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Rodriguez Betancourt A, Kripfgans OD, Meneghetti PC, Mendonça G, Pereira R, Teixeira W, Zambrana N, Samal A, Chan HL. Intraoral ultrasonography image registration for evaluation of partial edentulous ridge: A methodology and validation study. J Dent 2024; 148:105136. [PMID: 38885734 DOI: 10.1016/j.jdent.2024.105136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES Ultrasound (US) reveals details for diagnosing soft- and hard-tissue dimensions around teeth, implants, and the edentulous ridge, not seen in 2D radiographs. Co-registering free-hand US scans with other 3D modalities presents reliability challenges. This study first aims to develop and validate a registration method to longitudinally reproduce US images of the jawbone on a simulator. In addition, it also evaluates the degree of the anatomical match in humans between US images acquired by the proposed registration method and the commonly used freehand acquisitions in comparison to cone beam computed tomography (CBCT) and intra-oral optical scan (IOS), used as references. METHODS A previously introduced ultrasound phantom was employed as a CBCT-US hybrid, suitable for training and technique development of US guides in edentulous ridges. After establishing feasibility in the phantom, the methodology was validated in a cohort of 24 human subjects (26 cases). Soft tissues were delineated on US and IOS, and hard tissues on US and CBCT. US accuracy and repeatability from both guided and freehand scans (non-guided) was assessed as the average distance between US and the references. RESULTS Guided US images resembled the references more closely than freehand (non-guided) scans. Notably, delineation of soft and hard tissues was significantly more accurate when employing guides. In the phantom, guided scans exhibited an absolute mean deviation of 81.8 µm for gingiva and 90.4 µm for bone, whereas non-guided scans showed deviations of 150.4 µm and 177.2 µm, respectively. Similarly, in vivo, guided US outperformed non-guided US, with gingiva deviations of 125 µm and 196 µm, and bone deviations of 354 µm and 554 µm, respectively. CONCLUSIONS By using a registration method, guided US scans improved repeatability and accuracy of mapping hard and soft tissue of the edentulous ridge when compared to non-guided scans. CLINICAL RELEVANCE This guided US imaging method could lay the foundation for longitudinal evaluation of tissue behavior and dimensional changes with improved accuracy.
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Affiliation(s)
- Amanda Rodriguez Betancourt
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA; Department of Periodontics, University of Illinois Chicago, College of Dentistry, Chicago, IL, USA
| | - Oliver D Kripfgans
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Priscila Ceolin Meneghetti
- Department of Restorative Sciences, University of Alabama School of Dentistry, Birmingham, AL, USA; Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Gustavo Mendonça
- Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA; Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
| | - Rafael Pereira
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Wendel Teixeira
- Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Nataly Zambrana
- Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Ankita Samal
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA; Division of Periodontology, the Ohio State University, College of Dentistry, Columbus, OH, USA.
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Palombo D, Dobos A, Duran ML, Esporrin JS, Sanz M. Harvest of epithelialized gingival grafts without application of hemostatic sutures: A randomized clinical trial using laser speckle contrast imaging. J Periodontol 2024. [PMID: 38937873 DOI: 10.1002/jper.23-0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND This randomized controlled trial with two parallel arms and a 1:1 allocation ratio aimed to compare early microvascular healing (primary outcome), surgical times, and patient-reported outcomes (PROM) after harvesting palatal epithelialized gingival grafts (EGG), where hemostasis was achieved with sutures and hemostatic sponges (control) or with a sutureless approach (test). METHODS From a total of 33 patients, 34 EGG were harvested. Thirty-two were randomized to the test/control group (n = 16) and two were excluded. Early palatal microvascular healing was assessed at 7, 14, and 30 days with laser speckle contrast imaging (LSCI). Postoperative bleeding, pain, discomfort, and analgesic consumption were assessed over 2 weeks with a dedicated questionnaire. RESULTS A faster onset and resolution of postharvest hyperemia was observed in the test group where peak blood flow was reached at 7 days. No significant blood flow differences were observed between the groups at any of the evaluated timepoints. The mean surgical time was 13 min shorter in the test (p = 0.00). No significant differences were observed for postoperative bleeding and analgesic consumption at any timepoint. CONCLUSIONS The tested approach represents a viable alternative to the standard one, providing no relevant differences in microvascular, clinical, and patient-related results, but with significantly shorter surgical times.
