Association between hypomineralization of deciduous and molar incisor hypomineralization and dental caries

Abstract This study aimed to evaluate the association between the severity of hypomineralized second primary molars (HSPM), molar-incisor hypomineralization (MIH) and dental caries in children. 450 children between the ages of 6 and 7 years were included in this cross-sectional study. A calibrated examiner classified the enamel hypomineralizations and dental caries lesions using the MIH and HSPM and the Nyvad criteria, respectively. The primary outcome was the severity of MIH according to the severity of HSPM. Statistical analysis was performed using the generalized linear model and ordinal logistic regression. The prevalence of concomitant MIH and HSPM was 26% sex and age adjusted. Mild enamel defects were more frequent than severe enamel defects. An association was found between the severity of MIH and HSPM, both for mild defects (OR=87.54; 95%CI: 55.87, 137.17) and severe defects (OR=82.15; 95%CI: 45.72, 147.61). The severity of hypomineralization in permanent molars was associated with the activity of dental caries lesions (OR=29.85; 95%CI: 12.95, 68.83). To conclude, there is a strong association between the severity of HSPM and MIH, which is more significant in the presence of active dental caries lesions.

Resumo O objetivo desse estudo foi avaliar a associação entre a severidade da Hipomineralização de Segundos Molares decíduos (HSMD), da Hipomineralização de Molares e Incisivos (HMI) e cárie dentária em crianças. Neste estudo transversal foram incluídas 450 crianças entre 6 e 7 anos de idade. Um examinador calibrado classificou as hipomineralizações e lesões de cárie dentária utilizando o índice da HMI/HMD e o critério Nyvad, respectivamente. O desfecho primário foi a severidade da HMI de acordo com a severidade da HSMD. As análises estatísticas foram realizas usando o modelo linear generalizado e regressão logística ordinal. A prevalencia concomitante da HMI e HMSD foi de 26 % ajustada por sexo e idade. Defeitos leves foram mais frequentes que os defeitos severos. Foi encontrada a associação entre a severidade da HMI e da HSMD para defeitos leves (OR=87.54; IC95%: 55.87, 137.17) e severos (OR=82.15; IC95%: 45.72, 147.61). A severidade da hipomineralização em molares permamentes foi associada a atividade da lesão de cárie dentária (OR=29.85; IC95%: 12.95, 68.83). Conclui-se que existe uma forte associação entre a severidade da HSMD e da HMI, a qual foi mais significante na presença lesões ativas de cárie.

Consideraciones diagnósticas para la exodoncia de primeros molares permanentes severamente afectados por la Hipomineralización de Molares e Incisivos / Considerações diagnósticas para a exodontia de primeiros molares permanentes severamente afetados pela Hipomineralização de Molares e Incisivos / Diagnostic considerations for extraction of first permanent molars severely affected by Molar-Incisor Hypomineralization

Resumen La Hipomineralización de Molares e Incisivos (HMI) es un defecto de desarrollo del esmalte de origen multifactorial que afecta de uno a cuatro primeros molares permanentes y frecuentemente está asociada con incisivos permanentes. Clínicamente se caracteriza por presentar opacidades demarcadas de color blanco-crema y/o amarillo-café. En casos severos puede haber dolor, fracturas posteruptivas, lesiones de caries dental y/o restauraciones atípicas. Entre las opciones de tratamiento se encuentran restauraciones temporales con cemento de ionómero de vidrio, restauraciones en resina compuesta, coronas, restauraciones indirectas y exodoncia. El objetivo de este caso es analizar las consideraciones diagnósticas de la exodoncia de primeros molares permanentes severamente afectados por la HMI. Paciente de sexo femenino, 9 años de edad, patrón esquelético Clase I, maloclusión Clase I bilateral e HMI severa. Para el tratamiento se optó por realizar la exodoncia de los cuatro primeros molares permanentes bajo anestesia general. Luego de 10 meses, se observa que los segundos molares permanentes están clínicamente sanos y presentan inclinaciones y posiciones favorables para el cierre espontáneo del espacio. Se concluye que la exodoncia de primeros molares permanentes severamente afectados por la HMI es una estrategia que mejora el pronóstico del paciente y para realizarla, se requiere trabajar en conjunto con el ortodoncista para diagnosticar y planear individualmente cada caso.

Resumo A Hipomineralização de Molares e Incisivos (HMI) é um defeito de desenvolvimento do esmalte, de origem multifatorial que afecta de um a quatro primeiros molares permanentes e frequentemente está associada aos incisivos permanentes. Clinicamente se caracteriza como opacidades demarcadas de coloração branco-creme e/ou amarelo-café. Em casos severos pode haver dor, fraturas pós-irruptivas, lesões de cárie dentária e restaurações atípicas. Dentre as opções de tratamento estão as restaurações temporárias com cimento de ionômero de vidro, restaurações em resina composta, coroas, restaurações indiretas e a exodontia. Esta última opção permite que o segundo molar permanente se reposicione espontaneamente desde que realizada a tempo, portanto, é considerada uma alternativa viável e custo-efetiva. O objetivo deste caso foi analisar as considerações diagnósticas de exodontia de primeiros molares permanentes severamente afetados pela HMI. Paciente do sexo feminino, 9 anos de idade, padrão esquelético Classe I, maloclusão Classe I bilateral e HMI severa. Para o tratamento, optou-se por realizar a exodontia dos quatro primeiros molares permanentes sob anestesia geral. Após 10 meses, se observa que os segundos molares permanentes estão clinicamente saudáveis e apresentam inclinações e posicionamentos favoráveis para o fechamento espontâneo do espaço. Conclui-se que a exodontia de primeiros molares permanentes melhora o prognóstico do paciente e para realizá-la requer um trabalho em conjunto com o ortodontista para diagnosticas e planejar individualmente cada caso.

