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Physical properties of root cementum: Part 15.

Analysis of elemental composition by using
proton-induced x-ray and gamma-ray emissions
in orthodontically induced root resorption craters
of rat molar cementum after exposure to systemic
fluoride
Elaine Lim,a David Belton,b Peter Petocz,c Manish Arora,d Lam L. Cheng,e and M. Ali Darendelilerf
Sydney and Melbourne, Australia

Introduction: Root resorption resulting from orthodontic treatment is an unpredictable adverse effect. Literature
examining the potential protective influence of tooth cementum minerals against orthodontically induced
inflammatory root resorption has been sparse. Fluorine could have a role in minimizing the extent and severity
of resorptive lesions. The purpose of this study was to examine the elemental content of tooth cementum in or-
thodontically induced inflammatory root resorption lesions and the effect of systemic fluoride. Methods: Twenty
7-week-old Wistar rats were divided into 2 groups of 10 and exposed to systemic fluoride (100 ppm) or nonfluori-
dated drinking water for 2 weeks. Orthodontic tooth movement was implemented with a nickel-titanitum closing
coil with a force of 100 g. The molars were then extracted, dissected, and prepared for cross-sectioning through
the largest mesial midroot crater. The samples were mounted and scanned by using the Commonwealth
Scientific and Industrial Research Organisation and the Australian Research Council’s National Key for
Geochemical Evolution and Metallogeny of Continents Nuclear Microprobe (Melbourne, Victoria, Australia).
Analysis of variance (ANOVA) was used for statistical comparison of the elements and to determine the
effect of fluoride, and unaffected tooth structure compared with root resorption craters. The Student t test was
used to compare root crater lengths and depths of the fluoride vs no-fluoride groups. Results: Root resorption
lesions of the group exposed to fluoride were significantly reduced in length and depth (P \0.01). The mineral
content of the root resorption craters of the fluoride group had higher concentrations of fluorine and zinc
(P \0.01). There was less calcium in the craters of the no-fluoride group compared with the fluoride group
(P \0.05). Conclusions: Cementum quality (influenced by systemic fluoride exposure) might impact the extent
of orthodontically induced resorptive defects. (Am J Orthod Dentofacial Orthop 2011;139:e193-e202)

R
oot resorption resulting from orthodontic treat- of OIIRR has not been fully elucidated. After orthodontic
ment is an unpredictable adverse effect involving force application, tooth movement is associated with
transient inflammatory surface resorption. This local compression of the periodontal ligament and the
process has been termed orthodontically induced development of sterile necrosis.2 This morphometric
inflammatory root resorption (OIIRR).1 The mechanism phase is followed by biochemical changes. The sequence

a f
Private Practice Orthodontist, Melbourne, Victoria Australia. Professor and chair, Discipline of Orthodontics, Faculty of Dentistry, University
b
Manager, Nuclear Microprobe Applications Exploration and Mining, Common- of Sydney, Sydney, Australia.
wealth Scientific and Industrial Research Organisation (CSIRO), MARC, School of The authors report no commercial, proprietary, or financial interest in the
Physics, University of Melbourne, Melbourne, Australia. products or companies described in this article.
c
Associate professor, Department of Statistics, Macquarie University, Sydney, Reprint requests to: M. Ali Darendeliler, University of Sydney, Discipline of
Australia. Orthodontics, Faculty of Dentistry, Level 2, 2 Chalmers St, Surry Hills NSW
d
Senior lecturer, Population Oral Health Unit, Faculty of Dentistry, University of 2010 Australia; e-mail, adarende@mail.usyd.edu.au.
Sydney, Sydney, Australia. Submitted, April 2009; revised and accepted, December 2009.
e
Lecturer, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, 0889-5406/$36.00
Sydney, Australia. Copyright Ó 2011 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2009.12.028

