Case example:
Semmelweis University
János Vág PhD, d.m.d. drvagjanos@gmail.com
Eszter Molnár PhD, d.m.d. molnreszter@gmail.com
Réka Fazekas PhD, d.m.d. fazekas@medaker.hu
Bernadett Gánti PhD, d.m.d. gantiberni@gmail.com
Barbara Mikecs d.m.d. mikecsbarbara@gmail.com
Faculty of Dentistry, Semmelweis University
The Pericam PSI camera has been used:
- to evaluate the test and retest reliability of LSCI for blood flow measurement of the gingiva (1),
- to evaluate the palatal mucosal wound healing following connective tissue harvesting (2),
- to follow up healing of the gingiva after periodontal plastic surgery for root coverage utilizing xenogenic collagen (Geistlich Mucograft) or autologous graft (3),
- to assess the spatial and temporal character of post occlusive reactive hyperemia (PORH) after transient compression of the gingiva (4),
- to compare the blood flow in the surrounding tissues of dental implants and natural teeth by application of the PORH test (5).
- to assess the appropriate timing of early implant placement by measuring the restoration of the blood flow (6),
- to demonstrate the retrograde vasodilator effect of nitric oxide in the human gingiva (7).
- to investigate temporal and spatial blood flow patterns following vestibuloplasty procedures using a collagen matrix (CM) (9).
- to investigate the mucogingival vasculature in the maxillary esthetic zone by functional characterization on an individual level (10).
Here you can find four cases, which were captured by the PeriCam PSI:
Case 1: PORH-test on human gingiva
Figure 1 Regional differences in resting blood flow in the maxillary front area. Perfusion is highest in the interdental area above the papilla and lowest in the midbuccal area. Papillary blood flow is in-between them. Due to the bright wet surface, reflections can be observed. Spatial and temporal changes in human gingival blood flow during and after transient compression. Laser speckle images at four privileged moments of a measurement applying 5 s horizontal compression on the gingiva at tooth 12. Blood flow during baseline (A), during compression (B), at the hyperemic peak (C) and twenty minutes after releasing the pressure (D).
During the temporary compression process, the attached gingiva was pressed to the subjacent bone, resulting in an occlusion in the vessels of the mucoperiosteum, thereby causing transient ischemia. As a reaction to the brief period of ischemia a temporary increase in gingival blood flow occured, called reactive hyperemia. Blood flow returned to the baseline 20 minutes after the release of compression.
Case 2: Flap assessment in oral mucosa
Figure 2 Representative photographs and LSCI images on a patient following modified coronally advanced tunnel surgery with free gingival grafts at tooth 41 and 31 (labelled). Images representing from the preoperative perfusion and showing the wound healing and perfusion on day 3, 6, 10, 14 and 30.
LSCI method allow us to study the physiology of mucosa in the oral cavity, also to follow up the healing of different type of surgical methods and the behavior of materials and grafts. János Vág PhD, d.m.d. drvagjanos@gmail.com Eszter Molnár d.m.d. molnreszter@gmail.com Réka Fazekas d.m.d. fazekas@medaker.hu.
Case 3: Blood flow monitoring after vestibuloplasty
Figure 3 Representative photographs (upper line) and LSCI perfusion images (lower line) of the operated gingiva. The images present then wound healing and perfusion 1, 2, 3, 4, 5, 7, 9, 11, 14, 21, 28, 68, 98, 138, 154, 182 and 360 days postoperatively. Areas of high perfusion are shown in red while areas of low perfusion are blue.
Case 4: Investigation of the retrograde vasodilator effect of nitric oxide in human gingiva
The aim of our study was to prove the presence of spreading vasodilatation in human gingiva with applying nitric-oxide donor solution (Nitro POHL). Plastic wells were made on the labial surface of the right maxillary labial incisor. One well was applied on the left maxillary central incisor, where physiological saline was used as a control solution. The wells were opened toward the gingival sulcus.
Figure 4 Exported images from pimsoft software: before application of Nitro POHL (1mg/ml) (baseline), after adding 3µl solution (12 tooth), after 90 sec and after 5 min.
The PeriCam PSI allows us to study the physiology of mucosa in the oral cavity, also to follow up the healing of different type of surgical methods and the behavior of materials and grafts.
References:
- 1. Molnár E, Fazekas R, Lohinai Z, Tóth Z, Vág J. Assessment of the test-retest reliability of human gingival blood flow measurements by Laser Speckle Contrast Imaging in a healthy cohort. Microcirculation. 2018;25(2).
2. Molnár B, Molnár E, Fazekas R, Gánti B, Mikecs B, Vág J. Assessment of Palatal Mucosal Wound Healing Following Connective-Tissue Harvesting by Laser Speckle Contrast Imaging: An Observational Case Series Study. Int J Periodontics Restorative Dent. 2019;39(2):e64-e70.
3. Molnár E, Molnár B, Lohinai Z, Tóth Z, Benyó Z, Hricisák L, et al. Evaluation of Laser Speckle Contrast Imaging for the Assessment of Oral Mucosal Blood Flow following Periodontal Plastic Surgery: An Exploratory Study. BioMed research international. 2017;2017:4042902.
4. Fazekas R, Molnár E, Lohinai Z, Dinya E, Tóth Z, Windisch P, et al. Functional characterization of collaterals in the human gingiva by laser speckle contrast imaging. Microcirculation. 2018;25(3):e12446.
5. Mikecs B, Molnár E, Fazekas R, Vág J. Microvascular reactivity of peri-implant mucosa in humans: effect of abutment material. International Journal of Periodontology and Restorative Dentistry. 2021;accepted.
6. Fazekas R, Molnár E, Nagy P, Mikecs B, Windisch P, Vág J. A Proposed Method for Assessing the Appropriate Timing of Early Implant Placements: A Case Report. J Oral Implantol. 2018;44(5):378-83.
7. Ganti B, Molnar E, Fazekas R, Mikecs B, Lohinai Z, Miko S, et al. Evidence of spreading vasodilation in the human gingiva evoked by nitric oxide. Journal of periodontal research. 2019;54(5):499-505.
8. Vág J, Gánti B, Mikecs B, Szabó E, Molnár B, Lohinai Z. Epinephrine penetrates through gingival sulcus unlike keratinized gingiva and evokes remote vasoconstriction in human. BMC Oral Health. 2020;20(1):305.
9. Fazekas R, Molnár B, Kőhidai L, Láng O, Molnár E, Gánti B, et al. Blood flow kinetics of a xenogeneic collagen matrix following a vestibuloplasty procedure in the human gingiva-An explorative study. Oral Dis. 2019;25(7):1780-8.
10. Mikecs B, Vág J, Gerber G, Molnár B, Feigl G, Shahbazi A. Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone. BMC Oral Health. 2021;21(1):160.
11. Fazekas R, Molnár E, Mikecs B, Lohinai Z, Vág J. A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva. J Vis Exp. 2019(143). https://www.jove.com/video/58535/a-novel-approach-to-monitoring-graft-neovascularization-human
