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Alsulaimani L, Qali M. Relationship Between Cone-Beam CT Evaluation and Clinical Evaluation Before and After Orthodontic Treatment and the Rate of Gingival Recession: A Systematic Review. Cureus 2024; 16:e62536. [PMID: 39022498 PMCID: PMC11254124 DOI: 10.7759/cureus.62536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
A systematic review was conducted to investigate the correlation between gingival recession and orthodontic treatment analysis using cone-beam CT (CBCT) dental images to provide an accurate overview of the factors that can influence gingival recession. The literature was searched across several databases (PubMed, Scopus, Web of Science, etc.) for studies using CBCT dental images. Four full-text articles describe how CBCT is used to evaluate gingival recession during orthodontic treatment. The Risk-of-Bias VISualization tool was used to assess the risk of bias. In dentistry, CBCTs are used for various imaging modalities. An accurate assessment of gingival recession was made using CBCT. There were only 35 (22.5%) cases of retraction of the gingival margin after orthodontic treatment. In most studies, various types of malocclusions were treated successfully with fixed orthodontic treatment without gingival recession. Among the studies, 50% had a low risk of bias in all four areas, while one study (25%) had an unclear risk of bias. Only one study (25%) had a high risk of bias. CBCT systems have been extensively studied to show their wide application potential in preventing gingival recession. CBCT systems should be further investigated to address limitations associated with methodology and application. Dental applications of CBCT can be enriched by overcoming these challenges.
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Affiliation(s)
- Lujain Alsulaimani
- Department of General Dentistry, Al Baha Specialized Dental Hospital, Ministry of Health, Al Bahah, SAU
| | - Mohammad Qali
- Department of Surgical Sciences, College of Dentistry, Health Sciences Center, Kuwait University, Kuwait, KWT
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Cadenas de Llano-Pérula M, Castro AB, Danneels M, Schelfhout A, Teughels W, Willems G. Risk factors for gingival recessions after orthodontic treatment: a systematic review. Eur J Orthod 2023; 45:528-544. [PMID: 37432131 DOI: 10.1093/ejo/cjad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND/OBJECTIVES To systematically review the available evidence concerning the risk factors for gingival recessions (GR) after orthodontic treatment (OT). DATA COLLECTION AND ANALYSIS Data was obtained and collected by systematically searching 3 data bases: Pubmed, EMBASE, and Web of Science until 20 April 2023. Controlled trials, cohort, case-control or cross-sectional studies describing GR or clinical crown height (CCH) after OT were included. The risk of bias in the selected studies was evaluated with the methodological index for non-randomized studies. RESULTS Forty-eight articles were included, investigating the following six risk factors for GR: 1. OT (n = 21), 2. Type of orthodontic intervention (n = 32), 3. Patient's baseline occlusal and skeletal characteristics (n = 14), 4. Mucogingival characteristics (n = 10), 5. Oral hygiene (n = 9), and 6. Others (n = 12). Significantly higher prevalence, severity and extent of GR were found in orthodontic patients by 10/15, 4/10, and 2/2 articles respectively. 10/16 articles reported significantly more GR and increased CCH in patients where orthodontic incisor proclination was performed. The evidence surrounding maxillary expansion and orthodontic retention was too heterogeneous to allow for? definitive conclusions. Pre-treatment angle classification, ANB, overjet, overbite, arch width and mandibular divergence were found not to be associated with GR (9/14), while pre-treatment crossbite, symphysis height and width were (5/7 studies). A thin gingival biotype, presence of previous GR, baseline width of keratinized gingiva and facial gingival margin thickness were correlated with increased risk of GR after OT by nine articles, while pocket depth was not. Oral hygiene, sex, treatment duration, and oral piercings were found not to be linked with GR in orthodontic patients, while GR was reported to increase with age in orthodontic patients by 50 per cent of the articles investigating this factor. The mean risk of bias for comparative and not comparative studies was 14.17/24 and 9.12/16. LIMITATIONS The selected studies were quite heterogeneous regarding study settings, variables reported and included very limited sample sizes. CONCLUSION Although studies regarding the risk factors for GR are relatively abundant, they are very heterogeneous concerning design, studied factors, methodology and reporting, which often leads to contradictory results. Uniform reporting guidelines are urgently needed for future research. PROSPERO REGISTRATION CRD42020181661. FUNDING This research received no funding.
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Affiliation(s)
- Maria Cadenas de Llano-Pérula
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
- Research group Orthodontics, KU Leuven, Belgium
| | - Ana Belén Castro
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
- Research group Periodontology and Oral Microbiology, KU Leuven, Belgium
| | - Margaux Danneels
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
- Research group Orthodontics, KU Leuven, Belgium
| | - Alix Schelfhout
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
- Research group Periodontology and Oral Microbiology, KU Leuven, Belgium
| | - Guy Willems
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
- Research group Orthodontics, KU Leuven, Belgium
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Ramos de Faria F, de Sá Werneck C, Kuchenbecker Rösing C, Willer Farinazzo Vitral R, José da Silva Campos M. Lower incisor inclination and thickness of the alveolar process and mandibular symphysis in the development of gingival recession: A retrospective cohort study. Saudi Dent J 2023; 35:651-656. [PMID: 37817786 PMCID: PMC10562091 DOI: 10.1016/j.sdentj.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Retrospective studies have found conflicting results regarding the relationship between lower incisor inclination and the development of gingival recession (GR) after orthodontic treatment. Objective This study aimed to investigate the relationship between lower incisor inclination and alveolar process (AP) and mandibular symphysis (MS) thickness in the development of GR. Materials and Methods Frontal intraoral photography and cephalometric radiography were conducted before (T0) and after (T1) orthodontic treatment of 62 subjects. The presence of GR was considered when the cementoenamel junction was visible in the lower incisor on the frontal intraoral photograph. The circumstances for improvement, stability, and worsening of the gingival situation were based on the reduction, maintenance, and increase in the number of lower incisors with GR before and after treatment. To measure the incisor-mandibular plane angle (IMPA) and the thickness of the AP and the MS were used the cephalometric radiographs. Results Men had a significantly thicker MS than women at T0 and T1 (p < 0.0004). There was a significant reduction of approximately 10% in AP between T0 and T1 (p < 0.0001). Among subjects without GR at T0, 70.4% presented a stable gingival situation at T1. For subjects with 1 lower incisor with GR at T0, 50% showed improvement in the gingival situation at T1, 21.4% remained stable, and 28.6% experienced worsening. Sixteen lateral incisors presented a worsening gingival situation, representing an increase of 129% compared to the central incisors. Conclusion No relationship was found between lower incisor inclination and the thickness of the AP and MS in the development of GR.
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Affiliation(s)
| | - Carolina de Sá Werneck
- Department of Orthodontics – Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
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Periodontal Phenotype Modification Using Subepithelial Connective Tissue Graft and Bone Graft in the Mandibular Anterior Teeth with Mucogingival Problems Following Orthodontic Treatment. Medicina (B Aires) 2023; 59:medicina59030584. [PMID: 36984585 PMCID: PMC10057352 DOI: 10.3390/medicina59030584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Among the complications of orthodontic treatment, mucogingival problems with gingival recession in the mandibular anterior teeth are challenging for clinicians. Mucogingival problems can lead to esthetic deficits, thermal hypersensitivity, tooth brushing pain, and complicated plaque control. Herein, we present a case of a 16-year-old female with gingival recession in the left mandibular central incisor after orthodontic treatment. The preoperative clinical findings showed a thin soft tissue biotype with root prominence in the mandibular anterior area. The interdental area was relatively depressed. After reflection of the full-thickness flap, root coverage using a bone graft substitute and subepithelial connective tissue graft obtained from the palatal mucosa was performed. The 6-month and 5-year postoperative clinical findings showed improved soft tissue phenotype. The cross-sectional CBCT scans 5 years after surgery showed a well-maintained labial bone plate in the mandibular incisors. Within the limitations of this case report, for patients with gingival recession in the mandibular incisors after orthodontic treatment, a successful biotype modification can be achieved with a combined procedure using subepithelial connective tissue graft with bone graft substitutes.
