Orthodontic management of uneven gingival margins in patients with healthy or reduced periodontium to improve smile aesthetics.

Uneven gingival margins may cause visible asymmetries during smiling and may reflect alterations in the tooth shape and morphology, particularly in cases requiring restorative procedures. Despite being perceived as a minor health condition, presence of uneven gingival margins usually impacts the smile aesthetics and could affect the individual's appearance, self­esteem, and overall quality of life, especially in subjects with a high smile line. Uneven gingival margins may result from different causes, which makes an accurate diagnosis fundamental for its treatment planning. Orthodontic treatment often serves as a conservative approach for leveling these margins, by achieving the most appropriate tooth position. This article reviews the rationale, differential diagnosis, and clinical management of uneven gingival margins using orthodontic tooth movements, providing insights for orthodontists, periodontists, and restorative dentists on the interdisciplinary care needed to correct this condition, and hence, to improve the subject's smile aesthetics.

Free fillet flap: Outcomes in emergency microsurgical reconstruction of upper and lower limb.

INTRODUCTION: Despite its infrequency, 'spare-part surgery' represents a reconstructive strategy that uses segments of amputated limbs as donor tissue to preserve function in other injured anatomical regions. The purpose of this study was to review our 14-year experience in emergency microsurgical reconstruction of traumatised limbs using free fillet flaps obtained from non-salvageable amputated parts. MATERIALS AND METHODS: A retrospective observational study was conducted on patients who underwent urgent free fillet flap transfer for upper or lower limb reconstruction between 2007 and 2021. The characteristics and levels of injury, as well as the flap designs, functional outcomes and complications were documented. RESULTS: A series of eight clinical cases is presented. One osteo-tendino-cutaneous and seven fasciocutaneous flaps were filleted from non-replantable amputated limbs for free transfer. Stable coverage of the dorsal aspect of the hand and fingers was achieved in three patients, and limb shortening was avoided in five patients. An open thumb fracture with bone defect, three below-knee stumps and one trans-metatarsal level were preserved. The mean Quick-Disabilities of the Arm, Shoulder and Hand score for upper limb reconstructions was 16.75 points. In all the cases of lower limb reconstruction, the nerves were repaired, resulting in a protective sensitivity (S3 level) with no pressure ulcer development during the follow-up period. All patients were able to return to normal prosthetic ambulation with a mean Amputee Mobility Predictor Pro score of 45 points. Two haematomas, one surgical wound dehiscence and two immediate revisions of venous anastomoses were registered. CONCLUSIONS: The microvascular filleted flap demonstrated versatility in the emergency reconstruction of complex limb injuries, providing stable coverage and optimising limb length preservation within a single major surgical procedure, while eliminating morbidity from any other uninjured donor site.

Plasma Levels of Neuron/Glia-Derived Apoptotic Bodies, an In Vivo Biomarker of Apoptosis, Predicts Infarct Growth and Functional Outcome in Patients with Ischemic Stroke.

Evidence demonstrating the involvement of apoptosis in the death of the potentially salvageable area (penumbra zone) in patients during stroke remains limited. Our aim was to investigate whether apoptotic processes occur in penumbral brain tissue by analyzing circulating neuron- and glia-derived apoptotic bodies (CNS-ApBs), which are vesicles released into the bloodstream during the late stage of apoptosis. We have also assessed the clinical utility of plasma neuronal and glial apoptotic bodies in predicting early neurological evolution and functional outcome. The study included a total of 71 patients with acute hemispheric ischemic stroke (73 ± 10 years; 30 women). Blood samples were collected from these patients immediately upon arrival at the hospital (within 9 h) and at 24 and 72 h after symptom onset. Subsequently, isolation, quantification, and phenotypic characterization of CNS-ApBs during the first 72 h post-stroke were performed using centrifugation and flow cytometry techniques. We found a correlation between infarct growth and final infarct size with the amount of plasma CNS-ApBs detected in the first 72 h after stroke. In addition, patients with neurological worsening (progressive ischemic stroke) had higher plasma levels of CNS-ApBs at 24 h after symptom onset than those with a stable or improving course. Circulating CNS-ApB concentration was further associated with patients' functional prognosis. In conclusion, apoptosis may play an important role in the growth of the cerebral infarct area and plasma CNS-ApB quantification could be used as a predictive marker of penumbra death, neurological deterioration, and functional outcome in patients with ischemic stroke.

