CLINICIAN’S CORNER
Short-root anomaly in an orthodontic patient
Leandro Silva Marques,a Rodrigo Generoso,b Mônica Costa Armond,c and Camila Alessandra Pazzinid
Diamantina, Treˆs Corações, Minas Gerais, Brazil
Short-root anomaly is a rare condition, but it can be a problem for orthodontists and their patients. Our aim in
this article was to report the treatment of an orthodontic patient with short-root anomaly, highlighting the
diagnostic aspects involved and the strategy used. (Am J Orthod Dentofacial Orthop 2010;138:346-8)
S
hort-root anomaly (SRA) is a rare condition, with
a prevalence estimated at 1.3%. It is more com-
mon in female patients and principally affects
the premolars and the maxillary incisors, the apexes of
which are rounded rather than the usual pointed
shape.1,2 The condition has a genetic background and
is related to other dental anomalies, such as agenesis,
invaginated teeth, conoid teeth, supernumerary teeth,
microdontia, taurodontia, pulp calculus, and type I
dentin dysplasia.3-6 Moreover, it can be related to
syndromes, such as Down7 and Stevens-Johnson.8
SRA has also been associated with exogenous factors,
including radiation of the head and neck or chemother-
apy in children with malignant tumors during dental
development.9
Short dental roots, resulting in unfavorable root-
crown ratios, can affect the prognosis of teeth and compli-
cate the treatment plan in orthodontics and prosthodontics
when considering aspects such as anchoring and the ca-
pacity of teeth to bear mastication forces.10 Specifically
in orthodontic patients, this problem takes on an even
more critical dimension, because of the tendency in
patients with short roots toward root resorption during
orthodontic treatment.11,12 Moreover, anomalies such as
agenesis, ectopic teeth, and taurodontism are risk
factors for periapical resorption.13,14
Although SRA is a potential problem in the clinical
practice of orthodontists, no studies were found that di-
rectly address this subject. Thus, our aim in this study
a
Professor, Department of Orthodontics, University of Vale do Rio Verde
(UNINCOR), Três Corações, Brazil; private practice, Diamantina, Brazil.
b
Professor, Department of Orthodontics, University of Vale do Rio Verde
(UNINCOR), Três Corações, Brazil.
c
Professor, Department of Orthodontics, University of Vale do Rio Verde
(UNINCOR), Três Corações, Brazil.
d
PhD student, Pediatric Dentistry and Orthodontics Department, Federal
University of Minas Gerais (UFMG), Belo Horizonte-MG, Brazil.
The authors report no commercial, proprietary, or financial interest in the
products or companies described in this article.
Reprint requests to: Leandro Silva Marques, Arraial dos Forros, 215, Centro,
Diamantina, Minas Gerais, Brazil, Cep: 39100-000; e-mail, lsmarques.prof@
gmail.com.
Submitted, revised and accepted, August 2008.
0889-5406/$36.00
Copyright Ó 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.08.037
346
was to present the treatment of an orthodontic patient
with SRA, highlighting the diagnostic aspects involved
and the strategy used.
CASE REPORT
A girl, aged 10 years 7 months, sought orthodontic
care, accompanied by her parents. Their objective was
to continue the treatment that had been started 6 months
earlier by another orthodontist. The girl had an ortho-
dontic appliance in her maxillary arch from second
premolar to second premolar (Fig 1). She had a mesofa-
cial growth pattern, a convex facial profile, and a Class
II dental and skeletal malocclusion. The radiographs
showed SRA in the maxillary and mandibular central in-
cisors and first premolars (Fig 2). The mandibular cen-
tral incisors were affected to the greatest degree. There
were no reports of disease or systemic abnormalities.
The new treatment plan involved removal of the
fixed appliance and placement of a functional orthope-
dic appliance aimed at mandibular advancement
(Fig 3). Headgear was also prescribed to limit the
anterior movement of the maxilla. After 8 months of
functional orthopedic appliance treatment, the patient
exhibited significant mobility in the mandibular central
incisors. The decision was then made to place a fixed
lingual retainer, with a 0.025-mm braided fiber, on the
mandibular incisors and canines (Fig 4). After 19
months of retention, there was stability of the sagittal
correction and satisfactory intercuspation (Fig 5).
Throughout this period, there was no change in the
amount of root shortening (Fig 6).
DISCUSSION
There are 2 main reasons for short dental roots: dis-
turbance during dental development and resorption of
originally well-developed roots. Clinical orthodontists
should be careful not to diagnose SRA as root resorp-
tion. Because of the genetic background, the diagnosis
of SRA is established when members of the family
also have short roots and the possibility of systemic dis-
ease has been discarded.15 Root resorption is most often
American Journal of Orthodontics and Dentofacial Orthopedics Marques et al 347
Volume 138, Number 3

Fig 1. Intraoral photographs of a patient seeking to continue treatment started 6 months earlier with
a different provider.

Fig 2. Radiographs showed the SRA of the central incisors and first premolars.

Fig 3. Fixed appliances and a functional orthopedic ap-

pliance were placed.

Fig 4. Eight months later, the mandibular central inciors

considered a collateral effect of orthodontic treatment.
In the case presented here, although the patient was al-
ready in orthodontic treatment and the root shortening
affected both maxillary and mandibular teeth, this could
not be attributed to the forces of the appliance, since it
was attached only to the maxillary teeth. Furthermore,
the diagnosis of SRA was confirmed by a similar situa-
tion observed in the patient’s sister, although to a lesser
degree.
No reports were found in the literature regarding
orthodontic treatment in patients with SRA. However,
using the finite element method, Oyama et al16
showed significant mobility, so a fixed lingual retainer
was placed.
demonstrated that, in model short root, significant stress
was concentrated at the middle of the root, enough for
the development of root resorption. Thus, orthodontic
forces should be applied with considerable caution
and preferentially avoided in patients with this anomaly.
Fortunately, in our patient, the severity of the malocclu-
sion did not require complex mechanics or considerable
348 Marques et al
Fig 5. After 19 months of retention, there was stability in the sagittal correction and satisfactory
intercuspation.
Fig 6. Root shortening did not increase.
force. Moreover, she was in phase 2 (acceleration) of
vertebral maturation and, therefore, before the pubertal
growth spurt. These characteristics allowed a treatment
plan that preferentially addressed orthopedic aspects
(activator and headgear) that did not involve force di-
rectly on the affected teeth. Once mobility was found
in the mandibular incisors, we decided to apply a splint
to stabilize them to prevent movement and an overload
of forces as much as possible. A possible explanation for
the mobility observed in these teeth was the effect of the
projection of the incisors from the mandibular advance-
ment appliance.
CONCLUSIONS
The definition of short roots has been most often
used subjectively. However, orthodontists and dental
professionals should be careful to make a correct
diagnosis and an individualized treatment plan for this
abnormality, because these determinations could mean
the difference between success and failure of the
strategy.
American Journal of Orthodontics and Dentofacial Orthopedics
September 2010
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