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Dentistry Medical European Journal of Orthodontics - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives</div>To assess the distalization, tipping, and vertical movement of the maxillary first permanent molar in patients with and without erupted maxillary second molar (MSM)<div class="boxTitle">Methods</div><span style="font-style:italic;">Eligibility criteria:</span> Randomized/non-randomized clinical studies comparing distalization, tipping, and vertical movement of the maxillary first permanent molar in patients with and without erupted MSM. <span style="font-style:italic;">Information sources:</span> Unrestricted literature search of six databases was conducted up to May, 2024. <span style="font-style:italic;">Risk of bias:</span> The quality assessment of the studies was conducted using the Cochrane Risk of Bias Tool (ROBINS-I). <span style="font-style:italic;">Synthesis of results:</span> Random effects meta- analyses using standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were performed, followed by meta-regressions, sensitivity analyses, and assessment of the quality of evidence using GRADE.<div class="boxTitle">Results</div><span style="font-style:italic;">Included studies:</span> Eleven studies (8 retrospective and 3 prospective non-randomized trials) involving 562 participants (43.97% male) were included. <span style="font-style:italic;">Synthesis of results:</span> Distalization was significantly more effective when the maxillary second molar was unerupted (9 studies; SMD = −0.41; 95% CI: −0.81–−0.004; <span style="font-style:italic;">P</span> = .04; I² = 68.6%). The eruption status of MSM has no significant effect on tipping (8 studies; SMD = −0.27; 95% CI: −0.68–0.15; <span style="font-style:italic;">P</span> = .17), and vertical movement (4 studies; SMD = 0.08; 95% CI: −0.32–0.48; <span style="font-style:italic;">P</span> = .57) of upper first molars during distalization. Sensitivity analyses showed no significant differences based on study design, appliance type, or anchorage type, confirming the robustness of the findings. The certainty in the estimates was very low due to high risk of bias, methodological weaknesses, and small sample sizes.<div class="boxTitle">Discussion</div><span style="font-style:italic;">Limitations of evidence:</span> The inclusion of non-randomized, mostly retrospective studies, unmatched baseline, Class II severity, and insufficient reporting of treatment duration are key limitations. <span style="font-style:italic;">Interpretation:</span> Very low level of evidence indicates that it may be preferable to perform distalization before the eruption of the upper second molar.<div class="boxTitle">Registration</div>PROSPERO (CRD42024591126)</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>This study aimed to evaluate and compare the stability of mandibular dental arch dimensions and patient satisfaction between two types of fixed retainers—3-strand round twisted (RT) and 8-strand rectangular braided (RB)—both of which are bonded to all six anterior mandibular teeth.<div class="boxTitle">Trial design</div>2-arm parallel, two-center prospective randomized controlled trial.<div class="boxTitle">Methods: Participants</div>133 orthodontic patients (median age 24.6 years, 25th percentile = 17.2 years, 75th percentile = 32.4 years) were recruited.<div class="boxTitle">Interventions</div>These patients were randomly assigned to receive either an RT or RB wire retainer at a 1:1 ratio.<div class="boxTitle">Randomization</div>It was achieved using random permuted blocks of sizes 4, 6, or 8, which were concealed in sequentially numbered, opaque, sealed envelopes.<div class="boxTitle">Outcomes</div>The primary outcome was the change in the irregularity index, with secondary outcomes including arch length; intercanine, interpremolar, and intermolar widths; and patient satisfaction. Evaluations were performed at baseline and at 3, 6, 12, 18, and 24 months after retainer placement. Dental cast measurements were analyzed using random effects linear regression, and satisfaction was assessed at each time point.<div class="boxTitle">Blinding</div>Blinding of patients was not feasible. Only blinding the assessor for patient satisfaction was achieved.<div class="boxTitle">Results</div>Cast measurements remained relatively stable from T1 to T6, with no significant difference attributed to the retainer type (RT or RB). Time significantly affected all cast measurements except for the irregularity index. There was no significant correlation between retainer type or time and satisfaction questionnaire responses, although the responses varied by question. No harms were observed.<div class="boxTitle">Conclusions</div>Both RT and RB wire retainers effectively maintain mandibular arch alignment and are equally well tolerated by patients in the medium term.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Automatic landmarking software packages simplify the analysis of the 3D facial images. Their main deficiency is the limited accuracy of detecting landmarks for routine clinical applications. Cliniface is readily available open-access software for automatic facial landmarking, its validity has not been fully investigated.<div class="boxTitle">Objectives</div>Evaluate the accuracy of Cliniface software in comparison with the developed patch-based Convoluted Neural Network (CNN) algorithm in identifying facial landmarks.<div class="boxTitle">Materials /Methods</div>The study was carried out on 30 3D photographic images; twenty anatomical facial landmarks were used for the analysis. The manual digitization of the landmarks was repeated twice by an expert operator, which considered the ground truth for the analysis. Each 3D facial image was imported into Cliniface software, and the landmarks were detected automatically. The same set of the facial landmarks were automatically detected using the developed patch-based CNN algorithm. The 3D image of the face was subdivided into multiple patches, the trained CNN algorithm detected the landmarks within each patch. Partial Procrustes Analysis was applied to assess the accuracy of automated landmarking. The method allowed the measurement of the Euclidean distances between the manually detected landmarks and the corresponding ones generated by each of the two automated methods. The significance level was set at 0.05 for the differences between the measured distances.<div class="boxTitle">Results</div>The overall landmark localization error of Cliniface software was 3.66 ± 1.53 mm, Subalar exhibiting the largest discrepancy of more than 8 mm in comparison with the manual digitization. Stomion demonstrated the smallest error. The patch-based CNN algorithm was more accurate than Cliniface software in detecting the facial landmarks, it reached the same level of the manual precision in identifying the same points. The inaccuracy of Cliniface software in detecting the facial landmarks was significantly higher than the manual landmarking precision.<div class="boxTitle">Limitations</div>The study was limited to one centre, one groups of 3D images, and one operator.<div class="boxTitle">Conclusions</div>The patch-based CNN algorithm provided a satisfactory accuracy of automatic landmarks detection which is satisfactory for the clinical evaluation of the 3D facial images. Cliniface software is limited in its accuracy in detecting certain landmark which bounds its clinical application.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives</div>To compare cephalometric long-term outcomes in patients with unilateral cleft lip and palate (UCLP) and treated with three different surgical protocols for palatal repair. Furthermore, to investigate growth longitudinally and evaluate the possibility to predict the outcome at age 19 from cephalometric values at 5 years.<div class="boxTitle">Materials/Methods</div>Lateral cephalograms of 68 patients, operated according to the Veau–Wardill–Kilner technique (<span style="font-style:italic;">n</span> = 13), the minimal incision technique (<span style="font-style:italic;">n</span> = 39), or MIT with muscle reconstruction (MITmr) (<span style="font-style:italic;">n</span> = 16) were assessed. At a mean age of 19.0 (SD 0.7) years, 17 skeletal and 6 soft tissue variables were analysed using analysis of variance (ANOVA) with pairwise comparison. Lateral cephalograms at a mean age of 5.1 (SD 0.4) years, from 32 of the 68 patients were used to predict values at 19 years, using a multiple linear regression.<div class="boxTitle">Results</div>There were statistically significant differences between the three surgical techniques for eight of the skeletal variables and for two of the soft-tissue variables at 19 years. The angle between the sella/nasion plane and the nasion/A plane (SNA) was 74.5 (SD 3.8) after Veau-Wardill-Kilner (VWK), 77.6 (SD 5.3) after minimal incision technique (MIT), and 76.7 (SD 2.6) after MITmr. Adjusted for baseline values, at 5 years, only face height had a significant effect dependent on surgical technique.<div class="boxTitle">Limitations</div>Due to the exclusion criteria or missing medical records, only 43% of 157 consecutive patients could be included in the study.<div class="boxTitle">Conclusion</div>MIT and MITmr resulted in better cephalometric results regarding facial growth sagittally and vertically compared to VWK. Most of the cephalometric variables measured showed a strong positive relation between the value at 5 and the value at 19 years of age.