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Objectives <p>This study aimed to establish a method to detect and quantify mucosal malperfusion intraorally using state-of-the-art Endoscopic Hyperspectral Imaging (EHSI). For this purpose, mucosal ischemia was selectively induced by intraligamentary anesthesia (ILA) with and without + epinephrine using a standardized protocol.</p> Materials and methods <p>EHSI was performed using a novel endoscopic hyperspectral imaging system. Parameters assessed were Tissue Oxygen Saturation (StO<sub>2</sub> [%]), Tissue Hemoglobin Index (THI), Near Infrared Perfusion Index (NPI) and Tissue Water Index (TWI). Fifty-seven healthy subjects received ILA using Articaine 4% with (ILA+) and without (ILA-) epinephrine at a dosage of 1:200,000 administered mesially and distally to the target tooth 42 (Universal No. 26). Mucosal perfusion was assessed using EHSI for 45&#xa0;min post-injection.</p> Results <p>After ILA+, a distinct ischemia of the mucosa was already clinically apparent after 30&#xa0;s with significant reduction of THI and StO<sub>2</sub> by an average of 57% (<i>p</i> &lt; 0.001) and 7% (<i>p</i> &lt; 0.040) compared to baseline values. Persistent hypoperfusion of the oral mucosa was observed throughout the monitoring period, exhibiting a gradual resolution at the 30-minute mark, and nearing baseline perfusion approximately 45&#xa0;min post-injection. There was no papillary necrosis after ILA + injection.</p> Conclusion <p>EHSI is suitable to adequately detect and visualize actual perfusion of the intraoral mucosa. The study revealed that LA with epinephrine (1:200,000) induce temporary hypoxia in the dental papilla but without causing severe ischemia.</p> Clinical relevance <p>EHSI will enable promising applications in the future, i.a. success monitoring of periodontal therapies, intraoral free flap monitoring and the assessment of cancer margins.</p>

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Intraoral perfusion assessment using endoscopic hyperspectral imaging (EHSI)– first description of a novel approach

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月5日

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  • Paul Römer,
  • Sebastian Blatt,
  • Fabia Siegberg,
  • Shankeeth Vinayahalingam,
  • Bilal Al-Nawas,
  • P. W. Kämmerer,
  • Daniel G. E. Thiem

摘要

Objectives

This study aimed to establish a method to detect and quantify mucosal malperfusion intraorally using state-of-the-art Endoscopic Hyperspectral Imaging (EHSI). For this purpose, mucosal ischemia was selectively induced by intraligamentary anesthesia (ILA) with and without + epinephrine using a standardized protocol.

Materials and methods

EHSI was performed using a novel endoscopic hyperspectral imaging system. Parameters assessed were Tissue Oxygen Saturation (StO2 [%]), Tissue Hemoglobin Index (THI), Near Infrared Perfusion Index (NPI) and Tissue Water Index (TWI). Fifty-seven healthy subjects received ILA using Articaine 4% with (ILA+) and without (ILA-) epinephrine at a dosage of 1:200,000 administered mesially and distally to the target tooth 42 (Universal No. 26). Mucosal perfusion was assessed using EHSI for 45 min post-injection.

Results

After ILA+, a distinct ischemia of the mucosa was already clinically apparent after 30 s with significant reduction of THI and StO2 by an average of 57% (p < 0.001) and 7% (p < 0.040) compared to baseline values. Persistent hypoperfusion of the oral mucosa was observed throughout the monitoring period, exhibiting a gradual resolution at the 30-minute mark, and nearing baseline perfusion approximately 45 min post-injection. There was no papillary necrosis after ILA + injection.

Conclusion

EHSI is suitable to adequately detect and visualize actual perfusion of the intraoral mucosa. The study revealed that LA with epinephrine (1:200,000) induce temporary hypoxia in the dental papilla but without causing severe ischemia.

Clinical relevance

EHSI will enable promising applications in the future, i.a. success monitoring of periodontal therapies, intraoral free flap monitoring and the assessment of cancer margins.