the cementum root surface was investigated. A new method for volumetric analysis of resorption craters was developed. RESULTS: There were no significant differences for hardness and elastic modulus between the light and heavy force groups and no significant effects for different tooth positions. Significant inter-individual variation in the Ca, P and F concentrations was noted. Force-related data showed that mean volume of the resorption crater in light-force group was 3.49-fold greater than the control group, and the heavy-force group 11.59-fold more than control group. The heavy force group had 3.31-fold greater total resorption volume then light force group. Buccal cervical and lingual apical regions demonstrated significantly more resorption craters than the other regions. The 2D measurements were strongly correlated to 3D measurements. CONCLUSION: The application of light and heavy forces did not show any statistically significant differences in hardness and elastic modulus when compared with untreated teeth. The inconsistent increase or decrease of Ca, P and F contents between control and experimental teeth at sites of compression and tension were difficult to explain. There was more resorption by volume in the heavy force group as compared with the light group and controls. Our data also suggested that the high-pressure zones might be more susceptible to resorption after 28 days of force application.

Adolescent↗

PubMed2003

Transient root resorption after dental trauma: the clinician's dilemma.

UNLABELLED: The diagnostic shortcomings encountered in the clinical evaluation of pulpal and periodontal healing subsequent to trauma comprise a major problem in dental traumatology. An acute dental trauma may imply impact to the hard dental tissues and damage to the pulp and periodontium (including surrounding alveolar bone). In the case of luxation injuries, the trauma often results in rupture of the neurovascular supply at the level of the apical foramen, whereas in a root fracture, the same occurs at the level of the fracture. Conventional diagnostic criteria for pulpal status (coronal discoloration, loss of pulpal sensibility, tenderness to percussion, and radiographic change [i.e., resorption]) reflect, only indirectly, certain parameters of healing. These parameters are based empirically on clinical findings after dental caries and dental restorative techniques, where the pulp has an intact neurovascular supply apically. In these situations, long-standing bacterial or chemical attack can lead to irreversible change. In contrast, following traumatic impact, a presumably intact pulp is deprived of its neurovascular supply instantaneously. In the absence of infection, events following acute dental trauma aim at either tissue repair or regeneration. Thus, based on a series of long-term clinical studies, it was found that all conventional signs, with the exception of tenderness to percussion, could be signs of pulpal healing, as well as signs of pulpal death. Based on the results of these studies, this report discusses the significance of radiographic change (resorption) in relation to pulpal and periodontal healing following acute trauma. Moreover, implications of tooth luxation with respect to the long-term prognosis following crown, crown-root, and root fractures are discussed. CLINICAL SIGNIFICANCE: Whenever possible, it is to the patient's advantage that pulp vitality be preserved. Correct diagnostic techniques and patient selection enable the clinician to decide when endodontic therapy is appropriate and when intelligent observation is the "treatment" of choice.

Dental Pulp↗

PubMed1986