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Three-dimensional (3D) printing technology is a reality in medicine. In Orthopedics and Traumatology, 3D printing guides a precise and tailored surgical treatment. Understanding and disseminating its applicability, use, and outcomes can foster academicism and improve patient care. This is a report of a rare case of a female young adult patient with osteonecrosis of the humeral head due to avascular necrosis developed in early childhood. The treatment was tailored and optimized with 3D printing, which helped determine the steps for partial humeral arthroplasty.

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Investigation of the biological sex of human remains is a crucial aspect of physical anthropology. However, due to varying states of skeletal preservation, multiple approaches and structures of interest need to be explored. This research aims to investigate the potential use of distances between bifrontal breadth (FMB), infraorbital foramina distance (IOD), nasal breadth (NLB), inter-canine width (ICD), and distance between mental foramina (MFD) for combined sex prediction through traditional statistical methods and through open-access machine-learning tools. Ethical approval was obtained from the ethics committee, and out of 100 cone beam computed tomography (CBCT) scans, 54 individuals were selected with all the points visible. Ten extra exams were chosen to test the predictors developed from the learning sample. Descriptive analysis of measurements, standard deviation, and standard error were obtained. T-student and Mann-Whitney tests were utilized to assess the sex differences within the variables. A logistic regression equation was developed and tested for the investigation of the biological sex as well as decision trees, random forest, and artificial neural networks machine-learning models. The results indicate a strong correlation between the measurements and the sex of individuals. When combined, the measurements were able to predict sex using a regression formula or machine learning based models which can be exported and added to software or webpages. Considering the methods, the estimations showed an accuracy rate superior to 80% for males and 82% for females. All skulls in the test sample were accurately predicted by both statistical and machine-learning models. This exploratory study successfully established a correlation between facial measurements and the sex of individuals, validating the prediction potential of machine learning, augmenting the investigative tools available to experts with a high differentiation potential.

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Objective: To compare the medical image interpretation's time between the conventional and automated methods of breast ultrasound in patients with breast lesions. Secondarily, to evaluate the agreement between the two methods and interobservers. Methods: This is a cross-sectional study with prospective data collection. The agreement's degrees were established in relation to the breast lesions's ultrasound descriptors. To determine the accuracy of each method, a biopsy of suspicious lesions was performed, considering the histopathological result as the diagnostic gold standard. Results: We evaluated 27 women. Conventional ultrasound used an average medical time of 10.77 minutes (± 2.55) greater than the average of 7.38 minutes (± 2.06) for automated ultrasound (p<0.001). The degrees of agreement between the methods ranged from 0.75 to 0.95 for researcher 1 and from 0.71 to 0.98 for researcher 2. Among the researchers, the degrees of agreement were between 0.63 and 1 for automated ultrasound and between 0.68 and 1 for conventional ultrasound. The area of the ROC curve for the conventional method was 0.67 (p=0.003) for researcher 1 and 0.72 (p<0.001) for researcher 2. The area of the ROC curve for the automated method was 0. 69 (p=0.001) for researcher 1 and 0.78 (p<0.001) for researcher 2. Conclusion: We observed less time devoted by the physician to automated ultrasound compared to conventional ultrasound, maintaining accuracy. There was substantial or strong to perfect interobserver agreement and substantial or strong to almost perfect agreement between the methods.

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Introduction Onodi cells (OCs) are posterior ethmoid cells that are located above the sphenoid sinus, close to or even surrounding the carotid artery and optic nerve. Objective To investigate and evaluate the volumetric variation of OCs through multi-slice computed tomography (MSCT) scans. Methods We performed a retrospective review of MSCT scans of 79 subjects, 40 male and 39 female patients, Whose age ranged from 18 to 83 (mean: 39.6) years. The volumes of the OCs on the right and left sides were measured using the ITK-SNAP software (open-source) with semiautomatic segmentation. The possible relationships involving age, gender, contact with the optic nerve, extension of the pneumatization of the posterior ethmoid cells into the clinoid processes, mucous thickening in the anterior and posterior ethmoid cells, and obliteration of the sphenoethmoidal complex were analyzed with the Pearson correlation and Chi-squared tests according to the type of data compared and logistic regression models ( p < 0.05). Results We observed that an increase of one unit in the volume of OCs also increases the chance of extension of pneumatization into the clinoid processes by 0.15% ( p = 0.001). No significant correlations were identified regarding age, gender, and volume of the OCs. Conclusion The volume of the OCs has effects on the extension of pneumatization into the clinoid processes.

