Facial, dental, periodontal, and tomographic characteristics of the etiology of excessive gingival display: a cross-sectional clinical study.

PURPOSE: In this study, we examined the facial, dental, periodontal, and tomographic features associated with excessive gingival display (EGD) when smiling in young adults self-reporting a "gummy smile," categorized by potential etiology. METHODS: The study included 25 healthy adults (18-42 years old; 23 women and 2 men) who self-reported EGD. Participants completed a health questionnaire and underwent a periodontal examination assessing probing depth, clinical attachment level, keratinized gingival width, and gingival thickness (GT). Extraoral and intraoral photographs were taken for smile analysis and to determine facial and dental characteristics. Cone-beam computed tomography (CBCT), performed with a lip retractor in place, was used to measure the distance from the gingival margin (GM) to the cementoenamel junction (CEJ), the distance from the CEJ to the alveolar crest, buccal bone thickness, and GT. The extent of EGD when smiling was quantified as the distance from the GM at the upper central incisor to the upper lip edge when smiling fully. The smile was categorized into 4 types based on gingival exposure characteristics observed during full smile. RESULTS: Most participants were female (92%), with a mean age of 28.77±6.56 years. The average EGD was 4.2±2.44 mm, extending bilaterally from the anterior to the posterior maxilla. Two primary etiological factors were identified, alone or in combination: vertical maxillary excess (VME), predominantly indicated by an anterior maxillary height greater than 29 mm and a large interlabial gap; and altered passive/active eruption (APE), primarily characterized by square teeth (64%), upper central incisor width-to-height ratio (CIW:CIH) exceeding 87.5%, and GM-CEJ distance on CBCT exceeding 2 mm. CONCLUSIONS: These findings suggest a multifactorial etiology of EGD, primarily associated with VME and APE. Clinical periodontal examination, CBCT conducted with a lip retractor, CIW:CIH, and soft tissue facial cephalometric analysis may aid in identifying the etiological factors of EGD.

Home / Archives / Vol. 12 No. 1 (2024) / Articles SPATIAL DISTRIBUTION OF MOLAR INCISOR HYPOMINERALIZATION (MIH) OPACITIES IN FIRST PERMANENT MOLARS

Aim: To evaluate the spatial distribution of MIH opacities in first permanent molars (FPM). Materials and methods: an analysis of intraoral photographs of FPM with demarcated MIH opacities was conducted. The presence of opacity was computed in a digital matrix, discriminating the anatomical regions of the FPM surfaces. The frequencies of distribution of the opacities were descriptively analyzed through 227 FPM digital images of 89 children built in GIMP and Python and by Spearman correlation (= 0,05). Results: the occlusal surface was the most affected one (94% to 100%). In the upper FPM, the palatine surface was the second most affected one (84%-91%). In the lower FPM, the vestibular surface was the second most affected one (85%-80%). A similar pattern of opacity distribution was observed in the contralateral teeth. On smooth surfaces, opacities were more frequent in the regions closer to the occlusal surface than to the cervical one. Conclusion: MIH opacities were mostly present on occlusal, vestibular, and lingual/palatine surfaces, respectively. There is a possibility that the occurrences are in accordance with the chronology of dental formation.

Digital planning and guided dual technique in esthetic crown lengthening: a randomized controlled clinical trial.

OBJECTIVES: The present study aimed to compare the guided dual technique with the conventional technique in esthetic crown lengthening (ECL). MATERIALS AND METHODS: The trial registration number is NCT04922086. Twenty-four participants diagnosed with altered passive eruption (APE) type I subcategory B were selected and allocated into two groups. In the control group (n = 12), the ECL procedure was planned by clinical examination and transgingival probing; in the test group (n = 12), the ECL procedure was carried out using digital planning and a double guide. Clinical parameters were assessed at baseline, immediately after the intervention (IAI), and at 4, 8, and 12 months of follow-up. RESULTS: The clinical crown length (CCL) mean at baseline was 8.09 mm (± 0.77) and increased significantly to 9.92 mm (± 0.62) IAI, with minimal significant reduction after 12 months (9.47 mm [± 0.60]) in the control group. Similarly, in the test group, the mean CCL at baseline was 8.04 mm (± 0.69) and increased significantly to 9.94 mm (± 0.57) IAI, with minimal reduction after 12 months (9.35 mm [± 0.80]). No differences were found between the mean CCL determined in the digital planning and after 12 months. No correlation was found between gingival thickness and gingival margin stability. High esthetic satisfaction was demonstrated by participants/specialists without differences between groups. CONCLUSIONS: In conclusion, the guided dual technique was as effective as the conventional technique for treatment of APE, with stable results after 12 months of follow-up. CLINICAL RELEVANCE: The guided dual technique aims to transfer both the gingival and bone resection planned position to facilitate the ECL surgical procedure and increase treatment predictability.

Comparison of visual shade matching and photographic shade analysis.

