Cone Beam Computed Tomography (CBCT) Technology and Learning Outcomes in Dental Anatomy Education: E-Learning Approach

E-learning is an educational method that improves knowledge innovation by sharing relevant images for advanced learning, especially in a pandemic state. Furthermore, cone-beam computed tomography (CBCT) is a method that gathers medical or dental diagnostic images. This study aimed to analyze the effectiveness of dental anatomy education through a CBCT technology tool, through teachers' and students' perspectives, adjusted according to the disruptions caused by the Covid-19 pandemic. A cohort study and longitudinal exploratory analysis were performed. Forty undergraduate first-year dental students, from the University of Coimbra in Portugal, were selected as per the inclusion and exclusion criteria. Two different teaching methods were applied during an identical time-period: face-to-face lectures complemented by physical models (T1 cohort) and webinar lectures complemented by CBCT images (T2 cohort). Learning outcomes were then studied according to theoretical and spatial orientation contexts. A self-reported survey that focused on students' satisfaction, stress, and support was studied. Both teaching methods were analyzed with paired sample student's t-test and Pearson Correlation Confidence intervals 95% with P < 0.05. Furthermore, exploratory factor analysis (EFA) was used for self-reported satisfaction survey validity and reliability analysis. The learning outcomes between T1 and T2 cohorts were statistically significant, (P < 0.001) corresponding to differences with a large effect degree (r > 0.60). Students' satisfaction, as measured on a six-point Likert scale, was positively influenced by the webinar lectures supplemented with CBCT images (T2 cohort) in a learning context (4.95 ± 0.5) and future applications (5.92 ± 0.27). In conclusion, the webinar approach with CBCT images was more effective and better learning method for teaching dental anatomy.

Comparative analysis of impacted upper canines: Panoramic radiograph Vs Cone Beam Computed Tomography

Background

The use of CBCT exam in the study of IMC is not new. However, it’s still not known in what specific aspects CBCT exam shows a better result than then conventional exams. The aim of this study was to compare and conclude in what way the opinion regarding upper canine impaction differed when observing a panoramic image compared to the observation of a set of CBCT reconstructions.

Material and Methods

Twenty patients (10 males and 10 females) with a total of 28 impacted maxillary canines were identified from the database of the Department of Dentistry, Faculty of Medicine, University of Coimbra. For each canine, two different images were available: a panoramic image and a set of CBCT reconstructions. After a random distribution of both groups images, nine orthodontists completed a questionnaire where they were asked to evaluate ten different questions regarding canine impaction. Statistic analysis was performed using Cronbach’s alpha statistics, Kappa statistics and McNemar test, considering p<0,05 statistically significant.

Results

This study showed differences between the two images regarding tooth position. A statistical significant poor agreement was found between the two methods for the mesio-distal position of the apex (k=0,388, p<0,001) and for the labio-palatal tip cusp position (k=0,035, p=0,114). The adjacent root resorption showed a poor and very poor agreement between the two methods. Every other items were scored with an agreement between modalities ranging from moderate to strong.

Conclusions

The analyses of panoramic images versus CBCT images reconstructions provided different information regarding tooth position (especially concerning the mesio-distal apex position and the labio-palatal cusp position) but also in the assessment of root resorption. Further investigation should be done to determine in what cases CBCT exam has a clear advantage over conventional 2D exams, justifying its use.

Key words:Cone-Beam Computed Tomography, Orthodontics, Impacted Tooth, Root resorption.

Tri-dimensional pattern analysis of foodstuff bitemarks - A pilot study of tomographic database

The analysis of bitemarks has been mostly done through analogical methods. The advent of current technologies brings new and more reliable tools for analyzing evidence. Bitemarks can now be turned into more consistent evidence by using a digital tridimensional (3D) analysis. The aim of this study is to propose a reliable, accurate and monitorized approach of 3D bitemark analysis. 12 cranium Cone Beam Computed Tomographic (CBCT) files were randomly selected from a clinical database (Coimbra Hospital and University Center/Faculty of Medicine of the University of Coimbra). The individuals were recalled to bite an apple (golden delicious 65/80) immediately subjected to a CBCT scan. The 3D rendering of every bitemark was compared with the 3D upper dental arches obtained from the CBCT cranium scans of the simulated suspects. The research team was composed by 5 elements. The matching process consists of corresponding landmark points, in both the bitemark and the suspects' dentition (upper dental arch). 144 comparisons were obtained. The Kappa statistics analysis was performed. Cohen's Kappa values were obtained between 0,690 and 0,910. Fleiss Kappa obtained a value of 0,767. The Friedman's test was performed and the normality assumption was not verified (p>0,05). A non-destructive protocol of bitemark study by 3D analysis of tomographic volumes was presented. The statistic analysis supports its accuracy and reliability. This experimental study opens doors to a future where bitemark analysis could be done through software that searches for matching dentitions in a CBCT database.

Orofacial trauma injuries and disability assessment in adolescents: A Portuguese study

BACKGROUND/AIMS

Orofacial injuries are a significant public health issue. The evidence-based knowledge associated with adolescent violence and trauma is highlighted by the World Health Organization with regard to its specific needs related to disability, violence, and unintentional injuries. The main aim of this study was to present evidence-based information about orofacial traumatic injuries of an adolescent population using Portuguese epidemiological data. The second aim was to report follow-up data of injuries for disability assessment in a trauma prevention approach.

METHODS

An observational cohort study was performed using the clinical database of the national-specialist-healthcare-centre-of-trauma (2014-2018). Information was collected regarding gender, school age range, etiology, injury type, injury time, and severity. Mann-Whitney (p < .05), Kruskal-Wallis (p < .001), and Cox regression (p < .001) analyses were performed.

RESULTS

Orofacial trauma injuries were present in 23.3% of Portuguese adolescents (age range 10-18 years). The majority were male (72.6%), and no age range stood out in frequency. School accidents (90.6%) were the major etiology for all groups of injuries. The diagnosis of superficial intraoral injuries was the most frequent (50.8%), followed by similar injuries to the face (22.5%). A Cox regression model with an adequate fit was yielded (χ2 [6] = 54.893, p < .001), suggesting that variable injury type was a predictor of disability, considering injury time. Tooth and alveolar loss, complicated tooth fracture, complicated face injury, and temporomandibular injuries were more predictive (1<hazard ratio < 5.329 [95% CI:1.340-12.685]).

CONCLUSION

The type of injury could be used to predict the time of temporary disability. Regarding definitive damage, some injuries were more predictive of severity than others. Preventive procedures should be highlighted in schools.

Patient Safety in Dental Practice: Lessons to Learn About the Risks and Limits of Professional Liability

Introduction

Health professionals should work with the notion of risk involved in the health care process. Dental practice risk is of particular interest because it encompasses both aesthetic and functional components. Focusing on guidelines suggested by the World Health Organization and objectives on patient safety, this study has 2 objectives: to present Portuguese medicolegal data on corporal damage evaluation related to iatrogenic sequelae during dental practice and to present updated evidence on patient safety.

Materials and methods

A retrospective study was performed by analysing data from the database of the Laboratory of Forensic Dentistry of the Faculty of Medicine, University of Coimbra, Portugal, from 2013 to 2018.

Results

One hundred seven medicolegal files were selected according to the inclusion and exclusion criteria. Iatrogenic sequelae (73.8%, 79 out of 107) were categorised as risks (60 out of 79) and malpractice (19 out of 79). The risk was associated mostly with mandibular dysfunction and orthodontic treatment (62.2%). Malpractice was mostly associated with neurological deficit and implant rehabilitation (47.4%).

Discussion and conclusion

Greater attention to these data by professionals was emphasised, especially when considering patient safety and health care quality. This article presents the Portuguese data on professional liability in the field of dental practice, categorising iatrogenic sequelae into risks and malpractice, as well as the oral rehabilitation procedure and timeline.

Sex and age biological variation of the mandible in a Portuguese population- a forensic and medico-legal approaches with three-dimensional analysis

The medico-legal identification is based on a set of discriminatory characteristics between individuals in their biological, social, cultural, religious, legal and economic framework. The purpose of this study was to characterize the biological variation, regarding gender and age, in a Portuguese population. A three-dimensional (3D) analysis of 215 mandibles (7-20 years old) from the database of the Laboratory of Forensic Dentistry, Faculty of Medicine, University of Coimbra (CE-112/2019) was performed. A total of 13 cephalometric points defined 10 linear variables and 7 angular variables, on 3D reconstructions from ConeBeam Computed Tomography (CBCT) images. Intra and inter-observer errors were analyzed by Technical Measurement Error test. A descriptive statistics was performed. To verify the influence of gender and age on the variables and to determine its predictive value, ANOVA and Logistic Regression Analysis were performed. Gender and age influence most of the linear variables, however, the same is not true for angular variables. In the analysis of all variables, the model has a reasonable level of sensitivity (67.8%) according to gender. For the age prediction, with all variables, the model presented a reasonable level of sensitivity, classifying 79.4% of the individuals. The results supported, with a high level of statistical significance, an adequate recognition of individuals highlighting the identification and criminal imputability of Portuguese individuals.

Digital Orofacial Identification Technologies in Real-World Scenarios

Three-dimensional technology using personal data records has been explored for human identification. The present study aimed to explore two methodologies, photography and orofacial scanning, for assessing orofacial records in forensic scenarios, highlighting their impact on human identification. A pilot and quasi-experimental study was performed using Canon 5D-Full Frame equipment (Tokyo, Japan) and an i700 scanner (Medit, Lusobionic, Portugal) (Seoul, Republic of Korea) with Medit Scan for Clinics (MSC) and Smile Design software (V3.3.2). The sample included living patients (n = 10) and individuals in forensic cases (n = 10). The study was divided into two complementary phases: (i) data collection using 2D and 3D technologies and (ii) visual comparison by superimposition procedures, 3D dental images with 3D facial records (3D–3D), and 2D photography with screen printing of 3D facial records (2D-3S). Statistical analyses were performed using descriptive procedures (Likert scale) and the Mann–Whitney U test. The Mann–Whitney U test comparing the data (n = 220 records) from living individuals and those in forensic cases identified statistically significant differences in the performance of the photographic methods for evaluating intraoral mineralisation (p = 0.004), intraoral soft tissues (p = 0.016), intraoral distortion (p = 0.005) and the scan methods for intraoral extra devices (p = 0.003) and extraoral soft tissues (p = 0.005). A visual comparison (n = 40) allowed 3D–3D superimposition. Additionally, 2D-3S superimposition qualitatively identified the middle third of the face as the corporal area within the anatomical features required for successful surgery. In conclusion, the present study presented evidence-based data suggesting that the IO scan method, as an emergent technology, should be explored as a valuable tool in forensic facial identification in real-world scenarios.

Deoxyribonucleic Acid Extraction and Quantification from Human Saliva Deposited on Foods with Bitemarks

AIM

The aim of this study is to evaluate the potential of deoxyribonucleic acid (DNA) recovery from bite marks in foods, in different collection types, from DNA quantification.

MATERIALS AND METHODS

The sample consisted of 80 swabs, obtained from 20 cheese pieces, bitten by the same person, using the double-swab technique in the center and the periphery of the bite. A statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) statistical software version 20.0, with values of p < 0.05 being considered statistically significant.

RESULTS

The DNA was recovered in all cheese pieces, regardless of the collection types and the bite region. However, the comparative analysis of DNA recovery potential in the four swabs allowed us to infer that the collections in the central region of the bite (DC and WC) were the ones that presented better precision, in addition to extracting a higher DNA concentration, the dry swab being in the center of the bite which presented better results.

CONCLUSION

The results proved the effectiveness of the double-swab technique for collecting genetic materials in bite marks; however, in the food used, a single collection at the center of the bite would be enough, optimizing the resources and time needed for the analysis.

CLINICAL SIGNIFICANCE

Due to the difficulties of physically comparing a site of a skin lesion and the dental arches of the suspect, the evidence of DNA in saliva has been used to indicate the perpetrator of the bite. In addition, the collection, preservation, and isolation of saliva DNA can be done at low cost and provide flexibility for clinical and laboratory workflow.

Orofacial assessment as digital path for forensic and legal evidence record

In forensic scenarios, such as armed conflicts or mass disasters, the oral cavity can be a valuable source of identification information relevant to legal issues. In many European Union countries, it is mandatory to register dental records for identification purposes. A pilot and quasi-experimental study was performed. The study aims to analyze two methodologies, photography and wireless intraoral (IO) laser scanner, in the scope of the orofacial record in forensic pathology, highlighting their impact on human identification. The IO scanner i700 (Medit, Lusobionic, Portugal) and Canon 5D-Full Frame equipment were used to record the individual status, living patients (n = 5), and forensic cases (n = 5). IO and extraoral anatomical structures were recorded following six parameters: time, mineralized and soft detail, communication, extra devices, and distortion. The statistical analysis was performed in accordance with a scoring system and Mann-Whitney (P < 0.05) analysis. The photography method recorded extraoral data for all samples (score range between 15 and 23). The time elapsed to complete an IO scan in forensic cases was shorter than with photography, without requiring additional sources of light or mirror devices. Living patients and corpses identified statistically significant differences. It can be concluded that laser scanners are a valuable tool in the field of forensic pathology and can be used to record and analyze anatomic-morphological data for identification purposes accurately.

Key points

Human identification engages in orofacial details records.Photographic and laser scans record intraoral and extraoral anatomic structures.Forensic cases assessed by intraoral scanner technology are accurate and less time-consuming, optimizing the orofacial data for identification.

Assessment of complications in third molar surgery performed by resident surgeons: A comprehensive analysis

Introduction

Third molar extractions present a wide spectrum of reported complications, spanning from 2.6 % to 30.9 %, making it challenging to predict outcomes for individual patients.This study seeks to evaluate third molar extractions conducted exclusively by stomatology or maxillofacial surgery residents, examining associated complications. Its aim also extends to delineating the related risks concerning epidemiological and clinical factors, juxtaposed against findings in the existing literature.

Materials and methods

An observational prospective cohort study was conducted at the Clinical and Academic Centre of Coimbra, Portugal, from July 2021 to December 2023. Descriptive statistics were used considering the adequate statistical parameters. Inferential statistical analysis was performed using Student's t-test, the Chi-squared test, and Spearman rank correlation to analyze the relationship between study variables. A p-value of less than 0.05 was considered statistically significant.

Results

485 patients underwent third molar extractions performed exclusively by stomatology and maxillofacial surgery residents, comprising a total of 686 extracted teeth and resulting in 71 reported complications (14.6 % per patient and 10.3 % per extracted tooth). Results revealed that patients undergoing lower third molar extraction faced a 3.7 times higher risk of complications compared to those undergoing upper third molar extraction. Teeth categorized as "IIIC" by Pell and Gregory's classification and those undergoing osteotomy and odontosection also exhibited a higher-than-expected complication rate with statistically significant differences being observed. No other variables showed a positive or negative statistically significant correlation with complication occurrence.

Discussion and conclusion

Despite the expectation of a heightened complication rate, this study revealed that a successful and comprehensive training regimen results in encountering complication rates akin to those documented in established literature.These findings also underscore the importance of recognizing that a resident's surgical accomplishment is intrinsically tied to acknowledging and respecting their learning curve.

Temporomandibular joint trauma and disability assessment - A longitudinal exploratory study

BACKGROUND

Orofacial trauma can encompass, isolated or not, several anatomical regions, namely facial, dental and temporomandibular joint (TMJ), one of the most complex joints in the human body. Evidence-based knowledge in the field of TMJ trauma and in temporomandibular joint disorders (TMD) diagnosis and treatment, provides the necessary data for medico-legal assessment.

OBJECTIVE

The aim of this study is to bring up epidemiological data referring to TMJ injuries and sequelae, in order to present a medico-legal approach of TMJ disability.

METHODS

An observational longitudinal exploratory study was performed in the database of the National Institute of Legal Medicine and Forensic Sciences, Portugal, between 2000 and 2017, regarding inclusion and exclusion criteria.Statistical significance was set as P‹0.05, Fisher's exact test, Binomial test and Goodman and Kruskal's test were used.

RESULTS

Post-traumatic orofacial reports (n = 2622) included 234 TMJ-injury and 149 TMJ-sequelae.Epidemiological data was presented regarding age,gender, professional status and etiology. There was a statistically significant association between TMJ injury and TMJ sequela, despite a weak relation (ƛ = 0.170). No statistically significant association was identified between TMJ-injury/TMJ-sequelae and the professional status, etiology.

CONCLUSION

The TMJ sequela group is smaller than the TMJ-injury, reflecting that 2/3 of the injuries have been cured without a monetary compensation value and without Health costs. The association between TMJ injury and TMJ sequelae reinforces the necessity of preventive measures in TMJ trauma, namely in physical violence context and in medico-legal impairment.

Diagnostic Accuracy of Cone Beam Computed Tomography and Periapical Radiography for Detecting Apical Root Resorption in Retention Phase of Orthodontic Patients: A Cross-Sectional Study

Objectives: This clinical study aimed to evaluate and compare the diagnostic accuracy of intraoral periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting external apical root resorption (EARR) in orthodontic patients during the retention phase. Methods: The research involved 41 Caucasian patients who had undergone comprehensive orthodontic treatment, with a total of 328 teeth analyzed. The Kappa values for inter- and intra-examiner agreement were high for both PR and CBCT, indicating a robust level of agreement among examiners. The study used a four-point scale for classifying EARR. Results: This study showed comparable accuracy, sensitivity, and specificity between PR and CBCT when using the most stringent criterion of "Definitely present". The data suggested that CBCT outperformed PR when using a less stringent criterion ("Definitely present" or "Probably present"), particularly for maxillary incisors. However, overall diagnostic performance, as measured by the area under the ROC curve, showed only a slight advantage for CBCT over PR. Areas under the ROC curve range between 0.85 and 0.90 for PR and between 0.89 and 0.92 for CBCT. According to DeLong's test, there is no evidence to conclude that the area under the ROC curve is different for PR and CBCT. Conclusions: Both PR and CBCT are accurate diagnostic tools for identifying EARR, with PR being deemed more suitable for routine clinical use due to its cost-effectiveness and lower radiation exposure. The findings emphasize the importance of considering the risk-benefit ratio when deciding on imaging modalities for monitoring EARR in orthodontic patients.

Digital intraoral and radiologic records in forensic identification: Match with disruptive technology

While clinical dentistry has seamlessly integrated the digital revolution, there is a gap in the technological capabilities of forensic dentistry.The study aimed to compare the superimposition accuracy of two different three-dimensional record formats, namely the intraoral scanner and cone beam computer tomography, in the context of forensic identification.The sample consisted of randomly selected adults (n=10) of both sexes aged between 20 and 50 years. Following the acquisition of data using the Medit i700 wireless scanner and the iCAT Tomograph with InVivo software, the records were analysed and compared through superimposition using Medit Scan Clinic software to assess the technical precision of anatomical identification details.The results obtained through the superimposition of dental and bone records following intra- and inter-observer analysis enabled an accurate comparison and identification of an individual. This method can differentiate between positive and negative matches, achieving exclusion results and offering a potential solution to overcoming the absence of a standardisation procedure in human identification.

