Evaluation of the use of Clinical Practice Guidelines for Managing External Apical Root Resorption by Orthodontists in Pakistan

Abstract

Background: External apical root resorption (EARR) is a common side effect of fixed orthodontic treatment, resulting from complex biological and mechanical processes involving the periodontal ligament and alveolar bone.

Objectives: To assess the current practices of orthodontists in Pakistan regarding diagnosis, risk communication, management, and follow-up of external apical root resorption using a questionnaire derived from the Dutch Clinical Practice Guideline.

Materials and Methods: A cross-sectional survey was conducted among orthodontists registered with the Pakistan Medical and Dental Council. The total study duration was three months (May–July 2025). A 13-item questionnaire based on the Dutch Clinical Practice Guideline was distributed online to orthodontists in Pakistan. Sample size estimation using G*Power (α = 0.05, power = 0.80, effect size = 0.3) indicated that a minimum of 89 participants was required but, total of 101 orthodontists responded. Data were analyzed using SPSS. Descriptive statistics were computed, and Mann-Whitney U tests compared consultants and residents.

Result: Among 101 respondents, 64 were male and 37 were female, with most having less than five years of experience. Diagnostic awareness was 67.70%, and periapical radiographs were the preferred imaging method. Risk communication was 67.5%, as the majority informed patients about general and extraction-related risks. Management response reached 72.5%, with 40.6% very often stopping forces on affected teeth and 30.7% allowing a three-month rest period. Follow-up practices were 65.8%, including 43.0% retention reviews and 33.0% coordination with general dentists showing that both consultants and residents are weak in this domain. Consultants scored higher than residents in diagnosis and treatment management domains, reflecting adherence to clinical recommendations based on expertise.

Conclusions: Orthodontists in Pakistan follow an evidence-based and a conservative approach toward the management of external apical root resorption, showing good diagnostic awareness and patient communication; however, improvement is needed in coordination with general dentists among both consultants and residents. Consultants demonstrate stronger adherence to clinical guidelines than residents, highlighting the need to strengthen postgraduate training and interdisciplinary coordination with general dentists.

Keywords: External apical root resorption, Orthodontic treatment, Clinical practice guideline, Risk communication, Periapical radiograph, Cone beam CT(CBCT)