Soft Tissue Components Research Articles

Giant cell tumour of hand bones: outcomes of treatment.

The purpose of this study was to report the incidence of giant cell tumour of the hand bones in an Asian population, document treatment options and report outcomes of treatment. Of 698 giant cell tumours of bone that underwent surgery between January 2011 and December 2020 at our institute, only 22 (3%) were in the hand. Fourteen occurred in the metacarpals, eight in the phalanges. Fifteen were primary tumours and seven had recurrent disease. Twenty lesions had an associated soft tissue component. Two patients treated for primary disease and one who had been treated for recurrence had local recurrence. Recurrence occurred in two of nine patients treated with curettage, one of three with resection and none of five with ray or digit amputation. Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control.Level of evidence: IV.

English

A 49-year-old female patient was admitted in the medicine department of Assam Medical College with complaints of paraparesis of 15 days duration and backache of 3 months’ duration. She had history of dizziness and low blood pressure. On general examination, she had tachycardia (heart rate of 126 beats / min), tachypnoea (respiratory rate 24 / min), severe pallor and bilateral non-pitting pedal oedema. The patient had low haemoglobin (6.6 gm / dl) with red blood cell (RBC) count of 2.5 million / mm3 . She was sent to the radio-diagnosis department for non-contrast computed tomography (CT) scan of thorax and contrast enhanced magnetic resonance (CEMR) of dorsolumbar region. On CT scan, soft tissue density lesions were noted in paraspinal region extending from lower thoracic, lumbar region without destruction of vertebral bodies. Additional findings include hepato-splenomegaly and left sided pleural effusion. On CEMR, there was T1 hypo and T2 / T2FSisointense soft tissue lesion in paraspinal region extending from lower thoracic, lumbar and sacral vertebrae. The lesions were showing diffusion restriction, diffusion weighted imaging (DWI) with low apparent diffusion coefficient (ADC) value and mild enhancement on post contrast scan. The soft tissue component was noted to extend into the epidural space in multiple vertebral levels in thoracic, lumbar and sacral regions causing spinal canal stenosis, maximum (7.0 mm) at L4 vertebral level. Based on the imaging findings, a diagnosis of extramedullary haematopoiesis in paraspinal region with extension of the soft tissue in the epidural space leading to compression of spinal cord at multiple levels was made.

Total knee replacement in Osteogenesis Imperfecta: a case report and review of the literature

BackgroundA review of the literature revealed that only 9 total knee replacements were performed on patients with osteogenesis imperfecta (OI), with one being a revision procedure of a periprosthetic fracture. Of the 9 primary procedures, all used cemented prostheses, and 3 patients had an osteotomy at the same procedure. Our patient required a hinged prosthesis because of collateral ligament incompetence and is the first such case reported in the literature.Case presentationPresented here is a total knee replacement performed on a 52-year-old patient with osteogenesis imperfecta (OI) who injured her left knee and ruptured her anterior cruciate ligament. Her right knee suffered from severe degenerative changes with an incompetent medial collateral ligament. It was decided to replace the right knee before addressing the left knee injury. A hinged revision prosthesis was used. The smallest components available were used because of the small anatomical bony dimensions.ConclusionThis is the first reported case of a hinged prosthesis and highlights the soft tissue component of osteogenesis imperfecta. We also highlight the technical problems with these patients, including mal-alignment, small bony dimensions and bone fragility.

Obstructive Sleep Apnea

Aim: To evaluate diagnostic cephalometric parameters and their influence on skeletal and soft tissue components in obstructive sleep apnea (OSA). Materials and Methods: The study is a prospective case study of 40 diagnosed cases (as diagnosed by Type IV level study) of obstructive sleep apnea who were reported to the Department of Oral Medicine and Radiology with their age ranging from 28 to 75 years. Lateral cephalometric radiographs in upright and supine posture were taken, with teeth in centric relation, and the head aligned with Frankfort horizontal (FH) plane parallel to the floor. The focus-coronal plane distance was 5 feet, the film-coronal plane distance was 15 cm, and the magnification was 10%. Results: OSA patients experience an increase in values of sella nasion point A (SNA) and sella nasion point B (SNB) at the supine position with respect to the upright position and experience a decrease in values of nasion sella turcica odontoid process tangent (NSL-OPT) and nasion sella turcica- cervical vertebra tangent (NSL-CVT) at the supine position with respect to the upright position. The parameters of paramount importance in the pathogenesis of OSA are soft palate thickness, length, and tongue length. Conclusion: SNA, SNB and NSL-OPT, NSL-CVT are inversely related to each other and play a role in the consequence or pathogenesis of OSA. Tongue height is of the least significance in the pathogenesis of OSA. The cephalometric findings are of paramount importance to know the exact site of obstruction in the pathogenesis of OSA.

