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VOLUME 8 , ISSUE 2 ( 2016 ) > List of Articles


Gingival Thickness: Critical Clinical Dimension of Periodontium

Kharidhi Laxman Vandana, Pragya Goswami

Keywords : Gingiva, Gingival thickness, Mucosal thickness, Peri-implant mucosa

Citation Information : Vandana KL, Goswami P. Gingival Thickness: Critical Clinical Dimension of Periodontium. CODS J Dent 2016; 8 (2):108-120.

DOI: 10.5005/jp-journals-10063-0022

License: CC BY-NC-ND 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2016; The Author(s).


Clinical appearance of normal gingival tissue in part reflects the underlying structure of epithelium and lamina propria. It has been described that particular shape, topographical distribution, and width of gingival are clearly functions of presence and position of erupted teeth. Moreover, tooth shape seems to have an important impact on the clinical features of surrounding gingiva and probably also underlying tooth-supporting periodontal tissue. The thickness of masticatory mucosa was studied in a descriptive manner by conventional histology on cadaver jaws. Others assessed the mucosal thickness in edentulous patients using invasive method of injection needle, macroscopic measurement of histologic sections, a graduated periodontal probe or cephalometric radiographs. Noninvasive methods were performed with ultrasonic devices. A-mode ultrasonic device was used to measure tissue thickness in edentulous patients. B-mode was used to visualize soft and hard tissue relationships while also measuring soft tissue thickness. Among the various macroscopic features of gingiva, the gingival thickness (GT) is least discussed and not mentioned in the standard textbooks and journals. There are few terminologies which are not well defined in periodontal literature like periodontal phenotype, gingival phenotype, gingival architecture, gingival morphology, and GT; hence, this review article will put some light on these terminologies and literature review related to the clinical importance and relevance on masticatory mucosa thickness, chiefly on palatal mucosa and gingiva.

