The use of artificial intelligence tools in cancer detection compared to the traditional diagnostic imaging methods: An overview of the systematic reviews.

BACKGROUND AND PURPOSE: In comparison to conventional medical imaging diagnostic modalities, the aim of this overview article is to analyze the accuracy of the application of Artificial Intelligence (AI) techniques in the identification and diagnosis of malignant tumors in adult patients. DATA SOURCES: The acronym PIRDs was used and a comprehensive literature search was conducted on PubMed, Cochrane, Scopus, Web of Science, LILACS, Embase, Scielo, EBSCOhost, and grey literature through Proquest, Google Scholar, and JSTOR for systematic reviews of AI as a diagnostic model and/or detection tool for any cancer type in adult patients, compared to the traditional diagnostic radiographic imaging model. There were no limits on publishing status, publication time, or language. For study selection and risk of bias evaluation, pairs of reviewers worked separately. RESULTS: In total, 382 records were retrieved in the databases, 364 after removing duplicates, 32 satisfied the full-text reading criterion, and 09 papers were considered for qualitative synthesis. Although there was heterogeneity in terms of methodological aspects, patient differences, and techniques used, the studies found that several AI approaches are promising in terms of specificity, sensitivity, and diagnostic accuracy in the detection and diagnosis of malignant tumors. When compared to other machine learning algorithms, the Super Vector Machine method performed better in cancer detection and diagnosis. Computer-assisted detection (CAD) has shown promising in terms of aiding cancer detection, when compared to the traditional method of diagnosis. CONCLUSIONS: The detection and diagnosis of malignant tumors with the help of AI seems to be feasible and accurate with the use of different technologies, such as CAD systems, deep and machine learning algorithms and radiomic analysis when compared with the traditional model, although these technologies are not capable of to replace the professional radiologist in the analysis of medical images. Although there are limitations regarding the generalization for all types of cancer, these AI tools might aid professionals, serving as an auxiliary and teaching tool, especially for less trained professionals. Therefore, further longitudinal studies with a longer follow-up duration are required for a better understanding of the clinical application of these artificial intelligence systems. TRIAL REGISTRATION: Systematic review registration. Prospero registration number: CRD42022307403.

Fractal dimension analysis on CBCT scans for detecting low bone mineral density in postmenopausal women.

Purpose: The aim of this study was to compare the fractal dimension (FD) measured at 2 bone sites (second cervical vertebra and mandible) on cone-beam computed tomography (CBCT). The research question was whether FD could serve as an accessory tool to refer postmenopausal women for densitometric analysis. Therefore, the reliability and accuracy of FD were evaluated. Materials and Methods: In total, 103 postmenopausal women were evaluated, of whom 52 had normal bone mineral density and 51 had osteoporosis, according to dual X-ray absorptiometry of the lumbar spine and hip. On the CBCT scans, 2 regions of interest were selected for FD analysis: 1 at the second cervical vertebra and 1 located at the mandible. The correlations between both measurements, intra- and inter-observer agreement, and the accuracy of the measurements were calculated. A P value less than 0.05 was considered to indicate statistical significance for all tests. Results: The mean FD values were significantly lower at the mandibular region of interest in osteoporotic patients than in individuals with normal bone mineral density. The areas under the curve were 0.644 (P=0.008) and 0.531 (P=0.720) for the mandibular and vertebral sites, respectively. Conclusion: FD at the vertebral site could not be used as an adjuvant tool to refer women for osteoporosis investigation. Although FD differed between women with normal BMD and osteoporosis at the mandibular site, it demonstrated low accuracy and reliability.

The role of teledentistry in oral cancer patients during the COVID-19 pandemic: an integrative literature review.

