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Hoan NQ, Huyen NP, Son DC, Thien DH, Sabet CJ, Ngoc VTN. Effectiveness of resin infiltration in the management of anterior teeth affected by molar incisor hypomineralisation (MIH): A systematic review and meta-analysis. J Dent 2024; 149:105254. [PMID: 39067648 DOI: 10.1016/j.jdent.2024.105254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVES To evaluate the effectiveness of resin infiltration in improving the aesthetic appearance of anterior teeth affected by molar-incisor hypomineralisation (MIH). DATA SOURCES PubMed, Scopus, EMBASE, Web of Science, ScienceDirect, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2009 to 2024. The protocol was registered in the International Prospective Database of Systematic Reviews (PROSPERO CRD42023461909). STUDY SELECTION Interventional or comparative studies comparing resin infiltration and other treatments in MIH-affected anterior teeth were included. The risk of bias was evaluated using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I tool) and the Risk of Bias 2 (RoB 2.0) tool. Meta-analysis utilized a random-effects model. DATA Eighteen studies met the inclusion criteria, and twelve were included in the meta-analysis. Resin infiltration showed a higher color difference (ΔE) before and after treatment (mean difference 2.21, 95 % confidence interval [CI] 0.04-4.38, p < 0.001, I2 = 98.61 %, p < 0.001) and better optical improvement (standardised mean difference [SMD] 2.68; 95 %CI 0.30-5.06; p = 0.027, I2 = 97.8 %, p < 0.001) compared to controls. The estimated success rate based on dentist assessment was 92 % (95 %CI 88-95 %, I2 = 17.92 %, p = 0.06). Non-randomised trials showed high (8/14) or moderate (6/14) risk of bias, mainly from confounding and selection issues. Randomised trials had high risk (1/3) or some concerns (2/3) due to missing data. CONCLUSIONS The findings suggest that resin infiltration significantly improves aesthetic outcomes in MIH-affected anterior teeth, as evidenced by higher colour difference and optical improvement compared to controls. CLINICAL SIGNIFICANCE While our study shows promising results for resin infiltration, including high success rates and aesthetic improvements, larger-scale studies with longer follow-up periods are necessary to confirm these findings and assess its long-term efficacy.
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Affiliation(s)
- Nguyen Quoc Hoan
- School of Dentistry, Hanoi Medical University, Hanoi 100000, Viet Nam.
| | - Nguyen Phuong Huyen
- School of Dentistry, Hanoi Medical University, Hanoi 100000, Viet Nam; Hanoi National Hospital of Odonto-Stomatology, Hanoi 100000, Viet Nam
| | - Dang Cong Son
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Viet Nam
| | - Dang Huu Thien
- College of Health Sciences, VinUniversity, Hanoi 100000, Viet Nam
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Sinanovic AL, Messer-Hannemann P, Samadi M, Schwendicke F, Effenberger S. Effect of Bleaching on Resin-Infiltration-Masked Artificial White Spots In Vitro. J Funct Biomater 2024; 15:125. [PMID: 38786636 PMCID: PMC11122313 DOI: 10.3390/jfb15050125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/30/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Resin infiltration is an effective method to mask vestibular white spots. If needed, external bleaching is usually recommended before infiltration, whilst in clinical practice, this sequence may not always be feasible. This in vitro study evaluated the effect of bleaching after resin infiltration regarding surface roughness and color using bovine incisors. Unlike for the untreated specimens (control, n = 25), artificial caries lesions were created within the test group (n = 25) using a demineralization solution at 37 °C for five days (pH = 4.95). The lesions were subsequently infiltrated using a resin infiltrant (Icon, DMG, Hamburg, Germany), followed by polishing. Afterwards, all specimens were bleached with a 10% carbamide peroxide gel (Opalescence, Ultradent, South Jordan, UT, USA) for 8 h/day over a ten-day period. Between bleaching treatments, specimens were stored in an opaque container with moistened paper tissues at 37 °C. Surface roughness was measured using a profilometer, and color in the L*a*b* space was assessed spectrophotometrically before and after bleaching. Bleaching increased the L*-values of both infiltrated (mean ± SD; ΔL* = 3.52 ± 1.98) and untreated (control) specimens (ΔL* = 3.53 ± 2.30) without any significant difference between the groups (p = 0.983). Bleaching also induced a significant increase in the mean surface roughness of both infiltrated (p < 0.001) and untreated (p = 0.0134) teeth. In terms of clinical relevance; it can be concluded that bleaching resin-infiltrated enamel is as effective as bleaching sound enamel.
