Assessment of hard and soft tissue thickness at mandibular symphysis in skeletal Class III patients with different vertical patterns.

INTRODUCTION: This study aimed to assess the bony and soft tissue parameters at mandibular symphysis among skeletal Class III patients with different vertical growth patterns, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images of 60 skeletal Class III non-growing patients were evaluated (mean age 24.9 ± 8.4 years). Study samples were classified into three facial types based on the mandibular plane angle (SN-MP angle): low, normal, and high angle. The bony and soft tissue parameters at the mandibular symphysis were evaluated. RESULTS: Among hard tissue variables, symphysis and pogonion width were significantly narrower in the high-angle group (P < .05). The thickness of the buccal cortex at pogonion was also significantly thinner in subjects with high angles (P < .01). Symphysis height showed an increasing tendency from the low-angle to the high-angle group. However, no significant differences were found in chin width and height according to vertical patterns. Across all soft tissue measurements, the low-angle group exhibited the highest thickness, which gradually decreased in the high-angle group. Statistically significant differences in soft tissue thickness were observed at Menton (Me) and Gnathion (Gn) (P < .05). A significant negative correlation was observed between the SN-MP angle and the thickness of both hard and soft tissues. CONCLUSIONS: In skeletal Class III subjects, significant differences existed in both hard and soft tissues at the mandibular symphysis, depending on the vertical patterns. These results provide a comprehensive evaluation of symphyseal area, which can aid clinicians in identifying appropriate treatment approaches, especially for combined orthognathic and orthodontic treatment.

Effect of vertical implant position on marginal bone loss: a randomized clinical trial.

OBJECTIVES: One of the most important factors that has influence on dental implants success rate is marginal bone loss. The purpose of this study is to investigate the effect of the implant's vertical position and the soft tissue's thickness on the rate of marginal bone loss of the dental implant. MATERIALS AND METHODS: In this single-blind randomized clinical trial study, 56 implants placed in the posterior region of mandible of 33 patients (19 women, 14 men) were divided into two groups. The group of crestal (28 implants) and subcrestal (28 implants) implants, each group was divided into two sub-groups with soft tissue thickness of 2 mm and less than 2 mm (14 implants) and more than 2 mm (14 implants). The amount of marginal bone loss was measured by Scanora 5.2 program with radiographs Digital parallelism based on the effect of the vertical position of the implant, soft tissue thickness, three months after placement, and three months after loading implants (six months after implant placement). RESULTS: The results showed that marginal bone loss in subcrestal implants is significantly more than crestal implants (p-value = 0.001), and also marginal bone loss in the soft tissue thickness group of 2 mm and less is significantly more than the group of soft tissue thickness more than 2 mm (p-value < 0.001). The amount of marginal bone loss three months after implant loading was significantly higher than three months after implant placement (p-value < 0.001). CONCLUSION: The implant's vertical position and the soft tissue's thickness around the implant are effective factors in the amount of marginal bone loss. Marginal bone loss is more in subcrestal implants and in cases with less soft tissue thickness. The time factor significantly affects the amount of marginal bone loss. TRIAL REGISTRATION: this clinical trial was registered at Iranian Registry of Clinical Trials, registration number IRCT20120215009014N415, registration date 20,220,110, (https//en.irct.ir/trial/60,991).

A computerized facial approximation method for Homo sapiens based on facial soft tissue thickness depths and geometric morphometrics.

Facial approximation (FA) provides a promising means of generating the possible facial appearance of a deceased person. It facilitates exploration of the evolutionary forces driving anatomical changes in ancestral humans and can capture public attention. Despite the recent progress made toward improving the performance of FA methods, a limited understanding of detailed quantitative craniofacial relationships between facial bone and soft tissue morphology may hinder their accuracy, and hence subjective experience and artistic interpretation are required. In this study, we explored craniofacial relationships among human populations based upon average facial soft tissue thickness depths (FSTDs) and covariations between hard and soft tissues of the nose and mouth using geometric morphometrics. Furthermore, we proposed a computerized method to assign the learned craniofacial relationships to generate a probable facial appearance of Homo sapiens, reducing human intervention. A smaller resemblance comparison (an average Procrustes distance was 0.0258 and an average Euclidean distance was 1.79 mm) between approximated and actual faces and a greater recognition rate (91.67%) tested by a face pool indicated that average dense FSTDs contributed to raising the accuracy of approximated faces. Results of partial least squares (PLS) analysis showed that nasal and oral hard tissues have an effect on their soft tissues separately. However, relatively weaker RV correlations (<0.4) and greater approximation errors suggested that we need to be cautious about the accuracy of the approximated nose and mouth soft tissue shapes from bony structures. Overall, the proposed method can facilitate investigations of craniofacial relationships and potentially improve the reliability of the approximated faces for use in numerous applications in forensic science, archaeology, and anthropology.

