Aesthetic Results Research Articles

Penile Reconstruction with Radial Forearm Free Flap—Present State of the Art

Abstract Background Patients with congenital or acquired penile defects face significant psychological trauma. Various methods for penile reconstruction have been described of which the free radial artery forearm flap using the tube-within-tube design is found to be the most commonly used. We have assimilated the best practices described at different times in our bid to standardize the technique and have strived to make it reproducible. The reconstructed phalluses with this method can withstand the test of time, allowing the patients to lead a normal life. Materials and Methods We conducted a retrospective review of the past 16 years and collected data for all radial forearm free flap phalloplasties. We have modified the design originally described by Biemer. The urethra is kept 1 cm longer than the shaft and the proximal 5 mm of the prospective urethra is not sutured to allow for spatulation of the urethral anastomosis. Results A total of nine patients were included out of which six patients had congenital malformations, two had traumatic injuries, and one had penile carcinoma. Six out of the nine patients had implants placed which were wrapped in fascia lata graft. One of these patients experienced displacement of the implant which needed to be repositioned. Three patients faced postoperative complications. All patients had tactile and erogenous sensation at the tip of the glans at the end of 1 year and all patients could micturate while standing. One patient's esthetic and functional outcome was compromised. One of the married patients has fathered a child through normal sexual intercourse. Conclusion Radial forearm phalloplasty done by this technique allows us to achieve consistently stable functional and esthetic outcomes. We firmly believe that this standardized protocol for penile reconstruction could be of great benefit to patients as well as to the treating reconstructive surgeon in their quest to achieve a completely rehabilitated patient.

Premaxillary Graft with Costal Cartilage in Rhinoplasty: A Technique to Support the Nasal Tip.

Rhinoplasty is an ever-evolving field, with innovative techniques continually being developed to enhance both aesthetic and functional outcomes for patients. Increasingly, research has focused on the integral role of the facial skeleton in providing nasal support and projection. Central to the structural integrity of the nose is the maxillary bone, which occupies a pivotal position in the midface. The objective of this study is to assess the outcomes of patients who underwent rhinoplasty involving the placement of a premaxillary graft fashioned from costal cartilage. The study aims to evaluate the graft's tolerance, stability, and potential complications. The patient cohort comprised individuals who underwent open approach rhinoplasty with premaxillary insufficiency, necessitating the placement of a costal cartilage graft anterior to the nasal spine, performed by the same surgeon between 2021 and 2022. A total of 38 patients, consisting of 5 men and 33 women aged between 18 and 58years, were operated on during this period. Consistent maintenance of tip support was observed across all cases. Among the 33 patients, 20 were randomly chosen for a comparative assessment of the nasolabial angle in preoperative and postoperative profile photographs, demonstrating a statistically significant improvement. No complications such as graft displacement, scarring, extrusion, or infections were reported. The use of a premaxillary graft with costal cartilage appears to be a viable, well-tolerated option with favorable long-term outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Oncoplastic breast-conserving surgery: evolution, techniques, and the emerging role of acellular dermal matrix

Oncoplastic breast-conserving surgery (OBCS) has revolutionized breast cancer treatment, aiming to achieve optimal oncological outcomes while preserving an aesthetically favorable appearance. This review explores the evolution, techniques, and outcomes of OBCS, with a particular focus on the emerging role of acellular dermal matrix in volume replacement techniques. We conducted a comprehensive literature review using PubMed, Medline, and Cochrane databases, focusing on studies published between 2010 and 2024. OBCS demonstrates comparable oncological safety to traditional breast-conserving surgery, with local recurrence rates ranging from 2.7% to 5.7% at 5 years. Patient satisfaction rates are consistently high, with 85% to 95% reporting good to excellent aesthetic outcomes. Volume replacement techniques using acellular dermal matrix show promising results, with one study reporting that 94% of patients were highly satisfied with cosmetic outcomes. Although the current results are encouraging, future advancements in OBCS may require innovative approaches, including the integration of robotic surgery and artificial intelligence technologies.

