The demand for highly aesthetic  dental restorations has increased considerably in modern clinical practice, particularly in the anterior region where even minor discrepancies can significantly affect patient satisfaction.1 Tooth-supported fixed restorations remain one of the most commonly employed treatment modalities for restoring function and appearance; however, their success is not solely dependent on the prosthetic material or technical precision, but also on the condition and behavior of the surrounding periodontal tissues. Among the various biological determinants, soft tissue biotype has gained increasing attention as a critical factor influencing both immediate and long-term aesthetic outcomes.2

Soft tissue biotype, also referred to as periodontal phenotype, describes the thickness and morphology of gingival tissues and the underlying alveolar bone.3 It is generally categorized into thin and thick biotypes. Thin biotype is characterized by delicate, highly scalloped gingiva and reduced tissue thickness, whereas thick biotype exhibits dense, fibrotic tissue with a flatter gingival architecture.4 These structural differences significantly influence tissue response to restorative procedures, including crown preparation, impression taking, and placement of prosthetic margins.1

In patients with thin gingival biotype, the tissue is more susceptible to mechanical trauma and inflammatory changes, often resulting in gingival recession, loss of papillary height, and exposure of restoration margins.2 Such complications can severely compromise aesthetic  outcomes, particularly in high smile line cases. Conversely, thick biotype tends to be more resilient and stable, showing better resistance to recession and improved ability to maintain gingival contours over time. This makes it more favourable  for achieving predictable aesthetic  integration with fixed restorations.4

The interaction between restoration margins and gingival tissues is another critical aspect influenced by biotype.3 Subgingival margin placement, which is often required for aesthetic  reasons, can have varying effects depending on the thickness of the gingiva. While thick tissues can tolerate such placement with minimal adverse effects, thin tissues are more prone to inflammation and recession, leading to compromised results. Therefore, understanding the biological limitations associated with each biotype is essential for appropriate treatment planning.5

Despite growing awareness, the routine clinical assessment of gingival biotype is still not universally practiced, and its role in influencing aesthetic  outcomes is sometimes underestimated.1 Moreover, there is limited regional data evaluating this relationship in patients undergoing tooth-supported fixed restorations.6 This study was therefore designed to assess the impact of soft tissue biotype on key aesthetic parameters, including gingival contour, papillary fill, colour match, and marginal adaptation, to provide evidence-based guidance for improving clinical outcomes.

A cross-sectional clinical study was conducted in the Department of Prosthodontics and Periodontology over a duration of six months after approval from the ethical board. A total of 120 patients requiring anterior tooth-supported fixed restorations were included using non-probability convenience sampling. Patients aged between 18 and 60 years with good periodontal health were selected. Individuals with systemic diseases affecting periodontal status, smokers, and those with a history of periodontal surgery in the area of interest were excluded from the study.

Gingival biotype was assessed using the probe

transparency method. A periodontal probe was inserted into the gingival sulcus; visibility of the probe through the gingiva indicated a thin biotype, while non-visibility indicated a thick biotype.

Aesthetic evaluation was performed after placement of the definitive prosthesis using standardized criteria including gingival contour, color match, papillary fill, and marginal adaptation. Each parameter was scored on a three-point scale: 1 (poor), 2 (fair), and 3 (excellent).

Data were entered and analyzed using SPSS version 25. Descriptive statistics were calculated for frequencies and means. Independent t-test and Chi-square test were applied to assess the association between gingival biotype and aesthetic outcomes. A p-value of ≤ 0.05 was considered statistically significant.

A total of 120 patients were included in the study. Thick gingival biotype was more prevalent than thin biotype, indicating a relatively favourable periodontal phenotype distribution within the study population. The predominance of thick biotype suggests a potentially lower baseline risk for aesthetic complications in the study cohort; however, a substantial proportion (43.3%) with thin biotype still represents a clinically significant high-risk group requiring careful management.