3D printing in surgical simulation: emphasized importance in the COVID-19 pandemic era

3D printing in surgical simulation: emphasized importance in the COVID-19 pandemic era

Prediction of soft tissue coverage following distal femur bone sarcoma resection: A preliminary report.

We aimed to examine the predictability of the need for soft tissue reconstruction during limb-sparing surgery through preoperative magnetic resonance (MR) imaging in patients diagnosed with a malignant bone tumor in the distal femur. The study included 42 patients who were operated for a bone sarcoma of the distal femur at our clinic between 2016 and 2018. The recorded parameters included the demographic characteristics of the patients, tumor diagnosis, tumor side, total tumor volume, tumor soft tissue component volume, tumor soft tissue component volume-to-total tumor volume ratio, tumor localization by MR imaging, the need for soft tissue reconstruction, the muscles used for soft tissue reconstruction, the biopsy site, and the biopsy type. Tumor volume was calculated on MR imaging of the distal femur region performed before surgery. Our study established cut-off values for soft tissue reconstruction need following resection as a total tumor volume of 96.4 cm3 , a tumor soft tissue component volume of 22 cm3 , a tumor soft tissue component volume-to-total tumor volume ratio of 48.9%, and tumor localization in two different regions on axial distal femoral MR images. Considering these cut-off values, by calculating tumor volume values preoperatively we can predict the need for rotational muscle flaps for soft tissue coverage following distal femur bone sarcoma resection and endoprosthesis reconstruction. Anticipating the need for soft tissue reconstruction may affect the duration and success of the operation.

Arthroscopic Double-Row Bony Bankart Bridge Repair Using a Tensionable Knotless System

Posterior labral pathology is common in contact athletes; however, posterior glenoid avulsion fractures, also known as posterior bony Bankart lesions, are less common. Posterior instability affects approximately 10% of all patients with shoulder instability. Diagnosis in these high-risk individuals often follows a traumatic posterior dislocation. The patient feels grossly unstable but may or may not have recurrent dislocations beyond the initial trauma. Surgical correction and favorable surgical outcomes require a full understanding of both the soft-tissue and bony components of the injury. Stable osseous fixation is required to restore appropriate glenoid version, depth, and to prevent malunion. We present a technique to mobilize and stabilize a posterior bony Bankart lesion with a knotless suture bridge construct. We feel that this technique is reliable and reproducible and allows for a superior quality of fragment reduction when compared with systems using larger anchors and knotted systems.

Radiation Therapy (RT) target determination for irradiation of bone metastases with soft tissue component: Impact of multimodality imaging

Abdominal wall reconstruction and hernia repair surgery continue to evolve with the intention to successfully repair the abdominal wall,

Radiation Therapy (RT) target determination for irradiation of bone metastases with soft tissue component: Impact of multimodality imaging

Radiation Therapy (RT) target determination for irradiation of bone metastases with soft tissue component: Impact of multimodality imaging

Abstract PO-024: Boosting up knee bone tumor detection from radiology and magnetic resonance imaging by using deep learning techniques

