Gingival biotype assessement: visual inspection relevance and maxillary versus mandibular comparison

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.

Determining the periodontal phenotype-Probe transparency versus actual: A diagnostic study

AIMS

Assessment of the validity of the transparency of the periodontal probe as a tool for determining the periodontal phenotype.

MATERIALS AND METHODS

The periodontal phenotype was assessed at the six upper anterior teeth of 75 subjects using two methods. One is through assessing the transparency of the periodontal probe upon insertion into the gingival sulcus. The second method was through the assessment and clustering of the width of keratinized gingiva clinically and the gingival and buccal plate thickness on Cone Beam Computed Tomography scan.

RESULTS

The probe transparency approach correctly identified thick periodontal phenotype in most cases (41 out of 43 [95%]). However, this was not the case for thin periodontal phenotype; probe transparency approach identified 64% of the thin sites (261 out of 407) and misclassified nearly one third of the patients.

CONCLUSION

The probe transparency approach is a valid approach in identifying the phenotype in subjects with thick phenotype but not in subjects with thin phenotype.

CLINICAL SIGNIFICANCE

The definition of periodontal phenotype has recently changed. Accurate designation has been shown to affect treatment outcomes especially esthetic ones in different disciplines of dentistry. Probe transparency is commonly used by clinicians and researchers. Assessment of the validity of this method based on the most recent definition and compared to actual assessment of bone and gingival thickness is of great clinical value.

Evaluation of Gingival Phenotype in the Early Transitional Dentition Phase in Children-Comparison of Three Non-Invasive Methods

Gingival phenotype (GP) is determined based on the thickness and width of the gingival tissue. An evaluation of GP is essential for adequate treatment planning and outcome monitoring, including orthodontic treatments in a paediatric population. The present study aimed to compare the reliability of the visual and TRAN methods with that of the ultrasound biometer measurements in the early transitional dentition phase. One hundred ninety three generally healthy, 7-year-old children were examined. An assessment of GP was performed by a paedodontist and a periodontist. The average thickness of the gingiva was 0.76 ± 0.36 mm, which was classified as a thin GP. The agreement between a visual assessment and the biometric ultrasound measurements reached the highest (94%) level when assessing a very thin GP (Spearman's rank correlation coefficient r = 0.37, p < 0.01). Similarly, 99% agreement in the diagnosis of a thin GP was recorded for the TRAN and ultrasound methods (Spearman's rank correlation coefficient r = 0.49, p < 0.001). In total, 86% of cases diagnosed as having a thick GP using the TRAN method turned out to be thin according to the ultrasound measurements. The dentist's specialization and professional experience in the assessment of GP were irrelevant (Spearman's rank correlation coefficient r = 0.49, p < 0.001). All methods tested in the present study were proven to be easy to perform and well accepted by the children. The visual assessment and TRAN methods, despite the fact that they enabled the diagnosis of a thin GP (crucial for treatment planning), cannot be recommended during the teeth replacement period. A misdiagnosis of thick GP may deprive a young at-risk patient of special supervision, which may develop into mucogingival deformities. A biometric ultrasound, although expensive, allows for reliable assessment of the gingiva thickness when needed.

Ultrasound Imaging of the Periodontium Complex: A Reliability Study

Background

Ultrasonography is a noninvasive, low-cost diagnostic tool widely used in medicine. Recent studies have demonstrated that ultrasound imaging might have the potential to be used intraorally to assess periodontal biomarkers.

Objectives

To evaluate the reliability of interlandmark distance measurements on intraoral ultrasound images of the periodontal tissues.

Materials and Methods

Sixty-four patients from the graduate periodontics (n = 33) and orthodontics (n = 31) clinics were recruited. A 20 MHz handheld intraoral ultrasound transducer was used to scan maxillary and mandibular incisors, canines, and premolars. Distances between the alveolar bone crest and cementoenamel junction (ABC-CEJ), gingival thickness (GT), and alveolar bone thickness (ABT) were measured by 3 raters. The intercorrelation coefficient (ICC) and mean absolute deviation (MAD) were calculated among and between the raters. Raters also scored images according to quality.

Results

The ICC scores for intrarater reliability were 0.940 (0.932-0.947), 0.953 (0.945-0.961), and 0.859 (0.841-0.876) for ABC-CEJ, GT, and ABT, respectively. The intrarater MAD values were 0.023 (±0.019) mm, 0.014 (±0.005) mm, and 0.005 (±0.003) mm, respectively. The ICC scores for interrater reliability were 0.872 (95% CI: 0.836-0.901), 0.958 (95% CI: 0.946-0.968), and 0.836 (95% CI: 0.789-0.873) for ABC-CEJ, GT, and ABT, respectively. The interrater MAD values were 0.063 (±0.029) mm, 0.023 (±0.018) mm, and 0.027 (±0.012) mm, respectively.

