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Kumar MV, Kannan A, Kailasam V. Alveolar Bone and Gingival Changes in Mandibular Anterior Region Following Herbst Appliance Therapy: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2024; 17:114-120. [PMID: 38559862 PMCID: PMC10978510 DOI: 10.5005/jp-journals-10005-2715] [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] [Indexed: 04/04/2024] Open
Abstract
Objective To assess the alveolar bone changes and gingival recession following Herbst appliance therapy. Materials and methods Electronic databases such as PubMed, Ovid, Cochrane Library, Lilacs, Scopus, Web of Science, and Embase were searched until August 2022. Hand-searching of major orthodontic journals was performed to identify all peer-reviewed articles potentially relevant to the review. The quality of the selected studies was ranked using the revised Cochrane risk of bias tool for nonrandomized trials-Risk of Bias In Nonrandomized Studies (ROBINS) 1. Results Five relevant articles (all nonrandomized studies) were considered for qualitative analysis. The risk of bias was low for four studies and moderate for one. The reduction in the vertical alveolar bone height was 0.13 ± 0.07 mm, with the Herbst appliance. The mean difference in the loss of buccal cortical thickness between the Herbst appliance and untreated control group was 0.22 mm [95% confidence interval (CI) of -0.62-0.18]. Subsequent to Herbst appliance therapy, in the mandibular anterior region 0.1 ± 0.5 mm of gingival recession was observed. Conclusion Herbst appliance treatment produces a negligible reduction in the buccal cortical thickness, vertical alveolar bone height, and gingival recession. Clinical significance Though the changes produced by the Herbst appliance were minimal, they are clinically important considering the young age of the patients warranting periodic periodontal assessment. How to cite this article Kumar MV, Kannan A, Kailasam V. Alveolar Bone and Gingival Changes in Mandibular Anterior Region Following Herbst Appliance Therapy: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2024;17(1):114-120.
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Affiliation(s)
- Mrithulaa Vadivel Kumar
- Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Annapurna Kannan
- Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Vignesh Kailasam
- Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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Li Q, Li S, Xiao Q, Hu W, Xu L. Clinical investigation of gingival papilla recession after orthodontic treatment in adults. Clin Oral Investig 2023; 27:4425-4432. [PMID: 37289277 DOI: 10.1007/s00784-023-05061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/06/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the incidence, severity, susceptibility sites of gingival papillary recession (GPR) in adults after orthodontic treatment and the clinical impact of tooth extraction on GPR. METHODS A total of 82 adult patients were recruited and then divided into extraction and non-extraction groups according to whether the orthodontic teeth were extracted (teeth that needed to be extracted when performing orthodontic treatment). The gingival conditions of the two groups of patients before and after treatment were recorded using intraoral photos, and the incidence, severity and predilection sites of GPR after correction were investigated. RESULTS The results indicated that GPR occurred in 29 patients after correction, with an incidence rate of 35.4%. A total of 1648 gingival papillae were recorded among the 82 patients after correction, of which 67 exhibited atrophy, with an incidence of 4.1%. All occurrences of GPR were classified as papilla presence index 2 (PPI 2) (mild). The condition is most likely to occur in the anterior tooth area, especially in the lower incisor area. The results indicated that the incidence of GPR was substantially higher in the extraction group than in the non-extraction group, with the difference statistically significant. CONCLUSION Following orthodontic treatment, adult patients will have a certain proportion of mild GPR, which is more common in the anterior tooth area, especially the lower anterior tooth area.
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Affiliation(s)
- Qi Li
- Department of Orthodontics, Guiyang Hospital of Stomatology, Guiyang, 550002, China
| | - Shuo Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 of Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Qianwen Xiao
- Department of Orthodontics, Guiyang Hospital of Stomatology, Guiyang, 550002, China
| | - Wei Hu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 of Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
| | - Li Xu
- Department of Periodontology, Peking University School and Hospital of Stomatology, No. 22 of Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
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Zhang J, Liang Y, Chen R, Chen S, Lin J, Han B, Liu X. Inclination of mandibular incisors and symphysis in severe skeletal class III malocclusion. Head Face Med 2023; 19:16. [PMID: 37165461 PMCID: PMC10170675 DOI: 10.1186/s13005-023-00361-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE The aim of this study was to systematically explore the inclination of the lower central incisor and symphysis in alveolar bone in severe skeletal class III patients. MATERIALS AND METHODS A total of 198 severe skeletal class III patients (ANB ≤ -4°) who underwent combined orthodontic and orthognathic treatment were divided into three groups based on the mandibular plane angle (MP-SN). Pretreatment lateral cephalograms were analysed and compared among the three groups. We also assessed cone-beam computed tomography (CBCT) images of 11 samples to investigate the reliability of the cephalometric analysis. RESULTS ANOVA showed no statistically significant differences in the angle between the long axis of the mandibular symphysis and the long axis of the lower central incisor (MIA) among the low-angle, normal-angle and high-angle groups (P > 0.05), while significant differences were found in the angle between the axis of the lower incisor and the mandibular plane (IMPA) among the three groups (P < 0.001). The mean IMPA decreased with increasing MP-SN in the 198 patients. The mean MIA in the low-angle and normal-angle groups was 3.70° and 3.52°, respectively, while the value (2.33°) was smaller in the high-angle group. Paired-samples t test showed no statistically significant differences between the cephalometric and CBCT measurements of the MP-SN, the angle between the mandibular plane and the Frankfort plane (FH-MP) and the MIA (P > 0.05). CONCLUSIONS In severe skeletal class III patients, the long axis of the lower central incisor was highly consistent with the long axis of the mandibular symphysis, which was more obvious in the high-angle subjects. The MIA reflects the physiological inclination of the lower central incisor better than the IMPA.
