Skip to main content

Importance of periodontal phenotype in periodontics and restorative dentistry: a systematic review



Periodontal phenotype is regarded to be one of the key factors influencing the efficacy of restorative therapies in dental practice. The objective of the systematic review was to explore the importance of thin and thick periodontal phenotypes and how they affect the outcome of periodontal and restorative therapies by looking at a number of academic publications from various online databases.


Following the PRISMA guidelines (Preferred Reporting Items for Systematic Review standards), relevant data will be searched and retrieved from three significant scientific databases, including PubMed, EBSCO, and Scopus. The articles with full texts that matched the keywords and published in English between 2018 and 2023 were taken into consideration.


The majorities of these articles were based on the type of periodontal phenotype and their impact on periodontal and restorative treatment outcomes were selected. The initial search yielded a total of 530 articles. Only 273 were relevant to the review’s objectives, and these were considered for determining eligibility. Only 20 publications were eligible for analysis.


Understanding these anatomical aspects of periodontal phenotype is crucial to both periodontology and restorative dentistry. The clinical outcome of restorative, prosthetic, orthodontic, surgical, and periodontal therapies is determined in large part by the periodontal phenotype, which also plays a significant role in clinical failure or success in dental treatments.

Trial registration

This study protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) dated 16th June 2023 with the registration ID CRD42023432568.

Peer Review reports


Periodontal phenotypes are classified based on three essential features. These three factors are bone morphotype, keratinized tissue width, and gingival thickness. Each of these elements is essential to maintaining periodontal health [1, 2].

The term “gingival phenotype” refers to the morphological characteristics of the gingiva and the periodontium, while the terms “periodontal biotype, “periodontal morphotype, “gingival morphotype,” and “gingival phenotype” relate to the variations in the thickness of gingiva (GT) and width of keratinized tissue (KTW). The bone morphotype, keratinized tissue, and gingival thickness make up the periodontal phenotype. The gingival phenotype is made up of the latter two elements, which are located beneath the bone [3,4,5,6].

Gingival thickness, KTW and bone morphotype were three important parameters used to categorize biotypes and they were important in development or progression of mucogingival defects [7,8,9]. “Thin-scalloped, “thick-scalloped,” and “thick-flat” periodontal biotypes are the three types of periodontal biotypes that are taken into consideration in the World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions in 2017 [10,11,12].

The final aesthetic outcome of periodontal and restorative treatment methods depends on a variety of factors. The evaluation of the surrounding soft and hard tissues, which will be crucial to the success of periodontal and restorative therapies, is the most crucial of them [13,14,15].

Although gingival and bone thicknesses are known to influence treatment outcomes, various periodontal phenotypes may respond variably to inflammatory, surgical, and restoration techniques. After surgical procedures, poor treatment results are linked to a thin periodontal phenotype. In patients with thin GT, extra operations are typically required, whereas in people with thicker tissues, a straightforward technique can be used [16,17,18,19].

Prior to beginning the restorative treatment, it is crucial to ascertain the tissue biotype. The thickness of the gingival and bone tissues influences treatment outcomes, presumably due to changes in blood supply to the underneath bone and vulnerability to resorption [20,21,22].

Recession is more likely to occur in individuals with thin tissue and limited gingival width. Phenotype modification therapy (PhMT) may be beneficial for patients with thin gingival tissue and mucogingival abnormalities. The amount of mucosal recession surrounding implants may be partially reduced through surgically changing the phenotypic of the peri-implant soft tissue from thin to thick. PhMT may improve periodontal health in orthodontic patients, as well as lessen problems, improve stability, and speed up the course of orthodontic treatment [23, 24].

Dental professionals must have a sufficient understanding of current key changes in the periodontal phenotype in order to focus knowledge towards the best possible early diagnosis of patients. Several methods for improving or supplementing KT or GT have been suggested. However, it is currently unknown whether phenotype-modifying therapy (PMT) affects long-term periodontal and restoration treatment results [25, 26].

This systematic research set out to investigate the significance of thick and thin periodontal phenotypes for preserving periodontal health, especially prior to undergoing extensive restorative procedures.


Study design and setting

By adhering to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis), this systematic review concentrated on determining the importance of thin and thick periodontal phenotype in restorative and periodontal procedures. The purpose of this systematic review was to provide a comprehensive overview of the role and impact of periodontal phenotype on dental treatment outcomes.

