Gingival Biotype

Gingival Biotype- Prosthodontic Perspective
K. R. Nagraj, Ravindra C. Savadi, Anupama R. Savadi, G.T. Prashanth Reddy, Shrilakshmi J., Malathi Dayalan,
Jins John Indian Prosthodontic Society (march2010)
by- Farheen Sayyed

MDS 1st year
Contents
• Introduction
• Anatomy of dentogingival complex
• Gingival biotype
• Gingival bioform
• Tooth morphology
• Tissue biotype in prosthodontic treatment
• Ridge preservation
• Immediate implants
• Conclusion
• Critique
• Cross reference
Introduction
• The gingival perspective of esthetics is concerned with the soft tissue envelope
surrounding the teeth
• To provide excellent esthetics, evaluation of gingival type and form is very important
from the start of treatment plan to the final restorative placement
Anatomy of the Dentogingival Complex
• The dentogingival complex is composed of three entities:
• The supra-crestal connective tissue attachment

• Epithelial (or junctional epithelium) attachment
• The sulcus-coronal to the junctional epithelium is the gingival sulcus.
• The biologic width is 2.04 mm ( connective tissue +epithelial attachment)
Gingival Biotype and Bioform
• The gingival biotype is classified as thin or thick. Whereas the prevalence of thick biotype
is 85% and thin biotype is 15%.
Thin periodontal biotypes
• Thin gingival tissue -delicate and almost translucent in appearance
• Friable with a minimal zone of attached gingiva
• Escalates the risk of recession following crown preparation and implant surgery
• Compromise esthetics in the anterior regions of the mouth

Characteristics of Thin Gingiva
•Highly scalloped soft tissue and bony architecture
•Delicate friable soft tissue
• Minimal amount of attached gingiva
•Thin underlying bone
• bony dehiscence and fenestration
•Reacts to insults and disease with gingival recession

Thick periodontal biotype
• fibrotic and resilient
• resistant to surgical procedures
• tendency for pocket formation (as opposed to recession)
• more conducive for implant placement
• favorable esthetic outcomes.

Characteristics of Thick Gingiva
• Relatively flat soft tissue and bony architecture
• Dense fibrotic soft tissue
• Relatively large amount of attached gingiva
• Thick underlying osseous form
• Relatively resistant to acute trauma
• Reacts to disease with pocket and infrabony defect

Gingival Bioform
Three basic morphologies
• High
• normal
• flat
• Whereas the facial and lingual gingival scallop mimics the underlying bone architecture, but not
interproximal
Gingival Bioform
• The normal discrepancy is 4 mm between the interproximal gingival peaks (most

coronal) and the midfacial free gingival margin peaks (most apical)
• When this discrepancy is 4 mm discrepancy results in an exaggerated or high scallop

Tooth Morphology
• The basic tooth forms
• Convex acuity of a tooth circumference
• The basic tooth forms - circular, square or triangular, determine the degree of gingival
scallop
Tissue Biotype in Prosthodontic Treatment
Tooth preparation:
• Thin biotype- supragingival margins, over contoured restoration cause gingival recession
• Thick biotype- subgingival margins, over contoured restoration cause pocket formation
Gingival retraction:
• Thin retraction cord
• Not retained more than 15 min
• Recession
• More comfortable in thick biotype

Implant treatment:
• The stability of the osseous crest and soft tissue is directly proportional to the thickness
of the bone and gingival tissue
• Thick biotypes are associated with thick bony plates and thin biotypes are associated
with thin bony plates, with potential for fenestrations and dehiscence
• During postoperative healing phase, more dramatic alveolar resorption is seen in apical
and lingual direction for the ridge associated with thin biotype
Ridge Preservation in Thick vs Thin Biotypes
• Postextraction alveolar bone loss is critical in assuring implant success
• Socket or ridge preservation involves the use of a graft material
• Demineralized freeze-dried bone allograft, mineralized freeze-dried bone allograft,

xenograft (mostly of bovine source), and alloplastic materials (β-tricalcium phosphate,
durapatite, hydroxyapatite)
• When excessive bone is lost to resorption-block graft tech

Immediate Implants in Thick vs Thin Biotype
Thin biotype-
• resorption
• esthetic failure
• Tissue grafting procedures
Thick biotype-
• Predictable results
Conclusion
• Thick and thin gingival biotypes are associated with thick and thin osseous patterns
• They respond differently to the inflammation and trauma and have different patterns of
osseous remodeling
• In fixed prosthodontics, care to be taken in finish line placement and retraction and type
of restoration selection in esthetic zone.
critique
Cross reference
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Gingival Biotype- Prosthodontic Perspective

by- Farheen Sayyed

• The dentogingival complex is composed of three entities:

• The supra-crestal connective tissue attachment

• Thin gingival tissue -delicate and almost translucent in appearance

• Friable with a minimal zone of attached gingiva

• Compromise esthetics in the anterior regions of the mouth

•Highly scalloped soft tissue and bony architecture

•Delicate friable soft tissue

• Minimal amount of attached gingiva

•Thin underlying bone

• bony dehiscence and fenestration

•Reacts to insults and disease with gingival recession

• fibrotic and resilient

• resistant to surgical procedures

• tendency for pocket formation (as opposed to recession)

• more conducive for implant placement

• favorable esthetic outcomes.

• Dense fibrotic soft tissue

• Relatively large amount of attached gingiva

• Thick underlying osseous form

• Relatively resistant to acute trauma

• Reacts to disease with pocket and infrabony defect

• The normal discrepancy is 4 mm between the interproximal gingival peaks (most

• When this discrepancy is 4 mm discrepancy results in an exaggerated or high scallop

• The basic tooth forms

• Convex acuity of a tooth circumference

• Thin retraction cord

• Not retained more than 15 min

• More comfortable in thick biotype

• Postextraction alveolar bone loss is critical in assuring implant success

• Socket or ridge preservation involves the use of a graft material

• Demineralized freeze-dried bone allograft, mineralized freeze-dried bone allograft,

• When excessive bone is lost to resorption-block graft tech

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