Gingival Biotype Classification, Assessment, and Clinical Importance: A Review
PDF

Keywords

Gingival biotype
gingival biotype assessment
gingival biotype classification
gingival biotype clinical importance

Abstract

A normal scalloped gingival line at the cement enamel junction of the teeth forms one of the components of an aesthetic smile. Clinicians handle gingiva in several periodontal procedures and the resulting gingival architecture is not always ideal. In the era of aesthetic-driven dental therapy, it is important that a clinician should be well aware of all the prognostic factors that may affect the final aesthetic outcome of dental treatment. Gingival biotype is one of the important factors which influences indications and outcome of various periodontal, restoratives, surgical, and implant therapy. Thin gingival biotype responds differently than thick gingival biotype. Gingival biotype assessment before various dental-related procedures is mandatory now to achieve a predictable and stable gingival margin position. This review describes the various classifications, methods of assessment, and clinical importance of gingival biotype during dental treatment.

PDF

References

Newman MG, Takei HH, Klokkevold PR, Carranza FA, editors. Newman and Carranza's Clinical Periodontology. 13th ed. Philadelphia (PA): Saunders, Elsevier; 2018.p182.

Ochsenbein C, Ross S. A reevaluation of osseous surgery. Dent Clin North Am. 1969 Jan;13(1):87-102.

Seibert JL, Lindhe J. Esthetics and periodontal therapy. In: Lindhe J, editor. Textbook of Clinical Periodontology. 2nd ed. Copenhagen, Denmark: Munksgaard; 1989. p. 477‑514.

Kan JYK, Rungcharassaeng K, Morimoto T, Lozada J. Facial Gingival Tissue Stability After Connective Tissue Graft With Single Immediate Tooth Replacement in the Esthetic Zone: Consecutive Case Report. J Oral Maxillofac Surg. 2009 Nov 1;67(11):40-8.

Evans CDJ, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res. 2008;19(1):73-80.

Kao RT, Fagan MC, Conte GJ. Thick vs. thin gingival biotypes: a key determinant in treatment planning for dental implants. J Calif Dent Assoc. 2008 Mar;36(3):193-8.

Cohen ES. Atlas of Cosmetic and Reconstructive Periodontal Surgery. 3rd ed. Hamilton: BC Decker Inc.; 2007. p247.

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(5):428-33.

Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl1):S237-S248.

Kolte R, Kolte A, Mahajan A. Assessment of gingival thickness with regards to age, gender and arch location. J Indian Soc Periodontol. 2014;18(4):478-81.

Becker W, Ochsenbein C, Tibbetts L, Becker BE. Alveolar bone anatomic profiles as measured from dry skulls. Clinical ramifications. J Clin Periodontol .1997 Oct;24(10):727–31.

Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restor Dent. 2010;30(3):237-43.

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(7):654-7.

Egreja AMC, Kahn S, Barceleiro M, Bittencourt S. Relationship between the width of the zone of keratinised tissue and thickness of gingival tissue in the anterior maxilla. Int J Periodontics Restorative Dent. 2012 Oct;32(5):573-9.

Zweers J, Thomas RZ, Slot DE, Weisgold AS, Van Der Weijden FGA. Characteristics of periodontal biotype, its dimensions, associations and prevalence: A systematic review. J Clin Periodontol. 2014;41(10):958-71.

Müller HP, Eger T. Gingival phenotypes in young male adults. J Clin Periodontol. 1997 Jan;24(1):65-71.

Müller HP, Heinecke A, Schaller N, Eger T. Masticatory mucosa in subjects with different periodontal phenotypes. J Clin Periodontol. 2000 Sep;27(9):621-6.

Kois JC. The restorative-periodontal interface: biological parameters. Periodontol 2000. 1996 Jun 1;11(1):29-38.

Aimetti M, Massei G, Morra M, Cardesi E, Romano F. Correlation between gingival phenotype and Schneiderian membrane thickness. Int J Oral Maxillofac Implants. 2008 Nov-Dec;23(6):1128-32.

Fu JH, Yeh CY, Chan HL, Tatarakis N, Leong DJM, Wang HL. Tissue biotype and its relation to the underlying bone morphology. J Periodontol. 2010;81(4):569-74.

Greenberg J, Laster L, Listgarten MA. Transgingival Probing as a Potential Estimator of Alveolar Bone Level. J Periodontol. 1976 Sep;47(9):514-7.

Savitha B, Vandana KL. Comparative assesment of gingival thickness using transgingival probing and ultrasonographic method. Indian J Dent Res. 2005;16(4):135-9.

Cuny-Houchmand M, Renaudin S, Leroul M, Planche L, Guehennec L Le, Soueidan A. Gingival biotype assessement: visual inspection relevance and maxillary versus mandibular comparison. Open Dent J. 2013;7:1-6.

Kan JYK, Rungcharassaeng K, Umezu K, Kois JC. Dimensions of Peri-Implant Mucosa: An Evaluation of Maxillary Anterior Single Implants in Humans. J Periodontol. 2003 Apr;74(4):557-62.

