The Evaluation of Gingival Crevicular Fluid Biomarkers as Predictors of Gingival Enlargement in Patients Undergoing Fixed Orthodontic Treatment: A Prospective Study

Introduction Gingival enlargement (GE) poses a significant problem during fixed orthodontic treatment (FOT). Thus, the primary aim of the current study was to evaluate the concentrations of biomarkers present in the gingival crevicular fluid (GCF) of individuals receiving FOT. The ancillary aim was to examine and compare biomarker levels among patients exhibiting GE undergoing FOT, those without GE undergoing FOT, and a control group comprising individuals not undergoing FOT and to assess the predictors for GE in patients undergoing orthodontic treatment. Materials and methods A cross-sectional observational study was conducted on 129 patients who were divided into three groups: group 1, controls (n=18); group 2, patients who underwent FOT without GE (n=89); and group 3, patients who underwent FOT with GE (n=22). The gingival index (GI), periodontal index (PI), and inflammatory biomarkers such as interleukin 6 (IL-6), transforming growth factor-beta 1 (TGF-β1), tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase 9 (MMP-9), and prostaglandin E2 (PGE2) were estimated by enzyme-linked immunosorbent assay (ELISA) analysis at baseline (T0) and after one year of orthodontic treatment (T1). Results GE was observed in 22 (19.81%) of the 111 patients who were undergoing orthodontic treatment. No statistically significant differences were observed between the groups for GI, PI, and biomarkers at T0 (p>0.05), whereas there was a statistically significant increase in the levels of inflammatory biomarkers, GI, and PI in group 3, followed by group 2, compared to group 1 (p<0.05). Group 3 showed the greatest increase in the biomarker levels from T0 to T1 (IL-6, 3.66±1.91 pg/mL; TGF-β1, 7.52±3.85 pg/mL; TNF-α, 16.96±3.82 pg/mL; MMP-9, 30.72±7.07 pg/mL; PGE2, 78.29±20.53 pg/mL). GI and PI were strong predictors of GE, whereas biomarkers were weak predictors. Conclusion GE in patients with FOT was significantly associated with an increase in GI and PI due to insufficient oral hygiene, leading to increased levels of inflammatory biomarkers in the GCF.