Concordância entre instrumentos e proposta de parâmetros de referência para análise quantitativa do palato duro

Abstract

The clinical evaluation of the hard palate is subjective and often controversial among several professionals. In order to aid the correct morphological diagnosis of the hard palate, some studies use quantitative evaluation instruments. However, there is still a lack of support to affirm that different methods of evaluation are capable of providing the same results. In addition, the literature lacks studies that address standard reference measurements of the hard palate in representative samples, that could address the use of these devices in clinical practice. The theoretical reference was addressed in the first article of this thesis (Article One) with the objective of analyzing the influence of sex and age on the dimensions of the hard palate and, secondarily, to verify the reference parameters available in the literature and the measurement instruments used. Two original research articles, with cross-sectional design, were also carried out: the first one, with the objective of verifying the agreement among the instruments of quantitative evaluation of the hard palate (Article Two); the second one, in order to compare the dimensions of the hard palate among sex, race and periods of the mixed dentition, and to present reference parameters for the quantitative analysis of the hard palate (Article Three). In the systematic review of the literature (Article One), two examiners performed the research independently in the Cochrane Library, PubMed and Web of Knowledge databases, and 18 studies were selected for final analysis. Thirty children with Angle Class I malocclusion, 6 to 11 years old, participated in the first original article (Article Two). The transverse and vertical dimensions of the hard palate were obtained directly in the oral cavity and in a plaster model with digital calipers and three-dimensional Korkhaus compass, as well as with images reconstructed in the Dolphin Image Software, from cone beam computed tomography. In the second original research article (Article Three), 569 children were evaluated, being 300 girls and 269 boys, 7 to 13 years old, in the mixed dentition phase and with erupted upper first permanent molars, and the transverse and vertical dimensions of the hard palate were obtained directly in the oral cavity with digital calipers and three-dimensional Korkhaus compass. The systematic review (Article One) made it possible to conclude that the measurements were larger in males and that there was a progressive increase in the dimensions from birth to the permanent dentition period; the instruments used to obtain measurements were calipers, threedimensional compass and softwares. From the results of the first original research article (Article Two), it was verified that most of the instruments presented satisfactory agreement in the measurements related to the transverse plane of the hard palate, and only a comparison realized in the vertical plane showed acceptable agreement, being it in the comparison between the measure of depth obtained with compass in mouth and in model at the level of the second premolars. In the second original research article (Article Three), it was evidenced that the dimensions of the hard palate were larger in the boys and there was reduction in the width of the palate in the white race in relation to the others. The hard palate presented smaller dimensions in the first transitional period of mixed dentition. For the construction of the reference parameters, children who had one or more independent variables that showed effect on the dimensions of the hard palate in the multivariate linear regression analysis were excluded. The parameters presented were average, standard deviation and 95% confidence interval for the three phases of the mixed dentition according to gender and race.