Aesthetic Success Research Articles

Single Versus Separate Incisions in Oncoplastic Breast Surgery Techniques

Abstract Background Patient concerns with aesthetics have prompted the improvement of oncoplastic surgical approaches. It has been shown that the aesthetic success in breast malignancy surgical treatment leads enhanced sexual and social recovery. In this study a prospective comparison between cohorts of early-stage breast cancer patients treated with oncoplastic breast surgery. The first cohort will be treated with the single incision approach and the second cohort will be treated by the conventional breast conservative technique, which will be performed with double incision (one for the tumour resection and the other for the axillary dissection). Objective to compare between single incision & separate incisions in approach to axillary lymph nodes in oncoplastic breast surgery. Patients and Methods This is a prospective cohort comparative study between single incision & separate incisions in approach to axillary lymph nodes in oncoplastic breast surgery. This study will be conducted at breast surgery unit at Ain Shams University Hospitals and Maddi Military Complex starting from June 2022 to June 2023. Approval of the Ethical Committee and written informed consent from all participants will be obtained. Results There was significant no statistical difference in both group as regards the operative timing, seroma and the hospital stay but there is a statistical difference regarding hematoma between the two groups. In our study, 86.7% of the patients attained good to excellent cosmetic outcomes (70% as excellent and 26.7% as good) regarding single incision and 79.7% of the patients attained good to excellent cosmetic outcomes (65% as excellent and 26.7% as good) regarding separate incision. High cosmetic outcome was obtained as the patients were satisfied with presence and shape of their breasts relatively. Conclusion The choice of the oncoplastic technique is mainly based upon the location of the tumor, size of the breast and distance of the tumor from the nipple areola complex. So all cases should be adequately reviewed in order to tailor the decisions for every single case. There is statistically difference between Single incision in breast cancer lesion and separate incision as regards hematoma and the cosmetic outcome.

IMMEDIATE IMPLANT PLACEMENT AND LOADING IN THE MAXILLARY ESTHETIC ZONE DEMONSTRATE HIGH SURVIVAL RATES, BUT ESTHETIC AND FUNCTIONAL SUCCESS DATA IS STILL NEEDED

Hamilton A, Gonzaga L, Amorim K, Wittneben JG, Martig L, Morton D, Martin W, Gallucci GO, Wismeijer D. Selection criteria for immediate implant placement and immediate loading for single tooth replacement in the maxillary esthetic zone: A systematic review and meta-analysis. Clin Oral Implants Res. 2023 Sep;34 Suppl 26:304-348. doi:10.1111/clr.14109. Although it is not explicitly reported, it is understood that this study was supported by the International Team for Implantology (ITI) as part of their latest consensus initiative. Systematic review (with meta-analysis).

Biophysical and aesthetic recovery in incisor hypomineralisation: a modified protocol

The clinical management of incisor hypomineralisation (IH) as it pertains to biophysical and aesthetic recovery, especially in the teeth of young individuals, is fraught with complexity. Treatment modalities are wide and varied, and often, if used in the wrong sequence, can lead to a suboptimal aesthetic result. Approaches, such as chemical micro-abrasion, air particle abrasion and tooth whitening have been used in the past, in addition to resin infiltration for the treatment of affected enamel. The penetration depth of hypomineralised lesions by resin infiltrant has been reported to vary and be dependent on the pre-treatment modalities used. The elimination of brown-coloured aspects of the IH lesion via tray-delivered tooth whitening is critical prior to resin infiltration because once the resin has polymerised, it will be more impermeable and thus less likely to be modified by oxidative action. This case report describes an extended resin infiltration period under diminished ambient light prior to polymerisation that was required for aesthetic success. CPD/Clinical Relevance: Ideal sequencing of treatment prior to resin infiltration is critical for physico-aesthetic success. The length of resin infiltration can be increased if results are not seen by the manufacturer-prescribed application time.

