J Clin Periodontol 2000; 27: 621–626 Copyright C Munksgaard 2000

Printed in Denmark . All rights reserved

ISSN 0303-6979

Hans-Peter Müller1,2,
Masticatory mucosa in subjects Achim Heinecke3, Nils Schaller1 and
Thomas Eger2

with different periodontal

1
School of Dental Medicine, University of
Heidelberg; 2Department of Periodontology,
German Armed Forces Central Hospital,
Koblenz; 3Institute for Medical Informatics

phenotypes and Biostatistics, University of Münster,

Germany

Müller HP, Heinecke A, Schaller N & Eger T. Masticatory mucosa in subjects

with different periodontal phenotypes J Clin Periodontol 2000; 27: 621–626.
C Munksgaard, 2000.

Abstract
Aims. The aim of the present investigation was to study thickness of masticatory
mucosa and gingival width in subjects with different periodontal phenotypes.
Methods: Periodontal phenotypes were defined with the aid of cluster analysis of
standardised parameters including mean gingival thickness and width as well
as ratio of crown width to its length at maxillary canines, lateral and central
incisors of 40 young adults with healthy periodontal conditions.
Results: 3 groupings could be observed. Clusters A1 and A2 comprised 75% of
all subjects. They were characterised by thin gingiva and a slender tooth form.
Clusters A1 and A2 were differentiated by gingival width. Cluster B comprised
11 subjects with relatively thick and wide gingiva and a quadratic tooth shape. In
general, characteristics of the frontal sextant in the maxilla were also found in
other parts of the dentition. Thus, mean thickness of masticatory mucosa as
well as gingival width and crown form differed significantly among clusters. In
addition, cluster B subjects had a significantly greater mean periodontal probing
depth. Multiple linear regression analysis was employed to identify significant
factors influencing palatal mucosal thickness. Women had considerably thinner
palatal mucosa than men. Furthermore, cluster affiliation had a significant influ-
ence on thickness of palatal mucosa. Thickest tissue was found in the premolar
region, whereas the mucosa over the root prominence of the first molar repre- Key words: periodontal phenotype;
masticatory mucosa; ultrasonic method;
sented an anatomical barrier for graft harvesting. cluster analysis; GEE methods
Conclusions: Thickness of masticatory mucosa strongly depends on gender and
the periodontal phenotype. Accepted for publication 27 September 1999

The term gingival or periodontal
phenotype has recently been coined
(Müller & Eger 1997) to address a com-
mon clinical observation of great vari-
ation in thickness and width of facial
keratinized tissue. In an attempt to
more objectively categorize a group of
young male adults with healthy peri-
odontal conditions, cluster analysis was
employed. Based on thickness and
width of facial gingiva as well as crown
form of maxillary front teeth, 3 differ-
ent phenotypes could be identified. 2/3
of subjects were assigned to a pheno-
type characterised by ‘‘normal’’ thick-
ness and width of gingiva with rela-
tively slender front teeth. In contrast,
every 5th subject had considerably
wider and thicker gingiva and a more
quadratic shape of maxillary front
teeth. Interestingly, a further 12% of
subjects were identified showing ‘‘nor-
mal’’ thickness, quadratic tooth shape
and a narrow zone of keratinized tissue.
Some characteristics of these pheno-
types of upper front teeth, i.e., gingival
width and tooth form, were also found
at upper premolars. In the mandible,
gingival thickness at canines, gingival
width of incisors and tooth form at pre-
molars appeared to be influenced by the
periodontal phenotype defined by the
frontal tooth sextant in the maxilla
(Müller & Eger 1997).
Cluster analysis may be regarded an
initial, explorative method, whose find-
ings should be confirmed in indepen-
dent populations. Since the obser-
vations made in the previous study may
be valid only in that male caucasian
population, it would be of interest to
extend these investigations in order to
confirm the existence of the proposed
periodontal phenotypes and to deter-
mine their prevalence, for example, in
groups of different gender. Further-
more, distinct characteristics of facial
gingiva might also be mirrored in other
622 Müller et al.
parts of the oral mucosa. Thickness of
palatal mucosa, in particular, has re-
cently attracted considerable attention
with regard to a possible donor site for
connective tissue transplants in plastic
surgery (Studer et al. 1997, Müller et al.
