Date of Award


Document Type


Degree Name

Master of Science in Dentistry




College of Dental Medicine

First Advisor

Jing Zhou

Second Advisor

Joe Krayer

Third Advisor

Bryan Green


Introduction: It has been established that gingival inflammation is exacerbated during puberty, in women taking oral contraceptives, and during pregnancy. Increased levels of sex hormones are implicated in the changes in periodontal conditions. It has also been established that treatn1ent with fixed orthodontic appliances presents a favorable situation for plaque accumulation, making oral hygiene more difficult to maintain. Therefore, it was hypothesized that adolescents receiving orthodontic therapy during their pubertal growth peak, might be more susceptible to gingival enlargement than those being treated outside of puberty. Orthodontists often seek to treat adolescent patients during their pubertal growth peak and utilize the Cervical Vertebral Maturation (CVM) Index proposed by Baccetti et al in 2005 to identify this time point. The purpose of this study was to evaluate whether orthodontic patients treated during their pubertal growth spurt, defined as cervical stage 3 - cervical stage 4 by the CVM index, are more susceptible to gingival enlargement than those treated outside of puberty. Additional factors, such as gender, race, treatment length, and initial spacing, might be correlated with the severity of gingival enlargement. Therefore, these conditions were evaluated and controlled for. Methods: A retrospective review of the records of 232 patients treated with comprehensive orthodontics between the ages of 10 and 25 years old at the Medical University of South Carolina was performed. Subjects' pre-treatment intraoral photographs were evaluated from canine-canine for hygiene and amount of spacing. The final cephalograms were judged for cervical stage to indicate proximity to the pubertal growth spurt. A new method for photographically assessing gingival enlargement is proposed as part of this research and was utilized to evaluate the gingival condition in the final intraoral photographs. Statistical analysis was performed to identify factors correlated with post-orthodontic gingival enlargement, specifically: gender, ethnicity, initial hygiene, length of treatment, treatment type (space closure vs. crowding relief), and proximity to the pubertal growth spurt. Results: No correlation was found between gender, ethnicity, length of treatment, or pubertal stage and severity of gingival enlargement. Initial hygiene, amount of space, and arch (upper vs. lower) were associated with the severity of gingival enlargement. Patients with worse initial hygiene and more initial spacing exhibited greater degrees of gingival enlargement. More severe gingival enlargement was also found in the lower arch than the upper arch. Conclusions: Severity of photographically-assessed post-orthodontic gingival enlargement does not appear to be correlated with proximity to the pubertal growth spurt. Patients with poor initial hygiene and those planned for closure of anterior spacing are at risk for increased levels of gingival enlargement, especially in the lower arch. Increased efforts to manage hygiene during orthodontic treatment might be warranted in such patients.


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