Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment

original article Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment Fabricio Batistin Zanatta1, Thiago Machado Ardenghi1, Raquel Pippi Antoniazzi2, Tatiana Militz Perrone Pinto2, Cassiano Kuchenbecker Rösing3 DOI: http://dx.doi.org/10.1590/2176-9451.19.3.059-066.oar Objective: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. Methods: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson’s regression models. Results: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.021.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. Conclusion: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment. Keywords: Epidemiology. Orthodontics. Gingivitis. Gingival enlargement. Objetivo: o objetivo desse estudo foi verificar a associação entre volume gengival (AG) com condições periodontais e características sócio-demográficas em sujeitos com aparelho ortodônticos fixo. Métodos: uma amostra, de 330 participantes com aparelho ortodôntico fixo, por pelo menos seis meses, foi examinada, por um único examinador calibrado, para os índices de placa e gengivais, profundidade de sondagem, nível de inserção clínico e aumento de volume gengival. O status socioeconômico, tempo com aparelho ortodôntico fixo e uso de fio dental foram verificados por entrevista oral. A verificação das associações foi realizada por meio de modelos de regressão de Poisson sem ajuste e ajustados. Resultados: a presença de sangramento gengival (RR 1.01; 95% IC 1.00-1.01) e o excesso de resina em torno dos braquetes (RR 1.02; 95% IC 1.02-1.03) foram associadas a um aumento do AG. Não foram encontradas associações entre características sócio-demográficas e AG. Conclusão: sangramento gengival proximal na região anterior e excesso de resina no entorno dos braquetes estão associados a níveis mais altos de aumento de volume gengival na região anterior em sujeitos com aparelho ortodôntico fixo. Palavras-chave: Epidemiologia. Ortodontia. Gengivite. Aumento gengival. » Patients displayed in this article previously approved the use of their facial and intraoral photographs. » The authors report no commercial, proprietary or financial interest in the products or companies described in this article. How to cite this article: Zanatta FB, Ardenghi TM, Antoniazzi RP, Pinto TMP, Rösing CK. Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment. Dental Press J Orthod. 2014 MayJune;19(3):59-66. DOI: http://dx.doi.org/10.1590/2176-9451.19.3.059-066.oar Associate professor, Department of Stomatology, Federal University of Santa Maria (UFSM). 2 Assistant professor, Franciscano University Center (UNIFRA). 3 Postdoc in Periodontics, Adjunct professor, Federal University of Rio Grande do Sul, (UFRGS). 1 © 2014 Dental Press Journal of Orthodontics Submitted: September 22, 2012 - Revised and accepted: April 08, 2013 Contact address: Tatiana Militz Perrone Pinto Rua Roberto Holtermann, 314 – Medianeira – Santa Maria/RS — Brazil. CEP: 97.015-570 – E-mail: 59 Dental Press J Orthod. 2014 May-June;19(3):59-66 original article Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment odontic graduate program in Santa Maria, Brazil. Ethical approval was obtained from the Franciscan University Center Institutional Review Board prior to the start of the study (protocol registration number 1246 in the National Ethics Committee). Subjects who agreed to participate signed an informed consent form. Patients diagnosed with oral pathological conditions were advised to seek consultation and treatment. introduction The balance of health-disease processes in Periodontics depends on adequate supra and subgingival plaque control achieved by patient and professional’s combined efforts. Accumulation of supragingival plaque results in inflammatory alterations of gingival tissues. However, interindividual differences might explain the different patterns of response and time needed for evident clinical responses. It is possible that these variations may be associated with different plaque growth patterns, local and systemic individual resistance or even a specific microbial challenge.1,2 Clinical studies suggest that orthodontic treatment may be associated with a decrease in periodontal health.3,4,5 One of the adverse periodontal alterations is a hypertrophic form of gingivitis.5,6,7 The exact mechanism for the development of gingival enlargement (GE) is not yet completely understood, but it probably involves increased production by fibroblasts of amorphous ground substance with a high level of glycosaminoglycans. Increases in mRNA expression of type I collagen and up-regulation of keratinocyte growth factor receptor could play an important role in excessive proliferation of epithelial cells and development of GE.8 In some studies, poor oral hygiene increased GE.9,10 Other clinical studies concluded that overall gingival changes during orthodontic treatment are transient with no permanent damage to the periodontal supporting tissues.11,12 The presence of orthodontic brackets also increases the skills and effort required to maintain good levels of oral hygiene, especially on the proximal surfaces.11 Microbiological studies demonstrate that when fixed orthodontic appliances are placed, the potential for quantitative13,14 and qualitative15,16 changes in the microbial composition of these areas enhances. Thus, periodontal reaction might be elicited by a change in the microbiological environment. To the best of our knowledge, there are no studies assessing GE and associated factors in individuals undergoing orthodontic therapy. Thus, this study aimed at assessing the prevalence of GE and associated factors in a group of orthodontic patients. Eligibility criteria To be eligible for the study, individuals should have been undergoing fixed orthodontic treatment for at least 6 months. Exclusion criteria comprised presence of diseases and conditions that could pose health risks to the participant or that could interfere in clinical examination, for instance, users of nifedipine, cyclosporine or phenytoin, contraceptive a (...truncated)