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ORIGINAL RESEARCH
Year : 2018  |  Volume : 10  |  Issue : 1  |  Page : 37-41

Determining the gingival biotype based on dentopapillary compound


1 Department of Periodontics, Sri Sai Dental College and Hospital, Srikakulam, India
2 Department of Periodontics, Anil Neerukonda Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
3 Department of Periodontics, SRM Kattankulathur Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication6-Jul-2018

Correspondence Address:
Dr. Priyankar Chakraborty
Department of Periodontics, SRM Kattankulathur Dental College and Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_1_18

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   Abstract 


Introduction: Knowledge of the gingival biotype or phenotype is of fundamental importance to an oral clinician. There is a direct correlation between gingival biotype and susceptibility to gingival recession following surgical and restorative procedures. The thick and slightly scalloped marginal gingiva with short and wide teeth on the one hand and the thin and highly scalloped marginal gingiva with slender teeth on the other may be the reason for different periodontal entities or so-called “gingival biotypes.” Aim: The present study is to analyze gingival biotype based on dentopapillary complex, taking transparency of the periodontal probe through the gingival margin as a method to differentiate thin from thick gingiva in different age groups. Materials and Methods: Sixty periodontally healthy individuals with all anterior teeth in both the jaws were participated in this study. Results: Thick biotype had area of anterior crowns as 490.17 mm2. Thin biotype had area of anterior crowns as 420.14 mm2 with P = 0.00 having high clinical significance. Conclusion: Teeth with large dentopapillary area had thick gingival biotype. Taking into consideration that the shape, size, form of the tooth and the surrounding gingiva is of paramount importance for the causation and progression of disease.

Keywords: Dentopapillary compound, gingival biotype, mucogingival treatment


How to cite this article:
Tasneem S, Venugopal K, Ravishankar P L, Chakraborty P, Kandukuri V S, Saravanan A V. Determining the gingival biotype based on dentopapillary compound. J Int Clin Dent Res Organ 2018;10:37-41

How to cite this URL:
Tasneem S, Venugopal K, Ravishankar P L, Chakraborty P, Kandukuri V S, Saravanan A V. Determining the gingival biotype based on dentopapillary compound. J Int Clin Dent Res Organ [serial online] 2018 [cited 2018 Dec 15];10:37-41. Available from: http://www.jicdro.org/text.asp?2018/10/1/37/236088




   Introduction Top


The term “gingival biotype” has been coined to illustrate the common clinical observation of the great variation in the thickness and width of facial keratinized tissue. Gingival biotype has been detailed as the thickness of the gingiva in the faciopalatal/faciolingual dimension. Reduced gingival thickness is one of the critical factors that can cause periodontal attachment loss and marginal tissue recession in patients, which is a major concern for periodontal disease progression.

A clinician apprehension on gingival biotype is of prime importance in gaining ideal treatment outcomes. Clinical observation tittled gingival biotype as two variants, thick and thin gingival biotype. In 1969, Oschsenbein and Ross [1] indicated two main types of gingival anatomy, flat and highly scalloped. Later Seibert and Lindhe [2] have proposed two types of gingival biotype which are thick-flat and thin-scalloped types. Becker proposed three different biotypes: flat, scalloped and pronounced scalloped gingiva. There is definitive varying response for inflammation, restorative, trauma and para functional habits for different biotype.[3]

A gingival thickness of ≥2 mm is defined as thick biotype and thickness of <1.5 mm as thin biotype.[4] Several invasive and noninvasive methods have been documented in determining biotype. These include direct measurement under local anesthesia, probe transparency method, ultrasonic devices, and cone-beam computed tomography scan. The transparency of probe method was developed by De Rouck et al.[5] for determining thin and thick biotype noninvasively using a periodontal probe through the gingival sulcus. The outline of underlying probe can be seen through mid buccal sulcus for the thin biotype which is opposite for the thick one. This methodology was originally developed for the examination of the maxillary teeth.[6]

Another type of assessing gingival biotype is based on dentopapillary complex. Sammut described gingival biotype to an aggregate of four features of the soft tissues and the teeth they surround that build up to a specific picture. These are:

  1. The gingival width (keratinized tissue width): It refers to the width of the keratinized tissue when measured from the gingival margin to the mucogingival junction
  2. Gingival thickness (thick or thin): The thickness of the tissue in a buccopalatal dimension
  3. Papilla height/proportion: The part of the gingiva that fits in between teeth
  4. Crown width (CW)/height ratio: Long and slender teeth tend to be associated with contact points, which are distant from the alveolar crest and long papillae that fill the embrasures.


