Gingival Width Research Articles

Effect of orthodontic tooth movement on keratinized gingival width

OBJECTIVE The relationship between the orthodontic tooth movement and the change of keratinized gingival width was analyzed by measuring the keratinized gingival width and position of the teeth before and after 28 orthodontic treatments. METHODS The photos were matched to the model and the width of the keratinized gingival was obtained by measuring the length of the crown, and the keratinized gingiva. The pre- and post-treatment models were overlapped on rapidform 2006 and the change of tooth position before and after orthodontic movement could be accurately measured, and the relationship between tooth intrusion and extrusion, retraction and forward movement, torque variation and keratinized gingival width was statistically investigated. RESULTS Analysis of the correlation between data before and after treatments for 213 teeth in 28 patients revealed a strong correlation between changes in tooth torque angle and changes in keratinized gingiva width (r=-0.47, P 0.05). Regression coefficient was negatively relative to the reference incisor between the teeth for the canines and premolars (canine regression coefficient=-0.35, premolar regression coefficient=-0.38, P<0.05). Therefore, the study found that there was a strong negative correlation between the changes in tooth torque angle and width of keratinized gingival (r=-0.41, P<0.001), that is, an increase in positive torque led to the reduction of width of keratinized gingiva, and on the contrary the increase of negative torque would cause the width of keratinized gingiva increase. There was no significant correlation between the intrusion and extrusion of the teeth for the width of keratinized gingiva. The sensitivity of different teeth for the width of keratinized gingiva differed, with incisor compared with canines and premolars that were more prone to keratinized gingiva width changes. CONCLUSION Tooth movement during orthodontics affected the width of the keratinized gingiva width, and the increase in positive torque was more likely to cause a reduction in the width of keratinized gingiva. There was no significant correlation between the intrusion and retraction of the teeth and the change in the width of keratinized gingiva. Incisors were more prone to changes in the width of keratinized gingiva relative to the cuspids and premolars during tooth movement. In the orthodontic process, it is possible to predict the effect of changes in the position of the teeth on the keratinized gingiva width, and attention shoud be to the changes in the keratinized gingiva width.

Modified tunnel technique applied in the treatment of gingival recessions with non-carious cervical lesion

This study aimed to investigate the clinical effect of modified tunnel technique (MTUN) in the treatment of gingival recession with non-carious cervical lesion (NCCL). Forty-two teeth with Miller I degree gingival recession were divided into the NCCL group or control group depending on whether NCCL was present. Both groups were treated with MTUN plus subepithelial connective tissue. The periodontal probing depth (PD), gingival recession height (GRH), gingival recession width (GRW), attached gingival width (AGW), and clinical attachment loss (CAL) were recorded before and at 3 and 6 months after operation. The mean root coverage (MRC) at 6 months after operation was calculated and analyzed. A root coverage esthetic scoring system was used to record aesthetic scores. GRH, GRW, and CAL of the two groups after surgery were significantly lower than those before surgery, and no significant changes in PD and AGW were observed. The MRC in the NCCL group was 63.40%±28.02%, whereas that in the control group was 67.00%±21.72%; no significant difference between the two groups was found. In terms of aesthetic outcomes, no significant difference between groups was reported. MTUN can effectively improve gingival recession, and the presence of shallow NCCL (≤1 mm) will not affect the surgical effect of MTUN.

Root coverage with coronally advanced flap:6-year follow-up.

The aim of this study was to evaluate the long-term stability of root coverage without a regular control programme after coronally advanced flap (CAF) procedures in isolated gingival recessions. Recession defects were treated with CAF using microsurgery technique. Probing depth, clinical attachment level, keratinized gingival width, plaque index, papilla bleeding index, recession depth, recession width and root surface area was evaluated at baseline, and then postoperative 6-month and 6-year follow-up sessions. Percentages of root coverage and complete root coverage rates were also calculated. In total, 12 defects in 12 patients of the 36 defects in 30 patients were available for analysis at the 6-year follow-up examination (66.7% of the initial sites could be reached). Percentage of mean root coverage was 95.06% at 6-month and 69.27% at 6-year and the difference was statistically significant (P<0.05). Complete root coverage rate decreased from 75% (at 6-month) to 50% (at 6-year), but the difference was not statistically significant (P>0.05). Within the limits of this long-term follow-up study, there seems to be a rather high risk for relapse after root coverage with CAF possibly due to the lack of regular recalls and persistent traumatic tooth brushing habits.

