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Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone
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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995803/ https://www.ncbi.nlm.nih.gov/pubmed/33766000 http://dx.doi.org/10.1186/s12903-021-01445-y |
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author | Mikecs, Barbara Vág, János Gerber, Gábor Molnár, Bálint Feigl, Georg Shahbazi, Arvin |
author_facet | Mikecs, Barbara Vág, János Gerber, Gábor Molnár, Bálint Feigl, Georg Shahbazi, Arvin |
author_sort | Mikecs, Barbara |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7995803 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-79958032021-03-30 Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone Mikecs, Barbara Vág, János Gerber, Gábor Molnár, Bálint Feigl, Georg Shahbazi, Arvin BMC Oral Health Research Article 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. BioMed Central 2021-03-25 /pmc/articles/PMC7995803/ /pubmed/33766000 http://dx.doi.org/10.1186/s12903-021-01445-y Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Mikecs, Barbara Vág, János Gerber, Gábor Molnár, Bálint Feigl, Georg Shahbazi, Arvin Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone |
title | Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone |
title_full | Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone |
title_fullStr | Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone |
title_full_unstemmed | Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone |
title_short | Revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone |
title_sort | revisiting the vascularity of the keratinized gingiva in the maxillary esthetic zone |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995803/ https://www.ncbi.nlm.nih.gov/pubmed/33766000 http://dx.doi.org/10.1186/s12903-021-01445-y |
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