CBCT

Download as pdf or txt
Download as pdf or txt
You are on page 1of 7

www.scielo.

br/jaos
http://dx.doi.org/10.1590/1678-775720150224

Cone beam computed tomography study of apical


root resorption induced by Herbst appliance
João Paulo SCHWARTZ1, Taísa Boamorte RAVELI1, Kélei Cristina de Mathias ALMEIDA1, Humberto Osvaldo
SCHWARTZ-FILHO2, Dirceu Barnabé RAVELI1

1- Universidade Estadual Paulista, Faculdade de Odontologia, Departamento de Clínica Infantil, Disciplina de Ortodontia, Araraquara, SP, Brazil.
2- Universidade de Santo Amaro, Departamento de Odontologia, São Paulo, SP, Brazil.

Corresponding address: João Paulo Schwartz - Rua Rio Grande do Sul, 368 - apt 203 - Curitiba - PR - Brazil - 80620-080 -
Phone: 55 14 9682-8920 - e-mail: joaoschwartz@hotmail.com

6XEPLWWHG0D\0RGL¿FDWLRQ-XO\$FFHSWHG-XO\

ABSTRACT

O bjective: This study evaluated the frequency of root resorption during the orthodontic
treatment with Herbst appliance by Cone Beam Computed Tomography (CBCT).
Material and Methods: The sample comprised 23 patients (11 men, 12 women; mean ages
15.76±1.75 years) with Class II division 1 malocclusion, treated with Herbst appliance.
CBCT was obtained before treatment (T0) and after Herbst treatment (T1). All the dental
roots, except third molars, were evaluated, and apical root resorption was determined
using the axial guided navigation method. Paired t-tests and Wilcoxon T Test were used
to compare the dependent samples in parametric and nonparametric cases, respectively.
Chi-Square Test with Yates’ correction was used to evaluate the relationship between
apical root resorption and gender. 5esults were considered at a signi¿cance level of 5.
Results: Apical resorption was detected by CBCT in 57.96% of 980 roots that underwent
Herbst appliance treatment. All patients had minimal resorption and there was no statistical
signi¿cance between the genders. Conclusion: CBCT three-dimensional evaluation showed
association between Herbst appliance and minimal apical root resorption, mostly in the
anchoring teeth, without clinical signi¿cance.

Keywords: Root resorption. Activator appliances. Cone-beam computed tomography.

INTRODUCTION Orthodontic treatment has some risk factors


for root resorption such as treatment duration,
InÀammatory root resorption orthodontically tooth movement direction, amount of apical
induced is a side effect of tooth movement displacement, and type and magnitude of the force
related to the biological tissue response, and this applied28. Herbst is a ¿xed functional appliance
correlation was reported in literature for the ¿rst with a bilateral telescopic mechanism that keeps
time in 191413. It is a pathological or physiological the mandible in an anterior position and induces
localized condition, characterized by loss of the skeletal and dentoalveolar changes such as upper
cells layer surface that protects the tooth roots, molars distalization8,15,17-19,21, mesial movement
associated with a structure loss caused by clastic of the lower molars 8,18,19,21,26, and protrusion
cells10. of lower incisors2,9,17-19,21,26,27,29. Emil Herbst, in
Apical root resorption is usually classi¿ed as 1934, published his experience with the device
minor, moderate or severe4. Minor root resorption in Zahnärztliche Rundschau, and, in the same
can be repaired with secondary cementum once journal, Martin Schwarz criticized the Herbst
orthodontic movement ceases. However, when appliance, stating that the device could result in
root resorption is suf¿ciently severe to exceed the overloading the anchorage teeth with periodontal
reparative capacity of the root, a cementum island damage as a consequence20.
may separate from the root surface, resulting in There are only two studies in literature that
an irreversible root resorption mostly in the apical evaluated the apical root resorption induced by
part of the root10,20. Herbst appliance. In the ¿rst, statistical difference

J Appl Oral Sci. 479 2015;23(5):479-85


Cone beam computed tomography study of apical root resorption induced by Herbst appliance

was not found in upper and lower premolars. Patients used banded Herbst appliance until
However, regarding lower premolars, the ¿rst they complete eight months of treatment (mean
premolars showed more resorption than the 8.50±0.70 months) with one step mandibular
second premolars16. The second study supports advancement until the incisor edge to edge
that the teeth more affected by the apical root relationship19. The telescopic mechanism used was
resorption was the upper ¿rst molars and the lower Flip-Lock Herbst® (Tp Orthodontics, Inc.) model,
¿rst premolars11. which was constituted by connectors, tubes and
These orthodontic studies have evaluated pistons.
apical root resorption by conventional radiography, To upper anchorage, transpalatal ¿xed bar at
i.e., two dimension radiographies, periapical and the ¿rst molars was used, made with 1.2 mm steel
panoramic, respectively. However, conventional wire, distant 2 mm from the palate and with an
radiographs may underestimate or overestimate extension of 1.2 mm steel wire to second molar.
the amount of root structure loss5. Panoramic In the lower arch, the Nance lingual arch modi¿ed
radiography underestimates apical root resorption for Herbst was used in the ¿rst molars, made with
when compared with microtomography, and 1.2 mm steel wire and distant 3 mm from lingual
overestimates it when compared with periapical face incisors. Anchor appliances were constructed
radiography 24 . Periapical radiographs were only by one prosthetic.
considered less accurate than the cone beam To evaluate the apical root resorption induced
computed tomography (CBCT) to evaluate the by Herbst appliance, CBCT images were obtained
root length25. The apical root resorption is a three- before treatment (T0) and after treatment (T1)
dimensional change which can affect the root with Herbst appliance. Patients were scanned in
surface as a whole. The ability of CBCT to obtain an upright position with maximum intercuspation
distortion-free and reproducible images of single using tomography i-CAT ® Classic (Imaging
roots provides excellent possibilities to evaluate Sciences International, Hat¿eld, PA, USA) with
apical root resorption13. Different voxel sizes are a 17x13.3 cm of ¿eld of vision, 120 k9p tube
frequently found in the literature to evaluate the voltage, 18.45 mA tube current and 0.4 mm
apical root resorption induced by orthodontic tooth isometric voxel. CBCT images were examined using
movement by CBCT6,7,12,14,30. Dolphin® Imaging software (Dolphin Imaging and
Despite the common use of the Herbst Management Solutions, Chatsworth, Calif., USA)
appliance, there is still a lack of literature about the by multiplanar reconstruction (axial, sagittal and
consequences of its use. To our knowledge, there coronal).
are no studies assessing root resorption through All upper and lower teeth, except third molars,
the evaluation by CBCT. This research aimed to were evaluated by tooth length (apical root
evaluate the apical root resorption induced by the resorption). The coronal and sagittal cursors
Herbst device with CBCT. were adjusted in the tooth long axis (incisal edge
center or cusp to root apex) according to the tooth
MATERIAL AND METHODS root of interest6,7. The length measurement was
linear between two points, one at the root apex
This retrospective study was reviewed and and other at the incisal edge or tooth cusp. To
approved by the Ethics Committee of Araraquara precise the localization of root apex and incisal
Dental School, Univ. Estadual Paulista (FOAr- edge or cusp, the axial guided navigation (AGN)
UNESP). The subjects consisted of 23 patients, method was used. This method used the axial
sequentially treated (11 men, 12 women; mean cursor movement at the sagittal and coronal
age 15.76±1.75 years), who had skeletal Class II multiplanar reconstruction6,7. The reference point
division 1 malocclusion. to determine the root apex, incisal or cusp tooth
The inclusion criteria were bilateral Class II is the intersection between axial and sagittal or
molar relationship, overjet bigger than 5 mm coronal cursors (Figure 1).
and complete permanent dentition, except third Reference points to the measurements of each
molars. The exclusion criteria were syndrome tooth were: incisal edge to root apex of the central
patients, extreme vertical grow pattern and prior and lateral incisors (sagittal section); cusp tip to
orthodontics treatment. Face and occlusion were root apex of canines (sagittal section); buccal cusp
clinically analyzed to determine skeletal Class II tip to apex of single-rooted premolar (sagittal
division 1 malocclusion. Facial analysis observed section); buccal cusp tip to apex of buccal root
the convex pro¿le, straight nasolabial angle, and of two-rooted premolar (sagittal section); lingual
short mentocervical line, and occlusion analysis cusp tip to apex of lingual root of two-rooted
observed the molar and canines in Class II, equal premolar (coronal section); mesiobuccal cusp
to or higher than the half of a cusp, and overjet tip to apex of mesiobuccal root of upper molar
equal to or greater than 5 mm. (sagittal section); distobuccal cusp tip to apex of

J Appl Oral Sci. 480 2015;23(5):479-85


SCHWARTZ JP, RAVELI TB, ALMEIDA KCM, SCHWARTZ-FILHO HO, RAVELI DB

distobuccal root of upper molar (sagittal section); noteworthy that a more accurate assessment can
mesiolingual cusp tip to apex of lingual root of be obtained by the use of CBCT, which allows a
upper molar (coronal section); mesiobuccal cusp more accurate analysis of the treatment results12.
tip to apex of mesial root of lower molar (sagittal In T1 the roots were longer than at T0 for tooth
section); distobuccal cusp tip to apex of distal root 21, 22, buccal root of 15 and palatal root of 14, 15,
of lower molar (sagittal section) (Figure 2). 25, and 27 (Table 1). This occurs probably by the
Measurements were randomly reevaluated after accuracy of CBCT with voxel resolutions 0.4 mm
two weeks by the same examiner. The error of the to linear measurement of apical root resorption
method was evaluated by Intraclass Correlation used in this study. However, in a previous similar
Coef¿cient (ICC). Shapiro-Wilk Test was used to study with voxel resolutions 0.25 mm the same
assess normal distribution, and Student’s t-Test and problem was observed7, and this may be attributed
Wilcoxon t-Test were used to compare dependent to the incomplete development of the tooth apices,
samples in parametric and non-parametric cases, except for teeth 21 and 22, or by the CBCT issues
respectively. Chi-Square Test with Yates’ correction of methods sensitivity and speci¿city for apical
was used to evaluate the relationship between root resorption assessment.
apical root resorption and gender. Results were There was no statistical difference in apical
considered at a signi¿cance level of 5%. Statistical root resorption between genders, which is a data
analysis was performed using SPSS® (SPSS Inc, similar to those related in literature1,3. There was
Chicago, III) and GraphPad Prism® (GraphPad signi¿cant statistical difference for mesiobuccal
Prism Inc, San Diego). root of right upper ¿rst molar, distobuccal root of
left upper ¿rst molar, distobuccal root of left upper
RESULTS second molar, root of left lower second premolar,
distal root of left lower ¿rst molar, mesial root of
Systematic intra-examiner error indicated right lower ¿rst molar, mesial root of right lower
excellent reliability (ICC=0.91). There was second molar and distal root right lower second
statistical difference for mesiobuccal root of right molar. The Nance lingual arch modi¿ed to Herbst
upper ¿rst molar, distobuccal root of left upper ¿rst distant from lingual face of lower incisors, and the
molar, distobuccal root of left upper second molar, transpalatal ¿x bar in the upper arch may further
root of left lower second premolar, distal root of the apical root resorption in the anchorage teeth.
left lower ¿rst molar, mesial root of right lower Such resorption can be justified by the
¿rst molar, mesial root of right lower second molar fact that banded Herbst appliance might deliver
and distal root right lower second molar (Table 1). unphysiologic forces to immediate anchor teeth,
However, the apical root resorption detected was thereby exposing these to a higher risk of root
minimal, with mean smaller than 0.5 mm (Table 1). resorption than the other teeth incorporated
All subjects and 57.96% of 980 roots showed into the anchorage either directly via bands or
apical resorption. The root resorption frequency indirectly via occlusal and proximal contacts11.
for each tooth can be observed in Table 2. Apical Another study showed no signi¿cant statistical
root resorption analyses between genders do not difference in the roots morphology after the Herbst
show statistical difference (Table 3). appliance treatment, however, in relation to lower
premolars, the ¿rst showed more root resorption
DISCUSSION than the second16. Apical root resorption associated
to Herbst appliance showed a mean of teeth length
This CBCT study evaluated the apical root reduction smaller than 0.5 mm (Table 1). This root
resorption induced by Herbst appliance. Patients shortening is classi¿ed as minor root resorption,
with mean age of 15.76 years composed the group and is repaired with secondary cementum once
to simulate the post pubertal period, stage in which orthodontic movement ceases10,20. Despite the
Class II treatment with Herbst appliance shows apical root reduction, this minimal resorption has
more dentoalveolar than skeletal response23. no clinical signi¿cance.
CBCT images were used to analyze 980 tooth This CBCT study evaluated the amount of
roots, and 568 (57.96%) presented resorption apical root resorption and showed that the forces
after the Herbst appliance treatment. Previous delivered by the propulsion mechanism have no
studies showed a high frequency of apical root clinical signi¿cance to anchor teeth. Our results
resorption after the orthodontic treatment by are in accordance with Nasiopoulos, et al. 16
two-dimensional radiographs analisys 1,24. As (2006) and in disagreement with Kinzinger, et
already mentioned, there are no literature reports al.11 (2011), however, these studies evaluated
assessing apical root resorption induced by root resorption associated to Herbst appliance
Herbst appliance by CBCT, therefore, there are by two dimension radiographies, periapical and
no parameters for comparison of our results. It is panoramic, respectively.

