Editorial Board/Reviewing Committee

doi : 10.1016/S0901-5027(21)00419-7

Volume 51, Issue 1, January 2022, Page i

خرید پکیج و مشاهده آنلاین مقاله

Lymphovascular invasion as a prognostic tool for oral squamous cell carcinoma: a comprehensive review

M.Mascitti1aL.Togni1aV.C.A.Caponio2K.Zhurakivska2M.E.Bizzoca2M.Contaldo3R.Serpico3L.Lo Muzio2A.Santarelli14

doi : 10.1016/j.ijom.2021.03.007

Volume 51, Issue 1, January 2022, Pages 1-9

Oral cancer is the most common malignancy of the head and neck region, characterized by a poor prognosis. Novel prognostic markers are needed to better stratify these patients. Lymphovascular invasion (LVI) has been included in the eighth edition of the AJCC Cancer Staging Manual as an additional prognostic factor, but its influence on the recurrence risk and lymph node metastasis is relatively understudied. This is a comprehensive review of the literature on the clinical and prognostic role of LVI in oral cancer. A relevant search of the PubMed, Scopus, and Web of Science databases yielded 29 articles that satisfied the inclusion criteria. Findings indicated that LVI is an independent negative prognostic factor in oral cancer patients and appears to be associated with cervical lymph node metastasis and loco-regional recurrence. Notably, in oral tongue cancer, survival outcomes progressively worsen when LVI is associated with other adverse pathological features, especially in the early stages. Therefore, these patients could benefit from elective neck dissection and/or adjuvant therapy. The high variability of LVI prevalence hinders the comparison of literature results. Several methodological limitations were found to be present in the collected articles, including the lack of a rigorous definition for LVI, the difficult detection in routine histological section, the presence of potential confounders, the retrospective nature, and an inadequate sample size in most studies. Therefore, it is necessary to conduct prognostic studies using standardized methods to define and quantify LVI.

خرید پکیج و مشاهده آنلاین مقاله

What has the National Cancer Database taught us about oral cavity squamous cell carcinoma?

N.Graillon12O.Iocca3R.M.Carey4K.Benjamin5S.B.Cannady4L.Hartner6J.G.Newman4K.Rajasekaran4J.A.Brant4R.M.Shanti47

doi : 10.1016/j.ijom.2021.03.015

Volume 51, Issue 1, January 2022, Pages 10-17

The wealth of data in the National Cancer Database (NCDB) has allowed numerous studies investigating patient, disease, and treatment-related factors in oral cavity squamous cell carcinoma (OCSCC); however, to date, no summation of these studies has been performed. The aim of this study was to provide a concise review of the NCDB studies on OCSCC, with the hopes of providing a framework for future, novel studies aimed at enhancing our understanding of clinical parameters related to OCSCC. Two databases were searched, and 27 studies published between 2002 and 2020 were included. The average sample size was 13,776 patients (range 356–50,896 patients). Four areas of research focus were identified: demographic and socioeconomic status, diagnosis, prognosis, and treatment. This review highlights the impact of age, sex, ethnicity, and socioeconomic status on the prognosis and management of OCSCC, describes the prognostic factors, and details the modalities and indications for neck dissection and adjuvant therapy in OCSCC. In conclusion, the NCDB is a very valuable resource for clinicians and researchers involved in the management of OCSCC, offering an incomparable perspective on a large dataset of patients. Future developments regarding hospital information management, review of data accuracy and completeness, and wider accessibility will help clinicians to improve the care of patients affected by OCSCC.

خرید پکیج و مشاهده آنلاین مقاله

A population-based study of the epidemiology of oral squamous cell carcinoma in the Netherlands 1989–2018, with emphasis on young adults

