Quintessence International, Pre-Print

Objectives: To assess the prevalence of peri-implantitis and identify risk and protective indicators of peri-implantitis in a population that underwent implant therapy in a university dental clinic. Methods and Materials: Randomly selected patients from a postgraduate university dental clinic were invited to participate. Clinical and radiographic examinations were recorded. Peri-implantitis was defined as the presence of bleeding and/or suppuration on probing, probing depths of ≥6mm, and bone loss ≥3mm. Patient-, implant-, and bone- related factors were recorded and analyzed using a multivariate logistic regression analysis. Results: A total of 355 dental implants placed in 108 patients and exhibited at least 1 year loading time were included. The prevalence of peri-implantitis was 21.3% at patient-level, while 10.7% at implant-level. Simultaneous guided bone regeneration (OR: 2.76, 95% CI: 1.07-7.12, p=0.035), recurrent periodontitis (OR: 3.11, 95% CI: 1.02-9.45, p=0.045) and significant medical history (OR: 2.86, 95% CI: 1.08-7.59, p=0.034) were identified as risk indicators for peri-implantitis. The mean peri-implant bone loss was estimated to be 2.18  1.57 for the total number of implants, whereas implants diagnosed with peri-implantitis demonstrated 4.42  1.12 mm in a time period between 12 to 177 months. Conclusion: Within the limitations of the study, the prevalence of peri-implantitis in a cohort received dental implant therapy at a university dental clinic was 10.7% at implant level and 21.3% at patient level. Patient-reported systemic comorbidities and recurrent periodontitis as well as implants placed in ridge augmented sites were associated with greater risk of peri-implantitis. Schlagwörter: cross-sectional studies, dental implants, peri-implantitis, periodontal diseases, risk factors

Oral epitheliolysis or mucosal shedding is an infrequently described phenomenon characterized by epithelial desquamation, revealing mucosa of normal color & texture underneath. The condition has a predilection for middle-aged females and primarily affects non-keratinized oral tissues. Although some cases are idiopathic, certain oral hygiene products have been implicated as the culprit and resolution of the condition documented with their discontinuation. Severity of desquamation & symptoms vary with frequency and duration of contact with the irritant and its concentration. We report a dramatic case of shedding oral mucosa in an elderly female, which appeared to be caused by habitual chewing of an aspirin-containing OTC analgesic. Schlagwörter: aspirin burn, chemical injury, mucosal peeling, oral desquamation, oral shedding

Objectives: Clozapine, an atypical antipsychotic used to treat people with schizophrenia, has been proposed as a possible treatment for salivary gland hypofunction. This scoping review investigated the available literature on clozapine’s impact on salivary flow, in order to determine whether it could be used by dentists in low doses as a treatment for dry mouth. Data Sources: An electronic search was completed using Ovid MEDLINE (1996-Nov 2021). Key MESH search terms included “Clozapine”, “Clozaril”, “salivation”, “salivary flow rate”, “sialorrhea”, “hypersalivation”, and “drooling”. Two reviewers independently reviewed eligible articles and extracted the data based on the inclusion and exclusion criteria. Results: The initial search identified 129 studies, six of which were included in this review. Four of them (one cross-sectional and three interventional) described salivary flow rates in schizophrenic patients taking clozapine, while one of those and two others focused on the mechanism of clozapine-induced sialorrhea, with one study covering both. There were mixed findings, with one study observing a moderate association between clozapine dose and salivary flow, and the others reporting no differences. Findings on the putative mechanisms for clozapine-induced sialorrhea (CIS) were inconclusive. Conclusion: There is insufficient high-quality information to justify using low-dose clozapine to increase salivary flow in dental patients with salivary gland hypofunction. Well-designed interventional studies and randomised control trials are required. Schlagwörter: clozapine, Oral medicine, salivation, scoping review, Xerostomia

Covid-19 is a serious global infectious disease impairing the quality of life of people across the world. SARS-CoV-2 may reside in nasopharyngeal and salivary secretions of Covid-infected patients and spreads mainly through respiratory droplets and fomites. It has presented a challenge to dentistry, as many dental procedures generate aerosols which could lead to cross-contamination. It also presents many post-infection complications which may continue to debilitate patients, even after successful management of the virus. One such complication may be osteomyelitis of the jaw. Here, we present two cases of post-Covid osteomyelitis of the jaw that were determined to be unrelated to Mucormycosis in otherwise healthy individuals with no prior dental complaints. In this report, we attempt to shed light on clinical signs in post-covid cases that may point to a diagnosis of the condition. We have also shared our thoughts on the pathophysiology which may help in formulating guidelines to prevent and manage post-covid osteomyelitis of the jaw. Schlagwörter: Bacterial Infections and Mycoses, Case-report/series, incidental findings, jaw destruction, mandible, post covid

