Soft Tissue Modifications Research Articles

Reproducibility of a Digital Method to Evaluate Soft Tissue Modifications: A study of Inter and Intra-Operative Measurement Concordance.

Background:The soft tissue healing and quality around dental implant is a current debated topic in the recent literature. The free gingival margin and the quantity and quality of the mucosa around teeth and surrounding dental implants still determine the hard and soft tissue healing status.Objective:The aim of this study is to assess inter and intra-operative measurement concordance of a method aimed at evaluating the apico-coronal migration of free gingival margin, using intra-oral photography.Methods:The method was tested on peri-implant tissues that were treated with a connective tissue graft on the second stage surgery. Thirty-eight measurements on 13 implants in 8 patients were recorded. An intra-oral photograph was taken for the graft and the provisional crown, which enclosed a circular landmark with a previously determined diameter. The landmark was prepared with a red-resin by the same technician. Before crown cementation, the landmark was calibrated with a digital calibrator by the main investigator, to determine the precise diameter up to two decimal numbers.Results:On the intra-oral photograph, the distance was measured from the most apical point of the determined landmark to the zenith of the gingiva, using an image-processing program designed for scientific multidimensional images (Image J). Three independent examiners took these measurements.Conclusion:The main advantage of the present non-invasive technique is that the spatial plane of the prosthetic landmarks is the same of the tooth unlike the utilization of periodontal probe, which is generally positioned on different plans in the space (generally more vestibular).

Does the Papilla Preservation Flap Technique Induce Soft Tissue Modifications over Time in Endodontic Surgery Procedures?

IntroductionThe aim of the present controlled clinical trial was to compare 2 incision techniques, papilla base incision (PBI) and sulcular incision (IS), evaluating changes in papilla and recession height over a 12-month period. MethodsA total of 24 subjects requiring endodontic surgery on a single tooth were enrolled. PBI was used in 1 group and IS in the other group. The primary outcomes were changes in gingival recession of the tooth affected by periapical lesions and the mesial and distal teeth and the mesial and distal papilla height using the treated tooth as the reference. Outcome variables were assessed at baseline and 12 months after the surgical intervention. Statistical analysis was performed by a blinded operator through appropriate tests, with significance set at a P value equal to .05. ResultsIn the PBI group, the papilla height at the 12-month follow-up in the mesial and distal aspect decreased 0.10 ± 0.32 mm and 0.10 ± 0.32 mm, respectively, and 0.23 ± 0.68 mm and 0.25 ± 0.40 mm, respectively, in the IS group without any significant differences. There were no differences found for recession change values between groups. ConclusionsThe PBI and IS approaches in endodontic surgery showed similar results in terms of papilla height preservation and recession changes.

A systematic review on the effects of air polishing devices on oral tissues.

Air-polishing devices are used for the instrumentation of the root surface. Their potential of harm to the hard and/or soft tissues needs to be considered during periodontal treatment. The objective of this systematic review was to analyse the effects of air polishing devices on oral tissues. The electronic databases MEDLINE, EMBASE and the Cochrane Library were screened for studies published through 18 November 2013. The surface modifications on human cementum, dentine or gingiva after the instrumentation were considered as outcomes. Of the 1266 abstracts screened, 17 studies were included in the analysis. Different air polishing powders consisting of sodium bicarbonate, calcium carbonate, pumice or glycine were used in different ex vivo or in vitro settings. Thirteen publications reported data on the effects of air polishing devices on cementum and dentine. Hard tissue modifications, including defect depths and volume, caused by sodium bicarbonate or calcium carbonate powders were significantly greater compared to powders consisting of glycine. The soft tissue modifications using different modes of instrumentation were assessed in four publications. The data demonstrate less potential of harm to the gingiva after spraying with glycine powder compared to sodium bicarbonate powder or instrumentation with curettes. Glycine powder air polishing may be safely applied to human root surfaces and gingivae.

Soft and hard tissue modifications at immediate transmucosal implants (with Laser-Lok microtextured collar) placed into fresh extraction sites: a 6-month prospective study with surgical reentry.

