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...

Hepatopathy-thrombocytopenia syndrome after actinomycin-D therapy: treatment with defibrotide.

We report a case of administration compassionate use defibrotide in a 13-year-old girl with Sinusoidal Obstructive Syndrome and thrombocytopenia, also known as Hepatopathy--Thrombocytopenia Syndrome (HTS) during chemotherapy for Wilms' tumor.

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...

[Molecular diagnosis of retinoblastoma: molecular epidemiology and genetic counseling]. / Diagnóstico molecular del retinoblastoma: epidemiología molecular y consejo genético.

BACKGROUND AND OBJECTIVE: Retinoblastoma, a prototype of hereditary cancer, is the most common intraocular tumor in children and a potential cause of blindness from therapeutic eye ablation, second tumors in germ line mutation carriers, and even death when untreated. The molecular scanning of RB1 in search of germ line mutations in 213 retinoblastoma patients from Spain, Cuba, Colombia and Serbia, has led to the detection of 106 mutations whose knowledge is important for genetic counselling and characterization of phenotypic-genotypic relations. PATIENTS AND METHOD: Mutational study (PCR-sequentiation and microsatellites analysis) in patients with retinoblastoma, from Spain, Cuba, Colombia and Serbia. RESULTS: 45% of mutations, including most of the frame shift (FS), missense (MS) and splicing (SP), were new, while all nonsense mutations (NS) corresponded to hypermutable sites in RB1. Germ line mutations were found in 22% of unilateral sporadic patients. The incidence of SP plus MS mutations in this group of patients was greater (p = 0.018) than in bilateral patients. The frequency of SP mutations was higher (p = 0.0003) in Spain and France than in Germany and United Kingdom, while the incidence of NS mutations was lower (p = 0.0006). SP mutations were associated with the low penetrance phenotype and were also overrepresented (p = 0.018) in patients with delayed retinoblastoma onset. CONCLUSIONS: Mutational scanning of unilateral patients is important for genetic counselling and may help decipher the molecular mechanisms leading to low penetrance or expressivity. The functional characterization of mutations associated with low-penetrance or expressivity phenotypes and the molecular classification of tumors using multiple expression profiling is important for a better understanding of the retinoblastoma pathogenesis.

Diagnóstico molecular del retinoblastoma: epidemiología molecular y consejo genético / Molecular diagnosis of retinoblastoma: molecular epidemiology and genetic counseling

Fundamento y objetivo: El retinoblastoma, prototipo de cáncer hereditario, puede causar ceguera, por enucleación terapéutica, segundos tumores en pacientes con mutación germinal e incluso muerte si no se trata. El diagnóstico molecular de 213 pacientes a lo largo de 5 años ha conducido a la detección de 106 mutaciones que se analizan desde la perspectiva de la epidemiología molecular y consejo genético. Pacientes y método: Estudio mutacional (reacción en cadena de la polimerasa, secuenciación y análisis de microsatélites) en pacientes con retinoblastoma procedentes de España, Cuba, Colombia y Serbia. Resultados: Un 45% de las mutaciones analizadas son nuevas y corresponden a mutaciones de tipo de corrimiento de pauta de lectura, cambio de aminoácido o procesado del ácido ribonucleico. Todas las mutaciones sin sentido corresponden a sitios de alta mutabilidad. La tasa de detección de mutaciones en pacientes unilaterales esporádicos es alta (22%). En este grupo de pacientes se detecta una mayor incidencia (p = 0,018) de mutaciones de cambio de aminoácido y procesamiento. España y Francia muestran una incidencia mayor de mutaciones del procesado (p = 0,0003) que Alemania y el Reino Unido, países en los que predominan las mutaciones sin sentido (p = 0,0006). Las mutaciones del procesado se asocian al fenotipo de baja penetración y retraso en la aparición de tumores (p = 0,018). Conclusiones: La incidencia de mutaciones germinales en pacientes unilaterales y las relaciones fenotipo/genotipo analizadas indican la necesidad del consejo genético basado en el diagnóstico molecular temprano. La mejora de las técnicas diagnósticas, la caracterización funcional de mutaciones asociadas a baja penetrancia o expresividad y el estudio del transcriptoma de los tumores son objetivos necesarios para definir mejor la patogenia del retinoblastoma

