Comparison of external apical root resorption with clear aligners and pre-adjusted edgewise appliances in non-extraction cases: a systematic review and meta-analysis

Abstract

Summary Objective The aim of this study was to evaluate and compare the amount of external apical root resorption (EARR) observed during the orthodontic treatment with pre-adjusted edgewise appliance (PEA) or clear aligner therapy (CAT) and with 2D or 3D radiographic methods of measuring the root resorption. Search strategy and selection criteria A search of PubMed MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, LILACS, Web of Science, Dissertations & Theses Global, ClinicalTrials.gov registry, and the ISRCTN Registry was performed. Studies that have evaluated the amount of root resorption in non-extraction cases using CAT or PEA were selected for the systematic review. A meta-analysis was performed for the amount of root resorption of permanent maxillary incisors using PEA or CAT treatment modalities by either 2D or cone-beam computed tomography radiographic examination. Data collection and analysis Database research, elimination of duplicate studies, data extraction, and risk of bias were performed by authors independently and in duplication. A random-effect meta-analysis followed by subgroup comparisons were performed to evaluate EARR. Results A total of 16 studies (4 were prospective and 12 were retrospective) were identified for inclusion in the systematic review. The mean root resorption for the permanent maxillary incisors was in the range from 0.25 to 1.13 mm (overall: 0.49 mm; 95% confidence interval [CI] = 0.24 to 0.75 mm). The mean root resorption difference between CAT and PEA was statistically significant (P < 0.05) for 12 but not for 21, 11, or 22. Limitations One of the drawbacks is a lack of good quality prospective studies, specifically randomized clinical trials in the literature. Conclusions and implications Neither PEA or CAT technique leads to clinically significant root resorption (1 mm) of the maxillary incisors. The amount of EARR of maxillary incisors is not significant in comparing two treatment modalities (PEA and CAT), except for 12, where the PEA group has significantly more EARR when compared to CAT. Registration The protocol for this systematic review was based on the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 and was registered at PROSPERO database (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018113051). This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

The correlation between external apical root resorption and electric pulp test responses: a prospective clinical trial

“…14 Various factors including biological and mechanical elements are responsible for the initiation of EARR and its progress during orthodontic tooth movement. 15,16 The most common teeth to undergo EARR are the maxillary incisors and maxillary and mandibular canines, with the average amount of 0.2 to 2.93 mm. The error level of periapical radiographs is four times less than cephalometry radiographs.…”

“… 14 Various factors including biological and mechanical elements are responsible for the initiation of EARR and its progress during orthodontic tooth movement. 15 , 16 The most common teeth to undergo EARR are the maxillary incisors and maxillary and mandibular canines, with the average amount of 0.2 to 2.93 mm. The possible controversy regarding the average amount of EARR between studies is mostly due to difference in sample size, individual patient characteristics, type of the tooth considered for the study, type of orthodontic tooth movement, and the measurement method.…”

Clear aligner orthodontic treatment: Angle Society of Europe consensus viewpoint

“…The current evidence from one systematic review concluded that the use of clear aligners will not avoid root resorption, but both the incidence and severity of resorption could be lower compared with results of fixed appliance treatment (Fang et al, 2019). In addition, a further systematic review (Gandhi et al, 2021) found that neither preadjusted edgewise appliance or clear aligner therapy resulted in clinically significant root resorption (1 mm) of the maxillary incisors. However, while the amount of root resorption observed in relation to the maxillary incisors was not significantly different between the two treatment modalities, the maxillary right lateral incisor had significantly more root resorption with fixed appliance therapy (Gandhi et al, 2021).…”

“…In addition, a further systematic review (Gandhi et al, 2021) found that neither preadjusted edgewise appliance or clear aligner therapy resulted in clinically significant root resorption (1 mm) of the maxillary incisors. However, while the amount of root resorption observed in relation to the maxillary incisors was not significantly different between the two treatment modalities, the maxillary right lateral incisor had significantly more root resorption with fixed appliance therapy (Gandhi et al, 2021).…”

Applications of mini-implants in orthodontics

“…As more and more adult patients are undertaking orthodontic treatment, the emphasis for esthetic treatment modalities has increased. In addition to being esthetically pleasing, clear aligners have the advantage of applying low forces on the teeth, and thus can potentially lead to decreased root resorption as compared to fixed orthodontic appliances [23] . Over the years, the type of malocclusions that can be treated with clear aligners has increased because of the use of mini-implants with aligners.…”