Tissue Contour Research Articles

Soft Tissue Contours at Pontic Sites With or Without Soft Tissue Grafting-A 15-Year Follow-Up of a Controlled Clinical Study.

To report on soft tissue contour changes at pontic sites with or without soft tissue grafting over an observation period of 15 years. Fourteen patients received a fixed dental prosthesis (FDP) in the posterior zone in a controlled clinical study and were available at the 15-year follow-up. Eight patients received a subepithelial connective tissue graft in the pontic area (test) while six received the FDP without soft tissue grafting (control). Impressions were taken after FDP cementation and at 15 years. Casts were digitized and a profilometric analysis was performed (mean distance) and the pontic height (PH) and ridge width (RW) were analyzed at the mid-buccal area. A descriptive analysis and Wilcoxon-Mann-Whitney test was performed (level of significance: 5%). Profilometric changes (mean distance) from baseline to 15 years amounted to -0.68 mm (test) and to -0.33 mm (control) (p = 0.208), 95% CI for group difference (0.290; -0.750). PH measured -0.47 mm (test) and 0.0 mm (control) (p = 0.079) and RW amounted to -1.05 mm (test) and -0.38 mm (control) (p = 0.138). Remodeling of the soft tissue contour at pontic sites of FDPs was evident in both groups, but slightly more accentuated following soft tissue grafting. This study is the first to report on soft tissue changes at pontic sites over more than 10 years. It investigates whether tissue contour changes with and without soft tissue grafting before the insertion of FDPs. Remodeling of the soft tissue contour at pontic sites was observed over 15 years, with more pronounced changes when soft tissues were augmented with SCTGs before FDP insertion. The volume loss at the augmented site must be considered in relation to the overall tissue changes over long periods. Connective tissue grafts reliably improve shape and esthetics around the pontic unit. Further long-term studies with more patients are needed to evaluate the initial gains and long-term performance of these augmentations.

Effect of soft tissue volume on midfacial gingival margin alterations following immediate implant placement in the esthetic zone: a 1-year randomized clinical and volumetric trial.

The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm3) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. The midfacial gingival margin changes demonstrated a significant difference (P ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm3) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference (P > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm3) after 1 year and mid-facial gingival margin changes (P ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group (P = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups (P ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant(P > 0.05). This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm3) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023).

Exploratory study on a novel minimally invasive tunnel like flap approach for orthodontic movement of dental implants.

To propose a new flap design that utilize a minimally invasive approach to move implants. We also propose a 3D method to track changes in implant position without the need for CBCT. Implants were inserted in two mongrel dogs then a minimally invasive tunnel like flap was made. Bone cutting around implants was done using piezotome device and orthodontic force was applied on the implants. For tracking positional changes of implants, an impression was taken then scanned with an identical implant copy inside. The pre- and post-treatment 3D images were then superimposed over each other to detect changes in implant position. Healing of the flap was rapid with minimal swelling and edema. The position of the interdental papilla was preserved maintaining optimal esthetic outcome. Implant pocket depth was maintained. Our 3D imaging method was able to accurately detect the movement that occurred in the dental implants after their movement with significantly higher resolution than CBCT (6μm for this method versus 76-300μm for the CBCT). This flap can preserve the esthetic soft tissue contour of implants during orthodontic movement allowing rapid healing with minimum swelling and edema. Moreover, our proposed 3D method has many advantages over CBCT in tracking the movement of implants by being non harmful and cheap thus allowing several follow up points. Orthodontic movement of implants can be required in cases of improperly placed implants or to intentionally place the implant in a certain position then altering it to avoid the need for bone grafting.

