International Endodontic Journal, 43, 654662, 2010 2010 International Endodontic Journal 654

So snh ngoi tiu cung rng iu tr ty v rng i bn

trong chnh nha
J. M. Llamas-Carreras
1
, A. Amarilla
1
, E. Solano
1
, E. Velasco-Ortega
2
, L. Rodrguez-Varo
3
& J. J. Segura-
Egea
4

Khoa chnh nha
1
;
2
Nha khoa ton din;
3
Nha chu; v
4
Ni nha, Trng RHM, i hc Seville, Seville, Spain
Llamas-Carreras JM, Amarilla A, Solano E, VelascoOrtega E,
Rodrguez-Varo L, Segura-Egea JJ. So snh ngoi tiu cung
rng iu tr ty v rng i bn trong chnh nha. Tp ch nha
khoa quc tl, 43, 654662, 2010.
Tm tt
Mc tiu: Xc nh ngoi tiu cung (ERR) (h qu trong
chnh nha) c tng ng gia rng iu tr ty v rng
vn cn ty sng hay khng.
Phng php nghin cu: Tham gia nghin cu c 77
bnh nhn, tui trung bnh 32.7 10.7, c mt rng
iu tr ty trc khi hon thnh iu tr chnh nha c gn
band/mc ci t nht 1 nm. Vi mi bnh nhn u c
chp phim ton cnh k thut s trc v sau iu tr
xc nh mc ngoi tiu cung (PRR), tnh bng t l
tiu cung trn rng iu tr so vi rng i bn vn
cn ty sng. Cc phng php phn tch: Quy lut
student, ttest, anova v hi qui logistic c s dng
xc nh ngha thng k.
Kt qu PRR (mc ngoi tiu cung) l 1.00 0.13,
cho thy rng khng c s khc bit mang ngha thng
k v mc tiu cung trn rng iu tr ty so vi
rng bn tt c bnh nhn tham gia. Phn tch hi qui
logistic a bin gi rng PRR tng cao hn nhm rng
ca khi so snh gia cc rng (P = 0.0014; t sut chng =
6.2885, C.I. 95% = 2.019.4), v cao hn ph n khi so
snh v gii (P = 0.0255; t sut chng = 4.2, C.I. 95% =
1.214.6).
Kt lun: Khng c s khc bit ng k gia s lng
hay mc gia rng iu tr ty v rng i bn vn
cn ty sng trong qu trnh chnh nha.
T kha: tiu chp chn rng, ni nha, chnh nha



Li m u
Tiu cung l s mt m rng (v d xng hay ng rng)
do kt qu ca qu trnh odontoclastic (clastic: describes a
type of rock consisting of broken pieces of other rock).
Phn loi tiu cung theo v tr so vi b mt cung gm
c ngoi tiu v ni tiu. Ngoi tiu cung (ERR) c th
phn loi tip gm: tiu b mt, tiu vim, tiu thay th,
tiu c rng, tiu chp thong qua (?) (transient apical
breakdown) (Patel & Pitt Ford 2007).
Tiu b mt (tiu sa cha) l mt loi ca ERR gy
nn trong qu trnh phu thut, do sang chn c hc hay
lc p qu mc t rng ngm hay u (Andreasen et al.
1993). B mt b tn thng s b loi b bi i thc bo
v TB hy xng theo sau l qu trnh sa cha hnh
thnh nn xng rng mi v dy chng nha chu (PDL)
(Andreasen & Andreasen 2007).
ERR thng xuyn xy ra sau nhng tn thng mn
tnh tc ng ln PDL nh qu trnh chnh nha, sang chn
khp cn, sc p t cc nang pht trin/u ht quanh cung
v rng mc sai v tr (Andreasen 1985). Khi nhng yu t
ny c loi b, qu trnh sa cha s bt u, y l
in hnh ca qu trnh tiu sa cha When the trauma
and/or pressure is stopped, spontaneous healing takes
place, which is the typical feature of repair-related
resorption (Andreasen et al. 1993).
S di chuyn rng trong chnh nha da trn vic p
dng lc lm ti cu trc PDL v xng rng. c im
m hc c trng ca qu trnh ny l tiu PDL pha
nn cng vi vic hnh thnh vng khng t bo y do
s hot ng ca hy ct bo lm tiu xng rng ln
cn, pha cng c s bi xng ca to ct bo (Abuabara
2007). Thay i cc b do lc chnh nha gy nn c tt c
nhng c im ca vim: sng, nng, , au v suy
gim chc nng (Stedman 1982). Qu trnh vim ny tuy
rt cn thit cho s di chuyn rng nhng cng ng thi
khi ng qu trnh tiu cung (Bosshardt et al. 1998).
Yu t c v kch hot s tiu cung cng nh tiu xng
l cc cytokines. TB min dch thoi ra khi mao mch
vo vng PDL sau tng tc vi cc t bo ti ch
bng cch sn xut mt loi cc phn t tn hiu (Jager et
al. 2005). M khong ha b bc l s b hy ct bo i
Llamas-Carreras et al. Orthodontics and external root resorption

