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The concept of gingival phenotype and width of keratinized gingiva influencing the diagnosis and treatment in the periodontal scenario is relatively new. Soft and hard tissue dimensions of oral tissues are considered essential parameters in daily clinical practice. Factors such as the biotype category and the width of the keratinized gingiva help dentists seek the perfect therapy plan for each patient to achieve long-term stability of periodontal health. Several methods have been proposed to categorize phenotypes and each phenotype is characterized by various clinical characteristics. This review aims to discuss the possible association between the gingival phenotype and the width of keratinized gingiva along with the results appeared. After a rigorous search in major electronic databases, the results of the included studies indicated that the width of keratinized gingiva seems to be associated with the periodontal phenotype, with thick biotypes being characterized by a more pronounced keratinized gingival width. However, the heterogeneity of the included studies did not allow to make a conclusion about a direct relationship.

ObjectivesThe gingival thickness (GT) and keratinized tissue (KT) height are defined as the gingival phenotype. Both the modified coronally advanced tunnel technique (MCAT) and free gingival grafts (FGG) are used in modifying the gingival phenotype. This study aims to compare MCAT and FGG in gingival phenotype modification.Materials and methodsOne hundred and forty recessions in 50 patients with thin and insufficient keratinized tissue at the anterior mandible were treated with either MCAT or FGG. GT, KT height, recession depth, recession width, probing depth, and clinical attachment level were evaluated at baseline and 6 weeks, 6 months, and 12 months. GT change, KT change, root coverage (RC), clinical attachment gain, and complete root coverage (CRC) were calculated. The wound healing index, tissue appearance, patient expectations, aesthetic, and dentin hypersensitivity were assessed at baseline and 6 months.ResultsAll periodontal variables showed significant change from baseline to 12 months in both groups (p < 0.05). While FGG resulted in more KT change (p < 0.001), all MCAT sites showed at least 2 mm KT change in 12 months. MCAT resulted in greater GT change (p < 0.05) and RC (p < 0.003). In contrast, there was no significant inter-group CRC difference (p = 0.523). All patient-based variables were favorable to MCAT (p < 0.05), except dentin hypersensitivity (p = 0.225).ConclusionsBoth techniques were successful in terms of gingival phenotype modification in the anterior mandible. Additional GT increase, RC, and patient-based outcomes favored MCAT, though KT change proved greater with FGG.Clinical relevanceClinicians may choose MCAT for higher GT increase whereas FGG for more KTC.Trial registration number: NCT04690140 and date: 12/26/2020.

ObjectiveThis diagnostic accuracy study aims to present the first measurements of gingiva thickness around lower anterior teeth using dental magnetic resonance imaging (MRI) and to compare these measurements with two established methods: (1) gingival phenotype assessment via periodontal probing, and (2) the superimposition of cone-beam computed tomography (CBCT) scans with intraoral scans of teeth and gums.Materials and methodsTen patients with substantial orthodontic treatment need and anterior mandibular crowding were consecutively included in this clinical case series. After periodontal probing, each patient underwent a CBCT scan, an intraoral scan of the mandible, and an MRI investigation using a novel mandibula 15-channel dental coil.ResultsThe mean gingiva thickness was 0.72 mm measured on MRI and 0.97 mm measured on CBCT, with a mean difference between the measurement methods of 0.17 ± 0.27 mm (p < 0.001). Measurement agreement between the index tests (MRI and CBCT) and the clinical reference standard (probing) yielded an overall percent agreement of 64.94% and 47.02% for MRI and CBCT, respectively. Teeth with thin phenotypes were associated with lower soft tissue dimensions in both free (MRI: 0.56 mm vs. CBCT: 0.79 mm) and supracrestal gingiva (MRI: 0.75 mm vs. CBCT: 1.03 mm) when compared to those with thick phenotypes. However, only the measurements obtained from MRI scans showed statistically significant differences between the two phenotypes.ConclusionDental MRI successfully visualizes delicate structures like the gingiva in the anterior mandible and achieves a high correlation with superimposed CBCT scans, with clinically acceptable deviations.Clinical relevanceThe present study helps to establish dental MRI as a radiation-free alternative to conventional radiographic methods.

