The Width of Lingual Mandibular Attached Gingiva
MATERIALS
AND METHODS
One hundred and twenty individuals with clinical signs of normal gingiva were selected. Only those individuals with a Löe's Gingival Index score of zero or one were used. None of the teeth had orthodontic treatment, endodontic treatment, end to end occlusion or crossbite occlusion. Medical histories indicated no past or present disease, or medication that might influence the attached gingiva. Six age groups were studied: 3 to 5 (deciduous), 6 to 11 (mixed dentition), 9 to 14 (permanent dentition), 15 to 25, 26 to 35, and 36 and older (Table 1). The mandibular lingual zone of attached gingiva was measured with a periodontal probe calibrated in milli meters. The correction factor for deviations between the periodontal probes used was less than 0.4 mm. Therefore all fractionated measurements were rounded off to the nearest whole number of millimeters. Two measurements were recorded at the midline of each tooth: depth of the gingival sulcus, and distance from the margin of the free gingiva to the mucogingival junction. The mucogingival junction was outlined by alveolar mucosal tissue movement. By placing the back of the probe against the alveolar mucosal tissue, this tissue can be identified by its movement under pres sure. The attached gingiva shows no movement and the mucogingival junction between the two tissues can be delineated. The amount of attached gingiva was calculated by subtracting the sulcus depth from the mucogingival junction measurement. Statistical analysis was applied to each of the six groups. The means" and standard deviation were com puted for the width of lingual attached gingiva of each tooth of each group. Extreme measurements (low reading and high reading) for each tooth of each group was also recorded. The six groups were tested for differences among the groups and for differences within each group with a one-way multivariate analysis of variance. Grand means of each tooth were calculated on all permanent dentitions age 15 and older. (Groups IV, V and VI).
by JAMES P . VOIGT, D.D.S., M.S.* MICHAEL L . GORAN, B . A . f ROBERT M . FLEISHER, D.D.S.* of mucogingival surgery and free graft procedures the dental profession now has the capabilities of altering the width of attached gin giva. It is felt that the development and maintenance of healthy attached gingiva is beneficial to the oral environment and longevity of the dentition. Several studies have been done to establish baseline informa tion on facial and buccal attached gingiva. How ever, no studies have been published which deal with the presence of attached gingiva on the lingual mandib ular gingival surfaces. It is the purpose of this article to establish information concerning the width of gingiva on the lingual of mandibular teeth. Bowers showed that the width of facial attached gingiva varied for each tooth and that even though measurements varied greatly among patients, the pat tern of variation was constant. He showed that the mean widths of facial attached gingiva for individual teeth were the same for male and female. His studies showed that there was greater overall width of attached gingiva in the maxilla than in the mandible. Teeth that were prominent in the arch, such as mandibular cuspids and bicuspids, had a narrow zone of facial attached gingiva. There was an increase in mean width of facial attached gingiva from the deciduous dentition to the adult dentition. Bowers suggested that it was possible to have a narrow band of facial attached gingiva and maintain health, but some width of attached gingiva was necessary for healthy gingiva. Löe and Ainamo concluded similar findings. Rose and App studied the development of facial attached gingiva in deciduous, transitional and permanent dentition. They concluded that degree of tooth eruption, position of tooth in the arch, and muscle attachment do affect the width of facial attached gingiva of permanent maxillary and mandibular anterior teeth. Using these findings, a study was designed to deter mine the pattern, width and variation of attached gingiva on the lingual of mandibular teeth. W I T H T H E INTRODUCTION
1,2,6, 8
2
6
8
RESULTS
The mean, extremes and standard deviation for the six age groups are recorded in Table 2. The variation in the means classified by sex is shown in Table 3. By combining Groups IV, V and V I , the mean, extreme and standard deviation of permanent teeth are shown in Table 4. The analysis of variance that was done within each group and among the groups is shown in Table 5. The width of lingual attached gingiva varied with each tooth. The greatest average was on the lingual of the first and second mandibular molars. The width decreased on the bicuspids and third molars. The least amounts of lingual attached gingiva were on the central
* University of Pennsylvania, School of Dental Medicine, 4001 Spruce Street, Philadelphia, Pa 19174. †University of Pennsylvania, College of Arts and Sciences, Philadelphia, Pa 19174.
