正畸治疗中周围解剖结构与牙根外吸收之间关系的综述

doi:10.13591/j.cnki.kqyx.2025.05.013

摘要/Abstract

摘要：

根尖区牙根外吸收(external apical root resorption,EARR)是正畸治疗中最常发生的副作用之一。牙根移动过程中接触周围解剖结构是引起EARR的重要原因,然而,对于正畸治疗中周围解剖结构直接接触根尖而导致EARR的因素尚缺乏系统而全面的综述。本综述总结了与EARR相关的解剖结构,包括牙槽骨、切牙管、上颌窦、相邻牙齿和骨岛等。牙槽骨、切牙管和相邻牙齿在正畸治疗过程中可以直接导致EARR,而迄今为止尚未发现上颌窦和骨岛对EARR造成影响。通过分析牙根周围解剖来帮助制定更有效的方法来预防或减轻正畸治疗中EARR的发生。

关键词: 根尖区牙根外吸收, 正畸, 解剖结构, 锥形束CT

Abstract:

External apical root resorption(EARR)is one of the most common side effects of orthodontic treatment. Contact with surrounding anatomical structures during tooth movement is a significant cause for EARR. However, a comprehensive review of factors leading to EARR due to direct contact of surrounding anatomical structures with the root apex during orthodontic treatment is still lacking. This review summarizes the anatomical structures related to EARR, including alveolar bone, incisive canal, maxillary sinus, adjacent teeth, and bone islands. Alveolar bone, incisive canal, and adjacent teeth can directly cause EARR during orthodontic treatment, while the impact of the maxillary sinus and bone islands on EARR has not been discovered so far. Analyzing the anatomical structures around the tooth roots can help develop more effective methods to prevent or reduce the occurrence of EARR during orthodontic treatment.

Key words: external apical root resorption, orthodontics, anatomical structures, cone-beam CT

中图分类号:

R783.5

陈子昂, 刘子昂, 欧阳雨晴, 娄依婷, 施洁珺, 丁王辉. 正畸治疗中周围解剖结构与牙根外吸收之间关系的综述[J]. 口腔医学, 2025, 45(5): 394-400.

CHEN Ziang, LIU Ziang, OUYANG Yuqing, LOU Yiting, SHI Jiejun, DING Wanghui. A review of the relation between peripheral anatomical structures and external apical root resorption during orthodontic treatment[J]. Stomatology, 2025, 45(5): 394-400.

