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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Rehabilitation with implant-retained removable dentures and its effects on perioral aesthetics: a prospective cohort study</title><author><name sortKey="Lupi, Saturnino Marco" sort="Lupi, Saturnino Marco" uniqKey="Lupi S" first="Saturnino Marco" last="Lupi">Saturnino Marco Lupi</name><affiliation><nlm:aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</nlm:aff></affiliation></author><author><name sortKey="Cislaghi, Matteo" sort="Cislaghi, Matteo" uniqKey="Cislaghi M" first="Matteo" last="Cislaghi">Matteo Cislaghi</name><affiliation><nlm:aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</nlm:aff></affiliation></author><author><name sortKey="Rizzo, Silvana" sort="Rizzo, Silvana" uniqKey="Rizzo S" first="Silvana" last="Rizzo">Silvana Rizzo</name><affiliation><nlm:aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</nlm:aff></affiliation></author><author><name sortKey="Rodriguez Y Baena, Ruggero" sort="Rodriguez Y Baena, Ruggero" uniqKey="Rodriguez Y Baena R" first="Ruggero" last="Rodriguez Y Baena">Ruggero Rodriguez Y Baena</name><affiliation><nlm:aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27757052</idno><idno type="pmc">5053264</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053264</idno><idno type="RBID">PMC:5053264</idno><idno type="doi">10.2147/CCIDE.S115384</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002A96</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002A96</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Rehabilitation with implant-retained removable dentures and its effects on perioral aesthetics: a prospective cohort study</title><author><name sortKey="Lupi, Saturnino Marco" sort="Lupi, Saturnino Marco" uniqKey="Lupi S" first="Saturnino Marco" last="Lupi">Saturnino Marco Lupi</name><affiliation><nlm:aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</nlm:aff></affiliation></author><author><name sortKey="Cislaghi, Matteo" sort="Cislaghi, Matteo" uniqKey="Cislaghi M" first="Matteo" last="Cislaghi">Matteo Cislaghi</name><affiliation><nlm:aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</nlm:aff></affiliation></author><author><name sortKey="Rizzo, Silvana" sort="Rizzo, Silvana" uniqKey="Rizzo S" first="Silvana" last="Rizzo">Silvana Rizzo</name><affiliation><nlm:aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</nlm:aff></affiliation></author><author><name sortKey="Rodriguez Y Baena, Ruggero" sort="Rodriguez Y Baena, Ruggero" uniqKey="Rodriguez Y Baena R" first="Ruggero" last="Rodriguez Y Baena">Ruggero Rodriguez Y Baena</name><affiliation><nlm:aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</nlm:aff></affiliation></author></analytic><series><title level="j">Clinical, Cosmetic and Investigational Dentistry</title><idno type="eISSN">1179-1357</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The onset of perioral wrinkles often prompts patients to request treatment. This aesthetic deterioration linked to aging may be associated with tooth and alveolar bone loss in fully edentulous patients.</p></sec><sec><title>Purpose</title><p>To evaluate perioral wrinkles before and after maxillary and mandibular rehabilitation with implant-retained dentures in fully edentulous patients.</p></sec><sec><title>Methods</title><p>In this prospective cohort, single-center, blinded study, patients requiring maxillary and mandibular rehabilitation with implant-retained dentures were enrolled. The patients were photographed in the same position before and after oral rehabilitation. Wrinkles were evaluated in the photographs by blinded observers using validated rating scales. The following parameters were analyzed: upper and lower radial lip lines, marionette lines, upper and lower lip fullness, nasolabial folds, corner of the mouth lines, and the labiomental crease. Statistical analysis was performed using the Wilcoxon signed ranks test for paired data, with <italic>P</italic><0.05 considered significant.</p></sec><sec><title>Results</title><p>Upper and lower implant-retained dentures were applied in 31 patients (15 males; mean ± standard deviation age 62.13±8.69 years, range 47–77 years). The oral rehabilitation procedures significantly improved (<italic>P</italic><0.05) the upper and lower radial lip lines, marionette lines, upper and lower lip fullness, the nasolabial folds, and the corner of the mouth lines.