Geometric and Thermal Imaging for Post-operative Changes Following Periodontal Surgery

Objectives: Periodontal surgery is clinically validated for the treatment of periodontitis. There is scant evidence on the differences in post-operative healing following resective periodontal flap (RPF) and simplified papilla preservation flap (SPPF) for the surgical treatment of periodontitis. Intra and extra-oral, non-invasive imaging modalities may allow a comparison of post-operative healing at pre-defined time points relating them with surrogate clinical outcomes of periodontal treatment. The aim is to pilot the use of geometric and thermal imaging in assessing post-operative healing patterns following two periodontal surgical procedures.
Methods: This is a pilot (n=6) where one posterior sextant was randomly assigned to receive RPF or SPPF. Patients received dual facial geometric and thermal and intra-oral digital scans at days 1,3,7,14,30&90. Periodontal parameters (probing depths, clinical attachment levels) were recorded at baseline and day 90 by a calibrated examiner. A region of interest (ROI) corresponding to the surgical area was defined and extra-oral geometric scans were analysed by superimposing baseline images with those from each of the follow-up visits. The signed minimum and maximum differences on the superimposed images, mean (mm) and the volume difference (mm³) were obtained. Thermal images of ROI were superimposed and temperature changes in Celsius from baseline were recorded. Intra-oral geometric scans from the ROI were superimposed, and the signed mean distance (mm) and the volume (mm³) was recorded from the ROI corresponding to the surgical site.
Results: Geometric scans showed a trend for an increase in volume subsequent to both surgical procedures with a tendency for the largest increase to be at day 2 for the extra-oral and day 3 for the intra-oral scans followed by a reduction back to baseline values after day 7. Thermal scans demonstrate a temperature increase at days 2 and 3 . Both volumetric and temperature changes detected differences between RPF and SPPF.
Conclusions: The use of combined facial geometric and thermal extra-oral and intra-oral digital geometric imaging can be utilized to record post-operative changes with different surgical procedures. A larger sample is required to identify if there are significant post-operative healing patterns between different surgical techniques.