Biosecurity Perspectives in Oral and Maxillofacial Radiology in Times of Coronavirus disease (COVID-19): a Literature Review

ABSTRACT: The aim of this work was to report biosecurity measures in the Oral and Maxillofacial Radiology (OMR) clinic in the current context of COVID-19, based on a literature review. An electronic search for scientific papers was perform ed using PubMed, Embase, Web of Science, and Scopus database. Although the literature related to care in the OMR clinic regarding COVID-19 is still scarce, this unprecedented scenario created by the pandemic generated an urgent need for measures to prevent the transmission of the virus. Dentists are at maximum risk of contagion and, although the practice of OMR generally does not produce aerosols, radiologists and technicians are continually in contact with body fluids, such as saliva. In additio n, imaging exams are often indispensable for emergency or elective dental diagnosis and treatment. Training in infection control practices during major outbreaks of infectious diseases should be quickly reinforced and dental settings have unique characteristics that warrant specific infection control considerations. Some recommendations have been proposed and were discussed, which cover patient flow, equipment handling and environment, radiographic technique and processing, personal protective equipment and preparation and issuance of radiological reports and access to exam results. Due to the COVID-19 pandemic, biosecurity measures in the routine of the OMR clinic are indispensable to enable emergency dental care and the perspectives of returning to elective treatment. Biosecurity measures and staff training at the OMR clinic should be instituted immediately, since imaging exams are an important and often indispensable part of dental diagnosis and treatment.

RESUMEN: El objetivo de este trabajo fue reportar las medidas de bioseguridad en la clínica de Radiología Oral y Maxilofacial (OMR) en el contexto actual del COVID-19, a partir de una revisión de la literatura. Se realizó una búsqueda electrónica de artículos científicos utilizando PubMed, Embase, Web of Science y la base de datos Scopus. Si bien la literatura relacionada con la atención en la clínica OMR respecto al COVID- 19 aún es escasa, este escenario inédito creado por la pandemia generó una urgente necesidad de medidas para prevenir la transmisión del virus. Los dentistas tienen el máximo riesgo de contagio y, aunque la práctica en la OMR generalmente no produce aerosoles, los radiólogos y técnicos están continuamente en contacto con fluidos corporales, como la saliva. Además, los exámenes por imágenes a menudo son indispensables para el diagnóstico y el tratamiento dental de emergencia o electivo. La capacitación en prácticas de control de infecciones durante brotes importantes de enfermedades infecciosas debe reforzarse rápidamente y los entornos dentales tienen características únicas que justifican consideraciones específicas de control de infecciones. Se han propuesto y discutido algunas recomendaciones que cubren el flujo de pacientes, el manejo y el entorno del equipo, la técnica y el procesamiento radiográfico, el equipo de protección personal y la preparación y emisión de informes radiológicos y el acceso a los resultados de los exámenes. Debido a la pandemia de COVID-19, las medidas de bioseguridad en la rutina de la clínica OMR son indispensables para posibilitar la atención dental de emergencia y las perspectivas de volver al tratamiento electivo. Las medidas de bioseguridad y la capacitación del personal en la clínica OMR deben instituirse de inmediato, ya que los exámenes por imágenes son una parte importante y, a menudo, indispensable del diagnóstico y tratamiento dental.

A Multidisciplinary Outlook in Prosthodontics

Prosthodontic research needs to cover all aspects that can contribute to the clinical outcomes. Without a strong interdisciplinaryrelationship between other disciplines of dentistry and prosthodontics, the esthetic, functional, and/or biological outcome may becompromised and necessitate extensive and expensive retreatment. Through this paper, we would like to review the outline of theareas that overlap between prosthodontics and other branches of modern dentistry that dictates the interdisciplinary treatment.

Relato de caso clínico: tumor odontogênico queratocístico na primeira infância / Case report: keratocystic odontogenic tumor in early childhood

Em 2005, o queratocisto odontogênico foi renomeado e reclassificado para tumor odontogênico queratocístico pela Organização Mundial de Saúde. Seu comportamento agressivo e invasivo, sua elevada taxa de recidiva pós-operatória e novas descobertas moleculares possibilitaram esta reclassificação. Neste artigo pretendemos recordar alguns conceitos desta lesão bem como discutir alguns parâmetros de imagem destacando um caso clínico atípico desta lesão. Discutindo de que modo as novas tecnologias de diagnóstico por imagem auxiliam o Cirurgião-Dentista no planejamento terapêutico e no diagnóstico deste tipo de lesão.

