Ó 2015 CEO

Original Article Published by / Édité par Elsevier Masson SAS

All rights reserved / Tous droits réservés

Article original

Resorption of maxillary incisors after

orthodontic treatment – clinical study of
risk factors
La re
sorption des incisives maxillaires apre
s
traitement orthodontique – e
tude clinique des
facteurs de risque

Rajae ELHADDAOUIa,*, Hicham BENYAHIAa, Mohamed-Faouzi AZEROUALa,

Fatima ZAOUIa, Rachid RAZINEb, Loubna BAHIJEa
a
Facult
e de m
edecine dentaire, universit
e Mohammed V Souissi-Rabat, avenue Mohamed El
Jazouli, BP 6212, Rabat, Morocco
b
Laboratoire de biostatistique de recherche clinique et d’
epid
emiologie (LBRCE), facult
e de
m
edecine et de pharmacie, universit
e Mohammed V Souissi-Rabat, avenue Mohamed El Jazouli,
BP 6203, Rabat, Morocco

Available online: 27 January 2016 / Disponible en ligne : 27 janvier 2016

Summary
sume
Re

Introduction: External apical root resorption (EARR) is one of

Introduction : Les resorptions radiculaires apicales externes
the major problems associated with orthodontic treatment. Such (RRAE) constituent l’un des problemes  majeurs du traitement
lesions represent an iatrogenic risk that must be detected as

orthodontique. Ces lesions

representent un risque iatrogene 
early as possible, with regular radiological follow-up and ^ decel
non intentionnel qui doit etre
e
le plus tot ^ possible, faire
appropriate therapeutic precautions. The causes and mechan-

l’objet de surveillance radiologique reguli  et de precautions
ere

isms leading to susceptibility to root resorption following the

therapeutiques.
eralement,
Gen


les causes et mecanismes
application of an orthodontic force are often not clear and are intervenant dans la susceptibilite
à la resorption

radiculaire
generally said to be of multifactorial origin. The aim of this suite à l’application d’une force orthodontique ne sont pas
clinical study was to analyze the factors linked to the occurrence clairs et on parle plutot ^ d’une origine multifactorielle. Cette
of moderate to severe resorption (MSR) of upper incisors during

etude clinique avait pour objectif d’analyser les facteurs lies

orthodontic treatment in a group of Moroccan patients treated

à la survenue des resorptions moder
ees

à sev
eres
 (RMS)
in the Dento-Facial Orthopedic Department of the Dental des incisives maxillaires durant le traitement orthodontique,
Consultation and Treatment Center (Centre de consultation et chez une population marocaine traitee
au service
de traitements dentaires [CCTD]) in Rabat.

d’orthopedie dentofaciale au Centre de consultation et de
traitements dentaires (CCTD) de Rabat.
Material and methods: A total of 82 patients (28% males, 72%

Materiel

et methode : Un total de 82 patients (28 hommes,
females) aged between 12 and 27, with various malocclusions, 72 femmes) ag ^ es

de 12 à 27 ans, presentant



differentes mal-
who had been treated with fixed appliances for at least 1 year occlusions qui avaient et
e
traitees

à l’aide d’appareils fixes
and for whom panoramic X-rays at the start, during and at the pendant au moins 1 an, et qui avaient des radiographies
end of treatment were available, were selected randomly. The panoramiques au debut,
en cours et à la fin de traitement,
reduction in maxillary incisor root length was evaluated using
e
selectionn
ont et

au hasard. La reduction
es
de la longueur
resorption scores. The factors studied in relation to the risk of des racines des incisives maxillaires a et
e
evalu


en se
ee

*
Correspondence and reprints / Correspondance et tire
s à part.
e-mail address / Adresse e-mail : rajae.elhaddaoui@gmail.com (Rajae Elhaddaoui)

48 International Orthodontics 2016 ; 14 : 48-64

http://dx.doi.org/10.1016/j.ortho.2015.12.015
 Resorption of maxillary incisors after orthodontic treatment – clinical study of risk factors

sorption des incisives maxillaires apre
La re s traitement orthodontique – e

tude clinique des facteurs de risque

occurrence of MSR were: age, sex, treatment duration, extrac-

basant sur des scores de resorption. Les facteurs dont on a
tion or non-extraction, type of malocclusion (Class I arch-

etudi e
l’association avec le risque de survenue des RMS
length discrepancy, Class II, Class III), the vertical diagnosis

etaient ^
: l’age, le sexe, la duree
de traitement, l’extraction
(normal, supraocclusion, open bite), presence of dysfunction, ou la non extraction, le type de malocclusion (Classe I DDM,
impacted canines and root morphology. Statistical analysis Classe II, Classe III), le diagnostic vertical (normal, supraclu-
was performed using SPSS software, version 18.0. Statistical

sie, beance),

la presence de dysfonctions, l’inclusion canine
tests used were: Kaplan-Meier analysis and the univariate and et la morphologie radiculaire. L’analyse statistique a et
e

multivariate Cox models for the study of factors associated with
ee
realis
par le logiciel SPSS version 18.0, les tests statis-
MSR. The threshold of significance adopted was 0.05. tiques utilises
sont : la methode

de Kaplan-Meier et le modele 
de Cox univarie
et multivarie
pour l’etude
des facteurs
associes
aux RMS. Le degre
de significativite
a et
e
fixe

à 0,05.
Results: The factors that were significantly associated with the

Resultats

: Les facteurs qui etaient
de façon statis-
associes
occurrence of MSR at the level of the upper incisors were: tooth tiquement significative au risque de survenue des RMS au
type, with a greater risk for the lateral incisor (HR = 3.2 95% niveau des incisives maxillaires sont : le type de dents avec
CI [2.3–4.5] P < 0.001), treatments with extraction
e
pour l’incisive laterale
un risque plus elev
(HR = 3,2 IC 95 %
(HR = 1.64 95% CI [1.16–2.33] P < 0.05), the presence of [2,3–4,5] p < 0,001), les traitements avec extractions
supraocclusion (HR = 2.17 95% CI [1.33–3.53] P < 0.05) or (HR = 1,64 IC 95 % [1,16–2,33] p < 0.05), la presence
de
open bite (HR = 3.12 95% CI [1.66–5.86] P < 0.001) and root supraclusie (HR = 2,17 IC 95 % [1,33–3,53] p < 0,05) ou de
malformation (HR = 1.5 95% CI [1.09–2.07] P < 0.05). Age,

beance (HR = 3,12 IC 95 % [1,66–5,86] p < 0,001) et la dys-
sex, type of malocclusion, dysfunction and impaction of canines morphie radiculaire (HR = 1,5 IC 95 % [1,09–2,07] p < 0,05).
were not associated at a statistically significant level with the ^
L’age,
de traitement, le type de malocclusion,
le sexe, la duree
risk of occurrence of MSR of the upper incisors.

les dysfonctions et l’inclusion canine n’etaient pas associes
de
façon statistiquement significative au risque de survenue des
RMS des incisives maxillaires.
Conclusion: EARR is difficult to avoid; the orthodontist’s role

Conclusion : Les RRAE sont difficilement evitables, ^ de
le role
remains crucial in identifying risk factors so as to adopt a l’orthodontiste reste crucial pour identifier les facteurs de ris-
treatment strategy taking these factors into account. In our

que, afin d’adapter la strategie

therapeutique en fonction de
population, the risk of MSR in the upper incisors appeared to ces facteurs. Dans notre population, le risque de RMS des
increase in treatments with extraction, situations of supraocclu- incisives maxillaires augmenterait dans les cas avec extrac-
sion or open bite, and in the presence of root abnormalities. tions, les cas de supraclusie et de beance


et en presence
Finally, clinical recommendations for the prevention of the d’anomalies radiculaires. En dernier lieu, des recommanda-
occurrence of MSR of the maxillary incisors are proposed, tak-

tions cliniques pour prevenir la survenue de RMS au niveau
ing into account all the risk factors identified. des incisives maxillaires et qui tiennent compte de l’ensemble
des facteurs de risque ont et
e
enonc



ees.
Ó 2015 CEO. Published by Elsevier Masson SAS. All rights Ó 2015 CEO. Édité par Elsevier Masson SAS. Tous droits
reserved réservés

Key-words
s
Mots-cle
·· Root resorption.
Severity.
·· Re
Se

sorption radiculaire.

ve

rite

.
·· Maxillary incisor.
Orthodontic treatment.
·· Incisive maxillaire.
Traitement orthodontique.

