Innovations in microsurgery: The role of non-invasive blood perfusion imaging-A review and framework.

[BACKGROUND] This review evaluates current literature on non-invasive blood perfusion imaging in periodontology, with a focus on applications in periodontal microsurgery.

[METHODS] A hypothesis-building review was conducted by two reviewers from January 2022 to April 2025 across multiple databases.

[RESULTS] Laser speckle contrast imaging (LSCI) and ultrasound (US) emerged as the most promising modalities. LSCI measures superficial gingival perfusion with high spatial resolution, demonstrating sensitivity to vascular dynamics and sex-related differences during tissue compression. US, using B-mode and color flow-based imaging, provides both anatomical and functional assessment of gingival and peri-implant tissues, showing correlations with inflammation and healing outcomes. Both techniques have been validated in clinical and preclinical settings as reliable tools for assessing perfusion during regenerative procedures. A clinical case illustrates the use of LSCI and US to evaluate blood perfusion in a grafted alveolar ridge.

[CONCLUSIONS] Blood perfusion is a key factor in wound healing, heavily influenced by surgical trauma and flap tension. Microsurgical techniques may improve outcomes by minimizing soft tissue trauma and preserving vascular integrity during flap procedures. LSCI and US together could offer complementary, real-time, chairside imaging to monitor perfusion, advancing personalized treatment strategies and improving prediction of healing outcomes in periodontal and peri-implant therapy.

[KEY POINTS] Laser speckle contrast imaging (LSCI) and ultrasound (US) emerge as the leading non-invasive modalities for assessing periodontal tissue perfusion, with LSCI capturing superficial microvascular flow and US providing complementary anatomical and functional detail. Evidence from recent clinical and preclinical studies, and an illustrative case example, demonstrates that both technologies reliably evaluate perfusion during regenerative and microsurgical procedures, including grafted alveolar ridges. Because adequate perfusion is essential for wound healing, integrating LSCI and US into periodontal practice may support real-time, personalized, data-driven clinical decision making and help optimize outcomes in periodontal and peri-implant therapy.

[PLAIN LANGUAGE SUMMARY] This review examines the use of non-invasive imaging technologies to assess blood flow (perfusion) in periodontal tissues, with a focus on their application in periodontal microsurgery. A literature search covering studies published from January 2022 to April 2025 identified laser speckle contrast imaging (LSCI) and ultrasound (US) as the most promising modalities. LSCI provides high-resolution assessment of superficial gingival perfusion and is sensitive to vascular changes, while US, using B-mode and color Doppler, offers both anatomical and functional insights into gingival and peri-implant tissues. Both techniques have demonstrated clinical and preclinical reliability in evaluating perfusion during regenerative procedures, as seen in the literature review. A case example presented by the authors illustrates how LSCI and US can be used in combination to assess blood flow in a grafted alveolar ridge. Adequate perfusion is essential for wound healing and may be compromised by surgical trauma and flap tension. Microsurgical techniques, which aim to minimize tissue trauma and preserve vascular integrity, may enhance healing outcomes. The integration of LSCI and US into clinical practice could enable real-time, chairside assessment of tissue perfusion, supporting more personalized, data-driven decision making in periodontal and peri-implant therapies.