Root Resorption-Oussama Sandid-Mohamad Aboualnaser

External Root resorpton
in Orthodontcs
M. ABOULNASER- Orthodontst, BAU, USA.
O. SANDID- Orthodontst, D.C.D., D.U.O, C.E.S.B.B, C.E.S.O.D.F ,
S.Q.O.D.F, Paris. France.
Contact: dr.aboualnaser@hotmail.com
External Root resorptonin Orthodontcs-oussama sandid- olivier sandid -o sandid-mohamad aboualnaser-mohamad aboulnaser-m aboualnaser
External Root resorptonin

Orthodontcs
M. ABOULNASER- Orthodontist, BUA, USA.
O. SANDID- Orthodontist, D.C.D., D.U.O, C.E.S.B.B, C.E.S.O.D.F ,
S.Q.O.D.F, Ex charg de cours, Paris. France
Contact: dr.aboualnaser@hotmail.com
oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser
External Root resorptonin

Orthodontcs
www.orthofree.com
Plan
1-Definiton
2-Frequency
3-Localisaton
4-Formes
5-The mechanisms of root resorpton
6-Root resorptonclinical manifestatons.
7-Radiographicdiagnosisofroot resorpton
8-Root resorpton- Etology
9-External Root Resorpton Management
10-Root resorptons and responsibility
1-Definiton
O SANDID- M ABOULNASER
oussama
External
sandid-oussama-sandid-olivier
Root resorptonin Orthodontcs-oussama
sandid-olivier-sandid-mohamad
sandid- olivier sandid
aboualnaser-mohamad
-o sandid-mohamad aboualnser-sandid-aboualnaser
aboualnaser-mohamad aboulnaser-m
-mohmad
aboualnaser
aboulnaser
Root resorpton is a sterile inflammatory process resultng in loss of calcified tssues of the
root.
Is defined as the gradual disappearance partal or total dental root tssue.
The Orthodontc treatment causes damage to the soft tssue and hard tssue, called
"iatrogenic harm."
Frank Weiland, PROGRESS in ORTHODONTICS 2006; 7(2):156-163, Abuabara
2-Frequency
After orthodontc treatment, there are almost microscopic gaps 100% and about
10%
macroscopic damage.
- The root resorpton are more common in adults than in children, they increase
with age
- The same patent, some teeth are subjected to root resorpton (upper incisors).
- Gender: they are more common in girls.
All orthodontc treatment with fixed appliances are accompanied by root

resorpton radiographically detectable.
3-Localisaton
The most affected teeth are the maxillary incisors, the mandibular incisors, canines, premolars
molars
7
Ahu Topkara, Ali I Karaman, Chung H Kau, European Journal of Dentstry, October 2012 - Vol.6
4-Formes
Resorpton occurs in two marginal or apical forms:

- Marginal sawtooth, repairing is easier.
- Apical in half moon, there is no healing. EN DENT DE SCIE

Root resorpton is an inflammatory process resultng in loss of calcified tssues of the root. similar to those
responsible for bone resorpton.
It involves mechanisms of inflammaton, systemic factors and many mediators of cellular actvity such as
neurotransmitters, growth factors, prostaglandins, and other cytokines.

During orthodontc treatment, the roots are subjected to tension forces and pressure which cause bone
resorpton and remodeling by affixing the source of tooth movement. excessive pressure on the periodontal
ligament causes cell damage and inflammatory response induced cementum and dentn resorpton located .
http://www.hindawi.com/journals/tswj/2014/617032/fig2/
Stages of root resorpton

There are four stages:

1 - root outline irregular, apex blunt.
2 - Minor 2 mm resorpton.
3 - Severe reducton of 2 mm to 1 third root.
4 extreme - rsorpton exceeding 1 third root .
6-Root resorptonclinical manifestatons

Poor: Mobility, no pain.

Whether the injury is permanent. It can decrease the length of the root of a few tenths of a millimeter up to
half. ... ??
-Only radiographs (panoramic or long cone) regularly can help detect resorpton or monitor its evoluton.
-Panoramic radio is required from the 9th month of orthodontc treatment and then every year and the end of
treatment
- Tester mobility and vitality. To test for suspected teeth.
-Sign of alarm: a tooth that will not move and is not painful can mean early resorpton..........
12
7-Radiographicdiagnosisofroot resorpton
SANDID- M ABOULNASER
The diagnosis is radiological, with panoramic radiography,

lateral cephalometric radiograph, periapical.
Cone beamcomputed tomography, diagnostc imaging,root

resorpton
External Root resorptonin Orthodontcs-oussama sandid- olivier sandid -o sandid-mohamad aboualnaser-mohamad aboulnaser-m aboualnaserO
SANDID- M ABOULNASER
14
Carlos Estrela, , Mike Reis Bueno, JOE Volume 35, Number 11, November 2009
8- Root resorpton- Etology

Factors related to apical root resorpton
1) Heredity
2) General factors- Systemic factors, etc.
3) Local factors
4) Impacted teeth
5) Dysfunctons
6) Dental Trauma
7) Orthodontc treatment
8) Medicaton Factors
15
1) Hereditary predispositon
Genetcs is responsible for about half of the cases AERR, more specifically, two thirds of the cases
AERR central incisors of the upper jaw. Some studies suggest that women are more likely to
AERR than men.
Hartsfield,Breznik
2) General factors- Systemic factors etc ...

