<p>Ancestry is a complex and layered concept, but it must be operationalized for its objective use in genetic studies. Critical decisions in research analyses, clinical practice, and forensic investigations are based on genetic ancestry inference. For example, in genetic association studies for clinical and applied research, investigators may need to isolate one population of interest from a worldwide dataset to avoid false positive results, or in human identification, ancestry inferences can help reveal the identity of unknown DNA evidence by narrowing down a suspect list. Many studies seek to improve ancestry inference for these reasons. The research presented here offers valuable resources for exploring and improving genetic ancestry inference and intelligence toward identity. </p> <p>First, analyses with ‘big data’ in genomics is a resource-intensive task that requires optimization. Therefore, this research introduces a suite of automated Snakemake workflows, <em>Iliad</em>, that was developed to give the research community an easy-to-learn, hands-off computational tool for genomic data processing of multiple data formats. <em>Iliad</em> can be installed and run on a Google Cloud Platform remote server instance in less than 20 minutes when using the provided installation code in the ReadTheDocs documentation. The workflows support raw data processing from various genetic data types including microarray, sequence, and compressed alignment data, as well as performing micro-workflows on variant call format (VCF) files to merge data or lift over variant positions. When compared to a similar workflow, <em>Iliad </em>completed processing one sample’s raw paired-end sequence reads to a human-legible VCF file in 7.6 hours which was three-times faster than the other workflow. This suite of workflows is paramount towards building reference population panels from human whole-genome sequence (WGS) data which is useful in many research studies including imputation, ancestry estimation, and ancestry informative marker (AIM) discovery.</p> <p>Second, there are persistent challenges in ancestry inference for individuals of the Middle East, especially with the use of AIMs. This research demonstrates a population genomics study pertaining to the Middle East, novel population data from Lebanon (n=190), and an unsupervised genetic clustering approach with WGS data from the 1000 Genomes Project and Human Genome Diversity Project. These efforts for AIM discovery identified two single nucleotide polymorphisms (SNPs) based on their high allelic frequency differences between the Middle East and populations in Eurasia, namely Europe and South/Central Asia. These candidate AIMs were evaluated with the most current and comprehensive AIM panel to date, the VISAGE Enhanced Tool (ET), using an external validation set of Middle Eastern WGS data (n=137). Instead of relying on pre-defined biogeographic ancestry labels to confirm the accuracy of validation sample ancestry inference, this research produced a deep, unsupervised ADMIXTURE analysis on 3,469 worldwide WGS samples with nearly 2 million independent SNPs (r2 < 0.1) which provided a genetic “ground truth”. This resulted in 136/137 validation samples as Middle East and provided valuable insights toward reference samples with varying co-ancestries that ultimately affects the classification of admixed individuals. Novel deep learning methods, specifically variational autoencoders, were introduced for visualizing one hundred percent of the genetic variance found using these AIMS in an alternative method to PCA and presents distinct population clusters in a robust ancestry space that remains static for the projection of unknown samples to aid in ancestry inference and human identification. </p> <p>Third, this research delves into a craniofacial study that makes improvements toward key intelligence information about physical identity by exploring the relationship between dentition and facial morphology with an advanced phenotyping approach paired with robust dental parameters used in clinical practice. Cone-beam computed tomography (CBCT) imagery was used to analyze the hard and soft tissue of the face at the same time. Low-to-moderate partial correlations were observed in several comparisons of dentition and soft tissue segments. These results included partial correlations of: i) inter-molar width and soft tissue segments nearest the nasal aperture, the lower maxillary sinuses, and a portion of the upper cheek, and ii) of lower incisor inclination and soft tissue segments overlapping the mentolabial fold. These results indicate that helpful intelligence information, potentially leading towards identity in forensic investigations, may be present where hard tissue structures are manifested in an observable way as a soft tissue phenotype. This research was a valuable preliminary study that paves the way towards the addition of facial hard tissue structures in combination with external soft tissue phenotypes to advance fundamental facial genetic research. Thus, CBCT scans greatly add to the current facial imagery landscape available for craniofacial research and provide hard and soft tissue data, each with measurable morphological variation among individuals. When paired with genetic association studies and functional biological experiments, this will ultimately lead to a greater understanding of the intricate coordination that takes place in facial morphogenesis, and in turn, guide clinical orthodontists to better treatment modalities with an emphasis on personalized medicine. Lastly, it aids intelligence methodologies when applied within the field of forensic anthropology.</p>