OBJECTIVE: To compare the performance of a standardized photographic shade analysis (PSA) and visual shade matching (VSM) using two color difference formulas. MATERIALS AND METHODS: Fifty observers (35 undergraduate and 15 graduate students) evaluated the color of two upper left central incisors (LT-light tooth, and DT-dark tooth). VSM was performed using the VITA 3D Master (3D) shade guide in a controlled clinical environment. For PSA, a cross-polarized filter and a gray card (Whibal) were used to standardize the photographs taken (target teeth and shade tabs from 3D). From the pictures obtained, the CIELAB coordinates, and color differences ( Δ E ab * and ΔE00 ) were obtained. The shade tabs selected by two experienced researchers were conducted as part of the pilot study, and finally used as a standard for the analysis. Data were analyzed using descriptive statistics and the chi-square test (p ≤ 0.05). RESULTS: Shade tabs selections of VSM and PSA agreed only for LT. The best "Match" selected by the researchers agreed with data from PSA using ΔE00 . PSA using ΔE00 showed higher total percentages of "Match" and higher percentage of agreement among observers. A relationship was found for LT performing the PSA (p < 0.05). CONCLUSIONS: The performance of the PSA was better than the VSM, but only when the CIEDE2000 color difference formula was used. Therefore, the color difference formulas influenced on the performance of PSA. Finally, the PSA improved the precision of the VSM. CLINICAL SIGNIFICANCE: To use a standardized PSA to improve the VSM and shade communication in clinical esthetic dentistry.

Criterios exigidos en revistas odontológicas venezolanas para la publicación de la fotografía extraoral en casos clínicos / Criteria required in Venezuelan dental journals for the publication of the extraoral photographs in case reports

Objetivo. Describir los criterios exigidos en revistas odontológicas venezolanas para la publicación de la fotografía clínica extraoral en los casos clínicos publicados en el periodo 2010-2021. Métodos. Investigación de enfoque cuantitativo, alcance descriptivo y transversal. Se analizaron artículos científicos que incluyeran fotografías clínicas extraorales publicadas en revistas odontológicas venezolanas entre 2010 y 2021. Resultados. Se observó exigencia por parte de la editorial en las estrategias de preservación de identidad del paciente, sumado al uso del consentimiento informado para las publicaciones de fotografías clínicas extraorales de casos clínicos. Conclusiones. La revista Acta Odontológica hace mayor uso de consentimiento informado, además de utilizar el enmascaramiento y anonimato como método de preservación de la identidad en sus publicaciones.

Objective. To describe the criteria required in Venezuelan dental journals for the publication of extraoral clinical photography in clinical cases published in the period 2010- 2021. Methods. Research with a quantitative approach, descriptive scope, and cross-sectional design. Scientific articles that included extraoral clinical photographs published in Venezuelan dental journals between 2010 and 2021 were analyzed. Results. There was a need from the publisher in the strategies of preservation of the patient's identity, and to the use of informed consent for the publication of photographs. extraoral clinics of clinical cases. Conclusions. The Acta Odontológica journal makes greater use of in- formed consent, in addition to using masking and anonymity as a method of identity preservation in its publications.

Planejamento Digital do Sorriso / Planificación digital de la sonrisa / Digital Smile Planning

RESUMO Introdução: Avanços no campo da Odontologia Estética têm proporcionado métodos cada vez mais inovadores na construção de um sorriso funcional e harmonioso. O elevado grau de exigência do paciente por detalhes e por sorrisos personalizados evidencia a necessidade do clínico em lançar mão de meios que facilitem a comunicação para o melhor entendimento de seus pacientes em relação ao tratamento proposto. Objetivo: Realizar uma revisão de literatura sobre Planejamento Digital do Sorriso em Odontologia. Métodos: Com caráter atual e integrativo, esta revisão de literatura foi realizada utilizando os descritores estética dentária, sorriso e fotografia dentária, em portugês, inglês e espanhol, obtendo 302 artigos, dos quais foram utilizados 51 artigos e 1 livro como base científica para o estudo, obedecendo os critérios de inclusão e exclusão. Análise e integração da informação: Os avanços na informática, fotografia digital e processamento de imagens, bem como a redução dos custos envolvidos, têm proporcionado que um planejamento tradicional em odontologia para tratamentos estéticos tenha evoluído para um planejamento digital, fornecendo uma visão ampla do diagnóstico, melhorando a comunicação entre paciente e equipe profissional envolvida, tornando o tratamento mais previsível, facilitando a compreensão e permitindo sua análise crítica e participação mais ativa no planejamento. Considerações finais: As técnicas utilizadas para realização do Planejamento Digital do Sorriso tornam os procedimentos mais previsíveis, melhorando a visualização e compreensão das etapas a serem realizadas. O conceito de Visagismo não apresenta embasamento científico suficiente. Aplicações de conceitos de proporção áurea na odontologia têm sido bastante estudadas, porém seu uso não é consensual por existirem outros parâmetros(AU)