Some general conditons: predispose the patent to root resorpton,

asthma, stress,.
Endocrine problems, vascular problems, diabetes, osteoporosis,

allergies, growth disorders
Inflammatory tumor or local conditons also lead to high concentraton

of prostaglandins associated with the destructon of calcified tssues
LopatieneK,DumbravaiteA,Stomatologija.2008;10(3):89-95
17
3) Local factors- root forms- predispositon

SANDID- M
ABOULNASERaboulnaser-m aboualnaser
External Root resorptonin Orthodontcs-oussama sandid- olivier sandid -oO
sandid-mohamad
aboualnaser-mohamad
1 short root;
2 blunt root;
3 root with apical bend;
4 root with apical pipette shape.
Kirsten Nigul, Triin Jagomagi Stomatologija,BalticDentalandMaxillofacialJournal,8:76-9,2006
18
4) Teeth impacted: Example The canines can reduce the roots of maxillary lateral
incisors
19
AMORYCarole,TheseCECSMOMarseille,SandidOussama
Wilson teeth and root resorpton

Root resorpton of the neighbouring tooth

The inflammaton of the surrounding tssues caused by the dental plaque, together with the
pressure of the wisdom tooth pushing on the adjacent tooth in front, may cause the root of the
adjacent tooth to resorb
Minoru Yamaoka, Australian Dental Journal 1999;44:2.
20
5-Oral dysfuncton - Praxis

Parafunctons create the intermittent stress on the ligament cells and

moving back and forth teeth
(Atypical swallowing or mouth breathing)
The parafunctons (sucking, bruxism, onycophagie)
21
Thumb sucking-Tongue thrustng

Moving back and forth teeth
Sandidoussama
Root resorpton : Example of a patent with persistent lingual interpositon

and a recurrence of his anterior open bite after 2 years of orthodontcs
AMORYCarole,TheseCECSMOMarseille)
23
Mouth breathing -Root Resorpton- predispositon

AhuTopkara,AliIKaraman,ChungHKau,EuropeanJournalofDentistry,October2012-Vol.6
24
Generalized root resorpton: Example of a patent with mouth breathing

which has never been re-educated despite five years of orthodontcs

AMORYCarole,ThseCECSMOMarseille)
25
6) Dental trauma
Dental trauma, Before or during orthodontc treatment, increase the risk of root resorpton
26
AMORYCarole,TheseCECSMOMarseille)
8) Orthodontc treatment and root resorpton

All orthodontc treatment with fixed appliances are accompanied by root

resorpton radiographically detectable. root resorpton can be found with any
movement if the force used is inappropriate (intensity, pace and duraton) of forces.
-The Most dangerous movements seem incisor intrusion and torque, this is the
rocking motons, the lingual root torque and intrusion that cause the most AERR.
The intrusion cause AERR four tmes more than extrusion.
-Duraton Treatment: More treatment is longer, there is a risk of AERR.
-The AERR is directly proportonal to the distance traveled by the tooth.
Techniques and equipment used. Fixed orthodontc appliances cause more AERR
as removable devices. The use of conventonal cases does not lead to more AERR
that self-ligatng enclosures. ,
The use of nickel-ttanium son and stainless steel is correlated with the AERR
There is no correlaton between the use of various techniques and orthodontc root
resorpton. study demonstrates that qualified systems bioefficient cause the least
root resorpton.
27
7-Orthodontc forces-root resorpton
1-The amount of force: The forces of great magnitude would cause more
damage than lighter and intermittent forces are recommended to use light
bioprogressives strengths and short-term
-The Factors often incriminated are contnuous forces, cumbersome and lengthy.
Optmal strength for each category of teeth was set between 7 and 26 g / cm 2
of root surface (equal to the pressure of the blood capillaries.)
For comparison F minor 50-350 mg
F chewing 2-50 Kg ?? Heavy forces cause more craters resorpton, decreased more
calcium and phosphorus in Cement
Abuabara,Chan,Acar ,Ballard,
28
Control of tooth movements