Biótipogengival e sua correlação com a espessura da tábua óssea vestibular

INTRODUÇÃO: A reabilitação implantossuportada em região anterior maxilar é um desafio do ponto de vista estético e sua previsibilidade leva em conta o biótipo gengival e a espessura da tábua óssea vestibular. OBJETIVO: O objetivo deste trabalho é verificar a correlação entre as espessuras da gengiva e do osso subjacente, para efeito de análise de risco na reabilitação com implantes osseointegráveis. METODOLOGIA: Foram analisadas tomografias computadorizadas de feixe cónico (TCFC) de 32 pacientes dentados adultos (10 masc./ 22 fem.). A espessura dos tecidos moles foi medida 2mm apical a partir da margem gengival das unidades dentárias anteriores e pré-molares, sendo associada às medidas da tábua óssea vestibular, a qual foi mensurada nos três terços radiculares no menor ponto de espessura. RESULTADO: A espessura gengival entre os biótipos fino (1,1mm) e espesso (1,6mm) mostrou-se distinta, ao contrário da encontrada entre os sexos feminino (1,3mm) e masculino (1,4mm). A espessura da tábua óssea vestibular cervical não apresentou diferença na comparação entre os biótipos (0,33 – região anterior/0,53 – região posterior). CONCLUSÃO: A espessura da tábua óssea cervical não sofreu influência do biótipo gengival e sexo. O biótipo gengival não mostrou correlação significativa na comparação com as espessuras da tábua óssea vestibular.

Two procedures for ridge preservation of molar extraction sites affected by severe bone defect due to advanced periodontitis

To evaluate and to compare dimensional alterations of hard and soft tissues in molar extraction sites with irregular deficiency of bone plates due to advanced periodontitis receiving two different procedures, namely the flapped and flapless techniques with Bio-Gide membrane covering the Bio-Oss material for ridge preservation. Twenty-three patients with 24 infected-molar extraction sites received ridge preservation procedure, the first consecutive 12 sites belonged to the flap group (a full thickness mucoperiosteal flap and primary soft tissue closure) and the following 12 sites belonged to the flapless group (minimal flap with a collagen sponge and a secondary soft tissue closure). Width of keratinized tissue was evaluated before tooth extraction and after 6-month healing. Parallel periapical radiographs were taken immediately and 6 months after extraction to evaluate vertical bone changes. The width of the ridge was measured in the center of the ridge at the time of tooth extraction and after 6 months at implant placement. After 6 months, width of keratinized tissue decreased (1.6±1.5) mm in the flap group (P=0.004) when compared with (0.3±1.6) mm in the flapless group (P>0.05). Both groups showed increases in ridge height from the central aspect, (5.53±4.20) mm for flap group and (7.70±4.35) mm for flapless group. These differences between the groups were not statistically significant (P=0.226). The ridge widths were (9.5±2.2) mm for flap group and (9.3±1.0) mm for flapless group at the time of implant insertion, and no statistical significance was observed between the flap and flapless groups. The study points out that both ridge preservation techniques were effective in increasing ridge height and minimizing ridge resorption after tooth extraction, and the ridge width allowed the placement of implants 6 months after ridge preservation. The flapless technique gave positive outcome in terms of the keratinized gingival width than that of the flap technique.

Residents' journal review

Residents' journal review

The treatment of gingival recession with coronally advanced flap with platelet-rich fibrin

Background: Of the various techniques developed for the treatment of gum recession, the current innovation in the use of platelet rich plasma (PRF) has been applied to the treatment of root-end closure procedures. Purpose: This study analyzed the effect of the coronally advanced flap (CAF) in combination with platelet-rich fibrin (PRF) during treatment of gingival recession. Methods: This research constituted an experimental study incorporating a split-mouth design which was conducted on eight participants (with 16 recession defects) who were divided into two groups consisting of the CAF group with PRF and another CAF group without PRF. Clinical parameters consisting of gingival recession (GR), keratinized gingival width (KGW), recession width (RW) and clinical attachment level (CAL) were measured both before and 21 days after surgery). Results: The average differences between clinical parameters in the test group were as follows: GR (2.25 ± 0.27), KGW (1.81 ± 0.75), RW (3.44 ± 1.35), and CAL (2.56 ± 0.50); while in the control group they were as follows: GR (2.00 ± 0.71), KGW (1.94 ± 0.78), RW (3.50 ± 1.91) and CAL (2.00 ± 0.76). There were significant differences in the GR and CAL between the test and control groups (p ≤ 0.05). Conclusion: A combination of the CAF procedure and PRF was proven to be more effective in covering the GR and increasing the CAL.

