Clinical evaluation of the effect of gingival thickness on increasing the width of keratinized and attached gingiva with and without preserving periosteum in an animal study

Document Type: Original Article(s)


1 Assistant Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran

2 Associate Professor, Department of Clinical Sciences, School of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran

3 Professor, Department of Clinical Sciences, School of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran

4 Assistant Professor, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center AND Department of Periodontics, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

5 Private Practice, Bandar Abbas, Iran


BACKGROUND AND AIM: The present study was performed in order to assess the effect of gingival thickness on amount of gingival augmentation with and without preserving periosteum.METHODS: The study was conducted on 8 ecotype dogs aged 1-5 years. At the beginning, clinical probing depth and keratinized and attached gingiva width were measured. Totally, 64 sites were operated in this study. Periosteal fenestration and denuded beds were randomly created on opposite sides of upper and lower jaws (4 sites each side). The thickness of gingiva was measured in mucogingival junction after preparation of the beds. The clinical parameters were evaluated 2 months after the surgery. The data were analyzed by Mann-Whitney U, Wilcoxon, and Pearson correlation tests.RESULTS: The results showed the average increased width of keratinized and attached gingiva was 1.8 mm and 2 mm in periosteal fenestration sites and 1.9 mm and 2.3 mm in denudation sites, respectively at 2 months post-surgery. The difference between the width of keratinized gingiva and attached gingiva before and 2 months after operation was significant in both groups (P < 0.001). However, no significant difference was shown between the two groups in terms of attached and keratinized gingival width (P = 0.100 and P = 0.720, respectively). There was no correlation between the thickness of gingiva and the amount of increased width of keratinized and attached gingiva.CONCLUSION: A gingival thickness of 0.8 to 2 mm does not affect the increment of the attached and keratinized gingival width with and without preserving periosteum.


  1. Newman M, Takei H, Klokkevold P, Carranza FA, Jr. Carranza's clinical periodontology. 12th ed. Philadelphia, PA: Saunders; 2014. p. 628.
  2. Carranza FA, Jr., Carraro JJ. Mucogingival techniques in periodontal surgery. J Periodontol 1970; 41(5): 294-9.
  3. Ericsson I, Lindhe J. Recession in sites with inadequate width of the keratinized gingiva. An experimental study in the dog. J Clin Periodontol 1984; 11(2): 95-103.
  4. Stetler KJ, Bissada NF. Significance of the width of keratinized gingiva on the periodontal status of teeth with submarginal restorations. J Periodontol 1987; 58(10): 696-700.
  5. Ochsenbein C. Newer concepts of mucogingival surgery. J Periodontol 1960; 31(3): 175-85.
  6. Corn H. Periosteal separation—its clinical significance. J Periodontol 1962; 33(2): 140-53.
  7. Wilderman MN. Repair after a periosteal retention procedure. J Periodontol 1963; 34(6): 487-503.
  8. Robinson RE, Agnew RG. Periosteal fenestration at the mucogingival line. J Periodontol 1963; 34(6): 503-12.
  9. Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. J Clin Periodontol 1974; 1(4): 185-96.
  10. Bjorn H. Free transplantation of gingiva propia. Sveriges Tandlakt 1963; 22: 684-8.
  11. Silverstein L, Callan D. An acellular dermal matrix allograft and a palatal graft for tissue augmentation. Periodontal Insights 1996; 6: 3-6.
  12. McGuire MK, Nunn ME. Evaluation of the safety and efficacy of periodontal applications of a living tissue-engineered human fibroblast-derived dermal substitute. I. Comparison to the gingival autograft: a randomized controlled pilot study. J Periodontol 2005; 76(6): 867-80.
  13. Mohammadi M, Shokrgozar MA, Mofid R. Culture of human gingival fibroblasts on a biodegradable scaffold and evaluation of its effect on attached gingiva: a randomized, controlled pilot study. J Periodontol 2007; 78(10): 1897-903.
  14. Harris RJ. A comparative study of root coverage obtained with guided tissue regeneration utilizing a bioabsorbable membrane versus the connective tissue with partial-thickness double pedicle graft. J Periodontol 1997; 68(8): 779-90.
  15. Muller HP, Stahl M, Eger T. Dynamics of mucosal dimensions after root coverage with a bioresorbable membrane. J Clin Periodontol 2000; 27(1): 1-8.
  16. Brasher WJ, Rees TD, Boyce WA. Complications of free grafts of masticatory mucosa. J Periodontol 1975; 46(3): 133-8.
  17. Raghoebar GM, Tomson AM, Scholma J, Blaauw EH, Witjes MJ, Vissink A. Use of cultured mucosal grafts to cover defects caused by vestibuloplasty: an in vivo study. J Oral Maxillofac Surg 1995; 53(8): 872-8.
  18. Ueda M, Hata KI, Sumi Y, Mizuno H, Niimi A. Peri-implant soft tissue management through use of cultured mucosal epithelium. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86(4): 393-400.
  19. Carraro JJ, Carranza FA, Jr., Albano EA, Joly GG. Effect of bone denudation in mucogingival surgery in humans. J Periodontol 1964; 35(6): 463-6.
  20. Struillou X, Boutigny H, Soueidan A, Layrolle P. Experimental animal models in periodontology: a review. Open Dent J 2010; 4: 37-47.
  21. Carranza FA, Jr., Carraro JJ. Effect of removal of periosteum on postoperative result of mucogingival surgery. J Periodontol 1963; 34(3): 223-6.
  22. Allen DL, Shell JH. Clinical and radiographic evaluation of a periosteal separation procedure. J Periodontol 1968; 39(5): 290-5.
  23. Bowers GM. A study of the width of attached gingiva. J Periodontol 1963; 34(3): 201-9.
  24. Folke LE, Stallard RE. Periodontal microcirculation as revealed by plastic microspheres. J Periodontal Res 1967; 2(1): 53-63.
  25. Keller GJ, Cohen DW. India ink perfusions of the vascular plexus of oral tissues. Oral Surg Oral Med Oral Pathol 1955; 8(5): 539-42.
  26. Mormann W, Ciancio SG. Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study. J Periodontol 1977; 48(11): 681-92.