A Stereophotogrammetry Face Study Between Dentate and Edentulous Adults Rehabilitated with Either a Conventional Complete or an Implant-Supported Fixed Complete Denture.

Quantifying in edentulous patients the facial collapse and whether complete conventional denture (CCD) and implant-supported fixed complete denture (ISFCD) can restore the facial proportions to match those of a dentate patient (CG) is relevant for clinical dentists. One hundred and four participants were enrolled and divided into edentulous (n=56) and CG (n=48). The edentulous participants were rehabilitated with CCD (n=28) or ISFCD (n=28) in both arches. Anthropometric landmarks in the face were marked and captured by stereophotogrammetry. Linear, angular, and surface measurements were analyzed and compared among groups. The statistical analysis was performed by an independent t-test, the one-way ANOVA, and Tukey's test. The significance level was set at 0.05. The facial collapse was quantified as a significant shortening of the lower third of the face affecting facial aesthetics in all parameters evaluated and the same was observed in comparison among CCD, ISFCD, and CG. The CCD presented statistical differences with the CG group in the lower third of the face and labial surface, and the ISFCD showed no statistical differences with the CG and CCD. The facial collapse in edentulous patients could be restored through oral rehabilitation with an ISFCD similar to those of dentate patients.

Three-dimensional assessment of restored smiling mobility after reanimation of unilateral facial palsy by triple innervation technique.

The aim of this study was to assess surgically restored facial mobility using an optical 3D instrument. Eleven patients (age range 42-76 years) with unilateral facial palsy, treated by triple innervation procedure (masseteric and partial hypoglossal reinnervation, plus double cross-face facial grafting), performed five facial animations: rest position, smiling by contracting the healthy side, clenching the teeth, and pushing the tongue against the lower incisors and Mona Lisa smiling. These were recorded by stereophotogrammetry. Sixty healthy subjects were also recorded. The 3D reconstruction of each facial expression was registered onto the rest position scan, and the root mean square (RMS) point-to-point distance between the two 3D surfaces was calculated automatically for the facial thirds. RMS values on the rehabilitated hemiface were 74.8% (upper third), 46.6% (middle third), and 54.1% (lower third) of those recorded in healthy subjects. RMS values were higher in the middle and lower thirds than in the upper third, and during smile provided by masseteric stimulus (P<0.05). The rehabilitated hemiface differed more from healthy subject values than the healthy hemiface did (P<0.05). On average, patients were more asymmetric than healthy subjects (P=0.004). The proposed method is non-invasive and non-contact, and it can quantify localized facial movements after surgical procedures.

Reliability of optical devices for three-dimensional facial anatomy description: a systematic review and meta-analysis.

The use of three-dimensional (3D) optical instruments to measure soft tissue facial characteristics is increasing, but systematic assessments of their reliability, practical use in research and clinics, outcome measurements, and advantages and limitations are not fully established. Therefore, a review of the current literature was performed on the reliability of facial anthropometric measurements obtained by 3D optical facial reproductions as compared to conventional anthropometry or other optical devices. The systematic literature search was conducted in electronic databases following the PRISMA guidelines (PROSPERO registration: CRD42018085473). Overall, 815 studies were identified, with 27 final papers included. Two meta-analyses were conducted. Tested devices included conventional cameras, laser scanning, stereophotogrammetry, and structured light. Studies measured living people or inanimate objects. Overall, the optical devices were considered reliable for the measurement of linear distances. Some caution is needed for surface assessments. All instruments are suitable for the analysis of inanimate objects, but fast scan devices should be preferred for living subjects to avoid motion artefacts in the orbital and nasolabial areas. Prior facial landmarking is suggested to improve measurement accuracy. Practical needs and economic means should direct the choice of the most appropriate instrument. Considering the increasing interest in surface-to-surface measurements, fast scan devices should be preferred, and dedicated protocols devised.

Three-dimensional longitudinal evaluation of facial mimicry in orthognathic class III surgery.