2010 International Endodontic Journal International Endodontic Journal, 43, 654662, 2010
655
ti, khi u qu trnh tiu. Tuy nhin, nu khng c s
kch thch lin tc t cc t bo ny (do lc chnh nha) th
qu trnh ny s kt thc mt cch t nhin.
ERR l vn lin quan n qu trnh chnh nha v c
th xy ra giai on u ca qu trnh iu tr (Abuabara
2007). Tiu cung do chnh nha c xp vo tiu b mt
hay tiu vim thong qua (Andreasen & Andreasen 2007).
V hnh thi LS v trn XQ, c im tiu cung ny l t
hi cn hoc trn cung cho n tiu chp ln (Hamilton
& Gutmann 1999).
Mc ERR khc nhau cc bo co, gi tr trung
bnh trong khong t 0.5 - emm (Hamilton & Gutmann
1999). Mirabella & A rtun (1995) bo co tn s tiu
chp nng t 5 18%. Nghin cu ca Killiany (1999)
cho thy tiu cung > 3mm c tn s 30%, cn >5mm th
tn s l 5%
Nguyn nhn c th ca ERR trong qu trnh chnh nha
cha c hiu r, nhng n thng lin quan n nhng
lc ln, lc n hoc lc nghing (Kaley & Phillips 1991,
Vardimon et al. 1991). Cc yu t lin quan ti ERR c
th c chia thnh yu t c hc v sinh hc (Brezniak
& Wasserstein 1993). Sau y lc c hc: The following
are amongst the mechanical factors: extensive tooth
movement, root torque and intrusive forces, movement
type, orthodontic force magnitude, duration and type of
force (Harris et al. 1997). The biological factors include
the following: genetic susceptibility, systemic factors
(hormone unbalance), teeth agenesis and medication
intake (Brezniak & Wasserstein 1993, Harris et al. 1997,
Levander et al. 1998). It is therefore not surprising to find
terms such as individual susceptibility, genetics, and
systemic factors being discussed when damage is evident
after otherwise successful orthodontic treatment (Owman-
Moll et al. 1995, Killiany 1999). Levander & Malmgren
(1988) indicated that teeth with blunt or pipette-shaped
roots of maxillary central incisors were at greater risk for
ERR than teeth with normal root form.
With a multitude of studies identifying
the role of orthodontics for ERR on teeth
with vital pulps, the issue of root filled
teeth and ERR is important (Hamilton &
Gutmann 1999). Is the extent of ERR, that
may occur during orthodontic treatment,
the same on teeth with vital pulps as root
filled teeth? In animal models neither
Mattison et al. (1984) nor Mah et al. (1996)
found significant differences between ERR
of root filled and teeth with vital pulps
when both were subjected to orthodontic
forces. On the contrary, Spurrier et al.
(1990) studied 43 patients who had one or
more root filled teeth treated teeth before
orthodontic treatment and who exhibited
signs of apical root resorption after
treatment. The contralateral incisors with
vital pulps served as controls. Results
showed that incisors with vital pulps
resorbed to a significantly greater degree
than incisors that had been root filled.
Finally, Mirabella & A rtun (1995), in a
sample of 39 pairs of contralateral teeth
with and without root canal treatment in 36
patients, found that there was significantly
less resorption in root filled teeth.
The purpose of this study was to
compare, in the same patient, the ERR
associated with orthodontic treatment in
teeth with vital pulps and contralateral teeth
with root filling. The null hypothesis was
that there is no difference between root
resorption in root filled teeth and their
control teeth with vital pulps.
Materials and methods
Sample
The subjects for this study were 77 patients (21
men and 56 women), aged 32.7 10.7 years,
who had one root filled tooth before
orthodontic treatment. The scientific committee
of the Dental Faculty approved the study, and
all the patients gave written informed consent.
Of the 77 patients selected, 36.4% (28) had
Class I, 44.2% (34) had Class II (24 Division 1,
10 Division 2) and 19.5% (15) Class 3
occlusions.
Inclusion criteria
The patients included in this study had
completed multiband/bracket orthodontic
therapy, with duration of active treatment
exceeding 1 year (26.8 8.9 months). In
order that a comparison of the amount and
severity of root resorption could be made,
each patient selected had some degree of
resorption evident by the end of active
treatment. All endodontic therapy had been
completed before orthodontic band
placement. The contralateral tooth had
never had invasive pulp therapy, although
the extent to which either tooth may have
Orthodontics and external root resorption Llamas-Carreras et al.