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Affiliation(s)
- Alan Leon Sinanovic
- Clinical Research, DMG Dental-Material Gesellschaft mbH, 22547 Hamburg, Germany
- Department Biotechnology, University of Applied Sciences Hamburg, 21033 Hamburg, Germany
| | | | - Mariam Samadi
- Clinical Research, DMG Dental-Material Gesellschaft mbH, 22547 Hamburg, Germany
| | - Falk Schwendicke
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians University Munich, 80336 Munich, Germany
| | - Susanne Effenberger
- Clinical Research, DMG Dental-Material Gesellschaft mbH, 22547 Hamburg, Germany
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians University Munich, 80336 Munich, Germany
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Alghawe S, Raslan N. Management of permanent incisors affected by Molar-Incisor-Hypomineralisation (MIH) using resin infiltration: a pilot study. Eur Arch Paediatr Dent 2024; 25:105-116. [PMID: 38285169 DOI: 10.1007/s40368-024-00861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE To compare the aesthetic improvement of Molar-Incisor-Hypomineralisation (MIH) opacities treated by applying Icon-Etch for three cycles with the opacities treated by Icon-Etch for once, in the course of resin infiltration technique. METHODS Thirty incisors were sorted based on the colour of the opacities and then distributed according to the number of Icon-Etch cycles using a randomisation table into the groups: (1) White/Creamy one cycle, (2) White/Creamy three cycles, (3) Yellow/Brown one cycle, (4) Yellow/Brown three cycles. The primary outcomes of applying the resin infiltration to the opacities were compared amongst groups according to the parents' satisfaction, the amount of coverage, and the colour matching with the surrounding sound enamel. The stability of the results after 3 months was evaluated using a spectrophotometer. RESULTS The colour of the opacity pre-treatment affected the outcomes significantly (p < 0.05), compared according to the method of application (p > 0.05) in terms of parents' satisfaction. Whilst the multiple applications for Icon-Etch cycles showed more coverage amount in White/Creamy opacities than the application ones (p < 0.05); in colour matching, there was no statistically significant difference between the two methods (p > 0.05). For yellow/brown opacities, some negative results occurred with the single Icon-Etch cycle. CONCLUSION In MIH opacities, it is possible to rely on the resin infiltration as a minimally invasive method to achieve acceptable results, especially with multiple Icon-Etch cycles applications in the white/creamy opacities. The colour stability has not been affected by either the colour of the opacity or the number of cycles.
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Affiliation(s)
- S Alghawe
- Department of Paediatric Dentistry, Tishreen University, Lattakia, Syria.
