Glass Ionomer Sealants Can Prevent Dental Caries but Cannot Prevent Posteruptive Breakdown on Molars Affected by Molar Incisor Hypomineralization: One-Year Results of a Randomized Clinical Trial

Characteristics of phase 4 clinical trials on Dental Caries registered at Clinicaltrials.gov

BACKGROUND

Dental caries, a widespread chronic oral disease, is caused by multiple factors including microorganisms, genetic predisposition. Despite being preventable, it poses a significant global burden. This study reviews all phase 4 clinical trials on dental caries registered at ClinicalTrials.gov to provide a comprehensive overview of their characteristics.

METHODS

A search was conducted on the ClinicalTrials.gov database using keywords. The registration data for all relevant phase 4 studies concerning 'Dental Caries' were retrieved. This search was conducted on the 23rd of January, 2024.

RESULTS

The analysis included 58 phase 4 clinical trials, with most studies (67.2%) reporting complete data. The majority (63.8%) had fewer than 100 participants, and the predominant sponsors were medical institutions (77.6%). Geographically, the highest percentage of studies were conducted in South America (24.1%), with the lowest in North America (10.3%). Interventional trials primarily focused on treatment (51.7%) and prevention (41.4%), with a significant portion being randomized (93.1%). Blinding varied, with single and double blinding each used in 25.9% of studies. Drug interventions were the most common (60.6%), followed by other categories such as dietary supplements and procedures. Among drug interventions, agents containing fluoride were the largest category, accounting for 52.6% of the trials. Fluoride varnishes and silver diamine fluoride were the most frequently evaluated. Sedatives and pain relievers constituted 15.7% of the trials, with midazolam and ketamine being predominant. Other drugs accounted for 23.2% of the trials, featuring diverse substances such as inactivated poliovirus vaccine and xylitol. Dental materials and operative treatments made up 29.5% of the trials, with resin and fissure sealants being the most commonly evaluated.

CONCLUSION

This analysis of phase 4 clinical trials highlighted fluoride as the most studied intervention for dental caries prevention. The analysis also revealed a need for further research on non-fluoride interventions and emphasized the importance of using evidence-based practices in dental care for improved oral health outcomes.

CLINICAL TRIAL NUMBER

Not applicable.

Effectiveness of fissure sealants in 8- to 10-year-olds with and without molar-incisor hypomineralization (MIH) - results from a cross-sectional epidemiological study

OBJECTIVE

This cross-sectional study aimed to investigate the use, quality, and caries-preventive effects of fissure sealants (FSs) in 8- to 10-year-olds with and without molar-incisor hypomineralization (MIH).

MATERIALS AND METHODS

A total of 5,418 children (2,692 males, 2,726 females) were examined via standard instruments (dental mirrors, CPI probes, adequate lighting, mobile examination tables, and air syringes) and methods for the recording of caries (DMFT index, WHO method) and FSs. The classification of MIH followed the recommendations of the European Academy of Pediatric Dentistry (EAPD). Statistical analysis included descriptive analysis and mixed-effects logistic regression models.

RESULTS

59.0% of all children had at least one FS; this percentage was 57.8% in the MIH group. The proportions of fully intact sealants and minimal, moderate, or nearly complete loss of retention were 31.7%, 48.3%, 16.8%, and 3.2%, respectively. The mean caries experience was low, at 0.2 DMFT in the whole population. Lower DMFT means were registered in individuals with FSs without MIH (0.1) and with MIH (0.1). The regression analysis revealed a significant caries-protective effect of FSs and MIH in relation to the overall caries burden. In addition, the caries-protective effect was greater in individuals with fully retained sealants (aOR 0.269) than in those with minimal (aOR 0.346), moderate (aOR 0.567) or nearly complete loss of retention (aOR 0.721).

CONCLUSION

This study documented the comparable use, quality, and caries-preventive effects of FSs in individuals and permanent molar with and without MIH.

CLINICAL RELEVANCE

FSs are caries protective in children with and without MIH.

"Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study

BACKGROUND

Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up.

METHODS

Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient.

RESULTS

There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P = .049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P < .001) and a statistically significant difference in surface area changes between the 4 subgroups.

CONCLUSIONS

Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year.

TRIAL REGISTRATION

The study protocol was retrospectively registered on Clinical Trials (NCT05931822-05/ 07/2023).

