ORIGINAL ARTICLE

Histologic evaluation of root response to

intrusion in mandibular teeth in beagle dogs
Juan I. Ramirez-Echave,a Peter H. Buschang,b Roberto Carrillo,c P. Emile Rossouw,d William W. Nagy,e
and Lynne A. Oppermanf
Houston and Dallas, Tex, and Monterrey, Mexico

Introduction: The purpose of this article was to histologically evaluate root resorption and repair after orthodon-
tic intrusion with different force magnitudes and fixed anchorage. Methods: A randomized split-mouth
repeated-measure design was used. Intrusive forces were applied for 98 days to the mandibular second,
third, and fourth premolars of 8 mature beagle dogs. Two miniscrew implants were used as anchorage to
apply constant intrusive forces of 50, 100, or 200 g per tooth. Demineralized sections of each tooth were
stained and histologically studied for root resorption. Multilevel statistical procedures were used to evaluate
the results. Results: Root resorption was present in all teeth, independent of the force applied. Significant dif-
ferences were found between root regions, with the apices and the interradicular regions the most affected and
with dentin involvement at the furcation. There was cementum repair in 24.14% of the lacunae. Light constant
intrusive forces between 50 and 200 g showed no significant differences in the amount of resorption produced.
Resorption was more frequently seen at the level of the apices and the furcation. Conclusions: Orthodontically
induced root resorption is not clinically significant after application of continuous intrusive forces between 50 and
200 g. Moreover, there is no relationship between root resorption, the position of posterior mandibular teeth in
the arch, and the amount of intrusive force applied. (Am J Orthod Dentofacial Orthop 2011;139:60-9)