RESUMEN Introducción: Avances en el campo de la Odontología Estética han proporcionado métodos cada vez más innovadores en la construcción de una sonrisa funcional y armoniosa. El alto grado de exigencia del paciente por detalles y por sonrisas personalizadas evidencia la necesidad de que el clínico use medios que faciliten la comunicación para una mejor comprensión de sus pacientes con respecto al tratamiento propuesto. Objetivo: Realizar una revisión de literatura sobre planificación digital de la sonrisa en odontología. Métodos: Esta revisión de literatura se realizó utilizando los descriptores "estética dental", "sonrisa" y "fotografía dentaria", en portugués, inglés y español. Se recuperaron un libro y 302 artículos, de los cuales, el libro y 51 artículos fueron utilizados como base científica para el estudio. Análisis e integración de la información: Los avances en la informática, fotografía digital y procesamiento de imágenes, así como la reducción de los costos involucrados, han permitido que una planificación dental tradicional en odontología para tratamientos estéticos evolucione hacia la planificación digital y proporcione una visión amplia del diagnóstico. Esto ha mejorado la comunicación entre los pacientes y los equipos de profesionales involucrados y ha hecho el tratamiento más previsible. Así se ha facilitado la comprensión del paciente, se ha permitido su análisis crítico y su participación más activa en la planificación. Consideraciones finales: Las técnicas utilizadas para realizar la planificación digital de la sonrisa hacen los procedimientos más previsibles y mejora la visualización y comprensión de cada etapa. El concepto de Visagismo no presenta un fundamento científico suficiente. Las aplicaciones de conceptos de proporción áurea en la odontología han sido bastante estudiadas, pero, por existir otros parámetros, su uso no es consensual(AU)

ABSTRACT Introduction: Advances in the field of aesthetic dentistry have provided increasingly innovative methods for building a functional and harmonious smile. The high degree of patient demand for details and for personalized smiles shows the need for clinicians to use means that facilitate communication for better understanding of their patients regarding the proposed treatment. Objective: To carry out a literature review on digital smile planning in dentistry. Methods: This literature review was performed using the descriptors estética dental [dental aesthetics], sonrisa [smile], and fotografía dental [dental photography], in Portuguese, English and Spanish. A book and 302 articles were retrieved, of which the book and 51 articles were used as scientific basis for the study. Information analysis and integration: Advances in computer science, digital photography and image processing, as well as the reduction of costs involved, have allowed traditional dental planning in dentistry for aesthetic treatments to evolve towards digital planning and to provide comprehensive diagnostic insight. This has improved communication between patients and professional teams involved and has made treatment more predictable. Thus, the patient's understanding has been facilitated, as well as is has permitted his or her critical analysis and more active participation in planning. Final considerations: The techniques used to carry out digital smile planning make the procedures more predictable and improve the visualization and understanding in each stage. The concept of visagism does not present a sufficient scientific basis. The applications of golden ratio concepts into dentistry have been extensively studied, but, due to the existence of other parameters, their use is not consensual(AU)

Verificação do tempo de percepção da unicidade em marcas de mordidas e sua aplicação forense: estudo piloto / Uniqueness perception time verification in bite marks and their forensic application: pilot study

Introdução: As marcas de mordida são lesões que contribuem para a identificação de agressores, vítimas e criminosos, possuindo valor probatório em processos judiciais por apresentarem características peculiares de cada indivíduo, embora não apresentem imutabilidade e perenidade, salvo quando registradas fotograficamente. Objetivo: Verificar o potencial de autoimagens de marcas de mordida a partir de aparelhos celulares, tanto para identificação de agressores, bem como estimar o respectivo tempo de percepção da unicidade. Metodologia: A pesquisa consistiu na participação de 6 (seis) voluntários, sendo definido por sorteio que um destes seria a suposta vítima e outro o agressor. Após sorteio, o agressor desferiria uma mordida na porção medial do antebraço esquerdo da vítima. Foram feitas fotografias desta mordida com a câmera do celular e registrados os tempos com intervalos de 5 minutos até 40 minutos. Após esta etapa, foram realizadas fotografias dos arcos dentais superiores e inferiores dos 5 (cinco) suspeitos. O confronto dessas imagens com a autoimagem do agredido foi feito por comparação direta e sobreposição, utilizando um software livre. Resultados: Após a comparação dos arcos dentais dos suspeitos com as lesões, foi possível identificar o agressor. Conclusão: No presente estudo piloto, observou-se que as imagens fotográficas feitas até quinze minutos após a mordida mostraram características anatômicas suficientes para realizar o confronto e identificar o ofensor. Passados 20 minutos da agressão, não mais havia características lesivas na pele que embasassem o requisito da unicidade.

Introduction: Bite marks are injuries that contribute to victims and criminals identification, having probative value in lawsuits, since they present characteristics of each individual, even though they don't show immutability and permanence, except when photographed. Objective: Verify the potential of self-images of bite marks from mobile devices, for identification of aggressors and to estimate the respective time of perception of the unicity. Methodology: This research consists of the participation of 6 (six) volunteers, being defined by raffle that one will be the victim and another the aggressor. After this definition, the offender will bite on the medial portion of the victim's left forearm. Photographs of this bite were taken with the camera of the cell phone and the times registered with time spaces of 5 minutes to 40 minutes. After this step, photographs of the upper and lower arches of the 5 (five) suspects were taken. The confrontation of these images with the self-image of the assaulter was done by direct comparison and overlap using Image J (free software). Results: After comparing the arches of the 5 suspects, it was possible to identify the aggressor. Conclusion: In the present pilot study, it was observed that the photographical images taken up to fifteen minutes after the bite showed sufficient anatomical characteristics to compare and identify the offender. After 20 minutes of the picture being taken, there were no more harmful skin characteristics that would support the uniqueness requirement

Comparisons between photographic equipment for dental use: DSLR cameras vs. smartphones / Comparações entre equipamento fotográfico para uso odontológico: câmeras DSLR vs. smartphones

Objective: to compare the image quality obtained by six cameras used for dental documentation, including four DSLR cameras and two smartphones with different sensor size. Methods: the equipment determined the groups: APSCcan18-55 ­ Sensor APS-C Canon (EOS T5i) + 18-55 mm lens; APSCcan100 ­ Sensor APS-C Canon (EOS T5i) + 100 mm macro lens; APSCnik18-55 ­ Sensor APS-C Nikon (D5100) + 18-55 mm lens; APSCnik100 ­ Sensor APS-C Nikon (D5100) + 100 mm macro lens; ip1/3" ­ iPhone with 1/3-inch sensor; ga1/2.6"- Galaxy with 1/2.6-inch sensor. Two set of images -"dental documentation" and "small objects"- were obtained. The photographs were evaluated by three groups: US, undergraduate students; DS, dentists; and DP, dentists with photography experience. Scores between 0 and 10 were assigned. The results were compared by RM Anova and Tukey (α = 0.05). Results: the highest overall scores were obtained with APSCnik100 (8.5). For "dental documentation", APSCcan18-55 and APSCnik18-55 showed the lowest values, even compared to ga1/2.6" (for US, DS and DP evaluators) and ip1/3" (for US evaluators). For "small objects", DSLRs resulted in higher mean values compared to smartphones for US and DS. Conclusions: DSLR cameras with 18-55 mm lens and no circular flash should not be used for documentation photographs. DSLR cameras, regardless of lens, are superior to smartphones for small objects photographs. (AU)

Objetivo: comparar a qualidade da imagem obtida por seis câmeras utilizadas para documentação odontológica, incluindo quatro câmeras DSLR e dois smartphones com diferentes tamanhos de sensor. Métodos: a divisão dos grupos foi realizada pelo tipo de equipamento: APSCcan18-55 - Sensor APS-C Canon (EOS T5i) + lente 18-55 mm; APSCcan100 - Sensor APS-C Canon (EOS T5i) + lente macro de 100 mm; APSCnik18-55 - Sensor APS-C Nikon (D5100) + lente 18-55 mm; APSCnik100 - Sensor APS-C Nikon (D5100) + lente macro de 100 mm; ip1 / 3 "- iPhone com sensor de 1/3 de polegada; ga1 / 2.6 "- Galaxy com sensor de 1 / 2,6 polegadas. Dois conjuntos de imagens ­ "documentação odontológica" e "pequenos objetos" ­ foram realizados. As fotografias foram avaliadas por três grupos de examinadores: estudantes de graduação (US); dentistas (DS); e dentistas com experiência em fotografia (DP). Foram atribuídas pontuações entre 0 e 10. Os resultados foram comparados por Anova e Tukey (α = 0,05). Resultados: os maiores escores foram obtidos com o APSCnik100 (8,5). Para "documentação odontológica", APSCcan18-55 e APSCnik18-55 apresentaram os menores valores. Para "objetos pequenos", as DSLRs resultaram em valores médios mais altos em comparação aos smartphones. Conclusões: as câmeras DSLR com lentes de 18 a 55 mm e sem flash circular não devem ser usadas para fotografias de documentação. As câmeras DSLR, independentemente da lente, são superiores aos smartphones para fotografias de objetos pequenos. (AU)

Determinação do biótipo periodontal através da análise de fotografias intra-orais / Determination of periodontal biotype through analysis of intra-oral photographs

Objetivo: Caracterizar os Biótipos Periodontais (BP) por meio de fotografias, além de verificar a concordância com o método clínico de determinação, bem como com diferentes profissionais em Odontologia. Material e método: A avaliação clínica intra-bucal de 34 pacientes (n=34) e verificação de fotografias padronizadas foram realizadas para caracterização dicotômica do BP em fino e espesso. A avaliação subjetiva, por meio da fotografia, foi comparada ao método clínico da transparência à sondagem. A determinação do BP por meio de fotografias foi realizada através da aplicação de um questionário contendo três categorias (fino, espesso e intermediário), direcionadas a 90 cirurgiões-dentistas divididos igualmente em três grupos: clínicos gerais, periodontistas e protesistas. A concordância em ambas as comparações foi avaliada por meio do Teste Kappa, além dos testes de sensibilidade e especificidade. Resultado: Na comparação entre o método clínico e o fotográfico, não houve concordância (K = 0,264, p = 0,113). Na comparação entre os grupos dos profissionais, foi encontrada uma baixa concordância (kappa = 0,160; p<0,05) entre os periodontistas e protesisas, bem como entre protesistas e clínicos gerais (kappa = 0,110; p = 0,142). Houve maior concordância, ainda que fraca, entre periodontistas e clínicos gerais (kappa = 0,291; p = 0,00). O questionário obteve um valor de sensibilidade e especificidade maior para o diagnóstico do BP espesso. Conclusão: A avaliação clínica do paciente por meio dos parâmetros clínicos ainda é necessária para caracterizar o BP, visto que a determinação usando-se análise visual por meio do fotografia, independentemente da especialidade, não foi efetiva, embora o BP espesso tenha sido o mais facilmente identificado.