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Virtual surgical planning and three-dimensional (D) printing are rapidly becoming essential for challenging and complex surgeries around the world. An Ibero-American survey reported a lack of awareness of technology benefits and scarce financial resources as the two main barriers to widespread adoption of 3-D technologies. The Pereira Rossell Hospital Center is a publicly funded maternal and pediatric academic clinical center in Uruguay, a low-resource Latin American country, that successfully created and has been running a 3-D unit for 4 years. The present work is a step-by-step review of the 3-D technology implementation process in a hospital with minimal financial investment. References to training, software, hardware, and the management of human resources are included. Difficulties throughout the process and future challenges are also discussed.

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Abstract Introduction Onodi cells (OCs) are posterior ethmoid cells that are located above the sphenoid sinus, close to or even surrounding the carotid artery and optic nerve. Objective To investigate and evaluate the volumetric variation of OCs through multi-slice computed tomography (MSCT) scans. Methods We performed a retrospective review of MSCT scans of 79 subjects, 40 male and 39 female patients, Whose age ranged from 18 to 83 (mean: 39.6) years. The volumes of the OCs on the right and left sides were measured using the ITK-SNAP software (open-source) with semiautomatic segmentation. The possible relationships involving age, gender, contact with the optic nerve, extension of the pneumatization of the posterior ethmoid cells into the clinoid processes, mucous thickening in the anterior and posterior ethmoid cells, and obliteration of the sphenoethmoidal complex were analyzed with the Pearson correlation and Chi-squared tests according to the type of data compared and logistic regression models (p < 0.05). Results We observed that an increase of one unit in the volume of OCs also increases the chance of extension of pneumatization into the clinoid processes by 0.15% (p = 0.001). No significant correlations were identified regarding age, gender, and volume of the OCs. Conclusion The volume of the OCs has effects on the extension of pneumatization into the clinoid processes.

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Abstract Three-dimensional (3D) printing technology is a reality in medicine. In Orthopedics and Traumatology, 3D printing guides a precise and tailored surgical treatment. Understanding and disseminating its applicability, use, and outcomes can foster academicism and improve patient care. This is a report of a rare case of a female young adult patient with osteonecrosis of the humeral head due to avascular necrosis developed in early childhood. The treatment was tailored and optimized with 3D printing, which helped determine the steps for partial humeral arthroplasty.

Resumo A tecnologia de impressão tridimensional (3D) é uma realidade no âmbito da medicina. Na Ortopedia e Traumatologia, a impressão 3D direciona um tratamento cirúrgico preciso e individualizado. Compreender e difundir suas aplicações, utilidades e resultados pode fomentar o academicismo e melhorar o cuidado ao paciente. Trata-se de relato de um caso raro de uma paciente adulta jovem com osteonecrose da cabeça umeral por necrose avascular desenvolvida na primeira infância. O tratamento foi individualizado e otimizado com a impressão 3D, que ajudou a determinar os passos para o procedimento de artroplastia parcial de úmero.

