Gingiva and Orthodontic Treatment

Abstract

Orthodontic appliances, as well as mechanical procedures, are prone to evoke local soft-tissue responses in the gingiva. These effects can either be of positive nature, (physiologic recontouring), helping tooth movement, or negative ones, which should be avoided. The main source of negative outcomes involves orthodontic attachments, which inhibit efficient removal of bacterial biofilms (dental plaque). Undesirable complications are often due to an understandable lack of awareness while the orthodontist focuses on biomechanical matters. While conscientious attention to biomechanical progress justifies this focus, close attention should be paid to infection control and the possibility of iatrogenic side effects. This article considers the issues of ideal orthodontic clinical management as well as those of inadequate patient compliance and infection management. Exactly how therapeutic, prophylactic, and anti-infective issues are assumed or delegated by the orthodontist, patient, or the referring dentist is a matter of individual practice style and an integral part of the doctor-patient covenant. This article attempts to provide current information regarding clinical, microscopic, and molecular level effects of orthodontic tooth movement on gingival tissues during fixed appliance therapy, or remedial methods once orthodontic appliances are removed. Orthodontic appliances, as well as mechanical procedures, are prone to evoke local soft-tissue responses in the gingiva. These effects can either be of positive nature, (physiologic recontouring), helping tooth movement, or negative ones, which should be avoided. The main source of negative outcomes involves orthodontic attachments, which inhibit efficient removal of bacterial biofilms (dental plaque). Undesirable complications are often due to an understandable lack of awareness while the orthodontist focuses on biomechanical matters. While conscientious attention to biomechanical progress justifies this focus, close attention should be paid to infection control and the possibility of iatrogenic side effects. This article considers the issues of ideal orthodontic clinical management as well as those of inadequate patient compliance and infection management. Exactly how therapeutic, prophylactic, and anti-infective issues are assumed or delegated by the orthodontist, patient, or the referring dentist is a matter of individual practice style and an integral part of the doctor-patient covenant. This article attempts to provide current information regarding clinical, microscopic, and molecular level effects of orthodontic tooth movement on gingival tissues during fixed appliance therapy, or remedial methods once orthodontic appliances are removed.