The shape and size of tooth roots are genetically and phylogenetically predetermined. Clinical defects in root formation can manifest in the form of shortened roots caused by either root agenesis or root resorption. We report on a patient who came at age 7 years for space management. In the 2-year period after the initial visit, maxillary arch expansion was performed, followed by serial extractions of all 4 first premolars. A radiograph taken about 18 months after the serial extraction showed that although the crowns of all 4 second premolars had erupted fully into the arch, the roots were only about half of their normal length. With a family history of 1 sibling with a missing second premolar and the symmetrical distribution and pattern of the teeth in the 4 dental quadrants, we speculated that the arrested root development was due most likely to a genetic predisposition. Arrested root development is difficult to predict, but a potential warning sign is a family history of malformed or missing teeth. Proper, adequate, and accurate records continue to remain critical for both medical and legal purposes in the treatment of patients with potential problems in root agenesis.
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