Aims Use of 3D printed models in Endodontics has been gaining popularity since the technology to create them became more affordable. Currently, there are no studies that evaluate the influence of 3D models on endodontic surgical treatment planning and on operator confidence. Therefore, aims of this study were to: (i) Determine whether the availability of a 3D printed analogue can influence treatment-planning and operator confidence; and, (ii) Assess which factors of operator confidence are influenced, if any. Materials and Methods Endodontists were asked to analyze a pre-selected CBCT scan of an endodontic surgical case and to answer a questionnaire that determined their surgical approach for that case. After 30 days, the same participants were asked to analyze again the same CBCT scan. This time however, a 3D printed model of the scan was made available to the participants and to perform a mock osteotomy on the model. The participants were then asked to respond to the same questionnaire that they responded to 30 days prior to determine if there would be any changes to their treatment plan. A new set of questions were added to the survey to evaluate the influence of the 3D printed model on participants’ confidence in performing endodontic surgery. The responses were statistically analyzed using Chi square test followed by either logistic or ordered regression analysis while adjusting for experience of participant. Adjustment for multiple comparison analysis was done using Bonferroni correction. Statistical significance was set at £0.005. Results Availability of the 3D printed model and the CBCT scan together resulted in statistically significant differences in the participants’ responses to their ability to clearly detect bone landmarks, accurately predict the location of osteotomy, and in determining the following: size of osteotomy, angle of instrumentation, involvement of critical structures in flap reflection and involvement of vital structures during curettage. In addition, the participants’ confidence in performing surgery was significantly higher versus having CBCT scans alone. There were no statistically significant changes with decisions on flap design and extent, visualizing critical structures, lesion size, injury to vital structures during osteotomy, the length of root that could be resected and the number of roots involved. Conclusions The availability of 3D printed models did not alter the participants’ surgical approach, but it significantly improved their confidence for endodontic microsurgery, which can be attributed to better visualization of anatomical structures.

Cette thèse est constituée de deux principaux axes de recherche portant sur l'imagerie dentaire par la tomographie à rayons X : le développement de nouvelles méthodes itératives de reconstruction tomographique afin de réduire les artefacts métalliques et la réduction de la dose délivrée au patient. Afin de réduire les artefacts métalliques, nous prendrons en compte le durcissement du spectre des faisceaux de rayons X et le rayonnement diffusé. La réduction de la dose est abordée dans cette thèse en diminuant le nombre des projections traitées. La tomographie par rayons X a pour objectif de reconstruire la cartographie des coefficients d'atténuations d'un objet inconnu de façon non destructive. Les bases mathématiques de la tomographie repose sur la transformée de Radon et son inversion. Néanmoins des artefacts métalliques apparaissent dans les images reconstruites en inversant la transformée de Radon (la méthode de rétro-projection filtrée), un certain nombre d'hypothèse faites dans cette approche ne sont pas vérifiées. En effet, la présence de métaux exacerbe les phénomènes de durcissement de spectre et l'absence de prise en compte du rayonnement diffusé. Nous nous intéressons dans cette thèse aux méthodes itératives issues d'une méthodologie Bayésienne. Afin d'obtenir des résultats de traitement compatible avec une application clinique de nos nouvelles approches, nous avons choisi un modèle direct relativement simple et classique (linéaire) associé à des approches de corrections de données. De plus, nous avons pris en compte l'incertitude liée à la correction des données en utilisant la minimisation d'un critère de moindres carrés pondérés. Nous proposons donc une nouvelle méthode de correction du durcissement du métal sans connaissances du spectre de la source et des coefficients d'atténuation des matériaux. Nous proposons également une nouvelle méthode de correction du diffusé associée sur les mesures sous certaines conditions notamment de faible dose. En imagerie médicale par tomographie à rayons X, la surexposition ou exposition non nécessaire irradiante augmente le risque de cancer radio-induit lors d'un examen du patient. Notre deuxième axe de recherche porte donc sur la réduction de la dose en diminuant le nombre de projections. Nous avons donc introduit un nouveau mode d'acquisition possédant un échantillonnage angulaire adaptatif. On utilise pour définir cette acquisition notre connaissance a priori de l'objet. Ce mode d'acquisition associé à un algorithme de reconstruction dédié, nous permet de réduire le nombre de projections tout en obtenant une qualité de reconstruction comparable au mode d'acquisition classique. Enfin, dans certains modes d’acquisition des scanners dentaires, nous avons un détecteur qui n'arrive pas à couvrir l'ensemble de l'objet. Pour