Accuracy of high-resolution ultrasound (US) for gingival soft tissue thickness mesurement in edentulous patients prior to implant placement

Abstract

Objectives: To evaluate and compare the accuracy of high-resolution ultrasound (US) with two different cone beam CT (CBCT) units and clinical assessment for measuring gingival soft tissue thickness in edentulous patients prior to implant placement. Methods and materials: The study consisted of 40 maxillary implant sites of 40 healthy patients (20 females, 20 males; mean age, 47.88 years). We prospectively evaluated labial/buccal gingival thickness in 40 implant regions (16 anterior and 24 posterior) by using limited field of view (FOV) CBCT images and US images in comparison to gold standard transgingival probing measurements. One-way analysis of variance (ANOVA) was used to compare mean measurements obtained from CBCT (Morita and Planmeca), US, and transgingival probing. Interclass correlation coefficient (ICC) estimates were calculated based on means with two-way mixed and absolute-agreement model. Bland Altman plot was used to describe agreement between clinical vs US and CBCT measurements by constructing limits of agreement. Statistical significance was set at p < 0.05. Results: There was no significant difference between methods used according to mean gingival thickness measurements obtained from the top (p = 0.519) and bottom (p = 0.346) of the alveolar process. US and CBCT measurements highly correlated with clinical measurements for both top and bottom alveolar process gingival thickness (p < 0.001). Distribution of differences between clinical measurements and both CBCT measurements showed statistically significant differences according to 0 (p < 0.05). Distribution of differences between clinical measurements and US measurements did not show statistically significant difference (p > 0.05). Conclusion: High-resolution US provided accurate information for the measurement of gingival soft tissue thickness in edentulous patients prior to implant placement.

Methods to assess tooth gingival thickness and diagnose gingival phenotypes: A systematic review

“…Borges et al 23 also found substantial differences in soft‐tissue measurements using ultrasonic devices and transgingival probing. However, Sönmez et al 32 reported that the two methods had no distinction. All three studies showed a strong correlation between gingival measurements acquired by CBCT and transgingival probing.…”

“…One study assessed the index test before the reference standard by the same examiner, possibly introducing index test bias 24 . Regarding the reference standard bias, only three studies presented clear reference standards to classify gingival phenotypes 22,24,32 . Finally, all the articles defined the flowchart and timeframe of their cross‐sectional studies and thus had a low risk of flow and timing bias.…”

“…After a duplication check, 1237 articles remained for an eligibility check, and 12 articles were included by applying the inclusion and exclusion criteria. [21][22][23][24][26][27][28][29][30][31][32][33]…”

“…24 Patients with gummy smiles 23 or undergoing implant surgery were included in this study. 32,33 All the included studies were cross-sectional in design. Four studies compared CBCT measurements with direct transgingival probing.…”

“…22,[28][29][30] Another four included studies evaluated gingival thickness by both CBCT and ultrasonic measurements and compared it using direct clinical methods. 21,23,32,33 Six of the included studies only measured gingival thickness in a single jaw, and six studies evaluated both maxillary and mandibular teeth. The measurement sites around the natural teeth varied.…”