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PubMed2005

External cervical root resorption involving multiple maxillary teeth in a patient with hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) is an inherited syndrome characterized by mucocutaneous telangiectases that commonly involve the tongue, lips, fingers, and conjunctiva. While root resorption has been reported in association with central hemangiomas of bone, the association of HHT with external cervical root resorption has not been described to date. We report a case of a 57-year-old female with HTT who presented with advanced cervical root resorption involving multiple maxillary anterior teeth. Histologic examination of the gingival tissue adjacent to the area of root resorption demonstrated multiple thin-walled vascular elements as well as larger vascular channels surrounded by a thickened muscular layer. We hypothesize that the external root resorption seen in this case is the result of the HHT-related vascular process in the adjacent gingival tissue.

Female↗

PubMed2002

Orthodontically induced inflammatory root resorption. Part I: The basic science aspects.

Orthodontically induced inflammatory root resorption (OIIRR) or, as it is better known, root resorption, is an unavoidable pathologic consequence of orthodontic tooth movement. It is a certain adverse effect of an otherwise predictable force application. Although it is rarely serious, it is a devastating event when it is radiographically recognized. Orthodontics is probably the only dental specialty that actually uses the inflammatory process as a means of solving functional and esthetic problems. Force application initiates a sequential cellular process. We know exactly how and when it is evoked, but we are unable to predict its actual overall outcome. The extent of this inflammatory process depends on many factors such as the virulence or aggressiveness of the different resorbing cells, as well as the vulnerability and sensitivity of the tissues involved. Individual variation and susceptibility, which are related to this process, remain beyond our understanding. We are therefore unable to predict the incidence and extent of OIIRR after force application. This contemporary review is divided into two parts. In Part I, we discuss the basic sciences aspects of OIIRR as a continuation of our previously published work. In Part II, we present the clinical aspects of this subject.

Animals↗

PubMed1995

Short vs. long-term calcium hydroxide treatment of established inflammatory root resorption in replanted dog teeth.

This study examined, histologically, the healing of intentionally produced inflammatory root resorption of replanted teeth in beagle dogs, treated with short- or long-term placement of calcium hydroxide. Thirty beagle dog incisors were randomly divided into four groups. In group 1 (negative control), uninfected incisors were extracted, the roots were longitudinally grooved and the teeth were replanted within 2 min. In group 2 the root canals were artificially infected followed by extraction, longitudinal grooving, and replantation as in group 1. Radiographs were taken biweekly and at the first signs of inflammatory root resorption or at 4 weeks, the root canals were fully instrumented and medicated with calcium hydroxide. In group 2, the root canals were permanently obturated with gutta-percha and sealer after 1 week of calcium hydroxide. The teeth in group 3 were treated as described in group 2 but after 1 wk the calcium hydroxide dressing was repacked for the duration of the study. In group 4 (positive control) the teeth were treated as described in groups 2 and 3 but no endodontic treatment was performed. Twelve weeks after the initiation of the endodontic treatment, sacrifice and histological preparation were carried out. In group 1, complete cemental repair was seen in all teeth. In group 2, five of ten teeth showed complete cemental repair whereas in group 3 complete cemental repair was seen in nine of ten teeth. None of the teeth in group 4 showed cemental repair. It was concluded that long-term may be more effective than short-term calcium hydroxide treatment of established inflammatory root resorption.

Animals↗

PubMed1991

[A study of root resorption of deciduous teeth in dogs. Influence of successional tooth germ and occlusal force].

The role of successional tooth germ and occlusal force in root resorption of mandibular second deciduous molars was studied in 24 beagle dogs by means of radiographic and histologic evaluations. 70 days after birth their mandibular right third permanent premolar germs were surgically removed, and in 10 of the dogs the maxillary right and left second deciduous molars were extracted to decrease the occlusal force on the mandibular second deciduous molars. 1) When successional tooth germs were present, whether the occlusal force was normal or decreased, the alveolar bone and deciduous tooth adjacent to the tooth germ were resorbed, accompanied by eruption of the permanent tooth. After the resorption of the deciduous tooth reached half of the root, many odontoclasts were observed in the dental pulp of the deciduous tooth. The root resorption was hastened by internal resorption. 2) When successional tooth germs were removed, whether the occlusal force was normal or decreased, the root resorption was delayed. The resorption from the root surface progressed very slowly, but shortly after this resorption reached the pulp, internal resorption occurred and the deciduous tooth was resorbed in short time. 3) When the occlusal force was decreased, in the deciduous teeth in which successional tooth germs were present, the tooth resorption tended to delay to a later time. However in the deciduous teeth from which the successional tooth germs were removed, the processes of tooth resorption was very different in individuals, the difference between tooth resorption in normal occlusal force and in decreased occlusal force was not clear. 4) In all groups, shallow resorption on the deciduous root surface was observed before the successional tooth started to erupt, and this resorption was apart from the tooth germ. By repeating resorptive periods and resting periods, this resorption progressed according to the increase in age, and in the resting period, resorption was repaired by new deposits of cementum.

