Risk factors for gingival recessions after orthodontic treatment: a systematic review

Abstract

Summary Background/objectives To systematically review the available evidence concerning the risk factors for gingival recessions (GR) after orthodontic treatment (OT). Data collection and analysis Data was obtained and collected by systematically searching 3 data bases: Pubmed, EMBASE, and Web of Science until 20 April 2023. Controlled trials, cohort, case-control or cross-sectional studies describing GR or clinical crown height (CCH) after OT were included. The risk of bias in the selected studies was evaluated with the methodological index for non-randomized studies. Results Forty-eight articles were included, investigating the following six risk factors for GR: 1. OT (n = 21), 2. Type of orthodontic intervention (n = 32), 3. Patient’s baseline occlusal and skeletal characteristics (n = 14), 4. Mucogingival characteristics (n = 10), 5. Oral hygiene (n = 9), and 6. Others (n = 12). Significantly higher prevalence, severity and extent of GR were found in orthodontic patients by 10/15, 4/10, and 2/2 articles respectively. 10/16 articles reported significantly more GR and increased CCH in patients where orthodontic incisor proclination was performed. The evidence surrounding maxillary expansion and orthodontic retention was too heterogeneous to allow for? definitive conclusions. Pre-treatment angle classification, ANB, overjet, overbite, arch width and mandibular divergence were found not to be associated with GR (9/14), while pre-treatment crossbite, symphysis height and width were (5/7 studies). A thin gingival biotype, presence of previous GR, baseline width of keratinized gingiva and facial gingival margin thickness were correlated with increased risk of GR after OT by nine articles, while pocket depth was not. Oral hygiene, sex, treatment duration, and oral piercings were found not to be linked with GR in orthodontic patients, while GR was reported to increase with age in orthodontic patients by 50 per cent of the articles investigating this factor. The mean risk of bias for comparative and not comparative studies was 14.17/24 and 9.12/16. Limitations The selected studies were quite heterogeneous regarding study settings, variables reported and included very limited sample sizes. Conclusion Although studies regarding the risk factors for GR are relatively abundant, they are very heterogeneous concerning design, studied factors, methodology and reporting, which often leads to contradictory results. Uniform reporting guidelines are urgently needed for future research. PROSPERO Registration CRD42020181661. Funding This research received no funding.

Orthodontic Correction of an Anterior Open Bite with Periodontally Compromised Upper Incisors Using Miniscrews

“…In periodontally involved patients, dental expansion and advancement may cause recession and dehiscence and will worsen a preexisting gingival recession, especially in patients with a thin gingival biotype [40]. For such patients, the need for, and timing of, a mucogingival graft with/without phenotype modification need to be assessed by a periodontist [40]. In our case, the planned and executed teeth movement along with her normal gingival biotype did not warrant any surgical periodontal intervention.…”

“…Pre-orthodontic periodontal treatment for our patient included the use of desensitizing gel and fluoride application only. In periodontally involved patients, dental expansion and advancement may cause recession and dehiscence and will worsen a preexisting gingival recession, especially in patients with a thin gingival biotype [40]. For such patients, the need for, and timing of, a mucogingival graft with/without phenotype modification need to be assessed by a periodontist [40].…”

“…Therefore, guidelines need to be strictly implemented to enhance the possibility of achieving reliable, predictable and stable treatment outcomes. These guidelines include the establishment of periodontal health prior to orthodontic treatment and maintenance of proper periodontal health throughout orthodontic treatment [16,20,40,41]. Orthodontic treatment should be characterized by light, targeted and controlled forces in non-inflammatory conditions [29].…”

Treatment of Gingival Recession and Root Coverage Outcomes Using Fascia Lata Allograft: A Case Report with Two Years of Follow‐Up

“…“In several comparative studies, investigators have suggested that FL allografts and acellular dermal matrix serve as suitable alternatives to address the limitations associated with subepithelial connective tissue grafts, particularly in reducing postoperative morbidity and overcoming limitations related to available graft material [ 15 , 23 , 27 , 28 ]. Bednarz et al recognized the benefits of FL in patients unwilling to undergo surgery, thus reducing the need for extensive surgical procedures, especially in cases where adequate autologous graft material is limited [ 15 ].…”

“…The second risk factor was oral hygiene, which is directly related to the etiology of gingivitis and periodontitis, resulting in the importance of orthodontic-periodontic collaboration for interdisciplinary treatment to modify the gingival phenotype and control the etiology of periodontal disease with previous periodontal treatment before orthodontic treatment. In this case report, the patient had orthodontic treatment; therefore, orthodontic treatment is important for the treatment of gingival recession because properly aligning the teeth can redistribute the masticatory forces, reducing the pressure on the gum and preventing recession [ 28 , 29 ].…”