ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Orthodontic Treatment of Incisors with Resorbed Roots due to Impacted Canines Has a Good Prognosis
Clinical Question For a patient with impacted canines causing root resorption of the incisors, will the incisors be able to undergo subsequent orthodontic treatment with a good prognosis?
Clinical Bottom Line For patients with impacted canines causing root resorption, orthodontic treatment does not cause an increase in root resorption for the majority of patients and has a good prognosis.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21463218Bjerklin/201138 subjects with impacted caninesCase series
Key resultsThe 38 subjects included in the study had orthodontic treatment between 1976-1989, ectopic maxillary canines causing incisor root resorption, and radiographic evidence before treatment and after treatment. The subjects' mean age was 13.3 years and follow-up time was 13-28 years post treatment. The investigators measured the severity of root resorption and location of the resorption from 55 incisors by taking radiographs and CT scans. In 26 patients, root resorption was unchanged. In conclusion, 13 to 28 years after the completion of orthodontic treatment, 4 of 55 teeth were lost partly due to resorption. No clinically relevant symptoms were seen with the incisors, and root resorption did not progress in most cases.
#2) 18298199Falahat/200827 subjects with impacted caninesCase series
Key resultsInitial consultation of children with ectopically positioned maxillary canines between 9-15 years old included a radiographic examination with computed tomography scans. The CT scan determined presence, location, and severity of any resorption on the incisor roots. At the 2- to 10-year orthodontic follow-up, intraoral films were taken to identify the resorbed area, changes within the resorption sites, and other variables. The study showed that out of 32 incisors, 13 roots were normalized, 12 roots remain unchanged, and 7 roots had increased resorption. They concluded that the long-term prognosis and healing for incisors with root resorption was good.
Evidence Search (Prognosis/Broad[filter]) AND (ectopic AND root resorption)
Comments on
The Evidence
Validity: The strongest studies were case studies with a limited number of patients in each study. The studies followed cases throughout orthodontic treatment and for 2 to 28 years afterwards. Both studies involved patients unable to participate, who did not qualify, or who refused treatment. With Falahat et al study, the follow-up evaluation did not take CT radiographs. The results from these studies were based on radiographic comparison before and after treatment and clinical evaluation instead of statistical analysis. Perspective: Based on these results, orthodontic treatment is possible even when incisors have root resorption. One of the weaknesses with the study by Falahat et al was that the results were based on intraoral exams. The accuracy of aligning the radiographs has a higher risk for elongation and angulation in every radiograph compared to CT scans. Although there are weaknesses in both studies, the majority of incisor roots have either been maintained or show more resorption, but prognosis for the teeth are good.
Applicability Canine impaction is the second most common impacted tooth in the population. Although root resorption of the incisors is not seen in every case, it is important to be able to recognize and treat the case. Patients with incisors with root resorption are at a higher risk for problems in the future as mentioned by Bjerklin et al. Although the resorption did not cause the loss of the four teeth, it was partially due to the resorption. The benefits of this research are that the patient can undergo orthodontic treatment and still maintain their teeth with a good prognosis. It is important to inform the patients of their increased risk to future loss of the incisors if trauma or infection occurs.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Orthodontics) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Root resorption, impacted teeth, impacted canines, impacted cuspids, ectopic teeth, orthodontic treatment
ID# 3123
Date of submission: 11/21/2016spacer
E-mail laughinghous@livemail.uthscsa.edu
Author Megan Laughinghouse, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ravikumar Anthony, BDS, MDS, MS
Faculty mentor/Co-author e-mail anthonyr@uthscsa.edu
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