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OBJECTIVES: To analyze the differences in cusp height on radiographs, establishing proportional relationships between cusp and alveolar bone crest (ABC) measurements. The goal of this study was to develop a correction coefficient by considering this proportion. MATERIALS AND METHODS: Twenty-one artificial teeth, molars and premolars, and bovine ribs were used. Interproximal radiographs were taken with the aid of a positioner. The vertical angles used were: 0°, + 5°, and + 10°, and processed using three spatial resolutions measured in line pairs per mm (lp/mm): 20, 25 and 40. The Perio filter was applied to each image, in addition to the original one. Combinations of angle, resolution, and filter were made. Eighteen images were analyzed by three specialists, resulting in 252 measurements for each evaluator, totaling 756 measurements. RESULTS: The overall variability of the measurements can be explained mainly by the variation in tooth anatomy. The 0° 25 lp/mm Perio filter method was the closest one to the actual clinical scenario for both cusps and ABC. The correction factor managed to explain 71.45% of the errors. CONCLUSIONS: The variation in vertical angulation interferes with cusp and ABC measurements, and the angulation at 0º and spatial resolution of 25 lp/mm showed better results. The use of correction coefficients allowed approaching actual measurement values. CLINICAL RELEVANCE: More accurate ABC height measurements are essential even in radiographic exams that do not meet the standard of excellence because the need to repeat radiographic exams is then eliminated.
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Proceso Alveolar , Proyectos Piloto , Animales , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/anatomía & histología , Bovinos , Radiografía Dental , Costillas/diagnóstico por imagen , Costillas/anatomía & histología , Humanos , Técnicas In Vitro , Corona del Diente/diagnóstico por imagen , Corona del Diente/anatomía & histologíaRESUMEN
INTRODUCTION: The aim of this study was to evaluate the systemic sequelae, as well as the dental and craniofacial development, of patients with rhabdomyosarcoma in relation to the treatment received and clinical-pathological variables. MATERIALS AND METHODS: A retrospective cross-sectional study was performed. All individuals diagnosed with RMS between 1990 and 2022 were considered eligible. Cases who survived the primary tumor were included. Data were collected from medical records, and patients were called for clinical and radiographic examinations. RESULTS: Thirty-eight patients were assessed, with a mean disease-free survival of 216.68 months (±84.99). The primary location of the tumor was mainly the head and neck region (57.9 %). All patients received chemotherapy, and 30 (78.9 %) also underwent radiotherapy. The most frequently observed sequela was sensory impairment, which was significantly associated with tumors in the head and neck (p < 0.05), as well as with the use of radiotherapy (p = 0.034). Root formation failure was observed in 60 % of cases, microdontia in 50 %, and delayed tooth eruption in 40 %. A convex profile was predominant (80 %), along with maxillary (50 %) and mandibular (80 %) retrusion and a skeletal class II diagnosis (60 %). CONCLUSIONS: Late systemic, dental, and craniofacial developmental sequelae are observed in pediatric rhabdomyosarcoma survivors, especially in patients who underwent radiotherapy in the head and neck region. Younger individuals at the time of treatment are at greater risk of late sequelae.
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AIM: To evaluate the impact of acquisition protocols and artifact reduction filters in cone beam computed tomography on diagnosing vertical root fractures in endodontically treated teeth with and without intraradicular posts. MATERIALS AND METHODS: We analyzed 480 tomographic images acquired from two J. Morita scanners (0.125- and 0.08-mm voxel sizes protocols), with application of a blooming artifact reduction filter. Three evaluators assessed these images for root fractures using a 5-point Likert scale. Diagnostic accuracy between filters and protocols was determined using generalized linear models with binomial distribution for the outcome, considering protocol, filter, and dental status. Sensitivity, specificity, positive predictive value, and negative predictive value were also estimated for the filters and protocols. RESULTS: The 0.08-mm voxel size protocol demonstrated a significantly higher percentage of accurate diagnosis compared to the 0.125-mm protocol (p = .001). No statistically significant differences (p ≥ .087) were observed for filter application, interaction between protocol and filter, or dental status. Accuracy, sensitivity, and specificity values were respectively: .93, .87, 1.00 (protocol 1); .99, .99, .99 (protocol 2); .98, .96, .99 (no filter); .95, .90, 1.00 (with filter). CONCLUSION: The new findings found for the two J Morita scanners used in our study were that images acquired using the voxel size of 0.08 mm showed an improvement in the diagnosis of root fractures and the filters in these devices have no relevance significant for the diagnosis.