Some cross-sectional studies have examined variants that have relation between gingival biotype and the dentopapillary complex. The focus of the study is to determine the gingival biotype using transparency of probe method and correlating it with the dentopapillary complex.


   Materials and Methods Top


A total of 55 individuals visiting the Department of Periodontics, Outpatient Department, Sree Sai Dental College, Srikakulam, were participated in this study. The participants were selected based on the following inclusion and exclusion criteria.

Inclusion criteria

  1. Age range between 20 and 25 years
  2. Periodontally healthy dentition
  3. Presence of all anterior teeth in both the jaws.


Exclusion criteria

  1. Participants with prosthesis or any restoration in the anterior maxillary teeth
  2. Pregnant or lactating women
  3. Orthodontic treatment and rotations
  4. Participants who are taking medication that has known effect on the periodontium
  5. Participants with the clinical signs of periodontal disease having pockets more than 3 mm.


All the participants were explained about the study protocol. A written informed consent was signed by the individuals who participate in this study.

Various parameters were recorded such as:

  1. Gingival biotype based on the transparency of the periodontal probe method, proposed by De Ronek et al. Evaluation is done by the transparency at the midbuccal aspect of the tooth and categorized as thick [Figure 1] and thin [Figure 2]
  2. Impression of the participants was taken and the following measurements were done
  3. Figure 1: measuring crown length

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    Figure 2: measuring crown width

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    1. Crown length (CL) was measured from the incisal edge to the free gingival margin [Figure 3]
    2. CW was measured on the cast which denotes the mesiodistal dimension of the tooth [Figure 3]
    3. Finally, the total area of the teeth was calculated from canine to canine (AT)
    Figure 3: thin biotype

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  4. Papillary length (PL) is caluculated from the tip of the papilla to aline connecting the mid facial soft tissue of adjacent teeth [Figure 4]. Papillary width (PW) was calculated at the base of the papilla between two approximated tooth surfaces. The area of the facial papillae (AP) is calculated [Figure 5]. The proportion of dentopapillary complex is determined by the ratio of AP to AT (Area of facial papillae/total area) [Table 1].
Figure 4: calculating papillary length

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Figure 5: thick biotype

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Table 1: Ratio of AT/AP

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Data so collected were statistically analyzed using independent t- test through SPSS software (IBM, USA). Mean values and standard deviation were calculated for all continuous variables.


   Results Top


A total of 55 systemically and periodontally healthy individuals were included in the study of age 20–25 years. Thick biotype was exhibited by the crowns with mean CL of 11.2 mm, and for the thin biotype, mean CL value was 10.5 mm. The average CW for the thick biotype was 9.58 mm, whereas for thin biotype, it was 8.62 mm. The mean papillary length for thick biotype was 4.9 mm and 4.5 mm for thin biotype. The papillary width was average of 9.4 mm and 8.8 mm for thick and thin biotypes, respectively. The area of the anterior papilla was 262 mm 2 and 223 mm 2 for thick and thin biotype, respectively. Area of the anterior crown for thick biotype was 491 mm 2, and for the thin biotype, it was 418 mm 2. There was statistical significance for CL, CW [Graph 1], and area of anterior crown [Graph 2] for thick and thin biotype.




   Discussion Top


Tissue biotype is one of the critical factors that pave the way to the result of dental treatment. In recent years, the dimension gingival thickness has become the subject of considerable interest. The prediction of gingival biotype would provide the predictable outlook of future recession.[7] The gingival biotype plays a vital role in the development of mucogingival problems and in the success of the treatment of mucogingival problems and in success of the treatment for recession and wound healing.[8]

Clinical appearance of normal gingival tissue reflects the underlying structure of the epithelium and lamina propria. The thick biotype exhibited short and flat papillae, whereas thin biotype showed long and scalloped papillae.[9] This morphological difference could be assumed to be more papilla loss in thin biotype. Thick biotype contains flat soft-tissue and bony architecture, denser, and more fibrotic soft tissue with large amount of attached gingiva. The gingival thickness may be the reason of variable treatment outcome possibly because of the difference in amount of blood supply to the underlying bone. Patients with thin gingival biotype are at high risk of developing the gingival or periodontal diseases. Therefore, special consent should be taken from the patients during treatment modalities.