Objective: To characterize the Periodontal Biotypes (PB) through photographs and verify the agreement with the clinical method of determination as well as with different Dental professionals. Material and method: Standardized photographs and intraoral clinical evaluation of 34 patients (n = 34) were performed for dichotomous characterization of PB in thin and thick. The subjective assessment, through photography, was compared to clinical method of probing transparency. The PB determination by photographs was performed through the application of a questionnaire containing three categories (thin, thick intermediate) directed to 90 dental professionals. They were equally divided into 3 groups: general practitioners, periodontists and prosthodontists. The concordance in both comparisons was evaluated through the Kappa Test, in addition to the sensitivity and specificity tests. Result: In the comparison between the clinical and the photographic method, there was no agreement (K = 0.264, p = 0.113). However, in the comparison between the groups of professionals, a low agreement (kappa = 0.160; p <0.05) was found between periodontists and prothesis, as well as between prosthesis and general practitioners (kappa = 0.110; p = 0.142). Greater agreement, although weak, between periodontists and general practitioners (kappa = 0.291, p = 0.00). The questionnaire obtained a higher sensitivity and specificity value for the diagnosis of thick PB. Conclusion: The evaluation of patients through clinical parameters is still necessary to characterize PB, since the determination using visual analysis using photography, regardless of specialty, was not effective, although thick PB was the most easily identified.

Comparación de mediciones antropométricas directa y con sistema de imagen 3D, en adultos jóvenes / Comparison of direct and 3D anthropometric measurements in young adults

RESUMEN: Objetivo: El objetivo de este estudio fue determinar si existe equivalencia entre las medidas faciales obtenidas mediante antropometría facial directa y antropometría facial indirecta utilizando sistema de imagen digital en tres dimensiones en adultos jóvenes. Materiales y métodos: Estudio transversal descriptivo. La muestra consistió en 81 voluntarios (19-29 años). A cada uno se le realizó mediciones de 6 distancias faciales con el método antropométrico directo y 5 distancias faciales con el método fotogramétrico 3D. Se utilizaron los programas Excel 2013 y Stata14®. Se aplicó el test de Shapiro-Wilk, para establecer el tipo de distribución de los datos. Para los que presentaron distribución normal se aplicó t-Test; para aquellos con distribución no normal, se aplicó test de Mann-Whitney. Se comparó las mediciones obtenidas con ambos métodos. Resultados: Se compararon las 5 distancias faciales medidas con el método antropométrico directo con las 5 registradas mediante fotogrametría 3D y se determinó que no existe diferencia estadísticamente significativa entre los métodos utilizados. Hubo una medición que no pudo ser registrada con el método fotogramétrico 3D. Conclusión: La antropometría facial indirecta medida en imágenes 3D, entrega mediciones equivalentes a la antropometría facial directa.

ABSTRACT: Objective: The aim of this study was to determine if there is equivalence between facial measurements obtained through direct facial anthropometry and indirect facial anthropometry using a three-dimensional digital imaging system in young adults. Materials and methods: Descriptive cross-sectional study. The sample consisted of 81 volunteers (19-29 years). Each was measured with 6 facial distances with the direct anthropometric method and 5 facial distances with the 3D photogrammetric method. The programs Excel 2013 and Stata14® were used. The Shapiro-Wilk test was applied to establish the type of distribution of the data. For those with normal distribution, t-Test was applied; for those with non-normal distribution, a Mann-Whitney test was applied. The measurements obtained with both methods were compared. Results: We compared the 5 facial distances measured with the direct anthropometric method with the 5 recorded by 3D photogrammetry and it was determined that there is no statistically significant difference between the methods used. There was a measurement that could not be recorded with the 3D photogrammetric method. Conclusion: The indirect facial anthropometry measured in 3D images, provides measurements equivalent to direct facial anthropometry.