s'affranchir aux problèmes liés à la tomographie locale qui se pose alors, nous utilisons des acquisitions multiples suivant des trajectoires circulaires. Nous avons adaptés les résultats développés par l’approche « super short scan » [Noo et al 2003] à cette trajectoire très particulière et au fait que le détecteur mesure uniquement des projections tronquées. Nous avons évalué nos méthodes de réduction des artefacts métalliques et de réduction de la dose en diminuant le nombre des projections sur les données réelles. Grâce à nos méthodes de réduction des artefacts métalliques, l'amélioration de qualité des images est indéniable et il n'y a pas d'introduction de nouveaux artefacts en comparant avec la méthode de l'état de l'art NMAR [Meyer et al 2010]. Par ailleurs, nous avons réussi à réduire le nombre des projections avec notre nouveau mode d'acquisition basé sur un « super short scan » appliqué à des trajectoires multiples. La qualité obtenue est comparable aux reconstructions obtenues avec les modes d'acquisition classiques ou short-scan mais avec une réduction d’au moins 20% de la dose radioactive. / This thesis contains two main themes: development of new iterative approaches for metal artifact reduction (MAR) and dose reduction in dental CT (Computed Tomography). The metal artifacts are mainly due to the beam-hardening, scatter and photon starvation in case of metal in contrast background like metallic dental implants in teeth. The first issue concerns about data correction on account of these effects. The second one involves the radiation dose reduction delivered to a patient by decreasing the number of projections. At first, the polychromatic spectra of X-ray beam and scatter can be modeled by a non-linear direct modeling in the statistical methods for the purpose of the metal artifacts reduction. However, the reconstruction by statistical methods is too much time consuming. Consequently, we proposed an iterative algorithm with a linear direct modeling based on data correction (beam-hardening and scatter). We introduced a new beam-hardening correction without knowledge of the spectra of X-ray source and the linear attenuation coefficients of the materials and a new scatter estimation method based on the measurements as well. Later, we continued to study the iterative approaches of dose reduction since the over-exposition or unnecessary exposition of irradiation during a CT scan has been increasing the patient's risk of radio-induced cancer. In practice, it may be useful that one can reconstruct an object larger than the field of view of scanner. We proposed an iterative algorithm on super-short-scans on multiple scans in this case, which contain a minimal set of the projections for an optimal dose. Furthermore, we introduced a new scanning mode of variant angular sampling to reduce the number of projections on a single scan. This was adapted to the properties and predefined interesting regions of the scanned object. It needed fewer projections than the standard scanning mode of uniform angular sampling to reconstruct the objet. All of our approaches for MAR and dose reduction have been evaluated on real data. Thanks to our MAR methods, the quality of reconstructed images was improved noticeably. Besides, it did not introduce some new artifacts compared to the MAR method of state of art NMAR [Meyer et al 2010]. We could reduce obviously the number of projections with the proposed new scanning mode and schema of super-short-scans on multiple scans in particular case.

La proton thérapie est une modalité de traitement du cancer qu’utilise des faisceaux de protons. Les systèmes de planification de traitement actuels se basent sur une image de l’anatomie du patient acquise par tomodensitométrie. Le pouvoir d’arrêt des protons relatif à l’eau (Stopping Power Ratio en Anglais, SPR) est déterminé à partir des unités Hounsfield (Hounsfield Units en Anglais, HU) pour calculer la dose absorbée au patient. Les protons sont plus vulnérables que les photons aux modifications du SPR du tissu dans la direction du faisceau dues au mouvement, désalignement ou changements anatomiques. De plus, les inexactitudes survenues de la CT de planification et intrinsèques à la conversion HU-SPR contribuent énormément à l’incertitude de la portée des protons. Dans la pratique clinique, au volume de traitement s’ajoutent des marges de sécurité pour tenir en compte ces incertitudes en détriment de perdre la capacité d’épargner les tissus autour de la tumeur. L’usage de l’imagerie bi-énergie en proton thérapie a été proposé pour la première fois en 2009 pour mieux estimer le SPR du patient par rapport à l’imagerie mono-énergie. Le but de cette thèse est d’étudier la potentielle amélioration de l’estimation du SPR des protons en utilisant l’imagerie bi-énergie, pour ainsi réduire l’incertitude dans la prédiction de la portée des protons dans le patient. Cette thèse est appliquée à un nouveau système d’imagerie, l’Imaging Ring (IR), un scanner de tomodensitométrie conique (Cone-Beam CT en Anglais, CBCT) développé pour la radiothérapie guidée par l’image. L’IR est équipé d’une source de rayons X avec un système d’alternance rapide du voltage, synchronisé avec une roue contenant des filtres de différents matériaux que permet des acquisitions CBCT multi-énergie. La première contribution est une méthode pour calibrer les modèles de source et la réponse du détecteur pour être utilisés en simulations d’imagerie X. Deuxièmement, les recherches ont évalué les facteurs que peuvent avoir un impact sur les résultats