Is SDF better than the SMART (silver modified atraumatic restorative technique) in the management of molar incisor hypomineralisation molars with initial caries?

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.

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

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.

1-year Results of Molar Incisor Hypomineralization-affected Cases Treated with Silver Modified Atraumatic Restorative Treatment: A Retrospective Study

Aim and background

Silver-modified atraumatic restorative treatment (SMART) can be an alternative method for molar incisor hypomineralization (MIH)-affected cases. The purpose of this study was to assess whether tooth location and cavity preparation affect the clinical success of MIH-affected permanent molars treated with the SMART technique.

Materials and methods

Modified United States Public Health Service criteria were utilized for the analyzes. The clinical records (3, 6, and 12 months) of 19 MIH-affected cases (6-12 years; no spontaneous pain and percussion/palpation sensitivity) treated with the SMART technique were assessed. The groups were allocated based on tooth location (mandibular-maxillary) and cavity preparation (class 1-2). The Fisher exact the Chi-squared test was utilized, and the p-value < 0.05 was accepted as statistically significant.

Results

Overall success rates were 94.7% at 3 and 6 months and 52.63% at 12 months. Clinical success did not differ statistically regarding location (p > 0.05). The class 1 cavity preparation group was found to be significantly more successful at the 12-month assessments (p = 0.033).

Conclusion

The class of cavity preparation may affect the success of the treatment in long-term assessments. The SMART technique, especially in class 1 occlusal restorations, can be recommended as a short-term alternative to traditional treatment methods for MIH-affected cases.

How to cite this article

Bal C, Sozuoz MA, Sari MBD, et al. 1-year Results of Molar Incisor Hypomineralization-affected Cases Treated with Silver Modified Atraumatic Restorative Treatment: A Retrospective Study. Int J Clin Pediatr Dent 2024;17(6):683-689.

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial

Background

This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and casein phosphopeptide-amorphous calcium phosphate fluoride varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children.

Methods

A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed.

Results

The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV ( P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups ( P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period.

Conclusions

In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health.

Trial registration

ISRCTN54243749 (13/01/2022).

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial

BACKGROUND

This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and casein phosphopeptide-amorphous calcium phosphate fluoride varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children.

METHODS

A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed.

RESULTS

The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV ( P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups ( P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period.

CONCLUSIONS

In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health.

TRIAL REGISTRATION

ISRCTN54243749 (13/01/2022).

Efficacy of Glass Ionomer Cement as Pit and Fissure Sealant in Permanent First Molars

Background/Objectives Pit and fissure caries constitute a predominant portion, approximately 90% in permanent posterior teeth and 44% in primary teeth among children and adolescents. Among various preventive modalities, pit and fissure sealants play a pivotal role in safeguarding these vulnerable areas. Categorized by materials such as glass ionomer, composites, and polyacid-modified glass ionomers, these sealants offer effective protection. This study aims to evaluate the efficacy of glass ionomer-based pit and fissure sealants in terms of retention rate at 12-month post-procedure period in permanent first molars. Methodology This study was conducted at the Department of Operative Dentistry, Nishtar Institute of Dentistry, Multan, Pakistan. Fifty-six children, aged 7 to 12 years, presenting with pit and fissure caries in permanent first molar teeth were enrolled. Glass ionomer sealant was meticulously applied to the affected pits and fissures. The efficacy was assessed after 12 months based on predefined criteria. Results The age of participants ranged from 7 to 12 years, with a mean age of 9.24 ± 1.38 years. Among the 56 patients, 23 (41.2%) were male and 33 (58.8%) were female. Sealant retention was noted in 31 (55.35%) patients, while 25 (44.65%) experienced sealant loss. In the 7 to 9-year age group, 19 demonstrated complete sealant retention, whereas in the 10 to 12-year age group, 12 exhibited complete retention. Concerning gender distribution, 17 males and 14 females exhibited complete sealant retention. Conclusion Glass ionomer-based sealants demonstrate excellent properties for pit and fissure sealing owing to their low technique sensitivity, cost-effectiveness, and favorable retention rates. Therefore, they represent an optimal choice for this preventive dental procedure.

A critical look at outcome measures: Comparison between four dental research journals by use of a hierarchical model

AIM

To assess the status quo of outcome measures used in treatment studies in Endodontics, and potentially identify strategies for improvement, by (i) systematically assessing the outcome measures using a conceptual model and (ii) comparing these with measures used in corresponding studies in the adjacent fields.

METHODOLOGY

The International Endodontic Journal, Caries Research, The Journal of Clinical Periodontology and The Journal of Oral & Facial Pain and Headache were selected to cover four adjacent dental disciplines. In each journal, the 50 most recent consecutive publications fulfilling inclusion criteria were included. A hierarchical model for diagnostic imaging studies was modified to assess studies related to treatment. The model comprised six levels, with technical as the lowest level and societal as the highest. Extracted data included study origin, study type, and identified outcome measures. Fisher's Exact Tests with Bonferroni corrections compared studies. p < .05 was considered statistically significant.

RESULTS

Amongst 756 publications, the 200 most recent studies matching the inclusion criteria were identified. Less than half (36.5%) assessed the clinical, patient, or societal aspects of treatment; 10.0% in International Endodontic Journal, 28.0% in Caries Research, 38.0% in Journal of Clinical Periodontology, and 70.0% in Journal of Oral & Facial Pain and Headache (p < .001).

CONCLUSIONS

According to included publications, research on treatment within the endodontic field is mainly focusing on technical and biological outcomes. The benefits of patients and society were less frequently examined than in corresponding journals in adjacent disciplines. When designing studies, including higher-level outcomes should be considered.

Applications of Optical Coherence Tomography in the Diagnosis of Enamel Defects

Developmental defects of enamel (DDEs) are deviations from the normal appearance in terms of the quantity and quality of tooth enamel. They may be genetic or acquired. The most important DDEs are hypomineralization and hypoplasia. The aim of this study was to produce “in vivo” DDE in Wistar rats by administering amoxicillin to pregnant females and to highlight these lesions after sacrifice of the pups by macroscopic and microscopic examination and optical coherence tomography (OCT). Amoxicillin (100 mg/kg) was administered to two pregnant Wistar female rats for the production of DDEs. When the pups were 2 months old, they were sacrificed, and their jaws were harvested together with their teeth. The jaws were examined macroscopically, microscopically, and by OCT. Following the macroscopic and microscopic examination, it was established that four pups had a total of 42 DDE lesions. At the OCT examination, the hypomineralization was characterized by an intense, inhomogeneous OCT signal, and the hypoplasia was characterized by the absence of the signal. Administration of amoxicillin to pregnant females of Wistar rats resulted in DDEs in their offspring. The OCT examination confirmed the presence of these lesions in the teeth of rat pups.

Hypersensitivity relief of MIH-affected molars using two sealing techniques: a 12-week follow-up

OBJECTIVES

The aim of this study was to compare the efficacy in reducing hypersensitivity in molar incisor hypomineralization (MIH)-affected molars immediately and over 12 weeks after sealing using two different materials (composite and glass ionomer). Furthermore, the retention rates of both materials were analyzed.

METHODS

Thirty-nine children with two MIH-affected molars showing hypersensitivity and non-occlusal breakdowns were included. Hypersensitivity was assessed with an evaporative (air) stimulus. Both teeth were sealed by two calibrated operators using a split-mouth design with either Clinpro Sealant in combination with Scotchbond Universal (C) or Ketac Universal (K), respectively. Clinical pain assessments (Schiff Score Air Sensitivity Scale [SCASS], Visual Analog Scale [VAS]) were made at baseline ("pre"), immediately after treatment ("post"), and after 1, 4, 8, and 12 weeks. Paired t tests were calculated in each group between baseline and all other time points.

RESULTS

Thirty-eight children with 76 molars completed all stages of the study. Regardless of the material used, the application of the sealant decreased hypersensitivity significantly immediately as well as throughout the 12-week recalls (all p values < 0.001). We found no statistically significant difference among both materials chosen in any of the time points evaluated. Furthermore, retention of both materials was comparable in both groups.

CONCLUSIONS

Both sealant materials were able to reduce hypersensitivity successfully immediately and throughout the 12-week follow-up. Furthermore, their performance was similar in terms of retention.

CLINICAL RELEVANCE

Hypersensitivity can be a major complaint in patients with MIH. This is the first study evaluating hypersensitivity relief of MIH-affected molars using two sealing techniques.