Thickness Of Gingiva Research Articles

Volumetric changes in free gingival graft and gingival unit graft treatments evaluated using an indirect digital method

BackgroundThe aim of this study was to evaluate clinical one-dimensional changes such as root surface coverage, decrease seen in the amount of gingival recession and keratinised gingival width (KGW) obtained throughout a 6-month follow-up period following the treatment of Cairo class II gingival recession with free gingival graft (FGG) and gingival unit graft (GUG). Three-dimensional changes in gingival volume and thickness were also compared digitally using an indirect method. MethodsA total of 20 patients with localised Cairo class II gingival recession were randomly separated into two groups; 10 patients were treated with FGG and 10 patients treated with GUG. Preoperatively and at 6 months postoperatively, the initial position of the gingiva and KGW were recorded for all the patients and plaster models were formed from the obtained impressions with the traditional method. The plaster models were transferred to a digital environment by scanning with a model scanner. Using a software program, changes in gingival papillary height and gingival volume and thickness were compared between the groups and according to the baseline values from The Standard Tessellation Language (STL) files obtained. ResultsCompared to the baseline values, a significant increase was determined in the KGW, and a significant decrease in pocket depth, clinical attachment level, and gingiva recession depth in all the groups (p<0.05). No statistically significant difference was determined between the groups in respect of the changes in mean gingiva thickness, gingiva volume, and mean vertical papillary height (p>0.05). ConclusionThe study results showed that GUG treatment for Cairo class II localised gingival recession is an effective method in respect of increasing gingiva volume and thickness, increasing KGW, coverage of the root surface, and forming tissue contours that allow the patient to easily maintain oral hygiene. However, there was not seen to be any adventage of GUG and FGG over each other.

The Difference in the Morphometric Assessment of Gingival Biotype by Using Periodontal Probe Transparency Method and Photogrammetry

Objective: To evaluate the photogrammetric assessment of gingival biotype against the clinical gold standard method of probe transparency in terms of their consistency in assessment Study Design and Setting: Cross-sectional comparative; Periodontology Department, Institute of Dentistry, CMH Medical and Dental College, Lahore Methodology: The study targeted 149 adult subjects aged 18-30 years reporting to dental out patient department for routine dental treatment. A periodontal probe was inserted into the marginal gingiva of maxillary right central incisor and probe visibility through the gingival soft-tissues was judged. A probe visible through the tissues yielded thin gingiva and vice versa. For morphometric analysis, standardized clinical photographs were captured using digital DSLR camera. A photoshop software was used to measure crown width, crown height and papillary height for maxillary central incisor on all photographs. A crown width-to-height ratio &gt;0.75 and a papillary height &lt;4.5 mm indicated thick gingiva and vice versa. Data was analyzed via Statistical Package for Social Sciences version 24. Descriptive statistics were calculated. An inter-method reliability analysis using Cohen’s Kappa was performed to determine the consistency among the two methods in diagnosing gingival biotype. p=0.05 was taken as significant. Results: About 54.4% subjects were identified having a thin gingival biotype. A significant difference was observed between males and females as well as between age groups for gingival biotypes (p&lt;0.001). Using Cohen’s Kappa, a “perfect agreement” between probe transparency and photogrammetric methods was observed (ê = 1, p&lt;0.001) Conclusion: Photogrammetry offers a reliable and noninvasive method for evaluation of gingival thickness

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.

Cross-sectional analysis comparing prefabricated titanium to individualized hybrid zirconia abutments for cemented zirconia based fixed dental prostheses: a critical concept assessment.

Despite the differences in material properties and shapes among the different types of prefabricated titanium (pTiA) and individualized hybrid zirconia abutments (ihZiA), the biological and clinical relevance of materials and construction features remains vague. Yet, individualized ihZiA are increasingly implemented into daily routine aiming to satisfy rising expectations. The objective was to compare these two types of abutments in fixed dental prostheses (FDP). This cross-sectional study examined 462 implants in 102 patients comparing pTiA (52 patients) to ihZiA (50 patients) for FDP. These different treatment regimens were evaluated in terms of peri-implant health, radiographic bone loss, and oral-health related quality of life (OH-QoL) with special consideration of abutment type and superstructure design. ihZiA showed significantly different design features than prefabricated pTiA, but the annual bone loss in both groups did not. Visible titanium in the esthetic zone negatively impacted OHIP 14 scores. The combination of an emergence angle (EA) of < 30° and a concave emergence profile (EP) as well as gingiva thickness (p = 0.002) at the time of the prosthetic restoration significantly improved the annual peri-implant bone loss, independently of the abutment type. ihZiA showed comparable results to pTiA. To optimize the long-term outcome, not just material alone but generating adequate soft tissue thickness, minimizing the EA, and applying a concave EP seem to be the most relevant factors. To improve OH-QoL, particular attention must be paid to the esthetic zone.

