Apical root resorption during orthodontic treatment with clear aligners: A retrospective study using cone-beam computed tomography

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We aimed to investigate the incidence and severity of orthodontically induced inflammatory root resorption (OIIRR) on maxillary incisors with clear aligner therapy using cone-beam computed tomography and to identify possible risk factors.


The root lengths of maxillary incisors were measured on orthogonal images from pretreatment and posttreatment cone-beam computed tomography examinations of 160 patients who received comprehensive orthodontic treatment with clear aligners.


Mean absolute reductions in root length varied between 0.47 ± 0.61 mm and 0.55 ± 0.70 mm and were not significantly different between maxillary central and lateral incisors. The prevalence of severe OIIRR, defined as both maxillary central incisors experiencing greater than a 25% reduction in root length, was found to be 1.25%. Potential risk factors included sex, malocclusion, crowding, and posttreatment approximation of apices to the cortical plates. Race, interproximal reduction, previous trauma to the teeth, elastics, age, treatment duration, and pretreatment approximation of apices to the cortical plates did not significantly affect the amount of OIIRR.


Comprehensive treatment with clear aligners resulted in minimal root resorption. Sex, malocclusion, crowding, and posttreatment approximation to the cortical plates significantly affected the percentage of change in root length. Posttreatment approximation of root apices to the palatal cortical plate showed the strongest association for increased OIIRR.

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