Full Text

E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ:
∫ÚÈÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ Ì˯·ÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ
πÔ˘Ï›· πˆ·ÓÓ›‰Ô˘-ª·Ú·ıÈÒÙÔ˘,1 ªfiÛ¯Ô˜ ∞. ¶··‰fiÔ˘ÏÔ˜,2 ∞Ó‰Ú¤·˜ ∫fiÎη˜3
1
∞Ó·ÏËÚÒÙÚÈ· ∫·ıËÁ‹ÙÚÈ·, ∂ÚÁ·ÛÙ‹ÚÈÔ √ÚıÔ‰ÔÓÙÈ΋˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢.
∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ Î·È ™˘ÓÙÔÓÈÛÙ‹˜ ÙÔ˘ ªÂÙ·Ù˘¯È·ÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜, ∂ÚÁ·ÛÙ‹ÚÈÔ √ÚıÔ‰ÔÓÙÈ΋˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢.
3
√‰ÔÓÙ›·ÙÚÔ˜, ¢È‰¿ÎÙˆÚ, ∂ÚÁ·ÛÙ‹ÚÈÔ ∂Ó‰Ô‰ÔÓÙÔÏÔÁ›·˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢.
2
Orthodontic treatment and root resorption of teeth: Critical analysis
of mechanical factors
Ioulia Ioannidou-Marathiotou,1 Moschos A. Papadopoulos,2 Andreas Kokkas3
1
Associate Professor, Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Associate Professor and Program Coordinator, Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki,
Thessaloniki, Greece.
3
Doctor of Dentistry, Department of Endontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
2
¶EPI§HæH
™∫√¶√™: ªÂ ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ÂȯÂÈÚ›ٷÈ
ÌÈ· ÚÔÛ¿ıÂÈ· ÂÈηÈÚÔÔ›ËÛ˘, Î·È ÎÚÈÙÈ΋˜
·Ó¿Ï˘Û˘ ÙˆÓ Ì˯·ÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È
Ì ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ·
ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÔÚÚÔÊ‹ÛÂˆÓ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ.
ª∂£√¢√™: ¶ÚˆÙfiÙ˘· ¿ÚıÚ· Î·È ·Ó·ÛÎÔ‹ÛÂȘ Ô˘
·ÊÔÚÔ‡Ó ÙÔ ı¤Ì·, ·Ó·˙ËÙ‹ıËÎ·Ó ÛÙË ‚¿ÛË ‰Â‰Ô̤ӈÓ
PubMed ̤¯ÚÈ ÙÔÓ ª¿ÈÔ ÙÔ˘ 2009.
∂Àƒ∏ª∞∆∞: ∏ ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ
ÛËÌ·ÓÙÈΤ˜ ‰È·Î˘Ì¿ÓÛÂȘ. ∆· ¿ÙÔÌ· ÌÔÚ› Ó·
ÂÌÊ·Ó›˙Ô˘Ó ÂÏ¿¯ÈÛÙË, ‹ ÛËÌ·ÓÙÈ΋ ·ÔÚÚfiÊËÛË,
ÂÚÈÛÛfiÙÂÚË ·fi 3 mm, ÂÓÒ ÔÛÔÛÙfi 5% ÌÔÚ› Ó·
·ÚÔ˘ÛÈ¿ÛÂÈ ÂÚÈÛÛfiÙÂÚÔ ·fi 5 mm. ªÂٷ͇ ÙˆÓ
Ì˯·ÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÌÔÚ› Ó· ÂËÚ¿ÛÔ˘Ó
ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·ÔÚÚÔÊ‹ÛˆÓ, Ê·›ÓÂÙ·È Ó· Â›Ó·È ÙÔ
̤ÁÂıÔ˜ ÙˆÓ ‰˘Ó¿ÌÂˆÓ Ô˘ ·ÛÎÔ‡ÓÙ·È ·fi ÙÔÓ
ÔÚıÔ‰ÔÓÙÈÎfi, ÂÓÒ ·fi ÙȘ ηÙ¢ı‡ÓÛÂȘ ÌÂٷΛÓËÛ˘
ÙˆÓ ‰ÔÓÙÈÒÓ Ë ÂÌ‚‡ı˘ÛË Î·È ÔÈ ÎÈÓ‹ÛÂȘ
·ÏÈÓ‰ÚÔÌÈÎÔ‡ Ù‡Ô˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÔÈ ÈÔ
ÂÈ‚Ï·‚›˜. √È ·ÔÚÚÔÊ‹ÛÂȘ ÙˆÓ ‰ÔÓÙÈÒÓ Ê·›ÓÂÙ·È
·ÎfiÌË Ó· Â›Ó·È Û˘Ó‰Â‰Â̤Ó˜ Ì ÙÔ Â›‰Ô˜ ÙˆÓ
·ÛÎÔ˘Ì¤ÓˆÓ ‰˘Ó¿ÌˆÓ, ÙË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Ù˘
·ÛÎÔ‡ÌÂÓ˘ ‰‡Ó·Ì˘, ÙËÓ ¤ÎÙ·ÛË Ù˘ ÌÂٷΛÓËÛ˘ ÙÔ˘
‰ÔÓÙÈÔ‡, ·ÏÏ¿ Î·È Ì ÁÂÓÂÙÈÎÔ‡˜ Î·È ‚ÈÔÏÔÁÈÎÔ‡˜
·Ú¿ÁÔÓÙ˜, ηıÈÛÙÒÓÙ·˜ ¤ÙÛÈ È‰È·›ÙÂÚ· ‰‡ÛÎÔÏÔ ÙÔ
‰È·¯ˆÚÈÛÌfi Î·È ÙÔ ‚·ıÌfi Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ
·Ú·ÁfiÓÙˆÓ
·˘ÙÒÓ,
ÛÙËÓ
ÂΉ‹ÏˆÛË
ÙˆÓ
·ÔÚÚÔÊ‹ÛˆÓ.
™Àª¶∂ƒ∞™ª∞∆∞: √È ·ÔÚÚÔÊ‹ÛÂȘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
ABSTRACT
AIM: The aim of this review is the presentation and
critical analysis of the mechanical factors associated
with orthodontic treatment and implicated in the
formation of root resorption.
METHOD: Original articles and reviews pertaining to
this topic were searched at the data base PubMed
until May 2009.
FINDINGS: Root resorption shows considerable variations. Individuals may present minimal or significant resorption, more than 3 mm while a percentage
of 5% may present more than 5 mm. The magnitude
of forces applied by the orthodontist seems to be
among the mechanical factors that may affect the
formation of resorptions, while intrusion and jiggling seem to be the most harmful among the teeth
movement types. Teeth resorptions also seem to be
associated with the type and duration of the applied
forces, the range of tooth movement, as well as with
genetic and biological factors, rendering this way
the dissociation and the degree of participation of
these factors in the appearance of resorptions particularly difficult.
CONCLUSIONS: Root resorptions of teeth are an
unanticipated phenomenon of multifactorial etiology. Up until now, it seems that there is not enough
evidence that could lead to specific strategies efficient to minimize or prevent the phenomenon of
root resorption.
25
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
‰ÔÓÙÈÒÓ Â›Ó·È ¤Ó· ·Úfi‚ÏÂÙÔ Ê·ÈÓfiÌÂÓÔ,
ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜. ª¤¯ÚÈ Û‹ÌÂÚ· Ê·›ÓÂÙ·È
fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÙÂÎÌËÚȈ̤ÓË ¿Ô„Ë Ë ÔÔ›· ÌÔÚ›
Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÛÙÚ·ÙËÁÈΤ˜, ÈηӤ˜ Ó·
ÂÏ·¯ÈÛÙÔÔÈ‹ÛÔ˘Ó ‹ Ó· ·ÔÙÚ¤„Ô˘Ó ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘
·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ.
§¤ÍÂȘ ÎÏÂȉȿ: ∞ÔÚÚfiÊËÛË ÚÈ˙ÒÓ, Ì˯·ÓÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·
∂ÏÏ √ÚıÔ‰ ∂Èı 2010;13:25-42.
¶·ÚÂÏ‹ÊıË: 02.11.2009 – ŒÁÈÓ ‰ÂÎÙ‹: 14.01.2010
∂π™∞°ø°∏
∏ ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ Â›Ó·È Ì›· ·ÓÂÈı‡ÌËÙË, ȉȷ›ÙÂÚ· ÂÚ›ÏÔÎË Î·È ÌË ·ÓÙÈÛÙÚÂÙ‹
·ıÔÏÔÁÈ΋ ‰È·‰Èηۛ·, Ô˘ ¤¯ÂÈ Û˘Ó‰Âı› ¿ÌÂÛ· ÌÂ
ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·. ªÔÚ› Ó· ·ÊÔÚ¿ Ù· Â͈ÙÂÚÈο ÛÙÚÒÌ·Ù· Ù˘ ÔÛÙ½Ó˘, Ù˘ Ô‰ÔÓÙ›Ó˘ Ù˘ Ú›˙·˜,
‹ Î·È ÙÔ ·ÎÚÔÚÚ›˙ÈÔ (Bakland, 1992; Brezniak ηÈ
Wasserstein, 2002a). ŒÙÛÈ, ·Ó¿ÏÔÁ· Ì ÙÔ ‚·ıÌfi ·ÔÚÚfiÊËÛ˘, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÎÏËı› Ì›ˆÛË ÙÔ˘
Ì‹ÎÔ˘˜ Ù˘ Ú›˙·˜ ÙˆÓ ‰ÔÓÙÈÒÓ Î·È ¤ÓÙÔÓË ÎÈÓËÙÈÎfiÙËÙ·
Ì Â·ÎfiÏÔ˘ıÔ Ó· ‰È·Î˘‚‡ÂÙ·È ÙfiÛÔ Ë ÔÚıÔ‰ÔÓÙÈ΋
ıÂÚ·›· fiÛÔ Î·È Ë ÛÙ·ıÂÚfiÙËÙ· ÙÔ˘ ıÂÚ·¢ÙÈÎÔ‡
·ÔÙÂϤÛÌ·ÙÔ˜. ∞ÔÙÂÏ› Û˘ÓÂÒ˜ ¤Ó· ·fi Ù· ϤÔÓ
·ÓÂÈı‡ÌËÙ· Û˘Ì‚¿Ì·Ù·, ÙfiÛÔ Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· fiÛÔ
Î·È ÛÙÔ ¤Ú·˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜, ÂÓÒ ·ÎfiÌË
ı· ÌÔÚÔ‡Û ӷ ·ÔÙÂϤÛÂÈ ÛÙÔÈ¯Â›Ô Î·Îԉȷ¯Â›ÚÈÛ˘
ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì Â·ÎfiÏÔ˘ı· ËıÈο, ÔÈÎÔÓÔÌÈο ηÈ
ÓÔÌÈο.
∫ÏÈÓÈΤ˜ ¤Ú¢Ó˜ ¤¯Ô˘Ó ηٷÁÚ¿„ÂÈ ·ÔÚÚfiÊËÛË
ÚÈ˙ÒÓ Û fiÏ· Ù· ‰fiÓÙÈ·, ˆÛÙfiÛÔ, ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Î·È ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ·ÔÚÚfiÊËÛ˘ ÂÌÊ·Ó›˙Ô˘Ó
ÔÈ Ï¿ÁÈÔÈ Î·È ÎÂÓÙÚÈÎÔ› ¿Óˆ Î·È ÔÈ Î¿Ùˆ ÙÔÌ›˜ (∂ÈÎfiÓ· 1) (Levander Î·È Malmgren, 1988; Remington ηÈ
Û˘Ó. 1989; Kaley Î·È Phillips, 1991; Beck Î·È Harris,
1994; Alexander, 1996; Janson Î·È Û˘Ó., 2000;
Apajalahti Î·È Peltola, 2007).
∆Ô Â‡ÚÔ˜ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ
·ÍÈÔÏÔÁ‹ıËΠηٿ ηÈÚÔ‡˜ ÔÛÔÙÈο Î·È ÔÈÔÙÈο, ÌÂ
‰È¿ÊÔÚ˜ ÌÂıÔ‰ÔÏÔÁ›Â˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ Ù¯ÓÈΤ˜. √È
Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ Û˘Ó¤ÎÚÈÓ·Ó ÙÔ Ì‹ÎÔ˜ Ù˘ Ú›˙·˜ ÙˆÓ
‰ÔÓÙÈÒÓ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· ÌÂ
¯Ú‹ÛË Ï¿ÁÈˆÓ ÎÂÊ·ÏÔÌÂÙÚÈÎÒÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ
(Copeland Î·È Green, 1986; McFadden Î·È Û˘Ó., 1989;
Harris Î·È Baker, 1990; Parker Î·È Harris, 1998;
Horiuchi Î·È Û˘Ó., 1998), ·ÓÔÚ·ÌÈÎÒÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ
(Brin Î·È Û˘Ó., 1991; Apajalahti Î·È Peltola, 2007;
26
HELLENIC ORTHODONTIC REVIEW
Key words: Root resorption, mechanical factors,
orthodontic treatment
Hell Orthod Rev 2010;13:25-42.
Received: 02.11.2009 - Accepted: 14.01.2010
INTRODUCTION
Root resorption of teeth is an undesirable, particularly
complicated and non reversible pathologic process, directly associated with orthodontic treatment. It may be related to the external layers of cementum, the dentine of the
root, or the apex (Bakland, 1992; Brezniak and Wasserstein, 2002a). Thus, depending on the amount of resorption, a reduction of the root length and profound mobility may be induced with a consequent risk of the orthodontic treatment and the stability of treatment result.
Therefore, it forms one of the most undesirable incidents
during as well as at the end of the orthodontic treatment,
whereas it could also form an evidence of patient’s mismanagement with moral, financial and legal resultants.
Clinical researches have recorded root resorption on all
teeth; however, the lateral and central upper and lower
incisors show the highest incidence and amount of
resorption (Figure 1) (Levander and Malmgren, 1988;
Remington et al. 1989; Kaley and Phillips, 1991; Beck and
Harris, 1994; Alexander, 1996; Janson et al., 2000; Apajalahti and Peltola, 2007).
The extent of root resorption was occasionally quantitatively and qualitatively assessed using several methodologies and imaging techniques. The relevant studies
compared the root length of teeth before and after
orthodontic treatment using lateral cephalometric radiographs (Copeland and Green, 1986; McFadden et al.,
1989; Harris and Baker, 1990; Parker and Harris, 1998;
Horiuchi et al., 1998), panoramic radiographs (Brin et al.,
1991; Apajalahti and Peltola, 2007; Pandis et al., 2008),
periapical radiographs (Levander and Malmgren, 1988;
McFadden et al., 1989; Beck and Harris, 1994; Mirabella
and Artun, 1995a,b; Smale et al., 2005) or periapical radiographs with the parallel long cone technique, with
which any image distortion between initial and final
radiographs is corrected using records based on the
length of the crown of the tooth. This method, introduced by Linge and Linge (1983), has been used and
modified by others, as well (Dermaut and De Munck,
1986; Mavragani et al., 2000; Mohandesan et al., 2007;
van Loenen et al., 2007). The extent of root resorption of
teeth was occasionally quantitatively and qualitatively
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
∂ÈÎ. 1. ∂ÈÎfiÓ· 1. ¶·ÓÔÚ·ÌÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ·ÛıÂÓÔ‡˜ Ì ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ ÙˆÓ ¿Óˆ ÙÔ̤ˆÓ ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÔÚıÔ‰ÔÓÙÈ΋˜
ıÂÚ·›·˜.
Fig. 1. Panoramic radiograph of patient with root resorption of the
upper incisors before the application of orthodontic treatment.
Pandis Î·È Û˘Ó., 2008), ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÒÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ (Levander Î·È Malmgren, 1988; McFadden ηÈ
Û˘Ó., 1989; Beck Î·È Harris, 1994; Mirabella Î·È Artun,
1995a,b; Smale Î·È Û˘Ó., 2005) ‹ ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÒÓ
·ÎÙÈÓÔÁÚ·ÊÈÒÓ, Ì ÙËÓ ·Ú¿ÏÏËÏË Ù¯ÓÈ΋ Ì·ÎÚ¿˜
‰¤ÛÌ˘ (long cone), ÛÙËÓ ÔÔ›·, οı ·Ú·ÌfiÚʈÛË
ÂÈÎfiÓ·˜ ÌÂٷ͇ ÙˆÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ ÚÈÓ Î·È ÌÂÙ¿ ÙË
ıÂÚ·›·, ‰ÈÔÚıÒÓÂÙ·È ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ηٷÁڷʤ˜
‚·ÛÈṲ̂Ó˜ ÛÙÔ Ì‹ÎÔ˜ Ù˘ ̇Ï˘ ÙÔ˘ ‰ÔÓÙÈÔ‡. ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ Ô˘ ÂÈÛ‹¯ıË ·fi ÙÔ˘˜ Linge Î·È Linge
(1983), ¯ÚËÛÈÌÔÔÈ‹ıËΠ̠ÙÚÔÔÔÈ‹ÛÂȘ Î·È ·fi
¿ÏÏÔ˘˜ (Dermaut Î·È De Munck, 1986; Mavragani ηÈ
Û˘Ó., 2000; Mohandesan Î·È Û˘Ó., 2007; van Loenen
Î·È Û˘Ó., 2007). ∆Ô Â‡ÚÔ˜ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ
ÙˆÓ ‰ÔÓÙÈÒÓ ·ÍÈÔÏÔÁ‹ıËΠÔÈÔÙÈο ηٿ ηÈÚÔ‡˜ ÌÂ
ÔÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ (Reitan, 1974; Winter Î·È Û˘Ó.,
2009), Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Û¿ÚˆÛ˘
(scanning electron microscopy) (SEM) (Kvam,
1972a,b), Î·È Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ „ËÊȷ΋˜ ·Ê·ÈÚÂÙÈ΋˜
·ÎÙÈÓÔÁÚ·Ê›·˜ (Gröndahl Î·È Gröndahl, 1983; Kravitz
Î·È Û˘Ó., 1992; Reukers Î·È Û˘Ó., 1998; Heo Î·È Û˘Ó.,
2001; Artun Î·È Û˘Ó., 2005; Smale Î·È Û˘Ó., 2005; van
der Stelt, 2005), ηıÈÛÙÒÓÙ·˜ ¤ÙÛÈ ÛÙ·‰È·Î¿ ÈÔ ·ÛÊ·Ï‹, ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ‡ÚÔ˘˜ ÙˆÓ ·ÔÚÚÔÊ‹ÛˆÓ. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÌÂϤÙ˜ ‚·ÛÈṲ̂Ó˜
ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (Nance Î·È Û˘Ó., 2000;
Weiland, 2003), ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ΈÓÈ΋˜
‰¤ÛÌ˘ (Cevidanes Î·È Û˘Ó., 2006; Cohenca Î·È Û˘Ó.,
2007; Patel Î·È Dawood, 2007; Lane Î·È Harrell, 2008;
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
assessed with optical microscopy (Reitan, 1974; Winter
et al., 2009), scanning electron microscopy (SEM) (Kvam,
1972a,b), and digital subtraction radiography (Gröndahl
abd Gröndahl, 1983; Kravitz et al., 1992; Reukers et al.,
1998; Heo et al., 2001; Artun et al., 2005; Smale et al.,
2005; van der Stelt, 2005; Ioannidou-Marathiotou et al.,
2010), rendering in that way the quantitative determination of the extend of resorption gradually safer. During
the last years, studies based on computed tomography
(Nance et al., 2000; Weiland, 2003), on cone-beam computed tomography (Cevidanes et al., 2006; Cohenca et
al., 2007; Patel and Dawood, 2007; Lane and Harrell,
2008; Quereshy et al., 2008; Patel et al., 2009), and on
three-dimensional imaging techniques (Papadopoulos et
al., 2002), in combination with scanning electron
microscopy (Chan et al., 2004; Chan and Darendeliler,
2004) and microcomputed tomography (Harris et al.,
2006; Foo et al., 2007; Barbagallo et al., 2008; Cheng et
al., 2009), seem to open up new horizons for high reliability qualitative and quantitative assessment of the volume and the size of root resorption of teeth.
