Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment

Investigating salivary matrix metalloproteinase-2 and matrix metalloproteinase-9 activity in fixed orthodontic-induced gingival enlargement

Background

Gingival enlargement (GE) is a common clinical observation among orthodontic patients, yet its underlying causes remain unclear. This study aims to investigate the potential involvement of salivary matrix metalloproteinase (MMP)-2 and MMP-9 activity in orthodontic-induced GE.

Materials and Methods

In this case-control study, we enrolled 50 subjects, including 25 individuals with GE and 25 without. The participants, aged 10-35 years, were in the 4th or 5th month of their orthodontic treatment. Comprehensive clinical assessments, encompassing plaque index, gingival index, and GE score were performed, and saliva samples were subjected to gelatin zymography to assess enzyme activity. Statistical analysis, including the Chi-square test for age distribution, independent samples t-test for age comparison between study groups, Mann-Whitney U test for MMP activity comparison, and Wilcoxon signed-rank test for comparison of data from the 4th to 5th months of treatment, was performed using SPSS version 23.0, with a significance level set at 0.05.

Results

MMP-2 activity was undetectable in the zymograms. In the 4th month of treatment, MMP-9 activity was more prominent in the case group, though this disparity did not reach statistical significance in the 5th month. Furthermore, MMP-9 activity did not exhibit a correlation with the GE score.

Conclusion

The activity of MMP-9 in the saliva of orthodontic patients with GE increases during the 4th month of treatment, but no correlation exists with the degree of GE.

Gingival Enlargement Associated with Orthodontics Appliance Increases Protein Carbonylation and Alters Phosphorylation of Salivary Proteome

Gingival enlargement is a common clinical sign in the gingival diseases associated with orthodontic treatment. Its biological mechanisms are not completely understood; nevertheless, the biochemical changes associated with these inflammatory and overgrowth processes could alter the post-translational protein modifications occurring in various locations within the mouth. Here, changes in the profiles of the carbonylated and phosphorylated proteins in saliva were examined in donors with gingival enlargement (seven men and seven women) and healthy donors (six men and eight women). The sociodemographic characteristics of both groups did not present significant differences. Carbonylation was measured by a quantitative immunoassay (Dot Blot), whereas the profiles of the phosphorylated proteins were visualized by SDS-PAGE with quercetin staining. Some phosphopeptides were also identified using a typical LC-MS-MS approach. Our results showed that gingival enlargement induced a significant increase in oxidative damage in salivary proteins. While a significant reduction in phosphorylation was observed at the stain level in SDS-PAGE, there was a slight increase in the number of phosphorylated proteins identified by MS in samples with gingival enlargement.

Supragingival microbiome variations and the influence of Candida albicans in adolescent orthodontic patients with gingivitis

Introduction

Gingivitis is a prevalent complication in adolescents undergoing fixed orthodontic treatments. However, changes in the supragingival microbiome associated with gingivitis and the impact of Candida albicans remain elusive. Therefore, we investigated supragingival microbiome discrepancy and C. albicans colonization in adolescent orthodontic patients with gingivitis.

Methods

Dental plaques were collected from 30 gingivitis patients and 24 healthy adolescents, all undergoing fixed orthodontic treatment. The supragingival microbiome composition was analyzed using 16S rRNA sequencing. C. albicans colonization was determined using fungal culture and real-time quantitative polymerase chain reaction.

Results

Our analysis revealed significantly heightened microbial diversity in the Gingivitis group. Notably, patients with gingivitis exhibited an enrichment of periodontal pathogens, such as Saccharibacteria (TM7) [G-1], Selenomonas, Actinomyces dentalis, and Selenomonas sputigena. Additionally, 33% of the gingivitis patients tested positive for C. albicans, exhibiting significantly elevated levels of absolute abundance, while all healthy patients tested negative. Significant differences in microbial composition were also noted between C. albicans-positive and -negative samples in the Gingivitis group.

Conclusion

Significant disparities were observed in the supragingival microbiome of adolescent orthodontic patients with and without gingivitis. The presence of C. albicans in the supragingival plaque may alter the microbiome composition and potentially contribute to gingivitis pathogenesis.