Investigating Transducer–Tissue Interface Pressure for Soft Tissue Stress–Strain Behavior and the Effects on Echoic Intensities in Ultrasound Imaging of Periodontium

AbstractDiagnostic ultrasound (US) is a major imaging modality to visualize soft tissues and blood flow with the advantages of real‐time imaging, high acceptability to patients, and absence of ionizing radiation. US imaging provides important clinical measurements, e.g., thickness of gingiva for treatment planning in orthodontics, periodontics, and implantology; or thickness of subcutaneous adipose for optimizing insulin injection. However, the image quality and measurements of anatomical structures can be inconsistent, i.e., due to varying pressure exerted by an US transducer. Herein, a simple device is developed to real‐time measure the interface pressure applied on tissues by the US transducer. A thin‐film piezo‐resistive sensor with a small footprint is integrated to sense the pressure. A theoretical model, based on hyperelastic material behavior, is verified using the pressure measured by the thin film sensor and the thickness determined on ultrasonograms. The device is also tested on porcine samples in the pressure range of 50–300 kPa for imaging gingiva boundaries, identifying tissue thickness, and probing tissue biomenchanical properties. The device enables the understanding on the optimal range of applied pressure for higher contrast imaging. The information of the on‐tissue pressure and the tissue deformation determined on the US images help to derive the biomechanical stress–strain behavior of the tissues.

Integrated correlation analysis of the thickness of buccal bone and gingiva of maxillary incisors.

This study aimed to validate the integrated correlation between the buccal bone and gingival thickness of the anterior maxilla, and to gain insight into the reference plane selection when measuring these two tissues before treatment with implants. Cone beam computed tomography (CBCT) and model scans of 350 human subjects were registered in the coDiagnostiX software to obtain sagittal maxillary incisor sections. The buccal bone thickness was measured at the coronal (2, 4, and 6 mm apical to the cementoenamel junction [CEJ]) and apical (0, 2, and 4 mm coronal to the apex plane) regions. The buccal gingival thickness was measured at the supra-CEJ (0, 1mm coronal to the CEJ) and sub-CEJ regions (1, 2, 4, and 6 mm apical to the CEJ). Canonical correlation analysis was performed for intergroup correlation analysis and investigation of key parameters. The mean thicknesses of the buccal bone and gingiva at different levels were 0.64~1.88 mm and 0.66~1.37 mm, respectively. There was a strong intergroup canonical correlation between the thickness of the buccal bone and that of the gingiva (r=0.837). The thickness of the buccal bone and gingiva at 2 mm apical to the CEJ are the most important indices with the highest canonical correlation coefficient and loadings. The most and least prevalent subgroups were the thin bone and thick gingiva group (accounting for 47.6%) and the thick bone and thick gingiva group (accounting for 8.6%). Within the limitations of this retrospective study, the thickness of the buccal bone is significantly correlated with that of the buccal gingiva, and the 2 mm region apical to the CEJ is a vital plane for quantifying the thickness of these two tissues.

A novel approach for gingiva thickness measurements around lower anterior teeth by means of dental magnetic resonance imaging