Eger T, Müller HP, Heinecke A. Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features. J Clin Periodontol. 1996 Sep;23(9):839-45.

Bednarz W, Zielinska A . Ultrasonic Biometer and Its Usage in an Assessment of Periodontal Soft Tissue Thickness and Comparison of its Measurement Accuracy with a Bone Sounding Method. Dent Med Probl. 2011;48(4):481-9.

Barriviera M, Duarte WR, Januário AL, Faber J, Bezerra ACB. A new method to assess and measure palatal masticatory mucosa by cone-beam computerised tomography. J Clin Periodontol. 2009 Jul 1;36(7):564-8.

Eghbali A, De Rouck T, De Bruyn H, Cosyn J. The gingival biotype assessed by experienced and inexperienced clinicians. J Clin Periodontol. 2009 Nov;36(11):958-63.

Ronay V, Sahrmann P, Bindl A, Attin T, Schmidlin PR. Current Status and Perspectives of Mucogingival Soft Tissue Measurement Methods. J Esthet Restor Dent. 2011;23(3):146-56.

Müller HP, Barrieshi-Nusair KM, Könönen E. Repeatability of ultrasonic determination of gingival thickness. Clin Oral Investig. 2007 Nov 15;11(4):439-42.

Benavides E, Rios HF, Ganz SD, An C-H, Resnik R, Reardon GT, et al. Use of Cone Beam Computed Tomography in Implant Dentistry. Implant Dent. 2012 Apr;21(2):78-86.

Kois JC. Predictable single-tooth peri-implant esthetics: five diagnostic keys. Compend Contin Educ Dent. 2004 Nov;25(11):895-6, 898, 900 passim; quiz 906-7.

Weisgold AS. Contours of the full crown restoration. Alpha Omegan. 1977 Dec;70(3):77-89.

Romeo E, Lops D, Rossi A, Storelli S, Rozza R, Chiapasco M. Surgical and Prosthetic Management of Interproximal Region With Single-Implant Restorations: 1-Year Prospective Study. J Periodontol. 2008 Jun;79(6):1048-55.

Joshi N, Agarwal MC, Madan E, Gupta S, Law A. Gingival Biotype and Gingival Bioform : Determining Factors for Periodontal Disease Progression and Treatment Outcome. Int J Sci study. 2016;4(3):220-5.

Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, et al. Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol. 1999;70(9):1077-84.

Shah HK, Chaudhary SK, Goel K, Shrestha S. Management of Multiple Recession simultaneously with Modified Coronally Advanced Flap. J Neplese Soc Periodontol Oral Implantol. 2017;1(2):81-3.

Hwang D, Wang HL. Flap thickness as a predictor of root coverage: a systematic review. J Periodontol. 2006 Oct;77(10):1625-34.

Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014 Apr;41:S123-42.

Arora R, Narula SC, Sharma RK, Tewari S. Evaluation of supracrestal gingival tissue after surgical crown lengthening: a 6-month clinical study. J Periodontol. 2013;84(7):934-40.

Müller HP, Eger T. Gingival phenotypes in young male adults. J Clin Periodontol. 1997;24:65-71.

Rasperini G, Acunzo R, Cannalire P, Farronato G. Influence of Periodontal Biotype on Root Surface Exposure During Orthodontic Treatment: A Preliminary Study. Int J Periodontics Restorative Dent. 2015;35(5):665-75.

Tao J, Wu Y, Chen J, Su J. A Follow-Up Study of up to 5 Years of Metal-Ceramic Crowns in Maxillary Central Incisors for Different Gingival Biotypes. Int J Periodontics Restorative Dent. 2014 Sep;34(5):e85-92.

Linkevicius T, Puisys A, Svediene O, Linkevicius R, Linkeviciene L. Radiological comparison of laser-microtextured and platform-switched implants in thin mucosal biotype. Clin Oral Implants Res. 2015 May;26(5):599-605.

Lee A, Fu JH, Wang HL. Soft tissue biotype affects implant success. Implant Dent. 2011;20(3):e38-47.

Grover HS, Yadav A, Yadav P, Nanda P. Optimising Gingival Biotype Using Subepithelial Connective Tissue Graft: A Case Report and One-Year Followup. Case Rep Dent. 2011;2011:1-3.

Romeo E, Lops D, Rossi A, Storelli S, Rozza R, Chiapasco M. Surgical and prosthetic management of interproximal region with single-implant restorations: 1-year prospective study. J Periodontol. 2008;79:1048-55.

Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res. 2008;19:73-80.

Shetty SS, Chatterjee A, Bose S. Bilateral multiple recession coverage with platelet-rich fibrin in comparison with amniotic membrane. J Indian Soc Periodontol. 2014 Jan;18(1):102-6.

Bhola M, Jacobs LC, Kolhatkar S. Immediate implants for aesthetic success: New guidelines. J Int Clin Dent Res Organ. 2015;7:138-47.

Shah R, Sowmya N, Mehta D. Amnion membrane for coverage of gingival recession: A novel application. Contemp Clin Dent. 2014 Jul;5(3):293-5.