Current Oral Health Reports

, Volume 5, Issue 3, pp 202–209 | Cite as

The Use of Cone Beam Computed Tomography to Assess Periodontal Biotype

  • Jonathan KorostoffEmail author
  • Meshari Al-Abdulhadi
  • Panagiota G. Stathopoulou
Digital and Esthetic Dentistry (E Anadioti and P Stathopoulou, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Digital and Esthetic Dentistry


Purpose of Review

Periodontal biotype is a concept with great relevance to clinical practice. Although numerous factors contribute to determining biotype, including soft/hard tissue thickness, soft/hard tissue contours, amount of keratinized tissue, and tooth shape, gingival thickness has been mostly utilized. The use of cone beam computed tomography (CBCT) has been recently proposed as a state-of-the-art approach for assessing periodontal biotypes because it provides information relative to both soft and hard tissue dimensions.

Recent Findings

When used in conjunction with lip retraction or a dual-scan technique, reliable and reproducible measurements of gingival and alveolar thickness can be made on CBCT scans, with the potential to aid in periodontal biotype assessment.


While current data support the potential use of CBCT for periodontal biotype assessment, the technology in its current state should be used primarily for investigational purposes. The cost and radiation dose need to be considered and additional research is required before implementation into clinical practice.


CBCT Periodontal biotype Gingival biotype Soft tissue thickness 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Oschenbein C, Ross S. A reevaluation of osseous surgery. Dent Clin N Am. 1969;13(1):87–102. The first publication to propose the concept of flat versus scalloped gingival form and describe the relationship between soft tissue morphology and alveolar bone contour. Google Scholar
  2. 2.
    • Seibert J, Lindhe J. Esthetics and periodontal therapy. In: Lindhe, J. editor. Textbook of Clinical Periodontology, 2nd edition. Copenhagen: Munksgaard; 1989. pp.477–514. Coined the term “periodontal biotype.” Google Scholar
  3. 3.
    • Weisgold AS. Contours of the full crown restoration. Alpha Omegan. 1977;70(3):77–89. Proposed a differential response to inflammation; those with a thin/scalloped biotype developed gingival recession in contrast to the periodontal pockets that resulted in subjects with a thick/flat biotype. PubMedGoogle Scholar
  4. 4.
    Olsson M, Lindhe J. Periodontal characteristics in individuals with varying form of the upper central incisors. J Clin Periodontol. 1991;18(1):78–82.CrossRefPubMedGoogle Scholar
  5. 5.
    Zweers J, Thomas RZ, Slot DE, Weisgold AS, Van der Weijden GA. Characteristics of periodontal biotypes, its dimensions, associations and prevalence: a systematic review. J Clin Periodontol. 2014;41:958–71.CrossRefPubMedGoogle Scholar
  6. 6.
    Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implan Res. 2005;16(6):639–44.CrossRefGoogle Scholar
  7. 7.
    •• Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63(12):995–6. Demonstrated that the presence or absence of an interdental papilla is dependent upon the distance between the contact points of adjacent teeth and alveolar bone crest. Google Scholar
  8. 8.
    Ahmed AJ, Nichani AS, Vanugopal R. An evaluation of the effect of periodontal biotype on inter-dental papilla proportions, distances between and facial and palatal papillae in the maxillary anterior dentition. J Prosthodont. 2017;
  9. 9.
    Newell DH, Brunsvold MA. A modification of the “curtain technique” incorporating an internal mattress suture. J Periodontol. 1985;56(8):484–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Claffey N, Shanley D. Relationship of gingival thickness and bleeding to loss of probing attachment in shallow sites following nonsurgical periodontal therapy. J Clin Periodontol. 1986;13(7):654–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Avila-Ortiz G, De Buitrago JG, Reddy MS. Periodontal regeneration of furcation defects: a systematic review from the AAP regeneration workshop. J Periodontol. 2015;86(2-s):S108–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol. 2015;86(2-s):S8–51.CrossRefPubMedGoogle Scholar
  13. 13.
    Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, et al. Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol. 1999;70(9):1077–84.CrossRefPubMedGoogle Scholar
