Oral Radiology, 2026 (SCI-Expanded, Scopus)
Objectives: This study aimed to assess intra and interrater reliability of real-time periodontal measurements using different ultrasonographic probes. Methods: In this prospective observational study, four operators performed real-time B-mode ultrasonography on 12 maxillary anterior teeth. An 18-MHz linear probe was used for extraoral imaging, and a 15-MHz hockey-stick probe was applied both intraorally and extraorally. Gingival thickness (GT), gingival height (GH), alveolar bone crest–cementoenamel junction distance (ABC–CEJ), and alveolar bone thickness (ABT) were measured twice by each operator at a two-week interval. Intra- and inter-operator reliability was evaluated using intraclass correlation coefficients (ICC). Results: Intrarater reliability of periodontal ultrasound measurements varied across probes and operators. The hockey stick probe demonstrated higher interrater reliability for GH (ICC = 0.452, p = 0.004 in extraoral application; ICC = 0.388, p = 0.015 in intraoral application) and for ABC–CEJ measurements (ICC = 0.441, p = 0.033 in extraoral application; ICC = 0.461, p = 0.086 in intraoral application). GT and ABT demonstrated lower consistency, with several non-significant ICC values. The linear probe yielded limited reliability across parameters. Conclusion: Operator-dependent variability remains a major limitation in periodontal ultrasonography. Nevertheless, the extraoral application of the hockey-stick probe provided the most consistent reliability for gingival height and ABC–CEJ measurements, supporting its potential use in real-time chairside periodontal evaluation.