Gingival Perfusion and Tissue Biomarkers During Early Healing of Postextraction Regenerative Procedures: A Prospective Case Series

Abstract

Background Post-extraction alveolar bone loss, mostly affecting the buccal plate, occurs despite regenerative procedures. To better understand possible determinants, this prospective case series assessed gingival blood perfusion and tissue molecular responses in relation to post-extraction regenerative outcomes. Methods Adults scheduled to receive bone grafting in maxillary, non-molar, single tooth extraction site were recruited. Clinical documentation included probing pocket depth (PD), keratinized tissue width (KT), tissue biotype (TB), plaque (P) and bleeding. Wound closure was clinically evaluated. Gingival blood perfusion was measured by Laser Doppler Flowmetry (LDF). Wound fluid (WF) and gingival biopsies were analyzed for protein levels and gene expression, respectively, of relevant molecular markers. Bone healing outcomes were determined radiographically (Cone Beam Computerized Tomography; CBCT). Healing was followed for 4 months. Results Data from 15 patients (50 ± 5 years, 8 males) are reported. Postoperatively, neither complications nor changes in PD, KT or TB were observed. Postoperatively, LDF revealed decreased perfusion followed by hyperemia that persisted 1 month (p≤0.05). WF levels of angiopoietin-2, interleukin-8, tumor necrosis factor-α, and vascular endothelial growth factor peaked on day 6 (p≤0.05) and decreased thereafter. Only interleukin-8 and tumor necrosis factor-α exhibited increased gene expression. Linear bone changes were negligible. Volumetric bone changes were minimal but statistically significant, with more bone loss when membrane was used (p=0.05). Conclusion Gingival blood perfusion following post-extraction bone regenerative procedures follows an ischemia-reperfusion model. Transient increases in angiogenic factor levels and prolonged hyperemia characterize the soft tissue response. These soft tissue responses do not determine radiographic bone changes.

Bone grafting history affects soft tissue healing following implant placement

“…Any unintentional soft tissue tear was recorded. Freeze‐dried bone allograft (FDBA) and collagen membrane used for bone regeneration were identical for all GG cases in the present study 18 . All implant fixtures used were bone level implants with roughened surface, placed under one or two stage surgical protocol.…”

“…). Keratinized Tissue Width (KTW) measurements were taken preoperatively on the mid buccal portion of the surgical site using UNC‐15 probe 18 . Clinical wound healing was scored for each of the following parameters as previously described 18 : erythema (increased redness compared to adjacent non‐operated sites); bleeding (spontaneous bleeding at wound site); necrosis (visual soft and/or hard tissue necrosis at wound site).…”

“…Keratinized Tissue Width (KTW) measurements were taken preoperatively on the mid buccal portion of the surgical site using UNC‐15 probe 18 . Clinical wound healing was scored for each of the following parameters as previously described 18 : erythema (increased redness compared to adjacent non‐operated sites); bleeding (spontaneous bleeding at wound site); necrosis (visual soft and/or hard tissue necrosis at wound site). In addition, clinical wound exposure (farthest distance between flap margins or between flap margin and healing abutment for non‐submerged implant cases, measured with UNC‐15 probe) and hydrogen peroxide test result 18 were recorded.…”

“…Laser Doppler flowmetry (LDF) allows non‐invasive determination of tissue blood perfusion 15 and has been used to ascertain gingival flap perfusion following various periodontal surgeries 16,17 . Alssum et al 18 . used LDF to study buccal flap blood perfusion following bone grafting procedures performed before implant placement.…”

Blood flow kinetics of a xenogeneic collagen matrix following a vestibuloplasty procedure in the human gingiva—An explorative study

“…With a combination of LSCI and wound fluid measurements, we could estimate the proportion of blood supply and diffusion in various regions of the graft. The wound secretion contains a number of angiogenic biomarkers, of which vascular endothelial growth factor (VEGF) is detected the most frequently (Alssum et al, ; Morelli et al, ; Nissen et al, ). VEGF activates the proliferation, migration, and spread of endothelial cells which is required for the sprouting of new vessels (Ferrara, Gerber, & LeCouter, ).…”