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Affiliation(s)
- Jieni Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, China
| | - Yuqi Liang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, China
| | - Rui Chen
- Yuncheng Stomatological Hospital, Yuncheng, China
| | - Si Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, China
| | - Jiuxiang Lin
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, China
| | - Bing Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, China.
| | - Xiaomo Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, China.
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Orthodontic Loads in Teeth after Regenerative Endodontics: A Finite Element Analysis of the Biomechanical Performance of the Periodontal Ligament. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to analyse the stress distribution in the periodontal ligament and tooth structure of a cementum-reinforced tooth, a dentine-reinforced tooth and an immature tooth during orthodontic loads using a finite element analysis. A finite element model of a maxillary incisor and its supporting tissues was developed. The root was segmented into two parts: a part that represented a root in an immature state and an apical part that represented the tissue formed after regenerative endodontics. The apical part was given the mechanical properties of dentine or cementum. The three models underwent simulation of mesial load, palatal inclination and rotation. The mean stress values and stress distribution patterns of the periodontal ligament of the dentine- and cementum-reinforced teeth were similar in all scenarios. The maturation of the root, with either dentine or cementum, was beneficial for all scenarios, since the periodontal ligament of the immature tooth showed the highest mean stress values. Under the condition of this computational study, orthodontic loads can be applied in teeth previously treated with regenerative endodontics, since the distribution of stress is similar to those of physiologically mature teeth. In vivo studies should be performed to validate these results.
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Gingival Recessions and Periodontal Status after Minimum 2-Year-Retention Post-Non-Extraction Orthodontic Treatment. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The objectives of this study were to assess gingival recessions (GR) and periodontal status in patients previously treated with non-extraction orthodontic treatment and retention at a follow-up of a minimum of two years after the end of treatment. Data from patients aged between 16 and 35 years with a previous non-extraction orthodontic treatment and at least 2 years of retention and full records before and after treatment were collected. The casts were digitalized using the 3Shape TRIOS® intraoral scanner and the Viewbox4 software was used for the measurements. The following parameters were scored: inclination of the lower and upper incisors (IMPA and I^SN) and anterior crowding (Little index). The included patients were recalled for a clinical periodontal follow-up examination and the following parameters were evaluated: buccal and lingual GR (mm) of incisors and canines, bleeding of probing score, plaque score, and gingival phenotype. The digital cast analysis showed a mean Little index of 7.78 (SD 5.83) and 1.39 (SD 0.79), respectively, before and after treatment. The initial and final cephalometric analyses showed an I^SN of 103.53° and 105.78°(SD 7.21) and IMPA of 91.3°and 95.1°, respectively. At the follow-up periodontal visits, the patients showed an overall low oral hygiene with bleeding at probing in 66.6% and plaque in the anterior area in 76.2% of patients. From the total examined 240 teeth of the frontal sextants, three patients had GR (from 1 to 6.5 mm): in the upper arch two at canines and one at central incisor, whereas in the lower arch two at central and one at lateral incisors. The gingival phenotype was thick in 55% of cases. The lingual-to-lingual retainers at follow-up were present in 61.9% of patients. A slight increased risk for buccal GR development was found only in correlation with the presence of fixed retainer and thin gingival phenotype mainly in patients with gingivitis. Thus, non-extraction orthodontic treatment performed with controlled forces and biomechanics seems to not affect the development of GR or the periodontal health after retention.