OBJECTIVES: This integrative review aimed to assess the benefits of the use of teledentistry for patients undergoing treatment of oral and head and neck cancer during the COVID-19 pandemic. MATERIALS AND METHODS: We searched in PubMed, Cochrane, Scopus, Web of Science, Lilacs, Embase, Open Grey, Google Scholar, and Jstor databases for studies referring to the management, control, and assistance, through teledentistry, to patients with oral and head and neck cancer during the COVID-19 pandemic. RESULTS: We found 356 references in the databases, 209 after duplicates removal, 23 met criteria for full-text reading, and 11 studies were included for qualitative synthesis, in four categories: virtual visits, use of remote technology, patient's satisfaction, multidisciplinary approach in teledentistry. We found that 78% of patients currently preferred teledentistry; 92% of patients would recommend the use of video consultation to other patients. The continuity of dental care, the reduction of patient visits to the hospital, the reduction of the risk of infection with the coronavirus, and limitation of face-to-face consultations to protect health professionals are benefits that reinforce the use of teledentistry by health institutions. Two studies showed patients' satisfaction with the use of teledentistry in monitoring cancer patients and showed an improvement in quality of life. CONCLUSIONS: The teledentistry, as a remote technology for monitoring patients with oral and head and neck cancer, is well accepted by patients in preliminary studies. Although these studies pointed out some benefits of using remote technologies for the care of cancer patients, further robust scientific evidence is still needed in this regard.

Acesso e cobertura populacional à saúde bucal após a implementação da Política Nacional de Saúde Bucal "Brasil Sorridente" / Access and oral health population coverage after implementation of the National Oral Health Policy "Smiling Brazil" / Acceso y cobertura de la salud oral después de la implementación de la Política Nacional de Salud Oral "Brasil Sonriente"

O objetivo foi analisar a Política Nacional de Saúde Bucal, na perspectiva do acesso e cobertura das ações desenvolvidas na odontologia do Sistema Único de Saúde, entre 2002 e 2016. A partir do quadro conceitual da Organização Mundial da Saúde, que se divide em blocos para garantir acesso, cobertura e qualidade dos sistemas de saúde, foi realizado um estudo de caso do Brasil Sorridente referentes à implantação e financiamento das equipes. O bloco "força de trabalho" revelou um crescimento superior a 470% no número de equipes de saúde bucal no Brasil; no bloco "financiamento" fica evidente o grande aporte financeiro destinado à política, com ênfase ao papel indutor deste processo nos municípios; o bloco "tecnologia" evidenciou o incremento tecnológico para viabilizar os serviços de saúde bucal em todo o Brasil; já no bloco "disponibilidade dos serviços de saúde" observa-se uma ampliação de 4% na atenção básica e os serviços especializados essas porcentagens ultrapassam os 200% entre 2001 e 2015, finalmente, no bloco "acesso e cobertura" foi possível verificar o aumento de cobertura populacional de 9% para 43% no Brasil. Os dados apontam que a política permitiu um avanço referente aos blocos estruturantes do framework e melhorou o acesso e a cobertura em saúde bucal. (AU)

The objective was to analyze the National Oral Health Policy, from the perspective of access and coverage of dentistry actions in the Unified Health System, between 2002 and 2016. Based on the World Health Organization conceptual framework, which is divided into blocks to guarantee access, coverage and quality of health systems, a case study was carried out in the Smiling Brazil considering the implementation and financing. As a result, the "workforce" block revealed a growth rate superior than 470% in the number of oral health teams in Brazil. In the "financing" block, the great financial support to the policy is evident, with emphasis on the role of this process in the municipalities. The "technology" block evidenced the technological increase to make oral health services viable in Brazil. Furthermore, in the block "availability of health services" was observed an increase of 4% in primary care. On the other hand, between 2001 and 2015, in the specialized services this percentage exceed 200%. Finally, in the block "access and coverage" was possible to verify the increase of population coverage from 9% to 43% in Brazil. The data indicate that the policy allowed an advance regarding the framework structuring blocks, as well as improved the access and coverage in oral health. (AU)

El objetivo fue analizar la Política Nacional de Salud Oral, desde la perspectiva de acceso y cobertura de las acciones desarrolladas en la odontología del Sistema Único de Salud, entre 2002 y 2016. Desde el marco conceptual de la Organización Mundial de la Salud, que se divide en bloques para garantizar el acceso, la cobertura y la calidad de los sistemas de salud, se realizó un estudio de caso de Smiling Brazil sobre la implementación y el financiamiento de los equipos. El bloque de "fuerza laboral" reveló un crecimiento de más del 470% en el número de equipos de salud bucal en Brasil; En el bloque de "financiamiento", la gran contribución financiera a la política es evidente, con énfasis en el papel inductivo de este proceso en los municipios; el bloque "tecnología" evidenció el aumento tecnológico para habilitar los servicios de salud bucal en todo Brasil; En el bloque "disponibilidad de servicios de salud" hay un aumento del 4% en atención primaria y servicios especializados, estos porcentajes superan el 200% entre 2001 y 2015, finalmente, en el bloque "acceso y cobertura" fue posible verificar el aumento Cobertura poblacional del 9% al 43% en Brasil. Los datos indican que la política permitió un avance con respecto a los componentes básicos del marco y un mejor acceso y cobertura en salud bucal. (AU)

A new cone-beam computed tomography-driven index for osteoporosis prediction.

