Naira Figueiredo Deana

The aim of this systematic survey was to evaluate the quality of clinical practice guidelines (CPGs) that provide recommendations for the detection, diagnosis, and treatment of oral cavity cancer (OCC). We conducted a systematic search in MEDLINE, EMBASE, Epistemonikos, CPG websites, and scientific societies to identify documents providing recommendations for the detection, diagnosis, and treatment of OCC. Two reviewers independently assessed the included CPGs using the AGREE II instrument. We calculated standardized scores for the six domains and provided a final recommendation for each CPG. We identified twenty-five CPGs published between 2019 and 2024. The mean scores (higher scores indicate better domain assessment) per domain were as follows: scope and purpose, 80.5 ± 11.6%; stakeholder involvement, 55.6 ± 16.7%; rigor of development, 48.3 ± 20.1%; clarity of presentation, 83.8 ± 8.2%; applicability, 33.6 ± 19.1%; and editorial independence, 57.3 ± 22.4%. The overall mean rate was 4.8 ± 0.8, with a maximum score of seven. Reviewers recommended five guidelines for use in practice, twelve were recommended with modifications, and eight were not recommended. The overall quality of CPGs on OCC was suboptimal. CPG developers should strengthen the use of systematic, transparent methodologies and frameworks for evidence synthesis and recommendation formulation, thereby improving the quality of recommendations and facilitating implementation across diverse clinical contexts.

Introduction: Breast cancer-related lymphedema (BCRL) affects quality of life (QoL) and increases healthcare costs. Resistance training (RT) is proposed as a preventive strategy, although its safety and effectiveness remain uncertain. Objective: To evaluate the effectiveness and safety of RT in preventing BCRL in women at risk. Methods: MEDLINE, Embase, CENTRAL, PEDro, and LILACS databases were searched from their inception to January 2025, along with the gray literature, trial registries, and preprints. Risk of bias was assessed using RoB 2, and certainty of the evidence (CoE) was assessed using GRADE. Primary outcomes were the occurrence of lymphedema and overall QoL; secondary outcomes included pain, upper limb function, range of motion (ROM), grip strength, and adverse events. Results: Eight RCTs (n = 1131) were included. The effects of RT on lymphedema and arm volume are very uncertain (very low CoE). For QoL, pain, ROM, and grip strength, the findings were inconsistent and uncertain (low to very low CoE). Adverse events were mild and transient, with no serious complications. Conclusion: RT is probably safe in women at risk of developing BCRL. Its preventive effectiveness is highly uncertain. Well-designed RCTs with standardized diagnostic criteria, patient-centered outcomes, and long-term follow-up are needed to establish their role in BCRL prevention with greater certainty. Ethics and dissemination: This study did not require ethical approval. The results will be disseminated through publications in peer-reviewed journals and academic presentations. Registration: PROSPERO (CRD42023455720).

Background: Traumatic dental injuries (TDIs) are the fifth most prevalent condition worldwide. Proper diagnosis and emergency management are essential for ensuring a favourable outcome and prognosis. Although other international guidelines provide recommendations for the emergency management of TDI, specific clinical situations are not always addressed. Objective: To provide the dental health team and patients with recommendations based on the best scientific evidence available for the outpatient emergency management of people suffering from TDI. Methods: The Chilean Ministry of Health formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Universidad de La Frontera, supported the guideline‐development process, including evidence synthesis. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence‐to‐Decision frameworks. Recommendation: The panel agreed on 15 recommendations for outpatient management of TDIs, such as fractures, luxations and avulsions in primary and permanent dentition. Conditional recommendations for permanent teeth included performing partial pulpotomy with calcium hydroxide or bioceramic in complicated crown fractures, stabilizing with a rigid splint in cervical root fracture, performing digital repositioning and splinting in lateral and extrusive luxation for more than 48 h, performing dental reimplantation in avulsed teeth with extended extra‐oral time > 1 h, not treating the root surface and prescribe antibiotics in avulsed teeth. Conditional recommendations for primary teeth included performing just the extraction of the mobile fragment in complicated crown‐root fractures and not splint in teeth with subluxation, lateral or extrusive luxation. Conditional recommendations for the use of mouthwash with 0.12% chlorhexidine twice a day for a period of 7–14 days in people with TDIs and against prescribing antibiotics in people with crown fracture, intra‐alveolar root fracture or tooth luxation associated with trauma.

