This study sought to define the tissue responses at different implant-abutment interfaces by studying bone and peri-implant mucosal changes using a 5-year prospective randomized clinical trial design ...study. The conus interface was compared with the flat-to-flat interface and platform-switched implant-abutment systems.
One hundred forty-one subjects were recruited and randomized to the three treatment groups according to defined inclusion and exclusion criteria. Following implant placement and immediate provisionalization in healed alveolar ridges, clinical, photographic, and radiographic parameters were measured at 6 months and annually for 5 years. The calculated changes in marginal bone levels, peri-implant mucosal zenith location, papillae lengths, and peri-implant Plaque Index and bleeding on probing were statistically compared.
Forty-eight conus interface implants, 49 flat-to-flat interface implants, and 44 platform-switched implants were placed in 141 subjects. Six platform-switched interface and eight flatto- flat interface implants failed, most of them within 3 months. After 5 years, 33 conical interface, 28 flat-to-flat interface, and 27 platform-switched interface implants remained for evaluation. Calculation of marginal bone level change showed a mean marginal bone loss of -0.16 ± 0.45 (-1.55 to 0.65), -0.92 ± 0.70 (-2.90 to 0.20), and -0.81 ± 1.06 (-3.35 to 1.35) mm for conical interface, flat-to-flat interface, and platform-switched interface implants, respectively (P < .0005). The peri-implant mucosal zenith changes were minimal for all three interface designs (0.10 mm and +0.08 mm, P > .60). Only 16% to 19% of the surfaces had presence of bleeding on probing, with no significant differences (P > .81) between groups. Interproximal tissue changes were positive and similar among the implant interface designs.
Over 5 years, the immediate provisionalization protocol resulted in stable peri-implant mucosal responses for all three interfaces. Compared with the flat-to-flat and platform-switched interfaces, the conical interface implants demonstrated significantly less early marginal bone loss. The relationship of marginal bone responses and mucosal responses requires further experimental consideration.
We investigated how processing fluency and defamiliarization (the art of rendering familiar notions unfamiliar) contribute to the affective and esthetic processing of reading in an event-related ...functional magnetic-resonance-imaging experiment. We compared the neural correlates of processing (a) familiar German proverbs, (b) unfamiliar proverbs, (c) defamiliarized variations with altered content relative to the original proverb (proverb-variants), (d) defamiliarized versions with unexpected wording but the same content as the original proverb (proverb-substitutions), and (e) non-rhetorical sentences. Here, we demonstrate that defamiliarization is an effective way of guiding attention, but that the degree of affective involvement depends on the type of defamiliarization: enhanced activation in affect-related regions (orbito-frontal cortex, medPFC) was found only if defamiliarization altered the content of the original proverb. Defamiliarization on the level of wording was associated with attention processes and error monitoring. Although proverb-variants evoked activation in affect-related regions, familiar proverbs received the highest beauty ratings.
Excessive gingival display (EGD), also known as a gummy smile, is characterized by overexposure of the maxillary gingiva on smiling. EGD can cause embarrassment and reduce patient satisfaction. This ...study aimed to evaluate the clinical and psychological effects of lip repositioning surgery on the management of EGD.
This experimental study enrolled 14 patients with EGD who had undergone a modified lip repositioning technique, which comprised moving two strips of mucosa bilaterally to the maxillary labial frenum and repositioning the new mucosal margin coronally. The extent of gingival display (GD), lip mobility (LM), total lip length (TLL), lip length (LL), and internal lip length (ILL) was measured at baseline and 6 months postoperatively. The pre-operative psychological assessment was conducted using the social appearance anxiety scale (SAAS) scores, whereas the postoperative assessment was conducted using SAAS and visual analog scale (VAS) scores at 1 week, 3 months, and 6 months postoperatively.
Among the clinical parameters, TLL increased by 2.0 ± 1.038, LL increased by 2.28 ± 0.99, ILL reduced by 2.78 ± 1.36, LM reduced by 3.21 ± 1.12, and GD reduced by 3.14 ± 0.77 at 6 months postoperatively. Among the psychological parameters, SAAS reduced by 31.42 ± 1.907 from the baseline to 6 months, whereas the VAS score reduced to 3.14 ± 0.27 at 6 months postoperatively.
A significant reduction in GD, which is largely dependent on strict case selection, pain, and social anxiety was observed in this study, indicating that lip repositioning surgery is effective in managing EGD.
