Purpose: This systematic review aims to analyze the correlation between traditional clinical methods and cone-beam computed tomography (CBCT) in determining the periodontal biotype. Materials AND Methods: An electronic search was conducted to identify clinical observational and comparative studies comparing CBCT with conventional clinical techniques for assessing gingival and bone thickness. The study followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The risk of bias was evaluated using the Cochrane Collaboration’s Risk of Bias tool. Results: A total of 11 cross-sectional studies, including 540 patients, were analyzed. The findings revealed a significant increase in gingival thickness and underlying alveolar bone thickness in individuals with a thick periodontal phenotype. Clinical assessment of soft tissue thickness can be easily performed using a periodontal probe by evaluating the transparency of the probe’s contour through the gingival sulcus or via transgingival probing with an endodontic K-file under anesthesia. This correlation provides valuable insights during initial examinations, particularly for procedures that may impact periodontal structures, such as immediate implant placement and orthodontic treatment. Conclusions: The available evidence suggests that CBCT is a useful adjunctive tool for assessing gingival and alveolar bone thickness and characterizing the periodontal phenotype. However, the current evidence is mainly derived from heterogeneous observational studies, and further prospective investigations are required before definitive conclusions can be drawn regarding its superiority over conventional clinical methods.
Cite this paper
Bouallala, M. O. , Amine, K. , Belfellah, S. and Kissa, J. (2026). Correlation between Clinical Methods and CBCT Cone-Beam Tomography in Periodontal Biotype Determination: Systematic Review. Open Access Library Journal, 13, e15543. doi: http://dx.doi.org/10.4236/oalib.1115543.
Cortellini, P. and Bissada, N.F. (2018) Mucogingival Conditions in the Natural Dentition: Narrative Review, Case Definitions, and Diagnostic Considerations. <i>Journal</i> <i>of</i> <i>Periodontology</i>, 89, S204-S213. <br>https://doi.org/10.1002/jper.16-0671
Jepsen, S., Caton, J.G., Albandar, J.M., Bissada, N.F., Bouchard, P., Cortellini, P., <i>et </i><i>al</i>. (2018) Periodontal Manifestations of Systemic Diseases and Developmental and Acquired Conditions: Consensus Report of Workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. <i>Journal</i> <i>of</i> <i>Periodontology</i>, 89, S237-S248. <br>https://doi.org/10.1002/jper.17-0733
Grover, V., Malhotra, R., Bhardwaj, A. and Mohindra, K. (2014) Analysis of the Gingival Biotype Based on the Measurement of the Dentopapillary Complex. <i>Journal</i> <i>of</i> <i>Indian</i> <i>Society</i> <i>of</i> <i>Periodontology</i>, 18, 43-47. <br>https://doi.org/10.4103/0972-124x.128199
Fu, J.H., Yeh, C.Y., Chan, H.L., Tatarakis, N., Leong, D.J.M. and Wang, H.L. (2010) Tissue Biotype and Its Relation to the Underlying Bone Morphology. <i>Journal</i> <i>of</i> <i>Periodontology</i>, 81, 569-574. <br>https://doi.org/10.1902/jop.2009.090591
Stein, J.M., Lintel-Höping, N., Hammächer, C., Kasaj, A., Tamm, M. and Hanisch, O. (2013) The Gingival Biotype: Measurement of Soft and Hard Tissue Dimensions—A Radiographic Morphometric Study. <i>Journal</i> <i>of</i> <i>Clinical</i> <i>Periodontology</i>, 40, 1132-1139. <br>https://doi.org/10.1111/jcpe.12169
Moher, D., Liberati, A., Tetzlaff, J. and Altman, D.G. (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. <i>PLOS</i> <i>Medicine</i>, 6, e1000097. <br>https://doi.org/10.1371/journal.pmed.1000097
