Evaluation of Periodontal Phenotype Using CBCT, Computed Aided Design (CAD) and Prosthetic-driven Implant Planing (PDIP).
Condition: Periodontal Diseases
MeSH terms: Periodontal Diseases
Study type: Observational

Summary: 
      The use of CBCT/CAD and PDIP technology makes it possible to determine the gingival and the
      periodontal phenotype, and it can be useful in establishing treatment plan in which it is
      required to carry out radiological diagnostics. Assessment of the periodontal and the
      gingival phenotype in a patient using the method based on CW/CL ratio is unreliable.
      Determining it for each dento-gingival unit is the appropriate method.

      Positive correlation between FGT, WKT and AC-GM distance confirms the purpose of measuring
      these parameters for evaluation of the gingival phenotype and additional TLPAC2 for the
      periodontal phenotype.
    

Detailed description: 
      The gingival phenotype - (GP) is defined as three-dimensional volume of the gingiva, and is
      defined by 2 clinical parameters - gingival thickness (GT measured in mm ) and width of
      keratinized tissue (WKT0measured in mm ). Assessment of the gingival phenotype was performed
      with the use of visual methods, using the method of gingival transparency while probing the
      gingival grooves with a periodontal probe, on the basis of transparency of the free gingiva
      of the upper incisors, the shape of the crowns, the height of gingival papillae, and the
      width of the gingiva and, recently, using the Colorvue Periodontal Probes. The gingival
      phenotype may be determined more precisely by using biometry of width of keratinized tissue
      and gingival thickness. During surgical procedures in which it is planned to form a full
      thickness flap, GT can be measured in a direct way, for example using an orthodontic caliper
      or a gauge for thickness of prosthetic crowns measurement. Most often, however, it is
      advisable to determine the gingival or the periodontal phenotype before initiating dental
      treatment, at its planning stage.

      GT assessment can be performed with the use of invasive methods: with a needle, an endodontic
      tool or a periodontal probe, with the use of radiological methods - parallel profile
      radiographs and CBCT, and non-invasive methods - using an ultrasonic device and the optical
      coherence tomography. Measurements of keratinized tissue width are most often carried out
      using a periodontal probe calibrated every 1mm.

      Assessment of the phenotype is very important not only while planning dental treatment, but
      also in prediction of its results. A patient with healthy periodontium, but thin phenotype
      found in a single or in multiple dental units can be protected from the occurrence of
      complications of orthodontic, prosthetic or implant-prosthetic treatment . Radiological
      images, obtained by CT scans, are increasingly often assessed while planning such treatment .
      Scientists have begun to use the possibilities of 3D visualization for the assessment of the
      periodontal phenotype using the CBCT method.

      Assessment of the periodontal and the gingival phenotype in a patient, using the method based
      on CW/CL, is unreliable. The phenotype should be assessed for each dento-gingival unit.

      The presence of positive correlation between WKT, FGT and AC-GM confirms the validity of
      determining these parameters in the assessment of the gingival phenotype and, additionally,
      TLPAC2, in determining the periodontal phenotype.

      Using the CBCT CAD + PDIP technology allows for determination of the gingival and the
      periodontal phenotype, and can be useful while planning implantological and orthodontic
      treatment, in which conducting radiological diagnostics is required. In each case of gingival
      and periodontal phenotype assessment clinical examination of a patient along with
      determination of PD, CAL and WKT in the conditions of healthy periodontium should be carried
      out.
    

Intervention name(s): Measurements of gingiva thickness
Intervention type(s): Diagnostic Test
Intervention description(s): Measurements were performed at upper canines and incisors in thirty periodontally healthy patients. The CBCT/CAD technology along with the PDIP software were used to measure crestal (CGT in mm ), supracrestal (SGT in mm) and free gingival thickness (FGT in mm ) as well as alveolar crest-gingival margin (AC-GM) and cemento-enamel junction (AC-CEJ) distance and the TLPAC localized 2, 4 and 8mm apically than the edge of the AC. Width of keratinized tissue (WKT) were measured using a periodontal probe. For each patient, the periodontal phenotype was evaluated on the basis of coronal width/length (CW/CL in percentages) ratio of both upper central incisors. For each tooth, the gingival phenotype was assessed on the basis of the GT measurement( in mm).
Observational model: Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        male 16 female 14