When the Cyst is Driving the Resorption: Case Report Dr. Niloufar Ebrahimian is a general dentist practising in Toronto, with clinical interests in orthodontics, restorative dentistry and interdisciplinary treatment planning. Abstract An 11-year-old female patient underwent comprehensive orthodontic treatment for a severe Class II, division 1 malocclusion. During treatment, significant root resorption developed alongside bilateral periradicular radiolucencies associated with impacted mandibular third molars, confirmed histopathologically as an inflamed dentigerous cyst and an enlarged dental follicle. The most severe resorption affected the lower second molars, which were never bracketed, pointing to cyst-associated inflammation rather than orthodontic mechanics as the primary driver. Surgical management included extraction of all third molars, cyst enucleation and bone regeneration. Active treatment was concluded early, accepting a residual Class II relationship to preserve tooth vitality. This case underscored the importance of radiographic vigilance, early surgical referral and willingness to modify treatment goals when biology complicates mechanics. Introduction Class II malocclusions are among the most common orthodontic presentations, typically managed with functional appliances and fixed mechanics over extended treatment periods. Most cases progress without significant biological complications. Occasionally, however, underlying pathology surfaces mid-treatment and entirely reframes the clinical picture. External apical root resorption (EARR) is a known risk of orthodontic therapy. What is less routinely considered is that odontogenic lesions, particularly dentigerous cysts associated with impacted third molars, can independently drive resorption through chronic inflammation and pressure, independent of orthodontic forces. When both are present, distinguishing the contribution of each is both diagnostically and clinically important. This case illustrates that intersection: a growing patient whose resorption pattern pointed away from her orthodontic appliances and toward a bilateral cystic process that required surgical management and ultimately altered her treatment outcome. 30 | 2026 | Issue 4
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