Soft Tissue Changes Research Articles

Magnetic Resonance Imaging in the Evaluation of Avulsion Injuries of the Pelvis and Hip in Adolescent Professional Footballers: A Case Series.

Pelvic apophyseal avulsion fractures are uncommon injuries that frequently affect adolescents while participating in sports. This occurs because the enthesis cannot withstand the tractional force applied because the apophysis has not yet fully fused. Due to its complex muscular structure, being the origin of several muscles that cross two lower extremity joints, the pelvis has an increased risk for such injuries. The diagnosis of pelvic avulsion injuries depends heavily on imaging. The best way to detect soft-tissue changes, including tendon or muscle strain, bone marrow edema, hematomas, and soft tissue avulsion injuries, is with an magnetic resonance imaging . It is also the best at showing tendon retraction and can help the clinician spot patients who might benefit from surgical treatment. We report six cases of adolescents professional footballers that suffered avulsion injuries while playing football. The patients had painfully restricted hip range of motion and were unable to bear weight. Some of them on physical examination felt pain at the palpation of the injured area. Magnetic resonance revealed apophysis growth plate avulsion with or without displaced bone fragments that were treated conservatively with an excellent clinical and radiological outcome. For an accurate diagnosis of pelvic avulsion injuries and clinical management, it is important that everyone caring for this patient population is aware of the common injury mechanisms, radiographic findings, and available treatments.

Early implant placement in sites with ridge preservation or spontaneous healing: histologic, profilometric, and CBCT analyses of an exploratory RCT.

The aim of this study was to compare changes in soft and hard tissue and the histologic composition following early implant placement in sites with alveolar ridge preservation or spontaneous healing (SH), as well as implant performance up to 1 year after crown insertion. Thirty-five patients with either intact buccal bone plates or dehiscence of up to 50% following single-tooth extraction of incisors, canines, or premolars were included in the study. They were randomly assigned to undergo one of three procedures: deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered by a collagen matrix (DBBM-C/CM), DBBM-C alone, or SH. At 8 weeks, implant placement was carried out, and cone-beam computed tomography scans and impressions were obtained for profilometric analysis. Patients were followed up after the final crown insertion and again at 1 year post-procedure. Within the first 8 weeks following tooth extraction, the median height of the buccal soft tissue contour changed by -2.11 mm for the DBBM-C/CM group, -1.62 mm for the DBBM-C group, and -1.93 mm for the SH group. The corresponding height of the buccal mineralized tissue changed by -0.27 mm for the DBBM-C/CM group, -2.73 mm for the DBBM-C group, and -1.48 mm for the SH group. The median contour changes between crown insertion and 1 year were -0.19 mm in the DBBM-C/CM group, -0.09 mm in the DBBM-C group, and -0.29 mm in the SH group. Major vertical and horizontal ridge contour changes occurred, irrespective of the treatment modality, up to 8 weeks following tooth extraction. The DBBM-C/CM preserved more mineralized tissue throughout this period, despite a substantial reduction in the overall contour. All 3 protocols led to stable tissues for up to 1 year.

Five-Year Clinical, Radiographic, and Cone-Beam Follow-Up of Socket Shield Technique in Two Cases Treated with a Split Mouth Design.

The two presented cases of socket shield technique were done following a split mouth protocol in two patients, each received an immediate implant inserted conventionally on maxillary one side and another implant inserted applying the socket shield technique on the contralateral side. The outcomes including soft and hard tissue changes were compared clinically and radiographically. The four implants were followed for 5 years, and the outcomes were successful.

Experimental assessment of diffusible iodine-based contrast-enhanced computed tomography (diceCT) protocols.

