Final Aesthetic Result Research Articles

Resolución de irregularidades de color con un sistema restaurador bulk-fill bioactivo: Reporte de caso y seguimiento de 24 meses.

Bulk-fill resin composites represent an excellent alternative to the conventional incremental layering technique for the reduction of polymerization stress on the adhesive interface. Marginal seal can be further improved by the incorporation of bioactive fillers, such as those encountered in Giomers. However, the high translucency required for the adequate polymerization of bulk-fill materials can seriously jeopardize the final aesthetic outcome of the restorations, especially in the presence of inhomogeneous or stained dentin substrates. The aim of this case report was to present the combined use of two bulk-fill Giomer materials (Beautifil Bulk Flowable and Beautifil II LS, Shofu) for the restoration of three posterior maxillary teeth displaying a black stained dentin substrate due to amalgam corrosion products. This technique allowed completion of the restorations with a satisfactory aesthetic and biomimetic outcome. The adequate preservation of the anatomy and function of the three restorations after 24-months follow-up, provides evidence of the enhanced marginal sealing capacity of these bioactive materials and the success of bulk-fill techniques over time.

117 Poster - Angiosome theory findings using new protocol of CT-angiography improves outcomes in DIEP-flap reconstruction surgery in breast cancer patients

Introduction: Autologous breast reconstruction with deep inferior epigastric artery perforator flap considered as a gold standard of final esthetic result. More and more centers are trying to perform DIEP flap reconstruction, but still there are some problems appears. What method to use? What perforants to choose? Is there a «Plan B»?. Nowadays, the best method of preoperative preparation is CT-angiography. Only this method, among others, improves of outcomes of DIEP-flap surgery: lower complication rate, lower donor side morbidity, reduce operation time, improves overall results.

Determinants of surgeon choice in cases of suspected implant rupture following mastectomy or aesthetic breast surgery: Clinical implications.

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before.

Surgical approach to the management of field cancerization: Own experience.

The term field cancerization was proposed by Slaughter in 1953 to describe multifocal neoplastic lesions in the oral mucosa. Currently, it is well known that field cancerization can occur also in the skin. There is no one, universal and generally accepted management for the patients with multiple actinic keratosis and field cancerization. We presented two cases with large field cancerization on the face and the scalp. In both patients, we performed one stage surgery with split thickness skin graft with good final esthetic and functional result. Available literature on the role of classical surgical removal in treating field cancerization is very limited. We believe that surgery can be consider as an option for the treatment in some high risk patients with very large field cancerization, but further observation and evaluation of this method is needed.

Advanced esthetic laser procedures in orthodontic practice

The use of a soft tissue laser will not only improve the quality and speed of orthodontic treatment, it can dramatically enhance final esthetic results. To optimize the speed of treatment, esthetic considerations should be considered as part of the initial diagnosis. Using a laser allows cleaner finish lines and reduces damage to the gingival crests, with faster healing and less discomfort when compared to more conventional techniques. Even when dealing with complex altered passive eruption cases, soft-tissue laser procedures can provide significant benefits to patients.

Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle

The reverse homodigital dorsoradial flap remains a useful alternative for covering thumb defects. However, the description of pedicle width of dorsoradial flap is not clear. The aim of this study was to compare the results of narrow pedicle with wide pedicle in dorsoradial flaps and describe our experience with the thumb reconstruction. From July 2014 to February 2019, 42 patients were treated with the reverse dorsoradial flap for thumb reconstruction. The patients were divided as Group A (pedicle width ≤ 0.8cm) and Group B (pedicle width > 0.8cm). Flap survival, time to return to work, flap sensibility, the range of motion (ROM) of the joints, and final aesthetic outcomes were evaluated. Respectively in the Group A (17 cases) and Group B (25 cases), 14-19 flaps survived uneventfully, whereas 3-6 flaps experienced venous congestion with no or partial flap loss. No significant difference was identified between the two groups for the incidence of venous congestion, static 2-point discrimination and ROM of the injured thumbs. Time to return to work was significantly shorter in Group A. The aesthetic satisfaction of the patients in Group A was significantly better comparing with that in Group B. The reverse homodigital dorsoradial flap with narrow pedicle width is associated with more favorable outcomes in terms of time lost from work and aesthetic satisfaction of the patients.

Auricular avulsion injuries and reattachment techniques: A systematic review.