Objective: This pilot, prospective interventional study aimed to analyze the influence of supracrestal tissue height (STH) when using the one abutment-one time concept (OAOT) at the time of implant placement, on peri-implant hard and soft tissue remodeling in esthetic areas. The definitive crown was placed seven days later. Method and materials: Facial mucosal margin position (FMMP), mesial and distal papilla levels (MPL and DPL, respectively), and mesial and distal marginal bone loss (M-MBL and D-MBL, respectively) were assessed after seven days (placement of the definitive crown), and 1, 2, 3, 6 and 12 months after implant placement. Patients were classified according to the STH in thin (STH < 3 mm) and thick (STH ≥ 3 mm). Results: Fifteen patients fulfilled the eligibility criteria and were included in the study. Eight presented a thick STH and seven a thin STH. After 12 months, the implant success rate was 100%. The mean recession at FMMP was -0.47 ± 0.57 mm and -0.19 ± 0.41 mm in thin and thick groups, respectively (p = 0.29). The mean MPL recession was -0.19 ± 0.06 mm in the thin group and -0.01 ± 0.07 mm in the thick group (p < 0.01), and the mean DPL recession was -0.15 ± 0.09 mm in the thin group and 0.00 ± 0.15 mm in the thick group (p < 0.05). The mean bone loss was -0.21 ± 0.18 mm and -0.04 ± 0.14 mm in the thin and thick groups, respectively (p < 0.05). Conclusion: Single maxillary anterior implants with thin supracrestal tissue height (< 3 mm) at the time of implant placement had greater bone loss and papillary recession than implants with a thick soft tissue height (≥ 3 mm), even when using the one abutment one time concept. Schlagwörter: dental implants, marginal bone level, peri-implant tissue, single-tooth implants, supracrestal tissue height

Objective: To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing/regeneration in intrabony defects. Method and materials: Intrabony defects were surgically created in the mandible of 3 minipigs. Twelve defects were randomly treated with either rAmelX and carrier (test group) or with the carrier only (control group). At 3 months following reconstructive surgery, the animals were euthanized, and the tissues histologically processed. Thereafter, descriptive histology, histometry, and statistical analyses were performed. Results: Postoperative clinical healing was uneventful. At the defect level, no adverse reactions (e.g., suppuration, abscess formation, unusual inflammatory reaction) were observed with a good biocompatibility of the tested products. The test group yielded higher values for new cementum formation (4.81 ± 1.17 mm) compared to the control group (4.39 ± 1.71 mm) without reaching statistical significance (p=0.937). Moreover, regrowth of new bone was greater in the test compared to the control group (3.51 mm and 2.97 mm, respectively, p=0.309). Conclusions: The present results provided for the first-time histologic evidence for periodontal regeneration following the use of rAmelX in intrabony defects, thus pointing to the potential of this novel recombinant amelogenin as a possible alternative to regenerative materials from animal origins. Schlagwörter: Animal studies, intrabony defect, periodontal regeneration, recombinant amelogenin, Wound healing

Introduction: The role of lysis and lavage has shown excellent success rates in treating internal derangement of the temporomandibular joint (TMJ). This procedure has been shown to reduce pain and improve joint mobility, sometimes even in patients suffering from advanced stages of degenerative joint disease (Wilkes IV-V). There are two different approaches to lavage and arthrolysis: Arthrocentesis and TMJ Arthroscopy. Objectives: To assess both approaches’ efficacy in managing internal derangement of TMJ. Methods: 92 patients with clinical and radiographic documentation of internal derangement of the TMJ unresponsive to nonsurgical therapy were randomized to one of two surgical groups: Arthroscopic lysis and lavage level 1 (64 patients) and Arthrocentesis (28 patients). Radiological changes in the joint, pain (VAS), interincisal distance, lateral and protrusive movements, and clicks and sounds of the joints were recorded. Data were compared pre-surgically (T0) and in postoperative periods of 1 week (T1) and 1 (T2),3 (T3), and 6 (T4) months. Results: both surgical modalities achieved a similar outcome. A gradual improvement was demonstrated during the follow-up periods with no reliance on radiological changes to the joint or the TMJ diagnosis. More than that, significant differences were encountered in all parameters but protrusion between T0 and T4. VAS decreased from 7.16±2.48 to 1.75±1.98 for the arthroscopic group and from 7.53±2.69 to 1 ±1.86 for the arthrocentesis group (P-value=0.00001). Conclusion: Both approaches of Arthrocentesis and Arthroscopic level 1 have proven to reduce pain and improve mouth opening and lateral and protrusive movements over time. Schlagwörter: arthrocentesis, arthroscopic level 1, disc displacement with reduction, disc displacement without reduction, internal derangement, pain, temporomandibular joint, temporomandibular joint disorders

