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Early radiographic diagnosis of apical root resorption during orthodontic treatment: a study of maxillary incisors.

The purpose of this study was to evaluate the sensitivity of digital radiographs for detection of (i) simulated root resorption cavities in an experimental model and (ii) orthodontically-induced apical root resorption in vivo. The severity of root resorption after 3 and 6 months treatment was studied in relation to root form. The experimental study cavities, drilled in mandibular roots in a dry skull, were recorded in conventional and digital radiographs. In vivo root resorption was evaluated on digital radiographs of 92 maxillary incisors after 3 and 6 months treatment with fixed appliances. The results showed a similar sensitivity for the two methods. Sensitivity increased significantly with cavity size. After 3 months apical root resorption was detected in only a few teeth. The number had increased significantly after 6 months. There was a higher degree of root resorption in teeth with blunt and pipette-shaped apices. In such teeth a 3-month radiographic control is recommended.

Chi-Square Distribution↗

Root resorption after orthodontic treatment in high- and low-risk patients: analysis of allergy as a possible predisposing factor.

The development of excessive root resorption during orthodontic tooth movement is an adverse side-effect, which is of great concern. The aim of this investigation was to analyse factors that might be associated with orthodontically induced root resorption. After buccal movement of maxillary premolars in 96 adolescents, the experimental teeth were extracted and subjected to histological analysis and measurement of resorbed root area. Fifty individuals, 18 boys and 32 girls, mean age 13.4 years, were selected and divided into two equal groups: the high-risk group based on measurements of the most severe root resorptions, and the low-risk group on measurements of mild or no root resorptions. After a preliminary screening of possible risk factors regarding root resorption, i.e. root morphology, gingivitis, allergy, nail-biting, medication, etc., only those subjects with allergy showed an increased risk of root resorption, but this was not statistically significant.

Adolescent↗

The effects of exogenous prostaglandin E2 on root resorption in rats.

This study evaluated the amount and depth of root resorption associated with varying concentrations and frequencies of injectable, exogenous prostaglandin E2 (PGE2) in conjunction with orthodontic tooth movement in rats. The sample consisted of 155 maxillary right and left first molars from 88, 8-week old, male Sprague-Dawley rats. The animals were divided into three control groups and two experimental groups. The control animals were divided into one nonappliance and two appliance groups. The experimental animals were divided into 2- and 4-week experimental time periods that were further subdivided based on single and weekly injection intervals of PGE2 and four different injectable concentration levels, i.e., 0.1, 1.0, 5.0, and 10.0 micrograms. A fixed orthodontic appliance was ligated between the maxillary incisors and maxillary first molars with closed-coil nickel-titanium springs. The appliance had an initial activating force of 60 gm. Serial histologic sections of the mesial root of the maxillary first molar were made, and a quantitative histomorphometric analysis of root resorption on the mesial and distal surfaces was performed. This study demonstrated increased root surface resorption when using exogenous PGE2 injections to enhance orthodontic tooth movement over a 2-week period with increasing root resorption on the mesial surface as compared with the distal surface in PGE2 treated teeth. No differences in root resorption were found with either multiple injections or increasing concentration in the 4-week experimental group. Local injection of PGE2 appeared to have no effect on the number or depth of resorption lacunae in either the 2- or 4-week groups.

Analysis of Variance↗

Physical properties of root cementum: part 8. Volumetric analysis of root resorption craters after application of controlled intrusive light and heavy orthodontic forces: a microcomputed tomography scan study.

INTRODUCTION: Intrusion is a critical type of orthodontic tooth movement in relation to external root resorption. Our aims in this prospective randomized clinical trial were to quantify, 3 dimensionally, the amount of root resorption when controlled light and heavy intrusive forces were applied to human premolars and to establish the sites where root resorption is more prevalent. METHODS: Fifty-four maxillary first premolars, orthodontically indicated for extraction from 27 patients (left and right maxillary first premolars from each), were intruded for 28 days with buccal and palatal beta-titanium-molybdenum alloy 0.017 x 0.025-in cantilever springs. The patients were randomly divided into 3 groups, and various levels of force were used: group 1, heavy force (225 g) on 1 side and control force (0 g) on the contralateral side; group 2, light force (25 g) on 1 side and control force (0 g) on the contralateral side; group 3, light force (25 g) on 1 side and heavy force (225 g) on the contralateral side. After the experimental period, the teeth were extracted under a strict protocol to prevent root surface damage and analyzed by using a microcomputed tomography scan x-ray system (SkyScan-1072, Skyscan, Aartselaar, Belgium) and specially designed software for direct volumetric measurements. RESULTS: The volume of the root resorption craters after intrusion was found to be directly proportional to the magnitude of the intrusive force applied. The results showed that the control group had fewer and smaller root resorption craters, the light force group had more and larger root resorption craters than the control group, and the heavy force group had the most and the largest root resorption craters of all groups. A trend of linear increase in the volume of the root resorption craters was observed from control to light to heavy groups, and these differences were statistically significant. The mean volumes of the resorption craters in the light and heavy force groups were 2 and 4 times greater than in the control groups, respectively. The mesial and distal surfaces had the greatest resorption volume, with no statistically significant difference between the 2 surfaces.