Long-term effect of denosumab on bone microarchitecture as assessed by tissue thickness-adjusted trabecular bone score in postmenopausal women with osteoporosis: results from FREEDOM and its open-label extension.

In postmenopausal women with osteoporosis, up to 10 years of denosumab treatment significantly and continuously improved bone microarchitecture assessed by tissue thickness-adjusted trabecular bone score, independently of bone mineral density. Long-term denosumab treatment decreased the number of high fracture-risk patients and shifted more patients to lower fracture-risk categories. PURPOSE: To investigate the long-term effect of denosumab on bone microarchitecture assessed by tissue thickness-adjusted trabecular bone score (TBSTT) in post-hoc subgroup analysis of FREEDOM and open-label extension (OLE). METHODS: Postmenopausal women with lumbar spine (LS) or total hip BMD T-score <-2.5 and ≥-4.0 who completed the FREEDOM DXA substudy and continued in OLE were included. Patients received either denosumab 60 mg subcutaneously every 6 months for 3 years and same-dose open-label denosumab for 7 years (long-term denosumab; n=150) or placebo for 3 years and open-label denosumab for 7 years (crossover denosumab; n=129). BMD and TBSTT were assessed on LS DXA scans at FREEDOM baseline, month 1, and years 1-6, 8, and 10. RESULTS: In long-term denosumab group, continued increases from baseline to years 4, 5, 6, 8, and 10 in BMD (11.6%, 13.7%, 15.5%, 18.5%, and 22.4%) and TBSTT (3.2%, 2.9%, 4.1%, 3.6%, and 4.7%) were observed (all P < 0.0001). Long-term denosumab treatment decreased the proportion of patients at high fracture-risk (according to TBSTT and BMD T-score) from baseline up to year 10 (93.7 to 40.4%), resulting in increases in the proportions at medium-risk (6.3 to 53.9%) and low-risk (0 to 5.7%) (P < 0.0001). Similar responses were observed in crossover denosumab group. Changes in BMD and TBSTT were poorly correlated during denosumab treatment. CONCLUSION: In postmenopausal women with osteoporosis, up to 10 years of denosumab significantly and continuously improved bone microarchitecture assessed by TBSTT, independently of BMD, and shifted more patients to lower fracture-risk categories.

Influence of soft tissue thickness on marginal bone level around dental implants: A systematic review with meta-analysis and trial-sequential analysis.

OBJECTIVES: The aim of the present review and meta-analysis was to evaluate the influence of soft tissue thickness on initial bone remodeling after implant installation. MATERIALS AND METHODS: A literature search was conducted by two independent reviewers on electronic databases up to May 2022. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) performed on human subjects were included. The risk of bias was evaluated using Cochrane Collaboration's tool. Meta-analysis and Trial Sequential Analysis (TSA) were performed on the selected articles. The primary outcome was marginal bone loss. RESULTS: After screening, 6 studies were included in the final analysis, with a total of 354 implants, and a follow-up from 10 to 14 months. 194 implants were placed in a ≥ 2 mm soft tissue thickness, while 160 had <2 mm soft tissue thickness before implant placement. The included studies had a high level of heterogeneity (I2  > 50%). The meta-analysis indicated a statistically significant difference between the two groups (0.54; p = .027) and the TSA analysis confirmed the results, despite the limited number of dental implants. Additional analysis showed that age and follow-up parameters were not statistically significant factors influencing the bone loss (p = .22 and p = .16, respectively). CONCLUSIONS: Based on the available RCTS and CCTs, initial soft tissue thickness seems to influence marginal bone loss after a short follow-up period. Based on TSA analysis, further studies are needed to assess the influence of the soft tissue thickness on marginal bone loss. PROSPERO registration number: CRD42021235324.

