Dr. Greg Jorgensen
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1401 Barbara Loop SE
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.

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

  1. Phil says:

    Dr. Jorgenson,
    I am 62 and thinking about having orthodontia done to correct bottom teeth crowding and straighten the upper teeth. One consultation I had prior to moving, suggested one of the bottom teeth be removed to relieve the crowding. Shaving the teeth would not leave enough tooth structure left to be effective.
    What questions or topics should I bring up with the orthodontist to ensure everything is adequately covered?

    Thank you.

    • The biggest question to ask when having a lower incisor removed is “How are you going to compensate for having fewer teeth in the bottom arch than on the top?” If the teeth are all the right size, you’ll either be left with excessive overbite or a deep bite. One way to compensate for the discrepancy is to reduce the size of the top teeth (“shaving”).

  2. Ben C. says:

    Dr. Jorgensen
    What is your opinion and or experience with Acceledent? Does it really shorten orthodontic treatment safely? Is it harmful to roots or teeth?
    Thanks

    • I personally have no experience with Acceledent. I have colleagues who use it and have seen mixed results. I have seen research that supports shorter treatment times, but I have no personal experience with that. My patients don’t think that saving 3 to 6 months of treatment is worth an extra thousand dollars. As you can read in other blog articles I’ve written, root shortening is genetic and the speed of tooth movement is unrelated.

  3. Joy Chalton says:

    Hello, I am 60 years old and the first of the year, noticed that my front teeth were loose. I forgot to mention it to the dentist until my checkup six months later. My teeth at this time were definitely much looser. When I mentioned it to the dentist, he took x-rays and sent me to a specialist as he thought the bone in my upper jaw had receded so much, there was nothing for my teeth to be anchored to. I saw the specialist yesterday who said that the bone was fine, there was no evidence of peridontal disease and that the roots of my teeth were so shortened that I would eventually lose them. He said this is usually a problem caused from injury to the upper jaw (as in boxing). I have never had any kind of injury, except I had to wear orthodontics from the age of 14 to age 18. The dentist suspects this may be the cause. They are going to make a splint for me to wear to stabilize them for as long as possible. Is this a normal side effect of orthodontics some 40 years later? Many thanks, Joy

    • This is not something that happens 40 years later. Root shortening does happen in less than 5% of patients, but only DURING orthodontic treatment. It does not continue after braces removal. I think your dentist needs to look into some other possible explanations.

  4. Amy says:

    I find this confusing. My dentist informed me of the shortened root on my front tooth and he said it was from having had braces and the teeth moving too quickly. I’m 45. I had braces for about a year when I was 13. My front teeth never moved. My molars were pushed back to let my one eye tooth come down. I don’t understand how a tooth that never moved was affected in such a way. I do now experience sensitivity when brushing that front tooth.

    • Your dentist is speaking without enough evidence to back up his claim. First, there is no evidence that moving the teeth “too fast” damages the roots. This is an old myth that has been disproved time and time again. Even if it was related to previous orthodontic treatment, why would only one root be short? My guess is that the shortness is related to something else you mentioned, that being the trapped eye tooth. It is very common for an impacted tooth to affect the development of an adjacent one. I would not believe your dentist or blame your orthodontist.

  5. Felicie says:

    Hello Dr Jorgensen!

    My brother had braces and after they were removed his orthodontist and dentist were deeply concerned about the amount of root shortening that had occurred. I am planning on getting braces soon, and I have discussed everything in depth with my orthodontist. However, he never brought up root shortening. Should I inform him of my brother’s case?

    • Absolutely YES Felicie! I’m not telling you you shouldn’t have treatment, but you are more susceptible to root shortening. Your orthodontist will be glad you brought it up so he can watch closely.

  6. Felicie says:

    Hello again respected Dr Jorgensen:

    I was just looking at the comments and realized there were more than a hundred. It humbles me to see that you have responded personally to each and in a very timely fashion; you are doing the world an invaluable service. :)

    I have a lower premolar which is completely rotated – 180 degrees. The orthodontist’s original plan was to leave it as is, but I am thinking of requesting him to try to twist it back. However, I heard (from non authentic sources) that doing so could heighten the risk of root resorption. Is this legitimate?

    Also, in a fall, I fractured tooth #8 (which remained vital) and sustained pulp damage (requiring a root canal) to tooth #24. In a later visit, a dentist decided to pulp test #9 as they thought it looked significantly darker than #8 (I had noticed the same). This tooth did not respond to the endo ice test. However, since I was having no pain, they decided not to do a root canal. On the x rays, they also noticed that the root was blunted (not sure what that entails).

    Since I have a 10mm overjet, the front teeth will be receiving the most stress from braces. Do you think teeth such as the above mentioned are more inclined to root resorption?

    Thank you very much, Doctor!

    Yours,
    Felicie

    • Root resorption is a genetic problem that happens to less than 5% of patients no matter what. Some patients can have long treatment, fast treatment, big movements, etc. and never have any problems at all. Conversely, other patients show signs of resorption within 6 months of normal treatment. The key is to monitor the roots during treatment with xrays.

  7. Felicie says:

    Hello Doctor,

    Many thanks for your response! I wanted to ask: does root shortening occur purely on a genetic basis? Have any other risk factors been determined?

  8. Fernanda says:

    Dr. Jorgensen:

    (I’m about to get braces on)… I don’t brush my teeth three times a day, I only do it twice…Is there any chances for teeth falling out when I got them braces on?

    Thanks,

  9. Terry A. Schrock says:

    Dr. Jorgensen:
    I’m very impressed with the thorough yet succinct manner in which you have responded to each of these posts.

    My daughter is 13 years old and has had braces for one year. During her first annual exam her orthodontist took an x-ray showing what I understand is nearly 50% reduction in size of roots from beginning of treatment. The orthodontist has suggested that she plans on ceasing treatment and removing the braces before my daughter’s originally projected treatment time is up. I understand a retainer will still be implemented.

    I know that you are not familiar with the specifics of my daughter’s case, but generally speaking my questions are fourfold:(1) do you agree with the proposed plan of action;(2)what are your thoughts as to whether the teeth will remain in their present location, once the braces are removed;(3)what concerns should I have for the future of my daughter’s teeth, if any;(4)are you aware of any alternative treatment options.

    Thanks and best regards,
    Terry Schrock

    • Root resorption is an unfortunate response to treatment in a small percentage of orthodontic patients. If your daughter still has 50% of her roots, she will probably not have any issues in the future. I do agree that your orthodontist should find an acceptable stopping point to minimize the loss of any more root length. Good luck.

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