Apical Displacement Research Articles

Root Coverage Techniques: Coronally Advancement Flap vs. Tunnel Technique: A Systematic Review and Meta-Analysis

Introduction: Gingival recession, characterized by the apical displacement of the gingival margin, presents challenges to oral health. This study compares the effectiveness of the coronally advanced flap (CAF) and the tunnel technique (TT) for treating gingival recessions. Methods: Bibliographical searches included PubMed, Embase, Web of Science, Cochrane, Scopus, and the grey literature, with keywords “root coverage” “coronary advanced flap”, and “tunnel”. A systematic coreview was performed that included 26 studies evaluating root coverage, and 14 articles were included for the meta-analysis. Three groups were analyzed: Group 1 compared TT with connective tissue graft (CTG) versus CAF with CTG; Group 2 examined TT with CTG and/or other biomaterials versus TT with CTG alone; Group 3 compared TT with CAF, regardless of complementary biomaterials. Meta-analysis assessed mean root coverage (MRC), complete root coverage (CRC), and keratinized tissue gain (KTG). Results: In Group 1, TT with CTG demonstrated superior MRC compared with CAF with CTG (−8.68 CI95% −17.19 to −0.17; p = 0.0457). In Group 2, TT with CTG and/or other biomaterials showed similar MRC (4.17 CI95% −17.91 to 26.26; p = 0.7110) and CRC (0.37 CI95% −1.14 to 1.89; p = 0.6269) to TT with CTG alone, with variations in keratinized tissue gain. Group 3 indicated higher potential MRC for TT compared with CAF (5.73 CI95% −8.90 to 13.55; p = 0.685) but without statistically significant differences. Conclusions: This study suggests that TT with CTG might offer better root coverage than CAF with CTG; however, biomaterial selection requires consideration.

Cardiovascular magnetic resonance insights into anomalies of the mitral valve apparatus in Fabry cardiomyopathy and hypertrophic cardiomyopathy.

Despite different etiopathogenesis, Fabry Disease cardiomyopathy (FDc) and sarcomeric hypertrophic cardiomyopathy (HCM) share a similar hypertrophic phenotype, including anomalies of the mitral valve apparatus (AMVA). Some of these anomalies have also been described in the pre-hypertrophic stage of both diseases. This cardiovascular magnetic resonance (CMR) study aimed to: (i) compare AMVA between FDc and HCM with a similar degree of left ventricular hypertrophy (LVH), to add new insights into differential diagnosis; (ii) assess whether AMVA represent an early and progressive alteration in FDc; (iii) propose simple and potentially reproducible measurements of AMVA. This observational, retrospective study enrolled: (i) 80 Fabry patients, divided into three groups with increasing severity of cardiac phenotype (20 patients LVH-/normal T1, 20 patients LVH-/low T1 and 40 patients LVH+), and (ii) 40 patients with HCM. All patients underwent CMR. The LVH + FDc and the HCM groups were matched for age, sex, body surface area and left ventricular (LV) mass. The following AMVA were measured on cine images: papillary muscles (PMs) hypertrophy (maximal diameter (Dmax) of anterolateral (Al) and posteromedial (Pm) PM), apical displacement, anteriorization of Al PM and anterior mitral valve leaflet (AMVL) elongation. Reference values for defining AMVA were derived from a matched healthy control group (n = 40). Both HCM and FDc LVH + patients showed PMs hypertrophy, with a greater degree in the FDc LVH + group [Dmax Al PM 16 ± 3.4 vs. 15 ± 3.1 mm, p 0.017; Dmax Pm PM 14 ± 4.0 vs.12 mm (10.0-14.0), p 0.039] As compared to controls, both HCM and FDc LVH + patients showed PMs apical displacement (HCM 83% vs. healthy volunteers 8%, p < 0.001; FDc LVH + 65% vs. healthy volunteers 8%, p < 0.001), with a greater prevalence in HCM. Anteriorization of Al PM was only evident in HCM (15 ± 6.2 vs. healthy controls 21 ± 5.3 mm, p < 0.001). Elongation of AMVL was detected both in HCM and FDc with LVH + (HCM 29 ± 4.0 vs. healthy volunteers 24 ± 2.9 mm, p < 0.001; FDc LVH + 27 ± 4.0 vs. healthy volunteers 24 ± 2.9 mm, p < 0.001) without significant differences between the two phenocopies. The prevalence of myocardial crypts was higher among HCM patients than in FDc LVH + patients (75% vs. 48%, p 0.012). we report greater PMs hypertrophy in FDc and a higher prevalence of PMs positional alterations (anterior and apical displacement) and myocardial crypts in HCM. All these AMVA became more pronounced with the progression of the FDc phenotype. We suggest the systematic inclusion of the analysis of AMVA by simple linear measurements on cine images in the CMR assessment of hypertrophic cardiomyopathies, to help in the differential diagnosis between HCM and FDc and to facilitate early detection of cardiac involvement in FDc.