INPLASY202560071 PREVALENCE OF MAXILLARY SINUS SEPTA IN CONE BEAM COMPUTED TOMOGRAPHIES: A SYSTEMATIC REVIEW WITH META-ANALYSIS Keywords: Septa; Maxillary sinus; Prevalence; Meta-analysis; Morpholo…

The aim of this study was to determine differences in maturation stages of the mandibular third molars (MTM) of Chilean individuals by age, sex, and side. The maturation stage of 930 lower third molar teeth were analysed, in patients aged between 9 and 24 years (432 males and 498 females), by panoramic radiography. The stage of maturity of the MTM was classified from A to H, following the method established by Demirjian. Multinomial logistic regression was performed for maturation stage by age. The lowest age of complete maturity of the MTM was 16 years in both sexes (Stage H). The correlation between maturation stage and sex was significant, positive, and high for both sexes, in both tooth 48 and tooth 38, showing that increasing age and maturation stage are correlated. In both males and females, maturation Stage H of the MTM was associated with the age of 18 years. The fit of the model was significant, showing that it has a greater predictive power than the null model. Nagelkerke’s pseudo R2 explained 73.5% of the variations of the model. In the contemporary Chilean population, if the maturity of the MTM is at a stage prior to complete calcification of the crown (Stage D), it is very unlikely that the individual is aged 18 years or over. It is highly probable that a Chilean individual with complete root formation of the MTM is legally of age, regardless of side or sex.

Sex estimation is the first stage in the identification of an individual in the forensic context, and can be carried out from bone structures like the mandible. The aim of this study was to estimate sex from metric analysis of the mandible in cone beam computed tomography images (CBCT) of adult Chilean individuals. Six mandibular measurements were analysed, five linear and one angular, in CBCT of adult Chilean individuals of both sexes. ROC Curve analysis was performed, with cut-off points, and of the overall model quality. Univariate discriminant function analysis was used to determine the accuracy of each measurement for sex estimation. Multivariate discriminant function analysis, both directly and by steps, was used to obtain the predictive value of the mandible including all the measurements. The data included were 155 CBCT, 105 of females and 50 of males. The mandible presented great sexual dimorphism, with the mandibular ramus presenting greater predictive power than the mandibular body. When each mandibular measurement was analysed separately, the maximum height of the mandibular ramus presented the greatest predictive power (76.5%), while the mandibular angle was the least accurate parameter for sex estimation (58.1%). Direct method analysis presented 87.1% accuracy for sex identification of adult Chilean individuals, and joint analysis of maximum mandibular ramus height (MRH), corono-condylar distance and bigonial breadth presented 86.5% accuracy. In ROC Curve analysis the MRH was the variable with the greatest discriminating capacity (AUC = 0.833), MA was the only variable which presented no discriminating capacity (AUC = 0.386) and also presented low quality in model quality analysis. Metric analysis of the mandible in CBCT images presents an acceptable accuracy for sex estimation in Chilean individuals, and its use for that purpose in forensic practice is recommended.

Correct detailed description of the anatomy of the digastric muscle (DM) in different populations should be carried out to improve the teaching of anatomy, avoid misinterpretations and help to avoid intercurrences during surgical procedures in the region. The aim of this study was to carry out a study of the DM in adult Brazilian individuals. The sample consisted of 50 DM from adult individuals (22 right side and 28 left side) fixed in 10 % formaldehyde. The morphology of the DM was observed, identifying possible anatomical variations; these were characterized and classified according to the number of the muscle bellies, direction of the fibre, and points of origin and insertion. The morphometric measurements were performed using a digital calliper. Student’s t-test for dependent samples was used to measure differences between sides; one-way ANOVA was used to analyse the different classifications, and the chi-squared test to analyse qualitative variables, with significance threshold of 5 %. The anterior belly of the DM was classified as Type I in 28 samples (56 %), Type II in 20 (40 %) and Type III in 2 (4 %). The mean length was 37.8 mm, width 12.1 mm and thickness 5.39 mm, with no statistically significant differences found for these variables. The intermediate tendon of the DM was classified as Type I in 31 samples (62 %), Type II in 10 (20 %) and Type III in 9 (18 %); its mean total length was 45.1 mm. The posterior belly of the DM was Type I in 50 samples (100 %), with mean length 70.8 mm and width 8.15 mm. Anatomical variations of the DM, particularly its anterior belly, in Brazilian adults are very frequent. They must therefore be carefully identified to help avoid intercurrences during surgical procedures in the region, and to help correct evaluation of swollen lymph nodes in the submental triangle.