Movement causes a release of pressure concentraton areas at the apical

level. ??
The movement of torque: the pressure zone is in the middle third root,
then it occurs or at the apex. I need regular.
The ingression of movement: the pressure is concentrated at the apex.
The use of rectangular arches and Class II elastcs increase the risk of
resorpton.
The use of mobile devices and cause less functonal than the fixed root
resorptons apparatus; root movements are not the same.
Extraoral forces will also cause root resorpton.
29
Ingression and root resorpton

AMORY Carole, These CECSMO Marseille)

30
Contnuous forces and resorpton: two arcs superelastc

without control for 7 months

AMORYCarole,TheseCECSMOMarseille.
31
9-External Root Resorpton Management

Preventon: detailed history, mandatory radiological assessment, evaluaton of the benefits

and complicatons of orthodontc treatment
-Abstenton Orthodontc treatment: for patents with a high risk of resorpton. If there are
aesthetc urgency to deal with a mobile device. If the patent's cooperaton is good we can
consider treatment with fixed appliances, light forces of short duraton.
2) Precautons:
- Avoid long treatment, significant displacement, heavy forces, moving back and forth.
- Eliminate the dysfuncton and bruxism.
- Check hygiene and periodontal. Avoid occlusal trauma.
- Inform the patent and obtain informed consent. A medical questonnaire must be offered
to patents in order to identfy potental risks resorpton.
Provide regular monitoring, non-rigid long contenton and possibly occlusal equilibraton.
The phenomenon of resorpton stops after the disappearance of the ligament stress;
Orthodontc rest periods may be beneficial to
the root integrity, scar newly formed cementum is more resistant.
Fluorine appears to decrease the risk of resorpton ..

32
Conservatve Dental Treatments of Resorbed Teeth

Root canal treatment remains the treatment of choice of internal root

resorpton as it removes the granulaton tssue and blood supply of the
clastc cells.
The use of calcium hydroxide as an interappointment dressing
maximizes the effect of disinfecton procedures, helps to control the
bleeding, and necrotzes residual pulp tssue Management of internal
root resorpton with endodontc treatment and complete root canal
filling with warm gutta percha
33
InternationalJournalofDentistry,Volume2013(2013),ArticleID929486,7pages,http://dx.doi.org/10.1155/2013/929486
Conservatve Dental Treatments of Resorbed Teeth

Management of internal root resorpton and open apex induced using

MTA cement as root canal filling material
34
Surgical Treatment of Internal Root Resorpton

Surgical management of an internal resorpton through a retrofilling with MTA (tooth 11). (a) Preoperatve view: presence of a sinus
tract. (b) Preoperatve intraoral radiography with a gutta percha point in the sinus tract, leading to the source of infecton .(c), (d),
and (e) Sagittal, coronal, and axial CBCT cross-sectons. (f) Surgical cleaning of the root resorptve lesion and retrofilling with MTA.
(g) Postoperatve periapical X-ray of the root treatment: the filling is dense without overfilling. (h) One year followup: the clinical
view confirms the sinus tract disappearance and the healthy appearance of the gums. (i) Periapical X-ray corroborates the
periodontal regeneraton in close contact with MTA filling.
Treatment with cod liver oil mixed with calcium hydroxide

Study focused on a series of 20 clinical cases with root resorpton very pronounced. Our patents, aged 14-60
years, received a treatment with cod liver oil mixed with calcium hydroxide in endodontc medicaton
transient. We limited the duraton of treatment to a minimum of 40 days, at the rate of one applicaton
every 10 days next to a radiological control.
Clinically: a reducton or absence of tooth mobility caused by the loss of bone support
Radiologically: regression of bone loss
Histologically: a decrease in osteoblasts at sites treated with cod liver oil. The size of the vacuoles
resorpton treated teeth is less than that of the control teeth.
http://www.santemaghreb.com/tunisie/edit0604.htm
36
10-Root resorptons and responsibility

Before treatment
- * Make a panoramic radiograph and if in doubt, complete with
periapical radiographs.
- * Diagnosing patents with potental risk of root resorpton.
- * Inform the patent of the risk of root resorpton.
- * Make a care contract that it is desirable to sign.
- * Know discontnue treatment.
- * Inform the patent of the occurtrence of root resorpton.
- * Inform the patent of the existence of root resorpton.
- * Make therapeutc proposals to mitgate the consequences of
resorpton.
In cases of severe resorpton greater than 4 mm with a crown / root rato
of 1/1, a claim must be made to the insurance
37
Contenton mobile teeth

