Soft Tissue Adaptation Research Articles

Cranio-Maxillo-Facial Reconstruction with Polyetheretherketone Patient-Specific Implants: Aesthetic and Functional Outcomes.

Reconstructing cranio-maxillo-facial defects presents significant challenges. This study evaluates the results of polyetheretherketone patient-specific implants (PEEK PSIs) in primary and secondary cranio-maxillo-facial reconstructions, with a focus on aesthetic and functional outcomes and long-term complications. From October 2009 to February 2023, 45 patients underwent cranio-maxillo-facial reconstructions with PSIs. Patients aged 18 years or older, with a minimum follow-up period of 12 months, were included. The morpho-functional outcome was evaluated through a modified Katsuragy Scale, the Visual Analogue Scale (VAS) for pain, and four FACE-Q|Aesthetics© scales. In total, 44 PSIs were placed in 37 patients (51.3% males; mean age 45.1 years). The main cause of the defect was the resection of a tumor (55.4%). Mean follow-up was 78.6 months. Clinical evaluations showed an improvement in the postoperative period both in patient's and surgeon's scores (p: 0.01 and p: 0.002, respectively). Subgroup analysis confirmed a significant improvement in patients undergoing cranioplasty (p = 0.02) and mandible reconstruction (p = 0.03). No cases of prosthesis dislocation, rupture, or long-term infection were recorded. PEEK PSIs offer significant advantages in craniofacial reconstructions. Despite challenges in predicting soft tissue adaptation, overall patient satisfaction was high with no long-term complications. Future improvements should focus on predicting and enhancing soft tissue adaptations.

Increased Humeral Retrotorsion is not a Risk Factor for Overuse Injury of the Throwing Shoulder in Elite Youth Handball Athletes

PurposeTo identify the potential role of humeral retrotorsion (HRT) and range of motion (ROM) as a risk factor for shoulder overuse injury in elite youth handball players. The hypothesis was that increased HRT is associated with an increased risk of shoulder overuse injury. MethodsOver two seasons, 258 elite youth handball players (52% boys; age:14±0.8years) were included. Pre-season assessment included HRT and glenohumeral internal (IR) and external (ER) rotational ROM using ultrasound and a manual goniometer. Sports-specific adaptations between male and female athletes and the dominant and nondominant shoulder were calculated. In addition, players completed standardized questionnaires over the 2018-2019 or 2019-20 season and reported any shoulder overuse symptoms using the Western Ontario Shoulder Index questionnaire. ResultsComparing male and female players showed significantly decreased HRT and decreased internal ROM in the dominant side of male athletes (p≤0.027). No other difference was found. Significant side-to-side differences between the dominant and non-dominant shoulder were found for HRT, IR, and ER, regardless of sex (p<0.001). For total range of motion (TROM), only female athletes showed a significant increase in the dominant arm (p=0.032). The dominant side showed a significantly higher glenohumeral internal rotation deficit (GIRD) in male athletes than in female athletes (10°±17° vs. 5°±10°, p=0.011). Adaptations in HRT, ER gain, and TROM gain were not significant. Over the course of the two seasons, 20 athletes reported shoulder overuse injuries. Although GIRD was borderline non-significant (p=0.056), none of the parameters tested were significantly associated with shoulder overuse injuries. ConclusionDespite significant side-to-side differences and sport-specific adaptations, individual pre-season screening of humeral retrotorsion and soft tissue adaptations does not identify elite youth handball athletes at increased risk of shoulder overuse injury.

