SEARCHSYSTEMATIC_REVIEWbiomedical research, preclinical research

systematic_review·biomedical research, preclinical research, research methods, systematic review, internal medicine·PMC10505745

Under pressure—mechanisms and risk factors for orthodontically induced inflammatory root resorption: a systematic review

The European Journal of Orthodontics · 5 authors, 9 centres

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TL;DR

This systematic review of 118 studies found that orthodontic forces inevitably cause inflammatory root resorption, with its severity modified by various risk factors and protective agents. The review identified specific molecular mechanisms and clinical, genetic, and pharmacological factors that influence the extent of this dental complication.

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This systematic review synthesized evidence from in vitro, animal, and human studies on the pathophysiological mechanisms and risk factors for orthodontically induced inflammatory root resorption (OIIRR). The central result is that orthodontic force application consistently leads to increased incidence and severity of OIIRR across all study types. The review identified numerous modifying factors: malocclusion, previous trauma, and corticosteroid intake increased severity, while factors like oral contraceptives, baicalin, and high caffeine decreased it. Limitations include substantial methodological heterogeneity and risk of bias in the primary literature, with many studies using 2D radiography instead of 3D imaging.

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systematic_review

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biomedical research

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ORIGINAL PAPER

PMC10505745

Under pressure—mechanisms and risk factors for orthodontically induced inflammatory root resorption: a systematic review

The European Journal of Orthodontics

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ABSTRACT

Summary Background The application of orthodontic forces causes root resorption of variable severity with potentially severe clinical ramifications. Objective To systematically review reports on the pathophysiological mechanisms of orthodontically induced inflammatory root resorption (OIIRR) and the associated risk factors based on in vitro , experimental, and in vivo studies. Search methods We undertook an electronic search of four databases and a separate hand-search. Selection criteria Studies reporting on the effect of orthodontic forces with/without the addition of potential risk factors on OIIRR, including (1) gene expression in in-vitro studies, the incidence root resorption in (2) animal studies, and (3) human studies. Data collection and analysis Potential hits underwent a two-step selection, data extraction, quality assessment, and systematic appraisal performed by duplicate examiners. Results One hundred and eighteen articles met the eligibility criteria. Studies varied considerably in methodology, reporting of results, and variable risk of bias judgements. In summary, the variable evidence identified supports the notion that the application of orthodontic forces leads to (1) characteristic alterations of molecular expression profiles in vitro, (2) an increased rate of OIIRR in animal models, as well as (3) in human studies. Importantly, the additional presence of risk factors such as malocclusion, previous trauma, and medications like corticosteroids increased the severity of OIIRR, whilst other factors decreased its severity, including oral contraceptives, baicalin, and high caffeine. Conclusions Based on the systematically reviewed evidence, OIIRR seems to be an inevitable consequence of the application of orthodontic forces—with different risk factors modifying its severity. Our review has identified several molecular mechanisms that can help explain this link between orthodontic forces and OIIRR. Nevertheless, it must be noted that the available eligible literature was in part significantly confounded by bias and was characterized by substantial methodological heterogeneity, suggesting that the results of this systematic review should be interpreted with caution. Registration PROSPERO (CRD42021243431).

CITATION EXPORT

Hassan M Dawood, Annika Kroeger, Vinay Chavda et al.. Under pressure—mechanisms and risk factors for orthodontically induced inflammatory root resorption: a systematic review. The European Journal of Orthodontics. (2023). https://doi.org/10.1093/ejo/cjad011

AUTHORS

5 · 9 CENTRES

Hassan M Dawood, Annika Kroeger, Vinay Chavda, Iain L C Chapple, Moritz Kebschull

Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK
Department of Oral Surgery, School of Dentistry, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK
Birmingham Community Healthcare NHS Trust, Birmingham, UK
Birmingham Community Healthcare NHS Trust, Birmingham, UK
Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK
Birmingham Community Healthcare NHS Trust, Birmingham, UK
Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK
Birmingham Community Healthcare NHS Trust, Birmingham, UK
Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA