Aesthetic Deficits Research Articles

"Preventive Prosthodontics: An In-Depth Review Of Strategies And Practices"

Prosthodontics is a specialized field within dentistry dedicated to the restoration and maintenance of oral function, comfort, aesthetics, and overall health. This is achieved through the replacement of lost teeth or the restoration of natural teeth and craniofacial tissues using biocompatible materials. By addressing the functional and aesthetic deficits caused by tooth loss or damage, prosthodontics plays a critical role in enhancing patients' quality of life. On the other hand, "preventive dentistry" encompasses a range of practices and strategies designed to prevent oral health issues before they occur. These methods are implemented both in community dental health programs and individual dental practices, with the primary goal of averting the onset of oral diseases and discrepancies. Preventive dentistry is integral to modern dental care, as it emphasizes the preservation of oral structures, thereby reducing the need for more invasive prosthetic treatments in the future. This narrative review aims to synthesize existing knowledge and practices in the emerging field of preventive prosthodontics. By integrating principles from both prosthodontics and preventive dentistry, this review seeks to provide valuable insights for dental professionals. The ultimate goal is to promote improved patient care and oral health outcomes by encouraging preventive approaches that minimize the need for extensive prosthetic interventions. This comprehensive examination of preventive prosthodontics highlights its importance in the broader context of modern dentistry, offering guidance for dental practitioners committed to enhancing patient well-being through proactive oral health management

Rehabilitating Amputated Hallux with Dental Implant–Supported Double Magnet in Y-Bar–Retained Prosthesis

ABSTRACT Introduction Loss of hallux leads to aesthetic deficit and functional loss, with active push-off, weight-bearing ability, and pronation all being affected. Rehabilitation can be surgical or prosthetic; however, surgical alternatives can be unpredictable in terms of aesthetics and is not cost-effective. Therefore, prosthetic rehabilitation is often favored. However, loss of all 3 phalanges makes prosthetic rehabilitation challenging due to minimal scope of retention from the residual limb. Materials and Methods This technique presents a solution to this challenge, with an implant-supported, magnet-retained silicone prosthesis, having a novel abutment design, to provide dual (magnetic and frictional) retention. Conclusions The prosthetic design improved retention, facilitated easy handling by the patient, and prevented stress concentration on implant-bone interface. Clinical Relevance The prosthetic innovation improved retention during standing and walking, and increased the patient’s confidence to perform daily activities without fear of dislodgement.

Reshaping Faces, Redefining Risks: A Systematic Review of Orthognathic Surgery Outcomes in Cleft Lip and Palate Patients

Background: This study aims to determine a generalized outcome and risk profile for patients undergoing orthognathic surgery for the definitive treatment of cleft lip and palate. Furthermore, we hope to determine the key risk factors that cause increased risk for cleft lip and palate patients undergoing orthognathic surgery. Methods: This study includes a systematic review using PubMed, MEDLINE, Cochrane, and Scopus. Data curation utilized Covidence software, with dual-reviewer screening and conflict resolution by a third party, focusing on publications with the full texts available. Results: The initial search yielded 1697 articles. Following title, abstract, and full-text screening, a total of 62 articles were included in this review. A total of 70.9% of included articles had moderate bias, with the rest having low risk of bias. The sample consisted of 2550 patients with an average age of about 20 years and an average follow-up of 16.8 months. The most employed procedure was Le Fort I osteotomy (99%). In terms of velopharyngeal function, there were notable increases in insufficiency and severity scores, with an average 63% worsening score from the baseline. That being said, patients experienced an average 33% improvement in speech articulation. Furthermore, the average horizontal movement was reported to be 6.09 mm with a subsequent relapse of 0.98 mm overall. Conclusions: This systematic review distills data from 62 articles and 2550 patients. It highlights the efficacy of orthognathic surgery in addressing oropharyngeal and aesthetic deficits. This study identifies relapse and velopharyngeal insufficiency as recurrent complications. These insights inform surgical refinement and patient counseling, laying a foundation for enhanced clinical protocols.

A Novel Adjunct for Treatment of Orofacial Contractures After a Facial Burn Injury

Purpose: Surgical management of scar tissue and contractures from facial burns has systematic approaches, yet nonsurgical management continues to lack consensus regarding therapeutic approaches capable of providing stretching of the facial skin and muscles for both treating and preventing microstomia and orofacial contractures. This exploratory study introduces an intraoral splinting system designed to provide low-load, prolonged stretching of orofacial skin and musculature to treat contractures following a facial burn injury. The treatment adjunct described here has potential application across disciplines treating microstomia and orofacial contractures. Method: An 18-year-old man with full-thickness head and neck burns participated in a 5-week trial using intraoral splints to provide stretch to areas of contracture in the mid and lower face. The trial commenced 4 and a half months after his burn injury. Prescriptive placement, sizing, and time for use of the splints were provided. Changes in distance between facial landmarks were identified for 13 measurements taken for nine facial expressions. Results: Lengthening or shortening of the distances between two landmarks indicated the potential benefit from intraoral splints. For the expression “open mouth wide,” increased distance between two end points was noted in 11 of 13 measurements, ranging from 1.6 to 10.8 mm. This represents a lengthening of tissue, allowing for wider oral opening. Negative measurements between two end points occurred in two of 13 measurements, demonstrating elevation of the left and right nostrils. Visual data also demonstrated the appearance of change. Conclusions: When treating microstomia and orofacial contractures, consideration should be given to the use and further exploration of a more targeted intraoral methodology that uses a low-load, prolonged stretch to improve functional and aesthetic deficits. Oral splinting using an intraoral methodology is underutilized in the burn patient population and has application in both the acute care and chronic phases of recovery.

Selected aesthetic medicine treatment in patients with autoimmune diseases - a literature review


 
 
 Introduction Interest in cosmetic procedures has been increasing. Data on practices for correcting aesthetic deficits, including those caused by autoimmune diseases are limited. There are fears of disease reactivation and exacerbation of inflammation after surgery. Aim of the study The aim of the study was to investigate the potential influence and safety of aesthetic medicine treatment - hyaluronic acid, botulinum toxin and breast augmentation with implants in patients with autoimmune diseases. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: autoimmune disease, immunogenicity, inflammation, connective tissue, aesthetic medicine. Results Hyaluronic acid is considered the best filler for cosmetic procedures, mainly due to its lack of immunogenicity. No clinical studies have identified contraindications to the administration of hyaluronic acid-based dermal fillers in patients with inflammatory diseases. Botulinum toxin is essential in alleviating involuntary functions currently associated with dystonia, spasticity, and autonomic disorders. The long-term safety of implants should be assessed concerning genetic and environmental factors and whether the autoimmune disease is in remission.Conclusion With the increasing number of aesthetic procedures using hyaluronic acid, there are more reports of potential adverse events. Most side effects are associated with hypersensitivity reactions. The use of hyaluronic acid products in patients with autoimmune diseases is controversial. However, no clinical studies have identified contraindications to the administration of hyaluronic acid-based fillers. Botulinum toxin is used for healing and pain control in patients with systemic sclerosis who have suffered phalangeal ulcers. Despite epidemiological studies conducted to assess the association between breast implants and autoimmune diseases the results remain inconclusive
 
 

Combining superselective catheterization and electrochemotherapy: A new technological approach to the treatment of high-flow head and neck vascular malformations.

The study aims to demonstrate a combination of superselective catheterization and electrochemotherapy as a feasible and effective new technological approach in treating high-flow vascular malformations of the head and neck region. In the patient with high-flow arteriovenous malformation of the lower lip, superselective catheterization was performed under general anesthesia. The microcatheter was used to administer 750 IU BLM intra-arterially into the feeding vessel. The whole malformation surface was then covered with 15 applications of electric pulses using the plate electrode. Excellent response, without functional or aesthetic deficits, was obtained in 10 weeks. During this period, debridement and necrectomy were performed regularly on follow-up visits. The pain was managed with oral paracetamol and sodium metamizole. Combining electrochemotherapy using bleomycin with superselective catheterization and arteriography is a feasible treatment option for high-flow vascular malformations in the head and neck region and could play a significant role in managing these challenging lesions.

Tapered, Sand-Blasted, Large-Grit, and Acid-Etched Surfaced Internal Dental Implant in the Diverse Pathologic Jaw.