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  1. Muller HP, Eger T. gingival phenotypes in young adults. J Clin Periodontol 1997 Jan;24(1):65-71.
  2. Olsson M, Lindhe J, Marinello CP. The relationship between crown form and clinical features of the gingiva in adolescents. J Clin Periodontol 1993 Sep;20(8):570-577.
  3. Wennström, JL.; Berglundh, T. The mucosa at teeth and implants. In: Lindhe J, Lang NP, Karring T, editors. Clinical periodontology and implant dentistry. 5th ed. Oxford: Blackwell Munksgaard; 2008. p. 68.
  4. Kao RT, Pasquinelli K. Thick vs. thin gingival tissue: a key determinant in tissue response to disease and restorative treatment. J Calif Dent Assoc 2002 Jul;30(7):521-526.
  5. Wennström, JL.; Berglundh, T. The mucosa at teeth and implants. In: Lindhe J, Lang NP, Karring T, editors. Clinical periodontology and implant dentistry. 5th ed. Oxford: Blackwell Munksgaard; 2008. pp. 70-71.
  6. Ochsenbein C, Ross S. A re-evaluation of osseous surgery. Dent Clin North Am 1969 Jan;13(1):87-102.
  7. Seibert, JL.; Lindhe, J. Esthetics and periodontal therapy. In: Lindhe J, editor. Textbook of clinical periodontology. 2nd ed. Copenhagen: Munksgaard; 1989. pp. 477-514.
  8. Kan, JY, Rungcharassaeng K, Umezu K, Kois J. Dimensions of the peri-implant mucosa: an evaluation of maxillary anterior single implants in humans. J Periodontal 2003 Apr;74(4): 557-562.
  9. Jung RE, Holderegger C, Sailer I, Khraisat A, Suter A, Hammerle CH. The effect of all ceramic and porcelain fused-tometal restorations on marginal peri-implant soft tissue color: a randomized controlled clinical trial. Int J Periodontics Restorative Dent 2008 Aug;28(4):357-365.
  10. Kan JY, Rungcharassaeng K, Morimoto T, Lozada JL. 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;67 (11 Suppl):40-48.
  11. Vandana KL, Savitha B. Thickness of gingiva in association with age, gender and dental arch location. J Clin Periodontol 2005 Jul;32(7):828-830.
  12. Fu JH, Yeh CY, Chan HL, Tatarakis N, Leong DJ, Wang HL. Tissue biotype and its relation to the underlying bone morphology. J Periodontol 2010 Apr;81(4):569-574.
  13. Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restorative Dent 2010 Jun;30(3):237-243.
  14. Muller HP, Schaller N, Eger T. Ultrasonic determination of thickness of masticatory mucosa: a methodological study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999 Aug;88(2):248-253.
  15. Kydd WL, Daly CH, Wheeler JB. The thickness measurement of masticatory mucosa in vivo. Int Dent J 1971 Dec;21(4): 430-441.
  16. Barriviera M, Duarte WR, Janua'rio AL, Faber J, Bezerra AC. A new method to assess and measure palatal masticatory mucosa by cone-beam computerized tomography. J Clin Periodontol 2009 Jul;36(7):564-568.
  17. Goaslind GD, Robertson PB, Mahan CJ, Morrison WW, Olson JV. Thickness of facial gingiva. J Periodontol 1977 Dec;48(12):768-771.
  18. Olsson M, Lindhe J. Periodontal characteristics in individuals with varying form of the upper central incisors. J Clin Periodontol 1991 Jan;18(1):78-82.
  19. Anderegg CR, Metzler DG, Nicoll BK. Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects. J Periodontol 1995 May;66(5):397-402.
  20. Wennström JL, Zucchelli G. Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol 1996 Aug;23(8):770-777.
  21. Studer SP, Allen EP, Rees TC, Kouba A. The thickness of masticatory mucosa in the human hard palate and tuberosity as potential donor sites for ridge augmentation procedures. J Periodontol 1997 Feb;68(2):145-151.
  22. Müller HP, Heinecke A, Schaller N, Eger T. Masticatory mucosa in subjects with different phenotypes. J Clin Periodontol 2000 Sep;27(9):621-626.
  23. Müller HP, Schaller N, Eger T, Heinecke A. Thickness of masticatory mucosa. J Clin Periodontol 2000 Jun;27(6):431-436.
  24. Wara-aswapati N, Pitiphat W, Chandrapho N, Rattanayatikul C, Karimbux N. Thickness of palatal masticatory mucosa associated with age. J Periodontol 2001 Oct;72(10):1407-1412.
  25. Müller HP1, Eger T. Masticatory mucosa and periodontal phenotype: a review. Int J Periodontics Restorative Dent 2002 Apr;22(2):172-183.
  26. Müller HP, Könönen E. Variance components of gingival thickness. J Periodontal Res 2005 Jun;40(3):239-244.
  27. Savitha B, Vandana KL. Comparative assessment of gingival thickness using transgingival probing and ultrasonographic method. Indian J Dent Res 2005 Oct-Dec;16(4):135-139.
  28. 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 May;36(5): 428-433.
  29. Cuny-Houchmand M, Renaudin S, Leroul M, Planche L, Guehennec LL, Soueidan A. Gingival biotype assessment: visual inspection relevance and maxillary versus mandibular comparison. Open Dent J 2013 Jan;7:1-6.
  30. Stein JM, Lintel-Höping N, Hammächer C, Kasaj A, Tamm M, Hanisch O. The Gingival biotype: measurement of soft and hard tissue dimensions—a radiographic morphometric study. J Clin Periodontol 2013 Dec;40(12):1132-1139.
  31. Hwang D, Wang HL. Flap thickness as a predictor of root coverage: a systematic review. J Periodontol 2006 Oct;77(10): 1625-1634.