What happens after the free flap? Evaluation of aesthetic and functional elective revisions

BackgroundMicrovascular free flap reconstruction of a defect, as a single-stage procedure, does not always achieve the desired functional and esthetic result. Revisions may be necessary to achieve ideal contour, symmetry, and suspension of soft tissues, or to support dental rehabilitation. PurposeThe study purpose was to estimate the incidence and identify factors associated with elective free flap revisions.Study design, setting, sample: A retrospective cohort study of subjects who underwent free flap reconstruction was conducted to characterize the rate of elective free flap revision surgery. The study included subjects >18 years old, who underwent head and neck microvascular free flap surgery for any etiology, and both primary and secondary reconstructions, between 2014-2021. Subjects were excluded if they had incomplete records. Predictor variableThe predictor variable was composed of a set of variables, grouped into the following categories: subject demographic data, medical history, disease etiology, anatomical site, and postoperative complications. Main outcome variableThe outcome variable was time to elective revision surgery measured as months from the date of the initial operation to date of elective revision surgery. Elective revision surgery was defined as a procedure to enhance esthetics or function, which directly modifies the original surgical site, not including procedures to correct a complication, treat the original disease process, or emergencies. CovariatesNot applicable. AnalysisKaplan-Meier method was used to analyze the data, with p-value <0.05. Risk factors for elective revisions were analyzed with Cox Hazard ratio. ResultsThe sample was composed of 377 subjects that underwent free flap surgery, with a mean age of 55.9 +/- 15.9. Of these 67% were male, and 33% female, and sixty-two had an elective revision surgery (16.4%), with median follow-up period of 17 months (IQR 9-28). In the Cox regression model, only type of free flap was associated with an elective revision (p<0.05), where radial forearm had the lowest association with elective revision, and fasciocutaneous, latissimus dorsi, and scapula flaps had the highest. Conclusion and RelevanceAchieving basic wound coverage with free flaps can be a challenge, however, surgeons should prepare patients for the potential need for functional and esthetic revisions after free flap surgery to improve patient quality of life.

A comparison of preoperative soft tissue contour versus bone accuracy as a predictor of quality of life outcomes in osseous free flap jaw reconstruction using occlusal-based virtual surgical planning

ObjectivesOcclusal based virtual surgical planning (VSP) prioritises placement of endosseous dental implants, over replicating native bone contour. This may compromise facial aesthetics. This study aims to compare function and health-related quality of life (HRQOL) following maxillomandibular reconstruction according to ability to replicate preoperative soft-tissue contour and virtual plan. Materials and methodsPatients who had undergone occlusal based VSP osseous free flap reconstruction of the maxilla or mandible, with high-resolution pre- and postoperative facial computerised tomography imaging, and completion of FACE-Q questionnaire were retrospectively identified. Accuracy of reconstruction compared to preoperative soft tissue contour and virtual plan, was measured using 3DSlicer® and CloudCompare® in three dimensions. Random effects modelling determined associations between bony and soft tissue accuracy and HRQOL/functional domains. ResultsTwenty-two patients met the inclusion criteria. For mandibular and maxillary reconstructions, better soft tissue accuracy was associated with improved appearance (p = 0.048) and appearance distress (p = 0.034). For mandibular reconstructions, better soft tissue accuracy was associated with improved smile (p=0.039) and smile distress (p=0.031). For maxillary reconstructions, better bony accuracy was associated with improved appearance (p=0.023) and drooling distress (p=0.001). Unexpectedly, better bony accuracy was associated with worse eating and drinking (p=0.015), oral competence (p=0.005) and eating distress (p=0.013) in mandibular reconstructions. ConclusionWhilst soft tissue accuracy was associated with better functional and HRQOL outcomes, bone accuracy was associated with worse oral function/distress in mandibular reconstruction. These results need validation but should be considered when performing occlusal-based VSP, which prioritises dental rehabilitation over replicating facial bony contour.

Assessment of soft and hard tissue changes following micro crestal flap-Alveolar ridge preservation and augmentation at molar extraction sites in patients with stage III/IV periodontitis: A randomized controlled trial.

