Esthetic Score Research Articles

Horizontal platelet-rich fibrin versus advanced platelet-rich fibrin plus in gingival recession management.

Newer generation platelet concentrates, such as advanced platelet-rich fibrin plus (A-PRF+) obtained following low-speed centrifugation concept and horizontal platelet-rich fibrin (H-PRF) obtained from swing out and bucket system, showed increased platelet entrapment and growth factor release in the in-vitro studies. This prospective study aimed to evaluate and compare the clinical outcomes of A-PRF+ and H-PRF membranes in the treatment of gingival recession defects. The objectives of this study were to compare the changes in the recession height (RH) and the mean root coverage percentage (MRC%) between and within the research groups. Forty-four systemically healthy patients diagnosed with 84 Cairo's RT 1 and RT 2 gingival recession defects in the maxillary anterior and premolars were randomly treated with a combination of the coronally advanced flap (CAF) and A-PRF+ membrane (n = 22 subjects) or H-PRF membrane (n = 22 subjects). Patients were reviewed at 3 and 6 months postoperatively. Parameters including RH, MRC%, complete root coverage (CRC), gingival thickness, keratinized tissue height, and root coverage esthetic scores were documented. Both treatments resulted in a significant reduction in RH (p <0.001). The CAF + A-PRF+ group demonstrated a reduction in RH from 2.47 ±1.00mm to 0.59 ±0.52mm and the MRC% was 76.33 ±22.54%, at 6 months. In the CAF+H-PRF group, the mean RH decreased from 2.43 ±1.01mm to 0.38 ±0.59mm and the MRC% was 85.51 ±19.87%. Three- and six-month intergroup analysis revealed statistically insignificant differences in the observed clinical parameters between the groups (p >0.05). The study found that both CAF + H-PRF and CAF + A-PRF+ protocols resulted in similar clinical outcomes while treating maxillary gingival recession defects. Numerous modifications have been proposed to improve the growth factor content in the platelet concentrates and thereby therapeutic potential. This study compared platelet-derived membranes obtained by two different spin protocols in the treatment of gum recession. Forty-four patients were treated with either platelet-derived membrane obtained by horizontal spin protocol (test group) or low-speed spin concept (control group). Both treatment methods resulted in satisfactory healing. At the end of 6 months, no differences were noted with regard to the changes in clinical measurements and root coverage percentage indicating similar clinical efficacy of both preparatory techniques.

Narrow Versus Standard Diameter Implants for Supporting Single Crown Restorations in the Posterior Jaw: A Randomised Controlled Trial.

The aim of this randomised controlled trial was to assess clinical, radiographic and patient reported outcomes of narrow versus standard diameter titanium zirconium (TiZr) implants supporting single crown restorations in posterior sites with limited bone width. Participants requiring replacement of single missing posterior teeth with implant-supported crowns were randomly allocated into 2 treatment groups: narrow (3.3 mm) or standard (4.1 mm) diameter implant. All implants were restored with screw-retained monolithic zirconia crowns. The changes in marginal bone level (MBL) were assessed at the time of delivery of definitive crown and after 1 year of function. Implant stability was measured at placement, 3 and 12 months. Implant success, pink esthetic score (PES), peri-implant parameters, and patient satisfaction were also evaluated. A total of 20 participants with 20 implant-supported single crowns completed the 1-year follow-up. All implants were successful. The narrow diameter implants had a higher bone remodeling of 0.39 ± 0.92 mm after 1 year of loading compared with only 0.10 ± 0.29 mm for the standard diameter implants but the difference was not statistically significant (P = .40). There were no statistically significant differences between the 2 implant groups in terms of PES and peri-implant outcomes. Narrow and standard-diameter TiZr implants supporting screw-retained monolithic zirconia crowns in the posterior region were reliable treatment modalities with comparable clinical, radiographic and patient reported outcomes after 1 year of function. Patient satisfaction was high in both treatment groups. The clinical performance of narrow-diameter implants was comparable to standard-diameter implants in replacing a single missing posterior tooth in 12 months. Narrow- and standard-diameter implants can maintain marginal bone levels in 12 months.

