Effects of rapid maxillary expansion on sleep disturbance scale for children: A longitudinal CASE-series study.

OBJECTIVE: To evaluate the effects of rapid maxillary expansion (RME) on Sleep Disturbance Scale for Children (SDSC) with maxillary atresia. MATERIALS AND METHODS: The sample consisted of 27 paediatric patients evaluated through a Brazilian version of the SDSC, answered by their guardians at the following experimental time points: T0 (before installing the Hyrax expander), T1 (on the day of expander stabilization), T2 (3 months after expander stabilization), T3 (immediately after expander removal, following 6 months of retention), and T4 (3 months post-retention). Multilevel Poisson analysis adjusted for repeated measures was performed to compare outcomes across the assessment time points. RESULTS: The mean age of patients was 9.1 years (SD = 1.46). The total SDSC scores decreased and were statistically significant from T2 onwards (P < .01), with a decrease of 24% at T4 compared with T1 (IRR 0.76; 95% CI 0.69-0.84). The mean scores at T4 were already lower than the cutoff point for risk of sleep disorders. Regarding the specific domains, there was a significant reduction in sleep breathing disorders, sleep-wake transition disorders, and disorders of excessive somnolence as of T2 (P < .01), T3 (P < .05) and T4 (P < .05), respectively. CONCLUSION: RME in children with maxillary atresia had a positive effect on the reduction of total SDSC scores after 3 months of expander stabilization, sustained over 6 and 9 months and significant reduction in sleep breathing disorders domain, sleep-wake transition disorders domain, and disorders of excessive somnolence domain over time points.

Influence of examiner calibration on clinical and mri diagnosis of temporomandibular joint disc displacement: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to verify the accuracy of clinical protocols for the diagnosis of disc displacement (DD) compared with magnetic resonance imaging (MRI), considering examiners' calibration. METHODS: PubMed, Cochrane (Central), Scopus, Web of Science, LILACS, Embase, Science Direct, Google Scholar, and DANS EASY Archive databases were searched. Two reviewers independently screened and selected the studies. A meta-analysis was conducted using the R Statistical software. Results are shown using sensitivity and specificity, and 95% confidence intervals. RESULTS: Of the 20 studies included in the systematic review, only 3 were classified as low risk of bias. Seventeen studies were included in the meta-analysis. Compared to MRI, clinical protocols showed overall sensitivity and specificity of 0.75 (0.63-0.83) and 0.73 (0.59-0.84) for DD diagnosis, respectively. For DD with reduction, sensitivity was 0.64 (0.48-0.77) and specificity was 0.72 (0.48-0.87). For DD without reduction, sensitivity was 0.58 (0.39-0.74) and specificity 0.93 (0.83-0.97). Only 8 studies reported examiner calibration when performing clinical and/or MRI evaluation; nevertheless, calibration showed a tendency to improve the diagnosis of DD. CONCLUSION: The sensitivity and specificity of clinical protocols in the diagnosis of DD are slightly below the recommended values, as well as the studies lack calibration of clinical and MRI examiners. Examiner calibration seems to improve the diagnosis of DD.

Association among headache, temporomandibular disorder, and awake bruxism: A cross-sectional study.

OBJECTIVE: To evaluate the association between headache, myofascial temporomandibular disorder (TMD), and awake bruxism (AB). BACKGROUND: Bruxism seems to act as a risk factor for TMD and its associated comorbidities, such as headaches. METHODS: In total, 406 medical records of individuals who sought care at a university dental clinic were screened. The Research Diagnostic Criteria for Temporomandibular Disorders was used to assess and diagnose TMD, as well as to obtain self-reports of AB and headache. RESULTS: The sample consisted of 307 medical records. About 72.5% (221/305) of the sample reported having headaches, and 67.4% (180/267) and 68.4% (210/307) were diagnosed with AB and TMD, respectively. Individuals who reported having AB (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.09-4.7) and who were diagnosed with myofascial TMD (OR, 2.53; 95% CI, 1.15-5.5) were more likely to have had headaches in the past 6 months when compared with patients without myofascial TMD and bruxism. Also, individuals who self-reported headache were 2.27 times (95% CI, 1.09-4.7) more likely to have AB and 2.45 times (95% CI, 1.13-5.34) more likely to have myofascial pain than individuals without headaches. CONCLUSIONS: Individuals with myofascial TMD, headaches, or AB were more likely to have at least one of the other conditions.

