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Gingival Enlargement Induced by Orthodontic Therapy: A Systematic Review
María Dolores Rocha-Eiroa1,2, Albert Ramírez-Rámiz2,3, Lluís Brunet-Llobet1,2,3
1Department of Dentistry, Hospital Sant Joan de Déu (HSJD), University of Barcelona, Barcelona, Spain, ub.edu.
International Journal of Dentistry
|April 17, 2026
Summary
Orthodontic-induced gingival enlargement (OIGE) is multifactorial, often linked to poor hygiene and hormonal shifts. Mechanical stress from orthodontic devices, particularly in adolescents, is a primary driver of this condition.
Area of Science:
- Periodontology
- Orthodontics
- Oral Biology
Background:
- Orthodontic-induced gingival enlargement (OIGE) is a multifactorial condition influenced by poor oral hygiene, hormonal changes, and the presence of orthodontic appliances.
- Fixed orthodontic treatment can lead to the accumulation of dysbiotic microbial biofilms and mechanical stress on the periodontium, contributing to OIGE.
Purpose of the Study:
- To systematically review and analyze the primary factors involved in the pathogenesis of orthodontic-induced gingival enlargement (OIGE).
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, CENTRAL, Scopus, Web of Science).
- Included studies assessed gingival enlargement/overgrowth in patients undergoing fixed orthodontic treatment.
- Risk of bias and methodological quality were evaluated using the Newcastle-Ottawa Scale.
Main Results:
- OIGE is associated with increased matrix metalloproteinases (MMPs), collagen, nickel accumulation, and sex hormones (estradiol, testosterone).
- Higher prevalence was observed in males, anterior buccal regions, and with longer treatment duration, increased probing depth, and bleeding on probing.
- Metal brackets, elastomeric ligatures, excess resin, altered microbial profiles, thick periodontal phenotype, and mouth breathing were identified as contributing factors.
Conclusions:
- Mechanical stress from orthodontic devices appears to be the main etiological factor in the development of gingival enlargement.
- The risk and prevalence of OIGE are notably higher in the adolescent population.
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