Comparison between Retromandibular Anteroparotid Approach, Retromandibular Transparotid Approach and High Subangulomandibular Approach for Mandibular Subcondylar Fracture Fixation: A Prospective Randomised Study

Background: Condylar fractures remain a subject of ongoing debate in the field of oral and maxillofacial surgery. The choice of surgical approach depends on various functional and aesthetic considerations. This original research article compares three surgical approaches—retromandibular anteroparotid approach, retromandibular transparotid approach and high subangulomandibular approach—by evaluating facial nerve injury, scar aesthetics, and sialocele formation. Materials and Methods: A prospective study was conducted at the Sanjay Gandhi Institute of Trauma and Orthopedics, Bangalore, involving 33 patients who were divided into three groups of 11 patients each. The outcomes assessed included facial nerve injury, scar aesthetics, and sialocele formation, with follow-up for 3 months. Data analysis was performed using the Chi-square test. Results: The comparison of facial nerve injury incidence between different time intervals in each group, analyzed using Cochran's Q test, revealed that 9.1% of patients in Group A (retromandibular anteroparotid approach), 36.4% in Group B (retromandibular transparotid approach), and 18.2% in Group C (high subangulomandibular approach) experienced facial nerve injury on Day 1. Group B showed a statistically significant result with a p-value of 0.02. Sialocele formation on Day 1 occurred in 27.3% of Group A, 45.5% of Group B, and none in Group C, with a statistically significant p-value of 0.04. The comparison of mean scar aesthetic scores showed 1.45 ± 0.52 for Group A, 2.36 ± 0.51 for Group B, and 2.45 ± 0.52 for Group C, with a statistically significant result (p = 0.001). Significant differences were found between Group A and Group B (p = 0.002) and Group A and Group C (p = 0.001). Conclusion: This study indicates that the retromandibular anteroparotid approach (Group A) had the least incidence of facial nerve injury and better scar aesthetics. The high subangulomandibular approach (Group C) showed the least incidence of sialocele formation, though it posed challenges in accessing the fracture site. Therefore, the high subangulomandibular approach is recommended for low subcondylar fractures rather than high subcondylar fractures.

Patient-reported outcomes of esthetics, function and oral hygiene with single dental implants 10-15 years after placement: a cross-sectional study.

Little attention has been paid to patients' perception of function and esthetics with single dental implants. The aim of this study was therefore to describe patient-reported function and esthetic outcomes in single dental implants. A second aim was to study the objective esthetics in single dental implants. Patients with one single dental implant in the esthetic zone were selected. Two questionnaires with visual analog scales (VAS) were filled in by the patients, and intraoral photographs were taken. One of the questionnaires related to satisfaction with cleaning and function, and the other involved the esthetics of the single dental implant. One dentist reviewed the photographs using the pink esthetic score/white esthetic score (PES/WES) index. Results: For chewing and for speaking, the scores were 8.8 and 9.9 respectively on a VAS (best 10). The overall esthetic score on a VAS was 8.6 (best 10). The PES/WES in the present study was 14.6 (standard deviation [SD] ± 1.9), and 3/45 (6.7%) of the single dental implants never reached clinical acceptability. Conclusions: Patients reported high satisfaction with both the function and the esthetics of single dental implants. Both subjectively and objectively, the peri-implant mucosa was less favorable compared with the crown.

Peri-implant soft tissue conditioning of immediate posterior implants by CAD-CAM socket sealing abutments: a randomized clinical trial

