Root Resorption in Orthodontics: Clinical Implications and Preventive Strategies

Abstract

Root resorption is a significant complication of orthodontic treatment, characterized by the progressive loss of root structure due to mechanical forces applied during tooth movement. Although often subclinical, moderate to severe cases can compromise tooth stability, leading to mobility, sensitivity, and even tooth loss. The incidence and severity of resorption vary according to treatment duration, appliance type, and patient-specific factors. Fixed multi-bracket appliances are well documented to induce higher resorption rates compared to clear aligners, though evidence regarding aligner-associated risks remains limited. Root resorption may present externally, cervically, or internally, each with distinct pathophysiological mechanisms, diagnostic challenges, and therapeutic approaches. Cone-beam computed tomography (CBCT) has emerged as the most reliable imaging modality, offering superior diagnostic accuracy compared to conventional radiographs. Preventive strategies emphasize the use of light, intermittent forces, careful monitoring of maxillary anterior teeth, and early intervention with root canal therapy when indicated. Management protocols include calcium hydroxide dressings, bioactive materials such as mineral trioxide aggregate (MTA), and enhanced irrigation techniques for internal lesions. Understanding the multifactorial etiology of root resorption—including trauma, pulpal infection, systemic predisposition, and excessive orthodontic forces—is essential for risk mitigation. This review highlights current evidence on the types, causes, diagnostic methods, and management strategies of orthodontic root resorption, underscoring the need for individualized treatment planning and continued research to optimize patient outcomes.