Defeitos de desenvolvimento do esmalte e a sua relação com as fissuras orofaciais isoladas.
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Data
2023-03-03
Autores
Farias, Aline Leite de
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Universidade Estadual Paulista (Unesp)
Resumo
Pacientes fissurados podem ser mais suscetíveis aos defeitos de desenvolvimento do esmalte (DDE), porém é necessário conhecer quais tipos de DDE são mais frequentes, caracterizá-los e verificar se existe alguma relação com os procedimentos cirúrgicos. Os objetivos deste estudo foram caracterizar os DDE mais frequentes em pacientes fissurados; caracterizar a hipomineralização de molares decíduos (HMD) e a hipomineralização de molares e incisivos (HMI) nesta população, bem como de outros DDE que são diagnóstico diferencial entre si; e avaliar a associação entre a presença e severidade da HMD e HMI nesses pacientes, considerando a dentição, tipo de dente, quadrante, fenótipo e lateralidade das fissuras. Este estudo transversal avaliou fotografias intraorais de 290 pacientes fissurados com idades entre 3 e 14 anos e que foram atendidos em um hospital de referência no tratamento. Os fenótipos das fissuras foram divididos em: fissuras labiais (FL); labiais com acometimento de osso alveolar (FLa), labiopalatinas (FLP) e palatinas (FP), de acordo com as informações obtidas nos prontuários médicos. A classificação dos DDE foi realizada por um examinador previamente calibrado utilizando o índice HMI. Os dados foram analisados por meio de frequências e porcentagens para as variáveis categóricas e de média e desvio padrão para as variáveis quantitativas. Análises de associação foram realizadas usando um modelo linear generalizado binomial e regressão logística ordinal. A maioria da população era do sexo masculino (59,3%), sendo as FLP mais frequentes (68,3%), assim como o lado esquerdo foi o mais afetado (64,3%). Aproximadamente 77,2% dos pacientes avaliados apresentaram algum tipo de DDE e o mais frequente foi a hipomineralização demarcada. O fenótipo da fissura também teve influência sobre o tipo de DDE manifestado, sendo as FLP e FP mais associadas às hipomineralizações demarcadas, enquanto as FLa foram mais associadas às hipoplasias. O procedimento cirúrgico de adesão labial aumentou o risco para as hipoplasias. Dos 6432 dentes avaliados, os molares decíduos e permanentes foram mais afetados pela HMD e HMI, enquanto os incisivos e caninos foram mais afetados pelas hipoplasias. No geral, o arco superior foi o mais afetado e as fissuras com acometimento do palato foram mais associadas à HMD e HMI. A prevalência de HMD foi de 34,8%, de HMI de 36,6% e ambas as condições concomitantes estavam presentes em 19,4% dos pacientes. A presença de HMD aumentou o risco para HMI em 4,8 vezes. Houve uma forte associação entre as severidades, sendo que os casos severos de HMD aumentaram o risco da HMI severa. Conclui-se que a hipomineralização demarcada foi o DDE mais frequente em pacientes fissurados e o fenótipo da fissura tem influência sobre o tipo de DDE manifestado. O procedimento de adesão labial aumentou as chances de os pacientes apresentarem hipoplasia, enquanto a palatoplastia e enxerto ósseo alveolar diminuiu as probabilidades. Os pacientes apresentaram alta prevalência de HMD e HMI no arco superior e também estiveram associadas aos fenótipos mais severos das fissuras. A HMD também foi preditora para HMI nesses pacientes e com ênfase para os casos mais severos também apresentarem HMI severa.