Proposta de adaptação em afastadores labiais para fotografia oclusal / A proposal of adaptation in cheek retractors for occlusal photographs

Os autores apresentam uma técnica de adaptação em afastadores labiais em "C" para torná-los mais adequados às fotografias oclusais, evitando a sua interferência no posicionamento do espelho e permitindo mais abertura bucal durante a tomada fotográfica. As etapas de recorte, acabamento e polimento dos afastadores são demonstradas. A partir da proposta de alteração e recorte dos afastadores, obtém-se afastadores personalizados para uso em fotografias oclusais que permitirão melhor afastamento dos lábios e posicionamento do espelho, sem interferir na durabilidade dos acessórios. (AU)

The authors present a technique for adaptating "C" shaped cheek retractors, in order to make them more suitable for occlusal photographs, thus avoiding their interference in mirror positioning and allowing greater mouth opening while capturing these images. The steps of trimming, finishing and polishing the retractors are demonstrated. From this proposal of alteration and trimming of the retractors, one obtains customized retractors for use in occlusal photographs, which will allow better lip retraction and mirror positioning, without interfering with the durability of the accessories (AU)

Validation of the digital photographic assessment to diagnose traumatic dental injuries.

INTRODUCTION: Alternatives for monitoring dental trauma in epidemiological surveys may be useful, as data collection of epidemiological investigation can be jeopardized due to several conditions. AIM: To investigate the validity of standard digital photographs to determine the occurrence of anterior dental trauma compared to the clinical examination in an epidemiological survey. METHODS: Participants were children aged 8-12 years old attending both private and public schools; children were clinically evaluated for the assessment of dental trauma, and standard photographs were taken from maxillary and mandibular permanent incisors of each child. Validity was determined by calculating the percentages and respective 95% confidence interval of sensitivity, specificity, positive predictive value, and negative predictive value. Cohen's kappa statistic was also used. RESULTS: A total of 412 children were included, totaling 3296 teeth assessed for dental trauma presence. The prevalence of dental trauma was 11.2% (95% CI 8.29-14.61) and 10.2% (95% CI 7.45-13.53), respectively, for the clinical examination and the photographic method. Agreement between the gold standard and the photographic diagnosis was good: 0.64 for the prevalence of dental trauma and 0.66 for diagnosis of dental trauma on a tooth basis. The diagnosis through the photographic method had higher specificity (96.7%) than sensitivity (65.2%). High positive likelihood ratio and low negative likelihood ratio were also observed. CONCLUSION: The photographic assessment method of dental trauma was valid and reliable as compared to the oral clinical examination.

Delineamento dental computadorizado das bordas incisais, em fotografias de sorriso, com finalidade pericial / Computerized dental delimitation of incisal edges in smile photographs with forensic purposes

Introdução: O aumento da criminalidade no Brasil tem gerado um incremento dos casos de identificação humana envolvendo corpos carbonizados, putrefeitos e esqueletizados nos Institutos Médicos Legais dopaís. Neste contexto, a Odontologia Legal tem demonstrado sua importância na identificação humana porvárias técnicas, dentre elas a identificação por meio de fotografias do sorriso. Objetivo: Demonstrar, pormeio de um relato de caso, a execução da técnica de demarcação da linha incisal em fotografiascasuais/sociais de sorriso utilizando o software Power Point®(Microsoft®, Redmond, EUA), com finalidadede identificação humana. Relato de caso: um cadáver parcialmente carbonizado foi examinado para determinação da causa mortis e identificação humana. Diante da inexistência de registrosmédico/odontológicos, os supostos familiares foram orientados a apresentarem fotografias em que apessoa desaparecida aparecesse sorrindo, a fim de que essas fossem comparadas com fotografias análogas produzidas a partir das arcadas dentárias do cadáver. Por meio da delimitação das linhas incisais dos dentes inferiores utilizando o Power Point®(Microsoft®, Redmond, EUA) e comparação comlinha semelhante produzida a partir das fotografias de sorriso fornecidas, foi possível a identificaçãopositiva do cadáver. Conclusão: Apesar de a técnica ilustrada poder ser realizada com outros programasde computador, o Power Point®(Microsoft®, Redmond, EUA) permite a obtenção do delineamento incisalcom maior facilidade e com a mesma confiabilidade de programas mais complexos, em casos de análisepericial do sorriso.

Criminality increased in Brazil in the last years. Consequently, human identification cases involvingcharred and putrefied bodies, as well skeletal remains, became more prevalent. In this context, forensic dentistry played an important role enabling several pathways to aid human identifications, including the analysis of smile photographs. Objective: To report a case of human identification illustrating the techniqueused for tracing the contour of incisal borders using Power Point®(Microsoft®, Redmond, USA) softwarepackage in smile photographs. Case report: An unknown partially charred human body was referred fordental identification and investigation on the cause of death at the local medico-legal institute. In the lackof ante-mortem (AM) medical/dental data potential relatives of the victim were asked to provide socialphotographs showing the teeth of the victim (smile photographs). The obtained photographs were used forcomparison with photographs produced post-mortem (PM). In both AM and PM photographs the contour ofthe incisal borders were traced using Power Point®(Microsoft®, Redmond, USA) software package andqualitatively matched for a positive identification. Conclusion: Extracting the incisal contour of human teethis feasible through commonly used software packages and may support forensic investigations based onidentity.