OBJECTIVE: To verify whether mandibular cortical analyses accurately distinguish postmenopausal women with normal bone mineral density (BMD) from women with osteoporosis by means of a cone-beam computed tomography (CBCT)-driven composite osteoporosis index (three-dimensional mandibular osteoporosis index-3D MOI). MATERIAL AND METHODS: The comparison was performed between 52 women with normal BMD and 51 women with osteoporosis according to dual-energy X-ray absorptiometry (DXA) examination of the lumbar spine and hip. Mandibular cortical width (MCW) and cortical quality were evaluated on cross-sectional and panoramic reconstructed images. ANOVA, ROC curves and accuracy measurements were used for statistical analyses, as well as a predictive model combining the quantitative and qualitative analyses and age. RESULTS: All CBCT-driven measurements presented good to moderate intra- and interobserver agreements. MCW values were significantly lower in women with osteoporosis. Postmenopausal women with osteoporosis were 8 times more likely to have the cortex classified as C3, and 2.4 times more likely to have MCW thinner than 2.75 mm. The area under the ROC curve was 0.8 for the predictive model. CONCLUSIONS: The newly developed 3D MOI enables distinguishing women with osteoporosis from those with normal BMD with good sensitivity and specificity. CLINICAL RELEVANCE: Whenever a CBCT scan is performed for specific clinical indications, a 3D MOI may be performed to qualitatively and quantitatively assess the condition of the mandibular cortex. This may be surely helpful to assess the osteoporosis status in the ageing population and more specifically in peri- or postmenopausal women.

Evidence on the Use of Mobile Apps During the Treatment of Breast Cancer: Systematic Review.

BACKGROUND: Cancer is a major cause of morbidity, disability, and mortality worldwide, and breast cancer is the most common cause of death in women. Different modalities of cancer treatment can have adverse effects that reduce the quality of life of patients and lead to treatment interruptions, if not managed properly. The use of mobile technologies has brought innovative possibilities for improving health care. Mobile apps can help individuals manage their own health and well-being and may also promote healthy lifestyles and information access. OBJECTIVE: The aim of this study was to identify available evidence on the use of mobile apps to provide information and facilitate communication regarding self-care management related to the adverse effects of toxicities owing to breast cancer therapy. METHODS: This systematic review includes studies which were identified using a search strategy adapted for each electronic database: CINAHL, Cochrane Library, LILACS, LIVIVO, PubMed, SCOPUS, and Web of Science. In addition, a gray literature search was performed using Google Scholar. All the electronic database searches were conducted on April 17, 2019. Two investigators independently reviewed the titles and abstracts of the studies identified and then read the full text of all selected papers. The quality of the included studies was analyzed by the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies. RESULTS: A total of 9 studies which met the eligibility criteria-3 randomized clinical trials and 6 nonrandomized studies published in English from 2010 to 2018-were considered for this systematic review; 396 patients with breast cancer, as well as 40 experts in the medical and nursing fields, and 3 software engineers were included. CONCLUSIONS: The evidence from the studies included in this systematic review is currently limited but suggests that mobile apps for women with breast cancer might be an acceptable information source that can improve patient well-being; they can also be used to report symptoms and adverse treatment-related effects and promote self-care. There is a need to test more evidence-based apps in future randomized clinical trials.

A Conservative Approach for Localized Spongiotic Gingivitis Hyperplasia Using Photodynamic Therapy: A Case Report and Review of the Literature.

