MSc (Dentistry), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Problem. One of the sources of inaccuracy in utilising the CEREC Chairside CAD/CAM system has been the difficulty of accurately positioning the intraoral camera relative to the path of insertion of the preparation and restoration. The degree of inaccuracy produced by variations in the angulation of the camera relative to the path of insertion is not known. Purpose. The purpose of this study was to first review the literature and history of CAD/CAM in dentistry, and the CEREC Chairside System in particular, and then to determine the errors that may result from changes in angulation of the camera in three dimensions. Further, to design a device which would help stabilise the camera to eliminate such errors. Method and Materials. A prefabricated Aesthetic Base Gold (ABG) Model was used and mounted on an articulator in order to simulate changes in angulation of each of the three dimensional axes which cause variations in roll, pitch, and yaw in the positioning of the camera. Images were captured for angle variations of 0°, 1°; 3°, 5°, 10°, 15° and 20° using the CEREC software on a crown preparation for tooth 24. The same software was used to make measurements on the resulting images to determine the mesio-distal, bucco-lingual orientation and the occlusal, internal shoulder and external shoulder dimensions. In addition, a quality assessment was carried out to observe any shadows, surface texture changes, margin discrepancies and ability to automatically complete the restoration with ease and accuracy. An intraoral stabilising device was designed that could be placed intraorally using polyvinyl siloxane putty. The ABG model was positioned to simulate quadrants 2 and 4 on crown iv preparation for tooth 24. Time to set up and place the device was recorded, and a Visual Analogue Scale was used to determine ease of use. Results. Difficulties were encountered in measurements of images where there was an angle deviation of greater than 5º, and so it was only possible to analyse the four angles of 0, 1, 3, and 5º. A three-way ANOVA revealed expected significant differences between the different measurements (as they are measuring different things) but there were no other significant differences. Thus neither the four different angles nor the three different axes had any influence on the readings. There was also consistency across the measurements, for every combination of the levels of the three factors (angle, measurement and axis). The stabilising device proved quick and easy to set up and place the silicone putty (less than 20 seconds) and the average VAS score for using the device improved by 25.3% when using the device in the lower, and by 36.4% when using the device in the upper arch. Conclusions. The angle of the camera relative to the path of insertion of the restoration should not exceed 3° for changes in Pitch, or 5° for changes in Roll and Yaw of the camera. The stability device designed during this study proved to be more convenient and accurate for data capture as it decreased the time of search and reduced both the internal and external factors which interfere with data capture.

Thesis (M.S.)--University of Michigan, 1948.

O diagnóstico de cárie em estágio inicial é ainda um desafio, principalmente nas regiões oclusais de fóssulas e fissuras, que muitas vezes encontram- se pigmentadas gerando dúvida ao clínico quanto à necessidade de intervenção. O objetivo deste trabalho foi avaliar um método adicional clínico de diagnóstico de lesões cariosas de cicatrículas e fissuras através de imagens fotográficas. Este estudo foi realizado in vivo, em 18 indivíduos selecionados dentre os pacientes em atendimento odontológico nas clínicas de Dentística da FOB-USP e que possuiam molares permanentes com sulcos e fissuras pigmentados. Os dentes (n= 62) foram examinados clinicamente e através das imagens fotográficas digitais com aumento de 1:1 por 3 examinadores independentes que determinaram se o dente deveria receber intervenção terapêutica com preparo cavitário e restauração. Um estudo paralelo foi realizado in vitro, com o exame de 60 molares extraídos e fixados em um manequim odontológico, feito pelos mesmo examinadores da etapa in vivo e, também, pelo exame de fotografias digitais. O exame radiográfico digital foi realizado e, em seguida, os dentes foram seccionados em máquina de corte digital ISOMET® 1000, com disco diamantado dupla face Diamond Wafering Blade, perpendicularmente à superfície oclusal em cortes no sentido do sulco principal e novamente analisados pelos 3 avaliadores para a identificação da presença de lesão cariosa. Os dados foram avaliados pela estatística Kappa e pelo teste Qui-Quadrado (p<0,05). Os valores de Kappa interexaminador para as avaliações in vivo foram para análise visual: 0,65-0,55-0,53 e fotográfico: 0,79-0,89-0,89. Para as análises in vitro, os valores para o exame visual foram: 0,85-0,65-0,78 e fotográfico: 1- 0,86-0,86. Para a etapa in vitro o teste Qui-Quadrado demostrou que somente o exame clínico visual apresentou uma leve associação com as fatias (p= 0,036), porém para o exame fotográfico o valor de p foi de (p= 0,918). No entanto, a porcentagem de concordância quando comparados as fatias