Esthetic Area Research Articles

Crown Lengthening Surgery in the Esthetic Area for Optimized Results: A Review with Surgical Recommendations

Background: Crown lengthening (CL) in esthetic areas has become a versatile procedure with applications in many clinical situations. Knowledge concerning different periodontal phenotypes, and the supracrestal tissue attachment (STA)—former biological width—has allowed for a better understanding of surgical management, allowing for the individualization of surgical therapy. This review presented an individualized surgical approach to CL in esthetic areas based on evaluating the phenotype and current considerations about the STA, correlating them to suggestive surgical techniques. Methods: For an individualized surgical approach, it is primarily necessary to understand STA, including the relationship and distance between the cementoenamel junction (CEJ) and the bone crest (BC) and the position of the free gingival margin (FGM); secondarily, it is necessary to verify the periodontal phenotype to prepare surgical planning (gingivectomy or osseous resection/contouring). Three periodontal phenotypes are recognized, presenting different biological behaviors due to specific characteristics implicitly correlated to soft tissue management. Results: Then, after assessing the distance from the CEJ to the BC, the position of the FGM, and the periodontal phenotype, it is possible to individualize the treatment according to the phenotype. In cases of a thin and scalloped periodontium with delicate gingiva, there might be the presence of bone dehiscence, fenestration, and instability in the healing of the gingival margin, bringing extra attention to tissue manipulation and suggesting a minimally invasive technique (no flap). A partial-thickness flap is recommended for a thick and scalloped periodontium, keeping the periosteum adhered to the bone. For periodontium B (fibrous and dense gingiva and tissue resistant to injuries), the surgical approach recommended is an open full-thickness flap with osteotomy for horizontal and vertical bone volume removal. Then, observing first the specific parameters, such as the STA, CEJ, BC, FGM, and KTW, and then the characteristics of periodontal phenotypes, it is possible to determine the individualized surgical strategy and a reasonable surgical approach to tissue manipulation in clinical CL surgeries. Conclusions: The surgical approach must be defined according to individualized planning since several variables can influence the dynamics of the periodontal tissues.

Bilateral Symmetry in the Aesthetic Area Achieved by Digital Smile Design on 3D Virtual Patient and Conventional Diagnostic Wax-Up—A Comparative Study

Bilateral Symmetry in the Aesthetic Area Achieved by Digital Smile Design on 3D Virtual Patient and Conventional Diagnostic Wax-Up—A Comparative Study

Post occupancy evaluation of the relocatable modular construction method for temporary educational facilities

PurposeThis study aims to evaluate user satisfaction and perceptions of the relocatable modular school (RMS) system in South Korea. It seeks to identify key factors for improvement to enhance the performance of this innovative construction method, particularly in the temporary educational sector.Design/methodology/approachA comprehensive post occupancy evaluation (POE) was conducted, considering functional spaces, aesthetics, indoor environmental quality and technical aspects. This study also includes a comparative analysis with conventional school buildings to provide insights into the efficiency and potential of RMS.FindingsRelocatable modular schools can achieve the equivalent quality of building performance and user satisfaction as those built using traditional construction methods. The satisfaction performance of both methods falls within the “satisfied” level, with mean scores ranging from 3.35 to 3.90. Notably, when compared to ES, RMS exhibits a marginally lower satisfaction level in functional performance but a higher satisfaction level in the areas of aesthetics, IEQ and technical performance. Key factors identified for enhancement include optimizing classroom shape, balancing the window-to-wall ratio, enhancing natural ventilation and addressing floor noise and vibration concerns.Originality/valueThis research is pioneering in evaluating user satisfaction and perceptions of RMS in South Korea, a relatively unexplored area. By taking a holistic approach and incorporating comparative analysis with traditional school buildings, the study provides valuable insights into the practical application and potential of modular construction in educational facilities. The results contribute significantly to the advancement of high-performance modular educational buildings, informing practitioners and stakeholders of user demands and guiding future developments in the field.

