Relationships among the periodontal biotype characteristics in the maxillary anterior / 华西口腔医学杂志

OBJECTIVE@#To explore the correlation among gingival thickness (GT), underlying alveolar bone thickness (BT), and other periodontal biotype characteristics in the maxillary anterior.@*METHODS@#A total of 40 young volunteers with healthy periodontal were involved in this research. The periodontal probe was previously used to divide the gingiva from thick to thin. Two records were measured by cone beam CT (CBCT) GT, which was measured at the cement-enamel junction level; and BT, which was measured at 3 locations: 1, 3, 5 mm below the alveolar crest. Oral and gypsum measurements were used to analyze the associations of the crown width/crown length ratio (CW/CL), the keratinized mucosa width (KM), and the free gingival margin curvature.@*RESULTS@#Significant difference in the GT was observed between the thick and thin biotypes, which were divided by periodontal probe (P<0.01). Difference was observed in each periodontal biotype characteristic between the thick (GT≥1 mm) and thin biotypes (GT<1 mm) (P<0.05). BT was positively associated with GT (r=0.293, P=0.001), CW/CL (r=0.273, P=0.003), KM (r=0.291, P=0.001), and free gingival margin curvature (r=0.290, P=0.001).@*CONCLUSIONS@#The transparency of the probing in the sulcus could analyze the GT qualitatively. The thick and thin biotypes have different periodontal biotype characteristics. Compared with individuals with thick biotype, those with thin biotype are susceptible to risk dental aesthetic.

Influential factors and methods of evaluating the gingival biotype / 口腔疾病防治

@#Gingival biotypes are used to describe the morphological characteristics of periodontal tissue. According to thickness, the gingiva can be divided into thin and thick gingival biotypes. The gingival biotype has a wide range of influential factors and can be measured by various methods. In the process of oral treatment, to achieve good therapeutic effects and obtain a clear prognosis, it is particularly important to study the gingival biotype. This article reviews the influential factors and methods for assessing the gingival biotype. The results of literature review show that, factors influencing the gingival biotype include individual factors related to sex, age and ethnicity and oral soft and hard tissue characteristics related to crown shape, tooth position, alveolar bone thickness, keratinized gingival width and gingival papilla height. Gingival hypertrophy mainly occurs in young males and in people with square and round crowns, thicker alveolar bones and wider keratinized gingiva. With the development of methods for measuring the gingival biotype ranging from the traditional direct observation method, direct measurement methods and periodontal exploration methods to cone beam computed tomography and ultrasound have increased the accuracy of these measurements.

Relationship among gingival thickness, underlying alveolar bone thickness, and sagittal root position in the maxillary anterior / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to explore the relationship among gingival thickness (GT), underlying alveolar bone thickness (BT), and sagittal root position in the maxillary anterior measured by cone-beam computed tomography (CBCT). The theoretical foundation was applied to aesthetic dentistry, implant treatment planning, and therapeutic effect assessment.</p><p><b>METHODS</b>A total of 40 young volunteers with healthy periodontal status were involved in this research [16 males and 24 females aged 23-34 years with a mean age of (26.30±2.29) years]. Three records were measured by CBCT. GT was measured at the cemento-enamel junction level. Buccal BT was measured at three locations: 1, 3, and 5 mm below the alveolar crest, along the sagittal angle between the long axis of teeth, and along the long axis of the respective alveolar bone.</p><p><b>RESULTS</b>The average GT and alveolar BT thicknesses were (1.08±0.34) mm and (0.79±0.29) mm, respectively. The average angle between teeth and alveolar bone was 18.01°±8.96°. BT was positively associated with GT (r=0.293, P=0.001). The BT of canine was positively associated with the angle between teeth and alveolar bone (r=0.457, P=0.003).</p><p><b>CONCLUSIONS</b>BT was relatively thin. An angle was found between the long axis of teeth and that of the alveolar bone. BT was positively associated with GT. An accurate diagnosis of GT, underlying alveolar BT, and sagittal root position in the maxillary anterior is necessary before implant surgery to devise an appropriate implant treatment plan and achieve a predictable esthetic outcome.</p>

