Conservative orthodontic re-treatment management of severely proclined upper anterior teeth with root resorption

This case report presents conservative orthodontic re-treatment management for an adolescent patient with severe maxillary incisor proclination and advanced external apical root resorption. This treatment was proposed to improve incisor inclination and overjet while minimizing further biological risk and preserving long-term tooth vitality. A 13-year-old female patient with a history of prior orthodontic treatment presented with excessive maxillary incisor flaring, increased overjet, and radiographic evidence of moderate-to-severe external apical root resorption. Comprehensive clinical and radiographic examinations revealed shortened roots with open apices, though periodontal support and pulpal vitality were preserved. Treatment planning focused on minimizing additional root resorption through conservative biomechanics. Space was gained by extracting the maxillary second premolars, allowing controlled retraction of the maxillary incisors using light orthodontic forces. Periodontal health and pulpal vitality were closely monitored throughout the treatment. Significant improvements in maxillary incisor inclination, a reduction of overjet, and enhanced facial harmony were noted. Periodontal probing depths remained within normal limits, no pathological tooth mobility was observed, and pulpal vitality tests remained positive. Although root shortening persisted radiographically, no progression of root resorption was detected during treatment. Orthodontic re-treatment in adolescents with severe external apical root resorption can be successfully performed using conservative biomechanics and careful force control, achieving functional and esthetic improvements while preserving periodontal health and tooth vitality.