Aesthetic Complications Research Articles

From Tradition to Innovation: An In-Depth Review of Manganese Removal Techniques in Water Treatment

Contamination of water is currently one of the alarming issues all around the planet. Water that is contaminated with manganese (Mn) could potentially give rise to functional and aesthetic complications. Removal of manganese is critical and often has substantial implications for the layout of treatment trains. Precipitation, ion exchange, depth filtration, oxidation, adsorption, biosorption, and biological methods are the traditional chemical, physical, and biological processes for removing Mn (II) from contaminated water. All these treatment processes have some advantages and disadvantages and are based on which the implementation of any process varies. In recent years, the use of biofiltration to eliminate manganese (Mn) from water has grown owing to the progress made in molecular techniques for studying microorganisms found in biological Mn elimination systems. This study aims to contribute to the existing research on Mn occurrence and highlight the historical and current removal strategies used in drinking water treatment. The main objective is to assist future researchers in developing more efficient technologies and clarify the subject matter.

How to improve ZMC fracture reconstruction due to severe enophthalmos

Introduction and importanceZygomaticomaxillary (ZMC) fractures are common, often resulting from traffic accidents, and account for 17 % of facial fractures. These fractures can lead to issues such as enophthalmos, flattened cheeks, diplopia, maxillary hypoesthesia. If the reduction is inadequate to restore facial structure, long term-functional and aesthetic complications may arise. In such cases a computed tomography (CT) scan with 3-dimensional (3D) reconstruction is valuable to assessing the fracture and planning surgery, with current technological advancements, 3D printing can now be utilised for this purpose. Presentation of caseA 24-year-old male, after a motorcycle accident and initial surgery for maxillofacial fractures, experienced persistent diplopia and facial numbness. Physical examination showed malpositioning of the right eye, and a CT scan with 3D reconstruction revealed multiple fractures and prior internal fixation. A 3D-printed model was created to plan a second surgery using rib cartilage and a silicone orbital base for orbital rim reconstruction. Post-surgery, the patient reported minimal pain and no diplopia or blurred vision in the primary gaze position. Clinical discussions3D printing is beneficial in facial reconstruction, aiding in surgical planning by allowing precise measurement and design of graft. Rib cartilage can serve as an alternative for orbital rim reconstruction, and 3D printing facilitates accurate harvesting of the rib. ConclusionIn cases of severe ZMC fracture, 3D printing was utilised as a guide during surgical preparation to achieve improved outcomes.

Free Crushed Cartilage Filler Graft to Optimize Tip Aesthetics in Asian Rhinoplasty.

The thick skin and weak cartilages make tip rhinoplasty very challenging in Asian patients. Most require an open approach for structural grafting in order to achieve the desired projection and rotation. This need for substantial tip grafting may result in subtle imperfections that are only noticed as the incisions are closed. This study describes the senior author's technique of free crushed cartilage filler graft to optimize nasal tip aesthetics in Asian rhinoplasty. The goal is to introduce this easy-to-use and effective technique to refine the final nasal tip aesthetic with immediate visual and tactile feedback. This is a retrospective review of all patients with free crushed cartilage filler graft with at least 12months of follow-up. Medical records were reviewed for patient demographics, intra-operative manoeuvres, and complications. Photographs were analysed to evaluate changes in nasal length, tip height, and nasolabial and columellar-labial angles as well as aesthetic complications. Sixty-six patients were included in this study, with an average follow-up of 16.3months. Nasal length was 8.3% greater than pre-op (P < 0.01), and nasal tip height was 12.7% greater than pre-op (P < 0.01). Aesthetic analysis demonstrated that 6.1% of patients had an amorphous tip, 3.0% had an irregular or asymmetric tip, and 4.5% had visible tip grafts. 12.1% of patients expressed aesthetic dissatisfaction, but none was recommended for or pursued revision surgery. When used correctly, free crushed cartilage filler graft can improve the final tip aesthetic and help camouflage underlying prominences to give the patient a natural result. 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 .

