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Lall M. Is SDF better than the SMART (silver modified atraumatic restorative technique) in the management of molar incisor hypomineralisation molars with initial caries? Evid Based Dent 2024:10.1038/s41432-024-01062-y. [PMID: 39256484 DOI: 10.1038/s41432-024-01062-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/12/2024]
Abstract
DESIGN A prospective, randomized, split-mouth clinical study by the two previously trained and calibrated pediatric dentists without blinding operators and patients due to different protocols in both treatment groups. An SDF + potassium iodide (KI) and SDF + KI + glass ionmer cement (GIC) on International Caries Detection and Assessment System (ICDAS) 1/2 molar was received by each patient on either side of mouth. The local Ethics Committee approved this study. DATA SOURCE Sample size calculation was not performed due to the lack of published studies on the longevity of SMART sealant on MIH-affected molars and the absence of research on the apparent difference between the effectiveness of SMART and SDF treatments in preventing further caries and sensitivity. STUDY SELECTION These were children between the ages of 6 years to 13 years, who visited the Pediatric Dentistry Clinic at XX University School of Dentistry for routine exams and treatment between July 2019 to May 2020. They were in good health and had at least two fully erupted permanent first molars with MIH as per the European Academy of Pediatric Dentistry, ICDAS code 1/2. This study recorded 12 months of treatment outcomes on hypomineralised molars of 48 children with a follow-up of three years. Children were excluded with specific syndromes associated with enamel malformation, lack of cooperation, ongoing orthodontic treatment, and teeth with ICDAS 3/4/5/6 lesions, existing restorations, fluorosis, or pulpal symptoms. DATA ANALYSIS Mann-Whitney U Test was used to assess differences between independent groups (SDF and SMART) and the Friedman Test between dependent groups at different time points. Kaplan-Meier analysis to evaluate the cumulative survival of SMART sealants and survival of caries-free hypomineralised molars in both groups. Chi-Square test was used to compare the success percentages of the SDF and SMART groups. To assess the changes in success percentages at three different time intervals for the caries preventive effect of SDF and SMART, and to evaluate the retention percentages for the SMART group. McNemar's test with a Bonferroni correction was used for significant differences. Cohen's kappa test indicated that the inter-examiner reliability determining the presence of MIH was 0.87. The intra-examiner reliability for US Public Health Service (USPHS)-Modified criteria was 0.90. The statistical significance level was set at p < 0.05 for all statistical analyses. RESULTS At 12, 24 and 36 months the caries preventive effect was 100%, 67.9%, and 65.4% for SDF + KI-treated teeth; and 100%, 97.6%, and 94.7% for SMART (SDF + KI + GIC) respectively. During the recall period, there was no substantial difference in hypersensitivity scores between the groups. There was no hypersensitivity in teeth at 18 months and beyond. Compared to the baseline Schiff Cold Air Sensitivity Scale (SCASS) score 26 molar with initial hypersensitivity to hypomineralisation had a massive reduction at evaluation periods. The mean survival probabilities for the caries-preventive effect were considerably lower in SDF + KI-treated teeth (31.01 months) than in SMART-treated teeth (35.61 months) (p < 0.001). CONCLUSION Considering the limitation of the study, both SMART (SDF + KI + GIC) sealants and 6-monthly application of SDF + KI, provided similar and substantial levels of desensitisation on the permanent MIH molars. When used as a sealing material on non-cavitated permanent MIH molars, the clinical retention rate for SMART was 88.7%, 73.1%, and 66.6% at 1, 2, and 3 years respectively. The caries preventive effect of SMART (SDF + KI + GIC) sealants was superior to SDF + KI application in hypomineralised teeth, however, a long-term monitoring and review is essential due to the gradual decrease in retention of SMART sealants.
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Affiliation(s)
- Meenakshi Lall
- Stourcote Dental Practice, Stourbridge, Birmingham, DY8 1TS, UK.
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Bardellini E, Conti G, Veneri F, Majorana A, Amadori F. Awareness of Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPMs) among Northern Italian Dentists: A Questionnaire Survey. Dent J (Basel) 2024; 12:271. [PMID: 39195115 DOI: 10.3390/dj12080271] [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: 07/10/2024] [Revised: 08/02/2024] [Accepted: 08/20/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND The purpose of this study was to assess the awareness of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPMs) among dental practitioners in Northern Italy, and to gather data on the occurrence of these conditions in their paediatric patients. METHODS A cross-sectional study was conducted using a structured online questionnaire administered through Google Forms. The survey comprised 10 single-choice questions addressing the occurrence of MIH and HSPM in caries-free patients aged 6-9 years. RESULTS A total of 315 dentists participated in the survey, yielding a response rate of 31.5%. The majority of respondents reported that 1-25% of their paediatric patients exhibited HSPMs. Among this group, 43.62% of respondents observed MIH in 1-25% of cases. CONCLUSION The findings from this survey suggest a consistent perception of MIH and HSPMs among dental practitioners, aligning with known prevalence data and indicating recognition of these conditions within the dental community in Northern Italy.
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Affiliation(s)
- Elena Bardellini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, School of Pediatric Dentistry, University of Brescia, Pl. Spedali Civili 1, 25123 Brescia, Italy
| | - Giulio Conti
- Department of Medicine e Surgery, School of Dentistry, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
| | - Federica Veneri
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Unit of Dentistry & Oral-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Via del Pozzo, 41124 Modena, Italy
| | - Alessandra Majorana
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, School of Pediatric Dentistry, University of Brescia, Pl. Spedali Civili 1, 25123 Brescia, Italy
| | - Francesca Amadori
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, School of Pediatric Dentistry, University of Brescia, Pl. Spedali Civili 1, 25123 Brescia, Italy
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Erbas Unverdi G, Ballikaya E, Cehreli ZC. Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial. J Dent 2024; 147:105098. [PMID: 38797490 DOI: 10.1016/j.jdent.2024.105098] [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: 04/22/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES This study aimed to assess the clinical outcomes of utilizing silver diamine fluoride + potassium iodide (SDF + KI) treatment and Silver-Modified Atraumatic Restorative Technique (SMART/SDF + KI + Glass Ionomer Cement) over a three-year period on hypomineralised permanent molars with initial carious lesions. METHODS 112 hypomineralised permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF + KI and SMART (SDF + KI + GIC) groups (n = 56 teeth/group) in a split-mouth design. Hypersensitivity and caries development were evaluated in both groups. Schiff Cold Air Sensitivity Scale (SCASS) was used for evaluation of hypersensitivity, and the modified USPHS criteria were utilised for clinical assessments of SMART sealants at 1,6,12,18,24 and 36 months. Fisher's Exact test, Kaplan-Meier Survival Curves, Log-rank test, Mann Whitney U test, and Friedman test was performed for the statistical analysis. RESULTS The caries preventive effect was 100 %, 67.9 % and 65.4 % for SDF + KI-treated teeth; and 100 %, 97.6 % and 94.7 % for SMART(SDF + KI + GIC)-treated teeth at 12, 24 and 36 months, respectively. The mean survival probabilities for caries-preventive effect were significantly lower in SDF + KI-treated teeth (31.01 months) than SMART-treated teeth (35.61 months), (p < 0.001). Twenty-six molars with initial hypersensitivity due to hypomineralization demonstrated a significant reduction at all evaluation periods compared to baseline SCASS scores (p < 0.001). Additionally, there was no significant difference in hypersensitivity scores between the groups during the re-call periods, and none of the teeth exhibited hypersensitivity at the 18-month and beyond evaluations. CONCLUSIONS During the three-year assessment, both groups demonstrated effectiveness in reducing sensitivity in hypomineralised molars. However, SMART (SDF + KI + GIC) sealants offered better protection against tooth decay over time, despite experiencing gradual retention loss. CLINICAL SIGNIFICANCE Both SMART (SDF + KI + GIC) sealants and SDF + KI proved effective in alleviating hypersensitivity in hypomineralised molars for up to three years. SMART (SDF + KI + GIC) sealants showed greater caries-preventive effect compared to SDF + KI. However, continuous long-term monitoring is crucial due to the gradual decline in retention of SMART (SDF + KI + GIC) sealants. CLINICALTRIALS REGISTRATION NUMBER NCT03862014.
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Affiliation(s)
- Gizem Erbas Unverdi
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Sihhiye 06230, Ankara, Turkey
| | - Elif Ballikaya
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Sihhiye 06230, Ankara, Turkey
| | - Zafer C Cehreli
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Sihhiye 06230, Ankara, Turkey.
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Santos PB. Why orthodontists need to know about molar incisor hypomineralization. Am J Orthod Dentofacial Orthop 2024; 165:256-261. [PMID: 38149955 DOI: 10.1016/j.ajodo.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/28/2023]
Abstract
Molar incisor hypomineralization (MIH) is a systemic developmental qualitative defect of the enamel that affects 1-4 first permanent molars with or without incisor involvement. Enamel hypomineralization is identified visually as a demarcated opacity with a clear border with varying extensions and can be white, yellow, or brown. This opacity is characterized by a reduced quality of enamel that is of normal thickness but not fully mineralized. It is very common for the affected teeth to present with posteruptive breakdown, making them susceptible to caries, leading to their subsequent loss. Thus, MIH is a significant dental problem with clinical, economic, and psychosocial implications. The planned extraction of compromised teeth is a valid alternative to complex restorative treatment. Orthodontists' involvement is essential in developing effective treatment strategies for children affected by MIH, contributing to their oral health and well-being.