Abstract Molar and Incisor Hypomineralization (MIH) is an enamel development defect of multifactorial origin that affects one-to-four permanent first molars and is frequently associated with permanent incisors. Clinically it is characterized by demarcated white-cream and/ or yellow-brown opacities. In severe cases, there may be tooth pain, posteruptive fractures, dental caries lesions, and/ or atypical restorations. Treatment options include temporary restorations with glass ionomer cement, restorations with composite resin, crowns, indirect restorations, and tooth extraction. When extractions are performed at the right time, it allows the spontaneous replacement of the second permanent molar, therefore, it is considered a viable and cost/effective treatment. The objective of this case report is to analyze the diagnostic considerations for the extraction of first permanent molars severely affected by MIH. Female patient, 9 years old, Class I skeletal pattern, Class I malocclusion, and severe MIH. For the treatment, it was decided to perform the extraction of the first four permanent molars under general anesthesia. After 10 months, it is observed that the second permanent molars are clinically healthy and have favorable inclinations and positions for spontaneous closure of the space. It is concluded that the extraction of first permanent molars severely affected by MIH is a strategy that improves the patient's prognosis and to carry out, it is necessary to work together with the orthodontist to diagnose and plan each case individually.

Dental fluorosis severity in children 8-12 years old and associated factors / Severidad de fluorosis dental y factores asociados en niños de 8-12 años de edad

ABSTRACT The aim of this study was to determine the frequency and severity of dental fluorosis (DF) and the association between severity and risk factors. In a cross-sectional study, 8- to 12-year-old children, born in a Colombian district, were evaluated according to the Thylstrup and Fejerskov Index (TFI) by two calibrated examiners. Molar Incisor Hypomineralization (MIH) and dental caries (DC) were also evaluated. Ordinal logistic regression was applied (p<0.05). Risk factors and lifestyle factors were collected using a questionnaire answered by parents. DF was detected in 76 (98.7%) of the children (average of 18.4 ±1.81 permanent teeth affected). Grade TF2 was the most frequently observed (34.8%); TF5 was observed in all age groups; TF6- TF7 were observed in 12-year-olds. No association was found between DF severity and DC (Odds Ratio (OR)=1.35; 95%CI: 0.56-3.26) or MIH (OR=1.39; 95%CI: 0.43-4.46). DF severity was significantly associated with use of an indoor wood stove for food preparation (OR = 9.34; 95%CI: 1.11-78.57) and use of a pea-sized volume of toothpaste (OR = 27.42; 95%CI: 1.57-477.36). Prevalence of DC was 38.1% and prevalence of MIH was 14.4%. In this population, the frequency of DF was high and severity was associated with use of an indoor wood stove for food preparation and toothpaste amount used during childhood.

RESUMEN El objetivo de este estudio fue determinar la prevalencia y severidad de la Fluorosis Dental (FD) y la asociación de la severidad con factores de riesgo. Mediante un estudio transversal, niños (8-12 años-de-edad), nacidos en Ayapel (El Cedro-Colombia) fueron evaluados por 2 examinadores calibrados, según los criterios del índice de Thylstrup y Fejerskov (TFI) para FD. También se evaluaron la Hipomineralización molar-incisiva (HMI) y la caries dental (CD). Se aplicó un cuestionario de factores de riesgo y estilo de vida, a los padres/responsables de los niños. Se utilizó un modelo de regresión logística ordinal (p<0.05). Se encontró FD en 76 (98.7%) niños (con una media de dientes permanentes afectados de 18.4 ±1.81). La severidad categoría TF2 fue la más observada (34.8%) en los dientes evaluados. Las lesiones que presentan pérdida estructural moderada TF 6-7, fueron evidenciadas en el grupo de edad de 12 años. No se encontró asociación entre la severidad y la CD (OR=1.35; IC95%:0.56-3.26) o con HIM (OR=1.39; IC95%:0.43-4.46). Se encontró una asociación significativa con la severidad de la FD en los niños que utilizaban fogón de leña-interno para la preparación de los alimentos (OR=9.34; IC95%:1.11-78.57) y utilizaban un volumen de crema dental del tamaño de una alverja- pequeña (OR=27.42; IC95%:1.57-477.36). la prevalencia de CD fue 38.1% y de HMI fue 14.4%. La frecuencia de la FD fue alta y la severidad mostró correlación con la utilización de fogón de leña interno para la preparación de los alimentos y la cantidad de crema-dental utilizada.

Modified Hall technique for severely hypomineralized molars. Report of cases / Técnica de Hall modificada para molares severamente hipomineralizados. Reporte de casos / Técnica de Hall modificada para molares severamente hipomineralizados. Relato de caso

Abstract This article reviews the indications, objectives and step by step process of the Modified Hall Technique in the management of primary and permanent molars affected by severe enamel hypomineralization. Scientific based biological principles are discussed in order to provide relevant clinical information for Pediatric and General dentists in order to provide support for the safe use the technique in clinical practice.

Resumen En este artículo se revisan las indicaciones, objetivos y proceso paso a paso de la Técnica de Hall Modificada en el manejo de molares primarios y permanentes afectados por hipomineralización severa del esmalte. Los principios biológicos basados en la evidencia se discuten con el fin de proporcionar información clínica relevante para los odontólogos pediátricos y generales con el fin de proporcionar apoyo para el uso seguro de la técnica en la práctica clínica.

Resumo Neste artigo foram revisadas as indicações, objetivos e o passo a passo da Técnica de Hall Modificada para o manejo de molares decíduos e permanentes afetados pela hipomineralização severa do esmalte. Os princípios biológicos baseados na evidência são discutidos com o objetivo de proporcionar informações clínicas relevantes para odontopediatras e clínicos gerais, a fim de lhes fornecer apoio para o uso seguro da técnica na prática clínica.