Background: The prevalence and consequences of traumatic dental injuries (TDI) make them a public health problem. Trustworthy TDI clinical practice guidelines (CPGs) assist clinicians in determining a diagnosis and guide them to the most appropriate therapy. The aim of this systematic survey was to identify and evaluate the quality of CPGs for the diagnosis, emergency management, and follow-up of TDIs. Materials and methods: A systematic search was carried out in MEDLINE, EMBASE, Epistemonikos, Trip database, CPG websites, and dental societies to identify documents providing recommendations for the emergency and sequelae management of TDIs. Reviewers assessed the included guidelines independently and in duplicate, using the AGREE II instrument. ANOVA or Student’s t-tests were used to determine the attributes of CPGs associated with the total score in AGREE II. Results: Ten CPGs published between 2010 and 2020 were included, mostly from Europe (n = 6). The overall agreement between reviewers was very good (0.94; 95%CI 0.91–0.97). The mean scores (the higher the score, the better the domain assessment) per domain were as follows: Scope and purpose 78.0 ± 18.9%; stakeholder involvement 46.9 ± 29.6%; rigour of development 41.8 ± 26.7%; clarity of presentation 75.8 ± 17.6%; applicability 15.3 ± 18.8%; and editorial independence 41.7 ± 41.7%. The overall mean rate was 4 ± 1.3 out of a maximum score of 7. Two guidelines were recommended by the reviewers for use in practice and rated as high quality. CPGs developed by government organizations showed a significantly higher overall score. Conclusions: The overall quality of CPGs on TDI was suboptimal. CPG developers should synthesize the evidence and formulate recommendations using high-quality methodologies and standards in a structured, transparent, and explicit way.

The prevalence and consequences of traumatic dental injuries (TDI) make them a public health problem. Trustworthy TDI Clinical Practice Guidelines (CPGs) can assist clinicians in making a proper diagnosis, and guide them to the most appropriate therapy for every case. The aim of this study was to identify and evaluate the quality of CPGs for the diagnosis, emergency management and follow-up of TDIs. A systematic search was carried out in MEDLINE, EMBASE, Epistemonikos, Trip database, CPG’ websites, and dental societies to identify documents providing recommendations for the emergency and sequelae management of TDIs. Reviewers assessed the included guidelines independently and in duplicate, using the AGREE II instrument. T-student or ANOVA tests were used to determine the attributes of CPGs associated with the total score in AGREE II. Ten CPGs published between 2010 and 2020 were included, mostly from Europe (n=6). The overall agreement between reviewers was very good (0.94; 95%CI 0.91-0.97). The mean scores for each domain were as follows: Scope and purpose 78.0 ± 18.9%; Stakeholder involvement 46.9 ± 29.6%; Rigour of development 41.8 ± 26.7%; Clarity of presentation 75.8 ± 17.6%; Applicability 15.3 ± 18.8% and Editorial independence 41.7 ± 41.7%. The overall mean rate was 4 ± 1.3 out of a maximum score of 7. Only two guidelines were recommended by the reviewers and rated as high quality. The CPGs developed by governments showed a significantly higher overall score. The overall quality of CPGs on TDI was suboptimal. Therefore, the CPGs developers need to use a methodology that allows them to formulate recommendations in a structured, transparent, and explicit way.

The anastomosis between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) courses along half of the lateral wall of the maxillary sinus. Risk of injury to the anastomosis between PSAA and IOA during surgical procedures has been reported. The aim of the present study was to carry out a systematic review and meta-analysis to determine the frequency, location, and diameter of the anastomosis between PSAA and IOA in imaging studies (cone-beam computed tomography, spiral cone-beam computed tomography, and computed tomography). A search was carried out in the PubMed, EMBASE, and LILACS. Original works were included reporting imaging studies to analyze the frequency, location, and diameter of the anastomosis in humans. The risks of bias were analyzed using the AQUA tool. Generalized linear mixed models were used to estimate the frequency and the 95% CI in the meta-analysis. The variance in prevalence estimates was stabilized by logit transformation. The qualitative analysis included 49 studies with 10,837 patients. The frequency of the anastomosis between PSAA and IOA was 74% (prediction interval 0.20–0.97%). The anastomosis was most frequently located in the intraosseous region (60.0%), followed by the submembranous region (33.0%), and least frequently in an extraosseous location (5.0%). Arteries with diameter of 1.0–1.9 mm were most frequent (32.0%), followed by arteries with diameter less than 1 mm (23.0%); a small number with diameter greater than 2 mm was recorded (4.0%). These data can be used as a reference to help surgeons when planning interventions in the lateral wall of the maxillary sinus. Registration number: INPLASY, number 202120071.