original article

Severe root resorption resulting from orthodontic

treatment: Prevalence and risk factors
Caroline Pelagio Raick Maués1, Rizomar Ramos do Nascimento2, Oswaldo de Vasconcellos Vilella3

DOI: http://dx.doi.org/10.1590/2176-9451.20.1.052-058.oar

Objective: To assess the prevalence of severe external root resorption and its potential risk factors resulting from orthodontic
treatment. Methods: A randomly selected sample was used. It comprised conventional periapical radiographs taken in the
same radiology center for maxillary and mandibular incisors before and after active orthodontic treatment of 129 patients,
males and females, treated by means of the Standard Edgewise technique. Two examiners measured and defined root resorp-
tion according to the index proposed by Levander et al. The degree of external apical root resorption was registered defining
resorption in four degrees of severity. To assess intra and inter-rater reproducibility, kappa coefficient was used. Chi-square
test was used to assess the relationship between the amount of root resorption and patient’s sex, dental arch (maxillary or
mandibular), treatment with or without extractions, treatment duration, root apex stage (open or closed), root shape, as well
as overjet and overbite at treatment onset. Results: Maxillary central incisors had the highest percentage of severe root re-
sorption, followed by maxillary lateral incisors and mandibular lateral incisors. Out of 959 teeth, 28 (2.9%) presented severe
root resorption. The following risk factors were observed: anterior maxillary teeth, overjet greater than or equal to 5 mm at
treatment onset, treatment with extractions, prolonged therapy, and degree of apex formation at treatment onset. Conclusion:
This study showed that care must be taken in orthodontic treatment involving extractions, great retraction of maxillary inci-
sors, prolonged therapy, and/or completely formed apex at orthodontic treatment onset.

Keywords: Epidemiology. Root resorption. Orthodontics.

Objetivo: avaliar a prevalência de reabsorções radiculares externas severas e identificar prováveis fatores de risco decorrentes do
tratamento ortodôntico. Métodos: utilizou-se uma amostra selecionada aleatoriamente, composta de radiografias periapicais
de incisivos superiores e inferiores, obtidas no mesmo centro radiológico, de pré- e pós-tratamento ortodôntico ativo, de 129
pacientes, de ambos os sexos, tratados por meio da técnica Edgewise Standard. Dois examinadores mensuraram e definiram a
reabsorção radicular de acordo com índice proposto por Levander et al., e o grau de reabsorção foi registrado, definindo a reab-
sorção em quatro graus de severidade. Para avaliar a reprodutibilidade intra- e interexaminadores, adotou-se o índice de coefi-
ciente kappa ponderado. O teste chi-quadrado (c2) foi adotado para avaliar a relação entre a quantidade de reabsorção radicular
e o sexo dos pacientes, arcada dentária (superior ou inferior), tratamentos com ou sem extrações, duração do tratamento, forma
radicular, estágio do ápice radicular (aberto ou fechado), overjet e overbite no início do tratamento. Resultados: os incisivos
centrais superiores apresentaram a maior porcentagem de reabsorção radicular severa, seguidos dos incisivos laterais superiores
e dos incisivos laterais inferiores. Entre 959 dentes avaliados, 28 (2,9%) apresentaram reabsorção radicular severa. Os fatores de
risco relacionados foram: dentes localizados na região anterossuperior, overjet maior ou igual a 5mm ao início do tratamento,
tratamentos envolvendo extrações dentárias, tempo prolongado de terapia e formação radicular completa à época do início do
tratamento ortodôntico. Conclusão: o estudo demonstrou que cuidados devem ser tomados em tratamentos ortodônticos en-
volvendo extrações, com grande retração de incisivos superiores, tratamentos prolongados e/ou ápice radicular completamente
formado no início da terapia ortodôntica.

Palavras-chave: Epidemiologia. Reabsorção da raiz. Ortodontia.

