Background. Studies have shown a significant relationship between the width and thickness of keratinized gingiva around the implant and changes in marginal bone level, with a significant effect on the health and esthetic of tissues around the implant, especially in the anterior region of the maxilla, which is an esthetic area. Methods. Ten patients referring to the Faculty of Dentistry seeking implant placement in the anterior maxilla were included in the study. The connective tissue of the palatal gingiva of the surgical site was folded to the buccal aspect with the buccal base, and the thickness and width of keratinized gingiva around the buccal surface of each implant were measured in three time intervals, including before surgery and 6 and 12 weeks after surgery. Based on the results of the Kolmogorov-Smirnov test, Friedman test and repeated-measures ANOVA were used to analyze the data. Results. The intervention significantly affected changes in the gingival thickness. After the intervention, gingival thickness significantly increased compared to the baseline (P < 0. 05). The results also showed that the intervention did not significantly affect the width of keratinized gingiva. The width of keratinized gingiva at baseline was not significantly different from the two time intervals after intervention (P > 0. 05). Conclusion. Buccal-based modified palatal flap in anterior maxillary implants increased the thickness of keratinized gingiva, with no significant effect on the keratinized gingiva width.

Tissue-engineered gingival graft was used for regenerating facial gingiva around an implant at lower left first premolar area with insufficient attached gingiva. Engineered gingival graft was produced by mixing 250 ml bovine skin collagen with 250 ml nutritional medium containing human gingival fibroblasts (2×105). 3 months post-surgery, there were gains in the attached gingiva compared to pre-surgery. The histological examination revealed a keratinized tissue on the treated site. Based on the result of this investigation, this graft was safe and capable of generating keratinized gingiva.

Background and Aim: Different surgical techniques have been proposed for crown exposure among patients under orthodontic treatment. The aim of this study was to investigate periodontal indices in closed flap operation technique used for impacted teeth crown exposure.Materials and Methods: In this descriptive study (2001-2003) 20 patients (15 females and 5 males), age ranging from 15 to 20 years, were participated. Following the performance of closed flap operation technique, in 12 patients impacted canine and central incisors were exposed and treated orthodontically. Periodontal parameters including sulcular depth, width of keratinized gingiva and attachment loss were recorded. Results: The mean of gingival sulcus depth was 1.50±0.43, the means of keratinized gingival in central incisors and canines were 3.07±0.53 and 2.30±0.42, respectively. In one patient, attachment loss was reported.Conclusion: Considering the optimal sulcular depth and keratinized gingiva, the closed flap operation technique seems suitable.

Background. The reconstruction of soft tissue around implants is a critical factor in modern Implantology. Presence of sufficient keratinized gingiva may be a beneficial item for long term soft tissue stability. Methods. This article presents a detailed description of a novel and modern flap designs and modified incision techniques for preserved keratinized gingiva around dental implants such as (Modified Palacci technique, Papilla preserving modified roll technique, U-shaped incision, M flap design and papilla reconstruction techniques such as nemcovsky tech, bidra tech. ) with related clinical cases. Results. These modern techniques are simple and applicable and more effective and more predictable for create and preserved a keratinized gingiva around dental implant. Conclusions. today use of the new modern techniques for preservation of keratinized gingiva around dental implants are necessary and beneficial for long term soft tissue stability.

