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MDJ A Longitudinal investigation of the Periodontal … A Longitudinal investigation of the Periodontal changes in adult and adolescent orthodontic patients using bands or bonds on molars

Authors:
  • Al-Mustansiriya University-College of dentistry

Abstract

The present study was carried out to evaluate the differences in periodontal response to orthodontic treatment between banded and bonded molar teeth as well as the differences between adults and adolescents. The samples of the study consisted of 50 patients (16 adults and 34 adolescents) who were received full arch orthodontic appliances with banded or bonded molars. Clinical parameters included plaque and gingival indices as well as probing pocket depth were scored at [pretreatment and at 3, 6, 9, 12 months (during treatment) and at the end of the treatment]. The results demonstrated that during and at the end of the treatment, all the parameters were significantly higher for band molars than for analogous bonded molars. Also, the adolescents showed significantly higher levels of all clinical measurements than adults.
MDJ A Longitudinal investigation of the Periodontal Vol.:5 No.:2 2008
159
A Longitudinal investigation of the Periodontal
changes in adult and adolescent orthodontic patients
using bands or bonds on molars
Dr. Suhad M. A. Sadiq B.D.S., M.Sc. Lecturer.*
Dr. Raed A. Badea B.D.S., M.Sc. Lecturer. *
Abstract
The present study was carried out to evaluate the differences in periodontal
response to orthodontic treatment between banded and bonded molar teeth as well as
the differences between adults and adolescents.
The samples of the study consisted of 50 patients (16 adults and 34 adolescents)
who were received full arch orthodontic appliances with banded or bonded molars.
Clinical parameters included plaque and gingival indices as well as probing pocket
depth were scored at [pretreatment and at 3, 6, 9, 12 months (during treatment) and at
the end of the treatment]. The results demonstrated that during and at the end of the
treatment, all the parameters were significantly higher for band molars than for
analogous bonded molars. Also, the adolescents showed significantly higher levels of
all clinical measurements than adults.
Introduction
Orthodontic therapy may affect the
periodontium by favoring plaque
retention, by direct injury to the
gingiva as a result of overextended
bands, and by creating excessive
forces, unfavorable forces or both on
the tooth and supported structure (1,2).
Dental plaque is organized in a
biofilm complex that provides
protection and nutrients for
periodontopathic bacteria. Several
factors can affect microbial
colonization including restorations and
orthodontic bands and brackets. (3-7)
During the last three decades,
bonding brackets directly to tooth
surfaces has become the most widely
used method of securing fixed
orthodontic appliances. During the
same period, there has also been a
dramatic increase in the number and
percentage of adults receiving
orthodontic treatment. Yet few
systematic studies of periodontal
implications of these changes have
been undertaken. To date, most studies
of periodontal disease among
orthodontic patients have been
conducted on adolescents whose teeth
had been bonded. (8-13)
Zachrisson (14) compared treatment
associated periodontal changes in
adolescents treated with banded
appliances and those treated with
bonded appliances. The results of that
investigation showed less plaque
accumulation and gingival
inflammation around bonded teeth.
Other studies of adolescents using
fixed orthodontic treatment have
showed that plaque accumulation and
periodontal inflammation are more
MDJ
* College of Dentistry, Al-Mustansiria University.
MDJ A Longitudinal investigation of the Periodontal Vol.:5 No.:2 2008
160
severe on molar region than on anterior
teeth (15,16) and there is a reason to
suspect that bonded molars experience
less gingival inflammation than do
banded molars. (17)
Other study compared adolescents
and adults receiving fixed orthodontic
treatment showed that adolescents had
more gingival inflammation than
adults. (18) However, in that study, no
comparison was made between banded
and bonded teeth.
The present study was conducted to
test several hypotheses concerning
differences in periodontal response to
orthodontic treatment. Because
periodontal pathology is most likely to
be occurred first in the molar
interproximal region, (19,20) that region
was adopted as our experimental locus.
