Dr. Greg Jorgensen
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Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

Do Braces Make the Roots of Your Teeth Shorter?

Posted by Dr. Jorgensen on March 23rd, 2013

I was recently asked to be an expert witness against another orthodontist in my community that had “caused” some root shortening (root resorption) in one of his patients. Could something that orthodontist did actually have caused the roots to get shorter? How serious is root resorption? Can it be prevented or treated?

Braces work by creating little cramps or “Charlie Horses” around each tooth. The enzymes that are summoned by orthodontic forces cause old bone to dissolve where there is pressure and new bone to be formed where there is a void. These responses are normal and are the basis for orthodontic tooth movement. Research has shown that tooth movement causes at least small changes in the shape and length of the roots in ALL patients. In 98% however, these changes are undetectable with the naked eye.

In 1-2% of patients, however, obvious root shortening occurs during routine orthodontic treatment. These patients are just more genetically susceptible to root resorption. I have even noticed that root shortening runs in families (after noticing resorption in two children from the same family I looked at the mom’s records and found the same thing). This genetic predisposition is important and should be communicated to your orthodontist if you are aware that it has been noticed in your family.

Are there things an orthodontist can do to cause or prevent root resorption? Some have theorized that root resorption happens if the teeth are moved too quickly or too slowly. Teeth that are moved too quickly may be subject to too much force they say. However, in my cases where I’ve seen resorption I’ve used exactly the same amount of force for exactly the same amount of time as everyone else. Braces that are on longer logically have more time to cause a problem. Having said that, I’ve seen transfer cases that have had braces on for more than 5 years with no signs of root change. There really is neither documented cause of nor protocol to follow to prevent this shortening.

So what can be done about root shortening during treatment? About the only thing we can do as orthodontists is monitor our patients during treatment using routine x-rays. These should be taken at least annually as long as the braces are on. If root shortening is noticed, it should be pointed out and discussed with the patient and their family. Depending upon the amount of shortening, treatment may be continued as normal, the treatment time shortened (stopping after spaces close for example), or the braces immediately removed. It is generally believed however that a tooth can lose up to half of its root length and never have a problem. In my 21 years of private practice, not a single tooth has been lost to root resorption.

My answer to the prosecuting attorney trying to sue my competitor was this. “Root resorption is a normal consequence of orthodontic treatment. I’ll bet [the doctor] can produce hundreds of cases he’s treated exactly the same way without incident. As long as he took annual x-rays to monitor the presence and amount of shortening, I think he’s done everything he possibly could to give his patient good treatment. I don’t think you have a case.” I never heard from him again. Be sure you allow your orthodontist to take x-rays on a regular basis to monitor your progress and screen for problems during treatment. Ask him to specifically look for root shortening if he doesn’t bring it up himself.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

192 comments so far in response to “Do Braces Make the Roots of Your Teeth Shorter?”

  1. Jessica says:

    I’m so glad that you covered this topic on your blog! And, after looking through the comments, thank you so much for responding to all the questions! It’s very helpful!

    It’s been a year since I’ve had braces. I just got out of my orthodontist appointment on Saturday. I had some X-rays done, and my orthodontist showed them to me and notified me that I have root shortening on my first top four teeth. He said that it isn’t a grave concern because it’s only a little bit of the root for now. Therefore, he gave me the options to stop or continue with my treatment. However, if it gets worse, then he will stop my treatment.

    Now, I did decide to continue on because in that moment, I questioned myself if I wanted to stop the process when this is a $5000 plan. Of course, this will definitely be a question that I need to direct to my ortho, but he really is not sociable at all, and he rarely talks to me when I go in for my appointments (just except for this past Saturday about the root shortening). My question is, if it gets worse, and he proposes that we stop the treatment, but my teeth aren’t how I like them yet, will I still have to pay the full cost?

    If I will still have to pay the full cost, can I request to continue on even though the root shortening gets worse? What are the side effects of having severe root shortening?

    • I can’t answer for him, but if we have to stop treatment short of the finish for whatever reason, we adjust the fee accordingly. This is something you’ll have to discuss with your orthodontic office specifically.

  2. rongrong zhang says:

    I think this is the right place to talk my teeth problem.
    I have my brace on for 2.5 years.

    Frist, I am very worry about my lower front teeth. Because 1 of them visibly come out and also verified by the x-ray and dentist. The tooth gonna lost after the brace. Hoever my otho think it is still fine. He always thinks everything he did seems perfect. Even the X-ray tells the root is shorten and the teeth is moving.

    Secondly, after 2.5 years my lower teeth still crooked and lots of space. I do not know whether I need take the risk to continue wear the brace or take it off. Because I also see other otho and they suggest take the brace off immediately.

    thirly, I want to know if the teeth fall off after take off the brace. Can I ask for the compensation from my otho. One of the other otho tell me he put the charlie horse too close to the gum and put too much power on it.

    Last, I want to know if I take off the brace, it is still good to wear the bond retainer? Because the teeth is moving, my otho said he gonna put the bond wire to fix them to invoid the teeth lost. Do you think it is a good idea? does it affect the teeth recover?

    Thanks so much for your advice. I am so frustrated now. By the way this is the first time I have the brace and I am 33.

    • I’m sorry that you are having such a rough time with your treatment. It sound like you have lost confidence in your doctor. I would get a second opinion from another doctor in your area so you can get a fresh start. Good luck.

  3. Victoria says:

    Hi,
    I have read difference articles on your blog here. It is so motivating that you share your professional opinion. I just wonder about one thing. I am in treatment for over a year, and I can feel two of roots through the gum, it is not painful but it is kinda strange I can feel a relief so good and feel the move as I bite down. My orthodontist doesn’t seem to agree that it is there, nor concerned. Can this damage roots? I guess it happened as my teeth was tipped forward In my lower jaw, I believe I read somewhere about that. I am still under half way with treatment and it probably will get better as treatment progress but I am concerned as if it can destroy the teeth?? Shall I ask my orthodontist to look at it again?

    • It is not abnormal for you to be able to feel your roots under the skin. It does not mean that they are going to get shorter or damaged. If you have shared your concerns with your orthodontist and he is not worried, everything is probably normal.

  4. Preity says:

    Hi,

    I had a query regarding my braces treatment, I had gone through braces treatment almost 3 years ago, I had braces for 18 months but that time I had a milk tooth which is about to fall now it is not in still position. I am in a different location and cannot go for treatment to my orthodontist but I consulted him anyhow he is saying let milk tooth fall itself and I can have a implant then but that milk tooth is looking so weird as it came in front , sorry forgot to mention this milk tooth is right side molar, I consulted another dentist in my place and they suggested me to go for ortho again as they feel my ortho treatment was not done properly and I still have cross bite and little mid line shift issue.

    I am 27 and don’t want to go for ortho again, My mid line looks fine to me until it was highlighted by new dentist, They are saying they can go for rapid ortho but I feel it will reduce strength of my teeth also it will take more time to complete treatment and most importantly I don’t want to bear that pain again as I am a working professional and need to interact with many client regularly and having braces looks so bad.

    i asked him for alternative he said we can’t go for any alternative(invisible or invisalign ) in your case.

    I feel I can have a implant is pace of milk tooth and mid line looks fine and not noticable, I feel it is less than 2 mm shifted will it be going to impact my smile, please clear my confusion.

    • No one ever died from having less than perfectly aligned teeth. If you don’t want braces again, you could just have the implant. Just remember that you only get one set of permanent teeth. Shouldn’t you do everything you can to keep them healthy? Good luck in your decision.

  5. Michel says:

    Hello,
    I read your article but I’m still not sure if my case applies to this. I started having braces when I was 15 and now I’m 19. Just recently, my orthodontist told me I have root shortening on my first top four teeth.He told me not to worry about it but I needed to be aware. When I asked him what was the reason for it, he said that its unknown that sometimes this happens to patients without reason. As you see, I’m not satisfied with his answer. I was wondering if the root shortening is due to having braces for so long. I also have a jaw problem. Apparently my bite doesn’t match and that is making my treatment be longer.

    • Unfortunately the answer your orthodontist gave you is all we know. Some patients get it and some don’t. I’ve had patients with braces on over 5 years and not one bit of shortening and others with lots of resorption in less than 6 months. It is similar to men losing their hair. Some do and some don’t. The only thing we can do is detect root shortening, notify the patients when we see it, and modify the treatment plan if necessary.