Inheritance pattern of molar-incisor hypomineralization

Abstract The aim of this study was to investigate the segregation patterns of molar incisor hypomineralization (MIH) in families, given the evidence that its etiology is influenced by genetics. Clinically, MIH may be detected in parents and/or siblings of MIH-affected children. Our study included children with at least one first permanent molar affected by MIH (proband) and their first-degree relatives (parents and siblings). The participants were examined clinically to detect MIH, according to the European Academy of Paediatric Dentistry criteria (2003). A total of 101 nuclear families (391 individuals) were studied. Proband diagnosis was followed by MIH classification of the subject, his parents and siblings, as affected, unaffected, or unknown. Segregation analysis was performed using the multivariate logistic regression model of the Statistical Analysis for Genetic Epidemiology package, and segregation models (general transmission, environmental, major gene, dominant, codominant and recessive models). The Akaike information criterion (AIC) was used to evaluate the most parsimonious model. In all, 130 affected individuals, 165 unaffected individuals, and 96 unknown individuals were studied. Severe MIH was found in 50.7% of the cases. A segregation analysis performed for MIH revealed the following different models: environmental and dominance (p = 0.05), major gene (p = 0.04), codominant (p = 0.15) and recessive models (p = 0.03). According to the AIC values, the codominant model was the most parsimonious (AIC = 308.36). Our results suggest that the codominant model could be the most likely for inheriting MIH. This result strengthens the evidence that genetic factors, such as multifactorial complex defect, influence MIH.

In vivo effect of fluoride combined with amoxicillin on enamel development in rats

Abstract Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. Objective: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. Methodology: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). Results: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. Conclusion: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Aesthetical perception of dental fluorosis in a Colombian low income community / Percepção estética da fluorose dentária em uma comunidade colombiana de baixa renda / Percepción estética de la fluorosis dental en una comunidad colombiana de bajos ingresos

Abstract Introduction and objective: The Dental Fluorosis (DF) is a development defect of enamel resulting from overexposure to fluoride and can aesthetically compromise the patient. This study aims to investigate the relationship between aesthetic perception and dental fluorosis (DF) in a low-income community with high DF prevalence. Materials and methods: A cross-sectional study was conducted with 171 Colombian schoolchildren aged 8 to 12 years living in low socioeconomic community (El Cedro, district of Ayapel, Córdoba, Colombia). After receiving authorization, the students were examined for DMFT and dmft indexes (WHO criteria), and for DF (TF index). The aesthetic perceptions were verified by the Child Perceptions Questionnaire About Tooth Appearance (CQATA). Data analysis was carried out using descriptive statistics, the chi-square test, the Student´s t-test, the one-way ANOVA test, and linear regression at a significance level of p ≤ 0.05. Results: The prevalence of DF in this sample was 84.8% (n=145). Only the presence of caries (DMFT/ deft≠ 0) had a significant impact on aesthetic perceptions. A significantly lower rate was found in girls for the report of pleasant color domain. The number of teeth affected by DF had a significant positive correlation with mean overall perception of dental health. Conclusion: The presence of mild DF in children with low socioeconomic status, from a population with a high prevalence of the condition, did not seem to have an impact on the report of pleasant color of teeth domain.

Resumo Introdução e Objetivo: A fluorose dentária (FD) é um defeito de desenvolvimento do esmalte decorrente da sobre-exposição ao flúor e pode comprometer esteticamente o paciente. O presente estudo se propõe a investigar a relação entre percepção estética e fluorose dentária em uma comunidade de baixa renda com alta prevalência de FD. Materiais e métodos: Foi realizado um estudo transversal com 171 escolares colombianos de 8 a 12 anos de idade, moradores de uma comunidade de baixa renda (El Cedro, distrito de Ayapel, Córdoba, Colômbia). Após receber autorização, os estudantes foram examinados para os índices CPOD e ceod (OMS) e para o FD (TF index). As percepções estéticas foram verificadas pelo "Child Perception Questionaire about Teeth Appearence" (CQATA). A análise dos dados foi realizada por meio de estatística descritiva, teste do qui-quadrado, teste t de Student, teste ANOVA one-way e regressão linear em nível de significância de p ≤ 0,05. Resultados: A prevalência de FD nesta amostra foi de 84,8% (n = 145). Apenas a presença de cáries (CPOD/cpod≠0) teve um impacto significativo nas percepções estéticas. Uma taxa significativamente menor foi encontrada em meninas para o relato de domínio de cor agradável. O número de dentes afetados pela FD teve correlação positiva significativa com a percepção geral da saúde bucal. Conclusão: A presença de FD leve em crianças com baixo nível socioeconômico, de uma população com alta prevalência da doença, não parece ter impacto na satisfação com a coloração dos dentes.

Resumen Introducción y objetivo: La fluorosis dental (FD) es un defecto en el desarrollo del esmalte como resultado de la sobreexposición al fluoruro y puede comprometer estéticamente al paciente. Este estudio tiene como objetivo investigar la relación entre la percepción estética y la fluorosis dental en una comunidad de bajos ingresos económicos y con alta prevalencia de FD. Materiales y métodos: Se realizó un estudio transversal con 171 escolares de 8 a 12 años que viven en una comunidad socioeconómica baja (El Cedro, distrito de Ayapel, Córdoba, Colombia). Los estudiantes fueron examinados para caries dentaria (índices DMFT y dmft (criterios de la OMS) y para el fluorosis dentaria (índice TF). La percepción estética se verifico con el cuestionario sobre percepciones de los niños sobre la apariencia de los dientes (CQATA). El análisis de los datos se realizó mediante estadísticas descriptivas y las pruebas de chi cuadrado, t de Student, ANOVA de una vía y la regresión lineal (p ≤ 0.05). Resultados: La prevalencia de FD fue de 84.8% (n = 145). Solo la presencia de caries (DMFT/deft ≠ 0) tuvo un impacto significativo en las percepciones estéticas. Se encontró una tasa significativamente más baja en las niñas para el informe acerca de color agradable. La cantidad de dientes afectados por FD tuvo una correlación positiva significativa con la percepción general de la salud dental. Conclusión: La presencia de FD leve en niños con bajo nivel socioeconómico, en una población con una alta prevalencia de este defecto de esmalte, no pareció tener tuvo un impacto en la aceptción aceptar la apariencia del color de los dientes.