» The authors report no commercial, proprietary or financial interest in the prod- How to cite this article: Maués CPR, Nascimento RR, Vilella OV. Severe
ucts or companies described in this article. root resorption resulting from orthodontic treatment: Prevalence and risk fac-
tors. Dental Press J Orthod. 2015 Jan-Feb;20(1):52-8. DOI: http://dx.doi.
Submitted: November 19, 2013 - Revised and accepted: June 10, 2014 org/10.1590/2176-9451.20.1.052-058.oar

Contact address: Rizomar Ramos do Nascimento

1
DDS in Dentistry, Fluminense Federal University (UFF). Departamento de Ortodontia Faculdade de Odontologia
2
Specialist in Orthodontics, UFF. Universidade Federal Fluminense, Niterói, Rio de Janeiro — Brazil
3
Professor, Postgraduate program in Orthodontics, UFF. E-mail: rizonascimento@gmail.com

© 2015 Dental Press Journal of Orthodontics 52 Dental Press J Orthod. 2015 Jan-Feb;20(1):52-8
Maués CPR, Nascimento RR, Vilella OV original article

INTRODUCTION Orthodontics Department of Fluminense Federal

External apical root resorption (EARR) is an unde- University (UFF). As inclusion criteria, only patients
sirable side effect commonly associated with orthodon- presenting periapical radiographs pre and post-treat-
tically induced tooth movement.1-6 As it is considered a ment, and those who had completed orthodontic
borderline phenomenon between cost-benefit and iat- treatment were selected. Exclusion criteria excluded
rogenesis, such resorptions gain importance not only teeth with periapical lesions, history of dental trauma
due to being highly frequent, with potential biological or endodontic treatment, patients with severe crowd-
damage to the patient, but also due to potential legal ing in which overlap hindered visualization of roots
implications in daily orthodontic practice. and subsequent measurements. Low-quality radio-
Root shortening results from a combination of graphs were also eliminated.
complex biological activities in the region of the peri- All subjects were treated with conventional me-
odontal ligament, which will interact with force ex- tallic non pre-adjusted appliances (Edgewise Stan-
erted during orthodontic treatment.7 Factors such as dard) with 0.022 x 0.028-in bracket slots, and fol-
dental trauma prior to orthodontic treatment, bone lowed a predetermined archwire sequence during
density and morphology, shape of teeth roots,5,6,8 pa- levelling and alignment: For initial leveling, 0.014-in
tient’s age at orthodontic treatment onset,9 treatment and 0.016-in nickel-titanium (NiTi) archwires were se-
duration,5,6,8,10 as well as orthodontic mechanics and lected, followed by 0.017 × 0.025-in, 0.019 × 0.025-in
magnitude of force2,10-15 have been reported as signif- nickel-titanium (NiTi), and 0.019 × 0.025-in stain-
icant for the occurrence of EARR. less-steel archwires. In cases involving extractions,
Lateral cephalograms associated with panoramic straight 0.019  × 0.025-in stainless-steel archwires
radiograph or complete periapical radiographs are with “T” loops were used to close extraction spaces.
routinely requested for pretreatment planning. Stud- No temporary skeletal anchorage devices were used
ies highlight better precision of periapical radiograph in the selected sample.
when compared to panoramic radiograph when de- Due to applicability and broad acceptance, the
termining the magnitude of root resorption, due to index proposed by Malmgren et al17 was used to as-
lower distortion and accuracy of fine details. There- sess the degree of root changes yielded in this study.
fore, an increasing number of professionals request Zero degree was added to this index, as proposed by
complete periapical examination for treatment of Levander et al,9 in order to point out unaltered teeth
adult orthodontic patients.16 in the root apex (Fig 1).
The aim of this retrospective study was to determine, Tooth length was measured as the distance from
by means of periapical radiographs, the prevalence of se- the root apex tip to the midpoint of the incisal edge.
vere EARR (exceeding 1/3 of the original root length) A digital caliper (Lee Tools, Brazil) with an accu-
and its relationship with orthodontic treatment variables racy of ±0.02 mm and reproducibility of ±0.01 mm
in patients treated with Edgewise Standard technique. was used following the long axis of the tooth. Root
It also assessed potential risk factors. contour of maxillary and mandibular incisors as-
sessed before and after treatment were compared,
MATERIAL AND METHODS positioning the long axis of the tooth/root parallel to
The present study was submitted to Fluminense the index image. The degree of EARR was assessed
Federal University (UFF) Institutional Review according to the index proposed, using a 0-4 scale of
Board (protocol #188780) and performed in accor- severity, as follows:
dance to its norms. » Score 0: Absence of changes in the root apex;
A randomly selected sample was used. It comprised » Score 1: Irregular root contour;
conventional periapical radiographs taken in the same » Score 2: EARR of less than 2 mm;
radiology center for all incisors of 129 patients (males » Score 3: EARR from 2 mm to one-third of
and females) before and after active orthodontic treat- the original root length;
ment. Patients were treated by means of the Standard » Score 4: EARR exceeding one-third of the
Edgewise technique in the last fifteen years at the original root length.