图/表 1

参考文献 70

[1]	Li Y, Zhan Q, Bao MY, et al. Biomechanical and biological responses of periodontium in orthodontic tooth movement: Up-date in a new decade[J]. Int J Oral Sci, 2021, 13(1): 20-21. doi: 10.1038/s41368-021-00125-5 pmid: 34183652
[2]	Krishnan V, Davidovitch ZE. Cellular, molecular, and tissue-level reactions to orthodontic force[J]. Am J Orthod Dentofacial Orthop, 2006, 129(4): e1-32.
[3]	Brezniak N, Wasserstein A. Orthodontically induced inflammatory root resorption. Part Ⅰ: The basic science aspects[J]. Angle Orthod, 2002, 72(2): 180-184.
[4]	Reitan K. Initial tissue behavior during apical root resorption[J]. Angle Orthod, 1974, 44(1): 68-82. pmid: 4520953
[5]	Brezniak N, Wasserstein A. Root resorption after orthodontic treatment: Part 2. literature review[J]. Am J Orthod Dentofacial Orthop, 1993, 103(2): 138-146.
[6]	Mirabella AD, Artun J. Prevalence and severity of apical root resorption of maxillary anterior teeth in adult orthodontic patients[J]. Eur J Orthod, 1995, 17(2): 93-99.
[7]	Ellis PE, Benson PE. Potential hazards of orthodontic treatment: What your patient should know[J]. Dent Update, 2002, 29(10): 492-496.
[8]	Owman-Moll P. Orthodontic tooth movement and root resorption with special reference to force magnitude and duration. A clinical and histological investigation in adolescents[J]. Swed Dent J Suppl, 1995, 105: 1-45. pmid: 7638765
[9]	Sameshima GT, Sinclair PM. Predicting and preventing root resorption: Part I. diagnostic factors[J]. Am J Orthod Dentofacial Orthop, 2001, 119(5): 505-510.
[10]	Kaley J, Phillips C. Factors related to root resorption in edgewise practice[J]. Angle Orthod, 1991, 61(2): 125-132. doi: 10.1043/0003-3219(1991)061<0125:FRTRRI>2.0.CO;2 pmid: 2064070
[11]	Weiland F. Constant versus dissipating forces in orthodontics: The effect on initial tooth movement and root resorption[J]. Eur J Orthod, 2003, 25(4): 335-342.
[12]	Al-Qawasmi RA, Hartsfield JK Jr, Everett ET, et al. Genetic predisposition to external apical root resorption in orthodontic patients: Linkage of chromosome-18 marker[J]. J Dent Res, 2003, 82(5): 356-360. doi: 10.1177/154405910308200506 pmid: 12709501
[13]	Zasciurinskiene E, Lund H, Lindsten R, et al. Outcome of orthodontic treatment in subjects with periodontal disease. Part Ⅲ: A CBCT study of external apical root resorption[J]. Eur J Orthod, 2019, 41(6): 575-582.
[14]	Nishioka M, Ioi H, Nakata S, et al. Root resorption and immune system factors in the Japanese[J]. Angle Orthod, 2006, 76(1): 103-108. doi: 10.1043/0003-3219(2006)076[0103:RRAISF]2.0.CO;2 pmid: 16448277
[15]	Sameshima GT, Sinclair PM. Characteristics of patients with severe root resorption[J]. Orthod Craniofac Res, 2004, 7(2): 108-114. doi: 10.1111/j.1601-6343.2004.00284.x pmid: 15180089
[16]	Mavragani M, Brudvik P, Selvig KA. Orthodontically induced root and alveolar bone resorption: Inhibitory effect of systemic doxycycline administration in rats[J]. Eur J Orthod, 2005, 27(3): 215-225.
[17]	Sameshima GT, Iglesias-Linares A. Clinical management of orthodontics root resorption[J]. J World Fed Orthod, 2021, 10(4):135-143. doi: 10.1016/j.ejwf.2021.09.003 pmid: 34785166
[18]	Hartsfield JK Jr, Everett ET, Al-Qawasmi RA. Genetic factors in external apical root resorption and orthodontic treatment[J]. Crit Rev Oral Bio Med, 2004, 15:115-122.
[19]	Sharab LY, Morford LA, Dempsey J, et al. Genetic and treatment related risk factors associated with external apical root resorption concurrent with orthodontia[J]. Orthod Craniofac Res, 2015, 18(Suppl 1):71-82.
