ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Proclination Of Lower Incisors During Orthodontic Treatment Does Not Cause Gingival Recession
Clinical Question Does proclination of mandibular incisors during orthodontic treatment cause gingival recession versus no treatment?
Clinical Bottom Line Proclination of lower incisors during orthodontic treatment alone does not cause gingival recession. This is supported by two systematic reviews, one with 853 patients and the other with 529 patients, which show that recession is multi-factorial and there is no evidence that proclination has any impact on causing recession or worsening it. More research needs to be completed particularly randomized control trials since there are none.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21436861Joss-Vassalli/2010853 humansSystematic Review
Key resultsNo statistical values of any kind were included. For the 11 human trials, five of the studies had statistical significance, but most studies concluded that several variables played roles in recession such as mandibular symphysis width, a previous history of recession, gingival biotype, pretreatment width of keratinized gingiva, free gingival margin <0.5 mm, final inclination >95, and height of keratinized tissue <2 mm. Only two of the studies made the claim that there was more recession with orthodontic treatment compared to no treatment. Therefore, many factors are involved in causing gingival recession.
#2) 21696112 Aziz/2011529 humansSystematic Review
Key resultsOnly 2 of the 7 studies showed any amount of statistical significance, and even those values changed over time or when other were variables factored in. According to Artun and Krogstad, p<0.001 (significant) during treatment, but p<0.05 (not significant) after a 3-year follow-up;. Ruf showed no significance tested at p=0.05, 0.01, and 0.001. Artun and Grobety results were not significant tested at p=0.01 and 0.05. The Djeu study was also not significant, p>0.05. Allias and Melsen’s research showed no significance, p>0.05. Yared concluded significance, p<0.05, only if gingival margin thickness was less than 0.5 mm and proclination greater than 95 degrees, but it was not significant if proclination was greater than 95 degrees and gingival thickness greater than 0.5 mm. Again, the consensus is that gingival recession is multi-factorial.
Evidence Search orthodontic[All Fields] AND proclination[All Fields] AND ("gingival recession"[MeSH Terms] OR ("gingival"[All Fields] AND "recession"[All Fields]) OR "gingival recession"[All Fields])
Comments on
The Evidence
For the Joss-Vassalli review, there were no randomized control trials included, but a detailed and comprehensive search was performed while finding the included studies. The individual studies were assessed for validity. Included were 11 trials with 853 patients. A meta-analysis was not performed. For the Aziz review, it is not a review of randomized control trials. A comprehensive and detailed search was done for relevant trials, and all studies were assessed for validity. They included 7 trials with 529 patients, and a meta-analysis was not performed.
Applicability These studies are clinically applicable because of the amount of adolescents and adults in orthodontic therapy. Many dentists also believe that proclination causes gingival recession, which is not an accurate assumption.
Specialty/Discipline (General Dentistry) (Orthodontics) (Periodontics)
Keywords proclination, recession, orthodontics, incisors
ID# 2213
Date of submission: 04/13/2012spacer
E-mail loweryr@livemail.uthscsa.edu
Author Rachel Lowery
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail brykc@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Stephen Regan, Stephen Donoghue (San Antonio, Tx) on 11/28/2017
A new search was conducted in November 2017, and new evidence was located that pertains to this question: Kamak/ 2015 (PMID 25961071) and Antonarakis/2017 (PMID 28110408). Although Kamak/2015 supports the claim that there is no labial gingival recession secondary to lower incisor inclination, Antonarakis/2017 found an increased risk of lingual recession if inclination was greater that 10 degrees. Antonarakis/2017 tested 19 subjects with varying premolar extractions and still found a 17-fold increase in lingual recession. This slightly changes the statement to exclude lingual recession.
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