Facial soft tissue depth measurements in cone-beam computed tomography: A study of a Brazilian sample.

Forensic facial reconstruction (approximation) (FFR) is an aid to human identification when no presumed identity is available. It is based on average soft tissue thickness (STT) applied onto a skull. These averages vary at each landmark according to sex, ancestry, and Facial Growth Patterns (FGP). To obtain the reference, there are different protocols and conditions, such as needles in cadavers, ultrasound, magnetic resonance, and computer tomography. Using cone-beam computed tomography (CBCT), landmark placement and direction of measurement are critical. The purpose of this article is to detailly describe a method for STT measurement in CBCT DICOM files and to test it in the analysis of a multi-ancestral Brazilian sample, subdivided into sex, age and FGP. A sample of 100 (50 male and 50 female) CBCT exams were selected and the volume was primarily been repositioned to cephalometric standards. A detailed description of the location and measurement direction of 32 landmarks was provided and granted good reproducibility of the measurements. The averages were assessed by sex, age, and FGP. There were significant differences between males and females. The CBCT measuring protocol provided standardization of measurements and is a method to be used in future researches. Advantages of CBCT, such as the subject's upright position and adjustable volume positioning, also justify its usage. Limited differences of STT were related to age and FGP. The updated Brazilian soft tissue thickness chart is a reliable source of data for forensic and clinical purposes.

Forensic facial reconstruction: Nasal projection in Brazilian adults.

The nose has a marked cognitive influence on facial image; however, it loses its shape during cadaveric decomposition. The known methods of estimating nasal projection using Facial Reconstruction are lacking in practicality and reproducibility. We attempted to relate the points Rhinion, Pronasale and Prosthion by studying the angle formed by straight lines that connect them. Two examiners measured this angle with the help of analysis and image-processing software, Image J, directly from cephalometric radiographs. The sample consisted of 300 males, aged between 24 and 77 years, and 300 females, aged 24 to 69 years. The proposed angle ranged from 80° to 100° in both sexes and all ages. It was considered possible to use a 90° angle from projections of the Rhinion and Prosthion points in order to determine the Pronasale position, as well as to estimate the nasal projection of Brazilian adults.

Dispositivos jurídicos e argumentos mais utilizados em processos civis: análise de casuística em Odontologia / Legal devices and arguments mostly used in civil lawsuits: casuistry analysis in Dentistry

Diante do aumento de ações de indenizações materiais e morais em que o cirurgião-dentista (CD) responde a processos judiciais em âmbito civil pelo tratamento realizado, buscou-se investigar quais os dispositivos jurídicos e os argumentos levantados pelos pacientes que respaldaram esses pedidos. Foi realizado um estudo retrospectivo com amostragem de conveniência do casuístico pessoal dos autores de 41 peças processuais. O Código Civil foi o dispositivo jurídico mais citado (68,85%), em seus artigos 927, 949, 1538 e 1545; seguido pela referência às Jurisprudências (46,34% dos processos), Código de Defesa do Consumidor (36,58%); Código de Processo Civil (34,14%) e Constituição Federal (26,82%), sendo que mais de um dispositivo foi encontrado na mesma ação. Já os pacientes argumentaram e fundamentaram sua insatisfação com o tratamento principalmente no relatório do cirurgião-dentista que o atendeu após o tratamento questionado (46,34%) seguido pela atribuição de falha no diagnóstico, planejamento e/ou acompanhamento de seu tratamento (43,90%), entre outros. A defesa do CD contra estas alegações e a consequente comprovação do seu dever de cuidado para com o paciente somente será efetiva diante da correta documentação do atendimento

Facial soft tissue thickness of Brazilian adults.