Abstract Bone tumors can occur at all ages and also appear around skeletal positions of the human knee. Since the types and expression patterns are extremely diverse, some cases are non-specific symptoms or the onset of symptoms is delayed, and the diagnosis is delayed by low suspicion of physicians. However, timely diagnosis is very important for treatment to reduce extreme pain for patients. Therefore, detecting tumors from radiography and MRI images based on deep learning has recently emerged with the advantage of remarkably shortening time and a completely automatic diagnosis. In this study, we developed a radiology and MRI dataset for knee bone tumor and contributed a robust deep learning-based method to detect tumors. Through an association with Chonnam National University Hospital, we built the radiology knee bone tumor dataset with 1695 high-resolution images including normal, benign and malignant. It is the first dataset for knee bone tumor detection with five categories for classification, and tumor masks, bone regions for segmentation. We proposed multi-level distance features to exploit the tumors based on neighboring regions dealing with challenges from small size, appearance variety, and uncommon. It led to interpreting high-risk regions occurring tumors. Multi-task learning with classification and segmentation helped to learn the mutual benefit from the pixel-wise segmentation and image classification. Our model is fined-tuned in image patches to boost up the accuracy in malignant classification. In difficult cases, MRI has been proved to be a preeminent option to be capable of presenting bone marrow and soft tissue. Therefore, we built MRI knee bone tumor dataset with 104 study cases over 900 series. We used Slicer3D for making the ground-truth in T1-, T2-, and PD- weighted MRI. We generated tumor and bone segmentation masks and classified the study case into three groups: normal, benign, and malignant. We made the ablation study experiments to our radiology dataset. For multi-task learning, we increased Mean IoU from 69.5% to 77.3%. Multi-level distance features helped to increase to 78.8%. For classification, multi-task learning boosted the accuracy from 93% to 95.3%, and multi-level distance features helped the increase of 3%. Besides, the patching training improved malignant classification from 66.7% to 81.5%. The results demonstrated that our deep learning-based method made an important contribution to help doctors in the clinical diagnosis process using a radiology image. Furthermore, our method produced the high-risk neighbor tumor regions by multi-level distance features instead of extracting exactly tumor regions. To improve more accuracy in automatic detection, we hope that MRI images with high contrast resolution can describe clearly soft tissue components and help to recognize the attributes of the tumors clearly. Nonetheless, the dataset of knee bone tumor on MRI is raw and not standard with high complexity. Preprocessing these MRI images is also our initial success to the steppingstone of further research. Citation Format: Nhu-Tai Do, Sung-Taek Jung, Soo-Hyung Kim. Boosting up knee bone tumor detection from radiology and magnetic resonance imaging by using deep learning techniques [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PO-024.

Bilateral extra-adrenal perirenal myelolipomas: a case report

BackgroundMyelolipomas are mesenchymal tumors usually involving the adrenal gland. They are a rare entity with incidence ranging from 0.08 to 0.4% as per autopsy reports. Only 15% of these are in extra-adrenal locations such as pelvis, retroperitoneum, mediastinum, lungs, stomach, liver, spleen and kidneys. Very few (only 3) cases of bilateral extra-adrenal perirenal myelolipomas have been reported until now; and one such case has been presented in our case report.Case presentationA 45-year-old male presented with abdominal distension and bilateral lower limb edema for 2 months. Renal functions were mildly deranged. Ultrasound was suggestive of perirenal masses. CT scan of the abdomen confirmed the diagnosis of bilateral extra-adrenal, perirenal myelolipoma. The differentials of lipomatous retroperitoneal tumors were considered. Core biopsy from perirenal masses revealed adipose tissue with interspersed hematopoietic precursors.ConclusionExtra-adrenal myelolipoma are rare tumors that are not known to have malignant potential and may be symptomatic only due to mass effect. Diagnosis can be confirmed by imaging in most cases. Histopathology may not be able to confirm malignancy even in sarcoma if sample is not taken from the appropriate site, usually non-fatty soft-tissue components. This rare case is presented in order to add to literature, the varied presentations of extra-adrenal myelolipomas.

Robotic-assisted vs conventional surgery in medial unicompartmental knee arthroplasty: a clinical and radiological study