Background and aim Periodontal health is a critical factor in the development of gingival recession, which may be influenced by orthodontic treatment and various patient-related factors. The aim of this study was to evaluate the prevalence of gingival recession observed during the retention phase after orthodontic treatment and the contributing etiological factors. Materials and methods A total of 96 patients (65 females, 31 males; mean age 20.39 ± 2.21 years) were included in the study during routine follow-up examinations in the retention phase, at least six months after the completion of non-extraction fixed orthodontic treatment and their sociodemographic data, oral hygiene habits, and clinical periodontal measurements were evaluated. The relationships between dentoalveolar cephalometric measurements obtained from lateral cephalograms and gingival recession and gingival phenotype were evaluated. The normality of the data was assessed using the Kolmogorov-Smirnov test, and Mann-Whitney U and Chi-square tests were applied for continuous and categorical variables, respectively. Logistic regression analyses were performed to evaluate risk factors. Statistical significance was considered as p  < 0.05. Results Gingival recession was found to be more prevalent in thin gingival phenotypes compared to thick phenotypes and was observed to be more pronounced when bleeding on probing was 30% and higher ( p  < 0.05). It was observed that gingival recession increased with age ( p  < 0.05). No statistically significant difference was found between gingival recession and other periodontal clinical measurements, sociodemographic data, and oral hygiene habits ( p  > 0.05). No statistically significant relationship was observed between lower incisor protrusion and gingival recession ( p  > 0.05). Conclusions It was concluded that (i) gingival phenotype, bleeding percentage on probing, and age had a considerable effect on gingival recession, whereas orthodontic tooth movement had no significant effect, and (ii) after orthodontic treatment, despite the achievement of a well-aligned teeth and dental arch, the frequency of periodontal check-ups should be increased to reduce the risk of gingival recession. Clinical relavance Orthodontic treatment, consider periodontal conditions related to gingival recession, like thin phenotype and bleeding on probing.

Objectives This study aimed to accurately assess the gingival phenotype by comparing the mean gingival thickness (GT) measured at various levels with a single-point GT measurement. Materials and methods Fifty participants were divided into thin and thick gingival phenotype groups according to two different classifications. The first classification was based on the GT measured at the base of the gingival sulcus (GT1), whereas the second classification was based on the mean of the GT (GTm) measured at the base of the gingival sulcus (GT1 point) and 1 mm apical (GT2 point) and 2 mm apical to the base of the gingival sulcus (GT3 point). The GT was measured using the transgingival method from the buccal region of 1195 teeth, including the incisors, canines, premolars, and first molars, and was statistically analyzed. Results The mean GT was 0.95 ± 0.25 mm for GT1, 0.97 ± 0.3 mm for GT2, 0.81 ± 0.22 mm for GT3, and 0.91 ± 0.22 mm for the overall GTm. Good agreement was found between the GTm and GT1 and GT2 (k = 0.712; k = 0.758, p  < 0.001for both), and moderate agreement was found between the GTm and GT3 (k = 0.534, p  < 0.001). In both classifications, the effect of the dental arch location on the GT was found to be statistically significant. Conclusion Standardized methods are required to minimize the differences in measurements from different vertical levels, which can influence gingival phenotype classification. Clinical trial registration ClinicalTrials.gov identifier: NCT06369506. Clinical relevance Multiple gingival thickness measurements showed that gingival phenotype varied depending on the vertical level of the gingiva measurement point. Gingival phenotype assessment based on the mean of multiple gingival thickness measurements provided precise results, emphasizing the clinical importance of multiple measurements.

This study aims to determine the gingival phenotype around dental implants and the clinical evaluation of the existing phenotype in relation to the tissue health around the implant. Included were 202 dental implants applied to 60 individuals who applied to our service and had at least 1 implant in the mouth, whose prosthetic restoration was completed at least 1 year ago. The effects of keratinized mucosa width (KMW) and gingival thickness (GT), which form the gingival phenotype, on clinical periodontal parameters were evaluated with the obtained data. Of the implants included in the study, 115 were found to have adequate KMW and 87 had insufficient KMW. At the same time, the GT around 74 implants was found to be thick, and the GT around 128 implants was found to be thin. The KMW of those with thin GT was lower than those with thick GT. Plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing depth (PD), gingival recession (GR), and suppuration (SuP) were found to be low in those with adequate KMW. GI, BoP, PD, GR, and SuP were low in patients with thick GT, but there was no significant difference between GT and PI. KMW and GT were associated with peri-implant tissue inflammation and GR. To maintain the health of the peri-implant tissues, it is recommended to have a KMW of at least 2 mm and a thick gingiva.