| | - N Raslan
- Department of Paediatric Dentistry, Tishreen University, Lattakia, Syria
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Lopes PC, Carvalho T, Gomes ATPC, Veiga N, Blanco L, Correia MJ, Mello-Moura ACV. White spot lesions: diagnosis and treatment - a systematic review. BMC Oral Health 2024; 24:58. [PMID: 38195439 PMCID: PMC10775501 DOI: 10.1186/s12903-023-03720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND White spot lesions represent the first stage of caries and their prevalence has been increasing in recent years, particularly in patients undergoing orthodontic treatment. DIferential diagnosis and lesion activity are essential to decide on the clinical approaches to treatment. The aim of this study is to understand if the new diagnostic tools such as fluorescence, microradiography and computed microtomography have the potential to change the conventional treatment of white spots". METHODS A systematic search of available studies in the literature was carried out, using PRISMA guidelines, in Pubmed and Scopus electronic databases and manually to identify relevant articles to answer the PICO question: "Do the new diagnostic tools have the potential to change the conventional treatment of white spots?". This systematic review included randomized controlled trials (RCT), cross-sectional and longitudinal studies complying with the following inclusion criteria: (i) studies in humans, (ii) studies about white spot lesions, (iii) studies published between 2012 and 2023, (iv) studies having both diagnosis and treatment and (v) studies with full text available. In this review we excluded other systematic reviews of clinical trials and in vitro studies. The RoB tool was used to assess the risk of bias. RESULTS The systematic literature search identified 143 potentially relevant references, which after applying the exclusion criteria, resulted in 20 articles. Regarding diagnostic methods, most articles found were based on conventional methods of visual examination (n:10) or fluorescence (n:7). The least referenced diagnostic techniques were based on the use of clinical photographs (n:2), cross-sectional microradiography (n:1) and computed microtomography (n:1). The use of DIAGNOdent was reported by 3 in vitro studies. With regard to therapies, most studies reported the use of infiltrating resin (n:7) and fluoride-based products (n:5). Other studies have reported the use of self-assembling peptide P11-4 (n:1), home care (n:1), casein phosphopeptide-amorphous calcium phosphate (n:2) and hydrochloric acid (n:1). Combination therapies were also considered. CONCLUSION Diagnostic tool does not have the potential to change the form of treatment, whether it is a conventional method or a more differentiated one.
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Affiliation(s)
- Pedro C Lopes
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal.
| | - Teresa Carvalho
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Lisbon, PT, Portugal
| | - Ana T P C Gomes
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal
| | - Nelio Veiga
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal
| | - Letícia Blanco
- Department of Surgery, Universidad de Salamanca, Salamanca, Spain
| | - Maria José Correia
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal
| | - Anna Carolina Volpi Mello-Moura
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal
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Sanfelice EB, Heck ADS, Bittencourt HR, Weber J, Burnett LH, Spohr AM. Short-term Results of the Masking Effect of an Infiltrant Resin on Mild Molar Incisor Hypomineralization Lesions in Anterior Teeth. Oper Dent 2024; 49:34-42. [PMID: 38180470 DOI: 10.2341/23-029-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 01/06/2024]
Abstract
This non-controlled clinical study evaluated the masking effect of an infiltrant resin on mild molar incisor hypomineralization (MIH) lesions. Thirty MIH-affected anterior teeth with creamy/ white opacities from 12 children aged 6-15 years received the application of an infiltrant resin (Icon- DMG). Standard photographs were taken before (T1), immediately after (T2), and 1 week after (T3) resin infiltration. Two calibrated examiners qualitatively analyzed the color match using the Fédération Dentaire Internationale (FDI) scale. The binomial distribution test analyzed the scores of the color match at T1 with T2 and T3, and McNemar's test analyzed the scores of the color match between T2 and T3 (α=0.05). There was a significant increase in color match between T1 and T2 (p=0.0005), between T1 and T3 (p=0.0005), and between T2 and T3 (p=0.0019). It was concluded that infiltrant resin was effective in improving the esthetic appearance of creamy/white opacities on MIH-affected anterior teeth.