Metaphorical Mirrors: Aesthetic Reflections from Plato to Nietzsche (and Beyond)

AbstractThis article weaves together three main strands: first, the ambiguities of mirror metaphors in relation to concepts of artistic representation and expression; secondly, the double-sided and sometimes paradoxical influence of Plato in this area of aesthetics; thirdly, the need to interpret long-lasting metaphors in the history of ideas not as static figures of speech but as dynamic tropes which shift in sense and implications with changes of context. In constructing and exploring this thematic configuration of mirrors, metaphors, and Plato, the chief concern is to draw out—via a small selection of texts, including passages from Schopenhauer and Nietzsche—some underappreciated complexity in the various classical traditions that have contributed to aesthetics and philosophy of art.

The impact of collagen membrane fixation protocols on volume stability in horizontal ridge augmentation in the aesthetic area: A retrospective study.

This study aimed to evaluate the impact of different collagen membran fixation protocols on the volume stability in horizontal ridge augmentation in the aesthetic area. A total of 48 patients with 65 augmented sites were included in this study. Implants were placed in the aesthetic region, and simultaneous guided bone regeneration (GBR) surgery was performed for horizontal ridge augmentation. Participants were divided into four groups, each comprising 12 patients, based on different absorbable collagen membrane fixation protocols. Group 1: without fixation; Group 2: fixation with absorbable sutures; Group 3: fixation with titanium pins; Group 4: fixation with titanium pins and absorbable sutures. Cone beam computed tomography (CBCT) was performed immediately after surgery and at 6 months post-surgery, respectively. The horizontal thickness of the augmented region was analyzed for volume stability at the implant shoulder (H0) and 1-5 mm apical to the implant shoulder (H1-H5). Changes in labial thickness during bone healing were calculated as absolute values (mm) and relative values (%). After 6 months of bone healing, horizontal thickness was significantly reduced at all levels (H0-H5) in all groups compared to immediate post-surgery results (p < 0.05). At H1-H5, horizontal bone loss in group 1 was significantly higher than in the other three groups (p < 0.05). Group 4 exhibited significantly less horizontal bone loss compared to group 2 at H0-H2 (p < 0.05) and group 4 compared to group 3 at H0-H1 (p < 0.05). No significant difference in horizontal bone loss between groups 2 and 3 was detected at H0-H5 (p > 0.05). Guided bone regeneration in the aesthetic area with additional membrane fixation demonstrated superior volume stability of the augmented region compared to cases without fixation. There was no significant difference in bone volume stability between membrane fixation with titanium pins and fixation with absorbable sutures. However, the combined use of pins and absorbable sutures yielded superior volume stability.

AI assistance in aesthetic medicine-A consensus on objective medical standards.

Aesthetic medicine has traditionally relied on clinical scales for the objective assessment of baseline appearance and treatment outcomes. However, the scales focus on limited aesthetic areas mostly and subjective interpretation inherent in these scales can lead to variability, which undermines standardization efforts. The consensus meeting aimed to establish guidelines for AI application in aesthetic medicine. In February 2024, the AI Consensus Group, comprising international experts in various specialties, convened to deliberate on AI in aesthetic medicine. The methodology included a pre-consensus survey and an iterative consensus process during the meeting. AI's implementation in Aesthetic Medicine has achieved full consensus for enhancing patient assessment and consultation, ensuring standardized care. AI's role in preventing overcorrection is recognized, alongside the need for validated objective facial assessments. Emphasis is placed on comprehensive facial aesthetic evaluations using indices such as the Facial Aesthetic Index (FAI), Facial Youth Index (FYI), and Skin Quality Index (SQI). These evaluations are to be gender-specific and exclude makeup-covered skin at baseline. Age and gender, as well as patients' ancestral roots, are to be considered integral to the AI assessment process, underlining the move towards personalized, precise treatments. The consensus meeting established that AI will significantly improve aesthetic medicine by standardizing patient assessments and consultations, with a strong endorsement for preventing overcorrection and advocating for validated, objective facial assessments. Utilizing indices such as the FAI, FYI, and SQI allows for gender-specific, age adjusted evaluations and insists on a makeup-free baseline for accuracy.

