Clinical and image findings in bisphosphonate-related osteonecrosis of the jaws

Abstract: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is characterized as exposed bone in the jaws for more than 8 weeks in patients with current or previous history of therapy with bisphosphonates (BPs) and no history of radiotherapy in the head and neck. We report a case series of 7 patients with BRONJ and analyze the variations of clinical and imaging signs, correlating them with the presence or absence of bone exposure. Among the patients, 6 were women and 1 was a man, aged 42–79 years. Five of the patients were using zoledronic acid and the other 2 alendronate. The use of BPs varied from 3 to 13 years. In 5 patients, tooth extraction was the triggering event of injuries. Panoramic radiographs and computed tomography (CT) were evaluated by a radiologist blinded to the cases. There were persistent unremodeled extraction socket even several months after tooth extraction in 3 of the cases that were consistent wit CT findings that also showed areas of osteosclerosis and osteolysis. Patients were treated according to the recommendations of the AAOMS, with surgical debridement and antibiotic coverage with amoxicillin in the symptomatic patients. The follow-up of these patients ranged from 8 to 34 months, with a good response to treatment. The image findings in this case series were not specific and showed no difference between each stages of BRONJ (AAOMS, 2009). The image features were similar in presence or absence of exposed bone.

Steel fiber reinforced concrete pipes: part 1: technological analysis of the mechanical behavior

This paper is the first part of an extensive work focusing the technological development of steel fiber reinforced concrete pipes (FRCP). Here is presented and discussed the experimental campaign focusing the test procedure and the mechanical behavior obtained for each of the dosages of fiber used. In the second part ("Steel fiber reinforced concrete pipes. Part 2: Numerical model to simulate the crushing test"), the aspects of FRCP numerical modeling are presented and analyzed using the same experimental results in order to be validated. This study was carried out trying to reduce some uncertainties related to FRCP performance and provide a better condition to the use of these components. In this respect, an experimental study was carried out using sewage concrete pipes in full scale as specimens. The diameter of the specimens was 600 mm, and they had a length of 2500 mm. The pipes were reinforced with traditional bars and different contents of steel fibers in order to compare their performance through the crushing test. Two test procedures were used in that sense. In the 1st Series, the diameter displacement was monitored by the use of two LVDTs positioned at both extremities of the pipes. In the 2nd Series, just one LVDT is positioned at the spigot. The results shown a more rigidity response of the pipe during tests when the displacements were measured at the enlarged section of the socket. The fiber reinforcement was very effective, especially when low level of displacement was imposed to the FRCP. At this condition, the steel fibers showed an equivalent performance to superior class pipes made with traditional reinforced. The fiber content of 40 kg/m3 provided a hardening behavior for the FRCP, and could be considered as equivalent to the critical volume in this condition.

Diseño e implementación de un prototipo de enchufe inteligente mediante la placa Arduino

[ES] Este trabajo detalla las diferentes etapas del desarrollo de construcción del prototipo Clever Socket, abarcando desde su análisis, a su diseño e implementación.
Clever Socket es un conjunto hardware y software que facilita el control del encendido y el apagado de los aparatos electrónicos conectados a él a través de redes de comunicación LAN y WAN. Para lograr este propósito, el artefacto se apoya en la placa de desarrollo electrónico Arduino UNO y la placa Arduino WiFi Shield –que posibilita su conexión inalámbrica a la red–.
El dispositivo cuenta con cuatro bases de enchufe controladas a través de relés, que permiten la gestión de hasta cuatro dispositivos electrónicos de manera simultánea.
 En el lado del software se presentan tres componentes:
Un servicio web de bajo nivel destinado a la gestión de la placa Arduino. Permite la comunicación con la placa, la lectura y escritura de sus pines.
 Un servicio web específico del dispositivo Clever Socket. Facilita la comunicación con el prototipo hardware, permitiendo así la gestión de diferentes operaciones que se llevan a cabo sobre los aparatos conectados a sus enchufes.
 Una aplicación web. Actúa como interfaz entre el usuario y el servicio web de Clever Socket, permitiendo la gestión del dispositivo. El diseño de la aplicación es responsive, lo que posibilita su correcta visualización en todo tipo de dispositivos, tanto móviles como de escritorio.