Do facial soft tissue thicknesses change after surgeries correcting dental malocclusions? An intra- and inter-patient statistical analysis on soft-tissue thicknesses in BSSO + LFI surgeries.

OBJECTIVES: The aim of this study was to analyse changes in facial soft tissue thickness (FSTT) after corrective surgeries for dental malocclusion. The correlation between body mass index (BMI) and sex of patients and their FSTT before undergoing surgery was analysed. MATERIALS AND METHODS: Cone beam computed tomography of seventeen patients that underwent Le Fort I osteotomy in combination with bilateral sagittal split osteotomy were collected. Hard and soft tissue landmarks were selected basing on the interventions. FSTT were computed, and measurements from pre- to post-operative were compared. The relationship between FSTT, sex, and BMI was investigated. RESULTS: Considering the comparison between pre- and post-operative measurements, any significant difference emerged (p > .05). The Pearson's correlation coefficient computed between BMI and the FSTT (pre-operative) showed a correlation in normal-weight patients; the region-specific analysis highlighted a stronger correlation for specific landmarks. Higher median values emerged for women than for men; the subset-based analysis showed that women presented higher values in the malar region, while men presented higher values in the nasal region. CONCLUSIONS: The considered surgeries did not affect the FSTT of the patients; differences related to BMI and sex were found. A collection of FSTT mean values was provided for twenty landmarks of pre- and post-operative of female and male subjects. CLINICAL RELEVANCE: This exploratory analysis gave insights on the behaviour of STT after maxillofacial surgeries that can be applied in the development of predictive methodologies for soft tissue displacements and to study modifications in the facial aspect of the patients.

Association between radiographic soft-tissue thickness and increased length of stay, operative time, and infection rate after reverse shoulder arthroplasty.

BACKGROUND: Reverse shoulder arthroplasty (RSA) is a widely performed surgical procedure to address various shoulder pathologies. Several studies have suggested that radiographic soft-tissue thickness may play a role in predicting complications after orthopedic surgery, but there have been limited studies determining the use of radiographic soft-tissue thickness in RSA. The purpose of this study was to evaluate whether radiographic soft-tissue thickness could predict clinical outcomes after RSA and compare the predictive capabilities against body mass index (BMI). We hypothesized that increased radiographic shoulder soft-tissue thickness would be a strong predictor of operative time, length of stay (LOS), and infection in elective RSA. MATERIAL AND METHODS: A retrospective review of patients undergoing RSA at an academic institution was conducted. Preoperative radiographic images were evaluated including measurements of the radius from the humeral head center to the skin (HS), deltoid radius-to-humeral head radius ratio (DHR), deltoid size, and subcutaneous tissue size. Different correlation coefficients were used to analyze various types of relationships, and the strength of these associations was classified based on predefined boundaries. Subsequently, multivariable linear and logistic regressions were performed to determine whether HS, DHR, deltoid size, and subcutaneous tissue size could predict LOS, operative time, or infection while controlling for patient factors. RESULTS: HS was the most influential factor in predicting both operative time and LOS after RSA, with strong associations indicated by standardized ß coefficients of 0.234 for operative time and 0.432 for LOS. Subcutaneous tissue size, deltoid size, and DHR also showed stronger predictive values than BMI for both outcomes. In terms of prosthetic joint infection, HS, deltoid size, and DHR were significant predictors, with HS demonstrating the highest predictive power (Nagelkerke R2 = 0.44), whereas BMI did not show a statistically significant association with infection. Low event counts resulted in wide confidence intervals for odds ratios in the infection analysis. CONCLUSION: Greater shoulder soft-tissue thickness as measured with concentric circles on radiographs is a strong predictor of operative time, LOS, and postoperative infection in elective primary RSA patients.

[Measuring methods of volumetric changes of soft tissues at dental implants site and tooth recessions site]. / Metody issledovaniya ob"emnykh izmenenii myagkikh tkanei v oblasti dental'nykh implantatov i retsessii zubov.

The article is a review of literature on various methods for measuring gingival thickness at implant site and tooth recession. The purpose of the study was to analyze existing methods for assessing volumetric changes in soft tissues based on literature data and give recommendations on the choice of methods. The authors analyzed available methods and identified limitations and recommendations for the use of different methods. The literature review is also helpful to identify promising methods for assessing changes in soft tissue volume, which may help authors of future studies with method selection.

