Orthodontic treatment and root resorption: An overview of systematic reviews

Yassir A. Yassir (Lead / Corresponding author), Grant T. McIntyre, David R. Bearn

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)
620 Downloads (Pure)


Background: Root resorption can be considered the most unfortunate complication of orthodontic treatment.

Objective: To evaluate the available evidence regarding orthodontically induced inflammatory root resorption (OIIRR).

Search Methods: A comprehensive literature search was conducted for the systematic reviews investigating OIIRR published up to 24 May, 2020. This was accomplished using electronic databases: MEDLINE via OVID, EMBASE, AMED (Allied and Complementary Medicine Database), PubMed, and Web of Science. Any ongoing systematic reviews were searched using Prospero and a grey literature search was undertaken using Google Scholar and OpenGrey (www.opengrey.eu/). No language restriction was applied. 

Selection Criteria: Only studies investigating OIIRR were included.
Data Collection and Analysis: Screening, quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)], and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings from moderate and high-quality reviews.

Results: A total of 2033 potentially eligible studies were identified. After excluding the non-relevant studies, 28 systematic reviews were included. Of which, 20 systematic reviews (71.5%) were of moderate and high-quality level of evidence. The incidence and severity of OIIRR increase with the fixed appliance, especially with heavy force, intrusion, torquing movements, increased treatment duration, and treatment with extractions or with long apical displacement (particularly for maxillary incisors). There was insufficient evidence regarding most other treatment- and patient-related factors on OIIRR. Following all precautionary measures, pausing treatment and regular monitoring benefits patients with OIIRR.

Conclusions: There is a limited number of high-quality studies in terms of OIIRR. The influence of fixed appliance on root resorption was noted however the cause and effect relationship between OIIRR and orthodontic biomechanics has not been confirmed. Avoiding heavy, continuous forces and a greater amount of apical displacement over a long duration of treatment is recommended. Precautionary measures should be carefully considered when treating patients with a high risk of OIIRR.
Original languageEnglish
Pages (from-to)442-456
Number of pages15
JournalEuropean Journal of Orthodontics
Issue number4
Early online date20 Nov 2020
Publication statusPublished - 3 Aug 2021


  • incisors
  • maxilla
  • root resorption
  • teeth
  • duration of treatment
  • healthcare quality assessment
  • fixed orthodontic applicances

ASJC Scopus subject areas

  • Orthodontics


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