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

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.

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.

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.

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%.