Cone-beam computed tomography as a diagnostic method for determination of gingival thickness and distance between gingival margin and bone crest

Germana Jayme Borges, Luis Fernando Naldi Ruiz, Ana Helena Gonçalves de Alencar, Olavo César Lyra Porto, Carlos Estrela, Germana Jayme Borges, Luis Fernando Naldi Ruiz, Ana Helena Gonçalves de Alencar, Olavo César Lyra Porto, Carlos Estrela

Abstract

The objective of the present study was to assess cone-beam computed tomography (CBCT) as a diagnostic method for determination of gingival thickness (GT) and distance between gingival margin and vestibular (GMBC-V) and interproximal bone crests (GMBC-I). GT and GMBC-V were measured in 348 teeth and GMBC-I was measured in 377 tooth regions of 29 patients with gummy smile. GT was assessed using transgingival probing (TP), ultrasound (US), and CBCT, whereas GMBC-V and GMBC-I were assessed by transsurgical clinical evaluation (TCE) and CBCT. Statistical analyses used independent t-test, Pearson's correlation coefficient, and simple linear regression. Difference was observed for GT: between TP, CBCT, and US considering all teeth; between TP and CBCT and between TP and US in incisors and canines; between TP and US in premolars and first molars. TP presented the highest means for GT. Positive correlation and linear regression were observed between TP and CBCT, TP and US, and CBCT and US. Difference was observed for GMBC-V and GMBC-I using TCE and CBCT, considering all teeth. Correlation and linear regression results were significant for GMBC-V and GMBC-I in incisors, canines, and premolars. CBCT is an effective diagnostic method to visualize and measure GT, GMBC-V, and GMBC-I.

Figures

Figure 1
Figure 1
(a) Tomographic guide showing the marks made at the tip of each interproximal papilla and 3.0 mm above the gingival margin of each tooth. (b) Clinical guide following the contours of the gingival margin and the tips of the interproximal papillae. (c) Positioning the clinical guide to measure gingival thickness (GT) using ultrasound (US). (d) Positioning the US to measure GT. (e) Marking the point to measure GT. (f) Silicon limiter in contact with the external surface of the gum to measure GT. (g) Measuring the distance between the gingival margin and the vestibular bone crest (GMBC-V) at the highest point from the clinical guide margin to the vestibular bone crest. (h) Measuring the distance between the gingival margin and the interproximal bone crest (GMBC-I) from the point in the clinical guide which represents the tip of the interproximal papilla to the interproximal bone crest. (i) Patient's gummy smile. (j) Patient's smile after surgery.
Figure 2
Figure 2
(a) Transversal slice of tooth 13 evidencing hyperdense and round mark. (b) Measuring gingival thickness (GT, white line, perpendicular to the long axis of the tooth). (c) Transversal slice of tooth 13 evidencing hyperdense and round mark. (d) Measuring the distance between the gingival margin and the vestibular bone crest (GMBC-V, white line, parallel to the long axis of the tooth, traced from the gingival margin to the vestibular bone crest). (e) Transversal slice of the region between teeth 11 and 12 with hyperdense and round mark at the tip of the interproximal papilla. (f) Measuring the distance between the gingival margin and the interproximal bone crest (GMBC-I, white line).

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