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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.

The dimensions of gingiva and different parts of the masticatory mucosa have a profound impact in periodontics as it governs the way; the gingival tissue reacts to various physical, chemical, or bacterial insults. The purpose of the following study was to assess the gingival thickness (GT) and correlate it to gender, presence of recession, and width of keratinized gingiva (WKG) in a subset of the Indian population. A total of 400 subjects in the age range of 20-35 years (200 males and 200 females) were included in the study. Clinical parameters such as probing depth, recession depth, WKG, and GT were recorded for all the patients. The prevalence of thin biotype was 43.25%, and that of thick gingival biotype was 56.75%. The mean GT of central incisor, lateral incisor, and canine in Group I was 1.11 ± 0.17, 1.01 ± 0.16, and 0.82 ± 0.17 mm, respectively. No significant association was observed between the gender and the presence of gingival recession to GT. The mean WKG of central incisor, lateral incisor, and canine in Group I was 4.38 ± 1.18, 5.18 ± 1.25, 4.16 ± 1.16 mm, respectively. A positive correlation exists between WKG and the GT (P < 0.05). It was concluded that the prevalence of thick and thin gingival biotype is 56.75% versus 43.25%, respectively, and there is no significant relationship between age, gender, and the presence of recession to gingival biotype. A positive correlation exists between WKG and the GT.

Objectives To quantitatively assess periodontal soft tissue changes, including gingival thickness and keratinized gingiva width after periodontally accelerated osteogenic orthodontics (PAOO) surgery by digital measurements.  Methods This study enrolled 15 maxillaries with 89 anterior teeth and 16 mandibles with 94 anterior teeth from Chinese adult patients with skeletal Angle Class III malocclusion for whom PAOO surgery was proposed during orthodontic treatment. Intraoral scanning and cone beam computed tomography (CBCT) examinations were performed before PAOO surgery and 6 months after the surgery. Keratinized gingiva width was measured on the digital model acquired by intraoral scanning. The gingival thickness was measured using a digital three-dimensional (3D) model based on the combination of digital intraoral scanning and CBCT data. Results The mean gingival thickness before surgery was 0.91 ± 0.32 mm and 1.21 ± 0.38 mm at 6-month after PAOO. Patients showed periodontal soft tissue increase with a mean gingival tissue gain of 0.30 ± 0.33 mm. At 1 mm, 2 and 3 mm apical to cemento-enamel junction (CEJ) levels, the gingival thickness increase of the mandible was higher than that of the maxilla (0.38 ± 0.30 mm vs. 0.24 ± 0.31 mm, 0.43 ± 0.35 mm vs. 0.26 ± 0.41 mm, 0.36 ± 0.27 vs. 0.25 ± 0.32 mm, respectively, all P  < 0.05). Moreover, the sites of gingival thickness ≤ 1 mm before surgery showed more tissue gain than the sites > 1 mm (0.36 ± 0.32 mm vs. 0.18 ± 0.31 mm, P  < 0.001). The mean keratinized gingiva width at T0 was 3.88 ± 1.22 mm, and increased 1.05 ± 1.24 mm 6 months after PAOO surgery. Moreover, a digital 3D model for gingival thickness measurement based on the combination of digital intraoral scanning and CBCT displayed high reliability and accuracy with an intra-class correlation coefficient (ICC) of 0.897. Conclusion PAOO could improve an insufficient quantity of periodontal soft and hard tissues in patients with skeletal Angle Class III malocclusion, including the gingival thickness and keratinized gingiva width. A digital 3D model based on the combination of digital intraoral scanning and CBCT data could provide a new digital measurement of gingival thickness with high accuracy and reliability.

Objective:To systematically review the relationship between gingival biotype (GT) and malocclusion.Methods:The review followed PRISMA standards of quality for systematic reviews and meta-analyses reporting with PROSPERO registration number CRD42020126543. The systematic database search included MEDLINE, Scopus, Embase, PsychINFO, CINAHL, and other key journals; the article search was performed until February 2020. Cochrane’s risk of bias in non-randomized studies-of interventions (ROBINS-I) was used to grade the methodological quality of the included studies.Results:The systematic search identified 105 studies, six studies satisfied the inclusion criteria for eligibility. The study participants ranged from 26 to 200 (total n=812), with a mean of 135. Study participants were aged between 14 and 32 years. Five studies were graded as the moderate risk of bias and one study as low risk of bias. Two studies showed thin GT among individuals with severe crowding compared to mild crowding. Three studies showed a thin GT with a narrow zone of the keratinized gingival width compared to a thick GT. No relationship was found between GT and Angle’s classification of malocclusion.Conclusion:No relationship was observed between Angle’s classification of malocclusion and GT. Thin GT was prevalent among individuals with pro-inclination of incisors. Keratinized gingival width was narrow among individuals with thin GT.

