Evaluation of Plaque and Gingival Indices in Patients Treated with Fixed Orthodontic Appliances.

Abstract

Background/Aim:
The adverse effects of fixed orthodontic appliances in terms of gingivitis and periodontal plaque accumulation are well known, and the importance of patient education, motivation, and oral hygiene habits in periodontal health maintenance cannot be overestimated. This study aimed to prospectively determine the plaque and gingival indices of patients receiving fixed orthodontic treatment at Sanaa University, Yemen.

Methods:
This longitudinal observational study included forty-eight orthodontic patients (aged 16-30 years) undergoing active treatment for at least four months. The Plaque Index (PI) and Gingival Index (GI) were blindly assessed at baseline (T0), two months (T1), and four months (T2). Inter-arch and intra-arch (anterior vs. posterior) comparisons
were performed using the Mann-Whitney U test. Changes over time were analyzed using the Wilcoxon signed-rank test, with post-hoc Bonferroni tests for multiple comparisons (α = 0.05). Throughout the study, the patients received motivational support, including educational videos and regular WhatsApp reminders.

Results:
The general trends in GI scores showed a significant decline over time and a highly significant improvement at T0-T1 and T0-T2 (P < 0.001). The plaque score increased mildly during T0 and T1 but significantly dropped during T1 and T2 (P < 0.001). Plaque and gingival indices were always higher in the lower arch than in the upper
arch. The anterior-posterior difference in teeth was minimal and not significant.

Conclusion:
Fixed orthodontic appliances are not harmful to the health of the gums if the patients take proper care of the oral cavity. Permanent motivational reinforcement, education, and follow-up play a major role in enhancing plaque control and gingival status during orthodontic treatment.