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: [email protected]

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


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: [email protected]

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


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-DefinitonO 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."

5Frank Weiland, PROGRESS in ORTHODONTICS 2006; 7(2):156-163, AbuabaraFrank Weiland, PROGRESS in ORTHODONTICS 2006; 7(2):156-163, Abuabara




2-Frequency O SANDID- M ABOULNASER

• 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 O SANDID- M ABOULNASER

The most affected teeth are the maxillary incisors, the mandibular incisors, canines, premolars molars

7Ahu Topkara, Ali I Karaman, Chung H Kau, European Journal of Dentstry, October 2012 - Vol.6


4-FormesO SANDID- M ABOULNASER

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 resorptonO SANDID- M ABOULNASER

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 resorptonO SANDID- M ABOULNASER

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 resorptonO SANDID- M ABOULNASER

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 manifestatonsO SANDID- M ABOULNASER

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

14Carlos 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- EtologyFactors related to apical root resorpton

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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

O SANDID- M ABOULNASERExternal Root resorpton in Orthodontcs-oussama sandid- olivier sandid -o sandid-mohamad aboualnaser-mohamad aboulnaser-m aboualnaser

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

O SANDID- M ABOULNASER


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

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



http://www.ncbi.nlm.nih.gov/pubmed?term=Lopatiene%20K%5BAuthor%5D&cauthor=true&cauthor_uid=19001842

http://www.ncbi.nlm.nih.gov/pubmed?term=Dumbravaite%20A%5BAuthor%5D&cauthor=true&cauthor_uid=19001842

http://www.ncbi.nlm.nih.gov/pubmed/19001842

3) Local factors- root forms- predispositon 1 – short root; 2 – blunt root;

3 – root with apical bend; 4 – root with apical pipette shape.

18Kirsten 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

19AMORY Carole, These CECSMO Marseille, Sandid Oussama




Wilson teeth and root resorpton

20Minoru Yamaoka, Australian Dental Journal 1999;44:2.

Root resorpton of the neighbouring toothThe 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




23AMORY 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

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




25AMORY 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

26AMORY 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.

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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

28Abuabara,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.

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30 AMORY Carole, These CECSMO Marseille)

Ingression and root resorpton




31AMORY 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 ..

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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

33International Journal of Dentistry, Volume 2013 (2013), Article ID 929486, 7 pages, http://dx.doi.org/10.1155/2013/929486




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

34International Journal of Dentistry, Volume 2013 (2013), Article ID 929486, 7 pages, http://dx.doi.org/10.1155/2013/929486




http://dx.doi.org/10.1155/2013/929486

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.

International Journal of Dentistry, Volume 2013 (2013), Article ID 929486, 7 pages, http://dx.doi.org/10.1155/2013/929486




http://dx.doi.org/10.1155/2013/929486

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.

36http://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

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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.

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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.

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