Computer-assisted identification of the gingival sulcus and periodontal epithelial junction on high-frequency ultrasound images.

The primary aim of this study was to demonstrate that periodontal ultrasonography is a reliable method with which to identify and evaluate the attachment level of the gingival junctional epithelium. A secondary aim was to devise an automated computer-assisted method that allows the examiner to more easily identify the gingival sulcus contour on ultrasound images. Material and methods: This in vitro study was carried out on 36 sites on the lingual surface of eight pig mandibles. For each site, periodontal ultrasonography was performed by the same examiner, using DermaScan C Cortex Technology (Denmark) with a 20-MHz transducer. Subsequently, the mandibles were sectioned with a microtome and examined by direct microscopy. To facilitate identification of the gingival sulcus on ultrasound images, a computational method was adopted. Results: Computer processing of the ultrasound images slightly modified the contour of the gingival sulcus. The absolute mean differences in the linear measurements of the Dermascan-automated computer-generated values and the corresponding values of microscopy, which is the gold standard, varied between 0.06 and 1.75 mm. Statistical analysis showed that with respect to the gingival sulcus height, the correlation between the computer-processed ultrasound images and the direct microscopy images was stronger than the correlation between the non-processed ultrasound images and those from direct microscopy. Conclusions: Ultrasonographic examination of the periodontal tissues allows the examiner to localize the gingival epithelial attachment level and provides substantial data regarding the soft gingival tissues.