Facial soft-tissue thickness in children: A study of a CTBC Brazilian sample.

As an auxiliary method in the process of human identification, forensic facial approximation (FFA) is an important tool for identifying unknown human bodies whose remains do not present the necessary traceability to any antemortem data collection. Specific characteristics are necessary when addressing children aged between 6 and 10 years, who have little sexual differentiation and a mixed dentition. Due to the chronology of eruption of the permanent second molars in this population, it is not possible to measure facial soft-tissue thickness (FSTT) from specific landmarks such as supra and infra M2. The objective of this research was to report the method for measuring the average FSTT of 32 landmarks adapting the method for adults replacing the landmarks at the upper and lower second molars (Supra M2 and Infra M2) in children up to 10 years of age for a measurement using the deciduous second molars as reference. We found statistical differences for some points, considering the variables of age and sex, but with a maximum difference of 2 mm, which allows the use of a single FSTT table. The deciduous teeth can replace the reference of the thicknesses at the supra and infra M2 landmarks. In addition to the new FSTT data for children in Brazil, we concluded that the proposed adaptation to the deciduous M2 points can be applied to obtain soft-tissue data for 32 facial points.

Aprendizado baseado em problemas utilizando histórias em quadrinhos na Odontologia Forense / Aprendizaje basado en problemas utilizando cómics en Odontología Forense / Problem-based learning using comics in Forensic Dentistry

O objetivo desse estudo foi avaliar a percepção e aceitação dos discentes acerca da metodologia de aprendizado baseado em problemas (problem based learning-PBL) modificada para a modalidade online. Os estudantes da disciplina de Odontologia Forense foram inseridos em uma cena de crime simulada em formato de história em quadrinhos (HQ). Divididos em "equipes forenses", receberam como tarefa elaborar um laudo pericial desse local de crime com o auxílio de um tutor. Ao final do semestre, foi produzido um questionário pela plataforma Google Forms com perguntas acerca da metodologia utilizada, da disponibilização de materiais na plataforma virtual e do uso de um ambiente simulando a realidade forense. Utilizou-se questionário de modelo fechado e respostas baseadas na escala Likert. A amostra foi composta por 58 participantes, dos quais 50 (86,2%) concordaram ou concordaram totalmente que a metodologia foi estimulante e que proporcionou um aprendizadosólido e com propósito. Dentre os participantes, 49 (84,5%) concordaram ou concordaram totalmente que o uso do método PBL contribuiu para desenvolver a autonomia do aluno. Na percepção dos estudantes, a aplicação da metodologia PBL no ambiente virtual, por meio do recurso de HQ, contribuiu positivamente para o desenvolvimento da autonomia do aluno sobre o próprio aprendizado (AU).

El objetivo de este estudio fue evaluar la percepción y aceptación de los estudiantes sobre la metodología de aprendizaje basada en problemas (problem based learning-PBL) modificada para la modalidad en línea. Estudiantes de Odontología Forense fueron insertados en una escena del crimen simulada en formato de cómic. Divididos en "equipos forenses", se les encomendó la tarea de elaborar un informe pericial sobre estaescena del crimen con la ayuda de un tutor. Al final del semestre, se elaboró un cuestionario utilizando la plataforma Google Forms con preguntas sobre la metodología utilizada, la disponibilidad de materiales en la plataforma virtual y el uso de un entorno que simula la realidad forense. Se utilizó un modelo de cuestionario cerrado y respuestas basadas en la escala de Likert. La muestra estuvo conformada por 58 participantes, de los cuales 50 (86,2%) estuvieron de acuerdo o totalmente de acuerdo en que la metodología fue estimulante y proporcionó un aprendizaje sólido y propositivo. Entre los participantes, 49 (84,5%) estuvieron de acuerdo o muy de acuerdo en que el uso del método PBL contribuyó al desarrollo de la autonomía de los estudiantes. En la percepción de los estudiantes, la aplicación de la metodología PBL en el entorno virtual, a través del recurso del cómic, contribuyó positivamente al desarrollo de la autonomía del estudiante sobre su propio aprendizaje (AU).