The importance of otorhinolaryngology in correcting rhinoplasties with adverse events

Introduction: Rhinoplasty is a complex intervention aimed at enhancing both nasal aesthetics and functionality. The literature underscores the occurrence of adverse events in this procedure, prompting the search for effective correction strategies. In this context, otorhinolaryngology plays a crucial role, with a fundamental need to comprehend the incidence and types of complications to improve clinical practices. Methods: A systematic literature review was conducted to identify studies addressing adverse events in rhinoplasties and the role of otorhinolaryngology in their correction. The consulted databases included PubMed, Scopus, SciELO, Cochrane Library, LILACS, and Embase. Keywords such as "Rhinoplasty," "Otorhinolaryngology," "Adverse events," "Aesthetic outcomes," "Functional outcomes," "Nasal surgery," and "Complications in rhinoplasty" were combined using boolean operators "OR" and "AND." Results: The compiled results reveal a variety of adverse events in rhinoplasties, ranging from aesthetic complications to functional challenges. The analysis underscores the importance of a specialized otorhinolaryngological approach in minimizing these adverse events, emphasizing the need for treatment personalization to optimize outcomes. Conclusion: It is concluded that otorhinolaryngology plays an essential role in correcting adverse events in rhinoplasties. The systematic review highlights the complexity of these interventions, emphasizing the necessity of a multidisciplinary and specialized approach to achieve satisfactory aesthetic and functional outcomes. These findings support the significance of the otorhinolaryngologist's role in optimizing the quality of care provided to patients undergoing rhinoplasties.

Assessment of sexual function and quality of life in breast cancer patients before and after the occurrence of therapy-related skin changes

Background Patients with breast cancer (BC) who receive adjuvant chemotherapy or other treatment modalities may potentially benefit from an enhanced prognosis of survival. Physical or aesthetic complications may, nevertheless, result in significant distress as a consequence of adverse dermatologic responses. There has been a heightened focus on matters related to quality of life (QoL) as the number of BC survivors has risen. Sexual disorders are reported by as many as 75% of women who undergo treatment for BC. Despite this, the majority of oncologists lack the necessary training to identify patients who are particularly susceptible to developing sexual disorders. Patients diagnosed with BC frequently experience female sexual dysfunction. Objective To compare and evaluate the impact of skin changes induced by different treatment modalities in BC patients on their sexual function and QoL. Patients and methods This is a prospective cohort research on 58 cases diagnosed with BC, which was conducted in the outpatient clinic of the Clinical Oncology department, Faculty of Medicine, Menoufia University from April 2022 to February 2023. The calculated sample size for the current study using Epi info 7 programs was 56 women. The power of the study is 80% with a confidence level of 95% as determined by the Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University. Both sexual function and QoL were assessed before and 3–6 months after the occurrence of skin changes related to different treatment modalities using validated questionnaires irrespective of their tumor stage. Results Of the 58 patients, there was statistically significant variance regarding dermatological life quality index (DLQI) (P&lt;0.001), with 8.6% of patients experiencing a very large influence on their QoL, which increased to 19%. However, the number of patients having an extremely large influence on their quality of life changed from 0 to 5.2%. There was statistically significant variance (P&lt;0.001) regarding female sexual function index values among the six domains of female sexual function index before and after the occurrence of skin changes. There is a negative correlation between DLQI score and desire, arousal, lubrication, orgasm, and satisfaction scores, while there is a positive correlation between DLQI score and pain score. QoL was negatively affected by the occurrence of such skin lesions. Conclusion There was a significant negative impact of skin changes induced by different treatment modalities in BC patients on their sexual function and QoL.

Current status of prepectoral breast reconstruction in Argentina.