Objectives: Evaluating gingival thickness is an essential factor for aesthetic, function, and the maintenance of soft tissue health around natural teeth and dental implants. This study aimed to evaluate the accuracy of visual inspection procedures used to identify gingival phenotype by clinicians with different expertise and level of experience. Method and Materials: The gingival phenotypes of a total of two hundred cases were identified as either thick or thin via visual assessment with clinical photographs by eight clinicians. One periodontist examined the gingival phenotype of all subjects based on the translucency of the periodontal probe through the gingival sulcus. The accuracy between these two methods was evaluated using percentile agreement and k statistics. Results: The mean percentage of accurately identified cases was seventy-five percent of the cases irrespective of the clinician’s experience and expertise. Almost half of the thin phenotype cases were misclassified by clinicians. İnter-examiner agreement was generally fair to moderate and intra-examiner agreement was generally moderate. Conclusion: Within the limits of this study, the present findings demonstrated that the visual inspection method misclassified the cases, especially thin gingival phenotype, compared to the probe translucency method. Therefore, there is a need for identifying a universally accepted, accurate method and clear clinical definitions. Schlagwörter: Diagnostic procedure, Epidemiology, Etiology, experience, expertise, gingival phenotype, Periodontology, probe transparency, visual inspection

Purpose: This in vitro study evaluated the color differences when discolored tooth substrates were restored with CAD-CAM monolithic ceramics depending on ceramic type and thickness, and the try-in paste shade. Methods: Six ceramic types were tested: high-translucent lithium disilicate (LD-HT); medium-translucent lithium disilicate (LD-MT); low-translucent lithium disilicate (LD-LT); low-translucent leucite (LC-LT); feldspathic ceramic (FC); BL1 low-translucent lithium disilicate, stained to A1 shade (LD-BL1-LT). The ceramics were tested in disc-shaped specimens with 0.5, 1.0, and 1.5mm thickness (n=10; N= 180; shade A1). The try-in pastes tested to simulate luting materials corresponded to colors A1 and opaque white (OW). Six substrates were used: A1 (reference), B2, B3, A3, C2, and C3. Color differences (ΔE00) and translucency parameter (TP00) were assessed with the CIEDE2000 formula. The results were compared with acceptability (AT = 1.77) and perceptibility (PT = 0.81) thresholds. Results: Ceramic type, thickness, and the try-in paste shade influenced the color differences. LD-LT and LC-LT ceramics and OW try-in paste provided, in general, lower ΔE00 values. The most adequate ceramic thickness varied according to the substrate discoloration. With 1.0 mm of ceramic thickness, it was possible to obtain ΔE00 lower than the PT for substrates C2 and A3, and ΔE00 lower than the AT for C3 and B3. ΔE00 lower than the AT were obtained with 0.5mm of ceramic thickness for B2, A3, and C2. Conclusion: The use of low-translucent glass-ceramics and opaque white try-in paste are useful to reduce color differences. The most adequate ceramic thickness depends on the substrate discoloration. Schlagwörter: color difference, dental ceramics, discolored substrates, prosthodontics, translucency