The effect of bimaxillary orthognathic surgery on facial mimicry was assessed longitudinally in 15 patients with dentoskeletal class III facial dysmorphism (seven men, eight women, mean age 28 years). The patients were analysed pre-surgery and at 6, 12, and 24 months post-surgery while performing verbal (five vowels) and non-verbal (open and closed mouth smile, lip purse) soft tissue facial movements. The three-dimensional motions of right and left nasogenian, crista philtri, cheilion, and lower lip landmarks were detected by an optoelectronic instrument, and a total mobility index was obtained. Differences between the sides were quantified by the symmetry index. Patient values were compared to those collected previously from healthy volunteers by computing z-scores. On average, no significant differences were found in the mobility of the buccal soft tissues at 24 months after surgery (ANOVA P-value, range 0.075-0.808), with positive median z-scores (pooled mean value close to 0.6). Symmetry indices ranged around the control reference values, showing no stage-related differences (Friedman test P-value, range 0.252-0.937), and exceeding 90% for all movements at 24 months after surgery. Bimaxillary osteotomy does not compromise facial mimicry in either verbal or non-verbal facial movements.

Three-dimensional superimposition for patients with facial palsy: an innovative method for assessing the success of facial reanimation procedures.

Facial palsy is a severe condition that may be ameliorated by facial reanimation, but there is no consensus about how to judge its success. In this study we aimed to test a new method for assessing facial movements based on 3-dimensional analysis of the facial surfaces. Eleven patients aged between 42 and 77 years who had recently been affected by facial palsy (onset between 6 and 18 months) were treated by an operation based on triple innervation: the masseteric to temporofacial nerve branch, 30% of the hypoglossal fibres to the cervicofacial nerve branch, and the contralateral facial nerve through two cross-face sural nerve grafts. Each patient had five stereophotogrammetric scans: at rest, smiling on the healthy side (facial stimulus), biting (masseteric stimulus), moving the tongue (hypoglossal stimulus), and corner-of-the-mouth smile (Mona Lisa). Each scan was superimposed onto the facial model of the "rest" position, and the point-to-point root mean square (RMS) value was automatically calculated on both the paralysed and the healthy side, together with an index of asymmetry. One-way and two-way ANOVA tests, respectively, were applied to verify the significance of possible differences in the RMS and asymmetry index according to the type of stimulus (p=0.0329) and side (p<0.0001). RMS differed significantly according to side between the facial stimulus and the masseteric one on the paralysed side (p=0.0316). Facial stimulus evoked the most asymmetrical movement, whereas the masseteric produced the most symmetrical expression. The method can be used for assessing facial movements after facial reanimation.

Parry Romberg Syndrome and linear facial scleroderma: management in pediatric population.

Among all different types of cutaneous scleroderma, Parry Romberg syndrome and linear scleroderma "en coup de sabre" typically involve the visage. Gradual degeneration of the tissues, from the skin up to the bone, is the stigmata of the diseases and the range of clinical manifestations is wide. They typically start during childhood and slowly progress before stabilizing. Considering the gravity of the associated deformity and its impact on facial function and appearance, we strongly advocate a prompt intervention that however must be tailored on paediatric patients. There is not a general consensus on hemifacial atrophy treatment, but autologous fat grafting has been proved to be a suitable technique, due to its low morbidity, repeatability and efficacy in correcting volume defects and in improving skin texture. Following the same concept of safeness and non-invasiveness we propose 3D stereophotogrammetric acquisitions as a possible tool for the pre- and post-surgical follow up, indispensable to evaluate the surgical results. We present our case series composed of 8 paediatric patients, aged between 11 and 17 years, who underwent several lipofilling procedures, from 2012 to 2016. Starting from 2015, 3D stereophotgrammetric data has been obtained.

Surface electromyography before and after orthognathic surgery and condylectomy in active laterognathia: a case report.