ObjectiveThis diagnostic accuracy study aims to present the first measurements of gingiva thickness around lower anterior teeth using dental magnetic resonance imaging (MRI) and to compare these measurements with two established methods: (1) gingival phenotype assessment via periodontal probing, and (2) the superimposition of cone-beam computed tomography (CBCT) scans with intraoral scans of teeth and gums.Materials and methodsTen patients with substantial orthodontic treatment need and anterior mandibular crowding were consecutively included in this clinical case series. After periodontal probing, each patient underwent a CBCT scan, an intraoral scan of the mandible, and an MRI investigation using a novel mandibula 15-channel dental coil.ResultsThe mean gingiva thickness was 0.72 mm measured on MRI and 0.97 mm measured on CBCT, with a mean difference between the measurement methods of 0.17 ± 0.27 mm (p < 0.001). Measurement agreement between the index tests (MRI and CBCT) and the clinical reference standard (probing) yielded an overall percent agreement of 64.94% and 47.02% for MRI and CBCT, respectively. Teeth with thin phenotypes were associated with lower soft tissue dimensions in both free (MRI: 0.56 mm vs. CBCT: 0.79 mm) and supracrestal gingiva (MRI: 0.75 mm vs. CBCT: 1.03 mm) when compared to those with thick phenotypes. However, only the measurements obtained from MRI scans showed statistically significant differences between the two phenotypes.ConclusionDental MRI successfully visualizes delicate structures like the gingiva in the anterior mandible and achieves a high correlation with superimposed CBCT scans, with clinically acceptable deviations.Clinical relevanceThe present study helps to establish dental MRI as a radiation-free alternative to conventional radiographic methods.

Investigation of the Clinical Effects of Peri-Implant Gingival Morphology on Tissue Health.

This study aims to determine the gingival phenotype around dental implants and the clinical evaluation of the existing phenotype in relation to the tissue health around the implant. Included were 202 dental implants applied to 60 individuals who applied to our service and had at least 1 implant in the mouth, whose prosthetic restoration was completed at least 1 year ago. The effects of keratinized mucosa width (KMW) and gingival thickness (GT), which form the gingival phenotype, on clinical periodontal parameters were evaluated with the obtained data. Of the implants included in the study, 115 were found to have adequate KMW and 87 had insufficient KMW. At the same time, the GT around 74 implants was found to be thick, and the GT around 128 implants was found to be thin. The KMW of those with thin GT was lower than those with thick GT. Plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing depth (PD), gingival recession (GR), and suppuration (SuP) were found to be low in those with adequate KMW. GI, BoP, PD, GR, and SuP were low in patients with thick GT, but there was no significant difference between GT and PI. KMW and GT were associated with peri-implant tissue inflammation and GR. To maintain the health of the peri-implant tissues, it is recommended to have a KMW of at least 2 mm and a thick gingiva.

Evaluation of Gingival Phenotype in the Early Transitional Dentition Phase in Children-Comparison of Three Non-Invasive Methods.

Gingival phenotype (GP) is determined based on the thickness and width of the gingival tissue. An evaluation of GP is essential for adequate treatment planning and outcome monitoring, including orthodontic treatments in a paediatric population. The present study aimed to compare the reliability of the visual and TRAN methods with that of the ultrasound biometer measurements in the early transitional dentition phase. One hundred ninety three generally healthy, 7-year-old children were examined. An assessment of GP was performed by a paedodontist and a periodontist. The average thickness of the gingiva was 0.76 ± 0.36 mm, which was classified as a thin GP. The agreement between a visual assessment and the biometric ultrasound measurements reached the highest (94%) level when assessing a very thin GP (Spearman's rank correlation coefficient r = 0.37, p < 0.01). Similarly, 99% agreement in the diagnosis of a thin GP was recorded for the TRAN and ultrasound methods (Spearman's rank correlation coefficient r = 0.49, p < 0.001). In total, 86% of cases diagnosed as having a thick GP using the TRAN method turned out to be thin according to the ultrasound measurements. The dentist's specialization and professional experience in the assessment of GP were irrelevant (Spearman's rank correlation coefficient r = 0.49, p < 0.001). All methods tested in the present study were proven to be easy to perform and well accepted by the children. The visual assessment and TRAN methods, despite the fact that they enabled the diagnosis of a thin GP (crucial for treatment planning), cannot be recommended during the teeth replacement period. A misdiagnosis of thick GP may deprive a young at-risk patient of special supervision, which may develop into mucogingival deformities. A biometric ultrasound, although expensive, allows for reliable assessment of the gingiva thickness when needed.