BackgroundAnatomically formed healing abutments were suggested in literature to address many of the issues associated with immediate posterior implant insertion such as large extraction sockets that are extremely hard to seal without reflecting the mucoperiosteal flap, extraction sockets anatomy that are not suitable for regular healing abutment placement, and potentially high occlusal stresses when planning a temporary implant supported prothesis to improve the conditioning of supra implant tissue architecture and the emergence profile of the implant supported restorations.PurposeTo clinically evaluate the peri-implant soft tissue profile of single posterior implant retained restorations and to assess patient related outcomes of the implant restorations that were conditioned immediately by CAD-CAM socket sealing abutments (SSA) versus those conditioned by Titanium (Ti) standard healing abutments (SHA).MethodsTwenty participants received twenty-two single maxillary immediate implants after flapless minimally invasive tooth extraction and 3D guided implant placement in the posterior area (premolar and molar) and allocated randomly into two groups (n = 11), the intervention group: patients received PEEK SSA and the control group: the patients received Ti SHA. Modified Pink Esthetic Score (PES) was evaluated at 3 observation periods: Baseline T0 (immediate after implant supported crown insertion), 6 months T1 and 1 year of clinical performance T2. Patient satisfaction was assessed one week and one year after crown insertion using visual analogue scale (VAS).ResultsAt base line, after six as well as 12 months, SSA group showed statistically significant higher total modified PES scores than SHA group (P-value < 0.001). At the 2 clinical observation periods (baseline and after one year), SSA group showed statistically significantly higher overall satisfaction score than SHA group (P-value < 0.001).ConclusionAfter one year of clinical observation period, CAD-CAM PEEK socket sealing abutments together with flapless minimally invasive tooth extraction and 3D guided implant placement provided superior outcomes compared to Ti SHA in terms of peri-implant soft tissue profile.Trial registrationThis study was registered on clinicaltrials.gov with ID no. NCT05276765 on 03/03/2022.

Impact of gingival pigmentation on laypersons’ perception of smile aesthetics: an observational study

Aim: The study aims to assess laypersons’ perceptions of smile aesthetics before and after gingival depigmentation and to correlate these perceptions with the degree of gingival pigmentation. Methods: The retrospective observational study examined individuals who received gingival depigmentation following orthodontic treatment between 2019 and 2024. Fifteen records were selected based on the inclusion and exclusion criteria. The pre- and post-depigmentation frontal smile photos were standardized, included into a Google Form, and distributed to 40 laypeople for the assessment of smile aesthetics. The laypeople evaluated the attractiveness of smiles using a 10-point Likert scale. Experienced periodontists classified the gingival pigmentation utilizing the oral pigmentation index (OPI). The differences between the pre- and post-treatment OPI scores and smile esthetic scores were assessed using Wilcoxon signed-rank test. Spearman correlation was used to evaluate the association between smile scores and OPI scores. The intraclass correlation coefficient (ICC) was employed to evaluate the inter-rater reliability of the smile ratings and OPI scores. The statistical significance was established at p ≤ 0.05. Results: The average OPI scores before depigmentation were 2.67 ± 0.49; however, following depigmentation, the scores significantly declined to an average of 0.33 ± 0.5 (p &lt; 0.001). The mean smile aesthetic score pre-depigmentation was 6.72 ± 0.32, whereas after depigmentation the scores significantly improved to 7.91 ± 0.18 (p = 0.001). Spearman correlation indicated a statistically significant negative association between smile aesthetics scores and OPI scores (r = –0.76). ICC indicated excellent inter-rater reliability for the OPI (0.923) and good reliability for smile esthetic scores (0.756). Conclusions: The study found that gingival de-pigmentation procedures improve the OPI scores and laypeople perceive gingival hyperpigmentation unattractive. While gingival depigmentation is not mandatory, it may be recommended for individuals seeking cosmetic smile enhancements post-orthodontic therapy to improve the overall patient satisfaction.

Evaluation of sticky bone in guided bone regeneration in the aesthetic area of the anterior teeth: a retrospective study.

The retrospective study aimed to compare the space-maintaining effects of sticky bone (bone graft matrix enriched with injectable platelet-rich fibrin) and titanium mesh for bone augmentation in the aesthetic zone. Patients who underwent single implant placement and had type 2/4 alveolar bone defects (buccal bone wall loss is >50% of the expected implant length) were screened for inclusion in this study. The labial bone plate width was measured at 1, 3, and 5 mm below the apical implant platform on cone beam computed tomography images taken immediately and 6 months after surgery. Mimics and 3-matic software were used to measure the volume changes in the labial bone at 6 months post-surgery. Forty patients were included. There was no significant difference in the change in labial bone width between the groups at 1 mm (P = 0.22), 3 mm (P = 0.71), or 5 mm (P = 0.53). There was no significant difference in the change in labial bone volume (P = 0.70) or aesthetic scores (P = 0.27) between the groups. Sticky bone showed comparable space-maintaining effects as titanium mesh in bone augmentation for single-tooth implantation in type 2/4 bone defects in the anterior maxillary aesthetic area.