BackgroundThe use of unicompartmental knee arthroplasty (UKA) has increased and new technologies have been developed to improve patient survival and satisfaction, soft tissue balance, alignment, and component size. Robot-assisted systems offer an increase in surgical precision and accuracy. The purpose of this study is to evaluate the precision of component position using five radiological parameters in conventional and robotic-assisted medial UKA using the NAVIO system.MethodsA cohort study was designed for patients who underwent medial UKA between April 2017 and March 2019 in a single center. Patients were allocated in the conventional (UKA-C) or robotic-assisted (UKA-R) group. The variables analyzed were age, gender, affected knee side, length of hospital stay, surgical time, and radiological measurements such as anatomical medial distal femoral angle (aMDFA), anatomical medial proximal tibial angle (aMPTA), tibial slope, the sagittal femoral angle, and the component size. A target was defined for each measurement, and a successful UKA was defined if at least four radiological measures were on target after surgery. Also, patients’ reported outcomes were evaluated using the Oxford Knee Score (OKS) and a numeric rating scale (NRS) for pain.ResultsThirty-four patients were included, 18 of them underwent UKA-R. The success rate for UKA in the UKA-R group was 87%; meanwhile, in the UKA-C group this was 28%, this difference was significant and powered (Fisher’s exact test, p = 0.001; 1 − β = 0.95). Also, a 5-point difference in favor of the UKA-R group in the median OKS (p = 0.01), and a significantly lower median NRS for pain (p < 0.000) were found after surgery.ConclusionsUKA-R achieved more precision in the radiological parameters’ measure in this study. Also, UKA-R has a trend towards a better OKS and a lower NRS for pain at short-term follow-up.

COMPUTER TOMOGRAPHY AND X-RAY DIAGNOSTICS OF PERIPHERAL PRIMITIVE NEUROEECTODERMAL TUMORS (PNET) IN CHILDREN

Relevance: Peripheral primitive neuroectodermal tumor (PNET) belongs to the group of malignant tumors that develop from migrating embryonic neural crest cells. PNET includes a number of nosological forms: Askin's tumor, esthesioneuroblastoma, the very peripheral primitive neuroectodermal tumor, Ewing's sarcoma . PNET accounts for 3–9% of all soft tissue tumors in children and 19% of all soft tissue sarcomas. In European countries and the United States, the frequency of their occurrence is 3.4 cases per year per 1 million children under 15 years of age, in Kazakhstan - 0.6-1.2 cases per 1 million child population. Rapid tumor growth, malignancy and early metastasis to other organs and systems predetermines its special role in oncology. Objective of the study: to improve the quality and availability of early diagnosis of sarcomas in children in medical institutions of the general medical network. Results of the study: 35 cases of peripheral PNET in children were analyzed. The age of the patients is from 1.5 to 17 years. The average age is 9.3 years. There were 1.3 times more boys among patients than girls. Extra-skeletal localization was found in one patient (3.6%). Radiographically, it is often almost impossible to make a differential diagnosis between the manifestations of Ewing's sarcoma and primary chronic or "healed" (antibiotic) forms of acute hematogenous osteomyelitis in the initial phase of the process, before the formation of the extraosseous soft tissue component. The process of bone damage is more often localized in its diaphysis and subsequently spreads to the metaphyses of the bone.

Spheno-orbital meningiomas: surgical techniques and results

IntroductionSpheno-orbital meningiomas are characterized by bone invasion with extensive hyperostosis and possible encroachment into the orbit, infra-temporal fossa, and/or the cavernous sinus that render total surgical excision challenging. The surgical technique utilized is a key factor facilitating complete resection and hence improvement of proptosis and accompanying visual symptoms.MethodsThis is a retrospective study of twenty-two patients (including 4 recurrent cases) with meningioma en-plaque, presenting with hyperostosis and proptosis. We describe the surgical approaches used, technique, and extent of resection in addition to postoperative outcome.ResultsIn twenty patients, the pterional approach was used, while two patients were operated on via the mini orbito-zygomatic approach. Total resection of the tumor was achieved in 10 cases (45.5%), subtotal in 6 (27.3%), partial in 5 (22.7%), and in 1 case, injury to the internal carotid artery lead to premature termination of surgery. Seventeen patients (77.3%) had improvement of proptosis, 2 (9.1%) had partial improvement, and 2 (9.1%) had no improvement at 3 months of follow-up. Post-operative morbidities include cerebrospinal fluid leak, infection, and hydrocephalus, each occurred in one (4.5%) different case.ConclusionsProper drilling of the lateral and superior orbital walls with excision of any intra-orbital soft tissue components is all key points for better surgical resection and clinical regression of proptosis. However, factors such as extension of the hyperostosis to the infra-temporal fossa or medial orbital wall, tumor invasion of the cavernous sinus, or adherence of tumor to the orbital muscles, prevent total excision.

Optimization of a calibration phantom for quantitative radiography.

