Received: 4 October 2019 | Revised: 28 November 2019 | Accepted: 14 December 2019

DOI: 10.1111/jcpe.13235

C L I N I C A L I N N O VAT I O N R E P O R T

A novel, fully digital approach to quantifying volume gain after

soft tissue graft surgery. A pilot study

Carla Fons-Badal1 | Jorge Alonso Pérez-Barquero1 | Nuria Martínez- Martínez1 |

Joan Faus-López2 | Antonio Fons-Font1 | Rubén Agustín-Panadero1

1
Department of Oral Medicine, Faculty
of Medicine and Dentistry, University of Abstract
Valencia, Valencia, Spain Objective: Measuring soft tissue thickness after mucogingival surgery has tradition-
2
Valencia Dental Research Institute (IVIO),
ally been performed by means of a calibrated transgingival probe. The main aim of
Valencia, Spain
this study was to apply a non-invasive technique based on digital images formatted
Correspondence
as Standard Tessellation Language (STL) files to quantify soft tissue volume after con-
Antonio Fons-Font, Department of
Stomatology, Faculty of Medicine and nective tissue grafting.
Dentistry, University of Valencia, C/Gascó
Clinical Innovation Report: Ten patients who presented Cairo Class I gingival reces-
Oliag 1, 46010 Valencia, Spain.
Email: Antonio.fons@uv.es sion were selected for connective tissue grafting using the tunnel technique. In all
patients, the initial position of the gingiva and quantity of keratinized tissue were
recorded, and gingival recession was scanned with an intra-oral scanner. Six months
after surgery, the same intra-oral parameters were recorded and compared with the
initial registers using digital volumetric analysis software.
Results: Complete root coverage was obtained in most patients (90%), mean cover-
age being of 2.70 mm with a mean increase in volume of 115.49 mm3 in the treated
areas. No pattern was identified that indicated a statistically significant relation be-
tween gingival recession and coverage volume in mm3.
Conclusions: Digital processing of pre- and post-treatment images makes it possible
to measure the volume of tissue gained after tissue graft surgery simply and non-
invasively. The technique is an objective and reproducible method for measuring soft
tissue thickness.

KEYWORDS

connective tissue graft, digital, mucogingival, recession, STL file, tunnel technique, volumetric
analysis

tissue around the tooth, sometimes leaving a minimal amount or

1 | I NTRO D U C TI O N even no keratinized tissue so that only the mucosa remains.
Over the years, the minimum dimension of gum that constitutes
Gingival recession is a clinical presentation in which the gum mi- adequate gingival health has been a topic under investigation.
grates apically leaving the cemento-enamel junction exposed. The latest European Workshop in Periodontology (held in 2017)
This migration is often associated with a reduction in keratinized reached the conclusion that periodontal health may be maintained

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2020 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc.

614 | 
wileyonlinelibrary.com/journal/jcpe J Clin Periodontol. 2020;47:614–620.
FONS-BADAL et al. | 615