A.A.H.Al-Jamaei1B.A.C.van Dijk23M.N.Helder1T.Forouzanfar1C.R.Leemans4J.G.A.Mde Visscher1

doi : 10.1016/j.ijom.2021.03.006

Volume 51, Issue 1, January 2022, Pages 18-26

There has been an increasing trend in oral squamous cell carcinoma (OSCC) in patients under 45 years of age. The aim of this study was to evaluate the burden of OSCC in the Netherlands between 1989 and 2018 among young adults (age 20–34 years) when compared to adults (age 35–44 years), and to describe the burden in older groups as well, utilizing cancer registry data to characterize incidence patterns by age, sex, and risk factors. A total of 18,963 cases of OSCC were reported. The overall incidence rate, as measured by annual percentage change (APC), increased significantly from 1989 to 2010 by 1.3% per year (95% confidence interval (CI) 0.9–1.7%) but decreased thereafter by −0.9% (95% CI −2.5% to 0.7%). Annual incidence increased significantly by 2.4% (95% CI 1.1–3.8%) for patients aged 20–34 years, while it decreased for those aged 35–44 years by −0.9% (95% CI −1.7% to 0.0%). In patients older than 60 years, incidence rates increased overall (60–74 years: APC 1.8%, 95% CI 1.5–2.1%; ≥75 years: APC 1.5%, 95% CI 1.2–1.9%). Overall, 66.5% of patients were smokers and 65.3% were alcohol consumers. The marked differences in incidence within the young age subgroups warrants further investigation to elucidate any likely disparity in biological process and clinical outcomes in these populations.

خرید پکیج و مشاهده آنلاین مقاله

Immunohistochemical expression levels of cyclin D1 and CREPT reflect the course and prognosis in oral precancerous lesions and squamous cell carcinoma

Y.J.Siril12A.Kouketsu1H.Saito2T.Takahashi1H.Kumamoto2

doi : 10.1016/j.ijom.2021.03.012

Volume 51, Issue 1, January 2022, Pages 27-32

Cyclin D1 is the most essential progressive regulator of the cell cycle, and its transcription is enhanced by CREPT (cell cycle-related and expression-elevated protein in tumour). These molecules regulate cell growth, and their aberrant expression can cause malignant transformation. In this study, the expression of these molecules was explored to investigate the molecular alterations in oral precancerous lesions and squamous cell carcinoma. Cyclin D1 and CREPT expression was examined immunohistochemically in tissue specimens from 55 patients with oral epithelial precursor lesions (OEPLs) and 84 patients with oral squamous cell carcinoma (OSCC). Associations between the results and clinicopathological variables were examined. Cyclin D1 and CREPT expression levels were higher in OSCC than in OEPLs. Furthermore, there were statistically significant differences in cyclin D1 expression among the different grades of OEPLs and OSCC lesions. In OSCC, there were statistically significant differences in CREPT expression according to sex, T stage, and degree of differentiation. In addition, the expression of both molecules was significantly correlated with postoperative metastasis and modes of invasion. The expression of cyclin D1 and CREPT was found to depend upon the state of development and progression of the oral epithelial lesions, and clinicopathological behaviours might be affected by these molecules in OSCC.

خرید پکیج و مشاهده آنلاین مقاله

A simple method for preconditioning radial forearm flaps in the case of an insufficient ulnar vascular supply: a retrospective clinical analysis

N.Tödtmann1A.Weber2S.Hollstein1M.Kunkel1

doi : 10.1016/j.ijom.2021.03.013

Volume 51, Issue 1, January 2022, Pages 33-37

Due to its versatile applicability, many reconstructive surgeons use the radial forearm flap (RFF) as the first choice for soft tissue replacement. Donor site limitations of the flap arise with an insufficient blood supply along the ulnar artery. This study presents a simple and safe method for RFF preconditioning by recruitment of the deep palmar arch via the ulnar artery. Fourteen patients scheduled for RFF surgery between 2013 and 2018 showed an insufficient vascular supply according to the Allen test, which was confirmed by digital subtraction angiography (DSA). These 14 patients underwent temporary ligature of one or both radial arteries with elastic vessel loops under local anaesthesia and continuous pulse oximetry. A control DSA was performed about 24 hours later in 10 of the 14 patients. Recruitment of the blood supply along the enlarged ulnar artery or reanimated collaterals was confirmed in all 10 patients. No local complications such as ischemia of the hand were seen. All flaps could be harvested regularly and were used for different reconstructive purposes. This simple technique may help to overcome vascular limitations of the RFF via the rapid, efficient, and reliable recruitment of the biological vascular reserve. Within the limits of a case series, this procedure appears practicable and safe.

