Search Results (86)

Background: Patient care following botulinum toxin injections has long been guided by anecdotal instructions, often based on theoretical considerations. This study evaluates the necessity of extended post-treatment instructions by analyzing outcomes and satisfaction in patients who followed only a 10 min precaution protocol. Materials and Methods: A retrospective, multicentric study was conducted across six Italian centers, analyzing 5014 patients treated with botulinum toxin for upper facial wrinkles between 2015 and 2020. Outcomes included adverse effects—particularly upper eyelid ptosis—and patient satisfaction. Follow-up was performed at two weeks. Results: No cases of upper eyelid ptosis were observed. Among 4000 patients who attended follow-up, adverse effects occurred in only 5.99%, notably lower than rates reported in the literature. Of the 2010 patients who completed the satisfaction questionnaire, 90% reported being very satisfied. These findings support the safety of limiting post-treatment instructions to 10 min. Conclusions: Our findings indicate that omitting extended post-injection instructions does not negatively impact patient satisfaction or complication rates. Given the toxin’s rapid internalization and localized effect, extended behavioral restrictions may be redundant. However, the absence of a control group and lack of statistical analyses limit the strength of these conclusions. In addition, this is a short-term study. Future prospective, randomized trials are needed to develop evidence-based post-care protocols to optimize esthetic outcomes, patient safety, and long-term efficacy. Full article

Background and Clinical Significance: Juvenile ossifying fibroma (JOF) is a rare, benign, but locally aggressive fibro-osseous neoplasm that primarily affects the craniofacial skeleton of children and adolescents. Early surgical intervention is often required due to the lesion’s rapid growth and potential for significant facial deformity. Long-term functional and esthetic rehabilitation following maxillary resection in early childhood remains a clinical challenge. Case Presentation: This case reports a unique long-term follow-up of a 22-year-old female patient who underwent partial maxillary resection at the age of five due to JOF. Initial reconstructive efforts failed, necessitating a removable prosthesis to restore function and appearance. The patient experienced persistent self-consciousness and social withdrawal during adolescence, attributed to altered facial esthetics and repeated surgical disappointment. Nevertheless, prosthetic rehabilitation significantly improved mastication, phonetics, facial symmetry, and psychological well-being. Conclusions: The enduring psychosocial and functional impact of early maxillary resection for JOF and the pivotal role of prosthodontic management in long term rehabilitation are highlighted. A multidisciplinary approach that includes psychological support is suggested. This case report is among the few reports documenting long-term prosthetic outcomes for pediatric JOF patients extending into adulthood. Full article

Background: Surface electromyography (sEMG) enables the non-invasive assessment of muscle activity and is widely used in orthodontics for evaluating masticatory muscles. However, little is known about the dynamic changes in facial expression muscles during orthodontic treatment. This study aimed to investigate alterations in facial muscle tone during the leveling and alignment phase in adult female patients undergoing fixed appliance therapy. Methods: The study included 30 female patients aged 20–31 years who underwent sEMG assessment at four time points: before treatment initiation (T0), at the start of appliance placement (T1), three months into treatment (T2), and six months into treatment (T3). Muscle activity was recorded during four standardized facial expressions: eye closure, nasal strain, broad smile, and lip protrusion. Electrodes were placed on the orbicularis oris, orbicularis oculi, zygomaticus major, and levator labii superioris alaeque nasi muscles. A total of 1440 measurements were analyzed using Friedman and Conover-Inman tests (α = 0.05). Results: Significant changes in muscle tone were observed during treatment. During lip protrusion, the orbicularis oris and zygomaticus major showed significant increases in peak and minimum activity (p < 0.01). Eye closure was associated with altered orbicularis oris activation bilaterally at T3 (p < 0.01). Nasal strain induced significant changes in zygomaticus and levator labii muscle tone, particularly on the right side (p < 0.05). No significant changes were noted during broad smiling. Conclusions: Orthodontic leveling and alignment influence the activity of selected facial expression muscles, demonstrating a dynamic neuromuscular adaptation during treatment. These findings highlight the importance of considering soft tissue responses in orthodontic biomechanics and suggest potential implications for facial esthetics and muscle function monitoring. Full article