du procès de décomposition bi-énergie, dès paramètres d’acquisition au post-traitement. Les deux domaines, image et basée en la projection, ont été minutieusement étudiés, avec un spéciale accent aux approches basés en la projection. Deux nouvelles bases de décomposition ont été proposées pour estimer le SPR, sans avoir besoin d’une variable intermédiaire comme le nombre atomique effectif. La dernière partie propose une estimation du SPR des fantômes de caractérisation tissulaire et d’un fantôme anthropomorphique à partir d’acquisitions avec l’IR. Il a été implémentée une correction du diffusé, et il a été proposée une routine pour interpoler linéairement les sinogrammes de basse et haute énergie des acquisitions bi-énergie pour pouvoir réaliser des décompositions en matériaux avec données réelles. Les valeurs réconstruits du SPR ont été comparées aux valeurs du SPR expérimentales déterminés avec un faisceau d’ions de carbone. / Proton therapy is a promising radiation treatment modality that uses proton beams to treat cancer. Current treatment planning systems rely on an X-ray computed tomography (CT) image of the patient's anatomy to design the treatment plan. The proton stopping-power ratio relative to water (SPR) is derived from CT numbers (HU) to compute the absorbed dose in the patient. Protons are more vulnerable than photons to changes in tissue SPR in the beam direction caused by movement, misalignment or anatomical changes. In addition, inaccuracies arising from the planning CT and intrinsic to the HU-SPR conversion greatly contribute to the proton range uncertainty. In clinical practice, safety margins are added to the treatment volume to account for these uncertainties at the expense of losing organ-sparing capabilities. The use of dual-energy (DE) in proton therapy was first suggested in 2009 to better estimate the SPR with respect to single-energy X-ray imaging. The aim of this thesis work is to investigate the potential improvement in determining proton SPR using DE to reduce the uncertainty in predicting the proton range in the patient. This PhD work is applied to a new imaging device, the Imaging Ring (IR), which is a cone-beam CT (CBCT) scanner developed for image-guided radiotherapy (IGRT). The IR is equipped with a fast kV switching X-ray source, synchronized with a filter wheel, allowing for multi-energy CBCT imaging. The first contribution of this thesis is a method to calibrate a model for the X-ray source and the detector response to be used in X-ray image simulations. It has been validated experimentally on three CBCT scanners. Secondly, the investigations have evaluated the factors that have an impact on the outcome of the DE decomposition process, from the acquisition parameters to the post-processing. Both image- and projection-based decomposition domains have been thoroughly investigated, with special emphasis on projection-based approaches. Two novel DE decomposition bases have been proposed to estimate proton SPRs, without the need for an intermediate variable such as the effective atomic number. The last part of the thesis proposes an estimation of proton SPR maps of tissue characterization and anthropomorphic phantoms through DE-CBCT acquisitions with the IR. A correction for X-ray scattering has been implemented off-line, and a routine to linearly interpolate low-energy and high-energy sinograms from sequential and fast-switching DE acquisitions has been proposed to perform DE material decomposition in the projection domain with real data. DECT-derived SPR values have been compared with experimentally-determined SPR values in a carbon-ion beam.

Introduction : L’expansion palatine rapide assistée chirurgicalement (EPRAC) est une option de traitement privilégiée chez les patients ayant atteint la maturité squelettique et présentant une déficience transverse du maxillaire. L’effet bénéfique de l’EPRAC sur la fonction respiratoire est régulièrement mentionné, toutefois, encore peu d’études ont évalué son impact sur les voies aériennes supérieures. L’objectif de cette étude clinique prospective comparative consistait à évaluer les effets tridimensionnels de l’EPRAC sur la cavité nasale, le nasopharynx et l’oropharynx à l’aide de la tomodensitométrie. Méthodologie : L’échantillon était constitué de 14 patients (5 hommes, 9 femmes) dont l’âge moyen était de 23,0 ± 1,9 ans (16 ans 4 mois à 39 ans 7 mois). Tous ont été traités avec un appareil d’expansion de type Hyrax collé et l’expansion moyenne a été de 9,82 mm (7,5 - 12,0 mm). Tous ont eu une période de contention d’une année avant le début de tout autre traitement orthodontique. Une évaluation par tomodensitométrie volumique à faisceau conique a été réalisée aux temps T0 (initial), T1 (6 mois post-expansion) et T2 (1an post-expansion) et le volume des fosses nasales, du nasopharynx et de l’oropharynx ainsi que les dimensions de la zone de constriction maximale de l’oropharynx ont été mesurés sur les volumes tridimensionnels obtenus. Résultats : Les résultats radiologiques ont démontré une augmentation significative du volume des fosses nasales et du nasopharynx ainsi qu’une augmentation de la zone de constriction maximale de l’oropharynx à 6 mois post-expansion. Par la suite, une portion du gain enregistré pour ces trois paramètres était perdue à un an post-EPRAC sans toutefois retourner aux valeurs initiales. Aucun effet significatif sur le volume de l’oropharynx n’a été observé. De plus, aucune corrélation significative entre la quantité d’expansion réalisée et l’ensemble des données radiologiques