J Appl Oral Sci. 481 2015;23(5):479-85


Cone beam computed tomography study of apical root resorption induced by Herbst appliance

Table 1- Mean (xࡃ VWDQGDUGGHYLDWLRQ 6' DQGOHYHORIVLJQL¿FDQFH 3 RIWKHLQLWLDO 7 DQG¿QDO 7 PHDVXUHPHQWV


obtained by teeth (in millimeters)a

Tooth Root T0, xࡃ ± SD T1, xࡃ ± SD T1-T0, xࡃ ± SD P Value


11 SR 23.92 ± 2.18 23.86 ± 2.24 -0.06 ± 0.04 0.518
12 SR 22.80 ± 2.15 22.68 ± 2.40 -0.12 ± 0.08 0.355
13 SR 26.94 ± 2.44 26.90 ± 2.51 -0.04 ± 0.02 0.725
14 BR 21.24 ± 1.62 21.15 ± 1.54 -0.09 ± 0.06 0.586
14 PR 19.68 ± 1.54 19.95 ± 1.64 0.27 ± 0.19 0.308
15 BR 20.96 ± 1.40 20.97 ± 1.53 0.01 ± 0.00 0.968
15 PR 19.82 ± 1.82 20.20 ± 1.77 0.38 ± 0.26 0.068
16 MBR 19.35 ± 1.55 19.09 ± 1.45 -0.26 ± 0.18 0.009**
16 DBR 19.02 ± 1.53 18.87 ± 1.47 -0.15 ± 0.10 0.066
16 PR 20.99 ± 1.34 20.91 ± 1.44 -0.08 ± 0.05 0.446
17 MBR 19.02 ± 1.66 18.86 ± 1.72 -0.16 ± 0.11 0.195
17 DBR 18.65 ± 1.38 18.41 ± 1.35 -0.34 ± 0.16 0.117
17 PR 20.39 ± 1.22 20.38 ± 1.24 -0.01 ± 0.00 0.948
21 SR 23.93 ± 1.92 24.19 ± 1.92 0.26 ± 0.18 0.019
22 SR 22.55 ± 2.32 22.67 ± 2.33 0.12 ± 0.08 0.278
23 SR 26.80 ± 2.41 26.73 ± 2.32 -0.07 ± 0.04 0.727
24 BR 21.29 ± 1.73 21.19 ± 1.83 -0.10 ± 0.07 0.591
24 PR 19.83 ± 1.82 19.81 ± 1.73 -0.02 ± 0.01 0.924
25 BR 21.46 ± 2.00 21.33 ± 1.63 -0.13 ± 0.09 0.472
25 PR 20.80 ± 1.52 20.81 ± 0.79 0.01 ± 0.00 0.974
26 MBR 19.37 ± 1.67 19.25 ± 1.86 -0.12 ± 0.08 0.174
26 DBR 18.87 ± 1.60 18.67 ± 1.68 -0.20 ± 0.14 0.043*
26 PR 21.22 ± 1.60 20.99 ± 1.58 -0.23 ± 0.16 0.125
27 MBR 19.17 ± 1.54 18.95 ± 1.32 -0.22 ± 0.15 0.152
27 DBR 18.81 ± 1.51 18.47 ± 1.37 -0.34 ± 0.24 0.002**
27 PR 20.30 ± 1.20 20.38 ± 1.32 0.08 ± 0.05 0.585
31 SR 21.19 ± 1.33 20.94 ± 1.28 -0.25 ± 0.17 0.107
32 SR 22.48 ± 1.53 22.24 ± 1.61 -0.24 ± 0.16 0.174
33 SR 25.48 ± 1.86 25.08 ± 1.92 -0.40 ± 0.28 0.064
34 SR 21.88 ± 1.81 21.78 ± 1.65 -0.10 ± 0.07 0.526
35 SR 22.20 ± 2.08 21.86 ± 2.12 -0.34 ± 0.24 0.017*
36 MR 20.65 ± 1.14 20.52 ± 1.57 -0.13 ± 0.09 0.467