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Purpose: This study was conducted to investigate the safety of dental imaging in pregnant women with respect to fetal health. Materials and Methods: Searches were conducted of the PubMed, Scopus, and Web of Science databases in May 2023. The inclusion criteria encompassed cross-sectional and longitudinal studies that focused on the analysis of diagnostic dental imaging in pregnant women, as well as studies utilizing phantoms to simulate imaging examinations. The exclusion criteria consisted of reviews, letters to the editor, book chapters, and abstracts from scientific conferences and seminars. Results: A total of 3,913 articles were identified. Based on a review of the titles and abstracts, 3,892 articles were excluded, leaving 21 articles remaining for full-text review. Of these, 18 were excluded, and 4 additional articles were included as cross-references. Ultimately, 7 articles underwent quantitative-qualitative analysis. Three retrospective studies were focused on pregnant women who underwent dental imaging procedures. The remaining 4 studies utilized female phantoms to simulate imaging examinations and represent the radiation doses absorbed by the uterus or thyroid. Conclusion: Few dental radiology studies have been conducted to determine the safe radiation threshold for pregnant women. Additionally, the reviewed articles did not provide numbers of dental examinations, by type, corresponding to this dose. Dental imaging examinations of pregnant women should not be restricted if clinically indicated. Ultimately, practitioners must be able to justify the examination and should adhere to the "as low as diagnostically acceptable, being indication-oriented and patient-specific" (ALADAIP) principle of radioprotection.
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Background: This study aims to evaluate the diagnosis of proximal carious lesions through different parameters of execution and visualization of the images. Material and Methods: Proximal carious lesions were artificially induced in human teeth three different times (10, 20, and 30 hours) by in vitro demineralization. The teeth were radiographed with the Dürr digital system using three exposure times (0.10, 0.16, and 0.20s) and three different resolutions in the scanning of the phosphor plates (20-, 25- and 40-line pairs). After acquiring the images, they were submitted to VistaScan Fine, Caries 1, and Caries 2 software filters. Three radiologists analyzed the images in JPEG format. Results: The Pearson's chi-square test showed an association between longer demineralization time and the presence of injury according to the professional's classification. There was no statistically significant association among the other parameters, exposure time, resolution, and use of filters and the presence of a lesion. All parameters showed a greater sensitivity than specificity. The exposure time of 0.2s showed better accuracy, the resolutions 25 and 40lp showed equal results and better than 20lp and the Fine filter obtained better values than the Caries 1 and 2 filters. Conclusions: Despite the variation of parameters, exposure time, resolution, and use of filters, there were no statistically significant differences. For better diagnostic accuracy, it is recommended to use 0.2s of exposure time and a Fine filter, and scan the phosphor plates with 25lp. Key words:Orbital fracture, Etiology, Orbital trauma, Road traffic accidents, Trauma.
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Objetivo: Avaliar a percepção e segurança dos cirurgiões-dentistas servidores municipais de Porto Alegre - RS que realizam radiografias intrabucais em relação à conteúdos da radiologia odontológica. Materiais e métodos: Todos os 26 dentistas que atuam no Centro de Especialidades Odontológicas e Serviço de Apoio Terapêutico da Secretaria Municipal de Saúde foram convidados a participar de 15 horas do Projeto de Extensão em Radiologia Odontológica da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul, onde alunos de graduação atendem pacientes encaminhados pelas unidades básicas de saúde. Foi aplicado um questionário online de 19 questões relacionado a sua segurança e rotina na Radiologia. Os dados coletados foram submetidos à análise descritiva. Dez profissionais participaram do projeto, e oito responderam ao questionário (n=8). Resultados: Realização de técnicas e processamentos radiográficos, a maioria dos participantes mostrou-se segura, assim como os aspectos de radioproteção. Relataram maior dificuldade em realizar exames radiográficos em criança, molares e caninos superiores, além de preferirem, o método manual visual de processamento radiográfico. Foi identificada menor compreensão sobre biossegurança e efeitos biológicos determinísticos. Discussão: Conhecer esses servidores, suas rotinas e vivências com a radiologia, permitiu aprimorar o atendimento aos pacientes e a integração da Faculdade ao programa de educação permanente. Observa-se que princípios teóricos, não estão sedimentados o que pode interferir tanto na sua saúde como na do paciente. Conclusão: Os profissionais estudados sentem-se seguros em relação à prática e compreendem suas lacunas de conhecimento sobre efeitos biológicos e biossegurança na área da Radiologia.