Background and objective: Retinoblastoma, a prototype of hereditary cancer, is the most common intraocular tumor in children and a potential cause of blindness from therapeutic eye ablation, second tumors in germ line mutation carriers, and even death when untreated. The molecular scanning of RB1 in search of germ line mutations in 213 retinoblastoma patients from Spain, Cuba, Colombia and Serbia, has led to the detection of 106 mutations whose knowledge is important for genetic counselling and characterization of phenotypic-genotypic relations. Patients and method: Mutational study (PCR-sequentiation and microsatellites analysis) in patients with retinoblastoma, from Spain, Cuba, Colombia and Serbia. Results: 45% of mutations, including most of the frame shift (FS), missense (MS) and splicing (SP), were new, while all nonsense mutations (NS) corresponded to hypermutable sites in RB1. Germ line mutations were found in 22% of unilateral sporadic patients. The incidence of SP plus MS mutations in this group of patients was greater (p = 0.018) than in bilateral patients. The frequency of SP mutations was higher (p = 0.0003) in Spain and France than in Germany and United Kingdom, while the incidence of NS mutations was lower (p = 0.0006). SP mutations were associated with the low penetrance phenotype and were also overrepresented (p = 0.018) in patients with delayed retinoblastoma onset. Conclusions: Mutational scanning of unilateral patients is important for genetic counselling and may help decipher the molecular mechanisms leading to low penetrance or expressivity. The functional characterization of mutations associated with low-penetrance or expressivity phenotypes and the molecular classification of tumors using multiple expression profiling is important for a better understanding of the retinoblastoma pathogenesis

Identification of 26 new constitutional RB1 gene mutations in Spanish, Colombian, and Cuban retinoblastoma patients.

Constitutional mutations in the RB1 gene predispose to retinoblastoma development. Hence genetic screening of retinoblastoma patients and relatives is important for genetic counseling purposes. In addition, RB1 gene mutation studies may help decipher the molecular mechanisms leading to tumors with different degrees of penetrance or expressivity. In the course of genetically screening of 107 hereditary and non-hereditary retinoblastoma patients (11 familiar bilateral, 4 familiar unilateral, 49 sporadic bilateral and 43 sporadic unilateral) and kindred from Spain, Colombia and Cuba, using direct PCR sequencing, we observed 45 distinct mutations and four RB1 deletions in 53 patients (9 familiar bilateral, 2 familiar unilateral, 31 sporadic bilateral and 11 sporadic unilateral). Most of these mutations (26/45, 57%) have not been reported before. In 32 patients, the predisposing mutations correspond to nonsense (mainly CpG transitions) and small insertions or deletions whose expected outcome is a truncated Rb protein that lacks the functional pockets and tail. Five single aminoacid replacements and seventeen mutations affecting splicing sites were also observed in retinoblastoma patients. Two of these sixteen mutations are of unclear pathogenic nature.

Fluidificacion de la membrana microsomal hepatica y su relacion con el envejecimiento / Fluidity of hepatic microsomal membrane and its relation with aging

El efecto del envejecimiento sobre la composición fosfolipídica de la membrana hepática fue estudiada en dos grupos de ratas Wistar jóvenes (2 meses) y maduros (6 meses). Cuando fue analizado el contenido fosfolipídico microsomal total, el grupo de ratas maduras mostró un incremento significativo (73%). El patrón fosfolipídico microsomal también mostró un comportamiento diferente en ambos grupos, con un significativo incremento en fosfatidilcolina (62%), fosfatidilserina (124%), fosfatidilinositol (31%) y esfingomielina (10%) y aparente en fosfatidiletanolemina y fosfatidilglicerol en el grupo de 6 meses. Una elevada fluidificación de la membrana microsomal en animales añosos fue relevado por un incremento en el índice PC/EM (47%). Este incremento en la fluidificación durante el proceso de envejecimiento puede reflejar una respuesta adaptativa resultante en cambio en la actividad enzimática responsable del metabolismo de drogas y carcinógenos

Fluidificacion de la membrana microsomal hepatica y su relacion con el envejecimiento / Fluidity of hepatic microsomal membrane and its relation with aging

El efecto del envejecimiento sobre la composición fosfolipídica de la membrana hepática fue estudiada en dos grupos de ratas Wistar jóvenes (2 meses) y maduros (6 meses). Cuando fue analizado el contenido fosfolipídico microsomal total, el grupo de ratas maduras mostró un incremento significativo (73%). El patrón fosfolipídico microsomal también mostró un comportamiento diferente en ambos grupos, con un significativo incremento en fosfatidilcolina (62%), fosfatidilserina (124%), fosfatidilinositol (31%) y esfingomielina (10%) y aparente en fosfatidiletanolemina y fosfatidilglicerol en el grupo de 6 meses. Una elevada fluidificación de la membrana microsomal en animales añosos fue relevado por un incremento en el índice PC/EM (47%). Este incremento en la fluidificación durante el proceso de envejecimiento puede reflejar una respuesta adaptativa resultante en cambio en la actividad enzimática responsable del metabolismo de drogas y carcinógenos (AU)

