Redefining the Biologic Width in Severe, Generalized, Chronic Periodontitis: Implications for Therapy

Abstract

Previous studies demonstrated significant variability in the histologic biologic width in periodontal health and mild periodontitis. The purpose of this study was to determine whether the previously established dimensions of the biologic width applied to subjects with severe, generalized, chronic periodontitis. Twenty-eight subjects, aged 29 to 45 years, with severe, generalized, chronic periodontitis were included in the study. There were 18 males and 10 females, and 19 (68%) of the patients were smokers. Clinical and radiographic measures were taken by calibrated examiners. The clinical biologic width was determined from the most coronal level of clinical attachment to the crest of the alveolar bone for proximal surfaces only and compared to the histologic biologic width previously reported. The clinical biologic width in subjects with severe, generalized periodontitis was significantly greater than previously reported (P <0.001). For all evaluable proximal sites, the mean clinical biologic width was 3.95 mm versus the mean histologic biologic width of 2.04 mm. The greatest clinical biologic widths were seen with pockets <2 mm (5.02 +/- 2.48 mm; range: 1.60 to 9.00 mm) and 2 to 4 mm (4.16 +/- 1.32 mm; range: 0.20 to 6.40 mm). The mean clinical biologic width in subjects with severe, generalized, chronic periodontitis seemed to be significantly greater than the histologic biologic width previously reported for subjects not demonstrating significant periodontal pathology. In addition, sites with shallow probing depths demonstrated the greatest biologic width, suggesting that these sites may be at increased risk for losing clinically significant attachment during surgical procedures.