[20]	Ne RF, Witherspoon DE, Gutmann JL. Tooth resorption[J]. Quintessence Int, 1999, 30(1): 9-25. pmid: 10323155
[21]	He D, Kou X, Luo Q, et al. Enhanced M1/M2 macrophage ratio promotes orthodontic root resorption[J]. J Dent Res, 2015, 94(1): 129-139. doi: 10.1177/0022034514553817 pmid: 25344334
[22]	Nakano Y, Yamaguchi M, Fujita S, et al. Expressions of RANKL/RANK and M-CSF/c-fms in root resorption lacunae in rat molar by heavy orthodontic force[J]. Eur J Orthod, 2011, 33(4): 335-343.
[23]	Monje A, Chan HL, Galindo-Moreno P, et al. Alveolar bone architecture: A systematic review and meta-analysis[J]. J Periodontol, 2015, 86(11): 1231-1248. doi: 10.1902/jop.2015.150263 pmid: 26177631
[24]	Prabhakar AR, Paul JM, Basappa N. Gene therapy and its implications in dentistry[J]. Int J Clin Pediatr Dent, 2011, 4(2): 85-92.
[25]	Lupi JE, Handelman CS, Sadowsky C. Prevalence and severity of apical root resorption and alveolar bone loss in orthodontically treated adults[J]. Am J Orthod Dentofacial Orthop, 1996, 109(1): 28-37.
[26]	Horiuchi A, Hotokezaka H, Kobayashi K. Correlation between cortical plate proximity and apical root resorption[J]. Am J Orthod Dentofacial Orthop, 1998, 114(3): 311-318.
[27]	Nakada T, Motoyoshi M, Horinuki E, et al. Cone-beam computed tomography evaluation of the association of cortical plate proximity and apical root resorption after orthodontic treatment[J]. J Oral Sci, 2016, 58(2): 231-236. doi: 10.2334/josnusd.15-0566 pmid: 27349544
[28]	Mehmet A, Nisa GA, Taner O. Effects of root-cortex relationship, root shape, and impaction side on treatment duration and root resorption of impacted canines[J]. Eur J Orthod, 2021, 43(5): 508-515.
[29]	Picanço GV, de Freitas KM, Cançado RH, et al. Predisposing factors to severe external root resorption associated to orthodontic treatment[J]. Dental Press J Orthod, 2013, 18(1): 110-120. doi: 10.1590/s2176-94512013000100022 pmid: 23876958
[30]	Thilander B, Rygh P, Reitan K. Tissue reactions in orthodontics[J]. Current Ortho Paedics, 2005, 13(4):223-228.
[31]	Wainwright WM. Faciolingual tooth movement: Its influence on the root and cortical plate[J]. Am J Orthod, 1973, 64(3): 278-302. doi: 10.1016/0002-9416(73)90021-3 pmid: 4199008
[32]	Scheibel PC, Ramos AL, Iwaki LC, et al. Analysis of correlation between initial alveolar bone density and apical root resorption after 12 months of orthodontic treatment without extraction[J]. Dental Press J Orthod, 2014, 19(5): 97-102. doi: 10.1590/2176-9451.19.5.097-102.oar pmid: 25715722
[33]	Otis LL, Hong JSH, Tuncay OC. Bone structure effect on root resorption[J]. Orthod Craniofac Res, 2004, 7(3):165-177. doi: 10.1111/j.1601-6343.2004.00282.x pmid: 15359503
[34]	Lake, Iwanaga J, Kikuta S, et al. The incisive canal: A comprehensive review[J]. Cureus, 2018, 10(7):e3069.
[35]	Linjawi AI, Marghalani HYA. Relationship between maxillary central incisors and incisive canal: A cone-beam computed tomography study[J]. Folia Morphol (Warsz), 2022, 81(2): 458-463.
[36]	Romanos GE, Greenstein G. The incisive canal.considerations during implant placement: Case report and literature review[J]. Int J Oral Maxillofac Implants, 2009, 24(4): 740-745.
[37]	Pan YC, Chen S. Contact of the incisive canal and upper central incisors causing root resorption after retraction with orthodontic mini-implants: A CBCT study[J]. Angle Orthod, 2019, 89(2): 200-205. doi: 10.2319/042318-311.1 pmid: 30484326
[38]	Yu JH, Nguyen T, Kim YI, et al. Morphologic changes of the incisive canal and its proximity to maxillary incisor roots after anterior tooth movement[J]. Am J Orthod Dentofac Orthop, 2022, 161(3): 396-403.