This review was conducted from June 2023 to August 2023. The review covered publications from 2018 to 2023. This study’s analysis was conducted using JiraTM data analysis software. The Critical Appraisal Skills Programme (CASP) checklists were used to independently evaluate the study’s quality. Two distinct observers meticulously extracted the final data and reported their work. As indicated by the Kappa score of 0.75, there was good inter-observer agreement. The Boolean operator’s AND/OR/NOT was employed in PubMed to either restrict or expand the search to include all potential articles.

The research question in this study was “How the thin and thick periodontal phenotype affected the periodontal and restorative treatment outcome?”. This research question is translated using PICO which consists of Population, Intervention, Comparison, and Outcome.

PICO Search: P- Research on human adults; I- Research both with and without intervention; C- Groups of sites with thin or thick periodontal phenotype were included in the research. O- Research having data on gingival or periodontal outcome parameters were included.

Literature search protocol

The search for the articles was done by three reviewers independently. Publications of interest within the scope of this focused systematic review were searched in the electronic database PubMed, EBSCO, and Scopus.

Eligibility criteria for study

In this systematic review, research publications in English that met the following criteria were included: randomized controlled trials evaluating and comparing the importance of periodontal phenotype in restorative and periodontologyy were included, controlled clinical trials assessing the impact of periodontal phenotype on restorative and periodontal treatment outcomes, and any original research papers, case studies, and systematic reviews on the periodontal phenotypes both in restorative and periodontology were included. Research articles written in languages other than English, studies that don’t adhere to the objectives of the review’s research, technical remarks, short communications, editorial letters, and mini-reviews were not included.

This study protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) dated 16th June 2023 with the registration ID CRD42023432568. Based on the research publications that were available and our understanding of the subject, we came up with a list of keywords. The significance of the terms “periodontal phenotype”, “gingival phenotype”, and “bone morphotype” in periodontal and restorative treatment techniques was investigated.

The following terms used in the PubMed, EBSCO, and Scopus databases:

“phenotype“[All Fields]) AND (“treatment outcome“[MeSH Terms] OR (“treatment“[All Fields] AND “outcome“[All Fields]) OR “treatment outcome“[All Fields])

periodontal[All Fields] AND (“phenotype“[MeSH Terms] OR “phenotype“[All Fields]) AND periodontal[All Fields] AND (“treatment outcome“[MeSH Terms] OR (“treatment“[All Fields] AND “outcome“[All Fields]) OR “treatment outcome“[All Fields])

periodontal [All Fields] AND (“phenotype“[MeSH Terms] OR “phenotype“[All Fields]) AND restorative[All Fields] AND (“treatment outcome“[MeSH Terms] OR (“treatment“[All Fields] AND “outcome“[All Fields]) OR “treatment outcome“[All Fields]).

The Rayyan website was used for the research selection procedure. Results of searches from other databases that are duplicates will not be included. Inappropriate abstracts and titles will also be disregarded. The collected studies will be examined comprehensively to ensure they satisfy the predetermined inclusion and exclusion standards. They will then be evaluated for potential bias and incorporated into the qualitative synthesis (Systematic Review).


Research identification and selection

The search strategy employed for this systematic review aimed to locate research publications from 2018 to 2023 that are pertinent to answering the research issues associated with the review’s objectives. The date last searched was August 2023. As part of the plan, the search field for the use of role of periodontal phenotypes on restorative and periodontal treatment outcomes was defined.

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards were used when identifying research. Figure 1 provides a flow chart. The first step in the research identification process was to search three internet databases: PubMed, EBSCO, and Scopus.

Fig. 1
figure 1

Demonstrates flow diagram of the study selection process as indicated by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis)

The data extraction was done by two examiners and the method followed for data extracted was based on the public sources like journal articles, clinical trials that give useful information about methods and results of included articles. The collected data was used to develop outlines of tables and figures that will appear in the review to facilitate the design of data collection forms.

A quick keyword search produced a total of 906 results. Only 530 publications were left after the initial screening to be examined in accordance with the objectives of the systematic review. Only 395 papers were sought for retrieval, of which 273 were relevant to the review’s objectives or criteria, and these were considered for determining eligibility. From all the studies that were eligible, only 20 publications that provided comparative and systematic reviews on periodontal phenotypes and their impact on periodontal and restorative treatment outcomes were chosen. (Fig. 1) The included research papers and reviews are summarized with concluding remarks based on their study purpose and significance. Table 1 lists the features of the research papers considered in this systematic review.