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Affiliation(s)
- E B Sanfelice
- Eneida Beatriz Sanfelice, DDS, MS, PhD, Department of Restorative Dentistry, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ab da Silva Heck
- Amanda Baptista da Silva Heck, DDS, MS, Department of Restorative Dentistry, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - H R Bittencourt
- Hélio Radke Bittencourt, MS, PhD, Department of Statistics, Polytechnic School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jbb Weber
- João Batista Blessmann Weber, DDS, MS, PhD, Department of Restorative Dentistry, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - L H Burnett
- Luiz Henrique Burnett Júnior, DDS, MS, PhD, Department of Restorative Dentistry, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A M Spohr
- *Ana Maria Spohr, DDS, MS, PhD, Department of Restorative DentistryPontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Bekes K, Steffen R, Krämer N. Update of the molar incisor hypomineralization: Würzburg concept. Eur Arch Paediatr Dent 2023; 24:807-813. [PMID: 37856065 PMCID: PMC10657291 DOI: 10.1007/s40368-023-00848-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Molar incisor hypomineralization (MIH) is playing an increasingly important role in dental practice. MIH is defined as hypomineralization of systemic origin of one to four permanent first molars, often associated with affected incisors. Affected teeth are more susceptible to caries and post-eruptive enamel loss and should be diagnosed and treated as early as possible. In 2016, the Würzburg concept was developed for German-speaking countries including a classification index-the MIH Treatment Need Index (MIH-TNI)-and a treatment plan based on it for the use in daily practice. In the meantime, the concept has also gained international recognition. The aim of this paper is to update part 2 of the Würzburg concept, the treatment plan, as knowledge about MIH has increased and the disease has been studied more extensively in the last years. Other treatment approaches are now available and therefore need to be included in the concept. Although, the evidence of the different treatment options is still weak, practitioners need guidance in their daily practice. METHODS The authors reviewed the available literature, including clinical and laboratory studies and published guidelines. RESULTS The updated version of the Würzburg concept includes additional non-invasive strategies and temporary therapy options, as well as treatment approaches for incisors. It therefore covers currently available treatment modalities for MIH-affected teeth, ranging from prophylaxis, non-invasive treatment to restorative approaches and possibly even extraction. CONCLUSIONS This is intended to help guide the practitioner and will need to be further validated by clinical trials.
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Affiliation(s)
- K Bekes
- Department of Paediatric Dentistry, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria.
| | - R Steffen
- Private Practice, Weinfelden, Switzerland
| | - N Krämer
- Department of Paediatric Dentistry, Justus Liebig University, Giessen, Germany
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Sezer B. Does the scientific literature provide sufficient information on incisors affected by molar incisor hypomineralisation? Eur Arch Paediatr Dent 2023; 24:147-149. [PMID: 36588126 DOI: 10.1007/s40368-022-00779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/20/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Berkant Sezer
- Department of Paediatric Dentistry, School of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Turkey.
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Brescia AV, Montesani L, Fusaroli D, Docimo R, Di Gennaro G. Management of Enamel Defects with Resin Infiltration Techniques: Two Years Follow Up Retrospective Study. CHILDREN 2022; 9:children9091365. [PMID: 36138674 PMCID: PMC9497803 DOI: 10.3390/children9091365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022]
Abstract
Background: Developmental Defects of Enamel (DDE) represent an aesthetic, functional, and often psychological problem, especially in young patients. Infiltrative treatment with resin (Icon-DMG, Hamburg, Germany) is a minimally invasive technique based on the infiltration of high viscosity resin inside the hypomineralized enamel, modifying its optical properties. The aim of this paper is to evaluate the clinical efficacy of superficial infiltration in the treatment of white enamel defects of the anterior sector with pre-eruptive etiology and its stability over time. Methods: Thirty-three patients affected by DDE associated with mild and moderate Molar Incisor Hypomineralization (MIH), mild and moderate fluorosis, and post-traumatic hypomineralization treated with resin infiltration were retrospectively retrieved. Results: In all cases an improvement in aesthetic appearance was achieved, and the 24-month follow-up confirmed the stability of the results. However, in the cases of traumatic hypomineralization the results were not completely satisfactory. Conclusions: The superficial infiltration technique can be considered a valid minimally invasive alternative to traditional treatment of mild or moderate fluorosis and mild MIH.