The variety of methodologies makes the comparative
assessment of findings difficult, as the extent of resorption was determined sometimes in millimeters, sometimes in percentages and sometimes with arbitrary
numerical scales. Thus, it has been found to range
between 0.5-3 mm or to extend as far as the 1/4 or the
2/4 of the root length (Linge and Linge 1983; Linge and
Linge 1991; Mirabella and Artun, 1995a; Brezniak and
Wasserstein, 1993a; Brin et al., 2003; Artun et al., 2005).
In a systematic study, it is also reported that 5% of the
total orthodontic patients shows more than 5 mm reduction of the root length (Taithongchai et al., 1996).
In an effort to explain this phenomenon, several genetic
factors have been implicated (Newman, 1975; Hartsfield
et al., 2004), systemic aetiological factors, problems of
endocrine glands like hypothyroidism or several hormonal disorders, and nutrition deficient in calcium and vitamin D (Becks, 1939; Goldie and King, 1984; Malmgren et
al., 1982; Linge and Linge 1983; Andreasen 1985; Sharp
et al., 1987; Levander and Malmgren, 1988; Tronstad,
1988; McFadden et al., 1989; Goldin, 1989; Spurrier et
al., 1990; Brin et al., 1991; Linge and Linge, 1991; Kaley
and Phillips, 1991; Brezniak and Wasserstein, 1993 a,b;
Kjaer, 1995; Mirabella and Artun, 1995b; Vlaskalic et al.,
1998; Horiuchi et al., 1998; Kojima et al., 2002; Hartsfield
et al., 2004; Smale et al., 2005; Abuabara, 2007).
Biological factors have been also implicated, like sex
(Kjaer, 1995; Spurrier et al., 1990; Baumrind et al., 1996),
27
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
Quereshy Î·È Û˘Ó., 2008; Patel Î·È Û˘Ó., 2009), Î·È ÙȘ
ÙÚÈۉȿÛٷ٘ Ù¯ÓÈΤ˜ (Papadopoulos Î·È Û˘Ó., 2002),
ÛÂ Û˘Ó‰˘·ÛÌfi Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Û¿ÚˆÛ˘
(Chan Î·È Û˘Ó., 2004; Chan Î·È Darendeliler, 2004) ηÈ
·ÎÙÈÓÔÁÚ·ÊÈ΋ ÌÈÎÚÔÙÔÌÔÁÚ·Ê›· (Harris Î·È Û˘Ó.,
2006; Foo Î·È Û˘Ó., 2007; Barbagallo Î·È Û˘Ó., 2008;
Cheng Î·È Û˘Ó., 2009), Ê·›ÓÂÙ·È Ó· ·ÓÔ›ÁÔ˘Ó Ó¤Â˜ ÚÔÔÙÈΤ˜, ÁÈ· ˘„ËÏ‹˜ ·ÍÈÔÈÛÙ›·˜ ÔÈÔÙÈ΋ Î·È ÔÛÔÙÈ΋
·ÍÈÔÏfiÁËÛË ÙÔ˘ fiÁÎÔ˘ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ·ÔÚÚfiÊËÛ˘ Ù˘ Ú›˙·˜ ÙˆÓ ‰ÔÓÙÈÒÓ.
∏ ‰È·ÊÔÚÂÙÈÎfiÙËÙ· ÙˆÓ ÌÂıÔ‰ÔÏÔÁÈÒÓ Î¿ÓÂÈ ‰‡ÛÎÔÏË
ÙËÓ Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÙˆÓ ‰È·ÊfiÚˆÓ
ÂÚÁ·ÛÈÒÓ, ηıÒ˜ ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·ÔÚÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚ›ÛÙËΠ¿ÏÏÔÙ Û ¯ÈÏÈÔÛÙ¿, ¿ÏÏÔÙ Û ÂηÙÔÛÙÈ·›Â˜
·Ó·ÏÔÁ›Â˜ Î·È ¿ÏÏÔÙ Ì ·˘ı·›ÚÂÙ˜ ·ÚÈıÌËÙÈΤ˜ Îϛ̷Θ. ŒÙÛÈ ‚Ú¤ıËΠӷ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 0,5-3 mm ‹
Ó· ÂÎÙ›ÓÂÙ·È ÛÙÔ 1/4 ‹ 2/4 ÙÔ˘ Ì‹ÎÔ˘˜ Ù˘ Ú›˙·˜ (Linge
Î·È Linge 1983; Linge Î·È Linge 1991; Mirabella ηÈ
Artun, 1995a; Brezniak Î·È Wasserstein, 1993a; Brin
Î·È Û˘Ó., 2003; Artun Î·È Û˘Ó., 2005). ™Â Ì›· Û˘ÛÙËÌ·ÙÈ΋ ÌÂϤÙË ·Ó·Ê¤ÚÂÙ·È ·ÎfiÌË fiÙÈ 5% ÙÔ˘ Û˘ÓfiÏÔ˘
ÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚÈÛÛfiÙÂÚÔ
·fi 5 mm ÂÏ¿ÙÙˆÛË ÙÔ˘ Ì‹ÎÔ˘˜ Ù˘ Ú›˙·˜
(Taithongchai Î·È Û˘Ó., 1996).
™ÙËÓ ÚÔÛ¿ıÂÈ· ÂÚÌËÓ›·˜ ÙÔ˘ Ê·ÈÓfiÌÂÓÔ˘ ·˘ÙÔ‡,
ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó ‰È¿ÊÔÚÔÈ ÁÂÓÂÙÈÎÔ› (Newman, 1975;
Hartsfield Î·È Û˘Ó., 2004), Î·È Û˘ÛÙËÌ·ÙÈÎÔ› ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÚÔ‚Ï‹Ì·Ù· ÂÓ‰ÔÎÚÈÓÒÓ ·‰¤ÓˆÓ
fiˆ˜ Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ‹ ‰È¿ÊÔÚ˜ ÔÚÌÔÓÈΤ˜ ‰È·Ù·Ú·¯¤˜, ηıÒ˜ Î·È Ë ‰È·ÙÚÔÊ‹ ·fi ¤ÏÏÂÈ„Ë ·Û‚ÂÛÙ›Ô˘ Î·È ‚ÈÙ·Ì›Ó˘ D (Becks, 1939; Goldie Î·È King,
1984; Malmgren Î·È Û˘Ó., 1982; Linge Î·È Linge, 1983;
Andreasen 1985; Sharp Î·È Û˘Ó., 1987; Levander ηÈ
Malmgren, 1988; Tronstad, 1988; McFadden Î·È Û˘Ó.,
1989; Goldin, 1989; Spurrier Î·È Û˘Ó., 1990; Brin ηÈ
Û˘Ó., 1991; Linge Î·È Linge, 1991; Kaley Î·È Phillips,
1991; Brezniak Î·È Wasserstein, 1993 a,b; Kjaer, 1995;
Mirabella Î·È Artun, 1995b; Vlaskalic Î·È Û˘Ó., 1998;
Horiuchi Î·È Û˘Ó., 1998; Kojima Î·È Û˘Ó., 2002;
Hartsfield Î·È Û˘Ó., 2004; Smale Î·È Û˘Ó., 2005;
Abuabara, 2007).
∂›Û˘ ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó Î·È ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜,
fiˆ˜ ÙÔ Ê‡ÏÔ (Kjaer, 1995; Spurrier Î·È Û˘Ó., 1990;
Baumrind Î·È Û˘Ó., 1996), Ë ËÏÈΛ· (McFadden ηÈ
Û˘Ó., 1989; Goldin, 1989; Hendrix Î·È Û˘Ó., 1994), ÙÔ
ÛÙ¿‰ÈÔ ·Ó¿Ù˘Í˘ Ù˘ Ú›˙·˜ (Linge Î·È Linge, 1983,
1991), o Ù‡Ô˜ ÙÔ˘ ‰ÔÓÙÈÔ‡ (Sharpe Î·È Û˘Ó., 1987), Ë
ÌÔÚÊÔÏÔÁ›· Ù˘ Ú›˙·˜ (Kjaer, 1995; Levander Î·È Û˘Ó.,
1998b), Ë ·fiÎÏÈÛË Ù˘ Ú›˙·˜ (Levander Î·È Malmgren
1988; Mirabella Î·È Artun, 1995b), Ë ÂÁÁ‡ÙËÙ· Ù˘
28
HELLENIC ORTHODONTIC REVIEW
age (McFadden et al., 1989; Goldin, 1989; Hendrix et al.,
1994), the stage of root development (Linge and Linge,
1983, 1991), the type of tooth (Sharpe et al., 1987), root
morphology (Kjaer, 1995; Levander et al., 1998b), root
deviation (Levander and Malmgren 1988; Mirabella and
Artun 1995b), proximity of root with cortical bone (Kaley
and Phillips, 1991; Horiuchi et al., 1998), traumatized
teeth (Linge and Linge 1983; Andreasen, 1985; Brin et al.,
1991), endodontically treated teeth (Wickwire et al.,
1974) – which have been not implicated by others
(Mirabella and Artun, 1995a,b; Spurrier et al., 1990),
denture anomalies, like ectopia (Kojima et al., 2002),
ankylosis (Andersson et al., 1984), and multiple agenesis
(Kjaer, 1995; Levander et al., 1998b) - which have been
also not implicated by others (Lee et al., 1999), maxillofacial anomalies like open bite (Harris and Butler, 1992),
undesirable habits like nails biting (Odenrick and
Brattstrom, 1985), allergy (Owman-Moll and Kurol,
2000), tongue and lip dysfunction (Linge and Linge,
1991), resorption existing before orthodontic treatment
(Kaley and Phillips, 1991), medicines like aspirin
(Kameyama et al., 1994), and periodontal diseases
(Kinomoto et al., 2002).
Finally, an important degree of their involvement in root
resorption has been attributed to several qualitative
or/and quantitative characteristics of orthodontic treatment, like the duration of orthodontic treatment (Harry
and Sims, 1982; Linge and Linge, 1983; Sharpe et al.,
1987; Levander and Malmgren, 1988; Goldin, 1989;
McFadden et al., 1989), the type of orthodontic appliances and the technique used (Linge and Linge, 1983;
Malmgren and Omblus, 1985; Beck and Harris, 1994), the
type of tooth movement like intrusion (Harry and Sims,
1982; Dermaut and De Munck, 1986; Parker and Harris,
1998) or torque (Kaley and Phillips, 1991; Parker and Harris, 1998), the magnitude of the applied forces (Hollender et al., 1980; Linge and Linge, 1983; Sharpe et al.,
1987; Levander et al., 1994), and the use of elastics combined with rectangular wires (Linge and Linge, 1983,
1991; Mirabella and Artun, 1995b).
According to the above mentioned issues, it is obvious
that orthodontic treatment plays an important role in
the etiology of root resorption of the teeth undergoing
movements.
With this review based on the published data, the contemporary knowledge and the new developments concerning orthodontic movement, an attempt is made to
discuss and critical analyze the mechanical factors associated with orthodontic treatment and implicated in the
formation of root resorption.
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
Ú›˙·˜ Ì ÙÔ ÊÏÔÈ҉˜ ¤Ù·ÏÔ (Kaley Î·È Phillips, 1991;
Horiuchi Î·È Û˘Ó., 1998) Ù· ÙÚ·˘Ì·ÙÈṲ̂ӷ ‰fiÓÙÈ·
(Linge Î·È Linge, 1983; Andreasen, 1985; Brin ηÈ
Û˘Ó., 1991), Ù· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ·
(Wickwire Î·È Û˘Ó., 1974) Ù· ÔÔ›· fï˜ ·ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó ·fi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜ (Mirabella Î·È Artun,
1995a,b; Spurrier Î·È Û˘Ó., 1990), ÔÈ ·ÓˆÌ·Ï›Â˜ Ù˘
Ô‰ÔÓÙÔÊ˘›·˜, fiˆ˜ Ë ÂÎÙÔ›· (Kojima Î·È Û˘Ó., 2002)
Ë ·Á·ψÛË (Andersson Î·È Û˘Ó., 1984) Î·È Ë ÔÏÏ·Ï‹ ·ÁÂÓÂÛ›· (Kjaer, 1995; Levander Î·È Û˘Ó., 1998b),
ÔÈ Ôԛ˜ Â›Û˘ ·ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó ·fi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜ (Lee Î·È Û˘Ó., 1999), ÔÈ ÁÓ·ıÔÚÔÛˆÈΤ˜
·ÓˆÌ·Ï›Â˜ fiˆ˜ Ë ·ÓˆÁ̤ÓË ‰‹ÍË (Harris Î·È Butler,
1992), ÔÈ ·ÓÂÈı‡ÌËÙ˜ ¤ÍÂȘ fiˆ˜ Ë ÔÓ˘¯ÔÊ·Á›·
(Odenrick Î·È Brattstrom, 1985), Ë ·ÏÏÂÚÁ›· (OwmanMoll Î·È Kurol, 2000), Ë ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ÁÏÒÛÛ·˜
Î·È ÙˆÓ ¯ÂÈϤˆÓ (Linge Î·È Linge, 1991), Ë ÚÔ¸¿Ú¯Ô˘Û· ·ÔÚÚfiÊËÛË ÚÈÓ ·fi ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· (Kaley Î·È Phillips, 1991), Ê¿Ú̷η fiˆ˜ Ë ·ÛÈÚ›ÓË (Kameyama Î·È Û˘Ó., 1994), ηıÒ˜ Î·È ÔÈ ÓfiÛÔÈ
ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ (Kinomoto Î·È Û˘Ó., 2002).
∆¤ÏÔ˜, ÛËÌ·ÓÙÈÎfi˜ ‚·ıÌfi˜ Û˘ÌÌÂÙÔ¯‹˜ ÛÙȘ ·ÔÚÚÔÊ‹ÛÂȘ ÙˆÓ ÚÈ˙ÒÓ ·Ô‰fiıËÎÂ Î·È ÛÙ· ‰È¿ÊÔÚ· ÔÈÔÙÈο ‹/Î·È ÔÛÔÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜
ıÂÚ·›·˜, fiˆ˜ Ë ‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ (Harry Î·È Sims, 1982; Linge Î·È Linge, 1983;
Sharpe Î·È Û˘Ó., 1987; Levander Î·È Malmgren, 1988;
Goldin, 1989; McFadden Î·È Û˘Ó., 1989), ÙÔ Â›‰Ô˜ ÙˆÓ
ÔÚıÔ‰ÔÓÙÈÎÒÓ Û˘Û΢ÒÓ Î·È Ë Ù¯ÓÈ΋ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È (Linge Î·È Linge, 1983; Malmgren Î·È Omblus,
1985; Beck Î·È Harris, 1994), Ô Ù‡Ô˜ Ù˘ ÌÂٷΛÓËÛ˘
ÙÔ˘ ‰ÔÓÙÈÔ‡ fiˆ˜ Ë ÂÌ‚‡ıÈÛË (Harry Î·È Sims, 1982;
Dermaut Î·È De Munck, 1986; Parker Î·È Harris, 1998)
Î·È Ë ÚÔ‹ (Kaley Î·È Phillips, 1991; Parker Î·È Harris,
1998), Ë ¤ÓÙ·ÛË ÙˆÓ ‰˘Ó¿ÌÂˆÓ Ô˘ ·ÛÎÔ‡ÓÙ·È
(Hollender Î·È Û˘Ó., 1980; Linge Î·È Linge, 1983;
Sharpe Î·È Û˘Ó., 1987; Levander Î·È Û˘Ó., 1994),
ηıÒ˜ Î·È Ë ¯Ú‹ÛË ÂÏ·ÛÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÔÚıÔÁÒÓÈ· Û‡ÚÌ·Ù· (Linge Î·È Linge, 1983,
1991; Mirabella Î·È Artun, 1995b).
∞fi Ù· ·Ú·¿Óˆ ηı›ÛÙ·Ù·È ÚÔÊ·Ó¤˜ fiÙÈ Ë ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Û˘ÌÌÂÙ¤¯ÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÛÙËÓ
·ÈÙÈÔÏÔÁ›· Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ
Ô˘ ˘Ê›ÛÙ·ÓÙ·È ÌÂÙ·ÎÈÓ‹ÛÂȘ.
ªÂ ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ÂȯÂÈÚÂ›Ù·È Ì¤Û· ·fi Ù·
ÎÏ·ÛÛÈο ‰Â‰Ô̤ӷ, ÙË Û‡Á¯ÚÔÓË ÁÓÒÛË Î·È ÙȘ Ӥ˜
ÂÍÂÏ›ÍÂȘ ÛÙÔ ı¤Ì· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘, Ó·
Á›ÓÂÈ ÌÈ· ÚÔÛ¿ıÂÈ· ÂÈηÈÚÔÔ›ËÛ˘, Û˘˙‹ÙËÛ˘ ηÈ
ÎÚÈÙÈ΋˜ ·Ó¿Ï˘Û˘ ÙˆÓ Ì˯·ÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘
Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ÂÓÔ¯Ô-
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
MECHANICAL FACTORS OF ROOT RESORPTION
Type (direction) of orthodontic movement
Type or direction of orthodontic movement seems to
have different results in the degree of root resorption of
teeth.
Regarding the bodily tooth movement, it was found out
that the extent of root resorption is limited, and this is
due to the fact that during the bodily movement of the
tooth, the applied forces are distributed through the
whole length of its root, the stress (force per surface
unit) is reduced, and thus, the harmful effect of the
applied forces at the apex is reduced (Reitan, 1985).
However, it has been reported that the distance covered
by the tooth on the horizontal plane, especially in premolar extraction cases, is associated with the amount of
resorption (Sharpe et al., 1987; Kaley and Phillips, 1991).
Non visible root resorptions during bodily movement
were discovered by Parker and Harris (1998) in a study
with 110 adult patients with similar Class I bimaxillary
malocclusions. Thus, it seems that the forces applied during bodily movement of teeth induce root resorptions,
however, these are of limited extent and they are related to the distance covered by the teeth.
