From Biotype to Therapy: Tailoring Periodontal Treatment

For many years, clinicians described gingival tissue simply as “thin” or “thick.” Today, this view has expanded into the broader concept of the periodontal phenotype, which considers not only gingival thickness but also the width of keratinised tissue and the underlying bone structure. This evolution reflects growing recognition that soft tissue dimensions are not just anatomical features—they play a critical role in determining periodontal stability, aesthetic outcomes, and the risk of complications across preventive, surgical, restorative, orthodontic, and implant therapies. Individuals with a thin phenotype are more prone to gingival recession, whether triggered by inflammation or mechanical trauma. They also face greater challenges after surgery, with marginal tissue changes and a higher chance of aesthetic compromise when restorative or implant materials show through delicate tissue. In contrast, a thick phenotype generally offers more resilience: improved resistance to recession, better wound stability, and enhanced ability to conceal restorative components. Importantly, phenotype is not a fixed trait. Advances in mucogingival and peri-implant soft tissue augmentation now allow clinicians to increase gingival thickness and keratinised tissue dimensions, reducing risks and improving long-term stability. This review brings together current knowledge on definitions, diagnostic methods, biological mechanisms, and clinical implications of gingival biotype and periodontal phenotype. It emphasises practical decision-making and the value of interdisciplinary planning. Evidence from clinical studies and systematic reviews supports phenotype-based personalisation, particularly in mucogingival surgery and peri-implant care, where tissue thickness strongly influences early remodelling and the stability of soft tissue outcomes. At the same time, areas where evidence remains indirect are highlighted, along with the promise of emerging digital diagnostic workflows that may help standardise phenotype assessment in everyday practice.