Examining the Relationship Between Periodontal Disease in 60 Individuals and the use of Fixed Orthodontic Appliances

Adult patients’ need for orthodontic care has been seen to increase recently. Aesthetics are crucial to adult patients when considering treatment for sociocultural reasons [1]. Over the past 30 years, fixed lingual bracket systems have been created to offer orthodontic treatment that is virtually undetectable. There have been complaints that these prefabricated lingual bracket systems lead to issues such mouth pain, speech impairment, and mastication restriction. The majority of lingual appliance issues have been resolved in modern times because to computerized archwire production and tailored brackets [2,3]. Since not all patients are willing to undertake surgical treatment, an orthodontic camouflage with unilateral extraction is an effective alternative. The element to be extracted on the opposite side is chosen based on mechanical, cosmetic, and functional considerations [4,5]. For the greatest esthetic and functional outcome, restorative dental treatment with either build-ups or veneers at treatment end is required. The two viable treatment options are represented by either lateral incisor extraction or one premolar extraction [6,7]. The need for adult orthodontic treatment is rising, and lingual fixed appliances are becoming more and more well-liked [8,9]. Despite the clear aesthetic benefits of these systems, some orthodontists have been reluctant to recommend lingual-based treatment to their patients. This is frequently predicated on the perceived issues with lingual braces, which relate to patient discomfort and speech challenges as well as orthodontist difficulty using these appliances [10,11].

Despite some of these characteristics having been looked into, the evidence base is still lacking, partly as a result of the fact that these appliance systems are still developing [12]. Although the onset can be earlier with lingual brackets and the location is different, with the tongue more frequently implicated [13], pain and discomfort for the patient seem to be similar following the installation of labial or lingual appliances, according to research done to date [2,14]. Pre-fabricated lingual brackets may cause more pain than customized ones. Additionally, when wearing a lingual device, patients do appear to be more likely to struggle with speaking and mastication [15]. The lingual surfaces of the teeth may be more resistant to early demineralization and caries, according to some research. There is little information available about the effectiveness of therapy and how simple it is for the orthodontist to employ lingual or labial appliances, or alternative lingual systems [16]. The effectiveness of lingual appliance systems, for both the patient and the orthodontist, has to be investigated further[17].

The study was planned as a parallel trial with two sets of patients who were seen in succession. Between February and May 2022, evaluations of the lingual patients were conducted.

At three successive control visits, the periodontal health of thirty patients each wearing aligners or fixed lingual appliances was inspected. Patients from the Department of Orthodontics and Dentofacial Orthopedics at the Charité Berlin comprised all of the Invisalign patients as well as some of those wearing lingual appliances. The remaining individuals were sourced from the offices of two certified orthodontists.

nQuery Advisor 5.0 was used to calculate power and sample sizes (Statistical Solutions, Saugus, Massachusetts, USA). According to power calculations, a sample size of 25 would have a 90% chance of detecting a difference in means of 25%, assuming that the differences’ Standard Deviation (SD) was 25%. Throughout the trial, there were no dropouts noted [18]. The modified Gingiva, modified Plaque, and modified Papillary Bleeding Indexes were used to assess the periodontal health of the patients [19]. The sulcus probing depth was also determined. From the central incisor to the first molar, all indices were recorded lingually in the second and fourth quadrants and buccally in the first and third. Each quadrant’s first molar and first premolar had its sulcus probing depth assessed mesially, distally, buccally, and lingually. Following each control visit, specific, one-on-one oral hygiene instructions were given.

With regard to the reproducibility of clinical measurements, the empirical SD for PPD was 0.01±0.01mm, indicating excellent reproducibility. The results of the clinical examination was 12.4±8.2per cent at T₀ and 14.3±8.1per cent at T₁. PPD at the buccal sites remained mostly unchanged at 2.1±0.3mm at T0 and 2.1±0.2mm at T₁, whereas PI was 0.1±0.2 at T₀ and T₁. At the lingual sites, BOP was 22.2±19.0per cent at T₀ and 56.2±31.6per cent at T₁. PPD increased from 2.3±0.3mm at T₀ to 2.9±0.3mm at T₁ at the lingual sites, whereas PI was 0.1±0.2 at T₀ and 1.2±1.1 at T₁. The difference between T₀ and T1 was statistically significant for all clinical parameters at the lingual sites (P<0.05).

By promoting plaque formation during treatment with fixed buccal orthodontic appliances, which is linked to a worsening of clinical indicators like BOP and PPD, oral health is compromised. However, there have been no studies done to see if individuals receiving fixed, specially constructed lingual orthodontic appliances exhibit the same clinical outcomes [20]. The same physician at T₀ and T₁ examined all patients in order to prevent interobserver variations in gathering clinical parameters in the current investigation. To guarantee that periodontal and microbiological parameters increased as much as possible, the experiment was carried out during a defined period of three months. Six exemplary index teeth’s clinical parameters were identified. The outcomes of such a test are often equivalent to those of a comprehensive periodontal test. The first and third or second and fourth quadrants were randomly chosen for clinical examination, which allowed for the evaluation of confounders such preference for unilateral dental hygiene [6].

