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Infraocclusion of deciduous molars that also lack a permanent successor is found to progress more than where a successor is present, while exfoliation is severely retarded. The aplasia is the most important factor in treatment planning and timing.
Various combinations of orthodontic force, luxation, and observation are applied to 12 teeth traumatically intruded in 3 large dogs. All showed root resorption to some degree. Early orthodontic repositioning, with luxation if immobile, produced the best recovery.
A detailed radiographic study of 46 cases of maxillary incisor resorption related to unerupted cuspids finds most resorption in midroot, with about half on labial or lingual surfaces where it was not detectable on periapical radiographs. Resorption appears early, making it desirable to evaluate cuspid position no later than 10 or 11 years of age.
The present cross-sectional study was based on orthopantomograms of 1245 Greek children (590 males and 655 females), whose ages ranged from 6 years 10 months to 14 years. Three orthodontic practices were the source of these orthopantomograms which were taken before the start of orthodontic treatment. The resorption process of the deciduous mandibular canine and molar roots was divided into five stages and the root formation process of their permanent successors into eight stages. The percentage distribution of the deciduous root resorption stages for each root formation stage of the corresponding permanent teeth was then recorded. Exfoliation of these three deciduous teeth occurred when the root formation of their successors had reached the R2/3, R3/4 or the beginning of the Rc stage. As far as the effect of local factors on root resorption and formation process our findings indicated that decay, pulp necrosis and pulpotomy hastened the rate of root resorption of the deciduous molars, while they did not influence the rate of root formation of the corresponding permanent teeth.
The aim of this investigation was to study the reparative potential of orthodontically induced root resorption. Sixty-four maxillary right and left first premolars in 32 patients (15 boys and 17 girls, mean age 13.7 years) were moved buccally with fixed orthodontic appliances and a continuous force of 50 cN (approximately 50 g), activated weekly for 6 weeks. The patients were divided into 4 groups of 8. Retention periods varied from 1 week to 8 weeks. Histological preparations showed that root resorption affected all the test teeth. The percentage of resorptive areas that had begun to repair ranged from 28% after 1 week of retention to 75% after 8 weeks. The healing cementum was almost exclusively of the cellular type. Partial repair, with the resorption cavity walls only partially covered with cementum, was the most frequent type of repair during the first 4 weeks of retention (17% to 31%). Functional repair, with the total surface of the resorption cavity walls covered with varying thicknesses of cementum, dominated after 5, 6, 7 and 8 weeks of retention (33% to 40%). There were no large differences in the healing potential in the cervical, middle, and apical thirds of the root. After 8 weeks, three out of four resorptive areas showed some degree of repair. Individual variations in healing potential were large.
Orthodontic and periodontic management of a patient with bilaterally impacted maxillary canines and advanced resorption of the adjacent lateral incisors is presented. In treating the patient, the affected laterals were retained and the canines were surgically exposed, then moved away from the roots of the laterals and into position in the arch. Alternative treatment strategies are discussed. Long-term follow-up evaluation revealed successful maintenance of the dentition and of periodontal health.
The aim of this study was to compare the effects on root resorption of continuous and discontinuous force application. The experimental material consisted of 22 first premolars that were to be extracted as part of orthodontic treatment. Prior to extraction, a 100 g tipping force was applied to the experimental teeth by means of elastics. One side was randomly selected to be the continuous force side, and the contralateral side became the discontinuous force side. Elastics were worn 24 hours per day on the continuous force side and 12 hours per day on the discontinuous side. The experimental procedure lasted 9 weeks. Composite electron micrographs of the buccal surface of each specimen were digitized and areas affected by resorption were determined. The degree of root blunting was assessed by visual scoring. Mean percentage of resorption-affected areas was smaller and apical blunting was less severe on the discontinuous force side. The results of this study show that the application of discontinuous force results in less root resorption than does the application of continuous force.