Uso de Biodentine para restaurar un molar permanente severamente afectado por la Hipomineralización de Molares e Incisivos / Use of Biodentine to restore a affected permanent molar severely by Molar-Incisor Hypomineralization / Uso de Biodentine para restaurar um molar permanente severamente afetado pela Hipomineralização de Molares e Incisivos

Resumen La Hipomineralización de Molares e Incisivos (HMI) es un defecto cualitativo del desarrollo del esmalte que afecta de uno a cuatro primeros molares permanentes, pudiendo estar asociado con los incisivos permanentes. Se estima que la prevalencia mundial es del 14.2%, siendo América del Sur la región con mayor prevalencia (18%). Clínicamente, los dientes afectados por la HMI presentan esmalte poroso y blando, acúmulo de biopelícula, lesiones de caries dental e hipersensibilidad. Los cambios estructurales y químicos pueden afectar los procedimientos restauradores. El objetivo del caso fue reportar el uso de un material bioactivo para la restauración de un primer molar permanente severamente afectado por la HMI. Paciente femenino de 7 años de edad que presenta en el diente 36 una lesión de caries activa cavitada, hipomineralización severa con fractura posteruptiva y exposición de dentina e hipersensibilidad. Luego de realizar la remoción selectiva del tejido cariado, se puso un substituto bioactivo de dentina a base de silicato tricálcico (Biodentine). Un mes después, el diente se restauró definitivamente con resina compuesta. Al seguimiento clínico de 12 meses la restauración presenta adecuada adaptación marginal, forma anatómica adecuada y sin evidencia de lesión de caries dental secundaria. Radiográficamente se observa adecuada adaptación de la restauración y sin cambios en el espacio del ligamento periodontal y región periapical. El uso de materiales bioactivos muestra ser una alternativa promisoria para la restauración de molares severamente afectados por la HMI.

Abstract Molar Incisor Hypomineralization (MIH) is a qualitative defect in the development of dental enamel that affects one to four first permanent molars and it might be associated with permanent incisors. Worldwide prevalence is estimated around 14.2%, being the highest in South America (18%). Clinical signs include porous and soft enamel, excessive biofilm formation, dental caries and hypersensitivity. Structural and chemical changes may affect restorative procedures. The objective of this case report was to describe the use of a bioactive restorative material on a severely-affected first permanent molar. A 7-year-old female patient presented with active dental caries lesion, severe hypomineralization with post-eruptive fracture, dentine exposure and hypersensitivity in tooth 36. After selective removal of carious tissue, a bioactive dentine substitute containing tricalcium silicate (Biodentine) was placed. One month later, the tooth was restored using resin composite. A follow-up exami- nation at 12 months showed good marginal adaptation, proper anatomical shape and no evidence of secondary caries. Radiographical examination showed correct adaptation of the restoration and normal space of the periodontal ligament and the periapical region. The use of bioactive materials seems to be a promising alternative for restoration of molars severely affected by MIH.

Resumo A Hipomineralização de Molares e Incisivos (HMI) é um defeito qualitativo do desenvolvimento do esmalte que afeta de um a quatro primeiros molares permanentes, podendo estar ou não associado aos incisivos permanentes. Estima-se que a prevalência mundial é de 14,2%, sendo a América do Sul a região com a maior prevalência (18%). Clinicamente, os dentes afetados pela HMI apresentam esmalte poroso e macio, acúmulo de biofilme, lesões de cárie dentária e hipersensibilidade. As alterações estruturais e químicas podem afetar os procedimentos restauradores. O objetivo deste caso foi reportar o uso de um material bioativo para a restauração de um primeiro molar permanente severamente afetado pela HMI. Paciente do sexo feminino de 7 anos de idade apresentava no dente 36 uma lesão de cárie cavitada e ativa, hipomineralização severa com fratura pós-irruptiva, com exposição de dentina e hipersensibilidade. Após a remoção seletiva do tecido cariado, colocou-se um substituto bioativo de dentina a base de silicato de cálcio (Biodentine). Um mês depois, o dente foi restaurado definitivamente com resina composta. No acompanhamento clínico de 12 meses, a restauração apresentava adaptação marginal e for- ma anatômica adequada e sem evidência de lesão de cárie secundária. Radiograficamente, observou-se adequada adaptação da restauração e sem alterações no espaço do ligamento periodontal e região periapical. O uso de materiais bioativos demonstram ser uma alternativa promissora para a restauração de molares severamente afetados pela HMI.

The effect of amoxicillin on dental enamel development in vivo

Abstract The exposure to amoxicillin has been associated with molar incisor hypomineralization. This study aimed to determine if amoxicillin disturbs the enamel mineralization in in vivo experiments. Fifteen pregnant rats were randomly assigned into three groups to received daily phosphatase-buffered saline or amoxicillin as either 100 or 500 mg/kg. Mice received treatment from day 13 of pregnancy to day 40 postnatal. After birth, the offsprings from each litter continued to receive the same treatment according to their respective group. Calcium (Ca) and phosphorus (P) content in the dental hard tissues were analyzed from 60 upper first molars and 60 upper incisors by the complexometric titration method and colorimetric analysis using a spectrophotometer at 680 nm, respectively. Lower incisors were analyzed by X-ray microtomography, it was measured the electron density of lingual and buccal enamel, and the enamel and dentin thickness. Differences in Ca and P content and electron density among the groups were analyzed by one-way ANOVA. There was no significant difference on enamel electron density and thickness among the groups (p > 0.05). However, in incisors, the higher dose of amoxicillin decreased markedly the electron density in some rats. There were no statistically significant differences in Ca (p = 0.180) or P content (p = 0.054), although the higher dose of amoxicillin could affect the enamel in some animals. The amoxicillin did not significantly alter the enamel mineralization and thickness in rats.