Introduction Introduction

External apical root resorption (EARR) of orthodontic origin is Les re
sorptions radiculaires apicales externes (RRAE) d’ori-
an unwanted iatrogenic consequence frequently associated gine orthodontique constituent la conse
quence iatroge

nique
with orthodontic treatment. Various studies [1–7] have non intentionnelle, constamment associe
e aux the
rapeu-
reported prevalence rates for EARR ranging between 65.6%
rentes e
tiques orthodontiques. En effet, diffe
tudes [1–7] ont
and 98%. rapporte
une pre
valence des RRAE qui variait de 65,6 %
à 98 %.

International Orthodontics 2016 ; 14 : 48-64 49

 Rajae ELHADDAOUI et al.

According to Harry and Sims [4], most cases of EARR are mild Selon Harry et Sims [4], la majorite
des RRAE sont le
ge res et
and clinically insignificant. However, when there is moderate cliniquement insignifiantes, alors que dans les cas de
resorption limited to one third of the apex, and more particu-
sorptions mode
re
re

es confine
es au tiers de l’apex, ou parti-
larly in cases of severe resorption affecting more than one third culierement dans les cas de re
sorptions se
ve
res de
passant le
of root length, the longevity of the dentition and, consequently, tiers apical de la longueur radiculaire, la longe
vite

du syste me
the stability of the orthodontic treatment could be at risk. dentaire et par conse
quent, la stabilite
du traitement orthodon-
tique seraient compromises.
The etiology and mechanisms of action of EARR of orthodon- L’e
tiologie et le me
canisme d’action des RRAE d’origine ortho-
tic origin are not entirely clear [8]; several studies [1–4,9–12] dontique ne sont pas entie rement e
lucide
s [8] ; plusieurs
have suggested a multifactorial etiology involving both indi-
tudes [1–4,9–12] ont e
e
voque
une e
tiologie multifactorielle
vidual factors (age, systemic disease, individual susceptibil- faisant appel à des facteurs individuels (a ^ge, maladies
ity, root morphology, genetic factors, etc.) and factors inherent syste
miques, susceptibilite
individuelle, morphologie radicu-
to the orthodontic treatment (duration, extractions, type of laire, facteurs ge
ne
tiques. . .) ainsi qu’à des facteurs inhe
rents
appliance, force applied, amplitude of movement, etc.). The au traitement orthodontique (la dure
e de traitement, les
aim of this study was first to describe the prevalence of EARR extractions, le type d’appareillage, la force applique
e, l’ampli-
at the level of the upper incisors and secondly to report on the tude de de
placement. . .). Le but de la pre
sente e
tude e
tait
incidence of moderate to severe resorptions (MSR) in this dans un premier temps de de
crire la pre
valence des RRAE
group of teeth and to analyze the contribution of general and au niveau des incisives maxillaires, et dans un deuxie me
therapeutic risks factors to the occurrence of this resorption. temps, de rapporter l’incidence des re
sorptions mode
re

es

ve
à se res (RMS) au niveau de ce groupe de dents, ainsi que
la contribution des facteurs de risque ge
ne

raux et the
rapeu-
tiques dans la survenue de ces re
sorptions.

Materials and methods
riels et me

Mate
thodes

The sample
chantillon

L’e

The files of 350 patients were consulted; these are subjects Les dossiers de 350 patients ont e
te

consulte

s, il s’agit des
who finished a course of orthodontic treatment between 2003 sujets ayant acheve
leur traitement orthodontique entre 2003
and 2014 at the Dento-Facial Orthopedic Department of the et 2014 au Centre de consultation et de traitements dentaires
Dental Consultation and Treatment Center (Centre de consul- (CCTD) de Rabat. L’e
tude a concerne
318 dents chez
tation et de traitements dentaires [CCTD]) in Rabat. The study 82 patients se
lectionne
s au hasard, ayant satisfait aux
concerned 318 teeth in 82 randomly selected patients who res d’inclusion suivants : a
crite ^ge  12 ans, dure
e minimale
met the following inclusion criteria: age  12 years, minimum du traitement multi-attache de 12 mois, avec un bilan radiolo-
duration of multi-bracket treatment: 12 months, with com- gique complet avant, au cours et à la fin de traitement.
plete radiological work-up before, during and after treatment.
Exclusion criteria were as follows: patients suffering from res d’exclusion e
Les crite
taient les suivants : les patients
systemic diseases (diabetes, osteoarthritis, hypothyroidism,
sentant des maladies syste
pre
miques (diabe te, arthrose,
etc.), labio-alveolar-palatal clefts, previous traumatic epi- hypothyroı̈die. . .), des fentes labio-alve
olo-palatines, des
sodes, periodontal disease, immature incisors, endodonti-
ce
ante
dents de traumatisme ante
rieur, des parodontopathies,
cally-treated teeth, cases of bruxism and orthodontic-surgical des incisives immatures, des dents traite
es endodontique-
cases. ment, les cas de bruxisme et les cas orthodonticochirurgicaux.

The variables Les variables

In the selected patient files, the following factors were exam- Les dossiers retenus ont e
te

examine
s afin de relever les
ined so as to identify a possible association with the occur- facteurs dont on a e
tudie

l’association avec la survenue de
rence of MSR: age, sex, treatment duration, type of treatment ^ge, le sexe, la dure
RMS, à savoir : l’a
e de traitement, le type de
(with or without extractions), the type of malocclusion (Class 1 traitement (avec ou sans extractions), le type de malocclusion
arch-length discrepancy, Class II, Class III), the vertical diag- (Classe I DDM, Classe II, Classe III), le diagnostic occlusal
nosis (normal, supraocclusion, open bite), swallowing dys- vertical (normal, supraclusie, be
ance), la de

glutition dysfonc-
function, impacted canines and root morphology (normal, or tionnelle, l’inclusion canine et la morphologie radiculaire (nor-
root abnormality). male, anomalie radiculaire).

50 International Orthodontics 2016 ; 14 : 48-64

 Resorption of maxillary incisors after orthodontic treatment – clinical study of risk factors

sorption des incisives maxillaires apre
La re s traitement orthodontique – e

tude clinique des facteurs de risque

[(Fig._1)TD$IG]

Fig. 1: Classification of root morphology abnormalities

according to Levander and Malmgren (1998) [13].
Fig. 1 : Classification des anomalies de la morphologie
radiculaire selon Levander et Malmgren (1998) [13].

