Clinical and computed tomographic evaluations of periodontal phenotypes in a Chinese population: a cross-sectional study.

OBJECTIVES: To 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 METHODS: A 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. RESULTS: The 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. CONCLUSIONS: GT 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 RELEVANCE: GT measured with transgingival probing, with a cutoff of 0.8 mm, could serve as an objective measure to distinguish different gingival phenotypes.

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.

Assessment of gingival thickness in the maxillary anterior region using different techniques.

OBJECTIVES: Gingival phenotype is closely related to treatment success and aesthetic results in the maxillary anterior region. Several methods were proposed to measure the dimensions of the gingival tissue. This study aimed to evaluate the gingival thickness using clinical and radiographic techniques and to explore the association between gingival thickness and gingival phenotypes classified by color-coded phenotype probes. MATERIALS AND METHODS: The gingival thickness of 86 periodontally healthy maxillary anterior teeth was assessed using transgingival probing (TGP) and cone-beam computed tomography (CBCT). The gingival phenotype was classified as thin, medium, thick, or very thick by transparency of the color-coded probes through the gingival sulcus. The labial alveolar bone thickness was measured on CBCT images. The keratinized tissue width (KTW) was recorded. RESULTS: Good to excellent agreement was found between TGP and CBCT regarding the thickness of the gingiva (p<0.001). There was a very high correlation between the phenotypes determined by color-coded probes and the gingival thickness measured by TGP (r=0.953, p<0.001). KTW was significantly higher in thick and very thick phenotype groups compared with thin phenotype group. CONCLUSION: Cone-beam computed tomography images and the probe transparency method with color-coded probes are reliable for identifying the gingival phenotype in the maxillary anterior region, based on comparisons to direct transgingival probing. CLINICAL RELEVANCE: The assessment of the gingival phenotype is essential, especially in the aesthetic zone, to obtain predictable and favorable clinical outcomes in various dental procedures. The newly introduced color-coded probes comprise a non-invasive and reliable method for this.

Gingival phenotype assessment methods and classifications revisited: a preclinical study.

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.

Gingival biotype revisited-novel classification and assessment tool.

OBJECTIVES: To evaluate the relationship between gingival biotypes and gingival thickness based on probe transparency through the gingival margin and to assess the sensitivity of a novel classification method. MATERIAL AND METHODS: Sixty adult Caucasian subjects were stratified by their gingival biotype (GB) as defined by the transparency of a prototype double-ended periodontal probe through the buccal gingival margin into "thin" (30 subjects), "moderate" (15 subjects), and "thick" (15 subjects) GB. Three additional parameters were also assessed: gingival thickness (GT), probing depth (PD), and gingival width (GW). RESULTS: Median GT was 0.43 mm (P 25% 0.32; P 75% 0.58) for thin, 0.74 mm (P 25% 0.58; P 75% 0.81) for moderate, and 0.83 mm (P 25% 0.74; P 75% 0.95) for thick GB, respectively. GT was statistically significant different for thin versus moderate and thin versus thick, respectively (Kruskal-Wallis test, p < 0.05; Dunn's test, thin versus moderate: p = 0.002; thin versus thick: p < 0.001; moderate versus thick: p = 0.089). GW was directly correlated with GT (Spearman correlation p < 0.01). The sensitivity of the new classification tool for diagnosing a thin GB was 91.3%. No adverse events or complications were reported. CONCLUSION: GT differs significantly between the presented GB groups, hence, an alternative classification especially focusing on thin biotypes based on a modified periodontal probe might be advantageous. In addition, the presence of a thick gingiva is associated with a wide band of keratinized tissue. CLINICAL RELEVANCE: This clinical setting might to be useful to identify high-risk patients with a very thin biotype and, consequently, higher risk for gingival recession after dental treatments.

On the relationship between gingival morphotypes and different crown shape assessments in young Caucasians.

OBJECTIVES: The objective of this study was to determine the relationship between crown length as well as crown width and gingival morphotypes (primary aim) and their correlation with tooth shape and papilla height (secondary aim). MATERIAL AND METHODS: Thirty-six adult subjects were evaluated in this clinical study according to their gingival morphotype (GM) defined by transparency of a periodontal probe through the buccal gingival margin. Eighteen subjects comprised the thin entity group and 18 the control group thick entity, respectively. Besides crown length (CL) and crown width (CW), two different methods to assess crown shape (CW/CL ratio) were compared and analysis of their relation to papilla height was performed. RESULTS: Nineteen female and 17 male volunteers were enrolled in this study, with a mean age of 24.9 years (±3.4; minimum 18, maximum 35). A statistical significant difference for the crown length could be detected between both groups (p < 0.05) but not for crown width. No significant difference was found for apical or coronal CW/CL ratio besides on tooth 22. CONCLUSION: Within the limitations of this study and within this young Caucasian study population, only crown length seems to have an association with different gingival morphotypes. Furthermore, papilla height and crown shape do not have a clear correlation on tooth level. CLINICAL RELEVANCE: Crown shape seems to be not a strong parameter in assessing the gingival morphotype.