Insights into upper blepharoplasty: Conservative volume-preserving techniques.

This editorial commentary critically examines the systematic review by Miotti et al, which discusses the evolving trends in upper lid blepharoplasty towards a conservative, volume-preserving approach. The review emphasizes the shift from traditional tissue resection to techniques that maintain anatomical integrity, paralleling broader trends in panfacial rejuvenation. Miotti et al delve into the nuances of fat pad management, advocating for conservation over reduction to sustain natural contours and improve long-term aesthetic outcomes. This perspective is supported by comparative studies and empirical data, such as those from Massry and Alghoul et al, highlighting the benefits of conservative approaches in terms of patient satisfaction and aesthetic longevity. The review also stresses the importance of surgeon discretion in adapting procedures to diverse patient demographics, particularly in addressing distinct features such as the Asian upper eyelid. However, it identifies a significant gap in long-term comparative research, underscoring the need for future studies to substantiate the safety and efficacy of these minimalist techniques. Overall, Miotti et al.'s work contributes profoundly to the discourse on personalized, conservative cosmetic surgery, urging ongoing research to refine and validate surgical best practices in upper eyelid blepharoplasty.

Bikini line one-anastomosis gastric bypass (BLOGB): initial report

BackgroundThis study introduces a new access method for one-anastomosis gastric bypass (OAGB) by placing ports at the bikini line.ObjectiveTo describe our initial experience and assess the feasibility, safety, and effectiveness of this novel access.SettingUniversity Hospital.MethodsThis prospective case–control study included 72 patients: 42 were allocated to the bikini line one-anastomosis gastric bypass (BLOGB) group, and 30 were assigned to the control group. Exclusion criteria included a history of major abdominal surgery, hiatal hernia, extensive lower abdominal adhesions, or a body mass index (BMI) exceeding 55 kg/m2.ResultsThe mean preoperative BMI of the study sample was 40.01 ± 2.84. Weight loss was satisfactory, with the highest percent excess weight loss (%EWL) observed at 12 months: 90.88 ± 7.90 and 91 ± 7.11 (p = 0.474) in both groups, respectively. Both groups showed no significant differences in operative complications, hospital stay, weight loss, or resolution of obesity-associated diseases. However, the BLOGB patients had a longer mean operative time of 110.71 ± 17.72 min compared to 98 ± 18.27 min in the control group (p = 0.002). Moreover, they experienced less postoperative pain and reported greater satisfaction with the appearance of their scars.ConclusionBLOGB was found to be potentially feasible, safe, and effective, offering improved aesthetic outcomes and reduced postoperative pain. This approach may be suitable for a select group of patients concerned with scar appearance. However, large-scale studies are necessary to ensure that safety is not compromised in pursuit of aesthetic benefits.

Hip dips technique: Filling lateral depressions with hyaluronic acid of large particles.

Hip dips, often referred to as the pronounced trochanteric depression, can be caused by athletic muscular definition or the ageing process. This depression might impact the desirable contour of the buttocks in some female patients. A technique is described for female patients exhibiting moderate to severe degrees of lateral trochanteric depression. This technique utilizes a specific marking, a well-thought-out plan and a designated product. Eleven patients were selected to use this technique to improve their trochanteric depression and enhance their buttocks contour without undergoing surgery. The product used was Sofiderm Subskin, which was applied at the intermediate subcutaneous layer. The authors report favourable aesthetic results with the proposed technique, and the patients expressed high satisfaction levels. Though safe for injection, the lateral gluteal depression can still be challenging to expand. The product chosen has both a high G prime and a large molecular size, contributing to its resistance to deformation. The hip dips technique using hyaluronic acid for the augmentation of lateral depression has shown to be minimally invasive; it provides quick results without significant risks or downtime.

Three-Part Analysis for Designing Nasal Alar Reduction Surgery in Asian Patients.

