Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (2): 339-345. doi: 10.19723/j.issn.1671-167X.2020.02.023

Previous Articles     Next Articles

Gingival thickness assessment of gingival recession teeth

Zi-yuan CHEN1,Jin-sheng ZHONG2,Xiang-ying OUYANG2,△(),Shuang-ying ZHOU2,Ying XIE2,Xin-zhe LOU2   

  1. 1. Second Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100101, China;
    2. Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2019-09-23 Online:2020-04-18 Published:2020-04-18
  • Contact: Xiang-ying OUYANG E-mail:kqouyangxy@bjmu.edu.cn

RICH HTML

   

PDF (PC)

Abstract:

Objective: To evaluate the gingival thickness and gingival biotype of gingival recession teeth of Chinese population.Methods: A total of 112 non-molar teeth with gingival recession in 34 patients were included. Direct measurement, cone-beam computerized tomography (CBCT) measurement and periodontal probe method were used to evaluate gingival thickness and biotype. Gingival thickness was measured at 2 mm apical to the gingival margin. Direct measurement was performed with a caliper of 0.01 mm resolution and anesthesia needles attached to silicone disk stops. Gingival biotype was assessed by sulcus probing, if the periodontal probe was visible through the gingival tissue, the gingival biotype was thin; If not visible, the gingival biotype was thick. The differences of gingival thickness among different gingival biotype, tooth site and gingival recession type were analyzed respectively. Besides, the results of CBCT measurement was analyzed compared with the direct measurement.Results: The average gingival thickness of non-molar recession teeth was (1.17±0.41) mm. The average gingival thickness of thick and thin biotype group were (1.38±0.4) mm and (0.97±0.30) mm, respectively, with statistically significant difference (P＜0.001).The median of gingival thickness was 1.1 mm. Using 1.1 mm as the cut-off value of thick and thin gingival thickness group, the results matched well with the gingival biotype classification results by periodontal probe method (P=1.000). The average gingival thickness of maxillary teeth was significantly thicker than that of the mandibular teeth. They were (1.39±3.44) mm and (1.01±0.31) mm, respectively (P＜0.001). The mean gingival thickness of MillerⅠ, Ⅱ and Ⅲ degree gingival recession teeth were (1.15±0.34) mm, (0.83±0.17) mm and (1.26±0.56) mm, respectively, without statistically significant difference (P=0.205). The gingival thickness measurement results between CBCT method and direct measurement were without statistically significant difference (P=0.206).Conclusion: In the non-molar gingival recession teeth, the cut-off value of gingival thickness to classify thick and thin biotype of Chinese population was 1.1 mm. The average gingival thickness of the maxillary teeth was significantly thicker than that of the mandibular teeth. Besides, CBCT measurement was an accuracy method for evaluating facial gingival thickness.

Key words: Gingival thickness, Gingival biotype, Gingival recession

CLC Number: 

  • R781.4

Figure 1

CBCT scan with a plastic lip retractor"

Figure 2

Clear gingival margin on the CBCT image B, bottom; T, top, T: 0.15 mm, the images were reconstructed with the voxel of 0.15 mm."

Figure 3

Measurement of the buccal gingival thickness in the sagittal view Yellow line: 2 mm from the gingival margin; red line: the distance from the gingival surface to the root surface is 1.3 mm. B, bottom; T, top, T: 0.15 mm, the images were reconstructed with the voxel of 0.15 mm."

Table 1

Gingival thickness of different gingival biotype$\bar{x}±s $/mm"

Gingival
biotype		 n Rec PD WKT GTDM
Thick 55 2.46±1.00 1.60±0.56 3.11±1.66 1.38±0.42
Thin 57 2.44±0.99 1.58±0.53 2.69±1.50 0.97±0.30
P 0.895a 0.839a 0.233b <0.001c

Table 2

Gingival biotype assessment (frequency distribution)"

Gingival biotype
probe method		 Cut-off 1.0 mm Cut-off 1.1 mm
Thick
(>1.0 mm)		 Thin
(≤1.0 mm)		 Thick
(>1.1 mm)		 Thin
(≤1.1 mm)
Thick (55) 43 12 41 14
Thin (57) 21 36 15 42
Predictive value 43/55
(78.20%)		 36/57
(63.20%)		 42/55
(76.40%)		 42/57
(73.70%)
P 0.164 1.000

Table 3

Gingival thickness of different tooth site and tooth type $\bar{x}±s $/mm"