with a minimal quantity of keratinized tissue providing the patient

fulfils good oral hygiene practices and periodontal maintenance
Clinical Relevance
and that other factors associated with gingival recession are ab-
sent. It was also agreed that the presence of around 2 mm of at- Scientific rationale for the study: With the introduction of
tached keratinized gingival tissue around the tooth is necessary digital technologies in dentistry, this paper describes an
for oral health. So vestibular-lingual tissue thickness would appear alternative technique for measuring gingival thickness by
to play a key role in oral health maintenance (Cortellini & Bissada, analysing pre- and post-treatment images digitally.
2018). Principal findings: Digital image superimposition techniques
There is a series of risk factors for the development of gingival are non-invasive and avoid anaesthetizing the patient and
recession, the most important being a thin biotype, absence of at- puncturing newly gained tissue.
tached gum, and reduction in the bone crest resulting from dental Practical implications: This technique offers a simple and
malposition (Cortellini & Bissada, 2018). non-invasive method for measuring the volume of tissue
Sometimes gingival health is not compromised by gingival reces- gained after tissue graft surgery.
sion and does not cause the patient any problems. If the recession
remains stable over the years, it will not necessarily cause sensitiv-
ity, may remain free of gingival inflammation, and plaque-free, but it 2 | C LI N I C A L I N N OVATI O N R E P O RT
should be kept under observation in case of any deterioration. When
attached gum is absent, or there is dental sensitivity, compromised Ten patients were selected from the Dental Clinic at the Faculty of
aesthetics, progressive/active recession, or a need for dental resto- Medicine and Dentistry, University of Valencia (Spain), who pre-
ration by means of a fixed prosthesis of a tooth presenting recession, sented satisfactory periodontal health (absence of bleeding on prob-
then treatment is recommended to recover the recession with kera- ing, suppuration, or gingival inflammation, a probe depth ≤3 mm, and
tinized tissue. Silnes and Löe plaque index no greater than 1). All presented Class
Numerous techniques are available for treating gingival reces- I recession according to Cairo classification (Cairo, Nieri, Cincinelli,
sion, which aim to reposition gum tissue coronally. These include Mervelt, & Pagliaro, 2011) for treatment by connective tissue graft-
coronally advanced flap technique described by Zucchelli and De ing using the tunnel technique (Figure 1).
Sanctis (2000), and tunnel grafting technique first described by Following guidelines established in the Helsinki Declaration for
Allen (1994), later modified by other authors such as Zabalegui, experiments involving human subjects, the patients received full
Sicilia, Cambra, Gil, and Sanz (1999) and Zuhr, Fickl, Wachtel, Bolz, information about the periodontal treatment, all procedures, the
and Hürzeler (2007) among others (Allen, 1994; Zabalegui et al., aims of the study and the need to attend follow-up appointments.
1999; Zucchelli & De Sanctis, 2000; Zuhr et al., 2007). Patients gave their informed consent in writing before undergoing
To date, the success of these treatments has been assessed by treatment. All personal data, as well as medical information related
clinical measurements such as root coverage, reduction in the re- to treatment, were treated with absolute confidentiality by the per-
cession, the Root Coverage Esthetic Score (Cairo, Rotundo, Miller, sonnel conducting the trial. Each patient authorized the publication
& Pini Prato, 2009), the quantity of keratinized tissue, or the thick- of the results of the study when they gave their informed consent to
ness of keratinized tissue gained. To measure tissue thickness take part as stipulated in Data Protection Legislation, which ensures
some techniques have been used, like parallel profile radiograph their right to access, rectify or cancel any data by contacting the lead
(Alpiste-Illueca, 2004) that measures dentogingival unit on the buc-
cal surfaces of anterior teeth. Another method inserts a calibrated
instrument with a silicon marker perpendicularly into the tissue
3 mm below the gingival margin (Aroca, Keglevich, Barbieri, Gera,
& Etienne, 2009; Paolantonio, 2002). These methods suffer some
disadvantages, parallel profile radiograph only measures anterior
teeth, and the insertion of a calibrate instrument involves puncturing
newly gained tissue, the patient must be anaesthetized and newly
gained tissue is not homogeneous in its entire surface.
As an alternative to this invasive technique, this paper describes
digital volumetric analysis of pre- and post-treatment intra-oral im-
ages used to quantify tissue thickness after mucogingival surgery,
another of the new digital technologies being introduced into clinical
practice.
The objective was to apply this non-invasive technique, which uses
Standard Tessellation Language (STL) files to perform volumetric anal- F I G U R E 1 Initial pre-treatment situation, before performing
ysis, after treating gingival recession with connective tissue grafts. root coverage technique to the upper left canine
616 | FONS-BADAL et al.

F I G U R E 2 Post-treatment situation 6 months after connective F I G U R E 3 Digital antero-posterior image (vestibulo-lingual)

tissue grafting with tunnel technique of the grafted area, showing the increase in gingival tissue after
treatment

