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

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.