The studies focused on the effect of intrusion on root
resorption resulted in conflicted resu;ts. According to
some of them, it seems that there is no significant correlation between intrusion and root resorption (McFadden
et al., 1989; Mirabella and Artun, 1995b), while, according to others, forces generating intrusion of the teeth are
of the most aggressive (DeShields, 1969; Dermaut and
De Munck, 1986; Costopoulos and Nanda, 1996; Parker
and Harris, 1998; Vlaskalic et al., 1998; Gioka and Eliades, 2003; Han et al., 2005; Zafeiriadis and Lambrianidis,
2008). These forces are focused on the apex and because
of the profound stress applied, they induce an ischemic
necrosis at the periodontal ligament and activation on
cellular level of the mechanisms causing root resorption.
Especially interesting is a recent study in which the
authors recorded the harmful effect of intrusion forces at
the apex of the teeth (Chiqueto et al., 2008). This study
was based on a homogeneous sample of patients with
profound deep bite and a control group with normal
deep bite treated without teeth extractions. Deep bite
was treated in the first group with the use of intrusion
arches with acute reverse curve of Spee, whereas the
control group was treated without the application of
intrusion forces. The results of the research confirm the
formation of resorptions in the group where intrusion
29
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
ÔÈÔ‡ÓÙ·È ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÔÚÚÔÊ‹ÛÂˆÓ ÙˆÓ
ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ.
ª∏Ã∞¡π∫√π ¶∞ƒ∞°√¡∆∂™ ∞¶√ƒƒ√º∏™∏™ ƒπ∑ø¡
∆‡Ô˜ (ηÙ‡ı˘ÓÛË) Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘
√ Ù‡Ô˜ ‹ Ë Î·Ù‡ı˘ÓÛË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ‰È·ÊÔÚÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙÔÓ
‚·ıÌfi Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ Ô˘
ÙȘ ˘Ê›ÛÙ·ÓÙ·È.
ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÌÂٷΛÓËÛË ÙˆÓ ‰ÔÓÙÈÒÓ Ì ·Ú¿ÏÏËÏË ÌÂÙ·ÙfiÈÛË (bodily movement), ‰È·Ù˘ÒıËΠfiÙÈ
Ë ¤ÎÙ·ÛË Ù˘ ·ÔÚÚfiÊËÛ˘ Ù˘ Ú›˙·˜ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·È ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Î·Ù¿ ÙËÓ ·Ú¿ÏÏËÏË
ÌÂٷΛÓËÛË ÙÔ˘ ‰ÔÓÙÈÔ‡, ÔÈ ·ÛÎÔ‡ÌÂÓ˜ ‰˘Ó¿ÌÂȘ
ηٷӤÌÔÓÙ·È Û fiÏÔ ÙÔ Ì‹ÎÔ˜ Ù˘ Ú›˙·˜ ÙÔ˘, Ë ›ÂÛË
(‰‡Ó·ÌË ·Ó¿ ÌÔÓ¿‰· ÂÈÊ·Ó›·˜) Â›Ó·È ÌÂȈ̤ÓË, ηÈ
ηٿ Û˘Ó¤ÂÈ· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Ë ÂÈ‚Ï·‚‹˜ ‰Ú¿ÛË
ÙˆÓ ·ÛÎÔ‡ÌÂÓˆÓ ‰˘Ó¿ÌÂˆÓ ÛÙÔ ·ÎÚÔÚÚ›˙ÈÔ (Reitan,
1985). øÛÙfiÛÔ ¤¯ÂÈ ·Ó·ÊÂÚı›, fiÙÈ Ë ·fiÛÙ·ÛË Ô˘
‰È·Ó‡ÂÈ ÙÔ ‰fiÓÙÈ Î·Ù¿ ÙÔ ÔÚÈ˙fiÓÙÈÔ Â›‰Ô, ȉȷ›ÙÂÚ·
Û ÂÚÈÙÒÛÂȘ Ì ÂÍ·ÁˆÁ¤˜ ÚÔÁÔÌÊ›ˆÓ, ¤¯ÂÈ Û¯¤ÛË
Ì ÙÔ ‚·ıÌfi ·ÔÚÚfiÊËÛ˘ (Sharpe Î·È Û˘Ó., 1987;
Kaley Î·È Phillips, 1991). ∞ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ ÌË ‰È·ÎÚÈÙ¤˜ ηٿ ÙËÓ ·Ú¿ÏÏËÏË ÌÂٷΛÓËÛË, ‰È·›ÛÙˆÛ·Ó
ÔÈ Parker Î·È Harris (1998) Û ̛· ÌÂϤÙË Ì 110 ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·˙·Ó ·ÚfiÌÔȘ Û˘ÁÎÏÂÈÛȷΤ˜ ·ÓˆÌ·Ï›Â˜ ∆¿Í˘ π ηٿ Angle Î·È ·ÌÊÈÚÔ‚ÔÏ‹
ÙˆÓ ÁÓ¿ıˆÓ. º·›ÓÂÙ·È Û˘ÓÂÒ˜ fiÙÈ ÔÈ ‰˘Ó¿ÌÂȘ Ô˘
·ÛÎÔ‡ÓÙ·È Î·Ù¿ ÙËÓ ·Ú¿ÏÏËÏË ÌÂٷΛÓËÛË ‰ÔÓÙÈÒÓ
ÚÔηÏÔ‡Ó ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ, ˆÛÙfiÛÔ ·˘Ù¤˜ ›ӷÈ
ÂÚÈÔÚÈṲ̂Ó˘ ¤ÎÙ·Û˘ Î·È Â›Ó·È Û˘Ó¿ÚÙËÛË Ù˘ ·fiÛÙ·Û˘ Ô˘ ı· ‰È·Ó‡ÛÔ˘Ó Ù· ‰fiÓÙÈ·.
√È ÌÂϤÙ˜ Ô˘ ÂÛÙÈ¿ÛÙËÎ·Ó ÛÙËÓ Â›‰Ú·ÛË Ù˘ ÌÂٷΛÓËÛ˘ ÂÌ‚‡ıÈÛ˘ (intrusion) ÛÙËÓ ·ÔÚÚfiÊËÛË ÙˆÓ
ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ Î·Ù¤ÏËÍ·Ó Û ·ÏÏËÏÔÛ˘ÁÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ. ™‡Ìʈӷ Ì οÔȘ ·fi ·˘Ù¤˜ Ê·›ÓÂÙ·È
fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ Û¯¤ÛË ÌÂٷ͇ Ù˘ ÌÂٷΛÓËÛ˘ Ù˘ ÂÌ‚‡ıÈÛ˘ Î·È Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ
(McFadden Î·È Û˘Ó., 1989; Mirabella Î·È Artun,
1995b), ÂÓÒ Û‡Ìʈӷ Ì ¿ÏϘ fiÙÈ ÔÈ ‰˘Ó¿ÌÂȘ Ô˘
ÚÔηÏÔ‡Ó ÂÌ‚‡ıÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ Â›Ó·È ·fi ÙȘ ϤÔÓ
ÂÈıÂÙÈΤ˜ (DeShields, 1969; Dermaut Î·È De Munck,
1986; Costopoulos Î·È Nanda, 1996; Parker Î·È Harris,
1998; Vlaskalic Î·È Û˘Ó., 1998; Gioka Î·È Eliades,
2003; Han Î·È Û˘Ó., 2005; Zafeiriadis Î·È Lambrianidis,
2008). √È ‰˘Ó¿ÌÂȘ ·˘Ù¤˜ ÂÛÙÈ¿˙ÔÓÙ·È ÛÙÔ ·ÎÚÔÚÚ›˙ÈÔ
Î·È ÏfiÁˆ Ù˘ ¤ÓÙÔÓ˘ ›ÂÛ˘ Ô˘ ·ÛΛٷÈ, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÈÛ¯·ÈÌÈ΋ Ó¤ÎÚˆÛË ÛÙÔÓ ÂÚÈÔ‰ÔÓÙÈÎfi Û‡Ó‰ÂÛÌÔ
30
HELLENIC ORTHODONTIC REVIEW
mechanics were applied.
The forces generating extrusion of teeth and their association with root resorption were subjected to limited
research work (Mirabella and Artun, 1995b; Parker and
Harris, 1998), possibly because extrusion forces do not
charge teeth at the apex and thus, they do not constitute a resorption inducing factor. However, an animal
study demonstrated resorption at the apical third of the
root after extrusion of teeth (Weekes and Wong, 1995).
In addition, in an interesting comparative study, after the
application of intrusion and extrusion forces on the premolars of the same patient, it was found that intrusion
forces cause 4 times more resorption than extrusion
forces (Han et al., 2005). It seems therefore that extrusion can cause root resorptions in a limited extent, however, more studies are necessary in order to draw safer
conclusions.
With regard to torque forces, root resorption has been
observed on the lingual and labial surfaces following
their application for root or crown toque (Ten Hoeve and
Mulie, 1976; Williams, 1984; Reitan, 1985; Goldin, 1989).
According to a subsequent study, it seems that lingual
root torque combined with intrusion, are the most predictable factors inducing root resorption (Parker and Harris, 1998). In a recent study, resorption percentage was
assessed for Tip-Edge technique before and after torque
application (van Loenen et al., 2007). Findings showed
similar percentages of root resorption on the teeth studied in both cases. As a result, the authors concluded that
torque movement constitutes an aggravating and not an
emitting factor of root resorption, attributing the induction of this phenomenon primarily to genetic factors.
Regarding the forces generating teeth rotation, they
rotate the teeth around their axis inducing minimal
stress on their roots surface and consequently limited
root resorption, as it was observed in animal studies
(Brain, 1969; Redlich et al., 1996). However, in a relatively recent clinical study, cenotopia were observed on the
surfaces of all premolars undergoing rotation, while at
the same time these resorption surfaces were located on
the middle third of the root, namely, on surfaces where
root morphology has the most profound projection
(Jimenez-Pellegrin and Arana-Chavez, 2004).
Finally, jiggling of teeth was implicated as one more
mechanical factor inducing root resorption. Jiggling
movements cause occlusal trauma that can activate the
mechanism initiating root resorption (Linge and Linge
1983, 1991; Levander et al., 1998a; Killiany, 1999; Brezniak and Wasserstein, 1993b; Brezniak and Wasserstein,
2002b). Moreover, it was found that root resorption of
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
Î·È ÂÓÂÚÁÔÔ›ËÛË Û ΢ÙÙ·ÚÈÎfi Â›Â‰Ô ÙˆÓ ÂÎÏ˘ÙÈÎÒÓ
Ì˯·ÓÈÛÌÒÓ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ. π‰È·›ÙÂÚ· ÂӉȷʤÚÔ˘Û· Â›Ó·È ÌÈ· ÚfiÛÊ·ÙË ÌÂϤÙË ÛÙËÓ ÔÔ›· ÔÈ
Û˘ÁÁÚ·Ê›˜ ηٷÁÚ¿ÊÔ˘Ó ÙË ‚Ï·‚ÂÚ‹ ‰Ú¿ÛË ÙˆÓ
‰˘Ó¿ÌÂˆÓ ÂÌ‚‡ıÈÛ˘ ÛÙÔ ·ÎÚÔÚÚ›˙ÈÔ ÙˆÓ ‰ÔÓÙÈÒÓ
(Chiqueto Î·È Û˘Ó., 2008). ∏ ÌÂϤÙË ·˘Ù‹ ‚·Û›ÛÙËÎÂ
Û ÔÌÔÈÔÁÂÓ¤˜ ‰Â›ÁÌ· ·ÛıÂÓÒÓ Ì ¤ÓÙÔÓË ˘ÂÚÛ‡ÁÎÏÂÈÛË Î·È ¤Ó· ‰Â›ÁÌ· ÂϤÁ¯Ô˘ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ηٷÎfiÚ˘ÊË ÂÈÎ¿Ï˘„Ë, Ù· ÔÔ›· ıÂÚ·‡ÙËÎ·Ó ¯ˆÚ›˜
ÂÍ·ÁˆÁ¤˜ ‰ÔÓÙÈÒÓ. ∏ ˘ÂÚÛ‡ÁÎÏÂÈÛË ÛÙË ÚÒÙË
ÔÌ¿‰· ıÂÚ·‡ÙËΠ̠ÙfiÍ· ÂÌ‚‡ıÈÛ˘ Ì ¤ÓÙÔÓË ·ÓÙ›ÛÙÚÔÊË Î·Ì‡ÏË ÙÔ˘ Spee, ÂÓÒ Ë ÔÌ¿‰· ÂϤÁ¯Ô˘
ıÂÚ·‡ÙËΠ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ‰˘Ó¿ÌÂˆÓ ÂÌ‚‡ıÈÛ˘. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜ ÂȂ‚·ÈÒÓÔ˘Ó ÙËÓ
‰ËÌÈÔ˘ÚÁ›· ·ÔÚÚÔÊ‹ÛÂˆÓ ÛÙËÓ ÔÌ¿‰· fiÔ˘ ÂÊ·ÚÌfiÛÙËÎ·Ó ÔÈ Ì˯·ÓÈÛÌÔ› ÂÌ‚‡ıÈÛ˘.
√È ‰˘Ó¿ÌÂȘ Ô˘ ÚÔηÏÔ‡Ó ˘ÂÚ¤ÎÊ˘ÛË (extrusion)
ÙˆÓ ‰ÔÓÙÈÒÓ Î·È ÔÈ Û¯¤ÛÂȘ ÙÔ˘˜ Ì ÙËÓ ·ÔÚÚfiÊËÛË
ÙˆÓ ÚÈ˙ÒÓ ·ÔÙ¤ÏÂÛ·Ó ·ÓÙÈΛÌÂÓÔ ÂÚÈÔÚÈṲ̂ӈÓ
ÂÚ¢ÓÒÓ (Mirabella Î·È Artun, 1995b; Parker ηÈ
Harris, 1998), ›Ûˆ˜ ÂÍ’ ·ÈÙ›·˜ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ ÔÈ
‰˘Ó¿ÌÂȘ ˘ÂÚ¤ÎÊ˘Û˘ ‰ÂÓ ÂÈÊÔÚÙ›˙Ô˘Ó Ù· ‰fiÓÙÈ·
ÛÙÔ ·ÎÚÔÚÚ›˙ÈÔ Î·È Û˘ÓÂÒ˜ ‰ÂÓ Û˘ÓÈÛÙÔ‡Ó ·Ú¿ÁÔÓÙ·
ÚfiÎÏËÛ˘ ·ÔÚÚÔÊ‹ÛˆÓ. øÛÙfiÛÔ, ÌÈ· ÌÂϤÙË ÛÂ
ÂÈÚ·Ì·Ùfi˙ˆ· ·¤‰ÂÈÍ fiÙÈ ÌÂÙ¿ ÙËÓ ÌÂٷΛÓËÛË ˘ÂÚ¤ÎÊ˘Û˘ ‰ÔÓÙÈÒÓ ‰È·ÈÛÙÒıËΠ·ÔÚÚfiÊËÛË ÛÙÔ
·˘¯ÂÓÈÎfi ÙÚÈÙËÌfiÚÈÔ Ù˘ Ú›˙·˜ ÙÔ˘˜ (Weekes ηÈ
Wong, 1995). ∂›Û˘, Û ÌÈ· ÂӉȷʤÚÔ˘Û· Û˘ÁÎÚÈÙÈ΋
ÌÂϤÙË ÂÊ·ÚÌÔÁ‹˜ ‰˘Ó¿ÌÂˆÓ ÂÌ‚‡ıÈÛ˘ Î·È ˘ÂÚ¤ÎÊ˘Û˘ Û ÚÔÁÔÌÊ›Ô˘˜ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÛıÂÓ‹ ‚Ú¤ıËÎÂ
fiÙÈ ÔÈ ‰˘Ó¿ÌÂȘ ÂÌ‚‡ıÈÛ˘ ÚÔηÏÔ‡Ó 4 ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚË ·ÔÚÚfiÊËÛË ·fi fiÙÈ ÔÈ ‰˘Ó¿ÌÂȘ ˘ÂÚ¤ÎÊ˘Û˘ (Han Î·È Û˘Ó., 2005). º·›ÓÂÙ·È Û˘ÓÂÒ˜ fiÙÈ Î·È Ë
˘ÂÚ¤ÎÊ˘ÛË Â›Ó·È ÌÈ· ΛÓËÛË Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·ÔÚÚÔÊ‹ÛÂȘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ Û ÂÚÈÔÚÈṲ̂ÓË ¤ÎÙ·ÛË, ˆÛÙfiÛÔ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ ·ÛÊ·ÏÒÓ
Û˘ÌÂÚ·ÛÌ¿ÙˆÓ Â›Ó·È ··Ú·›ÙËÙ˜ ÂÈϤÔÓ ÌÂϤÙ˜.
ŸÛÔ ·ÊÔÚ¿ ÙȘ ‰˘Ó¿ÌÂȘ ÛÙÚ¤„˘ (torque) ¤¯ÂÈ ·Ú·ÙËÚËı› ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ ÙfiÛÔ Î·Ù¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ ÁÈ· ÙË ÛÙÚ¤„Ë Ù˘ Ú›˙·˜ ‹ Ù˘ ̇Ï˘ ÙˆÓ
‰ÔÓÙÈÒÓ ÙfiÛÔ ÁψÛÛÈο fiÛÔ Î·È ¯ÂÈÏÈο (Ten Hoeve
Î·È Mulie, 1976; Williams, 1984; Reitan, 1985; Goldin,
1989). ™‡Ìʈӷ Ì ÌÈ· ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË Ê·›ÓÂÙ·È
fiÙÈ Ë ÛÙÚ¤„Ë ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ ÁψÛÛÈο
(lingual root torque) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Î›ÓËÛË Ù˘
ÂÌ‚‡ıÈÛ˘, ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÈÔ ÚԂϤ„ÈÌÔ˘˜ ·Ú¿ÁÔÓÙ˜ ‰ËÌÈÔ˘ÚÁ›·˜ ·ÔÚÚfiÊËÛ˘ ÚÈ˙ÒÓ (Parker ηÈ
Harris, 1998). ™Â ÌÈ· ÈÔ ÚfiÛÊ·ÙË ÌÂϤÙË, ·ÍÈÔÏÔÁ‹ıËΠÙÔ ÔÛÔÛÙfi ·ÔÚÚfiÊËÛ˘ Ì ÙËÓ Ù¯ÓÈ΋ ∆ipEdge ÚÈÓ Î·È ÌÂÙ¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ ÌÂٷΛÓËÛ˘ ÛÙÚ¤-
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
upper molars was similar in cases where the upper
molars were used for the application of intermaxillary
elastics during the night, as well as when they were used
for extraoral traction, or for the application of Goshgarian transpalatal arch (Alwali et al., 2000). Finally, jiggling
movements and occlusal traumas leading to root resorption can be induced even by retention appliances placed
after the end of orthodontic treatment (Copeland and
Green, 1986).
Removable and fixed orthodontic appliances
The use of fixed orthodontic appliances and their effect
on the mechanism of inducing root resorption was for
many years the subject of investigation in a plethora of
studies (Ketcham, 1927; Massler and Malone, 1954;
Kvam, 1972a,b; Newman, 1975; Malmgren et al., 1982;
Copeland and Green, 1986; Beck and Harris, 1994;
Baumrind et al., 1996; and many others). However, the
studies dealing with the comparison between removable and fixed orthodontic appliances and their effect
on root resorption are limited. In such a study, it was
observed that the application of fixed appliances was
more harmful for the apex of the teeth (Linge and
Linge, 1983). Similar results have been drawn by another comparative study in patients 10 years after orthodontic treatment, in which root resorption was
observed in the patients where fixed appliances were
placed (Kennedy et al., 1983). Without doubt, the comparison between removable and fixed appliances implicates the latter. However, removable appliances cannot
be excluded as a possible etiological factor of root
resorption, as they are implicated for the induction of
occlusal traumas and jiggling movements, causing this
way a harmful effect on the apex of the teeth (Linge
and Linge, 1983; Odenrick and Brattstrom, 1985;
Copeland and Green, 1986).
