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.

Gingival biotypes in Mexican students aged 17-19 years old and their associated anatomic structures, socio-demographic and dietary factors.

This was a cross-sectional study with 550 students aged 17-19 years old. Gingival biotype (GB) was classified as thin, thick, and mixed based on visual inspection. Biotypes were associated with anatomical parameters from the anterior teeth, including probing depth, keratinized gingiva (KG), and gingival attachment (GA). Upper lip distance, facial thirds, tooth shape, gingival recessions, and gummy smile (GS) were also measured. Other variables included sex, age, dietary intake, and oral hygiene habits. Prevalence of thin, thick, and mixed biotypes was 68.4%, 19%, and 12.5%, respectively. Recessions occurred most often in those with thin biotypes. GS was more often seen in men with thin biotypes and in women with thick biotypes. There was a relationship between thin biotypes and oval teeth, and between thick biotypes and square teeth. The lower facial third was larger in thin biotypes. Thin biotypes were also related to larger canines, larger lateral and central incisors, and less KG and GA. Conversely, thick biotypes were associated with shorter teeth and with more KG and GA. Dietary intake and dental hygienic were not significantly associated with GB. Morphologic and phenotypic characterization of GBs can be relevant when planning and performing common dental procedures (e.g., prosthetics, implants, and orthodontics).

Assessment of gingival zenith position and its level relative to age and gender in maxillary anterior teeth.

OBJECTIVE: The gingival tissues surrounding the maxillary anterior teeth play a pivotal role in fostering a beautiful smile. The gingival zenith position (GZP) and its spatial orientation in the mesiodistal and apicocoronal direction can provide a valuable reference point. The present study was undertaken to evaluate the GZP and gingival zenith line (GZL) in maxillary anterior teeth in different age groups and genders. METHOD AND MATERIALS: The study population comprised 124 periodontally healthy patients equally divided into 21 to 40 years (Group I) and 41 to 60 years (Group II) age groups and gender distribution. The parameters of vertically bisected midline (VBM), GZP, and GZL were evaluated for all the teeth. RESULTS: The GZP was distally placed in 54.68% and 78.12% of the central incisors for males and females in Group I, while in Group II it was 65.62% and 75.00% respectively. The majority of lateral incisors and canines had coincidence of the GZP and VBM. The GZL was found to be at an apical position with reference to the GZP of lateral incisors. CONCLUSION: A distal deviation of GZP was observed for central incisors, while the GZP coincided with the VBM for lateral incisors and canines. The GZL was apically placed in relation to the GZP of lateral incisors. These elements can be taken up as reference points in periodontal and restorative procedures.

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.

Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix - 1-year randomised follow-up.

PURPOSE: A comparative, ultrasound evaluation of the thickness of keratinized mucosa (TKT) around implants one year after gingival augmentation (GA) by means of a connective tissue graft (CTG) and the xenogeneic collagen matrix (CMX). MATERIALS AND METHODS: A total of 75 bone level tapered implants (Conelog® Camlog) were inserted in 57 patients in the aesthetic area of both jaws. The patients were divided into 3 groups: control group I- without GA; group II- GA 3 months before implantation, and group III- GA 3 months after implantation. Groups II and III were divided into two subgroups depends on type of material used for GA: (a) CMX (Mucograft®, Geistlich Pharma AG) and (b) CTG. The patients underwent a clinical and ultrasound examination before, then after 3 and 12 months following GA respectively to evaluate TKT at two points using ultrasound equipment (Pirop®, Echoson). Point 1 was considered to be in the middle of the line connecting the cemento-enamel junction (CEJ) to the adjacent teeth, and point 2 on the mucogingival junction (MGJ). RESULTS: Three months after GA, the highest increase in gingival thickness was noted in group IIIb (point 1 - 0.95mm, 2 - 1.01mm). However, 12 months after GA the highest gingival thickness was observed in group IIb (point 1 - 1.76mm, 2 - 1.36m) and next IIIb (point 1 - 1.52mm, 2 - 1.15mm). CONCLUSIONS: Both CTG and Geistlich Mucograft® increased TKT, but higher values were noted using CTG augmentation before implantation. An ultrasonic device can be used as a non-invasive, reliable, and reproducible method for evaluating TKT.

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.

Assessment of gingival symmetry with digital measuring tools and its reproducibility.

