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49]

Original Article

Assessment of Gingival Sulcus Depth, Width of Attached Gingiva, and

Gingival Thickness in Primary, Mixed, and Permanent Dentition

Abstract K. L. Vandana,
Aim and Objective: The objective of this in  vivo study was to evaluate sulcus depth Singh Shivani,
width and thickness of facial attached gingiva in primary, mixed, and permanent dentition. B. Savitha1,
Materials and Methods: The study included 40 subjects  (22  males and 18  females) with
480 sites of an age range 4–25  years. Subjects were divided into three groups: the primary H. P. Vivek2
dentition  (4–6  years), mixed dentition  (7–13  years), and adult dentition  (16–25  years). All the Departments of Periodontics
parameters were measured in the upper and lower anterior segments. Results: Gingival sulcus and 2Community Dentistry,
College of Dental Sciences,
depth  (GSD), attached gingiva width  (AGW), and gingival thickness  (GT) were measured archwise 1
Department of Periodontics,
and toothwise in different dentition and overall dentition wise without differentiating archwise Consultant and Practiotioner,
and toothwise. GSD was significantly higher in maxillary mixed dentition  (1.75  ±  0.75), followed Davangere, Karnataka, India
by permanent and primary dentition. AGW was significantly higher in maxillary permanent
dentition  (3.4  ±  0.36) followed by maxillary mixed and permanent dentition. GT was significantly
higher  (P  =  0.001) in mixed dentition midbuccally (1.3  ±  0.46) and interdentally  (2.31  ±  0.71) in
both the arches. In all the dentition, maxillary central incisor showed significant GSD. AGW was
significantly higher in permanent maxillary canine  (3.5  ±  0.5). GT  (midbuccal) was significantly
higher in primary dentition  (1.4  ±  0.5), and GT  (ID) was significant in mixed dentition  (2.6  ±  0.7).
Conclusion: The sulcus depth and GT increases from primary to mixed dentition and significantly
higher in maxilla. The width of attached gingiva was less in mixed dentition than primary with
maxillary sites exhibiting higher values than mandibular.

Keywords: Gingival sulcus depth, gingival thickness, mixed dentition, permanent dentition, primary
dentition, width of attached gingiva

Introduction it is imperative that children receive a

The gingival unit is subject to morphological
changes due to normal pattern of oral
development. It has long been known
that this clinical appearance of marginal
periodontium differs from subject to subject
and even among different tooth types.
Many features are genetically determined,
others seem to be influenced by tooth
size, shape, and position, and biological
phenomenon such as gender, growth, and
age.[1] With age, changes may occur in each
of the tissues while some of these changes
are caused by inflammation, others are the
result of aging.[2] The severity of gingivitis
is less intense in children than in adults
with similar amount of plaque.[3] There is
so much lower prevalence of destructive
periodontal disease in children than in
adults, but diagnosis in children is more
periodontal examination as a part of their
routine dental visits.[1] The three anatomical
aspects of gingiva such as gingival
sulcus depth  (GSD), attached gingiva
width  (AGW), and gingival thickness  (GT)
are addressed scantity.
The GSD is an important clinical tool
for diagnosing periodontal disease and
evaluating therapy. One of the important
characteristics of this sulcus is its depth;
hence, the operator must become concerned Address for correspondence:
and informed about the changes which Dr. K. L. Vandana,
Department of Periodontics,
occur in the sulcus during life.[4] However, College of Dental Sciences,
it has some limitations because it does not Davangere ‑ 577 004,
detect current disease activity, but merely Karnataka, India.
demonstrates the past destruction pattern. E‑mail: vanrajs@gmail.com
The importance of attached keratinized
tissue around natural teeth is a controversial Access this article online

difficult; however, early diagnosis is
important for successful treatment. Thus,
This is an open access article distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com
topic.[5] Since historically, an adequate Website: www.jdrr.org
band of keratinized tissue was viewed DOI: 10.4103/jdrr.jdrr_42_17
as important to prevent future recession. Quick Response Code:
How to cite this article: Vandana KL, Shivani S,
Savitha B, Vivek HP. Assessment of gingival sulcus
depth, width of attached gingiva, and gingival thickness
in primary, mixed, and permanent dentition. J Dent
Res Rev 2017;4:42-9.