[39]	Guncu GN, Yildirim YD, Yilmaz HG, et al. Is there a gender difference in anatomic features of incisive canal and maxillary environmental bone?[J]. Clin Oral Implants Res, 2013, 24(9): 1023-1026.
[40]	Liang X, Jacobs R, Martens W, et al. Macro- and micro-anatomical, histological and computed tomography scan characterization of the nasopalatine canal[J]. J Clin Periodontol, 2009, 36(7): 598-603. doi: 10.1111/j.1600-051X.2009.01429.x pmid: 19538333
[41]	Ongprakobkul N, Ishida Y, Petdachai S, et al. Morphometric and volumetric analysis of the proximity between the incisive canal and maxillary central incisors during anterior retraction: A retrospective cone-beam computed tomography study[J]. Angle Orthod, 2022, 93(2): 159-167.
[42]	Chung CJ, Nguyen T, Lee JH, et al. Incisive canal remodelling following maximum anterior retraction reduces apical root resorption[J]. Orthod Craniofac Res, 2021, 24(Suppl 1): 59-65.
[43]	Takaki T, Tamura N, Yamamoto M, et al. Clinical study of temporary anchorage devices for orthodontic treatment: Stability of micro/mini-screws and mini-plates: Experience with 455 cases[J]. Bull Tokyo Dent Coll, 2010, 51(3): 151-163.
[44]	Kuc AE, Kotuła J, Nawrocki J, et al. The assessment of the rank of torque control during incisor retraction and its impact on the resorption of maxillary central incisor roots according to incisive canal anatomy-systematic review[J]. J Clin Med, 2023, 12(8):2774.
[45]	Sharan A, Madjar D. Maxillary sinus pneumatization following extractions: A radiographic study[J]. Int J Oral Maxillofac Implants, 2008, 23(1):48-56.
[46]	Shahbazian M, Vandewoude C, Wyatt J, et al. Comparative assessment of periapical radiography and CBCT imaging for radiodiagnostics in the posterior maxilla[J]. Odontology, 2015, 103(1): 97-104. doi: 10.1007/s10266-013-0144-z pmid: 24374983
[47]	Goller-Bulut D, Sekerci AE, Kose E, et al. Cone beam computed tomographic analysis of maxillary premolars and molars to detect the relationship between periapical and marginal bone loss and mucosal thickness of maxillary sinus[J]. Med Oral Patol Oral Cir Bucal, 2015, 20(5): e572-e579.
[48]	Ok E, Gungor E, Colak M, et al. Evaluation of the relationship between the maxillary posterior teeth and the sinus floor using cone-beam computed tomography[J]. Surg Radiol Anat, 2014, 36(9): 907-914. doi: 10.1007/s00276-014-1317-3 pmid: 24874032
[49]	Cacciafesta V, Melsen B. Mesial bodily movement of maxillary and mandibular molars with segmented mechanics[J]. Clin Orthod Res, 2001, 4(3): 182-188. pmid: 11553103
[50]	Savi de Carvalho R, Consolaro A, Francischone CE Jr, et al. Sinus augmentation by orthodontic movement as an alternative to a surgical sinus lift: A clinical report[J]. J Prosthet Dent, 2014, 112(4): 723-726. doi: 10.1016/j.prosdent.2014.01.025 pmid: 24767896
[51]	Kravitz ND, Kusnoto B, Tsay PT, et al. Intrusion of overerupted upper first molar using two orthodontic miniscrews. A case report[J]. Angle Orthod, 2007, 77(5): 915-922. pmid: 17902236
[52]	Oh H, Herchold K, Hannon S, et al. Orthodontic tooth movement through the maxillary sinus in an adult with multiple missing teeth[J]. Am J Orthod Dentofacial Orthop, 2014, 146(4): 493-505.
[53]	Yao CC, Wu CB, Wu HY, et al. Intrusion of the overerupted upper left first and second molars by mini-implants with partial-fixed orthodontic appliances: A case report[J]. Angle Orthod, 2004, 74(4): 550-557.
