Quality analysis of four filling techniques in ovoid root canals prepared with M® instruments

Aims: This study aimed to assess the quality of various filling techniques in ovoid root canals prepared using M® instruments. Materials and Methods: Sixty ovoid root canals underwent endodontic treatment with M® instruments and were subsequently divided randomly into four experimental groups, each employing a different obturation technique: TU - single cone; TL - active lateral condensation; TH - Tagger hybrid; TS - Schilder technique. Digital radiographs were taken in both mesiodistal and buccolingual directions to examine the filled teeth. The percentage of filling material and empty spaces was quantified using Photoshop® software. Data were subjected to statistical analysis using the one-way ANOVA test and T test (? = 0.05). Results: In the TL and TS groups, there was a significantly lower average percentage of unfilled spaces compared to the TU and TH groups (P<0.0001). When analyzing the radiographic directions, the mesiodistal view exhibited the highest mean percentage of unfilled spaces, with differences in filling quality observed only in the TU and TL groups. Conclusions: Active lateral condensation and Schilder techniques demonstrated superior performance in achieving effective filling of ovoid root canals.

The intra- and inter-rater reproducibility of bone level measurements at strategic mini-implants using dental panoramic radiography

Abstract Objectives: This experimental study focused on the intra- and inter-rater reproducibility of vertical bone level (VBL) measurements at strategic mini-implants (MI) using digital panoramic radiographs (PR). Study design: VBLs of 152 MIs for removable partial denture stabilization at 50 randomly chosen PRs from a clinical trial were digitally evaluated by three ratters. Rater deviations exceeding 0.5 mm were re-examined. The intra-class correlation coefficient (ICC) was applied to estimate reliability. The smallest detectable change (SDC) was interrelated to the minimal clinically important change of 0.2 mm. Results: The first measurement round revealed intra- and inter-rater ICCs of > 0.8. However, 28 sites (9 %) were unreadable, and 97 sites (32 %) revealed differences between observers of ≥ 0.5 mm. Following a consensus session and re-training, an additional 8 sites were excluded and all remaining VBL differences were ≤ 0.5 mm. Thus, the SDCs with 95 % credibility were improved from 0.73 to 0.31 mm in the intra-rater and from 1.52 to 0.34 mm in the interrater statistics. Given a 50 % credibility for this special setting, both the intra- and inter-rater SDCs were 0.11 mm. Conclusions: Digital PR can be reliably utilized to determine VBLs around MIs under conditions of at least two trained observers, mutual calibration sessions, and exclusion of unquantifiable radiographs. German Clinical Trials Register ID:DRKS00007589, www.germanctr.de

Influence of notebook computers screens and undergraduate level of dental students in the radiographic detection of carious lesions

Aim: To evaluate the influence of notebook computers screens and undergraduate level of dental students in the radiographic detection of carious lesions. Methods: Bitewing digital radiographs were presented to 3rd and 5th year dental students in three different notebooks computers: Notebook 1 with anti-glare screen (1366×768 pixels), Notebook 2 without anti-glare screen (1366×768 pixels), and Notebook 3 with anti-glare screen (1920×1080 pixels). A reference standard based on a consensus analysis was set by three senior professors of Oral Radiology and Cariology. Sensitivity, specificity and accuracy values were measured and submitted to two-way ANOVA at a significance level of 5%. Results: Notebook 2 provided significantly lower sensitivity values (Mean 56.5% ± 2.94) than notebook 3 (71.1% ± 2.82) (p = 0.002). We found no statistically significant differences between the two undergraduate years (p > 0.05). Conclusion: The anti-glare screen of notebook computers screens can influence the radiographic detection of carious lesions, but the undergraduate level of dental students does not influence this diagnostic task

Effect of composite radiopacity and margin location of the restoration on the diagnosis of secondary caries

Abstract This research aimed to evaluate the effect of the radiopacity of a Bulk-Fill composite (X-TraFil, VOCO, Germany) and a Conventional composite (P60, 3M ESPE, USA) and assessment of the margin location in the enamel and dentin on the diagnosis of secondary caries. 76 intact premolars with MOD preparation were divided into two equal groups and filled with the conventional and bulk-fill composite. Four regions were considered to simulate carious lesions (two regions in enamel and two regions in dentin). In each group, half of the regions in the dentin and half in the enamel were randomly selected for secondary caries simulation and filled with a wax-plaster combination while the remaining regions stayed intact. Bitewing imaging was done using the PSP digital sensor. Five examiners reviewed the images, and lesions were recorded. Caries diagnosis indicators and paired-sample t-test were used for statistical analysis. The reproducibility and accuracy of the examiners' responses were evaluated using the kappa and agreement coefficient (α=0.05). The sensitivity, specificity, and accuracy of diagnosing secondary carious lesions in enamel were significantly better under conventional than bulk-fill composite. Similarly, the sensitivity and accuracy of diagnosing secondary caries in dentin were significantly higher under conventional composite than bulk-fill composite (p<0.05). No significant differences were found in the agreement and kappa coefficient between conventional and bulk-fill composites in the enamel and dentin (p>0.05). The diagnostic accuracy of carious lesions was higher under conventional composite than bulk-fill composite. However, the location of the secondary was ineffective in caries diagnosis.

Resumo Essa pesquisa teve como objetivo avaliar o efeito da radiopacidade de resina composta Bulk-Fill (X-TraFil, VOCO, Alemanha) e de resina composta convencional (P60, 3M ESPE, EUA) e a avaliação da localização da margem no esmalte e na dentina no diagnóstico de cárie secundária. 76 pré-molares intactos com preparo MOD foram divididos em dois grupos iguais e restaurados de acordo com o grupo experimental. Quatro regiões foram consideradas para simular lesões de cárie (duas regiões no esmalte e duas regiões na dentina). Em cada grupo, metade das regiões na dentina e metade no esmalte foram selecionadas aleatoriamente para a simulação de cárie secundária e preenchidas com uma combinação de cera e gesso, enquanto as regiões restantes permaneceram intactas. As imagens de bitewing foram feitas usando o sensor digital PSP. Cinco examinadores analisaram as imagens, e as lesões foram registradas. Os indicadores de diagnóstico de cárie e o teste t de amostra pareada foram usados para análise estatística. A reprodutibilidade e a precisão das respostas dos examinadores foram avaliadas usando o kappa e o coeficiente de concordância (α=0,05). A sensibilidade, a especificidade e a precisão do diagnóstico de lesões cariosas secundárias no esmalte foram significativamente melhores com a resina composta convencional do que com a resina composta bulk-fill. Da mesma forma, a sensibilidade e a precisão do diagnóstico de cáries secundárias na dentina foram significativamente maiores com a resina convencional do que com a resina bulk-fill (p<0,05). Não foram encontradas diferenças significativas na concordância e no coeficiente kappa entre as resinas convencionais e bulk-fill no esmalte e na dentina (p>0,05). A precisão do diagnóstico de lesões cariosas foi maior com a resina composta convencional do que com a resina composta bulk-fill. Entretanto, a localização do secundário foi ineficaz no diagnóstico de cárie.