foi de 70% (exame clínico) e 60% (fotográfico) com um Kappa abaixo do esperado de 0,31 e 0,05, respectivamente. Concluiu-se que o exame fotográfico não contribui na decisão de intervir, bem como não foi possível validar este exame como um método adicional de diagnóstico. / The diagnosis of caries in early stage is still a challenge, especially in pigmentesd pit and fissure surfaces of posterior teeth. The purpose of this study was to evaluate the use of digital photographic images as an additional method to diagnose caries lesion in early stages.This in vivo and in vitro study was realized by examining 62 molars of 18 patients of the Restorative Dentistry Clinic of FOB- USP. The teeth were examined by 3 independent examiners who determined wether the tooth should be or not submitted to a cavity preparation and restoration. The same teeth were photographed and the digital images with 1:1 increase size were blind examined by the same examiners.The decision of the need of intervention was confronted by the two methods. A parallel study \"in vitro\" was conducted with 60 extracted human molars fixed in a dental manikin for to use of a digital photographic image as a diagnostic additional method for pit and fissure lesions, a study. The same examiners analyzed the oclusal surface and the correspondent digital photographic images. The decision of the need of intervention was confronted by the 2 methods. The extracted teeth were then sectioned in an ISOMET® 1000 digital cutting machine, witch doublé diamond disc face Diamond Wafering Blade, perpendicular to the occlusal surface cuts and examined by the 3 examers to identifying the presence of carious lesions. Kappa intra and inter examiners were for in vivo visual analysis 0.65- 0.55- 0.53 and in vivo photographic analysis: 0.79 -0.89 - 0.89. For in vitro visual analyzes were: 0.85- 0.65- 0.78 and in vitro photographic analysys: 1-0.86- 0.86. Data were evaluated by chi-square test (p < 0.05) showed that only the visual clinical examination showed as light association with the cuts (p = 0.036) and for the photographic examination (p = 0.918). The decision made by the examiners of the need of intervention on the pit and fissure surfaces was confronted with the examination of the teeth slices, wich allowed to confirm the presence of a carious lesion. The percentage of agreement was 70% (visual examination) and 60% (photographic images) with Kappa 0.31 and 0.05, respectively. It was concluded that the photographic images did not contribute to the decision of the need of intervention on pit and fissure surfaces.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A remoÃÃo seletiva de dentina cariada à um desafio para a Odontologia contemporÃnea, jà que os mÃtodos tradicionais de escavaÃÃo podem remover, alÃm do tecido cariado, dentina sadia. Objetivou-se determinar a efetividade de remoÃÃo de cÃrie (ERC) e o potencial minimamente invasivo (PMI) de trÃs mÃtodos mecÃnicos de escavaÃÃo. Doze molares humanos com lesÃes de cÃrie oclusal em dentina foram distribuÃdos, de forma randomizada, em trÃs grupos de acordo com o mÃtodo de remoÃÃo: broca carbide, cureta de dentina e broca de polÃmero. Todos os dentes, antes de serem submetidos à etapa de escavaÃÃo da cÃrie, tiveram suas raÃzes embutidas em resina acrÃlica. Seccionaram-se os dentes uma Ãnica vez no sentido longitudinal, tendo como referÃncia visual o centro da lesÃo. Cada uma das secÃÃes foi submetida a fotografias digitais padronizadas e escaneamento por microtomografia computadorizada de raios-X (micro-CT) (Skyscan 1174, Skyscan, Kontich, Belgium) em dois momentos distintos, antes e apÃs a remoÃÃo de cÃrie. Utilizou-se um programa de imagens de domÃnio pÃblico, ImageJ, para anÃlise das imagens obtidas. Definiram-se as Ãreas de dentina cariada inicial (CI), da cavidade preparada (CP) e da cÃrie residual (CR) nas fotografias e nas imagens de micro-CT de acordo com critÃrio visual. Determinou-se a ERC entre os mÃtodos com base na relaÃÃo CR/CI, enquanto o PMI foi determinado atravÃs da relaÃÃo entre CP/CI. Analisaram-se os dados obtidos atravÃs de AnÃlise de VariÃncia a Um CritÃrio e teste-t de Student ou Kruskal-Wallis e teste Student-Newman-Keuls. Tanto para a anÃlise de imagem digital quanto para a anÃlise de micro-CT, a broca carbide apresentou maior efetividade em relaÃÃo à cureta (p=0,0063; p=0,0263, respectivamente) e em relaÃÃo à broca de polÃmero (p=0,0028; p=0,0005, respectivamente), enquanto que cureta de dentina e broca de polÃmero mostraram resultados semelhantes para os dois tipos de imagens (p>0,05). Em relaÃÃo ao PMI, para a anÃlise de imagem digital, a broca de polÃmero apresentou-se como mÃtodo com potencial invasivo similar à cureta de dentina (p=0.1240), porÃm com invasividade menor do que a broca carbide (p=0,0028). Para a anÃlise de micro-CT, os valores de PMI de todos os grupos foram significantemente diferentes, e a broca de polÃmero tambÃm demonstrou o mÃtodo mais conservador, tanto em relaÃÃo à cureta de dentina (p=0,0030), quanto em relaÃÃo à broca carbide (p<0.001). Portanto, a broca carbide foi o mÃtodo mais efetivo para remoÃÃo de cÃrie, porÃm o menos conservador; e a broca de polÃmero apresentou baixo potencial invasivo, porÃm nÃo foi capaz de remover toda a dentina cariada.

O diagnóstico de cárie em estágio inicial é ainda um desafio, principalmente nas regiões oclusais de fóssulas e fissuras, que muitas vezes encontram- se pigmentadas gerando dúvida ao clínico quanto à necessidade de intervenção. O objetivo deste trabalho foi avaliar um método adicional clínico de diagnóstico de lesões cariosas de cicatrículas e fissuras através de imagens fotográficas. Este estudo foi realizado in vivo, em 18 indivíduos selecionados dentre os pacientes em atendimento odontológico nas clínicas de Dentística da FOB-USP e que possuiam molares permanentes com sulcos e fissuras pigmentados. Os dentes (n= 62) foram examinados clinicamente e através das imagens fotográficas digitais com aumento de 1:1 por 3 examinadores independentes que determinaram se o dente deveria receber intervenção terapêutica com preparo cavitário e restauração. Um estudo paralelo foi realizado in vitro, com o exame de 60 molares extraídos e fixados em um manequim odontológico, feito pelos mesmo examinadores da etapa in vivo e, também, pelo exame de fotografias digitais. O exame radiográfico digital foi realizado e, em seguida, os dentes foram seccionados em máquina de corte digital ISOMET® 1000, com disco diamantado dupla face Diamond Wafering Blade, perpendicularmente à superfície oclusal em cortes no sentido do sulco principal e novamente analisados pelos 3 avaliadores para a identificação da presença de lesão cariosa. Os dados foram avaliados pela estatística Kappa e pelo teste Qui-Quadrado (p<0,05). Os valores de Kappa interexaminador para as avaliações in vivo foram para análise visual: 0,65-0,55-0,53 e fotográfico: 0,79-0,89-0,89. Para as análises in vitro, os valores para o exame visual foram: 0,85-0,65-0,78 e fotográfico: 1- 0,86-0,86. Para a etapa in vitro o teste Qui-Quadrado demostrou que somente o exame clínico visual apresentou uma leve associação com as fatias (p= 0,036), porém para o exame fotográfico o valor de p foi de (p= 0,918). No entanto, a porcentagem de concordância quando comparados as fatias foi de 70% (exame clínico) e 60% (fotográfico) com um Kappa abaixo do esperado de 0,31 e 0,05, respectivamente. Concluiu-se que o exame fotográfico não contribui na decisão de intervir, bem como não foi possível validar este exame como um método adicional de diagnóstico. / The diagnosis of caries in early stage is still a challenge, especially in pigmentesd pit and fissure surfaces of posterior teeth. The purpose of this study was to evaluate the use of digital photographic images as an additional method to diagnose caries lesion in early stages.This in vivo and in vitro study was realized by examining 62 molars of 18 patients of the Restorative Dentistry Clinic of FOB- USP. The teeth were examined by 3 independent examiners who determined wether the tooth should be or not submitted to a cavity preparation and restoration. The same teeth were photographed and the digital images with 1:1 increase size were blind examined by the same examiners.The decision of the need of intervention was confronted by the two methods. A parallel study \"in vitro\" was conducted with 60 extracted human molars fixed in a dental manikin for to use of a digital photographic image as a diagnostic additional method for pit and fissure lesions, a study. The same examiners analyzed the oclusal surface and the correspondent digital photographic images. The decision of the need of intervention was confronted by the 2 methods. The extracted teeth were then sectioned in an ISOMET® 1000 digital cutting machine, witch doublé diamond disc face Diamond Wafering Blade, perpendicular to the occlusal surface cuts and examined by the 3 examers to identifying the presence of carious lesions. Kappa intra and inter examiners were for in vivo visual analysis 0.65- 0.55- 0.53 and in vivo photographic analysis: 0.79 -0.89 - 0.89. For in vitro visual analyzes were: 0.85- 0.65- 0.78 and in vitro photographic analysys: 1-0.86- 0.86. Data were evaluated by chi-square test (p < 0.05) showed that only the visual clinical examination showed as light association with the cuts (p = 0.036) and for the photographic examination (p = 0.918). The decision made by the examiners of the need of intervention on the pit and fissure surfaces was confronted with the examination of the teeth slices, wich allowed to confirm the presence of a carious lesion. The percentage of agreement was 70% (visual examination) and 60% (photographic images) with Kappa 0.31 and 0.05, respectively. It was concluded that the photographic images did not contribute to the decision of the need of intervention on pit and fissure surfaces.

