The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Root resorption in orthodontics /certified fixed orthodontic courses by Indi...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses the pre-adjusted edgewise appliance (PEA) for orthodontic treatment. It explains that in PEA, the first, second, and third order bends needed for proper tooth alignment are built into the brackets themselves, rather than the archwire. This allows the teeth to be positioned correctly from the beginning of treatment. The document also outlines the six stages of managing a case with PEA: 1) anchorage control, 2) leveling and aligning, 3) overbite control, 4) overjet reduction, 5) space closures, and 6) finishing and detailing. Each stage is achieved through the use of specific appliances, wires, springs, or elastics, as
Muscle deprogramming /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Finite element analysis in orthodontics/ /certified fixed orthodontic courses...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Loops in orthodontics /certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The document discusses the history and evolution of fixed orthodontic appliances, leading to the development of the pre-adjusted edgewise appliance. It describes Lawrence Andrews' research which identified six keys to optimal occlusion based on measurements of untreated dental casts. His studies found that traditional edgewise appliances did not achieve optimal occlusion in most treated cases. This led to the concept of a fully programmed pre-adjusted edgewise appliance that would incorporate his findings on natural tooth morphology and positioning.
Tweed merrifield philosophy /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Root resorption in orthodontics /certified fixed orthodontic courses by Indi...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses the pre-adjusted edgewise appliance (PEA) for orthodontic treatment. It explains that in PEA, the first, second, and third order bends needed for proper tooth alignment are built into the brackets themselves, rather than the archwire. This allows the teeth to be positioned correctly from the beginning of treatment. The document also outlines the six stages of managing a case with PEA: 1) anchorage control, 2) leveling and aligning, 3) overbite control, 4) overjet reduction, 5) space closures, and 6) finishing and detailing. Each stage is achieved through the use of specific appliances, wires, springs, or elastics, as
Muscle deprogramming /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Finite element analysis in orthodontics/ /certified fixed orthodontic courses...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Loops in orthodontics /certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The document discusses the history and evolution of fixed orthodontic appliances, leading to the development of the pre-adjusted edgewise appliance. It describes Lawrence Andrews' research which identified six keys to optimal occlusion based on measurements of untreated dental casts. His studies found that traditional edgewise appliances did not achieve optimal occlusion in most treated cases. This led to the concept of a fully programmed pre-adjusted edgewise appliance that would incorporate his findings on natural tooth morphology and positioning.
Tweed merrifield philosophy /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses various iatrogenic damages that can occur during orthodontic treatment and their management. It covers topics like acid etching of enamel leading to enamel loss, demineralization and white spot lesions, external root resorption, enamel wear and fractures, periodontal issues, allergies to materials used, and injuries from appliances. It provides details on alternatives to acid etching like crystal bonding agents, and strategies to manage issues like fluoride applications, varnishes, sealants and other measures to prevent or reduce demineralization during orthodontic treatment.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Roth philosophy /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Muscle physiology in orthodontics/certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document describes Dr. Duane Grummons' posteroanterior (PA) cephalometric analysis for evaluating facial asymmetry. The analysis involves constructing reference lines and planes to compare bilateral landmarks and structures. Measurements are made of linear distances, angles, ratios and volumetric comparisons. The comprehensive analysis evaluates multiple structures and parameters while the summary analysis focuses on key dental and skeletal factors. The analysis is useful for orthodontic-surgical treatment planning to determine the extent and location of asymmetries and surgical corrections needed.
This cephalometric analysis gives an idea about the planes ,facial types, arch and axis this slide includes Introduction
Planes,Classification of facial types,Archs,Axis,Dental axis
Conclusion,Ceph tracing
Growth rotations in relation to Orthodontics.
Determining rotational growth changes
Mandibular rotations
Clinical significance of Rotation :
Relationship between Condylar growth and Rotations
Relationship between Dentition and Rotations
Relationship between Chin position and Rotations
Prediction of Rotation
Prediction by the structural method
Reliability of prediction
Maxillary rotations
Maxillary Rotational Patterns:
Cranial base rotations
Interrelationship between rotation of skeletal components
Orthodontics and Rotation
Treatment protocol
MBT system in orthodontics /certified fixed orthodontic courses by Indian den...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Muscle function in orthodontics /certified fixed orthodontic courses by Indi...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses orthodontics for adult patients. It begins with an introduction stating that malocclusion is equally or more common in adults compared to children. It then covers the history of orthodontic treatment in adults, classifications of different types of adult patients, goals and objectives of treatment, and recent advances. Diagnosis and treatment planning requires a multidisciplinary approach due to additional considerations for adult patients like periodontal disease, TMJ disorders, and systemic health conditions. Psychological factors also play an important role in adult orthodontic treatment.
This document discusses various types of dental retention appliances. It begins by defining retention and explaining why it is necessary after orthodontic treatment. It then covers theories of retention, keys to eliminating lower retention, and classifications of retainers. The main types of retainers discussed are removable retainers like Hawley retainers, wrap-around retainers, and Essix retainers. Fixed retainers and principles of different retention times are also summarized.
Diagnosis & treatment planing /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses early treatment options for class III malocclusion. Class III malocclusion is defined as the lower first molar being positioned ahead of the upper first molar. It can be caused by maxillary retrusion, mandibular protrusion, or a combination. Early signs include a straight facial profile and zero overjet. Early treatment is recommended to guide growth, improve function and aesthetics, and simplify future treatment. Treatment options discussed include facemask therapy combined with rapid maxillary expansion, chin cups, functional appliances, and corrector plates. Timing of treatment is ideally between ages 5-8 when circummaxillary sutures are still open.
This document provides an overview of retraction mechanics. It begins with definitions of key terms like force, center of resistance, moment, and center of rotation. It then discusses different types of anchorage and bends that can be used. Several methods for retraction are covered, including Begg's technique, friction mechanics, frictionless mechanics using loops, and canine retraction techniques. Factors influencing tooth movement and various appliances for retraction like utility arches and translation arches are also summarized. In conclusion, the document reviews different retraction strategies and appliances.
