Orthodontic Root Resorption: Abhijeet Jaiswal

Orthodontic Root Resorption
Abhijeet Jaiswal
Junior Resident
Dept . Of Orthodontics and Dentofacial Deformities, CDER, AIIMS

17/10/2016
Content
 Introduction
 Root resorption process
 Cause of orthodontic root resorption
 Factor affecting root resorption
 Types of root resorption
 Preventive measures
 Management
 Clinical consideration
 Conclusion
Dept . Of Orthodontics and Dentofacial

17/10/2016
Deformities, CDER, AIIMS
INTRODUCTION
• Apical root resorption is a common idiopathic problem associated
with orthodontic treatment
• Loss of the apical root material is unpredictable and, when extending into
the dentin, it is irreversible.
• Extensive post-orthodontic root resorption compromises the benefits of an

otherwise successful orthodontic treatment

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Root resorption process
 Root resorption of the deciduous dentition is a normal, essential, and

physiologic process. Usually it is a necessary precursor to the eruption
of the permanent teeth. Some deciduous teeth, even with agenesis of
the succedaneous teeth, undergo root resorption.
 Root resorption of the permanent teeth is a complex biologic process

of which many aspects still remain unclear.
 Root resorption occurs when pressure on the the cementum exceeds its
reparative capacity and dentin is exposed , allowing multinucleated
odontoclasts to degrade the root substance.
 Orthodontically induced root resorption begins adjacent to hyalinized

zones and occurs during and after elimination of hyaline tissue .

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 Removal of hyalinized tissue leads to removal of cementoid and mature
collagen , leaving a raw cemental surface that is readily attacked by
dentinoclasts
 Because cementum is more resistant than bone ,forces applied to a tooth
usually cause bone resorption rather than loss of cementum .(Robert WE)
 However , forces are concentrated at the root apex because orthodontic
tooth movement is never entirely translatory , which places the narrow
periapical region in harm’s way.
 Rudolph noted that resorption usually attacks the root tip and travels
coronally making what has been termed a “shed roof “ effect to the root .

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 Alterations in the periodontal tissues specifically affect the alveolar bone,
periodontal ligament and the root surface
 Orthodontic force initiation stimulates the remodeling of alveolar bone ,

which results in tooth movement , initial changes in response to a local
compression of the periodontal ligament include a reduction in width and
vascular changes.
 Periodontal ligament changes occurs most noticeably at pressure sites

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Orthodontic tooth movement and biology of root resorption
Periodontal ligament changes during tooth movement
.
 Alterations in the periodontal tissues
specifically affect the alveolar bone,
periodontal ligament and the root
surface
 Orthodontic force initiation stimulates
the remodeling of alveolar bone , which
results in tooth movement , initial
changes in response to a local
compression of the periodontal ligament
include a reduction in width and
vascular changes.
 Periodontal ligament changes occurs
most noticeably at pressure sites

17/10/2016
 Tissue reactions include early proliferation of blood vessels , cellular
extravasations , extra vascular coagulation and tissue necrosis
 Hyalinization (devoid of cellular elements ) and tissue necrosis evident .
 Results of histological studies suggests that resorption occurs in response to

damage initiated by orthodontic treatment to the periodontal ligament .
 The innermost cells of the periodontal ligaments protective nature is lost ,

clast type cells may resorb not only necrotic tissue , but also root surface
indiscriminately

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Where do we find it?
 Normal teeth
 Replanted and transplanted teeth
 Necrotic pulp & periradicular inflammation
 Treated by surgical endodontics
 Periodontal disease

17/10/2016
.
 Following periodontal therapy
 Orthodontically treated teeth
 Teeth near expanding tumors &cysts
 Late & irregularly erupting teeth
 Traumatic occlusion
 Systemic diseases
 Ankylosed teeth

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Causes of orthodontic root resorption
 Duration of treatment
 Vitality/ Non-vitality of teeth
 Direction of tooth movement
 Type of orthodontic appliance (Fixed ,functional)
 Relapse
 Continuous/Interrupted forces
 Force magnitude
 Torque
 Movement into cortical plates

