Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial

Elif Ballikaya, Gizem Erbas Ünverdi, Zafer C Cehreli, Elif Ballikaya, Gizem Erbas Ünverdi, Zafer C Cehreli

Abstract

Objectives: This study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH).

Methods: One hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher's exact test, Kaplan-Meier analysis, Mann-Whitney U test, and Friedman test.

Results: Twenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively.

Conclusions: In hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application.

Clinical significance: Both SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars.

Trial registration: Clinical Trials Registration Number: NCT03862014.

Keywords: Clinical trials; Dental caries; Molar incisor hypomineralization; Prevention; Silver diamine fluoride.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Figures

Fig. 1
Fig. 1
Clinical intra-oral photos of the teeth in SDF and SMART groups at all time points. Intra-oral photos of the teeth: a at baseline with/without rubber dam, b after SDF application, c after SMART restoration, d at 1 month, e at 6 months, f at 12 months
Fig. 2
Fig. 2
Flow diagram of participants up to 1 year
Fig. 3
Fig. 3
Air blast test scores (Schiff score) of the hypersensitive molars (n = 26) during the study period

References

    1. Weerheijm KL. Molar incisor hypomineralisation (MIH) Eur J Paediatr Dent. 2003;4:115–120.
    1. Weerheijm KL, Duggal M, Mejare I, Papagiannoulis L, Koch G, Martens LC, Hallonsten AL. Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003. Eur J Paediatr Dent. 2003;4:110–113.
    1. Cabral RN, Nyvad B, Soviero VLVM, Freitas E, Leal SC. Reliability and validity of a new classification of MIH based on severity. Clin Oral Investig. 2019;24:727–734. doi: 10.1007/s00784-019-02955-4.
    1. Da Costa-Silva CM, Ambrosano GM, Jeremias F, De Souza JF, Mialhe FL. Increase in severity of molar–incisor hypomineralization and its relationship with the colour of enamel opacity: a prospective cohort study. Int J Paediatr Dent. 2011;21:333–341. doi: 10.1111/j.1365-263X.2011.01128.x.
    1. Jälevik B, Norén JG. Enamel hypomineralization of permanent first molars: a morphological study and survey of possible aetiological factors. Int J Paediatr Dent. 2000;10:278–289. doi: 10.1046/j.1365-263x.2000.00210.x.
    1. Pitiphat W, Savisit R, Chansamak N, Subarnbhesaj A. Molar incisor hypomineralization and dental caries in six-to seven-year-old Thai children. Pediatr Dent. 2014;36:478–482.
    1. Jalevik B, Klingberg GA. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent. 2002;12:24–32. doi: 10.1046/j.0960-7439.2001.00318.x.
    1. de Aguiar Grossi J, Cabral RN, Ribeiro APD, Leal SC. Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model. BMC Oral Health. 2018;18:65. doi: 10.1186/s12903-018-0528-0.
    1. Zhao IS, Gao SS, Hiraishi N, Burrow MF, Duangthip D, Mei ML, Lo ECM, Chu CH. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J. 2018;68:67–76. doi: 10.1111/idj.12320.
    1. Horst JA, Ellenikiotis H, Milgrom PM, Committee USCA. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications, and consent. J Calif Dent Assoc. 2016;44:16.
    1. MacLean J. Minimally invasive treatment for molar incisor hypomineralization. J Multidiscip Care Decis Dent. 2018;4:18–23.
    1. Hamama H, Yiu C, Burrow M. Effect of silver diamine fluoride and potassium iodide on residual bacteria in dentinal tubules. Aust Dent J. 2015;60:80–87. doi: 10.1111/adj.12276.