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Abstract Objective: To compare the medical image interpretation's time between the conventional and automated methods of breast ultrasound in patients with breast lesions. Secondarily, to evaluate the agreement between the two methods and interobservers. Methods: This is a cross-sectional study with prospective data collection. The agreement's degrees were established in relation to the breast lesions's ultrasound descriptors. To determine the accuracy of each method, a biopsy of suspicious lesions was performed, considering the histopathological result as the diagnostic gold standard. Results: We evaluated 27 women. Conventional ultrasound used an average medical time of 10.77 minutes (± 2.55) greater than the average of 7.38 minutes (± 2.06) for automated ultrasound (p<0.001). The degrees of agreement between the methods ranged from 0.75 to 0.95 for researcher 1 and from 0.71 to 0.98 for researcher 2. Among the researchers, the degrees of agreement were between 0.63 and 1 for automated ultrasound and between 0.68 and 1 for conventional ultrasound. The area of the ROC curve for the conventional method was 0.67 (p=0.003) for researcher 1 and 0.72 (p<0.001) for researcher 2. The area of the ROC curve for the automated method was 0. 69 (p=0.001) for researcher 1 and 0.78 (p<0.001) for researcher 2. Conclusion: We observed less time devoted by the physician to automated ultrasound compared to conventional ultrasound, maintaining accuracy. There was substantial or strong to perfect interobserver agreement and substantial or strong to almost perfect agreement between the methods.

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La microtomografía es un estudio que utiliza la ra-diación X para obtener imágenes de tamaños de mi-lésimas de milímetros y de alta resolución. Las imá-genes 2D son procesadas por diferentes softwares para lograr obtener volúmenes capaces de ser ana-lizados tridimensionalmente. La microtomografía es el estudio de elección a la hora de evaluar caracte-rísticas muy pequeñas con gran precisión. La obtu-ración endodóntica buscar lograr un sellado que no tenga espacios vacíos dentro de la masa de obtura-ción. Esto es importante debido a que los poros pue-den permitir, si están en contacto con la pared den-tinaria, la entrada de microorganismos al conducto radicular. El objetivo de este trabajo fue describir el procedimiento para el análisis y visualización de los espacios vacíos dentro de la obturación endodónti-ca, utilizando la microtomografía de rayos x, y esta-blecer un protocolo para ser utilizado por cualquier investigador(AU)

Microtomography is a study that uses X-radiation to obtain high-resolution images of sizes of thousandths of millimeters. The 2D images are processed by different software to obtain volumes capable of being analyzed three-dimensionally. Microtomography is the study of choice when evaluating very small features with great precision. Endodontic filling seeks to achieve a seal that does not have voids within the filling obturation. This is important because the voids can allow, if they are in contact with the dentin wall, the entry of microorganisms into the root canal. The objective of this work was to describe the procedure for the analysis and visualization of voids within the endodontic filling using microtomography and to establish the protocol to be used by any researcher (AU)

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ABSTRACT Purpose This study aimed to investigate three-dimensional facial soft tissue dimensions, maximum bite force (MBF), and occlusal contact area in patients with DFD. In addition, we analyzed the relationship between MBF and the three-dimensional facial measurements. Methods Thirty-two patients with skeletal Class III DFD and 20 patients with Class II DFD underwent a soft tissue evaluation using surface laser scanning, as well as MBF and occlusal contact area assessments. The DFD groups were compared with each other and with 25 healthy subjects. Results Significant morphological differences were found in the transversal, vertical, and anteroposterior dimensions between Class II DFD and Class III DFD. Both DFD groups presented an increased linear distance of chin height, which was strongly related with decreased MBF magnitude. The DFD groups exhibited lower MBF and occlusal contact area, with no significant differences between Class II and Class III DFD. Conclusion The presence of DFD affected 3D measurements of facial soft tissue, causing variations beyond normal limits, lower MBF, and occlusal contact area in both Class II and Class III DFD patients. The vertical dimension might have influenced the lower MBF magnitude in the studied skeletal deformities.

