Effect of orthodontic treatment on the subgingival microbiota: A systematic review and meta‐analysis
Open accessAbstract
The aim of this systematic review was to assess qualitative changes induced by fixed appliance orthodontic treatment on the subgingival microbiota. Seven databases were searched up to August 2017 for randomized and nonrandomized clinical studies assessing the effect of orthodontic appliances on the subgingival bacteria in human patients. After elimination of duplicate studies, data extraction and risk of bias assessment according to the Cochrane guidelines, random‐effects meta‐analyses of relative risks (RR) and their 95% confidence intervals (CI s) were performed. According to controlled studies, the presence of Aggregatibacter actinomycetemcomitans in the subgingival crevicular fluid of orthodontic patients was increased 3‐6 months after fixed appliance insertion compared to untreated patients (2 studies; RR = 15.54; 95% CI = 3.19‐75.85). There was still increased subgingival prevalence of Aggregatibacter actinomycetemcomitans (3 studies; RR = 3.98; 95% CI = 1.23‐12.89) and Tannerella forsythia in orthodontic patients up to 6 months after appliance removal compared to untreated patients. However, caution is warranted due to high risk of bias and imprecision. Insertion of orthodontic fixed appliances seems to be associated with a qualitative change of subgingival microbiota, which reverts to some extent back to normal in the first months after appliance removal. However, there is limited evidence on the timing and extent of these changes.
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Fixed appliance treatment is associated with increased bacterial accumulation, which may alter the oral ecosystem towards pathogenic colonization, and increases the risk of caries, periodontal inflammation, and enamel demineralization.
“Fixed appliance treatment is associated with increased bacterial accumulation, which may alter the oral ecosystem towards pathogenic colonization [7, 8], and increases the risk of caries, periodontal inflammation, and enamel demineralization [6, 9].”
From Influence of elastomeric and steel ligatures on periodontal health during fixed appliance orthodontic treatment: a systematic review and meta-analysis (2024) · cites this paper as [8]
Cites
A Re-Evaluation of Random-Effects Meta-Analysis
Higgins, J. P. T., Thompson, S. G., & Spiegelhalter, D. J. (2009) · Journal of the Royal Statistical Society Series A: Statistics in Society · doi:10.1111/j.1467-985x.2008.00552.x · Cited by 2,569 · cited 2× · see citing works
“hoc deviations were listed in detail (Appendix S12) and the review’s data set was transparently provided.(27) However, the present study also has some limitations.”
BackgroundMethodMethods to estimate the between‐study variance and its uncertainty in meta‐analysis
Veroniki, A. A., Jackson, D., Viechtbauer, W., Bender, R., Bowden, J., Knapp, G., Kuss, O., Higgins, J. P., Langan, D., & Salanti, G. (2016) · Research Synthesis Methods · doi:10.1002/jrsm.1164 · Cited by 1,685 · see citing works
Interpretation of tests of heterogeneity and bias in meta-analysis
Ioannidis, J. P. A. (2008) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2008.00986.x · Cited by 696 · cited 1× · see citing works
“4 | Data synthesis As the effect of orthodontic therapy on subgingival microbiota is bound to be affected by many factors, including type of orthodontic appliances, treatment duration, patient oral hygiene, and biological profile,(23-25) a random-effects model was deemed appropriate to incorporate this variability.(16…”
MethodArnold, S., Koletsi, D., Patcas, R., & Eliades, T. (2016) · Journal of Dentistry · doi:10.1016/j.jdent.2016.08.006 · Cited by 42 · see citing works
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Orthodontic treatment of patients with severe (stage IV) periodontitis
Papageorgiou, S. N., Antonoglou, G. N., Eliades, T., Martin, C., & Sanz, M. (2024) · Seminars in Orthodontics · doi:10.1053/j.sodo.2024.01.004 · Cited by 23 · see citing works
Self-citationHussain, U., Campobasso, A., Noman, M., Alam, S., Mujeeb, R., Shehzad, S., & Papageorgiou, S. N. (2024) · Progress in Orthodontics · doi:10.1186/s40510-024-00520-8 · Cited by 13 · see citing works
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- Authors
- Papageorgiou, S. N., Xavier, G. M., Cobourne, M. T., & Eliades, T.
- Affiliations
- University of Zurich (CH)
- King's College London (GB)
- Corresponding author
- Papageorgiou, Spyridon N.
- Venue
- Orthodontics & Craniofacial Research
- Publisher
- Wiley
- Published
- 2018-07-20
- Volume
- 21
- Issue
- 4
- Pages
- 175-185
- ISSN
- 1601-6335 (ISSN-L)
- 1601-6343
- OpenAlex
- W2883968820
- Cited by
- 56
- References
- 4
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 12 · 2023: 8 · 2022: 8 · 2021: 5 · 2020: 6 · 2019: 4
- FWCI
- 0.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.zora.uzh.ch
- Licence
- Locations
- Orthodontics and Craniofacial Research (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Keywords
- fixed orthodontic appliances, subgingival microbiota, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, periodontal pathogens, orthodontic treatment, periodontal disease
- MeSH terms
- Tannerella forsythia, Orthodontic Appliances, Fixed, Dental Plaque, Gingiva, Gingival Crevicular Fluid, Humans, Orthodontic Appliances, Orthodontics, Corrective, Databases, Factual, Aggregatibacter actinomycetemcomitans, Bacterial Load, Microbiota
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