Control radiográfico de trasplante dentario: reporte de caso / Radiographic control of dental transplantation: a case report

El trasplante dentario es una opción terapéutica para reemplazar un órgano dental perdido, causado por un proceso carioso extenso, agenesia, trauma-tismos o iatrogenias. Este procedimiento quirúrgico traslada un órgano dental íntegro desde un alveolo donante hacia su lecho receptor; para lo cual debe poseer ciertas características que permitan tener un pronóstico favorable a largo plazo. El presente estudio describe la evolución de un trasplante dental autólogo realizado hace 14 años a una paciente que acudió a la consulta para valoración del órgano den-tal 4.7, el que presentó un pronóstico desfavorable, por lo cual se realizó exodoncia y trasplante inme-diato del diente vital 4.8 al alveolo del órgano dental 4.7. Tras la planificación quirúrgica se procedió con la intervención conservando la vitalidad pulpar del diente a ser trasplantado, se realizó control clínico y radiográfico a los 15 días, 30 días, 6 meses, 1 año, 5 años y 14 años, en el que se observó conservación del paquete vasculonervioso y ligamento periodontal del órgano dental; a su vez se pudo evidenciar rizo-génesis en el diente trasplantado y un aumento de la altura del proceso alveolar, mediante mediciones realizadas en Auto CAD 2023 (AU)

Tooth transplantation is a therapeutic option to re-place a lost dental organ, caused by an extensive carious process, agenesis, trauma or iatrogenesis. This surgical procedure transfers a complete den-tal organ from a donor alveolus to its recipient bed; for which it must have certain characteristics that allow it to have a favorable long-term prognosis. The present study describes the evolution of an autolo-gous dental transplant carried out 14 years ago to a female patient who attended the consultation for evaluation of the dental organ 4.7, the same one that presented an unfavorable prognosis, for which an extraction and immediate transplantation of the 4.8 vital tooth was performed to the alveolus of the den-tal organ 4.7. After surgical planning, the intervention was carried out preserving the pulpal vitality of the tooth to be transplanted; clinical and radiographic control was performed at 15 days, 30 days, 6 months, 1 year, 5 years and 14 years, in which preservation of the vascular-nervous bundle and periodontal liga-ment of the dental organ was observed; in turn, rhizo-genesis in the transplanted tooth and an increase in the height of the alveolar process could be evidenced, through measurements made in Auto CAD 2023 (AU)

Two-year follow-up of the outcomes of endoscope-assisted minimally invasive nonsurgical periodontal therapy for deep intrabony defects / 口腔疾病防治

Objective@#To explore the clinical efficacy and imaging changes of minimally invasive nonsurgical periodontal therapy (MINST) assisted by endoscopy for deep intrabony defects and to compare its effectiveness with that of traditional scaling and root planning (SRP) to therefore provide a reference for clinical periodontal treatment.@*Methods@#Patients with deep intrabony defects ≥ 4 mm in size were selected and divided into two groups: the MINST (MINST, 20 cases, 81 sites) group and the classic scaling and root planing (SRP, 20 cases, 80 sites) group. Before treatment and 12 and 24 months after treatment, probing depth (PD) and clinical attachment loss (CAL) were examined. Moreover, changes in the depth and angle of the intrabony defects were analyzed. Follow-up examination and maintenance treatment should be conducted every 3 months for 12 months after the initial treatment and every 6 months thereafter until 24 months.@*Results@#The PD and CAL of patients in both groups continued to decrease (P<0.001), and imaging examinations revealed a decrease in defect depth and an increase in intrabony defect angle (P<0.001). The changes in the first 12 months were significantly greater than those in the last 12 months in both groups (P<0.001). The decreases in PD, CAL, and depth of intrabony defects and increase in angle in the MINST group were significantly greater than those in the SRP group (P<0.001). At 12 and 24 months after treatment, the PD and CAL in the MINST group were lower than those in the SRP group (P<0.001). The defect height of the MINST group decreased more than that of the SRP group (P<0.001), and the defect angle of the MINST group increased more than that of the SRP group (P<0.001).@*Conclusion@#Minimally invasive nonsurgical periodontal therapy can significantly promote the healing of deep intrabony defects and the regeneration of alveolar bone. Imaging reflects that alveolar bone healing is rapid at first and then slows. Compared with traditional SRP, endoscopically assisted MINST can yield better clinical indicators and imaging changes in intrabony defects.

Epidemiology of pediatriac scoliosis in a tertiary hospital in recife-pe / Epidemiologia da escoliose pediátrica em hospital terciário em recife-pe / Epidemiología de la escoliosis pediátrica en hospital terciario en recife-pe

ABSTRACT Objective: The present study aims to outline the epidemiological parameters of patients with scoliosis between the ages of 0 and 18 years old, who were evaluated at the Getúlio Vargas Hospital in Recife-PE. Methods: The participants completed a demographic questionnaire, followed by clinical evaluation, including Cobb angle measurement, clinical photographic registration and quality of life questionnaires. Results: The sample consisted of 103 patients, mostly females, with a mean age of 13.86 years, from the interior of the state, diagnosed with adolescent idiopathic scoliosis classified as Lenke 1. Neuromuscular and congenital scoliosis were less common. The quality-of-life questionnaire showed a significant difference in self-image perception among patients with idiopathic scoliosis, those who had a curve measuring under 50 degrees had better scores than those who had greater angles. Patients with larger curves scored lower on all questionnaire items, but there was no significant difference when compared to the other group. Conclusion: It was shown that the main epidemiological parameters in the pediatric population with scoliosis are girls, mean age 13 years, coming from the interior of the state being idiopathic scoliosis, the most common, classified as Lenke 1. Neuromuscular scoliosis was the main type of deformity following the idiopathic; cerebral palsy being the most common etiology. Level of evidence IV; Prognostic Studies Investigating the effect of a Patient characteristic on the outcome of Disease.