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OBJECTIVE: To compare direct visual analysis (DVA) and intraoral scanning (IOS) for the assessment of developmental defects of the enamel (DDE). METHODS: Thirty-nine extracted permanent human teeth with DDE were selected by an experienced examiner and digitised using IOS. The scanning was recorded using the OBS Studio software parallel to the IOS software to obtain a coloured high-definition MP4 file of the process. Two other experienced, blinded, and calibrated examiners randomly analysed the same teeth through DVA and IOS. A third examiner resolved any disagreements between the two examiners. Descriptive statistics were used to analyse the frequencies of the scores. Cohen's kappa test was used to determine whether the DVA scores were different from those assigned using IOS. Spearman's test was used to verify non-random examiner errors. The Chi-square test was used to compare score frequencies. Statistical significance was set at p <0.05. RESULTS: Scores indicating more severe and extended DDE (p <0.05) were more frequently assigned with IOS than with DVA (IOS: 25.64%, 25.64%, 38.46%, and 35.90% between one-third to two-third of the lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 10.26%, 7.69%, 15.38%, and 10.26% for the respective aforementioned tooth surfaces). Contrarily, 'no visible enamel defect' was significantly less assigned for IOS than for DVA (IOS: 15.38%, 43.59%, 35.90%, 15.38%, and 17.95% for buccal, lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 38.46%, 66.67%, 56.41%, 51.28%, and 43.59% for the respective aforementioned tooth surfaces). Kappa agreement ranged from fair to moderate when comparing DVA and IOS; the correlation between both methods was positive, indicating that the examiners assigned the scores properly and the differences arose from employing different methods. CONCLUSION: The assessment of DDE differed depending on the method used. IOS scores indicated more severe and extended DDE than DVA scores. Clinical investigation is the next step in validating the use of IOS for DDE diagnosis. CLINICAL SIGNIFICANCE: This study showed that DDE can be assessed differently using IOS. It is clinically relevant as it directly affects the determination of the severity of the defect and dental treatment planning.

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Abstract In this integrative review, we aimed to describe the records of time devoted by physicians to breast ultrasound in a review of articles in the literature, in order to observe whether the automation of the method enabled a reduction in these values. We selected articles from the Latin American and Caribbean Literature in Health Sciences (LILACS) and MEDLINE databases, through Virtual Health Library (BVS), SciELO (Scientific Electronic Library Online), PubMed, and Scopus. We obtained 561 articles, and, after excluding duplicates and screening procedures, 9 were selected, whose main information related to the guiding question of the research was synthesized and analyzed. It was concluded that the automation of breast ultrasound represents a possible strategy for optimization of the medical time dedicated to the method, but this needs to be better evaluated in comparative studies between both methods (traditional and automated), with methodology directed to the specific investigation of this potentiality.

Resumo Na presente revisão integrativa, objetivamos descrever os registros de tempo dedicado pelos médicos à ultrassonografia mamária em revisão de artigos da literatura, visando observar se a automação do método possibilitou redução destes valores. Selecionamos artigos nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e MEDLINE, através da Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (SciELO), PubMed e Scopus. Obtivemos 561 artigos e, após a exclusão de artigos duplicados e procedimentos de triagem, foram selecionados 9 artigos, cujas informações principais relativas à pergunta norteadora da pesquisa foram sintetizadas e analisadas. Foi concluído que a automação da ultrassonografia mamária representa uma possível estratégia de otimização do tempo médico dedicado ao método; porém, essa conclusão necessita ser melhor avaliada em estudos comparativos entre ambos os métodos (tradicional e automatizado), com metodologia direcionada à investigação específica desta potencialidade.

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The purpose of this study was to analyze the volume and area of sphenoid sinuses of Brazilian individuals' cone-beam computed tomography (CBCT) images using the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland), to assess a potential correlation to sex, age, skin color, and nutritional status, and to evaluate differences between the right and left sides. Three-dimensional volume and area measurements were made with the software using CBCT images of 113 living Brazilian individuals of both sexes (67 females and 46 males). TEM, rTEM, and R were used to assess the reproducibility of inter- and intra-examiner measurements. The measurement means were estimated with 95% confidence intervals according to sex and age group. There were no significant differences between the left and right sides for both volume and area and between the sexes and black and white individuals. Volume and area were significantly higher in 18 years or older (p < 0.05) and in individuals with normal body mass index (BMI) (p < 0.05). The obtained results do not allow indicating the use of sphenoid sinuses volume and area measurements to estimate sexual dimorphism, and the same occurred for skin color. However, such measures can help to estimate age. Further studies are suggested with a larger sample, especially for the nutritional status variable.