Dual energy radiography (DER) makes it possible to obtain separate images for soft-tissue and bony structures (tissue maps) based on the acquisition of two radiographs at different source peak-kilovoltage values. Current DER studies are based on the weighted subtraction method, which requires either manual tuning or the use of precomputed tables, or on decomposition methods, which make use of a calibration to model soft-tissue and bone components. In this study, we examined in depth the optimum method to perform this calibration. We used simulations to optimize the calibration protocol and evaluated the effect of the material and size of a calibration phantom composed of two wedges and its positioning in the system. Evaluated materials were water, PMMA and A-150 as soft-tissue equivalent, and Teflon, B-100 and aluminum as bone equivalent, with sizes from 5 to 30cm. Each material combination was compared with an ideal phantom composed of soft tissue and bone. Our simulation results enabled us to propose four designs that were tested with the NOVA FA X-ray system with a realistic thorax phantom. Calibration based on a very simple and inexpensive phantom with no strict requirements in its placement results in appropriate separation of the spine (a common focus in densitometry studies) and the identification of nodules as small as 6mm, which have been reported to have a low rate of detection in radiography. The proposed method is completely automatic, avoiding the need for a radiology technician with expert knowledge of the protocol, as is the case in densitometry exams. The method provides real mass thickness values, enabling quantitative planar studies instead of relative comparisons.

PET/MRI, aiming to improve the target for Fractionated Stereotactic Radiotherapy (FSRT) in recurrence of resected skull base meningioma after 2 years: Case report

The increasing use of highly conformal radiation deliberates a higher accurate targeting. Contouring and clinical judgment are presumably the crucial point, thus positron emission tomography/magnetic resonance imaging PET/MRI with somatostatin analogs appears to be useful in radiotherapy target definition. A case report of a 43-year-old woman presented with a recurrence of a meningioma (World Health Organization group I classification) in skull base, 2 years after resection. Magnetic resonance imaging (MRI) revealed a left sided skull base mass on sphenoid wing, anterior clinoid and with a soft tissue component in the lateral portion of the orbit. Contrast-enhanced MRI and a computed tomography (CT) dedicated were used to the radiotherapy planning. Aiming an improvement on target volume delineation, 68Ga-DOTATOC-PET/MRI was also performed due the difficult localization of the tumor in skull base. Was treated using intensity-modulated radiotherapy (IMRT) to a total dose of 54 Gy in 28 fractions. It was prescribed to the planning target volume (PTV), defined based of both imaging modalities. In our case PET/MRI helped to define the target, which volume becomes bigger than that based exclusively on MRI and CT.

Role of magnetic resonance imaging in diagnosis of pediatric bone tumors

ObjectivesTo evaluate the diagnostic effect of MRI in pediatric patients with suspected bone tumors and other bone pathologies.BackgroundBony lesions in pediatric age group is a frequent cause of pain and swelling. MRI is used to evaluate such patients, and information delivered by MRI is used to diagnose these lesions, whether benign or malignant. In addition, information delivered by MRI is used to guide biopsy procedure.Patients and methodsThis was a prospective study that included 50 patients. All were referred to the MRI unit in the diagnostic Radiology Department at Menoufia University Hospital from Menoufia University Hospital clinics and private clinics from June 2015 to November 2018.ResultsOur study revealed that MRI plays a sensitive diagnostic role in most cases not solved by plain radiography, for example, characterization of bony lesions like fatty content, cysts with and without fluid–fluid levels, and cartilaginous matrix, and also in aggressive bone lesions, MRI is used for locoregional staging and noninvasive evaluation of response to neoadjuvant treatment.ConclusionMRI is a sensitive and specific tool in primary detection and staging of pediatric bone tumors and tumor-like conditions. MRI helps guide biopsy from the soft tissue components and increases the chance of obtaining a definitive diagnostic result.

Basic Components of Connective Tissues and Extracellular Matrix: Fibronectin, Fibrinogen, Laminin, Elastin, Fibrillins, Fibulins, Matrilins, Tenascins and Thrombospondins.