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Affiliation(s)
- David Palombo
- Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Andrea Dobos
- Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Mercedes Lopez Duran
- Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Javier Sanz Esporrin
- Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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Ajan A, Roberg K, Fredriksson I, Abtahi J. Reproducibility of Laser Doppler Flowmetry in gingival microcirculation. A study on six different protocols. Microvasc Res 2024; 153:104666. [PMID: 38301938 DOI: 10.1016/j.mvr.2024.104666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Laser Doppler Flowmetry (LDF) is a non-invasive technique for the assessment of tissue blood flow, but increased reproducibility would facilitate longitudinal studies. The aim of the study was to assess the interday reproducibility of Laser Doppler Flowmetry (LDF) at rest, at elevated local temperatures, and with the use of the vasodilator Methyl Nicotinate (MN) in six interconnected protocols for the measurement of the blood supply to the microvascular bed of the gingiva. METHODS Ten healthy volunteers were included. Interweek LDF measurements with custom-made acrylic splints were performed. Six protocols were applied in separate regions of interest (ROI): 1; basal LDF, 2; LDF with thermoprobe 42 °C, 3; LDF with thermoprobe 45 °C, 4; LDF with thermoprobe 42 °C and MN, 5; LDF with thermoprobe 45 °C and MN and 6; LDF with MN. RESULTS Intra-individual reproducibility was assessed by the within-subject coefficient of variation (wCV) and the intraclass correlation coefficient (ICC). Basal LDF measurements demonstrated high reproducibility with wCV 11.1 in 2 min and 10.3 in 5 min. ICC was 0.9 and 0.92. wCV after heat and MN was 4.9-10.3 and ICC 0.82-0.93. The topically applied MN yielded increased blood flow. CONCLUSION This is the first study evaluating the reproducibility of basal LDF compared to single or multiple vasodilatory stimuli in gingiva. Multiple collector fibers probe and stabilizing acrylic splints are recommended. Vasodilatory stimulation showed a tendency toward higher reproducibility. Furthermore, MN yields vasodilation in gingiva.
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Affiliation(s)
- Aida Ajan
- Department of Oral and Maxillofacial Surgery, Linköping University Hospital, Linköping, Sweden; Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden.
| | - Karin Roberg
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden; Department of Otorhinolaryngology in Linköping, Region Östergötland, Linköping, Sweden.
| | - Ingemar Fredriksson
- Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden.
| | - Jahan Abtahi
- Department of Oral and Maxillofacial Surgery, Linköping University Hospital, Linköping, Sweden; Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden.
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Okada Y, Sato T, Islam ST, Ohke H, Saitoh M, Ishii H. Site-specific autonomic vasomotor responses and their interactions in rat gingiva. Microvasc Res 2024; 152:104646. [PMID: 38092222 DOI: 10.1016/j.mvr.2023.104646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
Blood flow in the gingiva, comprising the interdental papilla as well as attached and marginal gingiva, is important for maintaining of gingival function and is modulated by risk factors such as stress that may lead to periodontal disease. Marked blood flow changes mediated by the autonomic (parasympathetic and sympathetic) nervous system may be essential for gingival hemodynamics. However, differences in autonomic vasomotor responses and their functional significance in different parts of the gingiva are unclear. We examined the differences in autonomic vasomotor responses and their interactions in the gingiva of anesthetized rats. Parasympathetic vasodilation evoked by the trigeminal (lingual nerve)-mediated reflex elicited frequency-dependent blood flow increases in gingivae, with the increases being greatest in the interdental papilla. Parasympathetic blood flow increases were significantly reduced by intravenous administration of the atropine and VIP antagonist. The blood flow increase evoked by acetylcholine administration was higher in the interdental papilla than in the attached gingiva, whereas that evoked by VIP agonist administration was greater in the attached gingiva than in the interdental papilla. Activation of the cervical sympathetic nerves decreased gingival blood flow and inhibited parasympathetically induced blood flow increases. Our results suggest that trigeminal-parasympathetic reflex vasodilation 1) is more involved in the regulation of blood flow in the interdental papilla than in the other parts of the gingiva, 2) is mediated by cholinergic (interdental papilla) and VIPergic systems (attached gingiva), and 3) is inhibited by excess sympathetic activity. These results suggest a role in the etiology of periodontal diseases during mental stress.
