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Minerva Stomatologica 2019 April;68(2):84-8

DOI: 10.23736/S0026-4970.18.04127-4


lingua: Inglese

Oral mucosal complications in orthodontic treatment

Maurizio MANUELLI 1, 2, Marta MARCOLINA 1, 2, Nico NARDI 1, 2, Dario BERTOSSI 3, Daniele DE SANTIS 3, Giulia RICCIARDI 3, Umberto LUCIANO 3, Riccardo NOCINI 4, Alberto MAINARDI 5, Alessandra LISSONI 6, Silvio ABATI 6, Alessandra LUCCHESE 1, 2

1 Department of Orthodontics, Vita-Salute San Raffaele University, Milan, Italy; 2 Unit of Orthodontics, Department of Dentistry, Research Area in Dentofacial Orthopedics and Orthodontics, IRCCS San Raffaele, Scientific Institute, Milan, Italy; 3 Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; 4 Section of Ear Nose and Throat, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; 5 Department of Surgical Sciences, Specialization School of Orthodontics, Dental School, University of Turin, Turin, Italy; 6 Unit of Oral Pathology and Oral Medicine, Department of Dentistry, San Raffaele Hospital and Scientific Institute for Research and Care, Vita-Salute San Raffaele University, Milan, Italy

BACKGROUND: Orthodontic therapy is used to solve numerous oral problems, but the use of fixed oral devices can also impact negatively the oral cavity, if the treatment is not steadily under control. The aim of this study is to evaluate tooth, bone and soft tissues lesions due to the presence of fixed orthodontic appliances.
METHODS: One hundred patients with fixed orthodontic appliances were included in the study. In particular, 20 patients with rapid palatal expander (RPE), 20 patients with Forsus appliance, 20 patients with a fixed multibracket appliance treatment, 20 patients with just the lower vestibular multibracket treatment and 20 patients with both upper and lower vestibular multibracket treatment. An accurate oral examination of the oral cavity, comprehending teeth, bone and soft tissues, was carried out thoroughly, in order to find possible lesions caused by the fixed orthodontic treatment.
RESULTS: Concerning RPE, 35% patients had reversible palatal lesions, while 45% patients had the impression of the appliance on the tongue. Periodontal damages were observed in 5% of the patients, as well as tooth lesions (i.e. dental caries). 20% of the patients with Forsus appliance experienced the lesion on the cheek mucosa, while 10% individuals reported periodontal problems, and 15% of the subject suffered for WSL (white spot lesion) and dental caries. Upper vestibular multibracket appliance caused superior labial lesions (15%), cheek mucosal lesions (20%), gingivitis (55%), white spot lesions (WSL) of superior teeth (15%), while dental recessions and periodontitis due to the appliance were rarely observed (5%). Lower vestibular multibracket appliance was frequently the cause of inferior labial lesions (15%), cheek mucosal lesions (15%), gingivitis (50%), WSL of inferior teeth (20%) and also in lower arch dental recessions and periodontitis due to the appliance were rarely observed (5%). Patients with both superior and inferior multibracket appliance experienced upper and/or lower lip lesions (25%), lesions of cheek mucosa (25%), gingivitis (65%) and WSL (30%), and just in few cases periodontitis (10%). Data shows a more critical oral situation in patients with both superior and inferior appliances than people with one-arch therapy.
CONCLUSIONS: Orthodontic therapy offers a considerable number of advantages, but it is important to underline what may be the adverse consequences also. This allows the orthodontist to inform the patient of all the possible effects of their therapeutic choice. In most cases, RPE can cause an impression of the device on the tongue and reversible lesions of the palate. On the other hand, the orthodontic fixed therapy can cause gingivitis, followed by mucosal lesions, labial lesions and WSL. For these reasons, an accurate assessment of the patients before the application of fixed orthodontic treatment is necessary. Oral hygiene instructions and motivation are very important, as well as periodic controls of the fixed oral device.

KEY WORDS: Orthodontic brackets - Orthodontic appliances - Oral ulcer - Oral hygiene

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