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Abstract Objective: Pharyngocutaneous fistula is one of the severe complications related to head and neck surgeries. Detecting the accurate three-dimensional location of both the fistula and leakage is essential for surgical treatment. Videofluoroscopy is usually used for locating these; however, its imaging is two-dimensional. We evaluated pharyngeal leakage and fistulae using Cone Beam Computed Tomography (CBCT), known for its three-dimensional high spatial resolution imaging, taken in a sitting position, with oral contrast (contrast CBCT). Methods: Pharyngeal leakage and fistulae were evaluated in a total of 31 subjects by sequentially performing videofluoroscopy and contrast CBCT. The detection accuracy of videofluoroscopy and contrast CBCT for leakage and fistula, as well as the ability to determine the extent and depth for surgical planning, were investigated and compared. Results: Videofluoroscopy and contrast CBCT showed suspicious leakage and/or fistula in six and three of the 31 subjects, respectively. Surgical findings revealed the presence of leakage and/or fistula in three of the 31 subjects. The positive predictive values of videofluoroscopy and contrast CBCT were 50% (3/6) and 100% (3/3), respectively. Contrast CBCT provided more precise images, showing the extent and depth of leakage and fistula in three-dimensions. Conclusion: The present study's results indicate the usefulness of contrast CBCT in terms of accurate diagnosis of leakage and fistula, due to its three-dimensional imaging being performed with the patient in a sitting position. Level of evidence: 4.

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OBJECTIVE: Pharyngocutaneous fistula is one of the severe complications related to head and neck surgeries. Detecting the accurate three-dimensional location of both the fistula and leakage is essential for surgical treatment. Videofluoroscopy is usually used for locating these; however, its imaging is two-dimensional. We evaluated pharyngeal leakage and fistulae using Cone Beam Computed Tomography (CBCT), known for its three-dimensional high spatial resolution imaging, taken in a sitting position, with oral contrast (contrast CBCT). METHODS: Pharyngeal leakage and fistulae were evaluated in a total of 31 subjects by sequentially performing videofluoroscopy and contrast CBCT. The detection accuracy of videofluoroscopy and contrast CBCT for leakage and fistula, as well as the ability to determine the extent and depth for surgical planning, were investigated and compared. RESULTS: Videofluoroscopy and contrast CBCT showed suspicious leakage and/or fistula in six and three of the 31 subjects, respectively. Surgical findings revealed the presence of leakage and/or fistula in three of the 31 subjects. The positive predictive values of videofluoroscopy and contrast CBCT were 50% (3/6) and 100% (3/3), respectively. Contrast CBCT provided more precise images, showing the extent and depth of leakage and fistula in three-dimensions. CONCLUSION: The present study's results indicate the usefulness of contrast CBCT in terms of accurate diagnosis of leakage and fistula, due to its three-dimensional imaging being performed with the patient in a sitting position.

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OBJECTIVE: To compare and assess the reproducibility of 3 methods for registration of maxillary digital dental models in patients with anterior open bite. Settings and sample population Digital dental models of 16 children with an anterior open bite in the mixed dentition were obtained before (T1) and after 12 months of treatment with bonded spurs (T2). METHODS: Landmarks were placed on all T2 models and 3 registration methods (R1, R2 and R3) were independently performed by 2 observers. R1 was based on 10 landmarks placed on posterior teeth. R2 was based on 5 landmarks on the palate (2 anterior, 2 posterior and 1 central). R3 used regions of interest around the 5 palatal landmarks used in R2. The differences between the registration methods were calculated by comparing the mean differences and standard deviations between the corresponding x, y and z coordinates of 6 corresponding landmarks in the T2 registered models. Repeated measures analysis of variance followed by post-hoc Bonferroni tests were used for comparisons (P < .05). The agreement between methods and the intra and interobserver reproducibility were assessed with Bland-Altman tests and intraclass correlation coefficients (ICC). RESULTS: Comparisons of R2 with R3 methods showed greater agreement, mean differences ≤0.50 mm for all landmarks, than comparisons of R1 with R2, and R1 with R3, mean differences >0.50 mm for most of the y and z coordinates (P < .05). The R1 and R3 methods presented excellent intra and interobserver reproducibility and R2 method had moderate interobserver reproducibility. CONCLUSIONS: Longitudinal assessments of open bite treatment using digital dental models could consider the posterior teeth and/or the palate as references. The R1 and R3 methods showed adequate reproducibility and yield different quantitative results. The choice will depend on the posterior teeth changes and dental models' characteristics.

