Plaque Control, Periodontal Inflammation, and Orthodontic Treatment Stability: A Narrative Review

Abstract

Orthodontic treatment aims to achieve optimal dental alignment and occlusion, yet its success is intricately linked to periodontal health. Plaque accumulation, exacerbated by fixed appliances, can lead to gingival inflammation, periodontal attachment loss, and potential compromise of treatment stability. This narrative review synthesizes recent literature on the interplay between plaque control, periodontal inflammation, and the long-term stability of orthodontic outcomes. Drawing from peer-reviewed studies published between 2020 and 2025, we explore how orthodontic appliances influence microbial biofilms, inflammatory responses, and periodontal tissues. Key findings indicate that inadequate plaque control during treatment heightens the risk of gingivitis and periodontitis, which may contribute to post-treatment relapse through altered bone remodeling and soft tissue changes. Effective interventions, including powered toothbrushes, antimicrobial mouthrinses like chlorhexidine, and adjunctive tools such as water irrigators, have demonstrated superior plaque reduction and improved gingival health compared to conventional methods. Comparative analyses reveal that clear aligners may offer better periodontal outcomes than fixed appliances due to easier hygiene maintenance. Furthermore, periodontal inflammation during active orthodontics can impair tooth movement efficiency and increase susceptibility to root resorption, ultimately affecting retention phase stability. The review underscores the necessity of integrated orthodontic-periodontal management, emphasizing patient education and regular monitoring to mitigate inflammation and enhance stability. Future directions include personalized microbiome-targeted therapies and advanced biomaterials for plaque-resistant appliances. By prioritizing plaque control, clinicians can optimize orthodontic stability while preserving periodontal integrity, leading to more predictable and sustainable results. © 2025 Asian Journal of Periodontics and Orthodontics.