The external nasal alar reduction can be associated with many complications, such as nostril malformation and significant scarring. The authors proposed a 3-part analysis method for the design of nasal alar reduction surgery with the aim of improving nasal alar morphology more precisely. The 3-part analysis was based on the patient's flared nose, wide nasal base, and drooping ala, respectively. We included 20 patients who underwent this surgery between January 2021 and January 2022. The visual analog scale (VAS) and the Stony Brook Scar Evaluation Scale (SBSES) were used to assess postoperative scar outcomes. The preoperative and postoperative ratios of the interalar distance to intercanthal distance and nostril shape were analyzed. Patient-reported satisfaction with the esthetic outcome was also assessed. All operations were successfully completed. There were no postoperative complications, such as wound infection or skin necrosis. Both VAS and SBSES assessment of postoperative scarring suggested keloid hyperplasia at 3 months postoperatively. At 12 months postoperatively, the scarring was insignificant and improved significantly over 3 months postoperatively. The mean ratio of the interalar distance to intercanthal distance decreased significantly from 1.15 preoperatively to 1.01 postoperatively (P<0.05). The shape of the patient's nostrils was also significantly improved after surgery compared with the preoperative period. Patient-reported satisfaction after surgery was high at long-term follow-up. The 3-part analysis to design an external nasal alar reduction procedure can accurately improve the morphology of nasal flaring, excessively wide nasal alar base, and nasal ptosis in Asian patients. IV.

CONCERNS ABOUT FIBROADENOMA EXCISION IN YOUNG FEMALE PATIENTS VIA CIRCUMAREOLAR VERSUS RADIAL INCISION

Fibroadenoma is the most common benign breast tumour in young female patients between 15 to 30 years of age. Lumpectomy is the most common surgical procedure, usually carried out via Circumareolar or Radial incisions depending upon size and location in the breast. Both of these incisions for lumpectomy have advantages and disadvantages of their own. In this study, we compared the outcome in terms of healing of wounds, Aesthetics and patient satisfaction. Objective: The purpose of this study was to evaluate the effectiveness of Circumareolar and Radial incision for lumpectomy, Aesthetic outcome and patient satisfaction in young female patients who opted for surgical excision. Methods: After ethical approval from the Hospital ethical committee and informed written consent from the participants; 189 patients were included and equally divided into Group A for Circumareolar incision and into Group B for Radial Incision participants, who met inclusion and exclusion criteria for this study. Data was collected by the Concerned Surgeon on a Pre-Designed Questionnaire in the District Headquarters Teaching Hospital, Kohat Development Authority Kohat from January 2021 to July 2021. Data was analyzed and shown in Tables. Results: The results demonstrate a significant preference for the circumareolar incision over the radial incision in the excision of large and peripherally located fibroadenomas among young female patients. A higher percentage of young female patients (63.04%) underwent circumareolar incision, reporting shorter recovery times (mean = 2.04 weeks) and greater satisfaction with the surgical outcome (mean satisfaction score = 5.43), compared to those who had a radial incision (37.25% underwent the procedure, with mean recovery time = 0.91 weeks and mean satisfaction score = 0.03). Statistical analysis further supports the efficacy of the circumareolar approach over the radial one, with significant differences in both recovery time and satisfaction levels (p &lt; 0.000 for both measures), indicating its effectiveness and patient preference. Conclusion: Circumareolar incision is the best incision for large and peripherally located fibroadenoma excision in young female patients without any further morbidity or compromising quality of life.

Co-doped titanium dioxide nanoparticles decrease the cytotoxicity of experimental hydrogen peroxide gels for in-office tooth bleaching.

