|Year : 2016 | Volume
| Issue : 3 | Page : 116-120
Gingival biotype and its importance in restorative dentistry: A pilot study
DM Mallikarjuna1, Mallika S Shetty1, Anthony Kevin Fernandes1, R Mallikarjuna1, Kiran Iyer2
1 Department of Prosthodontics, Yenepoya Dental College, Mangalore, Karnataka, India
2 Department of Public Health Dentistrty, Ragas Dental College, Chennai, Tamil Nadu, India
|Date of Web Publication||7-Mar-2017|
D M Mallikarjuna
Department of Prosthodontics, Yenepoya Dental College, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The purpose of the present study was to identify the existence of gingival biotypes in a sample of periodontally healthy volunteers and correlate the prevalence of different gingival biotypes of upper anteriors, in accordance with age, gender. Methodology: 145 subjects (79 males and 66 females) with age groups of 20-35 years, 36-50 years were included in this study.Probe transparency method was adopted to assess the biotype at the midfacial aspect of the maxillary incisors and the canines bilaterally. Results: The association of age and gingival biotype was not significant .Study showed that thick biotype decreased with advancing age.The association of sex and gingival biotype was not significant in relation to 11,12,21and 22 but significant in relation to 13 and 23. Among the female subjects, the prevalence of thick biotype in relation to 11, 12, 21and 22 was less than males, whereas in relation to 13 and 23 the prevalence of thick biotype was high in females. Conclusion: These findings can be utilized for determining the gingival biotype and response of gingiva to dental operative procedures.
Clinical Relevance to Interdisciplinary Dentistry
Gingival biotype can affect the results of periodontal therapy, root coverage procedures, and implant placement. Thus it becomes necessary for a clinician to know the gingival biotype and carry out the treatment procedures.
Keywords: Gingiva, periodontal probe, thick biotype, thin biotype
|How to cite this article:|
Mallikarjuna D M, Shetty MS, Fernandes AK, Mallikarjuna R, Iyer K. Gingival biotype and its importance in restorative dentistry: A pilot study. J Interdiscip Dentistry 2016;6:116-20
|How to cite this URL:|
Mallikarjuna D M, Shetty MS, Fernandes AK, Mallikarjuna R, Iyer K. Gingival biotype and its importance in restorative dentistry: A pilot study. J Interdiscip Dentistry [serial online] 2016 [cited 2020 Aug 8];6:116-20. Available from: http://www.jidonline.com/text.asp?2016/6/3/116/201651
| Introduction|| |
Gingival biotype is considered as one of the factors for the success of the restoration. Thus, it is important to know the gingival biotype before placing a restoration.Ochsenbein and Ross in the year 1969 indicated that there were two main types of gingival anatomy flat and highly scalloped. The authors reported that flat gingiva was associated with a square tooth form, while scalloped gingiva was associated with a tapered tooth form. The authors also proposed that the gingival contour closely mimics the contour of the underlying alveolar bone. The term periodontal biotype was used later by Seibert and Lindhe, who classified the gingiva as either thin scalloped or thick flat.
Studies conducted in the past have confirmed that central incisors with a narrow crown form are at greater risk of recession than incisors with a wide, square form., According to the literature, the alveolar bone and the gingival margin surrounding a tooth with pronounced cervical convexity are located more apically than they would be in teeth with flat surfaces, suggesting that the gingival margin is affected by the cervical convexity of the crown. In general, facial gingiva is thicker in the maxilla than in the mandible. According to Evans and Chen, after immediate single implant placement, gingival recession was found to increase in patients with thin biotypes. An animal study by Berglundh and Lindhe concluded that thin gingival tissue can lead to marginal bone loss during formation of the peri-implant biologic width.
According to Weisgold, individuals with a thin, scalloped gingiva demonstrated a greater prevalence of recession. Scalloped gingiva can be categorized as high, normal, and flat. The normal scalloped gingiva is 4–5 mm coronal to the free gingival margin. In the normal and high scalloped gingival form, there is more tissue coronal to the interproximal bone than the facial bone. As such, higher scalloped gingival are at greater risk for gingival loss after tooth extraction. Cook et al. in his study stated that there is a significant association existed between gingival biotype and labial plate thickness thus extreme care should be taken in patients with a thin gingival biotype during extraction to prevent labial plate fracture.
