Radiologia odontológica: percepção e segurança de dentistas de centros de especialidades odontológicas e serviços de apoio diagnóstico públicos / Dental radiology: perception and safety of dentists from dental specialty centers and public diagnostic support services

Objetivo: Avaliar a percepção e segurança dos cirurgiões-dentistas servidores municipais de Porto Alegre - RS que realizam radiografias intrabucais em relação à conteúdos da radiologia odontológica. Materiais e métodos: Todos os 26 dentistas que atuam no Centro de Especialidades Odontológicas e Serviço de Apoio Terapêutico da Secretaria Municipal de Saúde foram convidados a participar de 15 horas do Projeto de Extensão em Radiologia Odontológica da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul, onde alunos de graduação atendem pacientes encaminhados pelas unidades básicas de saúde. Foi aplicado um questionário online de 19 questões relacionado a sua segurança e rotina na Radiologia. Os dados coletados foram submetidos à análise descritiva. Dez profissionais participaram do projeto, e oito responderam ao questionário (n=8). Resultados: Realização de técnicas e processamentos radiográficos, a maioria dos participantes mostrou-se segura, assim como os aspectos de radioproteção. Relataram maior dificuldade em realizar exames radiográficos em criança, molares e caninos superiores, além de preferirem, o método manual visual de processamento radiográfico. Foi identificada menor compreensão sobre biossegurança e efeitos biológicos determinísticos. Discussão: Conhecer esses servidores, suas rotinas e vivências com a radiologia, permitiu aprimorar o atendimento aos pacientes e a integração da Faculdade ao programa de educação permanente. Observa-se que princípios teóricos, não estão sedimentados o que pode interferir tanto na sua saúde como na do paciente. Conclusão: Os profissionais estudados sentem-se seguros em relação à prática e compreendem suas lacunas de conhecimento sobre efeitos biológicos e biossegurança na área da Radiologia.

Aim: To evaluate the perception and confidence of dental surgeons working in Porto Alegre - RS who perform intraoral radiographs in relation to the contents of dental radiology. Materials and methods: All 26 dentists who work at the Center for Dental Specialties and Therapeutic Support Service of the Municipal Health Department were invited to participate in 15 hours of the Extension Project in Dental Radiology at the School of Dentistry at the Federal University of Rio Grande do Sul, where students Undergraduate courses assist patients referred by basic health units. An online questionnaire of 19 questions related to your safety and routine in Radiology was applied. The collected data were submitted to descriptive analysis. Ten professionals participated in the project, and eight answered the questionnaire (n=8). Results: Performing radiographic techniques and processing, most participants proved to be safe, as well as radioprotection aspects. They reported greater difficulty in performing radiographic examinations in children, molars and upper canines, in addition to preferring the visual manual method of radiographic processing. Less understanding of biosafety and deterministic biological effects was identified. Discussion: Getting to know these public servants, their routines and experiences with radiology, made it possible to improve patient care and integrate the Faculty into the permanent education program. It is observed that theoretical principles are not settled, which can interfere with both your health and that of the patient. Conclusion: The professionals studied feel safe and understand their knowledge gaps such as biological effects and biosafety in the field of Radiology.

Influence of the presence of dental implants on the accuracy and difficulty level of diagnosis of furcation involvement in molars: An in vitro CBCT study.

OBJECTIVE: The aim of this study was to investigate the possible interference of image artifacts (IA) generated by dental implants in the evaluation of furcation involvement (FI) in molars. METHODS: Tomographic scans of first molars (1M) were performed in dry skulls in the absence and presence of titanium (TI) and zirconia (ZI) dental implants. FI grades were simulated in the alveoli of the 1Ms. Diagnostic accuracy of FI and level of difficulty were verified. Chi-squared test and logistic regression analysis were used. RESULTS: There was no difference in the diagnostic accuracy of FI between the arches (p = .117). The highest diagnostic accuracy value for the implant variable was found in the absence of implants (88.3%) and the lowest in the presence of two ZI implants (66.7%). The highest diagnostic accuracy value for FI was observed in grade 0 (G0). There was no significant difference between the arches regarding the evaluators' perception of difficulty (p > .05). Assessments were considered difficult in 12.7% of the TI implants and in 29% of the ZI implants. Regarding the number of dental implants, assessments were considered difficult in 24.4% cases including one implant and 17.4% cases including two implants. The logistic regression model showed a significant p-value only for one and two ZI implants (p = .0061 and p = .0096, respectively). CONCLUSION: The presence of dental implants in the region adjacent to the area of investigation of FI decreased the diagnostic accuracy while increasing the perception of difficulty by the examiners, especially in cases with ZI implants.

Impact of dentists and equipment in the performing dental imaging examinations: a longitudinal analysis.

