Effect of gingival biotype on orthodontic treatment-induced periodontal complications: A systematic review

Abstract

Background. It is crucial to maintain periodontal health in patients undergoing orthodontic treatment. Biotype is a critical factor to be considered in this regard. This systematic review investigated the scientific evidence on the relationship between gingival biotype and marginal periodontal alterations induced by orthodontic interventions. Methods. An electronic search was conducted for pertinent studies in three databases: PubMed, Scopus, and Cochrane up to August 1, 2019 based on a detailed protocol according to the PRISMA statement. The authors also completed a hand search in six dental journals and the bibliographic lists of the relevant studies. Results. Of 1512 citations retrieved through the electronic search, 602 were duplicate entries. By evaluating titles, abstracts, and full texts, eight articles conformed to the inclusion criteria; however, no relevant studies were found through hand searching. The evidence suggested that recession was inversely related with the thickness of the facial margin. These findings were more evident in proclined teeth and patients using fixed appliances. Conclusion. The existing evidence suggests that orthodontic therapy might result in mild detrimental effects on the periodontium, especially in patients with thin biotype. However, due to the limited investigations and their inconsistent methodology, further well-designed prospective studies are necessary.

Occlusal Contact Changes With Traumatic Occlusion After Orthodontic Treatment: A Prospective Study

“…Gingival biotype of lower anteriors was thin for almost 27 participants and thick for 13 participants which after orthodontic treatment showed that five participants had their gingival biotype reversed to normal from a thin biotype and the others did not have any difference at T1 (Table 1). A systematic review by Amid et al 17 studied the effects of orthodontic treatment on the periodontium and concluded that orthodontic treatment did have some mild detrimental effects on the periodontium especially in patients with thin gingival biotype. From Figure 3a–c, it is observed that the loss of gingival keratinization and thin gingival biotype with respect to the traumatized left central incisor has not reversed at the mid as well as post-orthodontic treatment (T1).…”

Periodontal phenotype modification in orthodontic patients

“…31 In the case of lingual movement, periodontal treatment can be postponed until after the completion of orthodontic movement. 2,6 Periodontal intervention during orthodontic therapy is justified in the case of progressive recessions in patients with KTW > 2 mm. 6 A recent systematic review reported a mean GT gain of 0.81 mm using collagen matrixes.…”

“…2,6 Periodontal intervention during orthodontic therapy is justified in the case of progressive recessions in patients with KTW > 2 mm. 6 A recent systematic review reported a mean GT gain of 0.81 mm using collagen matrixes. 32 As the mean increase in GT in this study was 2.02 ± 0.39 mm, it seems that the proposed method may be an efficient technique in soft tissue phenotype modification.…”

“…As the attachment level is minimal in the thin phenotype, it is more vulnerable to periodontal breakdown. Therefore, these patients may be prone to iatrogenic complications such as bony dehiscence leading to GR, dentine hypersensitivity, or tooth mobility 2,6 . Thus, hard and soft tissue conditions should be scrutinized before the inception of orthodontic tooth movement for risk stratification and management, and high‐risk patients may be warranted to receive phenotype modification therapy via hard and/or soft tissue augmentation 2 .…”

“…Therefore, these patients may be prone to iatrogenic complications such as bony dehiscence leading to GR, dentine hypersensitivity, or tooth mobility. 2,6 Thus, hard and soft tissue conditions should be scrutinized before the inception of orthodontic tooth movement for risk stratification and management, and high-risk patients may be warranted to receive phenotype modification therapy via hard and/or soft tissue augmentation. 2 Historically, autogenous soft and hard tissue grafts have been the gold standard because of favorable long-term results.…”