The objective of this study was to evaluate the students' perception and acceptance of problem-based learning methodology (PBL) modified for online application. Forensic Dentistry students were inserted into a simulated crime scene in comic book format. Divided into "forensic teams", they were assigned the task of preparing an expert report on this crime scene with the help of a tutor. At completion of the semester, a questionnaire was produced using the Google Forms platform with questions about the methodology used, availability of materials on the virtual platform and the use of an environment simulating forensic reality. A closed model questionnaire was used, and responses were based on the Likert scale. The sample consisted of 58 participants, of which 50 (86.2%) agreed or completely agreed that the methodology was stimulating and that it provided solid and purposeful learning. Among the participants, 49 (84.5%) agreed or strongly agreed that the use of PBL contributed to developing student autonomy. In the students' perception, the application of PBL methodology in the virtual environment, using the comic resource, contributed positively to the development of student's autonomy in their own learning (AU).

Facial soft tissue thickness in forensic facial reconstruction: Impact of regional differences in Brazil.

Forensic facial reconstruction aims to assemble and provide the appearance of a face over a skull, in order to lead to recognition of that individual, making possible the application of primary identification methods. The scientific literature presents facial soft tissue thickness (FSTT) tables for reference from a range of different geographic regions. However, the consensus on its importance or on how to use specific population data related to FSTT is not unanimous. Brazil is formed by geographic regions with diverse populations, which are reflected in facial features. This paper aimed to measure and compare FSTT of distinct Brazilian samples to ascertain the need for specific data sets for different regions. A specific protocol for cone beam computed tomography was used to standardize measurement, and it was applied in a sample of 101 subjects. The FSTT measurements of a Brazilian population from the Midwest Region was compared to a previous sample from Southeast, which was collected using the same protocol. High compatibility was observed when comparing the averages of FSTT among samples of these two different geographic regions. Regarding age groups, notable differences on the medium and inferior face were observed in females. Minor variances found are unlikely to affect the practice of forensic facial reconstruction. Facial features, such as eyes, lips, nose, and skin may also be relevant in the differentiation of people from these two areas in Brazil. Therefore, concerning the Southeast and Midwest Brazilian regions, the need to apply different data sets is unnecessary.

Avaliação da acurácia nas mensurações lineares craniofaciais por meio do programa Horos / Assessment of the accuracy of craniofacial linear measurements on Horos software

Introdução: Na antropometria craniofacial avaliam-se quantitativamente as estruturas anatômicas faciais, e as tomografias computadorizadas de feixe cônico (TCFC) têm contribuído significativamente para refinar essa abordagem. A análise antropológica e morfológica do crânio para estimativa de idade, ou a avaliação das espessuras de tecidos moles faciais para aproximação facial forense, podem ser beneficiadas com o avanço das ferramentas de reconstrução e visualização de imagens de TCFC em softwares open source como o HorosTM. Objetivo: Avaliar a confiabilidade e a precisão de medidas lineares realizadas em TCFC em Reconstrução Multiplanar (MPR), no modo de visualização de MIP, nas espessuras de corte mínima (Emín) e máxima (Emáx). Material e método: Foram selecionados 17 crânios pertencentes ao biobanco do Laboratório de Antropologia e Odontologia Forense da Universidade de São Paulo (OFLab-FOUSP) para a mensuração de 10 grandezas lineares, aferidas de três maneiras distintas: uma diretamente sobre o crânio (padrão-ouro) e duas no software (em Emín e Emáx). Para a análise estatística foi adotado o nível de significância de 5%. Resultados: O CCI (Coeficiente de Concordância Intra-classe) inter e intra-examinadores foi excelente. A consistência das medidas entre os métodos, nos grupos A (crânio-Emín) e B (crânio-Emáx) foi verificada pela análise de Bland-Altman. O grupo B apresentou maior precisão de medidas, porém, a diferença menor do que 1 mm encontrada no grupo A não compromete a análise craniométrica. Conclusão: Ambos os métodos são confiáveis para mensurações lineares

Introduction: In craniofacial anthropometry, facial anatomical structures are quantitatively evaluated, and cone beam computed tomography (CBCT) has significantly contributed to refine this approach. Anthropological and morphological analysis of the skull for age estimation or, assessment of facial soft tissue thickness for forensic facial approximation, can be benefited by advancement of CBCT image reconstruction and visualization tools at open-source software such as HorosTM. Objective: This study verified the reliability and accuracy of linear measurements performed in CBCT in Multiplanar Reconstruction (MPR), in MIP visualization mode, at minimum (STmin) and maximum (STmax) slab thicknesses. Material and Method: 17 skulls from biobank of the Laboratory of Forensic Anthropology and Dentistry of University of São Paulo (OFLab-FOUSP) were selected for measurement of 10 linear distances, measured in three different ways, one directly on the skull (gold standard) and two in software (in STmin and STmax). For statistical analysis, the significance level of 5% was adopted. Results: Inter- and intra-examiner ICC (Intraclass Correlation Coefficient) was excellent. The consistency of measurements between the methods in groups A (skull-STmin) and B (skull-STmax) was verified by Bland-Altman analysis. Group B showed greater measurement accuracy than group A. However, differences found in group A was smaller than 1 mm, and it does not compromise the craniometric analysis. Conclusion: Both methods are reliable for linear measurements