2000). 2 regions with comparatively
thin palatal mucosa of about 2 mm, on
average, were identified at central and
lateral incisors and at the prominence
of the palatal roots of 1st and 2nd mo-
lars. Thickest palatal masticatory mu-
cosa was observed in the 3rd molar re-
gion and at 2nd premolars at more cen-
tral locations with mean values of
about 3 mm (Müller et al. 2000).
Whereas the anatomical barrier over
the palatal root of 1st and 2nd molars
might be of clinical relevance in plastic
surgery, the question may arise as to
whether subjects with a thin peri-
odontal phenotype, which may be
prone to the development of gingival re-
cessions, may also have a thin palatal
mucosa which is probably not very suit-
able for graft harvesting for surgical
root coverage.
Thus, a 2nd aim of the present study
was to answer the question as to
whether individuals with a ‘‘thin’’ peri-
odontal phenotype, as defined by facial
thickness and width of gingiva at maxil-
lary front teeth, may also present with
rather thin palatal mucosa, by and large
unsuitable for proper graft harvesting.
Material and Methods
The study population has been de-
scribed elsewhere (Müller et al. 2000).
In brief, 40 systemically healthy young
adults, 19 to 30 years of age, were in-
vited to participate in a thorough clin-
ical examination of periodontal and
masticatory mucosal conditions. The 21
female and 19 male volunteers were
either dentists, dental students or dental
nurses. Thirty-seven subjects were of
Caucasian and 3 of Asian origin. 16
were light smokers with a median of 2
packyears. Subjects with destructive
periodontal disease (with a possible ex-
ception of localized gingival recessions),
pregnant or lactating women, subjects
with any medication known to affect
thickness of the periodontal soft tissues
as cyclosporin A, calcium channel
blockers or phenytoin, as well as sub-
jects comprising extensive restorations
or tooth replacement, were excluded. In
29 volunteers, 1 or more wisdom teeth
were missing, i.e., retained, not erupted
or surgically removed. In 8 subjects, 1
or more premolars had been extracted lingually with a standard periodontal
for orthodontic reasons. In addition, probe (PCPUNC 15, Hu Friedy, Lei-
one volunteer was missing a maxillary men, Germany) to the nearest mm. The
lateral incisor, another both maxillary mucogingival border was identified by
2nd molars, and 1 a maxillary 2nd pre- inspecting mucosal surface character-
molar. istics as colour and stippling and, if in
The ultrasonic measuring device doubt, functionally by applying a peri-
SDMA (Austenal Medizintechnik, odontal probe to the alveolar mucosa
Köln, Germany) was employed to parallel to the border thereby demarcat-
measure thickness of all parts of masti- ing the zone of the attached gingiva
catory mucosa. The device and its prin- (Bernimoulin et al. 1971).
ciple have been extensively described in Clinical periodontal conditions were
previous publications (Knapp & recorded at 3 sites buccally and 3 sites
Nentwig 1991, Eger et al. 1996, Müller palatally/lingually (mb, b, db, dp/l, p/l,
et al. 1999, 2000). Briefly, a piezo-crys- mp/l) of every tooth present. Peri-
tal is set oscillating by a pulse generator odontal probing depth and clinical
at 5 MHz. Ultrasonic pulses are trans- attachment level were measured by use
mitted through the sound-permeable of a standard periodontal probe to the
mucosa at an assumed velocity of about nearest mm. If loss of attachment was
1520 m/s and reflected in part at the greater than probing depth, the amount
surface of the alveolar bone or tooth. of recession of the gingival margin was
1000 signals per second are transmitted, recorded. Bleeding on probing within
received and analysed. By timing the re- 20 s was recorded as well as presence of
ceived echo with respect to the trans- dentogingival plaque after staining with
mission of the pulse, the thickness of a disclosing solution. A modified
the masticatory mucosa is determined bleeding/plaque ratio (Van der Velden
within 2–3 s and, while transmitting an et al. 1985) was calculated for every
acoustic signal, digitally displayed with proband. Thus, the % of sites bleeding
a resolution of 0.1 mm. The transducer
probe has a diameter of 4 mm.