In this study, we aimed to identify factors associated with performing dental imaging examinations in public health services. Brazilian data at the municipal level (n = 5,564) in two time periods, P0 (2005-2007) and P1 (2014-2016), were collated from health information systems. The increase in the municipal rates of intraoral and extraoral radiographic imaging procedures was the outcome. Changes in the use of clinical procedures and the rates of dentists and equipment were the main predictors. Multiple logistic regression analysis was performed to estimate the adjusted odds ratio (OR). Approximately 35.3% of the Brazilian municipalities increased the dental radiography equipment rate, 9.9% increased the fan-beam computed tomography (CT) equipment rate, and 5.9% increased the magnetic resonance imaging (MRI) equipment rate. In addition, 31.8% increased the periapical/interproximal radiography rate, 10.5% increased the CT rate, and 4.4% increased the MRI rate. Increases in the dental radiography, CT, and MRI rates were associated with higher chances of periapical/interproximal images (OR = 1.90, p < 0.01), face and neck images (OR =1 5.3, p < 0.01), and MR images (OR = 18.1, p < 0.01), respectively. Municipalities that increased the rates of endodontists increased the rates of periapical/interproximal (OR = 2.50, p < 0.01) and occlusal (OR = 1.60, p < 0.01) imaging procedures, and those that increased the rates of radiologists also increased the rates of occlusal (OR = 2.00, p < 0.01) and panoramic (OR = 1.70, p < 0.01) imaging procedures. The implementation of a secondary dental care center, Centro de Especialidades Odontológicas (CEO) was associated with an increase in the chances of performing periapical/interproximal and panoramic radiographic procedures in 1.5 and occlusal radiographic examinations in 2.0. The rates of dentists, equipment, specialized dental centers, and specific dental procedures were associated with the increased use of imaging procedures in dentistry in the Brazilian public health system.

Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management?

This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.

Can the method of cbct interpretation influence endodontic diagnosis? / O método de interpretação da tcfc pode influenciar o diagnóstico endodôntico?

Objetivo: Este estudo avaliou a influência do método de visualização e análise do exame de tomografia computa-dorizada de feixe cônico (TCFC) no diagnóstico de afecções endodônticas. Materiais e métodos: Vinte casos clínicos contendo doze diferentes afecções endodônticas foram ana-lisados por dois especialistas em radiologia odontológica e um especialista em endodontia. Inicialmente, os avaliadores visualizaram os casos em Portable Document Format (PDF) contendo uma seleção de imagens digitais e, por consenso, descreveram suas hipóteses diagnósticas para cada caso. Após uma semana, os avaliadores reavaliaram os casos, desta vez utilizando reconstrução multiplanar em um visualizador de imagens no formato Digital Imaging and Communications in Medicine (DICOM). Novamente, por consenso, eles indicaram suas hipóteses diagnósticas. Resultados: Em 10% dos casos, houve discrepância entre os diagnósticos realizados utili-zando as seleções de imagens digitais em PDF e utilizando a reconstrução multiplanar. A visualização das imagens em PDF obteve sensibilidade de 0.714, especificidade de 0.966, e acurácia de 90%. Discussão: Na maioria destes casos, as afecções endodônticas identificadas utilizando o visuali-zador de imagens DICOM (reconstrução multiplanar) não foram detectadas quando visualizados os PDF de imagens pré-selecionadas. Conclusão: Embora mais estudos sejam necessários, os autores reiteram que a utilização de recons-truções multiplanares sempre são preferíveis comparadas à outras formas de análise da TCFC, para que se atinja o máximo potencial diagnóstico do exame de imagem.

Aim: This study evaluated the influence of the method used for visualization and analysis of cone-beam com-puted tomography (CBCT) on the diagnosis of endodontic conditions. Materials and methods: Twenty clinical cases containing twelve different endodontic conditions were analyzed by two specialists in dental radiology and one specialist in endodontics. Initially, the evaluators viewed the cases in Portable Document Format (PDF) containing a selection of digital images and, by consensus, described their diagnostic hypotheses for each case. One week la-ter, the evaluators reassessed the cases, this time using multiplanar reconstructions with a Digital Imaging and Communications in Medicine (DICOM) format image viewer. Once more, by consensus, they recorded their diagnostic hypotheses. Results: In 10% of the cases there was a discrepancy between the diagnoses made using preselected digital images in PDFs and by viewing multiplanar reconstructions. The visualization of the PDF images obtained a sensitivity of 0.714, specificity of 0.966, and 90% accuracy. Discussion: In the majority of these cases, endodontic conditions identified using the DICOM image viewer (multiplanar reconstruction) were not detected using the PDFs of preselected images. Conclusion: Although more studies are needed, the au-thors reiterate that using multiplanar reconstructions should always be preferred to other forms of analysis for CBCT, so that the maximum diagnostic potential of the imaging exam can be achieved.

