CLINICIANS CORNER

Short-root anomaly in an orthodontic patient

Leandro Silva Marques,a Rodrigo Generoso,b Monica Costa Armond,c and Camila Alessandra Pazzinid s Diamantina, Tre Coraco Minas Gerais, Brazil es, Short-root anomaly is a rare condition, but it can be a problem for orthodontists and their patients. Our aim in this article was to report the treatment of an orthodontic patient with short-root anomaly, highlighting the diagnostic aspects involved and the strategy used. (Am J Orthod Dentofacial Orthop 2010;138:346-8)

hort-root anomaly (SRA) is a rare condition, with a prevalence estimated at 1.3%. It is more common in female patients and principally affects the premolars and the maxillary incisors, the apexes of which are rounded rather than the usual pointed shape.1,2 The condition has a genetic background and is related to other dental anomalies, such as agenesis, invaginated teeth, conoid teeth, supernumerary teeth, microdontia, taurodontia, pulp calculus, and type I dentin dysplasia.3-6 Moreover, it can be related to syndromes, such as Down7 and Stevens-Johnson.8 SRA has also been associated with exogenous factors, including radiation of the head and neck or chemotherapy in children with malignant tumors during dental development.9 Short dental roots, resulting in unfavorable rootcrown ratios, can affect the prognosis of teeth and complicate the treatment plan in orthodontics and prosthodontics when considering aspects such as anchoring and the capacity of teeth to bear mastication forces.10 Specically in orthodontic patients, this problem takes on an even more critical dimension, because of the tendency in patients with short roots toward root resorption during orthodontic treatment.11,12 Moreover, anomalies such as agenesis, ectopic teeth, and taurodontism are risk factors for periapical resorption.13,14 Although SRA is a potential problem in the clinical practice of orthodontists, no studies were found that directly address this subject. Thus, our aim in this study
Professor, Department of Orthodontics, University of Vale do Rio Verde (UNINCOR), Tres Coracoes, Brazil; private practice, Diamantina, Brazil. b Professor, Department of Orthodontics, University of Vale do Rio Verde (UNINCOR), Tres Coracoes, Brazil. c Professor, Department of Orthodontics, University of Vale do Rio Verde (UNINCOR), Tres Coracoes, Brazil. d PhD student, Pediatric Dentistry and Orthodontics Department, Federal University of Minas Gerais (UFMG), Belo Horizonte-MG, Brazil. The authors report no commercial, proprietary, or nancial interest in the products or companies described in this article. Reprint requests to: Leandro Silva Marques, Arraial dos Forros, 215, Centro, Diamantina, Minas Gerais, Brazil, Cep: 39100-000; e-mail, lsmarques.prof@ gmail.com. Submitted, revised and accepted, August 2008. 0889-5406/$36.00 Copyright 2010 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2008.08.037
a

was to present the treatment of an orthodontic patient with SRA, highlighting the diagnostic aspects involved and the strategy used.
CASE REPORT

A girl, aged 10 years 7 months, sought orthodontic care, accompanied by her parents. Their objective was to continue the treatment that had been started 6 months earlier by another orthodontist. The girl had an orthodontic appliance in her maxillary arch from second premolar to second premolar (Fig 1). She had a mesofacial growth pattern, a convex facial prole, and a Class II dental and skeletal malocclusion. The radiographs showed SRA in the maxillary and mandibular central incisors and rst premolars (Fig 2). The mandibular central incisors were affected to the greatest degree. There were no reports of disease or systemic abnormalities. The new treatment plan involved removal of the xed appliance and placement of a functional orthopedic appliance aimed at mandibular advancement (Fig 3). Headgear was also prescribed to limit the anterior movement of the maxilla. After 8 months of functional orthopedic appliance treatment, the patient exhibited signicant mobility in the mandibular central incisors. The decision was then made to place a xed lingual retainer, with a 0.025-mm braided ber, on the mandibular incisors and canines (Fig 4). After 19 months of retention, there was stability of the sagittal correction and satisfactory intercuspation (Fig 5). Throughout this period, there was no change in the amount of root shortening (Fig 6).
DISCUSSION

There are 2 main reasons for short dental roots: disturbance during dental development and resorption of originally well-developed roots. Clinical orthodontists should be careful not to diagnose SRA as root resorption. Because of the genetic background, the diagnosis of SRA is established when members of the family also have short roots and the possibility of systemic disease has been discarded.15 Root resorption is most often

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Fig 1. Intraoral photographs of a patient seeking to continue treatment started 6 months earlier with a different provider.

Fig 2. Radiographs showed the SRA of the central incisors and rst premolars.