Debonding techniques and enamel fracture patterns /certified fixed orthodonti...Indian dental academy
Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses orthodontic triage, which is the process of distinguishing moderate orthodontic treatment problems from complex cases. It outlines five steps for orthodontic triage: examining syndromes and developmental abnormalities, performing facial profile analysis, assessing dental development, analyzing space problems, and identifying other occlusal discrepancies. The document also discusses criteria for selecting growth modification patients and managing various orthodontic issues like crossbites, eruption problems, and space deficiencies.
El documento describe el proceso de mejora institucional de un instituto de nivel superior en Zapala. Se realizaron tres actos que incluyeron debates para definir el tema de mejora, escritura colaborativa para analizar concepciones y representaciones, y viajes para enriquecer la perspectiva. El objetivo final era generar conocimiento sistemático que contribuya a un posicionamiento concertado para mejorar la formación docente.
Este documento describe los esfuerzos de un grupo de docentes para presentar un proyecto institucional en 2007-2008 que involucró la compra de libros, mapas y otros materiales, y el compromiso de armar proyectos en grupos. Los docentes realizaron encuentros, jornadas y reuniones intra-institucionales para analizar obstáculos en el proceso de enseñanza-aprendizaje. Lograron reconocer limitaciones y modificar sus prácticas docentes. También generaron estrategias para intercambiar con otros colegas sobre los av
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses various iatrogenic damages that can occur during orthodontic treatment and their management. It covers topics like acid etching of enamel leading to enamel loss, demineralization and white spot lesions, external root resorption, enamel wear and fractures, periodontal issues, allergies to materials used, and injuries from appliances. It provides details on alternatives to acid etching like crystal bonding agents, and strategies to manage issues like fluoride applications, varnishes, sealants and other measures to prevent or reduce demineralization during orthodontic treatment.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Roth philosophy /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Muscle physiology in orthodontics/certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document describes Dr. Duane Grummons' posteroanterior (PA) cephalometric analysis for evaluating facial asymmetry. The analysis involves constructing reference lines and planes to compare bilateral landmarks and structures. Measurements are made of linear distances, angles, ratios and volumetric comparisons. The comprehensive analysis evaluates multiple structures and parameters while the summary analysis focuses on key dental and skeletal factors. The analysis is useful for orthodontic-surgical treatment planning to determine the extent and location of asymmetries and surgical corrections needed.
This cephalometric analysis gives an idea about the planes ,facial types, arch and axis this slide includes Introduction
Planes,Classification of facial types,Archs,Axis,Dental axis
Conclusion,Ceph tracing
Growth rotations in relation to Orthodontics.
Determining rotational growth changes
Mandibular rotations
Clinical significance of Rotation :
Relationship between Condylar growth and Rotations
Relationship between Dentition and Rotations
Relationship between Chin position and Rotations
Prediction of Rotation
Prediction by the structural method
Reliability of prediction
Maxillary rotations
Maxillary Rotational Patterns:
Cranial base rotations
Interrelationship between rotation of skeletal components
Orthodontics and Rotation
Treatment protocol
MBT system in orthodontics /certified fixed orthodontic courses by Indian den...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Muscle function in orthodontics /certified fixed orthodontic courses by Indi...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses orthodontics for adult patients. It begins with an introduction stating that malocclusion is equally or more common in adults compared to children. It then covers the history of orthodontic treatment in adults, classifications of different types of adult patients, goals and objectives of treatment, and recent advances. Diagnosis and treatment planning requires a multidisciplinary approach due to additional considerations for adult patients like periodontal disease, TMJ disorders, and systemic health conditions. Psychological factors also play an important role in adult orthodontic treatment.
This document discusses various types of dental retention appliances. It begins by defining retention and explaining why it is necessary after orthodontic treatment. It then covers theories of retention, keys to eliminating lower retention, and classifications of retainers. The main types of retainers discussed are removable retainers like Hawley retainers, wrap-around retainers, and Essix retainers. Fixed retainers and principles of different retention times are also summarized.
Diagnosis & treatment planing /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses early treatment options for class III malocclusion. Class III malocclusion is defined as the lower first molar being positioned ahead of the upper first molar. It can be caused by maxillary retrusion, mandibular protrusion, or a combination. Early signs include a straight facial profile and zero overjet. Early treatment is recommended to guide growth, improve function and aesthetics, and simplify future treatment. Treatment options discussed include facemask therapy combined with rapid maxillary expansion, chin cups, functional appliances, and corrector plates. Timing of treatment is ideally between ages 5-8 when circummaxillary sutures are still open.
This document provides an overview of retraction mechanics. It begins with definitions of key terms like force, center of resistance, moment, and center of rotation. It then discusses different types of anchorage and bends that can be used. Several methods for retraction are covered, including Begg's technique, friction mechanics, frictionless mechanics using loops, and canine retraction techniques. Factors influencing tooth movement and various appliances for retraction like utility arches and translation arches are also summarized. In conclusion, the document reviews different retraction strategies and appliances.
Debonding techniques and enamel fracture patterns /certified fixed orthodonti...Indian dental academy
Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses orthodontic triage, which is the process of distinguishing moderate orthodontic treatment problems from complex cases. It outlines five steps for orthodontic triage: examining syndromes and developmental abnormalities, performing facial profile analysis, assessing dental development, analyzing space problems, and identifying other occlusal discrepancies. The document also discusses criteria for selecting growth modification patients and managing various orthodontic issues like crossbites, eruption problems, and space deficiencies.
El documento describe el proceso de mejora institucional de un instituto de nivel superior en Zapala. Se realizaron tres actos que incluyeron debates para definir el tema de mejora, escritura colaborativa para analizar concepciones y representaciones, y viajes para enriquecer la perspectiva. El objetivo final era generar conocimiento sistemático que contribuya a un posicionamiento concertado para mejorar la formación docente.