Utilização de escâneres intraorais na Odontologia Legal: uma revisão de literatura / The use of intraoral scanners in Forensic Odontology: a literature review

A incorporação do chamado fluxo digital já é uma realidade na odontologia clínica, e suas vantagens podem ser incorporadas à Odontologia Forense. Particularmente, os escâneres, ou scanners intraorais (SIOs) geram modelos tridimensionais digitais em forma de arquivo que podem ser armazenados, analisados e comparados utilizando aplicativos próprios. Trata-se de técnica que obtém registros com agilidade e precisão, onde os dados podem ser obtidos, se necessário, no próprio local do encontro, como por exemplo, nos acidentes coletivos. O objetivo deste estudo é revisar a literatura sobre as aplicações mais recentes dos SIOs e dos arquivos por eles gerados na Odontologia Forense. Onze trabalhos foram selecionados para revisão. Os estudos mostram que as técnicas existentes se beneficiam do uso dos SIOs e dos modelos digitais, e que medidas exatas e precisas podem ser feitas digitalmente. Algoritmos de comparação e inteligências artificiais podem ser de grande contribuição para o processo de identificação, diminuindo a quantidade de suspeitos a serem comparados com uma determinada amostra e identificando restaurações metálicas. A técnica digital permite a diferenciação de gêmeos monozigóticos por análise das rugosidades palatinas. A identificação humana baseada apenas na análise física ou digital de marcas de mordida não é recomendada, pois é sujeita a viés do examinador

The digital workflow is already ubiquitous in the clinical dental practice, and its advantages can be incorporated to the forensic odontology. Intraoral scanners generate digital casts that can be stored, analyzed and compared using the proper software. It's a technique that swiftly and precisely registers the object of interest, and can be used on-site, if needed, in mass disasters, for example. The goal of this article is to review the most recent applications of the intraoral scanners and the digital files generated by them in the forensic odontology practice. Eleven articles were selected for revision. The studies demonstrate that the existing identification techniques can benefit from the use of intraoral scanners and digital casts, and measures can be taken digitally with precision and accuracy. Automated comparison algorithms and artificial intelligence models can be of great contribution to the identification process, decreasing the number of suspects that could match a sample and identifying metallic restorations. Digital analysis of palatal rugae was used successfully to identify monozygotic twins. Human identification relying solely on bitemark analysis, even with digital techniques, is not recommended, due to examiner bias

Facial reconstruction: Validation of the Tedeschi-Oliveira method for estimating the pronasale point in Brazilians.

Forensic facial reconstruction aids in the process of human identification by facial recognition. The nose plays an important role in this process; however, its soft tissues wither away during cadaveric decomposition. There are few studies in the area of facial recognition of the Brazilian population, especially concerning Brazilian nasal prediction guides. This study aimed to test the hypothesis that the angle formed by the tangents drawn from the rhinion and prosthion points (nose tip) is equal to 90º, as proposed by the pioneer study by Tedeschi-Oliveira et al. (2016). It is important to highlight that this is the only method to date developed to predict the nasal tip in Brazilians, and has not yet been tested in other populations. Images of computed tomography scans of 228 individuals (171 females and 57 males) were screened according to the same criteria used by the authors of the primary study. The images were analyzed using the Horos® program, version 1.1.7 - 64 bit. The mean angle studied was about 90º, and any difference between this mean and the real angle measured did not significantly compromise the accuracy of the nose tip location. The findings tested in the present study corroborate the hypothesis investigated by Tedeschi-Oliveira et. al. Therefore, we suggest that the method be used in forensic practice to estimate nose tips in Brazilians.

