Assessment of Effect of Fixed Orthodontic Treatment on Gingival Health: An Observational Study.

BACKGROUND: Prime components of fixed orthodontic treatments decrease the self-cleansing ability of the tongue and the cheeks leading to an increase in production of bacterial plaque. Hence, the present study was undertaken for assessing the effect of fixed orthodontic treatment on gingival health.
MATERIALS AND METHODS: A total of 120 patients who were scheduled orthodontic treatment were enrolled. Complete data records of all the patients were recorded. Intra- and extraoral radiographs were obtained and photographic records were noted in separate pro forma. Complete intraoral examination of all the patients was carried out for recording visible plaque, any inflammation (visible clinically), and gingival recession. Based on the assessment of gingival texture and capillary transparency, analysis of gingival biotype was done. Follow-up records were assessed.
RESULTS: The mean visible plaque value before treatment and after treatment was found to be 3.11 and 5.81, respectively. The mean visible inflammation value before treatment and after treatment was found to be 2.89 and 15.43, respectively. The mean gingival recession score value before treatment and after treatment was found to be 0.19 and 0.383, respectively. A significant increase in the visible plaque value, visible inflammation value, and gingival recession score was observed posttreatment. While comparing the gingival biotype, it was seen that in both the maxillary and mandibular arches, there was an increase in the thick gingival biotype while there was a decrease in thin maxillary biotype.
CONCLUSION: There is a significant increase in plaque accumulation, inflammation, and gingival recession following fixed orthodontic treatment. Hence, during the course of orthodontic treatment, regular oral prophylaxis should be done. Copyright:

INTRODUCTION

Restorative and periodontal needs may be the requirements of an adult patient receiving orthodontic treatment, and hence, it necessitates a multidisciplinary interaction for better treatment outcome. The role of an orthodontist may become of prime importance in patients suffering from pathologic tooth migrations and other related abnormalities. Orthodontic treatment can initiate improvement in dental esthetics by multiple means such as correcting the erroneous position of jaws, correcting the abnormalities of teeth, and also by facilitating an environment for better gingival health.[123]

It must be emphasized that the prime components of fixed orthodontic treatments decrease the self-cleansing ability of the tongue and the cheeks leading to an increase in production of bacterial plaque and thereby changing the qualitative and quantitative profile of the microbial flora. This change in the bacterial flora may just be a transitory effect and depends entirely on the status of oral hygiene maintenance. A reduction in the occlusal trauma and ease of plaque removal may be facilitated by aligning the teeth.[456]

The optimum balance between the status of health and level of disease in periodontics can only be established by proper plaque control, and this requires adequate inputs both from the patient's point of view and professional cleaning. Gingival tissues may show inflammatory changes as a consequence of supragingival plaque deposits.[345] Hence, the present study was undertaken for assessing the effect of fixed orthodontic treatment on gingival health.

MATERIALS AND METHODS

The present research was planned with the aim of assessing the impact of fixed orthodontic treatment on gingival health. A total of 120 patients who were scheduled orthodontic treatment were enrolled. Complete data records of all the patients were recorded. Intra- and extraoral radiographs were obtained and photographic records were noted in separate pro forma. Complete intraoral examination of all the patients was carried out for recording visible plaque, any inflammation (visible clinically), and gingival recession. Classification of gingival recession (if present) was done according to criteria given by Miller.[6] Based on the assessment of gingival texture and capillary transparency, analysis of gingival biotype was done.[7] Follow-up records were assessed. Analysis of all the results was done by SPSS software version 16.0 (IBM, Armonk, New York).

RESULTS

In the present analysis, a total of 120 patients sculled to undergo fixed orthodontic treatment were included. Among these 120 patients, dental extractions were carried out in 48 patients, while in the remaining 72 cases, all the fixed orthodontic treatment procedures were carried out without dental extractions. Majority of the patients of the present study were females as shown in Table 1. The mean visible plaque value before treatment and after treatment was found to be 3.11 and 5.81, respectively. The mean visible inflammation value before treatment and after treatment was found to be 2.89 and 15.43, respectively as shown in Table 2. The mean gingival recession score value before treatment and after treatment was found to be 0.19 and 0.383, respectively. A significant increase in the visible plaque value, visible inflammation value, and gingival recession score was observed posttreatment. In the present study, while comparing the gingival biotype, it was seen that in both the maxillary and mandibular arches, there was an increase in the thick gingival biotype while there was a decrease in thin maxillary biotype as shown in Table 3.