77
J. Periodontal. February, 1978
78 Voigt, Goran, Fleisher TABLE 1. Criteria for Selection of Groups Sex Description of group
Chronologic age range
Group Male
Female
I
10
10
II
10
10
III
10
10
IV
10
10
V
10
10
VI
10
10
Individuals have only deciduous man dibular teeth Individuals have mixed (deciduous + permanent) mandibular teeth Individuals have erupted permanent mandibular teeth Individuals have erupted permanent mandibular teeth Individuals have erupted permanent mandibular teeth Individuals have erupted permanent mandibular teeth with minimal or no recession.
3 - 5 years Mean — 5 years 4 months 6 - 1 1 years Mean—8 years 7 months 9 - 1 4 years Mean — 11 years 11 months 1 5 - 2 5 years Mean —22 years 2 months 2 6 - 3 5 years Mean—27 years 3 months 36 years and older Mean —46 years and 5 months
TABLE 2 . Width in Millimeters of Lingual Attached Gingiva by Groups Including Male and Female
deciduous
Dentition
SD
X
Mean
^ treme
Permanent Central incisor Lateral incisor Cuspid First bicuspid Second bicuspid First molar Second molar Third molar Deciduous Central incisor Lateral incisor Cuspid First molar Second molar
Group III
Group II 11 u—i 1 mixed
Group I
Mean
Ex
ft
SD
Ex
Mean
treme
1/1
SD
Group IV
Group V
15-25
26-35
Ex
Mean
treme
SD
Ex
Mean
treme
Group VI 36 and older
SD
Mean
treme
E x
" treme t
SD
0.9
1-2
0.9
0.7
0-1
0.3
1.6
1-2
0.4
1.2
1-3
0.4
1.3
1-2
0.4
0.9
1-2
0.9
0.9
0-1
0.3
1.5
1-2
0.6
1.0
1-3
0.5
1.5
1-2
0.3
1.3
1-2
0.4
0.3
4.1
0.4
3-5
3.0
1-5
1.6
3.0
1-5
1.6
3.0
1-5
1.6
2.5
2-3
0.9
4.3
3-5
1.6
3.1
2-4
0.9
4.3
3-5
1.6
3.7
2-5
1.4
1.0
1-1
0
1.5
1-2
0.6
1,2
1-3
0.4
1.5
1-2
2.0
1-3
1.0
2.0
1-4
1.7
1.9
1-4
0.7
2.0
1-3
1.0
2.0
1-3
1.0
2.4
1-4
0.7
1.9
1-4
0.8
2.4
1-3
0.8
2.9
2-4
0.6
3.3
2-6
1.4
3.3
1-7
1.8
5.3
3-7
1.4
2.7
2-4
0.6
4.2
1-7
1.4
3.5
1-6
1.5
5.0
3-7
1.4
2.8
1-6
1.5
2.5
1-4
1.4
4.0
4-4
0
* SD = Standard deviation.
TABLE 3. Mean Width in Millimeters of Lingual Attached Gingiva Male and Female Groups Group I
Group II
Group III
Group IV
Group V
3-5
6-11
9-14
12-25
26-35
Group VI 36 and older
Dentition Male mean
Female mean
Male mean
Female mean
Male mean
Female mean
Male mean
Female mean
Male mean
Female mean
Male mean
Female mean
0.9
0.9
0.9
0.9
1.5
1.4
1.1
1.0
1.0
1.5
0.9
0.8
0.9
0.8
1.4
1.5
1.0
1.1
1.0
2.0
1.3
1.4
Permanent Central incisor Lateral incisor Cuspid First bicuspid Second bicuspid First molar
4.3
4.4
Second molar Third molar Deciduous Central incisor
3.0
3.0
Lateral incisor
3.0
3.0
Cuspid First molar Second molar
3.0
3.0
2.4
2.5
4.3
4.3
3.2
3.1
4.3
4.3
3.7
3.4
1.1
1.0
1.4
1.5
1.1
1.0
1.0
2.0
2.1
2.0
2.1
2.2
1.8
1.7
2.5
2.0
2.1
2.0
2.5
2.4
1.8
1.7
2.5
2.0
3.0
3.2
3.5
3.4
3.2
3.3
7.0
4.0
2.7
2.6
4.4
4.4
3.4
3.5
3.0
4.5
3.0
3.0
2.4
2.4
4.0
4.0
Volume 49 Number 2
Lingual Mandibular Attached Gingiva 79
incisors, lateral incisors and cuspids. This pattern of variation for each tooth was about the same for most subjects, regardless of age or sex. Additional findings were: (1) The width of lingual attached gingiva did vary between individuals; some individuals had a broader band of attached gingiva than others. (2) There seems to be no sex-related variations in the width of attached gingiva. (3) The extreme measurements ranged from less than 1 mm to 8 mm widths of attached gingiva. These findings seem to coincide with Bowers con clusion on facial and buccal attached gingiva. 2
molar. The eruption of the first permanent mandibular molar as shown in Figure 4 indicates the position of the lingual mucogingival junction. This carried through to the permanent dentition as shown in Figure 1. Lingual attached gingiva showed that there was a variation in width with each tooth and between individ uals. There was no variation in width of lingual at tached gingiva between sexes (Table 3). As indicated in Table 4, the extreme measurements of lingual at tached gingiva in individuals with permanent dentition ranged from less than 1 mm to 8 mm. The variation in the width of lingual attached gingiva between groups and within each group is given in Table 5.