To evaluate the efficacy and cytotoxicity of experimental 6% and 35% hydrogen peroxide gels (HP6 or HP35) incorporated with titanium dioxide nanoparticles (NP) co-doped with nitrogen and fluorine and irradiated with a violet LED light (LT). Bovine enamel-dentin disks adapted to artificial pulp chambers were randomly assigned to bleaching (n = 8/group): NC (negative control), NP, HP6, HP6 + LT, HP6 + NP, HP6 + NP + LT, HP35, HP35 + LT, HP35 + NP, HP35 + NP + LT, and commercial HP35 (COM). Color (ΔE00) and whiteness index (ΔWID) changes were measured before and 14days after bleaching. The extracts (culture medium + diffused gel components) collected after the first session were applied to odontoblast-like MDPC-23 cells, which were assessed concerning their viability, oxidative stress, and morphology. The amount of HP diffused through the disks was determined. Data were analyzed by generalized linear models orKruskal Wallis Tests (α = 5%). RESULTS: HP6 + NP + LT exhibited ΔE00 and ΔWID higher than HP6 (p < 0.05) and similar to all HP35 groups. HP6 + NP + LT showed the lowest HP diffusion, and the highest cell viability (%) among bleached groups, preserving cell morphology and number of living cells similar to NC and NP. HP6 + LT, HP6 + NP, and HP6 + NP + LT exhibited the lowest cell oxidative stress among bleached groups (p < 0.05). HP35, HP35 + LT, and HP35 (COM) displayed the lowest cell viability. HP6 achieved significantly higher color and whiteness index changes when incorporated with nanoparticles and light-irradiated and caused lower cytotoxicity than HP35 gels. The nanoparticles significantly increased cell viability and reduced the hydrogen peroxide diffusion and oxidative stress, regardless of HP concentration. Incorporation of co-doped titanium dioxide nanoparticles combined with violet irradiation within the HP6 gel could promote a higher perceivable and acceptable efficacy than HP6 alone, potentially reaching the optimal esthetic outcomes rendered by HP35. This approach also holds the promise of reducing cytotoxic damages and, consequently, tooth sensitivity.

Can deep learning-designed anterior tooth-borne crown fulfill morphologic, aesthetic, and functional criteria in clinical practice?

ObjectivesThis study aimed to compare the design outcomes of anterior crowns generated using deep learning (DL)-based software with those fabricated by a technician using conventional dental computer-assisted design (CAD) software without DL support, with a focus on the evaluation of crown morphology, function, and aesthetics. MethodsTwenty-five in vivo datasets comprising maxillary and mandibular arch scans of prepared maxillary central incisors were utilized to design anterior crowns by using three methods: 1) a DL-based method resulting in as-generated outcome (DB), 2) a DL-based method further optimized by a technician (DM), and 3) a conventional CAD-based method (NC, control). Evaluations were conducted for crown morphology (total discrepancy volume (TDV), root mean square (RMS), positive average (PA) and negative average (NA) deviations), functional aspects (incisal path: deviations, length, and mean inclination), and aesthetics (crown width, height, width-to-height ratio, angular radius of mesioincisal line angle, proximal contact length, and tooth axis angle). ResultsSignificant differences in TDV ratio were noted between the DB–NC (32.3 ± 8.5 %) and DM–NC (26.5 ± 5.4 %) pairs (P = 0.006). No significant differences were observed in TDV between the DB–NC (65.3 ± 24.4 mm3) and DM–NC (54.3 ± 21.0 mm3) pairs (P = 0.095). For the entire palatal surface, significant differences in RMS and PA values were observed between the DB–NC and DM–NC pairs (P < 0.037). Significant differences in RMS values for the incisal half (P = 0.021) and in PA values for the cervical half (P = 0.047) of the palatal surface were also noted between these pairs. Significant differences in the deviation of the incisal path were observed between the DB–NC (290.4 ± 212.4 μm) and DM–NC (132.0 ± 122.3 μm) pairs (P < 0.001). However, no significant differences were found among the groups (DB, DM, and NC) in terms of the length and mean inclination of incisal paths or in aesthetic outcomes. ConclusionsA DL-based method can result in promising outcomes with clinically acceptable morphology and aesthetics for anterior crowns. Minor deviations in incisal path of the crowns may lead to anterior guidance discrepancies, which can be corrected by the dental technician at the design stage. Clinical significanceWith the potential of DL-based design methods in dental applications, integrating AI technology into dental CAD workflow can enhance the clinical efficiency and consistency of anterior crown design, although human intervention may be required to refine functional aspect.