Animals↗

PubMed2002

Restoration and retention of maxillary anteriors with severe root resorption.

BACKGROUND: 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. CASE DESCRIPTION: 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. CLINICAL IMPLICATIONS: 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.

Child↗

PubMed2006

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.

Adolescent↗

PubMed2002

A mouse model of inflammatory root resorption induced by pulpal infection.

OBJECTIVE: The present study was undertaken to determine the frequency and extent of apical root resorption associated with induced periradicular lesions in mice. STUDY DESIGN: Bone and root resorption was quantified by using two- and three-dimensional micro-computed tomography (mu-CT) in the lower first molars of mice subjected to pulp exposure and infection. RESULTS: mu-CT measurements showed significant apical resorption in exposed and infected teeth, resulting in an average distal root shortening of 12.7% (P <.001 vs unexposed). These findings were confirmed with three-dimensional reconstituted images that showed thinning and shortening of the distal root. Tartrate-resistant acid phosphatase clastic cells were associated with resorption lacunae on the cementum of root apices, as well as on bone at the periphery of the periradicular lesions. Brown and Brenn staining showed the presence of bacteria in dentinal tubules adjacent to resorbed cementum. CONCLUSIONS: Apical root resorption is a prominent and consistent finding associated with periradicular infection in the mouse. This species represents a convenient model for studying the pathogenesis of inflammatory root resorption in vivo.

Acid Phosphatase↗

PubMed2003

Peg-shaped and small lateral incisors not at higher risk for root resorption.

The purpose of this study was to examine the pattern of external root resorption for peg-shaped and small lateral incisors according to various conditions and to compare it with that of normal-shaped lateral incisors. The periapical radiographs of 114 patients with 60 peg-shaped and 54 small lateral incisors were measured before and after treatment. Crown shape was assessed by examining pretreatment study casts. Findings showed that there was no significant difference in external root resorption between peg-shaped (1.09 mm) and normal lateral incisors (0.88 mm). However, a statistically significant difference in apical root resorption between small lateral incisors (1.03 mm) and normal lateral incisors (1.62 mm) was found. Peg-shaped laterals were also coincidentally found to occur more frequently on the left side of the arch.

Adolescent↗

PubMed1993

Doxycycline prevents root resorption and alveolar bone loss in rats after periodontal surgery.

The effect of systemic doxycycline administration on frequency of root resorption cavities and extent of bone loss following periodontal surgery was studied in albino rats. Thirty Wistar rats with healthy gingiva were divided into four groups. Six untreated animals (Group 1) served as controls. Gingivectomy (Group 2, six rats), mucoperiosteal flap operation (Group 3, eight rats), and mucoperiosteal flap operation with doxycycline added to the drinking water (Group 4, 10 rats) were performed on the palatal aspect of maxillary left molars. After a healing period of 3 wk, the rats were killed by an overdose of sodium pentothal, and specimens of first molars were prepared for light microscopy. Root resorption was absent in normal and gingivectomized animals (Groups 1 and 2). Resorption cavities occurred in all flap-operated animals (Group 3) and in one of 10 doxycycline-treated animals (Group 4). The distance from cementoenamel junction to alveolar bone crest remained unchanged in gingivectomized (Group 2) and doxycycline-treated animals (Group 4), as compared with control specimens. In flap-operated animals (Group 3), the crestal bone level was located more apically than in doxycycline-treated rats (Group 4). This study has shown that root resorption and bone loss were associated with flap operations involving exposure of periodontal ligament and bone. Systemic doxycycline prevented both root resorption and bone loss.

Administration, Oral↗

PubMed2004

Effect of orthodontic forces on root resorption in molars submitted to experimental periodontitis.

