Incidence of Gingival Recessions in Adolescent Orthodontic Patients Treated With Fixed Appliances and Lingual Retainer

Abstract

Aim: To evaluate risk indicators for gingival recessions (GRs) in the lower anterior teeth of orthodontic patients post treatment and during a retention period of at least 5 years, compared to non-treated controls.

Material and methods: Eighty-nine orthodontically treated patients who were recession-free before treatment were recruited. Demographic, cephalometric and occlusal records were retrieved before (T1) and after treatment (T2), and periodontal outcomes were clinically evaluated at least 5 years post retention (T3). Eighty-eight non-treated patients served as controls. Recession areas were digitally assessed and compared using t-test and chi-square tests, and a multiple linear regression model was built.

Results: In the treated group, recession incidence was 11.24% at T2 and 67.42% at T3, all classified as type 1, class A (-). Among controls, recession prevalence was 15.91%, similar to the incidence at T2, but significantly lower than at T3. GR was most common in canines (1.85 mm²; 95% CI: 2.61-7.70; p < 0.005). Regression analysis identified higher incidence of recessions in female patients and in those with thin phenotype, high angle skeletal pattern, increased final inclination of lower incisors and greater probing depth.

Conclusions: GR incidence after orthodontic treatment was comparable to controls but increased significantly post retention. Several risk indicators may predict GR occurrence.

Keywords: fixed retainer; gingival recession; orthodontic retention; orthodontic treatment; risk indicator.

FIGURE 1

Study diagram. T1, before orthodontic treatment; T2, end of orthodontic treatment and T3, at least 5 years after treatment (retention phase). For the non‐exposed group, records were obtained during their pre‐orthodontic visit. Solid background indicates clinical assessment visit.

FIGURE 2

Example of recession area delimitation in the digital dental cast, verified against the corresponding clinical photograph. 1. Superimposition of the initial and final model in the Geomagic control program. 2. Image of the initial digital dental cast. 3a. Post‐retention clinical photograph showing recession of the lower incisors. 3b. Corresponding post‐retention digital dental cast showing recession of the lower incisors. 4a. Delimitation of the recession area (black dots) on the left central incisor. 4b. Calculation of the recession area on the digital dental cast of the left central incisor.

FIGURE 3

Bar diagram illustrating the analysis of recessions for each tooth individually and their progressive increase across the three study periods. T1, before orthodontic treatment; T2, end of orthodontic treatment and T3, at least 5 years after treatment (retention phase). 33, left mandibular canine; 32, left mandibular lateral incisor; 31, left mandibular central incisor; 41, right mandibular central incisor; 42, right mandibular lateral incisor; 43, right mandibular canine.