Ultrasonographic Vascular Supply

Ultrasonographic Evaluation of the Vascular Supply After Coronally Advanced Flap Surgery in the Lower Jaw: a Clinical Case Series

Pre-operative ultrasound enables visualization of mandibular arterial branches relevant to flap design in mucogingival surgery. This study documents the pre-and post operative course of these arteries in four CAF procedures using a CE-marked ulstrasound device within its intended purpose.

Study Overview

• Status: Completed
• Conditions: Gingival Recession, Generalized

Detailed Description

Pre-operative ultrasound imaging offers a non-invasive method to visualize superficial arteries of the mandible and can complement the surgeon's anatomical knowledge when planning incisions for CAF procedures. By mapping the vascular network before surgery and comparing it with intra- and post-operative findings, clinicians can better understand how arterial patterns relate to surgical anatomy and flap perfusion.

This prospective case series documents four CAF procedures (single recession lower incisors, multiple recessions lower incisors, single recession lateral posterior, multiple recessions lateral posterior) performed in the mandibular anterior region, aiming to describe the course and variability of the mental, ascending mental, submental, and inferior labial arteries. The ultrasound system used is CE-marked and applied strictly within its intended purpose (soft-tissue imaging). The study seeks to enhance anatomical awareness.

• Study Type: Observational
• Enrollment (Actual): 4

Contacts and Locations

Study Locations

• Belgium
  • Vlaams Brabant
    • Leuven, Vlaams Brabant, Belgium, 3000
      • UZLeuven, Campus St. Raphaël, Department Oral Health Sciences, Periodontology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Potential participants will be identified and recruited during participant consultations at the department of periodontology. No additional recruitment material (such as for example flyers, social media advertising, audio/video recordings) will be used.

Description

Inclusion Criteria:

1. Age ≥ 18 years.
2. Presence of at least one mandibular gingival recession defect (RT1 or RT2) at an anterior, canine, or premolar tooth with an indication for treatment using a coronally advanced flap (CAF).
3. Good oral hygiene: full-mouth plaque score (FMPS) ≤ 20% and full-mouth bleeding score (FMBS) ≤ 20%.
4. Periodontal stability: no active or untreated periodontitis; probing depths ≤ 4 mm at the study site.
5. Ability to undergo pre-operative and post-operative ultrasound imaging and clinical documentation.
6. No contraindication to local anaesthesia or minor periodontal surgery.
7. Ability and willingness to comply with all scheduled follow-up visits (days 7, 14, 30 and 4 months).
8. Provision of written informed consent prior to any study-related procedures.

Exclusion Criteria:

1. Systemic contraindications to minor oral surgery (ASA ≥ III, uncontrolled diabetes mellitus [HbA1c > 7.5%], immunosuppressive therapy, bleeding disorders, or coagulation abnormalities).
2. Current antithrombotic therapy that cannot be safely managed peri-operatively according to the treating clinician.
3. Smoking more than 10 cigarettes per day or equivalent vaping within the previous 6 months.
4. Previous mucogingival surgery, traumatic scarring, or soft-tissue grafting in the mandibular anterior or premolar region that could interfere with vascular assessment.
5. Active oral infection or acute gingival inflammation at or near the study site.
6. Untreated caries, endodontic pathology, or restorative defects at the involved tooth.
7. Pregnancy or lactation.
8. Known allergy or hypersensitivity to ultrasound gel or (if applied) indocyanine green (ICG) or iodine.
9. Liver dysfunction or other medical contraindication precluding ICG use (relevant only if optional perfusion imaging is performed).
10. Inability or unwillingness to comply with study procedures or follow-up schedule.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation	Correlation between pre-operative ultrasound findings and intra-/post-operative visualization of mandibular arterial branches (mental, ascending mental, submental, and inferior labial arteries), expressed as agreement in location, trajectory, and branching pattern	Immediately after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intra-operative bleeding	Incidence and severity of intra-operative bleeding (mild, moderate, severe)	during surgery
perfusion or ischemic changes	Presence of perfusion or ischemic changes in the flap area, evaluated clinically	14 days after surgery
Clinical outcome: percentage of root coverage	Clinical outcome including percentage of root coverage (%RC)	4 months after surgery
Clinical Outcome: Gain in keratinized tissue	Clinical outcome, including gain in keratinized tissue (KT, mm)	4 months after surgery
Feasibility of pre-operative ultrasound mapping	ability to visualize and identify relevant arterial branches before surgery (yes/no)	10 minutes before surgery

Collaborators and Investigators

• Sponsor: Universitaire Ziekenhuizen KU Leuven
• Investigators: Principal Investigator: Andy Temmerman, professor, UZLeuven Department of Oral Health Sciences, Periodontology

Study record dates

Study Major Dates

• Study Start (Actual): April 2, 2026
• Primary Completion (Actual): April 30, 2026
• Study Completion (Actual): June 30, 2026

Study Registration Dates

• First Submitted: July 17, 2026
• First Submitted That Met QC Criteria: July 22, 2026
• First Posted (Actual): July 27, 2026

Study Record Updates

• Last Update Posted (Actual): July 27, 2026
• Last Update Submitted That Met QC Criteria: July 22, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: ultrasonography; visualization; Mucogingival surgery; Vascular supply; Coronally Advanced Flap Surgery; arterial structure
• Additional Relevant MeSH Terms: Periodontal Atrophy; Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Gingival Diseases; Gingival Recession
• Other Study ID Numbers: S71602

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No