Influence of bone architecture on the primary stability of different mini-implant designs.

INTRODUCTION: Mechanical interlocking between a mini-implant (MI) and the bone substrate reflects directly on the primary stability achieved. The purposes of this study were to evaluate MI design performance in distinct bone substrates and correlate geometric characteristics with insertion site quality. METHODS: Two types of self-drilling MIs (1.6 × 8 mm) were allocated to 2 groups according to their geometric designs: Tomas system (Dentaurum, Ispringen, Germany) and Dual-Top (Rocky Mountain Orthodontics, Denver, Colo). Forty sections (8 × 10 mm) were taken from bovine pelvic ilium and pubic bone. Geometric design characteristics were evaluated using scanning electron microscope imaging and Image-Pro Insight software (Media Cybernetics, Rockville, Md). Bone quality parameters were assessed with a microcomputed tomography system, and primary stability was evaluated by insertion torque and pull-out strength. Intergroup comparisons were performed with analysis of variance and Tukey tests, and the Pearson correlation test was carried out (P <0.05). RESULTS: No significant difference was observed in the comparisons of the groups (Tomas: insertion torque, 12.87 N·cm; pull-out strength, 181 N; and Dual-Top: insertion torque, 9.95 N·cm; pull-out strength, 172.5 N) in the ilium. However, the Tomas group had a marked increase in insertion torque (25.08 N·cm; P <0.05) in the pubic bone. CONCLUSIONS: MI mechanical performance differed according to bone quality parameters, indicating that certain geometric parameters may be set depending on the insertion substrate.

Combined maxillary and mandibular distraction osteogenesis in patients with hemifacial microsomia.

INTRODUCTION: Hemifacial microsomia is a deformity of variable expressivity with unilateral hypoplasia of the mandible and the ear. In this study, we evaluated skeletal soft tissue changes after bimaxillary unilateral vertical distraction. METHODS: Eight patients (4 preadolescents 4 adolescents) each with a grade II mandibular deformity underwent a LeFort I osteotomy and an ipsilateral horizontal mandibular ramus osteotomy. A semiburied distraction device was placed over the ramus, and intermaxillary fixation was applied. Anteroposterior cephalometric and frontal photographic analyses were conducted before and after distraction. Statistics were used to analyze the preoperative and postoperative changes. RESULTS: Cephalometrically, the nasal floor and the occlusal and gonial plane angles decreased. The ratios of affected-unaffected ramus and gonial angle heights improved by 15% and 20%, respectively. The position of menton moved toward the midline. The photographic analysis showed a decrease of the nasal and commissure plane angles, and the chin moved to the unaffected side. The parallelism between the horizontal skeletal and soft tissue planes improved, with an increase in the affected side ramus height and correction of the chin point toward the midline. CONCLUSIONS: Simultaneous maxillary and mandibular distraction improved facial balance and symmetry. Patients in the permanent dentition with fixed orthodontic appliances and well-aligned dental arches responded well to this intervention.

Impact of orthodontic treatment on OHRQoL of adolescents: a longitudinal study.

OBJECTIVE: The aim of this study was to evaluate the extent to which orthodontic treatment need is perceived by the patients and by the orthodontist, as well as the possible impacts on the OHRQoL (Oral Health-Related Quality of Life) over the course of conventional orthodontic treatment in adolescent patients. METHODS: The sample consisted of 55 adolescents. The perception of patients and orthodontists relative to the malocclusion was evaluated by the IOTN (Index of Orthodontic Treatment Need). The OHRQoL was evaluated by the Child-OIDP (Child-Oral Impacts on Daily Performances) questionnaire before the conventional orthodontic appliance was bonded (T0); and at the following time intervals: after one week (T1), one month (T2), three months (T3), six months (T4), and after the end of orthodontic treatment (T5). RESULTS: Adolescents who had large orthodontic treatment needs had a poor OHRQoL, according to their self-perception (p=0.003) and according to the orthodontist's perception (p<0.001), when compared with patients with small and moderate needs. There was statistically significant difference in the OHRQoL between the time intervals T0 and T1 (p=0.021), T2 and T3 (p<0.001), T3 and T4 (p=0.033), and T0 and T5 (p<0.002). At the end of treatment, all evaluated participants reported an improvement in OHRQoL. CONCLUSIONS: It was concluded that adolescents and orthodontists agreed with regard to the perception of orthodontic treatment need. In the first week and in the first month of orthodontic treatment, there was a negative impact on the OHRQoL. After three months, an improvement of OHRQoL was detected, which has progressed over time.