Background/Objectives: Partial maxillectomy frequently results in severe impairments of oral functions, such as difficulties in chewing, speech, swallowing, and facial appearance. Immediate prosthetic rehabilitation is challenging because soft tissue healing is typically required before impression taking. This study aimed to (1) develop a comprehensive digital workflow for fabricating immediate obturator prostheses using preoperative data and (2) assess their early clinical effectiveness in restoring oral functions after surgery. Methods: In this prospective clinical study, 20 patients undergoing partial maxillectomy from January 2023 to January 2025 were enrolled. A digital workflow combining cone-beam computed tomography (CBCT), intraoral scanning, CAD/CAM design, and 3D metal printing was implemented. Obturator prostheses were digitally designed preoperatively and inserted immediately post-resection. Functional outcomes were postoperatively evaluated after one month using the Obturator Functioning Scale (OFS), which measures functional, speech, esthetic, and psychosocial aspects. Results: The digitally fabricated immediate obturator prostheses were successfully placed intraoperatively in all patients. Most participants reported mild to moderate difficulties, with speech-related issues being the most common, while esthetic concerns were minimal. Masticatory function was satisfactorily restored in 75% of cases, and 60% of patients experienced minimal fluid leakage during swallowing. No significant differences were found between genders. Patients with larger defects tended to report greater functional challenges. Conclusions: The digitally planned immediate obturator prosthesis provides a practical and effective solution for early rehabilitation following partial maxillectomy. This digital workflow reduces patient discomfort, restores key oral functions, and facilitates psychosocial recovery. Full article

This study aimed to evaluate the impact of Twin Block appliance therapy on skeletal, dentoalveolar, and facial soft tissue characteristics. The study included 18 participants with Class II skeletal malocclusion who were treated with the Twin Block appliance. Lateral cephalograms and 3D face scans were analyzed before and after therapy for each participant. Dependent t-test results showed a significant increase in the protrusion of the lower incisors (p < 0.001), proclination of the lower incisors (p = 0.021), SNB (p = 0.005), Ls:E (p = 0.040), mandibular length (p < 0.001), and soft tissue mandible length (p < 0.001) and a significant decrease in the ANB (p = 0.003), Wits (p = 0.001), ANPG (p = 0.001), overbite (p = 0.001), and the retrusion of upper incisors (p = 0.002). Twin Block therapy caused changes in skeletal and soft tissue characteristics. The increase in the SNB angle and mandibular length, accompanied by the decrease in the ANB and Wits values reduced the skeletal discrepancy. The reduction in the ANPG indicated an improvement in the skeletal profile. Additionally, the increase in the soft tissue mandible length and distance between the upper lip and E-line contributed to improved esthetic soft tissue profile characteristics. Full article

(1) Background: Esthetic regenerative medicine is increasingly in demand for facial and neck rejuvenation due to its proven efficacy, safety profile, and minimal downtime. This study aimed to evaluate the role of standardized assessment tools in optimizing the outcomes of non-invasive regenerative esthetic technologies, both during the treatment course and in follow-up. (2) Methods: A literature review of the main articles published in peer-reviewed journals was conducted to identify high-quality studies addressing the use of validated esthetic scales and questionnaires (patient-reported outcomes) for evaluating the effectiveness of non-invasive regenerative treatments for the face and neck using accessible clinical tools such as photographs and 3D facial scanning. (3) Results: Clinician-reported outcomes (CROs) can be collected using standardized and reproducible photographic documentation and facial scans. The esthetic scales and classifications target both specific facial areas (e.g., upper third, perioral, periorbital) and overall skin appearance. Furthermore, advanced software allows overlay facial scan analysis and wrinkle mapping for precise quantification of improvements. In addition to objective CROs, patient-reported outcomes (PROs) offer essential insights into perceived esthetic changes, satisfaction, and emotional well-being, completing a multidimensional evaluation of treatment efficacy. (4) Conclusions: Standardized evaluation protocols based on accessible tools such as clinical photographs, 3D facial scans, and validated PRO questionnaires are essential for guiding effective, personalized regenerative treatments. Their integration into routine practice enhances clinical decision-making and patient satisfaction. While advanced tools like dermal probes may further refine assessments, they require specific expertise and resources and may be less practical for daily clinical use. Full article

