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.

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

  1. Linda Steyn says:

    Hi
    My daughter had braces about three years ago for about 18 months (she is now 16) and we have just discovered that one of her teeth has died and she needs root canal treatment. My daughter can recall having pain inthe area at the time.

    Can I go back to her orthodontist and ask him to pay for the root canal treatment due to his possible negligence when fitting the braces?

    Thanks very much.

    Linda

    • No you should not Linda. Teeth have problems before, during, and after orthodontic care for a variety of reasons (trauma, decay, restoration, etc.). If root canal therapy was commonly needed after orthodontics, none of us would be in business. Things happen. I doubt your daughter’s orthodontist did anything different with your daughter than he does with any of his other patients. Devitalization of teeth (dying) during treatment is a rare risk that is listed on the American Association of Orthodontist consent form that all of my patients sign. Obviously no one wants that to happen during treatment, but unless your doctor did something grossly negligent, you should just get the tooth treated and move on.

  2. Dr. Cathy Andrew( medicine) says:

    I am 59. I had braces and head gear around the age of 10 for about18 months, although I have no records.
    My dentist says both my top and bottom teeth have short roots becasue of my braces.I only had treatment on the top, but she thinks I must have forgotten!.
    She says that I wont be able to have a root canal if needed becasue of the roots being so short.Is there any treatment
    like bone graft, I can do to preserve my teeth? I needed peridontal treatment 2 years ago.
    She has extracted one molar tooth recently( it basically just popped out) as well as 3 of my 4 wisdom teeth about 15 years ago.
    I am using a water pic regularly now.
    thanks-

    • It is really hard to say what happened 50 years ago Cathy. I’m not sure why short roots would prevent performing a root canal. I’d ask about that. As for periodontal procedures, those should be able to proceed as normal and as you’ve seen having teeth with short root removed is easier. Most patients who have root shortening keep their teeth the rest of their lives. As you’ve seen, you’ve had yours for 50 years and have had no major consequences. The root resorption you’re describing is not responsible for periodontal problems. Those are caused by plaque.

  3. Htran says:

    My 13 year old daughter has only a single one bottom tooth very light crooked (no crooked ones on the top) and underbite tendency.
    1. With some risks of orthodontic treatment, do you think it is worth for her to get orthodontic treatment or not.
    2. If treatment, should she get the traditional bracket or self ligating bracket?
    3. The orthodontist that we went for consultation recommend the custom bracket/insignia. She said the result will be very good and the length of treatment will be shorter. But, I am worry if shorter treatment length may need heavy force to move teeth. Can you please advise if you have experience about this method?

    I look forward for your opinion.
    Thank you

    • 1. Of course I think orthodontic treatment is worth it (that’s what I do). Not only will her teeth look better, they’ll wear more evenly and be easier to clean and care for. 2. Traditional brackets and self-ligating brackets will give exactly the same results. Choose your orthodontist by his skills and experience, not the bracket he uses. 3. Insignia is a way of straightening teeth that helps the orthodontist get from Point A to Point D without going through B and C. In other words, the digital technology takes you directly to the finish point which cuts out appointments. The wires and forces are the same, so it is just as safe.

  4. Htran says:

    Thank you so much for your reply. It’s really helpful.
    1.The orthodontist that I plan to go provide both traditional bracket (regular and mini bracket) and self ligating (Damon,…) If your kids need braces, which one you will pick for them? (please specify kind and name)
    2. My daughter gets grinding teeth at night. Do you think it will be a problem during orthodontic treatment? Will the grinding be less after treatment?
    3. I hear that if tooth got heavy force, it may get broken nerve, and need root canal….Is it true?

    • @Htran 1. It really doesn’t matter. As a consumer, you will not be able to tell the difference at the end of treatment anyway. I do not think that it is worth even a penny more to have a self-ligating bracket… and I’ve used both for years. 2. Grinding or bruxism is unrelated to orthodontic treatment. It is more stress and habit related. It could be a problem during and after treatment. In my office we will sometimes bond temporary cement over the teeth so that the grinding does not continually damage the braces. Afterwards we encourage a night guard be worn for enamel protections. 3. Normal orthodontic forces do NOT damage the nerves of teeth. Sometimes teeth are devitalized before, during, or after treatment. There is no way to predict or prevent this from happening. This is just a fact of life. If routine orthodontic treatment caused teeth to need root canal treatment, orthodontists would have big problems on their hands. It can happen, but it is very rare.

  5. Htran says:

    Your responses on (2) and (3) are very clear. Thanks.
    On (1), the result are the same on both kinds. But, is the self ligating more comfortable than the other? How did you hear your patients comment on both?

    Would you please explain what the continuos force and intermitten force are. Are they related to the braces that were used?

    After treatment, for any reason if my daughter doesn’t want to wear retainer, will the teeth keep shifting to the old position or less than that?

    • There have been many studies that disprove the claims that self-ligating brackets are any more comfortable that traditional braces. In fact there are studies indicating that although self-ligating brackets are slightly more comfortable in smaller wires at the beginning of treatment, they are actually more uncomfortable when you move into the bigger wires that are in for most of the treatment. As for continuous and intermittent forces, this has no relationship to the type of bracket used. It has more to do with the materials used to provide the forces (i.e. rubber versus nickel titanium). Don’t choose your orthodontist based up what he uses to straighten the teeth. Choose him based upon his reputation and results. Everyone is different when it comes to relapse after not wearing retainers. I’ve seen some who you couldn’t tell they ever had treatment and I’ve seen those who still look amazing despite non-compliance.

  6. htran says:

    Thank you for your explanation. I really appreciate it.

  7. Leesy says:

    Hi doc, im happy to find this article. Im 25 and thinking to go for orthodontist. But my xray result show that i have a shorter root for all my tooth especially the front tooth. If im advisable to go for the treatment? As i seen, there’s a risk for root absorption. Will my root be shorter and drop off easily after treatment? I have been thinking on this issue for a month. Thanks for your advise.

    • Short roots are definitely a concern. The decision to have treatment or not would have to take into consideration how much treatment you need, how long it would take, and how short your roots are at the beginning. All of these questions can be answered by an experienced orthodontist.

  8. Angel says:

    I have been wearing braces for the past rhree years and on my most recent visit they had seen that my roots on my low anterior teeth had shortened. Should I be worried? Is there anyway to help control the shortening? My treatment is expected to last only 4-5 months more, is the problem not a severe as I think?

    • The long term effects of root shortening are determined by how much shorter they are. If they are only 1/3 shorter, there will probably be no problem at all. If they are 2/3 shorter, you may have some issues if you have trauma (i.e. get hit in the mouth). There will probably not be any disadvantage to finishing your treatment if it is only 4 to 5 more months. As for prevention or control, there really is nothing short of just removing the braces early that will help. Some people get it, some don’t.

  9. My dentist said I have short roots on my front teeth and I was wondering if I needed a root canal treatment. I think the reason is because I had used 3 braces treatment all my life I started when I was around 7 since my over bit was to big and my first dentist said I had to get it at a young age and we had to keep switching because of insurance coverage. The thing I worry is that my teeth are already chipped badly and I’m scared if I loose my two front teeth. What do you suggest?

    • I can’t comment on your case specifically, but I would generally not recommend root canals therapy for teeth with short roots due to orthodontic treatment. Root canals can be used if there is root resorption due to trauma, but it is unnecessary following orthodontic treatment.

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