Soft Tissue Dimensions Research Articles

Epicrestal and subcrestal placement of platform-switched implants: 18month-result of a randomized, controlled, split-mouth, prospective clinical trial.

To evaluate the changes in marginal bone levels (MBL) and soft tissue dimension around platform-switched implants with the implant-abutment junction (IAJ) placed at the crest or 1.5-2mm subcrestally. In all, 96 platform-switched implants were placed in either the posterior maxilla or mandible in 48 partially edentulous patients in a split-mouth study. All implants were provisionally restored after 4-5months and definitively after 6months (T6). Radiographic assessment of MBL was assessed at implant placement (T0), T6, 12months (T12), and 18months (T18) after placement. Mid-buccal soft tissue and papilla measurements were performed at T6, T12, and T18. In all, 43 patients with 86 implants completed the study. The T18 examination showed an implant survival rate of 100% in both groups. Analysis showed that MBL varied as a function of IAJ location, which indicated more coronal bone levels with subcrestal (2.39±0.08mm) than with epicrestal placements (0.88±0.08mm) (p<.05). Greater average marginal bone loss was found in the subcrestal group (0.40±0.07mm) compared to the epicrestal group (0.13±0.08mm) although no statistically significant difference was found at T18 (p>.05). Levels of mid-buccal soft tissue had no significant changes over time, regardless of group (p>.05). There was a significant difference in increase in papilla between T6 and T12 and T18 (p=.005 and .001), but not between T12 and T18 (p=.61). These papilla levels and changes were similar between groups (p>.05). The MBL changes around platform-switched implants with same geometry were not affected by the epicrestal or subcrestal location of the IAJ. Furthermore, the location of the IAJ did not affect the implant survival and soft tissue dimensions. However, no bone loss was located apical to the IAJ when the implants were placed subcrestally.

Field-Based Radiographic Imaging of Marine Megafauna: Marine Iguanas (Amblyrhynchus cristatus) as a Case Study

Effective conservation of marine megafauna requires a thorough understanding of the ecology, physiology, population dynamics, and health of vulnerable species. Assessing the health of large, mobile marine animals poses particular challenges, in part because the subjects are difficult to capture and restrain, and in part because standard laboratory and diagnostic tools are difficult to apply in a field setting. Radiography is a critically important diagnostic tool used routinely by veterinarians, but it has seldom been possible to image live marine vertebrates in the field. As a first step toward assessing the feasibility of incorporating radiography into studies of vulnerable species in remote locations, we used portable radiographic equipment to acquire the first digital internal images of living marine iguanas, Amblyrhynchus cristatus, an iconic lizard endemic only to the Galapagos Islands of Ecuador. The radiographic machinery was powered by batteries and performed well on a rocky beach environment of an uninhabited island, despite high heat and humidity. The accuracy of radiographic measurements was validated by computing a snout-vent length (SVL) using bone dimensions and comparing this to standard measurements of SVL made externally with a tape measure. These results demonstrate the feasibility of using radiography to study animals in remote sites, a technique that may prove useful for a variety of physiological, ecological, and biomechanical studies in which reliable measurements of skeletal and soft-tissue dimensions must be acquired under challenging field conditions. Refinements are discussed that will help the technology reach its full potential in field studies.

Non-interventional 1-year follow-up study of peri-implant soft tissues following previous soft tissue augmentation and crown insertion in single-tooth gaps.

To assess peri-implant soft tissue dimensions at implant sites, previously augmented with a collagen matrix (VCMX) or an autogenous subepithelial connective tissue graft (SCTG), between crown insertion and 1year. Twenty patients with single-tooth implants received soft tissue augmentation prior to abutment connection randomly using VCMX or SCTG. Following abutment connection 3 months later, final reconstructions were fabricated and inserted (baseline). Patients were recalled at 6 months (6M) and at 1 year (FU-1). Measurements included clinical data, soft tissue thickness, volumetric outcomes and patient-reported outcome measures (PROMs). The buccal soft tissue thickness showed a median decrease of -0.5mm (-1.0;0.3) (VCMX) and 0.0mm (-0.5;1.0) (SCTG) (p=.243) up to FU-1. The soft tissue volume demonstrated a median decrease between BL and FU-1 of -0.1mm (-0.2;0.0) (p=.301) for VCMX and a significant decrease of -0.2mm (-0.4; -0.1) (p=.002) for SCTG, respectively. Intergroup comparisons did not reveal any significant differences between the groups for peri-implant soft tissue dimensions and changes up to FU-1 (p>.05). PROMs did not show any significant changes over time nor differences between the groups. Between crown insertion and 1 year, the buccal peri-implant soft tissue dimensions remained stable without relevant differences between sites that had previously been grafted with VCMX or SCTG.

Dimensional Variations in the Soft Tissue Profile After Removal of Implant-Supported Fixed Interim Restorations: A Pilot Clinical Study.

To measure dimensional changes of the periimplant soft tissue profile after removal of a single implant fixed interim restorations using digital impression procedures. Ten participants presenting with single implant-supported fixed interim restorations (ISFIRs) on the maxillary esthetic zone. A 2-step silicone impression was made of the maxillary arch with the ISFIRs. The experimental procedure was obtained by making digital impressions of the gingival contours immediately after ISFIR removal. The control procedure was formed by fabricating definitive casts from the conventional impression using the ISFIRs as a customized impression transfer and making digital impressions of these definitive casts. Both images of paired groups were digitally overlapped on the computer, and their profiles were measured at the coronal, midlevel gingiva in the buccolingual and mesiodistal width. Statistically significant differences between the ISFIR emergence profile width and the unsupported soft tissue profile width were observed at the midlevel gingiva in the buccolingual dimension (1.35 mm) and at the coronal (0.51 mm) and midlevel gingiva (1.29 mm) in the mesiodistal dimension. A digital impression, as used in this pilot study, does not capture accurately the desired soft tissue dimensions immediately after removal of the ISFIR.

Endotracheal tube placement during computed tomography of brachycephalic dogs alters upper airway dimensional measurements.

Computed tomography (CT) is used to document upper airway lesions in dogs with brachycephalic obstructive airway syndrome. The presence of an endotracheal tube during CT scanning is often required for general anesthesia. We hypothesized that the endotracheal tube placement would change the soft tissue dimensions of the upper airway. The aims of this prospective, method comparison study were to evaluate the reliability of the previously reported upper airway CT measurements with endotracheal tube placement, and to propose measurements that are minimally affected by the endotracheal tube. Twenty brachycephalic dogs were included in this study. Each dog underwent head/neck CT with an endotracheal tube, followed by a second scan without the endotracheal tube. Ten measurements of the soft palate, nasopharynx, and trachea were performed. Tracheal dimension was significantly larger with the endotracheal tube compared to without, whereas the soft palate cross-sectional area was significantly smaller with the endotracheal tube than without the endotracheal tube. The influence of the endotracheal tube on the caudal nasopharynx cross-sectional (transverse-sectional) area varied with a mean proportional absolute difference of 35%. Rostral soft palate thickness, tracheal perimeter, and cross-sectional area of the rostral nasopharynx were the measurements least affected by the endotracheal tube (intraclass correlation coefficient = 0.964, 0.967, and 0.951, respectively). Therefore, we proposed that these three measurements may be most useful for future brachycephalic obstructive airway syndrome studies that require CT scanning of intubated animals. However, with endotracheal tube placement, measurements of soft palate length, caudal nasopharyngeal cross-sectional area, and trachea height and width may not be reliable.

Influence of subcrestal implant placement compared with equicrestal position on the peri-implant hard and soft tissues around platform-switched implants: a systematic review and meta-analysis.