</p></sec><sec><title>Conclusion</title><p>Maxillary and mandibular rehabilitation with implant-retained dentures in fully edentulous patients improves perioral aesthetics. Patients requiring oral rehabilitation and desiring perioral aesthetic improvement could benefit from treatment with this type of prosthesis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Moran, A" uniqKey="Moran A">A Moran</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moran, A" uniqKey="Moran A">A Moran</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mazzola, P" uniqKey="Mazzola P">P Mazzola</name></author><author><name sortKey="Rimoldi, Sm" uniqKey="Rimoldi S">SM Rimoldi</name></author><author><name sortKey="Rossi, P" uniqKey="Rossi P">P Rossi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moran, A" uniqKey="Moran A">A Moran</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kahn, Dm" uniqKey="Kahn D">DM Kahn</name></author><author><name sortKey="Shaw, Rb" uniqKey="Shaw R">RB 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Cosmet Investig Dent</journal-id><journal-id journal-id-type="iso-abbrev">Clin Cosmet Investig Dent</journal-id><journal-id journal-id-type="publisher-id">Clinical, Cosmetic and Investigational Dentistry</journal-id><journal-title-group><journal-title>Clinical, Cosmetic and Investigational Dentistry</journal-title></journal-title-group><issn pub-type="epub">1179-1357</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27757052</article-id><article-id pub-id-type="pmc">5053264</article-id><article-id pub-id-type="doi">10.2147/CCIDE.S115384</article-id><article-id pub-id-type="publisher-id">ccide-8-105</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Rehabilitation with implant-retained removable dentures and its effects on perioral aesthetics: a prospective cohort study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lupi</surname><given-names>Saturnino Marco</given-names></name><xref ref-type="aff" rid="af1-ccide-8-105"></xref></contrib><contrib contrib-type="author"><name><surname>Cislaghi</surname><given-names>Matteo</given-names></name><xref ref-type="aff" rid="af1-ccide-8-105"></xref></contrib><contrib contrib-type="author"><name><surname>Rizzo</surname><given-names>Silvana</given-names></name><xref ref-type="aff" rid="af1-ccide-8-105"></xref></contrib><contrib contrib-type="author"><name><surname>Rodriguez y Baena</surname><given-names>Ruggero</given-names></name><xref ref-type="aff" rid="af1-ccide-8-105"></xref><xref ref-type="corresp" rid="c1-ccide-8-105"></xref></contrib></contrib-group><aff id="af1-ccide-8-105">Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy</aff><author-notes><corresp id="c1-ccide-8-105">Correspondence: Ruggero Rodriguez y Baena, Department of Clinical Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Piazzale Golgi 2, 27100, Pavia, Italy, Tel +39 03 8251 6255, Email <email>ruggero.rodriguez@unipv.it</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>30</day><month>9</month><year>2016</year></pub-date><volume>8</volume><fpage>105</fpage><lpage>110</lpage><permissions><copyright-statement>© 2016 Lupi et al. This work is published and licensed by Dove Medical Press Limited</copyright-statement><copyright-year>2016</copyright-year><license><license-p>The full terms of this license are available at <ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link> and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Background</title><p>The onset of perioral wrinkles often prompts patients to request treatment. This aesthetic deterioration linked to aging may be associated with tooth and alveolar bone loss in fully edentulous patients.</p></sec><sec><title>Purpose</title><p>To evaluate perioral wrinkles before and after maxillary and mandibular rehabilitation with implant-retained dentures in fully edentulous patients.</p></sec><sec><title>Methods</title><p>In this prospective cohort, single-center, blinded study, patients requiring maxillary and mandibular rehabilitation with implant-retained dentures were enrolled. The patients were photographed in the same position before and after oral rehabilitation. Wrinkles were evaluated in the photographs by blinded observers using validated rating scales. The following parameters were analyzed: upper and lower radial lip lines, marionette lines, upper and lower lip fullness, nasolabial folds, corner of the mouth lines, and the labiomental crease. Statistical analysis was performed using the Wilcoxon signed ranks test for paired data, with <italic>P</italic><0.05 considered significant.</p></sec><sec><title>Results</title><p>Upper and lower implant-retained dentures were applied in 31 patients (15 males; mean ± standard deviation age 62.13±8.69 years, range 47–77 years). The oral rehabilitation procedures significantly improved (<italic>P</italic><0.05) the upper and lower radial lip lines, marionette lines, upper and lower lip fullness, the nasolabial folds, and the corner of the mouth lines.</p></sec><sec><title>Conclusion</title><p>Maxillary and mandibular rehabilitation with implant-retained dentures in fully edentulous patients improves perioral aesthetics. Patients requiring oral rehabilitation and desiring perioral aesthetic improvement could benefit from treatment with this type of prosthesis.