Cleft patients may be more susceptible to enamel development defects (EDD), but it is necessary to know which types of EDD are more frequent, to characterize them, and to see if there is any relationship with surgical procedures. The aims of this study were to characterize the most frequent EDD in cleft patients; to characterize deciduous molar hypomineralization (DMH) and molar incisor hypomineralization (MIH), as well as other EDD that are differential diagnoses between them; and to evaluate the association between the presence and severity of DMH and MIH in these patients, considering dentition, tooth type, quadrant, phenotype, and cleft laterality. This cross-sectional study evaluated intraoral photographs of 290 cleft patients aged 3 to 14 years who were seen at a reference treatment hospital. Cleft phenotypes were divided into: cleft lip (CL), cleft lip with alveolar bone involvement (CLa), cleft lip and palate (CLP), and cleft palate (CP). The EDD classification was performed by a previously calibrated examiner using the MIH index. Data were analyzed using frequencies and percentages for categorical variables and means and standard deviation for quantitative variables. Association analyses were performed using a generalized binomial linear model and ordinal logistic regression. Most of the population was male (59.3%), CLP was the most frequent (68.3%), and the left side was the most affected (64.3%). Approximately 77.2% of the patients evaluated had some type of EDD, and the most frequent was demarcated hypomineralization. The cleft phenotype also had an influence on the type of EDD manifested, with CLP and CP being more associated with demarcated hypomineralizations, while CLa were more associated with hypoplasia. The surgical procedure of lip adhesion increased the risk for hypoplasias. Of the 6432 teeth evaluated, deciduous and permanent molars were more affected by DMH and MIH, while incisors and canines were more affected by hypoplasia. Overall, the upper arch was the most affected and clefts with palate involvement were most associated with DMH and MIH. The prevalence of DMH was 34.8%, MIH was 36.6% and both concomitant conditions were present in 19.4% of the patients. The presence of DMH increased the risk for MIH by 4.8-fold. There was a strong association between the severities, with severe cases of DMH increasing the risk of severe MIH. We conclude that demarcated hypomineralization was the most frequent EDD in cleft patients and the phenotype of the cleft has an influence on the type of EDD manifested. Patients had a high prevalence of DMH and MIH in the upper arch and were also associated with the most severe cleft phenotypes. The DMH was also predictive for MIH in these patients and with emphasis on the most severe cases also presented severe MIH.
Cleft patients may be more susceptible to enamel development defects (EDD), but it is necessary to know which types of EDD are more frequent, to characterize them, and to see if there is any relationship with surgical procedures. The aims of this study were to characterize the most frequent EDD in cleft patients; to characterize deciduous molar hypomineralization (DMH) and molar incisor hypomineralization (MIH), as well as other EDD that are differential diagnoses between them; and to evaluate the association between the presence and severity of DMH and MIH in these patients, considering dentition, tooth type, quadrant, phenotype, and cleft laterality. This cross-sectional study evaluated intraoral photographs of 290 cleft patients aged 3 to 14 years who were seen at a reference treatment hospital. Cleft phenotypes were divided into: cleft lip (CL), cleft lip with alveolar bone involvement (CLa), cleft lip and palate (CLP), and cleft palate (CP). The EDD classification was performed by a previously calibrated examiner using the MIH index. Data were analyzed using frequencies and percentages for categorical variables and means and standard deviation for quantitative variables. Association analyses were performed using a generalized binomial linear model and ordinal logistic regression. Most of the population was male (59.3%), CLP was the most frequent (68.3%), and the left side was the most affected (64.3%). Approximately 77.2% of the patients evaluated had some type of EDD, and the most frequent was demarcated hypomineralization. The cleft phenotype also had an influence on the type of EDD manifested, with CLP and CP being more associated with demarcated hypomineralizations, while CLa were more associated with hypoplasia. The surgical procedure of lip adhesion increased the risk for hypoplasias. Of the 6432 teeth evaluated, deciduous and permanent molars were more affected by DMH and MIH, while incisors and canines were more affected by hypoplasia. Overall, the upper arch was the most affected and clefts with palate involvement were most associated with DMH and MIH. The prevalence of DMH was 34.8%, MIH was 36.6% and both concomitant conditions were present in 19.4% of the patients. The presence of DMH increased the risk for MIH by 4.8-fold. There was a strong association between the severities, with severe cases of DMH increasing the risk of severe MIH. We conclude that demarcated hypomineralization was the most frequent EDD in cleft patients and the phenotype of the cleft has an influence on the type of EDD manifested. Patients had a high prevalence of DMH and MIH in the upper arch and were also associated with the most severe cleft phenotypes. The DMH was also predictive for MIH in these patients and with emphasis on the most severe cases also presented severe MIH.
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Palavras-chave
Fenda labial, Fissura palatina, Esmalte dentário, Hipoplasia do esmalte dentário, Cleft lip, Cleft palate, Dental enamel, Dental enamel hypoplasia