© 2015 Dental Press Journal of Orthodontics 53 Dental Press J Orthod. 2015 Jan-Feb;20(1):52-8
original article Severe root resorption resulting from orthodontic treatment: Prevalence and risk factors

Figure 1 - Degrees of external root resorption

based on Levander et al9 adding (zero) degree in
order to point out unaltered root apex.

Evaluations were carried out by two observers using RESULTS

an x-ray viewer with standard light intensity, equipped Sample distribution is shown in Table 1.
with a 5-x magnification loop (Cristófoli Equipamen- The  means of treatment duration, overbite, over-
tos de Biossegurança Ltda., Campo Mourão, Paraná, jet and changes between pre and post-treatment are
Brazil). After a 15–day interval, measurements were demonstrated in Table 2. Overbite and overjet were
reassessed by the observers using periapical radiographs measured by pre and post-treatment lateral cephalo-
of 20 patients (160 teeth)randomly selected before and grams obtained in the same radiology center.
after orthodontic treatment. According to the results shown in Table 3, max-
A total of 1,032 teeth were evaluated; out of illary central incisors had the highest percentage of
which 73 were excluded, thereby totaling 959 teeth. severe EARR, followed by maxillary lateral incisors
The prevalence of EARR was calculated for each and mandibular lateral incisors. Out of 959 teeth, 28
tooth. In order to identify potential risk factors, the (2.9%) had severe EARR.
following variables were assessed: sex, dental arch Table 4 shows the factors that could contribute to
(maxillary or mandibular), treatment with or with- severe EARR. Anterior maxillary teeth, dental ex-
out extractions, treatment duration, root apex stage traction for orthodontic purposes, treatment extend-
(open or closed), root shape, as well as overjet and ed to more than three years, closed root apex at treat-
overbite at treatment onset. Severity of resorption ment onset and cases presenting overjet greater than
was scored as follows: 0-3 (none to mild EARR); or equal to 5 mm were statistically significant and, for
4 (severe EARR). this reason, were considered risk factors of EARR.
Kappa coefficient revealed that agreement be-
STATISTICAL ANALYSIS tween the two measurement times was excel-
Results were formatted in a Microsoft Office lent (k = 0.84). Inter observer agreement was also
Excel (version 2007, Microsoft Office Corporation) excellent (k = 0.81).
spreadsheet. Sample size calculation was performed,
and the final sample was within the recommenda- DISCUSSION
tions established for this study. Periapical radiograph has been the examination
To assess intra and inter-rater reproducibility, most frequently used to evaluate EARR resulting from
kappa coefficient and chi-square test were used for orthodontic treatment due to its higher accuracy com-
comparison among groups. Level of probability was pared to panoramic radiograph and better cost-benefit
set at 5% (P < 0.05). relationship compared to CT scans.16
Both statistical tests and sample size calcula- In this  study, apical dental alterations were classi-
tion were performed with the aid of QuickCalcs fied according to the widely applicable and accepted
GraphPad software (version 2013), available at index proposed by Malmgren et al,17 and modified by
www.graphpad.com/quickcalcs. Levander et al.9 This method is predominantly used in

© 2015 Dental Press Journal of Orthodontics 54 Dental Press J Orthod. 2015 Jan-Feb;20(1):52-8
Maués CPR, Nascimento RR, Vilella OV original article

Table 1 - Sample distribution. Table 2 - Continuous variables.

Variable n
Variable Mean + SD Minimum Maximum
Male 397
Sex
Female 562 Initial overbite (mm) 2.37 ± 3.4 -4 9
Yes 413
Extraction Initial overjet (mm) 5.37 ± 4.14 -4 14
No 546
≤ 3 years 174
Treatment duration Change in overbite (mm) 1.86 ± 1.51 0 7
> 3 years 785
Class I 452 Change in overjet (mm) 2.57 ± 2.32 0 11
Angle’s classification Class II 428
Treatment duration (years) 7.15 ± 3.97 1 14
Class III 79

Table 3 - Prevalence of external apical root resorption (EARR) according to each tooth.