The start of treatment panorex was used for the study of root La radiographie panoramique du de
but de traitement a e
te


morphology abnormalities, based on the Levander and
e pour l’e
utilise
tude des anomalies de la morphologie radicu-
Malmgren classification (1998) [13] (fig. 1). laire en se basant sur la classification de Levander et
Malmgren (1998) [13] (fig. 1).
Root resorption was evaluated using the panoramic X-rays Les radiographies panoramiques demande
es au cours et à la
obtained during and at the end of treatment, with reference fin du traitement orthodontique ont e
te

examine
es pour
to the scores of the Levander and Malmgren classification
valuation des RRAE, en se re
l’e
fe

rant aux scores de la classi-
(1998) [14] (fig. 2). fication de Levander et Malmgren (1998) [14] (fig. 2).
Teeth showing signs of EARR were divided into 2 sub-groups Pour les dents pre
sentant des RRAE, elles ont e
te

divise

es en
according to the severity of resorption: slight resorption (SR) 2 sous-groupes selon la se
ve

rite
de la re
sorption : les
and moderate to severe resorption (MSR). re
sorptions le
ge
 res (RL), et les re
sorptions mode
re

es

ve
à se res (RMS).
The aim was to determine retrospectively the time to occur- Le but e
tait de de
terminer de manie re re

trospective le de
lai de
rence of MSR. For this purpose: survenue des RMS, pour cela :
— the period of evaluation of SRs extended from the date of — le de
lai d’e
valuation des RL s’e
tendait de la date du de
but
start of treatment to the date of end of treatment; de traitement à la date de fin de traitement ;
— the period of evaluation of MSRs extended from the date of — le de
lai d’e

valuation des RMS s’e
tendait de la date du de
but
start of treatment to the date of the panorex on which these de traitement à la date de la radiographie panoramique où ces
resorptions were visible W 6 months (fig. 3). re
sorptions e
taient visibles W 6 mois (fig. 3).

Statistical analysis L’analyse statistique

Descriptive: to describe the characteristics of the sample the Descriptive : pour de
crire les caracte
ristiques de l’e
chantillon,
quantitative variables were expressed as mean W standard les variables quantitatives sont exprime
es en
deviation, and the qualitative variables were expressed as moyenne W e
cart-type et les variables qualitatives sont
number and percentage. exprime
es en effectif et pourcentage.
Analytical: the occurrence of MSR was studied using the Analytique : l’e
tude de la survenue des RMS a e
te

re

alise

e par
Kaplan-Meier method. The characteristics of the MSR group la me
thode de Kaplan-Meier. Nous avons compare
le groupe
and the SR group were compared by means of the Log Rank avec RMS et le groupe avec RL concernant les diffe
rentes
test. Factors associated with MSR were studied using the Cox caracte
ristiques par le test de Log Rank. L’e
tude des facteurs
univariate and multivariate models. The multivariate model associe
s aux RMS a e
te

re

alise
e par le mode le de Cox uni-
comprised the variables which were associated at a statisti- varie
et multivarie

. Le mode le multivarie
ae
te

constitue
par les
cally significant level, or with P < 0.30 in the univariate variables qui e
taient associe
es de façon statistiquement sig-
analysis. The significance level adopted was 0.05. nificative, ou avec un p < 0,30 en analyse univarie
e. Le degre


ae
de significativite
te

fixe
à 0,05.

International Orthodontics 2016 ; 14 : 48-64 51

 Rajae ELHADDAOUI et al.

[(Fig._2)TD$IG]

Fig. 2: Stages of EARRs according to the classification of

Levander and Malmgren (1998) [14]. Score 0: regular root
outline; score 1: slight resorption, the outline of the apex is
diffuse, softened (< 2 mm); score 2: moderate resorption
(> 2 mm), the outline of the apex is discontinuous
(1/2 circle), resorption is limited to the apical third; score
3: severe resorption, the outline of the apex is very irregular,
resorption extends beyond the apical third.
Fig. 2 : Stades des RRAE selon la Classification de
Levander et Malmgren (1998) [14]. Score 0 : contour radi-
culaire re
gulier ; score 1 : re
sorption le
ge re, le contour de
l’apex est diffus/e
mousse
(< 2 mm) ; score 2 : re
sorption
mode
re

e (> 2 mm), le contour de l’apex est discontinu (demi
cercle), la re
sorption est confine
e à un tiers apical ; score 3 :
re
sorption se
ve
 re, le contour de l’apex est tre s irre

gulier, la
re
sorption de
passe le tiers de l’apex.

Results
sultats
Re

The characteristics of the study population are presented in Description de l’e
chantillon : les caracte
ristiques de
Table I.
chantillon sont pre
l’e
sente
es dans le Tableau I.
Females were predominant in our sample (72%) compared to Le sexe fe
minin e
tait pre

dominant dans notre e
chantillon
males (28%); ages varied between 12 and 27 with an average (72 %) par rapport au sexe masculin (28 %), l’a ^ge variait de
of 16.8 W 4.3 years, while the average duration of treatment 12 à 27 ans, avec une moyenne de 16,8 W 4,3 ans et la dure
e
was 30.7 W 10.7 months. Treatments with and without extrac- moyenne de traitement e
tait de 30,7 W 10,7 mois. Les traite-
tions were almost equivalent in number, 52.4% and 47.6%, ments avec extractions e
taient re

alise

s presque selon la
respectively. me ^me fre
quence que les traitements sans extractions
(52,4 % et 47,6 % respectivement).
[(Fig._3)TD$IG]

Fig. 3: Method of evaluation of time to occurrence of MSR.

thode d’e
Fig. 3 : Me
valuation du de

lai de survenue des RMS.

52 International Orthodontics 2016 ; 14 : 48-64

 Resorption of maxillary incisors after orthodontic treatment – clinical study of risk factors

sorption des incisives maxillaires apre
La re s traitement orthodontique – e

tude clinique des facteurs de risque

Table I Tableau I
Characteristics of the sample.
ristiques de l’e
Caracte
chantillon.

Variables / Variables Values / Valeurs

a
Age (years) / Âge (annees) 16.8 W 4.3
Sex / Sexeb
Male / Masculin 29 (28)


Female / Feminin 236 (72)
Type of teeth / Type de dentsb
Central / Centrale 164 (50)


Lateral / Laterale 164 (50)
Treatment duration (months) / Duree
de traitement (mois)a 30.7 W 10.7
Type of treatment / Type de traitementb
Non-extraction / Sans extractions 156 (47.6)
Extraction / Avec extractions 172 (52.4)
Type of malocclusion / Type de malocclusionsb
Class I ALD / Classe I DDM 188 (64.4)
Class II / Classe II 88 (30.1)
Class III / Classe III 16 (5.5)
Vertical diagnosis / Diagnostic verticalb
Normal / Normal 96 (29.3)
Overbite / Supraclusie 152 (46.3)


Open bite / Beance 80 (24.4)
Dysfunctions / Dysfonctionsb
No / Non 164 (50)


Dysfunctional swallowing / Deglutition dysfonctionnelle 164 (50)
b
Impacted canine / Canine incluse
No / Non 288 (87.8)
Yes / Oui 40 (12.2)
Root morphology / Morphologie radiculaireb
Normal / Normale 160 (50.3)
Root anomaly / Anomalie radiculaire 158 (49.7)
a
Expressed as mean W standard deviation / Exprim
e en moyenne W
ecart-type.
b
Expressed as actual and percentage / Exprim
e en effectif et pourcentage.

