Post-operative Blood Flow Measurements of the Oral Mucosa
Condition: Gingival Recession
MeSH terms: Gingival Recession
Study type: Observational

Summary: 
      Our overall goal is to characterize the role of the microcirculation in healing oral mucosa
      after routinely applied surgery intervention in order to facilitate treatment. Using Laser
      Speckle Contrast Analysis (LASCA), which provides blood perfusion data, the investigators
      will have the possibility to detect functional alterations in gingival microcirculation in
      case of wound healing. After periodontal surgery, by means of the detection of
      microcirculation as a prognostic and diagnostic factor, the investigators can follow-up the
      healing procedure and obtain data so as to design e.g. the incision line that takes
      microvascular anatomy into account, thus result in better wound healing later on.
    

Detailed description: 
      In today's periodontal plastic surgery numerous flap designs with various grafting
      alternatives (auto-allo- or xeno-grafts) are routinely applied. In order to achieve
      uneventful primary intention healing and to allow for graft integration resulting in
      successful clinical outcomes it is important to apply optimized surgical techniques with
      suitable graft materials to address various clinical demands (e.g. recession coverage,
      enlargement of keratinized tissues, correction of periimplant soft tissue deficiencies).
      Graft exposure during soft- and hard tissue augmentation might occur before any chance of
      graft vascularization due to wound healing disturbances and lack of primary intention
      healing. The reasons of flap failure could be compromised flap circulation, which can be
      avoided by proper flap design, tension free flap advancement. The role of flap design on the
      gingival blood flow was investigated after surgery and found that the simplified papilla
      preservation flap resulted in faster recovery of the blood flow than the modified Widman flap
      surgery. In order to minimize trauma on surrounding tissues (i.e. flap) it is recommendable
      to use the least invasive method for flap preparation, which may also protect the underlining
      graft tissue and support quick vascularization. These guidelines led to develop a minimal
      invasive flap design for root coverage surgery, namely supraperiosteal envelope Tunnel
      technique, which was later modified by Azzi et al. to coronally advance the mucogingival
      complex in order to cover the inserted graft. Later it was further modified by introducing
      microsurgical approach. The question still remains to be answered how the Tunnelling
      technique can influence microcirculation of the healing gingiva and how the underlying graft
      tissue affects the overlying mucosal flap.

      Recently a new non-invasive, two dimensional method, namely the laser speckle contrast
      analysis (LASCA) has been introduced to evaluate microcirculation of tissue. Clinical pilot
      studies are suggesting that this technique may be useful tool for assessing the proper
      circulation during surgical intervention and evaluating wound healing in the skin in human.
      This new method may let us monitor the entire surgical area real-time before and during the
      healing period.
    

Intervention name(s): laser speckle contrast imaging of the oral mucosa; wound fluid measurement
Intervention type(s): Device; Device
Intervention description(s): Non-invasive method to measure tissue blood perfusion applied for oral mucosa; Wound fluid at the gingival sulcus was volumetrically measured by Periotron 8000 instrument using filter strip
Other intervention name(s): LASCA, Perimed PSI; Periotron
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Caucasians subjects presenting multiple Miller Class I. and II. gingival recessions
        (Multiple Adjacent Recession Type Defects, MARTD) were recruited in the Department of
        Periodontology in Semmelweis University.
      
Keywords: microcirculation; wound healing; tunnel technique; gingival recession; Mucograft; laser speckle contrast analyzer