Why are brazilian orthodontists prosecuted and convicted? an overview of the contemporary jurisprudence / Por que ortodontistas brasileiros são processados ​​e condenados? uma revisão da jurisprudência contemporânea

Orthodontics figures as one of the largest community of specialists in Brazil. Unfortunately, numbers are high not only for the professionals but also for the lawsuits against them. The aim of this study was to screen the Brazilian jurisprudence in order to identify the reasons that motivated patients against orthodontists and motivated Judges towards convictions in lawsuits. The sample consisted of 395 lawsuits retrieved from the State Civil Courts of Brazil (n=27). The lawsuits were founded on conflicts between orthodontists and patients. Case-specific legal information were registered, such as patients' main reason behind the lawsuit and the decision in second instance. Chi-square and relative risk tests were calculated to investigate the influence of research variables towards conviction. Most of the lawsuits were judged in the State of São Paulo (n=151; 38.2%) and were published between 2011 and 2017 (rho: 0.797). The main reasons behind the lawsuits against orthodontists were the dissatisfaction with treatment outcomes (n=143, 36.2%), the occurrence of periodontal disease (n=45, 11.4%) and the need for tooth extractions (n=43, 10.9%). Statistically significant outcomes were detected between convictions in first and second instances and between convictions and the contractual obligation of result (p<0.001). The combination of I) patients' dissatisfaction and II) judgments under the obligation of results in second instance figure as the main risk factors for the prosecution and conviction of orthodontists.

A Ortodontia figura como uma das maiores especialidades no Brasil. Infelizmente, os números não são elevados apenas no que concerne aos profissionais, mas também quanto aos processos judiciais contra eles. O objetivo deste trabalho foi pesquisar a jurisprudência Brasileira para identificar as razões que levam os Ortodontistas a serem processados pelos pacientes e os motivos que levam os Magistrados a condená-los. A amostra consistiu de 395 processos judiciais obtidos dos Tribunais Judiciais Brasileiros (n=27). Todos os processos descreveram lides entre Ortodontistas e pacientes. Informações demográficas e legais foram registradas, como a queixa principal do paciente ao instaurar o processo e a decisão do Magistrado em segunda instância. Os testes de Qui-quadrado e de risco relativo foram utilizados para verificar a influência das variáveis sobre o desfecho. A maioria dos processos foi julgada no Estado de São Paulo (n=151; 38.2%) e publicada entre 2011 e 2017 (rho: 0.797). O principal motivo de processo contra Ortodontistas foi a insatisfação do paciente com os resultados do tratamento (n=143, 36.2%), seguido da ocorrência de doença periodontal (n=45, 11.4%) e da necessidade de extrações (n=43, 10.9%). Resultados estatisticamente significantes foram observados entre julgamentos em primeira e segunda instância e entre condenação e julgamento sob a obrigação de resultado (p<0.001). A combinação da I) insatisfação do paciente com II) o julgamentos sob a obrigação de resultados emergiram como principais fatores de risco para condenações.

Suicidal tandem bullets to the heart with subsequent embolization - a case report.

A tandem bullet phenomenon is a rare situation in which two bullets travel nose-to-base towards the target. In terminal ballistics, a classic feature of the tandem bullet phenomenon is the presence of a single entrance wound with two or more bullets inside the body. During the autopsy, the phenomenon may result in confusion, especially related to the dynamics of the shooting. The present study reports a case of suicide by tandem bullets to the heart with subsequent bullet embolization into the aorta. A 40-year-old Caucasian woman, with a previous history of suicide, shot herself in the chest with a 0.32 revolver. During the autopsy, a single entrance wound (one centimeter in diameter) was observed in the sternal region. The injury was a close-range shot. Internally, a single wound was detected in the right atrium of the heart. Two 0.32 S&WL lead bullets were found inside the descending abdominal aorta. The bullets fitted each other perfectly in a nose-to-base position. Both bullets were tracked back to a single firearm that belonged to the victim's father using forensic ballistics. The forensic report suggested a suicide. A multidisciplinary approach involving crime scene investigation, forensic pathology and forensic ballistics is necessary to investigate tandem bullet cases. Forensic experts must be aware of this phenomenon and, more importantly, they must be aware of its unusual manifestations, such as embolization, in order to come to optimal conclusions.

Dental Cingulum and Position of Fixed Orthodontic Appliance as Source of Morphological and Therapeutic Identifiers: An Unusual Case Report.

Orthodontic records, such as photographs, radiographs, and dental casts, provide information useful for identification purposes because it may reveal important morphological, therapeutic, and pathological dental identifiers. Among these identifiers, the type and position of orthodontic appliances figure as distinctive tools for human identification. In this context, the present study aims to report an uncommon case of identification of a putrefied body, found near to a forest region in Brazil. The postmortem (PM) examination showed that the victim had part of a fixed orthodontic appliance installed in the maxillary and mandibular dental arches. To identify the body, relatives of the potential victim presented orthodontic examinations containing panoramic radiography and photographs of the orthodontic treatment. The body was identified based on the analysis of the radiographs and photographs that confirmed the presence of the orthodontic appliances observed PM. More specifically, the identification was supported by the analysis of bracket bonding position of the maxillary and mandibular incisors and the presence of distinctive morphological traits of the canines and incisors, as well dental roots observed radiographically. The present case highlights the importance of orthodontic records as a source of morphological dental identifiers for cases in which only unrestored teeth are available.

Detecção de calcificação da artéria carótida em radiografias panorâmicas: levantamento na população goiana / Detection of carotide artery calcification in panoramic radiographs: survey on goias state population

Objetivo: Investigar a prevalência de imagens compatíveis com calcificação da artéria carótida (CAC), como achado incidental em exame por imagens panorâmicas na população Goiana. Métodos: Foram analisadas radiografias panorâmicas digitais obtidas de pacientes com idade igual ou superior a 40 anos, de ambos os gêneros, encaminhados ao serviço de radiologia de clínica particular. Dois examinadores, com conhecimento em radiologia, analisaram a presença de áreas radiopacas circunvaladas, na altura das vértebras C3 e C4, com angulação de 45 graus formada com o ângulo da mandíbula, sugestivas de CAC. Resultados: Foi encontrada uma prevalência de 14,1% de CAC na população estudada. Além de observado um risco mais elevado de desenvolvimento de CAC em pacientes com idade superior a 55 anos (OR=1,82). Houve diferença estatisticamente significante entre a presença de CAC e gênero (p=0,003). A concordância entre examinadores foi considerada muito boa (K=0,89). Conclusões: Observou-se que CAC apresentou uma prevalência considerável, sendo a radiografia panorâmica um método com potencial para detecção da presença de CAC, devendo o cirurgião-dentista atuar na prevenção e diagnóstico de pacientes em grupo de risco de eventos cardiovasculares e vasculocerebrais.

Introduction: To investigate the prevalence of images compatible with carotid artery calcification (CAC), as an incidental finding on examination by panoramic images in the Goias population. Methods: Digital panoramic radiographs were obtained from patients aged 40 years older, of both genders, referred to the private clinic radiology service. Two examiners, experienced in radiology, analyzed the presence of circumferential radiopaque areas, at the height of the C3 and C4 vertebrae, with 45 degree angulation formed with the angle of the mandible, suggestive of CAC. Results: A prevalence of 14.1% of CAC was found in the study population. A higher risk of developing CCS was observed in patients older than 55 years (OR = 1.82). There was a statistically significant difference between the presence of CAC and gender (p = 0.003). Agreement between examiners was considered satisfying (K = 0.89). Conclusion: It was observed that CAC presented a considerable prevalence, thus panoramic radiographs represent a potential method for detecting the presence of CAC, and the dentist should act in the prevention in the diagnosis of patients in a group at risk in cardiovascular and vascular-cerebral events.