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Chen J, Lv J, Zhang F, Zhang W, Wang Y, Xu Y, Pan Y, Li Q. Efficacy of periodontal soft tissue augmentation prior to orthodontic treatment on preventing gingival recession: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e058942. [PMID: 36523212 PMCID: PMC9748932 DOI: 10.1136/bmjopen-2021-058942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In adult patients with thin phenotype, gingival recession is obvious in the mandibular incisors after a large amount of lingual tooth movement. A systematic review indicated that soft tissue augmentation before orthodontic treatment might yield satisfactory results with respect to the progression of gingival recession. However, the studies included had a low-to-moderate level of evidence. This study was designed to investigate the efficacy of soft tissue augmentation prior to orthodontic treatment on the prevention of gingival recession. METHOD AND ANALYSIS This is a single-centre, single-blind, randomised controlled, double-armed parallel group comparison trial. This study was initiated in December 2021 and end in December 2025 (anticipated). Patients with mild crowding in the lower arch and a thin gingival type was enrolled and randomly assigned in a 1:1 ratio to either group A (having soft tissue augmentation prior to orthodontic treatment) or group B (having orthodontic treatment only). The planned number of enrolled patients was 48 (24 patients × 2 groups). The primary endpoint was the mean change in recession of the gingival margin. Secondary endpoints included the probing depth, gingival phenotype, frequency of complete root coverage, gingival thickness, width of the keratinised gingiva, clinical attachment level, gingival recession class, full-mouth plaque score, alveolar bone thickness in the faciolingual dimension of the lower anterior teeth and lower incisor inclination. ETHICS AND DISSEMINATION The study protocol was approved by the Ethical Committee of the Shanghai Stomatological Hospital (certificate number (2021)016). The study was conducted in accordance with the Declaration of Helsinki, the Clinical Trials Act and other current legal regulations in China. Written informed consent was obtained from all the participants. The results of this study will be reported in journal publications. TRIAL REGISTRATION NUMBER ChiCTR2100050892.
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Affiliation(s)
- Jing Chen
- Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, People's Republic of China
| | - Jiashu Lv
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, People's Republic of China
- Department of Periodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, People's Republic of China
| | - Fan Zhang
- Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, People's Republic of China
| | - Wei Zhang
- Biomedical Informatics and Statistics Center, School of Public Health, Fudan University, Shanghai, Shanghai, China
| | - Yuhui Wang
- Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, People's Republic of China
| | - Yichen Xu
- Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, People's Republic of China
| | - Yichen Pan
- Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, People's Republic of China
| | - Qiang Li
- Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Periodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, People's Republic of China
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Colet R, Cotrin P, Oliveira RC, Valarelli FP, Gobbi de Oliveira RC, Salmeron S, Freitas KMS. Gingival recession in mandibular anterior teeth in patients with Class II malocclusion treated with elastics and Twin Force appliance. Am J Orthod Dentofacial Orthop 2022; 162:529-537. [PMID: 35842358 DOI: 10.1016/j.ajodo.2021.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aimed to compare the early results of gingival recession in patients with Class II malocclusion treated with Class II intermaxillary elastics and the Twin Force appliance. METHODS The sample comprised 55 patients with Class II malocclusion treated without extraction and divided into 2 groups. Group 1 consisted of 23 patients treated with fixed appliances and Class II elastics, with mean initial age of 15.41 ± 5.65 years and a mean treatment time of 3.11 ± 0.91 years. Group 2 consisted of 32 patients treated with fixed appliances and the Twin Force mandibular protraction appliance, with a mean initial age of 18.45 ± 6.63 years and a mean treatment time of 3.17 ± 1.59 years. Dolphin software measured gingival recession in initial and final intraoral photographs. Initial and final lateral cephalograms were used to measure the position of the mandibular incisors. Intragroup and intergroup comparisons were performed by dependent and independent t tests, respectively. RESULTS In both groups, there was no significant increase in gingival recession with orthodontic treatment, and there was significant protrusion and buccal inclination of the mandibular incisors. When changes with treatment were compared between the groups, there was no statistically significant difference in gingival recession and mandibular incisor position. CONCLUSIONS There was no significant increase in gingival recession immediately after orthodontic treatment performed with intermaxillary elastics and the Twin Force appliance.
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Affiliation(s)
- Rosangela Colet
- Department of Orthodontics, Ingá University Center Uningá, Maringá, Paraná, Brazil
| | - Paula Cotrin
- Department of Orthodontics, Ingá University Center Uningá, Maringá, Paraná, Brazil.
| | | | | | | | - Samira Salmeron
- Department of Periodontics, Ingá University Center Uningá, Maringá, Paraná, Brazil
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Kus-Bartoszek A, Lipski M, Jarząbek A, Manowiec J, Droździk A. Gingival Phenotype Changes and the Prevalence of Mucogingival Deformities during the Early Transitional Dentition Phase-A Two-Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073899. [PMID: 35409581 PMCID: PMC8997368 DOI: 10.3390/ijerph19073899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 01/28/2023]
Abstract
Thin gingival phenotype (GPh) may contribute to periodontal tissue breakdown and recession development. Thus, the early identification of thin GPh in children can allow proper preventive care and the identification of children at risk during orthodontic treatment. The present long-term study aimed to monitor GPh changes, i.e., thickness (GT) and width of attached gingiva (AGW) during the early transitional dentition phase, as well as its potential associations with the mucogingival deformities. Materials and Methods: 83 systematically healthy children were examined twice with an interval of 2 years. Probing depth, GT and AGW at mandibular incisors, vestibular depth, type of lower lip frenum attachment and mucogingival defects were recorded. Results: 95.2% of participants at baseline and 93.9% at 2-year examination expressed thin GPh. During the transition from the deciduous to permanent dentition, GT and AGW declined, but the GT of permanent incisors already erupted at the baseline examination increased in the observation period. Conclusions: Gingival phenotype undergoes changes in the early transitional dentition phase. In spite of the thin gingival phenotype, only single pseudo-recessions and primary shallow vestibule were noticed.
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Affiliation(s)
- Agnieszka Kus-Bartoszek
- Independent Laboratory of Paediatric Dentistry, Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.K.-B.); (A.J.); (J.M.)
| | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Anna Jarząbek
- Independent Laboratory of Paediatric Dentistry, Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.K.-B.); (A.J.); (J.M.)
| | - Joanna Manowiec
- Independent Laboratory of Paediatric Dentistry, Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.K.-B.); (A.J.); (J.M.)
| | - Agnieszka Droździk
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-466-1690; Fax: +48-91-466-1692
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Does Early Treatment Improve Clinical Outcome of Class II Patients? A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020232. [PMID: 35204952 PMCID: PMC8870289 DOI: 10.3390/children9020232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
The present study was carried out to evaluate the benefits from one-phase Class II Early Treatment (ET) using extraoral forces and functional appliances but without intermaxillary forces and eventual lower leeway space preservation compared to two-phase Class II Late Treatment (LT) with the need for extractions and full fixed appliances as well as lower incisor proclination. The ET group (n = 239, 115 M, 124 F, mean age 10.6 ± 1.2 years), with first premolars not in contact and the second deciduous lower molars preserved, was compared to the LT group (n = 288, 137 M, 151 F, mean age 12.4 ± 1.5 years). The ET group was first treated with headgears, growth guide appliances, or Teuscher activators and, in borderline crowding cases, with lower space maintenance by a lingual arch, lip bumper, or fixed utility arch. The LT group and the second phase of ET were treated with full fixed appliances including intermaxillary forces such as Class II elastics or noncompliance devices; headgear and a growth guide appliance were also used. Cephalograms and plaster models were taken before (T1) and after treatment (T2) to calculate cephalometric changes and space balance discrepancies. The differences between T1 and T2 were analyzed by a t-test for normally distributed data and by the Mann-Whitney Test for nonnormally distributed data at a level of p < 0.05. The groups were defined as statistically homogeneous at T1. A statistical analysis showed that the ET group (mean treatment time 35.3 ± 13.3 months) was significantly associated with a 22.2% lower extraction rate, 15.9% less need for a full fixed appliance, and more than 5° less incisor proclination in the nonextraction cases compared to the LT group (mean treatment time 25.9 ± 8.1 months); treatment time significantly increased in the ET group compared to the LT group. Early Class II treatment resulted in a significant treatment effort reduction in more than one third of the patients and less lower incisor proclination, even if it clinically increased treatment time.