In 2005 the Keratocyst Odontogenic was renamed and reclassified to Keratocystic Odontogenic Tumor by the World Health Organization. His aggressive and invasive behavior, its high postoperative recurrence rate and new molecular discoveries made possible this reclassification. This article aims to recall some concepts of this injury as well as discuss some image parameters highlighting an atypical clinical case of injury. Discussing how new technologies diagnostic imaging helps the dentist surgeon in planning and diagnosis of this type of lesion.

A comparison between various radiological techniques in the localization and analysis of impacted and supernumerary teeth.

Background and Objectives: An increasing number of different types of commercial cone-beam computed tomography (CBCT) devices are available for three-dimensional (3D) imaging in the field of dental and maxillofacial radiology. When removing impacted or supernumerary teeth, surgical teams often operate adjacent significant anatomical structures such as nerves, vessels, adjacent teeth roots, and paranasal sinuses. It is therefore important to choose the appropriate surgical approach to avoid iatrogenic damage to the essential anatomical neighbouring structures. CBCT, also called digital volume tomography (DVT), can visualize impacted and supernumerary teeth in all standard planes, as well as multisectional 3D views. These devices have shown to be highly beneficial in the assessment of small bony lesions and maxillofacial injuries. However, it is still necessary to determine the effectiveness of such devices in the assessment of impacted and supernumerary teeth, in comparison to the conventional radiological methods of intraoral X-rays and panoramic X-rays. Materials and Methods: During a period of 2 years, a total of 61 patients of whom majority had impacted teeth or supernumerary elements in the frontal maxillary region were studied with CBCT and treated at the St. Olavs University Hospital. Patients were referred to our Department of Oral and Maxillofacial Surgery with both conventional and digital intraoral X-rays and/or panoramic X-rays. None had any acute infections or odontogenic abscesses, and most presented with asymptomatic impacted tooth. A comparison between the preoperative conventional and the CBCT images, the resulting diagnoses, and the intraoperative findings as "gold standard" were made and recorded in a compiled scoring sheet. The objects of interest were researched with the magnification method. Each patient was identified only with a patient number. Results: In contrast to the conventional X-rays, the pre-surgical evaluation with the CBCT revealed detailed imaging of significant anatomical structures and objects of interest, with highly accurate anatomical and morphologic imaging, when compared to the intraoperative findings. Furthermore, no diagnostic problems, in relation to the anatomical localization, occurred preoperatively. Conclusion: The CBCT provides true and precise anatomical information with high surgical predictability without distortion or artefacts, and is superior to conventional radiography. It enables more time-efficient surgeries and reduces costs and surgical complications.

Manejo de imágenes radiográficas digitalizadas para el auxilio diagnóstico / Digitized radiographic image management for diagnosis assistance

Evaluar las herramientas digitales utilizadas para la corrección de la calidad de la imagen de radiografías periapicales. Fueron confeccionadas cinco radiografías periapicales sin patrón de calidad, una radiografía con calidad ideal (Padrón Oro) y una con escala de densidad (ED). Las imágenes fueron transferidas a un computador y corregidas por las herramientas del software Picasa II (Google Co., EUA). Quince estudiantes de pregrado y quince profesionales confrontaron las imágenes antes y después de la corrección digital con el "Padrón Oro" y la "ED". Las medias de las evaluaciones de los dos grupos en cuanto al valor de "Padrón Oro", antes y después de la corrección y la "ED", fueron iguales (p<0,05). Se integró entonces un grupo homogéneo de evaluadores (n=30). El software mostró mayor eficiencia en la corrección de la sobreexposición y subfijación (p<0,05); y en las demás imágenes no fue eficaz (p<0,05). El software Picasa II mostró mejoras en las radiografías periapicales sobreexpuestas y subfijadas.