Objectives: In early life, children are exposed to microorganisms from maternal and environmental sources, which influence the development of their microbiome throughout life. Several studies have demonstrated the influence of the delivery mode and breastfeeding on the oral microbiome of children, mostly regarding bacterial colonization. However, their influence on the oral fungal carriage is still underexplored. This study aimed to assess the association of the delivery and feeding mode with the oral carriage of yeasts in adulthood. Method and Materials: Fungal oral carriage was evaluated by collecting unstimulated saliva in 185 healthy dental students (mean age of 21.51±1.55 years old; 81.6% females). Yeast identification was performed by culture in ChromAgar Candida medium and sequencing of the 18S genes and ITS regions for determination of the species. Demographic and clinical data of each participant was recorded through questionnaires and oral examinations were performed in a subgroup of participants (n=49). Results: Candida species were isolated in 37.5% of all participants. The prevalence of yeasts in the oral cavity was significantly higher in those who were born by vaginal delivery compared to those born by caesarean-section (p=0.035), whereas no statistically significant differences were observed regarding breastfeeding (p=0.398). Low salivary flow rate and frequency of dental visits also were associated with oral yeast carriage (p<0.05). Conclusion: Our study suggests a possible impact of the type of delivery on fungal colonization, which is sustained throughout life due to oral health-related factors. Schlagwörter: breastfeeding, Candida, mode of delivery, oral carriage, saliva, yeasts

Objective: To explore the feasibility of screening for type 2 diabetes (T2DM) and the prevalence of adult patients seen in a dental clinic at risk for T2DM based on American Diabetes Association (ADA) diabetes risk test (DRT) scores and Point of Care (POC) Hemoglobin A1C (A1C) values. Methodology: A cross-sectional analysis of data from adults 18-89 years old seen in an academic dental clinic between November 2019 and April 2022 without prior history of diabetes. Clinical and demographic data were obtained from electronic health records and odontograms. Frequency distributions, chi-square, and Mann-Whitney U tests were used for data analysis. Results: Of the 13,519 patients whose data were included, 54.7% (n=7,389) were female. Of those with race and ethnicity data, 53.6% (n=2,871) were white, 40.2% (n=2,153) were African American, and 29.5% (n=1,559) were Hispanic/Latino. Mean ±SD age was 47.0+17.0 years; mean±SD BMI was 28.0+6.1 kg/m2. Thirty-five percent (n=4,774) had DRT scores reflecting T2DM risk. Those at risk were more likely to be older, male, and overweight/obese than those not at risk (P<0.001). Of those at risk who consented to a POC A1C (9.8%, n=470), 40.2% (n=189) had values consistent with dysglycemia (A1C>5.7%); 34.9% (n=164) reflecting prediabetes (A1C= 5.7-6.4%) and 5.3% (n=25) diabetes (A1C>6.5%). Conclusions: Diabetes screening in a dental clinic identified that over one-third of adults without T2DM were at risk based on DRT scores. Of those who had POC AICs conducted; 40% had dysglycemia. Diabetes screening in an academic dental clinic can help identify patients at risk for T2DM. Schlagwörter: Dental Clinic, Diabetes Mellitus Type 2, Diabetes Screening, Glycated Hemoglobin, Prediabetic State

Background: The present study aimed to evaluate the local effect of antimicrobial photodynamic therapy (aPDT) as adjunctive treatment for grade C periodontitis in molars teeth. Methods: Thirty-eight molar teeth from 11 patients were included in this split-mouth randomized clinical trial. The teeth were randomly divided into two groups (n = 19 each) that were submitted to conventional scaling and root planing in addition to aPDT (test group) and to scaling and root planing in addition to aPDT simulation (control group). The following periodontal parameters were obtained prior to treatment (baseline) and at 3 months after the intervention: bleeding on probing, probing depth, gingival recession, clinical attachment level, and furcation level. A 5% significance level was adopted in the statistical analysis. Results: Both groups exhibited improvement in the clinical parameters (p < 0.001). However, the reductions in bleeding on probing and probing depth were greater in the test group (p < 0.001). There were no significant differences in the other clinical parameters between groups (p ≥ 0.13). Conclusions: Molar teeth treated with aPDT and scaling and root planing showed superior clinical improvement compared to those submitted only to scaling and root planning. Antimicrobial PDT may be used as adjunctive treatment for grade C periodontitis affecting molar teeth since it seems to improve the clinical response to conventional debridement. Schlagwörter: Aggressive Periodontitis, Photochemotherapy, Periodontal Diseases, Randomized Controlled Trial

Objectives: The aim of the present study was to evaluate effect of subgingival instrumentation (SI) with or without antibiotics on systemic inflammation. Moreover, systemic parameters were compared between periodontally healthy (PH) individuals and periodontitis patients. Method and materials: Patients with generalized periodontitis: stage III and PH individuals were recruited. Forty eight periodontitis patients were randomly allocated to each treatment group; systemic antibiotics for seven days after completion of SI (AB group), or SI alone (SI group). Periodontal parameters, serum high-sensitivity C-reactive protein (hsCRP), and haematological parameters were assessed at baseline and at 8th week. Multivariate analysis was applied to analyze predictive effect of treatment allocated and improvement in periodontal parameters on change in systemic parameters. Results: At baseline, hsCRP, total leukocyte count (TLC), neutrophil, and monocyte count were significantly higher in periodontitis patients. There was comparable reduction in neutrophil count in both treatment groups. At 8th week, change in periodontal parameters was similar in treatment groups, except for probing pocket depth (PPD). Improvement in both PPD and clinical attachment level (CAL) and CAL alone was predictive of change in TLC and lymphocyte count respectively. Conclusion: This study failed to demonstrate the significant benefit of systemic antibiotics as an adjuvant to SI on improvement in periodontal inflammation and systemic inflammatory parameters, despite significantly higher reduction in PPDs. Schlagwörter: C-reactive protein, inflammation, lymphocyte count, root planing

Objective: To evaluate the effectiveness of root coverage surgery in reducing dentin hypersensitivity (DH) through a systematic review and meta-analysis. Data sources: Unrestricted search of four indexed databases up to September 2022 was performed to identify randomized controlled trials (RCTs) evaluating the effect of root coverage surgery on DH frequency and/or intensity pre-surgically (baseline) and at least 3 months post-surgically. Two authors independently conducted study screening and data extraction. Subgroup meta-analyses were performed separately for stimulated and unstimulated DH frequency and intensity at different timepoints. The risk of bias and quality of the available evidence were assessed. Results: Nineteen RCTs presenting data from 7 days to 30 months after root coverage surgery with various treatment modalities were included from the 662 identified studies. A total of 486 patients contributed 784 recession defects. Results from the subgroup meta-analyses showed that, overall, root coverage surgery reduced the risk for DH by 67% (RR 0.33, CI: [0.21-0.53]) and 53% (RR 0.47, CI: [0.38-0.58] upon unstimulated and stimulated DH assessment, respectively. The DH intensity was also significantly reduced (mean VAS score difference: 2.37, CI: [2.02-2.71]) upon stimulated DH assessment. No significant changes in DH intensity were observed upon unstimulated DH assessment. The included studies did not have high risk of bias and the quality of evidence was low to high. Conclusion: Existing evidence suggests that root coverage surgery may effectively reduce the DH frequency and intensity. Schlagwörter: dentine hypersensitivity, Gingival recession, Periodontology, Review (systematic), Soft tissue management, Surgical procedure, Systematic review

Purpose: Present study aimed to assess the clinical and radiographic effect of the bone graft (BG) material (β-tricalcium phosphate + hydroxyapatite) alone and in combination with platelet rich fibrin (PRF) in intrabony defects (IBD) of periodontitis patients. Methods: It is a 6-month randomized controlled clinical trial carried out in 42 IBDs of periodontitis (average age 40 years). IBD ≥ 3 mm along with associated probing depth of ≥ 5 mm following phase-I therapy were treated either with open flap debridement (OFD) with bone graft (β-tricalcium phosphate + hydroxyapatite- i.e., Control group) or OFD with bone graft plus PRF membrane (i.e., Test group). Individual customized acrylic stent with grooves were used to ensure reproducible and repeatable measurements of clinical and radiographic parameters, including probing pocket depth (PPD), relative attachment loss (RAL), gingival marginal level (GML), vertical bone defect fill (VHD) and area of IBD (AOD) on intraoral periapical radiographs. PPD reduction and CAL gain were considered as primary outcomes and radiographic bone fill as secondary outcomes. [CTRI/2012/07/002793] Results: The preoperative PI, RAL, GML. PPD, VHD & AOD from control group was 1.06±0.08, 11.57±2.29 mm, 5.24±1.89 mm, 6.29±1.52 mm, 14.36±2.65 mm, & 7.79±4.39 mm2, whereas the same after 6-months was 1.08±0.14, 9.34±2.54mm, 5.81±2.20 mm, 3.52±0.93 mm, 12.64±2.34 mm, & 5.34±3.2 mm2 respectively. The preoperative PI, RAL, GML. PPD, VHD & AOD from experimental group was 1.14±0.05, 12.19±2.86mm, 4.38±1.63 mm, 7.81±2.6 mm, 13.46±3.42 mm, & 10.31±8.71 mm2 whereas the same after 6-months was 1.09±0.12, 8.62±2.62mm, 4.90±1.79 mm, 3.71±1.68 mm, 10.10±2.07 mm & 4.38±2.67 mm2 respectively. After 6 months of evaluation both the groups showed significant reduction in PPD (p<0.001) and significant gain in CAL (p<0.001), and significant improvement in radiographic VHD fill and AOD changes. Again, test group showed significant changes (p<0.001) over the control group considering the same outcomes. Conclusion: With the study limitations in mind, we conclude that, the treatment of intrabony defects with bone graft (β -tricalcium phosphate + hydroxyapatite) material or the same along with PRF membrane results in statistically significant improvement in clinical (CAL and PPD) and radiographic (VHD and AOD) parameters; the latter having highly significant benefits. The indigenous bone graft material needs improvement. Schlagwörter: Periodontitis, platelet rich fibrin, calcium phosphates, randomized controlled clinical trial.

