Gingival color in dentistry: A systematic review

To synthesize the available knowledge on gingival color and its relevance to aesthetics.

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

An electronic search was conducted in the Web of Science database using the keywords: gingivae, color, aesthetic, and their combinations. Only English-language articles published between 2014 and November 2024 were included.

The search strategy followed these steps: ALL=(gingival) OR ALL=(gingiva);ALL=(colour) OR ALL=(color);ALL=(esthetic) OR ALL=(aesthetic); Finally, the combined search was #1 AND #2 AND #3. Opinion articles, books, clinical cases, and prospective or retrospective studies were excluded. From an initial database of 275 results, and after applying exclusion criteria and full-text review by the authors, 21 studies were included.

Gingival color remains underexplored, with insufficient literature to draw robust conclusions. Recording, communicating, and reproducing gingival color is inherently complex. No studies to date have quantified gingival color changes in longitudinal designs. Some publications have highlighted chromatic discrepancies between natural gingiva, restorative materials, and even between similarly named gingival materials. Nearly all available studies are cross-sectional, limiting understanding of gingival color evolution over time. Multicenter longitudinal studies are needed, using representative populations of various racial backgrounds and standardized spectrophotometric protocols.

Despite advances over the past decade, studies addressing gingival color show a high degree of heterogeneity, both in vivo and in vitro, making direct comparisons difficult. Additionally, the lack of standardized methodologies in terms of measurement areas, racial and demographic characteristics, devices, inclusion criteria, and material diversity has left gingival color as an underexplored and poorly understood phenomenon. Coordinated efforts between manufacturers, commercial entities, and researchers are essential to generate reliable and clinically relevant knowledge for gingival restoration.