Background & Objectives: The spatial orientation and vertical thickness of periodontal soft tissues act as a critical biological barrier governing esthetic predictability and structural survival in periodontics, orthodontics, and implant dentistry. While conventional transgingival probing (TGP) under local anesthesia has served as the historical baseline, it is inherently invasive, operator-dependent, and prone to fluid-induced tissue deformation. This prospective, comparative clinico-radiographic study evaluates the diagnostic accuracy, reliability, and mathematical agreement of a novel non-invasive Cone-Beam Computed Tomography (CBCT) protocol utilizing a standardized radiopaque adhesive marker against conventional TGP in a North Gujarat cohort.

Methods: Sixty systemically healthy subjects (42 males, 18 females; mean age 34.42 ± 9.05 years) requiring CBCT scans were recruited. A standardized template featuring a 3-mm punched window positioned 3 mm apical to the marginal gingiva mid-buccally was affixed to the maxillary anterior teeth. A radiopaque 4-META/MMA-TBB adhesive cement marker was placed to establish an identical reference landmark. Digital cross-sectional measurements were recorded via high-resolution CBCT software (CS 9600 3D CMOS Sensor, voxel size ≥ 75 μm) and compared against direct bone sounding performed perpendicularly through the cement center using a UNC-15 probe with a rubber stopper and digital caliper (0.1 mm precision). Data were analyzed using descriptive statistics and the independent Student's t-test (α = 0.05).

Results: The mean soft tissue thickness recorded via conventional TGP was 1.95 ± 0.27 mm (range: 1.50–2.40 mm), while the corresponding mean thickness measured via digital CBCT was 1.93 ± 0.31 mm (range: 1.40–2.60 mm). The absolute

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mean difference between modalities was 0.02 mm. Statistical analysis confirmed no significant difference between the two techniques (t = 0.377, p > 0.05, p = 0.707). Both modalities demonstrated exceptional consistency and phenotypic clustering around the 1.9–2.0 mm structural threshold.

Conclusions & Healthcare Delivery Impact: Cone-Beam Computed Tomography combined with a standardized radiopaque marker protocol provides an exceptionally accurate, reproducible, and non-invasive alternative to invasive bone sounding. Transitioning to non-invasive digital phenotyping eliminates procedural patient trauma, optimizes pre-surgical risk stratification, and provides healthcare providers with a validated technology to enhance clinical workflow predictability and service quality...