E
xternal apical root resorption appears to be a com-
mon occurrence associated with orthodontic
tooth movement.1-3 However, some apical root
resorption can occur in patients who have never
had orthodontic tooth movement.1,4 It appears that
intrusive tooth movement might be the greatest factor
for causing root resorption.5 Root resorption is still an
unpredictable, unavoidable, and undesirable side effect
of orthodontic treatment requiring tooth intrusion. Cer-
tain factors causing root resorption have been identified.
Force application is such a factor in root resorption. It is
a
Private practice, Houston, Tex.
b
Professor and director, Orthodontic Research, Department of Orthodontics,
Texas A&M Health Science Center, Baylor College of Dentistry, Dallas, Tex.
c
d
Private practice, Monterrey, Mexico.
Professor and chairman, Department of Orthodontics, Texas A&M Health
Science Center, Baylor College of Dentistry, Dallas, Tex.
e
Professor and Graduate Program Director, Department of Prosthodontics, Texas
A&M Health Science Center, Baylor College of Dentistry, Dallas, Tex.
f
Professor, Department of Biomedical Sciences; director, Technology Develop-
ment, Texas A&M Health Science Center, Baylor College of Dentistry, Dallas, Tex.
The authors report no commercial, proprietary, or financial interest in the
products or companies described in this article.
Reprint requests to: Lynne A. Opperman, Texas A&M Health Science Center,
Baylor College of Dentistry, 3302 Gaston Ave, Dallas, TX 75246; e-mail,
lopperman@bcd.tamhsc.edu.
Submitted, February 2009; revised and accepted, July 2009.
0889-5406/$36.00
Copyright Ó 2011 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2009.07.014
60
thus important to understand the range of optimum
force levels for physiologic intrusive movements to avoid
damaging the periodontal ligament (PDL), roots, and
alveolar bone structures. The most important force fac-
tors are duration of force application, amount of force
applied, and type of force (constant vs intermittent)
applied.
Treatment time and amount of tooth movement have
been associated with root resorption and intrusion. Some
authors have reported a positive correlation between the
duration of intrusive treatment and root resorption,3,6-10
whereas others found no such relationship.11 In studies
of effects of heavier vs lighter intrusive force levels on
root resorption, it was reported that application of
heavier rather than lighter intrusive forces tended to
create more root resorption,3,12-14 although teeth not
subjected to intrusive force also showed resorption
craters.14 Other studies reported no significant differ-
ences between heavier and lighter forces.15-17 Intrusive
movements produced with continuous forces have
been shown to cause significantly more root resorption
than discontinuous forces,3,16,17 although all studies
do not support this relationship.18 The only consistent
findings were wide individual variations of responses.
Independent of the force applied, orthodontic intru-
sive forces are concentrated at the tooth furcations and
apices, increasing the risk of root resorption at these
Ramirez-Echave et al
sites.7,12,13,19,20 Root resorption at these sites is
especially prevalent in patients with a genetic
predisposition to resorption.21-23 This resorption can
be exacerbated by longer force duration, resulting in
greater root resorption in the apical and interradicular
regions, compared with shorter force application.7
The relationship between the amount of force ap-
plied and the degree of root resorption remains contro-
versial because of the various devices used to apply
intrusive forces. Most devices cannot produce pure
intrusive movements or control the amounts of force
applied. The use of miniscrew implants (MSIs) has in-
creased orthodontic treatment options and improved
treatment outcomes, most probably as a result of the
ability to obtain absolute anchorage and apply constant
forces through these bone-anchorage devices. MSI an-
chorage eliminates the unwanted side effects normally
associated with conventional approaches and allows
for the correction of certain malocclusions previously
treated with maxillofacial surgery, but with less depen-
dence on patient compliance. MSIs are especially useful
when intruding teeth because they make it possible to
apply continuous force perpendicular to the long axis
of the tooth.
Patient studies typically rely on radiographic evalua-
tions to assess root resorption. However, comparisons of
radiographic vs histologic evaluations have shown that
the former failed to show root resorption that was iden-
tified histologically.18,20,24-28 The purpose of this study
was to use the more sensitive histologic method to
evaluate root resorption and repair of mandibular
premolars after orthodontic intrusion with different
force magnitudes by using MSIs. Decalcified histologic
sections of the root apices, cervical regions, and
furcations were examined to determine the effects of
intrusive forces of different magnitudes on root
resorption and repair in various regions of the teeth, as
well as the response of teeth in different positions in
the mandibular arch.
MATERIAL AND METHODS
The teeth and surrounding tissues used in this study
were from the mandibles of 8 mature beagle dogs, aged
20 to 24 months. The experimental design was fully de-
scribed by Carrillo et al15 and approved by Baylor College
of Dentistry Institutional Animal Care and Use Commit-
tee. The procedures and timeline of the investigation
were performed in the same manner for each dog.
Briefly, before each intervention and record-taking ses-
sion, the animals were sedated with ketamine (2.2 mg
per kilogram, intramuscularly) and xylazine (0.22 mg
per kilogram, intramuscularly). While anesthetized, the
animals’ vital signs were monitored and recorded by
American Journal of Orthodontics and Dentofacial Orthopedics
61
Fig 1. Photograph of the left quadrant after appliance ac-
tivation, showing positions, angulations, and force vec-
tors used (reprinted from Carillo et al,15 with permission).
trained personnel. During the first intervention, the crowns
of the mandibular second, third, and fourth premolars were
prepared. Individual cast metal crowns were made for each
tooth. During the second intervention, the cast metal
crowns were cemented, and 2 MSIs were placed per tooth,
1 on the lingual surface and the other on the buccal sur-
face. The buccal MSI was placed in the mesial interradicular
bone, and the lingual MSI was placed in the distal interra-
dicular bone of the teeth being intruded.
There were 2 randomly assigned force magnitudes
for each contralateral pair of teeth: second premolars
(50 and 100 g), third premolars (100 and 200 g), and
fourth premolars (50 and 200 g). Forces were applied
by using 2 Sentalloy (GAC International, Bohemia, NY)
closed-coil springs (1 per MSI) attached with a 0.01-in
stainless steel ligature (Fig 1). Force levels were checked
every 14 days by using a gram-force gauge (Correx,
Haag-Streit, Koeniz, Switzerland) to ensure that they
were maintained throughout the experiment. Records,
including photographs, radiographs, force calibrations,
and assessments of MSI stability, were taken after appli-
ance activation and every 14 days thereafter until the
dogs were killed at day 98.
The resected tissue blocks containing the teeth mea-
sured approximately 40 3 12 3 12 mm. After fixation in
10% buffered formalin, the tissues were washed thor-
oughly in gently running tap water to remove unbound
fixative. They were then decalcified in 0.5 mol/L of ethyl-
inediaminetetraacetic acid, tetrasodium salt (Sigma,
St Louis, Mo), for varying periods of time, depending
on their overall size. The tissues were radiographed every
2 weeks to monitor the decalcification process. When all
the mineral salts had been removed, the mandibular
blocks were cut with a surgical blade, stained on the me-
sial portion with a green margin marker (Davidson
January 2011  Vol 139  Issue 1
62 Ramirez-Echave et al

