Gingival Phenotype Research Articles

Determining of the relationship between gum phenotype and anthropometric data of the face and gender

Relevance. Diagnosis of the condition of periodontal tissues at the stage of comprehensive treatment planning for a dental patient is an important step in the work of dentists. The presence of difficulties in diagnosing the phenotypic condition of the gums dictates the need to search for additional clinical diagnostic methods that allow determining the phenotype with minimal time and financial costs.Objective. To determine the relationship between anthropometric values of the face (width and height of the face) and gender with the gin-gival phenotype.Materials and methods. During the clinical examinations, an analysis was carried out of the anthropometric data of men and women obtained as a result of photometry, the results of a study of the gingival phenotype by transgingival probing using the De Rouck method and CBCT data (cone beam computed tomography) in patients with their further distribution into groups. A total of 45 people took part in the study, of which 12 were men and 33 were women.Results. Statistical processing of the obtained data showed that for men, the differences between the groups with different phenotypes (thick/ thin) are reliable for the parameter face width. For women with different gum phenotypes (thick and thin), reliable differences were obtained between the groups for the parameters face height and face width. The gum phenotype correlates with the face width (noticeable correlation for all, high for men and women separately); face height (moderate correlation for all, men and women); but does not correlate with the facial index and gender.Conclusion. Thus, the study showed that a combined diagnostic examination of the patient, taking into account gender, facial height and width in women, and facial width in men, can help in the correct assessment of the gingival phenotype.

The Effect of Corticotomy-Assisted Orthodontic Therapy (CAOT) or Periodontally Accelerated Osteogenic Orthodontics (PAOO) on Bone Remodeling and the Health of Periodontium: A Systematic Review of Systematic Reviews.

Background: Orthodontic treatment involves moving teeth within the alveolar ridge. Bone remodeling is associated with the activity of osteoblasts and osteoclasts. Procedures such as corticotomy-assisted orthodontic therapy (CAOT) or periodontally accelerated osteogenic orthodontics (PAOO) are intended to reduce bone density and negative stress on the grip side and therefore limit bone resorption during orthodontic movement or add bone substitute material so that the tooth does not cross the vestibular plate. Methods: The study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The study design was defined in the PICO format-Population (P): patients with full permanent dentition, both adolescents and adults; Intervention (I): orthodontic treatment with fixed appliances using additional supportive treatments such as CAOT or PAOO; Comparison (C): assessment of the impact of additional treatments during orthodontic treatment on the remodeling of the alveolar bone and the condition of the periodontium; Result (O): statistically significant/non-significant differences in the condition of the alveolar bone before and after orthodontic treatment. Search filters include the time of publication of the article, systematic reviews from the last five years, and publications that appeared in English. The information provided in the abstracts of systematic reviews that describe the effects of additional procedures during orthodontic treatment such as CAOT or PAOO on the health of periodontium was analyzed. Articles unrelated to the subject of the planned study and those in which tooth movement acceleration was analyzed were excluded. Results: Eight articles were selected in which a total number of 835 subjects took part. The changes in bone density and effects on periodontium were different after CAOT and PAOO. Conclusions: The validity of CAOT and PAOO procedures remains controversial. Better results are obtained when combined with tissue augmentation or thickening of the gingival phenotype rather than as stand-alone procedures, as their uses to protect periodontal tissues are limited.