Table 1 Qualitative Synthesis Results

Risk of bias assessment

This systematic review utilized the Cochrane Risk of Bias Tool to evaluate any potential risks of included articles consisting of randomized clinical trials and ROB-ME tool (Risk Of Bias due to Missing Evidence in a synthesis) to evaluate any potential risks in included systematic reviews. This risk assessment tool enabled us to create papers of the highest caliber with solid conclusions. The following criteria were used to evaluate the subjective risk of bias in relevant articles and classify it into one of three levels based on factors like sequence generation, allocation concealment, participant blinding, blinding outcome, incomplete data outcome, and selective outcome reporting. There were approximately 86.66% low risk judgments, 8.33% equivocal judgments, and 5% high risk judgments, according to the Cochrane risk of bias assessment tool (Fig. 2).

Fig. 2
figure 2

Risk assessment of bias by Cochrane collaboration tool

A quality assessment using the CASP (Critical Appraisal Skill Program) scale checklist was done to determine the strengths and limitations of the chosen studies by evaluating their methodologies. All CASP checklists will check the validity, results and clinical relevance of included articles of this systematic review. By selecting yes, no, or not as an answer to each of the eleven questions posed, the validity, transparency, and standardization of the included studies were evaluated using the CASP scale. Table 2.

Table 2 Quality assessments done by the Critical Appraisal Skills Program scale (CASP) for selected studies of systematic review

Qualitative synthesis

Twenty research studies were subjected to qualitative synthesis, with key findings extracted from each study. The type of the study, type of clinical trial, the number of participants, intervention and the treatment outcomes are all taken from the data and summarized in Table 1.


To improve patient satisfaction levels in terms of aesthetics and restoring the architecture and function of lost tooth parts as a result of the disease, it is now crucial to understand the significance of periodontal phenotype and how it affects periodontal and restorative treatment outcomes [27,28,29,30].

The treatment results are influenced by the thickness of the gingival and bone tissues, possibly as a result of a differential in blood flow and the underlying bone’s susceptibility to resorption. Prior to beginning the restorative treatment, it is usually crucial to ascertain the periodontal tissue biotype. The relationship between GT and KTW been examined by various research studies. The majority of investigations generally discovered a favourable relationship between the maxillary anterior teeth KTW and GT. Several studies assessed the relationship between periodontal phenotype and gingival thickness. In most research evaluating maxillary anterior teeth, periodontal phenotype, GT, and KTW were found to be positively correlated with each other. The literature generally indicates that in the anterior maxilla, GT and periodontal phenotype are linked. There is little and inconsistent data available for locations other than the anterior maxilla [31,32,33,34,35,36,37,38].

Positive features of thick gingival tissue quality that have been documented in the literature include resistance to trauma and recession, superior soft tissue handling properties compared with thin tissue, promotion of creeping attachment, reduction in clinical inflammation, and improvement of predictable surgical outcomes. Thick soft tissue is thought to be able to survive because of its large extracellular matrix and collagen content as well as its improved vascularity [39,40,41,42,43,44].

The success of restorative dentistry greatly depends on the periodontal health, which is dependent on the restoration’s continuing integrity. According to research, the periodontal apparatus of teeth is extremely sensitive to even the smallest environmental changes, necessitating extraordinary caution to preserve periodontal health and avoid accidental harm. This demonstrates the unmistakable link between periodontal health and repair. Margin, contour, occlusion, material, bridge design, removable partial denture design, and restorative dental techniques are crucial factors from a periodontal perspective [45,46,47,48].

Using vestibular incision subperiosteal tunnel access (VISTA), In 2023, Min S. et al. conducted a research to explore the kinetics of tissue thickness increase as a phenotypic modification therapy measure following treatment of various gingival recession disorders. Multiple gingival recession abnormalities were successfully treated with VISTA and sub-epithelial connective graft (SCTG), which produced sustained improvements in gingival thickness and suggested a feasible technique for phenotypic modification [49, 50].

In 2020, Tatum CL, et al. undertook a study to examine the results of immediate single-implant insertion in individuals with thick or thin tissue morphologies in aesthetic areas. According to the study’s findings, immediate implant placement results for individuals with various soft tissue morphologies do not significantly differ from one another [51,52,53,54,55,56].