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Südwasser S, Bock NC, Jost J, Killat S, Ruf S. Herbst-multibracket appliance treatment: is there an association between lower incisor position changes and the development of labial gingival recessions? J Orofac Orthop 2021; 82:363-371. [PMID: 33442753 PMCID: PMC8550700 DOI: 10.1007/s00056-020-00272-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/31/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess a potential association between lower incisor (LI) position changes during Herbst-multibracket appliance (Herbst-MBA) treatment and the development of labial gingival recessions (LGR). METHODS All class II patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who had undergone Herbst-MBA treatment until 2015 with study models and lateral cephalograms available from before (T0) and after treatment plus ≥24 months of retention (T3) were included (n = 259). Lateral cephalograms were evaluated regarding LI position changes: iiL/ML (angle between LI long axis and mandibular plane [MP]), ii-MLPg (distance between LI incisal edge and a line perpendicular to MP through pogonion), apex-MLPg (distance between LI apex and a line perpendicular to MP through pogonion), ii-MLii (distance between LI incisal edge and MP on a line perpendicular to MP through incisal edge). Using study models the distance between the cementoenamel junction and the deepest point of the gingival margin was defined as LGR. RESULTS The following cephalometric mean changes were recorded (T0-T3): iiL/ML +5.9 ± 5.76° (p = 0.929), ii-MLPg -0.2 ± 0.25 mm (p = 0.430), apex-MLPg +0.1 ± 0.32 mm (p = 0.363), ii-MLii +0.1 ± 0.36 mm (p = 0.206). The mean increase of LGR magnitude measured on the study models was 0.1 ± 0.35 mm. However, no association with the cephalometric LI position changes was found (|R| ≤ 0.2). CONCLUSION There is no association between the amount of LI position changes and the development of LGR during Herbst-MBA treatment plus retention. Nevertheless, individual predisposition or excessive treatment changes and extraordinary treatment approaches, respectively, might still lead to development of LGR.
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Affiliation(s)
- S Südwasser
- Department of Orthodontics, University of Giessen, Schlangenzahl 14, 35392, Giessen, Germany
| | - N C Bock
- Department of Orthodontics, University of Giessen, Schlangenzahl 14, 35392, Giessen, Germany.
| | - J Jost
- Private Practice, Limburg, Germany
| | - S Killat
- Private Practice, Stuttgart, Germany
| | - S Ruf
- Department of Orthodontics, University of Giessen, Schlangenzahl 14, 35392, Giessen, Germany
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Rathod SR, Gonde NP, Kolte AP, Bawankar PV. Quantitative analysis of gingival phenotype in different types of malocclusion in the anterior esthetic zone. J Indian Soc Periodontol 2020; 24:414-420. [PMID: 33144768 PMCID: PMC7592621 DOI: 10.4103/jisp.jisp_23_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background: For any esthetic treatment planning, the shape and form of gingiva should be a prime factor of concern. The correct identification of gingival phenotype (GP) ensures a firm foundation for future health and prognosis of the treatment indicated. Hence, the aim of the present study was to evaluate the correlation between the GP in the anterior esthetic zone with different types of maloclussion and severity of crowding. Materials and Methods: A total of 110 periodontally healthy controls were equally divided into two groups depending on the type of malocclusion. They were further divided according to the levels of dental crowding as mild, moderate, and severe. GP was measured on the anterior esthetic teeth using transgingival probing, and width of the attached gingiva (WAG) was measured using histochemical staining method. Results: In severe crowding group, the GP in 12 and 22 region was found to be thick (P = 0.035) while, in 32 and 42 region was thin (P = 0.042). The WAG shows a significant difference between WAG with 23 in severe crowding group with P = 0.042, whereas there was no significant relationship found between the GP with Angle's classification. Conclusion: Within the limitations of the study, it can be concluded that the teeth in the maxillary and mandibular anterior esthetic region showed the thin phenotype. When the severity of crowding increases, the GP and WAG vary depending on the position of the tooth. There is no association between the Angle's classification and the mean GP of the maxillary and mandibular anterior region teeth.
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Affiliation(s)
- Surekha Ramrao Rathod
- Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Noopur Pradeep Gonde
- Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Abhay Pandurang Kolte
- Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Pranjali Vijaykumar Bawankar
- Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
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Pernet F, Vento C, Pandis N, Kiliaridis S. Long-term evaluation of lower incisors gingival recessions after orthodontic treatment. Eur J Orthod 2020; 41:559-564. [PMID: 31220233 DOI: 10.1093/ejo/cjy086] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM The development of gingival recessions has been associated with orthodontic treatment; however, a clear etiology is still unknown. The aim of the present study was to further clarify potential association between the development of labial and lingual recessions and inclination of the lower incisors during orthodontic treatment, vertical facial morphology, width of the alveolar bone process, height and width of their symphysis after orthodontic treatment and at long-term retention. METHODS On dental casts and good quality lateral cephalograms of 126 orthodontically treated patients, relevant measurements were performed and gingival recessions were assessed and recorded before, immediately after treatment and at long-term retention. RESULTS Taking into account the whole sample at three different occasions, on the buccal side, the lateral incisors have significantly less recessions than the central incisor. On the lingual side, tooth 32 presented with lower risk of recession compared to all other three incisors. No association was found between the width of the alveolar bone process at the apex (Wapex), at the level of the crest (Wcrest) and at mid of the root (Wmid), the width (D), the vertical skeletal pattern (AnsPns-Go'Me) and the onset of buccal or lingual recessions. Development of new recessions was clearly associated with males and with increasing age. The symphysis height (Me-Wcrest) was statistically related with the onset of lingual recessions on 32 and 42. The ratio between the symphysis height and the width at the crest level demonstrated a statistically significant association with the presence of buccal and lingual recessions. Excessive proclination (≥10°) of the lower incisors demonstrated an association with the onset of recessions in 25 per cent of the cases. CONCLUSION Based on the sample of this study, there is some evidence that increased symphysis height (Me-Wcrest), and ratio between the symphysis height and the width at the crest level as well as big change of lower incisor inclination during treatment are associated with the development of recessions.
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Affiliation(s)
- Fabienne Pernet
- Department of Orthodontics and Dentofacial Orthopedics, Dental School, Medical Faculty, University of Geneva, Switzerland
| | - Cristina Vento
- Department of Orthodontics and Dentofacial Orthopedics, Dental School, Medical Faculty, University of Geneva, Switzerland
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School, Medical Faculty University of Bern, Switzerland
| | - Stavros Kiliaridis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School, Medical Faculty, University of Geneva, Switzerland
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Song YW, Jung H, Han SY, Paeng KW, Kim MJ, Cha JK, Choi YJ, Jung UW. Effects of soft tissue grafting prior to orthodontic treatment on preventing gingival recession in dogs. J Periodontal Implant Sci 2020; 50:226-237. [PMID: 32643324 PMCID: PMC7443382 DOI: 10.5051/jpis.2000420021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/23/2020] [Accepted: 04/20/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study was conducted to assess the efficacy of prophylactic gingival grafting in the mandibular anterior labial area for preventing orthodontically induced gingival recession. METHODS Eight mongrel dogs received gingival graft surgery at the first (I1) and third (I3) mandibular incisors on both sides based on the following group allocation: AT group (autogenous connective tissue graft on I1), AT-control group (contralateral side in the AT group), CM group (xenogeneic cross-linked collagen matrix graft on I3) and CM-control group (contralateral side in the CM group). At 4 weeks after surgery, 6 incisors were splinted and proclined for 4 weeks, followed by 16 weeks of retention. At 24 weeks after surgery, casts were made and compared with those made before surgery, and radiographic and histomorphometric analyses were performed. RESULTS Despite the proclination of the incisal tip (by approximately 3 mm), labial gingival recession did not occur. The labial gingiva was thicker in the AT group (1.85±0.50 mm vs. 1.76±0.45 mm, P>0.05) and CM group (1.90±0.33 mm vs. 1.79±0.20 mm, P>0.05) than in their respective control groups. CONCLUSIONS The level of the labial gingival margin did not change following labial proclination of incisors in dogs. Both the AT and CM groups showed enhanced gingival thickness.
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Affiliation(s)
- Young Woo Song
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Heekyu Jung
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Seo Yeon Han
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Kyeong Won Paeng
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Myong Ji Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Jae Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea.
| | - Ui Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.