Orthodontic techniques
The significant number of techniques used today does
not make feasible a comparative evaluation among
them. The existing data derive sometimes from the
assessment of only one technique, sometimes from the
comparison between 2 techniques, while one paper
refers to the comparative study among 3 techniques.
With regard to the Edgewise technique, Kaley and
Phillips (1991) found in a sample of 200 patients that 3%
these patients presented significant resorption (greater
than the _ of the root) of the root of the two upper cen-
31
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
„˘ (van Loenen Î·È Û˘Ó., 2007). ∆· Â˘Ú‹Ì·Ù· ¤‰ÂÈÍ·Ó
·ÚfiÌÔÈ· ÔÛÔÛÙ¿ ·ÔÚÚfiÊËÛ˘ ÚÈ˙ÒÓ ÛÙ· ˘fi ÂͤٷÛË ‰fiÓÙÈ· Î·È ÛÙȘ ‰‡Ô ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ Û˘ÁÁÚ·Ê›˜ Ó· Û˘ÌÂÚ¿ÓÔ˘Ó, fiÙÈ Ë ÌÂٷΛÓËÛË
ÛÙÚ¤„˘ ·ÔÙÂÏ› ÂÈ‚·Ú˘ÓÙÈÎfi Î·È fi¯È ÂÎÏ˘ÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ, ·Ô‰›‰ÔÓÙ·˜
¤ÙÛÈ ÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ ΢ڛˆ˜ Û ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜.
ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ‰˘Ó¿ÌÂȘ Ô˘ ÚÔηÏÔ‡Ó ÂÚÈÛÙÚÔÊ‹
(rotation) ÛÙ· ‰fiÓÙÈ·, ·˘Ù¤˜ ÛÙÚ¤ÊÔ˘Ó ÙÔ ‰fiÓÙÈ Á‡Úˆ
·fi ÙÔÓ ›‰ÈÔ ÙÔ˘ ÙÔÓ ¿ÍÔÓ· ÚÔηÏÒÓÙ·˜ ¤ÙÛÈ ÂÏ¿¯ÈÛÙ˜ ȤÛÂȘ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ÚÈ˙ÒÓ ÙÔ˘˜ Î·È Î·Ù¿
Û˘Ó¤ÂÈ· ÂÚÈÔÚÈṲ̂ÓË ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ fiˆ˜
Ê¿ÓËΠ۠ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· (Brain, 1969;
Redlich Î·È Û˘Ó., 1996). øÛÙfiÛÔ, Û ÌÈ· ÚfiÛÊ·ÙË
Û¯ÂÙÈο ÎÏÈÓÈ΋ ÌÂϤÙË ·Ú·ÙËÚ‹ıËÎ·Ó ÎÂÓÔÙfiÈ·
·ÔÚÚfiÊËÛ˘ ÛÙȘ ÂÈÊ¿ÓÂȘ ÙˆÓ ÚÈ˙ÒÓ fiÏˆÓ ÙˆÓ
ÚÔÁÔÌÊ›ˆÓ Ô˘ ˘¤ÛÙËÛ·Ó ÂÚÈÛÙÚÔÊ‹, ÂÓÒ ·Ú¿ÏÏËÏ· ·˘Ù¤˜ ÔÈ ÂÚÈÔ¯¤˜ ·ÔÚÚfiÊËÛ˘ ÂÓÙÔ›˙ÔÓÙ·Ó
ÛÙÔ Ì¤ÛÔ ÙÚÈÙËÌfiÚÈÔ Ù˘ Ú›˙·˜, Û ÂÚÈÔ¯¤˜ ‰ËÏ·‰‹
fiÔ˘ Ë ÌÔÚÊÔÏÔÁ›· Ù˘ Ú›˙·˜ ¤¯ÂÈ ÙËÓ ÌÂÁ·Ï‡ÙÂÚË
ÚÔ‚ÔÏ‹ (Jimenez-Pellegrin Î·È Arana-Chavez, 2004).
∆¤ÏÔ˜, ÔÈ ÌÂÙ·ÎÈÓ‹ÛÂȘ ·ÏÈÓ‰ÚÔÌÈÎÔ‡ Ù‡Ô˘ (jiggling)
ÙˆÓ ‰ÔÓÙÈÒÓ ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó ˆ˜ ¤Ó·˜ ·ÎfiÌË Ì˯·ÓÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÚfiÎÏËÛ˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ.
√È ÌÂÙ·ÎÈÓ‹ÛÂȘ ·ÏÈÓ‰ÚÔÌÈÎÔ‡ Ù‡Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó
Û˘ÁÎÏÂÈÛÈ·Îfi ÙÚ·‡Ì· ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ÚÔηϤÛÂÈ
ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ¤Ó·Ú͢ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ (Linge Î·È Linge 1983,
1991; Levander Î·È Û˘Ó., 1998a; Killiany, 1999;
Brezniak Î·È Wasserstein, 1993b; Brezniak ηÈ
Wasserstein, 2002b). ∂ÈÚfiÛıÂÙ·, ‰È·ÈÛÙÒıËΠfiÙÈ Ë
·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ¿Óˆ ÁÔÌÊ›ˆÓ Â›Ó·È ·ÚfiÌÔÈ·, ÙfiÛÔ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ ¿Óˆ ÁÔÌÊ›ÔÈ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜ ÁÈ· ÂÊ·ÚÌÔÁ‹ ÂÏ·ÛÙÈÎÒÓ ‰È·ÁÓ·ıÈÎÒÓ ‰˘Ó¿ÌˆÓ, fiÛÔ Î·È ÛÙȘ
ÂÚÈÙÒÛÂȘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· Â͈ÛÙÔÌ·ÙÈ΋
¤ÏÍË, ‹ ÁÈ· ÂÊ·ÚÌÔÁ‹ ˘ÂÚÒÈ·˜ ‰ÔÎÔ‡ ÙÔ˘ Ù‡Ô˘
Goshgarian (Alwali Î·È Û˘Ó., 2000). ∆¤ÏÔ˜, ÌÂÙ·ÎÈÓ‹ÛÂȘ ·ÏÈÓ‰ÚÔÌÈÎÔ‡ Ù‡Ô˘ Î·È Û˘ÁÎÏÂÈÛȷο ÙÚ·‡Ì·Ù·
Ì Â·ÎfiÏÔ˘ıÔ ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÔÚÚÔÊ‹ÛÂˆÓ ÚÈ˙ÒÓ
ÌÔÚÔ‡Ó Ó· ÚÔÎÏËıÔ‡Ó ·ÎfiÌË Î·È ·fi ÙȘ Û˘ÁÎÚ·ÙËÙÈΤ˜ Û˘Û΢¤˜ Ô˘ ÙÔÔıÂÙÔ‡ÓÙ·È ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘
ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ (Copeland Î·È Green, 1986).
∫ÈÓËÙ¤˜ Î·È ·Î›ÓËÙ˜ ÔÚıÔ‰ÔÓÙÈΤ˜ Û˘Û΢¤˜
∏ ¯Ú‹ÛË ·ÎÈÓ‹ÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Û˘Û΢ÒÓ Î·È Ë Â›‰Ú·ÛË ÙÔ˘˜ ÛÙÔÓ Ì˯·ÓÈÛÌfi ¤Ó·Ú͢ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ·ÂÙ¤ÏÂÛ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ·ÓÙÈΛÌÂ-
32
HELLENIC ORTHODONTIC REVIEW
tral incisors, whereas for the rest of the teeth, such a
great resorption was observed only in 1% of the
patients. Levander et al. (1998b) observed that root
resorption was more significant in patients with multiple
congenital missing teeth (4-16 missing teeth) than in
patients having 1-3 missing teeth, as well as in cases
with teeth having abnormal root structure.
A comparison between Begg and Tweed techniques
revealed that there is no difference between them in the
extent of induced resorption (Beck and Harris, 1994),
while the comparison between Begg and ∂dgewise techniques revealed that orthodontic treatment with Begg
technique induce 2.3 times more resorption on the roots
of the posterior teeth than ∂dgewise technique (McNab
et al., 2000). Moreover, when extractions have been performed during treatment, root resorption was 3.7 times
greater.
In a comparative study between Standard Edgewise
and Straight Wire techniques in a homogeneous sample
of patients with Class I malocclusions treated with
extractions of at least two upper first premolars, it was
found that the upper central incisors presented statically more significant root resorption when the Standard Edgewise technique was used, while there was no
difference between the two techniques in root resorption of the upper lateral incisors (Mavragani et al.,
2000). In a more recent study, however, no statistically
significant difference was found between Standard
Edgewise and Straight Wire techniques in root resorption of the central and lateral incisors (Mohandesan et
al., 2007).
From the comparative study among 3 techniques, the
Simplified Standard Edgewise, the Straight Wire and
the Bioefficient Therapy, it was found that the group of
the patients treated with the Bioefficient Therapy presented the least root resorptions. These findings were
attributed to the use of superelastic archwires and the
corresponding brackets used with each technique, to
the use of rectangular stainless steel archwires with a
smaller cross-section (0.018x0.025 inch placed in brackets with 0.022x0.028 inch slot) for the distalization of
the incisors, as well as to the procedures taking place
with each one of the techniques during the last phase
of the orthodontic treatment (finishing) (Janson et al.,
2000).
According to the above mentioned findings it seems that
up until today it cannot be concluded that a specific
technique is more advantageous than the others concerning the phenomenon of root resorption of orthodontically moved teeth.
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
Orthodontic wires
ÓÔ ¤Ú¢ӷ˜ ÌÈ·˜ ÏËıÒÚ·˜ ÂÚÁ·ÛÈÒÓ (Ketcham, 1927;
Massler Î·È Malone, 1954; Kvam, 1972a,b; Newman,
1975; Malmgren Î·È Û˘Ó., 1982; Copeland Î·È Green,
1986; Beck Î·È Harris, 1994; Baumrind Î·È Û˘Ó., 1996;
Î·È ÔÏÏÔ› ¿ÏÏÔÈ). øÛÙfiÛÔ, ÔÈ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó
ÙË Û‡ÁÎÚÈÛË ÌÂٷ͇ ÎÈÓËÙÒÓ Î·È ·Î›ÓËÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Û˘Û΢ÒÓ Î·È ÙËÓ Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜. ™Â Ì›· ·Ó¿ÏÔÁË
Ù¤ÙÔÈ· ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ Ë ÂÊ·ÚÌÔÁ‹ ·ÎÈÓ‹ÙˆÓ
Û˘Û΢ÒÓ ‹Ù·Ó ÈÔ ÂÈ‚Ï·‚‹˜ ÁÈ· ÙÔ ·ÎÚÔÚÚ›˙ÈÔ ÙˆÓ
‰ÔÓÙÈÒÓ (Linge Î·È Linge, 1983). ∞Ó¿ÏÔÁ· Û˘ÌÂÚ¿ÛÌ·Ù· ÚÔ¤Ú¯ÔÓÙ·È Î·È ·fi ¿ÏÏË Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË
·ÛıÂÓÒÓ 10 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·,
fiÔ˘ ·Ú·ÙËÚ‹ıËΠ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ ÛÙo˘˜ ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÙÔÔıÂÙ‹ıËÎ·Ó ·Î›ÓËÙ˜ Û˘Û΢¤˜
(Kennedy Î·È Û˘Ó., 1983). ∞Ó·ÌÊ›‚ÔÏ·, Ë Û‡ÁÎÚÈÛË
ÌÂٷ͇ ÎÈÓËÙÒÓ Î·È ·ÎÈÓ‹ÙˆÓ Û˘Û΢ÒÓ, ÂÓÔ¯ÔÔÈ› ÙȘ
‰Â‡ÙÂÚ˜. øÛÙfiÛÔ Î·È ÔÈ ÎÈÓËÙ¤˜ Û˘Û΢¤˜ ‰ÂÓ ÂÍ·ÈÚÔ‡ÓÙ·È ˆ˜ Èı·Ófi˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ù˘
·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ, ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÚfiÎÏËÛË Û˘ÁÎÏÂÈÛÈ·ÎÒÓ ÙÚ·˘Ì¿ÙˆÓ
Î·È ÌÂÙ·ÎÈÓ‹ÛÂȘ Ù·Ï¿ÓÙˆÛ˘, ÂȉÚÒÓÙ·˜ Ì ·˘Ùfi ÙÔÓ
ÙÚfiÔ ‚Ï·ÙÈο ÛÙÔ ·ÎÚÔÚÚ›˙ÈÔ ÙˆÓ ‰ÔÓÙÈÒÓ (Linge
Î·È Linge, 1983; Odenrick Î·È Brattstrom, 1985;
Copeland Î·È Green, 1986).
During orthodontic treatment, hyperelastic Ni-Ti and
stainless steel wires are commonly used. During the period of deactivation, a stable light force is transmitted for
a longer period with the hyperelastic wires, whereas
with the stainless steel wires, the applied force is of
greater magnitude and it reduces very quickly (Reitan,
1985, Miura et al., 1986; Reitan and Rygh, 1994; Maltha
and Dijkman, 1996; Faltin et al., 2001). According to a
study with a laser scanning electron microscope, in
which a comparison of root resorption of premolars in
adolescents with a mean age of 12.5 years was performed, after the use of hyperelastic and stainless steel
wires, it was found that the surface, as well as the
perimeter and the volume of resortion’s cenotopia were
significant greater (in a percentage of 140%) when the
teeth were removed with hyperelastic wires compared
with stainless steel wires. This result was attributed to
the possibility of high force application (0.8-1.0 ¡) used
in this study (Weiland, 2003). However, it is reported that
the action of these wires further depends on the magnitude and the duration of the applied forces, as well as on
individual variations (Linge and Linge, 1983; Maltha and
Dijkman, 1996; Weiland, 2003, 2006).
√ÚıÔ‰ÔÓÙÈΤ˜ Ù¯ÓÈΤ˜
Type of orthodontic forces
√ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ‰È·ÊfiÚˆÓ Ù¯ÓÈÎÒÓ Ô˘
¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û‹ÌÂÚ·, ‰ÂÓ Î·ıÈÛÙ¿ ÂÊÈÎÙ‹ ÌÈ·
Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÌÂٷ͇ ÙÔ˘˜. ∆· ˘¿Ú¯ÔÓÙ· ‰Â‰Ô̤ӷ ÚÔ¤Ú¯ÔÓÙ·È ¿ÏÏÔÙ ·fi ÙËÓ ·ÍÈÔÏfiÁËÛË ÌÈ·˜ ÌfiÓÔ
Ù¯ÓÈ΋˜, ¿ÏÏÔÙ ·fi ÙË Û‡ÁÎÚÈÛË 2 Ù¯ÓÈÎÒÓ, ÂÓÒ Ì›·
ÂÚÁ·Û›· ·Ó·Ê¤ÚÂÙ·È ÛÙË Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË 3 Ù¯ÓÈÎÒÓ.
ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Ù¯ÓÈ΋ Edgewise, ÔÈ Kaley ηÈ
Phillips (1991) ‰È·›ÛÙˆÛ·Ó fiÙÈ Û ¤Ó· ‰Â›ÁÌ· 200
·ÛıÂÓÒÓ, ÔÛÔÛÙfi 3% ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ·ÔÚÚfiÊËÛË (ÌÂÁ·Ï‡ÙÂÚË ·fi ÙÔ 1/4 ÙÔ˘ Ì‹ÎÔ˘˜) Ù˘ Ú›˙·˜
ÙˆÓ ‰‡Ô ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ, ÂÓÒ ÛÙ· ˘fiÏÔÈ·
‰fiÓÙÈ· Ù¤ÙÔÈ·˜ ¤ÎÙ·Û˘ ·ÔÚÚfiÊËÛË ‰È·ÈÛÙÒıËÎÂ
ÌfiÓÔ Û ÔÛÔÛÙfi 1% ÙˆÓ ·ÛıÂÓÒÓ. √È Levander ηÈ
Û˘Ó. (1998b), ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Ë ·ÔÚÚfiÊËÛË Ù˘
Ú›˙·˜ ‹Ù·Ó ÛËÌ·ÓÙÈÎfiÙÂÚË Û ·ÛıÂÓ›˜ Ì ÔÏÏ·Ϥ˜
Û˘ÁÁÂÓ›˜ ÂÏÏ›„ÂȘ ‰ÔÓÙÈÒÓ (4-16 ÂÏÏ›ÔÓÙ· ‰fiÓÙÈ·)
·fi fiÙÈ Û ·ÛıÂÓ›˜ Ô˘ ›¯·Ó 1-3 ÂÏÏ›ÔÓÙ· ‰fiÓÙÈ·,
ηıÒ˜ Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ ‰ÔÓÙÈÒÓ Ô˘ ·ÚÔ˘Û›·˙·Ó
·ÓÒÌ·ÏË ‰ÔÌ‹ Ú›˙·˜.
™˘ÁÎÚ›ÓÔÓÙ·˜ ÙËÓ Ù¯ÓÈ΋ Begg Î·È ÙËÓ Ù¯ÓÈ΋ Tweed,
‰È·ÈÛÙÒıËΠfiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ
‰‡Ô Ù¯ÓÈÎÒÓ ÛÙÔ Â‡ÚÔ˜ Ù˘ ·ÔÚÚfiÊËÛ˘ Ô˘ ˘Ê›-
Several researches seem to lead to conflicting conclusions concerning the type of orthodontic force that
should be applied in order to minimize the phenomenon
of root resorption.
Owman-Moll et al. (1995) did not found any significant
differences in the extent of root resorptions caused by
the application of continuous or interrupted forces. In
contrast, Maltha and Dijkman (1996) and Maltha et al.
(2004) found out in experimental studies in dogs that
interrupted forces induce root resorptions of less extent
compared to continuous forces. Acar et al. (1999) came
to similar conclusions after a clinical study in patients
treated with extractions of first premolars.
The differences among the above mentioned findings
could possibly attributed to the fact that these studies
are not comparable, as they differ in the technique used
and the duration of the applied forces. For example, the
findings of Owman-Moll et al. (1995) derive from the
application of continuous forces for 24 hours and interrupted forces for one every four weeks, the findings of
Maltha and Dijkman (1996) refer to interrupted forces
applied for 16 hours per day, whereas these of Acar et al.
