Gingival Phenotype and Dental Crowding in Pediatric Patients

Overview

The diagnostic evaluation of the soft and hard tissues surrounding the tooth is one of the most crucial factors in clinical dental practice. It can influence treatment planning and decision-making in multidisciplinary dental care. Since different periodontal phenotypes respond differently to chemical, physical, and bacterial insults, or trauma during dental treatments, this aspect is considered essential in determining the outcome of therapy across many dental specialties. Understanding the gingival phenotype can be of great importance in pediatric dentistry, as thick gingiva provides a solid and stable foundation for maintaining optimal oral hygiene and is one of the key elements in orthodontic treatment. The bucco-lingual thickness of the gingiva, combined with the direction of tooth movement, is considered an important factor in soft tissue changes and in the development or progression of mucogingival defects. In cases of a thin phenotype, dehiscence and/or fenestrations may occur, predisposing the patient to gingival recession if the tooth is moved beyond the biological limits-i.e., outside the bony housing. The mandibular incisors have been identified as the teeth most susceptible to the development of labial recession. Some malocclusions become evident as early as the early mixed dentition period. Intense changes in both soft and hard tissues occur during the growth and development of the stomatognathic system, as described in the literature, particularly during the mixed dentition phase. These changes can affect tooth position and the stability of periodontal tissues, making a proper evaluation of the gingival phenotype essential in pediatric patients. Interceptive orthodontics plays a key role in the prevention and early management of malocclusions, helping to reduce the risk of developing mucogingival defects in adulthood. Early identification of a thin gingival phenotype allows for the implementation of preventive strategies, such as controlling tooth movement within biological limits and, if necessary, using gingival grafts before performing critical orthodontic movements. Additionally, genetic, anatomical, and functional factors influence the gingival response to orthodontic forces. An accurate assessment of the gingival biotype, combined with personalized orthodontic planning, is essential to ensure effective treatment and long-term periodontal health. Currently, there are no studies in the literature regarding the association between the severity of dental crowding and periodontal biotype in pediatric patients. Furthermore, the data available in the adult population are inconsistent: Kaya et al. demonstrated that, in adulthood, there is no correlation between the gingival phenotype and skeletal malocclusion. On the other hand, Kong et al. reported a correlation between a thin biotype in skeletal Class I and III, site-specific to the left mandibular central incisor, and also found a significant association between the thin phenotype and the normodivergent and hypodivergent groups. To date, there is therefore no predictive model capable of identifying periodontal issues related to severe crowding. The aim of this study is primarily to assess the periodontal phenotype in pediatric patients at different stages of dental transition and to investigate a possible association between a thin periodontal biotype and severe dental crowding in childhood.