To evaluate the digital tools for correction of the image quality of periapical X-rays. Five periapical X-rays were made without quality standard, one X-ray with ideal (Gold) quality and one on a scale of density (SD). The images were transferred to a computer and corrected by the tools of the Picasa II software (Google Co., USA). Fifteen academics and fifteen professionals confronted the images before and after the digital correction with the "Gold" and the "SD". The averages of the evaluations of the two groups, as to the value of the "Gold", before and after the correction and as to "SD", were the same (p <0.05). A homogeneous group of evaluators was then formed (n=30). The software showed better efficiency in the correction of over-exposure and under-fixing (p <0.05); and in the other images it was not efficient (p <0.05). The Picasa software presented improvement of the over-exposed and under-fixed periapical X-rays.

Radiographic and imaging diagnosis of rhinolith in dental clinics: a case report / Diagnóstico radiográfico e imaginológico do rinólito na clínica odontológica: relato de caso

PURPOSE: Rhinolith is a calcification that occurs in the nasal cavity and may be discovered during routine radiographic exam. This calcification is rare, generally single, exogenous or endogenous, unilateral, and asymptomatic. It can cause nasal obstruction, fetid odour and purulent secretion. This study reported a case of rhinolith and its radiographic features. CASE DESCRIPTION: A female, 14-year-old patient had a radiopaque mass in the right nasal cavity. The primary treatment plan included oral surgery to remove a supposed impacted supernumerary tooth, which diagnosis was based on conventional radiographic exams. After an unsuccessful surgery, additional exam with computed tomography showed images compatible with a rhinolith. CONCLUSION: Computed tomographic scans are required for differential diagnosis of pathologies in the nasal cavity to provide proper treatment.

OBJETIVO: O rinólito é uma calcificação na cavidade nasal que pode ser descoberta durante o exame radiográfico odontológico de rotina. Esta massa calcificada é rara, pode exógena ou endógena, geralmente ocorre isoladamente, unilateral e assintomática. Pode causar obstrução nasal, odor fétido e secreção purulenta. Este estudo objetivou apresentar um caso de rinólito e suas características radiográficas. DESCRIÇÃO DO CASO: Uma paciente do sexo feminino, 14 anos de idade, tinha uma massa radiopaca na cavidade nasal direita. O tratamento odontológico primário incluía uma cirurgia para a remoção de um suposto dente supranumerário impactado diagnosticado após exames de radiografia convencional. Devido ao insucesso da cirurgia, foi realizado um exame por tomografia computadorizada e foi diagnosticado o rinólito. CONCLUSÃO: Exames de tomografia computadorizada adequados são necessários para o diagnóstico diferencial de patologias na cavidade nasal para proporcionar um tratamento adequado.

Apuntes sobre la enseñanza-aprendizaje de la radiología oral / Notes on the teaching-learning process of oral radiology

El innegable impacto que la radiología oral ha tenido sobre los diagnósticos clínicos y la incidencia de su prácticapara profesionales, teóricos, instructores y empíricos; lo mismo que para los pacientes constituyen el centro de este ensayo. El objetivo fue establecer un marco pedagógico y académico sobre el cual se evidenciara que enseñar radiología es tambiénuna cuestión y una oportunidad de aprendizaje. Se ofrece una mirada vivencial fundamentada en las experiencias y reflexiones surgidas en la enseñanza y aprendizaje de la radiología oral durante varios años. Finalmente se propone la enseñanza de la radiología como una disciplina que implica comprender una compleja práctica en la que se insertan y complementan saberes teóricos, prácticos y empíricos.

The remarkable impact that oral radiology has had on the clinical diagnosis and the importance of its practice for professionals, theoreticians, empirics and instructors, as well as patients, is the central objective of this essay. The objective was to establish a pedagogic and academic framework over which it will be evident that the teaching of radiology is also a matter oflearning opportunity (apprenticeship). A realistic point of view is offered, based on reflections and experiences arisen from the teaching and learning of oral radiology over several years. Finally as a proposal, the author suggests assuming the teaching of radiology as a complex practice in which theoretical, empirical and practical factors are complemented.