title: The "puffed cheek method" to evaluate mucosal thickness: case series.
abstract: OBJECTIVE
  Mucosal thickness should be considered in implant treatment planning. Needle probing to measure mucosal thickness is invasive and therefore not used in routine diagnosis. The "puffed cheek" method is an established technique to visualize the vestibule in computed tomography (CT). As CT assesses bone availability, a simultaneous mucosal thickness measurement would be useful. The aim of this study was to evaluate the reliability of mucosal thickness measurement in CT with distended cheeks.
  
  
  METHODS
  Buccal maxillary mucosa thickness was evaluated at four measurement sites in the incisor and molar area of 11 patients. Each site was evaluated via CT with cheek distension and needle probing. Measurement area was identified with the aid of a thermoplastic splint to localize the exact position by a gutta-percha marker point. The comparison between the two methods was performed by Bland-Altman diagram.
  
  
  RESULTS
  The mean clinical thickness was 1.17 mm (±0.31) compared to 1.11 mm (±0.31) in CT evaluation. The mean difference between the two methods was 0.07 mm (±0.40; CI-0.14;0.12, P = 0.88, Krippendorff α = 0.38). According to Bland-Altman diagram the mucosal thickness may diverge by up to 0.9 mm from the radiologic thickness.
  
  
  CONCLUSIONS
  The two measurement methods may not be interchangeably used. As additional information to three-dimensional bone analyses, CT may be performed as a pre-operative soft tissue analysis at most implant sites with distended cheeks. Nevertheless, this method yields less valid and reliable results than the gold standard.
authors.affiliation: Department of Oral Surgery, Bernhard Gottlieb Dental School, Medical University Vienna, Vienna, Austria. gabriella.dvorak@meduniwien.ac.at
authors.forename: G
authors.initials: G
authors.lastname: Dvorak
authors.forename: C
authors.initials: C
authors.lastname: Arnhart
authors.forename: P
authors.initials: P
authors.lastname: Schön
authors.forename: S
authors.initials: S
authors.lastname: Heuberer
authors.forename: G
authors.initials: G
authors.lastname: Watzek
authors.forename: A
authors.initials: A
authors.lastname: Gahleitner
mesh_terms: D000328:Adult; D000539:Alveolar Process / Q000000981:diagnostic imaging; D002610:Cheek; D003724:Dental Arch / Q000000981:diagnostic imaging; D005260:Female; D057918:Fiducial Markers; D005881:Gingiva / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007327:Insufflation; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D013165:Splints; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult