Rapid maxillary expansion and external root resorption in man: a scanning electron microscope study.

The effects of rapid maxillary expansion on the external root structure of thirteen appliance-attached and five unattached maxillary first premolars from nine patients have been investigated with the scanning electron microscope (SEM). Topographic features of cementum and dentine resorption, as well as initial and subsequent remineralization changes, are described in detail. All anchor premolars exhibited root resorption, which was mostly confined to the buccal surface. Generally, the longer an anchor tooth remained in fixed retention, the more extensive the buccal root resorption. In contrast, the unattached maxillary first premolars and the opposing mandibular first premolars showed no evidence of resorption. Active resorption was the dominant process in anchor premolars extracted almost immediately after rapid expansion. Subsequently, repair became the predominant process, but continuing resorption was apparent even after 9 months of retention. Repair of root defects occurred by the deposition of cellular cementum which revealed little evidence of principal periodontal fiber reattachment within the advancing mineral front. The resorption pattern identified in the scanning electron microscope was not detected by in vivo radiographic examination. The significance of the findings is discussed.