The aim of this article is to systematically review the effect of subcrestal implant placement compared with equicrestal position on hard and soft tissues around dental implants with platform switch. A manual and electronic search (National Library of Medicine and Cochrane Central Register of Controlled Trials) was performed for animal and human studies published up to December 2016. Primary outcome variable was marginal bone level (MBL) and secondary outcomes were crestal bone level (CBL), soft tissue dimensions (barrier epithelium, connective tissue, and peri-implant mucosa), and changes in the position of soft tissue margin. For primary and secondary outcomes, data reporting mean values and standard deviations of each study were extracted and weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated. A total of 14 publications were included (7 human studies and 7 animal investigations). The results from the meta-analyses have shown that subcrestal implants, when compared with implants placed in an equicrestal position, exhibited less MBL changes (human studies: WMD = - 0.18 mm; 95% CI = - 1.31 to 0.95; P = 0.75; animal studies: WMD = - 0.45 mm; 95% CI = - 0.66 to - 0.24; P < 0.001). Furthermore, the CBL was located at a more coronal position in subcrestal implants with respect to the implant shoulder (WMD = - 1.09mm; 95% CI = - 1.43 to - 0.75; P< 0.001). The dimensions of the peri-implant mucosa seem to be affected by the positioning of the microgap and were greater at implants placed in a subcrestal position than those inserted equicrestally (WMD = 0.60mm; 95% CI = 0.26 to 0.95; P < 0.001). While the length of the barrier epithelium was significantly greater in implants placed in a subcrestal position (WMD = 0.39mm; 95% CI = 0.19 to 0.58; P < 0.001), no statistical significant differences were observed between equicrestal and subcrestal implant positioning for the connective tissue length (WMD = 0.17mm; 95% CI = - 0.03 to 0.36; P = 0.10). This systematic review suggests that PS implants placed in a subcrestal position have less MBL changes when compared with implants placed equicrestally. Furthermore, the location of the microgap seems to have an influence on the dimensions of peri-implant soft tissues. Clinical relevance When compared with PS placed in an equicrestal position, subcrestal implant positioning demonstrated less peri-implant bone remodeling.

Tissue integration of zirconia and titanium implants with and without buccal dehiscence defects.

PurposeThe purpose of the present study was to validate an experimental model for assessing tissue integration of titanium and zirconia implants with and without buccal dehiscence defects.MethodsIn 3 dogs, 5 implants were randomly placed on both sides of the mandibles: 1) Z1: a zirconia implant (modified surface) within the bony housing, 2) Z2: a zirconia implant (standard surface) within the bony housing, 3) T: a titanium implant within the bony housing, 4) Z1_D: a Z1 implant placed with a buccal bone dehiscence defect (3 mm), and 5) T_D: a titanium implant placed with a buccal bone dehiscence defect (3 mm). The healing times were 2 weeks (one side of the mandible) and 6 weeks (the opposite side).ResultsThe dimensions of the peri-implant soft tissue varied depending on the implant and the healing time. The level of the mucosal margin was located more apically at 6 weeks than at 2 weeks in all groups, except group T. The presence of a buccal dehiscence defect did not result in a decrease in the overall soft tissue dimensions between 2 and 6 weeks (4.80±1.31 and 4.3 mm in group Z1_D, and 4.47±1.06 and 4.5±1.37 mm in group T_D, respectively). The bone-to-implant contact (BIC) values were highest in group Z1 at both time points (34.15%±21.23% at 2 weeks, 84.08%±1.33% at 6 weeks). The buccal dehiscence defects in groups Z1_D and T_D showed no further bone loss at 6 weeks compared to 2 weeks.ConclusionsThe modified surface of Z1 demonstrated higher BIC values than the surface of Z2. There were minimal differences in the mucosal margin between 2 and 6 weeks in the presence of a dehiscence defect. The present model can serve as a useful tool for studying peri-implant dehiscence defects at the hard and soft tissue levels.