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Affiliation(s)
- Yunosuke Okada
- Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
| | - Toshiya Sato
- Division of Physiology, Department of Oral Biology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
| | - Syed Taufiqul Islam
- Division of Physiology, Department of Oral Biology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
| | - Hanako Ohke
- Division of Dental Anesthesiology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
| | - Masato Saitoh
- Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
| | - Hisayoshi Ishii
- Division of Physiology, Department of Oral Biology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan.
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Vámos O, Kulcsár N, Mikecs B, Kelemen K, Kaán R, Abafalvi L, Dinya E, Vág J, Hermann P, Kispélyi B. Acute effects of traditional and electronic cigarettes on palatal blood flow in smokers: A cross-over pilot study. J Oral Biol Craniofac Res 2024; 14:152-157. [PMID: 38333089 PMCID: PMC10850968 DOI: 10.1016/j.jobcr.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/12/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
Background Smoking is a significant health hazard and contributes to cardiovascular and pulmonary diseases. It can increase postoperative complications during oral and maxillofacial surgery due to its topical effect on the oral mucosa. New alternatives to traditional tobacco products are gaining popularity, in particular, electronic cigarettes. Objectives This pilot study investigated the acute effects of nicotine-containing and nicotine-free electronic cigarettes on palatal blood flow (PBF), and compared their effects to traditional cigarettes. Materials and methods 14 medically healthy volunteers (8 males, 6 females, age: 34.7 ± 7.0) were recruited for the study. All patients (N = 14) were requested to smoke nicotine-containing (ECN) and nicotine-free electronic cigarettes (EC0) and a mouthpiece (end of a traditional cigarette) as a control sham smoking blind test (BT). EC users did not smoke a traditional cigarette (TC), resulting in 10 people in the TC group. Palatal blood flow was measured by Laser Speckle Contrast Imager before, immediately after, and 15 min after the exposures. Exhaled carbon monoxide (eCO) and carboxyhemoglobin (COHb) were measured before and immediately after smoking with a piCO+ Smokerlyzer machine. Results In all groups, no significant differences were observed in the changes of palatal blood flow between time points. Exhaled carbon monoxide and carboxyhemoglobin were significantly higher in the traditional cigarette (TC) group compared to the nicotine-containing electronic cigarette (ECN) and nicotine-free electronic cigarette (EC0) groups, both before and after the exposure (p < 0.05). Conclusion Acute use of either traditional or electronic cigarettes may have minimal impact on palatal blood flow, but additional studies are required to clarify their impact on the mucosa.