Management of Peri-implant Mucosal Dehiscences: A Scoping Review.

Several treatment-oriented classifications for the management of peri-implant marginal mucosal defects (PMMDs) have been published to date. While each classification provides valuable insights into key diagnostic and therapeutic aspects, there is a marked heterogeneity regarding the recommended clinical guidelines to achieve success in specific scenarios. The purpose of this review was to critically analyze and organize the similarities and differences enclosed in the available classifications linked with treatment recommendations on the management of PMMDs at single implant non-molar sites with the purpose of providing an overview of recommended interdisciplinary treatment options to facilitate clinical decision-making processes.

Evaluation and modelling of polycyclic aromatic hydrocarbon (PAH) bioavailability in soils affected by coal tar asphalt.

There are large masses of coal tar asphalt present in old roads, containing high concentrations of polycyclic aromatic hydrocarbons (PAHs). Uncertainty surrounding the risk they pose causes problems during road reconstruction and for the reuse of the asphalt present. To help elucidate potential risks, a parsimonious linear equilibrium partitioning model for the bioavailability of PAHs in soils contaminated by tar asphalt particles was developed. Furthermore, a set of partitioning coefficients for PAHs between sampled coal tar binders and water were determined experimentally, as well as measurements of freely dissolved concentrations using polyoxymethylene samplers in batch tests and column recirculation experiments with various mixtures of different soils (peat and sandy loam) and tar asphalts. The model predictions of freely dissolved concentrations were conservative and within an order of magnitude of measurements in both batch and column tests. The model presented here only relies on soil organic carbon content and the fraction coal tar binder in the soil to model PAH partitioning. This model could be used for more realistic. Low tier risk assessments towards rational prioritization of sensitive areas for risk reduction efforts.

Endovascular treatment in Danon disease: a case report.

BACKGROUND: Danon disease is a lysosomal storage disorder with X-linked inheritance. The classic triad is severe hypertrophic cardiomyopathy, myopathy, and intellectual disability, with different phenotypes between both genders. Ischemic stroke is an uncommon complication, mostly cardioembolic, related to intraventricular thrombus or atrial fibrillation, among others. CASE REPORT: We report the case of a 14-year-old Caucasian male patient with Danon disease who suffered from an acute ischemic stroke due to occlusion in the M1 segment of the middle cerebral artery. He underwent mechanical thrombectomy, resulting in successful revascularization with satisfactory clinical outcome. We objectified the intraventricular thrombus in the absence of arrhythmic events. CONCLUSION: To our knowledge, we report the first case of ischemic stroke related to Danon disease treated with endovascular treatment.

Effect of an algorithm for automatic placing of standardised test order sets on low-value appointments and attendance rates at four Spanish teaching hospitals: an interrupted time series analysis.

OBJECTIVE: Reducing backlogs for elective care is a priority for healthcare systems. We conducted an interrupted time series analysis demonstrating the effect of an algorithm for placing automatic test order sets prior to first specialist appointment on avoidable follow-up appointments and attendance rates. DESIGN: Interrupted time series analysis. SETTING: 4 academic hospitals from Madrid, Spain. PARTICIPANTS: Patients referred from primary care attending 10 033 470 outpatient appointments from 16 clinical specialties during a 6-year period (1 January 2018 to 30 June 2023). INTERVENTION: An algorithm using natural language processing was launched in May 2021. Test order sets developed for 257 presenting complaints from 16 clinical specialties were placed automatically before first specialist appointments to increase rates of diagnosis and initiation of treatment with discharge back to primary care. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes included rate of diagnosis and discharge to primary care and follow-up to first appointment index. The secondary outcome was trend in 'did not attend' rates. RESULTS: Since May 2021, a total of 1 175 814 automatic test orders have been placed. Significant changes in trend of diagnosis and discharge to primary care at first appointment (p=0.005, 95% CI 0.5 to 2.9) and 'did not attend' rates (p=0.006, 95% CI -0.1 to -0.8) and an estimated attributable reduction of 11 306 avoidable follow-up appointments per month were observed. CONCLUSION: An algorithm for placing automatic standardised test order sets can reduce low-value follow-up appointments by allowing specialists to confirm diagnoses and initiate treatment at first appointment, also leading to early discharge to primary care and a reduction in 'did not attend' rates. This initiative points to an improved process for outpatient diagnosis and treatment, delivering healthcare more effectively and efficiently.