Este documento describe los esfuerzos de un grupo de docentes para presentar un proyecto institucional en 2007-2008 que involucró la compra de libros, mapas y otros materiales, y el compromiso de armar proyectos en grupos. Los docentes realizaron encuentros, jornadas y reuniones intra-institucionales para analizar obstáculos en el proceso de enseñanza-aprendizaje. Lograron reconocer limitaciones y modificar sus prácticas docentes. También generaron estrategias para intercambiar con otros colegas sobre los av
Citigroup reported financial results for the first quarter of 2002, with the following highlights:
- Core income increased 5% compared to first quarter 2001 to $3.859 billion. Net income increased 37% to $4.843 billion, helped by a gain on sale of stock by a subsidiary.
- Global Consumer segment saw increases in core income for Cards (2%), Consumer Finance (35%), and Retail Banking (29%) compared to first quarter 2001.
- Capital ratios improved, with Tier 1 capital ratio at 9.13% versus 8.56% in first quarter 2001, reflecting Citigroup's overall financial strength.
- Total assets were $1.057 trillion
Este documento resume los derechos humanos fundamentales de acuerdo a la Declaración Universal de los Derechos Humanos. Establece que todos los seres humanos nacen libres e iguales y tienen derecho a la vida, la libertad, la seguridad, no ser esclavizados y ser tratados de la misma manera ante la ley, sin discriminación. También garantiza los derechos al matrimonio, la propiedad privada, la libertad de pensamiento y religión.
Este documento describe un proyecto de mejora institucional en un instituto de formación docente en Neuquén, Argentina. El proyecto incluyó la construcción de un laboratorio y sala de TIC para mejorar la enseñanza con recursos digitales. El proyecto involucró interactuar con diferentes personas y grupos para gestionar la obra y expansión edilicia. Se propone continuar mejorando las condiciones organizacionales e instalaciones a través de nuevos proyectos que profundicen el enfoque pedagógico y uso de recursos tecnológicos.
Este proyecto busca crear un laboratorio para mejorar la formación de docentes en el Instituto Superior de Formación Docente N°6 en Neuquén, Argentina. El laboratorio permitirá que los docentes diseñen e implementen nuevas estrategias de enseñanza utilizando tecnología para diferentes asignaturas. Participarán docentes de lengua, matemática, ciencias naturales, ciencias sociales y tecnología en la primera etapa y se sumarán más docentes en la segunda etapa. El objetivo es mejorar los procesos de enseñanza mediante
Este documento describe un proyecto de mejora institucional para fortalecer las instituciones de formación docente a través de la dotación de equipamiento, bibliografía y material didáctico, el intercambio de experiencias, y procesos de autoevaluación. Los fondos se asignarán según la matrícula de cada instituto y se destinarán a la compra de equipamiento y al proceso de autoevaluación institucional.
El documento presenta un plan de capacitación para el personal de la empresa LA PALMERA AMAZONICA S.A. para el segundo semestre de 2005. El plan busca mejorar el rendimiento del personal mediante la capacitación, la cual se llevará a cabo a través de diferentes tipos, modalidades y niveles. El plan incluye objetivos, estrategias, temas de capacitación, recursos y un presupuesto para financiar las actividades programadas.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses root resorption, including causes, types, and management strategies. It notes that avulsions and luxation injuries are common causes of dental trauma leading to root resorption. There are various types of root resorption including internal resorption, external resorption, replacement resorption, and invasive/cervical resorption. Key cells involved in the resorption process are monocytes, macrophages, osteoclasts and odontoclasts. Current strategies for managing root resorption include calcium hydroxide, enamel matrix derivatives, topical alendronate, and calcitonin. Prevention is emphasized as better than cure, including identifying and eliminating underlying causes and promoting
Cementum is one of the four tissues of the periodontium. It is the thin avascular mineralized tissue that covers the root surface of teeth underneath the gingiva. Cementum has both organic and inorganic components and comes in two forms - acellular and cellular cementum. It provides attachment for the periodontal ligament fibers and aids in tooth repair and regeneration after injury. Cementum is softer than dentine and can be more easily removed with abrasion when exposed by gingival recession, causing root sensitivity.
Cementum is one of the four tissues of the periodontium. It is the thin avascular mineralized tissue that covers the root surface of teeth and provides attachment of the periodontal ligament fibers. Cementum is classified based on the presence or absence of cells, the nature and origin of its organic matrix, and whether it contains intrinsic fibers, extrinsic fibers, or both. Cementum can undergo resorption and repair in response to trauma or disease, and plays an important role in tooth attachment and the regeneration of periodontal tissues.
this ppt includes information regarding a dental tissue know as the cementum.
It is a hard tissue covering the roots of the teeth.
this ppt includes, the composition, formation, types, cells and functions the cementum plays in maintaining the integrity of the tooth .
Cementum is the calcified tissue covering the root of a tooth. It is avascular and composed of non-collagenous proteins and collagen fibers. There are different types of cementum including acellular and cellular cementum. Acellular cementum lacks cells and contains Sharpey's fibers, while cellular cementum contains cementoblast cells. Cementum is deposited throughout life to compensate for tooth eruption and wear. It attaches to the tooth and permits nutrient diffusion. Conditions like hypercementosis and cementum resorption can affect the amount and structure of cementum.
Dentin /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Root resorption /certified fixed orthodontic courses by Indian dental academy Indian dental academy
This document discusses root resorption, which is the loss of tooth structure over the root surface due to physiologic or pathologic processes. It begins by classifying root resorption by type, location, and severity. It then focuses on orthodontically induced root resorption, discussing the biology and risk factors involved like tooth movement type, force type, root shape, and patient characteristics. The document concludes that while root resorption is an iatrogenic risk of orthodontic treatment, orthodontists should take measures to reduce its occurrence.