The Effectiveness of the Influence of the Second Generation Platelet-rich Fibrin in the Treatment of Localized Individual Miller I and II Gingival Recessions (Case Report)

BACKGROUND: The mucogingival surgical modality subepithelial connective tissue graft (SCTG) and the coronally positioned flap (CAF) in the treatment of Miller I and II gingival recessions are considered “gold standard,” that is, a technique for predictable and complete gingival root coverage defects, with long-term clinical stability of the obtained results. The counterpart of this type of technique is the relatively young platelet-rich fibrin (PRF) +CAF operational mode, due to the biological characteristics of this autologous platelet concentrate-PRF (angiogenesis, mitogenesis, osteopromotion, immunomodulation, and the capture of stem cells). The aim of this paper is to evaluate the clinical efficacy of the CAF+PRF combined technique, in the treatment of localized individual gingival recessions Miller I and II, through the comparison of the values of periodontal clinical parameters, measured preoperatively and 1 month postoperatively, as well as through the obtained immunohistochemical and histomorphometric analyzes of the taken biopsy material from the recipient site (the area of the grafted gingival defect), 1 month postoperatively. CASE REPORT: A 37-year-old man was admitted to the Clinic for Oral Surgery at JZU USKC “St. Panteleimon”- Skopje for surgical treatment of localized maxillary gingival recession Miller II at tooth 31. Periodontal clinical parameters were measured preoperatively: Vertical dimension of gingival recession (RD/VGR), periodontal pocket depth (PPD/PD), level of keratinized/attached gingiva (CAL), width of keratinized gingiva (KTW/KMW) and thickness of gingiva (GT), all measured in mm, as well as gingival biotype. A CAF+PRF therapy modality was used for the treatment of the gingival defect. One month postoperatively, repeated measurements of the values of the clinical periodontal indices were performed and they were compared with the measurements obtained preoperatively. CONCLUSION: A significant decrease in the values of RD, PPD, and CAL was determined at the 1-month measurements postoperatively. A non-significant gain in KTW and GT values was noted 1 month post-operative. There were no changes in the gingival biotype before and after surgery. PRF as second-generation autologous concentrates is not only an adjuvant and/or replacement of SCTG – the “gold standard” in the treatment of Miller I and II recessions but it is also a superior alternative in the surgical treatment of this type of shallow mucogingival defects.

Effect of Microneedling and Injectable Platelet-Rich Fibrin on Gingival Phenotype – A Case Series

Introduction: Gingival phenotype is a crucial determinant of the periodontium. It not only maintains the health of the tissue but also plays a decisive role in the prediction of periodontal treatment outcomes. Thin gingival phenotype poses certain risks of poor periodontal treatment outcome in cases of implant, coronally advanced flap, and other root coverage procedures. Thus it becomes the duty of the clinician to deal with such cases by prior planning treatments which can improve the gingival phenotype and thereby enhancing the postperiodontal treatment outcomes to benefit patients. In this case series, a nonsurgical treatment modality microneedling (MN) and injectable platelet-rich fibrin (i-PRF) are employed in an attempt to increase the thickness of thin gingival phenotype. Methods: Five systemically healthy patients with thin gingival phenotypes were included in this study. The lower anterior teeth with split-mouth study pattern have been randomly allocated to nonsurgical treatment modality, i.e., MN alone and MN along with i-PRF. All the patients were followed up for 9 months. Outcomes Assessed: Gingival thickness (GT), Width of Keratinized Tissue (WKT), oral hygiene index, gingival index (GI), the patient reported outcome measures. Results: Both the groups showed an increase in the thickness of gingiva in 9-month follow-up. The mean increase of 0.62 mm in thickness was seen in Group 1 (42%), whereas Group 2 showed a 0.34 mm (27.3%) of increment. No difference is seen with respect to the change in the width of keratinized gingiva in both groups. Conclusion: MN along with i-PRF can provide an efficient nonsurgical option to clinicians to increase GT in cases of thin gingival phenotype.

