title: Keratinized Gingiva Height Increases After Alveolar Corticotomy and Augmentation Bone Grafting.
abstract: BACKGROUND
  The aim of the present study is to compare the keratinized gingival tissue (KT) height labial to the mandibular incisors after active orthodontic treatment (AOT) with and without alveolar corticotomy and bone grafting.
  
  
  METHODS
  Two orthodontically treated groups of 35 patients each, with (Cort) and without (Conv) alveolar decortication and augmentation bone grafting, are matched in this case-control study for sample size, sex, mandibular premolar extractions, pretreatment age, post-treatment observation period, and pretreatment KT height. Standardized digital frontal occlusion photographs taken before and at least 1 year after AOT were adjusted to 96 dots per inch and measured with image analysis software for vertical KT height labial to each mandibular incisor.
  
  
  RESULTS
  An average of 1.5 years after completion of AOT, KT height had increased significantly by 0.78 mm (P < 0.001) in the Cort group and decreased 0.38 mm (P = 0.002) in the Conv group; a 1.28-mm KT height gain was demonstrated in the subgroup representing the lowest half of Cort KT height at pretreatment. Mandibular incisor inclination and prominence explained neither the decrease in KT height in Conv nor the KT height gain in Cort.
  
  
  CONCLUSIONS
  Orthodontic therapy combined with alveolar decortication and augmentation bone grafting resulted in a significant increase in KT height. Although KT height surrounding the dentition has been devalued by evidence-based studies, the value-added protection of KT height increase after decortication and augmentation bone grafting offsets the concerns of orthodontic proclination or expanding mandibular incisors facially.
authors.affiliation: Department of Periodontology, Case Western Reserve University, Cleveland, OH.|Private practice in Periodontology, Erie, PA.
authors.forename: M Thomas
authors.initials: MT
authors.lastname: Wilcko
authors.affiliation: European University College, Advanced Orthodontics Program, Dubai, United Arab Emirates.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Ferguson
authors.affiliation: European University College, Advanced Orthodontics Program, Dubai, United Arab Emirates.
authors.forename: Laith
authors.initials: L
authors.lastname: Makki
authors.affiliation: Department of Orthodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, PA.|Private practice in Orthodontics, Erie, PA.
authors.forename: William M
authors.initials: WM
authors.lastname: Wilcko
mesh_terms: D000293:Adolescent; D000328:Adult; D000539:Alveolar Process / Q000601:surgery*; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001641:Bicuspid / Q000601:surgery; D016025:Bone Transplantation / Q000379:methods*; D016022:Case-Control Studies; D002648:Child; D000071538:Cortical Bone / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000033:anatomy & histology* / Q000737:chemistry; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007180:Incisor / Q000033:anatomy & histology; D007633:Keratins / Q000032:analysis*; D008297:Male; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D010781:Photography / Q000379:methods; D014081:Tooth Extraction / Q000379:methods; D014087:Tooth Movement Techniques / Q000379:methods; D055815:Young Adult
chemical_list: D007633:Keratins
keywords: Alveolar process; bone transplantation; case-control studies; gingiva; humans; orthodontics