42 © 2017 Journal of Dental Research and Review | Published by Wolters Kluwer - Medknow
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Vandana, et al.: Gingival Sulcus depth, width and thickness in three dentitions
Lang and Löe suggested that a minimum of 2  mm of
keratinized tissue, 1  mm of which was attached was
necessary.[6] Few authors have reported that the tissue
could remain clinically healthy with  <1  mm of attached
gingiva.[7‑10] Certain types of adult periodontal diseases
may be anticipated by observations made during childhood
and adolescence, thus more attention should be given to
the zone of attached gingiva and its relationship to the
deciduous, transitional, and permanent dentition.[3]
In recent years, the dimensions of different parts of
masticatory mucosa, especially GT has become a subject
of considerable interest in periodontics, both from a
epidemiologic and a therapeutic point of view.[11] The
assessment of facial GT and its correlation with the
age, gender, and dental arch in the anterior segment is
scanty. Vandana and Savita in 2005 reported thicker
gingiva in younger age group than that of the older age
group.[12] The GT plays a vital role in the development of
mucogingival problems and in success of treatment for
recession[13] and wound healing,[14] hence, assessment of
GT is relevant.
We searched electronic databases and hand‑searched
bibliographies of already identified reports, as well as
online sites with reports accepted for publication ahead
of print for the most relevant scientific journals. We limit
our study in Humans and English language. Medline
search using keywords sulcus depth, AGW, and GT
revealed few studies in primary, mixed, and permanent
dentition. Thus, this study was conducted to evaluate the
GSD, AGW, and GT in primary, mixed, and permanent
dentitions.
Materials and Methods
The present study was conducted in the Department
of Periodontics and Pedodontics, College of Dental
Sciences, Davangere. Anterior teeth  (12 teeth) with 480
sites in 40 systematically healthy controls  (22  males and
18  females, age range 4–25  years) were analyzed in the
study. The study protocol was approved by institutional
IRB (Ref. No. CODS/1977/2015‑2016) fulfilling the
criteria of RGUHS, India. The primary dentition age
group (4–6 years) consisted of 10 subjects; mixed dentition
age group  (7–13  years) also consisted of 15 subjects and
the adult dentition age group  (16–25  years) consisted of
15 subjects. The inclusion criteria included the presence of
all anterior teeth in both upper and lower jaw, good oral
hygiene, clinically healthy periodontal tissues with no loss
of attachment. The exclusion criteria included gingival
recession in anterior teeth, known systemic disease, use
of any medications possibly affecting the periodontal
tissue such as phenytoin and cyclosporine A, extensive
restorations.
After collecting the information about this study such as the
objectives, expected outcomes, and the degree of discomfort
Journal of Dental Research and Review | Volume 4 | Issue 2 | April-June 2017
that might occur, the subjects gave their informed consent.
The selected volunteers were divided into three groups:
Group A  –  Primary dentition, Group  B  –  mixed dentition,
and Group C – permanent dentition.
In the first visit, plaque index[15] and gingival bleeding
index[16] were recorded followed by scaling and polishing.
The measurements were done using UNC‑15 periodontal
probe (Hu‑friedy USA) 1‑week postscaling.
Measurement of gingival sulcus depth
The width of keratinized gingiva was measured in midfacial
area for six anterior teeth in the maxillary and mandibular
regions from the gingival margin to the mucogingival
junction using UNC-15 periodontal probe [Figure 1].[17] The
probe was inserted parallel to the long axis to the tooth and
walked along the tooth. The probing depth was measured
from the free gingival margin to the deepest penetration of
periodontal probe. The readings were recorded and rounded
to the nearest millimeter.[18]
Measurement of attached gingiva width
The width of keratinized gingiva was measured in midfacial
area for six anterior teeth in the maxillary and mandibular
regions from the gingival margin to the mucogingival
junction using UNC-15 periodontal probe [Figure 2].[17]
The mucogingival junction was determined using a jiggle
method because of movable the alveolar mucosa and firmly
attached gingiva. A  blunt instrument was used to jiggle
the alveolar mucosa in an apicocoronal fashion and thus
delineating the mucogingival junction.[19] The width of
attached gingiva was obtained by subtracting the probing
sulcus depth from the width of keratinized gingiva at the
midbuccal aspect of each tooth.
AGW  =  Width of keratinized gingiva  −  probing sulcus
depth.[20]
Measurement of gingival thickness
The GT was assessed in subjects using transgingival
probing, midfacially in the attached gingiva, half way
between the mucogingival junction, and free gingival
groove and at the base of interdental papilla [Figure 3].[12]
The GT was assessed by anesthetizing the facial gingiva
with xylonor spray  (lignocaine 15  g) and if required
filtration was conducted using 2% lignocaine HCL with
1:80,000 adrenaline injection. GT was assessed after
a b
Figure 1: (a and b) Measurement of gingival sulcus depth in maxilla and
mandible
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Vandana, et al.: Gingival Sulcus depth, width and thickness in three dentitions

