An evaluation of gingival phenotype and thickness as determined by indirect and direct methods

OBJECTIVES

To evaluate gingival phenotype (GP) and thickness (GT) using visual, probing, and ultrasound (US) methods and to assess the accuracy and consistency of clinicians to visually identify GP.

MATERIALS AND METHODS

The GP and GT of maxillary and mandibular anterior teeth in 29 orthodontic patients (mean age 25 ± 7.5 years) were assessed using probing and US by a single examiner. General dentist and dental specialist assessors (n = 104) were shown intraoral photographs of the patients, including six repeated images, and asked to identify the GP via a questionnaire.

RESULTS

An increasing trend in GT values of thin, medium, and thick biotype probe categories was found, though this was not statistically significant (P = .188). Comparison of probing method to determinations of GT made by US yielded slight agreement (κ = 0.12). Using the visual method, assessors' identification of the second GP determination ranged from poor to moderate agreement (κ = 0.29 to κ = 0.53).

CONCLUSIONS

The probe method is sufficient in differentiating between different categories of GP. However, further research is required to assess the sensitivity of the probe method in recognizing phenotypes in the most marginal of cases. Assessors using the visual method lack the ability to identify GP accurately and consistently among themselves.

Correlation between Gingival Thickness and Occurrence of Gingival Recession

Background

Gingival recession (GR) has become a common problem among patients. GR is associated with increased accumulation of plaque, root caries, abrasion and cervical wear, and dentinal hypersensitivity. The present study aimed to examine the correlation between gingival biotypes and the occurrence of GR.

Methods

The study initially recruited 94 subjects; however, 54 of them did not have any recession sites, and hence were discarded. Therefore, the analysis was performed on 40 subjects. The study particularly compared the relationship between the recession length (RL) and width along with the gingival thickness (GT). As such, different clinical parameters were analyzed, namely, RL, recession width (RW), keratinized gingival width (KGW), and GT.

Results

Based on the statistical analysis (descriptive statistics and Pearson's correlation) conducted on the collected data, the study established that the gingival RL has a significant negative relationship with GT, which implied that the amount of thickness is inversely proportional to the RL. The study also found a significant positive correlation between RW and RL as well as between GT and KGW.

Conclusion

Based on the findings, the study thus concluded that the gingival biotype (thickness) significantly determines the occurrence and extent of GR.

Accuracy of cone-beam computed tomography in determining gingival thickness: a systematic review and meta-analysis

OBJECTIVE

To assess the accuracy of cone-beam computed tomography (CBCT) for determining gingival thickness.

MATERIAL AND METHODS

Searches were undertaken in PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, and gray literature (Google Scholar and ProQuest) for studies considered eligible according to the following criteria: cross-sectional observational studies, which compared CBCT accuracy with that of transgingival probing when determining gingival thickness, in adult patients with good periodontal health. No language or time restrictions were applied in this systematic review. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for analytical cross-sectional studies.

RESULTS

Six articles were included for qualitative synthesis, involving a pooled sample of 132 patients with a mean age of 29 years (18-51 years). Of these 6 studies, 5 were eligible for quantitative analysis. The meta-analysis showed no statistically significant difference between CBCT and transgingival probing measures of gingival tissue (mean difference of 0.10 (95% CI-0.17-0.38). No significant level of heterogeneity was detected (Tau²-P = 0.0662; I² = 0%; H²-P = 1.000; Q-P = 1.134). According to the GRADE criterion, confidence in the cumulative evidence was considered low.

CONCLUSIONS

CBCT is an accurate method for determining gingival tissue thickness, comparable to the reference standard (transgingival probing).

CLINICAL RELEVANCE

CBCT could be considered for gingival thickness measurement when bone thickness is also needed, and thereby aid in the assessment of gingival biotype without the discomfort and anesthesia needed in transgingival probing.

TRIAL REGISTRATION

This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42022326970. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022326970 .

Assessment of gingival biotype in different facial patterns: A cross-sectional study

Objective

The aim of the present study is to evaluate the relationship of gingival biotype in different malocclusions.

Methods

A total of 157 periodontally healthy subjects (88 males and 69 females) were enrolled in this cross-sectional study. The study participants were divided into three groups of skeletal class I, class II, and class III. The probe transparency method was used to determine the quality and gingival tissue into thick and thin biotype.

Results

There was significant difference in gingival biotype among different skeletal malocclusion with high prevalence of thin gingival biotype in class I subjects and more prevalence of thick biotype in class II and class III individuals (P-value: 0.022). Pairwise comparison of gingival biotype in class I versus class II showed significant difference (P-value: 0.032); however in class I versus class III and class II versus class III, the test result was nonsignificant. The overall frequency of thin gingival biotype was significantly less in female subjects with respect to males (P-value: 0.025).

