Root Resorption

Hello there, it's Dr. Andy Toy here, with another post in the Keep Calm and Carry On Aligning series.?

As you know, consent is very close to my heart. And I've got another post today based arund consent.?

My last post briefly mentioned the issue of root resorption when you're discussing Invisalign pre-treatment with patients and how you should put that into the balance, so that they understand the relative risk against the benefits of alignment.?

And for the vast, vast majority, the relative risks are extremely low.?

Well, funny enough. Today, I get through the post - Orthodontic Update.?

Now, Orthodontic Update is edited by the great Jonathan Sandler.?

You may know him as a Consultant Orthodontist in Chesterfield, but also he's taught a lot of GDPs on his course. He is a well respected authority in the orthodontic world.?

And in fact, there's an article in there, which is co-written by Jonathan, Fatemeh Roshanray (who is a fifth year dental student) and Cara Sandler, his daughter. And that's about root resorption - why we all need to get informed consent.?

So I thought, well, this is very timely!?

Let's have a good look at this. And maybe there's things in here that can help us with our consent process for patients.?

And here we go. ‘In order to minimise the effects of orthodontically induced external apical root resorption, the risk level of patients should be individually assessed as part of obtaining the valid consent. ‘

As with all consent processes, you really need to know your patient. And that's knowing them clinically, as well as obviously socially, medically, with a dental history as well.?

‘It is important to identify the patient-related risk factors, prior to commencing orthodontic treatment. Therefore, thorough history taking is essential.’

Absolutely right.?

‘Age and gender are two factors that are suggested to influence this apical root resorption.?

Other risk factors have been suggested to impact how different individuals experience root resorption. However, there's a low level of evidence to support these findings.?

This list of possible factors includes patients with pre-treatment trauma to their teeth, abnormal root length or shape, so that the shape could be pointed, pipette or dilacerated.’

Again, you'll see that on your standard X-ray.?

‘Agenesis, previous orthodontic treatment’

That's a very important one to pick up on with our adult patients, because many of them have had previous orthodontic treatment, especially those with extensive heavy fixed appliances.?

‘Other things to consider are systemic illnesses, such as asthma, and some medications such as steroids, NSCIDs’ (that's painkillers), ‘thyroxine and systemic fluoride. They can also have an impact.’?

So remember, there's not strong evidence for any of these. They’re only suggestions borne out of clinical experience. But I think it takes back to the fact that you need to do a really thorough history and assessment, using both you and your team.

And you want to have a good set of radiographs - in my hands an OPG. And if I can't see the anterior teeth, then I'm going to probably take a PA of those teeth as well.?

So that way you'll have a really good history.?

I think you then go into the conversation with that patient…

• Have they got short roots?
• Have they got mobility??

And if they have, you're going to have a conversation around: "Do you really, really need to move these teeth?

And if you do need to move these teeth, what would be the consequences if you did lose that tooth?"?

With some of these patients it's reasonable to say the tooth has a poor prognosis anyway.?

‘So there's a reasonable chance you’re going to lose these teeth one day in your life. And in general, if you do lose that tooth, it's going to be easier, a better treatment outcome if all the other teeth are in the right place. ‘

Let them understand that and think that through.?

If we are going to move the teeth, then I'm going to apply minimal velocity to minimise the forces. And you can do that easily with Invisalign. That is something that Invisalign is easier to apply, in my experience, than with fixed appliances.?

So there you go, I hope that is helpful to you.?

You've got a series of risk factors to consider. And also whether you choose to move that tooth or not. And if you do move that tooth, you apply minimal velocity and I hope that you're going to minimize the stress on those teeth.?

But it really ultimately is down to the patient and their decision about the potential benefits of alignment against the potential risks.?

And thankfully, for the vast majority of patients, there is no real risk of clinically significant root resorption with orthodontic treatment.

Andy

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