Class I ALD was the most frequent (64.4%), followed by Class La classe I DDM e
tait plus fre
quente (64,4 %), suivie de la
II (30.1%), while Class III represented only 5.5% of maloc- classe II (30,1 %), la classe III ne repre
sentait que 5,5 % des
clusions. Supraocclusion was predominant, with a frequency malocclusions. La supraclusie e
tait pre

dominante avec une
of 46.3%, while open bite cases represented 24.4%.
quence de 46,3 %, alors que les cas de be
fre
ance repre
sen-
Swallowing dysfunction was present in 50% of cases, and taient 24,4 %. Les cas de de
glutition dysfonctionnelle
there were 12.2% of impacted canines. The frequency of roots repre
sentaient 50 %, et l’inclusion canine e
tait note

e dans
with abnormalities was almost identical to that of roots without 12,2 %. La fre
quence des racines avec anomalies radiculaires
(49.7% and 50.3%, respectively).
tait presque e
e
gale à celle des racines sans anomalies radi-
culaires (49,7 % et 50,3 % respectivement).
When comparing the two incisors (Table II), the presence of En comparant les deux incisives (Tableau II), la pre
sence
root abnormalities was greater in the lateral, essentially on d’anomalies radiculaires e
tait plus pre
dominante pour l’inci-
account of the presence of short roots (22.2%), apical hook
rale, essentiellement par la fre
sive late
quence importante des
(24.1%) and thin roots (12%), compared with the central racines courtes (22,2 %), des apex coude
s (24,1 %) et gre
^ les

International Orthodontics 2016 ; 14 : 48-64 53

 Rajae ELHADDAOUI et al.

Table II Tableau II
Description of the root morphology according to the type of Description de la morphologie radiculaire selon le type de
teeth. dents.

Root morphology / Morphologie radiculaire P/p

Actual (%) / Effectif (%)
Tooth / Dent Normal / Short root / Blunt apex / Angled apex / Small apex /
Normale Racine courte

Apex emouss e
Apex coude
^
Apex grele
Central / Centrale 96 (60) 10 (6.3) 33 (20.6) 8 (5) 13 (8.1) 0.001


Lateral / Laterale 64 (40.5) 35 (22.2) 5 (3.2) 38 (24.1) 19 (12)

incisor, with 6.3%, 5% and 8.1%, respectively. This differ- (12 %), comparativement à l’incisive centrale (6,3 %, 5 % et
ence was statistically significant (P < 0.001). 8,1 % respectivement). Cette diffe
rence e
tait statistiquement
significative (p < 0,001).
The prevalence of EARR in our sample was 95%. In total, La pre
valence des RRAE dans notre e
chantillon e
tait de 95 %.
35.7% were slight resorptions (score 1), 40.3% were moderate Au total, 35,7 % e
taient des re
sorptions le
ge res (score 1),
(score 2), while severe resorptions (score 3) represented 19% 40,3 % e
taient des re
sorptions mode
re

es (score 2), alors
(Table III). que les re
sorptions se
ve
res (score 3) repre
sentaient 19 %
(Tableau III).
Incidence of moderate and severe resorptions (MSR): Incidence des re
sorptions mode
re

es à se

veres (RMS) :
— overall incidence: at 18 months, the estimated incidence — incidence globale : à 18 mois ; l’incidence des RMS a e
te


of MSR was 10%, at 24 months it was 31%, and 70% of MSR estime
e à 10 %, à 24 mois, cette incidence e
tait de 31 %,
occurred at 36 months and beyond (fig. 4); alors que 70 % des RMS ont survenu à partir de 36 mois
(fig. 4) ;
— incidence of MSR depending on the different variables: in — incidence des RMS selon les diffe
rentes variables : d’une
general, and for all the variables, the incidence of MSR manie re ge
ne

rale, et pour toutes les variables, l’incidence des
increased over time, from 18 to 24 months and then to RMS augmentait avec le temps, en allant de 18 mois
36 months. The incidence of MSR increased more signifi- à 24 mois, puis à 36 mois. L’incidence des RMS augmentait
cantly between 24 months and 36 months (12-month interval) de façon plus marque
e de 24 mois à 36 mois (12 mois
than between 18 months and 24 months (6-month interval) d’intervalle) que de 18 mois à 24 mois (6 mois d’intervalle)
(Table IV). (Tableau IV).
The incidence of MSR was higher among males (75.2%) than L’incidence des RMS e
tait plus importante chez le sexe mas-
females (67.4%). According to tooth type, the incidence of culin (75,2 %), que chez le sexe fe
minin (67,4 %). Selon le
MSR was higher for lateral incisors (82.5%). type de dents, l’incidence des RMS e
tait plus e
leve
e pour
l’incisive late
rale (82,5 %).

Table III Tableau III

Prevalence of EARR.
valence des RRAE.
Pre

Resorption stage / Stade de resorption Values / Valeurs
Actual (%) / Effectif (%)


Absence of resorption (score 0) / Absence de resorption (score 0) 16 (5)



Mild resorption (score 1) / Resorption legere (score 1) 113 (35.7)


Moderate resorption (score 2) / Resorption
ee
moder
(score 2) 128 (40.3)


Severe resorption (score 3) / Resorption
ere
sev  (score 3) 61 (19)

54 International Orthodontics 2016 ; 14 : 48-64

 Resorption of maxillary incisors after orthodontic treatment – clinical study of risk factors

sorption des incisives maxillaires apre
La re s traitement orthodontique – e

tude clinique des facteurs de risque

[(Fig._4)TD$IG]

Fig. 4: Curve of occurrence of MSR.

Fig. 4 : Courbe de survenue des RMS.

Concerning the other variables, the incidence of MSR was also Pour les autres variables, l’incidence des RMS e
tait e

galement
higher in cases with extractions (80%), class II malocclusions plus importante dans les cas avec extractions (80 %), les
(78%), supraocclusion (76%) and open bite (80%), and in the malocclusions de classe II (78 %), les cas de supraclusie
presence of swallowing dysfunction (77.4%) and root dys- (76 %) et de be
ance (80 %), les cas de de
glutition dysfonc-
morphism (71.6%). tionnelle (77,4 %) et de dysmorphie radiculaire (71,6 %).
Factors associated with MSR: when the contribution of each Les facteurs associe
s aux RMS : en e
valuant la contribution
factor was evaluated independently of the others by univariate de chaque facteur inde
pendamment des autres par analyse
analysis, the factors significantly associated with the risk of univarie
e, les facteurs significativement associe
s au risque de
occurrence of MSR were: tooth type, with a higher risk for the survenue des RMS e
taient : le type de dents avec un risque
lateral incisor (P < 0.001), treatments with extractions plus e
leve