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Causes of orthodontic root resorption
 Thin or dilacerated roots
 Movement of teeth with prior root resorption
 Abnormal habits
 Movement of teeth with compromised support
 Genetic predisposition
 Certain malocclusions: Open bite, excessive over jet, Class III
 Idiopathic

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Factors affecting root resorption
 Biologic
 Mechanical
 Combined Biologic & Mechanical
- BREZNIAK & WASSERTAIN :1993 AJODO

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Biologic factors
Individual Susceptibility
 A major factor in determining RR potential with or without
orthodontic treatment.
 Individual differences in tissue response and activity is noted.
 The RR process varies from persons & within same person at
different times.
 Metabolic signals like hormones, body type & metabolic rate
generate changes between osteoblastic & clastic activity.
 This modifies specific cell metabolism & person’s reaction to
disease, trauma, ageing.
- RYGH P- Angle Ortho 1974

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Genetics
 Suggested genetic component for shortened roots
 Possible autosomal dominant, autosomal recessive, polygenic modes of
inheritance.
-Newman WG AJO 1975

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Although heritability estimates do not provide information about the
number of possible genes contributing to the phenotype, there is probably
an important genetic predisposition to EARR.
 Several polymorphisms have been described in the genes of the IL-1

cluster & these polymorphisms have been associated with advanced adult
periodontitis.
The presence of IL-1 in the periodontal tissue during tooth movement

implicates a role for these mediators in tissue resorption.
-HARRIS et al: AJODO 1997

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Systemic Factors
 Paget’s disease
 Renal Osteodystrophy
 Herpes Zoster
 Hyperparathyroidism
 Hemifacial hypertrophy
 Osteopetrosis
 Hypo & Hyperpituitarism
 Hypophosphatemia

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Gender
• Females more susceptible to RR.
• Idiopathic RR ratio→ 3.7 : 1 (female to male). -Newman WG: AJO 1975
• Apical root material loss→ 0.73 mm : 0.67 mm (female to male)

-Linge BO , Linge L : EJO 1983
Habits
• Nail-biting, tongue thrust associated with open bite and increased tongue
pressure have been statistically related to increased root resorption.
-ODERNICK : BJO 1985

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.
Previously Traumatized teeth
• Traumatized teeth can exhibit RR.

Orthodontically moved traumatized teeth are more sensitive to further loss of
root material.
Average loss after orthodontic treatment was 1.70mm compared with 0.64
mm for untraumatized teeth.
-Andreasen AJO 1988
• Brin et al showed that incisors with clinical signs or patient reports of
trauma had essentially the same prevalence of moderate to severe OIIRR as
those without trauma. Mandall et al reported no evidence of incisor
trauma and RR. Levander et al also showed no statistically significant
correlations between RR an

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Endodontically Treated Teeth
•Higher frequency & severity of root resorption of endodontically treated

teeth during orthodontic treatment was reported.
•Recent studies show endodontically treated teeth are more resistant to RR
due to increased dentin hardness & density.
-Remington DN, et al,: AJODO 1989

Peg-shaped and small lateral incisors not at higher risk for root
resorption
This study showed that peg-shaped lateral incisors do not incur more root
shortening than do normal incisors. Nor are small lateral incisors at greater
risk.
Yoon-Ah Kook, DDS, MS,a Sohee Park, MS,b and Glenn T. Sameshima, DDS,(AJO 2003)

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• Teeth with unusual morphology
Brin et al examined the severity of RR in teeth with unusual morphology.
The results showed that teeth with roots having unusual morphology before
treatment were not significantly more likely to have moderate to severe
OIIRR than those with more normal root forms.
Root shape
Among different shape d root ends( normal , blunted , dilacerated , pipette
shaped , pointed , incomplete , ) least resorption was observed in blunted
and highest in tapered - McNab et al Angle ortho 2000.
Long narrow and deviated root increased risk root resorption
- Mirabella ,Artun AJO 1995

