ROOT RESORPTION

[Link] SATRA
INTRODUCTION
• Root resorption is a common iatrogenic consequence of orthodontic
treatment.
• External apical root resorption is an undesirable complication of
orthodontic treatment that results in permanent loss of tooth
structure from the root apex.
• However, it can be avoided with more accurate management of
orthodontic treatment.
• Most common type of root resorption occurring due to
orthodontic tooth movement is external apical root resorption.

• Bates -1856

• Schwarzkoff-1887

• Ottolengui-1914

• Ketchman-1927
• Becks and Marshall-1932

Term “Resorption”- "In all cases in which formed tissues are destroyed
and taken up by the blood or lymph stream."

The appropriate term to describe any form of apical root loss is

therefore resorption.
NORMAL STRUCTURES SURROUNDING THE
TEETH

[Link] LIGAMENTS:
• 0.25 MM WIDE, SOFT ,RICHLY VASCULAR AND CELLULAR CONNECTIVE TISSUE
that surrounds the roots of the teeth and joins the root cementum with the
lamina dura or alveolar bone proper.

• The main types of collagen in PDL are type I and type III. More than 70%
collagen is type I.
OTHER FIBERS:

SHARPEYS FIBERS:

• Terminal portion of the principal fibers that inserts into

cementum and bone.

• They are numerous but smaller at their attachment into

cementum than alveolar bone.
OXYTALAN FIBERS:

• Instead of running from bone to tooth, they tend to run in

axial direction.

• They run parallel to the root surface in the vertical direction

and bend to attach to cementum in cervical third of the root
and the other end in the wall of the blood vessel.

• They regulate vascular flow.

HISTOLOGY:

• The PDL consist of cells and extracellular compartment which is

made up of fibers and ground substance.

• Small blood capillaries are also seen in the PDL.

• Defense cells- macrophages, mast cells and eosinophils are also

found in PDL.
[Link]:

• It is the outer layer of the root is a SPECIALIZED MINERALIZED

tissue covering the root surface.

• Composition-
Inorganic: - 45% to 50%, calcium and phosphate ions in the form
of hydroxyapatite crystals. Highest fluoride content of all
mineralized tissue.

Organic: -
Type 1 collagen and proteoglycans.
• Two main types of root cementum:
 Acellular (primary).
 Cellular (secondary).

• There are two types of collagen fibers in cementum:

 Extrinsic (Sharpey’s) fibers- embedded principal fibers of the periodontal
ligament formed by fibroblast.

 Intrinsic fibers- belong to the cementum matrix and are produced by the
cementoblast.
• Acellular cementum forms first and covers approximately the cervical
margin to apical one third.
 • Cellular cementum formed after the tooth reaches the occlusal
plane, is more irregular and is present in the apical portion of
root. Less calcified than acellular cementum.

CELLULAR INTRINSIC FIBER CELLULAR MIXED FIBER

CEMENTUM (CIFC) CEMENTUM (CMFC)
• Thickness of cementum on the coronal half of the root-16-60 micrometers.

• Attains greatest thickness (upto150 to 200um) in the apical third and

bifurcation and trifurcation areas.

• Between the ages of 11 and 70 yr, the average thickness of cementum

increases 3 fold, with the greatest increase in the apical region.

• Average thickness of 95um at age 20 and 215um at age 60 has been reported.
FUNCTION:

• Medium for attachment of collagen fiber that binds the tooth to the alveolar
bone.

• Serves as a major reparative tissue for root surface.

• More resistant to resorption than bone, therefore orthodontic treatment is

made possible.
3. ALVEOLAR BONE:

• Bone is a connective tissue composed of cells ,fibers and

ground substance.

• Consists of a calcified matrix with osteocytes enclosed within

spaces called lacunae.

• It consists of two third inorganic matter and one third

organic matrix.
ALVEOLAR PROCESS:

• Part of the maxilla and mandible that supports the tooth

socket.

Cortical bone Cancellous bone

Alveolar bone proper

• The alveolar bone is constantly renewed constantly to functional
demands .

• Bone forming osteoblasts and osteoclasts involved in resorption are

responsible for this remodelling process.
 Reorganizes to
Osteoblasts
lamellated bone

Osteoid =collagen fibers + matrix

(proteoglycans ,glycoproteins)

Cells and fibers are

incoporated into bundle bone
Undergoes mineralization by deposition throughout life. When it
of minerals(calcium,phosphate)= reaches certain thickness and
BUNDLE BONE maturity
CLASSIFICATION

• ACCORDING TO SHAFER, HINE AND LEVY

• ACCORDING TO PROFFIT

• According to FUSS Z, TSESIS I and LIN S

• ACCORDING TO SHAFER, HINE AND LEVY:

1) External root resorption- resorption that begins on the external surface of

the tooth (arising as a result of tissue reaction in the periodontal and pericornal
tissue)

2) Internal root resorption- resorption that begins from inside of the

tooth(from a pulpal reactions).
 EXTERNAL ROOT RESORPTION
External root resorption may be due to:

• Periapical inflammation
• Reimplanted teeth
• Tumors and cysts
• Excessive mechanical and occlusal forces:
• Impaction of teeth
 Types of EXTERNAL ROOT RESORPTION :-

1)SURFACE RESORPTION:

• Physiologic process of resorption and repair that the root sustains during normal
physiologic activity(eg: mastication)

• Self-limiting process, usually involves small outlining areas followed by

spontaneous repair from adjacent intact parts of the periodontal ligament.

ROOT RESORPTION AFTER ORTHODONTIC TREATMENT,LITERATURE REVIEW,AJODO 1993

2) External inflammatory root resorption:

• Any resorption mediated by inflammatory process and includes

resorption caused by orthodontic tooth movement and trauma .

• This type of resorption can occur anywhere on the root surface where
there is periodontal attachment.

• Where initial root resorption has reached dentinal tubules of an

infected necrotic pulpal tissue
 External inflammatory root resorption:

Transient inflammatory resorption- Progressive inflammatory resorption-

3)Replacement Resorption:

• Bone replaces the resorbed tooth material that leads to ankylosis.

• Replacement resorption is rarely seen during or after orthodontic treatment.

 INTERNAL ROOT RESORPTION

• According to Shafer, Hine and Levy internal resorption mainly arises from
inflammatory hyperplasia of pulp.

• Begins centrally within the tooth.

• Cause of the pulpal inflammation and subsequent resorption of tooth

substances is unknown, although an obvious carious exposure and
accompanying pulpal infection are sometimes present.
• Clinically the first evidence of the lesion may be the appearance of a
pink-hued area on the hyperplastic, vascular pulp tissue filling the
resorbed area and showing through the remaining overlying tooth
substances.
• ACCORDING TO PROFFIT:

Shortening of roots after orthodontic treatment occurs in three distinct forms

that must be distinguished when the etiology of resorption is considered.

[Link] Generalized Root Resorption

2. Severe Generalized Root Resorption
[Link] Localized Resorption

PROFFIT
 [Link] Generalized Root Resorption

• Despite the potential for repair, careful radiographic examination of an

individual who has undergone comprehensive orthodontic treatment
shows that most of the teeth show some loss of root length, and this is
greater in patient whose treatment duration was longer.
ROOT RESORPTION ACCOMPANYING ORTHODONTIC TREATMENT CAN BE DIVIDED
INTO THREE CATEGORIES FOR MAXILLARY CENTRAL AND LATERAL INCISORS.
 2. Severe Generalized Root Resorption

• Severe root resorption of all teeth is rare.

• Some individuals are prone to root resorption even without

orthodontic treatment.

• If there is an evidence of root resorption before orthodontic

treatment, the patient is at considerable risk for further resorption
during orthodontic treatment.
• Various reports have suggested that above average resorption
can be anticipated if the teeth have conical roots with
pointed apices, distorted root form or history of trauma.
 [Link] Localized Resorption

• In contrast to severe generalized root resorption, severe localized root

resorption probably is caused by orthodontic treatment in many
instances.

• Prolonged orthodontic treatment increases the risk of root resorption.

• Kaley and Phillips reported a twenty-fold increase in the risk of severe
root resorption for maxillary incisors if their roots were forced against
the lingual cortical plate during treatment.
 According to FUSS Z, TSESIS I and LIN S:

• It is a clinically related classification and the various types of root resorption

are classified according to the stimulating factors.

Stimulating factors can be as follows:-

1. Pulpal infection root resorption.
2. Periodontal infection root resorption.
3. Orthodontic pressure root resorption.
4. Impacted tooth or tumor pressure root resorption.
5. Ankylotic root resorption.

