Orthodontic retreatment with clear aligners in a patient with open bite and severe root resorption: Case report
Abstract
Introduction: External apical root resorption (EARR) is a multifactorial orthodontic complication influenced by treatment duration, appliance type, and the magnitude of applied forces. Clear aligners have been shown to reduce the risk of EARR compared to fixed appliances by applying lighter and more controlled forces.
Case Report: This report describes retreatment with clear aligners in an adult patient with relapse of anterior open bite and severe EARR diagnosed through CBCT. The rate of tooth movement was reduced from 0.25 mm to 0.18 mm per aligner to preserve root integrity.
Conclusions: The controlled biomechanics of clear aligners, combined with an inter-disciplinary approach, enabled esthetic and functional outcomes in a patient with severe EARR, demonstrating that this therapy represents a safe option in complex retreatment scenarios.
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References
Gandhi V, Mehta S, Gauthier M, Mu J, Kuo CL, Nanda R, Yadav S. Comparison of external apical root resorption with clear aligners and pre-adjusted edgewise appliances in non-extraction cases: a systematic review and meta-analysis. Eur J Orthod. 2021;43(1):15-24. https://doi.org/10.1093/ejo/cjaa013. PMID: 32077935; PMCID: PMC7846172.
Inchingolo, F, Inchingolo AM, Palmieri G, Di Pede C, Garofoli G, de Ruvo E, Inchingolo A D, Palermo A, Mancini A, Di Venere D, Malcangi G, Dipalma G. Root Resorption during Orthodontic Treatment with Clear Aligners vs. Fixed Appliances—A Systematic Review. Applied Sciences, 14(2), 690. https://doi.org/10.3390/app14020690
Brezniak N, Wasserstein A. Orthodontically induced inflammatory root resorption. Part II: The clinical aspects. Angle Orthod. 2002; 72(2):180-4. https://doi.org/10.1043/0003-3219(2 002)072<0180:OIIRRP>2.0.CO;2. PMID:119 99 942.
García M. Etiología y Prevención de la reab-sorción radicular inducida por ortodoncia. Rev Cien Odontol. 2016;12(1):43-49.
Aman C, Azevedo B, Bednar E, Chandiramami S, German D, Nicholson E, Nicholson K, Scarfe WC. Apical root resorption during orthodontic treatment with clear aligners: A retrospective study using cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2018;153(6):842-851. https://doi.org/10.1016/j.ajodo.2017.10.026.
Li Y, Deng S, Mei L, Li Z, Zhang X, Yang C, Li Y. Prevalence and severity of apical root resorp-tion during orthodontic treatment with clear aligners and fixed appliances: a cone beam computed tomography study. Prog Orthod. 2020; 21(1):1. https://doi.org/10.1186/s40510-019-0301-1. PMID: 31903505; PMCID: PMC6943096
Fang X, Qi R, Liu C. Root resorption in orthodon-tic treatment with clear aligners: A systematic review and meta-analysis. Orthod Craniofac Res.2019;22(4):259-269. https://doi.org/10.1111/ocr.12337. Epub 2019 Aug 29. PMID: 31323701.
Fowler B. A comparison of root resorption bet-ween Invisalign treatment and contemporary orthodontic treatment. [Thesis]. University of Southern California. 2010.
Selvaraj M, Nivethitha B, Madhan B. Ortho-dontically induced external apical root resor-ption with clear aligners compared to fixed appliance treatment: An umbrella review. J Oral Biol Craniofac Res. 2025;15(5):938-947. https://doi.org/10.1016/j.jobcr.2025.06.011. Epub 2025 Jun 23. PMID: 40621584; PMCID: PMC12226120.
Krieger E, Drechsler T, Schmidtmann I, Jacobs C, Haag S, Wehrbein H. Apical root resorption during orthodontic treatment with aligners? A retrospective radiometric study. Head Face Med. 2013 Aug 14;9:21. https://doi.org/10.1186/1746-160X-9-21. PMID: 23941626; PMCID: PMC3751237.
Singh S, Jain RK, Balasubramaniam A. Com-parative assessment of external apical root resorption between subjects treated with clear aligners and fixed orthodontic appliances: A systematic review and meta-analysis. J Dent Res Dent Clin Dent Prospects. 2024; 18(2):85-94. https://doi.org/10.34172/joddd.40932. PMID: 39071210; PMCID: PM C11282194.