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The study aimed to compare the short- and long-term effectiveness of hybrid Hyrax (HH) -Facemask (FM) and HH-mentoplate (MP) treatment protocols for maxillary protraction using Alt-RAMEC.<div class="boxTitle">Methods</div>A single-center 2-arm parallel randomized controlled trial. <span style="font-style:italic;">Participants:</span> 28 skeletal class III patients (female: 14, male: 14; average age: 9.7 ± 1.3 years;) were included. <span style="font-style:italic;">Interventions:</span> Two treatment groups where protraction therapy was combined with Alt-RAMEC. Group 1: Facemask group (Hybrid Hyrax + Facemask) and Group 2: Mentoplate group (Hybrid Hyrax + Mentoplate). <span style="font-style:italic;">Objective: To compare skeletal and dental changes between groups using low dose computed tomography (CT) scan from which virtual lateral cephalograms were generated. Outcome:</span> Outcomes include changes in Wits appraisal (primary outcome), and cephalometric analysis of skeletal and dental changes (secondary outcomes) at 1 year and 5 years after treatment initiation. <span style="font-style:italic;">Randomization:</span> 28 patients were allocated to either treatment-protocols using sequentially numbered opaque, sealed envelopes. The randomization sequence was generated with a 1:1 allocation ratio. <span style="font-style:italic;">Blinding:</span> Due to the nature of the trial, the operator and children could not be blinded to the treatment allocation. However, blinding was used when assessing the outcomes.<div class="boxTitle">Results</div><span style="font-style:italic;">Follow-up:</span> one patient was lost at the one-year follow-up and an additional three patients were lost at the 5-year follow-up. <span style="font-style:italic;">Outcomes:</span> Both treatment protocols effectively improved intermaxillary relationship. Wits measurements showed improvements of 4.42 mm (FM) and 2.86 mm (MP) at T1, decreasing slightly to 3.33 mm (FM) and 1.50 mm (MP) at T2. While vertical control and incisor inclination were comparable between groups long-term, short-term differences were noted in upper and lower incisor inclination. Results remained equally stable after five years (T2). <span style="font-style:italic;">Harms:</span> minor harms were encountered with the anchor hooks (fracture or mucosal irritation), however none led to treatment cessation<div class="boxTitle">Conclusions</div>Early class III treatment with HH + MP provided similar outcomes and stability to that of HH + FM suggesting that the choice between FM and MP should be based on individual patient factors rather than presumed mechanical advantages.<div class="boxTitle">Trial registration</div>Clinical Trials ID: NCT02711111</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>This study aimed to analyze midfacial skeletal shape asymmetry in skeletal Class III patients using a three-dimensional spatially-dense method.<div class="boxTitle">Methods</div>Sixty skeletal Class III patients’ cone-beam computed tomography images were retrospectively enrolled and divided into three groups according to occlusal plane inclination (OPI) and mandibular lateral deviation (MD). A spatially-dense template of the anterior outer surface of the midfacial skeleton was established and validated. Through template registration, a large number of homologous quasi-landmarks of the midfacial skeleton were automatically identified. After robust superimposition of the original and mirror images, the root-mean-square error was calculated as the asymmetry index (AI). Color-coded maps were generated to visually display the location and magnitude of the asymmetry.<div class="boxTitle">Results</div>The median overall midfacial skeletal AIs of group 1 (with OPI and MD), group 2 (with MD without OPI), and group 3 (without OPI or MD) were 1.55, 1.27, and 1.19, respectively. The overall AI of group 1 was significantly higher than that of group 2 (<span style="font-style:italic;">P</span> < .05) and group 3 (<span style="font-style:italic;">P</span> < .01). Within group 1, the AI of the alveolar process was significantly higher than that of other regions.<div class="boxTitle">Conclusions</div>The three-dimensional spatially-dense method allows quantitative and visual analysis of shape asymmetry of the midfacial skeleton. Skeletal Class III patients with occlusal plane inclination and mandibular lateral deviation exhibit a significantly greater degree of midfacial skeletal asymmetry, with the alveolar process identified as the main asymmetric site of their midfacial skeleton.