{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:25:58Z","timestamp":1793327158533,"version":"4.5.0"},"reference-count":20,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["AOS"],"abstract":"<jats:p>Background: Orthodontically induced external apical root resorption is a common iatrogenic effect of tooth movement. With the increasing use of clear aligner therapy, it is important to evaluate whether its biomechanics reduce root resorption compared with fixed orthodontic appliances.\nAim: To compare apical root resorption in patients treated with clear aligners and fixed appliances using cone-beam computed tomography (CBCT).\nMethodology: A retrospective comparative CBCT-based analysis was conducted on 120 orthodontic patients. Root volumes and lengths were measured from the cementoenamel junction to the apex using pre- and post-treatment CBCT scans. Apical root resorption was quantified as percentage volume loss and absolute root length reduction. Primary analyses employed linear mixed-effects models adjusted for clustering of teeth within patients and for tooth type, arch, extraction status, and treatment duration.\nResults: Clear aligner therapy was associated with significantly lower apical root resorption than fixed appliances. Mean percentage root volume loss was lower in the aligner group (6.1 \u00b1 4.8%) than in the fixed appliance group (8.4 \u00b1 6.1%) (p = 0.004). Mean root length reduction was also smaller with aligners (p = 0.001). Clinically significant root resorption occurred less frequently in the aligner group (p = 0.048). Longer treatment duration increased resorption risk.\nConclusion: Clear aligner therapy is associated with less apical root resorption than fixed orthodontic treatment, while treatment duration remains an independent risk factor.<\/jats:p>","DOI":"10.2340\/aos.v85.46274","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T13:55:04Z","timestamp":1781186104000},"page":"342-347","source":"Crossref","is-referenced-by-count":1,"title":["Comparative evaluation of apical root resorption in adult patients treated with clear aligners and fixed orthodontic appliances using CBCT"],"prefix":"10.2340","volume":"85","author":[{"given":"Rakhi","family":"Issrani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Hammad","family":"Alshammari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Raji","family":"Alrwuili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Ahmed","family":"Aljabab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasser Attallah","family":"Alenzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poonam","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousef T.","family":"Aldoseri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"158794","unstructured":"Brezniak N, Wasserstein A. 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A retrospective radiometric study. Head Face Med. 2013;9:21.","DOI":"10.1186\/1746-160X-9-21"},{"key":"158798","doi-asserted-by":"crossref","unstructured":"Lund H, Gr\u00f6ndahl K, Gr\u00f6ndahl HG. Cone beam computed tomography for assessment of root length and marginal bone level during orthodontic treatment. Angle Orthod. 2010;80(3):466\u201373.","DOI":"10.2319\/072909-427.1"},{"key":"158799","doi-asserted-by":"crossref","unstructured":"Barbagallo LJ, Jones AS, Petocz P, Darendeliler MA. Physical properties of root cementum: part 10. Comparison of the effects of invisible removable thermoplastic appliances with light and heavy orthodontic forces on premolar cementum. A microcomputed-tomography study. Am J Orthod Dentofacial Orthop. 2008;133(2):218\u201327.","DOI":"10.1016\/j.ajodo.2006.01.043"},{"key":"158800","doi-asserted-by":"crossref","unstructured":"Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. 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Evaluation of root resorption after comprehensive orthodontic treatment using cone beam computed tomography (CBCT): a meta-analysis. BMC Oral Health. 2018;18(1):116.","DOI":"10.1186\/s12903-018-0579-2"},{"key":"158804","doi-asserted-by":"crossref","unstructured":"Gay G, Ravera S, Castroflorio T, Garino F, Rossini G, Parrini S, et al. Root resorption during orthodontic treatment with Invisalign\u00ae: a radiometric study. Prog Orthod. 2017;18(1):12.","DOI":"10.1186\/s40510-017-0166-0"},{"key":"158805","doi-asserted-by":"crossref","unstructured":"Zhang X, Zhou H, Liao X, Liu Y. The influence of bracket torque on external apical root resorption in bimaxillary protrusion patients: a retrospective study. BMC Oral Health. 2022;22(1):7.","DOI":"10.1186\/s12903-022-02042-3"},{"key":"158806","doi-asserted-by":"crossref","unstructured":"Singh S, Jain RK, Balasubramaniam A. Comparative assessment of external apical root resorption between subjects treated with clear aligners and fixed orthodontic appliances: a systematic review and meta-analysis. J Dent Res Dent Clin Dent Prospects. 2024;18(2):85\u201394.","DOI":"10.34172\/joddd.40932"},{"key":"158807","doi-asserted-by":"crossref","unstructured":"Selvaraj M, Nivethitha B, Madhan B. Orthodontically induced external apical root resorption with clear aligners compared to fixed appliance treatment: an umbrella review. J Oral Biol Craniofac Res. 2025;15(5):938\u201347.","DOI":"10.1016\/j.jobcr.2025.06.011"},{"key":"158808","doi-asserted-by":"crossref","unstructured":"Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. 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J Clin Orthod. 2013;47(6):346\u201351; quiz 387."},{"key":"158812","doi-asserted-by":"crossref","unstructured":"Chan E, Darendeliler MA. Physical properties of root cementum: part 5. Volumetric analysis of root resorption craters after application of light and heavy orthodontic forces. Am J Orthod Dentofacial Orthop. 2005;127(2):186\u201395.","DOI":"10.1016\/j.ajodo.2003.11.026"},{"key":"158813","doi-asserted-by":"crossref","unstructured":"Al-Qawasmi RA, Hartsfield JK, Jr, Everett ET, Flury L, Liu L, Foroud TM, et al. Genetic predisposition to external apical root resorption. 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