Extreme root resorption associated with induced tooth
               movement: A protocol for clinical management

Cases in which teeth have only the cervical third remaining from orthodontically induced external root resorption, cast the following doubts: 1) What care should be taken to keep these teeth in mouth with the least risk possible? 2) What care should be taken with regards to reading of imaging exams, particularly in terms of accurately determining cervical root and bone loss? 3) Why is not endodontic treatment recommended in these cases? The present study aims at shedding light on the aforementioned topics so as to induce new insights into the theme.

Tooth resorption; External apical resorption; Apical resorption; Orthodontic resorption; Apical rounding; Short roots

Authorship

Alberto Consolaro

Full professor, School of Dentistry,University of São Paulo/Bauru. Professor, Postgraduate Program, School of Dentistry, University of São Paulo/ Ribeirão PretoUniversity of São PauloRibeirão PretoFull professor, School of Dentistry,University of São Paulo/Bauru. Professor, Postgraduate Program, School of Dentistry, University of São Paulo/ Ribeirão Preto

Laurindo Zanco Furquim

Associate professor, Orthodontics, State University of Maringá (UEM)State University of MaringáAssociate professor, Orthodontics, State University of Maringá (UEM)

Contact address: Alberto Consolaro E-mail: consolaro@uol.com.br

SCIMAGO INSTITUTIONS RANKINGS

Associate professor, Orthodontics, State University of Maringá (UEM)State University of MaringáAssociate professor, Orthodontics, State University of Maringá (UEM)

Figures

Figures (9)

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Figure 1
Severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment. Most teeth, including first molars, have only the cervical third remaining. Note the detailed root and bone structures involved in the resorption process.

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Figure 2
For comparative purposes, note that conventional panoramic radiograph reveals the same severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment

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Figure 3
After four years of orthodontic treatment, some severe inflammatory root resorptions (Malmgren's grade 4) were mistakenly treated by means of endodontic therapy as revealed by digital panoramic radiograph.

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Figure 4
Severe inflammatory root resorption (Malmgren's grade 4) revealed by 3D tomographic scans that allow a contextual and comparative assessment of the process in each tooth and their respective surfaces

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Figure 5
Severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment, including premolars and molars. Apparently, teeth have no bone or alveolar cortical bone support; however, periapical radiograph reveals detailed root and bone structures involved in the resorption process. Thus, it is reasonable to assert that there exists periodontal support provided by the cervical third.

Thumbnail

Figure 6
Tomographic slices of severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment. Apparently, teeth have no bone or alveolar cortical bone support; however, periapical radiograph reveals detailed root and bone structures involved in the resorption process. Thus, it is reasonable to assert that there exists periodontal support provided by the cervical third.

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Figure 7
Clinical dental and gingival aspects of patient presenting with severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment.

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Figure 8
Clinical aspect after occlusal adjustment: incisal guidance and improved canines and molars occlusion.

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Figure 9
Clinical dental and gingival aspects of patient presenting with severe inflammatory root resorption (Malmgren's grade 4) after applying the protocol suggested with a 6-year control.

Figure 1 Severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment. Most teeth, including first molars, have only the cervical third remaining. Note the detailed root and bone structures involved in the resorption process.

Figure 2 For comparative purposes, note that conventional panoramic radiograph reveals the same severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment

Figure 3 After four years of orthodontic treatment, some severe inflammatory root resorptions (Malmgren's grade 4) were mistakenly treated by means of endodontic therapy as revealed by digital panoramic radiograph.

Figure 4 Severe inflammatory root resorption (Malmgren's grade 4) revealed by 3D tomographic scans that allow a contextual and comparative assessment of the process in each tooth and their respective surfaces

Figure 5 Severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment, including premolars and molars. Apparently, teeth have no bone or alveolar cortical bone support; however, periapical radiograph reveals detailed root and bone structures involved in the resorption process. Thus, it is reasonable to assert that there exists periodontal support provided by the cervical third.

Figure 6 Tomographic slices of severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment. Apparently, teeth have no bone or alveolar cortical bone support; however, periapical radiograph reveals detailed root and bone structures involved in the resorption process. Thus, it is reasonable to assert that there exists periodontal support provided by the cervical third.

Figure 7 Clinical dental and gingival aspects of patient presenting with severe inflammatory root resorption (Malmgren's grade 4) after four years of orthodontic treatment.

Figure 8 Clinical aspect after occlusal adjustment: incisal guidance and improved canines and molars occlusion.

Figure 9 Clinical dental and gingival aspects of patient presenting with severe inflammatory root resorption (Malmgren's grade 4) after applying the protocol suggested with a 6-year control.

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Extreme root resorption associated with induced tooth movement: A protocol for clinical management

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[1] Contact address: Alberto Consolaro E-mail: consolaro@uol.com.br