Digital Color Analysis of the Graft and Recipient Site After Free Gingival Graft Surgery

Completed

• Conditions: Digital Photography; Cross Polarized Filter; Free Gingival Graft

• Registration Number: NCT07199686
• Lead Sponsor: Bezmialem Vakif University

Brief Summary

This study evaluates gingival color following Free Gingival Graft (FGG) surgery using polarized digital photography to objectively analyze grafted and adjacent tissues. Conventional verbal descriptors (e.g., pale pink, salmon pink) lack precision; therefore, digital colorimetry provides objective, non-contact, and reproducible measurements. The protocol utilizes the CIELab system with standardized color disks and polarization to document postoperative color changes accurately.

The study objectives are: (1) to determine CIELab color values of FGG-treated gingiva in patients who underwent conventional surgery at least six months earlier; (2) to assess the influence of age, sex, time since surgery, and gingival thickness on these values; and (3) to compare graft color with adjacent gingiva.

Hypothesis: In FGG-treated patients, graft CIELab color values are unaffected by age, sex, postoperative duration, or gingival thickness.

Detailed Description

The aim of this cross-sectional study was to evaluate the color characteristics of free gingival graft (FGG) and the adjacent gingiva using polarized filtered digital photographs in cases where more than six months have elapsed since the procedure, and to assess the potential influence of clinical and sociodemographic factors on gingival color.

Fifty cases involving FGG procedures covering one or two lower anterior incisors were included in the study. Clinical parameters including probing pocket depth, bleeding on probing, clinical attachment level, width of keratinized gingiva, and thickness of keratinized gingiva were recorded. Standardized color reference disks were placed on the labial surfaces of the treated teeth, and both filtered and unfiltered photographs were taken. The images were saved in JPEG format and analyzed using the CIELab color system in Adobe Photoshop. A p-value of less than 0.05 was considered statistically significant.

Study Timeline

• Study Start: 2023-03-20
• Primary Completion: 2023-08-05
• Study Completion: 2025-04-20
• Status Verified: 2025-09
• Study First Submitted: 2025-09-10
• Study First Submitted QC: 2025-09-22
• Last Update Submitted: 2025-09-22
• Study First Posted: 2025-09-30
• Last Update Posted: 2025-09-30

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

• Postoperative period of at least 6 months after FGG
• Age between 18 and 65 years
• No known systemic diseases
• No use of medications adversely affecting gingival health (e.g., calcium channel blockers, immunosuppressants, antiepileptics)
• Full-mouth plaque index (PI)(1) and gingival index (GI)(2) < 1
• Probing pocket depth (PPD) ≤ 3 mm with no bleeding on probing (BOP)(3) in the mandibular anterior teeth
• Absence of habitual mouth breathing

Exclusion Criteria

• Current smoking
• Pregnancy or lactation
• Previous endodontic or restorative treatment in the mandibular anterior teeth
• Parafunctional habits (e.g., bruxism) or history of orthodontic treatment
• Conditions impairing salivary flow (e.g., Sjögren's syndrome or similar disorders)

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Characterization of the color values of the Free Gingival Graft (FGG) according to the CIELab color system	Through study completion, an average of 6 months	Standardized intraoral photographs were obtained from fifty participants. Digital images were obtained using a camera with standardized settings to ensure reproducibility. All images, taken with and without the filter. Photographs were analyzed in Adobe Photoshop programme using the CIELAB system. The FGG region was divided into three equal zones (coronal, middle, apical). For each region, mean L\*, a\*, and b\* values were calculated.
Characterization of the color values of the adjacent keratinized gingiva according to the CIELab color system	Through study completion, an average of 6 months	Standardized intraoral photographs were obtained from fifty participants. Digital images were obtained using a camera with standardized settings to ensure reproducibility. All images, taken with and without the filter. Photographs were analyzed in Adobe Photoshop programme using the CIELAB system. The adjacent keratized gingiva region was divided into two equal zones (coronal and middle) as the apical region corresponded to non-keratinized mucosa. For each region, mean L\*, a\*, and b\* values were calculated.

Secondary Outcome Measures

Name	Time	Method
Keratinized Gingiva Width	Baseline	For teeth within the operative area, the distance between the mucogingival junction and the gingival margin at the mesial, middle, and distal sites was measured. The mean of these three values was recorded as the keratinized gingiva width (KGW) for each tooth.
Periodontal pocket depth	Baseline	Periodontal pocket depth (PPD) was measured as the distance from the gingival margin to the base of the pocket at the mesio-buccal, mid-buccal, and disto-buccal surfaces of each tooth in the operative region. The mean of these three measurements was recorded as the PPD value for the tooth.
Clinical attachment level	Baseline	Clinical attachment level (CAL) was measured as the distance from the mesial, mid-buccal, and distal aspects of each tooth within the surgical area to the cemento-enamel junction (CEJ) and extended to the depth of the periodontal pocket. The mean of these three measurements was recorded, and the CAL for each tooth was determined accordingly.Time Frame:At the time of examination.
Measurement of gingival thickness	Baseline	The thickness of the free gingival graft (FGG) and adjacent keratinized gingiva (KG) was assessed using a transgingival probing method. After administering local anesthesia, a #25 endodontic spreader was inserted perpendicularly through the mucosa until it contacted the underlying hard tissue. The distance between the spreader tip and the stopper was measured with a digital caliper. In the FGG area, measurements were obtained at three points (mesial, middle, and distal). In the adjacent keratinized tissue, two measurements were taken 2 mm apical to the gingival margin of the neighboring tooth, corresponding to the coronal and mid-regions of the graft.
Influence of age on color values	Through study completion, an average of 6 months	Patient age was recorded, and the effect of age (year) on the CIELab values of the graft was assessed via One way Multivariate Analysis of Variance.
Influence of 'time since surgery' on color values	Through study completion, an average of 6 months	The duration 'since FGG surgery (months)' was recorded, and its effect on the CIELab values of the graft was assessed via One way Multivariate Analysis of Variance.
Influence of gender on color values	Through study completion, an average of 6 months	Patient gender (female/male) was recorded, and the effect of gender (female/male) on the CIELab values of the graft was assessed via One way Multivariate Analysis of Variance.
Influence of gingival thickness on color values	Through study completion, an average of 6 months	Gingival thickness was recorded, and the effect of gingival thickness (mm) on the CIELab values of the graft was assessed via One way Multivariate Analysis of Variance

Trial Locations

Locations (1)

Bezmialem Vakif University; Istanbul, Fatih, Turkey (Türkiye)