Determination of Gingival Phenotype and Gingival Recession Type in Patients Postorthodontic Treatment

Abstract

Purpose: Gingival recession is a commonly reported symptom following orthodontic treatment, for which identification is crucial to therapeutic management. The aims of this study were to determine the frequency of recession occurring after orthodontic treatment, assess the gingival phenotype in patients with recession, and investigate the various types of recession. Materials and Methods: This study involved 80 patients aged 18-65 years who had completed fixed orthodontic treatment, and they were categorized into two groups based on the presence of gingival recession. Periodontal indices were obtained for all patients. Patients with gingival recession had assessments taken for gingival recession depth, gingival recession width, gingival tissue thickness, and keratinized gingival width. Statistical analyses were performed with a significance level of p<0.05 to compare participants with and without gingival recession. Results: Patients with gingival recession exhibited significantly lower rates of gingivitis than those without gingival recession. Tooth number 31 exhibited the highest incidence of gingival recession, at 31.2%. Gingival recession was observed in 93.5% of Cairo Class 1 patients. Among the participants, 51.9% had a thin gingival phenotype, while 48.1% had a thick phenotype. Conclusion: To minimize the risk of gingival recession and maintain periodontal health, the study highlights the need for careful evaluation and preventive actions throughout and following orthodontic treatment.

Keywords

• gingival recession
• gingivitis
• orthodontics

References

1. Periodontology AAo. Glossary of Periodontal Terms. American Academy of Periodontology; 1992.
2. Aziz T, Flores-Mir C. A systematic review of the association between appliance-induced labial movement of mandibular incisors and gingival recession. Aust Orthod J. 2011;27(1):33–39. doi:10.2478/aoj-2011-0007.
3. Lindhe J. Textbook of Clinical Periodontology. John Wiley & Sons, Limited; 1989.
4. Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972;43(10):623–627. doi:10.1902/jop.1972.43.10.623.
5. Ong MM, Wang HL. Periodontic and orthodontic treatment in adults. Am J Orthod Dentofacial Orthop. 2002;122(4):420–428. doi:10.1067/mod.2002.126597.
6. Liu Y, Li CX, Nie J, Mi CB, Li YM. Interactions between Orthodontic Treatment and Gingival Tissue. Chin J Dent Res. 2023;26(1):11–18. doi:10.3290/j.cjdr.b3978667.
7. Kim DM, Neiva R. Periodontal soft tissue non-root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015;86(2 Suppl):S56–S72. doi:10.1902/jop.2015.130684.
8. Saravanan R, Neelofar Begum A, Helen Gracy M. Orthodontic Treatment Induced Gingival Recession- A Review on Impact and Treatment Outcomes. IJRAMR. 2021;2(8):81–84.