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Affiliation(s)
- Orsolya Vámos
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Norbert Kulcsár
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Barbara Mikecs
- Department of Restorative Dentistry and Endodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Kata Kelemen
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Réka Kaán
- Department of Oral Health Sciences, KU Leuven, Oude Markt 13, 3000, Leuven, Belgium
| | - Lilla Abafalvi
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Elek Dinya
- Institute of Digital Health Sciences, Faculty of Public Services, Semmelweis University, Üllői Road 26, Budapest, H-1085, Hungary
| | - János Vág
- Department of Restorative Dentistry and Endodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Péter Hermann
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Barbara Kispélyi
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
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Shahbazi A, Sculean A, Baksa G, Gschwindt S, Molnár B, Vág J, Bogdán S. Intraosseous arterial alteration of maxilla influencing implant-related surgeries. Clin Oral Investig 2023; 27:5217-5221. [PMID: 37460902 PMCID: PMC10492683 DOI: 10.1007/s00784-023-05141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/04/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVES To investigate the intraosseous arterial pathways and anastomoses in the alveolar aspects of the maxilla in order to better understand the arterial scattering pattern. MATERIALS AND METHODS Eleven cadavers were selected for macroscopic intraosseous arterial analyses by corrosion casting. The red-colored acrylic resin was injected into the external carotid arteries. The specimens were kept in an enzymatic solution at 36 °C for about 60 days, depending on the process progression. After removal of the soft tissues and drying, the bone was macerated by potassium hydroxide to analyze the course and the mean diameters of the intraosseous anastomoses. RESULTS Vertico-oblique and horizontal intraosseous arteries and anastomoses between the greater palatine-, posterior superior alveolar-, and infraorbital arteries were detected. The vertico-oblique anastomoses were found on the anterolateral wall of the maxilla and the alveolar crest with a mean diameter of 0.46 mm; nevertheless, the horizontal (transalveolar) anastomoses were identified in the interdental septum/alveolar crest with the mean diameter of 0.41 mm. From the horizontal anastomoses, small intraseptal branches supplied the territory of the alveolar socket in various directions. CONCLUSIONS The localization of intraosseous arterial anastomoses is critical in implant-related surgeries, predominantly to maintain proper circulation. CLINICAL RELEVANCE Based on vertico-oblique and transalveolar anastomoses, simultaneous buccal- and palatal flap elevation (particularly on the palatal side) should be avoided to minimize patient morbidity and intra- or postoperative complications. Moreover, preserving transverse loops in the interdental septum is essential during implant surgeries, which can significantly influence collateral periosteal and osteal circulation to prevent ischemia.
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Affiliation(s)
- Arvin Shahbazi
- Department of Anatomy, Histology and Embryology (Oral Morphology Group), Semmelweis University, Budapest, Hungary.
- Department of Periodontology, Semmelweis University, Budapest, Hungary.
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary.
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Gábor Baksa
- Department of Anatomy, Histology and Embryology (Oral Morphology Group), Semmelweis University, Budapest, Hungary
| | - Sebastian Gschwindt
- Department of Anatomy, Histology and Embryology (Oral Morphology Group), Semmelweis University, Budapest, Hungary
| | - Bálint Molnár
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - János Vág
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary
| | - Sándor Bogdán
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Budapest, Hungary
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Velasquez-Plata D. Osseous topography in biologically driven flap design in minimally invasive regenerative therapy: A classification proposal. Clin Adv Periodontics 2022; 12:251-255. [PMID: 36281479 DOI: 10.1002/cap.10209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/17/2022] [Indexed: 11/06/2022]
Abstract
Minimally invasive periodontal regenerative surgical procedures are a paradigm shift that demands a unique approach encompassing specialized armamentarium, magnification tools, knowledge of handling properties of biomaterials, and specific flap designs. Biologically driven flap design is dictated by optimal soft and hard tissue handling, flap perfusion, and wound stability, all in the pursuit of primary intention healing. The unique architecture of the infrabony defect is a determining factor on incision tracing, boundaries of flap extension, and biomaterial selection. The purpose of this article is to propose a flap design classification based on the osseous topography of infrabony defects during biologically driven minimally invasive surgical periodontal regenerative therapy.