Ottimizzazione, guidata dall'applicazione, della scansione di canali WiFi in kernel Linux

La tesi ha visto la creazione di una applicazione in grado di inviare e ricevere messaggi verso un kernel Linux 3.6.8, che e' stato modificato nel modulo net/mac80211. Lo scopo e' stato permettere all'applicazione di attivare/disattivare comportamenti alternativi del metodo di scansione di canali Wi-Fi. Sono rese possibili le seguenti funzionalita': disattivare la scansione, rendere non interrompibile la scansione software, ricevere notifiche a completamento di una scansione software. Per la comunicazione sono stati usati i socket netlink.

Observable stages and scheduling for alveolar remodeling following antemortem tooth loss

Zahnverlust zu Lebzeiten („antemortem tooth loss“, AMTL) kann als Folge von Zahnerkrankungen, Traumata, Zahnextraktionen oder extremer kontinuierlicher Eruption sowie als Begleiterscheinung fortgeschrittener Stadien von Skorbut oder Lepra auftreten. Nach dem Zahnverlust setzt die Wundheilung als Sekundärheilung ein, während der sich die Alveole mit Blut füllt und sich ein Koagulum bildet. Anschließend erfolgt dessen Umwandlung in Knochengewebe und schließlich verstreicht die Alveole derart, dass sie makroskopisch nicht mehr erkannt werden kann. Der Zeitrahmen der knöchernen Konsolidierung des Kieferkammes ist im Detail wenig erforscht. Aufgrund des gehäuften Auftretens von AMTL in menschlichen Populationen, ist die Erarbeitung eines Zeitfensters, mit dessen Hilfe durch makroskopische Beobachtung des Knochens die Zeitspanne seit dem Zahnverlust („time since tooth loss“, TSL) ermittelt werden kann, insbesondere im archäologischen Kontext äußerst wertvoll. Solch ein Zeitschema mit Angaben über die Variabilität der zeitlichen Abläufe bei den Heilungsvorgängen kann nicht nur in der Osteologie, sondern auch in der Forensik, der allgemeinen Zahnheilkunde und der Implantologie nutzbringend angewandt werden. rnrnNach dem Verlust eines Zahnes wird das Zahnfach in der Regel durch ein Koagulum aufgefüllt. Das sich bildende Gewebe wird rasch in noch unreifen Knochen umgewandelt, welcher den Kieferknochen und auch die angrenzenden Zähne stabilisiert. Nach seiner Ausreifung passt sich das Gewebe schließlich dem umgebenden Knochen an. Das Erscheinungsbild des Zahnfaches während dieses Vorgangs durchläuft verschiedene Stadien, welche in der vorliegenden Studie anhand von klinischen Röntgenaufnahmen rezenter Patienten sowie durch Untersuchungen an archäologischen Skelettserien identifiziert wurden. Die Heilungsvorgänge im Zahnfach können in eine prä-ossale Phase (innerhalb einer Woche nach Zahnverlust), eine Verknöcherungsphase (etwa 14 Wochen nach Zahnverlust) und eine ossifizierte bzw. komplett verheilte Phase (mindestens 29 Wochen nach Zahnverlust) eingeteilt werden. Etliche Faktoren – wie etwa die Resorption des Interdentalseptums, der Zustand des Alveolarknochens oder das Individualgeschlecht – können den normalen Heilungsprozess signifikant beschleunigen oder hemmen und so Unterschiede von bis zu 19 Wochen verursachen. Weitere Variablen wirkten sich nicht signifikant auf den zeitlichen Rahmen des Heilungsprozesse aus. Relevante Abhängigkeiten zwischen verschiedenen Variabeln wurden ungeachtet der Alveolenauffüllung ebenfalls getestet. Gruppen von unabhängigen Variabeln wurden im Hinblick auf Auffüllungsgrad und TSL in multivariablen Modellen untersucht. Mit Hilfe dieser Ergebnisse ist eine grobe Einschätzung der Zeitspanne nach einem Zahnverlust in Wochen möglich, wobei die Einbeziehung weiterer Parameter eine höhere Präzision ermöglicht. rnrnObwohl verschiedene dentale Pathologien in dieser Studie berücksichtigt wurden, sollten zukünftige Untersuchungen genauer auf deren potenzielle Einflussnahme auf den alveolaren Heilungsprozess eingehen. Der kausale Zusammenhang einiger Variablen (wie z. B. Anwesenheit von Nachbarzähnen oder zahnmedizinische Behandlungen), welche die Geschwindigkeit der Heilungsrate beeinflussen, wäre von Bedeutung für zukünftige Untersuchungen des oralen Knochengewebes. Klinische Vergleichsstudien an forensischen Serien mit bekannter TSL oder an einer sich am Anfang des Heilungsprozesses befindlichen klinischen Serie könnten eine Bekräftigung dieser Ergebnisse liefern.