Total Degree of final resorption

Tooth Degree 0 Degree 1 Degree 2 Degree 3 Degree 0-3 Degree 4

n (%)
n (%) n (%) n (%) n (%) n (%) n (%)

11 121 100 24 (19.8) 19 (15.7) 55 (45.4) 15 (12.3) 113 (93.4) 8 (6.6)

12 118 100 22 (18.6) 16 (13.5) 56 (47.4) 19 (16.1) 113 (95.8) 5 (4.2)

21 120 100 26 (22.1) 20 (16.6) 51 (42.5) 15 (12.5) 112 (93.3) 8 (6.6)

22 118 100 26 (22.0) 18 (15.2) 49 (41.5) 20 (16.9) 113 (95.7) 5 (4.2)

31 120 100 43 (35.8) 41 (34.2) 30 (25.0) 6 (5.0) 120 100 0 (0.0)

32 120 100 53 (44.1) 33 (27.5) 30 (25.0) 3 (2.5) 119 (99.2) 1 (0.8)

41 121 100 49 (40.5) 40 (33.0) 27 (22.3) 5 (4.1) 121 100 0 (0.0)

42 121 100 60 (49.6) 29 (23.9) 27 (22.3) 4 (3.3) 120 (99.2) 1 (0.8)

Total 959 100 303 (31.6) 216 (22.5) 325 (33.9) 87 (9.0) 931 (97.1) 28 (2.9)

Table 4 - Analysis of variables related to severe external root resorption (EARR).

Severe root resorption

Variable Total (%) c2 P-value
Absent n (%) Present n (%)

Male 389 (98.0) 8 (2.0) 397 (100)

Sex 1.95 0.162
Female 542 (96.4) 20 (3.5) 562(100)

Upper 451 (94.5) 26(5.4) 477 (100)

Dental arch 22.3 0.000
Lower 480 (99.6) 2 (0.4) 482 (100)

Yes 389 (94.1) 24 (5.8) 413 (100)

Extraction 21.3 0.000
No 542 (99.2) 4 (0.7) 546 (100)

Treatment < 3 years 174 (100) 0 (0) 174 (100)

6.4 0.011
duration > 3 years 757 (96.4) 28 (3.6) 785 (100)

Open 264 (100) 0 (0) 264 (100)

Apex 10.9 0.000
Closed 667 (96.6) 28 (4.0) 695 (100)

Romboidal 325 (96.7) 11 (3.3) 336 (100)

Root shape* 0.97 0.324
Triangular 342 (95.2) 17 (4.7) 359 (100)

< 5 mm 516 (98.7) 7 (1.3) 523 (100)

Overjet 10.4 0.001
≥ 5 mm 415 (95.2) 21 (4.8) 436 (100)

< 5 mm 693 (96.9) 22 (3.1) 715 (100)

Overbite 0.24 0.624
≥ 5 mm 238 (97.5) 6 (2.5) 244 (100)

*The sum of root shapes T and R (695) corresponding to the number of teeth with closed apex.

© 2015 Dental Press Journal of Orthodontics 55 Dental Press J Orthod. 2015 Jan-Feb;20(1):52-8
original article Severe root resorption resulting from orthodontic treatment: Prevalence and risk factors