Diffusible iodine-based contrast-enhanced computed tomography (diceCT) is an increasingly used digital complement, supplement, or alternative to traditional dissection-based anatomical research. The diceCT protocol, which has evolved and expanded over the past decade, employs passive diffusion of Lugol's iodine (KI3) to increase soft tissue radiodensity and improve structure contrast in the CT or microCT imaging of specimens. The development and application of diceCT has focused largely on specimens under 1 kg, and the varying reporting of methods on studies of both small and large specimens has initiated, but not yet established, an effective diceCT protocol for larger specimens based on monitored experiments of several fundamental variables (e.g., Lugol's iodine concentration, duration, and impacts of Lugol's iodine on tissues). In this study, we have experimentally assessed the efficacy of diceCT protocols for imaging whole-body specimens of the 1-4.5 kg Australian brushtail possum (Trichosurus vulpecula) using sequential CT imaging assessment across experimental conditions. We assessed the impact of varying Lugol's iodine concentration, the presence/absence of skin, solution volume and agitation on tissue radiodensity changes through weekly CT-based monitoring of tissue radiodensities over an 8-week experimental period. We have also quantified tissue volumetric changes across our experiment to assess the impact of diceCT applications on subsequent analyses of imaging datasets. Our results indicate that substantial changes in both soft-tissue radiodensity and soft-tissue volume occur within the first 28 days of Lugol's iodine treatment, followed by a slower rate of progressive soft-tissue radiodensity and volume changes across the experiment duration. Our results demonstrate the negligible benefit of skinning larger specimens to improve solution diffusion, and document significant soft-tissue volumetric changes with high concentration solutions (e.g., 10%) and long-duration exposure (e.g., beyond 5 weeks) that should guide individual diceCT protocol design and/or quantification and analysis for mammal specimens above 1 kg.

Skeletal, Dental and Soft Tissue Effects of Twin Block Appliance in Different Facial Divergence Cases

IntroductionClass II malocclusions refer to a discrepancy in the sagittal plane associated with either backward or upward rotation of the jaw. A backwardly positioned mandible is usually managed using a Twin block appliance which contains a bite plane to direct the occlusal forces in a more favorable direction. Our aim was to evaluate skeletal, dental, and soft tissue changes using twin-block appliance therapy in different facial divergence patients. MethodsA cephalometric study was conducted among two groups with 15 patients in each group. Group 1 have a Frankfort Mandibular plane Angle (FMA) of 18-25 degree while Group 2 have an FMA of 28 to 33 degree with Class II Division I malocclusion. All of them were treated with twin block appliances with modifications done according to FMA. Cephalometric analysis was done using Dolphin software (Dolphin Imaging 11.95) to evaluate skeletal, dental, and soft tissue changes after twin block therapy. ResultsAnalysis of variance and paired t-test were used to evaluate pre and post-treatment changes in cephalograms. The position of the mandible, maxillomandibular relation, and mandibular length was changed by 3.99 degrees, 5.23 degrees, and 4.04mm respectively in horizontal growers, while by 2.9 degrees, 1.74 degrees, and 1.07mm respectively in vertical growers. An increment in FMA by 4.59 degrees in horizontal growers with good vertical control and a little increment in FMA by 1.07 degrees in vertical growers were seen. Conclusions The twin block appliance is effective in skeletal, dental, and soft tissue correction in patients with different facial divergences.

Comparisons of soft tissue changes after Herbst appliance treatment in three different growth phases

This study aimed to compare the soft tissue effects of Herbst appliance in Class II malocclusion patients treated in three different craniofacial growth phases: prepubertal (PRE), circumpubertal (CIR), and postpubertal (POS). In total, 95 patients with Class II Division 1 malocclusion previously treated with a Herbst appliance were analyzed. Through the cervical vertebral maturation stages method, patients were allocated into three groups depending on the growth craniofacial phase at the beginning of treatment: PRE, CIR, and POS. Seventeen cephalometric measures were evaluated from each lateral radiograph before and after Herbst therapy using the Radiocef 2 software (Radio Memory, Belo Horizonte). Intragroup and intergroup treatment changes were compared statistically using a paired t test and MANOVA test, respectively. Soft tissue thickness changes were related only to mandible; all three mandibular measurements (L1_LL, B_B', and Pog_Pog') showed thickening for the PRE group ranging from 0.92 mm (Pog_Pog') to 2.02 mm (B_B'), and only lower lip thickened overtime for the POS group (L1_LL = 0.99 mm). Soft and hard tissue pogonion displaced anteriorly, but only the soft tissue showed differences among groups; PRE group presented more anterior displacement than POS group (3.61 mm and 1.39 mm, respectively). Hard and soft tissue facial convexity decreased more in the PRE and CIR groups than in the POS group. Mentolabial sulcus depth reduced more in the PRE (1.07 mm) and CIR (1.29 mm) groups than in the POS (0.55 mm) group. Horizontal movement of the skeletal and soft pogonion presented a moderate-high positive correlation (r = 0.783), and hard and soft facial convexity showed a moderate-low positive correlation (r = 0.403). Herbst appliance therapy produces soft tissue improvements in the three phases of craniofacial growth, being greater in patients in the PRE and CIR phases.