Qualidade de vida e percepção estética da cárie dentária / Quality of life and aesthetic perception of dental caries / Calidad de vida y la percepción estética de la caries dental

Objetivo: Relacionar a percepção estética e a qualidade de vida relacionada à saúde bucal na presença de cárie dentária em escolares. Métodos: Estudo transversal realizado em Araraquara, São Paulo, Brasil, entre outubro de 2014 e março de 2015, com 260 escolares, de 8 a 10 anos, divididos em grupos clínicos segundo a presença de cárie dentária. Utilizaram-se questionários "Child Perceptions Questionnaire" e "Child Questionnaire About Teeth Appearence" e avaliação clínica para detecção de dentes cariados, perdidos ou obturados em dentes permanentes e decíduos. Dados analisados através do teste qui-quadrado e Mann Whitney, p ≤ 0.05. Resultados: Dos 260 escolares, 130 (50%) apresentavam a doença cárie, com maior frequência (62,0%) na faixa etária 8 anos. Variáveis socioeconômicas, como menor renda familiar e menor escolaridade da mãe, estiveram associadas ao grupo com cárie (p<0,05 e p<0,01 respectivamente). No grupo com cárie, os domínios sintomas orais (4,9 vs 6,6), bem-estar emocional (3,0 vs 4,7) e bem-estar social (2,2 vs 3,5) foram maiores que no grupo sem cárie. Com relação à percepção estética, o domínio psicológico (0,94 vs 1,27) e a percepção geral de saúde bucal (2,26 vs 2,93) se apresentaram maiores no grupo com cárie. Na regressão linear, observou-se contribuição significativa dos números de dentes permanentes cariados e o índice ceo-d (dentes decíduos cariados, extraídos e obturados) na pior percepção de qualidade de vida. Conclusão: A cárie dentária afeta negativamente a percepção estética e a qualidade de vida em crianças de 8 a 10 anos.

Objetive: To relate the aesthetic perception and the oral health-related quality of life in the presence of dental caries in schoolchildren. Methods: Cross-sectional study carried out in Araraquara, São Paulo, Brazil, from October 2014 to March 2015, with 260 schoolchildren aged 8 to 10 years, divided into clinical groups according to the presence of dental caries. The Child Perceptions Questionnaire and the Child Questionnaire About Teeth Appearance were applied and a clinical evaluation of permanent and deciduous dentition was conducted for detection of decayed, missing or filled teeth. Data was analyzed using the chi-square test and Mann-Whitney's test, p ≤ 0.05. Results: Of the 260 students, 130 (50%) had caries disease, with the highest frequency (62.0%) in 8-year-olds. Socioeconomic variables, such as lower family income and lower maternal schooling, were associated with the dental caries group (p<0.05 and p<0.01, respectively). In the dental caries group, the domains oral symptoms (4.9 vs 6.6), emotional well-being (3.0 vs 4.7) and social well-being (2.2 vs 3.5) were higher than in the caries-free group. Regarding the aesthetic perception, the psychological domain (0.94 vs 1.27) and the overall perception of oral health (2.26 vs 2.93) were higher in the group with dental caries. In the linear regression, there was a significant contribution of the number of permanent decayed teeth and the dmft (decayed, missing and filled deciduous teeth) index to the worst perception of quality of life. Conclusion: Dental caries negatively affects aesthetic perception and quality of life in 8- to 10-year-old children.

Objetivo: Relacionar la percepción estética y la calidad de vida relacionada con la salud bucal de escolares con caries dental. Métodos: Estudio transversal realizado en Araraquara, São Paulo, Brasil, entre octubre de 2014 y marzo de 2015 con 260 escolares entre 8 y 10 años que fueron divididos en grupos clínicos según la presencia de caries dental. Se utilizaron los cuestionarios "Child Perceptions Questionnaire" y "Child Questionnaire About Teeth Appearence" y la evaluación clínica para detectar los dientes con caries, los perdidos u con obturaciones en dientes permanentes y deciduos. Los datos fueron analizados a través de las pruebas Chi-cuadrado y Mann Whitney con p ≤ 0,05. Resultados: Entre los 260 escolares, 130 (50%) tenían caries con más frecuencia en la franja de edad de 8 años (62,0%). Las variables socioeconómicas como la menor renta familiar y menor escolaridad de la madre se asociaron con el grupo que tenía caries (p<0,05 y p<0,01 respectivamente). Los dominios síntomas orales (4,9 vs 6,6), el bien estar emocional (3,0 vs 4,7) y el bien estar social (2,2 vs 3,5) fueron mayores en el grupo con caries que el grupo sin caries. Respecto la percepción estética, el dominio psicológico (0,94 vs 1,27) y la percepción general de salud bucal (2,26 vs 2,93) se presentaron mayores en el grupo con caries. A partir de la regresión linear se observó la contribución significativa de los números de dientes permanentes con caries y el índice ceo-d (dientes deciduos con caries, extraídos y con obturación) para la peor percepción de calidad de vida. Conclusión: La caries dental afecta de manera negativa la percepción de la estética y la calidad de vida de niños entre 8 y 10 años.

Clinical aspects of dental fluorosis according to histological features: a Thylstrup Fejerskov Index review / Aspectos clínicos da fluorose dentária de acordo com as características histológicas: revisão do índice Thylstrup Fejerskov / Aspectos clínicos de la fluorosis dental de acuerdo con las características histológicas: una revisión del índice de Thylstrup Fejerskov

Abstract Dental fluorosis is a developmental defect of enamel caused by chronic and excessive fluoride intake resulting in a hypomineralized enamel with increased porosity. It is clinically identified as spots ranging from mild white lines to opaque spots covering all or part of the enamel surface and breakdown after teeth eruption. However, the clinical definition of the fluorosis degree in teeth is not an easy task, having been presented many indices that generally qualify the severity degree with variations in the details. As the choice of treatment is closely linked to the defect severity, the purpose of this article is to present the clinical aspects of dental fluorosis represented through the Thylstrup-Fejerskov Index. The severity scores are presented according to histological features and the differences between them will be discussed in order to enable the dentist to correctly diagnose and choose the most appropriate treatment for the patient with DF.