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Alveolar bone density
• Becks & Tager related increased root resorption to bone architecture

resulting from hormonal and nutritional imbalance during growth
• Reitan –a strong continuous force on less dense alveolar bone causes the
same root resorption as mild continuous force on highly dense alveolar
bone.
• Lamellar bone is more difficult to resorb with orthodontic force than
bundle bone.
-REITAN :1985 GRABE&SWAIN

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Classification of malocclusion.
• . Among different malocclusions, based on Angle’s classification system,
studies have observed a statistically significant difference between class I
and class II div 1 malocclusion, with the latter exhibiting more resorption.
• Janson et al reported a higher resorption potential for class II div 2 cases in

comparison with class I , class II div I and class III patients.
• The rationale was that excessive intrusion mechanics were necessary to

correct the deep overbite in these cases and also the torque required to
correct the palatal inclination of the incisors was high

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Specific tooth vulnerability to root resorption.
 Different teeth have different tendencies to root resorption.
 maxillary teeth are more sensitive than mandibular teeth.
 The maxillary incisors are the teeth most affected by root resorption.
 The extent of movement in these teeth is usually greater than in others

because of malocclusion, function, and esthetics.

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It is believed that if there is no apical root resorption seen in the
maxillary and mandibular incisors, then significant apical
resorption in other teeth is less likely to occur.
The most frequently affected teeth, according to severity, are

 maxillary centrals, (Baumirind s AJO1996)
 maxillary laterals (Mcnab S Anngle 2000)
 mandibular incisors,
 distal root of mandibular
 first, mandibular second molars

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Occlusal forces
 heavy mastication , occlusal trauma and chronic bruxism each increases
the risk of root resorption
 Improper occlusion or inadequate dental restorations and prosthetic
appliances can also cause occlusal trauma

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Mechanical factors
Fixed vs Removable
 Use of fixed appliance is more detrimental to the roots.

Ketcham claimed that normal function is disturbed by the splinting effect
of orthodontic fixed appliances over a long period that can cause root
resorption
 Jiggling forces caused by removable appliance are more harmful for roots.
-STUTEVILLE
 A similar EARR predisposition was identified using either removable
aligners (Invisalign) or fixed appliances. (Alejandro Iglesias-LinaresAngle
Orthod. 2000;)

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• Removable thermoplastic appliance vs fixed light and heavy force
Barbagallo et al 41 compared forces applied with removable thermoplastic
appliances (TA) and fixed orthodontic appliances. The results showed that
teeth experiencing orthodontic movement had significantly more RR than
did the control teeth. Heavy force (225g) produced significantly more RR
(9 times greater than the control) than light force (25 g) (5 times greater
than the control) or TA force (6 times greater than the control) application.
Light force and TA force resulted in similar RR cemental loss.

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Begg vs Edgewise
 Although previous studies by could not find any significant resorption rate
between Begg light wire mechanics and edgewise ( Tweed ) techniques, a
recent study by McNab et al has reported a higher incidence of resorption,
as well as amount of root resorption in patients treated with the Begg
appliance. .

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• Straight wire vs standard edgewise
Reukers et al compared the prevalence and severity of RR after treatment
with a fully programmed edgewise appliance (F and a partly programmed
edgewise appliance . All FPA patients were treated with 0.022-in slot Roth
prescription . All PPA patients were treated with 0.018-in slot . Results
showed no statistically significant differences in the amount of tooth root
loss (FPA, 8.2%; PPA, 7.5%) between the groups.

