Apical root resorption during orthodontic treatment with aligners? A retrospective radiometric study

Elena Krieger, Thomas Drechsler, Irene Schmidtmann, Collin Jacobs, Simeon Haag, Heinrich Wehrbein, Elena Krieger, Thomas Drechsler, Irene Schmidtmann, Collin Jacobs, Simeon Haag, Heinrich Wehrbein

Abstract

Introduction: Objective of this study was to investigate the incidence and severity of apical root resorptions (ARR) during orthodontic treatment with aligners.

Materials and methods: The sample comprised 100 patients (17-75 years of age) with a class I occlusion and anterior crowding before treatment, treated exclusively with aligners (Invisalign®, Align Technologies, Santa Clara, CA, USA). The following teeth were assessed: upper and lower anterior teeth and first molars. Root and crown lengths of a total of 1600 teeth were measured twice in pre- and post-treatment panoramic radiographs. Afterwards, relative changes of the root length during treatment were calculated by a root-crown-ratio taking pre- and post-treatment root and crown lengths into consideration. A reduction of this ratio was considered as a shortening of the initial root length. Additionally, tooth movements of the front teeth were assessed by lateral cephalograms and the 3-dimensonal set up of each patient.

Results: All patients had a reduction of the pre-treatment root length with a minimum of two teeth. On average 7.36 teeth per patient were affected. 54% of 1600 measured teeth showed no measurable root reduction. A reduction of >0%-10% of the pre-treatment root length was found in 27.75%, a distinct reduction of >10%-20% in 11.94%. 6.31% of all teeth were affected with a considerable reduction of >20%. We found no statistically significant correlation between relative root length changes and the individual tooth, gender, age or sagittal and vertical orthodontic tooth movement; except for extrusion of upper front teeth, which was considered as not clinical relevant due to the small amount of mean 4% ARR.

Conclusions: The present study is the first analyzing ARR in patients with a fully implemented orthodontic treatment with aligners (i.e. resolving anterior crowding). The variety was high and no clinical relevant influence factor could be detected. A minimum of two teeth with a root length reduction was found in every patient. On average, 7.36 teeth per patient were affected.

Figures

Figure 1
Figure 1
Measurement of the panoramic radiographs: root and crown lengths and the calculation-formula for the relative change of the root-crown-ratio (RCR) during orthodontic treatment: post-treatment RCR relative to pre-treatment RCR (rRCR) in percentage; (CEJ = cemento-enamel junction) [7,10].
Figure 2
Figure 2
Distribution of the amount of the affected teeth per patient (n = 100).
Figure 3
Figure 3
Distribution of the maximum root length reduction, i.e. minimum rRCR (= min rRCR), of each individual tooth (n = 1600).

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