Esthetic Area Research Articles

Connective Tissue Graft with Coronally Advanced Flap for Complete Root Coverage in the Aesthetic Area: A Case Report

Connective Tissue Graft with Coronally Advanced Flap for Complete Root Coverage in the Aesthetic Area: A Case Report

Influence of connective tissue grafts on implants in the aesthetic area: A systematic review. Are connective grafts essential?

Achieving adequate aesthetics with implants in the anterior sector continues to be a challenge. One of the most studied and currently used techniques is the use of autologous connective tissue grafts to improve the peri-implant soft tissues in this area. Our objective is to analyze whether these techniques have a predictable impact on the tissues and aesthetics; and if it is worth performing them. A bibliographic search was carried out, including different digital portals. A total of 8 articles were analyzed. This procedure did not have an impact on the hard tissue but did have an impact on gingival recessions and soft tissue thickness. Regarding aesthetics, the results are controversial. It seems that they can slightly improve the PES (Pink Esthetic Score or Pink Index). Also, a negative impact on the texture of the soft tissue has been found. It is necessary to individualize each case (especially depending on the gingival biotype) since taking a connective tissue graft from the palate entails discomfort for the patient, and this technique is not free of complications. Key words:Dental implants, aesthetics, connective graft.

Color stability and solubility of Biodentine and NeoPutty in contact with different irrigation solutions.

This study aimed to evaluate the color stability and solubility of Biodentine and NeoPutty in contact with different irrigation solutions. Biodentine and NeoPutty were set in cylindrical molds with 7 mm diameter and 1.5 mm high and immersed in distilled water, 17% ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine (CHX), 9% 1-hydroxyethylidene 1,1-diphosphonate (HEDP), and 5% sodium hypochlorite (NaOCl) solutions for 24 hours. The color change was measured with a spectrophotometer. The solubility values were calculated as the mass loss was expressed as a percentage of the original mass using an analytical balance with 10-4 g accuracy. Data were analyzed with Kruskal-Wallis followed by Mann-Whitney U tests, and 2-way analysis of variance test followed by Bonferroni corrections for pairwise comparisons for solubility and color stability with a 5% significance threshold, respectively. Biodentine exhibited higher color changes compared to the NeoPutty contact with all solutions except distilled water (p < 0.05). Both hydraulic cements (HCs) showed higher discoloration values immersion in CHX followed by NaOCl. No statistically significant difference was found between Biodentine and NeoPutty regardless of irrigation solution in terms of solubility (p > 0.05). Solubility values were lower in the distilled water group compared to EDTA and CHX (p < 0.05). Tested HCs showed solubility and color changes at various rates. NeoPutty could be an appropriate material in aesthetic areas. The usage of HEDP as an irrigant solution can be considered suitable for various endodontic treatments due to its relatively lower solubility and discoloration values.

Italian School One Piece Implants Stabilized with Electrowelded Titanium Needle for The Rehabilitation in Aesthetic Area of Single Post-Extraction Edentulies with Immediate Loading

The stabilization of an one piece implant with an electrowelded titanium needle is a technique introduced at the end of the seventies of the last century to increase the primary stability, already acquired by means of the wide thread and bicorticalism, of the one-piece implants of the Italian school such as the Tramonte screw, especially in immediate loading rehabilitations of single edentulous upper front teeth and thus make the success of immediate loading predictable. The stabilization of a one piece implant is achieved by inserting a titanium needle (Scialom type) divergent from the axis of the main implant, a needle which must reach and impact the deep cortical bone and be welded with the intraoral welding machine to the one piece basic screw, to form a single prosthetic abutment. In addition to enhancing primary stability and increasing resistance to static and dynamic stress, given that by forming a single body with the implant it extends the support surface over a larger surface, needle stabilization also carries out an anti-rotational action, opposing the "unscrewing" effect that can be caused by the pressure exerted by the tongue during swallowing. Needle stabilization also helps to avoid those micromovements which, when they exceed 150 microns, can prevent the osseointegration process, leading to the failure of the immediate loading implant. Needle stabilization has proven to be particularly effective in the immediate loading of post-extraction single implants in the upper frontal sectors, with reduced bone depth, or with poorly mineralized bone.