20  min of injection using UNC‑15 probe. Measurements
were not rounded off to the nearest millimeter.
Statistical analysis
The measurements recorded were subjected to statistical
analysis. Mean values and standard deviations were
calculated. The analysis of variance and post hoc test was
used to compare the transgingival probing measurements,
midbuccally, and at the interdental papillary region.
Results
Each parameter was studied in anterior teeth with
480 sites in 40 subjects (22  males and 18  females) of
age group range between 4 and 25  years. GSD was
significantly higher  (P  =  0.001) in the maxillary mixed
dentition  (1.75  ±  0.75) followed by maxillary permanent
and primary dentition. The mandibular GSD was similar
in all the dentitions. On comparing both the jaws, mixed
and permanent dentition showed significantly higher GSD
in maxilla  (1.75  ±  0.75) and  (1.33  ±  0.14), respectively,
than mandible whereas, primary dentition showed no
significant difference  [Table  1]. In all the three dentitions,
in maxilla, GSD was significantly higher in central
incisors  (CIs), followed by lateral incisors  (LI), and
canine  (C). On interdentition comparison, maxillary mixed
CI  (2.2  ±  0.8) showed significantly higher  (P  =  0.001)
GSD followed by permanent CI  (1.4  ±  0.1) and primary
CI  (1.3  ±  0.4). In mandible, among all the dentitions,
only in permanent dentition, CI  (1.3  ±  0.3) showed
significantly higher GSD followed by permanent LI and
canine  (1.2  ±  0.1) and  (1.1  ±  0.4), respectively  [Graph  1].
In mixed dentition, maxillary CI  (2.2  mm), LI  (1.6  mm)
and in permanent dentition, maxillary LI  (1.3  mm)
showed significantly higher GSD than mandibular
teeth  [Table  2]. AGW was significantly higher  (P  =  0.001)
in maxilla than mandible in all 3 dentitions. Maxillary
permanent dentition  (3.4  ±  0.36) showed significantly
higher AGW than primary  (2.17  ±  0.71) and maxillary
mixed  (2.11  ±  0.71)  [Table  3]. On toothwise comparison,
AGW was highly significant  (P  =  0.001) in maxillary
canine  (3.5  ±  0.5) of permanent dentition, followed by
maxillary permanent CI  (3.3  ±  0.3), and LI  (2.5  ±  70.6)
whereas primary and mixed dentition showed
nonsignificant difference. Similarly, in mandible permanent
canine  (02  ±  0.4) showed higher AGW but the difference
was nonsignificant  (P  =  0.01). Significant difference was
found in mandibular permanent CI  (1.9  ±  0.1)  [Graph  2].
In all the dentition maxillary teeth showed higher GW
except in mixed dentition where mandibular LI showed
significantly higher AGW. In permanent dentition,
maxillary CI  (3.3  mm), LI  (2.5  mm), and canine  (3.5  mm)
showed significantly higher AGW than mandibular
teeth  [Table  4]. GT was significantly higher  (P  =  0.001)
in mixed dentition both midbuccally  (1.3  ±  0.46) and
interdentally  (2.31  ±  0.71) than primary and permanent
dentition. On comparison between the arches within
the dentition, primary dentition showed significantly
higher  (P  =  0.001) midbuccal GT  (MBGT) in
maxillary  (1.2  ±  0.4) than mandibular  (1.06  ±  0.25) arch.
In mixed dentition, similar midbuccal and interdental
GT  (IDGT) were seen similar in both the arches. In
permanent dentition, mandible  (1.74  ±  0.69) showed
significantly higher GT than maxilla (0.93 ± 0.3) [Table 5].
In all the 3 dentitions, in maxilla, MBGT was higher in CI
followed by LI and canine but the difference was significant
in primary dentition. On interdentition comparison, CI
of maxillary primary and mixed dentition  (1.4  ±  0.5)
was significantly higher than permanent CI  (1.0  ±  0.2)