This study aimed to assess hard and soft tissue contour changes following micro crestal flap-alveolar ridge preservation (MCF-ARP) and natural healing (NH) in periodontally compromised molar extraction sites and to analyse the feasibility and need for bone augmentation during implant therapy. Fifty-six patients with 70 sites were randomized into two groups at the site level (35 sites from 31 patients in the test group and 35 sites from 29 patients in the control group). Among whom, four patients contributed one tooth to the control group and one tooth to the test group. Hard tissue indicators were measured using cone beam computed tomography performed before tooth extraction and 6 months after surgery. Soft tissue contour changes were assessed using intraoral scanning performed before and immediately after surgery and also 2 weeks and 1, 3 and 6 months after surgery. Six months after surgery, the MCF-ARP group showed less resorption in buccal bone height (p = .032) and greater augmentation in central bone height (p = .001) and ridge width (p = .009). The mean, vertical and horizontal collapse of buccal soft tissue contour in the MCF-ARP group were 0.95 mm (p = .010), 0.61 mm (p = .019) and 0.56 mm (p = .013) less than that in the NH group, respectively. There were significantly (p = .007) fewer sites in the MCF-ARP group than in the NH group (0% vs. 26.7%) for staged bone augmentation and more sites that could be treated with simple implant procedure in the MCF-ARP group than in the NH group (71.9% vs. 56.6%). Compared with NH, MCF-ARP reduced bone resorption in periodontally compromised molar extraction sites and maintained the buccal soft tissue contour. MCF-ARP reduces the need for complex bone augmentation procedures in implant therapy. Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on 4 February 2022, Version 1.0.

Dynamic monitoring and esthetic evaluation of dimensional changes in the peri-implant soft tissue contour after the immediate implant placement and provisionalization with the modified socket-shield technique in the esthetic zone

Objective: To accurately measure the dynamic changes of peri-implant soft tissue within one year after the immediate implant placement and provisionalization with the modified socket-shield technique (MSST) in the esthetic zone, and to provide a basis for evaluating the effect of the modified socket-shield technique on the maintenance of peri-implant soft tissue. Methods: A total of 22 patients (22 implants) were prospectively included 1 year after completion of immediate implant placement and provisionalization (IIPP) within MSST in the esthetic zone from January 2022 to January 2024 at the Department of Oral Implantology in the Stomatological Hospital of Chongqing Medical University. The intraoral optical models of patients were obtained by an intraoral scanner system preoperatively and at 3, 6, and 12 months postoperatively, respectively. The standard tessellation language files of intraoral optical models at multiple time points were imported to Geomagic Studio 2013 to be superimposed and aligned for analyzing the peri-implant soft tissue contour on the labial side of the implant site at multiple levels. The amount of gingival margin recession, gingival papilla change, and thickness change of the labial side of the soft tissues at each postoperative point in time were measured at each postoperative time point, as well as evaluating the esthetic effect by the pink esthetic score (PES). Results: The patients were (40±13) years old (21-75 years), including 9 males and 13 females. No adverse events occurred in all the implants during the 12-month follow-up period. The recession level of the gingival margin of the implant site (GL) was 0.08 (0.07) mm, the recession level of the mesial papilla (ML) was 0.19 (0.25) mm, and the recession level of the distal papilla (DL) was 0.19 (0.10) mm. The average collapse thickness of the soft tissue contour on the labial side of the implant (ΔD) was (0.39±0.09) mm, mainly occurring within 2 mm of the root of the gingival margin. The height of the alveolar bone was reduced by (0.17±0.08) mm. The thickness of the labial alveolar bone at 1, 3, and 5 mm root side of the implant shoulder was reduced by (0.13±0.08), (0.12±0.10) and 0.04 (0.17) mm, respectively. The postoperative pink esthetic score was 13.00 (2.25) points at 12 months, which suggested that all implant sites achieved ideal esthetic results. Conclusions: The labial soft tissue contour at implant sites shows minimal change following immediate implant placement and provisionalization using the modified socket-shield technique for 1 year in the esthetic zone.

FCM-DCS: Fuzzy C means distorted contour-based segmentation model for breast cancer detection

