Usability of free software used for visualization and measurement of digital orthodontic models

The aim of this study was to evaluate the usability of the free software available that allow visualization and measurement of orthodontic digital models. 80 graduate students of orthodontics were asked to perform pre-defined tasks in a digital model through 3D Viewer ® and 3D-Tool ® software. The success in accomplishing the tasks and the time spent were recorded. To end, each participant answered a questionnaire to express their satisfaction regarding the software. There were no statistically significant difference between the software when compared to the accomplishment rates of tasks and the time spent by participants on each one. The software were evaluated as "slightly satisfactory" in several criteria. There is scope for optimization of orthodontic software by manufacturers since lack of their interface usability can discourage orthodontists' adherence to new resources that could provide benefits to their daily routine, even if they are freely available.

Extrusion of Endodontic Material to the Maxillary Sinus: Avoidable Intercurrence? / Extrusión de Material Endodóntico al Seno Maxilar: ¿Intercurrencia Evitable?

ABSTRACT: The objective of this study is to discuss and analyze whether extrusion of endodontic material constitutes avoidable intercurrence, discussing the clinical, ethical and legal implications. Patient LSR, 31 years old, female, attended a dental consultation complaining of pain in the second left maxillary premolar (tooth 25). Radiographically, a single root canal and thickening of the periodontal ligament associated with extravasation of 8 mm of gutta percha to the maxillary sinus were observed. The first endodontic session aimed to performing the desobturation, root canal preparation and intracanal medication placement. The root canal obturation was performed in the second session. Was carried out an apical surgery that removed 2 mm from the root apex and also performed the covered with a collagen membrane. A 22 months follow-up revealed a tooth function, absence of painful symptomatology or infection, and radiographically normal periodontal ligament and bone neoformation. The second single-root premolar is the type of premolar with less distance with the floor of the maxillary sinus. In this case, the extrusion of the obturator material occurred due to the superinstrumentation of the root canal associated with the proximity of the root with the membrane of the maxillary sinus. From the ethical and legal point of view, the patient has the right to be informed about any intercurrences that may arise during or after the treatment, and the informed consent form is essencial. This document will allow the patient to make a decision about performing an endodontic treatment in which the risk of an accident or complication is imminent or that treatment failure is already expected. It is important that professionals make appropriate diagnosis and treatment plan for each case, since this conduct may avoid clinical intercurrences. In addition, if the intercurrences occur, the patient should be advised of how to proceed.

RESUMEN: El objetivo de este estudio fue discutir y analizar si la extrusión de material endodóntico constituye una intercurrencia evitable, discutiendo las implicaciones clínicas, éticas y legales. Paciente LSR, de 31 años de edad, mujer, asistió a una consulta dental quejándose de dolor en el segundo premolar maxilar izquierdo (diente 25). Radiográficamente, se observó un solo conducto radicular y engrosamiento del ligamento periodontal asociado con la extravasación de 8 mm de gutapercha al seno maxilar. La primera sesión de endodoncia tuvo como objetivo realizar la desobturación, la preparación del conducto radicular y la colocación de medicación intracanal. La obturación del conducto radicular se realizó en la segunda sesión. Se llevó a cabo una cirugía apical que extrajo 2 mm del ápice de la raíz y también se realizó el recubrimiento con una membrana de colágeno. Un seguimiento de 22 meses reveló función dental, ausencia de sintomatología dolorosa o infección y ligamento periodontal radiográficamente normal y neoformación ósea. El segundo premolar de una sola raíz es el tipo de premolar con menos distancia con el piso del seno maxilar. En este caso, la extrusión del material obturador se produjo debido a la superinstrumentación del conducto radicular asociada con la proximidad de la raíz con la membrana del seno maxilar. Desde el punto de vista ético y legal, el paciente tiene derecho a ser informado acerca de cualquier inter-ocurrencia que pueda surgir durante o después del tratamiento, y el formulario de consentimiento informado es esencial. Este documento le permitirá al paciente tomar una decisión sobre la realización de un tratamiento de endodoncia en el que el riesgo de un accidente o complicación sea inminente o de que ya se espera un fracaso del tratamiento. Es importante que los profesionales realicen un diagnóstico y un plan de tratamiento adecuados para cada caso, ya que esta conducta puede evitar las intercurrencias clínicas. Además, si se producen intercurrencias, se debe informar al paciente sobre cómo proceder.

Comparative study of the usability of two software programs for visualization and analysis of digital orthodontic models.

