We wish to comment on the article, “Severe root resorption in orthodontic patients treated with the edgewise method: prevalence and predictive factors” (Marques LS, Ramos-Jorge ML, Rey AC, Armond MC, Ruellas ACO. Am J Orthod Dentofacial Orthop 2010;137:384-8). The authors must be commended for the study outcome and a genuine effort to highlight this potential side effect in its severe form in day-to-day practice. Root resorption has long intrigued orthodontists. The various attributes of this affliction are less understood and at times frustrating. What triggers this pathophysiologic activity remains a puzzle.
We are entrusted with our patients’ hopes for better oral health. Where is the essence of treating a patient with achievable optimal esthetics without the side effect of root shortening and another patient with radiologic evidence of root shortening? Many challenging case reports worth highlighting the mastery of treatment execution are hidden just because of root resorption. And the patient is convinced that this is sometimes common and harmless to the vitality of the dentition. How do we calculate this? Is there any evidence that provides a clear-cut explanation to the longevity of teeth affected with orthodontically induced root resorption? Or is a reduced crown-root ratio with a healthy periodontium no big concern? But it cannot be denied that the phenomenon is irreversible, so we try to prevent it from happening at the outset.
The study indirectly propagates an important point: it might be advisable to take periapical radiographs of the maxillary incisors for all our patients as a cautionary measure before the start of the treatment and 6 months into treatment. Thus, they become an essential diagnostic aid. Once we notice any predictive factors, it is our moral responsibility to tell the patient or parents about the possible sequelae and treatment options. The patient’s consent at this juncture becomes important.
We were a little disturbed by the word “edgewise” in the article title. Perhaps the appliance mechanics had a role in the development of root resorption, but it cannot be proven otherwise. No one patient can be studied with 2 types of mechanical appliances for comparison and give a foolproof result. This is the biggest limitation in any clinically oriented research. Nonetheless, we should focus our constructive abilities to calculate the incalculable.