Thickness of masticatory mucosa
was measured at a maximum of 149
sites in each volunteer. Measurement
areas are shown in Fig. 1 and were
essentially based on anatomical points,
i.e., cusps, interlobal incisions (Carlsen
1987) and interdental contact areas, as
well as the limitation emerging from the
4-mm transducer probe diameter. The
examination started at the tuberosity
measuring point of the right maxillary
wisdom tooth or 2nd molar (D). There-
after, thickness of the gingiva was
measured midbuccally (b) at the level of
the bottom of the gingival sulcus, i.e.,
the edge of the transducer probe touch-
es the gingival margin, as well as at the
base of the interdental papilla (mesio-
buccally of the distal tooth, mb). The
palatal mucosa of all teeth was meas-
ured midpalatally (p, pp, ppp) as well as
interdentally between 3rd and 2nd mo-
lars, 2nd and 1st molars as well as be-
tween central incisors (mp, mpp, mppp)
at each of 3 locations, about 4 mm
apart. In the mandible, thickness was Fig. 1. Definition of 149 measurement points
measured midbuccally (b) and midling- (P) for assessment of thickness of masticat-
ory mucosa was based on anatomical points
ually (l) as well as interdentally (mb, ml)
O ) of adjacent teeth as well as transducer
(P
between 3rd and 2nd as well as 2nd and probe diameter (4 mm). Coding of measure-
1st molars. Thickness of the retromolar ment sites as explained in the Material and
mucosa was also assessed (D). The Methods section (mb, b, p, pp, ppp, mp, mpp,
width of the gingiva was measured mid- mppp, l, ml, D, see arrows) is demonstrated
buccally and, at mandibular teeth, mid- for teeth 18 and 38.
 Masticatory mucosa 623

Table 1. Mean (∫standard deviation) facial gingival thickness (GTH) and width (GW) as well
as ratio of crown width to length (CW/CL) in clusters A1, A2, and B
Tooth . GTH/mm
11/21
cluster A1 (nΩ14) 0.81∫0.14
cluster A2 (nΩ15) 0.96∫0.25
cluster B (nΩ11) 1.29∫0.30
p ⬍0.001
12/22
A1 0.71∫0.16
A2 0.74∫0.14
B 1.20∫0.43
p ⬍0.001
13/23
A1 0.63∫0.11
A2 0.67∫0.12
B 0.81∫0.16
p ⬍0.01
on probing was divided by the % of sites
covered with supragingival plaque.
At premolars, canines and incisors,
the ratio of the width of the crown to
its length was measured according to
Olsson & Lindhe (1991). Crown length
was defined as the distance between the
gingival margin and the buccal cuspid
or incisal edge of the crown. The length
of the crown was divided into 3 por-
tions of equal height. Crown width, i.e.,
the distance between the proximal tooth
surfaces was measured at the border be-
tween the middle and the cervical por-
tion of the crown. Measurements were
made on stone model casts to the near-
est 0.1 mm by using a caliper.
Data analysis
In 11 volunteers, all measurements were
repeated after 24 h in order to deter-
mine reproducibility. For continuous
variables, the standard deviation of
measurements divided by 冪2 was used
to estimate measurement error (Co-
hen & Ralls 1988). Cohen’s k (Fleiss
1981) was calculated for plaque and
bleeding scores.
A major objective of the present
study was to confirm a previous report
on different periodontal phenotypes
GW/mm CW/CL
3.35∫0.72 0.75∫0.04
4.67∫0.70 0.80∫0.10
5.27∫0.56 0.87∫0.10
⬍0.001 ⬍0.01
3.68∫0.61 0.69∫0.08
5.13∫0.67 0.68∫0.10
6.59∫0.58 0.77∫0.12
⬍0.001 n.s.
3.36∫0.57 0.66∫0.07
4.27∫0.80 0.71∫0.08
5.09∫1.00 0.72∫0.08
⬍0.001 n.s.
(Müller & Eger 1997) in a separate
population. Therefore, cluster analysis
was employed in order to divide more
objectively the present population in a
similar way to the former study. The
Euclidean distance of 9 standardised
parameters was used as a measure of
similarity: gingival thickness and width
as well as ratio of crown width to its
length of central and lateral incisors as
well as canines in the maxilla. A par-
tition of the 40 subjects into 3 clusters
was iteratively improved by non-hier-
archical disjunct cluster analysis using
a k-mean algorithm (Hartigan & Wong
1979) in order to reduce the within-
group sum of squares. Analysis of vari-
ance was applied to search for differ-
ences among clusters. For all variables,
patient’s means were calculated. p-
values were adjusted for a possible in-
fluence of gender and smoking habits.
In order to analyse specifically differ-
ences in thickness of palatal mucosa,
multiple linear regression analysis using
generalised estimating equation (GEE)
methods were employed in order to ad-
just for the correlation between sites in
the same patient (DeRouen et al. 1995).
