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Comprehensively evaluating molar incisor hypomineralisation (MIH) involves the integration of anamnesis and clinical data to diagnose, create a care plan, and predict prognoses. Anamnesis reveals relationships between defects and time, patient expectations, and impacts on the quality of life. Clinical studies emphasize posteruptive breakdown in yellow-brown opacities, highlighting the importance of identifying risk factors. The classification and recording of the clinical features associated with MIH are essential and allow for the longitudinal follow-up of the patient. Assessment of dental caries lesions, oral hygiene, and pain guides the care plan. Depending on the severity of MIH and associated symptoms, intraoral radiographs and cone beam computed tomography may be necessary. In cases of scheduled extractions, extraoral radiographs, photographs, and study models are indicated. Evaluations of the quality of life, aesthetic perception, and dental fear and anxiety provide valuable insights into the patient's emotional status and guide empathetic practice. A positive dental experience is based on communication with the patient, trust, and the proper use of behavior guidance techniques.

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Hypomineralisation defects with demarcated opacities are also observed in the deciduous dentition and have been found to be a predictive factor for hypomineralisation defects in the permanent dentition. Deciduous molar hypomineralisation (DMH) represents a qualitative enamel defect primarily afflicting deciduous second molars, albeit its presence is not limited solely to deciduous second molars, as it can manifest in deciduous canines and first molars. Thus, the presence of demarcated hypomineralisation defects in deciduous teeth could be called as deciduous teeth hypomineralisation. Clinically, these defects are characterized by demarcated opacities, posteruptive enamel breakdown, atypical caries lesions, and atypical restorations. The accurate diagnosis of DMH continues to present a clinical challenge, and the reported prevalence of this defect exhibits notable variability across different countries. Its precise etiology remains elusive; however, there is a prevailing suspicion that events occurring during the prenatal, perinatal, or early postnatal periods, particularly those unfolding during the perinatal phase, are intricately linked to DMH development. Factors such as delivery complications, neonatal complications, prematurity, and low birth weight have been associated with DMH. Notably, there exists a possibility that, the more health-related events occur during this critical period, the greater the likelihood of a child presenting with this enamel defect. Nevertheless, the establishment of these associations warrants further investigation through prospective studies. Acquiring knowledge regarding the factors associated with this defect holds paramount importance for effective diagnosis, guidance for families with affected children, and the formulation of strategies to mitigate the incidence of these contributory factors.

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AIMS: This study aimed to characterize the prevalence of development defects of enamel (DDE) in patients with cleft based on the cleft phenotype and explore the relationship between surgical procedures and different types of DDE. MATERIAL AND METHODS: In this cross-sectional study, 290 standardized orthodontic documentation and medical records from a reference hospital were evaluated, which treated patients with: cleft lip (CL), cleft lip with alveolar bone involvement (CLa), cleft lip and palate (CLP), cleft palate (CP), cleft median (CM), and considering laterality as unilateral or bilateral. DDE was assessed using the Ghanim Index (2015). Information on surgical intervention periods was obtained from medical records. Statistical analyses were performed using prevalence ratio (PR) for DDE comparisons between cleft phenotypes and surgical procedures. RESULTS: The prevalence of DDE was 77.2%. Demarcated hypomineralization was associated with CP and CLP, while hypoplasia was associated with CLa, especially when bilateral. Hypoplasia was also associated with the labial adhesion surgery. CONCLUSION: Demarcated hypomineralization was the most common DDE in this population, and the cleft phenotype influenced the type of DDE manifested. The lip adhesion surgery increased the chances of hypoplasia manifestation. CLINICAL RELEVANCE: The type of DDE in patients with cleft depends on the cleft phenotype. Understanding this susceptibility enables the multidisciplinary team to monitor dental development, thus allowing early diagnosis and timely referral to the pediatric dentist and better prognoses.

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Resumo A decisão pela extração de dentes permanentes para a solução de problemas ortodônticos considera, além da extração em si, outros fatores, dentre eles, as características clínicas do esmalte dos dentes a serem extraídos. O objetivo deste artigo foi apresentar como a presença de defeitos de esmalte dentário (DDE) influenciou na tomada de decisão e modificou o plano de tratamento ortodôntico proposto para o paciente. A severidade do defeito, o número de dentes afetados e a presença e complexidade de má oclusão são fatores que influenciaram na definição do plano de tratamento. Quanto mais grave os defeitos e mais complexa a má oclusão, maior a dificuldade no planejamento do tratamento e, em muitos casos, é indicado incorporar a contribuição de vários especialistas na tomada de decisões. Foi possível demonstrar que o tratamento da má oclusão associada a DDE com a exodontia dos dentes mais severamente afetados apresentou resultados estético e funcional adequados. Concluiu-se que um tratamento bem-sucedido da má oclusão com resultado estético dentofacial adequado, saudável e funcional, requer a compreensão da inter-relação entre os componentes estruturais bucais, oclusão dentária e estética facial.(AU)

Abstract The decision to extract permanent teeth to solve orthodontic problems considers, in addition to the extraction itself, other factors, and among them are the clinical characteristics of the enamel of the teeth to be extracted. The objective of this article was to present how the presence of dental enamel defects (DED) influenced decision-making and modified the proposed orthodontic treatment plan for the patient. The severity of the defect, the number of affected teeth and the presence and complexity of the malocclusion are factors that influenced the definition of the treatment plan. The more severe the defects and the more complex the malocclusion, the greater the difficulty in planning the treatment and, in many cases, it is indicated to incorporate the contribution of several specialists in the decision-making process. It was possible to demonstrate that the treatment of malocclusion associated with DED with the extraction of the most severely affected teeth, presented adequate aesthetic and functional results. It is concluded that a successful treatment of malocclusion with adequate, healthy, and functional dentofacial aesthetic results, requires understanding the interrelationship between oral structural components, dental occlusion and facial aesthetics. (AU)

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