The correlation between the width of attached keratnized gingiva and gingival health

The amount of attached keratinized gingiva sufficcient to maintain periodontal health is still a matter of debate. Some studies established that lack of adequate amount of attached keratinized gingiva may facilitate inflammation and possible recession of the gingival margin. Some studies denied the association between the width of attached gingiva and development of soft tissue recession in case of proper plaque control. In assessment of width of attached keratinized gingiva probing pocket depth is subtracked from the amount of keratinized gingiva. Mukogingival junction represents the border between keratinized gingiva and alveolar mucosa. Due to its stability through life mukogingival junction serves as a landmark for measurements in periodontal changes. Cemento-enamel junction represents another stable reference point used for measurements of clinical attachment level and recession depth. In this study cemento-enamel junction (when detectable) and mucogingival junction were used as anatomical landmarks as well as conventional methods to measure the actual width of the attached keratinised tissue. Therefore the aim of this study is to evaluate the relationship between the width of attached keratinised gingiva measured from the cemento-enamel and mucogingival junction and the amount of gingival recession and inflamation. The study included the clinical data of 1322 teeth surfaces of 84 systemically and periodontally healthy volunteers with a mean age of 32,16±8,81.The exclusion criteria were pregnancy or lactation period, usage of drugs which can influence periodontal condition, presence of allergy to iodine solution, teeth with undetectable cementoenamel junction (including subgingival restoration or crown), volunteers with history of periodontal disease, absence of a tooth adjacent to the tooth which had been evaluated. Clinical measurements of probing pocket depth (UNC15 color coded periodontal probe), gingival index (Löe and Silness 1963), plaque index (Löe and Silness1964), gingival thickness, the width of the keratinized gingiva and the distance between the free gingival margin and cementoenamel junction were assessed by same investigator from the mid-buccal point of the first molar, first premolar, canine and central incisor teeth from each quadrant. In case of recession the distance between the cemento-enamel and mucogingival junction was calculated by adding the distance from cementoenamel junction to the free gingival margin to the width of keratinized gingiva. In case if no recession, distance between the free gingival margin and cementoenamel junction was subtracked from the width of keratinized tissue. When the cementoenamel junction and/or root surface was visible, tooth was associated with to the recession group. The phenotype was considered thin, if the tip of probe inserted into sulcus was clearly visible. The width of keratinized gingiva, attached keratinized gingiva and the distance between cementoenamel junction and mucogingival junction was found less in the lower jaw towards to the upper jaw. At the same time recessions were more often detected in the lower jaw. Recessions were mainly associated with less amount of keratinized gingiva.