Updated trabecular bone score accounting for the soft tissue thickness (TBSTT) demonstrated significantly improved bone microstructure with denosumab in the FREEDOM TBS post hoc analysis.

TBS algorithm has been updated to account for regional soft tissue noise. In postmenopausal women with osteoporosis, denosumab improved tissue thickness-adjusted TBS vs placebo independently of bone mineral density over 3 years, with the magnitude of changes from baseline or placebo numerically greater than body mass index-adjusted TBS. INTRODUCTION: To evaluate the effect of denosumab on bone microarchitecture assessed by trabecular bone score (TBS) in the FREEDOM study using the updated algorithm that accounts for regional soft tissue thickness (TBSTT) in dual-energy X-ray absorptiometry (DXA) images and to compare percent changes from baseline and placebo with classical body mass index (BMI)-adjusted TBS (TBSBMI). METHODS: Postmenopausal women with lumbar spine or total hip bone mineral density (BMD) T score < - 2.5 and ≥ - 4.0 received placebo or denosumab 60 mg subcutaneously every 6 months. TBSBMI and TBSTT were assessed on lumbar spine DXA scans at baseline and months 1, 12, 24, and 36 in a subset of 279 women (129 placebo, 150 denosumab) who completed the 3-year FREEDOM DXA substudy and rolled over to open-label extension study. RESULTS: Baseline characteristics were similar between groups. TBSTT in the denosumab group showed numerically greater changes from both baseline and placebo than TBSBMI at months 12, 24, and 36. Denosumab led to progressive increases in BMD (1.2, 5.6, 8.1, and 10.5%) and TBSTT (0.4, 2.3, 2.6, and 3.3%) from baseline to months 1, 12, 24, and 36, respectively. Both TBS changes were significant vs baseline and placebo from months 12 to 36 (p < 0.0001). As expected, BMD and TBSTT were poorly correlated both at baseline and for changes during treatment. CONCLUSION: In postmenopausal women with osteoporosis, denosumab significantly improved bone microstructure assessed by TBSTT over 3 years. TBSTT seemed more responsive to denosumab treatment than TBSBMI and was independent of BMD.

Efficacy of soft tissue augmentation procedures on tissue thickening around dental implants: A systematic review and meta-analysis.

OBJECTIVES: The first focused question (FQ1) was: What is the efficacy of connective tissue graft (CTG), as compared to the absence of soft tissue grafting procedure, in terms of gain in peri-implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? The second focused question (FQ2) was: What is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri-implant STT reported by RCTs or CCTs? MATERIALS AND METHODS: A manual and electronic search was performed for each question to identify RCTs and CCTs published up to July 2020. The primary outcome variable was changes in peri-implant STT and secondary outcomes were marginal bone level (MBL), clinical parameters for the diagnosis of peri-implant health, changes in the position of peri-implant soft tissues, esthetic outcomes, and patient-related outcome measures (PROMs). For primary and secondary outcomes, data reporting mean values and standard deviations for each study were extracted. Weighted mean differences (WMDs) or standardized mean differences as well as 95% confidence intervals (CIs) and prediction intervals (PIs) were calculated. RESULTS: Eight trials were included to answer the first focused question and eight to answer the second one, providing data for 254 and 192 patients, respectively. For the first focused question, a statistically significant difference of 0.64 mm in STT was found in favor of the grafted group (n = 8; 95% CI [0.16; 1.13]; 95% PI [-1.06; 2.35]; p = .01). Moreover, sites treated with CTG exhibited statistically significant less recession than implants without a graft (n = 4; WMD = 0.50 mm; 95% CI [0.19; 0.80]; 95% PI [-0.70; 1.69]; p < .001). For the second focused question, the meta-analysis showed a statistically significant gain of STT in the CTG group when compared to soft tissue substitutes (n = 8; WMD = 0.51 mm; 95% CI [0.28; 0.75]; 95% PI [-0.09; 1.12]; p < .001). Furthermore, the use of CTG resulted in significantly higher pink esthetic score values (n = 3; WMD = 1.02; 95% CI [0.29; 1.74]; 95% PI [-3.67; 5.70]; p = .01) and less recession (n = 2; WMD = 0.50 mm; 95% CI [0.10; 0.89]; 95% PI [not estimable]; p = .014) when compared to soft tissue substitutes. No statistically significant differences between groups were observed for any of the following secondary variables: MBL, clinical parameters for the diagnosis of peri-implant health, position of the interproximal tissues, keratinized mucosa or PROMS (p > 0.05), except for medication intake, which was significantly higher when using CTG as compared to soft tissue substitutes (n = 2; WMD = 1.68; 95% CI [1.30; 2.07]; 95% PI [not estimable]; p < .001). CONCLUSIONS: Soft tissue augmentation procedures are efficacious on soft tissue thickening and, in particular, CTG demonstrated a significant STT gain when compared to no graft or soft tissue substitutes.