Made available in DSpace on 2016-08-03T16:31:14Z (GMT). No. of bitstreams: 1 Ana Paula Morales.pdf: 1213456 bytes, checksum: 55c9a80ac27170e4b4a575007723155b (MD5) Previous issue date: 2009-03-31 / The purpose of this study was to evaluate horizontal and vertical smile characteristics; smile symmetry and smile arch of patients with maxillary atresy submitted to rapid palatal expansion. The sample was 81 extra oral photographs of maximum smile of 27 patients with medium age of 10 years. Photographs of maximum smile were taken at: inicial time or before expansion; 3 months after rapid palatal expansion ending and 6 months after rapid palatal expansion ending. The computer program CEFX 2001 Cefalometria Computadorizada CDT was used for photographies calibration and analysis. The reference points and measurements were chosen according to literature review about smile analysis. Statistical analysis was performed by using ANOVA variance analysis, at level of 5% of significance. Rapid palatal expansion resulted on estatistically significant increase of smile transversal area and upper central and lateral incisors display; maintenance of right and left side smile symmetry and absence of parallelism of curvature of the upper incisal edges and border of lower lip (smile arch).(AU) / O objetivo deste estudo foi avaliar as possíveis alterações das características horizontais, verticais, de simetria e do arco do sorriso de pacientes com atresia maxilar submetidos à expansão rápida da maxila. A amostra consistiu de 81 fotografias extra-bucais do sorriso máximo de 27 pacientes com idade média de 10 anos e 3 meses. Foram realizadas fotografias do sorriso máximo nos períodos: inicial (antes da instalação do aparelho expansor); 3 meses após a fixação do parafuso expansor; 6 meses após a fixação do parafuso expansor. Para a calibragem e análise das fotografias foi utilizado o programa CEFX 2001 CDT. Os pontos fotométricos e as medidas a serem analisadas foram escolhidos após revisão da literatura do sorriso realizada. Para avaliar as alterações no sorriso durante as fases, foi utilizada a análise de variância ANOVA, com nível de significância de 5%. A expansão rápida da maxila promoveu aumento estatisticamente significante da dimensão transversal do sorriso; aumento da quantidade de exposição dos incisivos centrais e laterais superiores; manutenção da simetria entre os lados direito e esquerdo e da falta de paralelismo entre a curvatura das bordas dos incisivos superiores com a curvatura do lábio inferior (arco do sorriso).(AU)

Indiana University-Purdue University Indianapolis (IUPUI) / Quantification of treatment outcomes (tooth displacement and bony changes) is the key to advance orthodontic research and improve clinical practices. Traditionally, treatment outcome were quantified by using two-dimensional (2D) cephalometric analysis. However, there are problems inherent in 2D analysis, such as tracing errors and inability to detect side-effects. Thus, a reliable three-dimensional (3D) image analysis method for treatment outcome quantification is of high interest. Systematic 3D image analysis methods were developed for digital dental cast models and Cone-Beam Computed Tomography (CBCT) models. A typical analysis procedure includes image reconstruction, landmarks identification, coordinate system setup, superimposition, and displacement or change calculation. The specified procedures for maxillary teeth displacements and anatomical landmarks movements were presented and validated. The validation results showed that these procedures were accurate and reliable enough for clinical applications. The 3D methods were first applied to a human canine retraction clinical study. The purposes of this study were to quantify canines and anchorage tooth movements, and to compare two commonly used canine retraction strategies, controlled tipping and translation. The canine results showed that (1) canine movements were linear with time; (2) the initial load system was not the only factor that controlled the canine movement pattern; and (3) control tipping was significantly faster than translation. The anchorage tooth results showed that (1) anchorage losses occurred even with transpalatal arch (TPA); (2) there was no significant difference in anchorage loss between the two treatment strategies; and (3) compared with removable TPA, fixed TPA appliance can significantly reduce the amount of anchorage loss in the mesial-distal direction. The second clinical application for the 3D methods was a mandibular growth clinical trial. The purposes of this study were to quantify skeletal landmark movements, and compare two widely used appliances, Herbst and MARA. The results showed that (1) the Herbst appliance caused mandibular forward movement with backward rotation; and (2) the treatment effects had no significant differences by using either Herbst or MARA appliances. The two clinical applications validated the methods developed in this study to quantify orthodontic treatment outcomes. They also demonstrated the benefits of using the 3D methods to quantify orthodontic treatment outcomes and to test fundamental hypotheses. These 3D methods can easily be extended to other clinical cases. This study will benefit orthodontic patients, clinicians and researchers.