a b
Figure 2: (a and b) Measurement of attached gingiva width in maxilla and
mandible Figure 3: Measurement of gingival thickness

Table 1: Sulcus depth in primary, mixed, and permanent dentition (mm) of maxilla and mandible
Primary Mixed Permanent ANOVA Tukey’s post hoc
F P
MB
Maxilla 1.18±0.39 1.75±0.75 1.33±0.14 26.71 0.001 (HS) Mixed > permanent > primary
Mandible 1.21±0.45 1.16±0.40 1.21±0.18 0.57 0.56 (NS)
Maxilla versus mandible (t, P) 0.43, 0.66 (NS) 6.53, 0.001 (HS) 4.62, 0.001 (HS)
NS: Not statistically significant, S: Statistically significant (P≤0.05), HS: Highly significant (P≤0.001). MB: Mid bucally

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Vandana, et al.: Gingival Sulcus depth, width and thickness in three dentitions

whereas in mandible, mixed dentition, CI  (1.4  ±  0.5) maxillary and mandibular anterior teeth of three dentitions,
showed significantly higher MBGT than primary and only maxillary CI  (1.4  mm) of primary dentition showed
permanent dentition. Within a dentition, mandibular significantly higher MBGT than mandibular CI and
canine  (1.2  ±  0.4) of primary dentition, and CI  (1.4  ±  0.5) interdentally, mandibular canine  (2.3  mm) of primary
of mixed dentition, showed significantly higher MBGT dentition showed significantly higher IDGT  [Table  6]. The
than other two teeth in mandibular arch  [Graph  3]. IDGT overall presentation of GSD, AGW, and GT  (MB and ID)
was significantly higher  (P  =  0.001) in CI, LI, and canine without differentiating of archwise and toothwise showed
of mixed dentition followed by primary and permanent that GSD  (1.4  mm), GT both midbuccally  (1.3  mm), and
dentition. Interdentally maxillary mixed CI  (2.6  ±  0.7) interdentally  (0.3  mm) was significantly higher in mixed
showed significantly higher  (P  =  0.001) IDGT followed dentition. The second in the line was primary dentition for
by maxillary mixed LI  (2.3  ±  0.6) and canine  (2.0  ±  0.6). GT in midbuccal  (1.1  ±  0.3) and interdental  (1.7  ±  0.6).
In mandible significant, IDGT  (P  =  0.001) was found in Gingival width was highly significant in the permanent
mixed dentition CI  (2.6  ±  0.7)  [Graph  4]. On comparing dentition  (2.5  ±  0.7) followed by mixed and primary
dentition [Table 7].
Table 2: Maxillary versus mandibular determination of
gingival sulcus depth of each tooth Discussion
Dentition Gingival sulcus depth t P In several clinical situations, information on thickness of
Tooth Maxillary Mandibular masticatory mucosa is highly desirable. A thin and delicate
Primary CI 1.3±0.4 1.3±0.4 0.33 0.74 gingiva might be prone to developing gingival recessions
dentition LI 1.1±0.3 1.1±0.3 0.01 1.00 after traumatic surgical or inflammatory injuries likewise
Canine 1.0±0.2 1.2±0.5 1.17 0.24 orthodontic tooth movement may also have detrimental
Mixed CI 2.2±0.8 1.1±0.3 6.36 0.001 (HS) influence on the mucogingival complex, especially at sites
dentition LI 1.6±0.6 1.1±0.3 3.69 0.001 (HS) where keratinized tissue and underlying bone appear to be
Canine 1.4±0.5 1.2±0.5 1.67 0.09 thin.
Permanent CI 1.4±0.1 1.3±0.1 2.13 0.03 (S)
dentition LI 1.3±0.1 1.2±0.1 3.85 0.001 (HS) In the present study, the three gingiva parameters such
Canine 1.2±0.1 1.1±0.1 3.26 0.002 (S) as GSD, AGW, and GT at midbucally  (MBGT) and
NS: Nonsignificant, S: Significant (P≤0.05), HS: Highly significant interdentally  (IDGT) were measured. The GSD of
(P≤0.001). CI: Central incisor, LI: Lateral incisor maxillary mixed dentition  (1.75  mm) was significantly