The wasting diseases of teeth, namely attrition, abrasion and dental erosion have taken their toll in the population around the world due to the changing lifestyles, increase in the stress levels and many others factors that were persistent earlier but have suddenly increased drastically. This presentation brings to light the new factors that have attributed to this condition as well as discusses the previous ones.
Root resorption /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Cementum is the specialized mineralized tissue that covers the anatomical root of a tooth. It begins at the cementoenamel junction and continues along the root to the apex. Cementum functions to attach periodontal ligament collagen fibers to the root, serving as a medium for reattachment during repair. Cementum is thickest at the root apex and thinnest cervically. It is deposited throughout life by cementoblast cells and maintains periodontal ligament attachment through cementocyte cellular activity and Sharpey's fiber insertion. Developmental anomalies such as enamel pearls, hypercementosis, and cementicles can occur and impact periodontal health.
seminar age changes in dental hard tissues.pptxDrDithykk
The document discusses the effects of aging on hard tissues like enamel, dentin, cementum, and alveolar bone. As people age, the thickness of enamel decreases and its permeability is reduced as enamel crystals grow in size. Dentin also undergoes changes - it becomes less elastic and its strength decreases with age. More sclerotic dentin and dead tracts are seen. Cementum thickness increases with age due to hypercementosis and its permeability decreases. The alveolar bone is also affected, showing more resorption and fatty infiltration with age.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides an overview of cementum, including:
- Cementum is the calcified tissue covering tooth roots that provides attachment for periodontal ligament fibers.
- It is classified based on the presence of cells, fiber composition, and location on tooth roots. Thickness varies along roots and increases with age.
- Cementum undergoes continuous deposition but is resistant to resorption under forces. It plays a role in tooth attachment and repairing root surfaces.
- Alterations can occur due to disease, trauma, systemic factors and periodontal pathology like calculus attachment and root resorption in pockets.
Tooth resorption can occur internally or externally and is classified based on location and etiology. Internal resorption is caused by damage to the pulp and occurs from within the tooth, appearing radiographically as a smooth, rounded radiolucency within the root canal. External resorption involves loss of cementum and dentin from outside the tooth, and appears as ragged radiolucencies on the root surface, often with accompanying bone loss. Management depends on severity and location of resorption and may include root canal therapy, surgery, or extraction.
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PHYSIOLOGIC AND PATHOLOGIC RESORPTION
HOW TOOTH IS NORMALLY RESISTANT TO RESORPTION...
Explained by 4 hypothesis..
RANK/RANKL/OPG SYSTEM
DEFINITION OF RESORPTION
CLASSIFICATION BY COHEN, WEINE, INGLE, ANDREASON
CELLS INVOLVED IN RESORPTION
ETIOLOGY AND PREDISPOSING FACTORS
MECHANISM OF TOOTH RESORPTION
FACTORS REGULATING TOOTH RESORPTION
TYPES: EXTERNAL AND INTERNAL
EXTERNAL RESORPTION: SURFACE, REPLACEMENT AND INFALAMMATORY RESORPTION.
EXTERNAL CERVICAL RESORPTION
EXTERNAL APICAL ROOT RESORPTION
INTERNAL RESORPTION
IDIOPATHIC ROOT RESORPTION
TRANSIENT APICAL BRAKEDOWN
ETIOLOGY, HISTOLOGICAL APPERANCE, RADIOGRAPHIC FEACTURES, CLINICAL FEATURES, PREVENTION AND MANAGEMNT OF ALL TYPES OF RESORPTION
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4. Root resorption is an essential
phenomenon that plays a
crucial role in the physiological
and dynamic process of tooth
eruption
Resorption of deciduous roots
during permanent tooth
eruption is a necessary
process that eventually results
in the exfoliation of the
deciduous tooth in anticipation
of the arrival of its permanent
successor
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Periapical radiograph
showing selective resorption
of deciduous canine root
during eruption of
permanent maxillary
canine.
5.
However, as the saying goes “.. to every
coin, there are two sides ”, root resorption
may not always be a wanted process
Root resorption that occurs in permanent
teeth is an unwanted process and is
considered pathologic.
The external resorption of roots has
perplexed the orthodontic specialty since
the early reports of Ottolengui in 1914
External apical root resorption ( EARR ) of
permanent teeth is an uncommon and
frequent sequel to orthodontic tooth
movement
Although apical root resorption occurs in
individuals who have never experienced
orthodontic tooth movement, the incidence
among treated individuals is seen to be
significantly higher www.indiandentalacademy.com
6.
Enormous amount of literature has been
published regarding this single iatrogenic
issue
The incidence of reported root resorption
during orthodontic treatment varies widely
among investigators.
Most studies agree that the resorption
process ceases once the active treatment
is terminated
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7.
Root resorption was found to be associated with
orthodontic treatment all the way back to the early
1900’s
1927, Albert Ketcham was the first to bring the
message that apical root resorption is a common
and occasionally severe iatrogenic consequence of
Orthodontic treatment.
Advent of the common-place dental x-ray
equipment made it possible for Ketcham to
evaluate a large series of treated cases.
Since then extensive research has been carried out
pertaning all aspects of root resorption and every
potential causative factor has been studied.
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8.
Even today, research is being carried out to
identify the exact mechanism of root
resorption and the factors which may be
responsible for its initiation.