Resumo A fluorose dental (FD) é um defeito de desenvolvimento do esmalte causado pela ingestão crônica e excessiva de flúor, resultando em um esmalte hipomineralizado com maior porosidade. Clinicamente é identificada como manchas que vão desde delicadas linhas brancas até manchas opacas que cobrem parte ou toda a superfície do esmalte podendo sofrer pigmentações ou fraturas após a irrupção. No entanto, a definição clínica do grau de comprometimento dos dentes não é uma tarefa fácil e tem sido apresentada na forma de índices que geralmente qualificam o grau de severidade com maior ou menor detalhes. Como a escolha do tratamento está intimamente ligada à gravidade do defeito, o objetivo deste artigo é apresentar os aspectos clínicos da fluorose dental representadas por meios do índice de Thylstrup-Fejerskov (1978). Os escores de severidade são apresentadas de acordo com as características histológicas e as diferenças entre eles serão discutidas a fim de permitir ao dentista diagnosticar corretamente e escolher o tratamento mais adequado para o paciente com FD.

Resumen La fluorosis dental (FD) es un defecto del desarrollo del esmalte dental causado por la ingesta crónica y excesiva de fluoruro, que resulta en un esmalte hipomineralizado y poroso. Clínicamente se manifiesta desde manchas y delicadas líneas blancas hasta manchas opacas que cubren parte o toda la superficie del esmalte, el cual es susceptible a pigmentaciones o fracturas post-eruptivas. Sin embargo, establecer el grado de compromiso de los dientes no es una tarea fácil y para esto se han presentado índices que determinan el grado de severidad con mayor o menor detalle. Como la decisión de tratamiento está estrechamente relacionada a la gravedad del defecto, el objetivo de este artículo es presentar los aspectos clínicos de la fluorosis dental de acuerdo al índice de Thylstrup-Fejerskov (1978). Los grados de severidad son representados de acuerdo con las características histológicas y las diferencias entre ellos son discutidas para que el odontólogo pueda diagnosticas correctamente y escoger el tratamiento más adecuado para el paciente con FD.

Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up

Abstract The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6–8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher’s exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

Comparación de medidas dentales y transversales realizadas en modelos de yeso con calibrador digital, y en modelos digitales con el software o3d / Comparison of dental and transversal measurements made on plaster model using a digital caliper and in digital model using the o3d software

Resumen Introducción y objetivo: Las medidas y análisis de modelos son esenciales para el diagnóstico de casos de ortodoncia. Actualmente, el análisis de modelos puede ser realizado de manera virtual a través de software de computador como el o3d. El objetivo de este estudio fue evaluar la reproductibilidad, confiabilidad y validez de medidas dentales y transversales en modelos digitales usando el software o3d y compararlas con las medidas obtenidas con el calibrador digital en modelos de yeso. Materiales y métodos: Treinta pares de modelos fueron escaneados y digitalizados. Dos examinadores midieron el tamaño dentario, distancia intercanina y distancia intermolar en modelos de yeso usando un calibrador digital y en modelos digitales usando el software o3d. Los datos fueron analizados usando el Coeficiente de Correlación Intraclase, prueba t pareada, la fórmula de Dahlberg y el análisis de varianza. Resultados: Excelente reproductibilidad intra e interexaminador fue observada en las medidas realizadas con el calibrador digital y el software o3d. No se presentaron errores aleatorios con ninguno de los dos métodos y el error sistemático fue más frecuente en los modelos digitales. Conclusión: El software o3d presentó un buen desempeño en términos de reproductibilidad, confiabilidad y validez en la medición del tamaño dentario y distancias transversales; aunque los métodos presentaron diferencias estadísticas, la magnitud de esa diferencia es clínicamente irrelevante.

Abstract Introduction and objetive: Measurements and analyses of dental casts are essential for precise diagnosis of an orthodontic case. At present, analyses of dental casts can be performed virtually, through computer software as o3d. The aim of this study was to evaluate the reproducibility, reliability and validity of measurements made in digital models using the o3d software compared to plaster models. Materials and methods: Thirty pair of plaster casts were scanned and digitized. Two examiners measured tooth size, intercanine distance and intermolar distance in a plaster model with a digital caliper and in a digital model using the o3d software system. The data were statistically analyzed by Intraclass Correlation Coefficient test, paired samples t test, Dahlberg's formula and analysis of variance. Results: Excellent intraexaminer and interexaminer agreement was observed in the measurments performed with digital caliper and o3d software. No random error was present in the measurements obtained with the digital caliper and o3d software; systematic error was more frequent in the digital casts. Conclusion: The o3d software presented a good performance in terms of reproducibility, reliability and validity in measuring tooth size and transverse distance. Although measurements made on plaster and digital models showed statistically significant differences, the magnitude of the differences does not appear to be clinically relevant.

Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth

The purpose of this study was to evaluate the 12-month clinical performance of glass ionomer restorations in teeth with MIH. First permanent molars affected by MIH (48) were restored with glass ionomer cement (GIC) and evaluated at baseline, at 6 and at 12 months, by assessing tooth enamel breakdown, GIC breakdown and caries lesion associations. The data were analyzed using the chi-square test and actuarial survival analysis. The likelihood of a restored tooth remaining unchanged at the end of 12 months was 78%. No statistically significant difference was observed in the association between increased MIH severity and caries at baseline (p > 0.05) for a 6-month period, or between increased MIH severity and previous unsatisfactory treatment at baseline (p > 0.05) for both a 6- and 12-month period. A statistically significant difference was observed in the association between increased MIH severity and extension of the restoration, involving 2 or more surfaces (p < 0.05) at both periods, and between increased MIH severity and caries at baseline (p < 0.05) at a 12-month period. Because the likelihood of maintaining the tooth structures with GIC restorations is high, invasive treatment should be postponed until the child is sufficiently mature to cooperate with the treatment, mainly of teeth affected on just one face.

Molar-incisor hypomineralization in schoolchildren of Manaus, Brazil

To analyze the prevalence and severity of Molar Incisor Hypomineralization (MIH) and its relationship with dental caries in public school children in Manaus/AM.Material and Methods:Overall, 2,062 primary school children aged 6-10 years were examined to obtain MIH, DMFT, dmft and DDE indexes. The participation of five schools in each district of the city of Manaus was randomly determined, totaling 40 schools, and in each of them, two classes of each grade of elementary school in two shifts were selected, totaling 10 classes. Clinical examinations were conducted by two previously calibrated examiners in school environment under natural lighting. Data collected were submitted to descriptive statistical analysis by Chi-square, Fisher's Exact and Mann-Whitney tests at 5% significance level. Results:The prevalence of MIH in Manaus was 9.12% and no significant association with gender and age of schoolchildren was found. The mandibular arch was the most affected, with greaternumber of teeth being affected on the left side. The most frequently affected teeth were the mandibular permanent first molars, followed by maxillary counterparts and maxillary/mandibular central incisors. The most frequent diagnosis was mild MIH. The DMFT of children with MIH was 1.58 and dmft was 2.47, higher than those of the unaffected group. A correlation was found between DDE and MIH. Conclusion:Earlydiagnosis of MIH is imperative, since children affected show high risk for the development of dental caries...