Neo-Omphaloplasty within a Vertical Scar: The Double Trapezium Flap Technique

Background: Various techniques for neo-omphaloplasty (or umbilicoplasty/umbiliconeoplasty) have been established in recent decades. However, when the omphaloplasty must be integrated into a vertical scar, most of these techniques are unsuitable. Method: We established a technique comprising two “cross-border” trapezium flaps that come together in a key-lock fashion to be applicable for umbilical reconstruction in vertical scars. Between 2020 and 2023, we performed the double trapezium flap technique in 11 patients requiring abdominal wall correction due to previous operations resulting in the loss of the original navel and a vertical midline scar. The follow-up period was 12 months. Results: We encountered two minor wound healing disorders not involving the omphaloplasty. One patient experienced a more severe wound healing complication involving the vertical scar and the lower flap of the neo-umbilicus. No cases of umbilical flattening or detachment of the anchorage stitches were detected. Patients ranked the aesthetic outcomes as “excellent” (n = 9) or “good” (n = 2). Physicians ranked the results as “excellent” (n = 7), “good” (n = 4), and “average” (n = 1). Conclusions: For the selected patients, this technique appears to be a good and reliable option to create a natural looking neo-umbilicus, creating sufficient umbilical depth with minimal scarring. While a study population of 11 patients is hardly enough to endorse a new technique, appropriate cases are comparatively rare and very specific.

Measurement of Anterior Maxillary Alveolar Ridge Dimension and Assessment of Sagittal Root Position by Cone Beam Computerized Tomography (CBCT)

Maxillary anterior region is the implant site that may require the most rigorous pre-operative assessment as it will have a direct influence on aesthetic outcome and stability of the dental implant. In the present study, CBCT (cone beam computerized tomography) images were used to evaluate alveolar ridge dimension in the maxillary anterior region. This observational radiographic study was done at Nepal Medical College Teaching Hospital. The width of the alveolar bone was measured from the labial cortex to the palatal cortex of the maxillary anterior teeth in mm at the alveolar crest (L1), mid-root (L2), and apical root region (L3) for each tooth. Alveolar height was also measured from the alveolar crest to the floor of the nasal fossa. The Sagittal Root Position (SRP) of the maxillary anterior teeth was also assessed. Results showed that the maximum width of the alveolar bone was seen at L3 of canine and lateral incisor showed least width of alveolar bone width at L1. Maximum alveolar bone height was seen in canines. Males were seen to have increased width of the alveolar bone as compared to the females in all anterior teeth. The most frequent sagittal root position was class I which was seen in 270 (51.4%) of the total teeth examined, which was followed by class IV observed in 210 (40%) of the teeth examined. It could be concluded that for maxillary anterior region, additional regeneration therapy maybe required since class I is the most frequent SRP observed.

Use of Total Auricular Fillet Flap to Reconstruct Defects After Auricular and Parotid Region Tumors.

The auricular fillet flap (AFF) is also used to reconstruct defects of the periauricular region and scalp.The aim of this study was to evaluate patients in whom the total AFF was used to reconstruct defects formed after the resection the skin of the auricular and parotid regions. Seven patients, who presented at the researchers' hospital between January 2017 and July 2020 with masses involving, to different degrees, the parotid region, the periauricular region, the external auditory canal, or the auricular anterior surface skin were retrospectively evaluated. The study retrospectively analyzed seven patients aged 71 to 92 (mean: 80.3 years), including two females (28.5%) and five males (71.5%). The defective region, formed as a result of surgery, was reconstructed with the TAFF in all patients. One patient developed a blood circulation deficiency at first but recovered within a week, while there were no problems with blood circulation or compatibility of the flaps in the other six patients. The researchers recommend using the TAFF as an alternative flap for reconstructing defects of the skin of the auricular and parotid regions. This reconstruction method can be achieved in one session and offers acceptable aesthetic results.