OBJECTIVE: The aim of this study was to investigate the accuracy of digital measuring tools to measure the position of gingival zeniths and to assess its reproducibility between different examiners. MATERIALS AND METHODS: A total of 108 subjects were photographed at the Louisiana State University School of Dentistry. The settings, positioning of the digital camera, and subjects' Frankfurt levels were standardized. A photograph was taken of the six anterior maxillary teeth of each subject, and their corresponding free gingival margins. Digital caliper measurements were taken intraorally from the zenith to the incisal edge of the right maxillary central incisor. A reference line was drawn across the screen on each image at the level of the zenith of tooth 8. Three calibrated examiners then measured the distance from the reference line to the zeniths of the other five anterior maxillary teeth. RESULTS/CONCLUSIONS: There was no statistically significant difference between the examiners regarding any of the measurements. Central incisors were at the same level in 84.24% of the subjects, and lateral incisors were within 0.5 mm of central incisors in only 58% of the subjects. Canine zeniths were within 0.5 mm of each other in 43% of the subjects. Only 28% of the subjects presented with zeniths of tooth 6 to tooth 11 within 0.5 mm of each other. Lateral incisors were at or beneath the line drawn from central incisors to cuspids in 90.8% of the subjects. Standardized digital photography taken with the aid of a stadiometer and used to evaluate esthetic parameters allowed for reproducible measurements.

Clinical assessment of interdental papilla competency parameters in the esthetic zone.

BACKGROUND: Interdental papilla occupies the space between two adjacent teeth. Its contour and health are regarded with utmost importance in esthetic dental therapy. The loss of papillary height can result in open gingival embrasures, phonetic problems, food impaction, and esthetic concerns: therefore in order to prevent its loss and to better understand the challenges of regenerating the lost gingival papillae, it is crucial to recognize the factors that influence papilla form. AIM: The purpose of this study is to evaluate various factors associated with the fill of interdental spaces by gingival papillae MATERIAL AND METHODS: 150 interdental papillae in 30 patients were assessed with clinical and study models. Papilla score (PS), tooth form/shape, gingival thickness, crest bone height, facio lingual thickness and gingival angle were recorded. RESULTS: In the study it was observed that complete papilla fill was associated with bone crest-contact point distance ≤ 5 mm and crown width: length ≥0.88 while interproximal gingival tissue thickness and gingival angle were significantly higher in competent as compared to incompetent papilla group. CONCLUSION: Interdental papillae appearance was associated significantly with tooth form/shape (CW/CL), crestal bone height, gingival thickness and gingival angle. CLINICAL SIGNIFICANCE: Presence of appropriately positioned interdental papillae in the anterior dentition is essential. Its deficiency leads to complex esthetic and functional problems while its reconstruction poses a formidable challenge. Thus a prior understanding of the various factors that affect its integrity in the anterior region allows for better management of the papillae leading to a more predictable outcome.

A Semi-automatic Algorithm for Preliminary Assessment of Labial Gingiva and Alveolar Bone Thickness of Maxillary Anterior Teeth.

PURPOSE: Soft and hard tissue volumes are critical for implant placement and long-term stability. Although the literature has adequately addressed tissue biotypes of Western populations, pertinent information about Asian populations is limited. This study aimed to evaluate the soft and hard tissue profiles of the maxillary anterior teeth of the Taiwanese population using a semi-automatic algorithm. MATERIALS AND METHODS: Cone beam computed tomography images of 11 adults with well-aligned maxillary anterior teeth were overlaid with those of cast models, based on the tooth crowns manually outlined by two independent observers. Each tooth was digitally trisected mesiodistally and apicocoronally. The thicknesses of the labial gingiva and alveolar bone were measured using a customized software program. RESULTS: No obvious difference between the observers was noted regarding the dimension of tooth crowns. The average thicknesses of the labial gingiva, the labial alveolar bone, and the palatal alveolar bone were 1.76 ± 0.11 mm, 1.02 ± 0.12 mm, and 1.80 ± 0.31 mm, respectively, with no significant differences between teeth. All parameters were thicker in the apical region than in the cervical region, and the alveolar bone was thinner in the midlabial region of incisors than in the interproximal regions. The thinnest areas were the midcervical compartment of the right central incisor (0.53 ± 0.33 mm) for the labial gingiva, the midcervical compartment of the right lateral incisor (0.23 ± 0.10 mm) for the labial alveolar bone, and the mesiocervical compartment of the left central incisor (0.33 ± 0.09 mm) for the palatal alveolar bone. CONCLUSION: This study presents an objective and comprehensive methodology for evaluating the soft and hard tissue profiles of maxillary anterior teeth and may be of value for presurgical planning for immediate implant placement. The results suggest that profiles of the Taiwanese subjects are similar to profiles of Western populations.

