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

Evolução normativa e legal para o exercício da Odontologia brasileira frente à pandemia da COVID-19 / Normative and legal evolution for the exercise of Brazilian dentistry against the COVID-19 pandemic

Introdução: A COVID-19 é uma enfermidade respiratória causada pelo vírus SARS-CoV-2, detectado pela primeira vez em Wuhan - China em dezembro de 2019. Atualmente, está bem definido que esse vírus possui alta e sustentada transmissibilidade entre as pessoas. Em decorrência do aumento da infecção humana pelo novo coronavírus e com o eminente risco de contágio e propagação da doença, iniciaram-se as medidas de prevenção e controle de infecção através da publicação de dispositivos legais com o objetivo de orientar os serviços de saúde e conter a disseminação do vírus. Sabe-se que a assistência odontológica apresenta alto risco para a disseminação do coronavírus e, por esse motivo, tornou-se de suma importância que os profissionais que atuam nos serviços de saúde estejam munidos de informações para evitar ou reduzir ao máximo a transmissão de microrganismos durante qualquer assistência realizada. Objetivo: Apontar, por meio de uma revisão de literatura, a evolução das normativas éticas e legais relacionadas ao exercício da odontologia frente à pandemia da COVID-19 no Brasil. Revisão Da Literatura: Foram verificados dispositivos legais publicados durante o período de pandemia com repercussão sobre a Odontologia nas esferas nacional, com ênfase para questões sanitárias e de fiscalização do exercício profissional, além de uma orientação associativa. Conclusão: As normativas publicadas até a presente data, que se relacionam ao exercício profissional, destacam a importância de os cirurgiões-dentistas manterem-se atualizados sobre estes aspectos para o exercício profissional, ressaltando, ainda, que novas orientações e atualizações podem ser feitas sobre esta pandemia.

INTRODUCTION: COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus, first detected in Wuhan - China in December 2019. Currently, it is well defined that this virus has a high and sustained transmissibility between humans. As a result of the increase of human infection by the new coronavirus and the imminent risk of contagion and spread of the disease, measures of prevention and control of the infection were initiated through the publication of several regulations aiming to guide and contain the spread of the virus. Due to the high risk of dissemination of the coronavirus associated with dental care, it has become extremely important to provide information to avoid or reduce, as much as possible, the transmission of microorganisms during any assistance performed. OBJECTIVE: To point out, through a literature review, the evolution of ethical and legal regulations related to the practice of dentistry in view of the COVID-19 pandemic in Brazil. LITERATURE REVIEW: Legal provisions published during the pandemic period with repercussions on Dentistry were examined, in national level, focusing on sanitary issues and supervision of professional practice, in addition to an associative orientation. CONCLUSION: The regulations published to date, which relate to professional practice, highlight the importance of dentists keeping up-to-date on these aspects for professional practice, also emphasizing that new guidelines and updates can be made about this pandemic

3D forensic facial approximation: Implementation protocol in a forensic activity.

The primary objective of this paper is to report on the successful implementation of forensic facial approximation in a real case in the forensic context. A three-dimensional (3D) facial approximation protocol of the skull was performed with free software, applying techniques in a virtual environment that have already been consolidated in the literature. The skull was scanned with the photogrammetry technique, the digital replica was imported in the Blender software (Blender Foundation, Amsterdam) and individualized model sketches of the face were traced with the MakeHuman software (MakeHuman Org) according to the anthropological profile of the victim. The face created was imported in Blender, where it was adapted, modeled, and sculpted on the 3D skull and its soft tissue markers, using an American open-source application of the technique in the digital environment. The face created in a virtual environment was recognized and legal identification procedures were started, resulting in the more agile delivery of the disappeared body to its next of kin. It is therefore concluded that facial approximation may not be a primary method of human identification, but it can be satisfactorily applied in the forensic field as an individual recognition resource. It has great value in narrowing the search, reducing the number of alleged victims, and leading to identification tests, therefore significantly reducing the number of genetic DNA (deoxyribonucleic acid) tests-which are considered costly for the State or Federation-and consequently reducing the waiting time before delivery of the body to its family.

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.

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.

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.

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).

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.

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.

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

Abstract 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.

Forensic facial approximation assessment: can application of different average facial tissue depth data facilitate recognition and establish acceptable level of resemblance?

Facial soft tissue thicknesses (FSTT) are important guidelines for modeling faces from skull. Amid so many FSTT data, Forensic artists have to make a subjective choice of a dataset that best meets their needs. This study investigated the performance of four FSTT datasets in the recognition and resemblance of Brazilian living individuals and the performance of assessors in recognizing people, according to sex and knowledge on Human Anatomy and Forensic Dentistry. Sixteen manual facial approximations (FAs) were constructed using three-dimensional (3D) prototypes of skulls (targets). The American method was chosen for the construction of the faces. One hundred and twenty participants evaluated all FAs by means of recognition and resemblance tests. This study showed higher proportions of recognition by FAs conducted with FSTT data from cadavers compared with those conducted with medical imaging data. Targets were also considered more similar to FAs conducted with FSTT data from cadavers. Nose and face shape, respectively, were considered the most similar regions to targets. The sex of assessors (male and female) and the knowledge on Human Anatomy and Forensic Dentistry did not play a determinant role to reach greater recognition rates. It was possible to conclude that FSTT data obtained from imaging may not facilitate recognition and establish acceptable level of resemblance. Grouping FSTT data by regions of the face, as proposed in this paper, may contribute to more accurate FAs.

