Correlation between gingival thickness and gingival recession in humans

Gingival phenotype changes after different periodontal plastic surgical techniques: a single-masked randomized controlled clinical trial

ABSTRACT: OBJECTIVES: Aim of this clinical study was to evaluate the effects on gingival thickness of three surgical techniques for root coverage: the coronally advanced flap (CAF) alone, with a sub-epithelial connective tissue graft (SCTG) or with leukocyte- and platelet-rich fibrin (L-PRF) membranes.

METHODS

Sixty patients with RT1 single maxillary gingival recession were treated with CAF + L-PRF (20 patients), CAF + SCTG (20 patients) or CAF alone (20 patients). At baseline and 6-month after treatment, gingival thickness (GT), keratinized tissue width (KT), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), PROMs, and the aesthetic outcome were recorded.

RESULTS

CAF + SCTG and CAF + L-PRF groups showed a significantly greater mean GT increase than CAF alone (0.31 ± 0.10 mm) with no significant differences between CAF + SCTG (0.99 ± 0.02 mm) and CAF + L-PRF (0.92 ± 0.52 mm) groups (p = 0.55). CAF + SCTG was associated with a significantly greater KT gain (3.85 ± 1.04 mm), while in CAF + L-PRF (2.03 ± 0.53 mm) and CAF (1.50 ± 0.69 mm) groups, KT was not significantly increased. Both GR and CAL showed a significant within groups' improvement, without among-groups differences. No significant among-groups difference for the aesthetic outcome but greater discomfort and pain-killer consumption in CAF + SCTG group was detected.

CONCLUSION

All investigated surgical techniques produced significant GR reduction and CAL gain. GT was similarly augmented by CAF + L-PRF and CAF + SCTG techniques; however, the CAF + SCTG technique produced a more predictable KT and GT increase.

CLINICAL RELEVANCE

The results of our study suggest that the CAF + SCTG technique represents the most predictable method for the clinician to improve the gingival phenotype, an important factor for long term gingival margin stability.

An extensive description of the microbiological effects of silver diamine fluoride on dental biofilms using an oral in situ model

Silver diamine fluoride (SDF) has been long studied in laboratories, and its clinical effectiveness in the treatment and prevention of root caries has been reported. In the present study, we assessed the microbiological effects of SDF on dental biofilms grown on demineralized dentin in situ. Specifically, demineralized bovine root dentin slabs used as biofilm substrates were treated with 38% SDF, and the biofilms formed after this treatment were analyzed via real-time PCR, DEAD/LIVE cell staining, and SEM. Next, the viable cell count was determined, and microbial profiles were compared using 16S rRNA gene sequencing. Untreated slabs were used as controls. We observed significant decreases in viable cell counts (p < 0.05), number of biofilm-forming cells (p < 0.01), biofilm thickness (p < 0.01), and high proportion of dead cells with SDF treatment (p < 0.01). The microcolonies in the SDF-treated biofilms showed less complexity, and only a limited number of genera were differentially abundant between the groups. Microbial diversity index comparisons showed no significant differences between the groups with respect to treatments days (p = 0.362). Thus, SDF negatively influenced dental biofilm growth on demineralized root dentin in situ; however, its antimicrobial action did not target a specific oral taxon.

Gingival thickness threshold and probe visibility through soft tissue: a cross-sectional study

Objectives

The aim was to retrieve the threshold of gingival thickness (GT), where the attribute of gingival translucency through probe visibility was altered.

Methods

In 200 patients, the soft tissue thickness was evaluated at both central mandibular incisors using ultrasound quantification (USD). Additionally, probe visibility was determined using a standard periodontal probe (PB) (CPU 15 UNC, Hu-Friedy), inserted 1 mm deep into the gingival sulcus. Frequencies and relative frequencies were calculated. Repeatability analyses and receiver operating characteristics (ROC) were conducted to determine the USD cut-off point for probe visibility.

Results

Regression model indicated that the probe was not visible at a thickness of 0.82 mm for the mandibular left central incisor (95% CIs 0.77, 0.86) and became visible at a thickness of 0.69 mm (95% CIs 0.65, 0.72). The respective values for the mandibular right central incisor were 0.82 mm (95% CIs 0.77, 0.87) and 0.70 mm (0.68, 0.74). ROC analysis confirmed the retrieved regression results by indicating the best fitting balance for specificity and sensitivity at a thickness of 0.8 mm for both mandibular incisors.

Conclusions

In the frame of the current study, the data revealed that gingiva becomes non-transparent at a thickness of approximately 0.8 mm.

Clinical relevance

Probe visibility at mandibular incisors for the discrimination between thin and thick soft tissues was correlated with a gingival thickness of 0.8 mm and a high repeatability.

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.

Three-dimensional quantitative measurement of buccal augmented tissue with modified coronally advanced tunnel technique and de-epithelialized gingival graft: a prospective case series

Background

The aim of this study is to investigate three-dimensional quantitative analysis of buccal augmented tissue alterations after surgery using a modified coronally advanced tunnel (MCAT) technique combined with a de-epithelialized gingival graft (DGG) within 1 year post-op, based on intraoral scanning.

Methods

25 Cairo class I gingival recession defects were treated using an MCAT technique with DGG. Digital impressions were taken using an intraoral scanner at baseline, 2 weeks, 6 weeks, 3 months, and 1 year after the surgery. Three-dimensional quantitative measurements within 1 year were analyzed for buccal augmented tissue after surgery, including postoperative gingival height gain (GHG), area gain (GAG), volume gain (GVG) and mean thickness (GMT) of region of interest, as well as the tissue thickness change at 1, 2, and 3 mm (TTC1, TTC2, and TTC3) apical to the cemento-enamel junction.