DISCUSSION
A visual pattern of the position of the mucogingival line emerged from the mean measurements of all permanent teeth. Figure 1 delineates the location of the mucogingival junction in relation to the mandibular teeth. The mean widths of attached gingiva were found to be smallest on the lingual of the central incisors, lateral incisors and cuspids. The bicuspids had the next largest width of attached gingiva. This was followed by the molars. The largest widths of lingual attached gingiva were found in the area of the first and second molars. Figure 2 shows the exact means of the width of attached gingiva in all permanent teeth. This same pattern of lingual attached gingiva persisted in the deciduous dention as is shown in Figure 3. This was similar to Bowers' findings on the facial and buccal attached gingiva of deciduous teeth. In the mixed dentitions the eruption of teeth appears to alter the mucogingival line at the first permanent mandibular
FIGURE 1. A line drawing of the mean width of lingual attached gingiva showing the mucogingival line in the perma nent dentition.
T A B L E 4. Width in Millimeters of Lingual Attached Gingiva Combining Group IV, V and VI Permanent Dentition Permanent Denti tion Central incisor Lateral incisor Cuspid First bicuspid Second bicuspid First molar Second molar Third molar
Mean
Extreme
Standard de viation
1.4
1-3
0.9
1.3
1-3
0.8
1.4
1-3
0.9
2
2-4
1.4
2.5
2-4
1.1
4.7
3-8
2.6
4.7
3-7
2.0
3
2-6
2.2
FIGURE 2. Bar graft showing the mean of attached gingiva in the permanent dentition.
T A B L E 5. Analysis of Variance for the Width of Lingual Attached Gingiva F-ratios, Faxb = MSaxb/MSwg. Results are an 'f' test significance level. Permanent dentition Between groups Within each group Deciduous dentition Between groups Within each group
Cuspid
First bicus pid
0.1%
0.1%
0.1%
0.1%
0.1%
0.1%
0.1%
0.4%
0.1%
0.3%
0.4%
0.3%
0.3%
04.4%
Central incisor
Lateral incisor
0.1% 0.4%
First molar
Second bicuspid
Central incisor
Lateral incisor
Cuspid
Second molar
0.1%
0.1%
0.1%
0.1%
0.1%
0.3%
0.3%
0.4%
4.4%
4.2%
First molar
Second molar
Third molar
80
Voigt, Goran,
J. Periodontol. February, 1978
Fleisher
FIGURE 3 . A line drawing of the mean width of lingual attached gingiva showing the mucogingival line in the decidu ous dentition.
sulcus, and the distance from the margin of the free gingiva to the mucogingival junction on the lingual mandibular teeth. The mean, extreme, standard devia tion and analysis of variance were computed. A distinct pattern of the width of healthy lingual attached gingiva was found. The largest width was found lingual to the first and second molars with a mean height of 4.7 mm. This was followed by the third molar (3 mm), second bicuspid (2.5 mm) first bicuspid (2 mm), and cuspid, lateral and central (1.9 mm). Lingual attached gingiva showed that there was a variation in width with each tooth and between individ uals. There was no variation in width of lingual at tached gingiva between sexes. The extreme measure ments ranged from less than 1 mm to 8 mm. The data from the study gives the dentist some indication of the mean and extreme ranges of lingual attached gingiva. This data can serve as a guide in diagnosis and treatment planning and in selecting pro cedures to reestablish these zones of attached gingiva. REFERENCES
FIGURE 4 . A line drawing of the mean width of lingual attached gingiva showing the mucogingival line in the mixed dention.