Diagnosis of juvenile idiopathic arthritis with asymptomatic involvement of the temporomandibular joint: A case report.

Juvenile idiopathic arthritis (JIA) is a broad term that describes a group of heterogeneous rheumatologic diseases, mainly characterized by inflammation in the joints of children and young people up to 16 years of age. Its etiology is still not well understood and the diagnosis, essentially clinical, begins with the exclusion of other joint diseases. When the disease affects the temporomandibular joint, diagnosis is a challenge, as many patients are asymptomatic. The objective of this paper is to present a case of JIA with severe involvement of the temporomandibular joint and to discuss the clinical, radiographic, laboratory findings and the importance of early diagnosis. The lack of diagnosis of active arthritis in the temporomandibular joint in patients with JIA can cause irreversible effects such as micrognathia, malocclusion and reduced maximum mouth opening. Early diagnosis of temporomandibular joint involvement in JIA is important and needs to be investigated early in the clinical manifestation of systemic disease. Laboratory tests and clinical history are important to define treatment and prognosis, but not to predict temporomandibular joint arthritis. Imaging exams are important diagnostic tools to identify morphological changes in soft and hard tissues of the temporomandibular joint.

TMD diagnosis: Sensitivity and specificity of the Fonseca Anamnestic Index.

OBJECTIVE: To verify whether the Fonseca Anamnestic Index (FAI) has adequate sensitivity and specificity to be used in the diagnosis of temporomandibular disorder (TMD). METHODS: Two hundred-sixty-five participants with symptoms of TMDs were assessed through the FAI and through the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and then classified as sick or non-sick. The sensitivity, specificity, and predictive values of the FAI in relation to the RDC/TMD were calculated using the STATA 14.0 software. RESULTS: Most of the patients were female, white, without a steady job, and the average age was 37.57 years. The FAI showed high sensitivity (97.21%) but obtained a low specificity (26.00%). The positive and negative predictive values were 84.96% and 68.42%, respectively. CONCLUSION: The FAI is very sensitive in identifying patients who actually have TMD but not very specific in identifying non-TMD patients, being indicated only for initial screening of patients.

Improvement on oral health related quality of life after orthosurgical treatment: a mixed methods study.

The aim of this study was to understand the influence of orthosurgical treatment on oral health-related quality of life (OHRQoL) in patients with Class II and III skeletal malocclusion by conducting a mixed method case series study. Nineteen patients submitted to orthosurgical treatment in a private practice in Brazil were included in the sample. Data were collected retrospectively and interviews were held from March 2020 to July 2021. Patients answered to the Oral Health Impact Profile (OHIP-14) in the first part of the interview and subsequently answered the qualitative questions. The overall mean of OHIP-14 after treatment was 4.21 (SD 4.68). The qualitative data were analyzed according to thematic analysis and four themes emerged from the interviews: a) concept of quality of life, b) pre-treatment life, c) post-treatment life, and d) positive and negative aspects of treatment. Quality of Life was reported by the patients as the absence of feeling pain, having emotional and physical health, having a satisfactory esthetic appearance and self-esteem. Before treatment, most Class II patients used to complain about breathing and sleeping problems, while Class III patients complained more intensely about esthetics. Pain was a common problem reported by both Class II and Class III patients. In general, improvement was perceived in self-esteem, esthetics, function and pain. Complaints about negative aspects of the treatment were restricted to the postoperative period. The orthosurgical treatment was important for improving the OHRQoL of patients in terms of esthetic, functional and psychosocial aspects.

Pulp chamber temperature rise in light-cure bonding of brackets with and without primer, in intact versus restored teeth.

OBJECTIVE: To evaluate the pulp chamber temperature rise (PCTR) in light-cure bonding of brackets with and without primer, in intact and restored mandibular central incisors (M1), maxillary first premolars (Mx4), and mandibular third molars (M8). MATERIAL AND METHODS: Ninety human teeth were included: M1 (n=30), Mx4 (n=30), and M8 (n=30). Light-cure bonding of brackets was performed in intact (n=60) and restored (n=30) teeth, with primer (n=60) or without (n=30) primer. PCTR was defined as the difference between initial (T0) and peak temperatures (T1), recorded with a thermocouple during light-cure bonding. Differences on PCTR between bonding techniques (primer vs. no primer), teeth types (M1 vs. Mx4 vs. M8), and teeth condition (intact vs. restored) were estimated by ANCOVA, with α=5%.Results: PCTR was significantly higher with the use of primer (2.05 ± 0.08oC) than without primer (1.65 ± 0.14oC) (p=0.02), and in M1 (2.23 ± 0.22oC) compared to Mx4 (1.56 ± 0.14oC) (p<0.01). There was no difference in the PCTR in M8 (1.77 ± 0.28oC) compared to M1 or Mx4 (p>0.05), and no difference between intact (1.78 ± 0.14oC) and restored (1.92 ± 0.08oC) teeth (p=0.38). There was no influence of dentin enamel thickness in the PCTR (p=0.19). CONCLUSION: PCTR was higher in light-cure bonding of brackets with primer, especially in M1. Light-cure bonding seems less invasive without primer.

Does bone mineral density influence the primary stability of dental implants? A systematic review.

OBJECTIVE: The aim of this systematic review was to investigate the influence of bone mineral density on the primary stability of dental implants. MATERIAL AND METHODS: A search of health science databases (Cochrane Library, MEDLINE-PubMed, ISI Web of Knowledge, EMBASE, LILACS) and grey literature was performed, including papers published until January 2011. The main key words used were "bone density" (MeSH/DeCS), "dental implant" (MeSH/DeCS), "implant stability", "implant stability quotient", "ISQ", "resonance frequency analysis", "RFA", "Osstell", "Periotest value", "PTV", "Periostest", "insertion torque", "placement torque", "cutting torque". The inclusion criteria comprised observational clinical studies performed in patients who received dental implants for rehabilitation; studies that evaluated the association between bone mineral density and implant primary stability; bone density assessment performed by measurement of Hounsfield units using cone beam computed tomography; and dental implant primary stability evaluated by ISQ value, PTV value or insertion torque measurement. The articles selected were carefully read and classified as low, moderate and high methodological quality, and data of interest were tabulated. RESULTS: Ten articles met the inclusion criteria, but only seven were included because of overlapping patients. They were classified as low or moderate methodological quality and control of bias, and presented positive association between primary stability and bone density. CONCLUSIONS: There is a positive association between implant primary stability and bone mineral density of the receptor site. However, the methodological quality and control of bias of the studies should be improved to produce stronger evidences.

Impacted incisors associated with supernumerary teeth treated with a modified Haas appliance.

Tooth impaction involves factors such as lack of space in the alveolar process, trauma, ankylosis, and mechanical barriers such as abnormal frenum, supernumerary teeth, tumors, and local cysts. When impaction occurs in the anterior region, esthetics are compromised. This report describes the successful approach to treatment for a young boy who had 2 supernumerary teeth associated with impaction of the left central and lateral permanent incisors. Treatment consisted of extracting the supernumerary teeth and performing maxillary expansion with a modified Haas appliance to guide the left central incisor into its appropriate position. The teeth erupted spontaneously after maxillary expansion and an increase in space. A fixed edgewise appliance was placed incrementally to correct the maxillary anterior tooth positions and finish the treatment. Adequate esthetics and function were achieved.

Miniscrew covering: an alternative to prevent traumatic lesions.

During orthodontic treatment with miniscrews, complications such as aphthous ulceration, soft-tissue coverage of the miniscrew head, soft-tissue inflammation, infection, and peri-implantitis can occur. Good hygiene can prevent inflammation by infection but does not prevent traumatic oral mucosal lesions at the buccal mucosa. The purpose of this article was to describe the use of a physical barrier--a light-cured temporary filling material--to cover the miniscrew head and prevent soft-tissue trauma.

Does marital status influence TMD-related chronic pain? A cross-sectional study.

