Evaluation of the Reliability of Color-Based Phenotype Probes in the Determination of Gingival Phenotype

Year 2024, , 1113 - 1119, 29.12.2024

Elif Töre Sari , Nazlı Zeynep Alpaslan

https://doi.org/10.33808/clinexphealthsci.1531304

Abstract

Objective: This study aimed to determine gingival thickness with newly developed color-based phenotype probes and to compare the results with the traditional method (transgingival probing).
Methods: 100 individuals with a mean age of 38.37 ± 11.03 years who had Miller I class gingival recession in the anterior region were included in the study. In measurements performed with color-based phenotype probes, white (thin), green (medium), and blue (thick) colored tips were used. In the transgingival probing method, a digital caliper with a penetration depth of 0.01 mm sensitivity was used.
Results: Of the teeth included in the analysis, 45% were in the maxillary anterior region, and 55% were in the mandibular anterior region. The mean tissue thickness was 0.76 ± 0.17 mm in the mandibular jaw and 1.22 ± 0.36 mm in the maxillary jaw (p= .001). A statistically significant relationship was found between the values determined with the transgingival method and the observed probe color (p= .001). The tissue thickness values of the cases whose observed probe color was white were significantly lower compared to those with green, blue, and no color (p< .05). When the mean tissue thicknesses were compared according to colors, tissue thickness significantly increased toward the blue color (p= .001). There was a statistically significant relationship with the gingival thickness measurement values (p= .001), and a low level of agreement was determined (Kappa=0.159). In addition, it was determined that different colors were observed with the color-based phenotype probes in the same quantitative ranges.
Conclusion: Based on the assumption that color-based phenotype probes yield more subjective results, we believe that they can be used in clinical practice to determine gingival phenotype, but when quantitative data are required, prefering to use the transgingival method woud give more accurate results.

Keywords

Phenotype, Gingiva, Tissue

Ethical Statement

The study commenced after approval was obtained from the Van Yüzüncü Yıl University Non- Interventional Clinical Research Ethics Committee (17.06.2020/Decision no:15).

Supporting Institution

This study was funded by the authors and Van Yuzuncu Yil University, Türkiye (Project no: TSA-2021-9462).

Project Number

TSA-2021-9462

Thanks

This study was supported by Van Yüzüncü Yıl University Scientific Research Projects Coordination Unit. We would like to thank the Scientific Research Projects Coordination Unit for their support (Project no: TSA-2021-9462).

References

• Alves PHM, Alves TCLP, Pegoraro TA, Costa YM, Bonfante EA, de Almeida ALPF. Measurement properties of gingival biotype evaluation methods. Clin Implant Dent Relat Res. 2018; 20:280–284. DOI: 10.1111/cid.12583
• Yilmaz MNN, Inonu E. The evaluation of gingival phenotype by clinicians using the visual inspection method. Quintessence Int. 2023; 54:600–606. DOI:10.3290/j.qi.b3974881.
• Jati AS, Furquim LZ, Consolaro A. Gingival recession: Its causes and types, and the importance of orthodontic treatment. Dental Press J Orthod. 2016; 21:18–29. DOI:10.1590/2177-6709.21.3.018-029.oin
• Pradeep K, Rajababu P, Satyanarayana D, Sagar V. Gingival Recession: Review and strategies in treatment of recession. Case Rep Dent. 2012; 563421. DOI: 10.1155/2012/563421
• Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 world workshop on the classification of periodontal and peri-ımplant diseases and conditions. J Periodontol. 2018; 89:S237–S248. DOI:10.1002/jper.17-0733
• Wang J, Cha S, Zhao Q, Bai D. Methods to assess tooth gingival thickness and diagnose gingival phenotypes: A systematic review. Journal of Esthetic and Restorative Dentistry 2022; 34:620–632. DOI: 10.1111/jerd.12900
• Aimetti M, Massei G, Morra M, Cardesi E, Romano F. Correlation between gingival phenotype and schneiderian membrane thickness. Int J Oral Maxillofac Implants 2008; 23:1128–1132.
• Kan JYK, Morimoto T, Rungcharassaeng K, Roe P, Smith D. Gingival biotype assessment in the esthetic zone: Visual versus direct measurement. Int J Periodontics Restorative Dent. 2010; 237–243.
• Müller HP, Heinecke A, Schaller N, Eger T. Masticatory mucosa in subjects with different periodontal phenotypes. J Clin Periodontol. 2000; 27:621–626. DOI: 10.1034/j.1600-051x.2000.027009621.x
• Olsson M, Lindhe J. Periodontal characteristics in individuals with varying form of the upper central incisors. J Clin Periodontol. 1991;18:78–82. DOI: 10.1111/j.1600-051x.1991.tb01124.x
• Kim DM, Bassir SH, Nguyen TT. Effect of gingival phenotype on the maintenance of periodontal health: An American Academy of Periodontology best evidence review. J Periodontol. 2020; 91:311–338. DOI: 10.1002/jper.19-0337
• Fischer KR, Richter T, Kebschull M, Petersen N, Fickl S. On the relationship between gingival biotypes and gingival thickness in young Caucasians. Clin Oral Implants Res. 2015; 26:865–869. DOI: 10.1111/clr.12356
• Seibert J, Lindhe J. Esthetics and periodontal therapy. Textbook of Clinical Periodontology 1989; 2: 477-514.
• Eger T, Müller HP, Heinecke A. Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features. J Clin Periodontol. 1996; 23:839–845. DOI: 10.1111/j.1600-051x.1996.tb00621.x
• Fischer KR, Künzlberger A, Donos N, Fickl S, Friedmann A. Gingival biotype revisited-novel classification and assessment tool. Clin Oral Investig. 2018; 22:443–448. DOI: 10.1007/s00784-017-2131-1
• Nisanci Yilmaz MN, Koseoglu Secgin C, Ozemre MO, İnonu E, Aslan S, Bulut S. Assessment of gingival thickness in the maxillary anterior region using different techniques. Clin Oral Invest. 2022; 26:6531-6538. DOI: 10.1007/s00784-022-04602-x
• Rasperini G, Acunzo R, Cannalire P, Farronato G. Influence of periodontal biotype on root surface exposure during orthodontic treatment: A preliminary study. Int J Periodontics Restorative Dent. 2015; 35:665–675. DOI: 10.11607/prd.2239
• Miller PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985; 5:8–13
• Fu J-H, Yeh C-Y, Chan H-L, Tatarakis N, Leong DJM, Wang HL. Tissue biotype and its relation to the underlying bone morphology. J Periodontol. 2010; 81:569–574. DOI: 10.1902/jop.2009.090591
• Hwang D, Wang H-L. Flap thickness as a predictor of root coverage: A systematic review. J Periodontol. 2006; 77:1625–1634. DOI: 10.1902/jop.2006.060107
• Müller HP, Eger T. Gingival phenotypes in young male adults. J Clin Periodontol. 1997; 24:65–71. DOI: 10.1111/j.1600-051x.1997.tb01186.x
• Bertl K, Al-Hotheiry M, Sun D, Olofsson J, Lettner S, Gotfredsen K, Stavropoulos A. Are colored periodontal probes reliable to classify the gingival phenotype in terms of gingival thickness? J Periodontol. 2022; 93:412–422. DOI: 10.1002/jper.21-0311
• Tunca M, Altindal D, Tunca Y. Comparison of Chu’s probe method with the actual dimension of maxillary anterior teeth and evaluation of gingival parameters in individuals who do not need orthodontic treatment: Methodological study. Türkiye Klinikleri J Dental Sci. 2024; 30:247–255. DOI: 10.5336/dentalsci.2023-98311
• Malpartida-Carrillo V, Tinedo-Lopez PL, Guerrero ME, Amaya-Pajares SP, Özcan M, Rösing CK. Periodontal phenotype: A review of historical and current classifications evaluating different methods and characteristics. J Esthet Restor Dent. 2021; 33:432–445. DOI: 10.1111/jerd.12661
• Tavelli L, Barootchi S, Avila-Ortiz G, Urban IA, Giannobile WV, Wang HL. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: A systematic review and network meta-analysis. J Periodontol. 2021; 92:21–44. DOI: 10.1002/jper.19-0716
• Kan JYK, Rungcharassaeng K, Umezu K, Kois JC. Dimensions of peri-implant mucosa: An evaluation of maxillary anterior single implants in humans. J Periodontol. 2003; 74:557–562. DOI: 10.1902/jop.2003.74.4.557
• De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: Transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol. 2009; 36:428–433. DOI: 10.1111/j.1600-051x.2009.01398.x
• Kloukos D, Koukos G, Gkantidis N, Sculean A, Katsaros C, Stavropoulos A. Transgingival probing: A clinical gold standard for assessing gingival thickness. Quintessence Int. 2021; 52:394–401. DOI: 10.21203/rs.2.14838/v1
• Cha S, Lee SM, Zhang C, Tan Z, Zhao Q. Correlation between gingival phenotype in the aesthetic zone and craniofacial profile—a CBCT-based study. Clin Oral Invest. 2021; 25:1363–1374. DOI: 10.1007/s00784-020-03444-9
• Kong J, Aps J, Naoum S, Lee R, Miranda LA, Murray K, Hartsfield JK, Goonewardene MS. An evaluation of gingival phenotype and thickness as determined by indirect and direct methods. Angle Orthod. 2023; 93:675–682. DOI: 10.2319/081622-573.1
• da Costa FA, Perussolo J, Dias DR, Araújo MG. Identification of thin and thick gingival phenotypes by two transparency methods: A diagnostic accuracy study. Journal of Periodontology 2023; 94:673–682. DOI: 10.1002/jper.22-0488
• Fischer KR, Büchel J, Testori T, Rasperini G, Attin T, Schmidlin P. Gingival phenotype assessment methods and classifications revisited: A preclinical study. Clin Oral Investig. 2021; 25:5513–5518. DOI: 10.1007/s00784-021-03860-5