DIEP Flap versus PAP Flap versus LAP Flap: A Propensity-Matched Analysis of Aesthetic Outcomes, Complications, and Satisfaction.

As free breast reconstruction options evolve, a patient- and body-centric approach can distinguish refined aesthetic outcomes. Although deep inferior epigastric perforator (DIEP), profunda artery perforator (PAP), and lumbar artery perforator (LAP) flaps are all safe and effective options for breast reconstruction, a head-to-head analysis of these 3 flaps has not been performed. The authors aim to compare these 3 flaps based on outcomes, BREAST-Q scores, and aesthetic results. After institutional review board approval, a retrospective review in a Research Electronic Data Capture database-guided analysis was conducted of patients who underwent simultaneous bilateral DIEP, PAP, or LAP flaps at a single academic institution. Propensity matching was performed to match 50 patients (100 flaps) in each group. Postoperative complications and BREAST-Q satisfaction survey scores were documented, and crowdsourcing was carried out to determine aesthetic preference in the general population. Overall patient postoperative breast satisfaction was insignificantly different across the 3 flap groups ( P > 0.05). Associations were seen with LAP flap donor-site seromas, PAP flap donor-site infections and wounds, and DIEP flap breast wounds and flap necrosis ( P < 0.05). DIEP flaps had a higher raw score average on crowdsourcing survey, although LAP flaps were rated significantly higher aesthetically than DIEP and PAP flaps when undergoing a matched head-to-head analysis ( P < 0.05). DIEP, PAP, and LAP flaps all have favorable outcomes with insignificantly different long-term satisfaction, with comparable complication profiles. Although DIEP flaps may initially score higher, LAP flaps score higher frequently when analyzed in a head-to-head analysis. For these reasons, tailoring breast reconstruction to the patient's anatomy and morphology provides optimal outcomes. Therapeutic, III.

Effectiveness of results of complex treatment of pathological wear of hard tissues of teeth

Background:Tooth wear is a multifactorial condition that results in the loss of hard dental tissue. Physiological wear does not usually result in any subjective symptoms. Pathological abrasion of hard dental tissues is accompanied by both morphological and functional disorders of the dental system Objective: To evaluate the functional and aesthetic results of complex treatment of pathological abrasion of dental hard tissues. Materials and methods: This is a prospective controlled study that included 82 patients with a clinically confirmed diagnosis of Increased tooth wear of the first and second degree of severity (from 2020 to 2024). The age of the patients ranged from 34 to 68 years (48 men, 34 women). The examination of patients included: collecting complaints and identifying concomitant somatic diseases, X-ray examination, photographs of the patient's face, bite height, and nasolabial folds. Distribution of the group: Group 1 included patients with the first degree of hard tissue loss 47 (29 men, 18 women) Group 2 included patients with the second degree of hard tissue damage 35 (21 men, 14 women). During examination, patients complained of aesthetic defects caused by tooth wear and discoloration, discomfort when closing, chewing and phonetic disorders, typical symptoms of TMJ dysfunction, such as pain and crunching in the joints, fatigue of the masticatory muscles and muscle pain, displacement of the lower jaw to the side during vertical movements, a feeling of distension in the ears, headaches and bruxism. In patients of group 1: tooth wear was restored with orthopedic structures. In patients of group 2: temporary prosthetic structures and occlusal splints were used to normalize occlusal relationships in case of TMJ and masticatory muscle dysfunction. Gradual raising of the bite was carried out by means of a set of kappa-splints for 14 days, 1 month and 3 months from 1.0 to 5.0 mm until complete restoration of the occlusal height depending on the severity of pathological abrasion of teeth, abrasion of teeth restored by orthopedic structures. Dynamic observation of the clinical condition of the prosthesis structure was carried out in the following periods: 1 week, 1, 6, 12, 24 months,assessment of the condition of the performed restorations were recorded in the medical record of the dental patient. Results:Clinical radiological results showed satisfactory results and are encouraging in patients of groups 1 and 2. After treatment in patients of groups 2, according to the analysis of the lateral teleroentgenogram of the head, an increase in the height of the lower third of the face is noted, in 28 patients the nasolabial folds were smoothed out. Patients were satisfied with the aesthetic and functional results of the treatment Conclusions: The results of the study showed that treatment using occlusal splints at the preparatory stage in patients of group 2 with occlusion disorders due to pathological abrasion of hard dental tissues and restoration with orthopedic structures is relevant for normalizing the occlusal relationships of the jaws and this complex treatment method provides a good aesthetic and functional result.

