Abstract
In this part of the editorial guest article, I would like to present the new term to orthodontic apical root shortening (OARS), namely, Orthodontitis.
In one of my consultation, a young mother, who has a medical background, asked me a simple question: “How come you can move teeth?”
“Be more specific please,” I said.
“Please explain to me how come you can move teeth and not for example ears? There are many that would like their ears to be leveled so…?”
I knew that I have to be very cautious with my answer; however, I decided to be direct:
“I don’t know whether you are aware that the teeth are connected to the bone via the Periodontial Ligament (PDL). They are not a part of the bone, and this 0.25 mm tissue is very unique, it allows us to move the teeth in space, in the bony space. This bone that surrounds the teeth called the alveolar bone.”
“Please explain to me what the process is?”
I drew a tooth and demonstrated to her the movement in the PDL, the development and the different reaction of the alveolar bone by resorption and apposition to the pressure and the tension sides, respectively, and the way a tooth moves according to the vectors of the force.
“And what about the tooth itself?” she asked.
This was the first time in my 35 years that the idiom “it hurts to think” flipped in my mind. I knew that she wanted to know more.
“I can hear your brain wrestles,” she said, until I began my speech.
She was right. I had to tell her more, to be direct, and I explained to her, the concept we developed in the last 4 years: Orthodontitis.
During the 3 years of residency, orthodontic students learn to master orthodontitis. This word is composed of orthodont + itis. Itis is the termination of an inflammation, and she of course knew it. I said:
This itis is activated and stopped on demand. It is iatrogenic and depends on the applied force. It is aseptic, no disease generators involved. It is limited to a confined zone. It owns 5 inflammation signs (heat, pain, redness, swelling, and loss of function). It moves teeth to solve esthetic and functional problems. It should give pride to all those that know how to use and control it. It is a part of the “defense mechanism” that the body owns.
“You want to tell me that you use a defense mechanism to move the teeth?” From her reaction I knew that she got the idea.
“Yes, we use it and control it; however, and unfortunately, this defense mechanism has rarely one fault, and it is that it shortens the roots.”
“What do you mean by that?”
I demonstrated some X-rays with short roots, and added that it was proved that the longevity, the function, and the color of the tooth remain as they were before the treatment.
I thought that this will end our conversations, but it did not. She wanted to know more, statistics, predictability, and prevention. As an answer I showed her the American Association of Orthodontics’ (AAO) informed consent. There we read together the following:
“Root Resorption: The roots of some patients’ teeth become shorter (resorption) during orthodontic treatment. ‘It is not known exactly what causes root resorption, nor is it possible to predict which patients will experience it.’ However, many patients have retained teeth throughout life with severely shortened roots. If resorption is detected during orthodontic treatment, your orthodontist may recommend a pause in treatment or the removal of the appliances prior to the completion of orthodontic treatment.”
“Unfortunately, this is the current status following more than 100 years of research,” I said.
She thought for a few moments and said: “Thanks for being open. I appreciate it. I promise that I will Google ‘Orthodontitis’.”
“You will not find anything but several publications that I’m signed on. The profession is ‘afraid’ to connect it to an inflammation, although it is, as I explained, a good one.”
She, as I mentioned before is a physician. She started to laugh. “No one should be afraid from the truth, especially this one. You should be proud, as you said before, that you can use it to cure malocclusion and malfunction!”
This last sentence deviates me to try to answer the question: Why OARS is a political issue, and who gains from it?
Researchers: In the last 100 years, and especially in the last 20 years, the number of publications related to OARS increased tremendously, from 1.7 articles per year (1900–1990), to 135 articles per year in 2011–2105. Most of those articles are retrospective studies, and those that are prospective ones are short-term in-vivo publications that study the defense mechanism and not the OARS. Those studies are relatively easy to perform if you have the needed tools. Looking under street light effect is probably the one that is behind those studies that, as far as I understand, does not contribute a single parameter to the predicting possibility nor to the treatment itself in the way to prevent OARS.
Orthodontists: The more obscure the OARS and the more pre-apology, like the AAO informed consent is, the less incentive the profession has to study the predictive as well as the means to prevent it.
Orthodontic supply companies: Those who can say, without any real base, that their appliances, for sure, are the ones that by using them, no root resorption will occur.
General dentists: Those who actually from lack of knowledge, or professional ignorance, are happy to extract teeth with OARS and move on into implant therapy. If possible, why not. For me this is a real malpractice issue.
Lawyers: Those who became not only ambulance chasers but, as well, root resorption chasers, as written in one of the expert witness website,
"I perform orthodontic manipulations routinely at both my university and hospital. Resorption is by far the most common reason why orthodontists get sued. Root resorption can occur at any time during orthodontic therapy, especially when excessive forces might be applied during manipulations. The likelihood that a patient would lose his/her teeth could be determined by examining the amount of root length left after the resorption occurs and the general dental health of the supporting bone around those teeth."
(Refer to
There might be others in the row; however, I believe that this list is long enough to keep the situation as is, and not to go further, to define this defense mechanism as orthodontitis and be proud that we know how to control it, if we are aware of its existence.