Root resorption associated with orthodontic tooth movement: A systematic review

Background Gingival recession in its localized or generalized form is an undesirable condition resulting in root exposure. The result often is not esthetic and may lead to sensitivity and root caries. Exposed root surfaces also are prone to abrasion. The purpose of this article is to describe the prevalence, etiology and factors associated with gingival recession. Types of Studies Reviewed The authors reviewed cross-sectional epidemiologic studies of gingival recession and found that they correlated the prevalence of recession to trauma, sex, malpositioned teeth, inflammation and tobacco consumption. The recent surveys they reviewed revealed that 88 percent of people 65 years of age and older and 50 percent of people 18 to 64 years of age have one or more sites with recession. The presence and extent of gingival recession also increased with age. Results More than 50 percent of the population has one or more sites with gingival recession of 1 mm or more. The prevalence of gingival recession was found in patients with both good and poor oral hygiene. It has been proposed that recession is multifactorial, with one type being associated with anatomical factors and another type with physiological or pathological factors. Recession has been found more frequently on buccal surfaces than on other aspects of the teeth. Clinical Implications Dentists should be knowledgeable about the etiology, prevalence and associating factors of gingival recession, as well as treatment options, so that appropriate treatment modalities can be offered to patients. Treatments for gingival recession include gingival grafting, guided tissue regeneration and orthodontic therapy. Such treatments typically result in esthetic improvement, elimination of sensitivity and a decreased risk of developing root caries.

The etiology and prevalence of gingival recession

The aim of this study was to evaluate the prevalence and the development/progression of attachment loss and gingival recession at buccal tooth surfaces in a population sample with a high standard of oral hygiene. An additional aim was to study the relationship between attachment loss and gingival recession. The subject sample examined comprised 225 regular dental care attendants at 12 community dental clinics in Sweden. All subjects were subjected to a baseline examination in 1977-78 and were re-examined after 5 years and 12 years. The clinical examinations involved assessment of plaque, gingivitis, probing depth, probing attachment loss and gingival recession. A full-mouth set of intraoral radiographs was obtained at each examination and used for determination of the height of periodontal bone support. The results of the cross-sectional and longitudinal analyses performed showed that in subjects with a high standard of oral hygiene (i) buccal gingival recession was a frequent finding, (ii) the proportion of subjects with recession increased with age, (iii) the prevalence as well as the incidence of recessions within the dentition showed different patterns depending on age, (iv) sites with recession showed susceptibility for additional apical displacement of the gingival margin and (v) loss of approximal periodontal support was associated with gingival recession at the buccal surface.

The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene

Root resorption after orthodontic treatment: Part 2. Literature review

Predicting and preventing root resorption: Part II. Treatment factors

The purpose of the present investigation was to determine the incidence and intensity of nailbiting and its possible role in root resorption during orthodontic treatment. A sample of 1365 boys and ...

Nailbiting: frequency and association with root resorption during orthodontic treatment.

Rapid maxillary expansion (RME) is a useful orthodontic technique for correction of posterior cross-bite of skeletal origin. The aim of the present study was to compare the frequency and nature of root resorption in premolars subjected to RME by means of either a tissue-borne, fixed split acrylic (Haas) palatal expansion applicance, or an all-wire framework appliance. Another factor examined was the relationship between the pattern of resorption and the duration of the retention period. RME was performed on five patients using the fixed split acrylic appliance and on four patients with the all-wire framework appliance. Following the transverse expansion, two upper and two lower premolars were extracted and processed for histological examination. Root resorption was found mainly on the buccal surfaces of all maxillary premolars. The resorption lacunae covered more of the root surface in premolars treated with an all-wire framework appliance compared to premolars treated with the acrylic expansion plate. The largest resorption areas were found on teeth extracted shortly after the expansion period and the smallest on premolars retained for a relatively longer period. Mandibular premolars showed neither buccal nor lingual resorptions. It was concluded that maximum anchorage of the expansion device, using the tissue-borne acrylic appliance, seems preferable in order to minimize the incidence of buccal surface root resorption. A longer post-treatment observation time is needed in order to draw more specific conclusions regarding the healing process of the damaged root surface.

Surface resorption following two forms of rapid maxillary expansion.

Replies to questionnaires distributed to 340 boys and girls aged 13 to 15 years showed that the incidence of nailbiting was 45%.

The possible effect of nailbiting on root resorption during orthodontic treatment was evaluated by radiographic examination of two groups, matched with regard to overjet, age, sex, and length and type of orthodontic treatment with fixed orthodontic appliances, one group consisting of 21 severe nailbiters and the other a group of 21 patients without the habit.

The apical root resorption index was significantly higher in the nailbiters before (P<0.01) and after (P<0.001) orthodontic treatment.

The effect of nailbiting on root resorption during orthodontic treatment.

The influence of a low force appliance on the maxilla in correction of unilateral cross-bite was studied clinically and radiographically in 29 preschool children following a standardized treatment schedule. Four weeks' expansion was followed by a 4-wk retention and a 12-wk postretention period. Inter- and intraobserver evaluations of the reliability of the measurements on radiographs were performed. In all children but one the cross-bites were corrected after 4 wk of expansion. The mean maxillary expansion was 3.3 mm in the second molar and 1.3 mm in the canine region, but decreased to 1.5 mm and 1.0 mm, respectively, at the end of the postretention period without relapse of the corrected malocclusion. No significant remaining orthopedic effects could be registered on radiographs by this low force appliance used. The modified quad helix appliance was found to be suitable for correction of unilateral cross-bite in the primary dentition and was well tolerated by the children.

Maxillary expansion of unilateral cross-bite in preschool children.

Playing wind instruments requires increased ventilation and increased orofacial muscle activity. The aim of the present investigation was to study the longitudinal effects on the dentofacial morphology of increased ventilation and orofacial muscle activity associated with playing wind instruments. Lateral cephalograms and dental casts obtained from wind instrument players at the ages of 6, 9, 12, and 15 years were studied and compared to control groups. In addition information was obtained as to how many hours per day they practised their instruments. Significant differences between the musicians and controls were found. The musicians had a decreased anterior facial height and wider dental arches. The findings are interpreted as being due to increased orofacial muscle activity and increased intra-oral pressure resulting from wind instrument playing.

Dentofacial morphology in children playing musical wind instruments: A longitudinal study

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