{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:27:05Z","timestamp":1792168025079,"version":"4.4.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100014584","name":"Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014584","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Oral Invest"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats: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 +\u2009epinephrine using a standardized protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      EHSI was performed using a novel endoscopic hyperspectral imaging system. Parameters assessed were Tissue Oxygen Saturation (StO\n                      <jats:sub>2<\/jats:sub>\n                      [%]), 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\u00a0min post-injection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After ILA+, a distinct ischemia of the mucosa was already clinically apparent after 30\u00a0s with significant reduction of THI and StO\n                      <jats:sub>2<\/jats:sub>\n                      by an average of 57% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 7% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.040) 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\u00a0min post-injection. There was no papillary necrosis after ILA\u2009+\u2009injection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-025-06197-5","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T05:42:48Z","timestamp":1738734168000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Intraoral perfusion assessment using endoscopic hyperspectral imaging (EHSI)\u2013 first description of a novel approach"],"prefix":"10.1007","volume":"29","author":[{"given":"Paul","family":"R\u00f6mer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Blatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabia","family":"Siegberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankeeth","family":"Vinayahalingam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Al-Nawas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. W.","family":"K\u00e4mmerer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G. E.","family":"Thiem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,5]]},"reference":[{"issue":"1","key":"6197_CR1","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s13005-021-00292-0","volume":"17","author":"DGE Thiem","year":"2021","unstructured":"Thiem DGE et al (2021) Hyperspectral imaging and artificial intelligence to detect oral malignancy - part 1 - automated tissue classification of oral muscle, fat and mucosa using a light-weight 6-layer deep neural network. Head Face Med 17(1):38","journal-title":"Head Face Med"},{"issue":"3","key":"6197_CR2","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1007\/s00784-020-03382-6","volume":"25","author":"DGE Thiem","year":"2021","unstructured":"Thiem DGE et al (2021) Hyperspectral analysis for perioperative perfusion monitoring-a clinical feasibility study on free and pedicled flaps. Clin Oral Investig 25(3):933\u2013945","journal-title":"Clin Oral Investig"},{"issue":"11","key":"6197_CR3","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.3390\/jpm11111101","volume":"11","author":"DGE Thiem","year":"2021","unstructured":"Thiem DGE et al (2021) New Approach to the Old Challenge of Free Flap Monitoring\u2014Hyperspectral Imaging outperforms Clinical Assessment by Earlier Detection of Perfusion Failure. J Personalized Med 11(11):1101","journal-title":"J Personalized Med"},{"key":"6197_CR4","unstructured":"Mathison M, Pepper T (2023) Local anesthesia techniques in Dentistry and oral surgery. In StatPearls. 2023: Treasure Island (FL) ineligible companies. Disclosure: Tom Pepper declares no relevant financial relationships with ineligible companies"},{"issue":"11","key":"6197_CR5","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1046\/j.1365-2591.2002.00592.x","volume":"35","author":"JG Meechan","year":"2002","unstructured":"Meechan JG (2002) Supplementary routes to local anaesthesia. Int Endod J 35(11):885\u2013896","journal-title":"Int Endod J"},{"issue":"1","key":"6197_CR6","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/S0099-2399(82)80312-9","volume":"8","author":"RE Walton","year":"1982","unstructured":"Walton RE, Garnick JJ (1982) The periodontal ligament injection: histologic effects on the periodontium in monkeys. J Endod 8(1):22\u201326","journal-title":"J Endod"},{"issue":"6","key":"6197_CR7","first-page":"289","volume":"33","author":"JP Cassidy","year":"1986","unstructured":"Cassidy JP, Phero JC, Grau WH (1986) Epinephrine: systemic effects and varying concentrations in local anesthesia. Anesth Prog 33(6):289\u2013297","journal-title":"Anesth Prog"},{"issue":"11","key":"6197_CR8","doi-asserted-by":"publisher","first-page":"1562","DOI":"10.14219\/jada.archive.2006.0092","volume":"137","author":"EV Hersh","year":"2006","unstructured":"Hersh EV et al (2006) The pharmacokinetics and cardiovascular effects of high-dose articaine with 1:100,000 and 1:200,000 epinephrine. J Am Dent Assoc 137(11):1562\u20131571","journal-title":"J Am Dent Assoc"},{"issue":"4","key":"6197_CR9","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.1007\/s00784-011-0608-x","volume":"16","author":"M Daublander","year":"2012","unstructured":"Daublander M et al (2012) Clinical use of an epinephrine-reduced (1\/400,000) articaine solution in short-time dental routine treatments\u2013a multicenter study. Clin Oral Investig 16(4):1289\u20131295","journal-title":"Clin Oral Investig"},{"issue":"2","key":"6197_CR10","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/s40368-013-0024-9","volume":"14","author":"PW Kammerer","year":"2013","unstructured":"Kammerer PW et al (2013) Epinephrine-reduced articaine solution (1:400,000) in paediatric dentistry: a multicentre non-interventional clinical trial. Eur Arch Paediatr Dent 14(2):89\u201395","journal-title":"Eur Arch Paediatr Dent"},{"issue":"5","key":"6197_CR11","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1515\/bmt-2017-0084","volume":"63","author":"C Sicher","year":"2018","unstructured":"Sicher C et al (2018) Hyperspectral imaging as a possible tool for visualization of changes in hemoglobin oxygenation in patients with deficient hemodynamics - proof of concept. Biomed Tech (Berl) 63(5):609\u2013616","journal-title":"Biomed Tech (Berl)"},{"issue":"5","key":"6197_CR12","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1177\/193229681000400508","volume":"4","author":"D Yudovsky","year":"2010","unstructured":"Yudovsky D, Nouvong A, Pilon L (2010) Hyperspectral imaging in diabetic foot wound care. J Diabetes Sci Technol 4(5):1099\u20131113","journal-title":"J Diabetes Sci Technol"},{"key":"6197_CR13","unstructured":"Everitt BS, Howell DC (2021) Encyclopedia of statistics in behavioral science, vol 2. Wiley"},{"issue":"5","key":"6197_CR14","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1515\/bmt-2017-0155","volume":"63","author":"A Holmer","year":"2018","unstructured":"Holmer A et al (2018) Hyperspectral imaging in perfusion and wound diagnostics - methods and algorithms for the determination of tissue parameters. Biomed Tech (Berl) 63(5):547\u2013556","journal-title":"Biomed Tech (Berl)"},{"key":"6197_CR15","doi-asserted-by":"crossref","unstructured":"Thiem DGE et al (2021) Hyperspectral imaging to study dynamic skin perfusion after injection of articaine-4% with and without epinephrine-clinical implications on local vasoconstriction. J Clin Med 10(15)","DOI":"10.3390\/jcm10153411"},{"issue":"8","key":"6197_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1117\/1.JBO.22.8.086009","volume":"22","author":"B Fei","year":"2017","unstructured":"Fei B et al (2017) Label-free reflectance hyperspectral imaging for tumor margin assessment: a pilot study on surgical specimens of cancer patients. J Biomed Opt 22(8):1\u20137","journal-title":"J Biomed Opt"},{"issue":"10","key":"6197_CR17","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1007\/s11548-019-02016-x","volume":"14","author":"M Maktabi","year":"2019","unstructured":"Maktabi M et al (2019) Tissue classification of oncologic esophageal resectates based on hyperspectral data. Int J Comput Assist Radiol Surg 14(10):1651\u20131661","journal-title":"Int J Comput Assist Radiol Surg"},{"issue":"1","key":"6197_CR18","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ijom.2009.10.012","volume":"39","author":"F Holzle","year":"2010","unstructured":"Holzle F et al (2010) Results of monitoring fasciocutaneous, myocutaneous, osteocutaneous and perforator flaps: 4-year experience with 166 cases. Int J Oral Maxillofac Surg 39(1):21\u201328","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"8","key":"6197_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1117\/1.JBO.24.8.080901","volume":"24","author":"W Heeman","year":"2019","unstructured":"Heeman W et al (2019) Clinical applications of laser speckle contrast imaging: a review. J Biomed Opt 24(8):1\u201311","journal-title":"J Biomed Opt"},{"issue":"3","key":"6197_CR20","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1177\/1358863X20909433","volume":"25","author":"RK Rogers","year":"2020","unstructured":"Rogers RK et al (2020) Assessment of foot perfusion: overview of modalities, review of evidence, and identification of evidence gaps. Vasc Med 25(3):235\u2013245","journal-title":"Vasc Med"},{"issue":"3","key":"6197_CR21","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1177\/00220345211035684","volume":"101","author":"S Barootchi","year":"2022","unstructured":"Barootchi S et al (2022) Ultrasonographic Tissue Perfusion in Peri-implant Health and Disease. J Dent Res 101(3):278\u2013285","journal-title":"J Dent Res"},{"issue":"3","key":"6197_CR22","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.1007\/s00784-021-04340-6","volume":"26","author":"M Elbarbary","year":"2022","unstructured":"Elbarbary M et al (2022) The applications of ultrasound, and ultrasonography in dentistry: a scoping review of the literature. Clin Oral Investig 26(3):2299\u20132316","journal-title":"Clin Oral Investig"},{"issue":"6","key":"6197_CR23","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1016\/j.tripleo.2008.02.005","volume":"105","author":"S Elad","year":"2008","unstructured":"Elad S et al (2008) The cardiovascular effect of local anesthesia with articaine plus 1:200,000 adrenalin versus lidocaine plus 1:100,000 adrenalin in medically compromised cardiac patients: a prospective, randomized, double blinded study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105(6):725\u2013730","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"issue":"11","key":"6197_CR24","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.14219\/jada.archive.2006.0093","volume":"137","author":"PA Moore","year":"2006","unstructured":"Moore PA et al (2006) The anesthetic efficacy of 4% articaine 1:200,000 epinephrine: two controlled clinical trials. J Am Dent Assoc 137(11):1572\u20131581","journal-title":"J Am Dent Assoc"},{"issue":"2","key":"6197_CR25","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1007\/s00784-013-1010-7","volume":"18","author":"PW Kammerer","year":"2014","unstructured":"Kammerer PW et al (2014) Comparative clinical evaluation of different epinephrine concentrations in 4% articaine for dental local infiltration anesthesia. Clin Oral Investig 18(2):415\u2013421","journal-title":"Clin Oral Investig"},{"issue":"2","key":"6197_CR26","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1902\/jop.2007.060314","volume":"78","author":"PA Moore","year":"2007","unstructured":"Moore PA et al (2007) Hemostatic and anesthetic efficacy of 4% articaine HCl with 1:200,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine when administered intraorally for periodontal surgery. J Periodontol 78(2):247\u2013253","journal-title":"J Periodontol"},{"issue":"8","key":"6197_CR27","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s00715-008-0077-2","volume":"105","author":"W Zugal","year":"2008","unstructured":"Zugal W, Taubenheim L (2008) Komplikationen Und Grenzen Der intraligament\u00e4ren An\u00e4sthesie. Stomatologie 105(8):187\u2013195","journal-title":"Stomatologie"},{"issue":"6","key":"6197_CR28","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1111\/jcpe.13800","volume":"50","author":"L Garcia-Caballero","year":"2023","unstructured":"Garcia-Caballero L et al (2023) Histological and histomorphometric study of human palatal mucosa: implications for connective tissue graft harvesting. J Clin Periodontol 50(6):784\u2013795","journal-title":"J Clin Periodontol"},{"key":"6197_CR29","doi-asserted-by":"crossref","unstructured":"Felli E et al (2022) Hyperspectral imaging in major hepatectomies: preliminary results from the ex-machyna trial. Cancers (Basel) 14(22)","DOI":"10.3390\/cancers14225591"},{"key":"6197_CR30","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.jss.2020.04.001","volume":"254","author":"M Mehdorn","year":"2020","unstructured":"Mehdorn M et al (2020) Hyperspectral imaging (HSI) in Acute Mesenteric Ischemia to detect intestinal perfusion deficits. J Surg Res 254:7\u201315","journal-title":"J Surg Res"},{"issue":"8","key":"6197_CR31","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/S0305-4179(99)00078-9","volume":"25","author":"W Eisenbeiss","year":"1999","unstructured":"Eisenbeiss W, Marotz J, Schrade JP (1999) Reflection-optical multispectral imaging method for objective determination of burn depth. Burns 25(8):697\u2013704","journal-title":"Burns"}],"container-title":["Clinical Oral Investigations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-025-06197-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00784-025-06197-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-025-06197-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T05:15:54Z","timestamp":1741065354000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00784-025-06197-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,5]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["6197"],"URL":"https:\/\/doi.org\/10.1007\/s00784-025-06197-5","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4950763\/v1","asserted-by":"object"}]},"ISSN":["1436-3771"],"issn-type":[{"value":"1436-3771","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,5]]},"assertion":[{"value":"21 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Rhineland-Palate (registration number: 2024\u201317582).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all subjects involved in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The authors declare no conflicts of interest.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}],"article-number":"115"}}