Breast cancer is among the most common cancers diagnosed in women, affecting one in eight women per year. Immediate implant-based breast reconstruction has emerged as the predominant approach for postmastectomy reconstruction, with a growing preference for the direct-to-implant (DTI) method over the traditional tissue expander technique. While conventionally, implants were typically positioned beneath the pectoralis major muscle, recent advancements have paved the way for implant placement above the muscle, in the prepectoral plane. Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) techniques can be combined with prepectoral breast reconstruction. The presence of sufficient fatty tissue coverage is considered one of the foremost independent factors influencing the success of immediate breast reconstruction and flap viability. DTI is a safe approach for prepectoral implant-based reconstruction with a number of advantages. However, careful patient selection and judicious assessment of flap perfusion help identify an appropriate subset of patients for prepectoral DTI reconstruction. Proposed breast tissue coverage classification (BTCC) and rigorous perfusion assessment techniques will aid to minimize postoperative complications and reconstruction failure. Based on the obtained range of coverage values (distance between the Cooper's ligaments and the skin) of preoperative digital mammogram evaluation, a three-type BTCC is as follows: Type 1: <1 cm (poor coverage), Type 2: between 1 and 2 cm (medium coverage), Type 3: >2 cm (good coverage). Prepectoral DTI reconstruction provides good results with complication rates similar to those of subpectoral techniques, eliminating breast animation. A meticulous surgical technique is essential to preserve the vascular network that guarantees the survival of the skin flap and nipple-areola complex (NAC). In the good coverage group (Type 3), an immediate DTI reconstruction could be safely performed. Aesthetic complications as rippling can occur if prepectoral implants are placed in Type 1 patients. Preoperative planning for prepectoral placement should not depend on breast volume, but on breast tissue coverage. Flap evaluation based on preoperative imaging measurements may be helpful when planning a conservative mastectomy. Patient selection, preoperative and intraoperative mastectomy flap evaluation, and modifications in implant technology play a critical role in this new and rapidly growing method for implant-based breast reconstruction.

Shear Wave Elastography of the Skin following Radial Forearm Free Flap Surgery in Transgender Patients: Observational Study.

Background: Ultrasound shear wave elastography (SWE) noninvasively measures the stiffness of tissue by producing and measuring tissue deformation. Scar formation, a crucial aspect of wound healing, can lead to functional and aesthetic complications when pathological. While SWE has shown promise in dermatological evaluations, its role in surgical scar assessment remains underestimated. Our study aims to investigate SWE in evaluating surgical scars at the donor site after forearm free flap surgery in transgender patients. Methods: After radial forearm free flap harvesting, the donor site was grafted with a split-thickness skin graft with or without interposition of Matriderm. Eleven patients were evaluated more than one year after surgery, using SWE alongside scar characteristics, sensory outcomes, and patient satisfaction surveys. Results: Our study revealed no significant difference in stiffness (p > 0.15), pigmentation (p = 0.32), or erythema (p = 0.06) between operated and non-operated sides. The interposition of Matriderm did not influence the stiffness. Patients significantly (p < 0.0001) reported a loss of discrimination. Patients' subjective scar evaluation appeared in line with our quantitative and objective results. Conclusions: This study contributes to the evolving understanding of SWE's role in scar assessment, highlighting its feasibility in evaluating surgical scars. However, continued research efforts are necessary to establish SWE as a reliable and objective method for surgical scar evaluation and management.

Analysis of keratopigmentation in the treatment of iridodialysis

Keratopigmentation has emerged as an innovative approach in the treatment of iridodialysis, an ocular condition that can result in serious visual and aesthetic complications. This study aimed to evaluate the efficacy and safety of keratopigmentation in the treatment of iridodialysis, considering both functional and aesthetic aspects. A comprehensive qualitative literature review was conducted, utilizing databases such as Scielo, Google Scholar, scientific journals, repositories, and virtual libraries. Inclusion criteria encompassed studies directly addressing keratopigmentation in the context of iridodialysis, while case studies and publications in languages not understood were excluded. The analysis revealed that keratopigmentation can significantly improve the visual functionality of patients, reducing symptoms such as photophobia and diplopia, while also providing satisfactory aesthetic results. The risks and complications associated with the procedure were minimal, especially with the use of micronized mineral pigments and advanced techniques like femtosecond laser. It was concluded that keratopigmentation is a viable and less invasive alternative compared to traditional techniques, offering significant therapeutic potential in the treatment of iridodialysis. This study contributes to the validation of the technique and suggests future research directions to optimize results and expand the clinical applications of this innovative approach.