Conclusion

A significant relationship is present between skeletal malocclusion and quality of gingival biotype. The prevalence of thick gingival biotype is found more in females as compared to male individuals. The thin gingival biotype is more commonly seen in skeletal class I than class II and class III.

Width and thickness of the gingiva in periodontally healthy individuals in a central Indian population: a cross-sectional study

OBJECTIVES

The present study was performed to determine the gingival dimensions (width and thickness) among young individuals in a central Indian population.

MATERIALS AND METHODS

Periodontal probing depth, width of the keratinized and attached gingiva, and gingival thickness were recorded on maxillary and mandibular teeth from central incisor to first molar unilaterally in 75 systemically healthy individuals (32 males and 43 females; 19-30 years of age). Comparisons were made gender-wise, arch-wise, tooth-wise, and site-wise using either the Student's t test or the ANOVA.

RESULTS

Keratinized and attached gingiva were wider in the maxilla than in the mandible both at proximal and at mid-buccal aspects (p < 0.001). At the tooth level also, gingiva was wider at the maxillary teeth than the corresponding mandibular teeth and at proximal aspects than at the mid-buccal aspect (p < 0.001). Regarding the thickness, gingiva was thicker among males, in the mandible, and at inter-proximal sites (p < 0.001). In either arch, maximum thickness was observed at the incisor region and least at the canine region.

CONCLUSIONS

Dimensions of the gingival tissues vary between different populations and between different areas of the dentition within the same subject. These variations need to be better understood because these aspects may have an important bearing on periodontal treatment planning as width and thickness of gingiva are important in terms of maintenance of periodontal health.

CLINICAL RELEVANCE

The dimensions of the clinically healthy gingiva are important in clinical practice as they can influence the progression of periodontal disease as well as impact the outcome of periodontal and restorative and orthodontic therapy.

Prevalence of gingival recession and its correlation with gingival phenotype in mandibular incisors region of orthodontically treated female patients: A cross-sectional study

Background:

Gingival recession is associated with dentin hypersensitivity, unesthetic appearance, and carious or noncarious cervical lesions. Orthodontic treatment, gingival thickness (GT), and keratinized tissue width (KTW) play roles in gingival recession etiology. The study is aimed to compare the prevalence of gingival recession in the mandibular incisor region of orthodontically-treated females with untreated controls, and to identify if there is any correlation among the GT, KTW, and gingival recession.

Subjects and Methods:

A total of 150 Saudi females were enrolled in this study. They were categorized into the treatment group (n = 75) and control group (n = 75). Background characteristics and clinical periodontal parameters including the plaque index, gingival index, GT, KTW, gingival recession length (GRL), and gingival recession width (GRW) were recorded and compared between groups, and any associations were identified.

Results:

Among the orthodontically-treated females, 31 (41.33%) had at least one mandibular incisor with gingival recession, in contrast to 18 (24%) of the controls. Pearson's correlation analysis indicated a significant positive correlation between the GT and KTW and between the GRL and GRW (P < 0.001). In addition, a significant negative correlation was observed between the KTW and GRL and between the KTW and GRW (P < 0.001). However, no significant correlation was found between the GT and GRL or between the GT and GRW.

Conclusions:

Our findings indicated that orthodontic treatment is a predisposing factor for the development or progression of gingival recession, particularly in females with a narrow KTW.

Multilevel analysis of site, implant, and patient-level factors with peri-implant bleeding on probing: a cross sectional study

AIM

This study was to evaluate the association between peri-implant bleeding on probing in peri-implant diseases and its association with multilevel factors (site specific factors, implant factors, and patient level factors).

METHODOLOGY

A cross-sectional study involved consented adult patients with ≥ 1 dental implant. Two calibrated operators examined the patients. BoP was outcome variable and peri-implant gingival biotype was principal predictor variable. The effects of site, implant, and patient level factors on BoP were assessed using a multilevel logistic regression model.

RESULTS

Eighty patients for a total of 119 implants and 714 sites were included in the study. Bleeding on probing was observed in 42 implants (35.29%) with a significant higher risk observed in presence of gingival recession, thin peri-implant gingival biotype, duration of implant placement, smokers, and male patients.

CONCLUSION

Peri-implant bleeding on probing was associated with site specific, implant, and patient level factors.