Clinical assessment of the gingival contours and proximal contact areas in the maxillary anterior dentition.

Gingival display has been identified as a critical element in a beautiful smile and thus in facial esthetics. The present study aimed to assess the gingival line angle (GLA); the distance between the gingival zenith of maxillary lateral incisor and the gingival line (LID); and the ratio between the height of the proximal contact area (PCA) and crown length, referred to as the proximal contact area proportion (PCAP). Fifty patients, aged 21-30 years, were recruited for study. Maxillary impressions were made using irreversible hydrocolloid and poured in dental stone, and facebow records were used to mount the master casts in an articulator. Standardized photographs of maxillary casts were taken, and image-processing software was used to assess GLA, LID, PCA, and PCAP. Data analysis revealed a statistically significant difference between bilateral measurements of GLA (r = 0.93; P < 0.001). The mean PCA dimensions decreased from mesial to distal sites in the maxillary dentition bilaterally. A paired t test exhibited a significant correlation between the parameters GLA and PCA and showed that an increase in GLA led to an increase in PCA. The gingival zenith of the canine was apical to that of the incisors (GLA less than 90 degrees). The results of the present study may be utilized in conjunction with clinical goals and subjective parameters to help the restorative dentist obtain a more predictable esthetic outcome.

Assessment of gingival biotype and facial hard/soft tissue dimensions in the maxillary anterior teeth region using cone beam computed tomography.

OBJECTIVE: This study sought to assess the relationship between facial gingival and bone dimensions in maxillary anterior teeth region using cone beam computed tomography (CBCT). DESIGN: This study assessed 621 maxillary anterior teeth in 144 patients. In the sagittal plane, facial bone thickness (BT) and gingival thickness (GT) were measured at the crestal level and at 2, 4 and 6mm apical to the cementoenamel junction (CEJ). The dentogingival complex (DGC) dimensions and the distance from the CEJ to bone crest were also measured on CBCT scans. To determine the gingival biotype, GT at 2mm apical to the gingival margin was measured and GT <1.5mm was categorized as thin while GT ≥1.5mm was categorized as thick. The data were analyzed using SPSS version 21 via repeated measures ANOVA and the Cochrane's Q, chi-square and independent samples t-tests. RESULTS: The BT around the maxillary central and lateral incisors and canine teeth at 4 and 6mm apical to the CEJ was significantly different in thick and thin gingival biotypes (P<0.05). The mean GT at 2 and 4mm apical to the CEJ was significantly different around central and lateral incisors (P<0.05). Thickness of crestal bone was significantly different between the two gingival biotypes around central and lateral incisors (P<0.05). CONCLUSION: The two gingival biotypes had significantly different mean BT; different biotypes and their relationship to BT varied around anterior maxillary teeth.

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.

A Clinical and Radiographic Assessment of Positional Variations of Gingival Papilla and Its Proportions.

In 60 healthy subjects, 720 interdental papilla sites in maxillary anterior teeth were investigated. Interdental papilla heights were measured from the gingival zenith along the clinical crown lengths. Radiovisiography was used to measure the relative bone length. Percentage of papilla height to crown length and radiographic bone length to crown length were computed and defined as papilla proportion (PP) and crestal papilla proportion (cPP), respectively. The overall mean mesial PP was 44.95 ± 6.80% and distal PP was 45.70 ± 7.87%. The total mean mesial cPP was 54.12 ± 9.50% and distal cPP was 54.95 ± 9.28%. Taken together, the cPP was around 55% and the PP was around 45% for all tooth groups.

Electronic assessment of peri-implant mucosal esthetics around three implant-abutment configurations: a randomized clinical trial.