International Endodontic Journal, 43, 654662, 2010 2010 International Endodontic Journal
656
been traumatized was not known.
Exclusion criteria
Teeth with fractured or otherwise mutilated
roots and teeth with radiological signs of
periapical pathosis in the pre-treatment
radiography (Periapical Index score of 3, 4
or 5) (rstavik et al. 1986) were excluded.
Patients with obvious incisal-edge changes
were also excluded from the study. Pre-
treatment and posttreatment orthodontic
study casts were evaluated to ensure incisal
integrity throughout the active treatment
period.
Radiographic examination and evaluation
For each patient, digital panoramic
radiographs, taken before and after
orthodontic treatment, were used. Two
trained radiology assistants using a digital
orthopantomograph machine (Promax,
Planmeca, class 1, type B, 80 KHz;
Planmeca, Helsinki, Finland) took the
panoramic radiographs. The same radiology
assistant and panoramic machine were used
for the two radiographs of each patient. A
mirror and horizontal and vertical light
guides, incorporated into the machine,
facilitated standardization of head
positioning. Images were obtained using
the Dimaxis Pro 3.1.1 program (Planmeca
Group). In all cases radiographs were of
good quality, showing the entire corono-
apical length of measured teeth with the
apex clearly defined. Digital panoramic
images were displayed in a 17 Plug-
andPlay model monitor using a NVIDIA
Riva TNT 2 model 64 graphic card with 32
bit quality colour and 1280 1024 pixels
resolution (120 ppp) in a room with
subdued light.
Measurements were made before and after orthodontic
treatment using Adobe Photoshop CS

software. The
reference points and lines for measurements are shown in
Fig. 1. First, radiographs were standardized by measuring
the greatest distance from incisal/oclusal edge to
cementoenamel junction on each patients in pre-treatment
and post-treatment radiographs. Thus, crown lengths in
the initial and final radiographs were calculated in the root
filled tooth (CEi and CEf) and in its contralateral tooth
with vital pulp (CVi and CVf) (Fig. 2). Secondly, root
lengths in the initial and final radiographs were also
calculated in the root filled tooth (REi and REf) and its
contralateral tooth with vital pulp (RVi and RVf)
measuring the distance from cementoenamel junction to
the line between both root apexes.
From these values, tables were constructed for
resorption in millimetres. To allow intrapatient
standardization, root resorptions in the root filled tooth
(RRE) and contralateral tooth with vital pulp ( RRV )
were calculated (Fig. 3). Then, the proportion of root
resorption (PRR) for each patient was calculated as
follows: PRR = RRE/RRV.
Statistical analysis
Students t-test, anova and logistic regression analysis
were applied. The level for statistical significance was set
at P < 0.05.
Error analysis
The same clinician, an experienced orthodontist ( LL-C),
performed all measurements. To assess intra-examiner
reliability, 10 randomly selected patient radiographs were
measured on three separate occasions at 1- week intervals
to determine the reliability (j = 0.82). Variance from
original measurements ranged from 0.00 to 0.33 mm. The
mean error was 0.27 mm for the measurement of the root
filled teeth and 0.15 mm for the control measurement.
Results
The characteristics of the patients, orthodontic treatments,
proportion of root resorption (PRR), and mean and
standard deviation of the total sample are listed in Table 1.
Thirty-seven of the 77 (48.0%) exhibited a
Figure 1 Reference points and lines for measurements.
Llamas-Carreras et al. Orthodontics and external root resorption

2010 International Endodontic Journal International Endodontic Journal, 43, 654662, 2010
657
Figure 2 Calculation of the crown and root lengths in the initial
and final radiographs in the root filled tooth (crown: CEi and
CEf, root: REi and REf) and its contralateral vital tooth ( crown :
CVi and CVf, root: RVi and RVf).


