Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system

OBJECTIVES

To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system.

MATERIALS AND METHODS

Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained.

RESULTS

Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54).

CONCLUSION

Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration.

CLINICAL RELEVANCE

This study can provide information for decision-making.

Association between molar hypomineralization, genes involved in enamel development, and medication in early childhood: A preliminary study

BACKGROUND

Molar hypomineralization (MH) is defined as a multifactorial condition, and thus, its presence may be defined by interactions between environmental and genetic factors.

AIM

To evaluate the association between MH, genes involved in enamel development, and the use of medication during pregnancy in early childhood.

DESIGN

One hundred and eighteen children, 54 with and 64 without MH, were studied. The data collected included demographics, socioeconomic data, and the medical history of mothers and children. Genomic DNA was collected from saliva. Genetic polymorphisms in ameloblastin (AMBN; rs4694075), enamelin (ENAM; rs3796704, rs7664896), and kallikrein (KLK4; rs2235091) were evaluated. These genes were analyzed by real-time polymerase chain reaction using TaqMan chemistry. The software PLINK was used to compare allele and genotype distributions of the groups and to assess the interaction between environmental variables and genotypes (p < .05).

RESULTS

The variant allele KLK4 rs2235091 was associated with MH in some children (odds ratio [OR]: 3.75; 95% confidence interval [CI] = 1.65-7.81; p = .001). Taking medications in the first 4 years of life was also associated with MH (OR: 2.94; 95% CI = 1.02-6.04; p = .041) and specifically in association with polymorphisms in ENAM, AMBN, and KLK4 (p < .05). The use of medications during pregnancy was not associated with MH (OR: 1.37; 95% CI = 0.593-3.18; p = .458).

CONCLUSION

The results of this study suggest that taking medication in the postnatal period appears to contribute to the etiology of MH in some evaluated children. There may be a possible genetic influence of polymorphisms in the KLK4 gene with this condition.

Evaluation of genetic polymorphisms in MMP2, MMP9 and MMP20 in Brazilian children with dental fluorosis

Recent studies suggested that genetics contribute to differences in dental fluorosis (DF) susceptibility among individuals having the same environmental exposure. This study evaluated if MMP2, MMP9 and MMP20 are expressed during enamel development and assessed the association between polymorphisms in these genes with DF. Mice susceptible and resistant to DF were used to evaluate if MMPs were candidate genes for DF. The animals received fluoride and their enamels were used for immunohistochemistry. Additionally, 481 subjects from a city with fluoridation of public water supplies were recruited. Genotyping was performed using real time PCR. Allele/genotype frequencies were compared between groups. MMP2, MMP9 and MMP20 immunostaining was detected in both animal groups. DF was observed in 22.4% of the subjects. A borderline association was observed in MMP2 (rs243865), MMP9 (rs17576) and in MMP20 (rs1784418) (p = 0.06, p = 0.08 and p = 0.06 respectively). Briefly, MMPs were expressed during enamel maturation and genetic polymorphisms were not associated with DF.

The functional EGF+61 polymorphism and nonsyndromic oral clefts susceptibility in a Brazilian population

Nonsyndromic oral clefts are considered a problem of public health in Brazil, presenting a multifactorial etiology that involves genetic and environmental components, such as maternal alcohol consumption. Several candidate genes have been investigated to identify some association with nonsyndromic clefts risk. The epidermal growth factor (EGF) gene is implicated in the normal craniofacial development and its functional +61 A>G polymorphism has been related to cancer susceptibility. It has been suggested that cancer and oral clefts may share the same molecular pathways.Objective Our goal was to evaluate the association between the EGF+61 A>G polymorphism and nonsyndromic oral clefts susceptibility.Material and Methods The case-control study included 218 cleft cases and 253 controls from Brazil. The control group was comprised of individuals without congenital malformations, dental anomalies and family history of clefts. The cleft phenotypes and subphenotypes were determined based on clinical examination. Genomic DNA was extracted from oral mucosa cells obtained by mouthwash. The EGF+61 A>G polymorphism genotype was determined by polymerase chain reaction-restriction fragment length polymorphism.Results We noticed the association between maternal alcohol consumption during pregnancy and cleft occurrence. The A allele and AA genotype were over-represented in cleft cases compared with control group when we considered the bilateral cleft lip with or without cleft palate (CL±P) cases, cleft cases with tooth agenesis and cleft cases presenting family history of cleft, but the differences were not statistically significant. Contradictorily, the G allele was higher in cleft palate only (CP) cases than in control group, showing a borderline p value. Comparing the different cleft phenotypes, we observed statistical differences between CP and CL±P cases. Our data suggest the EGF+61 A>G polymorphism was not related with nonsyndromic oral clefts susceptibility in a Brazilian population, but supported the different genetic background between CL±P and CP. Moreover, we confirmed the potential effect of maternal alcohol intake on cleft risk in our population.