Coverage of Soft-Tissue Defects of the Palm of the Hand: Introduction of a New Flap Design.

The palm is of great importance for maintaining a functioning hand. The reconstructive demands of thickness, texture, color matching, pliability, and sensation for palmar defects represent a unique challenge for plastic surgeons. This study introduced a novel versatile design for the ulnar palmar artery perforator flap (UPAPF) to cover large palmar soft-tissue defects of the hand. The fifth metacarpophalangeal joint was identified as a landmark where the perforator was nearly 1 to 1.5 cm proximal. A template of the defect was outlined after adequate debridement. Meticulous dissection was executed under loupe magnification to trace the perforator until an adequate length of the pedicle was obtained for rotation. The harvested type B fasciocutaneous flap was rotated nearly 90° to be insetting on the palmar defect. Two patients were presented with a soft-tissue defect of the palm measuring 4.8 × 5.5 cm2 and 3.8 × 5 cm2, respectively. The flap was harvested and positioned at the defects. The flaps survived in the 2 cases with minimal donor site complications. The patients acquired protective sensations within the flap at the end of the follow-up period. The UPAPF provides a stable coverage for palmar soft-tissue defects with satisfactory aesthetic and functional results. It is a convenient addition to the armamentarium for reconstructing palmar soft-tissue defects of the hand.

Gingival Augmentation Using Injectable Platelet-Rich Fibrin (i-PRF)-A Systematic Review of Randomized Controlled Trials.

Background: In recent years, the utilization of blood concentrates in dentistry has become increasingly prevalent. In 2014, the development of injectable platelet-rich fibrin (i-PRF) was achieved. One of the key benefits of i-PRF is its ability to consistently release a range of growth factors. This review aimed to determine whether i-PRF could be used for gingival augmentation. Methods: The research involved a search of the PubMed, Embase, Scopus, and Google Scholar databases using the following search terms: ("microneedling" or "micro needling" or "injectable platelet-rich fibrin" or "i-PRF") and ("gingival augmentation" or "augmentation" or "attached gingiva" or "attached mucosa" or "soft tissue augmentation" or "KM" or "keratinized mucosa"). Results: Of the 668 results, 8 articles meeting the inclusion criteria were included in the article. The results of the studies analyzed indicated a significant increase in gingival thickness. Furthermore, some articles demonstrated an increase in keratinized tissue width. The augmentation of the gingival thickness with i-PRF yielded no inferior results in comparison to the free gingival graft, which is the current gold standard, resulting in a superior aesthetic outcome and a reduction in postoperative discomfort. Conclusions: This systematic review allowed the authors to conclude that the use of i-PRF or hyaluronic acid may be the first step towards developing a non-surgical method of gingival augmentation.

The effectiveness of direct versus indirect restoration techniques following canal therapy