Resumo: Objetivo: Traçar o perfil epidemiológico dos pacientes portadores de escoliose entre as idades de 0 até 18 anos no Hospital Getúlio Vargas em Recife-PE. Métodos: Estudo transversal em que os participantes foram submetidos a um questionário demográfico, em seguida tiveram seu perfil clínico avaliado com a medição do ângulo de Cobb, realização de fotografias clínicas e aplicação de questionários de qualidade de vida. Resultados: A amostra foi construída com 103 pacientes, em sua maioria do gênero feminino, com idade média de 13,68 anos, provenientes do interior do estado, com diagnóstico de escoliose idiopática do adolescente classificadas como Lenke 1. Escoliose neuromuscular e congênita estiveram presentes em menor número. O questionário de qualidade de vida aplicado mostrou que houve diferença significativa na percepção da autoimagem de pacientes com escoliose idiopática que tinham curvas menores que 50 graus em relação aos que tinham maior deformidade. Aqueles com curvas de maior valor angular apresentavam menor pontuação em todos os quesitos do questionário, sugerindo pior qualidade de vida, mas não houve diferença significativa. Conclusão: Conclui-se que, o perfil epidemiológico dos pacientes portadores de escoliose pediátrica é formado por meninas com escoliose idiopática, com média de idade de 13 anos, provenientes do interior do estado, tendo diagnóstico de escoliose idiopática classificada como Lenke 1. Dos demais tipos de escoliose, o mais prevalente foi a escoliose neuromuscular secundária à paralisia cerebral. Nível de Evidência IV; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

Resumen: Objetivos: Describir el perfil epidemiológico de los pacientes diagnosticados con escoliosis de 0 a 18 años que son evaluados en el Hospital Getúlio Vargas en Recife-PE. Métodos: Los participantes fueron sometidos a una encuesta demográfica y luego a una evaluación clínica que incluyó la toma de fotos, la medición de ángulo de Cobb y un cuestionario de calidad de vida. Resultados: La muestra fue constituida por 103 individuos, la mayoría de género femenino, con edad media de 13,68 años, que provenían del interior del estado y que fueron diagnosticadas con escoliosis idiopática del adolescente, clasificada en Lenke 1. La escoliosis neuromuscular y congénita estuvieron presentes en un número más pequeño. El cuestionario de calidad de vida mostró que hubo una diferencia significativa en la percepción de autoimagen de los pacientes con escoliosis idiopática con curvas menores a 50 grados cuando se compararon con los que tenían curvas más grandes. Los pacientes con curvas mayores tenían menos puntos en todas las preguntas del cuestionario, pero sin diferencia significativa. Conclusión: Se concluyó que el perfil epidemiológico de los pacientes con escoliosis pediátrica era formado por niñas con escoliosis idiopática, con edad media de 13 años, que provenían del interior del estado, clasificadas como Lenke 1. De los demás tipos de escoliosis, la neuromuscular secundaria a parálisis cerebral fue la más común. Nivel de evidencia IV; Estudios pronósticos - Investigación del efecto de características de un paciente sobre el desenlace de la enfermedad.

Mandibular assessment of panoramic radiographs for sex identification / Análise do dimorfismo sexual através de índices radiomorfométricos em radiografias panorâmicas

ABSTRACT Sex determination plays a crucial role in the post-mortem identification of human remains. One effective approach for obtaining sex-related data is to use measurements of anatomical structures such as the mandible. This study aimed to evaluate the potential of mandibular radiomorphometric indices from panoramic radiographs (PRs) for the identification of sexual dimorphism. The study sample included 300 PRs of individuals aged 51 to 80 years from the northeastern region of Brazil. Four linear measures and three numerical indices were analyzed with Inkscape® version 1.0.1 for Windows by two blinded evaluators. After statistical analysis, the results showed that the linear measurements obtained from PRs are a reliable method for sex identification. However, the calculated indices of these measurements exhibited lower efficacy for the same purpose. Therefore, PRs proved to be a valuable method for sexual identification through mandibular assessment.

RESUMO A determinação do sexo é um dado importante para a identificação post-mortem de um indivíduo ou de restos mortais humanos. Uma maneira de adquirir dados quanto ao sexo é utilizar mensurações de estruturas como a mandíbula. O objetivo principal deste estudo é avaliar a utilização de índices radiomorfométricos de mandíbulas para a identificação de dimorfismo sexual, através de radiografias panorâmicas. O estudo foi realizado em exames radiográficos panorâmicos de 300 indivíduos entre 51 e 80 anos, residentes do Nordeste brasileiro. Foram analisadas quatro medidas lineares e três índices numéricos no software Inkscape® versão 1.0.1 para Windows, por dois avaliadores cegos. Após análise estatística, os resultados demostraram que as medidas lineares obtidas se configuram como um método seguro para a identificação sexual. Entretanto, os índices obtidos através destas medidas demostraram menor eficiência para o mesmo fim. Logo, as radiografias panorâmicas podem ser utilizadas como método eficaz para a obtenção da caracterização sexual através da mandíbula.

Radiological presentation of active pulmonary tuberculosis in kidney transplant recipients: a retrospective study of four cases and a review of the literature / Apresentação radiológica da tuberculose pulmonar ativa em transplantados renais: um estudo retrospectivo de quatro casos e revisão da literatura

Abstract Although kidney transplantation is the best therapeutic option for patients with chronic kidney disease, the immunosuppression required greatly increases susceptibility to infections that are responsible for high post-transplant mortality. Pulmonary tuberculosis (TB) represents a major cause of such infections, and its early diagnosis is therefore quite important. In view of that, we researched the manifestations of active pulmonary TB in kidney transplant recipients, through chest X-ray and computed tomography (CT), as well as determining the number of cases of active pulmonary TB occurring over a 3.5-year period at our institution. We identified four cases of active pulmonary TB in kidney transplant recipients. The CT scans provided information complementary to the chest X-ray findings in all four of those cases. We compared our CT findings with those reported in the literature. We analyzed our experience in conjunction with an extensive review of the literature that was nevertheless limited because few studies have been carried out in lowand middle-income countries, where the incidence of TB is higher.

Resumo Apesar de o transplante renal ser a melhor opção terapêutica para pacientes com doença renal crônica, a imunodepressão decorrente desse tratamento eleva muito a suscetibilidade desses pacientes a infecções, responsáveis por altas taxas de mortalidade pós-operatórias. A tuberculose (TB) pulmonar é uma significativa causa dessas infecções, sendo muito importante o seu diagnóstico precoce. Assim, nós pesquisamos as manifestações da TB pulmonar ativa nessa população de transplantados renais por meio de radiografias simples e tomografia computadorizada (TC) do tórax, também para estabelecer o número de casos de TB pulmonar ativa em nossa instituição após levantamento de 3,5 anos. Encontramos quatro casos de TB pulmonar ativa em pacientes transplantados renais. A TC forneceu informações adicionais em relação às radiografias de tórax em 100% dos casos analisados. Comparamos os nossos achados de TC com os relatados na literatura. Somamos a experiência obtida com extensa revisão da literatura, ainda limitada nessa questão, com poucos estudos realizados em países em desenvolvimento onde a incidência de TB é maior.

