Work

Digitally clinical and esthetic assessment on a modified connective tissue graft (epithelium island) technique

Year: 2026

Type: article

Abstract: Background The aim of this study was to evaluate the clinical efficacy and esthetic outcome of a modified connective tissue graft (the epithelium island, EI) technique for periodontal phenotype modification in patients undergoing orthodontic treatment via digital assessment of intra-oral scanning, cone beam computed tomography (CBCT), and the CIEDE2000 formula. Methods Fifteen patients with RT-2 localized gingival recession and thin periodontal phenotypes were enrolled. Clinical parameters were assessed pre-surgery (T 0 ) and 6 months post-surgery (T 3 ). Digital evaluations using 3Shape TRIOS® intra-oral scanning and CBCT data were performed to measure keratinized tissue width (KTW), gingival thickness (GT), and root exposure area (REA). Gingival color difference (ΔE 00 ) was objectively calculated by self-developed software (GAES®) based on the CIEDE2000 formula at T 0 , T 1 , and T 3 . Results RD significantly decreased from 3.00 ± 0.76 mm (T 0 ) to 0.90 ± 0.43 mm (T 3 ) ( p < 0.001), and RW reduced from 6.07 ± 0.80 mm to 3.73 ± 0.80 mm ( p < 0.005). KTW increased by 2.85 ± 0.28 mm at T 3 ( p < 0.001). GT of affected teeth increased by 0.73 ± 0.11, 1.09 ± 0.34, and 1.03 ± 0.30 mm at 0, 1, and 3 mm apical to the gingival margin (T 3 ) ( p < 0.001). Meanwhile, the REA decreased from 5.85 ± 0.97 mm 2 (T 0 ) to 0.76 ± 0.42 mm 2 (T 3 ), a reduction of 5.10 ± 1.07 mm 2 ( p < 0.001). The ΔE 00 values at T 3 decreased by 0.865 ± 0.323 (free gingival margin) and 0.845 ± 0.372 (middle zone of keratinized gingiva) compared to T 0 ( p < 0.001). Conclusion The EI technique effectively reduces gingival RD, RW, and REA, increases KTW and GT, and achieves favorable esthetic outcomes in patients with thin periodontal phenotypes during orthodontic treatment. Clinical relevance This study verifies that the EI technique provides a predictable surgical option for periodontal phenotype modification, enabling simultaneous periodontal functional reconstruction and esthetic improvement for orthodontic patients with fragile gingival conditions.

Source: Frontiers in Oral Health

DOI: 10.3389/froh.2026.1889034