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
33
HELLENIC ORTHODONTIC REVIEW
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
ÛÙ·ÓÙ·È Ù· ‰fiÓÙÈ· (Beck Î·È Harris, 1994), ÂÓÒ Û˘ÁÎÚ›ÓÔÓÙ·˜ ÙȘ Ù¯ÓÈΤ˜ Begg Î·È ∂dgewise, ‰È·ÈÛÙÒıËÎÂ
fiÙÈ Ë ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Ì ÙËÓ Ù¯ÓÈ΋ Begg ÚÔηÏ› 2,3 ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚË ·ÔÚÚfiÊËÛË ÛÙȘ Ú›˙˜ ÙˆÓ
ÔÈÛı›ˆÓ ‰ÔÓÙÈÒÓ Û ۯ¤ÛË Ì ÙËÓ Ù¯ÓÈ΋ ∂dgewise
(McNab Î·È Û˘Ó., 2000). ∂ÈϤÔÓ, fiÙ·Ó Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ·
Ù˘ ıÂÚ·›·˜ ¤ÁÈÓ·Ó ÂÍ·ÁˆÁ¤˜, Ë ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ
‹Ù·Ó 3,7 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË.
™Â Ì›· Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÌÂٷ͇ Ù˘ Ù¯ÓÈ΋˜ Standard
Edgewise Î·È Ù˘ Ù¯ÓÈ΋˜ Straight Wire Û ¤Ó· ÔÌÔÈÔÁÂÓ¤˜ ‰Â›ÁÌ· ·ÛıÂÓÒÓ ÌÂ Û˘ÁÎÏÂÈÛȷΤ˜ ·ÓˆÌ·Ï›Â˜ ∆¿Í˘ ππ,
ηÙËÁÔÚ›·˜ 1 ηٿ Angle Ô˘ ıÂÚ·‡ÙËÎ·Ó Ì ÂÍ·ÁˆÁ¤˜
ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙˆÓ ‰‡Ô ¿Óˆ ÚÒÙˆÓ ÚÔÁÔÌÊ›ˆÓ, ·Ú·ÙËÚ‹ıËΠfiÙÈ ÔÈ ¿Óˆ ÎÂÓÙÚÈÎÔ› ÙÔÌ›˜ ·ÚÔ˘Û›·˙·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfiÙÂÚË ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ Ì ¯Ú‹ÛË Ù˘ Ù¯ÓÈ΋˜ Standard Edgewise, ÂÓÒ ‰ÂÓ ˘‹ÚÍ η̛· ‰È·ÊÔÚ¿
ÛÙËÓ ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ ÙˆÓ ¿Óˆ Ï·Á›ˆÓ ÙÔ̤ˆÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ù¯ÓÈÎÒÓ (Mavragani Î·È Û˘Ó., 2000). ŸÌˆ˜ ÛÂ
ÌÈ· ÈÔ ÚfiÛÊ·ÙË ÌÂϤÙË ‰ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ Ù˘ Ù¯ÓÈ΋˜ Standard Edgewise ηÈ
Straight Wire ÛÙËÓ ·ÔÚÚfiÊËÛË Ô˘ ·ÚÔ˘Û›·˙·Ó ÔÈ
Ú›˙˜ ÙˆÓ ÎÂÓÙÚÈÎÒÓ Î·È Ï·Á›ˆÓ ÙÔ̤ˆÓ (Mohandesan
Î·È Û˘Ó., 2007).
∞fi ÙËÓ Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÌÂٷ͇ 3 Ù¯ÓÈÎÒÓ, ÙËÓ
Simplified Standard Edgewise, ÙËÓ Straight Wire Î·È ÙËÓ
Bioefficient Therapy, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ÔÌ¿‰· ·ÛıÂÓÒÓ
Ô˘ ıÂÚ·‡ÙËÎ·Ó Ì ÙËÓ Bioefficient Therapy ·ÚÔ˘Û›·˙·Ó ÙȘ ÌÈÎÚfiÙÂÚ˜ ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ. ∆· Â˘Ú‹Ì·Ù·
·˘Ù¿ ·Ô‰fiıËÎ·Ó ÙfiÛÔ ÛÙË ¯Ú‹ÛË ÙˆÓ ˘ÂÚÂÏ·ÛÙÈÎÒÓ
Û˘ÚÌ¿ÙˆÓ Î·È ÙˆÓ ·ÓÙÈÛÙÔ›¯ˆÓ ·ÁÎ˘Ï›ˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ Î¿ı Ù¯ÓÈ΋, fiÛÔ Î·È ÛÙË ¯Ú‹ÛË ÌÈÎÚfiÙÂÚ˘ ‰È·ÙÔÌ‹˜ ÙÂÙÚ¿ÁˆÓˆÓ Û˘ÚÌ¿ÙˆÓ ·ÓÔÍ›‰ˆÙÔ˘ ¯¿Ï˘‚· (‰È·ÙÔÌ‹˜ 0.018x0.025 inch ÙÔÔıÂÙË̤ӷ Û ·Á·ÏÈ·
Ì ‰È·ÙÔÌ‹ 0.022x0.028 inch), Ù· ÔÔ›· ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙËÓ ÚÔ˜ Ù· ¿ˆ ÌÂٷΛÓËÛË ÙˆÓ ÙÔ̤ˆÓ, fiˆ˜
Â›Û˘ Î·È ÛÙȘ ‰È·‰Èηۛ˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· Ì ÙËÓ
οı ÌÈ· Ù¯ÓÈ΋ ÛÙÔ ÙÂÏÂ˘Ù·›Ô ıÂÚ·¢ÙÈÎfi ÛÙ¿‰ÈÔ Ù˘
ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ (finishing) (Janson Î·È Û˘Ó.,
2000).
∞fi Ù· ·Ú·¿Óˆ Ê·›ÓÂÙ·È Û˘ÓÂÒ˜ fiÙÈ Ì¤¯ÚÈ Î·È Û‹ÌÂÚ·
‰ÂÓ ÌÔÚ› Ó· ÙÂÎÌËÚȈı› fiÙÈ ÌÈ· Û˘ÁÎÂÎÚÈ̤ÓË Ù¯ÓÈ΋
˘ÂÚÙÂÚ› ÛËÌ·ÓÙÈο ¤Ó·ÓÙÈ Î¿ÔÈ·˜ ¿ÏÏ˘ fiÛÔÓ ·ÊÔÚ¿
ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ
Ù· ÔÔ›· ÌÂÙ·ÎÈÓÔ‡ÓÙ·È ÔÚıÔ‰ÔÓÙÈο.
(1999) refer to the application of elastic forces in the
same patient either for 24 hours (continuous forces) or
for 12 hours per 24-hour (interrupted forces)
Magnitude of orthodontic forces
According to the existing research data, it seems that it
is not possible to give a well documented answer regarding the selection of using light or heavy orthodontic
forces. The use of light forces minimize the risk of root
resorption according to Reitan (1985), whereas histological findings of other studies do not support a difference
between light and heavy orthodontic forces (OwmanMoll, 1995; Owman-Moll et al., 1996a,b).
It is reported that the heavier the applied forces the
higher the applied stress per root surface unit, and thus
the more severe the root resorption (Harry and Sims,
1982; Mayoral, 1982; Reitan, 1985; Linge and Linge,
1991; Reitan and Rygh, 1994). However, even after the
application of continuous light forces of 50 gr, it seems
that no matter how small the applied force is, root
resorptions are observed, possibly due to the duration of
force application (Kurol et al., 1996). There are, however,
some conflicting data. For example, in an histological
study performed by Owman-Moll et al. (1996a,b) on premolars, it was found that despite the duplication or the
quadruplication of the force magnitude from 50 to 200
gr, no statistical significant difference was found in the
amount of the root resorption observed. Similar conclusions have reached other researchers who did not found
any correlation between root resorption and the magnitude of the applied force, and for that reason they
ascribe root resorption mainly to genetic and predisposition factors (Al-Qawasmi et al., 2003; Artun et al., 2005;
van Loenen et al., 2007). In a more recent study with
scanning electron microscope (SEM), in which root
resorptions of first premolars were volumetric assessed
after the application of light and heavy forces, greater
resorption was found after the application of heavy
forces (Darendeliler et al., 2004; Chan and Darendeliler,
2005). To similar conclusions came also other studies
using SEM in rats (Gonzales et al., 2008) and microcomputed tomography in humans (Cheng et al., 2009), in
which less root resorption was observed using light than
heavy orthodontic forces.
√ÚıÔ‰ÔÓÙÈο Û‡ÚÌ·Ù·
Type of malocclusion
∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ˘ÂÚÂÏ·ÛÙÈο Û‡ÚÌ·Ù· ÓÈÎÂÏ›Ô˘-ÙÈÙ·Ó›Ô˘ Î·È ¿Î·ÌÙ· Û‡ÚÌ·Ù· ·ÓÔÍ›‰ˆÙÔ˘ ¯¿Ï˘‚·. ∫·Ù¿
34
The number of published studies investigating the
degree of root resorption induced by orthodontic treat-
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
ÙËÓ ÂÚ›Ô‰Ô Ù˘ ·ÂÓÂÚÁÔÔ›ËÛ˘, Ì ٷ ˘ÂÚÂÏ·ÛÙÈο
Û‡ÚÌ·Ù· ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÈ· ÛÙ·ıÂÚ‹ ‰‡Ó·ÌË ‹È·˜ ¤ÓÙ·Û˘ ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÂÓÒ Ì ٷ Û‡ÚÌ·Ù· ·ÓÔÍ›‰ˆÙÔ˘ ¯¿Ï˘‚· Ë ·ÛÎÔ‡ÌÂÓË ‰‡Ó·ÌË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ˘ ¤ÓÙ·Û˘ Î·È ÂÏ·ÙÙÒÓÂÙ·È Ù·¯‡Ù·Ù· (Reitan, 1985,
Miura Î·È Û˘Ó., 1986; Reitan Î·È Rygh, 1994; Maltha ηÈ
Dijkman, 1996; Faltin Î·È Û˘Ó., 2001). ™‡Ìʈӷ Ì ÌÈ·
ÌÂϤÙË Ì ÌÈÎÚÔÛÎfiÈÔ Û¿ÚˆÛ˘ Ì laser, fiÔ˘ ¤ÁÈÓÂ
Û‡ÁÎÚÈÛË Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ÚÔÁÔÌÊ›ˆÓ
Û ¤ÊË‚Ô˘˜ Ì ̤ÛË ËÏÈΛ· 12.5 ¤ÙË, ÌÂÙ¿ ·fi ¯Ú‹ÛË ˘ÂÚÂÏ·ÛÙÈÎÒÓ Û˘ÚÌ¿ÙˆÓ Î·È Û˘ÚÌ¿ÙˆÓ ·fi ·ÓÔÍ›‰ˆÙÔ
¯¿Ï˘‚·, ‰È·ÈÛÙÒıËΠfiÙÈ ÙfiÛÔ Ë ÂÈÊ¿ÓÂÈ·, fiÛÔ Ë ÂÚ›ÌÂÙÚÔ˜ Î·È Ô fiÁÎÔ˜ ÙˆÓ ÎÂÓÔÙÔ›ˆÓ ·ÔÚÚfiÊËÛ˘ ‹Ù·Ó
ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ· (Û ÔÛÔÛÙfi 140%) fiÙ·Ó Ù· ‰fiÓÙÈ·
ÌÂÙ·ÎÈÓ‹ıËÎ·Ó Ì ˘ÂÚÂÏ·ÛÙÈο Û‡ÚÌ·Ù·, Û ۇÁÎÚÈÛË
Ì ÙÔ˘ ·ÓÔÍ›‰ˆÙÔ˘ ¯¿Ï˘‚·, ·Ô‰›‰ÔÓÙ·˜ ÙÔ ·ÔÙ¤ÏÂÛÌ·
·˘Ùfi, ÛÙËÓ Èı·ÓfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ ÌÂÁ¿Ï˘ ‰‡Ó·Ì˘ (0,81,0 ¡) ÛÙË ÌÂϤÙË ·˘Ù‹ (Weiland, 2003). øÛÙfiÛÔ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ‰Ú¿ÛË ·˘Ù‹ ÙˆÓ Û˘ÚÌ¿ÙˆÓ, ÂÍ·ÚÙ¿Ù·È Î·È ·fi
ÙËÓ ¤ÓÙ·ÛË Î·È ÙËÓ ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ÙˆÓ ÂÍ·ÛÎÔ‡ÌÂÓˆÓ
‰˘Ó¿ÌˆÓ, ηıÒ˜ Î·È ·fi ·ÙÔÌÈΤ˜ ‰È·Î˘Ì¿ÓÛÂȘ (Linge
Î·È Linge, 1983; Maltha Î·È Dijkman, 1996; Weiland,
2003, 2006).
∂›‰Ô˜ ÔÚıÔ‰ÔÓÙÈÎÒÓ ‰˘Ó¿ÌˆÓ
√È ‰È¿ÊÔÚÔÈ ÂÚ¢ÓËÙ¤˜ Ê·›ÓÂÙ·È Ó· ηٷϋÁÔ˘Ó Û ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ fiÛÔÓ ·ÊÔÚ¿ ÙÔ Â›‰Ô˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ‰‡Ó·Ì˘ Ô˘ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛÙ› ÚÔÎÂÈ̤ÓÔ˘
Ó· ÂÏ·¯ÈÛÙÔÔÈËı› ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ Ù˘
·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ.
ŒÙÛÈ, Ô Owman-Moll Î·È Û˘Ó. (1995) ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó
ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ
ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ Ô˘ ÚÔηÏÔ‡ÓÙ·È ÌÂÙ¿ ·fi ÂÊ·ÚÌÔÁ‹ Û˘Ó¯ÒÓ ‹ ‰È·ÎÔÙfiÌÂÓˆÓ ‰˘Ó¿ÌˆÓ. ∞ÓÙ›ıÂÙ·, ÔÈ
Maltha Î·È Dijkman (1996) Î·È Maltha Î·È Û˘Ó. (2004)
‰È·›ÛÙˆÛ·Ó Û ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ Û Û·ÏÔ˘˜ fiÙÈ ÔÈ
‰È·ÎÔÙfiÌÂÓ˜ ‰˘Ó¿ÌÂȘ ÚÔηÏÔ‡Ó ÌÈÎÚfiÙÂÚ˘ ¤ÎÙ·Û˘
·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ ·fi fiÙÈ ÔÈ Û˘Ó¯›˜ ‰˘Ó¿ÌÂȘ. ™Â
·ÚfiÌÔÈ· Û˘ÌÂÚ¿ÛÌ·Ù· η٤ÏËÍ·Ó Î·È ÔÈ Acar Î·È Û˘Ó.
(1999) Û ÌÈ· ÎÏÈÓÈ΋ ÌÂϤÙË Û ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜
Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÂÍ·ÁˆÁ¤˜ ÙˆÓ ÚÒÙˆÓ ÚÔÁÔÌÊ›ˆÓ
ÛÙ· Ï·›ÛÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÙÔ˘˜ ıÂÚ·›·˜.
√È ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ·Ú·¿Óˆ ¢ÚËÌ¿ÙˆÓ ı· ÌÔÚÔ‡Û·Ó Èı·Ó¿ Ó· ·Ô‰ÔıÔ‡Ó ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÌÂϤÙ˜
·˘Ù¤˜ ‰ÂÓ Â›Ó·È Û˘ÁÎÚ›ÛÈ̘ ηı’ fiÛÔÓ ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È
ÙfiÛÔ ˆ˜ ÚÔ˜ ÙËÓ Ù¯ÓÈ΋ fiÛÔ Î·È ÛÙË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ·
ÙˆÓ ÂÊ·ÚÌÔ˙fiÌÂÓˆÓ ‰˘Ó¿ÌˆÓ. ŒÙÛÈ, Ù· Â˘Ú‹Ì·Ù· ÙÔ˘
Owman-Moll Î·È Û˘Ó. (1995) ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂÊ·ÚÌÔÁ‹
ÙfiÛÔ Û˘Ó¯ÒÓ ‰˘Ó¿ÌÂˆÓ Â› 24ˆÚ˘ ‚¿Û˘, fiÛÔ Î·È ‰È·-
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
ment in relation to the type of malocclusion is limited
and their results lead to conflicting conclusions. Mirabella and Artun (1995b) did not found any correlation
between initial malocclusion and root resorption. Similar
results found also Fritz et al. (2003). On the contrary,
Taner et al. (1999) observed in patients with Class I and
Class II malocclusions treated with premolars extractions, that the upper incisors in Class II Division 1
patients presented a higher amount of root resorption
compared to Class I patients. Similar results found by
Brin et al. (2003), who retrospectively evaluated orthodontic treatment of Class II patients and concluded that
there is a good correlation between root resorption and
the amount of the initial overjet as well as the time period that the patient was under treatment with fixed
appliances.
The studies assessing root resorptions following treatment of Class III malocclusion are also limited. Kaley and
Phillips (1991) who studied root resorption after orthodontic treatment in patients with Class III malocclusion
observed that the upper central incisors in a percentage
of 90%, as well as the upper lateral incisors in a somewhat smaller percentage, had undergone severe resorption, which was visible after careful examination of
panoramic radiographs. This was attributed to the possibility of heavy pressure of these teeth against the cortical bone during orthodontic treatment, because of the
profound labial inclination that these teeth frequently
show after the end of orthodontic treatment in order to
compensate the skeletal Class III jaw relationship.
Finally, open bite treatment also seems to be a risk factor for induction of root resorption, something that
could be attributed to the jiggling movements of the
incisors or the diminished bone anchorage mainly at the
anterior teeth, combined with tongue dysfunction
(Odenrick and Brattstrom, 1985; Linge and Linge, 1991;
Harris and Butler, 1992). However, this is in contrast to
the findings of Katsaros and Berg (1993), who reported
that only a small number of patients with open bite
showed root resorption after orthodontic treatment
(greater than 10% of the initial root length). These
patients had a history of trauma or atypical root shape.
Duration of orthodontic treatment
Many researchers support the idea that root resorption
risk increases as the duration of the orthodontic treatment increases. In clinical studies it has been observed
that there is root resorption even after the first 6 months
of active orthodontic treatment, with a consequent
35
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
ÎÔÙfiÌÂÓˆÓ ÁÈ· Ì›· ‚‰ÔÌ¿‰· οı 4 ‚‰ÔÌ¿‰Â˜, Ù·
Â˘Ú‹Ì·Ù· ÙˆÓ Maltha Î·È Dijkman (1996) ·ÊÔÚÔ‡Ó ‰È·ÎÔÙfiÌÂÓ˜ ‰˘Ó¿ÌÂȘ Ô˘ ÂÊ·ÚÌÔ˙fiÙ·Ó 16 ÒÚ˜ ÙËÓ
Ë̤ڷ, ÂÓÒ ÙˆÓ Acar Î·È Û˘Ó. (1999) ·ÊÔÚÔ‡Ó ÂÊ·ÚÌÔÁ‹
ÂÏ·ÛÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ ·fi ÙÔÓ ›‰ÈÔ ÙÔÓ ·ÛıÂÓ‹, ›Ù Â›
24ˆÚ˘ ‚¿Û˘ (Û˘Ó¯›˜ ‰˘Ó¿ÌÂȘ), ›Ù ÁÈ· 12 ÒÚ˜ ÙÔ
24ˆÚÔ (‰È·ÎÔÙfiÌÂÓ˜ ‰˘Ó¿ÌÂȘ).