Indications and decision making in single and multiple treatment of the anterior sector

Gingival recessions, characterized by apical displacement of the gingival margin and exposure of the root surface, pose both esthetic and functional challenges. This paper reviews the indications and decision making in the management of anterior gingival recessions, a crucial aspect in esthetic and restorative dentistry. Over the years, the evolution of mucogingival surgery towards periodontal plastic surgery has led to the development of various surgical techniques, such as connective tissue grafts and advanced coronal flaps. These techniques aim to provide effective and durable root coverage, adapting to the specific anatomical characteristics of each patient. The selection of the most appropriate surgical technique depends on a detailed evaluation of local anatomical factors and the patient's esthetic expectations. While it is possible to maintain periodontal health with a minimal amount of keratinized gingiva, gingival recessions remain common, especially in individuals with thin periodontal phenotypes. An interdisciplinary approach is essential to ensure outcomes that optimize both periodontal health and esthetics in the long term

Effect of force direction and impaction angulation during dilaceration impacted central incisor traction: a finite element analysis

BackgroundThe effects of traction forces at different angles on impacted central incisors(ICI)with varying inverted angles (IA) may be different. The objective of this study was to analyze the biomechanical effects of different force directions (FD) on developmentally inverted ICI with multi-angle variations and to offer insights and guidance for the treatment of inverted ICI.MethodsThree-dimensional finite element method was employed to simulate clinical scenarios of inverted ICI traction. As such, 0.2 N of force (direction: antero-superior angles of 90°, 100°, 110°, 120°, and 130° relative to the long axis of the inverted ICI crown) was applied to the inverted ICI with inverse angles (IA) of 40°, 30°, 20°, 10° and 0°. Inverted ICI apical displacement and Von Mises stress on periodontal ligament (PDL) and alveolar bone were compared.ResultsIA and FD showed minimal influence on the stress distribution in the PDL, as higher stresses were concentrated in the apical region. The higher stresses in the alveolar bone are focused on the cervical and apical regions of the tooth. In particular, IA exerts a more significant impact on stress distribution in the alveolar bone than FD. The influence of IA on the apical displacement of inverted ICI is larger than that of FD.ConclusionsTo promote the health of the root and periodontal tissues, it is recommended to use an angle of 100°-110° relative to the long axis of the ICI crown when dealing with a large IA (> 20°) developmentally inverted ICI. Conversely, an angle of 110°-120° can be used.

Accuracy of computer-guided implant surgery in partially edentulous patients: a prospective observational study

PurposeThis study aims to evaluate the amount of distortion using computer-guided implant surgery with 3D printed surgical guides in limited edentulous spaces.Materials and methods25 bone level self-tapping implants (Straumann® BL and BLT) were randomly inserted in either distal or intercalary posterior mandibular edentulism using a fully digital protocol and 3D printed surgical guides. Amount of inaccuracy was evaluated after superimposing the 3 coordinates of virtually planned and final implant images, which were obtained using intra-oral scans and scan bodies. Four evaluation parameters were considered: origo-displacement, error depth, apical displacement and angle between the planned and the placed implant.ResultsThe average of distortion was 0.71 mm for the origo-displacement, 0.36 mm for the error depth, 0.52 mm for the horizontal displacement and 3.34º for the error angle.ConclusionThe major reason of exclusion was CBCT artifacts. Results of this study were aligned with the results of previous studies concerning partially edentulous spaces. CAD/CAM manufacturing process did not result in significant distortion whilst the biggest part of distortions originated from the surgical process. The learning curve in computer-guided implant surgery presented an important source of inaccuracy.