Objectives/Hypothesis
Deviations of the caudal nasal septum can impact airflow and aesthetics. The anterior septal reconstruction (ASR) technique, a modification of extracorporeal septoplasty, ...addresses this issue while preserving a segment of the dorsal septum. When ASR is combined with dorsal hump reductions and osteotomies, the keystone may be destabilized. This study evaluates the outcomes of this intervention.
Study Design
Retrospective chart review.
Methods
This is a retrospective study evaluating the functional and aesthetic outcomes of 58 patients who underwent ASR combined with dorsal hump reductions (with or without osteotomies). The Nasal Obstruction Symptom Evaluation (NOSE) and Standardized Cosmesis and Health Nasal Outcomes Survey Obstructive/Cosmetic (SCHNOS‐O, SCHNOS‐C) scores were measured and compared pre‐ and postoperatively. Linear regression analysis was performed to determine the impact of sex, gender, osteotomies, and trauma on outcomes.
Results
Mean improvement in NOSE, SCHNOS‐O, and SCHNOS‐C scores within the first 3 months after surgery were −41.8, −32.6, and −51.5 respectively (P < .05). At follow‐up >9 months, these improvements were also significant for NOSE and SCHNOS‐O scores and approached significance (P = .06) for SCHNOS‐C scores. A subanalysis of patients who underwent osteotomies yielded functional and aesthetic improvements across all follow‐up periods, all of which were significant with the exception of SCHNOS‐O scores at >9 months (P = .1). In a multiple linear regression analysis, osteotomies contributed significantly to change in SCHNOS‐C scores (β = −64.09, P = .001) at 3‐ to 9‐month follow‐up.
Conclusions
The combination of ASR, hump take down, and osteotomies is safe and efficacious with implications for patients who seek correction of caudal septal deviations in conjunction with changes in external contour deformities.
Level of Evidence
3 Laryngoscope, 2020
Periorbital hyperpigmentation (POH) is an aesthetic concern for patients. Etiologies of the condition include pigmentary, structural, vascular, and mixed causes.
To systematically review the current ...literature for treatment of POH.
A systematic literature review was performed on PubMed. Search terms included "infraorbital dark circles," "dark circles," "periorbital hyperpigmentation," "idiopathic hyperchromia AND orbital," "under-eye circles," "ICHOR (idiopathic cutaneous hyperchromia of the orbital region)," "dark circles" AND "treatment," and "filler" AND "dark circles."
A total of 39 studies were included. Effective treatments for POH include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections, blepharoplasty, and normobaric oxygen.
Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss. Blepharoplasty surgery is best when excessive skin laxity is the underlying cause. Various topical creams and chemical peels are useful in treating pigment-based POH, whereas lasers are mildly to moderately beneficial for both vascular and pigment types. Given the scarcity of high-quality evidence supporting these results, recommendations should be interpreted selectively. Additional randomized clinical trials studying POH will be helpful.
This case report introduces digital surgery-first approach orthognathic surgery assisted by three-dimensional virtual planning and combined with invisible orthodontic treatment for a 21-year-old ...female patient with a skeletal Class III high-angle gummy smile malocclusion. We explored the clinical significance of the widespread application of digital technology for rapid development of the orthodontic/orthognathic field. The regional acceleratory phenomenon and clear aligners were used to achieve fast and aesthetic tooth movement after surgery. The treatment lasted only 8 months, and the patient was satisfied with the aesthetic results. The results remained stable after 1 year of follow-up. This case report highlights the advantages of combining a digital design and a surgery-first approach to produce accurate, rapid, safe, stable, and fulfilling cosmetic results. The combination of the surgery-first approach and clear aligners can facilitate patient-oriented surgical orthodontic treatment.
Zirconia has become popular for dental implant abutments in the esthetic zone but can damage the implant connection interface. Studies have been conducted to compare zirconia abutments with ...conventional titanium abutments; however, a consensus or systematic review is lacking.
The purpose of this systematic review was to evaluate the performance of abutments made of zirconia and titanium in relation to wear and misfit at the implant-abutment interface.
Electronic databases (PubMed/MEDLINE, Embase, Web of Science) were independently searched by 2 researchers for relevant studies published up to June 2021. The population, intervention, comparison, outcome (PICO) question was “Do zirconia abutments cause greater wear at the implant-abutment interface than titanium abutments under occlusal forces?” Eligible studies included in vitro studies that evaluated changes in the surface of external and/or internal connections and single and/or multiple, screwed and/or cemented prostheses rehabilitated with titanium and zirconia abutments submitted to mechanical cycling.