[A pilot study on the consistency of biological widths measured by periodontal probe and cone-beam CT]

Objective: To compare the consistency of the biological widths measured by using cone-beam CT (CBCT) and periodontal probe in patients with two different gingival biotypes. Methods: Totally 27 patients [13 males, 14 females, (37.6±13.7) years old], who planned to receive the crown lengthening surgery, were recruited under the inclusion and exclusion criteria in Department of Periodontology, School of Stomatology, The Fourth Military Medical University during November 2017 to June 2018. A total of 40 teeth (14 front teeth, 26 posterior teeth) were involved in this study. The patients were divided into two groups according to their gingival biotypes: thin gingival biotype [5 males, 8 females, (40.2±15.0) years old, 21 teeth] and thick gingival biotype [8 males, 6 females, (35.1±11.9) years old, 19 teeth]. All the teeth were checked before crown lengthening procedures by using CBCT, and the biological widths and sulcus depths were measured during the surgery by using periodontal probes (Hu-Friedy, U S A). The data were recorded and statistically analyzed. Results: There were no significant differences of the biological widths between the two measuring methods amongst all of the 40 teeth [periodonial probe: (1.64±0.26) mm; CBCT: (1.69±0.20) mm], amongst 21 thin gingival biotype teeth [periodontal probe: (1.49±0.19) mm; CBCT: (1.57±0.12) mm] and amongst 19 thick gingival biotype teeth [periodontal probe: (1.80±0.21) mm; CBCT: (1.87±0.18) mm] (P>0.05). There were no significant differences of the biological widths [anterior teeth: (1.59±0.15) mm, posterior teeth: (1.67±0.29) mm, P=0.42] and of the sulcus depths [anterior teeth: (2.00±0.28) mm, posterior teeth: (2.11±0.43) mm, P=0.44] between anterior teeth and posterior teeth. The difference of biological widths, measured by two methods respectively, between thin and thick gingival biotype groups was statistically significant (P<0.01). There were significant differences of the sulcus depths, measured by the periodontal probes, between the thin [(1.93±0.28) mm] and thick [(2.24±0.41) mm] gingival biotype groups (P<0.01). Conclusions: The biological widths measured by CBCT is consistent with those measured by using periodontal probes. The biological widths and the depths of the sulcus of thin and thick gingival biotypes are different.

Gingival biotype revisited-novel classification and assessment tool

OBJECTIVES

To evaluate the relationship between gingival biotypes and gingival thickness based on probe transparency through the gingival margin and to assess the sensitivity of a novel classification method.

MATERIAL AND METHODS

Sixty adult Caucasian subjects were stratified by their gingival biotype (GB) as defined by the transparency of a prototype double-ended periodontal probe through the buccal gingival margin into "thin" (30 subjects), "moderate" (15 subjects), and "thick" (15 subjects) GB. Three additional parameters were also assessed: gingival thickness (GT), probing depth (PD), and gingival width (GW).

RESULTS

Median GT was 0.43 mm (P _25% 0.32; P _75% 0.58) for thin, 0.74 mm (P _25% 0.58; P _75% 0.81) for moderate, and 0.83 mm (P _25% 0.74; P _75% 0.95) for thick GB, respectively. GT was statistically significant different for thin versus moderate and thin versus thick, respectively (Kruskal-Wallis test, p < 0.05; Dunn's test, thin versus moderate: p = 0.002; thin versus thick: p < 0.001; moderate versus thick: p = 0.089). GW was directly correlated with GT (Spearman correlation p < 0.01). The sensitivity of the new classification tool for diagnosing a thin GB was 91.3%. No adverse events or complications were reported.

CONCLUSION

GT differs significantly between the presented GB groups, hence, an alternative classification especially focusing on thin biotypes based on a modified periodontal probe might be advantageous. In addition, the presence of a thick gingiva is associated with a wide band of keratinized tissue.

CLINICAL RELEVANCE

This clinical setting might to be useful to identify high-risk patients with a very thin biotype and, consequently, higher risk for gingival recession after dental treatments.

Prevalence of Gingival Biotypes among Young Dentate North Indian Population: A Biometric Approach

AIM

To evaluate the prevalence of various gingival biotypes and to corroborate gingival thickness and gingival biotypes across tooth type, site, and gender.

MATERIALS AND METHODS

A cross-sectional study was conducted across systemically healthy subjects. A systematic clinical evaluation for gingival biotypes and gingival thicknesses was recorded by modified Iwanson's gauge, to the nearest 0.1 mm, probing the gingival sulcus at the midfacial aspect of maxillary and mandibular central incisors and first molars. All measurements were made across a total of 920 sites in 115 subjects (69 female and 46 male) based on gingival transparency and were statistically analyzed.