n’a été observée. L’analyse de la corrélation intra-classe a démontré une excellente fiabilité intra-examinateur. Conclusions : L’EPRAC entraîne un changement significatif du volume de la cavité nasale et du nasopharynx. L’EPRAC ne modifie pas le volume de l’oropharynx, par contre, un effet significatif sur la zone de constriction maximale de l’oropharynx est noté. Les effets observés n’ont pas de corrélation avec le montant d’activation de la vis d’expansion. / Introduction: Surgically assisted rapid palatal expansion (SARPE) is a treatment of choice for patients who have reached skeletal maturity and present a maxillary transverse deficiency. It is often mentioned that SARPE has the benefit to improve respiratory function, however, only a few research projects have investigated the effects of SARPE on the upper airways. The objective of this clinical prospective comparative study was to evaluate the three-dimensional effects of SARPE on the nasal cavity, the nasopharynx and the oropharynx using computed tomography. Materials and Methods: The sample consisted of 14 subjects (5 males, 9 females) whose mean age was 23.0 ± 1.9 years (range: 16 y. 4 mo. to 39 y. 7 mo.). All patients were treated using a bonded Hyrax expander and the mean expansion was 9.82 mm (7.5-12.0 mm). A one-year retention period was undertaken before the beginning of any other orthodontic treatment. A cone-beam computed tomography (CBCT) evaluation was performed at T0 (initial), T1 (6 months post-expansion) and T2 (1 year post-expansion), and then the nasal cavity, nasopharyngeal and oropharyngeal volumes and the oropharyngeal minimal cross-sectional area were measured on the three-dimensional volumes that were obtained. Results: Radiological results have demonstrated a significant increase of the nasal and nasopharyngeal volumes and also an increase of the oropharyngeal minimal cross-sectional area at 6 months post-expansion. At one year post-SARPE, for these three parameters, a part of the gain was lost but did not return to the initial values. No significant effect on oropharyngeal volume was found. No significant correlation between expansion screw activation and radiological parameters were noted. Intra-class correlation analysis showed excellent intra-examiner reliability. Conclusions: SARPE causes significant changes of the nasal cavity and nasopharyngeal volumes. SARPE does not modify the oropharyngeal volume, but induces significant changes of the oropharyngeal minimal cross-sectional area. The observed effects do not have a correlation with the amount of expansion screw activation.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

A utilização de Células-tronco e técnicas da Engenharia Tecidual representa um grande avanço tecnológico e beneficiará muitos pacientes com suas conquistas. A descoberta de germes dentários como uma fonte confiável de células-tronco possibilitou diversas pesquisas nesta área. Duailibi et al. (2011) sugeriram uma nova classificação de desenvolvimento dentário baseada pela quantidade de material biológico coletado indicando a necessidade de métodos de diagnóstico por imagem para esta nova classificação. Na literatura diversos trabalhos indicam métodos de classificação dentária e métodos para estimar a idade fisiológica de indivíduos. O presente estudo tem o objetivo de adaptar alguns destes métodos para estimar o estágio de desenvolvimento proposto por Duailibi et al. (2011) consequentemente indicando a quantidade de células-tronco esperadas nas amostras. Para tanto, submeteu-se uma coleção de 67 dentes previamente classificados por Duailibi et al. (2011) à técnica rpcl e à tcfc para a obtenção de imagens e a aplicação de técnicas de estimativas por proporções lineares e volumétricas. Os resultados por análises lineares indicaram valores de R2 para o método de proporção de comprimento CDCP de 0,14050; CCCP de 0,65369; CCCR de 0,5408; CDCR de 0,54074; o método de proporção de área APAD de 0,23925; e método de proporção de volume VPVD de 0,08553, com valor de p menor ou igual à 0,05. Concluindo este estudo indica-se o método de rpcl utilizando a análise do comprimento entre coroa e polpa como o mais indicado para estimar o estágio de desenvolvimento. / The usage of human dental stem cells and tissue engineering technics represents a huge tecnological development and it may benefits many patients in a promissing future. The discovery of suitable source of human dental stem cells were made using tooth buds. Duailibi et al. 2011 indicated a new tooth classification on a stem cell harvesting based research, sugesting new methods for diagnosis these stages. Several method were developed for dental age assesement. The presente study aims to evaluate some of these dental age technics and make adaptations for estimating Duailibi et al. 2011 tooth stages. A 67 tooth sample previoulsy classificated by Duailbi et al. 2011 were submited through periapical parallel long cone X-rays and CBCT analysis. Age estimation ratio methods were applied by measuring tooth/root lenth, crown/root lenth, tooth/pulp lenth, crown/pulp lenth, tooth/poulp área and tooth/pulp volume. Results indicated by linear regression analisys a R2 value of tooth/pulp lenth 0,14050; crown/pulp lenth 0,65369; crown/root lenth 0,5408; tooth/root lenth 0,54074; pulp/tooth volume 0,23925; e tooth/pulp volume de 0,08553, with p value of 0,005. In conclusion , the best method for estimating Duailibi et al. 2011 tooth classification techinic is made by using periapical long cone X-rays using crown/pulp lenth ratio.