An exchangeable working correlation
structure was used. All calculations
were performed on a personal com-
puter using SAS/STAT 6.12 (SAS Insti-
tute Inc., Cary, NC, USA). No attempt
was made to adjust for multiple testing.
Results
The reproducibility of all variables was
tested in 11 volunteers by repeating
measurements after 24 h. Attachment
loss of 1 to 3 mm at one or the other
examination was observed in 8 prob-
ands at 47 out of 1890 sites (2.5%). All
but 2 measurements were reproduced
within 2 mm. Measurement error for
periodontal probing depth was 0.39
mm. After 24 h, presence or absence of
plaque was moderately reproduced with
a k-value of 0.50∫0.02; however a sig-
nificant Hawthorne effect (McNemar’s
c2Ω62, p⬍0.001) was observed. Since
most gingival units were free from overt
gingivitis, k for bleeding on probing
was only 0.13∫0.03. At 472 locations,
replicate measurements of gingival
width were made, and the measurement
error was 0.63 mm. Crown width and
length of premolars, canines and in-
cisors was repeatedly measured on
model casts. The respective ratios were
calculated and a measurement error of
0.04 was determined. Reproducibility of
ultrasonic determination of mucosal
thickness had been presented in a separ-
ate publication (Müller et al. 1999b).
Considerable variation of reliability was
noted in different parts of the oral cav-
ity. Measurement error at facial and lin-
gual gingiva was 0.26 mm, at papillary
gingiva 0.37 mm and at palatal mucosa
0.54 mm. The lowest reliability was ob-
served in the tuberosity and at retromo-
lar tissue with 1.26 mm (Müller et al.
1999b).
Cluster analysis was based on facial
thickness of gingiva, gingival width as
well as crown form of the maxillary
frontal jaw sextant. Among 40 young
adults, 3 clusters were created by the
computer program. Cluster A1 com-
prised 8 men and 6 women. Cluster A2
harboured 5 men and 10 women,

Table 2. Mean (∫standard deviation) thickness of masticatory mucosa (MTH), gingival width (GW), the ratio between crown width and
length of premolars, canines and incisors (CW/CL), as well as clinical parameters periodontal probing depth (PPD), recession (REC) and
bleeding/plaque ratio (B/P) in clusters A1, A2, and B
MTH/mm GW/mm CW/CL PPD/mm REC/mm B/P
cluster A1 1.70∫0.25 3.54∫0.65 0.67∫0.04 1.69∫0.26 0.04∫0.06 0.63∫0.45
cluster A2 1.78∫0.24 3.90∫0.60 0.69∫0.08 1.91∫0.28 0.03∫0.04 0.61∫0.46
cluster B 1.95∫0.21 4.80∫0.53 0.73∫0.06 2.00∫0.15 0.01∫0.02 0.52∫0.22
pa ⬍0.05 ⬍0.001 ⬍0.05 ⬍0.01 n.s. n.s.
a
Adjusted for gender and smoking status; CW/CL was only adjusted for gender.
624 Müller et al.
Fig. 2. Mean thickness of palatal mucosa between canines (tooth number 3) and 2nd molars
(tooth number 7) at sites p, pp, and ppp in clusters A1, A2 and B.
whereas cluster B comprised 6 men and
5 women (n.s.). Respective features of
cluster discriminating teeth are shown
in Table 1. Clusters A1 and A2, i.e., al-
most 3/4 of subjects, were characterised
by thin gingiva of below 1 mm and a
slender form of upper front teeth, in
particular central incisors. Both clusters
were distinguished by gingival width. In
cluster A1, a narrow band of gingiva of
about 3.5 mm, on average, was ob-
served, whereas gingiva of cluster A2
subjects was considerably wider
(4.27∫0.80 mm at canines up to
5.13∫0.67 mm at lateral incisors). In
contrast, the 11 subjects comprising
cluster B had considerably thicker
(0.81∫0.16 mm at canines up to
1.29∫0.30 mm at central incisors) and
wider gingiva (5.09∫1.00 mm at can-
ines up to 6.59∫0.58 mm at lateral in-
cisors) as well as a more quadratic
tooth shape of central incisors (crown
width to its length of 0.87∫0.10). With
the exception of the ratio of crown
width to its length at lateral incisors
and canines, analysis of variance re-
vealed differences to be highly signifi-
cant (Table 1).
Subjects with destructive periodontal
disease were excluded from the study.