Determination the differences in
periodontal response to orthodontic
treatment between banded and a
bonded molar as well as the
differences between adults and
adolescents was the aim of the present
study.
Materials and method
The sample consisted of 50
consecutive patients, adolescents and
adults, who were received fixed
orthodontic treatment in both arches at
orthodontic consultant clinic of the
college of dentistry, University of Al-
Mustansiriya, and who met the
following criteria: (1) no history of
rheumatic fever, congenital heart
disease, blood dyscreasis, diabetes
mellitus, or any type of periodontitis.
(2) no antibiotic therapy or any
antibacterial agent known to inhibit
plaque during the previous 6 months;
(3) between 10-16 years old for
adolescent group and over 21 years for
the adult group.
At the onset of the study there were
16 subjects (10femele, 6male) in the
adult group and 34 subjects (20 female,
14 male) in the adolescent group. The
mean age for the adolescent group was
14 years and the mean age for the adult
group was 25 years.
Scaling and polishing were done
for each patient one month prior to
orthodontic treatment and the routine
instructions and motivation for keeping
good oral hygiene and plaque control
were given to each patient shortly after
pretreatment recordings were made.
All these procedures were done by one
periodontist for all patients included in
the study. The periodontal recordings
consisted of assessments of pocket
depth and two clinical indices, the
plaque index (21) (to measure plaque
accumulation), the gingival index (22)
(to measure gingival inflammation).
All these measurements were recorded
for each subject at the pretreatment
examination (before appliance
placement) and at 3, 6, 9, and 12
months and at the end of the treatment
to determine the relation ship between
the time progression and the severity
of the periodontal changes. Pocket
depth was defined as the distance from
gingival margin to the bottom of the
clinical of the clinical pocket and was
measured with a calibrated William's
periodontal probe.
For each patient assessment were
made at two representative sites, on the
mesiobuccal aspects of the maxillary
first permanent molar and the
mandibular left first permanent molar.
All measurements were made by the
same examiner.
Orthodontic treatment
Maxillary and mandibular full arch
edgewise orthodontic appliances were
placed for each subject and routine
orthodontic treatment was delivered as
necessary. None of the patients had
fiberotomy or surgical exposure of
impacted teeth.
MDJ A Longitudinal investigation of the Periodontal Vol.:5 No.:2 2008
161
The distribution of banded and
bonded maxillary or mandibular
molars among the adults and
adolescents is shown in table (1).
Results
Of the original of 34 adolescent and
16 adults, three of the adolescents were
excluded because the bonds which had
originally been placed on their
maxillary teeth repeatedly became
loose and had to be replaced with
bands. Three other adolescents and two
adults did not complete the study
because they missed multiple treatment
appointments or study-related
periodontal examinations. Complete
study data were obtained for 14 adults
and 28 adolescents. The mean
treatment time for these patients was
16 months (SD=4.2 months).
At the treatment base line, there
were no significant differences in
periodontal status between banded and
bonded molars (maxillary and
mandibular) for the combined adult
and adolescent groups (Figure 1-3).
However, when pretreatment data for
all banded and bonded adults were
pooled and compared with similar data
for adolescents. Adolescent molars had
significantly higher values than did
adult molars for Plaque Index,
Gingival Index and Pocket depth
(Table 2 & 3).
During the period of active
orthodontic treatment for the combined
adult and adolescent groups, the values
for the Plaque and Gingival indices
and Pocket depth were all significantly
higher for banded maxillary and
mandibular molars than for the
analogous bonded molars (Figure 1-3).
When all adolescents were compared
with all adults, significantly higher
levels for all clinical measurements
were found (Table 2 & 3).
At the end treatment examination,
there were significantly higher values
for the Gingival index, Plaque index
and Pocket depth for the combined
adult and adolescent groups when
banded molars were compared to
bonded molars (Figures 1-3). In
addition, significantly higher mean
values were found for all clinical
measurements for both maxillary and
mandibular molars when the entire
adolescent group was compared to the
entire adult group (Tables 2 & 3).