Introduction: Gingival biotype is defined as the faciolingual thickness of keratinized gingiva which plays an important role in periodontal health. Moreover, it affects the periodontal response to physical trauma, the result of periodontal and implant surgery, and restorative and orthodontic treatment. In this regard, the present study aimed to investigate the relationship of gingival biotype with the width of the keratinized gingiva, depth of probe, and height of papilla in the patients who referred to the Dental School at Golestan University of Medical Sciences. Materials and Methods: This cross-sectional study was conducted on 130 patients who referred to the Periodontal Department of the Dental School. For the purposes of the study, their clinical parameters were assessed which included the width of keratinized gingiva, depth of the probe, and height of papilla. Finally, the relationship between the gingival biotype and clinical parameters was investigated. It should be noted that a P-value of 0. 05 was considered statistically significant. Results: Out of 130 participants, 70 and 60 patients had thin and thick gingival biotypes, respectively. Based on the results, the mean values of the keratinized gingiva width, depth of the probe, and height of papilla were 6. 23± 1. 44, 1. 12± 0. 44, and 3. 12± 0. 65 mm, respectively. Moreover, the mean values of keratinized gingiva width, depth of the probe, and height of papilla were 5. 27± 0. 91, 1. 07± 0. 37, and 3. 4± 0. 66 mm in thin gingival biotype, respectively, and 7. 35± 1. 10, 1. 19± 0. 49, and 2. 7± 0. 46 in the thick gingival biotype, respectively. Conclusion: It can be concluded that the mean value of the keratinized gingiva width of the thin biotype was less than that of thick biotype. However, the height of papilla was more in the thin biotype, compared to the thick biotype. Besides, no significant difference was observed between the depth of probe of these two biotypes.

Background. Anatomical characteristics of periodontium such as gingival thickness, width of keratinized gingiva and alveolar bone morphology determine the behavior of periodontium when subjected to physical and chemical stimuli, bacterial insult or during therapeutic procedures. Gingival biotype is one of the most important issues of concern in periodontal treatments especially root coverage and implant placement surgeries. Different tissue biotypes respond differently to inflammation and to surgical and restorative treatments; thus, it is crucial to identify tissue biotype before treatment. Thus, the aim of this study was to investigate the association between gingival thickness with the width of keratinized tissue and papillary fill in maxillary central incisor teeth of individuals with healthy periodontium. Methods. 62 patients referring to Borujerd dental clinic that matched the predefined inclusion criteria participated in this cross-sectional study. Clinical parameters including gingival thickness (measured by two methods of using an endodontic spreader and transparency of the periodontal probe through the gingival margin), width of keratinized tissue and papillary fill were measured and statistically analyzed. Results. Mean gingival thickness was 0. 85 mm for thin and 1. 20 mm for thick gingival biotype. Mean width of keratinized gingiva were 4. 86 mm and 5. 35 mm for thin and thick gingival biotype respectively. A positive correlation existed between the width of keratinized gingiva and the gingival thickness, also between age and the width of keratinized gingiva, as well between the amount of gingival thickness of left and right central incisors. According to the present study, one third of the population had a thin gingiva, of which 73% were female. The two methods of defining the gingival thickness yielded similar results in 84. 67% of cases. Conclusions. According to the results, gingival thickness was significantly correlated with the width of keratinized gingiva. There was no significant relationship between gingival thickness and papillary fill. Measuring the amount of spreader penetration was more accurate than the transparency of periodontal probe. However, defining the gingival biotype by visualizing transparency of the periodontal probe through the gingival margin has a high repeatability; it is simple, less costly and less time consuming. Therefore, it could be routinely used for determining the gingival thickness.

Introduction: The role of occlusal forces on dentition affected by periodontal diseases is not well known. Evidence suggests that high occlusal forces alter the extent of destruction and the nature of lesions. The effect of occlusal relationship on the periodontium has not been elucidated despite large number of studies, which have yielded contradictory results. The aim of this study was to evaluate the effect of different occlusal relationships on periodontal parameters.Materials and Methods: In this cross-sectional study, 60 healthy individuals were selected with anterior rise, cuspid rise, and group function occlusal relationships (n=20). They had no premature contacts on the balancing side. Periodontal parameters of pocket depth, attachment level, keratinized gingiva, gingival recession and plaque index were recorded. Data were analyzed with ANOVA and Kruskal-Wallis test (a=0.05).Results: Tukey test showed significant differences only in keratinized gingiva between anterior rise and cuspid rise occlusal relationships, in addition, Tukey test revealed significant differences in the upper jaw keratinized gingiva between anterior rise and cuspid rise occlusal relationships (p value<0.05).Conclusion: The results of this study did not determine which occlusal relationship is superior to others, although an increase in the keratinized gingiva was noted in cuspid rise occlusal relationship.In other words, all the three relationships had similar effects on periodontal parameters of pocket depth, attachment level, and gingival recession.

Objectives: This study aimed to evaluate the mucograft collagen matrix (CM) to increase keratinized tissue around teeth compared to free gingival graft (FGG). Materials and Methods: The present double-blind, randomized, controlled clinical trial studied 12 patients who had 2 mm or less keratinized gingiva bilaterally around mandibular premolars. The 6-month width of keratinized tissue, periodontal parameters (preoperatively and 1, 3, and 6 months postoperatively), color match, pain, and total surgical time were measured. Results: The mean dimensional change of keratinized gingiva 6 months postoperatively was 4. 1± 0. 7 mm for FGG and 8± 1. 7 mm for CM. Periodontal parameters were not affected in the two groups. The CM group had a significantly lower pain, experienced less surgery time, and gained better aesthetics compared to the FGG group. Conclusion: CM appears to be a suitable substitute for FGG in procedures designed to increase keratinized tissue around teeth. It has remarkable benefits, such as acceptable keratinized tissue gain, less pain, less surgical chair time, and better aesthetics.

Statement of the Problem: The periodontal health and marginal stability of gingiva can be negatively affected by a number of dental conditions in association with deficiency of attached gingiva. Purpose: This study aimed to compare the color and width of tissue grafted by two surgical techniques of keratinized gingival augmentation, namely free gingival graft(FGG) and connective tissue graft (CTG) covered by thin mucosal flap. Materials and Method: This clinical trial was performed on 15 adult individuals. The patients showed less than 2mm keratinized gingiva on two different recipient sides. One side was to be treated with CTG as the test group and the other side to be treated with FGG as the control group. The amount of keratinized gingiva before the surgery, size of grafted tissue during the surgery and 6 month after the surgery was documented. Six months after healing, the test and control sides were compared in terms of the width of generated gingiva on both sides, and the color match of the grafted areas with the surrounding gingiva or mucosa. The color of the grafted areas was determined and compared by using both professional evaluation and digital evaluation. Results: In digital evaluation, Δ E (which shows color mismatch) was higher in FGG. In professional evaluation, visual analogue scale (VAS) was used by two blinded periodontists. The mean VAS in FGG was less than CTG. The mean increase of gingival width was higher in CTG. The increased width in CTG technique was more than that in FGG technique. This difference was statistically, but not clinically, significant. Conclusion: Higher Δ E in control side and higher mean VAS CTG both showed better color adaptation of CTG side. FGG can be used in case of increasing keratinized gingiva, vestibular depth, and in patients with low smile line without esthetic concerns. However, using connective tissue in the underlying thin mucosal layer is preferred for gingival augmentation if there are adequate vestibule depth and esthetic concerns, like in maxillary canine.

Background. This study aimed to compare the color and width of tissue grafted by two surgical techniques of keratinized gingival augmentation, namely free gingival graft (FGG) and connective tissue graft (CTG) covered by thin mucosal flap. Methods. This clinical trial was performed on 15 adult individuals. The patients showed less than 2mm keratinized gingiva on two different recipient sides. One side was to be treated with CTG as the test group and the other side to be treated with FGG as the control group. The amount of keratinized gingiva before the surgery, size of grafted tissue during the surgery and 6 months after the surgery was documented. Six months after healing, the test and control sides were compared in terms of the width of generated gingiva on both sides, and the color match of the grafted areas with the surrounding gingiva or mucosa. The color of the grafted areas was determined and compared by using both professional evaluation and digital evaluation. Results. In digital evaluation, Δ E (which shows color mismatch) was higher in FGG. In professional evaluation, visual analogue scale (VAS) was used by two blinded periodontists. The mean VAS in FGG was less than CTG. The mean increase of gingival width was higher in CTG. The increased width in CTG technique was more than that in FGG technique. This difference was statistically, but not clinically, significant. Conclusions. Higher Δ E in control side and higher mean VAS CTG both showed better color adaptation of CTG side. FGG can be used in case of increasing keratinized gingiva, vestibular depth, and in patients with low smile line without esthetic concerns. However, using connective tissue in the underlying thin mucosal layer is preferred for gingival augmentation if there are adequate vestibule depth and esthetic concerns, like in maxillary canine.