Thin Biotype Research Articles

Prevalence of different gingival biotypes in individuals with varying forms of maxillary central incisors: A survey

Gingival Perspective: The gingival perspective in restorative dentistry is important in harmonizing esthetics and biological function. In this regard, the gingival biotypes have been stated to be thick or thin. Patients with thin biotype are more prone to recession, inflammation, and compromised soft tissue response. The correct recognition of gingival biotypes is important for the treatment of planning process in restorative and implant dentistry. The purpose of the survey was to evaluate the prevalence of different biotypes in individuals with varying forms of maxillary central incisors. Materials and Methods: A total of 200 subjects visiting the outpatient department in the range of 18-50 years participated in the study. Three clinical parameters were recorded by one examiner. This included the crown width/length ratio of the two central incisors, papillary height and gingival thickness. The measurements were tabulated and evaluated. Results and Conclusion: The thicker biotype was observed to be more prevalent in male population with short, wider forms of maxillary central incisors while the females had thinner biotypes and narrow, long form of maxillary central incisors. Among the different age groups, young group had a thicker biotype (73) compared to older group (40). The mean papillary height was in the range of 4.3-4.7 mm with decreased height in the thicker biotypes.

Gingival biotype: The probe test utility

Purpose: To evaluate the relevance of the probe test in classifying the gingival biotype and to determine if differences exist between maxillary and mandibular gingival biotypes in the same patient. Materials and Methods: 53 subjects were included. The gingival thickness was evaluated as thick or thin. This evaluation was based on the transparency of the periodontal probe through the gingival margin while probing the sulcus. In another hand, 124 clinicians were asked to identify the gingival biotype in the same 53 subjects based on visual inspection on pictures. For each examiner, the accuracy in identifying the gingival biotype was assessed using the percentage of cases correctly identified. Results: the percentile of agreement is greater than 70% in maxilla as well as in mandible. An imbalance was observed on the maxillary pictures concerning the gingival biotype and on the thin biotype between maxilla and mandible despite there being no statistical difference (p probe results demonstrates a weak percentile of agreement of gingival biotypes between maxillary and mandibular anterior teeth (57%). Conclusion: The use of probe transparency through the gingival margin is an accurate and simple method for gingival biotype diagnosis to discriminate a thin gingival from a thick gingival. Furthermore, individualizing the gingival biotype for each of the arches appears to be a new outcome that needs further investigation.

Dentin hypersensitivity: pain mechanisms and aetiology of exposed cervical dentin

ObjectivesThe paper’s aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology.Materials and methodsLiterature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease).ResultsThe many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion.ConclusionsThe current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility.Clinical relevanceWhilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients’ pain and expectations and prevent further dentin exposure with subsequent sensitivity.

Bovine pericardium based non-cross linked collagen matrix for successful root coverage, a clinical study in human.

IntroductionThe aim of this study was to clinically assess the capacity of a novel bovine pericardium based, non-cross linked collagen matrix in root coverage.Methods62 gingival recessions of Miller class I or II were treated. The matrix was adapted underneath a coronal repositioned split thickness flap. Clinical values were assessed at baseline and after six months.ResultsThe mean recession in each patient was 2.2 mm at baseline. 6 Months after surgery 86.7% of the exposed root surfaces were covered. On average 0,3 mm of recession remained. The clinical attachment level changed from 3.5 ± 1.3 mm to 1,8 ( ± 0,7) mm during the observational time period. No statistically significant difference was found in the difference of probing depth. An increase in the width of gingiva was significant. With a baseline value of 1.5 ± 0.9 mm an improvement of 2.4 ± 0.8 mm after six month could be observed. 40 out of 62 recessions were considered a thin biotype at baseline. After 6 months all 62 sites were assessed thick.ConclusionsThe results demonstrate the capacity of the bovine pericardium based non-cross linked collagen matrix for successful root coverage. This material was able to enhance gingival thickness and the width of keratinized gingiva. The percentage of root coverage achieved thereby is comparable to existing techniques. This method might contribute to an increase of patient's comfort and an enhanced aesthetical outcome.

Nuova tecnica per il trattamento dei siti di impianti postestrattivi immediati in zone estetiche. Caso clinico

Objectives The aim of this report is to present preliminary results of a new surgical approach in immediate implant flap-less post-extraction sites in aesthetic zones. Materials and methods A hopeless root was extracted and an immediate implant NobelActive™ (Nobel Biocare, Kloten, Switzerland) placement and loading in 14 position in one case of gingival thin biotype. The socket was object of sinus lift elevation and the gap between facial bone and implant surface was filled with Bio-Oss ® (Geistlich Biomaterials, Wolhusen, Switzerland). Biomaterial, besides, was located onto the implant shoulder of the platform-switched filling the distance between neck of the abutment and the internal surface of buccal-mesial-distal soft tissue of gingival margin, connective tissue and adjacent portion of juntional epithelium. An immediate temporary crown was located and bone and level tissue were registered. Results A slightly increased papillary level was noticed from baseline to delivery of definitive crown with a 1,5 mm mesial, 2 mm distal growth and no recession of gingival margins that preserved his initial measure of 10 mm. Distance between the implant platform end most apical mesial and distal bone edge was recorded, and revealed no sign of bone loss with a measure of 4.01 mm and 2.09 mm for either mesial and distal crest to 11 months of normal chewing activity. Conclusions In this case report the use of biomaterial, located above the implant platform to support crestal bone and gingival margins in a gingival biotype, was able to prevent bone-tissue recessions.