BACKGROUND: Pain is a complex sensory experience and can be influenced by psychosocial factors, such as romantic relationships. OBJECTIVE: To evaluate the association between marital status and temporomandibular disorder-related chronic pain. METHODS: Patients diagnosed with temporomandibular disorder (TMD) through Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I were assessed for chronic pain and marital and socioeconomic status, according to Axis II. Multinomial logistic regression models assessed the association between chronic pain and the predictive variables. RESULTS: Three hundred and ten patients were included in the sample, the majority being female (74.5%), single (52.3%), and diagnosed with chronic pain (85.1%). The adjusted analysis showed about a 5-time greater chance of chronic pain occurrence with high disability in individuals who were married or in a common-law marriage (OR 5.99; 95% CI 1.45-24.73). Also, women were 7.62 times more likely to develop chronic pain with high disability (OR 7.62; 95% CI 2.03-28.52). CONCLUSION: Marital status showed an impact on chronic pain, with married individuals and those in a common-law marriage being the most affected by high disability chronic pain.

Association between malocclusion in the mixed dentition with breastfeeding and past nonnutritive sucking habits in school-age children.

OBJECTIVES: To evaluate the association between malocclusion characteristics in the mixed dentition stage, breastfeeding, and past nonnutritive sucking habits in school-age children. MATERIALS AND METHODS: A total of 547 school children in the mixed dentition, in the age range between 7 and 13 years, were evaluated by means of questionnaire and clinical examination. Binomial and multinomial logistic regression models were used to evaluate the associations between breastfeeding and finger and pacifier sucking habits, the malocclusion characteristics of posterior crossbite, and excessive or deficient overjet and overbite. RESULTS: Individuals who had nonnutritive sucking habits had 2.16 times greater chance of having anterior open bite (odds ratio [OR] 2.16; 95% confidence interval [CI], 1.07-4.33) and 2.39 times greater chance of having posterior crossbite (OR 2.39; 95% CI, 1.56-5.49). Children who were exclusively breastfed up to at least 6 months of age had a higher frequency of normality for overjet and overbite and the lowest posterior crossbite index. However, in adjusted analysis, breastfeeding showed no association with malocclusion characteristics in the mixed dentition stage. CONCLUSIONS: Breastfeeding was not associated with the presence of malocclusion in the mixed dentition, whereas past nonnutritive sucking habits were associated with the occurrence of malocclusion.

Color stability of resin composites for orthodontic attachments: an in vitro study.

OBJECTIVE: The aim of the present study was to evaluate the color stability of Filtek Z350 XT, Filtek Z250 XT, Z100 resin composites and Transbond XT orthodontic resin, all used in orthodontic attachments, when immersed in popular beverages. METHODS: Thirty disk-shaped specimens of each resin composite (2 x 5mm) were manufactured and randomly divided into six groups according to immersion solutions: coffee, red wine, white wine, regular beer, dark beer and deionized water (control). The specimens were fully immersed in each of the solutions for six days at 37°C, representing approximately six months of consumption. The color measurements were evaluated by a reflection spectrophotometer, at baseline (before immersion) and after staining. L*a*b* coordinates were measured and the color change (ΔE00) was calculated using the CIEDE2000 formula. The data were analyzed by ANOVA/Tukey tests at a significance level of 0.05. RESULTS: The resin composites immersed in white wine and regular beer showed either imperceptible or clinically acceptable ΔE00, and no difference from the control group (p= 0.4449 and p= 0.467 respectively). Immersion in coffee and red wine were considered clinically unacceptable and were significantly different from the control group (p= 0.0028 and p= 0.0475 respectively). CONCLUSION: Based on the results of the present study, the consumption of coffee and red wine may cause color change of the resin composite attachments above the visual acceptability threshold, and impair aesthetics during treatment.

Correlation between cortical bone thickness at mini-implant insertion sites and age of patient.