The auxiliary technique known as Facial Reconstruction enables one to reestablish the contours of the soft tissues over the skull, therefore producing a face and increasing the probability of a facial recognition. The reliability of this technique depends on the evaluation of the mean values of soft tissue thicknesses observed in a given population. Measurements were evaluated in autopsied corpses in "Section of Technical Verification of Deaths" in Guarulhos, São Paulo, Brazil. Thickness was measured manually by puncturing 10 midline craniometrical points and 11 bilateral points on a sample of 40 corpses of both sexes aged between 17 and 90 years, classified by skin color and the nutritional state. The results for the average thickness values are higher for males, variations related to the nutritional state are proportional to the increased fat on the face and age was not significant. The ethnic variable related to skin color when compared to studies with other populations showed differences, with the need for a reference table for a given population application of Facial Reconstruction technique in skulls of non-attributable identity.

Reconstrução facial forense: projeção nasal / Forensic facial reconstruction: nasal projection

O nariz ocupando o terço médio da face, tem marcada influência cognitiva sobre a imagem facial. Constitui-se em grande parte pro tecido cartilaginoso, músculos, pele e gordura, perdendo sua forma durante a decomposição cadavérica. A técnica de Reconstrução Facial no restabelecimento da aoarência nasal pode influenciar o reconhecimento de um crânio sem identidade atribuível e tem sido alvo de numerosas críticas. Os métodos conhecidos para estimar essa projeção nasal a partir de elementos do crâniocarecem de praticidade e reprodutibilidade. Neste estudo, buscou-se relacionar os pontos prosopométricos Rinio (Rhi - ósseo), Pronasa (Pn-no tecido mole) e Próstio (Pr ósseo) estudando o ângulo formado pelas retas que os unem, observando-se a possibilidade de sua utilização na determinação do comprimento nasal. Dois examinadores independentes e calibrado mensuraram esse ângulo com o auxílio do programa de análise e processamento de imagem Image J, versão 1,43; diretamente em radiografias cefalométricas selecionadas a partir do acervo de documentações em arquivos digitais de quatro Institutos de Radiologia Odontológica situados na cidade de São Paulo - Brasil. Medidas lineares foram tomadas considerando a diferença do valor encontrado para o ângulo proposto e o valor hipotético de 90,00 graus. A amostra foi constituída por 600 radiografias laterais da cabeça (300 de indivíduos do sexo masculino com idade entre 24 e 77 anos e 300 do sexo feminino, com idade de 24 a 69 anos). Os dados foram analisados utilizando-se o programa Microsoft Office Exel 10.0. Os resultados obtidos demonstraram que os valores referentes às mensurações de ambos examinadores foram muito próximos a uma relação linear perfeita (r=0.99). Ambos os sexos apresentaram a mesma distribuição de idades nas amostras. O ângulo proposto Rinio-Pronasal-Próstio apresentou valores entre 80,00˚ a 100.00˚ em ambos os sexos e para todas as idades...

The nose, occupying the midle third of the face, has a marked cognitive influence on facial image. It consists largely of cartilage tissue, muscles, skin nad fat, and loses its shape during cadaveric decomposition. The technique of facial reconstruction to resore nasal appearance can influence the recognition of a skull that has no assignable identy and has been the subject of much criticism. The know methods of estimating nasal projection using elements of the skull are lacking in practicality and reproducibility. In this study, we attempted to relate the prosopometric points Rhinio (Rhi, bone), Pronasale (Ph, soft tissue) and Prosthion (Pr, bone) by studying the angle formed by straight lines that connect them, noting the possibility of its use in determining the length of the nose. Two independent and calibrate examinersmeasured this angle with thehelp of analysis and image processing software, image J. version 1.43, directly from cephalometric radiographs, which had been selected from a collection of documentation from the digital archives of four Dental Radiology institutes, located in São Paulo - Brazil. Linear measurements were taken by taking into consideration the difference of the value found for the proposed angle and the hypothetical value of 90.00 degrees. The sample consisted of 600 lateral radiographs of the head (of 300 males aged between 24 and 77 years females, aged 24 to 69 years). The data were analyzed using Microsoft Office Excel 10.10. The results showed that the values for the measurements of both investigators were very close to a perfet linear relationship (r=0,99)...