root resorption studies performed after orthodontically other  studies.5,10,22,24,25,26 Previous research on intru-
induced tooth movement, and has the major advantage sion and retraction movements of anterior teeth with
of not depending on standardization of initial radio- lingual root torque,2,12 required to reduce overjet7
graphs.13,18,19 An important factor that must be con- and to close extraction spaces, might support this
sidered in studies involving variables is the adequate finding. According to Martins et al,19 patients treated
review of the error of the method . The method used with intrusion mechanics combined with anterior re-
herein seems reliable, showing an excellent correla- traction had statistically greater maxillary incisor root
tion between the two measurements. Intra and inter resorption than those treated with anterior retraction
observer error of method was considered of little im- without intrusion. This finding is probably related
portance. These results validate the methods used to to greater tooth movement necessary to close extrac-
collect data in this research. tion spaces,8,27 specially when associated with intru-
In the present investigation, the risk factors associ- sive mechanics25 and torque movement,2,10,12 which
ated with severe EARR were teeth located in the an- overburdens the dental apex. In addition, proximity
terior region of the maxillary arch, treatment involv- between the roots of maxillary central incisors and
ing extractions, treatment duration (over 3 years), the cortical bone of the socket, the incisive canal and
overjet greater than or equal to 5 mm at treatment the alveolar bone on the buccal surface, combined
onset, and complete root formation (closed apex) with the type of movement may explain the higher
also at treatment onset. It was not possible to relate incidence of severe EARR in these teeth.24 On the
the degree of resorption to root shape, the amount of other hand, if the extraction space is used to relieve
overbite at treatment onset, or to patient’s sex. crowding,28 which is usual in the mandibular arch,
In agreement with the results of other incisors might not be submitted to major retractions.
researches,1,5,6,12,18,20,21 the present study found a low This could explain the discrepancy between maxil-
number of teeth with severe EARR (2.9%), while lary and mandibular teeth in this study.
97.1% showed no resorption or resorption classified The present investigation found that treatment du-
as moderate, i.e., clinically accepted as part of the bio- ration was significantly correlated with severe EARR.
logical costs of orthodontic treatment. Marques et al22 Extended treatment duration is cited as a risk factor
analyzed 1,049 patients treated by means of the Edge- in the development of severe EARR,5,6,10,26 although
wise technique alone. The authors found high per- some authors do not agree with this finding.1,8,13,19,21
centages of severe resorption (14.5%). However, they Confounding factors, such as more difficult treatment
reported difficulties in comparing the prevalence plans, appointment intervals and lack of patient’s coop-
found in their research with the findings of other eration, can increase treatment time and also be related
studies because their sample was larger than those to EARR.26 Moreover, longer treatment time might re-
found in the literature, which allowed the inclusion flect more severe malocclusion and the need for differ-
of more variables. Furthermore, they cited differences ent treatment mechanics, thereby resulting in extended
in methods and techniques as a factor that could help period of time for treatment finishing. For example, by
explain this discrepancy. Lim et al23 found differences assessing the influence of metal and ceramic brackets on
in procedures used in routine clinical practice, such as root resorption, some authors reported a higher inci-
the use of light forces and/or rest periods (discontinu- dence of EARR in patients treated with ceramic brack-
ous forces) every two to three months. Thus, groups ets. According to these authors, treatment with ceramic
of patients treated by different professionals, allied to brackets lasts longer, which may explain these find-
the relatively recent advent of superelastic material ings.29 Harris and Baker30 stated that there is a threshold
enabling the use of light and progressive forces es- time at which the dynamic process is overwhelmed and
pecially in the early stages of treatment,4,11,20 tend to significant resorption takes place. Therefore, it can be
show different final results.5,6,23 hypothesized that continuous stimulation of the root
Anterior maxillary teeth proved more like- leads to increased root resorption, and accumulation of
ly to present severe EARR than teeth located in surface root resorption over a long period of time can
the mandibular arch, which is in agreement with lead to the onset of severe EARR.24

© 2015 Dental Press Journal of Orthodontics 56 Dental Press J Orthod. 2015 Jan-Feb;20(1):52-8
Maués CPR, Nascimento RR, Vilella OV original article