INTRODUCTION: Orthodontic mini-implants (MI) are a reliable alternative to provide temporary orthodontic anchorage. Prior to miniscrew insertion, the best approach would be to evaluate each possible insertion site and measure the cortical bone thickness, and verify whether it would provide adequate primary stability. OBJECTIVE: This study aimed to evaluate the difference in cortical bone thickness in areas of mini-implants insertion in patients of different ages, by means of cone beam computed tomography (CBCT). METHODS: The sample of this retrospective study was composed of 123 CBCT scans, which were used to measure cortical bone thickness in the buccal and palatal inter-radicular space in the mesial region of the first permanent molars. These measures were compared by using the Student's t-test, ANOVA/Tukey tests, and Linear regression between male and female subjects, from 12 to 30 years old. RESULTS: No significant difference was found in cortical bone thickness between sex, race and sagittal facial patterns. Significantly higher measurement values were observed in patients older than 12 years of age at all sites evaluated. The coefficient ß at the adjusted linear regression analysis showed that at each increment in age, mean cortical thickness values increased by 0.06mm in the mandible, 0.03mm in the buccal region and 0.02mm in the palatal region of the maxilla. CONCLUSIONS: The increase in cortical bone thickness was positively associated with age; that is, the more advanced the patient's age was, the less chance there was of failure due to primary stability.

Rapid LLLT protocol for myofascial pain and mouth opening limitation treatment in the clinical practice: An RCT.

OBJECTIVE: To evaluate the effect of a rapid treatment protocol of low-level laser therapy (LLLT) in patients with myofascial pain and mouth opening limitation. METHODS: Twenty patients were randomly allocated into the laser group (LG) (n = 10) and the placebo group (PG) (n = 10). Two LLLT sessions or placebo were performed. They were applied to the pain points upon palpation, with a 48-hr interval. Patients were evaluated for spontaneous pain sensitivity during mandibular movements and for oral health-related quality of life, which was assessed using the Oral Health Impact Profile for Temporomandibular Disorders (OHIP/TMD) questionnaire. RESULTS: Two patients from the placebo group were lost during the study. A significant increase in the maximum mouth opening (p = 0.04) and improvement in OHIP/TMD scores (p = 0.003) were observed in the LG after 30 days. CONCLUSION: Spontaneous pain was reduced in both groups with low-level laser therapy.

Treatment of myofascial pain with a rapid laser therapy protocol compared to occlusal splint: A double-blind, randomized clinical trial.

OBJECTIVE: To compare the effect of a rapid low-level laser therapy (LLLT) protocol to Michigan occlusal splint in the treatment of myofascial pain, as well as to evaluate their impact on Oral Health-Related Quality of Life (OHRQoL). METHODS: Thirty participants were randomly allocated into three groups: G1: occlusal splint (n = 11), G2: LLLT (n = 10), and G3: LLLT placebo (n = 9). LLLT and placebo were applied in the points of pain upon palpation. RESULTS: G1 presented improvement in pain (p = 0.014) and in the diagnosis of myofascial pain (p = 0.008), while G2 and G3 did not. Regarding OHRQoL, G1 and G2 presented significant improvement (p = 0.005, in both), whereas, G3 did not. CONCLUSION: Michigan occlusal splint was effective in reducing pain and improving OHRQoL. Treatment with the rapid LLLT protocol only provided an improvement in OHRQoL.

Association between occlusal anomalies and dental caries in 3- to 5 year-old Brazilian children.

OBJECTIVE: To investigate the association between certain occlusal anomalies and the occurrence and severity of dental caries in Brazilian preschool children. DESIGN: Cross-sectional study. SETTING: Twenty-eight public nursery schools in Canoas, southern Brazil. SUBJECTS AND METHODS: The study population comprised 890 three- to five-year-old children. Five trained and calibrated observers examined children for determination of decayed, missing and filled tooth (dmft) index (World Health Organization criteria including white spots) and orthodontic variables. OUTCOME MEASURES: Caries severity (dmft) and caries occurrence (dmft ≥ 1). STATISTICAL ANALYSIS: Multivariable analysis was performed using Poisson regression with robust variance in order to determine the occlusal anomalies which represent risk factors for the occurrence of the binary outcome. RESULTS: Caries severity was significantly higher among children without spacing in the maxillary anterior teeth (P = 0·001) and mandibular anterior teeth (P = 0·003) and among children without accentuated overjet (P = 0·023). The multivariable analysis demonstrated that children without spacing in maxillary anterior teeth had an increased risk of dental caries (prevalence ratio = 1·43; 95% CI, 1·05-1·93). Open bite, accentuated overjet and posterior cross-bite were not associated with this outcome in the final model. CONCLUSIONS: Absence of spacing in the maxillary labial segment represents a risk factor for dental caries in preschool children.