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e194 Lim et al

of events involves fiber coalescence, hyalinization, and Evolution and Metallogeny of Continents Nuclear
degradation of connective tissue matrices (extracellular Microprobe (CSIRO-GEMOC NMP) (Melbourne, Victoria,
and intracellular pathways)3 followed by dissolution of Australia) provides superior spatial resolution (1-2 mm)
Sharpey’s fibers4 and, finally, odontoclastic activity. and quantitative data on elemental concentrations. As
The resorptive process initially occurs at the circumfer- yet, this machine has not been used in the study of
ence of the necrotic hyalinized area. This is followed root resorption lesions in the cementum.
by resorption of the root surface in the central part of The aims of this study were (1) to develop a method-
the necrotic zone.5 The later stages also demonstrate ology to use the CSIRO-GEMOC NMP to analyze the
areas of peripheral repair.6,7 elemental composition of root resorption craters and
Associated risk factors for increased incidence of root (2) to analyze the elemental composition of root resorp-
resorption include individual susceptibility, genetics, hor- tion craters on rat molars after their intake of systemic
monal imbalance, medical history, nutritional balance, fluoride.
age, dental history, tooth type, duration of treatment,
amount of tooth movement, appliance type, type of tooth MATERIAL AND METHODS
movement, and magnitude of orthodontic force.8 In this study, we used 20 seven-week-old female Wistar
There is currently no consensus on how to, or whether rats (Westmead Hospital Animal Ethics Committee, project
it is possible to, prevent root resorption. However, strat- 134.12-03). The rats were allowed a week to acclimatize to
egies have been suggested on ways to minimize root their new laboratory environment. They were then ran-
resorption, such as limiting treatment duration,9,10 domly divided into 2 groups of 10 animals. Group 1 had
using light intermittent forces,11 assessment of medical orthodontic tooth movement and received deionized water
history and familial tendency,12,13 control of habits,14 that was not fluoridated. Group 2 had orthodontic tooth
and, if required, cessation of treatment.15,16 movement and received fluoridated deionized water
The literature is sparse in regard to examining fluo- (100 ppm). Sodium fluoride was dissolved in Milli-Q
ride’s potential protective influence and the effect of (deionized water, Millipore, Bedford, Mass) to meet this
the mineral content of cementum against OIIRR. Foo concentration level. Water was given ad libitum. Every 2
et al17 used rats to induce orthodontic root resorption to 3 days, the water was monitored and replenished as
and exposed part of the sample to systemic fluoride, necessary.17
with an estimated intake of 1 mg per day. It was demon- Orthodontic tooth movement was implemented with
strated that the average crater volumes of teeth exposed nickel-titanium 100-g closing coils (NiTi 10-000-06,
to fluoride were about half the size. However, because of GAC International, Bohemia, NY). The coil was ligated
large variations in results, these differences were not to the rat’s mandibular left first molar by means of
significant at the level of P \0.05. a silk suture. The coil was activated via ligation to the
Our study appears to be unique in examining the mandibular incisors with steel ligatures.17 Attachment
elemental content of OIIRR craters. Such information of the nickel-titanium coils was performed under anes-
might increase our understanding of this process and thesia. The rats were administered a gaseous anesthetic
the possible protective effects that elements, such as agent (halothane), followed by the anesthetic agents
fluorine, impart to cementum. Although fluoride does xylazine (10 mg/kg) and ketamine (90 mg/kg).
not increase the physical hardness of cementum per se, The experimental period lasted 2 weeks. Then the rats
there are a number of possible mechanisms whereby were killed with carbon dioxide. Their mandibles were
fluoride can impart a protective effect against orthodon- dissected and sectioned mesially and distally to the
tically induced root resorption.18 These include direct mandibular left first molar. The samples were stored in
effect on osteoclasts, alteration of shapes of resorption Milli-Q. This has been shown to have an insignificant
pits, and mineralization of cementum.19 Thus, fluoride effect on leaching of trace elements from cementum
might be extrapolated as a potential preventive agent samples.20,21
against the severity of OIIRR. The teeth were progressively dissected from the man-
There are various methods to study the elemental dible, with the aim of minimizing fracture of the fine rat
composition of teeth. The nuclear microprobe uses pro- molar roots and contact below the cementoenamel junc-
ton induced x-ray emissions (PIXE) and proton induced tion. This was achieved by severing any remaining mar-
gamma-ray emissions (PIGE), allowing mapping of mul- ginal gingivae and then removing approximately a third
tiple elements at micrometer resolutions. Compared with of the alveolar bone surrounding the tooth followed by
other available techniques, the Commonwealth Scientific luxation with a blunt-ended periosteal elevator. This
and Industrial Research Organisation and the Australian was carried out under a light microscope (WILD M3B,
Research Council’s National Key for Geochemical Heerbrugg, Switzerland). After dissection, the teeth

