Objectives: This pilot study evaluates the correlation between periodontal pocket depth (PPD) measurements obtained by manual probing and those derived from an AI-coupled ultrasound imaging device in periodontitis patients. Materials and Methods: Thirteen patients with periodontitis underwent ultrasonic probing with an AI engine for automated PPD measurements, followed by routine manual probing. Results: A total of 2088 manual and 1987 AI-based PPD measurements were collected. The mean PPD was 4.2 mm (range: 2–8 mm) for manual probing and 4.5 mm (range: 2–9 mm) for AI-based ultrasound, with a Pearson correlation coefficient of 0.68 (95% CI: 0.62–0.73). Discrepancies were noted in cases with inflammation or calculus. AI struggled to differentiate pocket depths in complex clinical scenarios. Discussion: Ultrasound imaging offers non-invasive, real-time visualization of periodontal structures, but AI accuracy requires further training to address image artifacts and clinical variability. Conclusions: The ultrasound device shows promise for non-invasive periodontal diagnostics but is not yet a direct alternative to manual probing. Further AI optimization and validation are needed. Clini
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