Aim: To evaluate the perception and confidence of dental surgeons working in Porto Alegre - RS who perform intraoral radiographs in relation to the contents of dental radiology. Materials and methods: All 26 dentists who work at the Center for Dental Specialties and Therapeutic Support Service of the Municipal Health Department were invited to participate in 15 hours of the Extension Project in Dental Radiology at the School of Dentistry at the Federal University of Rio Grande do Sul, where students Undergraduate courses assist patients referred by basic health units. An online questionnaire of 19 questions related to your safety and routine in Radiology was applied. The collected data were submitted to descriptive analysis. Ten professionals participated in the project, and eight answered the questionnaire (n=8). Results: Performing radiographic techniques and processing, most participants proved to be safe, as well as radioprotection aspects. They reported greater difficulty in performing radiographic examinations in children, molars and upper canines, in addition to preferring the visual manual method of radiographic processing. Less understanding of biosafety and deterministic biological effects was identified. Discussion: Getting to know these public servants, their routines and experiences with radiology, made it possible to improve patient care and integrate the Faculty into the permanent education program. It is observed that theoretical principles are not settled, which can interfere with both your health and that of the patient. Conclusion: The professionals studied feel safe and understand their knowledge gaps such as biological effects and biosafety in the field of Radiology.
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Radiografía Dental , Exposición a la Radiación , OdontólogosRESUMEN
Objetivo: investigar a literatura relacionada à aplicação e desempenho da Inteligência Artificial (IA) em exames de imagem odontológicos. Revisão de literatura: foram incluídos 70 trabalhos experimentais e revisões sistemáticas da literatura, publicados em inglês, no período entre 2018 e 2021, que analisaram a aplicabilidade da IA na detecção automática de: pontos cefalométricos, lesões de cárie, lesões apicais, perda óssea periodontal, sistemas de implantes, cistos e tumores odontogênicos, osteoporose, sinusite maxilar, terceiros molares e canal mandibular, ateromas em carótida, fratura radicular vertical, osteoartrite em articulação temporomandibular, avaliação de morfologia radicular e numeração dentária. Resultados:58,73% dos trabalhos analisados mostrou acurácia diagnóstica acima de 80% com a utilização de IA. Discussão: A maior limitação encontrada foi em relação à aquisição de amostras em quantidade suficiente para treinamento e teste dos modelos, já que imagens radiográficas têm sua disponibilidade limitada por questões éticas e legais relativas aos pacientes e Instituições. A falta de padronização na segmentação e processamento das imagens foi outro fator a influenciar os resultados obtidos, dificultando comparação e generalização. Apesar disso, diversos estudos apresentaram sugestões ou possíveis aperfeiçoamentos para pesquisas futuras, de forma a reduzir estas limitações. Conclusão: A aplicação da IA no diagnóstico por imagens mostrou-se promissora nas diversas áreas pesquisadas, com desempenhos muito semelhantes ou mesmo superiores, muitas vezes, ao desempenho dos profissionais humanos. Contudo, para a legitimação de sua utilização como parte do fluxo de trabalho na clínica, limitações ainda presentes devem ser superadas, especialmente no treinamento dos algoritmos para obtenção de melhores valores de acurácia.
Aim:to investigate the literature related to the application and performance of Artificial Intelligence (AI) in the analysis of dental imaging. Literature review: 70 experimental studies and systematic literature reviews published in English between 2018 and 2021 were included, which analyzed the applicability of AI models in the automatic detection of the following: cephalometric landmarks, dental caries, periapical diseases, alveolar bone loss, dental implant, odontogenic cysts and tumors, osteoporosis, maxillary sinusitis, third molars and mandibular canal, carotid atheromas, vertical root fracture, osteoarthritis in temporomandibular joint, evaluation of root morphology and numbering of dental elements. Results: 58.73% of the analyzed studies showed diagnostic accuracy above 80%.Discussion:the greatest methodological limitation was the acquisition of samples in sufficient quantity for training and testing phases, since radiographic images are limited to their availability due to ethical and legal issues related to patients and institutions. Lack of standardization in the segmentation and image processing was another factor to influence the results, which was difficult to compare and generalize. Despite this, several studies presented suggestions or possible improvements for future research, in order to reduce the impact of these limitations. Conclusion:the investigation of the applicability of AI in theanalysis of dental radiographic images seems to be still in its early days. The implementation of AI tools as radiologists'auxiliaries in their daily practice depends on overcoming the limitations of current studies and obtaining better diagnostic accuracy indices in future evaluations.
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Radiología , Inteligencia Artificial , Aprendizaje ProfundoRESUMEN
The objective of this study was to better understand human variation by comparing cone-beam computed tomography-based cranial measurements between both sexes of individuals from two distinct populations: Brazilian and Dutch. Cone-beam computed tomography volumes of 311 patients between 20 and 60 years from Brazil and The Netherlands were selected. Two radiologists performed 16 linear measurements in the maxillary sinuses and mandibular canal. Kruskall-Wallis test compared measurements of the two cranial structures between male and female for the two populations and four age ranges (20-30, 31-40, 41-50, 51-60). Mann-Whitney test compared individual measurements obtained from the cranial structures between male and female for each population, and between both populations for both sexes. Intra- and inter-observer reliability was assessed by intraclass correlation test (α = 0.05). No significant differences were found in the linear measurements among the experimental groups including sex, population and age group for both cranial structures (p > 0.05). Most of the cranial linear measurements were significantly higher for male than those for female irrespective of the population (p ≤ 0.05). When the populations were compared regardless of sex, Brazilians presented four significantly higher measurements, and Dutch presented seven significantly higher measurements (p ≤ 0.05). The assessed cranial structures did not differ between Brazilian and Dutch populations for both sexes and four age ranges. Multiple linear measurements differed between both populations with a predominance of larger dimensions for the Dutch population.
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Tomografía Computarizada de Haz Cónico , Cráneo , Humanos , Masculino , Femenino , Brasil , Países Bajos , Reproducibilidad de los Resultados , Cráneo/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico/métodos , MandíbulaRESUMEN
In this study, we aimed to identify factors associated with performing dental imaging examinations in public health services. Brazilian data at the municipal level (n = 5,564) in two time periods, P0 (2005-2007) and P1 (2014-2016), were collated from health information systems. The increase in the municipal rates of intraoral and extraoral radiographic imaging procedures was the outcome. Changes in the use of clinical procedures and the rates of dentists and equipment were the main predictors. Multiple logistic regression analysis was performed to estimate the adjusted odds ratio (OR). Approximately 35.3% of the Brazilian municipalities increased the dental radiography equipment rate, 9.9% increased the fan-beam computed tomography (CT) equipment rate, and 5.9% increased the magnetic resonance imaging (MRI) equipment rate. In addition, 31.8% increased the periapical/interproximal radiography rate, 10.5% increased the CT rate, and 4.4% increased the MRI rate. Increases in the dental radiography, CT, and MRI rates were associated with higher chances of periapical/interproximal images (OR = 1.90, p < 0.01), face and neck images (OR =1 5.3, p < 0.01), and MR images (OR = 18.1, p < 0.01), respectively. Municipalities that increased the rates of endodontists increased the rates of periapical/interproximal (OR = 2.50, p < 0.01) and occlusal (OR = 1.60, p < 0.01) imaging procedures, and those that increased the rates of radiologists also increased the rates of occlusal (OR = 2.00, p < 0.01) and panoramic (OR = 1.70, p < 0.01) imaging procedures. The implementation of a secondary dental care center, Centro de Especialidades Odontológicas (CEO) was associated with an increase in the chances of performing periapical/interproximal and panoramic radiographic procedures in 1.5 and occlusal radiographic examinations in 2.0. The rates of dentists, equipment, specialized dental centers, and specific dental procedures were associated with the increased use of imaging procedures in dentistry in the Brazilian public health system.
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Radiografía Dental , Tomografía Computarizada por Rayos X , Radiografía Panorámica , Radiografía , Brasil , Radiografía Dental/métodos , OdontólogosRESUMEN
This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.
