Effect of connective tissue grafting on buccal bone changes based on cone beam computed tomography scans in the aesthetic zone of single immediate implants:A 1-year randomized controlled trial

BACKGROUND Connective tissue grafting has a beneficial effect on the peri-implant mucosa, but the effect of grafting the buccal mucosa on buccal bone thickness (BBT) has not been investigated, although BBT is proposed to be a key factor for the soft-tissue contour. The aim of this trial was to assess the outcome of a connective tissue graft (CTG) in the aesthetic zone of single immediate implants on the change of BBT according to cone beam computed tomography (CBCT) scan analysis. METHODS In a 1-year randomized controlled trial, 60 patients received an immediately placed implant and provisionalization, either combined with CTG (test group) or without CTG (control group). CBCTs were taken pre-operatively (T$_{pre}$ ) and 1 year after definitive restoration (T$_{2}$ ). Any change in BBT was assessed at different implant levels. Additionally, the change in mid-buccal mucosal level (MBML) and approximal marginal bone level were assessed. RESULTS Fifty-five patients were available for statistical analysis (test group, n = 28; control group, n = 27). At T$_{2}$ , the average change in BBT was significantly larger in the test group (-0.84 ± 0.61 mm) than in the control group (-0.46 ± 0.54 mm, P = 0.02). A MBML gain of 0.07 ± 0.85 mm in the test and a MBML loss -0.52 ± 1.16 mm in the control group was observed at T$_{2}$ . Average loss of marginal bone was 0.05 ± 0.33 mm and 0.01 ± 0.38 mm, respectively. CONCLUSIONS The application of CTG in the aesthetic zone of immediately placed and provisionalized implants is accompanied with more loss of BBT, but at the same time better maintains the mid-buccal mucosal level

Testing the potential of a virtual reality neurorehabilitation system during performance of observation, imagery and imitation of motor actions recorded by wireless functional near-infrared spectroscopy (fNIRS)

Background Several neurorehabilitation strategies have been introduced over the last decade based on the so-called simulation hypothesis. This hypothesis states that a neural network located in primary and secondary motor areas is activated not only during overt motor execution, but also during observation or imagery of the same motor action. Based on this hypothesis, we investigated the combination of a virtual reality (VR) based neurorehabilitation system together with a wireless functional near infrared spectroscopy (fNIRS) instrument. This combination is particularly appealing from a rehabilitation perspective as it may allow minimally constrained monitoring during neurorehabilitative training. Methods fNIRS was applied over F3 of healthy subjects during task performance in a virtual reality (VR) environment: 1) 'unilateral' group (N = 15), contralateral recording during observation, motor imagery, observation & motor imagery, and imitation of a grasping task performed by a virtual limb (first-person perspective view) using the right hand; 2) 'bilateral' group (N = 8), bilateral recording during observation and imitation of the same task using the right and left hand alternately. Results In the unilateral group, significant within-condition oxy-hemoglobin concentration Δ[O2Hb] changes (mean ± SD μmol/l) were found for motor imagery (0.0868 ± 0.5201 μmol/l) and imitation (0.1715 ± 0.4567 μmol/l). In addition, the bilateral group showed a significant within-condition Δ[O2Hb] change for observation (0.0924 ± 0.3369 μmol/l) as well as between-conditions with lower Δ[O2Hb] amplitudes during observation compared to imitation, especially in the ipsilateral hemisphere (p < 0.001). Further, in the bilateral group, imitation using the non-dominant (left) hand resulted in larger Δ[O2Hb] changes in both the ipsi- and contralateral hemispheres as compared to using the dominant (right) hand. Conclusions This study shows that our combined VR-fNIRS based neurorehabilitation system can activate the action-observation system as described by the simulation hypothesis during performance of observation, motor imagery and imitation of hand actions elicited by a VR environment. Further, in accordance with previous studies, the findings of this study revealed that both inter-subject variability and handedness need to be taken into account when recording in untrained subjects. These findings are of relevance for demonstrating the potential of the VR-fNIRS instrument in neurofeedback applications

Development of a Non-invasive Device for Swallow Screening in Patients at Risk of Oropharyngeal Dysphagia : Results from a Prospective Exploratory Study

Oropharyngeal dysphagia is prevalent in several at-risk populations, including post-stroke patients, patients in intensive care and the elderly. Dysphagia contributes to longer hospital stays and poor outcomes, including pneumonia. Early identification of dysphagia is recommended as part of the evaluation of at-risk patients, but available bedside screening tools perform inconsistently. In this study, we developed algorithms to detect swallowing impairment using a novel accelerometer-based dysphagia detection system (DDS). A sample of 344 individuals was enrolled across seven sites in the United States. Dual-axis accelerometry signals were collected prospectively with simultaneous videofluoroscopy (VFSS) during swallows of liquid barium stimuli in thin, mildly, moderately and extremely thick consistencies. Signal processing classifiers were trained using linear discriminant analysis and 10,000 random training-test data splits. The primary objective was to develop an algorithm to detect impaired swallowing safety with thin liquids with an area under receiver operating characteristic curve (AUC) > 80% compared to the VFSS reference standard. Impaired swallowing safety was identified in 7.2% of the thin liquid boluses collected. At least one unsafe thin liquid bolus was found in 19.7% of participants, but participants did not exhibit impaired safety consistently. The DDS classifier algorithms identified participants with impaired thin liquid swallowing safety with a mean AUC of 81.5%, (sensitivity 90.4%, specificity 60.0%). Thicker consistencies were effective for reducing the frequency of penetration-aspiration. This DDS reached targeted performance goals in detecting impaired swallowing safety with thin liquids. Simultaneous measures by DDS and VFSS, as performed here, will be used for future validation studies.Peer reviewe

How to detect and reduce movement artifacts in near-infrared imaging using moving standard deviation and spline interpolation

Near-infrared imaging (NIRI) is a neuroimaging technique which enables us to non-invasively measure hemodynamic changes in the human brain. Since the technique is very sensitive, the movement of a subject can cause movement artifacts (MAs), which affect the signal quality and results to a high degree. No general method is yet available to reduce these MAs effectively. The aim was to develop a new MA reduction method. A method based on moving standard deviation and spline interpolationwas developed. It enables the semi-automatic detection and reduction of MAs in the data. It was validated using simulated and real NIRI signals. The results show that a significant reduction ofMAs and an increase in signal quality are achieved. The effectiveness and usability of themethod is demonstrated by the improved detection of evoked hemodynamic responses. The present method can not only be used in the postprocessing of NIRI signals but also for other kinds of data containing artifacts, for example ECG or EEG signals

In vivo functional near-infrared spectroscopy measures mood-modulated cerebral responses to a positive emotional stimulus in sheep

The affective state of an animal, which is thought to reflect its welfare, consists of both short-term emotional reactions and long-term general mood. Because this state is generated and processed by the brain, we used non-invasive measurement of such brain activity as a novel indicator variable and investigated the interplay of mood and short-term emotional reactions in animals. We developed a wireless sensor for functional near-infrared spectroscopy (fNIRS), which assesses cortical perfusion changes, and consequently neuronal activity. Mood differences were induced by barren and enriched housing in a total of nine sheep and we observed their brain reaction in response to the positive situation of being groomed. We detected a decrease in cerebral oxyhaemoglobin concentration ([O(2)Hb]) which persisted during grooming. The localisation of the decrease in the brain did not depend on the site where the stimulus was applied. Also, the intensity of the response did not depend on the intensity of the grooming stimulus and a sham stimulus did not evoke an [O(2)Hb] response as seen with a grooming stimulus. Thus, we conclude that the observed haemodynamic brain response was unlikely to reflect pure somato-sensory information. We then found that the amplitude of the [O(2)Hb] response was larger if sheep were in a supposedly more negative mood. This contradicts the common assumption that negative mood generally taints reactions to emotional stimuli. Our results also demonstrate the potential of fNIRS for assessing affective states in freely moving animals