Comparison of three-dimensional soft tissue changes according to the split pattern after sagittal split osteotomy in patients with skeletal class III malocclusion

ObjectivesThis study aimed to analyse the changes in soft tissue and hard tissue stability associated with the split pattern, i.e. long split (LS) or short split (SS), after sagittal split osteotomy.Materials and methodsPatients who underwent sagittal split ramus osteotomy were classified into LS or SS groups according to postoperative computed tomography images. They were examined via lateral cephalography and three-dimensional (3D) optical scanning before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Six standard angles (SNA, SNB, ANB, FMA, FMIA, and IMPA) were used as measures of hard tissue change. The two sets of 3D data were superimposed, and the volumetric differences were calculated as the soft tissue change. The areas evaluated were delimited by 10 × 20-mm rectangles in the frontal aspect and a 25 × 25-mm square in the lateral aspect.ResultsA total of 42 sides (26 patients) were analysed, including 20 (16 patients) in the SS group and 22 (16 patients) in the LS group. We found no significant differences in cephalographic angle or soft tissue changes in the frontal aspect between the SS and LS groups. We found significant differences in the subauricular region from T0–T1 (p = 0.02), T0–T2 (p = 0.03), and T0–T3 (p = 0.037) in terms of soft tissue changes in the lateral aspect. The volume increase associated with posterior mandibular movement was greater in the LS group.ConclusionsWe found that LS patients with mandibular prognathism exhibited increased subauricular volumes following mandibular setback.Clinical relevanceIt is essential to predict the postoperative facial profile before surgery. The split pattern after sagittal split osteotomy affects the postoperative profile of patients with mandibular prognathism.

Shear Wave Elastography for Assessment of Changes in Abdominal Soft Tissues after Lipoabdominoplasty.

The changes in the elasticity of the abdominal skin, subcutaneous tissues and muscles after lipoabdominoplasty are still unknown. The aim of this study was to provide an objective assessment of tissue elasticity after lipoabdominoplasty using ultrasound elastography. A total of 21 female patients (31-41 years old) who underwent lipoabdominoplasty from Oct 2019 to Mar 2022 were included in this retrospective study. The elastography values of the skin, subcutaneous tissues and abdominal muscles were obtained with the ultrasound shear wave elasticity imaging system pre-operation (Pre) and 6 months post-operation (Post) at four different points. Twenty-one female patients were included. The elasticity of the abdominal skin, subcutaneous tissues, rectus abdominis and external oblique abdominis significantly increased at 6 months post-operation. The improvements in abdominal soft tissue elasticity were not uniform across the examined points. Significant changes in the elasticity of the abdominal skin, subcutaneous tissues and muscles were observed after lipoabdominoplasty. Ultrasound elastographic assessment was objective and feasible for evaluating the effect of lipoabdominoplasty on abdominal soft tissue. 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 .

Age-related variations in trunk composition and patterns of regional bone and soft tissue changes in adult Caucasian women by DXA.

