An occasionally irregular blog about orthodontics

New systematic reviews on orthodontics and gingival health.

New systematic  reviews on orthodontics and gingival health.

New systematic  reviews on orthodontics and gingival health.

This week saw the on-line publication of two systematic reviews on  orthodontics and gingival health. The first was concerned with the effect of clear aligners and the second was with professionally applied oral hygiene measures.

Both were published behind the European Journal of Orthodontics paywall and are not available to many people.

images-21Periodontal health during clear aligners treatment: a systematic review.

Rossini G et al

Eur J Orthod. 2014 Dec 29. pii: cju083.

PMID: 25548145

In this review they aimed to answer if the use of Clear Aligner Treatment lead to gingival problems because of coverage of the gingivae.

What did they do?

They carried out a systematic review of the literature from 1945 to 2014. This must be one of the longest inclusion periods in the history of orthodontic systematic reviews.  They did a nice description of their inclusion criteria.  They included the following types of study

  • Prospective studies of treatment with clear aligners
  • The primary outcome was the effect of the CAT on gingival health.

They graded the quality of evidence using a Swedish measure of quality from A (high quality) to C(low level of evidence).

What did they find?

Their search yielded five publications. Four were prospective non-randomised trials and one was a RCT.  They characterised the overall level of evidence as moderate.  They provided a great deal of information on the studies

What did they conclude?

They concluded that

  • Periodontal health was better during CAT than with fixed appliances
  • There was a significant increase in periodontal health with CAT

What did I think?

I thought that this was a good review and they found that CAT did not really have an adverse effect on gingival health. This is a very useful clinical finding.

The second review was concerned with the effect of professional oral hygiene and cleaning on orthodontic patients.

200_sEfficacy of professional hygiene and prophylaxis on preventing plage increase in orthodontic patients with multibracket appliances: a systematic review

Migliorati M

Eur J Orthod. 2014 Sep 22. pii: cju044. [Epub ahead of print]

PMID: 25246605

This systematic review was carried out to find out whether “it was clinically possible to avoid increases in plaque and prevent permanent tooth lesions in orthodontic patients”.

What did they do?

Again this was a well structured systematic review and the authors clearly set out their methodology.  They only included prospective RCTs and CCTs involving patients with full fixed appliances. They evaluated study quality with the Cochrane risk of bias tool.  Following the usual exclusion of papers that were not relevant they identified 10 studies. 8 were RCTs, 1 was a CCT and 1 was a before and after study.

Most of the studies were classified as being of unknown risk of bias because the trials had not been adequately reported.

What did they find?

It was surprising that they reported the results as a narrative and did not carry out a meta analysis. I could not find a reason for this approach and it was a shame because several of the trials reported on the same gingival index measure, as a result, a meaningful meta analysis was possible.

It was, therefore, very difficult to interpret the results and the discussion was very lengthy.  I think that they concluded that:

  • It is possible to teach oral hygiene techniques to young people wearing fixed appliances.
  • This can lead to an improvement in gingival health

These may be rather obvious conclusions and I am sure that if they had carried out a meta analysis their findings would have been more clinically relevant.


I have finished this blog with a sense of disappointment because my initial feeling, when I first saw these papers, was that they would be more interesting and relevant.  Unfortunately, they were not clear to me and I struggled to come to firm conclusions.  The very useful Dental Elf also came to the same conclusions.  I am not sure whether this is a simple matter of refereeing standards. I am sure that something is here.

Next weeks blog is going to be interesting, I have decided to start a series of posts called “Let’s talk about…” and next week we are going to discuss Acceledent….
Rossini G, Parrini S, Castroflorio T, Deregibus A, & Debernardi CL (2014). Periodontal health during clear aligners treatment: a systematic review. European journal of orthodontics PMID: 25548145

Migliorati M, Isaia L, Cassaro A, Rivetti A, Silvestrini-Biavati F, Gastaldo L, Piccardo I, Dalessandri D, & Silvestrini-Biavati A (2014). Efficacy of professional hygiene and prophylaxis on preventing plaque increase in orthodontic patients with multibracket appliances: a systematic review. European journal of orthodontics PMID: 25246605

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