Case Presentation Patient and Initial Findings An 11-year-old female was referred to an orthodontist in October 2022, presenting with a severe Class II, division 1 skeletal malocclusion. Diagnostic records were obtained and risks, including potential root resorption given pre-existing irregular root morphology, were discussed with the family. Treatment was accepted and commenced in November 2022 (Fig. 1). Clinical findings included mandibular retrognathia, maxillary spacing, mild mandibular crowding, deep overbite, severe overjet, midline discrepancy and narrow maxillary lateral incisors. A history of possible sleep apnea was noted. Treatment Timeline and Progress Orthodontic treatment commenced in November 2022 with a palatal expander to address the narrow maxillary arch, which was completed by March 2023. This was followed by a Crossbow Class II corrector and full fixed appliances, with an estimated total treatment duration of 36 months. Given the patient’s high caries risk and consistently poor oral hygiene, she was placed on a three-month recall schedule for hygiene and monitoring throughout the treatment period. Despite this, generalized mild gingivitis persisted and multiple bracket failures occurred, requiring reattachment on several occasions. Elastic wear compliance was inconsistent, limiting the skeletal correction achieved with the functional appliance. Complication: Bilateral Periradicular Radiolucencies In February 2024, approximately 15 months into active treatment, the patient presented at a routine recall appointment reporting a one-day history of lower right swelling and mild pain. Clinical examination revealed a large, fluctuant buccal swelling at the papilla between teeth 46 and 47, which was tender on palpation. There was no associated lymphadenopathy or systemic signs of infection (Fig. 2). Periapical radiography showed a large radiolucency on the distal root of 47. Panoramic imaging revealed an even larger radiolucency at the periapical region of 37, contiguous with the developing 38. The lower third molars displayed normal crown anatomy. CBCT was subsequently obtained, confirming bilateral periradicular lesions of significant extent. Notably, the mandibular second molars (37 and 47) which had never been bracketed, showed the most pronounced root shortening (Fig. 3 and Fig. 4). Figure 1. Pre-treatment panoramic radiograph demonstrating baseline dentition with irregular root morphology and early third molar tooth bud development bilaterally. Figure 2. Intraoral composite photograph taken at recall appointment in February 2024, demonstrating the large buccal swelling associated with 46, visible on clinical examination. Figure 3. Periapical radiograph taken at recall appointment in February 2024, showing the large periradicular radiolucency associated with 47 and significant root resorption. 31 Issue 4 | 2026 | Supporting Your Practice
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