Root Resorption – Orthodontic Braces, Treatment, Causes, Meaning, What to Do

Root resorption is a pathological process involving the loss of hard dental tissue from the tooth’s root structure. It can occur internally within the root canal space or externally on the root surface. Understanding tooresorption, its types, causes, and treatment options is crucial for maintaining oral health.

Key Facts

• Root resorption is a dental condition where the tooth’s root structure begins to break down and be absorbed by the surrounding tissues
• It can affect both primary (baby) teeth and permanent teeth
• There are two main types of root resorption: internal and external
• Root resorption can be caused by various factors such as trauma, orthodontics, cysts, and tumors
• Early diagnosis is crucial, as root resorption can lead to tooth loss if left untreated
• Treatment options depend on the cause and severity of the condition and can range from monitoring the tooth to root canal therapy or tooth extraction

What is Root Resorption?

Root resorption is a process in which the body’s cells break down the root structure of a tooth and absorb it into the surrounding tissue. While this is a natural process for primary teeth to make way for permanent teeth, it is abnormal when it occurs in permanent teeth.

Internal Root Resorption vs External Root Resorption

There are two main types of root resorption. Here’s the difference between internal root resorption and external root resorption:

• Internal Root Resorption: This occurs when the root’s inner tissue, or pulp, begins to resorb the tooth from the inside out. Internal resorption typically begins as chronic pulpal inflammation, often due to necrotic pulp, leading to the loss of tooth tissue internally. It can progress to perforating internal root resorption if not treated in time.
• External Root Resorption: This type occurs when the root structure is broken down from the outside of the tooth.
  External resorption affects the outer root surface, with several subtypes:
  1. External Cervical Resorption: Occurs at the cervical region of the tooth, near the epithelial attachment.
  2. External Inflammatory Resorption: Often a result of dental trauma or tooth avulsion.
  3. External Replacement Resorption: Involves the replacement of root structure with bone or calcified tissue, commonly seen in impacted teeth.
  4. Invasive Cervical Resorption: Characterized by invasive resorptive lesions at the cervical portion of the tooth.
• Transient Inflammatory Resorption: Transient inflammatory resorption, also known as transient apical breakdown, is typically a temporary response to trauma, with the potential for spontaneous resolution.

Causes of Root Resorption

Several factors can contribute to the development of root resorption:

• Trauma or Injury: Dental trauma is a significant cause of inflammatory root resorption. An injury to the tooth can damage the ligaments and cells around the root, leading to resorption.
• Orthodontic Treatment: Orthodontic tooth movement, especially if aggressive or rapid, can induce root resorption, particularly in the middle and apical thirds of the roots. The pressure applied to teeth during orthodontic treatment can sometimes lead to resorption, especially if the forces are too strong or applied for an extended period.
• Cysts and Tumors: Cysts or tumors in the jawbone can put pressure on the roots of the teeth, leading to resorption.
• Impacted Teeth: A tooth that is not able to erupt normally, such as an impacted wisdom tooth, can cause pressure on adjacent teeth, triggering external root resorption.
• Periodontal Factors: Conditions affecting the periodontal ligament and alveolar bone, such as periodontal treatment or periodontal involvement in diseases, can predispose a tooth to resorption.
• Chronic Teeth Grinding: Puts excessive force on teeth, potentially leading to root resorption.
• Endodontic Treatment: Root canal treatments, particularly in endodontically treated teeth, can sometimes lead to resorption.
• Genetics and Hormones: Some individuals may have a genetic predisposition to root resorption, and hormonal imbalances might play a role in some cases.

Root Resorption as a Consequence of Orthodontic Treatment

Teeth root resorption often occur as a result of orthodontics treatment. Orthodontic treatment can potentially cause both types of root resorption (internal and external), although it is more commonly associated with internal root resorption.

There are several factors that can increase the risk of root resorption during orthodontic treatment.

• The severity of the misalignment: More severe misalignment may require more aggressive treatment, which can increase the risk of root resorption.
• The presence of gum disease: Gum disease can cause inflammation within the tooth, which can lead to root resorption.
• The length of treatment: Longer treatment periods may increase the risk of root resorption.
• The presence of certain medical conditions: Certain medical conditions, such as autoimmune disorders, may increase the risk of root resorption.

To prevent external root resorption during orthodontic treatment, it is important for patients to follow their orthodontist’s instructions carefully and to visit their orthodontist regularly for check-ups. It is also important to maintain good oral hygiene during treatment to reduce the risk of gum disease and other infections.
If root resorption does occur, treatment will depend on the severity of the condition and the underlying cause. In some cases, the root structure may be able to regenerate on its own, while in more severe cases, a root canal or tooth extraction may be necessary.

Diagnosis: Clinical Signs of Root Resorption

Root resorption commonly occurs without symptoms in its early stages. However, it may present as pain or mobility in the affected tooth.