We did not assess the association between inter- researches.28,29 Teeth with incomplete root formation
maxillary elastics and EARR in this study. However, at orthodontic treatment onset continue to develop
several authors have related the use of elastics and their roots during therapy.29 In adults, the periodon-
EARR,8,24,25 while others have not found this associ- tal ligament becomes less vascularized, aplastic and
ation in their studies.6 In our sample, all patients used narrow; the bone becomes denser, avascular and
elastics for treatment finishing. Those who showed aplastic; and the cementum wider.28 These physio-
less cooperation usually had treatment time and the logical changes could explain the higher susceptibil-
use of elastics increased. It seems reasonable to as- ity to severe EARR found in this study.
sume that long-term jiggling forces caused by inter- In contrast to other studies, our study revealed
mittent use of elastics can be a contributing factor in no correlation between patient’s sex, root shape,
the prevalence of EARR.24 the amount of overbite at treatment onset and the
Most studies have found an association between amount of severe EARR. Table 2 shows that our
orthodontic treatment with extraction and the presence sample presented lower mean values of overbite than
of severe EARR.5,6,24,27 In the present study, cases with those found for overjet, for values measured before
extraction presented significantly more severe EARR treatment and the reduction values of these variables.
than those treated without extractions. Increased move- This may explain the poor relationship between
ment and retraction of the apex of incisors are necessary overbite and EARR found in our study.
to close extraction spaces. Additionally, extraction cases The results of this study suggest that care must be
usually require longer treatment time for orthodon- taken in orthodontic treatment with extraction, in
tic treatment finishing. Thus, it could be assumed that which great retraction of maxillary incisors is planned;
tooth extraction can increase the amount of movement treatment that exceeds three years; and specially treat-
and the duration of treatment, thereby playing an im- ment involving anterior maxillary teeth with com-
portant role as a risk factor. pletely formed apex at orthodontic treatment onset.
With respect to overjet, significant association Considering that severity of malocclusion, rather than
between its magnitude and the presence of severe its type (e.g. Angle’s classification),8 is a determining
EARR was observed, which is in agreement with factor in the amount and type of tooth movement as
other researches.3,5,6,8,28 Brin et al3 reported similar well as in the orthodontic mechanics used and the du-
association in incisor retraction used to reduce over- ration of orthodontic treatment, it can be assumed that
jet during fixed-appliance treatment. Nevertheless, EARR has a multifactorial cause, regardless of the sag-
this type of tooth movement was reduced in patients ittal characteristics of malocclusion.
who underwent early therapy to reduce Class II mal-
occlusion (e.g., headgear and/or functional applianc- CONCLUSION
es as a first phase of treatment). The authors stated The prevalence of severe EARR resulting from
that early growth modification, which reduces the orthodontic treatment was considered low in this
severity of overjet in Class II malocclusions, might study (2.9%). Risk factors involved were as follows:
play an important role in reducing the likelihood of treatment with extraction, anterior maxillary teeth,
severe EARR. overjet greater than or equal to 5 mm at treatment
It was found that teeth with complete root for- onset, prolonged therapy and teeth with complete
mation at treatment onset are more likely to develop root formation at treatment onset; all of which sug-
severe EARR, which is in agreement with other gest that EARR is a multifactorial phenomenon.

© 2015 Dental Press Journal of Orthodontics 57 Dental Press J Orthod. 2015 Jan-Feb;20(1):52-8
original article Severe root resorption resulting from orthodontic treatment: Prevalence and risk factors