The treatment of pathologic lesions in jaws either through conservative or radical approaches, frequently leads to a loss of teeth. As a result, patients will experience diminished masticatory and phonetic function as well as esthetic deficits. In this manuscript, we report multiple cases of successful implant rehabilitation after the conservative treatment of pathologic lesions in jaws utilizing allogeneic bone grafts and the installation of implant fixtures. In this study, we examined 8 patients with 8 different kinds of pathologic lesions in their jaws, who were treated with a conservative approach and rehabilitated with bone grafts and implant installations using internal dental implant type with tapered, sand-blasted, large-grit, acid-etched surfaces. Marginal bone loss was analyzed through radiograms, and the implant survival rates and graft outcome evaluations were recorded. No significant difference was found in the mean marginal bone loss throughout the follow-up period. The survival rate of the implant and the success rate of graft were recorded as 100%. The results of this study suggest that conservative surgical management for pathologic lesions based on the understanding of the pathologies can be helpful for successful oral rehabilitation. In bone grafting, it is necessary to determine an appropriate timing and method considering the risk of recurrence and the vascularity of the recipient site. For subsequent implant placement, selecting an implant system suitable for the site of placement and placing it within 3 to 6 months after bone grafting can help the long-term maintenance of the grafted bone and dental implant.

Successful Management of Post-Traumatic Residual Orbital Roof Defects with Cosmetic Disfigurement and Functional Deficits Using Innovative Titanium Plate Orbitoplasty.

Late presentations of post-traumatic residual orbital roof deformities ensuing from old, unaddressed orbital injuries, can be extremely challenging to manage and quite complicated to correct, owing to proximity of the brain and frontal sinus, malunion or bony fusion of the displaced, delicate orbital fracture fragments, necrosis of entrapped extraocular muscles and progressive intraorbital soft tissue fibrosis and adhesions. There exists a paucity in literature on delayed repair of displaced and comminuted orbital roof fractures and late reconstruction of the three-dimensional architecture of the orbital frame and internal orbit. To present an unusual case of severe post-traumatic residual orbital roof deformity, resulting in longstanding aesthetic disfigurement and persisting functional deficits, and its successful management. The patient had sustained orbital injuries sixteen months ago, on being punched in the face at a boxing tournament. The increased orbital volume produced by an impure blowout fracture of the left orbital roof, with comminution of the upper and lower orbital rims, had resulted in considerable cosmetic deformity, discomfort as well as functional debility, all of which were successfully and efficaciously managed by an innovative use of a Titanium Orbital Plate for orbital roof reconstruction. Overlooked, undetected or ignored derangements in intraorbital volume and contour, can lead to severe cosmetic disfigurement in the form of enophthalmos, hypoglobus, entropion, telecanthus, palpebral fissure width narrowing and ptosis; in addition to crippling functional deficits, such as diplopia, blurred vision, levator dysfunction, restricted ocular motility and reduced visual range and acuity. An innovative Titanium mesh orbitoplasty enabled achievement of both, the aesthetic and functional goals of reconstruction of the distorted bony orbit, with successful correction of severe functional and aesthetic deficits.

Dental Implant Supported Thumb Prosthesis with Friction Fit Retention System

ABSTRACT Introduction An amputated thumb causes aesthetic deficit and functional loss. Reconstruction can be surgical or prosthetic. A small residuum leaves little scope for rehabilitation with suction-retained prosthesis. Prosthetic management requires implant placement or distraction osteogenesis to be successful. This report presents the use of bone-anchored dental implants to support a prosthesis for rehabilitation of an amputated thumb. Case Description Satisfactory osseointegration of a dental implant placed in the amputated right pollex of a 24-year-old woman was achieved, after a two-stage surgical procedure. A healing abutment, which is normally placed transitionally after second-stage surgery, was modified to create a permanent friction fit coping. This was used to retain the silicone thumb. Discussion and Conclusions The study to some extent established off-the-label use of dental implants in rehabilitating amputated digits. Also, the friction fit retention system proved to be a cost- and armamentarium-effective method of retaining thumb prosthesis for cases with small residuum. Clinical Relevance This report describes a procedure for two-stage surgical placement of an osseointegrated dental implant in an amputated thumb with fabrication of prosthesis, which was effectively retained by a modified healing abutment.