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Lee JB, Baek SJ, Kim M, Pang EK. Correlation analysis of gingival recession after orthodontic treatment in the anterior region: an evaluation of soft and hard tissues. J Periodontal Implant Sci 2020; 50:146-158. [PMID: 32617180 PMCID: PMC7321713 DOI: 10.5051/jpis.2020.50.3.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/12/2019] [Accepted: 07/29/2019] [Indexed: 11/08/2022] Open
Abstract
Purpose The aim of this study was to investigate and identify the main causes of periodontal tissue change associated with labial gingival recession by examining the anterior region of patients who underwent orthodontic treatment. Methods In total, 45 patients who had undergone orthodontic treatment from January 2010 to December 2015 were included. Before and after the orthodontic treatment, sectioned images from 3-dimensional digital model scanning and cone-beam computed tomography images in the same region were superimposed to measure periodontal parameters. The initial labial gingival thickness (IGT) and the initial labial alveolar bone thickness (IBT) were measured at 4 mm below the cementoenamel junction (CEJ), and the change of the labial gingival margin was defined as the change of the distance from the CEJ to the gingival margin. Additionally, the jaw, tooth position, tooth inclination, tooth rotation, and history of orthognathic surgery were investigated to determine the various factors that could have affected anterior periodontal tissue changes. Results The mean IGT and IBT were 0.77±0.29 mm and 0.77±0.32 mm, respectively. The mean gingival recession was 0.14±0.57 mm. Tooth inclination had a significant association with gingival recession, and as tooth inclination increased labially, gingival recession increased by approximately 0.2 mm per 1°. Conclusions In conclusion, the IGT, IBT, tooth position, tooth rotation, and history of orthognathic surgery did not affect labial gingival recession. However, tooth inclination showed a significant association with labial gingival recession of the anterior teeth after orthodontic treatment.
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Affiliation(s)
- Jong-Bin Lee
- Department of Periodontology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Soo-Jin Baek
- Department of Periodontology and Prosthodontics, Graduate School of Clinical Dentistry, Ewha Womans University, Seoul, Korea
| | - Minji Kim
- Department of Orthodontics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun-Kyoung Pang
- Department of Periodontology, College of Medicine, Ewha Womans University, Seoul, Korea
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Class II:2 malocclusion-prevalence and progression of labial gingival recessions during Herbst-Multibracket appliance treatment. Clin Oral Investig 2020; 24:3653-3660. [PMID: 32108245 DOI: 10.1007/s00784-020-03243-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine the prevalence, incidence, and changes in magnitude of labial gingival recessions (LGR) in class II:2 patients during Herbst-Multibracket appliance (Herbst-MBA) treatment (Tx) plus retention. SUBJECTS AND METHODS All class II:2 patients of the Department of Orthodontics, University of Giessen, Germany who completed Herbst-MBA Tx (mean pre-Tx age 15.6 years). The cohort had undergone a Herbst phase (mean 8.1 months) as well as a subsequent MBA phase (mean 14.4 months). Study casts were evaluated from pre-Tx and after Herbst-MBA Tx plus ≥ 24 months of retention. RESULTS Ratable pre-Tx and post-retention study casts (total observation period 53.5 ± 10.3 months) were available from 94 out of 173 patients. No significant difference existed regarding pre-Tx LGR data between patients with and without complete records. The prevalence for teeth with LGR ≥ 0.5 mm was 1.4% pre-Tx respectively 6.7% post-retention. The highest values of up to 5.3% (pre-Tx) and 20.2% (post-retention) were determined for the upper first premolars and lower central incisors. Incidence values of 4.7% (all teeth) and up to 14.9% (upper first right premolars) respectively 11.1% (lower central incisors) were calculated (LGR ≥ 0.5 mm). The overall LGR mean magnitudes were 0.01 mm pre-Tx respectively 0.06 mm post-retention. CONCLUSIONS For the prevalence of LGR ≥ 0.5 mm an average increase of 5.3% was determined during ≈ 4.5 years of Herbst-MBA Tx plus retention. The highest incidence was seen for lower central incisors and upper right premolars (11.1/14.9%). The overall LGR mean magnitude increased by 0.05 mm. CLINICAL RELEVANCE Herbst-MBA Tx is a common approach for class II:2 malocclusions. Very little, however, is known regarding LGR development in respective patients.
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15
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Kalina E, Zadurska M, Sobieska E, Górski B. Relationship between periodontal status of mandibular incisors and selected cephalometric parameters : Preliminary results. J Orofac Orthop 2019; 80:107-115. [PMID: 31041493 PMCID: PMC6491396 DOI: 10.1007/s00056-019-00170-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this cross-sectional study was to evaluate the correlation between the periodontal tissue of mandibular incisors and several dentoalveolar and skeletal cephalometric parameters. Materials and methods The sample consisted of 35 patients (mean age 26.42 ± 8.02 years). Eligibility criteria included good overall health status with no history of dental trauma, congenital defects, active periodontal diseases, restorative and prosthetic treatment in the area of the mandibular incisors. Gingival recession width and height (GRW, GRH), gingival thickness (GT), width of keratinized gingiva (WKT) and clinical attachment loss (CAL) were evaluated at 140 lower incisors. Incisors inclination (1-:ML), skeletal class (ANB, WITS), intermaxillary angle (NL:ML) and mandibular symphysis dimensions (symph. length and width) were assessed in cephalograms. Spearman’s correlation coefficient was used for statistical analysis at the P < 0.05 level. Results A statistically significant positive moderate correlation was found for GT and WITS and also symph. length. WKT correlated positively with ANB, WITS and symph. length, with moderate strength of the correlation. GRW, GRH and CAL did not correlate with any cephalometric parameters. Conclusion The results of this study indicated evidence for an association between WKT and GT and some cephalometric variables—ANB, WITS, and symphysis length.
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Affiliation(s)
- Edyta Kalina
- Department of Orthodontics, Medical University of Warsaw, Nowogrodzka St 59, 02-006, Warsaw, Poland.
| | - Małgorzata Zadurska
- Department of Orthodontics, Medical University of Warsaw, Nowogrodzka St 59, 02-006, Warsaw, Poland
| | - Ewa Sobieska
- Department of Orthodontics, Medical University of Warsaw, Nowogrodzka St 59, 02-006, Warsaw, Poland
| | - Bartłomiej Górski
- Department of Periodontology and Oral Diseases, Medical University of Warsaw, Miodowa St 18, 00-246, Warsaw, Poland
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Bock NC, Ruehl J, Ruf S. Prevalence, magnitude, and incidence of labial gingival recession with Herbst-multibracket appliance treatment: A retrospective cohort study. Angle Orthod 2019; 89:535-543. [PMID: 30719934 DOI: 10.2319/032918-239.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess the prevalence and magnitude of labial gingival recession (LGR) before and after as well as the incidence during Class II:1 Herbst-Multibracket appliance (Herbst-MBA) treatment (Tx) plus retention in a retrospective cohort study. MATERIALS AND METHODS Records of Class II:1 patients who completed Herbst-MBA Tx (mean pre-Tx age 14.4 years) at Department of Orthodontics, University of Giessen, Giessen, Germany were analyzed. Tx consisted of a Herbst phase (mean 8.1 months) and a subsequent MBA phase (mean 16.1 months). Study casts from before and after Herbst-MBA Tx plus ≥24 months of retention were evaluated. RESULTS A total of 460 pre-Tx and 222 postretention study casts were available (total observation period: 59.2 ± 14.8 months). The overall prevalence for teeth with LGR ≥0.5 mm was 1.1% pre-Tx and 5.3% postretention. The highest prevalence of up to 5.3% (pre-Tx) and 16.4% (postretention) were seen for the lower incisors. Overall, the median magnitude of LGR was 0.0 mm pre-Tx/postretention (mean: 0.05 mm/0.08 mm). Incidence values of 4.0% (all teeth) and 10.0% to 11.4% (lower central incisors) were calculated for LGR ≥0.5 mm. CONCLUSIONS The prevalence of LGR ≥0.5 mm increased from, on average, 1.1% to 5.3% during ≈6 years of Herbst-MBA Tx plus retention. The highest incidence was seen in lower incisors (10.0%-11.4%). However, because of the overall mean magnitude of 0.08 mm postretention, the clinical relevance can be considered as insignificant.
