Gingival Phenotype

Anel Avila-Rincon

Gingival Phenotypes

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01

Introduction

• Hard and soft tissue assessments are a crucial component in a dental hygiene appointment

• In order to properly diagnose gum disease, we must look at bone level (x-rays) and Probe measurements (gum attachment & inflammation)
• For this presentation I wanted to focus on the topic of Gingival Phenotypes and their impact on patients with periodontal disease
• Gingival- relating to the gums
• Phenotypes- set of observable traits or characteristics of an organism
• In order to understand what gingival phenotypes consists of we need to look at the bigger picture beginning with periodontal phenotypes

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Periodontal Phenotypes

Originally known as “periodontal biotype” until the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Disease and Conditions chose to adopt the term ”Periodontal Phenotype”

+ info

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Periodontal Phenotype

Consists of 3 factors

Bone Morphotype

Keratinized tissue

Gum thickness

Thickness of buccal plate (bone)

MGJ to gingival margin

gingival margin thickness

Gingival Phenotype

Gingival phenotype is made up of :

• Keratinized tissue
• Gingival thickness
• Thick gingiva
• Thin gingiva

+ Types

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3 Types of gingival phenotypes

Thick-Scalloped

Thick-Flat

Thin-scalloped

Methods to measure gingival phenotypes

6 Methods

Transgingival probing ⭐️

Digital vernier caliper

Probe transparency (TRANS) method- easiest method

Cone-beam computed tomography (CBCT)

Ultrasonic device

ultrasonography

Thick gingival phenotypes

Responds to disease by deep pocket formation (deep probe depths) and infra bony defects (bone loss)

more resistant to inflammation and trauma

Photo

Is characterized by a broad zone of keratinized tissue and thick bony structure

One study found that men are more likely to have thicker gingival phenotypes than women

Thin gingival phenotypes

Although thin gingival margins are associated with shallow probe depths which can make it easier to maintain periodontal pockets clean; there is a higher chance for gum recession

Unfortunately, most surgical procedures used to treat periodontal disease in thin phenotypes have unfavorable outcomes

Characterized by thin band of keratinized tissue and bone structure

In Conclusion...

• After analyzing multiple research article there appears to be a common conclusion that thick gingival phenotypes have better periodontal outcomes that thin phenotypes and are associated with a healthy periodontium
• Future research would evaluate solutions for patients with thin gingival margins
• One study suggested altering the gingival phenotype but additional research is needed

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Thanks

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Resources

• Barootchi, S., Tavelli, L., Di Gianfilippo, R., Shedden, K., Oh, T. J., Rasperini, G., Neiva, R., Giannobile, W. V., & Wang, H. L. (2022). Soft tissue phenotype modification predicts gingival margin long-term (10-year) stability: Longitudinal analysis of six randomized clinical trials. Journal of periodontology, 49(7), 672–683. https://doi.org/10.1111/jcpe.13641
• Barootchi, S., Tavelli, L., Zucchelli, G., Giannobile, W. V., & Wang, H. L. (2020). Gingival phenotype modification therapies on natural teeth: A network meta-analysis. Journal of periodontology, 91(11), 1386–1399. https://doi.org/10.1002/JPER.19-0715

• Kim, DM, Bassir, SH, Nguyen, TT. (2019). Effect of gingival phenotype on the maintenance of periodontal health: An American Academy of Periodontology best evidence review. J Periodontol. 2020; 91: 311– 338. https://doi-org.mtrproxy.mnpals.net/10.1002/JPER.19-0337

• Malpartida-Carrillo, V., Tinedo-Lopez, P. L., Guerrero, M. E., Amaya-Pajares, S. P., Özcan, M.,& Rösing, C. K. (2021). Periodontal phenotype: A review of historical and current classifications evaluating different methods and characteristics. Journal of esthetic and restorative dentistry: official publication of the American Academy of Esthetic Dentistry ... [et al.], 33(3), 432–445. https://doi.org/10.1111/jerd.12661

• Manjunath, R. G., Rana, A., & Sarkar, A. (2015). Gingival Biotype Assessment in a HealthyPeriodontium: Transgingival Probing Method. Journal of clinical and diagnostic research : JCDR, 9(5), ZC66–ZC69. https://doi.org/10.7860/JCDR/2015/13759.5956

• Moisa, DH, Connolly, JA, Cheng, B, Lalla, E. (2019) Impact of connective tissue graft thickness on surgical outcomes: A pilot randomized clinical trial. J Periodontol. 2019; 90: 966– 972. https://doi.org/10.1002/JPER.18-0741

• Vlachodimou, E., Fragkioudakis, I., & Vouros, I. (2021). Is There an Association between theGingival Phenotype and the Width of Keratinized Gingiva? A Systematic Review. Dentistry journal, 9(3), 34. https://doi.org/10.3390/dj9030034

• Wang, J., Cha, S., Zhao, Q., & Bai, D. (2022). Methods to assess tooth gingival thickness anddiagnose gingival phenotypes: A systematic review. Journal of Esthetic & Restorative Dentistry, 34(4), 620–632. https://doi-org.mtrproxy.mnpals.net/10.1111/jerd.12900