Objective: To describe a clinical case of successful conservative management of Localized Juvenile Spongiotic Gingivitis Hyperplasia (LJSGH) using photodynamic therapy (PDT) and reviews the current literature on this pathology. Background data: LJSGH is a recently described rare disease with controversial treatment results. As of today, 13 publications report surgical treatment approaches. The use of CO2 laser and cryotherapy was reported only in one study. The use of PDT was not previously reported. Patients and methods: A 9-year-old male patient was referred to our institution with the chief complaint of asymptomatic "inflamed gingiva" starting 1 year before. Clinical examination revealed an erythematous line accompanying the gingival contour, with a certain degree of hyperplasia. The diagnosis of LJSGH was performed based on clinical features and later confirmed histopathologically. A novel approach using PDT was then proposed. The photosensitizer was methylene blue, and a semiconductor laser diode was used. Results: One week after starting PDT, gingival hyperplasia was partially reduced. Immediately after the end of treatment, a significant reduction of gingival hyperplasia was observed. PDT proved to be safe, quick and painless, with no esthetic harm. Conclusions: This case illustrates the benefit of a more conservative approach as opposed to surgical procedure, with good clinical response and decreased morbidity over a 2-year follow-up period.

A Conservative Approach for Localized Spongiotic Gingivitis Hyperplasia Using Photodynamic Therapy: A Case Report and Review of the Literature.

OBJECTIVE: To describe a clinical case of successful conservative management of Localized Juvenile Spongiotic Gingivitis Hyperplasia (LJSGH) using photodynamic therapy (PDT) and reviews the current literature on this pathology. BACKGROUND DATA: LJSGH is a recently described rare disease with controversial treatment results. As of today, 13 publications report surgical treatment approaches. The use of CO2 laser and cryotherapy was reported only in one study. The use of PDT was not previously reported. PATIENTS AND METHODS: A 9-year-old male patient was referred to our institution with the chief complaint of asymptomatic "inflamed gingiva" starting 1 year before. Clinical examination revealed an erythematous line accompanying the gingival contour, with a certain degree of hyperplasia. The diagnosis of LJSGH was performed based on clinical features and later confirmed histopathologically. A novel approach using PDT was then proposed. The photosensitizer was methylene blue, and a semiconductor laser diode was used. RESULTS: One week after starting PDT, gingival hyperplasia was partially reduced. Immediately after the end of treatment, a significant reduction of gingival hyperplasia was observed. PDT proved to be safe, quick and painless, with no esthetic harm. CONCLUSIONS: This case illustrates the benefit of a more conservative approach as opposed to surgical procedure, with good clinical response and decreased morbidity over a 2-year follow-up period.

Early bony changes associated with bisphosphonate-related osteonecrosis of the jaws in rats: A longitudinal in vivo study.

OBJECTIVE: To evaluate early bony changes in an animal model of Medication-Related Osteonecrosis of the Jaw (MRONJ) at the side of the local trauma and at the contralateral side, comparing with a control group. Bony changes were evaluated by Microcomputed Tomography (MicroCT) at three times points: at baseline (T0), after drug administration (T1) and after dental extraction (T2). DESIGN: Two groups were compared: the experimental group in which zoledronic acid (ZA) was administered (17 rats) and the control group (13 rats). Dental extractions of the lower left first molars were performed in all animals. The left side was considered as the supposed affected area in the ZA group, and the right side was considered as the unaffected area. In these areas, the following structural microtomographic bone parameters were calculated: Bone Mineral Density (BMD), Trabecular Thickness (Tb.Th), and Bone Volume Proportion (BV/TV). The comparison of quantitative bone parameters among the different sides and experimental phases of both studied groups were performed by ANOVA-factorial. RESULTS: None of the animals of the control group developed MRONJ. In the ZA group, 76% presented bone exposure. From T0 to T1, Tb.Th and BV/TV increased, and in T2, the mean values were higher in ZA group than in the control group. BMD increased throughout the different phases of both groups. CONCLUSIONS: Structural bony changes occurred in the ZA group at both mandibular sides before the dental extraction (T1). Tb.Th and BV/TV should be further investigated as potential early bone markers of MRONJ.