researcher. The study protocol was approved by the University of

Valencia Ethics Committee for Research Involving Human Subjects. most apical point of the recession (Point A) was marked on the
Surgical treatment of gingival recessions was performed using pre-treatment model, Point B being the cemento-enamel junc-
the modified coronally advanced tunnel technique as described tion (CEJ), and Point C the projection of point A, following the
by Zuhr, Fickl, Wachtel, Bolz, and Hürzeler (Zuhr et al., 2007). The X-axis, on the post-treatment model; Point D corresponded to the
donor site was the palate, harvesting connective tissue, grafting most coronal point of the gingiva on the post-treatment model
it at the host site and fixing it with resorbable sutures. Dental su- (Figure 3).
tures were used to reposition the tissue coronally. All patients were The distance from Point A to Point B was measured to quantify
treated by the same operator. Patients were prescribed antibiot- the patient's pre-treatment recession, the distance from Point A to
ics (500 mg amoxicillin three times a day for a week) and antisep- Point D to calculate the gain or loss of gingiva in vestibular-lingual
tic mouthwash (0.2% chlorhexidine three times a day for 7 days). direction as a result of mucogingival treatment (Figure 3). In addi-
Weekly check-ups were scheduled during the healing process, for tion, a colour map was created comparing the volumes of matrix
the first month after surgery. Then, patients returned for further obtained from the pre-model to the post-model in order to visualize
check-ups 3 and 6 months after surgery (Figure 2). the volume increase or decrease in the treated area, in both the area
The initial gingiva position (recession in millimetres) and the of recession (Figure 4a) and adjacent areas (Figure 4b).
quantity of keratinized tissue were recorded, and digital impres- To calculate the volume of tissue gain in mm3 after treatment,
sions were taken with an intra-oral scanner (True Definition, 3M). a 3D model of the grafted tissue was created. To do this, the
Six months after treatment these registers were repeated to anal- Geomagic software created boundaries on the post-treatment STL
yse treatment outcomes. All data collection was carried out by a model to isolate the graft's vestibular portion. The palatine/poste-
single trained clinician, who was not the operator who had carried rior portion of this 3D object corresponded to the vestibular por-
out treatment. tion of the pre-treatment STL file (Figure 4c). As the orientation of
To quantify the volumetric changes produced by treatment, pre- the graft matrix in the vestibular (obtained from the post-treatment
and post-treatment digital images were analysed using a measure- STL model) and palatine portions (obtained from the pre-treatment
ment method that superimposes pre- and post-treatment STL files. STL model) were the same, using the software's ‘flip normals’ tool,
In each case, the teeth adjacent to the treated teeth were selected the palatine portion could be inverted to provide perfect alignment
and were aligned by means of the best-fit algorithm using Geomagic of the grids. The last step was to close the object's grid by creating
software (3D Systems). planes. Lastly, the volume of the new object was calculated in mm3
Once superimposed, a transform matrix was generated to orient (Figure 4d).
the model in space, so that the Y-axis corresponded to the treated
tooth's longitudinal axis and the X-axis was oriented in vestibular-pal-
atine direction. This matrix was applied to the post-treatment STL file 2.1 | Statistical analysis
to align the two models now oriented along the same spatial axes. The
models were then exported as a binary STL to GOM Inspect software Descriptive statistics were calculated for the variables analysed:
(GOM GmbH) to perform measurement and volumetric analysis. mean, standard deviation, range and median.
For measurement and volume analysis, a section correspond- Applying the Shapiro–Wilk's test, no deviations from normal dis-
ing to the tooth's longitudinal axis was created on pre- (Figure 3: tribution were detected, although the small sample size required a
red line) and post-treatment (Figure 3, black line) models. The non-parametric approach to analysis. Spearman's rank correlation
FONS-BADAL et al. | 617

(a) (b)

(c) (d)

F I G U R E 4 (a) Quantification of gingival tissue volume gained as a result of root coverage treatment. (b) Best fit of pre-treatment and
post-treatment STL files show change in volume after connective tissue grafting in the area adjacent to gingival recession. Points were
selected randomly. P1-P6 indicate the name of the points, D: indicates the linear distance from the pre-treatment STL to the post-treatment
STL. Dx, Dy and Dz indicate the distance in each axis of the space. (c) Lateral digital image of superimposed pre- and post-treatment STL
files shows the volume of gingival tissue gained 3 months after surgery. (d) Quantification of increase in soft tissue volume 6 months after
connective tissue grafting

coefficient was estimated to evaluate the degree of association be- between recession and root coverage was moderate/strong and
tween gingival recession and the other parameters. close to statistical significance (r = 0.60; p = .068). When these
For relevant correlations (p < .1), a simple linear regression model three atypical cases are discarded, the remaining seven cases point
was estimated to quantify the impact of the magnitude of recession to a linear relation between these two variables. The linear regres-
on the dependent variable (tooth coverage). sion model to quantify the impact of the magnitude of recession on
The significance level set was 5% (α = 0.05). tooth coverage found a relation whereby the quantity of coverage
Post-hoc power was calculated; a sample of n = 10 patients obtained was determined by the original recession (adjusted coef-
reached a power of 67.9% to detect a statistically significant correla- ficient of determination R 2 = 0.966). The regression line represented
tion of moderate magnitude (r = 0.7). “root coverage,” =.344 + .922*. For “gingival recession,” the t-statistic
of the coefficient relative to gingival recession was t = 13.118, with
statistical significance (p < .001; Table 2).
3 | R E S U LT S The dispersion graph relates gingival recession and the volume
of coverage in mm3, but shows no pattern indicating a clear relation
After tissue graft surgery, complete root coverage was obtained in between them (r = 0.27; p = .455; Figure 6).
most patients (90%) and a mean increase in volume of 115.49 mm3
in the areas treated, as shown in Table 1. Observing individual cases,
for all patients, root coverage was greater than the distance of gin- 4 | D I S CU S S I O N
gival recession, with the exception of case 5 in which it was lower.
In cases 1 and 6, the root coverage measurement was much larger In recent years, digital workflows have been incorporated into
than gingival recession (Figure 5). Spearman's correlation coefficient many dental practices thanks to the development of intra-oral
618 | FONS-BADAL et al.