We explored the regional variations in body composition with advancing age in healthy Caucasian females living in the Mediterranean area. The objectives of this study were to establish body composition values for the trunk in healthy women of a Greek origin and to evaluate the effects of aging on the distribution of truncal bone mass, fat mass (FM) and lean mass (LM). Body composition of the trunk and detailed analysis of its anatomical components-the ribs, the thoracic spine, the lumbar spine and the pelvis, and FM and LM ratios--were calculated in 330 women aged 20-85years, using DXA. Peak bone mineral density (BMD) of the trunk was attained between ages 30 and 33. The overall truncal BMD reduction with age was 20.7% (p < 0.001). Peak %LM of the trunk was achieved at age 20. The overall reduction of %LM with age for the trunk was 9.8% (p < 0.001). Peak %FM of the trunk was attained between ages 68 and 73, and the overall %FM reduction with age was 2.8% (p > 0.05). Multiple comparative analyses showed that the 51-60years age group was the landmark age for significant changes of truncal bone mass measures across all age groups (p = 0). For truncal LM and FM metrics, multigroup comparative analysis showed the turning point of significant changes in soft tissue was the 41-50 age bracket (p = 0 and p = 0, respectively). In Greek women, truncal %LM exceeded by far %FM across all ages (p = 0). Our results suggest that aging affects body composition of the trunk in ambulatory healthy women of a Greek origin differently, leading to menopausal loss of bone mass, senior adulthood loss of lean mass, and middle-age storage of fat mass. In adult women, these age-related associations between bone and soft tissue metrics on DXA exams carry implications for the attainment of optimal peak values and shifts in body composition overtime, impacting lifelong skeletal health.

High-resolution ultrasound in diagnosing complications after facial contouring injections. A clinical case.

The development of new techniques of procedure and line extensions of products for facial contouring injections leads to an increase in the incidence of facial soft tissue complications and adverse reactions. The article presents a clinical case of complications after previous facial contouring injections with hyaluronic acid-based fillers. In high-resolution ultrasound the signs of inflammatory changes in the facial soft tissues were found, which affected the further treatment strategy.

Remodeling of soft tissue in the extremities during acute ischemia-reperfusion in the context of acute hemorrhage

Histological and morphometric investigation of the soft tissues of the femur in white rats was conducted following acute 2-hour limb ischemia induced by the application of a tourniquet under conditions of acute blood loss. Morphological changes in the soft tissues were examined two hours after the tourniquet application without reperfusion. Tissue examination was carried out at various intervals after the elimination of ischemia: in 2 hours, 1 day, 2 days, 7 days, and 14 days. The early postischemic period model was represented by groups of animals with reperfusion changes at 1 hour, 2 hours, and 1 day after the removal of the tourniquet, while the late postischemic period model comprised groups examined on the 7th day and the 14th day after the removal of the tourniquet.&#x0D; Pathological lesions in muscle tissue were evident as edema, structural and integrity impairments in myocytes, and leukocyte infiltration of endo- and perimysium. The lesions of microcirculatory bed were manifested by microarchitectonic damage, stasis, diapedesis hemorrhages, and perivascular cell infiltrates. The most pronounced changes in soft tissues due to reperfusion-ischemic syndrome under acute blood loss conditions were observed on the first day. During this period, the average diameter of muscle fibers ((43.66±0.41) μm) exceeded the corresponding control group indicator ((40.63±0.24) μm) by 6.94% (P &lt; 0.01). Subsequently, there was a gradual normalization of indicators, with the diameter on the 14th day ((40.83±0.36) μm) not significantly differing from the control (P &gt; 0.05).&#x0D; The revealed patterns can be used to develop new approaches and methods for the correction of structural and functional disorders of soft tissues in lower extremities by different types of acute ischemic trauma under conditions of acute blood loss.

Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor

ObjectiveTo verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). MethodsRetrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21–42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. ResultsThere was an increase in nasal width with an average of 1.3467mm and an increase in the alar base with an average of 1.7333mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. ConclusionAlthough our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. Level of evidenceLevel 4.

Comparison of soft tissue volumetric changes and pink aesthetics in immediate implant placement by socket shield and conventional technique: A randomized controlled trial.