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Affiliation(s)
- Diego Velasquez-Plata
- Private Practice, Fenton, Michigan, USA.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Vág J, Nagy TL, Mikecs B. Sex-related differences in endothelium-dependent vasodilation of human gingiva. BMC Oral Health 2022; 22:177. [PMID: 35562729 PMCID: PMC9107103 DOI: 10.1186/s12903-022-02186-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sex hormones influence circulation, periodontitis, and wound healing. The aim of the study was to compare the endothelium-dependent and independent vasodilation in human gingiva in men and women. Methods Gingival blood flow was evaluated in twelve male and twelve female subjects with healthy gingiva and no systemic conditions after acetylcholine or nitric oxide donor (NitroPOHL). Agonists were administered into the gingival sulcus at the right secondary incisor (test site). Regional gingival blood flow (GBF) was imaged by Laser Speckle Contrast Imager from the marginal gingiva to the mucogingival junction in four consecutive regions (coronal, midway1, midway2 and apical). Blood flow was expressed in Laser Speckle Perfusion Unit (LSPU). The absolute maximal blood flow change (Dmax), the area under the blood flow curve (AUC), and the time to peak (TTP) were calculated.
Results Males had higher baseline GBF than females (257 ± 18.2 vs. 225 ± 18.8 LSPU, p < 0.001). Acetylcholine and NitroPOHL significantly increased the GBF in all test regions. The Dmax after the acetylcholine was reduced apically compared to the coronal (90 ± 13 LSPU vs. 117 ± 7 LSPU, p < 0.01), but it was similar after NitroPOHL (78 ± 9 LSPU vs. 86 ± 6 LSPU, p = 0.398) in both sexes. The Dmax and AUC were higher, and the TTP was smaller in men in most regions after acetylcholine but not after NitroPOHL. Conclusion In the human gingiva, the endothelium-independent vasodilation propagates without attenuation in the line of the vascular supply in both sexes. At the same time, the endothelium-dependent ascending vasodilation attenuates similarly in men and women. However, men had more pronounced endothelium-dependent vasodilation than women. Therefore, it might contribute to the increased severity of periodontal disease in men. Trial registration The study was registered with ClinicalTrials.gov on 09.06.2021 (NCT04918563).
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Affiliation(s)
- János Vág
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Szentkirályi utca 47, Budapest, 1088, Hungary.
| | - Tamás László Nagy
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Szentkirályi utca 47, Budapest, 1088, Hungary
| | - Barbara Mikecs
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Szentkirályi utca 47, Budapest, 1088, Hungary
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Townsend D. Identification of venular capillary remodelling: a possible link to the development of periodontitis? J Periodontal Implant Sci 2022; 52:65-76. [PMID: 35187874 PMCID: PMC8860762 DOI: 10.5051/jpis.2101160058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/13/2021] [Accepted: 08/23/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- David Townsend
- Periodontology Unit, UCL Eastman Dental Institute, UCL, University of London, London, UK
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Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone. BMC Oral Health 2021; 21:160. [PMID: 33766000 PMCID: PMC7995803 DOI: 10.1186/s12903-021-01445-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/18/2021] [Indexed: 02/07/2023] Open
Abstract
Background The active arterial-to-arterial collaterals are a significant factor in the prevention of ischemia and extensive tissue necrosis in the case of arterial blockage of various tissues. The present study investigates the mucogingival vasculature in the maxillary esthetic zone mucosa in human cadavers and functionally evaluates the area, which is supplied by the terminal arterioles, on the individual level. Methods In the human cadaver study, macroscopic arterial analyses of the anterior maxillary vestibule in 7 specimens were scrutinized by latex milk injection. The tracks of the mucosal branches in relation to the mucogingival junction were investigated. In the functional study, individual gingival blood flow (GBF) changes were measured by laser speckle contrast imaging (LSCI) in 31 young subjects with healthy gingiva before and during 30-s compressions. This was conducted with a ball-shaped condenser. The data was analyzed by the linear mixed model. Results The vertically aligned branches of the superior labial artery (SLA) divided into small, slightly deviating sub-branches near the mucogingival junction. These arteries created collateral plexuses and supplied the attached gingiva. The compression of these branches resulted in ischemia coronally with significant individual variation. The ischemia was either apico-mesial, apico-distal, or straight apical to the compression. A significant correlation was found between the ischemic area and the magnitude of the decrease in GBF (r = 0.81, p < 0.001). In males, 77% of the subjects, and 50% of the female subjects had an ischemic response in either region. The horizontal extension of the ischemic area ranged between 0.26 mm and 8.76 mm. Males had significantly higher baseline GBF and larger ischemia than females. At the base of the papilla, significant restoration of GBF was observed during compression in males, but not in females. Conclusion The arcade anastomoses formed by the small arteries in the keratinized gingiva of the upper esthetic zone explain the consequences of vertical incisions. The considerable individual variations in ischemic responses might be the reason for unexpected surgical outcomes in some cases. Furthermore, there is increasing evidence that men have different vascular reactivity and/or regulation of collateral circulation than women, which may affect wound healing.
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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; 20:305. [PMID: 33148235 PMCID: PMC7640651 DOI: 10.1186/s12903-020-01296-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background It has been demonstrated in non-oral tissues that the locally evoked vasoconstriction could elicit remote vasoconstriction. This study aimed to investigate the spreading vasoconstrictor effects of epinephrine in the gingiva. Methods Gingival blood flow (GBF) was measured by laser speckle contrast imager in 21 healthy volunteers. In group A, two wells were fabricated from orthodontic elastic ligature and placed 2 mm apically to the free gingival margin at the mid buccal line of 12 (test side) and 21 (control side) teeth. The GBF was measured in the wells and tightly apical, coronal, distal and mesial to the wells. In group B, the wells were made on the buccal surface of the same teeth, including the gingival sulcus. Four regions were selected for measurement from the gingival margin reaching the mucogingival line (coronal, midway1, midway2 and apical). After the baseline recording, 3 µg epinephrine was applied into the test, and physiological saline into the control well. The GBF was recorded for 14 min. The gingival thickness was measured with a PIROP Ultrasonic Biometer. Results In group A, the GBF did not increase or decrease after the application of epinephrine. In group B, the GBF significantly decreased in all regions of the test side and remained low for the observation period. The vasoconstriction appeared with delays in more apical regions (at min 1 in the coronal and the midway1, at min 2 in the midway2, at min 4 in the apical region). Similarly, the amount of the decrease at 14 min was the largest close to sulcus (− 53 ± 2.9%), followed by the midway1 (− 51 ± 2.8%) and midway2 (− 42 ± 4.2%) and was the lowest in the apical region (− 32 ± 5.8%). No correlation was found between GBF and gingival thickness. Conclusion Epinephrine could evoke intense vasoconstriction propagating to the mucogingival junction, indicating the presence of spreading vasoconstriction in the human gingiva. The attached gingiva is impermeable to epinephrine, unlike the gingival sulcus. This trial was registered in ClinicalTrials.gov titled as Evidence of Spreading Vasoconstriction in Human Gingiva with the reference number of NCT04131283 on 16 October 2019. https://clinicaltrials.gov/show/NCT04131283
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Affiliation(s)
- János Vág
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary.
