Diagnostics and preparation of soft tissues before orthodontic treatment

Introduction
Orthodontic treatment with fixed braces aimed to expand dental arches may result in the loss of soft tissues and the formation or increase of the dimensions of already existing recessions. A periodontal phenotype is a vital factor affecting final treatment outcomes.

Aim
The aim of the article is to present problems of the effects of periodontal phenotypes on orthodontic treatment and to indicate a possibility of periodontal preparation of soft tissues for orthodontic treatment.

Material and methods
Using the PubMed database, articles on orthodontic treatment and a gingival phenotype were found. Selected studies were analysed. This publication is based on reports from 57 papers from the years 2000– 2019 and five books in the field of periodontology, supplemented by seven articles from before 2000, relevant to the development of a theory of periodontal anatomy and phenotypic types.

Results
The analysis of literature allowed to confirm a relationship between a gingival phenotype and a phenotype of hard tissues. Orthodontic treatment should be planned taking these phenotypes into account. A thin phenotype often requires a surgical procedure to thicken tissue before orthodontic treatment. In patients with a thick phenotype, in whom the risk of recession progression is lower, it is possible to introduce observation during orthodontic treatment and to correct defects after its completion, if possible.

Conclusions
Planning and conducting orthodontic treatment is sometimes limited by the structure of periodontal tissues. Periodontal diagnostics before the start of orthodontic treatment is used to assess periodontal features such as height and quality of the alveolar process and the type of a soft tissue phenotype. Most studies suggest improving the gingival phenotype before orthodontic treatment, but a decision should be made individually for each patient.