FUSS Z,TSESIS I,LIN [Link] RESORPTION –DIAGNOSIS ,CLASSIFICATION AND

TREATMENT CHOICES BASED ON STIMULATION [Link] TRAUMATOL2003
1. Pulpal infection root resorption.
• Clinically- teeth are usually asymptomatic in the early period of the
process. As the process progresses, the teeth may become
symptomatic and periradicular abscess may develop with increasing
tooth mobility.

• Radiographically, radiolucency is observed on external root surface of

the dentine and the adjacent bone, or in the internal root canal
dentinal walls.
 2. Periodontal infection root resorption.

• External root resorption may occur after injury to the cementum, apical to
the epithelial attachment, followed by stimulation of bacteria originating
in periodontal sulcus.
• Radiographically- can be seen as a single resorption lacuna in the
dentin usually at the crestal bone level, expanding in the coronal
and the apical direction.
3. Orthodontic pressure root resorption.

• occurs with injury originating from the force applied to the roots during
tooth movement.
• Teeth are asymptomatic and pulp is usually vital unless the force of operative
procedure is high enough to disturb the apical blood supply.

• Radiographically, this resorption is located in the apical third of the and no signs
of radiolucency can be observed in the bone or the root.
4. Impacted tooth or tumor pressure root resorption.

• Pressure root resorption can be observed during eruption of

permanent dentition, especially of maxillary canines (affecting
lateral incisors), and mandibular third molars (affecting
mandibular second molars).

• Tumors impinging on the root of the tooth could also be an

etiological factor for pressure resorption, which includes both
injury and the stimulating phases.
• It is asymptomatic with vital pulp throughout 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 adjacent to the

stimulating factor, the impacted tooth, or the tumor. There are no
radiolucent areas as no infection is involved in the process.
 5. Ankylotic root resorption.

• In severe traumatic injuries (intrusive luxation or avulsion); injury to the root

surface may be so large that healing with the cementum is not possible, and
the bone may come in contact with root surface without an intermediate
attachment apparatus. This phenomenon is called as “Dento-alveolar
Ankylosis”.
• Clinically, the ankylotic teeth lack the physiological mobility of the
normal teeth.

• These teeth usually have a special metallic percussion sound.

• Radiographically, resorption lacunae are filled with bone and the PDL
space is missing. No radiolucent areas are observed, and at some
stage, the whole root may be replaced by bone.
TYPES OF ORTHODONTICALLY INDUCED
INFLAMMATORY ROOT RESORPTION`

[Link] OR SURFACE RESORPTION.

2. DENTINAL RESORPTION WITH REPAIR.

[Link] APICAL ROOT RESORPTION.

ORTHODONTICALLY INDUCED INFLAMMATORY RESORPTION ,NAPHTALI BREZNIAK, ANGLE ORTHOD

2002
PERIODONTAL AND BONE RESPONSE
TO NORMAL FUNCTION AND
ORTHODONTIC FORCE
INFLAMMATION AND TOOTH MOVEMENT ,SEMIN ORTHOD 2012
PROCESS OF ROOT RESORPTION
EXTERNAL ROOT RESORPTION. JAMES HARTSFIELD , SHAZA ABASS, SEMIN ORTHOD 2007
GRADING OF APICAL ROOT
RESORPTION:

Robert W. De Shields (1969) using intraoral periapical X-rays described a

grading system for apical root resorption.

ROBERT V, A STUDY OF ROOT RESORPTION IN TREATED CLASSII ,DIVISION 1 MALOCCLUSIONS. ANGLE

ORTHOD,1969.
• Grade 0 No resorption

• Grade 1 Possible resorption

• Grade 2 Definite resorption. The apical outline was definitely

irregular but the root was not shortened or blunted.

• Grade 3 Mild apical blunting. The reduction in root length was less
than 3mm.

• Grade 4 Moderate apical blunting. Resorption more than 3mm

but
less than 1/3rd the root length.

• Grade 5 Severe blunting. More than 1/3rd of the original root

length
was lost.
David N. Ramington et al (1989) described the following grading scale for
apical root resorption
FACTORS AFFECTING ROOT
RESORPTION

• Biologic factors
• Mechanical factors
• Biologic and mechanical factors
• Other considerations

Brezniak, Naphtali, and Atalia Wasserstein. "Root resorption after orthodontic treatment: Part 2. Literature
review." American Journal of Orthodontics and Dentofacial Orthopedics 103.1 (1993): 62-66.
 BIOLOGIC FACTORS

1. INDIVIDUAL SUSCEPTIBILITY:
• According to Rygh, root resorption varies among individual, and within the
same person at different times.

• An ethnic dichotomy has been reported, with Asian patients having significantly
less EARR than Caucasian or Hispanic patients.
2. GENETICS:

• Newman W.G (1975) strongly suggested a genetic component for shortened

roots.

• Although no definite conclusion was found-

 Autosomal dominant,
 Recessive and
 Polygenic modes of inheritance are possible.
• There is considerable individual variation in EARR associated with
orthodontic treatment, indicating an individual predisposition and
multifactorial etiology.
[Link] FACTORS:

• Becks (1939) suggested that endocrine problems- hypothyroidism,

hypopituitarism, hyperpituitarism and other diseases are related to

root resorption.

• Deficiency of thyroid hormone could lead to generalized root

resorption, and occasional thyroid supplements for orthodontic
patients are suggested as a way to prevent this.
• Goldie R.S., King G.J- parathyroid hormone plays a major role in bone
metabolism, and low calcium levels caused significantly less root
resorption.

• Linge and Linge - hormonal imbalance does not cause but influences root
resorption.
4 .NUTRITION:

• Marshall (1929- malnutrition can cause root resorption.

• Becks (1936) demonstrated root resorption in animals

deprived of dietary calcium and vitamin D.

• Linge and Linge (1983)- it was later suggested that

nutritional imbalance is not a major factor in root resorption
during orthodontic treatment.
5 .CHRONOLOGIC AGE:

• The periodontal membrane becomes less vascular, aplastic and narrow,

the bone becomes denser, avascular, aplastic and cementum becomes

wider.

• These changes are reflected by higher susceptibility to root resorption seen

in adults.
6 .DENTAL AGE:

• During growth, root development can be affected by tooth movement.

7 .GENDER:

• Massler, Malone (1954); Rennky et al (1983)-showed no correlation

between gender and root resorption in treated and untreated cases.

• Perreault (1954), Dougherty H.L (1968), MasslerKinsella (1971) and Newman WG (1975)
Females-
 More susceptible.
 The idiopathic root resorption ratio was 3.7:1 females to males.
 Females had a greater apical root resorption than males, 0.73mm and 0.67mm.
8 .THE PRESENCE OF ROOT RESORPTION BEFORE ORTHODONTIC
TREATMENT:

• (Massler M., Malone, 1954)- there is a high correlation between the

amount and severity of root resorption present before treatment to the
root resorption discovered when orthodontic appliance is removed.

• Goldesen L, Henrikson (1975) reported that in such cases incidence of root

resorption increased from 4% to 77% after treatment.
9 . HABITS:

• Nail-biting and tongue thrust associated with open bite and increased
tongue pressure have been statiscally related to increase root resorption.
10 . TOOTH STRUCTURE AND SPECIFIC TOOTH VULNERABILITY TO ROOT
RESORPTION:

• Oppenheim (1942) -deviating root form is more susceptible to post-

orthodontic root resorption.

• Kinsella P (1972) - convergent apical root canal is considered to be

indicative of high root resorption potential.
ROOT RESORPTION DURING ORTHODONTIC THERAPY, HARRIS ET AL,AJODO -2006
 Dilacerated maxillary incisors and pointed teeth, in general, showed
greater root resorption. Blunted teeth had less resorption.

GLEN T AND PETER M,Predicting and preventing root resorption: diagnostic

factors ajodo 2001
• Within the anterior segment, several interesting patterns emerged.

• First, maxillary teeth are more severely affected than mandibular teeth.

• Incisors were more resorbed than canines within the arch.

• Second, the most severely resorbed teeth were maxillary lateral incisors,
followed by maxillary central incisors, maxillary canines, mandibular
canines, mandibular central incisors, and mandibular lateral incisors.
Kalkwarf et al modeled the shape of maxillary lateral incisor to quantify the
relationship between loss of tooth length and loss of surface area for attachment
.
ROOT RESORPTION DURING ORTHODONTIC THERAPY, HARRIS ET AL,AJODO -2006
11 . PREVIOUSLY TRAUMATIZED TEETH:

• Philips JR (1955) and Andreasen JO (1988) stated that traumatized teeth can
exhibit root resorption without orthodontic treatment.