Discussion
The results of the present study
tend in general to confirm the
hypotheses and finding of other similar
studies. The data revealed that: (1)
Banded molars in both adults and
adolescents had significantly more
plaque accumulation and gingival
inflammation than bonded molars. (2)
Adolescents whether banded or
bonded, showed more plaque
accumulation and gingival
inflammation than adults before and
with advancing time during
orthodontic treatment. It was also
noted that maxillary molars in general
exhibited a greater amount of
periodontal inflammation during
treatment. This is also in agreement
with several earlier studies. (11, 15, 23)
A highly probable explanation for
the differences in periodontal status
between banded and bonded molars is
that plaque removal on the banded
molars was made more difficult by the
over hanging gingival margins of the
orthodontic bands, causing prolonged
gingival inflammation and finally loss
of attachment and increasing probing
pocket depth. (24) An alternative
possible explanation for increasing
pocket depth is the mechanical injury
(25) caused by the subgingival
placement of orthodontic bands.
Many of our findings are in
agreement with those of previous
studies. These include the observations
MDJ A Longitudinal investigation of the Periodontal Vol.:5 No.:2 2008
162
that molars with orthodontic bands
have more plaque accumulation,
gingival inflammation, (26-28) than non
banded teeth or than banded or bonded
anterior teeth. Further, they have a
quantitatively and qualitatively
different type of bacterial flora whose
presence is positively associated with
gingival inflammation.
Only mesiobuccal surfaces were
used as study sites. They may have led
to under estimation of the actual
amount of periodontal inflammation.
However, a previous study (19) revealed
evidence that distal proximal surfaces
show recordings of periodontal
destruction similar to those of mesial
surfaces. Buccal surfaces were not
sampled because these surfaces tend to
show less periodontal inflammation
than proximal sites (20, 29) and are more
likely to show tooth brush abrasion. (30)
When the periodontal status of all
adults was compared with that of all
adolescents, statistically significant
differences were detected during
orthodontic treatment.
There are several possible reasons
why lower plaque accumulation and
gingival inflammation levels were
found adults than adolescents during
orthodontic treatment. First, adults
generally have teeth that are more fully
erupted and have longer clinical
crowns than adolescents. For this
reason, bonded attachments and band
margins in adults can be located
further occlusally with respect to the
gingival margin than is usually
possible in adolescent, thus facilitating
plaque removal. (18) Secondly, the
increased hormonal levels that occur
during pubertal growth during
adolescence are associated with an
increased degree of periodontal
inflammation and gingival hyperplasia.
(10) Thirdly, the periodontal indices
used in this study were weighted
heavily toward inflammatory changes
such as redness; swelling and bleeding
that are characteristics of gingivitis, a
condition which is more prevalent in
adolescents than in adults. (31)
The findings of this study are
predicated on the delivery of
preventive periodontal treatment in
conjunction with orthodontic treatment
to prevent the anticipated periodontal
destruction resulted from markedly
plaque accumulation around
orthodontic appliances. In addition,
during orthodontic treatment all
patients must be received monthly
reinforcement of instructions about
keeping good oral hygiene and plaque
removal.
Instructions and motivation for the
patients to achieve self plaque control
must include information about using
interdental cleaning aids when are
modified for orthodontic use. Also,
with patients lacking manual dexterity
or poor compliance it is advisable to
use chemical plaque control (like
chlorhexidine mouth wash) to assist
those patients to keep a good oral
hygiene during orthodontic treatment.
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MDJ A Longitudinal investigation of the Periodontal Vol.:5 No.:2 2008
164
Table 1: Distribution of bonded versus banded molars
Groups
Bonded
Banded
Total
Maxillary
Adult
5
9
14
Adolescent
5
23
28
Total
10
32
42
Mandibular
Adult
4
10
14
Adolescent
10
18
28
Total
14
28
42
Tables 2: Maxillary molars
During treatment
End of treatment
Adult
(n=14)
Adoles.