pour l’incisive late
rale (p < 0,001), les traitements
(P < 0.001), supraocclusion (P < 0.001) and open bite avec extractions (p < 0,001), la supraclusie (p < 0,001) et la
(P < 0.001), swallowing dysfunction (P < 0.05) and abnormal be
ance (p < 0,001), la de
glutition dysfonctionnelle (p < 0,05)
root morphology (P < 0.05). et la morphologie radiculaire anormale (p < 0,05).
The aim of multivariate analysis is to study the contribution of L’analyse multivarie
e vise à e
tudier la contribution de tous les
all factors simultaneously. The variables entered into the mul- facteurs simultane
ment. Les variables introduites dans le
tivariate model were those significantly associated with MSR, mode le multivarie
e
taient associe
es de façon statistiquement
or having a P-value < 0.30 in univariate analysis. significative ou avec un p < 0,30 en analyse univarie
e.
In multivariate analysis (Table V), and adjusting for all vari- En analyse multivarie
e (Tableau V) et en ajustant sur toutes
ables, the factors that were associated with the occurrence of les variables, les facteurs qui e
taient associe
s de façon statis-
MSR at a statistically significant level are: tooth type, with a tiquement significative au risque de survenue des RMS sont :
higher risk for the lateral incisor (HR = 3.2 95% CI [2.3–4.5] le type de dents avec un risque plus e
leve

pour l’incisive
P < 0.001), treatment with extractions (HR = 1.64 95% CI
rale (HR = 3,2 IC 95 % [2,3–4,5] p < 0,001), les traite-
late
[1.16–2.33] P < 0.05), the presence of open bite (HR = 3.12 ments avec extractions (HR = 1,64 IC 95 % [1,16–2,33]
95% CI [1.66–5.86] P < 0.001) or supraocclusion (HR = 2.17 p < 0,05), la pre
sence de be
ance (HR = 3,12 IC 95 % [1,66–
95% CI [1.33–3.53] P < 0.05) and root dysmorphism 5,86] p < 0,001) ou de supraclusie (HR = 2,17 IC 95 % [1,33–
(HR = 1.5 95% CI [1.09–2.07] P < 0.05) (Table VI). 3,53] p < 0,05) et la dysmorphie radiculaire (HR = 1,5 IC 95 %
[1,09–2,07] p < 0,05) (Tableau VI).
In our study, the risk of occurrence of MSR was multiplied by: Dans notre e
tude, le risque de survenue des RMS augmentait
de :
— 3 for the lateral incisor (95% CI [2.3–4.5] P < 0.001); — 3 fois plus pour l’incisive late
rale (IC 95 % [2,3–4,5]
p < 0,001) ;
— 1.64 for cases with extractions (95% CI [1.16–2.33] — 1,64 fois plus dans les cas avec extractions (IC 95 %
P < 0.05); [1,16–2,33] p < 0,05) ;
— 2 for cases of supraocclusion (95% CI [1.33–3.53] — 2 fois plus dans les cas de supraclusie (IC 95 % [1,33–
P < 0.05); 3,53] p < 0,05) ;

International Orthodontics 2016 ; 14 : 48-64 55

 Rajae ELHADDAOUI et al.

Table IV
Incidence of MSR according to sex, type of teeth, type of
treatment, type of malocclusion, vertical diagnosis, presence
of dysfunctions, presence of impacted canines and root
morphology.
Tableau IV
Incidence des RMS selon le sexe, le type de dents, le type de
traitement, le type de malocclusion, le diagnostic vertical, la
pre
sence de dysfonctions, de canine incluse et la morphologie
radiculaire.

Variables / Variables Incidence at Incidence at Incidence at

18 months (%) / 24 months (%) / 36 months (%) /
Incidence à Incidence à Incidence à
18 mois (%) 24 mois (%) 36 mois (%)
Sex / Sexe
Male / Masculin 15 37.7 75.2


Female / Feminin 8.4 29 67.4

Type of teeth / Type de dents

Central / Centrale 2.6 16.5 56.2


Lateral / Laterale 6 46 82

Type of treatment / Type de traitement

Non-extraction / Sans extractions 4 24 54
Extraction / Avec extractions 2 38 80

Type of malocclusion / Type de malocclusions

Class I ALD / Classe I DDM 2.8 28 67.6
Class II / Classe II 5.8 34.8 78
Class III / Classe III 18.7 32 50

Vertical diagnosis / Diagnostic vertical

Normal / Normal 6 14 44
Overbite / Supraclusie 3 35 76


Open bite / Beance 16 49 80

Dysfunctions / Dysfonctions
No / Non 9 22.4 61.2


Dysfunctional swallowing / Deglutition dysfonctionnelle 2.5 40 77.4

Impacted canine / Canine incluse

No / Non 3 34.4 71.6
Yes / Oui 5 12.5 55

Root morphology / Morphologie radiculaire

Normal / Normale 0.6 22.3 68.6
Root malformation / Dysmorphie radiculaire 4.5 40.5 71.6

56 International Orthodontics 2016 ; 14 : 48-64

 Resorption of maxillary incisors after orthodontic treatment – clinical study of risk factors

sorption des incisives maxillaires apre
La re s traitement orthodontique – e

tude clinique des facteurs de risque

Table V Tableau V
The factors associated with the occurrence of MSR in Les facteurs associe
s à la survenue de RMS en analyse
univariate and multivariate analysis.
e et multivarie
univarie
e.

Independent variables / Univariate analysis / Multivariate analysis /

Variables independantes

Analyse univariee

Analyse multivariee
HR / CI 95% / P/p HR / CI 95% / P/p
HR IC 95 % HR IC 95 %
Age / Âge 1 0.97–1.04 0.76
Sex / Sexe
Male / Masculin 1 1


Female / Feminin 0.76 0.56–1.03 0.08 0.8 0.56–1.13 0.2
Type of teeth / Type de dents
Central / Centrale 1 1


Lateral / Laterale 2.7 2.00–3.65 < 0.001 3.2 2.3–4.5 < 0.001

de traitement
Duration of treatment / Duree 1 0.97–1 0.35
Type of treatment / Type de traitement
Non-extraction / Sans extractions 1 1
Extraction / Avec extractions 1.8 1.79–1.32 < 0.001 1.64 1.16–2.33 0.005
Type of malocclusion / Type de malocclusion
Class I ALD / Classe I DDM 1 1
Class II / Classe II 1.33 0.97–1.84 0.07 1.13 0.8–1.6 0.4
Class III / Classe III 0.7 0.33–1.42 0.31 0.6 0.28–1.35 0.2
Vertical diagnosis / Diagnostic vertical
Normal / Normal 1 1
Overbite / Supraclusie 2 1.32–2.86 < 0.001 2.17 1.33–3.53 0.002


Open bite / Beance 2.77 1.80–4.26 < 0.001 3.12 1.66–5.86 < 0.001
Dysfunctions / Dysfonctions
No / Non 1 1
Dysfunctional swallowing / 1.56 1.16–2.08 0.04 1.09 0.72–1.64 0.67


Deglutition dysfonctionnelle
Impacted canine / Canine incluse
No / Non 1 1
Yes / Oui 0.63 0.4–1.02 0.061 0.53 0.2–1.4 0.72
Root morphology / Morphologie radiculaire
Normal / Normale 1 1
Root malformation / Dysmorphie radiculaire 1.32 1.00–1.76 0.04 1.5 1.09–2.07 0.01


HR: high of the resorption / hauteur de la resorption.

International Orthodontics 2016 ; 14 : 48-64 57

 Rajae ELHADDAOUI et al.

Table VI Tableau VI
Recap of the factors associated in statistically significant Re
capitulatif des facteurs associe

s de façon statistiquement
manner with the risk of onset of MSR. significative au risque de survenue des RMS.