Bednarz-Tumidajewicz, M., Furtak, A., Zakrzewska, A., Rąpała, M., Gerreth, K., Gedrange, T., <i>et al</i>. (2022) Comparison of the Effectiveness of the Ultrasonic Method and Cone-Beam Computed Tomography Combined with Intraoral Scanning and Prosthetic-Driven Implant Planning Method in Determining the Gingival Phenotype in the Healthy Periodontium. <i>International</i> <i>Journal</i> <i>of</i> <i>Environmental</i> <i>Research</i> <i>and</i> <i>Public</i> <i>Health</i>, 19, Article 12276. <br>https://doi.org/10.3390/ijerph191912276
Shao, Y., Yin, L., Gu, J., Wang, D., Lu, W. and Sun, Y. (2018) Assessment of Periodontal Biotype in a Young Chinese Population Using Different Measurement Methods. <i>Scientific</i> <i>Reports</i>, 8, Article No. 11212. <br>https://doi.org/10.1038/s41598-018-29542-z
Nisanci Yilmaz, M.N., Koseoglu Secgin, C., Ozemre, M.O., İnonu, E., Aslan, S. and Bulut, S. (2022) Assessment of Gingival Thickness in the Maxillary Anterior Region Using Different Techniques. <i>Clinical</i> <i>Oral</i> <i>Investigations</i>, 26, 6531-6538. <br>https://doi.org/10.1007/s00784-022-04602-x
Frumkin, N., Via, S. and Klinger, A. (2017) Evaluation of the Width of the Alveolar Bone in Subjects with Different Gingival Biotypes: A Prospective Cohort Study Using Cone Beam Computed Tomography. <i>Quintessence International</i>, 48, 209-216. <br>https://doi.org/10.3290/j.qi.a37642
Frost, N.A., Mealey, B.L., Jones, A.A. and Huynh-Ba, G. (2015) Periodontal Biotype: Gingival Thickness as It Relates to Probe Visibility and Buccal Plate Thickness. <i>Journal</i> <i>of</i> <i>Periodontology</i>, 86, 1141-1149. <br>https://doi.org/10.1902/jop.2015.140394
Younes, F., Eghbali, A., Raes, M., De Bruyckere, T., Cosyn, J. and De Bruyn, H. (2015) Relationship between Buccal Bone and Gingival Thickness Revisited Using Non-Invasive Registration Methods. <i>Clinical</i> <i>Oral</i> <i>Implants</i> <i>Research</i>, 27, 523-528. <br>https://doi.org/10.1111/clr.12618
Khoury, J., Ghosn, N., Mokbel, N. and Naaman, N. (2016) Buccal Bone Thickness Overlying Maxillary Anterior Teeth: A Clinical and Radiographic Prospective Human Study. <i>Implant</i> <i>Dentistry</i>, 25, 525-531. <br>https://doi.org/10.1097/id.0000000000000427
Chanmanee, P. and Charoemratrote, C. (2019) Maxillary Bone Characteristics between Thick and Thin Gingival Biotypes with Dentoalveolar Protrusion. <i>Journal</i> <i>of</i> <i>the</i> <i>World</i> <i>Federation</i> <i>of</i> <i>Orthodontists</i>, 8, 118-123. <br>https://doi.org/10.1016/j.ejwf.2019.02.002
Kim, Y.J., Park, J.M., Cho, H.J. and Ku, Y. (2021) Correlation Analysis of Periodontal Tissue Dimensions in the Esthetic Zone Using a Non-Invasive Digital Method. <i>Journal</i> <i>of</i> <i>Periodontal</i> <i>&</i> <i>Implant</i> <i>Science</i>, 51, 88-99. <br>https://doi.org/10.5051/jpis.2003460173
Amid, R., Kadkhodazadeh, M., Moscowchi, A., Tavakol Davani, S., Soleimani, M., Dehghani Soltani, A., <i>et al</i>. (2020) Effect of Gingival Biotype on Orthodontic Treatment-Induced Periodontal Complications: A Systematic Review. <i>Journal</i> <i>of</i> <i>Advanced</i> <i>Periodontology</i> <i>&</i> <i>Implant</i> <i>Dentistry</i>, 12, 3-10. <br>https://doi.org/10.34172/japid.2020.003
Zweers, J., Thomas, R.Z., Slot, D.E., Weisgold, A.S. and Van der Weijden, F.G.A. (2014) Characteristics of Periodontal Biotype, Its Dimensions, Associations and Prevalence: A Systematic Review. <i>Journal</i> <i>of</i> <i>Clinical</i> <i>Periodontology</i>, 41, 958-971. <br>https://doi.org/10.1111/jcpe.12275
Ronay, V., Sahrmann, P., Bindl, A., Attin, T. and Schmidlin, P.R. (2011) Current Status and Perspectives of Mucogingival Soft Tissue Measurement Methods. <i>Journal</i> <i>of</i> <i>Esthetic</i> <i>and</i> <i>Restorative</i> <i>Dentistry</i>, 23, 146-156. <br>https://doi.org/10.1111/j.1708-8240.2011.00424.x
Kan, J.Y., Morimoto, T., Rungcharassaeng, K., Roe, P. and Smith, D.H. (2010) Gingival Biotype Assessment in the Esthetic Zone: Visual Versus Direct Measurement. <i>International Journal of Periodontics & Restorative Dentistry</i>, 30, 237-243.