Emulazione di una colonnina di ricarica per auto elettrica tramite arduino

Internet of Energy for Electric Mobility è un progetto di ricerca europeo il cui scopo consiste nello sviluppo di infrastrutture di comunicazione, siano esse sia hardware che software, volte alla facilitazione, supporto e miglioramento di tutte quelle operazioni legate al processo di ricarica di auto elettriche. A tale progetto vi ha aderito anche l’Università di Bologna ed è stato oggetto di studio di Federico Montori e Simone Rondelli. Il primo ha dato il là allo sviluppo del progetto realizzandovi, in una fase embrionale, una piattaforma legata alla gestione di un servizio cittadino (bolognese) per la gestione di ricariche elettriche, un’applicazione mobile in grado di interagire con tale servizio ed un simulatore per la piattaforma. In un lavoro durato oltre un anno, Simone Rondelli ha ripreso il progetto di Federico Montori riscrivendone le componenti in maniera tale da migliorarne le funzionalità ed aggiungerne anche di nuove; in particolare ha realizzato in maniera efficiente un’applicazione mobile la quale si occupa di gestire la prenotazione di colonnine elettriche di ricarica e di monitorare lo stato attuale di un’auto peso, livello batteria, ecc... ). Nel marzo del 2014 è cominciato il mio contributo nel contesto di Internet of Energy di cui ne ho ereditato tutta l’architettura derivante dai due sviluppi precedenti. Il mio compito è stato quello di realizzare (cioè emulare) una colonnina di ricarica auto elettrica, tramite la piattaforma elettronica Arduino, la quale al suo primo avvio informa il database semantico del sistema (SIB) della sua presenza in maniera tale che il simulatore sia in grado di poter far ricaricare un’auto anche a questa nuova colonnina. Di conseguenza ho fatto in modo di instaurare (tramite socket) una comunicazione tra il simulatore e la colonnina così che il simulatore informi la colonnina che è stata raggiunta da un’auto e, viceversa, la colonnina informi il simulatore sullo stato di ricarica dell’auto in modo che quest’ultima possa ripartire al termine della ricarica. Ho anche realizzato un’applicazione mobile in grado di comunicare con la colonnina, il cui scopo è quello di ottenere un codice di ricarica che poi l’utente deve digitare per autenticarsi presso di essa. Realizzando tale tipo di contributo si è data dunque la possibilità di integrare una componente ”reale” con componenti simulate quali le auto del simulatore di Internet of Energy e si sono poste le basi per estensioni future, le quali permettano di integrare anche più componenti che si registrano nel sistema e danno dunque la possibilità di essere utilizzate dalle auto elettriche.

Un' app mobile interpiattaforma per la geolocalizzazione in tempo reale di membri di un gruppo

Realizzazione di un'app mobile interpiattaforma tramite phonegap che permette la geolocalizzazione di utenti di un gruppo. Connessione Client-Server attraverso Websocket. Librerie di Socket.IO e mappe di Google Maps.

