Difference in Buccal Gingival Thickness between the Mandible and Maxilla in the Aesthetic Zone: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
- P: Among the general population with a healthy periodontal status, what is the difference between;
- E: buccal gingiva thickness in the aesthetic zone in the maxilla versus;
- C: the mandible;
- O: around anterior teeth (including canines, lateral incisors, and central incisors) in absolute numbers (millimeters).
2.2. Search Strategy and Study Selection
2.3. Data Collection Process and Data Items
2.4. Risk of Bias Assessment
2.5. Method of Data Synthesis
- Mid-buccal vs. interdental measurements: Studies were classified based on whether tissue thickness was measured along the long axis of the tooth at mid-buccal sites or interdentally between the teeth.
- Apico-coronal measurement area: The location of the tissue thickness measurement along the vertical dimension was considered to account for potential variations at different apico-coronal levels. Due to the inconsistent use of landmarks amongst the studies, two main categories were defined by the authors: (1) supracrestal measurements, including measurements at the base of the sulcus or of the papilla and at the cementoenamel junction (CEJ); and (2) subcrestal measurements, including measurements in the attached gingiva or measurements halfway between the gingival crest and mucogingival junction.
- Measurement method: The studies were organized according to the measurement method that was employed for gingiva thickness assessment, encompassing transgingival measurements using a probe or a needle to penetrate the soft tissue, ultrasound measurements, or radiographic examinations.
- Tooth classification: Finally, the classification of teeth (incisors vs. canines) was extracted to account for potential variations in gingiva thickness between different tooth types.
3. Results
3.1. Study Selection and Characteristics
3.2. Differences in Gingiva Thickness between the Maxilla and Mandible
3.3. Data Synthesis
3.3.1. Risk of Bias within Studies
3.3.2. Results of Synthesis: Difference in Gingival Thickness between the Upper and Lower Jaws
3.3.3. Subgroup Analysis
3.3.4. Risk of Bias across Studies
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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First Author and Year | Country | Setting | Study Design | Measurement Method |
---|---|---|---|---|
Kydd et al. (1971) [30] | United States | University | Prospective cross-sectional | Ultrasonic |
Eger et al. (1996) [4] | Germany | German Armed Forces Central Hospital | Prospective cohort study | Ultrasonic |
Müller et al. (2000) [37] | Germany | German Armed Forces Central Hospital | Prospective cross-sectional | Ultrasonic |
Vandana et al. (2005) [21] | India | University | Cross-sectional | Transgingival probing |
Cha et al. (2008) [38] | Republic of Korea | University | Prospective cross-sectional | Ultrasonic |
La Rocca et al. (2012) [40] | Spain | University | Prospective cross-sectional | Transgingival probing |
Sharma et al. (2014) [39] | India | University | Cross-sectional | Transgingival probing + ultrasonic |
Kolte et al. (2014) [41] | India | University | Prospective cross-sectional | Transgingival probing |
Ranga et al. (2015) [36] | India | University | Cross-sectional | Transgingival probing |
Lee et al. (2017) [42] | Malaysia | Private | Prospective cohort study | Transgingival probing |
Kaya et al. (2018) [34] | Turkey | University | Prospective cross-sectional | Transgingival probing |
Park et al. (2018) [35] | Republic of Korea | University | Prospective cross-sectional | Transgingival probing |
Shao et al. (2018) [26] | China | University | Prospective cross-sectional | Transgingival probing + CBCT |
Rathod et al. (2020) [43] | India | University | Prospective cross-sectional | Transgingival probing |
Alkan et al. (2021) [44] | Turkey | University | Before-after study | Transgingival probing |
Anand et al. (2022) [31] | India | University | Prospective cross-sectional | Transgingival probing |
Han et al. (2022) [32] | China | University | Cross-sectional | CBCT + intraoral scan |
Sample Characteristics | ||||||
---|---|---|---|---|---|---|
First Author and Year | Sample Size Calculation | Study Population | Patients (N) | Sex (Female) | Age (Years) | |
Mean (±SD) | Range | |||||
Kydd et al. (1971) [30] | N | NR | 8 | NR | NR | 24–41 |
Eger et al. (1996) [4] | N | Healthy volunteers from the Armed Forces Central Hospital | 42 | 0 | NR | 20–25 |
Müller et al. (2000) [37] | N | Dental staff | 40 | 21 | NR | 19–30 |
Vandana et al. (2005) [21] | N | Systemically healthy subjects | 32 | 16 | NR | 16–38 |
Cha et al. (2008) [38] | N | Young adults | 61 | 33 | 25.3 | 19–35 |
La Rocca et al. (2012) [40] | N | Subjects in need for orthodontic treatment or implant placement | 15 | 7 | 29.53 | 22–49 |
Sharma et al. (2014) [39] | N | Subjects visiting the Department of Periodontics | 30 | 15 | NR | 18–30 |
Kolte et al. (2014) [41] | Y | Systemically healthy adults | 120 | 60 | NR | Three age groups: 16–24, 25–40, and >40 |
Ranga et al. (2015) [36] | N | Systemically healthy subjects from Department of Periodontics | 40 | 20 | NR | 16–38 |
Lee et al. (2017) [42] | Y | Subjects from National Dental Center | 51 | 27 | 30.4 ± 11.4 | NR |
Kaya et al. (2018) [34] | Y | Subjects from orthodontic department | 128 | NR | 16.79 ± 3.66 | NR |
Park et al. (2018) [35] | Y | Patients with skeletal class III malocclusion | 28 | 9 | 21.15 ± 4.02 | NR |
Shao et al. (2018) [26] | N | Students | 31 | 16 | NR | 18–30 |
Rathod et al. (2020) [43] | Y | Patients at Department of Periodontics and Implantology | 110 | 53 | NR | 18–30 |
Alkan et al. (2021) [44] | N | Subjects in need of fixed orthodontic treatment | 40 | 20 | 16.65 ± 3.23 | NR |
Anand et al. (2022) [31] | Y | Students or staff | 71 | 39 | NR | 19–30 |
Han et al. (2022) [32] | N | Patient with skeletal class III malocclusion and thin alveolar bone | 24 | 15 | NR | 18–30 |
Intervention Characteristics | Outcome Characteristics | ||||
---|---|---|---|---|---|
Study | Measurement Site | Measurement Area | Measurement Method | Gingiva Thickness (mm) | |
Maxilla (Tooth) 1 | Mandible (Tooth) 1 | ||||
Kydd et al. (1971) [30] 2 | Attached gingiva | Mid-buccally | Ultrasound | 1.1 ± 0.48 (13) | 0.69 ± 0.36 (43) |
0.77 ± 0.36 (23) | 0.50 ± 0.32 (33) | ||||
Eger et al. (1996) [4] | Base of sulcus | Mid-buccally | Ultrasound | 1.28 ± 0.40 (11, 21) | 0.87 ± 0.33 (31, 41) |
1.14 ± 0.39 (12, 22) | 0.91 ± 0.35 (32, 42) | ||||
0.89 ± 0.34 (13, 23) | 0.83 ± 0.29 (33, 43) | ||||
Müller et al. (2000) [37] | Base of sulcus | Mid-buccally | Ultrasound | 1.00 ± 0.30 (11, 21) | 0.65 ± 0.14 (31, 41) |
0.86 ± 0.33 (12, 22) | 0.71 ± 0.17 (32, 42) | ||||
0.70 ± 0.15 (13, 23) | 0.66 ± 0.15 (33, 43) | ||||
Base of papilla | Interdental | Ultrasound | 1.86 ± 0.45 (11, 21) | 1.13 ± 0.64 (31, 41) | |
1.32 ± 0.38 (12, 22) | 1.02 ± 0.42 (32, 42) | ||||
1.34 ± 0.45 (13, 23) | 1.43 ± 0.57 (33, 43) | ||||
Vandana et al. (2005) [21] | Midway | Mid-buccally | Transgingival | 1.00 ± 0.32 | 1.07 ± 0.34 |
(13, 12, 11, 21, 22, 23) | (43, 42, 41, 31, 32, 33) | ||||
Base of papilla | Interdental | Transgingival | 0.95 ± 0.35 | 1.13 ± 0.41 | |
(13, 12, 11, 21, 22, 23) | (43, 42, 41, 31, 32, 33) | ||||
Cha et al. (2008) [38] | Attached Gingiva | Interdental | Ultrasound | Men: | Men: |
1.20 ± 0.18 (11/21) | 1/1: 1.07 ± 0.26 (31/41) | ||||
1.84 ± 0.53 (11/12, 21/22) | 1/2: 1.07 ± 0.18 (41/42, 31/32) | ||||
1.48 ± 0.44 (12/13, 22/23) | 2/3: 1.27 ± 0.40 (42/43, 32/33) | ||||
Women: | Women: | ||||
1.28 ± 0.17 (11/21) | 1/1: 1.09 ± 0.29 (31/41) | ||||
1.48 ± 0.48 (11/12, 21/22) | 1/2: 1.18 ± 0.33 (41/42, 31/32) | ||||
1.26 ± 0.31 (12/13, 22/23) | 2/3: 1.24 ± 0.36 (42/43, 32/33) | ||||
La Rocca et al. (2012) [40] | Base of sulcus | Mid-buccally | Transgingival | 1.23 ± 0.79 (11, 21) | 0.89 ± 0.45 (31, 41) |
1.05 ± 0.50 (12, 22) | 0.89 ± 0.47 (32, 42) | ||||
1.01 ± 0.54 (13, 23) | 1.01 ± 0.85 (33, 43) | ||||
Midway | Mid-buccally | Transgingival | 1.28 ± 0.55 (11, 21) | 1.03 ± 0.47 (31, 41) | |
1.12 ± 0.46 (12, 22) | 0.95 ± 0.40 (32, 42) | ||||
1.01 ± 0.44 (13, 23) | 1.0 ± 0.49 (33, 43) | ||||
Sharma et al. (2014) [39] | Marginal groove | Mid-buccally | Transgingival | 0.587 ± 0.08 (12) | 0.574 ± 0.05 (42) |
0.574 ± 0.06 (22) | 0.556 ± 0.07 (32) | ||||
Ultrasound | 0.578 ± 0.08 (12) | 0.564 ± 0.05 (42) | |||
0.566 ± 0.06 (22) | 0.557 ± 0.07 (32) | ||||
Mucogingival junction | Mid-buccally | Transgingival | 0.961 ± 0.07 (12) | 0.926 ± 0.05 (42) | |
0.924 ± 0.06 (22) | 0.937 ± 0.04 (32) | ||||
Ultrasound | 0.951 ± 0.07 (12) | 0.9279 ± 0.04 (42) | |||
0.925 ± 0.07 (22) | 0.929 ± 0.04 (32) | ||||
Kolte et al. (2014) [41] | Midway | Mid-buccally | Transgingival | 1.04 ± 0.52 (13, 12, 11, 21, 22, 23) | 1.12 ± 0.69 (43, 42, 41, 31, 32, 33) |
Ranga et al. (2015) [36] | Base of papilla | Interdental | Transgingival | 1.30 ± 0.30 (13, 12, 11, 21, 22, 23) | 1.44 ± 0.44 (43, 42, 41, 31, 32, 33) |
Midway | Mid-buccally | Transgingival | 1.10 ± 0.15 (13, 12, 11, 21, 22, 23) | 1.16 ± 0.21 (43, 42, 41, 31, 32, 33) | |
Lee et al. (2017) [42] | Midway | Mid-buccally | Transgingival | 1.55 ± 0.30 (11, 21) | 1.01 ± 0.31 (31, 41) |
1.30 ± 0.30 (12, 22) | 1.04 ± 0.28 (32, 42) | ||||
1.26 ± 0.40 (13, 23) | 1.02 ± 0.27 (33, 43) | ||||
Kaya et al. (2018) [34] | Mean of two measurement sites | Mid-buccally | Transgingival | 1.13 ± 0.23 (13, 12, 11, 21, 22, 23) | 0.71 ± 0.16 (43, 42, 41, 31, 32, 33) |
Park et al. (2018) [35] | 1 mm apical to pocket base | Mid-buccally | Transgingival | 0.96 ± 0.34 (11, 21) | 0.79 ± 0.30 (31, 41) |
Shao et al. (2018) [26] | CEJ | Mid-buccally | Transgingival | 1.36 ± 0.24 (11, 21) | 0.89 ± 0.23 (31, 41) |
1.16 ± 0.19 (12, 22) | 0.84 ± 0.24 (32, 42) | ||||
1.10 ± 0.23 (13, 23) | 0.83 ± 0.20 (33, 43) | ||||
Rathod et al. (2020) [43] | Mean of two measurement sites | Mid-buccally | Transgingival | 1.02 ± 0.26 (11) | 0.80 ± 0.27 (31) |
1.00 ± 0.22 (21) | 0.83 ± 0.28 (41) | ||||
1.01 ± 0.25 (12) | 0.83 ± 0.27 (32) | ||||
1.00 ± 0.27 (22) | 0.85 ± 0.27 (42) | ||||
0.90 ± 0.26 (13) | 0.76 ± 0.31 (33) | ||||
0.93 ± 0.27 (23) | 0.80 ± 0.31 (43) | ||||
Alkan et al. (2021) [44] | Mean of two measurement sites | Mid-buccally | Transgingival | 1.24 ± 0.34 (11) | 0.67 ± 0.17 (31) |
1.16 ± 0.45 (12) | 0.76 ± 0.17 (32) | ||||
0.82 ± 0.24 (13) | 0.61 ± 0.19 (33) | ||||
1.23 ± 0.29 (21) | 0.70 ± 0.19 (41) | ||||
1.20 ± 0.42 (22) | 0.80 ± 0.28 (42) | ||||
0.82 ± 0.27 (23) | 0.61 ± 0.21 (43) | ||||
Anand et al. (2022) [31] | Base of sulcus | Mid-buccally | Transgingival | 1.3 ± 0.4 (11, 21) | 1.6 ± 0.5 (41, 31) |
1.2 ± 0.4 (12, 22) | 1.7 ± 0.3 (42, 32) | ||||
0.7 ± 0.3 (13, 23) | 0.9 ± 0.3 (43, 33) | ||||
Han et al. (2022) [32] | CEJ | Mid-buccally | CBCT | 1.29 ± 0.33 (13, 12, 11, 21, 22, 23) | 0.93 ± 0.21 (43, 42, 41, 31, 32, 33) |
3 mm below CEJ | Mid-buccally | CBCT | 0.87 ± 0.30 (13, 12, 11, 21, 22, 23) | 0.76 ± 0.18 (43, 42, 41, 31, 32, 33) |
Selection Bias | Selection Bias | Performance Bias | Detection Bias | Attrition Bias | Reporting Bias | |
---|---|---|---|---|---|---|
Risk of Bias | Selection of Participants | Confounding Variable | Measurement of Exposure | Blinding of Outcome Assessments | Incomplete Outcome Data | Selective Outcome Reporting |
Low | 6 (54.5%) | 4 (36.4%) | 10 (90.9%) | 11 (100%) | 11 (100%) | 11 (100%) |
Unclear | 4 (36.4%) | 5 (45.4%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
High | 1 (9.1%) | 2 (18.2%) | 1 (9.1%) | 0 (0%) | 0 (0%) | 0 (0%) |
Difference of Buccal Gingival Thickness between the Lower and Upper Jaws | ||||||||||
Population: Individuals with permanent dentition and healthy periodontal status. Setting: University or private practise. Intervention: Transgingival probing and ultrasound in the mid-buccal area. Comparison: Maxilla. | ||||||||||
Outcomes | Subgroups | Categories | n Study | n Teeth | ME | 95% CI | p-Value | I2 | p-Value | |
Mand | Max | |||||||||
Difference between the maxilla and mandible | Overall | 10 | 2100 | 2059 | −0.16 | −0.24, −0.07 | 0.0003 * | 96% | <0.001 | |
Measurement area | Subcrestal | 6 | 836 | 842 | −0.19 | −0.32, −0.05 | 0.007 * | 96% | <0.001 | |
Supracrestal | 7 | 1170 | 1128 | −0.14 | −0.24, 0.00 | 0.02 * | 96% | <0.001 | ||
Measurement method | Transgingival | 7 | 1388 | 1358 | −0.11 | −0.24, 0.01 | 0.08 | 97% | <0.001 | |
Ultrasound | 3 | 524 | 523 | −0.23 | −0.34, −0.11 | 0.001 * | 91% | <0.001 | ||
CBCT | 1 | 188 | 178 | −0.23 | −0.48, 0.01 | 0.06 | 95% | <0.001 | ||
Tooth category | Incisors | 7 | 1026 | 991 | −0.19 | −0.32, −0.06 | 0.003 * | 95% | <0.001 | |
Canines | 7 | 454 | 458 | −0.12 | −0.24, 0.00 | 0.05 | 91% | <0.001 |
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Schwarz, L.; Andrukhov, O.; Rausch, M.A.; Rausch-Fan, X.; Jonke, E. Difference in Buccal Gingival Thickness between the Mandible and Maxilla in the Aesthetic Zone: A Systematic Review and Meta-Analysis. J. Clin. Med. 2024, 13, 1789. https://doi.org/10.3390/jcm13061789
Schwarz L, Andrukhov O, Rausch MA, Rausch-Fan X, Jonke E. Difference in Buccal Gingival Thickness between the Mandible and Maxilla in the Aesthetic Zone: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2024; 13(6):1789. https://doi.org/10.3390/jcm13061789
Chicago/Turabian StyleSchwarz, Linda, Oleh Andrukhov, Marco Aoqi Rausch, Xiaohui Rausch-Fan, and Erwin Jonke. 2024. "Difference in Buccal Gingival Thickness between the Mandible and Maxilla in the Aesthetic Zone: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 13, no. 6: 1789. https://doi.org/10.3390/jcm13061789