Thickness of Facial Gingiva
A light spring was utilized to
by
G . D . GOASLIND*
P . B . ROBERTSON†
C . J . MAHAN ‡
W . W . MORRISON‡
J . V . OLSON‡
THE ANATOMIC LANDMARKS of the gingiva and their
dimensional interrelationships have been extensively
described. Width of the free and attached gingiva,
depth of the sulcus, and relationship of the cementoen-
amel junction to the gingival margin, terminal junc­
tional epithelium and alveolar crest have received
1-8
particular attention. Characterization of the thick­
ness of the gingiva, however, is less complete, and no
information is available on the association of gingival
thickness with other dimensional parameters. Initial
gingival thickness measurements have been reported
9
by K y d d , Daly and Wheeler who utilized ultrasonic
10
echo-ranging instrumentation to measure the resting
thickness of masticatory mucosa in selected sites and
the change in thickness as a result of compressive
mechanical stress. Resting thickness measurements in
dentated subjects ranged from 0.30 mm to 6.7 m m .
Measurements in facial cuspid and molar attached
gingival areas ranged from 0.50 mm to 1.13mm.
The purpose of the present investigation was to
extend previous studies on gingival thickness in specific
areas of healthy free and attached gingiva, and to
relate these measurements to other anatomic param­
eters.
MATERIALS AND METHODS
Gingival thickness measurements were determined
with a transformer probe assembly excited by an oscil­
lator and coupled to a digital voltmeter as illustrated
in Figure 1. The disassembled transformer probe is
shown in Figure 2. The differential transformer assem­
bly (Hewlett-Packard, Palo A l t o , California) displayed
a constant linear slope within a range of 0.00 mm and
2.60 m m . The fixed 0.040 inch diameter needle was
inserted into the gingiva until it contacted tooth surface
or bone. The acrylic sleeve surrounding the needle
and the attached transformer core were displaced a
distance corresponding to the thickness of the gingiva
* Wilford Hall U.S.A.F Hospital, San Antonio, Texas.
† The University of Connecticut Health Center School of Dental
Medicine, 263 Farmington Ave., Farmington, Conn. 06032.
$ The University of Texas Health Science Center at Houston,
Dental Branch, Houston, Texas.
768
being measured (Fig. 3).
maintain slight tension on the acrylic sleeve and trans­
former core, and to allow return to a zero point after
each measurement.
Preliminary experiments on mongrel dogs were con­
ducted to determine the accuracy and reproducibility
of the assembled instrument, the degree of gingival
compression which might be effected by the tension
spring, and the extent to which the probe needle
penetrated bone. A n acrylic stint, housing small screw-
nut assemblies of known thread characteristics (1:64)
was affixed to the dog teeth. The screws were turned
to a point of initial gingival contact. Gingival thickness
at that point was measured with the transformer probe.
A full thickness mucoperiosteal flap was reflected and
the screw was advanced to bone. Gingival thickness
was determined from gingival contact to bone contact
by measuring the net extension of the screw with a
Quadra D i a l Thickness Gauge (Quadra-Continental,
Seattle). The difference in measurements obtained
with the transformer probe and the acrylic stint assem­
blies were within 0.1 m m .
A series of 10 triplicate measurements at a single
point and approximately 1 mm apart along a horizontal
plane were conducted in anterior and posterior facial
gingiva of the dogs. The range of differences between
the highest and lowest measurement in each triplicate
series averaged 0.09 mm for measurements at a single
point and 0.11 mm for measurements spaced 1 mm
apart. The coefficient of variation for both series was
less than 3 % .
A n additional series of ten measurements was ob­
tained with and without the tension spring. While
slight compression of the gingiva was reflected in
differences between the two series of measurements,
the differences were constant and averaged less than
0.15 m m .
A number of measurements were obtained on alveo­
lar bone in the dog after reflection of a full thickness
mucoperiosteal flap and in human patients at time of
periodontal surgery. Penetration of the needle into
bone was negligible and never exceeded 0.03 m m .
The study population consisted of ten male subjects
with clinically healthy gingiva who ranged in age from
25 to 36. The nature of the investigation was explained
to each subject and a written consent form obtained.
A l l gingival measurements were obtained under block
local anesthesia. Sulcus depth reflecting free gingival
width, width of total gingiva, and gingival thickness
were determined on the facial aspect of the maxillary
right lateral (12), cuspid (13) and first molar (16);
maxillary left cuspid (23), and second bicuspid (25);
mandibular left lateral (32), cuspid (33) and first molar
(36); and mandibular right cuspid (43) and second
bicuspid (45). Total gingiva was measured from the
gingival margin to the mucogingival line. Attached
Volume 48
Number 12
Thickness of Facial Gingiva 769

