Introduction: The orthodontic forces applied to the teeth act in the same way on the bone and dental cement, which are separated by the periodontal membrane. If there were no difference in the biological behavior of these structures to the applied exogenous force, they would be resorbed equally. Since cement is more resistant to resorption compared to bone, the applied forces usually cause bone degradation, which leads to the displacement of the tooth and the preservation of the morphological and functional characteristics of the tooth root. A variety of factors, still insufficiently studied, can also cause resorption of dental root tissues—cement and dentin. The process is referred to as pathological root resorption and is an undesirable, irreversible side effect of orthodontic treatment. Pathological root resorption can significantly compromise the long-term functional stability of the affected teeth, as well as continue after the removal of the appliances or during retention. This necessitates the need for early diagnosis and monitoring of this undesirable process.
Aim: The aim of this review article is to present oral biomarkers linked to root resorption during orthodontic treatment with a potential for an early detection and monitoring of undesired and irreversible destruction of root structures, offering a noninvasive alternative to radiographic techniques.
Methods: A literature search was conducted in major databases—PubMed, ResearchGate, Thieme and Elsevier, along with a search of relevant articles with the following keywords: biomarkers, gingival crevicular fluid, orthodontic tooth movement, apical resorption, prognosis, with emphasis on publications in the last 10 years (2015–2025).
Abdul Wahab RM, Abu Kasim N, Senafi S, Jemain AA, Zainol Abidin IZ, Shahidan MA, Zainal Ariffin SH. Enzyme activity profiles and ELISA analysis of biomarkers from human saliva and gingival crevicular fluid during orthodontic tooth movement using self-ligating brackets. Oral Health Dent Manag 2014;13(2):194-199
Adel M Alhadlaq . Biomarkers of Orthodontic Tooth Movement in Gingival Crevicular Fluid: A Systematic Review. The journal of contemporary dental practice, July 2015; 16(7):578-587. 10.5005/jp-journals-10024-1725
Alnazeh AA, Kamran MA, Aseeri Y, Alrwuili MR, Aljabab MA, Baig EA, Hameed MS. Levels of Inflammatory and Bone Metabolic Markers in the Gingival Crevicular Fluid of Individuals Undergoing Fixed Orthodontic Treatment in Comparison to Those Utilizing Invisalign. Medicina (Kaunas). 2023 Dec 1;59(12):2107. doi: 10.3390/medicina59122107. PMID: 38138210; PMCID: PMC10744492.
Balducci L, Ramachandran A, Hao J, Narayanan K, Evans C, George A. Biological markers for evaluation of root resorption. Arch Oral Biol. 2007;52(3):203–8. doi: 10.1016/j.archoralbio.2006.08.018.
Bildt MM, Bloemen M, Kuijpers-Jagtman AM, Von den Hoff JW. Matrix metalloproteinases and tissue inhibitors of metalloproteinases in gingival crevicular fluid during orthodontic tooth movement. Eur J Orthod 2009;31(5):529-535.
Conchalves A. et al. Biological alterations associated with the orthodontic treatment with conventional appliances and aligners: A systematic review of clinical and preclinical evidence. Heliyon. A cell Press journal. Volume 10, Issue 12 June 30, 2024
Consolaro A. Extensive orthodontically induced dental resorption: What to do? Dental press Journal of Orthodontics 25(2):18-23 March 2020https://doi.org/10.1590/2177-6709.25.2.018-023.oin
Grant M, Wilson J, Rock P, Chapple I. Induction of cytokines, MMP9, TIMPs, RANKL and OPG during orthodontic tooth movement. Eur J Orthod 2013;35(5):644-651.
Inchingolo, F.; Inchingolo, A.M.; Malcangi, G.; Ferrante, L.; Trilli, I.; Di Noia, A.; Piras, F.; Mancini, A.; Palermo, A.; Inchingolo, A.D.; et al. The Interaction of Cytokines in Orthodontics: A Systematic Review. Appl. Sci. 2024, 14, 5133. https://doi.org/10.3390/app14125133
Kaczor-Urbanowicz KE, Deutsch O, Zaks B, Krief G, Chaushu S, Palmon A. Identification of salivary protein biomarkers for orthodontically induced inflammatory root resorption. Proteomics Clin Appl. 2017;11(9-10) doi: 10.1002/prca.201600119.
Kapoor P, Chowdhry A, Bagga DK, Bhargava D. Biomarkers in External Apical Root Resorption: An Evidence-based Scoping Review in Biofluids. Rambam Maimonides Med J. 2022 Oct 27;13(4):e0027. doi: 10.5041/RMMJ.10482. PMID: 36112165; PMCID: PMC9622392.
Krishnan V, Davidovitch Z. Cellular, molecular, and tissuelevel reactions to orthodontic force. Am J Orthod Dentofacial Orthop 2006;129(4):469.
Kuruthukulangara J, Eliades T, Koletsi D. Salivary and gingival crevicular fluid (GCF) protein biomarkers as proxies of root resorption following orthodontic tooth movement. A systematic review. J Clin Exp Dent. 2025 May 1;17(5):e576-e586. doi: 10.4317/jced.62494. PMID: 40485969; PMCID: PMC12142365.
Levander E, Malmgren O. Evaluation of the risk of root resorptionduring orthodontic treatment: a study of upper incisors. Eur J Orthod.1988;10(1):30-38
Malmgren O, Goldson L, Hill C, Orwin A, Petrini L, Lundberg M. Rootresorption after orthodontic treatment of traumatized teeth. Am J Orthod.1982 Dec;82(6):487-91.3.
Mandour KAA, Tawfeek MA, Montasser MA. Expression of biological markers in gingival crevicular fluid of teeth with orthodontically induced root resorption. J Orofac Orthop. 2021;82(5):313–320. doi: 10.1007/s00056-020-00267-x.
Ramos Sde P, Ortolan GO, Dos Santos LM, Tobouti PL, Hidalgo MM, Consolaro A. Anti-dentine antibodies with root resorption during orthodontic treatment. Eur J Orthod. 2011;33(5):584–91. doi: 10.1093/ejo/cjq145.
Vieira GM. Protein biomarkers of external root resorption: a new protein extraction protocol. Are we going in the right direction? Dental Press J Orthod. 2014;19(6):62–9. doi: 10.1590/2176-9451.19.6.062-069.oar.
Yashin D, Dalci O, Almuzian M, Chiu J, Ahuja R, Goel A. Markers in blood and saliva for prediction of orthodontically induced inflammatory root resorption: a retrospective case controlled-study. Prog Orthod. 2017;18(1):27. doi: 10.1186/s40510-017-0176-y.
Zhou J, Hu H, Huang R. A pilot study of the metabolomic profiles of saliva from female orthodontic patients with external apical root resorption. Clin Chim Acta. 2018;478:188–193. doi: 10.1016/j.cca.2017.12.046.