خرید پکیج و مشاهده آنلاین مقاله

Venous superdrainage using superficial circumflex iliac vein in deep circumflex iliac artery perforator flap with iliac crest for oromandibular reconstruction

W.-J.WuL.ZhengJ.ZhangX.-M.LvM.-W.HuangY.ShiS.-M.Liu

doi : 10.1016/j.ijom.2021.03.014

Volume 51, Issue 1, January 2022, Pages 38-43

The deep circumflex iliac artery perforator flap with iliac crest (DCIAPF) is considered a favourable single-flap option for oromandibular reconstruction. The aim of this study was to evaluate the effectiveness of venous superdrainage using the superficial circumflex iliac vein (SCIV) in the DCIAPF for oromandibular reconstruction. The data of 22 patients (12 female, 10 male) aged 10–76 years (median 53 years) who underwent simultaneous oromandibular reconstruction with a DCIAPF were reviewed retrospectively. Eleven patients received the DCIAPF with SCIV for superdrainage (group A) and another 11 patients received the conventional single-pedicled DCIAPF flap (group B). No flap loss occurred in either group. Venous congestion due to relative venous insufficiency was significantly more frequent in group B (P = 0.045). There was no significant difference in the incidence of partial flap necrosis and wound dehiscence, or in the total operation time between the two groups. Superdrainage using the SCIV has the potential to reduce the incidence of venous congestion due to relative venous insufficiency in DCIAPF used for oromandibular reconstruction.

خرید پکیج و مشاهده آنلاین مقاله

Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

W.-F.Yang1W.S.Choi1W.-Y.Zhu1C.-Y.Zhang2D.T.S.Li1J.K.-H.Tsoi3A.W.-L.Tang4K.-W.Kwok4Y.-X.Su1

doi : 10.1016/j.ijom.2021.02.033

Volume 51, Issue 1, January 2022, Pages 44-53

Spatial deviations of the temporomandibular joint (TMJ) after oncological mandibular reconstruction are important to the aesthetic and functional rehabilitation. The aim of this study was to clarify whether and how three dimensionally (3D) printed patient-specific surgical plates, and the preservation of the condyle or ramus, affect spatial deviations of the TMJ. A total of 33 patients who underwent mandibular reconstruction via computer-assisted surgery were included. Regarding absolute deviations, patients in the 3D-printed plate group showed smaller TMJ deviations compared to those in the conventional plate group. There was no difference in absolute deviations of the TMJ regardless of whether the condyle or ramus was preserved. Regarding physiological deviations, the impact on the contralateral TMJ was smaller in the 3D-printed plate group. Patients with both the condyle and ramus removed had significantly higher deviations of the condyle and joint space. In summary, 3D-printed patient-specific surgical plates improved the spatial accuracy of the TMJ. Under physiological conditions, TMJ deviations on the operated side were mainly affected by the preservation of the condyle. Removal of both the condyle and ramus caused more severe spatial interference to the TMJ; this should be further confirmed.

خرید پکیج و مشاهده آنلاین مقاله

SH3BP2-related fibro-osseous disorders of the maxilla and mandible: A systematic review

J.KueperabcC.TsimbalaB.R.OlsendL.KabaneE.C.Liaoab

doi : 10.1016/j.ijom.2021.04.001

Volume 51, Issue 1, January 2022, Pages 54-61

Cherubism is a disorder of bony overgrowth of the jaws that manifests in childhood. SH3BP2 gene variants have been associated with cherubism; this gene plays a major role in bone homeostasis. Due to its rare occurrence, there is as yet no comprehensive understanding of the natural history and clinical course of the disease. The aim of this review was to compile and analyze all cases of SH3BP2-related cherubism and cherubism-like disorders. Thirty publications were identified, including 92 individuals from 34 families, who were diagnosed with SH3BP2-related fibro-osseous lesions of the jaw. Only 15% of cases included in this review had no known family history of the disease. The distribution of cherubism was equal with respect to biological sex. Missing teeth were reported in 38% of cases. Lesions were restricted to the mandible in 36% of cases and involved both the maxilla and mandible in 54% of cases. The clinical phenotypes reported in the articles analyzed varied greatly in detail, making comparisons between studies and conclusive analysis difficult. Further work is necessary to describe the connection between SH3BP2 gene variants and cherubism in order to advance its diagnosis and treatment.