• Teeth with prior root resorption are more sensitive to further loss of root material.

• The average root loss for trauma patient after orthodontic treatment was 1.07mm
compared with 0.64mm for untraumatized teeth.

• Malmgren O et al (1982) found that traumatized teeth without previous signs of

resorption do not resorb more than non traumatized teeth.
12 . ENDODONTICALLY TREATED TEETH:

• Wickwire A et al (1974) - a higher frequency and severity of root resorption.

• Reitan (1985), Remington DN et al(1989)-increased dentin hardness and density

made endodontically treated teeth more resistant to root resorption.
13 . ALVEOLAR BONE DENSITY:

• Goldie RS (1984) and Reitan K (1985) found that the denser alveolar bone
was more prone for orthodontically induced root resorption.

• Wainwright (1973) showed that bone density affects the tooth movement
but has no relation to the extent of resorption.
• Reitan-1974- strong continuous force on less dense alveolar bone
causes the same amount of root resorption as mild continuous forces
on highly dense alveolar bone.
14 . CLASSIFICATION OF MALOCCLUSION:

• Vonder (1973) - no correlation between root resorption and malocclusion classification.

• cases with anterior openbites lose more root length than cases requiring
less incisor movement.

• Linge and Linge as well as Beck and Harris found highly significant, positive associations
between periapical resorption and both overjet.

• The common theme here is that the amount of movement is itself predictive of
the degree of resorption to occur.
MECHANICAL FACTORS

[Link]:
 Fixed versus removable-
• Ketcham (1929) -normal function is disturbed by the splinting effect of
orthodontic fixed appliances and over a longer period of time this can cause
root resorption.

• Stuteville (1937) - jiggling forces caused by removable appliances are more

harmful.
 Begg vs edgewise:-

• Malgren et al suggested that there is no difference between these

techniques but found that the frequency of root resorption was
significantly higher (48%) in traumatized maxillary incisors when
intruded by beg technique compared with edgewise.(43%)
 Extraction vs. Nonextraction-

• Vonder (1973) and McFedden (1989),found no difference in the extent of root

resorption between the two approaches.

• Sharpe et aL reported that incisors experienced more EARR in premolar

extraction cases in which retraction is greater than in nonextraction cases.
 Serial extractions-

• Kennedy JB (1983) stated that serial extractions without the

complementary orthodontic treatment gave the least root resorption
compared to serial extraction with fixed appliance therapy.
 Other appliances-

• Hill FJ (1987) reported severe root resorption with rapid maxillary

expansion.

• Vardimon et al (1992) have reported external root resorption with palatal

expansion.
[Link] MOVEMENT TYPE:

• Ketcham (1929), Hemley S (1941), Linge and Linge (1983), McFadden et al (1989),
stated that probably intrusion is the most detrimental to root, but tipping, torque,
bodily movement and palatal expansion can also be implicated.
• Harris et al administered intrusive forces. The results showed that the volume of RR
craters after intrusion was directly proportional to the magnitude of the intrusive
force. A statistically significant trend of linear increase in the volume of the RR craters
was observed from control to light (2 times increased) to heavy (4 times increased)
groups.
[Link] FORCE:

• Harry and Sims found distribution of resorbed lacunae directly related to the amount
of stress on the root surface and the rate of lacunae formation was more rapid with
increasingly applied forces.

• They concluded that higher stress causes more resorption.

 LIGHT VS CONTINUOUS FORCES:

• Chan and Darendeliler found the mean volume of the resorption craters in the
light-force group was 3.49 times greater than in the control group (not
significant) and the mean volume of the resorption craters was 11.59 times
greater in the heavy-force group than in the control group.

• Barbagallo et al also found that heavy force produced significantly more RR (9

times greater than the control) than light force (5 times greater than the
control).
 Continuous versus intermittent force-

• Reitan K (1964), Dougherty HL (1968), have shown that the pause in

treatment with intermittent forces allows the resorbed cementum to heal
and prevents further resorption.