Breast cancer (BC) is a commonly diagnosed cancer among women nowadays. The cancer cells in the breast tissues are known as BC. Comprehensive research on early-stage BC detection helped to increase the survival rate and reduce the amortality rate associated with this disease. Mammogram scan analysis is a commonly used breast tissue visualization method. This image data is analyzed adequately for accurate BC diagnosis. Region of interest (ROI) identification is crucial in an image-based BC detection system. The ROI detection helps to segment the cancer tissues from the mammogram images by analyzing the heterogeneity among cancerous and normal breast tissues. Early-stage BC issues have homogeneous features as normal breast tissues. So, it is an open challenge for the researchers to develop a more accurate segmentation method during the automatic BC stages detection system. This study introduced fuzzy C means (FCM) distorted contour-based segmentation (FCM DCS) method to address the real detection issues in present studies. It uses the distorted contour (DC) based method to identify the contour of the cancer tissue from mammogram images. The DC method is performed with the help of FCM to identify the cancer tissues. Moreover, a histogram and adaptive equalization method were utilized to reduce image noise and preserve the edge features. The result analysis shows that the FCM-DC methods achieved a maximum accuracy rate (98.76 %) than comparison methods in BC detection.

Evaluating automatically generated normal tissue contours for safe use in head and neck and cervical cancer treatment planning.

Volumetric-modulated arc therapy (VMAT) is a widely accepted treatment method for head and neck (HN) and cervical cancers; however, creating contours and plan optimization for VMAT plans is a time-consuming process. Our group has created an automated treatment planning tool, the Radiation Planning Assistant (RPA), that uses deep learning models to generate organs at risk (OARs), planning structures and automates plan optimization. This study quantitatively evaluates the quality of contours generated by the RPA tool. For patients with HN (54) and cervical (39) cancers, we retrospectively generated autoplans using the RPA. Autoplans were generated using deep-learning and RapidPlan models developed in-house. The autoplans were, then, applied to the original, physician-drawn contours, which were used as a ground truth (GT) to compare with the autocontours (RPA). Using a "two one-sided tests" (TOST) procedure, we evaluated whether the autocontour normal tissue dose was equivalent to that of the ground truth by a margin, δ, that we determined based on clinical judgement. We also calculated the number of plans that met established clinically accepted dosimetric criteria. For HN plans, 91.8% and 91.7% of structures met dosimetric criteria for automatic and manual contours, respectively; for cervical plans, 95.6% and 95.7% of structures met dosimetric criteria for automatic and manual contours, respectively. Autocontours were equivalent to the ground truth for 71% and 75% of common DVH metrics for the HN and cervix, respectively. This study shows that dosimetrically equivalent normal tissue contours can be created for HN and cervical cancers using deep learning techniques. In general, differences between the contours did not affect the passing or failing of clinical dose tolerances.

Artificial Intelligence-Based Radiotherapy Contouring and Planning to Improve Global Access to Cancer Care.

Increased automation has been identified as one approach to improving global cancer care. The Radiation Planning Assistant (RPA) is a web-based tool offering automated radiotherapy (RT) contouring and planning to low-resource clinics. In this study, the RPA workflow and clinical acceptability were assessed by physicians around the world. The RPA output for 75 cases was reviewed by at least three physicians; 31 radiation oncologists at 16 institutions in six countries on five continents reviewed RPA contours and plans for clinical acceptability using a 5-point Likert scale. For cervical cancer, RPA plans using bony landmarks were scored as usable as-is in 81% (with minor edits 93%); using soft tissue contours, plans were scored as usable as-is in 79% (with minor edits 96%). For postmastectomy breast cancer, RPA plans were scored as usable as-is in 44% (with minor edits 91%). For whole-brain treatment, RPA plans were scored as usable as-is in 67% (with minor edits 99%). For head/neck cancer, the normal tissue autocontours were acceptable as-is in 89% (with minor edits 97%). The clinical target volumes (CTVs) were acceptable as-is in 40% (with minor edits 93%). The volumetric-modulated arc therapy (VMAT) plans were acceptable as-is in 87% (with minor edits 96%). For cervical cancer, the normal tissue autocontours were acceptable as-is in 92% (with minor edits 99%). The CTVs for cervical cancer were scored as acceptable as-is in 83% (with minor edits 92%). The VMAT plans for cervical cancer were acceptable as-is in 99% (with minor edits 100%). The RPA, a web-based tool designed to improve access to high-quality RT in low-resource settings, has high rates of clinical acceptability by practicing clinicians around the world. It has significant potential for successful implementation in low-resource clinics.