Fig 2. A, Diagram of a section through a multi-radicular tooth showing the sections studied. Five areas
were identified as outlined by the numbered squares: 1, mesial apex; 2, distal apex; 3, mesio-cervical
surface of the root; 4, furcation; and 5, disto-cervical surface of the root. All lacunae were counted along
the length of the cementum in each area. B, Photograph showing a section through the pulp of a tooth
root apex. Only sections with the root canal were used for measuring lacunae. Arrows indicate the
PDL; b, bone; c, cementum; d, dentin; p, pulp chamber. Magnification, 2.5 times.

Marking System, Bradley Products, Bloomington, Minn)
and, on the buccal surface, with a black margin marker
(Staflab Medical Products, Lewisville, Tex). The specimens
were then dehydrated with 70% alcohol, cleared, cut mid-
sagittally to locate the pulp chamber, and infiltrated with
paraffin in an automatic tissue processor (VIP model
2000, Miles Scientific, Elkhart, Iowa). Next, the tissues
were embedded in paraffin blocks, which were hardened
on a cold plate and sectioned at 6 to 9 mm. The sections
were mounted on 1 3 3-in glass slides and dried on
a warming tray at 42 C for approximately 2 hours. The
sections were stained with hematoxylin and eosin, a few
drops of Permount (Fisher Scientific, Pittsburgh, Penn)
were placed on the slide, and a thin coverslip was applied
to cover each section.
The histologic sections were examined under a light
microscope (Axiophot, Zeiss, Petaluma, Calif) at 2.5
times magnification to identify 5 areas of interest: the
mesial and distal aspects of the cervical part of the
root, the furcation, and both root apices (Fig 2, A). For
each tooth, 1 histologic section for each region was
measured. Since not all regions were present on the
same slide, root resorption at each area was measured
based on 1 to 5 histologic sections. Each area of interest
was photographed at 10 times magnification (SPOT
camera, Kodak, Rochester, NY) and stored as a JPEG dig-
ital image. An examiner (J.I.R.) blinded to the force
groups and tooth positions performed all histologic reg-
istrations and histomorphometric analyses.
The lacunae measurements were taken at 10 times
magnification by using Bioquant Osteo II software (ver-
sion 8.11.20, Bioquant Image Analysis, Nashville, Tenn)
that was calibrated (1 pixel z 1 mm). Sections where the
root apex canal was present were chosen to examine
areas 1 and 2 (Fig 2). Areas 3, 4, and 5 were measured
from sections where the pulp chamber showed its great-
est dimensions. Measurements included (1) the depth of
each resorption lacuna from the deepest point visible, by
using the distance from the bottom of the cavity perpen-
dicular to the tangent passing through the borders of the
resorption lacuna on the root surface (Fig 3, A); (2) the
width of each resorption lacuna by using a line connect-
ing the highest points of the borders on either edge of
the lacunae (Fig 3, A); (3) the thickness of the intact ce-
mentum (Fig 3, B); (4) the area of each resorption lacuna
(Fig 4, A and B); (5) the area of each lacuna repaired with
bone or cellular cementum (Fig 4, C and D), with the per-
centage of each lacuna repaired obtained by multiplying
the lacuna area repaired by 100 divided by the total area
of the lacuna; and (6) the percentages of cementum
thickness affected by resorption by multiplying the lacu-
nar height by 100, divided by the cementum thickness
closest to that lacuna.
Statistical analysis
Multilevel statistical models take maximum advan-
tage of repeated measures, allow for missing data, and
make it possible to directly test the experimental effects.

January 2011  Vol 139  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Ramirez-Echave et al 63

Fig 3. Photographs showing sections through tooth roots with resorption lacunae. A, Green line rep-
resents the thickness of intact cementum. B, Light-blue line represents the width of the lacuna; dark-
blue line shows the depth of the lacuna, extending into the dentin. b, bone; c, cementum; d, dentin.
Magnification, 10 times.

