## 4 Discussion
On visualizing the root resorption three-dimensionally in this study, it was observed that the palatal surfaces of the root were affected most severely at 37.6%, followed by the distal surface at 14.7%; the least affected was the mesiobuccal surface at 1.8%. [PERSON] et al. also reported maximum involvement of the palatal surface [31], but [PERSON] and [PERSON] found that the distopalatal surface was most affected with root resorption involving an impacted maxillary canine [23]. The apical one-third of the root is more prone to come in close contact with the crown of an impacted maxillary canine. Moreover, the crown of the erupting maxillary canine is directed palatally with respect to the primary canine and the developing first premolar, implying the path of eruption in the palatal direction. This could be a plausible explanation of maximum root resorption being associated with the apical one-third level and the palatal surface of the roots of the tooth involved with maxillary canine impaction. In this study, we have used the criteria suggested by [PERSON] and [PERSON] in 2000 to grade the severity of root resorption [23]. Since CBCT cannot detect structures with <300 \(\upmu\)m, a grade 1 severity level of the classification has not been considered [28]. The thickness of the cementum is 10-50 \(\upmu\)m, and its evaluation is more suitable by histological methods. In this study, 55% of affected teeth have shown slight resorption, 10% moderate, and 35% severe resorption with pulp exposure. [PERSON] and [PERSON] reported 60% severe and 9% moderate root resorption [8]. [PERSON] reported 35% slight and 4% severe root resorption [20]. Severe root resorption has been reported in the literature at 8.1% by [PERSON] et al. [5], 8.1% by [PERSON] [32], 11.9% by [PERSON] et al. [30], 12.7% by [PERSON] et al. [13], 19.6% by [PERSON] et al. [14] and 30% by [PERSON] et al. [31]. This study's findings vary with other studies due to the high variability in the classification and categorization of root resorption severity. Nevertheless, any root resorption makes the tooth vulnerable to irreversible pulp damage and increased mobility. This, in turn, can affect the long-term prognosis and the functional benefits of the tooth. This study also found that females in the Saudi population with bilateral canine impaction were more likely to be affected by root resorption. This can be attributed to the fact that more females show up for orthodontic treatment and are thereby diagnosed with canine impaction. Moreover, sexual dimorphism and genetic and hormonal factors play a significant role in such outcomes. However, the role of bilateral impactions in increasing the severity of impaction needs to be further investigated. [PERSON] et al. [13] and [PERSON] et al. [33] found a significant association between gender (female) and root resorption. Other investigators have found no association between age, gender, type of impaction, side of impaction, or the number of teeth resorbed [34; 35]. Further studies with better CBCT machines, different voxel resolutions, evaluation of potential risk factors, and a large sample population can be conducted in the near future. Clinical management of impacted canines and associated root resorption can be complex and frustrating for the orthodontist and their team. When evaluating a patient for the first time, after thorough clinical and radiological investigations, the patient should be informed about the severity of root resorption. A mild to moderate degree of root resorption can only be dealt with using an endodontic treatment. Severe cases of root resorption might require the extraction of the affected tooth instead of the premolar to bring the impacted canine in occlusion. These factors should be considered before commencing the treatment, and the patient should be made aware of the risks and benefits associated with it. If the patient declines the orthodontic treatment, they should be advised for regular review to evaluate the effect of root resorption.