Management of Orthodontic-Induced Gingival Enlargement: A Case Report

The aetiology of gingival enlargement (GE) is highly distinct. Plaque-induced gingival inflammation can be the sole reason for gingival enlargement. Poor dental hygiene, irritation from anatomical variations, and ineffective restorative and orthodontic appliances are all factors that encourage the formation and retention of plaque. In the given case report, a case of gingival enlargement associated with an orthodontic appliance of a 23-year-old female patient referred from the Department of Orthodontics was reported to the Department of Periodontics. Under local anaesthesia, the excess gingival tissue is removed using a scalpel by gingivectomy and gingivoplasty procedures. The gingivectomy and gingivoplasty procedures using a scalpel gave the best results in the orthodontic treatment associated with gingival enlargement. After achieving hemostasis, the periopack (Coe-pack) was placed to assist healing by protecting the tissue. The above case report can appreciate the gingival tissue covering almost half of the crown, causing plaque retention and presenting the patient with aesthetic concerns. After the surgical procedure, a proper gingival contour eliminates suprabony pockets and provides pleasant esthetics. This case report demonstrates that eliminating the suprabony pockets by gingivectomy and gingivoplasty leads to a physiologic gingival contour and eliminates plaque retention. The conventional scalpel gingivectomy procedure is an effective form of treatment when indicated.

Gingivectomy with Diode Laser Versus the Conventional Scalpel Surgery and Nonsurgical Periodontal Therapy in Treatment of Orthodontic Treatment-Induced Gingival Enlargement: A Systematic Review

Background and objective: Some studies support the superiority of diode laser gingivectomy to scalpel surgery and nonsurgical treatments. However, a systematic review on this topic is lacking. This study aimed to compare gingivectomy with diode laser versus the conventional scalpel surgery and nonsurgical periodontal therapy (NSPT) in the treatment of orthodontic treatment-induced gingival enlargement (GE). Materials and methods: In this systematic review, an electronic search of the relevant literature was conducted in Web of Science, Medline/PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ProQuest with no language restriction. Randomized clinical trials published between 1985 and 2020 on comparative treatment of orthodontic treatment-induced GE by diode laser gingivectomy and scalpel surgery or NSPT regarding intraoperative and postoperative bleeding and/or pain were included. Risk of bias was assessed by the Cochrane 1 tool. Results: Of the initially retrieved 288 articles, 40 were duplicates and excluded; 236 articles were excluded following title and abstract screening, and 5 others were excluded following full-text assessment. Finally, 7 studies underwent systematic review. In the risk-of-bias assessment, 5 studies scored 2, and 2 studies scored 3 out of 6. Intraoperative and postoperative bleeding and pain were found to be significantly lower in the laser group. Conclusions: Within the limitations of this systematic review and with respect to the quality of evidence, the present results revealed lower level of pain and bleeding in diode laser gingivectomy compared with the conventional scalpel surgery and NSPT for treatment of orthodontic treatment-induced GE.

Complications and treatment errors involving periodontal tissues related to orthodontic therapy

In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.

A Novel Coating of Orthodontic Archwires with Chlorhexidine Hexametaphosphate Nanoparticles

Statement of the Problem. The use of orthodontic fixed appliances may adversely affect oral health leading to demineralizing lesions and the development of gingival problems. Aims of the Study. The study aimed to coat orthodontic archwires with chlorhexidine hexametaphosphate nanoparticles (CHX-HMP NPs) and to evaluate the elusion of CHX from CHX-HMP NPs. Materials and Methods. A solution of CHX-HMP nanoparticles with an overall concentration of 5 mM for both CHX and HMP was prepared, characterized (using atomic force microscope and Fourier transformation infrared spectroscopy), and used to coat orthodontic stainless steel (SSW) and NiTi archwires (NiTiW). The coated segments were characterized (using scanning electron microscopy SEM with energy dispersive X-ray spectrometry and field emission SEM) and subjected to the elusion assessment. Results. After having their composition validated, the average size of the CHX-HMP NPs was assessed to be 51.21 nm, and the analysis revealed that the particles had both chlorine and phosphorus. After 30 minutes in the coating solution, NPs deposited on the surface of the SSW and NiTiW. A continuous release of soluble CHX in artificial saliva was detected from both SSW and NiTiW as long as the experiment lasted for 28 days without reaching a plateau. However, the release from coated NiTiW was significantly more than coated SSW at 7, 14, and 28 days. While at day 21, the release from coated SSW was slightly greater than that from the coated NiTiW. Conclusion. Orthodontic stainless steel and NiTi archwires can be successfully coated with CHX-HMP NPs and give sustained release of CHX along the examined period.