Evaluation of effects of smoking on gingival thickness – A clinical study

Introduction: Smoking is a known risk factor of periodontitis. Cotinine, a metabolic by product of nicotine is involved in the pathogenesis of periodontitis. Changes in gingival microvasculature, gingival epithelium take place which manifest clinically as decreased bleeding on probing and reduced inflammatory response, increased gingival thickness etc. Knowing the importance of gingival thickness in various root coverage procedures and restorative treatments in periodontics and the increased incidence and prevalence of smoking, assessing the relation between these two entities is becoming important. This clinical study is sought to compare the thickness of gingiva in systemically healthy smokers and non-smokers Materials and methods: 40 age matched smokers and non-smokers were considered for the present study. Gingival thickness was measured in the maxillary and mandibular anterior teeth by transgingival probing using UNC-15 probe midbuccally in the attached gingiva and at the base of the interdental papilla. Plaque index and gingival bleeding index were recorded. Student’s independent ttest was employed for comparing various periodontal parameters between smokers and non-smokers. A P-value of less than 0.05 was considered statistically significant. All P-values were two tailed. Results: Both groups had similar gingival bleeding index and plaque index. Smokers had a higher thickness of gingiva both mid bucally and interdentally as compared to non-smokers. Conclusion: Both midbuccal and interdental areas are thicker among smokers when compared to nonsmokers at similar plaque and gingival bleeding levels.

An evaluation of the gingival biotype and the width of keratinized gingiva in the mandibular anterior region of individuals with different dental malocclusion groups and levels of crowding / 대한치과교정학회지

OBJECTIVE: To evaluate the relationship of gingival thickness (GT) and the width of keratinized gingiva (WKG) with different malocclusion groups and the level of crowding. METHODS: A total of 187 periodontally healthy subjects (121 females and 66 males) who presented at the Faculty of Dentistry in Yüzüncü Yıl University for orthodontic treatment were enrolled in the study. The individuals involved in the study were divided into three groups; Angle Class I malocclusion, Angle Class II malocclusion, and Angle Class III malocclusion. Each group was classified as mild, moderate, or severe according to the level of crowding. WKG was determined as the distance between the mucogingival junction and the free gingival margin. GT was determined by the transgingival probing technique. Factorial variance analysis and the Duncan multiple comparison test were employed to identify the extent to which a difference was apparent between the groups according to these parameters. RESULTS: It was determined that teeth in the mandibular anterior region display the thin gingival biotype. WKG and GT were observed as being higher at the mandibular incisor teeth in the severe crowding group and at the mandibular canine teeth in the mild crowding group. The GT of the mandibular right central and lateral incisors was found to be thinner in the Angle Class III group. CONCLUSIONS: Within the limits of this study, the results demonstrate that, there is no significant relationship of WKG and the mean GT in the mandibular anterior region according to the Angle classification.

Relationship between gingival thickness and the underlying bone thickness in maxillary anterior tooth area / 实用口腔医学杂志

Objective:To study the relationship between gingival thickness(GT)and the underlying alveolar bone thickness(BT)in maxillary anterior region and the distance from cemento-enamel junction(CEJ)to alveolar crest.Methods:30 young volunteers with healthy gingiva were included.GT was measured at 2mm below the CEJ,buccal BT were measured at 3 locations:2,4 and 6 mm below the alveolar crest respectively,the distance from CEJ to alveolar crest were measured by CBCT and clinical direct measure respectively. Results:The correlation coefficient (r)values between GT and BT at 2,4 and 6 mm below alveolar crest were 0.493,0.383 and 0.342 (P <0.001 )respectively,the r value between GT and the distance from CEJ to alveolar crest was -0.21 3(P <0.01 ).No statistically significant difference was observed between CBCT and clinical measurements(t =-0.521 ,P =0.603).Conclusion:There is positive correlation between GT and BT at 2,4 and 6 mm below alveolar crest and negative relation between GT and the distance from CEJ to alveolar crest.

Correlation between gingival thickness and gingival recession in humans / Correlação entre espessura do tecido gengival e recessão gengival

Gingival recession is characterized by the apical migration of the gingival margin, exposing the root surface. Studies have demonstrated several etiological factors for gingival recession such as periodontitis, traumatic toothbrushing, use of oral piercing, and past orthodontic therapy, among others. It might not be possible to identify and quantify the influence of each factor, and gingival recession at some sites may be the result of the combination of these factors. Gingival recession affects individuals at all ages, with prevalence increasing as time passes. The aim of this study was to observe whether there is correlation between gingival thickness and gingival recession. Fifty-five subjects of both genders aged 18-35 years participated in the study. The volunteers were under treatment at the School of Dentistry of the Federal University of Rio Grande do Sul. Buccal gingival thickness was measured on incisors, canines and bicuspids, under anesthesia, following inclusion and exclusion criteria. Statistical analysis was performed with STATA version 10.1. The results had a Pearson Correlation Coefficient of -0.216. Linear regression had a statistically significant p-value of 0.025. It may be concluded that there is weak negative correlation between gingival thickness and gingival recession.