The restoration of endodontically treated teeth is a critical aspect of dental practice, with the choice between direct and indirect restoration techniques being central to optimizing clinical outcomes. Direct restorations, such as composite resins, offer advantages in terms of cost, time efficiency, and preservation of tooth structure. However, their long-term performance, particularly in posterior teeth, may be compromised by issues such as marginal leakage, wear, and discoloration. Indirect restorations, including crowns, onlays, and inlays, provide enhanced durability, fracture resistance, and aesthetic outcomes, particularly for teeth that have undergone significant structural loss. These restorations, often made from ceramics or metals, offer superior longevity but come with higher costs and longer treatment times. The aesthetic performance of restorations plays a significant role in patient satisfaction. While direct restorations allow for immediate aesthetic adjustments and are generally more affordable, they may suffer from discoloration and wear over time. Indirect restorations, particularly porcelain-based options, offer better color stability and natural appearance, making them a preferred choice for patients with high aesthetic demands. Cost-effectiveness is another critical factor influencing clinical decision-making. While direct restorations are more affordable initially, their long-term cost-effectiveness may be compromised by the need for repairs or replacements. Indirect restorations, despite their higher upfront cost, often prove to be more economical in the long run due to their durability and reduced need for maintenance. The decision between direct and indirect restoration techniques should be individualized, considering factors such as tooth location, the extent of damage, aesthetic requirements, and financial constraints. A comprehensive evaluation of these factors, along with clear communication with the patient, is essential for achieving optimal clinical outcomes. Indirect restorations generally offer better long-term performance, particularly for heavily compromised teeth, while direct restorations remain a viable option for cases where cost and time efficiency are prioritized.

Comparative analysis of different filling materials in deciduous teeth

Dental caries in pediatric patients presents a significant challenge in maintaining oral health, making the choice of filling materials for deciduous teeth crucial for long-term success. Various restorative materials, including composite resins, glass ionomer cements (GICs), and resin-modified glass ionomers (RMGICs), have been used, each with distinct properties regarding durability, biocompatibility, and aesthetic outcomes. Composite resins are well-regarded for their ability to closely match the natural color of teeth, making them ideal for anterior restorations. However, they are technique-sensitive and may not provide sufficient durability in posterior regions subjected to high stress. Glass ionomer cements, known for their ease of placement and fluoride release, offer functional benefits in high-caries-risk patients, despite their lower aesthetic quality and susceptibility to wear over time. Resin-modified glass ionomers attempt to combine the strengths of both composites and GICs by improving durability and aesthetics while maintaining the fluoride-releasing property. The safety and biocompatibility of these materials also play a pivotal role in pediatric dentistry. While composite resins may release small amounts of bisphenol A (BPA), which has raised concerns about its potential health risks, GICs and RMGICs are generally considered safer due to their simpler chemical composition and fluoride release. In terms of functional longevity, composite resins offer better wear resistance compared to GICs, though resin-modified glass ionomers provide a compromise with improved strength and ease of use. Ultimately, the choice of restorative material should consider the specific clinical circumstances, including the child’s caries risk, tooth location, and the balance between aesthetic and functional needs. No single material is universally ideal for all cases, and a tailored approach is necessary to optimize outcomes in pediatric dental restorations.

Indications and outcomes for locoregional perforator propeller flaps in head and neck reconstruction: Topographical approach in 83 patients

BackgroundLocal perforator flaps have been used in head and neck for coverage of relatively small defects. In this study, we aimed to present our results using a wide spectrum of locoregional flaps in perforator propeller fashion in reconstruction of moderate-to-large sized soft tissue defects of the head and neck. Patients and MethodsFrom August 2012 to June 2023, a total of 83 patients with moderate to large-sized soft tissue defects of the head and neck underwent reconstruction using locoregional perforator propeller flaps. Data on the etiology and location of the defect, the flap of choice and the postoperative course were gathered from patients’ charts retrospectively. Clinical outcome was evaluated based on parameters such as flap survival, color match, duration of hospitalization, and subjective satisfaction of the patient. ResultsA total of 92 locoregional perforator propeller flaps were used in 83 patients with skin and soft tissue defects of the head and neck. The follow-up period ranged from 3 and 36 months, with an average follow-up duration of 12 months. The duration of hospitalization varied between 1 and 6 days, averaging 3 days. Distal partial flap loss occurred in 3 patients, while no postoperative infection, hematomas or seromas were observed. ConclusionLocoregional perforator propeller flaps provide reproducible, functional and aesthetic results in reconstruction of moderate-to-large sized soft tissue defects of the head and neck.