Validation and comparison of volume measurements using 1 multidetector computed tomography and 5 cone-beam computed tomography protocols: An in vitro study.

Purpose: The purpose of this study was to compare volume measurements obtained using 2 image software packages on Digital Imaging and Communications in Medicine (DICOM) images acquired from 1 multidetector computed tomography and 5 cone-beam computed tomography devices, using different protocols for physical volume measurements. Materials and Methods: Four pieces of bovine leg were prepared. Marrow was removed from 3 pieces, leaving cortical bone exposed. The resulting space of 1 piece was filled with water, another was filled with propylene glycol, and the third was left unfilled. The marrow in the fourth sample was left fully intact. Volume measurements were obtained after importing DICOM images into the Dolphin Imaging 11.95 and ITK-SNAP software programs. Data were analyzed using 3-way analysis of variance with a generalized linear model to determine the effects of voxel size, software, and content on percentage mean volume differences between tomographic protocols. A significance level of 0.05 was used. Results: The intraclass correlation coefficients for intraobserver and interobserver reliability were, respectively, 0.915 and 0.764 for the Dolphin software and 0.894 and 0.766 for the ITK-SNAP software. Three sources of statistically significant variation were identified: the interaction between software and content (P=0.001), the main effect of content (P=0.014), and the main effect of software (P=0.001). Voxel size was not associated with statistically significant differences in volume measurements. Conclusion: Both content and software influenced the accuracy of volume measurements, especially when the content had gray values similar to those of the adjacent tissues.

Impact of dentists and equipment in the performing dental imaging examinations: a longitudinal analysis

Abstract: In this study, we aimed to identify factors associated with performing dental imaging examinations in public health services. Brazilian data at the municipal level (n = 5,564) in two time periods, P0 (2005-2007) and P1 (2014-2016), were collated from health information systems. The increase in the municipal rates of intraoral and extraoral radiographic imaging procedures was the outcome. Changes in the use of clinical procedures and the rates of dentists and equipment were the main predictors. Multiple logistic regression analysis was performed to estimate the adjusted odds ratio (OR). Approximately 35.3% of the Brazilian municipalities increased the dental radiography equipment rate, 9.9% increased the fan-beam computed tomography (CT) equipment rate, and 5.9% increased the magnetic resonance imaging (MRI) equipment rate. In addition, 31.8% increased the periapical/interproximal radiography rate, 10.5% increased the CT rate, and 4.4% increased the MRI rate. Increases in the dental radiography, CT, and MRI rates were associated with higher chances of periapical/interproximal images (OR = 1.90, p < 0.01), face and neck images (OR =1 5.3, p < 0.01), and MR images (OR = 18.1, p < 0.01), respectively. Municipalities that increased the rates of endodontists increased the rates of periapical/interproximal (OR = 2.50, p < 0.01) and occlusal (OR = 1.60, p < 0.01) imaging procedures, and those that increased the rates of radiologists also increased the rates of occlusal (OR = 2.00, p < 0.01) and panoramic (OR = 1.70, p < 0.01) imaging procedures. The implementation of a secondary dental care center, Centro de Especialidades Odontológicas (CEO) was associated with an increase in the chances of performing periapical/interproximal and panoramic radiographic procedures in 1.5 and occlusal radiographic examinations in 2.0. The rates of dentists, equipment, specialized dental centers, and specific dental procedures were associated with the increased use of imaging procedures in dentistry in the Brazilian public health system.

Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management?

Abstract This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.

Avaliação da prevalência e localização de canais mandibulares bífidos: um estudo em TCFC / Evaluation of the prevalence and location of bifid mandibular canals: a CBCT study

Objetivo: Investigar a prevalência e localização de canais mandibulares bífidos (CMB) por meio de tomografia computadorizada de feixe cônico (TCFC). Materiais e métodos: Três radiologistas odontológicos treinados e calibrados avaliaram individualmente 1254 exames tomográficos por meio do software I-Cat Vision (Imaging Sciences International®) e classificaram em quatro tipos distintos (Retromolar, Dental, Anteriorizado e Bucolingual). Os dados de frequência, coletados a partir de um formulário Access (Microsoft® Office), foram analisados por meio dos testes de Fischer e Friedman. O nível de significância estatística foi estabelecido em 5%. Resultados: CMBs foram encontrados em 276 casos (22%), sem predileção por gênero (P=0,186). Houve diferença estatisticamente significante entre os tipos (P=0,001). Discussão: O reconhecimento de um CMB é de grande relevância quando associado a procedimentos anestésicos e cirúrgicos na região posterior da mandíbula. Apesar de muitos estudos demostrarem que o CMB não é comumente visto, uma falha em sua identificação pode resultar em danos ao nervo alveolar inferior (NAI) ou em dificuldade na obtenção do bloqueio anestésico. Conclusão: O tipo mais frequente de CMB em ambos os gêneros, foi o retromolar (P=0,001), representando 18,5%, e visualizado com taxas de 47,1% nas mulheres e 52,9% nos homens. A frequência de CMBs analisada por meio da TCFC foi significativa na população avaliada e apresentou-se com diferentes configurações. Desta forma, sua investigação não deve ser negligenciada frente a procedimentos cirúrgicos que envolvam a região posterior da mandíbula.

Aim: To investigate the prevalence and location of bifid mandibular canals (CMB) using cone beam computed to-mography (CBCT). Materials and methods: Three trained and calibrated dental radiologists individually evaluated 1254 CT scans using the I-Cat Vision software (Imaging Sciences International®) and classified them into four distinct types (Retromolar, Dental, Forward and Buco-lingual). Frequency data, collected from an Access form (Microsoft® Office), were analyzed using the Fischer and Friedman test. The level of statistical significance was set at 5%. Results: CMBs were found in 276 cases (22%), with no gender predilection (P = 0.186). There was a statistically significant difference between the types (P = 0.001). Dis-cussion: The recognition of a CMB is of great relevance when associated with anesthetic and surgical procedures in the posterior region of the mandible. Although many studies have shown that CMB is not commonly seen, a failure to identify it can result in damage to the lower alveolar nerve (NAI) or difficulty in obtaining anesthetic block. Conclusion: The most frequent type of CMB in both genders was retromolar (P = 0.001), representing 18.5%, and visualized with rates of 47.1% in women and 52.9% in men. The frequency of CMBs analyzed using the CBCT was significant in the population evaluated and presented in different configurations. Thus, its investigation should not be neglected in the face of surgical procedures that involve the posterior region of the mandible

[Dental imaging procedures in the Unified Health System and the expansion of secondary care: series between 2000-2016]. / Procedimentos de imagem em Odontologia no Sistema Único de Saúde e a expansão da atenção secundária: série entre 2000-2016.

The scope of this paper was to analyze the time series of dental procedures performed between 2000 and 2016 in the Brazilian Unified Health System (SUS). The data were obtained from the Outpatient Information System of the SUS (SIA-SUS). The influence of the 2004 National Oral Health Policy of Ordinance No. 600/2006 (which instituted the financing of Dental Specialty Centers - CEOs), and Ordinance No. 1,234/2013 (Financial incentive for the Program for Enhancement of Quality and Access - PMAQ-CEO) were analyzed. Descriptive analyses of the initial and final years of the time series were presented, assessing trends and seasonality in seven types of imaging procedures. The time series of rates of periapical/bitewing radiographic exams revealed a trend of moderate increase and was the only area in which the impact of the financial implementation policy of the CEOs was observed, though not of the PMAQ-CEO. Extraoral imaging exams, such as panoramic radiography, facial CT/TMJ and TMJ MRI revealed a strong upward trend, despite the very low rates. The conclusion reached is that between 2000 and 2016, the policy of expansion of secondary care increased the use of periapical/bitewing imaging exams.

O objetivo foi analisar a série temporal de procedimentos de imagem em Odontologia realizados entre os anos de 2000 e 2016 no Sistema Único de Saúde (SUS). Os dados foram obtidos do Sistema de Informações Ambulatoriais (SIA-SUS). Foram analisadas a influência da Política Nacional de Saúde Bucal de 2004, da Portaria nº 600/2006 (institui o financiamento dos Centros de Especialidades Odontológicas - CEOs) e Portaria nº 1.234/2013 (Incentivo financeiro do Programa de Melhoria do Acesso e da Qualidade - PMAQ-CEO). Apresentou-se análises descritivas dos anos inicial e final da série temporal, avaliando tendências e sazonalidade em sete tipos de procedimentos. A série temporal das taxas de exames radiográficos periapicais/interproximais demonstrou tendência de aumento moderado e foi a única em que se observou o impacto da política de implementação financeira dos CEOs, mas não do PMAQ-CEO. Os exames extraorais como: radiografia panorâmica, Tomografia Computadorizada (TC) da face/Articulação Temporomandibular (ATM) e Ressonância Magnética (RM) da ATM possuem forte tendência de aumento apesar das taxas serem muito baixas. Conclui-se que entre os anos 2000 e 2016, a política de expansão da atenção secundária, aumentou o uso de exames de imagem periapical/interproximal.

Association between internal carotid artery calcifications detected as incidental findings and clinical characteristics associated with atherosclerosis: A dental volumetric tomography study.