The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes: A systematic review and meta-analysis.

OBJECTIVES: In systematically healthy patients with an implant-supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri-implant soft tissues on aesthetic outcomes (O)? METHODS: Following an a priori protocol, a literature search of six databases was conducted up to August 2020 to identify prospective/retrospective clinical studies on healthy patients with an implant-supported fixed reconstruction. Measurement of the buccal soft tissue thickness and an aesthetic outcome was a prerequisite, and sites presenting with a buccal soft tissue thickness of <2 mm or shimmering of a periodontal probe were categorized as a thin phenotype. After study selection, data extraction, and risk of bias assessment, random-effects meta-analysis of Mean Differences (MD) or Odds Ratios (OR) with their corresponding 95% Confidence Intervals (CI) were conducted, followed by sensitivity analyses and assessment of the quality of evidence. RESULTS: Thirty-four unique studies reporting on 1508 patients with 1606 sites were included (9 randomized controlled trials, one controlled trial, 10 prospective cohort studies, 8 cross-sectional studies, and 6 retrospective cohort studies). The mean difference of the pink aesthetic score (PES) after the follow-up was not significantly different between thin (<2.0 mm) or thick soft tissues (≥2.0 mm) or phenotypes (12 studies; MD = 0.15; [95% CI = -0.24, 0.53]; p = .46). PES changes during the follow-up, however, were significantly in favour of thick soft tissues (≥2.0 mm) or phenotypes (p = .05). An increased mean mucosal thickness was associated with an increased papilla index (5 studies; MD = 0.5; [95% CI = 0.1, 0.3]; p = .002) and an increase in papilla presence (5 studies; OR = 1.6; [95% CI = 1.0, 2.3]; p = .03). Thin soft tissues were associated with more recession, -0.62 mm (4 studies; [95% CI = -1.06, -0.18]; p = .006). Patient-reported outcome measures (patient satisfaction) were in favour of thick soft tissues -2.33 (6 studies; [95% CI = -4.70, 0.04]; p = .05). However, the quality of evidence was very low in all instances due to the inclusion of non-randomized studies, high risk of bias and residual confounding. CONCLUSION: Within the limitations of the present study (weak study designs and various soft tissue measurements or time-points), it can be concluded that increased soft tissue thickness at implant sites was associated with more favourable aesthetic outcomes.

Peri-implant tissue augmentation by volume-stable collagen matrix transplantation: a study of dog mandibles.

The aim of this study was to investigate histologically the amount of peri-implant tissue augmentation after volume-stable porcine collagen matrix transplantation. Six male beagle dogs were used in the experiment. P2, P4, and M1 distal roots were extracted under general anesthesia. After 6 months, implants were placed in the same sites, and volume-stable porcine collagen matrix transplantation was performed. Impressions were taken at 1 and 2 weeks and at 1, 2, and 3 months after transplantation. The dogs were euthanized at 3 months, and their mandibles were removed and scanned using micro-computed tomography. Standard Triangulated Language data were also obtained. Using preoperative models as a reference, the data for all time points were compared, and changes in the thickness of the cross-section of the implant sites were measured. The model created at 3 months was then compared with the mandible data, and the thickness of collected peri-implant soft tissue was measured under optical microscopy. Increased thickness was found at some of the sites on the buccal side. Regarding the peri-implant soft tissue, the thickness of the measured sites on the buccal side was significantly increased at 3 months in the experimental group. Histological observations of the internal structures of the tissue in the experimental group revealed irregular collagen fibers and a remnant collagen matrix. Endogenous tissue was observed within the collagen matrix, indicating good fusion with the surrounding autologous tissue. These results suggest that volume-stable porcine collagen matrix transplantation promotes peri-implant tissue augmentation on the buccal side.