TÉCNICAS CIRÚRGICAS PARA ESTÉTICA GENGIVAL E PERFIL EMERGENTE EM IMPLANTODONTIA

Introduction: Implant dentistry seeks to improve the similarity of implants with natural teeth, focusing on soft tissue quality, authentic gingival shape and adequate crown. The emergence profile plays a vital role in implant esthetics, guiding the soft tissues and preventing food accumulation. Direct and indirect techniques manipulate tissue to create the emergence profile using grafts and temporary abutments. Connective grafts and PRF are options to improve the gingival phenotype, with standard CTG and PRF promising to treat peri-implant diseases. Choosing the right techniques is crucial to restoring the patient’s anatomical profile. This study explores the main surgical techniques for gingival aesthetics and the emerging profile in implant dentistry. Objectives: To address the main surgical techniques for gingival aesthetics and the emerging profile in implant dentistry. Results: 27 articles were obtained, 2 (by duplicity), 20 (by abstract) and 1 (by not meeting the eligibility criteria) were excluded. Finally, 4 articles were included in this review. Discussion: the appropriate surgical technique promotes an adequate emergency aesthetic profile that reduces the time of the clinical procedure and obtains the best osseointegration associated with a peri-implant tissue, stable, healthy, with ideal and safe extensions. Thus achieving longevity in protection and gingival health. Conclusion: The choice of surgical technique depends on the individual characteristics of each patient, and the anatomical and aesthetic aspects of the patient must be considered in order to create an emerging profile that is aesthetically healthy and functionally healthy.

Digital photometric analysis as a non-invasive method to determine gingival phenotype: A comparative study

ObjectiveIdentification of periodontal phenotype is critical in clinical practice. Thick and thin tissues respond differently to inflammation, and trauma. It significantly influences the outcomes of restorative treatment, regenerative therapy, and success of implants and periodontal surgery. Periodontal phenotype can be assessed via invasive or non-invasive methods. This study aimed to establish the reliability of non-invasive methods in determining gingival phenotypes in comparison with validated methods. MethodsThis preapproved cross-sectional observational study was conducted at Batterjee Medical College in Saudi Arabia. The participants were conveniently sampled based on the inclusion criteria. The clinical study utilized Colorvue® biotype probes to evaluate gingival tissue phenotype in the region of interest, intraoral digital scanner (IOS) (iTero® scanner), and digital photography. Densitometric acquisition of photographs and intraoral scans was performed using Adobe Photoshop to quantify three-dimensional color measurements expressed in Delta E values (ΔE). Furthermore, patient-reported experience measures (PREMs) were used to evaluate anxiety and pain perception. Values of p < 0.05 were considered statistically significant. ResultsThe analysis of color difference values (ΔE) revealed significant variations in color perception across methods for the thin, medium and very thick groups, indicating perceptible color differences (p < 0.001). The assessment of anxiety levels indicated a statistically significant decrease in stress levels in favor of the IOS method for the medium phenotype. Furthermore, perceived pain was significantly lower with the IOS method than with the probing method for all phenotypes. ConclusionDensitometric analysis of standardized clinical photographs and intraoral scans of the marginal gingiva offers a promising, non-invasive, less stressful, and virtually non-painful method of periodontal phenotype evaluation with reliable numerical outputs. Furthermore, these data may be used to feed AI systems, where machines can learn to recognize color differences and possibly deduce phenotype assessments.

A Comparative Analysis on the Effects of Two Different Grafts on Gingival Phenotype, Dentin Hypersensitivity, and Quality of Life: A 6-month Split-mouth Study

A Comparative Analysis on the Effects of Two Different Grafts on Gingival Phenotype, Dentin Hypersensitivity, and Quality of Life: A 6-month Split-mouth Study

Influence of gingival phenotype on crestal bone loss at implants

PurposeThe aim of this long-term cohort study in periodontally compromised patients with implants was to analyze the correlation between gingival phenotype and peri-implant crestal bone loss, and between clinical measures and gingival phenotype.MethodsImplant-supported single crowns and bridges were used to rehabilitate 162 implants in 57 patients. Patients were examined over a 2 to 20-year period on a recall schedule of 3 to 6 months. In addition to recording clinical parameters, intraoral radiographs were taken at baseline (immediately after superstructure insertion) and at 1, 3, 5, 10, 15, and 20 years. Patients were differentiated into phenotype 1 with thin, scalloped gingiva and narrow attached gingiva (n = 19), phenotype 2 with thick, flat gingiva and wide attached gingiva (n = 23), or phenotyp 3 with thick, scalloped gingiva and narrow attached gingiva (n = 15).ResultsThe mean peri-implant crestal bone loss during the first 12 months was 1.3 ± 0.7 mm. Patients with gingival phenotype 1 had a significantly greater rate of increased crestal bone loss at implants (p = 0.016). No significant differences were present in subsequent years. The prevalence of mucositis at all implants was 27.2%, and the prevalence of peri-implantitis 9.3%. Univariate analyses indicated a significantly higher peri-implantitis risk in patients with gingival phenotype 2 (p-OR = 0.001; p-OR = 0.020). The implants of patients with phenotype 2 had significantly greater probing depths (1st year p < 0.001; 3rd year p = 0.016; 10th year p = 0.027; 15th year p < 0.001). Patients with gingival phenotype 3 showed no significantly increased probing depths, signs of inflammation and crestal bone loss.ConclusionsPatients with a gingival phenotype 1 have greater crestal bone loss at implants during the first year of functional loading. Patients with gingival phenotype 2 had significantly greater probing depth at implants and risk of peri-implantitis.

