Longitudinal changes in the width of attached gingiva in children.

The width of the attached gingiva of 54 children 12-14 years old was measured and compared with its width measured five years before. The width of the attached gingiva of 96 mandibular permanent central incisors at the second examination was grouped according to its width at the first examination. In addition, the width of the attached gingiva of 67 mandibular central incisors, at both examinations, was grouped according to the width of the attached gingiva of the mandibular primary molars at the first examination. Eightyfour per cent of the incisors with less than 1 mm of attached gingiva at the first examination, showed an increase in width of the gingiva with time. A similar increase was evident in 30% of the incisors which had 1 mm or more of attached gingiva at the first examination; only 12 % showed a decrease. No correlation was found between the width of the attached gingiva of the permanent incisors and that of the mandibular primary molars. These findings should be taken into consideration when mucogingival surgery in children is considered. Longitudinal and cross-sectional epidemiologic studies have demonstrated that during the transition from the primary to the permanent dentition, a decrease in the width of the band of attached gingiva takes place. 1 After this initial decrease, with tooth eruption, a gradual increase takes place leading to a band of attached gingiva which is wider in adults than in the primary dentition. 2 Because of these developmental changes, the clinician often faces situations in which a narrow band of attached gingiva is present in the mandibular incisor area of children, and he is required to determine the prognosis and the possible need for surgical intervention. To solve this question the available epidemiological data may be helpful but insufficient since they indicate general tendencies only. The purpose of the present study is to examine the possibility of prediction of the 1 Birnstein and Eidelman 1983; Tenenbaum and Tenenbaum 1986; Bimstein et al. 1986. 2Bowers 1963; Rose and App 1973; Vincent et al. 1976. future width of the attached gingiva of the mandibular permanent central incisors from its width in the early mixed dentition period or from the width of the attached gingiva of the mandibular primary molars. Materials and Methods A total of 54 children (12-14 years of age), who participated in a previous study (Bimstein and Eidelman 1983), were available for re-examination five years after the baseline examination. The criteria for selection of cases required that no more than one tooth was missing in any posterior or anterior segment and that no advanced gingivitis or pulpal pathosis were evident. Two measurements were completed at the midline of the buccal aspect of each tooth: the probing depth of the gingival sulcus and the width of the keratinized gingiva. The latter was established by measuring the distance from the margin of the free gingival margin to the mucogingival junction (Figure). In young children, stippling is extremely fine, and the greater vascularization gives the attached gingiva a reddish color, making it difficult to distinguish it from the alveolar mucosa. Therefore, we used the jiggle method to delineate the mucogingival junction (Oschenbein and Maynard 1974). The measurements were carried out with a periodontal probe calibrated in millimeters and all fractionated measurements rounded to the nearest millimeter. The width of the attached gingiva was calculated by subtracting the probing depth from the width of the keratinized gingiva. 3 Ninety-six mandibular permanent central incisors were present at both examinations; for 67 of them the width of the attached gingiva of the mandibular primary molars at the first examination was available. The mean widths of the band of attached gingiva at the mandibular permanent central incisors at the second examination were grouped according to their mean in the first examination. The mean widths of the attached gingiva at the mandibular permanent cen3Rose and App 1973; Vincent et al. 1976; Hall 1977. 22 ATTACHED GLNGIVA IN CHILDREN: BIMSTEIN AND EIDELMAN