Fig 4. Photographs showing a section through a tooth root with a resorption lacuna. A, Green line
shows the outline of area of the lacuna. B, Area of the lacuna for measurement is filled in red.
C, The area of the repaired lacuna is outlined in green. D, The area of the repaired lacuna for measure-
ment is filled in red. b, bone; c, cementum; d, dentin. Arrow indicates PDL. Magnification, 10 times.

MLwiN software (version 2.01, Centre for Multilevel
Modeling, Institute of Education, London, United King-
dom) was used to analyze the results. The effects of
force, tooth site, and root zone on root resorption
(lacuna number, lacuna width, lacuna depth, lacuna
area, and percentages of cementum thickness and repair
[area repaired and percentage of area repaired]) were
evaluated in the fixed part of the model. The fixed part
of the model estimated the effects and the differences
between teeth and between regions of teeth. Random
variations were partitioned into 4 hierarchical levels
(zones, within teeth, within sides, within animals). Gen-
eralized least squares were used to estimate the effects. A
significance level of P \0.05 was used for testing.
RESULTS
Histology showed that, although 48 teeth were
treated, several were processed incorrectly and lost to
further study. Twenty-nine teeth were used. A normal
anatomic bell-shaped cementum thickness was distrib-
uted along the root surfaces: cementum thickness was
greatest at the apices and least at the cervical and
interradicular regions (Fig 5). The intact cementum
was classified as acellular cementum, which provides
attachment for the tooth.
Most resorption lacunae did not show evidence of
repair (Fig 6). Evidence of repair was seen in 24% of
the lacuna evaluated; the area repaired was larger at
the furcation than at the cervical region and the root
apex (Table I). Repair of the resorption lacunae occurred
almost exclusively with cellular cementum. PDL fibers
were seen closely associated with the reparative cellular
cementum in the lacunae (Fig 7).
Evidence of ankylosis was detected in only 2 lacunae
of 1 tooth exposed to 100 g of force and in 1 lacuna of
a tooth exposed to a force of 50 g (Fig 8). This represents
0.8% of the lacunae recorded.

American Journal of Orthodontics and Dentofacial Orthopedics January 2011  Vol 139  Issue 1
64 Ramirez-Echave et al

Fig 5. Photographs of root sections showing dentin (d), PDL (p), bone (b), and acellular cementum (ac). A,
Section through the apical region of a root. Note the difference in height of the cementum that is greater
close to the apical foramen (large double arrow) than it is closer to the furcation (small double arrow). B,
Section through the root cervical region; note the even distribution of the cementum. C, Section through
the interradicular region showing the even distribution of the acellular cementum. The cementum height
appears markedly thinner than that in the apical region in A. Magnification, 2.5 times.

Fig 6. Photographs of tooth root sections showing the dentin (d), area of resorption with PDL fibers
extending perpendicularly from the dentin surface (f), bone (b), and acellular cementum (ac). Note
that there is no visible repair in these lacunae. PDL fibers can be seen associated with resorption
lacunae. A and B, Lacunae can be seen impinging on the dentin in the interradicular region. C, Section
showing a resorption lacuna affecting only the cementum in the apical region. D, Section of the inter-
radicular region showing a resorption lacuna affecting the dentin on the left and 1 limited to the cemen-
tum on the right. Magnification, 10 times.

Histomorphometry showed resorption lacunae in all
specimens evaluated, affecting up to 66% of the cemen-
tum thickness at the apices and up to 29% at the cervical
region; at the furcation, dentin involvement in the lacunae
was observed. There was root resorption associated with
intrusive movements in all teeth, independently of the
forces applied. There also were no significant differences
in resorption between tooth sites (Table II).The data
in the tables reflect the differences between the regions
being compared. There were no significant differences in
root resorption between the mesial and distal apices, or
between the mesial and distal cervical regions (Table III).
Significant differences in root resorption were found
between tooth regions. The numbers of lacunae were