Background Gingival phenotype (GP) significantly influences periodontal health and treatment outcomes. Traditional methods for assessing GP, using gingival thickness (GT) alone, may lack sufficient accuracy for reliable GP classification. The present study aims to introduce and validate a novel non-invasive digital GP assessment measuring digital GT (dGT) and digital keratinized tissue width (dKTW). The primary objective is to assess the diagnostic performance of digital gingival phenotype (dGP) in distinguishing between thick and thin phenotypes. Methods This prospective, cross-sectional study was conducted at the Periodontology Department of Istanbul University-Cerrahpaşa, Turkey, from October to December 2024. Participants were included if they had all maxillary and mandibular anterior teeth present. Exclusion criteria included factors that could affect periodontal tissues, such as clinical attachment loss, systemic diseases (e.g., diabetes), gingival enlargement or recession, smoking, medications causing gingival hyperplasia, and melanin pigmentation. All subjects were screened for eligibility by S.K. prior to enrollment, with participants enrolled when S.K. was present at the periodontology department for preliminary examinations using a convenience sampling approach. KTW was assessed using clinical (cKTW), digital (dKTW), and rounded methods. cKTW and dKTW measured the distance between the gingival margin and mucogingival junction, while rounded KTW was calculated by rounding dKTW to the nearest whole number. GT was measured digitally in millimeters from the gingival margin level. GP was evaluated clinically (cGP) with a color-coded periodontal probe and digitally (dGP) by multiplying dKTW and dGT measurements. cKTW, dKTW, rounded KTW, dGT, and dGP are index tests, with cGP serving as the reference standard. The diagnostic accuracy of each method was evaluated using Receiver Operating Characteristic (ROC) analysis. Results Out of 348 participants, 31 met the inclusion criteria. Since each participant’s 12 teeth were evaluated, a total of 372 teeth were included in the study. The area under the curve (AUC) values and 95% confidence intervals (CI) for each method were as follows: dGT: 0.628 (95% CI: 0.570–0.687), cKTW: 0.730 (95% CI: 0.677–0.782), dKTW: 0.714 (95% CI: 0.661–0.767), rounded KTW: 0.710 (95% CI: 0.657–0.763), and dGP: 0.734 (95% CI: 0.683–0.785). The dGP model exhibited the highest diagnostic accuracy, while the dGT model showed the lowest. Conclusions The findings suggest that the digital gingival phenotype assessment provides superior diagnostic accuracy compared to other methods, achieving the highest AUC value. This demonstrates its efficacy in classifying GP and offers a reliable and accurate alternative to traditional clinical techniques for GP classification. Registration No trial registration was performed, as no invasive procedures were conducted in this study.

Aim : The aims of the present study were to explore the relations between the gingival phenotype (GP) and the periodontal health status and find the prevalence of a specific gingival phenotype in a small Bulgarian population. Materials and methods : We recruited 50 patients attending our dental practice with different periodontal diagnoses. A detailed periodontal status was taken to assess the diagnosis of each participant. Several clinical methods for evaluation of the gingival thickness and keratinized tissue width, including the TRAN method, transgingival probing, and direct measurement, were used. The data were summarized and analyzed statistically. Results : We found a significant prevalence of the thick gingival phenotype, in particular the thick flat type. The patients with periodontitis had a higher distribution of the thick gingival phenotype, while in those with gingivitis, the thin scalloped gingival phenotype was noted. In regards to the gingival thickness (GT), 36 participants were found to have GT >1 mm, and the remaining 14 had GT ≤1 mm. Statistically significant differences were found in the keratinized tissue width and the width of attached gingiva in the different gingival phenotypes. No significant differences were found in the age and sex of participants. Conclusions : We found a significant prevalence of the thick (with a mild prevalence of thick flat to thick scalloped) versus thin gingival phenotype in the studied sample. The highest relative proportion of patients with periodontitis was among the subsample of individuals with thick flat gingival phenotype. Regarding gingivitis, the highest proportion was in the thin scalloped phenotype subsample – 42.9%. The highest prevalence of periodontal health was among the individuals with thick scalloped GP (50%), followed by the thin scalloped GP (35.7%).

