Association Between Mandibular Anterior Crowding and Gingival Recession Following Orthodontic Treatment: A Retrospective Cohort Study

Background/Objectives: Gingival recession frequently affects the anterior mandibular region. Anatomical features, such as thin buccal bone, narrow keratinized gingiva, and root proximity, increase susceptibility to periodontal disease. Recession can progress over time and may be exacerbated by orthodontic treatment. However, it remains uncertain whether the severity of crowding before treatment contributes to recession after orthodontic therapy The present study aimed to determine whether a relationship exists between the degree of mandibular anterior crowding before orthodontic treatment and the development or progression of gingival recession after treatment completion. Methods: This retrospective study was conducted on 269 participants with pre- and post-treatment records. The Little’s irregularity index was used to assess the degree of crowding. Clinical photographs of the six mandibular anterior teeth (1614 sites) were digitally calibrated permit millimeter-based assessment of gingival recession and keratinized tissue (KT) width. Oral hygiene (OH) was also evaluated at both time points. Results: Post-treatment recession was detected in 76 teeth. (4.7% of sites) among 48 participants (17.8%). Pretreatment crowding severity was not significantly associated with the occurrence of recession after treatment. Pretreatment mucogingival deformities were independently associated with post-treatment gingival recession. Mandibular central incisors demonstrated the highest prevalence of post-treatment gingival recession. Conclusions: Pretreatment mandibular anterior did not appear to predict gingival recession at treatment completion. Periodontal characteristics may play a more important role in recession development, supporting careful periodontal evaluation before and throughout orthodontic care.