Table 1: Distribution of Gingival Biotype

A statistically significant difference was observed between thin and thick biotypes across all aesthetic  parameters, with thick biotype consistently demonstrating superior outcomes. All parameters showed statistically significant differences (p ≤ 0.003), indicating a strong association between gingival biotype and aesthetic outcomes.

The large effect sizes indicate that the differences are not only statistically significant but also clinically meaningful. Thick biotype provides visibly superior aesthetic integration, particularly in papillary fill, where the difference is most pronounced and directly impacts the presence or absence of black triangles.

Table 2: Aesthetic  Outcome Scores According to Biotype

A markedly higher prevalence of gingival recession was observed in patients with thin biotype compared to thick biotype, demonstrating a strong association between tissue phenotype and soft tissue stability. The association between gingival biotype and recession was statistically significant (Chi-square test, p < 0.001), indicating that gingival biotype is a strong predictor of soft tissue stability. Patients with thin biotype exhibited nearly three times higher risk of gingival recession compared to those with thick biotype. This finding highlights the need for preventive strategies, including conservative margin placement and possible soft tissue augmentation, in patients with thin periodontal phenotype

Table 3: Gingival Recession in Study Groups

statistically significant relationship between soft tissue biotype and aesthetic  outcomes in tooth-supported fixed restorations. Patients with thick gingival biotype consistently exhibited superior results across all evaluated parameters, including gingival contour, papillary fill, and marginal adaptation, whereas those with thin biotype showed comparatively compromised outcomes. These findings reinforce the concept that periodontal phenotype plays a fundamental role in determining the success of restorative procedures, particularly in aesthetic ally demanding regions.

One of the most prominent observations in this study was the higher incidence of gingival recession in patients with thin biotype. This can be attributed to the reduced thickness of both the soft tissue and the underlying alveolar bone, which makes these tissues more vulnerable to surgical and restorative trauma.^7,8 Even minimal violations of the biologic width or inaccuracies in margin placement can lead to apical migration of the gingival margin in such cases. This not only exposes restoration margins but also creates aesthetic  disharmony, especially in anterior teeth.⁹

Papillary fill was another parameter significantly affected by gingival biotype. Thick biotype demonstrated better preservation of interdental papilla, contributing to a more natural and harmonious appearance.¹⁰ In contrast, thin biotype showed a greater tendency for papillary loss, resulting in the formation of black triangles. This can negatively impact both aesthetic s and phonetics, highlighting the importance of maintaining adequate tissue volume in restorative procedures.¹¹ Marginal adaptation and gingival contour also showed strong correlation with tissue thickness.¹ Thick gingival tissues are more forgiving and capable of adapting to minor discrepancies in restoration margins, thereby maintaining a stable and pleasing contour.¹² On the other hand, thin tissues tend to reflect even minor imperfections, making it more challenging to achieve optimal aesthetic  results. This emphasizes the need for precise clinical execution and careful planning in patients with thin biotype.¹³

The findings of this study suggest that assessment of gingival biotype should be an integral part of the diagnostic phase in prosthodontic treatment planning. In cases with thin biotype, clinicians may consider alternative approaches such as supragingival margin placement, use of minimally invasive preparation techniques, or soft tissue augmentation procedures to enhance tissue thickness and improve outcomes.¹⁴ Additionally, selection of restorative materials with favourable  optical properties can help in masking underlying discrepancies.¹

Overall, the study highlights that successful aesthetic  rehabilitation is a multifactorial process that requires a thorough understanding of both prosthetic principles and periodontal biology. Ignoring the influence of soft tissue biotype may lead to suboptimal results, even when technical aspects of the restoration are well executed.⁷ Therefore, incorporating biotype assessment into routine clinical practice can significantly improve predictability and long-term success of fixed restorations.

Soft tissue biotype has a significant impact on aesthetic  outcomes of tooth-supported fixed restorations. Thick biotype is associated with more favourable  and stable results, while thin biotype presents a higher risk of aesthetic  complications. Proper evaluation and tailored treatment planning are essential for achieving optimal outcomes.

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