Histologic and clinical studies confirm that laser-microtextured implant collars favor the attachment of connective fibers and reduce probing depth and peri-implant bone loss when compared with machined collars. This prospective study aimed at assessing the alveolar dimensional changes after immediate placement of a transmucosal implant with a Laser-Lok microtextured collar associated with bone regenerative procedures. Thirteen implants were placed immediately into single-rooted extraction sockets. Peri-implant defects were treated with bovine-derived xenografts and resorbable collagen membranes. At 6-month surgical reentry, the Laser-Lok microtextured collar provided more favorable conditions for the attachment of hard and soft tissues and reduced the alveolar bone loss.

Periodontitis disease as a model of inflammation and bone remodelling to study osteoarthritis drug effects. Results from a pilot study in OA patients treated with chondroitin sulfate

Periodontitis disease as a model of inflammation and bone remodelling to study osteoarthritis drug effects. Results from a pilot study in OA patients treated with chondroitin sulfate

Modifications nasolabiales après chirurgie orthognathique

Esthetic modifications related to maxillary osteotomies are difficult to predict. The correlation between skeletal displacements and soft tissue modifications is quite variable. The data on transverse plane modifications is very limited. This review was focused on nasolabial modifications (nasal tip projection, nasolabial angle, alar width) after Le Fort I osteotomies and complementary surgery aiming at improving the esthetic results. Les modifications esthétiques liées aux ostéotomies maxillaires sont difficilement prévisibles. La corrélation entre les déplacements osseux et les modifications des parties molles est très variable. Les données liées aux modifications dans le plan transversal sont très parcellaires. Cette mise au point est centrée sur les modifications nasolabiales (projection de la pointe du nez, angle nasolabial, distance inter-alaire) après ostéotomie de Le Fort I et sur les gestes complémentaires améliorant le résultat esthétique.

Computer-Assisted Implant Rehabilitation of Maxillomandibular Defects Reconstructed With Vascularized Bone Free Flaps

Functional recovery for patients who undergo maxillomandibular reconstruction with vascularized bone free flaps (VBFFs) is potentially more attainable with computer-assisted implant rehabilitation. This prosthodontic-driven approach uses software planning and surgical templates for implant placement supporting fixed dental prostheses (FDP). Implant success with immediate load (IL) provisional and definitive FDP restorations in VBFFs is reported for the first time in a patient cohort. To determine implant success for FDP restorations and IL restorations. To determine factors that may influence success and predictability to provide FDP restorations in VBFFs. A retrospective medical chart review was conducted of patients who underwent VBFF reconstruction and computer-assisted planning (CP) for FDP implant rehabilitation. This study was conducted with approval from the institutional review board at Beth Israel Medical Center, New York, New York. Clinical procedures were conducted in operating room and outpatient facilities in a tertiary referral medical center. Twenty-eight consecutive patient treatments were reviewed. Inclusion criteria for all patients were VBFF reconstruction and CP for FDP restoration prior to stage 1 implant surgery. Patients were evaluated for implant success, surgical templates, IL provisional restorations, and prosthodontic framework design. A comparison is made between patients with IL provisional restorations and those patients who did not receive an immediate restoration. Implants that achieved osseointegration and used for prosthetic reconstruction determined success. Prosthodontic design considerations included whether the patient received an IL provisional restoration and 3 categories of FDP metal framework design. RESULTS Ninety-nine implants of 116 implants placed were used for prosthetic restorations, achieving an 85.4% success rate. Twenty-five of 28 patients received FDP restorations. Thirteen of 28 patients received IL provisional restorations at stage 1 implant surgery. Fifty of 56 implants were successful (89.3%) in the IL group. Computer-assisted implant rehabilitation of reconstructed defects can achieve superior results to provide FDP and IL provisional restorations. This prosthodontic-driven approach also uses unique framework design to account for mandible height discrepancy after fibula free flap reconstruction. Patient management for FDP rehabilitation is also dependent on radiation status, soft-tissue modification, and patient selection.