(n=28)
Sig.
Adult
(n=14)
Adoles.
(n=28)
Sig.
Adult
(n=14)
Adoles.
(n=28)
Sig.
Plaque
Index
0.65
0.59
NS
1.51
1.71
S
2.05
2.25
S
Gingival
Index
0.6
0.62
NS
1.37
1.66
S
1.85
2.2
S
Pocket
depth
1.9
1.96
NS
2.7
3.14
S
3.33
3.82
S
Tables 3: Mandibular molars
During treatment
End of treatment
Adult
(n=14)
Adoles.
(n=28)
Sig.
Adult
(n=14)
Adoles.
(n=28)
Sig.
Adult
(n=14)
Adoles.
(n=28)
Sig.
Plaque
Index
0.57
0.6
NS
1.38
1.6
S
1.85
2.33
S
Gingival
Index
0.52
0.57
NS
1.25
1.53
S
1.8
2.1
S
Pocket
depth
1.8
1.87
NS
2.52
3.13
S
3.18
3.7
S
MDJ A Longitudinal investigation of the Periodontal Vol.:5 No.:2 2008
165
0.68
0.71
0.735
0.76
1.61
1.33
1.55
1.37
2.323
1.7
2.28
1.79
0
0.5
1
1.5
2
2.5
PLI
Pretreatment During
Treatment End
treatment
Max. Band
Max. Bond
Mand. Band
Mand. Bond
0.56
0.52
0.5
0.7
1.36
1.03
1.31
1.17
2.12
1.78
2.02
1.7
0
0.5
1
1.5
2
2.5
GI
Pretreatment During
Treatment End
treatment
Max. Band
Max. Bond
Mand. Band
Mand. Bond
1.44
1.57
1.58
1.4
2.33
2.05
1.76
1.9
3.16
2.57
2.82
2.4
0
0.5
1
1.5
2
2.5
3
3.5
PD
Pretreatment During
Treatment End
treatment
Max. Band
Max. Bond
Mand. Band
Mand. Bond
Figure 1: Mean Plaque Index (PL I) of the combined adult and adolescent
groups for maxillary or mandibular banded or bonded molars
Figure 3: Mean Pocket depth (PD) of the combined adult and adolescent
groups for maxillary or mandibular banded or bonded molars
Figure 2: Mean Gingival Index (G I) of the combined adult and adolescent
groups for maxillary or mandibular banded or bonded molars
... P < 0.001), which indicates that the GE score was higher in younger subjects. Although Eid et al., [14] Akkaya et al., [2] and Sadiq and Badea [29] ended up with the same findings as in our study, Zanatta et al. [20] disagreed with them, largely due to the differences in the distribution of age between both studies. Another factor was oral hygiene, which also had a highly significant effect (β = 0.42; P < 0.001) with higher GE scores among subjects with fair OHI-S (scoring system: 0 = good; 1 = fair). ...
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Background: Gingival enlargement (GE) is one of the most common soft tissue problems encountered during fixed orthodontic treatment. Aims: This study aimed to evaluate the factors affecting GE in adolescents and young adults, compared with their normal peers. Subjects and methods: This is a cross-sectional comparative study. The sample consisted of 329 subjects (ages 10-30 years) of both genders, which was divided into four main groups: The control group (G0) with no orthodontic treatment; subjects who underwent orthodontic treatment were divided according to treatment duration into G1 (4-12 months), G2 (13-24 months), and G3 (>24 months). The clinical examinations included the level of debris, calculus (simplified oral hygiene), and GE indices. Regression analyses were used to assess the GE association in all the studied groups. Results: The mean GE score increased significantly with increased treatment duration (0.42 ± 0.29 for G0 and 1.03 ± 0.52 for G3). GE scores of the lower arch were significantly higher in the anterior segment than in the posterior segment among all treatment groups. Regression analysis revealed that gender, age, oral hygiene, and treatment duration had a significant effect on GE (P < 0.05), while angle classification, overjet, overbite, treatment stage, bracket type, and therapeutic extraction did not show significant associations (P > 0.05). Conclusion: Gender, age, oral hygiene, and treatment duration were the most important risk factors for GE during fixed orthodontic treatment.
