Discriminant analysis for the thin periodontal biotype based on the data acquired from three-dimensional virtual models of Korean young adults

Thermographic examination of gingival phenotypes: correlation between morphological and thermal parameters

OBJECTIVES

To evaluate the clinical and thermographic aspects of the gingival phenotype (GP) in healthy subjects.

MATERIALS AND METHODS

The study sample examined 264 teeth, upper and lower incisors, comprising 132 central incisors (CI) and 132 lateral incisors (LI), in 33 healthy volunteers. Four periodontal parameters were recorded systematically: ratio of width to length of the dental crown (CW/CL), height of the gingival attachment (KGW), probing depth (PD), and gingival transparency (GT). The temperatures of the attached gingiva (KGW temp) and the free gingival margin (FGM Temp) were also recorded by way of infrared thermography (IRT).

RESULTS

The average age of the sample was 30.70 ± 7.65 years. Of the 264 teeth evaluated, 76.1% had a thin GP. There was a significant association between CW/CL (p < 0.001), KGW (p < 0.001), PD (p < 0.007), and FGM Temp (p < 0.006) with the tooth groups. The results show a significant and inversely proportional correlation between clinical parameters and gingival temperature (p < 0.05). A significant association was found between CW/CL (p < 0.026); KGW (p < 0.001); and GP.

CONCLUSION

CW/CL, KGW, PD, and FGM Temp vary according to tooth group. The majority of the sample presented with the thin GP, which was more prevalent in the lower LIs and CIs. No significant association could be observed between thermographic parameters and GP.

CLINICAL RELEVANCE

Knowledge of the temperature of the gingival tissues can be useful in helping to diagnose and plan periodontal treatments. Moreover, our findings will help future studies evaluate the use of IR as an auxiliary diagnostic method in dentistry, eliminating GP as a confounding factor, since it does not seem to influence the temperature of the gingival tissues.

Is There an Association between the Gingival Phenotype and the Width of Keratinized Gingiva? A Systematic Review

The concept of gingival phenotype and width of keratinized gingiva influencing the diagnosis and treatment in the periodontal scenario is relatively new. Soft and hard tissue dimensions of oral tissues are considered essential parameters in daily clinical practice. Factors such as the biotype category and the width of the keratinized gingiva help dentists seek the perfect therapy plan for each patient to achieve long-term stability of periodontal health. Several methods have been proposed to categorize phenotypes and each phenotype is characterized by various clinical characteristics. This review aims to discuss the possible association between the gingival phenotype and the width of keratinized gingiva along with the results appeared. After a rigorous search in major electronic databases, the results of the included studies indicated that the width of keratinized gingiva seems to be associated with the periodontal phenotype, with thick biotypes being characterized by a more pronounced keratinized gingival width. However, the heterogeneity of the included studies did not allow to make a conclusion about a direct relationship.

Periodontal phenotype: A review of historical and current classifications evaluating different methods and characteristics

OBJECTIVE

To review the historical and current periodontal phenotype classifications evaluating methods and characteristics. Moreover, to identify and classify the methods based on periodontal phenotype components.

OVERVIEW

Several gingival morphology studies have been frequently associated with different terms used causing confusion among the readers. In 2017, the World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions recommended to adopt the term "periodontal phenotype". This term comprises two terms, gingival phenotype (gingival thickness and keratinized tissue width) and bone morphotype (buccal bone plate thickness). Furthermore, gingival morphology has been categorized on "thin-scalloped", "thick-scalloped" and "thick-flat" considering the periodontal biotype. However, by definition, the term phenotype is preferred over biotype. Periodontal phenotype can be evaluated through clinical or radiographic assessments and may be divided into invasive/non-invasive (for gingival thickness), static/functional (for keratinized tissue width), and bi/tridimensional (for buccal bone plate thickness) methods.

CONCLUSIONS

"Thin-scalloped," "thick-scalloped," and "thick-flat" periodontal biotypes were identified. These three periodontal biotypes have been considered in the World Workshop but the term periodontal phenotype is recommended. Periodontal phenotype is the combination of the gingival phenotype and the bone morphotype. There are specific methods for periodontal phenotype evaluation.

CLINICAL SIGNIFICANCE

The term periodontal phenotype is currently recommended for future investigations about gingival phenotype and bone morphotype. "Thin-scalloped," "thick-scalloped," and "thick-flat" periodontal phenotypes can be evaluated through specific methods for gingival thickness, keratinized tissue width, and buccal bone plate thickness evaluation.

Periodontal Risk Assessment Based on Dental and Gingival Morphology: A Comparative Analysis of African Versus Asian American Cohorts

FOCUSED CLINICAL QUESTION

With the 2018 AAP/EFP disease classification with the staging and grading systems, does risk assessment for different ethnic group result in a different focus for clinical needs? This comparative analysis aimed to assess two previously reported cohort studies in African-American (Af-A) and Asian-American (As-A) as to the risk for these two populations for clinical attachment loss (CAL) and gingival phenotype.

SUMMARY

In comparison of As-A and Af-A cohorts, As-A had higher frequency of thin tissue phenotype, less width of keratinized gingiva (KGW), and more gingival recession (GR). On other hands, Af-A showed higher prevalence of thick phenotype, longer total tooth length and root length (RL). These gingival and dental anatomical patterns suggest there are differential risk for GR, patterns for CAL, and periodontal prognosis between two cohorts.