| | - Bernadett Gánti
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
| | - Barbara Mikecs
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
| | - Enikő Szabó
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
| | - Bálint Molnár
- Department of Periodontology, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
| | - Zsolt Lohinai
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
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Wada-Takahashi S, Hidaka KI, Yoshino F, Yoshida A, Tou M, Matsuo M, Takahashi SS. Effect of physical stimulation (gingival massage) on age-related changes in gingival microcirculation. PLoS One 2020; 15:e0233288. [PMID: 32433681 PMCID: PMC7239467 DOI: 10.1371/journal.pone.0233288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/03/2020] [Indexed: 11/18/2022] Open
Abstract
The decline in circulatory function with aging may be alleviated by a combination of gingival massage (physical stimulation) and mechanical cleaning. Several studies have reported the systemic effect of physical stimulation on various parts of the body, including its therapeutic effect on pain in the neck and shoulders that becomes evident with age, and improvement in blood circulation. In contrast, few studies have reported on the changes in gingival microcirculation induced by gingival massage, while no previous study has evaluated the effect of gingival microcirculation on age-related changes in the hemodynamics of the oral cavity. This study aimed to investigate how gingival massage affects age-related changes in gingival microcirculation. Male Wistar rats (7-week, 6-month and 1-year old) were prepared for a gingival massage group and a control group. Mechanical stimulation was applied on the maxillary molar gingiva for 5 seconds twice a week for 4 weeks. Subsequently, gingival reactive hyperemia was measured using a laser Doppler flowmeter. In addition, morphological analyses were also performed by hematoxylin and eosin and Indian ink staining and a vascular resin cast model. Base Flow, maximum response (Peak), and time required for the maximum response to halve (T1/2) were reduced in 1-year-old rats compared with the other age groups. In the mechanical stimulated group, T1/2 was increased in 7-week, 6-month, and 1-year-old rats, and total blood flow (Mass) was increased in 6-month and 1-year-old rats. In addition, clear blood vessel networks and loop-like revascularization were only observed in the mechanical stimulated group. Changes in age-related decline in gingival microcirculatory function and vascular construction were reported in this study, and the results suggested that gingival massage activates both the functional and morphological aspects of gingival microcirculation and may be effective for maintaining oral health.
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Affiliation(s)
- Satoko Wada-Takahashi
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
- * E-mail: (SWT); (SST)
| | - Ko-ichi Hidaka
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Fumihiko Yoshino
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Ayaka Yoshida
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Masahiro Tou
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Masato Matsuo
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Shun-suke Takahashi
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
- * E-mail: (SWT); (SST)
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13
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Fazekas R, Molnár B, Kőhidai L, Láng O, Molnár E, Gánti B, Michailovits G, Windisch P, Vág J. Blood flow kinetics of a xenogeneic collagen matrix following a vestibuloplasty procedure in the human gingiva-An explorative study. Oral Dis 2019; 25:1780-1788. [PMID: 31336001 DOI: 10.1111/odi.13163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/24/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of the present study was to investigate temporal and spatial blood flow patterns following vestibuloplasty procedures using a collagen matrix (CM) to get an insight into the timing and direction of neovascularization in the CM. METHODS Five patients were treated using a modified apically repositioned flap combined with a CM. Intraoral photographs and blood flow measurements by laser speckle contrast imaging were taken for 12 months. Thirty regions of interest in the graft and the surrounding mucosa were evaluated. The clinical parameters were assessed after 6 and 12 months. VEGF expression was analyzed in the wound fluid on days 2 and 4. RESULTS At 6 months, the mean width of keratinized gingiva increased, but the thickness was unchanged. Scar formation was observed in all cases. Perfusion in the graft began to increase at the lateral and coronal edges and then spread concentrically toward the center. The apical side showed a significant delay in perfusion, the highest VEGF expression, and wound fluid production as well as the most abundant scar formation. CONCLUSIONS Neovascularization occurs mainly from the lateral and coronal edges, which may limit the extent of the surgical area. Abundant scar formation may be explained by increased VEGF expression induced by prolonged ischemia in this area.
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Affiliation(s)
- Réka Fazekas
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Bálint Molnár
- Department of Periodontology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - László Kőhidai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Orsolya Láng
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Eszter Molnár
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Bernadett Gánti
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Georgina Michailovits
- Department of Periodontology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Péter Windisch
- Department of Periodontology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - János Vág
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
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14
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Heeman W, Steenbergen W, van Dam GM, Boerma EC. Clinical applications of laser speckle contrast imaging: a review. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-11. [PMID: 31385481 PMCID: PMC6983474 DOI: 10.1117/1.jbo.24.8.080901] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 05/02/2023]
Abstract
When a biological tissue is illuminated with coherent light, an interference pattern will be formed at the detector, the so-called speckle pattern. Laser speckle contrast imaging (LSCI) is a technique based on the dynamic change in this backscattered light as a result of interaction with red blood cells. It can be used to visualize perfusion in various tissues and, even though this technique has been extensively described in the literature, the actual clinical implementation lags behind. We provide an overview of LSCI as a tool to image tissue perfusion. We present a brief introduction to the theory, review clinical studies from various medical fields, and discuss current limitations impeding clinical acceptance.
