UNASSIGNED: Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with nonanatomic scars and a short upper lip, creating a need for revision. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors\' experience, recreating the defect and utilizing the Fisher repair for revision have led to aesthetically pleasing results and less noticeable scars. A database was collected that included all cleft lip revisions performed at a large, comprehensive children\'s hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons. Data collected included sex, characteristics of the cleft lip, age at initial and index repair, type of initial repair, previous revisions, type of revision with any additional tissue rearrangement, and any nose repair. Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. This study demonstrates a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons\' experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.

In layered zirconia prosthesis, the choice of zirconia composition, framework design, and shade is closely related to the properties of the abutments. This interdependence emphasizes how crucial it is to take a deliberate and tailored approach to meet the unique needs of every therapeutic circumstance. To successfully treat anterior teeth and achieve restorations that look natural, challenges such as incorrect size and shape, atypical gingival contour, and unsightly hues need to be resolved. Ceramodetal restorations have occasionally allowed for the most appealing, authentic replication of natural teeth, despite its proven strength, endurance, and improved aesthetics. Due to their superior cosmetic results, metal-free materials have been used for anterior rehabilitation. Materials like dental zirconia, which offers excellent aesthetics and desired mechanical characteristics, have emerged in response to the increased need for visually appealing and metal-free alternatives. In this case study context, experiences in the clinic using multilayer zirconia prostheses intended exclusively for anterior teeth are discussed.

暂无摘要。

UNASSIGNED: Unlike tachyarrhythmias, which are common in pregnancy, there is a paucity of data regarding maternal bradycardias. Our objective was to describe the characteristics, associated conditions, and prognosis of women who develop bradycardia post-partum.
UNASSIGNED: We conducted a retrospective chart review of patients referred to the Obstetrical Medicine service at British Columbia Women\'s Hospital from January 2012 to May 2020 for post-partum maternal bradycardia.
UNASSIGNED: Twenty-four patients with post-partum bradycardia were included (age 34.2  ±  4.8 years; heart rate 40.4  ±  8.1 beats per minute; blood pressure 131/72 mm Hg). Sinus bradycardia (79.2%) was the most common rhythm. Dyspnea (29.4%) and chest pain (23.5%) were common symptoms. Mean time to resolution of bradycardia was 3.6  ±  3.8 days. Associated conditions potentially explaining the bradycardia were preeclampsia (54.1%), underlying (16.7%), medications (8.3%), and neuraxial anesthesia (8.3%).
UNASSIGNED: Maternal bradycardia is an uncommon condition complicating the post-partum period, that is generally self-limiting, with the majority only require clinical observation.

BACKGROUND: While the nasal fossa and nasopalatine canal are recognized limitations for immediate implants in esthetic areas, the canalis sinuosus (CS) and its branches have been largely overlooked. Neglecting this anatomy can lead to sensory issues, pain, and implant failure underscores the necessity of meticulous pre-surgical assessment and planning to mitigate risks and ensure implant success. This case highlights the need for comprehensive pre-surgical evaluation and precise planning to minimize these complications and ensure successful implant outcomes in this scenario.
RESULTS: A 41-year-old woman with a history of root perforation and external root resorption was referred for dental implant placement. Following clinical evaluation and computed tomography, the presence of an accessory canal of the CS was identified. After meticulous planning to avoid implant contact with this structure, ridge preservation was performed. After 6 months, the implant was successfully placed following guided osteotomy. The case demonstrates clinical and radiographic stability after 36 months of follow-up.
CONCLUSIONS: The correct diagnosis and planning, within a multidisciplinary team, can lead to successful implant placement in a challenging site with an anatomical variation. This study, to our knowledge, represents the first to propose an alternative treatment approach in the presence of CS in an esthetic region.
CONCLUSIONS: Why is this case new information? This case emphasizes the importance of thorough pre-surgical evaluation to mitigate potential complications related to the CS. It is the first, to our knowledge, to propose an alternative treatment approach in the presence of this anatomical variation in an esthetic region. What are the keys to successful management in this case? Comprehensive pre-surgical evaluation, precise planning with detailed CBCT assessment to identify the CS, careful consideration of its anatomy during surgical intervention, knowledge of the limitations of tissue reconstructions, and precise clinical strategies to minimize associated complications. What are the primary limitations to success in this case? The need to position the implant with a safety margin from the CS led to implant positioning resulting in fenestration of the buccal bone plate, preventing its reconstruction due to the bone envelope\'s design, resulting in a discrepant gingival margin compared to the contralateral tooth, which did not allow for further crown lengthening due to a rather short root.

