Abstract
Background/Objectives: Conventional radiographic methods, although considered the gold standard for dental implantology, are not exempt from certain limitations, including their two-dimensional nature, the exposure to ionizing radiation and the inability to assess soft tissues. Ultrasonography (US) has recently emerged as a promising diagnostic tool due to its non-invasive and radiation-free properties. This systematic review aimed to evaluate the clinical applications of ultrasonography in implant dentistry, focusing on both preoperative planning and postoperative monitoring and to compare its diagnostic performance with conventional imaging modalities. Methods: A comprehensive search was performed in PubMed, Scopus, Web of Science, and Cochrane databases (2005-2025) to identify clinical studies evaluating the diagnostic applications of ultrasonography in implant dentistry. The review included randomized controlled trials, diagnostic accuracy studies, case series and case reports. Risk of bias was assessed using the RoB-2 tool for RCTs, QUADAS-2 for diagnostic studies and the JBI checklist for case reports and series. Results: 17 eligible studies were included in this review, comprising 4 RCTs, 10 diagnostic accuracy studies, 2 case report and 1 case series, for a total of 371 patients evaluated. Ultrasonography proved effective in the preoperative setting for evaluating mucosal thickness, keratinized mucosa, tissue phenotype, ridge width and bone morphology, often showing high agreement with CBCT and clinical measurements. In the postoperative phase, US enabled monitoring of soft tissue healing, vascular perfusion, graft maturation and detection of peri-implant pathology, with some studies showing correlations between early ultrasonographic findings and long-term clinical outcomes. Comparative studies revealed strong concordance with CBCT (mean deviations < 0.5-1 mm) and superior performance in both soft tissue visualization and cases affected by radiographic artifacts. Conclusions: Ultrasonography represents a promising adjunctive tool in implant dentistry, capable of complementing or, in selected scenarios, replacing conventional radiographic methods. While current evidence highlights its diagnostic potential across different stages of implant therapy, further standardized, large-scale clinical studies are required before routine integration into daily practice.