E-learning em Diagnóstico Bucal: relato de experiência na Universidade de Brasília / E-learning in Oral Diagnosis: experience report at the University of Brasília

Define-se e-learning como qualquer tipo de situação educacional em que o conteúdo é disponibilizado eletronicamente via Internet quando e onde as pessoas precisam. Usando as possibilidades que o ambiente virtual oferece para o ensino, foi elaborado um e-módulo na Plataforma Moodle. O objetivo desse estudo foi verificar o acesso, desempenho e aceitação de estudantes de graduação em Odontologia frente à utilização do e-módulo nas atividades online da Disciplina de Diagnóstico Bucal na Universidade de Brasília. Avaliações de conteúdo (pré e pós-teste), pré-teste de expectativa e pós-teste de satisfação foram elaborados para avaliar o conteúdo e a aceitação do emódulo entre os participantes. Dos 25 participantes iniciais, dois concluíram o e-módulo, 11 começaram e não concluíram, nove não acessaram a Plataforma e três não aceitaram responder o pósteste de satisfação. Pré e pós-teste de conteúdo não apresentaram dados significativos. O pós-teste de satisfação mostrou que dos estudantes que não acessaram o e-módulo, ou acessaram e não concluíram, 80% alegaram "não ter tempo para acessar a Plataforma" e 15% afirmaram não participar, ou não concluir o e-módulo "porque este não trazia acréscimo de crédito ou nota". Em conclusão, apesar de os estudantes serem positivos em relação ao uso de novas metodologias, a participação foi muito baixa. Já o desempenho foi similar àquele das aulas presenciais. Vários fatores influenciam a atitude dos estudantes no e-módulo, incluindo o ganho de recompensas e a forma pedagógica dos conteúdos. Assim, persiste ao professor o papel motivacional e mediador entre aprendizado e mundo virtual (AU).

E-learning can be defined as any type of educational situation in which the content is available electronically via Internet when and where people need it. Using the possibilities that virtual environment provides for education, was developed an e-module in the Moodle Platform. The aim of this study was to verify the access, performance, and acceptance of undergraduate dentistry students to use the e-module in the online activities of Oral Diagnosis Discipline at the University of Brasilia. Evaluations of content (pre and post-test), pre-test of expectation and post-test of satisfaction were designed to evaluate the content and acceptance of e-module among participants. Of the 25 initial participants, 2 completed the e-module, 11 started and did not complete, 9 did not access the platform and three did not accept to answer the post-test of satisfaction. Pre and post-test of content showed no significant data. The post-test of satisfaction showed that the students who have not accessed the e-module, or accessed and did not complete, 80% said they "did not have time to access the Platform" and 15% said they did not participate or did not complete the e-module "because it would not improve GPA or course credit number". In conclusion, although students were positive regarding the use of new methodologies, the participation was very low. The performance was similar to presential classes. Several factors influence the attitude of the students in the emodule, including rewards gain and the pedagogical form of the contents. Thus, it is up to the teacher the motivational and mediating role between learning and the virtual world (AU).

Teaching and learning Oral Radiology via the social medium WhatsApp / Ensinando e aprendendo radiologia oral via mídia social WhatsApp

Social media can be defined as Internet-based applications that allow the widespread creation and exchange of user-generated content. The ease with which social media can be accessed through numerous mobile devices encourages medical educators to use social media to share content with students outside the classroom. The aim of this study was to introduce WhatsApp as a teaching tool in an Oral Radiology course. The secondary objective was to assess students' attitudes towards the use of this innovative tool in teaching of dentistry. In the first semester of 2016, 30 second-year undergraduate dental students at the University of Brasília were provided with weekly quizzes via a WhatsApp discussion group. The quizzes consisted of a tomographic or radiographic image from a real clinical case and a multiple-choice question. At the end of the semester students' attitudes were assessed using a satisfaction questionnaire. The results showed that students had a positive attitude towards the use of WhatsApp and considered it had helped them to learn about Oral Radiology. In conclusion, this technology can improve the way material is taught, since educators are prepared to develop better learning environments and students are concerned about the potential use of the social media in education (AU).

