Supracrestal tissue attachment dimension modulates outcomes of periodontal therapy across gingival phenotypes

Incompatibility of supracrestal tissue attachment (SCTA) violation with periodontal health leading to sequelae associated with persistent periodontal inflammation has been established. Limited data exist on how SCTA variations affect outcomes of periodontal therapy. This study aims to evaluate effect of SCTA dimensions on efficacy of subgingival instrumentation (SI) and open flap debridement (OFD) in stage II/III periodontitis patients with different gingival phenotypes (GPs).

Thirty-eight patients with 152 teeth and 912 sites underwent SI and OFD. Clinical parameters along with SCTA and GP were assessed at baseline, 8 weeks, and 6 months. Logistic regression analysis was performed to identify factors influencing the outcomes at patient-level, tooth-level, and site-level.

Two distinct groups were identified: one with higher supracrestal-attached tissue volume-SCTV (SCTA ≥ 2 mm/SCTA ≤ 1 mm: Thick GP; SCTA ≥ 2 mm: Thin GP) and another with lesser SCTV (SCTA ≤ 1 mm: Thin GP). Significantly difference was observed in the group with higher SCTV following OFD for bleeding on probing (0.21 ± 0.42 vs. 0.07 ± 0.42), probing pocket depth (1.44 ± 1.51 mm vs. 1.04 ± 1.39 mm), and clinical attachment level (CAL: 1.35 ± 1.45 mm vs. 0.83 ± 1.48 mm). In logistic regression model, the odds of having unit gain in CAL is 1.8 times more at sites with ≥2 mm SCTA.

This study offers a comprehensive view of multi-dimensional SCTV and emphasizes SCTV as important factor in influencing the clinical outcomes of periodontitis interventions. The findings highlight SCTV as a key determinant of healing, treatment predictability, and periodontal stability, providing a basis for more targeted and personalized therapies.

Supracrestal tissue attachment dimension has the potential to modulates the outcomes of periodontal therapy across GP. Patients with higher SCTV show superior improvements in BOP, PPD, and CAL after open flap debridement, and sites with SCTA ≥2 mm are nearly twice as likely to achieve significant clinical attachment gain. Recognizing SCTV as one of the determinants of healing can improve case selection, optimize surgical outcomes, and guide personalized periodontal therapy.

Supracrestaltissue attachment (SCTA) plays a critical role in maintaining periodontal health, yet limited data exist on how variations in SCTA influence outcomes of periodontal therapy. This study evaluated the effect of SCTA dimensions on the effectiveness of subgingival instrumentation and open flap debridement in stageII/III periodontitis patients with different gingival phenotypes. Patients were treated and monitored over six months, with clinical outcomes assessed at multiple time points. Sites with higher supracrestal tissue volume demonstrated greater improvements in bleeding control, reduction of probing depths, and gainin clinical attachment compared to sites with lower tissue volume. Higher SCTA was associated with more predictable and stable treatment outcomes. These findings suggest that SCTA dimensions may be helpful in targeted andpersonalized approaches to periodontitis management.