36 DR 19.95 ± 1.31 19.66 ± 1.36 -0.29 ± 0.20 0.028*
37 MR 20.28 ± 1.43 20.12 ± 1.74 -0.16 ± 0.11 0.337
37 DR 19.46 ± 1.18 19.41 ± 1.56 -0.05 ± 0.03 0.718
41 SR 20.98 ± 1.52 20.88 ± 1.42 -0.10 ± 0.07 0.518
42 SR 22.31 ± 1.49 22.14 ± 1.48 -0.17 ± 0.12 0.153
43 SR 25.26 ± 2.05 25.25 ± 2.20 -0.01 ± 0.00 0.929
44 SR 21.97 ± 1.72 21.89 ± 1.87 -0.08 ± 0.05 0.593
45 SR 22.08 ± 1.94 21.84 ± 1.93 -0.24 ± 0.16 0.079
46 MR 20.94 ± 1.46 20.44 ± 1.39 -0.50 ± 0.35 0.012*
46 DR 19.92 ± 1.20 19.74 ± 1.30 -0.18 ± 0.12 0.078
47 MR 20.45 ± 1.18 20.05 ± 1.49 -0.40 ± 0.28 0.011*
47 DR 19.81 ± 1.31 19.47 ± 1.07 -0.34 ± 0.24 0.013*

a
SR, single root; BR, buccal root; PR, palatal root; MBR, mesiobuccal root; DBR, distobuccal root; MR, mesial root; DR,
GLVWDOURRW 3 3

J Appl Oral Sci. 482 2015;23(5):479-85


SCHWARTZ JP, RAVELI TB, ALMEIDA KCM, SCHWARTZ-FILHO HO, RAVELI DB

Table 2- Absolute frequency and percentage frequency (%) of apical root resorptiona

Tooth Root n Absolute frequency Frequency %


11 SR 23 14 60.87
12 SR 23 14 60.87
13 SR 23 9 39.13
14 BR 23 12 52.17
14 PR 23 10 43.48
15 BR 23 13 56.52
15 PR 7 1 14.28
16 MBR 23 14 60.87
16 DBR 23 15 65.22
16 PR 23 14 60.87
17 MBR 23 13 56.52
17 DBR 23 12 52.17
17 PR 23 14 60.87
21 SR 23 4 17.39
22 SR 23 11 47.83
23 SR 23 15 65.22
24 BR 23 11 47.83
24 PR 23 12 52.17
25 BR 23 14 60.87
25 PR 7 2 28.57
26 MBR 23 16 69.57
26 DBR 23 16 69.57
26 PR 23 15 65.22
27 MBR 23 13 56.52
27 DBR 23 19 82.61
27 PR 23 11 47.83
31 SR 23 9 39.13
32 SR 23 13 56.52
33 SR 23 15 65.22
34 SR 23 14 60.87
35 SR 23 18 78.26
36 MR 23 12 52.17
36 DR 23 16 69.57
37 MR 23 14 60.87
37 DR 23 13 56.52
41 SR 23 11 47.83
42 SR 23 14 60.87
43 SR 23 9 39.13
44 SR 23 14 60.87
45 SR 23 13 56.52
46 MR 23 19 82.61
46 DR 23 15 65.22
47 MR 23 16 69.57
47 DR 23 19 82.61
- Total 980 568 57.96

a
SR, single root; BR, buccal root; PR, palatal root; MBR, mesiobuccal root; DBR, distobuccal root; MR, mesial root; DR,
GLVWDOURRW 3 3

