DYNAMICS OF CLINICAL ORAL HEALTH INDICATORS WITH A DIFFERENTIATED THERAPEUTIC AND PREVENTIVE COMPLEX IN PATIENTS WITH FIXED ORTHODONTIC APPLIANCES

Abstract

Fixed orthodontic appliances create additional retention surfaces for biofilm, which complicates individual oral hygiene and promotes inflammatory changes in the gingiva. Preventive care is mostly based on standard recommendations, whereas the possibility of differentiating it according to gingival phenotype remains insufficiently studied. Aim. To evaluate the clinical effectiveness of the proposed differentiated therapeutic and preventive complex (TPC) in patients with thin and thick gingival phenotypes compared with standard preventive care. Materials and methods. Sixty-eight patients aged 15–25 years were examined: 40 with a thin and 28 with a thick gingival phenotype. After one month of identical standard preventive care, main and control subgroups were formed within each phenotype by drawing lots: 20 patients each in the thin phenotype and 14 each in the thick phenotype. Patients of the main subgroups received the phenotype-differentiated TPC, patients of the control subgroups continued standard preventive care. OHI-S, PMA, BOP, the Williams orthodontic modification of the Silness-Löe index, GOi and new gingival recessions were assessed over the follow-up period. Results and discussion. In the thin gingival phenotype, between-subgroup differences in the dynamics of OHI-S, PMA, BOP and the Williams index from month 1 to month 12 were statistically significant (p<0.001; d 1.16 to 2.27). In the thick phenotype, at month 12 a significant difference remained only for the Williams index – 1.19±0.54 in the main and 1.57±0.40 in the control subgroup (p=0.043). At month 12, GOi was significantly lower in the main subgroups of both phenotypes: in the thin phenotype (p<0.001), in the thick phenotype (p<0.01). In patients with a thin phenotype and no baseline recession, new recessions occurred in 2 of 15 patients in the main and 4 of 15 in the control subgroup (p=0.651; RR=0.50; 95% CI 0.11–2.33); no new recessions were recorded in the thick phenotype. Conclusions. The differentiated TPC was associated with statistically significant between-subgroup differences in hygienic and periodontal indices within both gingival phenotypes; in the thin phenotype, at month 12 the differences involved all the clinical indices studied, and in the thick phenotype the Williams index.