Temporalis Muscle Changes Following Botulinum Toxin A Injections in Masseter Hypertrophy Patients: A Randomized Triple-Blinded Trial.

BACKGROUND: This study aimed to elucidate the effects of botulinum toxin A (BoNT-A) treatment for patients diagnosed with masseter hypertrophy on the temporalis muscle, with a particular focus on assessing alterations in muscle thickness, electromyographic (EMG) activity, and the development of muscle pain. METHODS: The present randomized triple-blinded clinical trial enrolled 26 female participants aged between 25 and 50 years complaining about masseter hypertrophy. Participants received 75U of BoNT-A (abobotulinumtoxinA) in both masseter muscles and after three months were randomized to receive a second treatment session of saline solution (S-BoNT-A) or BoNT-A (M-BoNT-A). Longitudinal assessments included temporalis muscle thickness through ultrasound, EMG activity, subjective pain, and masseter prominence severity after one, three, and six months of the first injection session. Muscle thickness, EMG, and subjective pain were analysed using two-way ANOVA with repeated measures and post hoc Sidak test, and for masseter prominence severity, Friedman and Mann-Whitney tests were used. RESULTS: Regarding inter-group comparisons, a higher muscle thickness (p < 0.02) and a higher EMG activity (p < 0.01) were found in the M-BoNT-A group at the 6-month follow-up. For subjective pain assessments, inter-group comparisons showed a higher prevalence of painful regions in M-BoNT-A group at the 6-month follow-up (p < 0.02). No significant differences were found in masseter prominence severity at the 6 months assessment between groups. CONCLUSION: BoNT-A treatment for masseter hypertrophy lead to structural and functional changes in the temporalis muscle, presenting higher changes after multiple injections of this treatment. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Long-term stability of gingival margin and periodontal soft-tissue phenotype achieved after mucogingival therapy: A systematic review.

BACKGROUND: The aim of this systematic review was two-fold: (i) to evaluate the long-term (≥5 years) stability of the gingival margin position, keratinized tissue width (KTW) and gingival thickness (GT) in sites that underwent root coverage (RC) or gingival augmentation (GA); and (ii) to assess the influence of different local variables on the long-term stability of dental and gingival tissues. MATERIALS AND METHODS: Randomized controlled trials (RCTs) and non-RCTs reporting short-term (i.e., 6-12 months after baseline surgical intervention) and long-term (≥5 years) follow-up data after surgical treatment of adult patients presenting single or multiple mucogingival deformities, defined as sites presenting gingival recession defects (GRDs) and/or (KTW) deficiency (i.e., <2 mm), were considered eligible for inclusion. MEDLINE-PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases were searched for articles published up to 15 May 2023. Mixed-effects multiple linear regression was used to assess the association between KTW, type of surgical procedure and time (i.e., independent variables) on the stability of the gingival margin in sites that received RC or GA therapy. RESULTS: Of the 2569 potentially eligible records, 41 (reporting 40 studies) met the eligibility criteria. Graphical estimates including data from all RC procedures found an upward trend in recession depth (RD) increase over time. Conversely, it was observed that in 63.63% of RC studies and in 59.32% of RC treatment arms KTW increased over time, particularly in sites treated with subepithelial connective tissue grafts (SCTGs). Conversely, sites that underwent GA procedures generally exhibited an overall reduction of KTW over time. However, sites treated with free gingival grafts (FGGs) showed a decrease in RD after 10 years of follow-up. Three main findings derived from the pooled estimates were identified: (i) Gingival margin stability was associated with the amount of KTW present during short-term assessment (i.e. the greater the KTW at 6-12 months after treatment, the more stable the gingival margin). (ii) The use of autogenous soft-tissue grafts was associated with lower RD increase over time. (iii) Treatment approaches that contribute to the three-dimensional enhancement of the gingival phenotype, as clearly demonstrated by FGG, were associated with gingival margin stability. CONCLUSIONS: The extent of apical migration of the gingival margin appears to be directly related to the amount of KTW and GT upon tissue maturation. Interventions involving the use of autogenous grafts, either SCTG or FGG, are associated with greater short-term KTW gain and lower RD increase over time.

High Levels of Physical Activity Reduce the Esthetic Durability of Botulinum Toxin Type A: A Controlled Single-Blind Clinical Trial.

The present study aimed to evaluate the influence of physical activity on the durability of the esthetic effect of botulinum toxin type A (BoNT-A). Sixty female patients were allocated to three groups (n = 20) according to their physical activity level (PA): Low PA, Moderate PA, and High PA. All groups received a single injection of onabotulinumtoxinA, considering standardized doses in the frontalis (12U), corrugator supercilia (7U, each), and procerus muscles (4U). Outcomes were measured using electromyography (EMG), Merz 5-point scales, and Face-Q scales (perceived age and lines between eyebrows). A follow-up occurred after 30, 60, and 90 days. EMG results showed a significant decrease in muscle activity in the Low-PA group at all follow-ups compared with the other groups (p < 0.001). The Merz scale scores showed that the severity of forehead and glabellar lines significantly improved in the Low-PA group throughout this study compared with the other groups (p < 0.001). No significant differences between groups were found in the Face-Q scale for perceived age, while the Face-Q scale for lines between eyebrows showed better results for Low-PA (p < 0.01) and Moderate-PA (p < 0.01) groups compared to the High-PA group at the 30- and 90-day follow-ups. The durability of the esthetic effect of BoNT-A seems to be negatively influenced by the level of physical activity.

Features to consider for mimicring tissues in orofacial aesthetics with optimal balance technology and non-animal stabilized hyaluronic acid (Restylane®): The MIMT concept.