Objective(s)Multiple surgical techniques exist in the acute management of auricular avulsion injuries, including reattachment of the tissue as a composite graft, reconstruction using local skin flaps, the pocket principle, the Baudet method, and microvascular repair. This review aimed to compare the success rates of reattachment methods in auricular avulsion injuries.MethodsA PubMed search systematically identified cases in which (a) an auricular avulsion injury occurred and (b) reattachment was attempted. Search results were combined with an extensive review of references from published studies. In total, 148 cases were identified. Three reviewers independently graded the final aesthetic result of each case using a 5‐point scale. The average grade of each repair was compared to the reattachment method to identify successful techniques.ResultsMicrovascular repair was associated with a statistically significant higher success rate compared to all other reattachment methods. Composite graft reattachment also tended to generate better final aesthetic outcomes, but this difference was not statistically significant.ConclusionMicrovascular repair of the avulsed segment consistently demonstrated higher success rates. Composite graft reattachment should also be considered under the right circumstances. Overall, microvascular repair and composite graft reattachment should be considered the best options in cases of auricular avulsion repair. The authors share a major concern that other methods that rely on the use of periauricular skin will compromise any future attempts for secondary reconstruction, such as staged procedures using costal cartilage grafts. Manipulation of these tissues and in particular burying of the avulsed ear cartilage is discouraged.Level of Evidence4

Comparative Study between Complications of Abdominoplasty after Weight Loss by Bariatric Surgeries versus Weight Loss by Non Surgical Methods

Abstract Background The abdomen plays a leading role in the aesthetic image of the human body, and is of prime importance in defining the overall contour of the individual. The abdomen is cited as the location with the most severe deformities after weight loss and the deformities are highly variable. Objectives The aim of this study is to compare between complications of abdominoplasty after weight loss by bariatric surgeries versus weight loss by non surgical methods according to operative time, intraoperative complications: bleeding, postoperative complications: seroma, hematoma, infection, wound-healing problems, and skin flap necrosis and final aesthetic outcome. Patients and Methods This study includes forty patients with abdominal wall redundancy after bariatric surgeries and non surgical methods. All the patients will be examined as regards age, sex, weight, height, BMI, general examination, co-morbidities & associated ventral hernia. This study was conducted in 6 months between April 2017 and October 2017 on patients who were admitted to El Demerdash hospital or authorized medical institutions under supervision of thesis supervisors. Results In this study the mean age of the post bariatric group was 44 years and the non surgical group was 42.4 years. The mean BMI of the post bariatric group was 29.9, a little higher than the non surgical group which was 28. The Pre - loss BMI of the post bariatric group was higher than the non surgical group. The ideal lost weight, actual lost weight and percent of lost weight of the post bariatric group was higher than the non surgical group. The resection weight and the operative time of the post bariatric group were higher than the non surgical group. The amount of drain day1, total amount of drain l& drain removal day of the post bariatric group was higher than the non surgical group. Conclusion To conclude, abdominoplasty after weight loss by bariatric surgeries has higher risk of complications more than abdominoplasty after non surgical methods.

Orthodontic management of patients with congenitally missing permanent teeth

Dental agenesis is one of the most common developmental anomalies in humans. It occurs as part of a genetic syndrome or as an isolated sporadic or familial finding. Third molars, second mandibular premolars and maxillary lateral incisors are the most frequently targeted teeth of the permanent dentition. Clinically, patients with congenitally missing permanent teeth seeking treatment present with unesthetic diastemas, midline deviation and tilting of adjacent teeth in the edentulous areas. The impact of tooth agenesis reflects on esthetics, function, psychological and social well-being of the individuals affected. Orthodontics can contribute to the treatment plan selected by rearranging the present teeth so as to open spaces for prosthetic restorations or close spaces by reshaping teeth if needed. Following orthodontic space opening/maintaining, the usual alternatives involve single implants, two-(cantilever) or full coverage(cantilever) prostheses. Less frequently, the treatment modality of autotransplantation is proposed with a good esthetic result but feasible only in young patients where the roots of the premolars are still developing. In orthodontic space closure, treatment is accomplished sooner without waiting for the completion of growth of the patient. Depending on various factors such as the malocclusion, the dento-skeletal profile, the smile line, the space requirements, the teeth missing, the periodontal issues, the age of the patient and any financial issues, the clinician will determine the most appropriate treatment approach. The final esthetic and functional result should resemble an intact natural dentition.

Aesthetic Outcome of Implants in the Anterior Zone after Socket Preservation and Conventional Implant Placement: A Retrospective Study.

Alveolar ridge resorption occurs after tooth extraction and has the potential to either complicate implant placement or impair the final aesthetic result. Techniques to preserve natural bone and soft-tissue contours are beneficial to clinicians and patients because postextraction buccal plate resorption may have significant clinical effects, especially in the aesthetic zone. This study aims to evaluate the aesthetic outcome of implants in the anterior zone after socket preservation and conventional placement. Data were collected from a total of 86,000 patients who visited Saveetha Dental College between June 2019 and March 2020. The data of 105 patients in whom anterior implants were placed either after socket preservation or after extraction in this frame were retrieved. Pink aesthetic scoring (PES) and white aesthetic scoring (WES) were carried out, and the data obtained were tabulated in SPSS for Windows, version 20. Unpaired t-testing compared the two techniques, and Pearson chi square correlation detected potential associations with age and gender. It was found that PES and WES scores were significantly higher (p < 0.05) in implant prostheses placed after socket preservation compared to those placed after a healing period of 3 to 6 months after tooth extraction. Associations of aesthetic scores with age and gender were statistically insignificant. It was concluded that aesthetic outcomes of implants placed after socket preservation were better than those for implants conventionally placed.

Esthetic aspects in implant-prosthetic rehabilitation.

The esthetic component is critical for the successful outcome and patients’ satisfaction regarding the implant-prosthetic therapy. The esthetic outcome success depends mostly on the optimization of the algorithms specific to the pro-implant and implant stage as well as to the designing and technological execution of the future prosthetic restoration. A proper planning of optimal facial esthetics must involve a multidisciplinary approach with inclusion of periodontists, orthodontists, oral surgeons and implantology specialists. The dental practitioner must consider various factors that influence the esthetic outcome (tooth position, root position of the adjacent teeth, biotype of the periodontium, tooth shape, smile line, implant site anatomy, implant positioning). Also, some factors (anatomical limits of the implant site, periodontal status, occlusal parameters), which can alter the final esthetic result, must be assessed prior to planning the esthetic parameters of the future prosthetic restoration. The esthetic outcome can be improved by using new digital technologies based on software applications for assessment of clinical and biological indices of the prosthetic field, virtual planning of implants positioning and design projection of future prosthetic restoration.

Recognition of the Asymmetrical Smile: A Comparison of Orthodontists, Oral and Maxillofacial Surgeons, and Laypersons

Studies have shown that an asymmetrical smile is a relatively common problem. Yet, many patients are unaware of having this condition. Because having an asymmetrical smile can affect the final esthetic result of orthodontic therapy or orthognathic surgery, such patients need to be aware of the problem. The purpose of this study was to determine what amount of smile asymmetry is clinically evident to orthodontists, oral and maxillofacial surgeons (OMSs), and the lay public. A total of 56 OMSs, 117 orthodontists, and 123 laypersons participated in the study. They were asked to view a randomly arranged series of computer-generated male and female facial photographs with the smile symmetrical or altered in 0.5-mm increments from 1 to 4mm and to indicate whether the person had an asymmetrical smile. The OMSs and orthodontists were able to recognize relatively smaller amounts of asymmetry than the laypersons (2mm vs 3 to 3.5mm). Although the clinicians performed better than the laypersons, both groups were able to recognize relatively small amounts of asymmetry. Because such a condition is generally not correctable and can affect the esthetic result, patients undergoing orthodontic therapy or orthognathic surgery need to be made aware of the situation before treatment.

Flangeless denture: an innovative technique for management of labial undercut in completely edentulous patient: a case report

&lt;p class="abstract"&gt;Labial ridge undercut is more commonly seen in maxilla than mandible in completely edentulous individuals and it possess a great threat to the final esthetic outcome. Construction of a labial flange in conventional manner might compromise the facial support and muscles of facial expression, limit function, and compromise aesthetics for a better prognosis, an unconventional approach is needed for the construction of complete denture. This case report describes an innovative, economical, nonsurgical treatment option for fabrication of complete denture in a patient with a prominent labial undercut to enhance the facial aesthetics of the patient.&lt;/p&gt;

