Root resorption during orthodontic treatment with Invisalign®: a radiometric study

Root resorption (RR) is described as a permanent loss of tooth structure from the root apex. Many reports in the literature indicate that orthodontically treated patients are more likely to have severe apical root shortening, interesting mostly maxillary, followed by mandibular incisors. The aim of the study was to investigate the incidence and severity of RR in adult patients treated with aligners. The study group consisted of 71 class I adult healthy patients (mean age 32.8 ± 12.7) treated with aligners (Invisalign®, Align Technologies, Santa Clara, CA, USA). All incisors, canines, upper first premolars, and first molars were assessed. Root and crown lengths of 1083 teeth were measured in panoramic radiographs at the beginning (T0) and at the end (T1) of clear aligner therapy. Individual root-crown ratio (RCR) of each tooth and therefore the relative changes of RCR (rRCR) were determined. A decrease of rRCR was assessed as a reduction of the root length during treatment.

All patients had a minimum of one teeth affected with a reduction of root length, on average 6.38 ± 2.28 teeth per patient. Forty one, 81% of the 1083, measured teeth presented a reduction of the pre-treatment root length. A reduction in percentage of >0% up to 10% was found in 25.94% (n = 281), a distinct reduction of >10% up to 20% in 12.18% (n = 132) of the sample. 3.69% (n = 40) of the teeth were affected with a considerable reduction (>20%).

Orthodontic treatment with Invisalign® aligners could lead to RR. However, its incidence resulted to be very similar to that described for orthodontic light forces, with an average percentage of RR < 10% of the original root length.