Comparison of different methods used in the classification of maxillary gingival phenotype: A diagnostic accuracy study.

This study aimed to evaluate the reliability and applicability of novel methods for determining gingival phenotypes and compare them with currently recommended methods. Six maxillary anterior teeth from 50 systemically and periodontally healthy patients were evaluated using two conventional methods (periodontal probe translucency method [PP] and transgingival measurement with an endodontic file [EF]), and two novel methods (colored biotype probe translucency method [CBP] and transgingival measurement with a Florida probe [FP]). All data were statistically analyzed. Intra-examiner reproducibility and inter-examiner reproducibility for all methods were analyzed using 10 randomly selected patients who were re-evaluated for each analysis. Moderate agreement was found between EF and PP, with statistically significant differences between median gingival thickness (GT) values for thick 0.8 mm (0.5-1.1 mm) and thin 1 mm (0.6-1.7 mm) phenotypes, and a threshold GT value of ≤0.92 mm (p < .001). FP and PP also showed moderate agreement, with statistically significant differences between median GT values for thick and thin phenotypes (0.80 mm [0.40-1.60 mm] and 0.89 mm [0.40-1.60 mm], respectively), and a threshold GT value of ≤0.8 mm (p < .001). PP and CBP values showed a substantial agreement (p < .001). A statistically significant difference was found between median EF values and CBP categories (p < .001); however, paired comparisons showed that the distinction was applicable only between thin and other phenotypes. Although CBP was found to be successful in detecting the thin phenotype, it was not successful in distinguishing between medium, thick, and very thick phenotypes; moreover, it did not appear to offer any advantages over PP. Although FP may be preferable to EF in measuring gingival thickness, the cost of FP is a disadvantage.

Gingival phenotype classification by visual and probe visibility assessments: Relationship with thickness and probe design.

This study investigated the agreement among dentists in classifying gingival phenotype (GP) through periodontal probe visibility (PPV) assessment with various probe types and the visual method. Additionally, the relationship between GP classifications and gingival thickness (GT) was evaluated. Photographs were taken with standard periodontal probe (SPP), color-coded periodontal probe (CCPP) tips in white, green, and blue, as well as metal phenotype probe (MPP) tips in gray and black. Evaluators (periodontist, periodontics resident, endodontics resident, dental student) assessed the photographs and classified the GPs. GT was measured by trans gingival probing. Visual method showed poor to fair agreement to classify GP. The lowest agreement regarding PPV was noted with white-tipped CCPP. The highest agreement in singular PPV was observed with CCPP blue (κ=0.932), followed by CCPP green (κ=0.791), MPP black (κ=0.783), SPP (κ=0.730), and MPP gray (κ=0.690). Combined PPV data revealed fair to moderate agreement with CCPP and moderate to substantial agreement with MPP in GP classification. The corresponding GT to different GP classifications based on combined PPV were comparable. The agreement between SPP and CCPP in classifying non-thin phenotypes was 89.8%, while the agreement between SPP and MPP was 75.4%. Based on PPV, no significant GT cutoff value was found to distinguish between thin and non-thin phenotypes. Determining a precise GT that guarantees the visibility of a given probe can be difficult when evaluating GP. Regardless of the type of probe, the PPV method has a high potential for misclassifying GP, despite having an acceptable agreement. Gingival phenotype (GP) is constituted by thickness of the gums and width of keratinized tissue around teeth. Direct visual evaluation or evaluating a periodontal probe's visibility beneath gums are established techniques to classify gingival phenotype. This study investigated how dentists classify GP using visual assessments and different types of periodontal probes, while also exploring the relationship between GP classifications and gingival thickness. Results showed varied agreement among dentists in classifying GP, with lower agreement observed when using certain types of probes, notably the white-tipped phenotype probe. The highest agreement was found with the blue phenotype probe. Data from periodontal probe visibility assessments indicated fair to moderate agreement with certain probes, suggesting some inconsistency in classification methods. Interestingly, GP classification with visual assessments or probes did not correlate with gingival thickness, which may highlight the importance of considering both factors in clinical practice. These findings underline the need for attention when relying solely on visual assessments or specific probe types for accurate GP classification.

