BACKGROUND: This study was conducted to determine accuracy, precision and repeatability of four different methods for assessing gingival thickness METHODS: This cross-sectional study evaluated gingival thickness on 200 consecutively included orthodontic patients. Gingival thickness was assessed at both central mandibular incisors with: 1) transgingival probing with a standard periodontal probe, 2) transgingival probing with a stainless-steel acupuncture needle, 3) ultrasound, and 4) a color-coded periodontal probe. Intra-examiner reproducibility and method error were also evaluated. RESULTS: Transgingival measurements with the standard periodontal probe were found to be more accurate than those with the acupuncture needle, after method error assessment. Acupuncture needle and ultrasound device yielded higher values than the probe. Expected differences between the two methods were 22% more for the mandibular left central incisor (95% confidence interval (CI) = 11% to 32%) and 26% more (95% CI = 13% to 39%) for the mandibular right central incisor when measured with the needle. Ultrasound measurements exceeded probe measurements on average by 0.16 mm at mandibular left central incisor (95% CI = 0.14 to 0.18) and by 0.11 mm for mandibular right central incisor (95% CI = 0.08 to 0.13). Intraclass correlation coefficient concluded good agreement for the color-coded periodontal probe (0.624). CONCLUSIONS: Within the inherent limit of the uncertainty about the true value of gingival thickness, the present results demonstrate the differences between the tested methods, as far as accuracy and reproducibility are concerned. Based on the reproducibility, the transgingival probing with the periodontal probe as well as the ultrasound determination, seem to present an adequate choice for every day practice.

Objective: Transgingival probing is often used in the clinic to assess gingival thickness. However, what is not completely known is how well this method represents the true value of soft tissue thickness. The aim of this study was to assess differences and variation in gingival thickness when measured with trans-gingival probing or scanned with an intraoral device. Method and materials: This ex vivo study evaluated gingival thickness on 20 porcine cadavers. Gingival thickness was assessed at both central and lateral mandibular incisors through transgingival probing with a standard metal periodontal probe and also using intraoral scanning, which was considered as the method providing the 'true value' of soft tissue thickness. Intra-examiner repeatability and method error were evaluated. Results: No evidence of systematic difference for any of the mandibular central or lateral incisors (mandibular right incisors: mean difference -0.17 to -0.01 mm, and mandibular left incisors: mean difference -0.11 to 0.04 mm) was observed between the periodontal probe and intraoral scanning methods. The absolute differences between the repeated measurements with intraoral scanning for each tooth type (n = 30) were calculated: the overall median was 0.089 mm and the interquartile range was 0.080 mm. Conclusions: Transgingival probing with a standard metal periodontal probe for assessing gingival thickness is a reliable method, with values very close to the true gingival thickness, and it can thus be considered as the clinical gold standard.

AIM: Bone remodelling can be followed through the bone turnover markers (BTMs). Aim of the present study was to record the fluctuation of an osteoclastic and an osteoblastic BTM [C-terminal telopeptide of type I collagen (CTX) and N-terminal pro-peptide of type I pro-collagen (PINP), respectively] in both the gingival crevicular fluid (GCF) and the serum of orthodontic patients before and after the initial application of orthodontic forces.

MATERIALS AND METHODS: Twenty-one Caucasian patients were prospectively evaluated. GCF and blood samples were collected in order to measure the selected biomarkers by ELISA at three time-points: exactly before, 5 days, and 14 days after bonding of the appliances. Standardized sample handling and patient preparation procedures were adopted in order to reduce pre-analytical variability.

RESULTS: GCF and serum CTX levels were found to be independent of age, although higher in the serum of female subjects. PINP levels were found higher in the serum of patients ≥25 years old, as well as in the GCF of males. A positive correlation between serum and GCF baseline PINP levels was observed.

LIMITATIONS: The effect of orthodontic treatment on bone remodelling might not be absolutely representative of the local bone microenvironment as the levels of the specific BTMs where measured within the GCF of the lower front teeth.

CONCLUSIONS: This is the first time PINP and CTX have been evaluated in the GCF and serum of orthodontic patients with fixed appliances. No statistically significant alterations of CTX and PINP levels in the GCF and the serum of patients were recorded over time during the initial stages of orthodontic treatment.

INTRODUCTION: The aim was to elucidate the magnitude of alterations in systemic blood counts in healthy patients during the first 14 days after fixed orthodontic appliance placement.

