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.

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

  1. Amy says:

    My daughter’s ortho said that she has “marginal” root shortening on her front teeth and he advices to go ahead with Invisalign. Does “marginal” mean minor and therefore insignicant?

    • Only your orthodontist can answer this. The key is following the progression of the root shortening during treatment. I would require a new x-ray every 6 months in my office.

  2. Monique says:

    I had an x-ray done on my teeth. My dentist said that my roots in ny front teeth are too short for braces and that if I do get braces the root might become so short that the tooth would fall out. Has this ever happened?

  3. Maria says:

    Hi,

    I have been in braces for 6 month now. Had extrations both up and down. Down they extracted teeth that comes after canines (#4). I only got my bottom arch braced 2,5 weeks ago. My orthodontist said that we had to do it kime this because of an overbite. To my surprise i had more pain first few days in my lower jaw after getting it braced then i did have with my upper jaw 6 month ago ata start of treatment. One premolar espesially was painfull. However four days after pain subsided and six days after i was almost painfree. But i noticed that one of the premolars in lower jaw, the on ethat was aching so much got VERY loose. Well at leats it looks like that to me. The way wire is placed i can see that orthodontist was aiming for moving it up as well as straigtehning it otherwise. It moves not on,y to the sides but also up und down, which i notice when i bite down! The other premolar on the other side also has same movement but it seems to be less. I am excited to get through the treatment but i wonder if tooth can just fall out?? I am not sure how much damage can 2,5 weeks can do to a tooth? Shall i be alarmed?

    • The feelings you are describing are very normal Maria. Not much damage, if any, can occur in that span of time. If you don’t feel a lot better in two more weeks, make an extra visit to see your orthodontist. Good luck!

  4. Phan Mai says:

    Hi Dr Jorgensen,

    I’m very concerned about root resorption for my 11-year old daughter in future. She had an x-ray some days ago. Two orthodontist looked at the x-ray and told me that the teeth root was still very young (I don’t know if “young” means “short”),easily getting root resorption. so she can’t wear braces now and should wait for at least 1-2 more years. Two other orthodontists confirmed me that no need to worry, that the younger you are, the easier for the root regeneration, and that the rate of root resorption will be higher in adults, not in children wearing braces. I’m very confused now and worried that I can make mistake for my child. Why can there be two such opposite opinions? Could you pls tell me what ‘s like in your experience? Should I let her wear braces now or wait until her teeth root longer?
    I’m looking forward to hearing from you soon. Thank you for your blog and your help to me.

    • Younger children have less root resorption. There is no way to make it faster or slower. It is dependent upon the patients biology. The key is to have which ever orthodontist you choose monitor the root lengths every 6 months and keep you informed all along the way.

  5. Jane Fiore says:

    I decided as a 50 yr old adult to get braces – mostly die to a very crooked lower tooth resulting in a canine tooth pushed out in front . The canine was extracted and I wore braces for 2 hrs on top but the bottoms for 2 1/2 yrs. I have never been satisfied with the lower ones . I got a permanent wire retainer as well as clear one – but 2 of the teeth were so lose – my regular dentist told me to go back and ask that the orthodontist bond the retainer. After bout a year the glue on one of the “looser” teeth popped off when I bit down . I was also concerned that this tooth was still loose …the tooth was re-bonded . But after the bond came lose 3 more times, the orthodontist suggested that I go to periodontist for gum roots to be reminded because he felt the tooth trying to turn that was popping the adhesive . I felt the tooth was never secure after braces and the periodontist confirmed today that there is little bone left under this tooth or the one next to it & No treatment other than bone implant or partial plates -dentires will fix this ! I am so upset because the # 1 reAson I paid $5000 for braces was to avoid periodontal problems as I aged . Now I am out $5000 and still face expensive implants or denture bridges which I do not want :(. I feel the orthodontist should have been taking X-rays even when I got the braces off and the lower teeth were lose . I will be contacting his office on Monday and plan to take action and get my records . How often does this happen ? This risk was Never explained to me – had it been I would not have gotten the braces

    • There are no guarantees with the human body. I have a mouth full of fillings that I have received over the years (and I’m probably your same age). As I’ve aged those fillings have become crowns. some of the crowned teeth have required root canals. A few have split, been removed, and then replaced by implants. As a dentist myself, I know that we as a profession do the best with what we are given. I don’t blame anyone for my dental problems. I just keep moving forward and keep getting fixed up. I would counsel that you not take “action” against your orthodontist. You would have to prove that he was negligent or that he intended to harm you. All he has to show is that he provided the standard of care and that your overall condition was improved by the treatment he provided. Save yourself a lot of grief and just keep moving forward. Legal action will be time intensive, expensive, and in the end you’ll still need to get the tooth replaced. Let it go and move on.