Variables / Variables HR / HR CI 95% / IC 95 % P/p

Lateral incisor / L’incisive laterale 3.2 2.3–4.5 < 0.001
Extraction treatments / Les traitements avec extractions 1.64 1.16–2.33 0.005
Overbite / La supraclusie 2.17 1.33–3.53 0.002


Open bite / La beance 3.12 1.66–5.86 < 0.001
Root anomalies / Les anomalies radiculaires 1.5 1.09–2.07 0.01


HR: high of the resorption / hauteur de la resorption.

— 3 for cases of open bite (95% CI [1.66–5.86] P < 0.001); — 3 fois plus dans les cas de be
ance (IC 95 % [1,66–5,86]
p < 0,001) ;
— 1.5 for cases with root abnormalities (95% CI [1.09–2.07] — 1,5 fois plus dans les cas avec anomalies radiculaires (IC
P < 0.05). 95 % [1,09–2,07] p < 0,05).

Discussion Discussion

Since this was a retrospective study, the evaluation of EARRs Puisqu’il s’agit d’une e
tude re
trospective, l’e
valuation des
and their evolution was performed using the panorex that was RRAE et leur e
volution a e
te

re
alise
e en utilisant le cliche

part of the standard radiological examination at start and end panoramique qui fait partie du bilan radiologique standard
of treatment and that is also often prescribed during treatment. du de
but et de fin de traitement, et qui est souvent prescrit
Unlike a periapical X-ray, the panorex does not enable root en cours de traitement. La radiographie panoramique ne per-
length to be measured in millimeters. We therefore chose to met pas une mensuration en millime tres de la longueur radi-
use the scores of the Levander and Malmgren classification culaire comparativement à la radiographie pe
ri-apicale, pour
(1998) [14]. In a previous study [15], the same method was cela, nous avons opte
pour des scores de la classification de
used. The results in terms of prevalence and severity were Levander et Malmgren (1998) [14]. Dans une e
tude
similar to those of other studies [10,16] that used periapical X- pre
ce
dente [15], la me ^me me
thode a e
te

utilise

e ; les re

sultats
rays. en termes de pre
valence et de se
ve
rite

e
taient similaires
à d’autres e
tudes [10,16] ayant utilise
la radiographie pe
ri-
apicale.
Our study concerned the upper incisors, which are considered Notre e
tude a concerne
les incisives maxillaires conside
re

es
to be the teeth most susceptible to EARR. Hollender et al. [17] comme e
tant les dents les plus sujettes aux RRAE : Hollender
noted a frequency of EARR of 72.9% for the maxillary incisors et al. [17] ont rapporte
une fre

quence des RRAE de 72,9 % au
against 34.7% for the other teeth. niveau des incisives maxillaires, alors qu’elle n’e
tait que de
34,7 % au niveau des autres dents.
The frequency of EARR in our sample was 95%, including La fre
quence des RRAE dans notre e
chantillon e
tait de 95 %
19% severe resorptions. Data in the literature confirm this dont 19 % e
taient des re
sorptions se
veres. Les donne
es de la
observation, with frequencies of EARR at the level of the
rature confirmaient ce constat en rapportant une
litte
upper incisors ranging from 73% to 98%, of which 2 to fre
quence des RRAE au niveau des incisives maxillaires de
17.2% were severe resorptions [13,18,19]. 73 % à 98 %, dont 2 à 17,2 % e
taient des re
sorptions se
ve
res
[13,18,19].
We focused our study on moderate to severe resorptions Nous avons concentre
notre e
tude sur les re
sorptions
(59.5% of the EARR in our sample). In terms of incidence, mode
re

es à se
veres (59,5 % des RRAE dans notre
10% of the cases of MSR occurred at 18 months, 31% at
chantillon) ; en termes d’incidence, 10 % de ces RMS surve-
e
24 months, and 70% from 36 months onwards. Other studies naient à 18 mois, 31 % à 24 mois, alors que 70 % des RMS
[10,16,20] confirmed this observation, considering that the survenaient à partir de 36 mois. D’autres e
tudes pre
ce
dentes
severity of resorptions increased after 18 months of treatment; [10,16,20] e
taient en accord avec ce constat, en estimant que
the highest risk for MSR was recorded after 33 to 38 months of la se
ve

rite

des re
sorptions augmentait apre s 18 mois de trai-
treatment. tement, le risque le plus e
leve
des RMS ayant e
te

enregistre

apre s 33 à 38 mois de traitement.

58 International Orthodontics 2016 ; 14 : 48-64

 Resorption of maxillary incisors after orthodontic treatment – clinical study of risk factors

sorption des incisives maxillaires apre
La re s traitement orthodontique – e

tude clinique des facteurs de risque

Several preceding studies [7,9,10,12,16,21–28] looked at the Plusieurs e
tudes pre

ce

dentes [7,9,10,12,16,21–28] ont e
tudie


severity of EARR after orthodontic treatment and the factors
ve
la se
rite

des RRAE apre s traitement orthodontique et les
associated with it: the results of these studies and our study are
s ; la comparaison des re
facteurs qui y sont associe
sultats de
presented in Table VII. ces e
tudes avec ceux de la pre
sente e

tude a e

te

pre

sente
e
dans le Tableau VII.

Sex and age ^ge

Sexe et a

Our study showed that the incidence of MSR was higher in Notre e
tude a montre
que l’incidence des RMS e
tait plus
males (75.2% at 36 months) than in females (67.4% at
leve
e
e chez les hommes (75.2 % à 36 mois) que chez les
36 months), although this difference was not statistically sig- femmes (67,4 % à 36 mois), bien que cette diffe
rence ne fût
nificant. As in most previous studies [7,10,12,14,16,25–28], pas statistiquement significative. Comme dans la plupart des
gender does not seem to be a risk factor for MSR.
tudes pre
e
ce

dentes [7,10,12,14,16,25–28], le sexe ne sem-
blerait pas e^tre un facteur de risque des RMS.
In line with majority of previous studies [12,14,21,25,27,28], De me ^me que la majorite
des e
tudes ante
rieures
our results showed no association between age and the risk of [12,14,21,25,27,28], l’a ^ge n’e

tait pas associe
au risque de
occurrence of MSR (P > 0.05). Mavragani et al. [6] showed survenue des RMS (p > 0,05). Mavragani et al. [6] ont montre

that it was not chronological age that was a factor associated ^ge chronologique ne serait pas un facteur associe
que l’a
à la
with the severity of resorption but rather the degree of maturity se
ve

rite

des re
sorptions, mais pluto
^t le degre
de maturite

de
of the apex, which would explain why subjects in different age l’apex, ce qui expliquerait que des sujets de diffe
rentes
groups but with the same degree of apex maturity can present tranches d’a ^ge mais avec le me ^me degre
de maturite
de
the same level of root resorption. l’apex, pourraient avoir la me ^me quantite
de re
sorption
radiculaire.

Tooth type Le type de dent

As in some other studies [9,10], the lateral incisor was more À l’instar des autres e
tudes [9,10], l’incisive late

rale e

tait plus
affected by MSR than the central (HR = 3.2 95% CI [2.3–4.5] touche
e par les RMS que l’incisive centrale (HR = 3,2 IC 95 %
P < 0.001). This can be explained essentially by the higher [2,3–4,5] p < 0,001). Ceci serait principalement explique
par
and statistically significant incidence (P < 0.001) of root la pre
dominance e
leve
e et statistiquement significative
abnormalities in the lateral incisor compared with the central (p < 0,001) d’anomalies radiculaires au niveau de l’incisive
incisor (Table II). In this study, as in all previous studies late
rale comparativement à l’incisive centrale (Tableau II) ;
[9,10,14,24,26,27], there was a higher incidence of severe or, comme la pre
sente e
tude, toutes les e
tudes pre
ce
dentes
resorptions in cases with root abnormalities. [9,10,14,24,26,27] avaient montre
une incidence plus e
leve
e
de re
sorptions se
ve
res dans les cas d’anomalies radiculaires.