In 2021, Barootchi S. et al. published the results of a randomized clinical experiment that looked at how gingival phenotype changed after root coverage with freeze-dried or solvent-dehydrated acellular dermal matrix (FDADM and SDADM), respectively. The investigations came to the conclusion that after 9 years, the results of gingival phenotypic change were still present in both groups and across all sites [57].

Rasperini G, et al., conducted a research in 2020 to investigate the influence of gingival phenotype (GPh) upon the surgical outcome of coronally advanced flap (CAF). The study’s findings demonstrated that, when compared to individuals with medium, thick, and extremely thick GPh, patients with thin GPh had the lowest mean root coverage and total root coverage [58].

Ahmed AJ et al. released a research in 2018, to determine the effects of interdental papillae (PIP) presence on periodontal biotype (PB), papillary proportions (PP), the distance between facial and palatal papillae (DFPP), and the base of interproximal contact area to interproximal bone crest (CP-BC). The results of this study show that PB changed the proportion of papillae and the distance among the facial and palatal papillae, which influenced the heights and existence of maxillary interdental papillae [59,60,61].

In 2021, Beire JM, et al. did a study to assess the periodontal phenotype (PP) and its morphometric changes in dental students with healthy periodontal tissues using cone-beam computed tomography (CBCT). According to the study’s findings, thick PP predominated in the sample examined, and in all measurements tested, gingival thickness was always thinner than bone thickness [62,63,64,65,66,67,68,69,70,71,72,73,74].

Within the parameters of the current systematic review, the prevalence of different periodontal phenotypes is associated with successful periodontal and restorative treatment outcomes. Understanding the significance of periodontal phenotypes can be used to create aesthetic results for individuals who needed restorative and periodontal therapy operations.

The limitation of this study was that meta-analysis of the periodontal phenotype impact on restorative and periodontal treatment outcome was not possible due to the lack of a uniform number of journals.


Practitioners’ knowledge of thin and thick periodontal phenotypes and the importance of periodontal phenotypes both in periodontology and restorative dentistry will help to generate outstanding esthetic results for patients who require restorative and periodontal therapies. Based on the findings gathered from this systematic review, individuals with narrow and thin gingiva typically exhibit higher rates of gingival recession in comparison to those with thick and wide gingiva. Positive correlations exist between gingival thickness, keratinized tissue, and bone morphotype and treatment outcomes in periodontics and restorative dentistry.

Data Availability

The corresponding author will have access to the data that were the basis for this article.


  1. Malpartida-Carrillo V, Tinedo-Lopez PL, Guerrero ME, Amaya-Pajares SP, Özcan M, Rösing CK. Periodontal phenotype: a review of historical and current classifications evaluating different methods and characteristics. J Esthetic Restor Dentistry. 2021;33.

  2. Zweers J, Thomas RZ, Slot DE, Weisgold AS, Van Der Weijden FGA. Characteristics of periodontal biotype, its dimensions, associations and prevalence: a systematic review. J Clin Periodontol. 2014;41.

  3. Vlachodimou E, Fragkioudakis I, Vouros I. Is there an association between the gingival phenotype and the width of keratinized gingiva? A systematic review. Dent J (Basel). 2021;9.

  4. Nagate RR, Tikare S, Chaturvedi S, AlQahtani NA, Kader MA, Gokhale ST. A novel perspective for predicting gingival biotype via dentopapillary measurements on study models in the Saudi population: cross-sectional study. Niger J Clin Pract. 2019;22.

  5. Al-Thomali Y, Mohamed RN, Basha S, Setty R, Manasali BS. Gingival biotype and its relation with malocclusion. Turk J Orthod. 2023;36.

  6. Fu J-H, Yeh C-Y, Chan H-L, Tatarakis N, Leong DJM, Wang H-L. Tissue biotype and its relation to the underlying bone morphology. J Periodontol. 2010;81.

  7. Mittal P, Gokhale ST, Manjunath S, Al-Qahtani SM, Magbol MAl, Nagate RR, et al. Comparative evaluation of locally administered 2% gel fabricated from Lemongrass polymer and 10% doxycycline hyclate gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis—A randomized controlled trial. Polym (Basel). 2022;14.

  8. Nair UP, Shivamurthy R, Nagate RR, Chaturvedi S, Al-Qahtani SM, Magbol MA, et al. Effect of injectable platelet-rich fibrin with a nano-hydroxyapatite bone graft on the treatment of a grade II furcation defect. Bioengineering. 2022;9.