Taurodontism in oral-facial-digital syndrome

Oro-facial-digital syndrome (OFDS) is one of the rare hereditary conditions involving various developmental anomalies of the oral cavity, face as well as digits. Oral-facial-digital syndrome, Type I (OFDS I), a variant of OFDS, is a X-linked dominant condition showing malformations involving the oral cavity, face, and digits, predominantly affecting the females and lethal in males. Taurodontism is a clinical condition rarely encountered in OFDS I. It is a tooth developmental anomaly caused due to the failure of Hertwig’s epithelial sheath to invaginate horizontally at proper level, thereby resulting in an enlarged pulpal chamber and apical displacement of the pulp floor. A case of OFDS I, with typical clinical findings along with a unique feature of taurodontism, is presented here. Performing root canal treatment in taurodontism is a challenge. An early diagnosis and treatment will help the patient to lead a normal and healthy life.

Endodontic retreatment of a mesotaurodontic mandibular first molar with C-shaped configuration in a patient with multiple taurodonts: A case report and review of literature

Abstract Taurodontism is a dental anomaly characterized by an apical displacement of the pulp chamber floor, resulting in a large pulp chamber with short roots. It can be associated with certain syndromes and abnormalities, although it is common to occur as an isolated characteristic. This anomaly can occur along with other root canal system anomalies such as C-type configuration. The aim of this report is to present the successful endodontic management of a C-shaped mesotaurodontic mandibular molar and review the literature available on this matter. A 23-year-old Persian female was referred by her dental surgeon to complete the root canal treatment of her right mandibular first molar (#46). Clinical examination showed a temporized cavity with no response to pulpoperiapical tests or visible pocket depth while an elongated root trunk with slight periodontal ligament widening, incomplete obturation of the root canal system, and periapical radiolucency was evident on the intraoral radiograph. Cone-beam computed tomography (CBCT) revealed a taurodontic and type III C-shaped root canal configuration. With a diagnosis of previous treatment and asymptomatic apical periodontitis, the patient was scheduled for root canal retreatment. The same anomaly was discovered in other molar teeth on the panoramic radiograph taken before the primary treatment of tooth #46. At a 2-month follow-up session, the tooth was found asymptomatic clinically and radiographically. The past publications about the management of nonsyndromic taurodontic molars were also reviewed. The review of 29 similar articles showed that preoperative CBCT, magnification with illumination, along with active irrigation are helpful items in managing such cases.

Surgical strategies in Ebstein anomaly: 28 years' experience in a pediatric hospital

Ebstein anomaly is a congenital defect characterized by a lack of delamination and apical displacement of the tricuspid valve, tricuspid insufficiency, right atrial enlargement, and ventricular dysfunction. To analyze the results and evolution of the different surgical strategies, data were collected from 45 patients operated on during 1990-2018. Twenty-six patients were included with a median age at initial surgery of 11.3 years (range: 13 days-18.6 years). Procedures were plastic 10 patients (38%), cone technique reconstruction 11 (42%), and replacement 5 (19%). Additional interventions were required in 7 patients: cavo-pulmonary anastomosis 4 and Cox-maze 4. Nine patients (34.6%) required reoperation due to severe tricuspid insufficiency. Six had previous plastic, two bioprothesis, and one, cone. Overall mortality was 11.5% (3)at a median of 10.1 years post-surgery (range: 5.7-10.12) associated with arrhythmias (p = 0.05), right (p = 0.008), left (p = 0.0001) ventricular dysfunction and reoperations (p = 0.03). None were previous conus. Median follow-up was 6.5 years (range: 1-29.1). Ninety-one-point-six percent were in functional class I/II and 79.2% in sinus rhythm. The results of the different classic techniques were similar, although not free of complications and reoperations. Cone reconstruction proved to be effective, with low surgical mortality, less need for reoperations, and durability in the medium term.

A Twenty-Year Follow-Up of Adults with Ebstein Anomaly with Special Focus on Supraventricular Arrhythmias, Supraventricular Arrhythmias and Effectiveness of Catheter Ablation in 20-Year Follow-Up of Adults with Ebstein Anomaly.

