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Original Papers ORIGINAL PAPERS Dent. Med. Probl. 2011, 48, 4, 00– © Copyright by Wroclaw Medical University ISSN 1644-387X and Polish Dental Society Wojciech Bednarz, Agata Zielińska Ultrasonic Biometer and its Usage in an Assessment of Periodontal Soft Tissue Thickness and Comparison of its Measurement Accuracy with a Bone Sounding Method Zastosowanie biometru ultradźwiękowego w badaniu grubości tkanek miękkich przyzębia i porównanie jego dokładności pomiarowej z metodą „bone sounding” brak adresu zakładu Abstract Background. The ability to identify a periodontal biotype accurately, and in particular knowledge of soft tissues thickness in the periodontium (GT – Gingival Thickness), have high influence on planning and conducting a tre- atment in all fields of dentistry, significantly affecting the final outcome. Objective. To compare the measurement accuracy of an ultrasonic and invasive method (bone sounding) in eva- luation of soft tissues thickness in the periodontium. Material and Methods. 30 subjects of both sexes aged 19–51 (21 females and 9 males) with a normal periodon- tium, without systemic and local comorbidities, that could affect periodontal tissues, were examined. Soft tissues thickness was measured by a non-invasive method, using Pirop® Ultrasonic Biometer with the A-scan probe with 20 MHz frequency, with 1540 m/s ultrasonic impulse velocity and accuracy up to 0.01 mm, and by a puncturing – bone sounding method with an endodontic tool with a limiter, and measurement readouts were taken from a calibrator with 0.1 mm accuracy. Measurements were made in area near 20 teeth in each subject (incisive, canine and premolar teeth in both jaws), at two points by each tooth. GT1 – in the middle of a keratinized gingiva width, GT2 – 2 mm apically from the mucogingival junction. Results from both non-invasive (N) and invasive (I) exa- minations were compared. Measurement accuracy between the invasive and ultrasonic method were compared in various metric ranges. The ranges were divided to: w1 ≤ 0.500 mm, w2 0.501–0.750 mm, w3 0.751–1.000 mm, w3 1.001–1.250 mm, w4 > 1.251 mm. Results. The mean value of all measurements with the N method was 0.784, and with the I method was 0.828. The difference was 0.044, and was statistically significant. In the invasive method, the GT1 and GT2 mean values were higher for all teeth. There were no statistically significant differences between the N and I method in GT1 points only by the tooth 32, and in GT2 by teeth 11, 21, 22, 31, 32. Although the difference were significant by the rema- ining teeth. The highest differences between mean values of soft tissues thickness in the periodontium in GT1 and GT2 points were observed in the lowest value range w1 ≤ 0.500 mm. Conclusions. The results of measuring soft tissues thickness in the periodontium with the ultrasonic and invasive methods – bone sounding are very similar, but the differences among the values are statistically significant for most measurement points. The ultrasonic method seems to be more accurate, especially in the lowest value range, taking into consideration the imperfection of the invasive examination (Dent. Med. Probl. 2011, 48, 4, 00–00). Key words: gingival thickness, ultrasonic method, invasive method, measurement. Streszczenie Wprowadzenie. Umiejętność prawidłowego rozpoznania biotypu przyzębia, a szczególnie znajomość parametrów grubości tkanek miękkich przyzębia (GT – Gingival Thickness) ma duży wpływ na planowanie i prowadzenie lecze- nia we wszystkich dziedzinach stomatologii, wpływa znacząco na wyniki kliniczne. Cel pracy. Porównanie dokładności pomiarowej metody ultrasonograficznej i inwazyjnej – bone sounding w ozna- czaniu grubości tkanek miękkich przyzębia. 2 W. Bednarz, A. Zielińska Materiał i metody. Zbadano 30 pacjentów obojga płci w wieku 19–51 lat (21 kobiet i 9 mężczyzn) ze zdrowym przy- zębiem, bez chorób ogólnych i miejscowych mogących mieć wpływ na stan tkanek przyzębia. Grubość tkanek mięk- kich przyzębia była mierzona metodą nieinwazyjną z użyciem biometru ultradźwiękowego Pirop® w prezentacji A, sonda o częstotliwości 20 MHz, z szybkością fali 1540 m/s i dokładnością pomiaru 0,01 mm oraz metodą nakłuwa- nia „bone sounding” z użyciem narzędzia endodontycznego z ogranicznikiem, a wartości pomiarowe odczytywano na kalibratorze z dokładnością do 0,1 mm. Pomiary prowadzono przy 20 zębach u każdego pacjenta (zęby sieczne, kły i zęby przedtrzonowe w szczęce i żuchwie), w dwóch punktach przy każdym zębie: GT1 – w połowie szerokości dziąsła zrogowaciałego, GT2 – 2 mm wierzchołkowo od połączenia śluzówkowo-dziąsłowego. Porównano wyni- ki uzyskane badaniem nieinwazyjnym (N) i inwazyjnym (I). Sprawdzono także dokładności pomiarowe między metodami inwazyjną i ultradźwiękową prowadzone w różnych zakresach