Abstract The aim of this study was to evaluate the observers diagnostic performance in panoramic radiography using monitor, tablet, X-ray image view box, and against window daylight as a visualization method in different diagnostic tasks. Thirty panoramic radiography were assessed by three calibrated observers for each visualization method, in standardized light conditions, concerning dental caries, widened periodontal ligament space, and periapical bone defects from the four first molars; mucosal thickening and retention cysts in maxillary sinus; and stylo-hyoid ligament calcification and atheroma. A five-point confidence scale was used. The standard-reference was performed by two experienced observers. Diagnostic values using window light were significantly lower for caries and periapical bone defect and retention cyst, stylo-hyoid ligament calcification detection (p<0.05). For atheroma detection, X-ray image view box, tablet, and widow light had lower accuracy than the evaluation on the monitor (p<0.05). Observers diagnostic performances are worsened using window light as an evaluation method for panoramic radiography for dental, sinus, and calcification disorders, while the monitor was the most reliable method.

Resumen El objetivo de este estudio fue evaluar el desempeño diagnóstico de los observadores en la radiografía panorámica utilizando monitor, tablet, caja de visualización de imágenes de rayos X y contra la luz del día de la ventana como método de visualización en diferentes tareas de diagnóstico. Treinta radiografías panorámicas fueron evaluadas por tres observadores calibrados para cada método de visualización, en condiciones de luz estandarizadas, con respecto a caries dental, espacio del ligamento periodontal ensanchado y defectos óseos periapicales de los cuatro primeros molares; engrosamiento de la mucosa y quistes de retención en el seno maxilar; y calcificación y ateroma del ligamento estilohioideo. Se utilizó una escala de confianza de cinco puntos. La referencia estándar fue realizada por dos observadores experimentados. Los valores diagnósticos con luz de ventana fueron significativamente menores para caries y defecto óseo periapical y quiste de retención, detección de calcificación del ligamento estilohioideo (p <0.05). Para la detección de ateroma, la caja de visualización de imágenes de rayos X, el tablet y la luz de viuda tuvieron una precisión menor que la evaluación en el monitor (p <0.05). El rendimiento diagnóstico del observador empeora al utilizar la luz de la ventana como método de evaluación de la radiografía panorámica para los trastornos dentales, de los senos nasales y de la calcificación, mientras que el monitor fue el método más fiable.

Resumen Este estudio tuvo como objetivo describir los aspectos imaginológicos de una concha bullosa hallada incidentalmente por medio de imágenes de tomografía computarizada de haz cónico (TCHC). Una paciente de sexo femenino fue sometida a examen de TCHC y se verificó una neumatización extensa bilateral de la concha media, presentando una mayor dimensión del lado derecho, asi como desvío del tabique. El paciente refirió obstrucción nasal y pérdida del olfato. La TCHC de la región maxilofacial permitió localizar este hallazgo incidental, permitiendo derivar al paciente para el tratamiento adecuado.

Abstract This study aimed to describe the imaging aspects of a concha bullosa discovered incidentally by means of cone-beam computed tomography (CBCT) imaging. A female patient underwent a CBCT exam, and a bilateral extensive pneumatization of the middle concha was verified, presenting a larger dimension of the right side and a deviated septum. The patient reported nasal obstruction and loss of smell. The CBCT for covering the maxillofacial region allowed the discovery of this incidental finding, allowing the patient to be referred for appropriate treatment.

RESUMO Embora antes da pandemia houvesse alguma resistência à virtualização da educação odontológica, a pandemia COVID-19 está nos fornecendo uma oportunidade única de superar várias barreiras que anteriormente bloqueavam a adoção do ensino à distância e teledontologia. Graças à ampla disponibilidade de telecomunicações, tecnologias digitais e plataformas, a educação à distância e a teledontologia parecem ser a escolha preferida para manter a educação odontológica e o atendimento ativo aos pacientes durante a pandemia, sem riscos de contaminação. Neste artigo, revisamos estratégias válidas de educação a distância e possíveis alternativas úteis na transformação virtual na educação odontológica. Além disso, o papel do teleodontologia e suas vantagens, assim como também os desafios. No atual contexto pandêmico, como educadores odontológicos, somos chamados a ser criativos e flexíveis. Cada escola de odontologia deve se adaptar e usar a educação à distância, tanto quanto possível, até que a atenção clínica possa ser readotada. As evidências apresentadas nesta revisão corroboram nossa posição de que, sob esta pandemia, a educação a distância e a telemedicina / teleodontologia podem ser “a solução virtual conveniente”, para adaptar e aprimorar a forma até então clássica de ensino de odontologia, agora por meio da teleducação.