BACKGROUND: Condylar hyperplasia is a rare bone disease characterised by excessive development of mandibular condyle, which can lead to the development of asymmetric facial deformity together with malocclusion, mandibular deviation, TMJ and masticatory musculoskeletal system dysfunction. There is not a treatment protocol universally accepted. In order to determine the correct management, treatment and intervention timing of these patients, morphological examinations should be coupled with functional assessments. CASE REPORT: In the present case report, morphological (bone scintigraphy; orthopantomography; posteroanterior and lateral cephalograms; 3D facial photographs) and functional (surface electromyography of masseter and temporalis muscles) quantitative data of a 20-year-old male patient affected by unilateral condylar hyperplasia are presented. The patient underwent a surgical treatment with high unilateral condylectomy associated to a maxillary Le Fort I osteotomy; as well as orthodontic treatment before and after surgery. Facial morphology and masticatory muscles activity were assessed before surgery and followed-up 6, 12 and 24 months after surgery. Twenty-four months after surgery, all electromyographic values were normal, and soft-tissue facial asymmetry was negligible at 3D assessment. CONCLUSION: Surface electromyography joins a set of clinical and morphological diagnostic tests that help the surgeon in planning the operation and managing the post-surgical patient.

Three-dimensional analysis of jaw kinematic alterations in patients with chronic TMD - disc displacement with reduction.

The study investigated whether chronic TMD patients with disc displacement with reduction (DDR), performing non-assisted maximum jaw movements, presented any changes in their mandibular kinematics with respect to an age-matched control group. Moreover, it was examined whether jaw kinematics and a valid clinic measure of oro-facial functional status have significant associations. Maximum mouth opening, mandible protrusion and bilateral laterotrusions were performed by 20 patients (18 women, 2 men; age, 18-34 years) and 20 healthy controls (17 women, 3 men; age, 20-31 years). The three-dimensional coordinates of their mandibular interincisor and condylar reference points were recorded by means of an optoelectronic motion analyser and were used to quantitatively assess their range of motion, velocity, symmetry and synchrony. Three functional indices (opening-closing, mandibular rototranslation, laterotrusion - right and left - and protrusion) were devised to summarise subject's overall performance, and their correlation with the outcome of a clinical protocol, the oro-facial myofunctional evaluation with scores (OMES), was investigated. TMD patients were able to reach maximum excursions of jaw movements comparable to healthy subjects' performances. However, their opening and closing mandibular movements were characterised by remarkable asynchrony of condylar translation. They had also reduced jaw closing velocity and asymmetric laterotrusions. The functional indices proved to well summarise the global condition of jaw kinematics, highlighting the presence of alterations in TMD-DDR patients, and were linearly correlated with the oro-facial functional status. The jaw kinematic alterations seem to reflect both oro-facial motor behaviour adaptation and a DDR-related articular impairment.

3D evaluation of maxillary arches in unilateral cleft lip and palate patients treated with nasoalveolar moulding vs. Hotz's plate.

To compare the three-dimensional changes occurring in the maxillary arch during the use of modified pre-surgical nasoalveolar moulding (PNAM) and Hotz's plate. A clinical trial including 32 children with unilateral cleft lip and palate (UCLP), 16 treated with Hotz's plate and 16 with PNAM, was performed. Impressions of the maxillary arches were taken: A. prior to pre-surgical orthopaedics, B. before cheiloplasty and C. after cheiloplasty. Models were digitised using a stereophotogrammetric instrument, and geodesic distances were calculated: anterior, canine and posterior widths of the arch, and lengths and cleft depths of the larger and shorter segments. The time and treatment effects were assessed by two-factor anova. A significant effect of treatment was found for cleft depth at the larger segment: children treated with Hotz's plate had significantly deeper cleft than children treated with PNAM. All distances significantly changed during time: the anterior and canine widths decreased, while the posterior width, the lengths and depths of the cleft segments increased. Significant treatment per time interactions was found. The anterior and canine widths reduced more with PNAM between time points A and B while Hotz's treatment was more effective between B and C. The shorter segment depth increased more between B and C with PNAM, and between A and B with Hotz's plate. During pre-surgical orthopaedics, therapy with PNAM obtained the best results in reducing the width at the anterior segment of the cleft. This treatment gave a lower increase in cleft depth than treatment with Hotz's plate.

Blood or spores? A cautionary note on interpreting cellular debris on human skeletal remains.