Results

Postoperative GHG, GAG, GVG, and GMT were distinctly encountered at 2 weeks post-op, then gradually decreased. At 1 year, GHG, GAG, GVG, and GMT were 2.211 ± 0.717 mm, 7.614 ± 2.511 mm², 7.690 ± 4.335 mm³ and 0.965 ± 0.372 mm, respectively. Significant decreases were recorded between 6 weeks and 1 year in terms of GHG, GAG, and GVG. The GMT was sustained after 6 weeks with an increase of nearly 1 mm at 1 year. TTC1 and TTC2 yielded thicker tissue change than TTC3.

Conclusions

Three-dimensional quantitative measurements taken via intraoral scanning showed that buccal augmented tissue acquired via MCAT with DGG tends to be stable after 3 months post-op. Digital measurement can be applied in periodontal plastic surgery as a clinically feasible and non-invasive evaluation method for achieving volumetric outcomes.

Trial registration

This study was retrospectively registered in the Chinese Clinical Trial Registry: ChiCTR1900026768. Date of registration: 21/10/2019.

Improvement of Periodontal Parameters with the Sole Use of Free Gingival Grafts in Orthodontic Patients: Correlation with Periodontal Indices. A 15-Month Clinical Study

The aim of this study was to evaluate the changes in periodontal parameters solely using free gingival grafts during orthodontic treatment without any oral hygiene re-enforcement. Methods: A total of 19 patients underwent periodontal examination before orthodontic treatment. Patients received oral hygiene instruction and professional hygiene therapy. Where needed; full periodontal treatment was completed. Only periodontally stable patients were included in the study. Periodontal indices and keratinized tissue were recorded at time 0 (T0) (delivery of orthodontic appliances), and at three months (T1) during orthodontic therapy; when surgery was performed. At T1; orthodontically treated sites with minimum keratinized tissue (≤1 mm) received a free gingival graft to enhance the band of keratinized tissue. At three months after surgery (T2), new measurements were recorded. The orthodontics-treated sites after three months (T1) were used as control. The same sites were used as a test three months after mucogingival correction (T2). Between T1 and T2; orthodontics was suspended; no professional oral hygiene was performed; and no additional oral hygiene instructions were given to the patient. No oral hygiene procedures were administered for 15 months (T3), when the final recordings were taken. Results: The results showed that there was a worsening of gingival index (GI) and plaque index (PI) of the treated sites between T0 and T1 during initial orthodontics treatment; whereas there was an improvement of the gingival inflammation at T2 when compared with T1. At T2; there was also a statistically significant improvement in GI and PI compared with T0. A T3 improvement in periodontal parameters was sustained. A non-parametric test (Wilcoxon signed-rank test) was used for statistical analysis. Conclusions: Augmentation of the width of keratinized gingiva; as the sole treatment; favors the improvement of GI and PI during orthodontic therapy.

Effects of crown movement on periodontal biotype: a digital analysis

Orthodontic treatment has important correlations with periodontal changes. Various mechanical and biological factors are involved in determining such changes, but anatomical and morphological variables, generally addressed as periodontal biotype, play a key role. In measurement of such modifications, digital and non-contact reverse engineering technologies may be of tremendous advantage. The aim of this study is to retrospectively evaluate, in a series of digitized dental casts, some of the parameters addressing periodontal biotype and correlate them to extent and direction of tooth movement. Pre- (T0) and post-treatment (T1) dental casts of 22 patients were scanned by 3Shape TRIOS 3® scanner. A number of variables (crown ratio, gingival margin position, gingival contour, papillae position, gingival scallop) were investigated and their variations calculated after digital measurements on single casts at T0 and T1, or after direct measurement (T1 vs T0) on the superimposition and alignment of digital models. Univariate and multivariate statistics were then performed. No significant correlation was detected between the sagittal or vertical movement of dental crown and displacement of the gingival margin. On the other hand, vestibular gingival contour resulted significantly altered by vestibular and extrusion movements. Further studies are needed to ascertain the differential effect of bone and soft tissue on such modifications. The relationship between orthodontic treatment and the periodontium overcomes the consideration of gingival recession and includes all the concepts of periodontal biotype with its characteristics. Digital technologies and non-contact reverse engineering techniques now available have the potential to allow a more precise definition of such a relationship.

Oral mucosal lesions in teenagers: a cross-sectional study

Background

Adolescence is a period of transition to adulthood. Little is known about oral mucosal lesions (OMLs) in teenagers, in which the emergence of new habits, unfamiliar to children, could affect the type of lesions.

The aim of this study was to evaluate the distribution of oral mucosal lesions (OMLs) in a wide sample of adolescents.

Methods

A retrospective cross-sectional study was carried out examining all medical records of adolescents (aged 13–18 years) treated at the Dental Clinic of the University of Brescia (Italy) in the period from 2008 to 2014. Cases with OMLs were selected. Data regarding age, gender, type of OML, bad habits, systemic chronic diseases were collected.

Results

A total of 6.374 medical records (mean age 15.2 + −1.7 years) were examined. We found 1544 cases (31.7%) of oral mucosal lesions; 36 different types of mucosal alterations were detected and the most frequent were: aphthous ulcers (18%), traumatic ulcerations (14.3%), herpes simplex virus (11%), geographic tongue (9.6%), candidiasis (5.5%), and morsicatio buccarum (4.7%). Papilloma virus lesions (1.7%), piercing-related lesions (4%), multiform erythema (0.13%), oral lichen planus (0.13%) and granular cell tumour (0.06%) were also diagnosed.

Conclusions

The prevalence of OMLs in adolescents are different from those in children and, in some conditions, it could increase with age.