PURPOSE: To evaluate the presence of calcifications in the internal carotid artery (ICA) in cone-beam computed tomography (CBCT), and to verify the association of these findings with sex, age, dental condition, and risk factors associated with vascular disorders. METHODS: The CBCT scans used in this study were obtained from the database of a private dental clinic requested for the planning of rehabilitation with dental implants. The selection criteria were patients aged 40 years and above. Out of a pool of 1176 CBCT examinations, a total of 284 scans of adult patients were evaluated by two blinded observers. Data were collected from patients' medical records. RESULTS: ICA calcifications were present in 63.0% of the examinations. Most calcifications were in the intracranial pathway (166). Despite being present in a smaller number 57 (C1), extracranial calcifications were more severe. Spearman's ρ coefficients (rS) indicated that the number of missing teeth was directly associated with the presence of calcifications (p = 0.042) and severity (p = 0.020). The age variable also had a direct relationship with the presence of calcifications (p ≤ 0.0001), increasing its frequency and severity over the years. In addition, hypertension (p = 0.036) and use of antihypertensive drugs (p = 0.015) were directly associated. CONCLUSIONS: There is a high occurrence of ICA calcifications in CBCT as incidental findings in adult patients, and it is directly associated with age, number of missing teeth and hypertension.

Procedimentos de imagem em Odontologia no Sistema Único de Saúde e a expansão da atenção secundária: série entre 2000-2016 / Dental imaging procedures in the Unified Health System and the expansion of secondary care: series between 2000-2016

Resumo O objetivo foi analisar a série temporal de procedimentos de imagem em Odontologia realizados entre os anos de 2000 e 2016 no Sistema Único de Saúde (SUS). Os dados foram obtidos do Sistema de Informações Ambulatoriais (SIA-SUS). Foram analisadas a influência da Política Nacional de Saúde Bucal de 2004, da Portaria nº 600/2006 (institui o financiamento dos Centros de Especialidades Odontológicas - CEOs) e Portaria nº 1.234/2013 (Incentivo financeiro do Programa de Melhoria do Acesso e da Qualidade - PMAQ-CEO). Apresentou-se análises descritivas dos anos inicial e final da série temporal, avaliando tendências e sazonalidade em sete tipos de procedimentos. A série temporal das taxas de exames radiográficos periapicais/interproximais demonstrou tendência de aumento moderado e foi a única em que se observou o impacto da política de implementação financeira dos CEOs, mas não do PMAQ-CEO. Os exames extraorais como: radiografia panorâmica, Tomografia Computadorizada (TC) da face/Articulação Temporomandibular (ATM) e Ressonância Magnética (RM) da ATM possuem forte tendência de aumento apesar das taxas serem muito baixas. Conclui-se que entre os anos 2000 e 2016, a política de expansão da atenção secundária, aumentou o uso de exames de imagem periapical/interproximal.

Abstract The scope of this paper was to analyze the time series of dental procedures performed between 2000 and 2016 in the Brazilian Unified Health System (SUS). The data were obtained from the Outpatient Information System of the SUS (SIA-SUS). The influence of the 2004 National Oral Health Policy of Ordinance No. 600/2006 (which instituted the financing of Dental Specialty Centers - CEOs), and Ordinance No. 1,234/2013 (Financial incentive for the Program for Enhancement of Quality and Access - PMAQ-CEO) were analyzed. Descriptive analyses of the initial and final years of the time series were presented, assessing trends and seasonality in seven types of imaging procedures. The time series of rates of periapical/bitewing radiographic exams revealed a trend of moderate increase and was the only area in which the impact of the financial implementation policy of the CEOs was observed, though not of the PMAQ-CEO. Extraoral imaging exams, such as panoramic radiography, facial CT/TMJ and TMJ MRI revealed a strong upward trend, despite the very low rates. The conclusion reached is that between 2000 and 2016, the policy of expansion of secondary care increased the use of periapical/bitewing imaging exams.

Benefits of using a photostimulable phosphor plate protective device.

OBJECTIVES: To develop and test a protective device (PD) to increase the resistance of photostimulable storage phosphor (PSP) plate to compressive load, and assess the resulting image quality. METHODS: Two prototypes, polyvinylchloride sheets of 0.3 mm and 0.7 mm each, were developed for PSP plate size 2. The resistance to compressive load was tested using eight new PSPs divided into four test groups: (1) PSP, (2) PSP and paperboard protector, (3) PSP and 0.3 mm PD, and (4) PSP and 0.7 mm PD. The resulting images were analyzed by three oral radiologists, based on the consensus for image artifacts. Additionally, the objective image quality test was performed with four new PSPs, using an 8-step wedge aluminum scale. The mean gray values and standard deviation were measured in a total of 240 images, and the data were analyzed using analysis of variance with Bonferroni post-hoc test. RESULTS: Artifacts were seen in the PSP control group starting at 40 n, and at 150 n, 175 n and 300 n in 0.3 mm PD, paperboard protector and 0.7 mm PD, respectively. Although there was no statistical difference among groups, there were differences between exposure times (0.06-0.25 s, 0.06-0.40 s, and 0.10-0.40 s). Scanning resolution of 20 lp/mm showed higher mean gray value than 25 and 40 lp/mm (p < 0.05). CONCLUSION: The developed PDs improved the PSP resistance to compressive forces, with low interference on the pixel gray values, regardless of exposure time and spatial resolution. Nevertheless, the 0.7 mm PD could withstand the maximum compressive load.