Cunning B, Sahhar A, Lawrence S, Manton D, Schneider P. Comparative assessment of the survival, stability and occlusal settling bet-ween two types of thermoplastic retainers: a prospective clinical trial. Australasian ortho-dontic j. 202;38(1):74-87. https://doi.org/10.21307/aoj-2022.011
Almagrami I, Albarakani AY, Almashraqi AA, Alhammadi MS, Al-Warafi LA, Almaqrami M, Qiao Y. Volumetric and tridimensional root re-sorption and alveolar bone changes in Class II malocclusion extraction protocol treated with clear aligners and fixed orthodontic ap-pliances: A comparative study. Am J Orthod Dentofacial Orthop. 2025;167(5):539-549. https://doi.org/10.1016/j.ajodo.2024.11.012. Epub 2025 Jan 9. PMID: 39797866.
Nakai Y, Praneetpong N, Ono W, Ono N. Me-chanisms of Osteoclastogenesis in Ortho-dontic Tooth Movement and Orthodontically Induced Tooth Root Resorption. J Bone Metab. 2023;30(4):297-310. https://doi.org/10.11005/jbm.2023.30.4.297. Epub 2023 Nov 30. PMID: 38073263; PMCID: PMC10721376.
Jiang RP, McDonald JP, Fu MK. Root resorption before and after orthodontic treatment: a clinical study of contributory factors. Eur J Orthod. 2010;32(6):693-7.
Segal GR, Schiffman PH, Tuncay OC. Meta analysis of the treatment-related factors of external apical root resorption. Orthod Cra-niofac Res. 2004;7(2):71-8. https://doi.org/10.1111/j.1601-6343.2004.00286.x. PMID: 151 80086.
Iber-Diaz P, Senén-Carramolino R, Palma-Fernández JC, Iglesias-Linares A. Reabsorción radicular apical externa tras la ortodoncia: factores clínicos y diagnósticos y análisis de redes de genes relacionados. Cient Dent. 2022. 9(2): 7-17.
Neves BMD, Fernandes LQP, Capelli Junior J. External apical root resorption after ortho-dontic treatment: analysis in different chro-nological periods. Dental Press J Orthod. 2022; 27(5):e2220100. https://doi.org/10.1590/2177-6709.27.5.e2220100.oar. PMID: 36350942; PM CID: PMC9639616.19.
Gay G, Ravera S, Castroflorio T, Garino F, Rossini G, Parrini S, Cugliari G, Deregibus A. Root re-sorption during orthodontic treatment with Invisalign®: a radiometric study. Prog Orthod. 2017;18(1):12. https://doi.org/10.1186/s40510-017-0166-0. Epub 2017 May 15. PMID: 28503724; PMCID: PMC5430001.
Harris K, Ojima K, Dan C, Upadhyay M, Alshehri A, Kuo CL, Mu J, Uribe F, Nanda R. Evaluation of open bite closure using clear aligners: a re-trospective study. Prog Orthod. 2020; 21(1):23. https://doi.org/10.1186/s40510-020-00325-5. PMID: 32830306; PMCID: PMC7443419.
Boyd RL. Esthetic orthodontic treatment using the invisalign appliance for moderate to complex malocclusions. J Dent Educ. 2008; 72(8):948-67. PMID: 18676803.
Olteanu ND, Romanec C, Cernei ER, Karvelas N, Nastri L, Zetu IN. Scoping Review-The Ef-fectiveness of Clear Aligners in the Mana-gement of Anterior Open Bite in Adult Patients. Medicina (Kaunas). 2025; 61(6):1113. https://doi.org/10.3390/medicina61061113. PMID: 40572801; PMCID: PMC12195066.
Orsini M, Benlloch D, Aranda Macera JJ, Flores K, Ríos-Santos JV, Pedruelo FJ, Ríos-Carrasco B, di Cesare M. Improvement of Periodontal Parameters with the Sole Use of Free Gingival Grafts in Orthodontic Patients: Correlation with Periodontal Indices. A 15-Month Clinical Study. Int J Environ Res Public Health 2020. 17(18):6578; https://doi.org/10.3390/ijerph17186578
Di Spirito F, D'Ambrosio F, Cannatà D, D'Antò V, Giordano F, Martina S. Impact of Clear Aligners versus Fixed Appliances on Periodontal Status of Patients Undergoing Orthodontic Treatment: A Systematic Review of Systematic Reviews. Healthcare. 2023;11(9):1340. https://doi.org/10.3390/healthcare11091340. PMID: 3717488 2; PMCID: PMC10178428.
Correa E, Michelogiannakis D, Barmak AB, Rossouw PE, Javed F. Efficacy of Clear Aligner Therapy for the Treatment of Anterior Open Bite in Adults: A Systematic Review and Meta-Analysis. Orthod Craniofac Res. 2025; 28(2):261-270. https://doi.org/10.1111/ocr.12868. Epub 2024 Oct 24. PMID: 39445659.
Zhang M, Zhang P, Koh JT, Oh MH, Cho JH. Evaluation of Aligners and Root Resorption: An Overview of Systematic Reviews. J Clin Med. 2024;13(7).
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