Bhawsar–Karandikar Stent: An Aid to Vestibuloplasty

The loss of teeth and their replacement by artificial denture is associated with many problems. Pre-prosthetic surgical procedures are performed to provide a better anatomic environment and to create proper supporting structures for construction of dentures. Whenever inadequate vestibular depth is present in edentulous mouth, deepening of vestibule is considered to increase the retention and stability of denture. Deepening of vestibule without any addition of the bone is termed as vestibuloplasty. This article describes the ease and convenience of vestibuloplasty followed by the use of Bhawsar-Karandikar stent to maintain the soft tissue modifications. The study yielded promising results and patient acceptance.

Seasonal modifications and morphogenesis of the hypercalcified sponge Petrobiona massiliana (Calcarea, Calcaronea)

The periodicity of sexual elements and soft tissue modifications during the life cycle of the hypercalcified sponge Petrobiona massiliana was investigated monthly from June 2006 to November 2007. Sexual reproduction, likely regulated by seawater temperatures, occurred during more than half of the year (from early April to late October); 70% of the samples appeared reproductively active. Specimens of P. massiliana displayed a high plasticity of tissue organization, allowing modulation and rearrangement of their aquiferous systems in response to life cycle phases and environmental changes. Permanent changes were observed in the basal region of the choanosome in non-reproductive specimens, such as disorganization/restructuring events leading to remodeling of the aquiferous system. Periodic modifications occurring during sexual reproduction included the transformation of choanocytes from a typical form to hourglass and vespiform shapes, and more global disorganization of the basal region of the choanosome during provisioning of oocytes and embryos, followed by restructuring after release of the larvae. Finally, episodic disorganization/reorganization phenomena occurred in a few specimens after unfavorable environmental conditions (e.g., decreasing seawater temperatures). Histological and ultrastructural observations of storage cells, located in peculiar trabecular tracts, suggest a transdifferentiation capacity that allows such soft tissue dynamics. © 2011 The American Microscopical Society, Inc.

Reconstruction of a maxillectomy patient with an osteocutaneous flap and implant-retained fixed dental prosthesis: A clinical report

This clinical report describes a multidisciplinary approach in the implant rehabilitation of a 53-year-old white male diagnosed with chondrosarcoma. Following a maxillectomy and insertion of a surgical obturator, the patient was unable to adapt physically and psychologically to the removable prosthesis. The patient underwent a microvascular free tissue transfer using an osteocutaneous free fibula flap to reconstruct a right/left infrastructure maxillectomy defect, a soft tissue modification of the skin component using an implant retained stent, and placement of maxillary dental implants to retain a fixed prosthesis. Prosthodontic planning and treatment considerations are discussed.

TU‐D‐204B‐08: A Setup for Patient Individual KV CBCT Scatter Prediction Using Monte Carlo Simulations

Purpose: To use Monte Carlo simulations for scatter subtraction on cone‐beam CT projection images to improve the Hounsfield Unit constancy. Materials and Methods: To accurately simulate the scatter contribution for the kV detector a detailed modeling of the entire OBI geometry is performed. We calculated the bremsstrahlung spectrum using MCNPX (v2.7b). A patient voxel model was created using CT images. The detector was accurately defined in MCNPX, including filtering, the anti‐scatter grid and other important structures. To separate the primary and scattered photons, we used the tally tagging functionality. In an alternative method we saved the phase space information at the detector after transport through the object of interest. Afterwards we applied energy response functions to better predict the contribution of scatter in the active layer of the detector. Soft tissue modification was used to study the possibility of scatter subtraction after weight loss for a head‐and‐neck patient. Results: Simulations of the bremsstrahlung spectrum were in good agreement with chamber measurements. The patient voxel model was used to determine the patient individual scatter characteristics. After weight loss the scatter increased due to the larger contribution of the scatter originating from the bowtie filter. The scattered photons was dominated by the primary photons and subtraction errors are believed to be small. Scatter estimates corrected for detector response were calculated using the phase space information for a flood field. The flood field simulation included the heel effect and scatter estimate of the flood field increased towards the unfiltered part of the beam. Conclusion: We provided an initial setup for patient individual scatter prediction using Monte Carlo simulations. When acquiring the phase space at the detector, we can apply detector response functions to approximate the scatter response in an physical kV OBI detector. Conflict of Interest: Research supported by a Varian research grant.