Immediate Implant Placement and Immediate Loading in the Aesthetic Zone: A flapless Approach

Replacing missing or failing teeth with implants can be a clinical challenge, especially in the aesthetic area, because patients expect an esthetically ideal prosthesis besides the osseointegration of implants. In this regard, immediate placement of implants with immediate loading is preferred by the patients, for the fewer surgeries involved and the immediate restoration of the potential edentulous sites. This article aims to present a case report of immediate placement of implant and immediate loading of the maxillary right lateral incisor.

The fusion of keratinized epithelium, an indication of early implant placement in the aesthetic area: an animal study

BackgroundIn the period of the early implant placement, the socket is mainly occupied by provisional matrix (PM). Keratinized epithelium (KE) is critical for primary wound closure. Although both KE and PM are important, the detailed relationship among migrating KE, PM formation and indication of the early implant placement is still unclear.ObjectiveThis research aimed to locate a healing stage of KE with highest osteogenic PM formation after tooth extraction, which could be treated as the optimal time point for early implant placement.Material and methodsMice were sacrificed on days 1, 2, 3, 4 and 6 after incisor extraction. Clinical, histological, and immunohistochemical evaluations of the extraction sockets were performed, and statistical analyses were conducted. We then inserted implants into the PM with the greatest bioactivity and observed its osseointegration pattern for 3, 10, 17 and 30 days.ResultWhen KE fusion was reached, sockets were dominated by PM with the greatest expression of osteocalcin (OC, P < 0.05) and high levels of CD34 and Runx2. OC and Runx2 expression were positively correlated with KE coverage (P < 0.05). When the implant was inserted at 4 days’ healing, the PM maintained its osteogenic ability, and osseointegration proceeded perfectly.ConclusionThe migration of KE was correlated with the formation of highly osteogenic and angiogenic PM. And the fusion of KE could be treated as an indication for early implant placement.

Aesthetic dental rehabilitation of children after dental trauma to anterior teeth with pulp chamber exposure. A clinical case

Relevance. The prevalence of dental injuries in children reaches 52.3%, based on age. Currently, the number of traumas of anterior maxillary teeth tends to increase. The search and application of the most optimal treatment options for dental injuries in an aesthetic area in children remains relevant.Description of the clinical case. The article presents the treatment results of an 8-year-old boy diagnosed with S02.52 according to ICD-10: fracture of the crown of tooth 2.1 within the enamel, dentin layers with pulp involvement. Vital amputation of the crown pulp with a direct pulp capping with "Rutdent", an MTA-based product, was chosen as the tactic of dental care. A tooth fragment was attached with a composite material (using an adhesive protocol) for aesthetic rehabilitation. The function and aesthetics of the tooth were restored. The result was stable six months after the treatment.Conclusion. The popularization of various sports events can lead to an increase in the incidence of dental traumas to anterior teeth in children. A pediatric dentist should be able to apply modern methods of diagnosing acute dental trauma to make the correct diagnosis and choose the optimal treatment method. The opportunities of modern pediatric dentistry allow the restoration of all dental functions lost during trauma: anatomical, aesthetic and physiological.

Surgical Treatment of Closed Fracture of the Anterior Wall of the Frontal Sinus with Displacement by the ORIF Technique using a Titanium Plate: A Case Report

Fractures associated with anterior and posterior frontal sinus walls are among the most challenging cranio-maxillofacial injuries. These represent a major emergency, having a potentially severe clinical picture, with intracranial hemorrhage, cerebrospinal fluid leak, meningeal lesions, pneumocephalus, contusion or laceration of the brain matter, coma, and in some cases, death. In this article, we present the case of a 32-year-old patient with the diagnosis of: Closed fracture of the anterior wall of the frontal sinus with displacement, fracture of the posterior wall of the frontal sinus without displacement and impairment of the upperface bone architecture. Despite the severity and complexity of the case, early initiation of correct ENT surgery, using ORIF (open fracture alignment and internal fixation) technique, led to the successful reconstruction and redimensioning of upperface architecture and to the restoration of the patient’s physiognomy. This article describes a case report on the use of titanium plates for the reconstruction of the upper aesthetic area of the face. The article also describes the use of the ORIF technique, its description, and its advantages, as well as a literature review in order to show its advantages in the avoidance of postoperative complications. The purpose of the work is to describe a new technique that helps to avoid aesthetic and functional complications in the future, which will be useful to otorhinolaryngologists and maxillofacial surgeons.

