Orthodontic Fixed Appliance and Periodontal Status: An Updated Systematic Review

Abstract

Background:Periodontal implications of orthodontic therapy are frequent, gingival and periodontal conditions need to be evaluated for every appointment. Several studies have analyzed the effects of fixed appliance on periodontal health.Objective:To evaluate whether there is updated scientific evidence on the relationship between fixed orthodontic therapy and periodontal health.Methods:A literature search was performed using the Pubmed and Cochrane databases and manual search; the search was carried out using the keywords “orthodontic” and “periodontal”. Articles published only in the English language from January 1997 to April 2017 were included. The inclusion criteria were: RCTs, cohort studies, cross-sectional studies and case-control studies only in English language; only studies on humans, with a minimum sample size of 20 patients and no restriction in terms of patient ages; orthodontic fixed appliances placed into the buccal tooth surface; standardization and training in oral hygiene; Periodontal Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Pocket Probing Depth (PPD), at least at baseline (before appliance was placed) and after follow up (with a minimum period of 3 months). The exclusion criteria were as follows: absence of baseline data before fixed appliances was placed; patients with systemic diseases, periodontal disease or craniofacial anomalies; removable appliances or orthodontic appliance on the lingual dental surface; and no standardization or training in oral hygiene.Studies were selected by abstract and title; then, inclusion and exclusion criteria were applied. The studies that satisfied the inclusion criteria were evaluated and classified as having low, moderate or high methodology quality.Results:Fifty-five records were reviewed on the basis of title and abstract. After full-text reading, 47 full texts were excluded, and 3 articles were classified as having low methodological quality and 5 as having moderate methodological quality.Conclusions:The present systematic analysis suggests that there is moderate scientific evidence that a fixed appliance influences periodontal status; no article reported a high score.

Periodontal status in long-term orthodontic retention patients up to 10 years after treatment – a cross-sectional study

“…Orthodontic treatment aims to establish good functional and aesthetic occlusion and to ensure long-term preservation of oral health [1,2]. Correcting crowded teeth enables patients to better perform oral hygiene and reduces occlusal trauma [1]. However, fixed orthodontic appliances might compromise adequate oral hygiene by increasing food residues and bacterial plaque retention [3].…”

“…None of the studies were adjusted for possible confounding factors. A recent systematic review [1] concluded that in short term follow-ups, orthodontic appliances seem to increase general plaque accumulation and gingivitis. After long-term follow-up, however, gingival status and periodontal values trend towards normalisation [13].…”

A Case of Mandibular Prognathism with Generalized Aggressive Periodontitis and Crowding

“…Plaque control and SRP performed before initiating pre-surgical orthodontic treatment may have temporarily suppressed inflamma- tion. However, multi-bracket devices make it difficult to clean tooth surfaces effectively 7,19) , and self-maintenance proved inadequate, with the periodontitis worsening throughout the period of active orthodontic therapy. This suggests that regular periodontal maintenance is essential during active orthodontic therapy 12,13) .…”

In vitro Evaluation of Structural Factors Favouring Bacterial Adhesion on Orthodontic Adhesive Resins

“…In any case, these levels of MS, return to normal after a complete removal of the orthodontic device. 4,5,6,7,8 B.S. Lim reported that the orthodontic adhesives have a greater ability to retain cariogenic streptococci in the material which constitutes the bracket.…”