Soft Tissue Modifications Research Articles

Technique for Soft Tissue Modification for Pontic Reception: A Case Report

Background The article discusses a technique for modifying the pontic site when replacing missing maxillary incisors in the anterior esthetic zone. In such cases, patient concern often centres around esthetics, especially considering factors like smile lines and the display of incisors. The esthetic zone may extend to the entire clinical crown and involve the surrounding soft tissue, particularly if the patient has a high smile line.  Case Summary The emergence profile is highlighted as a crucial aspect when dealing with pontics in the esthetic zone. The emergence profile refers to the way the pontic emerges from the gingival tissue, and it significantly influences the overall esthetics of the restoration.  Conclusion The technique described in this case report involves converting a flat gingival contour into a concave receptor site for the desired pontic without soft tissue grafting. This modification aims to enhance the emergence profile, contributing to a more natural and esthetically pleasing outcome when replacing missing maxillary incisors in the anterior esthetic zone.

Peri-surgical imaging of intersex and gender diverse youths.

This publication provides an overview of current imaging indications and practices for patients undergoing gender-affirming surgery, with an emphasis on the importance of tailored, patient-specific care. Gender-affirming surgeries are performed with personalized approaches at various stages of life for those with intersex traits or differences in sex development (I/DSD) and transgender and gender diverse (TGD) individuals. For I/DSD patients, ultrasound, genitography, or MRI occurs during infancy and puberty to evaluate genital and gonadal anatomy. Facial harmonization involves bony and soft tissue modifications, guided by maxillofacial computerized tomography (CT) with three-dimensional reconstruction. Ultrasound is the main modality in assessing hormone-related and post-surgical changes in the chest. Imaging for genital reconstruction uses cross-sectional images and fluoroscopy to assess neoanatomy and complications.

Incidental observation of bone modification by Crematogaster cf. liengmei (Hymenoptera: Formicidae) in Cape Town, South Africa.

Different taxa of insects have been reported to modify the skeletal remains of vertebrates during feeding or the creation of their larval and pupal chambers. Anecdotal reports on the modification of skeletal remains by ants exist but are rare. In this paper, a case of modification of bone due to the feeding activity of the ant, Crematogaster cf. liengmei (Hymenoptera: Formicidae), is reported. In November 2022, a bone was encountered incidentally in the vicinity of the Table Mountain National Park. The bone had been colonized by several individuals of Crematogaster cf. liengmei. Several ants were observed feeding on and removing bone particles and soft tissue remnants. A closer observation revealed striae/furrows on the epiphyseal ends of the bone. A 60-kg pig cadaver used in a winter decomposition trial in the same area was similarly colonized by this ant species, resulting in soft-tissue modification. Due to the similarity in the striae/furrows observed on the bone and the bitemarks inflicted by the ants on the right ear of the pig cadaver in the vicinity, it was concluded that the striae/furrows seen on the bone were created by the ants. Our observations show that Crematogaster cf. liengmei is an important taphonomic bio-agent that can contribute to the modification of skeletal remains in terrestrial environments.

Comparison of peri-implant modifications between immediate implantation and delayed implantation

Introduction: We speak of immediate implantation (II) when it is performed before the total healing of the alveolus in order to take advantage of the hemodynamic and scarring modifications generated by the avulsion to promote osseointegration. Unlike delayed implantation (De), which is performed when the bone tissues are fully consolidated. Objective: The objective of our study is to compare two implant techniques: extraction immediate implantation and delayed implantation with respect to soft and hard tissue modifications. In the maxillary and mandibular sector including all sextants with the exclusion of wisdom teeth. Materials and method: It’s a study prospective and comparative, it was performed on 102 implant sites, from December 2016 to March 2021, divided into two groups, 54 cases of delayed implantation and 48 cases immediate implantation in both jaws and including all sextants. The oral cavity can be divided into six frames; we therefore speak of a sextant. The sextants are respectively: the upper right premolar-molar group, the maxillary incisor-canine, the upper left premolar-molar, the lower left premolar-molar, the mandibular incisor-canine and finally the premolar lower right molar. Patients were followed for 6 months, during which time tissue changes and osseointegration were assessed using a NABERS periodontal probe and Radio Visio Graphy (RVG). Results: We did not obtain any rejection in the 2 techniques. For immediate implantation: osseointegration (OI) was obtained especially at 4 months for most of the implants. The loss of keratinized fibro mucosa (KFM) was localized to the mandible, it concerned sextant 4, much more for bone type 3 and 1, on the other hand the gain was observed at the level of sextant 1 and 6, especially for type 2 bone. The gain in the mesial bony crest (MBC) and distal bone (DBC) were higher in the male gender in the II compared to the female gender. The mesial fibro mucosa (MFM) was superior compared to the distal fibro mucosa (DFM) at 1 month and at 6 months. For delayed implantation: Osseointegration (OI) was mainly at 5 months for most of the implants. The loss of the keratinized fibro mucosa was localized at the level of the two maxillae. The gain in the mesial bony crest and distal bone were higher in the female gender in the (De) compared to the male gender Conclusion :It is difficult to find a consensus within the current literature as to the superior interest of the technique compared to the other but at the end of this work, we can conclude after the analysis of our results that the II is preferable to IR because it makes it possible to reduce manipulations on the soft tissues, limit the resorption of hard tissues and the filling of the papillae more quickly after loading of the implant more than in the delayed technique, this of course if the preservation of the papillae was performed during the dental extraction, hence an atraumatic or so-called periodontal extraction.

Bone and Soft Tissue Modifications in Immediate Implants Versus Delayed Implants Inserted Following Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial. Part II: Radiographic Outcomes

This study evaluated the radiographic alterations that occur in immediate postextraction implants and in delayed implants inserted in a preserved ridge. In group A, an implant was placed immediately after tooth extraction, grafting the bone-to-implant gap. In group B, alveolar ridge preservation was performed after tooth extraction, and delayed implant placement was performed 4 months later. The final follow-up was 1 year after prosthetic loading in both groups. The marginal bone level (MBL) was measured at implant insertion (T1), at loading (T2), and at the final follow-up, 12 months after prosthetic loading (T3). At tooth extraction (T0) and T3, the horizontal ridge width (HW) was measured on CBCT scans at three different levels. No statistically significant differences in MBL or HW were found between the two study groups. The outcomes suggest that it is possible to maintain MBL and alveolar bone volumes regardless of whether the procedure is performed through immediate postextraction implant placement or through delayed implant placement in a preserved ridge.

Intentional craniofacial remodelling in Europe in the XIXth century: Quantitative evidence of soft tissue modifications from Toulouse, France

Intentional skull deformations have been practiced by every human population, from the prehistoric times until the XXth century. In Europe, they were specifically prevalent in the region of Toulouse, France. The soft-tissue modifications due to such practices are not well characterized in the literature due to the rarity of photographic data. Most studies on skull deformations are thus based on skeletal remains. Here we performed a controlled geometric morphometric assessment of 31 frontal pictures and 70 lateral pictures of individuals from Toulouse with intentional deformations extracted from two XIXth century historical French photographic archives. We also measured the forces exerted on the skull vault by the traditional deformation device from Toulouse using a 3D-printed skull and pressure sensors. We showed that individuals with Toulouse deformations have distinctive facial features, caused by moderate forces exerted on the skull vault. Our results exhibit and quantify for the first time the real face of intentional skull deformations, which are a ubiquitous and distinctive feature of the human species.

Bone and Soft Tissue Modifications in Immediate Implants Versus Delayed Implants Inserted Following Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial. Part I: Esthetic Outcomes.

Soft tissue changes were evaluated over a period of 1 year in 48 patients who required extraction of a single tooth in the anterior maxillary arch (premolar to premolar) and its replacement with an implant. The patients were randomly divided into two groups: In group A, an immediate postextraction implant was placed, and the bone-to-implant gap was filled with bovine bone mineral; in group B, the alveolar ridge preservation technique was performed after extraction, and the implant was placed 4 months later. On the day of tooth extraction (T0) and 1 year after tooth extraction (T1), the soft tissue horizontal width, mesial and distal papillary levels, midfacial gingival level, and Pink Esthetic Score were evaluated in both groups. No significant differences were observed between the groups in any of the considered parameters. Statistically significant differences were found in the soft tissue horizontal width between T0 and T1. The clinical results of the two procedures were similar and comparable over time. When evaluating the stability of the soft tissue contour, and considering the specific indications of the two techniques, it is possible to choose either an immediate implant or an alveolar ridge preservation technique with staged placement.

