Evaluation of Laser Speckle Contrast Imaging for the Assessment of Oral Mucosal Blood Flow following Periodontal Plastic Surgery: An Exploratory Study

Abstract

The laser speckle contrast imaging (LSCI) is proved to be a reliable tool in flap monitoring in general surgery; however, it has not been evaluated in oral surgery yet. We applied the LSCI to compare the effect of a xenogeneic collagen matrix (Geistlich Mucograft®) to connective tissue grafts (CTG) on the microcirculation of the modified coronally advanced tunnel technique (MCAT) for gingival recession coverage. Gingival microcirculation and wound fluid were measured before and after surgery for six months at twenty-seven treated teeth. In males, the flap microcirculation was restored within 3 days for both grafts followed by a hyperemic response. During the first 8 days the blood flow was higher at xenogeneic graft comparing to the CTG. In females, the ischemic period lasted for 7-12 days depending on the graft and no hyperemic response was observed. Females had more intense and prolonged wound fluid production. The LSCI method is suitable to capture the microcirculatory effect of the surgical intervention in human oral mucosa. The application of xenogeneic collagen matrices as a CTG substitute does not seem to restrain the recovery of graft bed circulation. Gender may have an effect on postoperative circulation and inflammation.

Conflict of interest statement

All authors declare that they have no conflict of interests.

Figures

Figure 1

Representative photographs and LSCI images of a male (a, b, e, f) and a female (c, d, g, h) subjects. Combination of the modified coronally advanced tunnel and Geistlich Mucograft in both cases. (a, b, c, d) Images representing the preoperative perfusion. (e, f, g, h) Images showing the wound healing and perfusion 3 days postoperatively. Capital letters (A, B, and C) indicate the regions of interest for the blood flow evaluation.

Figure 2

Time-course of the changes of gingival blood flow (BF) in zone A, expressed in Laser Speckle Perfusion Unit (LSPU). Time points include preoperative data (bsl.) and postoperative days (1 to 180). Data are presented as means ± SE. In (a, b), statistically significant differences in the postoperative values versus bsl. are indicated by × in Geistlich Mucograft (n = 14) and by + in CTG (n = 13). The differences between grafts at the respective time points are indicated by #. In (c, d), the same data are shown in a different grouping as gender differences are depicted separately for Geistlich Mucograft and for CTG. ∗ indicates significantly different time points between the genders. ×, +, #, and ∗ mark significance levels of p < 0.05 after being adjusted by the Benjamini and Hochberg method.

Figure 3

Time-course of the changes of gingival blood flow (BF) in zone B, expressed in Laser Speckle Perfusion Unit (LSPU). Time points include preoperative data (bsl.) and postoperative days (1 to 180). Data are presented as means ± SE. In (a, b), statistically significant differences of the postoperative values versus bsl. are indicated by × in Geistlich Mucograft (n = 14) and by + in CTG (n = 13). The differences between grafts at the respective time points are indicated by #. In (c, d), the same data are shown in a different grouping as gender differences are depicted separately for Geistlich Mucograft and for CTG. ∗ indicates significantly different time points between the genders. ×, +, #, and ∗ mark significance levels of p < 0.05 after being adjusted by the Benjamini and Hochberg method.

Figure 4

Time-course of the changes of gingival blood flow (BF) in zone C, expressed in Laser Speckle Perfusion Unit (LSPU). Time points include preoperative data (bsl.) and postoperative days (1 to 180). Data are presented as means ± SE. In (a, b), statistically significant differences of the postoperative values versus bsl. are indicated by × in Geistlich Mucograft (n = 14) and by + in CTG (n = 13). The differences between grafts at the respective time points are indicated by #. In (c, d), the same data are shown in a different grouping as gender differences are depicted separately for Geistlich Mucograft and for CTG. There were no significant differences observed between the genders. ×, +, and # indicate significance levels of p < 0.05 after being adjusted by the Benjamini and Hochberg method.

Figure 5

The effect of time, graft, and gender on wound fluid (WF) production. The two upper graphs (a and b) show the interaction between graft and gender in wound fluid (WF) production during the whole period, expressed in Periotron Scores (PS). The lower plot (c) shows the changes of WF production over time when the graft data were grouped. Time points include preoperative data (bsl.) and postoperative days (1 to 180). Data are presented as means ± SE. Statistically significant differences of the postoperative values versus bsl. are indicated by × in females and by + in males. The differences between the genders are indicated by ∗ (p < 0.05, adjusted by the Benjamini and Hochberg method).