mandibular areas at both points G . S . and A . G . (Fig.

4 A , C ) consistently increased from anterior to poste­
rior. Thickness in maxillary attached gingiva (Fig. 4 D )
was fairly constant from anterior to posterior and
averages of measurements in this area (1.16 mm) were
less than averages in mandibular attached gingiva (1.34
mm), mandibular free gingiva (1.49 mm) and maxillary
free gingiva (1.62 mm) respectively. In general, gingi­
val thickness was greatest in maxillary and mandibular
posterior areas adjacent to the depth of the gingival
sulcus and least in mandibular anterior areas at both
points G . S . and A . G .
The mean sulcus depth was 1.5 mm + 0.44 with no
depth greater than 3.0 m m . A significant direct rela­
tionship (r = + 0.73, P < 0.05) was observed between
free gingival thickness measured at point G . S . and
free gingival width as reflected by the depth of the
gingival sulcus.
The mean width of attached gingiva was 3.54 mm +
1.22. Attached gingival width ranged from 0.5 mm to
8.0 mm and decreased from anterior to posterior. A
FIGURE 1. Schematic diagram of instrumentation utilized to
measure facial gingival thickness.

gingival width was calculated by subtracting sulcus

depth from total gingiva. Measurements were obtained
using a University of Michigan " O " probe with W i l ­
liams calibration. Two thickness measurements were
recorded on the direct facial aspect of each tooth. The
first corresponded to the depth of the gingival sulcus
( G . S . ) . The second was at a point midway between
the gingival sulcus measurements and the mucogingival
junction ( A . G . ) . Thus, the thickness measurement
obtained at a point adjacent to the sulcus depth repre­
sented the distance from the stratum corneum to the
tooth surface, while the attached gingival measurement
represented the distance from stratum corneum to
alveolar bone. The transformer probe was sterilized
with ethylene oxide and recalibrated prior to gingival
thickness determinations in each subject.

RESULTS

Gingival thickness varied considerably among sub­

jects and among areas within individual subjects. The
mean thickness at the depth of the gingival sulcus
(G.S.) for all teeth measured was 1.56 mm ± 0.39
and ranged from 0.53 mm to 2.62 m m . The mean
thickness midway between the depth of the sulcus and
mucogingival junction ( A . G . ) was 1.25 mm + 0.42
and ranged from 0.43 mm to 2.29 m m . A positive,
though not significant, association was observed be­ FIGURE 2. Disassembled differential-transformer probe. The
tween G . S . and A . G . measurements (r = 0.54, P > acrylic sleeve (A) and transformer core (B) were displaced in
0.05). the differential transformer ( C ) a distance equal to the penetra­
tion of the 0.040 inch diameter probe (D). The light spring
The distribution of mean facial gingiva thickness at
( E ) allowed to return to a zero point after each measurement.
points G . S . and A . G . associated with teeth measured The seating spring ( F ) maintained the position of the trans­
is shown in Figure 4. Measurements in maxillary areas former within the probe housing once the probe assembly was
adjacent to the depth of the sulcus (Fig. 4 B ) and in calibrated.

