Table 2 Clinical practice regarding the recommendations of the Orthodontic Root Resorption Guideline by orthodontists in the Netherlands before (T0) and after (T1) publication
T0 Median (IQR) | T1 Median (IQR) | Positive difference T1-T0 (N)a | No difference T1–T0 (N)b | Negative difference T1–T0 (N)c | P-value T1-T0 (N) | |
|---|---|---|---|---|---|---|
Root resorption diagnostics* | 10 (8–11) | 10 (8–12) | 35 (26.5%) | 91 (68.9%) | 6 (4.6%) | < 0.001 |
I consider making a panoramic X-ray 12 months after the start of the orthodontic treatment with fixed appliances in patients undergoing extraction therapy and compare this with a pre-treatment panoramic X-ray | 6 (4–7) | 6 (5–7) | 28 (21.2%) | 99 (75.0%) | 5 (3.8%) | < 0.001 |
I consider taking additional peri-apical images if the already available X-rays do not provide enough information about the roots of the teeth | 4 (3–5) | 4 (3–6) | 18 (13.7%) | 113 (85.6%) | 1 (0.7%) | 0.001 |
Risk factors* | 10 (8–11) | 11 (9–12) | 35 (26.5%) | 96 (72.8%) | 1 (0.7%) | < 0.001 |
I inform the patient about the risk of root resorption prior to orthodontic treatment | 7 (5–7) | 7 (6–7) | 14 (10.7%) | 118 (89.3%) | 0 | 0.001 |
I inform the patient undergoing extraction therapy of the potential increased risk of developing more severe root resorption | 4 (3–5) | 4 (3–5) | 31 (23.6%) | 100 (75.7%) | 1 (0.7%) | < 0.001 |
Treatment strategy if root resorption occurred during treatment* | 35 (31–39) | 37 (33–40) | 53 (40.2%) | 78 (59.1%) | 1 (0.7%) | < 0.001 |
After the occurrence of apical root resorption (≥ 2 mm), I review the treatment goals and treatment plan and discuss the consequences, the patient's wishes, and the treatment goals with the patient | 7 (5–7) | 7 (6–7) | 20 (15.2%) | 112 (84.8%) | 0 | < 0.001 |
In case of severe generalised root resorption (≥ 4 mm root length loss), I consider discontinuing the treatment | 6 (5–7) | 6 (6–7) | 14 (10.7%) | 117 (88.6%) | 1 (0.7%) | 0.001 |
In the case of severe local root resorption (≥ 4 mm root length loss), I consider ending force application to the affected teeth | 6 (5–7) | 6 (6–7) | 19 (14.5%) | 112 (84.8%) | 1 (0.7%) | < 0.001 |
If active treatment is continued, I consider a 3-month break before continuing treatment. During this interruption, the appliance must be made passive in such a way that the affected teeth are no longer loaded | 5 (3–7) | 6 (4–7) | 35 (26.5%) | 94 (71.2%) | 3 (2.3%) | < 0.001 |
If the treatment is continued, I try to limit movement of the affected teeth as much as possible | 6 (5–7) | 7 (6–7) | 16 (12.1%) | 115 (87.2%) | 1 (0.7%) | 0.001 |
If active treatment is continued, I consider taking an X-ray of the affected teeth 6 months after restarting treatment | 6 (5–7) | 7 (5–7) | 28 (21.2%) | 102 (77.3%) | 2 (1.5%) | < 0.001 |
What to do in patients with root resorption at the end of treatment* | 19 (16–20) | 19 (18–21) | 37 (28.1%) | 95 (71.9%) | 0 | < 0.001 |
I follow-up with the patient according to my regular retention protocol described in the ‘’Retention in Orthodontics’’ guideline (Wouters [13]) | 6 (5–7) | 7 (6–7) | 23 (17.4%) | 109 (82.6%) | 0 | < 0.001 |
At the end of the orthodontic treatment, I ensure good communication with the patient about expectations regarding the affected tooth | 7 (6–7) | 7 (6–7) | 16 (12.1%) | 116 (87.9%) | 0 | < 0.001 |
I ensure good communication with the dentist at the end of the orthodontic treatment | 7 (5–7) | 7 (6–7) | 19 (14.5%) | 112 (84.8%) | 1 (0.7%) | < 0.001 |
Cumulative score of the questionnaire** | 74 (66–79) | 83 (76–87) | 130 (98.5%) | 0 | 2 (1.5%) | < 0.001 |