The purpose of this study was to compare soft tissue volumetric changes on buccal aspect and pink aesthetics score in immediate implant placement by socket shield and conventional technique. This parallel-arm, randomized controlled trial included 22 participants requiring replacement of single maxillary incisor by immediate implant placement. Immediate implants were placed with socket shield technique (SST) and conventional technique (CT) in respective two groups after randomization. All implants were immediately loaded by immediate loading protocol. Definitive crowns were placed 6 months after implant placement. Scans of casts were recorded by using a digital white light scanner before implant placement and at the end of 12 months. Volumetric soft tissue changes on the buccal aspect was assessed by the superimposition of scanned cast. Esthetic evaluation of soft tissue was done by using pink esthetic score (PES) before implant placement, 6 months, and 12 months after implant placement. Statistical analysis of the data was performed using statistical software (Stata 16.0; Stata Corp LLC). The mean soft tissue volumetric change on the buccal aspect at the end of 12 months in the SST group was -0.1520 ±0.86 mm, and in the CT group was -0.643 ±0.35 mm and the difference was statistically significant (P=.001). Higher PES was observed in the SST group when compared to the CT group at all time intervals. The difference was statistically significant at 6 months (P=.001) and 12 months (P=.007). The results of the study show less volumetric change on the buccal aspect and higher PES in SST when compared to CT. Int J Prosthodont 2023. doi: 10.11607/ijp.8063.

Evaluation of Soft Tissue Changes Following Platelet-rich Fibrin in Immediate Implantation of Posterior Teeth: A Randomized Clinical Trial

Background: Currently, immediate implant placement is favored due to its reduced number of surgical appointments and shorter overall treatment duration. However, a notable disadvantage of this protocol is the inadequate dimension of soft tissue surrounding the implant, which presents a challenge for immediate implantation in posterior teeth. As a result, patients frequently necessitate soft tissue augmentation to alleviate potential complications. In this randomized clinical trial study, a minimally invasive technique utilizing platelet-rich fibrin (PRF) was employed to enhance soft tissue thickness and keratinized tissue width during immediate implantation in the posterior region of the jaw. Methods and Materials: A total of 20 bone-level implants were utilized in 20 patients through the immediate implantation protocol. In order to augment soft tissue, 10 patients were subjected to treatment with platelet-rich fibrin (PRF) on immediate implants in the test group, while 10 patients received connective tissue graft (CTG) on immediate implants in the control group. After a period of 3 months, all implants were uncovered through surgery, and healing abutments were placed on fixtures. Keratinized tissue width was measured using a periodontal probe at baseline, 1 month, and 3 months after implant placement, while soft tissue thickness was measured at baseline and 3 months after implant placement. Results: Treatment was successful for all the patients. The average keratinized tissue width in the test and control group was 3.45 and 2.65 at baseline, 4.00 and 3.40 one month after surgery, and 4.20 and 3.85 three months after implant placement, respectively. Average keratinized tissue thickness in the test and control group was 2.45 and 2.05 at baseline and 3.20 and 3.25 at reentry (three months after implant placement), respectively. The average increase in keratinized tissue thickness from baseline to 3rd month was 0.75 in the test and 1.20 in the control group. The average increase in keratinized tissue width from baseline to 1st month was 0.55 in the test and 0.75 in the control group, and from baseline to 3rd month, it was 0.75 in the test and 1.20 in the control group, respectively. Data for both parameters in each group from baseline to 3rd month were statistically significant. Data for keratinized tissue thickness (p=0.077) and keratinized tissue width (p=0.089) between both the groups were not statistically significant. Conclusion: Platelet-rich fibrin (PRF) has the potential to serve as a minimally invasive approach for augmenting soft tissue in the posterior region of the jaw during immediate implant placement. Clinical Trial Registration Number: The clinical trial registration number for this study is IRCT20190723044313N1.

Shear wave elastography assessment of buccinator stiffness in patients of different age groups

Objective: to assess the capabilities of lower face muscles stiffness measurement with shear wave elastography in female patients of various age groups.Material and methods. Ultrasound examination with buccinator muscle stiffness measurement in shear wave elastography was performed in 45 healthy female patients divided into three equal groups by the age (20–30, 31–40 and 41–50 years old) with the use of Epiq 5 (Phillips, the Netherlands) with a linear probe (4–18 MHz). Exclusion criteria were: a history of facial soft tissue pathology, neuromuscular disorders, invasive or minimally invasive facial cosmetology, long-term activity with an active use of facial muscles and articulation. The values of Young's modulus (kPa) were measured in the central and lateral parts of the buccinator muscle in the standing and supine positions of the patients.Results. There was no significant differences of Young's modulus in the central and lateral parts measured standing compared to supine position in all age groups (except the lateral part in group 1). A signifi cant progressive decrease of the buccinator muscle stiffness obtained in three age groups with minimal values of Young’s modulus in the age group of 41–50 years: median – from 5.8 to 9.1 kPa (minimum–maximum values – from 4.1 to 11.3 kPa ) depending on the area of measurements and the position of the patient. In patients of the age group 20–30 years – 8.6–13.8 kPa (7.6–16.5 kPa), 31–40 years – 8.0–11.8 kPa (6.0–13.7 kPa ), respectively.Conclusion. Shear wave elastography allows the assessment of age-related changes in soft tissue, as demonstrated by the decrease of buccinator muscle stiffness