A computed tomographic, mixed dentition, space analysis comparison

INTRODUCTION

A considered space analysis aims to predict the combined mesiodistal widths of unerupted permanent canine and premolars. A miscalculation can lead to the application of inadequate and irreversible treatments.

OBJECTIVE

To assess the level of agreement between predictions generated by three methods (Moyers' predictive tables at the 50th and 75th percentiles and Tanaka-Johnston's equations) on the sum of unerupted teeth compared with measurements derived from cone beam computed tomography, considered in the present study as a 'gold standard'.

MATERIALS AND METHODS

The study sample was comprised of children (N = 26) aged 8-13 who visited the Department of Dentistry. Moyers' predictive tables and the Tanaka-Johnston equation were applied to ascertain the space requirements. Cone beam computed tomography was performed on each patient and the volumetric data analysed. A concordance correlation coefficient between each method's predictions was applied.

RESULTS

The three methods tended to overestimate the cone beam computed tomography readings and were not able to entirely capture the variability of the sum of the unerupted teeth. Moyers' 50th percentile estimate revealed a more balanced distribution between over- and underestimation.

CONCLUSION

The present study suggested that Moyers' 50th percentile is the predictive method with the lowest absolute error and is preferred for clinical use.

Long-Term Benefits of Photobiomodulation Therapy on Health-Related Quality of Life in Burning Mouth Syndrome Patients: A Prospective Study

Background/Objectives: Burning Mouth Syndrome (BMS) patients experience a reduction in health-related quality of life and an increased intake of medication. Photobiomodulation with low-level laser therapy has been demonstrated to be an efficacious treatment for BMS. However, its long-term benefits remain relatively unknown. This study aimed to evaluate the impact of prolonged Photobiomodulation with low-level laser therapy on BMS patients by examining the efficacy of an outpatient protocol in a real-world setting. Methods: A prospective study was designed to address the research question. Photobiomodulation was performed, irradiating the affected areas once every two weeks for 12 months. Health-related quality of life was assessed using the EQ-5D-5L questionnaire at the initial consultation and after 6 months and 12 months of treatment. Additionally, the patients' pharmacological profile was also monitored. Nonparametric statistical analysis was performed (p < 0.05 was considered statistically significant). Results: The study was completed by 15 individuals, comprising 14 females and 1 male. The results indicated a statistically significant improvement (p < 0.001) in four of the five dimensions of the health-related quality of life questionnaire, namely self-care, usual activities, pain/discomfort, and anxiety/depression, along with the patients' perceived health level. A total of 13 participants reported suspending or reducing their intake of medications for Burning Mouth Syndrome. Conclusions: Therefore, Photobiomodulation with low-level laser therapy has a positive effect on improving patients' quality of life and reducing BMS symptoms, contributing to a subsequent reduction or suspension of previous medications. These findings support the efficacy of the applied protocol. Given the innovative methodology and promising results, further research is warranted.

Reflections about Blockchain in Health Data Sharing: Navigating a Disruptive Technology

A comprehensive analysis was performed, considering blockchain technology (BT) properties in digital health, addressing medicolegal, privacy, and regulatory considerations. Adherence to personal data protection and healthcare regulatory guidelines were analyzed and compared for GDPR (Europe), HIPAA (United States), CCPA (California), PIPEDA (Canada), the Privacy Act of 1988 (Australia), APPI (Japan), and LGPD (Brazil). Issues such as health systems, strengthening and aligning policy orientations and initiatives, and emphasizing the role of data analysis in shaping health policies were explored. The study addressed conflicts between the legal frameworks and blockchain, comparing and suggesting solutions like the revision of laws and the integration of compliance mechanisms. Additionally, it sought to enhance IT-health literacy by integrating the healthcare and legal domains. Ongoing collaboration between legal, health, and IT experts is essential for designing systems that effectively balance privacy rights and data protection while maximizing the benefits of disruptive technologies like blockchain.