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Moura W, Henriques JFC, Gambardela-Tkacz CM, Cotrin P, Garib D, Janson G. Mandibular incisor inclination and gingival recession after treatment with the Jasper Jumper: a 10-year follow-up. Prog Orthod 2021; 22:45. [PMID: 34957537 PMCID: PMC8710433 DOI: 10.1186/s40510-021-00389-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the long-term outcomes of Class II treatment with the Jasper Jumper appliance and comprehensive orthodontic treatment concerning inclination of the mandibular incisors and gingival recession. METHODS Sixteen patients with Class II malocclusion at a mean age of 12.54y (SD = 1.17) were treated with the Jasper Jumper appliance and comprehensive orthodontic treatment. The mean treatment time was 2.05y (SD = 0.21). Dental records were taken before (T1), after treatment (T2) and 11.90y (SD = 0.48) after debonding (T3). The frequency of gingival recession, clinical crown height and mandibular incisor position were evaluated using intraoral photographs, digital models and lateral cephalograms. Interphase changes were evaluated using dependent t and McNemar's tests. Correlation between clinical crown height and final position of the mandibular incisors was evaluated using Pearson correlation test (P < 0.05). RESULTS The frequency of gingival recessions increased over time and was observed in 6 (9.4%), 12 (18.8%) and 24 (37.5%) of the mandibular incisors at T1, T2 and T3, respectively. A significant increase in labial inclination and protrusion of the mandibular incisors was observed between T1 and T2 interval. The clinical crown height significantly increased in the follow-up period (T3-T2) and in the complete observation time (T3-T1). There was no correlation between the amount of labial inclination and protrusion of the mandibular incisors and clinical crown height for all time intervals. CONCLUSION No significant correlation between the amount of labial movement of the mandibular incisor and clinical crown height increase was found.
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Affiliation(s)
- Wilana Moura
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil.
| | - José Fernanado C Henriques
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
| | - Caroline M Gambardela-Tkacz
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
| | - Paula Cotrin
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
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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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Personalized Orthodontics: From the Sagittal Position of Lower Incisors to the Facial Profile Esthetics. J Pers Med 2021; 11:jpm11080692. [PMID: 34442336 PMCID: PMC8402232 DOI: 10.3390/jpm11080692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background: One of the goals of orthodontic treatment is to obtain maximum facial harmony. The sagittal position of the lower incisors plays a significant role in the planning of orthodontic treatment. The aim of the study was to evaluate the relationship between the sagittal position of lower incisors and facial profile esthetics with reference to the skeletal vertical dimension. Methods: There were 200 patients included in the study. Patients were allocated into three groups, depending on the vertical growth pattern: normal-angle, low-angle, and high-angle cases. Tweed–Merrifield cephalometric analysis was used to assess the sagittal and vertical position of the mandible, as well as to assess the sagittal position of the lower incisors. Results: Z-angle and Frankfort mandibular incisor plane angle (FMIA) decreased significantly (p < 0.001) with the increase of the skeletal vertical dimension. Incisor mandibular plane angle (IMPA) was significantly higher (p < 0.001) in low-angle patients compared to the high-angle ones. Z-angle appeared to be the most accurate parameter (area under curve, AUC = 0.957) describing patients with a convex profile. The cutoff value of Z-angle 68.0° was characterized by the sensitivity of 94.1% and the specificity of 84.3%. Conclusions: The sagittal position of the lower incisors significantly affects the facial profile convexity. The Z-angle is the parameter which most accurately describes the patients with a convex profile.
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Tepedino M, Franchi L, Fabbro O, Chimenti C. Post-orthodontic lower incisor inclination and gingival recession-a systematic review. Prog Orthod 2018; 19:17. [PMID: 29911278 PMCID: PMC6004340 DOI: 10.1186/s40510-018-0212-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present systematic review was carried out to determine the correlation between gingival recession/bone height and incisor inclination in non-growing post-orthodontic patients compared to adult untreated subjects or patients treated with different methodologies. MATERIALS AND METHODS PubMed, EMBASE, Web of Science, Scopus, Cochrane, and OpenGrey databases were searched without time and language restriction. Search terms included orthodontic, incisor, inclination, angulation, proclination, and gingival. Articles involving human participants and adult subjects receiving orthodontic treatment with fixed appliance, having incisors position, bone height and/or gingival recessions evaluated pre- and post-treatment were included. Two authors independently extracted data using predefined forms. Risk of bias in individual studies was assessed with the Newcastle-Ottawa Scale. RESULTS Two observational studies were included in the qualitative analysis. The heterogeneity in outcome assessment among the studies did not allow performing a meta-analysis. The two studies, while observing some effects of orthodontic treatment on the development of gingival recession, reported that these effects were not statistically or clinically significant. CONCLUSIONS There is no strong scientific evidence concluding that proclination of incisors by means of fixed orthodontic appliances can affect periodontal health. Further prospective studies are required to elucidate this statement. PROTOCOL PROSPERO database registration number CRD42016042369 .
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Affiliation(s)
- Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, Firenze, Italy
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, Università degli Studi di Firenze, Firenze, Italy.
| | - Omar Fabbro
- Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, Firenze, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, Firenze, Italy
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