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.

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.

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.

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.

Temporomandibular trauma and reflections on personal evaluation

The International Consortium Network/Orofacial Pain Special Interest Group focuses on temporomandibular disease diagnosis procedure guidelines as a reference iQAn this scope. Concerning this reference, the aim of this study was to comprehensively analyze injury and sequela frames within European and American approaches to personal damage. A quasiexperimental pilot study of Portuguese orofacial trauma cases in a medico-legal evaluation database was performed with an interrupted time series design. The clinical data were recorded following five criteria of TMJ diagnosis (jaw opening, pain, anatomical deficit, functional deficit, clinical sounds, and occlusal deficit) under three degrees of severity. The injury frame evaluation was recorded in the first-degree stage in all criteria. Pain, as a sequela, was the criterion present in 45% of the sample as spontaneous (20%) or stimulated (25%). Temporomandibular trauma damage evaluation emphasizes the accurate injury diagnosis and sequela framework. Orofacial trauma analysis should focus on the inclusion or exclusion of a TMD diagnosis. This study suggests revising the reference tables on personal damage, considering the inclusion of TMD and its categorization and impact.

Blockchain technology in migrant and refugee health: A scoping review

Background

The increase of forcibly displaced people worldwide is a challenge for health systems and their ability to provide access and equity in Health as a universal right. In the case of migrants and refugees, their journey exacerbates this challenge, as they go through diverse countries, camps, and humanitarian teams. Hence, the collection and analysis of health data are essential in providing quality care. The scientific community has been studying health digital technologies to answer health data consolidation, transparency, and global surveillance efficiency issues. Observing some empirical experiments with Blockchain in migrants and refugee health, we assessed the state-of-the-art by conducting a literature review.

Methods

Blockchain applications are still emerging, which means that peer-reviewed literature may still be scarce in life science databases. Therefore, to gather the most appropriate available evidence, we used a diverse and balanced set of databases that compile articles and journals from different fields. We used a multi-step scoping review to refine search keywords and analyse the literature. We included studies between 2008 and 2021 that reported value, utility, or use cases of Blockchain in support of migrant and refugee health.

Results

We identified a total of 69 articles, with 22 retained for full-text analysis and 8 of those being relevant. We employed Rayyan application to manage and evaluate the references by two researchers working independently. We identified two main uses of Blockchain technology to support migrant and refugee health: mitigate the lack of personal identification and make health records available. Blockchain also promotes data reliability in humanitarian aid, academic certificates, legal contracts, and financial transactions.

Conclusions

The availability of reliable information about individuals facilitates universal health coverage, improves cooperation between diaspora-related countries, and supports global health efficiency in line with the third goal of the Sustainable Development Goals 2030 agenda. Given its characteristics of decentralization, resilience, transparency, and auditability, Blockchain remains a promising avenue for future research in migrant and refugee health.

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.

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.

Oral health professional intervention and child physical abuse-European legal approach

Physical violence against children and adolescents is an issue of Global Public Health. This study aims to identify traumatic injuries and the medicolegal temporary framework of the victim's profile in the European legal approach. Participants and setting include the following: the clinical reports of a Portuguese European Clinical Academic Center database were analysed. An observational and prospective cohort study was performed. A descriptive analysis of the variables was conducted, considering gender, bimodal age groups, place of residence, offender data, place of occurrence, aetiology, localization, type of injuries, personal injury assessment by Quantum doloris, and injury time. The statistical analysis was performed by Spearman's rho and Kendall's tau-b correlation tests, Pearson's chi-square test of independence (χ2), and Mann-Whitney and Kruskal-Wallis nonparametric tests (P < 0.05). The relationship between age groups and the place of occurrence was statistically significant (P = 0.001). Orofacial and nonorofacial injuries were related (P = 0.035). The General Data Protection Regulation is not a barrier to the treatment and sharing of justified data but a framework for safeguarding individuals' fundamental rights, including the Right to Health. Meticulous reporting of the clinical situation involves the victim, the occurrence, and the potential offender.

Key points

An oral health professional's notification of the event is a fundamental step of the judicial process.The timeline is the core of traumatic injury assessment in a child physical abuse scenario.Medicolegal evaluation impacts disability prevention, imputability, and notification of the crime.

Risk and limits in dental practice: a Portuguese approach to medical-legal evaluation and professional liability

Patient safety and quality of healthcare delivery systems are an objective of WHO. This study aims to present and analyse Portuguese clinical data on risk and malpractice in dental practice. Data from the Forensic Dentistry Laboratory (Faculty of Medicine, University of Coimbra) was analysed, between the years of 2013 to 2018. One hundred and seven technical reports were selected, and seventy nine files were included in the iatrogenic sequelae group. Data included the analysis of the performance of dental professionals. Sequelae were divided in descending order of occurrence:1) mandibular dysfunction (53,2%)[(42)79]; 2) neurological deficit (39,2%)[(31)79]; 3) tooth loss (6,3%)[(5)79]; and 4) opening deficit (1,3%)[(1)79].Three major areas with significant expression in the field of expert evaluations were analysed: 1) orthodontic treatment (51,9%), implant rehabilitation (29,1%), and oral surgery. Given the prevalence of malpractice, the need to assess its causes and recognise standards for its prevention is necessary.

The tooth for molecular analysis and identification : a forensic approach

The aim of this study is to optimize laboratory preparation of teeth for DNA identification. By sectioning the tooth topographically into two different radicular portions, it was analyzed whether these portions of mineralized tissue differ in the quantity and quality of DNA they contain. 25 teeth were subject to different experimental conditions and total DNA was quantified for each individual tooth's radicular portion: apical and remaining root, according to a 2003 study by Gaytemenn and Sweet. We verified, with statistically significant figures, that the apical portion of the tooth is that which contains the greatest quantity of DNA. Different analytical procedures were studied for various polymorphic markers to evaluate the quality of the DNA. We concluded that the tooth is topographically distinct in both DNA quantity and quality. The tooth's apical portion is the preferential choice in sample preparation of dental mineralized tissue for molecular analysis and identification.