Fatty infiltration of hip muscles and trochanteric soft tissue thickness are associated with hip fractures in the elderly.

PURPOSE: Apart from bone conditions, muscle and soft tissue parameters might also influence hip fractures. We aimed to evaluate the association between hip muscle and trochanteric soft tissue parameters and hip fractures. METHODS: We retrospectively reviewed 60 patients with hip fractures and 114 controls without hip fractures. Cases and controls were matched for age, sex, and body mass index using propensity score matching. Muscle cross-sectional area (CSA), mean attenuation, and fatty infiltration rate (FIR) (proportion of intramuscular fat content) were measured on CT images for the gluteus maximus, the gluteus medius/minimus, and the anterior and medial compartments of the upper thigh. Trochanteric soft tissue thickness (TSTT) and femoral neck attenuation were also measured. Univariate and multivariate analyses were conducted to identify potential risk factors of hip fractures. RESULTS: Patients with hip fractures had significantly lower femoral neck attenuation, TSTT, and CSA of the gluteus maximus and anterior compartment than controls. FIR of all hip muscle groups were significantly higher in hip fracture patients than controls. Multivariate analysis revealed that every 1% increase in FIR of medial compartment independently increased the odds of hip fractures by 23.7% (OR = 1.237, 95% CI = 1.093-1.401) and every 1 cm longer TSTT independently decreased the odds by 32.8% (OR = 0.672, 95% CI = 0.477-0.946). CONCLUSION: Fatty infiltration of hip muscles can better discriminate hip fractures than muscle area. Increased TSTT is independently associated with low fracture risk.

Establishment of a finite element model based on craniofacial soft tissue thickness measurements and stress analysis of medical goggles.

In this study, an accurate finite element (FE) stress analysis of head-mounted products for Chinese users was performed. Using craniofacial computed tomography scans of 280 Chinese individuals, the total soft tissue thickness and thickness of the fat and muscle layers for 41 landmarks were measured. The data were used to construct FE head models (FEH). An FE stress test was conducted to analyse the wearing of medical goggles using two FE models based on one-layer (FEH 1) and three-layer (FEH 3) soft tissue material parameters. When compared with the experimental results, the modelling results for FEH 3 were more realistic than those for FEH 1. Wearing medical goggles led to stress concentration over five landmark areas, A: upper medial forehead, B: temporal, C: zygion, D: infraorbital fossa and E: rhinion, of which B, C and D caused the most discomfort during long-term goggle wear. Practitioner summary: A precise FE head model can reflect the complex contact pressure of a head-related product. Two FE models based on one- and three-layer soft tissue material parameters were established and tested separately with medical goggles. The model can be used to improve the comfort of head-related products. Abbreviations: FE: finite element; FEH: FE head models; FEH 1: FE models based on one-layer; FEH 3: FE models based on three-layer; VR: virtual reality; AR: augmented reality; 3D: three-dimensional; WSU: Wayne State University; WSUBIM: Wayne State University Brain Injury Model; CT: computed tomography; MRI: magnetic resonance imaging; CFSTT: craniofacial soft tissue thickness; FSR: force sensing resistor; NURBS: non-uniform rational basis spline; SPSS: statistical product and service solutions; STL: stereolithography; STP: standard for the exchange of product model data; BDF: glyph bitmap distribution format; EEG: electroencephalogram.

CBCT analysis of crestal soft tissue thickness before implant placement and its relationship with cortical bone thickness.