Reproducibility and Reliability of Intraoral Scanners for Evaluating Peri-Implant Tissues and Implant-Supported Prostheses: A Cross-Sectional Study.

To assess the reproducibility and reliability of the pink (PES) and white esthetic scores (WES) using digital images and the intra- and inter-examiner agreement among different clinical backgrounds and assessment methods. Standardized intraoral images were obtained from adult subjects with an implant-supported single-tooth fixed dental prosthesis located in the maxillary esthetic zone using a digital camera and a true-color intraoral scanner. According to the PES and WES criteria, the images were evaluated by 20 calibrated evaluators, 5 prosthodontists, 5 periodontists, 5 undergraduates, and 5 oral surgeons. The total number of individual PES and WES was 12600 and 9000, respectively. Similar PES and WES values were obtained with the intraoral scanner compared to the digital camera. Intra- and inter-rater variations were observed between and within evaluators' clinical backgrounds, with periodontists showing consistently lower mean PES and WES. The intraclass correlation coefficient ranges between 0.41 to 0.61 for the PES and 0.42 to 0.69 for the WES, resulting in fair to good agreement in both digital methods. The digital assessment of the peri-implant tissues and implant-supported prostheses utilizing images provided by an intraoral scanner offers a reproducible and reliable digital method comparable with the digital camera. This study highlights the reliability and reproducibility of using intraoral scanners for evaluating peri-implant tissues and implant-supported prostheses. The findings suggest that intraoral scanners are a viable digital alternative to traditional digital imaging for these assessments. However, the observed intra- and inter-rater variations in pink and white esthetic scores, according to the clinical background of evaluators, emphasize the need for caution when interpreting these values in clinical decision-making and research.

Esthetic and Colorimetric Assessment of Peri-implant Soft Tissue Augmented with the Strip Gingival Graft Harvested Either from the Buccal Soft Tissue or the Palate: A Retrospective Study.

It is well known that keratinized mucosa (KM) plays a crucial role for maintaining peri implant health and esthetic outcomes. The Strip Gingival Graft (SGG) technique, which involved an apically positioned flap (APF), in combination with an autogenous SGG and a xenogeneic collagen matrix (XCM), demonstrated its efficacy in re-establishing an adequate amount of KM width at implant sites. Nevertheless, it is still unclear whether harvesting the SGG from the palate (pSGG) or from the buccal aspect of natural dentition (bSGG) affects the esthetic outcomes at the augmented implant sites. Therefore, the objective of the present study was to compare the esthetic outcomes of dental implants augmented with either bSGG &#43; XCM or pSGG &#43; XCM. The present study was designed as a single-center retrospective study, assessing the esthetic and colorimetric outcomes of peri-implant KM augmentation with either pSGG &#43; XCM or bSGG &#43; XCM in cohort of 49 subjects. The two groups were compared in terms of colorimetric outcomes, assessed on clinical photograph using specific software able to identify and quantify the predominant color within the peri implant soft tissue. Colorimetric comparisons with adjacent untreated sites were also investigated. In addition, the Pink Esthetic Score (PES) and the Subjective Esthetic Score (SEE) were performed to further assess the esthetic outcomes of pSGG &#43; XCM and bSGG &#43; XCM. The colorimetric analysis did not show statistically significant differences among sites augmented with pSGG &#43; XCM, sites augmented with bSGG &#43; XCM, and untreated sites. Implants treated with bSGG &#43; XCM showed significantly greater PES (in terms of shape of the mesial and distal papilla, level of the soft tissue margin, soft tissue contour, anatomy of the alveolar process, and final PES) and SEE compared to implants augmented with pSGG &#43; XCM. The present study demonstrated that implant sites augmented with APF with either pSGG &#43; XCM or bSGG &#43; XCM did not show different colorimetric outcomes compared to adjacent untreated sites, while bSGG &#43; XCM obtained superior professional and subjective esthetic scores compared to pSGG &#43; XCM.

