A systematic review of the association between appliance-induced labial movement of mandibular incisors and gingival recession
To determine if an association exists between appliance-induced labial movement of mandibular incisors and gingival recession. Electronic databases were searched for studies with the terms: 'incisor', 'incisor proclination', 'tooth movement', 'orthodontic tooth movement', 'gingival recession' and 'orthodontic appliance'. The original articles and abstracts that met the initial inclusion criteria were retrieved, and their references hand searched for possible articles missed by the database searches. Inclusion criteria included human studies that suggested a link between labial movement of lower incisors produced by orthodontic treatment and gingival recession. Exclusion criteria included significant intrusion or extrusion of the mandibular incisors, periodontal disease, subjects taking medication that affects gingival health and subjects with systematic diseases. Seven articles fulfilled the selection criteria. Gingival recession after labial movement of lower incisors was assessed on dental casts, intra-oral slides, lateral cephalograms and gingival examination. The articles were analysed to determine the impact of their treatment methodology on the outcomes. No association between appliance-induced labial movement of mandibular incisors and gingival recession was found. Factors that may lead to gingival recession after orthodontic tipping and/or translation movement were identified as a reduced thickness of the free gingival margin, a narrow mandibular symphysis, inadequate plaque control and aggressive tooth brushing.