British Journal of Orthodontics

ISSN: 0301-228X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/yjor19

Root Resorption: The Aggressive, Unerupted

Second Premolar

Cheryl Tracey & R. T. Lee

To cite this article: Cheryl Tracey & R. T. Lee (1985) Root Resorption: The Aggressive, Unerupted
Second Premolar, British Journal of Orthodontics, 12:2, 97-101, DOI: 10.1179/bjo.12.2.97

To link to this article: http://dx.doi.org/10.1179/bjo.12.2.97

Published online: 21 Jun 2016.

Submit your article to this journal

Article views: 3

View related articles

Citing articles: 5 View citing articles

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=yjor19

Download by: [Australian Catholic University] Date: 20 August 2017, At: 05:56
 British Journal of Orthodontics/Vol 12/1985/97.-101
© 1985 British Society for the Study of Orthodontics

Root Resorption: The Aggressive,

Unerupted Second Premolar
Cheryl Tracey*, B.D.S., M.Sc., F.D.S., D.Orth.R.C.S.
R. T. Lee, B.D.S., F.D.S., D.Orth.R.C.S. . . L d E
Orthodontic Department, The London Hospital, Wh1techapel, on on 1

Abstract. Three cases of first molar root resorption, due to impacted maxillar~ and mandib:lar se~ond
Downloaded by [Australian Catholic University] at 05:56 20 August 2017

remolars resented over a period of 5 months. It is suggested that thts may not e sue an
~ncommo~ :ccurrence as is generally believed. The clinical situations in the. whic~ u~erupted sec~nd
premolar may start resorbing first molar roots are described and methods of 1dentafymg and treatmg
this problem suggested.

Introduction bilateral root resorption of the permanent first

molars by horizontally placed mandibular second
There is a generally held view that both upper premolars.
and lower second premolars usually erupt in the Over a period of 5 months three female
crowded dentition even if it involves their dis- patients with unerupted second premolars re-
placement out of the line of the arch. If however sorbing the first permanent molars presented for
these teeth fail to erupt their surgical removal orthodontic consultation. Two of these cases
may result in damage to the adjacent teeth. involved the maxillary dentition, the third in-
Therefore it may be considered safer to leave the volved the mandibular dentition. All three pa-
premolar with a view to its extraction should the tients had experienced bouts of pain from clini-
tooth erupt.
cally and radiographically caries free teeth.
The destructive capacity of misplaced, un-
erupted canines on adjacent roots has been
described. Howard (1971) suggested that resorp- Case 1
tion of the root of the lateral incisor by the
This 13-year-old female presente~ with a C~ass I
unerupted canine was relatively uncommon,
occlusion on a Skeletal I base, with well-ahgned
could be manifest after minimal or apparently no
arches complicated by the extraction of thefO two
initiating stimulus. and was associated with a
years earlier and the presence of u~erupted ~
genuine impaction of the canine. A case of late
A panelipse taken prior to extractwn of the_[O
root resorption, by a canine. in a 17-year-old has
shows the position of the unerupted _ili (Fig.
also been described (Brown and Matthews,
la). The 64146 were in contact. Twenty mo~ths
1981). There is however little reported evidence
later thel_i had erupted palatally and the patient
on the potential aggressiveness of the unerupted
complained of an intermi~tent pain in the_ ~pper
second premolar. Howard ( 1978), reported a
right buccal segment which appeared chmcally
case where an unerupted [5 which was vertically
sound. There was no palpable palatal swelling,
positioned. had resorbed the apical third of the
often associated with an unerupted second pre-
mesial root of the \6. Pi_ttel ( l978) desc~ibed a molar. Radiographic examination showed that
case of transposition of 15 and~- The rad~t~graph the.1.] appeared to be resorbing_§j(Fig. lb). An
clearly showed that the vertically pos1t10~ed,
upper anterior occlusal radiograph. ~hows the
unerupted [) had completely resorbed the d1stal
difference in the bucco-palatal positiOn of ~
root of the 16 and was lying under the molar
(Fig. le). The _§j _was th~refore extracte~ and
crown. Mamlcl ( llJ80) published a case report of
resorption of the mterradicular area confirmed
• Author\ l'Urrcnt .ulthl·,,: lkp.~rtmcrH n( Orthodonll'-"' .tnd l>cnti\ITY for
Children. <iuy\ 1hl'~plt.tl. i'loor ~:!. ( iuy·, To-.-.c.:r. London SL 1 (Fig. Id).

97
 Cheryl Tracey and R. T. Lee
Downloaded by [Australian Catholic University] at 05:56 20 August 2017

Fig. 1. (a) Panelipse February 1982 showing the unerupted§]§. (b) Panel ipse November 1983 showing the uneruptedE.J
with associated enlarged folliclewhilstl5 has erupted. (c) Upper anterior occlusal November 1983 showing.5Jiying more
in the line of the arch than!§, (d) March 1984 extracted.§lshowing resorption through the interradicular area into the pulp
chamber.

Case 2 views over 5 years (Figs 3a-c) show the eruptive

This 21-year-old female presented with a Class I
occlusion and well-aligned arches on a Skeletal I
base complicated by the clinical absence of [5.
She complained of intermittent pain from this
area. No lingual swelling was palpable in the 146
region. Radiographic examination (Fig. 2a)
showed resorption of the mesial root of the 16 by
15which was in the line of the arch (Fig. 2b). The
16was extracted (Fig. 2c).
Case 3
This 17-year-old female with a Class I occlusion
on a Skeletal I base with mild crowding of the
lower labial segment and clinical absence of j
had been under review since January 1979. It
had been decided to accept the occlusion and to
extractj_jwhen, or if, it erupted. Serial panelipse
98
capacity of the second premolar. The MJ were
initially in contact, and 5 years later a 4 mm gap
had appeared purely from distal movement of
~. with J1 partially erupted in the line of the
arch. At this time she complained of an intermit-
tent pain from the area. The bucco-palatal posi-
tion of the unerupted 2J had been noted as being
in the line of the arch on an earlier upper
anterior occlusal view (Fig. 3d). The treatment
plan was modified and the &J extracted (Fig. 3e).
All three cases showed extensive resorption of
the molar roots involving the pulp.
Discussion
There is very little reported evidence of root
resorption due to impacted second premolars in
both orthodontic and oral surgery journals and
this suggests it is a very uncommon occurrence.
 Root Resorption
Downloaded by [Australian Catholic University] at 05:56 20 August 2017
However, the cases presented show that the
potential for root resorption of the molar by the
unerupted premolar should not be overlooked.
All three cases involved unerupted second pre-
molars impacted in the line of the arch in the
crowded permanent dentition. It is therefore
Worthwhile in such cases, to locate their position
precisely. Intraoral examination will indicate
space availability for the second premolars and
their bucca-lingual position may be judged by
the presence of a swelling which may be seen or
palpated. A routine panoramic radiograph or
oblique lateral radiographs will aid confirmation
of the clinical findings. If the unerupted second
~remolar cannot be palpated then its bucco-
hngual position should be confirmed by further
radiographs. In the mandibular arch this is easily
performed with a true occlusal X-ray centred
over the site in question (Fig. 2b) whilst in the
maxillary arch it is possible to assess the bucca-
palatal position of the unerupted second premo-
Fill:._2. (a) Periapical August 1984 confirming resorption
ofl6 mesial root by[5. (b) Lower true occlusal August
1984 revealing 15 in the line of the arch. (c) September
1984, extracted[6 showing extensive resorption of the
mesial root.
Jar on a standard upper anterior occlusal radio-
graph (Figs le, 3d). This is clearly illustrated in
Case 1 where the position of the aggressive 21 was
obviously more in the line of the arch than the
contralateral, palatal [i. Alternatively parallax
views could be taken.
If a second premolar is noted to be impacted
and lying in the line of a crowded arch the
possibility of adjacent root resorption should be
considered, especially if the patient has express-
ed any pain or discomfort. Should resorption be
evident, extraction of the resorbed tooth may
have to be considered. If it is desirable to
maintain an intact lower arch then, where only
one root is involved, the molar may be root
treated and then hemisected with removal of the
affected root. This should allow space for the
eruption of the premolar.
When the position of the unerupted second
premolar can be verified as lying in the line of
the arch and impacted against the molar roots
99
 Cheryl Tracey and R. T. Lee
Downloaded by [Australian Catholic University] at 05:56 20 August 2017

Fig. 3. (a) Panelipse January 1979 showing the unerupted upper right second premolar with ~in contact. (b) Panelipse
August 1982 showing §!forcing 61japart. (c) Panelipse August 1984 showing further eruption of Q1 increasing space
between _M! and resorption of the mesial aspect of the_§froot. (d) Upper anterior occlusal August 1982 showing ..5l in
the line of the arch. (e) August 1984, extracted §!showing marked resorption of the mesio-buccal root into the
root canal.

100
 Root Resorption

then, in view of what has been described, serious Howard, R. D. (1971)

The displaced maxillary canines: positional variations associated with
consideration should be given to extraction of incisor resorption,
either the first premolar or first molar in order to Transactions of the British Society for the Study of Orthodontics,
149--157.
allow the second premolar to erupt.
Howard, R. D. (1978)
Acknowledgments Impacted tooth position: unexpected improvements,
I should like to thank Mr G. Waiters of the London Hospital British Journal of Orthodontics, S, 87-92.
Medical School for his photographic assistanct and Mrs S.
Belham for typing the manuscript. Mandel, M. S. (1980)
Resorption of permanent teeth,
References Oral Surgery, Oral Medicine and Oral Pathology, 49, 188.
Brown, I. D. and Matthews, R. W. (1981)
Apical resorption of a maxillary lateral incisor from a misplaced Patel, J, R. (1978)
canine in a 17-year-old. A case report, Transposed and submerged teeth,
British Journal of Orthodontics, 8, 3-5. Oral Surgery, Oral Medicine and Oral Pathology, 46, 599.
Downloaded by [Australian Catholic University] at 05:56 20 August 2017

101