Objetivo: O desenvolvimento da tecnologia em diagnóstico odontológico por imagem através dos Tomógrafos Computadorizados por Feixe Cônico, tornou possível e acessível a avaliação cefalométrica através de reconstruções volumétricas do crânio. Parâmetros baseados em evidências científicas são necessários para implementar o seu uso. Alguns parâmetros utilizados na cefalometria convencional (bidimensional) deverão ser esquecidos, outros deverão ser adaptados, outros, ainda, deverão ser criados. Propomos aqui a criação de um Cefalostato Virtual para orientação do crânio em TC, com a utilização de pontos intracranianos, que são mais estáveis. Também propomos a criação do ponto TS e da linha TS-Pg em substituição ao ponto S e ao eixo Y de crescimento de Downs, respectivamente. Além disso, propomos a linha Ba-Op como referência para casos de assimetria faciais onde não é possível a utilização do plano Horizontal de Frankfurt, em casos, por exemplo, de síndromes que afetem os pontos de referências mais externos. Métodos: 49 crânios pertencentes ao do Museu de Anatomia UNIFESP, foram escaneados em um tomógrafo computadorizado por feixe cônico (TCFC), na clínica ISOOrthographic, São Paulo. As pontuações foram realizadas em dois momentos, com espaçamento de uma semana. Foram calculadas estatisticamente medidas-resumo (média, quartis, mínimo, máximo e desvio padrão). Foram calculadas também as correlações intraclasse e correlações de Pearson entre o Eixo Y (S-Gn) e linha entre os pontos TS e Pg. Resultados: Apesar de se observar uma baixa reprodutibilidade nas coordenadas, para os pontos CE, Pg e Gn, foi observada alta correlação entre as medidas angulares em questão. Para descrever a inclinação do Eixo Y em função da inclinação da Linha TS e Pg adotou-se um modelo de regressão linear simples descrito pela equação abaixo: Ang Sö- Gn = 0,989 Ang TS Pgi i Conclusões: o uso do Cefalostato Virtual na orientação de Crânios em Tomografia Computadorizada é factível e favorece a reprodução do posicionamento craniano; apesar da baixa reprodutibilidade intra observador dos pontos CE, Pg e Gn, novos critérios tridimensionais na definição destes pontos poderiam aumentar a precisão na sua localização; a alta reprodutibilidade intra observador para os pontos Op, TS e N, sugere que os critérios anatômicos próprios das estruturas estudadas favorecem a sua determinação; o ponto TS apresentou maior reprodutibilidade do que o ponto S, embora esta diferença não tenha sido estatisticamente significante, podendo-se substituir o ponto S pelo TS em estudos futuros; existe alta correlação entre a linha entre os pontos TS e Pg e o Eixo Y; a avaliação do comportamento da inclinação da linha orbitomeática (HF) com relação à linha Básio-Opístio sugere que na presença de alterações cranianas este relacionamento propicie auxílio no diagnóstico das alterações craniofaciais. / Objective: The development of new technology in dental diagnosis by cone beam CT (CBCT) image, made possible and accessible the realization of cephalometric evaluation through volumetric reconstructions of the skull. Scientific parameters with evidence-based are needed to implement its use. Some parameters used in conventional cephalometry (2D) maybe need to be forgotten, others should be adapted, and others still to be created. In this research we propose to create a Virtual Cephalostat orientation of the skull in CT, with the intracranial landmarks, because they are more stable. We propose the creation of landmark TS (Tubercle Sella) and the TS-Pg line to replace the landmark S (Sella) and the Y-axis of growth (Downs), respectively. Furthermore, we propose to use the Basion-Opistion line as a reference for cases of craniofacial asymmetry where is not possible to use the Frankfurt horizontal plane, as in some cases of syndromes that affects the most external landmarks. Methods: 49 skulls of Anatomy Museum of UNIFESP Federal University of São Paulo, were scanned in a CBCT. The analyses were performed in 2 stages, within 1-week space. Statistics measurements were calculated (mean, quartiles, minimum, maximum and standard deviation). We also calculated the intraclass correlations (ICC) and the Pearson correlations between the Y axis (S-Gn) and the line between landmarks TS-Pg. Results: Even if there is a low reproducibility in the coordinates for landmarks EC (Ethmoidal Crest), Pg and Gn it was observed a high correlation between the angular measures in question. To describe the inclination of the Y axis according to the slope of the line adopted TS and Pg a simple linear regression model is used, showed by the equation bellow: Ang Sö- Gn = 0,989 Ang TS Pgi i Conclusions: The use of the Virtual Cephalostat in orientation of skulls using CBCT is feasible and facilitates the reproduction of the skull position, despite the low intra observer reproducibility of landmarks EC, Pg and Gn, new 3D criteria in the definition of these landmarks could increase the precision in its location. The high intra observer reproducibility at the landmarks Op, N and TS, suggests that the anatomical criteria themselves promote their reliability; The TS landmark showed a higher reproducibility than the S landmark, even though the difference was not statistically significant, and it should be replaced by the landmark TS in future studies. There is a high correlation between the TS - Pg line and Y-axis. The relationship between the slope of the HF plane and Ba -Op line suggests that in the presence of the alteration of morphology in craniofacial structure, this relationship offer help in the diagnosis of craniofacial changes.