Mídias sociais podem ser definidas como um grupo de aplicativos baseados em Internet que permitem a criação e troca de conteúdos gerados pelo usuário de forma bastante expandida. A facilidade de as mídias sociais serem acessadas em dispositivos móveis encoraja educadores da área de saúde a compartilhar nessas mídias conteúdos que vão além da sala de aula. O objetivo desse estudo foi introduzir a mídia social WhatsApp como uma ferramenta de ensino no curso de Radiologia Oral. Como segundo objetivo, as atitudes dos estudantes ao utilizar essa nova ferramenta durante a graduação em Odontologia foram avaliadas. No primeiro semestre de 2016, quizzes semanais foram disponibilizados em um grupo de discussão no WhatsApp, criado com 30 alunos do segundo ano de Odontologia da Universidade de Brasília. Os quizzes eram compostos por uma imagem radiográfica ou tomográfica de um caso clínico real e uma questão de múltipla escolha. Ao final do semestre, avaliou-se o comportamento dos estudantes por um questionário de satisfação. O estudo mostrou que os alunos têm atitude positiva em relação ao uso do WhatsApp e o consideraram útil para auxiliar o aprendizado de Radiologia Oral. Em conclusão, essa tecnologia é capaz de aprimorar a forma como os conteúdos são ensinados, desde que os educadores estejam preparados para desenvolver melhores ambientes de aprendizado e os estudantes estejam conscientes sobre o potencial uso das mídias sociais para educação (AU).

Effectiveness of FDG-PET/CT for evaluating early response to induction chemotherapy in head and neck squamous cell carcinoma: A systematic review.

BACKGROUND: F-Fluoro-Deoxy-Glucose Positron Emission Tomography with Computed Tomography (F-FDG PET/CT) may be a powerful tool to predict treatment outcome. We aimed to review the effectiveness of F-FDG PET/CT in the assessment of early response to induction chemotherapy (IC) in patients with advanced Head and Neck Squamous Cell Cancer (HNSCC) without previous treatment. METHODS: PubMed, Cochrane Library, Science Direct and Web of Science were searched to May 2016. Reference lists of the included articles and additional studies identified by one nuclear medicine expert were screened for potential relevant studies that investigated the effectiveness of F-FDG PET/CT performed before and after IC. Three authors independently screened all retrieved articles, selected studies that met inclusion criteria and extracted data. The methodology of the selected studies was evaluated by using the risk of bias checklist of the Agency for Healthcare Research and Quality (AHRQ). RESULTS: Seven out of 170 eligible studies met our inclusion criteria. A total of 207 advanced HNSCC patients were evaluated with F-FDG PET/CT at baseline and after IC in the selected articles. Six from seven studies concluded that F-FDG PET/CT allowed early evaluation response to IC and predicted survival outcomes. CONCLUSION: The present systematic review confirms the potential value of F-FDG PET/CT as a diagnostic tool for early IV response assessment in HNSCC patients. However, the lack of standard definitions for response criteria and heterogeneous IC protocols indicate the need to further studies in order to better define the role of F-FDG PET/CT in these patients.

Chamomile infusion cryotherapy to prevent oral mucositis induced by chemotherapy: a pilot study.

PURPOSE: The aim of this study is to compare cryotherapy made only with water and cryotherapy made with chamomile infusion for prevention and reduction of intensity of oral mucositis in patients with cancer receiving 5-fluorouracil and leucovorin. METHOD: This is a randomized pilot study with two groups: cryotherapy made only with water (control group, n = 18) and cryotherapy made with chamomile infusion (chamomile group, n = 20). Both groups were instructed to swish the ice around in their oral cavity for at least 30 min during chemotherapy. Assessment of oral mucosa occurred on days 8, 15, and 22 after the first day of chemotherapy. RESULTS: Fifty percent of the patients in the control and 30 % in the chamomile group developed oral mucositis. Mouth pain score was higher in patients in the control group on all evaluations (p = 0.02 for day 8, p = 0.09 for day 15, and p = 0.14 for day 22). Patients in the chamomile group never developed mucositis with grade 2 or higher. Presence of ulceration was statistically significant on day 8 (16 % in the control vs. 0 % in the chamomile group, p = 0.10), but not in days 15 and 22, although 11 % still had ulcerations in the control group and none in the chamomile group. CONCLUSION: The occurrence of oral mucositis was lower in patients in the chamomile group than in the control group. When compared to the controls, the chamomile group presented less mouth pain and had no ulcerations. Cryotherapy was well tolerated by both groups, and no toxicity related to chamomile was identified.

