Aesthetic Outcome Of Treatment Research Articles

The role of bacterial biofilms in aesthetic medicine: prioritising prevention

The purpose of this article is to explore the role of bacterial biofilm formation within the field of aesthetic medicine and discuss how practitioners can reduce patient risk. Substantial research into the bacterial pathogenesis of acute infections has been the primary focus of scientists over many years; however, a new category of chronic bacterial infection has emerged that represents significant global concern due to the bacteria's adaptive resistance to conventional antibiotics and to human host response mechanisms. This poses a significant risk not only to facial aesthetic treatment outcomes, but to patient safety. It is the consensus of expert opinion that biofilm formation post dermal filler treatment is primarily the likely result of a breach of aseptic technique. Biofilm formation can result in the development of sepsis, which can prove fatal.

Satisfaction of skeletal class III patients treated with different types of orthognathic surgery

The aim of this study was to compare the satisfaction of skeletal class III patients following treatment with three different methods of orthognathic surgery. Eighty-two patients were divided into three groups according to the surgical procedure performed to correct their class III dentofacial deformity, and answered a questionnaire designed to determine the patient's opinion of the aesthetic and functional treatment outcomes. Differences in the patterns of responses to questions in the questionnaire related to satisfaction between the three clinical groups were evaluated by χ2 and Fisher's exact tests (α=5%). Eighty patients (97.6%) reported being satisfied with the treatment received. There was no significant difference in response patterns among clinical groups when assessing the improvement in facial appearance, chewing, speech, and socialization. Maxillary advancement led to higher levels of improvement in breathing (P<0.0003). Class III patients treated by orthognathic surgery had high levels of satisfaction with the aesthetic and functional outcomes of their treatment.

The Role of Implant Position on Long‐Term Success

Focused Clinical Question: In the past, implants were placed where the bone was. This mode of treatment often led to implant‐related complications, such as peri‐implant soft‐tissue recession, esthetic challenges, and fractured implants and/or associated suprastructures. Therefore, advances in soft‐tissue and bone augmentation techniques have enabled implants to be placed in an ideal three‐dimensional position, thus ensuring adequate peri‐implant soft tissue and bone thickness for a stable and successful long‐term treatment outcome. The present report aims to answer the question: What are the clinical guidelines for implant placement to achieve long‐term success?Summary: In the maxillary anterior region where esthetics is of paramount importance, 2 mm of buccal bone anterior to the implant is preferred. This ensures stability of the buccal bone plate, minimizing peri‐implant mucosal recession. To achieve an esthetic emergence profile, the implant platform is generally placed 3 to 4 mm apical to the cemento‐enamel junction (CEJ) of the adjacent teeth and 1.5 to 2 mm away from the adjacent roots. In the posterior region, a minimum of 1 mm of buccal bone around the implant ensures stability of the buccal plate. Generally, implants with a polished collar are preferred because the collar can be placed supracrestally to compensate for any vertical ridge deficiency and yet not compromise the esthetics of the restoration. The implant is placed 1.5 to 3 mm apical to the CEJ of the adjacent teeth and 3 to 4 mm away from adjacent roots to create a smooth transition from implant platform to occlusal plane.Conclusion: Ideal three‐dimensional implant positioning ensures a long‐term stable esthetic and functional treatment outcome.

Comprehensive approach with implant

The critical factors affecting the esthetics of anterior implants can be summarized as following: 1) Correct positioning of implant fixture 2) Enough amount of alveolar bone 3) Optimum volume of soft tissue. The position of implant is probably the most important factor in obtaining esthetic treatment outcome. The 3-dimensional orientation of implant is determined by the position on the alveolar ridge and its direction. Clinicians often try to mimic natural teeth when fabricating restorations. During the course of esthetic diagnosis and treatment, however, one should not forget to consider the correlation between facial pattern, lips, gingiva, alveolar ridge, as well as remaining dentition. Since anterior region is biologically unfavorable when compared with posterior region, one minor discrepancy in positioning of implant can cause esthetically undesirable treatment outcome. If one understands the biological and prosthetic meaning of implant's 3-dimensional position, he or she can achieve superior esthetic outcome in anterior region.

