Metrika

  • citati u SCIndeksu: 0
  • citati u CrossRef-u:0
  • citati u Google Scholaru:[]
  • posete u poslednjih 30 dana:13
  • preuzimanja u poslednjih 30 dana:7

Sadržaj

članak: 1 od 28  
Back povratak na rezultate
2022, vol. 79, br. 8, str. 805-810
Biotip gingive - komparativna analiza različitih metoda ispitivanja
aUniverzitet u Prištini sa privremenim sedištem u Kosovskoj Mitrovici, Medicinski fakultet, Katedra za Stomatologiju
bVojnomedicinska akademija, Klinika za stomatologiju, Beograd
cUniverzitet u Beogradu, Medicinski fakultet

e-adresafilip85dj@gmail.com
Sažetak
Uvod/Cilj. Biotip gingive može imati značajan uticaj na ishod parodontalnih terapijskih postupaka i predvidljivost njihovog estetskog ishoda. Postoji visoka korelacija između biotipa i potencijalne recesije gingive nakon restaurativnih, parodontalnih i implantoloških hirurških zahvata. Stoga je tačna identifikacija biotipa gingive, pre započinjanja ovih postupaka, jedan od značajnih prediktivnih faktora njihovog uspeha. Cilj rada bio je da se proceni pouzdanost određivanja biotipa gingive primenom vizuelne metode i metoda parodontalnog i transgingivalnog sondiranja u odnosu na direktnu metodu merenja. Metode. Prospektivnom studijom obuhvaćena su 33 pacijenta kod kojih je bila indikovana resekcija vrha korena zuba u interkaninom sektoru gornje vilice. Identifikacija gingivalnog biotipa izvršena je kod svih pacijenata primenom: 1) vizuelne metode; 2) tehnike parodontalnog sondiranja; 3) tehnike transgingivalnog sondiranja i 4) direktnog merenja nakon odizanja režnja. Statistička analiza dobijenih podataka izvršena je radi procene dijagnostičke tačnosti vizuelne metode, parodontalnog sondiranja i transgingivalnog sondiranja u odnosu na direktnu metodu, koja se koristi kao zlatni standard u cilju evaluacije biotipa gingive (tanak nasuprot debelom). Rezultati. Ukupna tačnost testiranih dijagnostičkih postupaka u određivanju biotipa gingive, u poređenju sa metodom direktnog merenja, bila je: vizuelna metoda - 66,7%; parodontalno sondiranje - 78,8%; transmukozno sondiranje - 97,0%. Zaključak. Parodontalna metoda sondiranja može se preporučiti za određivanje biotipa gingive kao rutinska metoda, s obzirom da je njena senzitivnost i ukupna tačnost veća u odnosu na vizuelnu metodu. U pogledu senzitivnosti i sveobuhvatne tačnosti, transgingivalna metoda se gotovo u potpunosti poklapa sa direktnom metodom, ali je invazivnija u poređenju sa metodom parodontalnog sondiranja i mora se sprovesti uz prethodnu primenu lokalne anestezije.

Introduction

In recent years, the characteristics of the oral mucosa, especially gingival thickness, have become the subject of interest for both implantologists and periodontists, epidemiologists, and many others. The term "gingival biotype" has been used to describe the thickness of gingiva in vestibulooral direction [1][2][3]. The first analysis of gingival anatomy in this sense was given in 1969 by Ochsenbein and Ross [4], who described two main types of gingival morphology: flat and thick, and thin and scalloped gingiva. They have indicated a connection between the gingival contour and the contour of the underlying alveolar bone. Based on this classification, Seibert and Lindhe [5] later introduced the term "periodontal biotype", which further categorized gingiva into thick-flat and thin-scalloped biotypes.

After observing different variations of keratinized tissue and with the increasing use of dental implants, in 1997, Müller and Eger [6] joined the term gingival and periodontal biotype into a soft tissue biotype, which includes both tooth tissue and tissue around implants.

In general, it can be said that a gingival thickness of ≤ 1 mm is defined as a thin biotype and a gingival thickness of ≥ 1 mm as a thick biotype [7]. A thick biotype exists in about 85% of cases; it is characterized by thick gingival tissue and is usually associated with good periodontal health. It has a sufficient width of the attached gingiva, is more resistant to trauma and thus to recessions, and is much easier to be manipulated during surgical procedures. This is explained by the presence of a high percentage of extracellular matrix and collagen that allows tissue contraction as well as good vascularization. The thin biotype is present in the remaining 15% of cases. It is usually transparent and has a small attachment zone. It is usually characterized by bone defects, such as dehiscence and fenestration underneath, and is less resistant to inflammation and trauma [8][9].

