{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:59:16Z","timestamp":1791575956924,"version":"4.3.4"},"reference-count":54,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":104,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Dentistry"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The etiology of orthodontic\u2010induced gingival enlargement (OIGE) or orthodontic\u2010induced gingival overgrowth (OIGO) is multifactorial and is related to issues such as poor oral hygiene and the hormonal changes that are common during puberty. It is known that brackets facilitate the accumulation of dysbiotic microbial biofilm and that mechanical stress on the periodontium is a possible factor in the development of OIGE. Therefore, the objective of this systematic review was to analyze the principal factors involved in the pathogenesis of OIGE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Independent reviewers performed a systematic literature search of several databases, including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. The eligibility criteria included clinical studies assessing any type of gingival enlargement\/gingival overgrowth (GE\/GO) in healthy patients of any age undergoing fixed orthodontic treatment. The outcomes assessed included primary factors (mechanical stress, gingival fibrotic reaction, hormonal changes, nickel (Ni)\/titanium (Ti) sensitivity, and genetics) and secondary factors (demographic variables, dysbiotic microbial biofilm, orthodontic variables, periodontal parameters, and mouth breathing). The methodological quality and risk of bias of the studies included were analyzed using the Newcastle\u2013Ottawa Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Titles and abstracts of 670 articles were screened. Fifty\u2010six articles were selected for full\u2010text reading. From these, 27 were included and selected for extraction. From the selected studies, 17 assessed primary factors and 12 assessed secondary factors related to GE. The results of the studies indicated that the appearance of OIGE was associated with increases in matrix metalloproteinases (MMPs) MMP\u20108, MMP\u20109, collagen, Ni accumulation in gingival samples, increases in estradiol and testosterone in adolescents, and genes associated with the regulation of cell proliferation and migration. The rate of OIGE was higher in males (both in children and in adolescents), and it was most frequently located in the anterior buccal regions of both arches. There was a directly proportional relationship with the duration of orthodontic treatment, probing depth (PPD), and bleeding on probing (BOP). Metal brackets, elastomeric ligatures, excess resin, and change in the polymicrobial profile favored OIGE, and thick periodontal phenotype and mouth breathing were predisposing factors for this condition. The risk of bias was \u201cfavorable\u201d for 14\u2010case control, cohort, and cross\u2010sectional studies; medium for nine articles; and the assessment was \u201cunfavorable\u201d in four. The level of evidence for the studies selected was adequate, with an acceptable degree of recommendation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The results summarized in this systematic review suggest that the mechanical stress generated by the presence of orthodontic devices may be the main cause of the development of GE. The risk and prevalence of OIGE are highest in the adolescent population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/ijod\/2172939","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T10:23:50Z","timestamp":1776248630000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Gingival Enlargement Induced by Orthodontic Therapy: A Systematic Review"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3600-4700","authenticated-orcid":false,"given":"Mar\u00eda Dolores","family":"Rocha-Eiroa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6469-7781","authenticated-orcid":false,"given":"Albert","family":"Ram\u00edrez-R\u00e1miz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6573-7068","authenticated-orcid":false,"given":"Llu\u00eds","family":"Brunet-Llobet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7362-4047","authenticated-orcid":false,"given":"Pau","family":"Cahuana-Bartra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1971-9643","authenticated-orcid":false,"given":"Judit","family":"Rabassa-Blanco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8211-1561","authenticated-orcid":false,"given":"Jaume","family":"Miranda-Rius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-199615030-00007"},{"key":"e_1_2_14_2_2","doi-asserted-by":"crossref","first-page":"420","DOI":"10.2174\/1874210601711010420","article-title":"On