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Extraction of premolars is usually prescribed for the orthodontic treatment of cases with inadequate space within the dental arch or when anterior teeth retraction is indicated; however, it has been advocated that this treatment approach could negatively influence the airways.<div class="boxTitle">Objective</div>To identify and critically appraise studies of premolar extractions during orthodontic treatment on upper airway dimensions. <strong>Search methods:</strong> Electronic unrestricted searches in nine databases until October 2024. <strong>Selection criteria:</strong> Clinical studies on humans comparing comprehensive orthodontic treatment with versus without the extraction of premolars using cone-beam computed tomography to assess upper airway volume or minimum cross-sectional area (minCSA). <strong>Data collection and analysis:</strong> After duplicate study selection, data extraction, and risk-of-bias assessment according to Cochrane, random-effects meta-analyses of Mean Differences (MD) with their 95% confidence intervals (CI) were performed, followed by subgroup/meta-regression analyses and assessment of the quality of evidence.<div class="boxTitle">Results</div>Twelve papers corresponding to 11 unique retrospective non-randomized studies were included, covering 891 patients (35.8% male; 20.0 years-old on average). No statistically significant differences in the effect of orthodontic treatment on the volume of the nasopharynx, palatopharynx, glossopharynx, oropharynx or oral cavity were seen between patients treated with versus without premolar extractions (P > .05). Similarly, no significant differences were seen between extraction and non-extraction patients in terms of minCSA of the nasopharynx, palatopharynx, or glossopharynx (P > .05). On the contrary, patients treated with premolar extractions showed increased minCSA of the oropharynx compared to those treated without premolar extractions (4 studies; MD = 23.00 mm<sup>2</sup>; 95% CI = 10.74–35.26 mm<sup>2</sup>; P = .009). No significant effects from patient age, sex, or equivalence of the extraction/non-extraction groups were found, while the strength of evidence was moderate in all cases due to the inclusion of non-randomized studies with high risk of bias.<div class="boxTitle">Conclusions</div>Limited evidence of moderate strength indicates that, on average, premolar extractions during comprehensive orthodontic treatment have little to no effect on the volume and minCSA of the airways.<div class="boxTitle">Registration</div>CRD42024621355</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background/Objectives</div>Third molar agenesis and palatally impacted canines (PICs) are two independent dental phenotypes with different developmental backgrounds. Isolated reports indicate a common genetic origin for both, however, current data is inconsistent. The aim of this study was to investigate the presence of third molar agenesis in individuals with PICs, compared to individuals without PICs.<div class="boxTitle">Materials/Methods</div>This retrospective case-control study comprised 310 individuals (188 females and 122 males), half of whom presented with unilateral or bilateral PICs. Individuals with other dental anomalies of known genetic origin were excluded. The association between PICs and third molar agenesis was assessed using four regression models, with PIC as the dependent variable and sex, age, and third molar agenesis as predictors. One model treated PIC as a nominal variable (pattern) and the other as ordinal (severity), and both were run testing either third molar agenesis severity or third molar agenesis patterns. All statistical tests were performed assuming a type-1 error of 5%.<div class="boxTitle">Results</div>There was no significant association between canine impaction and third molar agenesis in any of the four regression models. Neither the severity nor the patterns of palatally impacted canines were associated with either the severity or the patterns of third molar agenesis (<span style="font-style:italic;">P</span> > .05).<div class="boxTitle">Limitations</div>Due to the common racial background of all participants, the results of this investigation might not be generalizable to the general population.<div class="boxTitle">Conclusions/Implications</div>Palatal canine impaction is not associated to third molar agenesis, after accounting for age, sex, and various patterns of PICs and third molar agenesis. These results indicate that these two dental phenotypes do not share a common biological mechanism for their occurrence.