Oral Cavity Measurements

Laser speckle contrast imaging (LSCI) has been shown to be capable of monitoring the microcirculation as it offers a two-dimensional map of blood flow with high spatial resolution. Progression and the healing of diseases in connection with microcirculation such as periodontitis, and surgical interventions in the oral cavity such as implant placement, involves substantial anatomical reorganization of the affected tissue. Only techniques capable of capturing the 2-D heterogeneity of blood flow changes are suitable for follow up. LSCI has the capacity to do so over an entire mucosal surface in a non-invasive manner without having contact with the surface of the tissue.

Laser Doppler Flowmetry has also been shown to be a powerful technique for measuring gingival and pulpal blood flow. The implementation of LDF in dentistry is still low, but it is in fact, the most  studied and well-documented method for registration of pulpal blood flow7 with hundreds of publications.

Oral cavity

Case example: Semmelweis University

Eszter Molnár, János Vág, Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University


We have used Pericam PSI camera:

  • to evaluate the test and retest reliability of LSCI for blood flow measurement of the gingiva1,
  • to evaluate the palatal mucosal wound healing following connective tissue harvesting2,
  • to follow up healing of the gingiva after periodontal plastic surgery for root coverage utilizing xenogenic collagen (Geistlich Mucograft) or autologous graft3,
  • to assess spatial and temporal character of post occlusive reactive hyperemia (PORH) after transient compression of gingiva4,
  • to assess the appropriate timing of early implant placement by measuring the restoration of the blood flow5.

See the video below for an example of how the PeriCam PSI can be used in the clinic6: https://www.jove.com/video/58535/a-novel-approach-to-monitoring-graft-neovascularization-human Here you can find two cases, which were captured by LSCI:  

Case 1: PORH-test on human gingiva

Case report 1

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

Case report 2

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

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See references

References

  • E. Molnár, R. Fazekas, Z. Lohinai, Z. Tóth Z, J. Vág Assessment of the test-retest reliability of human gingival blood flow measurements by Laser Speckle Contrast Imaging in a healthy cohort. Microcirculation. 2018 Feb    
  • B. Molnár, E. Molnár, R. Fazekas, B. Gánti, B. Mikecs, J. Vág Assessment of palatal mucosal wound healing following connective tissue harvesting by Laser Speckle Contrast Imaging: observational, case series study. The International Journal of Periodontics & Restorative Dentistry, accepted: 2018-07-14    
  • E. Molnár, B. Molnár, Z. Lohinai, Z. Tóth, Z. Benyó, L. Hricisák, P. Windisch, J. Vág Evaluation of Laser Speckle Contrast Imaging for the Assessment of Oral Mucosal Blood Flow following Periodontal Plastic Surgery: An Exploratory Study. Biomed Res Int. 2017;2017:4042902    
  • R. Fazekas, E. Molnár, Z. Lohinai, E. Dinya, Z. Tóth, P. Windisch, J. Vág Functional characterization of collaterals in the human gingiva by laser speckle contrast imaging. Microcirculation. 2018 Apr;25(3):e12446.    
  • R. Fazekas, E. Molnár, P. Nagy, B. Mikecs, P. Windisch, J. Vág A proposed method for assessing the appropriate timing of early implant placements: a case report. J Oral Implantol. 2018 Jun [Epub ahead of print]    
  • R. Fazekas, E. Molnár, B. Mikecs, Z. Lohinai, J.Vág. A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva.   -  https://www.jove.com/video/58535/a-novel-approach-to-monitoring-graft-neovascularization-human
  • H.J.J. Roeykens, R.J.G. De Moor (2016) Laser Doppler Flowmetry. In: G. Olivi, R. De Moor, E. DiVito (eds) Lasers in Endodontics. Springer, Cham    
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