Additively Manufactured Subperiosteal Implants for the Rehabilitations of Lateral Incisors Agenesis - a case series.

Tooth agenesis, particularly the absence of upper lateral incisors, presents substantial challenges for clinicians due to the associated bone atrophy, which limits the use of traditional implant solutions. Current options, such as endosseous implants combined with guided bone regeneration (GBR), often fail due to insufficient osseointegration in atrophic bone. This study aims to evaluate the effectiveness of custom-made, additively manufactured subperiosteal implants in addressing these challenges METHODS: This retrospective study assessed 16 custom-made subperiosteal implants used in 12 patients (10 females, 2 males; mean age 25 ± 2.3 years) with lateral incisor agenesis who had previously experienced early implant failure with conventional endosseous implants. The protocol included subperiosteal implants combined with bovine bone grafts and PRF membranes, allowing for immediate loading and correct prosthetic alignment. Clinical evaluations focused on implant stability, peri-implant tissue health and esthetic (including probing depths and bleeding on probing), and prosthetic success over time. During a follow-up period of 18 to 64 months (mean 48 ± 6.7 months), all patients maintained stable implants, with no implant failures reported. Biological outcomes demonstrated stable peri-implant health, with probing depths averaging 3 mm and minimal signs of inflammation. The mean pink esthetic score was 12.3 ± 1.1 (range: 10 to 14). Prosthetic complications were limited to minor adjustments, with two cases requiring recementing of crowns after three years. The results indicate that this new protocol provides a reliable, single-procedure solution for the rehabilitation of lateral incisor agenesis in patients with significant bone atrophy, achieving a 100% success rate in this study. Despite promising outcomes, the study is limited by a small sample size and the need for longer follow-up to assess durability. This approach offers a viable alternative for patients where traditional implants are not feasible due to bone deficiencies.

Different Esthetic Assessment of Anterior Restorations by Patient and Expert: A Prospective Clinical Study.

Esthetically pleasing, bright teeth and a symmetrical dental arch are of great importance. There are only a few scientific studies that compare the evaluation of anterior restorations by experts and patients. Additionally, there are hardly any studies that deal with the weighting of esthetic parameters. The current study was performed to test the hypothesis that patients and experts evaluate anterior restorations differently and place their emphasis differently. Therefore, aim of this prospective study was to compare the evaluation of the red and white esthetics of anterior restorations by patients and an expert and to find out which parameters play an important role in the evaluation of the esthetic appearance of anterior restorations. Anterior restorations of 21 patients were analyzed. All patients evaluated their own restorations using a questionnaire of ten defined parameters (pink esthetic score, PES and the white esthetic score, WES). Additionally, the questionnaire was used to determine how important the individual parameters are for them in relation to the assessment of the esthetic result. An expert also gave her assessment and weighting for all 21 patients. The statistical analysis of the questionnaires shows that the expert assigned lower values, particularly in the evaluation of the PES. The expert weighted individual parameters of the PES to be more important than the patients. The type of abutment of the restoration (tooth or implant) had no influence on the evaluation of the restorations. The study shows that patients and experts have different assessments of the esthetics and the weighting of the various parameters. Nevertheless, patients are sensitive to esthetic deviations and patient preferences should be taken into account in anterior restorations.

Evaluation of Nasolabial Aesthetics and Self-Image Satisfaction among 16- to 20-Year-Old Patients with Cleft Lip and Palate in Northeast Thailand

