Impact of the SARS-Cov2 Pandemic on Orthodontic Therapies: An Italian Experience of Teleorthodontics

Abstract Objective: To assess the possibility of controlling patients at a distance according to principles of teleorthodontics to understand its possible usefulness in the future routine activity and the impact pandemic may have had on different types of orthodontic treatments. Material and Methods: One hundred orthodontic patients (57 F, 43 M, age 7-46) during quarantine were checked through videocalls and photos sent by patients following proper instructions. Three groups have been distinguished based on the type of therapy: A-fixed appliances; B-removable appliances; C-clear aligners. Relevant events about dental and gingival health, integrity of appliances, orthodontic therapies related symptoms and overall progress of treatments were recorded. Results: A and B groups reported higher percentages of gingival inflammation (27 and 22%), dental plaque (16 and 13%), deciduous tooth loss (8 and 16%). Bracket and attachment detachment were the most frequent events in A and C groups (22 and 23%). Pain and discomfort were reported in A and B groups (35 and 32%). Therapies continued to progress better in C (51% improved dental alignment) and B (31% improved malocclusions) groups. Conclusion: Orthodontics is safe and allows during emergencies to postpone checks. Everyday mobile-technology is useful in managing orthodontic patients unable to carry out in-person control. When their effectiveness equals other systems, treatments with clear aligners without attachments should be preferred in patients unavailable for regular checks.

Color assessment in dental prostheses: the use of smartphones as process tools / Tomada de cor em prótese dentária: Uso de celular como auxílio do processo

Accurate color selection of direct or indirect dental restorations is a subjective task. Mobile phones are tools that may minimize color assessment errors. The objective was to use photographs taken with smartphones to guide the dental surgeon in choosing the right color in oral rehabilitation. A tooth was photographed for color assessment and the VITA Toothguide 3D-MASTER® shade guide was used. Photographs were submitted to an image editing software for full saturation removal. Images of the tooth and scale in black and white were compared. This method allowed to select the tooth's value, which is considered the most subjective dimension in color choice. Although it is an auxiliary and complementary method to traditional methods, smartphones are tools capable of reducing the range of color possibilities and minimizing possible failures (AU)

A correta seleção da cor das restaurações dentais diretas ou indiretas é uma atividade subjetiva. Os celulares são ferramentas que podem minimizar os erros da tomada de cor. O objetivo foi utilizar fotografias realizadas com smartphones para orientar o cirurgião-dentista na escolha da cor em reabilitação oral. Foi fotografado um dente para tomada de cor e a escala Vita 3D Master. As imagens foram submetidas a um software de edição de imagem para remoção total da saturação. As imagens em preto e branco do dente e da escala foram comparadas. A metodologia permitiu selecionar o valor do dente que é o aspecto considerado mais subjetivo na escolha da cor. Apesar de ser um método auxiliar e complementar aos métodos tradicionais é uma ferramenta capaz de diminuir o leque de possibilidades de cores e minimizar possíveis falhas (AU)

Diagnóstico à distância de lesões bucais com fotografias de smartphones / Remote diagnosis of oral lesions with smartphone photos

Objetivos: Avaliar o acerto diagnóstico entre a avaliação presencial de lesões bucais e a hipótese diagnóstica proposta à distância para uma amostra de imagens digitais obtidas por meio de um smartphone. Materiais e Métodos: O estudo teve desenho observacional transversal com amostra de conveniência. Os dados foram coletados no ambulatório de Estomatologia da Universidade Federal do Paraná, e obtidos a partir de exame físico oral, história da doença e registro fotográfico de lesões bucais realizado com um smartphone. Todos os pacientes que apresentaram lesões bucais visíveis à inspeção foram convidados a participar do estudo. A história clínica e as imagens dos participantes foram enviadas por e-mail para dois avaliadores, que foram solicitados a formular um mínimo de uma e máximo de duas hipóteses diagnósticas para cada caso. As hipóteses diagnósticas formuladas à distância foram comparadas com o padrão-ouro em cada caso clínico proposto, e medidas pelo coeficiente kappa. Resultados:O estudo avaliou uma amostra de 42 fotografias de lesões bucais obtidas de 23 pacientes. Em 91% e 87% dos casos, para os avaliadores 1 e 2, respectivamente, houve concordância do diagnóstico à distância comparado ao padrão-ouro. Os valores de concordância obtidos foram considerados ótimos de acordo com os valores de kappa (K = 0,864 - 0,909). Conclusão: O diagnóstico de lesões bucais por meio de imagens obtidas com um smartphone mostrou boa concordância e acerto diagnóstico comparável com aquele obtido presencialmente e pode ser sugerido como uma ferramenta auxiliar na referência de casos entre a atenção primária e a média complexidade em Estomatologia.

To evaluate the diagnostic accuracy between presential assessments of oral lesions and the diagnostic hypothesis proposed at distance with the use of a sample of photographs obtained with a smartphone.The study had a cross-sectional observational design with a convenience sample. The data were collected at the oral medicine ou patient clinic of Federal University of Paraná. They were obtained from clinical oral examination, a brief clinical history and photographic record of oral lesions taken with as martphone camera. The participants were all the patients with oral lesions visible to inspection. The clinical information and the photographs of were sent by email for two remote consultants, who weresolicited to formulate a maximum of two diagnostic hypotheses for each case. The diagnostic hypotheses formulated by the remote consultant were compared to the gold standard in each clinical caseand measured by the kappa coefficient. The sample was composed by 42 photographs of oral lesions obtained from 23 patients. In 91% and 87% of the cases, there was agreement from distant diagnosis when compared to the gold standard for consultants 1 and 2, respectively. The concordance obtained between the diagnostic hypotheses and the gold standard was considered “excellent” according to thevalues of kappa index (K = 0,864 - 0,909). The diagnosis of oral lesions through images obtained with as martphone showed good diagnostic accuracy and was comparable to that obtained in person. It canbe suggested as an auxiliary tool in refererring cases from primary to secondary care in oral medicine.