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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: A total of 200 subjects visiting the outpatient department in the range
of 18-50 years 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 4.3-4.7 mm
with decreased height in the thicker biotypes.

KEY WORDS: Papillary height, thick biotype, thin biotype, varying forms

INTRODUCTION considerations, periodontal bioform, and biotype.[2]

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
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]

Department of Prosthodontics, Including Crown and Bridge, On a contrary, ‘‘thin’’ gingival biotype is delicate,
A.B Shetty Memorial Institute of Dental Sciences, Mangalore, India thin with highly scalloped soft tissue with thin bony
Address for correspondence: Dr. Sonali Shetty, architecture characterized by bony dehiscence and
Prosthodontist, Famdent Clinic, Andheri West, Mumbai, Maharashtra, India. fenestrations. Such type is more prone to recession,
E‑mail: sonaliscorpio@yahoo.com
bleeding, and inflammation. Claffey and Shanley [6]
Access this article online defined the thickness not more than 1.5 mm as a thin
Quick Response Code: biotype while more than 2 mm as a thick biotype.
Website: The importance of the clinical identification helps in
www.jdionline.org
better determination of the treatment outcome. The
thinner periodontal biotype needs more attention when
DOI: extraction is carried out owing to their thin alveolar
10.4103/0974-6781.118888 plate.[5] The hard and soft tissue contouring is more
predictable after surgery in the case of thick biotype. The

116 Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2

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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
et al.,[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 et al.,[8] in his
study on 40 patients 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 non‑invasive 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 et al.,[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 18-50 years,
participated in the survey. Based on the age, they were
divided into two groups, i.e. group I (18-30 years) and
group II (30-50 years). Further selection criteria were
fixed as follows:
Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2 117
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 3 mm
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 [Figure 1a
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] [Figure 2].
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) [Figure 3]. 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 score 0 (59%) when
compared to males (41%) [Graph 1]
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.
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Bhat and Shetty: Prevalence of different gingival biotypes
Figure 1a: Measurement of crown length
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.[Graph 2]
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 (18-30 years) while
75 were in the older age group (30-50 years). 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) [Graph 3]
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 [Graph 4]
5. Evaluation of PH in relation to gingival biotype:
The mean PH was found to be 4.7 mm in males and
118 Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2
Figure 1b: Measurement of crown width
Figure 3: Evaluation of gingival thickness
4.3 mm in females. The PH was found to be lesser in
participants with thin biotype as compared to thick
biotype [Graph 5].
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. Kan et al.,[13] in their study concluded that the
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Bhat and Shetty: Prevalence of different gingival biotypes

 
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females with a thinner biotype. De rock et al. in their

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 et al.,[12] demonstrated no
significant association between visual and measured
gingival tissue forms. Eghbali et al., [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
clinician’s 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 et al.,[15] and
Muller  et al.,[16] who stated 1/3rd of the sample to be
study presented that male participants had thicker
gingiva to conceal the periodontal probe when compared
to female. Study by Eghbali et al.,[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 et al.,[20] in their study did not find any statistically

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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 et al.,[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 et al.,[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 et al.,[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 et al.,[25] explained
that racial and genetic factors contributed significantly
for the same.
In a recent study by Cook et al., [26] they evaluated
various gingival parameters in patients having different
periodontal biotypes. The results in their study
documented no significant differences between tissue
biotypes and crown height to width ratio, age, sex and
gingival margin position. In the present study, tooth
with rotations and malpositions were excluded. But, on a
wider range, most number of people are associated with
sight malrotations. It should be emphasized that tooth
position significantly can alter the gingival parameters.
The relevance of this survey in periodontal surgeries
and implant dentistry can be emphasized. The thicker
biotype prevents mucosal recession, hides the restorative
margins and camouflages the titanium implant shadows.
It also prevents biological seal around implants, thus
reducing the crestal bone resorption.[27]
CONCLUSIONS
Within the limitations of the present survey, following
conclusions were drawn:
1. The thicker gingival biotype is associated with short,
120 Journal of Dental Implants | Jul - Dec 2013 | Vol 3 | Issue 2
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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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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