ABSTRACT Although prior to the pandemic there was some resistance to the virtualization of dental education, the COVID-19 pandemic is providing us a unique opportunity to overcome several barriers that previously blocked the adoption of remote teaching and teledentistry. Thanks to the extended availability of telecommunications, digital technologies, and platforms, remote education and teledentistry appear to be the preferred choice to maintain dental education and patient care active under this pandemic, without contamination risks. In this paper, we review valid remote education strategies and possible alternatives useful in virtual transformation in dental education. Furthermore, the role of teledentistry and its advantages and challenges are also revised. Under the current pandemic context, as dental educators, we are called to be creative and flexible. Every dental school should adapt and use remote education as much as possible until clinical attention can be readopted. The evidence presented in this review supports our position that under this pandemic, remote education and telemedicine/teledentistry may be “the virtual convenient solution”, to adapt and improve the hitherto classic way of teaching dentistry through tele-education.

RESUMO INTRODUÇÃO: A proximidade das raízes com o seio maxilar pode criar uma variedade de riscos. OBJETIVO: Avaliar a relação entre as raízes dos dentes hígidos com o seio maxilar, assim como com a ocorrência de doenças sinusais. MÉTODO: Três radiologistas analisaram 109 imagens de tomografia computadorizada de feixe cônico (TCFC). O teste Kappa avaliou a concordância intra e interexaminadores. Os testes de Qui-quadrado e Razão de Prevalência foram utilizados para testar a hipótese de que raízes de dentes hígidos dentro do seio maxilar favorecem a ocorrência doenças sinusais (nível de significância = 0,01). RESULTADOS: A concordância intra e interexaminadores variou de boa a excelente. O teste Qui-quadrado mostrou uma diferença estatisticamente significante (p = 0,006) entre as raízes dentárias dentro do seio maxilar patológico (6,09%) e aquelas dentro do seio normal (3,43%). O teste de Razão de Prevalência mostrou uma ocorrência de raízes dentárias dentro de seios patológicos estatisticamente maior do que dentro de seios normais (p < 0,0001). As raízes dentro do seio maxilar foram encontradas 1,82 vezes mais associadas a seios patológicos. CONCLUSÃO: Raízes dentárias dentro do seio maxilar são quase duas vezes mais associadas a seios patológicos do que a seios normais. Dentes hígidos que têm raízes dentro do seio maxilar podem induzir uma resposta inflamatória da mucosa sinusal. Suspeita-se que procedimentos odontológicos possam agravar tal situação.

ABSTRACT INTRODUCTION: The proximity of the roots to the maxillary sinus can create a variety of risks. OBJECTIVE: To evaluate the relationship between the roots of healthy teeth and the maxillary sinus, as well as the occurrence of sinus pathologies. METHODS: Three radiologists analyzed 109 cone beam computed tomography (CBCT) images. The Kappa test was used to assess the intra- and inter-rater agreement. The chi-squared test and prevalence ratio were used to test the hypothesis that roots of healthy teeth in the maxillary sinus favored the occurrence of sinus pathologies ( p = 0.01). RESULTS: Intra- and inter-rater agreement ranged from good to excellent. The chi-squared test demonstrated a statistically significant difference ( p = 0.006) between the tooth roots in diseased maxillary sinuses (6.09%) and those in normal sinuses (3.43%). The prevalence ratio test showed a statistically significant higher prevalence of tooth roots in diseased sinuses than in normal sinuses ( p < 0.0001). Roots in the maxillary sinus were 1.82 times more associated with diseased sinuses. CONCLUSION: Dental roots in the maxillary sinus are almost twice as likely to be associated with diseased sinuses than normal sinuses. Healthy teeth whose roots are inside the maxillary sinus may induce an inflammatory response in the sinus membrane. It is suspected that dental procedures may exacerbate the condition.

There is now wide acceptance in medicine and dentistry that clinical practice should be as "evidence-based" as possible. Which is why many works have been published aimed at reducing radiation doses in different types of imaging modalities in dentistry, and that the major effect of radiation especially in children requires us to take necessary steps to rationalize their use especially the Cone Beam Computed Tomography (CBCT) method that provides the highest doses in dentistry. This review was written using this approach because of the purpose of streamlining the radiation dose in our patients. SEDENTEXCT team collected and analyzed relevant publications in the literature, guidelines that have proven effective in the past to reach recommendations, which can contribute to optimizing the use of ionizing radiation in dentistry, helping to see with others eyes the dose received by our patients. This paper recommend to consider the SEDENTEXCT project to prescribe more appropriately complementary exams we use daily