the Cellular and Molecular Mechanisms of Drug-Induced Gingival Overgrowth","volume":"31","author":"Ram\u00edrez-R\u00e1miz A.","year":"2017","journal-title":"The open dentistry journal"},{"key":"e_1_2_14_3_2","first-page":"1","article-title":"Gingival Enlargement in Different Age Groups during Fixed Orthodontic Treatment","volume":"6","author":"Eid H. A.","year":"2014","journal-title":"Journal of International Oral Health"},{"key":"e_1_2_14_4_2","doi-asserted-by":"publisher","DOI":"10.4103\/0976-237X.194099"},{"key":"e_1_2_14_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2016.10.042"},{"key":"e_1_2_14_6_2","doi-asserted-by":"publisher","DOI":"10.4103\/njcp.njcp_69_21"},{"key":"e_1_2_14_7_2","doi-asserted-by":"publisher","DOI":"10.5455\/msm.2022.34.121-125"},{"key":"e_1_2_14_8_2","first-page":"823","article-title":"Hormonal Receptors in Gingival Inflammation","volume":"38","author":"Staffolani N.","year":"1989","journal-title":"Minerva stomatologica"},{"key":"e_1_2_14_9_2","doi-asserted-by":"publisher","DOI":"10.2319\/080211-487.1"},{"key":"e_1_2_14_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/10454411970080030201"},{"key":"e_1_2_14_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjn127"},{"key":"e_1_2_14_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjq148"},{"key":"e_1_2_14_13_2","first-page":"49","article-title":"Heterogeneity of Collagen Secreting Cells in Gingival Fibrosis-an Immunohistochemical Assessment and a Review of the Literature","volume":"56","author":"Pascu E. I.","year":"2015","journal-title":"Romanian Journal of Morphology and Embryology"},{"key":"e_1_2_14_14_2","first-page":"53","article-title":"Expression of Type III Colagen in Hypertrophic Gingival Tissue of Patients With Orthodontic Treatment: A Pilot Study","volume":"32","author":"Simancas-Escorcia V.","year":"2020","journal-title":"Revista Facultad de Odontolog\u00eda Universidad de Antioquia"},{"key":"e_1_2_14_15_2","article-title":"Collagen Alteration in Gingival Hypertrophy in Orthodontic Patients: Histological and Immunohistochemical Characterization","volume":"53","author":"Simancas-Escorcia V.","year":"2021","journal-title":"Salud UIS"},{"key":"e_1_2_14_16_2","doi-asserted-by":"publisher","DOI":"10.47162\/RJME.61.4.29"},{"key":"e_1_2_14_17_2","doi-asserted-by":"publisher","DOI":"10.37358\/RC.20.2.7929"},{"key":"e_1_2_14_18_2","first-page":"515","article-title":"Correlations Between the Gingival Crevicular Fluid MMP8 Levels and Gingival Overgrowth in Patients With Fixed Orthodontic Devices","volume":"51","author":"Surlin P.","year":"2010","journal-title":"Romanian Journal of Morphology and Embryology"},{"key":"e_1_2_14_19_2","first-page":"161","article-title":"Collagen IV and MMP-9 Expression in Hypertrophic Gingiva During Orthodontic Treatment","volume":"53","author":"Surlin P.","year":"2012","journal-title":"Romanian Journal of Morphology and Embryology"},{"key":"e_1_2_14_20_2","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2007.060165"},{"key":"e_1_2_14_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0765.2012.01495.x"},{"key":"e_1_2_14_22_2","doi-asserted-by":"crossref","first-page":"520","DOI":"10.2174\/1874210601812010520","article-title":"The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review","volume":"12","author":"Miranda-Rius J.","year":"2018","journal-title":"The Open Dentistry Journal"},{"key":"e_1_2_14_23_2","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.recesp.2021.06.016","article-title":"Declaraci\u00f3n PRISMA 2020: Una Gu\u00eda Actualizada Para la Publicaci\u00f3n de Revisiones Sistem\u00e1ticas","volume":"74","author":"Page M. J.","year":"2020","journal-title":"Revista Espa\u00f1ola de Cardiolog\u00eda"},{"key":"e_1_2_14_24_2","doi-asserted-by":"publisher","DOI":"10.4103\/drj.drj_700_23"},{"key":"e_1_2_14_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sdentj.2020.07.001"},{"key":"e_1_2_14_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjm074"},{"key":"e_1_2_14_27_2","doi-asserted-by":"publisher","DOI":"10.2319\/081408-430.1"},{"key":"e_1_2_14_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.piro.2014.06.002"},{"key":"e_1_2_14_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.archoralbio.2021.105103"},{"key":"e_1_2_14_30_2","doi-asserted-by":"publisher","DOI":"10.3390\/ma16010081"},{"key":"e_1_2_14_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sjbs.2021.10.047"},{"key":"e_1_2_14_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10266-025-01194-2"},{"key":"e_1_2_14_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-021-01433-2"},{"key":"e_1_2_14_34_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016350802123126"},{"key":"e_1_2_14_35_2","doi-asserted-by":"publisher","DOI":"10.1590\/2176-9451.19.3.059-066.oar"},{"key":"e_1_2_14_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6831-12-53"},{"key":"e_1_2_14_37_2","first-page":"16347","article-title":"Determining the Relationship Between the Application of Fixed Appliances and Periodontal Conditions","volume":"10","author":"Sheibaninia A.","year":"2011","journal-title":"African Journal of Biotechnology"},{"key":"e_1_2_14_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2010.02.033"},{"key":"e_1_2_14_39_2","doi-asserted-by":"publisher","DOI":"10.1080\/20002297.2025.2513739"},{"key":"e_1_2_14_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2025.07.012"},{"key":"e_1_2_14_41_2","doi-asserted-by":"publisher","DOI":"10.2319\/030911-172.1"},{"key":"e_1_2_14_42_2","doi-asserted-by":"publisher","DOI":"10.1111\/ocr.12129"},{"key":"e_1_2_14_43_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjn090"},{"key":"e_1_2_14_44_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.00511"},{"key":"e_1_2_14_45_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.2002.290813.x"},{"key":"e_1_2_14_46_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2007.01070.x"},{"key":"e_1_2_14_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.archoralbio.2017.09.022"},{"key":"e_1_2_14_48_2","first-page":"58","article-title":"Allergy to Nickel in Orthodontic Patients: Clinical and Histopathologic Evaluation","volume":"58","author":"Pazzini C. A.","year":"2010","journal-title":"General Dentistry"},{"key":"e_1_2_14_49_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cji091"},{"key":"e_1_2_14_50_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.1991.tb05746.x"},{"key":"e_1_2_14_51_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-3083.2004.01014.x"},{"key":"e_1_2_14_52_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/12.3.284"},{"key":"e_1_2_14_53_2","first-page":"431","article-title":"Matrix Metalloproteinase 9 Levels in Gingival Crevicular Fluid in Patients After Periodontal Microsurgery for Orthodontic Induced Gingival Hypertrophy","volume":"52","author":"Rauten A. M.","year":"2011","journal-title":"Romanian Journal of Morphology and Embryology"},{"key":"e_1_2_14_54_2","doi-asserted-by":"crossref","first-page":"199","DOI":"10.4274\/TurkJOrthod.2022.2022.66","article-title":"Changes in the pH and the Flow Rate of Saliva During Orthodontic Treatment With Fixed Orthodontic Appliances: A Systematic Review","volume":"36","author":"Javavice R.","year":"2023","journal-title":"Turkish Journal of Orthodontics"}],"container-title":["International Journal of Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ijod\/2172939","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/ijod\/2172939","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ijod\/2172939","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T10:23:53Z","timestamp":1776248633000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/ijod\/2172939"}},"subtitle":[],"editor":[{"given":"Hannah","family":"Wesley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":54,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/ijod\/2172939"],"URL":"https:\/\/doi.org\/10.1155\/ijod\/2172939","archive":["Portico"],"relation":{},"ISSN":["1687-8728","1687-8736"],"issn-type":[{"value":"1687-8728","type":"print"},{"value":"1687-8736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2024-11-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"2172939"}}