Conclusions

The present study showed the high reliability of ultrasound in both intrarater and interrater assessments. Results suggest there might be a potential use of intraoral ultrasound to assess periodontium.

Gingival Phenotype Changes and the Prevalence of Mucogingival Deformities during the Early Transitional Dentition Phase-A Two-Year Longitudinal Study

Thin gingival phenotype (GPh) may contribute to periodontal tissue breakdown and recession development. Thus, the early identification of thin GPh in children can allow proper preventive care and the identification of children at risk during orthodontic treatment. The present long-term study aimed to monitor GPh changes, i.e., thickness (GT) and width of attached gingiva (AGW) during the early transitional dentition phase, as well as its potential associations with the mucogingival deformities. Materials and Methods: 83 systematically healthy children were examined twice with an interval of 2 years. Probing depth, GT and AGW at mandibular incisors, vestibular depth, type of lower lip frenum attachment and mucogingival defects were recorded. Results: 95.2% of participants at baseline and 93.9% at 2-year examination expressed thin GPh. During the transition from the deciduous to permanent dentition, GT and AGW declined, but the GT of permanent incisors already erupted at the baseline examination increased in the observation period. Conclusions: Gingival phenotype undergoes changes in the early transitional dentition phase. In spite of the thin gingival phenotype, only single pseudo-recessions and primary shallow vestibule were noticed.

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.

Correlation between gingival phenotype in the aesthetic zone and craniofacial profile-a CBCT-based study

OBJECTIVES

To investigate the correlation between gingival phenotype and craniofacial profile and to evaluate the morphology of periodontal supporting tissues in the maxillary and mandibular anterior zones.

MATERIALS AND METHODS

A total of 66 patients with 264 central incisors in good periodontal health were included in this cross-sectional study. CBCT images were used to assess gingiva and alveolar bone thickness of the maxillary and mandibular incisors at four vertical levels. Cephalometric analysis was used to assess the sagittal profile of the craniofacial structures. Gingival thickness was compared in patients with different craniofacial profiles based on ANB value. Linear regression coefficients adjusted by age and gender were used to evaluate the correlation between gingival thickness and the cephalometric parameters.

RESULTS

Individuals with a smaller ANB value (ANB< 2) presented with thinner supporting tissue and a keratinized gingiva width in the anterior zone. Labial gingival thickness on the mandibular incisors at the cementoenamel junction (G1) and at the alveolar bone crest (G2) was positively related to cephalometric measures, indicating a maxillae-mandibular sagittal relationship (ANB value, Wits appraisal, A-NPog value).

CONCLUSIONS

A moderate correlation was found between mandibular gingival thickness and the sagittal craniofacial profile. Patients with a concave craniofacial profile had a smaller keratinized gingiva width and gingival thickness in the aesthetic zone.

CLINICAL RELEVANCE

Knowledge of these features on supporting tissue and their correlations with craniofacial morphology will help clinicians to develop a reasonable treatment plan and make decisions to achieve the best aesthetic outcome.

Aesthetic aspects of adjacent maxillary single-crown implants-influence of zirconia and titanium as implant materials

The purpose of this retrospective survey was to assess the esthetic aspects of adjacent zirconia and titanium implants in the anterior maxillary area. A total of 40 patients and 109 adjacent implants (17 patients with 47 titanium implants and 23 patients with 62 zirconia implants) was included. The primary aim of this survey was to assess the papillary fill (Jemt score). Additionally, further esthetic aspects were assessed. Papillae were fully present (Jemt score 3) around 39.1% of adjacent zirconia implants and 17.4% of adjacent titanium implants (p<0.01). The papilla deficit was significantly higher 1.64 mm (SD 1.35) around titanium compared to zirconia implants 0.92 mm (SD 0.94, p<0.01). The evaluation of the soft tissue recessions revealed no differences between implant materials, whereas titanium implants presented more visible implant shadows (p<0.01). Zirconia implants had more implants with papillae that filled the entire proximal space compared to titanium implants. Furthermore, titanium implants had a greater frequency of visible implant shadowing than the zirconia implants. Esthetic rules such as the interdental contact area and golden percentage rules did not differ significantly between the titanium and zirconia implants.