January 2011  Vol 139  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Ramirez-Echave et al
Table I. Regional comparison of root repair related to intrusion
Cervical
Apex difference
Lacuna Estimate SE Estimate SE
Area repaired (mm2) 32.16 11.89 33.85 17.00
Area repaired (%) 15 6 5 9 19
greater in the apex and furcation regions than in the
cervical region. Lacunae depth and area were larger in
the apical region than in the furcation region, which
were in turn larger than in the cervical region. The percent-
ages of cementum thickness were larger at the furcation
than at the cervical region and the root apex (Table IV).
DISCUSSION
Orthodontic intrusive movements appear to be the
most detrimental to the roots, causing external root
resorption that can decrease root length.3,10,11,29 In
this study, we histologically identified root resorption
and repair on mandibular premolars of beagles during
orthodontic intrusion using different force magnitudes
applied with coil springs anchored from MSIs. To
specifically examine the degrees of injury and repair
during treatment, an experimental design was used
with no follow-up period after cessation of forces.
Previous studies that investigated root resorption after
intrusion used different methodologies to achieve intru-
sion and assess resorption, making the results difficult to
compare.3,5,7,10-14,20,24
The radiographic evaluation by Carrillo et al15 of the
specimens used in this study showed little or no evidence
of root resorption associated with the intrusive move-
ments. No periapical radiograph demonstrated blunting
of the root apices, and only a few radiographs showed
signs of resorption, averaging less than 0.1 mm in all
cases. The histologic evaluation of the same specimens
reported herein showed evidence of root resorption on
all specimens. Importantly, the extents of lacunar re-
sorption along the root length and the resorption areas
were larger than the resorption height, which cannot
be determined with conventional radiographs. In agree-
ment with the histologic data, Carrillo et al15 did not find
a clear pattern of resorption on the roots with respect to
the forces applied. Ohmae et al,20 who also observed no
root resorption radiographically, reported resorption de-
termined histologically at the root apex and the furca-
tion area for all of the teeth intruded. These findings
suggest that radiographic assessments of resorption un-
derestimate the extent of damage, since resorptive areas
can be extensive, shallow lacunae that are not visible on
American Journal of Orthodontics and Dentofacial Orthopedics
65
Furcation Apex
Cervical difference Furcation difference
Estimate SE Estimate SE Estimate SE Estimate SE
9.2 17.28 36.42 17.19 39.81 16.65 3.41 16.7
15 23 14 40 9 19 9
radiographs. Since root resorption is a 3-dimensional
phenomenon, histomorphometric measurements can
only give an indication of the extent of resorption in 2
dimensions and therefore can also lead to underestima-
tion of resorption. However, these measurements
provide good indicators of lacuna size and depth when
appropriate numbers of sections are examined.
Similar to the radiographic findings, histologic
evaluation of the teeth showed no blunting of the root
apices, but some involvement of the dentin at the apices
and furcation was observed.15 In agreement with other
studies, we found that the apices and the furcations
were more affected by resorption than the cervical
regions; this could be because apices and furcations
are perpendicular to the intrusive forces.12,15,19,20 The
percentages of cementum thickness affected, and the
percentages and areas of the lacunae repaired, were
greater at the furcations than at the cervical regions
and the apices. This could be related to the normal
anatomy and distribution of the dentin and cementum
around the tooth root. Cementum is thinner at the
furcation and at the mesial and distal aspects of the
root than at the apical region. Thinner cementum
might make the furcation more susceptible to
resorption involving the dentin, since resorptive
activity can penetrate the dentin earlier than in regions
with thicker cementum. These differences in thickness
of the cementum could be related to the age of the
animals, which were age-matched to the bone matura-
tion stage of patients in their teens. Younger animals
and patients might have more variability in cementum
thickness than older patients and therefore might be
more susceptible to resorption involving the dentin.
Cementum thickness might also differ between the
animal model and human patients, since human teeth
do not appear to have a thickened cementum at their
apices. Resorption in the apical region of the dogs’ teeth
might therefore underrepresent the amount of apical
root resorption found in patients.
Of all the treatment variables, treatment duration has
most often been correlated with resorption.3,6-10 After 7
months of tooth intrusion in beagles, Daimaruya et al24
reported amounts of root resorption that were radio-
graphically similar to those reported after 3 months of
January 2011  Vol 139  Issue 1
66
Fig 7. A, Photograph of a section through the interradic-
ular region showing dentin (d), reparative cellular cemen-
tum (cc) within lacunae and periodontal fibers closely
associated with the reparative cementum (f). B, Photo-
graph of a section through the apical region showing
dentin (d), bone (b), PDL (p), acellular cementum (ac),
and reparative cellular cementum (cc) in the lacunae
and the PDL fibers (f) closely associated with the cellular
cementum surface. Magnification, 10 times.
intrusion by Carrillo et al.15 The histologic examination
of Daimaruya et al showed that resorption reached the
cementum of teeth intruded for 4 months and the dentin
of teeth intruded for 7 months. In our study, root resorp-
tion reached the dentin in many specimens after 3
months, similar to the findings of Owman-Moll
et al16,17 and Maltha et al.27 This suggests that prolonged
treatment time does not necessarily coincide with ex-
tended periods of active tooth movement and thus might
be a poor predictive variable for root resorption.9
The correlation between force levels and root resorp-
tion remains the most controversial aspect of tooth in-
trusion. In our study, no significant difference in root
resorption was detected between low (50 g) and high
(200 g) force levels, indicating that light forces can
and do cause root resorption. A similar conclusion was
reached in the radiographic study of Carrillo et al,15
January 2011  Vol 139  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Ramirez-Echave et al
Fig 8. Photograph of a section through the interradicular
region of a tooth root showing repair of a lacuna with cel-
lular cementum, which is continuous with the bone in the
furcation (ankylosis). Dentin (d) and acellular cementum
(ac) are visible; arrows indicate the boundary between
dentin and cellular cementum that is indistinguishable
from, and fused to, the bone (*). Residual PDL between
the bone and cementum can be seen above the acellular
cementum on the left. Bone ankylosis can clearly be seen
to transect the PDL space. Magnification, 10 times.
who evaluated the same teeth that we examined. These
findings agree with human studies by Owman-Moll
et al,16,17 who found large individual variations in root
resorption, independently of force magnitude and
force regimen. The dog study by Maltha et al27 also
showed that force magnitude was probably not a decisive
indicator of root resorption. In contrast, Darendeliler
et al,30 who used scanning electron microscopy to quan-
tify the area, depth, and volume of resorption lacunae,
reported more resorption in their heavy-force group
than in the light-force group or the controls. However,
they applied orthodontic lateral forces to the maxillary
and mandibular first premolars for 28 days and did not
evaluate the effects statistically. Histologically, Dellin-
ger12 reported severe root resorption with a 300-g intru-
sive force, moderate resorption with 100 g, and slight to
moderate resorption with 10 and 50 g of intrusive force
applied to the first premolars of monkeys. However, be-
cause of the variability of the findings, the small sample
size, and the lack of statistical comparisons, it is difficult
to causally link the amount of root resorption to the
amount of force applied. Gonzales et al31 reported that
light mesially oriented 10-g forces applied to rats’ max-
illary first molars produced more tooth movement and
less root resorption than 25, 50, or 100 g of force appli-
cation. Since a human molar is approximately 20 times
larger than a rat molar, these forces most likely
corresponded to 200, 500, 1000, and 2000 g in a human
molar, so the higher force levels are not comparable with
the levels used in regular orthodontic tooth move-
ment.31 Using microtomography, Harris et al14 reported
Ramirez-Echave et al 67

Table II. Comparison of root response and tooth site related to intrusion
Difference between Difference between Difference between

Second premolar Third premolar Second premolar Fourth premolar Third premolar Fourth premolar

Lacuna Estimate SE Estimate SE Estimate SE Estimate SE Estimate SE Estimate SE

Number 2.19 0.53 0.73 0.57 2.34 0.68 0.50 0.70 2.26 0.63 0.69 0.68
Width (mm) 506.10 47.73 0.26 49.03 488.09 59.56 35.21 49.60 477.64 51.67 13.81 50.64
Depth (mm) 67.97 8.90 2.60 8.36 59.90 10.27 4.44 11.02 53.98 10.12 7.10 10.67
Area (mm2) 265.41 43.99 55.43 45.01 217.27 56.06 0.49 51.23 198.25 48.66 22.00 50.49
Area repaired (mm2) 30.52 16.20 23.61 18.53 35.61 13.11 12.37 13.89 40.30 15.96 6.13 16.57
Area repaired (%) 23 9 8 11 27 8 8 9 26 9 2 9
Cementum thickness (%) 68 14 9 13 60 13 10 14 72 15 13 15

Table III. Regional comparison of root resorption and repair related to intrusion, with comparisons of the differences
of the distal from the mesial apices, and the distal cervical from the mesial cervical regions
Mesial apex Distal apex difference Mesial cervical Distal cervical difference

Lacuna Estimate SE Estimate SE Estimate SE Estimate SE

Number 4.01 0.74 0.22 0.63 0.23 0.17 0.18 0.12
Width (mm) 564.20 53.16 22.67 43.52 509.15 134.90 52.51 116.30
Depth (mm) 76.23 9.36 7.29 7.70 25.86 6.84 0.98 5.90
Area (mm2) 318.40 60.18 26.91 51.82 91.25 17.59 0.37 15.17
Area repaired (mm2) 8.84 16.22 43.95 16.99 18.43 20.68 22.12 18.22
Repaired (%) 10 7 15 7 12 23 15 19
Cementum thickness (%) 73 8 4 6 34 0.27 3 24

Table IV. Regional comparison of root resorption related to intrusion, with comparisons of the differences of the cer-
vical from the apex, the furcation from the cervical, and the apex from the furcation
Apex Cervical difference Cervical Furcation difference Furcation Apex difference

Lacuna Estimate SE Estimate SE Estimate SE Estimate SE Estimate SE Estimate SE

Number 4.23 0.40 4.13 0.36 0.22 0.39 3.66 0.47 3.67 0.78 0.52 0.62
Width (mm) 541.42 44.83 95.63 54.08 464.12 68.60 49.24 61.81 442.85 53.10 122.58 38.13
Depth (mm) 73.30 7.04 47.35 8.33 17.21 9.06 23.73 8.16 46.67 9.24 23.54 7.79
Area (mm2) 305.04 45.18 239.44 52.37 72.49 15.98 44.57 14.33 130.83 50.67 168.12 41.77
Cementum thickness (%) 66 8 8 9 29 22 71 21 119 13 60 12

that root resorption was proportional to the magnitude
of the force applied, with the mesio-apical and disto-
apical surfaces showing significantly more resorption
volume than the other regions of the tooth roots. How-
ever, the device that they used for this experiment could
not apply a purely intrusive force perpendicular to the
long axis of the tooth, and subsequent tipping of the
premolars could have confounded the results. This group
also found small resorption craters on teeth not sub-
jected to intrusive forces, so the significance of histolog-
ically detectable but radiographically undetectable root
resorption remains unclear.
We found no relationship between root resorption,
position of multi-radicular mandibular teeth in the
arch, and the amount of force applied. This could be
related to the homogeneous density of the mandibular
alveolar bone and the similar root surface areas of these
multi-radicular teeth. This is important because all
previous studies applied forces on only 1 premolar, in
contrast to our study in which we intruded 3 premolars
on each side.
Several authors have reported that repair or remodel-
ing of the cementum occurred at the resorbed areas
when intrusive forces where discontinued.32,33 Our
study, as well as several others, showed evidence of
repair while the forces were being applied.3,20,24
According to Langford and Sims,34 resorption of root
dentin is irreversible, and resorption areas can only be re-
paired by cellular cementum deposition. This notion is
supported by our findings, where lacunae penetrating

American Journal of Orthodontics and Dentofacial Orthopedics January 2011  Vol 139  Issue 1
68
into the dentin showed evidence of cellular cementum
against the exposed dentin. Sporadic ankylosis was
noted in 2 lacunae being repaired with cellular cemen-
tum, with the cementum appearing continuous with
the surrounding bone. Interestingly, this phenomenon
was noted only at the lower force levels used in this study
and only in the interradicular regions of the teeth. This is
the first known report of ankylosis in tooth intrusion,
and the clinical implications of this finding are un-
known. These findings might be a result of our dog
model, and care should be taken when extrapolating
to human patients.
The findings reported in this study suggest that re-
sorption might have low clinical significance over the
time period studied. However, this statement must be
made cautiously, because of the variability of responses
between subjects. Furthermore, a positive correlation
has been reported between initial root length and the
amount of root resorption.8,35 Clinicians therefore
need to be concerned about resorption in patients with
short roots, for which more clinically relevant changes
might be noted.36
CONCLUSIONS
1. Light constant intrusive forces between 50 and 200 g
produced similar degrees of resorption.
2. There was no relationship between root resorption
and position of the posterior mandibular teeth in
the arch and the amount of force applied.
3. The reparative process was seen in 24.14% of the
lacunae observed.
4. Root resorption occurred more frequently at the
apices and interradicular regions when orthodontic
intrusive forces were applied.
5. Ankylosis was rare and appeared in association with
cellular cementum repair of lacunae.
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