Abstract Background Cleft lip and palate (CLP) impact nasolabial appearance, influencing the physical, psychological, and quality of life (QoL) of affected individuals. Evaluations of the nasolabial aesthetics by patients and medical professionals (both experienced and inexperienced) are critical for enhancing patient care. Methods This cross-sectional study enrolled 32 patients aged 16 to 20 years with CLP who underwent continuous treatment at a university hospital in Thailand. Participants were asked to complete the Thaicleft QoL questionnaire for nasolabial aesthetic self-assessment and had their two-dimensional facial images captured and then evaluated by two groups of medical evaluators: four experienced and four inexperienced professionals. Data are presented as means and percentages, with analysis including standard deviations, Cronbach's α for evaluator consistency, kappa for interrater reliability, and the Wilcoxon signed-rank test to compare aesthetic judgments between the experienced and inexperienced medical evaluators. Results Among the 32 patients, 19 (59.37%) were females, and 22 (68.75%) had unilateral CLP and 10 (31.25%) had bilateral CLP, all reporting high nasolabial aesthetic satisfaction. Inexperienced evaluators assigned higher aesthetic scores than their experienced counterparts (p = 0.01), with statistically significant agreement among inexperienced evaluators in their assessments (p &lt; 0.05). Both group of evaluators demonstrated high reliability in terms of the lip. Conclusion Experienced evaluators assigned lower aesthetic scores than inexperienced evaluators did. The patients themselves expressed high levels of satisfaction with their nasolabial appearance, indicating that the treatment outcomes were favorable from the patients' perspective.

Oncoplastic breast reconstruction with single-port laparoscopically harvested omental flap: insights from a ten-year tertiary center experience.

To evaluate the 10-year functional and oncological outcomes of single-port laparoscopically harvested omental flap (SLOF) for immediate breast reconstruction after breast cancer surgery. The technical feasibility and oncologic safety of breast reconstruction using a laparoscopically harvested omental flap remain controversial. We examined 236 patients with breast cancer (including 2 patients with malignant phyllodes tumors) who underwent nipple-sparing mastectomy or breast-conserving surgery followed by immediate SLOF reconstruction between February 2015 and March 2024 at our institution. Short- and long-term outcomes were assessed. Cosmetic outcomes were evaluated using a three-panel assessment and the Seoul Breast Esthetic Scoring Tool and compared with those of a matched cohort of patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction. The rate of clinically significant complications of Clavien-Dindo grade IIIa or greater was 3.8% (9/236). Two patients with flap failure required flap removal and conversion to other reconstruction procedures. The cosmetic satisfaction rates were 82.5% and 76.4% in the SLOF and DIEP groups, respectively (P = 0.467). Over a median 59-month follow-up, the local, regional, and systemic recurrence rates were 3%, 2.1%, and 3%, respectively. All patients underwent annual screening for gastric cancer via esophagogastroduodenoscopy, and there were no cases of delayed flap removal due to gastrectomy. Oncoplastic breast reconstruction using SLOF is safe and feasible. The natural contour and texture of the reconstructed breast and the nearly invisible scar at the abdominal single-port incision provide excellent cosmetic outcomes that are superior to those of other reconstruction methods.

Impact of labially inclined implant axes on immediate implant placement and provisionalization in anterior maxilla: A prospective cohort study.

To investigate whether a labially inclined implant axis compromises the clinical outcomes of immediate implant placement and provisionalization (IIPP) in the anterior maxilla. Patients with unsalvageable central or lateral maxillary incisors were enrolled. IIPP with simultaneous connective tissue graft (CTG) was performed in all participants. In the control group, the alveolar ridge had a long axis aligned with the tooth, which ensured that the immediate implant was aimed at the incisor edge or the cingulum of future restoration. The test group had a large angle between the axes of the ridge and tooth. To avoid bone fenestration, the implants were placed labially inclined and emerged from the labial side of future restoration. Intra-oral scanning and cone-beam computed tomography were performed to record soft and hard tissue profiles at baseline and 1 year later. Soft tissue stability, bone remodeling, and pink esthetic score (PES) were evaluated and compared between two groups. Thirty-nine participants (19 tests and 20 controls) completed the study. At 1-year post-surgery, the mid-facial gingival margin migrations were 0.85 ± 0.37 mm (test) and 0.81 ± 0.33 mm (control), without significant differences. No differences were identified in buccal profile alteration, linear ridge reduction, buccal bone thickness, or PES scores. The test group demonstrated thinner buccal soft tissue at the crestal level than the control group. When large tooth-ridge angulation presented, labially inclined implant, avoiding buccal ridge fenestration in IIPP with CTG, did not compromise the clinical outcome in short term.