Augmented reality as a new perspective in Dentistry: development of a complementary tool / Realidade aumentada como uma nova perspectiva em Odontologia: desenvolvimento de uma ferramenta complementar

The purpose of this study is to introduce a visualization and interaction tool of Augmented Reality in mobile devices using three-dimensional (3D) volumetric images from patients' real tomographic acquisition, and to describe the steps for preparing the models for such 3D visualizations. Augmented Reality was built correlating tomographic images and open-source software, in a sequence of (1) image acquired, that consists of multi-planar images that can be visualized as 3D renderings and are the basis for constructing polygonal surfaces of specific anatomic structures of interest, (2) creation of volumetric models, in which 3D volumetric model can be saved and exported as a 3D polygonal mesh in .stl file format, (3) model simplification, which must be done in order to simplify the matrix of polygonal surfaces, and reduce models' megabytes, and (4) create the augmented reality project. Once these procedures are performed, the augmented reality project can be saved and visualized in mobile devices. The volumetric model from a computed tomography acquisition is available in any mobile device screen, superimposed on a marker. This approach facilitates the visualization of the model, giving the precise location of structures and abnormalities, as supernumerary teeth, bone fractures and asymmetries. Also, the model is saved for future and multiple visualization. Augmented reality application is a new perspective in dentistry although it is in an early phase. It can be created by integrating multiple technologies and has a great potential to support learning and teaching, and improve how 3D models from medical images are seen (AU).

O objetivo desse trabalho é introduzir uma ferramenta de visualização e interação baseada em realidade aumentada (RA) em dispositivos móveis utilizando imagens volumétricas em três dimensões (3D) a partir de aquisições tomográficas reais de pacientes, e descrever os passos para o preparo dos modelos para tais visualizações tridimensionais. A RA foi construída correlacionando imagens tomográficas e programas de computador livres, na seguinte sequência: (1) imagem adquirida, que consiste em imagens mutiplanares que podem ser visualizadas como renderizações 3D e são a base para a construção de superfícies poligonais de estruturas anatômicas específicas de interesse, (2) criação dos modelos volumétricos, passo no qual o modelo 3D pode ser salvo e exportado como uma malha poligonal 3D em formato de arquivo .stl, (3)simplificação do modelo, que deve ser executada com a finalidade de simplificar a matriz de superfícies poligonais e consequentemente reduzir os megabytes do modelo, e (4) criação do projeto de realidade aumentada. Essa abordagem facilita a visualização do modelo tomográfico, dando a localização precisa de estruturas e anormalidades, como dentes supranumerários, fraturas ósseas e assimetrias. Além disso, o referido modelo pode ser salvo para múltiplias visualizações futuras. A aplicação da realidade aumentada é uma nova perspectiva em Odontologia apesar de estar em fase inicial. Pode ser criada integrando múltiplas tecnologias e apresenta grande potencial para auxiliar o ensino e a aprendizagem, e para melhorar a forma como modelos 3D originados de imagens médicas são visualizados (AU).

Promoção da Saúde Bucal

Este módulo, composto por seis exercícios, foi desenvolvido com intuito de proporcionar aprendizado interativo, dinâmico e contextualizado sobre saúde bucal visando discutir as contribuições desta no contexto da promoção de saúde, fazendo-se valer de situações que perpassam o cotidiano da equipe multidisciplinar da Estratégia de Saúde da Família (ESF), além de discutir as competências necessárias pelos profissionais no âmbito da atenção básica.

Imaging findings of bisphosphonate-related osteonecrosis of the jaws: a critical review of the quantitative studies.

Objectives. This paper offers a critical review of published information on the imaging strategies used for diagnosing bisphosphonate-associated osteonecrosis of the jaw (BRONJ) in patients taking intravenous bisphosphonates, pointing at the different methodologies and results of existing literature. Methods. Electronic literature search was performed in order to identify as many quantitative studies that discussed the imaging findings of BRONJ up to February 2014. Initially, the search for articles was based on the following four types of imaging modalities for evaluating BRONJ: computed tomography, plain film radiographs, magnetic resonance imaging, and nuclear bone scanning. Results. Eleven out of the 79 initially selected articles met the inclusion criteria. Most of the selected articles were cross-sectional studies. Regarding the selected studies, 54.5% have used plain films radiographs and 54.5% were based on computed tomography findings. All of the selected studies showed a small number of patients and none of the selected studies have tested the accuracy of the imaging examination for evaluating BRONJ. Conclusions. This critical review showed a scarcity of quantitative studies that analyzed the typical imaging findings related to BRONJ. Further studies are necessary in order to analyze the role of different imaging techniques in the assessment of BRONJ.