Dimensions of hard and soft tissue around adjacent, compared with single-tooth, zirconia implants

Preservation or regeneration of the papilla has always been a challenge around consecutive implants or with implants next to teeth, and many studies have evaluated the papilla’s behaviour and patterns based on surgical technique and prosthetic design, though evidence about its behaviour around zirconia implants is scarce. The aim of this study was to evaluate papilla behaviour between implants and teeth (tooth-implant group) and between consecutive implants (implant–implant group). Ninety patients with 122 zirconia implants (Straumann® PURE Ceramic Implant) were examined at the one-year follow up. We measured the effect of the distance: first from the base of the contact point of the crowns to the contact with bone at the implant site (D1); secondly, to the contact with the bone at the neighbouring tooth or implant site (D2); and thirdly on the papillary deficit (D3). In both the tooth-implant group and the implant–implant group, D1 and D2 correlated significantly with the papillary deficit (D3), whereas D2 was the major determinant factor (Spearman’s rho=0.60). In both groups, when D1 and D2 were <6mm, the papilla was present every time. The papillary deficit was significantly greater in the tooth-implant group than in the implant–implant group (p=0.048). We conclude that the ideal distance from the base of the contact point to the bone contact at the implant and to the bone contact at the adjacent tooth in both groups is <6mm. The height of the bone on the teeth adjacent to implants has a significant impact on that of the papilla.

Evaluation of peri-implant bone levels and soft tissue dimensions around zirconia implants—a three-year follow-up study

The aim of this study was to measure bone levels around zirconia implants during follow-up of up to 3 years. Additionally, the effect of clinical contact point positions on the papilla deficit was evaluated. Eighty-one patients with 105 zirconia implants were examined at the 3-year follow-up. Bone levels were measured on the date of implant placement and at 3 months, 1year, and 3 years thereafter. Distances between the first bone–implant contact and the contact point of the crowns and between the bone level at the adjacent tooth and the contact point of the crowns were assessed. The effect of the clinical contact point position on the papilla deficit was also assessed. Significant reductions in the distances between the bone–implant contact and the implant shoulder, as well as the contact point of the crowns, and between the bone level at the adjacent tooth and the contact point of the crowns, were found. A significant association was found between the papilla deficit and the height of the contact point. Implant survival was 100% and implant success was 95.4%. While zirconia implants presented little bone loss up to 1year, significant bone apposition was observed up to 3years. Low contact points correlated with full papillae, whereas high contact points were associated with a papilla deficit.

Effectiveness of Contour Augmentation with Guided Bone Regeneration: 10-Year Results

In aesthetic sites, the integrity of the facial bone wall dimension in the anterior maxilla is jeopardized by physiologic and structural changes postextraction. An effective regenerative protocol is key to reestablish and maintain the hard and soft tissue dimensions over time. The present prospective case series study examined the effectiveness of early implant placement with simultaneous contour augmentation through guided bone regeneration with a 2-layer composite graft in postextraction single-tooth sites over an observation period of 10 y among 20 patients. The median peri-implant bone loss was 0.35 mm between the 1- and 10-y examination. A success rate of 95% was obtained, with pleasing aesthetic outcomes and a high median Pink Esthetic Score (8). Implant crowns (ICs) revealed significant median facial recession between IC10y and IC1y (0.17 mm). The facial bone wall dimensions were assessed by preoperative cone beam computed tomography and 2 subsequent scans taken at 6 and 10 y. The median facial bone wall thickness increased significantly from 0 mm at surgery to 1.67 mm at the 10-y examination. The facial vertical bone wall peak (DIC) was located at a median distance of 0.16 mm coronal to the implant shoulder. The facial vertical bone loss of DIC amounted to 0.02 mm between 6 and 10 y. Equivalence testing was performed for the null hypothesis of a difference of >0.2 mm per year between 2 respective time points, showing stable bone conditions. Modulating factors influencing the regenerative outcomes at 10 y were the preoperative proximal crest width and soft tissue thickness. In conclusion, the present study confirmed the long-term effectiveness of early implant placement with simultaneous contour augmentation through guided bone regeneration with a 2-layer composite graft in postextraction single-tooth sites offering stable bone conditions with low risks of mucosal recessions over an observation period of 10 y (ClinicalTrials.gov NCT03252106).