770 Goaslind, Robertson, Mahan, Morrison, Olson
FIGURE 3. Measurement of facial gingiva with the transformer constant in the maxilla, and were inversely propor­
probe.
FIGURE 4. Distribution of facial gingiva thickness overlying giva and maxillary free gingiva increased from anterior
selected teeth arranged anterior to posterior measured at the to posterior. Thickness in maxillary attached gingiva
sulcus depth in the mandible (A) and maxilla (B) and in
attached gingiva in the mandible ( C ) and maxilla (D).
significant inverse relationship (r = - 0.63, P < 0.05)
was noted between the width of attached gingiva and
gingival thickness at point A . G .
DISCUSSION
The described instrumentation was sufficient to the
measurement of facial gingival thickness where prob­
lems of probe angulation and access were minimal,
J. Periodontol.
December, 1977
and provided valuable dimensional information prelim­
inary to the development of more comprehensive non­
invasive measurement techniques. Direct measurement
of gingival thickness by penetration is, of necessity,
affected by tissue deformation and the probe angle
with respect to alveolar bone. Neither factor appeared
to cause substantial error as total range difference
averages never exceeded 0.15 mm between triplicate
measurements at the same point and 1 mm adjacent
points, between measurements with and without the
tension spring, and between measurements obtained
independently with the probe and stint assembly.
While gingival thickness was subject to considerable
individual variation, several general trends related to
sulcus depth, attached gingival width, and arch position
were apparent. Thickness measurements at the base of
free gingiva averaged 1.56 m m , increased from ante­
rior to posterior and were directly proportional to
sulcus depth. Thickness measurements in attached gin­
giva averaged 1.25 m m , increased from anterior to
posterior in the mandibular arch, remained relatively
tional to attached gingival width. Free gingival thick­
ness was greater than that in attached gingiva and the
overall mean in both gingival areas was 1.41 m m .
SUMMARY A N D CONCLUSIONS
Gingival thickness was measured in 10 subjects with
healthy gingiva on the facial aspect of selected maxil­
lary and mandibular teeth at the depth of the gingival
sulcus and midway between the sulcus depth and
mucogingival line. Measurement instrumentation, con­
sisting of a differential transformer coupled to an
oscillator and digital voltmeter was sensitive to the
travel of a probe from the gingival surface to tooth
surface or alveolar bone. The probe assembly was
accurate to 0.01 mm and the average range of differ­
ences in replicate measurements under a variety of
conditions never exceeded 0.15 m m .
1. Free gingival thickness averaged 1.56 mm +
0.39, attached gingival thickness averaged 1.25 mm +
0.42 and the total mean thickness for all areas mea­
sured was 1.41 m m .
2. Thickness in mandibular free and attached gin­
remained fairly constant.
3. Thickness measured at the depth of the sulcus
was directly proportional to the free gingival width.
4. Thickness measured midway between sulcus
depth and mucogingival junction was inversely propor­
tional to attached gingival width.
REFERENCES
1. Ainamo, J . , and L ö e , H . : Anatomical characteristics
of gingiva. A clinical and microscopic study of the free and
attached gingiva. J Periodontol 37: 5, 1966.
Volume 48
Number 12
Thickness of Facial Gingiva 771

2. Bowers, G . JVL: A study of the width of attached 34:457, 1963.

gingiva. J Periodontal 34: 201, 1963.
3. Lang, M . P., and L ö e , H . : The relationship between
the width of keratinized gingiva and gingival health. J Perio­
dontal 43: 623,1972.
4. Orban, B.: Clinical and histologic study of the surface
characteristics of the gingiva. Oral Surg 1: 827, 1948.
5. Rothner, J. T . , and Saturen, B . B.: The gingival
sulcus: A clinical study of its depth. J Periodontal 25: 278,
1954.
6. Fuder, E . J . , and Jamison, H . C : Depth of gingival
sulcus surrounding young permanent teeth. J Periodontal
7. Waerhaug, J.: The gingival pocket. Odont Tidskr 60:
suppl 1, 1952.
8. Gargiulo, A . , Wentz, F. M . , and Orban, B.: Dimen­
sions and relations of the dentogingival junction in humans.
J Periodontal 32: 261, 1961.
9. Kydd, W. L . , Daly, C . H . , and Wheeler, J. B . , Ill:
The thickness measurement of masticatory mucosa in vivo.
Int Dent J 21:430, 1971.
10. Daly, C . H . , and Wheeler, J. B . , Ill: The use of
ultrasonic thickness measurement in the clinical evaluation
of the oral soft tissues. Int Dent J 21: 418, 1971.