Table 1

Demographic data

Parameter	Fixed orthodontic treatment (n=120)
	With dental extraction (n=48)	Without dental extraction (n=72)
Mean age (years)	15.6	14.2
Gender
Males	22	25
Females	26	47
Mean treatment time (months)	29.1	25.8

Table 2

Comparison of plaque, inflammation, and gingival recession values

Variable	Fixed orthodontic treatment	P
Visible plaque value
Before treatment	3.11	0.002*
After treatment	5.81
Visible inflammation value
Before treatment	2.89	0.017*
After treatment	15.46
Gingival recession score
Before treatment	0.19	0.000*
After treatment	0.38

*Significant

Table 3

Comparison of gingival biotype

Gingival biotype score	Number of patients (%)
Maxilla
Thin
Before treatment	45 (37.5)
; ; After treatment	39 (32.5)
; Thick
Before treatment	75 (62.5)
After treatment	81 (67.5)
Mandible
Thin
Before treatment	79 (65.83)
After treatment	77 (64.17)
Thick
Before treatment	41 (34.17)
After treatment	43 (35.83)

DISCUSSION

Orthodontic treatment not only corrects the abnormal alignment dentition but also helps to correct the dentoskeletal relationship. This in turn leads to improvement in mastication, speech, and facial esthetics. These further results in a better quality of life. Certain risks and unwanted results accompany orthodontic therapy just similar to any other treatment modality. In contrast with surgical and nonsurgical modalities, the risk and complication linked to orthodontic treatment are significantly lower.[567] However, both local and systemic complications are frequently associated with orthodontic treatment. A few of them may be in the form of discoloration of teeth/tooth, decalcifications, resorption of root, complications with the periodontal structures supporting the tooth, psychological disturbances, etc., One of the most common complications of orthodontic therapy may be in the form of gingival enlargement (GE) which may predispose to the development of pseudopockets and loss of attachment. These things may severely affect the quality of the patient's life if the anterior region is involved.[678] Hence, the present study was undertaken for assessing the effect of fixed orthodontic treatment on gingival health.

In the present analysis, a total of 120 patients sculled to undergo fixed orthodontic treatment were included. The mean visible plaque value before treatment and after treatment was found to be 3.11 and 5.81, respectively. The mean visible inflammation value before treatment and after treatment was found to be 2.89 and 15.43, respectively. The mean gingival recession score value before treatment and after treatment was found to be 0.19 and 0.383, respectively. Our results were in concordance with the results obtained by previous authors who also reported similar findings. Boke et al. carried out a study to assess the relationship between fixed orthodontic therapy and the health of the gingiva. One hundred and seventy-seven girls and 74 boys were incorporated in this study making a total sample size of 251 patients. It was observed that whether the patients received functional appliances therapy before or after the treatment, no significant differences were observed. A definite and significant increase in plaque buildup, gingival inflammation, and recession of gingival was observed after fixed orthodontic treatment. However, no significant differences were observed with the gingival biotype. Gingival recession was most commonly observed with canines. Keeping in mind the importance of the association between the health of gingiva and orthodontic treatment, a thorough co-operation between the patient, orthodontist, and the periodontist is of utmost importance.[8]

A high risk of caries development and hampered oral hygiene as a consequence of fixed appliances has been assessed by some authors. There may be alterations in the subgingival microbial flora owing to the difficulty in maintaining oral hygiene and subsequent development of plaque due to these appliances. These factors may eventually result in colonization of pathogenic bacteria which in turn would lead to inflammation of gingiva, destruction of periodontium, and alterations in the surface of enamel.[91011]

In the present study, a significant increase in the visible plaque value, visible inflammation value, and gingival recession score was observed posttreatment. Cerroni et al. evaluated the presence on any updated scientific proof establishing the relationship between fixed orthodontic therapy and periodontal health. PubMed and Cochrane databases were searched, and a manual search was also carried using keywords such as “orthodontic” and “periodontal” to find any relevant literature. Only articles of English literature were included in their study. In all, a total of 55 records were studied on the criteria of title and abstract. On the basis of the search process, it was observed that there was a presence of only moderate scientific evidence pertaining to the role of fixed appliance in influencing periodontal health; a high score was not shown by even a single article.[12]

In the present study, while comparing the gingival biotype, it was seen that in both the maxillary and mandibular arches, there was an increase in the thick gingival biotype while there was a decrease in thin maxillary biotype. Şurlin et al. evaluated patients receiving orthodontic therapy who possessed good oral and dental cleanliness exhibiting GO with no evident clinical signs of gingival inflammation.[13] Zanatta et al. investigated the presence of any association between GE, periodontal conditions, and sociodemographic variables in patients receiving fixed orthodontic treatment. A total of 330 patients were evaluated who were receiving fixed orthodontic treatment for at least 6-month duration. Their samples were evaluated by a single calibrated examiner to calculate plaque and gingival indexes, probing pocket depth, clinical attachment loss, and GE. Oral interviews were carried out to investigate socioeconomic background, duration of orthodontic treatment, and use of dental floss. An increase in the prevalence of GE was attributed to the presence of gingival bleeding and excess resin around brackets. Higher levels of anterior GE in patients receiving orthodontic treatment were shown to have an association with proximal anterior gingival bleeding and excess resin around brackets.[14]

CONCLUSION

A significant increase in plaque accumulation, inflammation, and gingival recession occurs following fixed orthodontic treatment. Hence, during the course of orthodontic treatment, regular oral prophylaxis should be done.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.