The thickness of mucosa can be evaluated by many different methods such as invasive and noninvasive modalities. Invasive methods include the use of injection needle, probes, and endodontic instruments with rubber stopper. Noninvasive methods would be the use of ultrasonic devices. Notwithstanding the fact that the ultrasonographic method of assessing gingival thickness is noninvasive, drawbacks encompassed the relative unavailability of instrument, difficulty in maintenances, and directionality of transducer and nonreliable results when the thickness of gingiva exceeds 2–2.5 mm. To overcome these problems, De Rouck et al.[5] introduced a method to check for the gingival thickness based on the transparency of the periodontal probe through the gingival margins and probing the sulcus through the midfacial aspect. If the periodontal probe could be seen through the gingival margin, it will be considered as thin if the probe is not seen it is considered as thick. The above-mentioned method was employed in the current study as it was relatively easy and noninvasive. Maxillary incisors were taken as reference teeth in the present study.

In the present study, results showed mean CL of 11.29 mm for thick biotype and for thin biotype showing statistical significance. There was also statistical significance for mean crown width between thick biotype (9.58 mm) and thin biotype (8.63 mm). The area of anterior crown was compared between the two morphological types and showed a very high statistical significance. The unpaired t-test reviled statistically significant correlation between the gingival biotype, CL, and width and area of anterior crowns.

Anand et al. in their report correlated the prevalence of thick and thin biotype with gender and tooth morphology and showed that quadratic tooth form showed a broad zone of keratinized tissue, low papillae, and thick gingiva.[10]

Manjunath et al. compared the gingival biotype among different age groups in men and women and stated that thick biotype was more in males than females.[9]

Frost et al. studied the accuracy of transparency of probe technique for determining the biotype but failed to identify a gingival thickness threshold that can be discriminated which is contrary to our study.[11]

Within the limitations of the current study, there seems to be a correlation between the gingival biotype and dentopapillary complex. The result of the present study showed a significant correlation between CLs, width area of the crown, and gingival biotype. These findings can be utilized in treatment planning of various periodontal surgical procedures. Further studies will be required to ascertain the findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ochsenbein C, Ross S. A reevaluation of osseous surgery. Dent Clin North Am 1969;13:87-102.  Back to cited text no. 1
    
2.
Seibert JL, Lindhe J. Aesthetics and periodontal therapy. In: Lindhe J, editor. Textbook of Clinical Periodontology. 2nd ed. Copenhagen, Denmark: Munksgaard; 1989. p. 477-514.  Back to cited text no. 2
    
3.
Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: Visual versus direct measurement. Int J Periodontics Restorative Dent 2010;30:237-43.  Back to cited text no. 3
    
4.
Claffey N, Shanley D. Relationship of gingival thickness and bleeding to loss of probing attachment in shallow sites following nonsurgical periodontal therapy. J Clin Periodontol 1986;13:654-7.  Back to cited text no. 4
    
5.
De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: Transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol 2009;36:428-33.  Back to cited text no. 5
    
6.
Hiba MJ, Mahash M. Clinical importance of gingival biotype (Review of literature). J Baghdad Coll Dent 2015;27:93-101.  Back to cited text no. 6
    
7.
Hwang D, Wang HL. Flap thickness as a predictor of root coverage: A systematic review. J Periodontol 2006;77:1625-34.  Back to cited text no. 7
    
8.
Anderegg CR, Metzler DG, Nicoll BK. Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects. J Periodontol 1995;66:397-402.  Back to cited text no. 8
    
9.
Manjunath RG, Rana A, Sarkar A. Gingival biotype assessment in a healthy periodontium: Transgingival probing method. J Clin Diagn Res 2015;9:ZC66-9.  Back to cited text no. 9
    
10.
Anand V, Govila V, Gulati M. Correlation of gingival tissue biotypes with gender and tooth morphology: A randomized clinical study. Indian J Dent 2012;3:190-5.  Back to cited text no. 10
    
11.
Frost NA, Mealey BL, Jones AA, Huynh-Ba G. Periodontal biotype: Gingival thickness as it relates to probe visibility and buccal plate thickness. J Periodontol 2015;86:1141-9.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]



 

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