Evaluation and treatment of facial feminization surgery: part II. lips, midface, mandible, chin, and laryngeal prominence.

Facial feminization surgery (FFS) refers to a set of procedures aimed at altering the features of a masculine face to achieve a more feminine appearance. In the second part of this twopart series, assessment and operations involving the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty, are discussed. Finally, we provide a review of the literature on patient-reported outcomes in this population following FFS and suggest a path forward to optimize care for FFS patients.

Evaluation and treatment of facial feminization surgery: part I. forehead, orbits, eyebrows, eyes, and nose.

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided.

The anatomy, phylogenetic relationships, and autecology of the carnivorous lizard “Saniwa” feisti Stritzke, 1983 from the Eocene of Messel, Germany

The evolution and interrelationships of carnivorous squamates (mosasaurs, snakes, monitor lizards, Gila Monsters) are a contentious part of reptile systematics and go to the heart of conflict between morphological and molecular data in inferring evolutionary history. One of the best-preserved fossils in this motley grouping is “Saniwa” feisti Stritzke, 1983, represented by complete skeletons from the early-middle Eocene of Messel, Germany. We re-describe it on the basis of superficial examination, stereoradiography, and high-resolution X-ray computed tomography of new and published specimens. The scalation of the lizard is unique, consisting of small, keeled scales on the head (including a row of enlarged medial supraorbitals) and large, rhomboidal, keeled scales (invested by osteoderms) that covered the rest of the body. Two paired longitudinal rows of enlarged scales ran down the neck. The head was laterally compressed and box-shaped due to the presence of a strong canthal-temporal ridge; the limbs and tail were very long. Notable osteological features include: a toothed, strap-like vomer; septomaxilla with a long posterior process; palpebral with a long posterolateral process; a lacrimal boss and a single lacrimal foramen; a well-developed cultriform process of the parabasisphenoid; two hypoglossal (XII) foramina in addition to the vagus; a lack of resorption pits for replacement teeth; and possibly the presence of more than one wave of developing replacement teeth per locus. There are no osteological modifications suggestive of an intramandibular hinge, but postmortem displacement of the angular-prearticular-surangular complex in multiple specimens suggests that there might have been some degree of mobility in the lower jaw based on soft-tissue modifications. Using phylogenetic analyses on a data-set comprising 473 morphological characters and 46 DNA loci, we infer that a monophyletic Palaeovaranidae Georgalis, 2017, including Eosaniwa Haubold, 1977, lies on the stem of Varanidae Merrem, 1820, basal to various Cretaceous Mongolian taxa. We transfer feisti to the new genus Paranecrosaurus n. gen. Analysis of gut contents reveals only the second known specimen of the cryptozoic lizard Cryptolacerta hassiaca Müller, Hipsley, Head, Kardjilov, Hilger, Wuttke & Reisz, 2011, confirming a diet that was at least partly carnivorous; the preservation of the teeth of C. hassiaca suggests that the gastric physiology of Paranecrosaurus feisti (Stritzke, 1983) n. comb. had high acidity but low enzyme activity. Based on the foregoing and linear discriminant function analysis, we reconstruct P. feisti n. comb., as a powerful, widely roaming, faunivorous-carnivorous stem monitor lizard with a sensitive snout. If the molecular phylogeny of anguimorphs is correct, then many of the features shared by Helodermatidae Gray, 1837 and Varanidae must have arisen convergently, partly associated with diet. In that case, a reconciliation of morphological and molecular data would require the discovery of equally primitive fossils on the helodermatid stem.

Intentional Craniofacial Remodelling in Europe in the XIX <sup>th</sup> Century: Quantitative Evidence of Soft Tissue Modifications from Toulouse, France

Intentional Craniofacial Remodelling in Europe in the XIX <sup>th</sup> Century: Quantitative Evidence of Soft Tissue Modifications from Toulouse, France

Evaluation of Peri-Implant Soft Tissue after Osteocutaneous Free Flap Reconstruction of Mandibular Defects: A Case Series

