Dr. Greg Jorgensen
(505) 891-9440
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.

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

  1. Caitlin says:

    Dear Dr. Jorgenson,

    I had braces on for approximately 36 months, which were removed 2-3 years ago. In the last 12 months I have had a series of problems with my teeth and jaw, including needing two RCTs on different molars, due to severe pain from root resorption, and extremely problematic TMJ pain and trismus.

    My family dentist has told me these problems likely stem from the orthodontic work I received (which happens to coincide with the onset of the TMJ problems). I also have extensive scarring on the inside of my mouth from the appliances I was fitted with to correct my bite.
    These dental problems have caused a host of other health issues due to difficulty eating.

    I’d like to ask your advice on returning to my previous orthodontist, to consult with him on these problems.

    Regards,
    Caitlin

    • These problems are not typical of orthodontic treatment. Unless your result was just terrible and your bite was completely off at the finish, I doubt that these problems can be attributed to braces. First, root resorption on molars due to braces is extremely rare (usually limited to the front teeth only), root resorption from braces is painless, and study after study has failed to show a relationship between having braces and TMJ. If your care was bad, you would have felt the symptoms during and immediately after treatment, not 2-3 years later. I would go see your former orthodontist just to let him take a look, but I am leery of the explanations being provided by your primary care dentist. They don’t match what I’ve seen in my 25 year career.

  2. steve says:

    hello, i had national health service orthodontic treatment in england, where i had two upper first premolars removed and train tracks fitted only to the top teeth to close the spaces.
    i also had to where retractive head gear for 9 months before that.
    the whole idea was to push the jaw back.
    since and during the treatment i have experienced headaches everyday, clicking pain in my lower jaw joint. stiff neck, and back pain, concentration problems and a multitude of other problems, that im convinced have been caused by the orthodontic treamtment 15 years ago.
    i had never experienced back pain or headaches in my life before the orthodontics, and i was 20 years of age when they started the treatment.
    is this a normal to only extract to upper premolars, and force the jaw back?
    thanks so much…
    steve

    • Removing two upper teeth does not move the upper jaw back, just the teeth. There is no research that supports the claims that orthodontic treatment causes the problems you are describing.

  3. Mandie says:

    Dr. Jorgensen,

    I am 2wks away from the initial phases of Invisalign. I proactively decided to see a DDS for a good tooth scrubbing prior to my treatment. All appeared well with the hygienist, but the DDS painted a different picture and advised my having root resorption on at least 2 teeth, specifically the 2 top incisors on either side of my 2 front teeth. He is now concerned with my orthodontia treatment and feels that it possible that those incisors will “fall out” with the shifting of my teeth during Invisalign. Have you seen a similar in your years of experience? Do you have any recommendations on my moving forward given the short period of time?

    • This is a decision that you need to make with your doctor, not the hygienist. The doctor is trained to recognize these problems and council you on how to proceed. You need to trust your doctor.

  4. Lu says:

    Hello Doctor,
    I need some answers please, I’ve recently started my ceramic braces treatment,(about 4months ago) yesterday I had my monthly visit and my doctor just noticed that I have very short roots in my front two teeth, all he said was he was sorry, he wants to wait another month to make a decision, he said he will monitor, I am scared, he had taken two teeth out already, and I don’t know what to do. wasn’t he supposed to take a look at the x-rays prior to make a decision on how to treat me?

    Please help.

    Thank you.

    • I hope that your doctor said “he was sorry” only because your roots are short and not because he caused it. Root shortening happens in a small number of patients who receive the exact same treatment as everyone else. As for the timing of this revelation, it is standard of care to examine dental x-rays before beginning treatment so that short roots can be identified. Radiographs should be repeated during treatment to watch for changes in root length.

      • Lu says:

        Thank you for your answer doctor, I had my orthodontist visit yesterday now I’ve been in treatment for 5 months, I asked him what is his plan he said he would monitor and slow down the process he I asked him if there is any other type of treatment that might suit me better and he said no, I’ve read that invisalign has less root resumption is that truth? I asked him about it and he said no, that treatment is very expensive and causes the same problems? I don’t know what to do, no I don’t know if I can trust my otrtho, I have a feeling he is not the best. should I seek for a different doctor? would they treat me? I’m desperate.

        • Root resorption occurs with braces and clear aligners. If the teeth are being moved, they can be affected no matter where the force comes from. The roots of the teeth only respond to force. They don’t care if the force was generated by metal braces, clear braces, retainers, or aligners. It doesn’t matter at all. The only thing a doctor can do is to monitor the length of the roots with regular x-rays and communicate what he is seeing.

  5. Chrissy says:

    I went to my orthodontist to begin braces for a 2nd time, the first was when I was very young 12-13 years of age for one year. I was never given a retainer after treatment and my teeth shifted back and I have a not so pretty smile as a result. The orthodontist told me I have short roots on my two front teeth and I could either stop treatment before I go any further or chance it and see if the roots are able to with stand orthodontic treatment. He said if they begin to shorten anymore he will stop treatment and will not continue. What are my chances of successful orthodontic treatment at this point? I have lost 1/4 of the root and while I am more then disappointed don’t want to give my self false hope I will be able to have straight teeth again. What is your opinion?

    • Your orthodontist is the only one who can determine this for you. It will be a risk. You and he need to decide how you’re going to determine if the treatment can proceed. He can’t stop root shortening. He can only identify it and inform you.