Selective Cut-back Protocol for Ceramic Prosthetics in the Esthetic Area

Selective Cut-back Protocol for Ceramic Prosthetics in the Esthetic Area

Cosmetic Makeover of Periodontally Compromised Patients using Flexible Gingival Mask and Porcelain Laminate Veneers: Report of Two Cases

Chronic periodontal disease can lead to advanced gingival tissue loss that can result in problems with esthetics, phonetics, food impaction and tooth sensitivity. One of the most difficult problem encountered in the management of periodontal disease is loss of interdental papillae which leaves unsightly “black triangles” between the teeth. The first step in the management of these problems is surgical correction of the defect. In cases where mucogingival surgery is unpredictable due to generalized recession and loss of large volume of gingival tissue, removable gingival prosthesis is an excellent alternative to correct the deformities remaining after the control of destructive periodontal disease specially in the maxillary anterior region. Gingival prostheses may be fixed or removable. It can be made from a range of materials like acrylic, silicones, porcelain- based materials and flexible resin denture material. This report describes two clinical situations in which combined periodontal/prosthodontic rehabilitation was done for patients with advanced periodontal disease. Accurately fitting flexible gingival prostheses and porcelain laminate veneers were fabricated to restore advanced gingival tissue loss in esthetic area following periodontal flap surgery. The flexible gingival masks not only help to achieve excellent cosmetic results but also reinstate the functional and psychological wellbeing of the patient.

The distally anchored connective tissue graft platform for papilla enhancement: A case report

AbstractBackgroundAs the need for using dental implants to replace single missing teeth grows, so does the demand for greater esthetic results. However, achieving complete interproximal papillae fill in single‐tooth implant restorations remains a challenge. The distally anchored connective tissue platform is a novel soft tissue augmentation technique that consists of harvesting an autogenous connective tissue graft from the palate, folding it, and positioning it at the level of the distal occlusal and buccal surfaces with the help of a distal sling suture to the adjacent distal tooth.MethodsThis case report describes how a maxillary central incisor with compromised hard and soft tissues were replaced using a comprehensive treatment plan.ResultsThe clinical outcomes showed stable mucosal margin levels and complete papillae fill. The patient expressed satisfaction with the achieved results.ConclusionsThe distally anchored connective tissue graft platform performed at the time of implant placement emerges as a viable and effective soft tissue augmentation technique that yields highly esthetic results.Key pointsWhy is this case new information? To the best of our knowledge, this is the first case report in the literature using the distally anchored connective tissue platform. What are the keys to successful management of this case? Adequate diagnosis and decision‐making, resulting in a treatment plan focused on reconstructing both soft and hard tissues in a single‐tooth implant within the esthetic area, yield favorable clinical, radiological, and patient‐reported outcomes. What are the primary limitations to success in this case? The primary limitation of this study is its reliance on a single case report.

A two-dimensional photographic and three-dimensional digital dental model comparative analysis in maxillary anterior teeth