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Lim et al e195

Fig 1. Wax marker system: A, microscopic view of the dental wax pushed over the tooth root to the
point to be sectioned; B, sample tooth floating with its crown down in Milli-Q in an ice cube tray.

were cleaned with sterile gauze soaked in Milli-Q, and root resorption crater. This was achieved by using fine
gross periodontal ligament fibers were manually re- and superfine Sof-Lex Discs (3M ESPE Monrovia, Calif)
moved with tweezers.22 The teeth were then stored in under Milli-Q irrigation to a surface polish of \0.2 mm.
Milli-Q at ambient room temperature (23 6 10C ).20 The specimens were then mounted on glass slides
All root resorption craters were located on each tooth with double-sided carbon adhesive tape. The slide and
with a microscope (SZCTV, Olympus, Tokyo, Japan). The the specimens were carbon coated (evaporated) in
largest midroot crater on the mesial root of each tooth a vacuum at 104 mm of mercury with an approximately
was identified. 20-nm layer. The glass slide was then encased in a metal
A “wax marker system” was developed by an author stub designed specifically for the nuclear microprobe
(E.L.) to indicate the point at which the tooth required (NMP).
sectioning (Fig 1). This achieved the goals of marking The spatial distribution of multiple elements based
a microscopic point that could be seen macroscopically on x-ray and gamma ray emissions was measured in
for hand sectioning and allowed minimal interference the resorption craters and the surrounding nonresorbed
with the tooth minerals. The initial microscope photo- cementum of the tooth roots. In this study, we used the
graphs allowed relocation of the midpoint of the root re- NMP developed by the Commonwealth Scientific and
sorption crater of interest. Industrial Research Organisation and the Australian
This technique involved softening the center point of Research Council’s National Key for Geochemical
an approximately 1 3 1 cm2 sheet of dental wax (Moyco Evolution and Metallogeny of Continents.
Union Broach, York, PA) with hot water delivered via The analysis was performed with 3.0 MeV protons,
a pipette. Under the microscopic view, the wax was pushed and the beam was focused at 1 3 1.8 mm2. Scanning
over the tooth root to the point of sectioning (Fig 1, A). was electrostatically driven in the y-axis between 800
The tooth was then floated in Milli-Q with its crown and 1500 mm, with the stage stepped in the x-axis (step
down in an ice cube tray (Fig 1, B). The trays were then size, 2.5 mm) to generate a rectangular image. The
frozen for 24 hours. The wax was removed, leaving the beam current was maintained at 4 nA. The total
exposed root portion to be cut and the exact point or accumulated charge for an average sized area was
region of interest embedded in the Milli-Q ice block. approximately 20 to 25 mC. An aluminum absorber of
The specimens were then sectioned transversely, in layers 100 mm was used between the target and germanium de-
from the apex, through to the identified midpoint of the tector (Canberra Ultra-Ge Detector, Canberra, Autstralia).

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Fig 2. A, Diagrammatic representation of regions deconstructed and analyzed to give mean concen-
trations, detection limits, and errors from scanned samples (red outline). Root resorption crater, repre-
sentation of marginal cementum (RRy); root resorption crater, representation of dentin floor of lesion

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The software used to evaluate spectra was Geo-PIXE II