  9. Rai JJ, Chaturvedi S, Gokhale ST, Nagate RR, Al-Qahtani SM, Magbol MA, et al. Effectiveness of a single chair side application of NovaMin® [Calcium Sodium Phosphosilicate] in the treatment of dentine hypersensitivity following ultrasonic scaling—A randomized controlled trial. materials. 2023;16.

  10. Reddy LKV, Madithati P, Narapureddy BR, Ravula SR, Vaddamanu SK, Alhamoudi FH, et al. Perception about health applications (apps) in smartphones towards telemedicine during COVID-19: a crosss-sectional study. J Pers Med. 2022;12:1920.

    Article  Google Scholar 

  11. Minervini G, Franco R, Marrapodi MM, Ronsivalle V, Shapira I, Cicciù M. Prevalence of temporomandibular disorders in subjects affected by Parkinson disease: a systematic review and metanalysis. J Oral Rehabil. 2023.

    Article  PubMed  Google Scholar 

  12. Qazi N, Pawar M, Padhly PP, Pawar V, D’Amico C, Nicita F, et al. Teledentistry: evaluation of instagram posts related to bruxism. Technol Health Care. 2023;31:1923–34.

    Article  PubMed  Google Scholar 

  13. Abraham S, Deepak KT, Ambili R, Preeja C, Archana V. Gingival biotype and its clinical significance - A review. Saudi J Dent Res. 2014;5.

  14. Müller HP, Heinecke A, Schaller N, Eger T. Masticatory mucosa in subjects with different periodontal phenotypes. J Clin Periodontol. 2000;27.

  15. 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.

  16. Kim DM, Bassir SH, Nguyen TT. Effect of gingival phenotype on the maintenance of periodontal health: an American academy of periodontology best evidence review. J Periodontol. 2020;91.

  17. Barootchi S, Tavelli L, Zucchelli G, Giannobile WV, Wang HL. Gingival phenotype modification therapies on natural teeth: a network meta-analysis. J Periodontol. 2020;91.

  18. Inchingolo AM, Malcangi G, Ferrara I, Patano A, Viapiano F, Netti A, et al. MRONJ treatment strategies: a systematic review and two case reports. Appl Sci. 2023;13:4370.

    Article  Google Scholar 

  19. Dohan Ehrenfest DM, Del Corso M, Inchingolo F, Sammartino G, Charrier J-B. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in human cell cultures: growth factor release and contradictory results. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2010;110:418–21.

    Article  Google Scholar 

  20. Sculean A, Romanos G, Schwarz F, Ramanauskaite A, Leander KP, Khoury F, et al. Soft-tissue management as part of the surgical treatment of periimplantitis: a narrative review. Implant Dent. 2019;28.

  21. Minervini G, Franco R, Marrapodi MM, Di Blasio M, Ronsivalle V, Cicciù M. Children oral health and parents education status: a cross sectional study. BMC Oral Health. 2023;23:787.

    Article  PubMed Central  Google Scholar 

  22. Rathi S, Chaturvedi S, Abdullah S, Rajput G, Alqahtani NM, Chaturvedi M, et al. Clinical trial to assess physiology and activity of masticatory muscles of complete denture wearer following vitamin D intervention. Medicina (B Aires). 2023;59:410.

    Article  Google Scholar 

  23. Holtzman LP, Blasi G, Rivera E, Herrero F, Downton K, Oates T. Gingival thickness and outcome of periodontal plastic surgery procedures: a meta-regression analysis. JDR Clin Trans Res. 2021;6.

  24. Cairo F, Cortellini P, Nieri M, Pilloni A, Barbato L, Pagavino G, et al. Coronally advanced flap and composite restoration of the enamel with or without connective tissue graft for the treatment of single maxillary gingival recession with non-carious cervical lesion. A randomized controlled clinical trial. J Clin Periodontol. 2020;47.

  25. Liu JY, Li GF, Tang Y, Yan FH, Tan BC. Multi-disciplinary treatment of maxillofacial skeletal deformities by orthognathic surgery combined with periodontal phenotype modification: a case report. World J Clin Cases 2022;10.

  26. Cha S, Lee SM, Zhang C, Tan Z, Zhao Q. Correlation between gingival phenotype in the aesthetic zone and craniofacial profile—a CBCT-based study. Clin Oral Investig. 2021;25.