Collagens are the most abundant components of the extracellular matrix (ECM) and many types of soft tissues. Elastin is another major component of certain soft tissues, such as arterial walls and ligaments. It is an insoluble polymer of the monomeric soluble precursor tropoelastin, and the main component of elastic fibers in matrix tissue where it provides elastic recoil and resilience to a variety of connective tissues, e.g., aorta and ligaments. Elastic fibers regulate activity of transforming growth factors β (TGFβ) through their association with fibrillin microfibrils. Elastin also plays a role in cell adhesion, cell migration, and has the ability to participate in cell signaling. Mutations in the elastin gene lead to cutis laxa. Many other molecules, though lower in quantity, function as essential, structural and/or functional components of the extracellular matrix in soft tissues. Some of these are reviewed in this chapter. Besides their basic structure, biochemistry and physiology, their roles in disorders of soft tissues are discussed only briefly as most chapters in this volume deal with relevant individual compounds. Fibronectin with its multidomain structure plays a role of "master organizer" in matrix assembly as it forms a bridge between cell surface receptors, e.g., integrins, and compounds such collagen, proteoglycans and other focal adhesion molecules. It also plays an essential role in the assembly of fibrillin-1 into a structured network. Though the primary role of fibrinogen is in clot formation, after conversion to fibrin by thrombin it also binds to a variety of compounds, particularly to various growth factors, and as such, fibrinogen is a player in cardiovascular and extracellular matrix physiology. Laminins contribute to the structure of the ECM and modulate cellular functions such as adhesion, differentiation, migration, stability of phenotype, and resistance towards apoptosis. Fibrillins represent the predominant core of microfibrils in elastic as well as non-elastic extracellular matrixes, and interact closely with tropoelastin and integrins. Not only do microfibrils provide structural integrity of specific organ systems, but they also provide basisfor elastogenesis in elastic tissues. Fibrillin is important for the assembly of elastin into elastic fibers. Mutations in the fibrillin-1 gene are closely associated with Marfan syndrome. Latent TGFβ binding proteins (LTBPs) are included here as their structure is similar to fibrillins. Several categories of ECM components described after fibrillins are sub-classified as matricellular proteins, i.e., they are secreted into ECM, but do not provide structure. Rather they interact with cell membrane receptors, collagens, proteases, hormones and growth factors, communicating and directing cell-ECM traffic. Fibulins are tightly connected with basement membranes, elastic fibers and other components of extracellular matrix and participate in formation of elastic fibers. Matrilins have been emerging as a new group of supporting actors, and their role in connective tissue physiology and pathophysiology has not been fully characterized. Tenascins are ECM polymorphic glycoproteins found in many connective tissues in the body. Their expression is regulated by mechanical stress both during development and in adulthood. Tenascins mediate both inflammatory and fibrotic processes to enable effective tissue repair and play roles in pathogenesis of Ehlers-Danlos, heart disease, and regeneration and recovery of musculo-tendinous tissue. One of the roles of thrombospondin 1 is activation of TGFβ. Increased expression of thrombospondin and TGFβ activity was observed in fibrotic skin disorders such as keloids and scleroderma. Cartilage oligomeric matrix protein (COMP) or thrombospondin-5 is primarily present in the cartilage. High levels of COMP are present in fibrotic scars and systemic sclerosis of the skin, and in tendon, especially with physical activity, loading and post-injury. It plays a role in vascular wall remodeling and has been found in atherosclerotic plaques as well.

Multiphoton imaging and Raman spectroscopy of the bovine vertebral endplate.

The interface between the intervertebral disc and the vertebral body is important to the discs' biomechanics and physiology, and is widely implicated in its pathology. This study aimed to explore biochemically and structurally the bony endplate, cartilage endplate and intervertebral disc, below the nucleus and below the annulus in healthy bovine tails. Multiphoton imaging and spontaneous Raman spectroscopy were employed. Raman spectroscopy provided relative quantification of mineral and matrix components across the vertebral endplate and its adjacent areas with microscopic spatial resolution. Microscopy utilising second-harmonic generation (SHG) and two-photon fluorescence (TPF) allowed for the structural identification of distinct endplate regions. The cartilage endplate was revealed as structurally distinct from both the bone and disc, supporting its biomechanical function as a transition zone between the soft and hard tissue components. The collagen fibres were continuous across the tidemark which defines the interface between the mineralised and non-mineralised regions of the endplate. Raman spectroscopy revealed gradients in phosphate and carbonate content through the depth of the endplate and also differences beneath the nucleus and annulus consistent with a higher rate of remodelling under the annulus.

The peri-implant phenotype and implant esthetic complications. Contemporary overview.

To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications. The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications. While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications. Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.