Page 102 - Effects of radiotherapy and hyperbaric oxygen therapy on oral microcirculation Renee Helmers

Chapter 5
in controls to maintain standardization. Before each measurement, a barrier to prevent direct contact between the probe and patient saliva during intraoral measurements was prepared using a disposable cap (CytoCam Protection Caps, Braedius Medical, Huizen, The Netherlands) placed on the CC and draped with a large Latex and powder free examination glove (Klinion® Protection, Medico BV, Oud-Beijerland, The Netherlands) with the tip of the middle finger cut off.
Participants were instructed to open their mouth slightly to measure the buccal mucosa and to put the teeth in occlusion to measure the mandibular gingiva. The tip of the handheld unit was placed in gentle contact with 4 regions of interest (ROIs) and always in the same sequential order for each measurement, i.e. the left and right cheek parallel to the upper premolar region, the left and right gingiva in the lower premolar region. The probe was kept exactly perpendicular to the targeted tissue locations with the lens of the probe placed flat over the epithelium of the mucosa. A modified pen grip, a precision grip used by dentists, was applied for stability during gingiva recordings using the adjacent teeth for support. After adjusting proper focus and contrast settings each measurement was performed during careful probe advancement and retraction maneuvers while in contact with the mucosa to ensure maximizing the presence of capillaries and avoiding pressure induced artefacts in the FOV. All image recordings were performed by an investigator (I) trained to manage the handheld device by an experienced researcher (II). An assistant (III) operated the CC PC manually for clip recordings, adjustments of contrast and focus settings, and recording of focal depth (Fd; mm). For each measurement 4 different clips of adjacent sites of 4 s each were recorded and averaged to represent each anatomic ROI. For the control group, all basic hemodynamic data was obtained by the same examiner (IV) prior to performing microcirculation imaging.
Data analysis
Microcirculation recordings were converted into two .avi file formats (full
screen and Automated Vascular Analysis (AVA) software compatible) and
exported using CCTools for analysis. Data was analyzed for Fd, classification
of angioarchitecture, total and functional capillary density (TCD and FCD
respectively), microvascular flow index (MFI), and buccal blood vessel diameter
(Ø ). Three types of classes can be distinguished in angioarchitecture 33: an bv
array of capillary loops (score 1), both capillary loops and vascular network 100