Ultrasonographic features of gingival tissue in health and gingivitis

Background: Gingivitis is a common inflammatory condition affecting the gingival tissues, often serving as a precursor to periodontitis. Ultra-high frequency ultrasonography (UHFUS) has emerged as a promising imaging modality capable of providing high-resolution visualization of superficial soft tissues. This cross-sectional study explores the application of UHFUS to the evaluation of gingival tissues, aiming to compare its findings in cases of gingivitis versus gingival health. In particular, the focus is on identifying and characterizing the ultrastructural changes associated with inflammation. Methods: Twenty participants affected by generalized gingivitis and twenty healthy controls were enrolled. All study participants underwent UHFUS scans (70 MHz) of gingival tissues on three areas per dental arch (anterior, middle right, middle left) using a standardized acquisition technique. Gingival thickness, echogenicity, and vascularization parameters (peak systolic velocity, time averaged peak velocity, resistive index, and pulsatility index) were evaluated and compared. Results: No differences in terms of age and sex distribution were noticed between study groups. Participants affected by gingivitis exhibited significantly reduced gingival thickness (p < 0.05) and echogenicity (p < 0.001) at soft tissue level. All vascular parameters indicated the presence of increased blood flow associated to higher vascular resistance, with resistive index values consistently > 0.8 compared with healthy study participants, who showed values between 0.6 and 0.7. Conclusions: Ultrasonography highlighted the presence of structural modifications in the presence of gingivitis compared with healthy study participants. Further assessment is advised to better address the modifications occurring following the development of gingival inflammation. Plain Language Summary: This study aimed to characterize the ultrastructural and vascular modifications in gingival tissue associated with inflammation using UHFUS. A cross-sectional clinical investigation compared 20 participants with generalized gingivitis to 20 periodontally healthy controls. Standardized UHFUS (70 MHz) imaging of designated gingival sites was performed to objectively quantify tissue thickness, echogenicity (textural echointensity), and key vascularization parameters via Doppler analysis. The results demonstrated significant morphofunctional alterations in inflamed gingiva. The objective UHFUS-derived metrics indicated that gingival inflammation involves not only increased perfusion but also substantive underlying architectural changes. The findings provide a foundational reference for detecting subclinical tissue changes and offer a potential objective framework for monitoring therapeutic outcomes in periodontal research and clinical trials.