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• Archwire sequence
Mandall et al compared 3 orthodontic archwire sequences in terms of
patient discomfort, RR, and time to working archwire. All patients were
treated with maxillary and mandibular preadjusted edgewise appliances
The results showed no statistically significant difference between archwire
sequences, for maxillary left central incisor RR .
There was also no statistically significant difference between the proportion
of patients with and without RR between archwire sequence groups

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• Two-phase vs 1-phase Class II treatment
Brin et al examined the effect of 2-phase vs 1-phase Class II treatment on
the incidence and severity of RR. The results showed that children treated
in 2 phases with a bionator followed by fixed appliances had the fewest
incisors with moderate to severe OIIRR, whereas children treated in 1
phase with fixed appliances had the most resorption.
• Self-ligating vs conventional orthodontic bracket
Scott et al investigated the effect of either Damon3 self-ligating brackets
or a conventional orthodontic bracket system on mandibular incisor RR.
Patients were treated with Damon3 self-ligating or conventionally ligated
brackets with identical archwires and sequencing in all patients. The results
showed that mandibular incisor RR was not statistically different

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Magnets
 Increase in force as space closes with time (attraction) can stimulate a more
physiologic tissue response, thus decreasing the potential for root
resorption .( Terushige Kawata, AJO1987) (review Darendeliler EJO 1997)
Intermaxillary Elastics
 Significant RR on the side where elastics were used – jiggling forces , the
result of function combined with elastics are responsible for incisor RR.
 Evidence of Class III elastics used for anchorage preparation increased
mandibular I molar Distal RR.
- LINGE & LINGE

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Other appliances
 Rapid maxillary expansion, Cervical traction have been reported to cause

severe root resorption.

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Orthodontic movement type
 Intrusion > torque is probably the most detrimental to the roots involved,
but tipping,, bodily movement, and palatal expansion can also be cause for
root resorption Parker and Harris, AJO Dec 1998
 Higher magnitudes of torque might cause more root resorption, particularly

in the apical region. Bartley N AJO 2011
 Stress distribution along roots – bodily movement < Tipping

- REITAN
 Extent of tooth movement :- RR is directly related to the distance moved

by the roots. Maxillary incisors are moved more than other teeth, hence the
higher rate of incidence

17/10/2016 Deformities, CDER, AIIMS
 Light force vs heavy force
• Chan and Darendeliler found the mean volume of the resorption craters in
the light-force group was 3.49 times greater than in the control group (not
significant)
mean volume of the resorption craters was 11.59 times greater in the heavy-
force group than in the control group.
All studies found that heavy forces produced significantly more RR than
light forces or controls
 Jiggling forces : resulting from use of intermaxillary elastics or active

removable appliance causes occlusal trauma & root resoption.

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 Continuous versus intermittent forces:
The pause in treatment with intermittent forces allows the resorbed
cementum to heal and prevents further resorption
Acar et all 50 compared a 100-g force with elastics in either an interrupted
(12 hours per day) or a continuous (24 hours per day) application. Teeth
experiencing orthodontic movement had significantly more RR that control
teeth. Continuous force produced significantly more RR than discontinuous
force application

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Extraction versus nonextraction:
• For maxillary canines, mandibular incisors, and mandibular canines, the

first premolar and other extraction cases had greater resorption than the
nonextraction . -Glenn T. Sameshima AJO 2001
,
• Serial extractions:
• Serial extractions without complementary orthodontic treatment gave the

least root resorption compared with serial extractions with orthodontic
treatment or to four premolar extractions followed by fixed appliance
treatment. Kennedy DB, AM J ORTIIOD 1983;

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Combined biologic & Mechanical factors
Treatment duration
• . Rudolph 79 reported that 40%, 70%, 80%, and 100% of the patients in
treatment demonstrated some root resorption after 1, 2, 3, and 7 years of
active treatment, respectively.
• Levander and Malmgren found that 34% of examined teeth showed root
resorption after 6 to 9 months of treatment, whereas at the end of active
treatment, lasting 19 months, root resorption increased to 56%.
• Goldin reported that amount of Root loss during treatment is 0.9 mm/year.
Relapse
Sharpe et al found a higher frequency of root resorption in patients
demonstrating relapse compared with patients without resorption

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Types of root resorption
• Andreasen defines three types of external root resorption:
1. surface resorption, which is a self-limiting process, usually involving

small outlining areas followed by spontaneous repair from adjacent intact
parts of the periodontal ligament;
2. inflammatory resorption, where initial root resorption has reached

dentinal tubules of an infected necrotic pulpal tissue or an infected
leukocyte zone;
3. replacement resorption, where bone replaces the resorbed tooth material

that leads to ankylosis.