BACKGROUND: The importance of crestal soft tissue thickness and its influence in peri-implant tissue health has been evaluated in few clinical studies. Cone beam computed tomography imaging offers a unique opportunity to investigate variations in crestal soft tissue thickness. The aim of this retrospective study was to evaluate the possible correlation between crestal soft tissue thickness and hard tissue measurements on CBCT images, and to compare crestal soft tissue thickness among different patients and edentulous site groups. METHODS: CBCT images of partially edentulous adult patients treated at ECU School of Dental Medicine were evaluated. 267 patients with 321 edentulous sites were included. Demographic data were collected from electronic health records. Cross-sectional CBCT images at the center of each edentulous site were used to measure soft tissue and hard tissue parameters. Linear mixed models were used to compare crestal soft tissue thickness and hard tissue measurements by gender, age groups, and edentulous sites. Pearson correlation was applied to evaluate the correlation between crestal soft tissue thickness and different hard tissue measurements. Association between crestal soft tissue thickness and independent variables (gender, age groups, edentulous sites) was evaluated using repeated measure logistic regression, while the crestal soft tissue thickness was dichotomized by a threshold of 2 mm. RESULTS: Mean age of patients included was 60 (range 21-85 years). Female to male ratio was 1.07. Mean crestal soft tissue thickness of all non-grafted native bone sites was 2.17 mm. Mean thickness of cortical bone at alveolar crest was 0.94 mm. Thickness of buccal and lingual cortical plates 5 mm apical to alveolar crest were 1.17 mm and 1.58 mm, respectively. Pearson's correlation showed moderate positive correlation among hard tissue measurements, but weak correlation between soft tissue thickness and hard tissue measurements. Anterior sites [OR = 3.429 (1.100-10.69)] and maxillary posterior sites [OR = 1.937 (1.077-3.482)] had higher odds of presenting with more than 2 mm of soft tissue at the alveolar crest. CONCLUSION: More than half of the patients had crestal soft tissues at edentulous sites thicker than 2 mm. Thickness of crestal soft tissue was not significantly associated with hard tissue measurements. Edentulous anterior sites and maxillary posterior sites presented with thicker crestal soft tissue at alveolar crest as compared to mandibular posterior sites.

Bone and gingival tissue thicknesses of maxillary anterior teeth with and without a metal post: a cone beam computed tomographic study.

The objective of this retrospective study was to evaluate buccal bone and gingival thickness measurements obtained from cone beam computed tomographic (CBCT) images of maxillary anterior teeth with and without metal posts. A convenience sample of 71 CBCT images of healthy maxillary anterior teeth and 61 CBCT images of maxillary anterior teeth with a metal post were selected from a database. Eight tomographic measurements (4 bone thicknesses and 4 gingival thicknesses) were performed in the parasagittal section of each tooth, perpendicular to the tooth axis. The Mann-Whitney U test was used to compare these thicknesses, and the Spearman correlation coefficient was calculated for correlation of age with sex. Statistically significant differences were observed for almost all measurements (P < 0.05); the CBCT images of teeth with metal posts displayed lower bone thickness values and higher gingival thickness values. No statistically significant correlations were observed between the thickness measurements and age. However, significantly higher bone thickness values were observed in men (P < 0.05). Cone beam computed tomographic images of teeth with metal posts showed differences in mean bone and gingival measurements compared to teeth without metal posts, suggesting a possible interference of metal artifacts.

Use of ultrasound fetal shoulder soft tissue thickness measurement in estimation of fetal weight.

AIMS: Birth weight (BW) estimation with ultrasound is of great importance in delivery decision and management of complications of delivery. The aim was to evaluate the effect of femur, humerus, and clavicular soft tissue thickness on BW and developed a formula for proper estimation of fetal weight. METHODS: This prospective cohort study, included 231singleton pregnancies, with 34 and 42 weeks of gestation, delivered within 48 h after ultrasound examination. In addition to four biometric ultrasound measures, shoulder soft tissue thickness, thigh and arm soft tissue thickness were measured from outer margin of skin to outer margin of bone shaft by same investigator. Spearman correlation test was used to assess correlations between soft tissue thickness measurements and BW. Linear regression model was used and R2 to test accuracy of the new formula. RESULTS: The mean humerus soft tissue thickness (HSTT) was 12 ± 3.5 mm (6-23.9 mm), mean femur soft tissue thickness (FSTT) was 15.9 ± 3.8 mm (7.3-32 mm), mean clavicular soft tissue thickness (CSTT) was 12.9 ± 3.2 mm (7.3-24 mm). There was a low correlation between BW and FSTT (r = 0.21, p = 0.001) and CSTT (r = 0.18, p = 0.005). Best fit formula was Log (BW) = -5697 + 7.2 (HC) + 15.3 (AC) + 22.6 (FL) + 17 (CSTT), was significantly correlated with BW (R2 = 0.60). CONCLUSION: BW increased as the ultrasound shoulder soft tissue thickness increased. Adding soft tissue thickness measurements to fetal biometry is similar in terms of estimating fetal weight from the existing estimated fetal weight formula.