J Appl Oral Sci. 483 2015;23(5):479-85


Cone beam computed tomography study of apical root resorption induced by Herbst appliance

Table 3- Absolute frequency and percentage frequency (%) of apical root resorption by gender

Gender Number of roots with resorption Number of roots without resorption P Value
Absolute Frequency, % Absolute Frequency, %
Frequency Frequency
Female 274 57.93 199 42.07 0.963
Male 294 57.99 213 42.01 -
Total 568 57.96 412 42.04 -

Regarding the acquisition of tomographic 8- Croft RS, Buschang PH, English JD, Meyer R. A cephalometric
image, the accuracy of CBCT with different and tomographic evaluation of Herbst treatment in the mixed
dentition. Am J Orthod Dentofacial Orthop. 1999;116:435-43.
voxel resolutions (0.2 and 0.4 mm) to linear
9- El-Fateh T, Ruf S. Herbst treatment with mandibular cast
measurement of apical root resorption was splints - revisited. Angle Orthod. 2011;81:820-7.
evaluated. There was no signi¿cant statistical 10- Estrela C, Bueno MR, Alencar AH, Mattar R, Valladares Neto
difference between these voxel protocols, and both J, Azevedo BC, et al. Method to evaluate inÀammatory root
are more accurate than the periapical radiograph resorption by using cone beam computed tomography. J Endod.
2009;35:1491-7.
to quantify the resorption22. More studies must
11- Kinzinger GS, Savvaidis S, Gross U, Gülden N, Ludwig B,
be performed with a larger sample size, including Lisson J. Effects of Class II treatment with a banded Herbst
control group, with others protocols of tomography appliance on root lengths in the posterior dentition. Am J Orthod
images acquisitions (smaller voxel size and ¿eld of Dentofacial Orthop. 2011;139:465-9.
vision to increase spatial resolution and decrease 12- Lund H, Gröndahl K, Gröndahl HG. Cone beam computed
tomography for assessment of root length and marginal bone
scatter noise) and with changes in the Herbst
level during orthodontic treatment. Angle Orthod. 2010;80:466-
appliance anchorage, a fact that may inÀuence the 73.
force distribution on anchorage teeth. 13- Lund H, Gröndahl K, Gröndahl HG. Cone beam computed
tomography evaluations of marginal alveolar bone before and
CONCLUSION after orthodontic treatment combined with premolar extractions.
Eur J Oral Sci. 2012;120:201-11.
14- Lund H, Gröndahl K, Hansen K, Gröndahl HG. Apical root
According to this study, three-dimensional resorption during orthodontic treatment. A prospective study
evaluation of dental roots by CBCT showed using cone beam CT. Angle Orthod. 2012;82:480-7.
an association between Herbst appliance and 15- McNamara JA Jr, Howe RP, Dischinger TG. A comparison of
orthodontically induced inflammatory root the Herbst and Fränkel appliances in the treatment of Class II
malocclusion. Am J Orthod Dentofacial Orthop. 1990;98:134-44.
resorption mostly in the anchoring teeth, however,
16- Nasiopoulos AT, Athanasiou AE, Papadopoulos MA, Kolokithas
root structure loss was minimal and clinically G, Ioannidou I. Premolar root changes following treatment with
insigni¿cant. the banded herbst appliance. J Orofac Orthop. 2006;67:261-71.
17- Obijou C, Pancherz H. Herbst appliance treatment of Class
REFERENCES II, division 2 malocclusions. Am J Orthod Dentofacial Orthop.
1997;112:287-91.
1- Apajalahti S, Peltola JS. Apical root resorption after orthodontic 18- Pancherz H. Treatment of class II malocclusions by jumping