Background: Ebstein anomaly (EA) is a rare congenital heart disease characterized by the apical displacement of the tricuspid leaflets, creating an enlarged functional right atrium. Supraventricular arrhythmias (SVA) are common, and catheter ablation remains challenging. SVA is considered a risk factor for sudden cardiac death in this population. Still, there are very few real-life data on the impact of SVA treated invasively or conservatively on a patient's prognosis. We aimed to analyze the incidence of SVA in adults with EA, evaluate the effectiveness of catheter ablation, and analyze the impact of SVA and catheter ablation on survival in this population. Methods and results: 71 pts (median age 53 years; range 24-84 years) with EA were evaluated retrospectively from 1988 to 2020. Forty patients (56.3%) had SVA, and eighteen of them (45.0%) required at least one catheter ablation (35 procedures in total). Indications for ablation were mostly intra-atrial reentrant tachycardia (IART) and atrioventricular reentrant tachycardia (AVRT) (14 pts [77.8% and 9 pts [50.0%], respectively. IART and AVRT coexisted in nine pts. One patient suffered from persistent atrial fibrillation. Procedural effectiveness was reported in 28 (80%) cases; over a longer follow-up (mean 12.6 ± 5.4 years), only eight (44.4%) patients were completely free from SVA after the first ablation. In total, 10 patients (14%) died due to cardiovascular events. There was no difference in survival between patients with or without SVA (p = 0.9) and between ablated and non-ablated EA individuals (p = 0.89). Conclusions: Supraventricular arrhythmia is frequent in adults with Ebstein anomaly. Patients often require more than one catheter ablation but eventually become free from arrhythmias. The imaging parameters assessed by echocardiography or cardiac magnetic resonance do not seem to be associated with ablation outcomes. The impact of supraventricular arrhythmia itself or treatment with radiofrequency ablation is questionable and should be thoroughly investigated in this population.

A Wnt10a-Notch signaling axis controls Hertwig’s epithelial root sheath cell behaviors during root furcation patterning

Human with bi-allelic WNT10A mutations and epithelial Wnt10a knockout mice present enlarged pulp chamber and apical displacement of the root furcation of multi-rooted teeth, known as taurodontism; thus, indicating the critical role of Wnt10a in tooth root morphogenesis. However, the endogenous mechanism by which epithelial Wnt10a regulates Hertwig’s epithelial root sheath (HERS) cellular behaviors and contributes to root furcation patterning remains unclear. In this study, we found that HERS in the presumptive root furcating region failed to elongate at an appropriate horizontal level in K14-Cre;Wnt10afl/fl mice from post-natal day 0.5 (PN0.5) to PN4.5. EdU assays and immunofluorescent staining of cyclin D1 revealed significantly decreased proliferation activity of inner enamel epithelial (IEE) cells of HERS in K14-Cre;Wnt10afl/fl mice at PN2.5 and PN3.5. Immunofluorescent staining of E-Cadherin and acetyl-α-Tubulin demonstrated that the IEE cells of HERS tended to divide perpendicularly to the horizontal plane, which impaired the horizontal extension of HERS in the presumptive root furcating region of K14-Cre;Wnt10afl/fl mice. RNA-seq and immunofluorescence showed that the expressions of Jag1 and Notch2 were downregulated in IEE cells of HERS in K14-Cre;Wnt10afl/fl mice. Furthermore, after activation of Notch signaling in K14-Cre;Wnt10afl/fl molars by Notch2 adenovirus and kidney capsule grafts, the root furcation defect was partially rescued. Taken together, our study demonstrates that an epithelial Wnt10a-Notch signaling axis is crucial for modulating HERS cell proper proliferation and horizontal-oriented division during tooth root furcation morphogenesis.

Ebstein's Anomaly With Right Atrial Thrombus in 23 Years Old Man at Reference National Teaching Hospital of Ndjamena: A Case Report.

Ebstein’s anomaly is a rare congenital heart disease. It is usually associated with other congenital defects, particularly atrial septal defect/patent foramen ovale (PFO). We report here the case of Ebstein's disease revealed in a 23-year-old adult admitted for palpitations and exertional dyspnoea. He was in heart failure. The EKG showed atrial flutter . Cardiomegaly was present with a cardiothoracic index of 0.7. On echocardiography, the apical displacement of the tricuspid septal leaflet was 15 mm/m2 , the Celermajer index was Grade 3. There was a large thrombus floating in the right atrium. While awaiting surgical management, the patient was being treated with diuretics, digitalis and anticoagulants.

Taurodontic teeth in cone beam computed tomography: pictorial review

Objective: Taurodontism is a developmental disorder with enlargement of the body of the tooth and lack of cervical constriction, which results in a large pulp chamber and small roots with the apical displacement of furcation. Taurodontism exists in deciduous, and definitive unilateral, and bilateral teeth. We found that taurodontism was also described in 67 syndromes. We proposed a review of the open access literature on taurodontism, a new clinical classification of taurodontic teeth with illustrations from free open access literature, and from our case serie of 15 patients.&#x0D; Material and methods: We performed a systematic search for articles with free full text about taurodontism. The search was performed by one observer in PubMed database. We found 168 articles, and after application of inclusion/exclusion criteria we finally selected 136 articles for the review.&#x0D; Results: we provided 34 figures of taurodontic teeth related to: 1) Unilateral mandibular first premolar, 2) Unilateral mandibular second premolar, 3) Bilateral mandibular first and second premolar, 4) Bilateral upper maxillary first premolars, 5) Bilateral mandibular second molars, 6) Bilateral upper maxillary second premolar and left first molar, 7) Bilateral upper maxillary third molars, 8) Bilateral upper maxillary first and second molars, 9) Bilateral upper maxillary first, second, and third molars, 10) Bilateral upper maxillary molars (third molars, second, and first left upper molars), and mandibular molars (first right, and left mandibular molars, right third molar), 11) Bilateral upper maxillary molars (first, second, third right, and left upper molars), and mandibular molars, 12) Unilateral first mandibular premolar with cleft, 13) Bilateral molars of the mandible and the upper maxilla (adolescent patient who received chemotherapy at the age of 3-years-old to treat retinoblastoma), 14) Unilateral first maxillary molar (Treacher-Collins syndrome).&#x0D; Conclusions: We proposed a new clinical classification of taurodontic teeth based on hypo-, meso-, and hypertaurodontism, and on different types of deciduous, and definitive teeth (42 boxes). We were first to provide free reference images for: 1) upper maxillary second premolar hypertaurodontism, 2) mandibular second premolar mesotaurodontism, 3) upper maxillary third molar meso-and hypertaurodontism, 4) mandibular first molar hypotaurodontism, 5) mandibular third molar mesotaurodontism. We were also first to freely illustrate taurodontism related with chemotherapy, cleft palate patients, and Treacher-Collins syndrome.

Anaesthetic management of a case of Ebstein’s anomaly undergoing a non cardiac surgery

Ebstein’s anomaly is a rare congenital heart disease characterized by apical displacement of the Tricuspid valve leaflets leading to Tricuspid Regurgitation. Here we report the successful management of a case of a patient with Ebstein’s anomaly who underwent Defunctioning Tranverse Colostomy. Given the complexity of Ebstein's anomaly and the potential for associated cardiac abnormalities, it is crucial to have a multidisciplinary team involved in the patient's care.

Prevalence of Taurodontism in Contemporary and Historical Populations from Radom: A Biometric Analysis of Radiological Data.

Taurodontism is a morphological anomaly of multirooted molars characterized by apical displacement of the pulp chamber, shortened roots, and the absence of constriction at the dentoenamel junction. It can negatively impact the outcome of dental treatment plans. This study aimed to compare the prevalence of taurodontism among contemporary and historical populations from Radom, Poland. Five hundred eighty-two panoramic radiographs of contemporary patients and 600 radiographs of historical individuals were analyzed using the Shifman and Chanannel index. Group differences were determined with Pearson's chi-square tests according to sex, site, tooth group, and historical period. The study also evaluated the degree of severity of taurodontism in relation to dental groups, gender, and the periods from which contemporary patients as well as historical individuals originated. In the contemporary population, taurodontism was observed in 34% of individuals. In the historical data, the highest prevalence of taurodontism (31%) was observed among individuals from the 18th and 19th centuries, while earlier periods exhibited considerably lower prevalence rates. Across contemporary and historical populations, the maxillary molars were the most commonly affected teeth. Hypotaurodontism was the most prevalent form of taurodontism. The prevalence of taurodontism has gradually increased from the 11th century to the current day. The results of the research are of great importance for the clinician in terms of planning comprehensive dental treatment.