Ultrathin Feldspathic Ceramic Veneers: A Pilot SEM Evaluation of Etched Intaglio Surfaces.

Ultrathin ceramic veneers are a viable therapeutic option to manage esthetic challenges in the anterior zone. Proper conditioning of the intaglio surface of porcelain veneers is essential to achieve an adequate bonding. In clinical practice, this is typically done with chemical etching using an acid-containing agent, such as hydrofluoric acid. While it is well established that the etching effect is dependent on etching time and the acid concentration, little is known about the impact of etching time and the veneer fabrication method. The purpose of this pilot study was to evaluate, using scanning electron microscopy (SEM), the effect that different etching-time protocols have on the intaglio surface characteristics of ultrathin ceramic veneers fabricated with either the platinum foil technique or the refractory die technique. Several replicas of an ultrathin feldspathic ceramic veneer for a maxillary central incisor were fabricated. Individual specimens were processed according to different intaglio surface-etching protocols: no etching, etching for 90 seconds, etching for 120 seconds, and etching for 150 seconds (9.6% hydrofluoric acid used for all etching groups). It was observed that the 120-second etching protocol resulted in a favorable microroughness surface pattern in the platinum foil group. This pattern was comparable to that obtained by etching for 90 seconds with hydrofluoric acid the intaglio surface of veneers fabricated with the refractory die technique. Increasing the etching time to 150 seconds did not result in a more favorable roughness pattern.

Respiratory syncytial virus infection in adults: Differences with influenza.

INTRODUCTION: Respiratory syncytial virus (RSV) causes an acute respiratory illness similar to influenza, although there are few data comparing both of them in adults. The existence of clinical differences between these two infections could have implications for their management. MATERIALS AND METHODS: Retrospective observational cohort study including 63 adults with positive PCR for RSV and 221 for influenza during winter 2018-2019. Epidemiological, clinical characteristics and outcomes were contrasted between both groups. RESULTS: Compared to influenza, RSV-positive patients presented a higher association with active neoplasia (OR=2.9; 95% CI: 1.2-6.9), dependence for basic activities of daily living (OR=3.4; 95% CI: 1.4-8.2) and immunosuppression due to chronic glucocorticoid administration (OR=7.6; 95% CI: 1.6-36.1). At diagnosis, fever was less common (OR=0.3; 95% CI: 0.2-0.7), and C-reactive protein level ≥100mg/l was more frequent (OR=2.1; 95% CI: 1.0-4.5). They developed bacterial co-infection by Staphylococcus aureus in a higher proportion (OR=8.3; 95% CI: 1.5-46.9) and presented a greater need for admission to the intensive care unit (OR=5.4; 95% CI: 1.4-19.2). CONCLUSION: RSV is an important cause of respiratory illness in adults during the influenza season. It especially affects vulnerable patients with chronic underlying diseases, and has a higher morbidity than influenza. For all these reasons, specific detection, prevention and treatment of RSV is necessary in order to reduce the consumption of health care resources due to RSV disease in adults.

Increased vertebral canal diameter measured by ultrasonography as a sign of vasculitis in patients with giant cell arteritis.