  27. Pini Prato GP, Di Gianfilippo R. On the value of the 2017 classification of phenotype and gingival recessions. J Periodontol. 2021;92.

  28. Chambrone L, Garcia-Valenzuela FS. Periodontal phenotype modification of complexes periodontal-orthodontic case scenarios: a clinical review on the applications of allogenous dermal matrix as an alternative to subepithelial connective tissue graft. J Esthetic Restor Dentistry. 2023;35.

  29. Santamaria P, Paolantonio M, Romano L, Serroni M, Rexhepi I, Secondi L, et al. Gingival phenotype changes after different periodontal plastic surgical techniques: a single-masked randomized controlled clinical trial. Clin Oral Investig. 2023.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Merijohn GK, Chambrone L, Brodsky AI, Xenoudi P. Mandibular anterior lingual recession: Keratinized tissue grafting and minimally invasive harvesting. Clin Adv Periodontics. 2021;11.

  31. Acunzo R, Gorbunkova A, Rezzolla M, Bellucci G, Rasperini G. Short-term effect of regular vs mini curettes on periodontal tissue according to phenotype: a randomized control clinical trial. Int J Esthet Dent 2021;16.

  32. Pini Prato G, Di Gianfilippo R, Pannuti CM, Allen EP, Aroca S, Avila-Ortiz G, et al. Diagnostic reproducibility of the 2018 classification of gingival recession defects and gingival phenotype: a multicenter inter- and intra-examiner agreement study. J Periodontol. 2023;94.

  33. Yilmaz BT, Comerdov E, Kutuk C, Nart J, Keceli HG. Modified coronally advanced tunnel versus epithelialized free gingival graft technique in gingival phenotype modification: a comparative randomized controlled clinical trial. Clin Oral Investig. 2022;26.

  34. Said KN, Abu Khalid AS, Farook FF. Anatomic factors influencing dimensions of soft tissue graft from the hard palate. A clinical study. Clin Exp Dent Res 2020;6.

  35. Sirinirund B, Wang I, Ramadan G, Kripfgans OD, Chan H. Ridge augmentation planning, wound healing evaluation, and peri-implant tissue phenotype assessment with ultrasonography: a case report. Clin Adv Periodontics. 2023.

    Article  PubMed  Google Scholar 

  36. Barootchi S, Tavelli L, Di Gianfilippo R, Shedden K, Oh TJ, Rasperini G, et al. Soft tissue phenotype modification predicts gingival margin long-term (10-year) stability: longitudinal analysis of six randomized clinical trials. J Clin Periodontol. 2022;49.

  37. Agudio G, Chambrone L, Selvaggi F, Pini-Prato GP. Effect of gingival augmentation procedure (free gingival graft) on reducing the risk of non-carious cervical lesions: a 25-to 30-year follow-up study. J Periodontol. 2019;90.

  38. Romano L, Paolantonio M, De Ninis P, Saleh MHA, Sinjari B, Xhajanka E, et al. Minimally invasive gingival phenotype modification in gingival recession associated with a non-carious cervical lesion using the root plastique technique: a quasi-experimental one-group pretest-posttest study. J Periodontol. 2023;94.

  39. Ercoli C, Tarnow D, Poggio CE, Tsigarida A, Ferrari M, Caton JG et al. The relationships between tooth-supported fixed dental prostheses and restorations and the periodontium. J Prosthodont 2021;30.

  40. Kao RT, Curtis DA, Kim DM, Lin GH, Wang CW, Cobb CM, et al. American academy of periodontology best evidence consensus statement on modifying periodontal phenotype in preparation for orthodontic and restorative treatment. J Periodontol. 2020;91.

  41. Hertel J, Frenzel S, König J, Wittfeld K, Fuellen G, Holtfreter B, et al. The informative error: a framework for the construction of individualized phenotypes. Stat Methods Med Res. 2019;28.

  42. Lin CY, Kuo PY, Chiu MY, Chen ZZ, Wang HL. Soft tissue phenotype modification impacts on peri-implant stability: a comparative cohort study. Clin Oral Investig 2023;27.

  43. Lin IP, Lai EHH, Lai CL, Su FY. Retrospective evaluation of gingival thickness and tissue stability after connective tissue grafting in Asian populations: 1 month to 3.5 years. J Formos Med Assoc 2021;120.

  44. Han Z, Wang C, Wei Y, Yang G, Hu W, Chung KH. The keratinized mucosa width at partially edentulous molar sites and its associated factors: a pilot study. BMC Oral Health. 2022;22.