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>aesthetic medicine</kwd><kwd>perioral wrinkles</kwd><kwd>implant-retained denture</kwd><kwd>overdenture</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>Introduction</title><p>Increased life expectancy is one of the greatest global public health challenges in developed countries. In Italy, the proportion of the population aged ≥65 exceeds 21%. In Western Europe, the proportion exceeds 16%, and in the US, Australia, and Oceania, it is 13%.<xref rid="b1-ccide-8-105" ref-type="bibr">1</xref>–<xref rid="b4-ccide-8-105" ref-type="bibr">4</xref></p><p>In parallel with changes in the age pyramid, age-related challenges arise, and interest in combating visible signs of skin aging increases. Aging of the face through a dynamic process characterized by the degeneration of both the soft tissues and the bone structure leads to an altered relationship between these components.<xref rid="b5-ccide-8-105" ref-type="bibr">5</xref> Skin aging is a gradual, natural process classified as intrinsic or extrinsic, and involves genetic, hormonal, and environmental mechanisms. Intrinsic aging, also called chronologic aging, may be influenced by exogenous factors such as smoking, alcohol consumption, and exposure to ultraviolet radiation, which are considered the main factors of extrinsic aging.<xref rid="b6-ccide-8-105" ref-type="bibr">6</xref></p><p>Wrinkle formation is a consequence of these processes.<xref rid="b7-ccide-8-105" ref-type="bibr">7</xref>–<xref rid="b12-ccide-8-105" ref-type="bibr">12</xref> Requests for cosmetic procedures with permanent or temporary filler to reduce the number and depth of wrinkles and to provide an appropriate volume to the lips<xref rid="b13-ccide-8-105" ref-type="bibr">13</xref>,<xref rid="b14-ccide-8-105" ref-type="bibr">14</xref> are increasing with variable results.<xref rid="b15-ccide-8-105" ref-type="bibr">15</xref> Reports of more or less serious complications are also increasing in number, however, even in the case of safe molecules such as hyaluronic acid.<xref rid="b16-ccide-8-105" ref-type="bibr">16</xref>–<xref rid="b18-ccide-8-105" ref-type="bibr">18</xref></p><p>Degenerative processes involving the teeth (tooth loss, poorly executed prosthetic rehabilitation, neglect of oral hygiene, etc) also contribute to aging the appearance of a face.<xref rid="b19-ccide-8-105" ref-type="bibr">19</xref> In fact, a face devoid of a smile with complete dentures appears more aged than one with a complete set of teeth, both subjectively and objectively with regard to the facial structures.<xref rid="b20-ccide-8-105" ref-type="bibr">20</xref> In addition, the condition of edentulism is associated with a well-known progressive centripetal resorption of the alveolar process of the maxillary bones,<xref rid="b21-ccide-8-105" ref-type="bibr">21</xref> with reduced support and stretching of the perioral tissues exerted by the teeth and underlying bone, and consequent worsening of wrinkles and lip volume.</p></sec><sec><title>Objective</title><p>To evaluate the effect of rehabilitation through removable implant-retained dentures on perioral wrinkles.</p></sec><sec sec-type="materials|methods"><title>Materials and methods</title><p>This prospective cohort, single-center trial, conducted in accordance with Good Clinical Practices in Human Beings, involved 31 subjects who underwent rehabilitation of the upper and lower jaws with implant-retained dentures.<xref rid="b22-ccide-8-105" ref-type="bibr">22</xref> This study was approved by the Ethic Committee of Pavia State, Fondazione IRCCS Policlinico “San Matteo”, Pavia, Italy (document 09/21/2016, n. 20020001513). The subjects were enrolled consecutively from among those who accessed the Oral Surgery and Implantology Service of the Department of Clinical Surgical, Pediatric, and Diagnostic Sciences at the University of Pavia.</p><p>The surgical<xref rid="b23-ccide-8-105" ref-type="bibr">23</xref> and prosthetic procedures used for all patients were those typically used by our team and included, briefly: medical history and clinical examination, obtaining consent, radiographic and hematologic evaluation, antibiotic prophylaxis, implant surgery, submerged healing for 6–8 weeks, second surgery, dental impressions, prosthetic proof-of-concept, and final restoration. The skin at the perioral tissue level was intact in all subjects, and none of the patients were taking topical or systemic medications or substances that could interfere with the evaluation of perioral wrinkles. Patients were informed about the purpose of the research and the use of any obtained photographs in which patients would not be recognizable. All patients freely provided their written consent to be included in this study and to the use of facial images for the purposes of the study. Perioral wrinkles and lip volume were evaluated by comparing photos at the beginning and end of the study for each case examined.