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Charavet C, Lecloux G, Bruwier A, Vandenberghe B, Le Gall M, Lambert F. Selective piezocision-assisted orthodontic treatment combined with minimally invasive alveolar bone regeneration: A proof-of-concept. Int Orthod 2018; 16:652-664. [PMID: 30391131 DOI: 10.1016/j.ortho.2018.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Piezocision is a localised piezoelectric alveolar decortication involving minimally invasive corticotomies to accelerate orthodontic treatments. The objective of this proof-of-concept was to describe an innovative protocol combining selective piezocision with minimally invasive bone regeneration to reduce the risk of buccal tissue dehiscences often observed in orthodontic treatments. This proof-of-concept initial report aimed at investigating whether this new surgical concept is relevant. MATERIALS AND METHODS A patient presenting an asymmetrical dental class II, overcrowdings, midline deviations and buccal bone dehiscences in the lower incisor region was treated with this new treatment approach. RESULTS From an orthodontic point of view, the dental class II, the overcrowdings and the midlines were completely corrected. From a periodontal perspective, no gingival recession was observed; however, scars related to the piezocision were slightly visible at the mandible. The post-imaging demonstrated the absence of bone dehiscences. Up to 3 years after the completion of the treatment, no relapse was observed. CONCLUSION This novel approach suggested several advantages and may be further investigated at a larger scale in order to validate the benefits and to define the scope of intervention.
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Affiliation(s)
- Carole Charavet
- Department of orthodontics and dentofacial orthopedics, University Hospital of Liège, Liege, Belgium; Dental biomaterials research unit, University Hospital of Liège, Liege, Belgium.
| | - Geoffrey Lecloux
- Department of periodontology and oral surgery, University Hospital of Liège, Liege, Belgium
| | - Annick Bruwier
- Department of orthodontics and dentofacial orthopedics, University Hospital of Liège, Liege, Belgium
| | - Bart Vandenberghe
- Medical imaging, Advimago, center for advanced oral imaging, Brussels, Belgium
| | - Michel Le Gall
- Department of orthodontics and dentofacial orthopedics, University Hospital of Marseille, 13385 Marseille, France
| | - France Lambert
- Department of periodontology and oral surgery, University Hospital of Liège, Liege, Belgium; Dental biomaterials research unit, University Hospital of Liège, Liege, Belgium
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18
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Traitement orthodontique assisté par piézocision et combiné à une régénération alvéolaire minimallement invasive : validation du concept. Int Orthod 2018; 16:652-664. [PMID: 30391130 DOI: 10.1016/j.ortho.2018.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Mijuskovic M, Gebistorf MC, Pandis N, Renkema AM, Fudalej PS. Tooth wear and gingival recession in 210 orthodontically treated patients: a retrospective cohort study. Eur J Orthod 2018; 40:444-450. [PMID: 29145570 DOI: 10.1093/ejo/cjx083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Aim To assess the association between tooth wear (TW) and gingival recession (GR). Materials and Methods Two hundred and ten orthodontically treated participants (100 males) were evaluated. GR and TW were rated independently by four raters on plaster models at four time points: before treatment (T1), mean age 13.8 years (SD = 3.7); after treatment (T2), mean age 16.7 years (SD = 3.9); 3 years after treatment (T3), mean age 19.7 years (SD = 4.2); and 7 years after treatment (T4), mean age 23.9 years (SD = 4.8). Univariable and mulitvariable random effects logistic regression analyses were performed with scores for GR as dependent variables and with TW, age, gender, dental segments (maxillary and mandibular anterior and posterior segments), time points, and Angle classification as independent variables. Method reliability was assessed with kappa statistics. Results Mandibular incisors, mandibular and maxillary first premolars and maxillary first molars were most vulnerable to GR. The prevalence of GR increased during the observation period. At T1 20.5% participants had one or more recession sites, at T4 85.7 % of the participants had at least one GR. There was evidence of association between moderate/severe TW and GR-for a tooth with moderate/severe wear, the odds of recession were 23% higher compared to a tooth with no/mild wear (odds ratio 1.23; 95% CI: 1.08-1.40; P = 0.002). Age, dental segment, and time were also significant recession predictors, whereas gender was not. Conclusions There is evidence that moderate/severe TW is associated with the presence of gingival recession. Clinical significance of this can be limited.
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Affiliation(s)
- Marco Mijuskovic
- Department of Orthodontics and Dentofacial Orthopedics,University of Berne, Switzerland
| | - Meret C Gebistorf
- Department of Orthodontics and Dentofacial Orthopedics,University of Berne, Switzerland
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics,University of Berne, Switzerland
- Private Practice, Corfu, Greece
| | - Anne M Renkema
- Department of Orthodontics and Craniofacial Biology, Radboud Universitiy, Nijmegen, Netherlands
| | - Piotr S Fudalej
- Department of Orthodontics and Dentofacial Orthopedics,University of Berne, Switzerland
- Department of Orthodontics, Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Sawan NM, Ghoneima A, Stewart K, Liu S. Risk factors contributing to gingival recession among patients undergoing different orthodontic treatment modalities. Interv Med Appl Sci 2018; 10:19-26. [PMID: 30363373 PMCID: PMC6167635 DOI: 10.1556/1646.9.2017.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the risk factors contributing to gingival recession among patients undergoing orthodontic treatment. METHODS Records of 100 Caucasian patients who completed orthodontic treatment were evaluated before and after treatment. Intercanine and molar widths, arch perimeter, arch depth, and keratinized gingival height were measured for both arches. The association of orthodontic treatment strategy (changing incisal inclination, expansion, and extraction), keratinized gingival height, and various other measurements with gingival recession was evaluated by using generalized linear mixed models with logistic regression analysis. RESULTS For each 1 mm increase in pre- and post-treatment keratinized gingival height, there was 0.77 and 0.51 times lower odds of gingival recession. For each 1 mm increase in post-treatment intercanine width, there was 0.80 times lower odds of gingival recession. And for each 1 mm increase in change in the arch depth, there was 1.16 times higher odds of gingival recession. For each 1 mm increase in pre- and post-treatment mandibular symphysis width, there was 0.47 and 0.39 times lower odds of gingival recession. CONCLUSION Regardless of the type of orthodontic treatment, increased keratinized gingival height, mandibular symphysis width, and post-treatment intercanine width lower the risk of gingival recession.
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Affiliation(s)
- Nozha Mahmoud Sawan
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Ghoneima
- Department of Orthodontic and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Kelton Stewart
- Department of Orthodontic and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN, USA
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21
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Ciavarella D, Tepedino M, Gallo C, Montaruli G, Zhurakivska K, Coppola L, Troiano G, Chimenti C, Laurenziello M, Lo Russo L. Post-orthodontic position of lower incisors and gingival recession: A retrospective study. J Clin Exp Dent 2018; 9:e1425-e1430. [PMID: 29410758 PMCID: PMC5794120 DOI: 10.4317/jced.54261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/23/2017] [Indexed: 02/05/2023] Open
Abstract
Background To evaluate if changes in lower incisor position following orthodontic treatment are correlated with development of gingival recessions. Material and Methods Pre- and post-treatment digital models and lateral cephalograms of 22 subjects were collected retrospectively. The clinical crown length, gingival scallop, and papilla height of the central lower incisor were measured along with the cephalometric incisor’s inclination, the distance from the mandibular plane, and the distance between the Infradentale and Menton points. Statistical correlations between gingival and cephalometric variables were studied. In addition, two groups were defined based on the post-treatment incisor inclination value (‘normal’ or ‘proclined’) and compared. Results The incisor inclination was correlated with the change in gingival scallop and papilla height. Moreover, there was a statistically significant difference in clinical crown height and gingival scallop between the ‘normal’ group and the ‘proclined’ group. Conclusions Changes in lower incisor position, especially an excessive proclination, after orthodontic treatment may play a role in the development of gingival recession. Key words:Orthodontic treatment, Incisor inclination, IMPA, Gingival recession, Alveolar bone.