Clinical, histopathological and immunohistochemical changes of the superficial marginal periodontium caused by orthodontic treatment with fixed metallic orthodontic appliances

Malocclusions negatively influence dental function, physical well-being, and quality of life. According to data provided by the World Health Organization (WHO), malocclusions represent the third most widespread oral health problem, after dental caries and periodontal diseases. In recent years, more and more people call for orthodontic treatment with fixed braces that aim at establishing a dental, aesthetic, and functional balance, compatible with a normal life. Our study assessed the histopathological and immunohistochemical changes that occurred in superficial marginal periodontal components, in a number of 23 patients diagnosed with malocclusions, as a result of orthodontic treatment with fixed metal braces. The purpose of the study was to evaluate the remodeling of the tissues in the superficial periodontium during orthodontic migration, microscopic aspects that are essential to evaluate the effectiveness of the orthodontic treatment.

Comprehensive evaluation of factors that induce gingival enlargement during orthodontic treatment: A cross-sectional comparative study

Background

Gingival enlargement (GE) is one of the most common soft tissue problems encountered during fixed orthodontic treatment. Aims: This study aimed to evaluate the factors affecting GE in adolescents and young adults, compared with their normal peers.

Subjects and Methods

This is a cross-sectional comparative study. The sample consisted of 329 subjects (ages 10-30 years) of both genders, which was divided into four main groups: The control group (G0) with no orthodontic treatment; subjects who underwent orthodontic treatment were divided according to treatment duration into G1 (4-12 months), G2 (13-24 months), and G3 (>24 months). The clinical examinations included the level of debris, calculus (simplified oral hygiene), and GE indices. Regression analyses were used to assess the GE association in all the studied groups.

Results

The mean GE score increased significantly with increased treatment duration (0.42 ± 0.29 for G0 and 1.03 ± 0.52 for G3). GE scores of the lower arch were significantly higher in the anterior segment than in the posterior segment among all treatment groups. Regression analysis revealed that gender, age, oral hygiene, and treatment duration had a significant effect on GE (P < 0.05), while angle classification, overjet, overbite, treatment stage, bracket type, and therapeutic extraction did not show significant associations (P > 0.05).

Conclusion

Gender, age, oral hygiene, and treatment duration were the most important risk factors for GE during fixed orthodontic treatment.

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

Background:

Prime components of fixed orthodontic treatments decrease the self-cleansing ability of the tongue and the cheeks leading to an increase in production of bacterial plaque. Hence, the present study was undertaken for assessing the effect of fixed orthodontic treatment on gingival health.

Materials and Methods:

A total of 120 patients who were scheduled orthodontic treatment were enrolled. Complete data records of all the patients were recorded. Intra- and extraoral radiographs were obtained and photographic records were noted in separate pro forma. Complete intraoral examination of all the patients was carried out for recording visible plaque, any inflammation (visible clinically), and gingival recession. Based on the assessment of gingival texture and capillary transparency, analysis of gingival biotype was done. Follow-up records were assessed.

Results:

The mean visible plaque value before treatment and after treatment was found to be 3.11 and 5.81, respectively. The mean visible inflammation value before treatment and after treatment was found to be 2.89 and 15.43, respectively. The mean gingival recession score value before treatment and after treatment was found to be 0.19 and 0.383, respectively. A significant increase in the visible plaque value, visible inflammation value, and gingival recession score was observed posttreatment. While comparing the gingival biotype, it was seen that in both the maxillary and mandibular arches, there was an increase in the thick gingival biotype while there was a decrease in thin maxillary biotype.

Conclusion:

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

Prioritization of predisposing factors of gingival hyperplasia during orthodontic treatment: the role of amount of biofilm

Background

The mechanism of gingival growth that may occur during fixed orthodontic treatment is not yet fully understood and the amount of dental plaque is often incriminated. The objective of this study was to evaluate the prevalence of gingival growth during multi-attachment orthodontic treatment and to prioritize its predicting factors, especially the quantity of biofilm.