Introduction: The diagnosis of giant cell arteritis (GCA) by ultrasonography including large vessels, apart from the temporal artery increases the sensibility of the study and informs about the risk of specific complications. However, there is less information about the study of these arteries, whose affection carries higher proportion of severe complications. Objectives: To describe and analyze the value of the diameter of the cervical vertebral canal of the vertebral artery (VA) as a sign of vertebral vasculitis (VV) related to GCA and estimate the risk of stroke complications. Materials and methods: Observational study of a population that includes patients with GCA with and without VA vasculitis as well as healthy subjects. We evaluated whether there were differences in VA diameter in the groups and, if so, we estimated the diagnostic capacity of the variable that best defines VA diameter using a ROC curve. Cut-off points with their associated reliability chosen thereafter. Results: There were 347 subjects included:107 with GCA of whom 37 had vertebral vasculitis, 240 healthy controls. In patients with GCA and VV, the VA diameter was increased (No GCA 3.4 mm, GCA without VV 3.6 mm, GCA with VV 5.2 mm p < 0.01). According to the ROC curves, the variable defining vertebral diameter with best diagnostic accuracy is the sum of both sides (area under the curve of 0.98). With a cut-off point of 8.45 mm, the reliability values are: sensitivity 94.1%, specificity 94.5%, PPV 82.1% and NPV 98.4%. With a cut-off point of 9.95 mm, the sensitivity is 52.9% and the specificity is 100%. Likewise, VA diameter is independently associated with the presence of stroke in the vertebrobasilar territory (OR 1.6, range 1.2-2.2). Conclusion: The VA diameter, measured as the sum of both sides, is an objectively measurable sign with very high reliability for detect vertebral vasculitis in patients with GCA. It is proposed here as a novel echographic sign, which can aid the detection of the involvement of an artery where the complications are especially serious.

Telemedicine in Elderly Hypertensive and Patients with Chronic Diseases during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

BACKGROUND: One aspect of the distancing measures imposed in response to the COVID-19 pandemic is that telemedicine consultations have increased exponentially. Among these consultations, the assessment and follow-up of patients with chronic diseases in a non-presential setting has been strengthened considerably. Nevertheless, some controversy remains about the most suitable means of patient follow-up. OBJECTIVE: To analyze the impact of the telemedicine measures implemented during the COVID-19 period on chronic patients. MATERIAL AND METHODS: A systematic review was carried out using the following databases: PubMed, Pro-Quest, and Scopus. The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search equation utilized descriptors sourced from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "hypertension AND older AND primary care AND (COVID-19 OR coronavirus)" and its Spanish equivalent. RESULTS: The following data were obtained: 14 articles provided data on 6,109,628 patients and another 4 articles focused on a study population of 9684 physicians. Telemedicine was less likely to be used by elderly patients (OR 0.85; 95% C.I. 0.83-0.88; p = 0.05), those of Asian race (OR 0.69; 95% C.I. 0.66-0.73; p = 0.05), and those whose native language was not English (OR 0.89; 95% C.I. 0.78-0.9; p = 0.05). In primary care, lower use of telemedicine was associated with residents of rural areas (OR 0.81; p = 0.05), patients of African American race (OR 0.65, p = 0.05), and others (OR 0.64; p = 0.05). A high proportion (40%) of physicians had no prior training in telemedicine techniques. The highest quality in terms of telephone consultation was significantly associated with physicians who did not increase their prescription of antibiotherapy during the pandemic (OR = 0.30, p = 0.05) or prescribe more tests (OR 0.06 p = 0.05), i.e., who maintained their former clinical criteria despite COVID-19. CONCLUSIONS: Telemedicine is of proven value and has been especially useful in the COVID-19 pandemic. A mixed remote-presential model is most efficient. Appropriate training in this area for physicians and patients, together with correct provision, is essential to prevent errors in implementation and use.

Interproximal Soft Tissue Height Changes After Unassisted Socket Healing versus Alveolar Ridge Preservation Therapy.

The primary aim of this study was to evaluate the efficacy of alveolar ridge preservation (ARP) therapy compared with unassisted socket healing (USH) in attenuating interproximal soft tissue atrophy. Adult subjects that underwent maxillary single-tooth extraction with or without ARP therapy were included in this study. Surface scans and cone beam computed tomography were obtained to digitally assess interproximal soft tissue height changes and measure facial bone thickness (FBT), respectively. Logistic regression models were conducted to investigate the individual effect of demographic and clinical variables. Ninety-six subjects (USH=49; ARP=47) constituted the study population. Linear soft tissue assessments revealed a significant reduction of the interproximal soft tissue over time within and between groups (P<.0001). ARP therapy significantly attenuated interproximal soft tissue height reduction compared to USH (USH mesial: -2.0±0.9mm vs. ARP mesial: -1.0±0.5mm / USH distal -1.9±0.7mm vs. ARP distal: -1.1±0.5mm; P<.0001). Thin FBT (≤1mm) upon extraction was associated with greater interproximal soft tissue atrophy compared with thick FBT (>1mm), independently of the treatment received (P<.0001). Nevertheless, ARP therapy resulted in better preservation of interproximal soft tissue height especially in thin bone phenotype by a factor of 2 for the mesial site (+1.3mm) and a factor of 1.6 (+0.9mm) for the distal site. This study demonstrated that ARP therapy largely attenuates interproximal soft tissue dimensional reduction after maxillary single-tooth extraction compared with USH.