The imaging role for diagnosis of idiopathic osteosclerosis: a retrospective approach based on records of 33,550 cases.

OBJECTIVE: The study aimed to describe the diagnostic imaging features of idiopathic osteosclerosis (IO) to aid in differential diagnosis of similar dentomaxillomandibular conditions. MATERIALS AND METHODS: An archive of 550 dentomaxillofacial radiographic (panoramic radiography (PR) and cone beam computed tomography (CBCT)) images and 33,000 histopathological records were reviewed to identify IO cases. Chi-square, Student's t test, and ANOVA tests, with a significance of p < 0.05, were applied for comparative analysis. In addition, we analyzed various studies to present a short review. RESULTS: After meticulous observation, 36 images of 34 patients revealed 60 IO lesions in 31 PR and 5 CBCT. Sex, age group, anatomical site, shape, regularity, and root relationship showed statistical significance: sex and age group (p = 0.046), sex and IO regularity (p = 0.007), age group and IO regularity (p = 0.014), anatomical site and IO shape (p = 0.010), anatomical site and IO regularity (p = 0.003), and IO shape and IO regularity (p = 0.002). We presented a short review from 26 articles, including retrospective, cross-sectional, and longitudinal studies, documenting 2307 patients with 2435 IO lesions from 51,160 imagiological examinations. CONCLUSIONS: A radiographic diagnostic profile of IO may guide the clinical practitioners in differentiating an incidental radiopacity. PR is a preliminary examination, with CBCT facilitating the IO diagnosis. CLINICAL RELEVANCE: Knowledge of imaging characteristics variability of idiopathic osteosclerosis is crucial for accurate diagnosis process when incidental radiopacities are found in the panoramic radiographs, thus avoiding unnecessary biopsies. CBCT scans facilitate the interpretation of idiopathic osteosclerosis overlapping the mandibular canal.

Does clinical experience impact students' capacity to diagnose dentoalveolar disorders using intraoral radiography? / A experiência clínica influencia na capacidade de alunos para o diagnóstico de alterações dentoalveolares utilizando exames radiográficos intraorais?

Mastery of interpretation of radiographic images is a contributing factor in correct diagnosis of conditions affecting the dentoalveolar apparatus. It is therefore essential that students' perfect these skills while studying for their degrees. Once they embark upon their professional careers outside of the university setting, it is expected that the theoretical knowledge and clinical experience accumulated during the course of their studies will have led to improved diagnostic performance. Objective: The objective of this study was to evaluate diagnoses made using intraoral radiographs by undergraduate students at a School of Dentistry in the South of Brazil, before and after their introduction to clinical practice. Materials and methods: Diagnoses made during the second (T0) and fourth (T1) years of the undergraduate course in dentistry using interproximal and periapical radiographs were analyzed. Descriptive statistics were calculated and the McNemar test was used to compare answers at T0 and T1. Results: Fifteen students answered questionnaires at both T0 and T1. The overall percentage of correct answers was 70.5% at T0 and 61.6% at T1, with a significant difference (p = 0.024). Discussion: This study highlights the need for educational strategies that improve diagnostic competence during undergraduate clinical activities, since radiographic examinations are essential in all areas of dentistry. Conclusions: Therefore, it was concluded that the rate of correct diagnosis of dentoalveolar disorders by intraoral radiography decreased significantly after the initial years of clinical training. (AU)

Introdução: O domínio da interpretação radiográfica contribui para o correto diagnóstico de alterações do complexo dento-alveolar, e seu aprimoramento durante o período da graduação é essencial. No momento em que se inicia a carreira profissional fora da faculdade, é esperado que o conhecimento teórico adquirido, associado à experiência clínica durante a graduação, melhore a performance diagnóstica do dentista. Objetivo: Esse estudo objetivou avaliar diagnósticos feitos a partir de exames radiográficos intrabucais, realizados por alunos de graduação de uma faculdade de odontologia do sul do Brasil, antes e após a sua introdução na prática clínica. Materiais e métodos: Para tal, diagnósticos de radiografias interproximais e periapicais, feitos durantes o Segundo ano (T0) e Quarto ano (T1) do curso de graduação, foram avaliados. Uma análise descritiva foi expressa e o teste de McNemar foi realizado para comparar as respostas em T0 e T1. Resultados: Quinze alunos completaram os dois questionários. De uma forma geral, a porcentagem de respostas corretas em T0 foi de 70.5%, e em T1 foi de 61.6%, com uma diferença significativa entre elas (p = 0.024). Discussão: Este estudo salienta a necessidade de estratégias educacionais que melhorem a competência diagnóstica durante as atividades clínicas da graduação, uma vez que exames radiográficos são essenciais em todas as áreas da odontologia. Conclusão: Neste estudo, o correto diagnóstico de alterações dentoalveolares a partir de radiografias intraorais apresentou um redução significativa após os primeiros anos de prática clínica. (AU)

