Effects of smoking on palatal thickness, density, and vascularization assessed by high-frequency ultrasonography

This study aimed to evaluate tissue thickness and vascularization of graft donor sites in heavy/chronic smokers and non-smokers using high-frequency ultrasonography. This single-center case-control study included 42 systemically healthy individuals (21 smokers, 21 heavy/chronic smokers) requiring palatal graft harvesting. Smoking status was biochemically confirmed using salivary cotinine. Preoperative high-frequency ultrasonography evaluated tissue thickness, density, and vascularization. Heavy/chronic smokers showed significantly greater epithelial thickness in premolar and molar regions (p < 0.001), with no differences in lamina propria or total tissue thickness (p > 0.05). Echo intensity did not differ between groups (p = 0.288), while Doppler/B-Flow values were lower in heavy/chronic smokers (p = 0.017), indicating reduced vascularization. Salivary cotinine (ρ = - 0.493, p = 0.001) and daily cigarette use (ρ = - 0.359, p = 0.020) were negatively correlated with vascularization, and positively correlated with epithelial thickness (cotinine: r = 0.538 [molar], r = 0.490 [5-6 mid]; cigarette consumption: r = 0.666 [molar], r = 0.652 [5-6 mid], r = 0.561 [premolar]; all p < 0.001). Age correlated positively with lamina propria and total thickness, whereas sex showed no association. High-frequency ultrasonography enables assessment of tissue thickness and vascularization in palatal graft donor sites. Smoking adversely affects vascularization without significantly altering overall tissue thickness. Ultrasonographic evaluation may aid in predicting graft healing and long-term tissue stability, particularly in heavy/chronic smokers.