Effects of three types of attachments in the displacements, and distribution of stress and plastic deformation, and trough finite elements (FEM)

Objectives: The aim of the study was to evaluate the effect of resin attachments on the displacement and deformation pattern of the aligner plastic, determine the center of rotation and stress distribution in the upper canine during space closure using the finite element method (FEM), and evaluate the plastic Aligner deformation. Materials and Method s: A computer-assisted design model of the superior right hemiarch was constructed with the simulation of a first premolar extraction and a canine distalization, recreating the periodontal ligament and alveolar bone. FEMs were created to analyze the behavior of stress and displacement of the upper right canine with aligners in four situations, one without attachment, and three with bonded attachments (vertical rectangular, rectangular beveled, optimized root control). In addition, the plastic deformation of the aligner was evaluated. Results: In the simulation without attachment, there was no apical movement, while with vertical rectangular and rectangular beveled the behavior was similar with crown distal displacement and mesial apex displacement. The optimized attachment had a better movement control of the canine body respecting the crown and apical movement toward the same direction. The mayor plastic deformation was shown without attachment and no deformation was evidenced with optimized attachment. Conclusion: The FEM showed that nevertheless the optimized attachment produced a distal crown and apical displacement with the use of plastic aligners during the space closure, the apex only moved ¼ of the distal crown movement. Our results suggest that to obtain a pure translation of the canine with aligners, it would be necessary the use of auxiliars which complement the needed biomechanics.

Soft tissue displacement for detection of left ventricle apical dyskinesis with transthoracic echocardiography

We tested the hypothesis that the use of outward displacement of the soft tissue between the apex and the chest wall as seen in TTE, is a sign of apical displacement and would allow for more accurate diagnosis of apical dyskinesis. This is a retrospective study of 123 patients who underwent TTE and cardiac magnetic resonance imaging (MRI) within a time frame of 6 months between 2008 and 2019. 110 subjects were deemed to have good quality studies and included in the final analysis. An observer blinded to the study objectives evaluated the echocardiograms and recorded the presence or absence of apical dyskinesis. Two independent observers evaluated the echocardiograms based on the presence or absence of outward displacement of the overlying tissue at the LV apex. Cardiac MRI was used to validate the presence of apical dyskinesis. The proportion of studies which were identified as having apical dyskinesis with conventional criteria defined as outward movement of the left ventricular apex during systole were compared to those deemed to have dyskinesis based on tissue displacement. By cardiac MRI, 90 patients had apical dyskinesis. Using conventional criteria on TTE interpretation, 21 were diagnosed with apical dyskinesis (23.3%). However, when soft tissue displacement was used as the diagnostic marker of dyskinesis, 78 patients (86.7%) were diagnosed with dyskinesis, p < 0.01. Detection of displacement of soft tissue overlying the LV apex facilitates better recognition of LV apical dyskinesis.

Accuracy of Zygomatic Implant Placement Using a Full Digital Planning and Custom-Made Bone-Supported Guide: A Retrospective Observational Cohort Study

The aim of the study was to evaluate the accuracy of zygomatic implant placement using customized bone-supported laser-sintered titanium templates. Pre-surgical computed tomography (CT) scans allowed to develop the ideal virtual planning for each patient. Direct metal laser-sintering was used to create the surgical guides for the implant placement. Post-operative CT scans were taken 6 months after surgery to assess any differences between the planned and placed zygomatic implants. Qualitative and quantitative three-dimensional analyses were performed with the software Slicer3D, recording linear and angular displacements after the surface registration of the planned and placed models of each implant. A total of 59 zygomatic implants were analyzed. Apical displacement showed a mean movement of 0.57 ± 0.49 mm on the X-axis, 1.1 ± 0.6 mm on the Y-axis, and 1.15 ± 0.69 mm on the Z-axis for the anterior implant, with a linear displacement of 0.51 ± 0.51 mm on the X-axis, 1.48 ± 0.9 mm on the Y-axis, and 1.34 ± 0.9 mm on the Z-axis for the posterior implant. The basal displacement showed a mean movement of 0.33 ± 0.25 mm on the X-axis, 0.66 ± 0.47 mm on the Y-axis, and 0.58 ± 0.4 mm on the Z-axis for the anterior implant, with a linear displacement of 0.39 ± 0.43 mm on the X-axis, 0.42 ± 0.35 mm on the Y-axis, and 0.66 ± 0.4 mm on the Z-axis for the posterior implant. The angular displacements recorded significative differences between the anterior implants (yaw: 0.56 ± 0.46°; pitch: 0.52 ± 0.45°; roll: 0.57 ± 0.44°) and posterior implants (yaw: 1.3 ± 0.8°; pitch: 1.3 ± 0.78°; roll: 1.28 ± 1.1°) (p < 0.05). Fully guided surgery showed good accuracy for zygomatic implant placement and it should be considered in the decision-making process.

