A comparative radiographic evaluation of external apical root resorption of maxillary incisors in Angles Class I malocclusion patients undergoing fixed orthodontic treatment with and without first premolar extraction a Prospective Cohort Study

A comparative radiographic evaluation of external apical root resorption of maxillary incisors in Angle’s Class I malocclusion patients undergoing fixed orthodontic treatment with and without first premolar extraction- a Prospective Cohort Study.

INTRODUCTION

External apical root resorption (EARR) is an undesirable pathological consequence of orthodontic tooth movement. During orthodontic treatment, mechanical forces are applied to move teeth and this results in a sterile, local inflammatory response which is complicated and has all characteristic inflammatory symptoms.Detection of EARR can be done clinically using two- dimensional (2D) radiography or three- dimensional (3D) cone beam computed tomography (CBCT). Even if CBCT is best clinical method for detection, it is costly and associated with a high dose of ionized radiation as observed by Samandara et al.However, periapical radiographs are part of the initial and final orthodontic records and can show different degrees of root resorption. This makes periapical radiographs a widely used complementary examination for root resorption evaluation in the clinical routine and research.

The presence and pattern of extractions is anticipated to play a significant role in orthodontically-induced inflammatory root resorption when compared with non-extraction treatment.Significant correlation was observed in the extraction groups between root resorption degree and amount of overjet correction and retraction of maxillary incisor apex.Extraction subjects generally require larger tooth movement and apical  displacement in order to correct malocclusions which results in more resorptive activity at the apical region. This may cause greater amount of EARR and a higher percentage of teeth with clinically significant resorption.  The purpose of the study is to evaluate the effect of fixed orthodontic treatment on external apical root resorption of maxillary incisors in Angle’s Class I malocclusion patients with and without first premolar extraction.

RATIONALE OF THE STUDY

Different studies have been undertaken to evaluate correlation between external apical root resorption with treatment-related factors and patient-related factors. But most of the studies were of a retrospective study design. Treatment - related factors include treatment duration, direction of tooth movement, magnitude and method of force application, amount of apical displacement, etc. and patient related risk factors include genetics, biologic and systemic factors, age, sex, ethnicity, medications, hormones, toothroot morphology, previous history of trauma, root resorption or endodontic treatment etc. Therefore, this study is done to compare and evaluate the degree of external apical root resorption of the maxillary incisors in patients with Angle’s Class I malocclusion undergoing fixed orthodontic treatment with and without first premolar extraction reporting to the Department of Orthodontics and Dentofacial Orthopedics, MES Dental College, Perinthalmanna.

RESEARCH QUESTION

Is there any difference in the severity of external apical root resorption of maxillary incisors evaluated using RVG in patients aged 13-30 years undergoing comprehensive orthodontic treatment for the correction of Angle’s Class I malocclusion with and without first premolar extraction in the Department of Orthodontics and Dentofacial Orthopedics, MES Dental College, Perinthalmanna from June 2023 – March 2025?

AIM

The aim of the study is radiographic evaluation of external apical root resorption of maxillary incisors in Angle’s Class I malocclusion patients undergoing fixed orthodontic treatment with and without first premolar extraction.

INCLUSION CRITERIA

1.     Patients with complete dentition apart from third molars

2.     Patients in the age group 13 – 30 years.

3.      Patients with Angle’s Class I malocclusion indicated for fixed orthodontic treatment with MBT technique 0.022” prescription.

4.     Group 1 patients will include Patients with Angle’s Class I malocclusion indicated for fixed orthodontic treatment with therapeutic extraction of first premolar teeth in the maxillary arch.

5.     Group 2 patients with Angle’s Class I malocclusion indicated for fixed orthodontic treatment without therapeutic extraction in the maxillary arch.

6.     Patients should be having healthy gingival and periodontal status.

7.     Patients with no evidence of root resorption radiographically.

 EXCLUSION CRITERIA

1.     Missing molars or any of the anterior teeth

2.     Previous history of orthodontic treatment

3.     Erupted or unerupted supernumeraries in the maxillary anterior segment, Impacted canines and Endodontically-treated teeth

4.     Periodontitis or History of avulsion or replantation

5.     History of bleaching

6.     Presence of cysts, tumors and other pathologies

7.     History of prolonged treatment with systemic steroids and NSAIDs, Systemic diseases including Diabetes mellitus or History of metabolic disorders

8.     Congenital anomalies or History of facial trauma