</p><p>The scale proposed by Lamperle et al<xref rid="b24-ccide-8-105" ref-type="bibr">24</xref> was used for evaluation of perioral wrinkles, in which a score from 0 to 5 is assigned according to the increasing severity of the wrinkles. Lip volume was graded according to the lip fullness scale,<xref rid="b25-ccide-8-105" ref-type="bibr">25</xref> in which a score from 0 (very thin) to 4 (full) is assigned. The patients were photographed before and after the rehabilitation program to compare the aesthetics of the perioral soft tissues with and without the final prosthesis in place. In this study, the following parameters were analyzed: upper and lower radial lip lines, marionette lines, upper and lower lip fullness, nasolabial folds, corner of the mouth lines, and labiomental crease.</p><p>Personal data and medical history were also collected, with an emphasis on intrinsic and extrinsic factors that promote skin aging:<xref rid="b26-ccide-8-105" ref-type="bibr">26</xref> prolonged periods of sun exposure, smoking, diet, and hormone replacement therapy.</p><p>The photographs were obtained using a professional digital SLR camera Fujifilm<sup>®</sup> S5 Pro (FUJIFILM Corporation, Tokyo, Japan), with a Nikkor<sup>®</sup> 35 mm (Nikon Corporation, Tokyo, Japan) fixed focal length lens. The images were recorded in high definition and saved in RAW format to allow for the optimum setting of image parameters in post-processing.</p><p>Two full-face photographs for each patient were obtained: one with and one without the dentures. The images were obtained of the frontal face position, with the mouth of the patient in rest position. To avoid bias due to the shooting point position, the camera was mounted on a tripod and positioned 1 m from the patient’s face, at the height of the mouth. Photographs of the smile were not obtained to avoid the possibility of biasing the observers. Once taken, the pictures were cut to place only the perioral area in the foreground (<xref ref-type="fig" rid="f1-ccide-8-105">Figure 1</xref>). The images were identified by a label code and randomly inserted into a PowerPoint<sup>®</sup> (Microsoft Corporation, Redmond, WA, USA) presentation with a black background. After proper training, two observers independently and blindly evaluated the clinical images using an iMac<sup>®</sup> computer (Apple, Cupertino, CA, USA) with a 27″ monitor in a dark room. Disagreements in the scoring between the observers were resolved through discussion. Data were collected using a diagram drawn by the authors (<xref ref-type="fig" rid="f2-ccide-8-105">Figure 2</xref>) and then input into an Excel<sup>®</sup> (Microsoft Corporation, Redmond, WA, USA) spreadsheet.</p></sec><sec><title>Statistical analysis</title><p>The collected data were statistically analyzed using R Core Team (2013); R: A language and environment for statistical computing (R Foundation for Statistical Computing, Vienna, Austria; <ext-link ext-link-type="uri" xlink:href="http://www.R-project.org/">http://www.R-project.org/</ext-link>).</p><p>Because the results were scored subjectively, the observations were treated as ordinal qualitative variables using the Wilcoxon test of ranks for paired data to determine the statistical significance.</p></sec><sec sec-type="results"><title>Results</title><p>In the period between January 2012 and June 2016, 31 patients (15 males), between 47 and 77 years of age (mean ± standard deviation, 62.13±8.69 years), were enrolled at the Service of Oral Surgery and Implant Dentistry of the Department of Clinical Surgical, Pediatric, and Diagnostic Sciences at the University of Pavia. All patients completed the study, and 31 mandibular and maxillary implant-prosthetic rehabilitations were completed. All implant-retained rehabilitations were successfully completed.</p><p>Rehabilitation with overdentures produced statistically significant improvement in the upper and lower radial lip lines, marionette lines, upper and lower lip fullness, nasolabial folds, and corner of the mouth lines (<xref ref-type="table" rid="t1-ccide-8-105">Table 1</xref>; <xref ref-type="fig" rid="f3-ccide-8-105">Figures 3</xref><xref ref-type="fig" rid="f4-ccide-8-105"></xref><xref ref-type="fig" rid="f5-ccide-8-105"></xref><xref ref-type="fig" rid="f6-ccide-8-105"></xref><xref ref-type="fig" rid="f7-ccide-8-105"></xref><xref ref-type="fig" rid="f8-ccide-8-105"></xref>–<xref ref-type="fig" rid="f9-ccide-8-105">9</xref>).