ª¤ÁÂıÔ˜ ÔÚıÔ‰ÔÓÙÈÎÒÓ ‰˘Ó¿ÌˆÓ
∆ÂÎÌËÚȈ̤ÓË ·¿ÓÙËÛË Û¯ÂÙÈο Ì ÙËÓ ÂÈÏÔÁ‹ ¯Ú‹Û˘
‹ÈˆÓ ‹ ÈÛ¯˘ÚÒÓ ‰˘Ó¿ÌˆÓ, Ê·›ÓÂÙ·È fiÙÈ Û‡Ìʈӷ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì ٷ ˘¿Ú¯ÔÓÙ· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ ·ÎfiÌË
‰ÂÓ ÌÔÚ› Ó· ‰Ôı›. √È ‹Ș ‰˘Ó¿ÌÂȘ, Û‡Ìʈӷ Ì ÙÔÓ
Reitan (1985), ÂÏ·¯ÈÛÙÔÔÈÔ‡Ó ÙÔÓ Î›Ó‰˘ÓÔ ÚÈ˙È΋˜ ·ÔÚÚfiÊËÛ˘, ÂÓÒ ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ ‰ÂÓ
ÂȂ‚·ÈÒÓÔ˘Ó ‰È·ÊÔÚ¿ ÌÂٷ͇ ‹ÈˆÓ Î·È ÈÛ¯˘ÚÒÓ ‰˘Ó¿ÌÂˆÓ (Owman-Moll, 1995; Owman-Moll Î·È Û˘Ó.,
1996a,b).
∞ӷʤÚÂÙ·È fiÙÈ fiÛÔ ÌÂÁ·Ï‡ÙÂÚ˘ ¤ÓÙ·Û˘ ‰˘Ó¿ÌÂȘ ·ÛÎÔ‡ÓÙ·È, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ÂÍ·ÛÎÔ‡ÌÂÓË ›ÂÛË ·Ó¿
ÌÔÓ¿‰· ÂÈÊ·Ó›·˜ Ù˘ Ú›˙·˜ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Î·È Ë ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ (Harry Î·È Sims,
1982; Mayoral, 1982; Reitan, 1985; Linge Î·È Linge, 1991;
Reitan Î·È Rygh, 1994). ŸÌˆ˜, Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÎfiÌË Î·È
Û˘Ó¯ÒÓ Î·È ÂÏÂÁ¯fiÌÂÓˆÓ ‹ÈˆÓ ‰˘Ó¿ÌÂˆÓ ÌÂÁ¤ıÔ˘˜
ÂÚ›Ô˘ 50 gr Ê·›ÓÂÙ·È fiÙÈ fiÛÔ ‹È· Î·È ·Ó Â›Ó·È Ë ÂÊ·ÚÌÔ˙fiÌÂÓË ‰‡Ó·ÌË ·Ú·ÙËÚÔ‡ÓÙ·È ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ
ÂÍ’ ·ÈÙ›·˜ Ì¿ÏÏÔÓ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ù˘ ¯ÚÔÓÈ΋˜ ‰È¿ÚÎÂÈ·˜
ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ‰˘Ó¿ÌÂˆÓ (Kurol Î·È Û˘Ó., 1996). À¿Ú¯Ô˘Ó ˆÛÙfiÛÔ Î·È Î¿ÔÈ· ·ÓÙÈÎÚÔ˘fiÌÂÓ· ÛÙÔȯ›·. ŒÙÛÈ, ÛÂ
ÈÛÙÔÏÔÁÈ΋ ÌÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔ›ËÛ·Ó ÔÈ Owman-Moll
Î·È Û˘Ó. (1996a,b) Û ÚÔÁÔÌÊ›Ô˘˜, ·Ú·Ù‹ÚËÛ·Ó fiÙÈ
·Ú¿ ÙÔÓ ‰ÈÏ·ÛÈ·ÛÌfi ‹ ÙÔÓ ÙÂÙÚ·Ï·ÛÈ·ÛÌfi ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ‰‡Ó·Ì˘ ·fi 50 Û 200 gr, ‰ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ ‚·ıÌfi ·ÔÚÚfiÊËÛ˘ ÙˆÓ
ÚÈ˙ÒÓ ÙÔ˘˜. ™Â ·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· η٤ÏËÍ·Ó Î·È ¿ÏÏÔÈ
ÂÚ¢ÓËÙ¤˜ ÔÈ ÔÔ›ÔÈ ‰ÂÓ ‚Ú‹Î·Ó Î¿ÔÈ· Û˘Û¯¤ÙÈÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ Ì ÙÔ
̤ÁÂıÔ˜ Ù˘ ·ÛÎÔ‡ÌÂÓ˘ ‰‡Ó·Ì˘, Î·È ÁÈ’ ·˘Ùfi ÙÔ ÏfiÁÔ
·Ô‰›‰Ô˘Ó ÙËÓ ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ Î˘Ú›ˆ˜ Û ÁÂÓÂÙÈÎÔ‡˜
‹ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (Al-Qawasmi Î·È Û˘Ó.,
2003; Artun Î·È Û˘Ó., 2005; van Loenen Î·È Û˘Ó., 2007). ™Â
ÈÔ ÚfiÛÊ·ÙË ÌÂϤÙË Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Û¿ÚˆÛ˘ (SEM) fiÔ˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÔÁÎÔÌÂÙÚÈο, ÌÂÙ¿ ÙËÓ
¿ÛÎËÛË ‹ÈˆÓ Î·È ÈÛ¯˘ÚÒÓ ‰˘Ó¿ÌˆÓ, ÔÈ ·ÔÚÚÔÊ‹ÛÂȘ
ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ÚÒÙˆÓ ÚÔÁÔÌÊ›ˆÓ ÚÈÓ ÙËÓ ÂÍ·ÁˆÁ‹
ÙÔ˘˜, ‰È·ÈÛÙÒıËΠÌÂÁ·Ï‡ÙÂÚË ·ÔÚÚfiÊËÛË ÌÂÙ¿ ·fi
ÙËÓ ¿ÛÎËÛË ÈÛ¯˘ÚÒÓ ‰˘Ó¿ÌÂˆÓ (Darendeliler Î·È Û˘Ó.,
2004; Chan Î·È Darendeliler, 2005). ™Â ·Ó¿ÏÔÁ· Û˘ÌÂÚ¿-
36
HELLENIC ORTHODONTIC REVIEW
increase of risk for more prominent root resorptions during the course of treatment (Copeland and Green, 1986;
Levander and Malmgren, 1988; Levander et al., 1994;
Taithongchai et al., 1996). On the contrary, other authors
argue that there is no correlation between root resorption and the duration of the active phase of orthodontic
treatment (Beck and Harris, 1994; Mirabella and Artun,
1995b; Baumrind et al., 1996; Taner et al., 1999; Fritz et
al., 2003).
New studies, however, appear to confirm that root
resorptions already develop at the first 6 to 12 months
after the initiation of the active treatment with fixed
appliances and they become more profound during the
next months (Artun et al., 2005; Smale et al., 2005).
Moreover, van Loenen et al. (2007) found out that in a
number of patients without root resorptions in the first
11 months of active treatment, resorptions were
observed later during the final phases of treatment. Similar results found other more recent studies, where a statistically significant correlation between the duration of
orthodontic treatment and the amount of root resorption was confirmed (Apajalahti and Peltola 2007;
Mohandesan et al., 2007).
Amount of orthodontic movement
There are also conflicting views with reference to the
amount or the extent of orthodontic movement and its
effect on root resorption. Some authors consider that
there is no correlation between root resorption and the
distance that a tooth is moving (Dermaut and De Munck,
1986; Fritz et al., 2003), while others conclude that there
is a direct correlation between these two parameters
(Hollender et al., 1980; Sharpe et al., 1987). Nevertheless, according to the results of a meta-analysis published relatively recently, it is substantiated that the total
distance covered by the apex and the time period needed for this movement are important factors directly correlated to each other, which reinforce root resorption of
teeth (Segal et al., 2004). As meta-analyses probably
show the highest level of evidence in medicine and dentistry (Papadopoulos and Gkiaouris, 2007), the results of
the above mentioned study could be regarded as reliable.
CONCLUSIONS
Following the presentation and discussion of the current
knowledge with regard to the involvement of the
mechanical factors of orthodontic movement in the
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
ÛÌ·Ù· η٤ÏËÍ·Ó Î·È ¿ÏϘ ÌÂϤÙ˜ Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Û¿ÚˆÛ˘ Û Â›Ì˘Â˜ (Gonzales Î·È Û˘Ó., 2008) ηÈ
Ì ÌÈÎÚÔ-˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· Û ·ÓıÚÒÔ˘˜ (Cheng
Î·È Û˘Ó., 2009), ÛÙȘ Ôԛ˜ Â›Û˘ ·Ú·ÙËÚ‹ıËΠÌÈÎÚfiÙÂÚË ÚÈ˙È΋ ·ÔÚÚfiÊËÛË Ì ÙËÓ ¿ÛÎËÛË ‹ÈˆÓ ‰˘Ó¿ÌˆÓ
Û ۇÁÎÚÈÛË Ì ÙȘ ÈÛ¯˘Ú¤˜ ‰˘Ó¿ÌÂȘ.
∂›‰Ô˜ Û˘ÁÎÏÂÈÛȷ΋˜ ·ÓˆÌ·Ï›·˜
√ ·ÚÈıÌfi˜ ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ÂÍÂÙ¿˙Ô˘Ó
ÙÔÓ ‚·ıÌfi ·ÔÚÚfiÊËÛ˘ ÚÈ˙ÒÓ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Ë ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ Ù˘
˘¿Ú¯Ô˘Û·˜ Û˘ÁÎÏÂÈÛȷ΋˜ ·ÓˆÌ·Ï›·˜ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓÔ˜ Î·È Ù· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ Ô‰ËÁÔ‡Ó Û ·ÓÙÈÎÚÔ˘fiÌÂÓ·
Û˘ÌÂÚ¿ÛÌ·Ù·. ŒÙÛÈ, ÔÈ Mirabella Î·È Artun (1995b), ‰ÂÓ
‰È·›ÛÙˆÛ·Ó Î¿ÔÈ· Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ·Ú¯È΋˜
Û˘ÁÎÏÂÈÛȷ΋˜ ·ÓˆÌ·Ï›·˜ Î·È Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ
ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ. ™Â ·ÚfiÌÔÈ· Û˘ÌÂÚ¿ÛÌ·Ù· η٤ÏËÍ·Ó Î·È ÔÈ Fritz Î·È Û˘Ó. (2003). ∞ÓÙ›ıÂÙ·, ÔÈ Taner Î·È Û˘Ó.
(1999) ‰È·›ÛÙˆÛ·Ó Û ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·˙·Ó
Û˘ÁÎÏÂÈÛȷΤ˜ ·ÓˆÌ·Ï›Â˜ ∆¿Í˘ π Î·È ∆¿Í˘ ππ ηٿ Angle
Î·È ıÂÚ·‡ÙËÎ·Ó Ì ÂÍ·ÁˆÁ¤˜ ÚÔÁÔÌÊ›ˆÓ, fiÙÈ ÔÈ ÙÔÌ›˜
Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∆¿ÍË ππ, ηÙËÁÔÚ›· 1
ÂÌÊ¿ÓÈ˙·Ó ÌÂÁ·Ï‡ÙÂÚÔ˘ ‚·ıÌÔ‡ ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ
ÙÔ˘˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∆¿ÍË π. ¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ·Ú·Ù‹ÚËÛ·Ó Î·È ÔÈ Brin Î·È Û˘Ó. (2003), ÔÈ ÔÔ›ÔÈ
·ÍÈÔÏfiÁËÛ·Ó ·Ó·‰ÚÔÌÈο ıÂÚ·›˜ ·ÛıÂÓÒÓ ÌÂ Û˘ÁÎÏÂÈÛȷο ÚÔ‚Ï‹Ì·Ù· ∆¿Í˘ ππ Î·È Û˘Ì¤Ú·Ó·Ó fiÙÈ ˘¿Ú¯ÂÈ
ÌÂÁ¿ÏË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ Î·È
ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ·Ú¯Èο ˘¿Ú¯Ô˘Û·˜ ÔÚÈ˙fiÓÙÈ·˜ ÚfiÙ·Í˘ ηıÒ˜ Î·È Ù˘ ¯ÚÔÓÈ΋˜ ‰È¿ÚÎÂÈ·˜ Ô˘ Ô ·ÛıÂÓ‹˜
ʤÚÂÈ ÙȘ ·Î›ÓËÙ˜ Û˘Û΢¤˜.
√È ÌÂϤÙ˜ Ô˘ ÂÍÂÙ¿˙Ô˘Ó ÙȘ ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ ÌÂÙ¿
·fi ıÂÚ·›· Û˘ÁÎÏÂÈÛÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ∆¿Í˘ πππ,
Â›Ó·È Â›Û˘ ÂÚÈÔÚÈṲ̂Ó˜. √È Kaley Î·È Phillips (1991)
Ô˘ ÂÍ¤Ù·Û·Ó ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÔÚÚfiÊËÛ˘ ÚÈ˙ÒÓ ÌÂÙ¿
·fi ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Û ·ÛıÂÓ›˜ ÌÂ Û˘ÁÎÏÂÈÛȷ΋
·ÓˆÌ·Ï›· ∆¿Í˘ πππ ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ÔÈ ÎÂÓÙÚÈÎÔ› ¿Óˆ
ÙÔÌ›˜, Û ÔÛÔÛÙfi 90%, fiˆ˜ Î·È ÔÈ Ï¿ÁÈÔÈ ¿Óˆ ÙÔÌ›˜
Û ϛÁÔ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ›¯·Ó ˘ÔÛÙ› ÛÔ‚·Ú‹ ·ÔÚÚfiÊËÛË ÔÚ·Ù‹ Û ÚÔÛÂÎÙÈ΋ ÂͤٷÛË ·ÓÔÚ·ÌÈÎÒÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ·Ô‰fiıËΠÛÙËÓ Èı·ÓfiÙËÙ·
Ù· ‰fiÓÙÈ· ·˘Ù¿ Ó· ¤¯Ô˘Ó ˘ÔÛÙ› ÛÔ‚·Ú¤˜ ȤÛÂȘ ̤۷
ÛÙÔ ÊÏÔÈ҉˜ ¤Ù·ÏÔ Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜,
ÏfiÁˆ Ù˘ ¤ÓÙÔÓ˘ ¯ÂÈÏÈ΋˜ ·fiÎÏÈÛ˘ Ô˘ Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Î·È Ë
ÔÔ›· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÁÈ· Ó· ·ÓÙÈÛÙ·ıÌ›ÛÂÈ ÙȘ ÛÎÂÏÂÙÈΤ˜ Û¯¤ÛÂȘ ∆¿Í˘ πππ ÙˆÓ ÁÓ¿ıˆÓ.
∆¤ÏÔ˜, Ë ıÂÚ·›· Ù˘ ·ÓˆÁ̤Ó˘ ‰‹Í˘ Ê·›ÓÂÙ·È Î·È
·˘Ù‹ Ó· ·ÔÙÂÏ› ¤Ó· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÚfiÎÏËÛË
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
development of root resorption of teeth, it seems that so
far there are no evidence based conclusions that could
lead to specific strategies, efficient to minimize or prevent the phenomenon of root resorption.
With regard to the type of teeth movement, it seems
that a safe movement to any direction is unfeasible. Of
course, most authors agree that intrusion and jiggling
movements are the most harmful. However, these movements as well as bodily movement, torque, or rotation
are associated with factors such as the magnitude of the
applied force, the duration and amount of orthodontic
movement, or the type of malocclusion. These factors
together with genetic predisposition and individual variations can lead to root resorptions of different extent.
The rest of the mechanical factors discussed in the present review can be assessed with the same approach,
such as the type of the applied orthodontic treatment,
the type of the orthodontic wires used, as well as the
type and the magnitude of the applied force. It seems
that, regardless of the technique used and the duration
of the treatment, any applied force that does not imitate
physiologic forces has harmful effects on the roots of the
teeth. Consequently, there is not one factor alone or a
group of emitting factors able to induce resorption of its
own. Root resorption seems rather to depend on a combination of interdependent mechanical and genetic factors. Contemporary researches focusing more on genetic
and molecular level, already confirm the correlations
between IL-1‚, TNF-alpha, TNSALP genes and root
resorption (Beertsen et al., 1999; Alhashimi et al., 2001;
Al-Qavasmi et al., 2003).
It seems, therefore, that the contemporary trends for the
explanation of the phenomenon of root resorption,
should overcome throiugh new research strategies the
existing methodological deficiencies and the lack in
quantitative comparisons which render safe conclusions
difficult. Furthermore, they should revise the
cause/effect relationship between orthodontic treatment
and root resorption, and focus on the study of the nature
of root resorption, as well as its correlation with the
mechanical factors of the orthodontic treatment.
References
Abuabara A. Biomechanical aspects of external root resorption in
orthodontic therapy. Med Oral Patol Oral Cir Bucal
2007;12:E610-3.
Acar A, Canyurek U, Kocaaga M, Erverdi N. Continuous vs discontinuous force application and root resorption. Angle Orthod
1999;69:159-63.
Alexander SA. Levels of root resorption associated with continuous
37
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
·ÔÚÚfiÊËÛ˘ ÚÈ˙ÒÓ, Ô ÔÔ›Ô˜ ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı›
ÛÙȘ ÎÈÓ‹ÛÂȘ ·ÏÈÓ‰ÚÔÌÈÎÔ‡ Ù‡Ô˘ ÙˆÓ ÙÔ̤ˆÓ ‹ ÛÙËÓ
ÂÏ·Ùو̤ÓË ÔÛÙÈ΋ ÛÙ‹ÚÈÍË Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î˘Ú›ˆ˜ Ù·
ÚfiÛıÈ· ‰fiÓÙÈ· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ‡·ÚÍË Û˘Ó‹ıˆ˜
‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ÁÏÒÛÛ·˜ (Odenrick Î·È Brattstrom,
1985; Linge Î·È Linge, 1991; Harris Î·È Butler, 1992).
øÛÙfiÛÔ ·˘Ùfi ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ٷ Â˘Ú‹Ì·Ù· ÙˆÓ
Katsaros Î·È Berg (1993), ÔÈ ÔÔ›ÔÈ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÌÈÎÚfi˜
ÌfiÓÔÓ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì ·ÓˆÁ̤ÓË ‰‹ÍË ·ÚÔ˘Û›·˙Â
·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ ÌÂÙ¿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·
(ÌÂÁ·Ï‡ÙÂÚË ·fi ÙÔ 10% ÙÔ˘ ·Ú¯ÈÎÔ‡ Ì‹ÎÔ˘˜ Ù˘ Ú›˙·˜).
∞˘ÙÔ› ‰Â ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·˙·Ó ÈÛÙÔÚÈÎfi ÙÚ·‡Ì·ÙÔ˜ ‹
¿Ù˘Ô Û¯‹Ì· ÚÈ˙ÒÓ.
ÃÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜
¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ô Î›Ó‰˘ÓÔ˜ Ù˘ ·ÔÚÚfiÊËÛ˘ ÚÈ˙ÒÓ ·˘Í¿ÓÂÈ fiÛÔ ·˘Í¿ÓÂÈ Î·È Ë ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜. ™Â ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯ÂÈ
·Ú·ÙËÚËı› fiÙÈ ˘¿Ú¯ÂÈ ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ ‹‰Ë ÌÂÙ¿
ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ Ù˘ ÂÓÂÚÁÔ‡ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜, ÌÂ Û˘Ó¤ÂÈ· Ó· ·˘Í¿ÓÂÈ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ (Copeland Î·È Green, 1986; Levander Î·È Malmgren,
1988; Levander Î·È Û˘Ó., 1994; Taithongchai Î·È Û˘Ó.,
1996). ∞ÓÙ›ıÂÙ·, ¿ÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ
˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ·ÔÚÚfiÊËÛ˘ ÚÈ˙ÒÓ Î·È
Ù˘ ¯ÚÔÓÈ΋˜ ‰È¿ÚÎÂÈ·˜ Ù˘ ÂÓÂÚÁÔ‡ Ê¿Û˘ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ (Beck Î·È Harris, 1994; Mirabella Î·È Artun,
1995b; Baumrind Î·È Û˘Ó., 1996; Taner Î·È Û˘Ó., 1999;
Fritz Î·È Û˘Ó., 2003).
¡ÂfiÙÂÚ˜ ÌÂϤÙ˜ Ê·›ÓÂÙ·È ˆÛÙfiÛÔ Ó· ÂȂ‚·ÈÒÓÔ˘Ó fiÙÈ
ÔÈ ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ ÂΉËÏÒÓÔÓÙ·È ‹‰Ë ·fi ÙÔ˘˜
ÚÒÙÔ˘˜ 6 ¤ˆ˜ 12 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÓÂÚÁÔ‡
ıÂÚ·›·˜ Ì ·Î›ÓËÙ˜ Û˘Û΢¤˜, ÂÓÒ Á›ÓÔÓÙ·È ÂÓÙÔÓfiÙÂÚ˜ ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜ (Artun Î·È Û˘Ó., 2005; Smale
Î·È Û˘Ó., 2005). ∂ÈϤÔÓ ÔÈ van Loenen Î·È Û˘Ó. (2007),
‰È·›ÛÙˆÛ·Ó fiÙÈ Û ¤Ó·Ó ·ÚÈıÌfi ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ ÙÔ˘˜ ÚÒÙÔ˘˜ 11 Ì‹Ó˜
Ù˘ ÂÓÂÚÁÔ‡ ıÂÚ·›·˜, ·ÚÔ˘ÛÈ¿ÛıËÎ·Ó ÌÂÙ·ÁÂÓ¤ÛÙÂÚ·,
ÛÙ· ÙÂÏÈο ÛÙ¿‰È· Ù˘ ıÂÚ·›·˜. ¶·ÚfiÌÔÈ· Â›Ó·È Ù·
Û˘ÌÂÚ¿ÛÌ·Ù· Î·È ¿ÏÏˆÓ ÚfiÛÊ·ÙˆÓ ÌÂÏÂÙÒÓ fiÔ˘ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û¯¤ÛË ÌÂٷ͇ Ù˘ ¯ÚÔÓÈ΋˜ ‰È¿ÚÎÂÈ·˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Î·È ÙÔ˘ ‚·ıÌÔ‡ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ (Apajalahti ηÈ
Peltola 2007; Mohandesan Î·È Û˘Ó., 2007).
ª¤ÁÂıÔ˜ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘
™Â Û¯¤ÛË Ì ÙÔ Ì¤ÁÂıÔ˜ ‹ ÙËÓ ¤ÎÙ·ÛË Ù˘ Ô‰ÔÓÙÈ΋˜ ÌÂÙ·-
38
HELLENIC ORTHODONTIC REVIEW
arch and sectional arch mechanics. Am J Orthod Dentofacial
Orthop 1996;110:321-4.
Alhashimi N, Frithiof L, Brudvik P, Bakhiet M. Orthodontic tooth
movement and de novo synthesis of proinflammatory
cytokines. Am J Orthod Dentofacial Orthop 2001;119:307-12.
Al-Qawasmi RA, Hartsfield JK Jr, Everett ET, Flury L, Liu L, Foroud
TM, Macri JV, Roberts WE. Genetic predisposition to external
apical root resorption. Am J Orthod Dentofacial Orthop
2003;123:242-52.
Alwali S, Marklund M, Persson M. Apical root resorption of upper
first molars as related to anchorage system. Swed Dent J
2000;24:145-53.
AnderssÔn L, Blomlof L, Lindskog S, Feiglin B, Hammarstrom L.
Tooth ankylosis.Clinical, radiographic and histological assessments. Int J Oral Surg 1984;13:423-31.
Andreasen JO. External root resorption: its implication in dental
traumatology, paedodontics, periodontics, orthodontics and
endodontics. Int Endod J 1985;18:109-18.
Apajalahti S, Peltola JS. Apical root resorption after orthodontic
treatment: A retrospective study. Eur J Orthod 2007;29:408-12.
Artun J, Smale I, Behbehani F, Doppel D, Van’t Hof M, Kuijpers-Jagtman AM. Apical root resorption six and 12 months after initiation of fixed orthodontic appliance therapy. Angle Orthod
2005;75:919-26.
Bakland LK. Root resorption. Dent Clin North Am 1992;36:491-507.
Barbagallo LJ, Jones AS, Petocz P, Darendeliler MA. Physical properties of root cementum: Part 10. Comparison of the effects of
invisible removable thermoplastic appliances with light and
heavy orthodontic forces on premolar cementum. A microcomputed-tomography study. Am J Orthod Dentofacial Orthop
2008;133:218-27.
Baumrind S, Korn EL, Boyd RL. Apical root resorption in orthodontically treated adults. Am J Orthod Dentofacial Orthop
1996;110:311-20.
Becks H. Orthodontic prognosis: evaluation of routine dentomedical examination to determine ‘good and poor risks’. Am J
Orthod 1939;25:610-24.
Beck BW, Harris EF. Apical root resorption in orthodontically treated subjects: analysis of edgewise and light wire mechanics. Am
J Orthod Dentofacial Orthop 1994;105:350-61.
Beertsen W, VandenBos T, Everts V. Root development in mice lacking functional tissue non-specific alkaline phosphatase gene:
inhibition of acellular cementum formation. J Dent Res
1999;78:1221-9.
Brain WE. The effect of surgical transsection of free gingival fibers
on the regression of orthodontically rotated teeth in the dog.
Am J Orthod 1969;55:50-70.
Brezniak N, Wasserstein A. Root resorption after orthodontic treatment. Part 1: Literature review. Am J Orthod Dentofacial
Orthop 1993a;103:62-6.
Brezniak N, Wasserstein A. Root resorption after orthodontic treatment. Part 2: Literature review. Am J Orthod Dentofacial
Orthop 1993b;103:138-46.
Brezniak N, Wasserstein A. Orthodontically induced inflammatory
root resorption. Part 1: The basic science aspects. Angle Orthod
2002a;72:175-9.
Brezniak N, Wasserstein A. Orthodontically induced inflammatory
root resorption. Part II: The clinical aspects. Angle Orthod
2002b;72:180-4.
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
ΛÓËÛ˘ Î·È ÙËÓ Â›‰Ú·Û‹ Ù˘ ÛÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ ˘¿Ú¯Ô˘Ó Â›Û˘ ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ. ªÂÚÈÎÔ› Û˘ÁÁÚ·Ê›˜ ıˆÚÔ‡Ó fiÙÈ
‰ÂÓ ˘¿Ú¯ÂÈ Û¯¤ÛË ÌÂٷ͇ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ
Î·È Ù˘ ·fiÛÙ·Û˘ Ô˘ ‰È·Ó‡ÂÈ ¤Ó· ‰fiÓÙÈ (Dermaut Î·È De
Munck, 1986; Fritz Î·È Û˘Ó., 2003), ÂÓÒ ¿ÏÏÔÈ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ ˘¿Ú¯ÂÈ ¿ÌÂÛË Û¯¤ÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ·˘ÙÒÓ
·Ú·ÁfiÓÙˆÓ (Hollender Î·È Û˘Ó., 1980; Sharpe Î·È Û˘Ó.,
1987). ¶¿ÓÙˆ˜ Û‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ÌÂÙ··Ó¿Ï˘Û˘ Ô˘ ‰ËÌÔÛȇıËΠۯÂÙÈο ÚfiÛÊ·Ù·, ÙÂÎÌËÚÈÒÓÂÙ·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û˘ÓÔÏÈ΋ ·fiÛÙ·ÛË Ô˘ ¤¯ÂÈ Ó·
‰È·Ó‡ÛÂÈ ÙÔ ·ÎÚÔÚ›˙ÈÔ, ηıÒ˜ Î·È Ë ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Ô˘
¯ÚÂÈ¿˙ÂÙ·È ÁÈ· Ó· Á›ÓÂÈ Ë ÌÂٷΛÓËÛË ·˘Ù‹, ·ÔÙÂÏÔ‡Ó
ÛËÌ·ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Î·È ÂÓÈÛ¯‡Ô˘Ó ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ
‰ÔÓÙÈÒÓ (Segal Î·È Û˘Ó., 2004). ∂Í’ ·ÈÙ›·˜ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜
fiÙÈ ÔÈ ÌÂÙ·-·Ó·Ï‡ÛÂȘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ›Ûˆ˜ Ù· ÈÔ ˘„ËÏ¿
Â›‰· ÙÂÎÌËÚ›ˆÛ˘ ÛÙËÓ È·ÙÚÈ΋ Î·È Ô‰ÔÓÙÈ·ÙÚÈ΋
(Papadopoulos Î·È Gkiaouris, 2007), Ù· Û˘ÌÂÚ¿ÛÌ·Ù·
Ù˘ ·Ú·¿Óˆ ÌÂϤÙ˘ ÌÔÚÔ‡Ó Ó· ıˆÚËıÔ‡Ó ˆ˜ ·ÍÈfiÈÛÙ·.
™Àª¶∂ƒ∞™ª∞∆∞
∂ÈηÈÚÔÔÈÒÓÙ·˜ ÙË ÁÓÒÛË Û¯ÂÙÈο Ì ÙËÓ ÂÌÏÔ΋ ÙˆÓ
Ì˯·ÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘
ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ
ÚÈ˙ÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ, Ê·›ÓÂÙ·È fiÙÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯ÂÈ ÙÂÎÌËÚȈ̤ÓË ¿Ô„Ë Ë ÔÔ›· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ
Û˘ÁÎÂÎÚÈ̤Ó˜ ÛÙÚ·ÙËÁÈΤ˜, ÈηӤ˜ Ó· ÂÏ·¯ÈÛÙÔÔÈ‹ÛÔ˘Ó
‹ Ó· ·ÔÙÚ¤„Ô˘Ó ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÔÚÚfiÊËÛ˘ ÚÈ˙ÒÓ.
ŒÙÛÈ, fiÛÔÓ ·ÊÔÚ¿ ÙÔ Â›‰Ô˜ Ù˘ ÌÂٷΛÓËÛ˘ ÙˆÓ ‰ÔÓÙÈÒÓ,
Ê·›ÓÂÙ·È fiÙÈ ÌÈ· ·ÛÊ·Ï‹˜ ÌÂٷΛÓËÛ‹ ÙÔ˘˜ Û ÔÔÈ·‰‹ÔÙ ηÙ‡ı˘ÓÛË Â›Ó·È ·Ó¤ÊÈÎÙË. µ¤‚·È·, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ
Û˘ÁÁÚ·Ê›˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ë ÌÂٷΛÓËÛË ÂÌ‚‡ıÈÛ˘ ηÈ
·ÏÈÓ‰ÚÔÌÈÎÔ‡ Ù‡Ô˘ Â›Ó·È ÔÈ ϤÔÓ ÂÈ‚Ï·‚›˜. øÛÙfiÛÔ,
·˘Ù¤˜ ÔÈ ÌÂÙ·ÎÈÓ‹ÛÂȘ fiˆ˜ Î·È Ë ·Ú¿ÏÏËÏË ÌÂÙ·ÙfiÈÛË,
Ë ÛÙÚ¤„Ë, ‹ Ë ÂÚÈÛÙÚÔÊ‹ Â›Ó·È ¿ÚÚËÎÙ· Û˘Ó‰Â‰Â̤Ó˜ ÌÂ
·Ú¿ÁÔÓÙ˜ fiˆ˜ ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·ÛÎÔ‡ÌÂÓ˘ ‰‡Ó·Ì˘, Ë
¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Î·È ¤ÎÙ·ÛË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘, ‹ ÙÔ Â›‰Ô˜ Ù˘ ÚÔ¸¿Ú¯Ô˘Û·˜ Û˘ÁÎÏÂÈÛȷ΋˜ ·ÓˆÌ·Ï›·˜. ∞Ó ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ‡˜ ÚÔÛÙÂı› Ë ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÙÔ˘ ·ÙfiÌÔ˘ Î·È ÔÈ ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó˜ ‰È·Î˘Ì¿ÓÛÂȘ, ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ·ÔÚÚÔÊ‹ÛÂȘ ÚÈ˙ÒÓ
¿ÏÏÔÙÂ ¿ÏÏÔ˘ ‚·ıÌÔ‡.
ªÂ ÙËÓ ›‰È· ÚÔÛ¤ÁÁÈÛË ·ÍÈÔÏÔÁÔ‡ÓÙ·È Î·È ÔÈ ˘fiÏÔÈÔÈ
Ì˯·ÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘˙ËÙ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û·
·Ó·ÛÎfiËÛË, fiˆ˜ ÌÂٷ͇ ¿ÏÏˆÓ ÙÔ Â›‰Ô˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ Ù¯ÓÈ΋˜ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È, ÙÔ Â›‰Ô˜ ÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Û˘ÚÌ¿ÙˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È, ηıÒ˜ Î·È ÙÔ Â›‰Ô˜
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
Brin I, Ben-Bassat Y, Heling I, Engelberg A. The influence of orthodontic treatment on previously traumatized permanent
incisors. Eur J Orthod 1991;13:372-7.
Brin I, Tulloch C, Koroluk L, Philips C. External apical root resorption in Class II malocclusion: A retrospective review of 1-versus
2-phase treatment. Am J Orthod Dentofacial Orthop
2003;124:151-6.
Cevidanes LHS, Styner MA, Proffit WR. Image analysis and superimposition of 3-dimensional cone-beam computed tomography models. Am J Orthod Dentofacial Orthop 2006;129:611-8.
Chan EK, Darendeliler MA. Exploring the third dimension in root
resorption. Orthod Craniofac Res 2004;7:64-70.
Chan E, Darendeliler MA. Physical properties of root cementum:
part 5. Volumetric analysis of root resorption craters after
application of light and heavy orthodontic forces, Am J Orthod
Dentofacial Orthop 2005; 127:186–95.
Chan EK, Darendeliler MA, Petocz P, Jones AS. A new method for
volumetric measurement of orthodontically induced root
resorption craters. Eur J Oral Sci 2004; 112:134–39.
Cheng LL, Türk T, Elekda_-Türk S, Jones AS, Petocz P, Darendeliler
MA. Physical properties of root cementum: Part 13. Repair of
root resorption 4 and 8 weeks after the application of continuous light and heavy forces for 4 weeks: a microcomputed
tomography study. Am J Orthod Dentofacial Orthop
2009;136:320.e1-10.
Chiqueto K, Martins DR, Janson G. Effects of accentuated and
reversed curve of Spee on apical root resorption. Am J Orthod
Dentofacial Orthop 2008;133:261-8.
Cohenca N, Simon JH, Mathur A, Malfaz JM. Clinical indications for
digital imaging in dento-alveolar trauma. Part 2: root resorption. Dent Traumatol 2007;23:105-13.
Copeland S, Green LJ. Root resorption in maxillary central incisors
following active orthodontic treatment. Am J Orthod
1986;89:51-5.
Costopoulos G, Nanda R. An evaluation of root resorption incident
to orthodontic intrusion. Am J Orthod Dentofacial Orthop
1996;109:543-8.
Darendeliler MA, Kharbanda OP, Chan EKM, Srivicharnkul P, Rex T,
Swain MV, Jones AS, Petocz P. Root resorption and its association with alterations in physical properties, mineral contents
and resorption craters in human premolars following application of light and heavy controlled orthodontic forces. Orthod
Craniofac Res 2004;7:79-97.
Dermaut LR, De Munck A. Apical root resorption of upper incisors
caused by intrusive tooth movement: A radiographic study. Am
J Orthod Dentofacial Orthop 1986;90:321-6.
DeShields RW. Root resorption in treated Class II, division 1 malocclusions. Angle Orthod 1969;39:231-45.
Faltin RM, Faltin K, Sander FG, Arana-Chavez VE. Ultrastructure of
cementum and periodontal ligament after continuous intrusion in humans: a transmission electron microscopic study. Eur
J Orthod 2001;23:35-49.
Foo M, Jones A, Darendeliler MA. Physical properties of root
cementum: part 9. Effect of systemic fluoride intake on root
resorption in rats. Am J Orthod Dentofacial Orthop
2007;131:34–43.
Fritz U, Diedrich P, Wiechmann D. Apical root resorption after lingual orthodontic treatment. J Orofac Orthop 2003;64:434-42.
Gioka C, Eliades T. Orthodontic dental intrusion: indications, histo-
39
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
Î·È Â‡ÚÔ˜ Ù˘ ‰‡Ó·Ì˘ Ô˘ ·ÛÎÔ‡Ó. º·›ÓÂÙ·È fiÙÈ ·ÓÂÍ¿ÚÙËÙ· Ù˘ Ù¯ÓÈ΋˜ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·È Ù˘ ¯ÚÔÓÈ΋˜
‰È¿ÚÎÂÈ·˜ Ù˘ ıÂÚ·›·˜, ÔÔÈ·‰‹ÔÙ ·ÛÎÔ‡ÌÂÓË ‰‡Ó·ÌË Ô˘ ‰ÂÓ ÌÈÌÂ›Ù·È ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜, ¤¯ÂÈ ‚Ï·ÙÈΤ˜ ÂÈÙÒÛÂȘ ÛÙȘ Ú›˙˜ ÙˆÓ ‰ÔÓÙÈÒÓ. ∫·Ù¿ Û˘Ó¤ÂÈ· ‰ÂÓ ˘¿Ú¯ÂÈ ¤Ó·˜ ‹ Ì›· ÔÌ¿‰· ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÈηӋ Ó·
ÚÔηϤÛÂÈ ·fi ÌfiÓË Ù˘ ·ÔÚÚfiÊËÛË. ∆Ô Ê·ÈÓfiÌÂÓÔ Ù˘
·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ Ê·›ÓÂÙ·È Ì¿ÏÏÔÓ Ó· ÂÍ·ÚٿٷÈ
·fi ¤Ó· Û‡ÓÔÏÔ ·ÏÏËϤӉÂÙˆÓ ·Ú·ÁfiÓÙˆÓ, ÙfiÛÔ Ì˯·ÓÈÎÒÓ fiÛÔ Î·È ÁÂÓÂÙÈÎÒÓ. √È Û‡Á¯ÚÔÓ˜ ¤Ú¢Ó˜, Ô˘
ÂÛÙÈ¿˙Ô˘Ó fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘˜ ÛÂ
ÁÂÓÂÙÈÎfi Î·È ÌÔÚÈ·Îfi Â›‰Ô, ÂȂ‚·ÈÒÓÔ˘Ó ‹‰Ë ÙÔ˘˜
Û˘Û¯ÂÙÈÛÌÔ‡˜ ÌÂٷ͇ ÙˆÓ ÁÔÓȉ›ˆÓ IL-1‚, TNF-alpha,
TNSALP Î·È Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ (Beertsen ηÈ
Û˘Ó., 1999; Alhashimi Î·È Û˘Ó., 2001; Al-Qavasmi ηÈ
Û˘Ó., 2003).