Effect of peri-implant soft-tissue phenotype on peri-implant health

Dental implant is a commonly used therapeutic option for reconstruction of edentulous space. Adequate peri-implant soft tissue is crucial for preventing biological and esthetic complications. Peri-implant soft-tissue phenotypes including supracrestal tissue height, mucosa thickness and keratinized mucosa width could reflect the quality and quantity of peri-implant soft tissue. Different soft-tissue phenotypes might impact the stability of implant restoration through altering the tissue remodeling or inflammatory response. This review will discuss the influence of peri-implant soft-tissue phenotypes on tissue remodeling and inflammatory response after implant placement.

Practical Reconstructive Techniques Using the Transoral Approach to Segmental Mandibulectomy With Cosmofix: Technical Report.

This paper introduces a new, less invasive, aesthetic, and functional reconstructive method using a transorally inserted, custom-made Cosmofix fixation plate. Two medication-related cases with stage 3 osteonecrosis of the jaw (MRONJ) are presented. Both procedures required a segmental mandibulectomy as the osteonecrosis had progressed to the mandibular inferior margin and was reconstructed by a transoral approach with a good prognosis. The reconstructed sites were satisfactorily restored with good occlusal conditions and with dentures. No esthetic or functional problems were evident >1 year after surgery. Compared to traditional reconstructive surgery involving facial skin incisions, this technique takes less time, is minimally invasive, is not associated with aesthetic complications, and does not cause facial nerve palsy. Therefore, this procedure may be safely performed in patients with advanced MRONJ who are in poor general condition or older patients.

Articulated Infra-Domal Columellar Flap, a Technical Note

Soft tissue triangle notching represents a complex challenge in rhinoplasty. To prevent this aesthetic complication, various techniques have been developed. When soft tissue triangle notching occurs, both surgical procedures and non-surgical methods like steroid injections and taping can be considered. Surgical management of alar and tip deformities involves the use of cartilage grafts and cartilage flaps. While cartilage grafts are effective in most cases, they may have associated limitations. On the other hand, cartilage flaps have advantages over cartilage grafts, including easier fixation, avoidance of cartilage harvesting, and the ability to use similar tissue for reconstructing the recipient site. In this study, we present a novel cartilage flap technique for addressing soft tissue triangle retraction, suitable for open, closed and preservation rhinoplasty approaches.

Retrospective, Multi-center, Cohort Study Evaluating Clinical, Technical, Biological, and Esthetic Outcomes of Implant Supported Zirconia Single Crowns Cemented on Titanium-base Abutments: 7-year Mean Follow-up.

To retrospectively evaluate the long-term clinical, technical, biological, and esthetic outcomes of implant supported single zirconia crowns (ISCs) intraorally cemented to Ti-base hybrid-abutments up to 16 years after placement. A total of 63 ISCs (Xive S, Camlog Screw Line, Replace Select TC NP, Branemark MK II, and 3i Osseotite) were evaluated in 36 patients at two different centers. Original Ti-bases were selected and zirconia meso structures and zirconia crowns were designed using CAD/CAM software and then milled from partially stabilized zirconia blocks. After the meso structures were cemented extraorally onto the Ti-bases, the ceramic crowns were intraorally luted to the hybrid abutments. The Ti-base ISC restorations were followed up for up to 16 years, and their clinical, biological, and esthetic outcomes were recorded at distinct time points (T1; T2) at three-year intervals. 36 patients (18 men, 18 women) received 32 ISCs in the anterior region and 31 in the posterior region of the maxilla and mandible. The mean follow-up of the Ti-base ISCs was 6.93 ± 2.60 years. The mean follow-up of the implants amounted to 8.11 ± 3.26 years. No implants were lost during follow-up, resulting in a cumulative implant survival rate of 100%. Abutment screw loosening was observed in two ISCs after one year in service. The overall cumulative restorative survival rate of the Ti-base restorations reached thus 96.83%. At T2 follow-up 24% of the ISCs exhibited an increase in PD despite maintaining clinically healthy peri-implant tissue. An 11% increase in BOP and a 3.17% decrease in PI were recorded. Despite spectrophotometrically measured ΔE values indicating visible discoloration of some restorations and their peri-implant soft tissue, a low incidence of esthetic complications was observed with an average PES/WES score of ≥ 12. No correlation was found between PES (R &#61; -0.25; p &#61; 0.27) and WES (R &#61; -0.18; p &#61; 0.43) scores and digital shade determination. The results of the present retrospective, multicenter, cohort study indicate satisfactory clinical outcomes for intraorally cemented single zirconia crowns (ISCs) supported by Ti-base hybrid abutments. An overall esthetic superiority of Ti-base ISCs could not be confirmed.

