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Unilateral short root anomaly: an incidental finding

on routine radiographic examination
Ratna Rachel Ponraj,1 Renu Sarah Samson,1 Vijayendranath Sujir Nayak,1
Melwin Mathew2

1
Orthodontics, Melaka Manipal DESCRIPTION
Medical College, Bukit Baru, A 19-­year old female patient with the report of
Melaka, Malaysia irregularly placed upper front teeth sought ortho-
2
Periodontics, Melaka Manipal
dontic treatment. Clinically,she exhibited an edge to
Medical College, Bukit Baru,
edge incisal relationship and class III malocclusion.
Melaka, Malaysia
Panoramic radiograph revealed the presence of all
Correspondence to teeth including four unerupted third molars. Teeth
Dr Ratna Rachel Ponraj; 16, 26 and 36 were restored due to dental caries.
​drratnarachelponraj@​gmail.​com The periodontal and supporting tissues were found
to be healthy. Due to suspicion of dental caries on
Accepted 14 December 2020 teeth 11 and 12, an intraoral periapical radiograph
(IOPA) was taken, which showed abnormally short
and conical root with respect to tooth 11, along Figure 2 (A) Pretreatment IOPA, (B) during treatment
with well-­defined radiopacity on the distoproximal IOPA, (C) posttreatment IOPA of tooth 11 and (D)
aspect of tooth 11 suggestive of previous resto- posttreatment panoramic radiograph showing unaltered
ration. Thereafter, a detailed radiological examina- root and bone structure after orthodontic treatment.
tion was carried out using cone beam CT (CBCT) in IOPA, intraoral periapical radiograph.
order evaluate the short-­rooted tooth,1 2 sectional
image obtained from the CBCT showed that total
length of the tooth was 14.57 mm, crown length treatment. Clinically, the crown of tooth 11 had the
from incisal tip to cementoenamel junction (CEJ) same size and morphology when compared with the
was 10.18 mm and root length from CEJ to the tip unaffected tooth 21. This is in accordance with the
of the root was 4.40 mm, (figure 1A–C). The labial literature on short root anomaly cases.3 The root is
alveolar bone concavity over tooth 11 appeared to theoretically considered short when its crown–root
be more pronounced as compared with the bone ratio is more than 1:1.4 Tooth 11 did not exhibit
morphology of the adjacent tooth 21 (figure 1D,E). any signs of mobility and tested positive for pulp
This finding suggests a possible developmental sensibility. All these findings were suggestive of
aetiology. short root anomaly (SRA).
On further evaluation, the patient stated SRA is a rare condition that is often allied with
no history of trauma or previous orthodontic genetic predisposition and higher female predilec-
tion.5–9 The aetiology of SRA is mostly characterised
as idiopathic.10 Other suggested aetiologies include
congenital or developmental origin,3 7 external
influences like trauma,11 syndromes,12–14 chemo-
therapy and radiotherapy.15 Literature affirms that
this condition always affects both the central inci-
sors.4 On the contrary, the clinical report presented
here displays a case of unilateral pattern of SRA.
Additionally, the root length was considerably short
in comparison to its bilateral counterpart. Based
on the literature search, there is a dearth in reports
exhibiting unilateral cases of SRA, which makes this
report unique.

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Limited 2021. No commercial
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permissions. Published by BMJ.

To cite: Ponraj RR, I was unaware of this condition as I had never

Figure 1 Cone beam CT image of (A) total length of
Sarah Samson R, Nayak VS, experienced any pain or distinct tooth movement
et al. BMJ Case Rep tooth 11, (B) crown length of tooth 11, (C) root length of
involving my incisor. I am relieved to know that
2021;14:e239438. tooth 11, (D) labial alveolar bone morphology of tooth 11
doi:10.1136/bcr-2020-
the tooth is stable and orthodontic therapy has
and (E) labial alveolar bone morphology of tooth 21 with
239438 improved the longevity of the tooth.
measurements.
Ponraj RR, et al. BMJ Case Rep 2021;14:e239438. doi:10.1136/bcr-2020-239438 1
 Images in…
Patient consent for publication Obtained.
Learning points
Provenance and peer review Not commissioned; externally peer reviewed.
►► Pretreatment orthodontic radiographs are extremely helpful
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VSN contributed to imaging and investigations. MM contributed in manuscript Clin Orthod 2015;49:659–65.
editing and submission. 22 Edwards DM, Roberts GJ. Short root anomaly. Br Dent J 1990;169:292–3.
23 Cutrera A, Allareddy V, Azami N, et al. Is short root anomaly (SRA) a risk factor for
Funding The authors have not declared a specific grant for this research from any increased external apical root resorption in orthodontic patients? A retrospective
funding agency in the public, commercial or not-­for-­profit sectors. case control study using cone beam computerized tomography. Orthod Craniofac Res
Competing interests None declared. 2019;22:1–6.

2 Ponraj RR, et al. BMJ Case Rep 2021;14:e239438. doi:10.1136/bcr-2020-239438

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Ponraj RR, et al. BMJ Case Rep 2021;14:e239438. doi:10.1136/bcr-2020-239438 3