  14. 14.
    • Rebele SF, Zuhr O, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versuscoronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol. 2014;41(6):593–603. Used an optical three-dimensional measurement system on scanned models and showed that “increased gingival thickness was associated with better surgical outcomes in terms of recession reduction and root coverage.” CrossRefPubMedGoogle Scholar
  15. 15.
    Buser DD, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants. 2014;19(Suppl):3–61.Google Scholar
  16. 16.
    Al-Sabbagh M. Implants in the esthetic zone. Dent Clin N Am. 2006;50(3):391–407.CrossRefPubMedGoogle Scholar
  17. 17.
    Evans CDJ, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implan Res. 2008;19(1):73–80.Google Scholar
  18. 18.
    Romeo E, Lops D, Rossi A, Storelli S, Rozza R, Chiapasco M. (2008). Surgical and prosthetic management of interproximal region with single-implant restorations: 1-year prospective study. J. Periodontol. 2008;79(6):1048–1055.Google Scholar
  19. 19.
    Monje A, Galindo-Moreno P, Tözüm TF, Suárez-López del Amo F, Wang HL. Into the paradigm of local factors as contributors for peri-implant disease: short communication. Int J Oral Maxillofac Implants 2016:31(2):288–292.Google Scholar
  20. 20.
    Wennström JL. Mucogingival considerations in orthodontic treatment. Sem Orthodont. 1996;2(1):46–54.CrossRefGoogle Scholar
  21. 21.
    La Rocca AP, Alemany AS, Levi P, Juan MV, Molina JN, Weisgold AS. Anterior maxillary and mandibular biotype: relationship between gingival thickness and width with respect to underlying bone thickness. Implant Dent. 2012;21(6):507–15.CrossRefPubMedGoogle Scholar
  22. 22.
    Rasperini G, Acunzo R, Cannalire P. Farronato G. (2015). Influence of periodontal biotype on root surface exposure during orthodontic treatment: a preliminary study. Int J Periodontics Restorative Dent 2015;35(5):665–675.Google Scholar
  23. 23.
    Olsson M, Lindhe J, Marinello CP. On the relationship between crown form and clinical features of the gingiva in adolescents. J Clin Periodontol. 1993;20(8):570–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Eger T, Müller HP, Heinecke A. Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features. J Clin Periodontol. 1996;23(9):839–45.CrossRefPubMedGoogle Scholar
  25. 25.
    • Kan JYK, Rungcharassaeng K, Umezu K, Kois JC. (2003). Dimensions of peri-implant mucosa: an evaluation of maxillary anterior single implants in humans. J Periodontol. 2003;74(4):557–62. First description of the probe transparency method for determining gingival thickness. Google Scholar
  26. 26.
    De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol 2009;36(5):428–433.Google Scholar
  27. 27.
    Rasperini G, Acunzo R, Cannalire P, Farronato G. Influence of periodontal biotype on root surface exposure during orthodontic treatment: a preliminary study. Int J Periodontics Restorative Dent. 2015;35(5):665–75.PubMedGoogle Scholar
  28. 28.
    • Alpiste-Illueca F. Dimensions of the dentogingival unit in maxillary anterior teeth: a new exploration technique (parallel profile radiograph). Int J Periodontics Restorative Dent. 2004;24(4):386–96. Described a radiographic approach to assessing the dimensions of the dentogingival unit. PubMedGoogle Scholar
  29. 29.
    Stein JM, Lintel-Höping N, Hammächer C, Kasaj A, Tamm M, Hanisch O. The gingival biotype: measurement of soft and hard tissue dimensions—a radiographic morphometric study. J Clin Periodontol. 2013;40(12):1132–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc. 2006;72(1):75–80.PubMedGoogle Scholar
  31. 31.
    Sherrard JF, Rossouw PE, Benson BW, Carrillo R, Buschang PH. Accuracy and reliability of tooth and root lengths measured on cone-beam computed tomographs. Am J Orthod Dentofac Orthop. 2010;137(4):S100–8.CrossRefGoogle Scholar
  32. 32.
    Benninger B, Peterson A, Cook V. Assessing validity of actual tooth height and width from cone beam images of cadavers with subsequent dissection to aid oral surgery. J Oral Maxillofac Surg. 2012;70(2):302–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Lund H, Gröndahl K, Gröndahl H. Accuracy and precision of linear measurements in cone beam computed tomography Accuitomo® tomograms obtained with different reconstruction techniques. Dentomaxillofac Radiol. 2009;38(6):379–86.CrossRefPubMedGoogle Scholar