Digital PBL-CBL teaching method improves students' performance in learning complex implant cases in atrophic anterior maxilla.

The clinical teaching of esthetic implant-supported restoration of the atrophic maxilla is challenging due to the complexity and unpredictability of bone and soft tissue augmentation. The traditional problem-based learning and case-based learning method (PBL-CBL method) with a full digital workflow (digital PBL-CBL method) provides the students a chance to view clinical cases in a more accurate and measurable way. The aim is to evaluate the effectiveness of the new digital PBL-CBL method in teaching complex implant cases in esthetic area. A full digital workflow of dental implant therapy was established for patients with severely atrophic anterior maxilla. The digital data of cases done in the new workflow was used as teaching materials in digital PBL-CBL teaching. Fifty-four postgraduate students were randomly selected and divided into three groups, including traditional PBL-CBL group (students taught in a PBL-CBL method with no digital cases), digital PBL-CBL group (students taught in a PBL-CBL method with full digital cases) and control group (students taught in didactic teacher-centered method). After training for three months, a study of the students' opinions on the corresponding teaching method was carried out through a feedback questionnaire. A theory test was used to evaluate students' mastery of knowledge about tissue augmentation and esthetic implant restoration. A case analysis was used to determine whether students could apply the knowledge to problem solving. The digital PBL-CBL method resulted in a higher rate of satisfaction than the traditional PBL-CBL method and the didactic teacher-centered method in all items except for "This approach decreases extracurricular work". Case analysis scores of the digital PBL-CBL group were significantly higher than that of the traditional PBL-CBL group and the control group. For the theory test, the digital PBL-CBL group (61.00±6.80) but not traditional PBL-CBL group (55.22±9.86) obtained a significant higher score than the control group (45.11±12.76), although no significant difference was found between the digital PBL-CBL group and the traditional PBL-CBL group. Compared with other methods, students taught with the digital PBL-CBL method showed higher satisfaction and better performance in acquisition of academic knowledge and ability in solving practical clinical problems. The digital PBL-CBL method provided a promising alternative for teaching complex implant cases at the anterior maxilla.

Clinical solutions for natural abutments with preexisting defected crown margin in the aesthetic area.

Crown replacement has remained one of the difficult methods for installing fixed prosthesis but is often performed because of aesthetic factors and invasion of biological width. This article focuses on the clinical scenario in which preexisting crown margin has defects. Given that clinical decisions regarding restoration management and perio-dontal tissues have to be made with caution, a decision tree of the decision making process for natural abutments in aesthetic area with preexisting defected crown margin is presented. The re-establishment of a new crown margin is the key to the success of a new restoration, and the new margin should be located at the proper esthetic position and right biological position. It should have fine, smooth, and continuous morphology.

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.

Considerations for predictable outcomes in static computer- aided implant surgery in the esthetic zone.

To provide technical and clinical recommendations for implementing a digital workflow in Static Computer-Aided Implant Surgery in the anterior maxilla. An optimal 3D implant position is crucial for achieving satisfying results in implant rehabilitation in the esthetic area. Due to its complexity, implant placement in the esthetic zone should be executed with precision and predictability. Static Computer-Aided Implant Surgery requires thorough planning and detailed attention to every step of the digital workflow protocol. Implant positioning in the esthetic zone using Static Computer-Aided Implant Surgery is a technique-sensitive procedure that requires precise execution of each step. This approach ensures accurate prosthetically driven 3D implant placement and prevents potential errors that could lead to inaccurate positioning. The proper implementation of Static Computer-Aided Implant Surgery may increase the level of agreement between the planned and definitive implant 3D positions in the esthetic zone, thus enhancing the esthetic outcomes of implant rehabilitation.