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Tomografía Computarizada de Haz Cónico Espiral , Diente Impactado , Tomografía Computarizada de Haz Cónico/métodos , Humanos , Mandíbula/diagnóstico por imagen , Tercer Molar/cirugía , Cirujanos Oromaxilofaciales , Radiografía Panorámica/métodosRESUMEN
Objetivo: Este estudo avaliou a influência do método de visualização e análise do exame de tomografia computa-dorizada de feixe cônico (TCFC) no diagnóstico de afecções endodônticas. Materiais e métodos: Vinte casos clínicos contendo doze diferentes afecções endodônticas foram ana-lisados por dois especialistas em radiologia odontológica e um especialista em endodontia. Inicialmente, os avaliadores visualizaram os casos em Portable Document Format (PDF) contendo uma seleção de imagens digitais e, por consenso, descreveram suas hipóteses diagnósticas para cada caso. Após uma semana, os avaliadores reavaliaram os casos, desta vez utilizando reconstrução multiplanar em um visualizador de imagens no formato Digital Imaging and Communications in Medicine (DICOM). Novamente, por consenso, eles indicaram suas hipóteses diagnósticas. Resultados: Em 10% dos casos, houve discrepância entre os diagnósticos realizados utili-zando as seleções de imagens digitais em PDF e utilizando a reconstrução multiplanar. A visualização das imagens em PDF obteve sensibilidade de 0.714, especificidade de 0.966, e acurácia de 90%. Discussão: Na maioria destes casos, as afecções endodônticas identificadas utilizando o visuali-zador de imagens DICOM (reconstrução multiplanar) não foram detectadas quando visualizados os PDF de imagens pré-selecionadas. Conclusão: Embora mais estudos sejam necessários, os autores reiteram que a utilização de recons-truções multiplanares sempre são preferíveis comparadas à outras formas de análise da TCFC, para que se atinja o máximo potencial diagnóstico do exame de imagem.
Aim: This study evaluated the influence of the method used for visualization and analysis of cone-beam com-puted tomography (CBCT) on the diagnosis of endodontic conditions. Materials and methods: Twenty clinical cases containing twelve different endodontic conditions were analyzed by two specialists in dental radiology and one specialist in endodontics. Initially, the evaluators viewed the cases in Portable Document Format (PDF) containing a selection of digital images and, by consensus, described their diagnostic hypotheses for each case. One week la-ter, the evaluators reassessed the cases, this time using multiplanar reconstructions with a Digital Imaging and Communications in Medicine (DICOM) format image viewer. Once more, by consensus, they recorded their diagnostic hypotheses. Results: In 10% of the cases there was a discrepancy between the diagnoses made using preselected digital images in PDFs and by viewing multiplanar reconstructions. The visualization of the PDF images obtained a sensitivity of 0.714, specificity of 0.966, and 90% accuracy. Discussion: In the majority of these cases, endodontic conditions identified using the DICOM image viewer (multiplanar reconstruction) were not detected using the PDFs of preselected images. Conclusion: Although more studies are needed, the au-thors reiterate that using multiplanar reconstructions should always be preferred to other forms of analysis for CBCT, so that the maximum diagnostic potential of the imaging exam can be achieved.
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Diagnóstico , Endodoncia/métodos , Tomografía Computarizada de Haz Cónico/métodosRESUMEN
Purpose: The purpose of this study was to compare volume measurements obtained using 2 image software packages on Digital Imaging and Communications in Medicine (DICOM) images acquired from 1 multidetector computed tomography and 5 cone-beam computed tomography devices, using different protocols for physical volume measurements. Materials and Methods: Four pieces of bovine leg were prepared. Marrow was removed from 3 pieces, leaving cortical bone exposed. The resulting space of 1 piece was filled with water, another was filled with propylene glycol, and the third was left unfilled. The marrow in the fourth sample was left fully intact. Volume measurements were obtained after importing DICOM images into the Dolphin Imaging 11.95 and ITK-SNAP software programs. Data were analyzed using 3-way analysis of variance with a generalized linear model to determine the effects of voxel size, software, and content on percentage mean volume differences between tomographic protocols. A significance level of 0.05 was used. Results: The intraclass correlation coefficients for intraobserver and interobserver reliability were, respectively, 0.915 and 0.764 for the Dolphin software and 0.894 and 0.766 for the ITK-SNAP software. Three sources of statistically significant variation were identified: the interaction between software and content (P=0.001), the main effect of content (P=0.014), and the main effect of software (P=0.001). Voxel size was not associated with statistically significant differences in volume measurements. Conclusion: Both content and software influenced the accuracy of volume measurements, especially when the content had gray values similar to those of the adjacent tissues.