Methods

This comprehensive cross-sectional descriptive study was conducted on orthodontic patients aged 9 to 30 years, in good health, treated by a fixed appliance. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, periodontal phenotype and gingival enhancement index were recorded. Likewise, the brushing habits and the date of the last scaling were noted. The orthodontic parameters studied were the duration of the treatment, the type of bracket, the alloys used for the arches and the type of ligatures. Descriptive statistics were carried out, and variables presenting p value < 0.25 were included in a multivariate analysis to calculate the Odds Ratio (OR) of gingival enlargement”.

Results

A total of 193 patients were included (16.38 ± 4.89 years). Gingival growth occurred for 49.7% of patients included. The predisposing factors for this pathology during fixed orthodontic treatment were conventional metal brackets (p = 0.021), mouth breathing (p = 0.040), male gender (p = 0.035), thick periodontal phenotype (p = 0.043), elastomeric ligations (p = 0.007), duration of treatment (p = 0.022) and presence of plaque (p = 0.004). After achievement of the logistic regression, only two factors remained related to gingival enlargement: metallic brackets (OR: 3.5, 95% CI: 1.1–10.55) and duration of treatment (OR: 2.03, 95% CI: 1.01–4.08). The amount of plaque would not be directly related to the development of gingival increase during orthodontic treatment.

Conclusions

Among the predisposing factors that underlie gingival growth during multi-attachment therapy, the amount of plaque is not found. The qualitative assessment of the plaque and its evolution during treatment could clarify the role of the biofilm in the occurrence of gingival overgrowth.

Quantification of matrix metalloproteinases MMP-8 and MMP-9 in gingival overgrowth

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Protein dot-blot method is suitable to compare expression levels of MMP-8 and MMP-9 in gums.

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The relative levels of MMP-8 and MMP-9 in mild and moderate gingival overgrowth were measured.

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Biological variability among individuals did not affect assay development.

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The protein dot blot was fast, highly sensitive, repeatable and economic.

Background

Matrix metalloproteinases (MMPs) are proteolytic enzymes involved in extracellular matrix remodeling of all body tissues, including oral tissues such as gingival tissue. Expression levels of MMPs are widely studied as important biomarkers for explaining the biochemical mechanisms and evolution of many oral diseases.

Objective

Demonstrate the sensitivity, reproducibility, repeatability, and robustness of the dot blot assay for the relative quantification of MMP-8 and MMP-9 expression levels in patients with GO associated with orthodontic treatment.

Methods

A validated dot blot assay was used to compare the relative expression levels of MMP-8 and MMP-9 in gingival samples. Methodological variability, reproducibility, sensitivity and robustness were determined with the use of control samples from healthy donors (G1). Next, expression levels were measured in gingival tissue from patients with mild and moderate gingival overgrowth associated with orthodontic treatment (G3 and G4) and patients without gingival overgrowth but with a history of using orthodontic appliances (G2).

Results

Dot blot assay demonstrated that MMP-8 and MMP-9 expression levels were higher in patients with gingival overgrowth and distinguished those with moderate clinical grade (G4) from those with mild overgrowth (G3). In addition, patients with a history of orthodontic treatment showed similar expression levels to the control group two years after removing orthodontic appliances.

Conclusions

With the assay used, we were able to detect differences in MMP-8 and MMP-9 expression in patients with different levels of severity of gingival overgrowth. Dot blot could be used to measure MMPs during the onset and progression of gingival overgrowth.

Conventional versus laser gingivectomy in the management of gingival enlargement during orthodontic treatment: a randomized controlled trial

OBJECTIVES

To compare the use of diode laser with conventional surgery evaluating the effectiveness of gingivectomy as an adjunct to non-surgical periodontal treatment in the management of gingival enlargement (GE) during orthodontic treatment.

TRIAL DESIGN

Prospective three-arm parallel group randomized clinical trial with 1:1:1 allocation ratio.