Evaluation of immunohistochemical expression of p16 and presence of human papillomavirus in oral and oropharyngeal carcinoma.

Carcinogenesis concerns several changes that eventually result in the inactivation of tumor suppressor genes and activation of protooncogenes, leading to loss of cell cycle control. Inactivation of p16 seems to be an early event in this process and occurs in approximately 80% of squamous cell carcinoma cases. The aims of this study were to evaluate the immunohistochemical expression of p16 protein in oral and oropharyngeal squamous cell carcinoma cases, with both the tumoral area itself and its surgical margin being analyzed (dysplastic areas and histologically normal epithelium adjacent to carcinoma), and to verify the presence of human papillomavirus (HPV) and its relation to p16 expression. Paraffin-embedded biopsy tissues from 26 patients, 13 with oral squamous cell carcinoma and 13 with oropharyngeal squamous cell carcinoma, comprised the analyzed samples. To detect HPV, a nested polymerase chain reaction test using PGMY 09/11 and GP5*/GP6* primers and visualization of the product on a 2% agarose gel was performed. Demographic data were obtained from medical records. The results showed low expression of p16 in the tumor area (38.46%), compared with surgical margins in the histologically normal epithelium (84.6%) and dysplastic areas (57.7%). These findings indicate the inactivation of p16 in the process of malignant transformation. The association described in the literature between expression of p16 and presence of HPV could not be verified in this study, because none of the cases was HPV positive.

Fractal dimension and mandibular cortical width in normal and osteoporotic men and women.

OBJECTIVE: To verify whether fractal dimensions (FD) on the mandibular trabecular and cortical bone and mandibular cortical width (MCW) differ between patients with normal bone mineral density (BMD) and osteoporosis. STUDY DESIGN: In this retrospective study, 133 dental panoramic radiographs from men aged >60 years and postmenopausal women with a bone densitometry report of the lumbar spine and hip classified as either normal or osteoporotic were selected. Fractal dimensions of five standardized trabecular and cortical mandibular regions of interest and mandibular cortical width were measured on the panoramic radiographs by an experienced oral radiologist, blinded to the densitometric diagnosis. The following statistical analyses were performed: ANOVA and a forward logistic stepwise regression to verify associations between dental panoramic measurements and the densitometric diagnosis. P values less than .05 indicated statistical significance. MAIN OUTCOME MEASURES: Fractal dimension and mandibular cortical width. RESULTS: Differences were found in the FD values on mandibular cortical bone and MCW between patients with normal BMD and with osteoporosis, but not in the FD values of trabecular bone. The odds of having lower mean values of MCW and FD on cortical bone were 2.16, 3125 and 1005 times in osteoporotic patients, respectively, compared with patients with normal BMD. CONCLUSION: The values of FD analysis on mandibular cortical bone and MCW were lower in women with osteoporosis. A well-adjusted logistic regression model showed that cortical bone measurements might be considered as auxiliary tools to referring patients for DXA exam.

Cone-beam computed tomography and microtomography for alveolar bone measurements.

PURPOSE: To compare cone-beam computed tomography (CBCT) and microtomography (micro-CT) for alveolar bone measurements. METHODS: Forty teeth and alveolar bone blocks of five pigs were scanned on a micro-CT with a 9.05 µm pixel size, and on a CBCT device at 0.125 mm voxel size. One height and four thickness measurements were performed twice in standardized slices by two radiologists to verify reliability. Agreement between imaging methods was assessed by correlation coefficients, Bland-Altman plots, and the difference was tested by a Wilcoxon signed-rank test. RESULTS: Regarding intra- and interobserver agreements, all bone measurements presented excellent precision values for micro-CT, but interobserver agreement for CBCT presented good to moderate values. Bone height differed about 0.3 mm, but no statistically significant differences were found for the bone thickness measurements. CONCLUSION: CBCT underestimated bone height. No statistically significant differences were found for bone thickness. Regions of thin bone tissue may not be visualized on CBCT images. There are risks of underestimating bone measurements with CBCT and assuming bone loss that does not exist clinically. Although the difference of the bone height measurement was small, the clinical relevance must be analyzed on how to interpret CBCT.