Nine studies were included for qualitative analysis. A total of 172 specimens were analyzed, 86 zirconia and 86 titanium abutments. In terms of wear on the implant connection surface, zirconia abutments caused more severe wear, more scratches, and more rounding of the hexagonal angles at the implant connection interface than titanium abutments. In terms of misfit at the connection interface, zirconia abutments showed greater misfit than titanium abutments.
Zirconia abutments produce more wear at the titanium implant connection interface, titanium abutments showed better fit to the implant connection interface, and the fit can be influenced by the abutment manufacturing method.
A long-lasting debate in the field of esthetics is the extent to which beauty is inherent to the object of appreciation or to the subject contemplating it. Several studies suggest that physical ...features of an artwork influence esthetic judgment. Nevertheless, this objectivist approach fails to explain the idiosyncratic nature of esthetic experiences (AE). Recent models propose a multiprocess account of AE, integrating a subjective evaluation based on self-referential processing. Nevertheless, behavioral data supporting this hypothesis is scarce. We took advantage of the self-reference effect (SRE) in memory to test the hypothesis that esthetic judgment is based on self-related processes. We predicted that if esthetic judgment recruits self-referential processing, encoding artworks in this condition should produce a similar mnemonic advantage as the SRE. We showed that at least paintings receiving extreme esthetic judgments were as well recognized as those encoded in self-reference condition.
Background: Vertical releasing incisions might damage the blood supply to the flap and result in unesthetic visible white scars. The aim of the present study was to compare root coverage and esthetic ...outcomes of the coronally advanced flap (CAF) with and without vertical releasing incisions in the treatment of multiple gingival recessions.
Methods: Thirty‐two systemically and periodontally healthy subjects with esthetic complaints due to the exposure of Miller Class I and II multiple (at least two) gingival recession defects (≥1 mm) affecting adjacent teeth of the same quadrant of the upper jaw were enrolled in the study. Sixteen patients (with 45 gingival recessions) were randomly assigned to the control group, and the other 16 patients (with 47 recession defects) were assigned to the test group. All recessions were treated with a CAF; vertical releasing incisions were performed in the control group, whereas an envelope‐type flap was used in the test group. The patient's postoperative morbidity was assessed 1 week after the surgery, whereas the esthetic evaluation, made by the patient and independent periodontist, and the clinical evaluation were made 1 year later.
Results: Surgical time was significantly shorter in the envelope‐type CAF group. No statistically significant difference was demonstrated between the two groups in terms of recession reduction and clinical attachment level gain. A statistically greater probability of complete root coverage (adjusted odds ratio, 3.76; 95% confidence interval: 0.92 to 15.33; P <0.05) and a greater increase in buccal keratinized tissue height were observed with the envelope type of CAF. Patient satisfaction with esthetics was very high in both treatment groups, with no statistically significant differences between them. A better postoperative course and better results in the esthetic evaluation made by an independent periodontist were demonstrated in patients treated with the envelope type of CAF.
Conclusions: Both CAF techniques were effective in reducing recession depth. The envelope type of CAF was associated with an increased probability of achieving complete root coverage and with a better postoperative course. Keloid formation along the vertical releasing incisions was responsible for the worst esthetic evaluation made by an independent expert periodontist.
Introduction
The aim of this randomized clinical trial was to assess the aesthetical and clinical outcomes of acellular dermal matrix graft (ADMG) plus coronally advanced flap (CAF) with vertical ...incisions or the envelope flap in the treatment of thin phenotype, multiple‐recession defects.
Material and Methods
Twenty‐two participants with 55 class recession type 1 (RT1) with a depth of ≥3 mm were investigated. Control group was treated with ADMG plus conventional CAF with vertical releasing incisions, whereas test group received the envelope flap with ADMG. Primary outcome variables were complete root coverage (CRC), root coverage aesthetic score and patient satisfaction.
Results
Tooth‐based CRC was observed in 23 of the 28 recession defects in mCAF + ADMG group (82.1%), whereas in 19 of the 27 recession defects in CAF + ADMG group (70.37%), with no inter‐group difference (p > .05). CRC was observed in 9 of the 11 patients in mCAF + ADMG group (81.8%). On the other hand, in CAF + ADMG group, CRC was achieved in 8 of the 11 patients (72.7%). Results were similar between the groups (p > .05).
Conclusions
Both techniques were successful in the management of multiple recessions; however, superior results regarding patient's satisfaction were achieved with mCAF + ADMG.
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