Digitally clinical and esthetic assessment on a modified connective tissue graft (epithelium island) technique
- 1Department of Periodontology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 2College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- 3National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
Abstract
BackgroundThe 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.MethodsFifteen patients with RT-2 localized gingival recession and thin periodontal phenotypes were enrolled. Clinical parameters were assessed pre-surgery (T0) and 6 months post-surgery (T3). 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 (ΔE00) was objectively calculated by self-developed software (GAES®) based on the CIEDE2000 formula at T0, T1, and T3.ResultsRD significantly decreased from 3.00 ± 0.76 mm (T0) to 0.90 ± 0.43 mm (T3) (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 T3 (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 (T3) (p < 0.001). Meanwhile, the REA decreased from 5.85 ± 0.97 mm2 (T0) to 0.76 ± 0.42 mm2 (T3), a reduction of 5.10 ± 1.07 mm2 (p < 0.001). The ΔE00 values at T3 decreased by 0.865 ± 0.323 (free gingival margin) and 0.845 ± 0.372 (middle zone of keratinized gingiva) compared to T0 (p < 0.001).ConclusionThe 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 relevanceThis 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.
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BibTeX
@article{liao2026digitally,
title = {{Digitally clinical and esthetic assessment on a modified connective tissue graft (epithelium island) technique}},
author = {Yue Liao and Yue Liao and Yue Liao and Han Hu and Han Hu and Han Hu and Huxiao Li and Huxiao Li and Huxiao Li and Huiwen Chen and Huiwen Chen and Huiwen Chen and Wentao Sun and Wentao Sun and Wentao Sun and Jiachen Dong and Jiachen Dong and Jiachen Dong and Zhongchen Song and Zhongchen Song and Zhongchen Song},
journal = {Frontiers in Oral Health},
year = {2026},
month = oct,
doi = {10.3389/froh.2026.1889034},
url = {https://doi.org/10.3389/froh.2026.1889034},
note = {CC BY},
}
RIS
TY - JOUR
TI - Digitally clinical and esthetic assessment on a modified connective tissue graft (epithelium island) technique
AU - Yue Liao
AU - Yue Liao
AU - Yue Liao
AU - Han Hu
AU - Han Hu
AU - Han Hu
AU - Huxiao Li
AU - Huxiao Li
AU - Huxiao Li
AU - Huiwen Chen
AU - Huiwen Chen
AU - Huiwen Chen
AU - Wentao Sun
AU - Wentao Sun
AU - Wentao Sun
AU - Jiachen Dong
AU - Jiachen Dong
AU - Jiachen Dong
AU - Zhongchen Song
AU - Zhongchen Song
AU - Zhongchen Song
PY - 2026
DA - 2026/10/23
JO - Frontiers in Oral Health
DO - 10.3389/froh.2026.1889034
UR - https://doi.org/10.3389/froh.2026.1889034
AB - BackgroundThe 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.MethodsFifteen patients with RT-2 localized gingival recession and thin periodontal phenotypes were enrolled. Clinical parameters were assessed pre-surgery (T0) and 6 months post-surgery (T3). 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 (ΔE00) was objectively calculated by self-developed software (GAES®) based on the CIEDE2000 formula at T0, T1, and T3.ResultsRD significantly decreased from 3.00 ± 0.76 mm (T0) to 0.90 ± 0.43 mm (T3) (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 T3 (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 (T3) (p < 0.001). Meanwhile, the REA decreased from 5.85 ± 0.97 mm2 (T0) to 0.76 ± 0.42 mm2 (T3), a reduction of 5.10 ± 1.07 mm2 (p < 0.001). The ΔE00 values at T3 decreased by 0.865 ± 0.323 (free gingival margin) and 0.845 ± 0.372 (middle zone of keratinized gingiva) compared to T0 (p < 0.001).ConclusionThe 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 relevanceThis 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.
SN - 2673-4842
ER -