A comparative study of the application of three digital imaging techniques to assess the thickness of the palatal mucosa of the maxillary anterior teeth

Abstract

Background: This study highlights the need for precise and efficient methods to measure palatal mucosal thickness in the maxillary anterior teeth, particularly for soft tissue augmentation in the aesthetic zone. The research evaluates three digital imaging techniques, suggesting that Cone Beam Computed Tomography (CBCT) combined with intraoral scanners (IOS) is a promising approach for reliable clinical assessment. Methods: Ten volunteers with healthy periodontium were selected, and three methods were employed: CBCT-based indirect gingival imaging, modified soft tissue CBCT (ST-CBCT), and CBCT combined with IOS. Measurements of palatal mucosal thickness were taken at multiple points along the palatal gingival margin. Statistical analysis included Bland-Altman plots for method agreement and intraclass Correlation Coefficient (ICC) analysis for reliability. All measurements were standardized, repeated for consistency, and accurate to 0.01 mm to ensure reliability. Results: The Bland-Altman plots showed that less than 5% of the points for palatal mucosal thickness differences measured by the gingival indirect radiographic method, modified ST-CBCT, and CBCT combined with IOS were located outside the 95% limits of agreement (LoA). The mean value of the differences was within 0.2 mm, indicating good clinical agreement among the three methods. The inter- and intra-study ICC values for palatal mucosal thickness measurements of the maxillary anterior teeth using the three CBCT methods were greater than 0.75 (P < 0.001), demonstrating reproducibility. Conclusions: Based on the evaluation of three digital imaging techniques, this study indicates that the combination of CBCT with IOS is a feasible method for measuring palatal mucosal thickness in the maxillary anterior teeth and demonstrates good reproducibility.