TA B L E 1 Dental coverage data recorded

Gingival recession (distance between gingival Root Mean horizontal volume of host Volume of treated
margin and cemento-enamel line) coverage area area
Patient Tooth (mm) (mm) (mm) (mm3)

1 1.3 1.98 3.25 1.76 102.59

2 2.3 2.54 2.76 1.56 146.40
3 1.3 3.05 3.12 1.26 114.67
4 2.3 1.87 2.14 1.86 104.78
5 1.1 1.84 1.72 1.92 89.56
6 1.1 2.45 3.53 2.12 134.65
7 1.3 1.78 1.86 2.08 126.78
8 2.3 2.68 2.76 1.53 124.89
9 2.1 2.45 2.70 1.86 101.34
10 2.1 3.12 3.20 2.04 109.23
Mean ± SD 2.38 ± 0.49 (2.5) 2.70 ± 0.62 1.80 ± 0.28 (1.86) 115.5 ± 17.4 (112.0)
(median) (2.76)

FIGURE 6 Relation between gingival recession and volume

TA B L E 3 Method reproducibility
F I G U R E 5 Scatter plot represents gingival recession data, root
coverage data and mean gingival volume increase after treatment Range CV Reproducibility

<1% Very high

1%–5% High
TA B L E 2 Estimation of linear regression coefficients between 5%–10% Moderate
root coverage and gingival recession
>10% Poor
Adjusted
Model B t Sig. R2 model
the digital reproduction of certain structures is subject to some
Constant .344 1.924 .112 0.966 limitation (Nedelcu, Olsson, Nyström, & Thor, 2018) especially
GIGIVAL .922 13.118 .000 full arches with multiple implants, mainly as a result of distortion
RECESSION (mm)
(Kašparová, Halamová, Dostálová, & Procházka, 2018; Mutwalli,
Braian, Mahmood, & Larsson, 2018). Digital image analysis has
scanners and dedicated software for processing the images cap- also been used to compare volumetric variations in alveolar mor-
tured. In the field of dental prosthetics, it has been possible to phology (Windisch et al., 2007).
establish completely digital workflows, from intra-oral scanning In the field of periodontics, digital imaging has been used to
and smile design to the fabrication of crowns using CAD-CAM compare volumetric changes to soft tissue. Thomason et al. an-
techniques, in both tooth-supported and implant-supported treat- alysed changes to gingival contours in patients with drug-in-
ments (Stanley, Gomes, Miguel, & Coachman, 2018). Nevertheless, duced overgrowth who underwent gingivectomies. Pre- and
FONS-BADAL et al. | 619