• Acar et al compared a 100-g force with elastics in either an interrupted (12

hours per day) or a continuous (24 hours per day) application. Continuous
force produced significantly more RR than discontinuous force application.
COMBINED BIOLOGIC AND MECHANICAL
FACTORS

[Link] DURATION:

• According to Reitan K (1964), Sharpe (1987), McFadden (1989), severity of

root resorption is directly proportional to the duration of orthodontic
treatment.
 [Link] RESORPTION AFTER ORTHODONTIC REMOVAL:

• Reitan (1985) claimed that additional active resorption lasts for about a
week after appliance removal followed by cemental repair that lasts 5 to
6 weeks of orthodontic inactivity.
3. LOSS OF CRESTAL BONE AND TOOTH STABILITY:

• GOLDIN ET AL is explained by the presence of large amounts of

periodontal fibers in the crestal area compared with the apical zone.
During orthodontic treatment, crestal bone loss is about 0.2 to 0.5 mm.

• According to Kalkwarf et al, 3 mm of root resorption is approximately

equivalent to 1 mm of crestal bone loss.
Repair process of root resorption
HENRY AND WEINMANN CLASSIFICATION

1. Anatomic repair

2. Functional repair

Henry, Joseph L., and Joseph P. Weinmann. "The pattern of resorption and
repair of human cementum." The Journal of the American Dental
Association42.3 (1951): 270-290.
Aplastic resorption state on the mesial
surface of the upper left first bicuspid

Note the characteristic

resting line and the absence of
cementum and cementoclasts (A )
B - dentin;
C, cementum;
D, loose connective tissue;
E, periodontal
membrane;
F, bone.
Anatomic repair of cementum and
dentin on the lingual surface of the
lower right cuspid

A - dentin;
B-reversal line,
C- cementum;
D- periodontal membrane;
E-bone.
Functional repair of the apex of the
upper left lateral incisor

A - dentin
B- cementurn
C- periodontal membrane
D- bone
E- cartilage-like
formation in response to shearing
forces.
A.D VARDIMON AND [Link] studied the repair process of
external root resorption and the role of retention mechanics in
enhancing external root resorption process.

A.D. Vardimon, [Link] and [Link]. Repair process of external root

resorption subsequent to palatal expansion treatment. Am J Orthod
Dentofac Orthod 1993; 103:120-130.
Short-term group

Active shallow external root resorption sites ------dissolved PDL

fibers with monoucleated and multinucleated odontoclasts located
in Howship’s lacunae.
• Adjacent lacunae coalesced into small patches, which gave
shallow dentinal resorption sites a honey comb appearance.

• The immediate pulp reaction to external root resorption stimulus

---increased vascularization, hyperemia, and accumulation of
pulp stones.
Long term group

2 forms of external root resorption repair were seen-

1. Non-functional retarded repair cementum.

2. Functional rapid repair cementum.
 Non-functional retarded repair cementum.

UV photomicrograph of a nonfunctional repair with massive pulp exposure

Functional rapid repair cementum.
Magnified view of the area outlined in A.
The repair process of FRC consisted of five
sequential Phases: acc. To presence of
INCREMENTAL LINES

1. Lag phase

2. Incipient phase (IP)

3. Peak phase (PP), maximal apposition of

mixed fibrillar cellular cementum

4. Steady phase (SP)

5. Retreating phase (RP)

Functional repair process in apical area

SEM photomicrograph of occluded of apical foramen. The new apical foramen

was translocated laterally away from the applied intrusive forces
Overproduction of cementum causes-

1. Occlusion of the apical foramen

2. Exostosis of cementum
3. Displacement of the pulpal tissues towards the tension
side.
CLINICAL CONSIDERATIONS

• Before treatment
• During treatment
• After treatment

Brezniak N, Wasserstein A. Orthodontically induced inflammatory root resorption. Part II: the clinical aspects.
The Angle orthodontist. 2002 Apr;72(2):180-4.
Before treatment

• General considerations

• Familial considerations

• General health

• The dentition

• The malocclusion
 During treatment

• The new light-force rectangular wires

• Longer intervals between activations remain strongly recommended

• Duration of active treatment

• When OIIRR is detected in the six-month periapical radiograph,

treatment should be halted for 2-3 months with passive arch wires.

• Habits
 After treatment

• Final records- inform patient/ parents

• Severe resorption, follow-up radiographic examinations -until

OIIRR is no longer evident.

• Use of teeth with severe resorption as abutment teeth should be

reconsidered.
THANKYOU