9. Dorfman HS. Mucogingival changes resulting from mandibular incisor tooth movement. Am J Orthod. 1978;74(3):286–297. doi:10.1016/0002-9416(78)90204-x.
10. Ciavarella D, Tepedino M, Gallo C, Montaruli G, Zhurakivska K, Coppola L, et al. Post-orthodontic position of lower incisors and gingival recession: A retrospective study. J Clin Exp Dent. 2017;9(12):e1425–e1430. doi:10.4317/jced.54261.
11. Vasconcelos G, Kjellsen K, Preus H, Vandevska-Radunovic V, Hansen BF. Prevalence and severity of vestibular recession in mandibular incisors after orthodontic treatment. Angle Orthod. 2012;82(1):42–47. doi:10.2319/021411-108.1.
12. Renkema AM, Fudalej PS, Renkema AA, Abbas F, Bronkhorst E, Katsaros C. Gingival labial recessions in orthodontically treated and untreated individuals: a case - control study. J Clin Periodontol. 2013;40(6):631–637. doi:10.1111/jcpe.12105.
13. Renkema AM, Fudalej PS, Renkema A, Bronkhorst E, Katsaros C. Gingival recessions and the change of inclination of mandibular incisors during orthodontic treatment. Eur J Orthod. 2013;35(2):249–255. doi:10.1093/ejo/cjs045.
14. 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(1):19–26. doi:10.1556/1646.9.2017.42.
15. 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(5):528–544. doi:10.1093/ejo/cjad026.
16. Emanuel EJ. Reconsidering the Declaration of Helsinki. Lancet. 2013;381(9877):1532–1533. doi:10.1016/s0140-6736(13)60970-8.
17. Silness J, Löe H. Periodontal Disease in Pregnancy II. Correlation Between Oral Hygiene and Periodontal Condition. Acta Odontologica Scandinavica. 1964;22(1):121–135. doi:10.3109/00016356408993968.
18. Löe H, Silness J. Periodontal Disease in Pregnancy. I. Prevalence and Severity. Acta Odontol Scand. 1963;21:533–551. doi:10.3109/00016356309011240.
19. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229–235.
20. Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011;38(7):661–666. doi:10.1111/j.1600-051X.2011.01732.x.
21. Jepsen K, Sculean A, Jepsen S. Complications and treatment errors involving periodontal tissues related to orthodontic therapy. Periodontol 2000. 2023;92(1):135–158. doi:10.1111/prd.12484.
22. Renkema AM, Navratilova Z, Mazurova K, Katsaros C, Fudalej PS. Gingival labial recessions and the post-treatment proclination of mandibular incisors. Eur J Orthod. 2015;37(5):508–513. doi:10.1093/ejo/cju073.
23. Gebistorf M, Mijuskovic M, Pandis N, Fudalej PS, Katsaros C. Gingival recession in orthodontic patients 10 to 15 years posttreatment: A retrospective cohort study. Am J Orthod Dentofacial Orthop. 2018;153(5):645–655. doi:10.1016/j.ajodo.2017.08.020.
24. Boke F, Gazioglu C, Akkaya S, Akkaya M. Relationship between orthodontic treatment and gingival health: A retrospective study. Eur J Dent. 2014;8(3):373–380. doi:10.4103/1305-7456.137651.
25. Kumar V, Singh P, Arora VK, Kaur S, Sarin S, Singh H. Assessment of Effect of Orthodontic Treatment on Gingival Health: A Clinical Study. J Pharm Bioallied Sci. 2018;6(6):5–7. doi:10.4103/jpbs.JPBS_589_20.
26. Kumar V, Singh P, Arora VK, Kaur S, Sarin S, Singh H. Assessment of Effect of Fixed Orthodontic Treatment on Gingival Health: An Observational Study. J Pharm Bioallied Sci. 2021;13(Suppl 1):S425–S428. doi:10.4103/jpbs.JPBS_589_20.
27. Karacaoglu F, Gazioglu C, Akkaya S, Akkaya M. Are the effects of fixed orthodontic treatment on gingival health similar in adolescents and young adults. J Biomed Sci. 2016;6(1):5. doi:10.4172/2254-609X.100049.
28. Crego-Ruiz M, Jorba-García A. Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2023;28(4):e330–e340. doi:10.4317/medoral.25760.
29. Melsen B, Allais D. Factors of importance for the development of dehiscences during labial movement of mandibular incisors: a retrospective study of adult orthodontic patients. Am J Orthod Dentofac Orthop. 2005;127(5):552–561. doi:10.1016/j.ajodo.2003.12.026.
30. Randhawa GK. Correlation between Orthodontic Treatment and Periodontitis - A Clinical Study. J Adv Med Dent Scie Res. 2018;6(1):110–113. doi:10.21276/jamdsr.
31. Renkema AM, Navratilova Z, Mazurova K, Katsaros C, Fudalej PS. Gingival labial recessions and the post-treatment proclination of mandibular incisors. Eur J Orthod. 2015;37(5):508–513. doi:10.1093/ejo/cju073.
32. Joss-Vassalli I, Grebenstein C, Topouzelis N, Sculean A, Katsaros C. Orthodontic therapy and gingival recession: a systematic review. Orthod Craniofac Res. 2010;13(3):127–141. doi:10.1111/j.1601-6343.2010.01491.x.
33. 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(3):146–158. doi:10.5051/jpis.2020.50.3.146.
34. Djeu G, Hayes C, Zawaideh S. Correlation between mandibular central incisor proclination and gingival recession during fixed appliance therapy. Angle Orthod. 2002;72(3):238–245.
35. Abdelhafez RS, Talib AA, Al-Taani DS. The effect of orthodontic treatment on the periodontium and soft tissue esthetics in adult patients. Clin Exp Dent Res. 2022;8(1):410–420. doi:10.1002/cre2.480.
36. Closs LQ, Branco P, Rizzatto SD, Raveli DB, Rösing CK. Gingival margin alterations and the pre-orthodontic treatment amount of keratinized gingiva. Braz Oral Res. 2007;21(1):58–63. doi:10.1590/s1806-83242007000100010.
37. Sim HY, Kim HS, Jung DU, Lee H, Lee JW, Han K, et al. Association between orthodontic treatment and periodontal diseases: Results from a national survey. Angle Orthod. 2017;87(5):651–657. doi:10.2319/030317-162.1.