post-treatment digital images were taken from plaster models and a visual inspection using perdiodontal tool that is only calibrated from
superimposed to compare the changes to soft tissue after surgery millimetre to millimetre. The technique currently taken as the gold
(Thomason et al., 2005). In the present study, the soft tissues in standard is clearly invasive, too dependent on the individual operator,
the oral cavity were scanned directly in order to eliminate inter- and calibrated in millimetres, so unable to measure microns.
mediate steps that could lead to distortion. This also saves time. Regarding the present clinical results, complete root coverage
Strebel et al. evaluated volumetric changes to inter-dental papil- was achieved in nine out of the ten cases. In statistical analysis, the
lae (adding a layer of composite to thicken the papilla) by means of data did not display a pattern that related recession in millimetres
optical impressions using scanning spray. Variations in volume were with the volumetric quantity of coverage. This is due to the fact that
calculated with three-dimensional analysis software, concluding that all the recessions were Cairo Class I, a type of recession associated
this was a valid method for evaluating periodontal tissues (Strebel et with highly predictable treatment outcomes, which usually obtain
al., 2009). These results coincide with the present findings, whereby complete root coverage.
it was found that the superimposition of digital models for compar-
ison offers a simple and objective means of evaluating volumetric
changes to tissues. 5 | CO N C LU S I O N S
The success of tissue graft surgery is assessed by measuring
certain parameters, such as root coverage in millimetres, the re- Digital processing of pre- and post-treatment images offers a simple
duction in recession, and the quantity of keratinized tissue gained. and non-invasive method for measuring the volume of tissue gained
The measurements are usually taken on the surface produced, with after tissue graft surgery. It is an objective and reproducible tech-
the exception of the tissue thickness parameter. This measurement nique for measuring thickness or volume in any research involving
is usually taken under local infiltrative anaesthetic, introducing a soft tissue evaluation.
measuring probe perpendicularly to the surface of the gum in the
same way as a periodontal probe (Samani, Saberi, Ali Tabatabaei, & AC K N OW L E D G E M E N T S
Moghadam, 2017), although other instruments can be used such as The authors would like to express their thanks to D. Alberto Alvarez
endodontic files with a rubber stop (Isler, Ozcan, Ozcan, & Omurlu, Garcia-Pumarino, Global Scientific Affairs Mgr. Digital Oral Care at
2018; Pietruska, Skurska, Podlewski, Milewski, & Pietruski, 2019), 3MEspe Spain, for his advice and guidance and help in creating and
needles (Mufti, Dadawala, Patel, Shah, & Dave, 2017), etc. This managing STL files. The authors have no support or funding to re-
method suffers several disadvantages. Firstly, the patient must be port and declare that no competing interests exist.
anaesthetized, and secondly, it involves puncturing newly gained
tissue. But digital image superimposition techniques are non-inva- ORCID
sive, objective, precise and measure not only tissue thickness but Carla Fons-Badal https://orcid.org/0000-0002-1483-0000
the whole range of parameters used to assess the outcomes of this
type of treatment. REFERENCES
To ensure that the quantification method was reliable and re- Allen, A. L. (1994). Use of the supraperiosteal envelope in soft tissue graft-
producible, a preoperative scan and ten post-operative scans of ing for root coverage. I. Rationale and technique. The International
Journal of Periodontics & Restorative Dentistry, 14(3), 216–227.
the clinical situation after the graft procedure were analysed. Each
Alpiste-Illueca, F. (2004). Dimensions of the dentogingival unit in max-
post-operative file was aligned to the original model using best-fit illary anterior teeth: A new exploration technique (parallel profile
algorithm. After alignment and orienting models in relation to the radiograph). The International Journal of Periodontics & Restorative
X-, Y- and Z-axes, they were exported for analysis by GOM Inspect Dentistry, 24(4), 386–396.
Aroca, S., Keglevich, T., Barbieri, B., Gera, I., & Etienne, D. (2009). Clinical
software. As explained above, a ‘Point A’ was established on the pre-
evaluation of a modified coronally advanced flap alone or in com-
operative model and points C and D on each of the post-operative bination with a platelet-rich fibrin membrane for the treatment of
models. In this way, the distances A-C and A-D were obtained be- adjacent multiple gingival recessions: A 6-month study. Journal of
tween the preoperative model and each of the post-operative scans. Periodontology, 80(2), 244–252.
Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., & Pagliaro, U. (2011). The
Standard deviation of the A-C distance was 0.007 mm and distance
interproximal clinical attachment level to classify gingival recessions
error for AD was 0.025, which may be considered an extremely low and predict root coverage outcomes: An explorative and reliability
figure in absolute terms. In relative terms (compared with the magni- study. Journal of Clinical Periodontology, 38, 661–666.
tude of the distance measured), the method error value (coefficient Cairo, F., Rotundo, R., Miller, P. D., & Pini Prato, G. P. (2009). Root cov-
of variation CV) for distance AC was 0.936%, indicating high repro- erage score: A system to evaluate the esthetic outcome of the
treatment of gingival recession through evaluation of clinical cases.
ducibility, and for distance AD 0.76%, also considered to indicate high
Journal of Periodontology, 80(4), 705–710.
reproducibility (Table 3). The capacity to obtain such precise mea- Cortellini, P., & Bissada, N. F. (2018). Mucogingival conditions in the
surements with an insignificant level of error (0.007 mm for distance natural dentition: Narrative review, case definitions, and diagnostic
AC, and 0.025 for distance AD) shows this technique to be highly reli- considerations. Journal of Clinical Periodontology, 45(20), S190–S198.
Isler, S. C., Ozcan, G., Ozcan, M., & Omurlu, H. (2018). Clinical evaluation
able—even a necessity—when it comes to measuring gingival volume,
of combined surgical/restorative treatment of gingival recession-type
while the classic measurement tool for measuring volume increase is
620 | FONS-BADAL et al.