خرید پکیج و مشاهده آنلاین مقاله

Pain management at iliac donor sites after grafting of alveolar clefts

A.TacheM.Y.Mommaerts

doi : 10.1016/j.ijom.2021.05.004

Volume 51, Issue 1, January 2022, Pages 62-69

The aim of this study was to answer the question: which analgesic protocol is most efficient and most effective in overcoming pain and promoting functional recovery after iliac bone grafting in cleft alveolus patients? A systematic review of the literature was performed. The population consisted of cleft lip and alveolus patients with or without cleft palate undergoing iliac crest bone grafting; the outcomes analysed were represented by the duration of hospital stay, subjective pain rating, and degree of impaired mobility. A total of 15 articles were selected for review. The following protocols were subject to comparison in this review: simple classic intravenous/per-oral analgesia, local anaesthetic infiltration in the donor site, anaesthetic-soaked sponge, neural blocks and continuous infusion at the donor site. The results of the included studies were individually reported identifying trends in the efficiency of the different pain-management techniques. Although hospital stay varied from same-day discharge to almost a week, other factors besides pain influenced this outcome. School was resumed after an average of 12.6 days and sport activities after maximum one month regardless of the used protocol. Even though the age of patients had a statistically significant influence on hospital stay durations, it did not determine the latter. The pain management protocols after iliac bone grafting of alveolar clefts selected for analysis have their advantages and drawbacks. All protocols seem effective meaning they reach adequacy in managing pain at the donor site. The efficiency of the protocols could not be assessed due to the lack of data and inconsistency in pain assessment scales. Further investigation through randomized controlled studies is required.

خرید پکیج و مشاهده آنلاین مقاله

Photogrammetric evaluation of corrective surgery for trigonocephaly

R.Kuehle1N.Ewerbeck1T.Rückschloß1O.Ristow1A.El Damaty2C.Freudlsperger1J.Hoffmann1M.Engel1

doi : 10.1016/j.ijom.2021.06.003

Volume 51, Issue 1, January 2022, Pages 70-77

The aim of this study was to capture preoperative, postoperative, and follow-up head shapes of male trigonocephaly patients who underwent fronto-orbital remodelling (FOR), using three-dimensional (3D) photography. Fifty-seven male infants with metopic synostosis operated on using standardized FOR during a 5-year period were included. All measurements were compared with those of an age-matched healthy control cohort (n = 253 for early postoperative comparison, n = 43 for the 1-year follow-up comparison) to determine the effect of FOR at 14 days and at 1 year post-surgery. Intracranial volume, frontal angle, nasofrontal angle, interfrontoparietal–interparietal ratio, and inter-orbital distances were measured 1 day preoperatively, 14 days and 1 year postoperatively. Mean age at surgery was 9.7 ± 1.1 months. Prior to surgery, boys with metopic synostosis showed a reduced intracranial volume (−7.0%, P < 0.001), frontal angle (−10.2%, P < 0.001), interfrontoparietal–interparietal ratio (−4.9%, P < 0.01), and orbital distances (−6.5%, P < 0.001) compared to the reference group, but values did not differ significantly from the specific control group after surgery (all P> 0.05). This was consistent by the time of the follow-up examination. Corrective surgery should therefore aim to achieve volume expansion and correction of the deformity. Furthermore, 3D photogrammetry provides a valuable alternative to computed tomography scans in the diagnosis of metopic synostosis, significantly reducing the amount of radiation exposure to the brain.

خرید پکیج و مشاهده آنلاین مقاله

A new classification of mandibular fractures

J.S.BrownA.KhanS.WareingA.G.Schache

doi : 10.1016/j.ijom.2021.02.012

Volume 51, Issue 1, January 2022, Pages 78-90

There is no accepted method of reporting mandibular fracture that reflects incidence, treatment and outcome for individual cases. As most series include anatomical site only for all fractures, the aim was to establish a new method to report fractures based on a systematic review of the literature and an internal audit. The classification proposed is: Class I; condyle, II; angle, IIc; II + condyle, III; body/symphysis, IIIc; III + condyle, IV; multiple fractures not including condyle, IVc; IV + condyle, V; bilateral condyle ± other fracture(s). A total of 10,971 adult and 914 paediatric cases were analyzed through systematic review, and 833 from the regional audit. Only 32% (14/44) of reported series could be reclassified which, when added to the audit data, showed Class IV was most common (29%), with similar proportions of Class III, Class IIIc and Class II (18–23%). External validation (literature review) in terms of treatment and outcome was non-informative, but the internal validation (audit) demonstrated an increasing requirement for adding maxillomandibular fixation (MMF) to open reduction and internal fixation (ORIF) as class increased. The heterogeneity of data reporting found in the systematic review confirms the need for a classification such as this, likely to enhance comparison of varying management protocols.