Comprehensive analysis of the elemental composition and surface relief of titanium abutments from contemporary manufactures

Relevance. The transgingival part of the prosthetic components of implant systems is a substrate for the primary adaptation of soft tissues and the formation of the gingiva collar - a complex of tissues acting as a biological barrier and ensuring the normal functioning of artificial supports in the microenvironment of the oral cavity. At the same time, the morphology of the surface of the abutment which will be in constant contact with the gingiva part during the loading period is of great importance. A change in the properties of the surface morphology of the transgingival part of orthopedic structures is fraught with the formation of a microbial bio-film in the subgingival zone with the with the subsequent development of mucositis and peri-implantitis. Based on the above, the study of the surface characteristics of orthopedic components of implantation systems seems relevant in the light of understanding the pathogenesis of inflammatory processes and assessing risk factors for the development of complications of dental implantation.Purpose. Study of differences in the elemental composition and features (or characteristics) of the surface morphology of orthopedic components - transgingival implant abutments from a number of modern manufacturers.Materials and methods. Prosthetic components from five manufacturing companies were selected for the study. For the assessment, elemental analysis of the surface of the components was used using a Hitachi S-3400N scanning electron microscope with an Oxford Instruments X-Max20 energy dispersive spectrometer, as well as morphological analysis using a TESCAN VEGA 3 scanning electron microscope. The samples were assessed for surface uniformity, the presence of inclusions, cracks and marks.Results. The study revealed significant differences in the components both in elemental composition and surface topography. The results obtained can be summarized in the form of a table.Conclusion. The method of comprehensive surface assessment used in the study can be recommended for describing and comparing orthopedic components from different manufacturing companies.

Development, characterization, and biological study of bioglass coatings 45S5 and BioK on zirconia implant surfaces.

Zirconia implants are gaining attention as a viable alternative to titanium implants due to their comparable osseointegration development, improved soft tissue adaptation, and enhanced aesthetics. An encouraging avenue for improving zirconia implant properties involves the potential application of bioactive coatings to their surfaces. These coatings have shown potential for inducing hydroxyapatite formation, crucial for bone proliferation, and improving implant mechanical properties. This study aimed to evaluate the effect of coating zirconia implants with two bioactive glasses, 45S5 and BioK, on osteogenesis in vitro and osseointegration in vivo. Zirconia samples and implants were prepared using Zpex zirconia powder and blocks, respectively. The samples were divided into three groups: polished zirconia (ZRC), zirconia coated with 45S5 bioglass (Z + 45S5), and zirconia coated with BioK glass (Z + BK). Coatings were applied using a brush and sintered at 1200°C. Chemical analysis of the coatings was carried out using x-ray diffraction and Fourier Transform Infrared Spectroscopy. Surface topography and roughness were characterized using scanning electron microscopy and a roughness meter. In vitro experiments used mesenchymal cells from Wistar rat femurs, and the coated zirconia implants were found to promote cell viability, protein synthesis, alkaline phosphatase activity, and mineralization, indicating enhanced osteogenesis. In vivo experiments with 18 rats showed positive results for bone formation and osseointegration through histological and histomorphometric analysis and a push-out test. The findings indicate that bioactive glass coatings have the potential to improve cell differentiation, bone formation, and osseointegration in zirconia implants.

Lateral knee laxity increases the risk of excessive joint line obliquity after medial opening-wedge high tibial osteotomy

