Letters From Our Readers

To: Editor, The Angle Orthodontist

Re: Does pulp have a role in root resorption? Naphtali Brezniak; Atalia Wasserstein. The Angle Orthodontist. 2022; 92: 815–817.

This guest editorial on root resorption was informative. From a teleologic standpoint, when an axial root surface goes into cortical conflict (with no concomitant apical ischemia), it makes sense that fenestration or dehiscence would cause only local thinning or perforation of the cortical plate. The literature shows us that apical root conflict with cortical bone correlates significantly with greater dehiscence (more than axial root conflict). It also makes sense that apices forced into conflict with cortical boundaries would cause a rapid melting of wider bone area (dehiscence) to relieve pressure on the neurovascular supply to preserve root vitality.

Understanding the etiology for apical root resorption may never emerge. However, since we do know that apices forced into cortical bone significantly correlate with dehiscence, wouldn't it serve our patients and medico-legal position to verify that apices stay clear of cortical boundaries during treatment to lessen iatrogenic damage? There is no way that two-dimensional x-ray imagery can provide clarity for where not to move apices in all three dimensions.

To get to the next level, we may need to go beyond knowing the diagnostic risks in three dimensions. When we can pair Dicomm to treatment device to easier anchorage, I believe we'll have stepped into an era of precision orthodontics reminiscent of travel by “GPS”: faster finishes with less damage.