Dentoskeletal effects and facial profile changes during activator therapy.

The aim of this retrospective study was to investigate cephalometrically the skeletal, dental, and soft tissue modifications induced by activator treatment in patients with Class II malocclusions caused by mandibular retrognathism. The subjects, all in the mixed dentition, were selected from a single centre and were divided into two groups: 40 patients treated with an incisor double capping activator (20 girls, 20 boys with a mean age of 10 years) and a control group of 30 subjects (15 girls, 15 boys with a mean age of 10 years). The dentoskeletal and aesthetic changes that occurred were compared on lateral cephalograms taken before treatment (T0) and after 18-24 months, when the activator was removed (T1). In the control group the radiographs were obtained before (T0) and after (T1) 21 months (standard deviation +/- 3 months). Activator treatment in these growing patients resulted in a correction of the Class II relationship (ANB -2.14 degrees), a restriction of maxillary growth (SNA -0.5 degrees), an advancement of the mandibular structures (SNB +1.64 degrees, FH--NPg +3.39 degrees; OLp-B +5.17 mm, OLp-Pg +5.14 mm, OLp-Go +2.44 mm), a correction of the overjet (-5.03 mm), an improvement in overbite (-1.17 mm) and uprighting of the maxillary incisors (1--FH -5.64 degrees). The activator appliance was effective in treating growing patients with mandibular deficiency: activator therapy corrected Class II malocclusions by a combination of skeletal and dental changes and improved the soft tissue facial profile.

Patient specific finite element model of the face soft tissues for computer-assisted maxillofacial surgery

This paper addresses the prediction of face soft tissue deformations resulting from bone repositioning in maxillofacial surgery. A generic 3D Finite Element model of the face soft tissues was developed. Face muscles are defined in the mesh as embedded structures, with different mechanical properties (transverse isotropy, stiffness depending on muscle contraction). Simulations of face deformations under muscle actions can thus be performed. In the context of maxillofacial surgery, this generic soft-tissue model is automatically conformed to patient morphology by elastic registration, using skin and skull surfaces segmented from a CT scan. Some elements of the patient mesh could be geometrically distorted during the registration, which disables Finite Element analysis. Irregular elements are thus detected and automatically regularized. This semi-automatic patient model generation is robust, fast and easy to use. Therefore it seems compatible with clinical use. Six patient models were successfully built, and simulations of soft tissue deformations resulting from bone displacements performed on two patient models. Both the adequation of the models to the patient morphologies and the simulations of post-operative aspects were qualitatively validated by five surgeons. Their conclusions are that the models fit the morphologies of the patients, and that the predicted soft tissue modifications are coherent with what they would expect.

Surgical crown lengthening: a 12-month clinical wound healing study.

Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing periodontal injuries in teeth with structurally inadequate clinical crowns or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. The few clinical studies in the current literature on postsurgical soft tissue modifications after crown lengthening procedures report conflicting results. The present study was designed to assess the alterations of the marginal periodontal tissues as an immediate outcome of surgical crown lengthening and over a 12-month healing period. The patient sample included 30 patients (84 teeth) who presented with various conditions hampering proper restorative measures in one or more teeth and, therefore, requiring surgical exposure of tooth substance. After initial supportive therapy, the patients were recalled for a baseline examination, and the following parameters were evaluated at interproximal and buccal/lingual sites of each experimental tooth: plaque index, gingival index, position of the gingival margin, probing depth, and attachment level. After baseline examination, the patients underwent apically positioned flap surgery with osseous and connective tissue attachment resection. During surgery, the amount of resection and the achieved lengthening of the clinical crown were evaluated. The patients were enrolled in a maintenance program including professional tooth cleaning every 2 to 4 weeks. The patients were reexamined 1, 3, 6, 9, and 12 months postoperatively. 1) Immediately after surgery, a significantly (P < 0.001) increased clinical crown length of 3.7 +/- 0.8 mm (mean) at interproximal and 4.1 +/- 0.9 mm (mean) at buccal/lingual sites was achieved; 2) healing resulted in a statistically significant coronal displacement of the gingival margin of 3.2 +/- 0.8 mm at interproximal (P < 0.001) and 2.9 +/- 0.6 mm at buccal/lingual (P < 0.002) sites; and 3) as a consequence of this postsurgical soft tissue regrowth, the amount of the available tooth structure immediately after surgery decreased to 0.5 +/- 0.6 mm at interproximal sites (P < 0.0015) and to 1.2 +/- 0.7 mm at buccal/lingual sites (P < 0.001) at the 12-month examination. The results of the present clinical investigation demonstrated that during a 1-year period of healing following surgical crown lengthening, the marginal periodontal tissue showed a tendency to grow in a coronal direction from the level defined at surgery. This pattern of coronal displacement of the gingival margin was more pronounced (P < 0.001) in patients with "thick" tissue biotype and also appeared to be influenced by individual variations in the healing response (P < 0.001) not related to age or gender.