Therefore, low mean periodontal prob-
ing depths of between 1.4 and 2.5 mm
and up to 0.4 mm mean loss of attach-
ment was observed. However, up to
39% sites bled upon probing and up to
90% sites harbored supragingival
plaque in individual subjects. Table 2
presents overall clinical features of sub-
jects in respective clusters. Cluster de-
fining characteristics for the frontal jaw
sextant in the maxilla could generally
be found in the whole dentition. Thus,
bleeding/plaque ratio, these differences
were not significant (Table 2).
Thickness of palatal mucosa between
canines and 2nd molars in respective
clusters is illustrated in Fig. 2. Since
thickness of the mucosa of 2 mm or less
generally excludes the possibility for
proper graft harvesting, the ordinate to
the right starts with 2.25 mm. Palatal
gingiva (site p, see Fig. 1) was at least 2
¿ as thick as facial/buccal gingiva. At
sites pp and ppp, the thickest mucosa
was observed at both premolars. Thick-
ness was largely reduced at the promi-
nence of the palatal root of 1st molars
(Fig. 2). Generalised estimating equa-
tion methods were employed in order to
identify factors influencing mucosal
thickness at the hard palate in the re-
gion between canines and second mo-
mean thickness of all parts of masticat- lars. The final linear regression model is
ory mucosa as well as mean width of shown in Table 3. According to the
gingiva differed significantly after ad- model, thickness of palatal mucosa was
justing for gender and smoking status. significantly influenced by gender.
Furthermore, the average ratio of Thus, women had a mean 0.3 mm thin-
crown width to its length of premolars, ner mucosa than men. Furthermore,
canines and incisors was different after cluster A1 subjects, presenting with thin
adjusting for gender (Table 2). Interest- and narrow facial gingiva at canines
ingly, subjects in cluster B characterised and incisors in the maxilla, had signifi-
by thick and wide gingiva as well cantly thinner palatal mucosa than
as quadratic shape of teeth had sig- cluster A2 and cluster B subjects. In ad-
nificantly greater probing depths dition, the model provides figures con-
(2.00∫0.15 mm versus 1.69∫0.26 mm firming the graphical impression of
in cluster A1). Although subjects with thicker mucosa in more central parts
thin and narrow gingiva tended to have (sites pp, ppp) of the hard palate and at
more gingival recession and a higher premolars, whereas at the root promi-
Table 3. Multiple linear regression analysis applying generalised estimation equation method-
ology
Parameter Estimate SE (estimate) p
constant 2.646 0.186 0.000
gendera) ª0.299 0.100 0.003
clusterb)
A2 0.294 0.132 0.026
B 0.226 0.114 0.048
sitec)
pp 0.155 0.042 0.000
ppp 0.403 0.067 0.000
toothd)
.3 0.021 0.109 0.850
.4 0.191 0.083 0.021
.5 0.187 0.083 0.024
.6 ª0.265 0.072 0.000
Dependent variable: thickness of palatal mucosa. Robust standard errors and p-values. Work-
ing dependence structure: exchangeable. Correlation estimate: 0.216.
a)
Site is encoded by dummy variables with possible values 0 and 1; reference (all dummies
equal zero) is site p.
b)
Tooth is encoded by dummy variables with possible values 0 and 1; reference is tooth .7.
c)
Gender is a dummy variable with male encoded as 1 and female as 2.
d)
Cluster is encoded by dummy variables with possible values 0 and 1; reference is cluster
A1.

nence of 1st molars, there appears to
be the thinnest tissue. The correlation
estimate was 0.216 (Table 3).
Discussion
In recent years, cluster analysis has
been appreciated as an interesting tool
in periodontics to divide more objec-
tively a large and complex population
into easier to survey fractions. However,
cluster analysis is generally understood
as a descriptive and exploratory
method whose findings should be con-
firmed in independent populations (Co-
hen 1997). One of the major objectives
of the present study was therefore to
confirm the results of a previous investi-
gation on periodontal phenotypes
(Müller & Eger 1997). In the former
paper, cluster analysis was employed in
order to identify groups of subjects with
similar conditions at maxillary front
teeth, i.e., gingival thickness and width
as well as tooth form. Thus, 3 distinct
clusters were created by the computer
program. In the present study on 40
young adults, cluster analysis also re-
vealed 3 clusters, which differed slightly
from the clusters of the previous investi-
gation. In particular, a cluster charac-
terised by thin and narrow gingiva at
upper front teeth, but with a distinct
quadratic tooth form (cluster C of the
former study), could not be identified.