Discordant tooth agenesis and peg-shaped in a pair of monozygotic twins: Clinical and molecular study

The present report aimed to study an uncommon case of a pair of twins that presented a discordant dental phenotype. Family investigation, clinical, radiographic examination and molecular analysis were performed in both girls. Molecular analysis confirmed the monozygosity by deoxyribonucleic acid chip technology. One twin presented tooth agenesis in left upper lateral incisor and peg-shaped on the contra lateral side while the other twin had no dental alterations. The dental casts study employed digital caliper to compare morphological dimensions and showed alteration only in peg-shaped tooth. In conclusion, this study provide support that one or more mutated gene could cause discordances in dental phenotype in these monozygotic twins.

Image-based evaluation of facial fractures in a child using computed tomography

This article describes the case of a boy who had a fracture of the mandibular parasymphysis region associated with a fracture of the contralateral condyle. Panoramic and computed tomography images were used to monitor bone remodeling.

TGFB3 and BMP4 polymorphism are associated with isolated tooth agenesis

OBJECTIVE

To evaluate the association of the polymorphisms in the TGFB3 gene (rs2268626) and the BMP4 gene (rs17563) with isolated human tooth agenesis.

MATERIALS AND METHODS

One hundred and seventy-five unrelated individuals (125 control individuals without tooth agenesis and 50 cases with tooth agenesis) were evaluated using a case-control design. The participants of the study were recruited through the Dental School of the Federal University of Rio de Janeiro, Brazil. Genotyping of the selected polymorphisms for TGFB3 (48 individuals with tooth agenesis and 125 control cases) and BMP4 (46 individuals with tooth agenesis and 88 control cases) were carried out by real-time PCR using the Taqman assay method from a genomic DNA isolated from buccal epithelial cells of all individuals.

RESULTS

Significant statistical differences were found for genotype frequencies between tooth agenesis and TGFB3 control samples (p = 0.026). In addition, significant differences were also observed for allele and genotype frequencies between unilateral tooth agenesis and TGFB3 control samples (p = 0.014 and 0.004 for allele and genotype frequencies, respectively). For BMP4, genotype distribution had a statistically significant difference between groups (p = 0.047). The GG genotype of BMP4 was more frequent in individuals with three or more missing teeth than in the control group (p < 0.0001).

CONCLUSIONS

These results indicate that polymorphisms in the TGFB3 gene and in BMP4 genes contribute to tooth agenesis. Nonetheless, the extents to which this polymorphism may actually contribute to the tooth agenesis status should be clarified.

Mesio-Distal and Buccal-Lingual Tooth Dimensions are Part of the Cleft Spectrum: A Pilot for Future Genetic Studies

Objective : Considering that oral clefts and tooth dimensions may be part of the same phenotypic spectrum, the aim of this study was to investigate tooth dimensions in permanent dentition and dental malformations, including tooth size discrepancies, of subjects born with clefts compared with individuals without clefts. Design : Cross-sectional study. Participants : The cleft group was composed of 66 subjects, and the noncleft group consisted of 66 healthy unrelated subjects. Main Outcome Measures : The mesio-distal and buccal-lingual crown diameter of fully erupted permanent teeth outside the cleft area was measured using a digital caliber. Clinical records and radiographs were used to evaluate the type of clefts and dental anomalies. Results : The lower second premolar was significantly reduced in the CLP and CP groups. The upper lateral incisor was found to be significantly smaller in the CP group, only for mesio-distal dimensions (P < .05). Dental agenesis was found in eight (12%) cleft subjects and supernumerary teeth in two (3%). Conclusions : Subjects born with oral clefts presented size reduction in specific dental groups.

Management of an unerupted dilacerated maxillary central incisor after trauma to the primary predecessor

The most common cause of permanent maxillary incisor dilaceration is usually trauma to the primary predecessor, such as avulsions, intrusions, or gross displacement of primary incisors. The purpose of this case report was to describe the surgical exposure and orthodontic traction of an unerupted dilacerated permanent maxillary central incisor performed on a young girl. During the surgical exposure, a hole was placed in the tooth crown, and elastic chains, inserted though the hole, were used for traction. The alignment and leveling of the impacted incisor were performed with sequential stainless steel wires. Good periapical and periodontal health, combined with adequate occlusion and a positive esthetic outcome, demonstrated the satisfactory results of this case.

Dental anomalies in children born with clefts: a case-control study

OBJECTIVE

To determine the presence of specific patterns of dental defects in a group of individuals born with clefts.

DESIGN

Case-control.

SETTING

Nossa Senhora do Loreto Municipal Hospital and Federal University of Rio de Janeiro Pediatric Dentistry Clinics, Rio de Janeiro, Brazil.

PATIENTS

642 radiographic and clinical records were evaluated for 321 cases and 321 controls.