Primary Mixed Permanent Primary Mixed Permanent

2.2
3.5
3.3
1.6
2.5
1.4 1.4
1.3 1.3 1.3 1.3 2 2.1 2.1 2.1 2
1.2 1.2 1.2 1.2 1.8 1.8 1.9 1.9 1.9
1.1 1.1 1.1 1.1 1.1 1.7 1.7 1.7 1.7
1 1.4

Central incisor Lateral incisor Canine Central incisor Lateral incisor Canine
Central incisor Lateral incisor Canine Central incisor Lateral incisor Canine
MAXILLARY MANDIBULAR
MAXILLARY MANDIBULAR

Graph 2: Toothwise width of attached gingiva intra and inter dentition

Graph 1: Toothwise gingival sulcus depth intra and inter dentition comparison (in mm) of maxilla and mandible
comparison (in mm) of maxilla and mandible

Primary Mixed Permanent

Primary Mixed Permanent

2.6 2.6
1.4 1.4 1.4 2.3 2.3 2.3
1.2 1.2 1.2 1.2 1.2 2 2
1.1 1.1 1.1 1.1 1.8 1.8 1.7
1 1 1 1 1.6 1.6 1.6
0.9 0.9 1.5 1.5

0.9 1 0.9

Central incisor Lateral incisor Canine Central incisor Lateral incisor Canine Central incisor Lateral incisor Canine Central incisor Lateral incisor Canine

MAXILLARY MANDIBULAR MAXILLARY MANDIBULAR

Graph 3: Toothwise gingival thickness intra and inter dentition Graph 4: Toothwise gingival thickness intra and inter dentition
comparison – midbucally (in mm) of maxilla and mandible comparison – interdentally (in mm) of maxilla and mandible

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Vandana, et al.: Gingival Sulcus depth, width and thickness in three dentitions

Table 3: Attached gingiva width in primary, mixed, and permanent dentition (mm) of maxilla and mandible
Primary Mixed Permanent ANOVA Tukey’s post hoc
F P
MB
Maxilla 2.17±0.71 2.11±0.71 3.42±0.36 127.90 0.001 (HS) Permanent > primary > mixed
Mandible 1.62±0.83 1.78±0.79 1.99±0.29 5.80 0.003 (S) Permanent > mixed > primary
Maxilla versus mandible (t, P) 3.79, 0.001 (HS) 2.94, 0.004 (S) 29.10, 0.001 (HS)
NS: Nonsignificant, S: Significant (P≤0.05), HS: Highly significant (P≤0.001). MB: Mid bucally