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Affiliation(s)
- Wido Heeman
- University of Groningen, Faculty Campus Fryslân, Leeuwarden, The Netherlands
- University Medical Centre Groningen, Department of Surgery, Optical Molecular Imaging Groningen, Groningen, The Netherlands
- LIMIS Development BV, Leeuwarden, The Netherlands
| | - Wiendelt Steenbergen
- University of Twente, Techmed Center, Faculty of Science and Technology, Biomedical Photonic Imaging Group, Enschede, The Netherlands
| | - Gooitzen M. van Dam
- University Medical Centre Groningen, Department of Surgery, Optical Molecular Imaging Groningen, Groningen, The Netherlands
| | - E. Christiaan Boerma
- Medical Centre Leeuwarden, Department of Intensive Care, Leeuwarden, The Netherlands
- Address all correspondence to E. Christiaan Boerma, E-mail:
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15
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Gánti B, Molnár E, Fazekas R, Mikecs B, Lohinai Z, Mikó S, Vág J. Evidence of spreading vasodilation in the human gingiva evoked by nitric oxide. J Periodontal Res 2019; 54:499-505. [PMID: 30865289 DOI: 10.1111/jre.12650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/18/2018] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Spreading vasodilation is an important means of increasing local blood flow effectively during increased metabolic demands or in case of vascular injury. Our aim was to develop a technique proving the presence of spreading vasodilation in the human keratinized gingiva. METHODS Local vasodilation was evoked by the application of nitric oxide (NO) donor nitroglycerin into a well, fixed 2 mm above the marginal gingiva, in 20 subjects with healthy periodontal tissue. Either 1 or 8 mg/mL nitroglycerin solutions were dropped into the test well at the upper right second incisor, and saline was applied into the control well at the upper left first incisor. The gingival blood flow (GBF) was recorded for 15 minutes by a laser speckle contrast imager below the well and in the surrounding area in the mesial, distal, apical and coronal directions. Gingival thickness was measured by an ultrasonic biometer. RESULTS Peak GBF increase was similar after 1 mg/mL and after 8 mg/mL nitroglycerin application in the well (51% ± 12% vs 42% ± 8%) and in the apical region (33 ± 9% vs 55% ± 13%). While the lower dose of nitroglycerin increased GBF only in the apical region around the well, the higher dose induced significant elevations in all surrounding regions, with apical prominence. Hyperaemia lasted 10-14 minutes in the low-dose group whereas it extended beyond the observation period in the high-dose group. Neither the baseline nor the NO-induced peak GBF were correlated with gingival thickness. CONCLUSION The role of the direct effect of NO in the regulation of perfusion was demonstrated in the human gingiva as well as the propagation of local vasodilation to distant, especially apical areas, probably by the mechanism of flow-mediated dilation. This mechanism may have a clinical importance for flap survival or wound healing.
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Affiliation(s)
- Bernadett Gánti
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
| | - Eszter Molnár
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
| | - Réka Fazekas
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
| | - Barbara Mikecs
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
| | - Zsolt Lohinai
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
| | - Sándor Mikó
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
| | - János Vág
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
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16
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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; 44:378-383. [PMID: 29870305 DOI: 10.1563/aaid-joi-d-17-00295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Réka Fazekas
- 1 Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Eszter Molnár
- 1 Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Pál Nagy
- 2 Department of Periodontology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Barbara Mikecs
- 1 Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Péter Windisch
- 2 Department of Periodontology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - János Vág
- 1 Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
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