خرید پکیج و مشاهده آنلاین مقاله

Assault-related facial fractures: does the injury mechanism matter?

A.Arpalahti1A.Haapanen1T.Puolakkainen1A.Abio23H.Thorén45J.Snäll1

doi : 10.1016/j.ijom.2021.06.001

Volume 51, Issue 1, January 2022, Pages 91-97

This study clarified the injury characteristics and occurrence of associated injuries in patients with assault-related facial fractures. Data from 840 assault-related facial fracture patients were included; demographic factors, facial fracture type, associated injuries, alcohol use, and injury mechanisms were recorded. Assault mechanisms most often included combinations of different mechanisms (57.5%) and resulted in the victim falling (50.1%). The perpetrator was most commonly a stranger (52.5%) and acted alone (57.7%). A total of 123 patients (14.6%) had associated injuries, with the most common being traumatic brain injury. Associated injuries occurred most frequently in patients with combined fractures of the facial thirds (24.2%) and upper third fractures (42.9%). The most significant differentiating factors for associated injuries were the number of perpetrators, falling, the use of an offensive weapon, and if the events of the assault remained unknown. In adjusted logistic regression analyses, statistically significant associations with associated injuries were found for age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03–1.07; P < 0.001), falling due to the assault (OR 2.87, 95% CI 1.49–5.50; P = 0.002), and upper third facial fractures (OR 6.93, 95% CI 2.06–23.33; P = 0.002). A single punch also caused severe injuries and should therefore not be overlooked, as this can be as dangerous as other assault mechanisms.

خرید پکیج و مشاهده آنلاین مقاله

A conceptual framework for treating jaw deformities in patients with abnormal condyles: preservation versus replacement of the glenoid fossa–disc–condyle–ramus

J.C.Posnick12L.B.Kaban3

doi : 10.1016/j.ijom.2021.03.010

Volume 51, Issue 1, January 2022, Pages 98-103

This article outlines a conceptual approach to the reconstruction of jaw deformities associated with abnormalities in the mandibular condyle. The authors describe a hierarchy of reconstruction, emphasizing use of the least invasive and progressing to the most complex and invasive techniques, depending on the nature and severity of the underlying deformity, prior operations, patient age, and stage of growth. Consider joint preservation orthognathic surgical correction, followed by biological techniques for replacement of the condyle, and avoid replacing a functional temporomandibular joint based only on radiographic remodeling and concerns about potential future flare-ups of disease based on anecdotal data.

خرید پکیج و مشاهده آنلاین مقاله

Interaction between posture and maxillomandibular deformity: a systematic review

A.Kerbrat12T.Schouman12D.Decressain1P.Rouch2V.Attali234

doi : 10.1016/j.ijom.2021.05.003

Volume 51, Issue 1, January 2022, Pages 104-112

Maxillomandibular deformity (MMD) and body posture appear to be correlated. However, no systematic literature review of the available evidence to support this correlation has been performed to date. The aim of this study was to conduct a systematic literature review on posture and MMD. This systematic literature review was registered in the PROSPERO database. Systematic searches of the MEDLINE, Scopus, Cochrane Library, and Web of Science databases were performed. In total, 13 clinical studies were included. Nine found a significant association between MMD and body posture or body balance: two studies showed a correlation between increased cervical lordosis and skeletal class III MMD, two studies showed an interaction between mandibular deviation and scoliosis, four studies demonstrated a significant association between lumbar column and pelvis anatomy and MMD, and one study found a correlation between displacement of the centre of mass and MMD. However, the level of evidence is low; the methods used to evaluate body posture and MMD were inconsistent. Orthognathic surgery could modify body posture. Although there seems to be an interaction between body posture and facial deformity, the number of studies is too small and the level of evidence too low to strongly support this association.

