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

Color Analysis of Graft and Recipient Site After Free Gingival Graft Surgery Using Polarized Digital Photograph

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.

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.

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)