BackgroundMedial opening-wedge high tibial osteotomy (HTO) is a well-recognized treatment for patient with varus knee osteoarthritis. Joint line obliquity has recently been suggested to negatively impact clinical outcomes following HTO, but little is known about what factors lead to increased joint line obliquity. The purpose of the current study was (1) to evaluate whether increased preoperative lateral knee laxity, represented by the joint line convergence angle, results in increased joint line obliquity in a consecutive series of patients treated with HTO and (2) to determine the effect of advanced arthritic changes on joint line obliquity. HypothesisIncreased joint line convergence angle would be associated with increased joint line obliquity. Patients and methodsAll HTOs performed at our center between 2010–2017 were retrospectively reviewed. Patients were excluded if pre- and postoperative standing alignment radiographs were not available. Varus-producing osteotomies were excluded. Patients were subdivided according to their preoperative joint line convergence angle (≤3° or >3°) and the degree of radiographic arthritic change. The primary outcome measure was the postoperative joint line obliquity. Categorical variables were compared using the paired samples t-test. Survival analysis was performed for failure and overall rate of reoperation. ResultsDuring the study period, 90 HTO were performed, and 38 patients (42 knees; M/F: 32/6; mean age: 41.6; mean follow-up: 4.72 years) met the inclusion criteria. The most common surgical indications were varus knee osteoarthritis (n=27, 64.3%) and osteochondritis dissecans (n=7, 8.2%). Patients with a preoperative joint line convergence angle >3° demonstrated significantly greater joint line obliquity postoperatively as compared to those with a joint line convergence angle ≤3° (6.4°±4.6° vs. 2.5°±5.7°, respectively; p=0.02). Patients with advanced arthritic changes had significantly lower preoperative (–3°±3.4° vs. –5.6°±4.1°; p=0.03) and greater postoperative (5.8°±4° vs. 2.2°±6.4°; p=0.04) joint line obliquity as compared to those with minimal arthritic changes. There were 12 complications among the 42 procedures: one conversion to total knee replacement (TKR), one hardware failure (fixation revised), one infection, and 9 hardware removals. Overall survival using conversion to TKR was 96.23% (95% CI 0.92–1.0) at 10 years. DiscussionLateral knee laxity, as defined by a preoperative joint line convergence angle >3°, and advanced arthritic changes are associated with increased postoperative joint line obliquity following medial opening-wedge high tibial osteotomy. Soft-tissue adaptation should be accounted for in order to avoid excessive joint line obliquity following high tibial osteotomy, and the planned correction should be reduced by 25% in patients with a preoperative joint line convergence angle >3° when templating using standing alignment radiographs. Level of evidenceIV.

Prosthetic rehabilitation in the Posterior Mandible with Tissue Level Implant: A Case Report

Implant is becoming the most appropriate option nowadays for replacement of single or multiple missing teeth which offers the predictable long-term results. Continuous innovations in implant design and approaches for placement have been proposed to achieve good osseointegration, esthetics and predictable soft tissue contour. Soft tissue level (STL) implants are placed trans-mucosally with platform away from alveolar bone crest so the microbial deposits in the micro-gap at implant abutment connection has less effect on alveolar bone. This type of implant has a rough surface placed subcrestally to facilitate osseointegration and a polished coronal part to facilitate soft tissue adaptation. This case report highlights about soft tissue level implant, its advantages and clinical success on replacing single missing posterior tooth.

Clinical and Radiographic Outcomes of Resective Surgery with Adjunctive Implantoplasty Over a 6- to 11-Year Follow-up: A Case Series.

Diverse surgical approaches, such as resective, reconstructive, and combined therapy, have been proposed for peri-implantitis treatment. A resective surgical approach with an adjunctive modified implantoplasty refers to the modification of the implant body into a constricted area to mimic a 'waist' silhouette. This modified technique forms an adequate concave smooth area that may favor the outcomes of resective surgical therapy for soft tissue adaptation, biofilm control, and possible peri-implant bone gain over the long term. The present case series aimed to exhibit the long-term clinical and radiographic outcomes of resective surgery with adjunctive implantoplasty over a 6- to 11-year follow-up. Four patients presenting four implants (one per patient) diagnosed with peri-implantitis (according to an established case definition) were included in the present case series. Patients underwent resective surgery, a modified implantoplasty approach, and implant surface decontamination. After surgical therapy, clinical and radiographic outcomes such as bleeding on probing (BoP), suppuration on probing (SoP), probing depth (PD), marginal recession (MR), modified plaque index (mPI), and marginal bone levels (MBLs) were recorded over a long-term follow-up period. Over the 6- to 11-year follow-up, mean BoP, PD, and SoP scores amounted to 17% ± 24%, 3.2 ± 0.66 mm, and 0%, respectively. Mean BoP, PD, and SoP scores were reduced by 67% ± 24%, 2.5 ± 1.26 mm, and 100%, respectively. Radiographic analysis revealed a mean radiographic bone gain of 3.1 ± 1.84 mm. Peri-implant marginal bone loss surface area decreased by 5.7 ± 3.77 mm2 over the long-term follow-up. Resective therapy with adjunctive implantoplasty promoted favorable clinical and radiographic outcomes at treated peri-implantitis sites over a long-term period.