Correction and prevention of tip asymmetries, bossae, and alar retraction

Secondary rhinoplasty to address complications from initial surgical intervention is a technically challenging operation. Common aesthetic complications that plague patients after primary rhinoplasty include nasal tip asymmetries, bossae, and alar retraction. These adverse outcomes are usually a result of over-manipulation and/or over-excision of native cartilage and are especially prevalent in patients with thick lower lateral cartilages and thin nasal skin. Techniques to minimize tissue handling, maintain natural nasal anatomic support and structure, and soften sharp edges from cartilage grafts or incisions are all essential in the prevention of nasal tip irregularities. In addition to prevention, there are many operative and procedural interventions to correct tip asymmetries, bossae, and alar retraction. These interventional corrections include varying cartilage and/or fascial grafts, camouflaging of previously performed grafts, and repositioning of the alar cartilage.

The quality of life after keratinized mucosa augmentation around dental implants using xenogenic collagen matrix with or without stent.

The substitution of missing teeth with implants is a dependable and anticipated therapeutic approach. Despite numerous studies affirming long-term success rates, there exists a spectrum of potential biological and aesthetic complications. The primary objective of this study was to assess patient responses subsequent to surgical interventions, with a specific emphasis on the utilization of xenogenic collagen matrix (XCM), both with and without the application of a stent secured over healing abutments, in the context of keratinized gingival mucosa augmentation. The principal aim was to evaluate and draw comparisons between the clinical outcomes resulting from these two procedural approaches, with a particular focus on critical parameters encompassing post-operative complications, patient comfort, and the overall efficacy in achieving successful keratinized tissue augmentation. Sixty patients were selected for this study. The patients were divided into three groups: A, B, and a control group, with each group comprising 20 participants. We used XCM in experimental group A, XCM covered with surgical stent in experimental group B, and free gingival graft (FGG) in the control group. After the surgical procedure, patients were required to complete a visual analogue scale (VAS) questionnaire for post-operative complications, and a quality of life (QOL) questionnaire on days 1, 3, and 7. Patients in the experimental groups A and B demonstrated markedly improved outcomes when compared with the control group. Assessments conducted on days 1, 3, and 7 demonstrated diminished levels of pain, bleeding, and swelling in both experimental groups, with experimental group B showing the least discomfort. The incorporation of XCM, either with or without stents, was associated with a reduction in analgesic consumption, underscoring its favorable influence on post-operative comfort, notwithstanding the exception of halitosis in experimental group B. Using XCM with or without a stent for keratinized tissue augmentation has better post-operative outcomes associated with reduced swelling, bleeding, and pain based on the QOL survey. This study provides data to support the clinical application of XCM and stents.

Impact of post-operative infection on revision procedures in breast reconstruction: A marketscan database analysis

BackgroundEsthetic complications, such as capsular contracture and soft-tissue contour defects, hinder the desired outcomes of breast reconstruction. As subclinical infection is a prevailing theory behind capsular contracture, we investigated the effects of post-operative infections on these issues and revision procedures. MethodsWe conducted a retrospective database study (2007–2021) on breast reconstruction patients from the MarketScan® Databases. Esthetic complications were defined by their associated revision procedures and queried via CPT codes. Severe capsular contracture (Grade 3–4) was defined as requiring capsulotomy or capsulectomy with implant removal or replacement. Moderate and severe soft-tissue defects were determined by the need for fat grafting or breast revision, respectively. Generalized linear models were used, adjusting for comorbidities and surgical factors (p < 0.05). ResultsWe analyzed the data on 62,510 eligible patients. Post-operative infections increased the odds of capsulotomy (OR 1.59, p < 0.001) and capsulectomy (OR 2.30, p < 0.001). They also raised the odds of breast revision for severe soft-tissue defects (OR 1.21, p < 0.001). There was no significant association between infections and fat grafting for moderate defects. Patients who had post-operative infections were also more likely to experience another infection after fat grafting (OR 3.39, p = 0.0018). In two-stage reconstruction, infection after tissue expander placement was associated with greater odds of infection after implant placement. ConclusionPost-operative infections increase the likelihood of developing severe soft-tissue defects and capsular contracture requiring surgical revision. Our data reinforce the role of infections in the pathophysiology of capsular contracture. Additionally, infections elevate the risk of subsequent infections after fat grafting for moderate defects, further increasing patient morbidity.

