Co-Relation of Gingival Biotype (Periodontal Phenotype) with Width of Keratinized Gingiva in Maxillary Anterior Teeth in Patients Reporting to a Local Tertiary Care Dental Hospital

Objective: To find out the correlation of gingival biotype with width of keratinized gingiva in maxillary anterior teeth in patients at tertiary care dental hospital presenting for routine periodontal care. Materials And Methods: In this crossectional study, a total of 87 patients were observed in department of Periodontology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore. The gingival biotype (gingival thickness) were determined by using the transparency of the periodontal probe through gingival sulcus. The width of the keratinized gingiva was measured by measuring the distance between the most coronal point of the gingival margin and the mucogingival junction measured at the midpoint of the vestibular face of the teeth using a Michigan O periodontal probe with William’s markings. Results: In this study mean age was 38 years with SD ± 10.88. Forty six percent patients were male and 54% patients were female. Mean width of keratinized gingiva was 4.22mm ± 1.10 while mean gingival biotype was 1.5 mm ± 0.65. The correlation coefficient r=0.277 shows a positive correlation of width of keratinized gingiva with gingival biotype Conclusion: The study concluded that there is a positive correlation of gingival biotype with width of keratinized gingiva in maxillary anterior teeth. Keywords: gingival biotype, width of keratinized gingival, maxillary anterior teeth

Is There an Association between the Gingival Phenotype and the Width of Keratinized Gingiva? A Systematic Review

The concept of gingival phenotype and width of keratinized gingiva influencing the diagnosis and treatment in the periodontal scenario is relatively new. Soft and hard tissue dimensions of oral tissues are considered essential parameters in daily clinical practice. Factors such as the biotype category and the width of the keratinized gingiva help dentists seek the perfect therapy plan for each patient to achieve long-term stability of periodontal health. Several methods have been proposed to categorize phenotypes and each phenotype is characterized by various clinical characteristics. This review aims to discuss the possible association between the gingival phenotype and the width of keratinized gingiva along with the results appeared. After a rigorous search in major electronic databases, the results of the included studies indicated that the width of keratinized gingiva seems to be associated with the periodontal phenotype, with thick biotypes being characterized by a more pronounced keratinized gingival width. However, the heterogeneity of the included studies did not allow to make a conclusion about a direct relationship.

Periodontal phenotype modification therapy in a patient undergoing orthodontic treatment: a case report

Introduction: Gingival recessions are mucogingival defects of multifactorial etiology that interfere with aesthetics and function; in many cases these defects require multidisciplinary treatment. Objective: To report a clinical case of gingival recession treatment using a periodontal and orthodontic approach. Case report: Patient a 20-year-old woman, sought the Extension Project of Clinical and Surgical Periodontics (PROEPECC/UFCG) complaining of developing gingival recession in tooth 31, which was poorly positioned in the arch after orthodontic movement. Periodontal examination revealed type 1 gingival recession associated with a prominent labial frenulum, with a gingival height of 3 mm, width of 2 mm, probing depth of 1 mm, and absence of attached gingiva. The root was covered using a subepithelial connective tissue graft removed from the palatal mucosa and coronally positioned flap; in addition, inferior labial frenectomy was performed. After 1 year and 6 months, tooth 31 was again moved to reposition it in the arch. One year and 10 months post-surgery, new periodontal examination was performed to evaluate the mucogingival characteristics of the treated area. The recession was completely covered and there was a 4-mm increase in the attached gingiva. Conclusion: Orthodontics may positively or negatively influence periodontal structures and periodontics may favor the prognosis of tooth movement in a risk area by modifying the periodontal phenotype, increasing its resistance to gingival recession.

Prioritization of predisposing factors of gingival hyperplasia during orthodontic treatment: the role of amount of biofilm

Background The mechanism of gingival growth that may occur during fixed orthodontic treatment is not yet fully understood and the amount of dental plaque is often incriminated. The objective of this study was to evaluate the prevalence of gingival growth during multi-attachment orthodontic treatment and to prioritize its predicting factors, especially the quantity of biofilm. Methods This comprehensive cross-sectional descriptive study was conducted on orthodontic patients aged 9 to 30 years, in good health, treated by a fixed appliance. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, periodontal phenotype and gingival enhancement index were recorded. Likewise, the brushing habits and the date of the last scaling were noted. The orthodontic parameters studied were the duration of the treatment, the type of bracket, the alloys used for the arches and the type of ligatures. Descriptive statistics were carried out, and variables presenting p value < 0.25 were included in a multivariate analysis to calculate the Odds Ratio (OR) of gingival enlargement”. Results A total of 193 patients were included (16.38 ± 4.89 years). Gingival growth occurred for 49.7% of patients included. The predisposing factors for this pathology during fixed orthodontic treatment were conventional metal brackets (p = 0.021), mouth breathing (p = 0.040), male gender (p = 0.035), thick periodontal phenotype (p = 0.043), elastomeric ligations (p = 0.007), duration of treatment (p = 0.022) and presence of plaque (p = 0.004). After achievement of the logistic regression, only two factors remained related to gingival enlargement: metallic brackets (OR: 3.5, 95% CI: 1.1–10.55) and duration of treatment (OR: 2.03, 95% CI: 1.01–4.08). The amount of plaque would not be directly related to the development of gingival increase during orthodontic treatment. Conclusions Among the predisposing factors that underlie gingival growth during multi-attachment therapy, the amount of plaque is not found. The qualitative assessment of the plaque and its evolution during treatment could clarify the role of the biofilm in the occurrence of gingival overgrowth.

Prioritization of predisposing factors of gingival hyperplasia during orthodontic treatment: the role of amount of biofilm.

Background: The mechanism of gingival growth that may occur during fixed orthodontic treatment is not yet fully understood and the amount of dental plaque is often incriminated. The objective of this study was to evaluate the prevalence of gingival growth during multi-attachment orthodontic treatment and to prioritize its predicting factors, especially the quantity of biofilm. Methods: This comprehensive cross-sectional descriptive study was conducted on orthodontic patients aged 9 to 30 years, in good health, treated by a fixed appliance. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, periodontal phenotype and gingival enhancement index were recorded. Likewise, the brushing habits and the date of the last scaling were noted. The orthodontic parameters studied were the duration of the treatment, the type of bracket, the alloys used for the arches and the type of ligatures. Descriptive statistics were carried out, and variables presenting p value < 0.25 were included in a multivariate analysis to calculate the Odds Ratio (OR) of gingival enlargement".Results: A total of 193 patients were included (16.38 ± 4.89 years). Gingival growth occurred for 49.7% of patients included. The predisposing factors for this pathology during fixed orthodontic treatment were conventional metal brackets (p = 0.021), mouth breathing (p = 0.040), male gender (p = 0.035), thick periodontal phenotype (p = 0.043), elastomeric ligations (p = 0.007), duration of treatment (p = 0.022) and presence of plaque (p = 0.004). After achievement of the logistic regression, only two factors remained related to gingival enlargement: metallic brackets (OR:3.5, 95% CI:1.1- 10.55) and duration of treatment (OR:2.03, 95% CI:1.01-4.08). The amount of plaque would not be directly related to the development of gingival increase during orthodontic treatment. Conclusions: Among the predisposing factors that underlie gingival growth during multi-attachment therapy, the amount of plaque is not found. The qualitative assessment of the plaque and its evolution during treatment could clarify the role of the biofilm in the occurrence of gingival overgrowth.Trial registration: Cross-sectional study.

Clinical evaluation of coronally advanced flap with acellular dermal matrix graft or connective tissue graft in the treatment of gingival recession with thin periodontal phenotype: study protocol for a split-mouth randomized controlled trial

BackgroundAmong all mucogingival deformities, gingival recession is one of the most prevalent conditions that demand surgical correction. Accordingly, root coverage procedures are essential parts of plastic periodontal surgeries. It is undeniable that autogenous tissue grafts remain the gold standard for root coverage procedures. Substantial evidences have identified that the connective tissue graft (CTG) combined with coronally advanced flap (CAF) achieves favorable root coverage of recession. Nevertheless, there are some noticeable disadvantages of harvesting autogenous tissue, such as postoperative bleeding, pain, or discomfort at the donor site, restricted tissue supply, increased morbidity, and longer operative duration. In order to overcome the drawbacks of autogenous tissue harvesting, several non-vital substitutes have been produced as alternative options for replacing connective tissue graft. Acellular dermal matrix (ADM) is an allograft derived from human skin, which has been used extensively in various areas of dental practice over the last two decades. ADM exhibits undamaged collagen and elastin matrices that has been used as a substitute for connective tissue for root coverage procedures. Although its clinical efficacy has been discussed in several reviews, conclusions about the application of this material are still unclear and controversial. Moreover, the level of evidence on the clinical outcomes and patient-reported outcomes relevant to ADM graft (ADMG) is low. Therefore, the objective of this split-mouth; randomized, controlled, clinical study is to compare the long-term clinical efficacy of ADMG combination with CAF on root coverage, aesthetics and patient satisfaction with CTG combination with CAF for gingival recession with thin periodontal phenotype, hoping to provide some reference to dentists.Methods/designForty participants with bilateral Miller Class I/II gingival recession randomly received ADMG (test group) on one side and CTG (control group) on the contralateral side in conjunction with CAF. Gingival recession depth (GRD), gingival recession width (GRW), keratinized tissue width (KTW) are measured at baseline, 2, 4, 12, 24, 48 and 96 weeks. Mean root coverage (MRC), complete root coverage (CRC), root coverage aesthetic score (RES), color change (∆E), and patient satisfaction are assessed in postoperative follow-up.DiscussionCAF combined with CTG has been shown as a predictable technique in root coverage. At present, there is limited long-term data evaluating ADM on root coverage, aesthetics and patient satisfaction for the treatment of gingival recession with thin periodontal phenotype. The result of this split-mouth randomized controlled clinical studies is performed to evaluate the long-time efficacy of ADM, particularly when compared to the “gold standard” (CTG), contributing to an advanced treatment strategy of gingival recession with ideal clinical outcome. Trial registrationInternational Clinical Trials Registry Platform (ICTRP), ID: ChiCTR2000033230. Registered on 25 May 2020, http://www.chictr.org.cn/showproj.aspx?proj=54052