The Width of Keratinized Gingiva During Orthodontic Treatment: Its Significance and Impact on Periodontal Status

Abstract

This study was performed to evaluate the effects of orthodontic therapy on the width of the zone of keratinized gingiva. Pre‐ and post‐treatment photographic slides, plaster study casts, and cephalograms were examined. The labial surfaces of 966 teeth in a sample of 100 orthodontic patients were studied. Widths of the keratinized gingiva were determined from photographic slides. Crown lengths were measured from the study casts, and measurements were performed on the cephalograms. Data were collected and analyzed in three categories: 1) The overall changes in the width of the keratinized gingiva and the lengths of the clinical crowns during the course of orthodontic therapy; 2) An analysis of grouped data with a comparison of the pre‐existing widths of keratinized gingiva to the post‐treatment periodontal status of the patient; and 3) A correlation analysis of the changes in the dimensions of the tissues to the changes in tooth position as measured on the cephalograms. The results of the study revealed: 1) Increases in the width of the keratinized gingiva may occur on some teeth during the course of orthodontic therapy; 2) Statistically significant increases in the clinical crown during orthodontic therapy are not reflected in statistically significant decreases in the width of keratinized gingiva; 3) Minimal widths of keratinized gingiva (less than 2 mm) are capable of withstanding the stresses of orthodontic mechanics; 4) Teeth that are lacking in any keratinized gingiva prior to orthodontic treatment will not form any new keratinized tissue during the course of orthodontic therapy; 5) Mucogingival problems noted after orthodontic therapy are often the result of a pre‐existing mucogingival problem; 6) Changes in the dimensions of the keratinized gingiva correlated statistically with the orthodontic movement of the maxillary central incisors (P < 0.001) and, with the maxillary and mandibular cuspids (P < 0.02).

Gingival Recession in Orthodontics: A Review

“…In the mandibular arch, the central incisors (10%) and the first premolars (8%) showed the highest prevalence of recession. The authors stated that the results from their sample were similar to that observed in epidemiologic studies for both orthodontic [48], [50], [66] and non-orthodontic samples [17], [18], [20].…”

“…Also, dental casts may have artifacts around the gingival margin. A method for measuring recession as an interval level variable using a combination of dental casts and intraoral photographs was established by based on a method originally applied by Coatoam et al [17]. In the study by Coatoam et al [17], the width of keratinized gingiva on the facial surface of the mandibular incisors was measured from slides that were calibrated for size using the corresponding dental casts.…”

Role of Gingival Tissue Biotype in Periodontal Management

“…A change of the tooth position in buccal direction results in reduced dimensions of the buccal gingiva, while an increase is observed following a lingual tooth movement. [7] Müller and Könönen in 2005 demonstrated that most of the variation in gingival thickness was due to the tooth position and that the contribution of subject variability was minimal. [8] Gingival Biotype And Periodontal Treatment Planning:…”

A New Innovative Approach for Treatment of Gingival Recession: A Clinical Case

“…Gingival recession is the apical migration of the gin gival margin to the cementoenamel junction, either coagnated with inflammatory periodontal disease 1 and mechanical trauma 2 or with the presence of a host of predisposing factors that include tooth malposition and root prominence, gingival phenotype, 3 underlying alveolar dehiscence, 4,5 orthodontic tooth movement, 4,6 aberrant frenulum attachment 7 and iatrogenic restorative and periodontal treatmentrelated factors (surgical recession). 8 For the correction and management of muco gingival deformities and defects, variety of perio dontal plastic surgery procedures have been described in the literature, with the aim to set up and preserve the dentition and periodontium, healthy and functional with most favorable esthetics throughout the life time.…”