Medical Research: Emerging Concepts and Applications Vol. 5

Esthetic Management of Single Implants in the Anterior Area: From Surgical Planning to Digital Prosthetic Workflow

2026-09-29T06:43:44+00:00

Restoration of a single missing tooth in the maxillary anterior region requires coordinated surgical, periodontal and prosthetic planning because implant survival alone does not ensure an acceptable aesthetic outcome. Successful treatment depends on recreating stable peri-implant soft-tissue architecture, preserving buccal volume, and reproducing natural crown form, colour and texture. This review synthesises the clinical principles governing three-dimensional implant positioning, timing of placement, minimally invasive surgery, hard- and soft-tissue management, immediate provisionalisation, and emergence-profile development, while integrating these elements with a contemporary digital prosthetic workflow. Particular emphasis is placed on prosthetically driven planning, careful selection of candidates for immediate implant placement, risk-based use of connective tissue grafting, and controlled modification of provisional restorations. The digital workflow combines CBCT, intraoral scanning, virtual planning, scan bodies, and CAD/CAM procedures, but its accuracy remains dependent on correct clinical execution. Transfer of the emergence profile is a critical stage because peri-implant tissues may collapse after provisional restoration removal; scanning the provisional restoration or using indirect digital transfer techniques can help preserve the clinically established contour. A reproducible sequence from diagnosis to definitive restoration can therefore support tissue stability, minimise aesthetic complications, and improve communication between clinician and laboratory. Digital techniques enhance planning and transfer but do not replace clinical judgement, accurate implant positioning, or appropriate management of hard and soft tissues.

Prospective Observational Study on Laparoscopic Sub-Total Cholecystectomy: A Safe Alternative in Difficult Gallbladder

2026-09-29T06:50:32+00:00

Background & Objectives: Standard laparoscopic cholecystectomy (LC) requires the unambiguous identification of anatomical structures within Calot's triangle to establish the Critical View of Safety (CVS). In patients presenting with severe acute or chronic inflammation, empyema, gangrene, severe adhesions, or anatomical distortions, achieving the CVS can be technically precarious, substantially elevating the risk of major bile duct injury (BDI) and vascular trauma. Laparoscopic sub-total cholecystectomy (LSTC) serves as a crucial operative bailout strategy that obviates the need for open conversion while preventing major biliary tree trauma. This study evaluated the feasibility, clinical outcomes, safety profile, and associated morbidity of LSTC in difficult gallbladder cases.

Methods: A hospital-based prospective observational study was conducted at the Department of General Surgery, Citizens Specialty Hospital, Hyderabad, India, over an 18-month period between September 2020 and March 2022. Out of a total cohort of 672 patients scheduled for laparoscopic cholecystectomy, 30 consecutive patients who underwent LSTC due to intraoperative technical difficulties were enrolled after obtaining informed consent. Detailed clinical characteristics, baseline comorbidities, surgical indications, intraoperative metrics, structural reasons for the difficult gallbladder, postoperative complications, length of hospital stay, and short-to-medium-term outcomes were systematically recorded and analysed.

Results: The overall incidence of LSTC in the studied cohort was 4.46% (30/672). The mean age of the patient cohort was 58.2 ± 12.1 years, with a slight male predilection (53.3%, n=16). Primary clinical indications for intervention were acute calculus cholecystitis (73.3%, n=22), gallbladder empyema (20.0%, n=6), and perforated/gangrenous gallbladder (6.7%, n=2). Prior ERCP with biliary stenting was documented in 16.7% (n=5) of patients. The primary intraoperative trigger for performing LSTC was a "frozen Calot's triangle" (56.7%, n=17), followed by a severely thickened, fibrotic gallbladder adherent to the liver bed (23.3%, n=7), dense visceral/omental adhesions (13.3%, n=4), and gangrenous/perforated tissue with pericholecystic abscess (6.7%, n=2). The mean operative duration was 59.5 ± 19.1 minutes. Conversion to open surgery was successfully avoided in 100% of cases (0% open conversion rate). One case of minor intraoperative bile duct injury (3.3%) occurred and was successfully managed with primary intraoperative laparoscopic repair. Postoperative complications were predominantly minor, including mild abdominal pain (16.7%, n=5) and transient pyrexia (6.7%, n=2), with no incidence of persistent postoperative bile leakage or abdominal distension. The majority of patients (83.3%, n=25) were safely discharged on postoperative day 2. Follow-up evaluation demonstrated symptom resolution in most patients, with a retained stump calculus reported in 1 patient (3.3%), who was managed conservatively, and no reoperations.

Conclusion: Laparoscopic sub-total cholecystectomy is a highly feasible, safe, and robust bailout manoeuvre. It effectively prevents iatrogenic bile duct injury, eliminates the morbidity associated with open conversion, shortens postoperative recovery time, and optimises outcomes in complex hepatobiliary pathology.

Recent Advances in the Prevention and Treatment of Peri-implant Diseases

2026-09-29T06:55:09+00:00

Dental implant maintenance is essential for preserving peri-implant tissue health and supporting the long-term success of implant therapy. This review summarises recent advances in the prevention, diagnosis, maintenance, and treatment of peri-implant diseases, with particular emphasis on peri-implant mucositis and peri-implantitis. It examines recognised patient-, implant-, prosthesis-, and maintenance-related risk factors and highlights the importance of individualised supportive peri-implant care based on each patient’s risk profile. Current approaches to clinical and radiographic monitoring are considered alongside professional biofilm-control strategies and developments in maintenance instrumentation, including implant-compatible ultrasonic devices and air-polishing systems using glycine or erythritol powders. Home-care measures, including toothbrushing, interproximal cleaning, flossing, oral irrigation, and patient education, are also addressed. For peri-implant mucositis, mechanical biofilm removal combined with improved oral hygiene remains central to management. For peri-implantitis, non-surgical treatment is generally the initial approach, while persistent or advanced lesions may require resective or reconstructive surgery. The review also discusses the European Federation of Periodontology clinical practice guideline and emerging research involving peri-implant biomarkers, microbiome assessment, and artificial intelligence-assisted radiographic analysis. Particular attention is given to prosthetic access for hygiene and avoidance of plaque-retentive restorative factors. Overall, prevention, early diagnosis, regular monitoring, effective biofilm control, and risk-based maintenance are presented as the principal components of contemporary peri-implant disease management.

Functional and Reconstructive Nasal Surgery: Insights from Post-Traumatic Rhinoplasty, Congenital Dorsal Lesions, and Septoplasty

2026-09-29T10:54:27+00:00

The external appearance of the nose and the patency of the nasal airway are governed by the same osteocartilaginous framework, so that trauma, congenital anomalies, and even purely "functional" procedures on the septum routinely have consequences on both sides of that functional–aesthetic divide. This chapter examines three clinical situations from the practice of a maxillofacial surgery department in a Tunisian military teaching hospital that illustrate this interdependence: the combined functional and aesthetic evaluation of post-traumatic rhinoplasty using surgeon- and patient-reported outcome measures; the surgical approach to a congenital dermoid cyst of the nasal dorsum through external rhinoplasty rather than the classical midline incision; and a prospective study identifying septal–upper lateral cartilage disarticulation as a risk factor for persistent nasal dorsum deviation after septoplasty. Taken together, these three original series argue for systematically incorporating an aesthetic dimension into the planning and outcome assessment of procedures traditionally considered purely reconstructive or functional, and for anticipating, rather than treating secondarily, the external consequences of internal nasal surgery.