defects using different restorative materials: A randomized clinical Strebel, J., Ender, A., Paqué, F., Krähenmann, M., Attin, T., & Schmidlin, P.
trial. Journal of Dental Sciences, 13(1), 20–29. R. (2009). In vivo validation of a three-dimensional optical method to
Kašparová, M., Halamová, S., Dostálová, T., & Procházka, A. (2018). Intra- document volumetric soft tissue changes of the interdental papilla.
oral 3D scanning for the digital evaluation of dental arch parameters. Journal of Periodontology, 80(1), 56–61.
Applied Sciences, 8(10), 1838. Thomason, J. M., Ellis, J. S., Jovanovski, V., Corson, M., Lynch, E., &
Mufti, S., Dadawala, S. M., Patel, P., Shah, M., & Dave, D. H. (2017). Seymour, R. A. (2005). Analysis of changes in gingival contour
Comparative evaluation of platelet-rich fibrin with connective tis- from three-dimensional co-ordinate data in subjects with drug-in-
sue grafts in the treatment of miller's class i gingival recessions. duced gingival overgrowth. Journal of Clinical Periodontology, 32,
Contemporary Clinical Dentistry, 8(4), 531–537. 1069–1075.
Mutwalli, H., Braian, M., Mahmood, D., & Larsson, C. (2018). Trueness Windisch, S., Jung, R. E., Sailer, I., Studer, S. P., Ender, A., & Hämmerle,
and precision of three-dimensional digitizing intraoral devices. C. (2007). Optical method for volume measurements. Clinical Oral
International Journal of Dentistry, 26, 5189761. Implants Research, 18(5), 545–551.
Nedelcu, R., Olsson, P., Nyström, I., & Thor, A. (2018). Finish line dis- Zabalegui, I., Sicilia, A., Cambra, J., Gil, J., & Sanz, M. (1999). Treatment
tinctness and accuracy in 7 intraoral scanners versus conventional of multiple adjacent gingival recessions with the tunnel subepithelial
impression: An in vitro descriptive comparison. BMC Oral Health, connective tissue graft: A clinical report. The International Journal of
18, 27. Periodontics & Restorative Dentistry, 19(2), 199–206.
Paolantonio, M. (2002). Treatment of gingival recessions by combined Zucchelli, G., & De Sanctis, M. (2000). Treatment of multiple reces-
periodontal regenerative technique, guided tissue regeneration, and sion-type defects in patients with esthetic demands. Journal of
subpedicle connective tissue graft. A comparative clinical study. Periodontology, 71(9), 1506–1514.
Journal of Periodontology, 73(1), 53–62. Zuhr, O., Fickl, S., Wachtel, H., Bolz, W., & Hürzeler, M. B. (2007).
Pietruska, M., Skurska, A., Podlewski, Ł., Milewski, R., & Pietruski, J. Covering of gingival recessions with a modified microsurgical tun-
(2019). Clinical evaluation of Miller class I and II recessions treat- nel technique: Case report. The International Journal of Periodontics &
ment with the use of modified coronally advanced tunnel tech- Restorative Dentistry, 27(5), 457–463.
nique with either collagen matrix or subepithelial connective tissue
graft: A randomized clinical study. Journal of Clinical Periodontology,
46(1), 86–95.
How to cite this article: Fons-Badal C, Alonso Pérez-Barquero
Samani, M. K., Saberi, B. V., Ali Tabatabaei, S. M., & Moghadam, M. G.
J, Martínez- Martínez N, Faus-López J, Fons-Font A, Agustín-
(2017). The clinical evaluation of platelet-rich plasma on free gingival
graft's donor site wound healing. European Journal of Dentistry, 11(4), Panadero R. A novel, fully digital approach to quantifying
447–454. volume gain after soft tissue graft surgery. A pilot study. J Clin
Stanley, M., Gomes, A., Miguel, I., & Coachman, C. (2018). Fully digital Periodontol. 2020;47:614–620. https​://doi.org/10.1111/
workflow, integrating dental scan, smile design and CAD-CAM: Case
jcpe.13235​
report. BMC Oral Health, 18, 134.