English

Maxilla can be considered a hexahedrium with close relationship to surrounding critical anatomic structures, and thereby invariably involved in the resection process of tumours that arise from maxillary sinus, palate, nasal cavity, orbital contents, or intro-oral mucosa.1 Maxillary defects created after tumour ablation can cause severe functional and aesthetic deficits. Orbital floor defects with displacement of the eyeball results in deformities with possible consequences of enophthalmos, diplopia and impaired visual acuity. The eyeball can become displaced either due to alteration in the position of the orbital walls caused by trauma, or due to loss of support of the orbital floor during resection of a lesion. The role of the suspensory ligament of Lockwood in maintaining the superio - inferior position of the visual apparatus is recognized. The preservation of this ligament, which acts like a hammock holding the eyeball in position, prevents any drastic downward displacement except for the small limit which the slack of the ligament allows. Surgical reconstruction of orbital floor defects is the primary treatment modality, but remains nonetheless a challenge for surgeons. Currently various types of materials such as titanium meshes, hydroxyapatite, silica gel, Teflon, Medpor and autogenous bones are used for orbital reconstruction.2,3 Prosthetic rehabilitation of maxillary surgical defects is so predictable and effective that reconstructive surgery is not indicated in most instances.4,5 Prosthetic management of defects with orbital floor resection is usually obturators with extensions to support the visual apparatus.6 In clinical situations involving the resection of the orbital floor and maxillary sinus, without the sacrifice of the floor of maxilla, no oro-antral communication is created. This eliminates the need for an obturator prosthesis. In this scenario the support for the visual apparatus will be solely dependent on surgical reconstruction. However, when dealing with invasive and progressive diseases of fungal and bacterial origin, immediate surgical reconstruction is not generally recommended till complete resolution of the disease is achieved. The potential for recurrence of tumours varies from 10 - 30 % with benign tumours and over 50 % with malignant tumours. This creates a need for long term follow up, to assess the resection margins for signs of recurrence.4

Canthoplasty repair for canthal rounding.

Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. Several surgical techniques to repair canthal rounding have been described previously. We report a new technique for canthoplasty repair of canthal rounding with the use of illustrative cases. This is a retrospective case series describing the technique using illustrative cases from across three sites (London [UK], Adelaide [Australia], Sydney [Australia]). Twelve patients with post-surgical canthal rounding were included. Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. There were no peri- or post-operative complications. All except one patient reported good surgical outcomes after one procedure. In one patient there was rounding recurrence. Our patients reported excellent outcomes post-operatively without any significant scarring.

Outcomes of osseointegrated implants in patients with benign and malignant pathologies of the head and neck: a 10-year single-centre study

The surgical management of head and neck pathologies involving the maxilla and mandible results in significant functional and aesthetic deficits, and ultimately reduced quality of life. Composite free flaps used for reconstruction address many of these deficits and create a foundation for the use of osseointegrated implants to support prosthetic replacement of the dentition. There are few comparative studies examining outcomes of implants in native and reconstructed bone in head and neck cancer patients. The aim of this retrospective cohort study was to compare survival rates and the effects of risk factors between implants placed in native and reconstructed bone. The Kaplan–Meier method estimated cumulative 1- and 5-year implant survival rates of 99.5% and 95% for native bone and 96% and 88% for reconstructed bone. Multivariate Cox regression found an increased risk of implant failure in reconstructed bone (hazard ratio (HR) 9.9, 95% confidence interval (CI) 3.4–29.7, P<0.001). Subgroup analysis of the cohorts found an increased risk of failure in the reconstructed group associated with radiotherapy (HR 6.4, 95% CI 1.8–22.3, P=0.004), current smoking (HR 23.2, 95% CI 2.7–198.6, P=0.004), and previous smoking (HR 9.0, 95% CI 1.1–71.9, P=0.038). There was no effect in the native bone group. Implants placed into reconstructed bone had higher rates of failure, and smoking status and radiotherapy increased the risk of implant failure.

“Pull-through” Resection for Total and Subtotal Glossectomy Involving the Posterior Third of Tongue

The lower lip-splitting incision associated with different types of mandibulotomy, in order to obtain wide access to total or subtotal glossectomy, is described. In those cases, high rates of functional and aesthetic deficit and postoperative morbidity (more in cases of patients in which adjuvant radiotherapy has been performed) are described. We present our experience in the treatment of patients undergoing total or subtotal glossectomy and contemporary reconstruction with flaps, and without lip-splitting incision and mandibulotomy. Materials and Methods: Data about patients affected by malignant tumors requiring total or subtotal (posterior third of the tongue) resection that were treated at our department from January 2004 to December 2014 were retrospectively reviewed. Data evaluated included: T and N stage, resection margins, operation time, and post-operative complications, such as fistula and flap necrosis. Results: 41 patients were identified. In two cases microscopic infiltration of one margin was found (R1); in one case a close margin was identified. In 26 cases reconstruction was performed using free flaps, and in the remaining cases a pectoralis major flap was used. In three cases postoperative complications were observed. Discussion and conclusions: In theory, lip-splitting and mandible discontinuity could allow for increased access and tumor visualization, and could facilitate flap positioning. Nevertheless, in our experience, it is not necessary in the case of total or subtotal glossectomy.