Patient satisfaction and esthetic outcome after immediate placement and provisionalization of single‐tooth implants involving a definitive individual abutment

To assess patient satisfaction and esthetic outcome after immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment and a provisional crown followed by later placement of a definitive crown. In private practice, a single-tooth implant was placed immediately after tooth extraction in the esthetic zone of 54 patients. A definitive individual abutment and a provisional crown were mounted in the same visit. The definitive crown was placed after a mean period of 7months. After a mean follow-up period of 33months, the subjective and professional evaluation of the total implant treatment, peri-implant soft tissues, and implant crown were assessed on a 10-cm visual analog scale (VAS). The professional esthetic treatment outcome was also evaluated using pink esthetic score (PES), white esthetic score (WES), and total score of PES/WES. The evaluation of total implant treatment, peri-implant soft tissues, and implant crown demonstrated a significantly higher subjective than professional score for all 3 parameters (P<0.001), for example, for the overall treatment, the mean scores were 9.4 and 7.0, respectively. A significant positive correlation was revealed between the professional VAS scores and the PESs and WESs. Immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment and provisional crown followed by later placement of a definitive crown demonstrated high subjective and professional satisfaction. Generally, the professionals seem to be more critical than the patients. A strong correlation was observed between the professional VAS scores and the PES and WES scoring systems.

Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public

The aesthetic outcome of cleft treatment is of great importance due to its complex management and the psychosocial consequences of this defect. The aim of the study was to assess the aesthetic evaluations of patients following cleft surgery by various groups and investigate potential associations of the assessments with life quality parameters. Head photos of 12 adult patients with treated unilateral cleft lip and palate were evaluated by laypeople and professionals. A questionnaire was distributed and answered by the patients and their parents. Intra-panel agreement was high (α > 0.8) for laypeople and professionals. Between-groups agreement was high for both laypeople and professionals, but not when patients and/or parents were tested. Professionals, parents, and patients were more satisfied with patients' appearance than laypeople, although in general all groups were not highly satisfied. Low satisfaction with aesthetics correlated with increased self-reported influence of the cleft in the patients' social activity and professional life (0.56 < rho < 0.74, p < 0.05). These findings highlight the observed negative influence of the cleft on the patient's social activity and professional life and underline the need for the highest quality of surgical outcome for this group of patients.

Comparative Analysis of Rationale used by Dentists and Patient for Final Esthetic Outcome of Dental Treatment

To compare and evaluate the perceptions of esthetics among dentists and patients regarding the final esthetic outcome of a dental treatment. Esthetics is a matter of perception and is associated with the way different people look at an object. What constitutes esthetic for a particular person may not be acceptable for another. Hence it is subjective in nature. This becomes more obvious during the post-treatment evaluation of esthetics by dentist and the concerned patient. Opinion seldom matches. Hence, the study is a necessary part of the process of understanding the mind of dentist and patient regarding what constitutes esthetics. A survey has been conducted by means of a questionnaire consisting of 10 questions, on two groups of people. First group consists of 100 dentists picked at random in Kanyakumari district of Tamil Nadu, India. Second group consisted of 100 patients who required complete denture prosthesis. The second group was divided into two subgroups A and B. Subgroup A consisting of 50 men and subgroup B consisting of 50 women. In each subgroup 25 patients were selected in age group of 40 to 50 and 25 patients were selected in the age group of 50 to 60. The questionnaire was given to both the groups and asked to fill up, which was then statistically analyzed to look for patterns of thought process among them. Results were subjected to statistical analysis by Student's t-test. Perceptions of esthetics differs from dentist who is educated regarding esthetic principles of treatment and a patient who is not subjected to such education. Since, the questions were formulated such that patients could better understand the underlying problem, the final outcome of survey is a proof that dentists need to take into account what the patient regards as esthetics in order to provide a satisfactory treatment. CLINICAL AND ACADEMIC SIGNIFICANCE: The current study helps the dentist to better educate the patient regarding esthetics so that patient appreciates the final scientifically based esthetic outcome of treatment. It also helps the dental students to understand the underlying patient's thought process regarding esthetics.

The impact of the sentinel node concept on the aesthetic outcome of breast cancer conservative surgery

The sentinel node (SN) concept has brought numerous advantages to women with breast cancer. Sparing axillary node anatomy and physiology may enhance the cosmetic results of breast cancer conservative surgery, either owing to less breast edema or to a better tolerance to the effects of surgery and radiotherapy. Our aim was to compare the cosmetic outcome of two randomized groups of patients, on a subjective and objective basis. A consecutive series of breast cancer patients (n = 60) submitted to partial mastectomy plus axillary dissection or partial mastectomy plus SN biopsy (included in a randomized trial) was photographed. Photos were analysed in three ways: by seven different observers according to seven features from poor to excellent; two observers estimated the percentage of breast retraction assessment (pBRA); or by the BCCT.core 1.0(®) software. The panel subjective analysis showed a benefit in terms of the skin colour for the patients submitted to SN biopsy only. This group of patients did not show any advantage in terms of pBRA estimates even after the complex BCCT.core appraisal. The sentinel node concept is not associated with improvements in the aesthetic outcome of breast cancer conservative treatment.