REFERENCES

1. Artun J, Van’t Hullenaar R, Doppel D, Kuijpers-Jagtman AM. Identification of 16. Sameshima GT, Asgarifar KO. Assessment of root resorption and root shape:
orthodontic patients at risk of severe apical root resorption. Am J Orthod periapical vs panoramic films. Angle Orthod. 2001;71(3):185-9.
Dentofacial Orthop. 2009;135(4):448-55. 17. Malmgren O, Goldson L, Hill C, Orwin A, Petrini L, Lundberg M. Root
2. Bartley N, Türk T, Colak C, Elekdaq-Türk S, Jones A, Petocz P, et al. Physical resorption after orthodontic treatment of traumatized teeth. Am J Orthod.
properties of root cementum: Part 17. Root resorption after the application of 1982;82(6):487-91.
2.50 and 150 of buccal root torque for 4 weeks: a micro computed tomography 18. Janson GP, Canto GL, Martins DR, Henriques JC, Freitas MR. A radiographic
study. Am J Orthod Dentofacial Orthop. 2011;139(4):e353-60. comparison of apical root resorption after orthodontic treatment with 3
3. Brin I, Tulloch JC, Koroluk L, Philips C. External apical root resorption in Class different fixed appliance techniques. Am J Orthod Dentofacial Orthop.
II malocclusion: a retrospective review of 1- versus 2-phase treatment. Am J 1999;118(3):262-73.
Orthod Dentofacial Orthop. 2003;124(2):151-6. 19. Martins DR, Tibola D, Janson G, Maria FR. Effects of intrusion combined with
4. Montenegro VJ, Jones A, Petocz P, Gonzales C, Darendeliler MA. Physical anterior retaction on apical root resorption. Eur J Orthod. 2012;34(2):170-5.
properties of root cementum: Part 22. Root resorption after the application of 20. Smale I, Artun J, Faraj B, Doppel D, van’t Hof M, Kuijpers-Jagtman AM. Apical root
light and heavy extrusive orthodontic forces: a microcomputed tomography resorption 6 months after initiation of fixed orthodontic appliance therapy. Am J
study Am J Orthod Dentofacial Orthop. 2012;141(1):e1-9. Orthod Dentofacial Orthop. 2005;128(1):57-67.
5. Sameshima GT, Sinclair PM. Predicting and preventing root resorption: Part I. 21. Makedonas D, Lund H, Hansen K. Root resorption diagnosed with cone beam
Diagnostic factors. Am J Orthod Dentofacial Orthop. 2001;119(5):505-10. computed tomography after 6 months and at the end of orthodontic treatment
6. Sameshima GT, Sinclair PM. Predicting and preventing root resorption: Part II. with fixed appliances. Angle Orthod. 2013;83(3):389-93.
Treatment factors. Am J Orthod Dentofacial Orthop. 2001;119(5):511-5. 22. Marques LS, Ramos-Jorge ML, Rey AC, Armond MC, Ruellas AC. Severe root
7. Krishnan V, Davidovitch Z. Cellular, molecular, and tissue-level reactions to resorption in orthodontic patients treated with the edgewise method: Prevalence
orthodontic force. Am J Orthod Dentofacial Orthop. 2006;129(4):469.e1-32. and predictive factors. Am J Orthod Dentofacial Orthop. 2010;137(3):384-8.
8. Mirabella AD, Artun J. Risk factors for apical root resorption of maxillary 23. Lim E, Sameshima G, Petocz P, Darendeliler A.Comparison of Australian and
anterior teeth in adult orthodontic patients. Am J Orthod Dentofacial Orthop. American orthodontic clinical approaches towards root resorption. Aust Orthod
1995;108(1):48-55. J. 2012;28(2):181-9.
9. Levander E, Malmgren O, Stenback K. Apical root resorption during orthodontic 24. Motokawa M, Sasamoto T, Kaku M, Kawata T, Matsuda Y, Terao A, Tanne K.
treatment of patients with multiple aplasia: a study of maxillary incisors. Eur J Association between root resorption incident to orthodontic treatment and
Orthod. 1998;20(4):427-34. treatment factors. Eur J Orthod. 2012;34(3):350-6.
10. Liou EJW, Chang PMH. Apical root resorption in orthodontics patients with en- 25. Chiqueto K, Martins DR, Janson G. Effects of accentuated and reversed
masse maxillary anterior retraction and intrusion with miniscrews. Am J Orthod curve of Spee on apical root resorption. Am J Orthod Dentofacial Orthop.
Dentofacial Orthop. 2010;137(2):207-12. 2008;133(2):261-8.
11. Chan E, Darendeliler MA. Physical properties of root cementum: Part 5. 26. Jung YH, Cho BH. External root resorption after orthodontic treatment: a study
Volumetric analysis of root resorption craters after application of light and heavy of contributing factors. Imaging Sci Dent. 2011;41:17-21.
orthodontic forces. Am J Orthod Dentofacial Orthop. 2005;127(2):186-95. 27. Freitas MR, Beltrão RTS, Janson G, Henriques JF, Chiqueto K. Evaluation of root
12. Parker RJ, Harris EF. Directions of orthodontic tooth movements associated resorption after open bite treatment with and without extractions. Am J Orthod
with external apical root resorption of the maxillary central incisor. Am J Orthod Dentofacial Orthop. 2007;132(2):143.e15-22.
Dentofacial Orthop. 1998;114(6):677-83. 28. Nanekrungsan K, Patanaporn V, Janhom A, Korwanich N. External apical root
13. Levander E, Malmgren O. Evaluation of the risk of root resorption during resorption in maxillary incisors in orthodontic patients: associated factors and
orthodontic treatment: a study of upper incisors. Eur J Orthod. 1988;10(1):30-8. radiographic evaluation. Imaging Sci Dent. 2012;42:147-54.
14. Weltman B, Vig KL, Fields HW, Shanker S, Kaizar EE. Root resorption associated 29. Lopatiene K, Dumbravait A. Risk factors of root resorption after orthodontic
with orthodontic tooth movement: a systematic review. Am J Orthod treatment. Stomatol Baltic Dent Maxillofac J. 2008;10:89-95.
Dentofacial Orthop. 2010;137(4):462-76. 30. Harris EF, Baker WC. Loss of root length and crestal bone height before and
15. Wu AJ, Tamer T, Colak C, Elekdag-Turk S, Jones AS, Petocz P, Darendeliler MA. during treatment in adolescent and adult orthodontic patients. Am J Orthod
Physical Properties of root cementum: Part 18. The extent of root resorption Dentofacial Orthop. 1990;98(5):463-9.
after the application of light and heavy controlled rotational orthodontic forces
for 4 weeks: a microcomputed tomography study. Am J Orthod Dentofacial
Orthop. 2011;139(5):E495-503.

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