The analysis of variance for differences within each group and among the groups indicated that all findings were significant to the 5% level. These two tests ruled out chance as a factor in the data that were analyzed. The recognition of lingual attached gingiva and a lingual mucogingival junction is important to the den tist. Ill-fitting mandibular partial dentures often destroy lingual attached gingiva and result in inflammation of the alveolar mucosa. The recognition of widths of lingual attached gingiva allow the periodontal surgeon to design surgical procedures to conserve maximum attached gingiva on the lingual of the mandibular teeth. The data from this study gives the dentist some indication of what can be accepted as a mean, and the extreme ranges of lingual attached gingiva. Knowledge of the width of lingual attached gingiva can serve as a guide when the clinician wishes to undertake mucogin gival procedures to reestablish a zone of attached gingiva in these areas. SUMMARY
One hundred and twenty individuals in good oral health were divided into six groups according to age. Measurements were made on the depth of the gingival
I. Borowik, D . , Grabowska, M . , Kaczynska, W . , Karas, N . , Lambas-Lisiecka, K . , Lisiecka-Opalko, K . , Martyka, D . , Mazurek, J . , Ostrysz, W . , and Pruchla, M . : Measurements of the width of gingiva, the depth of epithelial attachments and oral vestibule in children and adolescents. Czas Stomatol 22: 9 8 9 , 1969. 2. Bowers, G . M . : A study of the width of attached g i n g i v a . / . Periodontol 34: 2 0 1 , 1 9 6 3 . 3. Karring, T . , and L o e , H . : A computerized method for quantitative estimation of the epithelium-connective tis sue interface applied to the gingiva of various age groups. Acta OdontolScand 31: 2 4 1 , 1 9 7 3 . 4. L a n g , N . P . , and L ö e , H . : The relationship between the width of keratinized gingiva and gingival health. J Perio dontol 43: 6 2 3 , 1 9 7 2 . 5. Listgarten, M . A . : Normal development, structure, physiology, and repair of gingival epithelium. Oral Sci Rev 1: 3, 1972. 6. L ö e , H . , and A i n a m o , J . : Anatomical characteristics of gingiva: A clinical and microscopic study of free and attached gingiva. J Periodontol 37: 5 , 1966. 7. L o z d a n , J . : Studies on the mucogingival junction. Dent Pract (Bristol) 20: 3 7 9 , 1 9 7 0 . 8. Rose, S. T . , and A p p , G . R . : A clinical study of the development of the attached gingiva along the facial aspects of the maxillary and mandibular anterior teeth in the decidu ous, transitional and permanent dentitions. J Periodontol 44: 1 3 1 , 1 9 7 3 . 9. R y a n , E . J . , T o t o , P . D . , and Gargiulo, A . W . : A g i n g in human attached gingiva epithelium. / Dent Res 53: 74,1974. 10. Stone, J . S.: Overcoming problems of the attached gingiva. Dent Surv 49: 2 4 , 1 9 7 3 . I I . Valdrighi, L . : Morphological and histochemical ob servations of the normal human gingiva. Acta Anat (Basel) 8 1 : 4 4 8 , 1972. 12. Zachrisson, S., and Zachrisson, B . : Gingival condi tion associated with orthodontic treatment. Angle Orthod 42: 2 6 , 1972.
MATERIALS
AND METHODS
One hundred and twenty individuals with clinical signs of normal gingiva were selected. Only those individuals with a Löe's Gingival Index score of zero or one were used. None of the teeth had orthodontic treatment, endodontic treatment, end to end occlusion or crossbite occlusion. Medical histories indicated no past or present disease, or medication that might influence the attached gingiva. Six age groups were studied: 3 to 5 (deciduous), 6 to 11 (mixed dentition), 9 to 14 (permanent dentition), 15 to 25, 26 to 35, and 36 and older (Table 1). The mandibular lingual zone of attached gingiva was measured with a periodontal probe calibrated in milli meters. The correction factor for deviations between the periodontal probes used was less than 0.4 mm. Therefore all fractionated measurements were rounded off to the nearest whole number of millimeters. Two measurements were recorded at the midline of each tooth: depth of the gingival sulcus, and distance from the margin of the free gingiva to the mucogingival junction. The mucogingival junction was outlined by alveolar mucosal tissue movement. By placing the back of the probe against the alveolar mucosal tissue, this tissue can be identified by its movement under pres sure. The attached gingiva shows no movement and the mucogingival junction between the two tissues can be delineated. The amount of attached gingiva was calculated by subtracting the sulcus depth from the mucogingival junction measurement. Statistical analysis was applied to each of the six groups. The means" and standard deviation were com puted for the width of lingual attached gingiva of each tooth of each group. Extreme measurements (low reading and high reading) for each tooth of each group was also recorded. The six groups were tested for differences among the groups and for differences within each group with a one-way multivariate analysis of variance. Grand means of each tooth were calculated on all permanent dentitions age 15 and older. (Groups IV, V and VI).