A recessão gengival é caracterizada pelo deslocamento apical da margem gengival, expondo a superfície radicular. Pesquisas têm apresentado vários fatores relacionados à etiologia da recessão gengival como: periodontite, escovação traumática, uso de piercing oral, tratamento ortodôntico passado, entre outros. Pode não ser possível identificar e quantificar a influência de cada fator,e a recessão gengival, em determinados sítios, pode ser o resultado da confluência de várias causas. A prevalência da recessão gengival atinge indivíduos de todas as idades, aumentando significativamente com o passar dos anos. O objetivo do presente estudo foi observar se existe correlação entre a espessura do tecido gengival e a recessão gengival. Participaram da pesquisa pacientes de ambos os gêneros, com idade entre 18 e 35 anos, que estavam em tratamento nas clínicas odontológicas da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul.Foram medidas a espessura e recessão gengival das faces vestibulares dos dentes incisivos, caninos e pré-molares, previamente anestesiados, seguindo os critérios estabelecidos para inclusão e exclusão no estudo. Para avaliação e comparação dos resultados foi utilizado o programa estatístico STATA versão 10.1. Os resultados mostraram que a correlação de Pearson entre a espessura gengival e a recessão foi de -0.216. A regressão linear apresentou um p= 0.025, estatisticamente significativo. Pode-se concluir que existe uma correlação fraca e inversa entre espessura gengival e recessão gengival.

Evaluation of an innovative radiographic technique - parallel profile radiography - to determine the dimensions of dentogingival unit.

Background: Maintenance of gingival health is a key factor for longevity of the teeth as well as of restorations. The physiologic dentogingival unit (DGU), which is composed of the epithelial and connective tissue attachments of the gingiva, functions as a barrier against microbial entry into the periodontium. Invasion of this space triggers inflammation and causes periodontal destruction. Despite the clinical relevance of the determination of the length and width of the DGU, there is no standardized technique. The length of the DGU can be either determined by histologic preparations or by transgingival probing. Although width can also be assessed by transgingival probing or with an ultrasound device, they are either invasive or expensive Aims: This study sought to evaluate an innovative radiographic exploration technique - parallel profile radiography - for measuring the dimensions of the DGU on the labial surfaces of anterior teeth. Materials and Methods: Two radiographs were made using the long-cone parallel technique in ten individuals, one in frontal projection, while the second radiograph was a parallel profile radiograph obtained from a lateral position. The length and width of the DGU was measured using computer software. Transgingival probing (trans-sulcular) was done for these same patients and length of the DGU was measured. The values obtained by the two methods were compared. Pearson product correlation coefficient was calculated to examine the agreement between the values obtained by PPRx and transgingival probing. Results: The mean biologic width by the parallel profile radiography (PPRx) technique was 1.72 mm (range 0.94-2.11 mm), while the mean thickness of the gingiva was 1.38 mm (range 0.92-1.77 mm). The mean biologic width by trans-gingival probing was 1.6 mm (range 0.8-2.2mm). Pearson product correlation coefficient (r) for the above values was 0.914; thus, a high degree of agreement exists between the PPRx and TGP techniques. Conclusions: We conclude that the biologic width of the DGU in humans can be measured with the PPRx technique. The values obtained agree with the values obtained by transgingival probing, a technique considered standard so far. Thus, the PPRx technique offers a simple, concise, noninvasive, and reproducible method that can be used in the clinical setup to measure both the length and thickness of the DGU with accuracy.

Clinical features of the gingiva according to maxillary anterior teeth form in adult / 대한치주과학회지