Reconstrução facial forense digital: uma revisão sobre o emprego da técnica / A review on the use of the computer-aided forensic facial reconstruction technique

A Reconstrução Facial Forense (RFF) é uma técnica auxiliar de identificação, aplicável quando o cadáver se encontra irreconhecível em razão do estado de decomposição, carbonização ou mutilação, e pode ser realizada de forma manual ou digital. Os métodos digitais fazem uso de recursos computacionais para aproximar a aparência em vida da face do cadáver. O desenvolvimento de novas tecnologias nas áreas da imaginologia e tecnologia da informação tem permitido o aperfeiçoamento da técnica da reconstrução facial digital. O propósito deste artigo é fornecer uma visão geral do método digital de RFF, destacando a evolução do método, as vantagens e algumas limitações relacionadas ao emprego dessa técnica. A RFF digital, por meio de recursos de tecnologia da informação, permite que sejam realizados ajustes virtuais, sendo possível avaliar cada etapa da reconstrução durante o processo, corrigindo eventuais erros e produzindo diversas variações para uma mesma face, visando a facilitar um possível reconhecimento.

Facial reconstruction: Validation of the Tedeschi-Oliveira method for estimating the pronasale point in Brazilians

Abstract Forensic facial reconstruction aids in the process of human identification by facial recognition. The nose plays an important role in this process; however, its soft tissues wither away during cadaveric decomposition. There are few studies in the area of facial recognition of the Brazilian population, especially concerning Brazilian nasal prediction guides. This study aimed to test the hypothesis that the angle formed by the tangents drawn from the rhinion and prosthion points (nose tip) is equal to 90º, as proposed by the pioneer study by Tedeschi-Oliveira et al. (2016). It is important to highlight that this is the only method to date developed to predict the nasal tip in Brazilians, and has not yet been tested in other populations. Images of computed tomography scans of 228 individuals (171 females and 57 males) were screened according to the same criteria used by the authors of the primary study. The images were analyzed using the Horos® program, version 1.1.7 - 64 bit. The mean angle studied was about 90º, and any difference between this mean and the real angle measured did not significantly compromise the accuracy of the nose tip location. The findings tested in the present study corroborate the hypothesis investigated by Tedeschi-Oliveira et. al. Therefore, we suggest that the method be used in forensic practice to estimate nose tips in Brazilians.

The need for implant dentists to know about the method of forensic human identification using dental implants

The aim of this study is to present two cases in which dental implants greatly enhanced the forensic human identification and to show the important role of the implant dentist in this process. The skeletonized remains of two victims with dental implants were sent for exams. The morphological features (qualitative) and linear measurements (quantitative) of the implants were analyzed in the ante-mortem and postmortem radiographs. The points of coincidence observed in both the implants and teeth showed compatibility of findings that led the experts to determine the positive identification. The implants found in the bodies were decisive in the process of identification. This identification was only possible because the implant dentists presented complete documentation with good technical quality, enabling an efficient expert approach to comparison of the data. Therefore, it is important to make implant dentists aware of this significant role because they may be asked by the authorities or family members of the deceased to present a complete record chart.

O objetivo desse trabalho é apresentar dois casos em que os implantes foram essenciais no processo identificação e mostrar a importância do papel do implantodontista nesse processo. Dois corpos esqueletizados com implantes dentais foram encaminhados para exames. Foram analisadas as características morfológicas (qualitativas) e medidas lineares (quantitativas) dos implantes nas radiografias antemortem e postmortem. Os pontos de coincidência observados tanto nos implantes quanto nos dentes mostram a compatibilidade dos achados, o que levou os peritos a determinarem a identificação positiva. Os implantes encontrados nos corpos foram decisivos no processo de identificação. Essa identificação só foi possível porque os implantodontistas apresentaram uma documentação completa e com boa qualidade técnica, permitindo uma abordagem pericial segura no confronto dos dados. Portanto, é importante que os implantodontistas estejam cientes do seu papel já que podem ser solicitados pelas autoridades ou membros da família para apresentarem o prontuário da pessoa falecida

Necropsia odontolegal: técnicas e vias de acesso com finalidade de identificação humana / Dental autopsy: techniques and access ways with human identification purpose