De Rouck, T., Eghbali, R., Collys, K., De Bruyn, H. and Cosyn, J. (2009) The Gingival Biotype Revisited: Transparency of the Periodontal Probe through the Gingival Margin as a Method to Discriminate Thin from Thick Gingiva. <i>Journal</i> <i>of</i> <i>Clinical</i> <i>Periodontology</i>, 36, 428-433. <br>https://doi.org/10.1111/j.1600-051x.2009.01398.x
Rasperini, G., Acunzo, R., Cannalire, P. and Farronato, G. (2017) Influence of Periodontal Biotype on Root Surface Exposure during Orthodontic Treatment: A Preliminary Study. <i>The</i> <i>International</i> <i>Journal</i> <i>of</i> <i>Periodontics</i> <i>&</i> <i>Restorative</i> <i>Dentistry</i>, 35, 655-675. <br>https://doi.org/10.11607/prd.2239
Eghbali, A., De Bruyn, H., Cosyn, J., Kerckaert, I. and Van Hoof, T. (2014) Ultrasonic Assessment of Mucosal Thickness around Implants: Validity, Reproducibility, and Stability of Connective Tissue Grafts at the Buccal Aspect. <i>Clinical</i> <i>Implant</i> <i>Dentistry</i> <i>and</i> <i>Related</i> <i>Research</i>, 18, 51-61. <br>https://doi.org/10.1111/cid.12245
Becker, W., Ochsenbein, C., Tibbetts, L. and Becker, B.E. (1997) Alveolar Bone Anatomic Profiles as Measured from Dry Skulls. <i>Journal</i> <i>of</i> <i>Clinical</i> <i>Periodontology</i>, 24, 727-731. <br>https://doi.org/10.1111/j.1600-051x.1997.tb00189.x
Chen, S.T. and Buser, D. (2014) Esthetic Outcomes Following Immediate and Early Implant Placement in the Anterior Maxilla—A Systematic Review. <i>The</i> <i>International</i> <i>Journal</i> <i>of</i> <i>Oral</i> <i>&</i> <i>Maxillofacial</i> <i>Implants</i>, 29, 186-215. <br>https://doi.org/10.11607/jomi.2014suppl.g3.3
Shafizadeh, M., Amid, R., Tehranchi, A. and Motamedian, S.R. (2022) Evaluation of the Association between Gingival Phenotype and Alveolar Bone Thickness: A Systematic Review and Meta-Analysis. <i>Archives</i> <i>of</i> <i>Oral</i> <i>Biology</i>, 133, Article ID: 105287. <br>https://doi.org/10.1016/j.archoralbio.2021.105287
Swasty, D., Lee, J.S., Huang, J.C., Maki, K., Gansky, S.A., Hatcher, D., <i>et al</i>. (2009) Anthropometric Analysis of the Human Mandibular Cortical Bone as Assessed by Cone-Beam Computed Tomography. <i>Journal</i> <i>of</i> <i>Oral</i> <i>and</i> <i>Maxillofacial</i> <i>Surgery</i>, 67, 491-500. <br>https://doi.org/10.1016/j.joms.2008.06.089
Tolentino, E.S., Yamashita, F.C., de Albuquerque, S., Walewski, L.A., Iwaki, L.C.V., Takeshita, W.V., <i>et al</i>. (2018) Reliability and Accuracy of Linear Measurements in Cone-Beam Computed Tomography Using Different Software Programs and Voxel Sizes. <i>Journal</i> <i>of</i> <i>Conservative</i> <i>Dentistry</i>, 21, 607-612. <br>https://doi.org/10.4103/jcd.jcd_314_18
Icen, M., Orhan, K., Şeker, Ç., Geduk, G., Cakmak Özlü, F. and Cengiz, M.İ. (2020) Comparison of CBCT with Different Voxel Sizes and Intraoral Scanner for Detection of Periodontal Defects: An <i>in</i> <i>Vitro</i> Study. <i>Dentomaxillofacial</i> <i>Radiology</i>, 49, Article ID: 20190197. <br>https://doi.org/10.1259/dmfr.20190197
