Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients.

OBJECTIVE: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). MATERIAL AND METHODS: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. RESULTS: At oral physical examination, the most frequent findings were tooth loss (568-85.67%), coated tongue (422-63.65%) and oral bleeding (192-28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14 vs 13.69%, p = 0.02; 23.44 vs 15.50%, p = 0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development (OR = 1.61 (1.03-2.51) and OR = 1.69 (1.08-2.66), respectively). CONCLUSIONS: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. CLINICAL RELEVANCE: The results of this paper reinforce the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU.

Assessment of three methods of geometric image reconstruction for digital subtraction radiography.

OBJECTIVES: To evaluate three methods of geometric image reconstruction for digital subtraction radiography (DSR). METHODS: Digital periapical radiographs were acquired of 24 teeth with the X-ray tube at 6 different geometric configurations of vertical (V) and horizontal (H) angles: V0°H0°, V0°H10°, V10°H0°, V10°H10°, V20°H0° and V20°H10°. All 144 images were registered in pairs (Group V0°H0° + 1 of the 6 groups) 3 times by using the Emago(®) (Oral Diagnostic Systems, Amsterdam, Netherlands) with manual selection and Regeemy with manual and automatic selections. After geometric reconstruction on the two software applications under different modes of selection, all images were subtracted and the standard deviation of grey values was obtained as a measure of image noise. All measurements were repeated after 15 days to evaluate the method error. Values of image noise were statistically analyzed by one-way ANOVA for differences between methods and between projection angles, followed by Tukey's test at a level of significance of 5%. RESULTS: Significant differences were found between most of the projection angles for the three reconstruction methods. Image subtraction after manual selection-based reconstruction on Regeemy presented the lowest values of image noise, except on group V0°H0°. The groups V10°H0° and V20°H0° were not significantly different between the manual selection-based reconstruction in Regeemy and automatic selection-based reconstruction in Regeemy methods. CONCLUSIONS: The Regeemy software on manual mode revealed better quality of geometric image reconstruction for DSR than the Regeemy on automatic mode and the Emago on manual mode, when the radiographic images were obtained at V and H angles used in the present investigation.

Evaluation of simulated external root resorptions with digital radiography and digital subtraction radiography.

INTRODUCTION: Root resorption can cause damage in orthodontic patients. Digital subtraction radiography (DSR) is a useful resource for the detection of mineral losses. The purpose of this study was to compare the efficacy of digital radiography (DR) and DSR in detecting simulated external root resorption. Examiner agreement between the 2 techniques was also evaluated. METHODS: Root resorptions of various sizes were simulated on the apical and lingual aspects of 49 teeth from 9 dry human mandibles. The teeth were radiographed in standardized conditions. The radiographs were registered with Regeemy Image Registration and Mosaicking (version 0.2.43-RCB, DPI-INPE, São José dos Campos, São Paulo, Brazil) and subtracted with Image Tool (University of Texas Health Science Center at San Antonio). The subtracted images and the digital radiographs were evaluated by 3 oral radiologists. RESULTS: No statistically significant differences were found for the methods in the detection of apical root resorptions, independently from lesion size, and of lingual resorptions of 1.2 mm or greater. DSR was significantly better than DR for detection of lingual resorptions up to 1 mm. Resorptions less than 0.5 mm were not precisely detected by either method. DSR provided better intraexaminer and interexaminer agreement than did DR. CONCLUSIONS: Both methods are precise for detection of apical root resorptions as small as 0.5 mm and lingual resorptions of 1 mm or more. However, DSR frequently performed better than did DR.

Avaliação de reabsorções radiculares externas por meio de reconstrução digital de imagens e subtração radiográfica digital / Assessment of external root resorptions using digital reconstruction and digital subtraction radiography