OBJECTIVES: To objectively assess the influence that three different implant-abutment interface designs had on peri-implant mucosal esthetics at 1 year post-implant placement via the pink esthetic score (PES). Additionally, to demonstrate the novel employment of a tablet-based digital imaging format to reliably assess and score clinical images as part of a multicenter clinical trial according to PES criteria. MATERIALS AND METHODS: Adult subjects (n = 141) with healed tooth-bound edentulous sites in the anterior maxilla as well as first premolar region were randomized to receive one of three different implant-abutment interface designs (conical interface = CI; flat-to-flat interface = FI; or platform switch interface = PS). Immediate provisionalization was performed with prefabricated titanium abutments, with definitive custom CAD/CAM zirconia abutments and all-ceramic cement-based crowns being delivered 12-week post-implant placement. Bilateral (anterior sites) or unilateral (premolar sites) digital clinical photographs were made at 1, 3, 6, and 12 months post-implant placement. Five calibrated faculty evaluators of different clinical backgrounds scored images during a 4-week timeframe on a standardized, tablet-based, digital imaging format. RESULTS: Six hundred and forty-nine clinical photographs were evaluated resulting in a total of 3245 sum PES values and 22,715 individual PES values. Faculty evaluator intra- and inter-rater reliability was found to be "strong" (ICC = 0.84) and "substantial" (ICC = 0.64), respectively, demonstrating repeatability of both the PES, evaluator calibration, and standardization of tablet-based scoring. All implant-abutment interface groups demonstrated significant improvements in mean sum PESs up to 1 year, with the largest improvement between restoration delivery and 6 months. No significant differences were found between groups in mean sum PESs both for individual study visits as well as for changes between study visits. CONCLUSIONS: No significant differences in mean sum PESs were found between subjects randomized to three different implant-abutment interfaces. However, significant differences were found as a function of time for all three groups, with the largest improvement in mean sum PESs occurring between definitive abutment and restoration delivery and 6 months. Use of electronic, tablet-based digital imaging scoring formats represents a novel and repeatable methodology for scoring PES images in large, multicenter clinical trials.

Assessment of Posterior Teeth Preparations for Metal-Ceramic Crowns.

OBJECTIVES: To evaluate teeth preparation designs for metal-ceramic crowns in private dental practice in Jordan. MATERIALS AND METHODS: One-hundred and seventy two dies were included. Different aspects of tooth preparations were quantified, analyzed and compared with the recommended guidelines. RESULTS: Almost 64% of preparations finish lines were positioned subgingivally. Shoulder finish lines were observed in 74.4% where-as 22.7% showed chamfer finish lines. Total occlusal convergence angles were 29.8 degrees in BL plane, 247 degrees in MD plane. CONCLUSIONS: Dental practitioners in private practice in Jordan did not fully adhere to the recommendedguidelines for tooth preparations for MCRs.

Wound Healing of the Laterally Positioned Flap: A Histomorphometric Assessment.

The aim of this study was to histomorphometrically assess the soft tissue anatomy in single gingival recessions (GR) treated with a laterally positioned flap (LPF). Five patients presenting maxillary first molars with GR to the apex of the buccal surface of the mesial-buccal root were invited to take part. The LPF-treated roots were removed en bloc (the root and the soft tissue covering the treated GR) 3 to 4 months postoperatively. Photomicrographs of Mallory trichrome stain sections were taken to allow reassessment of the specimens regarding the longitudinal dimensions of the crevicular/sulcular and junctional epithelia. The use of LPF resulted in new attachment with formation of crevicular epithelium, long junctional epithelium, and some connective tissue, re-establishing the normal anatomical characteristics of the soft tissues covering the previously exposed root.

Assessment of dynamic smile and gingival contour in young Chinese people.

OBJECTIVES: This study aimed to classify the dynamic smile and to quantify the gingival line (GL), as well as apico-coronal displacement of the gingival zenith (GZ), in the maxillary anterior dentition in a young Chinese population. METHODS: Two-hundred young Chinese subjects (100 men and 100 women; 20-35 years of age) with healthy dentogingival tissue were recruited. The dynamic smile process was captured using a digital camera. The smile type, GL type, the vertical distance of the GZ between the canine and the central incisor on the same side and the GZ of the lateral incisor-GL relationship were measured using a self-developed smile-analysis method. The kappa statistics was used to examine the reliability of the data recorded by the rater. The Pearson chi-square test was used to analyse the differences between subjects regarding the frequencies of smile type and GL type at α = 0.05. RESULTS: Data revealed that 45.5% of subjects had a high smile and 45.5% had an average smile; 58.2% of the subjects presented an upwards GL. The GZ of canine teeth was 0.33 mm apical to the corresponding central incisor and no significant difference between both sides of the GZ was observed. The GZ of the lateral incisor was located coronal to the GL in 87.9% of samples. The vertical distance between the GZ of the lateral incisor and the GL was 0.59 mm and no statistically significant difference was detected. CONCLUSIONS: The most common findings were a high or average smile type, combined with an upward GL. In the majority of subjects, the GZ of the lateral incisor is coronal to the GL. The apico-coronal displacement of the GZ showed bilateral symmetry.