Assessment of Gingival Phenotype in Type 2 Diabetic Patients in Sulaimani City

Objective: To determine the prevalence of gingival phenotype (GP) in type 2 diabetic patients in Sulaimani city and its relation with the severity of periodontal diseases.Methods: A sample of 150 individuals with type 2 diabetes were selected with an age range of 40-65. Probe transparency method involving a colorvue biotype periodontal probe was used to assess GP through the mid-labial gingival margin on the maxillary and mandibular central, lateral incisors, and canines. Clinical periodontal parameters including keratinized gingival width (KGW), probing pocket depth (PPD), plaque index (PI), bleeding index (BI), and clinical attachment loss (CAL) were recorded with a Williams periodontal probe. In addition, standardized HBA1C was assessed for each participant.Results: The majority of patients in this study had thin gingiva (42.7%), followed by medium, thick, and very thick gingiva (38%, 14.7%, and 4.7%, respectively). The association between gingival thickness and severity of periodontal disease (gingivitis, periodontitis stage 1, stage 2, stage 3, and stage 4) was non-significant. However, significant differences were detected between the mean of KGW and the severity of periodontal disease. Furthermore, there was no statistically significant association with gingival thickness according to sex. Conclusions: Thin gingiva was the most common gingival phenotype among type 2 diabetes patients in Sulaimani city, followed by medium gingiva, while thick and very thick gingiva were less common. Furthermore, there was no statistically significant association between gingival phenotype and the severity of the periodontal diseases.

Injectable Platelet-Rich Fibrin and Microneedling—A Non-Surgical Approach for Gingival Augmentation: A Randomized Controlled Clinical Trial

Aim: The present study aimed to assess the efficacy of combining microneedling (MN) and injectable platelet-rich fibrin (i-PRF) administration with i-PRF alone in augmenting the thickness of gingiva to manage thin periodontal phenotype. Methodology: The clinical trial involved 36 patients who were diagnosed with thin periodontal phenotype. They were randomized under two groups: MN + i-PRF versus i-PRF alone, carried out as a split-mouth trial. One quadrant was treated only with i-PRF delivery through the gingival sulcus, while the contralateral side was treated with MN and i-PRF in 3 sessions at 10-day intervals. The primary parameter measured was the thickness of the gingiva, at baseline and 3 months following therapy. Statistical analysis was performed using the Mann-Whitney U test. Wilcoxon’s signed ranking test for inter-group and intra-group analysis, respectively. Results: The study results showed a significantly greater increase in gingival thickness (GT) in sites where both MN and i-PRF injection was done, compared to i-PRF alone, with a p value of .04. Conclusion: Both treatment modalities showed improvement in GT, being a minimally invasive alternative for mucogingival surgery. Adjunctive MN was found to be more beneficial than i-PRF alone. However, further research should be carried out to address the drawbacks of the study and for a better understanding of this novel approach.

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

To investigate the diagnostic value of probe transparency related to gingival thickness (GT) and keratinized gingival width (KGW) at individual and site levels and explore the relationship of buccal bone plate thickness (BT) with GT and KGW. A total of 1,606 teeth from 167 patients with periodontally healthy maxillary anterior region were included. GT was measured with probe transparency and transgingival probing. KGW was measured directly. BTs were assessed at the level 1mm apical to the alveolar crest (BT1) and midpoint of the root (BT2) and evaluated at individual and tooth levels along with their mutual associations. The prevalence of thick gingiva was 53% with probe transparency measurement and 51% with transgingival probing. The cutoff gingival thickness was 0.8mm, which correlated moderately with a Cohen's kappa of 0.386. The mean GT, KGW, and BTs (BT1 and BT2) in the maxillary anterior region were 0.97 ± 0.46, 5.51 ± 1.62, 0.85 ± 0.31, and 0.79 ± 0.32mm, respectively. GT and KGW correlated mildly (r = 0.261), and GT and BTs correlated moderately (BT1: r = 0.298; BT2: r = 0.338). GT and BTs differed significantly between men and women and among different tooth sites. GT and BTs correlated positively in the maxillary anterior region and varied within and among individuals. Sex was a factor influencing the gingival phenotype and bone morphotype. GT measured with transgingival probing, with a cutoff of 0.8mm, could serve as an objective measure to distinguish different gingival phenotypes.