Sviluppo applicazione mobile del gioco del Mahjong

L’obiettivo di questa tesi è la trasposizione del gioco da tavolo “Mahjong” su un’applicazione mobile. Essa è sviluppata in Android, ma l’idea è quella di estenderla anche alle altre piattaforme. Col passare del tempo il Mahjong si è diffuso in molti paesi e per questo ne sono nate molte varianti. In questo caso si adotta il regolamento ravennate 200-400, opportunamente modificato per adattarlo all’applicazione. Il nome dell’applicativo nasce dal fatto che esso dovrà gestire un numero molto elevato di lingue e che nessuno ha ancora sviluppato un gioco multiplayer sul Mahjong, per cui sarà il primo a livello mondiale. Nell’applicazione un utente dovrà creare il tavolo di gioco e solo allora gli altri potranno visualizzarlo. Dopo che tutti si saranno seduti, chiunque potrà chiedere di iniziare una partita, che comincerà non appena tutti avranno accettato la richiesta. È stato progettato un database, in modo da salvare lo stato attuale di tutti i tavoli. Le informazioni sullo stato di ogni partita, invece, sono salvate in un file diverso per ciascuna. L’architettura utilizzata per lo sviluppo dell’applicativo è del tipo client-server. Per la parte server dell’applicazione si è scelto di usare il linguaggio java, utilizzando le socket e instaurando connessioni SSL. Il server utilizza inoltre connessioni non persistenti. Tutte le richieste inviate e ricevute dal server sono create in un formato adatto all'interscambio di dati fra applicazioni client-server, chiamato JSON. Nel server si è creato, inoltre, un servizio di “caching” delle partite, in modo da incrementare le prestazioni e la velocità di elaborazione delle richieste. Per connettere in modo corretto il server al database si utilizza JDBC.

Immediate implant placement with transmucosal healing in areas of aesthetic priority. A multicentre randomized-controlled clinical trial I. Surgical outcomes

OBJECTIVES: To compare the clinical outcomes of standard, cylindrical, screw-shaped to novel tapered, transmucosal (Straumann Dental implants immediately placed into extraction sockets. Material and methods: In this randomized-controlled clinical trial, outcomes were evaluated over a 3-year observation period. This report deals with the need for bone augmentation, healing events, implant stability and patient-centred outcomes up to 3 months only. Nine centres contributed a total of 208 immediate implant placements. All surgical and post-surgical procedures and the evaluation parameters were discussed with representatives of all centres during a calibration meeting. Following careful luxation of the designated tooth, allocation of the devices was randomly performed by a central study registrar. The allocated SLA titanium implant was installed at the bottom or in the palatal wall of the extraction socket until primary stability was reached. If the extraction socket was >or=1 mm larger than the implant, guided bone regeneration was performed simultaneously (Bio Oss and BioGide. The flaps were then sutured. During non-submerged transmucosal healing, everything was done to prevent infection. At surgery, the need for augmentation and the degree of wound closure was verified. Implant stability was assessed clinically and by means of resonance frequency analysis (RFA) at surgery and after 3 months. Wound healing was evaluated after 1, 2, 6 and 12 weeks post-operatively. RESULTS: The demographic data did not show any differences between the patients receiving either standard cylindrical or tapered implants. All implants yielded uneventful healing with 15% wound dehiscences after 1 week. After 2 weeks, 93%, after 6 weeks 96%, and after 12 weeks 100% of the flaps were closed. Ninety percent of both implant designs required bone augmentation. Immediately after implantation, RFA values were 55.8 and 56.7 and at 3 months 59.4 and 61.1 for cylindrical and tapered implants, respectively. Patient-centred outcomes did not differ between the two implant designs. However, a clear preference of the surgeon's perception for the appropriateness of the novel-tapered implant was evident. CONCLUSIONS: This RCT has demonstrated that tapered or standard cylindrical implants yielded clinically equivalent short-term outcomes after immediate implant placement into the extraction socket.

The "flap-shaft" prosthesis for insensate feet with Chopart or Lisfranc amputations

BACKGROUND: The inevitable detachment of tendons and the loss of the forefoot in Chopart and Lisfranc amputations result in equinus and varus of the residual foot. In an insensate foot these deformities can lead to keratotic lesions and ulcerations. The currently available prostheses cannot safely counteract the deforming forces and the resulting complications. METHODS: A new below-knee prosthesis was developed, combining a soft socket with a rigid shaft. The mold is taken with the foot in the corrected position. After manufacturing the shaft, the lateral third of the circumference of the shaft is cut away and reattached distally with a hinge, creating a lateral flap. By closing this flap the hindfoot is gently levered from the varus position into valgus. Ten patients (seven amputations at the Chopart-level, three amputations at the Lisfranc-level) with insensate feet were fitted with this prosthesis at an average of 3 (range 1.5 to 9) months after amputation. The handling, comfort, time of daily use, mobility, correction of malposition and complications were recorded to the latest followup (average 31 months, range 24 to 37 months after amputation). RESULTS: Eight patients evaluated the handling as easy, two as difficult. No patient felt discomfort in the prosthesis. The average time of daily use was 12 hours, and all patients were able to walk. All varus deformities were corrected in the prosthesis. Sagittal alignment was kept neutral. Complications were two minor skin lesions and one small ulcer, all of which responded to conservative treatment, and one ulcer healed after debridement and lengthening of the Achilles tendon. CONCLUSIONS: The "flap-shaft" prosthesis is a valuable option for primary or secondary prosthetic fitting of Chopart-level and Lisfranc-level amputees with insensate feet and flexible equinus and varus deformity at risk for recurrent ulceration. It provided safe and sufficient correction of malpositions and enabled the patients to walk as much as their general condition permitted.

Prediction of spatial orientation and morphology of calcaneonavicular coalitions

BACKGROUND: Calcaneonavicular coalitions (CNC) have been reported to be associated with anatomical aberrations of either the calcaneus and/or navicular bones. These morphological abnormalities may complicate accurate surgical resection. Three-dimensional analysis of spatial orientation and morphological characteristics may help in preoperative planning of resection. MATERIALS AND METHODS: Sixteen feet with a diagnosis of CNC were evaluated by means of 3-D CT modeling. Three angles were defined that were expressed in relation to one reproducible landmark (lateral border of the calcaneus): the dorsoplantar inclination, anteroposterior inclination, and socket angle. The depth and width of the coalitions were measured and calculated to obtain the estimated contact surface. Three-dimensional reconstructions of the calcanei served to evaluate the presence, distortion or absence of the anterior calcaneal facet and presence of a navicular beak. The interrater correlations were assessed in order to obtain values for the accuracy of the measurement methods. Sixteen normal feet were used as controls for comparison of the socket angle; anatomy of the anterior calcaneal facet and navicular beak as well. RESULTS: The dorsoplantar inclination angle averaged 50 degrees (+/-17), the anteroposterior inclination angle 64 degrees (+/-15), and the pathologic socket angle 98 degrees (+/-11). The average contact area was 156 mm(2). Ninety-four percent of all patients in the CNC group revealed a plantar navicular beak. In 50% of those patients the anterior calcaneal facet was replaced by the navicular portion and in 44% the facet was totally missing. In contrast, the socket angle in the control group averaged 77 degrees (+/-18), which was found to be statistically different than the CNC group (p = 0.0004). Only 25% of the patients in the control group had a plantar navicular beak. High, statistically significant interrater correlations were found for all measured angles. CONCLUSION: Computer-aided CT analysis and reconstructions help to determine the spatial orientations of CNC in space and provide useful information in order to anticipate morphological abnormalities of the calcaneus and navicular.

Reverse total shoulder arthroplasty

The radical changes in prosthetic design made in the mid 1980s transformed the historically poorly performing reverse ball-and-socket total shoulder prosthesis into a highly successful salvage implant for pseudoparalytic, severely rotator cuff-deficient shoulders. Moving the center of rotation more medial and distal as well as implanting a large glenoid hemisphere that articulates with a humeral cup in 155 degrees of valgus are the biomechanical keys to sometimes spectacular short- to mid-term results. Use of the reverse total shoulder arthroplasty device allows salvage of injuries that previously were beyond surgical treatment. However, this technique has a complication rate approximately three times that of conventional arthroplasty. Radiographic and clinical results appear to deteriorate over time. Proper patient selection and attention to technical details are needed to reduce the currently high complication rate.

Dimensional ridge alterations following immediate implant placement in molar extraction sites: a six-month prospective cohort study with surgical re-entry

AIM: To assess dimensional ridge alterations following immediate implant placement in molar extraction sites. MATERIAL AND METHODS: Twelve subjects received 12 immediate transmucosal implants in molar extraction sites. Peri-implant defects were treated according to the principles of Guided Bone Regeneration by means of a deproteinized bone substitute and a bioresorbable collagen membrane. Changes in vertical (IS-BD, CREST-BD) and horizontal distances (EC-I, IC-I) of alveolar bony walls to the bottom of the defects (BD) and to the implant surfaces (I) were compared between implant placement and surgical re-entry at 6 months. RESULTS: The implant survival rate at 6 months was 100%. Statistically significant differences (P<0.01) were observed in the mean changes in vertical distances IS-BD and CREST-BD between baseline and re-entry. At re-entry, all peri-implant marginal defects assessed from the internal socket wall to the implant surface (IC-I) were healed. The residual combined thickness of the buccal wall with the newly formed peri-implant bone at sites with an initial thickness of 1 mm was statistically significantly smaller (P<0.05) compared with that of sites with an initial buccal thickness of 2 mm (2.50 +/- 0.76 vs. 4+/-0 mm). CONCLUSIONS: The marginal defects around immediate implants placed in molar extraction sites were completely filled after 6 months of healing through de novo bone formation. Bone resorption was observed from the external aspects of the buccal and oral socket walls. Dimensional changes of the external socket walls were mostly pronounced at the buccal aspects.