Inherited human ezrin deficiency impairs adaptive immunity.

BACKGROUND: Inborn errors of immunity (IEI) are a group of monogenic diseases that confer susceptibility to infection, autoimmunity, and cancer. Despite the life-threatening consequences of some IEI, their genetic cause remains unknown in many patients. OBJECTIVE: We investigated a patient with an IEI of unknown genetic etiology. METHODS: Whole-exome sequencing identified a homozygous missense mutation of the gene encoding ezrin (EZR), substituting a threonine for an alanine at position 129. RESULTS: Ezrin is one of the subunits of the ezrin, radixin, and moesin (ERM) complex. The ERM complex links the plasma membrane to the cytoskeleton and is crucial for the assembly of an efficient immune response. The A129T mutation abolishes basal phosphorylation and decreases calcium signaling, leading to complete loss of function. Consistent with the pleiotropic function of ezrin in myriad immune cells, multidimensional immunophenotyping by mass and flow cytometry revealed that in addition to hypogammaglobulinemia, the patient had low frequencies of switched memory B cells, CD4+ and CD8+ T cells, MAIT, γδ T cells, and centralnaive CD4+ cells. CONCLUSIONS: Autosomal-recessive human ezrin deficiency is a newly recognized genetic cause of B-cell deficiency affecting cellular and humoral immunity.

[Outbreak of monkeypox in the Canary Islands from may 15 to june 6, 2022]. / Estudio descriptivo del brote de viruela del simio en las Islas Canarias, mayo a octubre de 2022.

OBJECTIVE: Since May 2022, non-endemic countries reported the appearance of non-imported cases of monkeypox (Mpox). Spain was one of the most affected countries. The objective of the study was to describe the clinical-epidemiological characteristics of the first confirmed cases of Mpox in the Canary Islands and the main difficulties in contact tracing. METHODS: Retrospective observational descriptive study with confirmed cases of Mpox and their close contacts in the Autonomous Community of the Canary Islands. We conducted a descriptive analysis, using frequencies and percentages for qualitative variables, and median (interquartile range) for quantitative variables. RESULTS: One hundred and seventy-seven cases of Mpox were reported in the Canary Islands, with a median age of 39 years (32.8-48.3); 46.6% were HIV seropositive, and 6.8% were foreign. The most frequent clinical symptom was anogenital rash (68.8%), and at pustules stage (61.4%). One hundred and three declared risky sexual behaviors. Only fifty-three (30%) collaborated in the identification of close contacts. There were difficulties in: establishing communication with the cases, communicating the isolation measures, requesting tests, and due to delayed sample processing. CONCLUSIONS: Most common clinical symptom at diagnosis is anogenital rash in pustule stage. Most of the cases report risky sexual relations. The main barriers in contact tracing are the difficulty in contacting cases, the lack of identification data and the lack of experience of health professionals regarding Mpox.