ABSTRACT Background: Gingival recession (GR) has become a common problem among patients. GR is associated with increased accumulation of plaque, root caries, abrasion and cervical wear, and dentinal hypersensitivity. The present study aimed to examine the correlation between gingival biotypes and the occurrence of GR. Methods: The study initially recruited 94 subjects; however, 54 of them did not have any recession sites, and hence were discarded. Therefore, the analysis was performed on 40 subjects. The study particularly compared the relationship between the recession length (RL) and width along with the gingival thickness (GT). As such, different clinical parameters were analyzed, namely, RL, recession width (RW), keratinized gingival width (KGW), and GT. Results: Based on the statistical analysis (descriptive statistics and Pearson's correlation) conducted on the collected data, the study established that the gingival RL has a significant negative relationship with GT, which implied that the amount of thickness is inversely proportional to the RL. The study also found a significant positive correlation between RW and RL as well as between GT and KGW. Conclusion: Based on the findings, the study thus concluded that the gingival biotype (thickness) significantly determines the occurrence and extent of GR.

The long-term functional success of implant treatment depends on the stability of the crestal bone around the implant platform. The esthetic result is achieved by adequate quality and quantity of soft tissue in the peri-implant area. The soft tissue creates the buffer area that ensures the mechanical and biological protection of the underlying bone. Therefore, it is necessary to maintain in the long term, not only implant osseointegration, but also the integrity of the soft tissue around the sub- and suprastructures of the implant restoration. To create the protective soft tissue area, it is necessary to ensure 3 criteria. This treatment approach will be defined as TWS–soft tissue management: T for thickness, W for width, and S for stability. There are many ways to achieve the first 2 criteria, which are described in the literature. Achieving the third criterion of stability has become possible only recently because of the development of digital treatment planning, surgically guided, and prosthetic-assisted technology that uses a 1-time abutment and its implementation into the dental practice. The purpose of this article is to present with clinical cases a detailed description of each criterion.

IntroductionGuided tissue regeneration (GTR) combined with bone grafting for periodontal regenerative surgery has ideal clinical results for intrabony defect. However, some sites of intrabony defects often suffer from insufficient keratinised gingival width, which affects the efficacy and long-term prognosis of periodontal tissue regeneration. Free gingival graft (FGG) is an effective surgical procedure to widen the keratinised gingiva, but there are few clinical studies on FGG prior to GTR combination with bone grafting to improve clinical outcomes.MethodsThis study is an open-label randomised controlled trial. 68 patients with periodontitis with at least one intrabony defect depth with ≥3 mm are recruited and randomly grouped. In the test group, FGG is performed first, followed by GTR and bone grafting 3 months later; while in the control group, only periodontal tissue regenerative procedures are performed. After completion of all procedures, the patients will be recalled at 3 months, 6 months and 12 months and the relevant clinical and radiographic examinations will be carried out and statistical analysis of the data will also be performed. The present research has received approval from the Ethics Committee of Shanghai Stomatological Hospital (No.2022–007) on 4 August 2022.DiscussionExploring the effectiveness of the two-stage approach of FGG prior to periodontal tissue regenerative surgery for the treatment of keratinised gingival width deficient intrabony defects can provide a high-level evidence-based basis for the formulation of relevant treatment strategies in clinical practice.Ethics and disseminationThe present research has received approval from the Ethics Committee of Shanghai Stomatological Hospital (No.2022–007) on 4 August 2022. The patients will be incorporated into this trial only after their written informed consent has been obtained. The study will be performed according to the 2013 revision of the Helsinki Declaration of 1975. Personal information of all subjects will be stored in the Department of Periodontology of Shanghai Stomatological Hospital. Data of the present research will be registered with the Clinical Trials Registry Platform. Additionally, we will disseminate the results through scientific journals.Trial registrationChinese Clinical Trial Registry, ID: ChiCTR 2200063180. Registered on 1 September 2022.

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.