Nonsurgical cosmetic treatments have significantly increased over the last decade. Therefore, this study aims to review the features that should be considered in orofacial esthetic procedures, thorough of a proposal of a new concept called the tissue mimicry concept (MIMT concept) and filling techniques. The MIMT concept described in this article comprises knowledge about anatomy of the face and associated structures, understanding of aging and how this process affects the facial tissues interactions (skin, subcutaneous tissues, muscles, and bones), interpretation of facial analysis, comprehension of dermal fillers characteristics and discernment of the correct filling technique for each region. Based on these variables the MIMT concept proposes the implantation of the minimum-effective quantity of acid hyaluronic fillers (HA) with different physical, chemical and rheological properties (complex viscosity and elastic modulus) in the correct layers; in order to optimize their performance resulting in a natural appearance with fewer risks of adverse events. the versatility, acceptable safety profile, biocompatibility and greater patient compliance presented in the Restylane® line (by Galderma) should be taken in consideration, since the use of a proper HA is noteworthiness. The Non-Animal Stabilized Hyaluronic Acid Tecnology (NASHA®) and the Optimal Balance Technology (OBT®), which make up this line of fillers, allow us to have very firm to very flexible gels, with different particle sizes, with an optimal concentration of HA and with viscoelastic and biocompatible characteristics according to the region of the treated face.

Implante Cone Morse em área anterior: relato de caso clínico / Morse taper implant: a case report

Introdução: o aprimoramento das técnicas de reabilitação bucal permite melhor qualidade e previsibilidade nos resultados finais dos tratamentos que demandam alta performance estética. Métodos: esse artigo descreve um caso clínico de fratura radicular no dente 11, onde realizou-se planejamento reverso e optou-se pela seguinte sequência de tratamento: exodontia, instalação de implante imediato associado a regeneração óssea guiada e instalação de coroa temporária imediata. Preocupando-se em minimizar a reabsorção óssea peri-implantar, manter saúde do tecido periodontal e obter alta performance estética, optou-se pelo implante com conexão do tipo Morse, por sua maior estabilidade biomecânica e selamento bacteriano. O dente provisório foi anteriormente confeccionado seguindo a simetria dos dentes adjacentes, dos lábios e do tecido gengival, a fim de se criar uma harmonia global no sorriso do paciente. Conclusão: concluiu-se que, na Implantodontia atual, não basta apenas obter o adequado posicionamento tridimensional do implante, mas, sim, aliar um planejamento adequado a uma conexão eficiente, posicionando o implante de acordo com biótipo periodontal do paciente, de forma a prever um perfil de emergência satisfatório à futura prótese, devolvendo estética, função e fonética ao paciente...

Introduction: Improvements in oral rehabilitation techniques allow esthetically demanding treatments to yield better and more predictable results. Methods: This paper reports a case of root fracture of tooth #11 treated by means of reverse planning comprising the following steps: tooth extraction, immediate implant placement associated with guided bone regeneration and immediate temporary crown placement. Due to its biomechanical stability and bacterial sealing properties, a Morse taper connection implant was used to reduce peri-implant bone resorption, preserve periodontal tissue health and yield highly satisfactory esthetic results. The temporary tooth had been previously fabricated in accordance with the symmetry of adjacent teeth, lips and gingival tissue, which resulted in a pleasant smile. Conclusion: It is reasonable to conclude that establishing an appropriate three-dimensional positioning of implants is not enough for Implantodontics. It requires that an appropriate planning be associated with an efficient connection so as to place an implant in accordance with patient's periodontal biotype, thus predicting a satisfactory emergence profile, in addition to recovering patient's esthetics, function and speech...

Avaliação dos trespasses vertical e horizontal como indicadores prognósticos nas decisões de tratamentos cirúrgicos / Evaluation of vertical and horizontal overlaps as prognostic indicators for surgical treatment decisions

A manutenção das dimensões do rebordo alveolar pós-extração dentária torna-se fundamental para se alcançar resultados satisfatórios em reabilitações com implantes osseointegráveis. Atualmente, há uma grande variedade de opções de tratamento de rebordos reabsorvidos, entre elas: enxerto de tecido conjuntivo (ETC), regeneração óssea guiada (ROG), enxertos ósseos em bloco, cirurgia ortognática, distração osteogênica, entre outras. A grande dificuldade do cirurgião-dentista está em eleger a técnica mais adequada. Sendo assim, neste artigo desenvolveu-se um método de eleição do tratamento mais viável baseado na avaliação da resposta biológica básica em indivíduos sem alterações sistêmicas (normo responsivos), executado por profissional com domínio das técnicas propostas. Tal método está representado na forma de tabelas e, através da descrição de casos clínicos, visou-se exemplificar a utilização das mesmas para tratar déficits baseados nos trespasses verticaise horizontais do rebordo em relação à posição da coroa clínica...

he maintenance of alveolar ridge after tooth extraction becomes crucial to achieve satisfactory outcomes for dental implant treatment. Nowadays, there are several options for resorbed alveolar ridges, such as connective tissue grafts (CTGs), guided bone regeneration (GBR), block bone grafts, orthognathic surgery, and distraction osteogenics. One of the greatest issues is to choose among the most appropriate technique. Thus, in this article, a more feasible decision-making process based on the evaluation of basic biological response in subjects without systemic changes was developed by a high-skilled professional on those suggested techniques. Such method is summarized and illustrated through clinical case presentations, aiming to demonstrate the use of this process to treat vertical and horizontal overlap defi ciencies regarding clinical crown position...