OBJETIVO: Desde mayo de 2022, países no endémicos notificaron la aparición de casos no importados de viruela del simio (Mpox), siendo España uno de los más afectados. El objetivo del estudio fue describir las características clínico-epidemiológicas de los casos confirmados de Mpox en las Islas Canarias y las principales dificultades en el rastreo de contactos. METODOS: Se realizó un estudio retrospectivo observacional descriptivo con casos confirmados de Mpox y sus contactos estrechos en la Comunidad Autónoma de Canarias. Se realizó un análisis descriptivo, indicando frecuencias y porcentajes para variables cualitativas y mediana (rango intercuartílico) para cuantitativas. RESULTADOS: Se notificaron ciento setenta y siete casos de Mpox en las Islas Canarias, con una mediana de edad de 39 años (32,8-48,3), un 46,6% de seropositivos por VIH, y un 6,8% de extranjeros. La manifestación clínica más frecuente fue exantema anogenital (68,8 %), y en estadio de pústulas (61,4%). Ciento tres declararon conductas sexuales de riesgo. Solo cincuenta y tres (30%) colaboraron en la identificación de contactos estrechos. Se produjeron dificultades al establecer comunicación con los casos, al comunicar las medidas de aislamiento, en la solicitud de pruebas y, finalmente, debido al procesamiento de muestras con retraso. CONCLUSIONES: La manifestación clínica más frecuente al diagnóstico es el exantema anogenital en estadio de pústulas. La mayoría de los casos reportan relaciones sexuales de riesgo. Las principales barreras en el rastreo de contactos resultan la dificultad para contactar con los casos, la falta de datos de identificación y la inexperiencia de los profesionales sanitarios en relación con Mpox.

Relationship between supracrestal soft tissue dimensions and other periodontal phenotypic features: A cross-sectional study.

BACKGROUND: The purpose of this study was to determine the association between periodontal supracrestal soft tissue dimensions (PSSTDs) and other phenotypic features in non-molar maxillary teeth. MATERIALS AND METHODS: Adult subjects in need of comprehensive dental treatment were recruited. Periodontal phenotypic variables (i.e., facial and palatal gingival thickness [GT], alveolar bone thickness [BT], and PSSTDs, namely distance from the gingival margin to the bone crest defined as periodontal supracrestal tissue height [PSTH] and distance from the cementoenamel junction to the bone crest [CEJ-BC]) were recorded using cone-beam computed tomography scans. Standardized intraoral photographs were obtained to assess facial keratinized tissue width (KTW) and other anatomical parameters (i.e., tooth type, gingival architecture, and interproximal papilla height). RESULTS: The study sample was constituted of 87 participants that contributed with a total of 522 maxillary anterior teeth. Differences in mean values of PSSTDs, KTW, GT, and BT were observed between tooth types and sex. Males exhibited a thicker GT and BT, and taller PSTH and KTW compared to females. Shorter CEJ-BC was associated with shorter PSTH, wider KTW, and thicker GT and BT. Shorter PSTH was associated with thicker facial BT. Notably, BT and GT were positively correlated at both facial and palatal sites, meaning that the thicker the gingival phenotype, the thicker the bone morphotype. Facial BT and facial GT were positively correlated with KTW. A flat gingival architecture was associated with the thick periodontal phenotype. Square teeth had shorter CEJ-BC, wider KTW, and thicker GT. CONCLUSIONS: Periodontal phenotypic features vary across and within subjects, between facial and palatal sites at different apico-coronal levels, and as a function of sex and tooth type. The shorter the PSSTDs, the wider the KTW and the thicker the GT and BT. PSSTDs, particularly PSTH, should be considered an integral component of the periodontal phenotype.

Effect of periodontal phenotype characteristics on post-extraction dimensional changes of the alveolar ridge: A prospective case series.

AIM: This study was primarily aimed at assessing the effect that specific periodontal phenotypical characteristics have on alveolar ridge remodelling after tooth extraction. MATERIALS AND METHODS: Patients in need of extraction of a non-molar maxillary tooth were enrolled. Baseline phenotypical characteristics (i.e., mid-facial and mid-palatal soft tissue and bone thickness, and supracrestal soft tissue height [STH]) were recorded upon extraction. A set of clinical, digital imaging (linear and volumetric), and patient-reported outcomes were assessed over a 14-week healing period. RESULTS: A total of 78 subjects were screened. Forty-two subjects completed the study. Linear and volumetric bone changes, as well as vertical linear soft tissue and alveolar ridge volume (soft tissue contour) variations, were indicative of a marked dimensional reduction of the alveolar ridge over time. Horizontal facial and palatal soft tissue thickness gain was observed. Thin facial bone (≤1 mm) upon extraction, compared with thick facial bone (>1 mm), was associated with greater linear horizontal (-4.57 ± 2.31 mm vs. -2.17 ± 1.65 mm, p = .003) and vertical mid-facial (-0.95 ± 0.67 mm vs. -4.08 ± 3.52 mm, p < 0.001) and mid-palatal (-2.03 ± 2.08 mm vs. -1.12 ± 0.99 mm, p = 0.027) bone loss, as well as greater total (-34% ± 10% vs. 15% ± 6%, p < 0.001), facial (-51% ± 19% vs. 28% ± 18%, p = 0.040), and palatal bone volume reduction (-26% ± 14% vs. -8% ± 10%, p < 0.001). Aside from alveolar bone thickness, STH was also found to be a predictor of alveolar ridge resorption since this variable was directly correlated with bone volume reduction. Patient-reported discomfort scores progressively decreased over time, and the mean satisfaction upon study completion was 94.5 ± 0.83 out of 100. CONCLUSIONS: Alveolar ridge remodelling is a physiological phenomenon that occurs after tooth extraction. Post-extraction alveolar ridge atrophy is more marked on the facio-coronal aspect. These dimensional changes are more pronounced in sites exhibiting a thin facial bone phenotype (Clinicaltrials.gov NCT02668289).