CONCLUSION(S)

Because of nature of dental and gingival anatomy between these two cohorts, As-A are more susceptible in GR and the short RL affords this population less ability to withstand the clinical presentation of periodontal disease. From a therapeutic perspective, clinicians should evaluate patients with different risk assessment based on their dental and gingival characterization. Af-A may have clinical characteristics that makes this population less at risk for mucogingival defects. Conversely, phenotype modification therapy should be considered when treating As-A because of the high prevalence of thin tissue phenotype, inadequate KGW, and GR. Clinicians should also diligently monitor periodontal CAL around the teeth with shorter RL in periodontal or orthodontic therapy for better teeth prognosis.

Minimally invasive procedures for deficient interdental papillae: A review

OBJECTIVE

Deficient interdental papillae cause a series of problems, including food impaction, phonetic difficulties, and esthetic concerns. The purpose of this article is to provide valid clinical recommendations for clinicians to address these problems in a predictable and less invasive way.

OVERVIEW

Numerous treatments are available for interdental papillae reconstruction, but most of them involve surgery and yield unpredictable outcomes. Minimally invasive treatments have the advantages of being effective, predictable, and involving only slight injury as compared to surgical treatments. We included 66 studies obtained after searching for relevant papers in PubMed and Web of Science. The etiology and classification of deficient interdental papillae are explained and minimally invasive procedures for deficient interdental papillae reconstruction are summarized.

CONCLUSIONS

Minimally invasive procedures are promising ways to reconstruct deficient interdental papillae, and have the advantages of slight pain and rapid recovery. It should be noticed that some of the minimally invasive treatments still require further long-term observation to confirm their efficacy.

CLINICAL SIGNIFICANCE

Familiarity with etiology and classification of deficient interdental papillae can help clinicians to choose the appropriate minimally invasive approach as well as help with case collection to enhance esthetics status in patients with deficient interdental papillae.

Correlation between clinical parameters of crown and gingival morphology of anterior teeth and periodontal biotypes

Background

In this study, we conducted a quantitative analysis of the clinical parameters of crown and gingival morphology (CGM) of the maxillary anterior teeth (MAT). We also analyzed the correlation of these parameters with periodontal biotype (PB), with a view to providing objective standards for PB diagnosis.

Methods

The three-dimensional (3D) maxillary digital models of 56 individuals were obtained using an intra-oral scanner. The following parameters were measured with the SpaceClaim software: gingival angle (GA), papilla width (PW), papilla height (PH), crown length (CL), crown width (CW), crown width/crown length ratio (CW/CL), bucco-lingual width of the crown (BLW), contact surface width (CSW), and contact surface height/crown length ratio (CS/CL). The PB were determined based on the transparency of the periodontal probe through the gingival sulcus. Independent factors influencing PB were analyzed by logistic regression, and the optimal cutoff values for the independent influencing factors were analyzed using receiver operating characteristic curves (ROC curves).

Results

There was no significant difference in the parameters of CGM of the MAT at the left and right sides. The thick biotype accounted for 69.6%, and the parameters of GA, PW, PH, CW, CW/CL and CS/CL were significantly correlated with PB (P ≤ 0.2). GA (odds ratio (OR) = 1.206) and PW (OR = 5.048) were identified as independent predictive factors of PB, with areas under the ROC curve (AUC) of 0.807 and 0.881, respectively, and optimal cutoff values of 95.95° and 10.01 mm, respectively.

Conclusion

The CGMs of the MAT at the left and right side are symmetrical. The thin biotype accounts for a small proportion, and GA and PW are independent influencing factors of PB. GA of 95.95° and PW of 10.01 mm are the optimal cutoff values for categorization of individuals as thick biotype. This indicates that when the GA and PW of the right maxillary central incisor are G ≥ 95.95° and ≥ 10.01 mm, respectively, there is a higher probability that these individuals will be categorized as thick biotype.

Analysis of the gingival biotype based on the measurement of the dentopapillary complex

Background:

The gingival morphology of the maxillary anterior region plays an important role in determining the final esthetic outcome. Knowledge of the periodontal biotype is of fundamental importance because the anatomical characteristics of the periodontium, such as gingival thickness, gingival width and alveolar bone morphology, will determine periodontium behavior when submitted to physical, chemical, or bacterial injury or during periodontal or implant surgical procedures and orthodontic treatment.

Materials and Methods:

50 subjects with healthy periodontal tissues with no loss of attachment and (b) presence of all anterior teeth in both upper and lower jaw were selected. On clinical examination gingival thickness was recorded based on the transparency of periodontal probe. Following parameters are recorded from dental cast, i.e., crown length, crown width, papillary length (PL) and papillary width.

Results:

There was highly significant correlation between gingival biotype and crown length and area of papilla with P value −0.002 and 0.013 respectively. Significant correlation was found between area of crown and PL with P value −0.013 and 0.016. The results of discriminant function analysis showed that average crown length was the best single determinant of biotype and area of papilla was the next best choice.

Conclusion:

Within the limits of the current investigation, the existence and correlation of different gingival biotypes and dentopapillary complex dimension has been confirmed. These findings can be utilized as objective guidelines for determining the biotype and response of gingiva to many dental operative procedures.