Three-dimensional assessment of soft tissue changes associated with bone-anchored maxillary protraction protocols.

The aim of this study was to assess the 3-dimensional soft tissue changes in growing Class III patients with maxillary deficiency associated with 2 bone-anchored maxillary protraction protocols in relation to an untreated control group of Class III patients. Growing skeletal Class III patients between the ages of 10 and 14years participated in this study. In group 1 (n=10), skeletally anchored facemasks were used with miniplates placed at the zygomatic buttress. In group 2 (n=10), the patients were treated with Class III elastics extending from infrazygomatic miniplates in the maxilla to symphyseal miniplates in the mandible. Group 3 (n=10) was an untreated control group. Three-dimensional stereophotogrammetry images were acquired before and after treatment, and then superimposed and analyzed. In addition, lateral cephalometric radiographs were analyzed. The maxilla moved forward significantly in groups 1 and 2 compared with the untreated control group (group 1, 4.87mm; group 2, 5.81mm). The 3-dimensional soft tissue analysis showed significant treatment effects; the major changes were observed in the upper lips, cheeks, and middle of the face, which had a significant positive sagittal displacement in both treatment groups. The lower lip and chin area showed significant negative sagittal changes that indicated that the soft tissue growth in this area was restrained with backward displacement especially in group 1 more than in group2. The 2 bone-anchored maxillary protraction protocols effectively improved the Class III concave soft tissue profile.

Comparison of Periodontal Biotypes Between Maxillary and Mandibular Anterior Teeth: A Clinical and Radiographic Study.

Periodontal biotype is a key element influencing esthetic treatment outcomes in clinical practice. However, while the soft and hard tissue thicknesses of maxillary anterior teeth have been widely studied, information regarding mandibular anterior teeth is scarce. Therefore, the aim of this study was to determine whether there is a relationship in terms of hard and soft tissue thickness between maxillary and mandibular anterior teeth. The present study included 90 maxillary and 90 mandibular anterior teeth in 15 healthy patients. Clinical and cone beam computed tomography measurements were taken to determine gingival and buccal bone thickness, respectively, and a correlation was made between maxillary and mandibular anterior teeth. No statistically significant differences were found when comparing gingival and buccal bone thickness at the crestal third and midpoint of maxillary and mandibular teeth (P > .05). However, some differences were observed at the apical third between the two groups. The results suggest that soft and hard tissue dimensions of maxillary and mandibular anterior teeth are comparable, especially in the coronal third. However, more studies are necessary to confirm that maxillary anterior teeth can be used as a reference when dealing with mandibular incisors and canines.

Associations between mandibular symphysis form and craniofacial structures.

This study aimed to (1) analyze the relationships between mandibular symphysis characteristics (height, prominence, inclination, concavity, and convexity) and facial pattern, skeletal class, lower incisor position, and sex, and (2) determine the associations between the symphysis soft tissue dimensions and the underlying osseous structures. Cone-beam computed tomography (CBCT) images were selected for 385 patients (206 women and 179 men). The patients were classified according to their skeletal class and vertical pattern. The lower incisor inclination (IMPA) was recorded. Twelve measurements were taken for each mandibular symphysis using Invivo5 software (Anatomage, San Jose, CA, USA). Symphyseal measurements were larger in males than in females. Skeletal Class II and III hyperdivergent patients showed the highest symphysis height values. Hypodivergent individuals showed lower symphysis convexity angles. Concavity of the symphysis was greater for Class II hyperdivergent patients. Lower incisor inclination showed a positive correlation with symphysis concavity and inclination. Moderate and weak correlations were found between hard tissue and soft tissue parameters. Only a few characteristics of symphysis morphology depend on sex, incisor position, skeletal class, and vertical pattern. More significant relationships are found when the vertical pattern and skeletal class are analyzed in combination. The shape of the symphysis soft tissue is not directly correlated with the underlying skeletal structures.