Objective: To assess the accuracy of two-dimensional (2D) photographs in measuring esthetic parameters of the maxillary anterior teeth by comparing them with measurements obtained from three-dimensional (3D) dental models. Methods: A total of one hundred volunteers (49 males, 51 females, aged 18-23 years) were recruited from School and Hospital of Stomatology, Wuhan University from January to February 2024. 3D digital models of their dentitions were obtained using an intraoral scanner, and standardized frontal 2D intraoral photographs were captured with a digital camera. The lengths, widths and width/length ratio of the bilateral incisors, lateral incisors and canines were measured on both the 3D digital models and the 2D intraoral photographs. The width ratios of adjacent maxillary anterior were also calculated on the 2D intraoral photographs and the frontal view of 3D digital models. Results: The widths of lateral incisors [(5.85±0.60) mm] and canines [(4.73±0.71) mm] and the lengths of canines [(8.72±0.96) mm] in the 2D intraoral photographs were significantly lower than those in 3D digital models [(6.65±0.59), (7.76±0.60), (8.90±0.86) mm] (t=-18.24, P<0.001; t=-54.43, P<0.001; t=-4.40, P<0.001), while there were no significant differences in the lengths and widths of the other teeth (P>0.05). The width/length ratios measured from the 2D intraoral photographs for the lateral incisors and canines (0.74±0.08, 0.55±0.08) were significantly lower than those measured in the 3D digital models (0.84±0.09, 0.88±0.09) (t=-19.68, P<0.001; t=-50.21, P<0.001), and the width/length ratio of the central incisors showed no significant difference between the two groups (P>0.05). The width ratios of canines/lateral incisors and lateral incisors/central incisors measured on the 2D intraoral photographs (0.72±0.06, 0.85±0.11) were significantly smaller than those measured in the frontal view of 3D digital models (0.75±0.06, 0.89±0.11) (t=-9.31, P<0.001; t=-6.58, P<0.001). Conclusions: There is a difference between 2D and 3D measurement results of teeth in the esthetic area and the magnitude of the difference varies with their position in the dental arch. When analyzing the measurement of the anterior teeth, it is necessary to choose the appropriate method according to the target tooth position.

Comparison of clinical esthetic effects of two abutments of maxillary anterior dental implants with single crown

Objective: To compare and evaluate the clinical esthetic effect of angle screw channel abutment and personalized zirconia adhesive abutment for single crown restoration in esthetic area. Methods: A total of 44 patients (21 males and 23 females), aged (37.4±13.5) years (18-67 years) who completed single crown restoration in the esthetic area of the Department of Oral Implantology, Dalian Stomatological Hospital from January 2018 to June 2022 were retrospectively selected. A total of 44 implants were inserted. According to the abutment selected for final restoration, the patients were divided into angle screw channel abutment group and personalized zirconia bonding abutment group, with 22 patients and 22 implants in each group. The implant survival rate, complication rate, pink and white esthetic score and marginal bone resorption were compared between the two groups. Results: Follow-up to 12 months after final restoration, implant survival rates were 100% (22/22) in both groups, and there was no statistically significant difference in the incidence of mechanical complications between the two groups [9% (2/22) in the angle screw channel abutment group and 0(0/22) in the personalized zirconia bonding abutment group, χ2=2.10, P=0.148]. In the follow-up appointment 12 months after final restoration, the pink esthetic score of the angle screw channel abutment group (12.95±1.05) was significantly better than that of the personalized zirconia bonding abutment group (11.45±2.02) (t=3.10, P=0.003). There was no significant difference in white esthetic scores between the two groups (t=1.27, P=0.212). There was no significant difference in the marginal bone resorption between the two groups (t=0.32, P=0.749). Conclusions: When a single implant supported restoration is delivered in the esthetic area of the anterior maxilla, high implant survival rate and stability of the marginal bone can be obtained by using the angle screw channel abutment or the personalized zirconia bonding abutment. The clinical efficacy of the angle screw channel system is reliable, and it will provide clinicians with a new treatment option.