خرید پکیج و مشاهده آنلاین مقاله

Three-dimensional evaluation of distal and proximal segment skeletal relapse following isolated mandibular advancement surgery in 100 consecutive patients: A one-year follow-up study

S.ShujaataE.ShaheenaC.PolitisaR.Jacobsab

doi : 10.1016/j.ijom.2021.03.020

Volume 51, Issue 1, January 2022, Pages 113-121

The aim of this study was to perform a three-dimensional evaluation of the skeletal relapse of the proximal and distal mandibular segments following isolated bilateral sagittal split osteotomy advancement surgery. One hundred consecutive patients (mean age 25.8 ± 11.7 years), comprising 65 female patients (mean age 26.4 ± 12.1 years) and 35 male patients (mean age 24.6 ± 11.0 years) requiring mandibular advancement without genioplasty, were enrolled prospectively in the study. Cone beam computed tomography scans were acquired for each patient at three time-points: preoperatively, immediately (1–6 weeks) after surgery, and 1 year after surgery. A validated tool was utilized to assess the surgical movement and relapse. Based on percentage, the majority of the distal and proximal translational and rotational movements relapsed within the range of ≤2 mm and ≤2°. The distal segment revealed a significant relapse in a posterior, inferior, and clockwise pitch direction. Both left and right proximal segments showed a significant translational relapse in the medial, posterior, and superior direction. Amongst the rotational parameters, proximal segments relapsed significantly in clockwise pitch, clockwise roll, and counterclockwise yaw direction. Overall, both distal and proximal bone segments showed a clinically acceptable translational and rotational stability. The proximal segments torqued towards their original position with a reduction of flaring.

خرید پکیج و مشاهده آنلاین مقاله

Non-grafted versus grafted sinus lift procedures for implantation in the atrophic maxilla: a systematic review and meta-analysis of randomized controlled trials

S.A.N.Lie12R.M.M.A.Claessen1C.A.W.Leung1H.-A.Merten3P.A.W.H.Kessler12

doi : 10.1016/j.ijom.2021.03.016

Volume 51, Issue 1, January 2022, Pages 122-132

The aim of this systematic review and meta-analysis was to critically evaluate the currently existing clinical evidence on the efficacy of graftless maxillary sinus membrane elevation for implantation in the atrophic posterior maxilla. A search protocol without limitations to November 2020 was followed by two independent researchers. Randomized controlled trials using the lateral window approach for graftless sinus membrane elevation were included. Uncontrolled, retrospective, non-comparative studies, case reports, and experimental studies in animals or cadavers were excluded. The search identified 2777 studies. Critical selection by two independent researchers then led to the inclusion of a total of nine studies. A risk of bias assessment was applied using the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was conducted for seven studies. Results showed a high overall implant survival rate in both the graftless and bone-grafted sinus lift groups (97.92% and 98.73%, respectively). The graftless sinus lift group showed a significantly lower vertical bone height gain, with a mean difference of −1.73 mm (P = 0.01), and a significantly lower bone density, with a mean difference of −94.7 HU (P < 0.001). The implant stability quotient values did not differ significantly between the test and control groups (P = 0.07).

خرید پکیج و مشاهده آنلاین مقاله

Flapped versus flapless alveolar ridge preservation: a systematic review and meta-analysis

M.A.Atieh12L.Alfardan1N.H.M.Alsabeeha3

doi : 10.1016/j.ijom.2021.05.023

Volume 51, Issue 1, January 2022, Pages 133-142

Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. Flapped and flapless surgical approaches have been used for ARP; however, there is a lack of strong scientific evidence regarding their specific influences on the clinical outcomes of ARP. The aim of this systematic review and meta-analysis was to evaluate the effects of flapped and flapless surgical approaches on the dimensional changes of hard and soft tissues and patient-reported outcomes following ARP. Electronic databases were searched to identify randomized controlled trials (RCTs) that compared flapped ARP by means of a coronally advanced flap to flapless ARP where barrier membranes were left exposed. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. Data were analysed using a statistical software program. A total of 754 studies were identified, of which five studies with 149 extraction sockets in 128 participants were included. Overall, meta-analysis did not show any significant differences in the changes in ridge width or height between flapped and flapless ARP. The use of flapless ARP was associated with significantly less postoperative pain, thicker labial soft tissues, and marginally more favourable changes in width of the keratinized tissues compared to the flapped approach. The short-term hard tissue changes following ARP with a flapped or flapless approach are comparable. Postoperative pain and labial soft tissue changes are more favourable following ARP using a flapless approach. Further evidence from long-term RCTs is still required to substantiate the current findings.

خرید پکیج و مشاهده آنلاین مقاله