The effect of different gingival phenotypes on dimensional stability of free gingival graft: A comparative 6-month clinical study.

The aim of this study is to compare the effect of mesial and distal adjacent gingival phenotypes of the tooth or teeth region of free gingival graft (FGG) on the shrinkage ratio of graft at 6 months postoperatively. Thirty-one patients with inadequate keratinized gingival width (KGW) around mandibular incisors were included in this study. The phenotype of the mesial and distal terminal teeth was evaluated by the probe transparency method and keratinized gingival thickness measurements; study groups were divided as thick and thin phenotype. The plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and recession height (GRH), recession width (GRW) and KGW measurements were recorded at baseline and sixth month. Vertical dimension of graft (VDG), horizontal dimension of graft (HDG), recipient area horizontal width (RAHW), recipient area vertical depth (RAVD) were recorded during surgery. The shrinkage ratio was calculated with a Java-based analysis program. There was no significant difference in the clinical and surgical measurements between the groups. KGW mean values for both of adjacent teeth increased at 6th month compared to baseline but there was no difference between the groups at 6 months. GRH value has decreased significantly in thick phenotype group at the 6th month. The shrinkage ratio was found 23.14 ± 12.21% and 17.76 ± 11.05% in the thin and thick phenotype group, respectively. The difference between the groups was not statistically significant (p=0.210). The phenotype of the adjacent teeth has a similar impact on FGG shrinkage ratio at the sixth month. Thick phenotype of adjacent teeth seems to be more supportive for root coverage.

Effect of Gingival Retraction Method to Lateral Gingival Displacement Width

Objective: To analyze the efficacy of retraction cord with a hemostatic agent in comparison with retraction paste on lateral gingival displacement, to achieve the success of fixed dental prostheses (FDP). Material and Methods: Test samples included 32 teeth that required treatment with metal-porcelain FDP at RSKGM FKG Universitas Indonesia. Impressions were taken before the gingival retraction procedure. From the 32 samples, 16 teeth were retracted using a combination of retraction cord and hemostatic agent, whereas the other half were retracted with retraction paste. Impressions were then taken. The sample was made using cutting die. Lateral gingival displacement width was measured on die-cast using an optical microscope. Results: The mean value of group A before gingival retraction was 0.1695 mm, and after gingival retraction was 0.4705 mm. The mean value of group B before gingival retraction was 0.1767 mm, and after gingival retraction was 0.3289 mm. Lateral gingival displacement width between a combination of cord retraction and hemostatic agent group in comparison with the retraction paste group showed a significant difference (p<0.001). The combination of cord retraction and hemostatic agent group showed higher mean value. Conclusion: Gingival displacement width as a result of cord retraction with the hemostatic agent was larger compared to the retraction paste. Even though both of them are still considered to be effective in providing access for impression material.

Evaluation of gingival displacement using foam cord and retraction cord: An in vivo study

Aims and Objectives: Newer gingival displacement materials such as magic foam are available now and hence, there is a need to assess those materials with the commonly used gingival retraction cord. This study aimed to evaluate the gingival displacement width obtained using plain retraction cord and magic foam cord on an unprepared mandibular molar. Materials and Methods: Twelve patients in the age group of 20–30 years satisfying the inclusion criteria were selected. For each patient, pre- and post-displacement impressions were made using regular body addition silicone. The predisplacement impression served as the control. Gingival displacement procedures were performed in the buccal gingival sulcus of unprepared 1st mandibular molar. Both pre- and post-displacement impressions were sectioned and evaluated using a profile projector. The values were tabulated and analyzed using SPSS 16 software. Results: There was an increase of 62.4% in width of the gingival sulcus when displaced with cord and 61.6% increase using magic foam cord. The retraction cord provided 0.8% more gingival displacement when compared to the magic foam cord, which was not statistically significant. Conclusion: Weighing the pros and cons, it can be concluded that magic foam cord could be preferred over plain retraction cord as both methods provided almost the same amount of gingival retraction, and magic foam cord caused less trauma to the gingiva, was less time consuming, and easy to use.

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.

Comparison of Gingival Troughing by Laser and Retraction Cord

This study was aimed at comparing the most common two methods for gingival troughing: presaturated cord and lasers (including diode, Nd:YAG, and Er:YAG). A total of 108 anterior teeth (58 maxillary and 50 mandibular) in 50 patients were included in this study. Gingival treatment was carried out in the following four groups: presaturated cord, diode laser, Nd:YAG laser, and Er:YAG laser. The gingival width and gingival recession (GR) were measured at different times (at the time of treatment, after 1 week, and after 4 weeks). The presaturated cord resulted in significantly higher (P < .05) GR than lasers and narrower gingival sulci. Er:YAG laser resulted in the quickest and most uneventful wound healing when compared to diode and Nd:YAG lasers.