Adolescent↗

[Clinic study of root resorption caused by edgewise appliance combined with flat bite plate treatment ].

OBJECTIVE: To study the root resorption caused by edgewise appliance combined with flat bite plate treatment. METHODS: 65 patients with edgewise technique and flat bite plate treatment were chosen. All patients were taken panoramic radiograph before flat bite plate treatment, immediately after flat bite plate treatment and 6 months after flat bite plate treatment. Root resorption grade of mandibular permanent incisors were analyzed. RESULTS: There were statistical difference in the root resorption grade of three groups (P < 0.05), but there was no statistical difference between male and female (P > 0.05). CONCLUSION: Flat bite plate can cause root resorption of mandibular permanent incisors, but the root resorption is slight.

Aged↗

Orthodontic tooth movement and root resorption with special reference to force magnitude and duration. A clinical and histological investigation in adolescents.

The purpose of orthodontic treatment is to move teeth as efficiently as possible with least damage to teeth and their supporting tissues. Root resorption may occur as an unwanted side effect and may in some instances jeopardize an otherwise successful treatment. The general aim of this series of clinical investigations was to study the association between applied force, achieved tooth movement and related root resorptions. In 144 adolescents, the maxillary first or second premolar was buccally moved with a fixed orthodontic appliance. The variables studied were duration, magnitude and type of force. Moreover, both the occurrence of orthodontically induced root resorptions and the reparative potential were investigated in histological preparations of the teeth. When a continuous force of a clinically relevant magnitude (50 cN approximately 50 g) was applied, tooth movement increased gradually over time. Root resorptions were recorded in all test teeth but 4 (93%). After 3 weeks a few teeth revealed root resorptions extending half way to the pulp or more in the apical third of the root. No association was found between root resorptions and tooth movement. Doubling the force magnitude (100 cN approximately 100 g) affected neither the tooth movement nor the severity of root resorptions. However, when the force was increased 4 times (200 cN approximately 200 g), tooth movement increased 50% but still with no significant increase in the occurrence or severity of root resorptions. Tooth movement was achieved more efficiently with a continuous force than with an interrupted type of force of the same magnitude (50 cN). Root resorptions, though, did not seem to be affected differently by the two types of forces. Reduction of all types of applied forces was considerable, about 25-30%, already within one week. Repair with secondary cementum was recorded almost 3 times more often after 8 weeks (75%) of retention than after 1 week (28%). Irrespective of magnitude and type of force, large individual variations were observed regarding tooth movements and root resorptions as well as their reparative potential. The possible clinical consequences of the results obtained are discussed with regard to cost-benefit effects, convenience to the patient and risk of complications.

Adolescent↗

Effect of soluble receptors to interleukin-1 and tumor necrosis factor alpha on experimentally induced root resorption in rats.

OBJECTIVE: In this study, the role of the inflammatory cytokines interleukin-1 (IL-1) and tumor necrosis factor alpha (TNFalpha) in the course of mechanically induced root resorption was investigated. METHODS: Mechanical induction of root resorption was performed on the upper left first molars in 18 male Wistar rats according to the method of Nakane and Kameyama. Starting on day minus 1, six animals received daily intraperitoneal injections of 2 ml of 1 micro g/ml soluble receptors to IL-1 (sIL-1RII) and another six animals were administered the same dose of soluble receptors to TNFalpha (sTNFalpha-RI). Six animals served as a control. On d 7 the left maxillae were prepared for histological and morphometric analysis of the extent of the root resorption that had developed. RESULTS: The qualitative and quantitative results demonstrated that in both receptor groups the amount of root resorption was significantly reduced. Especially following systemic application of sTNFalpha-RI, root resorption was nearly completely prevented. CONCLUSIONS: Our results indicate that IL-1 and more particularly TNFalpha are important for the induction and the further process of mechanically induced root resorption in the rat.

Acid Phosphatase↗

A histopathological study of the role of periodontal ligament tissue in root resorption in the rat.

