Scoping review maps CBCT evidence gaps on root resorption

A new scoping review in the International Journal of Oral and Maxillofacial Surgery takes aim at a specific blind spot in dentofacial research: CBCT-based evidence of external apical root resorption following orthognathic surgery. The review examines what has actually been published on root changes in surgical versus non-surgical jaws among orthognathic patients, and, just as importantly, where the evidence is still missing. Based on the broader literature, that gap appears meaningful rather than academic. Earlier reviews have found that root resorption can occur after orthognathic procedures, but the available studies have been sparse and methodologically uneven. (sciencedirect.com)

The background is familiar to anyone working in orthodontics or maxillofacial surgery. External apical root resorption is a recognized adverse effect of orthodontic tooth movement, and previous CBCT-based meta-analyses have shown orthodontic treatment is associated with reduced tooth length and root volume. One such meta-analysis also flagged a subgroup of pre-operative orthodontic patients preparing for orthognathic surgery as showing greater root resorption, reinforcing the idea that surgical cases may deserve separate scrutiny rather than being folded into general orthodontic datasets. (link.springer.com)

What has made the question hard to answer is the quality of the underlying literature. A prior systematic review of orthognathic surgery and root resorption found only one CBCT-based study among the included papers; most relied on two-dimensional imaging, and overall prevalence estimates ranged widely, from about 1% to 36%. That review concluded that SARME and Le Fort I osteotomy appeared to have the highest association with root resorption, while bilateral sagittal split osteotomy appeared to have less impact, but the authors stressed that the evidence should be interpreted cautiously because of limited study numbers, lack of non-surgical controls, and weak objective quantification. (sciencedirect.com)

That context helps explain the value of the new scoping review. Rather than claiming a definitive risk estimate, it appears aimed at mapping the field: what CBCT studies exist, how they define and measure EARR, which jaws and tooth groups are compared, and where the methodological gaps are. That is timely because inconsistency in resorption assessment is a wider problem across the literature. A separate recent scoping review on EARR assessment found poor agreement among authors on diagnosis and measurement methods, leading to inconsistent results across studies. (pubmed.ncbi.nlm.nih.gov)

Expert and professional commentary outside this exact paper points in the same direction. The American Association of Endodontists has described CBCT as the imaging modality of choice for diagnosing and planning treatment in resorptive lesions, while also noting that imaging decisions should remain case-specific rather than automatic. In other words, three-dimensional imaging can sharpen detection and characterization, but better imaging alone does not solve the larger evidence problem if studies use different thresholds, landmarks, follow-up intervals, and outcome definitions. (aae.org)

Why it matters: For veterinary professionals, especially those following oral surgery, dentistry, and comparative craniofacial care, this review is a reminder that sophisticated imaging can expose uncertainty as much as it resolves it. In translational terms, the issue is not simply whether root resorption happens, but when it is clinically meaningful, which interventions elevate risk, and how to separate the effects of orthodontic movement from osteotomy-related vascular or mechanical changes. The current evidence suggests anterior teeth may be especially vulnerable, and that procedure type may matter, but the field still lacks standardized, prospective CBCT studies robust enough to support strong risk counseling or surveillance protocols. (sciencedirect.com)

There is also a practical message for clinicians who collaborate across specialties. Orthognathic care is inherently multidisciplinary, and this literature suggests that pre-surgical orthodontic mechanics, surgical planning, imaging strategy, and follow-up timing all shape how root outcomes are interpreted. Reviews of CBCT use in orthodontics have already highlighted root resorption as one of the modality’s important applications, but they also underscore that the evidence base remains fragmented. For teams managing complex dentofacial cases, the need now is less for another broad reminder that EARR exists and more for standardized protocols that can tell clinicians which findings should change management. (pubmed.ncbi.nlm.nih.gov)

What to watch: The next step will likely be prospective CBCT studies that compare surgical and non-surgical jaws within the same patients, stratify by procedure type, and use harmonized EARR definitions so the field can move from descriptive concern to actionable risk estimates. (sciencedirect.com)