O objetivo principal desta pesquisa foi justificar a proposta de utilização de um novo método tomográfico (cone beam) de avaliação das espessuras ósseas alveolares, maxilares e mandibulares, por meio de testes objetivos das Condições de Repetitividade e de Precisão Intermediária associadas à variação intra e interoperadores, e conforme a utilização de programa computacional independente (AutoCAD®) para a realização das medições, aplicadas à sequência do Procedimento Operacional Padrão (POP) definido para este experimento. A Fase I da pesquisa registrou os critérios de obtenção da qualidade final das imagens tomográficas definitivas, a partir de equipamento iCAT® (Imaging Sciences International, Hatfield, Pa), com parâmetros de aquisição de 120KVp, 37,7mA e 26,9s, e considerando FOV cilíndrico de 13cm e matriz de 512x512 pixels. A resolução do voxel foi de 0,25mm; A Fase II registrou os critérios exploratórios relativos às condições operacionais do software de visualização, registro (inspeção e identificação) e medição das grandezas selecionadas. A Fase III registrou a realização dos testes de repetitividade e de reprodutibilidade das medidas. Um total de 72 grandezas lineares foram previamente definidas e metodologicamente testadas em sua qualidade de inspeção, identificação e medição, a partir da avaliação de sete (7) operadores independentes, cinco dos quais eram especialistas e com Mestrado Acadêmico em Ortodontia pela FOUSP e, o outro, especialista em Radiologia Odontológica e Doutor em Diagnóstico Bucal (FOUSP). Os examinadores foram previamente instruídos, calibrados e treinados considerando os requerimentos necessários à execução dos testes propostos. O protocolo de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Odontologia da Universidade de São Paulo (Parecer CAAE 0120.0.017.000-11). A análise estatística dependeu da utilização de Modelo de Componentes de Variância (hierárquico), e foram consideradas como fontes de variação: as medidas, efetuadas por um mesmo operador ou por diferentes operadores; a face considerada, vestibular ou lingual/palatina; os locais (três níveis de espessura óssea alveolar) em cada uma das faces e, ainda, os diferentes dentes. Esta análise foi realizada de forma separada para mandíbula e maxila. Valores de p<0,05 indicaram significância estatística. Os resultados indicaram significativa confiabilidade geral no método proposto, considerando a Condição de Repetitividade, com apenas 0,24% da variabilidade maxilar total atribuível a um único operador, e mandibular de 0,53%; e com valores expressivos relativos às incertezas de medida maxilares (0,156mm) e mandibulares (0,091mm), desse modo atestando significativa consistência interna (repetibilidade) do método. Os testes da Condição de Precisão Intermediária também indicaram significativa confiabilidade geral no método proposto, com apenas 1,52% da variabilidade total mandibular atribuível à participação de diversos operadores, e maxilar de 0,25%; e com valores também expressivos relativos às incertezas de medida mandibulares (0,149mm) e maxilares (0,158mm), desse modo atestando significativa condição final de reprodutibilidade. Conclui-se que a utilização de imagens provenientes de tomógrafo iCAT®, conforme indicação de resolução de imagem com voxel de 0,25mm, em humanos vivos e a partir de cortes trans-axiais sistematicamente operacionalizados com auxílio de Software AutoCAD®, propicia a geração de condições metodológicas suficientemente favoráveis à obtenção de mapeamento quantitativo linear de espessuras ósseas alveolares, vestibulares e palatinas/linguais, tanto para a maxila quanto para a mandíbula. / This research aimed to justify the proposed use of a new tomography method (cone beam) in the clinical assessment of alveolar, maxillary and mandibular bone width, through objective tests of the Conditions of Repetitiveness and Intermediate Precision associated with intra- and inter-operator variation, using the independent computer program (AutoCAD®) for the execution of the measurements according to the Standard Operating Procedure (SOP) sequence defined for this experiment. Phase I of the research recorded the criteria for obtaining the final quality of the tomography images, using iCAT® (Imaging Sciences International, Hatfield, Pa, USA) equipment with acquisition parameters 120KVp, 37.7mA, and 26.9s, and considering cilindric field-of-view (FOV) of 13cm and 512x512 pixels matrix. The voxel resolution was 0.25mm. Phase II recorded the exploratory criteria relative to the operational conditions of the visualization software, registry (visual inspection and landmark identification) and measurement of the selected magnitudes. Phase III recorded the tests of repeatability and reproducibility of the measurements. A total of 72 linear magnitudes were previously defined and methodologically tested for their quality of inspection, identification and measurement, based on assessment by seven (7) independent operators, five of whom were specialists, with masters degrees