Immediate Implant Placement at an Inflammatory Periapical Cyst Site in the Aesthetic Area

A healthy 47-year-old woman consulted the Oral Surgery and Implantology Unit of the University Hospitals of Geneva with a request to treat her painful tooth 11 and replace the missing tooth 21. The dental history revealed that the patient had lost teeth 21 and 22 due to advanced caries. On clinical examination, tooth 11 showed an ill-fitting prosthetic crown with overhanging margins, an increased localized probing depth of 8 mm in the disto-vestibular area, and sensitivity to percussion. The edentulous site 21 showed horizontal bone atrophy. Radiological examination revealed a well-defined unilocular radiotransparent lesion surrounded by a thin radiolucent border, located at the apex of tooth 11 and measuring 10 × 8 mm. The treatment consisted of extraction of 11, enucleation of the apical lesion, and insertion of implants at sites 11 and 21 with simultaneous bone augmentation in a single surgical procedure, with aesthetic and functional results at 3-year follow-up without any complications. Our case highlights that immediate implant placement in cases of cystic periapical lesions represents a good valid alternative to standard treatment.

Entrepreneurship and innovation in public management

Social entrepreneurship comprises a recent form that has as its main objective the carrying out of activities (through products and services) that have a social impact, that is, that enable development, improving people's quality of life, combined with sustainability. In this sense, the objective was to analyze the Social Work Project (SWP), which is a project of the Caixa Econômica Federal (a Brazilian Government Federal Bank) in partnership with Forcon Condominiums, a private company that was hired to foster social entrepreneurship at Residential Buena Vista I and III, in Goiânia, GO. The final report of the execution of the SWP was analyzed as part of the methodology employed and 30 people were interviewed about the impact of the project on their lives. Questions about whether the entrepreneurial activity improved the quality of life, about Forcon's participation in the development of activities, the Public Powers, and the difficulties encountered for the exercise of the activity were asked. The results showed that most of the beneficiaries of the project were women, between 18-29 years old, who sought to undertake small businesses in the area of aesthetics, especially salons and manicures. KEYWORDS: Planning; Public Policies;Social work

Immediate Implant Placement in the Aesthetic Area using Inverted Body-shift Design: A Prospective Clinical Pilot Study.

A prospective clinical pilot study was carried out to evaluate a novel macroimplant design with a 12° angled platform. The implant is placed at the center of the socket, optimizing all the alveolar bone. In addition, the prosthetic emergence should be ideal, as it is corrected and emerges through the cingulate area. Twelve patients were enrolled in an immediate implant placement procedure with immediate aesthetic rehabilitation to replace an anterior maxillary tooth, and were treated with inverted body-shift design with 12° angled neck. Only type I sockets according to the Elian classification were considered eligible for the study. There were no implant failures after one year of loading. Regarding the horizontal and vertical hard tissue changes, there was a statistically significant median overall horizontal change of -0.99 mm at 1 mm and of -0.61 mm at 3 mm. On the other hand, stability was observed at 5 mm, since the result obtained was not statistically significant. The median pink esthetic score (PES) at one year of follow-up was 11.5. This implant may be useful in the immediate tooth replacement treatment of maxillary anterior post-extraction sockets, nevertheless, comparative studies with conventional implants should be carried out.

Immediate versus early implant placement for single tooth replacement in the aesthetic area: A systematic review and meta-analysis.

