ORIGINAL ARTICLE

Prevalence of different gingival biotypes in individuals

with varying forms of maxillary central incisors:A survey
Vinaya Bhat, Sonali Shetty
ABSTRACT

Gingival Perspective: The gingival perspective in restorative dentistry is important in harmonizing

esthetics and biological function. In this regard, the gingival biotypes have been stated to be thick
or thin. Patients with thin biotype are more prone to recession, inflammation, and compromised soft
tissue response. The correct recognition of gingival biotypes is important for the treatment of planning
process in restorative and implant dentistry. The purpose of the survey was to evaluate the prevalence
of different biotypes in individuals with varying forms of maxillary central incisors.
Materials and Methods: Atotal of 200 subjects visiting the outpatient department in the range
of 18-50years participated in the study. Three clinical parameters were recorded by one examiner.
This included the crown width/length ratio of the two central incisors, papillary height and gingival
thickness. The measurements were tabulated and evaluated.
Results and Conclusion: The thicker biotype was observed to be more prevalent in male population
with short, wider forms of maxillary central incisors while the females had thinner biotypes and narrow,
long form of maxillary central incisors. Among the different age groups, young group had a thicker
biotype(73) compared to older group(40). The mean papillary height was in the range of 4.3-4.7mm
with decreased height in the thicker biotypes.
KEY WORDS: Papillary height, thick biotype, thin biotype, varying forms

INTRODUCTION
Recently, in restorative dentistry, more emphasize is
being given to gingival perspective for harmonizing
esthetics along with function. Mimicking the gingival
silhouette as the adjacent teeth in any restorative
procedure exhibits an excellent treatment outcome.[1]
The gingival perspective depends on gingival complex,
tooth morphology, contact points, hard and soft tissue
Department of Prosthodontics, Including Crown and Bridge,
A.B Shetty Memorial Institute of Dental Sciences, Mangalore, India
Address for correspondence: Dr.Sonali Shetty,
Prosthodontist, Famdent Clinic, Andheri West, Mumbai, Maharashtra, India.
Email:sonaliscorpio@yahoo.com

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DOI:
10.4103/0974-6781.118888

116

considerations, periodontal bioform, and biotype.[2]

The gingival or periodontal biotype in humans have
been classified as thin or thick.[3] Various studies have
shown a wide range of clinical difference in form and
appearance in tissue biotypes.[4,5] The thick biotype
consists of flat soft tissue and thick bony architecture and
is most often found to be prevalent in the population.
This type of tissue form is dense and fibrotic with large
zone of attachment, thus making them more resistant to
gingival recession.[5]
On a contrary, thin gingival biotype is delicate,
thin with highly scalloped soft tissue with thin bony
architecture characterized by bony dehiscence and
fenestrations. Such type is more prone to recession,
bleeding, and inflammation. Claffey and Shanley [6]
defined the thickness not more than 1.5mm as a thin
biotype while more than 2mm as a thick biotype.
The importance of the clinical identification helps in
better determination of the treatment outcome. The
thinner periodontal biotype needs more attention when
extraction is carried out owing to their thin alveolar
plate.[5] The hard and soft tissue contouring is more
predictable after surgery in the case of thick biotype. The
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Bhat and Shetty: Prevalence of different gingival biotypes

value of thick biotype has been emphasized in increased

wound coverage, site protection, stability of implants
by creating a seal around implants. [1] Linkevicius
etal.,[7] studied the influence of soft tissue thickness
on crestal bone changes around implant, documented
significant peri implant bone loss in sites with thin tissue
compared to thick tissues. Nisapakultorn etal.,[8] in his
study on 40patients documented a thin biotype being
significantly associated with increased risk of facial
mucosal recession.
Various methodologies have been documented for
measurement of the gingival tissue form. This includes
visual inspection, ultrasonic devices, trans gingival
probing, and Cone beam computerized tomography
imaging.
The use of trans gingival probing serves as a simple
method but requires local anaesthesia leading to
distortion of soft tissues. The ultrasonic devices though
are noninvasive fail to determine minor differences in
gingival tissues.[9] The use of Cone beam computerized
tomography (CBCT) is gaining popularity in regards to the
same but this procedure requires technical expertise and
becomes expensive with higher radiographic exposure.[1]
Hence, the use of simple methods to identify the gingival
tissue biotype can help the clinician with the better
treatment planning and definitive treatment outcome.
Kan etal.,[10] in his study had stated a simple method
to differentiate between the gingival biotype, based on
the transparency of the periodontal probe through the
gingival margin. Hence, this survey was undertaken
to determine the prevalence of gingival biotype in the
Southwest coastal population of India, as related to the
varying forms of maxillary central incisors.

Objectives

1. To assess the gingival thickness(biotype)

2. To study the prevalence of gingival biotypes of upper
central incisors in relation to sex and age
3. To study the prevalence of gingival biotypes with
varying forms of central maxillary incisors
4. To determine the prevalence of gingival biotype in
relation to papillary height.

MATERIALS AND METHODS

A total of 200 subjects visiting the outpatient department
of A.B. Shetty Memorial Institute of Dental Sciences,
Mangalore, Karnataka in the age range of 18-50years,
participated in the survey. Based on the age, they were
divided into two groups, i.e.groupI(18-30years) and
groupII(30-50years). Further selection criteria were
fixed as follows:
Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2

Exclusion criteria

1. Subjects with restorations in the anterior maxillary

teeth
2. Pregnant or lactating mothers
3. Subjects with clinical signs of periodontal disease
having pockets more than 3mm
4. Orthodontic treatment, rotations
5. Subjects with clinical signs of periodontal disease or
clinical attachment loss.
A written informed consent was taken by the subjects to
participate in the study. Three clinical parameters were
recorded by one examiner to avoid bias. First, Crown
width/crown length ratio(CW/CL) of the right and
the left central incisor was measured.[11] The assessment
was recorded with the help of digital calipers. The crown
length was measured as the distance between the incisal
length of the crown and the free gingival margin or
Cemento enamel junction (CEJ) on the central incisors,
while the crown width was measured as the border
between the middle and the cervical portion[Figure1a
and b].
Secondly, papillary height(PH) was calculated as the
distance from the top of the papilla to a line connecting
the midfacial soft tissue margin of the two adjacent teeth
and the mean value was calculated[12][Figure2].
Lastly, the gingival thickness(GT) was assessed and
categorized into thick and thin on the site level. This
evaluation was based on measurement with the help
of periodontal probing into the sulcus at the midfacial
aspect of both the central maxillary incisors.[10]
If the outline of the underlying periodontal probe
could be seen through the gingival, it was categorized
as thin(score 0)[Figure3]. If it was not visible, it was
categorized as thick(score 1).
The measurements were tabulated.

RESULTS
1. Frequency distribution of different biotypes among
male and female-Among the male population, thicker
gingival biotype was observed to be more prevalent
with score 1(63%) while compared to thin form(37%).
Among the female subjects, higher prevalence of
thin biotype was found with a score0(59%) when
compared to males(41%)[Graph1]
2. Prevalence of varying central incisors(Crown
width/Length ratio) among different gender: The
frequency distribution of male population was
125 while female was 75 among the 200 subjects
participating. The male population had a ratio of 0.79
and 0.80 of the right and left central incisors resp.
117

Bhat and Shetty: Prevalence of different gingival biotypes

Figure 1a: Measurement of crown length

Figure 1b: Measurement of crown width

Figure 3: Evaluation of gingival thickness

Figure 2: Evaluation of papillary height

While female population have a ratio of 0.81 and

0.82 of the right and left central incisors, respectively.
Males had a short wide form while females had long,
narrow form.[Graph2]
3. Prevalence of different gingival biotypes in the
participants with varying forms of upper central
incisors in relation to age: Out of the total participants,
125 were in the younger age group(18-30years) while
75 were in the older age group(30-50years). Among
the young group, more participants had thick gingival
biotype(73) than then thinner biotype(42). In the older
age group, more prevalence of thinner biotype(40)
was seen compared to thicker biotype(35) [Graph3]
4. Prevalence of different gingival biotypes in
participants with varying forms of central maxillary
incisors: Among the participants with short, wide
tooth form of maxillary central incisors, 56% had a
thick gingival biotype while 44% had thin biotype
while for the long, narrow tooth form of central
incisors, 39% had thick gingival biotype while 62%
had thin biotype [Graph4]
5. Evaluation of PH in relation to gingival biotype:
The mean PH was found to be 4.7mm in males and
118

4.3mm in females. The PH was found to be lesser in

participants with thin biotype as compared to thick
biotype[Graph5].

DISCUSSION
Demands for an excellent esthetic outcomes requires
the establishment of periodontium and its compatibility
with the surrounding hard and soft tissues. Various
factors influence the position and form of gingival tissue
around the natural tooth or fixed prosthesis. The gingival
biotype plays an important role in harmonizing the ideal
esthetics for any restorative procedure. The objective of
the present survey was to evaluate the prevalence of the
different gingival tissue biotypes in individuals with
varying forms of upper central incisors. The survey was
carried on 200 subjects divided into two age groups.
The method of assessment of gingival biotype ranges
from assessment with periodontal probe, or visual
examination, ultrasonic devices or radiographic
methods. The use of the periodontal probe for
penetration within the sulcus was carried out in this
study. Kanetal.,[13] in their study concluded that the
Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2

Bhat and Shetty: Prevalence of different gingival biotypes





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Graph 3: Prevalence of different gingival biotypes in the

participants with varying forms of upper central incisors in
relation to age

Graph 5: Evaluation of papillary height in relation to gingival

biotype

gingival biotype identification with periodontal probe

and direct measurement is not statistically different
and is adequately reliable and objective. In contrast,
study conducted by Olsson etal.,[12] demonstrated no
significant association between visual and measured
gingival tissue forms. Eghbali etal., [14] also did a
study to compare the assessment of gingival biotype
in experienced and in experienced clinician. They
concluded that simple visual inspection could not
be relied as an effective method irrespective of the
clinicians experience.
The frequency distribution of GT states thicker
biotype(score 2) in males(63%) as compared to females.
Females have more number of thin biotype(59%)
while 41% have a thick biotype. The results stated
are in agreeable to those with De Rock etal.,[15] and
Muller etal.,[16] who stated 1/3rdof the sample to be
Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2


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Graph 4: Prevalence of different gingival biotypes in

participants with varying forms of central maxillary incisors

females with a thinner biotype. De rock etal. in their

study presented that male participants had thicker
gingiva to conceal the periodontal probe when compared
to female. Study by Eghbali etal.,[14] documented the
presence in 1/3rd of female samples with thin scalloped
gingival form while 2/3rd of the male samples with broad
band of keratinized tissue and thick flat biotype. They
also mentioned that the thin biotype in females was
associated with long slender teeth while males showed
quadratic teeth with thicker biotype.
The frequency distribution of prevalence of GT in relation
to groups of subjects with different combinations of
morphometric data related to central maxillary incisors
states that short, wider teeth are associated with thick
biotype while long slender teeth are associated with thin
biotype. Oschbein and Ross[17] were the first to document
the relation of flat thick gingival form with square tooth
form and thin gingival biotype with tapered tooth
form. Studies by Morris,[18] Lindhe[11] documented that
individuals with tapered crowns have a thinner biotype,
making them more susceptible to gingival recession.
Chow and Wang[19] in their review article stated the
presence of long narrow form with thin gingival tissue.
Seo etal.,[20] in their study did not find any statistically
119

Bhat and Shetty: Prevalence of different gingival biotypes

significant differences between the longer and shorter

teeth in relation to gingival biotypes.
On comparing the prevalence of gingival biotypes
between different age groups, the thicker biotype has
been more prevalent in younger age groups. Vandana
and Savita[21] in their study on GT on 32 individuals
showed thicker gingiva in younger age group and
stated that decrease in keratinisation and changes
in oral epithelium may be the contributing factors.
Chang[22] in his study stated that an inverse relationship
has found to be existing between PH and age. In the
present study, the decreased PH has been observed
in relation with thick biotype. Sanavi etal.,[23] in their
review article described that the inter root bone is
more in the thinner biotype. This in turn can cause
more recession. They also stated that the interproximal
papilla does not cover the spaces between two teeth
in thinner biotype as compared to thick biotype. This
could possible relate to increased amount of recession
and also the presence of thin biotype in older age
group. Chow etal.,[24] also evaluated various factors
associated with the appearance of gingival papillae and
found significant associations with age and the crown
form and GT. Olsson etal.,[11,12] documented that the
central incisors with narrow tooth form had greater
amount of recession when compared to incisors with
square form. With age, the interdental papilla recedes;
this explains the greater frequency of thin biotype seen
with older age group. Warasswapati etal.,[25] explained
that racial and genetic factors contributed significantly
for the same.

wider form of teeth while thinner scalloped biotype

is associated with long, narrow tooth form
2. The thicker biotype is more prevalent in male
population while the female population consists of
thin, scalloped gingival biotype
3. The thick flat biotype is seen in younger individuals
while older age group shows thin scalloped gingival
biotype
4. Decrease in PH is observed with thin biotype.

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The relevance of this survey in periodontal surgeries

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CONCLUSIONS
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120

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How to cite this article: Bhat V, Shetty S. Prevalence of different gingival
biotypes in individuals with varying forms of maxillary central incisors:
A survey. J Dent Implant 2013;3:116-21.
Source of Support: Nil, Conflict of Interest: None.

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