Staged Regenerative-Phenotype Modification Therapy for Multiple RT3 Gingival Recessions in Periodontally Compromised Anterior Mandibular Teeth: A Case Report.

We report the successful treatment of multiple recession type (RT) 3 gingival recessions in periodontally compromised mandibular anterior teeth with limited keratinized tissue. A 35-yearold man with stage III, grade C periodontitis underwent a two-stage intervention. Initially, a modification of the connective tissue graft (m-CTG) wall technique was used as part of phenotype modification therapy. The CTG acted as a protective 'wall,' securing space for periodontal regeneration, enhancing root coverage, soft tissue thickness, and keratinized mucosal width. Recombinant human fibroblast growth factor-2 and carbonate apatite promoted periodontal regeneration. This procedure successfully facilitated periodontal regeneration, resulting in the transition from RT3 to RT2 gingival recession and adequate keratinized mucosal width. Eighteen months later, the second surgery used a tunneled coronally advanced flap (TCAF) for root coverage. TCAF involved combining a coronally advanced flap and tunnel technique by elevating the trapezoidal surgical papilla and using a de-epithelialized CTG inserted beneath the tunneled flap. Root conditioning with ethylenediaminetetraacetic acid and enamel matrix derivative gel application were performed. Consequently, mean CAL gain was 5.3 mm, mean root coverage was 4.5 mm in height, and the gingival phenotype improved at the treated sites by the 12-month follow-up. This staged approach addresses the challenges of treating RT3 gingival recession with promising outcomes.

Management of Miller’s Class-III multiple recession defects in mandibular anterior teeth using vista technique and PRF membrane: A case report

Gingival recession, characterized by the displacement of gingival tissue towards the root surface, poses challenges like compromised aesthetics and heightened vulnerability to dental issues such as root caries and sensitivity. Various surgical techniques have been developed to address these concerns, with recent advancements like the Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique showing promise, especially for multiple recession defects in the esthetic zone. VISTA reduces tissue trauma and promotes optimal healing by minimizing micromotion, thus enhancing the overall success of root coverage procedures. Integrating Platelet-rich fibrin (PRF) membranes aids in soft tissue healing and graft integration, offering a cost-effective and immune-friendly option to bolster procedure success.In a 31-year-old female patient with receding gums and mobile teeth, vestibuloplasty was performed after oral prophylaxis and stabilization of mobile teeth to address the inadequate vestibular depth and mucogingival deformity. Post-operative care included antibiotics and pain relief medications. Subsequently, a Miller’s Class-III multiple gingival defect (MRD) was corrected using the VISTA technique combined with Platelet-rich fibrin (PRF) membrane application. PRF was inserted into the tunnel to cover the denuded roots and to improve the gingival phenotype and the surgical site was sutured. One month later, successful healing was evident with increased vestibular depth, demonstrating effective treatment outcomes.

Assessment of gingival translucency at the mandibular incisors with two different probing systems. A cross sectional study

ObjectivesIncreasing evidence indicates that the thickness of periodontal soft tissues plays an important role in various clinical scenarios, thus pointing to the need of further clinical research in this area. Aim of the present study was to assess gingival thickness at the mandibular incisors by translucency judgement with two different probes and to validate if these methods are comparable and applicable as diagnostic tools.Materials and methodsA total of 200 participants were included; gingival tissue thickness was measured by judging probe translucency at both central mandibular incisors, mid-facially on the buccal aspect of each tooth using a standard periodontal probe and a set of color-coded probe, each with a different color at the tip, i.e. Colorvue Biotype Probe (CBP). Frequencies and relative frequencies were calculated for probe visibility. Agreement between the standard periodontal probe and the CBP was evaluated via the kappa statistic.ResultsWhen the periodontal probe was visible, the frequency of CBP being visible was very high. Kappa statistic for the agreement between the standard periodontal probe and the CBP was 0.198 (71.5% agreement; p-value < 0.001) for tooth 41 and 0.311 (74.0% agreement; p-value < 0.001) for tooth 31, indicating a positive association of the two methods.ConclusionsAn agreement that reached 74% was estimated between the standard periodontal probe and the color-coded probe at central mandibular incisors. Clinical relevanceIn the context of the present study, the two methods of evaluating gingival thickness seem to produce comparable measurements with a substantial agreement. However, in the 1/4 of the cases, the visibility of the color-coded probe could not assist in the categorization of the gingival phenotype.

Comparison of gingival thickness by CBCT versus transgingival probing and estimation of cut-off values for gingival phenotype – A cross-sectional study in adults

Aim: Gingival phenotype (GP) is regarded as valuable indicators for forecasting the probability of attaining favourable aesthetic and functional results with orthodontic treatment. This study aimed to investigate the accuracy and reproducibility of cone beam computed tomography (CBCT) for assessing gingival thickness (GT) in both the arches compared to transgingival probing method. The secondary objective was to determine the optimal cut-off values for GT using CBCT.Methods: This cross-sectional study was conducted where GP was determined based on the probe transparency method (TRAN). The GT measurements were obtained by both the methods at 2 mm from the free gingival margin (FGM) for all teeth anterior to the first molar. The data was statistically analysed using intraclass correlation coefficient (ICC), Bland‒Altman plots, and Receiver operating characteristic (ROC) curves. The statistical significance level was set at a p value<0.05.Results: The study included 60 subjects (1200 teeth). The mean GT in both the maxillary (1.14±0.17 mm) and mandibular (0.94±0.15 mm) arches was significantly greater (p<0.05) for the transgingival probing method than for the CBCT method. As shown in the Bland‒Altman plot, the bias between the two methods was greater in the maxillary jaw (0.060; 95% CI; 0.044 to 0.076) and in individuals with a thick GP (0.096; 95% CI; 0.082 to 0.109). The optimal values for GT measurements were 1.15 mm for the maxillary jaw, 1.02 mm for the mandibular jaw, 1.02 mm for males, and 1.09 mm for females.Conclusions: CBCT exhibited notable precision in diagnosing GT, while demonstrating minimal disparities compared to the conventional transgingival probing technique, particularly evident in thin GPs, and in the mandibular dental arch. The constraints associated with the utilization of CBCT were observed in the maxillary arch and in cases with thick GP.

Influence of crown-lengthening surgery on teeth rehabilitated with ceramic single crowns: A 12-month prospective clinical study

ObjectiveTo compare the clinical periodontal parameters of teeth restored with a single ceramic crown, with and without crown lengthening procedure. MethodsThis prospective, longitudinal, controlled, and single-blinded clinical trial involved 22 patients with a total of forty-one teeth with ceramic crowns. The teeth were divided into two groups: test (n = 21), comprising teeth rehabilitated post crown-lengthening surgery, and control (n = 20), comprising teeth rehabilitated without crown-lengthening surgery. Plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BoP), and clinical attachment level (CAL) were compared between groups (surgically treated and non-surgically treated) and within each group for each type of site (treated -tt; adjacent – ad; and nonadjacent - nad). Additionally, gingival phenotype (GP), gingival recession (GR), and keratinized tissue width (KTW) were also assessed post- restoration. Statistical analyses used a significance level set at 5 %. ResultsPI, GI, and BoP were reduced, but no statistically significant differences were observed within each group or between groups for most follow-up periods. CAL of the TT sites was consistently higher in the test group, and PD was also higher in the test group (p < 0.05), except at T3. adPD, nadPD, adCAL, and nadCAL demonstrated no significant differences between groups and periods. A significant association was identified between GP and the occurrence of GR, with the thick-flat phenotype demonstrating less association with GR, regardless of whether crown lengthening was performed or not. ConclusionCrown-lengthening surgery in rehabilitated teeth does not significantly affect PI and GI after 12 months. Although crown-lengthening surgery affected PD and CAL in TT sites, it did not affect adjacent and non-adjacent sites. Clinical relevanceThese findings emphasize the importance of considering individual patient factors and the potential impact on periodontal tissues when planning crown-lengthening surgery. Clinicians must have a comprehensive understanding of the dynamics of the periodontal tissues involved in restorative treatments to optimize the procedure, increase success rates, and minimize potential complications.

Comparison Between Autologous Albumin Gel and Liquid Platelet-Rich Fibrin Mixture Versus Connective Tissue Graft to Modify the Gingival Phenotype: A Randomized Controlled Trial.

Objectives To assess changes in gingival thickness (GTH) and the width of keratinized gingival tissue (KTW) following treatment with either connective tissue graft (CTG) or an albumin gel-platelet-rich fibrin mixture (Alb-PRF). Materials and methods Twenty treatment sites were included in a split-mouth design involving 10 patients with a thin gingival phenotype in the mandibular anterior region. The sample was randomly divided into two groups, with the Alb-PRF applied to the experimental group and CTG used for the control group. GTH and KTW were measured at baseline and after one, three, and six months. Results GTH increased in both groups during all follow-up periods. However, no statistically significant differences (p > 0.05) between the groups were observed at baseline and six months. At three months, the experimental group exhibited significantly higher GTH (p < 0.001). Additionally, at three and six months, the CTG group showed a superior increase in KTW (p < 0.05). Conclusion Within the constraints of this study, Alb-PRF application for modifying thin gingival phenotypes proved to be an effective therapeutic option, potentially serving as an alternative to CTGs. Although Alb-PRF resulted in thicker gingiva, CTG demonstrated a greater enhancement in KTW.

Cirurgia de Recobrimento Radicular com Enxerto Conjuntivo Subepitelial no Tratamento de Recessão Gengival: Relato de Caso Clínico

Gingival recession, a common periodontal condition, occurs when the gingival margin migrates apically to the cementoenamel junction (CEJ), exposing the root and potentially causing dental hypersensitivity, caries, and aesthetic dissatisfaction. Causes include bacterial biofilm, frenulum and frenum insertions, band of keratinized gingiva, gingival phenotype, alveolar morphology, tooth positioning, and mechanical trauma. It is classified into three types: RT1 (no CEJ exposure), RT2 (interproximal loss equal to or less than buccal loss), and RT3 (interproximal loss greater than buccal loss). Among root coverage techniques, the subepithelial connective tissue graft (SCTG) is highlighted for its predictability, color compatibility with adjacent gingival tissue, and good blood supply, reducing the likelihood of necrosis. This qualitative and descriptive study reported a clinical case of root coverage surgery with SCTG in a 60-year-old female patient with Miller class III and Cairo RT2 recessions on teeth 31 and 41. The palate was chosen as the donor site for the graft due to its adequate thickness. The SCTG technique combined with a laterally positioned flap and double papilla was used. The procedure resulted in reduced dentinal hypersensitivity and patient satisfaction with aesthetics, along with an increase in keratinized tissue, despite not achieving total root coverage. The success of the treatment was attributed to the precise indication of the case and professional skill.

Prevalence of the Gingival Phenotype in Adults and Associated Risk Factors: A Systematic Review of the Literature.

