J Clin PcriiKhmol 1903; 20: 570-577 Copyright Miinksgiiard 1993

Pruned in Denmark . .411 righii rt'serv

cliflical periodontologii
ISSN 0303-6979

On the relationship between M. Olsson\ J. LJndhe^ and

C. P. Marinello^
^Department of Periodontology, Faculty of

crown form and clinical features of

Odontology, University of Goleborg,
Goteborg, Sweden;
^Department of Crown and Bridge
Prosthodontics, Dental Institute, University of

the gingiva in adolescents ZiJrioh, Zurich, Switzerland

Olsson M, Lindhe J and Marinello CP: On the relationship between crown form
and clinical features of the gingiva in adolescents. J Clin Periodontol 1993; 20:
570-577. Munksgaard, 1993.

Abstract. The purpose of the present study was to examine the relationship
between the form of the crowns in the maxillary front tooth segment and (1) a
group of morphological characteristics and (2) the thickness of the gingiva. 108
subjects devoid of symptoms of destructive periodonta] disease were examined
regarding, e.g., probing depth, thickness of the free gingiva, width of the kera-
tinized gingiva and the contour of the marginal gingiva. From clinical photo-
graphs of the maxillarj' front tooth region, the width (at the apical third - CW)
and the length (CL) of the crowns of the 6 front teeth were determined. A CW/
CL-ratio was calculated for each tooth and averaged for each tooth region. The
individual mean CW/CL-ratio values for the central incisors were ranked. After
correction for incisal attrition, the 10 subjects ranked highest and the 10 ranked
lowest were selected as having either a long-narrow (group N) or a short-wide
(group W) form of the crown of the tooth. The data for each of the examined
parameters were averaged for each tooth region in each subject and mean values
for subjects in groups W and N were compared using the Student i-test. Stepwise
multiple regression analysis, including data from the whole sample, was performed
for each tooth region with the thickness of the free gingiva as the dependent
variable. The results from the analyses demonstrated that individuals with a long-
narrow form of the central incisors displayed, compared to individuals with a
short-wide crown, form (i) a narrow zone of keratinized gingiva, (ii) shallow
probing depth, and (iii) a pronounced "scalloped" contour of the gingival margin.
There was no significant difference between groups N and W with respect to the
thickness of the free gingiva. The CW/CL-ratio data revealed that a certain form
of the crowns in the central incisors was accompanied by a similar form in the
lateral incisor and canine tooth region. The regression analyses demonstrated
that the thickness of the free gingiva in central incisors was significantly related to
(i) the width of the keratinized gingiva, (ii) the buccolingual width of the crown
and (iii) the presence of an interproximal gingival groove. In lateral incisors,
the thickness of the free gingiva was associated with the probing depth at the Key words: gingival thickness; periodontal
biotype; gingival characleristics.
buccal surface. No single variable was significantly related to the thickness of
the gingiva in canines. Accepted for publication 19 August 1992

The morphological characteristics of
the periodontium in general, and the
gingiva in particular, are in part reiated
to the shape and form of the teeth
(Wheeler ]96!, Glickman 1972, Seibert
1973, Schluger et al, 1977, Grant et ai,
1988). Early empirical reports suggested
that the position of the gingivai margin
was influenced by the cervical convexity
of the crown (Hirschfeid 1923, Morris
1958) and that the alveolar bone and
the gingiva of a tooth with pronounced
mesiodistal curvature and/or marked
cervical convexity were located more
apicaily than at a tooth with a flat sur-
face. It was aiso proposed that two basic
types of gingival architecture exist, the
"sca!loped-thin" and the "flat-thick''
(Oschenbein & Ross 1973, Weisgold
1977, Seibert & Lindhe 1989), The
"scalioped-thin" gingiva was described
to be associated with a tooth with (i)
tapered crown form; (ii) subtle cervical
convexity; and (iii) minute proximal
contact areas located near the incisai
edge of the tooth. The "flat-thick" gin-
giva, on the contrary, was described to