  32. Kolliyavar B, Setty S, Thakur SL. Determination of thickness of palatal mucosa. J Indian Soc Periodontol 2012 Jan;16(1):80-83.
  33. Zigdon H, Machtei EE. The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res 2008 Apr;19(4):387-392.
  34. Bouri A Jr, Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 2008 Mar-Apr;23(2):323-326.
  35. Linkevicius T, Apse P, Grybauskas S, Puisys A. The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implants 2009 Jul-Aug;24(4):712-719.
  36. Lee A, Fu JH, Wang HL. Soft tissue biotype affects implant success. Implant Dent 2011 Jun;20(3):e38-e47.
  37. Cook DR, Mealey BL, Verrett RG, Mills MP, Noujeim ME, Lasho DJ, Cronin RJ Jr. Relationship between clinical periodontal biotype and labial plate thickness: an in vivo study. Int J Periodontics Restorative Dent 2011 Jul-Aug;31(4):345-354.
  38. Foushee DG, Moriarty JD, Simpson DM. Effects of mandibular orthognathic treatment on mucogingival tissues. J Periodontol 1985 Dec;56(1):727-733.
  39. Zachrisson, BU. Orthodontics and periodontics. In: Lindhe J, Karring T, Lang NP, editors. Clinical periodontology and implant dentistry. 3rd ed. Copenhagen: Munksgaard; 1997. pp. 741-793.
  40. Reiser GM, Rabinovitz Z, Bruno J, Damoulis PD, Griffin TJ. Evaluation of maxillary sinus membrane response following the elevation with the crestal osteotome technique in human cadavers. Int J Oral Maxillofac Implants 2001 Nov- Dec;16(6):833-840.
  41. Schwartz-Arad D, Herzberg R, Dolev E. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol 2004 Apr;75(4):511-516.
  42. Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus. J Oral Maxillofac Surg 2006 Feb;64(2):277-282.
  43. Berengo M, Sivolella S, Majzoub Z, Cardioli G. Endoscopic evaluation of the bone-added osteotome sinus floor elevation procedure. Int J Oral Maxillofac Surg 2004 Mar;33(2):189-194.
  44. van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing DB. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000 Jun;11(3):256-265.
  45. 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):1128-1132.
  46. Tissot RJ, Sullivan HC. Evaluation of survival of partial thickness and full thickness flaps. J Dent Res 1971;50:170.
  47. Mormann W, Schaer F, Firestone AR. The relationship between success of free gingival grafts and transplant thickness. Revascularization and shrinkage—a one year clinical study. J Periodontol 1981 Feb;52(2):74-80.
  48. McFall WT Jr. The laterally repositioned flap—criteria for success. Periodontics 1967 Mar-Apr;5(2):89-92.
  49. Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, Cortellini P. Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol 1999 Sep;70(9): 1077-1084.
  50. Cho KH, Yu SK, Lee MH, Lee DS, Kim HJ. Histological assessment of the palatal mucosa and greater palatine artery with reference to subepithelial connective tissue grafting. Anat Cell Biol 2013 Sep;46(3):171-176.
  51. Ahmad I. Anterior dental aesthetics: dental perspective. Br Dent J 2005 Aug;199(3):135-141.
  52. Atwood DA. Post extraction changes in the adult mandible as illustrated by microradiographs and mid-sagittal section and serial cephalometric roentgenographs. J Prosthet Dent 1963;13:810-816.
  53. Uchida H, Kobayashi K, Nagao M. Measurement in vivo of masticatory mucosal thickness with 20 MHz B-mode ultrasonic diagnostic equipment. J Dent Res 1989 Feb;68(2):95-100.
  54. Hermann JS, Buser D, Schenk RK, Schoolfield JD, Cochran DL. Biologic width around one- and two-piece titanium implants. Clin Oral Implants Res 2001 Dec;12(6):559-571.
  55. Cardaropoli G, Lekholm U, Wennstrom JL. Tissue alterations at implant-supported single-tooth replacements: a 1-year prospective clinical study. Clin Oral Implants Res 2006 Apr; 17(2):165-171.
  56. Berglundh T, Lindhe J. Dimension of the peri implant mucosa. Biological width revisited. J Clin Periodontol 1996 Oct;23(10):971-973.
  57. Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 2005 Oct;76(10):1729-1734.
  58. Abrahamsson I, Berglundh T, Wennstrom J, Lindhe J. The peri implant hard and soft tissues at different implant systems. A comparative study in the dog. Clin Oral Implants Res 1996 Sep;7(3):212-219.
  59. Goodacre CJ, Kan JY, Rungcharassaeng K. Clinical complications of osseointegrated implants. J Prosthet Dent 1999 May;81(5):537-552.
  60. Kois JC. Predictable single-tooth peri-implant esthetics: five diagnostic keys. Compend Contin Educ Dent 2004 Nov;25(11):895-900.
  61. Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res 2008 Jan;19(1):73-80.
  62. 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):1048-1055.
  63. Nagaraj KR, Savadi CR, Savadi AR, Prashanth Reddy GT, Srilakshmi J, Dayalan M, John J. Gingival biotype— prosthodontic perspective. J Indian Prosthodont Soc 2010 Mar;10(1):27-30.
  64. Jung RE, Sailer I, Hämmerle CH, Attin T, Schmidlin P. In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent 2007 Jun;27(3): 251-257.
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