Gingival Enlargement During Orthodontic Treatment: A Narrative Review

Gingival enlargement is commonly seen during orthodontic treatment, specifically in individuals with fixed appliances. Its clinical significance stems from its multifactorial etiology. The purpose of this narrative review is to evaluate the available evidence related to the causes, influential components, symptomatic profiles, and therapeutic approaches to gingival enlargement during orthodontic treatment. An electronic literature research was carried out in PubMed without any limitations. A total of 10 studies were chosen, incorporating one randomized clinical trial and nine observational studies, including cross-sectional descriptive, histological, clinical observational, clinical and histological, and case report studies. The selected articles were focused on gingival alterations in individuals with either fixed or removable orthodontic devices. Then, the determinations were synthesized narratively and thematically. The outcomes propose that multiple factors are associated with gingival enlargement. Fixed orthodontic appliances are associated with an increased risk of gingival enlargement and may influence immune-mediated responses, resulting in thickened epithelium and proliferation of connective tissue, as demonstrated by histological findings. The overall therapy time, the type of device, and local irritants are considered influential factors. The treatment can be either conservative, such as improved dental health and the administration of antimicrobials, or invasive, including gingival excision or laser surgery. Laser therapy may be considered less invasive due to minimal hemorrhage and better recovery outcomes, although based on limited evidence. Gingival enlargement associated with orthodontic devices is a condition influenced by multiple factors, including microbial, mechanical, and substance-related factors. Even though inflammation can be reduced with minimally invasive treatments, surgical interventions are often essential in ongoing cases. Additional longitudinal research is essential to explain the etiology and strengthen prophylactic and healing approaches. The objective of this narrative review was to evaluate existing information on gingival enlargement associated with orthodontic appliances, with a particular focus on the underlying mechanisms, clinical consequences, and therapeutic strategies.