The present experimental study addresses the issue of the development and size of root resorption areas in molars of rats submitted to orthodontic forces of 51 or 75 g and the induction of periodontal disease by placing a cotton ligature around the cervix of the first upper molars for 48 hours. Immediately on removal of the ligature or 48 hs later we put an orthodontic device in place. The device comprised two steel bands. The arms of a helicoidal spring that exerted force towards palatine passed through the palatine tubes welded to the bands. The number of odontoclasts and the percentage of root resorption areas were determined histomorphometrically on bucco-palatine sections obtained at the level of the central roots. The data showed an increase in root resorption areas when the orthodontic forces were applied to molars of rats following the induction of periodontitis. The magnitude of the force was proportional to the size of the resorption areas and to the number of odontoclasts. Both these end-points exhibited smaller values when the forces were applied once the inflammatory reaction had subsided. The present study shows that the risk of development of root resorption areas in patients with periodontal disease submitted to orthodontic treatment would be lower if lighter forces were applied and treatment were delayed until the inflammatory signs have subsided.

Animals↗

PubMed2006

Root resorption and immune system factors in the Japanese.

The objective of this study was to determine whether there is an association between excessive root resorption and immune system factors in a sample of Japanese orthodontic patients. The records of 60 orthodontic patients (18 males, age 17.7 +/- 5.7 years; 42 females, age 16.4 +/- 6.0 years) and 60 pair-matched controls (18 males, age 15.9 +/- 4.5 years; 42 females, age 18.5 +/- 5.2 years) based on age, sex, treatment duration, and the type of malocclusion were reviewed retrospectively. The validity of our hypothesis was tested using the logistic regression analysis. The pretreatment records revealed that the incidence of allergy and root morphology abnormality was significantly higher in the root resorption group (P = .030 and .001), with a mean odds ratio of 2.794 and 6.317 and 95% confidence interval of 1.107-7.053 and 2.043-19.537, respectively. The incidence of asthma also tended to be higher in the root resorption group. From these results, we concluded that allergy, root morphology abnormality, and asthma may be high-risk factors for the development of excessive root resorption during orthodontic tooth movement in Japanese patients.

Adolescent↗

PubMed1989

[Apical root resorption during orthodontic treatment].

Pre- and posttreatment radiographs of 2050 orthodontically treated patients were examined and apical root resorptions of more than 2 mm were identified. 30 patients (211 teeth) were affected. Treatment characteristics and objectives of this group (with severe apical root resorption) were compared to a treated group of 30 patients (with no resorption) to determine clinical risk factors. Extrusion, but especially jiggling and a long treatment period were found to be significantly more frequent in the group exhibiting resorption than in the control group. Pathogenesis of treatment-induced root resorption is discussed in respect to histological results.

Adolescent↗

PubMed2003

Root resorption related to hypofunctional periodontium in experimental tooth movement.

Orthodontic movement of non-occluding teeth may result in undesirable apical root resorption. These teeth present with a histologically altered periodontium and are considered to be hypofunctional. The purpose of this study was to compare the amount of root resorption associated with a normal and a hypofunctional periodontium in rats during experimental tooth movement caused by heavy continuous force. The mandibular first molar was induced into a non-occluding condition in the hypofunctional periodontium group. Mesial orthodontic force was applied by means of 50-gram-force closed-coil springs for 15 days in both groups. The active root-resorption lacunae from histological sections, identified by tartrate-resistant acid phosphatase, were measured in terms of length, depth, and area. The results showed that the amount of root resorption was significantly greater in teeth with a hypofunctional periodontium than in those with a normal periodontium (p < 0.05). These results suggest that orthodontic movement of non-occluding teeth should be performed with caution.

Acid Phosphatase↗

PubMed2001

Radiographic diagnosis of root resorption in relation to orthodontics.

The literature regarding external root resorption in relation to orthodontics and its radiographic diagnosis is reviewed, including a summary of the more common radiographic techniques available. Sample cases are presented which demonstrate the need for good radiographic technique and an awareness of the limitations of certain radiographs. A provisional diagnosis of external root resorption may need to be confirmed by further radiographic views where appropriate.

Humans↗

PubMed2000

Long-term follow-up of maxillary incisors with severe apical root resorption.

The purpose of the study was to analyse the mobility of teeth with severe orthodontically induced root resorption, at follow-up several years after active treatment, and to evaluate mobility in relation to root length and alveolar bone support. Seventy-three maxillary incisors were examined in 20 patients, 10-15 years after active treatment in 13 patients (age 24-32 years) and 5-10 years after active treatment in seven patients (age 20-25 years). All had worn fixed or removable retainers; seven still had bonded twistflex retainers. Total root length and intra-alveolar root length were measured on intra-oral radiographs. Tooth mobility was assessed clinically according to Miller's Index (0-4) and the Periotest method. Crestal alveolar bone level, periodontal pocket depth, gingival, and plaque indices, occlusal contacts during occlusion and function, and dental wear were recorded. There was a significant correlation (P < 0.05) between tooth mobility, and total root length and intra-alveolar root length. No correlation was found between tooth mobility and retention with twistflex retainers. None of the variables for assessment of periodontal status, occlusion and function were related to total root length or tooth mobility. It is concluded that there is a risk of tooth mobility in a maxillary incisor that undergoes severe root resorption during orthodontic treatment, if the remaining total root length is < or = 9 mm. The risk is less if the remaining root length is > 9 mm. Follow-up of teeth with severe orthodontically induced root resorption is indicated.