Precision Prosthodontic Rehabilitation of Flabby Ridge with a Modified Window Technique: Case Report

Flabby ridge, also known as a soft (mobile), movable, or displaceable ridge, presents a common clinical challenge in dental practice. It primarily affects the alveolar ridges of the upper (maxillary) or lower (mandibular) arches. The anterior region of the maxilla is especially susceptible in edentulous patients. The flabby ridge lacks the firmness and stability required, leading dentures to become loose and unstable. Consequently, this instability can result in discomfort, speech and eating difficulties, and reduced quality of life for denture wearers. The flabby ridge often does not provide the necessary contour and resilience needed to establish an effective seal and maintain suction between the denture base and the underlying tissues. This compromises denture retention, making them susceptible to dislodgement during typical oral functions. Therefore, rehabilitating a completely edentulous patient with flabby tissue presents a formidable challenge for prosthodontists, as it undermines the retention, stability and support of complete dentures. Methods for managing flabby ridges encompass surgical removal, ridge augmentation, specialized impression techniques, balanced distribution of occlusal loads and implant therapy. Various impression techniques have been proposed to address the complexities of such cases. By carefully applying the principles of complete denture construction, a palliative treatment approach can be achieved. Special impressions often employ the window technique to capture a static impression of the flabby area, which introduces its own set of challenges. This innovative case report introduces a modified window technique that incorporates precise record transfer of the flabby ridge using tissue (blotting) paper. Specifically designed for the anterior mandibular flabby ridge, the technique employs a custom tray with a window positioned over the flabby tissues. A mucostatic impression material is utilized to minimize pressure on the flabby tissue, thereby reducing potential tissue distortion during the impression process. The procedure is executed in two steps: first, stable structures are recorded, followed by capturing the mobile tissues using light-body polyvinyl siloxane (PVS) elastomeric impression material within the window area. This method ensures an accurate record of the denture-supporting structures while maintaining the contour and details of the flabby tissues without displacement. Importantly, the technique is crafted for straightforward implementation by general dental practitioners within a primary dental care setting.

Current Concepts in Alveolar Ridge Augmentation

Ridge augmentation is a predictable procedure that can correct the defects caused by bone loss in areas with missing teeth. More importantly, this procedure allows the chance to return the natural contours of the soft tissues that existed before the loss of the tooth. It is done in patients with insufficient bone height and width by using various bone substitute materials and bone graft procedures where the successful placement of dental implants is difficult with regards to maintaining an ideal pathway and avoiding important anatomical structures. This review article will be carried out to describe the various techniques of ridge augmentation.

Analysis of left ventricle regional myocardial motion for cardiac radioablation: Left ventricular motion analysis.

Left ventricle (LV) regional myocardial displacement due to cardiac motion was assessed using cardiovascular magnetic resonance (CMR) cine images to establish region-specific margins for cardiac radioablation treatments. CMR breath-hold cine images and LV myocardial tissue contour points were analyzed for 200 subjects, including controls (n=50) and heart failure (HF) patients with preserved ejection fraction (HFpEF, n=50), mid-range ejection fraction (HFmrEF, n=50), and reduced ejection fraction (HFrEF, n=50). Contour points were divided into segments according to the 17-segment model. For each patient, contour point displacements were determined for the long-axis (all 17 segments) and short-axis (segments 1-12) directions. Mean overall, tangential (longitudinal or circumferential), and normal (radial) displacements were calculated for the 17 segments and for each segment level. The greatest overall motion was observed in the control group-long axis: 4.5±1.2mm (segment 13 [apical anterior] epicardium) to 13.8±3.0mm (segment 6 [basal anterolateral] endocardium), short axis: 4.3±0.8mm (segment 9 [mid inferoseptal] epicardium) to 11.5±2.3mm (segment 1 [basal anterior] endocardium). HF patients exhibited lesser motion, with the smallest overall displacements observed in the HFrEF group-long axis: 4.3±1.7mm (segment 13 [apical anterior] epicardium) to 10.6±3.4mm (segment 6 [basal anterolateral] endocardium), short axis: 3.9±1.3mm (segment 8 [mid anteroseptal] epicardium) to 7.4±2.8mm (segment 1 [basal anterior] endocardium). This analysis provides an estimate of epicardial and endocardial displacement for the 17 segments of the LV for patients with normal and impaired LV function. This reference data can be used to establish treatment planning margin guidelines for cardiac radioablation. Smaller margins may be used for patients with higher degree of impaired heart function, depending on the LV segment.