Introdução: A Odontologia Legal ocupa importante espaço dentre as Ciências Forenses, oferecendo seus conhecimentos específicos da Odontologia em prol da resolução de casos de natureza cível, criminal, administrativa e trabalhista. O avanço da Odontologia Legal está diretamente ligado à busca pela identificação humana, o que tornou possível a crescente presença do perito odontolegista nos Institutos Médico Legais (IMLs), oficializada pela Lei 5081/66. O objetivo deste trabalho foi apresentar, por meio de uma revisão de literatura, as principais técnicas de necropsia bucal com finalidade de permitir o exame de identificação humana, bem como as diferentes vias de acesso, desenvolvidas ou utilizadas pelos odontolegistas. As técnicas preconizam incisões em diversas regiões de cabeça e pescoço, com a remoção ou não dos maxilares e são selecionadas para serem utilizadas de acordo com o estado de degradação dos corpos e a necessidade de preservação das estruturas e tecidos faciais, já que em diversos casos, os cadáveres deverão ser devolvidos aos seus familiares para serem velados posteriormente. Conclui-se que o uso das técnicas de necropsia bucal é necessário para a análise detalhada dos arcos dentais, de onde são retiradas as informações post-mortem para, em seguida, serem confrontadas à documentação ante-mortem do cadáver. Essas técnicas devem ser escolhidas de acordo com a praticidade e agilidade do exame, mas sob os critérios do estado inicial do corpo e a necessidade estética final do procedimento

Forensic Dentistry plays an important role within the Forensic Sciences, offering its expertise in Dentistry for the resolution of cases for civil, criminal, administrative and labor. The advancement of Forensic Dentistry is directly linked to the search for human identification, which is made possible the growing presence of the forensic odontologist in the Medical Legal Institutes (IMLs), a right granted by the Brazilian Federal Law n. 5081/66. The objective was to present, through a literature review, the main techniques of oral autopsy, and the various access ways, developed and used by dental examiners in order to facilitate and expedite the identification of bodies. Such techniques recommends incisions in various regions of the head and neck, with or without removal of the jaws, and are selected according to the state of preservation of the bodies, and the need for preservation of facial tissues and structures since, in many cases, the bodies must be returned to their families later to be veiled. It is concluded that the use of oral necropsy techniques is necessary for a detailed analysis of the dental arches, where postmortem data can be acquired and then confronted to the documented antemortem data of the corpse. The techniques are chosen by a practical and less time consuming criteria, but under the initial state of preservation and necessity of final aesthetic variables

Forensic Facial Approximation: Study of the Nose in Brazilian Subjects.

Forensic facial approximation is an auxiliary method for human identification and allows facial recognition. The midface, that includes the nose, is vital for the recognition of a familiar face. The purpose of this study was to set hard tissue parameters to estimate nasal width, to test the method to estimate nasal width of Brazilians, and to analyze the relationship between nasal profile and facial type. A total of 246 computed tomography scans (183 females and 63 males) of adults were analyzed in Horos. Bone tissue measurements and facial type classification were performed on the skull scan. Nasal profile morphology was accessed through the tool 3D surface rendering. There was a difference around 3 mm from real to predicted nose through the method to estimate nasal width in Brazilians. So, the method may be used in forensic practice. Straight nose was associated with long face type.

Age estimation: Cameriere's open apices methodology accuracy on a southeast Brazilian sample.

Age estimation plays an important role in clinical and forensic dentistry. Cameriere's 2007 open apices method for age estimation was applied in a sample of 612 digital panoramic orthopantomographs from Brazilian subadult individuals of known age and sex. The sample was composed of 290 males and 322 females individuals aged between four and 16 years of age from São Paulo metropolitan area who had undertaken radiographs for clinical purposes. Participant's ethnicity data was not available. An open code computer-aided drafting software (ImageJ) was used to measure the variables according to the author's published guidelines. Subjects' age was firstly estimated under the application of the European formula (2007) showing under-estimation (-1.24yr). On the other hand, the linear regression analysis modeled for this specific population was able to explain 91.2% of the chronological age variation with a standard error of 0.91yr. Residual analyses confirmed independent errors and a normal distribution. In conclusion, the present results support Cameriere's method for age estimation in Brazilian subadults to be a reliable method, although correlations may vary between specific groups and, hence, specific formulae may be useful for an accurate prediction.

Assessment of accuracy and recognition of three-dimensional computerized forensic craniofacial reconstruction.