by JAMES P . VOIGT, D.D.S., M.S.* MICHAEL L . GORAN, B . A . f ROBERT M . FLEISHER, D.D.S.* of mucogingival surgery and free graft procedures the dental profession now has the capabilities of altering the width of attached gin giva. It is felt that the development and maintenance of healthy attached gingiva is beneficial to the oral environment and longevity of the dentition. Several studies have been done to establish baseline informa tion on facial and buccal attached gingiva. How ever, no studies have been published which deal with the presence of attached gingiva on the lingual mandib ular gingival surfaces. It is the purpose of this article to establish information concerning the width of gingiva on the lingual of mandibular teeth. Bowers showed that the width of facial attached gingiva varied for each tooth and that even though measurements varied greatly among patients, the pat tern of variation was constant. He showed that the mean widths of facial attached gingiva for individual teeth were the same for male and female. His studies showed that there was greater overall width of attached gingiva in the maxilla than in the mandible. Teeth that were prominent in the arch, such as mandibular cuspids and bicuspids, had a narrow zone of facial attached gingiva. There was an increase in mean width of facial attached gingiva from the deciduous dentition to the adult dentition. Bowers suggested that it was possible to have a narrow band of facial attached gingiva and maintain health, but some width of attached gingiva was necessary for healthy gingiva. Löe and Ainamo concluded similar findings. Rose and App studied the development of facial attached gingiva in deciduous, transitional and permanent dentition. They concluded that degree of tooth eruption, position of tooth in the arch, and muscle attachment do affect the width of facial attached gingiva of permanent maxillary and mandibular anterior teeth. Using these findings, a study was designed to deter mine the pattern, width and variation of attached gingiva on the lingual of mandibular teeth. W I T H T H E INTRODUCTION
1,2,6, 8
2
6
8
RESULTS
The mean, extremes and standard deviation for the six age groups are recorded in Table 2. The variation in the means classified by sex is shown in Table 3. By combining Groups IV, V and V I , the mean, extreme and standard deviation of permanent teeth are shown in Table 4. The analysis of variance that was done within each group and among the groups is shown in Table 5. The width of lingual attached gingiva varied with each tooth. The greatest average was on the lingual of the first and second mandibular molars. The width decreased on the bicuspids and third molars. The least amounts of lingual attached gingiva were on the central
* University of Pennsylvania, School of Dental Medicine, 4001 Spruce Street, Philadelphia, Pa 19174. †University of Pennsylvania, College of Arts and Sciences, Philadelphia, Pa 19174.
77
J. Periodontal. February, 1978
78 Voigt, Goran, Fleisher TABLE 1. Criteria for Selection of Groups Sex Description of group
Chronologic age range
Group Male
Female
I
10
10
II
10
10
III
10
10
IV
10
10
V
10
10
VI
10
10
Individuals have only deciduous man dibular teeth Individuals have mixed (deciduous + permanent) mandibular teeth Individuals have erupted permanent mandibular teeth Individuals have erupted permanent mandibular teeth Individuals have erupted permanent mandibular teeth Individuals have erupted permanent mandibular teeth with minimal or no recession.
