Reproducibility of a Digital Method to Evaluate Soft Tissue Modifications: A study of Inter and Intra-Operative Measurement Concordance

Davide Rancitelli1, Marco Cicciù2, *, Francesco Lini1, Davide Fumagalli1, Anna Chiara Frigo3, Carlo Maiorana1
1 Department of Dental Implants, Maxillofacial Surgery and Odontostomatology Unit, University of Milan, Milan, Italy
2 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
3 Department of Cardiological Sciences, University of Padua, Padua, Italy

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© 2017 Rancitelli et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, Via Consolare Valeria, Gazzi, C.A.P. 98100 Messina, Italy, Tel: 0039090/2216910 Fax: 0039090/2216920; E-mails:;



The soft tissue healing and quality around dental implant is a current debated topic in the recent literature. The free gingival margin and the quantity and quality of the mucosa around teeth and surrounding dental implants still determine the hard and soft tissue healing status.


The aim of this study is to assess inter and intra-operative measurement concordance of a method aimed at evaluating the apico-coronal migration of free gingival margin, using intra-oral photography.


The method was tested on peri-implant tissues that were treated with a connective tissue graft on the second stage surgery. Thirty-eight measurements on 13 implants in 8 patients were recorded. An intra-oral photograph was taken for the graft and the provisional crown, which enclosed a circular landmark with a previously determined diameter. The landmark was prepared with a red-resin by the same technician. Before crown cementation, the landmark was calibrated with a digital calibrator by the main investigator, to determine the precise diameter up to two decimal numbers.


On the intra-oral photograph, the distance was measured from the most apical point of the determined landmark to the zenith of the gingiva, using an image-processing program designed for scientific multidimensional images (Image J). Three independent examiners took these measurements.


The main advantage of the present non-invasive technique is that the spatial plane of the prosthetic landmarks is the same of the tooth unlike the utilization of periodontal probe, which is generally positioned on different plans in the space (generally more vestibular).

Keywords: Periodontal probe, Soft tissues, Periodontal disease, Peri-implant tissues, Apico-coronal migration.