Assessment of Gingival Biotype and Keratinized Gingival Width of Maxillary Anterior Region in Individuals with Different Types of Malocclusion.

The aim of the present study is to evaluate the relationship of gingival thickness and width of keratinized gingiva with different malocclusion groups and amount of crowding. A total of 181 periodontally healthy subjects were enrolled in the present study. The study participants were divided into three malocclusion groups: Angle Class I, Angle Class II, and Angle Class III. Each group was divided into subgroups according to the amount of dental crowding, namely mild, moderate, and severe. The width of keratinized gingiva was calculated as the distance between mucogingival junction and free gingival margin, whereas gingival thickness was determined by a transgingival probing technique. Tooth numbers 13 and 23 were observed to have thin gingival biotype. The width of keratinized gingiva for tooth numbers 13 and 23 was narrower in the severe crowding group than in the moderate and mild crowding groups. The relationship of gingival thickness and width of keratinized gingiva with Angle classification was not found to be significant. Although it is thought that there is a relationship between gingival thickness, width of keratinized gingiva, and Angle classification with regard to malaligned teeth, this cross-sectional evaluation of 181 patients failed to show a significant relationship.

Evaluation of fracture resistance of premolars restored with packable composite resin using different types of adhesive systems

Purpose The aim of this study was to evaluate the fracture resistance of human extracted premolars restored with packable composite resin by using three types of adhesive systems: two-step etch-and-rinse system, two-step self-etch primer adhesive system, and one-step self-etch adhesive system. Materials and methods Fifty sound maxillary second premolars were selected. Forty specimens received class II mesio-occluso-distal cavities with a 2 ± 0.2 mm pulpal depth, 1.5 ± 0.2 mm gingival width, 2 ± 0.2 mm axial height, and parallel proximal walls with 3 ± 0.2 mm buccolingual width. All samples were divided into five groups (10 each): group I: positive control group (intact teeth), group II: negative control group (prepared unrestored), groups III, IV, and V: prepared and restored with Filtek Z350 XT packable composite resin by using three types of adhesive systems; Adper Single Bond, Clearfil liner Bond F, Single Bond Universal Adhesives respectively. After thermocycling, Specimens were subjected to compressive axial loading, and were tested individually in a universal testing machine. Peak loads at fracture were recorded. Statistical analysis was performed using SPSS, version 20.0. Results All groups were significantly higher than prepared but unrestored teeth with no significant difference was recorded between the three types of adhesives. Conclusion Restoring with packable composite using adhesive system had improved the fracture resistance of teeth subjected to class II mesio-occluso-distal preparations. Using the adhesive systems, insignificantly affect fracture resistance of premolars.

Correlation of Gingival Thickness with Gingival Width, Probing Depth and Papillary Fill in Mandibular Anterior Teeth

AIM - The aim of this study is to correlate the gingival width, probing depth and papillary fill in relation to mandibular anterior region. OBJECTIVE - To correlate the gingival thickness with gingival width, probing depth and papillary fill in mandibular anterior region. BACKGROUND - Gingival biotype is of utmost importance for esthetics and biological functions. Anatomical characteristic of periodontium such as gingival thickness, width of keratinized gingiva and alveolar bone morphology will determine the behaviour of periodontium when subjected to physical, chemical or bacterial insult. It helps in the assessment before treatment planning for therapeutic modalities such as orthodontic treatment, periodontal surgeries and implant surgeries. The different biotypes have diverse effects on clinical outcome of any therapeutic procedures. REASON - These parameters are required for treatment planning and can be used to predict the outcome of therapies.

Correlation between periodontal soft tissue and hard tissue surrounding incisors in skeletal Class III patients.

To investigate the association between the periodontal soft tissue, alveolar bone and dental parameters surrounding the incisors at baseline in patients with skeletal Class III malocclusion. The study sample comprised 154 teeth from 28 patients with skeletal Class III malocclusion (19 men and 9 women, 21.15 ± 4.02 years). Periodontal soft tissue examination and hard tissue measurements with cone-beam computed tomography (CBCT) were performed. Factor analysis was used to reduce the CBCT variables, and correlation analysis between the hard tissue factors and soft tissue parameters was performed. Differences in hard tissue parameters between thick and thin gingival types were evaluated. CBCT measurements were reduced to three hard tissue factors: lingual plate, coronal-buccal plate, and apical-buccal plate. Keratinized gingiva width and thickness were positively correlated with the coronal-buccal plate factor and negatively correlated with the apical-buccal plate factor. In the thin gingival biotype, mandibular incisors were more proclined, and the apical part of the buccal alveolar plate and the coronal part of lingual alveolar plate were thicker than in the thick gingival biotype. In the anterior teeth in cases of skeletal Class III malocclusion, hard tissue structures on the buccal side can be grouped based on coronal and apical factors that are significantly correlated with keratinized gingival width and thickness. Thick and thin gingival biotypes exhibited differences in tooth inclination and alveolar plate thickness with regard to the mandibular incisors.

Creation of a Zone of Immobile Connective Tissue with Acellular Dermal Matrix Allografts.

Acellular dermal matrix allografts (ADMs) have been hypothesized to create a zone of immobile connective tissue (ICT) extending apical to the mucogingival junction (MGJ). This 12-month prospective randomized trial investigated the presence of ICT after the use of two commercially available ADMs with coronally advanced flaps in the treatment of Miller Class I and II recession defects. This study demonstrated that the use of either type of ADM resulted in predictable root coverage and a zone of ICT extending apical to the MGJ by 1.88 to 2.69 mm. Hence, minimal keratinized gingival width should not preclude the use of ADMs.

Gingival biotype revisited-novel classification and assessment tool.

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. 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). Median GT was 0.43mm (P 25% 0.32; P 75% 0.58) for thin, 0.74mm (P 25% 0.58; P 75% 0.81) for moderate, and 0.83mm (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. 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. 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.

Soft tissue engineering with micronized-gingival connective tissues.

The free gingival graft (FGG) and connective tissue graft (CTG) are currently considered to be the gold standards for keratinized gingival tissue reconstruction and augmentation. However, these procedures have some disadvantages in harvesting large grafts, such as donor-site morbidity as well as insufficient gingival width and thickness at the recipient site post-treatment. To solve these problems, we focused on an alternative strategy using micronized tissue transplantation (micro-graft). In this study, we first investigated whether transplantation of micronized gingival connective tissues (MGCTs) promotes skin wound healing. MGCTs (≤100 µm) were obtained by mincing a small piece (8 mm3 ) of porcine keratinized gingiva using the RIGENERA system. The MGCTs were then transplanted to a full skin defect (5 mm in diameter) on the dorsal surface of immunodeficient mice after seeding to an atelocollagen matrix. Transplantations of atelocollagen matrixes with and without micronized dermis were employed as experimental controls. The results indicated that MGCTs markedly promote the vascularization and epithelialization of the defect area 14 days after transplantation compared to the experimental controls. After 21 days, complete wound closure with low contraction was obtained only in the MGCT grafts. Tracking analysis of transplanted MGCTs revealed that some mesenchymal cells derived from MGCTs can survive during healing and may function to assist in wound healing. We propose here that micro-grafting with MGCTs represents an alternative strategy for keratinized tissue reconstruction that is characterized by low morbidity and ready availability.

Gingival profiles in a select Asian cohort: A pilot study.

The aim of the present study was to determine the facial gingival profiles of teeth with a healthy periodontium in an Asian population. A total of 51 patients with a healthy periodontium were examined. Gingival thickness (GT) and gingival width (GW) were assessed at the maxillary and mandibular incisors to the first molars. GT was measured by transgingival probing (GT-TGP), and probe visibility through the marginal gingiva (GT-TRAN) was assessed. Results between groups (anterior and posterior, tooth types) were analyzed using one-way analysis of variance and t-test. The mean age was 30.3±11.4years, with 27 females and 24 males. The mean GT-TGP was 1.39±52mm, while the mean GW was 4.59±1.34mm. Considerable intra-individual and interindividual variation in GT (TGP and TRAN) was noted. GT increased from the anterior to posterior, and was thinnest at the mandibular centrals to the first premolars and maxillary canines. GT-TGP and GW were influenced by tooth type, plaque, recession, and TRAN, but not age, sex, or ethnicity. GW were recorded lowest at the mandibular canines and all premolars. Thin gingiva was recorded at 63.8%-92% (GT-TGP<1.5mm) and 75%-90% (GT-TRAN) of the anterior teeth. A high percentage of anterior teeth had thin marginal gingiva. There was poor agreement between GT-TGP and GT-TRAN.