[Comparison of clinical and radiological features of keratinized gingiva and buccal cortical bone in patient with gingival recession]

Compare clinical and radiological features of keratinized gingiva and buccal cortical bone of identical corresponding contralateral teeth with recession (recession group) or without recession (control group). A total of 60 teeth from 27 patient were observed. The thickness of gingiva was significant reduced in recession group (0.85 mm, range 0.7-0.95 mm) that in control group (0,95 mm, range 0.8-1.0 mm), p<0.05. In recession and control group the height of keratinized gingiva was 1.58 mm (range 0.9-1.9 mm) and 3.0 mm (range 2-3.4 mm), correspondingly (p<0,05). The mean distance from cementoenamel junction to buccal cortical bone was strongly different in recession and control group (5,8 mm vs 4,47 mm, p<0.05).

Determinação do biótipo periodontal através da análise de fotografias intra-orais

Resumo Objetivo Caracterizar os Biótipos Periodontais (BP) por meio de fotografias, além de verificar a concordância com o método clínico de determinação, bem como com diferentes profissionais em Odontologia. Material e método A avaliação clínica intra-bucal de 34 pacientes (n=34) e verificação de fotografias padronizadas foram realizadas para caracterização dicotômica do BP em fino e espesso. A avaliação subjetiva, por meio da fotografia, foi comparada ao método clínico da transparência à sondagem. A determinação do BP por meio de fotografias foi realizada através da aplicação de um questionário contendo três categorias (fino, espesso e intermediário), direcionadas a 90 cirurgiões-dentistas divididos igualmente em três grupos: clínicos gerais, periodontistas e protesistas. A concordância em ambas as comparações foi avaliada por meio do Teste Kappa, além dos testes de sensibilidade e especificidade. Resultado Na comparação entre o método clínico e o fotográfico, não houve concordância (K = 0,264, p = 0,113). Na comparação entre os grupos dos profissionais, foi encontrada uma baixa concordância (kappa = 0,160; p<0,05) entre os periodontistas e protesisas, bem como entre protesistas e clínicos gerais (kappa = 0,110; p = 0,142). Houve maior concordância, ainda que fraca, entre periodontistas e clínicos gerais (kappa = 0,291; p = 0,00). O questionário obteve um valor de sensibilidade e especificidade maior para o diagnóstico do BP espesso. Conclusão A avaliação clínica do paciente por meio dos parâmetros clínicos ainda é necessária para caracterizar o BP, visto que a determinação usando-se análise visual por meio do fotografia, independentemente da especialidade, não foi efetiva, embora o BP espesso tenha sido o mais facilmente identificado.

Comparative in vitro study of two methods for gingival biotype assessment

Background

The gingival thickness seems to have an important role in different dental treatments. There are different methods of quantifying this thickness, but it is not known which of them can be the most effective. The objective to assess the accuracy of two different methods for gingival thickness measurement: the transgingival needle probing (TGNP) and the tension-free caliper (TFC) in an in vitro model, by comparing them with direct physical measurements (reference standard).

Material and Methods

Gingival thickness (GT) was evaluated in 27 female pigs with four implant sites 1, 2 and 3mm from the gingival margin with three different methods: 1) transgingival needle probing 2) tension-free caliper and 3) Direct visualization after making a incision in the mucosa and measuring GT with a periodontal probe. Wilcoxon test for paired samples were used with a confident level of 95%.

Results

A total of 324 points were measured, 59% of the sites presented a thin biotype with DV, it was correctly assessed with the TGNP in 84% of the times and in 86% with the TFC. 41% of the sample presented thick biotype, 76% was the percentage measured with the TGNP and 0% of the sites evaluated with TFC resulted in this biotype.

Conclusions

Transgingival needle probing constitutes an accurate method when measuring GT at different levels. Tension free caliper is not a good tool for assessing the gingival biotype as long as it is unable to predict thick biotype.

Key words:Periodontal Biotype, Gingival Thickness, Periodontal Tissue and Diagnosis.