Rather, cluster A was subdivided into 2
fractions of 14 and 15 subjects each,
who presented with thin gingiva and
slender tooth form, and were differen-
tiated by gingival width. Cluster A1
subjects had a narrow band of kera-
tinized tissue, whereas the gingiva in
cluster A2 was considerably wider. The
11 subjects comprising cluster B re-
sembled subjects in cluster B of the for-
mer study (Müller & Eger 1997), both
in characteristics and prevalence. These
subjects had thicker and wider gingiva,
and central incisors, in particular, had
a quadratic shape. In general, gingiva
was thinner in the present study. This
was due to the mixed gender popula-
tion, whereas in the previous report,
only young male adults were examined.
Masticatory mucosa of women was sig-
nificantly thinner than masticatory mu-
cosa of men (Müller et al. 2000). Mean
gingival width and tooth form of clus-
ters A1 and B at cluster discriminating
teeth correspond with conditions in re-
spective clusters A and B of the former
study.
Similar to observations made in the
previous paper, characteristics at maxil-
lary front teeth could also be observed
in other parts of the dentition. Thus,
after adjusting for gender and tobacco
smoking (only 3 subjects were of Asian
descent; therefore, no adjustment was
made for ethnic background), subjects
in cluster B had the thickest overall
masticatory mucosa, the widest gingiva
and the largest ratio between crown
width and length (p⬍0.05). Whereas
trends of more recession and an un-
favorable bleeding/plaque ratio in sub-
jects with thin gingiva were not signifi-
cant, mean periodontal probing depth
was significantly higher in subjects of
cluster B. This is in agreement with ob-
servations made by Olsson et al. (1993)
and Eger et al. (1996), who identified
probing depth as a significant factor
positively influencing gingival thick-
ness. The fact that thicker tissue may
result in greater probing depth may
allow some interesting speculations re-
garding interindividual variation of the
so-called biological width, i.e., the dis-
tance between the bottom of the gingi-
val sulcus and the alveolar bone crest,
which should be considered during re-
storative (Braegger et al. 1992) and im-
plant (Berglundh & Lindhe 1996) ther-
apy. Based on clinically normal autopsy
material ‘‘with various phases of pass-
ive exposure’’ of the root, Gargiulo et
al. (1961) calculated a mean of 1.07 mm
of supracrestal connective tissue attach-
ment, a mean of 0.97 mm epithelial
attachment and a sulcus depth of 0.69
mm, on average. As usual in biomedical
research, a great individual variation of
all distances was reported. Thus, the
biological width may in fact depend on
and is an expression of the periodontal
phenotype. In subjects with a thin and
delicate gingiva, respective mean values
of Gargiulo et al. (1961) are clearly too
large, whereas these distances in sub-
jects with thick and wide keratinized
tissue are easily violated by placing
crown margins about 2 mm distant
from the alveolar crest. Interestingly,
the periodontal phenotype may be al-
tered by combined implant and pros-
thetic therapy (Chang et al. 1999).
Another objective of the present
study was to test the hypothesis that
subjects with a thin periodontal pheno-
type have also relatively thin palatal
mucosa not very suitable for harvesting
connective tissue grafts. Multiple linear
regression analysis employing general-
ized estimating equation methods were
applied in order to consider the corre-
Masticatory mucosa 625
lation of observations made in a given
subject. The final model revealed that
palatal mucosa of the region between
canines and 2nd molars was a mean 0.3
mm thinner in women than in men.
This is in contrast to results reported
by Studer et al. (1997), who determined
mucosal thickness at 18 sites of the hard
palate (by and large corresponding to
sites in the present study) and 6 points
within the tuberosity by bone sounding
with a periodontal probe after local an-
aesthesia. They did not find a signifi-
cant gender effect in a population of 31
Caucasians with a mean age of 35 years.
Smaller sample size, older age range,
different statistical analysis as well as a
relatively crude method of assessing
mucosal thickness may be responsible
for the lack of significance. In general,
mean values of thickness of the mucosa
of the hard palate, as reported by Stud-
er et al. (1997), surpassed our own re-
sults, probably due to the injection of a
local anaesthetic. Of considerable inter-
est may be the observation that, in the
present study, cluster affiliation had a
significant effect on mucosal thickness.
In fact, both cluster A2 and cluster B
subjects had significantly thicker mu-
cosa than cluster A1 subjects. And fi-
nally, thickness was most pronounced
in the premolar region in a more central
direction, whereas mucosa was thinnest
over the root prominence of the first
molar. These observations corroborate
findings by Studer et al. (1997).
