RESUMO
BACKGROUND: Temporomandibular joint (TMJ) morphologies are complex, and changes in joint components have been studied extensively. TMJ conditions have many different etiologies, appearances, and relevant clinical significance. OBJECTIVE: The objective of this study was to evaluate the concordance of the diagnosis of degenerative changes in the TMJ in panoramic radiographs. MATERIALS AND METHODS: Cone beam computed tomography (CBCT) was used as a reference standard. Images of 84 patients (168 TMJs), 61 females (72.6%) and 23 males (27.4%) with an average age of 47.4 years, were evaluated by three radiologists who established the presence or absence of degenerative changes in the jaw heads. The data were collected and organized in a spreadsheet. Concordance between evaluators was analyzed using agreement percentages, statistical κ, and confidence intervals. In the analysis of compliance with CBCT, sensitivity, specificity, predictive positive and negative values, and probabilities of false positives and negatives were also calculated. All inferential tests were performed with a 5% significance level. RESULTS: The percentage of agreement among raters in panoramic radiographs ranged from 66.7% to 82.9%, considered mild to moderate. Correlation between radiographic and tomographic images ranged from 45.5% to 64.9% in the inter-evaluator reviews, representing a very mild agreement. Sensitivity ranged from 28.6% to 58.7% and specificity from 66.7% to 100.0%. Positive predictive value ranged from 77.1% to 100.0%; the negative predictive value was lower, ranging from 32.2% to 54.8%. The probability of false negatives was higher than that of false positives, ranging from 45.2% to 67.8%. CONCLUSION: The rater did not reach acceptable diagnosis levels.
RESUMO
Atualmente, a maior parte dos pacientes ortodônticos gostaria de ser tratado com alinhadores transparentes, preferindo esses aos brackets metálicos ou estéticos. Assim se torna fundamental o ortodontista dominar a técnica desde as fases iniciais (fluxo de trabalho) até a condução dos casos. O tratamento ortodôntico com alinhadores possui uma série de vantagens em relação ao convencional, pois é mais discreto, estético, confortável, permite uma higienização mais fácil e não há restrição de alimentação. Entretanto algumas desvantagens aparecem, tais como a necessidade de cooperação por parte do paciente e algumas limitações biomecânicas. Alguns sistemas têm se destacado no mercado por oferecerem aos dentistas serviços de planejamento digital e produção de alinhadores ortodônticos, tornando esses aptos a conduzirem de forma mais direta e com maior autonomia os seus tratamentos com alinhadores. Dessa forma o propósito desse artigo é apresentar de forma simplificada o sistema de alinhadores Cleartek e alguns casos clínicos e assim fornecer subsídios para o ortodontista que pretende utilizá-lo, desde o planejamento até o acompanhamento clínico e finalização dos casos tratados.(AU)
Currently, most orthodontic patients would like to be treated with transparent aligners, preferring these to metal or aesthetic brackets. So it becomes essential to the orthodontist to master the technique from the initial phases to the conduction of the cases. Orthodontic treatment with aligners has a number of advantages compared to conventional ones, because it is more discreet, aesthetic, comfortable, allow easier hygiene and there is no food restriction. However, some disadvantages appear, such as the need of patient cooperation and some biomechanical limitations. Some systems have excel out in the market for offering dentists services of digital planning and production of orthodontic aligners, allowing them to be able to lead in a more direct form and with more autonomy their treatments with aligners. So the purpose of this article is to present in a simplified way Cleartek aligners system and some clinical cases and thus to provide subsidies for the orthodontist that intends to use them, from the planning to the clinical follow-up and completion of the treated cases. (AU)