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 According to Tronstad, inflammatory resorption is related to the presence of
multinucleated cells that colonize the mineralized or denuded cemental
surface. He characterizes two kinds of inflammatory resorption
 . Transient inflammatory resorption occurs when the stimulation to the

damage is minimal and for a short period. This defect is usually undetected
radiographically and is repaired by a cementum-like tissue.
 progressive inflammatory resorption.

When stimulation for a long period .
Root resorption after orthodontic treatment is surface resorption, or transient

inflammatory resorption. Replacement resorption is rarely ever seen after
orthodontic treatment.

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Orthodontically induced inflammatory
root resorption
Degrees of severity of OIIRR:
1. Cemental or surface resorption with remodeling. In this process, only the

outer cemental layers are resorbed, and they are later fully regenerated or
remodeled. This process resembles trabecular bone remodeling.6
2. Dentinal resorption with repair (deep resorption). In this process, the
cementum and the outer layers of the dentin are resorbed and usually
repaired with cementum material. The final shape of the root after this
resorption and formation process may or may not be identical to
the original form.
3. Circumferential apical root resorption. In this process, full resorption of the
hard tissue components of the root apex occurs, and root shortening is
evident.
BREZNIAK & WASSERTAIN : AO 2002
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Diagnostic aids
 Radiographs are the most popular tool in the diagnosis procedure.
The ordinary scale used to score the extent of external apical root resorption . Malmgren et al 1982
• Grade 0 depicts normal , intact root morphology , in which the apical outline is smooth and continuous. ,
distance between root and lamina dura is uniform
• .grade 1 shows evidence of erosion periapically , but length not yet affected
• . Grade 2 shows scalloping blunting of the apex .
• Grade 3 occurs when at least one fourth of the root has been resorbed .
• grade 4 involves the loss of at least one half of the original root length

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Diagnostic aids
 Computer tomography
 Radio Visuo Graph (RVG).
 Digital reconstruction using computer software will also enable more accurate
analysis
OTHER METHODS
• Light or electron microscopy
• Micro CT
• Histomorphometric methods
• Biologic markers for root resorption in crevicular fluid (dentine sialoprotein (DSP),
dentine phosphoprotein (DPP)) - Kereshanan S EJO 2008
• OPG and RANKL - Joanna B JOS2010

17/10/2016
Management
• Review of literature reveals that when a tooth loses its apical
material beyond the cementum, no regeneration is possible.
• The reparative process begins 2 weeks after the force is

discontinued, and the effects are evident within 6-8 weeks.
• Acellular cementum is laid down in the initial stages, followed by
cellular cementum.
• The according to various authors, the process starts from either the
peripheral region, the apex, or in all directions, and individual
variations seem to be very common as far as the repair is concerned.
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• Progress periapical films or panoramic radiographs should be analyzed
during the treatment.
• A review of literature supports a temporary halt in orthodontic treatment for

a period of 4 – 6 months.
• Literature support the view that there will be no apparent increase in
resorption after termination of active orthodontic treatment.
• Modification of the treatment plan with the aim of minimizing tooth
movement is suggested

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Clinical considerations
• The patient or his parents must be informed that apical root shortening
(root resorption) may be a consequence of orthodontic treatment. Its
incidence is highly unpredictable.
• Periapical radiographs
 an important part of complete orthodontic records as any pretreatment
record
 particularly useful to compare pretreatment and post treatment root
resorption.
 impossible to predict the onset of root resorption, periodic control
radiographs are indicated.
 Post treatment radiographs are an essential part of complete records to
assess the bone/root integrity after treatment.