Predictors of re-consultation and impact of the retainer on relapse and debonding rate ten years after removal of orthodontic appliances

Once the orthodontic retention phase is complete, a number of patients return to the office following retainer detachment or complaining about the stability of the result. The aim of this study was to search for predictors of re-consultation and to evaluate how the choice of retainer impacts re-consultation for misalignment or debonding. A systematic retrospective cohort study was conducted ten years after removal of orthodontic appliances. Of the 380patients included, 23% re-consulted on average 4.5years after appliance removal. The patients most likely to re-consult were those with a severe initial aesthetic deficit. Mandibular retainers bonded on six teeth resulted in three-fold more re-consultations than wires bonded exclusively on the canines, but the difference was non-significant. Mandibular retainers bonded on the canines certainly generated significantly more maintenance appointments than the six-teeth retainers, but fewer malposition problems (non-significant result). These results raise questions regarding indications for bonded maxillary retainers as opposed to removable devices and also regarding the management of long-term post-retention follow-up.

Reconstruction of Orbital Floor Fractures with Titanium Micromesh: Our Experience.

The purpose of this study was to assess the use and accuracy of the titanium micromesh for primary internal orbital reconstruction in cases of either pure or impure orbital blowout fractures. Retrospective case series of 21 patients with a mean follow-up of 12months. Department of Dental Surgery of a teaching tertiary medical college Hospital. Twenty-one consecutive patients who underwent surgical reconstruction of orbital floor/or Combination of floor and rim fractures usingtitanium micromesh. Persistence of diplopia, orbital dystopia, implant extrusion, enophthalmos, infection, and complications. The recorded data included age, gender, cause of trauma, diplopia, enophthalmos, ocular motility, preoperative orbital PNS/CT, and postoperative paranasal sinus view skull preoperative and postoperative ophthalmological examination. Most of the patients were males and resulted from trauma inflicted during RTA, sport injuries or assault. The most Common fracture pattern was impure Blow out fractures, and commonly associated other facial fractures were midfacial fractures. Clinical examination along with diagnostic aids such as computed tomography of orbital fractures was used. Orbital floor exploration was performed in 21 cases due to functional or aesthetic deficits. All orbital floor bone defects required reconstruction. In these cases, orbital floor was reconstructed with .3mm titanium micromesh implant. We did not encounter any major complications related to the incisions or implant material, though sample size was small. The rate of complication in which correction was difficult (diplopia) was lower [4%, 1 case]. Titanium mesh gives excellent result in orbital floor fractures. Surgical anatomical landmarks knowledge is very important to prevent any intra- or postoperative complications.

Advances in biomaterials for skeletal muscle engineering and obstacles still to overcome.

Repair of injured skeletal muscle is a sophisticated process that uses immune, muscle, perivascular, and neural cells. In acute injury, the robust endogenous repair process can facilitate complete regeneration with little to no functional deficit. However, in severe injury, the damage is beyond the capacity for self-repair, often resulting in structural and functional deficits. Aside from the insufficiencies in muscle function, the aesthetic deficits can impact quality of life. Current clinical treatments are significantly limited in their capacity to structurally and functionally repair the damaged skeletal muscle. Therefore, alternative approaches are needed. Biomaterial therapies for skeletal muscle engineering have leveraged natural materials with sophisticated scaffold fabrication techniques to guide cell infiltration, alignment, and differentiation. Advances in biomaterials paired with a standardized and rigorous assessment of resulting tissue formation have greatly advanced the field of skeletal muscle engineering in the last several years. Herein, we discuss the current trends in biomaterials-based therapies for skeletal muscle regeneration and present the obstacles still to be overcome before clinical translation is possible. With millions of people affected by muscle trauma each year, the development of a therapy that can repair the structural and functional deficits after severe muscle injury is pivotal.

Discoloration of surface sealants by plaque disclosing solution.