METHODS

Sixty subjects (33 males and 27 females), with a mean age of 14.4 ± 1.9 years, were selected according to inclusion criteria: overgrown gingivae on the labial side of the anterior teeth secondary to fixed appliance therapy, six maxillary anterior teeth present, and healthy non-smokers patients. Patients were enrolled in the study and randomly assigned to three groups by a computer-generated randomization list and by a block size of 4. The allocation information was concealed in opaque and sealed envelopes by the statistician. In the first group, all subjects underwent a conventional scalpel gingivectomy of the maxillary anterior sextant. In the second group, all subjects were treated using laser-assisted gingivectomy; while subjects assigned to the third group underwent only non-surgical periodontal treatment and served as control group (CG). The observer who performed all the measurements was blinded to the group assignment. Blinding was obtained by eliminating from the elaboration file every reference to patient group assignment. Intergroup comparisons of changes in the periodontal parameters were conducted at 1, 3, and 6 months using ANOVA with repeated measures and Tukey's post hoc tests. The significance level was set at P <0.05.

RESULTS

After 1 month, the TGs showed a significant improvement of all periodontal parameters when compared with the CG. No statistically significant differences were observed between the two TGs. At the 3-month observation, a relapse occurred in the TGs, while the CG showed the greater improvement of soft tissue health. In the 6-month versus 3-month evaluation, no significant differences between the three groups were found for any periodontal measurements. In the long-term evaluation (6 months versus baseline), a significant greater reduction of pockets were found in the TGs when compared with the CG.

CONCLUSIONS

The adjunct use of both scalpel gingivectomy and laser gingivectomy was more effective in controlling gingival inflammation than non-surgical periodontal treatment alone at 1, 3 and 6 months. In the control group, greater improvement in the periodontal parameters were observed within 3 months, depending on a self-care approach for the management of GE.

LIMITATIONS

This study was a short-term study (6-month follow-up).

TRIAL REGISTRATION

ClinicalTrials.gov (registration number: NCT03514316).

Healing without Surgery: A Case of Supernumerary Tooth,

Background:

Supernumerary teeth are present in 0,2-3% of the population. Multiple supernumeraries are often associated with syndromes such as cleidocranial dysplasia and Gardner's syndrome. They often hinder the permanent eruption’s teeth, causing cavities, periodontal lesions, pulp necrosis, and in some cases follicular cysts. Reactive lesions such as fibroma, local fibrous hyperplasia, pyogenic granuloma, and peripheral ossifying fibroma are frequent gingival lesions.

Materials and Methods:

We reported a case of a 9 years old patient with the missed eruption of a permanent element caused by a supernumerary tooth, associated with an exophytic palatine lesion. The deciduous incisor was still present and the supernumerary included. It was decided to proceed with the extraction of the deciduous and to wait for scheduling checks every two months. After a few months, the conoid shape supernumerary tooth erupted in the maxillary arch, so a fixed orthodontic therapy was performed to create the space for the central incisor’s eruption.

Results:

After a few months, the tooth began to erupt in the arch thanks to orthodontic traction. The patient was instructed to correct and specific oral hygiene maneuvers to lower the plaque index and try to reduce gingival hypertrophy.

Conclusion:

Supernumerary teeth often hinder the eruption and development of the related permanent tooth causing localized periodontal problems. Corrective fixed orthodontics requires more strict oral hygiene to avoid periodontal complications.

Elements of morphology: Standard terminology for the teeth and classifying genetic dental disorders

Dental anomalies occur frequently in a number of genetic disorders and act as major signs in diagnosing these disorders. We present definitions of the most common dental signs and propose a classification usable as a diagnostic tool by dentists, clinical geneticists, and other health care providers. The definitions are part of the series Elements of Morphology and have been established after careful discussions within an international group of experienced dentists and geneticists. The classification system was elaborated in the French collaborative network "TÊTECOU" and the affiliated O-Rares reference/competence centers. The classification includes isolated and syndromic disorders with oral and dental anomalies, to which causative genes and main extraoral signs and symptoms are added. A systematic literature analysis yielded 408 entities of which a causal gene has been identified in 79%. We classified dental disorders in eight groups: dental agenesis, supernumerary teeth, dental size and/or shape, enamel, dentin, dental eruption, periodontal and gingival, and tumor-like anomalies. We aim the classification to act as a shared reference for clinical and epidemiological studies. We welcome critical evaluations of the definitions and classification and will regularly update the classification for newly recognized conditions.