Extractions Les extractions

It was noted that cases with extractions of the premolars pre- On a constate
que les cas avec extractions de pre
molaires
sented higher levels of MSR than cases without extractions pre
sentaient plus de RMS que les cas sans extractions
(HR = 1.64 95% CI [1.16–2.33] P < 0.05). These results con- (HR = 1,64 IC 95 % [1,16–2,33] p < 0,05). Ces re
sultats con-
firm those of previous studies [24–26,28,29] and could be due firmaient ceux des e
tudes pre
ce

dentes [24–26,28,29] et ceci
to the fact that treatments with extractions are generally asso- ^tre dû au fait que les traitements avec extractions
pourrait e
ciated with longer treatment duration and greater amplitude of
ne
sont ge
ralement associe
s à des dure

es de traitement et des
tooth movement [28,30]. Several preceding studies amplitudes de mouvements plus importantes [28,30].
[14,21,22,24–26,28] showed that the severity of resorption Plusieurs e
tudes pre
ce

dentes [14,21,22,24–26,28] ont mon-
increased with the duration of treatment, although in our study
que la se
tre
ve

rite

des re

sorptions augmentait avec la dure
e
the association between these two factors was not statistically de traitement, bien que ces deux facteurs ne fussent pas
significant (P > 0.05). associe
s de façon statistiquement significative dans notre

tude (p > 0,05).
e

Root morphology La morphologie radiculaire

The results of our study show that the risk of occurrence of
sultats de notre e
Les re
tude ont montre
que le risque de
MSR was greater in cases with root abnormalities (HR = 1.5 survenue des RMS e
tait plus important dans les cas

International Orthodontics 2016 ; 14 : 48-64 59

60

Rajae ELHADDAOUI et al.

Table VII Tableau VII
Comparison of factors associated with severity of resorption of Comparaison des facteurs associe
s à la se

ve

rite

des re

sorptions des incisives maxillaires
maxillary incisors between previous studies and present
tudes pre
entre les e
ce

dentes et la pre

sente e
tude.
study.

Authors / Auteurs Sex / Sexe Age / Âge Duration of Extraction/ Type of Supraocclusion / Open bite / Dysfunctional Root morphology /
treatment / non-extraction / malocclusion / Supraclusion

Beance swallowing / Morphologie radiculaire
Duree
de Extractions/ Type de

Deglutition
traitement Non-extractions malocclusion dysfonctionnelle
Linge and Linge (1991) / No / Non No / Non – – – No / Non Yes / Oui Yes / Oui –
Linge et Linge (1991)
Mirabelle and Artun (1995) / – – No / Non – No / Non No / Non Yes / Oui – Yes: short roots /
Mirabelle et Artun (1995) Oui : racines courtes
Baumrind et al. (1996) Male ++ / No / Non Yes / Oui No / Non No / Non No / Non – – –
Masculin ++
Levander et al. (1998) No / Non No / Non Yes / Oui – – – – – Yes: blunt apex /
Oui : apex mousses
Mavragani et al. (2000) No / Non Yes / Oui No / Non – – No / Non – No / Non No / Non
Sameshima and Sinclair (2003) / No / Non Adult > young / – – – No / Non – – Yes: pointed/angled apices /
Sameshima et Sinclair (2003) Adulte > jeune

Oui : apex pointus/coudes
Brin et al. (2003) – – Yes / Oui – Cl. II,1 > Cl. I / – – – –
Cl. II,1 > Cl. I
Nishioka et al. (2005) – – – No / Non – – – No / Non Yes: root anomaly /
Oui : anomalie radiculaire
Mohandesan et al. (2007) Women ++ / – Yes / Oui Yes / Oui – – – – –
Femmes ++
International Orthodontics 2016 ; 14 : 48-64

Ruo-ping Jiang et al. (2010) No / Non Yes / Oui Yes / Oui – – – – –

Nanekrungsan et al. (2012) No / Non Adult > young / Yes / Oui Yes / Oui No / Non No / Non – No / Non Yes: pointed/angled apices /
Adulte > jeune

Oui : apex pointus/coudes
Motakawa et al. (2013) No / Non No / Non No / Non No / Non No / Non – – – Yes: root anomaly /
Oui : anomalie radiculaire
Lond D Tieu et al. (2014) No / Non No / Non Yes / Oui Yes / Oui – – – – –
Present study (2015) / No / Non No / Non No / Non Yes / Oui No / Non Yes / Oui Yes / Oui No / Non Yes: root anomaly /


Presente

etude (2015) Oui : anomalie radiculaire
 Resorption of maxillary incisors after orthodontic treatment – clinical study of risk factors

sorption des incisives maxillaires apre
La re s traitement orthodontique – e

tude clinique des facteurs de risque

95% CI [1.09–2.07] P < 0.05). Other authors have made the
same observation [9,10,14,24,26,27], and have shown that the
risk was greatest for apical hooks and thin roots [10,26].
d’anomalies radiculaires (HR = 1,5 IC 95 % [1,09–2,07]
p < 0,05). D’autres e
tudes ont rapporte

le me ^me constat
[9,10,14,24,26,27], et ont montre
que ce risque e
tait plus

es et gre
important dans les cas de racines coude ^ les [10,26].

Open bite
ance

Les cas de be

The results of our study also showed that MSR was more Les re
sultats de notre e
tude ont e
galement montre
que les cas
frequent in cases with anterior open bite than in cases with de be
ance ante
rieure pre
sentaient plus de RMS que les cas
normal overbite (HR = 3.12 95% CI [1.66–5.86] P < 0.001). de recouvrement normal (HR = 3,12 IC 95 % [1,66–5,86]
This result is in agreement with that of previous studies p < 0,001). Ce re
sultat e

tait en accord avec celui des e
tudes
[9,12,31,32] and could be explained by the dysfunctional pre
ce
dentes [9,12,31,32] et pourrait e ^tre explique

par l’origine
origin of the open bite, accompanied by reciprocating move- dysfonctionnelle de la be
ance qui s’accompagne de mouve-
ments [9,31]. In addition, Tanaka et al. [33] and ments de va-et-vient [9,31]. D’autre part, Tanaka et al. [33]
Sringkarnboriboon et al. [34] have shown that the reduction ainsi que Sringkarnboriboon et al. [34] ont montre
que la
in occlusal function in cases of open bite is a prelude to
duction de la fonction occlusale dans les cas de be
re
ance,
atrophy of the periodontal ligament which becomes hypofunc- pre
ludait à l’atrophie du ligament parodontal qui devient hypo-
tional, with weak resistance to external stimuli and thus fonctionnel, avec une faible re
sistance aux stimuli externes,
increased susceptibility to resorption. augmentant ainsi sa susceptibilite
aux re
sorptions.

Incisal supraocclusion Les cas de supraclusion incisive

Unlike most other studies [7,9,10,12,21,26] that evaluated Contrairement à la plupart des e
tudes [7,9,10,12,21,26] qui
supraocclusion, and that reported no statistically significant
value
ont e
la supraclusie, et qui n’ont pas rapporte
d’associa-
association between this factor and the severity of resorption at tion statistiquement significative entre ce facteur et la se
ve

rite


the level of the upper incisors, our study showed that there des re
sorptions au niveau des incisives maxillaires, notre
were more MSRs in cases with deep bite than in cases with
tude a montre
e
que plus de RMS survenaient dans les cas
normal overbite (HR = 2.17 95% CI [1.33–3.53] P < 0.05). pre
sentant un recouvrement exage
re

que dans les cas de
This result could be explained by the use of intrusive forces recouvrement normal (HR = 2,17 IC 95 % [1,33–3,53]
which, according to Han et al. [35], increase the surface area p < 0,05). Ce re
sultat pourrait e ^tre explique
par l’utilisation
of the zone of resorption at the apex by a factor of 4, thereby de forces d’ingression, qui d’apre s Han et al. [35], augmenter-
increasing the severity of the resorption. Similarly, Martins et aient 4 fois plus la superficie de la zone re
sorbe
e au niveau de
al. [36] showed that the risk of severe resorptions was greater if l’apex, aggravant ainsi la se
ve

rite

des re
sorptions. De me ^me,
intrusive mechanics was associated with retraction of the Martins et al. [36] ont montre
que le risque de survenue de
incisors. re
sorptions se
ve
res e
tait plus important si une me
canique
d’ingression avait e
te

associe
e à la re

traction incisive.

Conclusion Conclusion

The frequency of MSR of the maxillary incisors in our study La fre
quence des RMS des incisives maxillaires dans notre
was 59.5%. MSR affected the lateral incisors more often than
chantillon e
e
tait de 59,5 %. L’incisive late
rale pre

sentait plus
the centrals. The risk of occurrence of MSR also increased to a de RMS que l’incisive centrale. Le risque de survenue des
statistically significant degree in cases with extractions, in RMS augmentait e
galement et de façon statistiquement sig-
cases of supraocclusion and open bite, and in the presence nificative dans les cas avec extractions, les cas de supraclusie
of root abnormalities. et de be
ance, et en pre
sence d’anomalies radiculaires.
Age, sex, duration of treatment, type of malocclusion, swal- ^ge, le sexe, la dure
L’a
e de traitement, le type de malocclusion,
lowing problems and impacted canines did not show any sta- la de
glutition dysfonctionnelle et l’inclusion canine n’e
taient
tistically significant association with the risk of occurrence of pas associe
s de façon statistiquement significative au risque
MSR. de survenue des RMS.
In the light of the risk factors identified in this study and those Face aux facteurs de risque identifie
s dans notre e
tude, ainsi
reported in the literature, it seems useful to suggest some que ceux e
nonce
s dans la litte

rature, il nous a semble
inte

res-
clinical guidelines for the prevention of the occurrence of sant de proposer des recommandations cliniques en vue de
MSR at the level of the upper incisors: pre
venir la survenue de RMS au niveau des incisives
maxillaires :

International Orthodontics 2016 ; 14 : 48-64 61

 Rajae ELHADDAOUI et al.

— make a full study of the patient’s medical history, looking — approfondir l’anamne se à la recherche d’e
ventuelles mala-
for possible systemic diseases (osteoarthritis, diabetes, aller- dies syste
miques (arthrose, diabe te, allergies. . .), de prise
gies, etc.), use of medication, in particular anti-inflammatory me
dicamenteuse (notamment des anti-inflammatoires), des
drugs, traumatic antecedents or family history of resorption; ante
ce
dents traumatiques ou familiaux de re
sorption ;
— inform the patient of the risk of occurrence of EARRs and — informer le patient sur le risque de survenue des RRAE et
obtain enlightened consent before beginning orthodontic obtenir son consentement e
claire

avant de commencer le
treatment; traitement orthodontique ;
— perform a full periapical radiological work-up before the — re
aliser un bilan radiologique re
troalve

olaire, long co ^ne de
treatment, preferably with a long-cone system, so as to detect pre
fe

rence, avant le traitement, afin de de
celer d’e
ventuelles
any abnormal root morphologies, pre-existing signs of resorp- anomalies de la morphologie radiculaire, des re
sorptions
tion, impacted canines, etc; pre
alablement existantes, une inclusion canine. . . etc ;
— correct dysfunctions in general and swallowing problems in — re
e

duquer les dysfonctions en ge
ne
ral et la de

glutition dys-
particular, and eliminate parafunctional activity (nail-biting, fonctionnelle en particulier et e
liminer les parafonctions (ony-
thumb-sucking, labial dysfunction, bruxism, etc.); chophagie, succion de pouce, dysfonctions labiales,
bruxisme. . .) ;
— keep treatment duration short; — limiter la dure
e du traitement ;
— adapt the intensity of orthodontic forces to the patient’s — adapter l’intensite
des forces orthodontiques à l’environne-
neuro-muscular and periodontal environment; ment neuromusculaire et parodontal du patient ;
— make use of orthodontic-surgical protocols in cases requir- — avoir recours aux protocoles orthodonticochirurgicaux
ing excessively large tooth movements; dans les cas ne
cessitant des amplitudes de de
placements
dentaires trop importantes ;
— adapt the therapeutic protocol to root physiology by limit- — adapter le protocole the
rapeutique à la physiologie apicale
ing movements associated with risk (intrusion, torque, tipping, en limitant les mouvements à risque (ingression, torque,
etc.); tipping. . .) ;
— perform regular X-ray checks, generally every 6 months — re
aliser des contro^ les radiologiques
guliers,
re
for the anterior segment. These checks should be more fre- ge
ne
ralement tous les 6 mois pour les dents ante
rieures.
quent for patients who have suffered trauma and for those Ces contro ^ les devraient e ^tre plus fre
quents chez les patients
taking anti-inflammatory treatment or who present a high risk ayant subi un traumatisme, ainsi que chez les sujets sous
of root resorption; traitement anti-inflammatoire ou à risque e
leve
de re
sorptions
radiculaires ;
— if resorption is detected during treatment, its etiology — si des re
sorptions sont de
tecte

es au cours du traitement,
should be determined, and depending on its severity, the leur e
tiologie doit e ^tre recherche
e et en fonction de leur
number of teeth concerned and the periodontal environment, se
ve
rite

, du nombre de dents atteintes et de l’environnement
the treatment goals may have to be reviewed. It may be pos- parodontal, les objectifs du traitement doivent e ^tre re
e
value

s.
sible to suspend treatment momentarily, for at least 3 months,

Eventuellement, le traitement pourrait e ^tre arre ^ te

momen-
leaving passive arch-wires in place; tane
ment, pendant au moins 3 mois, en maintenant des arcs
passifs ;
— if resorption evolves quite rapidly, even after withdrawal of — si les re
sorptions se de
veloppent assez rapidement, me ^me
orthodontic forces, it is advisable to perform root canal treat- apre s arre ^ t des forces, il serait pre
fe

rable de re
aliser un traite-
ment using calcium hydroxide so as to reduce periapical ment canalaire à l’hydroxyde de calcium pour re
duire l’inflam-
inflammation [8,14,28]. mation au niveau du pe
riapex [8,14,28].

Disclosure of interest
claration de liens d’inte

De
re
^ts

The authors declare that they have no competing interest.
clarent ne pas avoir de liens d’inte
Les auteurs de
re
^ ts.

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