Spatial frequency domain imaging combining profile correction enables accurate real-time quantitative mapping of optical properties of apples

Spatial frequency domain imaging technology enables non-contact, wide-field quantitative analysis of optical properties in strong turbid media, thereby enhancing bruise detection in fruits based on changes in optical property values. However, precise and real-time measurement of the optical properties of curved biological materials is challenging due to the significant influence of tissue contours. This paper primarily presents a research study on real-time correction method based on the property that DC component diffuse reflectance (Rd_DC) and AC component diffuse reflectance (Rd_AC) are influenced by the contour trend of the tissue in a similar manner. The aim of this method is to eliminate the significant impact of sample contour angle on demodulation and enhance the detection of apple bruise. Sinusoidal illumination at a spatial frequency of 0.2 mm−1 was projected at 730 nm, with the experiments carried out on standard reflector, polytetrafluoroethylene sphere, and non-bruised and bruised apples. The results showed that, the relative error of the planar standard reflector decreased from the maximum value of 52.85–4.74%. The median of the Rd_AC for the polytetrafluoroethylene spherical standard, which fluctuated between 0.6 and 0.8, was corrected to the theoretical value of 1. For normal apples, the maximum fluctuation in the standard deviation of Rd_AC, after median filtering, reduced from 172.94% at 300×300 pixels to 18.69%. The boxplot of Rd_AC for bruised apples became smaller, with the lower fence being corrected from nearly 0–0.1750, which closely matched the theoretical value of 0.17. Additionally, the correlation of reduced scattering coefficient (μs′) in the ideal region of interest (100×100 pixels) remained at 0.9785 before and after correction, while other areas were corrected, making the bruising more pronounced. The correction method did not require additional experiments, with the consumed time in millisecond level.

Outcomes of Immediately &amp; Conventionally Loaded Dental Implants

Clinical dentistry has been subjected to a revolution by introduction of “Osseo integrated” dental implants. New trends have always been of keen interest in “implant prosthodontics”. The aim behind this systematic review was to assimilate the outcomes of “immediately” &amp; “conventionally” loaded implants. To do so a detailed electronic search was performed on PubMed, Science Direct &amp; Research gate to identify pertinent articles published between 2000 to 2021. After detailed scrutiny, six studies met the preset eligibility criteria &amp; hence were shortlisted for this project. As far as the results were concerned, no remarkable difference was seen between the success of “immediately” &amp; “conventionally” loaded implant groups. There was no remarkable difference in marginal bone levels, masticatory efficiency, bleeding on probing, implant stability quotients, peri-implant soft tissue contours among both the groups provided that immediately loaded implants had significant primary stability. In selected patients “immediate loading protocol” can successfully be practiced ensuring that adequate primary implant stability has been achieved. Cochrane Review number: COCHRANEPHAHS-2022-00152

Retroperitoneal Mullerian Cyst of Renal Origin in a Cat - A Case report

Extreme rarely reported mullerian cysts of the retroperitoneum are considered to be a subtype of urogenital cysts. Retroperitoneal cysts can be categorized into lymphatic cysts, mesothelial cysts, enteric cysts and urogenital cysts based on embryological origin and histogenesis. The present case is an rare encounter and the successful management of the same is herewith discussed. A twelve months old intact female domestic short hair cat was presented with a history of progressive abdominal distension, anorexia, lethargy and oliguria. On abdominal palpation, an extensive globular mass was palpable in the cranial abdomen a survey radiography of the abdomen and thorax revealed a soft tissue contour at the cranial abdomen at the left renal position, thoracic radiography revealed absence of any abnormalities. Renal functional status was ascertained with intravenous pyelography which revealed unilateral cystic dysgenesis of left kidney and agenesis of left ureter. Hematobiochemical profiles and preoperative assessment were done to rule out general organ health. Following routine and special diagnostic procedures, an exploratory laparotomy confirmed the cystic renal distension that was excised through an unilateral nephrectomy and the cat was observed on periodic reviews to confirm any abnormalities if any which was absent and the animal had an uneventful recovery,.

Hard and soft tissue alterations using dual-zone concept versus connective tissue graft at maxillary immediate implant placement: A 1-year randomized clinical and volumetric trial.

To evaluate the esthetic outcome, as well as clinical, radiographic, and volumetric tissue alterations 1 year after immediate implant placement (IIP) with connective tissue grafting (CTG) versus dual-zone concept (DZ) at sites with thin labial bone in the esthetic zone. This randomized clinical trial included 30 patients treated with IIP simultaneous with either CTG or DZ (n = 15 each). Pink esthetic score (PES) was assessed 6 months after crown placement as the primary outcome. Amount of bone labial to the implant, labio-palatal ridge reduction, and crestal bone changes were measured via CBCT after 1 year. Volumetric analysis of linear labial soft tissue contour, interdental, and mid-facial soft tissue level changes, and total volume loss (mm3) were measured after 1 year. Similar PES was observed in the CTG (12.53 ± 1.13) and DZ (12.13 ± 1.55) groups, with no significant difference (p = 0.42). Likewise, there were no statistically significant differences found between the two groups in labio-palatal bone reduction (mm&%), interdental papillae, and mid-facial gingival levels (p > 0.05). However, the mean vertical crestal bone changes in the CTG and DZ groups were -1.1 ± 0.6 mm and 0.2 ± 1.0 mm, respectively, with a statistically significant difference (p = 0.0002). Moreover, CTG revealed less linear and total volume (mm3) loss in the labial soft tissue which was statistically significant compared to DZ (p = 0.007). Both groups demonstrated the same PES, nevertheless, volumetric analysis revealed twice total labial volume loss in DZ compared to CTG. It might be concluded that the use of CTG with IIP caused less horizontal reduction in the supra-implant complex compared to the DZ.

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КОЛЛАГЕНОВОГО МАТРИКСА ПРИ МЕНЕДЖМЕНТЕ МЯГКИХ ТКАНЕЙ В ОБЛАСТИ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ ВО ФРОНТАЛЬНОМ ОТДЕЛЕ ВЕРХНЕЙ ЧЕЛЮСТИ

The aim is to comparatively analyze the using of collagen matrix and free connective tissue graft in soft tissue thickness increase in the area of dental implants in the anterior region of the upper jaw.&#x0D; Materials and methods. 30 patients with partial absence of teeth and soft tissue thickness deficit in the anterior part of the upper jaw took part in the study. In the 1st group (n = 15) a free connective tissue graft (CTG) from the hard palate was transplanted, in the 2nd group (n = 15) a collagen matrix (CM) was used. The primary endpoint was the amount of soft tissue thickness gain 3 months after surgery. Secondary endpoints were: duration of surgery, severity of collateral edema and pain, amount of analgesic medication consumed, quality of life assessment, width of keratinized attached gingiva, and soft tissue aesthetics.&#x0D; Results. 3 months after augmentation the increase in soft tissue thickness from the vestibular surface was 0.86 ± 0.25 mm and 0.77 ± 0.26 mm (p = 0.34), from the occlusal surface - 0.46 ± 0.14 mm and 0.37 ± 0.18 mm (p = 0.137) in patients of the 1st and 2nd groups, respectively. The use of CM was characterized by less prolonged surgery (p = 0.002), less pronounced postoperative pain on the 1st and 3rd day (p = 0.007; p = 0.023), less consumption of analgesic drugs on the 1st, 3rd and 5th day (p = 0.014; p = 0.033; p = 0.002) and less reduction of patients' quality of life in the first 7 days after surgery (p = 0.023). When analyzing the "Pink Esthetics Scale" (PES) in patients, group 2 showed more pronounced inconsistencies in the assessment of the zenith level (p &lt; 0.001), less natural soft tissue contour (p &lt; 0.001) and more significant deficit of the alveolar ridge (p &lt; 0.001).&#x0D; Conclusion. Collagen matrixes make it possible to obtain soft tissue augmentation comparable with the use of CTG, to reduce the time of surgical intervention and to provide a more comfortable postoperative period. The use of autogenous grafts provides better results in terms of soft tissue aesthetics.