Objective To compare gingival phenotype assessment methods based on soft tissue transparency on different backgrounds and assessor experience levels. Methods For this purpose, 24 gingival specimens were retrieved from pig jaws with tissue thicknesses from 0.2 to 1.25 mm. Three methods were assessed: periodontal probe PCP12 (thin/thick), double-ended periodontal probe DBS12 (thin/moderate/thick) and colour-based phenotype probe CBP (thin/moderate/thick/very thick). Each sample was photographed with each probe underneath and categorized whether the probe was visible or not using different coloured backgrounds. To measure experience level influence, dentists, dental undergraduate students and laypersons ( n = 10/group) performed the evaluation. Results PCP12 probe showed a threshold between 0.4 and 0.5 mm. To distinct between thin and moderate thick gingiva, a comparable range for DBS12 was found while moderate thickness was between 0.5 and 0.8 mm and for thick above 0.8 mm. CBP also showed a comparable threshold of 0.5 mm for thin versus moderate as compared with the other methods; above 0.8 mm, predominantly a very thick tissue was measured. In general, the background colour had a minor impact on PCP12 and DBS12, and investigator experience showed no clear influence on GP assessment. Conclusion Based on probe transparency and within the limitation of a preclinical study, we suggest GP differentiation into three entities: thin (< 0.5 mm; high risk), moderate (0.5–0.8 mm; medium risk) and thick (> 0.8 mm; low risk). Clinical relevance All three GP assessment methods are easy to perform and seem to have a high predictive value with a three entities classification for DBS12 and CBP.

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.

ObjectivesTo investigate the diagnostic value of probe transparency related to gingival thickness (GT) and keratinized gingival width (KGW) at individual and site levels and explore the relationship of buccal bone plate thickness (BT) with GT and KGW.Materials and methodsA total of 1,606 teeth from 167 patients with periodontally healthy maxillary anterior region were included. GT was measured with probe transparency and transgingival probing. KGW was measured directly. BTs were assessed at the level 1 mm apical to the alveolar crest (BT1) and midpoint of the root (BT2) and evaluated at individual and tooth levels along with their mutual associations.ResultsThe prevalence of thick gingiva was 53% with probe transparency measurement and 51% with transgingival probing. The cutoff gingival thickness was 0.8 mm, which correlated moderately with a Cohen’s kappa of 0.386. The mean GT, KGW, and BTs (BT1 and BT2) in the maxillary anterior region were 0.97 ± 0.46, 5.51 ± 1.62, 0.85 ± 0.31, and 0.79 ± 0.32 mm, respectively. GT and KGW correlated mildly (r = 0.261), and GT and BTs correlated moderately (BT1: r = 0.298; BT2: r = 0.338). GT and BTs differed significantly between men and women and among different tooth sites.ConclusionsGT and BTs correlated positively in the maxillary anterior region and varied within and among individuals. Sex was a factor influencing the gingival phenotype and bone morphotype.Clinical relevanceGT measured with transgingival probing, with a cutoff of 0.8 mm, could serve as an objective measure to distinguish different gingival phenotypes.

Objectives The purpose of this study was to estimate the prevalence of thin and thick gingival phenotype (GPh) in a sample of Dominican subjects and correlate it with clinical parameters. Materials and methods One-hundred seven periodontal healthy volunteers in the range of 18–73 years were enrolled in the study. GPh was defined by the transparency of a periodontal probe through the buccal gingival margin on the upper right or left central incisor. Clinical periodontal parameters such as keratinized gingiva width (WKG), attached gingiva width (WAG), probing depth (PD), plaque index (PI), and gingival index (GI) were recorded by a calibrated examiner. Frequency distribution of qualitative variables was calculated. For quantitative variables, Mann-Whitney and Kruskal-Wallis tests were used for comparison of groups. Results There was no association between GPh and sex. There were no significant differences between thin and thick GPh regarding age, PD, GI, and interproximal index. The association between tooth morphology and GPh was significant ( p = 0.018). Median amount of keratinized gingiva was significantly larger ( p = 0.01) in subjects with thin gingival phenotype (median = 6.00 mm) when compared with subjects with thick gingival phenotype (median = 5 mm). Conclusions Subjects with thin GPh presented larger WKG. Furthermore, there was an association between tooth morphology and GPh. Clinical relevance This is the first study to report the distribution of gingival phenotype and its relationship with different periodontal parameters of a Caribbean population. Our findings can contribute to the clinicians when planning or performing dental procedures.