The research is mainly concentrated at the
molecular level and is aimed at identifying
and understanding the molecular signaling
that takes place during this process
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10. Cementum
Layer of calcified tissue covering the
dentin of the root
Specialized connective tissue similar in
physical and chemical properties to the
bone but is avascular and has no
innervations
First demonstrated in 1835 by two pupils
of Purkinje
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11. Cementum is less readily resorbed compared to alveolar
bone, a feature that is important for permitting orthodontic
tooth movement
The reason for this feature is unknown but it may be related
to:
Differences in physicochemical or biological properties
between bone and cementum
The presence of an unmineralized layer the “cementoid”
on the surface of the cementum
The increased density of Sharpey’s fibres (particularly in
acellular cementum)
The proximity ofwww.indiandentalacademy.comrests to the root surface
epithelial cell
12. Physical characteristics
Light yellow color with a hardness less than that of dentin
Composition
45%-50% inorganic substances
• Calcium and phosphate ( in the form of
hydroxyapatite )
• Numerous trace elements
• Highest fluoride content in the body
50%-55% organic substances
• Type I collagen
• Proteoglycans ( protein polysaccharides )
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13. Structure
Types ( under light microscope )
Acellular cementum
• Do not incorporate the spiderlike cementocytes
• Covers the root dentin from the CEJ to the apex
but is often missing at the apical third.
Cellular cementum
• Incorporates cementocytes in spaces called
lacunae
• A typical cementocyte has numerous cell
processes or canaliculi, radiating from its cell body
• These branch or anastamose with other processes
mostly directed towards the periodontal surface
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of the cementum
14. Electron microscope
AA –acellular cementum
- ACELLULAR CEMENTUM
view of an embedded
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cementocyte
B – CELLULAR CEMENTUM
B - cellular cementum
15. Collagen fibres
• Arranged in both cellular and acellular cementum in a very
complex fashion
•In some areas relatively discrete bundles of collagen
fibrils are seen, particularly in tangential sections
•These are Sharpeys fibres
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16. Function of cementum
Primary function – furnish a medium for attachment
of collagen fibers that bind the tooth to the alveolar
bone.
There is a continuous deposition of cementum
(unlike bone, it does not resorb under normal
conditions)
New cementum is laid down as the most
superficial layer ages ( hence keeps the attachment
apparatus intact)
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17.
Also serves as a major reparative tissue
for root surfaces
Root damages ( minor fractures ,
resorptions can be repaired by deposition
of new cementum )
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22. SURFACE RESORPTION
Occurs constantly as microdefects on all
roots.
These normally repair themselves without
notice.
May occur anywhere but most common
periapically.
Stops when the instigating agent is removed
and there is repair of the cementum.
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25. According Brezniak and Wasserstein
( classification of Orthodontically induced root
resorption )
Cemental or surface resorption with remodeling
Dentinal resorption with repair (deep resorption)
Circumferential apical root resorption.
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26.
Cemental or surface resorption
with remodeling:
In this process, only the outer
cemental layers are resorbed,
and they are later fully
regenerated or remodeled. This
process resembles trabecular
bone remodeling.
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27.
Dentinal resorption with repair (deep
resorption):
In this process, the cementum and the outer
layers of the dentin are resorbed and usually
repaired with cementum material. The final
shape of the root after this resorption and
formation process may or may not be identical
to the original form.
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28.
Circumferential apical root resorption:
In this process, full resorption of the hard tissue
components of the root apex occurs, and root
shortening is evident. Different degrees of apical
root shortening are, of course, possible.
When the root loses apical material beneath the
cementum, no regeneration is possible.
External surface repair usually occurs in the
cemental layer. Over time, sharp edges may be
gradually leveled. Ankylosis is not a common
sequel of orthodontically induced root resorption
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29. ETIOLOGY
Root resorption may occur as a result of :
•
•
•
•
Dental trauma / surgical procedures / Infections
Orthodontic treatment
Pressure from tumors / cysts
Irritation from chemicals ( Eg. H2O2 during
bleaching)
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30. Pulpal infection root
resorption
The most common stimulation
factor for root resorption is
pulpal infection.
Following injury to the
precementum or predentin,
infected dentinal tubules may
stimulate the inflammatory
process with osteoclastic activity
in the periradicular tissues or in
pulpa tissues, consequently
initiating external or internal root
resorption.
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31. •Clinically teeth are not usually
symptomatic in the early period
of the process, and resorption
may be seen at this stage only in
radiographs. However, as the
process progresses, the teeth
may becme symptomatic and
periradicular abscesses may
develop with increasing tooth
mobility.
•Radiographically, radiolucency
is observed in the external root
surface of the dentin and
adjacent bone, or in the internal
root canal dentinal walls.
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32. Periodontal infection root
resorption
Infrequently, external root
resorption may occur after
injury to the pre-cementum,
apical to the epithelial
attachment, followed by
bacterial stimulation
originating from the
periodontal sulcus.
Injury may be caused by
dental trauma, and chemical
irritation may be caused by
bleaching agents, eg
hydrogen peroxide 30 %,
orthodontic or periondontal
procedures.
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33.
Bacteria from the
periodontal sulcus may
penetrate patent dentinal
tubules, coronal to the
epithelial attachment, and
exit apical to the epithelial
attachment without
penetrating the pulpal
space.
Consequently, the damaged
area of the root surface is
colonized by hard tissue
resorbing cells, which
penetrate into dentin
through a small denuded
area causing the resorption
inside the root to spread.
At first stage, the resorptive
process does not penetrate
the pulp space because of
the protective layer of
predetin, but rather spreads
around the root in an
irregular fashion. www.indiandentalacademy.com
With time,
the preocess may penetrate
into the root canal
34.
Aditionally, periodontal infection
resorption will include the
alveolar bone adjacent to the
resorption lacuana in the tooth.
If the resorptive process
reaches a supragingival area of
the crown, the vascularized
granulation tissue of the
resorption lcuna may be visible
through the enamel showing a
pink discoloration at the crown.
Radiographically, periodontal
infection resorption can be seen
as a single resorption lacuna in
the dentin usually at the crestal
bone level, expanding to the
conronal and apical direction.
With progression of the process,
radiolucency may be observed at
the alveolar bone adjacent to the
resorption lacuna of the dentin.
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35. Orthodontic pressure
root resorption
The injury originating in the
orthodontic root resorption is
from the pressure applied to the
roots during tooth movement.