Adult↗

PubMed1995

Prevalence and severity of apical root resorption of maxillary anterior teeth in adult orthodontic patients.

The purpose of this study was to evaluate prevalence and severity of apical root resorption of maxillary anterior teeth in a large sample of adult orthodontic patients, to analyse any difference between subgroups of patients with and without a history of earlier orthodontic treatment, and to test the hypothesis that endodontically treated teeth are less likely to experience apical root resorption. Differences in tooth length measurements of standardized periapical radiographs made before and after treatment of 343 adults, representing groups of consecutively treated patients from four orthodontic practices, were calculated. Sample means of averaged root resorption of all six anterior teeth and of the most severely resorbed tooth per patient were 0.94 mm (SD 0.88) and 2.39 mm (SD 1.43), respectively. Forty per cent of the adults had one or more teeth with 2.5 mm resorption or greater. The subsample of 31 patients with a history of earlier orthodontic treatment had less root resorption than the remaining patients (P < 0.001). Evaluation of the 39 contralateral pairs of teeth with and without endodontic treatment in 36 of the patients revealed less resorption of the endodontically treated teeth (P < 0.05).

Adult↗

PubMed2005

Apical root resorption 6 months after initiation of fixed orthodontic appliance therapy.

INTRODUCTION: Individual predisposition might be a major reason for the observed variation in apical orthodontic root resorption. If so, resorption might be expressed during the initial stages of orthodontic therapy in patients at risk. METHODS: To explore this hypothesis, we evaluated standardized, digitized periapical radiographs made before treatment (T1) and at a mean period of 6.4 months (SD 0.9) after placement of maxillary incisor brackets (T2) in 290 patients (age range, 10.1 to 57.1 years at T1). Anamnestic and treatment parameters were recorded according to a protocol, and maxillary incisor irregularity was measured on T1 study models. RESULTS: The mean average root resorption for 4 incisors was 0.53 mm (SD 0.47), whereas the sample mean of the most severely resorbed tooth per patient was 1.18 mm (SD 0.86). A total of 4.1% of the patients had an average resorption of 1.5 mm or more, and 15.5% had at least 1 tooth with 2.0 mm or more resorption. The maximum amount of resorption was 4.4 mm. Multivariate linear regression showed that deviated root form and increased T1-to-T2 time period were risk factors for apical root resorption of the central incisors; normal root form and wide roots were preventive factors, with an explained variance of 14%. Similarly, long roots, narrow roots, and increased T1-to-T2 time period were risk factors for resorption of the lateral incisors, whereas normal root form was a preventive factor, with an explained variance of 24%. Parameters associated with use of rectangular wire, presence of incisor irregularity, and history of trauma were not identified as risk factors. Use of elastics was not included in the regression analyses. CONCLUSIONS: Root resorption can begin in the early leveling stages of orthodontic treatment. About 4.1% of patients studied had an average resorption of 1.5 mm or more of the 4 maxillary incisors, and about 15.5% had 1 or more maxillary incisors with resorption of 2.0 mm or more from 3 to 9 months after initiation of fixed appliance therapy. Although teeth with long, narrow, and deviated roots are at increased risk of resorption during this early stage, the explained variance of these risk factors is less than 25%.

Adolescent↗

PubMed1996

An evaluation of root resorption incident to orthodontic intrusion.

A new radiographic method was developed for measuring changes in root length. With this technique, orthodontic intrusion was investigated as a potential cause of apical root resorption of maxillary incisors. The experimental group consisted of 17 patients with excessive overbite who were treated with a Burstone-type intrusion arch, which delivered a low level of force (about 15 gm per tooth). A control group was made up of 17 patients in full-arch fixed appliances who were randomly selected. After a period of approximately 4 months, the intrusion group had only slightly more root resorption than the controls, 0.6 mm versus 0.2 mm (statistically significant difference). Intrusion measured at the center of resistance of the central incisor averaged 1.9 mm. The amount of resorption was not correlated with the amount of intrusion. A weak correlation, r = 0.45, was found between resorption and movement of the apex (i.e., in addition to intrusion, there was often palatal root movement). Results of this study seem to indicate that intrusion with low forces can be effective in reducing overbite while causing only a negligible amount of apical root resorption.

Adolescent↗