Anatomic measures of upper airway structures in obstructive sleep apnea.

ObjectiveDetermine if anatomic dimensions of airway structures are associated with airway obstruction in obstructive sleep apnea (OSA) patients.MethodsTwenty-eight subjects with (n = 14) and without (n = 14) OSA as determined by clinical symptoms and sleep studies; volunteer sample. Skeletal and soft tissue dimensions were measured from radiocephalometry and magnetic resonance imaging. The soft palate thickness, mandibular plane-hyoid (MP-H) distance, posterior airway space (PAS) diameters and area, and tongue volume were calculated.ResultsCompared to controls, the OSA group demonstrated a significantly longer MP-H distance (P = 0.009) and shorter nasal PAS diameter (P = 0.02). The PAS area was smaller (P = 0.002) and tongue volume larger in the OSA group (P = 0.004). The MP-H distance, PAS measurements, and tongue volume are of clinical relevance in OSA patients.ConclusionsA long MP-H distance, and small PAS diameters and area are significant anatomic measures in OSA; however the most substantial parameter found was a large tongue volume.

Early Changes in Facial Profile Following Structured Filler Rhinoplasty: An Anthropometric Analysis Using a 3-Dimensional Imaging System.

Quantitative measurements are important for objective evaluation of postprocedural outcomes. Three-dimensional (3D) imaging is known as an objective, accurate, and reliable system for quantifying the soft tissue dimensions of the face. To compare the preprocedural and acute postprocedural nasofrontal, nasofacial, nasolabial, and nasomental angles, early changes in the height and length of the nose, and nasal volume using a 3D surface imaging with a light-emitting diode. The 3D imaging analysis of 40 Korean women who underwent structured nonsurgical rhinoplasty was conducted. The 3D assessment was performed before, immediately after, 1 day, and 2 weeks after filler rhinoplasty with a Morpheus 3D scanner (Morpheus Co., Seoul, Korea). There were significant early changes in facial profile following nonsurgical rhinoplasty with a hyaluronic acid filler. An average increase of 6.03° in the nasofrontal angle, an increase of 3.79° in the nasolabial angle, increase of 0.88° in the nasomental angle, and a reduction of 0.83° in the nasofacial angle was observed at 2 weeks of follow-up. Increment in nasal volume and nose height was also found after 2 weeks. Side effects, such as hematoma, nodules, and skin necrosis, were not observed. The 3D surface imaging quantitatively demonstrated the early changes in facial profile after structured filler rhinoplasty. The study results describe significant acute spatial changes in nose shape following treatment.

Clinical relevance of dimensional bone and soft tissue alterations post‐extraction in esthetic sites

The key to achieving pleasing esthetics in implant dentistry is a thorough understanding of the biological processes driving dimensional bone and soft tissue alterations post-extraction. The aim of the present report is first to characterize the extent of bone and soft tissue changes post-extraction and second to identify potential factors influencing tissue preservation in order to facilitate successful treatment outcomes. The facial bone wall thickness has been identified as the most critical factor influencing bone resorption and can be used as a prognostic tool in order to identify sites at risk for future facial bone loss subsequent to tooth extraction. Clinical studies indicated that thin bone wall phenotypes exhibiting a facial bone wall thickness of 1mm or less revealed progressive bone resorption with a vertical loss of 7.5mm, whereas thick bone wall phenotypes showed only minor bone resorption with a vertical loss of 1.1mm. This is in contrast to the dimensional soft tissue alterations. Thin bone wall phenotypes revealed a spontaneous soft tissue thickening after flapless extraction by a factor of seven, whereas thick bone wall phenotypes showed no significant changes in the soft tissue dimensions after 8weeks of healing. In sites exhibiting a limited bone resorption rate, immediate implant placement may be considered. If such ideal conditions are not present, other timing protocols are recommended to achieve predictable and pleasing esthetics. Socket preservation techniques for ridge preservation utilizing different biomaterials and/or barrier membranes often result in a better maintenance of tissue volumes, although the inevitable biological process of post-extraction bone resorption and bone modeling cannot be arrested. In summary, the knowledge of the biological events driving dimensional tissue alterations post-extraction should be integrated into the comprehensive treatment plan in order to limit tissue loss and to maximize esthetic outcomes.