Abordaje conservador y mínimamente invasivo de la Hipomineralización Molar-Incisivo (HMI) -Relato de casos clínicos / Minimally invasive treatment for esthetic management of Molar-Incisor Hypomineralization (MIH) -A case report

La Hipomineralización Molar-Incisivo (HMI) es un defecto de esmalte de origen sistèmico que afecta uno o varios molares permanentes, asociado en algunos casos a los incisivos permanentes. Defectos de esmalte, como la HMI pueden influenciar negativamente la calidad de vida, percepción estètica y autoestima de niños y adolescentes. Las opciones de tratamiento para este tipo de alteración, incluye desde medidas preventivas y procedimientos restauradores hasta la extracción dental. Factores como la edad y expectativas del paciente, severidad de la alteración y materiales deben ser considerados en el plan de tratamiento del paciente con HMI. La utilización de resinas compuestas para la restauración de molares e incisivos ha mostrado buenos resultados relacionados a la durabilidad y estètica. Este artículo presenta dos casos clínicos sobre el abordaje de la HMI en dientes anteriores, realizando preparos cavitários conservadores por medio de puntas ultrasónicas adaptadas a un sistema de ultrasonido y restauración con resina compuesta, obteniendo resultados estéticos favorables con un año de acompañamiento.

Molar-Incisor Hypomineralization (MIH) is a qualitative developmental enamel defect that affects one to four permanent first molars, with or without involvement of permanent incisors. Enamel defects may produce many symptoms that have physical, social and psychological effects and influence day-to-day living or quality of life. The available treatment modalities for teeth with MIH are extensive, ranging from prevention, restoration, to extraction. Factors such as age, patient expectations, severity of the lesion and materials should be considered in the treatment of the patient with MIH. Restoration with composite resin is an alternative choice for posterior and anterior MIH defective teeth and its use has been show acceptable results. This article describes two clinical cases involving pediatric patients with MIH whose procedure of cavity preparation was based on the use of CVD ultrasound diamond tips and restored using composite resin obtaining favorable esthetics results after a 1 year follow-up.

Avaliação em modelos digitais das modificações ocorridas em modelos de gesso em função do posicionamento da moldeira / Evaluation of digital models changes in plaster cast as a result of the position of tray

O objetivo deste estudo foi avaliar se o posicionamento da moldeira durante o tempo de presa do gesso pode causar a distorção dos modelos. Um total de 30 pares de modelos-mestre foi moldado com alginato e imediatamente vertido com gesso pedra especial. Os modelos foram divididos em dois grupos: no grupo 1, o gesso foi vertido sobre o molde e aguardada a presa; no grupo 2, depois de vertido o gesso, o conjunto (molde e gesso) foi posicionado sobre uma bancada de trabalho, ficando sobre o gesso a moldeira e o molde. O tamanho dos dentes e as distâncias foram medidos utilizando-se as ferramentas do software O3D (Widialabs, Brasil) nas imagens dos modelos de gesso digitalizados por scanner a laser (3Shape R-700, 3Shape A/S). Os dados foram analisados pelo teste t pareado e pela regressão linear ao nível de significância de 5%. A maioria das medidas foi semelhante para ambos os grupos, exceto para a distância intermolares inferiores. Não foi possível comprovar a presença de distorções nas medidas analisadas em função da posição da moldeira durante a presa do gesso.

The objective of this study was to assess if the positioning of the impression tray could cause plaster casts distortion during gypsum setting time. Fifteen pairs of master models were cast with alginate impression material and immediately poured with gypsum. Impressions were allowed to set with the tray in the not inverted position (group A) or in the inverted position (group B). The plaster models were digitized using a laser scanner (3Shape R-700, 3Shape A/S). Tooth size measurements and distances were obtained using O3D software (Widialabs, Brasil) measurement tools. Data were analyzed by paired t test and linear regression with 5% significance. Most measurements of both groups were similar, except for the lower intermolar distance.It was not possible to corroborate the presence of distortions owing to the position of the impression tray during gypsum setting time.

Non-nutritive sucking associated with self-mutilating behavior / Hábito de sucção não-nutritiva associada à automutilação

Although sucking activity has been considered an essential behavior of early childhood to satisfy nutritive and non-nutritive needs, digit andpacifier sucking are deleterious oral habits that may interfere with child development. Furthermore, this clinical picture may be compounded by other concerning habits, such as self-mutilating behavior. This article reports 4-year follow-up of a child in whom non-nutritive sucking was associated with an unusual self-mutilating behavior; namely, the child would pull out her own hair after wrapping it around her finger every time she sucked on the pacifier. This occurred specially at bedtime, while she was watching TV, or when she was somewhat anxious, and remitted and recurred throughout the follow-up period. In an attempt to address this behavior, pacifier use was discontinued and the child?s head was shaved. Ultimately, the case was only solved through combined efforts involving the child, her family, and health professionals. Based on the parents? reports and clinical examination and follow-up findings, we emphasize the importance of investigating the origin of the problem and considering emotional aspects and its association with other habits in such cases.