metrycznych. Zakresy podzielono na: w1 ≤ 0,500 mm, w2 0,501–0,750 mm, w3 0,751–1,000 mm, w3 1,001–1,250 mm, w4 > 1,251 mm. Wyniki. Średnia wartość dla wszystkich pomiarów metodą N wyniosła 0,784, a metodą I 0,828. Różnica wynosiła 0,044 i była istotna statystycznie. Dla wszystkich zębów wartości średnie GT1 i GT2 były większe w metodzie inwa- zyjnej. W punktach GT1 tylko przy zębie 32 i w punktach GT2 przy zębach 11, 21, 22, 31, 32 różnic istotnych sta- tystycznie między badaniem N i I nie stwierdzono, a przy pozostałych zębach różnice były znamienne. w punktach GT1 i GT2 największe różnice między średnimi wartościami grubości tkanek miękkich przyzębia występowały w zakresie najmniejszych wartości w1 ≤ 0,500 mm. Wnioski. Wyniki pomiaru grubości tkanek miękkich przyzębia metodą ultradźwiękową i inwazyjną – bone soun- ding są do siebie zbliżone, ale różnice między wartościami w większości miejsc pomiarowych są znamienne staty- stycznie. Biorąc pod uwagę niedoskonałości badania inwazyjnego wydaje się, że metodą dokładniejszą, szczególnie w przypadku cienkiego dziąsła, jest metoda ultrasonograficzna (Dent. Med. Probl. 2011, 48, 4, 00–00). Słowa kluczowe: grubość dziąsła, metoda ultradźwiękowa, metod inwazyjna, pomiar. Practicing in various fields of dentistry re- instead. To increase predictability and efficacy of quires an assessment of periodontal thickness utilization of a potential donor site for connec- with respect to anatomic and physiologic issues. tive tissue grafts, that are located on the mucosa It is particularly important to determine a dental of the hard palate, detailed assessment is needed. plaque index, gingival index and parameter values Knowledge of gingival thickness near teeth, that indicating the location of a connective tissue at- will support permanent prosthetic restorations, tachment, gingival margin, mucogingival border and in the first place near teeth that will be under relative to a cementoenamel junction and sound- the influence of orthodontic forces, allows to plan ing depth in every dentogingival unit [1]. The as- measures to avoid occurrence of periodontal re- sessment of thickness of the keratinized gingiva cession, with the presence of a thin biotype [5]. and movable mucosa on the jaw bones and the Determination of soft tissues thickness in the mucosa of the hard palate are becoming nowadays periodontium with observational techniques, based a standard practice [2]. on the comparison of a width to length proportion Measured gingival thickness on the site of a of medial crowns in incisive teeth in the jaw, mea- planned surgical procedure with the necessity of surements of a keratinized gingiva width and inter- making a flap allow to choose a method of shap- dental papilla height, provide only the initial diag- ing the flap with a full or partial thickness. nosis [6, 7]. Similarly, visual assessment of gingival When covering dental recessions, while gingi- thickness during probing of gingival grooves with val thickness is under 0.7 mm, surgical procedures periodontal probe, based on tissues transparency, only with moving the flap should not be performed does not give a reliable result. Kan et al. [8] classi- – free connective tissue grafts should be used in- fied the biotype as thin, when a periodontometer stead [3]. When using barrier membranes, the tis- was visible during probing of gingival grooves, or sues of keratinized gingiva have to be augmented when gingival thickness above the alveolus after a at first, and then they should be utilized in the tooth extraction was ≤ 1 mm. Biotype was classi- next stage of directed regeneration of periodon- fied as thick, when a periodontometer was not vis- tal tissues or they should be swapped for enamel ible during probing of gingival grooves, or when matrix proteins. While planning an implantation gingival thickness above the alveolus after a tooth procedure at a site with the thin mucosa, with its extraction was > 1 mm. Admittedly, there were no thickness measured earlier, the procedure has to statistically significant differences in comparison be broaden with an implantation of a submucosal of these two methods, conducted by Kan et al. [8], connective tissue [4]. Similarly, if thickness of the but the assessment was only to assign the results mucosa covering a toothless segment of an alveo- to a thin or thick biotype. Therefore measurements lar process is greater than biological width, that of periodontal soft tissues thickness are necessary. is determined for the patient, the subsequent aug- Such measurements can be made with invasive, mentation of soft tissues can not be planned, and minimally invasive or non-invasive techniques. augmentation of a bone tissue should be planned The first one [9] includes soft tissue punctures with Measurement Accuracy
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