    1. Knight G, McIntyre J, Craig G, Zilm P, Gully N. An in vitro model to measure the effect of a silver fluoride and potassium iodide treatment on the permeability of demineralized dentine to Streptococcus mutans. Aust Dent J. 2005;50:242–245. doi: 10.1111/j.1834-7819.2005.tb00367.x.
    1. Hu S, Meyer B, Duggal M. A silver renaissance in dentistry. Eur Arch Paediatr Dent. 2018;19:221–227. doi: 10.1007/s40368-018-0363-7.
    1. Alvear Fa B, Jew J, Wong A, Young D. Silver Modified Atraumatic Restorative Technique (SMART): an alternative caries prevention tool. Stoma Edu J. 2016;3:18–24.
    1. Modasia R, Modasia D. Application of silver diamine fluoride as part of the Atraumatic Restorative Technique. BDJ Student. 2021;28:42–43. doi: 10.1038/s41406-021-0199-1.
    1. Bridge G, Martel A-S, Lomazzi M. Silver diamine fluoride: transforming community dental caries program. Int Dent J. 2021 doi: 10.1016/j.identj.2020.12.017.
    1. Mei ML, Li Q-L, Chu C-H, Lo E-M, Samaranayake LP. Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilm on caries. Ann Clin Microbiol Antimicrob. 2013;12:4. doi: 10.1186/1476-0711-12-4.
    1. Craig G, Knight G, McIntyre J. Clinical evaluation of diamine silver fluoride/potassium iodide as a dentine desensitizing agent. A pilot study. Aust Dent J. 2012;57:308–311. doi: 10.1111/j.1834-7819.2012.01700.x.
    1. Schulz KF, Altman DG, Moher D, C. Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010;11:1–8. doi: 10.1186/1745-6215-11-32.
    1. Lygidakis N, Wong F, Jälevik B, Vierrou A, Alaluusua S, Espelid I. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH) Eur Arch Paediatr Dent. 2010;11:75–81. doi: 10.1007/BF03262716.
    1. Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, Pitts NB. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol. 2007;35:170–178. doi: 10.1111/j.1600-0528.2007.00347.x.
    1. Jeremias F, Souza JFd, Costa Silva CMd, Cordeiro RdCL, Zuanon ÂCC, Santos-Pinto L. Dental caries experience and molar-incisor hypomineralization. Acta Odontol Scand. 2013;71:870–876. doi: 10.3109/00016357.2012.734412.
    1. Schiff T, Delgado E, Zhang Y, Cummins D, DeVizio W, Mateo L. Clinical evaluation of the efficacy of an in-office desensitizing paste containing 8% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity. Am J Dent. 2009;22:8A–15A.
    1. Frencken J. Atraumatic restorative treatment and minimal intervention dentistry. Br Dent J. 2017;223:183–189. doi: 10.1038/sj.bdj.2017.664.
    1. Schmalz G, Ryge G. Reprint of Criteria for the clinical evaluation of dental restorative materials. Clin Oral Investig. 2005;9:215–232. doi: 10.1007/s00784-005-0018-z.
    1. Seifo N, Robertson M, MacLean J, Blain K, Grosse S, Milne R, Seeballuck C, Innes N. The use of silver diamine fluoride (SDF) in dental practice. Br Dent J. 2020;228:75–81. doi: 10.1038/s41415-020-1203-9.
    1. Leppaniemi A, Lukinmaa P-L, Alaluusua S. Nonfluoride hypomineralizations in the permanent first molars and their impact on the treatment need. Caries Res. 2001;35:36–40. doi: 10.1159/000047428.
    1. Fagrell TG, Lingström P, Olsson S, Steiniger F, Norén JG. Bacterial invasion of dentinal tubules beneath apparently intact but hypomineralized enamel in molar teeth with molar incisor hypomineralization. Int J Paediatr Dent. 2008;18:333–340. doi: 10.1111/j.1365-263X.2007.00908.x.
    1. Krämer N, Khac N-HNB, Lücker S, Stachniss V, Frankenberger R. Bonding strategies for MIH-affected enamel and dentin. Dent Mater. 2018;34:331–340. doi: 10.1016/j.dental.2017.11.015.