Facial reconstruction is a technique that aims to reproduce the individual facial characteristics based on interpretation of the skull, with the objective of recognition leading to identification. The aim of this paper was to evaluate the accuracy and recognition level of three-dimensional (3D) computerized forensic craniofacial reconstruction (CCFR) performed in a blind test on open-source software using computed tomography (CT) data from live subjects. Four CCFRs were produced by one of the researchers, who was provided with information concerning the age, sex, and ethnic group of each subject. The CCFRs were produced using Blender® with 3D models obtained from the CT data and templates from the MakeHuman® program. The evaluation of accuracy was carried out in CloudCompare, by geometric comparison of the CCFR to the subject 3D face model (obtained from the CT data). A recognition level was performed using the Picasa® recognition tool with a frontal standardized photography, images of the subject CT face model and the CCFR. Soft-tissue depth and nose, ears and mouth were based on published data, observing Brazilian facial parameters. The results were presented from all the points that form the CCFR model, with an average for each comparison between 63% and 74% with a distance -2.5 ≤ x ≤ 2.5 mm from the skin surface. The average distances were 1.66 to 0.33 mm and greater distances were observed around the eyes, cheeks, mental and zygomatic regions. Two of the four CCFRs were correctly matched by the Picasa® tool. Free software programs are capable of producing 3D CCFRs with plausible levels of accuracy and recognition and therefore indicate their value for use in forensic applications.

Analysis of student satisfaction regarding the use of online technologies and resources in Forensic Dentistry / Análise da satisfação discente quanto ao uso de tecnologias e recursos online na Odontologia Forense

This study aimed to assess the level of satisfaction and the learning effectiveness evaluated by undergraduate students after using the virtual environment and its didactic materials offered by the Discipline of Forensic Dentistry, School of Dentistry, University of São Paulo. A case study was carried out with 113 participants, through a semi-structured online questionnaire and Moodle report for data collection. A simple descriptive analysis of the quantitative data and a content analysis of the qualitative data were performed, with subsequent triangulation and correlation of the results. The most accessed didactic materials were activities such as review questions and case studies (n = 1309), followed by workbooks (n = 230) and videos (n = 122). The activities of the virtual learning environment (VLE) helped students associate theory and practice (89%), achieve content fixation and identify occasional learning difficulties (93%). Ninety-eight percent of the students responded that the workbooks had a clear and interactive language, thus promoting autonomy and the ability to learn. Eighty-nine percent of the students agreed that the videos were satisfactory regarding quality and usefulness for learning. The comments made in response to the open-ended question corroborate these figures. The students considered the VLE useful for learning, motivating, accessible and organized, and allowing users freedom of access (AU).

Este estudo teve como objetivo investigar o nível de satisfação e a efetividade de ambiente virtual de aprendizagem e dos materiais didáticos nele disponíveis, experimentados por estudantes de graduação da Faculdade de Odontologia Universidade de São Paulo. Foi realizado um estudo de caso com 113 participantes, em que a coleta de dados ocorreu por meio de grupo focal e questionário online semiestruturado. Foi realizada a análise descritiva simples dos dados quantitativos e a análise de conteúdo dos dados qualitativos, com posterior triangulação e correlação dos resultados. Os materiais didáticos mais acessados foram atividades como questionários e estudos de caso (n= 1309), seguidas das apostilas (n=230) e vídeos (n= 122). Para os alunos, as atividades do ambiente virtual de aprendizagem (AVA) auxiliaram na associação da teoria com a prática (89%), foram importantes para a fixação do conteúdo e auxiliaram na identificação de eventuais dificuldades na aprendizagem (93%). As apostilas possuem linguagem clara e interativa, promovendo autonomia e capacidade de aprender, de acordo com 98% dos estudantes. Em relação aos vídeos, a concordância de que estes foram satisfatórios quanto à qualidade e úteis na aprendizagem foi de 89%. Os comentários da questão aberta corroboram os números. Os discentes consideraram o AVA útil para o aprendizado, motivador, acessível, organizado e que permite liberdade de acesso ao usuário (AU).