Background/Objectives: Orbital fractures are common facial injuries that require precise reconstruction to restore both function and esthetics. Heterologous cortical lamina and titanium preformed meshes are widely used for orbital wall reconstruction; however, comparative data on their outcomes remain limited. Methods: This retrospective observational study analyzed 67 patients treated for orbital fractures at Santa Maria Hospital, Terni, between January 2021 and November 2024. Patients underwent orbital reconstruction using either a heterologous cortical lamina or titanium mesh. Clinical data, including demographics, trauma etiology, fracture characteristics, surgical approach, and postoperative complications were collected. Outcomes such as diplopia, enophthalmos, ocular motility, and sensory impairment were assessed preoperatively and postoperatively and compared between groups. Statistical analyses included Chi-square and Mann–Whitney U tests, with logistic regression to identify risk factors for complications. Results: Accidental falls were the leading cause of injury (46.3%), with the orbital floor being the most commonly affected site (83.6%). Postoperative complications occurred in 15% of patients, with diplopia significantly reduced from 47.8% preoperatively to 10.4% postoperatively (p < 0.05). Sensory impairment and motility restrictions also improved significantly. Patients reconstructed using heterologous cortical lamina experienced significantly fewer postoperative complications compared to those treated with titanium mesh (OR = 0.171, 95% CI: 0.023–0.799, p = 0.040). Conclusions: Both heterologous cortical lamina and titanium mesh provide effective orbital reconstruction; however, the heterologous cortical lamina was associated with fewer postoperative complications, particularly diplopia and sensory impairment. Material selection should consider the fracture complexity, patient characteristics, and potential long-term outcomes. Full article

Background/Objectives: Temporomandibular joint (TMJ) ankylosis, characterized by osseous–fibrous fusion, severely impairs mandibular function. While alloplastic total joint replacement (TJR) is the gold standard, long-term outcomes remain understudied. The aim of this study is to evaluate the long-term esthetic and functional outcomes of prosthetic replacement and to retrospectively analyze our 20-year experience. Methods: A retrospective observational study (2003–2024) was conducted at a tertiary referral center in Turin and enrolled patients who underwent alloplastic total joint replacement for TMJ ankylosis. Data collected included demographic variables, etiology, characteristics of the ankylosis, prosthesis type (stock/custom), surgical details, and outcomes (maximal interincisal opening [MIO], pain, quality of life, diet consistency, Helkimo index, complications). Results: Among 28 patients (61% female, mean age 51.8 years), etiologies included post-traumatic (39%), osteoarthritis (32%), congenital (25%) and neoplastic (4%) causes. Custom prostheses were used in 57% of cases. Median follow-up was 11.5 years. Significant improvements were observed in MIO (p = 0.001), pain level (p = 0.001), quality of life (p = 0.001), diet score (p = 0.002), and Helkimo index (p = 0.001). Complications included facial nerve dysfunction (32.1%), salivary leakage (14.3%), and one recurrence (2.2%). Conclusions: Alloplstic TJR provides durable functional and esthetic restoration for TMJ ankylosis, with custom prostheses excelling in complex anatomies. Long-term stability (>10 years) supports its role as a definitive solution. Full article

Background/Objectives: Smile esthetics are a crucial aspect of facial attractiveness, playing a central role in social interactions. Dental students’ perception of smiling esthetics may evolve as they progress through their education and clinical exposure. This study aimed to investigate the influence of educational level on dental students’ perception of altered smile esthetics. Methods: A cross-sectional study was conducted among 410 undergraduate dental students across five academic years at the National and Kapodistrian University of Athens. Participants evaluated 22 digitally altered smile images, including single and combined esthetic discrepancies, using a visual analog scale (VAS). Perceived attractiveness scores were analyzed in relation to academic year, gender, and specific types of smile alterations. Results: The perception of smile attractiveness varied significantly across academic years for certain esthetic discrepancies, including central incisor length mismatch, midline diastema, and open gingival embrasures (p < 0.05). Clinical-year students (years 4–5) demonstrated a more critical assessment compared to preclinical students. Female students exhibited greater sensitivity to specific discrepancies, including fluorosis and reduced tooth lightness. The combination of a midline diastema, a gummy smile, and reduced lightness received the lowest attractiveness scores across all groups. Conclusions: The perception of altered smile esthetics among undergraduate dental students evolves throughout their education, although this progression does not follow a linear trajectory. Dental education appears to influence the perception of specific smile esthetic discrepancies, reflecting a selective influence on features. Clinical training appears to be a critical parameter of dental education, influencing the perception of smiling esthetics. Full article