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Affiliation(s)
- Patrícia Bittencourt Santos
- Department of Orthodontics and Pediatric Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, 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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Vicioni-Marques F, Carvalho MR, Raposo F, de Paula-Silva FWG, de Queiroz AM, Leal SC, Manton DJ, de Carvalho FK. Association of dental hypersensitivity and anxiety in children with molar-incisor hypomineralisation (MIH). Eur Arch Paediatr Dent 2023:10.1007/s40368-023-00803-4. [PMID: 37199855 DOI: 10.1007/s40368-023-00803-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
AIM The objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH. METHODS For this cross-sectional study, 1830 students between the ages of 6 and 12 years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS). RESULTS MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age. CONCLUSION No association was found between dental fear and dental hypersensitivity in children with MIH.
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Affiliation(s)
- F Vicioni-Marques
- Department of Pediatric Dentistry, University of São Paulo at School of Dentistry of Ribeirao Preto, Ribeirao Preto, Brazil
| | - M R Carvalho
- Department of Pediatric Dentistry, University of São Paulo at School of Dentistry of Ribeirao Preto, Ribeirao Preto, Brazil
| | - F Raposo
- Department of Pediatric Dentistry, University of Brasilia, Federal District, Brasilia, Brazil
| | - F W G de Paula-Silva
- Department of Pediatric Dentistry, University of São Paulo at School of Dentistry of Ribeirao Preto, Ribeirao Preto, Brazil
| | - A M de Queiroz
- Department of Pediatric Dentistry, University of São Paulo at School of Dentistry of Ribeirao Preto, Ribeirao Preto, Brazil
| | - S C Leal
- Department of Pediatric Dentistry, University of Brasilia, Federal District, Brasilia, Brazil
| | - D J Manton
- University of Groningen, UMCG, Centre for Dentistry and Oral Hygiene, Groningen, The Netherlands
| | - F K de Carvalho
- Department of Pediatric Dentistry, University of São Paulo at School of Dentistry of Ribeirao Preto, Ribeirao Preto, Brazil.
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Grieshaber A, Waltimo T, Haschemi AA, Erb J, Steffen R, Bornstein MM, Kulik EM. Prevalence of and factors associated with molar-incisor hypomineralisation in schoolchildren in the canton of Basel-Landschaft, Switzerland. Clin Oral Investig 2023; 27:871-877. [PMID: 35881241 PMCID: PMC9889500 DOI: 10.1007/s00784-022-04648-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES As prevalence of molar-incisor hypomineralisation varies considerably in different countries and regions, the aim of this study was to obtain representative epidemiological data for schoolchildren living in the canton of Basel-Landschaft, Switzerland. MATERIAL AND METHODS A representative population of schoolchildren of three different age groups, i.e. 1st grade (mean age: 7.4 years), 6th grade (mean age: 12.6 years), and 9th grade (mean age: 15.7 years) visiting compulsory schools in the canton of Basel-Landschaft, Switzerland, was examined. The presence or absence of molar-incisor hypomineralisation at time of examination was recorded as well as potential influencing factors such as age group, gender, nationality, or the children's place of residence. RESULTS A total of 1252 schoolchildren could be included. On average, the prevalence of MIH in the study population was 14.8%. No statistically significant differences were found for nationality, gender, or place of residence. Although not statistically significant, children from the youngest age group had the highest while children from the oldest age group had the lowest MIH prevalence. CONCLUSION With a mean value of 14.8%, MIH prevalence among schoolchildren living in the canton of Basel-Landschaft, Switzerland, is comparable to mean values recorded globally. CLINICAL RELEVANCE This study represents the first study on MIH prevalence in Switzerland and also provides further evidence on potential influencing factors.
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Affiliation(s)
- Andreina Grieshaber
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Tuomas Waltimo
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Asin A. Haschemi
- Department of General Pediatric and Adolescent Dentistry, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Judith Erb
- Department of General Pediatric and Adolescent Dentistry, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Richard Steffen
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland ,Private Practice, 8570 Weinfelden, Switzerland
| | - Michael M. Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Eva M. Kulik
- Department Research, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland
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