Effects of Thread Depth in the Neck Area on Peri-Implant Hard and Soft Tissues: An Animal Study.

Implants with deep thread depth have been developed for the purpose of increasing total implant surface area. However, effects of implant thread depth remain controversial. The aim of this study is to examine effects of thread depth on peri-implant tissues in terms of bone-implant contact (BIC), bone-implant volume (BIV), and hard and soft tissue dimensions using comprehensive analyses, including microcomputed tomography (micro-CT). Five beagle dogs received experimental intramandibular implants 3 months after removal of their premolars and first molars (P2, P3, P4, and M1). Two different types of implants were installed in each animal: deep threaded (DT) and shallow threaded (ST). Resonance frequency testing was performed on the day of implantation as well as 4 and 8 weeks after implantation. Intraoral radiography, micro-CT, and histomorphometry were used to evaluate peri-implant tissues 4 and 8 weeks after implantation. There were no significant differences in resonance frequency test results between the two groups. Although radiographic analysis showed no group differences, micro-CT (P = 0.01) and histomorphometry (P = 0.003) revealed the DT group had significantly lower BIC values than the ST group at 4 weeks. However, by 8 weeks, BIC values of the two groups did not differ significantly. No significant differences in BIV or soft tissue height were observed between the two groups at either time point. DT implants showed no benefits over ST implants when inserted in dog mandibles.

Anatomical Features of Dislocation of the Peroneal Tendon

Category: Ankle Introduction/Purpose: Dislocation of the peroneal tendons is one of the major injuries of the ankle. However, the pathology underlying this condition is still unclear. The purpose of this study was to evaluate the anatomical features of dislocation of the peroneal tendon using MRI. Methods: We compared twenty cases of dislocation of the peroneal tendon and twenty three controls. Both groups were matched for age, gender and BMI. The following patients were excluded: those with an acute injury within the past three weeks and/or findings of peroneal tendon tears or a dislocated peroneal tendon on MRI. MRI axial images of the ankle were retrospectively observed and the shape (concave, convex or flat) of the posterior fibular malleolar groove and the soft tissue dimensions within the peroneal tendon sheath at the level of the ankle joint (joint level) and the middle level between the ankle joint and the fibular malleolar tip (lower level) were investigated. The measurement was performed using a Konica i-pacs SX measurement system (Konica Minolta Health Care, Tokyo, Japan). Results: No significant differences were observed in the shape of the posterior fibular malleolar groove at both levels (Joint level, peroneal dislocation: concave, convex, flat = 2, 10, 8 cases vs. control: 4, 12, 7 cases. P=0.70. Lower level, peroneal dislocation: concave, convex, flat = 3, 6, 11 cases vs. control: 6, 6, 11 cases. P=0.36, Chi-square test for independence). However, a significant difference was confirmed in the soft tissue dimensions within the peroneal tendon sheath (Joint level, peroneal dislocation: 144.6±41.4mm2 vs. control: 97.5±29.1mm2. P &lt; 0.0001. Lower level, peroneal dislocation: 120.2±36.1mm2 vs. control: 84.3±26.8mm2. P &lt; 0.0001, Student's t-test). Conclusion: These results suggest that a larger amount of soft tissue inside of the peroneal tendon sheath at the level of the distal fibula is a significant anatomical feature associated with peroneal tendon dislocation, and could be a potential risk factor for unstable peroneal tendons. It remains unclear whether the soft tissue was bulky prior to injury. However, the presence of enlarged soft tissue within the peroneal tendon sheath is considered to be involved in the pathology of recurrent dislocation of the peroneal tendon.

Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–Supported Crowns: A 1‐Year Retrospective Study

This study aims to evaluate the effect of the distance between the alveolar crest of a full-ceramic implant to the lowest point of the contact area of the crowns on the interdental papilla. Therefore, the authors proposed a new concept of linear measurements for the reproducible and metric evaluation of distances relevant for the assessment of hard and soft tissue changes around dental implants. A total of 216 sites were examined in 87 patients. In a radiographic and clinical evaluation, four relevant distances were evaluated. In the x-ray image, the tip of the papilla was marked with a radiodense mixture of tungsten powder and temporary cement. In a clinical photograph, the lowest point of the interdental contact zone of the crowns was visualized by a metallic interdental ligature. Using the proposed measuring methodology, four different papilla-deficit situations around ceramic implants could be reproducibly distinguished. When the measurement from the bone crest at the implant was ≤5 mm, the papilla was completely present in 100% of cases. When this distance was 10 mm, the papilla was still present in 67% of the cases, without any cosmetically apparent deficit. A close relationship is observed between the distance from the contact point to the bone and the presence of the papilla. Using a combination of radiographically and clinically visible landmarks allows the reproducible measurement of these distances.

Treatment of Labial Soft Tissue Recession Around Dental Implants in the Esthetic Zone Using Guided Bone Regeneration With Mineralized Allograft: A Retrospective Clinical Case Series

Soft tissue augmentation procedures are often performed to correct gingival recession on the facial aspects of implants in the esthetic zone. This retrospective clinical case series reports on the use of guided bone regeneration (GBR) and a coronal advancement flap with a resorbable membrane and allograft. We analyzed the records of 14 patients (7 men and 7 women) with a mean age of 36.78years (SD, 13.9years) who were treated for soft tissue recessions around implant-supported restorations in the maxillary central or lateral incisor location. Implant diameters ranged from 3.3 to 4.7mm. All patients had bone loss confined to the labial surface of the implant. A solvent-dehydrated particulate mineralized allograft (Puros Cancellous Bone Allograft; Zimmer Biomet Dental, Palm Beach Gardens, FL) and a resorbable membrane (CopiOs Pericardium; Zimmer Biomet Dental) were used in a GBR surgical procedure in combination with a roughened titanium tenting screw placed 3 to 4mm below the implant platform to restore unesthetic defects in the anterior maxilla. All postoperative tissue changes from their preoperative states were statistically significant (P<.05, Wilcoxon signed rank test). Mean preoperative crestal bone thickness (measured 2mm from crest) and mid-implant buccal bone thickness increased by 1.84mm (SD, 0.89mm; 95% confidence interval [CI], 1.32 to 2.35mm) and 2.07mm (SD, 0.81mm; 95% CI, 1.60 to 2.53mm), respectively, approximately 1year after treatment (P < .001). Significant mean increases of 1.28mm (SD, 0.53mm; 95% CI, 0.97 to 1.58mm), 1.29mm (SD, 0.81mm; 95% CI, 0.82 to 1.75mm) and 1.23mm (SD, 0.53mm; 95% CI, 0.92 to 1.53mm) also were noted in soft tissue thickness, keratinized tissue width, and gingival height, respectively (P < .001). Use of the allograft and xenogeneic membrane effectively increased alveolar hard and soft tissue dimensions in the esthetic zone of the anterior maxilla. Future prospective clinical trials with a control group are needed to compare this technique with conventional methods such as connective tissue graft.