Factors affecting soft tissue level around anterior maxillary single‐tooth implants

Peri-implant soft tissue recession is a major esthetic concern for the anterior implants. The aim of this study was to determine the factors that affected the facial marginal mucosal level and papilla level around single-tooth implants in the anterior maxilla. Forty single-tooth implants in the anterior maxilla were studied. Variables possibly associated with the soft tissue level were obtained from clinical measurements, study models, peri-apical radiographs, and computerized tomograms. Fisher's exact test, analysis of variance, and binary logistic regression analysis were used to determine the influence of each factor on the facial marginal mucosal level and papilla level. The majority of the implants (75%) replaced the upper central incisors. The facial mucosal margin of the implant was 0.5+/-0.9 mm more apical than that of the contralateral tooth. Half or more of papilla fill was observed in 89% of the samples. More apical level of the facial mucosal margin at the implant sites was significantly influenced by many factors including a thin peri-implant biotype, a proclined implant fixture angle, more apical level of the facial bone crest, increased distance from the contact point to the bone crest, contact point to the platform, and contact point to implant bone. A thin biotype was the most significant factor in determining the facial marginal mucosal level. Increased distance from the contact point to the bone crest was the only factor significantly associated with less papilla fill. The papilla level around single-tooth implants in the anterior maxilla was mainly influenced by the interproximal bone crest level of the adjacent tooth. Facial marginal mucosal level, on the other hand, was affected by multiple factors including the peri-implant biotype, the facial bone crest level, the implant fixture angle, the interproximal bone crest level, the depth of implant platform, and the level of first bone to implant contact.

Clinical investigation of mucosal thickness stability after soft tissue grafting around implants: A 3-year retrospective study

To assess the long-term stability of gingival grafts placed around dental implants at the time of second surgery uncovering and to further investigate the association between mucosal thickness (MTh) by demographic variables and clinical investigation. Fourteen patients with submerged dental implants covered by inadequate keratinized mucosa were studied. The subjects underwent a periimplant plastic surgery (PPS) at the second-stage dental implant surgery and free gingival autograft orsubepithelial connective tissue graft were used according to the patients' clinical situation. Clinical measurement of MTh was assessed by bone sounding with a periodontal probe using customized acrylic stents andthe values were recorded at baseline (day of graft) and at 0.5, 1.5, 4, 12, 24 and 36 months after grafting. At 12 months postoperatively, the mean MTh was 2.89 mm, with a mean additional increase of 1.75 mm when compared with baseline (P=0.0001). No statistically significant differences in MTh were found between the 12- and the 36-month observations (P=0.09). In addition, at 36 months, a thin mucosa was associated with a greater increase in the MTh compared with a thick mucosa (2.14 and 0.64 mm, respectively, P=0.006). Similarly, the mandibular sites were associated with a greater increase in the MTh in comparison with the maxillary sites (2.17 and 0.81 mm, respectively; P=0.02). Within the limitations of this investigation, the data suggest that PPS at the second-stage dental implant surgery could results in additional increases in MTh, especially when it is performed in areas where the mucosa is of a thin biotype.

M643: Esthetic Soft Tissue Management “A to Z”

Synopsis: As surgeons, our ability to predictably produce soft tissue quality and quantity at implant sites is critical for a successful outcome. We will discuss assessment and management of a continuum of treatment challenges from inadequate attached tissue, thin biotype and immediate implant sites through more complex defects using:

Periodontal Biotype Influence on the Volume Maintenance of Onlay Grafts

Autogenous osseous transplants have advantages, including the maintenance of bone density and high concentrations of growth factors. Little is known about the potential long-term influence of periodontal biotype on the volume maintenance of block grafts. Forty patients who received autogenous block transplants prior to implant placement were included in the study. Digital photographs and periapical radiographs were taken after restoration. Clinical parameters, including bleeding on probing, mobility, suppuration, mucosal recession, and buccal tissue transparency, were recorded at yearly intervals. A computerized tomography (CT) scan was taken at an average of 42 months (n = 20) postaugmentation. The clinical examination revealed no implant transparency, mucosal recession, mobility, bleeding on probing, or suppuration (n = 40) at 48 months. CT scans showed varying thicknesses (0.5 to 4 mm) of buccal cortical bone around the implants. The increased width at the recipient site postgraft was 7.6 mm, maintaining, on average, 98% of the augmented width. The buccal osseous thickness at the implant sites averaged 2.0 +/- 0.8 mm compared to 0.7 +/- 0.5 mm for the adjacent teeth (95% confidence interval: 0.85 to 1.65 mm; P <0.0001). Even when adjacent teeth had a thin biotype, the transplanted sites maintained statistically significant thicker buccal cortical plate at all sites (P <0.0001). Grafted site phenotype did not seem to be influenced by the adjacent teeth biotype. Autogenous osseous transplants can predictably reconstruct function and esthetics and seemed to maintain stable bone volume around implants at an average of 3.5 years.

Immediate Loading: Three Cases with up to 38 Months of Clinical Follow-up

Since the first report describing the placement of dental implants into fresh extraction sockets, there has been an increasing interest in this technique. The advantages of immediate implant placement have been reported to include a reduction in the number of surgical interventions, potentially decreased alveolar bone resorption after tooth loss, and shorter treatment time. Appropriate indications, good surgical technique, and the use of a prosthetic protocol have resulted in success for immediate loading and immediate implantation. Adverse patient-related factors, such as systemic health, a smoking habit, poor oral hygiene, presence of a thin biotype, or an infection in the region of the extraction, are contraindications for this treatment. Patient satisfaction is very high, and some difficulties related to the implantation site in late implantations may be eliminated. This article reports on three cases of immediate loading with up to 30 months of clinical follow-up.

Immediate Implant Placement Postextraction Without Flap Elevation

The aim of this retrospective study was to assess soft tissue and esthetic outcomes at single-tooth immediate implants placed without flap elevation in maxillary central and lateral incisor sites. Photographic records of 85 consecutive patients with immediate single-tooth implants in maxillary central and lateral incisors that were placed without elevation of surgical flaps were selected. The change in mucosal level was expressed as a percentage of the length of the reference central incisor. Significant recession of the mesial papilla (-6.2% +/- 6.8%), distal papilla (-7.4% +/- 7.5%), and facial mucosa (-4.6% +/- 6.6%) between surgical placement and 1 year was observed (P <0.001). Recession was greater for implants placed facially within the extraction socket compared to those placed lingually (P = 0.009). Sites with gingival margins initially coronal achieved mucosal levels close to the line of symmetry with the contralateral tooth. Sites initially level or apical failed to reach the line of symmetry and remained receded. For sites with initially level gingival margins, recession >10% occurred at six of 25 thin biotype sites compared to two of 19 thick biotype sites. Acceptable outcomes were achieved in the majority of sites; between 10% and 20% of sites had suboptimal esthetic results. Immediate implant placement without elevation of surgical flaps is associated with recession of the marginal mucosa that may fall within the threshold of visually detectable change. The orofacial position of the implant shoulder and the tissue biotype are important contributory factors.

Bilaminar Subepithelial Connective Tissue Grafts for Immediate Implant Placement and Provisionalization in the Esthetic Zone

Immediate implant placement and provisionalization has been considered as a preservative procedure when replacing failing teeth, especially in the esthetic zone. Nevertheless, an average facial gingival tissue recession of 1 mm is still common after one year of function. Furthermore, facial gingival recession of thin periodontal biotype seems to be more pronounced than that of thick biotype. Biotype conversion around both natural teeth and implants with subepithelial connective tissue graft has been advocated, and the resulting tissues appear to be more resistant to recession. A technique combining subepithelial connective tissue graft and immediate implant placement and provisionalization is devised to achieve a more stable peri-implant tissue in thin biotype situations. This article describes the surgical and prosthodontic approach of this procedure as well as its clinical rationale.

Dimensions of peri-implant mucosa: an evaluation of maxillary anterior single implants in humans.

Attempts have been made to evaluate the biologic dimension of osseointegrated implants, however, most are histologic studies in animals, and the effect of soft tissue support from adjacent teeth on the interproximal dimension of the peri-implant mucosa for anterior single implants has not been addressed. This study clinically evaluated the dimensions of the peri-implant mucosa around 2-stage maxillary anterior single implants in humans after 1 year of function. The influence of the peri-implant biotype was also examined. Forty-five patients (20 males and 25 females) with a mean age of 47.3 years were included in this study. A total of 45 maxillary anterior single implant crowns with a mean functional time of 32.5 months (range, 12 to 78) were evaluated. The dimensions of peri-implant mucosa were measured by bone sounding using a periodontal probe at the mesial (MI), mid-facial (F), and distal (DI) aspects of the implant restoration and the proximal aspects (MT, DT) of adjacent natural teeth. In addition, the peri-implant biotype was evaluated and categorized as thick or thin. Statistical analysis was performed using an independent t test (P<0.05). The means and standard deviations of the dimensions of peri-implant mucosa at MT, MI, F, DI, and DT were 4.20 +/- 0.77 mm, 6.17 +/- 1.27 mm, 3.63 +/- 0.91 mm, 5.93 +/- 1.21 mm, and 4.20 +/- 0.64 mm, respectively. The dimensions of peri-implant mucosa in the thick biotype were significantly greater than the thin biotype at MT, MI, and DT (P<0.05). The mean facial dimension of peri-implant mucosa of 2-stage implants is slightly greater than the average dimension of the dentogingival complex. The level of the interproximal papilla of the implant is independent of the proximal bone level next to the implant, but is related to the interproximal bone level next to the adjacent teeth. Greater peri-implant mucosal dimensions were noted in the presence of a thick peri-implant biotype as compared to a thin biotype.