in Orthodontics from FOUSP; and the other, a specialist in Dental Radiology and Doctor of Oral Diagnosis (FOUSP). The examiners were previously instructed, calibrated and trained according to the requirements for performing the proposed tests. The research protocol was approved by the Committee for Ethics in Research of the Faculty of Dentistry at the University of São Paulo (Protocol # 102/11-CAAE 0120.0.017.000-11). Statistical analysis used the (hierarchical) Components of Variation Model, and the sources of variation were considered to be: the measurements, made by the same operator or by different operators; the face considered, whether vestibular or lingual/palatal; the locations (three levels of alveolar bone thickness) in each of the faces and, also, the different teeth. This analysis was carried out separately for the mandible and the maxilla. Values of p<0.05 indicated statistical significance. The results indicated overall significant reliability in the proposed method considering the Condition of Repetitiveness, with only 0.24% of total maxillary, and 0.53% of mandibular, variability attributable to a single operator; and with expressive values relative to measurement uncertainties of maxillary (0.156 mm) and mandibular (0.091mm) averages, thereby attesting to significant internal consistency (\"repeatability\") of the method. Tests for the Condition of Intermediate Precision also indicated overall significant reliability of the proposed method, with only 1.52% total mandibular, and 0.25% maxillary, variability attributable to the participation of the various operators; and, also, with expressive values relative to measurement uncertainties of mandibular (0.149mm) and maxillary (0.158mm) averages, thereby attesting to the significant final condition of reproducibility. It is concluded that the use of images from iCAT® tomography, as indicated by image resolution with voxels of 0.25mm, in live humans and from transaxial cuts performed systematically with the help of AutoCAD® Software, provides methodological conditions sufficiently favorable for obtaining linear quantitative mapping of alveolar, vestibular and palatal/lingual bone thicknesses, for both the maxillary and mandibular dental arches.

O objetivo deste estudo foi comparar o eixo de rotação verdadeiro com o anatômico em ambiente virtual 3D, e seus efeitos sobre dois pontos anatômicos mandibulares. O eixo verdadeiro foi determinado em 14 indivíduos por meio de axiografia, e transferido para o ambiente virtual por TCFC, e posteriormente determinado anatomicamente, onde foram medidas as distâncias entre ambos. Foram simuladas rotações de 2º, 5º e 8º da mandíbula nos dois eixos, tanto para abertura como fechamento, e quantificadas as diferenças nos pontos da linha média inferior (LMI) e pogônio (Pg). O teste t pareado foi utilizado para examinar as diferenças entre as médias nas posições desses pontos (p<0,05). Os eixos verdadeiros localizaram-se dentro de um raio de 5 mm do anatômico em 67,86% da amostra. A distância absoluta média entre os eixos foi de 4,79 mm, enquanto que a vetorial foi de 2,33 no plano horizontal e 3,03 mm no vertical, resultando na direção anteroinferior em 71,43% dos eixos verdadeiros. Houve diferença estatisticamente significante na posição dos pontos LMI e Pg para todas as magnitudes e direções, entre os eixos. O eixo verdadeiro está localizado na direção anteroinferior em relação ao anatômico. Os efeitos na mandíbula são significantes e diferentes em todas as amplitudes, tanto para abertura como fechamento, porém com possível pequena relevância clínica. / The aim of this study was to compare the true hinge axis to the anatomic one in a virtual 3D environment, and also their respective effects on two mandibular anatomic points. The true axis has been determined in 14 individuals by means of axiography, and later transferred to a virtual environment by CBTC, where the anatomical axis was determined, and measured the distances between them. Mandibular rotation of 2º, 5º and 8º in both axes were performed, both for opening and closing, as well as the quantification of the difference found in the points of the lower midline (LM) and pogonion (Pg). Paired t-test was used to examine differences between the average values in the position of those points (p<0,05). The true axis was located within a 5mm-radius of the anatomic axis throughout 67.86% of the sample. The average absolute distance between the axes was 4.79 mm, while the vector distance was 2.33 mm in the horizontal plane e 3.03mm in the vertical plane, amounting to an anteriorinferior direction of 71.43% of the true axis. There was significant difference in the position of points LM and Pg to all magnitudes and directions within the axes. The true hinge axis is located in the anterior-inferior direction in relation to the anatomic axis. The effects observed onto the mandible are significant and different in all amplitudes, both for opening and closing positions, however they present small clinical relevance.