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Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Crescenzio Gallo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Ludovica Coppola
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Lucio Lo Russo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Handelman CS, Eltink AP, BeGole E. Quantitative measures of gingival recession and the influence of gender, race, and attrition. Prog Orthod 2018; 19:5. [PMID: 29376198 PMCID: PMC5787531 DOI: 10.1186/s40510-017-0199-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Gingival recession in dentitions with otherwise healthy periodontium is a common occurrence in adults. Recession is clinically measured using a periodontal probe to the nearest millimeter. The aim of this study is to establish quantitative measures of recession, the clinical crown height, and a new measure the gingival margin-papillae measurement. The latter is seen as the shortest apico-coronal distance measured from the depth of the gingival margin to a line connecting the tips of the two adjacent papillae. Methods Measurements on all teeth up to and including the first molar were performed on pretreatment study models of 120 adult Caucasian and African-American subjects divided into four groups of 30 by gender and race. Results Both the clinical crown height and the gingival margin-papillae measurements gave a true positive result for changes associated with gingival recession. Tooth wear shortens the clinical crown, and therefore, the measure of clinical crown height can give a false negative result when gingival recession is present. However, the gingival margin-papillae measurement was not affected by tooth wear and gave a true positive result for gingival recession. Tooth wear (attrition) was not associated with an increase in gingival recession. These measures are also useful in detecting recession prior to cemental exposure. Measures for recession and tooth wear were different for the four demographic groups studied. Conclusions These measures can be used as quantitative standards in both clinical dentistry, research, and epidemiological studies.
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Affiliation(s)
- Chester S Handelman
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA.
| | - Anthony P Eltink
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Ellen BeGole
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
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Jati AS, Furquim LZ, Consolaro A. Gingival recession: its causes and types, and the importance of orthodontic treatment. Dental Press J Orthod 2017; 21:18-29. [PMID: 27409650 PMCID: PMC4944726 DOI: 10.1590/2177-6709.21.3.018-029.oin] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 11/22/2022] Open
Abstract
Gingival recession has direct causes and predisposing factors. Orthodontic treatment is able to prevent recession and even contribute to its treatment, with or without periodontal approach, depending on the type and severity of gingival tissue damage. There is no evidence on the fact that orthodontic treatment alone might induce gingival recession, although it might lead the affected teeth (usually mandibular incisors or maxillary canines) to be involved in situations that act as predisposing factors, allowing direct causes to act and, therefore, trigger recession, especially when the buccal bone plate is very thin or presents with dehiscence. Several aspects regarding the relationship between orthodontic treatment and gingival recession have been addressed, and so has the importance of the periosteum to the mechanism of gingival recession formation. Clinical as well as experimental trials on the subject would help to clarify this matter, of which understanding is not very deep in the related literature.
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Affiliation(s)
- Ana Suzy Jati
- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Laurindo Zanco Furquim
- Department of Orthodontics, School of Dentistry, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Alberto Consolaro
- Department of Orthodontics, School of Dentistry, Universidade de São Paulo, Bauru, São Paulo, Brazil
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24
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Ferguson DJ, Mazumder U, Makki L, Thomas Wilcko M, Wilcko WM. Mandibular Incisor Position Changes do not Explain Increase in Keratinized Gingiva Height after Periodontally Accelerated Osteogenic Orthodontics. APOS TRENDS IN ORTHODONTICS 2017. [DOI: 10.4103/apos.apos_78_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose
This study aimed to reexamine the relationship between mandibular incisor inclination, prominence and vertical changes in position, and keratinized gingival tissue (KT) height changes labial to the mandibular incisors after orthodontic treatment with and without augmented corticotomy (Cort).
Materials and Methods
Two orthodontically treated groups of 35 individuals each, with (Cort) and without (conventional [Conv]) alveolar decortication and augmentation bone grafting (periodontally accelerated osteogenic orthodontics [PAOO]), were matched for sample size, gender, mandibular premolar extractions, pretreatment age, posttreatment observation period, and pretreatment KT height in this case–controlled retrospective study. Pre- and post-treatment lateral cephalometric radiographs were evaluated for mandibular incisor vertical, inclination, and prominence changes.
Results
As reported previously (Wilcko 2015), KT height had significantly increased by 0.78 mm (P = 0.001) in the Cort group and decreased by 0.38 mm (P = 0.002) in Conv on an average of 1.5 years after completion of active orthodontic therapy. In this study, Cort mandibular incisors proclined and protruded significantly during therapy while Conv incisors did not. Changes in mandibular incisor inclination and prominence explained neither the decrease in keratinized gingiva height in Conv nor the KT height gain in Cort.
Conclusions
In spite of mandibular incisor proclination and protrusion, orthodontic therapy combined with alveolar decortication and augmentation bone grafting resulted in a clinically significant increase in keratinized gingiva height 1.5 years’ posttreatment.
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Affiliation(s)
- Donald J. Ferguson
- European University College, Advanced Orthodontics Program, Dubai, United Arab Emirates
| | - Urmi Mazumder
- Former EUC Orthodontic Resident, Private Practice in Orthodontics, Dubai, United Arab Emirates
| | - Laith Makki
- European University College, Advanced Orthodontics Program, Dubai, United Arab Emirates
| | - M. Thomas Wilcko
- Department of Periodontology, Case Western Reserve University, Cleveland, OH, USA
| | - William M. Wilcko
- Department of Orthodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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Kaya Y, Alkan Ö, Keskin S. An evaluation of the gingival biotype and the width of keratinized gingiva in the mandibular anterior region of individuals with different dental malocclusion groups and levels of crowding. Korean J Orthod 2017; 47:176-185. [PMID: 28523244 PMCID: PMC5432439 DOI: 10.4041/kjod.2017.47.3.176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 11/04/2016] [Accepted: 12/02/2016] [Indexed: 01/14/2023] Open
Abstract
Objective To evaluate the relationship of gingival thickness (GT) and the width of keratinized gingiva (WKG) with different malocclusion groups and the level of crowding. Methods A total of 187 periodontally healthy subjects (121 females and 66 males) who presented at the Faculty of Dentistry in Yüzüncü Yıl University for orthodontic treatment were enrolled in the study. The individuals involved in the study were divided into three groups; Angle Class I malocclusion, Angle Class II malocclusion, and Angle Class III malocclusion. Each group was classified as mild, moderate, or severe according to the level of crowding. WKG was determined as the distance between the mucogingival junction and the free gingival margin. GT was determined by the transgingival probing technique. Factorial variance analysis and the Duncan multiple comparison test were employed to identify the extent to which a difference was apparent between the groups according to these parameters. Results It was determined that teeth in the mandibular anterior region display the thin gingival biotype. WKG and GT were observed as being higher at the mandibular incisor teeth in the severe crowding group and at the mandibular canine teeth in the mild crowding group. The GT of the mandibular right central and lateral incisors was found to be thinner in the Angle Class III group. Conclusions Within the limits of this study, the results demonstrate that, there is no significant relationship of WKG and the mean GT in the mandibular anterior region according to the Angle classification.
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Affiliation(s)
- Yeşim Kaya
- Department of Orthodontics, Faculty of Dentistry, Yüzüncü Yıl University, Van, Turkey
| | - Özer Alkan
- Department of Orthodontics, Faculty of Dentistry, Yüzüncü Yıl University, Van, Turkey
| | - Sıddık Keskin
- Department of Biostatistics, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
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Antonarakis GS, Joss CU, Triaca A, Kuijpers-Jagtman AM, Kiliaridis S. Gingival recessions of lower incisors after proclination by orthodontics alone or in combination with anterior mandibular alveolar process distraction osteogenesis. Clin Oral Investig 2017; 21:2569-2579. [PMID: 28110408 DOI: 10.1007/s00784-017-2056-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/09/2017] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Gregory S Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.
| | - Christof Urs Joss
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Orthodontics and Craniofacial Biology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud university medical center, Nijmegen, The Netherlands
| | - Stavros Kiliaridis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Mazurova K, Renkema AM, Navratilova Z, Katsaros C, Fudalej PS. No association between gingival labial recession and facial type. Eur J Orthod 2016; 38:286-91. [PMID: 26136434 PMCID: PMC4914901 DOI: 10.1093/ejo/cjv042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate if facial type is a predictor of the development of gingival recession. METHODS A cohort of 179 orthodontic patients (76 males, 101 females; age before treatment T S = 12.4 years, SD = 0.8) were followed until 5 years post-treatment (T 5 = 20.7 years, SD = 1.2). The presence of recessions was scored ('Yes' or 'No') by two raters on initial (T S), end of treatment (T 0), and post-treatment (T 5) plaster models. A recession was noted (scored 'Yes') if the labial cemento-enamel junction was exposed. The clinical crown heights were measured at T S, T 0, and T 5 as the distances between the incisal edges and the deepest points of the curvature of the vestibulo-gingival margins. Determination of the facial type was based on the inclination of mandibular plane relative to cranial base (Sella-Nasion/Mandibular Plane) and the proportion of posterior to anterior face heights (PFHs; SGo/NMe × 100 per cent) on pre-treatment cephalograms. RESULTS From T 0 to T 5, the number of subjects with recessions increased from 2 (1.1 per cent) to 24 (13.6 per cent), and the number of recession sites increased from 2 to 39. However, most patients had either one or two recession sites. The mean clinical crown height of mandibular incisors increased by 0.86mm (SD = 0.82, P < 0.001). Regression analysis showed that mandibular plane inclination had no effect on the development of gingival recession or on the increase of clinical crown heights of mandibular incisors. CONCLUSIONS Facial type is not a predictor of the occurrence of gingival recession.