It has been suggested that morphologic characteristics of the periodontium are partly related to the shape and form of the teeth. Furthermore, the severity of symptoms of periodontal disease have been proposed to differ among these various morphologic entities or "biotypes". The purpose of the present study was to examine the relationship between the form of the crowns in the maxillary anterior tooth segment and (1) a group of morphological characteristics and (2) the thickness of the gingiva. The thickness of gingiva was measured by ultrasonic device(SDM). 100 subjects devoid of symptoms of destructive periodontal disease were examined regarding, e.g., probing depth, gingival recession, width of keratinized gingiva, thickness of the keratinized gingiva. From maxillary study cast, the width(at the apical third-CW) and the length(CL) of the crowns of the 6 anterior teeth were determined. A CW/CL-ratio was calculated for each tooth and averaged for each tooth region. The individual mean CW/CL-ratio values for the central incisors were ranked. The 10 subjects ranked highest and the 10 ranked lowest were selected as having either a long-narrow(group N) or a short-wide(group W) form of the crown of the tooth. The data for each of the examined parameters were averaged for each tooth region in each subject and mean values for subjects in groups W and N were compared using the Student t-test. Stepwise multiple regression analysis, including data from the whole sample, was performed for each tooth region with the thickness of the free gingiva as the dependent variable. The results from the analyses demonstrated that individuals with a long-narrow form of the central incisors displayed, compared to individuals with a short-wide crown, form (1) a narrow zone of keratinized gingiva, (2) a pronounced "scalloped" contour of the gingival margin. There was no significant difference between groups N and W with respect to the thickness of the keratinized gingiva. The CW/CL-ratio data revealed that a certain form of the crowns in the central incisors was accompanied by a similar form in the lateral incisors and canine tooth region. The regression analyses demonstrated that the thickness of the keratinized gingiva in central, lateral incisors and canines was significantly related to the width of the keratinized gingiva.

The relationship between clinical crown form and gingival feature in upper anterior region / 대한치주과학회지

The purpose of the present study was to examine the relationship between the form of the clinical crowns in the maxillary anterior segment and the clinical feature of gingiva such as morphological characteristics and the gingival thickness. Fifty periodontally healthy subjects were clinically examined regarding the probing depth, the thickness of the free gingiva, and the width of the keratinized gingiva. From study models of the maxillary anterior region, the width at cervical third(CW) and the length(CL) of the clinical crown, the papillary height, and the gingival angle of the 6 anterior teeth were measured. Each tooth was classified into 4 groups (long-narrow, NL; narrow, N; wide, W; short-wide, WS) according to CW/CL ratio and all the data were compared between groups NL and WS using independent t-test. Stepwise multiple regression analysis was performed for each tooth region with the gingival thickness at the level of sulcus bottom, the width of keratinized gingiva, and gingival angle as the dependent variables. As the results, the NL group of the upper anterior teeth displayed, higher papilla height, and narrower keratinized gingiva, more acute gingival angle resulting in pronounced "scalloped" contour of the gingival margin, compared to the WS group. There was no significant difference between groups NL and WS with respect to probing depth and the gingival thickness. The regression analyses demonstrated that the gingival thickness in central incisors was significantly associated to the mesio-distal width and bucco-lingual width of the crown, and labial probing depth. The width of keratinized gingiva was significantly associated with labial probing depth in central incisors and with proximal probing depth and gingival angle in lateral incisors, and with labial and proximal probing depth, and gingival angle in canines. The gingival angle was significantly associated with papillary height and CW/CL ratio and additionally with proximal probing depth in central incisors, with the width of keratinized gingiva in lateral incisors, and with labial probing depth and the width of keratinized gingiva in canines. These results indicate that the form of clinical crown in upper anterior region could influence the clinical feature of gingiva and the influencing factors might be different according to the tooth region.

The effect of periodontal therapy on the gingival thickness in patients with drug-induced gingival enlargement / 대한치주과학회지

The purpose of this study was to observe the effects of periodontal therapy, including nonsurgical periodontal therapy with azithromycin, surgical therapy, and maintenace therapy on the drug-induced gingival enlargement, by means of measuring gingival thickness. The test group of 18 patients with drug-induced gingival enlargement received scaling, root planing with azithromycin for 5 days, with or without surgical periodontal treatment. The control group of 18 patients who had not taken any medication, received scaling and root planing, with or without surgical periodontal treatment. Both groups received supportive periodontal therapy every 3 months for 2 years. The mean period of total treatment is 32 months in the test group and 31 months in the control group. The thickness of the buccal gingiva was measured using an ultrasonic device of SDM(R)(Krupp Corp., Essen, Germany). The results revealed that the test group(1.21+/-0.51mm) showed statistically thicker buccal gingiva than the control group(1.01+/-0.3mm). In the test group, the buccal gingiva was thickest on 2nd molars and was thinnest on canines of both dental arches. In the control group, the buccal gingiva was thickest on central incisors in the maxilla and 2nd molars in the mandible, while the thinnest areas were on canines in the maxilla and 1st premolars in the mandible. It would be concluded that the periodontal treatment with azithromycin aids in decreasing the degree of the gingival enlargement but cannot prevent the recurrence completely.