Gingival biotype can affect the results of periodontal therapy, root coverage procedures, and implant placement. It has been shown that patients with thin gingival biotype were more likely to experience gingival recession following nonsurgical periodontal therapy.
Many methods (both invasive and noninvasive) have been used to evaluate the thickness of facial gingival and other parts of the masticatory mucosa. These methods include conventional histology on cadaver jaws, injection needles, transgingival probing, histologic sections, cephalometric radiographs, probe transparency, ultrasonic devices, and cone-beam computed tomography.
In this particular study, the probe transparency method was adopted since the gingival tissue's ability to cover the underlying prosthesis and restoration is necessary for achieving esthetic results, especially in cases of implant and restorative dentistry, where subgingival restorations are used widely.
Using a metal periodontal probe to evaluate gingival tissue thickness is the simplest way to determine gingival biotype. With a thin biotype, the tip of the probe is visible through the gingiva. This method is minimally invasive, and periodontal probing procedures are performed routinely during periodontal and implant treatments.
The present study was conducted among the outpatients in the Department of Prosthodontics, in a Dental College in South Canara, Karnataka, India. The purpose of the present study was to identify the existence of gingival biotypes in a sample of periodontally healthy volunteers and correlate the prevalence of different gingival biotypes of upper anteriors in accordance with age, gender.
| Methodology|| |
A cross-sectional survey was conducted between September 2016 and November 2016. 145 subjects (79 males and 66 females) with age groups of 20–35 years, 36–50 years were included in this study. The subjects with healthy periodontal tissues in the presence of bilateral maxillary central and lateral incisors and canines were included in the study. The study participants were made to sign an informed consent form before commencement of the study. A single-blinded trained and calibrated examiner conducted the entire procedure.
Subjects on medication which affects the periodontal tissues such as cyclosporin A, calcium channel blockers, and phenytoin, pregnant or lactating mothers, history of orthodontic therapy and prosthetic restorations in relation to maxillary incisors were excluded from the study.
The clinical evaluation of gingival biotype of the bilateral maxillary incisors and canines were determined using a UNC-15 periodontal probe (HuFreidy ®, USA) for each of the subjects. The biotype was assessed by probing the gingival sulcus at the midfacial aspect of the maxillary incisors and the canines. The gingival biotype was then categorized as either thick or thin according to the visibility of the underlying periodontal probe through the gingival tissue.
Ethical clearance to conduct a study was obtained from Institutional Review Board, Yenepoya University.
The gathered data were analyzed using Chi-square test. P < 0.05 was considered statistically significant.
| Results|| |
The study sample consisted of 145 subjects, who were stratified into two different age groups of 20–35 years and 36–50 years of age groups. Among them, 76 (52.4%) were in the age group of 20–35 years and 69 (47.6%) were in the 36–50 years age group.
Of the total population 79 (54.5%) were males and 66 (45.5%) were females.
The distribution of subjects according to age and gingival biotype is given in [Table 1] and [Table 2].
|Table 1: The distribution of subjects according to age and gingival biotype,,|
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|Table 2: The distribution of subjects according to age and gingival biotype,,|
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The distribution of subjects according to sex and gingival biotype is given in [Table 3] and [Table 4].
|Table 3: The distribution of subjects according to sex and gingival biotype,,|
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|Table 4: The distribution of subjects according to sex and gingival biotype,,|
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The association of age and gingival biotype was not significant in relation to 11, 12, 13, 21, 22, and 23. The study showed that thick biotype decreased with advancing age.
The association of sex and gingival biotype was not significant in relation to 11, 12, 21, and 22 but significant in relation to 13 and 23 as cervical one-third of the tooth is more prominent.
Among the female subjects, the prevalence of thick biotype in relation to 11, 12, 21, and 22 was less than males, whereas in relation to 13 and 23 the prevalence of thick biotype was high in females [Figure 1] and [Figure 2].
|Figure 1: Thin biotype-outline of the underlying periodontal probe could be seen through the gingiva|
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|Figure 2: Thick biotype-outline of the underlying periodontal probe could not be seen through the gingiva|
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| Discussion|| |
Clinical appearance of healthy periodontium differs from subject to subject and even among different tooth types. Various factors influence the form of gingival tissue around the natural tooth or fixed prosthesis. Many features are genetically determined; others seem to be influenced by tooth size, shape and position, and biological phenomena such as aging. Age groups of 20–35 years, 36–50 years were included in this study because as age progresses periodontal condition deteriorates.