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Affiliation(s)
- Alessia Vincenza Brescia
- Paediatric Dentistry, Doctoral School in Materials for Health, Environment and Energy, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Correspondence:
| | | | - Dimitri Fusaroli
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Raffaella Docimo
- Paediatric Dentistry, Department of Surgical Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Management of Teeth Affected by Molar Incisor Hypomineralization Using a Resin Infiltration Technique—A Systematic Review. COATINGS 2022. [DOI: 10.3390/coatings12070964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In recent years, an increase in children diagnosed with molar incisor hypomineralization (MIH) has been observed. Children with MIH show a high failure rate with conservative treatment. The ICON® system (DMG, Hamburg, Germany), which is an infiltration of decalcified lesions with resin, may strengthen the tooth structure, improve its aesthetics, and cure hypersensitivity. The following article is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Scientific articles in the PubMed and Google Scholar databases describing the use of the ICON system in the treatment of MIH published in the years 2012–2022 were analyzed. Two independent study authors selected publications that show that the ICON system can be used during the treatment of children with MIH. So far, in the literature, there are no standardized protocols for the dental treatment of patients with hypomineralization of the incisors using the ICON system. Therefore, clinicians rarely use this method of treatment. The ICON system may be successfully used to infiltrate tooth decalcification in children with MIH. However, the depth of infiltration and the achievement of enamel hardness after such therapy are not precisely defined.
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Athayde GDS, Reis PPGD, Jorge RC, Americano GCA, Fidalgo TKDS, Soviero VM. Impact of masking hypomineralization opacities in anterior teeth on the esthetic perception of children and parents: A randomized controlled clinical trial. J Dent 2022; 123:104168. [PMID: 35643218 DOI: 10.1016/j.jdent.2022.104168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of treating demarcated opacities in anterior teeth on the esthetic perception of children and their parents. Additionally, the masking effect was evaluated quantitively and qualitatively. METHODS Thirty-nine patients, 8-18 years-old, presenting white-creamy opacity in permanent incisors were randomly allocated to test or control group. Test received resin infiltration and control received a placebo. The questionnaire Child's and Parent's Questionnaire about Teeth Appearance was used. The masking effect was quantitatively analyzed using the Lab System to calculate the color difference (ΔE) between the opacity and the surrounding enamel in Photoshop. Fisher's, Chi-square, Wilcoxon, Mann-Whitney tests and Spearman's correlation were applied to data analysis. RESULTS In the test group, a significant impact on physical and psychological domains in parents' and in social domain in parents' and children's perception was observed (p<0.05). Significant difference in ΔE between test and control groups was seen from 15 min of application onwards (p<0.05). After treatment, the mean ΔE was 4.07 (SD=3.07) in the test and 7.35 (SD=3.54) in the control group (p<0.01). One month later, the mean ΔE was 4.22 (SD=2.96) in the test and 6.06 (SD=2.52) in the control group (p<0.01). Total masking was seen only in the test group (p<0.01). CONCLUSION Aesthetic treatment of hypomineralization opacities in anterior teeth with resin infiltration impacted positively on parents and children. Resin infiltration reduced the color difference between opacities and sound enamel significantly after an application time of at least fifteen minutes. CLINICAL SIGNIFICANCE Opacities in anterior teeth impact the self-image of children and parents negatively. This study demonstrated that 15 min resin infiltration can mask opacities in permanent incisors and recover social wellbeing. This minimally invasive approach can be offered to MIH children who report dissatisfaction with their incisors.
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Affiliation(s)
- Glaucia Dos Santos Athayde
- Department of Preventive and Community Dentistry, Dental School, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Dental School, Centro Universitário Serra dos Órgãos, Teresópolis, Brazil
| | - Patrícia Papoula Gorni Dos Reis
- Department of Preventive and Community Dentistry, Dental School, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Dental School, Centro Universitário Arthur Sá Earp Neto, Petrópolis, Brazil
| | - Roberta Costa Jorge
- Department of Preventive and Community Dentistry, Dental School, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Dental School, Centro Universitário Arthur Sá Earp Neto, Petrópolis, Brazil
| | | | - Tatiana Kelly da Silva Fidalgo
- Department of Preventive and Community Dentistry, Dental School, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vera Mendes Soviero
- Department of Preventive and Community Dentistry, Dental School, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Dental School, Centro Universitário Arthur Sá Earp Neto, Petrópolis, Brazil.
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