Virtual implant planning in the edentulous maxilla: criteria for decision making of prosthesis design

To evaluate prosthetic parameters in the edentulous anterior maxilla for decision making between fixed and removable implant prosthesis using virtual planning software. CT- or DVT-scans of 43 patients (mean age 62 ± 8 years) with an edentulous maxilla were analyzed with the NobelGuide software. Implants (≥3.5 mm diameter, ≥10 mm length) were virtually placed in the optimal three-dimensional prosthetic position of all maxillary front teeth. Anatomical and prosthetic landmarks, including the cervical crown point (C-Point), the acrylic flange border (F-Point), and the implant-platform buccal-end (I-Point) were defined in each middle section to determine four measuring parameters: (1) acrylic flange height (FLHeight), (2) mucosal coverage (MucCov), (3) crown-Implant distance (CID) and (4) buccal prosthesis profile (ProsthProfile). Based on these parameters, all patients were assigned to one of three classes: (A) MucCov ≤ 0 mm and ProsthProfile≥45(0) allowing for fixed prosthesis, (B) MucCov = 0-5 mm and/or ProsthProfile = 30(0) -45(0) probably allowing for fixed prosthesis, and (C) MucCov ≥ 5 mm and/or ProsthProfile ≤ 30(0) where removable prosthesis is favorable. Statistical analyses included descriptive methods and non-parametric tests. Mean values were for FLHeight 10.0 mm, MucCov 5.6 mm, CID 7.4 mm, and ProsthProfile 39.1(0) . Seventy percent of patients fulfilled class C criteria (removable), 21% class B (probably fixed), and 2% class A (fixed), while in 7% (three patients) bone volume was insufficient for implant planning. The proposed classification and virtual planning procedure simplify the decision-making process regarding type of prosthesis and increase predictability of esthetic treatment outcomes. It was demonstrated that in the majority of cases, the space between the prosthetic crown and implant platform had to be filled with prosthetic materials.

An Esthetic Treatment Outcome of Orthognathic Surgery and Dentofacial Orthopedics in Class II Treatment: A Cephalometric Study

The main objective of any orthodontic treatment is to achieve well-established stable occlusal relationship with a definite positive change in facial profile. The purpose of this study was to determine, if such a goal is achievable for patients who could be classified as borderline surgical cases without the invasive use of the actual surgery or, with the use of the recently developed and rapidly spreading fixed functional appliance system (Forsus) and a comparison of the esthetic treatment outcome with the two systems. Twelve postadolescent borderline skeletal class II patients with a deficient mandible. All the patients used in the study were treated by a preadjusted edgewise appliance for presurgical decompensation with or without extractions and for postsurgical finishing and detailing. Out of the 12 patients six were treated with bilateral saggital split osteotomy (BSSO) and six were treated with fixed functional appliance (Forsus). The results suggested that although surgical patients had a better mandibular advancement, profile reduction, and marked improvements in soft tissue structures, the patients who had undergone fixed functional therapy also had comparable improvement in the above aspects. In the maxilla there was no change in cases treated with surgery but in case of Forsus some retraction of anterior dental segment was evident. In surgical group, class II malocclusion correction was more skeletal than dental, whereas in functional group class II malocclusion correction was more dental than skeletal. Looking at the common surgical risks, cost-effective and postsurgical problems and patients with borderline class II malocclusion, fixed functional therapy is a valuable adjunct in the management of class II malocclusion.

Timing of Anterior Implant Placement Postextraction: Immediate Versus Early Placement.