Effects of crown movement on periodontal biotype: a digital analysis

Orthodontic treatment has important correlations with periodontal changes. Various mechanical and biological factors are involved in determining such changes, but anatomical and morphological variables, generally addressed as periodontal biotype, play a key role. In measurement of such modifications, digital and non-contact reverse engineering technologies may be of tremendous advantage. The aim of this study is to retrospectively evaluate, in a series of digitized dental casts, some of the parameters addressing periodontal biotype and correlate them to extent and direction of tooth movement. Pre- (T0) and post-treatment (T1) dental casts of 22 patients were scanned by 3Shape TRIOS 3® scanner. A number of variables (crown ratio, gingival margin position, gingival contour, papillae position, gingival scallop) were investigated and their variations calculated after digital measurements on single casts at T0 and T1, or after direct measurement (T1 vs T0) on the superimposition and alignment of digital models. Univariate and multivariate statistics were then performed. No significant correlation was detected between the sagittal or vertical movement of dental crown and displacement of the gingival margin. On the other hand, vestibular gingival contour resulted significantly altered by vestibular and extrusion movements. Further studies are needed to ascertain the differential effect of bone and soft tissue on such modifications. The relationship between orthodontic treatment and the periodontium overcomes the consideration of gingival recession and includes all the concepts of periodontal biotype with its characteristics. Digital technologies and non-contact reverse engineering techniques now available have the potential to allow a more precise definition of such a relationship.

Prevalence of fimA genotypes of Porphyromonas gingivalis in adolescent orthodontic patients

Background

The placement of fixed orthodontic appliances may alter the composition of oral microbiota and has the potential risk of periodontal complication. Porphyromonas gingivalis fimbriae play a critical role in colonization of P. gingivalis in subgingival regions. In this study, we investigated the association between the prevalence of P. gingivalis-specific fimA genotypes and periodontal health status in adolescent orthodontic patients, to identify the pathogencity of P. gingivalis during orthodontic therapy.

Methods

Sixty-one adolescent orthodontic patients were enrolled in the case group, while the control group consisted of 56 periodontally healthy adolescents. At baseline (T0), clinical parameter (gingival index) was tested, and subgingival plaque samples were obtained from the lower incisors. The incidences of P. gingivalis and fimA genotypes were detected by polymerase chain reaction. All parameters were reassessed after 1 month (T1), 2 months (T2), 3 months (T3), and 6 months (T4) in the case group and then compared with those of the controls.

Results

Both microbiological and clinical parameters from orthodontic patients started to increase after placement of fixed appliances. Maximum values were reached at 3 months after placement and followed by their decreases at six months. However, the microbiological and clinical parameters in the case group were significantly higher than those of the control group. The GI of fimA II, IV-positive samples was significantly higher than that of negative samples.

Conclusion

P. gingivalis carrying fimA II or IV was closely related to orthodontic gingivitis. In addition, proper oral hygiene control could lead to little increase in dental plaque accumulation, and exert a beneficial effect to periodontal tissues.

Gingival enlargement in orthodontic patients: Effect of treatment duration

INTRODUCTION

In this study, we aimed to assess the effect of the duration of fixed orthodontic treatment on gingival enlargement (GE) in adolescents and young adults.

METHODS

The sample consisted of 260 subjects (ages, 10-30 years) divided into 4 groups: patients with no fixed orthodontic appliances (G0) and patients undergoing orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Participants completed a structured questionnaire on sociodemographic characteristics and oral hygiene habits. Clinical examinations were conducted by a calibrated examiner and included the plaque index, the gingival index, and the Seymour index. Poisson regression models were used to assess the association between group and GE.

RESULTS

We observed increasing means of plaque, gingivitis, and GE in G0, G1, and G2. No significant differences were observed between G2 and G3. Adjusted Poisson regression analysis showed that patients undergoing orthodontic treatment had a 20 to 28-fold increased risk for GE than did those without orthodontic appliances (G1, rate ratio [RR] = 20.2, 95% CI = 9.0-45.3; G2, RR = 27.0, 95% CI = 12.1-60.3; G3 = 28.1; 95% CI = 12.6-62.5).

CONCLUSIONS

The duration of orthodontic treatment significantly influenced the occurrence of GE. Oral hygiene instructions and motivational activities should target adolescents and young adults undergoing orthodontic treatment.