Biofilm and Orthodontic Therapy.

Dental biofilms can cause major oral diseases like gingivitis, periodontitis, and caries. Orthodontic appliances promote supra- and subgingival biofilm accumulation, alter the oral microbiome, and hamper oral hygiene. Orthodontic treatment can be associated with adverse effects, such as enamel decalcification, gingivitis, and periodontal disease. The aim of this review is to summarize the changes in supra- and subgingival biofilm and periodontal tissues during and after orthodontic treatment. Studies have reported elevated levels of Streptococcus mutans and periodontopathogenic bacteria in patients undergoing orthodontic treatment. In general, the microbial changes and periodontal parameters decreased to pretreatment levels after appliance removal. Nevertheless, some adverse effects associated with orthodontic treatment are not reversible, such as enamel decalcifications caused by metabolic products of high levels of cariogenic bacteria. The evidence suggests that the roughness and constituents of the orthodontic materials influence the bacterial colonization. Therefore, several antibacterial orthodontic bonding systems, which show antibacterial effects in vitro, have been developed. The importance of adequate oral hygiene should be emphasized to all orthodontic patients. They should be frequently reminded and motivated to obtain a good oral hygiene. The evidence from the current literature suggests the safest way for orthodontic treatment in periodontally diseased patients may be after successful completion of the periodontal therapy. However, the exact time point needs to be better clarified in future studies.