Gingival recessions of lower incisors after proclination by orthodontics alone or in combination with anterior mandibular alveolar process distraction osteogenesis

Abstract

Objectives: The aim of this study was to longitudinally compare periodontal conditions in consecutive patients who had orthodontic treatment with proclination of lower incisors either by orthodontics alone or in combination with anterior mandibular alveolar process distraction osteogenesis (DO).

Materials and methods: Nineteen patients had orthodontic treatment with DO, 18 with extraction of lower premolars (Ex), and 18 without extractions (Nonex). Lateral cephalograms were used to evaluate lower incisor proclination, while study casts and intraoral photographs were used to evaluate labial and lingual gingival recessions before (T1) and at an average of 4.5 years (T2) after treatment.

Results: No differences in labial recessions on lower incisors were present between the patient groups despite greater lower incisor proclination in the Nonex and DO groups. The Ex group showed no new development of lingual recessions in contrast to the Nonex (eight sites; two subjects) and DO groups (seven sites; three subjects). Severe lingual recessions (increased ≥1 mm) were more present in the Nonex group (five sites; two subjects) compared to the Ex group (no sites). Proclination of lower incisors of 10° or more either by orthodontic tooth movement or displacement of the whole alveolar process increased the risk of lingual gingival recessions 17 times. This was not the case with labial gingival recessions.

Conclusions: Orthodontic or surgical proclination of lower incisors beyond a 10° limit increases the risk of inducing lingual gingival recessions.

Clinical relevance: During orthodontic treatment, with or without DO, one should avoid proclining lower incisors more than 10° to decrease the risk of gingival recessions.

Keywords: Alveolar process; Distraction osteogenesis; Gingival recession; Orthodontics; Tooth movement.