Background. Software programs for visualization and analysis of digital orthodontic models, apart from presenting the necessary features for diagnosis and treatment planning, also need to be user-friendly. This characteristic refers to software' usability, a measure that evaluates how easy it is to use it is by a specific group of professionals. The aim of this study was to compare the usability of free available versions of two software programs for visualization and analysis of digital orthodontic models. Methods. Digimodel® and OrthoCAD® usability were evaluated through their interface analysis and executing the following procedures: malocclusion classification and models analysis (arch-length and tooth-size discrepancies). Results. Digimodel® and OrthoCAD® software programs had an installer only for Windows platform, occupied less than 110 megabytes of virtual space and only read files from their respective manufacturers. None possessed Portuguese as a language option. Both allowed visualization of the models in different axes through options present in initial screen, at a click. For model analysis, both software programs required to measure tooth to tooth and performed necessary calculations automatically. However, OrthoCAD® software program was less intuitive because the option for these actions was among several others, within menus, which could cause confusion during navigation. In addition, the marking of points did not always obey the clicked site. Conclusion. The free access version of the evaluated software programs exhibited usability limitations related to language, supported file format and even the model analysis execution for orthodontic diagnosis. Although OrthoCAD® was inferior, both did not meet orthodontists' clinical demand against these factors in the evaluated versions.

A importância das variações anatômicas das raízes de incisivos inferiores para a identificação humana ­ relato de caso pericial / The importance of anatomical variations of mandibular incisor roots to human identification ­ forensic case report

Introdução: Em decorrência dos altos índices de violência urbana, existe uma crescente necessidade de se realizar a identificação humana. A forma mais comum de identificar um indivíduo é a análise das impressões digitais. Entretanto, há casos em que a utilização da odontologia legal é fundamental devido às condições do corpo (mutilado, putrefeito, carbonizado ou esqueletizado). Objetivo: Demonstrar a aplicação da Odontologia Legal na identificação humana por meio de confronto radiográfico periapical antemortem (AM) e postmortem (PM) de um indivíduo esqueletizado. Relado de Caso: Uma ossada incompleta foi encontrada e removida ao IML-Goiânia para análise. A possível família apresentou radiografias periapicais AM que foram replicadas no PM para confronto odontolegal. Existe uma grande possibilidade de se combinar materiais e procedimentos odontológicos em uma população. Entretanto, as características anatômicas, bem como suas variações, podem auxiliar no processo de identificação de um indivíduo. Por meio das radiografias PM, constatou-se que o indivíduo em questão possuía dois canais no dente 41, também encontrados nas radiografias fornecidas pela família. Além disso, outras similaridades e discrepâncias explicáveis foram encontradas, sem que houvesse a ocorrência de nenhuma discrepância inexplicável, o que tornou possível identificar positivamente a vítima em questão. Conclusão: As características únicas de um indivíduo, como variações anatômicas em canais radiculares, são excelentes parâmetros que auxiliam a identificação humana pela técnica da odontologia legal.

Introduction: Due to the high rates of urban violence, there is a growing need for human identification. The most common way to identify an individual is the analysis of fingerprints. However, there are cases in which Legal Dentistry is fundamental considering body's condition (mutilated, putrefied, charred or skeletonized). Objective: To demonstrate the use of Legal Dentistry to human identification by means of antemortem (AM) and postmortem (PM) periapical radiographic comparison of a skeletonized individual. Case Report: An incomplete bone was found and analyzed in the Medico-Legal Institute of Goiânia. The possible family presented AM periapical radiographs that were replicated in the PM for odontolegal confrontation. There are many combination possibilities of dental materials and procedures in a population. However, anatomical characteristics, as well as their variations, can aid in the identification process of individuals. Through the PM radiographs, it was verified that there were two canals in the right inferior central incisor of the individual, also found in the radiographs provided by the family. In addition, other explainable similarities and discrepancies were found, without any inexplicable discrepancy occurring, which could positively identify the victim. Conclusion: The unique characteristics of an individual, such as anatomical variations in root canals, are excellent parameters that aid human identification by the Legal Dentistry radiograph comparison technique.