Continuous pressure stimulates
the resorbing cells in the apical
third of the roots, a possibility of
significant shortening of the
root.
Teeth are asymptomatic and
the pulp is usually vital unless
the pressure of the operative
procedure is high, which
disturbs the apical blood
supply.
Radiographically, orthodontic
pressire resorption is located in
the apical third of the root and
no signs of radiolucecy can be
www.indiandentalacademy.com
observed in the bone of the
root.
36. Impacted tooth or tumor pressure root resorption
Pressure root resorption can be observed
during the eruption of the perimanenet
dentition, especially of maxillary canines (
affecting lateral incisors ) and mandibular
third molars ( affecting madubular second
molars ).
Tumors and osteosclerosis impingning on
the root of the tooth could also be an
etiological factor for pressure resorption,
which includes both the injury and the
stimulation phases. Stimulation is related to
the pathological process that activates the
resorptive cells, tumors that produce root
resorption are most frequently those in
which growh and expansion are not rapidm
such as cysts, ameloblastomas, giant cell
tumors, and fiber-osseoseous lesions.
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37.
This type of root resorption is
asymptomatic with vital pulp
through –out the process unless
the impacted tooth or tumor is
located near the apical foramen,
disturbing the blood supply to the
pulp.
Radiographically, the resorption
area is located adjacane to the
stimulation factor, the impacted
tooth or the tumor. There are no
radiolucent areas as no infection
is involved in the process.
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39. Ankylotic root resorption
In severe traumatic injuries ( intrusive
luxation or avulsion with extended dry
time ), injury to the root surface may
be so large that the healing with
cementum is not possible, and the
one may come into contact with the
root surface without an intermediate
attachment apparatus. This
phenomena is termed dentoalveolar
ankylosis.
The process may be reversed if less
than 20% of the root surface is
involved. Because there is no
stimulation factor and the process
proceeds as a result of the direct bone
attachment to dentin, the term
‘ankylotic resorption’ is adequate.
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40. oClinically, ankylotic teeth lack the
physiologic mobility of normal teeth.
This is one diagnostic sign for
ankylotic resoprtion. In addition,
these teeth usually have special
metalli percussion sound and if the
process continues, they are in infraocclusion.
oRadiographically, resorption lacunae
are filled with bone, and the
periodontal ligament space is
missing. No radiolucent areas are
observedm and at some stage, the
whole root may be replaced by bone.
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42.
Force application on teeth in orthodontics leads to
adaptive changes in the entire surrounding
periodontium.
This Orthodontic force leads to microtrauma of the
PDL and activation of a cascade of cellular events
associated with inflammation.
The first signs of change in response to these
forces is seen as remodelling changes by the PDL
and the surrounding alveolar bone because of the
high adaptability and regenerating capabilities of
these two tissues.
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43.
However, root resorption may occur when the pressure
on the cementum exceeds its reparative capacity and
dentin is exposed allowing multinucleated odontoclasts
to degrade the root substance.
Orthodontically induced root resorption begins
adjacent to hyalinized zones and occurs during and
after elimination of hyaline tissues. Removal of
hyalinized tissue leads to removal of cementoid and
mature collagen, leaving a raw cemental surface that
is readily attacked by dentinoclasts.
There is a positive association between removal of
hyalinized tissue and root resorption.
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45.
The studies in mice and rats conducted by Brudvik and
Rygh confirmed that orthodontically induced root
resorption is a part of the hyaline zone elimination
process.
The first cells to be involved in this necrotic tissue
removal are cells that are negative for tartrate resistance
acid phosphatase (TRAP –ve ) and that have no ruffled
borders.
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46.
These are Macrophage-like cells, are most
probably activated by signals coming from the
sterile necrotic tissue, the result of the
orthodontic force application.
Macrophages are scavenger cells from the
hematopoietic lineage, and their role is to
eliminate necrotic tissues. As described by
Brudvik and Rygh, the initial elimination
process takes place at the periphery of the
hyaline zone, where blood supply to the
periodontal ligament exists or is even
increased.
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47.
During removal of the hyaline zone, the nearby
outer surface of the root, which consists of the
cementoblast layer covering the cementoid, can
be damaged, thus exposing the underlying
highly dense mineralized cementum.
It is possible that the orthodontic pressure itself
directly damages the outer root surface layers
in such a way that there is a need for their
removal as well.
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48.
The root surface under the main hyaline zone is
resorbed only several days later when the repair
process in the periphery is already taking place.
The cells responsible for this later stage of removal
include TRAP +ve cells. These cells, in the process
of removal of necrotic periodontal tissue, continued
to remove the cemental surface also.
These finding have been confirmed by studies of
human premolars that were moved buccally before
their extraction.
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49. Orthodintic force
Compression of
PDL
Removal of
hyaline material
Removal of
superficial
surface of
cementum
Root
resorption
www.indiandentalacademy.com
Hyalinization
& inflammation
Activation of
osteoclasts
50. The repair process
Morphologically, the repair process of the
resorbed lacunae is described as beginning
from the periphery, the bottom, or all directions.
It begins about two weeks after force removal,
with the placement of acellular cementum
succeeded by cellular cementum. This process
is evident in 38% and 82% of human premolar
lacunae after two and five weeks, respectively.
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51.
In bone, osteoclasts undergoing apoptosis leave at the
bottom of the lacuna a protein layer that is composed
partially of osteopontin and bone sialoprotein. This layer is
recognized later as the cemental line with which the
osteoblasts meet on bone formation.
According to Bosshardt and Schroeder the odontoclasts
leave the root lacunar surfaces exposed with no sediment
at the base of the crater. Recently, however, it has been
reported that a specific cementum attachment protein
(CAP) has been identified in human cementum
This protein has the ability to bind to mineralized root
surfaces with high affinity. Its role in cementogenesis and
cementoblast recruitment is still under investigation.
