title: Estimating effects of craniofacial morphology on gingival recession and clinical attachment loss.
abstract: OBJECTIVE
  Evidence on possible associations between facial morphology, attachment loss and gingival recession is lacking. We analysed whether the facial type, which can be described by the ratio of facial width and length (facial index), is related to periodontal loss of attachment, hypothesizing that a broad face might be associated with less gingival recession (GR) and less clinical attachment loss (CAL) than a long face.
  
  
  METHODS
  Data from the 11-year follow-up of the population-based Study of Health in Pomerania were used. Periodontal loss of attachment was assessed by GR and CAL. Linear regression models, adjusted for age and gender, were used to assess associations between specific landmark based distances extracted from magnetic resonance imaging head scans and clinically assessed GR or CAL (N = 556).
  
  
  RESULTS
  Analysing all teeth, a higher maximum cranial width was associated with a lower mean GR (B = -0.016, 95% CI: -0.030; -0.003, p = 0.02) and a lower mean CAL (B = -0.023, 95% CI: -0.040; -0.005, p = 0.01). Moreover, a long narrow face was significantly associated with increased mean GR and CAL (facial index, P for trend = 0.02 and p = 0.01, respectively). Observed associations were more pronounced for incisors and canines than for premolars and molars.
  
  
  CONCLUSIONS
  This study revealed craniofacial morphology, specifically the cranial width and the facial index, as a putative risk factor for periodontal loss of attachment.
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Loutfi
authors.initials: L
authors.lastname: Salti
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Birte
authors.initials: B
authors.lastname: Holtfreter
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Christiane
authors.identifier: http://orcid.org/0000-0001-5950-2716
authors.initials: C
authors.lastname: Pink
authors.affiliation: Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.|Department of Radiology, Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Habes
authors.affiliation: Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Biffar
authors.affiliation: Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Stavros
authors.initials: S
authors.lastname: Kiliaridis
authors.affiliation: Department of Orthodontics and Orofacial Orthopedics, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Karl-Friedrich
authors.initials: KF
authors.lastname: Krey
authors.affiliation: Department of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Robin
authors.initials: R
authors.lastname: Bülow
authors.affiliation: Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kocher
authors.affiliation: Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Amro
authors.initials: A
authors.lastname: Daboul
mesh_terms: D002508:Cephalometry; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000453:epidemiology*; D012886:Skull / Q000033:anatomy & histology*; D013997:Time Factors
keywords: clinical attachment loss; craniofacial morphology; gingival biotype; gingival recession; magnetic resonance images