Even though the entire mouth, including the keratinized gingiva, is covered for almost the entire day while using Invisalign®, the periodontal risk is lower than when using fixed lingual appliances. This might be as a result of the detachable nature of aligners, which allows for unhindered dental hygiene. In contrast, when using a fixed appliance, the lingual tooth surfaces are exceedingly challenging to clean.

This article was presented and published at the International Conference on Dentistry and Medical Sciences in Kuala Lumpur, Malaysia 2022.

1. Musskopf ML, Daudt LD, Weidlich P, Gerchman F, Gross JL, et al. (2017) Metabolic syndrome as a risk indicator for periodontal disease and tooth loss. Clinical Oral Investigations 21(2): 675-683.
2. Luchian I, Moscalu M, Goriuc A, Nucci L, Tatarciuc M, et al. (2021) Using salivary MMP-9 to successfully quantify periodontal inflammation during orthodontic treatment. Journal of Clinical Medicine 10(3): 379.
3. Gastel J, Quirynen M, Teughels W, Carels C (2007) The relationships between malocclusion, fixed orthodontic appliances and periodontal disease. A review of the literature. Australian orthodontic journal 23(2): 121-129.
4. Desai M, Messer LB, Calache H (2001) A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Australian dental journal 46(1): 41-50.
5. McFall WT (1982) Tooth loss in 100 treated patients with periodontal disease: A long‐term study. Journal of Periodontology 53(9): 539-549.
6. Atack NE, Sandy JR, Addy M (1996) Periodontal and microbiological changes associated with the placement of orthodontic appliances. A review. Journal of periodontology 67(2): 78-85.
7. Freitas JAdS, Garib DG, Oliveira M, Lauris CMC, Almeida ALPF, et al. (2012) Rehabilitative treatment of cleft lip and palate: Experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)-Part 2: Pediatric dentistry and orthodontics. Journal of Applied Oral Science 20(1): 268-281.
8. Melnyk A, Filonenko V (2023) Clinical and phonetic features of dentognathic deformations, their orthodontic treatment. UK.
9. Primožič J, Poljšak B, Jamnik P, Kovač V, Čanadi Jurešić G, et al. (2021) Risk assessment of oxidative stress induced by metal ions released from fixed orthodontic appliances during treatment and indications for supportive antioxidant therapy: A narrative review. Antioxidants 10(9): 1359.
10. Arulmari S, Athul A, Bhuvaneswari M, Vijayarangan A, Elumalai A, et al. (2023) Assessment of pulp vitality in multirooted teeth with advanced periodontal disease: A clinical and histological study. Cureus 15(1): 33298.
11. Andrade KM, Silva BPM, Oliveira LR, Cury PR (2023) Automatic dental biofilm detection based on deep learning. Journal of Clinical Periodontology.
12. Passinato Gheller S, Porto AN, Borba AM, Veiga KA, Aranha AMF (2021) Periodontal findings in children and adolescents with cleft lip and/or palate: A case-control study. Pediatric Dentistry 43(2): 133-139.
13. Perkowski K, Balraza W, Conn DB, Marczynska-Stolarek M, Chomicz L (2019) Examination of oral biofilm microbiota in patients using fixed orthodontic appliances in order to prevent risk factors for health complications. Annals of Agricultural and Environmental Medicine 26(2): 231-235.
14. Marincak Vrankova Z, Rousi M, Cvanova M, Gachova D, Ruzicka F, et al. (2022) Effect of fixed orthodontic appliances on gingival status and oral microbiota: A pilot study. BMC Oral Health 22(1): 455.
15. Rashid ZJ, Gul SS, Shaikh MS, Abdulkareem AA, Zafar MS (2022) Incidence of gingival black triangles following treatment with fixed orthodontic appliance: A systematic review. Healthcare 10(8): 1373.
16. Al-Omiri MK, Abu Alhaija ES (2006) Factors affecting patient satisfaction after orthodontic treatment. The Angle Orthodontist 76(3): 422-31.
17. Wahab RA, Hasan SK, Yamin NEM, Ibrahim Z (2019) Awareness of fake braces usage among Y-generations. Journal of International Dental and Medical Research.
18. Ericsson I, Thilander B (1978) Orthodontic forces and recurrence of periodontal disease: An experimental study in the dog. American Journal of Orthodontics 74(1): 41-50.
19. Nadar S, Dinesh SS (2016) A questionnaire study about oral hygiene awareness among orthodontic patients. International Journal of Orthodontic Rehabilitation 7(3): 97.
20. Heasman P, Wilson Z, Macgregor I, Kelly P (1998) Comparative study of electric and manual toothbrushes in patients with fixed orthodontic appliances. American Journal of Orthodontics and Dentofacial Orthopedics 114(1): 45-49.