Impact of peri-implant soft tissue characteristics on health and esthetics.

OBJECTIVE: To review the impact of key peri-implant soft tissue characteristics on health and esthetics. MAIN CONSIDERATIONS: The keratinized mucosa width (KMW), the mucosal thickness (MT), and the supracrestal tissue height (STH) are essential components of the peri-implant soft tissue phenotype. An inadequate KMW (<2 mm) has been associated with local discomfort upon oral hygiene performance and increased risk for the onset of peri-implant diseases. A minimum buccal MT (≥2 mm) is generally required to prevent esthetic issues related to the effect of transmucosal prosthetic elements on the color of the mucosa and can also contribute to long-term mucosal stability. STH is directly related to marginal bone remodeling patterns during the early healing process that follows the connection of transmucosal prosthetic components. Short STH, generally defined as <3 mm, has been consistently associated with marginal bone loss resulting from the physiologic establishment of the mucosal seal. Insufficient STH may also derive into the fabrication of unfavorable transmucosal prosthetic contours, which frequently results in unpleasing esthetic outcomes and predisposes to submarginal biofilm accumulation. Peri-implant soft tissue dehiscences (PISTDs) are a type of peri-implant deformity that are associated with esthetic issues and often occur in sites presenting KMW, MT, and/or STH deficiencies. PISTDs should be correctly diagnosed and treated accordingly, usually by means of multidisciplinary therapy. CONCLUSION: Understanding the impact of different dimensional and morphologic features of the peri-implant mucosa on health and esthetic outcomes is fundamental to make appropriate clinical decisions in the context of tooth replacement therapy with implant-supported prostheses.

Comparative histological evaluation of intra- and extraorally de-epithelialized connective tissue graft samples harvested from the posterior palate region.

BACKGROUND: Autologous connective tissue graft (CTG) is generally considered the gold standard for peri-implant soft tissue phenotype modification and root coverage therapy. The presence of epithelial remnants in CTG has been associated with complications after soft tissue augmentation surgery. However, a specific method for de-epithelization that is patently superior has not been identified yet. This study aimed to evaluate the effectiveness of two different approaches to de-epithelialize CTG samples harvested from the posterior palate. METHODS: Patients in need of periodontal or implant-related surgery that required harvesting a CTG from the posterior palate region were recruited. CTG samples harvested with an indirect approach were de-epithelialized using either an intraoral (IO group) or an extraoral (EO group) method. Tissue specimens were subsequently processed for histological analysis. The presence or absence of oral epithelial remnants was determined by two examiners using light microscopy. RESULTS: Twenty-four patients, who provided a total of 46 analyzable CTG samples, were enrolled in this study. Histological assessment revealed that 19 out of 22 samples in the IO group were free of epithelial remnants. In the EO group, 20 out of 24 samples did not exhibit epithelial residues. These results translate into 86.4% and 83.3% of epithelium-free samples in the IO and EO groups, respectively. CONCLUSIONS: Although the intraoral method may provide several practical advantages compared with the extraoral technique, both approaches for de-epithelialization of CTG samples harvested from the posterior palate region tested in this study were comparably effective. However, none of these methods ensured complete removal of the oral epithelium in a predictable manner, which should be considered in clinical practice.