correspond to a tooth with (i) squared
facial form, (ii) distinct cervical con-
vexity and (iii) relatively large, more
apically located contact areas.
Not only the gingival morphology
but also the thickness of the alveolar
bone was considered to be related to the
form of the tooth. Hence, the "scal-
loped-thin" gingivai "morphotype" may
be accompanied by a comparatively
thinner bone than the "flat-thick"
counterpart. It has also been proposed
that the severity of different symptoms
associated with periodontal disease may
vary in dentitions of different peri-
odontal "morphotype" (Oschenbein &
Ross 1973, Weisgold 1977, Seibert &
Lindhe 1989). Thus, deep periodontal
pockets may be the result of a plaque
associated inflammation in individuals
with a "flat-thick" appearance of their
periodontal tissue, while individuals
with a "sca!loped-thin" appearance may
respond with recession of the gingival
margin. In order to identify these vari-
ous morphologic types, the term "peri-
odontal biotype" was introduced by Sei-
bert & Lindhe (1989).
Olsson & Lindhe (1991) analyzed the
relationship between the form of the
crown of the maxillary central incisors
and symptoms associated with peri-
odonta! disease. They reported that in-
dividuals with a long-narrow form of
the upper central incisors had experi-
enced more recession at bttccal surfaces,
than subjects with a short-wide form.
This was found to be valid not only at
the central incisors (the reference teelh)
but at al! teeth in the dentition. Due to
the character of the study no expla-
nation could be provided with respect
to the cause of the difference in the
amount of recession between the
groups. Animals studies have indicated,
however, that an inllammatory lesion
residing in a thin gingiva] tissue may
result in more gingival recession than
if the lesion occurs in a thick gingiva
(Baker & Seymour 1976, Ericsson &
Lindhe 1984, Wennstrom et al. 1987).
Since recession is an important symp-
tom of periodonial disease and an un-
desired side-effect in periodontai ther-
apy, it seems important to further ana-
lyze the reiationship between the
morphology of the crown, the shape
and thickness of the gingiva and symp-
toms of periodontal disease. The pur-
pose of the present study was to exam-
ine, in a subject sample devoid of symp-
toms of destructive periodontal disease,
the relationship between the form of the
crown and (!) the morphological
characteristics and (2) the thickness of
the gingiva. The examination was con-
fmed to the maxillary front tooth seg-
ment.
Material and Methods
The subject sample consisted of 108 vol-
unteers, 16-19 years of age (mean age
17.1 years), who were recruited from
the patient pool of the Public Dental
Service, Molndal, Sweden. They were
all scheduled for a regular dental exam-
ination during the first 4 months in
1990. Since tooth size has been shown
lo vary between different racial groups
(Lavelle 1972), the sample was confined
to Caucasians.
In conjunction with the dental exam-
ination, a comprehensive survey of the
maxillary front tooth segment (centra!
incisors, lateral incisors, canines) was
performed. This additional examination
was comprised of clinical measurements
and analysis of various criteria in clin-
ical photographs and study models.
Clinical measurements
Assessments of gingival inflammation
(Loe !967), probing depth (PD), clinical
attachment level (CAL) and location of
the gingival margin (GM) were per-
formed at 6 !ocations at each of the 6
teeth; mesiobucca!, bucca!, distobucca!,
mesiolingual, !ingua! and distolingual.
Values for approximal surfaces (mcsio-
buecal, distobuccai, mesiolingua!, disto-
lingual) were averaged and a mean
value for the approxima! surfaces was
computed for each tooth. Measure-
ments of probing depth, clinicai attach-
ment level and location of the gingival
margin were made using a calibrated
periodonial probe (00.45 mm) and
were determined to the nearest mm.
The degree of incisal attrition was
scored according to Smith & Knij^ht
(1984). Score 0 = no ioss of enamel sur-
face characteristics for incisors, and no
loss of contour for canines. If loss of
enamei surface characteristics for inci-
sors or minimal loss of contour for can-
ines were noted, a score 1 was given.
Score 2 was given lo incisors which dis-
p!ayed dentine exposure or canines with
loss of contour but less than 1 mm deep
defects in the enamel.
For assessment of gingivai morph-
ology, the following parameters were re-
corded.
Width of keratinized gingiva. The dis-
Crown form and gingiva 571
tance was measured midbuccally, to the
nearest mm, from the mucogingival
junction to the gingivai margin. If the
mucogingival junction was not readiiy
perceivabie, the "wrinkle technique"
(IVlazeiand 1978) was utilized.
Presence of gingival groove. Presence/
absence was assessed at 2 locations;
midbuccal over Ihe root and midbuccal
over the distal papilla.
Gingival thicktiess. The thickness was
measured midbuccaliy at the base of the
probeabie pocket. After the depth of the
buccai pocket had been recorded, the
probe was placed on the outside of the
gingiva with the probe lip placed at the
level of the recorded pocket depth. A
disposable sterile syringe needle ( 0 =
0.40 mm/27 G) witii an endodontic
depth marker was pierced into contact
with the tooth surface at a direction
perpendicular to both the mesiodistal
and the eoronoapical planes of the
tooth surface. The depth marker was
placed in contact with the gingiva after
whicii the needle was removed. The dis-
tance from the needle tip to the depth
marker was measured in the iight micro-
scope (magnification x 25).
Citnicai photographs
A ciinical photograph (magnification
!:1) was obtained from each of the 6
front teetli. Each photograph was mag-
nified (X 10) on a screen by empioying
an ADA-Realist radiograph viewer
(ADA Products Inc. Milwaukee. USA).
A transparent paper was mounted on
the screen, the outline of the tooth was
depicted and the image analyzed in a
digitizer (Bit Pad One, Summagraphics,
Fairfield, CT, USA). The following as-
sessments were made (Fig. I).
Length of the crown (CL). The dis-
tance was measured between the gingi-
val margin, or if discernible, the cemen-
Fig. 1. SchaTiatic illustration of measured dis-
tances of ciinical photographs (CL, CW. a,
b. c) and on casts (PH). CL = crown length.
CW = crown width. Lines a, b and c are in-
corporated in the cosine formnia for assess-
ment or the angle a. PH = height of distal
papiila.
 572 Olsson et al.

to-enamd junction and the incisal edge tracted from the in/e;ranine-distance.
of the crown. Thus, a low denVdi arch value repre-
Width of the crown (CW). The CL- sented an '(7"-/brmed arch and a high
distance was divided inio 3 equaJ por- value a "V"-formed arch.
tions: Cervical (C). Middle (M) and In- Height of the interdental papilla, A
cisal (I), The width of the crown was line was drawn on the cast connecting
measured between the approximai tooth the most apical points of the gingivaJ
surfaces at the borderiine between por- margin at midbuccal points of two ad-
tions C and M. jacent teeth. The distance from the top
Gingival angle (GA), The curvature of the papilla to the line was determined
of the marginal gingiva was defined as parallel to the tooth axes. Each value Fig, 2, Individual with a long-narrow crown
the angle that forms at ihe intersection was then associated with the mesiaily form of [he upper central incisors (group N),
betv^'een the 2 lines that connect the positioned tooth (Fig, 1).
most apical portion of the buccal gingi- Cervical convexity, A surveyor with a
val margin with the most coronai por- depth of 0,5 mm was placed with the
tions of the papillae. The angle was cal- undercut edge in contact with the tooth
culated by means of the formula; surface at the midbuccal level of the
cosa^(a- + b- e-)/2ah. Hence, the dis- gingival margin. After placing a colored
tances from the most apical portion of occlusal paper between the shankle of
the gingival margin to the most coronal the surveyor and the tooth surface,
portions of the papillae was measured short mesiodistal movements were per-
(a and b in the formuJa). The hne con- formed, generating marks oi" the loca-
necting the top of the two papillae was tion of contact. The distance from the
measured and constituted the c-value in most apical mark to the gingival margin
Fig, 3, Individual with a short-wide crown
the formuia. was determined. Hence, a tooth with form of the upper central incisors (group W),
pronounced cervical convexity pro-
Study models
duced a mark close to the gingival mar-
gin and a low measurable value, while were compared by means of a Student
Alginate impression of the upper jaw a tooth with a flat surface had the mark /-test.
were taken after completion of al! regis- placed more coronally. The infiuence of various parameters
trations and study models produced. Ail measurements on the casts were on the thickness of the free gingiva was
The following parameters were assessed recorded to the nearest 0.01 mm, using examined by means of stepwise multiple
on the casts. a dial caiiper (Mitutoyo 500-300, Mitu- regression, including data from the
Position. The position of each indi- toyo Manufacturing Co. Ltd., Japan) whole sample. Hence, linear models
vidual tooth was determined in relation with tips sharpened to improve access were constructed with the thickness of
to an imaginary ideal line following the in the interproximal areas. the gingiva as the dependent variable
midiine of the aiveoiar process (Bjdrn and the individual mean CW/CL-ratio
et ai, 1964). Teeth whose contact points for central incisors, the width of the
deviated ^ 2 mm from the ideal line Data analysis keratinized gingiva, the probing depth
" were classified as having a normal posi- A CW/CL-ratio {Olsson & Lindhe at midbuccai surfaces, the presence of a
tion. If the distance was > 2 mm., a buc- 1991) was calculated separately for each gingival groove, the "gingival angle",
cai or lingual alignment was recorded. tooth and an individual mean value was the height of the papilla, the cervical
Rotation. A tooth was considered ro- computed for each tooth region (central convexity, the mesiodistal width of the
tated if the mesio-distal axis was deviat- incisors, lateral incisors, canines). Since crown, the buccolingual width of the
ing ^45"" from the ideal hne, the CL-value can be influenced by the crown, and the arch form as indepen-
Mesio-distal width of the erown. The degree of incisal attrition, teeth with at- dent variables. Regression analysis was
distance was measured between the ap- trition scores > 1 were excluded from performed separately for each of the
proximai contact points or surfaces in the computations, 12 individuals dis- three tooth regions. A /^-value of 0,15
a piaiie parallel to the incisal and ves- played attrition values > 1 in both of or iower was the prerequisite for a vari-
tibular planes, according to description their centra! incisors and were excluded able to be included in the models. How-
by Hunter & Priest (I960). from al] analyses. Based on the individ- ever, the discriminating ratio (mean
Bueeo-lingual width of the crown. The ual mean value for the central incisors, ratio-vaiue in central incisors) was al-
distance was measured between the the remaining 96 subjects were ranked ways included irrespective of the signifi-
most prominent points on the buccal according to ascending mean ratio- cance level.
and palatal surfaces and parallel to the vaiues. The 10 individuals ranked low- Since the thickness of the free gingiva
incisal and vestibular planes. est and the 10 ranked highest were se- may be infiuenced by factors such as
Form of the dental areh. The form was lected as having a long-narrow (group (i) pronounced buccal or hngual tooth
determined by measuring the width of N) (Fig, 2) or a short-wide (group W) position (Wennstrom et al. 1987). (ii)
the arch at 2 locations; between the (Fig, 3) form of the central incisors. rotation, and (iii) degree of gingival in-
highest points of (I) the mesiopalatal The data for each of the examined fiammation, all teeth in a buccal/lingual
cusp tips of the first molars and (2) the parameters were averaged for each or rotated position or with a gingiva!
incisal tips of the canines. The intermo- tooth region in each subject and mean index score > 1 were excluded from the
iar-distance was subsequently sub- values for subjects in groups W and N multiple regression analyses.
 Crown form and gingiva 573

Table I. Standard deviation of duplicate as- gingival and denta! characteristics in
sessments of clinica! parameters and cast groups W and N are reported in Table 3,
measurements
and are presented separately for central
gin^val groove 0,38 incisors, lateral incisors and canines.
gingival index 0.41 The ratio-data revealed that a low CW/
gingivai margin 0.3K CL-vaiue in central incisors was ac-
gingival thickness 0.30 companied by low values in lateral inci-
gingival width 0,68
sors and canines. Thus, individuals with
probing attachment level 0.08
a long-narrow form of the central inci-
probing depth 0.36
attrition 0,18 sors had a similar crown form in their
buccolingua! width 0,07 lateral incisors and canines and con-
distance 13-23 0.19 versely, individuals with a short-wide
distance 16-26 6,13 form of the reference teeth displayed
mesiodistal width 0.06 a similar form in lateral incisors and
papilla height 0.25 canines. The difference between the
groups was statistically significant in
both lateral incisors (/'<0.001) and
The Statistical Analysis System pack- canines (p<0.05).
age (SAS Institute Inc., Cary, NC, The data for gingival characteristics,
USA) was used for all calculations. i.e. thickness of the free gingiva, width
of keratinized gingiva, height of inter-
dental papilla and ''gingival angle",
Error ot the method were found to be in agreement with the
10 randomly selected subjects and 10 descriptions of the 2 basic "biotypes":
randomly selected study models were the "scalloped-thin" and the "flat-
examined and measured, with respect to thick". Thus, in group N, in reference
all parameters, twice with an interval of teeth as well as in lateral incisors and
!-week. The variation in the measure- canines: (i) the free gingiva was thinner:
ments for each of the parameters as- (ii) the zone of keratinized gingiva was
sessed was calculated as the standard more narrow; (iii) the height of the pa-
deviation of duplicate registrations and pilla was higher; (iv) the "gingival
is presented in Table 1, angle" was smaller, compared to the
corresponding values for group W
(Table 3).
Results However, when the various morpho-
The individual mean values for ratios, logical parameters were studied separ-
gingival and dental characteristics in the ately, the differences in thickness of the
entire sample are presented in Table 2. free gingiva were small (0.06-0.18 mm)
Mean values for probing depth and clin- and not statistically significant for any
ical attachment level arc presented in tooth type.
Fig. 4, The data are reported separately The zone of the keratinized gingiva
for central incisors, lateral incisors and was found to be significantly wider in
canines. all tooth types in individuals with a
The individual mean data for ratios. short-wide form of their central incisors
than in individuals with long-narrow
central incisors. The greatest difference
between the groups was noted in the
central incisor (1.35 mm, p<0,01) and
the smallest in the canine tooth region
(1.20 mm, p<0.05). The scailoped con-
tour of the gingiva margin can be de-
scribed in terms of height of the inter-
dental papilla and the "gingival angle".
Consistently larger values in mean
height of the distal papilla were ob-
served in individuals in group N com-
pared to individuals in group W. The
differences varied between 0.62 mm in
canines (/<0.05) and 0.81 in central
incisors {p<0.0\). In both the N- and
W-groups, the highest and the lowest
papilla scores were invariably found in
canines and lateral incisors, respectively.
A more acute "gingival angle" was
observed in all tooth regions in group N
compared to group W, with a difference
between the groups of 8.5'' (canines,
;j<0.05), 18,9^ (central incisors, p<
O.OOi) and 19.8' (lateral incisors, p<
0.001),
The differences in the mean values
for the cervical convexity followed no
consistent pattern, were of small magni-
tude (0.21-0.33 mm) and not statisti-
cally significant for any tooth type. The
mesiodistal width of the crowns was sig-
nificantly larger in central {p < 0.05) and
lateral {p<0.0\) incisors in group W
than in group N, The buccotingual
width of the crown, however, displayed
no unifonn pattern and the observed
differences were of a smaller magnitude
than those which were seen in the mesi-
odistal dimensions.
The mean values for the maxillary
arch form revealed that individuals with
a long-narrow crown form tended to
have a more "V"-shaped dental arch,

Table 2. Mean values and standard deviation for ratios, gingiva! and dental characteristics in all subjects (JJ = 108)
Central Lateral
incisors incisors Canines
Variables mean SD mean SD mean SD mean SD

ratio CW/CL 0,76 (0.07) 0.66 (0,09) 0,69 (0,09)

gingiva! thickness 1,46 {0.27} 1,15 (0,26) 1.12 (0,22)

width keratinized gingiva 4,92(1.10) 5,76 (1,15) 3.79(1.31)
papilla height 4,16(0.64) 4,02 (0,65) 4.21 (0.70)
gingiva! angle 86.60 (7.72) 82,80 (10.48) 80.29 (8.98)

gingival groove buccally - percent presence 29 28 28

gingival groove approximally - percent presence 22 28 62

cervical convexity 2.93 (0,60) 2.75 (0,56) 2,86 (0,74)

buccolingual width 7.33 (0.56) 6.51 (0,57) 8.29 (0.65)
mesiodistal width 8,80 (0.53) 6.88 (0,59) 7.92 (0,46)
arch form 5.93 (2,69)

SD: standard deviation.

 574 Olsson et al.

CETIB-SI Indstus LaleiaJ \mlias CanJnss

Approxlmsl surface

d d

Cemral inosffls Uleral iso Csninas

O CT. CM rsi OS
(~J c^ >o o lO

(0.
Lfngual surfaces
o cJ r-^ d d
o
oo

rN od

' O IO O
Cenual incisors Lareral Jncfscrs (N p u"i so
o _.: o &!
Fig. 4. Mean values and standard deviation
for probing depth and clinical attachment
leve! in central incisors, lateral incisors and
canines in all subjects [n--^ 108). The probmg
depths are given positive values and the clin-
ical attachment levei valu es are given negative
values.

while in individuals with a short-wide

form the dental arch was more "U"-
shaped. This difference between the
groups was, however, not statistically
significant. rN l O
O d
The mean values for probing depth
and chnical attachment level for group
N and W are presented in Fig. 5. The
probing depth was consistently greater
in group W than in group N. The
greatest difference between the 2 groups o IO m
was observed at buccal surfaces in cen- rzi ci a
tral incisors, with a mean depth of 1.15
mm in group N and 1,85 mm in group
W. Statistically significant differences
between the groups were observed at
buccal surfaces in central (p<0.01) and
V V
lateral incisors (p<0.05).
It was observed that the clinical
attachment level occasionally, and ex- a.
^ -
clusively at buccal surfaces, was located
apical of the cemento-enamel junction.
The mean attachment loss was signifi-
cantly greater in lateral incisors in group
N than in group W (/J<0.05). NO sig-
nificant difference was observed for the
other tooth types.
The results fi-om the three stepwise V
multiple regression models are pre-
 Crown form and gingiva 575

reached a level of significance ( p ^ 0.01), tation recognized we observed, how-

Fig. 5. Mean values and standard deviation
for probing depth and clinical attachment
level in central incisors, lateral incisors and
canines in group N (n^\0) and W (w=10).
The probing depths are given positive values
and the clinica! attachment level values are
given negative values. Filled bars denote
group N and hatched bars denote group W,
seated in Table 4, The thickness of the
gingiva in central incisors was signifi-
cantly influenced by the buceo-lingual
width of the crown (p = 0.00\), the
width of the keratinized gingiva (/> =
0.001) and presence of interproximal
gingiva] groove {p = 0.04). In lateral in-
cisors., the probing depth at buccal sur-
faces was the sole variable which
Furthermore, multiple regression re-
vealed that the variability in thickness
of the free gingiva couid be explained,
to 56% in central incisors, 29% in lateral
incisors and 14% in canines, by the vari-
ables that displayed a /'-value<0,I5,
Discussion
In the present investigation, attempts
were made to study if individuals with
different morphologica] characteristics
of the gingiva could be distinguished
by the form of the crown of maxillary
central incisors. The results demon-
strated that individuals with a long-nar-
row form of Ihe centra! incisors dis-
played, compared to individuals with a
short-wide crown form (i) a thin free
gingiva, (ii) a narrow zone of kera-
tinized gingiva, (iii) shallow probing
depth, and (iv) a pronounced "scal-
loped" contour of the gingival margin,
expressed as the height of the distal pa-
pilla and the "gingival angle". Although
statistically significant differences be-
tween group N and W were not ob-
served for the thickness of the gingiva,
the findings of the present study and the
data by Olsson & Lindhe (1991) tend to
support the hypothesis of the existence
of two basic groups of periodontal "bio-
types", i.e. the "scalloped-thin" and the
"flat-thick" (Oschenbein & Ross 1973,
Weisgold 1977, Seibert & Lindhe 1989),
and that such "biotypes" may be dis-
tinguished by the CW/CL-ratio.
Since several tests of statistical sig-
nificance were performed in the pres-
ence analysis, the problem of multiple
comparisons must be considered when
the various differences between the
groups are evaluated. With this limi-
ever, that most of the gingival variables,
which in the present study were con-
sidered relevant to the "biotype" hypo-
thesis, displayed /^-values of <0,01.
The CW/CL-ratio used in the present
analysis has previously been used in a
study where the relationship was exam-
ined between the form of the crown of
the maxillary central incisors and symp-
toms associated with periodontal dis-
ease (Oisson & Lindhe 1991), The prob-
lem of using the CW/CL-ratio to ident-
ify the tooth form is mainly associated
with difficulties in determining the
proper reference points. Thus, at teeth
with (1) no attachment toss but (2) deep
probing depth, the true apical border of
the crown will be concealed and the CL-
value underestimated. In cases with high
papillae, the length of the CW-line may
be difficult to properly determine. Ac-
cordingly, there may be a risk for a high
degree of covariation between the CW/
CL-ratio and the variables "gingival
angle" and "papilla height". This prob-
lem is, however, difficult to overcome
since in subjects with minimal attach-
ment loss a part of the crown will con-
sistently be covered by the gingiva. In
an older age-cohort, the gingival margin
will often be positioned apical to the
cemento-enamel junction and will,
therefore, not interfere with CL- and
CW-measurements. In such an older
sample, however, incisal attrition (Hu-
gosson et al, 1988) may compromise the
CL-determinations.
The present data failed to support
the hypothesis that a "scalloped-thin"
periodontal "biotype" is associated with
a thin gingiva and a "fiat-thick biotype"
is associated with a thick gingiva. Thus,
in the present study the differences in

Table 4. Stepwise multiple regression analyses: dependent variable: gingival thickness

Parameter Estimate /j-value
central incisors ratio -0,58 0,34 degrees of freedom: model 7
bucco-lingual width 0.22 0.001 degrees of freedom; error 37
width keratinized gingiva 0.15 0.001 r-square 0,56
gingival groove approximal 0.16 0.04
probing depth - buccal 0,12 0,06
arch form 0.02 0.12
cervical convexity -0.09 0,14
lateral incisors ratio -0,04 0,90 degrees of freedom: model 4
probing depth - buccal 0,08 0.01 degrees of freedom; error 42
gingival groove - buccal 0.07 0.12 r-square 0,29
papilla height -0,05 0.13
canines ratio 0,07 0,90 degrees of freedom; model 2
probing depth - bucca! 0.13 0.06 degrees of Ireedom; error 27
r-square 0,14
 576 Olsson et ai
gingival thickness between group N and
W were small and statistically insignifi-
cant. Moreover, the regression models
used in the present sample failed to
demonstrate a relationship between the
discriminating CW/CL-ratio and the
thickness of the gingiva. In the present
analysis, however, a positive relation-
ship was observed between the thickness
of the free gingiva and the probing
depth. This finding confirms data pre-
sented by, e.g., Goaslind et a!. (1977)
and suggests that the form of the crown
may determine the position of the mar-
ginal soft tissue but not the thickness of
the free gingiva.
It has been suggested that a relation-
ship exists between the cervical con-
vexity of the crown and the position of
the gingival margin (Hirschfeld 1923,
Morris 1958, Oschenbein & Ross 1973,
Weisgoid 1977). Morris (1958) de-
scribed the gingiva to be positioned
more apically in the cases of a marked
prominence of the crown, while Weis-
gold (1977) related a tooth with pro-
nounced cervical convexity to a "fiat-
thick biotype". In the present study,
however, no infiuence of the convexity
of the crown on the two basic "bio-
type"-groups could be observed. This
may in part be explained by the fact
that in cases with no attachment loss,
some part of the convex area is located
subgingivaliy and thereby not readily
accessible for measurement (Weisgold
1977).
The observed relationship between
the thickness of the gingiva in central
incisors and the buccolingual width of
the crown (/? = 0.001) was anticipated
and compatible with the observations
of a reiationship between a lingually or
buccally posifioned tooth and the
thickness of the associated gingiva
(Wennstrom et al. 1987).
The most apparent difference be-
tween groups N and W was the vari-
ation in width of the keratinized gin-
giva. Thus, individuals with a short-
wide form of their upper central incisors
had 1.20-1.35 mm wider zones of kera-
tinized gingiva than individuals with a
long-narrow crown form. Also the
width of the attached gingiva (kera-
tinized gingiva minus the probing
depth) was wider in group W than in
group N.
Since both the width of the kera-
tinized gingiva and the thickness of the
gingiva are important variables in the
characterization of various "biotypes",
it was interesting to find that there was a
strong relationship (;7 = 0.001) between
the 2 variables in the stepwise multiple
regression model in central incisors.
This observation is in accordance with
Wennstrom et a H 1981, 1982) who ana-
lyzed the dimensions of the gingiva in
the beagle dog foiiowing various surgi-
cal treatments. They reported that gin-
gival units with a wide zone of kera-
tinized gingiva was consistently more
voluminous than units with a narrow
Acknowledgements
The authors would like to thank Mr.
Tommy Johnsson, Department of Stat-
istics, University of Goteborg for assist-
ance with statistical analyses, and the
staff at Public Dental Service, Moindal,
County of Molndal for notable service
in administering the subjects in the
study. This study was supported by
grants from the Colgate-Palmoiive Co.,
Piscataway, NJ, USA, Faculty of Odon-
tology, University of Goteborg and
Swedish Dental Society.
Zusammenfassung
Uber das Verhdltnis zwischen der Kroiienform
und klinischen Merkmalen der Gingiva von Ju~
gendlichen
Der Zweck der vorliegenden Studie war die
Untersuchung des Verhiiltnisses zwischen der
Kjonenfonn im maxiliaren Frontzahngebiet
und (1) einer Gruppe von morphologischen
Charakteristika sowie (2) der Dicke der Gin-
giva. 108 Personen ohne Anzeichen einer de-
struktiven Parodontalerkrankung wurden
hinsichtlich folgender Merkmale untersucht:
Sondierungstiefe, Dicke der freien Gingiva,
Breite der keratinisierten Gingiva und Kon-
tur der marginaien Gingiva. Anhand von kli-
nischen Photos des maxillaren Fronizahnge-
bietes wurde die Breite (im apikalen Drittel
- CW) und die Lange (CL) der Kronen der
6 Frontzahne bestimml. Das CW/CL-Ver-
haltnis wurde fiir jeden Zahn berechnet und
der Durchschnitt fur jede Zahnregion gebii-
det. Ftir die individuellen Mittelwerte des
CW/CL-VerhaltnJs.ses der mittleren Inzisivi
wurde eine Raiigfolge ersLellt. Nach Korrek-
tur der inzisalen Abnutzung wurden die 10
Individuen mit dem hochsien und die 10 mit
dem niedrigsten Rang ausgewahlt und nach
dem Vorliegen einer langen-schmalen (Grup-
pe N) oder kurzen-breiten (Gruppe W) Form
der Zahnkrone ausgewahlt. Fiir jede Person
wurden die Durchschnitte aller untersuchten
Parameter fiir jede Zahnregion gebildet und
die Mittelwerte fur Personen in den Gruppen
W und N wurden unter Verwendung des
Student r-Tests verglichen. Mit den Daten
des gesamten Untersuchungsgutes wurden
schrittweise Regressionsanalysen fur jede
Zahnregion mit der Dicke der freien Gingiva
als abhangige Variable durchgefuhrt. Die Er-
gebnisse der Anaiysen zeigten, daB Individu-
en mit einer langen-schmalen Form der mitt-
leren Inzisivi im Vergleich zu Individuen mit
einer kurzen-breiten Kronenform (i) eine
schmaie Zone keratinisierter Gingiva, (ii) ge-
ringe Sondierungstiefe und (iii) eine betont
"giriandenformige" Kontur des Gingivaran-
des aiifwiesen. Zwischen Gruppe N und W
bestand kein signifikanter Unterschied im
Hinblick auf die Dicke der freien Gingiva.
Die Daten zum CW/CL-Verhiiitnis legten
dar, daG eine bestimmte Kronenfomi der
mittieren Inzisivi mit einer ahnlichen Form
der lateralen Inzisivi und Eckzahne verbun-
den ist. Die Regressionsanalysen zeigten. dafi
die Dicke der freien Gingiva an mittleren In-
zisivi signifikant mit (i) der Breite der kerati-
nisierten Gingiva. (ii) der bukkolingualen
Breite der Krone und (iii) der Anwesenheii
einer approximaien Furche verbunden war.
Bei den lateralen inzisivi war die Dicke der
freien Gingiva mit der Sondierungstiefe der
bukkalen Flache assoziiert. Keine einzige Va-
riable war mit der Dicke der Gingiva bei den
Eckzahnen signifikant verbunden.
Resume
Rapport entre la forme de la cowonne dentaire
et les earaeteristiques cliniques de la gencive
chez les adolescents
Le present travail avait pour but d'etudier le
rapport entre ia forme des couronnes dentai-
res dan.s le segment anterieur de la machoire
superieure et (I) un groupe de caracteristi-
ques morphologiques et (2) l'epaisseur de la
gencive. Chez 108 sujets ne presentant aucun
symplome de maladie parodontale destructri-
ce, on a pratique un examen concernant entre
autre la profondeur des poches, I'epaisseur
de la gencive libre, la hauteur de ly gencive
keratinisee et le contour du rebord gingiva!.
Sur des photographies cliniques de la region
anterieure de ia machoire superieure, la lar-
geur des couronnes des 6 dents anterieures
(au tiers apical - CW) et leur longueur (CL)
ont ete mesurees. Un rapport CW/CL a ete
calcule pour chacune des dents et sa moyenne
calculee pour chacune des regions dentaires.
Les valeurs moyennes individuelles du rap-
port CW/CL pour les incisives cenlrales ont
ete classees par ordre de grandeur. Apres cor-
rection pour I'attrition incisale, les !0 sujets
ayant les valeurs rangees comme les plus ele-
vees et les iO sujets ayant les vaieurs rangees
comme Jes plus basses ont ete choisis comme
ayant une forme de couronne dentaire
longue-etroite (groupe N) ou une forme cour-
te-large (groupe W). Les moyennes des don-
nees obtenues pour chacun des parametres
consideres ont ete calcuiees pour chacune des
regions dentaires chez chacun des sujets, et
les valeurs moyennes pour les sujets des grou-
pes W et N ont ete eomparees a I'aide du
test-r de Student. Une analyse de regression
multiple echelonnee, concernant les donnees
de tout i'echantillon, a ete pratiquee pour
chacune des regions dentaires, l'epaisseur de

la gencive libre etant prise comme la variable
dependante. Les resuitats des analyses ont
montre que les sujets ayant des incisives cen-
trales de forme longue-etroite avaient, par
rapport aux sujets ayant une forme coronaire
courte-large (i) une zone de gencive keratini-
see etroite, (ii) une faible profondeur de po-
ches et (iii) un rebord gingivai de contour
nettement "festonne", Du point de vue de
l'epaisseur de la gencive hbre. il n'y avait pas
de difference significative entre ies groupes N
et W. Les donnees concemant le rapport
CW/CL ont mis en evidence que le type de
forme de ia couronne des incisives centraies
etait accompagne du meme type de forme
dans ia region de i'incisive laterale et de ia
canme, Les analyses de regression ont montre
qiie Tepaisseur de ia gencive iibre au niveau
des incisives centraies elait iiee significative-
ment a (i) la hauteur de la gencive keratinisee.
(ii) Ja iargeur vestibiilo-linguale de la couron-
ne et (iii) ia presence d'un siilon gingival in-
terproximai, Dans !es incisives laterales, l'e-
paisseur de la gencive libre etait associee a la
profondeur de sondage au niveau du la face
Vfstibulaire, Aucune des variables isolees n'e-
tait liec significativement a l'epaisseur de la
"encive des canines.
References
Baker, D, L, & Seymour, G, L. (1976) The
possible pathogenesis of gingival recession.
Journal of Clinical Periodontology 3.
208-219,
Bj6rn, A,, Krebs, A, & Solow, B, (1964) A
method for epidemiological registration of
malocclusion, Acta Odontologica Scandi-
navica 22, 27-41,
Ericsson. I, & Lindhe, J, (1983) Reces.sion in
sites with inadequate width of the kera-
tinized gingiva. An experimental study in
the dog. Journal of Clinical Periodontology
U. 95-103.
Glickman, I, (1972) Clinical periodontology.
4th edition, p. 21, Philadelphia: W, B.
Saunders Company,
Goaslind, G. D,, Robertson, P. B,, Mahan. C,
J., Morrison, W, W, & Olson, J, V, (1977)
Thickness of facial gingiva. Journal of Peri-
odontology 4%, 768-771,
Grant, D. A,, Stern, I, B. & Listgarten, M.
A. (1988) Periodontics, 6th edition, pp, 9,
460-461. St, Louis: The C.V, Mosby Com-
pany,
Hirschfeld, L (1923) A study of skulls in the
American Museum of Natural Histor>' in
relation to periodontal disease. Journal of
Dental Research 5, 241-265,
Hugosson, A., Bergendal, X, Ekfeldt, A, &
Heiklmo. M, (1988) Prevaience and sever-
ity of incisal and occlusal tooth wear in an
adult Swedish population. Acta Odontolo-
gica Scandinavica 46, 255-265,
Hunter, W, S. & Priest, W R, (1960) Errors
and discrepancies in measurement of tooth
size. Journal of Denial Research 39.
405-414,
Lavelle, C, L. B, (1972) Maxillary and man-
dibuiar tooth size in different racial groups
and in different occlusal categories. Amer-
ican Journal of Orihodomics 61, 29-37.
Loe, H, (1967) The Gingival Index, the
Piaque Index and the Retention Index sys-
tems. Journal of Periodoniology 38,
610-616.
Mazeland. G, R, J, (1978) Jaws and gums.
The mucogingival complex in relation to al-
veolar process height in man. Academisch
Proefscrift, Universitet van Amsterdam.
Morris, M. L. (1958) The position of the
margin of the gingiva. Oral Surgery, Oral
Medicine. Oral Pathology 11, 969-984,
Ochsenbein. C. & Ross. S, (1973) A concept
of osseous surgery and its clinical appli-
cation. In: Ward. H. L, & Chas, C, T,
(ed,): A periodontal poini of view, ch, 13,
Springfield, Illinois. Charles C, Thomas.
Olsson, M, & Lindhe, J. (1991) Periodonta!
characteristics in individuals with varying
form of the upper central incisors. Journal
of Clinical Periodontology 18, 78-82,
Crown form and gingiva 577
Schluger, S,, Yuodelis, R. A. & Page, R.
(1977) Periodontal disease, 1st edition, pp.
10, 513-515, Philadelphia: Lea & Febiger,
Seibert, J. S, (1973) Surgical management of
osseous defects. In: Goldman, H. M. &
Cohen, D, W. (ed,): Periodontat therapy,
5th edition, p, 765-766. Saint Louis, The
CV Mosby Company,
Seibert, J, & Lindhe, J, (1989) Esthetics and
periodonta] therapy. In: Lindhe, J. (ed,):
Textbook of clinical periodontology, 2nd
edition, ch. 19. Copenhagen, Munksgaard.
Smith, B. G. N, & Knight, J. K, (1984) An
index for measuring the wear of teeth,
British Dental Journal 156, 435-438,
Weisgold, A, (1977) Contours of the full
crown restoration. Alpha Omegan 70,
77-89,
Wennstrom, J., Lindhe, J. & Nyman, S.
(1981) Role of keratinized gingiva for gin-
gival health. Ciinical and histological study
of normal and regenerated gingival tissue
in dogs. Journal of CUnical Periodoniology
8, 311-328.
Wennstrom, J,. Lindhe, J, & Nyman, S.
(1982) The role of keratinized gingiva in
plaque-associated gingivitis in dogs. Jour-
nal of Clinical Periodontology 9, 75-85,
Wennstrom, J, L,, Lindhe, J., Sinclair, F, &
Thilander, B. (1987) Some periodontal
tissue reactions to orthodontic tooth
movement in monkeys. Journal of Ciinical
Periodantology 14, 121-129,
Wheeler, R, C. (1961) Complete crown form
and the periodontium. The Journal of
Prosthetic Dentistrv 11. 722-734,
Address:
M. Olsson
Department of Periodoniology
Faculty of Odontology
University of Goteborg
Goteborg
Sweden