Table I. Mean fluorine concentrations for dentin and
(version 3.8, CSIRO Melbourne Australia). The elements
cementum in no-fluoride vs fluoride groups
detectable under gamma rays were sodium (Na), fluorine
(F), manganese (Mn), aluminum (Al), and silicon (Si); un- Mean concentrations
der x-rays, calcium (Ca), iron (Fe), nickel (Ni), copper (Cu), Group Analysis region of fluoride*,y
zinc (Zn), bromine (Br), rubidium (Rb), strontium (Sr), tin No fluoride Root resorption Dentin 8553.83
crater
(Sn), barium (Ba), and lead (Pb) were measurable. Cementum 10474.83
The Geo-PIXE II computer program was used to ex- Normal teeth Dentin 9430.83
tract the raw data generated by the scanning process.23 Cementum 10705.5
A manual analysis of regions, to provide quantitative Fluoride Root resorption Dentin 10822.67
data, was conducted by a function that allowed shapes crater
Cementum 21166.33
to be drawn over the downloaded image. The regions Normal teeth Dentin 11267.17
analyzed were a “traverse” through the middle of the Cementum 31388.0
deepest point of the root resorption crater and adja-
*ppm; ySE, 3151.51.
cent cementum. Readings from dentin below the crater
at its marginal cementum and corresponding areas of
distant physically unaffected root structure of the variation was also calculated from the standard error
same tooth surface were recorded (Fig 2, A). This measure as a percentage of the mean.
was repeated for each slice generated from both the Because of the large number of dependent tests
x-ray and the gamma-ray scans. In addition to the conducted, a P value of less than 0.01 was taken to
quantitative data, the information was also used to indicate statistical significance, and P values between
process spectral (elemental) graphs and picture plots 0.01 and 0.05 were assigned “marginal” status.
(Fig 2, B). Spectral graphs are traverse concentration
profiles of each element, showing the pattern of distri- RESULTS
bution through the tooth structure. Picture plots are
qualitative representations (maps) of relative concen- The fluoride and no-fluoride groups were analyzed for
trations, distributed across the scanned region, for their elemental content. The error of the measurement
each element. was found to be minor, with the highest coefficient of
variance 9.4% for Mg. The results for each tooth sample
were divided for evaluation of root resorption crater
Statistical analysis cementum (representing the margin of the lesion), root
SPSS software (version 14, SPSS, Chicago, Ill) was resorption crater dentin (representing the surface of the
used to compare the element concentrations between crater floor and its immediate subsurface layer), and the
the fluoride and no-fluoride groups. Analysis of variance cementum and dentin of the adjacent tooth physically
(ANOVA) was conducted to examine the concentrations unaffected by resorption. Multivariate ANOVA analysis,
of elements (F, Mg, Na, Al, Zn, Sr, and Ca), and the taking the group of minerals as a whole, demonstrated
factors included were fluoride vs no-fluoride, root re- significant differences between fluoride and no fluoride
sorption crater vs normal tooth structure, and cementum (P \0.01), and dentin and cementum (P \0.01), with
vs dentin. Significant interactions between factors were a marginally significant interaction (P 5 0.01). However,
also included in these models. A multivariate ANOVA there were no significant differences between overall
was used to examine the effects of these factors on the elemental concentrations in root resorption and normal
complete collection of elements as a whole. tooth structure (P 5 0.27), although there was a marginal
The error of the measurement was calculated for F, interaction between fluoride and no fluoride and root
Mg, Na, Ca, and Zn and was based on triple measure- resorption and normal tooth (P 5 0.027). Essentially,
ments performed on randomly selected samples from the greatest differences were between fluoride and no
the fluoride and no-fluoride groups. An ANOVA was per- fluoride, followed by dentin and cementum (Table I).
formed, by using each group of repeated measurements When individual elements were assessed, the fluoride
as a unit. The root mean square error was used to give group had significantly more fluorine concentration in
the standard error of measurement. The coefficient of the cementum compared with the no-fluoride group

= and subsurface (iz); normal (physically unaffected) tooth structure, representation of dentin and cemen-
tum (iiz); transverse section through root resorption crater (T1§ ). B, Deconstructed raw data from
Geo-PIXE computer program.

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Fig 3. Mean fluorine (F) concentrations (ppm) for no-fluoride vs fluoride groups divided according to
the location in the tooth. PIXE spectral plots (traverse concentration profile) demonstrating mineral
concentrations through a root resorption crater in each group. Left to right, cementum through pulp
(generated by the Geo-PIXE computer program).

(P \0.01) (Table I, Fig 3). Overall, the fluoride group had

a greater concentration of fluorine (mean concentration, Table II. Mean mineral concentrations for root resorp-
18661.04 ppm) compared with the no-fluoride group tion craters of no-fluoride vs fluoride groups
(mean concentration, 9791.25 ppm) (Table II). However, Mineral Fluoride groupz No-fluoride groupz SE
both groups had similar distribution patterns of fluorine Fluoride* 18661.04 9791.25 1575.75
in the dentin (Fig 3). Zinc* 270.29 174.04 16.06
There was no significant difference between magne- Sodium* 14091.54 8232.04 440.96
Calciumy 35.58% 26.10% 1.42
sium in any of the analyzed groups (Fig 4). Sodium
demonstrated significantly higher concentrations in *P \0.01; yP \0.05; zppm unless stated otherwise.
the fluoride group (mean concentration, 14091.54
ppm; SE, 440.96) compared with the no-fluoride group
(mean concentration, 8232.04 ppm; SE, 440.96) 125.21 ppm) (P \0.05). However, no other differences
(P \0.01). There was significantly more sodium in were noted.
dentin (mean concentration, 12639.79 ppm) vs cemen- Zinc had amarginally significant greater concentra-
tum (mean concentration, 9633.79 ppm) (P \0.01). tion in the fluoride group (mean concentration, 270.29
There were no other significant differences. ppm; SE, 16.06) compared with the no-fluoride group
Aluminum had marginally significant increases in (mean concentration, 174.04 ppm) (P \0.05). The root
cementum (mean concentration, 307.125 ppm; SE, resorption craters had more zinc in their dentin (mean
55.33) compared with dentin (mean concentration, concentration, 207.92 ppm; SE, 22.72) compared with