The identification of red blood cells on both skeletal human remains and decomposed corpses is of remarkable importance in forensic sciences, irrespective of its diagnostic value; their presence is often perplexing and difficult to interpret especially when in the context of decomposition and taphonomical variables. Some clinical research has focused on the morphological changes of red blood cells over time by scanning electron microscopy (SEM), but no research has investigated whether botanical structures can be confused for red blood cells. Since some literature has recently presumed the detection of erythrocyte-like cells on skeletal remains (even ancient) as surely erythrocytes, and most have never taken into consideration the chance of an origin different from blood, such as botanical, the present study aims at verifying the possibility of confusion between erythrocytes and botanical cells by applying SEM analysis and at highlighting the pitfalls in this particular issue through a test submitted to pathologists and natural scientists asked to discriminate between red blood cells and different vegetal structures (60 images obtained by SEM analysis). The results showed that although there are diagnostic features useful in identifying red blood cells from botanical structures, some spores resulted very similar to decaying red blood cells, which calls for attention and great caution when studying decomposed human remains.

Evaluation of three-dimensional mandibular movements after reconstruction with free fibula flap.

Seven patients who underwent mandibular reconstruction with a fibula free flap (one on the midline, six on either right or left side) and were rehabilitated with implant supported prostheses, performed free mandibular border movements (maximal mouth opening and closing, right and left lateral excursions, protrusion) that were recorded by a non-invasive motion analyser. Temporomandibular joint (TMJ) kinematic parameters were compared to those calculated in healthy control subjects using z-scores. Maximum mouth opening was reduced in all patients, with z-scores ranging from -2.742 to -0.106, and performed with a reduced sagittal plane mandibular rotation. Interincisal point forward movement during protrusion was reduced in all but one patient. Lateral mandibular movements (displacement of the interincisal point) and bilateral condylar movements during mouth opening were very variable and sometimes asymmetrical. Mandibular rotation was also variable, with z-scores ranging from -1.265 to 1.388. Together with mandibular range of motion, we investigated biomechanical characteristics of TMJ motion that can provide further information about the joint without submitting the patient to harmful procedures, and that can be followed-up during healing. The investigation indicates those areas that need to be given special attention in preoperative planning, patient information and rehabilitation.

An osteological revisitation of autopsies: comparing anthropological findings on exhumed skeletons to their respective autopsy reports in seven cases.

Forensic anthropologists and pathologists are more and more requested to answer questions on bone trauma. However limitations still exist concerning the proper interpretation of bone fractures and bone lesions in general. Access to known skeletal populations which derive from cadavers (victims of violent deaths) who underwent autopsy and whose autopsy reports are available are obvious sources of information on what happens to bone trauma when subjected to taphonomic variables, such as burial, decomposition, postmortem chemical and mechanical insults; such skeletal collections are still however quite rare. This study presents the results of the comparative analysis between the autopsy findings on seven cadavers (six of which victims of blunt, sharp or gunshot wounds) and those of the anthropological assessment performed 20 years later on the exhumed dry bones (part of the Milano skeletal collection). The investigation allowed us to verify how perimortem sharp, blunt and gunshot lesions appear after a long inhumation period, whether they are still recognizable, and how many lesions are no longer detectable or were not detectable at all compared to the autopsy report. It also underlines the importance of creating skeletal collections with known information on cause of death and trauma.

Alendronate impairs epithelial adhesion, differentiation and proliferation in human oral mucosa.

OBJECTIVE: This study aimed at evaluating from a morphological point of view the effects of alendronate (ALN), a widely used nitrogen-containing bisphosphonate for the chronic treatment of osteoporosis, on the oral epithelium of healthy keratinized human oral mucosa. Bisphosphonate-related osteonecrosis of the jaw is a well-known severe consequence, but the effects during chronic therapy on the oral soft tissues are still matter of debate. MATERIALS AND METHODS: Six women over 60 year-old undergoing treatment of osteoporosis with 70 mg per week of oral ALN (lasting at least 2 years) were recruited and compared with a gender and age-matched group (n = 6). Proliferation, apoptosis, intercellular adhesion and terminal differentiation (TD) were investigated by immunofluorescence. In parallel, ultrastructural analysis was carried out. RESULTS: By immunofluorescence, a statistically significant decrease in keratinocyte proliferation was detected in the oral epithelium of the ALN group without any sign of apoptosis, but accompanied by a reduction in desmoglein 1 and keratin 10 expressions. In the uppermost layers of the oral epithelium of the ALN group, thin desmosomes were visible by transmission electron microscopy. CONCLUSION: Our results show that epithelial adhesion, TD and proliferation are affected by ALN therapeutic doses in clinically healthy human oral mucosa.