  6. Malich eatchison says:

    I’ve had orthodontics for 5 years with still more time to go. After going in for a routine cleaning and a full set of X-rays I was informed that the roots on three of my front teeth are completely gone. My front teeth wiggle and are uncomfortable when eating. It’s been 8 weeks since my last treatment and now I’m worried that my teeth will fall out when the braces come off. Is there any hope that they will not just fall out when the brackets are removed? Are implants my only option at this point? My orthodontist only took one X-ray about three years into treatment and nothing since then. I just don’t know what to do at this point. Thanks in advance

    • I can’t answer this question for you, but you need to talk to your orthodontist about it ASAP. If your orthodontist will not give you a straight answer, you need to get a second opinion. The root shortening does not mean your doctor did anything wrong, but not identifying it, monitoring it, or discussing it with you during 5 years of treatment is a problem.

  7. Myrna says:

    Hi, I just took my son for an orthodontics consultation and the Dr. made me aware my son has short roots on most of his teeth. If we decide to go ahead with treatment we run the risk of more root resorption. My son is 11 yrs. old, I defintely don’t want to put his teeth at risk for root resorption. They did say they would be montoring it closely by X-rays if we decide to get him the braces. His two front teeth are crooked, has an over bite (not a severe one), & a little bit of crowding on the bottom teeth that they would also have to correct. Would you recommend us to go ahead with treatment or to avoid it? I’m really conflicted and concerned! I would rather him have crooked teeth than for him to loose his teeth. Your advise would be truly appreciated, thank you.

    • Only you and your orthodontist can make this decision because it is a judgment call. I think it is a good sign that your orthodontist pointed out the short roots and made you aware of it. He will probably be very diligent during treatment to keep his eye on them. If it were my son, I would decide what really needs attention and discuss various “stopping points” where the braces could come off should the doctor notice that the roots are getting shorter as treatment progresses. For example: 1) resolve the crowding and align the teeth (then take an x-ray), 2) level the bite (then take another x-ray), 3) reduce the overbite (then take an x-ray), etc.

  8. Stephanie says:

    Hello. Thanks for the informative article. You seem to be so diligent and knowledgeable and I’m in a bit of a panic.

    2 years ago my now 12 y/o son fell and knocked #8 up into his head. We (including dentist) thought he knocked it out until viewing the x-ray.

    The next morning an oral surgeon re-implanted the tooth and wired everything back together. The surrounding teeth were loose and he aligned things but once that wire came off his teeth returned to terribly crooked. He had a root canal but the root and gum continued to resorb and he needed orthodontics anyway so I was referred to an orthodontist.

    The pediatric dentist I respect and rely so heavily upon and has spent so much time and care with him suggested shifting the remaining teeth so that #7 moves into 8′s position and #6 to 7′s position etc and then reshaping them with cosmetic dentistry. His partner agreed.

    The orthodontist offered a different plan. He wanted to leave a gap there and attach a temporary tooth to the braces. When they came off a flipper would be placed until he became old enough for an implant. I wasn’t thrilled with the prospect but consented. However, he complained of some tooth pain just before he was to have a palate expander and lingual bar placed and the general dentist how treats the teens in that practice saw him on an emergency basis. I explained what the orthodontist was about to do an he said, “Oh that is a terrible idea. What should be done is…” and he went on to propose the same tx option as the two pediatric dentists.

    Not being fond of the implant idea to begin with I put the brakes on. I told the orthodontist that I would only proceed with the plan all 3 dentists approved and if he wouldn’t agree, I’d find an orthodontist who would. Actually, I never even spoke to him about it. The dentists did all the talking and the plan was just changed.

    Here I am a year later. He actually got the braces on October 30th. The dead tooth is extracted and they have begun the process of realigning his teeth as I insisted. I have an old friend who is a general dentist in another part of the country. I spoke to him last week and explained the treatment option I chose and he said, “That’s a terrible idea. Braces cause roots to shorten and the lateral incisors are the weakest in the mouth.”

    #7 at this point is pretty much in #8′s spot. These teeth have been moved pretty quickly. At his last visit 6 weeks ago they put a “spring” in and bands are being used on the opposite side to help pull the teeth along. My son has been through so much already and I’m beginning to feel like I should get the worst mother in the history of mothers award.

    The orthodontist did take an x-ray probably back in April. Is it too soon for me to ask for another? Do you have any words of comfort for me? He has another appointment scheduled on the 20th. Honestly, his mouth is such a mess I don’t know about just taking those braces off at this point and from what you’ve described (I read all the comments too) I think trying to move it back will only make things worse.

    Please allow me to thank you in advance for your help.

    • First of all, you are not even close to the worst mother in the world. I cannot comment you your son’s case individually, but I want to use your experience to share a few thoughts. First, I specialize in moving teeth. I think I can hold my own with anyone when it comes to braces. I defer to specialists when it comes to making decisions in complex cases like your son’s. So when it comes to trauma and surgery, I consult with an oral surgeon. When it comes to replacing teeth, I always consult with a prosthodontist. Prosthodontists are dentists with advanced training and experience in replacing teeth. Whenever I have a case like your son’s, I have a face-to-face consultation with them. Second, in my experience, lateral incisors don’t make very good centrals. I’ve done this before and there have been a lot of “issues” with the size, the shape, the gum tissue, etc. Although everyone is different, my prosthodontic friends almost always have me leave the laterals where they are and prepare the patient for implants later. Third, when there are concerns about root resorption, it is not too much in my mind to take a radiograph every six months. Lastly, and this is important, your son has had trauma to his teeth. Unfortunately he’ll never be perfect again. This team of doctors you’ve put together are doing the best humanly possible to put your son back together. Please accept the fact that there will be compromises. But know this, he can live a long, healthy life with weak laterals, bridges, or implants. Good luck!

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