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Fig 4. PIGE spectral plots (traverse concentration profile) demonstrating mineral concentrations
through a root resorption crater in each group. Left to right, cementum through pulp (generated by
the Geo-PIXE computer program).

the nonroot crater tooth structure (mean concentration, root resorption craters of this group had significantly
188.75 ppm) (P \0.01) (Fig 5). increased concentrations of F and Zn (P \0.01) and
Strontium had significantly higher concentrations in marginally significant increased Ca concentrations
the dentin (mean concentration, 244.58 ppm; SE, 7.93) (P \0.05) (Table II).
of all the examined groups compared with cementum
(mean concentration, 194.79 ppm) (P \0.01). There
were no other significant differences for this element. DISCUSSION
Calcium was found to be significantly higher in the Overall, there was only a marginally significant dif-
dentin (mean concentration, 37.97%; SE, 1.42) com- ference between the fluoride and no-fluoride groups
pared with cementum (mean concentration, 23.71%) and the elemental concentration of root resorption cra-
(P\0.01). There was also a marginally significant differ- ters and normal tooth structure. This might be due to the
ence between the no-fluoride (mean concentration, ability for cementum to resist root resorption to a limited
26.10%; SE, 1.42) and fluoride groups (mean concentra- degree.24
tion, 35.58%) (Table II, P \0.05). The overall pattern of Resorption is usually followed by remineralization. A
distribution of calcium in the fluoride group was low dynamic exchange of minerals occurs superficially, and
superficially and quickly peaked in the dentin. this limits the extent of more minor resorptive defects.
An analysis of the total elemental concentrations Subjacent unaffected tissue provides a reservoir for dif-
demonstrated a significant difference between the fluo- fuse transition of elements.25 Minerals in the circulating
ride and no-fluoride groups (Table II) and the dentin and fluid can also react with cementum. A relative time frame
cementum comparisons (P \0.01). However, the differ- for remineralization can be extrapolated from fluorine
ences between root resorption crater tooth structure and that is incorporated into enamel within 1 hour from
normal tooth, and also between the dentin and the the microcirculation.26 When the root surface is
cementum, of the fluoride and no-fluoride groups breached, repair matrices become attached to the re-
were marginally significant (P \0.05). sorbed surface.27 After the detachment of odontoclasts,
The fluoride group overall had a significantly the cementogenic cells repopulate. This is followed by
altered cementum elemental content. These teeth had electron-dense globular accumulations indicating remi-
more F, Zn, and Na (Table II, P \0.01). Also, the neralization. There is a suggestion that fluoride is an

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Fig 5. Mean zinc (Zn) concentrations (ppm) for the no-fluoride vs fluoride groups divided according to
the location in the tooth. PIXE spectral plots (traverse concentration profile) demonstrating mineral
concentrations through a root resorption crater in each group. Left to right, cementum through pulp
(generated by the Geo-PIXE computer program).