Objective: The present study compares interleukin 1-beta (IL-1β) and soluble urokinase plasminogen activation factor receptor (suPAR) levels in periimplant sulcular fluid (PISF) of patients with cement-retained (CR) and screw-retained (SR) implants. Method and materials: Patients with CR and SR implants were encompassed. Demographic data was collected and implant-related characteristics (geometry, insertion torque, loading and retention protocol, jaw location, duration in function and depth of insertion) were retrieved from records. Modified plaque index (mPI), crestal bone loss (CBL) probing depth (PD) and modified bleeding index (mBI) were measured. suPAR and IL-1β levels were assessed in PISF. Statistical comparisons were done and correlation between clinicoradiographic parameters and PISF IL-1β and suPAR were assessed. P<0.05 were judged statistically significant. Results: Clinical and radiographic parameters showed no difference among SR and CR implants. There was no difference PISF volume among patients with CR (0.22±0.004 μl) and screw-retained (0.19±0.005 μl) implants. Levels of IL-1β and suPAR in patients with CR and SR implants were 50.08±0.6 ng/ml and 44.6±0.08 ng/ml, and 0.28±0.05 ng/ml and 0.22±0.006 ng/ml, respectively. Conclusion: Implants with CR or SR restorations are comparable to one another in terms of clinico-radiographic status and demonstrate IL-1β and suPAR levels within the normal range in the PISF provided oral hygiene is stringently maintained. Schlagwörter: Case-control study, Implantology, Inflammation, Maintenance, soluble urokinase plasminogen activation factor

With increasing age and edentulism, numerous aesthetic changes occur to the perioral region. The upper lips lose definition, flatten and lengthen, the cupid’s bow is lost, and the oral commissures descend. The nasolabial folds deepen, marionette lines become prominent, vertical rhytids around the lips form, and chin rhytids form. Chronic exposure to UVA radiation from the sun can lead to photodamage, characterized by wrinkles, lentigines, actinic keratoses, and other pigment changes. In addition, edentulism leads to jaw atrophy, which often compromises soft tissue support. Removable dentures, the conventional treatment to restore missing teeth, not only replaces teeth, but also provides support to the lips via the labial flange. Implant supported fixed prostheses are a very popular option to restore completely edentulous arches; these prostheses are flangeless, providing no bulk to the lips. Addressing changes in the perioral region due to aging and edentulism requires a combination of treatments, with each addressing different issues. Onabotulinum toxin A can be used to treat dynamic perioral and chin rhytids, and upturn the corners of the mouth. Hyaluronic acid filler can be used to treat deep nasolabial folds, marionette lines, and re-volumize the lips. Chemical peels can treat photodamaged skin, static rhytids, and other dermatological pathologies. The subnasal lip lift, developed by Cardoso and Sperli in 1971, has become an increasingly common technique used to rejuvenate the upper lip in elderly and edentulous patients. This case report describes an elderly patient who was treated with a combination of subnasal lip lift, hyaluronic acid filler, Onabotulinum toxin A, and chemical peel to achieve superior perioral esthetics. This case will highlight the synergy of each procedure when done in combination to achieve highly effective results. Schlagwörter: Case-report/series, Cosmetics, Full edentulism, Implantology, Oral surgery , Perioral Esthetics, Soft tissue management