Influence of Proportions of the Nose on Aesthetic Score of an IndividualA Pilot Study

Introduction: Achieving an ideal dental, skeletal and appealing soft tissue adaptation and profile of the patient is of utmost importance postorthodontic treatment. The soft tissue profile is the key determinant of the aesthetics of the individual. Nose, being the centre of the face, plays a major role in determining the aesthetics. But, do morphological changes of the nose influence the perception of aesthetics? Aim: To assess if the proportions of the nose influence the aesthetics/aesthetic score of an individual. Materials and Methods: The present pilot cross-sectional study was conducted on 50 patients reporting to the Outpatient department at Saveetha Dental College and Hospitals, Chennai who were randomly selected to participate in this study. Calibrated anterior and right lateral profile view photographs as black and white images were taken. The basal alar width, length of the nose and the nasal index were calculated using software. Each photograph was also scored on a scale of 0-10 by 4 individuals on the basis of their perception of aesthetics to determine the aesthetic score. The obtained data was tabulated and statistically analysed using Pearson’s correlation method. Results: Mesorrhine type of nose was the most prevalent type of nose in the selected population. With Pearson’s correlation, a negative correlation that was statistically non significant (p-value &lt;0.05) was observed between nasal index and aesthetic score. Patients with leptorhinne type of nose have an increased aesthetic score than mesorrhine and platyrrhine type of nose. Conclusion: The type of nose does not influence the aesthetics of an individual. The divine or golden proportions are not the actual determinants of facial attractiveness and aesthetics. The golden proportions are one of the determinants of facial attractiveness and aesthetics.

A Life Dedicated to Climbing and Its Sequelae in the Fingers—A Review of the Literature

Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic.

Characteristics of Shoulder and Trunk Mobility of Adolescent Female Volleyball Players

&lt;p&gt;目的 : 反覆的過肩動作容易導致運動員肩關節外轉角度增加、內轉角度減少、及前側關節囊鬆弛，進而導致肩部傷害，本研究目的是比較青少年女性排球選手慣用手及非慣用手肩部與軀幹活動度差異。方法 : 共 16位高中女性排球選手參與,使用關節角度計評估慣用側與非慣用側的肩部及軀幹活動度，並計算肩內外轉全距、肩內/外轉兩側差異百分比、同側的肩內/外轉角度差異百分比、以及內轉角度缺損差異角度。以相依樣本 t 考驗分析參與者兩側之肩部活動度及軀幹活動度差異。結果 : 比較高中女性排球運動員的兩側肩關節活動度表現，僅在肩外轉角度項目，慣用側顯著大於非慣用側 ( p &lt; .05 )，其餘項目則未達顯著水準。另外，軀幹右轉與左轉活動度亦無顯著差異。慣用側與非慣用側的兩側差異百分比在內轉角度差異值達 14.30 &amp;plusmn; 27.18 %，在外轉角度差異值達 -9.01 &amp;plusmn; 12.54 %;同側內外轉角度差異百分比在慣用側達 31.73 &amp;plusmn; 39.69 %，在非慣用側達 6.06 &amp;plusmn; 30.08 %。結論 : 結果發現青少年女性排球選手在慣用側肩外轉角度明顯大於非慣用側，顯示健康選手在慣用側使用上已產生關節角度及軟組織適應的情形，軀幹活動度則無代償狀況發生，建議加強肩關節後側伸展，以及強化肩部肌力。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Purpose: Repeated overhead movement could lead to an increase in external angle and decrease in internal angle of shoulder, and relaxation of anterior capsule, which may cause shoulder injuries. The purpose of this study is to compare the shoulder and trunk mobility of dominant and non-dominant side of the adolescent female volleyball players. Methods: 16 high school female volleyball players engage in this study. The range of motion of the shoulder and trunk of the dominant side and the non-dominant side was evaluated by using the joint goniometer, and the total range of shoulder rotation, the percentage of differences of internal and external rotation angle between dominant and non-dominant side, the percentage of difference between internal and external angle of same side, and the deficit of internal rotation angle was calculated. Dependent-samples t-test was used to analyze the difference of shoulder and trunk mobility between two sides. Results: Comparing the shoulder mobility of both limbs in high school female volleyball players, it was found that only in the angle of external rotation of dominant side was significantly larger than the non-dominant side, with no other differences between two sides. In addition, there was no significant difference in the range of motion of trunk rotation. The difference at internal rotation angle between two sides was 14.30 &amp;plusmn; 27.18 %, at external rotation angle was -9.01 &amp;plusmn; 12.54 %. The differences between internal and external rotation angle at the dominant side was 31.73 &amp;plusmn; 39.69 %, and at the non-dominant side was 6.06 &amp;plusmn; 30.08 %. Conclusions: The results showed that the external rotation angle of the shoulders on the dominant side of adolescent female volleyball players was significantly greater than that on the non-dominant side. It shows that healthy athletes have produced joint angles and soft tissue adaptations on the dominant side, while the range of motion of the trunk has no compensation. It is recommended to stretch the back of the shoulder joint and strengthen the shoulder muscles.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Screw-Type Collar vs. Non-Screw-Type Collar Implants—Comparison of Initial Stability, Soft Tissue Adaptation, and Early Marginal Bone Loss—A Preclinical Study in the Dog