3 - 5 years Mean — 5 years 4 months 6 - 1 1 years Mean—8 years 7 months 9 - 1 4 years Mean — 11 years 11 months 1 5 - 2 5 years Mean —22 years 2 months 2 6 - 3 5 years Mean—27 years 3 months 36 years and older Mean —46 years and 5 months
TABLE 2 . Width in Millimeters of Lingual Attached Gingiva by Groups Including Male and Female
deciduous
Dentition
SD
X
Mean
^ treme
Permanent Central incisor Lateral incisor Cuspid First bicuspid Second bicuspid First molar Second molar Third molar Deciduous Central incisor Lateral incisor Cuspid First molar Second molar
Group III
Group II 11 u—i 1 mixed
Group I
Mean
Ex
ft
SD
Ex
Mean
treme
1/1
SD
Group IV
Group V
15-25
26-35
Ex
Mean
treme
SD
Ex
Mean
treme
Group VI 36 and older
SD
Mean
treme
E x
" treme t
SD
0.9
1-2
0.9
0.7
0-1
0.3
1.6
1-2
0.4
1.2
1-3
0.4
1.3
1-2
0.4
0.9
1-2
0.9
0.9
0-1
0.3
1.5
1-2
0.6
1.0
1-3
0.5
1.5
1-2
0.3
1.3
1-2
0.4
0.3
4.1
0.4
3-5
3.0
1-5
1.6
3.0
1-5
1.6
3.0
1-5
1.6
2.5
2-3
0.9
4.3
3-5
1.6
3.1
2-4
0.9
4.3
3-5
1.6
3.7
2-5
1.4
1.0
1-1
0
1.5
1-2
0.6
1,2
1-3
0.4
1.5
1-2
2.0
1-3
1.0
2.0
1-4
1.7
1.9
1-4
0.7
2.0
1-3
1.0
2.0
1-3
1.0
2.4
1-4
0.7
1.9
1-4
0.8
2.4
1-3
0.8
2.9
2-4
0.6
3.3
2-6
1.4
3.3
1-7
1.8
5.3
3-7
1.4
2.7
2-4
0.6
4.2
1-7
1.4
3.5
1-6
1.5
5.0
3-7
1.4
2.8
1-6
1.5
2.5
1-4
1.4
4.0
4-4
0
* SD = Standard deviation.
TABLE 3. Mean Width in Millimeters of Lingual Attached Gingiva Male and Female Groups Group I
Group II
Group III
Group IV
Group V
3-5
6-11
9-14
12-25
26-35
Group VI 36 and older
Dentition Male mean
Female mean
Male mean
Female mean
Male mean
Female mean
Male mean
Female mean
Male mean
Female mean
Male mean
Female mean
0.9
0.9
0.9
0.9
1.5
1.4
1.1
1.0
1.0
1.5
0.9
0.8
0.9
0.8
1.4
1.5
1.0
1.1
1.0
2.0
1.3
1.4
Permanent Central incisor Lateral incisor Cuspid First bicuspid Second bicuspid First molar
4.3
4.4
Second molar Third molar Deciduous Central incisor
3.0
3.0
Lateral incisor
3.0
3.0
Cuspid First molar Second molar
3.0
3.0
2.4
2.5
4.3
4.3
3.2
3.1
4.3
4.3
3.7
3.4
1.1
1.0
1.4
1.5
1.1
1.0
1.0
2.0
2.1
2.0
2.1
2.2
1.8
1.7
2.5
2.0
2.1
2.0
2.5
2.4
1.8
1.7
2.5
2.0
3.0
3.2
3.5
3.4
3.2
3.3
7.0
4.0
2.7
2.6
4.4
4.4
3.4
3.5
3.0
4.5
3.0
3.0
2.4
2.4
4.0
4.0
Volume 49 Number 2
Lingual Mandibular Attached Gingiva 79
incisors, lateral incisors and cuspids. This pattern of variation for each tooth was about the same for most subjects, regardless of age or sex. Additional findings were: (1) The width of lingual attached gingiva did vary between individuals; some individuals had a broader band of attached gingiva than others. (2) There seems to be no sex-related variations in the width of attached gingiva. (3) The extreme measurements ranged from less than 1 mm to 8 mm widths of attached gingiva. These findings seem to coincide with Bowers con clusion on facial and buccal attached gingiva. 2
molar. The eruption of the first permanent mandibular molar as shown in Figure 4 indicates the position of the lingual mucogingival junction. This carried through to the permanent dentition as shown in Figure 1. Lingual attached gingiva showed that there was a variation in width with each tooth and between individ uals. There was no variation in width of lingual at tached gingiva between sexes (Table 3). As indicated in Table 4, the extreme measurements of lingual at tached gingiva in individuals with permanent dentition ranged from less than 1 mm to 8 mm. The variation in the width of lingual attached gingiva between groups and within each group is given in Table 5.