INITIALS REFERENCE POINTS

FINAL REFERENCE POINTS
Ei1 Incisal/oclusal edge of RFT before
orthodontic treatment
Ef1 Incisal/oclusal edge of RFT after
orthodontic treatment
Ei2 Amelo-cemental junction of RFT
before orthodontic treatment
Ef2 Amelo-cemental junction of RFT
tooth after orthodontic treatment
Ei3 Line between root apices of RFT
before orthodontic treatment
Ef3 Line between root apices of RFT
after orthodontic treatment
Vi1 Incisal/oclusal edge of VCT tooth
before orthodontic treatment
Vf1 Incisal/oclusal edge of VCT tooth
after orthodontic treatment
Vi2 Amelo-cemental junction of VCT
before orthodontic treatment
Vf2 Amelo-cemental junction of VCT
after orthodontic treatment
Vi3 Line between root apices of VCT
before orthodontic treatment
Vf3 Line between root apices of
VCT after orthodontic treatment
RFT: root filled tooth. VCT: vital contralateral tooth.

Crown Endodontically initial (CEi) |Ei2 Ei1|

Root Endodontically initial (REi) |Ei3 Ei2|

Crown Endodontically final (CEf) |Ef2 Ef1|

Root Endodontically final (REf) |Ef3 Ef2|

Crown Vital initial (CVi) |Vi2 Vi1|

Root Vital initial (RVi) |Vi3 Vi2|

Crown Vital final (CVf) |Vf2 Vf1|

Root Vital final (RVf) |Vf3 Vf2|

CEi
= RRE
RRf

CEf
CVi
=

RRV
RVf


CVf
Figure 3 Calculation of the standardized root
resorption. RR endo, standardized root resorption
in the root filled tooth; RR vital, standardized
root resorption in the contralateral vital tooth.
PRR > 1, showing greater resorption of
their root filled teeth than their contralateral
control. In 36 patients (46.7%) the control
teeth with vital pulps resorbed to a greater
extent (P > 0.05). The mean and standard
deviation of PRR were 1.00 0.13,
indicating that, in the total sample, there
was no significant differences between the
amounts of root resorption in the root filled
teeth and its contralateral control teeth with
vital pulps.
Sample distribution by tooth type is
showed in Table 2. PRR was significantly
higher in incisors compared to canines (P =
0.0061). Multivariate logistic regression
was run with gender (0 = men; 1 = women),
age (year), treatment length (months), type
of treatment (0 = without extractions; 1 =
with extractions), and tooth type (0
REi
RVi
RFT
VCT
Orthodontics and external root resorption Llamas-Carreras et al.

International Endodontic Journal, 43, 654662, 2010 2010 International Endodontic Journal
658
= not incisor; 1 = incisor) as independent
explanatory variables, and PRR
(dichotomized: 0 = PRR < 1; 1 = PRR > 1)
as the dependent variable (Table 3). The
analysis suggested that tooth type (B
coefficient = 1.8393; P = 0.0031) was a
factor associated significantly with greater
resorption of the root filled teeth than the
controls. Gender (B coefficient = 1.0483; P
= 0.0873) was marginally significant. Age
(P = 0.4396), treatment length (P = 0.53.71)
and treatment type (P = 0.8502) were not
associated with PRR and were eliminated
from the analysis. A refined multivariate
logistic regression analysis including only
tooth type and gender as explanatory
variables(Table 4), suggested that PRR was
significantly greater in incisors (P = 0.0014;
odds ratio = 6.2885, C.I. 95% = 2.019.4),
compared to other teeth, and in women (P =
0.0255; odds ratio = 4.2, C.I. 95% = 1.2
14.6), compared to men.
Discussion
In this study, pre- and post-treatment tooth
lengths of the maxillary and mandibular
teeth were measured on panoramic
radiographs of 77 subjects. Previous studies
have also used panoramic radiographs in
assessing ERR during orthodontic
movement (Brin et al. 2003, Armstrong et
al. 2006, Pandis et al. 2008). In general,
extra-oral radiographs are considered less
accurate than periapical radiographs in
studying the extent of
ERR. The use of panoramic films to measure pre- and
post-treatment root resorption may overestimate
(Sameshima & Asgarifar 2001) or underestimated (Dudic
et al. 2009) the amount of root loss after orthodontic tooth
movement. However, Katona (2006) questioned the
validity of the periapical films in accurately depicting
ERR because of errors from the variability in tooth shape.
It has been demonstrated that an important source of
error associated with panoramic radiographs is head
positioning with respect to tilting. Stramotas et al. (2002)
concluded that linear measurements on panoramic
radiographs taken at different times are sufficiently
accurate if the occlusal plane is positioned similarly on the
two occasions and the extent of tilting does not exceed 10.
In this study, the same radiology assistant and panoramic
machine were used for all radiographs, and a mirror, and
horizontal and vertical light guides, incorporated into the
machine, facilitated standardization of head positioning.
Moreover, the objective was to compare the ERR in both
teeth groups rather than to determine the absolute values
of root lost.
The measurement of root resorption in this study has
been performed taking into account the length of the
crown. Thus, root resorption was calculated as
standardized root resorption, being a more accurate
measure than those used in other studies ( Armstrong et
al. 2006, Pandis et al. 2008).
This study revealed that, although in 48% of patients
ERR in root filled teeth was greater than controls, in the
total sample there were not significant differences
between the amounts of root resorption in the root filled
teeth and their contralateral teeth with vital pulps.
Root resorption occurring during orthodontic treatment
was the same on teeth with vital pulps as on teeth with
previous root canal treatment has been studied previously.
Weiss (1969) reported no significant difference in the
amount of root resorption between vital and non-vital
