Objectives: To study the soft and hard tissue anatomy in the maxillary anterior area and to assess the relationship between sagittal root position (SRP) and periodontal phenotype and between the thickness of the facial bone and the gingival thickness (GT).

Materials and Methods: Seventy-five subjects (450 teeth) were enrolled. The clinical examination included the crown width/ length ratio, gingival width, papilla height and GT. The radiographic assessment, using cone beam computed tomography scans included the GT, thickness of buccal alveolar bone and SRP of the maxillary six anterior teeth.

Results: The frequency distribution of SRP classes was 87.3% Class I, 6.9% Class II, 0.0% Class III and 5.8% Class IV. The SRP was not found to be related to the periodontal phenotype parameters; no significant differences in GT, bone thickness (BT) and papilla height were found between different classes. Central incisors with Class II SRP showed less keratinized gingiva and lower mean GT (at 3 mm level) in comparison with Class I (P= 0.055, P< 0.001 respectively) and Class IV (P < 0.05 for both). 74% of class II teeth were triangular shaped teeth. A positive correlation was found between bone and GT at all levels (P < 0.001) and 78% of all the examined sites showed labial plate thickness < 1mm.

Conclusions: The SRP of the maxillary anterior teeth is not related to the periodontal phenotype. Yet, bone and GT are positively correlated.