Facial pattern analysis: critic review and collection of facial proportions in a brazilian sample using cone-beam computed tomography / Análise de tipos faciais: revisão crítica e coleta de proporções faciais em amostra de brasileiros utilizando tomografia computadorizada de feixe cônico

The classification of facial vertical patterns is a common practice among dentists of different specialties. It influences treatment planning and expected outcomes, but is usually carried out qualitatively. The aim of this study is to better understand vertical facial proportions, combining a critic review of the literature with the collection of data from 100 Brazilian adult sample in search of 3D quantitative parameters with the use of Cone-Beam Computed Tomography (CBCT) measurements. In Pubmed database, the following quoted phrases were used: "Facial pattern" AND "Facial Index" AND "Facial height Index" AND "Facial height" AND "Dolichofacial" AND "Brachyfacial" AND "Longface syndrome" AND "Short-face syndrome" in a 25 years interval (1990-2015). Study selection was performed searching for crucial facial features, commonly used to determine the facial pattern of a patient. In CBCT exams, 100 patients had facial features measured and classified by the three most reliable methods. The literature on the field can be very confusing, as the methods, landmarks and averages differed considerably. Most of the facial features researched had different values when the literature was analyzed and compared to our data. This indicates that ethnic, age and gender variations play an important whole in facial pattern diagnostic and should be taken in account when using general cephalometric approaches on diagnosis. With a group sorting method, combining the ratios between the anterior Facial height and the width, the anterior vertical proportion and the gonial angle divergence, and with anatomical landmarks we successfully correlated the sample to the qualitative description, as shorter faced patients to larger bi-zygomatic distances and less divergent gonial angles and longer faced patients with narrower and more divergent faces.

A classificação de padrões faciais verticais é prática comum entre Cirurgiões Dentistas de diferentes especialidades. Esta influencia o planejamento de tratamento e resultados esperados, no entanto, essa tarefa é frequentemente realizada de forma qualitativa. O objetivo deste trabalho foi compreender melhor as proporções verticais da face, combinando uma análise crítica da literatura com a coleta de dados de 100 adultos brasileiros na procura por parâmetros quantitativos em 3D, usando tomografias computadorizada de feixe cônico (TCFC). Na base de dado pubmed, a seguinte frase foi utilizada: "Facial pattern" AND "Facial Index" AND "Facial height Index" AND "Facial height" AND "Dolichofacial" AND "Brachyfacial" AND "Long-face syndrome" AND "Short-face syndrome" em um intervalo de 25 anos (1990-2015). A seleção dos estudos foi realizada procurando características faciais cruciais e métodos comuns para a determinação do padrão facial do paciente. Em exames de TCFC de 100 pacientes adultos, foram medidas as dimensões faciais foram registradas e os três métodos mais confiáveis e encontrados na literatura foram testados. A literatura sobre o assunto pode ser muito confusa, ao ponto de que os métodos, pontos de referência e médias variaram consideravelmente. Muitas das características pesquisadas tinham valores diferentes quando analisada a literatura em comparação com os dados dessa pesquisa. Isso indica que variações de etnia, idade e gênero tem papel importante no diagnóstico do padrão facial e deve ser levada em consideração quando utilizados padrões cefalométricos para diagnóstico. Com a metodologia de agrupamento, utilizando o índice entre a altura facial anterior e a largura, a proporção anterior da face e a divergência do ângulo goníaco, assim como os pontos cefalométricos selecionados, nós correlacionamos com sucesso a amostra com as descrições qualitativas como: os pacientes de face curta e as distâncias bi-zigomáticas e ângulos faciais menos divergentes, assim como os pacientes de face longa com faces mais estreitas e menos divergentes.

Forensic Facial Reconstruction: Relationship Between the Alar Cartilage and Piriform Aperture.

During forensic facial reconstruction, facial features may be predicted based on the parameters of the skull. This study evaluated the relationships between alar cartilage and piriform aperture and nose morphology and facial typology. Ninety-six cone beam computed tomography images of Brazilian subjects (49 males and 47 females) were used in this study. OsiriX software was used to perform the following measurements: nasal width, distance between alar base insertion points, lower width of the piriform aperture, and upper width of the piriform aperture. Nasal width was associated with the lower width of the piriform aperture, sex, skeletal vertical pattern of the face, and age. The current study contributes to the improvement of forensic facial guides by identifying the relationships between the alar cartilages and characteristics of the biological profile of members of a population that has been little studied thus far.

Differentiation between palatal rugae patterns of twins by means of the Briñón method and an improved technique

Palatal rugae patterns are anatomic structures considered unique to each person. Monozygotic twins present similarities, however, Rugoscopy in particular, may contribute to their individualization for forensic purposes. The aims of this study were: to study the palatal rugae classifications of Briñón; to propose improvements to facilitate use of this method, if pertinent; and to characterize palatal rugae in a sample of Brazilian monozygotic twins and singletons. Precise reproducibility of the two methods of Briñón, from 1982 and 2011, was prevented by poor intra-examiner agreement (70% and 13% respectively). Our proposed improvements to these methods, although preliminary, were associated with better results. The most common palatal rugae patterns were types A, M, and Q. Palatal rugae were confirmed to be unique to each individual, even in monozygotic twins. Furthermore, twins did not exhibit any special patterns that might facilitate their differentiation from singletons.