The skeletal anchorage system (SAS) was developed as intraoral rigid anchors for open-bite correction by intrusion of molars. Since the application of SAS is a new modality in orthodontic treatment, the influences of radical molar intrusion on the root and the inferior alveolar neurovascular bundle were unknown. The purpose of this research is to verify the effect of molar intrusion on the neurovascular bundle, the level of osseointegration of bone screws, and root resorption. The results of this study showed mandibular molars were intruded 3.4 mm on the average over 7 months in dogs. The miniplates were well stabilized with osseointegrated bone screws and the peri-implant soft tissues showed slight inflammatory changes. Neither nerves nor blood vessels were damaged. Root resorption was observed but was repaired with new cementum. We concluded that the SAS utilizing transmucosal titanium miniplates as an immovable orthodontic anchorage could provide a new modality for molar intrusions without serious iatrogenic problems.
A total of 61 children who had 83 maxillary canines impacted were followed up for a mean of 3.5 years (range 1.1-10.9 years) after treatment to evaluate the long-term results of the treatments. In most of the children, the impacted maxillary canines had been surgically exposed and treated with fixed orthodontic appliances. In 11 cases, lateral incisors had been extracted because of extensive root resorption. The esthetic results as well as functional and periodontal conditions were evaluated. Only four of the 61 children were not satisfied with the esthetic result, whereas orthodontists judged only 56% of the results as esthetically acceptable on clinical evaluation and 57% as esthetically acceptable on color slides. The periodontal conditions and the occlusal function on sides with previously impacted canines and on sides with normally erupted canines, on the whole, were similar. Exceptions were pocket depths of the left lateral incisors and left canines, but these variables were significantly different mainly because of one patient. In lateral movements of the mandible, however, significant differences in contact pattern were found between sides with normally erupted canines and sides with impacted canines. Canine rise occurred more often on working sides with normally erupted canines than with impacted canines.
This is a case report of a patient with bilateral labial impaction of maxillary canines causing pressure resorption on the lateral aspects of the maxillary central incisors. The orthodontic treatment plan included extraction of the impacted canines, positioned between the central and the lateral incisors. Six years after the orthodontic treatment, the affected central incisors remained asymptomatic.
Monoblock appliances were used in combination with intermaxillary elastics for treatment of adult skeletal Class III patients. The patients showed predisposing upper incisors problems, significant mobility in patient 1 and root resorption in patient 2, which contraindicated direct intrusion of the incisors. Using the monoblock with selective extrusion of the molars, a clockwise rotation was induced to reduce overbite and to achieve a better profile. It was also possible to reduce the excessive force to the upper incisors during and after treatment, which improved incisor mobility to a physiologic extent (patient 1) and prevented further progression of root resorption (patient 2). Stability was high after the 2-year follow-up, which suggests a stable vertical control approach by using the monoblock appliance in combination with a fixed appliance in adults.
This article describes the diagnosis and treatment of a case of extensive apical external root resorption in the presence of a large periradicular lesion. The diagnosis was made in retrospect because the result of the resorption mimicked an immature root. The treatment consisted of the use of calcium hydroxide to induce apexification. Healing was obtained after 24 months.
CLINICAL TECHNIQUE: It is generally accepted that the success of root-canal treatment is mainly dependent on the proper cleaning, shaping and hermetic obturation of root canals. Obturation of the root canal is of importance as 60% of endodontic failures are attributable to incomplete obliteration of the root-canal system. The clinical application of many obturation techniques used today demands the preservation of the natural apical construction or the preparation of an artificial equivalent during chemo-mechanical preparation. However, in clinical practice there are cases where the apical foramen is wide because of over-instrumentation, root-end resection during periradicular surgery, root resorption or because the apex of the root is incompletely formed. Thus the preparation of an artificial apical stop is very difficult to achieve. It is a common experience that performing usual gutta-percha condensation techniques in such canals often results in overfilling and therefore special obturation techniques are needed. Some clinical cases of teeth with wide apical foramen treated by a special obturation method are presented in this paper. In this method the end point of the primary gutta-percha cone is elasticized with a heated instrument and inserted into the root canal to record the internal morphology of the apical portion.