A interface entre odontologia legal e odontologia do esporte / The interface between forensic dentistry and sports dentistry

Vinte e duas especialidades odontológicas são atualmente reconhecidas e regulamentadas pelo Conselho Federal de Odontologia Brasileiro. Em posição de destaque, a Odontologia Legal figura como especialidade odontológica que respalda não somente a clínica geral, mas se comunica com todas as outras especialidades ­ seja fundamentando e guiando o exercício lícito da atuação profissional ou providenciando conhecimento científico específico para determinados procedimentos técnicos. Dentre as diversas interfaces da Odontologia Legal com as demais especialidades odontológicas, aquela evidenciada mais recentemente se dá com a Odontologia do Esporte. Esta especialidade, reconhecida em 2014, veio a salientar o papel do Cirurgião-dentista frente às necessidades que emergiam em decorrência de práticas esportivas. A melhora do desempenho profissional e a prevenção de traumas dentais, maxilofaciais e articulares são objetivos comumente explorados nesta especialidade. Contudo, pouco se discute a função pericial do Cirurgião-dentista na prática esportiva. A presente revisão da literatura fornece um estudo diferenciado da Odontologia do Esporte, sob um escopo odontolegal. Mais especificamente, a perícia documental de atletas, assim como sua estimativa de idade e determinação do sexo são retratadas como assuntos de expertise odontolegal em contribuição à Odontologia do Esporte. Acrescentando à escassa literatura científica, o presente trabalho confirma a atuação multidimensional da Odontologia Legal e apresenta suas ferramentas aplicáveis às mais diversas atividades odontológicas.

Twenty-two specialties are currently recognized by the Brazilian Federal Council of Dentistry. In a privileged position, Forensic Dentistry supports not only the general clinical practice but also communicates with every other specialty in Dentistry ­ from the fundamental guiding of best practices to the advanced knowledge provided to more technical procedures. Among the different interfaces of Forensic Dentistry, the most recent figures with Sports Dentistry. This specialty was recognized in 2014 and highlights the role of Dentists under the needs that emerge from sport practice. Improvement of sport performances and the prevention of dental and maxillofacial trauma are constantly explored in this field. However, little is known about the forensic contribution to sport practice. With a forensic scope, this scientific literature review provides different insights in Sports Dentistry. More specifically, forensic expertises in personal documents, as well age estimation and sex determination are discussed as potential contributions of Forensic Dentistry to Sports Dentistry. Innovating in the scarce scientific literature, the present study confirms the multidimensional range of Forensic Dentistry and exposes forensic tools applicable to the most diverse needs in the routine of dentistry.

A violação dos aspectos éticos e legais de uma rede social profissional odontológica / Ethycal and legal aspects violation of a professional dental social media

A exposição indiscriminada e acrítica de casos clínicos relacionados à prática odontológica em mídias sociais é uma preocupação crescente no que tange aos aspectos éticos e legais que regem a profissão. Este trabalho buscou analisar a proposição, a estratégia, a operacionalização, a forma, o conteúdo disponibilizado e a medida de segurança relacionados à mídia denominada iDent® e contrapô-los aos preceitos da ética odontológica e da legislação aplicável. O mapeamento da mídia e a coleta de dados foi feita no período de agosto de 2016, com amostra de cada uma das áreas/especialidades nela presentes, em publicações feitas por seus usuários e videoaulas da mídia, buscando-se evidenciar o teor do conteúdo exposto, por meio de análise quantitativa e qualitativa, material este confrontado com as normas vigentes. Foram selecionadas para análise 190 publicações e 30 videoaulas. Dentre as publicações analisadas, 130 (70%) apresentaram abordagem técnico-científica, embora muito limitada em informações. Por outro lado, as poucas unidades amostrais que incluíam estes elementos expunham imagens de pacientes. Além disso, 7 das 10 (70%) categorias de videoaulas assistidas expunham imagens de pacientes. A mídia social iDent® é, portanto, uma potencial ferramenta de educação odontológica, assim como local de exposição reprovável de conteúdos e/ou pessoas que viola a privacidade, o sigilo e a confidencialidade de dados de pacientes, contrariando normas éticas e legais, previstas em documentos que, direta ou indiretamente, regulamentam a prática odontológica.

The indiscriminate and uncritical exposure of clinical cases related to dental practice in social media is a growing concern regarding the ethical and legal aspects that govern the profession. The objective of this study is to analyze the proposition, the strategy, the operationalization, the form, the content made available and the safety measure related to the social media called iDent®, and to counter them to the precepts of dental moral and the applicable legislation. The mapping of the media and data collection was done in August 2016, with a sample of each of the areas/specialties in the network, in publications made by its users and video-lessons, seeking to evidence the contents of the data exposed, through quantitative and qualitative analysis, if this material is in conflict with current regulations. One hundred ninety publications and thirty video classes were selected for analysis. In the analysed publications, 130 (70%) presented a technical-scientific approach, although very limited in information. On the other hand, the few sample units that included these elements exposed patients' images. In addition, 7 of the 10 (70%) categories of video-assisted classes exposed patient images. iDent® is therefore a potential dental education tool, as well as a place of reproachful exposure of contents and/or people that violates privacy, secrecy and confidentiality of patient data, contrary to ethical and legal norms, foreseen in documents that, directly or indirectly, regulate the dental practice.