Predictability in anterior aesthetic implants: assessment, planning and execution

Implant placement in the anterior maxilla has been shown to have success rates comparable to posteriorly placed implants. However, the aesthetic outcome of these implants is, unsurprisingly, of much greater importance to patients, and can provide a significant clinical challenge. Predictable outcomes are undoubtedly harder to achieve and sustain, and greater consideration must be given to the precision of implant positioning and restoration in order to achieve clinical and aesthetic success. This article discusses the many factors affecting aesthetic implant predictability, from assessment and planning, through to materials, execution and restoration, with a focus on timings and early (Type II) placement. CPD/Clinical Relevance: For the majority of clinicians, Type II methodology for anterior implants is the more appropriate choice and gives predictable and stable outcomes.

The effect of fluoride varnish application on colour change due to paediatric drug usage in polyacid-modified composite resin: an in vitro study.

Colour stability is important in the long-term aesthetic success of restorative materials and is affected by both internal and external factors. Internal discolourations are due to the properties of the restorative materials. External discolourations can be associated with frequent consumption of food and beverages and the use of suspensions or syrups containing colourants/additives. Fluoride varnish application has an important place in preventive dentistry. The purpose of the research was to examine the protective effect of fluoride varnish application on the colour change on polyacid-modified composite resin restorative materials caused by the use of various paediatric drugs. Two hundred ten discs were prepared from polyacid-modified composite resin material and divided into two groups: flouride varnish was applied to one group and flouride varnish was not applied to the other group. The groups were further divided into seven subgroups and the samples were kept in artificial saliva, amoxicillin + clavulanic acid, cefuroxime axetil, clarithromycin, paracetamol, ibuprofen, and iron supplement drug solutions. The colour change values of the discs were measured using a spectrophotometer device before immersion in the drug solutions and on the 7th, 14th, 21st, and 28th days after the immersion. The obtained data were calculated and statistically evaluated using IBM SPSS V23 software. It was found that the application of fluoride varnish in the iron supplement drug group prevented the colour change of the polyacid-modified composite resins for 28 days. In the amoxicillin + clavulanic acid, cefuroxime axetil, and paracetamol groups, the fluoride varnish did not prevent colour change in the polyacid-modified composite resin restorative materials at the end of the 14th day. It is thought that fluoride varnish application may be beneficial as a preservative in the colour change of polyacid-modified composite resins due to the use of various paediatric drugs, and this protective feature may be effective for a specific period of time.

Establishing Clinically Acceptable PES/WES Threshold for Single- Tooth Implant Restoration.

Determining the esthetic success of single-tooth implant restorations (STIR) requires an objective tool such as one devised by Belser et al., 2009 - pink esthetic scores and white esthetic scores (PES/WES). This study aimed to utilized PES/WES to establish threshold scores based on (1) detectability and (2) acceptability of a STIR by lay person perception, (3) to study the difference in the ability of laypeople and dentists in detecting the presence of STIR, and (4) to study the pink and white deficiencies in relation to the detectability of the presence of STIR. A total of 38 calibrated photographs of STIR in the anterior region were scored with PES/WES by 3 prosthodontists. Next, 100 laypeople and 60 dentists were instructed to identify the STIR among the anterior teeth and provide reasoning behind the identification (based on pink and white esthetic criteria). The acceptance of the STIR was recorded. Receiver Operating Characteristics (ROC) analysis was utilized to determine the threshold scores. At the PES/WES score of 17, 71% of laypeople could not correctly identify the STIR, and at the PES/WES score of 12, 80% of laypeople accepted the implant. Out of 3,800 occasions, laypeople correctly identified the STIR 1,770 (46.58%) of those occasions. Among the correctly identified STIR, 751 (42.43%) of those occasions were identified with pink deficiencies and 1019 (57.57%) of those occasions were with white deficiencies. Out of 2,280 occasions, dentists correctly identified STIR 1869 (81.98%) of those occasions. The PES/WES score of 12 indicates the clinically acceptable threshold, while the score of 17 indicates the detectable threshold for an exceptional esthetic outcome. Laypeople tend to accept the implant despite its detectability. For both laypeople and dentists, root convexity/soft tissue color and texture are the most focused criteria of PES/WES, followed by overall white deficiencies that remain influential. Compared to laypeople, dentists tend to have a higher ability to detect STIR.