38
11-Conclusion
Irreversible nature, root resorption may be large enough to cast

doubt on the benefit provided to the success of orthodontic
treatment.
Therefore many studies look at their treatment of drug
processes, Cod Liver Oil, Fluor ...
For all patients, it is essential to achieve any radiographic
control during treatment with the first radiographs performed 69 months after the start of treatment.
If signs of resorption were observed on these pictures, it will
suspend processing for a period of 1 to 3 months to allow for
tissue repair.
39
Bibliography
K. Nigul, T. Jagomgi Stomatologija, Baltc Dental and Maxillofacial Journal, 2006, Vol. 8., No. 3.
Diane J. Milberga Angle Orthodontst, Vol 76, No 1, 2006
Frank Weiland, External root resorptons and orthodontc forces: correlatons and clinical consequences PROGRESS in
ORTHODONTICS 2006; 7(2):156-163
Szarmach IJ1*, Szarmach J2, Waszkiel D3 Complicatons in the course of surgical-orthodontc
treatment of impacted maxillary canines Advances in MCedoimcapll iSccaiteinocness i n tVhoe lc. o5u1r se 2o0f 0s6u rg
icSaulp-oprlt.h 1o
Babak Falahata; Sune Ericsonb; Rozmary Mak DAmicoc; Krister Bjerklind FOLLOW-UP OF ROOT RESORPTION Angle
Orthodontist, Vol 78, No 5, 2008
Steven R. Tucker DMD, PSC Oral and Maxillofacial Surgery
LAURE FRAPIER, LAURENT MASSIF, MATHILDE LEPLUS, MONIQUE CHOUVIN, PIERRE CANALConduite tenir face aux
rsorptons radiculaires revue d `odf,septembre 2007
ALAIN BRY Rsorptons radiculaires et responsabilit revue d `odf,septembre 2007
me anne CECSMO Marseille) Poster
carole AMORY, 4me
Brezniak N, Wasserstein A. Root resorpton after orthodontc treatment: Part 2. Literature review. American Journal of
Orthodontcs and Dentofacial Orthopedics 1993; 103: 138-143.Le Norcy, Lautrou, Legoff. Facteurs affectant la rsorpton
associe aux traitements dorthodonte. Internatnnal Orthodontcs, juin 2005; vol 3 N02:129-140Pizzo G, Licata ME, Guiglia
R, Giuliana G. Root resorpton and orthodontc treatment. Review of the literature. Minerva Stomatol. 2007PROFFIT,
William. Contemporary Orthodontcs, St-Louis, Mosby, 2000, 739 p.
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External Root resorpton

External Root resorptonin

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

External Root resorptonin

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

Frank Weiland, PROGRESS in ORTHODONTICS 2006; 7(2):156-163, Abuabara

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

- Gender: they are more common in girls.

All orthodontc treatment with fixed appliances are accompanied by root

Resorpton occurs in two marginal or apical forms:

5-The mechanisms of root resorpton

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

5-The mechanisms of root resorpton

Stages of root resorpton

There are four stages:

6-Root resorptonclinical manifestatons

Poor: Mobility, no pain.

The diagnosis is radiological, with panoramic radiography,

Cone beamcomputed tomography, diagnostc imaging,root

8- Root resorpton- Etology

2) General factors- Systemic factors etc ...

Some general conditons: predispose the patent to root resorpton,

Endocrine problems, vascular problems, diabetes, osteoporosis,

Inflammatory tumor or local conditons also lead to high concentraton

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

3) Local factors- root forms- predispositon

Kirsten Nigul, Triin Jagomagi Stomatologija,BalticDentalandMaxillofacialJournal,8:76-9,2006

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

Wilson teeth and root resorpton

Root resorpton of the neighbouring tooth

Minoru Yamaoka, Australian Dental Journal 1999;44:2.

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

5-Oral dysfuncton - Praxis

Parafunctons create the intermittent stress on the ligament cells and

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

Thumb sucking-Tongue thrustng

Moving back and forth teeth

Root resorpton : Example of a patent with persistent lingual interpositon

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

Mouth breathing -Root Resorpton- predispositon

Generalized root resorpton: Example of a patent with mouth breathing

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

8) Orthodontc treatment and root resorpton

All orthodontc treatment with fixed appliances are accompanied by root

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

7-Orthodontc forces-root resorpton

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

Control of tooth movements

Movement causes a release of pressure concentraton areas at the apical

Ingression and root resorpton

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

AMORY Carole, These CECSMO Marseille)

Contnuous forces and resorpton: two arcs superelastc

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

9-External Root Resorpton Management

Preventon: detailed history, mandatory radiological assessment, evaluaton of the benefits

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

oussama sandid-oussama-sandid-olivier sandid-olivier-sandid-mohamad aboualnaser-mohamad aboualnser-sandid-aboualnaser -mohmad aboulnaser

Conservatve Dental Treatments of Resorbed Teeth