Early implant placement in sites with ridge preservation or spontaneous healing: histologic, profilometric, and CBCT analyses of an exploratory RCT.

The aim of this study was to compare changes in soft and hard tissue and the histologic composition following early implant placement in sites with alveolar ridge preservation or spontaneous healing (SH), as well as implant performance up to 1 year after crown insertion. Thirty-five patients with either intact buccal bone plates or dehiscence of up to 50% following single-tooth extraction of incisors, canines, or premolars were included in the study. They were randomly assigned to undergo one of three procedures: deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered by a collagen matrix (DBBM-C/CM), DBBM-C alone, or SH. At 8 weeks, implant placement was carried out, and cone-beam computed tomography scans and impressions were obtained for profilometric analysis. Patients were followed up after the final crown insertion and again at 1 year post-procedure. Within the first 8 weeks following tooth extraction, the median height of the buccal soft tissue contour changed by -2.11 mm for the DBBM-C/CM group, -1.62 mm for the DBBM-C group, and -1.93 mm for the SH group. The corresponding height of the buccal mineralized tissue changed by -0.27 mm for the DBBM-C/CM group, -2.73 mm for the DBBM-C group, and -1.48 mm for the SH group. The median contour changes between crown insertion and 1 year were -0.19 mm in the DBBM-C/CM group, -0.09 mm in the DBBM-C group, and -0.29 mm in the SH group. Major vertical and horizontal ridge contour changes occurred, irrespective of the treatment modality, up to 8 weeks following tooth extraction. The DBBM-C/CM preserved more mineralized tissue throughout this period, despite a substantial reduction in the overall contour. All 3 protocols led to stable tissues for up to 1 year.

RMAP-ResNet: Segmentation of brain tumor OCT images using residual multicore attention pooling networks for intelligent minimally invasive theranostics

Background and objectiveThe occurrence of brain tumors seriously affects patients both mentally and physically, reducing their quality of life. Automatic recognition and segmentation of tumor boundaries are essential for computer-aided diagnosis and treatment. While optical coherence tomography (OCT) has been widely employed in the detection and analysis fundus lesions and vascular segmentation due to its high resolution and real-time imaging advantages, the segmentation of brain tumor OCT images based on deep neural network has not been studied. However, despite the encoding and decoding structure based on deep learning has achieved good results in medical image segmentation, these models still face limitations in accurately segmenting tumor OCT images due to variations in tumor shapes, sizes, and numbers, and the low contrast of OCT images. Accurate segmentation of tumor tissue contours is crucial as the absence of this mechanism hampers the effective application of OCT imaging methods for brain tumor diagnosis and treatment in clinical practice. Therefore, we propose a novel neural network that can accurately segment brain tumors and their residual tissues in OCT images. MethodsIn this study, we propose a novel residual multi-core attention pooling network (RMAP ResNet) for the segmentation of tumorous and its residual tissue. The RMAP module primarily relies on multiple associative effective receptive fields. These fields enable the detection of targets of various sizes. The module also incorporates an attention structure to adjust connection weights, suppressing irrelevant information and emphasizing the characteristics of tumor OCT images. This process restores the contextual dependencies. ResultsWe validated our proposed RMAP ResNet method on the dataset of mouse tumor OCT imaging obtained using the sweep source OCT imaging system. The experimental results demonstrate that RMAP ResNet achieves superior performance in tumor tissue segmentation. The proposed method improves the quality of tumor segmentation for various shapes and sizes, leading to superior results. RMAP ResNet achieved Dice and IoU values of 94.78% and 90.58%, respectively, confirming the effectiveness and advancement of our proposed technology. ConclusionsOur proposed method addresses the crucial issue of the limited use of the OCT imaging modality in tumor resection surgery. It overcomes the challenge of visually identifying the tumor boundary in OCT modality imaging, where physicians using the naked eye may encounter difficulties. This study has potential applications in the fields of surgical navigation and intelligent minimally invasive treatment of brain tumors.