Numerous studies [8][10][11][12][13][14] have shown that gingival biotype can have a significant impact on the outcome of the therapeutic procedures and the predictability of the aesthetic outcome. There is a strong correlation between gingival biotype and possible gingival recession after restorative, periodontal, and implant surgical procedures. Therefore, accurate identification of gingival biotype before initiating these procedures is one of the essential predictive factors for their success. In that sense, there is a number of methods for determining the gingival biotype: the visual method [2][10] biotype identification method with the use of periodontal probe [11], direct measurement of the gingival thickness [15], trans-gingival probing [16], ultrasonic measurement and cone-beam computed tomography (CBCT) radiographic examination [17][18][19][20][21].

The aim of this study was to evaluate the reliability of the gingival biotype determination by using the visual method, periodontal probe, and trans-gingival probing in relation to the direct measurement method.

Methods

This prospective clinical study was performed at the Department of Oral Surgery of the Clinic of Dental Medicine, Faculty of Medicine, University in Priština/Kosovska Mitrovica, Kosovska Mitrovica, Serbia, and the private dental practice "Radix" in Kruševac, Serbia. The selection of patients who participated in the study was done according to pre-established criteria. All patients were older than 18 years, had good oral hygiene, and were previously indicated for apical surgery in the intercanine sector of the upper jaw due to chronic periapical lesions that could not be treated endodontically. In addition, an important parameter was the existing indication for the use of a flap design with a horizontal intrasulcular incision. Additional parameters were the presence of attached gingiva > 5 mm wide, as well as a negative history of previous interventions in the intercanine sector of the upper jaw, such as soft tissue augmentation, treatment for gingival recessions, or esthetic extension of the clinical tooth crowns. Patients with fixed prosthetic works, marginal gingiva inflammation, systemic diseases, and bad habits that could compromise the results, such as smoking, alcoholism, or oral breathing due to airway obstruction, were excluded from the study. Systemic therapy with medications that might affect the oral and gingival condition also represented an exclusive factor.

The study included 33 patients (20 males and 13 females) aged 18-72 years. Gingival biotype identification was performed in the lateral incisor zone in 17 patients, the central in 11 patients, and the canine in 5 patients. The evaluation was performed first by visual method and then by periodontal probing. After administrating infiltration anesthesia to perform oral surgery, gingival biotype identification was performed using trans-gingival probing. In the end, immediately after the full-thickness mucoperiosteal flap elevation, a direct measurement of gingival thickness was performed using a modified caliper. The entire testing procedure was performed by the same researcher.

Visual method

A visual method of gingival biotype assessment was performed by observing the appearance of the gingiva in the dental area where oral surgery was indicated and also by observing other teeth of the upper intercanine region as follows: thick biotype - the gingiva around the observed tooth is thickened and fibrous, the interdental papillae towards the adjacent teeth are short, the contact points are wide, teeth are of square shaped, with pronounced cervical convexity (Figure 1); thin biotype-the gingiva around the observed tooth looks thin and delicate, the interdental papillae are narrow and long, the contact points to adjacent teeth are narrow and more incisally displaced, while the teeth are elongated and triangular in shape (Figure 2).

Figure 1 Thick gingival biotype

Figure 2 Thin gingival biotype. Note the gingival recessions on teeth 11, 21, and 22 – a common clinical finding associated with the thin gingival biotype

Periodontal probing

Periodontal assessment of gingival biotype was performed using a periodontal probe (WHO Probe 550b, LM Dental). Clinical evaluation was done by sulcus probing in the central part of the vestibular side of the tooth, on which oral surgery was indicated (Figure 3). The gingival biotype was classified according to the visibility of the periodontal probe through the gingival tissue as follows: thick biotypethe periodontal probe is not visible through the gingival tissue; thin biotype - the periodontal probe is visible through the gingival tissue [11].

