Orthodontic Fixed Appliance and Periodontal Status: An Updated Systematic Review

Silvia Cerroni*, Guido Pasquantonio, Roberta Condò, Loredana Cerroni
Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy

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© 2018 Cerroni et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, Via. Montpellier, 1, 00133 Rome, Italy; Tel: +39672596377; E-mail:



Periodontal implications of orthodontic therapy are frequent, gingival and periodontal conditions need to be evaluated for every appointment. Several studies have analyzed the effects of fixed appliance on periodontal health.


To evaluate whether there is updated scientific evidence on the relationship between fixed orthodontic therapy and periodontal health.


A literature search was performed using the Pubmed and Cochrane databases and manual search; the search was carried out using the keywords “orthodontic” and “periodontal”. Articles published only in the English language from January 1997 to April 2017 were included. The inclusion criteria were: RCTs, cohort studies, cross-sectional studies and case-control studies only in English language; only studies on humans, with a minimum sample size of 20 patients and no restriction in terms of patient ages; orthodontic fixed appliances placed into the buccal tooth surface; standardization and training in oral hygiene; Periodontal Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Pocket Probing Depth (PPD), at least at baseline (before appliance was placed) and after follow up (with a minimum period of 3 months). The exclusion criteria were as follows: absence of baseline data before fixed appliances was placed; patients with systemic diseases, periodontal disease or craniofacial anomalies; removable appliances or orthodontic appliance on the lingual dental surface; and no standardization or training in oral hygiene.

Studies were selected by abstract and title; then, inclusion and exclusion criteria were applied. The studies that satisfied the inclusion criteria were evaluated and classified as having low, moderate or high methodology quality.


Fifty-five records were reviewed on the basis of title and abstract. After full-text reading, 47 full texts were excluded, and 3 articles were classified as having low methodological quality and 5 as having moderate methodological quality.


The present systematic analysis suggests that there is moderate scientific evidence that a fixed appliance influences periodontal status; no article reported a high score.

Keywords: Orthodontic therapy, Periodontal status, Fixed appliance, Systematic review, Orthodontics effects.