Endoscopic-Assisted Latissimus Dorsi Muscle Flap for Chest Wall Reconstruction in Poland Syndrome: Clinical Application and Literature Review.

Poland syndrome is a rare congenital chest wall developmental defect. Traditional reconstruction applies open to harvest of the latissimus dorsi muscle flap, but issues like large incisions and high complication rates exist. Endoscopic-assisted harvest of the latissimus dorsi muscle flap has minimally invasive advantages worth exploring for application in Poland syndrome patients. We retrospectively analyzed the surgical situations of five Poland syndrome patients at our center, and systematically searched the literature, including 31 cases of endoscopic-assisted latissimus dorsi muscle flap reconstruction. Data on surgical complications, postoperative shoulder function scores, aesthetic scores, and patient satisfaction were collected and comprehensively analyzed in combination with literature reports. Endoscopic surgery had smaller incisions, fewer complications, shorter recovery time, and high patient scar satisfaction. Postoperative aesthetic results were good, but the obtained flap tissue volume was limited. Upper limb function at the donor site was preserved, but there was some degree of strength decline. Endoscopic-assisted latissimus dorsi flap surgery (ELDM) allows for clear visualization of the surgical field, reduces complications, minimizes scarring, shortens recovery time, and provides better cosmetic results, making it suitable for young Poland syndrome patients seeking improved aesthetic outcomes. 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 .

Research on optimization method of landscape design based on computer algorithms

Traditional landscape design primarily depends on the experience and subjective judgment of designers, lacking systematic and scientific algorithmic support, making it difficult to find the optimal solution in large-scale and complex scenes. This article proposes an interactive genetic algorithm for landscape design, which searches for the optimal solution in large-scale design spaces and improves design efficiency. Collect a large amount of landscape-related data, preprocess it, and ensure its quality, and ensure the quality of the data. Introduce elements such as plants, water bodies, and hard structures to initially design the space, extract features from landscape design images, and perform 3D reconstruction to obtain richer design space information. Generate initial design schemes using genetic algorithms and introduce subjective opinions from designers through interactive processes. The experimental results show that the average aesthetic score of interactive genetic algorithm for landscape design optimization is 9.0, and the average design time of interactive genetic algorithm is 34.5 days. Introducing the subjective opinions of designers into landscape design optimization based on heritage algorithms can effectively improve design aesthetics and shorten the total design time.

Internally Submerged, Tapered, Bone-level Dental Implants in the Anterior Esthetic Region.

Aesthetics is a crucial consideration in the anterior region, alongside dental implant survival and marginal bone loss (MBL). Bone-level implants are advantageous in the esthetic zone as they create a natural emergence profile with the use of customized abutments. This study aimed to assess the esthetic outcomes of internally submerged, tapered, bone-level dental implants and to evaluate associated alveolar bone changes. Patients received Luna implants (Shinhung, Seoul, Korea) from 2012 to 2020. MBL was measured immediately after surgery and at 3-month, 6-month, and 1-year follow-ups. Pink and White Esthetic Scores (PES/WES) were evaluated after final restoration and at 6-month and 12-month follow-ups using standardized photographs. Seventy-eight patients (37 males, 41 females) with a mean age of 73.42 years met the study's inclusion criteria. At the 1-year follow-up, the mean MBL was 0.39 ± 0.74mm on the mesial aspect and -0.09 ± 0.97mm on the distal aspect. A statistically significant difference in MBL on the mesial aspect was observed between immediate functional loading and the 12-month follow-up (P = 0.029). All implants achieved PES/WES scores of 6 or higher, meeting the threshold for clinical acceptance. Within the study's limitations, Luna implants demonstrated satisfactory esthetic outcomes and stable bone levels. The results support their use as a viable option for implant placement in the anterior esthetic zone, ensuring both aesthetic and functional success.

