In Vivo Evaluation of Periodontal Phenotypes Using Cone-Beam Computed Tomography, Intraoral Scanning by Computer-Aided Design, and Prosthetic-Driven Implant Planning Technology

Abstract

Background Two clinical parameters, the gingival thickness (GT) and the width of keratinized tissue (WKT), describe the gingival phenotype, which is defined as the 3-dimensional volume of the gingiva. The periodontal phenotype additionally includes the thickness of the labial plate of the alveolar crest (TLPAC). Material/Methods Thirty patients with healthy periodontium on the upper canines and incisors underwent measurements for crestal, supracrestal, free gingival thickness (FGT), the alveolar crest-gingival margin (AC-GM), alveolar crest-cementoenamel junction distance, and the TLPAC at 2, 4, and 8 mm apically from the edge of the alveolar crest using cone-beam computed tomography (CBCT) with computer-aided design and prosthetic-driven implant planning technology. For each tooth, the gingival and periodontal phenotype was evaluated on the basis of the gingival thickness, width of keratinized tissue (WKT), and TLPAC measurements. Each patient’s periodontal phenotype was evaluated according to the coronal width/length ratio of both the upper central incisors. Results The dentogingival units had varying average values for the 3 periodontal phenotypes (thin phenotype: FGT 0.65±0.06 mm, WKT 4.85±1.18 mm, AC-GM 3.17±0.64 mm, TLPAC2 0.66±0.28 mm; medium phenotype: FGT 0.87±0.07 mm, WKT 5.49±1.23 mm, AC-GM 3.36±0.65 mm, TLPAC2 0.76±0.37 mm; and thick phenotype: FGT 1.20 mm, WKT 6.00 mm, AC-GM 3.90 mm, TLPAC2 0.90 mm). Positive correlations were seen among WKT, FGT, AC-GM, and TLPAC2. Conclusions Positive correlations between the FGT and WKT, and the AC-GM distance confirm that measurements using CBCT with computer-aided design and prosthetic-driven implant planning technology can evaluate the gingival phenotype and TLPAC2 for the periodontal phenotype.

Comparison of the Effectiveness of the Ultrasonic Method and Cone-Beam Computed Tomography Combined with Intraoral Scanning and Prosthetic-Driven Implant Planning Method in Determining the Gingival Phenotype in the Healthy Periodontium

“…Therefore, the biometric methods measuring the gingival thickness and the width of the keratinized tissue (WKT) seem to be burdened with a lower risk of measurement error. The measurement of WKT is commonly performed using a periodontal probe calibrated up to 1 mm, while gingival thickness measurement is carried out with the use of invasive, minimally invasive, or non-invasive methods [16][17][18][19][20][21][22][23]. An invasive examination is performed under local anesthesia by puncturing the soft tissues (bone sounding) with a periodontal probe, injection needle, or endodontic instrument [16,17,24].…”

“…An invasive examination is performed under local anesthesia by puncturing the soft tissues (bone sounding) with a periodontal probe, injection needle, or endodontic instrument [16,17,24]. Radiological examination (parallel profile radiographs, CBCT-cone beam computed tomography) is atraumatic method but associated with receiving a dose of ionizing radiation, whereas optical coherence tomography and ultrasound examination are non-invasive [18,21,22,25,26]. Retraction of lip and tongue from the alveolar processes and teeth during scanning of the patient, which is used in the Soft Tissue Cone Beam Computed Tomography (ST CBCT) technique, allows for very detailed imaging of periodontal soft tissues [12,27,28].…”

“…In modern CBCT devices, the risk of radiation is much more reduced [29], therefore, they are widely used in dental diagnostics [22,28,[30][31][32]. Moreover, 3D intraoral scanners are also utilized for imaging oral tissues, including teeth and the surface of the mucosa [22,[33][34][35][36].…”

“…In modern CBCT devices, the risk of radiation is much more reduced [29], therefore, they are widely used in dental diagnostics [22,28,[30][31][32]. Moreover, 3D intraoral scanners are also utilized for imaging oral tissues, including teeth and the surface of the mucosa [22,[33][34][35][36]. The scans of the gingiva and the mobile mucous membrane, conducted before the augmentation procedures, were superimposed on post-procedure scans, and the existing differences were compared, namely the increase in the volume of soft tissue.…”

“…Currently, the obtained images of the surfaces of the teeth, gingiva, and mucosa are saved as STL files. They could be imported into the software, together with the image of tissue received in the CBCT examination, and used in Prosthetic-Driven Implant Planning (PDIP) [22,36,37]. Three-dimensional visualization of oral tissues, based on combining the images of CBCT examination with the results of intraoral scanning, allows for more accurate and precise measurements of gingival thickness as well as the thickness of the labial alveolar bone plate to categorize periodontal phenotype.…”