Hyaluronic acid (HA) dermal fillers represent a cornerstone of modern esthetic medicine, providing a minimally invasive solution for facial volume restoration and skin rejuvenation. However, the diversity of available products, each utilizing distinct crosslinking technologies, presents a challenge for objective comparison and clinical decision making. This study introduces a scientific framework to evaluate and categorize the physicochemical properties of HA fillers based on two key parameter groups: dynamic parameters (e.g., rheology and gel content) and consistency parameters (e.g., extrusion force, water uptake, and gel particle size). Using standardized methodologies, 23 commercially available fillers from five major manufacturers were analyzed, enabling cross-technology comparisons. The findings reveal how specific crosslinking approaches influence the rheological behavior, handling characteristics, and potential clinical applications. By offering an integrated and reproducible assessment, this work helps practitioners select the most suitable filler for individualized treatment plans and encourages manufacturers to enhance product transparency through harmonized testing protocols. Full article

Background/Objectives: Orthodontic camouflage is a treatment strategy designed to address mild to moderate skeletal discrepancies through dental compensation when growth modification or orthognathic surgery (OGS) is unsuitable or declined by the patient. This report highlights the treatment of a child with a skeletal Class II pattern, Class II division 1 malocclusion, a 10.8 mm overjet, traumatic overbite, and unilateral temporomandibular joint (TMJ) ankylosis on the left side. Methods: The treatment plan focused on correcting the proclination of the maxillary incisors and improving the facial profile. A non-extraction camouflage approach using pre-adjusted edgewise appliances was implemented following a gap arthroplasty procedure on the left TMJ. Results: The patient achieved a satisfactory treatment outcome, with an ideal static and functional occlusion and significant improvement in facial esthetics. The approach effectively managed the severe mandibular retrognathia and TMJ ankylosis without OGS, thereby minimizing the risk of progressive condylar resorption. Conclusions: This case underscores the importance of personalized treatment plans tailored to each patient’s dental, skeletal, and individual needs. It demonstrates that non-surgical camouflage treatments can be a viable alternative for addressing severe mandibular retrognathia with TMJ ankylosis, achieving favorable esthetic and functional outcomes. Full article

Background/Objectives: Calcium hydroxylapatite (CaHA)-based dermal fillers are widely used in esthetic medicine due to their dual volumizing and biostimulatory properties. Despite their rising popularity, comparative clinical outcome data evaluating different CaHA fillers remain limited. This prospective, single-center, unblinded study aimed to establish the effectiveness of the CaHA filler Rennova^® Diamond Intense via comparison to the well-established CaHA filler Radiesse^® in terms of clinical performance, safety, and patient satisfaction. Methods: Thirty patients (28 female, 2 male) underwent a single-session bilateral injection of Rennova^® Diamond Intense (right side) and Radiesse^® (left side) in the lower and medial posterior facial regions. Outcomes evaluated at multiple time points included dermal thickness, skin elasticity, transepidermal water loss, patient-reported outcomes (S-GAIS), physician-assessed outcomes (P-GAIS), and adverse events. Results: Both fillers showed improvements across all parameters. Patient-reported S-GAIS indicated predominantly “improved” outcomes at days 60 and 120, whereas physician assessments (P-GAIS) predominantly indicated “very improved” results at day 120. Ultrasound revealed increases in dermal thickness for both fillers. Similarly, improvements in skin elasticity and decreases in transepidermal water loss were observed bilaterally. Mild, transient adverse events (pain, swelling, redness, bruising) resolved spontaneously within 30 days post injection. Conclusions: Rennova^® Diamond Intense effectively increases dermal thickness, improves skin elasticity, and reduces transepidermal water loss, achieving high patient and physician satisfaction. These findings underscore its safety, versatility, and efficacy for esthetic facial rejuvenation, warranting further long-term evaluation. Full article