Tooth site n Rec PD WKT GTDM
Maxillary 48 2.34±0.96 1.71±0.54 3.42±1.66 1.39±0.44
Incisors 15 1.57±0.60 1.87±0.64 4.67±1.14 1.27±0.44
Canines 11 2.64±0.78 1.55±0.52 3.27±1.21 1.18±0.28
Premolars 22 2.73±0.96 1.68±0.48 2.64±1.68 1.57±0.46
Mandibular 64 2.53±1.02 1.50±0.54 2.44±1.38 1.01±0.31
Incisors 22 2.52±0.98 1.41±0.50 3.43±1.49 0.93±0.31
Canines 13 2.04±0.72 1.46±0.52 2.23±0.88 1.04±0.25
Premolars 29 2.76±1.11 1.59±0.57 1.74±0.97 1.06±0.33
P 0.326a 0.045a 0.001a <0.001b

Table 4

Gingival thickness of different gingival recession type $\bar{x}±s $/mm"

Gingival
recession		 n Rec PD WKT GTDM
Miller Ⅰ 77 2.35±0.92 1.56±0.55 2.88±1.29 1.15±0.34
Miller Ⅱ 3 2.83±1.04 2.00±0.00 0 0.83±0.17
Miller Ⅲ 32 2.66±1.15 1.63±0.55 3.19±1.96 1.26±0.56
Total 112 2.45±1.00 1.59±0.55 2.89±1.58 1.17±0.41
P 0.189a 0.305b 0.012b 0.205b
[1] Miller PD . A classification of marginal tissue recession[J]. Int J Periodontics Restorative Dent, 1985,5(2):8-13.
[2] Zucchelli G, Mounssif I . Periodontal plastic surgery[J]. Periodontol 2000, 2015,68(1):333-368.
[3] Addy M, Griffiths G, Dummer P , et al. The distribution of plaque and gingivitis and the influence of toothbrushing hand in a group of South Wales 11-12 year-old children[J]. J Clin Periodontol, 1987,14(10):564-572.
[4] Gillette WB, Van House RL . Ill effects of improper oral hygeine procedure[J]. J Am Dent Assoc, 1980,101(3):476-480.
[5] Abrams H, Kopczyk RA . Gingival sequela from a retained piece of dental floss[J]. J Am Dent Assoc, 1983,106(1):57-58.
[6] Loe H, Anerud A, Boysen H . The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession[J]. J Periodontol, 1992,63(6):489-495.
[7] van Palenstein Helderman WH, Lembariti BS, van der Weijden GA , et al. Gingival recession and its association with calculus in subjects deprived of prophylactic dental care[J]. J Clin Periodontol, 1998,25(2):106-111.
[8] Tugnait A, Clerehugh V . Gingival recession-its significance and management[J]. J Dent, 2001,29(6):381-394.
[9] Merijohn GK . Management and prevention of gingival recession[J]. Periodontol 2000, 2016,71(1):228-242.
[10] Anderegg CR, Metzler DG, Nicoll BK . Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects[J]. J Periodontol, 1995,66(5):397-402.
[11] Baldi C, Pini-Prato G, Pagliaro U , et al. Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series[J]. J Periodontol, 1999,70(9):1077-1084.
[12] Hwang D, Wang HL . Flap thickness as a predictor of root coverage: a systematic review[J]. J Periodontol, 2006,77(10):1625-1634.
[13] Kim DM, Neiva R . Periodontal soft tissue non-root coverage procedures: a systematic review from the AAP regeneration workshop[J]. J Periodontol, 2015,86(Suppl 2):S56-S72.
[14] Scheyer ET, Sanz M, Dibart S , et al. Periodontal soft tissue non-root coverage procedures: a consensus report from the AAP Regeneration Workshop[J]. J Periodontol, 2015,86(Suppl 2):S73-S76.
[15] Kan JY, Rungcharassaeng K, Umezu K , et al. Dimensions of peri-implant mucosa: an evaluation of maxillary anterior single implants in humans[J]. J Periodontol, 2003,74(4):557-562.
[16] De Rouck T, Eghbali R, Collys K , et al. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva[J]. J Clin Periodontol, 2009,36(5):428-433.
[17] Eghbali A, De Rouck T, De Bruyn H , et al. The gingival biotype assessed by experienced and inexperienced clinicians[J]. J Clin Periodontol, 2009,36(11):958-963.
[18] Kan JY, Morimoto T, Rungcharassaeng K , et al. Gingival biotype assessment in the esthetic zone: visual versus direct measurement[J]. Int J Periodontics Restorative Dent, 2010,30(3):237-243.
[19] Berlucchi I, Francetti L, Del Fabbro M , et al. The influence of anatomical features on the outcome of gingival recessions treated with coronally advanced flap and enamel matrix derivative: a 1-year prospective study[J]. J Periodontol, 2005,76(6):899-907.
[20] Andrade PF, Grisi MF, Marcaccini AM , et al. Comparison between micro- and macrosurgical techniques for the treatment of localized gingival recessions using coronally positioned flaps and enamel matrix derivative[J]. J Periodontol, 2010,81(11):1572-1579.