teeth when both were subjected to orthodontic forces.
However, the power of this study was low because the
sample consisted of only eighteen patients who had
completed orthodontic therapy. A sample of this size is
usually considered too small for statistical significance.
Llamas-Carreras et al. Orthodontics and external root resorption

2010 International Endodontic Journal International Endodontic Journal, 43, 654662, 2010
659
Table 1 Characteristics of the patients and orthodontic treatments,
and proportion of root resorption ( PRR )
Table 1 ( Continued )
Patient
Age
(year)
Gender
(M; F)
Treatment
length
(months)
Tooth
type PRR
55 45 F 23 CI 1.08
56 27 F 16 PM 1.08
57 34 F 24 M 1.09
58 30 F 38 M 1.10
59 43 F 42 LI 1.11
60 27 F 22 M 1.11
61 31 M 17 CI 1.12
62 18 M 24 CI 1.12
63 24 F 26 CI 1.13
64 24 F 51 CI 1.13
65 36 F 22 M 1.14
66 17 F 26 M 1.14
67 47 F 30 LI 1.14
68 25 F 32 CI 1.14
69 14 F 20 CI 1.15
70 31 F 24 M 1.17
71 10 M 40 CI 1.17
72 24 F 51 LI 1.19
73 14 M 27 CI 1.19
74 52 M 22 LI 1.19
75 37 F 19 CI 1.20
76 47 F 25 LI 1.22
77 33 F 18 LI 1.34
Total 33 11 21M/56F 27 9 1.00 0.13
CI, central incisor; CA, canine, M, molar, PM, premolar; LI,
lateral incisor.
Wickwire et al. (1974) in a retrospective
study reviewed 45 orthodontic patient case
histories that contained 53 root filled teeth.
They found that appeared to be greater
radiographic evidence of root resorption in
the root filled teeth compared to those with
vital pulps. On the contrary, Spurrier et al.
(1990) studied 43 patients who had one or
more root filled teeth before orthodontic
treatment and exhibited signs of apical root
resorption after orthodontic treatment. In
this study, contralateral incisors with vital
pulps served as controls. The results
showed that incisors with vital pulps
resorbed to a significantly greater degree
than incisors that had been root filled.
Mirabella & A rtun (1995) reported that
there was significantly less resorption in
root filled teeth in a sample of 39 pairs of
teeth with and without endodontic
treatment in 36 patients.
Huettner & Young (1955) evaluated the
root structure of monkey teeth with both
vital and non-vital pulps (root canal
treatment) following orthodontic movement
and observed similar root resorption in both
Patient
Age
(year)
Gender
(M; F)
Treatment
length (months)
Tooth type PRR
1 32 M 34 CI 0.77
2 24 M 20 CI 0.79
3 16 M 33 CI 0.80
4 21 M 37 M 0.80
5 17 F 13 CI 0.81
6 46 F 37 CI 0.82
7 27 F 16 CA 0.82
8 41 F 30 CA 0.82
9 24 F 28 PM 0.85
10 31 F 22 CI 0.86
11 30 F 38 CI 0.86
12 41 F 30 CA 0.87
13 49 F 12 CA 0.87
14 33 F 20 M 0.87
15 27 F 16 PM 0.88
16 53 M 21 M 0.88
17 19 F 25 PM 0.89
18 40 F 46 M 0.89
19 41 F 20 CA 0.89
20 12 F 33 M 0.89
21 43 F 41 M 0.90
22 24 F 27 M 0.90
23 24 F 25 PM 0.90
24 16 M 29 M 0.91
25 44 F 24 CA 0.91
26 43 F 41 PM 0.91
27 23 F 27 LI 0.91
28 28 F 24 LI 0.92
29 24 F 27 M 0.92
30 38 M 22 M 0.93
31 45 F 37 CA 0.94
32 53 M 21 M 0.95
33 42 F 13 CA 0.96
34 26 F 16 M 0.97
35 52 M 22 M 0.97
36 41 F 30 PM 0.98
37 30 M 21 CI 1.00
38 30 M 21 LI 1.00
39 27 F 22 M 1.00
40 46 F 24 M 1.00
41 39 F 29 CI 1.02
42 38 M 22 LI 1.03
43 39 F 29 LI 1.03
44 47 F 29 CA 1.03
45 39 F 29 CI 1.03
46 38 M 22 CI 1.03
47 34 F 24 PM 1.04
48 37 F 19 LI 1.05
49 27 F 26 M 1.05
50 34 F 19 PM 1.05
51 29 M 17 CI 1.05
52 31 M 39 CI 1.06
53 30 M 51 M 1.06
54 45 F 22 M 1.07
Orthodontics and external root resorption Llamas-Carreras et al.

