Quantification of Supracrestal Tissue Attachment Using High-Frequency Ultrasound

Abstract Objectives To develop and validate a noninvasive ultrasound (US)-based framework for quantifying supracrestal tissue attachment (STA) and evaluating tooth-type variation in STA dimensions, to assess the accuracy of conventional periodontal probing against photographic ground truth (GT), and US images. Methods A high-frequency, miniaturized side-facing US transducer was used to simultaneously image gingival soft tissue, alveolar bone, and periodontal probes. Ex vivo swine jaws were imaged to compare US-derived probing depth and STA measurements with ground-truth photographic measurements and conventional manual probing. Measurement bias and agreement were evaluated using statistical analyses. Observed anatomical trends were further examined using full-mouth human cadaver imaging and validated in vivo in human subjects. Power analysis was performed to determine sensitivity for detecting biologically relevant differences between tooth types. Results US-derived probing depth measurements showed lower bias (0.23 ± 0.42 mm) relative to GT than manual probing (0.54 ± 0.25 mm) and enabled direct visualization of STA with a periodontal probe. Agreement analyses showed improved accuracy of US measurements compared with conventional probing. Systematic differences in STA were identified between molar (1.86 ± 0.88 mm) and premolar (2.59 ± 0.53 mm) teeth in ex vivo specimens. These trends were confirmed in full-mouth cadaver imaging and in vivo human validation. Power analysis indicated 80% statistical power to detect clinically meaningful differences in STA dimensions across tooth types. Conclusions STA is not uniform across the dentition and varies depending on the tooth type. High-frequency US provides a robust, noninvasive modality for direct anatomical measurement and may improve the quantitative assessment of periodontal structures in clinical practice. Advances in knowledge This study challenges the long-standing assumption of uniform STA and introduces a validated US-based method for direct anatomical measurement. The findings highlight clinically relevant tooth-type variation and support the integration of high-frequency US into periodontal diagnostics and treatment planning.