</p></sec><sec sec-type="discussion"><title>Discussion</title><p>This study evaluated the effect of implant-retained denture rehabilitation<xref rid="b22-ccide-8-105" ref-type="bibr">22</xref> on perioral wrinkles in edentulous patients. The rating scale used is simple to read and facilitates comparison of the photographs of the observed cases. Moreover, the high definition photographs obtained with a professional camera allowed for better visualization of wrinkles because the images could be magnified to highlight the details of the observed elements.</p><p>Statistical analysis revealed that implant-retained denture rehabilitation significantly improved the aesthetics of the perioral soft tissues with regard to almost all wrinkle types evaluated. Statistically significant improvements were observed for the upper and lower radial lip lines, marionette lines, upper and lower lip fullness, nasolabial folds, and the corner of the mouth lines. Only the labiomental crease showed no significant improvement.</p><p>Numerous studies have evaluated oral and perioral aesthetics, focusing on the form,<xref rid="b27-ccide-8-105" ref-type="bibr">27</xref>,<xref rid="b28-ccide-8-105" ref-type="bibr">28</xref> structure,<xref rid="b29-ccide-8-105" ref-type="bibr">29</xref> color,<xref rid="b30-ccide-8-105" ref-type="bibr">30</xref> and position<xref rid="b31-ccide-8-105" ref-type="bibr">31</xref>,<xref rid="b32-ccide-8-105" ref-type="bibr">32</xref> of the teeth, and the influence of prosthetic rehabilitation on the aesthetics of the smile.<xref rid="b33-ccide-8-105" ref-type="bibr">33</xref> This is the first study to evaluate the influence of implant-retained rehabilitation on the appearance of perioral wrinkles and lip volume.</p><p>With aging, the whole organism undergoes structural changes and at the same time the skin undergoes significant alterations due to intrinsic or extrinsic factors. These processes result in the loss of elasticity and firmness of the tissue, leading to the formation of wrinkles. In addition to this damage, loss of the teeth and consequent resorption of alveolar bone tissues considerably worsens the overall appearance of the face, with an accentuation of the typical features of aging: wrinkles, skin laxity, loss of tone, a decreased intermaxillary vertical dimension, mandibular prognathism, and lowering of the nasal tip.<xref rid="b19-ccide-8-105" ref-type="bibr">19</xref>,<xref rid="b20-ccide-8-105" ref-type="bibr">20</xref></p><p>Implant-retained denture rehabilitation allows – in addition to the restoration of masticatory function and the intraoral aesthetic – for restoration of the volume of the alveolar process and thus leads to optimal support of the perioral soft tissues. Therefore, proper prosthetic rehabilitation may help to improve the aesthetics of the perioral skin, reducing the amount and size of wrinkles involved in face aging and providing greater support to the lips. Moreover, besides the advantages of being less expensive than a full-arch implant-supported fixed prosthesis and providing greater stability compared to the traditional removable denture, overdentures are indicated even in cases in which the patient desires aesthetic improvement of the perioral soft-tissues. In addition, rehabilitation with overdentures allows for easier maintenance of hygiene around implants compared to a full-arch implant-supported fixed prosthesis.<xref rid="b34-ccide-8-105" ref-type="bibr">34</xref> While traditional removable dentures may also somewhat restore lost volume and provide optimum support to the soft tissues, these benefits are limited by the need to optimize stability. In the case of overdentures, which have extremely superior stability, modeling of the prosthetic flanges and positioning of the teeth can be oriented not only to the recovery of optimal masticatory function, but also to the appropriate restoration of lost volume and support of soft tissues. The results of this study highlight the importance of a comprehensive assessment that includes the dental situation of patients in need of an aesthetic medical intervention to improve the appearance of perioral tissues.</p><p>Further research should be conducted to assess whether there are significant differences between the perioral aesthetics of full-arch implant-supported fixed prostheses and implant-retained denture rehabilitation.</p></sec><sec><title>Conclusion</title><p>A global treatment plan that aims to restore facial aesthetics in fully edentulous patients should consider implant-retained denture rehabilitation to provide adequate deep support of the perioral soft-tissue. In these patients, the use of aesthetic medicine techniques such as fillers may benefit from dental rehabilitation. In fully edentulous patients, overdentures can improve the aesthetics of perioral wrinkles.</p></sec></body><back><fn-group><fn fn-type="COI-statement"><p><bold>Disclosure</bold></p><p>The authors report no conflicts of interest in this work.