O uso da imagem fotográfica como método adicional de diagnóstico para regiões de cicatrículas e fissuras pigmentadas de dentes permanentes / The use of the photographic image as an additional diagnostic Method for regions of pits and fissures of permanent teeth pigmented "evaluation in vivo and in vitro"

O diagnóstico de cárie em estágio inicial é ainda um desafio, principalmente nas regiões oclusais de fóssulas e fissuras, que muitas vezes encontram- se pigmentadas gerando dúvida ao clínico quanto à necessidade de intervenção. O objetivo deste trabalho foi avaliar um método adicional clínico de diagnóstico de lesões cariosas de cicatrículas e fissuras através de imagens fotográficas. Este estudo foi realizado in vivo, em 18 indivíduos selecionados dentre os pacientes em atendimento odontológico nas clínicas de Dentística da FOB-USP e que possuiam molares permanentes com sulcos e fissuras pigmentados. Os dentes (n= 62) foram examinados clinicamente e através das imagens fotográficas digitais com aumento de 1:1 por 3 examinadores independentes que determinaram se o dente deveria receber intervenção terapêutica com preparo cavitário e restauração. Um estudo paralelo foi realizado in vitro, com o exame de 60 molares extraídos e fixados em um manequim odontológico, feito pelos mesmo examinadores da etapa in vivo e, também, pelo exame de fotografias digitais. O exame radiográfico digital foi realizado e, em seguida, os dentes foram seccionados em máquina de corte digital ISOMET® 1000, com disco diamantado dupla face Diamond Wafering Blade, perpendicularmente à superfície oclusal em cortes no sentido do sulco principal e novamente analisados pelos 3 avaliadores para a identificação da presença de lesão cariosa. Os dados foram avaliados pela estatística Kappa e pelo teste Qui-Quadrado (p<0,05). Os valores de Kappa interexaminador para as avaliações in vivo foram para análise visual: 0,65-0,55-0,53 e fotográfico: 0,79-0,89-0,89. Para as análises in vitro, os valores para o exame visual foram: 0,85-0,65-0,78 e fotográfico: 1- 0,86-0,86. Para a etapa in vitro o teste Qui-Quadrado demostrou que somente o exame clínico visual apresentou uma leve associação com as fatias (p= 0,036), porém para o exame fotográfico o valor de p foi de (p= 0,918)...

The diagnosis of caries in early stage is still a challenge, especially in pigmentesd pit and fissure surfaces of posterior teeth. The purpose of this study was to evaluate the use of digital photographic images as an additional method to diagnose caries lesion in early stages.This in vivo and in vitro study was realized by examining 62 molars of 18 patients of the Restorative Dentistry Clinic of FOB- USP. The teeth were examined by 3 independent examiners who determined wether the tooth should be or not submitted to a cavity preparation and restoration. The same teeth were photographed and the digital images with 1:1 increase size were blind examined by the same examiners.The decision of the need of intervention was confronted by the two methods. A parallel study "in vitro" was conducted with 60 extracted human molars fixed in a dental manikin for to use of a digital photographic image as a diagnostic additional method for pit and fissure lesions, a study. The same examiners analyzed the oclusal surface and the correspondent digital photographic images. The decision of the need of intervention was confronted by the 2 methods. The extracted teeth were then sectioned in an ISOMET® 1000 digital cutting machine, witch doublé diamond disc face Diamond Wafering Blade, perpendicular to the occlusal surface cuts and examined by the 3 examers to identifying the presence of carious lesions. Kappa intra and inter examiners were for in vivo visual analysis 0.65- 0.55- 0.53 and in vivo photographic analysis: 0.79 -0.89 - 0.89. For in vitro visual analyzes were: 0.85- 0.65- 0.78 and in vitro photographic analysys: 1-0.86- 0.86. Data were evaluated by chi-square test (p < 0.05) showed that only the visual clinical examination showed as light association with the cuts (p = 0.036) and for the photographic examination (p = 0.918). The decision made by the examiners of the need of intervention on the pit and fissure surfaces was confronted with the examination...

Evaluation of a photographic method to measure dental angulation.

OBJECTIVE: To analyze the reliability and reproducibility of a simplified method for analysis of dental angulation using digital photos of plaster dental casts. METHODS: Digital and standardized photographs of plaster casts were performed and posteriorly imported to an angle reading graphic program in order to have measurements obtained. Such procedures were repeated to evaluate the random error and to analyze reproducibility through intraclass correlation. The sample consisted of 12 individuals (6 male and 6 female) with full permanent dentition and not orthodontically treated. The analyses were bilaterally carried out, and generated 24 measurements. RESULTS: The random error showed variation of 0.77 to 2.55 degrees for teeth angulation. The statistical analysis revealed that the method presents excellent reproducibility (p < 0.0001) for all teeth, except for the upper premolars. In spite of that, it is still considered statistically significant (p < 0.001). CONCLUSION: The proposed method presents enough reliability that justifies its use in the development of scientific research as well as in clinical practice.

Evaluation of a photographic method to measure dental angulation

Objective: To analyze the reliability and reproducibility of a simplified method for analysis of dental angulation using digital photos of plaster dental casts. Methods: Digital and standardized photographs of plaster casts were performed and posteriorly imported to an angle reading graphic program in order to have measurements obtained. Such procedures were repeated to evaluate the random error and to analyze reproducibility through intraclass correlation. The sample consisted of 12 individuals (six male and six female) with full permanent dentition orthodontically untreated. The analyses were bilaterally carried out, and generated 24 measurements. Results: The random error showed variation of 0.77 to 2.55 degrees for teeth angulation. The statistical analysis revealed that the method presents excellent reproducibility (p < 0.0001) for all teeth, except for the upper premolars. In spite of that, it is still considered statistically significant (p < 0.001). Conclusion: The proposed method presents enough reliability that justifies its use in the development of scientific research as well as in clinical practice. .

Objetivo: analisar a confiabilidade e reprodutibilidade de um método simplificado para análise da angulação dentária que faz uso de fotografias digitalizadas de modelos de gesso. Métodos: foram realizadas fotografias digitalizadas e padronizadas de modelos de gesso, posteriormente transportadas para um programa gráfico de leitura de ângulos, para a obtenção das medidas. Tais procedimentos foram repetidos para avaliação do erro do método casual e para a análise da reprodutibilidade por meio da Correlação Intraclasse. A amostra constituiu-se de 12 indivíduos com dentição permanente completa e não tratados ortodonticamente, sendo seis do sexo masculino e seis do feminino. As análises foram feitas bilateralmente, gerando 24 medidas. Resultados: o erro casual mostrou uma variação de 0,77 a 2,55º para a angulação dos dentes. A análise estatística revelou que o método apresenta uma excelente reprodutibilidade (r = 0,65 - 0,91; p < 0,0001) para todos os dentes, exceto para os pré-molares superiores, mas ainda assim estatisticamente significativa (p < 0,001). Conclusão: o método proposto apresenta confiabilidade suficiente para justificar seu uso no desenvolvimento de pesquisas científicas, bem como na prática clínica. .

Fotografia em odontologia: a escolha do equipamento fotográfico / Dental photography: choosing the photographic equipment

A fotografia odontológica tem se beneficiado dos avanços tecnológicos que ocorreram nos últimos anos. O preço dos equipamentos está mais acessível e sua qualidade atingiu níveis superiores. Isso tem permitido aos cirurgiões-dentistas utilizar essas ferramentas de diagnóstico, tratamento e na comunicação com pacientes e demais profissionais da área odontológica. Assim, o objetivo deste artigo é orientar os profissionais na escolha de equipamentos fotográficos de uso odontológico.

Dental photography has taken advantage of the technological developments in the last years. Price are more affordable and quality attained superior levels. It has allowed dentists to use these tools for diagnosis, treatment and communication with patients and dental professionals. The purpose of this paper was to guide practitioners to choose dental photographic equipment.

Agreement in the diagnosis of dental fluorosis in central incisors performed by a standardized photographic method and clinical examination / Concordância no diagnóstico da fluorose dentária em incisivos centrais realizado por um método fotográfico padronizado e pelo exame clínico

The aim of this study was to assess agreement in the diagnosis of dental fluorosis performed by a standardized digital photographic method and a clinical examination (gold standard). 49 children (aged 7-9 years) were clinically evaluated by a trained examiner for the assessment of dentalfluorosis. Central incisors were evaluated for the presence or absence of dental fluorosis and were photographed with a digital camera. Photographs were presented to three pediatric dentists, who examined the images. Data were analyzed using Cohen’s kappa and validity values. Agreement in the diagnosis performed by the photographic method and clinical examination was good (0.67) and accuracy was 83.7%. The prevalence ofdental fluorosis was reported to be higher in the clinical examination (49%) compared with the photographic method (36.7%). The photographic method presented higher specificity (96%) thansensitivity (70.8%), a positive predictive value (PPV) of 94.4% and a negative predictive value (NPV) of 77.4%. The diagnosis of dental fluorosisperformed using the photographic method presented high specificity and PPV, which indicates that the method is reproducible and reliable for recording dental fluorosis.

O objetivo do estudo foi comparar o diagnóstico de fluorose dentária realizado por um método fotográficocom o exame clínico (padrão ouro). Quarenta e nove crianças, de 7 e 9 anos, foram clinicamente examinadas por um examinador calibrado para fluorose dentária. Os incisivos foram fotografados com câmera digital e as fotografias foram apresentadas a três odontopediatras, que examinaram as imagens. A concordância por kappa entre o método fotográfico e o padrão ouro foi boa (0,67) e a acurácia foi de 83,67%. A prevalência de fluorose dentária foi levemente maior pelo método clínico (49%) do que pelo fotográfico (36,7%). O método fotográfico apresentou maior especificidade (96%) que sensibilidade (70,83%), valor de predição positivo (VPP) de 94,44% e valor de prediçãonegativo (VPN) de 77,42%, com poucos casos de falsos positivos (6%). O diagnóstico de fluorose dentária usando-se o método fotográfico apresentou altaespecificidade e VPP, indicando que é adequado para registrar fluorose dentária, com poucos casos de falsospositivos. O método é reprodutível e confiável quando comparado com o diagnóstico clínico e pode ser usado para o diagnóstico da fluorose dentária.