Possibility of contrast-free MR-perfusion using in differential diagnosis of soft tissue tumor

Contrast-free MR-perfusion of "labeled arterial blood spins" ("ASL-perfusion") is an MR-technology for qualitative and quantitative assessment of tissue perfusion properties based on of arterial blood proton spins labeling by radiofrequency pulses and their subsequent measurement when passing through the area of interest. The most of ASL-perfusion application clinical data referred to central nervous system diseases diagnostics, but some works showing the effectiveness of this technique in assessment of skeletal muscle perfusion and diagnostics of soft tissue tumors appeared recently.Two presented clinical cases (soft tissue tumor and post-traumatic benign changes) demonstrate the possibility of this technique usage to assess vascularization of pathological changes in hip soft tissues.

Correlation between differences in intraoperative jumping gaps and soft tissue changes around immediate implant placement and provisionalization in the maxillary anterior region.

This study aims to evaluate the correlation between differences in intraoperative jumping gaps and soft tissue changes around immediate implant placement and provisionalization (IIPP) in the maxillary anterior region. Results will provide a basis for clinical evaluation of the change trend and long-term stability of the labial soft tissue contours of patients with different jumping gaps. Thirty-two patients with single tooth loss in the maxillary aesthetic area were enrolled, and they all received immediate implant placement and restoration. All patients were divided into three groups: A, B, and C according to the size of the jumping gap, group A: horizontal defect dimension (HDD) ≤2 mm; group B: 2 mm<HDD≤3 mm; group C: HDD>3 mm. Geomagic studio 2013 was used to quantitatively analyze the contour volume of the soft tissue around the implant and the level of the labial gingival margin. The pink esthetic score (PSE) was used for the final aesthetic evaluation. All implants had osseointegration within 6 months after the surgery. The average thickness of soft tissue contour volume changed by 0.62 mm±0.15 mm, and the average PES was 11.09±0.99. The changes in the gingival mucosa levels in the three groups at 6 months after operation were 0.45 mm±0.11 mm, 0.40 mm±0.12 mm, and 0.35 mm± 0.11 mm, respectively. The changes in the average thickness of the soft tissue contour volume in the three groups at 6 months after the operation were 0.77 mm±0.16 mm, 0.63 mm±0.17 mm, and 0.54 mm±0.11 mm. A moderate negative correlation was found between the jumping gap size and the gingival mucosa level, and the average thickness changed. No significant correlation was found between size of jumping gap and PES. Although the contour volume of the labial soft tissue continuously decreased within 6 months after IIPP in the maxillary anterior region, the surgical procedure can achieve a satisfactory aesthetic effect, and the level of soft tissue around the implant can be well maintained.

Comparison of Rapid Maxillary Expansion and Alternate Rapid Maxillary Expansion and Constriction Protocols with Face Mask Therapy.

This study compared dentoskeletal and soft tissue changes with face mask (FM) therapy. Rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocols were used with the two different types of expansion appliance, and their effects on the treatment outcome were investigated. The study consisted of 79 (37 and 42 patients in the RME and Alt-RAMEC groups with FM, respectively) patients who had received FM treatment. The effects of the RME/FM (20 female, 17 male) and Alt-RAMEC/FM (14 female, 28 male) protocols were evaluated using lateral cephalometric films. The chronological ages of the RME/FM and Alt-RAMEC/FM groups were 11.58 and 11.99 years, respectively. In addition, both groups were divided into two subgroups based on the design of the expansion appliance (Spolyar or full coverage type). Differences in all parameters were analyzed using Student's t-tests. The maxilla significantly moved forward in both the RME/FM and Alt-RAMEC/FM groups (p<0.001). No significant skeletal differences were observed between the groups. Sagittal movement of the upper incisors significantly increased, and the lower incisors significantly retruded in both groups. While similar skeletal changes were found between the Spolyar and full-coverage appliance groups, the upper incisors protruded significantly more in the full-coverage type. RME/FM and Alt-RAMEC/FM therapies were found to be efficient for maxillary protraction and resulted in similar skeletal changes. A full-coverage expansion appliance produced a more upper incisor protrusion than a spherical-type appliance.

