Ultrasonographic Tissue Perfusion in Peri-implant Health and Disease

Abstract

Color flow ultrasonography has played a crucial role in medicine for its ability to assess dynamic tissue perfusion and blood flow variations as an indicator of a pathologic condition. While this feature of ultrasound is routinely employed in various medical fields, its intraoral application for the assessment of tissue perfusion at diseased versus healthy dental implants has never been explored. We tested the hypothesis that quantified tissue perfusion of power Doppler ultrasonography correlates with the clinically assessed inflammation of dental implants. Specifically, we designed a discordant-matched case-control study in which patients with nonadjacent dental implants with different clinical diagnoses (healthy, peri-implant mucositis, or peri-implantitis) were scanned and analyzed with real-time ultrasonography. Forty-two posterior implants in 21 patients were included. Ultrasound scans were obtained at the implant regions of midbuccal, mesial/distal (averaged as interproximal), and transverse to compute the velocity- and power-weighted color pixel density from color velocity (CV) and color power (CP), respectively. Linear mixed effect models were then used to assess the relationship between the clinical diagnoses and ultrasound CV and CP. Overall, the results strongly suggested that ultrasound’s quantified CV and CP directly correlate with the clinical diagnosis of dental implants at health, peri-implant mucositis, and peri-implantitis. This study showed for the first time that ultrasound color flow can be applicable in the diagnosis of peri-implant disease and can act as a valuable tool for evaluating the degree of clinical inflammation at implant sites.

Prevalence and risk indicators of midfacial peri‐implant soft tissue dehiscence at single site in the esthetic zone: A cross‐sectional clinical and ultrasonographic study

“…The following measurements were computed using a commercially available software package, as previously described 14,21,23–25,27,28 and were performed by a single experienced examiner (JM), who has been calibrated in previous trials (k ≥ 0.87): MT: horizontal thickness of the peri‐implant soft tissue, calculated as the distance between the soft tissue margin and the abutment/implant fixture/buccal bone on a line parallel to the long axis of the implant body in the mid‐facial scan. MT was measured at 1 mm and 3 mm (MT1 and MT3, respectively) from the soft tissue margin. Peri‐implant buccal bone distance (BBD): Distance between the implant platform and the peri‐implant bone crest evaluated on a line parallel to the long axis of the implant body in the mid‐facial scan. Peri‐implant buccal bone thickness (BBT): evaluated 0.5 mm apical to the bone crest as the distance between the peri‐implant crestal bone and a line parallel to the long axis of the implant body in the mid‐facial scan. …”

“…The ultrasound equipment setup and the scanning procedures have been previously described in detail. [21][22][23][24][25] Briefly, a commercially available ultrasound imaging device ‡ was coupled with 24 MHz (64-μm axial image resolution) and miniature-sized (≈30-mm long × 18-mm wide × 12-mm thick) probe (L30-8) to generate ultrasound images (pixel size 0.05 mm) 26 (Figs. 1 and 2).…”

“…The ultrasound (US) probe was oriented perpendicular to the occlusal plane and parallel to the long axis of the implant at its midfacial aspect. 21,24 The following measurements were computed using a commercially available software package, § as previously described 14,21,[23][24][25]27,28 and were performed by a single experienced examiner (JM), who has been calibrated in previous trials (k ≥ 0.87):…”

Reliability assessment of the classification for facial peri‐implant soft tissue dehiscence/deficiencies (PSTDs): A multi‐center inter‐rater agreement study of different skill‐level practitioners

“…[1][2][3] The tremendous rise in the popularity of implants has also accompanied certain complications and adverse events. [4][5][6][7] Among them, esthetic challenges have rapidly become an emerging concern for clinicians and patients, especially given the rise in patients' esthetic demands. 8,9 Implant esthetic complications can include discoloration of the peri-implant soft tissues, apical shifting of the implant mucosal margin and exposure of the implant components, an implant-supported crown that is longer than its homologous contralateral tooth, or a combination of these events.…”

“…Dental implants have become a popular treatment modality for the replacement of missing teeth, particularly in the recent years 1–3 . The tremendous rise in the popularity of implants has also accompanied certain complications and adverse events 4–7 . Among them, esthetic challenges have rapidly become an emerging concern for clinicians and patients, especially given the rise in patients’ esthetic demands 8,9 …”