The Effect of Sapodilla Leaf Extract on IL-6 and TGF- β Levels of Skin Tissue (Experimental Study on Male White Rats of Wistar Strain Exposed to UV Light)

Excessive exposure to ultraviolet light affects cell and tissue homeostasis which has a damaging effect on DNA characterized by the formation of reactive oxygen species (ROS). Inflammation due to UV rays is the main cause of oxidative stress in the skin. Healing of wounds caused by sunburn through a complex process consisting of inflammatory cell infiltration, cell proliferation, and tissue remodeling phases to restore normal skin integrity and function, rapid healing and epithelialization to prevent infection and minimize functional and aesthetic complications. The researchers aimed to see the effect of administering sapodilla leaf extract cream (Manilkara zapota) on IL-6 and TGF-β levels in Wistar rats with sunburn. Experimental study with a post test only control group design using a total of 30 mice as experimental animals, divided randomly into 4 treatment groups consisting of a control group, a placebo group, a sapodilla leaf cream group with a dose of 25% and a 50% cream group. Mouse skin tissue exposed to UV was analyzed using the ELISA method to determine the levels of IL-6 and TGF-β. There was no significant difference in the average IL-6 levels between treatment groups with the one way anova difference test, a p value of 0.25 (p0.05), there was a significant difference in the average TGF-β levels for each group with a p value of 0.005 (P0.05), Manilkara zapota leaf extract cream had a significant effect on TGF-β levels at a dose of 50%. Administration of Manilkara zapota leaf extract cream has a dose-dependent effect on IL-6 and TGF-β levels in skin tissue of mice exposed to UV.

Risk of complications in panfacial bone fracture according to surgeons: A meta-analysis

BackgroundPanfacial bone fractures pose intricate challenges due to severe fragmentation and loss of landmarks. Surgeons use a variety of reduction techniques, including bottom-up and top-down approaches. This single proportional meta-analysis explores sequencing differences and complications between oal and maxillofacial Surgery surgeons (OMSs) and plastic and reconstructive surgeons (PRSs) in treating panfacial bone fractures. MethodsThe PubMed and Scopus databases were searched systematically, and we compiled fourteen studies published between 2007 and 2023 involving 1238 patients. A systematic review of the included studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and data on the reduction techniques; total complication rates; and rates of malocclusion, enophthalmos, infection, asymmetry, and aesthetic complications were collected. ResultsThe bottom-up technique was the most prevalent for both types of surgeons (57.1%, 8 out of 14). Malocclusion rates (I2=0% for OMSs and 41% for PRSs) were similar between the groups (p=0.72), but PRSs tended to have a lower enophthalmos rate (I2=0% for OMSs and 32% for PRSs) than OMSs (p < 0.01). Infection rates remained consistent across all studies. However, high heterogeneity was observed for the total complication rate (I2=94% for OMSs and 85% for PRSs) and asymmetry and aesthetic complications (I2=88% for OMSs and 92% for PRSs), making direct comparison between the two groups inconclusive. ConclusionsIn this study, the differences in surgical techniques and levels of interest have a greater impact on the outcomes of panfacial bone fracture than the surgeon’s specialty. However, more in-depth studies are needed to accurately pinpoint panfacial bone fracture reduction trends and differences in postoperative complications in the two expert groups.

Implant-Based Breast Reconstruction: Impact of Body Mass Index on Postoperative Complications and Aesthetic Results: A 5-Year, Single-Center Study.