active participant in the precipitation process and influ- mineral.29 There was a significantly increased fluorine
ences the nature of biogenic apatites.28 The role of fluo- concentration in the cementum of rats that were exper-
ride was suggested to be vital in calcium phosphate imentally exposed to fluorine (Fig 5). This might also
formation for teeth in vivo, affecting both the process demonstrate that short-term exposure, during the ex-
and characteristics of the final products. Fluoride was perimental period of 2 weeks, to fluoridated drinking
seen to accelerate the hydrolysis of acidic precursors water was already reflected in the tooth root structure.
and increase apatite growth rates via precipitation.28 This agrees with the concept that minerals in the circu-
Our study supports the proposal that cementum has lating fluid can react with cementum.30 This might have
inherent abilities to resist resorption. Furthermore, this clinical implications, since it would be the history of not
might mean that pretreatment cementum quality im- only fluoride intake, but also exposure during orthodon-
pacts the ability for tooth roots to resist damage, since tic treatment, that could influence the dynamic ex-
the outcome of root resorption reflects the original min- change of elements at the cementum interface and
eral concentration. Second, fluorine might increase subsequently root resorption.
repair (or limit destruction) by being an active partici- When comparing the root resorption crater dentin,
pant in accelerating calcium phosphate precipitation. both the fluoride and no-fluoride groups had less fluo-
Therefore, fluoride can be extrapolated as a potential rine concentration than did normal dentin. A similar pat-
preventive agent in limiting the extent of orthodonti- tern was found in the cementum. Mineral dissolution is
cally induced root resorption craters. said to occur as a result of the OIIRR process and might
Fluorine concentration in teeth has been previously have caused this general reduction in fluorine concen-
shown to reflect the environmental exposure to this tration overall.30 However, in the fluoride group, the

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concentrations of fluorine remained significantly higher can be reduced up to 50%.37 Like zinc, strontium has
than in the group not exposed to fluoridated water. been related to reducing bone resorption.38 However,
In contrast, magnesium maintained its concentration the implications of this for root resorption are unknown.
between and in the groups. This disagrees with a previous Ideally, the morphology and mineral content of OIIRR
study looking at overall mineral concentrations of cat craters should be studied in 3 dimensions without the
teeth exposed to resorptive pathology.31 Magnesium is need to prepare the samples. The use of NMP machines
present in the hydroxyapatite lattice, has been suggested must meet the condition for a flat, polished surface for
to be important in contributing to cementum minerali- reliable data to be generated. Thus, only 1 crater per
zation, and plays a role in controlling hydroxyapatite tooth could be examined. The choice of using the largest
crystal growth.32 The finding that magnesium is similar midroot crater on the surface exposed to the direction of
in both root resorption craters and normal tooth the force (mesial root surface) was intended to maximize
structure might mean that this element is able to the representation and ensure greater consistency of the
resist dissolution better than the elements that fall in samples. Midroot minerals have been suggested to
concentration. reflect on average the entire tooth root,25 whereas the
Unlike the elements that were maintained or reduced locations of craters at sites of compression have been
in concentration in root craters, zinc actually increased. shown to be associated with root resorption lesions.39
Zinc was present in higher concentrations in the deeper Such issues can be addressed with the development of
parts of the craters and in the group exposed to fluori- future technologies. Nevertheless, with current limita-
dated water (Fig 5). Like magnesium, zinc might be an tions, in this study, we demonstrated the elemental
important contributor to the ability for teeth to resist distribution and concentrations in OIIRR craters.
OIIRR. Modulation of osteoclastic resorption of bone
and dental tissue in the presence of zinc has been exam- CONCLUSIONS
ined.33 It was established that the lacunae developed on
tooth cementum in the presence of extracellular zinc 1. The midroot section of a tooth root seemed to resist
were fewer and had smaller surface areas. major alterations to its pattern of elemental
Sodium was higher in dentin and in the fluoridated distribution as a result of the OIIRR process.
group. An increase in sodium for the fluoride group 2. OIIRR craters of the group exposed to systemic
could be attributed to the sodium fluoride in their drink- fluoride had reduced lengths and depths, possibly
ing water. In contrast, the root resorption craters did not due to altered shape.
have a significantly greater concentration of sodium. 3. Systemic fluoride intake was associated with in-
This disagrees with a study that looked at overall mineral creased concentrations of fluorine and zinc, which
concentrations in root resorption lesions in cats and might have contributed to a trend toward mainte-
found that the teeth with resorption had higher concen- nance of higher calcium concentrations in these
trations of sodium.31 root resorption lesions.
In contrast to sodium, calcium concentrations were 4. The pretreatment fluoride concentration in cemen-
lower in the resorption craters but followed the same tum might have an impact on the extent and severity
pattern of distribution, with higher concentrations in of root resorption defects induced by orthodontic
dentin compared with cementum.34 Of note is the main- forces.
tenance of higher concentrations of calcium in all parts
of the teeth in the rat sample exposed to systemic fluo-
rine. This might relate to the finding that teeth exposed REFERENCES
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February 2011
Vol 139
Issue 2 American Journal of Orthodontics and Dentofacial Orthopedics