The relevance of assessing the gingival phenotype prior to the initiation of periodontal, orthodontic, or prosthetic therapy has been clearly demonstrated. However, publications on this subject are either old or concerned with the means of assessing the gingival phenotype or the main factors likely to modify it. The main objective of this systematic review of the literature was therefore to investigate the prevalence of different gingival phenotypes in adults in good general health and with a healthy periodontium. A systematic review of the literature was performed following the guidelines of PRISMA recommendations using an electronic search strategy on four databases (PubMed, Scopus, Cochrane Library, and Embase) complemented by a manual search. Three independent authors were involved in study selection, data extraction, and bias assessment. Results: Of 807 articles, 17 of them, published between 2012 and 2023, involving 3277 subjects from 11 countries and 9766 dental sites, fulfilled the inclusion criteria. The prevalence of the gingival phenotype could not be determined at the level of an individual or a dental arch because all the publications assessed this phenotype only at the level of certain dental sectors, and were not chosen at random. The maxillary central incisors and maxillary or mandibular first molar sectors were associated with a high and thick gingival phenotype, independently of the dental morphology, gender, and age of adult subjects. Furthermore, in these regions, this gingival phenotype tended to be associated with a thick vestibular bone table. In contrast, maxillary and mandibular incisors and premolars more often had a thin gingival phenotype. For other teeth, the results were less conclusive. It is important not to rely solely on the overall appearance of the dentition but to independently assess the thickness and height of the gingiva at each dental site requiring intervention. Finally, this study highlights a key point, namely the need for further longitudinal studies to determine the prevalence in healthy adults. For practicality and feasibility reasons, these studies should be designed according to therapeutic needs, dental sector by dental sector, and within homogeneous source populations. PROSPERO registration: CRD 42023392602.

Gingival proteomics reveals the role of TGF beta and YAP/TAZ signaling in Raine syndrome fibrosis

Raine syndrome (RNS) is a rare autosomal recessive osteosclerotic dysplasia. RNS is caused by loss-of-function disease-causative variants of the FAM20C gene that encodes a kinase that phosphorylates most of the secreted proteins found in the body fluids and extracellular matrix. The most common RNS clinical features are generalized osteosclerosis, facial dysmorphism, intracerebral calcifications and respiratory defects. In non-lethal RNS forms, oral traits include a well-studied hypoplastic amelogenesis imperfecta (AI) and a much less characterized gingival phenotype. We used immunomorphological, biochemical, and siRNA approaches to analyze gingival tissues and primary cultures of gingival fibroblasts of two unrelated, previously reported RNS patients. We showed that fibrosis, pathological gingival calcifications and increased expression of various profibrotic and pro-osteogenic proteins such as POSTN, SPARC and VIM were common findings. Proteomic analysis of differentially expressed proteins demonstrated that proteins involved in extracellular matrix (ECM) regulation and related to the TGFβ/SMAD signaling pathway were increased. Functional analyses confirmed the upregulation of TGFβ/SMAD signaling and subsequently uncovered the involvement of two closely related transcription cofactors important in fibrogenesis, Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ). Knocking down of FAM20C confirmed the TGFβ-YAP/TAZ interplay indicating that a profibrotic loop enabled gingival fibrosis in RNS patients. In summary, our in vivo and in vitro data provide a detailed description of the RNS gingival phenotype. They show that gingival fibrosis and calcifications are associated with, and most likely caused by excessed ECM production and disorganization. They furthermore uncover the contribution of increased TGFβ–YAP/TAZ signaling in the pathogenesis of the gingival fibrosis.

Micro-needling versus acellular dermal matrix in RT1 gingival recession coverage: A randomized clinical trial.