Surgical treatment of hypospadias with lichen sclerosus: Long‐term outcomes from a single center

AbstractBackgroundHypospadias with lichen sclerosus (LS) poses surgical challenges due to lack of materials for urethral reconstruction and coverage and the limited number of reports on this clinical condition.ObjectivesTo report surgical strategies and outcomes for primary and redo hypospadias patients with LS.Materials and methodsWe conducted a retrospective observational descriptive study with 31 patients with primary/redo hypospadias and LS between 2013 and 2023. Of these patients, 9 had primary hypospadias with 7 distal types and 2 proximal types, and 22 were redo patients. Nineteen of the 31 patients underwent various surgical techniques, and 12 underwent the oral mucosa onlay procedure (OMOP). Postoperative uroflowmetry, hypospadias objective scoring evaluation (HOSE), and complications were evaluated.ResultsFor primary distal hypospadias with LS‐affected skin, five patients underwent circumcision; these patients had normal postoperative urinary flow, and only one patient had an inconspicuous penis after surgery. For the patients with primary proximal hypospadias with an LS‐affected urethra, one patient required perineal urethrostomy following a modified Koyanagi procedure for recurrent stricture; the other patient underwent two‐stage transverse preputial island flap urethroplasty with no postoperative lower urinary tract symptoms (LUTS) and satisfactory aesthetic scores. In two remaining cases of primary distal hypospadias with meatus/urethral LS, no LUTS or postoperative complications occurred following meatoplasty/circumcision and penile basal fixation. During reoperations, compared with those of patients who underwent other redo procedures, twelve patients who underwent OMOP had better Qmax and uroflowmetry (p = 0.002) and higher HOSE scores (p = 0.01).ConclusionsFor primary hypospadias patients with LS, enhanced exposure of the penile shaft and glans may benefit distal hypospadias, whereas staged surgery may be suitable for proximal hypospadias. The oral mucosa is favored for urethral augmentation in patients with redo hypospadias complicated with LS, and the OMOP can address neourethra coverage effectively.

A Cartilage-Saving Technique for Tragus and Antitragus Fabrication in Auricular Reconstruction.

Background: For auricular reconstruction surgery using autologous costal cartilage, younger patients typically have a limited amount of costal cartilage available. Objective: We introduce a cartilage-saving technique for fabricating the tragus and antitragus, and evaluate its effectiveness based on aesthetic score and complications. Methods: For tragus fabrication, the residual part of the seventh costal cartilage was reoriented by 90° to increase its height and carved into a seagull-shaped structure. The antitragus was constructed by bending the antihelix and stabilizing it on the broadened base frame. Postoperative aesthetic outcomes and complications were documented and analyzed. Results: This study included a total of 658 patients with lobule-type microtia, of whom 356 (54.1%) were male and 302 (45.9%) were female. The average age was 6.5 ± 0.7 years, and the average follow-up period was 13.6 ± 3.5 months. The average aesthetic outcome score was 9.0 ± 0.7. Wound dehiscence at the tragus was seen in four patients, while circulation disturbance at the incisura intertragica area was noted in six patients. Conclusions: This cartilage-sparing technique demonstrated effectiveness in shaping aesthetic tragus and antitragus.

Comparing Medium to Long-Term Esthetic, Clinical, and Patient-Reported Outcomes Between Freehand and Computer-Assisted Dental Implant Placement: A Cross-Sectional Study.

The aim of the study was to compare medium to long-term clinical and patient-reported outcomes between implants placed with computer-assisted implant surgery (CAIS) and freehand protocols. Thirty dental implants in the anterior maxillary region with an average of 4 years after loading were assessed by means of Pink Esthetic Scores (PESs), marginal bone level (MBL), and clinical and patient-reported outcomes. CAIS significantly outperformed freehand placement with regard to PES scores (p = 0.011). Likewise, implants placed with CAIS showed significantly higher MBLs (p < 0.001). Bleeding on probing, probing depth, and prevalence of mucositis did not differ between the groups, while no peri-implantitis was diagnosed. The use of CAIS leads to superior outcomes in terms of esthetics and MBLs for implants placed in the esthetic zone as observed in medium to long-term follow-up. No difference was however observed with regard to peri-implant mucosa inflammation. This article highlights the outcome of computer-assisted implant surgery in achieving higher esthetic, MBL, and esthetic satisfaction compared to freehand implant placement. TCTR20240422015.