Optimal Aesthetic Results Research Articles

One phase prosthetic and orthodontic treatment in children: Case study

Background: Dental trauma in children is reported about 25–33%. Besides dental trauma, children are also at high risk for malocclusion. The prevalence of malocclusion in children was reported as 39% in children and 93% in adolescents. If the patient has malocclusion and a history of tooth loss due to trauma at the same time, there is often a dilemma as to which treatment should be prioritized. This case report will combine the Prosthetic phase and the orthodontic phase at the same time. Case reports regarding denture-modified removable orthodontic appliances in children have so far not been found. Case Report: An 11-year-old boy came with his mother to pediatric dentistry department at Universitas Airlangga with the chief complaint of missing teeth due to extraction at the dentist two years ago due to trauma. On intraoral clinical examination, it was found missing 11, crossbite 21 with 31 and 32. Case Management: Patients were planned treatment of malocclusion with removable orthodontic appliances added with riding pontic 11. Discussion: Tooth loss in children will affect speech, eating, and self-confidence. Several authors have reported appliance modifications and reported satisfactory results. During malocclusion treatment, dentures may not provide optimal aesthetic results. However, the advantages provided by the presence of dentures during the treatment of malocclusion are considered to be greater. Conclusion: Modification of removable orthodontic appliances combined with dentures can be a solution to both prosthodontic treatment needs and malocclusion.

Surgical techniques for the webbed neck: a narrative review with a comparative study and surgical decision-making algorithm for an optimal aesthetic result.

A webbed neck is a conspicuous deformity that requires meticulous repair. Several surgical techniques are available; however, there is no guideline, or gold standard technique reference based on webbed neck characteristics. This article aims to conduct a narrative review of the surgical techniques with a comparative study to select those leading to the best aesthetic results and to propose a decision-making algorithm for surgical techniques according to the characteristics of the webbed neck. A narrative review of surgical techniques of the webbed neck was performed by searching the PubMed and Google Scholar databases to summarize their particularities. A comparison of surgical techniques was made according to technicality and outcome characteristics. Clinical features of the webbed neck were reviewed to propose a classification of the webbed neck. Twenty-five articles were identified describing surgical techniques realized on 66 patients. Durak and Hikade techniques offered better results in the Z-plasty category. The Actaturk technique leads to better outcomes in the posterior approach techniques. Reichenberger and Mehri Turki's techniques were the most suitable lateral approach techniques. Otherwise, four types of webbed necks were defined based on the fibrotic band and the hair pattern. According to the typology of the web, a surgical decision-making algorithm is built to assist surgeons in finding the most suitable selected techniques for an optimal aesthetic result which corresponds to the achievement of a symmetrical neck contour with highly satisfactory hair placement while avoiding noticeable scars and recurrence.

Aesthetic considerations for treating the Asian patient: Thriving in diversity international roundtable series.

The unique anatomy of the Asian face, along with the influence of cultural forces and regional preferences, has led to the development of specialized approaches to rejuvenation and beautification that are applicable to the aesthetic practice within Asia as well as those who serve these patients internationally. To discuss similarities and differences in anatomy and treatment preferences of Asian patients and explore how these differences may influence aesthetic practices. In support of clinicians who wish to serve a diverse patient population, a six-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021 to May 16, 2022. The results of the sixth and final roundtable in the series, the Asian Patient, are described here. Anatomical differences and their influence on treatment preferences are discussed, and specific procedural information provided for management of facial shape and projection, including advanced injection techniques for the eyelid-forehead complex. The continued exchange of ideas and treatment techniques support not only optimal aesthetic outcomes for a diverse range of patients within a given practice, but also the evolution of aesthetic medicine. The expert approaches detailed here may be used to inform treatment plans tailored to the Asian population.

21. A Tale of Two Surgeries: Predicting the Need for Secondary Revision Procedures after Breast Reconstruction Using Machine Learning