Effectiveness of Functional Mandibular Advancer in Patients with Class II Malocclusion: A Systematic Review and Meta-analysis.

We aimed to evaluate the effectiveness of functional mandibular advancer (FMA) in treating growing patients with Class II malocclusion. Electronic searches were conducted in MEDLINE (via PubMed), Cochrane Library, Web of Science, Scopus, Embase, and Lilacs from 1945 to 30th November 2021. Studies were selected based on the following inclusion criteria: human studies, Class II growing patient treated with FMA, untreated control group or a comparable group treated with another fixed functional appliance, pre- and post-treatment lateral cephalograms/magnetic resonance imaging/cone-beam computed tomography, randomized clinical trials, prospective studies, and retrospective studies. Data extraction of the included articles was independently performed independently by two authors. The risk of bias was assessed using the ROBINS-I tool. Meta-analysis was performed using the inverse generic model. Seven articles met the criteria and were included in the systematic review and three articles were included in the meta-analysis. Three studies had at low risk of bias and four studies had a moderate risk of bias. All articles reported anterior positioning of the mandible along with an increase in mandibular length. The meta-analysis results indicated a negligible difference between FMA and other functional appliances for the parameters SNA [0.11, 95% confidence interval (CI) of -1.07 and 1.29] and ANB (-1.00, 95% CI of -1.34 and -0.65). The evidence was limited for soft tissue changes. Class II correction with FMA involved a combination of skeletal and dentoalveolar changes and was similar to other fixed functional appliances.

Long-term evaluation of soft-tissue changes after miniscrew-assisted and conventional rapid palatal expansion using voxel-based superimposition of cone-beam computed tomography scans

This study aimed to evaluate the soft-tissue changes in the long-term after miniscrew-assisted rapid palatal expansion (MARPE) and conventional rapid palatal expansion (RPE) appliances compared with a matched control group using voxel-based superimposition of cone-beam computed tomography (CBCT) scans. A total of 180 CBCTs for 60 patients at 3-time points were evaluated: pretreatment (T1), postexpansion (T2), and posttreatment (T3) for 3 groups: (1) MARPE, (2) RPE, and (3) controls (time-period T1 to T3: MARPE, 2 years 8 months; RPE, 2 years 9 months; control, 2 years 7 months). The voxel-based superimposition technique was used to superimpose the CBCT scans, after which the soft-tissue surfaces were extracted from the superimposed T1-CBCT, T2-CBCT, and T3-CBCT scans. Nine landmarks were identified on the CBCT scans: nasion, A-point, pogonion, right and left alar base, right and left zygoma, and right and left gonion. The coordinates of the 9 parameters were obtained in the x-axis, y-axis, and z-axis for the CBCT scans and subjected to statistical analyses. The changes in the soft-tissue surfaces were also evaluated by color-coded maps for short-term (T2) and long-term (T3) changes. The mean changes from T1 to T2 and T1 to T3 were tested against no change within the groups by paired t test, and the mean changes among the 3 groups were compared with analysis of variance F test with Tukey's Honest significant difference used for adjusting P values for multiple testing. In the short term, both MARPE and RPE led to a significant downward movement of pogonion, left gonion, and lateral movement of the right and left alar base compared with controls at T2 (P<0.05). In addition, MARPE led to a significant downward movement of right gonion than controls at T2 (P<0.05). Moreover, RPE led to a significant downward and forward movement of A-point and downward movement of the right and left alar base than controls at T2 (P<0.05). However, in the long-term, there were no significant differences in the soft-tissue changes among the MARPE, RPE, and control groups. MARPE and RPE do not lead to significant soft-tissue changes in the long term when compared with controls.