Announcements
UNIVERSITY OF COLORADO SCHOOL OF DENTISTRY iodontics, University of Pennsylvania School of Dental
Medicine
The University of Colorado School of Dentistry, Office of Contin­
Vacation and Learn —Mullet Bay St. Maartens — Tuition $100.
uing Education announces the following course:
TITLE: Endodontic/Periodontic Refresher Course TITLE: Clinical Periodontology
DATES: Feb. 13-16, 1978 DATES: April 9-11
LOCATION: Keystone Resort, Cillon, Colo. FACULTY: JAN LINDHE, L.D.S., Faculty of Odontology, University
of Goteborg, Sweden
FACULTY: ROBERT E . AVERBACH, D.D.S., Chairman of Endodon­
DR. WALTER COHEN, D.D.S., Dean, Professor of Perio­
tics, University of Colorado School of Dentistry
dontics, University of Pennsylvania, School of Dental
RICHARD B. CHAFFEE, JR., D.D.S., Chairman of Perio­
Medicine
dontics, University of Colorado School of Dentistry
MARVIN A . GROSS, D.D.S., Associate Clinical Professor MORTON AMSTERDAM, D.D.S., Sc.D., Professor of Perio­
of Endodontology, Temple University School of Den­ dontics, University of Pennsylvania, School of Dental
tistry Medicine
LESLIE M. SALKIN, D.D.S., Associate Professor of Per­ Tuition $250-2.1CEU
iodontology, Temple University School of Dentistry TITLE: Advanced Course: Adult Tooth Movement in Compre­
This course will provide an update for both the generalist and the hensive Dentistry
specialist in the fields of Endodontics and Periodontics. Emphasis DATES: April 27-29
will be placed on current concepts of diagnosis, treatment planning FACULTY: MANUEL MARKS, D.D.S., Associate Professor of Perio­
and clinical therapy. dontics, University of Pennsylvania, School of Dental
For further information contact: Mrs. Ruth G . Bush, Director of Medicine
Continuing Education, University of Colorado School of Dentistry, I. STEPHEN BROWN, D.D.S., Associate Professor of
C284, 4200 E. Ninth Ave., Denver, Colo 80262. Periodontics, University of Pennsylvania, School of
Dental Medicine
Tuition: $225-2.1CEU
TITLE: Periodontal Surgery
DATES: May 15-17
UNIVERSITY OF PENNSYLVANIA SCHOOL OF DENTAL
FACULTY: ANTHONY RUGGERIO, D.D.S., Assistant Professor of
MEDICINE
Periodontics, School of Dental Medicine, University
The University of Pennsylvania School of Dental Medicine an­ of Pennsylvania,
nounces the following courses: J. GEORGE COSLET, D.D.S., M.Sc.D., Associate Profes­
TITLE: Current Practical Concepts of Endo-perio Treatment sor of Periodontics, University of Pennsylvania, School
DATES: February 26-March 5 of Dental Medicine.
FACULTY: SEYMOUR OLIET; D.D.S. Professor of Chemistry, De­ Tuition $250-2.1CEU
partment of Endodontics, University of Pennsylvania For further information: Contact Continuing Education Depart­
School of Dental Medicine ment, School of Dental Medicine, University of Pennsylvania, 4001
J . GEORGE COSLET, D.D.S., Associate Professor of Per­ Spruce St., Phila., Pa 19104.