{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:24:37Z","timestamp":1787163877899,"version":"build-2736575974"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Orthodontically induced root resorption (RR) is frequent, and invasive surgically accelerated orthodontic (ISAO) procedures may increase it. This study aimed to assess the effect of ISAO on RR in teeth adjacent to surgically treated segments compared with conventional orthodontic treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA, five major databases and four grey literature sources were searched through August 2025 without language or date restrictions. Eligible studies were randomized controlled trials and comparative non-randomized intervention studies, including split-mouth designs, that reported quantitative root resorption after flap-based procedures. Two reviewers independently selected studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-I. Root resorption ascertainment and harms reporting were appraised with a modified McMaster Harms tool, and certainty was evaluated with GRADE. The review was registered in PROSPERO (CRD420251166274).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven studies involving 352 patients were included. Because of substantial heterogeneity in surgical protocols, imaging methods, root resorption metrics, and follow-up periods, findings were synthesized narratively. In cone-beam computed tomography studies, plain corticotomy showed either small increases or no clear between-group differences in root resorption. Some graft-augmented corticotomy or osteotomy protocols were associated with slightly lower measured root resorption than conventional controls. In two-dimensional or index-based assessments, most comparisons showed no clear difference. Across studies, observed root resorption generally remained within commonly accepted clinical limits, but evidence certainty was low to very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Current low- to very low-certainty evidence does not demonstrate a large increase in root resorption with invasive surgically accelerated orthodontics. However, the available studies are small, heterogeneous, and frequently at high risk of bias, preventing firm conclusions about safety. Findings suggesting slightly lower measured root resorption with some graft-augmented protocols remain hypothesis-generating and require confirmation in larger, better-designed studies with standardized outcomes and harms reporting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356175","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:30:20Z","timestamp":1787160620000},"page":"e0356175","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does invasive surgical acceleration of orthodontic tooth movement increase root resorption? A harms-focused systematic review"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5494-570X","authenticated-orcid":true,"given":"Mohamad Radwan","family":"Sirri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Osama","family":"Namera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Yaman","family":"Salahi Alasbahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaher","family":"Alswaidan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salar","family":"Karim 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resorption during orthodontic treatment with clear aligners and fixed appliances: a cone beam computed tomography study","volume":"21","author":"Y Li","year":"2020","journal-title":"Prog Orthod"},{"issue":"5","key":"pone.0356175.ref004","doi-asserted-by":"crossref","first-page":"284","DOI":"10.4041\/kjod24.030","article-title":"Genetic polymorphisms in external apical root resorption and orthodontic tooth movements: a systematic review","volume":"54","author":"\u00c1 Andrade ALC de","year":"2024","journal-title":"Korean J Orthod"},{"issue":"5","key":"pone.0356175.ref005","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.3390\/jcm13051248","article-title":"Diagnostic accuracy of cone beam computed tomography and periapical radiography for detecting apical root resorption in retention phase of orthodontic patients: a cross-sectional study","volume":"13","author":"SA Pereira","year":"2024","journal-title":"J Clin 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Hong","year":"2025","journal-title":"Appl Sci"},{"issue":"4","key":"pone.0356175.ref009","doi-asserted-by":"crossref","first-page":"503","DOI":"10.3390\/applbiosci3040032","article-title":"Distraction Osteogenesis: a comprehensive review","volume":"3","author":"B Adejuyigbe","year":"2024","journal-title":"Applied Biosciences"},{"issue":"1","key":"pone.0356175.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40902-021-00331-5","article-title":"Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon","volume":"44","author":"E Keser","year":"2022","journal-title":"Maxillofac Plast Reconstr Surg"},{"issue":"3","key":"pone.0356175.ref011","doi-asserted-by":"crossref","first-page":"427","DOI":"10.17219\/dmp\/161553","article-title":"Pain and root resorption due to surgical interventions to accelerate tooth movement in orthodontics: a systematic review and meta-analysis","volume":"61","author":"M 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