Simple SummaryImplant neck characteristics may affect initial implant stability, soft tissue healing, and early marginal bone loss (EMBL) at second-stage surgery. Screw-type rough-surface collar implants had statistically significant poorer soft tissue healing and increased marginal bone loss compared to non-screw type implants at the time of 2nd-stage surgery. The significance of the novel implant design results in preventing EMBL awaits further research.Background: Implant neck characteristics may affect initial implant stability, soft tissue healing, and early marginal bone loss (EMBL) at second-stage surgery. The null hypothesis was that, following two-stage implant insertion, rough surface, non-screw-type collar implants will present lower EMBL at 2nd-stage surgery than rough-surface, screw-type collar implants. Methods: The study comprised seven male beagle dogs (mean weight 10.57 ± 2.8 kg; range 9–17 kg). A novel implant design was developed, composed of 2 parts: an apical part resembling a regular threaded implant, and a coronal non-screw-type collar, 4.2 mm long, served as the study group, whereas standard threaded implants served as control. Twenty-eight implants were placed: two on each side of the mandible. All implants were sand-blasted/acid-etched and of similar dimensions. Each dog received four implants. To assess location (anterior vs. posterior) impact on the outcomes, implants were placed as follows: group I—posterior mandible right—non-screw-type collar implants; group II—anterior mandible right—similar non-screw-type collar implants. To assess the collar-design effect on the outcomes, implants were placed as follows—Group III—anterior mandible left—control group, screw-type collar implants; Group IV—study group, posterior mandible left—non-screw-type collar implants. The following parameters were measured and recorded: insertion torque, soft tissue healing, early implant failure, and EMBL at 2nd-stage surgery. Results: No statistically significant differences were noted between groups I and II regarding all outcome parameters. At the same time, although insertion torque (55 N/cm) and early implant failure (0) were similar between groups III and IV, group III presented significantly poorer soft tissue healing (1.43 vs. 0.14) and increased marginal bone loss (0.86 vs. 0 mm). Conclusions: When a two-stage implant protocol was used, rough-surface non-screw-type collar implants led to superior outcomes at 2nd-stage surgery. Implant location did not affect the results. The significance of this result in preventing EMBL awaits further research.

Pumping the Periosteum: A Feasibility Study.

Gradual elevation of periosteum from the bone surface is known to promote the adaptation of soft tissues and the formation of hard tissues. The aim of our study was to estimate the benefit of periosteal distraction osteogenesis (PDO) on de novo bone formation in a rat model. After device placement, animals were allowed for a latency period of 7 days. Animals in the PDO group were subjected to distraction at a rate of 0.1 mm/d for 10 days. In the periosteal pumping (PP) group, the animals were subjected to distraction at a rate of 0.1 mm/d. The direction of distraction was alternated every 2 days. The animals were euthanized at 17, 31, and 45 days after surgery, and the samples were analyzed histologically and by microcomputed tomography. In both groups, the new bone was characterized as primary woven bone that was located at the leading edge of bone apposition. Bone volumes significantly increased throughout the observation period both in the PP group ( P = 0.018) and in the PDO group ( P < 0.001). The new bone was denser and more mature in the PP group than in the PDO group, and the difference was significant at the 31-day time point ( P = 0.024). However, the volume of the new bone was higher in the PDO at the 45-day time point ( P < 0.001). We propose that the PP may be applied to enhance the osteogenic capacity of periosteum without plate elevation. Because this is only a proof-of-principle study, the alternated protocol of periosteal distraction warrants evaluation in the future studies.

Preliminary investigation of Allosauroidea facial integument and the evolution of theropod facial armor

In amniotes, the growth of specialized facial integument, or external skin tissues, has a close relationship with the texture and morphology of underlying cranial bones. Osteological correlates of facial skin structures have been used before to reconstruct the integument of several extinct dinosaurian lineages but not for theropods from the clade Allosauroidea, whose members exhibit exceptionally rugose and heavily ornamented skulls. This study aims to investigate, in a preliminary sense, the facial integument of Allosauroidea by examining osteological correlates from high-resolution photographs of fossil material. We compared the inferred integument of allosauroids to analogous structures in modern animals in order to discuss potential biological and behavioral implications, with soft-tissue adaptations suggesting headbutting or sparring in some taxa. Allosauroids display an evolutionary trend for increasing cranial cornification throughout their history, and their most derived members exhibit greater development of facial armor than other tetanurans. We developed three hypotheses to explain the selective pressures that may have driven the independent evolution of this dermal armor in several unrelated theropod clades, namely abelisaurids, carcharodontosaurids, and tyrannosaurids. Empirical tests of paleoecological data did not support any of the three hypotheses of intraspecific conflict, competition from other carnivores, or dangerous prey items as the main pressure that drove the evolution of theropod facial armor. We suggest that more sampling of armor-faced theropods and their associated ecosystems, especially those from the Southern Hemisphere, is needed to reveal the reasons behind the convergent evolution of this integument.

Facial soft-tissue changes after anterior maxillary osteotomy: A prospective study.

The aim of this study was to analyze and assess the soft-tissue response in patients treated by anterior maxillary osteotomy (AMO) in the postoperative period at 3, 6, and 9 months and to qualitatively assess the outcome of the surgery by the patients. The study included twenty adult healthy patients between 18 and 25 years with skeletal Class II malocclusion and requiring AMO setback for the correction of facial deformity. Preoperative and postoperative lateral cephalograms were taken and soft-tissue changes that occurred following AMO were compared at 3, 6, and 9 months postoperatively. The stability and acceptance of the soft-tissue changes were analyzed, and the patient's acceptance for the soft-tissue changes was measured on the surgical rating scale (SRS). All the soft-tissue parameters showed noticeable changes following AMO. Statistically significant difference was observed with nasolabial angle, upper lip, and lower lip inclination. All the patients were moderately satisfied with the outcome of the surgery. This study aims in quantifying the soft-tissue changes following the AMO and the quality of the changes were recorded based on the SRS by the patients. Although there are changes associated with all the parameters assessed, significant differences was observed in nasolabial angle, upper lip, and lower lip inclination. The surgeon must be aware of the soft-tissue adaptation following the surgery for better outcomes.

Rethinking the decision-making process to treat gingival recession associated with non-carious cervical lesions.

The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.

Factors Affecting Soft and Hard Tissues Around Two-Piece Transmucosal Implants: A 3-Year Prospective Cohort Study.

