Periodontal changes induced by fixed orthodontic therapy

Abstract

Background: Orthodontic therapy is a complex process involving a series of specialists in the dental field: the oral-maxillo-facial surgeon, the periodontologist, sometimes even the prosthetist, implantologist, or general practitioners. The injuries of the oral mucosa induced by orthodontic therapy include gingival overgrowths, traumatic lesions of the oral mucosa, different degrees of periodontal damage manifested by gingival retraction, alveolar bone resorption.

Methods: From a total of 327 subjects who came to the Dental Clinic in Craiova 74 subjects were selected, who presented with gingival overgrowth associated with fixed orthodontic therapy. Subjects' age ranged from 14 to 56 years and experienced bleeding and gingival discomfort as well as alterations in physiognomic function. None of the patients included in the study have systemic diseases and are not under medical treatment. The clinical and statistical study took place between May 2022 and December 2023. Each patient was given a personal record containing personal data as well as oral and systemic health status. The examination of the periodontal status aimed at the evaluation of the following indices: assessment of oral hygiene using the OHI-S index and the O'Leary plaque index, assessment of superficial periodontal status using the Löe/Silness gingival inflammation index, periodontometry was performed in order to determine the depth of periodontal pockets, the level of gingival insertion, and the McGaw gingival overgrowth index. OHI-S index comprises two elements: the Debris Index and the Calculus Index. The purpose of our study is to present the incidence of cases of gingival overgrowth induced by fixed orthodontic therapy and to highlight how certain irritating factors can exacerbate the symptoms of gingival overgrowth of orthodontic etiology.

Results: The majority of patients were female, aged between 30 and 55 years. Most clinically examined patients have presented with Grade II gingival hyperplasia. Factors that have exacerbated the symptoms of orthodontically induced gingival overgrowth include: incorrectly adapted prosthetic restorations, unpolished massive coronal fillings, root remnants, bacterial plaque, and tartar. Clinical examination of the oral cavity revealed the presence of gingival inflammation (localized or generalized), simple or complicated, treated and untreated odontal lesions, and coronal fillings made of light-curing composite material of significant size, being unfinished and unpolished, sometimes with sharp edges directly injuring the adjacent gingival mucosa, marginally incorrectly adapted prosthetic works. In the case of child and adolescent patients, significant amounts of bacterial plaque and tartar buildup were observed. In most of the cases examined, it was observed that the gingival overgrowth had a firm consistency, pinkish-reddish colour and gingival bleeding was evident during probing.

Conclusion: Gingival overgrowth caused by orthodontics induces a number of important periodontal changes. It is worth noting that gingival overgrowth induced by fixed orthodontic therapy, in most of the cases examined, co-exists with favouring factors that amplify its severity. In our study, the favouring factors were bacterial plaque and calculus accumulation, sharp-edged odontal lesions, marginally ill-fitting prosthetic restorations or massive unfinished crown fillings. Therefore, removing the contributing factors can help improve the symptoms but also to reverse the inflammatory phenomena.

Keywords: fixed orthodontic appliances; gingival overgrowth; orthodontic treatment.

Figure 1

Clinical aspects of gingival overgrowth induced by fixed orthodontic therapy.

Figure 2

A. Distribution of cases by age; B. Distribution of cases according to the place of origin; C. Distribution of cases by gender.

Figure 3

Distribution of cases by smokers/non-smokers.

Figure 4

A. Distribution of cases by degree of gingival overgrowth; B. Distribution of local causes that exacerbated gingival overgrowth induced by fixed orthodontic therapy.

Figure 5

A. Distribution of cases by oral hygiene index (OHI-S); B. Distribution of cases by Löe/Silness gingival index.

Figure 6

A. Distribution of cases by OHI-S and cause of gingival overgrowth; B. Distribution of cases by McGraw index of gingival overgrowth in patients with good oral hygiene.

Figure 7

A. Distribution of cases according to McGraw index of gingival overgrowth in patients with satisfactory oral hygiene; B. Distribution of cases by McGraw index of gingival overgrowth in patients with poor oral hygiene.

Figure 8

A. Distribution of cases by O’Leary bacterial plaque index; B. Distribution of cases by OHI-S and Löe/Silness gingival index.

Figure 9

A. Distribution of cases by OHI-S and gender; B. Distribution of smoking and non-smoking patients by OHI-S.

Figure 10

A. Distribution of cases by OHI-S and age; B. Distribution of cases by O’Leary Bacterial Plaque Index and Löe/Silness Gingival Index.

Figure 11

A. Distribution of cases by McGraw Index for mild gingivitis; B. Distribution of cases by McGraw Index for moderate gingivitis; C. Distribution of cases by McGraw GO Index for severe gingivitis.

Figure 12

Distribution of cases according to Papillary Bleeding Index at survey and cause of GO.