Comparative evaluation between collagen membrane (PerioCol®) and periosteum membrane in the treatment of gingival recession defects of maxillary anterior teeth: a clinical study

Abstract Background: The most common mucogingival defect is gingival recession (GR), which is characterized by apical displacement of the gingival margin from the cementoenamel junction and root exposure. Several techniques are available for treating GR and are collectively termed root coverage (RC) procedures. This study presents 3 months’ results of a randomized clinical trial comparing RC in areas of isolated GR by coronally advanced flap (CAF) with periosteum membrane and PerioCol® membrane. Materials and Methods: Twenty recession sites were selected for the study and further divided into two groups (Test group 1 [C AF + Periosteum membrane] and Test group 2 [CAF + Guided tissue regeneration membrane]) and completed the 3-month follow-up. Result: Satisfactory result obtained after three months in both the cases but CAF+Periosteum showed better and fast healing. Conclusion: Both treatment modalities showed a significant improvement in clinical parameters at 3 months postoperatively.

Apical papillary muscle displacement is a prevalent feature and a phenotypic precursor of apical hypertrophic cardiomyopathy.

Papillary muscle (PM) abnormalities are considered part of the phenotypic spectrum of hypertrophic cardiomyopathy (HCM). The aim of this study was to evaluate the presence and frequency of PM displacement in different HCM phenotypes. We retrospectively analysed cardiovascular magnetic resonance (CMR) findings in 156 patients (25% females, median age 57 years). Patients were divided into three groups: septal hypertrophy (Sep-HCM, n = 70, 45%), mixed hypertrophy (Mixed-HCM, n = 48, 31%), and apical hypertrophy (Ap-HCM, n = 38, 24%). Fifty-five healthy subjects were enrolled as controls. Apical PM displacement was observed in 13% of controls and 55% of patients, which was most common in the Ap-HCM group, followed by the Mixed-HCM and Sep-HCM groups (respectively: inferomedial PM 92 vs. 65 vs. 13%, P < 0.001; anterolateral PM 61 vs. 40 vs. 9%, P < 0.001). Significant differences in PM displacement were found when comparing healthy controls with patients with Ap- and Mixed-HCM subtypes but not when comparing them with patients with the Sep-HCM subtype. T-wave inversion in the inferior and lateral leads was more frequent in patients with Ap-HCM (100 and 65%, respectively) when compared with Mixed-HCM (89 and 29%, respectively) and Sep-HCM (57 and 17%, respectively; P < 0.001 for both). Eight patients with Ap-HCM had prior CMR examinations because of T-wave inversion [median interval 7 (3-8) years], and in the first CMR study, none showed apical hypertrophy [median apical wall thickness 8 (7-9) mm], while all of them presented with apical PM displacement. Apical PM displacement is part of the phenotypic Ap-HCM spectrum and may precede the development of hypertrophy. These observations suggest a potential pathogenetic, mechanical link between apical PM displacement and Ap-HCM.

A rare case: Coexistence of noncompaction cardiomyopathy and Ebstein anomaly

Noncompaction cardiomyopathy is a rare type of cardiomyopathy that can result in left ventricular failure, thromboembolic events, tachyarrhythmias, and sudden cardiac death. It is a congenital cardiomyopathy in which deep trabeculations and cavities in the left ventricle are formed due to the cessation of the development of myocardial tissue in the intrauterine period. Ebstein's anomaly is a congenital anomaly characterized by apical displacement of the tricuspid valve septal leaflet. Although the association of noncompaction cardiomyopathy and ebstein is a rare disease, there are cases described in the literature. A 23-year-old male patient, who presented with palpitations and fatigue, was diagnosed with noncompaction cardiomyopathy and ebstein anomaly. After the diagnosis, the patient is followed closely without complications with appropriate medical follow-up. Congenital heart diseases can be seen alone or in association with other cardiac malformations. When there are suspicious findings in a patient with ebstein's anomaly, it may be associated with noncompaction cardiomyopathy, and screening with echocardiographic and cardiac MRI should be considered.