    • Nikhil says:

      Hello doctor. I have had braces for 18months alignment with no root resorption and there is still 12months gap closure process, does this mean I do not have to worry about root resorption? Thanks & Regards

  6. Jeanine says:

    my friend is 34 and she had invisalign more than 2 years ago and it caused her so much pain she only wore them at night. She completed the course 18 months ago but has been in continual terrible teeth pain which starts in the evenings. can you please advise if there is anything she can do?

    • If she finished her orthodontic treatment 18 months ago and is still in pain, there is something else going on. She needs to consult with her dentist to determine the source of the pain she is now experiencing.

  7. Michelle says:

    My 15yo daughter is having root resorption (not shortening) in her top front tooth. They said she will probably need an implant by the time she is 20. She is one year in for the two year treatment. What are the chances this will occur in other teeth? I’m afraid, with her, the risk is now outweighing the benefit and strongly considering stopping treatment. Thoughts?

    • I’m not sure I understand what you mean by “root resorption” that is not shortening. Perhaps you are talking about internal root resorption, but that is not in any way related to orthodontic treatment. I would have my child seen by an endodontist who specializes in root canals that can be used to stop internal resorption.

  8. Renee says:

    Hello my daughter is 17 years old and has had braces on for approx. 2 years. We took them off in Nov 2015 due to root shortening. She now has movement in her bottom front teeth. Her orthodontist is sending her to do x-rays and pathology to make sure her bone is healthy and there are no other issues going on before we consider bonding the teeth together to anchor them in. My question is her jaw is still growing will bonding her teeth together cause any other problems further down the line and is the right path of treatment? Thanks

    • Bonding the teeth together will not cause any other problems. The most important thing is to get the braces off and wear a retainer. The shortening usually stops once the orthodontic forces are removed.

  9. Hana Simon says:

    My Orthodontist told me (32 F) in haste today that we need cease treatment after almost 3 years of braces because of root resorption. I have an unerupted upper right canine that he says is too dangerous to move now, given the root resorption, and that I should instead get an implant. He simply said that these things happen. That doesn’t seem like it’s the whole story, and I’m SO confused as to how this wasn’t picked up on immediately after looking at my x-rays.

    My first X-ray with him was July 2013, and when I asked about my short teeth at the time to him and to my dentist later, it was explained to me that the x-rays don’t convey the angle of the root, so it could be longer than it appears. They also mentioned that I have large nasal cavities. Seemed legit, and what do I know about dentistry? Is that a legit response though? Should he have considered my roots were short to begin with and that it should have been monitored?

    The second and latest x-ray he had me do after that was January 2016, which as he pointed out only today shows a ton more root resorption in my upper premolars and first molars (right and left). Since that time, after moving my left upper canine in place since that time, my upper teeth are splayed out in a strange way. What are the chances of this getting much worse in the last six months?

    I asked him for another x-ray today to see how much has been resorbed since January. I’m going back on Monday to get that done. I will also ask him why he didn’t mention this in January when he first saw the x-ray. I’m also curious as to why this wasn’t being monitored with regular x-rays. Are there other questions I can ask him?

    • It sounds like you are already on top of this. It comes down to trust. If you believe that your doctor is being honest with you, then you two need to work together to determine the best outcome for you. If you don’t trust him, you should see a second opinion.

  10. Kh says:

    I am 45 years old have Hashimoto’s thyroiditis, and also fibromyalgia pain which I do not allow to control me. I do take synthroid however that is the only RX I take. I exercise and garden and work out when I can. I am worried about me possibly being predisposed to root resorption. I do have issues with inflammation as I had a blood test done that did show some increased level of inflammatory process. I have had a gum graft in preparation (front bottom at the four incisors). I did fine with that. I have been researching and am almost talking myself out of braces after wanting them for so long. My teeth are not bad at all in top but I have one tooth incisor that is totally crooked on the bottom. Reason for braces…… Can you tell me 1) if traditional braces cause root resorption more than Invisalign? 2). With my health issues does that predispose me to root resorption? My ortho said of the 24 years he has been in practice he has only had about 15 cases of root resorption. That sounded like a lot to me? 3). Does that sound like a lot to you? Any advise would be helpful.. I am super sensitive too…..doc says I have over sensitivity……..

    • 15 cases in 24 years is VERY LOW. Research suggests that it affects about 2% of patients which would be 3 patients per year in a small practice or more than a dozen per year in a big one. The key is identifying the problem as treatment progresses. We take an x-ray at the start and at six months. We then repeat the x-rays at least once per year to be sure.

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