[21] Bittencourt S ,Del Peloso Ribeiro E,Sallum EA, et al.Surgical microscope may enhance root coverage with subepithelial connective tissue graft: a randomized-controlled clinical trial[J]. J Periodontol, 2012,83(6):721-730.
[22] Ahmedbeyli C, Ipci SD, Cakar G , et al. Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype[J]. J Clin Periodontol, 2014,41(3):303-310.
[23] Dogan SB, Dede FO, Balli U , et al. Concentrated growth factor in the treatment of adjacent multiple gingival recessions: a split-mouth randomized clinical trial[J]. J Clin Periodontol, 2015,42(9):868-875.
[24] Januario AL, Barriviera M, Duarte WR . Soft tissue cone-beam computed tomography: a novel method for the measurement of gingival tissue and the dimensions of the dentogingival unit[J]. J Esthet Restor Dent, 2008,20(6):366-374.
[25] Barriviera M, Duarte WR, Januario AL , et al. A new method to assess and measure palatal masticatory mucosa by cone-beam computerized tomography[J]. J Clin Periodontol, 2009,36(7):564-568.
[26] Fu JH, Yeh CY, Chan HL , et al. Tissue biotype and its relation to the underlying bone morphology[J]. J Periodontol, 2010,81(4):569-574.
[27] Cairo F, Cortellini P, Pilloni A , et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial[J]. J Clin Periodontol, 2016,43(10):849-856.
[28] Aroca S, Molnar B, Windisch P , et al. Treatment of multiple adjacent Miller class I and Ⅱ gingival recessions with a modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial[J]. J Clin Periodontol, 2013,40(7):713-720.
[29] Ozenci I, Ipci SD, Cakar G , et al. Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions[J]. J Clin Periodontol, 2015,42(12):1135-1142.
[30] Maroso FB, Gaio EJ, Rosing CK , et al. Correlation between gingival thickness and gingival recession in humans[J]. Acta Odontol Latinoam, 2015,28(2):162-166.
[31] Rajendran V, Uppoor A, Kadakampally D , et al. Comparison of minimally invasive coronally advanced flap and modified coronally advanced flap for the management of multiple adjacent gingival recession defects: A split mouth randomized control trial[J]. J Esthet Restor Dent, 2018,30(6):509-515.
[32] Jepsen S, Caton JG, Albandar JM , 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]. J Clin Periodontol, 2018,45(Suppl 20):S219-S229.
[33] Goncalves Motta SH, Ferreira Camacho MP, Quintela DC , et al. Relationship between clinical and histologic periodontal biotypes in humans[J]. Int J Periodontics Restorative Dent, 2017,37(5):737-741.
[34] 龚寅, 谢玉峰, 束蓉 . 上海汉族青年牙龈生物型的 CBCT 检测[J]. 上海交通大学学报(医学版), 2017,37(8):1111-1115.
[35] 祖青, 杨川, 陈文君 . 上前牙区角化龈宽度和牙龈厚度之间的相关性分析[J]. 中国美容医学, 2017,26(11):98-100.
[36] 林璐, 何平华, 苏莎 , 等. 牙龈厚度与上前牙唇侧骨板厚度的相关性研究[J]. 实用口腔医学杂志, 2016,32(4):569-572.
[37] 张瑞, 束蓉 . 采用锥形束CT测量汉族年轻人群前牙唇侧健康牙龈厚度[J]. 临床和试验医学杂志, 2018,17(2):214-218.
[38] 孟焕新, 张胡 . 120名汉族青年前段牙弓唇侧角化龈宽度的测量[J]. 中华口腔医学杂志, 2010,45(8):477-481.
[39] Stefanini M, Zucchelli G, Marzadori M , et al. Coronally advanced flap with site-specific application of connective tissue graft for the treatment of multiple adjacent gingival recessions: a 3-year follow-up case series[J]. Int J Periodontics Restorative Dent, 2018,38(1):25-33.
[40] Huang LH, Neiva RE, Wang HL . Factors affecting the outcomes of coronally advanced flap root coverage procedure[J]. J Periodontol, 2005,76(10):1729-1734.
[41] Cao J, Hu WJ, Zhang H , et al. A novel technique for measurement of dentogingival tissue by cone beam computed tomography[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015,119(2):e82-87.
[1] Ke-ang FAN,Jin-sheng ZHONG,Xiang-ying OUYANG,Ying XIE,Zi-yuan CHEN,Shuang-ying ZHOU,Yuan ZHANG. Vestibular incision subperiosteal tunnel access with connective tissue graft for the treatment of Miller classⅠ and Ⅱ gingival recession [J]. Journal of Peking University(Health Sciences), 2019, 51(1): 80-85.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd