Minimally interventive restorative care of teeth with molar incisor hypomineralization and open apex-A 24-month longitudinal study

Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system

OBJECTIVES

To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system.

MATERIALS AND METHODS

Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained.

RESULTS

Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54).

CONCLUSION

Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration.

CLINICAL RELEVANCE

This study can provide information for decision-making.

Evaluation of antimicrobial photodynamic therapy and minimal intervention associated with deproteinisation in permanent teeth with molar incisor hypomineralisation: study protocol for a clinical, controlled, blinded trial

INTRODUCTION

Molar incisor hypomineralisation (MIH) is a qualitative defect of enamel development that occurs in the mineralisation phase. MIH affects one or more permanent molars and, occasionally, permanent incisors. The aim of the proposed study is to evaluate the clinical effect of antimicrobial photodynamic therapy (aPDT) on permanent teeth with MIH through decontamination and sensitivity control.

METHODS AND ANALYSIS

Patients from 8 to 12 years of age with permanent molars will be randomly allocated to three groups. Group 1: selective chemical-mechanical removal of carious dentinal tissue around the walls of the cavity with Papacárie Duo and a curette followed by the application of aPDT and deproteinisation with Papacárie Duo; group 2: selective removal of carious dentinal tissue around the walls of the cavity with a curette, followed by the application of aPDT and deproteinisation with a 5% sodium hypochlorite solution; group 3: selective removal of carious dentinal tissue using a curette. The selected teeth must have a carious lesion in the dentin and posteruptive enamel breakdown on one or more surfaces with an indication for clinical restorative treatment. The teeth will subsequently be restored using a mixed technique with resin-modified glass ionomer cement and bulk-fill composite resin. The data will be submitted to descriptive statistical analysis. Associations with age and sex will be tested using either the χ2 test or Fisher's exact test. Pearson's correlation coefficients will be calculated to determine the strength of correlations between variables. Comparisons of the microbiological results (colony-forming units) will be performed using analysis of variance and the Kruskal-Wallis test. Kaplan-Meier survival analysis will be performed to assess the performance of the restorations.

ETHICS AND DISSEMINATION

This protocol has been approved by the Human Research Ethics Committee of Nove de Julho University (certificate number: 61027522.0.0000.5511/approval date: 23 August 2022). The findings will be published in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05443035.

Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review

AIM

This systematic review aimed to comprehensively evaluate the available literature on treating molar incisor hypomineralization (MIH) or enamel hypomineralization published between 2013 and 2023, focusing on identifying relevant studies and their characteristics.

MATERIALS AND METHODS

The search process encompassed reputable academic databases, including PubMed, Scopus, Cochrane Library, and Web of Science, using a precise keyword strategy ("((molar incisor hypomineralization) OR (enamel hypomineralization)) AND (treatment)"). A total of 637 articles were initially retrieved, followed by a strict selection process adhering to PRISMA guidelines. The inclusion criteria encompassed Randomized Control Trials (RCTs), case series with more than five clinical cases (CSs), studies involving human participants, availability as free full-text or accessible with university credentials, and English-language publications. Exclusion criteria included systematic or literature reviews, editorials, single-case reports, studies conducted in vitro, those involving animals, paid articles, and non-English-language publications.

RESULTS

The search yielded 864 articles, of which 23 met the stringent inclusion criteria after a meticulous selection process. These studies will serve as the basis for a comprehensive analysis of MIH treatment approaches. The systematic review ensures the quality and relevance of the chosen studies for a detailed assessment of MIH treatment strategies.

CONCLUSIONS

This systematic review will provide valuable insights into the characteristics of selected studies, patient profiles, and available treatment options for molar incisor hypomineralization, contributing to a better understanding of this dental condition's management.

Management of compromised first permanent molars in a cohort of UK paediatric patients referred to hospital-based services

BACKGROUND

There are diverse opinions among dentists about managing compromised first permanent molars (cFPMs) in children and a perceived lack of guidance to help them evaluate prognosis.

AIM

To evaluate the current management of cFPM in children referred to a UK hospital centre and to report the severity of the affected teeth.

DESIGN

A service evaluation was undertaken, based on case records of medically fit children (6-11 years) referred to for the management of cFPMs. The presence of hypomineralisation, post-eruptive breakdown and the proposed care plans were recorded. Radiographic signs of severity were scored using the ICDAS index (intra/inter-rater kappa 0.96/0.82).

RESULTS

From 349 records screened over a 4-month period, 249 met the selection criteria. Almost 81% were planned to have extraction of at least one cFPM, whereas 19.3% were managed without extraction. More than half of the extraction cases (n = 105) had radiographic radiolucencies not exceeding the middle third of dentine in the worst-affected FPM. At the time of extraction, the mean age of the patients was 9.8 years (±0.9). GA was used in 196 (97.5%) cases, and 40.8% had not received previous treatment in any of their cFPMs.

CONCLUSION

Potentially restorable cFPMs in children is, most of the time, in a cohort of UK patients referred for tier 3 services, being managed by timed extractions under general anasethesia.

Outcome of vital pulp therapy in deeply carious molars affected with molar incisor hypomineralisation (MIH) defects: a randomized clinical trial

PURPOSE

To evaluate clinical and radiographic outcomes of vital pulp therapy (VPT) in deeply carious young permanent first molars (PFM) affected with MIH over 24 months.

METHODS

In this prospective randomized clinical trial, n = 50 children with deeply carious young PFM affected with MIH, and diagnosed with reversible or irreversible pulpitis were randomized into 2 groups: indirect pulp treatment (IPT) and pulpotomy (partial or complete). Teeth were followed up clinically and radiographically for 24 months. Statistical analysis was done using Chi-square test; P ≤ 0.05 was considered significant.

RESULTS

A total of  n = 50 teeth/patients (n = 26 females (52%), n = 24 males (48%)) were included, and 14 upper and 36 lower PFM were treated. Mean age was 11 ± 3.2 years. Clinical and radiographic success rates were: 96% for IPT, 90% for PP and 82% for CP (and 86% for both types of pulpotomy combined) over 24 months. There were no significant differences in outcomes between treatment groups. Age, gender and tooth location/jaw were found to have no statistically significant difference in outcomes among treatment groups, nor did pulpal status or root maturity, regardless of type of VPT and follow up period.

CONCLUSIONS

VPT is a valid treatment option in deeply carious young permanent first molars affected with MIH over 24 months. IPT had a higher clinical and radiographic success rate (96%) than partial or cervical pulpotomy (total 86%), but the difference was not statistically significant. Future randomized clinical trials on VPT for teeth affected with MIH are recommended with larger sample size and longer follow-up.

Survival of stainless-steel crowns and composite resin restorations in molars affected by molar-incisor hypomineralization (MIH)

BACKGROUND

Currently, there is no consensus on the superiority of any material for the restorative treatment of molars affected by molar-incisor hypomineralization (MIH).

AIM

To evaluate the survival of restorations with stainless-steel crown (SSC) or composite resin (CR) in first permanent molars affected by MIH for 24 months.

DESIGN

In this retrospective cohort study, 61 CR and 54 SSC restorations placed on molars affected by MIH of patients, aged between 7 and 10, that were treated and overseen at a university dental clinic in the period of 2017-2020 were evaluated. The primary outcome was the failure-free survival time. Parametric survival models were used for data censored by interval, and the comparison between SSC and CR was performed using the hazard ratio function with a 95% confidence interval.

RESULTS

The survival of SSC and CR restorations after 24 months was 94.4% and 49.2%, respectively. This difference was influenced by the presence of previous restoration (aHR = 3.4; 95% CI: 1.2-9.4) and cusp involvement (aHR = 4.0; 95% CI: 1.5-11.2).

CONCLUSION

In molars with MIH and the need for restorative treatment, SSC had a significantly higher survival rate than CR over 24 months.

An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review

PURPOSE

To systematically review the treatment modalities for molar-incisor hypomineralisation for children under the age of 18 years. The research question was, 'What are the treatment options for teeth in children affected by molar incisor hypomineralisation?'

METHODS

An electronic search of the following electronic databases was completed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Google Scholar and Open Grey identifying studies from 1980 to 2020. The PRISMA guidelines were followed. The studies were screened, data extracted and calibration was completed by two independent reviewers.

RESULTS

Of 6220 potential articles, 34 studies were included. Twenty studies investigated management of molars with fissure sealants, glass ionomer cement, polyacid modified resin composite, composite resin, amalgam, preformed metal crowns, laboratory-manufactured crowns and extractions. In four articles management of incisors with microabrasion, resin-infiltration and a combination of approaches was reported. Eight studies looked at strategies to mineralise MIH-affected teeth and/or reduce hypersensitivity. Two studies investigated patient-centred outcomes following treatment. Due to the heterogeneity between the studies, meta-analysis was not performed.

CONCLUSION

The use of resin-based fissure sealants, preformed metal crowns, direct composite resin restorations and laboratory-made restorations can be recommended for MIH-affected molars. There is insufficient evidence to support specific approaches for the management of affected incisors. Products containing CPP-ACP may be beneficial for MIH-affected teeth.

Follow-up of patients subjected to direct and indirect pulp capping of young permanent teeth. A retrospective study

OBJECTIVE

A retrospective study of the success rate of direct pulp capping (DPC) and indirect pulp capping (IPC) was carried out in children between 6-14 years-old, considering separately primary caries or caries affecting teeth with molar incisor hypomineralization (MIH).

MATERIAL AND METHODS

Data were collected in a dental public health service. Following the inclusion criteria, 232 treatments were analyzed. Success was defined by the presence of a functional tooth without clinical signs or symptoms of pulpal or periapical disease. The success rate was correlated to patient gender, the affected tooth and the indication of therapy using the chi-squared and Fisher exact test. The success time related to treatment type was evaluated through the Mann-Whitney test.

RESULTS

The IPC and DPC success rate was 99.4%, and 84.6%, respectively (p = .01). Success was significantly lower when caries affected teeth with MIH than when caries affected teeth without MIH (p = .01). The mean survival for DPC and IPC was 14.07 ± 1.30 and 15.98 ± 0.80 months, respectively (p = .07).

CONCLUSIONS

When caries were located in teeth that were not affected by MIH, IPC was significantly more successful than DPC, but did not differ significantly when caries were placed in teeth with MIH. Key points Minimally invasive therapy is a successful approach for decayed young permanent teeth. The success of IPC was greater than the success of DPC wen caries was placed in teeth not affected by MIH. In teeth not affected by MIH the success of DPC or IPC did not differ significantly.

Case report of a novel interim approach to prevent early posteruptive enamel breakdown of molar-incisor hypomineralization-affected molars

BACKGROUND AND OVERVIEW

Severely molar-incisor hypomineralization (MIH)-affected teeth are prone to develop early posteruptive enamel breakdown (PEB) and caries. A novel conservative interim approach for the prevention of this complication is presented.

CASE DESCRIPTION

A 6-year-old boy with strong hypersensitivity and extensive brown opacities in the partially erupted mandibular permanent first molars (PFMs) was diagnosed with MIH. Constant hygiene and dietary counseling were followed by the application of luted orthodontic bands and glass ionomer sealants to protect PFMs from caries and PEB until the complete eruption of the teeth. After 36 months, the PFMs were completely erupted, with no caries and PEB, and the cooperation of the child increased.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Temporary strategies are useful to preserve MIH-affected PFMs. With the methodology described, the hypersensitivity decreased and the patient reached a good degree of cooperation, making possible definitive rehabilitative considerations.