Influência do tipo de compósito e tempo de exposição aos raios-x na produção de artefatos radiográficos em modelo de restaurações classe II / Influence of the composite type and exposure time to x-rays on the production of radiographic artifacts in a class II restoration model

Aim: To evaluate the effect of the exposure time and the type of composite in the production of radiographic artifact at the tooth / restorative interface. Materials and Methods: In 20 healthy bovine incisors, cavity preparations and class II restorations were made using composite resins Filtek Bulk Fill One (group 1) and Filtek Z350 (group 2). Then, the teeth were exposed to obtain digital radiographs, varying the exposure time by 0.07, 0.10, 0.14, 0.20 and 0.25s. The images were evaluated for investigation of the presence of artifact through the analysis of the modified number of pixels (QPXD) and the average gray value in class II (MGVR) restorations, using the Image J software (National Health Institute). Results: The presence of artifact was observed in all evaluated samples, regardless of the type of restorative material and the exposure time employed. There was no statistically significant difference in QPXD and MGVR between the resins used (ANOVA 2 factors, p p> 0.05). The MGVR analysis indicated that there were no statistically significant differences between resins or between exposure times (p> 0.05). There was a correlation between QPXD and MGVR (r = 0.29) for Filtek Bulk Fill One resin. Discussion: This study reveals the importance of attention to the region of the tooth-restoration interface by the Surgeon-Dentist, who must combine the radiographic findings diagnosed using digital tools to clinical signs in order to compose a unique therapeutic project with a real need for intervention, if there is such need. Conclusion: The presence of altered pixels on dentin in the region of the tooth-restoration interface was identified in all specimens. The variation in the exposure time as well as the type of the restorative composite did not influence the increase or decrease of QPXD and neither in MGVR. However, there was a correlation between QPXD and MGVR for Filtek Bulk Fill One resin.

Objetivo: Avaliar o efeito do tempo de exposição e do tipo de compósito na produção de artefato radiográfico na interface dente/material restaurador. Materiais e Métodos: Em 20 incisivos bovinos hígidos foram feitos preparos cavitários e restaurações classe II utilizando resinas compostas Filtek Bulk Fill One (grupo 1) e a Filtek Z350 (grupo 2). Em seguida, os dentes foram expostos para obtenção das radiografias digitais, variando o tempo de exposição em 0,07, 0,10, 0,14, 0,20 e 0,25s. As imagens foram avaliadas para investigação da presença de artefato através da análise do número de pixels modificado (QPXD) e do valor médio de cinza nas restaurações de classe II (MGVR), utilizando o software Image J (Instituto Nacional de Saúde, Bethesda, MD, EUA). Resultados: Observou-se a presença de artefato em toda amostra avaliada, independente de tipo de material restaurador e tempo de exposição empregado. Não se observou diferença estatisticamente significativa na QPXD e nos MGVR entre as resinas utilizadas (ANOVA 2 fatores, p p>0,05). A análise do MGVR indicou que não houve diferenças estatisticamente significativas entre as resinas nem entre os tempos de exposição (p>0,05). Observou-se uma correlação entre a QPXD e o MGVR (r=0,29) para a resina Filtek Bulk Fill One. Discussão: Como significado clínico, o presente estudo revela a importância da atenção à região da interface dente-restauração por parte do Cirurgião-Dentista, o qual deve aliar os achados radiográficos diagnosticados com o auxílio de ferramentas digitais aos sinais clínicos, para compor um projeto terapêutico singular com uma real necessidade de intervenção, caso haja. Conclusão: Foi identificado a presença de pixels alterados sobre a dentina na região da interface dente-restauração em todos os corpos de prova. A variação do tempo de exposição como também o tipo do compósito restaurador não influenciou no aumento ou diminuição do QPXD e nem tão pouco no MGVR. Contudo houve correlação entre o QPXD e o MGVR para a resina Filtek Bulk Fill One.

Depth and proximity of third molars to the inferior alveolar canal in panoramic radiographs of a Latin American population

Introduction: extraction of lower third molars involve the possible occurrence of complications such as injury of the content of the Inferior Alveolar Canal. Methods: a cross-sectional study was conducted with a sample of 6488 lower molar records of digital panoramic radiographs of patients from 6 Latin American countries from 2010-2015. The variables studied were the depth of lower third molar according to the Pell and Gregory classification, and the proximity of a third molar to the Inferior Alveolar Canal that was evaluated according to the proposed classification, based on a modification of the Langlais et al classification.20 Descriptive and bivariate statistical analyses were performed. Results: in terms of the proximity, the highest frequency was Intact with 27.45%(n=1781). Regarding the depth of the lower third molar, the most frequent were the Position B with 46.90%(n=3043) and Position A with 46.75%(n=3033). The proximity and depth of the lower third molar had statistical difference according to age(p<0.01) and sex (p<0.001). The overall proximity of the lower third molar to the Inferior alveolar canal, according to depth was 37.52%(n=1766) in Position A, in Position B it was 54.51%(n=2566) and Position C was 7.97%(n=375) and had association between variables(p<0.001). Conclusions: taking into consideration the modified classification of Langlais et al.20, lower third molars are close to the Inferior Alveolar Canal, and according to the Pell and Gregory classification for the depth, the most frequent positions are A and B. In addition, proximity and depth were associated with each other, and with the co-variables country, age, and sex.

Introducción: la extracción de terceros molars inferiores implica la posible aparición de complicaciones, como la lesión del contenido del Canal Alveolar Inferior. Métodos: se realizó un estudio transversal con una muestra de 6488 registros de terceros molares inferiores de radiografías panorámicas digitales en pacientes de 6 países latinoamericanos, entre 2010-2015. Las variables fueron profundidad del tercer molar inferior según la clasificación de Pell y Gregory, y proximidad del tercer molar al Canal Alveolar Inferior, evaluada según una clasificación propuesta, basada en la clasificación modificada de Langlais et al.20 Se realizaron análisis estadísticos descriptivos y bivariados. Resultados: en la proximidad, la mayor frecuencia se presentó en Intacto con 27,45%(n=1781); en cuanto a la profundidad del tercer molar inferior, las más frecuentes fueron la Posición B con 46,90%(n=3043) y la Posición A con 46,75%(n=3033). La proximidad y profundidad del tercer molar inferior presentaron diferencias estadísticas de acuerdo con la edad (p<0,01) y sexo (p<0,001). La proximidad total del tercer molar inferior al canal alveolar inferior, según la profundidad fue de 37,52%(n=1766) en Posición A, en Posición B de 54,51%(n=2566) y Posición C de 7,97%(n=375). Además, se presentó asociación entre las variables (p<0,001). Conclusiones: considerando la clasificación modificada de Langlais et al.20, la mayoría de los terceros molares inferiores están próximos al canal alveolar inferior; y según la profundidad de Pell y Gregory, las posiciones más frecuentes son A y B. Además, la proximidad y la profundidad se asociaron entre sí, y con las co-variables país, edad y sexo.

Niveles de referencia diagnósticos en equipos de radiografía dental en Bogotá, Colombia

Introducción: Las radiografías dentales son una de las exposiciones médicas más frecuentes a la radiación ionizante. El uso de radiación ionizante está asociado a un riesgo probable de desencadenar efectos biológicos adversos y posibles daños a la salud del paciente. Para evitar que los pacientes reciban dosis innecesariamente altas durante estas exposiciones, la Comisión Internacional de Protección Radiológica recomienda la utilización de los niveles de referencia para diagnóstico, como una herramienta efectiva de ayuda a la optimización de la protección radiológica de los pacientes. Objetivo: Estimar los niveles de referencia para diagnóstico en radiografía dental intraoral y panorámica en la ciudad de Bogotá, D. C. Metodología: Se evaluaron los parámetros de exposición radiográficos de los equipos y la calidad de imagen en 68 equipos de radiografía dental periapical y 23 equipos de radiografía panorámica. Se estimaron las magnitudes dosimétricas de kerma incidente en aire (Kai) en equipos intraorales para la radiografía de un maxilar molar de un adulto y el producto kerma aire-área (PKA) en equipos de radiografía panorámica en un examen de un adulto estándar. Resultados: El tercer cuartil de la distribución de kerma incidente en aire para radiografía intraoral fue de 3,3 mGy y del producto kerma aire-área para radiografía panorámica fue de 103,9 mGycm2. En la distribución de frecuencias de kerma incidente en aire para radiografía intraoral, el porcentaje más alto de equipos estuvo en el rango de 2,0-3,0 mGy. En la distribución de frecuencias del producto kerma aire-área para los equipos de radiografía panorámica, el porcentaje más alto de equipos estuvo en el rango de 60 a 80 mGycm2. Discusión: Las instituciones consideradas para establecer los Niveles de Referencia para Diagnóstico en este estudio contaron con una adecuada calidad de la imagen evaluada con un maniquí dental, pero las variaciones en las dosis de radiación entre instituciones señalan la necesidad de implementar herramientas que contribuyan a la optimización de las prácticas. Conclusiones: Se recomienda usar los valores de los niveles de referencia para diagnóstico encontrados en esta investigación para optimizar la protección radiológica en las exposiciones radiológicas dentales, y se espera que este estudio sirva de base para nuevas investigaciones en las demás ciudades del país.

Introduction: Dental X-rays are one of the most frequent medical exposures to ionizing radiation. The use of ionizing radiation is associated with a probable risk of triggering adverse biological effects and possible damage to the patient's health. To prevent patients from receiving unnecessarily high doses during these exposures, the International Commission on Radiological Protection recommends the use of diagnostic reference levels as an effective tool to help optimize radiological protection for patients. Objective: To estimate diagnostic reference levels in intraoral and panoramic dental radiography in the city of Bogotá, D.C. Methodology: In 68 periapical dental radiography equipment and 23 panoramic radiography equipment, the radiographic exposure parameters of the equipment and image quality were evaluated. The dosimetric magnitudes of incident air kerma (Ka,i) in intraoral equipment for the radiography of a maxillary molar of an adult and the air kerma-area product (PKA) in panoramic radiography equipment in a standard adult examination were estimated. Results: The third quartile of the incident air kerma distribution for intraoral radiography was 3,3 mGy and the air kerma-area product for panoramic radiography was 103,9 mGycm2. In the frequency distribution of incident air kerma for intraoral radiography, the highest percentage of equipment was in the range of 2,0-3,0 mGy, and in the frequency distribution of the air kerma-area product for equipment of panoramic radiography, the highest percentage of the equipment was in the range of 60 to 80 mGy cm2. Discussion: The institutions considered to establish the diagnostic reference levels in this study had an adequate quality of the image evaluated with a dental phantom, but the variations in radiation doses between institutions indicate the need to implement tools that contribute to the optimization of the practices. Conclusions: It is recommended to use the values of the diagnostic reference levels found in this research to optimize radiological protection in dental radiological exposures, and it is expected that this study will serve as a basis for further research in other cities of the country.

El conocimiento y cumplimiento de las normas de protección sobre la radiación ionizante en una clínica dental docente / Knowledge and compliance with ionizing radiation protection standards in a teaching dental clinic

Introducción: El uso de radiografías como elemento complementario para el diagnóstico es fundamental para la práctica profesional de todo cirujano dentista. Por tanto, es importante conocer no solo los beneficios de la radiología oral y los fundamentos de protección radiológica, sino también determinar su nivel de aplicación o la adherencia frente al cumplimiento de los aspectos normativos que regulan el uso de la radiación ionizante en odontología. Objetivo: Relacionar el conocimiento sobre los cuidados en radiología bucal, las ventajas y los peligros en la toma de radiografías con el cumplimiento de las normas de protección radiológica y radiación ionizante en estudiantes de odontología de una clínica dental docente. Métodos: La población de estudio estuvo constituida por 180 estudiantes del cuarto año de la carrera de odontología, que emplearon los equipos radiológicos en la clínica docente asistencial durante los años 2019 (segundo semestre) y 2020 (primer trimestre). Se tomó como muestra representativa a 104 estudiantes, incorporados al estudio mediante muestreo aleatorio simple. Se aplicaron dos instrumentos de recolección de datos, uno para evaluar el conocimiento (cuestionario) y otro para verificar el cumplimiento de normas (lista de chequeo) sobre la protección radiológica y el diagnóstico por imágenes en la práctica odontológica. Para el análisis estadístico se aplicó la prueba estadística chi cuadrado con un nivel de significancia del 95 %. Resultados: No se encontró relación estadísticamente significativa (p = 0,30) entre el conocimiento teórico sobre la protección radiológica y el diagnóstico por imágenes, respecto el cumplimiento de las normas que regulan su aplicación (p > 0,05). El 90 % de participantes tienen conocimientos entre regulares y excelentes. Sin embargo, solo el 32 % cumple las normas técnicas de protección sobre radiación ionizante en su práctica clínica. Conclusión: Los estudiantes de odontología tienen suficiente conocimiento sobre protección radiológica y diagnóstico por imágenes. Sin embargo, este conocimiento no se refleja en prácticas adheridas a las normas.