Table 4: Maxillary versus mandibular determination of compensate the occlusal surface attrition leading to the
attached gingiva width of each tooth attached gingiva coronal migration of CEJ while the mucogingival junction
width remains unchanged.[28] Maxillary showed higher values
Dentition Tooth Maxillary Mandibular t P than mandibular. In maxillary and mandible, permanent CI,
Primary CI 2.00±0.6 1.4±0.8 2.51 0.01 (S) LI and canine (C) showed higher AGW followed by mixed
dentition LI 1.8±0.8 1.7±0.9 0.53 0.59 and primary dentition. The AGW was found to be similar
Canine 2.1±0.6 1.7±0.7 1.46 0.15 in CI, LI, and C of primary and mixed dentition. A  study
Mixed CI 2.1±0.8 1.7±0.8 1.97 0.05 (S) reported the mean value of AGW between 1.36 and
dentition LI 1.8±0.7 1.9±0.8 0.15 0.87 3.85  mm except in the newly erupted permanent anterior
Canine 2.1±0.4 1.7±0.6 2.68 0.009 (S) teeth where the mean ranged from 1.12 to 2.53 mm.[26] With
Permanent CI 3.3±0.3 1.9±0.1 17.69 0.001 (HS) the eruption of the permanent tooth, there is an increase in
dentition LI 2.5±0.6 1.9±0.1 5.11 0.001 (HS) the alveolar bone, but at the same time, there is no increase
Canine 3.5±0.5 2.0±0.4 1.54 0.001 (HS) in the width of the keratinized and/or attached gingiva due
NS: Nonsignificant, S: Significant (P≤0.05), HS: Highly significant to the more buccal position of the erupting permanent tooth
(P≤0.001). CI: Central incisor, LI: Lateral incisor as compared to its predecessor.[29,30] Study conducted by
Bowers in 1963 on four age groups  3–5, 15–25, 25–35,
higher than primary and permanent dentition, whereas in and over  35  years reported increased mean width of
mandibular arch, it was similar in all the dentitions. Studies attached gingiva from the deciduous dentition to the adult
conducted by Srivastava et al.[21] and Kim[22] also confirmed dentition and it became extremely narrow in the cuspid
the increased sulcus depth around newly erupted permanent and first bicuspid region.[7] AGW increases with age having
teeth of mixed dentition with narrower width of attached the greatest width in maxillary incisors and mandibular
gingiva. It is probably due to the reasons such as lagging premolars the least width[29] whereas Shaju and Zade[18]
of active eruption behind the passive,[23] the lesser quality and Chandulal et  al.[31] reported least width in mandibular
of the “primary attachment apparatus” which offers less molars.
resistance to probing[24] and “eruption gingivitis” which In the current study, MBGT and IDGT were highly
allows for deeper probe penetration beyond the histological significant in mixed dentition followed by primary and
sulcus.[25] A study showed that GSD of anterior teeth in permanent dentition in both the arches. In the primary
mixed dentition ranged between 1.48 and 2.75 mm while dentition, maxilla showed significantly higher MBGT than
in childhood and adolescence, it ranged between 1.06 and mandible. However, in mixed and permanent dentition,
1.96 mm.[26] MBGT was found to be similar in both the arches.
In the present study, in general, the CIs showed higher Contrary to the MBGT, IDGT was higher in the mandible.
sulcus depth followed by LIs and canines. Among different In maxilla and mandible, MBGT of CI, LI, and canine
dentition, maxillary mixed CI showed significantly higher was found to be similar in all the 3 dentitions. However,
GSD followed by permanent and primary dentition whereas the MBGT was found to be highly significant in CI of
mixed dentition. Thickness mainly depends on tooth type
mandible showed similar GSD in CI, LI, and canine in all
and is correlated with width of gingiva. A  study conducted
the dentition. Bimstein and Eidelman also reported higher
on 200 subjects on three age groups  (20–25, 40–45,
GSD maxillary permanent CI  (2.7  mm) of mixed dentition
and 55–60  years) to showed that in the maxilla, mean
than primary CI (1.7 mm).[27]
GT varied between 0.9  mm  (canines and first molars),
In the present study, the AGW was significantly and 1.3  mm  (second molars) and in the mandible, GT
higher in permanent dentition followed by mixed and ranged between 0.8  mm  (canines) and 1.5  mm  (second
primary dentition. Between the arches, the AGW of all molars).[32] GT varies with age, gender, and dental arch
the maxillary dentition was significantly higher than location. Vandana and Savita in 2005 in their study on
mandibular. The reasons for increased AGW with age 32 subjects of age group  16–38  years determined the
are concomitant reduction in sulcus depth[21] and there is thickness of facial gingiva through transgingival probing
constant eruption of teeth throughout one’s lifespan to in the maxillary and mandibular anteriors. The younger

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Vandana, et al.: Gingival Sulcus depth, width and thickness in three dentitions