Type of Case: Implant placement in a postextraction site in the esthetic zone is a challenge for clinicians, since esthetic expectations of patients are high and potential esthetic complications can be devastating. The timing of implant placement is crucial, since it has an influence on esthetic treatment outcomes and the risk of complications. The topic of this paper is the timing of dental implant placement in the esthetic zone in relation to removal of the tooth to be replaced. Two opinions on the topic are presented. The first author (TGW) contends that under certain circumstances, immediate implant placement is appropriate in the esthetic zone. The second author (DB) favors early implant placement performed after 4 to 8 weeks of soft tissue healing. Both cite literature to substantiate their position and present their current therapeutic approach. Each author has been allowed to review the paper with the opposing view and comment. Clinical Approach #1 (TGW): By definition, an immediate implant is one that is put into position at the same surgery that the tooth to be replaced is removed. Sites that respond optimally to this approach in the esthetic zone are those with adequate bone for implant stability and an intact socket. Also important is the complete degranulation of the socket and in infected sites, the use of systemic antibiotics. The best implant position is normally to the palatal side of the extraction socket. This allows placement of hard and soft tissue grafts on the facial aspect, which increases the probability of esthetic outcomes. Clinical Approach #2 (DB): Following tooth extraction, early implant placement is performed after 4 to 8 weeks of soft tissue healing. This surgical approach allows implant insertion and simultaneous guided bone regeneration with an intact mucosa, which improves the predictability of contour augmentation. It is done with a resorbable collagen membrane, which is combined with autogenous bone grafts and a low-substitution, hydroxyapatite-based bone filler. In combination with a correct 3-dimensional implant position, successful contour augmentation provides a low risk for mucosal recession, and a convex contour of the alveolar process. Both are important prerequisites for successful esthetic outcomes.

Instant provisionalization of immediate single‐tooth implants is essential to optimize esthetic treatment outcome

The immediate single-tooth implant has become a viable treatment option. However, the impact of the restorative procedure on esthetics is currently unclear. The goal of this study was to compare the soft tissue outline at immediate implants following two restorative protocols: immediate connection of a temporary crown or submerged healing during which a removable partial denture is used. A 1-year single-blind randomized clinical study was performed in 49 patients. Twenty-four patients were assigned to the immediate restoration group and 25 to the delayed restoration group. Clinical and radiographic evaluations of soft and hard tissues were carried out after 3, 6 and 12 months. Implant survival, bone remodeling, probing depth and bleeding tendency were not influenced by the restorative protocol. Delayed restoration resulted in initial papilla loss taking up to 1 year to attain comparable height as for immediate restoration. Midfacial recession was systematically 2.5-3 times higher following delayed restoration pointing to a 0.75 mm additional loss in comparison with immediate restoration after 1 year. If the primary implant stability permits it, immediate single-tooth implants should be instantly provisionalized in the interest of optimal midfacial esthetics.

Efficacy of a polyurethane dressing versus a soft silicone sheet on hypertrophic scars

To compare the efficacy and safety of a polyurethane dressing with a silicone sheet in the treatment of hypertrophic scars. Sixty patients participated in this intra-individual 12-week clinical trial. Each scar was divided into two areas, to which the polyurethane dressing and the silicone sheet were randomly allocated. The primary outcome measure was the percentage change in the overall scar index (SI) between baseline and week 12. Secondary outcome measures included changes in skin redness, objectively measured by chromametry, and patients views on the aesthetic outcome of treatment. Both therapies achieved favourable results for all of the above outcome measures. Results were comparable for the primary outcome measure: 29.4% versus 33.7% for the silicone sheet and polyurethane product respectively. The decrease in the overall SI was significantly more pronounced for the polyurethane product after week 4 (5.6% versus 15.8% for the silicone sheet; p<0.0001) and week 8 (20.2% versus 27.1%; p=0.012). Both regimens were associated with a significant reduction in the clinical signs of hypertrophic scars over 12 weeks of treatment. The polyurethane dressing demonstrated a significantly more pronounced reduction in severity of these clinical signs after four and eight weeks of treatment and was better tolerated than the silicone sheet. l This study was funded by Beiersdorf AG. proDERM is an independent research company, and none of the authors have an interest in the sponsors commercial activities.

