Root-resorption-oussama-sandid-mohamad-aboualnaser-1

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 resorpton in Orthodontcs-oussama sandid- olivier sandid -o sandid-mohamad aboualnaser-mohamad aboulnaser-m aboualnaser

External Root resorpton in
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 chargé 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 resorpton in
Orthodontcs
www.orthofree.com

Plan
• 1-Definiton
• 2-Frequency
• 3-Localisaton
• 4-Formes
• 5-The mechanisms of root resorpton
• 6-Root resorpton clinical manifestatons.
• 7-Radiographic diagnosis of root resorpton
• 8-Root resorpton- Etology
• 9-External Root Resorpton Management
• 10-Root resorptons and responsibility
4

1-Definiton
O SANDID- M 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."
5
Frank Weiland, PROGRESS in ORTHODONTICS 2006; 7(2):156-163, AbuabaraFrank 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.
6

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
8External Root resorpton in Orthodontcs-oussama sandid- olivier sandid -o sandid-mohamad aboualnaser-mohamad aboulnaser-m aboualnaser

5-The mechanisms of root resorpton
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.
9

5-The mechanisms of root resorpton
http://www.hindawi.com/journals/tswj/2014/617032/fig2/
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.

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 - résorpton exceeding 1 third root.

6-Root resorpton clinical manifestatons
12
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..........

7-Radiographic diagnosis of root resorpton
SANDID- M ABOULNASER
The diagnosis is radiological, with panoramic radiography,
lateral cephalometric radiograph, periapical.

Cone beam computed tomography, diagnostc imaging, root
resorpton
14
Carlos Estrela, , Mike Reis Bueno, JOE — Volume 35, Number 11, November 2009
O SANDID- M ABOULNASERExternal Root resorpton in Orthodontcs-oussama sandid- olivier sandid -o sandid-mohamad aboualnaser-mohamad aboulnaser-m aboualnaser

8- Root resorpton- Etology
Factors related to apical root resorpton
15
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

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
17
Lopatiene K, Dumbravaite A, Stomatologija. 2008;10(3):89-95.

3) Local factors- root forms- predispositon
1 – short root;
2 – blunt root;
3 – root with apical bend;
4 – root with apical pipette shape.
18
Kirsten Nigul, Triin Jagomagi Stomatologija, Baltic Dental and Maxillofacial Journal, 8:76-9, 2006

4) Teeth impacted: Example The canines can reduce the roots of maxillary lateral
incisors
19
AMORY Carole, These CECSMO Marseille, Sandid Oussama

Wilson teeth and root resorpton
20
Minoru Yamaoka, Australian Dental Journal 1999;44:2.
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

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

Sandid oussama
Thumb sucking- Tongue thrustng
Moving back and forth teeth

23
AMORY Carole, These CECSMO Marseille)
Root resorpton : Example of a patent with persistent lingual interpositon
and a recurrence of his anterior open bite after 2 years of orthodontcs

Mouth breathing -Root Resorpton- predispositon
24
Ahu Topkara, Ali I Karaman, Chung H Kau, European Journal of Dentistry, October 2012 - Vol.6

25
AMORY Carole, Thèse CECSMO Marseille)
Generalized root resorpton: Example of a patent with mouth breathing
which has never been re-educated despite five years of orthodontcs

6) Dental trauma
Dental trauma, Before or during orthodontc treatment, increase the risk of root resorpton
26
AMORY Carole, These CECSMO Marseille)

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
28
Abuabara,Chan,Acar ,Ballard,

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

30AMORY Carole, These CECSMO Marseille)
Ingression and root resorpton

31
AMORY Carole, These CECSMO Marseille.
Contnuous forces and resorpton: two arcs superelastc
without control for 7 months

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
International Journal of Dentistry, Volume 2013 (2013), Article ID 929486, 7 pages, 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.
36
http://www.santemaghreb.com/tunisie/edit0604.htm

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 6-
9 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. Jagom‫ن‬gi 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 s·e 2o0f 0s6u rg·
icSaulp-oprlt.h 1o
• Babak Falahata; Sune Ericsonb; Rozmary Mak D’Amicoc; 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 à tenir face aux
résorptons radiculaires revue d òdf,septembre 2007
ALAIN BÉRY Résorptons radiculaires et responsabilité revue d òdf,septembre 2007
• carole AMORY, 4ème
année CECSMO Marseille) Poster
• 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 résorpton
associée aux traitements d’orthodonte. 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.
• K. Nigul, T. Jagom‫ن‬gi 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 s·e 2o0f 0s6u rg·
icSaulp-oprlt.h 1o
• Babak Falahata; Sune Ericsonb; Rozmary Mak D’Amicoc; 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 à tenir face aux
résorptons radiculaires revue d òdf,septembre 2007
ALAIN BÉRY Résorptons radiculaires et responsabilité revue d òdf,septembre 2007
• carole AMORY, 4ème
année CECSMO Marseille) Poster
• 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 résorpton
associée aux traitements d’orthodonte. 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.
40

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