  34. 34.
    Van Dessel J, Nicolielo LFP, Huang Y, Coudyzer W, Salmon B, Lambrichts I, et al. Accuracy and reliability of different cone beam computed tomography (CBCT) devices for structural analysis of alveolar bone in comparison with multislice CT and micro-CT. Eur J Oral Implantol. 2017;10(1):95–105.PubMedGoogle Scholar
  35. 35.
    Schulze R, Heil U, Gross D, Bruellmann DD, Dranischnikow E, Schwanecke U, et al. Artefacts in CBCT: a review. Dentomaxillofac Radiol. 2011;40(5):265–73.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Pauwels R, Jacobs R, Bogaerts R, Bosmans H, Panmekiate S. Reduction of scatter-induced image noise in cone beam computed tomography: effect of field of view size and position. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121(2):188–95.CrossRefPubMedGoogle Scholar
  37. 37.
    • Fu J, Yeh C, Chan H, Tatarakis N, Leong DJM, Wang H. Tissue biotype and its relation to the underlying bone morphology. J Periodontol 2010;81(4): 569–74. One of the first studies to utilize CBCT scans to evaluate the relationship between patients’ soft tissue morphology and contour of the supporting alveolar bone. Google Scholar
  38. 38.
    Frumkin N, Via S, Klinger A. Evaluation of the width of the alveolar bone in subjects with different gingival biotypes: a prospective cohort study using cone beam computed tomography. Quintessence Int. 2017;48(3):209–16.PubMedGoogle Scholar
  39. 39.
    Cook DR, Mealey BL, Verrett RG, Mills MP, Noujeim ME, Lasho DJ, et al. Relationship between clinical periodontal biotype and labial plate thickness: an in vivo study. Int J Periodontics Restorative Dent. 2011;31(4):345–54.PubMedGoogle Scholar
  40. 40.
    Amid R, Mirakhori M, Safi Y, Kadkhodazadeh M, Namdari M. Assessment of gingival biotype and facial hard/soft tissue dimensions in the maxillary anterior teeth region using cone beam computed tomography. Arch Oral Biol. 2017;79:1–6.CrossRefPubMedGoogle Scholar
  41. 41.
    • Nikiforidou M, Tsalikis L, Angelopoulos C, Menexes G, Vouros I, Konstantinides A. Classification of periodontal biotypes with the use of CBCT. A cross-sectional study. Clin Oral Investig. 2016;20(8):2061–71. Data suggests that CBCT scanning can be used to classify individuals into periodontal biotypes. CrossRefPubMedGoogle Scholar
  42. 42.
    • Januário AL, Duarte WR, Barriviera M, Mesti JC, Araujo MG, Lindhe J. Dimension of the facial bone wall in the anterior maxilla: a cone-beam computed tomography study. Clin Oral Implants Research 2011;22(10):1168–71. Describes the lip retraction technique for visualizing gingiva via CBCT facilitating measurement of the distance between the gingival margin and the alveolar crest as well as the width of the facial gingiva (biotype). Google Scholar
  43. 43.
    Schertel Cassiano L, Barriviera M, Suzuki S, Giacomelli Nascimento G, Lourenço Januario A, Hilgert LA, et al. Soft tissue cone beam computed tomography (ST-CBCT) for the planning of esthetic crown lengthening procedures. Int J Esthet Dent. 2016;11(4):482–93.PubMedGoogle Scholar
  44. 44.
    Silva J, Andrade PF, Souza Picorelli Assis NM, Pires Carvalho AC, Devito KL. Influence of lip retraction on the cone beam computed tomography assessment of bone and gingival tissues of the anterior maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(6):714–20.CrossRefPubMedGoogle Scholar
  45. 45.
    • Kim Y, Park J, Kim S, Koo K, Seol Y, Lee Y, et al. (2016). New method of assessing the relationship between buccal bone thickness and gingival thickness. J Periodontal Implant Sci 2016;46(6):372–81. Describes a novel “dual scan” technique to superimpose a stereolithographic image (STL data) derived from three-dimensional intraoral scans of subjects onto the data from the CBCT DICOM files that might have great potential for measuring the dimensions of the dentogingival unit and alveolar bone. Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jonathan Korostoff
    • 1
    Email author
  • Meshari Al-Abdulhadi
    • 2
  • Panagiota G. Stathopoulou
    • 1
  1. 1.Department of PeriodonticsUniversity of Pennsylvania School of Dental MedicinePhiladelphiaUSA
  2. 2.Jaber HospitalKuwait Ministry of HealthKuwait CityKuwait

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