USE OF BOTULINUM TOXIN TYPE A (BOTOX) AND ITS AESTHETIC BENEFITS

The skin is the most external organ responsible for protecting the innermost layers of the body, protecting it against thermal agents, climate change and other organic defenses in relation to the environment. Human development is marked by several natural processes within the body itself, however, skin aging is a factor that occurs intrinsically or extrinsically, leaving the appearance of wrinkles and expression lines visible. The use of botulinum toxin type A (TBA or Botox) has been carefully used for aesthetic purposes in the treatment of discomfort resulting from facial skin aging. The present study aimed to present the aesthetic benefits of using botulinum toxin - Botox. This is an integrative review of the literature using the National Library of Medicine (PubMed) and Virtual Health Library (VHL) databases with the search for articles using the descriptors “botulinum toxin”; “aesthetics” and “facial aging” registered in DeCS with the help of the boolean operator and. The selection of articles was carried out using the inclusion criteria where articles from the last five were selected, in Portuguese or foreign language and which were correlated with the main theme of the research. For the exclusion criteria, articles that were not consistent with the theme and duplicate articles were excluded by title or abstract. Thus, the present study aimed to achieve the objectives described through literature review analysis, where it was possible to verify the effectiveness and benefits of TBA in the facial aging process. Furthermore, it was possible to enable scientific research as a development for further studies in the area of aesthetics in general and contributing to a greater collection of knowledge.

Clinical feasibility evaluation of a digital workflow of prosthetically oriented onlay bone grafting for horizontal alveolar augmentation: a prospective pilot study

BackgroundOnlay bone grafting is considered highly reliable for reconstructing severe horizontal bone defects. A critical problem is how to achieve precise position of the bone block to control alveolar ridge dimensions. This research aims to establish a digital workflow for prosthetically oriented onlay bone grafting and evaluate its accuracy and efficiency.MethodsThis prospective pilot study investigated eight patients who required implant restoration in the esthetic area with horizontal alveolar bone defects. The workflow includes preoperative virtual planning, design and manufacture of patient-specific templates, bone grafting surgery, and implant insertion. Primary outcomes were graft accuracy, defined by root mean square estimate (RMSE) values between preoperatively designed and actual implanted outer contours of bone blocks. Secondary outcomes were bone graft and implant success rates. Besides, the surgeons used the visual analog scale (VAS) to rate the intuitiveness, ease of understanding, and helpfulness of the workflow.ResultsNo bone grafts or implants failed in any of the eight patients, resulting in a 100% success rate. The RMSE values between the preoperative design and the implanted outer contour of bone blocks were 0.41 ± 0.15 mm. The digital approach showed advantages in intuitiveness (9.3 ± 0.5), understanding (9.0 ± 0.5), and helpfulness (8.4 ± 1.1) according to surgeons' VAS scores.ConclusionsA digital workflow provided encouraging results, in terms of accuracy and efficacy, for horizontal bone augmentation.Trial registrationThis study was registered in the National Clinical Trials Registry in 16/02/2023 under the identification number ChiCTR2300068361.

The Effectiveness of Guided Implant Placement and Bone Regeneration in the Aesthetic Area. Implant Therapy–A Case Report

The Effectiveness of Guided Implant Placement and Bone Regeneration in the Aesthetic Area. Implant Therapy–A Case Report

Pre- and Postoperative Evaluation of Immediate and Early Implant Placement in Esthetic Areas with Pre-Extraction Facial Dehiscence: A Retrospective Clinical Study.

The clinical requirement for a good esthetic result for immediate implant placement is the absence of dehiscence in the anterior facial alveolar bone. In the presence of dehiscence, it is recommended to use a connective tissue graft in addition to immediate implant placement or to change to early implant placement. However, the literature focusing on dehiscence is scarce, and the influence of different placement times and combined use of connective tissue graft on postoperative esthetics in cases with dehiscence is unclear. Therefore, we quantitatively evaluated the pre-extraction dehiscence morphology and postoperative changes in the facial tissue of implants in three groups: immediate implant placement (Group I), immediate implant placement with connective tissue graft (Group IC), and early implant placement (Group E). To this end, 52 implants were obtained (20 in Group I, 16 in Group IC, and 16 in Group E). A wider dehiscence increases the risk of soft tissue regression, which was one reason for choosing early implant placement. A combination of immediate implant placement and connective tissue graft, or early implant placement, tended to result in less soft tissue regression due to the thicker postoperative facial soft tissue volume.