Patient assessment: preparing for a predictable aesthetic outcome.

The flux of patients seeking to make changes to the appearance of their smile zone appears to be on a pathway of continual increase. This is possibly due to an increase in awareness towards oral health, and perhaps social, peer and media pressures, respectively. Cohorts of dental practitioners have thus responded to the latter demands by attending a plethora of educational courses, often focusing on either restorative techniques or other disciplines, notably orthodontics and clear aligners in particular. Consequently, treatment planning and thus treatment provision may carry the risk of being biased or indeed 'outcome driven' whereby the skills and knowledge of any clinician towards a particular faculty may significantly influence the ultimate treatment plan, with the unfortunate tendency sometimes to overlook the role of the interdisciplinary approach of concomitant restorative and contemporary techniques. The role of orthodontics to facilitate the provision of such treatment, along with predictable enamel bonding, has the distinct advantage of providing an acceptable aesthetic result with minimal biological intervention. However, to achieve an optimal result in such cases requires meticulous treatment planning and patient selection to avoid pitfalls with regards to long-term stability and function. This article suggests a standardized approach to patient assessment, with an interdisciplinary perspective in mind. Clinical Relevance: With the growth of patient demand for improving the appearance of the smile, a meticulous assessment protocol is required along with effective interdisciplinary communication. This enables a comprehensive treatment plan to be developed with the correct priorities.

Purpose of esthetic risk assessment in prosthetic rehabilitations with gingiva-shade ceramics.

Esthetic predictability and the possibility to reduce the need for more aggressive surgical interventions have been two strong reasons for the growing acceptance of gingiva shade ceramics in dental treatments. However this type of rehabilitation also has several esthetic constraints. The aim of this paper is to present an assessment system that may serve as a clinician's guideline to clearly identify the risk factors influencing the esthetic result of gum-shade ceramics and, in the end, to grade these clinical situations as high, medium or low esthetic risk. Over several years of clinical experience, the authors have identified different factors that influence the achievement of satisfactory esthetic results using gumshade ceramics: smile line, extension of the prosthetic rehabilitation, anatomical area, vertical and horizontal transition between the prosthesis and the natural gingiva, contact surface, framework material, and color. In conclusion, despite the great applicability of gingiva-shade ceramics in the resolution of clinical cases involving complex architecture of the hard and soft tissues, this procedure should not be considered one free of esthetic risk. There are different factors that should be evaluated when considering the esthetic results with gingiva-shade ceramics.

Assessment of palatal masticatory mucosa: a cross-sectional study.

AIM: To treat mucogingival problems palatal masticatory mucosa is used as a donor material. This study aimed to determine the thickness of donor palatal mucosa and associations of age and gender in Indian subjects aged 14 to 60 years by direct clinical technique. MATERIALS AND METHODS: Forty systemically and periodontally healthy Indian subjects (20 males; 20 females; age range of 14 to 60 years) enrolled in this study. Under local anesthesia bone sounding technique was performed at 15 defined and predetermined points. The Wilcoxon test was used to determine the difference in mucosal thickness between the age groups and between genders. Significance of the difference between individuals of different body mass index (BMI) was assessed by independent t-test. RESULTS: With mean thickness of 2.0 to 3.7 mm, the younger age group demonstrated significantly thinner donor mucosa (mean 2.8±0.3 mm) than the older age group (mean 3.1±0.3 mm). Within the same age group though statistically not significant; males had thicker mucosa than females. From the canine to second premolar areas and in the sites furthest from the gingival margin mucosa thickness increased. When correlated with subject's BMI, in all probed sites males demonstrated significantly a thicker mucosa than females. Within each group subjects with high BMI demonstrated thicker donor mucosa. CONCLUSION: Current study showed that in both adult and young individuals, premolar and canine areas can be the right site for harvesting donor tissue. Even in young subjects subepithelial connective tissue (CT) graft can be harvested in adequate volume. Donor tissue thickness can be influenced by factors like genetics and race, which need to be further evaluated. CLINICAL SIGNIFICANCE: Premolar and canine areas serve as appropriate choice to harvest palatal masticatory mucosa. Even in young patients the volume of donor tissue available is sufficient enough to consider the subepithelial CT graft procedure. Donor tissue thickness can be influenced by factors like genetics and race, which need to be further evaluated.