This study was done bilaterally from central incisor to canine whereas several studies have been done unilaterally and on central incisors.,
In the age group of 20–35 years, it was found that 52.4% of individuals have thin gingival biotype. Patients with a thin biotype are more vulnerable to connective tissue loss and epithelial damage, thus they need special atraumatic treatment and oral hygiene techniques. Thin gingival biotypes are less stable, and the occurrence of the papillary and marginal recession is more common in them. Hence, more caution should be exercised while planning a subgingival margin placement or crown lengthening for patients with a thin biotype.
The thicker biotype of tissue form is dense and fibrotic with a wider zone of attached gingiva, thus making them more resistant to gingival recession. This type of tissue prevents mucosal recession, hides the restorative margins. It also prevents biological seal around implants, thus reducing the crestal bone resorption.
In the present study, on comparing the prevalence of gingival biotypes between different age groups, the thicker biotype has been more prevalent in younger age groups. A similar result was found by Bhat and Shetty, Abraham and Athira, and Vandana and Savitha  in their study. They stated that decrease in keratinization and changes in oral epithelium may be the contributing factors. With age, the interdental papilla recedes this explains the greater frequency of thin biotype seen with the older age group.
In the present study, the prevalence of thick biotype in relation to 11, 12, 21, and 22 was more in males than females, whereas in relation to 13 and 23 the prevalence of thick biotype was high in females. A study by Abraham and Athira  observed that the male population had thicker gingival biotype to be more prevalent (74%) while compared to thin form (26%). Among the female subjects, higher prevalence of thin biotype was found (66%) when compared to males (34%). A similar result was reported by De Rouck et al., wherein, the thin gingival biotype occurred in one-third of the study population and was most prominent among women, while the thick gingival biotype occurred in two-thirds of the study population and occurred mainly among men. Shah et al. found no significant association between the gender.
| Conclusion|| |
Within the limits of the current investigation, the existence and correlation of different gingival biotypes with age and gender has been shown. These findings can be utilized for determining the gingival biotype and response of gingiva to dental operative procedures since the gingival tissue's ability to cover the underlying prosthesis and restoration is necessary for achieving esthetic results, especially in cases of implant and restorative dentistry, where subgingival restorations are used widely.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ochsenbein C, Ross S. A reevaluation of osseous surgery. Dent Clin North Am 1969;13:87-102.
Seibert JL, Lindhe J. Esthetics and periodontal therapy. In: Lindhe J, editor. Textbook of Clinical Periodontology. 2nd
ed. Copenhangen, Denmark: Munksgaard; 1989. p. 477-514.
Olsson M, Lindhe J. Periodontal characteristics in individuals with varying form of the upper central incisors. J Clin Periodontol 1991;18:78-82.
Olsson M, Lindhe J, Marinello CP. On the relationship between crown form and clinical features of the gingiva in adolescents. J Clin Periodontol 1993;20:570-7.
Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res 2008;19:73-80.
Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol 1996;23:971-3.
Weisgold AS. Contours of the full crown restoration. Alpha Omegan 1977;70:77-89.
Cook DR, Mealey BL, Verrett RG, Mills MP, Noujeim ME, Lasho DJ, et al
. Relationship between clinical periodontal biotype and labial plate thickness: An in vivo
study. Int J Periodontics Restorative Dent 2011;31:345-54.
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.
Bhat V, Shetty S. Prevalence of different gingival biotypes in individuals with varying forms of maxillary central incisors: A survey. J Dent Implants 2013;3:116-21.
Abraham S, Athira PR. Correlation of gingival tissue biotypes with age, gender and tooth morphology: A cross sectional study using probe transparency method. IOSR J Dent Med Sci 2015;14:64-9.
Newman MG, Takei HH, Klokkevold PR, Carranza FA. Textbook of Clinical Periodontology. 11th
ed. Missouri: W.B. Saunders Company; 2012.
Vandana KL, Savitha B. Thickness of gingiva in association with age, gender and dental arch location. J Clin Periodontol 2005;32:828-30.
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.
Shah R, Sowmya NK, Mehta DS. Prevalence of gingival biotype and its relationship to clinical parameters. Contemp Clin Dent 2015;6 Suppl 1:S167-71.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]