Effect of orthodontic treatment on periodontal clinical attachment: a systematic review and meta-analysis

Abstract

Background: Insertion of orthodontic fixed appliances has been known to induce a mostly transient qualitative and quantitative alteration of the intraoral microbiota. However, the extent to which treatment with fixed appliances might have a lasting adverse effect on the periodontal attachment of the teeth has not yet been investigated in an evidence-based manner. Objectives: Aim of this systematic review was to assess the effect of comprehensive treatment with fixed orthodontic appliances on clinical attachment levels of adolescent and adult periodontally healthy patients. Search methods: Seven databases were searched from inception to February 2017. Selection criteria: Prospective non-randomized longitudinal clinical studies. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, Paule-Mandel random-effects meta-analyses of the clinical attachment loss and its 95 per cent confidence intervals (CIs) were calculated. Results: A total of 9 trials were identified that included 335 treated patients (at least 34 per cent male / 66 per cent female) with an average age of 22.6 years. The average pooled clinical attachment loss was 0.11 mm (9 studies; 335 patients; 95 per cent CI = 0.12 mm gain to 0.34 mm loss; P = 0.338) with high heterogeneity. Furthermore, one study hinted that a small amount of clinical attachment might be gained by intrusion of upper incisors. Additional analyses indicated that the results were robust to addition of untreated patient groups, while patient age and timing of outcome measurement might play an important role. Conclusions: According to existing evidence from longitudinal clinical studies orthodontic treatment with fixed appliances has little to no clinically relevant effect on periodontal clinical attachment levels. Registration: PROSPERO (CRD42017057042). Funding: None.