  45. Pandolfi A. A modified approach to horizontal augmention of soft tissue around the implant: Omega roll envelope flap. Description of surgical technique. Clinica Terapeutica 2018;169.

  46. Shakibaie B, Sabri H, Blatz MB, Barootchi S. Comparison of the minimally-invasive roll-in envelope flap technique to the holding suture technique in implant Surgery: a prospective case series. J Esthetic Restor Dentistry. 2023;35.

  47. Lin GH, Curtis DA, Kapila Y, Velasquez D, Kan JYK, Tahir P, et al. The significance of surgically modifying soft tissue phenotype around fixed dental prostheses: an American Academy of Periodontology best evidence review. J Periodontol. 2020;91.

  48. Aljasser R, Bukhary S, Alsarhan M, Alotaibi D, Aloraini S, Habib SR. Regenerative therapy modality for treatment of true combined endodontic-periodontal lesions: a randomized controlled clinical trial. Int J Environ Res Public Health. 2021;18.

  49. Bittencourt TC, Souza Picorelli Assis NM, Ribeiro CG, Ferreira CF, Sotto-Maior BS. Evaluation of the peri-implant tissues in the esthetic zone with prefabricated titanium or zirconia abutments: a randomized controlled clinical trial with a minimum follow-up of 7 years. J Prosthet Dent. 2023;129.

  50. Min S, Wang Y-C, Hamaguchi J, Chang C-C, Kim T, Carames G, et al. Kinetics of phenotype modification therapy with VISTA: a retrospective case series using 3D digital analysis. Int J Periodontics Restorative Dent. 2022.

    Article  Google Scholar 

  51. Tatum C, Saltz A, Prihoda T, DeGroot B, Mealey B, Mills M, et al. Management of thick and thin periodontal phenotypes for immediate dental implants in the esthetic zone: a controlled clinical trial. Int J Periodontics Restorative Dent. 2020;40.

  52. Soegiantho P, Suryawinata PG, Tran W, Kujan O, Koyi B, Khzam N, et al. Survival of single immediate implants and reasons for loss: a systematic review. Prosthesis. 2023;5:378–424.

    Article  Google Scholar 

  53. Yokoyama M, Shiga H, Ogura S, Sano M, Komino M, Takamori H, et al. Functional differences between chewing sides of implant-supported denture wearers. Prosthesis. 2023;5:346–57.

    Article  Google Scholar 

  54. Vozzo LM, Azevedo L, Fernandes JCH, Fonseca P, Araújo F, Teixeira W, et al. The success and complications of complete-arch implant-supported fixed monolithic zirconia restorations: a systematic review. Prosthesis. 2023;5:425–36.

    Article  Google Scholar 

  55. Iacono R, Mayer Y, Marenzi G, Ferreira BV, Pires GE, Migliorati M, et al. Clinical, radiological, and aesthetic outcomes after placement of a bioactive-surfaced implant with immediate or delayed loading in the anterior maxilla: 1-year retrospective follow-up study. Prosthesis. 2023;5:610–21.

    Article  Google Scholar 

  56. Bollero P. Oral health and implant therapy in Parkinson’s patients: review. Oral Implantol (Rome). 2017;10:105.

    Article  PubMed  Google Scholar 

  57. Barootchi S, Tavelli L, Di Gianfilippo R, Stefanini M, Zucchelli G, Rasperini G, et al. Gingival phenotype modification as a result of root coverage procedure with two human dermal matrices: Long-term assessment of a randomized clinical trial. Int J Periodontics Restorative Dent. 2021;41.

  58. Rasperini G, Codari M, Paroni L, Aslan S, Limiroli E, Solís-Moreno C, et al. The influence of Gingival phenotype on the outcomes of coronally advanced flap: a prospective multicenter study. Int J Periodontics Restorative Dent. 2020;40.

  59. Ahmed AJ, Nichani AS, Venugopal R. An evaluation of the effect of periodontal biotype on inter-dental papilla proportions, distances between facial and palatal papillae in the maxillary anterior dentition. J Prosthodont 2018;27.