International Endodontic Journal, 43, 654662, 2010 2010 International Endodontic Journal
660
groups.
The results
of this study
are in
accordance
with previous
studies
carried out in
animal
models, such
as
O
v
e
r
a
l
l

m
o
d
e
l

f
i
t
:

v
2
= 14.0188; df = 2; P = 0.0009.
those of the in vivo study developed by
Mattison et al. (1984) on cats showing no
significant difference between ERR in root
filled or in teeth with vital pulps when both
were subjected to orthodontic forces.
However, that study was an animal study
carried out over a 4-month treatment
period. This may have been too brief a time
for significant differences to become
apparent.
This study is also in agreement with the
finding of Mah et al. (1996) evaluating the
effectiveness of orthodontic forces in
moving root filled teeth and the degree of
ERR that may occur in the ferret animal
model. These investigators found greater
loss of cementum after tooth movement in
root filled teeth than in teeth with pulps, but
without significant differences in
radiographic root length. The root filled
teeth also showed more resorption lacunae
than teeth with vital pulps, but the small
difference in incidence between active
(orthodontically) root filled teeth and
inactive root filled teeth was not
statistically significant. This suggests that
the incidence of resorption lacunae may be
related to non-vitality and probably the
presence of periradicular pathosis rather
than orthodontic forces.
In this study, multivariate logistic regression analysis
indicated that root resorption was significantly greater in
root filled teeth compared to their control teeth with vital
pulps in women (P = 0.0255; odds ratio = 4.2 , C.I. 95% =
1.214.6). On the contrary, Spurrier et al. (1990) reported
that, when the sample was subdivided by gender, no
significant difference in the amount of root resorption of
the root filled teeth was evident, but the male patients
exhibited a greater degree of change in the control teeth (P
< 0.02). This different result could be attributed to the
type of teeth included in the study: the study of Spurrier et
al. only analyzed incisors but this study included all teeth
types. Previous studies have reported inconclusive results.
Phillips (1955) and Sameshima & Sinclair (2001) found
no difference in the incidence or severity of resorption
between male and female patients, but Newman (1975)
found female patients to be more susceptible to ERR
during orthodontic movement.
Multivariate logistic regression analysis also revealed
that tooth type was an explanatory variable statistically
associated with greater ERR in root filled teeth (P =
0.0014; odds ratio = 6.2885, C.I. 95% = 2.0 19.4). Thus,
Table 2 Sample distribution by tooth type, age (years), gender (male/female), cause of root canal treatment (TI, tooth injury; TD, tooth
decay), treatment length (months) and proportion of root resorption ( PRR )
Tooth type Number (%) Age (year) Gender Cause Length* PRR
Incisor 35 (45.5) 31.0 10.6 14/21 TI 27.5 9.3 1.04 0.14
Canine 9 (11.7) 41.9 6.3** 0/9 TD 23.4 8.7 0.90 0.07
Premolar 9 (11.7) 30.3 8.2 0/9 TD 24.9 7.8 0.95 0.09
Molar 24 (31.2) 32.7 11.7 7/17 TD 27.6 8.9 0.99 0.10
Total 77 (100) 32.7 10.6 21/56 26.7 8.8 1.00 0.13
*P > 0.05; **P < 0.05.
PRR: incisor vs canine: unpaired t-test (two-tailed) = P value equals 0.0061.
PRR: incisor vs pre-molar: unpaired t-test (two-tailed) = P value equals 0.0751.
Table 3 Multivariate logistic regression analysis of the influence of the independent variables gender (0 = male; 1 = female), age (year),
treatment length (months), type of treatment (0 = without extractions; 1 = with extractions), and tooth type (0 = not incisor; 1 = incisor)
on the dependent variable proportion of root resorption (PRR) (0 = PRR < 1; 1 = PRR > 1)
Independent variables B P Odds ratio
C.I. 95%
Inf. limit
C.I. 95 %
Sup. limit
Gender 1.0483 0.0873 2.8527 0.8577 9.4887
Age 0.0190 0.4396 1.0192 0.9713 1.0694
Treatment length )0.0193 0.5371 0.9809 0.9225 1.0429
Treatment type 0.1151 0.8502 1.1220 0.3398 3.7046
Tooth type 1.8393 0.0031 6.2924 1.8625 21.2588
Overall model fit: v
2
= 12.5987; df = 5; P = 0.0274.
Table 4 Multivariate logistic regression analysis of the influence of the independent variables gender (0 = male; 1 = female) and tooth
type (0 = not incisor, 1 = incisor) on the dependent variable proportion of root resorption (PRR) (0 = PRR < 1 ; 1 = PRR > 1)
Independent variables B P Odds ratio
C.I. 95%
Inf. limit
C.I. 95 %
Sup. limit
Gender 1.4279 0.0255 4.1701 1.1909 14.6014
Tooth type 1.8387 0.0014 6.2885 2.0364 19.4199

Llamas-Carreras et al. Orthodontics and external root resorption

2010 International Endodontic Journal International Endodontic Journal, 43, 654662, 2010
661
the PRR (resorption in root filled tooth/ resorption in
contralateral vital tooth) during orthodontic movement
was greater in incisors compared to the others tooth types.
Two considerations are relevant in relation to this result.
(i) This result could be attributed to the greater amount of
resorption that orthodontic movement causes in maxillary
incisors, compared to other tooth types, as reported by
Sameshima & Sinclair (2001). Remington et al. (1989)
reported that the maxillary incisors underwent root
resorption more frequently and to a greater degree than
the rest of the teeth during orthodontic treatment. This
could be because of their less root surface area. (ii)
Moreover, the pathology that motivated the root canal
treatment also could explain this result. In this study, all
root filled incisors were treated endodontically because of
dental injury: all incisors had been traumatized
previously. On the contrary, all other teeth (canines, pre-
molars and molars) were root filled teeth because of
pulp/periapical pathosis as a consequence of tooth decay.
Hamilton & Gutmann (1999) concluded that if a
previously traumatized tooth exhibits resorption, there is a
greater chance that orthodontic tooth movement will
enhance the resorption process. If a tooth has been
severely traumatized (intrusive luxation/avulsion), there
may be a greater incidence of resorption with tooth
movement. These two considerations explain the greater
ERR in incisors that emphasize the significance of
differences between non-vital and vital teeth.
Conclusions
There was no significant difference in the amount or
severity of external root resorption during orthodontic
movement between root filled teeth and their contralateral
healthy controls. However, the PRR (resorption in root
filled tooth/resorption in contralateral vital tooth) during
orthodontic movement was greater in incisors compared
to others tooth types.
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