Forensic importance of intraoral photographs for human identification in dental autopsies ­ a case report / Importância pericial das fotografias intraorais para a identificação humana em autopsias odontológicas ­ relato de caso

Human identification may be achieved through fingerprint, teeth and DNA analyses. In these approaches, identification is given comparatively ­ between antemortem (AM) and postmortem (PM) data. Intraoral photographs, commonly used in Orthodontics, represent a source of dental identifiers in Forensic Dentistry. The present study aims to report a case of human identification founded on the analysis of intraoral photographs. An unknown human body was referred for cadaveric examination, which revealed all the permanent teeth fully erupted in the oral cavity. Among the distinctive dental traits, occlusal amalgam restorations were observed in the mandibular first molars, as well fixed orthodontic appliances with bands in the same teeth. Intraoral photographs were provided by the relatives of the potential victim. In these photographs, the same distinctive dental traits were observed leading to a positive identification without explainable discrepancies. The use of intraoral photographs for forensic purposes must be encouraged in medicolegal institutes because these are practical, low-cost, absent of radiation and reliable tools in the human identification process.

O processo de identificação humana pode se dar cientificamente confiável por meio dos exames da papiloscopia, odontologia e genética. Nestas três vertentes, a identificação comparativa ­ entre dados antemortem (AM) e postmortem (PM). As fotografias intrabucais, comumente utilizadas em Ortodontia, representam fonte de caracteres identificadores em Odontologia Legal. O presente estudo objetiva relatar um caso pericial fundamentado na utilização de fotografias intrabucais para a identificação humana. Um corpo não identificado foi encaminhado para exame necroscópico revelando a presença de todos os dentes permanentes completamente erupcionados na cavidade bucal. Dentre os caracteres dentais distintivos observados na vítima, encontravam-se restaurações oclusais de amálgama nos primeiros molares inferiores, assim como aparelho ortodôntico fixo ancorados por bandas nestes mesmos dentes. Fotografias intrabucais provenientes de tratamento ortodôntico foram fornecidas pelos familiares da suposta vítima. Nestas, os mesmo caracteres distintivos foram detectados gerando identificação positiva sem discrepâncias inexplicáveis. A utilização de fotografias intrabucais com finalidade forense deve ser divulgada e encorajada em institutos médico-legais, uma vez que representa meio prático, de baixo custo, isento de radiação e confiável para o processo de identificação humana.

Importancia Pericial de los Modelos de Yeso Odontológicos para la Identificación de Cuerpo Putrefacto - Relato de Caso / Forensic Importance of Dental Plaster Models for Putrefied Body Identification - Case Report

RESUMEN: Frente a casos complejos de identificación humana, como cuerpos en avanzado estado de descomposición, la aplicación de técnicas odontológicas se hace necesaria para establecer la identidad de una persona desaparecida. En este sentido, la existencia y obtención de registros odontológicos ante-mortem de una supuesta víctima, así como el análisis de las particularidades odontológicas del respectivo cadáver, puede constituirse en una posibilidad rápida y de bajo costo para la realización de pericias odontológicas de identificación humana. El objetivo de este relato es presentar un caso pericial, demostrando la importancia de los modelos de yeso para la identificación positiva de un cuerpo putrefacto, discutiendo los aspectos inherentes alarchivo y descarte de los mismos, después de su uso clínico. Los modelos de yeso odontológicos resultan sustanciales para el diagnóstico, planeamiento y ejecución de determinados tratamientos, debiendo ser almacenados en medio físico o digital. De igual manera, poseen relevante potencial para la identificación humana, al permitir, de forma confiable, la evaluación tridimensional de los dientes, sus posiciones en los arcos dentales y las peculiaridades odontológicas eventualmente presentes.

ABSTRACT: Faced with complex cases of human identification, such as bodies in an advanced state of decomposition, the application of dental techniques becomes necessary to establish the identity of a missing person. In this sense, the existence and obtaining of ante-mortem dental records of an alleged victim, as well as the analysis of the dental specificities of the respective corpse, can constitute a quick and low-cost possibility for human identification by dental features. The objective of this report is to present a forensic case, demonstrating the importance of plaster models for the positive identification of a decomposed body, discussing the inherent aspects of archiving and discarding them after their clinical use. Dental plaster models are substantial for the diagnosis, planning and execution of certain treatments, and must be stored on physical or digital media. Likewise, they have a significant potential for human identification by reliably allowing the three-dimensional evaluation of the teeth, their positions in the dental arches and the dental peculiarities that may be present.