... In the past, studies have compared the use of bands or bonds on molars and have demonstrated greater periodontal inflammation associated with bands. [8][9][10] Huser et al. (1990) in their study analyzed the effects of orthodontic bands on microbiological and clinical parameters. [11] There was an increase in the PI and bleeding scores of banded teeth and the placement of orthodontic bands was associated with the establishment of microorganisms usually found in periodontal diseases. ...
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Aim: Banding molars for anchorage may cause periodontal inflammation due to various reasons. To maintain a reasonably good periodontal status during orthodontic treatment, adequate oral hygiene maintenance measures should be followed and monitored. Hence, the aim of this study was to evaluate the effect of non-surgical periodontal therapy on the first molars banded for fixed orthodontic treatment. Materials and Methods: A double-blinded randomized clinical trial including 35 patients scheduled for fixed orthodontic treatment was recruited, from which, 32 patients with banded first molars were divided into Group A and Group B with 16 patients each. Both the groups underwent routine full-mouth supragingival and subgingival scaling around all banded first molars. Group B also underwent subgingival irrigation with 0.2% chlorhexidine gluconate solution around the banded first molars. Treatment for both the groups was performed at the 3rd, 6th, and 9th month. Full-mouth plaque index (PI) and gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) of each banded first molar were recorded at baseline, 6th month, and 12th month. Alveolar crestal bone level around each banded first molar was assessed radiographically at baseline and 12th month. Results: Intragroup comparison showed significant reduction in PI and Group B showed a significant increase in PPD and CAL from 0 day to 12th month. However, intergroup comparison did not show a significant difference in clinical parameters and radiographic crestal bone level. Conclusion: The use of 0.2% chlorhexidine gluconate solution showed no significant benefit on the banded molars as compared to scaling alone.
... In congruence with the current study, Boyd R et al. [2] reported that banded molars showed significantly greater gingival inflammation and plaque accumulation than bonded molars during treatment. The present study is comparable with Sadiq and Badea [27] who concluded that banded molars in both adults and adolescents had significantly more plaque accumulation and gingival inflammation than bonded molars. Arikan et al. [28] investigated the effect of fixed and removable space maintainers on periodontal status in children. ...
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Background: Chemokines are pro-inflammatory cells that can be induced during an immune response to recruit cells of the immune system to a site of infection. Aim: This study was conducted to detect the presence of chemokines, macrophage inflammatory protein-1α (MIP-1α), and 1β (MIP-1β) and estimate their levels in gingival crevicular fluid (GCF) in children with band and loop space maintainers. Materials and methods: MIP-1α and MIP-1β levels were estimated in GCF samples from twenty healthy children and twenty children with band and loop space maintainers. Periodontal status was evaluated by measuring gingival index, plaque index, and Russell's periodontal index. The GCF samples were quantified by ELISA, and the levels of MIP-1α and MIP-1β were determined. Results: The mean MIP-1α concentrations in healthy children and those with space maintainers were 395.75 pg/µl and 857.85 pg/µl, respectively, and MIP-1β was 342.55 pg/µl and 685.25 pg/µl, respectively. MIP-1α and MIP-1β levels in GCF from children with space maintainers were significantly higher than in the healthy group, and statistically significant difference existed between these two groups. Conclusion: MIP-1α and MIP-1β can be considered as novel biomarkers in the biological mechanism underlying the pathogenesis of gingival inflammation in children with space maintainers.
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