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OBJECTIVE: To evaluate the acceptance of orthodontists, laypeople and the patient when progressive mandibular advancements are performed in class II subjects with mandibular retrognathism. SETTING AND SAMPLE: 3D images were obtained by an optical surface scanning of fifteen individuals (12 males and three females, mean age of 23 years and 8 months) with mandibular retrognathism in three mandibular positions: maximum intercuspation (MIC) and progressive mandibular advancement of 2 and 4 mm. METHODS: The images (n = 45) were evaluated through a scale by two groups of panellist, 20 orthodontists, 20 laypeople and by the patients themselves (n = 15). The participants evaluated and rated each video and give scores between 0 and 10, according to their perception of facial harmony. MANOVA for repeated measures was used for intra- and intergroup differences and to evaluate the patients' self-perception. RESULTS: Laypeople reported better face acceptance than orthodontists in MIC and progressive mandibular advancement of 2 and 4 mm (P < .0001). 80% of the patients evaluated their own face as pleasant in MIC. Around half of them did not note significant difference following mandibular advancement of 2 mm as compared with MIC and even two-third attributed lower scores when the mandible was advanced 4 mm. CONCLUSION: A high variability was observed among all groups of raters. Patient´s opinion should be taken into account when mandibular advancement of 4 mm or more is planned. This study suggests that a thorough discussion of facial changes resulting from mandibular advancement should be carried out among professionals, parents and patients.

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Resumo Objetivo: Esse estudo teve como objetivo comparar a acurácia de mensurações lineares realizadas, de acordo com o método de Moyers, em modelos de gesso pelo método manual com paquímetro em modelos digitais 3D digitalizados por scanner de mesa e em modelos digitais 3D obtidos por Tomografia Computadorizada Multislice com protocolo CTdBem. Método: Um único operador selecionou 90 modelos de gesso da arcada inferior para análise de dentição mista. Os métodos testados e o método manual foram comparados usando o teste-t pareado. Para avaliar o acordo entre os métodos, a correlação de Pearson foi utilizada. O gráfico de Bland-Altman foi construído para avaliar a diferença entre as medidas de cada amostra. Resultados: Não houve diferenças significativas entre as medidas do scanner e da Tomografia Computadorizada Multislice, quando comparadas com as medidas do método manual (p>0.05). Ambos os métodos digitais apresentaram correlação alta e significativa com o método manual com coeficientes de 0,98 e 0,97 para o scanner e a Tomografia Computadorizada Multislice, respectivamente (p<0.01). Conclusão: Os modelos digitais obtidos por scanner de mesa e por Tomografia Computadorizada Multislice com protocolo CTdBem produziram medidas lineares e com boa acurácia, compatíveis com as medidas manuais realizadas em modelo de gesso. (AU)

Abstract Aim: This study has aimed to compare the accuracy of linear measurements made, according to the Moyers method, on plaster casts by the manual method using a pachymeter in digital 3D models digitalized by a desktop scanner and in 3D digital models scanned by Multislice Computed Tomography using the CTdBem protocol. Method: A single operator has selected 90 plaster casts of the mandibular arch for analysis of mixed dentition. The methods tested and manual method were compared by using the paired t-test. To assess the agreement between the methods, Pearson's correlation was performed. The Bland-Altman plot was built to evaluate the difference among the measurements for each sample. Results: There were no significant differences between scanner and Multislice CT measurements when compared to the manual method measurements (p> 0.05). Both digital methods have had a high and significant correlation with the manual method with coefficients of 0.98 and 0.97 for the scanner and Multislice CT method, respectively (p<0.01). Conclusions: The digital models obtained by means of the desktop scanner and Multislice Computed Tomography by means of CTdBem protocol produced linear measurement and with good accuracy, compatible with the manual measurements made on plaster casts (AU)

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