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Abstract: In this study, we aimed to identify factors associated with performing dental imaging examinations in public health services. Brazilian data at the municipal level (n = 5,564) in two time periods, P0 (2005-2007) and P1 (2014-2016), were collated from health information systems. The increase in the municipal rates of intraoral and extraoral radiographic imaging procedures was the outcome. Changes in the use of clinical procedures and the rates of dentists and equipment were the main predictors. Multiple logistic regression analysis was performed to estimate the adjusted odds ratio (OR). Approximately 35.3% of the Brazilian municipalities increased the dental radiography equipment rate, 9.9% increased the fan-beam computed tomography (CT) equipment rate, and 5.9% increased the magnetic resonance imaging (MRI) equipment rate. In addition, 31.8% increased the periapical/interproximal radiography rate, 10.5% increased the CT rate, and 4.4% increased the MRI rate. Increases in the dental radiography, CT, and MRI rates were associated with higher chances of periapical/interproximal images (OR = 1.90, p < 0.01), face and neck images (OR =1 5.3, p < 0.01), and MR images (OR = 18.1, p < 0.01), respectively. Municipalities that increased the rates of endodontists increased the rates of periapical/interproximal (OR = 2.50, p < 0.01) and occlusal (OR = 1.60, p < 0.01) imaging procedures, and those that increased the rates of radiologists also increased the rates of occlusal (OR = 2.00, p < 0.01) and panoramic (OR = 1.70, p < 0.01) imaging procedures. The implementation of a secondary dental care center, Centro de Especialidades Odontológicas (CEO) was associated with an increase in the chances of performing periapical/interproximal and panoramic radiographic procedures in 1.5 and occlusal radiographic examinations in 2.0. The rates of dentists, equipment, specialized dental centers, and specific dental procedures were associated with the increased use of imaging procedures in dentistry in the Brazilian public health system.
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Abstract This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.
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Objetivo: Investigar a prevalência e localização de canais mandibulares bífidos (CMB) por meio de tomografia computadorizada de feixe cônico (TCFC). Materiais e métodos: Três radiologistas odontológicos treinados e calibrados avaliaram individualmente 1254 exames tomográficos por meio do software I-Cat Vision (Imaging Sciences International®) e classificaram em quatro tipos distintos (Retromolar, Dental, Anteriorizado e Bucolingual). Os dados de frequência, coletados a partir de um formulário Access (Microsoft® Office), foram analisados por meio dos testes de Fischer e Friedman. O nível de significância estatística foi estabelecido em 5%. Resultados: CMBs foram encontrados em 276 casos (22%), sem predileção por gênero (P=0,186). Houve diferença estatisticamente significante entre os tipos (P=0,001). Discussão: O reconhecimento de um CMB é de grande relevância quando associado a procedimentos anestésicos e cirúrgicos na região posterior da mandíbula. Apesar de muitos estudos demostrarem que o CMB não é comumente visto, uma falha em sua identificação pode resultar em danos ao nervo alveolar inferior (NAI) ou em dificuldade na obtenção do bloqueio anestésico. Conclusão: O tipo mais frequente de CMB em ambos os gêneros, foi o retromolar (P=0,001), representando 18,5%, e visualizado com taxas de 47,1% nas mulheres e 52,9% nos homens. A frequência de CMBs analisada por meio da TCFC foi significativa na população avaliada e apresentou-se com diferentes configurações. Desta forma, sua investigação não deve ser negligenciada frente a procedimentos cirúrgicos que envolvam a região posterior da mandíbula.
