Title	In Patients with Moderate Malocclusion, Orthodontic Treatment Provides No Significant Improvement to Periodontal Health
Clinical Question	In patients with moderate malocclusion, would orthodontic treatment provide long-term periodontal benefits, as measured by pocket depths and gingival recession?
Clinical Bottom Line	Although some studies have suggested that malocclusion can have adverse effects on the periodontium, current evidence does not recommend correcting this malocclusion to improve one’s long-term periodontal health. At this time, orthodontics is only a valuable treatment for improving esthetics in individuals with malocclusion. This conclusion is supported by a meta-analysis of 5 studies.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18385025 Bollen/2008 2 studies on pocket depth and 3 studies on gingival recession Meta-Analysis Key results After completing a hand and electronic search of articles dating back to 1980, only one randomized controlled trial and 11 non-randomized studies were determined to meet the study’s criteria. Of the 12 studies comparing those with and without orthodontic treatment, 3 studies reported slightly increased gingival recession (mean difference=0.03 mm, p=0.0001) in the treatment group and 2 studies reported slightly deeper pocket depths (mean difference=0.23 mm, p=0.00001) in the treatment group. At this time, the evidence suggests that correcting malocclusion with orthodontics does not improve one's long-term periodontal health.
Evidence Search	(effects[All Fields] AND orthodontic[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND periodontal[All Fields] AND ("health"[MeSH Terms] OR "health"[All Fields])) AND (Comparative Study[ptyp] OR systematic[sb] OR Meta-Analysis[ptyp] OR Review[ptyp])
Comments on The Evidence	Validity: The evidence in the meta-analysis was found to have a moderate amount of bias and considered of low-quality because follow-up time after orthodontic treatment varied, control groups included individuals without malocclusion, and adjustments were not made for socioeconomic status, personal oral hygiene habits, and smoking. Perspective: Based on Bollen et. al., orthodontic therapy does not provide significant benefits to long-term periodontal health. However, these studies focus on young to middle-aged adults and do not assess the periodontal outcomes that may become more apparent later in adulthood. Although the studies evaluate a sufficient number of patients, future studies could provide more reliable and conclusive evidence by decreasing bias and adjusting for the variability in both the study and control group.
Applicability	Although many practicing dentists claim correcting malocclusion can provide long-term periodontal benefits to their patients, evidence has not shown this to be true. In patients with malocclusion, orthodontic treatment should only be recommended for esthetic purposes.
Specialty	(General Dentistry) (Orthodontics) (Periodontics) (Dental Hygiene)
Keywords	Malocclusion, Periodontal disease, Pocket depth, Gingival Recession
ID#	2740
Date of submission	06/25/2014
E-mail	nguyent16@livemail.uthscsa.edu
Author	Teresa Nguyen
Co-author(s)	Saad Almujel, Abdulmohsen Mohammed Alqasir
Co-author(s) e-mail	saadalmojel@yahoo.com, abood6000@gmail.com
Faculty mentor	Clarence C. Bryk, DDS, MS
Faculty mentor 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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available