º·›ÓÂÙ·È Û˘ÓÂÒ˜, fiÙÈ ÔÈ Û‡Á¯ÚÔÓ˜ ηÙ¢ı‡ÓÛÂȘ ÁÈ·
ÙËÓ ÂÚÌËÓ›· ÙÔ˘ Ê·ÈÓfiÌÂÓÔ˘ Ù˘ ·ÔÚÚfiÊËÛ˘, Ú¤ÂÈ
·ÊÂÓfi˜ Ó· ÍÂÂÚ¿ÛÔ˘Ó Ì Ӥ˜ ÂÚ¢ÓËÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜
ÙȘ ˘¿Ú¯Ô˘Û˜ ÌÂıÔ‰ÔÏÔÁÈΤ˜ ·‰˘Ó·Ì›Â˜ Î·È ÙËÓ ¤ÏÏÂÈ„Ë ÔÛÔÙÈÎÒÓ Û˘ÁÎÚ›ÛÂˆÓ Ô˘ ηıÈÛÙÔ‡Ó ‰‡ÛÎÔÏË ÙËÓ
‰ÈÂÍ·ÁˆÁ‹ ·ÛÊ·ÏÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ. ∂ÈϤÔÓ, ı·
Ú¤ÂÈ Ó· ·Ó·ıˆڋÛÔ˘Ó ÙËÓ Û¯¤ÛË ·ÈÙ›Ô˘/·ÔÙÂϤÛÌ·ÙÔ˜ ÌÂٷ͇ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Î·È ·ÔÚÚfiÊËÛ˘
ÚÈ˙ÒÓ Î·È Ó· ÚÔÛ·Ó·ÙÔÏÈÛÙÔ‡Ó ÛÙËÓ ÌÂϤÙË Ù˘ ›‰È·˜
Ù˘ ʇÛ˘ Ù˘ ·ÔÚÚfiÊËÛ˘, ηıÒ˜ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi
Ì ÙÔ˘˜ Ì˯·ÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘.
¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜:
π. πˆ·ÓÓ›‰Ô˘-ª·Ú·ıÈÒÙÔ˘
∂ÚÁ·ÛÙ‹ÚÈÔ √ÚıÔ‰ÔÓÙÈ΋˜
√‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹
∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢
54124 £ÂÛÛ·ÏÔÓ›ÎË
E-mail: [email protected]
Reprint requests to:
I. Ioannidou-Marathiotou
Department of Orthodontics
School of Dentistry
Aristotle University of Thessaloniki
GR-54124 Thessaloniki
Greece
E-mail: [email protected]
40
HELLENIC ORTHODONTIC REVIEW
logical changes, biomechanicals principles, possible side
effects. Hell Orthod Rev 2003;6:129-46.
Goldie RS, King GJ. Root resorption and tooth movement in orthodontically treated, calcium-deficient, and lactating rats. Am J
Orthod 1984;85:424-30.
Goldin B. Labial root torque: effect on the maxilla and incisor root
apex. Am J Orthod Dentofacial Orthop 1989;95:208-19.
Gonzales C, Hotokezaka H, Yoshimatsu M, Yozgatian JH, Darendeliler MA, Yoshida N. Force magnitude and duration effects
on amount of tooth movement and root resorption in the rat
molar. Angle Orthod 2008;78:502-9.
Gröndahl HG, Gröndahl K. Subtraction radiography for the diagnosis of periodontal bone lesions. Oral Surg Oral Med Oral
Pathol 1983;55:208-13.
Han GH, Huang S, Von den Hoff JW, Zeng X, Kuijpers-Jagtman AM.
Root resorption after orthodontic intrusion and extrusion: an
intra-individual study. Angle Orthod 2005;75:912-8.
Harris EF, Baker WC. Loss of root length and crestal bone height
before and during treatment in adolescent and adult orthodontic patients. Am J Orthod Dentofacial Orthop 1990:98:4639.
Harris EF, Butler ML. Patterns of incisor root resorption before and
after orthodontic correction in cases with anterior open bites.
Am J Orthod Dentofacial Orthop 1992;101:112-9.
Harris DA, Jones AS, Darendeliler MA. Physical properties of root
cementum: part 8. Volumetric analysis of root resorption
craters after application of controlled intrusive light and heavy
orthodontic forces: a microcomputed tomography scan study.
Am J Orthod Dentofacial Orthop 2006;130:639–47.
Harry MR, Sims MR. Root resorption in bicuspid intrusion. A scanning electron microscope study. Angle Orthod 1982;52:235-58.
Hartsfield JK Jr, Everett ET, Al-Qawasmi RA. Genetic factors in external apical root resorption and orthodontic treatment. Crit Rev
Oral Biol Med 2004;15:115-22.
Hendrix I, Carels C, Kuijpers-Jagtman AM, Van’T Hof M. A radiographic study of posterior apical root resorption in orthodontic patients. Am J Orthod Dentofacial Orthop 1994;105:345-9.
Heo MS, Lee SS, Lee KH, Choi HM, Choi SC, Park TW. Quantitative
analysis of apical root resorption by means of digital subtraction radiography. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2001;91:369-73.
Hollender L, Ronnerman A, Thilander B. Root resorption, marginal
bone support and clinical crown length in orthodontically
treated patients. Eur J Orthod 1980;2:197-205.
Horiuchi A, Hotokezaka H, Kobayashi K. Correlation between cortical plate proximity and apical root resorption. Am J Orthod
Dentofacial Orthop 1998;114:311-8.
Janson GR, De Luca Canto G, Martins DR, Henriques JF, De Freitas
MR. A radiographic comparison of apical root resorption after
orthodontic treatment with 3 different fixed appliance techniques. Am J Orthod Dentofacial Orthop 2000;118:262-73.
Jimenez-Pellegrin C, Arana-Chavez VE. Root resorption in human
mandibular first premolars after rotation as detected by scanning electron microscopy. Am J Orthod Dentofacial Orthop
2004;126:178-85.
Kaley J, Phillips C. Factors related to root resorption in edgewise
practice. Angle Orthod 1991;61:125-32.
Kameyama Y, Nakane S, Maeda H, Fujita K, Takesue M, Sato E.
Inhibitory effect of aspirin on root resorption induced by
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
mechanical injury of the soft periodontal tissues in rats. J Periodontal Res 1994;29:113-7.
Katsaros C, Berg R. Anterior open bite malocclusion: a follow-up
study of orthodontic treatment effects. Eur J Orthod
1993;15:273-80.
Kennedy DB, Joondeph DR, Osterberg SK, Little RM. The effect of
extraction and orthodontic treatment on dentoalveolar support. Am J Orthod 1983;84:183-90.
Ketcham AH. A preliminary report of an investigation of apical root
resorption of permanent teeth. Int J Orthod 1927;13:97-127.
Killiany DM. Root resorption caused by orthodontic treatment: an
evidence-based review of literature. Semin Orthod 1999;5:12833.
Kinomoto Y, Noro T, Ebisu S. Internal root resorption associated
with inadequate caries removal and orthodontic therapy. J
Endod 2002;28:405-7.
Kjaer I. Morphological characteristics of dentitions developing
excessive root resorption during orthodontic treatment. Eur J
Orthod 1995;17:25-34.
Kojima R, Taguchi Y, Kobayashi H, Noda T. External root resorption
of the maxillary permanent incisors caused by ectopically
erupting canines. J Clin Pediatr Dent 2002;26:193-7.
Kravitz LH, Tyndall DA, Bagnell CP, Dove SB. Assessment of external root resorption using digital subtraction radiography. J
Endod 1992;18:275-84.
Kurol J, Owman-Moll P, Lundgren D. Time-related root resorption
after application of a controlled continuous orthodontic force.
Am J Orthod Dentofacial Orthop 1996;110:303-10.
Kvam E. Scanning electron microscopy of tissue changes on the
pressure surface of human premolars following tooth movement. Scand J Dent Res 1972a;80:357-68.
Kvam E. Scanning electron microscopy of organic structures on the
root surface of human teeth. Scand J Dent Res 1972b;80:297306.
Lane C, Harrell WJr. Completing the 3-dimensional picture. Am J
Orthod Dentofacial Orthop 2008;133:612-20.
Lee RY, Artun J, Alonso TA. Are dental anomalies risk factors for
apical root resorption in orthodontic patients? Am J Orthod
Dentofacial Orthop 1999;116:187-95.
Levander E, Malmgren O. Evaluation of the risk of root resorption
during orthodontic treatment: a study of upper incisors. Eur J
Orthod 1988;10:30-8.
Levander E, Bajka R, Malmgren O. Early radiographic diagnosis of
apical root resorption during orthodontic treatment: a study of
maxillary incisors. Eur J Orthod 1998a;20:57-63.
Levander E, Malmgren O, Eliasson S. Evaluation of root resorption
in relation to two orthodontic treatment regimes. A clinical
experimental study. Eur J Orthod 1994;16:223-8.
Levander E, Malmgren O, Stenback K. Apical root resorption during
orthodontic treatment of patients with multiple aplasia: a
study of maxillary incisors. Eur J Orthod 1998b;20:427-34.
Linge BO, Linge L. Apical root resorption in upper anterior teeth.
Eur J Orthod 1983;5:173-83.
Linge L, Linge BO. Patient characteristics and treatment variables
associated with apical root resorption during orthodontic
treatment. Am J Orthod Dentofacial Orthop 1991;99:35-43.
Malmgren O, Goldson L, Hill C, Orwin A, Petrini L, Lundberg M.
Root resorption after orthodontic treatment of traumatized
teeth. Am J Orthod 1982;82:487-91.
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
Malmgren O, Omblus J. Treatment with an orthopaedic appliance
system. Eur J Orthod 1985;7:205-14.
Maltha JC, Dijkman GEHM. Discontinuous forces cause less extensive root resorption than continuous forces. Eur J Orthod
1996;18:420.
Maltha JC, van Leeuwen EJ, Dijkman GE, Kuijpers-Jagtman AM.
Incidence and severity of root resorption in orthodontically
moved premolars in dogs. Orthod Craniofac Res 2004;72:11521.
Massler M, Malone AJ. Root resorption in human permanent teeth.
A Roentgenographic study. Am J Orthod 1954;40:619-33.
Mavragani M, Vergari A, Selliseth NJ, Boe OE, Wisth PJ. A radiographic comparison of apical root resorption after orthodontic treatment with a standard edgewise and a straight-wire
edgewise technique. Eur J Orthod 2000;22:665-74.
Mayoral G. Treatment results with light wires studied by panoramic radiography. Am J Orthod 1982;81:489-97.
McFadden WM, Engstrom C, Engstrom H, Anholm JM. A study of
the relationship between incisor intrusion and root shortening.
Am J Orthod Dentofacial Orthop 1989;96:390-6.
McNab S, Battistutta D, Taverne A, Symons AL. External apical root
resorption following orthodontic treatment. Angle Orthod
2000;70:227-32.
Mirabella AD, Artun J. Prevalence and severity of apical root
resorption of maxillary anterior teeth in adult orthodontic
patients. Eur J Orthod 1995a;17:93-9.
Mirabella AD, Artun J. Risk factors for apical root resorption of
maxillary anterior teeth in adult orthodontic patients. Am J
Orthod Dentofacial Orthop 1995b;108:48-55.
Miura F, Mogi M, Ohura Y, Hamanaka H. The super-elastic property
of the Japanese NiTi alloy wire for use in orthodontics. Am J
Orthod Dentofacial Orthop 1986;90:1-10.
Mohandesan H, Ravanmehr H, Valaei N. A radiographic analysis of
external apical root resorption of maxillary incisors during
active orthodontic treatment. Eur J Orthod 2007;29:134-9.
Nance RS, Tyndall D, Levin LG, Trope M. Diagnosis of external root
resorption using TACT (tuned-aperture computed tomography). Endod Dent Traumatol 2000;16:24-8.
Newman WG. Possible etiologic factors in external root resorption
Am J Orthod 1975;67:522-39.
Odenrick L, Brattstrom V. Nailbiting: frequency and association
with root resorption during orthodontic treatment. Br J Orthod
1985;12:78-81.
Owman-Moll P, Kurol J. Root resorption after orthodontic treatment in high- and low-risk patients: analysis of allergy as a
possible predisposing factor. Eur J Orthod 2000;22:657-63.
Owman-Moll P, Kurol J, Lundgren D. Continuous versus interrupted continuous orthodontic force related to early tooth movement and root resorption. Angle Orthod 1995;65:395-401.
Owman-Moll P, Kurol J, Lundgren D. ∂ffects of a doubled orthodontic force magnitude on tooth movement and root resorptions. An inter-individual study in adolescents. Eur J Orthod
1996a;18:141-50.
Owman-Moll P, Kurol J, Lundgren D. The effects of a four-fold
increased orthodontic force magnitude on tooth movement
and root resorptions. An intra-individual study in adolescents.
Eur J Orthod 1996b;18:287-94.
Pandis N, Nasika M, Polychronopoulou A, Eliades T. External apical
root resorption in patients treated with conventional and self-
41
√ÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· Î·È ·ÔÚÚfiÊËÛË ÚÈ˙ÒÓ / Orthodontic treatment and root resorption
ligating brackets. Am J Orthod Dentofacial Orthop
2008;134:646-51.
Papadopoulos MA, Christou PK, Athanasiou AE, Boettcher P, Zeilhofer HF, Sader R, Papadopulos NA. Three-dimensional craniofacial reconstruction imaging. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2002;93:382-93.
Papadopoulos MA, Gkiaouris I. A critical evaluation of meta-analyses in orthodontics. Am J Orthod Dentofacial Orthop
2007;131:589-99.
Parker RJ, Harris EF. Directions of orthodontic tooth movements associated with external apical root resorption of the maxillary central incisor. Am J Orthod Dentofacial Orthop 1998;114:677-83.
Patel S, Dawood A. The use of cone beam computed tomography
in the management of external cervical resorption lesions. Int
Endod J 2007;40:730-7.
Patel S, Dawood A, Wilson R, Horner K, Mannocci F. The detection
and management of root resorption lesions using intraoral
radiography and cone beam computed tomography - an in vivo
investigation. Int Endod J 2009;42:831-8.
Quereshy FA, Savell TA, Palomo JM. Applications of Cone Beam
Computed Tomography in the practice of oral and maxillofacial
surgery. J Oral Maxillofac Surg 2008;66:791-6.
Redlich M, Rahamim E, Gaft A, Shoshan S. The response of supraalveolar gingival collagen to orthodontic rotation movement
in dogs. Am J Orthod Dentofacial Orthop 1996;110:247-55.
Reitan ∫. Initial tissue behavior during apical root resorption. Angle
Orthod 1974;44:68-82.
Reitan K. Biomechanical principles and reactions. In: Graber TM,
Swain BF, eds. Orthodontics: Current principles and techniques.
St Louis: Mosby,1985:101-92.
Reitan K, Rygh P. Biomechanical principles and reactions. In: Graber
TM, Vanarsdall RL Jr, eds. Orthodontics: Current principles and
techniques. St Louis: Mosby; 1994:159-62.
Remington DN, Joondeph DR, Artun J, Riedel RA, Chapko MK.
Long-term evaluation of root resorption occurring during
orthodontic treatment. Am J Orthod Dentofacial Orthop
1989;96:43-6.
Reukers EA, Sanderink GC, Kuijpers-Jagtman AM, van’t Hof MA.
Radiographic evaluation of apical root resorption with two different types of edgewise appliances. Results of a randomized
clinical trial. J Orofac Orthop 1998;59:100-9.
Segal GR, Schiffman PH, Tuncay OC. Meta analysis of the treatment-related factors of external apical root resorption. Orthod
Craniofac Res 2004;7:71-8.
Sharpe W, Reed B, Subtelny JD, Polson A. Orthodontic relapse, apical root resorption, and crestal alveolar bone levels. Am J
Orthod Dentofacial Orthop 1987;91:252-8.
42
HELLENIC ORTHODONTIC REVIEW
Smale I, Ärtun J, Behbehani F, Doppel D, van’t Hof M, Kuijpers-Jagtman AM. Apical root resorption 6 months after initiation of
fixed orthodontic appliance therapy. Am J Orthod Dentofacial
Orthop 2005;128:57-67.
Spurrier SW, Hall SH, Joondeph DR, Shapiro PA, Riedel RA. A comparison of apical root resorption during orthodontic treatment
in endodontically treated and vital teeth. Am J Orthod Dentofacial Orthop 1990;97:130-4.
Taner T, Ciger S, Sencift Y. Evaluation of apical root resorption following extraction therapy in subjects with Class I and Class II
malocclusions. Eur J Orthod 1999;21:491-6.
Ten Hoeve A, Mulie RM. The effect of antero-posterior incisor repositioning on the palatal cortex as studied with laminagraphy. J
Clin Orthod 1976;10:804-22.
Taithongchai R, Sookkorn K, Killiany DM. Facial and dentoalveolar
structure and the prediction of apical root shortening. Am J
Orthod Dentofacial Orthop 1996;110:296-302.
Tronstad L. Root resorption – etiology, terminology and clinical
manifestations. Endod Dent Traumatol 1988;4:241-52.
van der Stelt PF. Research methods in dentistry. 8. Methods for longitudinally detecting differences in bone density: digital subtraction radiography. Ned Tijdschr Tandheelkd 2005;112:46-50.
van Loenen M, Dermaut LR, Degrieck J, De Pauw GA. Apical root
resorption of upper incisors during the torquing stage of the
tip-edge technique. Eur J Orthod 2007;29:583-8.
Vlaskalic V, Boyd RL, Baumrind S. Etiology and sequelae of root
resorption. Semin Orthod 1998;4:124-31.
Weekes WT, Wong PD. Extrusion of root-filled incisors in beaglesa light microscope and scanning electron microscope investigation. Aust Dent J 1995;40:115-20.
Weiland F. Constant versus dissipating forces in orthodontics: the
effect on initial tooth movement and root resorption. Eur J
Orthod 2003;25:335-42.
Weiland F. External root resorptions and orthodontic forces: correlations and clinical consequences. Prog Orthod 2006;72:15663.
Wickwire NA, Mc Neil MH, Norton LA, Duell RC. The effects of
tooth movement upon endodontically treated teeth. Angle
Orthod 1974;44:235-42.
Williams S. A histomorphometric study of orthodontically induced
root resorption. Eur J Orthod 1984;6:35-47.
Winter BU, Stenvik A, Vandevska-Radunovic V. Dynamics of orthodontic root resorption and repair in human premolars: a light
microscopy study. Eur J Orthod 2009;31:346-51.
Zafeiriadis A, Lambrianidis T. Influence of orthodontic movement
on dental tissues, focusing on vertical movements. Endodontologia 2008;3:35-42.
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2