Aim: To investigate the prevalence and location of bifid mandibular canals (CMB) using cone beam computed to-mography (CBCT). Materials and methods: Three trained and calibrated dental radiologists individually evaluated 1254 CT scans using the I-Cat Vision software (Imaging Sciences International®) and classified them into four distinct types (Retromolar, Dental, Forward and Buco-lingual). Frequency data, collected from an Access form (Microsoft® Office), were analyzed using the Fischer and Friedman test. The level of statistical significance was set at 5%. Results: CMBs were found in 276 cases (22%), with no gender predilection (P = 0.186). There was a statistically significant difference between the types (P = 0.001). Dis-cussion: The recognition of a CMB is of great relevance when associated with anesthetic and surgical procedures in the posterior region of the mandible. Although many studies have shown that CMB is not commonly seen, a failure to identify it can result in damage to the lower alveolar nerve (NAI) or difficulty in obtaining anesthetic block. Conclusion: The most frequent type of CMB in both genders was retromolar (P = 0.001), representing 18.5%, and visualized with rates of 47.1% in women and 52.9% in men. The frequency of CMBs analyzed using the CBCT was significant in the population evaluated and presented in different configurations. Thus, its investigation should not be neglected in the face of surgical procedures that involve the posterior region of the mandible
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Prevalencia , Tomografía Computarizada de Haz Cónico , Variación Anatómica , Canal Mandibular/diagnóstico por imagen , Estudios Transversales , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate the presence of calcifications in the internal carotid artery (ICA) in cone-beam computed tomography (CBCT), and to verify the association of these findings with sex, age, dental condition, and risk factors associated with vascular disorders. METHODS: The CBCT scans used in this study were obtained from the database of a private dental clinic requested for the planning of rehabilitation with dental implants. The selection criteria were patients aged 40 years and above. Out of a pool of 1176 CBCT examinations, a total of 284 scans of adult patients were evaluated by two blinded observers. Data were collected from patients' medical records. RESULTS: ICA calcifications were present in 63.0% of the examinations. Most calcifications were in the intracranial pathway (166). Despite being present in a smaller number 57 (C1), extracranial calcifications were more severe. Spearman's ρ coefficients (rS) indicated that the number of missing teeth was directly associated with the presence of calcifications (p = 0.042) and severity (p = 0.020). The age variable also had a direct relationship with the presence of calcifications (p ≤ 0.0001), increasing its frequency and severity over the years. In addition, hypertension (p = 0.036) and use of antihypertensive drugs (p = 0.015) were directly associated. CONCLUSIONS: There is a high occurrence of ICA calcifications in CBCT as incidental findings in adult patients, and it is directly associated with age, number of missing teeth and hypertension.
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Aterosclerosis , Enfermedades de las Arterias Carótidas , Adulto , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Arteria Carótida Interna/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Humanos , Hallazgos IncidentalesRESUMEN
The scope of this paper was to analyze the time series of dental procedures performed between 2000 and 2016 in the Brazilian Unified Health System (SUS). The data were obtained from the Outpatient Information System of the SUS (SIA-SUS). The influence of the 2004 National Oral Health Policy of Ordinance No. 600/2006 (which instituted the financing of Dental Specialty Centers - CEOs), and Ordinance No. 1,234/2013 (Financial incentive for the Program for Enhancement of Quality and Access - PMAQ-CEO) were analyzed. Descriptive analyses of the initial and final years of the time series were presented, assessing trends and seasonality in seven types of imaging procedures. The time series of rates of periapical/bitewing radiographic exams revealed a trend of moderate increase and was the only area in which the impact of the financial implementation policy of the CEOs was observed, though not of the PMAQ-CEO. Extraoral imaging exams, such as panoramic radiography, facial CT/TMJ and TMJ MRI revealed a strong upward trend, despite the very low rates. The conclusion reached is that between 2000 and 2016, the policy of expansion of secondary care increased the use of periapical/bitewing imaging exams.
O objetivo foi analisar a série temporal de procedimentos de imagem em Odontologia realizados entre os anos de 2000 e 2016 no Sistema Único de Saúde (SUS). Os dados foram obtidos do Sistema de Informações Ambulatoriais (SIA-SUS). Foram analisadas a influência da Política Nacional de Saúde Bucal de 2004, da Portaria nº 600/2006 (institui o financiamento dos Centros de Especialidades Odontológicas - CEOs) e Portaria nº 1.234/2013 (Incentivo financeiro do Programa de Melhoria do Acesso e da Qualidade - PMAQ-CEO). Apresentou-se análises descritivas dos anos inicial e final da série temporal, avaliando tendências e sazonalidade em sete tipos de procedimentos. A série temporal das taxas de exames radiográficos periapicais/interproximais demonstrou tendência de aumento moderado e foi a única em que se observou o impacto da política de implementação financeira dos CEOs, mas não do PMAQ-CEO. Os exames extraorais como: radiografia panorâmica, Tomografia Computadorizada (TC) da face/Articulação Temporomandibular (ATM) e Ressonância Magnética (RM) da ATM possuem forte tendência de aumento apesar das taxas serem muito baixas. Conclui-se que entre os anos 2000 e 2016, a política de expansão da atenção secundária, aumentou o uso de exames de imagem periapical/interproximal.