Whether periodontal ligament (PDL) tissue is capable of inducing root resorption was examined. The distal root of the rat molar was sectioned at the furcation and the PDL tissue removed from the root (non-PDL group, n=40). The distal root with the PDL intact was also prepared (PDL-intact group, n=40). The roots were transplanted into the dorsal skin of the rat. On the 1st, 3rd, 5th, 7th, 10th, 14th, 21st or 28th day after transplantation, the roots were removed together with surrounding dorsal subcutaneous tissue and were fixed, demineralized and embedded in paraffin. Serial sections from each block were stained with haematoxylin and eosin or by the tartrate-resistant acid phosphatase (TRAP) method to observe root-resorbing cell formation. Cyclo-oxygenase-2 (COX2) was also detected immunohistologically to examine prostaglandin E(2) production. On the 7th day after transplantation, multinucleated root-resorbing cells with TRAP were observed in the PDL-intact group. The number of TRAP-positive cells peaked on the 10th day after transplantation. COX2-positive cells were observed in PDL during the early experimental stages. No root resorption was seen in the non-PDL group. These results suggest that PDL tissue is involved in the formation of root-resorbing cells and root resorption.

Acid Phosphatase↗

[The study of root resorption of human deciduous teeth. I. Histological observation by light microscope].

Sixty-four human non-carious deciduous teeth were used to observe the root resorption of deciduous teeth by means of light microscope. The extent of root resorption was classified into 6 grades: Res. O, Res. i, Res. 1/4, Res. 1/2, Res. 3/4, Res. Co. In the physiological root resorption of deciduous tooth, there are numerous, large multinucleated odontoclasts and mononuclear fibroblasts or macrophages residing at the Howship's lacunae. The odontoclasts resorbed hard dental tissues, including cementum, dentin. A characteristic of active or "resorbing" odontoclasts, but not in free or inactive odontoclasts is cytoplasmic projections, or brush borders, which were found near the underlying hard dental tissues. The deciduous root resorption was found to be most advanced in the apical areas. Because of the different eruption path of the permanent successors, the position of deciduous root resorption varied. Generally, the lingual surface was resorbed more extensively than the labial surface in the deciduous anterior teeth; the resorption of the furcal area and interradicular cementum surface of the roots were more advanced in the deciduous molars. Predentin can be resorbed by odontoclasts, too. However, it seems more resistant to resorption than dentin. Resorption lacunae could be observed in the root canal and pulp chamber. This means that the internal root resorption probably occur simultaneously. Periodontal fiber attachment was observed in some Howship's lacunae of the root surface. Inflammatory changes occurred in the pulp of deciduous teeth during the shedding process, especially when the deciduous root was resorbed more than one half way. The appearance of the repairing cellular cementum and periodontal fiber attachment was clearly observed in some deciduous roots.

Child↗

Pulp-dentine complex changes and root resorption during intrusive orthodontic tooth movement in patients prescribed nabumetone.

Pulpitis, external root resorption, and pain may be experienced during orthodontic movement. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been suggested to control these changes. The purpose of this study was to observe pulp-dentinal reactions, root resorption, tooth pain, and tooth movement after the application of a 4-ounce intrusive orthodontic force to human maxillary first premolars in patients given the NSAID nabumetone. Thirty-four maxillary first premolars were evaluated. A placebo was prescribed to 17 patients after an intrusive force was activated and reactivated for an 8-week period on the right side. The same procedure was repeated on the left side after patients were given nabumetone. Pulp-dentinal reactions and external root resorption were evaluated by histology. Pain and movement were also evaluated. Nabumetone was found to be useful in reducing pulpitis, external root resorption, and pain caused by intrusive orthodontic movement, without altering tooth movement in response to the application of orthodontic force.

Adolescent↗

Bilateral root-resorption of upper first permanent molars.

Root-resorption of first permanent molars by impacted premolars is generally considered to be rare, although a few cases have been reported. A case is presented, of bilateral root-resorption of upper first permanent molars by unerupted second premolars, and a number of clinical conclusions are discussed.

Bicuspid↗

Does an impacted tooth cause root resorption of the adjacent one?

External root resorption caused by an adjacent impacted tooth was studied radiographically in 199 cases. Resorption of the root had occurred in fifteen instances (7.5 per cent), the cervical region being least affected. The incidence was highest in the 21 to 30-year-old group and mainly involved male patients. Resorption of the periodontium alone was found in sixteen additional patients; of these, five were followed for 1 year after extraction of the impacted tooth. During this period, the damaged periodontium was completely re-established.

Adolescent↗

Anomalous dental morphology and root resorption during orthodontic treatment: a pilot study.

The present study investigated the relation between anomalous dental morphology and root resorption during orthodontic treatment. One hundred and eleven sets of orthodontic records (a total of 1,630 teeth) were examined. Root resorption was determined from post-treatment panoramic radiographs using a five-grade quantitative measurement. It was found that patients with short or blunt roots before treatment underwent significant root shortening during orthodontic treatment. Patients with any one dental anomaly had a significantly higher degree of root resorption compared with patients with no dental anomaly. Invaginated teeth, teeth with thin or pipette-shaped roots and teeth with short or blunt roots were likely to be more susceptible to root resorption than those without such anomalies. Possible linkages between the aetiological factors of dental anomalies and the susceptibility to root resorption were discussed. The presence of anomalous dental morphology should be taken into account in orthodontic treatment planning.

