Gingival Zenith Positions and Levels of Maxillary Anterior Dentition in Cases of Bimaxillary Protrusion: A Morphometric Analysis.

AIM: To investigate the two clinical parameters, such as gingival zenith positions (GZPs) and gingival zenith levels (GZLs), of maxillary anterior dentition in bimaxillary protrusion cases and collate it with severiety of crown inclination.

MATERIALS AND METHODS: Gingival zenith position and GZL in 40 healthy patients (29 females and 11 males) with an average age of 21.5 years were assessed. Inclusion criteria involved absence of periodontal diseases, Angle's class I molar relationship, and upper anterior proclination within 25 to 45° based on Steiner's analysis; exclusion criteria included spacing, crowding, anterior restoration and teeth with incisor attrition or rotation. The GZP was evaluated using digital calipers from voxel-based morphometry (VBM), and GZL was assessed from the tangent drawn from GZP of central incisor and canines to the linear vertical distance of GZP of lateral incisor.

RESULTS: All the central incisors showed a GZP distal to VBM with a mean average of 1 mm. Severe proclination between 40 and 45° showed a statistically significant variation. Lateral incisors displayed a mean of 0.5 mm deviation of GZP from the vertically bisected midline. In 80% of canine population, GZP was centralized.

CONCLUSION: We conclude that the degree of proclination of maxillary anterior dentition was correlated to the gingival contour in bimaxillary cases. The investigation revealed that there is a variation in the location of GZP as the severity of proclination increases.

CLINICAL SIGNIFICANCE: This study highlights the importance of microesthetics in fixed orthodontic treatment. The gingival contour should be unaltered while retraction during management of bimaxillary protrusion.