DISCUSSION
A visual pattern of the position of the mucogingival line emerged from the mean measurements of all permanent teeth. Figure 1 delineates the location of the mucogingival junction in relation to the mandibular teeth. The mean widths of attached gingiva were found to be smallest on the lingual of the central incisors, lateral incisors and cuspids. The bicuspids had the next largest width of attached gingiva. This was followed by the molars. The largest widths of lingual attached gingiva were found in the area of the first and second molars. Figure 2 shows the exact means of the width of attached gingiva in all permanent teeth. This same pattern of lingual attached gingiva persisted in the deciduous dention as is shown in Figure 3. This was similar to Bowers' findings on the facial and buccal attached gingiva of deciduous teeth. In the mixed dentitions the eruption of teeth appears to alter the mucogingival line at the first permanent mandibular
FIGURE 1. A line drawing of the mean width of lingual attached gingiva showing the mucogingival line in the perma nent dentition.
T A B L E 4. Width in Millimeters of Lingual Attached Gingiva Combining Group IV, V and VI Permanent Dentition Permanent Denti tion Central incisor Lateral incisor Cuspid First bicuspid Second bicuspid First molar Second molar Third molar
Mean
Extreme
Standard de viation
1.4
1-3
0.9
1.3
1-3
0.8
1.4
1-3
0.9
2
2-4
1.4
2.5
2-4
1.1
4.7
3-8
2.6
4.7
3-7
2.0
3
2-6
2.2
FIGURE 2. Bar graft showing the mean of attached gingiva in the permanent dentition.
T A B L E 5. Analysis of Variance for the Width of Lingual Attached Gingiva F-ratios, Faxb = MSaxb/MSwg. Results are an 'f' test significance level. Permanent dentition Between groups Within each group Deciduous dentition Between groups Within each group
Cuspid
First bicus pid
0.1%
0.1%
0.1%
0.1%
0.1%
0.1%
0.1%
0.4%
0.1%
0.3%
0.4%
0.3%
0.3%
04.4%
Central incisor
Lateral incisor
0.1% 0.4%
First molar
Second bicuspid
Central incisor
Lateral incisor
Cuspid
Second molar
0.1%
0.1%
0.1%
0.1%
0.1%
0.3%
0.3%
0.4%
4.4%
4.2%
First molar
Second molar
Third molar
80
Voigt, Goran,
J. Periodontol. February, 1978
Fleisher
FIGURE 3 . A line drawing of the mean width of lingual attached gingiva showing the mucogingival line in the decidu ous dentition.
sulcus, and the distance from the margin of the free gingiva to the mucogingival junction on the lingual mandibular teeth. The mean, extreme, standard devia tion and analysis of variance were computed. A distinct pattern of the width of healthy lingual attached gingiva was found. The largest width was found lingual to the first and second molars with a mean height of 4.7 mm. This was followed by the third molar (3 mm), second bicuspid (2.5 mm) first bicuspid (2 mm), and cuspid, lateral and central (1.9 mm). Lingual attached gingiva showed that there was a variation in width with each tooth and between individ uals. There was no variation in width of lingual at tached gingiva between sexes. The extreme measure ments ranged from less than 1 mm to 8 mm. The data from the study gives the dentist some indication of the mean and extreme ranges of lingual attached gingiva. This data can serve as a guide in diagnosis and treatment planning and in selecting pro cedures to reestablish these zones of attached gingiva. REFERENCES
FIGURE 4 . A line drawing of the mean width of lingual attached gingiva showing the mucogingival line in the mixed dention.
The analysis of variance for differences within each group and among the groups indicated that all findings were significant to the 5% level. These two tests ruled out chance as a factor in the data that were analyzed. The recognition of lingual attached gingiva and a lingual mucogingival junction is important to the den tist. Ill-fitting mandibular partial dentures often destroy lingual attached gingiva and result in inflammation of the alveolar mucosa. The recognition of widths of lingual attached gingiva allow the periodontal surgeon to design surgical procedures to conserve maximum attached gingiva on the lingual of the mandibular teeth. The data from this study gives the dentist some indication of what can be accepted as a mean, and the extreme ranges of lingual attached gingiva. Knowledge of the width of lingual attached gingiva can serve as a guide when the clinician wishes to undertake mucogin gival procedures to reestablish a zone of attached gingiva in these areas. SUMMARY
One hundred and twenty individuals in good oral health were divided into six groups according to age. Measurements were made on the depth of the gingival
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