Adolescent↗

Multiple idiopathic external root resorption.

An unusual case of multiple idiopathic root resorption involving all of the maxillary and mandibular incisor, canine, and premolar teeth is presented. A review of the literature reveals that this case is unusual in that, although other cases of multiple idiopathic root resorption have been described, the site of the resorption has been at the cervical margin in most reports, not at the apices as in this case. In other reports in which the resorption did affect the apices, the resorption usually affected only one, two, or three teeth. The pattern of resorption in this case, affecting only teeth with deciduous precursors, appears to be unique.

Adolescent↗

External root resorptions and orthodontic forces: correlations and clinical consequences.

Orthodontically induced root resorption is the most frequent unwanted side effect of orthodontic tooth movement that is unavoidable. This is due to the fact that both bone remodelling and root resorption are based upon a sterile inflammatory process, initiated by force application. In addition to individual factors that have a bearing on the amount of resorption, the type and magnitude of orthodontic forces play a major role. In animal and human experiments it could be shown that continuous forces, as produced by materials with pseudo- elastic characteristics, seem to produce more resorptions than discontinuous forces. Recent research shows that the magnitude of the orthodontic force up to 200cN is probably not decisive for root resorption.

Animals↗

Can the severity of root resorption be accurately judged by means of radiographs? A case report with histology.

INTRODUCTION: Root resorption of lateral incisors caused by the pressure of erupting canines is a well-known but relatively rare problem in orthodontics and general dentistry. It is usually diagnosed on radiographs. The purpose of this article is to discuss some difficulties associated with evaluating root resorption from radiographs alone. A case report is presented as an example. METHODS: Radiographs showed that an 11-year-old girl had marked root resorption of the maxillary lateral incisors, caused by the impacted permanent canines. The incisors were to be extracted. Several months before the extractions, a canine had been surgically exposed to remove pressure from the incisor root. The lateral incisors were analyzed histologically, and the histologic findings were compared with those of the patient's mandibular first premolars, which had been extracted. RESULTS: The resorption of the lateral incisors was more severe than expected from the radiographs. The resorption extended far into the pulp. Most, although not all, root resorption areas showed histologic evidence of repair, but the amount of repair was far from functional repair levels. The mandibular first premolars had no signs of resorption, thus excluding systemic causes. CONCLUSIONS: The severity of root resorption of lateral incisors cannot be accurately judged from radiographs alone.

Bicuspid↗

Two cases of molar root resorption.

The presence of unerupted teeth in close proximity to adjacent teeth can cause root resorption. The third molars and mandibular premolars are the most frequent teeth to be impacted and the relationship between impacted teeth causing root resorption of adjacent teeth has been well documented, but it is surprising how few studies have analysed the incidence of root resorption in these cases. This paper discusses two patients who have undergone molar root resorption due to adjacent unerupted impacted teeth.

Adolescent↗

Cellular roles in physiological root resorption of deciduous teeth in the cat.

This study has attempted to assess the importance of mesenchymal cells, fibroblasts, cementoblasts, and mononuclear phagocytes (i.e., macrophages) in physiological root resorption of feline deciduous teeth. Deciduous incisors of three- to six-month-old kittens undergoing root resorption were investigated by means of electron microscopy. In an early phase of root resorption, the resorption organ consisted of many fibroblasts and relatively few macrophages and odontoclasts, the last with a wide, clear zone and narrow, immature, ruffled border. In the active phase of root resorption, the resorption organ contained many odontoclasts with a well-developed ruffled border and a reduced clear zone, cementoblasts, fibroblasts, macrophages, neutrophils, and many blood vessels. Cementoblasts were present usually on the resorbing dentin surface adjacent to odontoclasts and, in many cases, these cells communicated with each other via gap junctions. Cementoblasts frequently extended broad cell processes with secretion granules and with phagosomes containing collagen fibrils into the dentinal tubules exposed to resorption lacunae. Some macrophages exhibiting a clear zone-like structure also appeared on resorbing dentin surfaces. In the resting phase of root resorption, the dentin surface was covered mostly with cementoblasts resembling bone lining cells. There was an occasional macrophage, but no odontoclasts were observed during this phase. During removal of the periodontal ligament concomitant with root resorption, many fibroblasts phagocytosed mature collagen fibrils, as well as amorphous fluffy material. These results suggest that these mesenchymal cells, as well as odontoclasts, are essential for the cellular removal of dental hard and soft tissues during shedding of feline deciduous teeth.

Animals↗