Diagnostic efficacy of different cone beam computed tomography scanning protocols in the detection of chemically simulated external root resorption.

OBJECTIVES: The aim of this study was to evaluate the efficacy of different high-resolution cone beam computed tomography protocols in the diagnosis of chemically simulated external root resorption (ERR). STUDY DESIGN: ERR was simulated in 3 sizes by using an acid decalcification protocol in the cervical, middle, and apical thirds of 30 single-rooted premolars. Four scans of each tooth were acquired with different voxel sizes: 0.080, 0.085, 0.120, and 0.133 mm. The images were analyzed by 2 blinded evaluators for the presence of ERR. The evaluation of diagnostic performance was based on receiver operating characteristic (ROC) curve analysis. RESULTS: No statistically significant differences were found in the detection of ERR with regard to lesion sizes or the different root thirds. Areas under the ROC curve were 0.901, 0.892, 0.887, and 0.767 for voxel sizes of 0.080, 0.085, 0.120, and 0.133 mm, respectively. Voxel sizes of 0.080 and 0.085 mm presented significantly larger areas under the ROC curve compared with the voxel size of 0.133 mm. There were no statistically significant differences among the protocols with the use of voxel sizes of 0.080, 0.085, and 0.120 mm. CONCLUSIONS: Cone beam computed tomography examinations with higher-resolution protocols demonstrated better performance in the diagnosis of ERR. Further investigations using simulations that more closely resemble the actual ERR process are warranted.

Can Cone-beam Computed Tomography Change Endodontists' Level of Confidence in Diagnosis and Treatment Planning? A Before and After Study.

INTRODUCTION: This study evaluated the influence of cone-beam computed tomography (CBCT) on endodondists' level of confidence in their diagnosis of endodontic cases and their treatment plans. METHODS: Twenty clinical cases with periapical radiographs and small-volume CBCT scans were classified according to the American Association of Endodontists guidelines. Information was provided on patient clinical history, and both extraoral and intraoral examinations were simulated. Fifteen endodontists filled out 2 questionnaires. In the first (Q1), the clinical description and a periapical radiograph were presented, followed by the questions. Thirty days later, they answered a second questionnaire (Q2) containing the same clinical description and CBCT. Their confidence in diagnosis and treatment planning was analyzed before and after receiving the tomographic images. Responses were recorded on a 5-point Likert scale, and the Wilcoxon test was used to investigate before and after levels of confidence in diagnosis and treatment planning. RESULTS: The CBCT images influenced confidence in diagnosis and treatment planning of endodontic cases classified as complex (Wilcoxon test; P ≤ .05). There was a substantial change in the treatment planned in both moderate and complex cases after CBCT. Case complexity did not affect the participants' decision to request complementary information through CBCT. CONCLUSIONS: In complex cases, CBCT increased endodontists' confidence to diagnose and plan treatment, when compared with periapical radiographs. Endodontists tended to recommend intervention when periapical images were supplemented with CBCT. CBCT proved to be an imaging method that influences endodontists' preoperative evaluation and treatment choice.

Undergraduate students as knowledge multipliers and facilitators in the teaching-learning process about adigital radiographic system / Estudantes de graduação como multiplicadores e facilitadores de conhecimento no processo de ensino-aprendizagem sobre sistema radiográfico digital

This report presents the five-stepmethodology adopted for the empowerment and trainingofprofessorsand studentsfor the use of anew intraoral radiographdigital system. Ithighlightsthe importance of undergraduate students as facilitators and multipliers in the teaching-learning process. Two students were selected to act as facilitators in the teaching-learning process and multipliers of knowledge regarding the radiographic system. These students, together withoral radiology professors, participated in meetings with the board and administrative techniciansto define goals(step1), organized teaching materials(step2), developed 2-hour theoretical-practical activities forprofessors andall clinical students(step3), followedthe system implementationstageduringone semester(step04)and appliedthe evaluationof thesystem used(step 5),on the Dental Teaching Hospital. Students and professors from two clinical disciplines were chosen to experience the onset of this implementation. At the end of the semester, a survey was conducted to evaluate the usability of theradiographicsystem. Overall, 176students and 12 professors participated in the theoretical-practical activity. During system implementation, 68 students and 34 professors experienced the new technology. The usability assessment according tostudents and professors was 73.35 and 79.37, respectively. The proposed digital system wasimplemented correctly. The experience of undergraduate students in the different stages of the project, problematization of the theme, accomplishment of their work in a collaborative manner, and the application of solutions developed by them contributed to the formation of professionals always open to critically change (AU).