Table 5: Gingival thickness in primary, mixed and permanent dentition (mm) of maxilla and mandible
Primary Mixed Permanent ANOVA Tukey’s post hoc
F P
MB
Maxilla 1.20±0.40 1.30±0.46 1.00±0.30 12.90 0.001 (HS) Mixed > primary > permanent
Mandible 1.06±0.25 1.30±0.46 1.08±0.36 9.43 0.001 (HS) Mixed > primary = permanent
Maxilla versus 2.17, 0.001 (HS) 0.001, 1.00 (NS) 1.66, 0.09 (NS)
Mandible (t, P)
Interdental
Maxilla 1.66±0.54 2.31±0.71 0.93±0.30 141.48 0.001 (HS) Mixed > primary > permanent
Mandible 1.83±0.71 2.31±0.71 1.74±0.69 16.11 0.001 (HS) Mixed > primary = permanent
Maxilla versus 1.14, 0.15 (NS) 1.00, 1.00 (NS) 10.04, 0.001 (HS)
Mandible (t, P)
NS: Nonsignificant, S: Significant (P≤0.05), HS: Highly significant (P≤0.001). MB: Mid bucally

Table 6: Maxillary versus mandibular determination of maxilla.[12] Palatal mucosa may be thin in subjects with a
gingival thickness-mid bucally and interdentally of each thin and narrow gingiva and a slender shape of upper front
tooth teeth.[34] A study performed in younger  (14–21  years) and
Dentition Tooth Maxillary Mandibular t P older age group  (30–59  years) reported thinner palatal
GT-MB mucosa 2.8 ± 3.0 mm in younger age group than older age
Primary CI 1.4±0.5 1.0±0.0 3.55 0.001 (HS) group 3.1 ± 3.0 mm.[33]
LI 1.1±0.3 1.0±0.0 1.45 0.15 The assessment and comparison of GSD and AGW has
Canine 1.1±0.3 1.2±0.4 0.87 0.38 been attempted by few authors.[17‑19,21] However, GT has
Mixed CI 1.4±0.5 1.4±0.4 0.62 0.53 been attempted for the first time in primary and mixed
LI 1.2±0.4 1.2±0.4 0.40 0.68 dentition. Archwise and toothwise measurement of GSD
Canine 1.2±0.4 1.2±0.4 2.84 0.07 and GT in all the three dentition also has been attempted
Permanent CI 1.0±0.2 1.1±0.3 0.50 0.61 for the first time.
LI 1.0±0.3 0.9±0.3 1.84 0.07
Canine 0.9±0.2 1.1±0.4 0.01 1.00 To summarize the current study, the archwise and
GT-ID toothwise assessment of GSD, AGW, and GT were
Primary CI 1.8±0.5 1.5±0.6 1.29 0.20 done. The overall presentation includes measurements
LI 1.6±0.4 1.6±0.6 0.01 1.00 of all the teeth in maxilla and mandible to ease the
Canine 1.5±0.6 2.3±0.5 4.03 0.001 (HS) clinical presentation of data in general. If any specific
Mixed CI 2.6±0.7 2.6±0.7 0.66 0.50 consideration is required, individual tooth archwise data
LI 2.3±0.6 2.3±0.6 1.21 0.23 are presented in the current study which is extensive and
Canine 2.0±0.6 2.0±0.6 0.25 0.80 clinically not feasible.
Permanent CI 0.9±0.3 1.8±0.7 1.64 0.10 The GSD of the current study demonstrated the highest
LI 1.0±0.4 1.6±0.6 1.21 0.23 sulcus depth in maxillary mixed dentition  (1.75  mm)
Canine 0.9±0.2 1.7±0.6 1.38 0.17 and least in mandibular mixed dentition  (1.16  mm).
NS: Nonsignificant, S: Significant (P≤0.05), HS: Highly significant In maxilla, the maximum GSD was observed in CI of
(P≤0.001). ID: Interdentally, GT: Gingival thickness, MB: Mid
mixed dentition  (2  mm) and least in the primary canine
bucally, CI: Central incisor, LI: Lateral incisor
tooth  (1  mm). In mandible, the maximum GSD was
observed in the primary and permanent CI  (1.3  mm) and
age group of 16–24  years demonstrated significantly least in LI of primary and mixed dentition and canine of
thicker gingiva  (1.63 and 1.73  mm midbuccally and permanent dentition  (1.1  mm). In primary dentition CI,
1.59 and 1.78  mm interdentally) than that of the older age LI, and Canine showed almost similar GSD in both jaws.
group of 25–38  years,  (0.97 and 1.03  mm midbuccally In mixed and permanent dentition, maxillary CI, LI, and
and 0.93 and 1.07  mm interdentally).[12] Younger age canine showed higher GSD than mandible.
group had significantly thicker gingiva than that of The AGW of the current study demonstrated that among
the older age group, it might be because of changes in all the dentitions, AGW was maximum in maxillary
the oral epithelium caused by age, related to thinning of the permanent dentition  (3.42  mm) and least in mandibular
epithelium and diminished keratinization.[2] There may be primary dentition  (1.62  mm). In interdentition comparison
other confounding factors that influence GT such as racial of maxilla, maximum AGW was found in CI of permanent
and genetic factors.[33] The gingiva was found to be thinner dentition (3.3 mm) and minimum width was in LI of mixed
in females than males and in the mandibular arch than the and primary dentition (1.8 mm). In mandible, the maximum