Individual variations characterize the repair process as
evident in EARR
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53.
EARR can be defined operationally as the
degree a root has shortened from its original
( or expected ) length by clastic activity
Broadly, two methods have been used to
quantify resorption :
Ordinal scale data :Visually assessed grades
of resorption assigned
Ratio scale data: Measurements with
calipers or some computer aided device)
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54. GRADE 4
THE ORDINAL SCALE USED TO MEASURE EARR
BYoLoss of atleast
LEVANDER E. & MALMGREN
one-half the
original length
GRADE 2
GRADE I0
3
Evidence
oNormal of of
One-fourth
Scalloping
erosion
the blunting
and root
Intact root
periapically
resorbed
of apex
morphology
oRoot length
Apical outline
probably and
is smoothnot
yet affected
continuous
oDistance
between the
root and
lamina dura is
www.indiandentalacademy.com
uniform
56. Type of malocclusion
Among different malocclusions, based on Angle’s
classification system, studies have observed a
statistically significant difference between class I and
class II div 1 malocclusion, with the latter exhibiting
more resorption.
Janson et al reported a higher resorption potential for
class II div 2 cases in comparison with class I , class II
div I and class III patients.
The rationale was that excessive intrusion mechanics
were necessary to correct the deep overbite in these
cases and also the torque required to correct the
palatal inclination of the incisors was high.
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57.
EXTRACTION VS NON
EXTRACTION
The analysis of literature reveals that
both the extraction and the non
extraction treatment have the potential
to produce damage, with the
extraction therapy being potentially
more detrimental.
Among all the extraction patterns,
extraction of all the first premolars
showed the greatest resorption
potential.
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58.
Mechanotherapy Begg Vs edgewise
Although previous studies by could not
find any significant resorption rate
between Begg light wire mechanics and
edgewise ( Tweed ) techniques, a
recent study by McNab et al has
reported a higher incidence of
resorption, as well as amount of root
resorption in patients treated with the
Begg appliance.
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59.
They concluded that the incidence
rate of root resorption was 3.72 times
higher when extractions were
performed as part of Begg appliance
therapy.
Root resorption was also observed in
all three stages of Begg treatment,
with the second stage exhibiting the
least severity
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60. Type of tooth movement :
Intrusion and torque movements are found to be most
commonly associated with the resorption process.
This is evident when studying class II div 2 correction
as well as Begg mechanics. The intrusion performed
in the first stage and the torquing in the third stage
make the Begg technique more vulnerable to
resorption.
The highest root resorption is reported to occur when
3 to 4.5 mm of torquing movement was performed.
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61. Length of treatment time
The length of treatment time and root
resorption have been positively
correlated by almost all studies
These studies revealed have shown
that increased treatment time makes
tooth roots more prone to iatrogenic
response.
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62. Type of force applied
( Continuous vs interrupted )
Interrupted forces were shown
according to studies to cause less
severe apical blunting and smaller
resorption- affected areas.
The authors of these studies
emphasize the use of less detrimental
discontinuous forces ( in the form of
elastic usage, instead of elastomeric
chains ) during space-closure stages
of orthodontic mechanotherapy.
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63. Tooth specificity:
Evaluation of the vulnerability of specific teeth to the
resorption process in the literature has resulted in
common agreement among authors that the maxillary
incisors are the teeth that are the most susceptible to
the process.
However, Controversy still exists regarding which
incisors resorb the most: the centrals or the laterals..
The majority of the studies published reported that the
central incisors were more susceptible to the process.
Following the incisors in susceptibility to resorption in
the maxillary arch are the molars, followed by the
canines.
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64.
In the mandibular arch the most resorption-vulnerable tooth
is the canine, followed by the lateral and central incisors.
Among the posterior teeth, the most resorbed are the
mandibular molars ( with the distal root exhibiting more
resorption ), followed by maxillary molars, mandibular
premolars, maxillary first premolars, and maxillary second
premolars.
Beck and Harris in their classic article, described the
relationship of mechanotherapy to root resporption in the
distal roots of molars. According to them anchorage
archwire bends at the mesial of molars for bite opening
cause the distal roots to be compressed in the tooth
sockets, thereby initiating root resorption
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65. Root shape
Various authors have evaluated abnormalities in
root shape and its association to the resorptive
process.
Among differently shaped root ends ( normal,
blunted, dilacerated, pipette shaped, pointed, and
incomplete) , the least resorption was observed
in blunted root ends and the greatest was seen in
pointed or tapered root ends.
This phenomena is explained by the fact that the
pressure from the axial component of orthodontic
forces is felt most at the root apex regions which
are abnormal in shape. This results in localized
ischemic necrosis, which denudes the
precmentum and cementoblasts, permitting
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colonization of dentinoclasts.
66.
In comparison to the normal root shape,
dilacerated roots show the most resorption
followed by pipette- shaped and the
incomplete roots.
Hence, any abnormal root shapes observed
in the pre-treatment diagnostic records
should be observed with caution and should
be monitored throughout the treatment
period for any iatrogenic damage.
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67. Root length:
A positive correlation is found
between the root length and root
resorption. The studies in this regard
report that longer roots are more
prone than shorter ones to resorption.
This may be due to the greater
displacement required to produce an
equal amount of torque, versus
shorter roots.
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68. History of trauma:
Previous history of trauma and the
presence of pretreatment root resorption
have been positively correlated with root
resorption seen after orthodontic treatment.
Also studies have found a relationship
between cortical plate proximity and
increased root resorption. All these findings
point towards the importance of obtaining
pretreatment diagnostic records and proper
evaluation. So that any risk elements can
be identified and described.
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69. Overjet or overbite:
Studies to date have agreed with a
positive correlation between an
increase in overjet and root
resorption.
The main reasons attributed to this
phenomenon are the greater amount
of torque and greater root
displacements required to correct
excessive overjet.
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70. Age, Gender and ethnicity: are
they contributing factors?