Este relato objetiva apresentar uma metodologia em cinco etapas adotada para capacitar a comunidade docente e discente no uso de um sistema radiográficodigital, e ressaltar a importância do estudantede graduação como facilitador e multiplicador no processo ensino-aprendizagem. Dois estudantesforam selecionados para atuarem como facilitadores nesteprocessoe multiplicadores de conhecimento em relação ao sistema radiográfico. Essesacadêmicos, juntamente com os professores de radiologia, participaram de reuniões com a direção e técnicos administrativos para a definição dos objetivos (etapa 1), organizaram material didático (etapa 2), elaboraram atividades teórico-práticas de 2 horas para os alunos das clínicas e professores (etapa 3), acompanharam, por um semestre, a etapa de implementação do sistema no Hospital de Ensino Odontológico (etapa 4), e aplicaram a avaliação do uso do sistema digital (etapa 5). Duas disciplinas clínicas, seus alunos e professores, foram escolhidos para vivenciar a etapa de implementação. No término do semestre, foi realizada uma enquete que avaliou a usabilidade do sistema. Como resultado, 176 estudantese 12 professores participaram das atividades teórico-práticas. Na etapa de implementação, participaram 68 discentese 34 professores. A avaliação da usabilidade respondida pelos alunos e professores que utilizaram o sistema foi de 73,35 e 79,37, respectivamente. A implementação do sistema digital proposta ocorreu de forma adequada. A vivência dos estudantesde graduação nas diferentes etapas do projeto, da problematização do tema, da execução do seu trabalho de forma colaborativa, e aplicação de soluções por eles elaboradas contribuiu na formação de profissionais sempre abertos às mudanças de maneira crítica (AU).

Central Cemento-Ossifying Fibroma: Clinical Imaging and Histopathological Diagnosis / Fibroma Cemento-Osificante Central: Diagnóstico Clínico, Imagenológico e Histológico

ABSTRACT: Central ossifying fibroma is a lesion in which diagnosis has proved intriguing and unclear for presenting clinical, radiographic, and even histopathological similarities to other types of lesions such as the fibrous dysplasia of bone and cement-bone dysplasia. It is a benign neoplasm of uncertain etiology and slow development in which the mandible is affected more frequently than the maxilla. We described a case of central cemento-ossifying fibroma involving the right mandible of a thirty-five-female patient by presenting its clinical, radiographic, and histological characteristic sand discussing some differential diagnoses.

RESUMEN: El fibroma cemento-osificante central es una lesión que requiere un diagnóstico diferencial ya que muestran similitud clínica, histológica y radiológica con la displasia fibrosa y con la displasia cemento-ósea. Esta lesión es un tumor benigno de etiología incierta, presenta crecimiento lento y afecta principalmente la mandíbula más que el maxilar. Se reporta un caso de un paciente de sexo femenino de 35 años, diagnosticada con fibroma cementoosificante central que le afectó el lado derecho de la mandíbula. Se describen las características clínicas, histológicas y radiológicas de la paciente y se discuten los diversos diagnósticos diferenciales.

Airway volume analysis: is there a correlation between two and three-dimensions?

Objectives: No consensus exists on the assessment of airway in CBCT scans. Two-dimensional measures remain the standard in the cephalometric analysis. This research aimed to evaluate linear and area measurements in two-dimensional views from specific airway regions of interest and compare these to the correspondent volume in CBCT exams. Materials and Methods: 250-selected CBCT scans were retrospectively analyzed. A trained and calibrated examiner performed the linear, area and volume measurements in specific sites for nasal cavity, nasopharynx and oropharynx compartments. Dolphin Software was used for the analysis. The correlations were performed using Pearson coefficient. Results: The highest positive correlations were observed in the nasopharynx and oropharynx sagittal areas and the most constricted area in the oropharynx. Nasopharynx linear measures and nasopharynx coronal area did not present correlation with whole volume. Two-dimensional measurements in the soft palate (width and sagittal area) showed very low positive correlations. Although nasal cavity presented highest volume means, changes in oropharynx contributed more to variations in total volume, compared with the other two sections. Conclusion: Airway sagittal areas, as well as the most constricted axial area in oropharynx remains a useful guide to correlate with airway volume in two-dimensional images.