In conclusion, the present study con-
firmed that periodontal phenotypes
similar to those described in a previous
paper by Müller & Eger (1997) do actu-
ally exist. Specific characteristics at
maxillary front teeth are also easily
found in other parts of the dentition. In
particular, palatal mucosa may be
rather thin in subjects with a thin and
narrow gingiva and a slender shape of
upper front teeth. Masticatory mucosa
is generally thinner in women.
Zusammenfassung
Mastikatorische Schleimhaut bei Patienten
mit unterschiedlichen parodontalen Pheno-
typen
Das Ziel der vorliegenden Untersuchung war,
die Dicke der mastikatorischen Mukosa und
die gingivale Breite bei unterschiedlichen pa-
rodontalen Phenotypen zu untersuchen. Die
parodontalen Phenotypen wurden mit Hilfe
der Cluster-Analyse definiert, die die mittlere
gingivale Dicke und Breite sowie das Verhält-
nis der Kronenbreite zu ihre Länge bei den
oberen Eckzähnen, lateralen und zentralen
626 Müller et al.
Schneidezähnen bei 40 jungen Erwachsenen
mit gesunden parodontalen Verhältnissen
einschloß. 3 Gruppen konnten beobachtet
werden. Cluster A1 und A2 enthielten 75%
aller Personen. Sie waren durch dünne Gingi-
va und eine schlanke Zahnform charakteri-
siert. Die Cluster A1 und A2 wurden mit der
gingivalen Breite unterschieden. Cluster B
enthielt 11 Personen mit relativ dicker und
breiter Gingiva und einer quadratischen
Zahnform. Im allgemeinen wurden die Cha-
rakteristika des frontalen Sextanten im Ober-
kiefer auch an anderen Teilen der Dentition
gefunden. So unterschieden sich die mittlere
Dicke der mastikatorischen Schleimhaut so-
wie der gingivalen Breite und die Kronen-
form signifikant zwischen den Clustern. Zu-
sätzlich hatten die Personen des Clusters B
signifikant größere mittlere parodontale Son-
dierungstiefen. Die multiple lineare Regres-
sionsanalyse wurde durchgeführt, um signi-
fikante Faktoren zu identifizieren, die die
Dicke der palatinalen Mukosa beeinflussen.
Frauen hatten bedeutend dünnere palatinale
Mukosa als Männer. Auch die Clusterzusam-
menfassung hatte einen signifikanten Einfluß
auf die Dicke der palatinalen Mukosa. Das
dickste Gewebe wurde in der Prämolarenre-
gion gefunden, während die Mukosa über
der Wurzelprominenz des ersten Molaren
eine anatomische Barriere zur Transplantat-
gewinnung repräsentierte.
Résumé
La muqueuse masticatoire chez des sujets
ayant différents phénotypes parodontaux
Le présent travail avait pour but d’étudier
l’épaisseur de la muqueuse masticatoire et la
largeur de la gencive chez des sujets ayant dif-
férents phénotypes parodontaux. Les phéno-
types parodontaux ont été définis à l’aide de
l’analyse par cluster de paramètres standardi-
sés comprenant l’épaisseur et la largeur
moyennes de la gencive, ainsi que le rapport
de la largeur de la couronne à sa longueur au
niveau des canines et des incisives latérales et
centrales du maxillaire, chez 40 jeunes adul-
tes ayant un parodonte sain. On pouvait ob-
server 3 groupements. Les clusters A1 et A2
comprenaient 75% de tous les sujets. Il
étaient caractérisés par une gencive mince et
une forme dentaire élancée. Les clusters A1
et A2 se distinguaient l’un de l’autre par la
largeur de la gencive. Le cluster B comprenait
11 sujets ayant une gencive relativement
épaisse et large et une forme dentaire qua-
dratique. Dans l’ensemble, les caractéristi-
ques du sextant antérieur du maxillaire se re-
trouvaient dans d’autres parties de la dentu-
re. Ainsi, aussi bien l’épaisseur moyenne de
la muqueuse masticatoire que la largeur de la
gencive et la forme de la couronne différaient
significativement parmi les clusters. De plus,
les sujets du cluster B avaient une profondeur
moyenne des poches significativement plus
élevée. L’analyse de regression linéaire multi-
ple a été utilisée pour identifier les facteurs
significatifs ayant une influence sur l’épais-
seur de la muqueuse palatine. Les femmes
avaient une muqueuse palatine considérable-
ment plus mince que les hommes. L’apparte-
nance à un cluster avait aussi une influence
significative sur l’épaisseur de la muqueuse
palatine. Les tissus le plus épais ont été trou-
vés dans la région des prémolaires, tandis que
la muqueuse recouvrant la saillie de la racine
de la première molaire représentait une bar-
rière anatomique pour le prélèvement de
greffons.