Diante dos prejuízos que a reabsorção severa da raiz pode acarretar, e considerando a técnica de subtração radiográfica digital (SDR) importante recurso para detecção precoce de alterações minerais, propõe-se neste estudo avaliar a eficiência de um programa de computador, que execute o registro das imagens e SRD, no diagnóstico da reabsorção radicular externa simulada, comparado à radiografia digital, além da concordância intra e interexaminadores nos 2 métodos de diagnóstico. Os 49 dentes de mandíbulas humanas maceradas com reabsorções de diferentes dimensões, simuladas na região apical e lingual, foram radiografados com variação de ângulos de projeção. A radiografias foram registradas a posteriori pelo programa Regeemy® e subtraídas pelo programa Image Tool®. A quantidade de ruído estrutural nas imagens subtraídas foi obtida pela mensuração da média e desvio-padrão dos níveis de cinza. Para avaliação do desempenho dos métodos de diagnóstico, pares de radiografias periapicais e imagens subtraídas foram apresentadas a 3 radiologistas. De acordo com os resultados, o ruído das imagens subtraídas de radiografias após variações de 10º e 20º do ângulo vertical e 10º horizontal e corrigidas a posteriori, foi significantemente maior que das imagens subtraídas de radiografias padrão, independente da região radiografada. Não houve diferença estatisticamente significativa entre os métodos na detecção de reabsorções apicais, independentemente do tamanho da lesão, assim como não houve diferença entre os métodos na detecção de reabsorções linguais de 1,2mm ou mais. A SRD foi significantemente superior à radiografia digital para detecção de lesões linguais de cerca de 1 mm. Cavidades na superfície lingual de cerca de 0,5 mm não foram detectadas com precisão por nenhum dos métodos. A concordância intra e interexaminadores na interpretação das reabsorções foi substancial ou quase perfeita em ambos os métodos, sendo maior quando se utilizava a SRD.

Análise da proporção áurea em indivíduos dolico, braqui e mesofaciais, por meio de radiografias cefalométricas laterais / Assessment of the golden proportion of brachyfacial, dolicofacial and mesofacial individuals on lateral cephalometric radiographs

Sabe-se que a proporção áurea pode ser aplicada nos valores estéticos, já que, algumas relações, reconhecidas como sendo belas aos olhos humanos, confortantes e prazerosas à mente humana, seguem estas proporções, além de estar associada ao crescimento e à função saudável. É propósito, neste estudo, verificar, por meio de radiografias cefalométricas laterais de indivíduos com oclusão Classe I de Angle, se algumas medidas apresentam-se áureas no esqueleto crâniofacial de indivíduos com padrões faciais distintos. Foi utilizado o programa Radiocef 2.0 (Radiomemory, Brasil) para a marcação e análise cefalométrica dos pontos nas radiografias. Os padrões faciais foram classificados pelo ângulo FMA e pelo coeficiente de Jarabak. Os dados foram submetidos aos testes t de Student, ANOVA e Tukey, e foram encontradas: 1 razão áurea no Grupo Dolico, nenhuma no Grupo Braqui e 4 razões áureas no Grupo Meso. Concluiu-se que é importante empregar análises cefalométricas individualizadas a fim de obter um plano de tratamento adequado e específico para pacientes com diferentes padrões de crescimento facial.

Influence of the facial pattern on ANB, AF-BF, and Wits appraisal.

AIM: To assess the correlation between Wits and AF-BF appraisals with the ANB angle, and verify the influence of the facial type on these appraisals. METHODS: Lateral cephalometric radiographs from 118 untreated individuals were separated into 3 groups according to the facial pattern (brachyfacial, mesofacial, and dolichofacial). The radiographs were digitized and submitted to ANB angle and Wits and AF-BF appraisals on computer software. All radiographs were retraced for intraobserver and interobserver error tests. RESULTS: The Student's t test demonstrated no statistically significant differences on the intraobserver's test (P > .05). There were statistically significant differences in the readings of Wits values of the 3 groups and for AF-BF values in the brachyfacial and mesofacial groups (P <.05). The multiple linear regression tests demonstrated high correlation between ANB and AF-BF for the 3 groups (r2, 0.768). The same result was found for ANB and Wits (r2, 0.624). CONCLUSION: Facial pattern does not have an influence on the correlation between ANB and AF-BF nor between ANB and Wits, but it does influence the measurements of ANB, AF-BF, and Wits.

Estudo da proporção áurea em indivíduos braqui e mesofaciais por meio de radiografias cefalométricas laterais / Assessment of the golden proportion of brachyfacial and mesofacial individuais on lateral cephalometric radiographs

Introdução - Considerando a proporção áurea uma forma de individualizar a análise cefalométrica a partir das características próprias de cada pessoa, propõe-se neste estudo verificar se algumas razões estão em proporções áurea, tanto em indivíduos braquifaciais como em mesofaciais, e assim identificar padrões que caracterizam esses tipos faciais, auxiliando no plano de tratamento. Material e Métodos - Foram utilizadas radiografias cefalométricas laterais de 48 indivíduos braquifaciais e 43 mesofaciais, do sexo masculino e do feminino, com idades cronológicas entre 17 e 25 anos e relação molar Classe I de Angle. Resultados - Das oito razões avaliadas, quatro diferiram estatisticamente entre os dois grupos, sendo as razões Or-Me/A-Pog, Or-Me/Co-Go, Ena-AA/N-Ena e SO-POOr/Ena-Enp, áureas nos indivíduos mesofaciais. O grupo Braqui não apresentou nenhuma das razões estudadas em proporção áurea. Conclusão - As razões áureas podem proporcionar uma análise cefalométrica individualizada, e a possibilidadede identificar padrões específicos de cada tipo facial, criando, assim referências para o plano de tratamento adequado