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Affiliation(s)
- Katerina Mazurova
- Department of Orthodontics, Palacky University, Olomouc, Czech Republic
| | - Anne-Marie Renkema
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Christos Katsaros
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Switzerland
| | - Piotr S Fudalej
- Department of Orthodontics, Palacky University, Olomouc, Czech Republic, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Switzerland
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Bock NC, Ruf S, Wiechmann D, Jilek T. Herbst plus Lingual versus Herbst plus Labial: a comparison of occlusal outcome and gingival health. Eur J Orthod 2016; 38:478-84. [PMID: 27141935 DOI: 10.1093/ejo/cjw034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To analyse and compare the effects during Herbst treatment combined with a lingual (completely customized) or labial (straight-wire) multibracket appliance (MBA), with special regard to lower incisor gingival recessions. SUBJECTS AND METHODS Eighteen Class II:1 patients [overjet ≥ 5mm, Class II molar relationship ≥ 0.5 cusp widths (CW) bilaterally or 1.0 CW unilaterally, median age 16.0 years] treated with a Herbst appliance in combination with a lingual MBA (group LINGUAL) were retrospectively matched (molar relationship and skeletal maturity) to 18 Class II:1 patients treated with a Herbst appliance combined with a labial MBA (group LABIAL). Study models and intraoral photographs from before and after treatment were evaluated regarding occlusal variables and gingival recessions. Lateral cephalograms from before, during (before and after Herbst), and after treatment were analysed to assess lower incisor changes. RESULTS Both groups showed similar reductions of overjet (5.4/5.6mm), overbite, (2.9/2.7mm) and sagittal molar relationship (0.9/0.8 CW). During the Herbst phase, the changes in lower incisor inclination and incisal edge position were significantly smaller in the LINGUAL than in the LABIAL group (iiL/ML: +7.0/+12.7degrees, P = 0.002; ii-MLppg: +2.5/+3.9mm, P = 0.004). For the total treatment period, no significant differences were found (iiL/ML: +5.3/+8.6degrees; ii-MLppg: +2.1/+2.4mm). No clinically relevant gingival recessions were seen. CONCLUSION Both treatment approaches successfully corrected the malocclusion. The group LINGUAL exhibited significantly less proclination during the Herbst phase only. Neither treatment approach induced deleterious gingival recessions.
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Affiliation(s)
- Niko C Bock
- Department of Orthodontics, Justus-Liebig-University, Giessen
| | - Sabine Ruf
- Department of Orthodontics, Justus-Liebig-University, Giessen,
| | - Dirk Wiechmann
- Department of Orthodontics, Hannover Medical School, Private Practice, Bad Essen, and
| | - Theresa Jilek
- Department of Orthodontics, Hannover Medical School, Private Practice, Wolfratshausen, Germany
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Villard N, Patcas R. Does the decision to extract influence the development of gingival recessions? J Orofac Orthop 2015; 76:476-92. [DOI: 10.1007/s00056-015-0308-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chan HL, Chun YHP, MacEachern M, Oates TW. Does Gingival Recession Require Surgical Treatment? Dent Clin North Am 2015; 59:981-96. [PMID: 26427577 DOI: 10.1016/j.cden.2015.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Gingival recession represents a clinical condition in adults frequently encountered in the general dental practice. Clinicians often face dilemmas of whether or not to treat such a condition surgically. An initial condensed literature search was performed using a combination of gingival recession and surgery controlled terms and keywords. An analysis of the search results highlights the limited understanding of the factors that guide the treatment of gingival recession. Understanding the cause, prognosis, and treatment of gingival recession continues to offer many unanswered questions and challenges in periodontics as we strive to provide the best care possible for our patients.
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Affiliation(s)
- Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, R3323B 1011 North University Avenue, Ann Arbor, MI 48105, USA
| | - Yong-Hee Patricia Chun
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, 1135 East Catherine Street, Ann Arbor, MI 48109, USA
| | - Thomas W Oates
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Choi YJ, Chung CJ, Kim KH. Periodontal consequences of mandibular incisor proclination during presurgical orthodontic treatment in Class III malocclusion patients. Angle Orthod 2015; 85:427-433. [PMID: 25090134 PMCID: PMC8612433 DOI: 10.2319/021414-110.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/01/2014] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE To test the hypothesis that periodontal changes are similar between proclined and minimal-changed mandibular incisor position groups during presurgical orthodontic treatment for Class III orthognathic surgery. MATERIALS AND METHODS The following measurements were performed before and after presurgical orthodontic treatment of 75 patients (proclination group, 39 subjects; minimal-change group, 36 subjects): clinical crown length, sulcus and bone probing depths, and width of attached gingiva from clinical examination; infradentale-to-MP (perpendicular distance of infradentale to mandibular plane) from examination of lateral cephalograms; and the distance between the cementoenamel junction and alveolar crest from examination of periapical radiographs. Data were compared between the two groups, and a regression analysis was performed to investigate factors affecting the periodontal changes. RESULTS In both groups, clinical crown length and bone probing depth increased during presurgical orthodontics (P < .05). Infradentale-to-MP and the width of attached gingiva decreased more in the proclination group than in the minimal-change group (P < .05). Proclination and protrusion of the mandibular incisors, and treatment duration affected the periodontal changes. CONCLUSIONS The null hypothesis was rejected. Proclination of the mandibular incisors for decompensation in Class III surgery patients seems to result in labial alveolar bone recession and a decrease in width of attached gingiva. However, the amount of the periodontal recession appeared to be clinically insignificant.
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Affiliation(s)
- Yoon Jeong Choi
- Clinical Assistant Professor, Department of Orthodontics, Gangnam Severance Dental Hospital, College of Dentistry, The Institute of Craniofacial Deformity, Yonsei University, Seoul, Korea
| | - Chooryung J. Chung
- Associate Professor, Department of Orthodontics, Gangnam Severance Dental Hospital, College of Dentistry, The Institute of Craniofacial Deformity, Yonsei University, Seoul, Korea
| | - Kyung-Ho Kim
- Professor, Department of Orthodontics, Gangnam Severance Dental Hospital, College of Dentistry, The Institute of Craniofacial Deformity, Yonsei University, Seoul, Korea
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The effect of changes in lower incisor inclination on gingival recession. ScientificWorldJournal 2015; 2015:193206. [PMID: 25961071 PMCID: PMC4415674 DOI: 10.1155/2015/193206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 03/31/2015] [Indexed: 11/30/2022] Open
Abstract
Aim. Orthodontic treatment may promote development of recessions. The mechanism by which orthodontic treatment influences occurrence of recessions remains unclear. The aim of this study was to test the hypothesis that a change of mandibular incisor inclination promotes development of labial gingival recessions. Materials and Methods. The study sample comprised dental casts and lateral cephalograms obtained from 109 subjects before orthodontic treatment (Tb) and after orthodontic treatment (Ta). Depending on the change of lower incisor inclination during treatment, the subjects were divided into three groups: Retroclination (R), Stable Position (S), and Proclination (P). The presence of gingival recessions of mandibular incisors and clinical crown heights were assessed on plaster models. Results and Conclusions. From Tb to Ta, Inc_Incl showed a statistically significant change in the R, P, and S groups (p < 0.05). Increase of clinical crown heights of the lower incisors (42, 4, and 31) was not statistically significant in any group. The only statistically significant intergroup difference was the greater increase of the clinical crown height of tooth number 32 in the P group in comparison with the R group (p = 0.049). The change of lower incisor inclination during treatment did not lead to development of labial gingival recessions in the study sample.
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Renkema AM, Navratilova Z, Mazurova K, Katsaros C, Fudalej PS. Gingival labial recessions and the post-treatment proclination of mandibular incisors. Eur J Orthod 2014; 37:508-13. [DOI: 10.1093/ejo/cju073] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pancherz H, Bjerklin K. Mandibular incisor inclination, tooth irregularity, and gingival recessions after Herbst therapy: a 32-year follow-up study. Am J Orthod Dentofacial Orthop 2014; 146:310-8. [PMID: 25172253 DOI: 10.1016/j.ajodo.2014.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 02/01/2014] [Accepted: 02/01/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the very long-term results after Herbst treatment with respect to changes in the mandibular incisor segment: incisor inclination, incisor alignment, and gingival status. METHODS Fourteen patients were derived from a sample of 22 consecutive patients with Class II Division 1 malocclusions treated with the banded Herbst appliance. Intraoral photographs, mandibular dental casts, and lateral head films were analyzed from before (T1, age 12.5 years) and after (T2, age 14 years) treatment, and at 6 years (T3, age 20 years) and 32 years (T4, age 46 years) after treatment. RESULTS At T1, incisor inclination in the 14 subjects was, on average, 100.1°. From T1 to T2, the incisors were proclined in 11 (79%) of the 14 patients, with an average value of 5.2°. Maximum proclinations of 10° were found in 2 subjects. From T2 to T4, tooth inclination recovered completely in 7 (63%) of the 11 patients. Incisor irregularity values were, on average, 3.4 mm at T1 and 3.0 mm at T2. These increased from T2 to T4 by 40% and had an average value of 5.0 mm at T4. Clinically insignificant labial gingival recessions on single front teeth were registered in 1 subject at T2 and in 8 subjects at T4. Gingival recessions were seen especially on bodily displaced incisors. CONCLUSIONS In Herbst patients followed for 32 years after therapy, proclined mandibular incisors generally rebounded. The increase in posttreatment incisor tooth irregularity was not thought to be related to incisor tooth inclination changes but more likely resulted from physiologic processes occurring throughout life. Minor gingival recessions (especially on bodily displaced and crowded canines and incisors) seen in a few patients, 32 years after treatment, seemed not to be related to the posttreatment tooth inclination changes.
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Affiliation(s)
- Hans Pancherz
- Professor and chair emeritus, Department of Orthodontics, University of Giessen, Giessen, Germany.
| | - Krister Bjerklin
- Associate professor, Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Pandis N, Fleming PS, Kloukos D, Polychronopoulou A, Katsaros C, Eliades T. Survival of bonded lingual retainers with chemical or photo polymerization over a 2-year period: a single-center, randomized controlled clinical trial. Am J Orthod Dentofacial Orthop 2013; 144:169-75. [PMID: 23910197 DOI: 10.1016/j.ajodo.2013.02.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this trial was to compare the survival rates of mandibular lingual retainers bonded with either chemically cured or light-cured adhesive after orthodontic treatment. METHODS Patients having undergone orthodontic treatment at a private orthodontic office were randomly allocated to fixed retainers placed with chemically cured composite or light-cured composite. Eligibility criteria included no active caries, restorations, or fractures on the mandibular anterior teeth, and adequate oral hygiene. The main outcome was any type of first-time lingual retainer breakage; pattern of failure (adapted adhesive remnant index scores) was a secondary outcome. Randomization was accomplished with random permuted blocks of 20 patients with allocation concealed in sequentially numbered, opaque, sealed envelopes. Blinding was applicable for outcome assessment only. Patients were reviewed at 1, 3, and 6 months and then every 6 months after placement of the retainer until completion of the study. Data were analyzed using survival analysis including Cox regression; sensitivity analysis was carried out after data imputation for subjects lost to follow-up. RESULTS Two hundred twenty patients (median age, 16 years; interquartile range, 2; range, 12-47 years) were randomized in a 1:1 ratio to either chemical or light curing. Baseline characteristics were similar between groups, the median follow-up period was 2.19 years (range, 0.003-3.64 years), and 16 patients were lost to follow-up. At a minimum follow-up of 2 years, 47 of 110 (42.7%) and 55 of 110 (50.0%) retainers had some type of failure with chemically cured and light-cured adhesive, respectively (log-rank test, P = 0.35). Data were analyzed on an intention-to-treat basis, and the hazard ratio (HR) was 1.15 (95% confidence interval [CI], 0.88-1.70; P = 0.47). There was weak evidence that age is a significant predictor for lingual retainer failures (HR, 0.96; 95% CI, 0.93-1.00; P = 0.08). Adhesive remnant index scoring was possible for only 66 of the 102 (64.7%) failures and did not differ between composites (Fisher exact test, P = 0.16). No serious harm was observed other than gingivitis associated with plaque accumulation. CONCLUSIONS The results of this study indicated no evidence that survival of mandibular lingual retainers differs between chemically and light-cured adhesives. The overall failure rate was 46.4%; however, this included any type of failure, which may have exaggerated the overall failure rate.
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Affiliation(s)
- Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Medicine, University of Bern, Bern, Switzerland.
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Reichert C. Gingival recessions and the change of inclination of mandibular incisors during orthodontic treatment. J Orofac Orthop 2013. [DOI: 10.1007/s00056-013-0183-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johal A, Katsaros C, Kiliaridis S, Leitao P, Rosa M, Sculean A, Weiland F, Zachrisson B. State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting). Prog Orthod 2013; 14:16. [PMID: 24325787 PMCID: PMC4394408 DOI: 10.1186/2196-1042-14-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 07/02/2013] [Indexed: 11/10/2022] Open
Abstract
Background Controversy exists in the literature between the role of orthodontic treatment and gingival recession. Whilst movement of teeth outside the alveolar bone has been reported as a risk factor for gingival recession, others have found no such association. Findings The Angle Society of Europe devoted a study day to explore the evidence surrounding these controversies. The aim of the day was for a panel of experts to evaluate the current evidence base in relation to either the beneficial or detrimental effects of orthodontic treatment on the gingival tissue. Conclusions There remains a relatively weak evidence base for the role of orthodontic treatment and gingival recession and thus a need to undertake a risk assessment and appropriate consent prior to the commencement of treatment. In further prospective, well designed trials are needed.
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Affiliation(s)
- Ama Johal
- Centre for Oral Growth and Development, 5th Floor, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Turner Street, Whitechapel, London E1 2AD, UK.
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Renkema AM, Fudalej PS, Renkema AAP, Abbas F, Bronkhorst E, Katsaros C. Gingival labial recessions in orthodontically treated and untreated individuals: a case - control study. J Clin Periodontol 2013; 40:631-7. [PMID: 23587032 DOI: 10.1111/jcpe.12105] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the long-term development of labial gingival recessions during orthodontic treatment and retention phase. MATERIAL AND METHODS In this retrospective case-control study, the presence of gingival recession was scored (Yes or No) on plaster models of 100 orthodontic patients (cases) and 120 controls at the age of 12 (T12 ), 15 (T15 ), 18 (T18 ), and 21 (T21 ) years. In the treated group, T12 reflected the start of orthodontic treatment and T15 - the end of active treatment and the start of retention phase with bonded retainers. Independent t-tests, Fisher's exact tests and a fitted two-part "hurdle" model were used to identify the effect of orthodontic treatment/retention on recessions. RESULTS The proportion of subjects with recessions was consistently higher in cases than controls. Overall, the odds ratio for orthodontic patients as compared with controls to have recessions is 4.48 (p < 0.001; 95% CI: 2.61-7.70). CONCLUSIONS Within the limits of the present research design, orthodontic treatment and/or the retention phase may be risk factors for the development of labial gingival recessions. In orthodontically treated subjects, mandibular incisors seem to be the most vulnerable to the development of gingival recessions.
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Affiliation(s)
- Anne Marie Renkema
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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