Levantamento jurisprudencial: provas em processo de responsabilidade civil odontológica / Jurisprudential study: evidences in dental civil liability lawsuit

Introdução: Nas ações de responsabilidade civil, o juiz ou o Tribunal não está adstrito ao laudo pericial para formar sua convicção, mas deve expor os motivos de sua decisão com base no conjunto probatório. Este estudo visa analisar as principais provas utilizadas em ações de responsabilidade civil em face do Cirurgião-Dentista para fundamentação da sentença. Metodologia: Foram analisadas as decisões do Tribunal de Justiça do Estado de São Paulo em um período de doze meses. 95 processos foram selecionados para estudo. Para a coleta de dados, foram lidos todos os julgados integralmente, tendo-se como parâmetros os tipos de prova utilizados no caso, as motivações da sentença e as decisões do Tribunal. Resultados: A principal motivação para a decisão do Tribunal baseou-se na conclusão do laudo pericial e as demais se referiram ao prontuário odontológico. Em 80 casos houve perícia. Destes, em 62 a decisão do Tribunal estava de acordo com a conclusão do laudo pericial, 15 laudos foram inconclusivos, e em três, o laudo não foi a principal prova utilizada no acórdão, tendo sido utilizado o prontuário odontológico. Dos casos em que houve apresentação de prontuário, 71% foram julgados a favor do profissional. No que tange à decisão do Tribunal, em 41 casos (n=43%) foi concluído pela má-prática profissional. Conclusão: A perícia técnica foi significativa para a comprovação da correta técnica do procedimento profissional, tendo sido o principal meio de prova para a decisão do Tribunal. A manutenção de um prontuário odontológico adequado é importante para fazer prova no processo.

Background: In civil liability lawsuits, the Court is not obliged to follow the expert report to form its conviction, but it must present its motives for decision based on the evidences. This study aims to analyze the main evidence used in civil liability lawsuits related to the dental surgeon as a basis for sentencing. Methods: The decisions of the Court of Justice of the State of São Paulo were analyzed over a period of twelve months (between 2013 and 2014). Ninety-five lawsuits were selected, and all the decisions were read in their entirety, using the types of evidence used in the case, the motivations for the sentence and the Court’s decision as parameters. Results: The main motivation for the Court’s decision was based on the conclusion of the expert report and the others referred to the dental records. Experts were used in 80 cases. In the most of cases, Court decided in agreement with the conclusion of the expert report (95.38%), and in three, this report was not the main evidence used in the decision, with the dental records being used for such. Of those cases in which the records were presented, 71% were decided in favor of the professional, whose main motivation was treatment abandonment. Dental malpractice was determined in 41 cases (43%). Conclusion: The expert report was the principal means of evidence for the Court’s decision. Maintaining appropriate dental records is important for establishing evidence in the lawsuit.

Aproximação facial forense: relação entre as estruturas ósseas e a porção inferior do nariz / Forensic facial approximation: relationship between the bone structure and the inferior portion of the nose

Este trabalho teve o propósito de avaliar a relação entre a cartilagem alar e a abertura piriforme a partir de imagens de tomografia computadorizada cone-beam e a relação do nariz com o padrão esquelético vertical da face. A pesquisa foi realizada com 96 imagens de indivíduos de ambos os sexos (49 masculino e 47 feminino), com idades entre 18 e 65 anos classificados de acordo com sua tipologia facial. Para a realização das marcações e mensurações de interesse foi utilizado o software OsiriX. A tipologia facial foi acessada através de três metodologias: índice facial, ângulo goníaco e proporção entre as alturas faciais. No corte axial da imagem de tomografia computadorizada, foram aferidas quatro grandezas lineares: largura do nariz externo, distância entre as inserções alares, extensão da base da abertura piriforme e máxima largura da abertura piriforme. Todas as grandezas foram mensuradas por dois examinadores em concordância. A análise dos resultados obtidos mostrou que há correlação entre as larguras do nariz externo e da abertura piriforme e entre a base da cavidade nasal e a distância entre as inserções alares. A largura da abertura piriforme aumenta proporcionalmente mais que a do nariz. Além disso, a tipologia facial longa associa-se à largura nasal.

The aim of this study was to evaluate the relationship between the alar cartilage and the pyriform aperture using cone-beam computed tomography (CT) imaging, and the relationship between the morphology of the nose and the vertical skeletal pattern of the face. 96 images of subjects (49 male and 47 female), aged 18-65 years classified according to the vertical skeletal pattern of the face were used in this study. The OsiriX software was used to measure the structures of interest. The facial pattern was obtained according to three techniques: facial index, gonial angle, and facial proportions. From an axial section of the CT imaging, four measurements were performed: nasal width, distance between the alar insertions, extension of the base of the pyriform aperture and width of the pyriform aperture. All measurements were obtained by two calibrated examiners. There is correlation between the nasal width and the breadth of the pyriform aperture, and between the base of the nasal cavity and the distance between the alar insertions. The width of the pyriform aperture proportionally increases more than the nasal breadth. Furthermore, the long face type is associated with nasal width.