Orthopantomographic assessment of the width of attached gingiva

Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial

The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.

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.

The width of radiologically-defined attached gingiva over deciduous teeth

The aim of the present cross-sectional study was to radiologically investigate the continuous eruption process in the deciduous dentition by assessing the difference in the width of radiologically-defined attached gingiva (RAG) in 6-year-old and 10-year-old children. The group of 6-year-olds had predominantly deciduous teeth and the 10-year-olds were in their mixed dentition period. The mucogingival junction was revealed with Schiller's iodine solution and marked mid-labially along the long axis of each tooth with a piece of metal wire prior to taking panoramic radiographs. The width of RAG over deciduous canines and molars was measured from the cementoenamel junction to the mucogingival junction. A significant increase in the width of RAG was found from 6 to 10 years of age.

The width of radiologically-defined attached gingiva over permanent teeth in children

Several authors have determined clinically the width of attached gingiva (AG) over the deciduous and early permanent dentitions in children. They have noticed that when comparing the width of AG over deciduous teeth to the width of AG over the succeeding newly erupted permanent teeth, a clear diminishing in AG can be seen. The aim of the present cross-sectional study was to assess the width of radiologically-defined AG (RAG) over the permanent teeth of 6-, 10- and 12-year-old children. Altogether 123 subjects were recruited. The mucogingival junction (MGJ) was revealed with Schiller's iodine solution and marked over each tooth with a piece of metal wire before taking a panoramic radiograph. The width of RAG over permanent teeth was measured from the radiographs as the midfacial distance from the cementoenamel junction to the mucogingival junction. When comparing the width of RAG over 1st molars and the 1st and 2nd incisors, statistically significant differences were found between 6- and 10-year-olds, between 6- and 12-year-olds and between 10- and 12-year-olds. For the 1st maxillary incisor, the difference in width was not statistically significant between ages 10 and 12 years. The findings seem to justify the conclusion that an inadequate width of AG will correct itself from 6 to 12 years of age without interference by means of periodontal surgery.