AIM: To assess the reliability of routine single radiographs in the diagnosis of inflammatory apical root resorption by correlating the radiographic and histological findings. METHODOLOGY: The material comprised serial and step serial sections of plastic-embedded root-apices with attached apical periodontitis lesions that were prepared for a previous study and the diagnostic radiographs. The histological sections of 114 specimens were analysed by light microscopy and categorized into three groups: (i) those without any resorption (0); (ii) those with moderate resorption (+); and (iii) those with severe resorption (+ +). The radiographs were examined by a separate examiner and graded with a similar categorization of no resorption (0); moderate (+); and severe (+ +) apical resorption. RESULTS: Radiographically, 19% of the teeth were diagnosed as having apical inflammatory root resorption, whereas histologically, 81% of the teeth revealed apical inflammatory root resorption. A correlative radiographic and histological assessment (n = 104) revealed a coincidence of diagnosis in 7% of the specimens and noncoincidence of diagnosis in 76% of the specimens. CONCLUSIONS: The results indicate that routine single radiographs are not sufficiently accurate or sensitive to consistently diagnose apical root resorptive defects developing as a consequence of apical periodontitis.
AIM: The aim of this study was to determine the prevalence of various periapical pathologies and their association with the presence and extent of apical external inflammatory root resorption in human teeth. METHODOLOGY: One hundred and four root apices from extracted teeth with periapical lesions were examined. Semi-serial sections of soft tissue lesions were stained with HE. The lesions were classified as noncystic or cystic, each with different degrees of acute inflammation: 0, 1, 2 and 3, increasing in severity. The root apices were analysed by SEM. External root resorption was classified according to site, as periforaminal or foraminal, and the extension of the resorbed area graded in increasing area as 0, 1, 2 or 3. RESULTS: Cysts accounted for 24.5% of the samples, 84% of which were associated with marked inflammation. The most prevalent diagnosis was noncystic periapical abscess with varying degrees of severity (63.7%). Periapical granuloma was not a frequent finding. SEM analysis showed that 42.2% of the root apices had periforaminal resorption extending over 50% of their circumference. When the foraminal resorption was evaluated, 28.7% had resorption affecting >50% of the periphery. Only 8.9% of the samples showed no periforaminal or foraminal resorption. CONCLUSIONS: In the sample of extracted teeth investigated, 24.5% of the periapical lesions were cysts. Most periapical lesions (84.3%) displayed acute inflammation, whether cystic or not. Periforaminal resorption was present in 87.3% of the cases, and foraminal resorption in 83.2%. Periforaminal and foraminal resorptions were independent entities. There was no association between external root resorption and the nature of the periapical lesions.
This study examined the tissue level mineralisation density distribution in mandibles from 88 adult humans. Mandibles (19-96 y) were sectioned vertically in midline (MID), mental foramen (MF), and third molar (M3) regions. Surgical fragments from M3 were obtained from individuals aged 16-38 y. All specimens were cleaned, embedded in PMMA, micromilled and examined by digital 20 kV backscattered electron (BSE) stereology. Quantitation was based on rescaling image histograms to the signal range between a monobrominated (0) and a monoiodinated (255) dimethacrylate resin standard. Mineralisation density increased with age (r=0.70; P < 0.0001): the mean for 39 individuals aged between 16 and 50 y was significantly lower (P < 0.0001) than for 35 individuals over 51 y (mean (+/-S.E.M.): 158.20 (1.63) and 174.71 (1.27) normalised grey level units respectively). There was good correlation in mean mineralisation density between different sites in the same mandible, but MID was significantly less highly mineralised than the other sites: MID 173.90, MF 177.34, M3 177.11 (P < 0.002 and 0.01 for MF and M3 respectively; paired t test), as was the alveolar bone density when compared with the bone of the inferior cortex (e.g. MID: 171.13 (1.53) and 174.46 (1.14) P < 0.0001). No sex difference was found. Partially dentate mandibles generally had regions of higher mineralisation than fully dentate and edentulous mandibles. The lowest density bone occurred at the alveolar crest anteriorly and superolingually at M3, matching sites of net resorption following tooth loss. Highest densities were found inferolingually at MID, inferiorly at MF and buccally at M3, matching the sites thought to experience the highest functional strains. This stresses the importance that local factors may have in the remodelling of the edentulous mandible. Morphology showed that there is a preponderance of highly mineralised cement lines, and of packets containing dead, mineralised, osteocytes.
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