To compare immediate implant placement (IIP) with early implant placement (EIP) for single tooth replacement in the aesthetic area in terms of aesthetic, clinical, and patient-reported outcomes. Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to February 2023. Randomized Controlled Trials (RCTs) comparing IIP with EIP were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue change. Secondary outcomes were horizontal midfacial soft tissue change, vertical papillary change, pink esthetic score (PES), implant survival, buccal bone thickness, marginal bone level change, patient discomfort, chair time, and patient satisfaction. Out of 1185 records, 6 RCTs were selected, reporting on 222 patients who received 222 single implants (IIP: 112 implants in 112 patients; EIP: 110 implants in 110 patients) in the anterior maxilla or mandible. Patients had a mean age ranging from 35.6 to 52.6 years and were followed between 8 and 24 months. Two RCTs showed some concerns, and four showed a high risk of bias. Four studies could be included in a meta-analysis on the primary outcome and three only considered cases with an intact buccal bone wall. Meta-analysis failed to demonstrate a significant difference in terms of vertical midfacial soft tissue change between IIP and EIP (mean difference: 0.31 mm, 95% CI [-0.23; 0.86], p = .260; I2 = 83%, p < .001). No significant differences were found for PES (standardized mean difference: 0.92, 95% CI [-0.23; 2.07], p = .120; I2 = 89%, p < .001), implant survival (RR: 0.98, 95% CI [0.93, 1.03], p = .480; I2 = 0%, p = .980), and marginal bone level change (mean difference: 0.03 mm, 95% CI [-0.12, 0.17], p = .700; I2 = 0%, p = .470). Insufficient data were available for meta-analyses of other secondary outcomes. In low-risk patients with an intact buccal bone wall, there seems to be no difference between IIP and EIP in terms of aesthetic and clinical outcomes. The strength of this conclusion is rated as low since studies showed an unclear or high risk of bias. In addition, state-of-the-art therapy was only delivered in a minority of studies. Future RCTs should also provide data on patient-reported outcomes since these have been underreported.

Influence of screw channel angulation on reverse torque value and fracture resistance in monolithic zirconia restorations after thermomechanical cycling: an in-vitro study

BackgroundWhile the concept of angled screw channels has gained popularity, there remains a scarcity of research concerning the torque loss and fracture strength of monolithic zirconia restorations with various screw channel angulations when exposed to thermomechanical cycling. This in-vitro study aimed to evaluate the reverse torque value and fracture resistance of one-piece screw-retained hybrid monolithic zirconia restorations with angulated screw channels after thermomechanical cycling.MethodsOne-piece monolithic zirconia restorations, with angulated screw channels set at 0°, 15°, and 25° (n = 6 per angulation) were fabricated and bonded to titanium inserts using a dual-cure adhesive resin cement. These assemblies were then screwed to implant fixtures embedded in acrylic resin using an omnigrip screwdriver, and reverse torque values were recorded before and after thermomechanical cycles. Additionally, fracture modes were assessed subsequent to the application of compressive load. One-way ANOVA and Bonferroni post hoc test were used to compare the groups (α = 0.05).ResultsThe study groups were significantly different regarding the fracture resistance (P = 0.0015), but only insignificantly different in the mean percentage torque loss (P = 0.4400). Specifically, the fracture resistance of the 15° group was insignificantly higher compared to the 0° group (P = 0.9037), but significantly higher compared to the 25° group (P = 0.0051). Furthermore, the fracture resistance of the 0° group was significantly higher than that of the 25° group (P = 0.0114).ConclusionsOne-piece hybrid monolithic zirconia restorations with angulated screw channels can be considered an acceptable choice for angulated implants in esthetic areas, providing satisfactory fracture strength and torque loss.

Socket-shield Technique and immediate implant placement for ridge preservation in the aesthetic region: a 1-year clinical and tomographic follow-up

Objective: To describe the clinical, radiographic and tomographic aspects, as well as complications, success, aesthetic and functional results of an implant placed using the “socket shield” technique. Case Details: Represents a 46-year-old patient, with increased mobility of the crown in the bucco-palatal direction, with indication for extraction replaced by immediate implant. Atraumatic extraction, socket preservation technique and immediate implant placement were performed. The socket-shield technique was designed for placing implants to protect the oral bone and achieve adequate aesthetics. The buccal fragment of the tooth was kept fixed and the implant was placed in contact with the tooth fragment. Cone Bean computed tomography showed bone formation in the buccal aspect 1 year later, and demonstrated stability of the peri-implant bone tissue and replacement of the root remnant by bone. The clinical appearance demonstrated maintenance of peri-implant soft tissues and good aesthetics without gingival retraction. Final considerations: One-year follow-up shows adequate healing and healthy peri-implant tissue, suggesting that the socket-shield technique with immediate implant placement can be an excellent alternative for preserving the vestibular cortex and implant placement, especially in the aesthetic area.