Effect of the Lateral Bone Augmentation Procedure in Correcting Peri-Implant Bone Dehiscence Defects: A 7-Years Retrospective Study

Guided bone regeneration (GBR) is a well-documented and widely-used dental surgical procedure for the treatment of various types of alveolar bone defects. The aim of the study was to evaluate the long-term effectiveness of the GBR procedure in correcting small peri-implant bone dehiscence using the xenogeneic deproteinized bovine bone mineral material and a xenogeneic native bilayer collagen membrane. The present study was designed as a retrospective study. Seventy-five bone-level tapered two-piece dental implants Conelog®, Camlog (Biotechnologies AG, Switzerland) were divided into two groups G1—no bone augmentation (no GBR)—44 implants and G2—bone augmentation (GBR)—31 implants. For both groups, the closed healing protocol with a primary wound closure was used. The incidence of peri-implantits was evaluated, the quantitative assessment of soft tissue thickness was performed using the ultrasound (USG) device, quantitative assessment of marginal bone loss (MBL) was done. The prevalence of peri-implantitis was 5.3%, with a three-fold increase in peri-implantitis comparing the groups without and with bone augmentation (G1 = 2.27%, G2 = 9.7%). The average keratinized gingiva thickness was 1.87 mm and did not differ significantly between groups. No statistically significant differences in MBL between G1 and G2 were found. When dividing patients by gender, no statistically significant differences were observed. When dividing patients by age groups, statistically significant differences were observed between the youngest and oldest groups of patients. Within the limitations of this study, it can be concluded that the use of xenogeneic bone and a xenogeneic collagen membrane in a GBR procedure can be recommended to correct small peri-implant bone dehiscence.

In vitro and in vivo evaluation of a modified porcine acellular dermal matrix for soft tissue augmentation.

To evaluate the effects of a modified porcine acellular dermal matrix (P-ADM), subepithelial connective tissue graft (SCTG) and other commercial bovine acellular dermal matrix membrane materials (B-ADM) on gingival soft tissue augmentation in the oral esthetic zone. The characteristics of P-ADM were observed by scanning electron microscope (SEM), Hematoxylin and eosin (H&E) and Masson's trichrome staining (Masson staining). The biocompatibility of P-ADM was verified by CCK8, phalloidin and living/dead cell staining. Beagle dog models were constructed and the thickness of gingiva was analyzed by the intraoral scanner. The morphology was observed by H&E and Masson staining. Scanning electron microscopy, H&E and Masson staining showed that the P-ADM was mainly composed of collagen fibers, with no component of nuclear. The results of CCK8, phalloidin and living/dead cell staining indicated that the P-ADM had good cytocompatibility and no cytotoxicity. Human gingival fibroblasts were able to adhere and stretch on the surface of the material with pseudopodia. The SCTG group outperformed the B-ADM and P-ADM groups in terms of effectiveness, according to the analysis of digital oral scanning data at various time points following incremental soft tissue surgery. Compared with the B-ADM group, the effect of soft tissue increment was better in the P-ADM group. P-ADM, as a biocompatible biomaterial, can be used as an alternative biomaterial for oral soft tissue thickening. However, the results of this study need to be verified by more clinical trials.

A Novel Application of Partially Epithelized-Subepithelial Connective Tissue Graft for Management of Complex Mucogingival Condition

Multiple adjacent gingival recessions in the mandibular anterior region are frequently associated with critical anatomic factors such as inadequate attached gingiva, high frenum insertion, or shallow vestibule. In addition, the loss of interdental soft and hard tissues make these mucogingival conditions more complex and challenging for the clinician. Multiple periodontal plastic surgical procedures are often required to treat such conditions which increase patient discomfort and surgical morbidity. The cases present for the first time a novel application of the bilaminar technique of reverse partially epithelized-subepithelial connective tissue graft (PESCTG) with bridge flap to treat severe multiple contiguous recessions and augment gingiva and vestibular depth in mandibular anterior teeth as a single-staged surgical approach. The technique achieved good esthetics and clinical outcomes in terms of recession coverage, increase in width and thickness of gingiva, and vestibular depth.

Dimensional Changes in the Alveolus after a Combination of Immediate Postextraction Implant and Connective Grafting and/or Socket Shield Technique.

Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar survival rates to late implant placement procedures. However, placing an implant immediately after dental extraction does not counteract the physiological remodeling of alveolar bone. For this reason, additional surgical techniques have been developed, such as the placement of a connective tissue graft (CTG) or the socket shield technique (SST). Dimensional changes in the peri-implant tissues were observed after placement of immediate implants following the extraction and CTG and/or SST. A total of 26 surgical interventions were carried out in which dimensional change variables of peri-implant tissues were analyzed. The preoperative state and immediate postoperative situation were compared with the situation after one year. Measurements were taken at 3, 5, and 7 mm from the gingival margin and analyzed in this CBCT radiological study (Planmeca Promax 3D). The implant platform was used as a reference point for the measurement of changes in alveolar crest height. One year after performing either of the two techniques (CTG and/or SST), a significant increase in the gingiva thickness and vestibular cortex occurred at 5 mm (0.65 ± 1.16 mm) and 7 mm (0.95 ± 1.45 mm) from the gingival margin. Additionally, an increase in thickness of palatal bone was registered at 3 mm (0.48 ± 0.90 mm). The graft placement group showed an increase in thickness of peri-implant tissue in the vestibular area after one year, although CTG and SST groups were clinically similar. The implementation of SST revealed promising results regarding the buccal thickness of hard and soft tissues after one year. A significant increase in vestibular cortical bone thickness, as well as the overall mucosa thickness and buccal bone at 3 mm from the gingival margin, was observed. A significant reduction in the distance from the bone crest to the platform was detected in both techniques. Both techniques (CTG and SST) are appropriate to provide sufficient volume to peri-implant tissues in the vestibular area of anterior maxillary implants. Some limitations were detected, such as the lack of an aesthetic analysis or small sample size, so results should be interpreted with caution. Future studies are necessary to further evaluate the long-term predictability of these techniques.

Gingival Biotype Variations with Gender in Indian Population Using Direct Visual Inspection, Probe Transparency and Transgingival Probing Technique: A Cross -Sectional Study

Background Gingival biotype is the thickness of gingiva in the labiopalatal or labiolingual aspect. It is directly related to periodontal health and disease. It also describes the prognosis and outcome of periodontal treatment. It differs from person to person and with gender. Hence one should have a better understanding of the gingival biotype in the population.Aim The aim of the study was to assess the variations in gingival biotype with gender in Indian population males and females.Methodology A total of 200 subjects 100 males and 100 females were included in the study. Subjects with healthy gingiva were considered. Gingival biotype was measured in the esthetic region ndash anteriors. The methods used for the measurement of gingival biotype were direct visual inspection probe transparency and transgingival probing methods.Results It was observed that males showed thicker gingival biotype whereas females showed thinner type. Statistical significance was established with p lt0.05.Conclusion A definitive clear thick gingival biotype was observed in males as compared to females who presented thin gingiva.

The Effect of Initial Biologic Width on Marginal Bone Loss: A Retrospective Study.

To evaluate the short-term effect of dental implant placement, mucosa thickness, and their combined effects (initial biologic width) on marginal bone loss. This was a retrospective study on patients who received implant surgery in the posterior region without bone augmentation surgery between 2012 and 2016, and implants had been loaded for more than 12 months. Each patient received radiographic examination before and after implant surgery, before the stage-two surgery, and during the 1- to 5-year follow-up. The thickness of mucosa, depth of dental implant placement, and crestal bone loss were evaluated on digital radiographs. The interaction was discussed by defining the combination of initial mucosal thickness and implantation depth as the initial biologic width. The implants were divided into four study groups based on the quartile of the initial biologic width. This study included 266 patients (94 male and 172 female, 22 to 85 years of age, mean age: 51.43 years), with 413 dental implants placed including 239 Straumann implants and 174 Ankylos implants. The average follow-up was 21.50 months. After 1 to 5 years, the median crestal bone loss around implants was 0.35 mm (0.30 mm for Straumann BL and 0.40 mm for Ankylos). The implants were divided into four groups: group A (≤ 2.85 mm), group B (2.85 to 3.40 mm), group C (3.40 to 3.97 mm), and group D (> 3.97 mm). Group B showed significantly less crestal bone loss than group A (0.38 mm vs 0.25 mm; P < .05) and group C (0.25 mm vs 0.40 mm; P < .05) during the follow-up. Significantly more crestal bone loss around implants was observed in the thin mucosa group than in the thick mucosa group (0.50 mm vs 0.30 mm; P < .001), while implants placed beneath the bone level displayed a significantly higher amount of marginal bone loss than implants placed even with the bone crest (0.50 mm vs 0.10 mm; P < .001). The initial biologic width has an effect on crestal bone loss. When the initial biologic width was between 2.85 and 3.40 mm, the marginal bone loss was lowest. Based on radiographic evaluation, implants placed in thick gingiva and even with the bone level showed less alveolar marginal bone loss compared with implants placed in thin gingiva and below the crestal bone level.