Accuracy of Acetabular Cup Implantation, as a Function of Body Mass Index and Soft-tissue Thickness, with a Mechanical Intraoperative Support Device: A Retrospective Observational Study.

HipCOMPASS, a mechanical intraoperative support device used in total hip arthroplasty (THA), improves the cup-alignment accuracy. However, the alignment accuracy achieved by HipCOMPASS has not been specifically examined in obese patients. In this study, we retrospectively evaluated the relation between alignment accuracy and several obesity-related parameters in 448 consecutive patients who underwent primary THA using HipCOMPASS. We used computed tomography (CT) to measure the preoperative soft-tissue thickness of the anterior-superior iliac spine (ASIS) and pubic symphysis and the differences between preoperative and postoperative cup angle based on the cup-alignment error. We found significant correlations between the absolute value of radiographic anteversion difference and body mass index (r = 0.205), ASIS thickness (r = 0.419), and pubic symphysis thickness (r = 0.434). The absolute value of radiographic inclination difference was significantly correlated with ASIS (r = 0.257) and pubic symphysis thickness (r = 0.202). The receiver operating characteristic curve showed a pubic symphysis thickness of 37.2 mm for a ≥ 5° implantation error in both radiographic inclination and anteversion simultaneously. The cup-alignment error for HipCOMPASS was large in patients whose pubic symphysis thickness was ≥ 37.2 mm on preoperative CT. Our results indicate that methods other than HipCOMPASS, including computed tomography-based navigation systems, might be preferable in obese patients.

Gingival phenotype assessment methods and classifications revisited: a preclinical study.

OBJECTIVE: To compare gingival phenotype assessment methods based on soft tissue transparency on different backgrounds and assessor experience levels. METHODS: For this purpose, 24 gingival specimens were retrieved from pig jaws with tissue thicknesses from 0.2 to 1.25 mm. Three methods were assessed: periodontal probe PCP12 (thin/thick), double-ended periodontal probe DBS12 (thin/moderate/thick) and colour-based phenotype probe CBP (thin/moderate/thick/very thick). Each sample was photographed with each probe underneath and categorized whether the probe was visible or not using different coloured backgrounds. To measure experience level influence, dentists, dental undergraduate students and laypersons (n = 10/group) performed the evaluation. RESULTS: PCP12 probe showed a threshold between 0.4 and 0.5 mm. To distinct between thin and moderate thick gingiva, a comparable range for DBS12 was found while moderate thickness was between 0.5 and 0.8 mm and for thick above 0.8 mm. CBP also showed a comparable threshold of 0.5 mm for thin versus moderate as compared with the other methods; above 0.8 mm, predominantly a very thick tissue was measured. In general, the background colour had a minor impact on PCP12 and DBS12, and investigator experience showed no clear influence on GP assessment. CONCLUSION: Based on probe transparency and within the limitation of a preclinical study, we suggest GP differentiation into three entities: thin (< 0.5 mm; high risk), moderate (0.5-0.8 mm; medium risk) and thick (> 0.8 mm; low risk). CLINICAL RELEVANCE: All three GP assessment methods are easy to perform and seem to have a high predictive value with a three entities classification for DBS12 and CBP.

New Method for Analysis of the Temporomandibular Joint Using Cone Beam Computed Tomography.

Modern dentistry commonly uses a variety of imaging methods to support diagnosis and treatment. Among them, cone beam computed tomography (CBCT) is particularly useful in presenting head structures, such as the temporomandibular joint (TMJ). The determination of the morphology of the joint is an important part of the diagnosis as well as the monitoring of the treatment results. It can be accomplished by measurement of the TMJ gap width at three selected places, taken at a specific cross-section. This study presents a new approach to these measurements. First, the CBCT images are denoised using curvilinear methods, and the volume of interest is determined. Then, the orientation of the vertical cross-section plane is computed based on segmented axial sections of the TMJ head. Finally, the cross-section plane is used to determine the standardized locations, at which the width of the gap between condyle and fossa is measured. The elaborated method was tested on selected TMJ CBCT scans with satisfactory results. The proposed solution lays the basis for the development of an autonomous method of TMJ index identification.