[54]	Lopes LJ, Gamba TO, Bertinato JV, et al. Comparison of panoramic radiography and CBCT to identify maxillary posterior roots invading the maxillary sinus[J]. Dentomaxillofac Radiol, 2016, 45(6): 20160043.
[55]	Roscoe MG, Meira JBC, Cattaneo PM. Association of orthodontic force system and root resorption: A systematic review[J]. Am J Orthod Dentofacial Orthop, 2015, 147(5): 610-626.
[56]	Wehrbein H, Bauer W, Wessing G, et al. The effect of the maxillary sinus floor on orthodontic tooth movement[J]. Fortschr Kieferorthop, 1990, 51(6): 345-351. pmid: 2286348
[57]	Ledesma-Montes C, Jiménez-Farfán MD, Hernández-Guerrero JC. Idiopathic osteosclerosis in the maxillomandibular area[J]. Radiol Med, 2019, 124(1): 27-33. doi: 10.1007/s11547-018-0944-x pmid: 30244367
[58]	McDonnell DJOS. Dense bone island: A review of 107 patients[J]. Oral Surg Oral Med Oral Pathol, 1993, 76(1): 124-128.
[59]	Eversole LR, Stone CE, Strub D. Focal sclerosing osteomyelitis/focal periapical osteopetrosis: Radiographic patterns[J]. Oral Surg Oral Med Oral Pathol, 1984, 58(4): 456-460.
[60]	Loo LE, Li KY, Wong HM, et al. Panoramic radiographic evaluation of prevalence, distribution of the dense bone island and its influence on tooth movement among orthodontic patients[C]. The 32nd IADR-SEA Division Annual Scientific Meeting, Da Nang, Vietnam, 2018:International Association for Dental Research (IADR). 2018: Final Presentation ID: 0235.
[61]	Ashari A, Oliver G, Rajaran J, et al. Dense bone islands: A case series and implications for orthodontic treatment[J]. 2022, 25(2): 85-92.
[62]	Sinnott PM, Hodges S. An incidental dense bone island: A review of potential medical and orthodontic implications of dense bone islands and case report[J]. J Orthod, 2020, 47(3): 251-256. doi: 10.1177/1465312520917975 pmid: 32419572
[63]	Nitzan D, Keren T, Marmary Y. Does an impacted tooth cause root resorption of the adjacent one?[J]. Oral Surg Oral Med Oral Pathol, 1981, 51(3): 221-224.
[64]	Simic S, Nikolic P, Stanisic, et al. Root resorptions on adjacent teeth associated with impacted maxillary canines[J]. Diagnostics, 2022, 12(2):380.
[65]	Heravi F, Shafaee H, Forouzanfar A, et al. The effect of canine disimpaction performed with temporary anchorage devices (TADs) before comprehensive orthodontic treatment to avoid root resorption of adjacent teeth[J]. Dental Press J Orthod, 2016, 21(2): 65-72. doi: 10.1590/2177-6709.21.2.065-072.oar pmid: 27275617
[66]	Carvalho de Melo AU, de Farias Martorelli SB, Cavalcanti PH, et al. Maxillary odontogenic myxoma involving the maxillary sinus: Case report[J]. Braz J Otorhinolaryngol, 2008, 74(3): 472-475. doi: S0034-72992008000300026 pmid: 18661026
[67]	Marques J, Figueiredo R, Aguirre-Urizar JM, et al. Root resorption caused by a maxillary sinus mucocele: A case report[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2011, 111(5): e37-40.
[68]	Suzuki SS, Garcez AS, Suzuki H, et al. Low-level laser therapy stimulates bone metabolism and inhibits root resorption during tooth movement in a rodent model[J]. J Biophotonics, 2016, 9(11/12): 1222-1235.
[69]	Choi J, Baek SH, Lee JI, et al. Effects of clodronate on early alveolar bone remodeling and root resorption related to orthodontic forces: A histomorphometric analysis[J]. Am J Orthod Dentofacial Orthop, 2010, 138(5): 548.e1-8;discussion548-549.
[70]	Cha JY, Yoon HI, Yeo IS, et al. Panoptic segmentation on panoramic radiographs: Deep learning-based segmentation of various structures including maxillary sinus and mandibular canal[J]. J Clin Med, 2021, 10(12): 2577.