An optimal esthetic result is essential for an implant-supported restoration in the anterior zone. In the esthetic zone, providing immediate interim restorations following implant surgery has been proposed as a reliable and desirable treatment approach. A well-contoured interim restoration following implant placement minimizes hard and soft tissue changes in the peri-implant zone. This in turn has the potential to enhance the esthetic outcome and, therefore, patient satisfaction. Multiple prosthetic and surgical aspects need to be carefully planned and executed to achieve the intended final result. This is a report describing the steps involved in recontouring the gingiva to achieve an optimal emergence profile following the immediate loading of a single implant in the esthetic zone.

BACKGROUND: A minimally invasive aesthetic suturing technique was employed in aesthetic crown lengthening surgery (ACLS). The objective of this report was to evaluate the clinical and patient- reported outcomes of this technique for ACLS.
METHODS: Fifteen patients who underwent ACLS were treated utilizing the described suturing technique. Clinical parameters, including plaque index (PI), gingival index (GI), bleeding index (BI), papilla index score (PIS), early wound healing index (EHI), visual analogue scale (VAS), pink esthetic score and white esthetic score (PES/WES), were recorded at baseline, immediately post-surgery and during follow-up visits spanning 5 days to 24 months. The two-sample t-test was performed to evaluate statistical significance (α = 0.05).
RESULTS: 100% of the patients reported a high level of satisfaction, with a stable high postoperative VAS scores. From baseline to 5-day postoperation, there was no statistically significant increase in PI, although there was a slight deterioration observed in GI (0.13Å}0.23, P＜0.05) and BI (0.49Å}0.55, P＜ 0.05). Early wound healing (EHI 1) was achieved by all patients at 5 days post-surgery. Additionally, 3 patients exhibited changes in PIS within the initial 3 months following surgery, after which, all patients attained an optimal degree of papilla filling (degree III).
CONCLUSIONS: The application of the minimally invasive aesthetic suturing technique in ACLS demonstrates favorable outcomes in terms of patient satisfaction and long-term stability. However, the assertion of its superiority over conventional suturing methods for ACLS necessitates substantiation through rigorous investigation via well-designed randomized controlled clinical trials.

Implant-supported rehabilitation in high-risk patients poses significant challenges for the dental team. The presence of comorbidities and increased infection risk can, for example, lead to a higher risk of implant loss. For the therapy to be completed with as few complications as possible, special anamnesis, detailed diagnostics, and a risk analysis based on those findings are indispensable. The aim of all considerations is to keep the risk of infection for the patient with a disease history to a minimum and to strive for an appropriate functional and esthetic therapeutic success. Particularly in the esthetic zone, in addition to the general health risks of the surgical procedure, esthetic aspects are increasingly taken into account in planning. The present article describes the implant-prosthetic replacement of a single anterior tooth in a dialysis patient. Several aspects (regular dialysis, missing buccal lamella, high smile line, functional risk) increased the risk of complications in this case.

In the maxillary anterior area, the esthetic integration of prosthetic restorations is a challenge, particularly for screw-retained implant prostheses. This case report presents the management and clinical outcome of an old partial edentulous maxillary jaw in an esthetic zone in a young patient with a very limited mouth opening. This patient was rehabilitated with an implant screw-retained fixed partial denture (FPD) using both digital and conventional techniques.

An attractive smile enhances an individual\'s self-confidence. The overall harmony of a smile can be attributed to the interplay of the teeth\'s shape, color, and position along with the gingival tissue. Gingival pigmentation is observed across all human races, exhibiting variations from one race to another. Typically, gingival hyperpigmentation results from the abnormal buildup of melanin in the gingival tissue, imparting a dark appearance on the gums. Various procedures, collectively known as gingival depigmentation, are employed to address gingival hyperpigmentation. While the initial outcomes of depigmentation procedures are often promising, one common issue associated with them is the potential for re-pigmentation. This article aims to evaluate the clinical effectiveness and patient-reported outcomes of intraepidermal (oral mesotherapy) vitamin C injection for nonsurgical management of physiologic gingival melanin hyperpigmentation.