Latissimus dorsi seroma prevention with running quilting suture using barbed suture

Dorsal seroma is a common complication of autologous latissimus dorsi flap (ALDF) in breast reconstruction, and has limited the use of this technique, despite its aesthetic success. It is important to find a right technique to limit the incidence of seroma formation after ALDF. The aim of this study was to evaluate the effectiveness and tolerance of a dorsal quilting technique called "running quilting" using barbed resorbable suture in seroma prevention. Three hundred patients who underwent ALDF breast reconstruction in the period between 2004 and 2014 were included in this study. The population was divided in 3 groups; without quilting, with simple quilting suture, and with running quilting using barbed suture. The incidence of small seromas (requiring 1 or 2 aspirations during routine postoperative visits without adding additional appointments to the follow-up routine) was not significantly decreased: it was 54% in the non-quilted group, 47% in group 2 Quilting, and 34% in group 3 running quilting. However, quilting reduced the duration of drainage, and the rate of late seromas (from 8% to 0%), and chronic sero-hematomas completely disappeared in our experience. Running quilting using barbed suture is highly effective in preventing late and refractory donor-site seromas. Its effectiveness is expected to increase the use of ALDF in breast reconstruction, which we consider currently as one of the best autologous reconstruction techniques.

Effect of coffee on color stability and surface roughness of newly introduced single shade resin composite materials

BackgroundDentists started to follow the era of using single-shade resin composite restorations to avoid color shade selection. Our study was done to evaluate and compare the color stability of two single-shade resin composite materials.MethodsSixty samples were randomly allocated into two main groups (n = 30) according to the composite resin used: Group O: (Omnichroma) samples and Group V: (Venus Peral) samples. Each group was then divided into two subgroups (n = 15): group O1 and V1: samples immersed in coffee. Group O2 and V2: samples immersed in distilled water. Color changes (ΔE) and roughness values (Ra) were evaluated at baseline, first, and 14th days of immersion. The color change was assessed using Vita Easyshade V, while surface roughness was assessed using a profilometer and Atomic Force Microscope (AFM). Data were collected and statistically analyzed using two-way variance analysis (ANOVA) and Tukey's post-hoc test (p < 0.05).ResultsGroup O1 and V1 recorded the highest ΔE00 (P = 0.002, 0.0001, respectively) and Ra values (P < 0.001) with no significant difference between both materials at 14 days.ConclusionSingle shade resin composite with innovative chromatic material technology has dramatic color change and surface roughness that sacrifice esthetic success.

The color change effect of children's beverages on preheated polyacid-modified composite resins

AimColor stability is crucial to the esthetic success of restorative materials. The research carried out on the development of restorative materials, especially the preheating process to resins draws attention due to some advantages. The purpose of the research was to examine the effect of preheated polyacid-modified composite resins of children's beverages on color stability in vitro.Materials and methodsThe discs were prepared from A2-colored polyacid-modified composite resin material preheated at four different temperatures (4, 23, 39, and 55°C). The discs were kept in distilled water, cola, cherry juice, and chocolate milk. The data obtained by calculating the color changes were statistically evaluated using a two-way robust analysis of variance.ResultsNo significant color change was observed in the chocolate milk group compared to the distilled water group at all preheating temperatures on the working period. In the cola group, a similar color change was observed for up to 60 days at pretemperature values of 39 and 55°C, and up to 30 days at temperatures of 4 and 23°C.ConclusionIt should be considered that the preheating process may be beneficial for the longevity of the color stability of restorations, and that different beverage groups may have different effects.