Comfort of two shoulder actuation mechanisms for arm therapy exoskeletons: a comparative study in healthy subjects

Robotic exoskeletons can be used to study and treat patients with neurological impairments. They can guide and support the human limb over a large range of motion, which requires that the movement trajectory of the exoskeleton coincide with the one of the human arm. This is straightforward to achieve for rather simple joints like the elbow, but very challenging for complex joints like the human shoulder, which is comprised by several bones and can exhibit a movement with multiple rotational and translational degrees of freedom. Thus, several research groups have developed different shoulder actuation mechanism. However, there are no experimental studies that directly compare the comfort of two different shoulder actuation mechanisms. In this study, the comfort and the naturalness of the new shoulder actuation mechanism of the ARMin III exoskeleton are compared to a ball-and-socket-type shoulder actuation. The study was conducted in 20 healthy subjects using questionnaires and 3D-motion records to assess comfort and naturalness. The results indicate that the new shoulder actuation is slightly better than a ball-and-socket-type actuation. However, the differences are small, and under the tested conditions, the comfort and the naturalness of the two tested shoulder actuations do not differ a lot.

Esthetic outcomes following immediate and early implant placement in the anterior maxilla: a systematic review.

PURPOSE The objectives of this systematic review are (1) to quantitatively estimate the esthetic outcomes of implants placed in postextraction sites, and (2) to evaluate the influence of simultaneous bone augmentation procedures on these outcomes. MATERIALS AND METHODS Electronic and manual searches of the dental literature were performed to collect information on esthetic outcomes based on objective criteria with implants placed after extraction of maxillary anterior and premolar teeth. All levels of evidence were accepted (case series studies required a minimum of 5 cases). RESULTS From 1,686 titles, 114 full-text articles were evaluated and 50 records included for data extraction. The included studies reported on single-tooth implants adjacent to natural teeth, with no studies on multiple missing teeth identified (6 randomized controlled trials, 6 cohort studies, 5 cross-sectional studies, and 33 case series studies). Considerable heterogeneity in study design was found. A meta-analysis of controlled studies was not possible. The available evidence suggests that esthetic outcomes, determined by esthetic indices (predominantly the pink esthetic score) and positional changes of the peri-implant mucosa, may be achieved for single-tooth implants placed after tooth extraction. Immediate (type 1) implant placement, however, is associated with a greater variability in outcomes and a higher frequency of recession of > 1 mm of the midfacial mucosa (eight studies; range 9% to 41% and median 26% of sites, 1 to 3 years after placement) compared to early (type 2 and type 3) implant placement (2 studies; no sites with recession > 1 mm). In two retrospective studies of immediate (type 1) implant placement with bone graft, the facial bone wall was not detectable on cone beam CT in 36% and 57% of sites. These sites had more recession of the midfacial mucosa compared to sites with detectable facial bone. Two studies of early implant placement (types 2 and 3) combined with simultaneous bone augmentation with GBR (contour augmentation) demonstrated a high frequency (above 90%) of facial bone wall visible on CBCT. Recent studies of immediate (type 1) placement imposed specific selection criteria, including thick tissue biotype and an intact facial socket wall, to reduce esthetic risk. There were no specific selection criteria for early (type 2 and type 3) implant placement. CONCLUSIONS Acceptable esthetic outcomes may be achieved with implants placed after extraction of teeth in the maxillary anterior and premolar areas of the dentition. Recession of the midfacial mucosa is a risk with immediate (type 1) placement. Further research is needed to investigate the most suitable biomaterials to reconstruct the facial bone and the relationship between long-term mucosal stability and presence/absence of the facial bone, the thickness of the facial bone, and the position of the facial bone crest.