Biologic factors such as age at the start of
treatment and gender, have long been
associated with risk factors for the initiation of
root resoption.
Age at the start of the orthodontic treatment
and incidence of root resorption have been
poorly correlated in almost all recent studies.
Conflicting results have been seen when
gender is considered. Various studies
supported that females are more prone to root
resorption whereas various others stated that
men were more prone.
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71.
The majority of the studies support a
lack of correlation between gender and
resorption.
The relationship between ethnicity and
root resorption was evaluated recently.
The results showed less severity
among Asians in comparison to
Caucasians and Hispanics.
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72. EFFECT OF DRUGS
Drugs such as corticosteroids and alcohol have been
identified as predisposing factors.
An increased risk for root resorption among asthamatic
patients was also recently reported by Mc Nab et al.
they did a tooth – specific analysis and found a higher
incidence of resorption for the roots of maxillary molars.
The changes they observed were attributed to changes
in the immune system of patients and the close
proximity of maxillary molar roots to the maxillary sinus.
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74.
Quantitative as well as qualitative analyses of resorptive
process are required to prevent the occurrence of the most
common iatrogenic damage following orthodontic tooth
movement.
Before treatment
General considerations. The patient/parents must be
informed about the risk of EARR as a consequence of
orthodontic treatment.
Root resorption should be discussed during
consultation.
Every informed consent form signed by the
patient/parents (and the orthodontist) should specifically
outline the risk of EARR
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75.
The rule of thumb is better to inform early
than to later apologize.
It is obvious that if the orthodontist decides
to initiate treatment after reviewing all of the
relevant data collected, the expected
esthetic and functional benefits far outweigh
the minor root changes observed in most
patients.
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76. At the start of treatment
The importance of diagnostic records and
thorough evaluation of them should not be
overlooked from a medico-legal point of view.
Obtaining records periodically during active
treatment is a must.
Of the various methods ( clinical, histological,
radiographic, biologic markers), radiographs
remain the most important tool for evaluation
of pre treatment, in-progress, and post
treatment status of tooth roots.
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77.
Recent researchers have recommended
periapical films for patients at high risk of root
resorption and bone loss. They have also found
that abnormalities were clearer in periapical
films.
Levander et al have supported the use of digital
images for the purpose of visualizing root
resorption. Digital images provide a better image
quality than the conventional radiographs and
also the radiation exposure is lesser to the
patient.
The use of computerized tomography for
evaluation of resorption and its sensitivity in sitespecific ( mesial, distal, buccal, or lingual )
detection of the process has been reviewed
lately.
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78.
Recently, Mah and Prasad discovered
biologic markers for root resorption in
crevicular fluid. In their experiment, they
measured dentin sialophosphoprotein
and found their levels to be high in GCF
that was in proximity to resorbing
primary and permanent tooth roots.
This research may be in future used as
a simple and practical method for
predicting initiation of the process
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80. Is the process reversible?
Review of literature reveals that when a
tooth loses its apical material beyond
the cementum, no regeneration is
possible.
The reparative process begins 2 weeks
after the force is discontinued, and the
effects are evident within 6-8 weeks.
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81.
Acellular cementum is laid down in the
initial stages, followed by cellular
cementum.
The according to various authors, the
process starts from either the
peripheral region, the apex, or in all
directions, and individual variations
seem to be very common as far as the
repair is concerned.
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82. Midtreatment approach to
root resorption
Progress periapical films or panoramic
radiographs should be analyzed during
the treatment.
A review of literature supports a
temporary halt in orthodontic treatment
for a period of 4 – 6 months.
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83.
The resorptive process ceases and
the reparative process starts within
this period.
Appropriate follow up and necessary
counseling should always accompany
this approach.
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84.
The role of drugs in decreasing root
resorption has been reported in some
recent publications.
Drugs such as bisphosphonates,
Nambumetone ( an NSAID ), various
hormones and cytokines including
prostaglandin E2 and L-thyroxine etc
have been tried and tested to little
clinical success.
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85.
A recent report by Baily et al
evaluated the effect of lowintensity pulsed ultrasound
( LIPUS ) in the healing
process of orthodontically
induced root resorption in
humans. The result of this
study are quite encouraging,
as it demonstrates a noninvasive method to reduce
root resorption in humans.
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87.
External apical root resorption is an iatrogenic
consequence of orthodontic treatment. Keeping this in
mind, we as orthodontists should take all known
measures to reduce its occurrence.
Although several protective procedures have been
suggested, none of them can actually prevent EARR
with any degree of certainty.
Probably in the future, more genetically based studies,
as well as other basic science research, might clarify
the exact nature of EARR and hopefully help to
prevent or even eliminate this phenomenon.
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90.
Current principles and techniques : Graber Vanarsdal :
3rd edition
Root resorption: The possible role of extracellular matrix
proteins: Adam Lee ; Glen Schneider : AJO 2004 ; 126
Critical issues concerning root resorption : A
contemporary review : Krishnan V. ; World Journal of
orthodontics,vol & no.1 2005, pg 30-39
Root resorption in orthodontic therapy: : Edward F. Harris
; Seminars in orthodontics : 183-191
Root resorption- diagnosis,classification and treatment
planning based on stimulation factors : Dental
Traumatology 2003 : 19;175-182
Contemporary Orthodontics, William R. Profitt, 3rd edition
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91.
Oral Anatomy, Histology & Embryology, B.K.B.
Berkovitz, 3rd edition
Brezniak N, Wasserstein A. Root resorption after
orthodontictreatment: Part 1. Literature review. Am J
Orthod 1993;103:62-6.
Brezniak N, Wasserstein A. Root resorption after
orthodontic treatment: Part 2. Literature review. Am J
Orthod 1993;103:138-46.
Predicting and preventing root resorption : Part I :
Diagnostic factors : Glen T. Sameshima : AM j Orthod
; May 2001, 119
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92. Thank you
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