The use of osteocutaneous free flaps has been a long-standing, predictable method of reconstruction for mandibular defects that has allowed patients to regain form and function. Placement of dental implants into the osteocutaneous free flap has been a significant advancement that has improved mastication, retention, and stability of dental prostheses. However, several challenges have been noted, such as peri-implant mucositis and gingival tissue overgrowth, that have limited implant longevity due to lack of adequate peri-implant hygiene. Other contributors to this problem may be inherent to skin itself as a peri-implant tissue, flap thickness, and skin mobility. The aim of our study was to analyze soft tissue challenges and their effect on implant success after dental implant placement into osteocutaneous free flaps. A case series identified 6 patients who underwent dental implant placement in microvascular mandibular reconstructions between 2012-2019 in an academic institution. Patient-specific information, such as indication for osteocutaneous fibula free flap reconstruction and history of radiation to the head and neck region, were evaluated. Furthermore, implant-specific information, such as implant longevity, radiographic changes of surrounding peri-implant bone, and implant success as defined by the Albrektsson criteria, were examined. Tissue-specific factors, such as type and number of tissue modification procedures performed, were collected. We also analyzed the type of dental restoration each patient obtained. A total of 20 (16 BioHorizons Laser-Lok and 4 NobelActive TiUnite) dental implants were placed into osteocutaneous fibula free flaps. One patient in the cohort received radiation therapy to the head and neck. Based on the Albrektsson criteria, 3 of the 20 (15%) implants failed due to severe peri-implant bone loss and implant mobility. Secondary gingival debridement, flap debulking, and vestibuloplasty procedures were performed in 4 patients. Two patients underwent simultaneous implant placement and flap debulking; however, both required additional flap debulking prior to dental rehabilitation. Two patients obtained soft tissue debulking, vestibuloplasty, or gingival debridement after implant placement. Of the patients with post-implant placement soft tissue modifications, 1 patient required serial gingival debridements. Of the 5 patients with restorative data, 1 patient had implants restored with a fixed partial denture, and 4 patients are being restored with an implant retained mandibular partial overdenture (3 loaded and 1 awaiting final restoration). Endosseous dental implant placement into osteocutaneous fibula free flaps continues to be an acceptable treatment option for dental reconstruction. Even though dental implants allowed for a stable dental rehabilitation, significant soft tissue challenges exist that require multiple pre-prosthetic and maintenance surgeries to maintain implant function.

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.

Copy milling to duplicate the emergence profile for implant-supported restorations

This technique article describes the duplication of a definitive implant-supported computer-aided design and computer-aided manufacture (CAD-CAM) crown with soft-tissue modification on a misplaced implant. Gingival contours were ideally shaped in the stone die, and a custom healing abutment was designed. After scanning the modified surface, images were correlated with the initial intraoral digital scan, and the definitive restoration was designed, milled, and delivered with an ideal soft-tissue emergence profile.

Volumetric Analysis of Fat Injection by Computerized Tomography in Orthognathic Surgery: Preliminary Report on a Novel Volumetric Analysis Process for the Quantification of Aesthetic Results.

Integrated approaches to orthognathic surgery should include accurate volumetric evaluation of the skull and soft tissues. In patients with dentofacial deformities, the most frequent aesthetic deficits are attributable to an underdevelopment of hard and soft tissues. Traditional osteotomic procedures often fail to guarantee a stability of soft tissues over time. For this reason, in selecting a surgical strategy, the surgeon should consider not only traditional osteotomies, but also soft-tissue improving procedures, such as lipofilling. Preoperative surgical planning systems, such as the Virtual surgical planning (VSP) protocol, are based mainly on skeletal movement prediction. Quantitative estimation of soft-tissue modifications is not part of common clinical practice. Most commonly, the evaluation of soft-tissue modifications after orthognathic procedures is instead performed by clinical qualitative means.The purpose of this study was to describe a novel computed tomography (CT)-based volumetric analysis process for the quantification of injected autologous adipose tissue in patients who have undergone simultaneous orthognathic and lipofilling procedures. This was a retrospective review of consecutive patients who underwent combined orthognathic surgery and lipofilling from June 2016 to May 2017 for malocclusion with functional and aesthetic impairments. Preoperative planning included clinical evaluation and virtual osteotomy planning according to the VSP protocol. The volume of fat to be injected was estimated clinically by comparing virtual renderings with preoperative clinical photographs. The surgical technique involved Le Fort I and sagittal split mandibular osteotomies, combined with autologous fat injection in the malar and perioral regions. Postoperative evaluation was performed with a novel imaging process based on CT image segmentation to quantify the exact volume of injected fat. Skeletal stability was also evaluated at 3 months. Sixteen patients were enrolled in the study, all females, with a mean age of 24.5 years (range, 18-36 years). The mean difference between the fat tissue injected and that quantified postoperatively was 6.01 cm. All patients had clinically satisfactory facial convexity, with complete restoration of the cheekbone contour, at 3 months. This study introduces a novel CT-image based technique to quantitatively assess the contribution of injected fat to the postoperative soft-tissue volume increase after combined orthognathic surgery with autologous lipofilling. In the future, this CT-based volumetric analysis technique could be the gold standard for evaluating facial lipofilling outcomes, and for assessing clinical aesthetic outcomes based on the injected volume of fat.