</p></fn></fn-group><ref-list><title>References</title><ref id="b1-ccide-8-105"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moran</surname><given-names>A</given-names></name></person-group><article-title>North America</article-title><source>Glob Heart</source><year>2014</year><volume>9</volume><issue>1</issue><fpage>29</fpage><lpage>34</lpage><pub-id pub-id-type="pmid">25432109</pub-id></element-citation></ref><ref id="b2-ccide-8-105"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moran</surname><given-names>A</given-names></name></person-group><article-title>Australasia</article-title><source>Glob 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person-group-type="author"><name><surname>Lupi</surname><given-names>SM</given-names></name><name><surname>Granati</surname><given-names>M</given-names></name><name><surname>Butera</surname><given-names>A</given-names></name><name><surname>Collesano</surname><given-names>V</given-names></name><name><surname>Rodriguez</surname><given-names>Y</given-names></name><name><surname>Baena</surname><given-names>R</given-names></name></person-group><article-title>Air-abrasive debridement with glycine powder versus manual debridement and chlorhexidine administration for the maintenance of peri-implant health status: a six-month randomized clinical trial</article-title><source>Int J Dent Hyg</source><comment>Epub</comment><year>2016</year><month>2</month><day>4</day></element-citation></ref></ref-list></back><floats-group><fig id="f1-ccide-8-105" position="float"><label>Figure 1</label><caption><p>Female patient (59 years of age) before (<bold>A</bold>) and after (<bold>B</bold>) rehabilitation of the maxilla and mandible with the overdenture.</p></caption><graphic xlink:href="ccide-8-105Fig1"></graphic></fig><fig id="f2-ccide-8-105" position="float"><label>Figure 2</label><caption><p>Diagram used for evaluation of the photographs.</p></caption><graphic xlink:href="ccide-8-105Fig2"></graphic></fig><fig id="f3-ccide-8-105" position="float"><label>Figure 3</label><caption><p>Graph of the distribution of the upper radial lip lines, showing a decrease in the severity of wrinkles after treatment.</p></caption><graphic xlink:href="ccide-8-105Fig3"></graphic></fig><fig id="f4-ccide-8-105" position="float"><label>Figure 4</label><caption><p>Graph of the distribution of the lower radial lip lines, showing a decrease in the severity of wrinkles after treatment.</p></caption><graphic xlink:href="ccide-8-105Fig4"></graphic></fig><fig id="f5-ccide-8-105" position="float"><label>Figure 5</label><caption><p>Graph of the distribution of the nasolabial folds, showing a decrease in the severity of wrinkles after treatment.</p></caption><graphic xlink:href="ccide-8-105Fig5"></graphic></fig><fig id="f6-ccide-8-105" position="float"><label>Figure 6</label><caption><p>Graph of the distribution of the marionette lines, showing a decrease in the severity of wrinkles after treatment.</p></caption><graphic xlink:href="ccide-8-105Fig6"></graphic></fig><fig id="f7-ccide-8-105" position="float"><label>Figure 7</label><caption><p>Graph of the distribution of the corner of the mouth lines, showing a decrease in the severity of wrinkles after treatment.</p></caption><graphic xlink:href="ccide-8-105Fig7"></graphic></fig><fig id="f8-ccide-8-105" position="float"><label>Figure 8</label><caption><p>Graph of the distribution of the upper lip fullness, showing improvement of the lip profile after treatment.</p></caption><graphic xlink:href="ccide-8-105Fig8"></graphic></fig><fig id="f9-ccide-8-105" position="float"><label>Figure 9</label><caption><p>Graph of the distribution of the lower lip fullness, showing improvement of the lip profile after treatment.</p></caption><graphic xlink:href="ccide-8-105Fig9"></graphic></fig><table-wrap id="t1-ccide-8-105" position="float"><label>Table 1</label><caption><p>Statistical findings of the effects of overdenture treatment on wrinkles and fullness of the lips</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Perioral sign</th><th valign="top" align="left" rowspan="1" colspan="1"><italic>P</italic>-value</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Upper radial lip lines</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lower radial lip lines</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Marionette lines</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Upper lip fullness</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lower lip fullness</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Nasolabial folds</td><td valign="top" align="left" rowspan="1" colspan="1"><0.01</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Corner of the mouth lines</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Labiomental crease</td><td valign="top" align="left" rowspan="1" colspan="1">Not significant</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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