References
Berglundh, T. & Lindhe, J. (1996) Dimension
of the periimplant mucosa. Biological
width revisited. Journal of Clinical Period-
ontology 23, 971–973.
Bernimoulin, J. P., Son, S. & Regolati, B.
(1971) Biometric comparison of three
methods of determining the mucogingival
junction. Helvetica Odontologica Acta 15,
118–120.
Brägger, U., Lauchenauer, D. & Lang, N. P.
(1992) The surgical lengthening of the clin-
ical crown. Journal of Clinical Periodonto-
logy 19, 58–63.
Carlsen, O. (1987) Dental morphology, 1st
edition, p. 22–46. Copenhagen: Munks-
gaard.
Chang, M., Wennström, J. L., Ödman, P. &
Andersson, B. (1999) Implant supported
single-tooth replacements compared to
contralateral natural teeth. Crown and
soft tissue dimensions. Clinical Oral Im-
plants Research 10, 185–194.
Cohen, M. E. (1997) On the interpretation of
microbial clusters in periodontal disease.
Journal of Periodontal Research 32, 47–53.
Cohen, M. E. & Ralls, S. A. (1988) False
positive rates in the determination of
changes in probing depth-related peri-
odontal measurements. Journal of Peri-
odontal Research 23, 161–165.
DeRouen, T. A., Hujoel, P. P. & Mancl, L.
A. (1995) Statistical issues in periodontal
research. Journal of Dental Research 74,
1731–1737.
Eger, T., Müller, H.-P. & Heinecke, A. (1996)
Ultrasonic determination of gingival
thickness. Subject variation and influence
of tooth type and clinical features. Journal
of Clinical Periodontology 23, 839–845.
Fleiss, J. L. (1981) Statistical methods for
rates and proportions. 2nd edition, pp.
212–236, New York: John Wiley & Sons.
Gargiulo, A. W., Wentz, F. M. & Orban, B.
(1961) Dimensions and relations of the
dentogingival junction in humans. Journal
of Periodontology 32, 261–267.
Hartigan, J. A. & Wong, M. A. (1979) A k-
mean clustering algorithm. Applied Stat-
istics 28, 100–108.
Knapp, G. & Nentwig, G.-H. (1991) Ul-
traschall-Laufzeitmessung zur klinischen
Bewertung der Schleimhautperiostdicke.
Zeitschrift für Zahnärztliche Implantologie
7, 97–99.
Müller, H.-P. & Eger, T. (1997) Gingival
phenotypes in young male adults. Journal
of Clinical Periodontology 24, 65–71.
Müller, H.-P., Schaller, N. & Eger, T. (1999)
Ultrasonic determination of thickness of
masticatory mucosa – A methodologic
study. Oral Surgery, Oral Medicine, Oral
Pathology, Oral Radiology, and Endodont-
ics 88, 248–253.
Müller, H.-P., Schaller, N., Eger, T. & Hei-
necke, A. (2000) Thickness of masticatory
mucosa. Journal of Clinical Periodontology
27, 431–436.
Olsson, M. & Lindhe, J. (1991) Periodontal
characteristics in individuals with varying
form of the upper central incisors. Journal
of Clinical Periodontology 18, 78–82.
Olsson, M., Lindhe, J. & Marinello, C. P.
(1993) On the relationship between crown
form and clinical features of the gingiva in
adolescents. Journal of Clinical Periodon-
tology 20, 570–577.
Studer, S. P., Allen, E. P., Rees, T. C. & Kou-
ba, A. (1997) The thickness of masticatory
mucosa in the human hard palate and tu-
berosity as potential donor sites for ridge
augmentation procedures. Journal of Peri-
odontology 68,145–151.
Van der Velden, U., Winkel, E. G. & Abbas,
F. (1985) Bleeding/plaque ratio. A possible
prognostic indicator for periodontal
breakdown. Journal of Clinical Periodonto-
logy 12, 861–866.
Address:
Hans-Peter Müller
School of Dental Medicine
University of Heidelberg
Im Neuenheimer Feld 400
D-69120 Heidelberg
Germany
e-mail: perio/t-online.de