Are Extreme Anatomical Modifications Required for Fish to Move Effectively on Land? Comparative Anatomy of the Posterior Axial Skeleton in the Cyprinodontiformes.

Many teleost fishes with no apparent modifications for life on land are able to produce effective terrestrial locomotor behaviors, including a ballistic behavior called the "tail-flip" jump. Cyprinodontiformes (killifishes, Teleostei: Atherinomorpha) that live at the water's edge vary in morphology and inclination to emerge onto land. Do fish with an amphibious predisposition have extensive modification of the propulsive region of the body when compared to fully aquatic relatives? We quantified body shape and anatomy of the caudal peduncle and tail (the propulsive organ on land and in water) in 11 cyprinodontiform species and two outgroup taxa (Atherinomorpha). We hypothesized that amphibious species would have longer, "shallower" bodies (larger body fineness ratios), deeper (proportionally larger) caudal peduncles, and more robust bones in the tail fin (larger ossified area of the hypural/epural bones) to facilitate locomotor movements on land. We found no evidence of convergence in body shape or skeletal anatomy among species known to make voluntary sojourns onto land. In fact, deep-bodied species, shallow-bodied species, and species with intermediate morphologies all are able to emerge from the water and move on land. It is possible that there are as-yet-undocumented subtle soft-tissue (muscle, tendon, and ligament) modifications that enhance terrestrial locomotor performance in species known to spend large periods of time on land. However, it is also possible that extreme anatomical changes are not required for aquatic cyprinodontiform species to produce effective locomotor movements when they emerge out of the water and move across the land. Anat Rec, 2019. © 2019 American Association for Anatomy.

Soft and hard tissue modifications around tissue‐level Laser‐Lok implants

Soft and hard tissue modifications around tissue‐level Laser‐Lok implants

Anatomical Modifications during the Lateral Transpsoas Approach to the Lumbar Spine. The Impact of Vertebral Rotation.

We investigated impact of vertebral axial rotation on neurovascular anatomy in adult spinal deformity (ASD) patients and provided recommendations on the approach based on degree of axial rotation. In order to isolate vertebral rotation (VR) impact from the superimposed degenerative cascade observed in adulthood, adolescent idiopathic scoliosis (AIS) patients were analyzed. Magnetic resonance imaging (MRI) scans (L1-S1) from 50 right-convex thoracic (left-convex lumbar) AIS patients were analyzed. At each intervertebral level, VR, lumbar plexus depth (LPD), and vascular structure depth (VSD) were evaluated. Paired t test analyses were used to describe anatomic differences between the concave and convex aspect of our patients' curves. Correlation analysis was used to investigate relationships with soft tissue modifications and VR. Fifty AIS patients (17M, 33F) with mean thoracic Cobb of 50.6° ± 17.0° and mean lumbar Cobb of 41.9° ± 13.0° were included. Mean VR at each level was L1-2 = -6.6°, L2-3 = -7.7°, L3-4 = -6.5°, L4-5 = -4.7°, L5-S1 = -2.6° (negative value denotes clockwise rotation). We found significant differences (P < .05) between concave-convex (right-left) LPD at each level (L1-2 = 3.7 mm, L2-3 = 5.1 mm, L3-4 = 4.2 mm, L4-5 = 2.2 mm, L5-S1 = 2.2 mm). Vascular structure depth was significantly different at L1-L2 (3.2 mm) and L5-S1 (3 mm). Significant correlation was found between increasing VR and concave-convex LPD difference (r = 0.68, P < .001). This study demonstrates that displacement of the lumbar plexus is tied to the magnitude of VR in patients with AIS. When approaching the lumbar spine, this displacement widens the safe surgical corridor on the convex side and narrows the corridor on the concave side. IV. Preoperative review of MRI scans should occur to assess the patient's safe surgical corridor for lateral lumbar interbody fusion (LLIF). Adult spinal deformity surgeons who approach a degenerated spine in patients with progressive AIS in adulthood must carefully plan for patient positioning, neurovascular anatomy, and realignment objectives prior to the day of surgical intervention.

