Title Periodontal Probe Visibility Is the Clinical Gold Standard in Determining Gingival Phenotype; However, Inter-operator Heterogeneity Is of Concern
Clinical Question Is periodontal probing more accurate than transgingival sounding in clinical determination of gingival phenotype?
Clinical Bottom Line Periodontal probe visibility is associated with reduced measurements of clinical gingival thickness. Periodontal probing is a convenient and reliable method for assessment of gingival phenotype clinically.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
26110452Frost/201556 sequentially enrolled patientsGold standard-controlled diagnostic study
Key results56 patients (23 males and 33 females, aged 20 to 78 years; mean age: 53 years) were recruited from a patient group undergoing comprehensive treatment at a dental school. The unit of measurement was the tooth (n=306). Enrollment was by sequential convenience. No thickness of gingival tissue reliably masked probe visibility. However, probe visibility was associated with reduced measurements of clinical gingival thickness. Thick phenotypes were present in 83% of cases. Thin phenotypes were most common in lateral incisor (23%) and canine sites (24%). An association was found between probe visibility and buccal plate thickness; however, this was not statistically significant.
Evidence Search Evidence Search: ("bone and bones"[MeSH Terms] OR ("bone"[All Fields] AND "bones"[All Fields]) OR "bone and bones"[All Fields]) AND ("cone-beam computed tomography"[MeSH Terms] OR ("cone-beam"[All Fields] AND "computed"[All Fields] AND "tomography"[All Fields]) OR "cone-beam computed tomography"[All Fields] OR ("cone"[All Fields] AND "beam"[All Fields] AND "computed"[All Fields] AND "tomography"[All Fields]) OR "cone beam computed tomography"[All Fields]) AND ("gingiva"[MeSH Terms] OR "gingiva"[All Fields]) AND ("phenotype"[MeSH Terms] OR "phenotype"[All Fields])
Comments on
The Evidence
This is a well-designed and reasonably powered clinical study that appears to draw valid clinical conclusions based on the reported results. Unlike a previous study by Kan et al., 2010, no threshold thickness of tissue with an absolute numeric value was seen where the probe becomes invisible. Transgingival sounding is a valid and reliable method for determining tissue thickness; however, as reported by Cook et al., 2011, periodontal phenotype is not determined by individual site-specific factors viewed in isolation. It is clear, therefore, that multiple potential methods are available to determine gingival phenotype. This heterogeneity complicates and limits the potential for comparisons to be drawn between clinical trials and confounds the extrapolation to clinical treatment. However, due to the ease of assessment, periodontal probe visibility could be considered the clinical gold standard. This study does not discuss the ethnicity of the patient being assessed, nor does it mention any site-specific gingival pigmentation. These factors may, in theory, affect the assessors’ ability to accurately assess the visibility of a periodontal probe. A potential design flaw is that the assessment was completed via screen projectors; potentially, clinical assessment may have been more suitable.
Applicability Accurate determination of the gingival phenotype is an important component of successful treatment. In modern clinical practice, the increasing importance of “pink aesthetics” is driving the requirement of an accurate phenotypical diagnosis. Periodontal probing is an important tool in making this clinical diagnosis and is incorporated routinely into both aesthetic and periodontal examination. Gingival phenotype is now known to influence the outcomes of procedures performed in clinical practice. Accurate and predictable assessment of patient phenotype is a fundamental requirement to allow the creation of a personalized treatment plan to ensure predictable aesthetics, emergence, and marginal soft tissue position.
Specialty (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Gingival phenotype, gingival biotype, periodontal probing, buccal plate
ID# 3408
Date of submission 11/26/2019
E-mail keelingf@uthscsa.edu
Author Francis Keeling B Dent Sci, MSc, MFDS RCSI
Co-author(s) Caitlin Janusz, DDS
Co-author(s) e-mail janusz@livemail.uthscsa.edu
Faculty mentor Antonella Botto, DDS
Faculty mentor e-mail botto@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available