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      Gingival Biotype Assessement: Visual Inspection Relevance And Maxillary Versus Mandibular Comparison

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          Abstract

          Objective:

          This clinical study was aimed at evaluating the accuracy of gingival visual inspection procedures during clinical examination and determining whether differences existed between the maxillary and mandibular gingival biotypes.

          Materials and Methods:

          The study included 53 patients and 124 clinicians. The clinicians were asked to assign to each subject, using photographic documents, one of three biotypes: thin-scalloped, thick-scalloped, or thick-flat gingival biotype. A total of 19716 responses were collected for statistical analysis.

          Results:

          Identification accuracy of the gingival biotype and the intra-examiner repeatability presented poor highlighting of the limited relevance of visual inspection. In addition, the percent of agreement between classifications based on the global view of both the maxilla and mandible and the classification based on the individual mandibular or maxillary anterior teeth was not statistically significant.

          Conclusion:

          Based on the above results, it can be concluded that a simple visual inspection is not effective for the identification of gingival biotype. Furthermore, evidence suggests that a difference of biotype between the maxilla and the mandible in the same patient is conceivable. Therefore, orthodontic clinical examination should incorporate a reproducible method of determining the individualized gingival biotype for each group of teeth that will be moved.

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          Most cited references23

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          Gingival biotype assessment in the esthetic zone: visual versus direct measurement.

          This study evaluated the reliability of assessing visually the facial gingival biotype of maxillary anterior teeth with and without the use of a periodontal probe in comparison with direct measurements. Forty-eight patients (20 men, 28 women) with a single failing maxillary anterior tooth participated in this study. Three methods were used to evaluate the thickness of the gingival biotype of the failing tooth: visual, periodontal probing, and direct measurement. Prior to extraction, the gingival biotype was identified as either thick or thin via visual assessment and assessment with a periodontal probe. After tooth extraction, direct measurement of the gingival thickness was performed to the nearest 0.1 mm using a tension-free caliper. The gingival biotype was considered thin if the measurement was =or 1.0 mm. The assessment methods were compared using the McNemar test at a significance level of a=.05. The mean gingival thickness obtained from direct measurements was 1.06+/-0.27 mm, with an equal distribution (50%) of sites with gingival thicknesses of =or 1 mm. The McNemar test showed a statistically significant difference when comparing the visual assessment with assessment using a periodontal probe (P=.0117) and direct measurement (P=.0001). However, there was no statistically significant difference when comparing assessment with a periodontal probe and direct measurement (P=.146). Assessment with a periodontal probe is an adequately reliable and objective method in evaluating gingival biotype, whereas visual assessment of the gingival biotype by itself is not sufficiently reliable compared to direct measurement.
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            The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva.

            To detect groups of subjects in a sample of 100 periodontally healthy volunteers with different combinations of morphometric data related to central maxillary incisors and surrounding soft tissues. Four clinical parameters were included in a cluster analysis: crown width/crown length ratio (CW/CL), gingival width (GW), papilla height (PH) and gingival thickness (GT). The latter was based on the transparency of the periodontal probe through the gingival margin while probing the buccal sulcus. Every first volunteer out of 10 was re-examined to evaluate intra-examiner repeatability for all variables. High agreement between duplicate recordings was found for all parameters, in particular for GT, pointing to 85% (kappa=0.70; p=0.002). The partitioning method identified three clusters with specific features. Cluster A1 (nine males, 28 females) displayed a slender tooth form (CW/CL=0.79), a GW of 4.92 mm, a PH of 4.29 mm and a thin gingiva (probe visible on one or both incisors in 100% of the subjects). Cluster A2 (29 males, five females) presented similar features (CW/CL=0.77; GW=5.2 mm; PH=4.54 mm), except for GT. These subjects showed a clear thick gingiva (probe concealed on both incisors in 97% of the subjects). The third group (cluster B: 12 males, 17 females) differed substantially from the other clusters in many parameters. These subjects showed a more quadratic tooth form (CW/CL=0.88), a broad zone of keratinized tissue (GW=5.84 mm), low papillae (PH=2.84 mm) and a thick gingiva (probe concealed on both incisors in 83% of the subjects). The present analysis, using a simple and reproducible method for GT assessment, confirmed the existence of gingival biotypes. A clear thin gingiva was found in about one-third of the sample in mainly female subjects with slender teeth, a narrow zone of keratinized tissue and a highly scalloped gingival margin corresponding to the features of the previously introduced "thin-scalloped biotype" (cluster A1). A clear thick gingiva was found in about two-thirds of the sample in mainly male subjects. About half of them showed quadratic teeth, a broad zone of keratinized tissue and a flat gingival margin corresponding to the features of the previously introduced "thick-flat biotype" (cluster B). The other half could not be classified as such. These subjects showed a clear thick gingiva with slender teeth, a narrow zone of keratinized tissue and a high gingival scallop (cluster A2).
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              Tissue biotype and its relation to the underlying bone morphology.

              Tissue biotypes have been linked to the outcomes of periodontal and implant therapy. The purpose of this study is to determine the dimensions of the gingiva and underlying alveolar bone in the maxillary anterior region and to establish their association. Tissue biotypes of 22 fresh cadaver heads were assessed clinically and radiographically with cone-beam computed tomography (CBCT) scans. Maxillary anterior teeth were atraumatically extracted. The thickness of both soft tissue and bone were measured using a caliper to the nearest 0.1 mm by two calibrated examiners. Probing depths and gingival recession were measured at two points (mid-labial and mid-palatal). Clinical and CBCT measurements of both soft tissue and bone thickness were subsequently compared and correlated. No statistically significant differences were observed between the clinical and CBCT measurements of both soft tissue and bone thickness except the palatal soft tissue measurements. The labial gingival thickness was moderately associated with the underlying bone thickness measured with CBCT (R = 0.429; P <0.05). Gingival recession was not associated with the thickness of both labial gingiva and bone. CBCT measurements were an accurate representation of the clinical thickness of both labial gingiva and bone. In addition, the thickness of the labial gingiva had a moderate association with the underlying bone radiographically.
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                Author and article information

                Journal
                Open Dent J
                Open Dent J
                TODENTJ
                The Open Dentistry Journal
                Bentham Open
                1874-2106
                24 January 2013
                2013
                : 7
                : 1-6
                Affiliations
                [1 ]Department of Periodontology, U 791, UIC Odontologie, School of Dentistry, Nantes, France
                [2 ]Department of Orthodontics, School of Dentistry, Nantes, France
                [3 ]Department of Prosthodontics, School of Dentistry, Nantes, France
                [4 ]Cellule de Promotion de la Recherche Clinique, CHU, Nantes, France
                Author notes
                [* ]Address correspondence to this author at the UFR Odontologie de Nantes, 1, place Alexis Ricordeau, 44042 NANTES Cedex / France; Tel: 02 40 41 29 23; Fax: 02 40 20 18 67; E-mail: assem.soueidan@ 123456univ-nantes.fr
                Article
                TODENTJ-7-1
                10.2174/1874210601307010001
                3565230
                23400554
                a42fdff2-c564-470a-8357-6173a31cfd82
                © Cuny-Houchmand et al.; Licensee Bentham Open.

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                : 18 September 2012
                : 28 November 2012
                : 4 December 2012
                Categories
                Article

                Dentistry
                clinical examination,gingival biotype,maxilla,mandible,visual inspection.
                Dentistry
                clinical examination, gingival biotype, maxilla, mandible, visual inspection.

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