Abstract
<title>Abstract</title> <p>Objectives To compare periodontal phenotype, gingival esthetic indices, and the risk of mandibular incisor labial gingival recession (LGR) in skeletal Class III patients treated with combined orthodontic–orthognathic therapy, with or without periodontally accelerated osteogenic orthodontics (PAOO). Materials and Methods Thirty-three skeletal Class III patients undergoing orthodontic–orthognathic treatment were included. In total, 131 mandibular incisors were analyzed, including 63 incisors in the conventional management group (NS) and 68 incisors in the PAOO group. Overall treatment duration was \(\:3.71\pm\:1.02\)years in the NS group and \(\:3.52\pm\:0.81\)years in the PAOO group. Periodontal soft-tissue outcomes included keratinized gingival width (KGW), average gingival thickness (AGT), and LGR. Hard-tissue outcomes included CEJ–AC and alveolar width (AW). Gingival esthetic indices were open gingival embrasure (AOGE) and mucosal scarring index (MSI). Patient-reported satisfaction regarding postoperative gingival/periodontal conditions was recorded. Time-to-LGR was evaluated using Kaplan–Meier analysis with log-rank testing, and hazard ratios were calculated. Results Compared with NS, PAOO was associated with more favorable changes in periodontal phenotype–related measures (KGW and AGT) and alveolar bone parameters (CEJ–AC and/or AW). Survival analysis demonstrated a significant between-group difference in time-to-LGR (log-rank \(\:p=0.02\)), with a higher hazard of LGR in the NS group (hazard ratio \(\:=5.13\)). Interdental papilla/open embrasure–related findings were not evidently improved by PAOO. Patient-reported satisfaction regarding postoperative gingival/periodontal conditions favored PAOO. Conclusions Among skeletal Class III patients receiving orthodontic–orthognathic treatment, PAOO was associated with improved periodontal phenotype–related outcomes and a reduced hazard of mandibular incisor LGR, while interdental esthetic limitations persisted. Clinical Relevance : In skeletal Class III patients undergoing combined orthodontic–orthognathic treatment, PAOO may help enhance periodontal phenotype and reduce the risk of mandibular incisor labial gingival recession, thereby supporting better periodontal stability during treatment.</p>