PURPOSE: Breast revision surgery after two-stage implant-based reconstruction is an effective way to correct existing defects and improve aesthetic outcomes. For new patients, providing a quantifiable “likelihood of revision surgery to achieve satisfaction” may enable them to make a more informed decision regarding the modality of reconstruction. METHODS: Retrospective chart review was done on two-stage breast reconstruction patients between 2012-2021. The outcome of revision/corrective surgery was determined based on physician note and operative record. Patient characteristics that emerged as significant on both univariate and multivariate analysis were used to construct the machine learning model. Supervised learning models were evaluated using k-fold cross validation (k=3). A neural network model was also evaluated with a 0.8/0.1/0.1 train/validate/test split on the dataset. RESULTS: 185/406 (45.57%) required post-operative revision surgery to achieve more optimal aesthetic outcomes. On multivariate analysis, never smoking (OR 0.61), hypertension (OR 0.40), and textured expander (OR 0.52) corresponded to lower odds of undergoing revision surgery (p<0.05). Higher initial tissue expander volume (OR 1.002), vertical radial incision (OR 4.79), and larger nipple-inframammary fold distance (OR 1.12, p-value 0.03) conferred higher odds of needing additional revisions. Support Vector Machine achieved the highest performing machine learning model, with an accuracy of 61.3, and ROC AUC 0.67+/-0.05. CONCLUSION: Machine learning can help predict the probability of requiring secondary surgeries after implant-based reconstruction. As an example, for patients at high risk of needing further revisions, surgeons can provide more robust counseling on the use of autologous abdominal tissue vs. tissue expander/implant.

Use of Customized Thickness Anterolateral Thigh Flap in Head and Neck Reconstruction

Objective: This study demonstrates different techniques of anterolateral thigh flap (ALT) with the appropriate surgical planes according to the thickness of the defect, which have not been previously found in the literature, with our reconstruction experiences. &#x0D; Materials and Methods: A retrospective study was performed including 26 flaps in 25 patients who underwent reconstruction of head and neck defects with different surgical planes of ALT flap including subfascial, superthin, suprafascial, chimeric and composite flaps from March 2017 through December 2020. Flap planes were chosen according to the thickness of the defect, determined during surgery by using caliper. We evaluated the characteristics, flap thicknesses, complications and need of revision surgery in postoperative period. &#x0D; Results: One of the superthin flaps was totally lost; there was not any other flap loss. Three patients died in postoperative period. Although appropriate plane of the flaps was chosen, 4 of all 26 flaps needed revision surgery. One of the patients who was performed lip reconstruction with superthin ALT flap had bulky appearance needed liposuction in postoperative 6 months and 3 patients who received subfascial ALT flaps were performed debulking surgeries. &#x0D; Conclusion: ALT flap is a versatile, reliable flap which can be harvested in different planes according to the thickness of the defect in head and neck region. The ALT flap with convenient thickness provides definitive reconstruction in a single stage without revision surgeries and the most optimal aesthetic results can be obtained.

Cheek wrinkles revisited: Etiological classifications and nonsurgical treatment options.

Wrinkles are one of the key signs of an aging face. Cheek wrinkles have a prominent negative impact on facial aesthetic. Recognizing the pathology and types of different cheek wrinkles, and the possible minimal invasive interventions to treat them, are crucial for optimal aesthetic outcome. The classification of cheek wrinkles based on etiology, past literature, and wrinkle pattern, and the outlining of possible treatment options. Five different types of cheek wrinkles are described: Type 1-Atrophic cheek wrinkles, Type 2-dynamic expressional cheek wrinkles, Type 3-static expressional cheek wrinkles, Type 4-laxity cheek wrinkles, and Type 5-sleep cheek wrinkles. Treatment options and techniques for different types of cheek wrinkles are recommended accordingly.

Aesthetic Considerations in Extremity Salvage and Reconstruction.

After studying this article, the participant should be able to: 1. Have an in-depth understanding of the functional and aesthetic requirements of lower extremity reconstruction. 2. Describe the considerations for achieving an optimal aesthetic outcome in the primary reconstruction settings. 3. Describe modalities of secondary flap revision for achieving an optimal aesthetic outcome. Significant advancements have been made in the management of lower extremity reconstruction since Dr. Taylor's seminal case in 1973. Improvements in our understanding of vascular anatomy and evolution of microsurgical techniques have allowed for an ever-increasing array of free tissue transfer options for lower extremity reconstruction. The resulting expertise has engendered a paradigm shift toward the reconstructive elevator approach, with increased emphasis on cosmetic results. In the primary setting, aesthetic considerations play an important role in precoverage wound preparation, flap selection, and harvest technique, with the goal of achieving excellent like-with-like reconstruction at the time of initial surgery. Flap selection should be made to best match the three-dimensional architecture of the wound, and take into account the defect thickness, flap thickness, flap composition, and pedicle length. Primary flap thinning and harvest in the superficial fascial plane has been shown to be an effective modality to address excess adiposity and improve contour. Despite these efforts, secondary procedures are often required to optimize the limb's final appearance and functional outcomes, particularly in the foot and ankle region. These include debulking, liposuction, and staged excisions. As the field of limb salvage keeps evolving, aesthetics will continue to play an important role in extremity reconstruction planning and execution.