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• Orthodontic treatment should begin as early as possible
• The orthodontic force should be intermittent and light.
• When root resorption is detected during active treatment, final goals must
be reassessed. A decision should be made to terminate the treatment or to
arrive at a treatment compromise. When necessary, applied forces should
be stopped and/or a bite plane used to disocclude the teeth.

17/10/2016
• Habits such as nail biting or tongue thrust should be stopped, since root
resorption is more severe in such orthodontic patients.
• All types of tooth movement can cause root resorption. It seems that
intrusion is the most detrimental.
• Occlusal traumatism and jiggling are potentially detrimental to the roots,

and it is suggested to finish treatment with a correct occlusion.

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• It is essential to recognize that routine orthodontic tooth movement can have
anatomic and physiologic limitations. If the objectives of treatment are beyond
these limitations, surgical intervention may be required.
• In choosing treatment appliances, the risk of root resorption should be weighed

against appliance efficiency and individual treatment objectives.
• Treatment time should be as short as possible while adhering to other

important principles.
• Traumatized teeth should be treated cautiously since they are more prone to
root resorption during orthodontic treatment.

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• Medical examination and familial tendency records are of value especially
in cases of severe or extensive root resorption.
• If root resorption continues after appliance removal or during retention,

sequential root canal therapy with calcium hydroxide is advisable. Gutta-
percha filling is the definitive therapy only after root resorption ceases.
• It is advisable to take full-mouth radiographs when receiving a transfer

case.

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CONCLUSION
 It may be concluded that an optimal orthodontic force is one that is applied
with full attention to the anatomical constraints and peculiarities of every
individual patient.
 Therefore, orthodontic treatment plans must focus on the desired changes in

dental root position, rather than on adherence to some “universal” system of
mechanotherapy as a solve-all approach. Issues such as force magnitude,
duration, and direction, must be considered individually for each patient, with
the clear understanding that anatomical constraints should not be violated or
ignored during the correction of a malocclusion. When potentially damaging
movements of dental roots, such as round tripping, uncontrolled tipping, and
moving roots into or through labial, buccal, or palatal compact bone plates are
avoided, orthodontic forces may be considered biologically and clinically
optimal.

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Reference
• 1) chapter 6 Biological basis for orthodontic tooth movement (prof. O.P.
kharbanda)
• 2)Chapter 26 root resorptions and tissue changes during orthodontic
treatment.Vicki Valasaki and Robert L Boyd (Bisharra)
• 3)Root resorption after orthodontic treatment part 1 and 2
Nappthali Brezniak, Wasserstein.(AJO jan 1993 )
• 4)Orthodontically induced inflammatory root resorption
Brezniak and wasserstein. Angle 2002
• 5) Root resorption associated with orthodontic tooth
• movement: A systematic review Belinda Weltman,a Katherine W. L. Vig,b
Henry W. Fields,c Shiva Shanker,d and Eloise E. KaizarAm J Orthod
Dentofacial Orthop 2010;137:462-76

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• Linge L, Linge BO. Patient characteristics and treatment variables
associated with apical root resorption during orthodontic treatment.
American Journal of Orthodontics and Dentofacial Orthopedics. 1991 Jan
31;99(1):35-43
• Kjaer I. Morphological characteristics of dentitions developing excessive
root resorption during orthodontic treatment. The European Journal of
Orthodontics. 1995 Feb 1;17(1):25-34.
• Mirabella AD, Årtun J. Risk factors for apical root resorption of maxillary
anterior teeth in adult orthodontic patients. American Journal of
Orthodontics and Dentofacial Orthopedics. 1995 Jul 31;108(1):48-55.
• Baumrind S, Korn EL, Boyd RL. Apical root resorption in orthodontically
treated adults. American Journal of Orthodontics and Dentofacial
Orthopedics. 1996 Sep 30;110(3):311-20.