This 3-year study aimed to evaluate hard and soft tissue modification around a two-piece implant characterized by a transmucosal hyperbolic neck in healthy consecutive patients with a need for single-tooth replacement. Two-piece implants (n = 66) were placed with a flapless technique in 56 patients (27 men; 29 women; mean age 55 ± 9 years): 16 immediately after root extraction (immediate group), 20 after 8 to 12 weeks (early group), and 30 after 10 or more months (delayed group). The transmucosal hyperbolic neck was exposed 1 to 1.5 mm above gingival level. Customized abutments were positioned 3 months later with the implant-abutment connection located approximately 1 to 1.5 mm above soft tissue level. Provisional cemented resin crowns were designed with the finishing line at the hyperbolic neck and then positioned to avoid excessive compression of soft tissue, to guide gingival contours. Twenty days later, a definitive metal-ceramic crown was cemented. In all patients, the gingival biotype (thin or thick) was also evaluated. The primary outcomes were as follows: 36-month implant survival rate, peri-implant marginal bone level (MBL, in mm) changes observed in single-blind on radiographs at 1, 3, 6, 12, 24, and 36 months (T1, T3, T6, T12, T24, and T36), and pink esthetic score (PES) at T6, T12, and T36 to analyze soft tissue adaptation after loading and crown application. The secondary outcomes were as follows: plaque score and bleeding on probing (BOP). Linear regression models and multilevel mixed logistic regression were used to detect any statistical difference of MBL according to operative parameters. Kruskal-Wallis one-way analysis of variance (ANOVA) on ranks was performed to assess statistical differences of PES at T6, T12, and T36. The survival rate was 100%. The dropout rate was 1.79%. No infections, mucositis, or peri-implantitis were reported. Implants placed in thick-biotype tissues showed a statistically different lower bone loss at 36 months with respect to the thin biotype (P < .05). At 36 months, the early group showed lower bone loss compared with the delayed group (P < .05). Multilevel mixed logistic regression revealed that gingival biotype was the parameter that was most related to MBL variations (P = .025). The PES value (mean ± SD) at T6 was 10.76 ± 1.19 (median: 11; range: 8 to 13; IQR: 10 to 12). The values statistically increased at T12 and T36, where the mean values were 11.76 ± 1.10 (median: 12; range: 9 to 13; IQR: 11 to 12) and 11.83 ± 1.03 (median: 12; range: 9 to 14; IQR: 11 to 13). MBL and soft tissue clinical parameters measured around two-piece hyperbolic-neck implants were stable during the 3-year follow-up and free from complications. The exposure of the hyperbolic neck for 1.0 to 1.5 mm allowed a flapless one-stage surgery, which supported fast adaptation of the soft tissues, evidenced by high PES values and low percentages of BOP. The results from the study imply a new simple approach in the clinical management of gingival and bone tissue.

Immediate Loading of Single Implants, Guided Surgery, and Intraoral Scanning: A Nonrandomized Study.

To compare clinical and esthetic outcomes between immediately loaded single implants placed with and without a fully guided surgical procedure. Patients with a missing maxillary tooth (second premolar to second premolar) were considered for inclusion in this 1-year prospective nonrandomized study. Exclusion criteria were general health contraindications for oral surgery besides the need for bone grafting or ridge augmentation. One group received digital implant planning, fully guided surgery, and immediate loading (DIL). The other group received freehand surgery and immediate loading (IL). Outcome measures were implant survival, marginal bone loss, soft tissue changes, papilla index, pink and white esthetic scores (PES and WES, respectively), and patient-reported outcome measures (PROMs). Two of 21 implants failed in the DIL group soon after placement, resulting in a 1-year implant survival rate of 90.5%, while no implants failed in the IL group. Significantly higher papilla index scores and lower soft tissue changes were found for the DIL group compared to the IL group. No differences were found after 1 year regarding marginal bone loss, PES, WES, or PROMs. Within the limitations of this study, immediate loading in combination with fully guided surgery might negatively affect implant survival. Immediate loading, fully guided surgery, and a digital workflow appear to have a positive effect on early soft tissue adaptation.

Categorizing 10 Sports According to Bone and Soft Tissue Profiles in Adolescents.

Considering the different loading and training characteristics of the sports practiced during growth, it is important to specify and categorize the bone and soft tissue adaptations in adolescent athletes. This study aimed to categorize 10 different loading sports and a nonsport group and identify the differences in bone density and soft tissues. The sample included 625 adolescents (10 to 17 yr of age) of 10 sports (soccer, basketball, volleyball, track and field, judo, karate, kung fu, gymnastics, baseball, and swimming) and a nonsport group. Dual-energy x-ray absorptiometry assessed areal bone mineral density (aBMD), bone mineral apparent density (BMAD), and soft tissues (lean soft tissue and fat mass). The results were adjusted for sex, peak height velocity status, lean soft tissue, fat mass, and weekly training volume. The comparisons among groups showed that soccer had the highest whole-body aBMD (mean ± SEM: 1.082 ± 0.007 g·cm) and lower limb aBMD (1.302 ± 0.010 g·cm). Gymnastics presented the highest upper limb aBMD (0.868 ± 0.012 g·cm) and whole-body BMAD (0.094 ± 0.001 g·cm). Swimming presented the lowest aBMD values in all skeletal sites (except at the upper limbs) and whole-body BMAD. The soft tissue comparisons showed that soccer players had the highest lean soft tissue (43.8 ± 0.7 kg). The lowest fat mass was found in gymnasts (8.04 ± 1.0 kg). The present study investigated and categorized for the first time 10 different sports according to bone density and soft tissue profiles. Soccer and gymnastics sport groups were found to have the highest bone density in most body segments, and both sports were among the groups with the lowest fat mass.

Increased posterior shoulder capsule thickness in youth elite handball players: a sonographic investigation

Range of motionadaptations in the shoulders of overhead throwing athletes have been reported, but knowledge about the development of soft-tissue adaptations is limited. The purpose of this study was to investigate differences in posterior shoulder capsule thickness and internal rotation between the throwing and non-throwing shoulder. On the basis of the sample size calculation, we assessed 63 youth elite handball players (33 boys and 30 girls, mean age: 13.6 ± 0.9 years) for glenohumeral internal and external rotational range of motion, humeral retrotorsion, and posterior capsule thickness (PCT) with a manual goniometer and a portable ultrasound device and calculated sports-specific differences between the throwing and non-throwing shoulder as well as correlations with PCT. Youth handball players showed side-to-side differences in internal rotation, external rotation, and humeral retrotorsion between the throwing and non-throwing shoulder. Posterior shoulder capsules were 1.21 times thicker (95% confidence interval: 1.1-1.3) in the throwing shoulder than in the non-throwing shoulder (1.3 ± 0.3 mm vs. 1.2 ± 0.2 mm, P < .0001). Loss of internal rotation did not correlate with PCT. In youth elite handball athletes, posterior shoulder tightness and subsequent sports-specific loss of internal rotation in the throwing shoulder are not related to PCT. Thus, in this age class, other (soft-tissue) factors must be responsible for this condition.

Effect of Rough Surface Platforms on the Mucosal Attachment and the Marginal Bone Loss of Implants: A Dog Study.

The preservation of peri-implant tissues is an important factor for implant success. This study aimed to assess the influence of the surface features of a butt-joint platform on soft-tissue attachment and bone resorption after immediate or delayed implant placement. All premolars and first molars of eight Beagle dogs were extracted on one mandible side. Twelve-weeks later, the same surgery was developed on the other side. Five implants with different platform surface configurations were randomly inserted into the post-extracted-sockets. On the healed side, the same five different implants were randomly placed. Implants were inserted 1 mm subcrestal to the buccal bony plate and were connected to abutments. The primary outcome variables were the supracrestal soft tissue (SST) adaptation and the bone resorption related to the implant shoulder. The SST height was significantly larger in immediate implants (IC95% 3.9–4.9 mm) compared to delayed implants (IC95% 3.1–3.5 mm). Marginal bone loss tended to be higher in immediate implants (IC95% 0.4–0.9 mm) than in delayed implants (IC95% 0.3–0.8 mm). Linear-regression analysis suggested that the SST height was significantly affected by the configuration of the platform (0.3–1.9 mm). Roughened surface platforms resulted in higher SST height when compared to machined surface platforms. Marginal bone loss was less pronounced in roughened designs.