  6. Lety says:

    Okay so my daughter has had braces for 3 years now and the recently took them off . But when they took them off the top teeth were sticking out looking slanted. The only way they could be able to fix them if they take 2 tooths from the top off and 2 from the bottom . But they told my daughter that her 2 front teeth had kind of small roots and that there might be a slight chance they will get loose. I’m very worried because I don’t want both of her tooth’s to fall , but I also don’t want her to have her front teeth sticking out . I have no Idea what to do please help .

    • This is a tricky situation. The only recommendation I have is to sit down with your orthodontist and discuss the pro’s and con’s of continuing treatment. It will come down to deciding which situation is the least acceptable to you. If the teeth stick out, you may need to continue with treatment even if it means replacing some of the ones with shorter roots someday.

  7. Pita says:

    I got my braces removed about 4 years ago, still use my retainer every night. But I’ve noticed that one of my upper front tooth has been feeling a little loose. I dont floss very often, due to the fact that I feel my teeth begin to move when I do, making my retainer super tight at night. I recall my orthodontist mentioned that I had short roots. Reason why I had my braces removed earlier than expexted. Is this a sign of potential tooth loss?

    • All of these questions must be answered by a local orthodontist with an x-ray in hand. Something is going on and I think you need some answers and advice. Flossing should not move your teeth.

  8. Ben C. says:

    Is it true that Invisalign causes significantly less root resorption than traditional braces?

    • I have never seen any scientific data to back up this claim. I don’t know how it cold be true when the teeth can’t tell where the force is coming from. Force is force whether from wires, rubber positioners, or plastic aligners. If there is a study proving this claim, I’d like to see it.

      • Ben C. says:

        Thanks for responding to me. The study about this I recently read was done at USC, at the following website: http://digitallibrary.usc.edu/cdm/ref/collection/p15799coll127/id/15548

        • Thank you for this reference Ben. I am open minded and always willing to look at any real science that is out there. This link is to a thesis written about the difference in the prevalence of root resorption when comparing conventional braces with Invisalign. I acknowledge that the authors found more root shortening in the braces group in this study. I would like to see the authors submit this thesis in the form a scientific article to a refereed orthodontic journal like the AJO-DO or the Angle Orthodontist so that the validity of the study can be evaluated by those not associated with the school or the study. My gut reaction is that conventional braces move the roots of the teeth more than plastic aligners (i.e. lateral tip and buccolingual torque) and that may be both a positive (better root positions) and a negative (more root resorption).

  9. Ben C. says:

    I am 39 years old and when I was 19, I had surgical assisted palatal expansion followed by braces, which wore for 9 months and then retainers which I wore as directed up until a month ago. About a 3 weeks ago, I had a new spring Hawley retainer made to push my top right front tooth forward because in the past 6 or so months, it has shifted slightly inwards and down and my bite has felt off and uncomfortable. I wanted to try this before doing braces again. I wore this retainer for only one week and decided to stop because it pushed my top right and left lateral incisors inward too far. They also made a light crackling sound when I lightly bit down. (I read this is the ligaments loosening). Also, I could feel it slowly move my right front tooth forward which was good. Within a few days my incisors shifted back to where they were before I got this new retainer. They were a little sore for more than a week if I lightly pushed on them but that went away. Yesterday, after I got back from vacation, I went to my orthodontist and he filed down parts of the acrylic covering the wire on the front of the retainer but again, my lateral incisors feel like they are being pushed inward and my right one is again sometimes making the slight crackling sound when I lightly bite down. I am going to see my orthodontist again on Tuesday. *How much longer do you think I should wear this retainer?
    Thanks

    • I’m not a fan of trying to move teeth with removable retainers. It is imprecise and frustrating for both the doctor and the patient. You could get clear brackets on your front teeth and get the result you’re looking for very quickly and easily compared with the frustration of a removable retainer.

  10. Jaquelin Avitis says:

    If root resorption is present from prior ortho, can patient do ortho again?

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