Two Cases Diagnosed with Idiopathic Root Resorption and Low Serum Vitamin D Raise New Questions on Aetiology

Abstract

Aims: In this report, two cases, A and B, with idiopathic resorptions are presented. In both cases the hypothesis was that the idiopathic resorption processes had a general medical cause, presumably an inborn calcification deficit. The aim was to evaluate this hypothesis. Presentation of Cases: Case A. Healthy Caucasian male, born 1999, with no anamnestic information on diseases or medications, was treated with orthodontic fixed appliances for agenesis of a mandibular incisor, lack of space in the maxilla for cuspid eruption and bilateral open bite. A sister had minor resorption defects after orthodontic treatment. What is extraordinary in case A, and seemingly not described before, is the aggressive resorption occurring in the retention period and in the 4-year post retention period. Case B. Caucasian male, born in a pre-term delivery in 2003 with an anamnestic information on late development and ADHD. Case B has never received orthodontic treatment. Both patients underwent a serum test and case A was also offered a genetic test.  Findings: Cases A and B both had low values of vitamin D. In addition, case B had low value of alkaline phosphatase (ALP). Case A was genetically negative for hypophosphasia (HPP). By retrospection, both cases revealed severe resorption in the primary dentition before onset of orthodontic treatment. Conclusion: It was concluded that the resorptions observed in the permanent teeth in case A was not a consequence of the orthodontic treatment. It is suggested that case A could have osteomalasia, while case B may have HPP. Limitations: This study represents a new approach in revealing the aetiology behind severe idiopathic root resorption. Further collaboration with medical specialists is need for improving the indications and the limitations for the serological methods.