Directions of orthodontic tooth movements associated with external apical root resorption of the maxillary central incisor.

External apical root resorption is a multifactorial problem encountered in all disciplines of dentistry, but it is most commonly seen in cases treated orthodontically. Specific tooth movements that are most likely to exacerbate external apical root resorption are poorly understood. Purpose of the present investigation was twofold: (1) to quantify apical and incisal movements of the maxillary central incisor in the sagittal and vertical planes from cephalograms and (2) to use stepwise multivariate linear regression analyses to see which tooth movements and skeletodental relationships are most predictive of external apical root resorption. The sample consisted of 110 adolescents with similar pretreatment malocclusions (Class I crowded or bimaxillary protrusive) and treatment planned similarly (extraction of four first premolars) by experienced private practitioners. Each of three practitioners used a different orthodontic appliance; the sample was divided proportionately into cases treated with Tweed standard edgewise technique, Begg lightwire technique, and Roth-prescription straightwire technique. Lateral cephalograms were analyzed at the start, middle, and end of treatment. There was no statistical difference in average external apical root resorption between sexes or among techniques. Measures of tooth movement were highly predictive, explaining up to 90% of the variation in root resorption. Apical and incisal vertical movements and increase in incisor proclination were the strong predictors of external apical root resorption for each regression model. Incisor intrusion with increase in lingual root torque together were the strongest predictors of external apical root resorption. In contrast, distal bodily retraction, extrusion, or lingual crown tipping had no discernible effect.