Reconstruction of Moderate-Sized Scalp Defects: A 1–2–3 Rule

Background and objectiveExcision of cutaneous scalp tumors results in surgical defects that are difficult to repair because of poor distensibility in this area of the body. The main aim of this study was to develop a structured algorithm to help choose the best technique for reconstructing scalp defects. Material and methodsRetrospective study of patients who required surgical reconstruction following excision of a cutaneous scalp tumor. We excluded patients with defects that could be closed by simple direct suture and defects for which it was initially decided to use a skin graft or healing by secondary intention. The defects were classified into 5 groups according to the minimum distance between edges. The different reconstruction techniques used were evaluated in each group. The outcomes analyzed were complete defect closure, intraoperative and postoperative complications, and final aesthetic result. ResultsWe included 119 patients (102 men and 17 women) with a mean age of 71 years (range, 32–93 years). Mean follow-up was 42 months (range, 6–120 months). Sixty-eight patients had a moderate-sized defect with a distance between edges of 1 to 4cm. Reconstructions started with relaxation incisions in 43 defects and resulted in the successful closure of 22 of them. Defects with a distance of 1 to 2cm required a single relaxation incision. Two incisions were required for defects with a distance of 2 to 3cm, while 3 incisions were required for those with a distance of 3 to 4cm. In the 21 cases in which relaxation incisions were insufficient to close the defect, the incisions were extended to mobilize the flap to achieve closure. Relaxation incisions alone were insufficient for closing defects with a distance greater than 4cm. ConclusionsThe 1-2-3 rule can help in choosing the best reconstruction technique for moderate-sized defects based on the principle that 1, 2, or 3 initial relaxation incisions are needed depending on the minimum distance between edges (1-2cm, 2-3cm, or 3-4cm). In all cases, incision extension to mobilize the corresponding flaps remains an option.

Comparative evaluation of the quality of life of patients depending of different inframammary fold creation techniques during a two-stage breast reconstruction

Reconstruction of natural-looking breast involves the restoration of all the constituent elements that define the identity of a normal breast. The inframammary fold is one of the main anatomical elements that determine the shape of the breast. That is why the technical features of various methods of the inframammary fold reconstruction affect the final aesthetic result of the reconstructive surgery. This article considers a comparative evaluation of the quality of life and satisfaction with the reconstructed breast after the two-stage breast reconstruction with different inframammary fold creation techniques.

Pink esthetic defects of restoration in anterior teeth and the treatment protocol

How to achieve the esthetic results with the restoration in anterior teeth is key aims which both of dentists and patients concern about now. Previously, the shape, color and texture of the teeth, i.e. "white esthetics" , were main objectives that prosthodontists want to achieve. The development of dental materials has played a key role in this field. More and more, the prosthodontist has realized that the healthy soft tissue is also very important for the final esthetic results. The healthy periodontal tissue is not only the basis for the longevity of restoration, but also the basis of esthetic results. The shape, color and texture of soft tissue, the mesial and distal gingival papilla, the margin and symmetry of the gingival, i.e. "pink esthetics" , have ultimate relationship with final esthetic results. The objective of the article is to introduce the common pink esthetic defects for the restorations in anterior teeth, the treatment protocol and methods to improve pink esthetic results.

Influence of the fixed implant-supported provisional phase on the esthetic final outcome of implant-supported crowns: 3-year results of a randomized controlled clinical trial.

The aim of this investigation was to evaluate whether the use of a provisional implant-supported crown improves the final esthetic outcome of implant crowns that are placed within esthetic sites. Twenty endosseous implants were inserted in sites 13 to 23 (FDI) in 20 patients. Following the reopening procedure, a randomization process assigned them to either cohort group 1: a provisional phase with soft tissue conditioning using the "dynamic compression technique" or cohort group 2: without a provisional phase. Screw-retained all ceramic crowns were inserted. Clinical follow-up appointments were completed at 36 months evaluating clinical, radiographic outcomes, and implant success and survival. After 3 years, all implants survived; one implant-supported crown was excluded from the study due to adjacent tooth failure replaced with a further implant supported crown. Modified pink esthetic score (ModPES) scores were significantly different between groups 1 and 2 (P = .018); white esthetic scores (WES) were not statistically different between both groups (P = .194). Mean values of combined modPES and WES were 15.6 for group 1, with a SD of 3.20. Group 2 had a mean combined modPES and WES of 12.2, with a SD of 3.86. Mean bone loss after 3 year was -0.05 and -0.04 mm for groups 1 and 2 respectively, without being statistically significant. Fixed implant-supported provisionals improve the final esthetic outcome of the peri-implant mucosa.

Efficacy of methotrexate as anti-inflammatory and anti-proliferative drug in dermatology: Three case reports.

Methotrexate (MTX) is a folic acid analog with anti-proliferative (anti-neoplastic, cytotoxic), immunosuppressive and anti-inflammatory properties, which has been used in the treatment of various cutaneous disorders, such as psoriasis, keratoacanthoma, pityriasis rubra pilaris, atopic dermatitis, mycosis fungoides, bullous skin diseases, systemic sclerosis, morphea, lupus erythematosus, dermatomyositis and crusted scabies. Inhibition of cell proliferation is explained through its role in blocking DNA/RNA synthesis, by inhibiting dihydrofolate reductase, necessary for the production of pyrimidine and purine nucleotides. An anticancer effect can be related to α-oxoaldehyde metabolism (MTX increases methylglyoxal levels). Its anti-inflammatory property is based on the inhibition of 5-aminoimidazole-4-carboxamide ribonucleotide transformylase, thus increasing intracellular and extracellular adenosine, a purine nucleoside with anti-inflammatory effect. This drug can limit inflammation by scavenging free radicals and decreasing malondialdehyde-acetaldehyde protein-adduct production. Moreover, the anti-proliferative and anti-inflammatory effects can also be related to inhibition of the DNA methylation pathway, thus inhibiting methionine formation. The aim of the present study was to report various dermatological cases from our daily practice that demonstrate the efficacy of MTX in the treatment of cutaneous diseases, highlighting different mechanisms of action: its anti-inflammatory effect in psoriasis and its anti-proliferative, and anti-neoplastic effect in well-differentiated squamous cell carcinoma or in keratoacanthoma. Moreover, different administration pathways and doses are addressed. Assessment of the treatment plan, clinical improvement of cutaneous lesions, biologic evaluation, final aesthetic result, quality of life, as well as potential adverse effects and drug tolerance related to each case mentioned.

Regla «1-2-3» para la reconstrucción de defectos de mediano tamaño del cuero cabelludo

Background and objectiveExcision of cutaneous scalp tumors results in surgical defects that are difficult to repair because of poor distensibility in this area of the body. The main aim of this study was to develop a structured algorithm to help choose the best technique for reconstructing scalp defects. Material and methodsRetrospective study of patients who required surgical reconstruction following excision of a cutaneous scalp tumor. We excluded patients with defects that could be closed by simple direct suture and defects for which it was initially decided to use a skin graft or healing by secondary intention. The defects were classified into 5 groups according to the minimum distance between edges. The different reconstruction techniques used were evaluated in each group. The outcomes analyzed were complete defect closure, intraoperative and postoperative complications, and final aesthetic result. ResultsWe included 119 patients (102 men and 17 women) with a mean age of 71 years (range, 32–93 years). Mean follow-up was 42 months (range, 6–120 months). Sixty-eight patients had a moderate-sized defect with a distance between edges of 1 to 4cm. Reconstructions started with relaxation incisions in 43 defects and resulted in the successful closure of 22 of them. Defects with a distance of 1 to 2cm required a single relaxation incision. Two incisions were required for defects with a distance of 2 to 3cm, while 3 incisions were required for those with a distance of 3 to 4cm. In the 21 cases in which relaxation incisions were insufficient to close the defect, the incisions were extended to mobilize the flap to achieve closure. Relaxation incisions alone were insufficient for closing defects with a distance greater than 4cm. ConclusionsThe 1-2-3 rule can help in choosing the best reconstruction technique for moderate-sized defects based on the principle that 1, 2, or 3 initial relaxation incisions are needed depending on the minimum distance between edges (1-2cm, 2-3cm, or 3-4cm). In all cases, incision extension to mobilize the corresponding flaps remains an option.

Effect of time on tooth dehydration and rehydration.

To estimate the time required for teeth to dehydrate and rehydrate and its relation to the accuracy of tooth shade selection. Thirty-two participants were recruited, and color measurements were conducted using a spectrophotometer placed with a custom jig. After isolation, baseline measurements were made at 1, 2, 3, 5, 7, 10, and 15 min intervals to determine dehydration time. After mouth rinsing, measurements were made to determine rehydration time. CIEDE2000 values were obtained for color change between the baseline recordings and all intervals and compared to the 50:50% perceptibility and acceptability thresholds. Analysis of variance (anova) and Tukey test was used for multiple comparisons. The tooth color changes were beyond the ΔE00 perceptibility threshold (0.8) within the first minute of dehydration (P > 0.0001). After the first minute, 87% of the teeth were beyond the ΔE00 perceptibility threshold (0.8), and 72% of the teeth were beyond the ΔE00 acceptability threshold (1.8). After 15 min of rehydration, 90% of the teeth were beyond the perceptibility threshold, and 65% were beyond the acceptability threshold. Shade selection procedures should be carried out within the first minute and before teeth dehydrate by means of isolation. Teeth do not rehydrate within 15 min after rehydration. Teeth dehydration has a negative impact on shade selection, which can affect the final esthetic outcome. Shade selection should be performed at the beginning of any restorative procedure.