Orthodontic treatment through fixed appliances, such as orthodontic bands, brackets, archwires, ligatures, and auxiliaries, often complicates oral hygiene procedures and facilitates biofilm accumulation on both the teeth and the surfaces of these appliances. Periodontal self-care and oral hygiene procedures, in conjunction with regular check-ups and professional oral care services are essential for maintaining periodontal health.
Biofilm control and clinical periodontal inflammation are generally worse in orthodontic clients with fixed appliances than in clients with removable appliances and non-orthodontic clients. This difficulty with maintaining good oral hygiene during orthodontic treatment leads to negative impacts on oral health, including inflammation, which in turn precipitates periodontitis progression and tissue destruction.
The present umbrella review included 17 systematic reviews investigating the periodontal parameters in healthy individuals in fixed orthodontics in relation to manual, orthodontic, or powered toothbrushes; chlorhexidine-containing or other organic products; probiotics; and motivational methods.
Conclusions:
- Powered and manual toothbrushes showed no significant differences in biofilm accumulation, although some evidence revealed significant improvements in inflammatory, bleeding, and periodontal pocket depth values in the short term with powered toothbrushes.
- Chlorhexidine (CHX) mouthrinses, but not other CHX-containing products (gels, varnishes, pastes), may be better used to control plaque accumulation in addition to tooth brushing, but only for a limited period.
- Effectiveness of other organic products due to their antimicrobial properties was reported for aloe vera and chamomile and seemed comparable to CHX without its side effects in the long term, particularly for herbal-based mouthrinses.
- Motivational methods also showed beneficial effects on periodontal biofilm control and inflammation, while no evidence supported probiotics administration.
- Future research should determine standardized periodontal self-care protocols for optimal periodontal health management in orthodontic clients with fixed appliances.
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