Increasing adoption of implant-based breast reconstruction (IBR) has raised expectations regarding postoperative outcomes and aesthetic results. BMI has been extensively explored as a predictor of complications. This study is the first to examine complication rates in underweight subjects, and compares these rates among underweight, normal weight, overweight, and obese patients. The aim of this study was to investigate the influence of BMI on postoperative complications and aesthetic results in IBR following mastectomy. Retrospective analysis encompassed patients undergoing mastectomy with subsequent IBR, performed by a collaborative team of breast and plastic surgeons. Demographics, treatment specifics, and outcomes were evaluated by univariate and multivariate regression models. Significance was determined at P < .05. In total, 1046 IBRs were performed in 921 patients, of whom 63 had a BMI <18.5 kg/m2, 572 were normal weight, 215 were overweight, and 71 were obese. Significantly higher complication rates were observed in both obese and overweight patients compared with normal-weight patients (P < .001). Each unit increase in BMI correlated to 7% increased odds of overall complications and 13% increased odds of reconstructive failure. Underweight individuals had higher capsular contracture rates than normal-weight patients, 14.3% vs 3.65%, respectively (P = .001). In addition, aesthetic complications rates in underweight patients were higher than in normal-weight patients, 36.4% vs 25.7%, respectively (P < .05). This study confirmed BMI to be a strong predictor of postoperative complications and aesthetic outcomes, and demonstrates that low BMI has a significant impact on the incidence of capsular contracture and aesthetic complications.

Treatment of esthetic complications with peri-implant soft tissue: A description of the "apical approach" surgical technique and presentation of two clinical cases.

Peri-implant soft tissue deformities are an increasingly common phenomenon in the esthetic zone. While the most widely studied esthetic complications are peri-implant soft tissue dehiscences, there are other esthetic concerns in routine clinical practice that require investigation and treatment. Against this backdrop, this report on two clinical cases aimed to describe a surgical approach using the apical access technique for treatment of peri-implant soft tissue discoloration and fenestration. In both clinical scenarios the defect was accessed via a single horizontal apical incision, without removing the cement-retained crowns. A bilaminar technique using apical access with a simultaneous connective tissue graft seems to offer promising results for the treatment of peri-implant soft tissue deformities. After the 12-month reevaluation, an increase in peri-implant soft tissue thickness was observed, resolving the pathologies presented.

Group 1 ITI Consensus Report: The role of bone dimensions and soft tissue augmentation procedures on the stability of clinical, radiographic, and patient-reported outcomes of implant treatment.

The aims of Working Group 1 were to address the role (i) of the buccolingual bone dimensions after implant placement in healed alveolar ridge sites on the occurrence of biologic and aesthetic complications, and (ii) of soft tissue augmentation (STA) on the stability of clinical, radiographic, and patient-related outcomes of implant treatments. Two systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, recommendations for future research, and reflections on patient perspectives were based on structured group discussions until consensus was reached among the entire group of experts. The statements were then presented and accepted following further discussion and modifications as required by the plenary. Dimensional changes of the alveolar ridge occurred after implant placement in healed sites, and a reduction in buccal bone wall thickness (BBW) of 0.3 to 1.8 mm was observed. In healed sites with a BBW of <1.5 mm after implant placement, increased vertical bone loss, and less favorable clinical and radiographic outcomes were demonstrated. Implants with buccal dehiscence defects undergoing simultaneous guided bone regeneration, showed less vertical bone loss, and more favorable clinical and radiographic outcomes, compared to non-augmented dehiscence defects during initial healing. At healthy single implant sites, probing depths, bleeding and plaque scores, and interproximal bone levels evaluated at 1 year, remained stable for up to 5 years, with or without STA. When single implant sites were augmented with connective tissue grafts, either for soft tissue phenotype modification or buccal soft tissue dehiscence, stable levels of the soft tissue margin, and stable or even increased soft tissue thickness and/or width of keratinized mucosa could be observed from 1 to 5 years. In contrast, non-augmented sites were more prone to show apical migration of the soft tissue margin in the long-term. Favorable aesthetic and patient-reported outcomes after STA were documented to be stable from 1 to 5 years. It is concluded that dimensional changes of the alveolar ridge occur after implant placement in healed sites and that sites with a thin BBW after implant placement are prone to exhibit less favorable clinical and radiographic outcomes. In addition, it is concluded that STA can provide stable clinical, radiographic, aesthetic, and patient-reported outcomes in the medium and long-term.