METHODS: This prospective cohort study consecutively included 35 White Caucasian patients starting orthodontic treatment with fixed appliances. The mean age was 24.48 ± 6.68 years. All patients were physically and periodontally healthy. Blood samples were collected at 3 time points: (1) baseline (exactly before the placement of appliances), (2) 5 days after bonding, and (3) 14 days after baseline. Whole blood and erythrocyte sedimentation rates were analyzed in automated hematology and erythrocyte sedimentation rate analyzer. Serum high-sensitivity C-reactive protein levels were measured by the nephelometric method. Standardized sample handling and patient preparation procedures were adopted to reduce preanalytical variability.

RESULTS: A total of 105 samples were analyzed. All clinical and orthodontic procedures were performed without complications or side effects during the study period. All laboratory procedures were performed per protocol. Significantly lower white blood cell counts were detected 5 days after bracket bonding, compared with baseline (P <0.05). Hemoglobin levels were lower at 14 days than baseline (P <0.05). No other significant shifts or alteration patterns were observed over time.

CONCLUSIONS: Orthodontic fixed appliances led to a limited and transient change in white blood cell counts and hemoglobin levels during the first days after bracket placement. The fluctuation of high-sensitivity C-reactive protein levels was not significant, demonstrating a lack of association between systemic inflammation and orthodontic treatment.

Objective: This prospective controlled study aimed to assess whether changes in mandibular incisor inclination during orthodontic treatment with fixed appliances affect gingival thickness (GT) and the width of keratinized gingiva (WKG), and having as reference an untreated group of participants. Materials and methods: Forty consecutively recruited adult orthodontic patients and 40 untreated volunteers, matched for age and gender and selected from the same background population serving as controls, were included. Mandibular incisor inclination was measured in lateral cephalograms before treatment commencement (T0) and 1 month before fixed appliances’ removal (T1). Gingival thickness was measured using an Ultrasound Device (US) and width of keratinized gingiva (WKG) using a standard periodontal probe within the frames of a full periodontal examination at T0, T1, and 1 year after bracket removal (T2), that is, at about 30 months from T1. Results: Nineteen females and 21 males in each group [mean age in years (range): intervention group 23.1 (16.8–43.3); control: 21.85 (18.2–43.9)] were analysed. Overall, change in incisor proclination [mean change in Incisor Mandibular Angle Plane—IMPA (ΔIMPA) was 6.35° (SD 5.08°)] was not associated with any significant change in soft tissue thickness and with alterations in WKG. The group receiving fixed appliances did not exhibit thickening or thinning of GT in comparison to the control group; the WKG was reduced in the intervention group in comparison to the untreated group, where it essentially remained unchanged (#41: coeff.: −0.29, P value: .1, 95% CIs: −0.65, 0.06; #31: coeff.: −0.51, P value: .01, 95% CIs: −0.88, −0.14). Conclusions: Lower incisor proclination during orthodontic treatment does not appear to significantly alter GT and WKG, but orthodontic treatment, overall, leads to reduction of the WKG.

Objective: To assess in a prospective controlled study whether orthodontic treatment with fixed appliances results in development of gingival recession (GR), compared with an untreated group of participants.

Materials & Methods: The sample consisted of 40 consecutive adult orthodontic patients (Intervention group) and 40 untreated adult volunteers, that satisfied the inclusion and exclusion criteria and were selected from the same background population, as the control group. GR was measured as part of a full periodontal assessment: before treatment (T0) and 12 months after removal of the fixed appliances (T1) in the intervention group, i.e. at about 30 months from T0, and at baseline (T0) and 30 months after (T1) in the control group. A count data model was fit using the sum of recessions at T1 and as predictors: treatment, periodontal phenotype (thin/thick), side (buccal/lingual), sex, age, and number of recessions at baseline, with robust standard errors to account for the multiple within patient observations.

Results: Nineteen females and 21 males in each group [mean age in years (range): intervention group 23.1 (16.8 - 43.3); control: 21.85 (18.2 - 43.9)] were analyzed. During the whole study period, the control group exhibited a modest increase in the number of recessions over time. Several patients in the intervention group exhibited a larger increase in the number of recessions than the controls. However, this was partly counteracted by a considerable amount of reduction in the number of recessions in several patients receiving treatment. The adjusted incidence for recession was 67% higher for the intervention group versus the control group (IRR = 1.67, 95% CIs: 1.05, 2.67, P = 0.03). Most recessions, though, were up to 1mm. The most affected teeth were the canines and the first premolars.

Conclusions: Compared to untreated individuals, patients undergoing orthodontic treatment with fixed appliances showed a higher incidence rate of gingival recession at 1-year posttreatment, adjusted for age, periodontal phenotype, side, gender and number of recessions at baseline. However, the severity of gingival recessions was of limited extent.