INTRODUCTION:

The thickness of the gingiva in the faciopalatal/ faciolingual dimension is known as gingival biotype.^{[1],[2],[3],[4]}In 1969, healthy gingival tissue was categorized into thin scalloped or thick flat. Ochsenbien and Ross stated that gingival biotypes are of two types

1. scalloped and thin or

2. flat and thick.

They also proposed that the underlying bone depicts the contour of the gingival above.^[5] Later Siebert and Lindhe categorized the gingiva into ‘‘thick - flat’’ and ‘‘thin – scalloped’’ biotypes.^[6] A gingival thickness of ≥ 2 mm was considered as thick tissue biotype and a gingival thickness of <1.5 mm was referred as thin tissue biotype.^[7]

Becker et al., proposed three different periodontal biotypes: flat, scalloped and pronounced scalloped gingival margin.^[8]According to literature, the alveolar bone and gingival margin surrounding a tooth which had a pronounced cervical convexity are located more apically than in other teeth with flat surfaces, suggesting the anatomy of the tooth also influences the contour of the underlying bone.^[9]

Gingival biotype is considered to be related to the masticatory characteristics^[10],orthodontic treatment^{[11],[12],[13]}, periodontal diseases^[14],[15]periodontal therapy^[16],inflammatory episodes^[17],conventional prosthodontics^[18], surgical intervention^[19],[20], implant therapy and root coverage procedures^[21]. Thick and thin periodontal biotypes respond differently to inflammation and surgical insult, and that influence the periodontal treatment. Different individual factors contribute to biotype difference including genetics, tooth morphology and position, age, gender and type of growth.^[22]

Reduced gingival thickness is one of the factors that can cause periodontal attachment loss and marginal tissue recession in a patient, which is a major concern for periodontal disease progression.^[4]This study was undertaken to study the influence of malocclusion on various gingival biotypes in school children with developing dentition.

Aim:

To assess the knowledge of malocclusion, attitude towards treatment, oral hygiene practices and its correlation with the prevalence of gingival biotypes among school children from the age 15-17.

Objective:

To study the prevalence of different gingival biotypes and knowledge of malocclusion in school children between the age 15-17 and correlate the association between gingival biotypes and malocclusion.

MATERIALS AND METHODS:

The study was done in Nazareth Matriculation Higher seconday school, Avadi. A total of 189 students from the age 15-17 participated in the study. A questionnaire survey consisting of 12 questions was distributed to assess their knowledge of malocclusion and attitude towards treatment and oral hygiene practices. Gingival thickness was assessed using transparency of periodontal probe technique. This was assessed on maxillary central incisor. Occlusion status was assessed by Angle’s classification. Statistical comparison of the obtained data was done by using SPSS version 20.

Inclusion criteria:

1. Systemically healthy school children from the age 15-17

Exclusion criteria:

1. Students with crowns or extensive restorations on their anterior maxillary teeth

2. Students who are taking certain medication with known effects on the periodontal soft tissues

3. History of previous orthodontic treatment.

Fig 2 Represents prevalence of malocclusion

Fig 3 represents relation between malocclusion and gingival biotypes

Table 1 Represents the relationship between gingival biotypes and malocclusion.

Type of malocclusion	Gingival biotype				Total
Type of malocclusion	Thin	P value	Thick	P value
Class 1	120	0.08	25	0.24	145
Class 2	30	0.49	11	0.73	41
Class 3	3	0.78	0	0.95	3
Total	153		36		189

The study population of 189 children consisted of 97 males and 92 females with age ranging from 15-17 of which majority of the students were 16 years old. The results of the survey showed that school children exhibited less awareness towards orthodontic treatment as shown in fig 1. 77% of the students had angle’s class 1 type of malocclusion. 21% students had Angles class 2 malocclusion and 2% students had Angle’s class 3 type of malocclusion as shown in fig 2. 51% of the students had crowding. 22% of the students had spacing and 7% of the students had proclination. The comparison of gingival biotypes with malocclusion is represented in fig 3. Subjects with normal occlusion showed thin biotype. Thick biotype was more prevalent in subjects with crowding when compared with subjects having spacing and proclination. This indicates that there might be a possibility of developing periodontitis in subjects with crowding. However, in this study, there were no statistically significant association between the gingival biotypes and malocclusion.

DISCUSSION:

Gingival biotype, malocclusion and oral hygiene practices are inter-related. Reduced gingival thickness in thin gingival biotype subjects is one of the factors that can cause periodontal attachment loss and marginal tissue recession, which is a major concern for periodontal disease progression.^[4]Owing to the idea of preventing periodontal disease progression at an early stage, this study was done to assess the knowledge of malocclusion, attitude towards treatment, oral hygiene practices and its correlation with the prevalence of gingival biotypes among school children from the age 15-17. A questionnaire survey was distributed to 189 school children to assess their knowledge of malocclusion and attitude towards treatment. Gingival thickness was assessed using transparency of periodontal probe technique.^[9] Occlusion status was assessed by Angle’s classification.

Questionnaire structure:

To assess knowledge of malocclusion, the students were asked to answer yes/no for the following questions.

1. Do you know that mal-aligned teeth have ill effects?

2. Do you know that thumb sucking / lip biting affects teeth alignment?

3. Do you know that ear pain / jaw pain is associated with mal-aligned teeth?

The students were asked to answer yes/no for the following questions to assess their attitude towards dental treatment.

1) When you look at yourself in the mirror, have you notice that you have crooked teeth?

2) Do you feel that your teeth are mal-aligned, crowed, projected outward or are there gaps in between your teeth?

3) Have you felt the need to wear brackets?

4) Do you want to treat your crooked teeth?

5) Will you be regular for the treatment?

The following questions were asked to assess the student’s oral hygiene practices

1) Do you brush your twice daily?

2) Do you use mouthwash /floss /other aids to clean your teeth?

3) Have you visited a dentist before?

4) Have you undergone any dental treatment before?

Gingival biotype are one of the critical factors that determine the result of orthodontic treatment. Initial gingival thickness predicts the outcome of any root coverage procedures or any restorative treatments. In orthodontic treatment, the characteristics and thickness of the gingival tissue plays an important role especially, for aesthetic reasons, in the maxillary anterior area. However, the association between gingival recession andorthodontic treatment is still a matter of debate.^[23] Earlier studies reported that when the thickness of the attached gingiva is more than 0.5 mm, the risk of gingival recession was reduced^[24] Therefore, it was concluded that a thicker attached gingiva may play a significant function in avoiding gingival recession even when the alveolar bone is reduced or absent.

Gingival thickness is assessed by an invasive and a non-invasive method. Invasive methods such as injection needle or probe, histologic sections or cephalometric radiographs while non-invasive methods included visual examination, the use of ultrasonic devices, probe transparency and cone beam computed tomography (CBCT).(1,9,25,26) The visual assessment of the gingival biotype by itself is not sufficiently reliable and may not be considered as a valuable method as previous studies have found.^[1],[25]The ultrasonographic method of assessing gingival thickness is a non-invasive method but it has multiple drawbacks that includes but not limited to the nonreliability of results when the thickness of gingival exceeds 2-2.5mm and the difficulty to determine the correct position and achieve a reproducible measurements.^[26]The accurate representation of the clinical thickness of labial gingiva and bone were more reliable in the measurements by CBCT^[27]However, the limitation were exposure to radiation and cost.

In our study, there were no significant correlation between the gingival biotype and prevalent malocclusion. This present study could not demonstrate a definite relationship between gingival biotypes and Angle’s classification. No significant differences were observed between classes I,II and III relationship and the gingival biotype. The bucco-lingual tooth position within the bone housing may have an influence on the gingival thickness. Our study demonstrated that thicker gingival biotype are more prevalent in crowded teeth. However, the limitations of the study are less sample size and only students from one school were included in the study. Further studies with larger sample size from different schools may be needed to demonstrate a relationship between gingival biotypes and malocclusion in south Indian population.

CONCLUSION:

According to the results of our survey

1. School children exhibited less awareness towards orthodontic treatment.

2. There is no significant association between gingival biotypes and malocclusion.

CONFLICT OF INTEREST:

Nil.

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Received on 21.04.2018 Modified on 11.05.2018

Research J. Pharm. and Tech 2018; 11(11): 4884-4887.

DOI: 10.5958/0974-360X.2018.00889.2