On the relationship between gingival biotypes and gingival thickness in young Caucasians.

OBJECTIVES: To evaluate a possible relationship between gingival biotypes and gingival thickness, papilla height and gingival width. MATERIAL AND METHODS: Thirty-six adult subjects were stratified by their gingival biotype (GB), as defined by transparency of a periodontal probe through the buccal gingival margin, into "thin" (18 subjects) and "thick" (18 subjects) GB. Out of these, extreme cases (6 "very thin", 6 "very thick") were identified. Four different parameters were assessed: gingival thickness (GT), papilla height (PH), probing depth (PD) and gingival width (GW). RESULTS: When comparing "thin" and "thick" GB, midfacial GT (0.40 ± 0.07 vs. 0.72 ± 0.11 mm; P < 0.0001), PH (3.76 ± 0.50 vs. 3.95 ± 0.41 mm, P = 0.02) and GW (3.01 ± 1.26 vs. 4.63 ± 0.86 mm, P = 0.04) were lower in the "thin" GB group. Further stratification into moderately and extremely "thin"/"thick" GB eliminated the differences between the moderate groups. CONCLUSION: Our data support the traditional hypothesis that two different gingival biotypes with concomitant properties distinguishable by gingival transparency exist. In addition, we provide evidence that an alternative classification into "very thick", "moderate" and "very thin" biotypes might be advantageous, because the unique properties were seemingly primarily driven by subjects with extreme values.

Assessment of gingival biotype in different facial patterns: A cross-sectional study.

Objective: The aim of the present study is to evaluate the relationship of gingival biotype in different malocclusions. Methods: A total of 157 periodontally healthy subjects (88 males and 69 females) were enrolled in this cross-sectional study. The study participants were divided into three groups of skeletal class I, class II, and class III. The probe transparency method was used to determine the quality and gingival tissue into thick and thin biotype. Results: There was significant difference in gingival biotype among different skeletal malocclusion with high prevalence of thin gingival biotype in class I subjects and more prevalence of thick biotype in class II and class III individuals (P-value: 0.022). Pairwise comparison of gingival biotype in class I versus class II showed significant difference (P-value: 0.032); however in class I versus class III and class II versus class III, the test result was nonsignificant. The overall frequency of thin gingival biotype was significantly less in female subjects with respect to males (P-value: 0.025). Conclusion: A significant relationship is present between skeletal malocclusion and quality of gingival biotype. The prevalence of thick gingival biotype is found more in females as compared to male individuals. The thin gingival biotype is more commonly seen in skeletal class I than class II and class III.

Gingival phenotype distribution in young Caucasian women and men - An investigative study.

OBJECTIVES: To evaluate the relationship between gingival phenotype and tooth location based on selected index teeth ("Ramfjord") and assess possible differences between women and men. MATERIAL AND METHODS: Thirty-six women and 20 men voluntarily participated in this investigation with an average age of 23 years (min: 19; max: 37). Gingival phenotypes (GP) were assessed by transparency of a periodontal probe through the buccal gingival margin. RESULTS: A comparable and similar GP on all index teeth was only found in seven out of the 56 subjects, that is, thin or thick only: Five participants (three male/two female) showed a uniform and constantly thick and two females a constantly thin GP. While the majority of molars (94.6%; p = 0.006) showed a thick GP, premolars (61.6%; p = 0.09) as well as incisors (70.5%; p = 0.046) were predominantly categorized as thin. In addition, significantly thicker GP was in general observed for maxillary teeth (p = 0.001) but without differences between genders (p = 0.722). CONCLUSION: No constant GP can be expected within one dentition. The use of the "Ramfjord teeth" may serve as a quick overview and reliable method to screen GP distribution.

Assessment of Gingival Biotypes in Patients Visiting a Tertiary Care Centre in Eastern Nepal.

BACKGROUND: Evaluation of gingival biotype has become a routine procedure in periodontal examination because the type of gingival biotype can positively or negatively affect the outcome of periodontal, restorative, orthodontic and implant therapy. The aim of the study was to assess the proportion of types of gingival biotypes in patients visiting a tertiary care center in eastern Nepal. METHODS: Two hundred and fifty patients between 25 to 45 years attending the Periodontology and Oral Implantology were assessed. Gingival biotype of the patents was determined with Probe Transparency technique Results: Out 250 patients assessed, 73 patients (approximately 29.2 %) had thin gingival biotype and remaining 177 patients (approximately 70.8 %) had thick gingival biotype. The number of the male with thin biotype was 31 whereas the number of the male with thick biotype was 82. Similarly, out of 137 female, 42 had thin biotype and remaining 95 female had thick biotype. The types of biotypes were not associated with gender (p=0.67). CONCLUSIONS: Thicker gingival biotype was the more common type of gingival biotype in patients attending the tertiary care center of Eastern Nepal. The occurrence of thick gingival biotype was more common in Adivasi Janajati ethnic community compared to Brahmin / Chhetri ethnic community.