High-intensity focused ultrasound (HIFU) is a non-invasive technology widely used for facial and body rejuvenation, skin tightening, and fat reduction. It stimulates collagen production and induces apoptosis in fat cells, offering an effective alternative to surgical procedures with minimal downtime and reduced recovery periods. As a result, HIFU has become an increasingly popular choice for patients seeking non-surgical esthetic enhancements. A comprehensive literature search was conducted using PubMed, Scopus, and SpringerLink to assess HIFU-related complications. Twenty-two studies published between 2010 and 2025 were identified, all involving female participants. The findings confirm that HIFU is generally safe and effective, with most complications being mild and transient, such as temporary erythema, swelling, and discomfort. These side effects typically resolve within a few hours to days without requiring medical intervention. However, rare but significant complications like fat atrophy, nerve irritation, and hyperpigmentation have been linked to improper device settings, inadequate practitioner expertise, and insufficient patient assessment. Ensuring proper training, adherence to standardized treatment protocols, and individualized patient evaluations can significantly minimize these risks and optimize patient outcomes. Long-term follow-up studies and further research on standardized safety protocols, optimal energy settings, and patient selection criteria are essential for enhancing the effectiveness, predictability, and safety of HIFU in esthetic medicine. Full article

Background: The superficial temporal artery (STA) typically bifurcates into frontal and parietal branches in the temporal region. This study describes a rare anatomical variation identified during a cadaveric dissection where the STA presented an early cervical bifurcation. Methods: A cadaveric dissection was performed on a 58-year-old Caucasian female specimen injected with synthetic polymers. The STA was meticulously dissected, and anatomical findings were documented through photographs and measurements. Results: An unusual cervical bifurcation of the STA was observed. The frontal and parietal branches originated at the level of the posterior belly of the digastric muscle, ascending separately. The anterior branch, identified as the frontal branch, coursed below the facial nerve and stylomastoid artery, reaching the temporal line without further branching after giving the transverse facial artery as the only collateral branch. The posterior parietal branch extended posteriorly to the external acoustic meatus, compensating for the absence of the posterior auricular artery. This anatomical variation might influence surgical approaches to the head and neck region, particularly in parotid and reconstructive surgeries. Discussion: Variations in STA anatomy can significantly impact clinical practices, including reconstructive surgery, vascular interventions, and esthetic procedures. Imaging techniques, though useful, may not detect such rare variants. Cadaveric dissection remains a crucial tool for detailed anatomical assessment. Conclusions: This study highlights the importance of recognizing the STA’s vascular variations for safe surgical planning and improving patient outcomes. Further studies correlating imaging findings with cadaveric dissections are recommended. Full article

Background: The lower third of the face plays a crucial role in overall facial harmony, and age-related volume loss in areas such as the pre-jowl region, labiomental folds, and lips can significantly impact esthetic appearance. High-resolution ultrasound is helpful for identifying key structures, such as the facial artery, parotid gland, and masseter muscle, which are critical to avoid during filler injections. Objectives: This article, the final installment in a three-part series on ultrasound-guided facial injections, provides an in-depth analysis of the sonographic anatomy of the lower face, including the mandibular, marionette, and chin regions. Methods: This article outlines step-by-step techniques for ultrasound-guided filler procedures, with a focus on the importance of pre- and intra-procedural scanning to ensure safe and accurate filler placement. Results: By employing techniques like “scan before injecting” and “scan while injecting”, injectors aim to reduce risks such as vascular occlusion, muscle injection, and skin necrosis. Discussion: The use of ultrasound guidance in these regions enhances both esthetic outcomes and patient safety, providing optimal results while minimizing complications. With continued advancements, ultrasound-guided injections will become increasingly precise, enabling more targeted and safer treatments in the lower face. Full article