Influence of image filters on the reproducibility measurements of alveolar bone loss

The reproducibility of measurements of alveolar bone loss on radiographs may be a problem on epidemiologic studies, as they are based on comparisons of the diagnosis of various examiners. The aim of the present research paper was to assess the inter- and intra-examiner reproducibility of measurements of the interproximal alveolar bone loss on non-manipulated digital radiographs and after the application of image filters. Five Oral Radiologists measured the distance between the cementoenamel junction (CEJ) to the alveolar crest or to the deepest point of the bony defect on 12 interproximal digital radiographs of molars and bicuspids of a dry human skull. The digital manipulation and the linear measurements were obtained with the Trophy Windows software (Throphy®). For each image, six different versions were created: 1) non-manipulated; 2) bright-contrast adjustment; 3) negative; 4) negative with brightness-contrast adjustment; 5) pseudo-colored; 6) pseudo-colored with brightness-contrast adjustment. In order to prevent interpretation bias because of the repetition of measurements, the examiners measured the radiographs in a random sequence. The two-way ANOVA test at 5 percent level of significance to compare the means of readings of the same operator with each filter indicated p<0.05 for the majority of operators, while the comparison between the mean values of operators using the same filter indicated p>0.05 for all filters. Based on the results, we concluded that linear measurements of interproximal alveolar bone loss on digital radiographs are highly reproducible among examiners. Nevertheless, the application of image filters significantly influenced the degree of intra-examiner reproducibility. Some filters even reduced the reproducibility of intra-examiner readings.

A reprodutibilidade de medidas da perda óssea alveolar em radiografias pode se tornar um problema em levantamentos epidemiológicos, que são baseados em comparações de diagnóstico de vários observadores. O objetivo neste estudo foi avaliar a reprodutibilidade intra e inter-examinador de medidas da perda óssea interproximal, em radiografias digitais não manipuladas e após a aplicação de diferentes filtros de imagem. Cinco radiologistas avaliaram a distância da junção cemento-esmalte até a crista óssea alveolar ou ponto mais apical do defeito ósseo em 12 radiografias digitais interproximais da região de molares e pré-molares de crânio humano macerado. As manipulações digitais e as medidas lineares foram realizadas no programa de computador do sistema radiográfico (Throphy®). Para cada imagem foram criadas seis diferentes versões: 1) não manipulada digitalmente; 2) manipulada por ajuste de brilho e contraste; 3) negativo; 4) negativo com ajuste de brilho e contraste; 5) pseudo-colorida; 6) pseudo-colorida com ajuste de brilho e contraste. Para prevenir tendências da mesma leitura pela avaliação repetida das radiografias, determinou-se uma ordem para a interpretação das imagens. O teste ANOVA fator duplo sem repetição, com nível de significância de 5 por cento, realizado para comparação das médias de um mesmo examinador nas diferentes versões de imagem revelou p<0,05 para a maioria dos examinadores, enquanto para análise entre os examinadores, com cada ferramenta, p>0,05. A análise dos resultados nos permite concluir que medidas lineares da perda óssea alveolar interproximal em radiografias digitais apresentam alto grau de reprodutibilidade inter-examinadores, entretanto a aplicação de filtros de imagem não influenciou significativamente no grau de reprodutibilidade dessas medidas. Ao contrário, certas ferramentas reduziram a reprodutibilidade das medidas intra-examinador.

Cleidocranial dysplasia: importance of radiographic images in diagnosis of the condition.

Cleidocranial dysplasia (CCD) is a rare syndrome usually caused by an autosomal dominant gene, although 40% of cases of CCD appear spontaneously with no apparent genetic cause. This condition is characterized by several cranial malformations and underdevelopment, absence of the clavicles, and multiple supernumerary and impacted permanent teeth. The diagnosis of this condition is usually based on the presence of the main features (supernumerary teeth, partial or total absence of one or both the clavicles, and bony malformations) and on clinical and familial evidence. The bony and dental features of CCD may be visualized on radiographic images of the face and skull. Here, we present a familial case of CCD and discuss the importance of dental radiographs in diagnosis of the condition.

Avaliação do ângulo ANB e da análise Wits em indivíduos portadores de oclusão normal nos três tipos faciais / Assessment of the ANB angle and the Wits appraisal in normal occlusion individuals of three facial types

O ângulo ANB é a medida mais utilizada na avaliação das desarmonias sagitais maxilo-mandibulares, entretanto, está sujeita a fatores que podem tornar sua interpretação duvidosa, como a rotação dos maxilares em relação aos planos de referência do crânio. Foi desenvolvida então a análise Wits. O objetivo neste estudo foi verificar a influência do tipo facial e a correlação entre o ângulo ANB e a análise Wits em indivíduos portadores de oclusão normal. Foram utilizadas 90 radiografias cefalométricas laterais de indivíduos com idades entre 17 e 24 anos, do sexo masculino e do feminino. Com auxílio do programa de cefalometria Radiocef Studio 1.0, a amostra foi dividida, segundo análise de Ricketts, nos grupos: braquifacial (B), dolicofacial (D) e mesofacial (M); e os valores de ANB e de Wits, no plano oclusal funcional, foram obtidos. A análise estatística não mostrou diferença significativa entre os sexos. No teste de correlação de Pearson p=0,540 no grupo M, p=0,021 no grupo B e p=0,042 no grupo D. Na amostra total, 76,13% e 55,68% dos indivíduos apresentaram valores de ANB e de Wits, respectivamente, dentro do padrão. No grupo D, entretanto, essa porcentagem foi menor que as observadas nos outros grupos (63,88% e 44,44%). No total da amostra não houve correlação entre o ângulo ANB e a análise Wits. Os indivíduos apresentaram valores de ANB mais próximos da norma clínica que a análise Wits. O ângulo ANB e a análise Wits sofrem influência do tipo de rotação dos maxilares, embora a rotação no sentido horário (tipo dolicofacial) apresente maior influência sobre as duas grandezas.

Influence of image filters on the reproducibility measurements of alveolar bone loss.

The reproducibility of measurements of alveolar bone loss on radiographs may be a problem on epidemiologic studies, as they are based on comparisons of the diagnosis of various examiners. The aim of the present research paper was to assess the inter- and intra-examiner reproducibility of measurements of the interproximal alveolar bone loss on non-manipulated digital radiographs and after the application of image filters. Five Oral Radiologists measured the distance between the cementoenamel junction (CEJ) to the alveolar crest or to the deepest point of the bony defect on 12 interproximal digital radiographs of molars and bicuspids of a dry human skull. The digital manipulation and the linear measurements were obtained with the Trophy Windows software (Throphy). For each image, six different versions were created: 1) non-manipulated; 2) bright-contrast adjustment; 3) negative; 4) negative with brightness-contrast adjustment; 5) pseudo-colored; 6) pseudo-colored with brightness-contrast adjustment. In order to prevent interpretation bias because of the repetition of measurements, the examiners measured the radiographs in a random sequence. The two-way ANOVA test at 5% level of significance to compare the means of readings of the same operator with each filter indicated p<0.05 for the majority of operators, while the comparison between the mean values of operators using the same filter indicated p>0.05 for all filters. Based on the results, we concluded that linear measurements of interproximal alveolar bone loss on digital radiographs are highly reproducible among examiners. Nevertheless, the application of image filters significantly influenced the degree of intra-examiner reproducibility. Some filters even reduced the reproducibility of intra-examiner readings.

Anteroposterior location of the mandibular foramen of 7 to 12 year-old children in panoramic radiographs / Localização ântero-posterior do forame mandibular em crianças na faixa etária de 7-12 anos por meio de radiografias panorâmicas

The mandibular foramen (MF) location is considerably important in dentistry practice. It determines the success of anesthesia procedures on the mandibular structures. Many researches about its location in adults can be found in the literature; however the results are not always in agreement. The aim of this study was to evaluate the anteroposterior position of the MF, and verify the possible changes on its location on 7 to 12 year-old children. Ninety panoramic radiographsfrom the Dentomaxillofacial Radiology department at the Dentistry School of São José dos Campos - São Paulo State University - were examined. The shortest anteroposterior length of the mandibular ramus and the distance between the point correspondent to the MF to the deepest portion of the anterior border of the mandibular ramus were obtained using a digital caliper. All the measurements were registered in millimeters. The ratio between the measurements was calculated. The descriptive statistic analysis and the 95% confidence interval ANOVA (one-way) test were applied. The results showed that the anteroposterior location of the MF is, on average, at the medium third of the mandibular ramus. No statistically significant differences were found between ages (p>0.05)