Introduction: The use of radiographs as a complementary element for diagnosis is fundamental to the professional practice of every dental surgeon. Therefore, it is important to know not only the benefits of oral radiology and the fundamentals of radiological protection, but also to determine their level of application or adherence to compliance with the regulatory aspects that regulate the use of ionizing radiation in dentistry. Objective: To relate the knowledge of oral radiology care, the advantages and dangers in taking radiographs with compliance with the norms of radiological protection and ionizing radiation in dental students of a dental teaching clinic. Methods: The study population consisted of 180 fourth year dental students who used the radiological equipment in the teaching dental clinic during 2019 (second semester) and 2020 (first quarter). A representative sample of 104 students was taken, incorporated into the study by simple random sampling. Two data collection instruments were applied, one to evaluate knowledge (questionnaire) and the other to verify compliance with standards (checklist) on radiological protection and diagnostic imaging in dental practice. For the statistical analysis the chi-square statistical test was applied with a significance level of 95 %. Results: No statistically significant relationship was found (p = 0.30) between theoretical knowledge of radiological protection and diagnostic imaging with respect to compliance with the norms that regulate its application (p > 0.05). Ninety percent of participants have fair to excellent knowledge. However, only 32 % comply with the technical norms of ionizing radiation protection in their clinical practice. Conclusion: Dental students have sufficient knowledge of radiation protection and diagnostic imaging. However, this knowledge is not reflected in practices that adhere to the standards.

Sex Determination in the Contemporary Chilean Population by Mandible Analysis in Panoramic Radiographies / Estimación Sexual de la Población Chilena Contemporánea Mediante Análisis de la Mandíbula en Radiografías Panorámicas

SUMMARY: Sex identification of a deceased human individual by means of the mandible is very important for forensic dentistry. The aim of the present study was to determine the sex of Chilean individuals by mandible analysis in panoramic radiographies. Linear and angular parameters of the mandible were analyzed from panoramic radiographies (PR). The study included PR of adult Chilean individuals, of both sexes, with optimum solution and contrast, and which allowed the angles and rami of the mandible to be viewed. Sex was determined by univariate and bivariate discriminant function analysis. The sample consisted of 594 PR of individuals aged between 18 and 84 years. The best sex predictor using univariate discriminant function analysis was the mandibular ramus height (MRH) (74.1 %), followed by the distance from the mental foramen - mandibular base (DMF-MB) (69.1 %) and the bicondylar breadth (BC) (66.7 %). The parameters that presented the lowest sex prediction were the angle of the mandible (AM) with 55.0 % and the distance between mental foramina (DMF) with 53.7 %. The best sex prediction was obtained by the step model of discriminant function analysis (80.2 %), including only three parameters: MRH, BC and DMF-MB. The parameters height of the mandibular ramus, bicondylar breadth and distance from the mental foramen - base of the mandible are good predictors of sex in Chilean individuals when used in conjunction; they are therefore indicated for sex determination in the contemporary Chilean population.

La identificación humana de un individuo fallecido a través de la mandíbula es muy relevante para la odontología forense. El objetivo de este estudio fue estimar el sexo de individuos Chilenos a través del análisis de la mandíbula, utilizando radiografías panorámicas. Fueron analizados parámetros lineales y angulares de la mandíbula, a través de radiografías panorámicas (RP). Se incluyeron RP de individuos chilenos adultos, ambos sexos, con solución y contraste óptimos, y que permitían la visualización de los ángulos y ramas de la mandíbula. Se realizó análisis por función discriminante univariada y bivariada para estimación del sexo. Fueron incluidas 594 RP de individuos entre 18 y 84 años. Para el análisis de función discriminante univariado, la altura de la rama mandibular (ARM) fue el parámetro más predictivo (74,1 %), seguido de la distancia foramen mentoniano - base de la mandíbula (DFM-BM) (69,1 %) y el ancho bicondilar (ABCo) (66,7 %). Los parámetros que presentaron menor predicción sexual fueron el ángulo de la mandíbula (AM) con un 55,0 % y la distancia inter-forámenes mentonianos (DIFM), con el 53.7 %. El análisis por pasos fue el modelo de análisis de función discriminante que presentó la mayor predicción sexual (79,5 %), en el cual fueron incluidos sólo tres parámetros: ARM, ABCo y DFM-BM. Los parámetros altura de la rama de la mandíbula, ancho bicondilar y distancia desde el foramen mentoniano hasta la base de la mandíbula son buenos predictores del sexo en individuos Chilenos cuando utilizados en conjunto y están indicados para estimar el sexo en la población chilena contemporánea.

Hallazgos radiológicos en pacientes con la COVID-19

Introducción: La COVID-19 ha impuesto un reto para los servicios de salud desde el punto de vista económico y social. El papel de la radiografía de tórax ha sido fundamental para el tratamiento de estos pacientes. Objetivo: Caracterizar los hallazgos radiológicos más frecuentes en pacientes confirmados a la COVID-19. Método: Se realizó un estudio descriptivo en 859 pacientes ingresados, confirmados a la COVID-19, que presentaron lesiones radiológicas durante su estadía hospitalaria; se realizaron radiografías de tórax al ingreso y evolutivas, según el protocolo de atención vigente en el momento del estudio. Las variables utilizadas fueron: edad, sexo biológico, gravedad del cuadro radiológico, patrón radiológico y localización de las lesiones. Resultados: La mayor frecuencia fue de adultos (65,7 %), masculinos (60,4 %); predominaron las lesiones de moderada gravedad (51,6 %); solo el 17,4 % evolucionó a formas radiológicas graves. El 64,8% mostró un patrón radiológico mixto; con mayor frecuencia en la localización bilateral (89,9 %), la periférica/subpleural (66,7 %) y en campos inferiores (90,9 %). Conclusiones: Los hallazgos radiológicos se caracterizan por presentar lesiones de gravedad moderada, con patrón mixto, en las localizaciones bilateral, periférica/subpleural y en campos inferiores.

Introduction: COVID-19 has imposed a challenge for health services, from an economic and social point of view. The role of chest radiography has been fundamental in the management of these patients. Objective: To characterize the most frequent radiological findings in patients confirmed to COVID-19. Methods: A descriptive study was carried out in 859 admitted patients, confirmed to COVID-19, who presented radiological lesions during their hospital stay; chest X-rays were taken on admission and during evolution, according to the protocol of care in force at the time of the study. The variables used were: age, biological sex, severity of the radiological picture, radiological pattern and location of the lesions. Results: Adults (65.7%), males (60.4%), were more frequent; moderate severity lesions predominated (51.6%); only 17.4% evolved to severe radiological forms. 64.8% showed mixed radiological pattern; with higher frequency in bilateral (89.9%), peripheral/subpleural (66.7%) and in lower fields (90.9%). Conclusions: Radiological findings are characterized by presenting lesions of moderate severity, with mixed pattern, in bilateral, peripheral/subpleural and in inferior fields locations.