RESULTS

A significant agreement on the reproducibility of the measurements was noted. The median overall gingival thickness was recorded at 0.75 mm with interquantile difference of 0.39 mm. The thin biotype variant showed across the ranges of 0.3 to 0.6 mm of gingival thicknesses and thick biotype variant across the ranges of 1.0 to 1.2 mm, with more prevalence in anterior and posterior site respectively. Moreover, for gingi-val thickness of 0.7 mm, the probe visibility showed tendency toward both thin/thick biotype variant in both anterior and posterior segments. The disposition of male participants toward thick biotype and female participants toward the thin biotype variant has been noted.

CONCLUSION

Within the limitations of the current study, our data support the traditional hypothesis of two main gingival biotypes as distinguishable by gingival transparency. In addition, we provide evidence of existence of intermediate biotypes with respect to gingival thickness. These findings can be utilized as objective guidelines for determination of biotype and can be implicated in many dental operative procedures. How to cite this article: Rathee M, Rao PL, Bhoria M. Prevalence of Gingival Biotypes among Young Dentate North Indian Population: A Biometric Approach. Int J Clin Pediatr Dent 2016;9(2):104-108.

Correlation of gingival thickness with gingival width, probing depth, and papillary fill in maxillary anterior teeth in students of a dental college in Navi Mumbai

Context:

The gingival biotype is of utmost importance for esthetics and biologic function. Anatomical characteristic of periodontium such as gingival thickness (GT), width of keratinized gingiva, and alveolar bone morphology will determine the behavior of periodontium when subjected to physical, chemical, or bacterial insult or during therapeutic procedure.

Aims:

The aim of this study was to correlate the GT with gingival width (GW), probing depth (PD), and papillary fill (PF) in relation to maxillary anterior region.

Settings and Design:

Undergraduate dental students and interns from a dental college in Navi Mumbai were enrolled in the study according to the inclusion criteria. Six teeth per subject were assessed; a total of 2178 maxillary anterior teeth were examined.

Subjects and Methods:

Subjects were examined clinically for GT, width of keratinized gingiva, pocket depth, and interdental PF. The data obtained was tabulated and subjected to statistical analysis.

Statistical Analysis Used:

Spearman's correlation analysis test was performed to find the correlation of GT with GW, PD, and PF.

Results:

Positive correlation was found between GT and GW (r = 0.241). No significant correlation could be found between GT and PD; and between GT and PF.

Conclusions:

The present study confirmed a positive correlation between GT and GW. A weak negative correlation was found between GT and PD.

Classification of periodontal biotypes with the use of CBCT. A cross-sectional study

OBJECTIVES

The aim of this study is to investigate the relationship between periodontal morphometric parameters and to develop a biotype classification based on the variables examined with the use of cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

Forty-two periodontally healthy subjects that underwent a CBCT examination as part of a different diagnostic procedure participated in the study. Measurements were performed on sectional images and included gingival thickness and labial bone plate thickness midbuccally, crown width to crown length ratio, bone crest to the CEJ distance and bone crest to the gingival margin distance midbuccally, and at the approximal aspects of 186 maxillary anterior teeth.

RESULTS

Gingival thickness at the level of CEJ was positively correlated with labial bone plate thickness and crown form. Crown form was not correlated with labial bone plate thickness. Cluster analysis supported the existence of four periodontal biotypes, "thin," "thick," "average," and "mixed." Labial bone plate thickness was thinner than 1 mm at 70 % of the measured sites.

CONCLUSIONS

Only 50 % of the teeth belonged to thin or thick biotype. The other 50 % of the teeth belonged to the average cluster or presented mixed characteristics. Assessment of labial bone plate thickness based on periodontal biotype should be made with caution.

CLINICAL RELEVANCE

Taking into consideration the characteristics of periodontal biotypes enables the clinician to avoid complications in periodontology, prosthetic dentistry, implant dentistry in the esthetic zone, and orthodontics.

Soft tissue surgery for implants

Adequate quality and quantity of soft tissue plays an integral part in the esthetic outcome of dental implants. Adequate band of attached tissue decreases the incidence of mucositis and improves hygiene around implants. This article discusses a variety of techniques for soft tissue augmentation. Soft tissue grafting can be achieved at various stages of implant therapy. Epithelial connective tissue grafts are commonly used to increase the band of attached tissue. Subepithelial connective tissue grafts are great for increasing soft tissue thickness and improving the gingival biotype.