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>Molar distalization is a therapeutic approach commonly used for treating Class II malocclusions. However, the extended duration of this treatment often leads to its replacement with alternative methods that offer shorter treatment times. Micro-osteoperforation (MOP) has been introduced as a technique aimed at accelerating tooth movement and reducing treatment duration. The purpose of this study is to evaluate the impact of MOP on molar distalization outcomes to provide evidence for its effective and safe use.<div class="boxTitle">Search methods</div>A comprehensive search was conducted across multiple databases, including MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane’s CENTRAL, up to April 2024, without any language or date restrictions.<div class="boxTitle">Selection criteria</div>Only randomized clinical trials (RCTs) that addressed the defined PICO question were included in the analysis. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool.<div class="boxTitle">Data collection and analysis</div>Relevant data were extracted using custom-designed forms, and a random-effects inverse variance meta-analysis was performed to synthesize the results. The primary outcomes analyzed were the rate and amount of molar distalization, while secondary outcomes included pain levels, root resorption, and periodontal health.<div class="boxTitle">Results</div>Four RCTs, involving a total of 71 participants, were included in this exploratory review. Most studies were at low or some concerns risk of bias. The meta-analysis revealed no significant differences in the rate or amount of molar distalization between the MOP and control groups (mean difference [MD] = 0.1 mm/month and 0.01 mm, respectively, <span style="font-style:italic;">P</span> > .05). However, the MOP group reported significantly higher pain levels on the day of the procedure (MD = 2, <span style="font-style:italic;">P</span> = .01) on a 10-point visual analog scale (VAS) compared to the control group. This difference in pain perception was no longer significant seven days after the procedure (MD = 0.52, <span style="font-style:italic;">P</span> = .52).<div class="boxTitle">Conclusion</div>While MOP is associated with increased immediate postoperative pain, it does not significantly enhance the efficiency of molar distalization. Therefore, the use of MOP for distalization should be judiciously considered and reserved for cases that involve particularly challenging or prolonged movements, based on the specific needs and characteristics of each patient. Limitations of this review include the small number of available RCTs and variability in MOP protocols, which may limit the generalizability of the findings.<div class="boxTitle">Registration</div>The protocol for this systematic review was registered at PROSPERO with the ID CRD42024589482</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives</div>The aim of the study was to determine the genetic and environmental effects on transverse growth of craniofacial structures, within and between identical and fraternal twins.<div class="boxTitle">Methods</div>The sample consisted of 142 children in total, divided into 29 pairs of monozygotic twins, 42 pairs of dizygotic twins, and 1 set of dizygotic triplets. Postero-anterior cephalometric radiographs were taken at the ages of 9, 12, and 15 years. Intercanine width, maxillary width, mandibular width, nasal width, and facial width variables were measured. The genetic and environmental components of variance were analyzed with structural equation modeling for multilevel mixed effects.<div class="boxTitle">Results</div>Intercanine width was initially mainly characterized by a moderate genetic component at 9 years (53%), with environmental influence increasing at age 12 (36%) and peaking at 15 years (84%). Maxillary width was under strong genetic influence at 9 years (70%), with genetic influence remaining strong up to 15 years (73%). Mandibular width was under additive genetic influence at 9 years (76%), with dominant genetic influence remaining high at 15 years (81%). Nasal width was under strong additive genetic influence at 9 years (69%) but switched to increased environmental influence at 15 years (59%). Finally, facial width had a moderate genetic influence at 9 years (66%), which increased at 15 years (90%).<div class="boxTitle">Limitations</div>This study included patients of European descent, which may limit the generalizability of the findings to other ethnic groups.<div class="boxTitle">Conclusions</div>Although monozygotic and dizygotic twins share at least part of their genetic material, environmental factors accounted for about 10%–84% of variability at various ages, with intercanine width being most affected.