Relationship Between Sagittal Root Position and Alveolar Wall Thickness of Maxillary Teeth in the Esthetic Area for Immediate Implant Treatment Planning in a Peruvian Population.

The purpose of this retrospective study was to assess facial and palatal alveolar wall thickness (AWT) in relation to sagittal root position (SRP) of maxillary anterior teeth using cone-beam computed tomography (CBCT). 102 CBCT images (60 females, 42 males) of anterior maxillary teeth were reviewed. SRP was classified according to Kan's classification, and AWT was evaluated at coronal (4 mm from the cementoenamel junction), mid-root, and apical (2 mm from the apex) levels of the facial and palatal. Secondary variables of sex, age and tooth type were analyzed. The SRP distribution was 76.6% class I, 11.3% class II, 0.8% class III, and 11.3% class IV. AWT, from thickest to thinnest, was found in palatal apical>mid>coronal, followed by facial coronal>mid>apical. AWT was thickest in SRP class II, followed by class I and III, and least thick in class IV at all measured areas (P<.05). A significantly higher AWT was associated with class I in central incisors, class II in canine teeth and in males, and class IV in central incisors and canines.

Clinical decision and related factors influencing implant direction in the esthetic area.

Implant treatment in the esthetic area requires stable osseointegration and successful esthetic outcomes. Achieving this goal requires careful consideration of accurate implant axis and ideal three-dimensional position. Owing to the high esthetics and the special anatomical structure of the maxillary, a successful implant means a synthesized deli-beration of the residual bone dimensions, soft-tissue thickness, and the relationship of the residual alveolar ridge with the planned restoration. This article offers an in-depth analysis of the clinical decisions and key factors affecting the implant direction in the esthetic area.

Standardization of vertical root resection during socket shield technique in immediate implant placement

Objectives. The aim of the present study was to standardize an accurate and significant technique of root separation during socket shield technique. Patients and methods. Two phases of the study were conducted. In vitro study was performed on 20 extracted single-rooted anterior teeth. The second phase was clinical application of the new technique on 10 patients seeking to restore their badly decayed anterior teeth in the esthetic area with immediate implant placement utilizing the socket shield technique. Decoronation was done. The root canal was mechanically enlarged by means of manual assorted files. Canals were further enlarged with Gates Glidden drills. Peeso Reamer drills were used till the root was entirely separated into two parts (buccal &amp; palatal). The palatal root was cautiously removed when the labial and palatal root halves were sufficiently separated. In case the root to be removed was endodontically treated, Gutta-percha was mechanically removed using Gates Glidden, &amp; Gutta-percha solvent to remove the coronal and apical parts. Outcomes. Using manual endodontic K-files, Gates Glidden burs, and Peeso Reamer’s drills in separating the single-rooted teeth into two halves is a reproducible, and reliable procedure during socket shield technique. Conclusions. This technique prevents possible complications of root sectioning during socket shield technique with immediate implant placement. It preserves surrounding soft tissue structures, and labial shield during shield preparations, maintains the integrity of the labial plate of bone during extraction. Additionally, it offers total root apex removal by entirely separating the palatal portion from the labial shield.

Estetica e significazione. Sul rapporto fra linguaggio ed esperienza sensibile

Is language an evolutionarily independent faculty from other cognitive capacities? In recent years two opposing views have clashed: the innatist view, of which linguist and philosopher Noam Chomsky is the main exponent, which answers in the affirmative; the constructivist-empiricist one according to which, on the other hand, language is but the ultimate evolution-complication of non-linguistic capabilities already present in non-human animals.&#x0D; This paper presents and comments on the position of the scientist and philosopher Giorgio Prodi (1928-1987) who avoids this contraposition by thematising an original aesthetic area that would be at the origin of both animal and then human cognition as well as properly human language. Unlike the constructivist view, however, for Prodi such an original aesthetic field can only ground language because it is co-extensive with the original space of biosemiosis.&#x0D; Lastly, the theme of co-evolution is analysed, the only evolutionary mechanism capable, according to Prodi, to account for both the similarities and differences of human language compared to the forms of communication of non-human animals and plants.