Strategies for microbial biofilm control and gingival inflammation management during orthodontic treatment: a critical appraisal of recent clinical evidence
Authors
Giovanni Cattaneo, Marco Farronato, Niccolò Cenzato, Laura Viganò, Gregorio Menozzi, Benedetta Cattaneo, Andrea De Giacomo, Sabina Saccomanno, Claudia Ciocia, Antonio Musciacchio, Grazia Marinelli, Erda Qorri
Abstract
Aim: Dental plaque is the primary etiological factor for gingival and periodontal diseases, and plaque control is often compromised by orthodontic appliances. Brackets, archwires, and ligatures create plaque-retentive areas that may increase the Plaque Index (PI), Gingival Index (GI), and Modified Papillary Bleeding Index (MPBI). This narrative review aims to compare the effectiveness of oral hygiene strategies and adjunctive tools for controlling plaque accumulation and maintaining gingival health during orthodontic treatment. Materials and Methods: A structured literature search was performed in PubMed, Embase, and Web of Science for studies published between 2015 and 2025, focusing on oral hygiene interventions in patients undergoing orthodontic treatment. After screening and eligibility assessment, 18 studies (randomized controlled trials, crossover trials, and observational studies) were included. Results: Overall, powered toothbrushes (particularly oscillating–rotating and microcurrent-emitting devices) showed equal or greater plaque reduction than manual brushes in several studies, although outcomes were influenced by age, technique, and adherence. The most pronounced short-term improvements in PI, GI, and MPBI were reported when mechanical plaque removal was combined with chemical adjuncts, especially 0.2% chlorhexidine mouthrinse. Specialized devices (e.g., triple-headed brushes and water flossers) were generally comparable or superior to conventional methods. Removable aligner therapy was often associated with better periodontal indices than fixed appliances. Conclusions: Effective plaque control during orthodontic treatment requires individualized protocols that account for patient factors and appliance type. Manual brushing can be effective with adequate instruction and motivation; however, powered brushing and selected chemical adjuncts used appropriately may enhance plaque and gingival inflammation control. Clinicians should provide tailored hygiene education and adjust periodontal monitoring according to the appliance used.
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