Composicion fosfolipidica de la membrana microsomal hepatica u su relacion con la actividad de la bilirrubina UDP-Glucuroniltransferasa en colestasis humana / Phospholipid composition of the hepatic microsomal membrane and its relationship to bilirubin UDP glucuronyltransferase in human cholestasis

Han sido descriptos diversos cambios estructurales y morfológicos sobre el hepatocito cuando se utilizaron modelos de coelstasis experimental asimismo se han documentado alteraciones en la actividad de las denominadas "enzimas unidas a membrana" frente a los cambios en el entorno lipídico. En el presente estudio se estableció la actividade de la bilirrubina UDP-Glucuraniltransferasa y el perfil fosfolipídico microsomal en hepatocitos de individuos control y en pacientes con colestasis extrahepática prolongada. No se hallaron diferencias significativas en la actividad total de Bilirrubina UDP-Glucuroniltransferasa entre ambos grupos de pacientes (normales: 1,11 ñ 0,66; colestáticos: 1,93 ñ 0,82 nmoles bilirrubina conjugada/mg proteína en 10 min). Sin embargo cuando el producto final de la reacción se analizó, los controles presentaron 80% de bilirrubina diglucuronido (20% bilirrubina monoglucuronido), resultando ausente este metabolito en los pacientes colestáticos (100% bilirrubina monoglucuronido). El análisis cualitativo de los fosfolípidos reveló una disminución en el contenido de fosfatidilcolina (-9,5%) y fosfatidiletanolamina (-62,9%) y, paralelamente, incrementos en fosfatidilserina (+143,4%) y esfingomielina (+475,6%) en los microsomas dle grupo colestático cuando se comparó con el grupo control. Por el contrario el contenido de fósforo total resultó similar en ambos grupos estudiados (normales: 979, 55 ñ 42,15; colestáticos: 958, 26 ñ 30,86 umol Pi/mg proteina). Los datos presentados en este estudio demuestran que la capacidad de bilirrubina y el perfil fosfolipídico microsomal se ven seriamente afectados durante la colestasis humana. En próximas experiencias se intentará esclarecer la relación entre ambos hechos como así también delucidar el mecanismo de los cambios inducidos por la acumulación de bilis (AU)

Composicion fosfolipidica de la membrana microsomal hepatica u su relacion con la actividad de la bilirrubina UDP-Glucuroniltransferasa en colestasis humana / Phospholipid composition of the hepatic microsomal membrane and its relationship to bilirubin UDP glucuronyltransferase in human cholestasis

Han sido descriptos diversos cambios estructurales y morfológicos sobre el hepatocito cuando se utilizaron modelos de coelstasis experimental asimismo se han documentado alteraciones en la actividad de las denominadas "enzimas unidas a membrana" frente a los cambios en el entorno lipídico. En el presente estudio se estableció la actividade de la bilirrubina UDP-Glucuraniltransferasa y el perfil fosfolipídico microsomal en hepatocitos de individuos control y en pacientes con colestasis extrahepática prolongada. No se hallaron diferencias significativas en la actividad total de Bilirrubina UDP-Glucuroniltransferasa entre ambos grupos de pacientes (normales: 1,11 ñ 0,66; colestáticos: 1,93 ñ 0,82 nmoles bilirrubina conjugada/mg proteína en 10 min). Sin embargo cuando el producto final de la reacción se analizó, los controles presentaron 80% de bilirrubina diglucuronido (20% bilirrubina monoglucuronido), resultando ausente este metabolito en los pacientes colestáticos (100% bilirrubina monoglucuronido). El análisis cualitativo de los fosfolípidos reveló una disminución en el contenido de fosfatidilcolina (-9,5%) y fosfatidiletanolamina (-62,9%) y, paralelamente, incrementos en fosfatidilserina (+143,4%) y esfingomielina (+475,6%) en los microsomas dle grupo colestático cuando se comparó con el grupo control. Por el contrario el contenido de fósforo total resultó similar en ambos grupos estudiados (normales: 979, 55 ñ 42,15; colestáticos: 958, 26 ñ 30,86 umol Pi/mg proteina). Los datos presentados en este estudio demuestran que la capacidad de bilirrubina y el perfil fosfolipídico microsomal se ven seriamente afectados durante la colestasis humana. En próximas experiencias se intentará esclarecer la relación entre ambos hechos como así también delucidar el mecanismo de los cambios inducidos por la acumulación de bilis