Manejo conservador del neumotórax oculto en trauma

Introducción: El neumotórax oculto (NTXO) se encuentra hasta en el 15% de los traumatismos torácicos. Existen antecedentes del manejo conservador de esta patología (sólo observación), aunque su práctica continúa siendo discutida, especialmente, en traumatismos penetrantes. El objetivo de este trabajo es describir nuestra experiencia en el manejo conservador del NTXO. Materiales y Método: Estudio de cohorte retrospectivo realizado durante un período de 3 años en un Hospital de Trauma nivel I. Se incluyeron pacientes con traumatismo torácico (cerrado o penetrante) con NTXO. Se dividieron en dos grupos (conservados o drenados), realizándose una comparación de su evolución. Resultados: En 3 años fueron admitidos con traumatismo torácico 679 pacientes. De 93 pacientes con NTXO, 74 (80%) fueron conservados inicialmente y 19 (20%) tratados con drenaje pleural. Dos (3%) presentaron progresión del neumotórax en el seguimiento radiológico (conservación fallida). No se registraron complicaciones relacionadas con la ausencia de drenaje pleural. Las complicaciones y estancia hospitalaria fueron menores en el grupo de manejo conservador. Conclusión: Pacientes con NTXO por traumatismo de tórax (cerrado o penetrante), sin requerimiento de ventilación asistida y hemodinámicamente estables, pueden manejarse de manera conservadora con un monitoreo cercano durante 24 horas en forma segura, con menor tasa de complicaciones y de estancia hospitalaria.

Background: Occult pneumothorax (OPTX) is found in up to 15% of chest injuries. There is a history of conservative management of this pathology (only observation), although its practice continues to be discussed, especially in penetrating trauma. The objective of this paper is to describe our experience in the conservative management of OPTX. Materials and Method: Retrospective cohort study conducted over a 3-year period at a level I Trauma Center. Patients with thoracic trauma (blunt or penetrating) with OPTX were included. They were divided into two groups (preserved or drained) comparing their evolution. Results: Over a 3-year period 679 patients were admitted with chest trauma. From 93 patients with OPTX, 74 (80%) were initially preserved and 19 (20%) drained. Two patients (3%) presented pneumothorax progression in the follow-up imaging. There were no complications related to the absence of pleural drainage. Complications and hospital stay were lower in the conservative management group. Conclusion: Patients with OPTX due to chest trauma (blunt or penetrating), without requiring assisted ventilation and hemodynamically stable, can be safely conservative managed with close monitoring for 24 hours, with a lower rate of complications and hospital stay.

Analysis of Wrist Morphology Through Hamate and Lunate Bone Variations in Anatolian Population Using Plain Radiography / Análisis de la Morfología de la Articulación Radiocarpiana a Través de las Variaciones de los Huesos Hamato y Semilunar en la Población de Anatolia Mediante Radiografía Simple

SUMMARY: The present study aimed to evaluate wrist (lunate) anatomy in terms of the incidence of lunatum morphology on plain-radiographs among the Anatolian (Turkey) population, accompanied by demographic analysis. We obtained all the patients' data regarding demographical features, diagnosis, and posteroanterior (PA) X-ray imaging. Two radiograph-reviewers repeated the analysis twice, one month later, blinded to their findings before the previous review. The lunatum structure was determined as Type-1 (n:293) and Type-2 (n:207) for each radiograph. Most of the 500 wrists' radiographs [n:293 (58.6 %)] were type-I lunate. The mean age was 36.7±13.3 (range:18-90) years. Sex distribution was as follows: 185 (63.1 %) males to 108 (36.9 %) females. Type-2 lunate was seen in 207 participants (41.4 %). The mean age for type-2 was 41.6±15.2 (18-88) years. 142 (68.6 %) participants were male sex, while 65 (31.4 %) were females. The mean age of subjects with type-I showed a difference with type-II (p=0.007). There was no relationship in terms of sex (p=0.206) between the groups. In the Anatolian region, type-1 lunate was dominant compared to type-2. The incidence rate of lunate type in Anatolian population was similar to the Arab population.

El presente estudio tuvo como objetivo evaluar la anatomía de la articulación radiocarpiana en términos de la incidencia de la morfología del hueso semilunar en radiografías simples entre la población de Anatolia (Turquía), acompañado de un análisis demográfico. Obtuvimos todos los datos de los pacientes con respecto a las características demográficas, el diagnóstico y las imágenes de rayos X posteroanteriores (PA). Dos revisores de radiografías repitieron el análisis dos veces, un mes después, sin conocer sus hallazgos antes de la revisión anterior. La estructura del lunatum se determinó como Tipo-1 (n:293) y Tipo-2 (n:207) para cada radiografía. La mayoría de las 500 radiografías de muñecas [n:293 (58,6 %)] fueron semilunar tipo I. La edad media fue de 36,7±13,3 (rango: 18-90) años. La distribución por sexos fue la siguiente: 185 (63,1 %) hombres y 108 (36,9 %) mujeres. El semilunar tipo 2 se observó en 207 participantes (41,4 %). La edad media para el tipo 2 fue de 41,6±15,2 (18-88) años. 142 (68,6 %) participantes eran del sexo masculino, mientras que 65 (31,4 %) eran del sexo femenino. La edad media de los sujetos con tipo I mostró una diferencia con el tipo II (p = 0,007). No hubo relación en cuanto al sexo (p=0,206) entre los grupos. En la región de Anatolia, el semilunar tipo 1 era dominante en comparación con el tipo 2. La tasa de incidencia del tipo semilunar en la población de Anatolia fue similar a la de la población árabe.

A Importância dos Métodos de Determinação das Idades Esquelética e Dentária na Ortodontia e Odontopediatria ­ uma Revisão de Literatura / The Importance of Methods for Determination of Squeletal and Dental Age in Orthodontics and Pediatric Dentistry ­ a Literature Review

O estágio de desenvolvimento humano é intimamente relacionado à sua maturidade óssea ou dentária, sendo essencial para a escolha do tratamento de alterações dentofaciais em crianças e adolescentes por ortodontistas e odontopediatras. Existem diversos indicadores biológicos para determinar a maturação do indivíduo, como a idade cronológica e as alterações hormonais, porém esses indicadores podem sofrer interferências. Visando uma determinação de desenvolvimento e dos picos de crescimento mais precisa, para um melhor diagnóstico e plano de tratamento, foram desenvolvidos diversos métodos para determinar a idade esquelética e a idade dentária, sendo estes a avaliação da maturação carpal, da morfologia das vértebras cervicais, da fusão óssea da sincondrose esfeno-occipital e da sutura palatina mediana, bem como dos estágios da calcificação dentária. A avaliação das radiografias de mão e punho é o padrão ouro da predição da idade esquelética, e sua correlação com outros métodos já é evidente. Sendo assim, é possível utilizar a avaliação das vértebras cervicais e das idades dentárias de Nolla e Demirjian.