    1. Lygidakis N, Chaliasou A, Siounas G. Evaluation of composite restorations in hypomineralized permanent molars: a four year clinical study. Eur J Paediatr Dent. 2003;4:143–148.
    1. Rolim TZC, da Costa TRF, Wambier LM, Chibinski AC, Wambier DS, da Silva Assunção LR, de Menezes JVBN, Feltrin-Souza J. Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial. Clin Oral Investig. 2020;25:1513–1524. doi: 10.1007/s00784-020-03459-2.
    1. de Souza JF, Fragelli CB, Jeremias F, Paschoal MAB, Santos-Pinto L, R.d.C.L. Cordeiro, Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization. Clin Oral Investig. 2017;21:1725–1733. doi: 10.1007/s00784-016-1968.
    1. Hilgert LA, Leal SC, Freire GML, Mulder J, Frencken JE. 3-year survival rates of retained composite resin and ART sealants using two assessment criteria. Braz Oral Res. 2017;31:1–13. doi: 10.1590/1807-3107BOR-2017.
    1. De Amorim R, Frencken J, Raggio D, Chen X, Hu X, Leal S. Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis. Clin Oral Investig. 2018;22:2703–2725. doi: 10.1007/s00784-018-2625-5.
    1. Holmgren CJ, Lo EC, Hu D, Wan H. ART restorations and sealants placed in Chinese school children–results after three years. Community Dent Oral Epidemiol. 2000;28:314–320. doi: 10.1034/j.1600-0528.2000.280410.x.
    1. Zanata RL, Fagundes TC, de Almendra Freitas MCC, Lauris JRP, de Lima Navarro MF. Ten-year survival of ART restorations in permanent posterior teeth. Clin Oral Investig. 2011;15:265–271. doi: 10.1007/s00784-009-0378-x.
    1. Garg S, Sadr A, Chan D. Potassium iodide reversal of silver diamine fluoride staining: a case report. Oper Dent. 2019;44:221–226. doi: 10.2341/17-266-S.
    1. Zhao IS, Mei ML, Burrow MF, Lo EC-M, Chu C-H. Effect of silver diamine fluoride and potassium iodide treatment on secondary caries prevention and tooth discolouration in cervical glass ionomer cement restoration. Int J Mol Sci. 2017;18:1–12. doi: 10.3390/ijms18020340.
    1. Mjör IA, Toffentti F. Secondary caries: a literature review with case reports. Quintessence Int. 2000;31:165–179.
    1. Sayed M, Matsui N, Hiraishi N, Inoue G, Nikaido T, Burrow MF, Tagami J. Evaluation of discoloration of sound/demineralized root dentin with silver diamine fluoride: in-vitro study. Dent Mater J. 2018;38:143–149. doi: 10.4012/dmj.2018-008.
    1. Bekes K, Heinzelmann K, Lettner S, Schaller H-G. Efficacy of desensitizing products containing 8% arginine and calcium carbonate for hypersensitivity relief in MIH-affected molars: an 8-week clinical study. Clin Oral Investig. 2017;21:2311–2317. doi: 10.1007/s00784-016-2024-8.
    1. Ozgül BM, Saat S, Sönmez H, Oz FT. Clinical evaluation of desensitizing treatment for incisor teeth affected by molar-incisor hypomineralization. J Clin Pediatr Dent. 2013;38:101–5. doi: 10.17796/jcpd.38.2.92mx26l6n482j682.
    1. Mei M, Nudelman F, Marzec B, Walker J, Lo E, Walls A, Chu C. Formation of fluorohydroxyapatite with silver diamine fluoride. J Dent Res. 2017;96:1122–1128. doi: 10.1177/0022034517709738.
    1. Castillo J, Rivera S, Aparicio T, Lazo R, Aw T-C, Mancl L, Milgrom P. The short-term effects of diammine silver fluoride on tooth sensitivity: a randomized controlled trial. J Dent Res. 2011;90:203–208. doi: 10.1177/0022034510388516.
    1. Duangthip D, Chu C, Lo E. A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides—18 month results. J Dent. 2016;44:57–63. doi: 10.1016/j.jdent.2015.05.006.
    1. Horst J. Silver fluoride as a treatment for dental caries. Adv Dent Res. 2018;29:135–140. doi: 10.1177/0022034517743750.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren