Gingival Phenotype and Dental Crowding in Pediatric Patients, a Pilot Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Enrollment
- 180
- Locations
- 1
- Primary Endpoint
- Gingival Phenotype in Pediatric Patients Across Dentition Stages
Study Overview
Brief Summary
The periodontal phenotype influences treatment outcomes across dental specialties, as tissues of different thickness respond differently to chemical, bacterial, and mechanical insults. In pediatric patients, understanding the gingival phenotype is particularly relevant: a thin phenotype may predispose to dehiscence, fenestration, and gingival recession-especially at the mandibular incisors-when tooth movement exceeds the biological limits of the bony housing.
During the mixed dentition phase, significant changes in soft and hard tissues affect tooth position and periodontal stability, making early phenotype assessment essential. Interceptive orthodontics can reduce the long-term risk of mucogingival defects; early identification of a thin biotype allows for preventive strategies, including soft tissue grafting before critical orthodontic movements.
No studies have examined the association between dental crowding severity and periodontal phenotype in children. Adult data remain inconsistent: Kaya et al. found no correlation between phenotype and skeletal malocclusion, while Kong et al. reported a site-specific association between thin biotype and skeletal Class I/III at the mandibular central incisor. No predictive model exists for periodontal risk related to severe crowding in childhood.
This study aims to assess the periodontal phenotype in pediatric patients across different stages of dental transition and to investigate a possible association between a thin periodontal biotype and severe dental crowding.
Detailed Description
Background and Rationale
The periodontal phenotype-defined by the bucco-lingual thickness of the gingiva, the width of keratinized tissue, and the underlying bone morphology-plays a central role in the response of periodontal tissues to orthodontic forces, bacterial insults, and restorative or surgical procedures. Thin-scalloped phenotypes are associated with a higher risk of gingival recession, dehiscence, and fenestration, especially when teeth are moved beyond their bony envelope.
During the mixed dentition phase, significant changes occur in both soft and hard tissues as part of the normal development of the stomatognathic system. These changes may affect tooth position and the stability of periodontal tissues, making evaluation of the gingival phenotype particularly relevant in pediatric patients. Mandibular incisors have been identified as the most vulnerable teeth for the development of labial gingival recession following orthodontic treatment.
Interceptive orthodontics aims to prevent or limit the severity of malocclusions at an early age. Early identification of a thin gingival phenotype enables clinicians to consider preventive measures-such as restricting tooth movement within biological limits or planning soft tissue augmentation procedures prior to critical orthodontic movements.
Genetic, anatomical, and functional factors influence the gingival response to orthodontic forces; therefore, personalized orthodontic planning that integrates periodontal assessment is essential for long-term treatment outcomes and periodontal health.
Study Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Prospective
Eligibility Criteria
- Ages
- 5 Years to 16 Years (Child)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Pediatric patients attending the Pediatric Dentistry and/or Orthodontics clinic (consultation and/or outpatient appointment).
- •Parents and/or legal guardians have signed the informed consent for participation in the study.
- •Age between 5 and 16 years.
- •Clinical dentition criteria by group:
- •Group 1 (Primary Dentition): Presence in the mandibular arch of deciduous teeth from canine to canine. Group 2 (Early Mixed Dentition): Presence in the mandibular arch of at least two permanent mandibular incisors, fully erupted (incisal edge at occlusal level) or partially erupted (≥50% of the crown), with no clinical attachment loss, and healthy gingiva or mild gingivitis (Gingival Index, GI ≤ 1). Group 3 (Late Mixed Dentition): Presence in the mandibular arch of all four permanent mandibular incisors fully erupted (incisal edge at occlusal level), with no clinical attachment loss, and healthy gingiva or mild gingivitis (GI ≤
- •. Group 4 (Permanent Dentition): Presence in the mandibular arch of all four permanent mandibular incisors fully erupted (incisal edge at occlusal level), with no clinical attachment loss, and healthy gingiva or mild gingivitis (GI ≤ 1).
Exclusion Criteria
- •Patient-related:
- •Parents and/or legal guardians have not signed the informed consent.
- •Patients who are not sufficiently cooperative to allow a routine dental examination.
- •Non-cooperative patients, including those with special needs.
- •Children with systemic diseases or undergoing medication that affects gingival tissues.
- •Patients who have already undergone orthodontic treatment or are currently undergoing orthodontic treatment.
- •Tooth-related:
- •Presence of dental agenesis or dental anomalies.
- •Dental sites with mucogingival problems.
Arms & Interventions
Pediatric patients in the primary dentition stage
This group includes children who still have all their primary (baby) teeth, with no eruption of permanent teeth. Typically, this stage ranges from approximately 2 to 6 years of age.
Intervention: Orthodontic and periodontal analysis (Other)
Pediatric patients in the early mixed dentition stage
This group includes children in the initial phase of tooth transition, where the first permanent molars and incisors have erupted while primary teeth are still present. This stage generally occurs between 6 and 8 years of age.
Intervention: Orthodontic and periodontal analysis (Other)
Pediatric patients in the late mixed dentition stage
This group consists of children in the later phase of dental transition, when canines and premolars begin to replace primary teeth. It usually occurs between 9 and 12 years of age.
Intervention: Orthodontic and periodontal analysis (Other)
Pediatric patients in the permanent dentition stage
This group includes adolescents who have completed the transition and have all or nearly all of their permanent teeth, excluding third molars (wisdom teeth). This stage typically begins around age 12 and up.
Intervention: Orthodontic and periodontal analysis (Other)
Outcomes
Primary Outcomes
Gingival Phenotype in Pediatric Patients Across Dentition Stages
Time Frame: 24 months (18 months data collection, 12 months data processing and analysis)
Assessment of gingival phenotype in pediatric patients categorized by dentition stage: Group 1: Primary dentition Group 2: Early mixed dentition Group 3: Late mixed dentition Group 4: Permanent dentition Gingival phenotype will be classified as thin or thick based on standardized clinical criteria. Measurement Tool: Transgingival probing using a periodontal probe (probe transparency method) Unit of Measure: Categorical variable: Thin vs. Thick gingival phenotype Gingival thickness measured in millimeters (mm), if quantitative assessment is used.
Secondary Outcomes
- Comparison of Crowding Indices and Periodontal Biotype(From ethics committee approval through 24 months (18 months data collection, 12 months data processing and analysis))