Apesar de a atividade de sucção ser considerada um comportamento essencial da primeira infância por satisfazer as necessidades nutritivase não-nutritivas, a sucção do dedo e chupeta são hábitos deletérios ao desenvolvimento da criança. Além disso, esse quadro clínico podeser ainda mais preocupante se houver associação com outros hábitos, como o da automutilação. Neste contexto, no presente artigo sãorelatados 4 anos de acompanhamento de uma criança que costumava arrancar seus cabelos depois de enrolá-los nos dedos enquanto estavacom a chupeta na boca, sem demonstrar sinal algum de sintomatologia dolorosa. Tal fato ocorria especialmente próximo a períodos de sono, ansiedade ou quando assistia à televisão, havendo períodos de remissão e exacerbação. Na tentativa de solucionar o caso foi proposta, além da interrupção do uso da chupeta, a raspagem de todo o cabelo da criança. Contudo, a solução definitiva só foi possível quando houve o envolvimento coletivo, abrangendo criança, família e profissionais da saúde. Baseando-se no relato dos pais, no exame clínico e no acompanhamento do caso, enfatiza-se a importância de se investigar a origem do problema, considerando os aspectos emocionais e sua associação com outros hábitos.

Facial type measurements influence on transverse dimensions of normal occlusion arches / Influência das medidas do tipo facial nas dimensões transversas das arcadas em oclusão normal

To correlate facial type measurements of Caucasian individuals with transverse dimensions of normal occlusion arches. Methods -Twenty-one pairs of dental models were selected according to the following inclusion criteria: presence of all permanent teeth from 1st molar to 1st molar; normal occlusion; no prosthetic crowns; no previous orthodontic treatment and 2 mm or less of crowdings or spacings. The cephalometric measurements of lateral cephalometric X-ray of the same individuals were taken and tabulated.To evaluate the repetition of arch measurements, paired Student's t-test and Pearson's correlation coefficient were used. The relationship between the measurements was analysed by using the Pearson's correlation. Results - The repetition of the measurements showed high correlation and no systematic error. In the comparison between the measurements, a moderate negative correlation was observed between facial axis angle and the measurements Upper and Lower 6-6, whereas a positive correlation was observed between dentition height and the latter. Conclusion - It was observed a negative correlation between facial axis angle and upper and lower inter-molar distance as well as a positive correlation between dentition height and upper and lower inter-molar distance...

Correlacionar medidas do tipo facial, em indivíduos leucodermas, com dimensões transversas das arcadas em oclusão normal. Métodos -Vinte e um pares de modelos de gesso foram selecionados de acordo com os requisitos de inclusão: presença de todos os dentes permanentes de 1° molar a 1° molar; oclusão normal; sem coroas protéticas; nenhum tratamento ortodôntico prévio e apinhamentos ou espaçamentos menores ou iguais a 2 milímetros. As medidas cefalométricas das telerradiografias laterais destes mesmos indivíduos foram consultadas e tabuladas. Para a avaliação da repetibilidade das medidas das arcadas foram utilizados o teste t de Student pareado e o coeficiente de Pearson. O grau de associação entre as medidas foi analisado pelo coeficiente de correlação de Pearson. Resultados - A repetibilidade de medidas demonstrou alta correlação e ausência de erro sistemático. Na comparação entre as medidas houve correlação negativa moderada do ângulo do eixo facial com as medidas Sup 6-6 e Inf 6-6 e correlação positiva da altura da dentição com as medidas Sup 6-6e Inf 6-6. Conclusão - Houve correlação negativa entre ângulo do eixo facial e as distâncias intermolares superiores e inferiores e, correlação positiva entre a altura da dentição e as distâncias intermolares superiores e inferiores...

Comparison of space analysis performed on plaster vs. digital dental casts applying Tanaka and Johnston's equation

OBJECTIVE: The purpose of this study was to compare dental size measurements, their reproducibility and the application of Tanaka and Johnston regression equation in predicting the size of canines and premolars on plaster and digital dental casts. METHODS: Thirty plaster casts were scanned and digitized. Mesiodistal measurements of the teeth were then performed with a digital caliper on the plaster and digital casts using O3d software system (Widialabs©).The sum of the sizes of the lower incisors was used to obtain predictive values of the sizes of the premolars and canines using the regression equation, and these values were compared with the actual sizes of the teeth. The data were statistically analyzed by applying to the results Pearson's correlation test, Dahlberg's formula, paired t-test and analysis of variance (p<0.05). RESULTS: Excellent intraexaminer agreement was observed in the measurements performed on both dental casts. No random error was present in the measurements obtained with the caliper and systematic error (bias) was more frequent in the digital casts. Space prediction obtained by applying the regression equation was greater than the sum of the canines and premolars on the plaster and digital casts. CONCLUSIONS: Despite an adequate reproducibility of the measurements performed on both casts, most measurements on the digital casts were higher than those on the plaster casts. The predicted space was overestimated in both models and significantly higher in the digital casts.

OBJETIVO: comparar medidas de tamanhos dentários, suas reprodutibilidades e a aplicação da equação de regressão de Tanaka e Johnston na predição do tamanho dos caninos e pré-molares em modelos de gesso e digital. MÉTODOS: trinta modelos de gesso foram escaneados para obtenção dos modelos digitais. As medidas do comprimento mesiodistal dos dentes foram obtidas com paquímetro digital nos modelos de gesso e nos modelos digitais utilizando o software O3d (Widialabs). A somatória do tamanho dos incisivos inferiores foi utilizada para obter os valores de predição do tamanho dos pré-molares e caninos utilizando equação de regressão, e esses valores foram comparados ao tamanho real dos dentes. Os dados foram analisados estatisticamente, aplicando-se aos resultados o teste de correlação de Pearson, a fórmula de Dahlberg, o teste t pareado e a análise de variância (p < 0,05). RESULTADOS: excelente concordância intraexaminador foi observada nas medidas realizadas em ambos os modelos. O erro aleatório não esteve presente nas medidas obtidas com paquímetro, e o erro sistemático foi mais frequente no modelo digital. A previsão de espaço obtida pela aplicação da equação de regressão foi maior que a somatória dos pré-molares e caninos presentes nos modelos de gesso e nos modelos digitais. CONCLUSÃO: apesar da boa reprodutibilidade das medidas realizadas em ambos os modelos, a maioria das medidas dos modelos digitais foram superiores às do modelos de gesso. O espaço previsto foi superestimado em ambos os modelos e significativamente maior nos modelos digitais.