Blunt end roots
Not sure if I've made a post about this before. I am treating a case at the moment where premolar extractions and orthodontics in the past has resulted in root resorption of the remaining premolars and incisors. The combination of this and perio has resulted in very early mobility of the teeth in question. Orthodontics and root resorption is a separate issue but I wanted to make a post on the possible causes I could think of of short roots on an xray.
In this case I noted the short premolar roots but didn't question it until I noticed that 4 premolars were missing. I then questioned about orthodontics and put two and two together. Other differential reasons I could think of were:
-Apical periodontitis causing apical resorption: As far as I have seen, it is more likely that this resorption is oblique as the apical foramen tends to occur away from the radiographic apex whereas orthodontic resorption seems to occur symmetrically resulting in a generalised flattening of the root tip. Orthodontic resorption also appears rounder and probably won't have a radiolucency associated with it whereas apical periodontitis will generally have a radiolucency (unless it has been root treated) and may have sharped angles associated.
-A severe curve in the root to the buccal or lingual will make the root appear shorter radiographically. Root tip curves tend to be near the apex so the blunting effect will not be as severe as in orthodontic related resorption. The root tip will still look fairly tapered, it will just be slightly shorter than expected.
-A tooth tilted Buccolingually out of the arch will cause the angle between the tooth and the film to change either resulting in foreshortening or elongation of the root. This should be obvious clinically.
-Developmental abnormality e.g Peg lateral incisor
-Post trauma resorption: May tend to affect multiple sites along the root
-Variation in the population: Some people have shorter roots than average and some people have longer roots. This will tend to be consistent among all their teeth.
In this case I noted the short premolar roots but didn't question it until I noticed that 4 premolars were missing. I then questioned about orthodontics and put two and two together. Other differential reasons I could think of were:
-Apical periodontitis causing apical resorption: As far as I have seen, it is more likely that this resorption is oblique as the apical foramen tends to occur away from the radiographic apex whereas orthodontic resorption seems to occur symmetrically resulting in a generalised flattening of the root tip. Orthodontic resorption also appears rounder and probably won't have a radiolucency associated with it whereas apical periodontitis will generally have a radiolucency (unless it has been root treated) and may have sharped angles associated.
-A severe curve in the root to the buccal or lingual will make the root appear shorter radiographically. Root tip curves tend to be near the apex so the blunting effect will not be as severe as in orthodontic related resorption. The root tip will still look fairly tapered, it will just be slightly shorter than expected.
-A tooth tilted Buccolingually out of the arch will cause the angle between the tooth and the film to change either resulting in foreshortening or elongation of the root. This should be obvious clinically.
-Developmental abnormality e.g Peg lateral incisor
-Post trauma resorption: May tend to affect multiple sites along the root
-Variation in the population: Some people have shorter roots than average and some people have longer roots. This will tend to be consistent among all their teeth.
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