Fig 3. Fixed appliances and a functional orthopedic appliance were placed. Fig 4. Eight months later, the mandibular central inciors showed signicant mobility, so a xed lingual retainer was placed.

considered a collateral effect of orthodontic treatment. In the case presented here, although the patient was already in orthodontic treatment and the root shortening affected both maxillary and mandibular teeth, this could not be attributed to the forces of the appliance, since it was attached only to the maxillary teeth. Furthermore, the diagnosis of SRA was conrmed by a similar situation observed in the patients sister, although to a lesser degree. No reports were found in the literature regarding orthodontic treatment in patients with SRA. However, using the nite element method, Oyama et al16

demonstrated that, in model short root, signicant stress was concentrated at the middle of the root, enough for the development of root resorption. Thus, orthodontic forces should be applied with considerable caution and preferentially avoided in patients with this anomaly. Fortunately, in our patient, the severity of the malocclusion did not require complex mechanics or considerable

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Fig 5. After 19 months of retention, there was stability in the sagittal correction and satisfactory intercuspation.

REFERENCES 1. Apajalahti S, Holtta P, Turtola L, Pirinen S. Prevalence of short root anomaly in healthy young adults. Acta Odontol Scand 2002;60:56-9. 2. Apajalahti S, Sorsa T, Ingman T. Matrix metalloproteinase -2, -8, -9, and -13 in gingival crevicular uid of short root anomaly patients. Eur J Orthod 2003;25:365-9. 3. Lerman RL, Gold R. Idiopathic short root anomaly. J Pedod 1977; 1:327-33. 4. Brook AH, Holt RD. The relationship of crown length to root length in permanent maxillary central incisors. Proc Br Paedod Soc 1978;8:17-20. 5. Nasman M, Bjork O, Soderhall S, Ringden O, Dahllof G. Distur bances in the oral cavity in pediatric long-term survivors after different forms of antineoplastic therapy. Pediatr Dent 1994;16:217-23. 6. Desai RS, Vanaki SS, Puranik RS, Rashmi GS, Nidawani P. An unusual combination of idiopathic generalized short-root anomaly associated with microdontia, taurodontia, multiple dens invaginatus, obliterated pulp chambers and infected cyst: a case report. J Oral Pathol Med 2006;35:407-9. 7. Prahl-Andersen B, Oerlemans J. Characteristics of permanent teeth in persons with trisomy G. J Dent Res 1976;55:633-8. 8. De Man K. Abnormal root development, probably due to erythema multiforme (Stevens-Johnson syndrome). Int J Oral Surg 1979;8:381-5. 9. Jaffe N, Toth BB, Hoar RE, Ried HL, Sullivan MP, McNeese MD. Dental and maxillofacial abnormalities in long-term survivors of childhood cancer: effects of treatment with chemotherapy and radiation to the head and neck. Pediatrics 1984;73:816-23. 10. Holtta P, Nystrom M, Evalahti M, Alaluusua S. Root-crown ratios of permanent teeth in a healthy Finnish population assessed from panoramic radiographs. Eur J Orthod 2004;26:491-7. 11. Lind V. Short root anomaly. Scand J Dent Res 1972;80:85-93. 12. Jacobsson R, Lind V. Variation in root length of the permanent maxillary central incisor. Scand J Dent Res 1973;81:335-8. 13. Kjaer I. Morphological characteristics of dentitions developing excessive root resorption during orthodontic treatment. Eur J Orthod 1995;17:25-34. 14. Levander E, Malmgren O, Stenback K. Apical root resorption during orthodontic treatment of patients with multiple aplasia: a study of maxillary incisors. Eur J Orthod 1998;20:427-34. 15. Apajalahti S, Arte S, Pirinen S. Short root anomaly in families and its association with other dental anomalies. Eur J Oral Sci 1999; 107:97-101. 16. Oyama K, Motoyoshi M, Hirabayashi M, Hosoi K, Shimizu N. Effects of root morphology on stress distribution at the root apex. Eur J Orthod 2007;29:113-7.

Fig 6. Root shortening did not increase.

force. Moreover, she was in phase 2 (acceleration) of vertebral maturation and, therefore, before the pubertal growth spurt. These characteristics allowed a treatment plan that preferentially addressed orthopedic aspects (activator and headgear) that did not involve force directly on the affected teeth. Once mobility was found in the mandibular incisors, we decided to apply a splint to stabilize them to prevent movement and an overload of forces as much as possible. A possible explanation for the mobility observed in these teeth was the effect of the projection of the incisors from the mandibular advancement appliance.

CONCLUSIONS

The denition of short roots has been most often used subjectively. However, orthodontists and dental professionals should be careful to make a correct diagnosis and an individualized treatment plan for this abnormality, because these determinations could mean the difference between success and failure of the strategy.