Factors Influencing the Preservation of the Periimplant Marginal Bone

Esthetic outcomes cannot be attributed to a single parameter. Rather, as this article shows, they are the result of a number of important factors, especially in the esthetic zone. An understanding of the meaning of biologic width, of the integration of the platform-switching concept into implant treatment facilitates the preservation of a stable marginal bone level around the implant neck. This stable bone then serves to support the soft tissue, determining the long-term esthetic and functional treatment outcomes stability. The following points should be noted: (1) A prefabricated post that can be used both as a temporary post and as the definitive abutment helps to avoid a frequent replacement of secondary components, provided that the 3-dimensional position of the implant is correct. It prevents a repeated destruction of the connective-tissue attachment on the biologic width, which would carry with it the risk of bone resorption. (2) A special implant and abutment design (a ledge and integration of the biologic width/tapered shape of the post) facilitates nonsurgical lengthening and thickening of the periimplant soft tissue. This leads to the establishment of a wider and more resistant zone of connective tissue. (3) A microrough and nanorough titanium surface extending to the implant shoulder in conjunction with the platform-switching concept provides osseous integration along the entire length of the implant. A fine thread optimally distributes the masticatory forces in the region of the implant neck, avoiding further bone loss in this region.

Comparison of surgical and non-surgical methods of treating palatally impacted canines. II - Aesthetic outcomes

Abstract Background Palatally impacted maxillary canines may appear unsightly after treatment because of changes in position and colour. Aim To determine if palatally impacted canines treated either by surgical exposure and orthodontic repositioning or by creation of space in the arch and unassisted eruption have different aesthetic outcomes. Methods Twenty eight subjects with unilateral palatally impacted canines who had completed orthodontic treatment at least 6 months previously were recruited from three specialist practices. In 14 subjects the canines had been treated by surgical exposure, orthodontic extrusion and repositioning in the arch (SE group) and in the remainder the deciduous canines were extracted and excess space created in the arch for the canines to erupt naturally (OT group). The contralateral canines were used as controls. The mean pretreatment ages of the subjects in the SE and OT groups were 13.5 (SD: 1.6) years and 13.5 (SD: 1.3) years respectively. The position and colour of the canines were assessed on post-treatment study models and 35 mm slides using the American Board of Orthodontics Objective Grading System (ABO OGS) and subjective appraisal by two orthodontists. Each subject used a semantic scale to rate the aesthetic outcome of treatment. Results Sixty four per cent of the treated canines in the SE group were significantly more ‘intruded’ than the treated canines in the OT group (p = 0.004) and the control canines (p = 0.004). The ABO OGS grades of the canines in the SE and OT groups were similar (p = 0.173). While the assessors detected a lack of labial root torque and gingival margin changes in the canines in the SE group, the subjects in both groups were satisfied with the appearance of the canines post-treatment. Conclusions Palatally impacted canines treated by surgical exposure, extrusion and orthodontic treatment were more likely to be displaced vertically (‘intruded’) after treatment than palatally impacted canines treated by extraction of the overlying deciduous canines and creation of excess space in the arch. Small occlusal and aesthetic changes detected by the orthodontists, but not the ABO OGS, did not appear to detract from the satisfaction of the subjects with the results of orthodontic treatment.

Objective assessment of aesthetic outcomes of breast cancer treatment: Measuring ptosis from clinical photographs

The aesthetic outcome of breast cancer treatment is an important factor in breast cancer survivors’ quality of life. We investigated new quantitative, objective measurements of breast ptosis based on ratios of distances between fiducial points manually identified in oblique and lateral clinical photographs. Ptosis refers to the extent to which the nipple is lower than the inframammary fold. The new objective measures were compared to ratings made using an existing subjective scale. The variability in the objective measurements due to intra- and inter-observer variability in marking fiducial points was shown to be equivalent to less than one point on the subjective ptosis scale.

Periodontal regeneration in gingival recession defects.

Surgical treatment of gingival recession defects aims at obtaining soft tissue coverage of exposed root surfaces and/or augmentation of gingival tissue dimensions. A variety of protocols have been developed to manage these clinical problems. Since one goal of periodontal therapy is the regeneration of the lost attachment apparatus of the tooth, full restoration of defect should be accomplished following mucogingival procedures. This implies regeneration of all periodontal structures, including formation of new cementum with inserting connective tissue fibers, alveolar bone regeneration and recreation of a functional and aesthetic morphology of the mucogingival complex. Animal and human histological studies have shown that healing at gingiva-root interface following pedicle flaps or free soft tissue grafts generally includes a long junctional epithelium with varying amounts of a new connective tissue attachment in the most apical aspect of the covered root surface. Limited bone regeneration has been observed. Adjunctive use of root conditioning agents and cell excluding, wound-stabilizing devices may amplify regenerative outcomes. Changes in the amount of keratinized tissue, which can significantly affect the aesthetic outcome of treatment, have been shown to depend on the interactions among various tissues involved in the healing process and the selected surgical procedure.