Implant rehabilitation of the esthetic area: A five-year retrospective study comparing conventional and fully guided surgery.

To compare the clinical outcomes of anterior single maxillary implants placed using conventional or guided implant surgery. In this retrospective clinical study 44 patients rehabilitated with a single anterior implant in the maxillary arch were included. Twenty-four implants were inserted applying a guided surgery approach (GS), and 20 applying a conventional freehand approach (CS). Outcome measures were: implant survival rate and complications; mean bone level (MBL) evaluated at surgery (T0), after 6 weeks (6W), and after 1 year (1Y), 2 years (2Y), 3 years (3Y), 4 years (4Y), and 5 years (5Y); patients' satisfaction evaluated through a questionnaire filled out before surgery (BS) and at 1week, 6W, 2Y and 5Y; Pink esthetic score (PES) and white esthetic score (WES) evaluated at 1Y, 3Y and 5 Y. Significance of differences between groups were tested by Fisher's exact test, Mann-Whitney U test, and Wilcoxon's signed rank test. During the 5-year follow-up there were no drop-outs and no implant failed. No significant differences between groups were found in MBL. A significant difference between groups was found in VAS scores regarding speech at 2 years, aesthetics at 6 weeks, confidence at 1week and 6 weeks, satisfaction at T0 and at 1W, pain/comfort at 1W and at 6W; all VAS scores resulted significantly improved compared to baseline. No significant differences in WES were found, while significant differences in PES scores between CS and GS groups were found at 3 and 5 years (p value=0.023 and 0.004 respectively) with better outcomes for GS. A significant difference over time was found in PES between 5-year and one-year values. Guided surgery and conventional surgery implants did not show any difference in MBL during the 5-year observation period. Guided surgical procedure guarantee optimal esthetic outcome and seems able to guarantee better soft tissue result over time, even though more long-term studies are necessary to confirm this data.

Giant basal cell carcinoma of the scalp: rotation advancement flap as a successful dermatosurgical approach.

Giant keratinocyte tumors, in particular basal cell carcinomas of the scalp area, are a serious challenge for dermatosurgeons, oncologists, and maxillofacial and reconstructive surgeons. The scalp area is limited in terms of skin mobility, and its elasticity decreases with age. The size of the tumors in this area and the degree of infiltration of the underlying tissues are important for the therapeutic choice, from surgical removal, waiting for granulations to form, and placing a split skin mesh graft (at a later stage) to performing complex rotational/transpositional or advancement flaps. Achieving an optimal aesthetic result is often the consequence of interventions carried out or based on the decisions of multidisciplinary teams. Alternatives, such as radiotherapy and targeted therapy with vismodegib, could be administered both preoperatively and postoperatively or as first-line therapy, depending on the tumor board decisions. We present the case of a 69-year-old female patient with a histopathologically proven preoperative giant basal cell carcinoma of the scalp that did not infiltrate the tabula externa. A preoperative ultrasound was performed to preserve the feeding flap arteries. Surgical treatment under general anesthesia was planned and subsequently carried out. During surgery, the surgical resection lines were in close proximity to the arterial vessels, but they remained preserved and ensured a subsequently unproblematic healing process. After the application of the rotational advancement flap technique under general anesthesia, an optimal cosmetic effect was achieved.

Histology and Long-term Clinical Outcome of Crushed Cartilage with Double-layer Gelatin Sponge Membrane for Dorsum Refinement in Primary Rhinoplasty.

This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery.

Transconjunctival Lower Eyelid Blepharoplasty with Volume Augmentation for Correction of the Lower Eyelid and Cheek Junction.

Aesthetic surgical management of the inferior periorbital region should include an approach to volume augmentation of the midface and infraorbital hollow, reduction of fat pseudoherniation in the lower eyelids, and treatment of the overlying skin. A combined approach using volume augmentation with fat grafting, a transconjunctival approach to the lower eyelid fat pads, and conservative management of the lower eyelid skin can produce optimal aesthetic results while minimizing complications. Fat harvest from the thigh and abdominal region allows for ample grafting material to the lateral cheek, midface, and orbital rim. The treatment paradigm is to restore volume optimally while minimizing fat resection in the lower eyelids. Volume augmentation is used to restore youthful contours, as well as to counter deflation and laxity in the periorbital and midfacial regions.

Osteoma in the temporomandibular joint (Case report)

Osteomas are benign slow growing osteogenic tumors mostly arising in the craniofacial region and characterized by the deposition of differentiated and mature either or both cancellous and compact bone. Osteoma accounts for 2-3% of all bone primary tumors with an incidence of 10-12% among all benign skeletal neoplasms. Objective: The objective of this work is to describe a clinical case of an osteoma in the temporomandibular joint diagnosed in the maxillofacial surgery service of the General Hospital of Pachuca in the State of Hidalgo, Mexico. Clinical Case: A 39-year-old female patient who comes to the General Hospital Pachuca, Mexico due to pain and noises in the right preauricular region of 6 years of evolution, with facial asymmetry, mandibular deviation to the left and limited mouth opening. Clinically, facial asymmetry, mandibular deviation to the left, right posterior crossbite, anterior open bite mainly on the affected side, preauricular pain, joint sounds, and limitation of mandibular movements were observed. Radiographic examination revealed a trapezoidal mass measuring 2.5 by 2.0 cm, with alteration of the condyle-mandible anatomy on the right side. An insertional biopsy is performed, reporting an osteoma, and surgical intervention is continued. Conclusion: The osteoma in the temporomandibular joint is a rare lesion, its timely value is essential for its treatment. Surgical resection is the gold standard treatment, which is based on a radical excision that extends to the altered normal bone, with the contextual objective of achieving an optimal aesthetic result by choosing the least invasive surgical treatment possible.

Basal cell carcinoma - principles of treatment

Basal cell carcinoma (BCC) is one of the most common malignant tumors in human medicine and the most common skin malignancy, with the largest number of lesions found on exposed parts of the skin, on the face, head, and neck. The average age of the patients is 60 years, with an increasing incidence in younger ages and an increased incidence in males. The incidence of BCC is increasing and doubles every 25 years. Annually, there are approximately 1,000,000 newly diagnosed cases worldwide. The frequency of malignant skin tumors depends on the influence of external factors such as ultraviolet radiation and other biological properties of the skin with a higher incidence in fair-skinned people (Fitzpatrick type I and type II skin types). BCC is a slow-growing malignant tumor that arises from the basal layer of the epidermis, the outer layer of hair follicles, or the sebaceous glands. BCC can be locally invasive and, if neglected, can infiltrate surrounding structures (muscles and cartilage) and vital structures, which can ultimately lead to death. The clinical presentation is very diverse and dependent on the histological subtype. Prevention is the most important and effective approach towards reducing the burden of BCC. The best treatment for BCC is surgical excision with confirmation and verification of surgical margins. The therapeutic goal is oncologic radical resection of the tumor, followed by reconstruction of the affected area for structure and optimal aesthetic result.

Three-dimensional Computer-aided Design System used in Orthodontics and Orthognathic Surgery for Diagnosis and Treatment Planning- A Narrative Review

Three dimensional advancements in technology have made a profound impact on various fields, and dentistry, particularly the branch of orthodontics and orthognathic surgeries, which has not been exempt from this transformative influence. Among the cuttingedge technologies that have gained significant traction is Three-Dimensional (3D) printing, which has found its initial applications in orthodontics for producing dental casts. By integrating intraoral scanners, dentists now possess the remarkable ability to obtain dental impressions without subjecting patients to the discomfort associated with traditional methods. Furthermore, 3D planning techniques have emerged as a pivotal element in orthodontics, especially when striving for optimal aesthetic and occlusal outcomes. Precise treatment planning plays a vital role in ensuring successful orthognathic surgeries and other orthodontic interventions. The utilisation of 3D planning techniques facilitates the gathering of comprehensive data, thereby achieving two main objectives: an accurate diagnosis of the dentoskeletal deformity and the formulation of a treatment plan that can be faithfully replicated during the clinical procedure. Even 3D imaging technology, such as Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT), has become an indispensable tool in dentistry. These imaging techniques provide volumetric images of a patient's facial anatomy, enabling the transformation of intricate details into precise 3D representations of the craniofacial skeleton and soft tissue layers. Consequently, this progress has led to the development of computerised resources dedicated to preoperative planning and the fabrication of surgical splints. The integration of advanced technologies, including 3D printing, 3D planning techniques, and 3D imaging technology, has revolutionised orthodontics, providing dentists with precise tools for accurate diagnosis, treatment planning, and ultimately, enhanced patient care. As this field continues to progress, the potential for further advancements and innovative applications utilising artificial intelligence becomes an exciting prospect in the ever-evolving landscape of modern dentistry.

The use of argon plasma coagulation in mammoplasty as a prevention of postoperative complications

The frequency of reoperations associated with complications after mammoplasty reaches 15 % during the first year . There are many ways and means for processing the soft tissues of the breast during mammoplasty , helping to reduce the risk of postoperative complications . The purpose of this work was to develop an algorithm for the application of the argon plasma technique for tissue treatment in mammoplasty . Material and methods . The study included 30 females aged 23 to 46 who underwent mammoplasty . The patients were divided into 2 groups of 15 people . In group 1, standard methods of processing soft tissues were used , and in group 2, the argon plasma technique was used in conjunction with the use of Aristo glue . Patients were observed in the early , late and distant postoperative period . Results . In the course of the study , in addition to the excellent coagulation and bactericidal action of argon plasma , the effect of “ pulling up ” the soft tissues of the mammary gland was found , which , in case of ptosis of I and II degrees , made it possible to use a smaller implant to achieve an optimal aesthetic result . Also , when using the argon plasma technology , no inflammatory processes were observed , the amount of exudative fluid in the drains decreased , the pain syndrome was significantly less pronounced in comparison with patients who underwent the standard method of tissue processing . Conclusions . This study confirms the fact that the use of argon plasma coagulation in the processing of breast tissue has a significant number of advantages compared to standard methods .

Long-Term Esthetically Depigmented Gingiva in a Short Operative Duration, Using Two Modes of 940 nm Diode Lasers-A Randomized Clinical Trial.

This study aims to compare the effectiveness of the two modes of 940 nm diode lasers on gingival depigmentation. Twenty patients (11 females and 9 males) participated in this study; they were free of any systemic or local condition and randomly assembled into two groups: continuous wave (CW) and pulsed groups, in contact modes. The diode laser was of 940 nm wavelength and 1-2 W irradiation power for the two modes in all cases. A single session of irradiation was applied to the facial gingivae of the upper and lower anterior segments. Photographs were taken preoperatively and postoperatively for all patients, and a questionnaire and follow-up were carried out for the next four weeks and after three years. The intraoperative duration of both modes was considerably short, with a short chair time subsequently. A statistically significant decrease in the intensity of pain, discomfort, and bleeding (p ≤ 0.05) was noticed during the first week of follow-up within each group. Nonetheless, the two groups showed a close pattern of decline with no statistically significant differences between them. It was also clear that pain and discomfort were strongly correlated with each other within each group, and the correlation was statistically significant. On the other hand, carbonization was minimal in a few cases treated with CW mode but still not statistically significant. Finally, although the gingival pigmentation index (GPI) differences were not statistically significant between the two groups, they were significant within each group. The diode laser (940 nm) offered an effective and safe modality, providing an optimal aesthetic result that can meet patient satisfaction with minimal pain, bleeding, discomfort, intraoperative time, and the possibility of recurrence in the treatment of gingival hyperpigmentation.

Neuroaesthetics in Plastic and Reconstructive Surgery: Opportunities for Interdisciplinary Collaboration.

Neuroaesthetics is a burgeoning discipline concerned with the neural basis for the perception and creation of art1 and neuroscientific mechanisms of human aesthetic experiences.2 Research in this field has combined principles of neurology, neuroanatomy, psychology, and art history to answer questions about the experience of beauty.2 Vision has received particularly close attention, especially human perception of faces, paintings, landscapes, and architecture.3 Neuroaesthetics has made meaningful contributions to unraveling neurologic mechanisms underpinning the aesthetic experience, previously regarded as a philosophical concept. Research has demonstrated aesthetic evaluations are important for human activity in consumer behavior, mate selection, and determination of morality.4 The field has identified neuroanatomic structures implicated in the perception of beauty broadly, notably the medial orbital frontal cortex, as well as cortical and subcortical structures specific to certain visual or auditory experiences.2 Within plastic surgery, neuroaesthetics overlaps with the specialty’s goal of characterizing optimal aesthetic outcomes for people. Plastic surgery research on aesthetic preferences may be augmented through collaboration with our colleagues in neuroaesthetics, who offer valuable expertise in neuroscience and aesthetic principles. In return, plastic surgery offers clinical, anatomic, and human aesthetic perspectives that may broaden the neuroaesthetic scope of inquiry. The fields complement one another to enhance the sophistication of questions posed, data generated, and analyses of those data. One example of such a collaboration is the University of Pennsylvania’s Center for Human Appearance, in which neuroaesthetics, plastic surgery, oral surgery, dermatology, oculoplastic surgery, and ear, nose, and throat play key complementary roles in designing studies that enhance understanding of appearance and clinical outcomes. Examples of the center’s initiatives include employing crowdsourcing to compare layperson aesthetic preferences, applying eye-tracking technology to characterize gaze patterns toward visual stimuli, and leveraging face databases to associate character traits to those with facial anomalies.1 Such studies have had an effect on understanding clinical outcomes in aesthetics, craniofacial surgery, and breast surgery. These clinical studies may be augmented with techniques common to the neuroaesthetics toolbox, including functional magnetic resonance imaging or magnetoencephalography to characterize brain activity in response to visual stimuli or convolutional neural networks to learn image features from datasets.5 Other efforts to leverage architectural and artistic principles are also poised to improve health care infrastructure and optimize the patient experience. Plastic surgery has not been regarded as a subdomain of neuroaesthetics inquiry. Plastic surgery would be an asset to the evolution of neuroaesthetics and should seek opportunities to foster relationships with colleagues in this nascent field. This convergence of interests is an exciting opportunity to continue plastic surgery’s history of collaboration to answer unique, multidisciplinary questions with implications for the outcomes of our patients. Disclosure The authors have no financial interest to declare in relation to the content of this article.