Figure 3 Periodontal examination of gingiva thickness

Trans-gingival probing

Gingival biotype assessment, using trans-gingival (mucosal) probing, was done by measuring its thickness with a root canal instrument number 25 with a rubber stopper (K-file Maillefer, Dentsply). After applying infiltration anesthesia in order to perform the planned oral-surgical intervention, a root canal instrument was used to pierce the soft tissue of the gingiva on the vestibular side of the tooth indicated for surgery at a distance of 3 mm from the marginal gingival edge, set perpendicular relative to the alveolar ridge till the bone contact. The rubber stopper of the root canal instrument was then placed on the surface of the alveolar ridge mucosa (Figure 4). After that, the distance from the tip of the needle to the rubber stopper was measured with a millimeter ruler, based on which the gingival biotype was identified as follows: thick biotype - the distance between the tip of the root canal instrument and the stopper was > 1mm; thin biotype - the distance between the tip of the root canal instrument and the stopper was < 1mm [22].

Figure 4 Trans-gingival probing

Direct measurement

The modified caliper with a millimeter ruler (Wax caliper, Odontomed), with tips blunted to minimize the pressure and trauma to the soft tissue, was used for the direct measurement of the gingival thickness (Figure 5). After the fullthickness flap elevation, the gingival thickness on the vestibular side of the tooth was measured at a distance of 3 mm from the edge of the marginal gingiva, based on which the gingival biotype was classified, namely: thick biotype-gingival thickness was > 1 mm; thin biotype-gingival thickness was < 1mm [7].

Figure 5 Direct measurement

After all the measurements for each patient, the obtained results were statistically processed. Measures of sensitivity, specificity, and overall accuracy were applied to assess the diagnostic accuracy of the visual method, periodontal biotype identification, and trans-gingival probing in relation to the direct measurement method, used as a gold standard, the most objective method to discriminate the gingival thickness biotype (thin versus thick) [7].

Results

To assess the diagnostic accuracy of visual, periodontal, and trans-gingival probing methods for discrimination of gingival thickness biotype (thin to thick), measures of sensitivity, specificity, and overall accuracy, in relation to direct measurement, were applied.

Although invasive, the direct method of measurement is considered the reference method in most studies. The success of all other methods is measured according to the direct method. The results obtained in this study showed that the average gingival thickness, measured by the direct method, was 0.982 mm, with an almost uniform distribution of gingival thickness values larger or smaller than this average (51.5% larger and 48.5% smaller than the mean value). For this reason, we can agree that a borderline value between the gingival thickness for thin and thick gingival biotypes could be considered 1 mm.

By examining the gingival biotype in 33 patients with the visual method, a thin biotype was diagnosed in 8 (24.2%) cases, while a thick biotype was diagnosed in 25 (75.8%) cases (Table 1). When the periodontal examination was used, a thin biotype was found in less and a thick one in more cases, while, when the trans-gingival method was used, a thin biotype was found in most and a thick one in the least number of respondents (Table 1). Direct measurements of the gingival thickness, however, resulted in a thin biotype in 51.5% of respondents and a thick one in 48.5% (Table 1).

Table 1. Frequency of different gingival biotypes determined by visual method, periodontal probing, trans-gingival method and direct methods

Method Frequency Percent Valid percent Cumulative percent
Visual
 thin biotype 8 24.2 24.2 24.2
 thick biotype 25 75.8 75.8 100.0
Total 33 100.0 100.0
Periodontal probing
 thin biotype 12 36.4 36.4 36.4
 thick biotype 21 63.6 63.6 100.0
Total 33 100.0 100.0
Trans-gingival
 thin biotype 18 54.5 54.5 54.5
 thick biotype 15 45.5 45.5 100.0
Total 33 100.0 100.0
Direct
 thin biotype 17 51.5 51.5 51.5
 thick biotype 16 48.5 48.5 100.0
Total 33 100.0 100.0

When examining the diagnostic accuracy of different methods for identifying a thin biotype, the compatibility of results between visual and direct methods was determined in only 7 out of 17 cases. The statistical analysis showed that the value of sensitivity of this method was 41.2% for thin biotype identification, relative to the direct measurement used as a gold standard. On the other hand, the accuracy of this method in identifying the thick biotype was noticed in 15 out of 16 cases identified using the direct method, which indicates a specificity value of 93.8%. Based on the presented results, the calculated overall accuracy value was 66.7% (Table 2 and Table 3).

Table 2. Compatibility of results: visual method, periodontal probing, and trans-gingival probing in relation to the direct method

Method Direct nominal Total
thin biotype thick biotype
Visual
 thin biotype 7 1 8
 thick biotype 10 15 25
Total 17 16 33
Periodontal probing
 thin biotype 11 1 12
 thick biotype 6 15 21
Total 17 16 33
Trans-gingival
 thin biotype 17 1 18
 thick biotype 0 15 15
Total 17 16 33

Table 3. Diagnostic accuracy measures of the tested methods in relation to the direct method

Diagnostic accuracy measures Visual method Periodontal probing Trans-gingival probing
Sensitivity (Se), % 41.2 (18.4–67.1) 64.7 (38.3–85.8) 100.0 (72.7–100.0)
Specificity (Sp), % 93.8 (69.8–99.8) 93.8 (69.8–99.8) 93.8 (69.8–99.8)
Overall accuracy, % 66.7 (48.2–82.0) 78.8 (61.1–91.0) 97.0 (84.2–99.9)

Results are given as mean (95% confidence interval)

With the use of the periodontal probing method, a thin gingival biotype was diagnosed in 11 out of 17 cases determined by direct measurement. When examining the thick biotype, compatibility with the direct measurements was in 15 out of 16 cases, indicating its sensitivity of 64.7%, while the specificity was 93.8%. The overall accuracy of the periodontal probing method was 78.8% (Table 2 and Table 3).

The sensitivity of the trans-gingival method in the thin gingival biotype identification, in relation to the direct measurement, was 100.0%, while the specificity was 93.8%. Its overall accuracy was 97.0% (Table 2 and Table 3).

Discussion

Gingival biotype is an important clinical parameter that can affect not only the success but also the planning and prognosis of the programmed restorative, periodontal, or implant procedure. The thin gingival biotype around natural teeth increases the risk of gingival recession after surgical, restorative, or even mechanical trauma [6][22][23]. A similar phenomenon has also been noticed in the peri-implant mucosa [24]. In addition, this gingival biotype is often associated with the presence of a thin lamellar bone around the teeth, together with the presence of fenestration and dehiscence, which can be a significant limiting factor in terms of possible immediate implant procedures. From a dental implantology point of view, it is important to emphasize that the frequency of gingival recession, around the implant, after the replacement of one lost tooth increases with the reduction of gingival thickness [25]. In addition, Hwang and Wang [26] concluded in their histological study that a thin gingival biotype at the implantation site is more likely to have angulated bone defects, in contrast to a thick biotype where greater stability of the cortical bone is noticed [27]. Finally, the success of numerous periodontal procedures for the coverage of gingival recessions is significantly lower in patients with a thin gingival genotype [27][28]. Bearing in mind all the mentioned data concerning the significance of the gingival biotype, numerous methods have been developed to evaluate the thickness of the gingival tissue.

The visual method of gingival biotype identification represents the simplest and one of the most commonly used methods. However, its biggest deficiency is the lack of standardization among accurate clinical parameters, so the method itself is often based on the subjective evaluation and experience of the dentist alone. This is the main reason why the precision of this method is insufficient compared to the others available to clinicians [9]. According to the results of this study, when using the visual method in gingival biotype detection, a thin gingival biotype was noticed in only 24.2% of cases, which is markedly different compared to the direct method taken as a reference, where the percentage was 51.5%. This discrepancy is smaller in other examined methods. Concerning the identification of the thick biotype, the diagnostic accuracy of this method showed its sensitivity of 41.2%, while its overall accuracy was 66.7% and specificity 93.8%. In addition, unlike the previous parameters, it does not differ from other examined methods, which indicates that the possibility of erroneous identification of a thin biotype by this method was far greater than that of a thick one.

According to different authors, a much more suitable method for determining gingival biotype is periodontal probing [6][7]. The procedure is quite simple, with precise clinical parameters, which reduces the possibility of subjective assessments in contrast to the visual method. On the other hand, it is less invasive compared to the trans-gingival and direct methods. The trans-gingival method requires the application of anesthesia in an examined area, while the direct method can be used only during the surgical intervention and cannot be used to determine the gingival biotype in order to plan and predict the success of the future treatment. The results of this study show that the concordance of the measurements of the periodontal and the direct method in determining the thin biotype is higher than when using the visual method. Statistical analysis showed that its sensitivity value was higher compared to the visual method, although still lower compared to the transgingival method. Similarly, the value of the overall accuracy was 78.8%, and it is higher compared to the visual method, which gives an advantage to this method for determining the gingival biotype. On the other hand, it is lower compared to the much more invasive trans-gingival method. For this reason, the method of periodontal probing can be recommended as a method of choice in everyday routine practice.

The sensitivity of the trans-gingival method, as well as the overall accuracy, is the highest of all examined methods - 100% and 97%, respectively, and, therefore, almost coincides with the direct method. During the study, a slightly larger deviation in the values of gingival thickness was observed compared to the direct method in the thick biotype (> 1 mm), which is explained by the incomplete insertion of a needle into the thickened gingival tissue. However, these discrepancies do not affect the overall results of this study. Therefore, although invasive and in need of local anesthesia of the examined area, which is considered a shortcoming of this method, compared to the method of periodontal probing, it is still more precise, almost at the level of the direct method. In addition, it can be used for preoperative evaluations.

This almost coincides with the findings of Kan et al. [7], who found the average gingival thickness of 1.06 mm.

Conclusion

The periodontal probing can be recommended for gingival biotype determination as a routine method because its sensitivity and overall accuracy (in relation to direct measurement) are higher compared to the visual method, and it is less invasive compared to the trans-gingival method, although not as accurate.

References

1.Kan JYK, 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;67(11 Suppl):40-8.
2.Kan JYK, Rungcharassaeng K. Site development for anterior single implant esthetics: The dentulous site. Compend Contin Educ Dent. 2001;22(3):221-6, 228, 230‒1; quiz 232.
3.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):428-433.
4.Ochsenbein C, Ross S. A Reevaluation of Osseous Surgery. Dent Clin North Am. 1969;13(1):87-102.
5.Seibert JL, Lindhe J. Esthetics and periodontal therapy. In: Lindhe J, editor(s). Textbook of Clinical Periodontology. Denmark, Copenhagen: Munksgaard. 1989; p. 477-514.
6.Muller H, Eger T. Gingival phenotypes in young male adults. J Clin Periodontol. 1997;24(1):65-71.
7.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;30(3):237-43.
8.Joshi N, Agarwal MC, Madan E, Gupta S, Law A. Gingival biotype and gingival biofilm: determining factors for periodontal disease progression and treatment outcome. Int J Sci Study. 2016;4(3):220-225.
9.Ahmadi RS, Tavassoli R, Sayar F, Ghaffari K, Sarlati F. Gingival thickness assessment: Visual versus direct measurement. J Islam Dent Assoc Iran (JIDAI). 2016;28(4):149-54.
10.Olssoin M, Lindhe J, Marinello CP. On the relationship between crown form and clinical features of the gingival in adolescents. J Clin Periodontol. 1993;20(8):570-7.
11.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;74(4):557-562.
12.Alves PHM, Alves TCLP, Pegoraro TA, Costa YM, Bonfante EA, de Almeida ALPF. Measurement properties of gingival biotype evaluation methods. Clin Implant Dent Relat Res. 2018;20(3):280-284.
13.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;41(Suppl 15):S123-42.
14.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;26(5):599-605.
15.Goaslind GD, Robertson PB, Mahan CJ, Morrison WW, Olson JV. Thickness of Facial Gingiva. J Periodontol. 1977;48(12):768-71.
16.Esfahrood ZR, Kadkhodazadeh M, Talebi Ardakani MR. Gingival biotype: A review. Gen Dent. 2013;61(4):14-7.
17.Kydd WL, Daly CH, Wheeler JB3rd. The thickness measurement of masticatory mucosa in vivo. Int Dent J. 1971;21(4):430-41.
18.Slak B, Daabous A, Bednarz W, Strumban E, Maev RG. Assessment of gingival thickness using an ultrasonic dental system prototype: A comparison to traditional methods. Ann Anat. 2015;199:98-103.
19.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):569-574.
20.Lindhe J, Lang N, Karring T. Clinical periodontology and implant dentistry. 5th ed. Hoboken: Wiley-Blackwell. pp 69-71. 2008.
21.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.
22.Cosyn J, Sabzevar MM, de Bruyn H. Predictors of inter-proximal and midfacial recession following single implant treatment in the anterior maxilla: A multivariate analysis. J Clin Periodontol. 2012;39(4):895-903.
23.Muller HP, Eger T, Schorb A. Gingival dimensions after root coverage with free connective tissue grafts. J Clin Periodontol. 1998;25(5):424-30.
24.Bengazi F, Wennström JL, Lekholm U. Recession of the soft tissue margin at oral implants: A 2-year longitudinal prospective study. Clin Oral Implants Res. 1996;7(4):303-310.
25.Evans CDJ, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res. 2008;19(1):73-80.
26.Hwang D, Wang HL. Flap Thickness as a Predictor of Root Coverage: A Systematic Review. J Periodontol. 2006;77(10):1625-1634.
27.Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L. 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):1077-1084.
28.Kahn S, Almeida RA, Dias AT, Rodrigues WJ, Barceleiro MO, Taba MJr. Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or Thick Biotype. Int J Periodontics Restorative Dent. 2016;36(3):409-415.
Reference
Novododat članak: provera, normiranje i linkovanje referenci u toku.
Kan JYK, 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; 67(11 Suppl): 40-8.
Kan JYK, Rungcharassaeng K. Site development for anterior single implant esthetics: The dentulous site. Compend Contin Educ Dent 2001; 22(3):221-6, 228, 230-1; quiz 232.
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.
Ochsenbein C, Ross S. A reevaluation of osseous surgery. Dent Clin North Am 1969; 13(1): 87-102.
Seibert JL, Lindhe J. Esthetics and periodontal therapy. In: Lindhe J, editor. Textbook of Clinical Periodontology. 2nd ed. Denmark, Copenhagen: Munksgaard; 1989. p. 477-514.
Müller HP, Eger T. Gingival phenotypes in young male adults. J Clin Periodontol 1997; 24 (1): 65-71.
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; 30(3): 237-43.
Joshi N, Agarwal MC, Madan E, Gupta S, Law A. Gingival biotype and gingival biofilm: determining factors for periodontal disease progression and treatment outcome. Int J Sci Study 2016; 4(3): 220-5.
Ahmadi RS, Tavassoli R, Sayar F, Ghaffari K, Sarlati F. Gingival thickness assessment: Visual versus direct measurement. J Islam Dent Assoc Iran (JIDAI) 2016; 28(4): 149-54.
Olsson M, Lindhe J, Marinello CP. On the relationship between crown form and clinical features of the gingival in adolescents. J Clin Periodontol 1993; 20(8): 570-7.
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; 74(4): 557-62.
Alves PHM, Alves TCLP, Pegoraro TA, Costa YM, Bonfante EA, de Almeida ALPF. Measurement properties of gingival biotype evaluation methods. Clin Implant Dent Relat Res. 2018; 20(3): 280-4.
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; 41 Suppl 15: S123-42.
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; 26(5): 599-605.
Goaslind GD, Robertson PB, Mahan CJ, Morrison WW, Olson JV. Thickness of facial gingiva. J Periodontol 1977; 48(12): 768-71.
Esfahrood ZR, Kadkhodazadeh M, Talebi Ardakani MR. Gingival biotype: a review. Gen Dent 2013; 61(4): 14-7.
Kydd WL, Daly CH, Wheeler JB 3rd. The thickness measurement of masticatory mucosa in vivo. Int Dent J 1971; 21(4):430-41.
Slak B, Daabous A, Bednarz W, Strumban E, Maev RG. Assessment of gingival thickness using an ultrasonic dental system prototype: A comparison to traditional methods. Ann Anat 2015; 199: 98-103.
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; 81(4): 569-74.
Lindhe J, Lang N, Karring Th. Clinical Periodontology and Implant Dentistry. 5th ed. Hoboken: Wiley-Blackwell; 2008; pp 69-71.
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.
Cosyn J, Sabzevar MM, De Bruyn H. Predictors of inter-proximal and midfacial recession following single implant treatment in the anterior maxilla: a multivariate analysis. J Clin Periodontol 2012; 39(4): 895-903.
Muller HP, Eger T, Sorb A. Gingival dimensions after root coverage with free connective tissue grafts. J Clin Periodontol 1998; 25(5): 424-30.
Bengazi F, Wennström JL, Lekholm U. Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clin Oral Implants Res 1996; 7(4): 303-10.
Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res 2008; 19(1): 73-80.
Hwang D, Wang HL. Flap thickness as a predictor of root coverage: a systematic review. J Periodontol 2006; 77(10): 1625-34.
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 19case series. J Periodontol 1999; 70(9): 1077-84.
Kahn S, Almeida RA, Dias AT, Rodrigues WJ, Barceleiro MO, Taba MJr. Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or Thick Biotype. Int J Periodontics Restorative Dent 2016; 36(3): 409-15.
 

O članku

jezik rada: engleski
vrsta rada: originalan članak
DOI: 10.2298/VSP210318056D
primljen: 18.03.2021.
revidiran: 13.05.2021.
prihvaćen: 21.05.2021.
objavljen onlajn: 22.05.2021.
objavljen u SCIndeksu: 03.09.2022.
metod recenzije: dvostruko anoniman
Creative Commons License 4.0

Povezani članci

Nema povezanih članaka