Periodontal Phenotypes Recession and Anomalies Flashcards

1
Q

Define the terms genotype, phenotype and morphotype

A

Genotype
• The set of genes or genetic composition/sequence of an individual organism
• Non- modifiable

Phenotype
• The observable characteristics of an individual organism, which are influenced by both its genotype and the environment

Morphotype
• Individual or set of individuals within a population with a distinctive physical characteristic (E.g. alveolar bone morphotypes – scalloped, flat)

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2
Q

Define ‘normal mucogingival condition’

A

Absence of pathosis or disease’ (i.e. gingival recession, gingivitis, periodontitis), with variability evident amongst individuals

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3
Q

Give examples of mucogingival conditions

A

Lack of keratinized tissue, position and shape of frena and shallow vestibular depth can be associated with periodontal health

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4
Q

List the three types of periodontal phenotypes

A

Thin scalloped biotype

Thick flat biotype

Thick scalloped biotype

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5
Q

For the thin scalloped biotype, list:

  • Gingival thickness/keratinised tissue
  • Born morphotype
  • Tooth dimension
A

Gingival thickness/ keratinised tissue:
• Narrow zone of keratinised gingiva

Born morphotype:
• Thin alveolar bone

Tooth dimension:
• Slender, triangular crown

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6
Q

For the thick flat biotype, list:

  • Gingival thickness/keratinised tissue
  • Born morphotype
  • Tooth dimension
A

Gingival thickness/ keratinised tissue:
• Thick, fibrotic gingiva

Born morphotype:
• Thicker alveolar bone

Tooth dimension:
• Square shaped teeth

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7
Q

For the thick scalloped biotype, list:

  • Gingival thickness/keratinised tissue
  • Born morphotype
  • Tooth dimension
A

Gingival thickness/ keratinised tissue:
• Fibrotic gingiva with pronounced gingival scalloping

Born morphotype:
• Thick

Tooth dimension:
• Thin, slender narrow teeth

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8
Q

Describe the assessment methods used to determine periodontal biotype

A

Transgingival probing (accuracy to the nearest 0.5 mm), performed under local anaesthesia

• Ultrasonic measurement: Probe visibility after its placement in the facial sulcus

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9
Q

What are the measurements for ‘thin’ and ‘thick’ gingiva

A

Gingiva is defined as thin (≤1.0 mm) or thick (>1mm) upon the observation of the periodontal probe visibility through the gingiva

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10
Q

How do you measure Keratinised Tissue Width (KTW) and bone thickness?

A

KTW
• Easily measured with a periodontal probe positioned between the gingival margin and the muco-gingival junction
• 2mm of KTW and 1mm of attached gingiva are desirable around teeth to maintain periodontal health

Bone Thickness
• Assessment through Cone Beam-computed Tomography (CBCT) has high diagnostic accuracy, exposure to radiation has potential harmful effect

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11
Q

How can tooth positioning affect phenotype?

A

For example, teeth tilted or rotated labially
• the labial bony plate is thinner and located further apically than on adjacent teeth
• the gingival margin is recessed apically to follow the bone, leading to exposure of the root
• the gingiva is bulbous on the lingual surface
• the bone margins are closer to the CEJ

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12
Q

Mention the characteristics of a thin periodontal biotype and how brushing or restorations serve as risk factors for gingival recession

A

Decreased width of keratinized tissue
• Reduced thickness of alveolar bone due to abnormal tooth position in the arch
• Studies have found poor toothbrushing habits to be potential risk factors for recession: hard pressure, hard bristles, duration of brushing

  • Restorative crowns that go sub gingivally in a thin- biotype can increase gingival recession
  • The apical extent of the restorative margin should ideally be a minimum of 2.5mm from alveolar crest to avoid violation of biologic width, leading to: gingival recession and bone loss
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13
Q

List the classifications for recession

A
  • Class I: recession does not extend to the mucogingival junction and there is no tissue loss in the interproximal area
  • Class II: recession extends to or beyond the mucogingival junction. There is no periodontal loss in the interproximal area
  • Class III: recession extends to or beyond the mucogingival junction. Bone or soft tissue loss is present in the interdental area
  • Class IV: recession extends to or beyond the mucogingival junction.
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14
Q

Consider impact of interproximal recession on clinical attachment

A

• CAL: measured from the CEJ to the base of the sulcus

Interproximal recession can increase CAL

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15
Q

Discuss treatment considerations for patients without recession for thick periodontal biotypes

A

Thick gingival biotype

• Prevention through good oral hygiene instruction and monitoring of the case

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16
Q

Discuss treatment considerations for patients without recession for thin periodontal biotypes

A

Thin gingival biotype
• Since there is a greater risk for development of recession, prevention and careful monitoring should be employed
• If there are areas with severely thin gingival biotype, mucogingival surgery may be considered to prevent future mucogingival damage

17
Q

Discuss the prevention/ control approach of treatment for patients with recession

A

periodontal charting
monitor exposed root surfaces for determination
measure the distance from the free gingival margin to the CEJ to determine the amount of keratinized tissues

18
Q

Discuss the treatment oriented approach of treatment for patients with recession and thin biotypes

A

patient concerns regarding aesthetics/dentinal hypersensitivity, presence of cervical caries or non-carious cervical lesions (NCCL)