The challenge of implant support prosthesis with a bony defect in the esthetic zone: a clinical report

The replacement of a single incisor with an implant-supported prosthesis is considered as a professional challenge in daily practice. The aesthetic success of the restoration depends on several local and loco-regional factors that the practitioner must perfectly know. This article describes a 29 years old female patient who presented in the department of prosthodontics for the replacement of her lateral incisor and the restoration of her canine. After clinical and radiographic study, the minimal bone volume could only accommodate the placement of a narrow implant to support a ceramic incisor.

Validation of a Hyperspectral Imaging System for Color Measurement of In-Vivo Dental Structures.

A full comprehension of colorimetric relationships within and between teeth is key for aesthetic success of a dental restoration. In this sense, hyperspectral imaging can provide point-wise reliable measurements of the tooth surface, which can serve for this purpose. The aim of this study was to use a hyperspectral imaging system for the colorimetric characterization of 4 in-vivo maxillary anterior teeth and to cross-check the results with similar studies carried out with other measuring systems in order to validate the proposed capturing protocol. Hyperspectral reflectance images (Specim IQ), of the upper central (UCI) and lateral incisors (ULI), were captured on 30 participants. CIE-L*a*b* values were calculated for the incisal (I), middle (M) and cervical (C) third of each target tooth. ΔEab* and ΔE00 total color differences were computed between different tooth areas and adjacent teeth, and evaluated according to the perceptibility (PT) and acceptability (AT) thresholds for dentistry. Non-perceptible color differences were found between UCIs and ULIs. Mean color differences between UCI and ULI exceeded AT (ΔEab* = 7.39-7.42; ΔE00 = 5.71-5.74) in all cases. Large chromatic variations between I, M and C areas of the same tooth were registered (ΔEab* = 5.01-6.07 and ΔE00 = 4.07-5.03; ΔEab* = 5.80-8.16 and ΔE00 = 4.37-5.15; and ΔEab* = 5.42-5.92 and ΔE00 = 3.87-4.16 between C and M, C and I and M and I, respectively). The use of a hyperspectral camera has proven to be a reliable and effective method for color evaluation of in-vivo natural teeth.

Adaptive Audacity: Uncovering Queer Attachments and Re-evaluating Marriage Narratives in John William De Forest's Miss Ravenel's Conversion from Secession to Loyalty

Adaptive Audacity: Uncovering Queer Attachments and Re-evaluating Marriage Narratives in John William De Forest's <i>Miss Ravenel's Conversion from Secession to Loyalty</i>

Clinical investigation of the main approaches to exodontics and aesthetic preservation for the dental implant: a concise systematic review

Introduction: In the context of tooth extraction and aesthetic care, steps are needed for tooth extraction. Alveolar bone resorption after tooth extraction often leads to situations where the long-term function and esthetic success of dental implant restorations is a challenge. Thus, the Socket shield has been described as an alternative technique to maintain the alveolar ridge in the placement of immediate implants. Objective: Conducted a concise systematic review of key considerations and clinical outcomes of minimally traumatic treatment of tooth extraction and dental implants. Methods: The present study followed a concise systematic review model, following the rules of systematic review – PRISMA. The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The present study was carried out from January to March 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. A total of 47 articles were fully evaluated and 26 were included in this study. The results suggest that the adjunctive use of connective tissue grafting is not mandatory to achieve successful esthetic results for well-planned immediate implant placement with non-functional immediate provisional restoration in a fresh extraction socket. Still, the success/modified success rate, survival, mean resorption of the oral plate, and patient satisfaction, there were no differences between immediate implants placed with a flap or with an envelope flap of minimal thickness.

Should the Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on Implant Survival.

Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications. This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less than optimal glycemic control. Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients. In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.

Esthetic complications in implant dentistry.

Esthetic complications in implant dentistry have become a significant consideration for patients and practitioners. This review presents an appraisal on the current knowledge of the physiological peri-implant soft-tissue dimensions and factors that may compromise peri-implant tissue esthetics. Factors such as papilla fill adjacent to the implant and midfacial mucosal height are critical parameters that determine the esthetic success of implant-supported restorations. Papilla fill adjacent to a single dental implant appears to depend upon the clinical attachment level of the neighboring tooth. A horizontal inter-implant distance of at least 3mm is necessary to ensure optimal interproximal mucosal embrasure between two adjacent implants in the anterior maxilla. In cases where implants cannot be placed at least 3mm apart, a single implant with a cantilever bridge should be considered. Buccolingual implant positioning plays a major role in midfacial mucosal height. Soft-tissue volume grafting following immediate implant placement in the presence of a thin soft-tissue phenotype or simultaneous to surgical peri-implantitis therapy might help to overcome facial mucosa recession.

Feasibility analysis of an ultrasound on line diagnostic approach for oral and bone surgery

During implant surgery procedures, surgical precision is an essential prerequisite for the functional and aesthetic success of the prosthetic crown to be placed on the dental implant. A modern implant surgical approach should be standardized as much as possible to guarantee extreme precision in the insertion of the implant into the upper and lower bone jaws. Among the most common surgical errors during implant surgery there is the over-preparation of the surgical alveolus with possible damage to the contiguous anatomical structures. To avoid this problem, in the recent years, there has been an increasing attention to the development of new control techniques. In this paper, we describe an innovative ultrasound approach, which exploits the integration of an electro-acoustic transducer with the surgical drill used for realizing the alveolus in the bone that will host the implant. Specifically, he proposed approach is based on the “time-of-flight” detection technique for measuring the thickness of the residual bone subjected to the drilling. In order to demonstrate the feasibility of the proposed approach, here we report on a detailed numerical analysis aimed at studying the propagation of ultrasonic waves through the drill-bit and through the involved tissues. The obtained results confirm the validity of our approach, and enable for a future first prototype implementation of a hi-tech surgical drill-bit, which in general is suitable not only for dental implant surgery but also for other uses in oral surgery, maxillofacial surgery and for bone surgery.

I. A. KRYLOV — THE FABULIST IN THE ASPECT OF SELF-CONSCIOUSNESS

The article deliberately addresses the issue of self-consciousness of I. A. Krylov the fabulist. It identifies the factors that contributed to the concentration of an already mature poet, playwright and prose writer on work in a particular genre, as well as the impulses of his entry into the specifics of the fable and the world genre tradition in the conditions of the formation of an internal request for the status of a national poet and the authority of expressing folk wisdom. The crystallization of the macro-intention of Krylov’s nine books of fables, the identification of the strategy of his book-making is understood as the explication of the dynamics and structuring of the author’s self-awareness, his aesthetic and poetological purposefulness and value success in Russian culture on the transition from the traditionalist to the individual creative paradigm of the development of artistic literature. The meaningful component of the fable is seen as a system of requirements for the arrangement of the peacekeeping apparatus of the master of the word and the possibilities of the national speech tradition to respond organically to the common challenge. Krylov’s subjectivity is seen as a purposeful process of building oneself as a national and competitive global figure into a number of the highest representatives and exponents of the wisdom of mankind. The authors of the article proceed from the fact that the type of self-consciousness of the fabulist pre-establishes the synthesis of nature, society and the individual, striving for a reasonable, orderly and optimistic coexistence, taking into account the genetic experience of universal metaphor and aphorism, genre inclusions of sentimentalism and romanticism. The links in the promotion of Krylov’s individual artistic system are also fixed, in particular his comedic practice, as a prerequisite for the transition to the decisive choice of the form of aesthetic expression. The research methodology is focused on combining elements of cultural, historical-genetic, semiotic, typological approaches to the analysis of literary phenomena with a common frame of achievements of Russian historical poetics.