ILIOPSOAS SYNDROME IN DANCERS

1639 Iliopsoas syndrome (internal coxa saltans, iliopsoas tendinitis and bursitis) has been identified as a cause of anterior hip symptomatology in dancers. This is usually the result of repetitive active hip flexion with the hip in an abducted, externally rotated position. We are reporting on the incidence, clinical findings, treatment protocol and results of treatment of iliopsoas syndrome in a dance population. A retrospective chart review of 653 professional (370), student (186), and amateur (67) dancers evaluated for musculoskeletal injury or complaint was performed. Diagnosis of iliopsoas syndrome was made on the basis of characteristic complaints along with the specific clinical finding of pain and/or weakness with resisted hip flexion in a turned out position. Other hip pathology was specifically ruled out. Dancers with asymptomatic snapping of the hip were excluded. 7.5% (49/653) of dancers evaluated were diagnosed as having iliopsoas syndrome. The incidence in female dancers was 9.2% (43/465) compared to 3.2% (6/188) in male dancers. Although fewer in number, the 12.8% incidence (10/78) in dancers less than 18 years old was greater than the 7% (39/557) incidence in dancers 18 years of age or older(age range: 14-49). Student dancers had a higher incidence (14%) than either professional (4.6%) or amateur dancers (7.5%). Symptoms (pain, clicking, weakness) frequently occurred during passé developpé in a turned out position (active flexion, abduction and external rotation). Associated ipsilateral lower back pain was present in 44%. Clicking and/or snapping could be elicited in 78%, with a positive “iliopsoas test” (pain and/or weakness) in 100%. 73.5% of patients had pain and/or tightness upon passive hip extension. All patients underwent physical therapy, which included hip flexor stretching and strengthening, pelvic and peripelvic mobilization and soft tissue work, alignment exercises, and modification of dance technique or exposure as required. A follow-up via clinical evaluation and/or telephone interview was performed averaging > 2 years from initial evaluation. All patients responded well to conservative management. No patients required corticosteroid injections or surgical intervention. This is the largest series reported to date of iliopsoas syndrome in dancers, or any other subject population.

Late stage soft tissue modification for anatomically correct implant-supported restorations

For the past decade, the dental profession has developed techniques for producing functionally equivalent implant supported restorations to replace complete dentures. Little thought was given to the development of proper emergence profiles to develop anatomic restorations that were contoured like natural teeth. This article presents a simple method of modifying soft tissues coronal to the implant head that will allow the development of a restoration with correct emergence profile and anatomic contour.

Soft-Tissue Modifications of Surgical Techniques for Placement and Uncovering of Osseointegrated Implants

The recommended modifications of soft-tissue management for two-stage implant surgeries have resulted in improved access for implant placement, accommodation of surgical stents, less formation of cicatrix in the vestibules, better control of flap extensions resulting in improved esthetics, and improved tissue quality for long-term peri-implant maintenance and success. The implication of periodontal guidelines to the uncovering procedure of dental implants result in decreased thickness of peri-implant tissues and less pocket formation around the transmucosal sleeves. These modifications contribute significantly to the long-term periodontal maintenance of peri-implant tissues.