1. Clinical Examination: The first step in diagnosing root resorption involves a thorough clinical examination by a dental professional. The dentist looks for visible signs of resorption, such as changes in tooth structure, discoloration, or the presence of roots pain. Patient history, especially regarding dental trauma or previous orthodontic treatment, is also crucial in this stage.
2. Radiographic Examination
   Conventional Radiographic Examination: Traditional X-rays can show the loss of root structure. Conventional radiographs, such as periapical radiographs, are often the first imaging modality used. They can reveal changes in the tooth’s root structure, indicating the presence of resorption. However, conventional radiography may not always detect early stages of resorption or distinguish between different types.
   Advanced Imaging Techniques
   • Cone Beam Computed Tomography (CBCT): CBCT provides three-dimensional view of the teeth and surrounding bone, offering a detailed view of the resorption site, making it easier to identify root resorption lesions. It’s particularly useful in diagnosing complex cases and determining the extent of the resorption.
   • Computed Tomography: Offers detailed images to assess the extent of resorption, especially when it occurs in more than one tooth.
   • Magnetic Resonance Imaging (MRI): While less commonly used, MRI can be helpful in certain cases, especially where the surrounding soft tissues need to be assessed.
3. Differential Diagnosis and Identifying the Underlying Cause: In diagnosing root resorption, it’s important to differentiate it from other dental conditions that may present with similar symptoms, such as dental caries, periodontal diseases, or even certain types of oral cancer. This differentiation is crucial for determining the appropriate treatment plan. Part of the diagnostic process involves identifying potential causes or predisposing factors for root resorption, such as:
   • Chronic teeth grinding
   • Dental trauma or tooth avulsion
   • History of orthodontic treatment
   • Periodontal ligament issues

In some cases, especially with mild or early-stage resorption, monitoring the progression may be part of the diagnostic process. Regular check-ups and follow-up radiographs can help determine the rate of resorption and the effectiveness of preventive or conservative treatments.

Symptoms of Root Resorption

In many cases, internal root resorption as well as external root resorption may not present any noticeable symptoms in the early stages.
As the condition progresses, some signs and symptoms might include:

• Sensitivity to hot or cold
• Discoloration of the affected tooth
• Swelling or redness of the gum around the affected tooth
• Loosening of the tooth
• Pain or discomfort (in advanced cases)

It is important to note that root resorption is often detected through routine dental X-rays before any symptoms are evident.

Treatments for Root Resorption

The treatment of root resorption depends on the cause, type, and severity of the condition.
Some of the options to treat root resorption include:

• Monitoring: If the resorption is minimal and not progressing, the dentist may choose to monitor the tooth closely with regular X-rays.
• Root Canal Treatment: For internal root resorption, root canal treatment is the primary intervention to remove the inflammatory or necrotic tissue and stabilize the tooth.
• Orthodontic Treatment Modification: If resorption is due to orthodontic treatment, adjustments may be made to the treatment plan to alleviate the pressure on the affected tooth. Modifying or halting tooth movement might be necessary to prevent further damage.
• Managing External Resorption: Treatment of external resorption depends on the type and severity. In cases of cervical or invasive cervical resorption, surgical access to remove the granulation tissue followed by restoration is required.
• Surgical Intervention: In severe cases, or when resorption is due to cysts or tumors, surgical intervention may be necessary. This could include the removal of the cyst or tumor, or in some cases, extraction of the tooth.
• Tooth Extraction: In severe cases, particularly where there is significant tooth tissue loss or apical periodontitis, tooth extraction may be the only viable option.
• Managing Resorption in Primary Teeth (Baby Teeth): In primary dentition, root resorption is a natural process associated with losing baby teeth. However, abnormal resorption patterns in baby teeth can affect the permanent dentition.
• Cosmetic and Functional Implications: A cosmetic dentist may be involved in restoring the aesthetics and function of teeth affected by resorption, especially in cases of external surface resorption or in visible areas like a lateral incisor.

Prevention: Can You Prevent Root Resorption?

In order to avoid the need to treat dental root resorption with invasive treatments like root canal treatment or extraction it’s advisable to reduce risk factors causing tooth resorption.

• Maintaining Oral Health
  1. Regular Dental Checkups: Early detection through regular check-ups can identify signs of resorption.
  2. Good Oral Hygiene: Proper brushing and flossing can prevent periodontal disease, reducing the risk of root resorption.
• Managing Dental Trauma: Immediate treatment of dental injuries can prevent the development of root resorption. This includes appropriate endodontic or periodontal treatment as needed.
• Care During Orthodontic Treatment: Orthodontic forces must be applied carefully to avoid excessive pressure on teeth, which can lead to root resorption. Regular monitoring during orthodontic treatment is crucial.

Bottom line

Tooth resorption, a complex condition affecting the roots of teeth, can have significant implications for oral health. Early diagnosis through a periapical radiograph or Cone Beam Computed Tomography, understanding predisposing factors, and timely intervention by a dental professional are key to managing this condition effectively. Whether through periodontal, surgical or endodontic treatment, addressing root resorption is vital to preserve the affected tooth and maintain overall dental health. Regular dental check-ups are vital for early detection and management of this condition, as there are steps that patients and their orthodontists can take to minimize the risk. If you experience any symptoms such as tooth sensitivity, discoloration, or swelling, it is essential to consult a dentist for evaluation and appropriate treatment.

This article is complete and was published on January 8, 2021, and last updated on December 22, 2023.