The musical language of Yuen Ren Chao: A cultural and empirical study of the modernization of Chinese music

In the Chinese art song repertoire, "How can I help but think of you" has long enjoyed enormous prestige since its publication in the 1920s. The song is memorable not only because of its innovative use of language by Liu Bannong in the lyrics but also because of the ingenious arrangement of tonalities, forms, and melodies by Chao Yuen Ren in the music. This essay will be devoted to a cultural and empirical analysis of the song, with the aim of understanding the efforts made by eminent scholars at the early stage of modernization of Chinese music and language. To this end, we will first explore how the lyrics are structured phonetically and syntactically. Tonal complexity and ambiguity in the music will then be analyzed, followed by the discussion of qǐ-chéng-zhuǎn-hé in the musical form. The pentatonicism embedded in the song and its relationship with what generally makes music "sound Chinese" will also be examined. In the end, we will also review an essential concept, yìjìng (or mindscape), in Chinese aesthetics and philosophy to better appreciate how various components in the music and lyrics together contribute to the aesthetic success of the song.

A Useful Approach to I-Shaped Crooked Nose Correction: Cross-Spreader Graft Technique.

Correction of crooked nose with long-term functional and aesthetic success remains a great challenge for rhinoplasty surgeons. The aim of this study was to present the aesthetic and functional results of the cross-spreader graft technique applied for the correction of I-shaped crooked nose. A retrospective examination was made of 25 patients applied with open technique rhinoplasty using cross-spreader graft for the correction of I-shaped crooked nose between March 2016 and June 2019. The functional results of the patients were evaluated using the Nasal Obstruction Symptoms Evaluation scale. The Rhinoplasty Outcomes Evaluation was used to evaluate the subjective aesthetic results, and the external nose deviation angle was measured from the frontal aspect to evaluate the objective aesthetic results. Evaluation was made of 25 patients comprising 11 males and 14 females with a mean age of 26.64±7.08 years. The post-operative mean NOSE and ROE scores were significantly improved compared to the preoperative values (p<0.001). A statistically significant improvement was determined in the deviation angle values from preoperative to postoperative (p< 0.001). According to the current study functional and aesthetic results of the cross-spreader graft technique applied for the correction of I-shaped crooked nose, this new technique appears to be an effective method for the treatment of I-shaped crooked nose deformity. 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 .

Mathematical Tooth Proportions: A Systematic Review.

The aim of this systematic review was to evaluate and compare three commonly used proportions that include the golden proportion, golden percentage, and Recurring Esthetic Dental (RED) proportion to identify which of the mathematical formulas, if any, can be used to provide predictable and repeatable esthetic clinical outcomes. A comprehensive search of electronic databases that included EBSCO, ProQuest, SCOPUS, Science Direct, Wiley, Google Scholar and PubMed was conducted using the terms: "golden proportion," "golden percentage," and "Recurring Esthetic Dental (RED) proportions" alone or in concurrence with one or both ensuing terms: "tooth proportions" and "esthetic tooth proportions." In addition, the following journals were hand searched for relevant articles: Journal of Prosthodontics, Journal of Prosthetic Dentistry and Journal of Esthetic and Restorative Dentistry. Related citations were also considered. Tooth proportions varied substantially in the natural dentition. No studies revealed findings that supported the use of one mathematical formula to predict esthetic success. The golden proportion is present between the central to lateral incisor in some cases, but rarely between the lateral incisor and the canine. When compared to the other proportions, the golden percentage provided better starting points for tooth shape and size, but only when values were adjusted to consider other factors such as ethnicity and/or facial proportions. Mathematical formulas did not provide consistent results that would allow for their use as a standardized guide for esthetically pleasing smiles. Although the golden percentage may be a good starting point if the percentages are adjusted on a case-by-case basis, generalized esthetic ideals cannot be determined by a mathematical formula and are open to interpretation by both the clinician and the patient.