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Abstract

Severe root resorption with excessive tooth mobility may compromise the capability of the teeth to sustain occlusal loading, and possibly lead to extraction. Apical external root resorption (AERR) is considered as one of the risks associated with orthodontic treatment. Some clinical factors have been shown to correlate with orthodontic treatment, whereas the determinants for predicting AERR consistently were not found. Therefore, orthodontists must monitor the amount of root resorption during the course of orthodontic treatment. Multiple idiopathic root resorption (MIRR) is a rare condition. If MIRR is present, the severity of tooth mobility may get worsen during orthodontic treatment. The risk of AERR would be higher in these patients compared to regular orthodontic patients. Moreover, the condition of MIRR will increase the treatment difficulty and complexity in patients who require orthognathic correction of malocclusion. In this report, we present a 25 y/o female with facial asymmetry and mandibular protrusion. Her chief complaints were chin deviation, anterior openbite, and crossbite. The skeletal analysis revealed mandible prognathism and mild maxilla retrusion, which leading to concave facial profile. Severe MIRR was noticed in the panoramic radiograph taken for routine orthodontic examination. Full mouth orthodontic treatment combined with orthognathic surgery was indicated to resolve her malocclusion. To minimize the risk of root resorption possibly induced by the torque effect exerted from rectangular archwires, we used light round archwires throughout the course of pre-surgical orthodontic treatment. Though rectangular archwires were used to facilitate the placement of surgical hooks for inter-arch elastic traction after surgery, rectangular archwires were rounded specifically at slot sites. One-jaw surgery was conducted via bilateral sagittal split osteotomy for mandibular setback and slight counterclockwise rotation. Her facial esthetics and occlusal relationship were significantly improved. Occlusal stability was maintained at 1 year and 9 months follow-up.

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