Receiver Operating Characteristic Evaluation of Cementum Protein-1, Dentin Sialophosphoprotein, and Matrix Metalloproteinase-9 in the Diagnostic Accuracy of Orthodontic Root Resorption Severity

Objectives Orthodontic root resorption is a common, unavoidable, and undesirable side effect of orthodontic treatment, particularly during anterior tooth retraction and intrusion. Early identification of patients at risk can guide treatment planning and reduce complications. Biomarkers such as cementum protein-1 (CEMP-1), dentin sialophosphoprotein (DSPP), and matrix metalloproteinase-9 (MMP-9) have been proposed as potential diagnostic tools for assessing root resorption risk. The objectives of this study were to evaluate and compare the diagnostic accuracy of CEMP-1, DSPP, and MMP-9 in predicting severe orthodontically-induced root resorption using receiver operating characteristic (ROC) analysis. Materials and Methods This prospective observational study involved forty patients undergoing fixed orthodontic treatment with either retraction alone (Group 1) or combined retraction and intrusion using skeletal anchorage (Group 2). Gingival crevicular fluid (GCF) samples were collected and analyzed for CEMP-1, DSPP, and MMP-9 levels at designated time points. Root resorption severity was assessed radiographically and graded. ROC curve analysis was performed to determine the area under the curve (AUC), sensitivity, specificity, and diagnostic capability of each biomarker in identifying severe (grading ≥2) root resorption. Results CEMP-1 demonstrated the highest diagnostic accuracy with an AUC of 0.757, followed by DSPP with an AUC of 0.729. MMP-9 showed no significant predictive ability (AUC = 0.583). Conclusion Among the three biomarkers tested, CEMP-1 demonstrated the most promising diagnostic potential for identifying patients at risk for severe root resorption. Incorporating biochemical monitoring with traditional radiographic assessment may enhance early detection and allow for more personalized orthodontic interventions.