Electromyographic assessment of jaw muscles in patients with All-on-Four fixed implant-supported prostheses.

This study evaluated the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant-supported prostheses according to All-on-Four(®) principles and in control healthy dentate subjects. Twenty-six subjects aged 50-74 years were examined. Eighteen were edentulous and had been successfully rehabilitated with (i) mandibular All-on-Four(®) implant-supported fixed prostheses and maxillary complete dentures (10 patients) and (ii) mandibular and maxillary All-on-Four(®) implant-supported fixed prostheses (eight patients). Eight reference subjects had natural dentition. Surface EMG recordings of the masseter and temporalis muscles were performed during maximum voluntary teeth clenching and during unilateral gum chewing. All values were standardised as percentage of a maximum clenching on cotton rolls. During clenching, a good global neuromuscular equilibrium was found in all participants. During chewing, all groups had similar values of working-side muscle activities and of chewing frequency. No significant differences in the analysed EMG parameters were found between the patients with mandibular and maxillary All-on-Four(®) implant-supported prostheses and the reference subjects. In contrast, standardised pooled muscle activities and standardised muscular activities per cycle were larger in patients with a maxillary removable prosthesis than in control subjects (Kruskal-Wallis test, P < 0·01). Also, patients wearing a complete maxillary denture showed a poor neuromuscular coordination with altered muscular pattern and lower values of the index of masticatory symmetry than dentate control subjects (P < 0·01). EMG outcomes suggest that All-on-Four(®) implant-supported prostheses may be considered a functionally efficient treatment option for the rehabilitation of edentulous patients with reduced residual bone volume.

Age changes of facial measurements in European young adult males: implications for the identification of the living.

Metric and morphological analyses of facial features are currently applied in cases of personal identification of the living on images acquired from video surveillance systems. However, facial assessment in the forensic context needs to be based on reliable comparative data for facial measurements. Facial changes in the age range of early adulthood (20-30 years) have been rarely described so far, although such knowledge would be beneficial for comparative personal identification on images. This study investigates changes in facial measurements in European males aged between 20 and 30 years in order to identify metric characters that can be used for personal identification in young adults. A sample of 404 males of European ancestry, aged between 20 and 30 years from Germany, Italy and Lithuania were recruited for this project. Fourteen facial measurements were taken and correlation coefficients were calculated for each cranial measurement with age. Only two measurements - labial width and physiognomic ear length - seem to change between 20 and 30 years with a positive statistically significant correlation (p<0.05). These results suggest caution for what may concern personal identification by assessment of ear and mouth morphology.

A new 3-D tool for planning plastic surgery.

Face plastic surgery (PS) plays a major role in today medicine. Both for reconstructive and cosmetic surgery, achieving harmony of facial features is an important, if not the major goal. Several systems have been proposed for presenting to patient and surgeon possible outcomes of the surgical procedure. In this paper, we present a new 3-D system able to automatically suggest, for selected facial features as nose, chin, etc., shapes that aesthetically match the patient's face. The basic idea is suggesting shape changes aimed to approach similar but more harmonious faces. To this goal, our system compares the 3-D scan of the patient with a database of scans of harmonious faces, excluding the feature to be corrected. Then, the corresponding features of the k most similar harmonious faces, as well as their average, are suitably pasted onto the patient's face, producing k+1 aesthetically effective surgery simulations. The system has been fully implemented and tested. To demonstrate the system, a 3-D database of harmonious faces has been collected and a number of PS treatments have been simulated. The ratings of the outcomes of the simulations, provided by panels of human judges, show that the system and the underlying idea are effective.