Three-dimensional stereophotogrammetric analysis of nasolabial soft tissue effects of rapid maxillary expansion: a systematic review of clinical trials.

SUMMARYThe aim of this systematic review is to analyse the quality and clinical evidence in the literature analysing, through 3D stereophotogrammetry, the nasolabial soft tissue modifications that may occur after rapid maxillary expansion (RME). This systematic literature review was based on the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: CRD42017079875. Pubmed, Cochrane, EBSCO, Scopus, Web of Science databases were searched with no restriction of year or publication status. Selection criteria were: randomised clinical trials, controlled clinical trials, cohort studies, cross-sectional studies, case-control studies on patients with unilateral/bilateral crossbite, transverse maxillary deficiency and crowding, treated with RME and monitored by 3D stereophotogrammetry. 652 articles were retrieved in the initial search. After the review process, 11 full-text articles met inclusion criteria. After the evaluation process, 4 publications were included for the present literature review. Due to the heterogeneous methodology meta-analysis was not possible; consequently, a systematic assessment of the studies and summary of the findings from the available evidence were used to answer the research question. The maximum widening of the alar cartilage is 1.41 ± 0.95 mm, whose clinical significance is open to question. The effect of RME on the mouth width remains controversial. In Altindis et al., the difference between pre-treatment and post-treatment mouth width (1.80 mm increment in the banded RME group) was statistically significant, while in Baysal 1.86 mm was considered a non-significant value. Inconsistencies and limitations in the study population and measurement protocols were detected between studies. These data underline the necessity for updated guidelines that allow to standardise, for this type of study, sample selection, measurement methods and collection of results.

Bone and Soft Tissue Response in Bone-Level Implants Restored with Platform Switching: A 5-Year Clinical Prospective Study.

The aim of this prospective study was to evaluate radiographic levels of peri-implant bone crest as well as soft tissue response, papilla height, and buccal mucosa recession, in bone-level implants restored with platform switching after 1-year and 5-year follow-ups. This prospective study called for the placement of 59 implants to obtain a target of 90% power. To compensate for possible dropouts, the sample size was adjusted to 67 implants. To assess marginal bone level changes, periapical radiographs were taken at baseline, 1 year, and 5 years after the definitive restorations. Peri-implant soft tissue modifications were evaluated by performing a photographic sequence at 15 days, 1 year, and 5 years after implant restoration. Parameters measured were: (1) distance from the tip of the papilla to the contact point and (2) apicocoronal crown length. A one-way analysis of variance (ANOVA rank test) was used to compare quantitative data among the three time points studied. Mean marginal bone level changes were as follows: -0.06 ± 0.32 mm from baseline to 1 year, -0.23 ± 0.38 mm from 1 to 5 years, and -0.28 ± 0.45 mm from baseline to 5 years. In bone-level outcomes, no statistically significant differences were found between baseline and 1 year, while the mean differences between 1 and 5 years and baseline and 5 years showed statistically significant differences. In the soft tissue analysis, the distance from the tip of the papilla to the contact point showed the following values: baseline, 2.08 mm; 1 year, 1.54 mm; 5 years, 1.31 mm. No statistically significant differences were found between baseline and 1 year, whereas statistically significant differences between 1 and 5 years and baseline and 5 years were found. Apicocoronal crown length measurements showed the following values: baseline, 9.44 mm; 1 year, 9.28 mm; 5 years, 9.81 mm. No significant differences were found between times studied. This prospective clinical study of 67 bone-level implants restored according to the platform-switching concept reported that radiographic levels of peri-implant bone crest were statistically significant between 1 and 5 years and baseline and 5 years. For the soft tissue response, the greatest reduction in the distance from the papilla to the contact point from 1 to 5 years and baseline to 5 years was observed. No significant differences were shown in the buccal margin.