Recent advances in the mechanisms, management, and nanomaterial-based strategies for root resorption

Abstract Root resorption (RR) involves the loss of mineralized root tissues and may compromise tooth integrity and long-term retention. Internal and external RR arise in different pulpal and periodontal microenvironments and require etiology-specific management. Although conventional treatment can arrest many lesions, persistent infection, complex resorptive defects, and limited control of inflammatory or clastic-cell activity remain therapeutic challenges. This narrative review summarizes RR classification, clinical management, and key mechanisms, including protective-tissue disruption, receptor activator of nuclear factor-κB ligand (RANKL)-dependent clastic-cell activation, inflammatory signaling, and mechanotransduction, and evaluates nanomaterial-based approaches by function. Potential benefits are weighed against cytotoxicity, local retention, effects on physiological remodeling, and the risk of inappropriate bone formation or ankylosis. Most current evidence remains preclinical, and substantial challenges related to efficacy, safety, targeting, manufacturing, and clinical validation must be addressed before clinical translation. Whether nanomaterials developed for bone resorption can be adapted to promote cementum-like repair of the resorbed root surface remains a hypothesis requiring RR- and cementum-specific validation.