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Orthodontic Root Resorption An Update For The Clinician Glenn Sameshima. Episode 55. IOC 2020

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Farooq Ahmed

Defined

  • Irreversible shortening of the root due to tooth movement

 

When moving a tooth what happens to the root?

  • Craters in the cementum – due to over activation of cementoblasts
  • Craters resolves on the root services
    • But not on the apex, unsure why

 

Prevalence of RR

  • 25% up to 2mm
  • 5% up to 4mm, Smemhima 2004

 

Aetiology Hartsfield 2010

  • Genetics 65%
  • Mechanics 15%
  • Unknown 20%

 

Predispositions

  • No difference in gender
  • Slight increase in adults
  • Idiopathic root syndrome
  • Multiple idiopathic apical external root resorption

 

Treatment factors 15% of aetiology

  • Extended treatment time systematic review Roscoe 2015
    • Genetic explanation, allele where there is a threshold to forces, resulting in no repair after a certain time. Al-Qasami
  • Apical displacement of the root (overjet and extraction) Iglesias-linares 2017, Nuria 2017
    • 5mm – 4.5mm apical displacement = 1-1.7mm resorption

 

Systematic reviews

  • Apical displacement and treatment duration increase RR Segal 2004
  • Light forces for intrusion reduces risk of root resorption Weltman 2010
  • Increased force levels and treatment time increase RR Roscoe 2015
  • Increased continuous force, intrusion and treatment duration increase RR Currell 2019

 

RR of root canal treated teeth

  • No difference in RR Castro 2014
  • Slight reduction in RR Kolcuoglu 2020

 

Immature apex

  • Less likely to get RR

 

Aligners and RR

  • No difference – Iglesias-Linares 2017
    • Depends on tooth movement, not type of appliance

 

No difference with micro perforation or photobiomodulation

 

What to do if RR?

  • Stop for 3 months
  • When resume less likely RR

 

Prognosis long term of RR

  • Lateral incisors with severe RR (from canines) long term stable , even with 20% increase crown : root ratio Becker 2009
  • Increase in mobility with extreme RR
  • NO TOOTH LOSS RR Jonsson 2007
  • Teeth with severe RR usually stabilise
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