Use of an Alternate Light Source to Detect Tooth and Bone.

The aim of this study was to identify the combination of wavelength and filter that best detects tooth and bone, and to determine which biological materials (enamel, dental root or bone) have highest fluorescence intensity when exposed to an alternate light source (ALS). Tooth and bone samples were lighted with ALS and photographed. Adobe Photoshop™ and ImageJ™ softwares were used for image analysis. Data obtained by measuring the photograph pixels were subjected to analysis of variance. The mean values of significant effects were compared by the Tukey test. In all tests, the significance level was set at p≤0.05 and the values calculated by the SAS system. The results showed that the best combination for detecting tooth and bone is an illumination wavelength of 455 nm with an orange filter. The fluorescence of dental root is greater than that of enamel, which in turn is greater than that of bone. The biological material had markedly higher fluorescence than the inert material. This knowledge can help the forensic expert to screen and detect biological materials, for example in situations where there are fragmented teeth and small bones, both at the scene and in the laboratory.

Comparison Among Manual Facial Approximations Conducted by Two Methodological Approaches of Face Prediction.

This study verified the difference between two methods of forensic facial approximation (FFA) regarding recognition and resemblance rates. Three-dimensional models of skulls were obtained from computerized tomography (CT) scans of two subjects (targets). Two manual FFAs were performed for each target, by applying two different guidelines for the facial structures (what we called "American method" (AM) and "Combined method" (CM)). Unfamiliar assessors evaluated the sculptures by recognition and resemblance tests. The AM was that which allowed more correct responses of recognition and higher resemblance's scores for the male target (p < 0.001). Regarding guidelines for modeling characteristics of the face, the ones that are practical and easily performed for sculptures, such as the length of the anterior nasal spine multiplied by 3 for nose prediction, may offer better results in terms of resemblance.

Use of an Alternate Light Source to Detect Tooth and Bone

Resumo O objetivo desse trabalho foi identificar a combinação do comprimento de onda e filtro que melhor detecta dente e osso e verificar qual material biológico (esmalte, raiz dental ou osso) possui maior fluorescência quando exposto a uma fonte de luz alternativa (ALS). Amostras de dente e osso foram iluminadas com uma ALS e fotografadas. Os programas Adobe Photoshop™ e ImageJ™ foram usados para análise das imagens. Os dados obtidos das medidas dos pixels das fotografias foram submetidos a análise de variância. Os valores com efeitos significativos tiveram suas médias comparadas pelo teste de Tukey. Em todos os testes, o nível de significância adotado foi p≤0,05 e os valores calculados pelo sistema SAS. Os resultados mostraram que a melhor combinação para detectar dente e osso é o comprimento de onda 455 nm com o filtro laranja. A fluorescência da raiz é maior que a do esmalte que é maior do que o osso. O material biológico teve maior fluorescência que o material inerte. Esse conhecimento pode auxiliar o perito a triar e detectar esses materiais biológicos, por exemplo em situações em que dentes e pequenos ossos estiverem fragmentados, tanto na cena do crime quanto no laboratório.

Abstract The aim of this study was to identify the combination of wavelength and filter that best detects tooth and bone, and to determine which biological materials (enamel, dental root or bone) have highest fluorescence intensity when exposed to an alternate light source (ALS). Tooth and bone samples were lighted with ALS and photographed. Adobe Photoshop™ and ImageJ™ softwares were used for image analysis. Data obtained by measuring the photograph pixels were subjected to analysis of variance. The mean values of significant effects were compared by the Tukey test. In all tests, the significance level was set at p≤0.05 and the values calculated by the SAS system. The results showed that the best combination for detecting tooth and bone is an illumination wavelength of 455 nm with an orange filter. The fluorescence of dental root is greater than that of enamel, which in turn is greater than that of bone. The biological material had markedly higher fluorescence than the inert material. This knowledge can help the forensic expert to screen and detect biological materials, for example in situations where there are fragmented teeth and small bones, both at the scene and in the laboratory.