Assessment of Periodontal Biotype in a Young Chinese Population using Different Measurement Methods

Periodontal biotype is used to describe the morphological characteristics of periodontal tissues and is closely related to periodontal health and prognosis of many dental treatments. This study was undertaken to explore the periodontal biotype distribution in a young Chinese population and to evaluate the accuracy of different methods for gingival thickness (GT) measurement. A total of 372 teeth from 31 periodontally healthy subjects were included. GT was measured simultaneously by probe transparency, transgingival probing and cone-beam computed tomography (CBCT). Some other anatomic parameters, including crown width/crown length ratio, attached gingival width, labial bone thickness and papilla volume were recorded for periodontal biotype classification. As found by probe transparency, the gingivae of 222 teeth (59.68%) were thick, while those of 150 teeth (40.32%) were thin. The mean GT of included subjects was 1.03 ± 0.31 mm as measured by transgingival probing and 1.03 ± 0.24 mm as measured by CBCT. Four groups were identified by cluster analysis. Thick-flap biotype, average-scalloped biotype, average-flap biotype and thin-scalloped biotype comprised 137 teeth (36.83%), 96 teeth (25.81%), 39 teeth (10.48%) and 100 teeth (26.88%), respectively. These results demonstrate that the most common periodontal biotype in this young Chinese population was the thick-flap type with low aesthetic risk.

A Non-Invasive and Accurate Measurement of Gingival Thickness Using Cone-Beam Computerized Imaging for the Assessment of Planning Immediate Implant in the Esthetic Zone-A Pig Jaw Model

INTRODUCTION

The objective of the study is to compare the accuracy of the measurement of gingival thickness using cone-beam computerized tomography (CBCT) with direct clinical measurement on a pig jaw model, aiming to provide an alternate and precise method to aid assessment of the gingival biotype before immediate implant placement at the esthetic zone.

MATERIALS AND METHODS

Four pig mandibles were categorized separately into 14 different zones with each prominent tooth cusp as one. A high-resolution CBCT image was taken. Measurement of gingival thickness was performed using computer software and was compared with direct clinical measurements.

RESULTS

Intraclass correlation coefficient between clinical and CBCT measurements were 0.995 (pig 1), 0.945 (pig 2), 0.966 (pig 3), and 0.932 (pig 4), which indicated a good match between 2 measuring methods. Independent t test showed no significant difference between 2 independent investigators in all aspect of measurements (P > 0.05).

CONCLUSION

Measuring gingival thickness using CBCT is a predictable and accurate method to assess the gingival biotype of a patient, so as to predict the suitability of immediate implantation.

Assessment of gingival thickness using an ultrasonic dental system prototype: A comparison to traditional methods

Knowledge of periodontal anatomy is essential when performing surgical and non-surgical procedures in the field of oral healthcare. Gingival thickness (GT) is often assessed for this purpose. A dental system prototype was recently developed for quantitative, non-invasive GT assessment by high-frequency (HF) ultrasound. Laboratory trials were conducted to validate system performance against a traditional method of assessment. A system with a 50 MHz broadband, spherically-focused transducer was used. The transducer was housed in a small, hand-held probe equipped with a continuous water supply. A-scans were obtained and thickness at each location was determined. For comparison, the traditional method of transgingival probing through tissue with an endodontic k-file needle was also implemented. Preliminary experiments were performed on phantoms simulating the anatomical and acoustic properties of human periodontal tissues. A porcine cadaver was obtained for further laboratory trials. The speed of sound through porcine gingiva was determined to be 1564 ± 21 m/s. Finally, a multiple-point experiment involved GT assessment in an array of locations on the buccal gingival surface in the fourth quadrant. Ultrasonic measurements were found to yield similar GT values to those obtained from invasive methods. Results obtained in this experiment validate the applicability of ultrasound as a diagnostic tool for assessing periodontal anatomy.

Gingival biotype in relation to incisors' inclination and position

OBJECTIVES

To study the association between gingival biotypes and inclination and position of the maxillary and mandibular incisors.

METHODS

This cross-sectional study included 142 consecutive orthodontic patients (64 males and 78 females) who were seeking orthodontic treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia from February 2013 to January 2014. Gingival biotype was assessed independently for the maxillary and mandibular central incisors using the transparency of periodontal probe method. Maxillary and mandibular incisors' inclination and position were measured using cephalometric analysis.

RESULTS

The mean age was 23.56 (±2.55) years. The prevalence of thin gingival biotype was 43% for the maxillary and 52.1% for the mandibular incisors. Females were 4 times more likely to have thin gingiva for the maxillary incisors and 5 times more likely for the mandibular incisors. A significant association was found between mandibular incisor inclination and position and thin gingival biotype, while there was no association between the maxillary incisor inclination and position and gingival biotypes.

CONCLUSION

Mandibular incisor proclination and protrusion is associated with thin gingival biotype while no association is found in the maxilla. The evaluation of the gingival biotype is essential during diagnosis and treatment planning for potential orthodontic patients.