Erozan, Ç. and Ozan, O. (2020) Evaluation of the Precision of Different Intraoral Scanner-Computer Aided Design (CAD) Software Combinations in Digital Dentistry. <i>Medical</i> <i>Science</i> <i>Monitor</i>, 26, e918529. <br>https://doi.org/10.12659/msm.918529
Silva, J.N.N., Andrade, P.F.D., Sotto-Maior, B.S., Souza Picorelli Assis, N.M., Pires Carvalho, A.C. and Devito, K.L. (2017) Influence of Lip Retraction on the Cone Beam Computed Tomography Assessment of Bone and Gingival Tissues of the Anterior Maxilla. <i>Oral</i> <i>Surgery</i>, <i>Oral</i> <i>Medicine</i>, <i>Oral</i> <i>Pathology</i> <i>and</i> <i>Oral</i> <i>Radiology</i>, 123, 714-720. <br>https://doi.org/10.1016/j.oooo.2017.02.005
Kalina, E., Zadurska, M. and Górski, B. (2021) Postorthodontic Lower Incisor and Canine Inclination and Labial Gingival Recession in Adult Patients. <i>Journal</i> <i>of</i> <i>Orofacial</i> <i>Orthopedics/Fortschritte</i> <i>der</i> <i>Kieferorthopädie</i>, 82, 246-256. <br>https://doi.org/10.1007/s00056-020-00263-1
Kim, D.M., Bassir, S.H. and Nguyen, T.T. (2020) Effect of Gingival Phenotype on the Maintenance of Periodontal Health: An American Academy of Periodontology Best Evidence Review. <i>Journal</i> <i>of</i> <i>Periodontology</i>, 91, 311-338. <br>https://doi.org/10.1002/jper.19-0337
Benavides, E., Rios, H.F., Ganz, S.D., An, C., Resnik, R., Reardon, G.T., <i>et al</i>. (2012) Use of Cone Beam Computed Tomography in Implant Dentistry: The International Congress of Oral Implantologists Consensus Report. <i>Implant</i> <i>Dentistry</i>, 21, 78-86. <br>https://doi.org/10.1097/id.0b013e31824885b5
Kloukos, D., Koukos, G., Doulis, I., Sculean, A., Stavropoulos, A. and Katsaros, C. (2018) Gingival Thickness Assessment at the Mandibular Incisors with Four Methods: A Cross‐sectional Study. <i>Journal</i> <i>of</i> <i>Periodontology</i>, 89, 1300-1309. <br>https://doi.org/10.1002/jper.18-0125
Renkema, A.M., Fudalej, P.S., Renkema, A.A.P., Abbas, F., Bronkhorst, E. and Katsaros, C. (2013) Gingival Labial Recessions in Orthodontically Treated and Untreated Individuals: A Case-Control Study. <i>Journal of Clinical Periodontology</i>, 40, 631-637. <br>https://doi.org/10.1111/jcpe.12105
Renkema, A., Navratilova, Z., Mazurova, K., Katsaros, C. and Fudalej, P.S. (2015) Gingival Labial Recessions and the Post-Treatment Proclination of Mandibular Incisors. <i>The</i> <i>European</i> <i>Journal</i> <i>of</i> <i>Orthodontics</i>, 37, 508-513. <br>https://doi.org/10.1093/ejo/cju073
Hwang, D. and Wang, H. (2006) Flap Thickness as a Predictor of Root Coverage: A Systematic Review. <i>Journal</i> <i>of</i> <i>Periodontology</i>, 77, 1625-1634. <br>https://doi.org/10.1902/jop.2006.060107
Zuhr, O., Bäumer, D. and Hürzeler, M. (2014) The Addition of Soft Tissue Replacement Grafts in Plastic Periodontal and Implant Surgery: Critical Elements in Design and Execution. <i>Journal</i> <i>of</i> <i>Clinical</i> <i>Periodontology</i>, 41, S123-S142. <br>https://doi.org/10.1111/jcpe.12185