treatment - a retrospective study. Eur J Orthod. 2007;29:408-12. the bite with the Herbst appliance. A cephalometric investigation.
2- Barnett GA, Higgins DW, Major PW, Flores-Mir C. Immediate Am J Orthod. 1979;76:423-42.
skeletal and dentoalveolar effects of the crown- or banded type 19- Pancherz H. The mechanism of Class II correction in Herbst
Herbst appliance on Class II division 1 malocclusion. Angle appliance treatment. A cephalometric investigation. Am J Orthod.
Orthod. 2008;78:361-9. 1982;82:104-13.
3- Blake M, Woodside DG, Pharoah MJ. A radiographic comparison 20- Pancherz H. History, background, and development of the
of apical root resorption after orthodontic treatment with the Herbst appliance. Semin Orthod. 2003;9:3-11.
edgewise and Speed appliances. Am J Orthod Dentofacial Orthop. 21- Pancherz H, Hansen K. Occlusal changes during and after
1995;108:76-84. Herbst treatment: a cephalometric investigation. Eur J Orthod.
4- Brin I, Tulloch JFC, Koroluk L, Philips C. External apical root 1986;8:215-28.
resorption in Class II malocclusion: a retrospective review of 22- Ponder SN, Benavides E, Kapila S, Hatch NE. 4uanti¿cation
1- versus 2-phase treatment. Am J Orthod Dentofacial Orthop. of external root resorption by low- vs high-resolution cone-
2003;124:151-6. beam computed tomography and periapical radiography: a
5- Campos MJ, Silva KS, Gravina MA, Fraga MR, Vitral RW. Apical volumetric and linear analysis. Am J Orthod Dentofacial Orthop.
root resorption: the dark side of the root. Am J Orthod Dentofacial 2013;143:77-91.
Orthop. 2013;143:492-8. 23- Ruf S, Pancherz H. When is the ideal period for Herbst therapy
6- Castro I, Valladares-Neto J, Estrela C. Contribution of cone - early or late? Semin Orthod. 2003;9:47-56.
beam computed tomography to the detection of apical root 24- Sameshima GT, Asgarifar KO. Assessment of root resorption
resorption after orthodontic treatment in root-¿lled and vital and root shape: periapical vs panoramic ¿lms. Angle Orthod.
teeth. Angle Orthod. 2014. Epub ahead of print. 2001;71:185-9.
7- Castro IO, Alencar AH, Valladares-Neto J, Estrela C. Apical 25- Sherrard JF, Rossouw PE, Benson BW, Carrillo R, Buschang
root resorption due to orthodontic treatment detected by cone PH. Accuracy and reliability of tooth and root lengths measured
beam computed tomography. Angle Orthod. 2013;83:196-203. on cone-beam computed tomographs. Am J Orthod Dentofacial
Orthop. 2010;137:100-8.

J Appl Oral Sci. 484 2015;23(5):479-85


SCHWARTZ JP, RAVELI TB, ALMEIDA KCM, SCHWARTZ-FILHO HO, RAVELI DB

26- Valant JR, Sinclair PM. Treatment effects of the Herbst 29- Weschler D, Pancherz H. Ef¿ciency of three mandibular
appliance. Am J Orthod Dentofacial Orthop. 1989;95:138-47. anchorage forms in Herbst treatment: a cephalometric
27- Von Bremen J, Pancherz H, Ruf S. Reduced mandibular cast investigation. Angle Orthod. 2005;75:23-7.
splints an alternative in Herbst therapy? A prospective multicentre 30- Yu J, Shu K, Tsai M, Hsu J, Chang H, Tung K. A cone-beam
study. Eur J Orthod. 2007;29:609-13. computed tomography study of orthodontic apical root resorption.
28- Weltman B, Vig KW, Fields HW, Shanker S, Kaizar EE. J Dent Sci. 2013;8:74-9.
Root resorption associated with orthodontic tooth movement:
a systematic review. Am J Orthod Dentofacial Orthop.
2010;137:462-76.

J Appl Oral Sci. 485 2015;23(5):479-85

You might also like