What question did this study set out to answer?

To assess the effect of invasive surgically accelerated orthodontic procedures on root resorption in teeth adjacent to surgically treated segments compared with conventional orthodontic treatment.

August 22, 2026PLoS ONE0 citationsOpen Access

Does invasive surgical acceleration of orthodontic tooth movement increase root resorption? A harms-focused systematic review

MSMohamad Radwan Sirri MNMohammad Osama Namera MAMohamad Yaman Salahi Alasbahi

Key Points

To assess the effect of invasive surgically accelerated orthodontic procedures on root resorption in teeth adjacent to surgically treated segments compared with conventional orthodontic treatment.
Searched five databases and four grey literature sources through August 2025 following PRISMA guidelines (PROSPERO: CRD420251166274).
Included 11 randomized controlled trials and comparative non-randomized intervention studies comprising 352 patients receiving flap-based surgical acceleration.
Evaluated risk of bias and harms using RoB 2, ROBINS-I, and a modified McMaster Harms tool, and appraised evidence certainty using GRADE.
Cone-beam computed tomography evaluations demonstrated that plain corticotomy resulted in either minor increases or no clear difference in root resorption compared with conventional controls, whereas graft-augmented protocols showed slightly lower resorption.
Two-dimensional imaging and index-based assessments showed no clear between-group differences in root resorption across most comparative evaluations.
Root resorption generally remained within clinically acceptable limits across all included studies, but overall certainty of evidence was graded as low to very low.

Abstract

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

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