Journal of Dental Research and Review | Volume 4 | Issue 2 | April-June 2017 47

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Vandana, et al.: Gingival Sulcus depth, width and thickness in three dentitions
Table 7: Overall dentition wise measurement
Primary Mixed Permanent
Sulcus depth 1.2±0.4 1.4±0.6 1.2±0.1
Gingival width 1.8±0.7 1.9±0.7 2.5±0.7
GT MB 1.1±0.3 1.3±0.4 1.0±0.3
GT ID 1.7±0.6 2.3±0.7 1.3±0.6
NS: Nonsignificant, S: Significant (P≤0.05), HS: Highly significant (P≤0.001). ID: Interdentally, GT: Gingival thickness, MB: Mid bucally
AGW was found in canine of permanent dentition (2.0 mm)
and least in CI of primary dentition  (1.4  mm). In all
the dentitions, canine showed maximum width in
maxillary (3.5 ± 0.5) and mandible (2.0 ± 0.4).
The GT of the current study demonstrated that among all
the dentitions, the greatest GT was found in maxillary
mixed dentition both midbucally  (MBGT 1.3  mm) and
interdentally  (IDGT 2.3  mm). The least GT was found in
maxillary permanent dentition both midbucally (1 mm) and
interdentally  (0.93  mm). In maxilla, MBGT was maximum
in CI (1.4 mm) of mixed dentition. Minimum GT was found
in canine (0.9 mm) of permanent dentition. In mandible, the
MBGT was maximum in CI  (1.4  mm) of mixed dentition.
Minimum MBGT was found in LI  (0.9  mm) of permanent
dentition. In maxilla, IDGT was maximum in CI  (2.6  mm)
of mixed dentition. Minimum GT was found in CI and
canine  (0.9  mm) of permanent dentition. In mandible, the
IDGT was maximum in CI  (2.6  mm) of mixed dentition.
Minimum IDGT was found in CI  (1.5  mm) of primary
dentition.
Clinical transfer of the study
The mixed dentition period is a transient phase. Hence, any
measurements of sulcus depth, AGW, and GT should never
be attempted for therapeutic correction. GT and gingival
width are important from the point of periesthetics and
restotarive esthetics. The due consideration for GT and
AGW measured should be kept in mind to minimize post
esthetic consequences.
Conclusion
GSD is higher in mixed dentition  (1.4  mm), followed by
permanent (1.2 mm) and primary dentition (1.2 mm). AGW
is higher in permanent dentition  (2.5  mm) followed by
mixed  (1.9  mm) and primary dentition  (1.8  mm). GT is
higher in mixed dentition both mesiobucally  (1.3  mm) and
interdentally  (2.3  mm) followed by primary  (1.1  mm MB
and 1.7  mm, ID) and permanent dentition  (1.0  mm, MB
and 1.3 mm, ID). The archwise and anterior tooth wise data
presentation is useful in these clinical issues to delineate
healthy and disease status of gingiva.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
48 Journal of Dental Research and Review | Volume 4 | Issue 2 | April-June 2017
F P Post hoc
12.53 0.001 (HS) Mixed > permanent > primary
46.05 0.001 (HS) Permanent > mixed > primary
18.79 0.001 (HS) Mixed > primary > permanent
89.72 0.001 (HS) Mixed > primary > permanent
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