PurposeSurface sealants are widely used as a prevention strategy and are indicated for young patients with insufficient oral hygiene who also need plaque removal by professional tooth cleaning. The aim of this study was to evaluate discoloration of surface sealants by plaque disclosing solutions and to test to what extent this discoloration can be reduced again by professional tooth cleaning.MethodsIn all, 96 extracted lesion-free human teeth were randomly assigned to treatment with either Pro Seal® (PS; Opal Orthodontics, South Jordan, UT, USA) or Opal®Seal™ (OS; Reliance Orthodontic Products, Itasca, IL, USA). Color evaluations after application of the plaque disclosing solution Mira-2-Ton® (Hager & Werken, Duisburg, Germany) were performed using a clinical spectrophotometer. Staining and polishing were repeated once. Color differences (∆E) above 3.77 were regarded as clinically relevant.ResultsAll sealants showed high, clinically relevant ∆E values after the first staining. Polishing led to significantly decreased ∆E values on PS-treated teeth; however, the median ∆E value remained above the clinically relevant threshold. Polishing on OS-treated teeth only slightly reduced ∆E values. After professional tooth cleaning both PS and OS showed clinically relevant ∆E values.ConclusionSurface sealants show clinically relevant discoloration after exposure to plaque disclosing solution under in vitro conditions. Such discolorations could not be removed by professional tooth cleaning. Thus, in clinical practice, plaque disclosing solutions might cause esthetic deficits in surface sealant-treated teeth. The impact of plaque disclosing solutions under clinical conditions (e.g., in the presence of saliva and by various aspects of a person’s nutrition) should be investigated in clinical studies.

Sports-Related Pediatric Facial Trauma: Analysis of Facial Fracture Pattern and Concomitant Injuries.

Objective Sports-related injuries, such as facial fractures, are potentially debilitating and may lead to long-term functional and aesthetic deficits in a pediatric patient. In this study, we analyze sports-related facial fractures in the urban pediatric population in an effort to characterize patterns of injury and improve management strategies and outcomes. Methods Retrospective chart review was performed for all facial fractures resulting from sports injuries in the pediatric population at a level-1 trauma center (University Hospital, Newark, NJ). Results Seventeen pediatric patients were identified as having sustained a fracture of the facial skeleton due to sports injury. Mean age was 13.9 years old. A total of 29 fractures were identified. Most common fracture sites included the orbit ( n = 12), mandible ( n = 5), nasal bone ( n = 5), and zygomaticomaxillary complex ( n = 3). The most common concomitant injuries included skull fracture ( n = 3), intracranial hemorrhage ( n = 4), and traumatic brain injury ( n = 4). One patient was intubated upon arrival to the emergency department. Hospital admission was required in 13 patients, 4 of which were admitted to an intensive care setting. Nine patients required operative intervention. Mean length of hospital stay was 2.4 days. No patients were expired. Conclusions Sports-related facial fractures are potentially debilitating injuries in the pediatric population. Analysis of fracture pattern and concomitant injuries is imperative to develop effective management strategies and prevention techniques.

Periorbital Trauma: A New Classification.

Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients' visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and functional status were evaluated. The periorbital region was identified. Anatomical categorization of periorbital injuries included periocular, frontal, temporal, and malar regions. Injuries/deficits were categorized into simple, composite, complex, and isolated bony injuries according to the depth and involved tissues. Subsequently, the classification was formulated. In the retrospective study, the incidence of extended simple injuries was the highest, while the least was the extended complex injuries. Functional deficits occurred in 24 patients (9.23%) and aesthetic deficits occurred in 55 patients (21.15%). Required secondary operations for this group included redo of fixation, correction of medial canthal ligament, repair of canalicular system, scar revisions, fat grafting, and creation of natural creases. The results of this study demonstrated that unsatisfactory aesthetic and functional results occurred when injuries of important structures were overlooked, aesthetic units were not respected, and when management was delayed. A three-dimensional, oriented, new classification of periorbital trauma based on anatomical and clinical categorization is proposed to help in identifying injured structures, stimulate the search for other injuries, structure preoperative evaluation, and recommend a surgical plan that would ultimately achieve precise primary repair with best aesthetic and functional outcome.

Oral status and aesthetics after nonsurgical periodontal treatment: Do patient's perception and dentist's evaluation agree?

ObjectivesPeriodontal healing is often accompanied by side effects, which may cause an aesthetic deficit. The present investigation was focussed to compare patient's subjective perception of their posttherapy aesthetics with the objective measures of the results.Materials and methodsSurvey results from patients (subjective parameters) on oral status and aesthetics were compared against routine clinical parameters and corresponding survey results from treating dentists (objective parameters), both before and after periodontal treatment. Subjective outcome parameters were then suitably transformed and compared with the objective ones to investigate the agreement between patients' perception and actual outcomes.ResultsObjective recordings of periodontal status by the dentist and subjective awareness of the patient are quite contradictory to each other for almost all participants. Further, it was found that their aesthetics in the front were better after treatment, but dentist professionals targeted for future treatment needs.ConclusionsIn this study, it was found that patients improved aesthetically on the upper jaw front after the therapy, which was not shared by the dentists. This discrepancy was due to the clinicians' view on more aesthetic corrective procedures than on patients' need.