Asunto(s)
Programas de Gobierno , Atención Secundaria de Salud , Brasil , Política de Salud , Humanos , Radiografía PanorámicaRESUMEN
Resumo O objetivo foi analisar a série temporal de procedimentos de imagem em Odontologia realizados entre os anos de 2000 e 2016 no Sistema Único de Saúde (SUS). Os dados foram obtidos do Sistema de Informações Ambulatoriais (SIA-SUS). Foram analisadas a influência da Política Nacional de Saúde Bucal de 2004, da Portaria nº 600/2006 (institui o financiamento dos Centros de Especialidades Odontológicas - CEOs) e Portaria nº 1.234/2013 (Incentivo financeiro do Programa de Melhoria do Acesso e da Qualidade - PMAQ-CEO). Apresentou-se análises descritivas dos anos inicial e final da série temporal, avaliando tendências e sazonalidade em sete tipos de procedimentos. A série temporal das taxas de exames radiográficos periapicais/interproximais demonstrou tendência de aumento moderado e foi a única em que se observou o impacto da política de implementação financeira dos CEOs, mas não do PMAQ-CEO. Os exames extraorais como: radiografia panorâmica, Tomografia Computadorizada (TC) da face/Articulação Temporomandibular (ATM) e Ressonância Magnética (RM) da ATM possuem forte tendência de aumento apesar das taxas serem muito baixas. Conclui-se que entre os anos 2000 e 2016, a política de expansão da atenção secundária, aumentou o uso de exames de imagem periapical/interproximal.
Abstract The scope of this paper was to analyze the time series of dental procedures performed between 2000 and 2016 in the Brazilian Unified Health System (SUS). The data were obtained from the Outpatient Information System of the SUS (SIA-SUS). The influence of the 2004 National Oral Health Policy of Ordinance No. 600/2006 (which instituted the financing of Dental Specialty Centers - CEOs), and Ordinance No. 1,234/2013 (Financial incentive for the Program for Enhancement of Quality and Access - PMAQ-CEO) were analyzed. Descriptive analyses of the initial and final years of the time series were presented, assessing trends and seasonality in seven types of imaging procedures. The time series of rates of periapical/bitewing radiographic exams revealed a trend of moderate increase and was the only area in which the impact of the financial implementation policy of the CEOs was observed, though not of the PMAQ-CEO. Extraoral imaging exams, such as panoramic radiography, facial CT/TMJ and TMJ MRI revealed a strong upward trend, despite the very low rates. The conclusion reached is that between 2000 and 2016, the policy of expansion of secondary care increased the use of periapical/bitewing imaging exams.
Asunto(s)
Humanos , Atención Secundaria de Salud , Programas de Gobierno , Brasil , Radiografía Panorámica , Política de SaludRESUMEN
OBJECTIVES: To compare surgical (ST) and non-surgical (NST) debridement for the treatment of peri-implantitis in a two-center randomized trial. MATERIALS AND METHODS: Forty-five individuals with 63 implants with probing depth (PPD) ≥5mm, bleeding on probing (BOP), and radiographic bone loss ≥2mm were included. In the NST (30 implants), submucosal debridement was performed. In the ST (33 implants), a mucoperiosteal flap was raised and surfaces were decontaminated only by debridement as performed in NST. Clinical parameters and radiographs were compared at baseline and after 12 months. Means and standard errors were reported. RESULTS: PPD considering all implant sites reduced significantly in NST from 4.14±0.25 to 3.25±0.18mm. In ST, PPD also significantly changed (3.74±0.22 to 3.00±0.29mm). No significant differences were observed between the two groups. For deep sites (≥7mm), PPD was 7.82±0.20mm at baseline and reduced to 5.10±0.30mm in NST, while in ST group, it was 7.11±0.11mm and changed to 5.22±0.91mm (between-groups p value=0.51). BOP significantly reduced from ~60 to 35% of all sites in both groups, without significant differences between them. When sites with radiographic bone level ≥3mm at baseline were analyzed, there was a significant difference between groups in bone gain after 12 months in favor of ST (ST=0.78±0.30mm compared to NST=0.25mm±0.13; p=0.03). CONCLUSIONS: Surgical and non-surgical debridement for the treatment of peri-implantitis present similar clinical outcomes. Bone levels were better improved in ST than NST for sites with higher initial bone loss. CLINICAL RELEVANCE: The treatment of peri-implantitis is still a challenge in clinical practice, since less than half of affected implants achieve health after surgical or non-surgical debridement. Considering the lack of clinically relevant differences between these two treatments, non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.