Management of Facial Second-Degree Burns with Nanocellulose-Based Dressing: A Case Series and Systematic Review.

Previous studies have evaluated the effectiveness of bacterial nanocellulose (BNC) for the treatment of thermal injuries, but the synergic effect of platelet-rich plasma (PRP) with BNC-based dressing for burns still requires further investigation. Herein, we evaluated the effectiveness of BNC dressings in the management of facial burns using PRP. Patients with second-degree facial burns were treated with BNC-based wound dressings after debridement. The burn's depth and epithelialization were evaluated by clinical assessment. Besides using the dressings, we injected PRP subcutaneously into the left-hemifacial burns. The right hemiface was only treated with the dressings. Scar quality was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Eight patients were included with superficial second-degree burns in 75% of the cases and deep second-degree burns in 25%. Overall, dressings were placed 3.25 days after the initial insult. None of the patients presented with complications after dressing placement. Dressing changes were not required, and no further surgical management was necessary. The mean time for epithelialization was 11.4 days. During subgroup analysis, we did not find a significant difference in the epithelialization time when comparing BNC-based dressings (11.8 days) to BNC-based dressings + PRP (11 days, p = 0.429). The mean POSAS scores from a patient (17 vs. 12.3, p = 0.242) and surgeon (13.5 vs. 11.3, p = 0.26) standpoint were not significantly different using BNC-based dressings versus BNC-based dressings + PRP. Nanocellulose-based dressings are effective to treat second-degree facial burns. It enhances reepithelialization with optimal esthetic outcomes with or without PRP.

Rethinking a Reconstructive Technique: A Modified V-Y Flap Suture Technique with Horizontal Branch. Presentation of a Clinical Case

The surgical techniques used to close a primary wound, while sharing common principles and su- ture material, are multiple. With guaranteed aseptic wound conditions, modern requirements focus on achieving optimal aesthetic results. We present a V-Y suture technique that allows you to obtain a low tension suture, levelled with adaptation to the dermo-epidermal interface of the wound. Our technique is particularly suitable for indications in cosmetic plastic surgery, where high distracting forces of the wound in the transition phase between the aesthetic subunits typically occur with the cancer removal of the face in particular of the neck. The designed technique has never been applied to date.

Maxillary incisor-based objectives in present-day orthodontics

<h2>ABSTRACT</h2> Orthodontists should be familiar in examining all the components of a smile. A parallel position of the facial aspect of the incisor crown to the face is considered to be the most aesthetic position of the maxillary incisor. A more anterior position of the maxillary central incisors has been shown to be more acceptable than a more posterior position. Exposition of the incisor should not be larger than 3 mm in relationship to the upper lip. The lack of objective criteria to position incisors may be a first step to make the patient become dissatisfied with the treatment result. This paper discusses the ideal buco-ligual inclination for maxillary central incisor, and their horizontal and vertical position. A simple way to determine a virtual goal for maxillary incisor position, using digital tools, will be explained as well as how to transfer the occlusal plane to 3d planning softwares. A clinical case is presented using the Glabellar vertical line, the Mid-forehead vertical line and the Functional Esthetical Oclusal Plane as tools to determine where the maxillary central incisors should be positioned for optimal esthetic results.