The stage of human development is closely related to bone or dental maturity, being essential for the choice of treatment for dentofacial changes in children and adolescents by orthodontists and pediatric dentists. There are several biological indicators to determine an individual's maturation, such as chronological age and hormonal changes, but these indicators can suffer interference. Aiming at a more accurate determination of development and growth peaks, for a better diagnosis and treatment plan, several methods have been developed to determine skeletal age and dental age, these being the assessment of carpal maturation, the morphology of the cervical vertebrae, bone fusion of the spheno-occipital synchondrosis and the median palatal suture, as well as the stages of dental calcification. The evaluation of hand and wrist radiographs is the gold standard for predicting skeletal age, and its correlation with other methods is already evident. Therefore, it is possible to use the assessment of cervical vertebrae and dental ages by Nolla and Demirjian.

The most requested imaging tests in the treatment of aneurysmal bone cyst and their relationship to outcome: an update / Los exámenes de imagen más solicitados en el tratamiento del quiste óseo aneurismático y su relación con el resultado: una actualización / Os exames de imagem mais frequentemente solicitados no tratamento do quisto ósseo aneurismático e a sua relação com o resultado: uma atualização

ABSTRACT This study aimed to review the most required imaging tests, their characteristics, and whether the primary choice is sufficient for lesion management. PubMed, Web of Science, and Scopus databases were searched. The included articles were case reports or series of aneurysmal bone cysts in the mandible or maxilla that had all the information about the case, from diagnosis to follow-up. The 32 included articles showed that the first imaging test required is a panoramic radiographic examination of the cases, with only a few choosing computed tomography as the first option. The treatment of choice is usually curettage, and 9 cases had recurrences, although 17 did not report follow-up. 2D imaging examinations were the most required type when diagnosing an aneurysmal bone cyst, but 3D examinations were necessary in many cases for better evaluation and to provide more details.

RESUMEN El objetivo de este estudio fue revisar cuáles son los exámenes de imagen más requeridos, sus características y si la elección principal es suficiente para el manejo de la lesión. Se realizaron búsquedas en las bases de datos PubMed, Web of Science y Scopus. Los artículos incluidos eran informes de casos o series de casos de quistes óseos aneurismáticos en la mandíbula o el maxilar que tenían toda la información sobre el caso, desde el diagnóstico hasta el seguimiento. Los 32 artículos incluidos mostraron que el primer examen de imagen requerido es el examen radiográfico panorámico de los casos, y solo unos pocos eligen la tomografía computarizada como primera opción. El tratamiento elegido suele ser el curetaje, y 9 casos presentaron recidivas, aunque 17 no informaron del seguimiento. Los exámenes de imagen 2D fueron el tipo más requerido a la hora de diagnosticar un quiste óseo aneurismático, pero los exámenes 3D fueron necesarios en muchos casos para una mejor evaluación y para proporcionar más detalles.

RESUMO O objetivo deste estudo foi analisar quais os exames imagiológicos mais frequentemente solicitados, as suas características e se a escolha principal é suficiente para a gestão da lesão. Foram pesquisadas as bases de dados PubMed, Web of Science e Scopus. Os artigos incluídos eram relatos de casos ou séries de casos de cistos ósseos aneurismáticos na mandíbula ou maxila que continham todas as informações sobre o caso, desde o diagnóstico até o acompanhamento. Os 32 artigos incluídos mostraram que o primeiro exame de imagem solicitado é o exame radiográfico panorâmico dos casos, sendo que apenas alguns escolheram a tomografia computadorizada como primeira opção. O tratamento de escolha é geralmente a curetagem, e 9 casos tiveram recidivas, embora 17 não tenham relatado o acompanhamento. Os exames de imagem 2D foram os mais solicitados para o diagnóstico de cisto ósseo aneurismático, mas os exames 3D foram necessários em muitos casos para uma melhor avaliação e para fornecer mais detalhes.

Development of a convolutional neural network for diagnosing osteoarthritis, trained with knee radiographs from the ELSA-Brasil Musculoskeletal / Desenvolvimento de rede neural convolucional para o diagnóstico radiográfico de osteoartrite dos joelhos no ELSA-Brasil Musculoesquelético

Abstract Objective: To develop a convolutional neural network (CNN) model, trained with the Brazilian "Estudo Longitudinal de Saúde do Adulto Musculoesquelético" (ELSA-Brasil MSK, Longitudinal Study of Adult Health, Musculoskeletal) baseline radiographic examinations, for the automated classification of knee osteoarthritis. Materials and Methods: This was a cross-sectional study carried out with 5,660 baseline posteroanterior knee radiographs from the ELSA-Brasil MSK database (5,660 baseline posteroanterior knee radiographs). The examinations were interpreted by a radiologist with specific training, and the calibration was as established previously. Results: The CNN presented an area under the receiver operating characteristic curve of 0.866 (95% CI: 0.842-0.882). The model can be optimized to achieve, not simultaneously, maximum values of 0.907 for accuracy, 0.938 for sensitivity, and 0.994 for specificity. Conclusion: The proposed CNN can be used as a screening tool, reducing the total number of examinations evaluated by the radiologists of the study, and as a double-reading tool, contributing to the reduction of possible interpretation errors.

Resumo Objetivo: Desenvolver um modelo computacional - rede neural convolucional (RNC) - treinado com radiografias da linha de base do Estudo Longitudinal de Saúde do Adulto Musculoesquelético (ELSA-Brasil Musculoesquelético), para a classificação automática de osteoartrite dos joelhos. Materiais e Métodos: Trata-se de um estudo transversal abrangendo todos os exames da linha de base do ELSA-Brasil Musculoesquelético (5.660 radiografias dos joelhos em incidência posteroanterior). Os exames foram interpretados por médico radiologista com treinamento específico e calibração previamente publicada. Resultados: A RNC desenvolvida apresentou área sob a curva característica de operação do receptor de 0,866 (IC 95%: 0,842-0,882). O modelo pode ser calibrado para alcançar, não simultaneamente, valores máximos de 0,907 para acurácia, 0,938 para sensibilidade e 0,994 para especificidade. Conclusão: A RNC desenvolvida pode ser utilizada como ferramenta de triagem, reduzindo o número total de exames avaliados pelos radiologistas do estudo, e/ou como ferramenta de segunda leitura, contribuindo com a redução de possíveis erros de interpretação.