Discoloration after revascularization using calcium phosphosilicate-based bioceramic versus mineral trioxide aggregate in necrotic immature permanent anterior teeth: A Randomized clinical trial.

The aim of the current study is to evaluate the effect of calcium phophosilicate-based bioceramic "Totalfill bioceramic putty" and white mineral trioxide aggregate (WMTA) as the coronal plug on discoloration after revascularization of necrotic immature permanent anterior teeth. This study was conducted on (48) necrotic young permanent central incisors in children ranging from 8 to 14 years old, that were randomly allocated to either Totalfill bioceramic (Group I = 24) or WMTA (Group II = 24) as the coronal plug. Two visits revascularization protocol was adopted in this study using 1.5% sodium hypochlorite, followed by 17% ethylenediaminetetraacetic acid, and ending with a saline flush as irrigation solution. The double antibiotic paste was used as intracanal medication. The blood clot was used as scaffold followed by the application of collagen membrane followed by coronal plud malterial. Finally, the access was sealed using resin composite restoration and composite restoration. Clinical assessment was conducted at 1, 3, 6, 9, and 12 months, while radiographic assessment was conducted at 6 and 12 months. Data were statistically analyzed using the Chi-squared test for intergroup comparisons and Cochran's Q test for intragroup comparison. Clinically, Group I exhibited a success rate of 100%, whereas Group II exhibited a success rate of 85.7%. Radiographically, both materials showed a 90.5% success rate. There was no statistically significant difference between both materials for all assessed clinical and radiographic parameters at different follow-up periods. Both Totalfill bioceramic putty and WMTA can be used successfully as coronal plug in esthetic areas.

Management of Green Open Space in the Karanganyar Regency Government Based on the Principles of Good Environmental Governance

The high level of industrial development in Indonesia is parallel to population growth which has an impact on changes in land use. Green Open Space or RTH is the smallest part of an area in a city or district which is used not only as an aesthetic area but also as a green area as a place for community activities with a health connotation. Green open areas in Karanganyar Regency have not yet reached the applicable standards by Karanganayar Regency Regional Regulation No. 12 of 2022 concerning the Management of Green Open Spaces. The research method uses qualitative descriptive and data collection techniques by interviewing various data sources, conducting direct observations in the field, library research, documentation. Government websites and Instagram, transparency, and accountability, access to information through local government websites, and reporting in the annual LKPJ, decentralization is not yet strong enough but decision-makers are still the authorities and institutions and agencies, do not have their own RTH institutions, but each section carries out duties according to its main duties, access to law enforcement, complaints are submitted on the online public application and complaint service website, and the open spaces of Karanganyar Regency can be accessed by the public. The overall analysis is quite good, but several aspects are less than optimal, namely decentralization. So there needs to be innovation from the Karanganyar Regency government.

Computer-guided Surgery in Anterior Esthetic Area with Autologous Deciduous Tooth-Derived Material: Case Report

Background The literature has described several biomaterials for guided bone regeneration. Some authors have proposed using a material derived from dentin/ enamel among autologous biomaterials. This study aims to test the effectiveness of autologous material derived from deciduous teeth in guided bone regeneration. Case Presentation A 24-year-old female shows up with missing tooth #1.1 for a domestic accident. This requires implant-prosthetic rehabilitation. It is decided to be performed before implant therapy, a bone regeneration guided using biomaterial resulting from the patient’s deciduous teeth stored in a plastic box. GBR (Guided Bone Rehabilitation) is performed, and after 6 months, the implant is inserted by computer-guided surgery, and then a provisional prosthesis is placed. Discussion The material deriving from deciduous teeth, not preserved with precautions, has had excellent integration results. This allowed the implant to be placed in the best position for the final prosthetic rehabilitation. Conclusion This clinical case shows that using biomaterial derived from deciduous teeth has allowed an excellent result with negligible biological cost.