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>B-cell lymphoma 6 (Bcl6) inhibits osteoclast differentiation <span style="font-style:italic;">in vitro</span>; however, its role in orthodontic tooth movement (OTM) remains unclear. This study aimed to investigate the role of Bcl6 in OTM of rat molars.<div class="boxTitle">Materials and methods</div>OTM was performed on the maxillary first molars of male rats using nickel-titanium coil springs (25 gf) for 14 days with or without local injection of FX1 (50 mg/kg), a Bcl6 inhibitor (n = 10 per group). Micro-computed tomography (CT) images were used to analyse OTM distance and bone morphometric parameters. Immunohistochemistry (IHC) determined Bcl6 expression and tartrate-resistant acid phosphatase staining (TRAP) staining assessed osteoclast differentiation. TRAP staining, and reverse transcription-quantitative polymerase chain reaction determined the effect of FX1 (1 μM) on <span style="font-style:italic;">in vitro</span> rat osteoclast differentiation. The effect of FX1 on cell proliferation and Smad4 expression in periodontal ligament (PDL) cells was determined.<div class="boxTitle">Results</div>Administration of FX1 significantly increased OTM distance and decreased the bone/tissue volume compared with vehicle treatment. IHC staining showed that the vehicle-OTM group had higher expression of Bcl6 than the FX1-OTM group. The number of osteoclasts on the compression side was significantly higher in the FX1-OTM group than that in the vehicle-OTM group. FX1 enhanced osteoclast differentiation and expression of <span style="font-style:italic;">Nfatc1, Dc-stamp,</span> and <span style="font-style:italic;">Ctsk</span> mRNA in osteoclasts <span style="font-style:italic;">in vitro</span>. FX1 significantly promotes PDL cell proliferation <span style="font-style:italic;">in vivo</span> and <span style="font-style:italic;">in vitro</span>.<div class="boxTitle">Limitations</div>We evaluated only 14 days of OTM.<div class="boxTitle">Conclusions</div>Bcl6 may play an important role in OTM <span style="font-style:italic;">via</span> modulation of osteoclast differentiation and PDL cell proliferation.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background/Objectives</div>Mandibular second molar (MdM2) is often lost, and its space is filled with a bridge or implant. MdM2 extraction followed by orthodontic treatment protracting mandibular third molar (MdM3) towards the MdM2 position may overcome the missing of MdM2. The objectives of our study were to describe the outcome of the procedure and examined clinical risk factors such as external apical root resorption (EARR) and alveolar bone loss (ABL), as the indicators of poor orthodontic treatment outcomes.<div class="boxTitle">Materials/Methods</div>This retrospective study included 70 cases in 56 patients who received orthodontic treatment at Tokyo Medical and Dental University Hospital between 2007 and 2018. Multi-bracket appliances were used in all patients for MdM3 protraction. Using linear mixed effects models, EARR and ABL were regressed on various factors, including panoramic and cephalometric variables.<div class="boxTitle">Results</div>With the mean treatment duration of 1040.4 ± 441.8 days, MdM2 space closure was achieved in 92.8% (65 cases). The ANB angle (<span style="font-style:italic;">P</span> = .023) and the use of temporary anchorage devices (TADs) (<span style="font-style:italic;">P</span> = .021) were significantly associated with the greater EARR, while the mandibular plane angle (<span style="font-style:italic;">P</span> = .033) was associated with the greater ABL. MdM3 protraction using the fixed appliances resulted in the closure of MdM2 space in > 90% of cases without evident root resorption.<div class="boxTitle">Limitation</div>There is a possibility of residual confounding due to the nature of observational study.<div class="boxTitle">Conclusion/Implication</div>Orthodontic treatment of MdM3 protraction may be a feasible strategy to close the space of the missing MdM2.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>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.<div class="boxTitle">Materials and methods</div>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.<div class="boxTitle">Results</div>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, <span style="font-style:italic;">P</span> value: .1, 95% CIs: −0.65, 0.06; #31: coeff.: −0.51, <span style="font-style:italic;">P</span> value: .01, 95% CIs: −0.88, −0.14).<div class="boxTitle">Conclusions</div>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.</span>
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