Root Resorption of Endodontically Treated Teeth Following Orthodontic Treatment: A Cross-Sectional Study.

BACKGROUND: Root resorption is an unwanted phenomenon occurring in a substantial population proportion these days. Hence, the current study was conducted to evaluate root resorption in endodontically treated teeth following fixed orthodontic treatment.
MATERIALS AND METHODS: A total of 100 patients were enrolled. Only those patients were enrolled that were scheduled to undergo fixed orthodontic therapy. Pretreatment examination was done in all the patients, and their radiographs were obtained. Both orthopantomograms and peri-apical radiographs were taken. All the patients were recalled on follow-up, and radiographic examination was again carried out. Pretreatment radiographs and follow-up radiographs were compared. The incidence of root resorption was documented. The data were entered in an Excel sheet (Microsoft office version 2007) and analyzed using IBM SPSS software version 20.
RESULTS: Root resorption was present in 30 patients. Among these 30 patients, 20 were male, whereas 10 were female. In 19 patients, root resorption was present in the maxillary arch, whereas in 11 patients, it was seen in the mandibular arch. The most common tooth involved with root resorption was premolars, followed by anteriors and molars.
CONCLUSION: The risk of root resorption is higher in endodontically treated teeth under the influence of orthodontic forces. Copyright:

INTRODUCTION

Resorption of the tooth root is an unwanted phenomenon occurring in a significant proportion of the population. It is a complicated process and is irreversible. It involves cementum's external layers, radicular dentin/apex. It is often regarded as an undesirable adverse effect associated with orthodontic treatment. Significant data published in the past literature have documented the number of cases highlighting orthodontic treatment associated with external tooth resorption. On force application, within the tissues, inflammatory process is initiated causing bone remodelling and root resorption.[123] Root resorption related to the fixed orthodontic treatment can occur because of several factors, like the type and magnitude of orthodontic forces and the duration of treatment. Orthodontic patients who have notable root resorption during the first 6 months of their active treatment are expected to experience resorption in later in the treatment.[456] Hence, in light of the data mentioned above, the current study was undertaken to assess the rate of root resorption in endodontically treated teeth following fixed orthodontic treatment.

MATERIALS AND METHODS

The current study was done in the Department of Orthodontics and Dentofacial Orthopedics of the Minority Dental College and Hospital. The dental institution approved the ethical clearance for the study. All the patients were explained about the treatment and the study, and their written consent was obtained. A total of 100 patients were enrolled. Only those patients were enrolled that were scheduled to undergo fixed orthodontic therapy and had endodontically restored teeth. Pretreatment examination was done in all the patients, and their radiographs were obtained. Both v and peri-apical radiographs were taken. Treatment planning was done based on diagnostic casts, and fixed orthodontic was started. All the patients were recalled on follow-up, and radiographic examination was again carried out. Pretreatment radiographs and follow-up radiographs were compared. The incidence of root resorption was documented. The data were entered in an Excel sheet analyzed using IBM SPSS (Statistical Package for the Social Sciences, IBM, USA) software version 20.

RESULTS

In the present study, a total of 100 patients were enrolled. The mean age was 15.4 years. Out of 100 patients, root resorption was present in 30 patients. Among these 30 patients, 20 were male, whereas 10 were female. In 19 patients, root resorption was present in the maxillary arch, whereas in 11 patients, it was seen in the mandibular arch. The most common tooth involved with root resorption was premolars, followed by anteriors and molars [Tables 1 and 2].

Table 1

Incidence of root resorption

Variable	Number of patients (%)
Root resorption	28 (28)

Table 2

Demographic and clinical data among patients with root resorption

Variable	Number of patients (%)
Gender
Females	8 (26.67)
Males	20 (66.67)
Jaw
Maxillary	19 (63.33)
Mandibular	11 (36.67)
Tooth type
Anteriors	9 (30)
Premoalrs	13 (43.33)
Molars	8 (26.67)

DISCUSSION

Apical root resorption is usually characterized by rounding the root apex. It is a common sequela of fixed orthodontic treatment. The predisposing factors causing root resorption include endocrine disturbances, anatomical factors, genetic influence, the mechanics applied, and individual susceptibility. Orthodontists understand these risks that vigorous forces and extended treatment are the main culprits for an increase in root resorption. According to a few studies, bisphosphonates and anti-inflammatories could avert the root resorption intensity at some level. However, these drugs are known to cause slower tooth movement rates.[56789] Hence, in light of the above-mentioned data, the current study was undertaken to evaluate the rate of resorption of the root in endodontically treated teeth following fixed orthodontic treatment.

One hundred patients were enrolled in the present study. The mean age was 15.4 years. Out of 100 patients, root resorption was present in 30 patients. Among these 30 patients, 20 were male, whereas 10 were female. Steadman observed that endodontically treated teeth are recognized as a foreign body, and due to chronic irritation, foreign-body type reactions is seen therefore they are more susceptible to resorption. Wickwire et al. in their study concluded that devital teeth have an increased frequency of root resorption than vital teeth, but they studied the teeth that were endodontically treated after trauma, which as stated by Mah et al. are more susceptible to resorption. Furthermore, an critical aspect in analyzing the rate of root resorption.[891011]

In the current study, in 19 patients, root resorption was present in the maxillary arch, whereas in 11 patients, it was seen in the mandibular arch. The most common tooth involved with root resorption was premolars, followed by anteriors and molars. For an endodontic treatment to be called successful, the treated tooth should be able to act as an abutment for fixed and removable partial denture as well as it should be strong enough to tolerate the orthodontic forces along with the physiologic masticatory forces. Orthodontists should be mindful that endodontically treated teeth may be subjected to different types of forces in addition to the normal masticatory force. An inflammation within the tissues is caused by force functional or parafunctional forces which when overloads may lead to root resorption. Mostly, the teeth undergoing fixed orthodontic treatment are prone to root resorption. Many studies have linked apical root resorption to fixed orthodontic treatment as only 10% of teeth involved in the orthodontic movement are not at risk for apical root resorption. Resorption of almost one-third of the root's actual length may occur in <5% of the involved teeth in cases of orthodontically induced external root resorption. Among the orthodontic-related factors that can affect the orthodontic-induced external root resorption are magnitude, duration, and orthodontic force vector. In cases where orthodontically induced external root resorption is detected in the first 6 months of the active fixed orthodontic treatment, it is expected that those teeth shall probably undergo more resorption later during the treatment.[121314]

CONCLUSION

In view of the results of the current study, the authors concluded that endodontically treated teeth are susceptible to root resorption under orthodontic force influence.

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Nil.

Conflicts of interest

There are no conflicts of interest.