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• Chan E, Darendeliler MA. Physical properties of root cementum: part 7.
Extent of root resorption under areas of compression and tension. American
Journal of Orthodontics and Dentofacial Orthopedics. 2006 Apr
30;129(4):504-10.
• Montenegro VC, Jones A, Petocz P, Gonzales C, Darendeliler MA. Physical
properties of root cementum: Part 22. Root resorption after the
application of light and heavy extrusive orthodontic forces: A
microcomputed tomography study. American Journal of Orthodontics and
Dentofacial Orthopedics. 2012 Jan 31;141(1):e1-9.
• Kereshanan S, Stephenson P, Waddington R. Identification of dentine
sialoprotein in gingival crevicular fluid during physiological root resorption
and orthodontic tooth movement. The European Journal of Orthodontics.
2008 Jun 1;30(3):307-14.

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Orthodontic Root Resorption

Dept . Of Orthodontics and Dentofacial Deformities, CDER, AIIMS

Dept . Of Orthodontics and Dentofacial

• Extensive post-orthodontic root resorption compromises the benefits of an

Dept . Of Orthodontics and Dentofacial

 Root resorption of the deciduous dentition is a normal, essential, and

 Root resorption of the permanent teeth is a complex biologic process

 Orthodontically induced root resorption begins adjacent to hyalinized

Dept . Of Orthodontics and Dentofacial

Dept . Of Orthodontics and Dentofacial

 Orthodontic force initiation stimulates the remodeling of alveolar bone ,

 Periodontal ligament changes occurs most noticeably at pressure sites

Dept . Of Orthodontics and Dentofacial

Dept . Of Orthodontics and Dentofacial

 Hyalinization (devoid of cellular elements ) and tissue necrosis evident .

 Results of histological studies suggests that resorption occurs in response to

 The innermost cells of the periodontal ligaments protective nature is lost ,

Dept . Of Orthodontics and Dentofacial

 Replanted and transplanted teeth

 Necrotic pulp & periradicular inflammation

 Treated by surgical endodontics

Dept . Of Orthodontics and Dentofacial

 Orthodontically treated teeth

 Teeth near expanding tumors &cysts

 Late & irregularly erupting teeth

Dept . Of Orthodontics and Dentofacial

Dept . Of Orthodontics and Dentofacial

Dept . Of Orthodontics and Dentofacial

 Combined Biologic & Mechanical

- BREZNIAK & WASSERTAIN :1993 AJODO

Dept . Of Orthodontics and Dentofacial

- RYGH P- Angle Ortho 1974

Dept . Of Orthodontics and Dentofacial

-Newman WG AJO 1975

Dept . Of Orthodontics and Dentofacial

 Several polymorphisms have been described in the genes of the IL-1

The presence of IL-1 in the periodontal tissue during tooth movement

Dept . Of Orthodontics and Dentofacial

Dept . Of Orthodontics and Dentofacial

• Idiopathic RR ratio→ 3.7 : 1 (female to male). -Newman WG: AJO 1975

• Apical root material loss→ 0.73 mm : 0.67 mm (female to male)

Dept . Of Orthodontics and Dentofacial

• Traumatized teeth can exhibit RR.

Dept . Of Orthodontics and Dentofacial

•Higher frequency & severity of root resorption of endodontically treated

-Remington DN, et al,: AJODO 1989

Dept . Of Orthodontics and Dentofacial

Dept . Of Orthodontics and Dentofacial

• Becks & Tager related increased root resorption to bone architecture

Dept . Of Orthodontics and Dentofacial

• Janson et al reported a higher resorption potential for class II div 2 cases in

• The rationale was that excessive intrusion mechanics were necessary to

Dept . Of Orthodontics and Dentofacial

 Different teeth have different tendencies to root resorption.

 maxillary teeth are more sensitive than mandibular teeth.

 The extent of movement in these teeth is usually greater than in others

Dept . Of Orthodontics and Dentofacial

The most frequently affected teeth, according to severity, are

Dept . Of Orthodontics and Dentofacial