En la actualidad existe una gran aceptación por la medicina y la odontología, en que la práctica clínica debe ser "basada en evidencia científica", tanto como sea posible. Es por eso que múltiples trabajos se han publicado orientados a disminuirlas dosis de radiación en los diferentes tipos de modalidades imaginológicas usados en la odontología, ya que el mayor efecto de las radiaciones, sobre todo en niños, nos obliga a tomar medidas necesarias para racionalizar su uso, especialmente con la tomografía computarizada Cone Beam (TCCB), método que aporta las mayores dosis en la odontología. Esta revisión fue escrita utilizando un enfoque de este tipo con el propósito de racionalizar la dosis de radiación en nuestros pacientes. El equipo del proyecto SEDENTEXCT recopiló y analizó relevantes publicaciones en la literatura, pautas que han demostrado su eficacia en el pasado, para llegar a formular recomendaciones que contribuyan a la optimización del uso de las radiaciones ionizantes enla odontología, ayudando de esa manera a ver con otros ojos la dosis recibida por los pacientes, y con la presente se recomienda tener en cuenta dicho documento para poder prescribir de manera más adecuada los exámenes complementarios que usamos diariamente.

New techniques have been accompanying the development of dentistry and seek to overcome obstacles present nowadays. The Rapid Prototyping (RP) was inserted into the dentistry in order to assist procedures, minimize risk and reduce the surgical time. From Computed Tomography exams and Magnetic Resonance, are been created design assisted by a specific computer, then processed in its own language; so from there, such designs are transformed into physical objects in 3 dimensions (prototype), trusted in the initial model created in the computer. There are many techniques for production of 3D models, varying the type of material that will be added by the process of adding layers. Many areas were benefited by the PR, however Surgery, Implantology, Orthodontics and Prosthodontics, absorbed the principles of this technique which is helping significantly in their daily practice. The benefits of PR are undisputed, whether in the reduction of surgical risks, precision maneuvers, and gain time in the trans-operative period, cosmetic procedures and in the communication between the dentist and the patient. The disadvantages of the technique are also reported as high initial cost and considerable time preparing the prototype. What has been observed is that this PR is becoming increasingly present in the dental practice and the benefits are overcoming some disadvantages still persistent.

Nuevas técnicas van acompañando la evolución de la odontología y buscan superar obstáculos presentes en la actualidad. El prototipado rápido (PR) fue insertado en el medio odontológico con el propósito de auxiliar procedimientos, minimizar riesgos y disminuir el tiempo quirúrgico. A partir de exámenes tomográficos y de resonancia magnética, son creados diseños asistidos por medio de un computador específico, luego de ello son transformados en un lenguaje propio, para que a partir de ahí, estos diseños sean transformados en objetos físicos en 3 dimensiones (prototipos), fieles al modelo inicial hecho en la computadora. Existen muchas técnicas para la confección de los modelos 3D, variando el tipo de material que se añadirá, por el proceso de adición en capas. Muchas son las áreas beneficiadas por el PR; sin embargo, cirugia, implantología, prótesis y ortodoncia, asimilaron más los principios de esta técnica la cual está ayudando de manera significativa en su práctica diaria. Los beneficios del PR son numerosos, sea en la disminución de riesgos quirúrgicos, precisión de maniobras, disminución de tiempo transoperatorio, estética en los procedimientos y hasta en la comunicación entre el cirujano dentista y el paciente. Las desventajas de la técnica incluyen el elevado costo inicial y un considerable tiempo de preparación del prototipado. Lo que se viene observando es que el PR se está convirtiendo cada vez más de uso cotidiano odontológico y sus beneficios superan algunas desventajas aún persistentes.

Cone Beam Computed Tomography (CBCT) is a rapidly evolving technology that provides high spatial resolution of the craniofacial complex in three dimensions (3D). During the last decade, the number of publications related to CBCT in the literature has increased significantly, but the fundamental question is whether this technology leads to better results. CBCT and the application in orthodontics is very important as this new technology evolves ever faster and new images are needed to answer some cases, for example cases of recurrence. The tomographic image will allow us to give a different view compared to conventional images, and this view goes hand in hand with the movements for correcting malocclusion or facial disproportion

La Tomografía Computarizada Cone Beam (TCCB) es una tecnología en rápido desarrollo que proporciona imágenes de alta resolución espacial del complejo craneofacial en tres dimensiones (3D). Durante la última década, el número de publicaciones relacionadas a la TCCB en la literatura se ha incrementado de manera significativa, pero la cuestión fundamental es si esta tecnología conduce a mejores resultados. La TCCB y su aplicación en la ortodoncia es muy importante ya que esta nueva tecnología va evolucionando cada vez más rápido y nuevas imágenes se necesitan para responder algunos casos como los de recidiva. La imagen tomográfica nos va permitir tener una visión diferente comparando con las imágenes convencionales, y esta visión va de la mano con los movimientos realizados para la corrección de la maloclusión o desproporción facial.