This randomized trial assessed for the first time the efficacy of coronally advanced flap (CAF) followed by micro-needling (MN) in contrast to CAF with acellular dermal matrix (ADM) on gingival thickness (GT, primary outcome), keratinized tissue width (KTW), clinical attachment level (CAL), probing depth (PD), recession depth (RD), recession width (RW), recession reduction (Rec-Red), complete root coverage (CRC) and percentage of root coverage (all secondary outcomes) in management of RT1 gingival recession in patients with thin gingival phenotype. A total of 24 patients (n = 24) with a thin gingival phenotype and single RT1 gingival recession in the aesthetic zone were randomly allocated to test- (CAF + MN; n = 12) or control group (CAF + ADM; n = 12). All clinical parameters were evaluated at baseline, 3 and 6 months. Both groups independently demonstrated significant gain in GT, RW, RD, CAL, PD, Rec-Red, CRC and percentage of root coverage, with reduced PI and BOP (p < .05) at 3 and 6 months, without intergroup differences (p > .05). At 6 months, KTW gain was significantly higher in CAF + MN (5.08 ± 0.9 mm) than in CAF + ADM-group (4.25 ± 1.06 mm; p < .05). Stepwise linear regression model with GT as dependent variable showed that base-line GT was the only statistically significant predictor for GT with a direct correlation between base-line GT and GT after 6 months. CAF followed by MN could represent a promising graft-less approach for increasing gingival thickness, comparable to CAF with ADM, with superior keratinized tissue width improvement, in the treatment of RT1 recession defects in patients with thin gingival phenotype.

Gingival Biotype: A Key to Successful Aesthetics–Its Role and Functions–Observation-Based Research

To achieve primary implant stability and enhance bone-to-implant contact, implant dentistry has seen significant advancements. The emphasis is now on developing an aesthetic restoration that blends in with natural teeth and is long-lasting. Patients now have higher expectations for improved aesthetics due to dental treatment advancements in implant and perioplastic surgery. Planning the best course of action for periodontal and implant therapy involves considering how predictable post-operative outcomes will be. Therefore, a thorough comprehension and examination of the surrounding tissues is required. The long-term success of aesthetic restorations is influenced by a number of variables, including gingival phenotype, gingival tissue architecture, and anterior tooth shape. Therefore, determining the gingival tissue biotype accurately is crucial to developing a suitable treatment strategy and obtaining a predictable aesthetic result. As a result, this study demonstrates how important gingival biotype is to the success of implants.

Passive Root Coverage Through Creeping Attachment of the Gingiva Before and After Scaling and Root Planning Therapy in the Mandibular Anterior Teeth: A Clinical Study.

Introduction Root coverage is one of the most imperative procedures in periodontal therapy. The demands from patients for aesthetics and sensitivity are some of the complaints in root exposure cases. Creeping attachment is a passive apical migration of the marginal gingiva and can be proposed as a noteworthy root coverage technique. The purpose of this study was to evaluate the position of the marginal gingiva and quantify the creeping attachment before and after the scaling and root planning (SRP) procedure. Materials and methods The present study was based on a single-centreclinical trial in which 30 sites from 10 patients were selected. Patients with Miller's class I gingival recession were selected. The plaque index, gingival biotype, and gingival margin position were measured at baseline and then at 10 and 21 days after SRP. The gingival biotype was measured with an endodontic file with a stopper and a digital vernier calliper. The gingival margin position was measured from the incisal surface of the tooth to the marginal gingiva with the help of a University of North Carolina (UNC) 15 periodontal probe. After recording the clinical parameters, a thorough SRP was performed using an ultrasonic scaler and manual instruments. Results The results were compared clinically at baseline and after 10 days and 21 days postoperatively. Statistical analysis was conducted for pre-SRP and post-SRP findings using the IBM SPSS Statistics for Windows, Version 19 (Released 2010; IBM Corp., Armonk, New York) software. A statistically significant improvement was seen in all the clinical parameters at baseline, at 10 days, andat 21 days postoperatively after the procedure (P < 0.01). Conclusion The position of the gingival margin was shifted towards the crown, and the creeping attachment was significantly observed from baseline to 10 and 21 days. Clinical significance Creeping attachment after the SRP procedure can be considered a significant root coverage technique. The genetic memory of the gingiva may playan important role in achieving root coverage. Once local irritants are removed, the gingiva attempts to regain its original position. In addition, the gingival phenotype plays an important role in gingival marginal positioning after basic therapy and root coverage procedures.