RESULTS

Individuals born with clefts presented considerably more dental anomalies in comparison with controls (p  =  .0001). The most frequent was tooth agenesis (n  =  53; p  =  .001), followed by supernumerary teeth (n  =  14; p  =  .11) and tooth malposition (n  =  11; p  =  .33). Regarding tooth agenesis, the upper lateral incisors were more frequently absent in the cleft group (31/86), and control individuals presented more agenesis of the mandibular second premolars (19/45).

CONCLUSIONS

The higher prevalence of dental anomalies, especially number anomalies, opposite the cleft area, in individuals born with cleft lip and/or palate is the most common associated dental anomaly outside the cleft area.

Prevalence of dental anomalies in nonsyndromic individuals with cleft lip and palate: a systematic review and meta-analysis

OBJECTIVE

To assess whether individuals born with nonsyndromic oral clefts display a higher frequency of dental anomalies.

DESIGN

A search of MEDLINE, BIREME, OVID ALL EMB Reviews, and The Cochrane Library was conducted. The methodologic quality of the papers selected was assessed and scored. Papers reporting observational controlled studies of nonsyndromic forms of oral cleft matched for dental anomalies in primary and/or permanent teeth were included without language restrictions. Eligible studies were scored as "A"-low risk of bias, "B"-moderate risk of bias, or "C"-high risk of bias and poor quality. Fixed and random effects models were used to aggregate individual odds ratios (OR) and to derive pooled estimates and 95% confidence intervals.

RESULTS

Six studies fulfilled our selection criteria and were included in the meta-analysis. Three distinct subgroup analyses were carried out in terms of dental anomalies. In the tooth agenesis meta-analysis, a random effects model was used because of heterogeneity and showed a significant association between tooth agenesis and oral clefts (OR  =  12.31; 95% confidence interval [CI]  =  3.75 to 40.36). In the remaining analyses, the fixed effects model revealed a positive association between supernumerary (OR  =  4.99; 95% CI, 2.58 to 9.64) and crown morphologic abnormalities (OR  =  5.69; 95% CI, 3.96 to 8.19) with oral clefts. Most included studies were of low to moderate quality.

CONCLUSION

Although general limitations in study design were observed, the evidence suggests that a higher number of dental anomalies in the permanent dentition are noted in individuals born with oral clefts.

Supernumerary teeth vary depending on gender

The presence of supernumerary teeth (ST) is a dental developmental anomaly of patterning and morphogenesis. Its variability of morphology, location and developmental timing can shed light on its etiology. In this work we report ST patterns. Orthopantomograms of 1,166 pediatric subjects were examined and the morphology, location and timing of the formation of ST were determined. The frequency of supernumerary teeth in the studied population was 2.3% (n = 27). Twenty-five subjects presented one ST. Maxilla midline was the most commonly affected region (nine cases). We noted high incidence of conical morphology in the midline region. Only teeth with tuberculate morphology presented delayed formation. ST in the midline region occurred more often in males whereas ST in the incisor region were more common in females. In conclusion, ST patterns vary depending on gender.

Developmental dental alterations in permanent teeth after intrusion of the predecessors: clinical and microscopic evaluation

This case report describes the management of developmental dental alterations in permanent dentition as a consequence of severe intrusive luxation in its predecessors in a child of 2 years. At 10 years of age, this patient was referred for consultation due to lack of permanent maxillary right central and lateral incisors. Radiographic examination revealed impaction of hypoplasic permanent maxillary central incisor, absence of the lateral incisor and compound odontoma in region of the permanent maxillary lateral incisor. The odontoma was surgically removed and unerupted central incisor was placed in orthodontic traction over a period of 8 months. The central incisor presented with abnormal shape and was restored with composite resin. Odontoma histologic analysis was carried out through Hematoxylin and Eosin coloration and Scanning Electron Microscopy. Cement and osteocement formations were found in soft tissue, as well as some irregularly distributed dentine islands of tooth-like structures, indicative of compound odontoma. We followed up this patient for 5 years and orthodontic management was successfully performed for correct alignment of the maxillary right central incisor impacted by compound odontoma.

Studies of dental anomalies in a large group of school children

The identification of specific patterns of dental anomalies would allow testing the hypothesis that certain genetic and environmental factors contribute to distinct dental anomaly subphenotypes. A sexual dimorphism in tooth agenesis and its association with other dental anomalies has been suggested. The aim of this study was to investigate a large group of children to define dental anomaly subphenotypes that may aid future genetic studies. Orthopantamograms of 1198 subjects were examined and 1167 were used in this study. The frequency of tooth agenesis in the studied population was 4.8%. Male:female ratios varied from 2:1 in the agenesis of upper lateral incisors to 0.5:1 in premolar agenesis. The risk of infra-occlusion of primary molars and double formation of primary incisors was increased in individuals with tooth agenesis.