  60. Di Paola A, Tortora C, Argenziano M, Marrapodi MM, Rossi F. Emerging roles of the iron chelators in inflammation. Int J Mol Sci. 2022;23:7977.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Tortora C, Di Paola A, Argenziano M, Creoli M, Marrapodi MM, Cenni S, et al. Effects of CB2 receptor modulation on macrophage polarization in pediatric celiac disease. Biomedicines. 2022;10:874.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Beire JM, De Paulo DCH, Devito KL, Falabella MEV. Clinical and tomography evaluation of periodontal phenotypes of Brazilian dental students. J Indian Soc Periodontol. 2021;25.

  63. Srimaneepong V, Heboyan A, Zafar MS, Khurshid Z, Marya A, Fernandes GVO, Rokaya D. Fixed prosthetic restorations and periodontal health: a narrative review. J Funct Biomater. 2022;13(1):15. PMID: 35225978; PMCID: PMC8883934.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Avetisyan A, Markaryan M, Rokaya D, Tovani-Palone MR, Zafar MS, Khurshid Z, Vardanyan A, Heboyan A. Characteristics of periodontal tissues in prosthetic treatment with fixed dental prostheses. Molecules. 2021;26:1331.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Heboyan A, Bennardo F. New biomaterials for modern dentistry. BMC Oral Health. 2023;23(1):817. PMID: 37899445; PMCID: PMC10613365.

    Article  PubMed Central  Google Scholar 

  66. Patil P, Madhav VN, Alshadidi AAF, et al. Comparative evaluation of open tray impression technique: investigating the precision of four splinting materials in multiple implants. BMC Oral Health. 2023;23:844.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Humagain M, Rokaya D, Srii R, Dixit S, Kafle D. Gender based comparison of gingival zenith esthetics. Kathmandu Univ Med J (KUMJ) 2016 Apr-Jun;14(54):148–52. PMID: 28166072.

  68. Humagain M, Rokaya D. Integrating digital technologies in dentistry to enhance the clinical success. Kathmandu Univ Med J (KUMJ) 2019 Oct -Dec;17(68):256–7. PMID: 33311031.

  69. Amornvit P, Bajracharya S, Rokaya D, Keawcharoen K, Supavanich W. Management of obstructive sleep apnea with implant retained mandibular advancement device. World J Dentistry. 2014;5:184–9.

    Article  Google Scholar 

  70. Kongkiatkamon S, Booranasophone K, Tongtaksin A, Kiatthanakorn V, Rokaya D. Comparison of fracture load of the four translucent zirconia crowns. Molecules. 2021;26(17):5308. PMID: 34500741; PMCID: PMC8433771.

    Article  PubMed Central  Google Scholar 

  71. Spagnuolo G, Annunziata M, Rengo S. Cytotoxicity and oxidative stress caused by dental adhesive systems cured with halogen and LED lights. Clin Oral Investig. 2004;8(2):81–5. Epub 2003 Dec 16. PMID: 14677051.

    Article  PubMed  Google Scholar 

  72. Franco R, Miranda M, Di Renzo L, De Lorenzo A, Barlattani A, Bollero P. Glanzmann’s thrombastenia: the role of tranexamic acid in oral surgery. Case Rep Dent. 2018;2018:1–4.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Lee DE. Bacterial contamination on the inner surface of the masks used by clinicians in a dental clinic. Dent Med Probl. 2022;59(2):177–85.

    Article  PubMed  Google Scholar 

  74. Satyarup D, Mohanty S, Nagarajappa R, Mahapatra I, Dalai RP. Comparison of the effectiveness of 38% silver diamine fluoride and atraumatic restorative treatment for treating dental caries in a school setting: a randomized clinical trial. Dent Med Probl. 2022;59(2):217–23.

    Article  PubMed  Google Scholar 

Download references


Not Applicable.


The authors extend their appreciation to the Deanship of Scientific Research at King Khalid University for funding this work through a Small Group Research Project under grant number RGP 1/169/44.

Author information

Authors and Affiliations



Conceptualization MKP, RRN, SC; methodology MMMA, MAAQ, MC; software, STG, ARA, AAB.; validation, MKP, RRN, AAB; formal analysis, SC, MMMA, RRN; writing—original draft preparation, GM, MC; writ-ing—review and editing, GM, MC; visualization, MC, AAB, VR; supervision, GM, MC; project administration, SC; funding acquisition, SC. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Mohan Kumar P, Saurabh Chaturvedi or Giuseppe Minervini.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

P, M.K., Nagate, R.R., Chaturvedi, S. et al. Importance of periodontal phenotype in periodontics and restorative dentistry: a systematic review. BMC Oral Health 24, 41 (2024).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: